Psychology Research Digest
Psychoanalytic Psychology - Vol 43, Iss 4
Psychoanalytic Psychology serves as a resource for original contributions that reflect and broaden the interaction between psychoanalysis and psychology.
Melanie Klein, Heinz Kohut, and Ronald Fairbairn meet at the grandiose position: Implications for understanding and treating complex psychopathology.
Grandiosity is a complex psychopathological problem: It cuts across numerous psychiatric diagnoses and imbues maladaptive and adaptive aspects. In this article I describe “the grandiose position,” a psychological organization that sheds light on the psychodynamics and interpersonal behavior related to grandiosity. Such theoretical description is based on my years-long reformulation of Melanie Klein’s notion of the depressive positions using extant (neuro)psychological science and a social–cognitive nomenclature. Specifically, M. Klein defined the position as an amalgamation of anxieties (paranoid vs. depressive/guilt ridden), defenses (primitive vs. neurotic), and object relations (part vs. whole). My reformulation substitutes anxiety with “affective tone,” defenses with affect-regulatory maneuvers, and object relations with schemas/scripts of self-with-others. This reformulation also adds a focus on lived interpersonal action and on projecting the self onto the (relational) future. Herein, I continue from where M. Klein left off in her initial charting of manic defenses and integrate this theorization with Heinz Kohut’s description of grandiose narcissism and Ronald Fairbairn’s notion of the exciting object. The result consists of (a) an elated, albeit condescending and dismissive, affect, (b) counter-vulnerability defense mechanisms, and (c) an inflated self that belittles deficient others while pursuing exciting ones. Clinical implications are discussed, primarily regarding differential diagnosis, management of rupture–repair in the transference–countertransference, and addressing suicidal and self-destructive behavior in therapy. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 13 Jul 2026 00:00:00 GMT Access the article >>Working through resistance: A neuropsychoanalytic model of defensive and structural resistance to change.
Resistance to change remains central to psychoanalytic practice: Patients often maintain dysfunctional beliefs and relational patterns even when they recognize their destructive nature. While psychoanalysis has richly described resistance as a defense against painful affect and threats to internal object relations, the process-level dynamics through which resistance persists over time have remained incompletely articulated. This article proposes a neuropsychoanalytic model that conceptualizes resistance in terms of two interconnected regulatory constraints: defensive resistance arising through affective gating and structural resistance rooted in the inertia of deeply entrenched beliefs. Integrating psychoanalytic formulations of affect tolerance and working through with principles of predictive processing, the model clarifies why therapeutic transformation often proceeds in oscillating cycles and what conditions enable patients to bear the affective intensity required for change. By linking clinical observation with process-level accounts of mind–brain functioning, the framework seeks to deepen psychoanalytic understanding of resistance and therapeutic transformation while fostering dialogue with contemporary neuroscience. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 13 Jul 2026 00:00:00 GMT Access the article >>The colonized psyche: A psychoanalytic differentiation between complex posttraumatic stress disorder and borderline personality disorder.
The present article proposes a psychoanalytic differentiation between complex posttraumatic stress disorder (C-PTSD) and borderline personality disorder, emphasizing that the former constitutes not merely a set of cumulative traumatic events but a structural colonization of the psychic apparatus. Drawing upon Ferenczi’s concepts of identification with the aggressor and denial (Verleugnung), as well as Bion’s notion of the unprocessed element, the author explores how the continuity of traumatic submission reorganizes the subject’s internal world under a “foreign agency” of the introjected aggressor. While borderline personality disorder is characterized by fragmentation and oscillation between idealized and persecutory object relations, C-PTSD reveals a psychic regime in which the subject’s selfhood becomes subordinated to the aggressor’s logic. The article argues that in C-PTSD, the trauma is no longer merely remembered—it operates as the very environment of psychic life, a form of existence in which the ego has ceded authorship as a means of psychic survival. Clinical vignettes illustrate how the traumatic environment persists as a colonizing presence that shapes the subject’s perception, desire, and sense of agency. Distinguishing C-PTSD from borderline personality disorder is therefore not only diagnostically relevant but ethically and clinically necessary, allowing therapeutic work to focus on the restitution of self-authorship rather than mere behavioral regulation or adaptive functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 30 Jul 2026 00:00:00 GMT Access the article >>Worldmaking in the consulting room: Why psychoanalysis’s “problem” is actually its promise.
