MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

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 countertransference dream1

Can the analyst's night‐dream about his patient be considered as a manifestation of countertransference‐and, if so, under what conditions? In what way can such a dream represent more than just the disguised fulfillment of a repressed wish of the analyst? Is there not a risk of the analyst unconsciously taking up and ‘using’ the content of a session or other elements coming from the analytic situation for his own psychic reasons? The author, closely following Freud's dream theory, shows the mechanisms which can allow us to use the dream content in the analytical situation: preserved from the secondary processes of conscious thinking, other fantasies and affects than in the waking state can emerge in dream thought, following an ‘unconscious perception’. After examining the countertransference elements of Freud's dream, ‘Irma's injection’, which leads off The interpretation of dreams, the author presents a dream of her own about a patient and its value for understanding affects and representations which had hitherto remained unrepresented.     

Where is here? When is now?1

With a Kleinian perspective influenced by Betty Joseph, the author describes the distinctive ‘here and now’ of a psychoanalysis as the place and the time of the patient’s inner subjective world as it emerges in the work of patient and analyst. This psychoanalytic ‘here’ and ‘now’ is examined with clinical material from the analysis of Mr X; first, with an account of the way his analysis begins and then through a detailed session five years later.The author identifies Mr X’s problems with place and time, and how these change over the course of the analysis. He moves from sequestered dyadic relationships towards an Oedipal and family space, and from disconnection and timelessness to acquiring a sense of duration, of being in the present with a past and a future – all of which, the paper aims to show, has implications for technique.     

Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s “Plato’s Pharmacy” to Psychoanalysis

This paper presents a metaphorical heuristic to expand psychoanalysts’ views on the nature and method of interpretation from an intersubjective perspective. It uses one of Jacques Derrida’s findings in his essay “Plato’s Pharmacy,” a critique of Plato’s Phaedrus, as a model of psychoanalytic interaction. A parallel is drawn between psychoanalytic interpretation and the pharmakon—an ancient Greek term for ‘drug’ that means both remedy and poison. From this comparison, the inescapable dependence of personal meaning on contextual factors, specifically the context of the clinical intersubjective field, is shown. As a result, when an interpretation is offered, the analyst cannot truly know if the patient will receive it as remedy or poison. By keeping the context-dependent nature of personal meaning in awareness through the use of the pharmakon metaphor, analysts increase their abilities of interpretive understanding. In further discussion, the classical psychoanalytic concept of ‘negative therapeutic reaction’ is presented as an example of a decontextualized and reified psychoanalytic construct that becomes superfluous when interpretations are viewed through an intersubjective lens as pharmakon. Without the burden of expectation for being the authoritative imparter of reality and truth, the analyst may now attend to the patient in a way that is more fluid and reciprocal, where the relational field becomes what is primarily interpreted. Further, practical clinical implications of the concept of pharmakon suggest that since the analytic interpretation is subjective in every respect, effective clinical practice cannot be reduced to rigid protocols of technique.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

‘Translation’ and ‘transformation’ in the analytic situation: Freud – Bion – Laplanche

Following a short introduction to the core theses of Jean Laplanche’s theory of a ‘general seduction’ the author presents the resultant clinical position of the analyst. In the same way that an adult sends ‘enigmatic messages’ to the child, it is the analyst’s task to reopen this primal situation so that the patient can find new ‘translations’ for these messages. Laplanche distinguishes between the function of the analytic frame – which represents and supports attachment – and the ‘sexual’– which is the repressed and constitutes the unconscious. Only the focus on this unconscious facilitates the deconstruction of ‘incorrect’ translations. Accordingly, the analyst, says Laplanche, should not take part in construction – this is a self‐construction of the patient – but only in reconstruction. The author compares this clinical model with Freud’s notions and the ‘transformation processes’ through the alpha function as described by Bion. She illustrates Laplanche’s model and the interpretation strategy with case material.     

