Strangers to Ourselves: Exploring the Limits and Potentials of the Analyst's Self Awareness in Self- and Mutual Analysis

The analyst's self-analysis—originally fashioned on Freud's solo foray into his own unconscious mind—continues to play an important psychoanalytic role. A summary of relevant literature is presented that includes recent relational psychoanalytic and neuroscientific data. Three major findings emerge: First, analysts' achievement of self-awareness in the analytic setting is clearly limited, more limited than we might like to admit, especially when we act alone; second, analysts reaching clinical self-awareness is a mutual, interactive process that, in addition to psychological processes, can be understood on the basis of operations uncovered by neuroscience, especially the mirror neuron system; third, accordingly, a form of “mutual” analysis is seen as an indispensable element of the analytic process. Analysts' achievement of self-awareness is discussed with a particular focus on our intrinsic relationality, and on mentalization, self-reflexivity, new relational experience, and therapeutic action. Illustrative case material is discussed.     

CHEMISTRY AND CONTAINING: THE ANALYST'S USE OF UNAVOIDABLE FAILURES

Certain patients overwhelm the analyst's capacity to contain both the patient and the analyst's own unbearable feelings. Though some such failures of containing may lead fairly quickly to self‐correction and others to clinical impasse, our focus is on an in‐between state in which the analyst's ability to tolerate his inevitable failures and gradually to (re)establish his containing capacities through difficult self‐analytic work can lead to significant change that might not otherwise be possible. The authors argue that this internal psychological work on the analyst's part, which may require considerable time, effort, and suffering, is an important aspect of “good enough” containing. The unique chemistry generated between patient and analyst plays an important role in both establishing and maintaining this kind of productive analytic process.     

Vulnerability,Affect, and Depth in Group Psychotherapy

This paper describes the importance of a clinical focus on affect and narcissistic vulnerability in the deepening of therapeutic process. An experience of the analyst's emotional availability and understanding is also essential to mutative change. The case material illustrates how such a focus, within a relational context that includes the analyst's own vulnerability, can lead to change.     

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.     

From “disciplined subjectivity” to “taming wild thoughts”: Bion's elaboration of the analysing instrument

Abstract

Freud encouraged the analyst to use his unconscious “as an instrument of the analysis,” but did not elaborate on how this should be done. This recommendation opened the door to a consideration of unconscious communication between the analyst and patient as an intersubjective exchange. Both Wilfred Bion and Erik Erikson emphasised the importance of the analyst's intuition, and the author compares and contrasts these two approaches. Erikson advocated a more cautious attitude regarding the analyst's subjectivity, while Bion promoted a broader application of the analyst's various private reactions to the analysand. A brief vignette from the analysis of a five-year-old boy is offered to illustrate the importance of the analyst's reveries, the mutual process of containment and transformation between analyst and patient, and the co-creation of an analytic narrative.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

The Fusion of Horizons: Dissociation,Enactment, and Understanding

All understanding is context dependent, and one of the most significant contexts for clinical purposes is the self-state. How we understand the other, and ourselves, depends on the state(s) we occupy. Dissociations between an analyst's self-states can, therefore, limit or impede understanding of the analysand by depriving the analyst of a fitting context within which to grasp what the analysand says and does. Clinical understanding may require the breach of such dissociations. I lay out some of the implications of thinking about transference and countertransference along these lines, with detailed examples illustrating the consequences of the analyst's dissociations and their eventual resolutions. Among the advantages of this way of thinking is that it amounts to a psychoanalytic account of the hermeneutic circle.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

THE USE OF THE ANALYST AND THE SENSE OF BEING REAL: THE CLINICAL MEANING OF WINNICOTT'S “THE USE OF AN OBJECT”

“The Use of an Object and Relating through Identifications” (1968) represents Donald Winnicott's theoretical and clinical legacy. The author develops this concept from a clinical point of view, through the analysis of a woman with psychotic functioning. He reflects upon the dramatic quality of risks inherent in the processes linked to the use of the object with seriously disturbed patients. He explores different meanings of the analyst's survival, linking it to the analyst's response. The processes of the use of the object—that is, the encounter between the patient's potential destructiveness and the analyst's capacity to respond through his own judicious subjectivity—let the patient experience the analyst's capacity to keep his own subjectivity, authenticity, and creativity alive. It is starting from the traces of this live object that patients gradually form their own personal sense of being real.     

The Particularities of Form: Reply to Commentary

In this brief reply to Bollas's commentary on our paper about his work, the cycles of intersubjective dialogue endlessly sustaining should be apparent. We begin with an example of the form—content distinction and attempt to use it as a springboard for further disentangling some of the nuances of Bollas's intersubjective theorizing. Bollas's emphasis on form over content as a means of conceptualizing the analyst's contribution to the analytic process is indeed compelling. We all know from both sides of the couch the profoundly different meanings and messages that an analyst's mien invites: whether she's abrupt, verbose, meditative, tranquil. Yes, the medium is the message, and, thus, whether the analyst conveys a message through the effects of form that Bollas points out, such as “We have all the time you need for the nuances of unconscious figuring” versus “This is hot—we hafta figure it out now” surely does have an effect on the psychic material produced in the analytic process. We go on to add to Bollas's discussion of form by considering the particularities of form and how these too affect the analytic process.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Creating an Intersubjective Reality: Commentary on Paper by Arnold Rothstein

The author discusses Arnold Rothstein's paper “Compromise Formation Theory: An Intersubjective Dimension” and challenges his definition of intersubjectivity. She offers a perspective in which the import of intersubjectivity theory is less to dissolve the notion of objectivity than to grasp processes of mutual engagement, regulation, and recognition. While it is true that the recognition that the analyst is also a subject and therefore does not have exclusive knowledge is an important shift in the psychoanalytic paradigm, the author suggests that the intersubjective is far more encompassing than this. Intersubjective theory emphasizes the active creation of consensus or conflict about reality rather than merely the recognition that the analyst's perspective on reality is subjective. This cocreation produces a different emotional experience of connection, not merely a change in the quality of insight. Finally, Rothstein's case illustrates how he responds to the need for recognition and regulation. He shows us how focusing on the procedural allowed him to make an intersubjective shift, not simply an intrapsychic interpretation of compromise formation.     

