Raffaello Cortina Editore

The author discusses some reflections arising from clinical work, on the subject of risk as a pathological potentiality or, on the contrary, as an opportunity for growth. She presents an evolutionary point of view in the evaluation of the patient that also takes into account risk indices and transformative possibilities, in consideration of environmental stimuli. She emphasises in conclusion the need not to move away from an ethical vision that privileges the need for patient care as the first objective that does not preclude, but rather favours the expansion of the patient’s mind and of the analytic couple at work.KEY WORDS: Developmental potential, ethics, psychotic potential, risk.

After preliminary remarks about the risks of merging with the mother for the infantile psyche, the author underlines the need to adapt the setting to reach the mother-child unit, and work toward stable transformations of internal and external reality. The case of Davide and his mother exemplifies some technical aspects and developmental moments of mother-infant psychotherapy, shedding light on the child’s role in the mother’s transformations. The clinical process shows the gradual creation of a ‘third space’, later occupied by the father with an increasingly active participation in the analytic process, and how this led to a further adaptation of the setting.KEY WORDS: Developmental risk, mother-child merging, mother-infant psychotherapy, setting adaptation, the father’s space.

In order to shed light on the complex form of contemporary analytical experience, in the present article I shall attempt to trace in parallel the evolution of theatre towards the composite form we know today – made of action, narration and intersubjective dialogue – and that of psychoanalysis which, starting from narration, has come to discover and include dramatic,  dialogic and action elements, all typical features of the theatrical form, finally achieving what is not possible in theatre: going beyond the predefined plot and creating a form of real life  on the analytical scene. This might allow us to glimpse intersubjective risk as peculiar to contemporary psychoanalysis.KEYWORDS: Chamber theatre, crazy dance, dialogue, evolutionary transference, intersubjective dialogue, intersubjective risk, peekaboo game, primary conversation, repetition transference, self-object transference.

The author follows the pathways of violence within the setting in a therapeutic situation underlying a constant, not better defined, state of alarm (of elimination?). She hypothesizes encystments of destructiveness in parts of the patient’s body as an attempt to avoid total suicide. She questions whether a sort of countertransferential «not understanding» of the  intensity of the violence might have contributed, more or less protectively, to the continuation of the therapeutic relationship, and to the staying alive of the relationship itself, as well as of the protagonists.KEY WORDS: Countertransferential «not understanding», body, destructiveness, psychosis, suicide.

The clinical vignettes show the risk for the analyst resonating with the severely ill patient to contract a similar illness. In one case, from within the patient-psychoanalyst relationship and in a moment of crisis, a series of communicative exchanges through bodies come to the fore: the anguished body of the patient and the aching body of the analyst. In the crisis of the relationship a health risk becomes apparent for both, patient and analyst. At the same time, both experience a new primary object in the transference: the jammed therapeutic process resumes with renewed impetus. Some theoretical considerations on non-verbal exchanges in the psychoanalytic relationship follow.KEY WORDS: Body language, psychoanalytic process, transference, transformations, unison.

It is proposed to differentiate suicide from suicide attempts (or even communications). On a dynamic level, the former represents the net loss of all investment in/on the Self, while the latter represents an extreme and powerful investment in it. Suicide attempts are not the search for death, but the attempt to adapt the body’s potentialities to the potentialities of the  Self. The body, therefore, is summoned to a buffer function of uncontainable anxieties on an affective or symbolic level. Finally, the containment of suicide attempts may be possible  through modifications of the setting that, in the logic of the Enactment Process, are transferentially solicited by the patient. The analyst modulates and cares for a setting in which the patient can trace specific elements that tell of his presence and that the analyst introduces as a concrete signal of his capacity for intimate listening.KEY WORDS: Body-buffer, deformed self, enactment, setting, suicide attempts.

Proven effective and widely practiced during the COVID-19 pandemic, online psychotherapy is today a fundamental tool in the toolbox of the psychoanalyst and the psychotherapist: to be studied in depth in its possible indications and counter-indications and to be included in the training programs of our training schools. Our thesis is that it does not represent a risk, but rather the stimulus to progress for our discipline.KEY WORDS: Online psychotherapy, online setting, risk.

