Psychoanalytic Healing,Love, Life,and Death: Commentary on Paper by Sheldon Bach

In his seminal clinical writings on psychoanalysis, Sheldon Bach transcends the limiting confines of individual and parochial schools of psychoanalysis. Both in “On Digital Consciousness” and in his 2006 Getting From There to Here: Analytic Love, Analytic Process, we see a strong relational dimension in Bach's work (see also Bach 1985 Bach, S. 1985. Narcissistic states and the therapeutic process, Northvale, NJ: Aronson.  [Google Scholar] and 1994), though he comes from firmly within the psychoanalytic mainstream. Bach's writings speak to clinicians across schools of thought, are clinically near to experience and are often moving. While he makes occasional mention of his contemporaries, Bach is grounded in more traditional references and only hints at his intellectual connection to relational and intersubjective theorists. One purpose of this commentary is to reflect on Bach's contribution to contemporary psychoanalysis and to draw out the connections between his work and the work of those within the broader relational and intersubjective community of psychoanalysis.     

It is All Personal: Further Thoughts on Therapeutic Action: Commentary on Paper by Noelle Burton

This paper evolved from an earlier panel presentation on conceptual tributaries to relational thinking at the 2015 International Association for Relational Psychoanalysis and Psychotherapy Conference in Toronto. Representing the place of Object Relations theory in the DNA from which Relational Psychoanalysis emerged, I emphasized—and provide here an abbreviated review of—the contributions of Fairbairn, Klein, and Winnicott. Then, as now, believing in the communicative power of clinical examples, I offer an extended clinical narrative in which the medium is the message and clinical phenomena such as multiple self-states, enactments, negotiation, play, and the residue of internal object relations (in both patient and analyst) are brought to life. Also, as the Toronto Plenary overview paper by Jody Davies has developed into its current substantial elaboration of distinctly relational issues (multiple self-states, co-creation, and the interplay of process and insight) and serves as the capstone paper for this published version of our panel, I respond to Jody’s conceptual contributions and her perspective on Relational thinking.     

Suffering Passion,Together: Commentary on Paper by Peter Shabad

In this appreciative discussion of Shabad's paper, the author suggests an expanded role for intrapsychic conflict around the passionate drive to grow and change. At the same time, he suggests that the parent or analyst may need to “suffer passion” him or herself in order to help the patient or child evolve in this way.     

Commentary on Paper by Hilary Hoge

In this discussion the author raises the question of the analyst's freedom to sustain paradoxical viewpoints, specifically with regard to dream interpretation and related links to internal objects and the self as they appear in the transference. Paradox allows for the creation of multiple, coexisting meanings that can be played with by patient and analyst. Paradox also makes possible an experience of decentering and destabilization pursuant to Bion's catastrophic change. The risk inherent in the emotional experience of catastrophic change may limit and at times foreclose both patient's and analyst's freedom to tolerate and sustain the effects of paradox.     

Commentary on Paper by Michael Parsons

A range of clinical psychoanalytic approaches in the United States is considered as they may parallel Parsons's presentation of an “independent” orientation in Britain.

Attention is paid in particular to the analyst's sense of outsiderness and concern for otherness, along with their moral implications for clinical work. In addition, the limitations of theory and defensive misuse of theory are also addressed.     

Commentary on Paper by Julie Gerhardt

This review discusses factors producing excessive envy in some personalities innate, environmental and developmental. He agrees with Julie Gerhardt that envy is not atomic but molecular and evoked in triangular situations. However he suggests that factors that may manifest themselves in the earliest infantile stage can contribute to its later development and agrees with Gerhardt that the earliest mother infant interaction is crucial.     

Commentary on Paper by Terry Marks-Tarlow

This discussion of the paper merging and emerging: A nonlinear portrait of intersubjectivity during psychotherapy focuses on how the original paper demonstrates the usefulness of the concepts of nonlinear dynamics systems theory (NLD) to clinical psychoanalysis. Diagnosis conceptualize in NLD terms successfully resists the pressure to reduce complex situations to overly simple few word phrases. The phenomena of transference and repetition are redescribed as resulting from an iterative process that is evident in complex adaptive systems. The model of psychoanalysis in terms of coupled oscillators is demonstrated to be clinically useful as is the concept of emergence which overcomes some of the less useful aspects of the reductionist program. The idea of studying boundaries per se, as opposed to their function of separating individuals, arises naturally from the study of fractals and promises to clarify the oversimplified discussions of these matters in the psychoanalytic literature. The original author has successfully demonstrated how useful NLD conceptualizations can be to the clinical psychoanalyst.     

Commentary on Paper by Danielle Knafo

The author discusses the importance of Knafo's rich paper on the often neglected subject of solitude but argues for a clearer demarcation of the multifarious states of aloneness, solitude, loneliness, and isolation. While solitude constitutes a state of plentitude, demonstrating an ability to be alone in the company of an Other, loneliness, in contrast, conjures up a sense of dread and despair, foreseeing no link to an Other. Hence, an artwork can fulfill radically different aspects of the various states of aloneness, it can be a product emerging out of a full sense of solitude, or it can function as a forceful shield against the unbearable sense of loneliness.     

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.     

Commentary on Paper by Debra Rothschild

In my response to this paper, I begin by appreciating Debra Rothschild's relational approach and pointing to the links with our work at the Clinic for Dissociative Studies. For example, we all respond differently to child alters/states than to adult ones, consider the attachment relationship to be the crucial tool, do not like to see distancing mechanisms privileged by abusing the original concept of “neutrality,” and consider honesty and authenticity are essential when working with extreme trauma. In this we agree with Bass (2007) Bass, A. 2007. When the frame doesn't fit the picture. Psychoanalytic Dialogues, 17: 1–27. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar] that one size does not fit all. We consider patients need to choose between integration or separateness. Where integration is sought we speak of “merger not murder.” I express concern at the prevailing idea that a person with Dissociative Identity Disorder needs safety, stabilisation, and symptom reduction initially when the most needy clients are those who will never be safe. I also raise issues around secondary traumatisation to the therapist, the meaning of self-injury, and the language used to describe the angry alter.     

