The author explores some ways that we help patients to hold paradoxical realities intrinsic to transference and play in analytic work. He suggests that Winnicott\'s guardianship of the setting for the emergence of playing raises questions about the role of neutrality in an ontological analysis. The author tries to demonstrate some ways that the work of helping patients to hold paradox in play overlaps with a concept that he has earlier referred to as an activity of neutrality. He explores how in the analytic process, understanding and being are two dimensions of the analytic process that work in concert with each other. Often the analyst works quietly in spaces between epistemological and ontological approaches in the holding of paradox.

Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists\' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a \"medical model,\" may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.

The educational and clinical effects of the process of case writing during analytic training have not been extensively studied, even though the case report, as a product, has prompted attempts to make it a more revealing and accurate document. Countertransference experiences during an analysis can constrain both the candidate\'s writing and the analytic work, while examining them during the writing process can deepen the candidate\'s analytic work. Three overlapping resistances to the writing, and their underlying anxieties, are described. These are publication resistances: concerns about the anticipated reception of the candidate\'s work by potentially critical readers; transference resistances: feelings toward the analytic institute that requires the writing; and countertransference or reimmersion resistances: fears of reawakening reactions from the analysis. These can interfere with finding a safe internal space in which to write. Examples are given of writing through of these resistances during case supervision, resulting in more open writing and in a deepening of the analytic work. As the case writing process can have direct and potentially profound effects on the candidate\'s current and future analytic work, it is proposed that the process of case writing is a fourth pillar of analytic training, in addition to the candidate\'s personal analysis, case supervision, and didactic seminars.

This reflection on the initial stages of treatment of a latency girl whose previous analyst died offers some insights into inner workings of mourning in children. The mourning process intersects in complex ways with a developmental stage, object constancy, unconscious phantasies, and conscious ideas about life and death. Clinical material illustrates some challenges that emerge in the transference-countertransference matrix when working with a child who lost both her primary object (the mother) and her transference object (the analyst). The reality of the analyst\'s death emphasizes that for a child patient the analyst is always a transference object and a real object at once.