In response to the request of Editor-in-Chief of the Rivista di Psicoanalisi, Lombardozzi, the author provides a comprehensive account of his professional journey spanning over forty years. Throughout this trajectory, he grappled with the tension between social intense needs that manifest as psychic suffering and the helping dimension within the prism of the  potential use of psychoanalysis. The repeated scientific verification of high efficacy coefficients of psychoanalytically-oriented supporting methods favoured their development and  expansion over time. In Baldini’s journey, the pivotal role played by the Italian Psychoanalytic Society is emphasised, as the Society actively engaged with public institutions and private  social organisations, universities, the cultural realm, journalism, and local and central administrations. Throughout the author’s account, the theme of risk looms large, intricately linked  to the concept of prevention. It emerges as the back drop, permeating every facet of institutional and personal helping professions.KEYWORDS: Applied psychoanalysis, institutions, prevention, private social life, risk, social.

Pensando alle nostre istituzioni: lasciti, transiti e depositi Partendo da un sogno che segnala la fine di un’esperienza istituzionale, l’autore riflette su alcuni passaggi della vita istituzionale psicoanalitica e sanitaria, sul lavoro psichico da compiere per diventare soggetto sociale. Centrale diventa pensare al valore della funzione istituzionale per la vita societaria, sulla necessità di osservare la dimensione interstiziale della comunità soprattutto in un periodo di virtualità dovuta all’esperienza del covid. Anche nelle istituzioni sanitarie si riproducono fenomeni simili. Lo sviluppo di piccoli gruppi di soci che coltivano interessi specifici costituisce un potente fattore di elaborazione e favorisce i transiti all’interno della vita istituzionale. Il piccolo gruppo, se ben inserito nella vita societaria, costituisce un’esperienza tra pari; rappresenta una risorsa intermediaria rispetto al tema della trasmissione tra generazioni di analisti per contrastare i fenomeni conformistici tipici delle famiglie analitiche a funzionamento endogamico. Parole chiave: Interstizio nelle istituzioni di cura, istituzione e funzioni intermediarie, piccolo gruppo,trasmissione generazionale nelle famiglie analitiche. Thinking about our institutions: bequests, transits and deposits. Starting from a dream that signals the end of an institutional experience, the author reflects on some passage of psychoanalitical and healthcare institutional life, on the psychic workbe done to become a social subject. It becomes central to think about the value of the institutional function for corporate life, on the need to observe the interstitial life of the community, especially in a period of virtuality due to the experience of the covid. Similar phenomena are also reproduced in health institutions. The development of small groups of members who cultivate specific interests is a powerful processing factor and promotes transits within institutional life. The small group, if well integrated into corporate life, constitutes an experience between equals; it represents an intermediary resource with respect to the issue of transmission between generations of analysts to counter the conformistic phenomena typical of analytic families with endogamous functioning. Key words: Institution and intermediary functions, generational transmission in analytic families, interstice in health care institutions, small group. En réfléchissant sur nos institutions: legs, transits et dépôts. Partant d’un rêve qui signale la fin d’une expérience institutionnelle, l’auteur réfléchit sur quelques passages de la vie institutionnelle psychanalytique