"Transference is an inevitable necessity" – thoughts on unilateral terminations of psychotherapy in view of Freud's Dora case-story

Dr. Ayelet Naeh

It is surprising, and possibly ironic, that the first documented psychoanalytic treatment is a case of unilateral termination. The story of Freud's treatment of Dora (Ida Bauer), is a fascinating text for many reasons, also because the discovery of the transference is weaved into it. Freud arrives at the conclusion that the abrupt termination occurred because he had not noticed signs that indicated negative aspects of the transference in time: "If the theory of analytic technique is gone into, it becomes evident that transference is an inevitable necessity" (Freud, [1905] 1891, p.116). These words of Freud reflect an ambivalent attitude towards the transference, an attitude which, in my opinion, prevails to this day. It is regarded as an occurrence that cannot be averted, but at the same time arouses a desire to evade it and its negative aspects. From a study of Freud's thinking regarding Dora's treatment, it is possible to denote directions for therapeutic work with the negative aspects of the transference, with the intention of preventing, as much as possible, sudden and unilateral terminations of therapy. Unilateral terminations by patients confront therapists with a complex personal and professional challenge. Unilateral terminations are acts, enactments; as such, they arouse raw, powerful emotions in therapists that have not been processed into thoughts. This article addresses various clinical aspects of unilateral terminations of therapy and presents directions for coping with them that emerge from Freud's description of the case of Dora and from the writings of additional theoreticians and researchers.

Keywords: Freud, Dora, Transference, Unilateral terminations of therapy.

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Homecoming  - the domestic environment as a psychic envelope

Dr. Basmat Klein

This article focuses on the domestic space and on its possibility to provide its inhabitants a psychic envelope. Although the house is an important theme in psychoanalytic literature, many psychoanalytic theories have focused mainly on the symbolic characteristic of the domestic space. Thus, although many of them attach important symbolic meaning to the concept of home, they rarely observe the actual physical space it consists of and its possible impact on the psychic experience. This article seeks to answer the question of how home as an environment, as well as an architectural entity with unique features, may affect the psychic experience.I argue that a house is a meaningful space supporting mental transformation and that this transformation comes about by actively engaging with the various objects occupying the house and with the environment itself. It is my contention that the influence of the space on its inhabitants can also promote the understanding of psychopathology and its relation to the environment. In the same way one's surrounding can enable growth and development, it can also enhance pathology and lead to distress and difficulty. I will substantiate this claim using an interdisciplinary exploration containing ideas from psychoanalysis and architecture. Based on these understandings, a set of therapeutic tools are offered that could be taken into the consulting room. The article will contain case studies from both literature and clinical practice.

Keywords: Psychoanalysis, Domestic space, Place and identity, Architecture, Phenomenology.

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A Tale of Four Parents - Psychodynamic Play Therapy for Children in Foster Care

Dr. Prins-Engelsman Shimrit, Dr. Keydar Cohen Karin

This article describes the significant contributions offered by the psychodynamic approach to the psychotherapy of children in foster care. Foster care is a temporary alternate parenting aiming to provide a benevolent parenthood experience to a child whose parents are unable to care for and who experienced ongoing childhood trauma and neglect. How well a child adjusts to foster care depends on the child's attachment history. An internal model of a neglectful or abusive attachment figure often provides a challenge for developing a benevolent relationship with new therapeutic figures. Unique characteristics of psychodynamic play therapy in the treatment of foster children are described using a clinical case study. Difficulty in relating and trusting, a lack of playfulness, deprivation of primary needs, traumatic reconstructions and an inner world saturated with destruction and loss were observed and expressed in the play and the therapeutic relations. Also discussed in this article is how reflecting on the processes of transference, countertransference, and projective identification enabled the therapist’s emotional capacity to contain and reconstruct the child’s destructive inner world. Due the unique emotional challenges in treating foster children, this paper emphasizes the importance of proper supervision, which provides space for the therapist’s inner world and supports them in carrying the therapeutic relationship. In a parallel process, an attentive therapist to the needs and emotions, helps the foster child reconnect with the strengths and hope hidden within them. Thus, may provide a reparative experience for the loss and instability that the foster child has experienced.

Keywords: Children in foster care, Psychodynamic play therapy, Trauma, Attachment.

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God and me, God is me - Dialogue with religion as a mechanism for coping with emotional distress

Dr. Esther Hess

In this article I seek to clarify the different ways in which religious ultra-orthodox Jewish patients, accustomed to the continuous presence of God in their daily lives, relate to God in times of crisis and within the therapeutic framework.  While the accepted, ongoing dialogue with God is characterized by prayer and a highly respectful relationship towards a divine, spiritual authority, in times of distress we find that patients may “use” God in other ways as well. These “uses of God” may be categorized into four main groups: a relationship to God as  a projection of the patient’s relationship to his/her parents; the idealization and glorification of God, from a place of distance, authority and supremacy;  a relationship to God of  “closeness” and mutuality; and a relationship of “objectification” – the idea that God exists for me as an object, to serve or help me in my daily life. Each category is illustrated by a case study, with a focus on the therapeutic work and in particular the issue of transference. 

Keywords: God, Almighty, Religious faith, Religious observance, Psychotherapy, Transference.

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The dream conflict

Dr. Kobi Segal

Man have been interested in dreams since ancient times. The ability to dream and to remember dreams is part of human creativity and ability to solve problems, and it is related to mental health. I agree with Ferro's metaphor of the different theories and techniques of analyzing dreams as "rungs of the ladder", that through their knowledge enable us to dive into the depths of the unconscious. The "rungs of the ladder" that I work with are four approaches : Freud, Jung, Klein and Bion. These approaches place the dream in the center, and in my opinion, combining them together broadens the work with dreams. Being a psychoanalyst with dreams at the center of my work, I am curious about the "dream conflict" that causes many therapists and patients question the degree to which dreams should be given a central place in psychodynamic psychotherapy.  I think that the root of this conflict is in an internal conflict, conscious and unconscious, of the therapist and the patient, who are drawn to work with dreams and are also recoiled from it. The main reasons for the patient "dream conflict" are his wish to know and not to know the depths of his psyche, his anxieties of encountering  the unconscious and strong emotional intensities which are manifested in the dream; For the therapist, the conflict is in the difficulty to encounter emotional intensities of the patient which are projected into him, and the narcissism of the therapist who is afraid to disappoint the patient by not giving a mutative  interpretation to his dream. I believe the awareness to the "dream conflict" and working through it will help bringing the dream back to its central place in psychodynamic psychotherapy.

Keywords: Dream conflict, "Rungs of the ladder", Anxiety from the unconscious, Narcissism of the analyst, Counter-transference dream.

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The meaning of the phenomenon of hope in psychodynamic supervision

Dr. Ofir Levi 

In this article I will describe using two case studies, the role of the "phenomenon of hope" in individual dynamic psychotherapy supervision. The development of the concept phenomenon of hope was based on the description of the concept of hope in the psychodynamic and cognitive behavioral theories, and on the encounter with complex trauma victims. The phenomenon has significance in supervision relationships, especially in formal relationships that take place as part of formal training processes, such as three-year programs for psychotherapy, which are characterized with strong interdependencies between the supervisor and the student. Understanding the concept of the phenomenon of hope and its contribution to the evolving supervision process in psychodynamic psychotherapy, could help the supervisors who are responsible for training therapists.

Keywords: Phenomenon of hope, Individual-dynamic supervision, Transference and countertransference, Process

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