The multiple dimensions of our contemporary psychoanalytic discourse

In July 2019 I published a book with the title Freud, Sullivan, Mitchell, Bion, and the multiple voices of international psychoanalysis, in which I connected the clinical approach of the abovementioned authors and their psychoanalytic perspective to their most important life experiences and to the scientific and interpersonal contexts in which their contributions developed, including the main partners accompanying their professional evolution. I thus tried to demonstrate not only the importance of the history of psychoanalysis for the practicing clinician, but also its relevance as a key to the pluralistic and international character of contemporary psychoanalysis.

A pioneer of the field of “comparative psychoanalysis,” the sociologist Edith Kurzweil (1924–2016) showed in her 1989 book The Freudians. A comparative perspective how psychoanalysis differs in the various countries of the world, and how we should take cultural, social, and political factors into consideration, together with the theoretical ones. According to Jay Greenberg and Stephen Mitchell (1983), Roy Schafer (1922–2018) had been the pioneer of the kind of theoretically grounded “comparative psychoanalysis” so well articulated by them in Object relations in psychoanalytic theory. Although I helped Stephen Mitchell (1946–2000) introduce and promote his work in Italy, and still value very much his generous and creative contribution, I ended up appreciating Joseph Sandler’s (1927–1998) “mixed model” more than a simply relational model like the one Mitchell started formulating in 1988 through Relational concepts in psychoanalysis. An integration. Out of it came an important enrichment of our clinical work, but also an underevaluation of the complexity of psychoanalysis, Mitchell having downplayed several dimensions of it, that is, not only the originality and ongoing value of Freud’s contribution, but also, for example, the importance of empirical research. My book was so well received that it won the American Board and Academy of Psychoanalysis 2020 Historical Book Prize and was positively reviewed – in English – by Carlo Bonomi (2020), John Foehl (2021), and Giovanni Foresti (2022).

Two days before writing this Editorial, on September 28, 2022, the German colleague Herbert Will gave a very interesting paper on the complex structure of psychoanalytic clinical work at the Munich Akademie für Psychoanalyse und Psychotherapie, in which he distinguished the following dimensions: general psychoanalytic theory, theory of technique, and what he called “subjective theory” (Will, 2022). Through the first dimension we learn how our psyche works, and through the second how to treat our patients, with the third one allowing us to understand what we feel and how we can best work with our individual patients. Joseph Sandler was a pioneer of the third dimension through his 1983 article “Reflections on some relations between psychoanalytic concepts and psychoanalytic practice,” in which he introduced the concept of our “private theories.” As we know, relational psychoanalysis blurred the boundary between the way in which our psyche works and how the analytic relationship impacts upon us. In Herbert Will’s paper I found a similar appreciation of the complexity of psychoanalysis to the one I tried to reconstruct in my book.

 I will now profit from the opportunity of introducing our readers to the articles in the present issue by formulating the complexity of psychoanalysis as a whole in terms of the following dimensions: its history; the developmental psychology it contributed to formulating, including its neuro-psychological aspects; the psychodynamic dimension behind our patients’ problems; the variety of theories on our psychic life; our theories of technique; the way we work with the individual patient; the empirical research through which our work can be documented and verified; the application of psychoanalysis to cultural and social issues; and – last but not least – the philosophical and epistemological implications of the discipline we cultivate and practice. Such a formulation of the complex nature of our contemporary psychoanalytic discourse can be a good key for the presentation of the articles of this issue.

In their article “1927–2017: Ferenczi and the interpersonal school of psychoanalysis, the debate continues,” the Italian colleagues Antonio Puglisi and Stefano Ragusa (Turin) revisit Sándor Ferenczi’s pioneer contribution in terms of his “attempt to restore a voice to the patient” and help them find their “true voice,” in terms of how Edgar Levenson appears to conceive the self “as the fruit of a mutual sense of agency” and of how Jonathan Slavin developed the concept of “agency,” that is, by viewing it in the light of the child’s relationship to their parents. This is how they see Ferenczi’s technical stance in terms of his attempt “to activate, awaken, or validate a sense of offended and damaged agency.” In fact, such a goal plays a very important role in the analytic therapy not only of any patient with a narcissistic personality disorder, but also of all those patients who keep experiencing themselves as victims and find it hard to recognize and take their own responsibility for their lives.

In their article “The adaptive unconscious in psychoanalysis,” the Italian colleagues Jessica Leonardi, Francesco Gazzillo, and Nino Dazzi from the University of Rome revisit Freud’s and Hartmann’s ego psychology in the light of Joseph Weiss’s (1924–2004) control mastery theory (CMT), and its validation through the San Francisco Psychotherapy Research Group (see Weiss, Sampson, & the Mount Zion Psychotherapy Research Group, 1986). Before going into this, they deal with Wilson’s concept of “adaptive unconscious,” Damasio’s concept of a “conscious-unconscious continuum,” the three main heuristics identified by Kahneman, the crucial role of the “sense of safety,” and the so-called “unconscious higher mental functioning as showed by empirical research.” To such a dimension of our unconscious way of functioning belong unconscious complex judgements, unconscious goal setting and pursuing, implicit learning and unconscious relational patterns, behaviors and expectations. The presentation of the main concepts of CMT (adaptation to reality as the aim of mental functioning, its regulations through the safety–danger principle, and the role of pathogenic beliefs, and of how our patients put us to test) is accompanied by the presentation of three clinical vignettes. CMT certainly represents a very good example of an empirically validated psychoanalytic clinical theory.

