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In searching for an operational definition of aggression, five different aspects of the concept of aggression are described: aggression as an instinct, as a behavior pattern, as an emotion, as a trait of character and as a defense. Discussion of the role of aggression is made very difficult because there still exist a great many unsolved fundamental problems in quantifying each aspect of the concept. Behaviorists and psychophysiologists have made important contributions toward solving the problem of quantification. The meaning of aggression for psychosomatic disorders has been intensively studied by psychoanalysts. The psychoanalytic model poses two hypotheses which are subject to critical consideration, namely: 1) the therapeutic meaning of the abreaction of repressed and suppressed strangulated affects [1] and 2) the pensée opératoire [2]. Psychotherapeutic practice is often disappointing in providing answers, but we can look for clarification by studying the specific meaning of patient-doctor relationships in which aggression as an emotion in interaction plays a leading role. In many cases the onset of the somatic symptom may be iatrogenic; the course and recovery may also be dependent on this or analogous relationships.

(1974). The Drive to Become Both Sexes. The Psychoanalytic Quarterly: Vol. 43, No. 3, pp. 349-426.

Social and behavioral scientists, including psychotherapists, have become increasingly aware of themselves and the necessity to study and define themselves as "objects" of scientific investigation. As students and specialists in understanding human intrapsychic and interpersonal systems, psychotherapists have developed increasing interest in aspects of self and personality which go beyond transference in effecting the therapeutic process and outcome. It is difficult to accurately define such everyday concepts as personality and self. Lasswell stated, "The frequency of occurrence of an act on comparable occasions in the career line of a person is a trait of the personality." Webster defines personality as (1) a quality or state of being personal or of being a person and not a thing or abstraction; (2) that which makes a being a person; personal existence or identity; (3) that which constitutes distinction of a person; distinctive personal character; individuality; (9) philosophically: the mode of being of the soul when joined to the body; (10) psychologically: (a) the totality of an individual's characteristics, especially as they concern his relations to other people; (b) an integrated group of emotional trends, interests, behavior tendencies, etc. At times the concept of personality is used synonomously with the concept of character. For example, "that man shows himself alternatingly as two different characters or personalities." So personality is not considered to be a mood or fleeting emotion, although a person might be described as having or being a "moody character" or "personality." There is no doubt in my mind as to the importance of the therapist's personality in the therapeutic process for individuals, couples, and groups. For us to speak of the personality structure of the group therapist we must be aware when we use this concept that what is reflected in personality are cultural mores and traits, drives, needs, desires, values, anxiety, controls, inherited familial biology and transmitted myths, conditioning, social conformity and rebellion, super-ego, conscience, idealized image, adaptive functions, awareness of context or situation, capacity for reality testing, and of course residual elements of unconscious multi-transferences. All these are in operation simultaneously and the past in the present is reflected as transferential phenomena. Much waste of patient and therapist time, money, and potential occurred in the evolution of modern, dynamic, psychoanalytically oriented psychotherapy when so many therapists dehumanized, mechanized, and masked themselves and their personalities in a misguided attempt to be perfectly scientific and perfectly objective with their patients. Because of the trend at that time they could not clearly see that the detachment and silence of the therapist was experienced as abandonment, cruelty, and not caring. Such

SYSNOPSISA comparison is made between two forms of treatment for patients with interpersonal difficulties—one, an established treatment in the form of brief psychotherapy, and the other, social skills training, a form of behaviour modification designed to provide or improve the social skills necessary for successful social interaction. In a pilot study using social skills training, six out of seven patients showed marked clinical and social improvement. In the controlled trial, there was evidence that both types of treatment improved behaviour, but that social skills training tended to maintain its effect for longer, even though psychotherapy patients had more than twice the number of therapy hours.

Psychotherapeutic interventions are metaphorical treatments that stand in the same sort of relation to medical treatments as criticizing and editing television programs stand to repairing televisio...

This paper deals with the peculiar characteristics of the negative therapeutic reaction shown by a patient. As long as envy was interpreted as the cause of this reaction, analysis did not progress....

This article presents a parsimonious statement of essential conditions for psychotherapeutic change: (a) a helping relationship patterned after the parent-child relationship; (b) the creation of a pow

(1974). Fantasy and Identification in Empathy. The Psychoanalytic Quarterly: Vol. 43, No. 1, pp. 26-50.

(1974). Psychotherapeutic Assistance to a Blind Boy with Limited Intelligence. The Psychoanalytic Study of the Child: Vol. 29, No. 1, pp. 277-300.

