Racial Enactments in Dynamic Treatment

The aim of this paper is to discuss racial enactments for what they might contribute to our understanding of the intersubjectivity of race and racial experience. “Racial enactments” designate interactive sequences embodying the actualization in the clinical situation of cultural attitudes toward race and racial difference. I present examples of racial enactments in several social contexts, as well as in an extended clinical vignette. I consider racial enactments in the light of contemporary psychoanalytic theory and suggest that collaborative methods facilitate the effective analysis of racial material.     

On Unconscious Communications and Covert Enactments: Some Reflections on Their Role in the Analytic Situation

By means of an extended clinical example, this paper focuses on the impact that unconscious communications in the form of nonverbal behavior may have on the course and outcome of an analysis.

Responding to sudden catastrophic illnesses in their fathers, patient and analyst created enactments aimed at blinding them to hard truths about their relationships with this parent.

Serving as powerful resistances that led to a stalemate and all but ended treatment, these nonverbal enactments had to be recognized, confronted, and understood by both participants before analytic work could be resumed and progress achieved in this analysis.     

The analyst's implicit alpha-function, trauma and enactment in the analysis of borderline patients

The present paper discusses situations in which patient and analyst are involved in obstructive collusions, non-dreams-for-two, shaping enactments. Specifically, it describes explosions in the analytical field, acute enactments, which the analyst assigns, at first sight, to his faulty conduct. The subsequent amplification of the analytical dyad's capacity of symbolization makes the analyst investigate his presumed fault. The present work shows how acute enactments revive traumatic situations that were concealed by previous obstructive collusions, or chronic enactments. During chronic enactments unconscious exchanges occur between the dyad, in which the analyst provides implicit alpha-function to the patient, little by little recovering the traumatized parts. When there is enough recovery, the protective collusion is undone and the trauma is revived as acute enactment. This revival will not be traumatic because there are mental resources ready at hand to symbolize it. These situations are articulated with borderline patients. The patient clings to the analyst, using him as a protective shield against reality traumas. The implicit and explicit alpha-function exerted by the analyst contributes to the processing and symbolization of this reality, recovering the injured mind and elaborating the trauma. So the patient creates a triangular space to dream and think.     

What happens before and after acute enactments? An exercise in clinical validation and the broadening of hypotheses

This paper seeks to validate clinical facts and theoretical hypotheses that have been discussed before and that address configurations involving chronic and acute enactments. Its validation process compares clinical material from psychoanalytic work in different psychoanalytic cultures - work from South America-Uruguay (Yardino), Europe-Spain (Sapisochin), South Africa (Ivey), Europe-UK (Bateman). It documents clinical facts described in four articles and confirms that during chronic enactments the analytic dyad gets caught up in a dual relationship that veils and congeals the triangular situation because acknowledging it would be traumatic. The lack of triangular space impedes the formation of symbols as well as dreaming and creates non-dreams-for-two. During chronic enactments analysts use their implicit alpha-function to assemble traumatic areas. These areas emerge as a mix of discharges and non-dreams that are dreamed through acute enactments. Acute enactments occur when chronic enactments dissolve and patients experience an abrupt contact with reality. The attenuated trauma is then dreamed alive. The linking of new symbols develops a network of symbolic thought and creates dreams-for-two and broadens the patient's mental universe. The validation process has deepened our vision concerning clinical facts, especially in relation to: (1) the wavering between acute and chronic enactments, (2) analysts' inhibitions and feelings of guilt, and (3) the influence of analysts' personalities on the configurations they describe. These theoretical hypotheses have been confirmed and broadened not only in relation to the vicissitudes of dream work in traumatic areas, but also in relation to defenses such as thin or thick skin, and in relation to listening in countertransferential detours.     

