Elements of analytic style: Bion's clinical seminars

The author finds that the idea of analytic style better describes significant aspects of the way he practices psychoanalysis than does the notion of analytic technique. The latter is comprised to a large extent of principles of practice developed by previous generations of analysts. By contrast, the concept of analytic style, though it presupposes the analyst's thorough knowledge of analytic theory and technique, emphasizes (1) the analyst's use of his unique personality as reflected in his individual ways of thinking, listening, and speaking, his own particular use of metaphor, humor, irony, and so on; (2) the analyst's drawing on his personal experience, for example, as an analyst, an analysand, a parent, a child, a spouse, a teacher, and a student; (3) the analyst's capacity to think in a way that draws on, but is independent of, the ideas of his colleagues, his teachers, his analyst, and his analytic ancestors; and (4) the responsibility of the analyst to invent psychoanalysis freshly for each patient. Close readings of three of Bion's 'Clinical seminars' are presented in order to articulate some of the elements of Bion's analytic style. Bion's style is not presented as a model for others to emulate or, worse yet, imitate; rather, it is described in an effort to help the reader consider from a different vantage point (provided by the concept of analytic style) the way in which he, the reader, practices psychoanalysis.     

On teaching psychoanalysis

Teaching psychoanalysis is no less an art than is the practice of psychoanalysis. As is true of the analytic experience, teaching psychoanalysis involves an effort to create clearances in which fresh forms of thinking and dreaming may emerge, with regard to both psychoanalytic theory and clinical practice. Drawing on his experience of leading two ongoing psychoanalytic seminars, each in its 25th year, the author offers observations concerning (1) teaching analytic texts by reading them aloud, line by line, in the seminar setting, with a focus on how the writer is thinking/writing and on how the reader is altered by the experience of reading; (2) treating clinical case presentations as experiences in collective dreaming in which the seminar members make use of their own waking dreaming to assist the presenter in dreaming aspects of his experience with the patient that the analytic pair has not previously been able to dream; (3) reading poetry and fi ction as a way of enhancing the capacity of the seminar members to be aware of and alive to the effects created by the patient's and the analyst's use of language; and (4) learning to overcome what one thought one knew about conducting analytic work, i.e. learning to forget what one has learned.     

DREAMING THE ANALYTIC SESSION: A CLINICAL ESSAY

This is a clinical paper in which the author describes analytic work in which he dreams the analytic session with three of his patients. He begins with a brief discussion of aspects of analytic theory that make up a good deal of the context for his clinical work. Central among these concepts are (1) the idea that the role of the analyst is to help the patient dream his previously “undreamt” and “interrupted” dreams; and (2) dreaming the analytic session involves engaging in the experience of dreaming the session with the patient and, at the same time, unconsciously (and at times consciously) understanding the dream. The author offers no “technique” for dreaming the analytic session. Each analyst must find his or her own way of dreaming each session with each patient. Dreaming the session is not something one works at; rather, one tries not to get in its way.     

Patient-therapist match: revelation or resistance?

Patient-therapist match is a relatively new yet frequently invoked concept within psychoanalysis. Despite Freud's appreciation of the influence of the analyst's past to his or her work within the analytic setting, psychoanalysts have historically held varied opinions about the degree to which the analyst's personality and conflicts affect the analytic process. As analysis was reconfigured as a two-person system, attention focused on the fit between patient and analyst. The literature on patient-therapist match is reviewed, and the conclusion reached that this intuitively appealing concept suffers from a lack of rigorous definition and operationalization. Many authors invoke match in ways that imply that it is real, static, external to the domain of analytic inquiry, and unaffected by analytic process. In its present form, the concept of patient-therapist match obstructs rather than facilitates analytic exploration and obscures rather than clarifies what happens between analyst and analysand in psychoanalysis. By suggesting that match exists as a reality outside the domain of transference and countertransference, analysts may overlook the importance of psychoanalytic technique in creating a sense of match. Analysts may attribute stalemated or limited analyses to a bad match, rather than tenaciously exploring the transference-countertransference configurations that remain at the heart of analytic work.     

