Analytic Sadism and Analytic Restraint

Csillag challenges us to consider the presence and impact of the analyst’s sadism in the clinical encounter. Her theme usefully adds to the literature on the analyst’s countertransference and pushes us to look harder at ourselves. I distinguish between sadistic intent and experienced sadistic impact and suggest that Csillag is mostly speaking about the latter. Additionally, I address the absence of analytic restraint as a professional ideal that might moderate our slide to sadism in the countertransference.     

Ordinary Sadism in the Consulting Room

The analyst’s retaliatory sadism can be construed as a perversion of the wish to penetrate, just as masochism can be viewed as a degradation of the desire to surrender. When a patient refuses to speak any other language but that of domination and submission, ordinary attempts for communication and recognition fail. In her attempt to reach the patient, to reinstate herself as an active agent and subject, and also to dislodge the patient from a rut of despair, passivity, or malignity, the analyst may escalate to a sadistic response, even if she suspects that this might cause the patient pain. This type of sadomasochistic enactment can gather strength when disowned self-states of analyst and analysand are activated. In this process, an analytic interpretation, seemingly legitimate, can be used as a knife, a weapon, an instrument of retaliation and sadistic control. The disastrous potential of the analyst’s sadism is easy to imagine. Through a couple of clinical vignettes I will demonstrate that even something as lamentable as the analyst’s sadistic retaliation can lead to growth as long as such sadism can enter the analytic dialogue and the patient is allowed to perceive and reflect upon the analytic misbehavior, and the analyst is willing to join the patient in the quest to understand their co-created predicament.     

The Risks of Therapist Passivity and the Potentials of Constructivist Influence

Francesca Colzani’s rich report of her sensitive work with Elisa highlights the therapist’s struggle with the issue of the exercise of power and authority bearing on the patient’s choices. It is suggested that sometimes the analyst poses her dilemma in dichotomous terms, choosing, in effect, between coercion and passivity. Also, it is argued that moral choices can be obscured by a turn to medicalization, diagnosis and treatment, of the patient’s “condition.” An alternative is proposed in which the analyst may offer constructive suggestions imbued with her subjectivity—her experience of conflict and uncertainty—leaving Elisa room for the exercise of her own responsible agency. In finding her own voice, the analyst may awaken selves or aspects of self of the patient that might otherwise remain dormant, potentially to her detriment. An example of an interpretation of projective identification, with self-disclosure on the analyst’s part, is proposed that might encourage collaborative reflection on a seemingly dissociative dimension of Elisa’s way of being and relating.     

Poetics in the Clinical Encounter

Amidst a mounting impasse, a patient’s startling slip of the tongue opens this analyst to a crucial awareness of her affective experience so that she can begin to reenter her patient’s. The analyst’s openness to her own vulnerability serves to free both participants from collapse into a doer–done-to complementarity. The enactive communication expands the depth of their connection and dis-connection in the moment. Just as a poem says metaphorically what cannot be said in ordinary prose, the slip jolts both participants into more imaginative intersubjective ground that transcends a sense of time and potentiates clinical momentum.     

From Dead to Alive: Desire,Dissociation and Passion in the Analytic Dyad

When patients present in a deadened state, the analyst may feel a sense of futility and shame in his efforts to have impact. This may cause him to withdraw and contribute to an enactment in which both participants purge themselves of wanting anything from the other, sapping the treatment of purpose and aliveness. The author presents a model in which the analyst can reawaken his desire for recognition and connection and utilize it to introduce the patient to his or her own dissociated longings. This involves fortitude on the therapist’s part, since he must withstand the rejection that had caused him to withdraw in the first place, and also be sensitive to the patient’s fear of retraumatization. But if the analyst can do this, he can not only break through the impasse, but enliven the patient and infuse the treatment with a sense of purpose and hope.     

Emotional Communication and the Unconscious in the Analytic Setting

ABSTRACT

One type of unconscious communication is conceptualized as a form of emotional communication, the channel of communication that conveys information about a person’s emotional state through the nonsymbolic expression of feelings and is experienced as feeling in the receiver. Some of the analyst’s feelings are attuned responses to the patient’s unconscious communications; others are disjunctive and related only to the analyst’s unconscious. Attuned feelings can be identified by their congruence—similarities, consistencies, and analogies—with the patient’s verbal material, which reveals the meaning that the analyst’s feeling has within the patient’s subjectivity. Attuned feelings also have a meaning within the analyst’s subjectivity. Two cases are discussed, one in which the analyst experiences the patient’s unconscious communication within the symbolism of one of her own childhood memories. The other illustrates the risk of confusing disjunctive feelings emanating from the analyst’s own unconscious with unconscious communication from the patient.     

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.     

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.”     

