ABSTRACT Somatoform pain poses major challenges in medicine. There is a lack of quantitative instruments that systematically assess psychosocial aspects of somatoform pain. A better knowledge of such aspects could contribute (1) to gaining further insight into the relationship between psychodynamic and psychosocial components of pain, and (2) to facilitating the development and monitoring of improved interventions targeting psychodynamic and psychosocial mechanisms of pain. An item pool on biopsychosocial aspects of pain was developed and completed by 200 patients with somatoform pain disorder. In addition, anxiety (STAI), depression (BDI II), somatization (SOMS-2), and quality of life (SF-36) were assessed. As compared to norm data, patients reported higher scores for anxiety (STAI), depression (BDI-II) somatization (SMOS-2), and lower quality of life (SF-36). Applying item and factor analyses, a new questionnaire (QSP-31) was developed to identify psychodynamic and psychosocial aspects of pain. There was evidence for the construct validity of the six scales through confirmatory factor analysis: Relationships between pain and negative emotions, Negative attitudes towards help-seeking, Negative pain-related childhood experiences, Negative attitudes towards own body, Negative aspects of the doctor-patient relationship, and Perceived pain control. Cronbach's alpha coefficients for these scales lay within the range of .81-.92. Regarding criterion validity, moderate correlations in expected directions were found between all scales and anxiety, depression, somatic symptom severity, and quality of life, except for the scale Perceived pain control. The QSP-31 appears promising for the identification of relevant psychosocial aspects associated with the experience of pain and might be a useful instrument.

ABSTRACT Receptivity to our patients’ experience is a vital aspect of the psychoanalytic endeavor. As we receive incoming transmissions, we resonate with what is active in the patient. We hope to then jointly metabolize the experience. When we meet neurodiversity, realms of experience emerge that may elude us. Precipitously formulated ideas in the therapist, based on a neurotypical frame of reference, can impinge upon the discovery of our patients’ authentic world. How do we open ourselves to receive their true experience? This clinical narrative tracks the psychoanalytic travels of an individual who identifies as neurodivergent, who helped the therapist learn to deepen receptivity by dipping into a less differentiated place to follow the here-and-now experience from the bottom up. Throughout the journey, interweaving neuroscientific and psychoanalytic perspectives offered a powerful matrix from which an enriched understanding of our process could emerge. Psychoanalytic concepts including evenly suspended attention, unconscious-to-unconscious communication, alpha function, reverie, and negative capability are explored alongside neuroscientific insights into the stress response, mirror neurons, and the default mode network. A predictive coding lens introduced a view of the therapeutic exchange as a continuous reciprocal prediction, evoking the hypothesis that deepening receptivity required opening awareness to incoming signals and lessening the hold of prior predictions. To bring greater therapist awareness to the present moment and lessen the influence of self-referential evaluation, neuroscientifically-informed reflections also inspired the practice of mindfulness. Subsequent developments suggest that these approaches helped deepen receptivity to the experiences being communicated, leading to new understandings with transformative potential.

ABSTRACT The purpose of this study is to return to Freud’s original descriptions of the primary and secondary processes in the light of modern neurosciences. In his Project for a Scientific Psychology, Freud draws the axes of the architecture of a mental apparatus: on a horizontal plane, the primary process transfers the excitation by impinging stimuli over a sequence of analogous states towards their discharge; thus, the primary process is essentially characterized by its associative tendency. On a vertical plane, the secondary process opposes the primary bottom-up pressure by a top-down inhibition with its origins in the purposive idea: the secondary process is essentially characterized by its inhibitory interventions. Freud later proposed that the primary and secondary process are seeking for perceptual, respectively thought identity. These different elements are coherent with the dynamics of the ventral and dorsal brain pathways respectively. Moreover, the dorsal pathway has an inhibitory influence upon the ventral pathway, much like the secondary has upon the primary. This influence is exerted thanks to what Freud called the “indications of reality.” We propose to equate these indications with the efference copies in modern neurosciences since they proceed from the same physiology and have the same function, besides originating from the same Helmholtzian source. Finally, even if both primary and secondary processes serve the death drive through the pleasure and the reality principle respectively, only the secondary process, requiring the bearing of an accumulation of excitations, also serves the life drive.

ABSTRACT As the knowledge derived from the dialog between neuroscience and psychoanalysis has provided relevant insights in topics such as affects, instincts, consciousness, memory, dreams, and many others, the question of its clinical applications has gained increasing interest. Using psychoanalytic techniques with neurological patients has gradually become a more common practice. However, integrating neuropsychoanalytic perspectives into work with non-neurological patients has represented a challenge that is being taken with caution. Case reports have been crucial for the development of psychoanalytic ideas. Based on this principle, progress in the clinical applications of neuropsychoanalytic knowledge can also benefit from case presentations. Nevertheless, the neuropsychoanalytic perspective entails added challenges. Hence, the editorial team of this journal gave a clinical writing workshop in February 2022. We present here brief essays that cover some of what we consider the most important topics involved in clinical writing in neuropsychoanalysis.