Creativity,Spontaneity, Impasse,and Leaps of Faith: Reply to Commentaries

In my reply to the commentaries, I address several points of convergence with and divergence from Drs. Danielle Knafo and Philip A. Ringstrom. I clarify my view that while shame can drive the creative process, the thrust of my paper is about ways in which shame can close down access to one's creative potential, as well as creating obstacles to vitality and intimacy in relationships. I expand on how it was indeed a visceral, embodied sense of my own shame which served as an “informant,” as Ringstrom suggests, of Julia's chronic experience of shame, opening a door to our exploration of the repetitive enactments between us. Grounding my understanding of therapeutic action and enactments in a relational perspective, I describe how I view enactments as inevitable and co-created, and reflecting on them collaboratively as a potentially useful opportunity in analytic work. I resonate with Ringstrom and Knafo's belief in the creativity inherent in the psychoanalytic process, and the importance of spontaneity and risk taking, particularly in negotiating impasses in treatment. Finally, I describe Julia's poetic reflections upon reading the paper.     

Enactments and amplification

Advances in the understanding and articulation of enactments allow a reassessment of analytical psychology's method of amplification. Subjective and objective aspects of the amplificatory process, evolving notions of its role in analysis together with the use of countertransference phenomena provide the frame for reexamination of this method. Using a single analytic day, this paper explores the inevitable play of enactments with a focus on countertransferential components contained in the act of amplification. An internal examination of such an act is used to attempt to identify and differentiate the operative personal, interpersonal and collective aspects. The impact and traces of this act are followed through the workings of the day and demonstrate that the impulse to amplify is a suitable object for analytic scrutiny. This leads to a more general question of the mythic nature of enactments.     

ACUTE ENACTMENT AS A 'RESOURCE' IN DISCLOSING A COLLUSION BETWEEN THE ANALYTICAL DYAD

The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the 'natural history' of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.     

Development of the Family Therapy Enactment Rating Scale

This report describes the development of a new scale designed to establish how therapists intervene and clients respond during effective enactments in family therapy sessions. The Family Therapy Enactment Rating Scale (FTERS) was developed by clinically trained investigators who observed 27 videotaped family therapy sessions and listed therapist interventions and client responses during four phases of enactments: pre-enactment preparation, initiation, facilitation, and closing commentary. Interrater reliabilities for the FTERS were calculated by training 6 undergraduate volunteers to rate independently a sample of 12 enactments. When reliabilities were found to be relatively low, a second study was conducted in which the FTERS was revised and reliabilities were calculated with a different sample of 21 videotaped enactments and a new group of 6 undergraduate raters. Reliability for the FTERS was found to be sufficiently robust to make this measure of therapist interventions and client responses a useful instrument for evaluating what takes place during enactments. Findings on the FTERS were used to offer tentative guidelines for effective initiation and facilitation of enactments in family therapy sessions.     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

Ethics,Boundaries, and Supervision. Commentary on Trauma Triangles and Parallel Processes: Geometry and the Supervisor/Trainee/Patient Triad

The author discusses the clinical and ethical issues in enactments that are interwoven between relational therapy and supervision as described in the case illustration. The tendency to focus on enactments involving physical action risks obscuring attention to psychological boundary crossings that can be equally harmful. The current maternal tilt in psychoanalysis can unwittingly lead analysts and supervisors to avoid confrontation and analysis of hostility and aggression, thereby inhibiting the working through of intense negative transference and countertransference. The similarities and differences between supervision and treatment are discussed in terms of maintaining responsible boundaries.     

Parallel process and projective identification in psychoanalytic supervision

In the present paper I explore the notion of the parallel process, a controversial concept in psychoanalytic supervision. I suggest that the parallel process is essentially the operation of the defensive process of projective identification, which in some quarters is similarly viewed with skepticism and/or is mistakenly seen as primarily a malignant defense operating exclusively in severe character pathology (Kernberg, 1975; Mendelsohn, 2009). Further, I present several vignettes of psychoanalytic supervision where a series of parallel processes occurred, and I suggest that these parallel enactments are the result of the projective identifications which stimulated them. I agree with critical writers who say that simply suggesting the presence of a parallel process in the supervision adds no new information to the supervision, but I show how an exploration of the parallel enactments, which includes (1) exploring the patient-therapist dyadic dynamics, (2) a narrowly focused exploration of the dynamics of the therapist/presenter, and (3) and an exploration of the dynamics of the therapist-supervisor dyad, can enrich the treatment, as well as the supervision. Finally I suggest that while the projective identification that occurs in the supervisory dyad does not always lead to a parallel process, every parallel process is the result of projective identification(s). I further suggest that while every parallel process does not lead to an enactment via projective identification, enactments can only occur via the parallel process instigated by projective identification.     

