The Analyst's Secret Delinquencies

Despite a burgeoning literature on major analytic boundary violations, there has been little investigation of what might be called analytic delinquencies or misdemeanors—the small and virtually ubiquitous ways in which analysts deliberately withdraw from the therapeutic endeavor. I consider the impact of professional misdemeanors on patient and analyst and compare both with more serious analytic “crimes” and enactments. Professional delinquencies may reflect a therapeutic reenactment, an expression of the analyst's split-off or disavowed need, or an unconscious attempt to self-regulate or to negotiate space within the constraints of the treatment setting. Because the professional ideal leaves so little room for the analyst's humanity, it is often difficult for us to address and work with evidence of our own need when it clashes with what we regard as the analytic contract.     

INTUITING THE TRUTH OF WHAT'S HAPPENING: ON BION'S “NOTES ON MEMORY AND DESIRE”

Bion's “Notes on Memory and Desire” (1967a) is an impossible paper that this article's author has struggled with for decades. He views the paper, only two and a half pages in length, as a landmark contribution. Despite its title—and its infamous dictates to resist the impulse to remember past sessions and desire for “results”—the paper is not, most importantly, about memory and desire. It proposes a new analytic methodology that supplants awareness from its central role in the analytic process and, in its place, instates the analyst's (largely unconscious) work of intuiting the (unconscious) psychic reality of the present moment by becoming at one with it. This article's clinical examples, provided from the author's own work, illustrate something of his ways of talking with his patients.     

Search Yourself: Commentary on Paper by Kenneth A. Frank

This commentary has as its point of departure essential questions about selfhood, self-knowledge, and therapeutic action. Frank's contemporary redefinition of “mutual analysis” and its impact on the clinical surround are examined, with a special emphasis placed on the willingness of the analyst to change and grow. The vital role and theme of the analyst's emotional honesty are explored with an eye toward the clinical impact of contextualism, psychoanalytic complexity, and the personal attitudes that inevitably permeate the analytic relationship and its trajectory. This commentary, in concert with Frank's paper, encourages clinicians to embrace a more collaborative, mutually analytic posture in their clinical endeavors.     

Therapeutic Passion in the Countertransference

The place of the analyst's “influence” in psychoanalytic theory and practice is explored. There is a current in the literature in which it is welcomed as an aspect of “corrective experience,” although usually legitimized by being forced into the narrow channel of interpretation and understanding. A taboo on influence persists despite theoretical shifts that would seem to clear the way for greater acceptance of its importance. Among other factors, the aversion to influence is traced to its association with hypnotic “suggestion,” which implies little room for the patient's autonomy. Opening the door to embracing the possibility of influence goes hand in hand with, on one hand, the analyst respecting the patient as a competent free agent and, on the other hand, the analyst combining willingness to take a stand with willingness to reflect critically on his or her participation. In that context, and with those caveats, the analyst takes on the responsibility to combat destructive introjects and to become an inspiring, affirmative presence in the patient's life. The analyst's passion for the patient's well-being and for changes that entail the realization of dormant potentials now has its place. Different kinds of expression of therapeutic passion in the countertransference are described and illustrated.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

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.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

SOME VIEWPOINTS ON WOMAN'S INNER SPACE

In this paper, illusion is examined as a prerequisite and necessary medium for the analysand's finding the genuine subjective reality of his own in the psycho-analytic interaction. Two kinds of illusion are discussed The first of them, transference illusion, is well-known, as is its understanding as a simultaneous existence of experiences stemming from different levels of reality. At its side, the author introduces the concept of developmental illusion, as an essential constituent of the analytic process. As contrasted to transference illusion, the wishes inherent in a developmental illusion have never become meaningfully represented in the analysand's mind. These interrupted developmental needs attaining shape and meaning, and thus the possibility to develop further in the analytic relationship, is dependent on the analyst's ability and ways to receive and meet the analysand's activated developmental illusion. The rôle of the analyst's ways to reach and convey his understanding is considered decisive in this process.     

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.     

Marco Conci interviews Stefano Bolognini

Abstract

This paper suggests that the understanding of intersubjectivity, which refers to “the dynamic interplay between the analyst's and the patient's subjective experiences in the clinical situation”, is crucial for psychoanalytic work. The analyst's inner experiences, from the first moment that he or she thinks about or meets the patient, belong to an intersubjective situation. Not only are these experiences a valuable channel through which the inner experiences of the patient can be understood, but—as Theodore Jacobs puts it—they are often complementary to that which comes from the patient. The author tries to illustrate the above through the study of the analytic process in the psychoanalytic therapy of a severely disturbed patient. This therapy from its very early phase led to the reawakening of some of the analyst's old conflicts. The patient's difficulties in tolerating the limits of the analytic setting and using free association are discussed, as are his enactments. The analyst's close observation of the interaction between her and the patient, the permanent engagement with her countertransference, and the use of her inner experiences with the patient helped her to contain the enactments, defined the nature of her interventions, and contributed to the analytic process.     