et sanitaire, sur le travail psychique à accomplir pour devenir un sujet social. Il devient central de réfléchir sur la valeur de la fonction institutionnelle pour la vie sociétaire, d’observer la dimension interstitielle de la communauté surtout dans une période de virtualité due à l’expérience du Covid. Des phénomènes similaires se reproduisent également dans les institutions de santé. Le développement de petits groupes de membres qui cultivent des intérêts spécifiques constitue un puissant facteur d’élaboration et favorise les transitions au sein de la vie institutionnelle. Le petit groupe, s’il est bien intégré à la vie de la société, constitue une expérience entre égaux; il représente une ressource intermédiaire par rapport à la question de la transmission entre générations d’analystes, pour s’opposeraux phénomènes conformistes typiques des familles analytiques au fonctionnement endogame. Mots-clés: Interstice dans les institutions de santé, Institutions et institutions intermédiaires, petit groupe, transmission générationnelle dans les familles analytiques. Pensando en nuestras instituciones: legados, tránsitos y depósitos. A partir de un sueño que marca el final de una experiencia institucional, el autor reflexiona sobre algunos pasajes de la vida institucional psicoanalítica y asistencial y sobre el trabajo psíquico a realizar para convertirse en sujeto social. Se vuelve central pensar en el valor de la función institucional para la vida corporativa, en la necesidad de observar la dimensión intersticial de la comunidad especialmente en un período de virtualidad por la experiencia del covid. Fenómenos similares se reproducen también en las instituciones de salud. El desarrollo de pequeños grupos de miembros que cultivan intereses específicos constituye un poderoso factor de elaboración y favorece las transiciones dentro de la vida institucional. El pequeño grupo, bien integrado en la vida corporativa, constituye una experiencia entre iguales; representa un recurso intermediario respecto al tema de la transmisión entre generaciones de analistas para contrastar los fenómenos conformistas propios de las familias analíticas con funcionamiento endogámico. Palabras clave: Funciones de institución e intermediación,intersticio en instituciones de salud, pequeño grupo, transmisión generacional en familias analíticas. Nachdenken über unsere Institutionen: Nachlässe, Übergänge und Einlagerungen. Ausgehend von einem Traum, der das Ende einer institutionellen Erfahrung markiert, stellt der Verfasser Überlegungen zu einigen Übergängen des psychoanalytischen und gesundheitlichen institutionellen Lebens an, zur psychischen Arbeit, die zu leisten ist, um ein soziales Subjekt zu werden. Im Mittelpunkt steht das Nachdenken über den Wert der institutionellen Funktion für das gesellschaftliche Leben, über die Notwendigkeit, die interstitielle Dimension der Gemeinschaft zu berücksichtigen, insbesondere in einer Phase der der Covid-Erfahrung geschuldeten Virtualität. Auch in Einrichtungen des Gesundheitswesens finden sich ähnliche Phänomene. Die Entwicklung kleiner Gruppen von Mitgliedern, die spezifische Interessen pflegen, stellt einen wirkmächtigen Faktor der Ausarbeitung dar und fördert die Übergänge innerhalb des institutionellen Lebens. Die kleine Gruppe ist, wenn sie gut in das gesellschaftliche Leben integriert ist, eine Erfahrung unter gleichen; bezüglich des Themas der Übertragung zwischen Generationen von Analytikern ist sie eine intermediäre Ressource, die konformistischen Phänomenen entgegenwirkt, die für analytische Familien mit endogamer Funktionsweise typisch sind. Schlüsselwörter: Generationale Weitergabe in analytischen Familien, Institution und intermediäre Funktionen, kleine Gruppe, Zwischenraum in Pflegeeinrichtungen.

