With Respect to the Analytic Frame: Commentary on Paper by Steven Stern

In this discussion of Steven Stern's paper, support is expressed for the position that analysis should not be defined simply by external criteria such as four-times-a-week frequency, but should get its definition from intrinsic criteria. This raises the question, however, of what the intrinsic criteria are understood to be, and what status to accord the fact that certain extrinsic or objective aspects of the clinical framework (a fixed setting, ground rules, prohibitions, and social and legal sanctions) seem non-negotiable, indispensable, and even constitutive of the therapeutic process, as is the analyst's unilateral application of analytic techniques. Note is made of how the paper lacks a rigorous approach to the actual phenomenology of the frame, thus forfeiting a conceptual appreciation of its distinctive structuring role and its complex functionality. In lieu of an adequate exploration of how the frame works in its own right, the paper superimposes a theory-driven and highly partisan position regarding the necessary malleability of the frame, deriving from the belief that everything in the clinical encounter is co-created and negotiated. A critique of this approach is offered, centering on what is seen as an inadequate distinction between structure and process in this model of the clinical encounter.     

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.     

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.     

Field Theory: Commentary on Paper by Donnel B. Stern

Stern offers a compelling introduction to a comparative theory of the field in his examination of its origins in the work of Harry Stack Sullivan and of Madeleine and Willy Baranger. Although he notes that Sullivan and the Barangers developed their field concepts separately, I suggest that there is a common context, and I detail this in regard to the early history of the concept, particularly in regard to Merleau-Ponty. Stern describes well the points of common use of the field concept and highlights differences that are the defining line between relational thinking and other orientations. In his view, the Barangers do not adequately take into account the analyst's inevitable participation and do not in the end step out of framing the unconscious as an internal process. I question this reading and ask how we might benefit from an “epistemological pluralism” that would invite working from diverse perspectives.     

A Neuropsychoanalytic Viewpoint: Commentary on Paper by Steven H. Knoblauch

In October 2004 it was my pleasure to present at a cutting-edge conference entitled The Interplay of Implicit and Explicit Processes in Psychoanalysis. In addition to offering an address (“The Essential Role of the Right Brain in the Implicit Self: Development, Psychopathogenesis, and Psychotherapy”), I also provided a commentary to Steven Knoblauch's excellent paper, “Body Rhythms and the Unconscious: Toward an Expanding of Clinical Attention.” In the following, I briefly summarize these presentations, with the purpose of showing how current advances in developmental and neuropsychoanalysis are being incorporated into the practice of clinical psychoanalysis. This work is part of an ongoing effort to expand regulation theory, an overarching theoretical model of the development, psychopathogenesis, and treatment of the implicit self.     

Shades of Mark Twain: Commentary on Paper by Steven H. Cooper

The author considers Cooper's notion of the pluralistic third from several angles as Cooper's use of the term covers a range of applications from that of an internal supervisor to the use of ideas from psychoanalytic traditions other than one's own in evaluating one's clinical work. The impression created of the American situation is contrasted with the institutionalized pluralism of the British Psychoanalytical Society since the Second World War. The author believes that the theoretical question of the analyst's accountability to a professional authority is overdetermined in the paper because the clinical material is dominated by the patient's problems in facing up to parental authority. A crucial enactment is seen as starting at the analyst's first contact with the patient, which seems to subvert the analyst's capacity to be an authority figure. The analyst finds a working relationship with his own psychoanalytic authority in the second session of the analysis but seems to lose it through an overextension of the ideas of “play,” self-questioning, and the seeking of agreement between patient and analyst. The author considers the clinical material from the point of view that his peer supervision group would take.     

More or Less Life: Commentary on Paper by Ken Corbett

This paper elaborates on Ken Corbett's sense of inclusive and paradoxical solutions to what are traditionally described as conflicts of gender.     

Solitude: Potential Gift,Danger or Both: Commentary on Paper by Danielle Knafo

This discussion lauds the main thrust of Dr. Knafo's paper, which is the crucially important, and too often neglected, role of solitude in the fullest development of self. Questions are raised regarding conflicting aspects of solitude as presented, and clarification from Dr. Knafo is sought. In addition further explication is requested on some of her points of view. The abiding response from this discussant is “Bravo.”     

