New frontiers in psychoanalysis: Expanding our human, scientific, and clinical horizons

In 1954 the New York psychoanalyst Leo Stone (1904–1997) published an article by the title “The Widening Scope of Indications for Psychoanalysis” in which he wrote:

In no other field, save surgery, to which Freud frequently compared analysis, is the personal equation so important. It is up to us to know our capacities, intellectual and emotional … Again, special predilections, interests, emotional textures may profoundly influence prognosis, and thus – in a tangible way – the indications. I suppose one might generalize crudely to the effect that, apart from skills, a therapist must be able to love a psychotic or a delinquent, and be at least warmly interested in the ‘borderline’ patient (whether or not this feeling is utilized technically), for optimum results. For in a sense, their ‘transferences’ require new objects, the old ones having been destroyed or permanently repudiated, or nearly so …  (1954, pp. 592–593)

In the following years Stone developed this innovative and courageous line of thought into the 1961 book The Psychoanalytic Situation: An Examination of its Development and Essential Nature, by which Stone “dropped a ‘bomb’ on the New York Psychoanalytic Society by advocating spontaneity, warmth and humanity” (Altman, 1995, p. 197), as Linda Altman wrote in the Journal of the American Psychoanalytic Association 34 years later, reporting on a panel dedicated to this classic of psychoanalysis, held in Philadelphia in 1994. In fact, up to that time, due to the prevalence of the ego-psychological paradigm, “anything than pure interpretation was considered a deviation from correct analytic technique” (p. 197).

In his new book Psychoanalytische Behandlungstechnik, the Munich colleague Wolfgang Mertens (an emeritus professor of clinical psychology and psychoanalysis at the Munich Ludwig-Maximilians-Universität), not only places the intersubjective dimension at the center of our clinical work, but also shows the recent evolution of our scientific knowledge about it coming from inside and outside of our field. From inside of our field it comes from analytic personality theory (see attachment theory), analytic developmental psychology (see infant research), analytic psychopathology (see, for example, the role of trauma and dissociation), and analytic theory of technique (see, for example, the nonverbal and the embodied dimensions). From outside of our field it derives from the social and cultural sciences (see the gender debate), from linguistics and philosophy (from Peirce’s semiotic theory to postmodern subject theories), and from neuroscience and cognitive science (see the work of Damasio, Gallese, and Schore).

In a recent debate on the topic of “Intersubjectivity in psychoanalysis” promoted by the Italian journal Psicoterapia e Scienze Umane, one of the authors of this Editorial (M.C.) showed the importance not only of the philosophical dimension (as articulated by Giuseppe Civitarese), and of recent empirical research (as underlined by Filippo Maria Ferro and Giuseppe Riefolo), but also of taking into consideration how the intersubjective dimension of our work was conceptualized along the whole history of our discipline (starting with H.S. Sullivan, and including the revisitation of the concept of countertransference through Paula Heimann and Heinrich Racker) (Conci, 2023).

Giving our readers such a background in the history of our profession represents for us a good way of introducing them to the variety of contributions that we were able to put together in this issue, under the title “New Frontiers in Psychoanalysis – Expanding our Human, Scientific, and Clinical Horizons,” and through which we start the thirty-third year of life of the International Forum of Psychoanalysis.

The Lithuanian-Swedish colleague Aleksandras Kulak is the author of the first paper, with the title “Restoring the Links in Countertransference.” After having very clearly articulated the theoretical dimension of the interaction between transference and countertransference that informs his clinical work, the author shows through a very detailed clinical vignette both his personal resonance with and professional permeability to the emotions and the fantasies produced by one of his male patients at the beginning of a treatment. As a reader, I found Kulak’s way of working not only very much in line with the challenge originally formulated by Leo Stone, as to the necessity of expanding our readiness to find as many common wavelengths as possible with our patients, but also very moving. Developing such a good contact with a patient depends on the links we can establish – or “restore,” as Kulak says – with ourselves, that is, our countertransference.

“Binocular Vision in the Total Situation” is the title of the following paper, written by Christo Joannidis, a member of the Hellenic Psychoanalytic Society. Following the genealogy and further developments of the notion of “total situation,” the author spans his discourse from the founder of phrenology, the Austrian medical doctor Francis Gall, to the social scientist Theodor Adorno, passing through Freud. Joannidis traces back the first introduction of the idea of “transference as a total situation” to Melanie Klein, and then discusses the further development of the concept by her pupil Betty Joseph in a much-known and much-quoted paper dated 1985. In order to be able to interpret transference as a total situation – as Joannidis argues – we need to rely on what Wilfred Bion called a “binocular” kind of vision, which enables us to appreciate depth of space and the three-dimensionality of the object. Finally, he offers clinical material for explaining how our understanding of the psychoanalytic process is enhanced by bridging the concept of “total situation” with that of “binocular vision.” This is the fifth paper by Christo Joannidis that we have published in this journal, starting with “Madness: Terror and Necessity – Thoughts on Winnicott” in 2013.

