The Return of Dissociation as Absence within Absence

My aim is to translate Ferenczi’s central concepts of the intrapsychic impact and imprint of early developmental trauma into both revived and contemporary conceptualizations. The concept of dissociation was renounced by Freud, yet it is returning as a cornerstone of recent trauma theories. Ferenczi used the concept of “repression,” but used it in the sense of an intrapsychic imprint of early external trauma that fragments consciousness, that is, as dissociation. Furthermore, early trauma is double: an absence of protection that threatens existence of the self, combined with an absence of attachment and of recognition of this threat and terror; thus it is an absence-within-absence. This contemporary conceptualization entails a widening of the intrapsychic realm to include an intersubjective one, and regards dissociation as a unique and complex intrapsychic absence, which is a negative of the external absence-within-absence in the early environment.     

One Need Not Be a House to Be Haunted: On Enactment,Dissociation, and the Dread of “Not-Me”—A Case Study

This paper examines psychic trauma as experience so shockingly strange that it exceeds the threshold for cognitive processing and begins to flood the mind with unintegratable affect that threatens to disorganize the internal template on which one's experience of self-coherence, self-cohesiveness, and self-continuity depends. A detailed clinical vignette illustrates how the unprocessed “not-me” experience held by a dissociated self-state as an affective memory without an autobiographical memory of its traumatic origin “haunts” the self. It remains a ghostly horror even in an otherwise successful psychoanalysis unless a new perceptual reality is created between patient and analyst that alters the narrative structure maintaining the dissociation as though the past were still a present danger. The analyst's making optimal use of dissociative processes in an intersubjective and interpersonal context enables the patient more readily to self-regulate affect in those areas of implicit memory where trauma has left its mark; the dissociated ghosts of “not-me” are thus persuaded, little-by-little, to cease their haunting and participate more and more actively and openly as self-reflective, self-expressive parts of “me.”     

When the analyst is physically ill: Vicissitudes in the analytical relationship

Something that happened to one of the authors recently led them to refl ect upon what the analyst's falling ill may represent and the problems it may give rise to in the analytic relationship. Such an eventuality injects a massive dose of the analyst's personal reality into the analytic space, thereby allowing the patient a glimpse of images of vulnerability, frailty and loss, and mobilizing emotions, fantasies and defences in both the analyst and the patient. The authors' survey of the literature ranges between two different theoretical perspectives intrapsychic and intersubjective that, in their most radical formulations on technique, call for maintaining either the strictest neutrality and anonymity or symmetrical relationality. In both cases, that which is denied is the unconscious communication that enables the analyst, irrespective of his conscious intentions, to allow either parts of himself or inner objects of the patient to act in the relationship. In closing, the authors shall illustrate the concept discussed through three clinical vignettes.     

Narrating the Unsayable: Enactment,Repair, and Creative Multiplicity in Group Psychotherapy

This article introduces an approach to group analysis that places dissociation of traumatic experience at the center of group interaction. Healing in group is regarded as hinging on the enactment of unformulated and dissociated experience and affect. Enactments are regarded as involving the members of the group, the group as a whole, and the group analyst. Clinical examples are offered to illustrate the enactment of dissociated trauma that was unable to be suffered earlier and the enactment of absence and neglect that is non-represented. In this hermeneutic conception, the group comes to narrate what has happened but never been experienced, and healing accrues through the group’s witnessing and making affectively real what was hitherto unsayable and unthinkable. The group analyst uses and shares his or her own experience to facilitate this process.     

