Cross-Continental Divides Regarding Survival,Play, and Enactment: Reply to Commentaries by Keene,Ilahi, and Coen

The author distinguishes between the ways that the Independent Group and Relational Theorists conceptualize object survival, play, enactment, and mutuality. American relational theory is simultaneously focused on both the patient's and analyst's experience and the patient's inner representational world. Interaction is informed by and informs our understanding of the patient's conflicts including forms of enactment. In contrast, analysts from the Independent Group tend to view the American interest in interpersonal phenomena and perceptual dimensions of the patient's experience as a distraction from unconscious representations. For relational analysts in the United States, maternal functions of reverie emphasized by the Independent Group are seen as one dimension of the analyst's complex subjectivity, which may be used in containment and interpretation. For relationally oriented analysts containment itself is postulated as to some degree porous unlike the notion of analytic functions of reverie emphasized by the Independent Group. The author tries to focus on these points of divergence and overlap between the two theoretical orientations and their application to case material.     

Tactics and empathy: Defences against projective identification

In this paper the author argues that interpretations made when the analyst has not done the emotional work of recognising and bearing what kind of object she has become in the patient's psychic reality will be experienced as empty tactics – even lies – rather than interpretations of integrity. However, interpreting from a position of bearing the truth of the patient's perception will be technically difficult and indicate turmoil as the analyst struggles to take in the patient's view of her. If the analyst avoids integrating her own picture of herself with the patient's picture (despite giving voice to the patient's picture) the split inside the analyst will be felt and intensify the patient's need to split. Vignettes demonstrate how the analyst, believing she is trying to understand, may become a projective‐identification‐refusing object and the issue of the analyst's disclosure of her countertransference is examined. Ultimately, the author argues, a capacity to receive and bear projective identification requires empathy with both patient and analyst‐as‐patient's object, engaged in a process about which both are ambivalent.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Looking back,looking forward: A reexamination of Benjamin Wolstein’s interlock and the emergence of intersubjectivity

In this paper the author takes a close look at Benjamin Wolstein’s chapter, ‘Therapy’, from his book, Countertransference, published in 1959. This chapter contains a discussion of what he refers to as the interlock between analyst and patient, or today what we might describe as transference/countertransference enactment. The author shows how Wolstein’s concept of the interlock and its relation to the analyst’s countertransference was radical and innovative for its time. Wolstein’s notion of a transference/countertransference interlock, along with the seminal contributions of Ferenczi and some of the early interpersonal theorists, anticipates the complexities of a two‐person psychology and the entanglement which can occur from the intermingling of unconscious processes of analyst and patient in the experiential field. The author highlights three main ideas. First, the author provides a brief review of enactment with an emphasis on the role of the analyst’s participation as conceptualized by the various theoretical perspectives. An historical context is given for Wolstein’s clinical theorizing. Second, the author explicates Wolstein’s concept of the interlock, with particular attention to the processes involved which account for the complexities it presents. Third, the author examines the ‘working through’ process, including the emergence of intersubjectivity in the resolution of the interlock. The author shows throughout Wolstein’s emphasis on the influence of the analyst’s personal psychology, mutuality, and intersubjectivity, all of which anticipated the gradual interpersonalization of psychoanalysis across the various schools of thought.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

On Becoming One-Self: Reflections on the Concept of Integration as Seen Through a Case of Dissociative Identity Disorder

This paper explores the concept of “integration” as it relates to the development of self-awareness and the recognition that one exists as a self. It is argued that this awareness relies on a capacity for self-reflection which is intimately tied to the ability to locate oneself in time and in space. Through the presentation of a patient with Dissociative Identity Disorder, the author demonstrates how the development of the patient's consciousness of self progressed through the treatment and particularly, through the relationship between analyst and patient. In the case presented, the patient began treatment unaware of her dissociative structure. She was also unaware of the continuity of time, including the concepts of past, present, and future as they related to herself, and to the fact that she existed in a body that was subject to the basic laws of physics such as being able to be in only one place at one time. Through the development of a self-reflective capacity and a growing familiarity with the various aspects of herself, the patient began to develop a sense of herself as a continuous entity physically, psychologically and spiritually.     

Trauma and the transference‐countertransference: working with the bad object and the wounded self

This paper focuses on the transference‐countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma‐related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference‐countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual‐aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the ‘wounds’ that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self‐object, in order to enable the patient to safely express and ‘be’ themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto‐sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring ‘humanity’ (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.     