The tripartite model of the therapy relationship, which includes the working alliance, real relationship, and transference-countertransference configuration, has been a useful way to conceptualize the complexity of the connection between a therapist and a client. However, little research has focused on the interrelationships between these three components over time. This study sought to replicate the findings of Bhatia and Gelso (2018) by examining the between-person relationships among each of the three elements averaged across all sessions. Additionally, we extended earlier work by examining the within-person relationship between the working alliance, the real relationship, and transference-countertransference with themselves as well as with each of the other elements across sessions. Using 5,931 sessions across 142 clients and 36 therapists, we examined time-ordered associations among the cocreated working alliance, cocreated real relationship, and the therapist-rated transference-countertransference configuration using latent variable dynamic structural equation modeling. Results replicated the findings of Bhatia and Gelso (2018), demonstrating that in one session, the working alliance and the real relationship were positively related, and both the working alliance and the real relationship were negatively related to the transference-countertransference configuration. Regarding the interrelations over time, the findings revealed that the working alliance in the previous session had a significant and positive relationship with real relationship in the current session, and the real relationship in the previous session was related to reduced transference-countertransference in the current session. These findings provide support for complex interrelations among the components over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Synchronicity describes a meaningful coincidence of events, which is familiar to us from treatments of our patients, but unfortunately has not yet been empirically substantiated. Adding to previous findings that point out beneficial aspects of synchronicity (Marlo, 2022; Lagutina, 2021; Connolly, 2015), in this paper I will show through a series of five synchronistic moments which happened in the context of therapy and analysis and which have been documented empirically, how synchronicities occur and can be used therapeutically. In my research I found several situational factors that can be considered structural aspects of synchronistic moments. Furthermore, I will show that synchronistic phenomena can have a positive influence if certain relational and transference-countertransference referential aspects are considered by the therapist and analyst. The concept of synchronicity brings the possibility of a further therapeutical instrument for the patient-analyst-dyad.
La synchronicité décrit une coïncidence significative d\'événements, qui nous est familière dans les traitements de nos patients, mais qui malheureusement n\'a pas encore pu être étayée scientifiquement. Dans cet article - tout en allant dans le sens d\'articles antérieurs qui montrent les aspects bénéfiques de la synchronicité (Marlo, 2022; Lagutina, 2021, Connolly, 2015) - je montrerai, à travers une série de cinq moments synchronistiques qui se produisirent dans le contexte de thérapie et d\'analyse et qui ont été documentés de manière empirique, comment les synchronicités se produisent et comment elles peuvent être utilisées de manière thérapeutique. Dans ma recherche j\'ai trouvé plusieurs facteurs situationnels qui peuvent être considérés comme des aspects structurels de moments synchronistiques. De plus, je montrerai que les phénomènes de synchronicité peuvent avoir une influence positive si certains aspects relationnels, et qui font référence au transfert-contretransfert, sont pris en compte par le thérapeute et l\'analyste. Le concept de synchronicité offre la possibilité d\'un instrument thérapeutique de plus pour la dyade patient-analyste.
Synchronizität beschreibt ein sinnvolles Zusammentreffen von Ereignissen, das uns aus der Behandlung unserer Patienten bekannt ist, aber leider noch nicht wissenschaftlich belegt werden konnte. In Ergänzung zu früheren Erkenntnissen, die auf vorteilhafte Aspekte der Synchronizität hinweisen (Marlo 2022, Lagutina 2021, Connolly 2015), werde ich in diesem Aufsatz eine Reihe von fünf synchronistischen Momenten aufzeigen, die im Kontext von Therapie und Analyse aufgetreten und empirisch dokumentiert sind und die veranschaulichen, wie Synchronizitäten auftauchen und therapeutisch genutzt werden können. Bei meiner Forschung habe ich mehrere situative Faktoren gefunden, die als strukturelle Aspekte synchronistischer Momente betrachtet werden können. Darüber hinaus werde ich zeigen, daß synchronistische Phänomene einen positiven Einfluß haben können, wenn bestimmte relationale und auf Übertragung-Gegenübertragung bezogene Aspekte vom Therapeuten und Analytiker berücksichtigt werden. Das Konzept der Synchronizität bietet die Möglichkeit eines zusätzlichen therapeutischen Instrumentes für die Patient-Analytiker-Dyade.
La sincronicità descrive una coincidenza significativa di eventi, che ci è familiare dal lavoro con i nostri pazienti, ma che sfortunatamente non è stata ancora scientificamente provata. In aggiunta ai risultati precedenti che evidenziano gli aspetti benefici della sincronicità (Marlo, 2022; Lagutina, 2021; Connolly, 2015), in questo articolo mostrerò come si verificano le sincronicità e come possono essere usate a scopo terapeutico, attraverso una serie di cinque momenti sincronici avvenuti nel contesto della terapia e dell\'analisi e che sono stati documentati empiricamente. Nella mia ricerca ho trovato diversi fattori situazionali che possono essere considerati aspetti strutturali di momenti sincronici. Inoltre, mostrerò che i fenomeni sincronici possono avere un\'influenza positiva se certi aspetti relazionali di transfert-controtransfert vengono considerati dal terapeuta e dall\'analista. Il concetto di sincronicità porta con sé la possibilità di un ulteriore strumento terapeutico per la diade paziente-analista.
Синхронистичностью называют значимое совпадение событий; мы знаем о ней благодаря нашим пациентам, однако эта концепция, к сожалению, пока не получила научного обоснования. В дополнение к предыдущим материалам, свидетельствующим о ценных аспектах синхронистичности (Marlo, 2022; Lagutina, 2021; Connolly, 2015), в данной статье я демонстрирую на примере пяти синхронистичных моментов, произошедших в контексте терапии и анализа и обоснованных эмпирически, как синхронистичность возникает и может быть использована в терапевтических целях. В ходе исследования я обнаружил несколько ситуационных факторов, которые можно рассматривать как структурные аспекты синхронистичных моментов. Кроме того, я покажу, что синхронистичные явления могут оказывать положительное влияние, если терапевт и аналитик учитывают определенные референтные аспекты переноса и контрпереноса. Концепция синхронистичности открывает возможность создания дополнительного терапевтического инструмента для диады пациент-аналитик.
La sincronicidad describe una coincidencia significativa de eventos, que nos es familiar a partir de los tratamientos de nuestros pacientes, pero que desafortunadamente aún no ha sido científicamente fundamentada. Sumándome a hallazgos previos que dan cuenta de aspectos beneficiosos de la sincronicidad (Marlo, 2022; Lagutina, 2021; Connolly, 2015), en este trabajo mostraré a través de una serie de cinco momentos sincronísticos que sucedieron en el contexto de la terapia y el análisis y que han sido documentados empíricamente, cómo suceden las sincronicidades y cómo pueden utilizarse terapéuticamente. En mi investigación encontré varios factores situacionales que pueden considerarse aspectos estructurales de los momentos sincronísticos. Además, mostraré que los fenómenos sincronísticos pueden tener una influencia positiva si ciertos aspectos relacionales y vinculados a la transferencia-contratransferencia son considerados por el analista - terapeuta. El concepto de sincronicidad brinda la posibilidad de un instrumento terapéutico más para la díada paciente-analista.
心理治疗中共时性时刻的结构面向:心理治疗和精神分析中关于共时性实证研究的发现 共时性指一个有意义的巧合事件, 这是我们通过病人已然熟知, 但却未曾证实的事情。此前研究已经指出共时性事件可以带来的多方面获益 (Marlo, 2022; Lagutina, 2021; Connolly, 2015), 这篇文章在此基础上, 通过五个被实证记录在案的治疗和分析中发生的共时性时刻, 来展示共时性事件如何发生, 以及如何被治疗性的使用。在我的研究中, 我发现了几个情境因素, 它们可以被视为共时性时刻的结构面向。此外, 我将呈现, 当治疗师和分析师可以考虑到某些与关系相关的, 及与移情-反移情相关的方面, 那么共时性现象可以具备积极的影响。共时性的概念可能为病人-分析师联合体提供另一种治疗工具。.