Field of Vision: Radical Uncertainty and the Analyst's Conduct: Commentary on Paper by Donnel B. Stern

There is a relationship between biography and theory. The analyst's ideas or formulations about his patients—theories really—must be determined, to some degree, by the certain and uncertain impact of his own history. Harry Stack Sullivan brought psychoanalysis squarely into the ambit of the relational/historical world by insisting that the mind is thoroughly and inherently social. In doing so, he staked a claim for the link between history, that is, social experience, and personhood. Our personalities and our theories are social-historical constructions. In relation to this, some differences between the interpersonal/relational and Bionian concepts of field theory are provided. One important difference pertains to the role of the analyst's conduct. Two meanings of conduct—to behave or to organize behavior—are at the center of what distinguishes the interpersonal/relational view of the analyst's position in the field from the Bionian view. For the relational analyst, action in the analytic field, including enactment, is conduct, and conduct is always bidirectional. The analyst, then, is a medium to alter, to reconstruct the self. He does not provide experience, he is experience. The form of an analytic exchange gives shape to the field and its content.     

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.     

The Interplay of Subsymbolic and Symbolic Processess in Psychoanalytic Treatment: Commentary on Paper by Steven H. Knoblauch

Bucci's model of emotional communication, developed in the context of her theory of multiple coding and the referential process, is applied to Knoblauch's microanalytic report of his experience of the patient and himself and their interactions during a single session of an ongoing treatment. The referential process is a bidirectional function connecting the diverse sensory, somatic, and motoric representations of the subsymbolic system with imagery and words. The process operates partially and to varying degrees within both participants; in the case presented here, the dissociation among systems is severe, and emotional communication within the dyad occurs at first primarily in subsymbolic, bodily forms. Where gaps in the referential process exist for the patient, the analyst's own experience and associations operate to evoke new connections for her; we see this process in moment-by-moment glimpses of the analyst's experience and his interactions with the patient. Gaps in the reader's knowledge, and possibly the analyst's knowledge, of the patient are discussed.     

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.     

Reply to Commentary by Daniel N. Stern

I respond to Stern's largely affirming discussion by fleshing out a few points, for example, improvisation is more than just being spontaneous, it is ensemble work that plays off and with patterns emergent in the personalities of both parties. These patterns illuminate something about the unconscious of each from which blossom things heretofore unimagined or unarticulated. Several principles are then emphasized: First, improvisational moments arise when the “characters” in the moment draw from something real within themselves along with who they are inducing one another to become. Second, the cultivation of play in improvisation lends itself to putting to rest the myth of the perfectly analyzed analyst as not only impossible but as being both unnecessary and undesirable—a seminal point to the entire relational canon. Third, improvisation is a means for putting live flesh on the sterile bones of a host of theories now informing the contemporary psychoanalytic perspective such as chaos and complexity theory, along with dynamic systems theory. I also note that improvisational moments exhibit an emerging sense of vitality and a deepened sense of connection between the partners. Their work obtains a greater sense of focus, though not a deliberate focus as that their relational unconsciouses are “directing” them. Improvisational work feels liberating, playful, as well as affirming and recognizing what what each is bringing to their coauthorship. By contrast, when the improvisation fails, it devolves into negative thirdness or one-upsmanship, the qualities of which reflect deadness, avoidance, confusion, constriction of play, and a misrecognition of one another that devolves into a mutual sense of defeat. Responding to Stern's question about posi-traums, I affirm there is a phenomenon in which an entrenched emotional conviction of a patient's can be dramatically altered. This happens when something positive occurs that cannot be assimilated within the patient's intransigently negative belief system such that she must accommodate a new organizing principle, that is, a new emotional conviction to make sense of it. I concede, however, that it may be too soon to tell how much such phenomena penetrate the more physiologically encoded elements of trauma.     

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 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 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 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 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.