Deep Diving: Imagination,Intuition, and the Interpenetration of Minds

How do we help patients who come to us without access to feelings and without curiosity about themselves and others? The author suggests that the analyst’s imagination and intuition provide a channel or medium through which to apprehend aspects of the patient’s internal life, make contact and communicate with younger parts of the patient, and provide containment to these parts of the person. As the analyst engages her imagination in this way, communication channels open and shared states of consciousness between analyst and patient are created, thereby facilitating the interpenetration of minds and the opening up of previously closed object worlds. In the course of this work, compassion serves as a vehicle for truth, penetrating previously closed object relational systems. This kind of work poses risks for the analyst.     

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.     

Seeing,mirroring, desiring: The impact of the analyst’s pregnant body on the patient’s body image

The paper explores the impact of the analyst’s pregnant body on the course of two analyses, a young man, and a young woman, specifically focusing on how each patient’s visual perception and affective experience of being with the analyst’s pregnant body affected their own body image and subjective experience of their body. The pre‐verbal or ‘subsymbolic’ material evoked in the analyses contributed to a greater understanding of the patients’ developmental experiences in infancy and adolescence, which had resulted in both carrying a profoundly distorted body image into adulthood. The analyst’s pregnancy offered a therapeutic window in which a shift in the patient’s body image could be initiated. Clinical material is presented in detail with reference to the psychoanalytic literature on the pregnant analyst, and that of the development of the body image, particularly focusing on the role of visual communication and the face. The author proposes a theory of psychic change, drawing on Bucci’s multiple code theory, in which the patients’ unconscious or ‘subsymbolic’ awareness of her pregnancy, which were manifest in their bodily responses, feeling states and dreams, as well as in the analyst s countertransference, could gradually be verbalized and understood within the transference. Thus visual perception, or ‘external seeing’, could gradually become ‘internal seeing’, or insight into unconscious phantasies, leading to a shift in the patients internal object world towards a less persecutory state and more realistic appraisal of their body image.     

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.     

A Postscript to Panel Discussion of Gianni Nebbiosi’s “The Smell of Paper: On the Usefulness of Musical Thought in Psychoanalytic Practice”

Gianni Nebbiosi’s paper, “The Smell of Paper: On the Usefulness of Musical Thought in Psychoanalytic Practice,” explores many levels of the analyst’s clinical sensibility. These include the finding of a patient in the mind of the psychoanalyst, the discovery of new points of creative inflexion in developing metaphors with a patient who is frightened of symbolic meaning, the use of countertransference analysis to explore the analyst’s points of resistance to helping his or her patient, and the development of a creative shared frame of reference between patient and analyst that emerges from the patient’s unconscious life.     

The “Once and Future” Focus of a Relational Psychoanalysis: Discussion of “Vitalizing Enactment”

In this discussion of Amy Schwartz Cooney’s paper (this issue) I focus on the current interest in relational theorizing on the analyst’s proactive role vis-à-vis her patient, that is, what she actually does for or gives to her patient. I consider the role of the analyst’s own internal “bad” objects in facilitating or inhibiting the therapeutic process. I end with a set of theoretical propositions about the ways in which an intense and deadening shame can lead to dissociation and/or repression of hopeful fantasies about the future.     

Hörräume – Klanghüllen

In psychoanalytic research little attention has been given to one of the analyst’s chief instruments, namely his/her voice, although, apart from a few exceptions, the patient has to rely mainly on the acoustic channel in the course of the psychoanalytic process. The author presumes this to be a sign of a collective resistance among analysts which protects them against an unsettling idea: Our utmost restraint notwithstanding, it is in our voice that our physical nature materializes, that our presence is felt in a sensory way thus affecting our patients. An attempt is undertaken to show to what extent the analyst’s voice as a part of the atmosphere in the analyst’s practice affects the patient physically, thus making it possible for him/her an aesthetic experience, which may as a sensory perception lead to changes of the habitual ways of perception and thus to new experiences. Using the concept of “The Performance” devised by Fischer-Lichte, a lecturer in the theory of drama, the author explains to what extent meanings are created by both participants of a psychoanalytic process: Fischer-Lichte regards the aesthetics of performance as aesthetics of presence which arouse the sensation of physical presence. If the patient’s focus on the voice is not merely interpreted as a means of defence against comprehending the semantic meanings of the words, but is accepted as a necessary transition stage leading to re-animating the patient’s conception of reality, then a new listening and performing horizon is opened where the presence of other things can be experienced.     

What’s So Great About Authenticity Anyway? The Therapeutic Function of an Analyst’s Lie

How can we understand moments when the analyst lies to her patient? When it’s not the patient’s lying at issue but the analyst’s? When we suddenly find ourselves being deliberately disingenuous in the analytic hour? When our commitment to authenticity conflicts with the patient's need to create and sustain certain fantasies about us? Psychoanalytic literature typically focuses on the dynamics of the patient’s lie but rarely is the analyst's authenticity questioned. Are there times when the analyst might choose to lie in order to preserve herself, as well as, the relational bond? The complexity of this “choice” is explored and the erosion of an analyst’s authenticity unpacked during the final days of a difficult treatment.     

