Mutuality*

Ferenczi’s striving for mutuality, a call which Freud didn’t take up, let him explore this concept with his analysands. He thus became the originator of mutual analysis, although with caveats, and of the concept of introjection, another important Ferenczian notion. The analyst’s attitude of knowing the ‘objective’ and independent Truth is changing its orientation into that of a co-construction in the analytic work; here the analyst and the analysand build a third internal world, which they share and which remains their own. Clinical vignettes illustrate the implications of these views.     

Essential elements of the work of a supervisor

The supervisor’s prime task is to consider from the very beginning the analytic ability of the analyst presenting the case; this can be assessed by observing how the colleague transcribes the clinical material and describes what is meaningful in the session. It is extremely important to understand whether the patient’s suffering is neurotic, or whether he suffers from an initial psychotic disorder. In this latter case, the analyst will know that he cannot employ the same tools that he uses for the neurotic patient. It is fundamental to draw careful attention to the importance of the patient’s personal history. In the process of reconstructing the past, the patient’s difficulties are gradually understood by the analyst, the patient and the supervisor. Given that a memory may be distorted by present emotions and conflicts, the analyst must form meaningful hypotheses that, through reconstructing interaction with the original objects, help to comprehend the precarious equilibrium of the present. Over the course of supervision, I consistently emphasize the construction of the analytic relationship, which is based on the analyst’s mind and of the patient’s ability to communicate emotionally, so as to promote the analysand’s mental growth.

     

Essential anxiety: COVID-19 in analytic practice

This paper explores the impact of the COVID-19 pandemic on my relationship with analysands and my inner world. I reflect on the role of the archetypal Self during times of existential anxiety that may lead to an experience of ‘essential anxiety’. This term refers to a meeting by a fearful ego with an inward recognition of the Self, when faced with threat. The efforts to curb the spread of the pandemic changed our ways of life, while the virus itself threatened our existence in debilitating or outright destructive ways. But what also came into view, in sessions of analysis and supervision, was the creative instinct, and a celebration of life. The soul-to-soul relationship, and the connection with images of the archetypal Self, made the experience of existential anxiety at times an essential experience that facilitated psychological growth. I discuss some advantages of on-line Jungian analysis where, despite distance and partial view, the body still serves as container to hold important psychological material, conferring a sense of wholeness for analyst and analysand. The COVID-19 crisis is terrible and terrifying but it also provides an opportunity for self-regulation and individuation.     

Naturalistic Observation in Psychoanalysis

Abstract

The writer advocates a naturalistic approach to psychoanalysis. The Jane Goodall technique is an application of this approach in which the analyst studies the analysand as a naturalist would study and document the behavior of an animal species. The technique is particularly useful during difficult phases of treatment, and is sometimes quite powerful. Case material is presented showing how use of the technique can identify various forms of emotional induction used by analysands, the kinds of inductions which often produce countertransference reactions. Topics discussed include projective identification, supervision, and nature of psychoanalytic facts.     

The supervisory field and projective identification1

Taking as their starting point the Baranger and Baranger model of the ‘psychoanalytic field’, the authors extend the notion of intersubjectivity in the analytic relationship to the supervision process. They use a practical example of a supervision to show the development of what they term the ‘supervisory field’, formed from the superimposition of the two fields of analyst‐patient and supervisor‐supervisee. They emphasize the interplay of projective identifications with objects emanating from the inner world of the patient that are relived in the analytic relationship and transposed to the supervisory field. They believe that the concept of the ‘supervisory field’ contributes to a deeper understanding of the unconscious processes occurring in the mind of analysand, supervisee and supervisor during supervision, particularly regarding the identification, comprehension and resolution of persistent disturbances in the supervisory process.     

Racial and cultural in-betweenness meet in the consulting room: the case of ‘Anna’

An upper-middle-class black woman, who grew up adapting to a white-dominated environment, entered the consulting room of a multicultural ‘white-passing’ analyst, and here unique emotional experiences were reflected in dream images of racial disorganization, internal racism, and identity confusion. While sorting through the analysand’s internal dynamics, the external world erupted in May 2020 with the murder of George Floyd, catapulting both analysand and analyst (and the nation) into a transformative confrontation with their mutual, deep-seated woundings of American racial and cultural inequities. The analysand’s racial complexity directly impacted the analyst’s ‘white-passing’ privilege, bringing into question established classifications of American whiteness. Overlapping dynamics and experiences as ‘in-betweeners’ and ‘outsiders’ – a black woman subsumed by a white-dominated society and an immigrant refugee acculturated to American life – provided a common exilic ground for mutual understanding and mirroring. The analyst explores the racial and multicultural straddling that served as a lens into the analysand’s fragmented racial identity during the eruption of American racial unrest.     

A Story of a Split and Hope

ABSTRACT

This article, written by the analyst and his supervisor, presents the handling of a persistent obstruction of the analyst’s empathic capability. The mutual activation of a relentless empathic search led to the obstruction’s dissolution through the revelation of a personal part of the analyst’s life, and its connection to the patient’s inner life. The recognition of the split that existed in the analyst and the joy of finding the lost empathy and expanding it opened a new path in the analysis and enabled the beginning of a psychic transformation in the patient, which main essence is Hope.     