La difesa «esistenziale» del Sé nei confronti della propria caducità: pandemia e paura di morire L’autore prendendo spunto dall’impatto emotivo che la pandemia ha avuto nella stanza d’analisi effettua un breve excursus teorico sul tema dell’angoscia di morte e della capacità di tollerare la solitudine e analizza tali dinamiche mentali. Individua come una delle fisiologiche difese della mente dal senso di caducità sia una negazione, che viene definita «esistenziale», del senso della propria finitezza per poter fornire al Sé coesione e senso di permanenza nel tempo. Questa difesa esistenziale è sostenuta da un livello moderato di onnipotenza che si acquisisce con la maturità e al termine del percorso dell’analisi personale. Viene analizzato per questo il particolare assetto mentale necessario ad accompagnare il morente nel momento del trapasso. Assetto mentale necessario, all’analista in seduta, per tollerare le angosce di morte dei pazienti e le proprie. Parole chiave: Caducità, cure palliative, morte, negazione, pandemia. Existential defense» of the Self against one’s own transcience of life: the Pandemic and the fear of death. Inspired by the emotional impact the pandemic had in the psychoanalytic room, this paper presents a short theoretical excursus on the fear of death and the ability to deal with loneliness. The author characterizes a form of negation, defined here as «existential», as one of the physiological defenses put up by the human mind against the realization of the frailty of life. Thus, the refusal of one’s own transience anchors the Self in time, giving it a sense of permanence. This form of existential defense is sustained by a certain sense of omnipotence, acquired both with maturity and the end of the personal analytic journey. This peculiar state of mind is both necessary to guide the dying through the moment of passing and to help the analyst deal with the fear of death of their patients, as well as their own. Keywords: Caducity, Death, Denial, Palliative Care, Pandemic. La défense « existentielle » du Soi contre sa propre caducité : Pandémie et peur de mourir. S’inspirant de l’impact émotionnel que la pandémie a eu dans le cabinet de consultation, l’auteur fait un bref excursus théorique sur le thème de l’angoisse de la mort et de la capacité à supporter la solitude, et analyse ces dynamiques mentales. Il identifie comment l’une des défenses physiologiques de l’esprit contre le sens de la caducité est un déni, défini comme «existentiel», du sens de sa propre finitude afin de doter le Soi d’une cohésion et d’un sentiment de permanence dans le temps. Cette défense existentielle est soutenue par une toute-puissance modérée qui s’acquiert avec la maturité et au bout du chemin de l’analyse personnelle. Pour cette raison, l’Auteur analyse l’attitude mentale particulière nécessaire pour accompagner le mourant au moment de sa mort. Attitude nécessaire à l’analyste en séance pour tolérer les angoisses de mort des patients et les siennes propres. Mots-clés: Caducité, décès, déni, pandémie, soins palliatifs. La defensa «existencial» del Self frente a su propia Transitoriedad: Pandemia y miedo de Morir. El autor tomando como referencia el impacto emocional que ha tenido la pandemia en el consultorio analítico realiza un breve excursus teórico sobre el tema de la angustia de muerte y de la capacidad de tolerar lasoledad y analiza estas dinámicas mentales. Sostiene que una de las defensas fisiológicas de la mente a la transitoriedad seala negación, que define como «existencial», de la propia finitud para dotar al Self de cohesión y significado de permanencia en el tiempo. Esta defensaexistencial se sustenta en un nivel moderado de omnipotencia que se adquiere con la madurez y alfinal del proceso de análisis personal. Por esta razón, se analiza la condición mental necesaria para acompañar al moribundo en el momento de la muerte. Condición mentalnecesaria para que el analista en sesión tolere las angustia de muerte de pacientes y la propias. Palabras clave: Cuidados paliativos, muerte, negación, pandemia, transición. Die existenzielle Abwehrreaktion des Selbst in der Konfrontation mit der eigenen Vergänglichkeit: Pandemie und Angst vor dem Sterben. Der Verfasser nimmt die emotionale Auswirkung, die die Pandemie auf das Analysezimmer hatte, zum Anlass für einen kurzen theoretischen Exkurs zum Thema der Todesangst und der Fähigkeit, die Einsamkeit zu ertragen, sowie eine Analyse dieser mentalen Dynamiken. Als eine der physiologischen Abwehrreaktionen des Geistes gegen das Gefühl der Vergänglichkeit identifiziert er eine als ‚existentiell’ definierte Negation des Gefühls der eigenen Endlichkeit, um dem Selbst Kohäsion und ein Gefühl der Permanenz in der Zeit zu geben. Diese existenzielle Abwehrreaktion wird von einem moderaten Ausmaß an Allmacht aufrechterhalten, das mit zunehmender Reife und am Ende des Weges der persönlichen Analyse erworben wird. Aus diesem Grund wird die besondere geistige Verfassung analysiert, die für die Begleitung des Sterbenden im Augenblick des Todes notwendig ist. Eine geistige Verfassung, die für den Analytiker in der Sitzung notwendig ist, um die Todesängste der Patienten und die eigenen zu ertragen. Schlüsselwörter: Negation, Palliativbehandlungen, Pandemie, Tod, Vergänglichkeit.

