Discussion: On Some Contributions of the Interpersonal Tradition to Contemporary Psychoanalytic Praxis

Writers identified with the interpersonal psychoanalytic tradition are primarily responsible for initiating the relational turn in psychoanalysis: the evolution from an objectivist one-person model of analytic praxis to that of an intersubjective, two-person paradigm. The two papers discussed here focus on two qualities in the analyst—curiosity and spontaneity—and how these elements of the analyst's subjectivity have helped lead to a potential enrichment of patients’ responsivity to analytic engagement.     

The Analyst as Catalyst: Cultivating Mind in the Shadow of Neglect

I describe an effort to cultivate mind and deepen relatedness in patients who exhibit rudimentary thought and constricted forms of object contact, due to the effects of certain neglect or serious disturbance. Some of these patients require the analyst to serve as a catalyst, who takes proactive steps to summon a psychic realm to the patient’s experience and to forge components of the dyadic bonds that promote such function. The insights of the object relations tradition into foreclosed development are noted. I argue that such insights can be optimally applied with the benefit of the relational school’s emphasis on forms of dyadic engagement and use of the analyst’s subjectivity. In some cases of neglect, and others in which serious developmental challenge is the result of disturbance, priority is placed on the patient’s growth. Similarly, in my case illustration, my goal in using my subjectivity, as a catalyst, is for my patient to take his own emerging mind and psychic self with interest.     

Making Music Together: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Finding life in our patients is a common goal for analysts. Historically this project had been defined as one of freeing unacceptable impulses from their imprisoning defenses with the analyst, via interpretation, then contrasting the patient’s internal fantasied reality with “actual” reality. Untangling fantasy from reality could free the impulses to provide energy for more realistic projects. This imagery stands in stark contrast to the fluidity of a contemporary relational conceptualization of human experience where our inner experience is now understood to be the lens through which we construct our vision of external reality, always a subjective perception. Clinical change—finding life—now depends more on the activation of a generative intersubjective process between patient and analyst, which contributes to the expansion of the patient’s subjective experience. Gianni Nebbiosi’s use of music and of mime to help him feel his way into his patient’s and ultimately into his own similarly defended experience demonstrates the creativity and idiosyncratic clinical approaches that emerge from a contemporary relational orientation. This orientation recognizes the analyst’s subjectivity as a fundamental tool of clinical change—a vehicle through which any theoretical approach will necessarily be shaped. Differing approaches to a clinical situation do not always simply reflect theoretical disagreements; they may also reflect the expression of the particular subjectivity of the analyst.     

Death Is Nothing at All: On Contemplating Non-Existence. A Relational Psychoanalytic Engagement of the Fear of Death

This paper engages the secular mind’s struggle with mortality from a relational perspective. It critically reviews the legacy of Freud’s refusal to grant mortality psychic significance and the ways in which the fear of death has consequently been understood theoretically and addressed clinically. Analytic omnipotence is foregrounded as an impediment to the kind of intersubjective engagement that minds need from other minds in grappling with the loss of the self through death. A clinical illustration is used to explore the ways in which the analyst found himself relating with a patient around her extreme fear of death, which over the course of treatment became modified into a more bearable anxiety about her own mortality. A conceptual framework is offered to account for these changes, emphasizing the analyst’s personal relationship with mortality as a crucial variable in how the fear of death is engaged psychoanalytically. The author calls for a revisionist psychoanalysis that allows for death’s centrality in both theory and practice.     

Forging Components Anew,Modes of Therapeutic Action: Reply to Discussions by Drs. Hirsch and Newirth

I elaborate my view of the analyst’s role as catalyst, and use of an enlivening presence, to foment the growth of mentalized thought in some patients. The need to forge certain components anew in such patients’ rendering of experience mentally is highlighted, in contrast to an emphasis on patients’ capability, expressed by Dr. Hirsch. I argue for a place for deficit in relational thought, and for a relational reframing of the concept. Compatibility is seen with Dr. Newirth’s focus on the transformation of mental processes as integral to therapeutic action and the value of Bion’s models of containment and thinking in striving toward such ends.     

Deep Diving: Imagination,Intuition, and the Interpenetration of Minds

How do we help patients who come to us without access to feelings and without curiosity about themselves and others? The author suggests that the analyst’s imagination and intuition provide a channel or medium through which to apprehend aspects of the patient’s internal life, make contact and communicate with younger parts of the patient, and provide containment to these parts of the person. As the analyst engages her imagination in this way, communication channels open and shared states of consciousness between analyst and patient are created, thereby facilitating the interpenetration of minds and the opening up of previously closed object worlds. In the course of this work, compassion serves as a vehicle for truth, penetrating previously closed object relational systems. This kind of work poses risks for the analyst.     

