Man on Wire: Walking the Therapeutically Transformative Tightrope of the Analyst’s Cancer

Almost nothing was clear to me when I was diagnosed with pancreatic cancer. I knew that I intended to inform all of my patients about my illness. But how could the focus remain on their needs when my mortality was so at risk? Unexpectedly, I discovered that I coped with my fears most effectively in my office. It was the one place where I could maintain a grasp on a holistic sense of myself and hold conflicting intense emotions. Additionally striking was the corresponding capacity of my patients to remain in treatment while addressing the unpredictable dyadic changes generated by my sickness. In this paper, I address this point of intersubjective transformation—the interactive contributions that generated each treatment’s unique rhythm. I also discuss the temporality of illness and how my continuing reconfigurations of self-experience impacted my ability to maintain authenticity and analytic balance both during and after treatment.     

Enactment as Therapeutic Hand Grenade: How Bursts of Emotional Honesty Can Get a Stuck Treatment Moving Again: Discussion of Holly Levenkron's Paper

In my discussion of Levenkron's article, I consider ways of understanding the patient's therapeutic progress that were not highlighted by the author. Adding my own criteria to Levenkron's definition of enactment, I suggest that what the author labels as enactment might be seen as a last-ditch but successful effort to get patient and analyst out of a stuck and painful place. I explore the interplay of confrontational and nonconfrontational interventions in contributing to cure, and I suggest placing a greater emphasis than did the author, on the intersubjective contexts out of which the patient's troublesome behaviors emerged.     

All Roads Do Not Lead to Rome

In commenting on Philip A. Ringstrom's paper I add a few caveats of my own regarding the comparison of intersubjective theories under consideration, then go on to take up some of the topics Ringstrom highlights including projective identification, mutual recognition, reified language, and analytic authority. The strength of Ringstrom's paper is to return us to the type of critical inquiry regarding comparative psychoanalysis that Mitchell made the hallmark of his own intellectual project.     

NATURAL GOODNESS,RIGHTNESS, AND THE INTERSUBJECTIVITY OF REASON: REPLY TO ARROYO,CUMMISKEY, MOLAND,AND BIRD‐POLLAN

Abstract: In response to Arroyo, I explain my position on the concept of “natural goodness” and how my use of that concept compares to that of Geach and Foot. An Aristotelian or functional notion of goodness provides the material for Kantian endorsement in a theory of value that avoids a metaphysical commitment to intrinsic values. In response to Cummiskey, I review reasons for thinking Kantianism and consequentialism incompatible, especially those objections to aggregation that arise from the notion of the natural good previously described. In response to Moland, I explain why I think Hegelian worries about the supposed emptiness of the Kantian self do not apply to my account. And in response to both Moland and Bird‐Pollan, I argue that, contrary to the view of some Hegelians, the intersubjective normativity of reason is not something developed through actual social relations; rather, it is something essential to an individual's relations with himself or herself.     

Response to MacIntosh’s Review and Discussion of the Psychoanalytic Couple Therapy Journal Literature: A Self Psychological,Intersubjective Perspective

ABSTRACT

After expressing my appreciation to Heather MacIntosh and highlighting her article’s significant contributions to the field, I comment briefly on some of the implications of her methodology and findings. I then elaborate on her summary of the history of the application of self psychology (Kohut, 1971) and intersubjective systems theory (Stolorow, Brandshaft, and Atwood, 1987) to couple therapy, highlighting the key contributions of both theories and describing the current state of the field.     

Forgiveness – It Depends: A Discussion of “An Analyst Has a Birthday - Can Forgiveness Heal?”

Diane Barclay’s article (this issue) is a clear example of rich and productive clinical work and how in some contexts, both patient and analyst can benefit personally from the inherently intersubjective nature of psychoanalytic practice. Both analyst and patient spent years struggling to forgive mothers who were very deficient and who bore considerable resemblance to one another. Ultimately forgiving their respective mothers proved very helpful to both analytic partners, though I argue in my discussion that we cannot conclude that forgiveness per se, ought to be a universal value or aim.     

Motivation: Sic Transit Gloria?