The same is true for Peter Fonagy’s concept of “mentalization” (Fonagy, Gergely, Jurist, & Target, 2002), around which centers the article “Mentalization promotion and affect mobilization in clinical work” by the colleague Daniela de Robertis (Rome), which she developed out of the paper she presented at the XXIst IFPS Forum held in Lisbon in February 2020. In the theoretical part of this article, the author refers not only to Fongay’s work, but also to Edward Tronick’s and Louis Sander’s concept of “recognition,” as “an action that leads to an expansion of consciousness,” that is, to their convergence on the importance of “social cognition,” according to which “individuals learn through the mind of others how to know their own mind and then how to know themselves by exercising their reflective function.” This allows her to propose a reformulation of the Cartesian expression “cogito, ergo sum” as “cogitas de me, ergo sum” (you think of me, therefore I am), and to conceptualize our way of being and working with our patients in terms of promoting their “perception of thinking themselves in the mind of the analyst.” Given these theoretical premises, Daniela De Robertis reports in detail two sessions with her patient Mattia, centering on his way of trying to read the analyst’s mind, and on how she dealt with such an unconscious strategy, that is, interpreting it as a test of her readiness to be receptive enough to his problems.

The two following articles, “Sense of self and psychosis, Part 1: Identification, differentiation and the body – A theoretical basis for amniotic therapy” and “Sense of self and psychosis, Part 2: A single case study of amniotic therapy,” come from Maurizio Peciccia (Perugia) and his research team, which also includes the famous neurophysiologist Vittorio Gallese (Parma). In 1996 Peciccia and Gaetano Benedetti (1920–2013) published in our journal the article “The splitting between separate and symbiotic states of the self in the psychodynamic of schizophrenia” (Benedetti & Peciccia, 1997), the best expression of their collaboration, and the starting point of the research work leading to the conceptualization and practice of “amniotic therapy.”

An Italian medical doctor, Benedetti specialized in psychiatry in Zurich with Manfred Bleuler (1903–1994) and trained as an IPA psychoanalyst with Gustav Bally (1893–1966), becoming in the early 1950s a pioneer of the psychotherapy of schizophrenia, and founding with Christian Müller (1921–2013) the International Society for the Psychotherapy of Schizophrenia – whose last conference was organized by Maurizio Peciccia in Perugia in September 2022. Thanks to Gaetano Benedetti’s initiative, the Milan Associazione di Studi Psicoanalitici became an IFPS member society in 1989, at the VIth IFPS Forum of Rio de Janeiro, and he regularly participated in its scientific life (see Benedetti, 1993; Benedetti & Peciccia, 1998).

The relevance of parental care/cutaneous interactions in the pathogenesis of psychosis was already known to the pioneers of the psychoanalytic approach to psychosis. This is what led the research group to explore the role of the surface of the body and its early sensorimotor interactions in the process of self/other identification and differentiation. When the body’s surface is projected intrapsychically, we have differentiation, and when it is projected externally onto the body’s surface of the other, we have identification. Identification is a reciprocal process, in which the self’s and the other’s surfaces mutually contain each other and co-create a shared field. This is the neurophysiological and psychological basis of “amniotic therapy,” with which the authors deal in detail in the second part of their contribution. In it they show how this new form of therapy can increase the protective strength of self-boundaries and the integration of identification/differentiation processes in psychotic patients.

The next contribution to this issue comes also from Italy and consists of Giuseppe Salerno’s “Online psychoanalysis: Interview with Paolo Migone.” The coeditor-in-chief of the Italian journal Psicoterapia e Scienze Umane, Paolo Migone (Parma) is also the co-chair of the Rapaport-Klein Study Group (Stockbridge, Massachusetts), and was a pioneer of the discussion of the topic of online psychoanalysis, having always considered psychoanalysis “a general theory that is applied to infinite clinical situations.” Online psychoanalysis can become a problem only for those colleagues who miss understanding the fact that the analytic process can also develop under conditions different from the ones considered as “classical.”

To our New York colleague Henry (Zvi) Lothane we owe the two book reviews at the end of this issue. These are on the books by Lawrence Friedman, Freud’s papers on technique and contemporary clinical practice, and by Ahron Friedberg and Sandra Sherman, Psychotherapy and personal change: Two minds in a mirror. I too highly recommend both books. We can only profit very much from keeping alive our dialogue with Freud and with his clinical genius, as Lawrence Friedman does. And Friedberg and Sherman must be congratulated on how well they show how they can help their patients positively deal with the traumas and dramas of their lives.

Before finishing this Editorial, I would like to thank Grigoris Maniadakis for having worked with me as a coeditor-in-chief of this journal with so much intelligence and commitment, as he has done since October 2014. We spontaneously shared many common wavelengths and this made our work not only easy, but also very satisfying. At the same time, I welcome Gabriele Cassullo (Turin) who will succeed him in the same role after the next IFPS Forum, which is about to occur in Madrid, to celebrate the 60th anniversary of the IFPS.