Nicolò Anna Maria, Trapanese Gemma (A Cura Di) (2005). Quale Psicoanalisi Per La Famiglia?.Milano: Franco Angeli.

Nicolò Anna Maria, Trapanese Gemma (A Cura Di) (2005). Quale Psicoanalisi Per La Famiglia?.Milano: Franco Angeli.

Valdimiro P. Pellicanò

Both this second volume and its “twin” Quale psicoanalisi della coppia? contain the “improved” versions of papers presented to the First International Congress held in Naples, Italy, in December 2000, with the title What psychoanalysis for couples and families.

The strong point of this book is by means of clinical examples and theoretical discussions that it shows how we can use psychoanalysis in a family setting.

The papers presented are the outcome of field research. Nearly all of them, in fact, make use of case histories both to prove the value of a reference model and to try to create new models that help us to understand what Anna Maria Nicolò aptly calls “subject relations”.

In their introduction the editors discuss the meaning of Freud’s meeting with Little Hans’s father for the history of psychoanalysis. They wonder whether it can be considered an intervention on parenting and more in general on the environment where personality is formed with its phantasms, relations and links.

The editors also stress that a limit of some psychoanalytical models is represented by their polarization either on the intrapsychic or on the interpersonal. This makes it necessary for analysts to oscillate from one to the other model in order to make their clinical practice more effectual. It is also important that analysts working with families (or couples) do not neglect the link between persons and the interactions taking place in sessions: “Link or relation or collusion or connivance or unconscious contract or role responsiveness or attunement or coconstruction or whatever we want to call it, a couple and family psychoanalyst does not only look at unconscious contents in a person (my italics) but at what happens at the different levels, from the more superficial to the deepest ones, between individuals, at what unites and separates them both at superficial levels and at deeper unconscious ones” (Nicolò, Trapanese 2, 2005, p. 11).

After a survey of the concept of interaction (bi or multi-dimensional process for the silent regulation of behaviour and the mutual experience of the participants), the editors specify that, beyond models, in the sessions with families we see an intertwining of emotional, affective, bodily, representational, fantastic, ideological and mythical elements that are variously activated. They close their introduction by stating that psychic illness is only an aspect of the pathology of a link that cannot be treated if we do not understand what status the other has in our psychic life and if we do not observe not only our troubling unconscious but also the other within ourselves, the others that make up ourselves and of whom we are an expresssion since the inception of life.

What psychoanalysis for families includes four parts and collects papers on the following topics: families and their treatment, parenting, families and their pathologies and generational transmission.

The papers are original and interesting but I cannot review them all, so I will dwell on the main issues brought forward in the hope that my readers are stimulated to read these volumes.

Part one. Families and their treatment

The book opens with a very interesting paper by Stefano Bolognini, The analyst’s family that addresses an extremely delicate issue: the psychoanalytical community as a family equivalent. The author discusses the question of the resolution of the transference at the end of treatment and of some of its developments up to the acknowledgment of “who is present” in the internal place where we meet our patients.

This is a very interesting journey in the internal world of future analysts touching fantasies and phantasms concerning the family of origin and the future analytical family (made up of the candidate analyst, supervisors, teachers and candidates/brothers). The candidate analyst, writes Bolognini, moves in a space that can favour new beginnings while it accepts the inevitable repetitions of old models. This reminds me of the journey of an Oedipus patient that, in going from Corinth to Thebes and back succeeds in avoiding the tragedy of actually killing his father (with the help of his personal analysis) and in integrating both adoptive and real parents in his personality, with the ensuing opportunity of orienting himself in the varied world of the various models suggested by the “larger analytical family”.

Anna M. Pandolfi mentions two roots, a subjective and a group root, in her paper Play between subjectivity and group. The sense of self, writes the author, is strictly related to the sense of belonging to a group, in particular a family. This belonging is located not only on a horizontal axis in the present, but also diachronically in time. Identity finds its roots in the meeting of subjectivity and group (be they families or other groups) and its originality in a sense of belonging that does not overcome but favours psychic work. This applies also to clinicians of the psyche.

In his paper Psychoanalytical psychotherapy of groups and families: common areas and differences, Rudolf Branner analyzes with clarity and concision the differences and common areas of these two kinds of psychotherapy.

The last paper in this section was written by a working group of the Milano-Trento  research group in psychotherapy: Concerning incest: the space of incest in clinical consultation for families. Reflections of the CeRP study group.

