Commentary on Paper by Françoise Davoine

Françoise Davoine sees madness as a research project involving the uncanny presence of ghosts arising from the realm of the transference as well as the “big” history of wider social catastrophes across the generations, in effect “cut-out” pieces of the unconscious. Madness is a rupture in the social link that needs repairing. The therapist is a coresearcher with the individual whose madness tells a story embedded in the heart of madness itself. Davoine presents her work with a woman who has a history of multiple psychiatric hospitalizations. She invites her patient to link up with and speak of that which formerly resided in the Lacanian Real, that is, the unsymbolized haunting absence of her mother who was tragically murdered by the Nazis. The therapist's dream becomes a bridge to this world of ghosts for both patient and therapist. The dream ushers in an enactment and a transference interpretation by the therapist, which leads to a disappearance of madness from the analytic stage. I attempt to apply the theories of Post Kleinians, as well as Harold Searles and Gaetano Benedetti, to help illuminate the processes of therapeutic action. Contemporary psychoanalytic approaches to dreams and a relational view of madness are also addressed.     

Arrested Histories: A Response to Françoise Davoine

This commentary examines the psychoanalytic drama narrated by Françoise Davoine in terms of the dream at its crossroads: a site within the analysis (and its dramatic narrative) in which the dead and the living change places and the untold stories of the patient's and analyst's mothers begin to emerge. Davoine's narrative recounts the emergence of a language in which the hidden stories become entangled with each other as well as the breakdown of signification in which an uninscribed history appears on the scene. Ultimately the analysis turns around an arrest of signification, a form of madness that reveals the violent history at the heart of the exchanges enacted in the analytic encounter. This is also the point, I suggest, at which the possibility of a new relation to history and a new form of address open up.     

How Françoise Dolto links Lacanian psychoanalysis with the Christian Gospels

This article introduces to an English-speaking audience of pastoral therapists, the writings of the French Lacanian psychoanalyst, Fran?oise Dolto (1908-1988) on the links she discovered between the most profound question raised by Lacanian psychoanalysis in its dynamics effects and the questions raised by the Christian Gospels. The author summarizes the main points of Dolto's Lacanian thought and where she departed from Lacan in her interpretation of the unconscious ethic of desire. Using Dolto's three writings on Lacanian psychoanalysis and the Bible, as well as material from her published clinical studies, the author illustrates Dolto's approach to the Bible, the parable of the Good Samaritan, and her application of the dialectical principles of desire in three case studies.     

Relational Lacunae: Gaps in the Relational Literature and Clinical Practice? Commentary on Paper by Paul Wachtel

I question whether Wachtel’s assertion that there are gaps in the relational literature and residues of a one-person psychology is little more than a reflection of the relational tradition, which encompasses a multiplicity of perspectives. This notwithstanding, his paper helpfully addresses a neglected dimension of clinical practice and provides the opportunity to explore the evolution of Stephen Mitchell’s thinking about the baby as a psychoanalytic metaphor. In doing so, I briefly, if somewhat tangentially, discuss the structure of the inner world, the role of memory in psychoanalysis, the nature of transference, and the extent to which early experiences with caregivers influence adult intimate relationships. To further illuminate Wachtel’s theoretical and therapeutic model, I summarize Mitchell’s (2000) case study of Connie, focusing on his detailed inquiry into her everyday relationship with her husband.     

In Search of the Person in the Patient: An Interpersonal Perspective on “Roles in the Psychoanalytic Relationship”: Commentary on Paper by Richard Almond

I am postulating an irreconcilable discrepancy between psychoanalytic metapsychology and praxis. Metapsychology reaches for the abstract, for the general class of which the patient is an ostensible member—said class, somewhat tautologically, demonstrating the validity of the professed metapsychology. Yet, from the Interpersonal view, therapy depends on grasping the highly idiosyncratic way the patient plays out his or her life both in and out of the therapy room. Abstracting the patient concretizes the process and reduces information. As a consequence, the clinical material falls short of utilizing the rich, recursive patterning of the therapist's exchanges with the patient, failing to fully realize the uncanny enmeshment of unconscious gears that so defines the psychoanalytic mystique.     

