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The integration of non‐verbal, creative/implicit processes into ongoing psychoanalytic treatment as a highly effective modality to process trauma, also understood as Mentalization as a core element in the correction of pathological thinking caused by trauma (Allen et al., 2008. Mentalizing in clinical practice. Arlington, VA: American Psychiatric Publication) will be presented. This clinical approach is designed to gain access to deeper unconscious, implicit, pre‐verbal memories and material that may have been otherwise inaccessible for clinical processing on a purely verbal level. The author will offer an ongoing case study of a client who was initially resistant to direct verbal processing of traumatic memories. He will then demonstrate how the communication of implicit stimuli, in the form of photographs and drawings, can be structured as the primary initial communication of non‐verbal material within this treatment. Images were presented by the patient at the beginning of each virtual session, allowed her to access traumatic material without triggering overwhelming anxiety allowing adequate affect regulation and enabling successful clinical processing of this previously inaccessible material. The author offers, from both a neurological and psychoanalytic perspective, demonstrations of clinical processing and intervention techniques that have, up until now, been utilized within the clinical fields of creative art therapy and psychoanalysis on an intuitive level without having a firmer foundation in demonstrable neuroscience. It is the intended purpose of this article to bridge this gap between previous intuitive interventions and neuroscientific research, within our clinical work. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Humanistic Perspective is the property of Fuat Aydogdu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This manuscript presents data on how counselors can use theoretical concepts derived from three major schools of psychoanalysis to understand and treat clients with a disability. We survey historical data on the three schools of psychoanalysis (classical, ego psychology, and self-psychology), as well as detailed information on the founders and major contributors to these various schools of psychoanalysis. The data are presented not only to inform counselors about the three approaches to psychoanalysis, but also to help practitioners facilitate their clients' emotional health. In other words, the manuscript serves both an educational and clinical objective. [ABSTRACT FROM AUTHOR]

Through a sort of 'journey in time', this work aims to present a brief update on the latest developments on the subject of 'care of the subject' in psychoanalysis. In particular, the emphasis is placed on the therapeutic vision that characterized the early days of this discipline, which was essentially oriented in a single direction from the therapist to the patient, and on its shift to the current dominant perspective, which is different in that it is instead based on the concept of 'mutuality'. In this more recent view, the changes in the psychic structure of the patient over time derive from the changes that the patient has, mostly unknowingly, produced over time in the psychic structure of the therapist who has taken care of and is taking care of him/her. All this occurs on the basis of concepts and models that have only entered the sphere of interest of psychoanalysis in recent decades, for example, the 'Theory of Chaos' and the various systemic theories that have developed from Ludwig von Bertalanffy's 'General system Theory' to the most recent models of interpretation of 'complex nonlinear dynamical systems'. [ABSTRACT FROM AUTHOR]

This essay examines the combination of psychoanalytic therapy and psychedelic substances in mid-20th century Argentina. Through document analysis, it examines the intersection of psychedelics and psychoanalysis, drawing from historical texts and writings by local psychoanalysts to develop a comprehensive understanding of the distinctive clinical practices and therapeutic approaches in the Argentine context. It details the experimental use of these substances, the clinical practices developed, and the professional and societal challenges encountered. Notably, psychoanalysts Luisa de Álvarez de Toledo, Alberto Tallaferro, and Alberto Fontana conducted pioneering research, exploring the therapeutic potential of these substances and publishing their findings in academic papers and books. According to these psychoanalysts, the use of psychedelic drugs in therapy could enhance transference, catalyze catharsis, and circumvent unconscious defenses, allowing for a vivid exploration of the patient's psyche that necessitated interpretation. Despite the innovative nature of this work, resistance from within the Argentine Psychoanalytic Association led to the eventual cessation of psychedelic research in this country. The essay calls for a reconsideration of the psychoanalytic community's relationship with psychedelics, emphasizing the potential for renewed dialogue and incorporation of these substances in contemporary therapeutic practices. In conclusion, this article sheds light on an overlooked chapter of psychoanalysis in a local setting and serves as a call for future explorations in broader scenarios. The resurgence of interest in psychedelics for mental health treatment presents an opportunity for psychoanalysts to engage with emerging research, enriching both theory and practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This reflection problematizes the notion and practice of the psychoanalytic conference, a genre that, while useful, also embodies deadness. By first reminding what is at stake in conferences as usually staged-readings of texts-the reflection is focused on what is at stake in the prospect of psychoanalytic conferences that function psychoanalytically. Using an event he helped imagine and execute as both a matrix of thinking and a source of examples, the author examines the challenges and potentials of new forms of participation, co-existence, and exchange in the psychoanalytic field.

