PSYCHOTHERAPY AS PHASE-SPECIFIC INTERACTION

I am writing this paper to help myself, and hopefully some readers, to a better understanding of why some analysands in certain phases of the analysis develop the idea that they are homosexuals or that their analyst is homosexual. My basic thought is that even if these ideas have their individual roots and differ from case to case, they are also dependent on certain phenomena that are included in the analytic encounter and specified by different gender constellations constituting the analytic couple. I will present two examples from my own practice. From these two vignettes, I will draw some conclusions which are supported by my general psychoanalytic experience. The first example concerns male analysands. I have often seen male patients develop the fantasy that they “in reality” are homosexual. This fantasy is so common that it is a rule in my experience. I see it as a product of the fact that the psychoanalytic constellation consists, as in my case, of two men. The second example concerns female analysands. In a few cases with female analysands, I have seen the fantasy emerge that I, the analyst, am homosexual—a fantasy not seen in my male cases. Another difference is that I can't see this as a rule like the fantasy of the male analysands. In both the male and the female cases, I see the homosexual fantasies as a protection against discovery of the mother-transference to me. However, the fantasies have found different expressions depending on the specific gender constellation of the analytic couple: man and man and woman and man, respectively.     

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept ‘unconscious fantasy’ attempts to describe it from a ‘bottom‐up’ perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a ‘bottom‐up’ perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as ‘unconscious fantasy’, allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy.     

Mit Imagination an Albträumen arbeiten

According to Jung fantasies appear during sleep as dreams and while awake, they appear as more or less conscious fantasies. He understood fantasy as an activity of the psyche itself. Fantasy is that which simply occurs without any effort on our part and is always present. Imagination is what we call fantasy when we concentrate on it, i.e. perceive it and do something with it. Due to the close relationship of dreams, fantasies and imagination, the more they are consciously observed and perceived, the more it is possible to use imagination with dreams to better understand them. This is especially true for nightmares so that through imagination helplessness can be overcome and self-efficacy can be stimulated. Steven Starker already proposed using imagination for working on nightmares in 1974 and he also showed how the style of the nocturnal dreams changed as a consequence. In a clinical vignette I show how this technique can be used and what an influence it has. The analyst and analysand are in a communal space of visualization, framed in the beginning by the nightmare. This space is considered as a space of interaction and of potential transformation. The analyst is a part of the process, offering ideas in a symbolic form and reinforcing the analysand’s ideas which lead to stress-reducing behaviour and images that provide an opening for the future. There are pauses in the imaginative work to talk together about the experiences, to link the situation in the imagination to biographical material, and to understand the resources opening up in the material, through the analysand herself. The goal of working with imagination is to ban the anxiety in the dream and to let the dreamer experience the fact that dreams and imagination are not only determined by the anxious feelings but it is also possible to transform these kinds of energy into creative fantasies.     

Thoughts on the limits of a mutual technique*

Ferenczi’s appreciation of the inherently mutual nature of the analytic encounter led him, and many who followed, to explore the value of mutual openness between patient and analyst. Specifically, Ferenczi saw the analyst’s openness as an antidote to his earlier defensive denial of his failings and ambivalence toward the patient, which had undermined his patient’s trust. My own view is that, while the analyst’s openness with the patient can indeed help reestablish trust and restore a productive analytic process in the short term, it also poses long-term dangers. In certain treatments it may encourage “malignant regression”, where the patient primarily seeks gratification from the analyst, resulting in an unmanageable “unending spiral of demands or needs” (Balint, 1968, p. 146). I suggest that an analyst’s “confessions”, in response to the patient’s demand for accountability, can sometimes reinforce the patient’s fantasy that healing comes from what the analyst gives or from turning the tables on his own sense of helplessness and shame by punishing or dominating the analyst. In such situations, the patient’s fantasy may dovetail with the analyst’s implicit theory that healing includes absorbing the patient’s pain and even accepting his hostility, thus confirming the patient’s fantasies, intensifying his malignant regression and dooming the treatment to failure. When malignant regression threatens, the analyst must set firmer boundaries, including limits on her openness, in order to help the patient shift his focus away from expectations of the analyst and toward greater self-reflection. This requires the analyst to resist the roles of rescuer, failure, or victim—roles rooted in the analyst’s own unconscious fantasies.     