Sic transit gloria—so passes away the glory once accorded to motivation as a central focus of psychoanalytic theory and practice. How and why? That is the subject of this paper. I will track the ups and downs of motivation historically and its current replacement by the attention correctly afforded to relationships across a spectrum of contemporary theories. I will then take up my proposal of five motivational systems embedded in an intersubjective context and consider critiques of the proposal from different vantage points. Despite waning interest, motivation remains an intrinsic component of psychoanalysis.     

Enactive Fields: An Approach to Interaction in the Kleinian-Bionian Model: Commentary on Paper by Lawrence J. Brown

In taking up the matter of intersubjectivity in Kleinian-Bionian theories Brown creatively reimagines the clinical situation, transcending demarcations of analytic schools to arrive (though never fully arrive) at new understandings of interaction. I discuss Brown's engaging paper from my own emerging concept of enactivity, drawing distinctions between this approach and Bion's approach and extending the enactive to a consideration of enactive fields that, like Brown's paper, draws on the seminal reinterpretation of Kleinian theory by the Barangers. In writing of the field as an emergent process of becoming I rely on Merleau-Ponty's notion of “singing the world” to illustrate my developing understanding of the possibilities for interaction in the Kleinian-Bionian tradition. My comments on Brown's clinical case material focus on what appears to me to be the intersubjective aspects of his approach.     

Domination and Dialogue in Merleau-Ponty's Phenomenology of Perception

Merleau-Ponty's claim in Phenomenology of Perception (1962) that the anonymous body guarantees an intersubjective world is problematic because it omits the particularities of bodies. This omission produces an account of “dialogue” with another in which I solipsistically hear only myself and dominate others with my intentionality. This essay develops an alternative to projective intentionality called “hypothetical construction,” in which meaning is socially constructed through an appreciation of the differences of others.     

Reply to Reviews of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

I reply here to reviews by three inspiring thinkers, Ethel Person, Susan Sands, and Allan Schore who, though uniquely different from one another in their conceptual frames of reference, share a sensibility as clinicians and creative scholars that has led them to engage and appreciate my work in depth while enriching it with their individual perspectives. Ethel Person's review is meaningful to me for many reasons, not the least of which is the fact that we think very much alike about “how we are” with patients despite the diversity in our families of origin. Her thinking, which extends the boundaries established by any one school of thought, transcends doctrine, especially that of “technique.” I am equally grateful to Susan Sands, whose review stimulated a dialogue between us about the similarities and differences in our views of the analyst's personal role in enactments with severe trauma survivors and whether there is reason to distinguish between life-threatening and developmental trauma. My reply to Allan Schore's review satisfies a long-standing wish to engage with him in dialogue about what he refers to in his review as “a remarkable overlap between Bromberg's work in clinical psychoanalysis and my work in developmental neuropsychoanalysis, a deep resonance between his treatment model and my regulation theory” (this issue, p. 755). In my reply I comment from my own vantage point on how our shared commitment to an interpersonal and intersubjective perspective—my interpersonal/relational treatment model and his “Interpersonal Neurobiology” led us to arrive at overlapping views on developmental trauma, attachment, the dyadic regulation of states of consciousness, and dissociation.     

Better Identity Politics

Suchet's paper is an inspiring demonstration of the power of openness and vulnerability. It offers a clinically daring and theoretically far-reaching account of the transformation that can sometimes occur in the psychoanalytic relationship. My commentary focuses on two of the paper's major threads: the interplay of subjective experience, intersubjective space, and collective forces, and the ethical dimension of the psychoanalytic project. From the outset, the meeting between Ara and Suchet is not only a meeting of bodies and minds, but also a meeting of collective histories and politics. Suchet finds, and in her account powerfully demonstrates, that addressing her patient's trouble requires an exploration of how collective traumas and political narratives infuse the possibilities of intersubjective exchange and subjective meaning. In my commentary I trace and elaborate on the trajectory of this analytic process, contemplating the ways in which identities and identifications involve both familial and social attachments. I attempt to highlight Suchet's contribution to our understanding of how what happens, and is made meaningful, in the register of collective identification and experience, forms the very substance of subjective and intersubjective life, and should be therefore formulated as an intrinsic aspect of the analytic endeavour. Turning to Suchet's engagement with the philosophy of Emmanuel Levinas, I consider her drive to reach beyond the traditional boundaries of psychoanalytic discourse. Following the same drive, I add some ideas developed by Theodor Adorno, as means of illustrating the trouble and the potential for reconciliation inherent in the experience and politics of identity.     