This contribution examines the position of expert knowledge in the institutional context of an American preschool and a consulting psychoanalyst's refusal to join in its unquestioned dynamic. It interrogates the shift, both theoretical and clinical, occurring if and when the authority of knowledge is supplanted by attention to transference. By arguing that a classroom is the space for the psychoanalytic act and by making a distinction between what it means to be useful rather than right, the author opens a perspective for psychoanalysis in extension that the cared-for children may welcome more than the caring adults.

This paper explores experiences of surrender to an aspect of mind that is unconfined, empty of dualistic concepts, and lucidly aware. Ghent's concept of surrender, Farber's unconscious will, and Buddhist philosophers' essence of mind all link to creative processes described by Poincaré and Mozart. This impressionistic collage points to the spaciousness to know beyond our usual stories. From this essential mind more wholesome actions proceed., (© 2024. Association for the Advancement of Psychoanalysis.)

The author presents a long analysis of a patient, Giulia, whose obstinate will to achieve evokes the workings of alchemical sulphur at its fieriest and a dread of its coniunctio with alchemical salt. Jung's description of these symbols in Mysterium Coniunctionis offers a useful imaginal perspective to clinical work in the area of compulsion and its possible transformations. Right from the start, the analytic relationship appeared to be mirrored and affected by this alchemical perspective. However, it was only after much time, uncertainty and emotional endurance that a fuller psychological experience of sulphur and salt could be accessed, allowing the analysis to take a more imaginative and mercurial turn. In the course of his work with Giulia the author has witnessed and experienced a range of intense affects-the many colours that the combustion of sulphur can generate-whether on the verge of unstoppable creation or ruthless destruction, often of archetypal intensity. This experience has been lived through and has undergone a transformative relation with salt, which until then had lived a dissociated existence in the fixed trauma of the compulsion and in a nocturnal underworld of tears., (© 2024 The Society of Analytical Psychology.)

In this paper I propose a model of the fundamental components of psychoanalytic psychotherapies that I try to explicate with contemporary theories of the Bayesian brain and the Free Energy Principle (FEP). I first show that psychoanalytic therapies require a setting (made up of several envelopes), a particular psychic state and specific processes (transference, free association, dreaming, play, reflexivity and narrativity) in order to induce psychic transformations. I then analyze how these processes of transformations operate and how they can be enlightened by the FEP. I first underline the fact that psychoanalytic therapies imply non-linear processes taking time to unfold and require a setting containing high entropy processes. More precisely, these processes are characterized by an interplay between extension and reduction of free energy. This interplay also favors the emergence of new orders of subjective experience, which occur following states of disorder, according to a certain energetic threshold allowing the modification and improvement of mental functioning. These high entropy states are also characterized by random functioning and psychic malleability which favors the exploration of subjective experience in an original manner. Overall, the approach proposed in this paper support the dialogue between psychoanalysis and other fields of research while underlining how psychoanalytical theoretical and conceptual constructs can also be useful to other disciplines, in particular the neurosciences of subjectivity. [ABSTRACT FROM AUTHOR]