The body one has and the body one is: Understanding the transsexual’s need to be seen

The transsexual individual confronts the analyst with a disturbing otherness. How this otherness is understood, that is, how the analyst ‘looks’ at the patient through her distinctive theoretical lens impacts, in turn, on the patient’s experience and what transpires between them. In this paper the author outlines a developmental model rooted in attachment and object relations theory to provide one alternative way of ‘looking’ at some of these patients’ experiences in the clinical setting. It is suggested that in some cases of transsexuality the primary object(s) did not mirror and contain an early experience of incongruity between the given body and the subjective experience of gender: it remains unmentalized and disrupts self‐coherence leading to the pursuit of surgery that is anticipated to ‘guarantee’ relief from the incongruity. Through an account of work with a male to female (MtF) transsexual who underwent surgery during her five years of psychotherapy, the author explores how a focus on the transsexual’s experience of ‘being seen’, that is, of being taken in (or not) visually and mentally by the object in their state of incongruity, affords another window through which to approach the transsexual’s experience in the transference–countertransference dynamics.     

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.     

Impervious and intrusive: The impenetrable object in transference and countertransference

The author describes an internal object that he calls the ‘impenetrable object’ which has two characteristics: being impervious to the projections from the patient and being intrusive, i.e. projecting into the patient. It arises out of an early relationship with a mother who may be generally disturbed or traumatized so that she is unable to take in or tolerate the child's projections and may use the child as a receptacle for her own projections. He links the concept of an impenetrable object with other concepts such as Williams's ‘reversal of the container–contained relationship’ and Green's ‘dead mother’. If such an object dominates the patient's internal world, it can lead to severe difficulties in the analytic process. Interpretations may be experienced as violent projections from the analyst which the patient has to ward off and the analyst may enact an impervious or intrusive object in various ways. The author describes a case in which such dynamics played a significant role. He argues that intensive work in the countertransference is required to detect subtle enactments and allow a shift in the analyst, which in turn can enable change in the patient. He gives clinical material that demonstrates such work by the analyst and illustrates the shift from an impenetrable object to a more permeable one in the patient's internal world.     

Psychoanalytic transformations1

The author describes how Bion took Freud's conception of dreams as a form of thought and used it as the basis of his theory of transformations. Bion developed an expanded theory of ‘dream thought’, understood as a process of selection and transformation of sensory and emotional experiences. In this theory, the work of analysis is in turn conceived as a process not only of deciphering symbols, of revealing already existing unconscious meanings, but also of symbol production‐of a process for generating thoughts and conferring meaning on experiences that have never been conscious and never been repressed because they have never been ‘thought’. Analysis, in its specific operational sense, becomes a system of transformation whereby unconscious somatopsychic processes acquire the conditions for representability and become capable of translation into thoughts, words and interpretations. The rules of transformation applied by the patient in his representations and those applied by the analyst in his interpretations have the same importance for the analytic process as those described by Freud for the process of dreaming. The author discusses the broad categories of transformation adduced by Bion (rigid motion, projective, and in hallucinosis) and introduces some further distinctions within them.     

What the analyst does not hear

In the clinical situation, the analyst fails to hear more than he or she hears and spends much time working in the dark. The author raises questions about how we can take cognizance of that state of affairs in our thinking about analytic work. A clinical example illustrates how, in an analytic atmosphere, a patient will correct an analyst's failure to hear. Some ideas are offered about how to maximize the patient's participation in that effort. The author suggests that the problem may not fall precisely under the heading of technique so much as reflecting the analyst's attitude.     

Die institutionelle und die innere Familie des Analytikers

The author postulates the existence of an intense interaction between the analyst’s two families, the historical one of his infancy and the institutional one of his psychoanalytic education. In his opinion they both step into the analyst’s work with his patient on the level of his inner fantasy and to different degrees according to the various moments in the work. He points out that the common element between the infantile experience and the analytic one is the enormous opportunity for profound introjection. There are important moments that favor introjection in the young analyst’s training course which establish and constitute the cultural, theoretical and clinical foundations of his working ego and of his working self. The importance of a thoroughly analyzed separation process from the personal analyst and from the supervisors during the analysis is strongly emphasized.     

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.     