On talking-as-dreaming

Many patients are unable to engage in waking-dreaming in the analytic setting in the form of free association or in any other form. The author has found that 'talking-as-dreaming' has served as a form of waking-dreaming in which such patients have been able to begin to dream formerly undreamable experience. Such talking is a loosely structured form of conversation between patient and analyst that is often marked by primary process thinking and apparent non sequiturs. Talking-as-dreaming superficially appears to be 'unanalytic' in that it may seem to consist 'merely' of talking about such topics as books, films, etymology, baseball, the taste of chocolate, the structure of light, and so on. When an analysis is 'a going concern,' talking-as-dreaming moves unobtrusively into and out of talking about dreaming. The author provides two detailed clinical examples of analytic work with patients who had very little capacity to dream in the analytic setting. In the first clinical example, talking-as-dreaming served as a form of thinking and relating in which the patient was able for the first time to dream her own (and, in a sense, her father's) formerly unthinkable, undreamable experience. The second clinical example involves the use of talking-as-dreaming as an emotional experience in which the formerly 'invisible' patient was able to begin to dream himself into existence. The analyst, while engaging with a patient in talking-as-dreaming, must remain keenly aware that it is critical that the difference in roles of patient and analyst be a continuously felt presence; that the therapeutic goals of analysis be firmly held in mind; and that the patient be given the opportunity to dream himself into existence (as opposed to being dreamt up by the analyst).     

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience-for which both and neither of the members of the analytic pair may claim authorship-in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.     

On not being able to dream

In this paper, the author explores the phenomenon of not being able to dream (as opposed to not being able to remember one's dreams) from three different vantage points. First, from the point of view of psychoanalytic theory, he discusses Bion's idea that the work of dreaming creates the conscious and unconscious mind (and not the other way around). A person who cannot dream is unable to generate differentiable conscious and unconscious experience and, consequently, lives in a psychic state in which he is unable to differentiate waking from sleeping, dreaming from perceiving. The author then approaches the problem of the inability to dream from the perspective achieved by a literary work. He discusses a Borges fiction that creates, in a singularly artful way, the experience of not being able to dream. Finally, the author utilises the vantage point of a detailed account of a clinical experience to explore what it means not to be able to dream. He describes an initial state characterised by the patient's proliferation of unutilisable 'psychic noise' which, over a period of years, led to the analyst's experiencing 'reverie-deprivation' and brief periods of countertransference psychosis. Two analytic sessions are presented and discussed in which psychological work was done that contributed to an enhanced capacity on the part of both patient and analyst for genuine dreaming - both in sleep and in analytic reverie states.     

Fromm's Impact on Interpersonal Psychoanalysis: A Well Kept Secret

Erich Fromm was one of the founders of the William Alanson White Institute in New York City and an important contributor to the development of the interpersonal approach to psychoanalysis. Many of Fromm's ideas about psychoanalysis have found their way into the mainstream of analytic thinking. Much of what he taught in supervision and in his lectures had to do with the role of the analyst, the analyst's use of himself in the analytic process and the necessity that the analyst experience what his patient is experiencing. From did not necessarily use terms like projective identification but his understanding presaged much of what analysts talk about today. Fromm himself did not write much about clinical practice. And while he repeatedly expressed his respect for Freud he was explicit in his disagreements. Fromm rejected the notion of the analyst as a blank mirror. Instead, analysis requires a passionate wish for truth both in the analysand and the analyst. Fromm calls this passion biophilic, implying that the unconscious does not only harbor destructive drives that need to be tamed; it also harbors creative drives which, while also irrational, are constructive and need be liberated through the analysis.     

On dreaming one's patient: reflections on an aspect of countertransference dreams

This paper explores the phenomenon of the countertransference dream. Until very recently, such dreams have tended to be seen as reflecting either unanalyzed difficulties in the analyst or unexamined conflicts in the analytic relationship. While the analyst's dream of his/her patient may represent such problems, the author argues that such dreams may also indicate the ways in which the analyst comes to know the patient on a deep, unconscious level by processing the patient's communicative projective identifications. Two extended clinical examples of the author's countertransference dreams are offered. The author also discusses the use of countertransference dreams in psychoanalytic supervision.     