Psychoanalysis has an image problem. The dominant narrative in the mental health professions and in society is that psychoanalysis is outmoded, discredited, and debunked. What most people know of it are pejorative stereotypes and caricatures dating to the horse and buggy era. The stereotypes are fueled by misinformation from external sources, including managed care companies and proponents of other therapies, who often treat psychoanalysis as a foil and whipping boy. But psychoanalysis also bears responsibility. Historically, psychoanalytic communities have been insular and inward facing. People who might otherwise be receptive to psychoanalytic approaches encounter impenetrable jargon and confusing infighting between rival theoretical schools. This article provides an accessible, jargon free, nonpartizan introduction to psychoanalytic thinking and therapy for students, clinicians trained in other approaches, and the public. It may be helpful to psychoanalytic colleagues who struggle to communicate to others just what it is that we do. [ABSTRACT FROM AUTHOR]

In this paper I propose a model of the fundamental components of psychoanalytic psychotherapies that I try to explicate with contemporary theories of the Bayesian brain and the Free Energy Principle (FEP). I first show that psychoanalytic therapies require a setting (made up of several envelopes), a particular psychic state and specific processes (transference, free association, dreaming, play, reflexivity and narrativity) in order to induce psychic transformations. I then analyze how these processes of transformations operate and how they can be enlightened by the FEP. I first underline the fact that psychoanalytic therapies imply non-linear processes taking time to unfold and require a setting containing high entropy processes. More precisely, these processes are characterized by an interplay between extension and reduction of free energy. This interplay also favors the emergence of new orders of subjective experience, which occur following states of disorder, according to a certain energetic threshold allowing the modification and improvement of mental functioning. These high entropy states are also characterized by random functioning and psychic malleability which favors the exploration of subjective experience in an original manner. Overall, the approach proposed in this paper support the dialogue between psychoanalysis and other fields of research while underlining how psychoanalytical theoretical and conceptual constructs can also be useful to other disciplines, in particular the neurosciences of subjectivity.

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Previous research has shown that Balint groupis effective in the professional and personal development ofresidents. The aim of this study was to investigate the experienceof psychiatric residents about Balint groups.Methods: This is a qualitative study using a phenomenologicalapproach. Seven sessions of the Balint groups were held witha number of psychiatric residents at Mazandaran Universityof Medical Sciences. Two of the leaders were psychoanalyticpsychotherapist. Finally, eight in-depth semi-structuredinterviews and focused group interview were conducted. Datawere collected by tape recorded interviews. Data were analyzedusing MAXQDA-10 software.Results: Three main themes were obtained from the interviewsthat included “Early experiences”, “Touching the Balint group”and “Relationship with Balint group”. The category of “Earlyexperiences” included three categories of “defenseless”, “fire underthe ashes” and “deep feeling”. Touching the Balint group themeincluded categories such as “Empathetic”, “I am not the only one...”, “Releasing”, “Reading story”, “This patient”, and “Gettingcloser”. The relationship with Balint group theme included threecategories of “first of all”, “attachment” and “courage and time”.Conclusion: Based on the findings of this study, while someaspects of Balint group are stressful but ultimately improve theemotions and better understanding of the patient. This researchshows incorporating Balint group into the educational programand curriculum of psychiatric residents in Iran might be helpful,but more qualitative and quantitative research is necessary.

The paper further explores the development of psychotherapy in Polish psychiatry in the interwar period. Jaroszyński attempted to sketch out the idea of "emotional psychotherapy". Stryjeński organized a counseling clinic for the mentally ill, using psychotherapy as one of the means of treatment. Bilikiewicz developed oneiroanalysis - a psychotherapeutic method of dream analysis based on modifications of psychoanalysis. Gottliebowa advocated for the use of psychoanalytically influenced psychotherapy in the gynaecologist practice. Markuszewicz considered psychoanalysis the only psychotherapeutic modality aimed at unearthing the real causes of mental illnesses. Henryk Higier proposed to consider psychoanalysis practically as a method of psychotherapy and saw its heterogeneity as its advantage. Critical views on psychoanalysis as a psychotherapeutic method were delivered by Wirszubski and Mikulski. In general, psychotherapy in Polish psychiatry of the interwar period was highly influenced by psychoanalysis. Moreover, the understanding and practice of psychotherapy in public psychiatric facilities differed from that in private practice. In public psychiatric facilities, it was used mainly to deal with psychoses, so it urged clinicians to modify the classic psychoanalytic approach. In private practice, psychiatrists were dealing mainly with cases of neuroses and therefore could apply standard psychoanalytic procedures. Methods of suggestion, persuasion and hypnosis, characteristic of nineteenth-century psychotherapy, were still in use in Polish psychiatry of the interwar period. The main obstacles to the development of Polish psychotherapy in the interwar period were antisemitic attitudes contributing to hostility towards psychoanalysis, as well as the biological orientation of the majority of the Polish psychiatric society.