On talking-as-dreaming

Many patients are unable to engage in waking-dreaming in the analytic setting in the form of free association or in any other form. The author has found that 'talking-as-dreaming' has served as a form of waking-dreaming in which such patients have been able to begin to dream formerly undreamable experience. Such talking is a loosely structured form of conversation between patient and analyst that is often marked by primary process thinking and apparent non sequiturs. Talking-as-dreaming superficially appears to be 'unanalytic' in that it may seem to consist 'merely' of talking about such topics as books, films, etymology, baseball, the taste of chocolate, the structure of light, and so on. When an analysis is 'a going concern,' talking-as-dreaming moves unobtrusively into and out of talking about dreaming. The author provides two detailed clinical examples of analytic work with patients who had very little capacity to dream in the analytic setting. In the first clinical example, talking-as-dreaming served as a form of thinking and relating in which the patient was able for the first time to dream her own (and, in a sense, her father's) formerly unthinkable, undreamable experience. The second clinical example involves the use of talking-as-dreaming as an emotional experience in which the formerly 'invisible' patient was able to begin to dream himself into existence. The analyst, while engaging with a patient in talking-as-dreaming, must remain keenly aware that it is critical that the difference in roles of patient and analyst be a continuously felt presence; that the therapeutic goals of analysis be firmly held in mind; and that the patient be given the opportunity to dream himself into existence (as opposed to being dreamt up by the analyst).     

Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology – a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the ‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘countertransference’ and the ‘analyst's free‐floating introspectiveness’. More recent investigations refer to ‘process qualities’ of the analytic relationship, such as ‘synchronization’ and ‘self‐efficacy’. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process‐orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

Fire at the theatre: (Un)reality of/in the transference and interpretation1

Only in Bion's extended idea of ‘waking dream thought’ is the oneiric paradigm of the cure (already an obvious Freudian principle) completely applicable. The author's basic hypothesis is that, by adopting this paradigm thoroughly, one can combine the radical antirealism which is expressed in the postulate by which all the patient's communications are transference‐connected (here meaning ‘false connection’‐i.e. as projection/displacement of elements of the patient's inner psychic world) with the ‘reality’ of the transference, that is to say with the conviction that the facts of the analysis are co‐determined by the patient‐analyst dyad and actually rooted in how they interact. The Freudian metaphor of the fi re at the theatre is reintroduced here to suggest the crisis of the therapist's internal setting and capacity for reverie, which occurs when the irreducible ambiguity of the transference is resolved defensively, either in the patient's external reality or in his unconscious fantasy constellation. The author gives three clinical examples. The fi rst shows some of the not necessarily negative effects of this temporary crisis. The other two vignettes show a way of listening to the traumatic events of the patient's life from a perspective (that of the ‘analytic fi eld’) which is thought to be potentially the most transformative and vital to the analytical relationship.     

Countertransference—Transference seen from the Point of View of Child Psychoanalysis

This paper explores the ‘point of interaction’, that interface where the psyches of the patient and analyst meet. The author examines what is activated in the analytic pair at the point of interaction, with a particular focus on the mental activity of the patient and analyst. This exploration of the mental activity of the patient and analyst is from a theoretical position that combines contemporary Freudian and Kleinian perspectives on the therapeutic process. The author concludes that the capacity for mutuality in both the patient and analyst rests upon a part of the mind that is connected to a certain aspect of the Oedipus complex. Finally, the point of interaction is also discussed as a place where there is a potential meeting of minds around divergent methods and applications of psychoanalytic treatment. Clinical material is presented to illustrate these points.     

Some Thoughts on Supervision

Quite often we have the experience that adolescents do not accept an offer of treatment, in spite of the fact that they feel miserable. Or, that they do start in treatment and then change their minds and break off contact. The author reflects about factors and conditions contributing to these analytic failures. He discusses elements of analytic method, setting, neutral position, analytic relationship, and how the frames are put under pressure in work with adolescents. He thereafter presents some vignettes and examples of analytic work, where intuitive interventions and interpretations appear against a background of ordinary psychoanalytic method. For the analyst, these interventions can feel unexpected, incidental, like ideas out of the blue. On second thoughts, we may sometimes be able to trace and understand how these intuitions are based on non-conscious processes, like counter-transference feelings, an understanding of the patient still unclear and unarticulated for the analyst or perhaps a last desperate attempt to reach the patient and get in contact at a decisive or critical moment. Finally, the author reflects on the double face of psychoanalysis: both a contemplated, carefully described and systematic method and a craft with elements of intuition, creativity and, sometimes, inspiration.