Which Horse do You Ride? Trauma from a Relational Perspective. Discussion of Prince's “The Self in Pain: The Paradox of Memory. The Paradox of Testimony”

Discussing Dr. Robert Prince's clinical case example, the author presents a relational psychoanalytic perspective on working with the traumatized patient. She considers the presentation of his work with a Holocaust survivor from a relational perspective with particular attention to the dyadic interaction, the intersubjectivity and co-creations of patient and analyst, and finally, addresses the role of the “witness” in psychoanalytic work. The idea of the witness has particular currency in contemporary psychoanalytic thinking. The author briefly examines the dimensions of the “witness” from a relational point of view. Consideration is also given to the necessary distinction between adult onset and childhood onset trauma and the repercussions of each for the analytic couple.     

Applications,Implications, Complications: Reply to Reviews by Elkind,Gerson, and Levine

The author appreciates the careful reading and thoughtful reviews by Sue Elkind, Sam Gerson, and Howard Levine. Elkind's review particularly captures and articulates many of the key ideas in the book Building Bridges: The Negotiation of Paradox in Psychoanalysis and creatively applies concepts of negotiation, paradox, an inherently multiple “distributed self,” and metaphor in her own work consulting on treatment impasses. Gerson incisively focuses on the core idea of recognizing, accepting, and bridging differences and contradictions in personal, and national, perspectives; he also articulates an understanding of the attempt of relational analytic writers to bridge the intrapsychic and the interpersonal with due recognition of each. The author replies extensively to Levine's comparison of Pizer's work with that of Semrad and other “classical” analysts and challenges Levine's premise that a relational perspective, grounded as it is in a two-person contextual psychology, ignores or devalues interpretation, insight, free association, and autonomous mental functioning. Quoting from clinical material in his book, Pizer presents the outcome of a “relational” analysis in terms of the patient's increased access to internal “potential space,” unconscious experience, curiosity, and reflectiveness about the mental life of self and other, and an increased ability to value personal experience in relationship and in solitude.     

Altruistic love in psychoanalysis opportunities and resistance

Many patients manifest a desire to help the analyst. This is usually understood as being derivative of defensive aims or in the service of other primary motivations. This paper argues for the developmental and clinical importance of primary altruistic aims, which are often warded off by the patient because of his or her fears of exploitation or rejection. Several pathogenic beliefs and varieties of psychopathology result from the failure of the patient's caretakers to allow the child to contribute to their welfare, to “take”; the child's “help.”; Similarly, some patients require tangible evidence that they are having a positive impact on their analyst. Ordinary “good‐enough”; technique often reinforces the patient's view that he or she has nothing to offer. A full appreciation by the analyst of the importance to patients of having their altruistic gestures and concerns recognized and accepted can open up possibilities for analytic progress and therapeutic growth. Various sources of resistance to and misunderstanding of these dynamics are explored, ranging from ethical concerns to certain traits that cluster in the personalities of analysts.     

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.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

Affective Experiences and Honesty in the Interaction: Discussion of Holly Levenkron's Paper

Anchoring her views in the work of Benjamin and other American relational authors, Levenkron asserts that intersubjective relatedness in which there is recognition of separate realities is essentially the only form of relatedness. Framing growth as coming about through the recognition of another's subjectivity provides a basis for “confrontation” and for a more direct injection of the analyst's subjectivity into the analytic encounter. More specifically, it fosters the expression of the analyst's subjectivity from what this author calls the “other-centered” and “self” perspectives.

In contrast, the recognition of selfobject and caretaking relatedness positions the analyst to express directly aspects of the analyst's subjectivity pertaining to mirroring, idealizing, and twinship selfobject needs. Kohut and classical self psychologists have delineated selfobject needs and the selfobject dimension of relatedness and transference and have emphasized the consistent use of the empathic listening/experiencing perspective. American relational theorists have delineated intersubjective relatedness and the usefulness of the other-centered listening/experiencing perspective. This author focuses on an integrative theory including three forms of relatedness and different listening/experiencing perspectives. Different listening/experiencing perspectives and forms of relatedness fundamentally influence analysts' affective experiences within the analytic encounter as exemplified in Levenkron's case.     

