Wade in the Water: Transference Actualization and the Ethics of Memory—Discussion of Bartlett’s “Time-Soaked”

In this discussion of Bob Bartlett’s compelling paper “Time-Soaked,” I shift attention away from the vivid account of the interpersonal dynamics between Bartlett and his patient to describe the perspectives offered by theories of social memory and transgenerational haunting. I attempt to speak for and convey the voices and vulnerabilities of previous generations that I argue—if heard within the analytic dyad—can further inform and deepen the therapeutic endeavors undertaken by Bartlett and his patient.     

The Things We Carry: Finding/Creating the Object and the Analyst’s Self-Reflective Participation

I reflect on the interaction between the analyst’s dedicated attention to the patient’s internal object relations and the analyst’s self-reflective participation. Our stops and starts of attention to the patient’s internal objects and our own is in some sense one of the most important elements of our personal participation. I suggest that the patient’s and analyst’s needs for privacy and the illusion of privacy in the presence of the other, undertheorized within relational theory, is not at odds with an emphasis on valuing the patient’s capacity for a “read” on the analyst. Needs for privacy and the illusion of privacy held by patient and analyst need to be integrated into any psychoanalytic theory and form part of the basis of intimate regulatory systems between two people.     

Accompaniment in Jazz and Psychoanalysis

The author explores a fundamental role of the analyst as improvisational accompanist. This role requires a dedicated attention to the shared rhythmic dimension of the interaction, a mode of psychoanalytic attention of embodied self-awareness and sensitivity–that is, embodied attunement to the pulse of the interaction. Directed action follows by providing various forms of accompaniment that depend on the nature of the patient’s needs and emotional state. By refining our accompaniment to meet clinical situations and challenges, we enlarge the range of analytic engagement. Using examples from jazz, the way the rhythm section finds the right form of accompaniment to support the soloist’s creativity and unique voice, the analyst similarly accompanies his or her patient, providing a temporal framework, a pulse that affirms emotionally shared states, recognition, differentiation, and creative expression. Various forms of analytic accompaniment include steady and present beat, an unobtrusive and loose presence, an interactive and conversational presence, or disruptive rhythms. From experiences of solid support and recognition, accompaniment can fuel the patient’s improvisations, allowing him to move away from the analyst and create a clearer differentiated voice. As the patient separates, he ventures out into new or difficult territory, the analyst’s presence is there following.     

Royaumont Revisited

Michael Dummett has claimed that the only way to establish communication between the analytic and Continental schools of philosophy is to go back to their point of divergence in Frege and the early Husserl. In this paper, I try to show that Dummett's claim is false. I examine in detail the discussions at the infamous 1958 Royaumont Colloquium on analytic philosophy. Many – including Dummett – believe that these discussions underscore the futility of attempting to bridge the gap between Continental and analytical philosophies in anything like their current shapes. I argue, however, that a close study of the Royaumont proceedings rather reveals how close some of the analytical speakers were to some of their Continental listeners.     

Essential elements of the work of a supervisor

The supervisor’s prime task is to consider from the very beginning the analytic ability of the analyst presenting the case; this can be assessed by observing how the colleague transcribes the clinical material and describes what is meaningful in the session. It is extremely important to understand whether the patient’s suffering is neurotic, or whether he suffers from an initial psychotic disorder. In this latter case, the analyst will know that he cannot employ the same tools that he uses for the neurotic patient. It is fundamental to draw careful attention to the importance of the patient’s personal history. In the process of reconstructing the past, the patient’s difficulties are gradually understood by the analyst, the patient and the supervisor. Given that a memory may be distorted by present emotions and conflicts, the analyst must form meaningful hypotheses that, through reconstructing interaction with the original objects, help to comprehend the precarious equilibrium of the present. Over the course of supervision, I consistently emphasize the construction of the analytic relationship, which is based on the analyst’s mind and of the patient’s ability to communicate emotionally, so as to promote the analysand’s mental growth.

