Bertha Pappenheim was the real name of Anna O, the first psychoanalytic patient. In her treatment with Joseph Breuer, Pappenheim invented what she called “Chimney-sweeping,” the procedure of tracing a symptom back to its origins using free association. After her treatment and several subsequent hospitalizations, Pappenheim went on to become a pioneer of German-Jewish social work, a leading feminist, campaigner for women’s rights, and protector of unwed mothers and orphans. I have obtained multiple documents that reveal aspects of her life that have been unappreciated. She was cured not just by her psychoanalytic treatment, but also by realizing her intellectual gifts via her writing and by changing the society that was making her ill. In these ways, she resembled Harry Stack Sullivan, the founder of interpersonal psychoanalysis. Both faced a major crisis in late adolescence and went on to create environments that insulated victims of prejudice and allowed them to flourish.

AIDS has changed all of us, as mental health professionals, as individuals, and as a society. One of the most troubling situations for the psychotherapist is when a patient who is HIV-positive confides that he is having unsafe sex and lying to his sex partner that he is HIV-negative. "Risk groups," the term used by epidemiologists, was itself very misleading. It implied that those who were not members of the risk groups were not at risk of contracting HIV. A patient with advanced AIDS told me that as a teenager he had been severely ill for four years and seemed near death. The doctors were confused, but finally a specialist determined that he had a very rare illness that was curable. AIDS has taught us to deal psychoanalytically with a greatly expanded range of problems. Some of these issues are quite new, and some, while ever-present, are difficult topics that many of us avoid as much as possible.

The relationship of psychoanalysis and issues of race has been complex. In this article, I will discuss three main issues: (1) What can psychoanalysis teach us about the psychology of racism; (2) How does racism affect psychoanalysis today; and (3) How can racism in psychoanalytic institutes be lessened or ameliorated?

The author stresses the importance of working in the open air and in natural surroundings. To make the most of this approach, one must devise a particular therapy for each patient, seeking to understand whatever might involve the analysand in meaningful communication and emotional connection. In keeping with this profoundly interpersonal perspective, the listener chooses her answers to her interlocutor, bearing in mind not only the semantic contents but also the other dimensions of the communication, such as its tone, its implicit emotion, and the accompanying bodily attitude. The therapist's contribution to the dialogue is shaped, to a great extent, by the other's response. The author's therapeutic strategy, as he outlines it here, involves the analyst's reaching an agreement with the sane part of the patient's communications, which requires considerable sensibility, as well as a capacity for attentive listening, on the part of the analyst. If the therapist focuses on the other's madness, the dialogue seems crazier and there is an increase in the anxiety of both participants. If instead the therapist responds only to what is rational and meaningful in the patient's communication, the dialogue makes the patient seem saner and can actually make him saner.

As this journal was founded in 1999, and the 20th Congress of the International Neuropsychoanalysis Society took place in 2019, this year seems a fitting time to celebrate the 20th anniversary of n...

My fundamental approach is to first explore the most concrete understanding of any clinical phenomenon. Only after this consideration of the concrete do I go on to consider metaphoric or symbolic meanings. I assume there are specific facts to be discovered about our patients and that those facts are significant in the patient's psychology. With patients experiencing panic attacks, a detailed interview may reveal a life situation in which the patient should be afraid but does not connect the danger with the symptom. With dreams, this approach endorses a combined intersubjective and objective approach, searching for how a dream may depict a real problematic situation for the dreamer that is being dissociated. Finally, disagreeing with Greenberg and Mitchell that combined drive-relational models do not work, I propose a model of multiple drives that can each be connected with different self-states.

In The Mindbrain and Dreams: An Exploration of Dreaming, Thinking, and Artistic Creation, Mark J. Blechner argues that the mind and brain should be understood as a single unit – the – which manipulates our raw perceptions of the world and reshapes that world through dreams, thoughts, and artistic creation. This book explores how dreams are key to understanding mental processes, and how working with dreams clinically with individuals and groups provides an essential route towards achieving transformation within the psychoanalytic process. Covering such key topics as knowledge, emotion, metaphor, and memory, this book sets out a radical new agenda for understanding the importance of dreams in human thought and their clinical importance in psychoanalysis. Blechner builds on his previous work and takes it much further, drawing on the latest neuroscientific findings to set out a new way of how the mindbrain constructs reality, while providing guidance on how best to help people understand their dreams. The Mindbrain and Dreams: An Exploration of Dreaming, Thinking, and Artistic Creation will appeal to psychologists, psychoanalysts, philosophers, and cognitive neuroscientists who want new ways to explore how people think and understand the world.