Roles of Engagement: Commentary on Paper by Richard Almond

Richard Almond's discussion on the benefits of attending to the tension between what he refers to as analyst role and nonrole behaviors is quite stimulating and highlights important issues within the world of psychoanalysis. Although appreciating Almond's efforts to add clarity and perspective to the discourse on relational analytic activity, I point out the ways in which dichotomizing the analytic endeavor into “role” and “nonrole” behaviors can be limiting. It is proposed that prioritizing the tension between these polarities as mutative does not encourage the “spaces” between these role and nonrole behaviors to be maximally used, minimizes the interactive component, and privileges observing over experiencing. It is also contended that an affectively alive analyst, including one in the midst of enactments is acting within role. A clinical example is used to demonstrate that neither interpretation nor interaction should be privileged in terms of therapeutic action.     

Moments of Therapeutic Impasse: Commentary on Jody Messler Davies's “Whose Bad Objects Are We Anyway? Repetition and Our Elusive Love Affair with Evil”

Davies contributes to the development of relational theory by formulating and illustrating what occurs during especially difficult moments in an analytic exchange. In understanding enactments, Davies importantly underscores the contribution of both the analyst's and patient's “bad objects.” This author attempts to build bridges between Davies' language and concepts anchored in object relations theory and this author's language and concepts based in contemporary or relational self psychology, including the integration of cognitive psychology. In addition, this author delineates the use of the “empathic,” “othercentered,” and “analyst's self” listening/experiencing perspectives to explicate the case material and to provide alternative understandings and pathways for psychoanalytic work. The thesis set forth is that the use of different listening/experiencing perspectives expands choice for the analyst when working in difficult moments of the clinical exchange.     

Developing a Psychoanalytic Practice

Abstract

This paper examines two methods of developing a psychoanalytic practice. The first is an “internal” approach that helps a patient make the transition from therapy to analysis with the same analyst. This may be accomplished by attenuating the patient's unconscious fears of analysis as a facilitator of an anticipated regressive loss of control and as a reactivator of feared desires and impulses. Increased motivation for analysis may also result from a therapy that leads the patient to an awareness that an ongoing level of distress is internal, together with the experience of a deepened therapy and of the analyst as safe and potentially providing relief. The second method of developing an analytic practice is an “external” approach that provides others, such as analytic, mental health, medical, and academic colleagues, an experience of the analyst as person and some idea of the type of work he or she does.     

DREAMING THE ANALYTIC SESSION: A CLINICAL ESSAY

This is a clinical paper in which the author describes analytic work in which he dreams the analytic session with three of his patients. He begins with a brief discussion of aspects of analytic theory that make up a good deal of the context for his clinical work. Central among these concepts are (1) the idea that the role of the analyst is to help the patient dream his previously “undreamt” and “interrupted” dreams; and (2) dreaming the analytic session involves engaging in the experience of dreaming the session with the patient and, at the same time, unconsciously (and at times consciously) understanding the dream. The author offers no “technique” for dreaming the analytic session. Each analyst must find his or her own way of dreaming each session with each patient. Dreaming the session is not something one works at; rather, one tries not to get in its way.     

Review Essay: Constructivism with a Human Face

Irwin Hoffman's book Ritual and Spontaneity includes, but goes well beyond, his series of seminal papers—written over the past several decades—developing a psychoanalytic, constructivist perspective. A new, existential framework depicts what Hoffman calls the “psychobiological bedrock” at the core of the human process of constructing meaning—the lifelong effort to create a livable, subjective world in face of our ever present sense of loss, suffering, and, ultimately, mortality.