Part two. Parenting

In the second part we find papers written by clinicians that have been working for years in the analysis of couples and families, such as Lucarelli, Dare, Palacio, Espasa and Dora Knauer, Chiarelli and Picece Bucci, Piperno and Capozzi, who provide original contributions on a field that, as Lucarelli says,  poses various new questions and concerns also in relation to the scientific breakthroughs of the past decades, such as genetic manipulation.

This second part is opened by Daniela Lucarelli with her Can we dream a child, can we think its parents that addresses the question of establishing identity, “reinventing identity” in a context that includes the intrapsychic and interpersonal dimensions and keeps account of the changes imposed by society (such as the lack of grandparents in child rearing, the tendency to entrust children to social institutions and the increase in divorce rates). According to Lucarelli, the reduced transmission of family values and myths makes it difficult for individuals and families to achieve representational processes. The biggest complaint of parents would then be an excess of reality that, while hampering fantasizing  and imagination, would feed the narcissistic side of the parents’ relation with their children causing an inability to acknowledge alterity, difference and generational gaps. In addition there would be an excess of psychologization in the parents at the expense of the ability to be a spontaneous parent, emotionally engaged in this function.

Some extremely interesting stimuli come from Christofer Dare’s paper on the parents of anorexic patients. In this paper, Don’t touch! A couple, parents of an anorexic daughter, the author stresses that, even when family therapy is successful, a clinical difficulty remains in treating the marital problem and understanding the marital situation. Dare writes that the symptom could be the expression of the anorexic patient’s difficulty in communicating and expressing her emotions towards her parents.

The value of this paper lies, in my opinion, in its conclusion, deriving from a wealth of clinical material, where the authors relates the causes of this eating disorder to both the family and the anorexic patient.

In the paper The technique of brief psychodynamic treatment. Mother- father-child, Dora Knauer and Palacio Espasa (who wrote a book on mother-child psychotherapy with Cremer in 1994) introduce the father. It is a valuable paper that, in addition to stressing the importance of the third, a role that can be played by either parent, also examines the pros and cons of brief therapies.

Other couples of authors are Riccardo Chiarelli and Silvana Picece Bucci with Psychoanalytical psychotherapy of parents of seriously ill children: narcissism, internal objects and transgenerational in the couple’s dream experience and Francesca Piperno and Flavia Capozzi with The silence of adults as an additional trauma in a case of sexual abuse.

In the limited space of a review it is not possible to mention all authors, but I suggest to read these two papers as they show that it is possible to treat also psychic situations that are beyond representation and concern alien embedded elements or traumas that are hard to elaborate. 

Part three. Families and their pathologies

This part addresses a very complex issue, that of serious pathologies and their treatment with psychoanalysis.

The first paper, in my opinion the most clinically relevant of the whole book, is by Anna Nicolò: Families and psychosis. A psychoanalytical view of transpersonal pathologies.

From the beginning Anna Nicolò tackles this complex issue with clarity: “I think that psychotic pathologies, before being intrapsychic pathologies are transpersonal pathologies. A psychotic subject is at the intersection of biasing pathological links that he formed and contributed to forming. The study and transformation of these links is the first condition for starting and successfully completing an individual treatment”.

The author presents us with a clinical vignette showing a family situation where the issue of identity (of son and father) is the prevailing theme. She then analyzes two dreams of the parents by means of two interpretive positions that show a pathology in the couple link and an incestuous link between a parent and the son.

But once we have identified the problem, how do we proceed with treatment? Only a careful survey will allow to evaluate how the symptom constellation can be ascribed to personal problems and/or interactive features of the family functioning or of the couple. Only after these evaluations are made, can we propose a therapeutic project.

The paper continues with clinical considerations on the pathology of the marital couple and moves to the complex functioning of family organizations both at the interactive and fantasy level. The author suggests that the defensive function of some links (up to intrusion into identity) tends to overcome the transformational quality of these links.

I cannot dwell longer on this paper but I suggest to read it with attention and emotional participation.

Gianna Polacco Williams and Gerard Descherf, the group made up of Antonio Brignone, Nicoletta Fragomeno, Giuseppe Saraò, Giacomo Tessari, Giovanni Trapani, and Lilia Bagnarli and J.L.Dorey also discuss family pathologies.