This paper explores the mechanisms that lead to a destructive tendency in the formation and functioning of the psychic apparatus, to the characteristic states of subjects who are drawn to non-life. The dynamics of the primary mother-child relationship involve a structural interaction between mind and body, subject and object. The dialectic between the life drive and the death drive is conceptualized as the structuring of homeostatic dynamic equilibria, in which both drives belong to the living, provided they are kept in a non-isolated system. This conception has analogies with other disciplines that have changed their paradigms, such as neurobiology, which, for living beings in open systems, hypothesises a continuous interconnected Becoming of undivided separation and of discontinuity. In unitary psyche-soma functioning, a dynamic homoeostatic balance marks the state of health of the relating subject; or if, instead, the system is isolated, a pathological dysregulation depending on the emotional-affective vicissitudes it undergoes. Two clinical cases illustrate these dynamics. For this tendency on the level of the somatopsychic unit, the name alloiosis has been put forward, in analogy with cellular apoptosis.

The author elaborates some of the fantasies and defenses that protect some patients in their oedipal fixations, particularly those related to forms of personal isolation. To some extent, cover-up is intrinsic to oedipal conflict and fantasy, but what is covered up is quite variable. In this paper, the author highlights elements of personal isolation that the patient cultivates in order to protect love for a desired oedipal parent and the conscious and unconscious fantasies associated with this love. The patients described here use forms of personal isolation to cover up and secure the gratification of oedipal fantasies. Their isolation also serves to protect them from fantasies of unique forms of destructiveness in relation to self and the desired other. The citadel, a concept from Guntrip's description of defenses protecting the schizoid patient's fear of destructive love, is characterized here for the neurotic patient as virtual because in some ways, each of the participants in oedipal conflict turn a "blind eye" to a staged cover-up. Clinical illustrations examine the transference-countertransference process of shifts from turning a blind eye to sustaining a process of seeing what is being covered up but has already been seen.

Through the literary explorations and poetry of Alice Oswald, and through analysis of detailed clinical material from a Kleinian perspective, the authors expand the bounds of reverie as it is usually construed in psychoanalytic consulting rooms. The authors draw attention to the presence of a relationship to the more-than-human world as an integral aspect of our internal experience, and to the value of consideration of the quality and dynamic meaning of connections to the natural world in ordinary analytic work. The relationship to the primary object heavily influences the form taken by the relationship to the natural world, but once established, this connection has the possibility for a life of its own, that can provide a different kind of containment than the human variety, allow experimentation with new ways of being, and can strengthen the ego. The authors address the clinical implications of listening enhanced by an ear for affiliation to the natural world.

The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability Abstract: Objective: The OPD-CA2 manual for assessing psychodynamic aspects in children and adolescents is well established in clinical practice. However, publications regarding its reliability and validity are limited to (1) adolescents, (2) the structure of the first version of the manual and not to the comprehensive revision of the OPD-CA2, (3) the axes "structure" and (partly) "conflict" but not the axis "relationship," and (4) missing applicability in everyday clinical practice. Methodology: The present study comprised 42 children aged 6-12 years (age level 2 of the OPD-CA2), with and without mental illness, and assessed them using two randomly assigned raters. We assessed them using a low-structured diagnostic symbol game with miniature figurines and objects based on videotapes. We also tested the interrater reliability of the OPD-CA2 axes. Results: The overall assessment of structure and the assessment of the four subdimensions succeeded with good to very good agreement. We could also determine the presence of relevant conflict dynamics with very high agreement, while not recognizing specific conflicts in the clinical sample. Our assessment of the items of the relationship axis shows a low level of agreement. Conclusions: Overall, we can confirm the reliability of the OPD-CA2 for everyday clinical assessment in the younger age groups. Finally, we discuss which factors contribute to the heterogeneous picture.