On Some Advantages of Mutual Sexual Fantasy in the Analytic Situation: Commentary on Paper by Christopher Bonovitz

This commentary reflects a fundamental agreement with Christopher Bonovitz' main thesis—fantasy, indeed, cannot be seen as a product of an isolated mind and is intrinsic to the development of both optimal internal and interpersonal richness. The theme of mutual sexual fantasy between analyst and patient in particular is highlighted for discussion. It is argued that, contrary to the more discussed dangers of erotic countertransference feelings, the absence of analysts' reciprocal sexual fantasy has the potential to deaden the analytic relationship and result in a less than satisfactory analytic experience.     

The Cocreation of Fantasy and the Transformation of Psychic Structure

This author argues that therapeutic action in child psychoanalytic psychotherapy rests with the creation and transformation of fantasy through play, which in turn shifts psychic structure. The paper details the treatment of an eight-year-old girl whose mother's inability to playfully participate in the inner world of her child interfered with the child's development of a fantasy life. The author suggests that the introduction of objective reality (i.e., interpretations that link the child's play with the real world) potentially impinges on and interferes with the transformational processes of fantasy. Developing the capacity to distinguish reality from fantasy does not take place through a forced accommodation to reality, but rather through the expansion of fantasy and a widening of the realm of the imagination. The elaboration of fantasy in concert with a parent or analyst is what builds the child's capacity to differentiate reality from fantasy.     

Alchemy in the image of the analyst

The author aims to demonstrate the activation in the transference relationship of a figure representing 'sameness' in a number of forms. In the first clinical vignette, she shows how a child projects his own difficulty symmetrically on to the analyst, with the aim of creating the conjunction of opposites which the psyche needs for its growth.
During the archetypal reworking which adolescence provides we again find this figure of 'sameness' in the foreground, in the phase of homosexual object choice. A second clinical vignette shows how this figure of 'sameness' can be represented in the fantasy or the desire of becoming an analyst.
The author puts forward the hypothesis that this fantasy represents an imago whose characteristics include being a tool for linking feeling and thinking in the inner world; it is constituted in the entre deux , the space between self and other, and, like Winnicott's transitional object, it facilitates the capacity to symbolize. Being 'off centre' with regard to infantile positions in relation to the parental imagos, this imago offers a vantage point for 'evaluation' ( sich auseinandersetzen ) and 'consideration' ( betrachten ). Finally this imago is transistory, because its destiny is to be deconstructed (as shown in the third clinical vignette which concerns an adult patient), in order to be integrated through the work of analysis.     

The threat of male-to-female erotic transference

Vignettes from an ongoing psychoanalysis with a patient, Michael, are presented to illustrate the various dimensions of the erotic transference at different phases of the treatment. The relation to power, the experience and expression of aggression, how these may be organized by gender, and the female analyst's countertransference are discussed as potentially fostering or inhibitory in the development of an erotic transference. Traditional sociocultural gender stereotypes kept alive in fantasy can cause female analysts to subtly foreclose the impending threat of an intense erotic transference with male analysands due to a fear of outwardly directed male aggression. It is suggested that the maternal/containing transference can be unconsciously fostered by both analyst and analysand to defensively avoid expression of the aggressivized erotic transference in its full intensity. Similarities and differences in cases of sexual boundary violations with opposite-gender pairings are discussed.     

Erotized transference reconsidered: expanding the countertransference dimension

A reconsideration of the erotized transference from a contemporary perspective has been presented utilizing detailed case material provided by Stoller. The main thesis is that this type of transference, traditionally conceived as a product of a particular kind of patient often felt to be borderline, is better understood as arising in a specific intersubjective context involving both participants in the psychoanalytic situation. The focus is on the intricate interaction of analyst and patient, recognizing that either may serve as a selfobject for the other. This view assumes a more expanded countertransference role than recognized in the earlier literature. The psychoanalytic situation can be erotized by either or both participants. A corollary thesis is that the details of a patient's fantasy should also be viewed as codetermined and that imbedded within it might be the patient's subjective experience of the psychoanalytic interaction. Alluded to peripherally is that the erotized transference in the interaction between male analyst and female patient is, in part, a manifestation of traditional roles assumed in situations involving a male authority figure in close engagement with a female who perceives herself as relatively powerless. This issue has recently received considerable attention from writers who have addressed themselves to the important gender issues in psychoanalysis.     