The following case study provides a description of the transference-focused psychotherapy (TFP) treatment of a young man diagnosed with narcissistic personality disorder (NPD). TFP is an individual, psychodynamic therapy developed to treat a range of personality disorders. TFP is evidence-based for the treatment of borderline personality disorder and has been adapted for the treatment of NPD. This case illustrates the application of the strategies and techniques of TFP to treatment of NPD as well as challenges clinicians may face in arriving at timely diagnosis of the disorder. Although no specific treatment for NPD has been empirically validated, TFP utilizes the therapeutic techniques identified across modalities for successful treatment of pathological narcissism. This report describes how treatment interventions such as goal setting, developing a therapeutic alliance, using a treatment contract and addressing treatment interfering behaviors contributed to this patient\'s improvement in self-reflection, formation of healthier and more flexible ideas about self and other, increased self-agency, tolerance of normative disillusionments and increase in empathy.

I use the clinical example of a traumatized adolescent to talk about how a transference experience creates the frame where the analytic work occurs. Out of the external boundaries of the relationships with an object, the internal frame, the womb of transformation processes, is created. The analyst\'s capacity to wait is essential for the transformation that creates and shapes the transference experience, which, like playing, becomes the matrix of the frame where it happens as it happens. As the traumatic experiences find their place in the transference and begin to be integrated, the adolescent becomes more present and real in the session.

Institutional transference is a phenomenon describing patients\' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. Here, we present three cases which demonstrate the phenomenon of institutional transference in patients with serious illness and the resulting clinical implications, which include countertransferential responses of clinicians caring for them. We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference.

The article presents a view of transference from the early versions of transference by Classical/Structural analysts, through a variety of analytic positions that extend and implicitly question the concept of transference. After looking at Brenner and Bird\'s transference positions, we trace the beginning of relational analysis as articulated by Gill. The differences among several subsequent relational positions are then explicated. Self-Psychology is conceptualized as providing a clarification of Freud\'s view of narcissism leading to a new perspective on narcissistic transference states. The article concludes by detailing Contemporary Freudian concepts that integrate various object relation positions within an overriding Freudian theoretical structure. The Contemporary Freudian positions in some ways mirror Ogden\'s attempts to integrate diverse positions.