Systematic assessment of 12 ego functions in 25 schizophrenics, 25 neurotics, and 25 normals was carried out in a 5-year research project. In the present article this ego function assessment is applied to the study of a single patient in psychoanalytic psychotherapy. Utilizing the intensive design t

The author has for some time been involved in a series of epidemiological studies which attempt to determine the possible association between certain simple and easily definable characteristics of the early family environment and adult mental illness. The areas of primary concern have been sibship size and birth order and early bereavement. A historical review of these areas of study provided reasonable grounds for anticipating that carefully designed comparative studies of psychiatric patient and control samples might prove rewarding. Such has not been the case and it is argued that failure to discover consistent trends in such studies is due to the restrictions imposed by the epidemiological method. The appeal of the factors selected for study is the ease with which they may be expressed in numerical terms and therefore their suitability for statistical analysis and the more conventional tests of significance. It is proposed that the resemblance of epidemiology to the natural sciences has contributed to the extensive adoption of this type of strategy in psychiatric research. A number of writers have suggested however that such an approach tends to treat human beings as though they were objects and ignores the important ways in which people and objects differ. There would appear to be considerable debate as to whether the more subjective aspects of man, which contribute to the significance of interpersonal relationships, are amenable to scientific investigation. The problem is further complicated by the failure of scientists to acknowledge that it will never be possible to evolve a science of man which has the numerical exactness of the natural sciences. Comparisons of the findings of the epidemiological analyses of family factors and more intensive single case studies indicate that the important causal connections between the early environment and adult mental illness are not detected by the crude statistical approach. In a search for possible alternatives to the epidemiological approach the contributions of psychoanalysis, family research methodology, ethology, social psychology, sociology and fiction are examined. It is concluded that at the present stage of research into families greater stress should be laid upon the verbal descriptive type of study and the researcher should beware of the temptation to seek false security in presenting his findings in numerical terms.

The great triumphs of 19th century scientific medicine in the fields of morbid anatomy, microbiology and biochemistry resulted also in a narrowly organic orientation which fostered increasing specialization and a neglect of the psychological aspects of medicine. Freud, Pavlov and Cannon paved the way for the introduction of the psychosomatic approach to medical practice and research. Their methods and theories offered potential tools for the measurement of emotions and access to repressed, unconscious, psychological content. The psychosomatic movement which started in Germany and Austria was further elaborated through the psychosomatic research of American psychiatrists and particularly psychoanalysts, with psychologists increasingly entering the field. Gradually, interest in the psychodynamics and psychoanalytic treatment of patients with psychosomatic disorders yielded to a growing exploration of the place of environmental stress, consultation psychiatry and pharmacotherapy in psychosomatic disorders. As laboratory studies have burgeoned, occasional rifts have occurred between those in basic psychosomatic research and those in applied psychosomatic medicine. The numerous conceptual models of mind-body relationships in general and psychosomatic diseases in particular are summarized and discussed. While uncertainty abounds and initial hopes of finding an exclusive psychogenic explanation for puzzling diseases and methods of treating them easily by psychotherapy have not materialized, the psychosomatic approach has nonetheless had a profound impact on medicine.

Many of the legislative proposals for national health insurance fail to include or severely limit coverage of psychiatric services. The author advances a number of arguments for covering these services, including psychoanalysis, and makes suggestions aimed at a more equitable distribution of psychiatric care under national health insurance.

This paper describes the etiology, dynamics and therapy of a case of somnambulism in an eleven-year-old child who underwent a trauma following the injury of his father in an Israeli security operat...

(1974). Contributions to Child Analysis. The Psychoanalytic Study of the Child: Vol. 29, No. 1, pp. 13-20.

Self-report questionnaires of rated in-therapy behaviors, demographic characteristics, and theoretical ascriptions were analyzed for 86 therapists (47 males and 39 females) with diverse backgrounds and experience levels. “Style” factors obtained for this sample were compared with those from a previous sample of predominantly male therapists. The results indicated: a) a relatively consistent set of style factors relating to self-reported in-therapy behaviors emerging from the two therapist samples; b) significant style differences between male and female therapists—women therapists report themselves to be more varying in their therapy behavior, less “anonymous” in therapy, and more judgmental; c) experienced therapists are more oriented toward historical material, show more varied in-therapy behavior, and place more emphasis on feelings than inexperienced therapists; and d) the theoretical orientation of the therapist is related to differences in self-reported in-therapy behaviors, along somewhat stereotyped lines. In addition, co-therapists in the sample described the in-therapy behavior of each other. Using this procedure, evidence was obtained for the generalizability of self-reported to other-described in-therapy behaviors.