Panic attacks are a major mental health problem in the United States. Patients with panic attacks use up a lot of time in medical practices and emergency rooms, when they show up repeatedly, thinking they are having a heart attack or a stroke or some other medical crisis. Milrod and her colleagues have studied a traditional psychoanalytic approach to panic disorder. They have written a manual of what they call "Panic-Focused Psychodynamic Psychotherapy" and have received large grants from the government to study their approach. The dissociation between ideas and affects brings up an interesting connection between panic attacks and obsessional neurosis. The chapter presents the case study of three panic patients. It summarizes some of the generalizations that have been made about panic patients and then evaluates them in terms of therapist's own clinical data. The chapter suggests some ways in which therapists might revise their theory of panic attacks and test out a newly formulated theory.

Muriel Dimen showed us how disgust and delight live around the corner from each other. Disgust is a central affect that powerfully determines human behavior, often unconsciously. Politicians have evoked the power of disgust to unite people irrationally against a purported common enemy. Disgust for bitter and sour taste is inborn. Disgust with excreta is acquired by acculturation. Many forms of disgust are overcome and transformed by sexual desire during puberty. Psychotherapists need to monitor their own disgust reactions and differentiate between their reactions of disgust and erotic fascination as well as those of their patients.

Disgust is one of the primal emotions described by Darwin and strongly influences human motivation, behavior, and psychopathology. Disgust has sensory aspects, but when combined with certain cognitions it can take on moral implications. Although the biological source of disgust is protection from harmful substances, it can be manipulated to achieve political ends. Disgust combined with lust can sometimes lead to heightened sexual excitement. Disgust reactions may also be a defensive denial of our hidden desires. Psychotherapists must be careful to distinguish their own disgust reactions from the patient's lovemap. In couples therapy, disgust reactions and mutual shaming processes can be clarified and restructured.

Psychoanalysts were once thought to be experts on sexual issues, but that is less true today. The rift between psychoanalysis and scientific sexology that occurred in the mid-20th century may be partly responsible. In this article, I suggest ways this situation can be remedied. Psychoanalysts can best become more literate about variant forms of sexuality by reading first-person accounts and by garnering information from empirical research and Internet sites for specific forms of sexuality. In addition, psychoanalysts need to examine their own attitudes to different forms of sexuality, make sure they learn a patient's goals in treatment, be honest and open about whether they can help achieve those goals, and pay attention to the difference between psychopathology and societal pathology. In addition, the analyst needs to be aware of how sexual excitement can unconsciously bind erotic experience with other complex emotions and motivations. A case of coercive voyeurism is presented to illustrate these principles.

The term bigender is proposed to describe people who combine male and female gender identities. Bigenderism is to be distinguished from bisexuality whose meaning would be limited to sexual attraction to both sexes. This change in terminology allows for more precise theory and clinical formulations, since some cases of bigenderism have been mistakenly identified as transgender. The relationship between gender identity and sexual orientation is discussed in the classification schemes of Kinsey, F. Klein, and Krafft-Ebing, and in some cases described by contemporary clinicians. Irrational ideas about bisexuality and bigender, and the way they inform understanding of transference and countertransference, are identified and analyzed.

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsMark J. BlechnerMark J. Blechner, Ph.D., is editor emeritus of Contemporary Psychoanalysis. He has published three books: Hope and Mortality (1997), The Dream Frontier (2001) and Sex Changes: Transformations in Society and Psychoanalysis (2009). At the William Alanson White Institute, he is training and supervising psychoanalyst. As founder and director of the White Institute's HIV Clinical Service (1991–2001), Dr. Blechner led the first psychoanalytic clinic devoted to working with people with AIDS, their relatives, and caregivers.

The official condemnation of all sexual contact between psychotherapists and patients can be called the “absolutist position.” Some therapists harbor private views that differ from the absolutist position, such as the view that such relations may be more acceptable if they lead to a happy marriage, the “relativist position” or the “empathic-sentimental” position. A few clinicians have condoned such relationships, claiming that they are helpful to patients at least half the time, which is not supported by research. Mending the disconnection among public, private, and unconscious views may lead to more consistent and fair handling of sexual boundary violations.

Click to increase image sizeClick to decrease image sizeKeywords: dreamspsychoanalysisrebusvectorssymbolstertiary revision Additional informationNotes on contributorsMark J. BlechnerMark J. Blechner, Ph.D., is training and supervising analyst at the William Alanson White Institute and editor emeritus of Contemporary Psychoanalysis.