This review describes Hoffman's encompassing, existential perspective and discusses how, within this framework, he uses his dialectical sensibility to frame our understanding of both parenting and analysis as “semisacred” activities. The “dialectic of ritual and spontaneity”—the vital clash between disciplined adherence to the analytic frame and personally expressive deviations from it—represents the creative tension between the “magical” dimension of analytic authority and the healing influence of a genuinely expressive human relationship. Hoffman's perspective on the self-interested, “dark side” of the analytic relationship is compared with Winnicott's views on the vital, therapeutic role of “hate” and the paradoxical process by which the patient comes to “use” the analyst.

Unlike most postmodernist “constructivists,” Hoffman openly reveals his underlying belief in certain “transcultural, transhistorical universals”—his “psychobiological bedrock.” In acknowledging these “essentials” (assumptions about human nature) that in some form are integral, yet often hidden, elements of any system of thought, Hoffman saves his own dialectical constructivism from falling into dichotomous (constructivist vs. essentialist) thinking.     

Report on a Panel Discussion on Interpretation

A case is presented where the patient's early experiences of violence and neglect have resulted in a defensive organization that has protected him against intolerable anxiety, at the cost of development and growth. In the analytic setting, the patient withdrew into his perverse fantasy world, an area of relative peace where he had omnipotent control, whenever contact with the analyst within a “room for relatedness” was experienced as threatening or frustrating. His avoidance of contact with the analyst was also an avoidance of reality, and proved to be a strong obstacle to progress in the treatment. During the terminal phase, he was forced to face reality and it seemed then that some widening of his psychic reality took place.     

What’s So Great About Authenticity Anyway? The Therapeutic Function of an Analyst’s Lie

How can we understand moments when the analyst lies to her patient? When it’s not the patient’s lying at issue but the analyst’s? When we suddenly find ourselves being deliberately disingenuous in the analytic hour? When our commitment to authenticity conflicts with the patient's need to create and sustain certain fantasies about us? Psychoanalytic literature typically focuses on the dynamics of the patient’s lie but rarely is the analyst's authenticity questioned. Are there times when the analyst might choose to lie in order to preserve herself, as well as, the relational bond? The complexity of this “choice” is explored and the erosion of an analyst’s authenticity unpacked during the final days of a difficult treatment.     

At Death's Door: Therapists and Patients as Agents

This paper explores the interrelationship between patients' exercise of will to make advances in an analysis and their readiness to forgive their analysts for their human limitations. There is a thin line between idealization of the analyst, probably a necessary component of the process, and resentment of the analyst for his or her privileged position in the world and in the analytic situation itself. The patient's “progress” emerges as a kind of reparative gift, one that implicitly overcomes the patient's tendency to withhold such change out a sense of chronic, malignant envy. Particularly poignant in terms of its potential to elicit the patient's reparative concern is the situation in which the analyst is struggling with his or her mortality because of aging or life-threatening illness. In this essay two clinical vignettes are presented to illustrate some of the issues that this situation poses. One begins with an elderly patient appearing at the door of the analyst's (the author's) home the day of his return from the hospital after coronary bypass surgery. The other begins with an analyst who is terminally ill appearing at the door of a patient who is threatening suicide. The two stories are compared in terms of their implications for human agency, the exercise of will, and the coconstruction of meaning in the face of mortality in the analytic process.     

RUPTURES IN THE ANALYTIC SETTING AND DISTURBANCES IN THE TRANSFORMATIONAL FIELD OF DREAMS

This paper explores some implications of Bleger's (1967, 2013) concept of the analytic situation, which he views as comprising the analytic setting and the analytic process. The author discusses Bleger's idea of the analytic setting as the depositary for projected painful aspects in either the analyst or patient or both—affects that are then rendered as nonprocess. In contrast, the contents of the analytic process are subject to an incessant process of transformation (Green 2005). The author goes on to enumerate various components of the analytic setting: the nonhuman, object relational, and the analyst's “person” (including mental functioning). An extended clinical vignette is offered as an illustration.     