Being “Done For” in Analysis: Commentary on Paper by Stuart A. Pizer

Stuart A. Pizer's fascinating article explores through a relational lens analytic impasse, and its manifestation through transference and countertransference love. How this love is demonstrated (or not) and the ways in which we provide for our patients will have profound effect on the process (and progress) of any treatment. But, too often, reluctance to “do for” our patients compromises our ability to provide what may be needed in any given moment. Perhaps an expansion of the “doer—done to” dyadic paradigm into a “doer—done for” model might allow more analytic leeway and more possibility of growth within our patients.     

One or Many? Commentary on Paper by Debra Rothschild

This discussion of Rothschild's case history of a multiple personality disorder (MPD) treatment situates the issue of integration versus multiple self states in terms of cultural values, psychoanalytic theory, and transference–countertransference experience of MPD patients and therapists. Views from autobiographies of multiple personalities are included, and some questions are raised about the relationship of “parts” to traumatic experience: When, and for whom, is integration a treatment goal? When is dissociation a characterological defense, and when do the parts each hold separate traumatic knowledge? How does this question bear on treatment—what gets integrated, the knowledge or the parts? Are termination and integration simultaneous? A recommendation is offered for a wider, more complex view of narrative and historicity in the understanding of narrative reconstruction. A concrete focus on veridicality can be a defense against the overwhelming nature of traumatic experience. A final view is offered which positions the author as more distant from integration as a goal than is Rothschild.     

The Bright Forms … . .: Commentary on Paper by Vivian Dent

This brief commentary on Vivian Dent's paper about my way of introducing the horizontal axis of siblings engages in a two-way dialogue about what art can tell us of the unconscious psyche and what psychoanalysis can tell us of the art object. It urges us to look at siblings in the transference and countertransference.     

Object Relationships—Symmetry and Asymmetry: Commentary on Paper by Anthony Bass

Current understanding of the process of therapy and development focuses on the interactions between the partners. The interaction is a negotiation of differences and of change. The equilibrium of the relationship is inevitably subject to frequent destabilizations, by virtue of normal developmental processes, life events such as losses, and the divergence of aims as each process unfolds.

The destabilizations are pivotal to the creation of new states. If a newly emerging state is to be advantageous for the development of the infant or the health of the patient, the associated toxic affects have to be tolerated and dealt with openly. If the analyst defensively hides, opportunities for change will be lost and the old patterns will persist. The therapist and patient, like the parent and child, are engaged together in this mutually altering process.     

Follow the Bird—A Story of Survival in the Treatment of Addictions Commentary on Paper by Lisa Director

Lisa Director proposes a relational model with an emphasis on enactment for the treatment of chronic drug and alcohol use. She illustrates her thesis with an extensive case report. The story of her patient's addiction, and of the embroiled analytic developments, is engaging, disturbing, and rewarding. I suggest that the telling of this inspiring story, and the narration of her theoretical framework, is a response to the devastation involved in the encountering of addictions and that this story unintentionally obscures some basic issues about addiction and the psychoanalytic treatment of it. I believe that the survival of patient and analyst was achieved with the help of three underemphasized factors: Director is an expert in the assessment and treatment of chemical dependency problems, and her patient, Helena, knew this; despite her chronic addiction, Helena brought exceptional resources for survival to the analysis; and the authority of the analyst was used for leverage to help replace Helena's reliance on drinking and drugs.     

Pitfalls on our “New Royal Road”: Commentary on Paper by Joyce Slochower

In discussing Joyce Slochower’s paper “Going Too Far: Relational Heroines and Relational Excess,” (this issue) the author welcomes its self-critical emphasis, suggesting that analysts from all schools of thought benefit more from noticing the risks and pitfalls in their own approach—thus becoming able to improve their own clinical work—than from polemically highlighting what is faulty in other, competing approaches. Such polemics run a risk of their own: turning our theoretical homes into theoretical fortresses, and blocking richer communication among analysts. He shares the concern about some specific attributes of relational and intersubjective clinical work but relates many of the issues raised by Slochower to tensions and dilemmas present in older models of the analytic relationship as well, offering examples from the work of Freud, Ferenczi, Balint, Winnicott, and Racker.     

