Here and now: My perspective1

In this paper the author describes her particular perspective in doing analytic work. She stresses working in the here and now. For example, making interpretations that grow out of what the patient says or does in the sessions, keeping the patient’s history in mind, but not letting it lead interpretations. The analysis tries to understand why something is being said now, in this way, and what impact it may have or be designed to have in the analytic relationship. The term ‘here’ refers to what is going on between patient and analyst in the room while not leaving out the patient’s immediate reality in the outside world, his everyday life. The word ‘now’ implies awareness of time that is not just of the past and future but of the patient’s situation at the moment in analysis, which is constantly shifting.The author believes that by working primarily in the present the patient will feel more anchored, both patient and analyst can observe what is going on, for example how anxiety arises or decreases, how defences are mobilised or lessen. Both analyst and patient experience movement and change rather than relying on more theoretical explanations.     

DREAMING THE ANALYTIC SESSION: A CLINICAL ESSAY

This is a clinical paper in which the author describes analytic work in which he dreams the analytic session with three of his patients. He begins with a brief discussion of aspects of analytic theory that make up a good deal of the context for his clinical work. Central among these concepts are (1) the idea that the role of the analyst is to help the patient dream his previously “undreamt” and “interrupted” dreams; and (2) dreaming the analytic session involves engaging in the experience of dreaming the session with the patient and, at the same time, unconsciously (and at times consciously) understanding the dream. The author offers no “technique” for dreaming the analytic session. Each analyst must find his or her own way of dreaming each session with each patient. Dreaming the session is not something one works at; rather, one tries not to get in its way.     

Recognition of Difference in the Author–Discussant Relation: Reply to Commentary

This author describes how poetry infuses her way of thinking, feeling, and writing and her way of working analytically. She introduces the concept of a nonanalytic third—the analyst's personal, intimate, and substantially abiding relationship to some body of experience unrelated to materia psychoanalytica. She posits that this nonanalytic third, the nature of which is unique to each analyst, constitutes a source of enrichment, texture, and dimensionality as well as personally compelling metaphors that the analyst may offer to the patient as other-than-me substance and a placeholder for cultivating the potential in the discourse of analytic potential space, in addition to serving as a facilitator and comfort for transition when the analyst must recognize and promote the necessary ending of an intimate analytic relationship.

Using Stephen Mitchell's notions of intersubjectivity and also using the analyst's and patient's separate role responsibilities in the creation of a context for the absence of conscious intentions, the author develops her concept of the nonanalytic third and the particular contribution of poetry to clinical process. These ideas are illustrated with a detailed case example of an unfolding analytic process that includes an e-mail exchange at the time when a shocking form of nonanalytic third appeared—September 11, 2001.     

Breakdown in communication: On finding the child in the analysis of an adult

SUMMARY

In this paper a patient is described in whom communication with parts of herself and with her objects, internal and external, had broken down. I suggest that her way of communicating was achieved by projective identification, as described by Klein (1946) and Bion (1962). The only way she could deal with and communicate her own very “bothered” feelings was to “put them” into the analyst. In this way she “bothered” the maternal or analytic mind in such a way as to make the analyst experience feeling like a “bothered” child.

I have tried to show how the analyst holds or contains these feelings, and to show the gradual establishment in the patient of a different way of communicating with the analyst and with the more primitive parts of herself.     

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).     

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.     

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

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

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

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

Silence as the Voice of Trauma

Silence is a key to the unspoken world of the patient. Rather than interpreting silence as a defensive maneuver, the analyst may understand this disruption as a royal road to the patient’s traumatic experiences. The author proposes to recognize traumatic silences in the analytic process and the transference as a re-experiencing of past, unpredictable traumatic affective states and memories. Silences in this context are both a repeat of a disconnecting experience as well as a manifestation of a silencing identification with the original silencer. The clinical material illustrates effects of a German mother’s World War II (WWII) personal traumata and collective shame-based silence on her daughter’s self and good object development. In the daughter’s analysis, the patient and the analyst, who herself experienced similar WWII traumata, face the pain of trauma recovery and un-silencing. The author suggests that the deadening effect of past traumata may be reversed by an analytic process of re-membering and re-speaking for both the patient and analyst. This allows for a more transparent, subjective experience in the transference and a verbal integration of ego functions.     