THE PATIENT'S OBJECTS IN THE ANALYST'S MIND

In every analysis, the analyst develops an internal relationship with the patient's objects—that is, the people in the patient's life and mind. Sometimes these figures can inhabit the analyst's mind as a source of data, but at other times, the analyst may feel preoccupied with or even invaded by them. The author presents two clinical cases: one in which the seeming absence of a good object in the patient's mind made the analyst hesitate to proceed with an analysis, and another in which the patient's preoccupation with a “bad” object was shared and mirrored by the analyst's own inner preoccupation with the object. The use and experience of these two objects by the analyst are discussed with particular attention to the countertransference.     

Exploring a patient's shift from relative silence to verbal expressiveness: Observations on an element of the analyst's participation

By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.     

Conviction and conversion: the role of shared fantasies about analysis.

This paper is an attempt to understand the origin of the analyst's conviction about both the patient's analyzability and the psychoanalytic endeavor. Clinical material will be used to illustrate the way that the intensity of the analyst's conviction is or isn't noticed or interpreted, by both patient and analyst. The primary hypothesis to be proposed is that the analyst's awareness of the transmission of conviction during conversion (or evaluation) can trigger recognition and use of a critical period for identification with an underlying mutual fantasy of intergenerational, analyst-patient conviction about analysis.     

Obstacles facing the psychoanalyst when interpreting narcissistic pathologies: Characteristics of the authoritarian patient

This paper explores the unconscious agreements between patient and analyst that promote some aspects of conflict to be excluded from the content of the interpretations. This generates an experience of exerting omnipotent control over the analyst, which subsequently consolidates a narcissistic phantasy. A stagnation of the analytic process is established in the course of the analysis but this remains hidden by areas of partial progress in the patient. Clinical material is provided in order to show the vicissitudes of the interrelationship between patient and analyst. It also demonstrates the working through by the analyst of a situation of both transferential and countertransferential conflict. This leads to an inhibition on the part of the analyst in his interpreting function. The use of projective identifications, which are mutually contradictory and incompatible, is also under discussion. This, as a result of being expressed simultaneously, constitutes a paradox, which may lead the analyst to confusion and an experience of paralysis. The subsequent confusional anxieties are considered. Additionally, authoritarianism is discussed, including its attendant difficulties of establishing boundaries between the self and the object. Finally, under consideration is the risk one takes in formulating authoritarian interpretations, which, in certain cases, can impose criteria on the patient.     

Report on a Panel Discussion on Interpretation

A case is presented where the patient's early experiences of violence and neglect have resulted in a defensive organization that has protected him against intolerable anxiety, at the cost of development and growth. In the analytic setting, the patient withdrew into his perverse fantasy world, an area of relative peace where he had omnipotent control, whenever contact with the analyst within a “room for relatedness” was experienced as threatening or frustrating. His avoidance of contact with the analyst was also an avoidance of reality, and proved to be a strong obstacle to progress in the treatment. During the terminal phase, he was forced to face reality and it seemed then that some widening of his psychic reality took place.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.     

“With you I’m Born Again”: Themes and Fantasies of Birth and the Family Circumstances Surrounding Birth as These are Mutually Evoked in Patient and Analyst

Themes of birth and rebirth, being born and born-again, can be readily observed in clinical psychotherapy and psychoanalysis even as they remain undertheorized. A clinical case is presented that traces the first four years of an analysis as seen through the lens of four consecutive supervisory experiences. This paper explores the central importance of fantasies and narratives of one’s origins and birth and the observations, fantasies, and expectations generated by one’s family circumstances at the time of birth. The paper examines birth narratives, fantasies, and myths of origination by following a clinical case across four supervisions. The patient’s birth-related fantasies are shown to interact with the analyst’s concordant and complementary fantasies as the analyst interacts with a series of supervisors in the process of being born as an analyst. The analyst’s personal birth narrative is linked to his fantasies about being born professionally as an analyst, and these are shown to interact with the patient’s birth fantasies. The paper suggests the ongoing significance of unconscious fantasy within the framework of contemporary relational psychoanalysis.     

Free-swinging attention

Psychoanalytic listening enlists the analyst's capacity for, and relative comfort in, rapidly shifting levels of attention and organization. Such shifts are not effortless and can be characterized as part of "free-swinging attention," a term that suggests some dimensions of the analyst's work. The need to establish meaning in the individual and immediate context parallels the task of a child in learning language, and the role of the analyst as child is an important if usually overlooked one. The author compares psychoanalytic with psychotherapeutic listening, as well as some current views on free association and evenly suspended attention.