Vulnerability,Resilience, and Surviving Destruction: Discussion of “The Analyst’s Experience of Trust and Mistrust”

In this response to Danielle Novack’s intellectually astute and clinically rich paper on the “analyst’s trust,” I reflect on the valuable ways in which Novack elucidates this undertheorized aspect of the analyst’s experience and reconfigures trust/mistrust as a meaningful intersubjective dimension of the therapeutic relationship. Novack shows how attending to shifts in trust/mistrust can provide valuable clues for deciphering the transference/countertransference. While I strongly agree with her construction of trust as a psychoanalytic achievement, I question the notion that the analyst’s trust is a necessary condition for her participation. Novack’s work on the analyst’s trust joins a broader contemporary conversation about potential overreaches in the relational paradigm, which I discuss. Finally, I consider the implications of Novack’s work for specifying the factors that underly resilience and engaging a conversation about surviving destruction in contemporary relational psychoanalysis.     

On Relational Hierarchy: Friends or Parents? Discussion of Lisa Director and Robert Grossmark

Two very successful clinical experiences are presented to illustrate each analyst’s preferred ways of engaging clinically with patients. In my discussion I contend that analysts’ preferred theories of therapy often drive the nature and texture of analytic engagement and that each analyst works best in the context of embracing those cherished theories. More specifically, I attempt to contrast psychoanalytic traditions that, on one hand, situate the analyst in a hierarchical parental role and, on the other hand, conceive of the analyst as more of a flawed peer.     

Originality,Dread, and Object Usage: Commentary on Papers by Sarah Mendelsohn and Deborah Dowd

Both Deborah Dowd and Sarah Mendelsohn capture the fraught experience of staying near a patient’s dread. I discuss dread as an engagement with unrepresented trauma. With each case I interpret a critical clinical moment as an instance of Winnicott’s object usage, by which the patient leaves omnipotence and finds externality. I introduce a crucial meaning of object usage that I find only implicit in Winnicott’s text: Not only must the analyst survive the patient’s destructiveness, but the analyst also must be disrupted by the patient’s unrepresented trauma. Their patients’ experience of this disruption positions each of these analysts as an other who can be used.     

The Things We Carry: Finding/Creating the Object and the Analyst’s Self-Reflective Participation

I reflect on the interaction between the analyst’s dedicated attention to the patient’s internal object relations and the analyst’s self-reflective participation. Our stops and starts of attention to the patient’s internal objects and our own is in some sense one of the most important elements of our personal participation. I suggest that the patient’s and analyst’s needs for privacy and the illusion of privacy in the presence of the other, undertheorized within relational theory, is not at odds with an emphasis on valuing the patient’s capacity for a “read” on the analyst. Needs for privacy and the illusion of privacy held by patient and analyst need to be integrated into any psychoanalytic theory and form part of the basis of intimate regulatory systems between two people.     

Contexts,Polarities, and Pluralism. Discussion of Slochower’s “Going Too Far: Relational Heroines and Relational Excess”

In her searching paper “Going Too Far: Relational Heroines and Relational Excess,” (this issue) Slochower finds the potential for excess as inherent in any psychoanalytic theory. I argue that context is key in understanding this phenomenon within relational psychoanalysis; what she describes may not be the case for other theories. The beginnings of relational theory as a movement, generational and radical, could lead to therapeutic overconfidence or certainty around countertransference insights and disclosures. Slochower sees an abundance of certainty in this stance, as well as pressure for premature mutuality. As a complement or balance to this intense mode of interpersonal engagement, Slochower elaborates her own work on holding, wherein the analyst “brackets” her experience and respects the patient’s need for privacy and nonimpingement. Uncertainty is an affirmative stance in letting the patient’s inner life come into being. There are a number of polarities in Slochower’s paper—between mutuality and privacy, certainty and uncertainty, and in the origin story of relational psychoanalysis between relational and classical theories. I argue that pluralism offers a path forward from polarities to a rich complex world of multiple possibilities and recognition of different minds and theories.     

The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness”

I define the analyst’s generous involvement as inherent to human encounter and a necessary element of therapeutic process. When the analyst’s generous involvement goes missing, it can be read as a sign of disengagement and disconnection. Using as metaphor H. S. Sullivan’s concept of the “tension of tenderness,” I argue that the analyst’s recognition of a need or affect state in the patient evokes an internal tug constituting the analyst’s need to provide for what has been recognized. I elaborate on what the analyst’s generous involvement is, and what it is not, including countertransference pitfalls and corruptions that may masquerade as generosity. I engage a relational conversation with the radical ethical ideas of Emmanuel Levinas. An extended clinical vignette illustrates the challenges and conflicts entailed in the analyst’s finding an analytically useful form of expressing the tug of generous involvement in the immediate moment.     

What’s So Great About Authenticity Anyway? The Therapeutic Function of an Analyst’s Lie

How can we understand moments when the analyst lies to her patient? When it’s not the patient’s lying at issue but the analyst’s? When we suddenly find ourselves being deliberately disingenuous in the analytic hour? When our commitment to authenticity conflicts with the patient's need to create and sustain certain fantasies about us? Psychoanalytic literature typically focuses on the dynamics of the patient’s lie but rarely is the analyst's authenticity questioned. Are there times when the analyst might choose to lie in order to preserve herself, as well as, the relational bond? The complexity of this “choice” is explored and the erosion of an analyst’s authenticity unpacked during the final days of a difficult treatment.     