Commentary on Paper by Steven Cooper

In this discussion of Steven Cooper's paper, it is argued that, although Cooper's desire to hold himself “accountable” in his work with patients is laudable, the “pluralistic third” approach that he employs gives rise in his doing so to several difficulties in the way that it is described in the paper. The vivid clinical material that Cooper provides to illustrate his approach is used as a starting point to offer an understanding of what transpired between analyst and patient, which although convergent with Cooper's formulations in some respects nevertheless follows a very different line of thinking in other areas. Broadly speaking, it is suggested that although these divergences arise from many sources—a discussion of which is beyond the scope of this contribution—one particular issue involved is a rather different understanding of the role of early internalized object relations in the patient's psychic life and the way these get lived out at many levels in the treatment situation. It is further argued that Cooper's conceptualization of the approaches of schools different from his own appears somewhat circumscribed and this detracts from his desire to make an authentic comparison between his way of working and those of other schools, something that is called for by his proposed pluralistic third method of keeping himself accountable. This is not considered surprising given the difficulties inherent in our becoming adequately familiar, in more than just an intellectual way, with the approaches of schools different from our own, especially when wide divergences are involved between schools.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

Need,Paradox, and Surrender: Commentary on Paper by Adam Phillips

Despite its centrality in the lives of many people, psychoanalysis, with its traditional emphasis on psychosexuality and rationalism, has generally undervalued the importance of love and romance. This essay explores this devaluation within psychoanalytic theorizing and the parallel widespread degradation of love in everyday life. Whereas common wisdom claims that familiarity extinguishes love, I argue that the illusory security that familiarity often masks is endangered by genuine love, with all its accompanying risks.     

Dance,Don't Interpret!: Commentary on Paper by Steven Cooper

With difficult patients who seek to engage the analyst through struggle rather than through warm connection, analysts struggle whether to interpret or contain. I use Cooper's case example to consider these two initial treatment approaches. I argue for the approach that is most difficult for all analysts—to let the patient be himself guiding us toward what he does and does not need.     

Shakespeare,Psychoanalysis and Creativity: Commentary on Paper by Lauren Levine

This discussion speaks to the creative dimension in the clinical encounter described by Levine in her paper. In particular, it addresses the creativity necessary to move beyond impasses in the treatment. The positive and negative associations to enactments are discussed as well as the creative possibilities offered in dreamwork and the analytic relationship.     

Murakami,Connoisseur of Uncertainty: Commentary on Paper by Thomas Rosbrow

My discussion embroiders around Thomas Rosbrow's view of Murakami as a “trauma analyst.” I highlight the ways in which Murakami's writing reflects his keen sensitivity to existential uncertainty and how he seems to understand trauma, much as I do, as a shattering experience that destroys the certainties that organize psychological life and generates efforts at self restoration. Although I share Rosbrow's view that “After the Quake” depicts a character's awakening from the dissociative manifestations of trauma, I spell out how my perspective on this process differs from his.     

Our Theories,Our Selves: Commentary on Paper by Ruth Gruenthal

Ruth Gruenthal invites us to explore the dynamics embedded in disengagement. She suggests that this very concept is an oxymoron; by virtue of the fact that the patient is in treatment she is, in fact, engaged. Gruenthal focuses on disengagement's self-sustaining function, noting that it represents an attempt to regulate emotional distance while still retaining a connection to the other. Recognizing how difficult work with withdrawn patients can be, Gruenthal suggests that theory can actually shift the analyst's negative countertransference response. Implicitly she challenges the relational assumption that active engagement around the analyst's subjectivity always lies at the center of therapeutic process. I offer my own take on the dynamics at the heart of Gruenthal's treatment of Helen, proposing that neither disengagement nor containment can be accounted for by the patient or analyst alone. I explore how theory helps us manage our subjectivity while also embodying it.     

Stained Hands: Commentary on Paper by Gillian Straker

I attempt, in this discussion, to deconstruct the jouissance present in the witnessing of a deliberate annihilation of a human being. I propose that the crisis in the analyst's subjectivity is linked to an unconscious identification with that which is most abhorrent and unacceptable. The unknowability of trauma ensures that its presence will be enacted in a complex system of mutual influence between analyst and patient in which the roles of victim, perpetrator and bystander oscillate between and within the participants. Taking the discussion to the broader sociopolitical level, I make an analogy between the destructiveness of the South African regime under apartheid and the current destructiveness of the U.S. engaging in a pre-emptive war. In a similar way to how Straker may feel contaminated by her patient's complicity in annihilation, so too are we contaminated by the atrocities perpetuated in the name of our country, even if they are policies we condemn.     

More Metaphor: Commentary on Paper by Ken Corbett

Beyond the inevitability of countertransference feelings is the question of countertransference enactments. From a two‐person, participant‐observer or observing‐participant perspective, enactments are inevitable. The analyst becomes influenced by the patient (and influences the patient as well) and enmeshed in the patient's internalized interpersonal configurations. Analysis works not by avoiding such action but by analyzing from within the interactional system. Analysts who are different from one another become engaged in different ways, since the person of the analyst is a significant variable. This article, using case examples, explores two analyst‐related variables, age and family configuration, to expand the examination of countertransference enactments and some effects on the analytic process.