On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.     

Creating New Ways of Being and Relating

The therapeutic action of psychoanalysis has been broadened beyond interpretation to the creation of new ways of being and relating. The concept of analysis as including both understanding and creation is rooted in two major analytic traditions: the British Independent school and the relational movement. It is proposed that central concepts from each tradition can be combined to form a theory of technique that is focused creating new ways of being to replace the patient's historical patterns. The clinical strategy advocated here is aimed toward bringing dissociated self states to consciousness and then using the now conscious conflicting states to create new self-world relationship patterns. A theory of technique is suggested that combines the relational concepts of dissociated patterns of interaction with Winnicott's theory of potential space for the purpose of transforming latent psychic capacities into new forms of being. Specific criteria are proposed for identifying new potentially authentic ways of being, and a technique for facilitating their evolution from nascent dispositions to new ways of being is delineated. Two cases are used to illustrate how the technical strategy can be used to create ways of being from previously dormant psychic potential.     

The Analyst's Secret Delinquencies

Despite a burgeoning literature on major analytic boundary violations, there has been little investigation of what might be called analytic delinquencies or misdemeanors—the small and virtually ubiquitous ways in which analysts deliberately withdraw from the therapeutic endeavor. I consider the impact of professional misdemeanors on patient and analyst and compare both with more serious analytic “crimes” and enactments. Professional delinquencies may reflect a therapeutic reenactment, an expression of the analyst's split-off or disavowed need, or an unconscious attempt to self-regulate or to negotiate space within the constraints of the treatment setting. Because the professional ideal leaves so little room for the analyst's humanity, it is often difficult for us to address and work with evidence of our own need when it clashes with what we regard as the analytic contract.     

Muting,filtering and transforming space: Autistic children's sensory ‘tactics’ for navigating mainstream school space following transition to secondary school

Mainstream school spaces provide significant sensory challenges to children with Autism Spectrum Disorder (ASD). In this paper, we provide in-depth qualitative insight of the ‘sensory tactics’ developed by children to navigate neurotypical spaces following transition to secondary school. Informed by work in sensory geography, and de Certeau's ‘strategies’ and ‘tactics’ concepts, we demonstrate that through muting, filtering and transforming space, children find ways to navigate the sensorially demanding environments of mainstream secondary school, e.g. finding quiet, orderly spaces - albeit in ways that do not entirely negate the sensory challenges the school environment presents. The paper concludes with several recommendations regarding ways that mainstream school spaces can be designed and/or existing spaces altered so as to be more sensitive to the sensory diversity of children with ASD.     

Concerning Transference and Countertransference

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations—including transference reactions—have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.     

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.     

Relations of Power in Different Spaces: An Exploration of the Schooling Experiences of Children in an HIV/AIDS Context

In this article we explore how the concept of relations of power in different spaces plays out in the lives of school children living in an HIV/AIDS context, and how processes of inclusion and exclusion are associated with particular spaces. The article uses Foucault's (2000) identification of four distinct relations of power to argue that within different school spaces we find economic, political, judicial and epistemological relations of power that are embedded in the way children experience reality. The study was conducted in five primary schools, three secondary schools, one early Childhood Education (ECD) centre, a special school and their communities in the province of KwaZulu Natal. Participants were teachers, learners, out of school youth, and members of community organisations working in the district. Data collection methods included individual and focus group interviews. Within the focus group interviews various participatory research techniques were used, including ranking exercises, projective activities, transect walk, body mapping, photo voice. The findings in the study revealed three complex and contradictory schooling spaces: policy space, curriculum space, and safe spaces in which learners' schooling lives are played out. The study showed that space is fundamental in the exercise of power as revealed in the exclusionary and inclusionary ways in which children experienced their schooling lives.     

The Nature of the Co-Therapy Relationship

Termination is a complex phase in the total therapeutic process. Criteria for termination of long-term analytic group therapy encompass both intrapsychic and behavioral changes. One of the useful ways of conceptualizing the termination phase is in terms of the issues of separation-individuation. Three different kinds of termination that can occur and the techniques for working with each are described. Multiple transferences are worked with in the long-term analytic group and both real and transferential losses acknowledged. The ability to leave group therapy with a stronger, better defined sense of self is one of the goals of therapy.     

Re-enchanting the body: overcoming the melancholy of anatomy

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control.     

The Blank Screen of Cyberspace

Internet communication (cyberspace) media, which have entered our culture in various ways, present novel opportunities—and challenges—for analytic practice. The availability of new modes of interaction prompts reflection about the role of familiar structures for analytic work. We describe the most prominent interactional environments in the cyberspace world; factors affecting analytic work in cyberspace; and ways in which the cyberspace dimension of the outside world may affect even traditional analytic settings. For guidance, we invoke the familiar longstanding discussion of the role of the couch.     