American psychiatry has tended to divide into two camps—one seeking to understand persons as bodies, and the other seeking to understand them in terms of a mechanistic mental life. Both these approaches, while rewarding in certain respects, fail in the quest of understanding persons as persons. Since psychiatry is rooted in this type of understanding, it is unfortunate that the division within its ranks should be along lines which confuse the major issue of psychiatry and obstruct the development of a systematic understanding of persons which is the major task of psychiatry.

(1974). Current Status of the Concept of Infantile Neurosis. The Psychoanalytic Study of the Child: Vol. 29, No. 1, pp. 183-188.

This paper describes the results of a clinical trial of a new method, intensive group therapy, devised explicitly to incorporate the principal advantages of three traditionally separate techniques: the intensive five-day-a-week format of psychoanalysis; the real-life quality of group therapy, which promotes social-interaction analysis and modification; and the punishment/reinforcement techniques of behavior therapy. The eight patients treated in the group all had had extensive but largely unsuccessful therapy; during the first 18 months of intensive group therapy seven of the eight made appreciable therapeutic gains.

An attempt is made to describe the supervisory process from the point of view of the supervisee. The supervisory process is divided into four main stages: (1) A relationship of teacher and pupil; (...

An effective treatment program involves measures for correction of both the malnutrition and the psychological disturbance in patients with anorexia nervosa. A novel approach to re-feeding, using motivational incentives in a controlled hospital setting, has been useful in the restoration of weight. The difficulty in maintenance of desirable weight after leaving hospital might be related to continuing disturbances in family relationships and to perceptual distortions. Treatment to prevent recurrence of symptoms should involve efforts to improve family communications and relationships, and correcting the patient's faulty perceptions. Both the disturbance in recognition of satiety and overestimation of the width of her trunk are reflected in limitation in caloric intake and relentless pursuit of thinness. Attention to correcting these perceptual disturbances might allow the patient to realize an accurate and acceptable sense of self, and to tolerate fears involving physical and psychological aspects of sexual maturation.

The records of 45 patients identified as blue-collar workers were examined as part of a larger study of patients treated at the Columbia Psychoanalytic Clinic. A sizable number of the blue-collar patients were rated as having benefited from dynamic psychotherapy, although the proportion rated as improved was smaller than among the other patients in the study. Sociological and psychological stereotypes were not helpful in identifying patients who improved. Therapists who were rated highly for their clinical skills were more often successful with these patients; they were able to deal with differences in class, color, and religion as these differences emerged in defenses and resistance.

In recent years dire predictions have been made about the future and futility of psychoanalysis. This has been disturbing to one who has spent years learning the discipline of psychoanalysis, enjoying its practice, and witnessing its fertility. After all that time and effort, was one going to be thrust out of one's place in society, one's contribution flushed away as waste, even regarded as another pollutant? Was society going to disregard good efforts much as patients often note their failures more than their achievements? When one is confronted with such questions and spectres looming on the horizon, there are three possibilities at the onset: (1) run into a corner to hole in and hold out; (2) jump on the very next bandwagon hell-bent for anywhere; (3) or confront the issues and try to know the nature of what one is dealing with before taking any action. The first possibility elicits fear, and the second points to ultimate impoverishment and destruction in the power struggles that take place there. The third evokes hope. Therefore, when confronted with the cries of "Down with psychoanalysis" that had begun to be heard (but may already be lessening), I had to raise the question of the nature of the problem. Why is what had been of such obvious importance to twentieth-century society now in a worse position than a defeated candidate after an election? At least the defeated one is just forgotten; in the case of psychoanalysis, people were staying around to knock it. The similarity between the incipient fate of psychoanalysis and that of religion and monarchies is striking. What were the interdigitating dynamics of the rise and fall of societal leaders? What do people do with and for fallen leaders? What makes for a loss or shift of leadership from the leader to the former followers? I formulated the question: psychoanalysis and society-which leads, which follows? In trying to answer that question, one can focus on some of the reasons for the alternating rise and fall, that is, the psychodynamics of leadership in the specific example of society and psychoanalysis. Society is here defined broadly as a collective or a group of people at a certain time in history. Society is the matrix in which psychoanalysis developed and from which it then either stepped or was thrust forth as that part to guide the progress and satisfy needs of the group, the part now leading the whole. Later, for whatever reasons, psychoanalysis became a fallen leader. What accounted for the loss of leadership? Another observation has led me to a further question. Psychoanalysis has been singled out for particular criticism by those active in the current wave of the feminist movement. This criticism and what followed in its wake are extremely interesting and important to the question of the nature and dynamics of leadership.

Graphing is an innovative technique in which a line diagram correlates external stimuli, feelings, and behavior in a time sequence for the patient and therapist. Graphs are indicated when the patient has difficulty forming a therapeutic alliance. The graph technique is an adjunct to psychotherapy rather than a total treatment approach.