Conversation With Mark Solms.

Occasioned by the publication of , the text represents exchanges held in the summer of 2024 at the invitation of . It addresses the genesis and the history of the project, and its impact on psychoanalytic rethinking, formation, and practice. While exploring the potential and the limits of revisioning, it also raises questions about the nature of transmission of psychoanalytic knowledge and about the field's relation to the state of its own standards in the age of Anthropocene.

Psychoanalytic object relations theory revised: Affect systems and the notion of drives.

This paper explores the concept of drives as basic motivational neurobiological structures determining the organization of psychic life. I express my agreement with Mark Solms' radical reformulation of the general principles organizing human behaviour at the neurobiological and psychodynamic levels, his combination of Friston's computational information theory and Panksepp's affect systems. I agree with him that the affect systems described by Panksepp constitute the primary drives and that the conflicts between affect systems are the origin of unconscious intrapsychic conflict.

Treatment Objectives, Memory, and Desire.

This article explores the problems of the frequent loss, in the course of treatment, of the initial goals and motivation for treatment by both patient and therapist, and the connected lack of clarity of the real initial motivation for treatment on the part of both participants. It is strongly proposed that a true coincidence of at least one important initial motivational goal of patient and therapist is essential to assure the success of psychotherapy and that particular care is required to establish such agreement. On this basis, the goals of therapy may be expanded in the course of the therapist's experience, countertransference, and the patient's changing reality during treatment, and the existential and philosophical value systems of the therapist may play an important role in such widening of the therapist's expectations for the patient.

Aging, Dying, and the Analytic Process.

The panel discussion presented at the New York Psychoanalytic Society and Institute's 1066th Scientific Meeting held on June 8, 2023, takes up aging and dying of an analyst and their impact on patients and on the nature of analytic process. Participants reflect on conflicts and challenges arising with more analysts and patients living to an advanced age, on the unregulated nature of analysts' retirement, and on multilayered meanings of analysts' ethical commitment to their work.

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies.

Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects.

Borderline Personality Disorder: A Review.

Importance: Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US.

Differential neural response to psychoanalytic intervention techniques during structural interviewing: A single-case analysis using EEG.

Background: Previous studies detected changes in the electroencephalographic (EEG) signal as an effect of psychoanalytic interventions. However, no study has investigated neural correlates of specific psychoanalytic interventions in the EEG power spectrum yet. In the present case study, we contrasted three types of interventions (clarification, confrontation, and interpretation) and a neutral control condition during a structural psychoanalytic interview conducted while EEG was recorded.

Extensions of Psychoanalytic Technique: The Mutual Influences of Standard Psychoanalysis and Transference-Focused Psychotherapy.

The author describes the differences between standard psychoanalysis and transference-focused psychotherapy (TFP) and reviews particular difficulties that psychodynamically trained clinicians have in learning TFP. In delineating differences between standard psychoanalysis and TFP, the author discusses mutual influences between standard psychoanalytic techniques and techniques of TFP. TFP is an extension and modification of standard psychoanalysis, but with quantitative modifications geared to the treatment of the most severe segment of personality disorders that tend not to be treatable by standard analysis.

Challenges for the Future of Psychoanalysis.

This paper summarizes the current crisis of psychoanalysis in its relations to the scientific and cultural environment. It proposes tasks to assure the survival and contributions of psychoanalysis as science, profession, and humanistic discipline. It proposes emphasis on empirical research in the boundaries with the neurosciences and social psychology, and the development of an infrastructure for research linked to its educational program.

Thoughts on Transference Analysis in Transference-Focused Psychotherapy.

Transference-focused psychotherapy (TFP) represents a specific extension of psychoanalytic therapy for treatment of individuals with personality disorders, who may be helped without the more significant time investment required of a standard psychoanalysis. The treatment represents a contemporary formulation of psychoanalytic psychotherapy, updated in light of both empirical research and scientific developments in boundary fields close to the psychodynamic endeavor, particularly affective neuroscience and the psychology of couples and small groups. In TFP, the transference signifies the enactment in the here and now of a specific affective relationship between patient and therapist that reflects one aspect, defensive or impulsive, of a pathogenic dynamic unconscious conflict.

Development and Validation of the Interview of Personality Organization Processes in Adolescence (IPOP-A).