Is Verbal Symbolization A Necessary Requirement of Analytic Change?

This paper considers the potential of bidirectional, nonverbal (procedural) enactments for effecting therapeutic change. Whether such nonverbal enactments need to be symbolized for clinical change to occur is discussed. Clinical and conceptual material is presented which indicates that changes in self-representations can and do occur without the need for verbal symbolization.     

The evocative power of enactments.

The inevitability of analytic enactments, defined as symbolic interactions between patient and analyst, is discussed. Clinical material from the psychoanalysis of a latency-age child is presented to illustrate the role of enactments and to demonstrate their usefulness in furthering the analytic work.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

Enactment controversies: a critical review of current debates

This critical review of the current disputes concerning countertransference enactment systematically outlines the various issues and the perspectives adopted by the relevant psychoanalytic authors. In the light of this the 'common ground ' hypothesis concerning the unifying influence of contemporary countertransference theory is challenged. While the existence of enactments, minimally defined as the analyst's inadvertent actualization of the patient's transference fantasies, is widely accepted, controversies regarding the specific scope, nature, prevalence, relationship to countertransference experience, impact on the analytic process, role played by the analyst's subjectivity, and the correct handling of enactments abound. Rather than taking a stand based on ideological allegiance to any particular psychoanalytic school or philosophical position, the author argues that the relative merits of contending perspectives is best evaluated with reference to close process scrutiny of the context, manifestation and impact of specific enactments on patients' intrapsychic functioning and the analytic relationship. A detailed account of an interpretative enactment provides a context for the author's position on these debates.     

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.     

Enactments and Dissociations Driven by Cultural Differences

Cultural differences between the analytic dyad can foster powerful transference-counter-transference feelings and potentially promote traumatic re-enactments. Those patients who are more directly affected by traumatic experiences may be able to verbalize what has happened to them only if they are convinced that their analysts are "taking in their horror, holding it for them, responding to it emotionally (reenacting) and giving it back in more modulated and containable" manner (Davies, 1997, p. 24). These mutual enactments that emerge in patients and their analysts can be understood as dissociated self-states. Clinical material is presented from the treatment of an African-American inner-city teenager and an Israeli teenage soldier to illustrate the emergence of enactments and dissociation in patient-analyst dyads.     

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.     

Enactment as understanding and as misunderstanding

The author considers the concept of enactment as a ubiquitous event that is best seen as part of a sequence in the process of understanding a patient. As such, enactments are not unusual or special save as they are often subject to disavowal or to being singled out by the analyst as especially subject to scrutiny. Once recognized, enactments need to be interpreted: not so much in terms of their unconscious origins, but more with regard to the need to include them in the analytic dialogue.     

Enactments of Race in the UK’s Blood Stem Cell Inventory

Recent sociological analyses of the intersections of race and science recognise race’s quality as an enacted object. Through this analytic lens, race is always materialising in the practices and processes that enrol it and therefore enjoys a kind of multiplicity. The context of blood stem cell transplantation, a scientific domain marked by a more and less explicitly racialised logic, offers an opportunity to see the conceptual assertion of race’s multiplicity play out. Indeed, an exploration of the UK’s stem cell inventory reveals—through analysis of interviews, policy and parliamentary meetings—how race materialises in the various practices that comprise this increasingly popular cancer treatment option. Looking at practices of recruitment, inventory management and tissue selection in particular provides an interesting window to look upon race and the many signifiers that implicate it. These cases reveal moments of race’s stablisation and silencing; its oscillation between the status of vital information to the life of a public stem cell inventory, and of secondary data that provides little useful information to clinicians selecting tissue. Adopting an analytic lens that attends to race’s multiple enactments allows us to begin asking why enactments take the shape they do, and why the particular practices that mobilise them come to be.