"Free association" and the "fundamental rule" are bedrock for psychoanalytic therapy and apply to what both patient and analyst should experience in the process. The article traces Sigmund Freud's revolutionary recognition of the importance of free association that began with his tribute to the works of Ludwig Börne and Friedrich Schiller. The author invokes other proposals akin to free association made by artists and scientists, including John Keats, Charles Dickens, Robert Frost, Thomas S. Kuhn, Arthur Koestler, and Albert Einstein. While emphasizing the importance and the liberatory potential of free association as it relates to effective treatment and discovery, the author contends that there is a "moral press" for both the patient and the analyst to permit free associative thoughts, particularly to question assumptions about how things are supposed to be.

Psychoanalysis is often viewed as a practice relevant only to educated people of means. This article describes a project that matches psychoanalytically trained clinicians with unhoused and formerly unhoused adults in a large urban community. D. W. Winnicott's ideas about impingement, the holding environment, fear of breakdown, and careful monitoring of the analyst's interiority have proven to be most valuable theoretical and clinical tools. A decade-long case example demonstrates the challenges and healing potentials of the work.

Groups of Jungian analysts, which included the present authors, met to discuss four key theoretical concepts, each of which was felt to have problematic aspects if used unquestioningly in contemporary practice. The concepts were: The Primitive, Inner and Outer Worlds, Contrasexuality and Participation Mystique. The discussions were informed by clinical material and specific papers chosen for their critical evaluation of the topic. Four recorded transcripts were made, with permission, for further consideration of the relationship between contemporary Jungian theory and practice using the research method of thematic analysis. Three main themes were identified: Work of Analysis, Frames of Reference and Power Dynamics. The authors discuss the themes in relation to the overarching theme of power, understood as operating at conscious and unconscious levels. The artwork "Cold Dark Matter: An Exploded View" by Cornelia Parker is used as a metaphor in discussing the dynamic of challenging foundational concepts. The authors suggest that power dynamics are intrinsic in both the difficulty and the benefits of critically evaluating key concepts, binding together the theoretical (what informs us) with the clinical (what we do in the consulting room) as well as blowing apart pre-conceived notions of what underpins the analyst's work., (© 2024 The Society of Analytical Psychology.)

Through the personal reflection on chronic pain, the author engages the question of how clinicians and their patients manage various forms of loss within the clinical encounter. The notion of developmental grief is introduced as a stepping-stone from phallicism to genitality, whereby the capacity to grieve and thus tolerate limitedness enables growth. Hannah Arendt's concept of natality is offered as a hopeful corrective to the resistance to accepting limitations.

While Jung's notion of archetypes has had far-reaching universal appeal and significance, it remains less obvious how these ideas might benefit the analytic patient. In particular, the therapist and/or patient may struggle to hold the tension between the latter's personal neuroses and how transpersonal/archetypal elements inform his/her experience. While Jung strove to develop a treatment that dealt primarily with the archetypal/objective psyche, the personal psyche is arguably the medium through which the archetypes are experienced. I contend that the "discipline" of Jungian analysis evolved from a transposition of Jung's ideas around transpersonal, philosophical and religious themes (borne out of his own self-analysis), into a two-person psychotherapeutic process. Jung provides little description of his clinical encounters and the way in which he conducted his analyses leaving an uncertainty that has likely contributed to the divergence of approaches practised today by analytical psychologists. This article considers the implication of these divergences for contemporary Jungian practice and proposes a way of working in the Jungian spirit that maintains a connection to the symbolic realm while at the same time remaining focused on the complexities of personal and relational dynamics., (© 2024 The Society of Analytical Psychology.)