Hope When There Is No Hope: Discussion of Jill Scharff's Case Presentation

Jill Scharff's case material is viewed and discussed here from the vantage point of the two partners being an interpenetrating unit held in the grip of an “enactment”—a coconstructed event in which the analyst's participation sometimes becomes so enmeshed with the patient's in an ongoing way that analyst and patient seem to be trapped together in a narrow and concrete tunnel of reality from which they cannot find an escape, gradually making the treatment feel more and more hopeless because it is immune to interpretation of internal conflict. In the language of enactment, analyst and patient are held conjointly in the grasp of a shared dynamic that is a central hallmark of dissociation—an intrapsychic phenomenon that is played out interpersonally. The relationship between trauma, dissociation, shame, and affect regulation is explored in the context of impasse, repair, and psychoanalytic “technique.”     

The not-so-silent couple in the individual

This paper aims to examine two often separate areas of analytical enquiry, the nature of the self, with its foundation in the concept of a primary self which may achieve a sense of coherence over time, and the nature of internal objects, a concept that forms the basis of theories concerning part selves and sub-personalities. It is argued that these concepts might be integrated to provide a unified model of the self, thereby integrating theoretically disparate aspects of mental structure and functioning. Through an examination of clinical material, the archetype of the coniunctio is evoked to offer an understanding of how, in the absence of a stable conjunction of (maternal) reverie and (paternal) thinking functions, a series of linked but oppositional internal couples may be created which lends to the self the experience of a combined and sustaining inner couple. The internal couple creates a source of psychological survival for the self, with the function of providing a reliable structure in which the processes of the self may unfold, but equally requiring strict adherence to a pernicious system of internal defences that allows for very little interaction with others outside the self. At the same time, these defences inevitably become blocks to further development, and the work of transformation is thwarted. For transformation to occur, it is necessary for the self to find another, often the analyst, who may be allowed to partake in the internal conjunction, thereby promoting a better grounding for the self.     

Getting Personal: Thoughts on Therapeutic Action Through the Interplay of Intimacy,Affect, and Consciousness

How do patients internalize new good object experience and how do these previously closed systems open up? What happens within and between analyst and patient that leads to the opening up of affective channels between them and allows consciousness to become transpersonal? The ways in which self-state experience becomes more fluid and cohesive, or less dissociated, is an affective process. This process occurs intersubjectively, as well as between self-states within each individual. When particular self-states come together between analyst and patient, especially those associated with pain and shame, disruption and instability may result within the mind-system (intrapsychic organization) of either or both partners. Managing the affective strain and psychic destabilization are vital tasks for the analyst and patient, in order for relationships between parts of the self (within one individual) to move from pain and hiddenness to compassionate recognition, thereby allowing and facilitating for parts of the self within the other individual to, in turn, move from pain and hiddenness to compassionate recognition. This is a core process of internal life, leading to the development of intimacy between self-states as well as between individuals.     

No one here gets out alive: the Bluebeard story in therapy and in the culture

In this paper, the Bluebeard story is used to highlight mechanisms underlying an individual analytic case and some cultural phenomena from a Jungian perspective. I describe a patient whose psyche was dissociated into a tormenting monstrous figure and a regressed childish self, which Kalsched explains as activation of the archetypal defence system. As her analyst, I had to survive attacks of the patient's persecuting inner object, which she related to Bluebeard as a representation of relentless murderousness. At the cultural level, Bluebeard pertains to the concept of the totalitarian object (Sebek 1996) and to the pole of grandiosity of the Russian cultural complex.     

THE PSYCHOANALYST AND THE BABY: A NEW LOOK AT WORK WITH INFANTS

The author argues that objections to involving the infant in a relationship with an analyst have led psychoanalysts to overlook the possibility that the interaction between the infant and the analyst may be able to activate and retrieve those parts of the infant's inner world that have been excluded from containment and be conducive to a vitalisation of the emotional disturbance that can then become worked through in the mother-infant relationship. As long as the infant's ego is weak, the infant and the mother have a unique flexibility that enables them to repair disturbances in their relationship when the emotional container-contained link is (re-)established. Based on the assumptions (1) that a relationship can be established between the infant and the analyst, (2) that the infant has a primordial subjectivity and self as base for intersubjectivity and the search for containment, (3) that the infant has an unique flexibility in changing representations of itself and others that comes to an end as the ego develops, and (4) that the infant is able to process aspects of language, three cases, at the ages of 6, 18 and 20 months, are presented to illustrate what is considered to be a novel approach to work with infants.     