The longstanding debate over whether psychoanalysis constitutes a science or belongs to the humanities rests on a false dichotomy that misunderstands both knowledge creation and psychoanalysis itself. This article applies Nelson Goodman’s philosophical framework of “worldmaking” and symbol systems to reconceptualize psychoanalysis as a sophisticated integration of scientific and humanistic approaches. Drawing on Goodman’s analysis of how different disciplines construct rather than discover their realities, the article demonstrates that psychoanalysis employs multiple symbolic modes—from quasinotational diagnostic categories to dense metaphorical interpretations—each appropriate to different aspects of psychological complexity. The plurality of psychoanalytic schools (e.g., Freudian, Kleinian, self psychology, relational, Lacanian) represents not prescientific confusion but epistemological maturity, paralleling theoretical diversity in physics. Goodman’s concept of projectibility offers a more relevant epistemic standard than Popper’s falsifiability, while his irrealist stance reframes Grünbaum’s contamination critique by showing all observation is theory-laden. Rather than defending psychoanalysis as failed science or retreating to pure hermeneutics, this reconceptualization positions it as a pioneering human science that models how systematic knowledge can emerge from integrating multiple ways of understanding. The implications extend beyond psychoanalysis, suggesting how human sciences generally can achieve rigor without reductionism. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 09 Jul 2026 00:00:00 GMT Access the article >>Play in the psychotherapy for psychosis.
Play is a central aspect of psychotherapeutic technique that can facilitate learning, intimacy, and personal growth. Nevertheless, little has been written about how play can be used when working with patients experiencing psychosis, which risks undermining the possibility of connection and meaning-making and reinforcing stigma. In this article, barriers to play are explored, including both the patient’s contributions such as concrete thinking, metacognitive challenges, and paranoia, and the therapist’s contributions, including fears of exploring psychotic thoughts, an attitude of excessive seriousness, and the riskiness of play. After exploring impediments to play, there is a discussion about how to assess the patient’s readiness for play and how therapists can foster play by embodying an attitude of improvisation and curiosity and trusting their mind and irrational associations. Finally, the authors explore how to play with different psychotic presentations, including delusions and negative symptoms. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 10 Aug 2026 00:00:00 GMT Access the article >>The kid(ney) and the (m)Other: Lacanian psychoanalysis and living nondirected kidney donation.
Living nondirected kidney donations are on the rise. Yet we know little about these donors’ motivations, particularly their unconscious sources. Here we attempt to explore these sources from a Lacanian approach. We first turn to Lacanian theory. We offer an explication of key Lacanian concepts such as the master-signifier, desire, and object (a). We then present a portrait of a research participant who sat down for three interviews to discuss freely her reasons for donating a kidney nondirectedly. In the discussion that follows, we attend to two significant moments in the subject’s interview: (a) the deployment of a master-signifier (“once I heard that”) and (b) the donor’s experience of disappointment and abandonment postsurgery. Grounded in a master-signifier and the subject’s postsurgical experience, we offer an interpretation of the donated kidney as a metaphor for childbirth and conclude that nondirected donation may be, in this case, an unconscious attempt to deliver the imaginary phallic object to the (m)Other. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 13 Aug 2026 00:00:00 GMT Access the article >>Malignant self-regard, grit, and perfectionism: A construct validation effort with significant clinical implications.
In this article, malignant self-regard (MSR) is reviewed, and its research effort is briefly discussed. It is noted that an expansion of MSR’s construct validity is required. The article then focuses on the gaps in the literature between perfectionism, grit, and MSR. We introduce an object-relations account of perfectionism and depressive personality, which predicts a positive association between MSR and perfectionism. Then, we review the literature on grit’s relationship with perfectionism, achievement, and depression, which predicts MSR will be negatively associated with grit. Inferential analysis of the online sample (n = 309) is consistent with expectations. As MSR increases, (a) grit declines, (b) rigid perfectionism stays relatively stable, and (c) self-critical and narcissistic perfectionism rises significantly. In the discussion, attention is dedicated to the clinical implications of these findings. We then discuss ways to navigate the clinical complexities that arise from this situation that can be applied in dynamic and nondynamic treatment models. We then close with important limitations and outline future research directions for MSR. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 23 Jul 2026 00:00:00 GMT Access the article >>How do sadomasochistic dynamics of transference and countertransference unfold in nonpsychoanalytic psychotherapy?