Blowin' in the Wind—Considering the Impact of “Inadvertent Touch” Commentary on Paper by Graham Bass

In my discussion of Graham Bass's paper, my comments fall under three main categories: an aspect of Bass's theoretical/technical view that informs his conscious clinical choices, his incredible work with Robert as presented in the written case, and, finally, theory in practice as exemplified in his phrase, “inadvertent touch.” I mean for my perspective and the purely personal associations that are stimulated by this case to evoke further discussion and, in general, open some sort of useful dialogue. I believe that anybody who sits with severely dissociated patients would agree that, side-by-side with the necessary terror creeping around in the room, we often experience a confusing, sometimes even silly, “higgledy-piggledy” that seems pathognomonic to the work entailed. This weird experience seems, almost, to set our sense of continuity and logic on its edge. When reading Bass's paper, we must, to maintain our equilibrium, begin by taking for granted some of the contradictory, nonlinear aspects of his reporting, which is, after all, an accurate reflection of what happens in this work. At the level of theory in practice, I consider the implications for symbolic realization in the clinical process when touch need not be relegated to the category of the “inadvertent.”     

Discussion of “Unraveling Whiteness”: Commentary on Paper by Melanie Suchet

In this discussion I consider several influences on the contemporary project of deconstructing racism and the concept of racialized subjectivity. This discussion applauds the turn in Suchet's work toward self-examination in a consideration of the experience of race and racism. Suchet's work moves the debates about racialized subjectivities into a deeper and more complex understanding of all the ways in which identifications and attachments cross race and class lines for many individuals. This discussion focuses on Suchet's treatment of the power of hybridic and biracial identifications, beginning with autobiographical material from Suchet's own childhood in South Africa. In this discussion of “Unraveling Whiteness” I integrate psychoanalytic concepts of enigmatic signification (the work of Laplanche) into a discussion of early attachment, and relational configurations with children and nonparental caretakers. The question of trauma or potential transformation in interracial experience is discussed, and some distinctions between American and South African experience are considered.     

Compensation in the Service of Individuation—Phenomenological Essentialism and Jungian Dream Interpretation: Commentary on Paper by Hazel Ipp

This reply elucidates the ideas originally presented in “Countertransference: Our New Royal Road to the Unconscious” (PD 9/3, 1999) in acknowledgment of Irwin Hirsch's commentary (this issue). It refutes Hirsch's erroneous conception that my paper suggested that the personality of the analyst could be extricated from the interactional matrix of the psychoanalytic relationship and that persons could be separated from their minds. By drawing these false dichotomies, Hirsch only polemicizes rather than clarifies the complex relationship existing between an analyst's subjectivity and his or her personality.     

Identifying with the Other—A Conflictual,Vital Necessity: Commentary on Paper by Jay Frankel

Frankel's paper is related to issues in the study of multiple personality, as well as to the dilemmas of identification in psychoanalytic training. The main point raised in this discussion is that the generalization that all identification is related to fear is untenable and that a continuum should be recognized between identification with the other in a close relationship as a constructive building block of one's identity and a traumatic identification with the aggressor that results in alienation.     

The Protective Skin of the Analyst’s Case Formulation: Commentary on Paper by Tom Wooldridge

The contours of every psychoanalytic process are shaped by its case formulation. This discussion of Tom Wooldridge’s paper (this issue) of the long-term, psychodynamic treatment of a patient with severe anorexia provides opportunity to demonstrate that formulation derives from aspects of the clinician’s clinical education and personal growth. Wooldridge’s metaphor of the containing functions of the entropic body is extended to include particular paternal functions that an analyst provides his patient and that are suggested in the dialogue of this clinical material. Psychoanalytic case formulation distinguishes it from other aspects of an integrated treatment plan for eating disorder patients; in particular, clinician and patient discover important metaphors and elaborations of personal history that assist in recovery. Thinking through a case from different lenses provides real gratification for the psychoanalyst and a bulwark to assist in potentially life-saving work because of its protective and enriching functions. Drawing upon the metaphors Wooldridge expands upon such as secondary skin formations and the entropic body, I suggest that clinicians who work in the field of eating disorders could draw great benefit from learning more about what psychoanalytic case formulation offers patients. Detailed, evocative case examples such as the one Tom Wooldridge puts forward may be one way to reach this important audience because they bring to life many of the unique features of contemporary psychoanalysis.