Reading these papers (Polacco discusses the destructive Superego, Descherf the Munchausen syndrome, the group serious patients in institutions, Gagnarli integration of individual development and family processes, Dorey deaf children and their families) I can say that although these colleagues refer to different models of therapeutic intervention, a common element among them concerns their capacity for listening that allows them to accept the stress present in the therapeutic field and proceed to a careful diagnosis. All these papers stress the fact that only with a careful diagnosis can we propose settings adequate to the various clinical situations.

Carefully tracing the motives that lead our colleagues to favour one setting over the other can give us great insight for our own serious cases. I think, in fact, that only by accepting what we do not know, can we arrive to understand the nature of the clinical problem that we have to address and to find an adequate answer.

I also think that an advantage for the therapist can be to have the possibility to consider a few theoretical models, discuss them and use them with greater awareness in the different clinical situations and in the different areas of intervention.

Part four. Generational transmission

To find a clear orientation in the complex field of generational transmission, I suggest the paper by Gemma Trapanese and Massimiliano Sammantico called The construction of the generational paradigm. Historical-biographical survey.

As the title says, the authors survey a large number of publications, starting from Freud, and try to rethink and redefine the concept of generational transmission.

One of their main concepts (mentioned also in the first volume of the series) is that of link. Intersubjective links, links between objects, defensive links and more are transported, projected, deposited, diffracted into others from one generation to the next and in the same generation. Some qualities of these links can be defined “horizontal” as they keep a group united, whereas other qualities are “vertical”, in that they are intergenerational and link different generations. Links are also kept alive by unconscious alliances that can have the function to ensure generational continuity or “transmit the negative”.

The authors also define the concept of intergenerational and transgenerational psychic transmission, analyzing the considerations of other authors on this concept (Nicolò, Cigoli, Eiguer, Ruffiot, Taccani, Laplanche, Kaës, etc).

Other issues discussed in depth in this paper are the family secret (both in its positive and negative aspeects) and mourning (the work of mourning and pathological mourning) and their transmission (psychic vampirism). Their final consideration is that there is always a generational transmission because there is always another different from oneself, because the process of subjectivation always implies the assumption of a stranger within oneself.

Five more papers are included in this section on generational transmission.      Evelyn       Granjon     in      Intergenerational and transgenerational transmission addresses the complex and fascinating issue of how transmitted matters are changed in the passage from one generation to the other and from one family member to another. She then touches on the relationship between family suffering and transmission and ends by questioning the efficacy of psychoanalytical family treatment (PFT), in particular in cases of dysfunctions in the psychic transmission processes in a family, what is aptly defined “transgenerational negative”. Another basic question discussed by Granjon is “what can the objective of PFT be?”

Simona Taccani in her Reflections on intergenerational and transgenerational transmission focuses on ambiguity (a concept derived by Racamier), on the question of psychic space and the therapeutic effects of words and thinkability in PFT.

Vittorio Cigoli in From generation to generation. To transmit, to bequeath, to transfer talks about transformations of myths in families with an interesting review of the myth of Oedipus and Orestes, passing then to considerations on novels and generational trauma. Through myths, writes Cigoli, we try to make sense of our relations, to open new spaces for humanity, to create new links. In the case of novels, instead, the subject clashes with social requirements (marriage as an economic contract) and searches for the truth of feelings in an unending motion aimed at being both subject to history and the subject of history. Other questions discussed in this paper with the help of clear clinical examples are soul names, death and rebirth.

The last two papers are Couples, families and transgenerational secrets by M. Luisa Drigo, Clara Monari and Simona Taccani and Destiny and metamorphosis of transmission among siblings by Rosa

Jaitin.

In the first one, the authors distinguish thinkable (positive) secrets and unthinkable (negative) secrets that are not known and discuss how we can work in PFT with these secrets.

On siblings groups and their horizontal links in addition to the vertical links with their ancestors, Jaitin, who continues her personal research in the area of siblings, closes this rich and stimulating collection of works that can enrich our wealth of theoretical and clinical information and boost the tools we use in our clinical practice in the effort of managing personal and family discomfort.

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Bibliography

Eiguer A. (1984). Le mythe familiare, le mythe social, le mythe de couple, Dialogue, n° 84, pp. 86-101.

Nicolò A. M (1996). Il transgenerazionale fra mito e segreto. Interazioni, 1/1996, pp. 138-152.