Meditations on Aggression,Loss, Discovery,and Influence in Psychoanalysis

Psychoanalysis requires acts of creative destruction. At the same time that analysts create new ways of being for themselves and each other, old ways are consequently destroyed. Just as parents envision futures for their children, analysts envision futures for their patients, reflecting a desire or effort to change them. Awareness of the destruction inherent in facilitating growth can enrich an analyst's work, but anxiety about being destructive, and being destroyed, can stifle it. This paper presents an analyst's reflections on creative and destructive aspects of psychoanalysis. Autobiographical and clinical data are presented to illuminate this theme.     

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept ‘unconscious fantasy’ attempts to describe it from a ‘bottom‐up’ perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a ‘bottom‐up’ perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as ‘unconscious fantasy’, allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy.     

Lies and Body Cruelties in the Analytic Hour

Discussing an intensive case study of female sexual dysfunction, this paper studies mutual deregulation and disintegration as it unfolds in the transference–countertransference dyad. I propose that ethical transgressions are potentiated in analytic dyads in which the analyst's hope for either solitude or mutuality is foreclosed. This hope can be foreclosed by the particulars of the therapeutic interaction as well as by the theoretical and clinical aspects of analytic training. The deregulation that both precipitates and follows such transgression can be healed (in the analyst, in the analysis) only by the restitution of the therapist's agency, the reduction of paranoid-schizoid guilt and shame, and the location (in the analyst) of depressive, “I-Thou” remorse.     

Inside Out: The State of the Analyst and the State of the Patient

This paper presents my work with a man before and after my undergoing an emergency, life-threatening surgical episode, and subsequent experience of living with a temporary colostomy, that shifted me to a more ungrounded, bodily aware, vulnerable, nonlinear, spontaneous and risk-taking, and affectively intensified “right brain” state. My story represents one instance of how the contingent nature of the analyst's life and existential exposure, and the various chancy life circumstances governing the analyst's self-state, may constitute an impingement on clinical process with potential for inadvertent positive or negative impact on the therapeutic relationship and work. Much has been written about the causes and consequences of shifts in the analyst's self-state induced within the relational dynamics of the transference-countertransference matrix. Here I specifically consider that side of the intersubjective therapeutic equation generated by the effects of the analyst's own state on the patient and the dyad's interactive process.     

Analytic Idealizations and the Disavowed: Winnicott,His Patients,and Us

This paper explores the dynamics of mutual idealization within the analytic dyad. While the subject of idealization is not a new one, very little has been written about the analyst's own participation in patients' idealizations or her vulnerability to idealizing the patient. I use both published and unpublished materials to muse about coconstructed idealizations as they appear to have coalesced in Winnicott's treatment of Masud Khan and Harry Guntrip. Because the notion that we might be involved in being idealized by our patients—or in idealizing them—collides with our professional vision, we tend to be highly resistant to acknowledging these dynamics and often turn to denigration when they are unmasked. I argue for the ubiquity of idealization's dynamics and against the demonization of Winnicott.     

‘A Way Out’ and A Way In: Reply to Commentary

I express my appreciation for Michal Rieck's thoughtful and fully felt reading of my paper. I underline her points that the regression that an unobtrusive yet fully engaged analyst can allow, is not solely a phenomenon in work with more disturbed patients, and that the essence of this position is to be without separateness. I outline a process of the “flow of enactive engagement,” which fosters a narrative unfolding of the field of the treatment. I suggest that the flow of enactive engagement is a contemporary mutual form of enacted free association and that Rieck is correct in saying that from my perspective psychoanalytic cure need not involve the analyst's interpretation. The mutual enactment itself can be the interpretation.     

Working in the countertransference

Ferenczi (1988) described the procedure of mutual analysis, in which the patient and analyst switch roles for part of the time in the analysis. This procedure allowed patients in stalled analyses to make progress and enabled the analyst to overcome certain countertransference blocks but was ultimately rejected for certain drawbacks. Working in the countertransference is a modification of mutual analysis that retains some of its benefits and eliminates some of its drawbacks. In such work, the psychoanalyst's personality and psychodynamics become the center stage of the manifest content of the session; the analyst avoids interpretations of the transference and, instead, elicits the patient's detailed understanding of the analyst's psychodynamics. The analyst does not, however, generally volunteer his free associations or facts about his own life. This process allows deep work with patients with a predominance of projective identification. Working in the countertransference may be preferred in cases of severe psychopathology to other procedures for its lessening of the frequency, severity, and persistence of transference psychoses. The procedure is also a useful supplement to transference analysis with neurotic patients, for whom it can break through blocks caused by anxiety‐laden issues or countertransference impediments.