Working therapeutically with and through embodiment is a topical issue in the psychoanalytic literature. Vice versa, body psychotherapy is deeply rooted in psychoanalytic theory and practice. This paper will explore corresponding themes, historic developments, and recent literature with reference to their actual and potential mutual influences, aiming to demonstrate: (1) that contemporary body psychotherapy practice continues to be informed and influenced by psychoanalytic theory, in particular the relational emphasis in psychoanalysis; and (2) that psychoanalytic psychotherapy, in turn, can be enriched and furthered while utilizing the theoretical paradigm of embodiment and body-oriented, experiential intervention strategies developed in body psychotherapy. [ABSTRACT FROM AUTHOR]

Burning mouth syndrome (BMS) is a painful disorder characterized by severe burning in the oral cavity in the absence of clinical signs. In this case-control study, 60 patients were allocated to 3 groups: patients with BMS, patients with benign changes in the oral cavity (anxiety [positive] control group), or healthy patients (negative control group). A visual analog scale (VAS), Beck Anxiety and Depression inventories, Lipp Stress Symptoms Inventory, Xerostomia Inventory-Dutch Version, and a BMS questionnaire were used. Statistical analyses (P< 0.05) were performed using the Kruskal-Wallis with Dunn post hoc, Pearson chi-square, Fisher exact, and multinomial logistic regression tests. Most of the patients were female. The BMS group had more patients who were older than 60 years (P = 0.008), more patients with high VAS scores (P < 0.001), and more patients with moderate or severe anxiety (P < 0.001) and depression (P < 0.001) than the 2 control groups. Patients in the BMS group also had higher rates of stress during the alarm (P = 0.003), resistance (P < 0.001), and exhaustion phases (P < 0.001). All patients with BMS reported burning and xerostomia, 90% reported a feeling of dry mouth, and 80% reported a change in taste; these values were significantly higher than those in the control groups (P < 0.001). Anxiety was independently associated with a 123.80 times greater risk of having BMS (P = 0.004). Psychological factors are directly associated with BMS, and anxiety is the most important of these factor. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapie im Alter is the property of Psychosozial-Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

José Bleger's paper on the setting ( encuadre ) is integral to his 1967 book Symbiosis and Ambiguity . Relevant concepts from the book are summarised before examining his view of the setting as a "non-process" consisting of "constants", complementing the "variables" of the analytic process. Process and setting are related as figure and ground in Gestalt psychology. The ideally maintained setting is studied as a thought experiment, uniting the categories of institution, personality, body schema, and body. Deposited in the setting, the psychotic part of the personality, or "agglutinated nucleus", is a remnant of early symbiosis with the mother. Bleger distinguishes two settings: the analyst's and the patient's. The latter can only be analysed by strictly maintaining the former. Ritualisation of the setting denies temporal reality. De-symbiotisation is not always possible. A concept of "internal" setting is suggested, but Bleger nowhere mentions this and the concept is problematic, leaving open the question of how to listen to the silence of the setting. Bleger's concept of encuadre can be applied to constants (invariants) in the wider world, the psychotic part of the personality being deposited in everything that is familiar and felt to be constant, including technology, which creates a "platform" for human activity.

Patients enter states that in their spontaneity and deep interiority have qualities of the revelatory. I propose we recognize such a state as a clinical event: The person is in a state of intense internal receiving of self. We might think of it as a state of internal communication happening as the person speaks. The person feels real to herself. Her relation to her mind in this revelatory moment is easily intruded on-even by ventures of play. When the state is gone, it is gone. I single out this clinical moment from moments that are cocreated and happening within an analytic third. I argue that in the revelatory moment, a patient builds capacities to be present for pain, desire-for raw experiences ordinarily difficult to access. The state makes a strict demand on the analyst. I see it as a moment of object usage-that is, it is a moment of risk with the analyst. This moment challenges and deepens our understanding of Winnicott's usage formulation.