Dalla diagnosi psichiatrica al percorso diagnostico in psicoanalisi. Alcune note sulla diagnosi di attacco di panico In diversi suoi scritti, Freud, almeno per alcuni aspetti, valorizza la diagnosi psichiatrica, riconoscendo il valore della lezione di Charcot. Il medico deve non solo toccare, ma anche guardare, osservare, riconoscere e decifrare i sintomi per ordinarli e ricondurli a un sapere organizzato. Per Freud l’osservazione psicoanalitica, però, prolunga l’osservazione psichiatrica e se ne allontana, diventando un vero e proprio percorso diagnostico, che non è isolabile dall’insieme del processo psicoanalitico e dal necessario contesto narrativo. Un caso clinico di attacco di panico evidenzia la sostanziale differenza fra la diagnosi psichiatrica e il percorso diagnostico in psicoanalisi. Parole Chiave: Attacco di panico, diagnosi, eziologia, narrazione, percorso diagnostico. From psychiatric diagnosis to the diagnostic pathway in psychoanalysis. Some notes on panic attack diagnosis. In several of his writings, Freud, at least in some aspects, values psychiatric diagnosis, recognising the value of Charcot’s lesson. The doctor must not only touch, but also look, observe, recognise and decipher the symptoms in order to order them and bring them back to an organised knowledge.For Freud, however, psychoanalytic observation prolongs psychiatric observation and moves away from it, becoming a true diagnostic pathway, which cannot be isolated from the whole psychoanalytic process and from the necessary narrative context. A clinical case of panic attack highlights the substantial difference between the psychiatric diagnosis and the diagnostic pathway in psychoanalysis. Keywords:  Aetiology, diagnosis, diagnostic pathway, narrative, panic attack. Du diagnostic psychiatrique au parcours diagnostique en psychanalyse. Quelques notes sur le diagnostic d’attaque de panique. Dans plusieurs de ses écrits, Freud, au moins par certains côtés, valorise le diagnostic psychiatrique, reconnaissant la valeur de la leçon de Charcot. Le médecin doit non seulement toucher, mais aussi regarder, observer, reconnaître et déchiffrer les symptômes afin de les ordonner et de les ramener à unsavoir organisé. Pour Freud, cependant, l’observation psychanalytique prolonge l’observation psychiatrique et s’en éloigne, devenant un véritable processus diagnostique, qui ne peut être isolé du processus psychanalytique dans son ensemble et du nécessaire contexte narratif. Un cas clinique d’attaque de panique souligne la différence substantielle entre le diagnostic psychiatrique et le processus diagnostique en psychanalyse. Mots Clés: Attaque de panique, diagnostic, étiologie, parcours diagnostique, récit. Del diagnóstico psiquiátrico al recorrido diagnóstico en psicoanálisis. Algunas notas sobre el diagnóstico del ataque de pánico. En varios de sus escritos, Freud, al menos en algunos aspectos, valora el diagnóstico psiquiátrico, reconociendo el valor de la lección de Charcot. El médico no sólo debe tocar, sino también mirar, observar, reconocer y descifrar los síntomas para ordenarlos y reconducirlos al conocimiento organizado. Para Freud, sin embargo, la observación psicoanalítica prolonga la observación psiquiátrica y toma distancia de ella, convirtiéndose en un verdadero proceso diagnóstico, que no puede ser aislado del proceso psicoanalítico en su conjunto y del necesario contexto narrativo. Un caso clínico de ataque de pánico destaca la diferencia sustancial entre el diagnóstico psiquiátrico y la vía diagnóstica en psicoanálisis. Palabras Clave: Ataque de pánico, diagnóstico, etiología, narrativa, vía diagnóstica. Von der psychiatrischen Diagnose zum diagnostischen Weg in der Psychoanalyse. Anmerkungen zur Diagnose von Panikattacken. In mehreren seiner Schriften würdigt Freud die psychiatrische Diagnose und erkennt dabei den Wert von Charcots Lehre an. Der Arzt soll die Symptome nicht nur berühren, sondern auch sehen, beobachten und entschlüsseln, um sie zu ordnen und in ein organsiertes Wissen zu überführen. Für Freud erweitert die psychoanalytische Beobachtung jedoch die psychiatrische Beobachtung und entfernt sich von ihr, und wird dadurch zu einem wirklichen diagnostischen Weg, der nicht von der Gesamtheit des psychoanalytischen Prozesses und dem notwendigen narrativen Kontext isoliert werden kann. Ein klinischer Fall von Panikattacken verdeutlicht den substantiellen Unterschied zwischen der psychiatrischen Diagnose und dem diagnostischen Weg in der Psychoanalyse. Schlüsselwörter: Ätiologie, Diagnosen, diagnostischer Weg, Erzählung, Panikattacke.