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.     

The compulsion to confess and the compulsion to judge in the analytic situation

In this paper the author shows that human beings have two quasi‐instinctual primitive tendencies – namely, the compulsion to confess and the compulsion to judge (to condemn or to absolve). These compulsions are originally unconscious and become conscious during the course of the analytic process. The compulsion to judge is a natural consequence of the compulsion to confess. These two tendencies are intensified by the analytic situation. The patient has a compulsion to confess to the analyst and to himself, and likewise the analyst has a compulsion to confess to himself and to the patient. The patient therefore has a compulsion to judge himself as good or bad and to judge the analyst as good or bad while, on the other hand, the analyst has a compulsion to judge himself as good or bad and to judge the patient as good or bad. The task of analysis is to make both patient and analyst conscious of their compulsions to confess and to judge (to condemn or to absolve). The compulsion to judge in the analyst, particularly if unconscious, may give rise to mistakes in diagnosis, technique, treatment, and the assessment of analysability. The requirement of analytic neutrality in the analyst constantly conflicts with his compulsion to judge. If we are profoundly involved in our patient's dramatic conflict, we are bound to pass a judgement (condemnation or absolution); however, when we judge, we are not neutral and therefore become incapable of intellectual consciousness of the patient's conflict. Conversely, if we do not judge, we are neutral, but are then relatively uninvolved in the patient's conflict and are hence virtually unable to achieve emotional consciousness. The author attempts to show that neutrality cannot and must not be a preconstituted attitude in the analyst, but can and must be a point of arrival following a profound, intensely felt existential experience based on an attitude of non‐condemnation and non‐absolution.     

Trauma Triangles and Parallel Processes: Geometry and the Supervisor/Trainee/Patient Triad

Relational psychoanalytic literature is filled with discussion regarding how the concept of intersubjectivity has enhanced the space between and within patients and analysts. As the relationship between the dyad expands and contracts, prior traumatic experiences become ripe for reenactment. What happens when the therapist is a trainee and her supervisor reenacts the abuse experienced by the patient onto her? When the enactment extends beyond the dyad and moves into the triad, how can the trainee use this shared experience to create agency for both herself and the patient? And how does the institutionalized authority of the training environment expand or collapse the transitional space required for trainees to create their own analyst identity? This paper explicates a case in which the trainee was able to use a rupture in the supervisory relationship to further enter the subjugated space of the patient, ultimately empowering both to develop a new way of relating to each other that moved them out of such constricted complimentary roles.     

Reply to Commentaries

Questions of historical context resonate with an Independent view of the importance of history. The historical backgrounds of North American and British psychoanalysis are relevant. Some American analysts may be seen as belonging to the Independent tradition, and the relation between Independent analysis in Britain and Relational analysis in America needs further consideration. I ask how far Relational analysis is taking on an institutional identity, and link this to Poland's discussion of “outsiderness.” Responding to Bass's and Berman's comments on my clinical examples I discuss why I sometimes do think analysts need to ascribe meaning to a patient's material. In other instances an analyst will invite the patient more into the process by which meaning evolves between them. To move freely between these positions is central to my view of clinical technique. I express doubts about analysts asking patients for their emotional reaction to an analyst's interventions. This risks being intrusive, and may tend to keep the exchange at the conscious level of a patient's mind. The analytic relationship is an interpersonal one between real people, but the analyst needs also to remain symbolically available as an object of unconscious fantasy and projection.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in 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.     

Destruction reconceived: On Winnicott's ‘The Use of an Object and Relating through Identifications’

‘The Use of an Object and Relating through Identifications’ is a landmark contribution that I find very difficult to write about because so much of what lies at its core is merely suggested. It is necessary for the reader not only to read the paper, but also to write it. In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort. The author presents clinical discussions of analyses in which the analyst survives destruction and is unable to survive destruction.     

Enactment as Therapeutic Hand Grenade: How Bursts of Emotional Honesty Can Get a Stuck Treatment Moving Again: Discussion of Holly Levenkron's Paper

In my discussion of Levenkron's article, I consider ways of understanding the patient's therapeutic progress that were not highlighted by the author. Adding my own criteria to Levenkron's definition of enactment, I suggest that what the author labels as enactment might be seen as a last-ditch but successful effort to get patient and analyst out of a stuck and painful place. I explore the interplay of confrontational and nonconfrontational interventions in contributing to cure, and I suggest placing a greater emphasis than did the author, on the intersubjective contexts out of which the patient's troublesome behaviors emerged.     