“Why do (don't) you ask?” transference and the desire (not) to know

One of the criterial distinctions of psychoanalysis is its renunciation of indoctrination through suggestion. In spite of the fact that psychoanalysis is both an organized body of knowledge and a disciplined form of interpersonal influence, it regards an analyst who tells the analysand what to think or do as essentially doing harm by substituting a new form of prejudice and alienation for the preexisting form he is attacking. Even though an analyst regards his knowledge of psychoanalytic theory as adequate at a general level, this "truth" is not an adequate mode of discourse with an individual. Why not? It is a fact that analysands often do not accept an analyst's idea. However, the fundamental problematic of clinical psychoanalysis comes precisely at the point that the analysand would accept the analyst's idea, involving the distinction between a properly psychoanalytic cure and a transference cure. Psychoanalytic theory itself holds that unreflective incorporation of another's idea about oneself comes at the expense of autonomous and spontaneous self-revelation. Despite its resolute pursuit of new truths, the aim of psychoanalysis is less concerned with attaining specific ideas about unrecognized conflicts than it is with achieving a general attitude--that self-understanding requires a capacity to admit dubious and unwanted ideas and feelings that symptoms, dreams, and free associations bring to light. This "psychoanalytic" attitude permits a new type of discourse in which the person recognizes himself or herself through expression, rather than parrotting the analyst's (or others') words, or continuing rigidly to hide the truth of desire for oneself. In the long run, psychoanalysis offers to correct a primary misunderstanding: that one can acquire a comprehensively true image of oneself. As Barratt (1988) emphasizes, this transformation is tantamount to a change in personal epistemology for the analysand and a change in epistemological theory for the culture as a whole. In our culture, most analysts and lay people alike take for granted that the ego is an agent that is to be integrated and strengthened in order to direct one's life. Likewise, the unconscious is commonly regarded as a type of savage alter ego that must be mastered by the ego. According to Lacan's critique, the ego is a snare and a delusion for the patient, however highly commended by society it may be, because its very essence is to furnish the illusion of enduring self-knowledge.(ABSTRACT TRUNCATED AT 400 WORDS)     

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fi ction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.     

Dreaming as a 'curtain of illusion': Revisiting the 'royal road' with Bion as our guide

One of Bion's most unique contributions to psychoanalysis is his conception of dreaming in which he elaborates, modifies, and extends Freud 's ideas. While Freud dealt extensively with dream-work, he showed more interest in dreams themselves and their latent meaning and theorized that dreams ultimately constituted wish-fulfillments originating from the activity of the pleasure principle. Bion, on the other hand, focuses more on the process of dreaming itself and believes that dreaming occurs throughout the day as well as the night and serves the reality principle as well as the pleasure principle. In order for wakeful consciousness to occur, dreaming must absorb (contain) the day residue, and transfer it to System Ucs . from System Cs . for it to be processed (transformed) and then returned to System Cs . through the selectively-permeable contact-barrier. Dreaming, consequently, allows the subject to remain awake by day and asleep by night by its processing of the day's residue. Bion seems to conceive of dreaming as an ever-present invisible filter that overlays much of our mental life, including perception, as well as attention itself. He further believes that dreaming is a form of thinking that normally involves the collaborative yet oppositional (not conflictual) activity of the reality and pleasure principles as well as the primary and secondary processes. He also conflates Freud 's primary and secondary processes into a single 'binary–oppositional' structure ( Lévi-Strauss, 1958, 1970 ) that he terms 'alpha-function', which constitutes a virtual model that corresponds to the in-vivo activity of dreaming. He further believes that the analyst dreams as he or she listens and interprets and that the analysand likewise dreams while he or she freely associates.     

Psychic reality in the psychoanalytic process.

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities. Thus, components of the analytic relation--transference/countertransference, alliance, and real relation--are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false-each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.     

Toward a definition of psychoanalytic neutrality

The word and concept of neutrality play an important but confusing role in the history of psychoanalysis. Does neutrality imply indifference? The origin of this ambiguity is traced to the fact that Freud himself never used the word "neutrality" (Neutralitaet) in his own writings. (His term Indifferenz was translated as "neutrality" by Strachey.) The essence of the controversy that has simmered in the psychoanalytic literature ever since is contained in the question: "Is remaining true to the concept of neutrality somehow antithetical to the analyst's genuine involvement with the patient?" In this paper, I examine the feeling and power aspects of the word and suggest that the concept of neutrality becomes clinically useful when the analyst asks himself the question, "Neutral to what?" The analyst's awareness of his motives for recognizing and addressing certain conflicts and for overlooking others is heightened. With three clinical vignettes as illustrations, I explore the role of the concept of neutrality in deepening our understanding of (1) the analytic relationship; (2) The influence, on the conduct of the treatment, of the analyst's goals and theoretical persuasion regarding how the goals are to be achieved. As examples, I use the current debates over the relative value of the analyst's focusing his attention on: (a) the patient's mind in the hour rather than his life outside the hour and, (b) transference over nontransference interpretation. Finally, I emphasize the far-reaching implications of adding an explicit concept of "external reality" to A. Freud's exclusively intrapsychic definition of the "objective" analyst's position of neutrality as equidistant from id, ego, and superego. The addition of this fourth point to the analyst's "compass" widens the analytic field toward which the analyst is neutral. The concept of neutrality with respect to specifiable conflicts is thereby also broadened to include (a) interpersonal conflict within the psychoanalytic relationship and (b) conflict within the analyst. With these explicit additions, the concept of neutrality with respect to conflict becomes congruent with the current emphasis on the nonauthoritarian two-persons aspects of the psychoanalytic relationship, without detracting from the primary analytic goal of deeper understanding of intrapsychic conflict.     

