LAUSR

In its short lifetime, neuropsychoanalyis has been successful in promoting healthy dialogue between psychoanalysis and neighboring disciplines. We have taken on numerous theoretical issues of great consequence – for example, about dreams, drive theory, and the nature of both consciousness and the unconscious. Questions about the clinical applications of this dialogue, in contrast, have proceeded a bit more modestly; caution has guided any suggestions about changes in technique that might be suggested by neuropsychoanalytic developments. Similarly, any models of the processes underlying therapeutic action are understandably tentative, bounded by the constraints of good science. However, an energetic literature in clinical neuropsychoanalysis has indeed been emerging, both in our pages and in other venues. In this issue, the generative exploration of the clinical applications of neuropsychoanalysis continues. We have observations from clinical neuropsychoanalysis, which entails working psychodynamically with patients with brain injury, or thinking about the sequelae of brain injury from a psychoanalytic perspective. We also have some suggestions of how neuropsychoanalytic insights may be used to illuminate “ordinary” psychoanalytic process with nonneurological patients. First, Rudy Coetzer, Cathryn Roberts, Oliver Turnbull, and Frances Vaughan have contributed a thorough survey of the highly productive neuropsychoanalytic clinical work and research that has emerged from their service in Bangor, Wales. Their piece, entitled “Neuropsychoanalytically informed psychotherapy approaches to rehabilitation: The North Wales Brain Injury Service–Bangor University experience 1998–2018,” reviews a wealth of material that they and many colleagues have generated in the past 20 years. As readers will see, these clinicians and researchers are making an important contribution to the world of clinical neuropsychology, as they advocate for the importance of extended treatment for patients with brain injury that takes seriously their inner worlds, their emotions, their modes of affect regulation, and their interpersonal relationships. In a clinical report entitled “The mental apparatus in left MCA infarction: Relational language deficit and changes to ego function in conduction aphasia,” Michelle Jackson observes the impact of conduction aphasia in a woman whose brain injury affects her capacity to analyze and synthesize audioverbal structures. This impairment in a cognitive relational capacity, typically seen in primarily linguistic terms, is also interpreted as underlying a fundamental difficulty in relating herself to the therapist, and integrating insights, and thus is seen as affecting her ego functions. This is a particularly interesting case report, as there is rich and poignant process material from two phases of neuropsychoanalytically-oriented treatment, as Jackson worked with the patient after a first stroke, which affected more motoric aspects of language, and a second stroke, which impaired more underlying synthetic capacities. These two pieces of clinical neuropsychoanalysis are followed by a paper applying neuropsychoanalytic insights to a typical psychoanalytic treatment, in a piece entitled “Examination of the hypothesis that repression is premature automatization: A psychoanalytic case report and discussion” by Rob Smith and Mark Solms. This paper is an edited version of the dialogue between the authors from two neuropsychoanalytic events in New York and Chicago. We view this article as a fine stepping-off point for discussions about whether and how neuropsychoanalytic explorations might affect psychoanalytic treatment. In the paper, a psychoanalytic case presented by Dr. Smith is discussed by Dr. Solms in light of his recent hypotheses on repression. Solms proposes that repression is a fundamental phenomenon based on processes involving automating solutions to problems encountered in the first years of life. The nuanced description of Dr. Smith’s case is used to illustrate and interrogate Solms’s proposition that one of the mechanisms of change in psychoanalytic psychotherapy is the problematizing of “illegitimate” automated predictions, which interfere with the patient actually getting his needs met in his current life, so that the patient may acquire new predictions. Central to his proposal is the idea that working in the transference, or otherwise directly exploring the expectations or predictions that a patient has, allows for the creation of new predictions by bringing the unconscious expectations into consciousness, to the extent possible. The process is hypothesized to facilitate change through the laying down of new pathways, or perhaps transforming old pathways, through the reconsolidation of memory. In this issue we also have a theoretical paper which may have clinical implications. In their paper “Fantasy, Dream, Vision, and Hallucination: Approaches from a Parallactic Neuropsychoanalytic Perspective,” Lutz Goetzmann, Barbara Ruettner, and Adrian Siegel offer a novel heuristic device, a Moebius strip, as an analogy to help conceptualize the relationship between mind and brain. In this analogy,