Identifications Annealed,Adhesive and Political: Commentary on Paper by Nina Farhi

Farhi's fascinating paper pays tribute to and extends those segments of Milner's clinical work that Milner hesitated to theorize explicitly herself. Seeking to understand the latter, I trace psychoanalytic politics in general and the history of Milner's relationships with Winnicott, Klein, and Riviere in particular to explore how her dutiful compliance to the rigid taxonomy of psychoanalytic power of her time bore on the trajectory of her becoming an analyst with a mind of her own. It is in accounting for how she struggled to disentangle herself from that web, that we discover how Milner was able to creatively refashion her work with her patient Susan, a process by which Susan was greatly impacted.

Following the trail of Farhi's ideas around this process and considering her thoughts around their psychic meanings for both analyst and patient, I explore their clinical implications. I focus on the transferential iterations of these dynamics to consider Farhi's suggestion that an annealed bond needs to be established in the treatment of patients who have, early in life, failed to develop annealed identifications. This opens up questions around how such bonds can malignantly colonize the analyst's mind and psychic reality, raises questions of self-care in the analyst and contributes to prognostically anticipating certain sets of enactments in the course of long-term psychoanalyses.     

Standard Dominance Versus Creation of Interludes of Equalization of Power in the Psychoanalytic Situation: Discussion of Case Presentation by Joseph Newirth

Joseph Newirth tells us that it is his aim in the analytic work to facilitate a “symmetrical dialogue [that] involves an equalization of power, [and] a radical view of mutuality and of self-disclosure in the analytic relationship.” My thesis here is that the process falls short of that objective. Instead, it is characterized by an enactment in which the analyst is always dominant. Several examples of “power plays” are presented in which the analyst, in a manner partially institutionalized as standard psychoanalytic practice, repeatedly gains the upper hand in the analytic relationship. One important aspect of this enactment entails a systematic bias in favor of interpretations that attribute neurotic, primitive, or regressive motives to the patient at the expense of hearing and taking seriously the patient's more mature perceptions and judgments, including those focused on the analyst himself.     

Ordinary Sadism in the Consulting Room

The analyst’s retaliatory sadism can be construed as a perversion of the wish to penetrate, just as masochism can be viewed as a degradation of the desire to surrender. When a patient refuses to speak any other language but that of domination and submission, ordinary attempts for communication and recognition fail. In her attempt to reach the patient, to reinstate herself as an active agent and subject, and also to dislodge the patient from a rut of despair, passivity, or malignity, the analyst may escalate to a sadistic response, even if she suspects that this might cause the patient pain. This type of sadomasochistic enactment can gather strength when disowned self-states of analyst and analysand are activated. In this process, an analytic interpretation, seemingly legitimate, can be used as a knife, a weapon, an instrument of retaliation and sadistic control. The disastrous potential of the analyst’s sadism is easy to imagine. Through a couple of clinical vignettes I will demonstrate that even something as lamentable as the analyst’s sadistic retaliation can lead to growth as long as such sadism can enter the analytic dialogue and the patient is allowed to perceive and reflect upon the analytic misbehavior, and the analyst is willing to join the patient in the quest to understand their co-created predicament.     

Embodying analysis: the body and the therapeutic process

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split‐off complexes of the analysand. The analysty’s own attempt at mind‐body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung’s ‘psychology of the transference’ and the idea of the ‘subtle body’ as an unconscious shared area. The re‐attribution of meaning to pre‐verbal psychic experiences within the ‘embodied reverie’ of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.     

Privacy, reverie, and the analyst's ethical imagination

The author illustrates varying ways of using and thinking about forms of analytic reverie and the analyst's privacy. He discusses a few different registers from which the analyst can illuminate points of transference-countertransference enactment. The modality by which the analyst communicates these formulations of unconsciously held object relations and defenses varies and includes verbal interpretation through symbolic speech, interpretive action (Ogden 1994a), and, at times, interpretations that involve a construction of the analyst's subjectivity put forward to enhance the patient's understanding of enactments of the transference-countertransference. The author develops a concept, the analyst's ethical imagination, defined as the ways in which we consider and anticipate the implications of our interpretations.