Psychopathology I: Neurotic-Level Character and Symptom Disorders

Second Year Adult Psychoanalytic Training (APT)
2022-23, 3rd Trimester — Fridays, 1:45-3:15pm
Michael Pauly, MD
Kelly Lippman, LMHC

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March 31, 2023 — Neurotic Level Transference – Countertransference and the Pain of Change

[33 pages]

Extending the discussion from thinking about the role of content versus underlying personality organization (mental capacities) we now shift our attention to the transference-countertransference experience and the pain (narcissistic depression) involved in change.

Sugarman redefines insight as a process he calls insightfulness. He suggests that patients present with mentalizing difficulties and that the focus of psychoanalysis is to regain inhibited or repudiated mentalization, not to regain access to specific repressed content. In this way the analyst helps the patient become aware of their experience and the causes for regressions to action modes, with an emphasis on helping them subordinate this tendency to the verbal, symbolic mode. He extends his thinking to more broadly conceptualize transference as the interpersonalization of mental structure. What do you think?

Lax’s paper offers a close look at the adaptive developmental processes involved in symptom and character formation (ego syntonic) and puts forward a way of working through the analytic processes of change by encouraging the curiosity essential to making that which is ego-syntonic ego-dystonic, struggled with, and given up / mourned.

Sugarman, A. (2006) Mentalization, Insightfulness, and Therapeutic Action: The Importance of Mental Organization; IJP, 87:965-987.

Lax, R.F. (1989). “The Narcissistic Investment in Pathological Character Traits and the Narcissistic Depression: Some Implications for Treatment.” IJP, 70:81-90.