The assessment of personality and personality pathology in adolescence represents a critical topic to understand adolescent's difficulties, predict long-term outcome in adulthood, and indicate adequate treatment. Personality Organization, and its underlying dimensions, plays an essential role in shaping how adolescents face their developmental tasks as they are connected with psychosocial functioning and psychopathological severity. However, few measures are available to assess personality organization during adolescence.

Therapeutic Implications of Transference Structures in Various Personality Pathologies.

Definitions of specific organizations of transference developments are proposed for neurotic, borderline, narcissistic, schizoid, symbiotic, and psychotic character structures. These distinct organizations of transference developments correspond to the underlying characteristics of internalized object relations stemming from the conflictual implications of split-off, idealized, and persecutory self- and object representations. The transference structures described have implications for the corresponding application of psychoanalytic technique.

Psychotic Personality Structure.

This article discusses the concept of psychotic personality organization. I relate psychotic personality organization to observations and speculations about psychotic transferences and to behavioral developments during the treatment of chronically psychotic patients (particularly those with schizophrenia). The overwhelming theoretical perspectives used are twofold: (1) object relations theory and (2) a model integrating neurobiological advances in the study of psychosis with contemporary psychodynamic perspectives.

Malignant Narcissism and Large Group Regression.

This paper explores the mutual relationship between large group regression and leadership with the characteristic of the syndrome of malignant narcissism. Regressed large groups intuitively search for such leadership and personalities with these characteristics are prone to aspire to the correspondent role. The underlying dynamics of groups and leaders are complementary and determine a mutually reinforcing psychopathology.

Reflections on Supervision.

This paper explores basic tasks involved in the supervisory process, and frequent problems in carrying out these tasks. Basic tasks include clarification of mutual expectations of supervisor and supervisee; the establishment of mutual trust as fundamental for countertransference analysis; "parallel process" exploration and clarification of explicit and implicit theoretical assumptions by both supervisor and supervisee. Frequent problems include the extent of initial evaluation of patients; problems of intervening "without memory or desire"; transference and countertransference diagnoses and interpretive consequences; clarification of affective dominance; interventive shifts with severe psychopathology, and realistic goals of patient, supervisee and supervisor.

What's Next? A Clinical Overview.

This rich and comprehensive set of studies on the borderline personality disorder presents the reader with an up-to-date review of new findings and developments in our understanding of this serious and highly prevalent condition. It also outlines areas of controversies and open questions regarding conceptual models, psychopathology, genetic and environmental etiologic features, neurobiology, and treatment.

Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study.

Background: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [1-4] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. This exploratory study sought to develop, using established assessment methods, a dimensional measure of malignant narcissism that incorporates the key features of grandiose narcissism, paranoid propensities, psychopathic features, and proclivity for a sadistic and aggressive interpersonal style.

Thoughts on the Present and Future of Psychoanalytic Education.

This paper originated in a series of dialogues between the authors over a period of approximately one year, focused on present problems (and possible solutions) in psychoanalytic education, internationally but particularly in the U.S. Both authors have been involved in psychoanalytic education and governance over many years and share a concern with where psychoanalysis presently stands and where it is going.

New developments in transference focused psychotherapy.

This paper will summarize recent clinical developments in the treatment of borderline patients at the Personality Disorders Institute at Cornell. The experiences under review will include the careful, ongoing monitoring of developments in the patient's life outside the sessions, and their consideration in diagnosing affective dominance during the hours. Other issues include the discussion of a 'second chance' approach to contract violations; the assessment and concern with the patient's assumption of responsibility for himself; the contradictions between actual behavior patterns and life goals, and between personality potentials and present functioning; the technical implications of particular constellations of regressive narcissistic features; drug dependence and antisocial behavior; and life goals and treatment goals.

Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder.

Aims: Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP.

NARCISSISTIC DEFENSES IN THE DISTORTION OF FREE ASSOCIATION AND THEIR UNDERLYING ANXIETIES.

This paper examines particular distortions in the process of free association characteristics of patients with narcissistic personality disorders. The author proposes that the dominant narcissistic transference developments typical of the early and middle phases of the analytic treatment of these patients are reflected in these distortions of free association. This paper gathers the various patterns that these defensive distortions present, along with technical interventions geared to deal with them.