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.     

Rebirth fantasy and the psychoanalytic process

In this paper, Jungian and Freudian perspectives on the fantasy of rebirth are explored and a brief review of the literature on the theme is used to show how that the rebirth fantasy seems to be a universal fantasy in the human mind, connected with the experience of both destruction and creation. In the psychoanalytic process the rebirth fantasy is connected with initial hopes for a better life, but is also a vehicle for creating the analytic pair and for separating from the 'totalitarian object'. An account of clinical work with a patient is given to illustrate the mutual and parallel process of rebirth in both the patient and the therapist. For the patient, the therapy was experienced as an awakening or a birth. The therapist was initially doubtful about the patient's capacity to engage in the analytic process but his involvement and interest were 'born' during the early sessions, enabling the patient to rely on him to lead her out of the claustrophobic power of the totalitarian object.     

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.     

On becoming a psychoanalyst

One has the opportunity and responsibility to become an analyst in one's own terms in the course of the years of practice that follow the completion of formal analytic training. The authors discuss their understanding of some of the maturational experiences that have contributed to their becoming analysts in their own terms. They believe that the most important element in the process of their maturation as analysts has been the development of the capacity to make use of what is unique and idiosyncratic to each of them; each, when at his best, conducts himself as an analyst in a way that reflects his own analytic style; his own way of being with, and talking with, his patients; his own form of the practice of psychoanalysis. The types of maturational experiences that the authors examine include situations in which they have learned to listen to themselves speak with their patients and, in so doing, begin to develop a voice of their own; experiences of growth that have occurred in the context of presenting clinical material to a consultant; making self-analytic use of their experience with their patients; creating/discovering themselves as analysts in the experience of analytic writing (with particular attention paid to the maturational experience involved in writing the current paper); and responding to a need to keep changing, to be original in their thinking and behavior as analysts.     

Illness theodicies in the New Testament

The New Testament writers advocate or at least mention six different religious explanations for the origin of sickness. First, Satan may thus victimize the innocent. Second, God may send sickness as a punishment for the sufferer's sins. Third, God may send sickness to punish one's parents' sins. Fourth, God may so punish one's own sins committed in a previous life. Fifth, God may inflict illness in order to show his power by subsequent healing. Sixth, God may inflict illness in order to show his power by sustaining the sufferer through the illness instead of healing it.     

Mass psychology of the led and the leaders

Abstract

Some salient features of a Sullivanian perspective are given as a background for a discussion of the case of Anna. Lived experience is mentioned as of equal importance as fantasy. Technically, analytic inquiry in the form of questions is stressed. In his review of the case presentation, the author observes that too much emphasis is given to content, compared to form. He notes that the therapist does not report key transference and non-transference interactions with the patient and further suggests that the patient still has significant narcissistic problems. He suggests that it is time to confront the patient with her characterological ways of relating to the analyst.     

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.     

Use of the analyst as a fetish.

In some cases a gratifying transference fantasy is the subject of progressive analytic work, while in other cases the same type of fantasy eludes investigation, and its enactment causes treatment to become an unproductive endless task. One cause for the latter difficulty can be that the patient uses his or her analyst as a fetish, permitting the distinction between reality and fantasy to remain inconclusive, so that relinquishment of magical expectations does not take place. The particular form of thinking involved in use of the analyst as a fetish is described. The role of illusion, its various clinical manifestations, the countertransference reactions they can evoke, and the technical problems posed are discussed. Special attention is given to the crucial issue of termination. By considering extreme instances in which use of the analyst as a fetish predominates, the author hopes to call attention to a phenomenon that appears to some degree in many, if not all, analyses.     

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.     

Some implications of the analyst feeling disturbed while working with disturbed patients

The analyst's experience of patients' disturbances is explored as an aspect of analytic technique. A number of premises are examined. First, it is expected that the analyst is committed to tolerating and understanding disturbances evoked in him by his patients' personalities and their disturbances. Second, that he regards the disturbances evoked in him as a form of manifest content to be understood in the usual method of association. Third, countertransference attitudes may propel the analyst toward rapid formulaic conceptions of his patients' disturbances or to considerations of diagnostic designations carrying serious, if not pejorative implications, such as borderline, narcissistic, perverse, or sociopathic. Such attitudes may also underlie the urge to consider psychotropic medications in response to the patients' disturbances. A selected review of the literature as well as illustrative work with disturbing patients are presented in support of the paper's premises.     