Exploring a patient's shift from relative silence to verbal expressiveness: Observations on an element of the analyst's participation

By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.     

Insight and the analytic dyad

Insight reflects the unitary nature of psychic activity in contrast to the fragmentation created in abstracting categories for the purpose of study and discussion. The unique analytic clinical dyad offers a structure in which intrapsychic fragments can be actualized and integrated. As a result, the analyst's contribution is more crucially one of exploration than of revelation. Whatever the area of examination, past or present, the link to analytic immediacy offers the opportunity to make meanings meaningful, to convert known facts to psychic truths. The analyst's clinical task requires his private self-analysis as part of the collaborative exploration of how the patient's mind works. Higher level ego functioning, including acutely active remembering, is at times transiently loosened in order for the analyst to share in the clinical work of discovery. The words the analyst uses to communicate his understanding convey only approximate manifest meanings, though they structurally reveal deeper messages of importance to the patient. These verbal approximations help stimulate self-reflection in the analysand as a step in the process of gaining insight.     

The analyst's theory: A third source of countertransference

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory - because it has no intrinsic relevance to the essential phenomena of individual analytic processes - may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.     

Losing a training analyst for ethical violations: A candidate's perspective

The author presents her experience as the analysand of a training analyst who was investigated and expelled for ethical violations with another patient, including sexual-boundary violations, during her analytic training. While boundary violations by training analysts are not uncommon, the particular trauma experienced by 'bystanders' such as candidates and supervisees is not discussed in the literature, nor the response of institutes to the educational problems that are generated. The author illustrates the complications for candidates that arise from the dual roles of training analyst as educator and analyst when he or she faces investigation or censure, including isolation and secrecy, which promote various splits in the candidate, analytic dyad and group, as well as loyalty conflicts. The discussion covers three phases of the author's experience as a candidate-analysand, namely the period encompassing the institute's ethics investigation, the announcement of findings to her and to the institute as a group, and the ensuing individual and group dynamics generated by her analyst's expulsion from the institute and revocation of his medical license. Theoretical perspectives are utilized to understand the group regression, including contamination and contagion fears, which occurred in the wake of the training analyst's expulsion, and the impact of these processes on the candidate, including the pressure to function as a 'container' for projections of the group. Implications and recommendations for candidates and institutes are made for dealing helpfully with trainees who are affected by the process of dealing with a training analyst's ethical violations. Short-term and longer-term outcomes of the experience are considered.     

From Freud’s dream-work to Bion’s work of dreaming: The changing conception of dreaming in psychoanalytic theory

Bion moved psychoanalytic theory from Freud's theory of dream-work to a concept of dreaming in which dreaming is the central aspect of all emotional functioning. In this paper, I first review historical, theoretical, and clinical aspects of dreaming as seen by Freud and Bion. I then propose two interconnected ideas that I believe reflect Bion’s split from Freud regarding the understanding of dreaming. Bion believed that all dreams are psychological works in progress and at one point suggested that all dreams contain elements that are akin to visual hallucinations. I explore and elaborate Bion’s ideas that all dreams contain aspects of emotional experience that are too disturbing to be dreamt, and that, in analysis, the patient brings a dream with the hope of receiving the analyst’s help in completing the unconscious work that was entirely or partially too disturbing for the patient to dream on his own. Freud views dreams as mental phenomena with which to understand how the mind functions, but believes that dreams are solely the ‘guardians of sleep,’ and not, in themselves, vehicles for unconscious psychological work and growth until they are interpreted by the analyst. Bion extends Freud's ideas, but also departs from Freud and re-conceives of dreaming as synonymous with unconscious emotional thinking – a process that continues both while we are awake and while we are asleep. From another somewhat puzzling perspective, he views dreams solely as manifestations of what the dreamer is unable to think.