     

How Do We Use Theory Now? Commentary on Paper by Melanie Suchet

Melanie Suchet's frank and engaging paper exemplifies a narrative-based discourse that is gaining prominence in the analytic literature. Eschewing any definition of terms, this discourse appropriates a wide array of analytic concepts to support a narration of co-creation of meaning and self-restoration in the clinical encounter. I examine a portion of the clinical case material to highlight some perceived pitfalls that arise from an uncritical and unsystematic use of theory. A particular pitfall is revealed in the way the author, while jettisoning the constraints of orthodox clinical theories, ends up overvaluing a singular explanatory model, thus unwittingly imposing a top-heavy, over-saturated interpretation on the clinical material. This unexamined theoretical bias leaves it unclear what should constitute the data of analytic observation: While ascribing crucial explanatory significance to socio-political narratives, which lead the analyst to feel that historical guilt over intercommunal conflicts must actually be redressed in the patient–analyst relationship, the author nevertheless pays little attention in the report to guilt dynamics arising from actual conflict in the here-and-now of the therapeutic encounter. Conceptual disarray is particularly noticeable in the confusion between identity and identification—that is, between a relatively fixed and consciously symbolized identity narrative, and something unconsciously taken on as a transient identification.     

Working at the “Intimate Edge”: Intersubjective Considerations—Comments on “A Case Study of Power and the Eroticized Transference–Countertransference”

Working from the premise that as analysts we are always vulnerable to unconscious collusion and enactment, and that this has radical implications for how we conceive of the analytic process, I try to illustrate how the process of working at the “intimate edge” of the analytic relationship, and explicitly engaging what goes on intersubjectively between patient and analyst expands the analytic process and the analytic possibilities. I especially focus on how deconstructing interactive enactment can help to access unconscious aspects of what might be in play in relation to the issues of power and eroticized transference–countertransference under discussion here, and how this process itself can become the medium of the work and the focus of therapeutic action.     

Receptivity,or Going on (Not) Being: Commentary on Paper by Robert Grossmark

“The treatment hinged on my being able to live with him in this ongoing non-existence and know it and tolerate it, and expect no more,” writes Dr. Robert Grossmark about himself and his patient, Kyle (pp. 637–638). This is a key sentence, outlining the core of the enlightening analytic work done. I comment on the linkage between living the ongoing nonexistence and going-on-(not)-being, then reflect about the distinction between what I call the “outward” technique, which is everything Grossmark describes about treating Kyle, and the “inward” technique, which is all that occurred within him, in an inner, hidden, powerful, unconscious dialogue with the patient, and which is only hinted at. In this context, with patients like Kyle, who bring to the analyst physical sensations and actions for dreaming, the analyst's corporeality, by which I mean his experience of his body and his capacity to connect it to emotion, thereby lending it meaning, has a critical importance. I bring, in a nutshell, references to several psychoanalytic writers about the subject of corporeality in analytic treatment and use a vignette from an analysis to demonstrate the point.     

Discussion of Craige's “Terminating Without Fatality”

Craige's concept of termination and the related concept of post-termination contact are based on Freud's early, one-person model of analytic therapy as a medical treatment for the cure of a disease. Post-termination contact was considered appropriate only if the patient needed additional therapy. Subsequent development to a two-person model of treatment, which recognizes the critical importance of the patient–analyst relationship, requires modification both of concepts of termination and of post-termination contact. I propose that whether there should be such contact, and what it's nature should be, should be mutually decided by patient and analyst in the termination phase, based on their risk/benefit evaluation of such meetings. The intimate, loving patient–analyst relationship, which has enhanced the patient's development, should be able to continue in some form after the end of treatment unless substantial, unresolved problems of either patient or analyst proscribe such meetings.     