To illuminate transference and countertransference dynamics in sadomasochism, this study explored the intricate relational patterns that emerge in the psychotherapy process of individuals with sadistic, masochistic, and sadomasochistic personality characteristics. This study used a qualitative research design because the main purpose was to discover the relational patterns co-constructed by clients and psychotherapists in the interpersonal reality of their psychotherapy processes. The interactional patterns of four female client–therapist dyads—recruited via convenience sampling—were analyzed using conversation analysis. Psychodynamic diagnostic prototypes were used to assess clients’ personality structures. Twenty-four sessions were analyzed; the therapies followed cognitive–behavioral, schema, and eclectic orientations. The analysis yielded three interaction patterns. Some conversational strategies clients employed served to build and maintain collaboration. The other major interactional pattern included a break in collaboration, during which dyads had conflicting conversational goals and expressed negative feelings. In the last pattern, the ambiguity of collaboration, the interaction was characterized by the co-occurrence of collaboration and the break in collaboration in the same sequences. Transference and countertransference dynamics related to sadomasochistic characteristics are interpreted to be reflected in a complex interplay of therapeutically relevant issues, ranging from the capacity to develop a reciprocal relationship and the potential for change to submission, problems with ego boundaries, disavowal of destructiveness, need for control, and dominance. It was concluded that the co-constructed nature of these specific transference and countertransference dynamics deserves further attention from practitioners and researchers regarding the psychotherapy process. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 23 Jul 2026 00:00:00 GMT Access the article >>Psychic pain and psychosocial adaptation following residential treatment: A long-term follow-up study of a high-risk psychiatric sample.
This naturalistic long-term follow-up study explored psychosocial and suicide-related outcomes among high-risk adult psychiatric patients treated within a psychoanalytically oriented residential program. Longitudinal outcomes pertaining to suicide mortality rate and changes in risk and protective factors for suicide were examined approximately 7 years following completion of the baseline study, which evaluated states of mind preceding near-lethal suicidal behavior. The original baseline cohort consisted of 131 participants; however, one participant subsequently withdrew consent and was excluded from the current analyses, resulting in an analytic baseline sample of 130 participants. Of the original analytic baseline sample (N = 130) who participated in the baseline study, the suicide mortality rate was 7.7%. Participants who provided follow-up data (n = 44) reported significant improvements in protective factors, including resilience (d = 0.89) and reasons for living (d = 0.72), and a significant reduction in psychic pain (d = 0.68) compared with baseline levels. However, psychic pain scores at follow-up remained elevated compared with cutoff scores associated with suicide risk, suggesting continued elevations in risk and impairment despite improvements in other areas. These findings underscore both the persistence of vulnerability to experiences of emotional pain and the considerable potential for positive long-term psychosocial adaptation and growth in individuals at elevated risk for suicide. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 24 Aug 2026 00:00:00 GMT Access the article >>The vulnerability to shame for the narcissistic self.
Narcissism is increasingly conceptualized as a dynamic, multidimensional configuration of the self encompassing both grandiose and vulnerable expressions. Whereas grandiosity reflects self-enhancement, assertiveness, and defensive distancing from self-conscious affect, vulnerability is marked by hypersensitivity, contingent self-esteem, and emotional fragility. Across psychoanalytic, developmental, and interpersonal models, shame, rather than guilt, has long been theorized as the central affective process organizing narcissistic self-regulation, yet empirical findings had not been systematically integrated. This systematic review synthesized 27 empirical studies examining associations among narcissism, shame, and guilt across nonclinical and clinical samples, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. In nonclinical populations, a consistent pattern emerged: Vulnerable narcissism showed moderate-to-strong positive associations with shame, indicating that shame constitutes its core organizing affect. Grandiose narcissism, particularly when assessed with the Narcissistic Personality Inventory, demonstrated small negative associations with shame. When grandiosity was measured with maladaptive instruments (e.g., the Pathological Narcissism Inventory), links with shame were more variable, reflecting a more affect-reactive and clinically proximal form of grandiosity. Clinical studies showed that narcissistic personality disorder showed low shame and guilt proneness but high shame aversion together with elevated implicit state shame suggesting that grandiosity co-occurs with a latent, easily activated vulnerability to shame. Clinical vulnerability was strongly linked to internalized shame, as well as depressive symptoms and suicidal ideation, underscoring shame’s central role in emotional collapse and clinical risk. Overall, findings demonstrate that shame, rather than guilt, is the primary affect differentiating and regulating grandiose and vulnerable narcissistic states across the continuum from personality style to disorder. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 15 Jun 2026 00:00:00 GMT Access the article >>Review of Developments in attachment research.