Standard Dominance Versus Creation of Interludes of Equalization of Power in the Psychoanalytic Situation: Discussion of Case Presentation by Joseph Newirth

Joseph Newirth tells us that it is his aim in the analytic work to facilitate a “symmetrical dialogue [that] involves an equalization of power, [and] a radical view of mutuality and of self-disclosure in the analytic relationship.” My thesis here is that the process falls short of that objective. Instead, it is characterized by an enactment in which the analyst is always dominant. Several examples of “power plays” are presented in which the analyst, in a manner partially institutionalized as standard psychoanalytic practice, repeatedly gains the upper hand in the analytic relationship. One important aspect of this enactment entails a systematic bias in favor of interpretations that attribute neurotic, primitive, or regressive motives to the patient at the expense of hearing and taking seriously the patient's more mature perceptions and judgments, including those focused on the analyst himself.     

State of the Hope: The New Bad Object in the Therapeutic Action of Psychoanalysis

Until recently, most psychoanalytic conceptualizations of the analyst as a new object have tended to equate newness with good experience and safety. Recent papers in the relational literature have explored not only the therapeutic value, but also the inevitability of the patient's experience of the analyst as bad, as well as the analyst's participation in this experience. This author examines the multifarious nature of hope, goodness, and badness in the clinical situation. The patient gets to know not only elements of his or her own self that are held by the analyst, but also ways in which the patient holds elements related to the particulars of the analyst's person in the analytic situation. Shifts in American psychoanalysis regarding conceptualizations of the analyst as a new object are examined. Limitations of a bifurcated approach to goodness and badness in clinical conceptualizations are also explored.     

Reply to Commentaries

Questions of historical context resonate with an Independent view of the importance of history. The historical backgrounds of North American and British psychoanalysis are relevant. Some American analysts may be seen as belonging to the Independent tradition, and the relation between Independent analysis in Britain and Relational analysis in America needs further consideration. I ask how far Relational analysis is taking on an institutional identity, and link this to Poland's discussion of “outsiderness.” Responding to Bass's and Berman's comments on my clinical examples I discuss why I sometimes do think analysts need to ascribe meaning to a patient's material. In other instances an analyst will invite the patient more into the process by which meaning evolves between them. To move freely between these positions is central to my view of clinical technique. I express doubts about analysts asking patients for their emotional reaction to an analyst's interventions. This risks being intrusive, and may tend to keep the exchange at the conscious level of a patient's mind. The analytic relationship is an interpersonal one between real people, but the analyst needs also to remain symbolically available as an object of unconscious fantasy and projection.     

Attention and Narration to Micro-Moment Registrations of Embodied Dialogue in the Clinical Interaction: How Are We Doing?

ABSTRACT

This article offers a comparison between two different strategies for clinical attention. The author compares his lens shaped by a musical metaphor of “polyrhythmic patterning” on embodied registrations which he describes as “fluidity” in contrast to a lens of structures or categories of experience. He then contrasts this lens to that offered by Lewis which she describes with the metaphor of an “imaginary camera” with which she creates “snapshots” as representations of unbearable (and often unformulated) trauma shaped by the patient's narrative and her own trauma history. Acknowledging the exquisite connection between analyst and patient, the author uses 2 clinical moments to further illustrate the benefits of each metaphoric lens for possible analytic work.     

Language and Intersubjectivity: Multiplicity in a Bilingual Treatment

This paper explores the psychodynamics of analytic work conducted between a French patient and an American analyst who are both bilingual in French and English. The depth of the patient's early traumatic relational history is initially bound and cloistered in French, her mother tongue. The author argues that through the symbolization of a series of initially dissociated enactments a transitional space is created in the treatment, facilitating the integration of the patient's (and analyst's) early French-speaking selves. Language is considered as a container for both dissociative and associative forms of multiplicity, as it serves to mediate an external and internal intersubjective expansion both between and within patient and analyst.