The Wisdom of Sharing a Frame: Commentary on Papers by Anthony Bass and Ilana Laor

In this discussion I agree with Anthony Bass, who shows how the analytic frame has properties that involve both the process and the structure, and I suggest replacing the term structure with the term constraints. Bass considers analytic frames as contexts: Different frames organize different contexts of experience. He says that the frame is cocreated by patient and analyst and evolves over time. I think that Dafna's case presented by Ilana Laor is a good example of this aspect. I agree with Laor, who shows how the frame reflects the negotiation process between patient and analyst, emphasizing that this process itself is therapeutic. Following Bass I emphasize that a polarization between stability versus flexibility should be replaced by the dialectic between stability and flexibility. I conclude wondering how Bass's and Laor's “wisdom” regarding flexibility and elasticity can be passed over to younger psychoanalysts who are beginning their clinical work.     

Engaging with Buddhism

In his new book, Jay Garfield invites philosophers of all persuasions to engage with Buddhist philosophy. In part I of this paper, I raise some questions on behalf of the philosopher working in the analytic tradition about the way in which Buddhist philosophy understands itself. I then turn, in part II, to look at what Orthodox Buddhism has to say about the self. I examine the debate between the Buddhist position discussed and endorsed by Garfield and that of a lesser-known school that he mentions only briefly, the Pudgalavāda (“Personalists”). I suggest that the views of the Pudgalavādins are strikingly similar to a position held, in the twentieth century analytic philosophy, by Peter Strawson.     

Trust and the Analytic Dialogue: Reply to Schwartz Cooney and Newirth

In this response to discussions by Amy Schwartz Cooney and Joseph Newirth, I recognize that both authors, coming from different theoretical perspectives, call attention to the ways that issues of trust in the analytic dyad shine a light on difficulties in a relational approach that is seen as emphasizing self-disclosure and expressivity. While Schwartz Cooney notes the importance of a relational “critique from within,” Newirth, a contemporary Kleinian, offers a structural perspective that emphasizes unconscious processes. I address some of the points raised by Schwartz Cooney, clarifying my thoughts on trust as both a prerequisite for and an achievement of psychoanalysis. I view Newirth’s formulation of modern Oedipal rivalry as helpful in understanding the enactment with Julia, but I differ from him regarding how I would make use of it clinically.     

Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address

This paper will attempt to broaden the conception of witnessing in analytic work with traumatized patients by extending the idea to incorporate the patient’s developing and varied capacity for witnessing, as well as a witnessing that occurs within the analytic relationship itself. Actions occuring as part of traumatic repetition are understood to represent memory phenomena and are distinguised from dissociated self‐state experience. These experiences are not therapeutically intended to be symbolized, but rather lived‐through with the analyst, thus transforming the patient’s own relation to the experience. I suggest that the scene in which this living‐through takes place is the transference–countertransference matrix, and that it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction. A clinical vignette illustrates the turning of trauma’s imperative for witnessing into an address in the analytic encounter.     

A note on notes: note taking and containment

In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.     

Training Analysis: Oxymoron or Viable Compromise? Training Analysis,Power, and the Therapeutic Alliance

Balint was among the first to express concern about the “hidden power dynamics” that underlie training analyses. In this paper, I identify some of the problems with this form of treatment, which simultaneously tries to educate the candidate about analytic treatment and ensures that the candidate satisfies certain requirements before he or she is permitted to practice analysis. I argue that the candidate's trying to complete the training analysis—a prerequisite to becoming a full-fledged psychoanalyst—may prevent the full manifestation of the breadth and extent of the candidate's neurosis. Paying attention to the therapeutic alliance assists the analytic dyad in navigating the complex work of a training analysis.     

Discussion of Holly Levenkron's “Love (and Hate) With the Proper Stranger”

I agree with Holly Levenkron that the value of an intersubjective perspective is pragmatic: It directs the analyst toward more effective technique. Also, I agree with her view that a successful analytic process is a negotiation between analyst and patient. However, I question Levenkron's idea that the analyst must loosen her hold on her own subjectivity in order for the negotiation to proceed. An analyst cannot and need not diminish her subjectivity. Rather, what is required for clinical analytic work to unfold is that the analyst include the patient within the analyst's subjectivity—or, in other words, that the analyst come to love the patient.     

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.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).