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This panel explored the question of what new types of psychopathology analysts are seeing and how they are responding to these changes, and concluded with a thoughtful reflection on how these changes deepen our understanding of psychoanalysis itself.
The presentation began with an eloquent and evocative description by Elias Barros of a new kind of reaction analysts can have to their patients. Based on his experiences supervising analysts in many settings, Barros noted the powerful cultural forces at play not only on patients, but also on analysts, which push for rapid symptom reduction, efficient and focal treatment, and an emphasis on behavioral results at the expense of deepened experience. Drawing from the psychoanalytic literature on individuals' response to narcissistic culture, he reminded the audience of our patients' all too frequent complaint about the emptiness of life, and the loss of deep intimate relationships in a two-dimensional world. Referring to the classic work Flatlandia, he analogized the analyst's experience to the feeling of being three-dimensional in a two-dimensional world. The treatment of sexual disorders with sildenafil citrate (Viagra®) may be the apotheosis of this approach—successful in terms of symptoms, but potentially robbing the individual of the potential intimacy gained through an understanding and working through of the conflicts involved in sexual dysfunction.
Barros elucidated the concept of preformed countertransference—derived from Meltzer's (1967, 2000) term preformed transference—as a way of conceptualizing the analyst's response to this dilemma. The preformed countertransference he is concerned about is an unconscious outlook on the patient's problem which prevents the usual analytic attitude from developing. This occurs because of narcissistic fears of loss of ability and effectiveness, and because of the isolation analysts can feel when they are separated from the dominant culture's attitude about the mind and its afflict