External and internal reality: The impact of the current socio‐economic crisis on the analytic dyad

This paper addresses the impact of the current economic crisis on the psychic functioning of the patient and the analyst, their relationship and collaboration. This intrusion of ‘external reality’ is multidimensional, and thus with multiple meanings. The critical role of the economic factor brings various dimensions of money into play, such as self‐preservation, power as well as aspects of psychosexual development. In addition, the crisis involves symbolic loss of basic ideals such as honesty and social responsibility. Patient and analyst are affected in similar and different ways in their respective roles as well as according to the specific intrapsychic functioning of each. Moreover, unique characteristics of the crisis often create a crisis in the analysis. In order to avoid deformation of the analytic relationship, the analytic dyad must examine and work through the multiple meanings of the crisis as well as the meaning of the impact of the crisis on the analytic relationship for both patient and analyst. This complex transference‐ countertransference interplay poses specific challenges to the analyst. After discussion of these issues, clinical material is presented that demonstrates how they appear in analytic practice today.     

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.     

Fear and Shame in an Israeli Psychoanalyst and His Patient: Lessons Learned in Times of War

Living in the midst of a war presents unique challenges to ongoing psychotherapeutic treatment. This paper focuses on the ever-present threat of fracture to the analytic frame and the limited ability of the therapist to create a safe, insulated environment— a reliable container—in which to work, while coping with a violent external reality. Using an intrapsychic lens, as well as an interpersonal one, the dynamics of both the analyst's and the patient's fear and shame are brought into focus. This delicate balance is illustrated through two cases: one occurring during the First Gulf War (1991) and the second taking place during the Second Lebanon War (2006). In both cases, fear and shame cause a stalemate in the psychotherapeutic process. The analyst recalls his active duty as a soldier during the Yom Kippur War (1973). These memories and their attendant acknowledgement of fear and shame by the analyst, as well as his analysand's “supervisory” comments, gradually dissolve the knot and repair the rupture in the analytic process. The ability to fully experience fear, shame, and helplessness is at the core of psychic health, a health once destroyed by dissociation and denial of these feelings. This ability to experience fear and shame is the psyche's antidote to mental breakdown. Following discussion of the two case studies, this paper seeks to illustrate how the very structure of a society, in this case Israel, can codify societal defense mechanisms against emotions like fear and shame, exacerbating the very problems it seeks to assuage.     

Dangerous Transitions and the Traumatized Adolescent

One of the developmental tasks for the adolescent is to construct a new transitional space that leads to internal changes and adapts to the external world. When a nurturing matrix is unavailable, adolescents experience the entrance into the adult world as a dangerous transition. The author bases his arguments on psychoanalytic theories, mostly Winnicott's, and illustrates these with clinical material. He suggests that, even though these traumatized adolescents experienced nonfunctional transitional spaces, it is proven that they could be treated psychoanalytically. Here, the main task of the analyst is to establish a holding environment as a type of transference, resulting in less emphasis on interpretation of inner conflicts.     

Commentary on Paper by Ken Corbett

A report on the third analysis of a 41-year-old man who had been a feminine boy is used as a vehicle to describe the idiographic aspects of this way of being as well as to specify the input of the environment—parents, analysts, community. The role of self with mother, self with father, and self with mother and father together representations is explored and Zadie Smith's concept of dual citizenship and multiple internal voices is featured as an integrating and explanatory concept. The ways in which each analysis highlights different aspects of the patient's conflicts and dilemmas and reflects successive intrapsychic organizations is also explored.     

Knowing another from a dynamic systems point of view: the need for a multimodal concept of empathy.