Death Is Nothing at All: On Contemplating Non-Existence. A Relational Psychoanalytic Engagement of the Fear of Death

This paper engages the secular mind’s struggle with mortality from a relational perspective. It critically reviews the legacy of Freud’s refusal to grant mortality psychic significance and the ways in which the fear of death has consequently been understood theoretically and addressed clinically. Analytic omnipotence is foregrounded as an impediment to the kind of intersubjective engagement that minds need from other minds in grappling with the loss of the self through death. A clinical illustration is used to explore the ways in which the analyst found himself relating with a patient around her extreme fear of death, which over the course of treatment became modified into a more bearable anxiety about her own mortality. A conceptual framework is offered to account for these changes, emphasizing the analyst’s personal relationship with mortality as a crucial variable in how the fear of death is engaged psychoanalytically. The author calls for a revisionist psychoanalysis that allows for death’s centrality in both theory and practice.     

Where are you,my beloved?: On absence,loss, and the enigma of telepathic dreams

The subject of dream telepathy (especially patients' telepathic dreams) and related phenomena in the psychoanalytic context has been a controversial, disturbing ‘foreign body’ ever since it was introduced into psychoanalysis by Freud in 1921. Telepathy ‐ suffering (or intense feeling) at a distance (Greek: pathos + tele)‐is the transfer or communication of thoughts, impressions and information over distance between two people without the normal operation of the recognized sense organs. The author offers a comprehensive historical review of the psychoanalytic literature on this controversial issue, beginning with Freud' years‐long struggles over the possibility of thoughttransference and dream telepathy. She then describes her own analytic encounter over the years with five patients' telepathic dreams' dreams involving precise details of the time, place, sensory impressions, and experiential states that the analyst was in at that time, which the patients could not have known through ordinary sensory perception and communication. The author's ensuing explanation combines contributory factors involving patient, archaic communication and analyst. Each of these patients, in early childhood, had a mother who was emotionally absent‐within‐absence, due to the absence of a significant figure in her own life. This primary traumatic loss was imprinted in their nascent selves and inchoate relating to others, with a fixation on a nonverbal, archaic mode of communication. The patient's telepathic dream is formed as a search engine when the analyst is suddenly emotionally absent, in order to find the analyst and thus halt the process of abandonment and prevent collapse into the despair of the early traumatization. Hence, the telepathic dream embodies an enigmatic ‘impossible’ extreme of patient‐analyst deep‐level interconnectedness and unconscious communication in the analytic process. This paper is part of the author's endeavour to grasp the true experiential scope and therapeutic significance of this dimension of fundamental patient‐analyst interconnectedness.     

Identifications Annealed,Adhesive and Political: Commentary on Paper by Nina Farhi

Farhi's fascinating paper pays tribute to and extends those segments of Milner's clinical work that Milner hesitated to theorize explicitly herself. Seeking to understand the latter, I trace psychoanalytic politics in general and the history of Milner's relationships with Winnicott, Klein, and Riviere in particular to explore how her dutiful compliance to the rigid taxonomy of psychoanalytic power of her time bore on the trajectory of her becoming an analyst with a mind of her own. It is in accounting for how she struggled to disentangle herself from that web, that we discover how Milner was able to creatively refashion her work with her patient Susan, a process by which Susan was greatly impacted.

Following the trail of Farhi's ideas around this process and considering her thoughts around their psychic meanings for both analyst and patient, I explore their clinical implications. I focus on the transferential iterations of these dynamics to consider Farhi's suggestion that an annealed bond needs to be established in the treatment of patients who have, early in life, failed to develop annealed identifications. This opens up questions around how such bonds can malignantly colonize the analyst's mind and psychic reality, raises questions of self-care in the analyst and contributes to prognostically anticipating certain sets of enactments in the course of long-term psychoanalyses.     

The patient's transference experience of the analyst's gender: Projection,factuality, interpretation,or construction

The constructivist/relational perspective has challenged the analyst's emotional superiority, her omniscience, and her relative removal from the psychoanalytic dialogue. It at first appears to be antithetical to treatment approaches that emphasize the analyst's holding functions. In this essay I examine the holding model and its resolution from a relational perspective. I propose that the current discomfort with the holding function is related to its apparent, but not necessarily real, implications. I discuss the analyst's and patient's subjectivity during periods of holding. I believe that the holding process is essential when the patient has intensely toxic reactions to “knowing”; the analyst and is therefore not yet able to stand a mutual analytic experience. During holding, the patient experiences an illusion of analytictic attunement. This requires that the analyst's dysjunctive subjectivity be contained within the analyst, but not that it be abandoned. Ultimately, it is the transition from the holding position toward collaborative interchange that will allow analyst and patient explicitly to address and ultimately to integrate dependence and mutuality within the psychoanalytic setting and thereby engage in an intersubjective dialogue. The movement toward mutuality will require that the analyst of the holding situation begin to fail in ways that increasingly expose her externality and thus her subjectivity to the patient.