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.     

Reflections on Janine Puget's Paper

In my discussion of Janine Puget's deeply thought-provoking paper, I focus on her central argument that the subject's interior world and the world of intersubjective relationships answer to different logics and evolve along separate developmental paths. Puget's argument hinges on a notion of the other, and of otherness as disruptive and traumatic to the subject. My discussion aims to problematize this notion on two fronts. First, I suggest that otherness is not only external to the subject. I point to some ways in which psychoanalysis conceives of otherness and of the other as integral to the constitution and development of the subject. Further, I argue that individuals sometimes desire and actively seek otherness. I engage in this context the question of social displacement and immigration, Puget's other main concern in her paper. Life tourists, as Puget calls them, are a paradox of will and necessity, where the prospect of confronting otherness and being othered is both a threat and a life-affirming recourse. Yet there seems to be more involved in immigration than the psychology of individuals or their relationships. Drawing on my personal and clinical experience as an immigrant working with other immigrants, I suggest that beyond the self-other relation, we can recognize otherness on a third dimension, that of collective, socio-political, normative discourse. Looking at the psychoanalytic notion of Oedipus, I suggest the possibility that Puget's view of the subjective and intersubjective as disparate captures the effect this third, social dimension of human life on the construction of subjectivity and of human relating. I argue that the fault line Puget recognizes may be understood as the effect, within subjectivity, of social power.     

Intersubjectivity Theory and the Dilemma of Intersubjective Motivation

This paper explores the topic of intersubjective motivation, understood as the process of being motivated by the subjectivity of other subjects. The author outlines a general conception of intersubjective motivation, arguing for the importance of that conception in advancing the relational project within psychoanalysis. The author reviews a handful of relational and intersubjective approaches, identifying and evaluating strategies that might be employed to explain the phenomenon of intersubjective motivation. Using Jessica Benjamin's theory of intersubjectivity as a starting point, the author proposes an original model of the intrapsychic conditions for intersubjective motivation identified as the intersubjective relational configuration. The clinical implications of these ideas are traced out, and an argument is made for the development of a comprehensive psychoanalytic theory of motivation, one that includes intrapsychic as well as intersubjective elements.     

Psychoanalysis in Three Dimensions: Ringstrom’s Relational Metapsychology: Discussion of “Three Dimensional Field Theory”

Although the analytic intersubjective field remains infinite in its potential forms, processes, and transformations, this commentary highlights Ringstrom’s 3D model (this issue) as tackling the challenge of theorizing the relational analytic act, explaining simultaneously the dimensions of metapsychology and practice. Within the epistemological premises of information theory, the 3D model offers a triangulation between the asymmetry of hemispheral modes of processing, consciousness as truth seeking and an intersubjective dramaturgic dimension to describe the vicissitudes and evolutions of an intersubjectively embedded subjectivity. Reading Ringstrom’s model through the corridor of some basic Freudian intuitions, I formulate my reading of the model’s unique conceptions of time, nothing, and otherness as agents of transformation in the thick relational web of the analytic dyad.     

Intersubjectivity and Naturalism — Husserl's Fifth Cartesian Meditation Revisited

As Husserl argues in the fifth Cartesian Meditation, the similarity of my Body (Leib) with the body (Körper) of another person is the founding moment of the experience of the other. This similarity is based on the previous objectivation of my Body. Husserl continuously worried to explicate this similarity-premise and by doing so, it appeared that this objectivation already presupposes intersubjectivity. By running into this problem, the Meditation actually fulfils its program by showing that the other is co-constitutive of the world and more precisely of my existence as a worldly human being. At the same time he developed an alternative approach by identifying the original experience of the other as an expressive unity (Ausdruckseinheit) as the condition of possibility of intersubjective experience. By drawing on the relevant Forschungsmanuskripte in the volumes on Intersubjectivity and on Ideas II, it appears that the Meditation offers a naturalistic theory of intersubjectivity that results from the introduction of the reduction to primordiality. When one takes into account Husserl's analysis of the experience of an expressive unity, that is a defining characteristic of the personalistic attitude, one can clarify the derivative nature of this naturalistic approach.     