Self‐disclosure,trauma and the pressures on the analyst

This paper argues that self‐disclosure is intimately related to traumatic experience and the pressures on the analyst not to re‐traumatize the patient or repeat traumatic dynamics. The paper gives a number of examples of such pressures and outlines the difficulties the analyst may experience in adopting an analytic attitude – attempting to stay as closely as possible with what the patient brings. It suggests that self‐disclosure may be used to try to disconfirm the patient's negative sense of themselves or the analyst, or to try to induce a positive sense of self or of the analyst which, whilst well‐meaning, may be missing the point and may be prolonging the patient's distress. Examples are given of staying with the co‐construction of the traumatic early relational dynamics and thus working through the traumatic complex; this attitude is compared and contrasted with some relational psychoanalytic attitudes.     

State of the Hope: The New Bad Object in the Therapeutic Action of Psychoanalysis

Until recently, most psychoanalytic conceptualizations of the analyst as a new object have tended to equate newness with good experience and safety. Recent papers in the relational literature have explored not only the therapeutic value, but also the inevitability of the patient's experience of the analyst as bad, as well as the analyst's participation in this experience. This author examines the multifarious nature of hope, goodness, and badness in the clinical situation. The patient gets to know not only elements of his or her own self that are held by the analyst, but also ways in which the patient holds elements related to the particulars of the analyst's person in the analytic situation. Shifts in American psychoanalysis regarding conceptualizations of the analyst as a new object are examined. Limitations of a bifurcated approach to goodness and badness in clinical conceptualizations are also explored.     

The Role of Psychoanalysis in the Conflict of Interpretations

This paper describes how the temporary illness of the analyst affects the analytic work when it breaks the habitual analytic setting and exposes the analyst to countertransference reactions. The illness stimulates different meanings and reactions in the analysand. The paper describes how the fostering of the habitual analytic work helps the analysand to make use of the event, i.e., to integrate it into the transference. In the light of the patient cases, it would seem that corporeality is the key: the crucial question is what it means not only to the analyst him/herself but also to the analysand, that the analyst's body remains unchanged, secure, living and stable and does not require any particular attention.     

Making Good Use of Combined Therapeutic Modalities: Discussion of “Somatic Experiencing”

A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well.     

Developing a Psychoanalytic Practice

Abstract

This paper examines two methods of developing a psychoanalytic practice. The first is an “internal” approach that helps a patient make the transition from therapy to analysis with the same analyst. This may be accomplished by attenuating the patient's unconscious fears of analysis as a facilitator of an anticipated regressive loss of control and as a reactivator of feared desires and impulses. Increased motivation for analysis may also result from a therapy that leads the patient to an awareness that an ongoing level of distress is internal, together with the experience of a deepened therapy and of the analyst as safe and potentially providing relief. The second method of developing an analytic practice is an “external” approach that provides others, such as analytic, mental health, medical, and academic colleagues, an experience of the analyst as person and some idea of the type of work he or she does.     

Dreams and the holistic nature of interpersonal psychoanalytic experience

Patients’ dreams and analysts’ dreams about patients are assumed to reflect each analytic participant's attitude and psychic conduct toward the other, and an unconscious overlapping of psychic issues and struggles between them as well. This makes it possible to deal with dreams from one‐person and two‐person models of psychological functioning, as well as from an additional psychic dimension that is assumed to be a creation of the analysis itself. As a source of freely moving experience within both participants, one that is assumed to have a life and direction of its own, this latter dimension of analysis permits patient and analyst to undergo more freely the actual experience of the treatment as a modality that is separate from and prior to positivistically grounded determinations that can be made about either the patient or analyst individually, or about the two of them jointly.