This paper explores the concept of empathy within the context of current debate regarding the advantages of an intersubjective versus an intrapsychic focus on the treatment process. The author explores the way in which dynamic systems theory, the parent of intersubjectivity, can potentially embrace the wisdom of both relational psychoanalysis and ego psychology. The ongoing analytic discourse is represented in two modes, by schematic and symbolic representations, which roughly correspond to the intersubjective and the intrapsychic record. Empathy is redefined as the enactive, imaginal, and interpretive efforts an analyst makes toward understanding both the schematic and symbolic discourse with her patient.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.     

The self in transformation: the passage from a two- to a three-dimensional internal world

This paper seeks to describe some of the steps in the process of transformation from a two-dimensional to a three-dimensional inner world as experienced by a patient who had essentially used up her remaining vital resources. An important hurdle had first to be crossed when the analyst was required to demonstrate her capacity to survive with her in a two-dimensional claustrum, in a solitary confinement. Here, an oppositional defensive system had been created in which positive and negative personifications of vital but withdrawn energies ensured that she was locked within an interior world that sought to bar entry to anyone else, and where the possibility of the transformation of her self was disallowed. The patient had to accept the risk of breaching the system of self-defence before the analyst was allowed a mutual position within her interior world. A series of dreams tracks this transformation internally and in relation to the analyst.     

Clinical and theoretical aspects of enactment

Enactment as a concept can serve analytic discourse through its established meaning of an act intended strongly to influence, persuade, or force another to react. We might agree to use the term in two complementary ways: Broadly, enactment can designate all behaviors of both parties in the analytic relationship, even verbal, in consequence of the intensification of the action intent of our words created by the constraints and regressive push induced by the analytic rules and frame. Patient and analyst are vulnerable to falling back on behaviors that actualize their intentions, doing so in ways motivated by and reflecting transference hopes, fears, and compromises shaped in their developmental past. Specifically, enactment can then be defined as those regressive (defensive) interactions between the pair experienced by either as a consequence of the behavior of the other. While nominally an interpersonal perspective, this concept of enactment facilitates more balanced attention to the involvement of both parties and to the intrapsychic dynamics in both that specifically shape their interactions. A clinical vignette illustrates the analyst's contributions to enactment, especially those reflecting his reactivated conflicts and their relation to his theoretical and technical preferences.     

Idealization of the analyst by the young adult

Idealization is an intrapsychic process that serves many functions. In addition to its use defensively and for gratification of libidinal and aggressive drive derivatives, it can contribute to developmental progression, particularly during late adolescence and young adulthood. During an analysis, it is important to recognize all the determinants of idealization, including those related to the reworking of developmental conflicts. If an analyst understands idealization solely as a manifestation of pathology, he may interfere with his patient's use of it for the development of autonomous functioning.     

Mixed Race and the Negotiation of Racialized Selves: Developing the Capacity for Internal Conflict

The author uses contemporary psychoanalytic theory in further understanding the negotiation of conflict and dissociation in biracial patients who are both African-American and White. Drawing on the work of contemporary theorists who have made efforts to navigate the relationship between inner and outer worlds in our understanding of race from a psychoanalytic perspective, the author examines the relationship between race, culture, and internalized self-other relations—how they interact with each other and impact splitting and dissociative processes among self-states. The author argues for a notion of the unconscious as one that contains historical trauma related to race relations that influences the developing capacity to sustain internal conflict between opposing self-states borne out of this trauma. The author shows how society works against the integration of racialized self-states and interferes with the capacity to contain conflict. Through an extended clinical vignette from an analysis of a mixed-race patient, the author looks at the interplay of self-states between a White analyst (author) and a mixed-race patient (African-American and White) as manifested through a series of enactments and the unconscious “mating” between dissociated self-states in both patient and analyst. The author argues that the analyst's engagement of his or her own dissociated self-states and containment of internal conflict is critical to aiding the patient in moving toward greater integration.