"Reflexive Embodied Empathy": A Phenomenology of Participant-Researcher Intersubjectivity

In this article, I advocate a research process that involves engaging, reflexively, with the embodied intersubjective relationship researchers have with participants. I call this practice reflexive embodied empathy. First, I explicate the concept of empathy through exploring ideas from the philosophical phenomenological literature. I then apply this theory to practice and offer examples of reflexive analysis of embodied empathy taken from various hermeneutic phenomenological research projects. Three interpenetrating layers of reflexivity are described, each involving different but coexisting dimensions of embodied intersubjectivity. The 1st layer-connecting-of-demonstrates how people can tune into another's bodily way of being through using their own embodied reactions. The 2nd layer-acting-into-focuses on empathy as imaginative self-transposal and calls attention to the way existences (beings) are intertwined in a dynamic of doubling and mirroring. The 3rd layer-merging-with-involves a "reciprocal insertion and intertwining" of others in oneself and of one in them (Merleau-Ponty, 1964/1968, p. 138), where self-understanding and other-understanding unite in mutual transformation. Through different examples of reflexive analysis from my research, I have tried to show how intersubjective corporeal commonality enables the possibility of empathy and how, in turn, empathy enables understanding of the Other and self-understanding. I discuss how the coexisting layers of empathy and the resultant understandings can be enabled through hermeneutic reflection and collaborative research methods.     

Crash: What We Do When We Cannot Touch: Commentary on Paper by Meira Likierman

This commentary aims to show the congruence and difference between Likierman's position on recognizing otherness and working with enactment and her relational, intersubjective position. Differences in my reading of the case include stressing the repetition of early attachment trauma, the level of implicit procedural relating, and the patient's contribution to the shared third of rupture and repair. I try to show that enactments arise not merely because the patient is able to pull the patient into forbidden behavior but because the dissociated parts of the patient pull the analyst into dissociation even when the analyst is acting “properly.” The rupture or collision—the “crash”—that the patient helps to formulate represents an opportunity to see the life-giving element in what we, analysts along with patients, inevitably also experience as frightening and even life-threatening.     

The Fortune of a Precocious Awareness

This article affords me an opportunity for après-coup reflection on personal experiences that contributed to shaping the motivations that determined my theoretical choices. The attempt to find explanations for clinical diversity that were not reduced to drive theory led me to draw up a model of thought in psychopathology that allows for different production mechanisms for the same type of symptom and requires differential and specific therapeutic interventions. My dissatisfaction with the Freudian views on femininity showed me the way toward the role of the adult, of the parents, in the evaluation of the self of the child, examining gender differences in the intersubjective theory of sexuality. Symptoms such as hysteria, anorexia-bulimia, and the high incidence of anxiety and depression in women require an understanding of the interpersonal and gender-related factors in its causation.     

We: Commentary on Papers by Trevarthen,Ammaniti & Trentini,and Gallese

In my discussion of papers by Trevarthen, Ammaniti & Trentini, and Gallese, I situate their work within an emerging paradigm of intersubjectivity. This new model finds philosophic grounding in the work of the phenomenologists (Husserl, Merleau-Ponty, Nancy) as it draws from the multiple sources that come together to comprise the new field of cognitive and affective neurosciences. These papers hold the potential to make relational psychoanalysis more relational by providing new foundations for rethinking the biological, developmental and clinical. What emerges is an intersubjective theory based in motor action and perception that serves as the embodied basis for human culture and community, a shared “we” space of basic human affinity. I extend this conception into the analytic setting with a brief introduction to enactive participation in clinical process.