The development and organizing function of perversion: the example of transvestism

Perversion had been viewed as oedipally determined and in a reciprocal relationship with neurosis. In our widening scope, however, pre-oedipal and traumatic contributions have been increasingly emphasized. While both perspectives represent aspects of clinical reality, the tendency has been to overlook sexual and aggressive drive derivatives, with their related conflicts, object representations, and symbolic enactments, even though they may make significant contributions to the analytic situation. These latter, 'classical' patients have what I consider 'organized' perversions: complex, evolved, neurotic-level, stable psychopathological formations that may be distinguished from borderline or near psychotic syndromes enlisting perverse mechanisms to ward off disorganization. This paper will review Freud's work, briefly consider some recent trends in conceptualizing perversion and perverse mechanisms, characterize organized perversion, and present clinical material to illustrate its evolution, clinical manifestations, and analysis. Transsexualism, overtly similar to transvestism but not functioning as an organized perversion, will serve as a point of contrast.     

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

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

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

Psychosexuality and the representational world.

The sensual experiences, fantasies and enactments that occur in the course of normal development are seen as psychic organizers which contribute vitally to the structuralization of the representational world. In the sexual perversions which occur in structurally deficient, developmentally arrested individuals, this function of early psychosexual experiences has been retained and is regressively relied upon in order to restore or sustain the cohesion and stability of crumbling, fragmenting or disintegrating self and object representations. Analytic exploration of the details of perverse fantasies and acts, their origins and functions, reveals the particular ways in which they compensate for specific structural weaknesses in patients' representational worlds. Some clinical illustrations and therapeutic implications of these formulations are briefly presented.     

“E” Enactments in Psychoanalysis: Another Medium,Another Message

This paper explores sources of therapeutic action located in inchoate experience, in the often-preconscious resonance that is generated in that dimension of experience which we have come to regard as enacted in the transference/countertransference field. The living and working through of a wide range of problematic and reparative elements distilled in the analytic relationship are described as a crucial source of therapeutic action. A brief historical treatment of the place of enactment in different psychoanalytic traditions is followed by the explication of two different kinds of enactments: ordinary, quotidian enactments that form the daily ebb and flow or ordinary analytic process and (capital E) Enactments. The latter are highly condensed precipitates of unconscious psychic elements in patient and in analyst that mobilize our full, heightened attention and define, and take hold of, analytic activity for periods of time. Clinical vignettes by Theodore Jacobs and Margaret Black are discussed in explicating the latter distinction and considering its implications for technique.     

Addictions and the Quest to Control the Object

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

Going Deep,Going Wide

Contemporary theories of psychoanalytic action have for the most part shifted from an archeological model—analyst as objective scientist/detective in search of patients’ deeply repressed affective experience—to analyst as often unwitting co-participant in a relationship ultimately designed to broaden patients’ awareness and acceptance of their varied internalized self-other configurations. These sometimes dissociated configurations often emerge in the context mutual enactments between patient and analyst.     

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

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

Orientations of psychotic activity in defensive pathological organizations

The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

Desire,Domination, Sadism,and the Degradation of Love: Reply to Commentaries by Joyce Slochower and Christopher Bonovitz

In her response to commentaries by Joyce Slochower and Christopher Bonovitz, the author further clarifies her understanding of countertransferential sadism and how it compares to other enactments. She addresses Slochower’s concern about psychoanalytic restraint in the relational frame. The author responds to Bonovitz, who used a Fairbairnian perspective to comment on the clinical material she presented, and she considers how Fairbairn’s concepts of the libidinal ego, the rejecting object and the internal saboteur apply to analytic sadism. Finally, she contemplates whether the sadistic enactments described in her paper can be viewed as a prelude to the expansion of analytic love.     

Enactments and Dissociations Driven by Cultural Differences

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

Scopophilia and object loss.

The study of a case of voyeuristic perversion and of some previously published cases of simple scopophilia suggests that fear of object loss early in life may be an important factor predisposing one to a propensity for voyeurism. The increased need to maintain visual contact with the object and to incorporate it visually leads to a hypercathexis of the visual function which is at the base of voyeurism. This need later becomes sexualized, while still retaining its pregenital connotations. Although object loss was apparently significant in the case of the patient described in this paper, it is not necessarily a factor in all cases of perverse voyeurism and, when present, may be considered as only one element in its pathogenesis.     

Perverse dreams and dreams of perversion

This paper (1) posits the occurrence of perverse dreams as a type of mental phenomenon in the constellation of perverse processes; (2) considers manifest dreams of frank perversion as a type of perverse dream within the class of perverse dreams as a whole; (3) relates the subtype of perverse dreams without manifest perversions to the occurrence of perverse defenses and the development of a perverse transference; and (4) suggests that consideration to perverse dreams in the psychoanalytic process finds application in identifying and differentiating perverse defenses from neurotic and other characterologic patterns; in identifying and tracing the vicissitudes of difficult perverse transference-countertransference constellations; and in furthering perverse patients' recognition and understanding of particularly troublesome and seemingly intractable issues in their psychic makeup. Clinical material illustrates perverse dreams and their usefulness in the often arduous process of analyzing perverse defenses.     

Silent dialogues in the analytic relationship

Abstract

In borderline or even narcissistic patients, the relation to the objects is built on the basis of omnipotent control, so that those patients present difficulties related to mourning for the loss, as well as for the independence, of the objects. Their basic trait is a huge inability to recognize the separateness of others, together with an excessive use of primitive defense mechanisms, such as projective identification. Each experience that contains the danger of re-experiencing the primal separation poses an attack on the analytic setting, in order to avoid such a re-experiencing. Those attacks sometimes take the known form of acting out, whereas other times they are limited to a special use of speech, which lacks any communicational faculty and is used rather as a weapon. This special climate affects the analyst, causing specific countertransferential reactions. Nowadays, we tend to consider such a communication not mostly as an obstacle, but rather as an opportunity, allowing the analyst to comprehend the patient, through his countertransference, and create a meaning to replace the void those patients usually experience. The transference and countertransference enactments, their silent dialogues taking place in the analytic setting, are those which progressively give meaning in this primitive non verbal communication.     

Racial Enactments in Dynamic Treatment

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

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Enactment controversies: a critical review of current debates

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

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.