This case study describes and analyzes the psychodynamic experiences of an adult hospitalized after an acute cardiac event. Pierre, a 46-year-old Brazilian man with a high level of education, sought medical care for ches...This case study describes and analyzes the psychodynamic experiences of an adult hospitalized after an acute cardiac event. Pierre, a 46-year-old Brazilian man with a high level of education, sought medical care for chest pain and was diagnosed with acute myocardial infarction. He was immediately admitted to a hospital coronary care unit, where, after clinical stabilization, he agreed to undergo psychological assessment using self-report instruments and projective methods. While Pierre did not show clinical indicators of psychological distress on the self-report scales, his responses on the projective methods revealed signs of conflict in interpersonal relationships, with strong repression of affective experiences, suggesting difficulties in emotional management and a potential link to his physical illness. This case study, using a multimethod design, enriched the understanding of his psychological functioning and supported the identification of resources for coping with cardiac illness.
This paper explores the relational approach in psychoanalysis not merely as a theoretical model but as a clinical sensibility that has fundamentally altered therapeutic practice across theoretical boundaries. Unlike clas...This paper explores the relational approach in psychoanalysis not merely as a theoretical model but as a clinical sensibility that has fundamentally altered therapeutic practice across theoretical boundaries. Unlike classical psychoanalytic innovations that emerged from clinical observations, the relational approach represents a new type of innovation-one that challenges epistemological assumptions rather than proposing new psychic facts. Drawing on clinical vignettes and training experiences, this paper examines how relational sensibilities have infiltrated contemporary practice, creating new therapeutic possibilities while generating novel clinical dilemmas. The paper argues that understanding innovation in terms of "sensibilities" rather than just theoretical systems provides crucial insights into how psychoanalytic knowledge develops and spreads in the contemporary era.
This paper considers the relevance of personal names and the process of naming in relation to unconscious dynamics, implicit associations, cultural influences, and our relationships with our parents. Particular attention...This paper considers the relevance of personal names and the process of naming in relation to unconscious dynamics, implicit associations, cultural influences, and our relationships with our parents. Particular attention is paid to our associations with certain names, names in relation to the structure of the ego, and the use of names in clinical practice, with references drawn from current and historical psychoanalytic literature.
This article argues that the question of whether we are alone in the universe is a symptom of Western apparatuses that produce an ontological rift between human beings and other species. This rift comprises instrumental,...This article argues that the question of whether we are alone in the universe is a symptom of Western apparatuses that produce an ontological rift between human beings and other species. This rift comprises instrumental, ruling epistemologies that depersonalize other species, thus legitimating our indifference to their manifold intelligences and communications. The Western apparatuses that produce the rift can be understood in terms of a normative and historical unconscious, as well as the defenses of weak dissociation and projection. These defenses operate to secure a conscious and preconscious sense of existential significance while rendering unconscious the terrifying reality of existential insignificance. This analysis also provides a partial explanation for the sources of the climate polycrisis and the strong resistance to effective climate action. That is, dissonant subjects have an antagonistic relation to "nature," deeming all that falls under this abstraction mute and dumb (unintelligent).
This essay offers a psycho-spiritual and psychoanalytic meditation on the horse-human relationship as a nonverbal site of attunement, regulation, and meaning-making. Drawing on autobiographical clinical narrative, it exp...This essay offers a psycho-spiritual and psychoanalytic meditation on the horse-human relationship as a nonverbal site of attunement, regulation, and meaning-making. Drawing on autobiographical clinical narrative, it explores how horseback riding became a medium for experiencing and reflecting upon embodied connection, mutual responsiveness, and contemplative presence. Encounters with horses illuminate forms of reciprocity that preceded and exceed speech, while also opening reflection on maternal attachment, separation, loss, and the emergence of selfhood. In dialogue with Freud, Winnicott, Piaget, and Buber, the essay argues that the horse-rider dyad may be understood as a lived analogue to central psychoanalytic concerns, including attunement, play, symbolization, and the I-Thou relation. The horse emerges not merely as metaphor, but as a sentient other whose responsiveness invites humility, emotional integration, and spiritual deepening. The essay ultimately suggests that sustained attention to the nonverbal-whether in relation to children with disabilities or to sentient beings-may enlarge psychoanalytic understandings of embodiment, intersubjectivity, and transcendence.
I offer a psychoanalytic interpretation of as an allegory of father-daughter incest and psychological recovery. Christine Daaé's journey illustrates the internal dynamics of trauma-denial, dissociation, and identificati...I offer a psychoanalytic interpretation of as an allegory of father-daughter incest and psychological recovery. Christine Daaé's journey illustrates the internal dynamics of trauma-denial, dissociation, and identification with the abuser-while her final confrontation with the Phantom symbolizes the reclamation of agency and selfhood. Drawing on symbolic actions such as unmasking and descent into the unconscious, the analysis explores how narrative, performance, and relational support can reflect the nonlinear process of healing. Ultimately, Christine's transformation from victim to survivor reveals the potential for integration and autonomy through insight, confrontation, and emotional truth.