Reviews the book, Developments in Attachment Research by editedf Robbie Duschinsky (2025). In his latest book, Duschinsky offers a new account of contemporary attachment theory as a rich tapestry of voices and perspectives, at times complementary and at times in tension, challenging this received image of unity. The volume presents a comprehensive examination of the work of selected research groups, from those of Everett Waters to Karlen Lyons-Ruth, Jay Belsky, Marinus van IJzendoorn, Sheri Madigan, and others. Through the author’s rigorous and imaginative prose, readers will discover that several assumptions that we identify attachment research with have now been superseded by attachment researchers themselves. Crucially, the book shows how the narrative of consensus obscures substantial differences between research traditions, unresolved questions, and the often difficult relationship between researchers and practitioners. Rather than portraying the researchers as solitary, Promethean figures towering over a mistshrouded landscape, Duschinsky excels in reconstructing the broader context in which they made their discoveries. Indeed, as in the novels of Italo Calvino, what makes Duschinsky’s book compelling is the logic guiding the narrative, more than the protagonists themselves. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Thu, 11 Jun 2026 00:00:00 GMT Access the article >>Review of the Right brain and the origin of human nature.
Reviews the book, The Right Brain and the Origin of Human Nature by Allan Schore (2025). This book is the latest of six books by Schore devoted to deepening and expanding basic ideas, developing new aspects of regulation theory, integrating it with adjacent fields, and keeping his readers updated on new findings in the neurosciences that support the two-person neurobiology (interpersonal neurobiology) that forms the basis of his work (Schore, 2003a, 2003b, 2012, 2019a, 2019b). The theme Schore weaves throughout the book is that the right brain is the locus of, to paraphrase Harry Stack Sullivan, what makes us all more human than otherwise. Human nature derives from the unconscious Freud was looking for, the unconscious processes that form the bottom of a mind that emerges from the body and becomes the human subject. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 06 Jul 2026 00:00:00 GMT Access the article >>Review of Ruptures in the American psyche: Containing destructive populism in perilous times.
Reviews the book, Ruptures in the American Psyche: Containing Destructive Populism in Perilous Times by Michael J. Diamond (2022). This review examines Diamond’s work by highlighting its psychoanalytic analysis of Trumpism as a form of destructive populism rooted in regressive large-group dynamics. Drawing on Freud, Klein, Bion, Volkan, and Critical Theory, Diamond explores how social upheaval, economic inequality, racism, and authoritarian leadership can foster paranoid and anti-democratic collective processes. The review praises the book’s interdisciplinary integration of psychoanalytic, sociopolitical, and historical perspectives and its nuanced account of contemporary U.S. authoritarianism. At the same time, it argues that Diamond gives insufficient attention to the role of capitalism and meritocratic ideology in producing the social discontent, shame, and inequality that fuel authoritarian movements. Despite this critique, the review concludes that Ruptures in the American Psyche offers a timely and insightful framework for understanding the psychological and social forces underlying contemporary threats to democracy. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 13 Jul 2026 00:00:00 GMT Access the article >>Review of Life drive & death drive, libido & lethe: A clear road through Freud’s metapsychology leading to helpful findings and new concepts (updated version).
Reviews the book, Life Drive & Death Drive, Libido & Lethe: A Clear Road through Freud's Metapsychology Leading to Helpful Findings and New Concepts (Updated Version) by Cordelia Schmidt-Hellerau (2024). This review assesses Schmidt-Hellerau’s rigorous attempt to reconstruct Freud’s metapsychology as a coherent theory of psychic functioning while advancing her own reformulation of drive theory. The book is particularly strong as a guide to Freud’s most difficult theoretical writings, clarifying the development of key concepts through careful historical and conceptual analysis. Schmidt-Hellerau’s distinction between phenomenological, clinical, and metapsychological levels of explanation brings unusual precision to psychoanalytic theory. The review focuses especially on her concept of Lethe, a self-preservative, de-intensifying tendency proposed as a revision of Freud’s death drive. While this model offers a compelling account of withdrawal, passivity, and the reduction of excitation, it raises questions about whether it adequately captures the destructiveness and conflict central to Freud’s original formulation. Although the book’s systematic coherence can at times smooth over the contradictions of Freud’s thought, it makes a significant contribution to contemporary debates about the value of metapsychology. Stimulating and ambitious, the volume invites readers to reconsider whether psychoanalysis still requires a general theory of psychic life. (PsycInfo Database Record (c) 2026 APA, all rights reserved)
Publication date: Mon, 17 Aug 2026 00:00:00 GMT Access the article >>