The other between fear and desire – countertransference fantasy as a bridge between me and the other

This paper attempts to show how unrepresented rupture/injury of primary expectations of the early relationship is reactivated in the analytic process. This becomes perceptible especially as unconscious fear and a specific defence described as ‘living behind a glass-wall’. The author, however, postulates the existence of an inherent dialogical-dyadic principle in the psyche, which she calls archetypal hope, and shows how this principle may become active in the analytical space. These aspects of analytical treatments are sketched with two vignettes, in which unconscious processes of exchange cause the analyst to experience unrepresented states. The author describes how the analyst is gradually able to experience and understand this, and how this understanding finally – without first becoming explicit – becomes effective in the analytical space. Special attention is given to the analytic attitude. A readiness to accept and move into regression and a receptivity to attune to the early sensory experience of the analysand is regarded as essential. Through this the analyst gains access to the inner space of the analysand and, through bodily experience and pre-symbolic processes, the unrepresented may thus become figurable. The reverie and countertransference fantasies are understood as a bridge: they connect the analytic pair. However, the reverie also creates the transition between that which was not – the absent representation – and that which wants to emerge. It thus bridges the personal unconscious (implicit expectation) and the archetypal (the archetypal hope). Through this, the space of hope may become a space of possibility, and help bridge the chasm between the experienced and the hoped-for.     

On The Dynamics Of Alper And Bridger

Bridger and Alper (1999) maintain that the nonphysical featuresof the supertasks described by Pérez Laraudogoitia (1996) involving a system containing an infinite number of particles may be avoided by introducing, in a specific way, Hilbert space in classical dynamics. I argue that it is possible to interpret their proposal in two ways, neither of which is acceptable for the purpose for which it was introduced.     

Spatial metaphors of the mind

A case in which the author began to understand her patient as "collapsing the space between them," rather than as continuing only to free associate, is the occasion for a contemplation of the way psychoanalytic theory effects a transition between what is inner, or lived, and outer, or experienced. Metaphor is seen as the agent of this transition. The author discusses metaphor in relation to the case described, while also examining spatial metaphors of mind in classical analysis and in Kleinian theory. It is suggested that both may be integrated in a third metaphorical-spatial construct, Green's analytic space.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

The patient's part in analytic process: the influence of the analyst's expectations.

The psychoanalyst's expectations of the patient are complex and crucial to the work of analysis. These expectations, operating at a level generally outside the consciousness of patient and analyst, are part of the "microstructure" of analysis, the interactional give-and-take that brings about change. The view taken here is that analytic process is necessarily interactive, as well as intrapsychic. In addition to transference-countertransference motivations, both parties to an analysis operate in a social context that prescribes a range of desired and undesired behavior. The analyst brings to the interaction professional analytic attitudes about how to listen and act, and a set of expectations of the patient. These attitudes and expectations modulate subjective reactions to the patient's transferentially driven actions, and influence the expression of countertransference. The mutative process of psychoanalysis involves the action of these attitudes and expectations on the patient, both in ways specific to individuals and in more general ways. Such expectations lie behind analytic tactics and, though not often written of, are part of the oral tradition of psychoanalysis. Here the expected patient role is described in terms of five bipolar continua: (1) reporting and editing; (2) transferring and containing; (3) thinking about oneself and thinking about the analyst; (4) regressing and listening/self-observing; (5) initiating trial action and mediating among inner states. The activity and thinking of the dyad move constantly along these continua. A clinical example from the beginning of an hour illustrates how these expectancies emerge in analytic work.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in the analytic process.     

From analytic surface to analytic space.

Utilizing a clinical illustration, the concept of the surface of the patient's mind, which arose early in analytic history, is reexamined in relation to the analytic space, the unique affective and communicative dyadic context of the analytic process. The shift from analytic surface to analytic space reflects in clinical theory the metapsychological shift from early structural views to current appreciation of compromise formation. Also, this approach permits broadening of consideration of active unconscious forces in both the patient and the analyst.     

Some limitations of analysis

Abstract :  This paper ¹ considers some of the difficulties that exist in reconciling the 'treatment' and the 'cultural' aspects of analytic ideas and practice; the extent, for example, to which analysis is both ordinary, and extra-ordinary in more than one way. The implications for this for the place of analysis and analytical psychotherapy in the mental health services is considered along with the ways in which there is a diversity of views about the importance of maintaining the presence of analytic ideas and analytic practice in hospitals and clinics. Some of the limitations of analysis are discussed where analytic ideas and methods move away from their application to patients and patients' material into the wider world.     

Analytic preparation: the creation of an analytic climate with patients not yet in analysis

The art and science of beginning an analysis has a life of its own and can be considered in many ways quite apart from its later stages. An incremental path forward is smoothed for patients who are not yet prepared to analyze, and builds eventually into something readily recognizable as an analysis. The term analytic preparation refers to this set of processes. Early on, the analyst is concerned less with facilitating an early replica of an idealized analysis than with facilitating the mutual adaptation of patient and analyst as they begin to negotiate a "thought community." Since analytic preparation is not an entity, it does not neatly overlap in real time with the opening phase as usually described, does not have a discrete beginning or end, and does not abruptly shift mid-stream into analysis proper. Some relations between analytic preparation, analytic interaction, and the interpretation of transference are examined.