This dimension of analysis is said also to reflect a holism that characterizes conscious and unconscious psychoanalytic experience. Dreams and unconsciously generated dreamlike clinical phenomena are presented to try to illustrate this holistic character of analytic work, and to show how either participant's psychic productions maybe used to evoke significant experiences and further clinical knowledge.     

The Write of Passage From Candidate to Analyst: The Experience of Writing Analytic Process

This article describes my experience of learning to write analytic process. It illustrates how the depth of understanding I achieved from learning to write transparently about analytic work was instrumental in the consolidation of my analytic training and my development of an analytic identity. Practicing analysis requires letting our minds function at multiple levels—integrating, synthesizing, free-associating, attending, and maintaining our own reverie—simultaneously. This is a large task for any analyst, much less a beginning analyst. Writing about this process necessitates not only understanding what has transpired in our offices with our patients but also developing the ability to explain that intimate and unique interpersonal dyad to our peers. Learning to do analytic work is not the same as learning to write about it; and writing about psychoanalytic process is very different from participating in it (Reiser, 2000). The goal of writing analytic process is not primarily to tell the story of the patient but to demonstrate our thinking, experience, and understanding as analysts. To do this requires both a depth of understanding of what we do and a mastery of analytic process.

While there may be different ways to synthesize and integrate our analytic training and to accomplish the significant task of progressing from candidate to analyst, learning to write analytic process was pivotal for me. It was a “rite of passage,” culminating in the development of an increased sense of identity, maturity, and confidence as an analyst.     

Fromm's Impact on Interpersonal Psychoanalysis: A Well Kept Secret

Erich Fromm was one of the founders of the William Alanson White Institute in New York City and an important contributor to the development of the interpersonal approach to psychoanalysis. Many of Fromm's ideas about psychoanalysis have found their way into the mainstream of analytic thinking. Much of what he taught in supervision and in his lectures had to do with the role of the analyst, the analyst's use of himself in the analytic process and the necessity that the analyst experience what his patient is experiencing. From did not necessarily use terms like projective identification but his understanding presaged much of what analysts talk about today. Fromm himself did not write much about clinical practice. And while he repeatedly expressed his respect for Freud he was explicit in his disagreements. Fromm rejected the notion of the analyst as a blank mirror. Instead, analysis requires a passionate wish for truth both in the analysand and the analyst. Fromm calls this passion biophilic, implying that the unconscious does not only harbor destructive drives that need to be tamed; it also harbors creative drives which, while also irrational, are constructive and need be liberated through the analysis.     

When Avoidance Is Mutual Regulation: Disorganized Attachment and Analytic Attunement

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patient together, along with the feelings engendered by “waiting.”     

An Analyst Has a Birthday - Can Forgiveness Heal?

Forgiveness is a challenging endeavor in human experience and in clinical work. Is it an important and/or legitimate analytic concept? Long the province of theologians and philosophers, forgiveness has had little theoretical place in the psychoanalytic lexicon. This paper considers the analytic place of forgiveness through a treatment that was shadowed by two lost mothers – the patient’s and analyst’s - in the consulting room. The patient’s question, “must we forgive to heal?” will be examined in this story of healing for both him and his analyst.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

The Wisdom of Sharing a Frame: Commentary on Papers by Anthony Bass and Ilana Laor

In this discussion I agree with Anthony Bass, who shows how the analytic frame has properties that involve both the process and the structure, and I suggest replacing the term structure with the term constraints. Bass considers analytic frames as contexts: Different frames organize different contexts of experience. He says that the frame is cocreated by patient and analyst and evolves over time. I think that Dafna's case presented by Ilana Laor is a good example of this aspect. I agree with Laor, who shows how the frame reflects the negotiation process between patient and analyst, emphasizing that this process itself is therapeutic. Following Bass I emphasize that a polarization between stability versus flexibility should be replaced by the dialectic between stability and flexibility. I conclude wondering how Bass's and Laor's “wisdom” regarding flexibility and elasticity can be passed over to younger psychoanalysts who are beginning their clinical work.