Trauma and the transference‐countertransference: working with the bad object and the wounded self

This paper focuses on the transference‐countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma‐related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference‐countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual‐aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the ‘wounds’ that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self‐object, in order to enable the patient to safely express and ‘be’ themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto‐sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring ‘humanity’ (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.     

Relational Psychoanalysis and the Inner Life: Commentary on Cooper,Corbett, and Seligman

Relational analysts know that their experience feels private and contemplative during a significant portion of their working hours. A consideration of the inner life, both the analyst’s and the patient’s, is part of relational praxis. Yet relational analysts also recognize that they are continuously involved with their patients, even at those very same quiet moments. Cooper, Corbett, and Seligman recognize both these parts of relational clinical work and argue that both are necessary. Making this argument explicit is important for its own sake, but also because analysts from other schools sometimes write as if there is no place in relational clinical practice for a quiet consideration of the inner life. Two examples of such criticism are offered, in both of which relational analysts are described as being too focused on social interaction and too little on the inner life. I offer my own version of the kinds of arguments about privacy and contemplation offered by Cooper, Corbett, and Seligman. I then make the case that all psychoanalytic theories come with risks of excess. Relational and interpersonal theories come with the risk of an overenthusiastic embrace of clinical interaction, whereas more intrapsychic theories carry the risk of attending too little to the impact on their patients of present-day relatedness—which is just as likely to have unconscious roots as the inner life.     

The Great Mother and the Terrible Mother: mimesis,alterity and attachment in adolescence

This paper discusses attachment, the longing for familiarity and sameness (mimesis), the search for difference and separateness (alterity) and the problem with the Other¹ seen through the lens ofthe individuation process in adolescence. These are explored with reference to relational aspects and Levinas and Girard's divergent views of the Other. The relational space, which in Phillip Bromberg's (2003) words is ‘uniquely relational, but still uniquely individual’ and in which analyst and patient ‘stand together in the space between realities’, might under exceptional circumstances be transformed into ‘a twilight space where the impossible becomes possible’ (p. 573). I will sketch a developmental trajectory starting from primitive states, in which the presence of the Other,as a separate entity cannot be tolerated and where the patient strives for total mimesis. Should the analyst prematurely shatter this illusion, she becomes an alien ‘Other’; a wolf in sheep's clothing. I trace the current psychoanalytic paradigm shift to an emphasis on the co‐creation of meaning in the interpersonal space and explore what alterity consists of and how much of the other's unknowability can be tolerated and respected without a translation into one's own idiom. The clinical vignettes illustrate aspects of therapy which normally lie outside the analytical remit and are culled from an inpatient setting and private practice.     

The Unobtrusive Relational Analyst

I describe an unobtrusive relational approach to the psychoanalytic treatment of nonalive and nonspeakable states and ways of being. I build upon a contemporary relational sensibility that values the intersubjective engagement of analyst and patient and the enactment of dissociated and unformulated states, together with the concepts of regression and the unobtrusive analyst central to the work of the British independent analysts, with a special focus on Michael and Enid Balint. I stress that in being unobtrusive, the analyst is not neutral or abstinent, but deeply engaged and becomes the analyst the patient needs. A case is offered as an account of analytic work that was enhanced and made possible by my engaged but unobtrusive presence, and the privileging of the patient's own idiom, object relating and early developmental needs. I offer a contemporary rendition of regression that encompasses mutuality, regulation and accompaniment. I suggest a concept of “benign regressive mutual regulation” and outline and differentiate some of the influences from the contemporary psychoanalytic field.     

The “Once and Future” Focus of a Relational Psychoanalysis: Discussion of “Vitalizing Enactment”

In this discussion of Amy Schwartz Cooney’s paper (this issue) I focus on the current interest in relational theorizing on the analyst’s proactive role vis-à-vis her patient, that is, what she actually does for or gives to her patient. I consider the role of the analyst’s own internal “bad” objects in facilitating or inhibiting the therapeutic process. I end with a set of theoretical propositions about the ways in which an intense and deadening shame can lead to dissociation and/or repression of hopeful fantasies about the future.     

The patient's transference experience of the analyst's gender: Projection,factuality, interpretation,or construction

The constructivist/relational perspective has challenged the analyst's emotional superiority, her omniscience, and her relative removal from the psychoanalytic dialogue. It at first appears to be antithetical to treatment approaches that emphasize the analyst's holding functions. In this essay I examine the holding model and its resolution from a relational perspective. I propose that the current discomfort with the holding function is related to its apparent, but not necessarily real, implications. I discuss the analyst's and patient's subjectivity during periods of holding. I believe that the holding process is essential when the patient has intensely toxic reactions to “knowing”; the analyst and is therefore not yet able to stand a mutual analytic experience. During holding, the patient experiences an illusion of analytictic attunement. This requires that the analyst's dysjunctive subjectivity be contained within the analyst, but not that it be abandoned. Ultimately, it is the transition from the holding position toward collaborative interchange that will allow analyst and patient explicitly to address and ultimately to integrate dependence and mutuality within the psychoanalytic setting and thereby engage in an intersubjective dialogue. The movement toward mutuality will require that the analyst of the holding situation begin to fail in ways that increasingly expose her externality and thus her subjectivity to the patient.