The making of an analyst: from 'ideal' to 'good-enough'

This paper addresses the issue of variances in training modalities and how this is linked to one's personal experience of training and to one's analytic lineage. The author, who bases his reflections on discussions held during the yearly directors of training meeting of the North American Jungian Societies, suggests that, while each institute aims to provide an 'ideal' training programme for its candidates, the philosophy underlying how this ideal is defined depends, in large part, on the theoretical and philosophical orientation of the founding fathers and mothers. This results in a form of analytic lineage that necessarily impacts on the form and content of the 'ideal' programme. Shadow issues related to analytic lineage in the admissions procedures, case consultation, exam committees and review committees are presented. Motivation for why we choose to train and reflections on what makes an analyst 'Jungian' are explored.     

Elements of analytic style: Bion's clinical seminars

The author finds that the idea of analytic style better describes significant aspects of the way he practices psychoanalysis than does the notion of analytic technique. The latter is comprised to a large extent of principles of practice developed by previous generations of analysts. By contrast, the concept of analytic style, though it presupposes the analyst's thorough knowledge of analytic theory and technique, emphasizes (1) the analyst's use of his unique personality as reflected in his individual ways of thinking, listening, and speaking, his own particular use of metaphor, humor, irony, and so on; (2) the analyst's drawing on his personal experience, for example, as an analyst, an analysand, a parent, a child, a spouse, a teacher, and a student; (3) the analyst's capacity to think in a way that draws on, but is independent of, the ideas of his colleagues, his teachers, his analyst, and his analytic ancestors; and (4) the responsibility of the analyst to invent psychoanalysis freshly for each patient. Close readings of three of Bion's 'Clinical seminars' are presented in order to articulate some of the elements of Bion's analytic style. Bion's style is not presented as a model for others to emulate or, worse yet, imitate; rather, it is described in an effort to help the reader consider from a different vantage point (provided by the concept of analytic style) the way in which he, the reader, practices psychoanalysis.     

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.     

Commentary on Paper by Lawrence J. Brown

Brown's historical overview of post-Kleinian psychoanalysis traces key steps in the evolving and diverse practice of working in the psychoanalytic situation while regarding it as a two-person field. The Barangers' “The Analytic Situation as a Dynamic Field” is central to his narrative. I develop my understanding of the originality of their contribution in theorizing a situational unconscious, and of their continuing relevance for thinking about analytic listening and intersubjective collaboration. Brown presents a countertransference dream of his own along with the dream of a patient as an example of the Barangers' concept of the “shared unconscious fantasy” of the analytic couple. A detailed alternative reading of Brown's clinical vignette reveals an absence of fit with the Barangers' views on collaboration in the analytic situation. Some uses of Bion's “dreaming” and “becoming” are implicitly questioned as they risk encouraging the idealization of special states over process.     

A note on notes: note taking and containment

In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.     

Deconstruction and Reconstruction

The authors present and elaborate their thesis that psychoanalysis is a hermeneutic science concerned with the causal nature of meaning. They contend that psychoanalysis is concerned primarily with uncovering the meaning of experience as unconsciously determined, that is, caused, by fantasy and as revealed by symptomatic effects. The cause-and-effect interrelationship that exists among fantasy, meaning, and symptom derives from certain abnormal experiences of self relative to selfobject that occur during early development. The authors draw upon their clinical studies of patients diagnosed with panic disorder, OCD, and OCPD and present two clinical vignettes for illustrative purposes. Using a combined method of "analytic deconstruction" and reconstruction, the authors demonstrate how various psychopathological states are reflective of failures to transform archaic narcissistic fantasies that unconsciously determine the meaning of the symptoms suffered by those diagnosed with these specific self-disorders.     

The Development of an Analytic Perspective in the Group Leader: Some Basic Thoughts

Previous experience working with individuals on a one-to-one basis along with previous analytic therapy are important prerequisites for analytic group training. Training must emphasize understanding of group-as-a-whole processes, such as basic assumption life, complex transference manifestations, as well as awareness of one's countertransference toward individuals, subgroups and the group-as-a-whole. Specific concepts derived from object-relations theory such as projective identification are crucial to master. Personal analytic group therapy is recommended.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

On the aesthetic illusion

The aesthetic illusion--the experience of the content of a work of art as reality--occurs through the mobilization and intensification of typical infantile fantasies in the beholder. This necessarily evokes intrapsychic conflict in the mature adult. Two illusion-producing strategies ameliorate this conflict and effect the aesthetic illusion. The first illusion is that the artist's proffered fantasy is the beholder's own personal and private fantasy. This isolates the beholder from the shame- and guilt-evoking social surround. The second illusion is that the protagonist depicted in the work is an actual person. This defends the beholder from the painful emotions attendant upon his instinctually gratifying identification with the protagonist. The first illusion is necessary for the establishment of the second, but it is the second that establishes the aesthetic illusion. The aesthetic illusion exists in a highly unstable dynamic equilibrium with the beholder's usual reality orientation. If either orientation is too powerful, the dynamic equilibrium is disrupted and the aesthetic experience as such is abolished.