Psychotic symptoms are a prevalent yet underrecognized feature of borderline personality disorder (BPD), with studies estimating their occurrence in up to 60% of patients. Despite their clinical and theoretical relevance...Psychotic symptoms are a prevalent yet underrecognized feature of borderline personality disorder (BPD), with studies estimating their occurrence in up to 60% of patients. Despite their clinical and theoretical relevance, these phenomena are marginalized in contemporary diagnostic frameworks, which emphasize affective instability and interpersonal dysfunction while minimizing impairments in reality testing. We review the historical roots of BPD as a schizophrenia-like condition and examine the phenomenology of hallucinations and delusions in this population. Drawing on psychoanalytic object-relations theory, particularly the contributions of Otto Kernberg and John Gunderson, we propose that psychotic symptoms in BPD serve an object-restitutive function, preserving internal relational continuity amid psychic disintegration. We argue that these symptoms are neither incidental nor epiphenomenal but reflect core features of the disorder that warrant greater attention in diagnosis and treatment. Improved clinical recognition and theoretically informed interventions are essential to addressing this neglected dimension of BPD.
In this essay, the author analyzes Bob Dylan's contentious mid60s break with the folk movement, exploring ways in which it may have been telegraphed by his lyrics, while also acknowledging the pitfalls of seeking psychol...In this essay, the author analyzes Bob Dylan's contentious mid60s break with the folk movement, exploring ways in which it may have been telegraphed by his lyrics, while also acknowledging the pitfalls of seeking psychological or biographical insights into artists via their work, generally and particularly with regard to Dylan. From there, the author explores the fallout of Dylan's pivot from overtly political work, and the larger debate over what roles politics and activism should play in art and literature. Finally, the author offers two key ways in which this exploration of Dylan could be relevant to analysts.
Case material is used to illustrate a Kleinian-informed psychoanalytic approach to working with a patient captured by obsessive cycles of controlling others along with the threat of losing their love. Obsessive disorders...Case material is used to illustrate a Kleinian-informed psychoanalytic approach to working with a patient captured by obsessive cycles of controlling others along with the threat of losing their love. Obsessive disorders involve either controlling the self and the other or feeling confined and controlled by the self and the other. These phantasy states bring on intense fear of difference, fear of the unknown, and fear of abandonment. During treatment, as the patient improves, there is often a fluctuation between more disturbed and more balanced mental experiences of life. The Kleinian-informed psychoanalytic approach demonstrated in this case material aims to address this lack of psychological integration and help patients regain or discover psychological clarity, stability, and balance in how they feel, think, and relate.
This paper explores the mystical unconscious as a dimension of psychoanalysis that moves beyond psychoanalysis's emphasis on repression and interpretation. Drawing from psychoanalytic insights, mystical traditions, and p...This paper explores the mystical unconscious as a dimension of psychoanalysis that moves beyond psychoanalysis's emphasis on repression and interpretation. Drawing from psychoanalytic insights, mystical traditions, and personal clinical encounters with states of spirit possession, the author argues for a psychoanalytic stance of witnessing. Through concepts such as the mystical vertex, internal third, and the analyst as a double, the author presents psychoanalysis as an art of profound attunement-one that welcomes spectral, sublime, and sacred psychic experiences not as pathology, but as meaningful enactments of suffering, cultural memory, and transformation. This reframes psychoanalysis as an aesthetic and spiritual communion.
The premise of Colette Dowling's was a scalding one when it was first published in 1981, but the book struck a deep chord and became an instant bestseller. Nowadays the "Cinderella Complex" might seem like a dated conce...The premise of Colette Dowling's was a scalding one when it was first published in 1981, but the book struck a deep chord and became an instant bestseller. Nowadays the "Cinderella Complex" might seem like a dated concept, but it remains strikingly relevant for two of my patients. Both hold deeply entrenched Cinderella fantasies that arose from having served as narcissistic extensions. Through exploring and reconsidering various versions of the fairytale that parallel my patients' own histories, I attempt to work through their deep sense of emotional impoverishment, from which they might only be rescued by a more powerful other.
Since Freud's rejection of religion and spirituality as a collective neurosis, psychoanalysts have come to appreciate new perspectives on these ethereal matters. This article focuses on five psychoanalytic approaches to...Since Freud's rejection of religion and spirituality as a collective neurosis, psychoanalysts have come to appreciate new perspectives on these ethereal matters. This article focuses on five psychoanalytic approaches to matters of religion and spirituality. Psychoanalytic work is not merely intended to analyze the linear and logical. We are dedicated to acknowledging the prelinguistic, unconscious, and oceanic sensations that are intangible but very real to our patients. Enhancing clinical awareness of the ways religion and spirituality influence our patients is especially significant today because our patients' spiritual sensibilities may not fit into traditional definitions.
Many suffer intense guilt feelings when they harm others, even when they did so blamelessly and they know it. For these faultless injurers, therapy and other treatments face a distinct challenge: the subjects experience...Many suffer intense guilt feelings when they harm others, even when they did so blamelessly and they know it. For these faultless injurers, therapy and other treatments face a distinct challenge: the subjects experience their guilt feelings as fitting, something they should not even try to overcome, despite being fully aware that they are above criticism. Some theorists have sought to explain this resistance to treatment or consolation-what I call the normative meta-phenomenology of faultless guilt-by showing why faultless guilt can sometimes be reasonable or justified. Here I argue, to the contrary, that it cannot be justified. Instead, I try to account for faultless guilt as the way moral agents naturally experience the tension between what they have done and what they are deeply invested in not doing. On this understanding, faultless injurers are bound to feel guilty, on pain of abandoning their basic moral commitments.