Also very challenging on both the human and the technical level is the third paper of this issue, “The Dream-like Event,” by the Israeli colleague Gideon Lev, whose paper “Conditions for Love: The Psychoanalytic Situation and the Analyst’s Emotions” was published in 2023 by the journal. His new contribution centers around a whole series of clinical vignettes dealing with his creative and therapeutically useful way of approaching specific casual real-life events characterized by a highly symbolic value and relevance to his patients’ inner life. The theoretical background behind such a way of working includes C.G. Jung’s concept of “synchronicity” (Jung, 1952), Antonino Ferro’s concept of “transformation in dreaming” (Ferro, 2009), as well as Donald Winnicott’s concept of “transitional space” (Winnicott, 1971) and Wilfred Bion’s psychoanalytic ontology.

Starting from the study of the “sensory function of the digestive system,” especially during early stages of child development, the Israeli colleague Michael Schein explores the general role of the digestive system in our mental life and in the construction of interpersonal relations. In the paper entitled “Back to our Senses: Some (Psycho)somatic Aspects of the Digestive System and their Potential Relevance to the Study of Eating Disorders,” he argues that:

the biological functions of the digestive system vis-à-vis the sensations stimulated by these functions may become systemically associated with certain emotional experiences, forming, in turn, mental correlates that become inscribed in our mind, impacting a wide range of mental phenomena.

Moreover, Schein suggests that a “defensive usage” of the digestive system in adult life can give rise to “certain adverse conditions” that lead to the “formation of an interface between the functioning of the digestive system and the mental apparatus.” In so doing, Schein follows Bion’s conceptualization of the “proto-mental apparatus,” Anzieu’s “ego-skin” perspective (Anzieu, 2016), and Esther Bick's concept of “second skin” (Bick, 1968), and links them to the clinical issue of eating disorders.

Francesco Gazzillo and Jessica Leonardi from the Department of Dynamic Psychology of the University of Rome are the authors of the paper “Burdening Guilt: Theoretical and Clinical Features,” through which they further articulate the clinical and therapeutic potential of control-mastery theory (CMT), as they started doing in this journal through the 2022 article “The Adaptive Unconscious in Psychoanalysis” (Leonardi et al., 2022). We mention this paper also in connection with the fact that its third author, Nino Dazzi, died a few days ago (on January 17, 2024) at the age of 86, after having been one of the most important Italian university professors of psychology, a highly respected scholar, and an important source of inspiration for many generations of Italian psychologists. CMT posits that the “self-perceived burden” stems from the belief that one’s emotions, needs, and ways of being are a burden to significant others and can explain it in the light of a coherent theory of development, emphasizing its connection with early traumatic or adverse experiences with caregivers that give rise to the formation of pathogenic beliefs – a central concept of CMT. In its “double nature,” burdening guilt can represent both a self-blame for what one is, as well as the expression of the need to take care of important others. Through the detailed clinical vignette accompanying this article we learn about the specific therapeutic approach generated by CMT.

The next contribution, with the title “Probing the Impact of Psychoanalytic Therapy for Bipolar Disorders: A Scoping Review,” stems from the research work of a team of authors (namely, Alberto Stefana, Daniela D’Imperio, Antonios Dakanalis, Eduard Vieta, Paolo Fusar-Poli, and Eric Youngstrom) belonging to different countries and institutions based in Pavia, Padua, Milan, Barcelona, London, and Ohio. The article provides a systematic overview of the literature about the effectiveness of psychoanalysis for treatment outcomes in bipolar depression and mania.

Alberto Stefana is the author of the review of the book From the Abyss of Loneliness to the Bliss of Solitude: Cultural, Social and Psychoanalytic Perspectives, edited by Aleksandar Dimitrijević and Michael Buchholz. This is the second of a trilogy of edited books that includes Silence and Silencing in Psychoanalysis. Cultural, Clinical and Research Perspectives (Dimitrijević & Buchholz, 2021), and, the most recent, Encountering Silencing: Forms of Oppression in Individuals, Families and Communities (Buchholz & Dimitrijević, 2024). We must acknowledge a mistake in the review: Patrizia Arfelli’s beautiful contribution “The Silent Cry, the Maze of Pipes, the Mice, and the Cellar: The Many Voices of Infantile Loneliness” has been, as it were, silenced. For reasons related to article indexing, the error can no longer be corrected. The International Forum for Psychoanalysis apologizes to the author and the readers.

A further new frontier of contemporary psychoanalysis is represented by the fascinating levels and dimensions of interdisciplinary dialogue developed in the last years with the field of music. Exactly this is the topic of the book by the London colleague Roger Kennedy with the title “The Power of Music: Psychoanalytic Explorations,” as we learn from the very sympathetic and clear review of it written by the Munich colleague Ingrid Erhardt. Besides being a very competent psychoanalyst, she is very familiar with the fields of both empirical research (see Erhardt, 2014) and music therapy, being also a member of the council of the German Society for Psychoanalysis and Music, and having edited a very interesting collection of papers on the topic (Erhardt, 2021).