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.     

The Particularities of Form: Reply to Commentary

In this brief reply to Bollas's commentary on our paper about his work, the cycles of intersubjective dialogue endlessly sustaining should be apparent. We begin with an example of the form—content distinction and attempt to use it as a springboard for further disentangling some of the nuances of Bollas's intersubjective theorizing. Bollas's emphasis on form over content as a means of conceptualizing the analyst's contribution to the analytic process is indeed compelling. We all know from both sides of the couch the profoundly different meanings and messages that an analyst's mien invites: whether she's abrupt, verbose, meditative, tranquil. Yes, the medium is the message, and, thus, whether the analyst conveys a message through the effects of form that Bollas points out, such as “We have all the time you need for the nuances of unconscious figuring” versus “This is hot—we hafta figure it out now” surely does have an effect on the psychic material produced in the analytic process. We go on to add to Bollas's discussion of form by considering the particularities of form and how these too affect the analytic process.     

CHEMISTRY AND CONTAINING: THE ANALYST'S USE OF UNAVOIDABLE FAILURES

Certain patients overwhelm the analyst's capacity to contain both the patient and the analyst's own unbearable feelings. Though some such failures of containing may lead fairly quickly to self‐correction and others to clinical impasse, our focus is on an in‐between state in which the analyst's ability to tolerate his inevitable failures and gradually to (re)establish his containing capacities through difficult self‐analytic work can lead to significant change that might not otherwise be possible. The authors argue that this internal psychological work on the analyst's part, which may require considerable time, effort, and suffering, is an important aspect of “good enough” containing. The unique chemistry generated between patient and analyst plays an important role in both establishing and maintaining this kind of productive analytic process.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

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.     

From “disciplined subjectivity” to “taming wild thoughts”: Bion's elaboration of the analysing instrument

Abstract

Freud encouraged the analyst to use his unconscious “as an instrument of the analysis,” but did not elaborate on how this should be done. This recommendation opened the door to a consideration of unconscious communication between the analyst and patient as an intersubjective exchange. Both Wilfred Bion and Erik Erikson emphasised the importance of the analyst's intuition, and the author compares and contrasts these two approaches. Erikson advocated a more cautious attitude regarding the analyst's subjectivity, while Bion promoted a broader application of the analyst's various private reactions to the analysand. A brief vignette from the analysis of a five-year-old boy is offered to illustrate the importance of the analyst's reveries, the mutual process of containment and transformation between analyst and patient, and the co-creation of an analytic narrative.     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

Lies and Body Cruelties in the Analytic Hour

Discussing an intensive case study of female sexual dysfunction, this paper studies mutual deregulation and disintegration as it unfolds in the transference–countertransference dyad. I propose that ethical transgressions are potentiated in analytic dyads in which the analyst's hope for either solitude or mutuality is foreclosed. This hope can be foreclosed by the particulars of the therapeutic interaction as well as by the theoretical and clinical aspects of analytic training. The deregulation that both precipitates and follows such transgression can be healed (in the analyst, in the analysis) only by the restitution of the therapist's agency, the reduction of paranoid-schizoid guilt and shame, and the location (in the analyst) of depressive, “I-Thou” remorse.     

Discussion: The Analyst's Involvement in the Creative Aspect of Analysis

Recent formulations on the psychology of creativity in the analytic context, such as Albert Rothenberg's “homospacial thinking,” Arnold Modell's “unconscious metaphoric thought,” and Thomas Ogden's “transformational thinking,” are discussed. These concepts enable previously unconnected experiences to be combined within the mind, while emphasizing interpersonal imaginative processes such as identification and empathic knowledge; the dual cognitive features of these formulations permit awareness of the complexity of feelings in oneself and others, essential for psychoanalytic creativity. Further, the articles in this issue are synthesized, highlighting the importance of the analyst making creative (new and valuable) use of his or her entire life experience, feelings, attitudes, and fantasies in treatment. From this dicussion, it is evident that the analyst's creative use of self should be more systematically incorporated into psychoanalytic theory of technique.     

The Analyst's Necessary Vertigo

The euphemistic phrase “the difficult to reach patient” often refers to work with patients who have serious difficulties relating. The author examines the basic construct of “reach,” its pitfalls, and potentials. In the author's view, often we are talking about patients who do not fully experience their own subjective existence or the existence of others. This requires unusual efforts to “reach” the patient in order for the patient to consolidate a sense of self and other, creating the possibility of reflective relating. In contrast to views that see such psychoanalytic “reach” as associated primarily with the analyst's needs or pathology, the author views the analyst's extraordinary efforts as responsive to the patient's need to move the analyst into the foundations of the analyst's own being.