On presence in the psychoanalytic relation

This paper discusses presence in the psychoanalytic relation, the analysand’s and the analyst’s. Clinical situations with different qualities of presence will be considered focusing on what kind of interplay between analysand and analyst they may lead to. As examples, I have chosen three different clinical situations: In the first there is an interplay between the analysand’s free associations and the analyst’s ‘evenly suspended attention’. In connection with this I will discuss Bion’s concepts of ‘reverie’ and of ‘O’. In the second there is where the interaction is characterised by what Meltzer calls ‘geographical confusion’. In the third there is a ‘transference delusion’ in the psychoanalysis of breakdown as Winnicott describes it.     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

Speaking of feelings affects,language, and psychoanalysis

For a surprising number of analysands, many with above‐average intelligence and facility with language, words do not adequately capture or convey emotion or symbolize experience. This often subtle difficulty can have a powerful impact on the ability to verbally communicate emotions, process affect, and utilize traditional psychoanalytic interventions. Analysands with these problems therefore often have difficulty using analysis to explore and understand their own experience, yet the reasons for such difficulties are often not recognized by either analyst or analysand. In this article, I suggest that the concept of alexithymia can provide a valuable tool for understanding this gap between affects and language and, in its broadest interpretation, can aid therapists in their pursuit of meaningful approaches to the analytic process. Using the concept as a starting point, I describe and illustrate an approach in which paying attention to apparently insignificant aspects of an analysand's experience gradually helps analysands identify and explore personal symbols and meanings in their lives.     

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.     

Clinical Flexibility in the Psychoanalytic Situation: The Elasticity Principle

Abstract

This paper explores the development of the Elasticity Principle, first introduced by Ferenczi based upon his clinical observations. This important shift away from classical neutrality was inspired by Ferenczi's human approach to psychoanalysis. Learning from his analysands, he not only determined that in order to reduce resistances the analyst should present any interpretations in a tactful, empathetic manner, but also that the analytic work should bend or yield toward the analysand. The paper traces the evolution of the Elasticity Principle to The Grand Experiment, which was Ferenczi's analysis of Elizabeth Severn utilizing provision as an analytic tool. The paper follows the contemporary extensions of the Elasticity Principle in the development of Self Psychology and in the Relational perspective. A clinical example illuminates aspects of the Elasticity Principle in the work with a difficult analysand.     

Vicissitudes of ideas of cure in analysands and their analysts: a longitudinal interview study

This longitudinal prospective study focuses on analysands' and analysts' implicit ideas of how psychoanalysis might help analysands' psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst's observance of such incongruities and an openness to work through them.     

A Picture Book of Internal Events: The Colours of Rage and Love

The views on countertransference in psychoanalytic theory and practice have undergone a change within the last fifty years. From being considered an impediment to analysis, countertransference is today looked upon as an important potential for a tentative understanding of what is unconsciously communicated from the analysand to the analyst. This implies that the analyst is susceptible to the unconscious interaction in the transference and the countertransference, and that he/she becomes conscious as quickly as possible of what is taking place. This applies especially to erotic feelings which are often intensified in analyses with patients with a serious psychopathology, as well as in analyses with patients in regressive phases where projective identification is the dominant factor used as a defence and a communication. Opinions differ as regards the question of how to deal with such a situation, especially whether it is right to be candid about the analyst's countertransference feelings towards the analysand, something most would caution against. In an example from an analysis, the analyst describes how he was influenced by an unconscious erotic countertransference. After three years of therapy with a patient with a serious psychopathology, he developed ?motherly” feelings, which he interpreted as reflecting a child's longing for closeness and physical contact. The result was that a few times, he ?forgot” to indicate the end of the session, which was then prolonged, and also that he embraced her on several occasions before she left the session. One year later, he had intense sexual fantasies and dreams about the analysand, which he experienced as both enticing and alarming, and as an impediment to the analysis. He soon became aware of the element of projective identification in the interaction, and by interpreting the analysand's unconscious communication, he regained his ability to maintain an analytic attitude and clear boundaries.     

THE TRIADIC INTERSUBJECTIVE MATRIX IN SUPERVISION: THE USE OF DISCLOSURE TO WORK THROUGH PAINFUL AFFECTS3

The use of the psychoanalyst's subjective reactions as a tool to better understand his/her patient has been a central feature of clinical thinking in recent decades. While there has been much discussion and debate about the analyst's use of countertransference in individual psychoanalysis, including possible disclosure of his/her feelings to the patient, the literature on supervision has been slower to consider such matters. The attention to parallel processes in supervision has been helpful in appreciating the impact of affects arising in either the analyst/patient or the supervisor/analyst dyads upon the analytic treatment and its supervision. This contribution addresses the ways in which overlapping aspects of the personalities of the supervisor, analyst and patient may intersect and create resistances in the treatment. That three‐way intersection, described here as the triadic intersubjective matrix, is considered inevitable in all supervised treatments. A clinical example from the termination phase of a supervised analysis of an adolescent is offered to illustrate these points. Finally, the question of self‐disclosure as an aspect of the supervisory alliance is also discussed.     

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fi ction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.     

The analytic third: implications for psychoanalytic theory and technique

The author views the analytic enterprise as centrally involving an effort on the part of the analyst to track the dialectical movement of individual subjectivity (of analyst and analysand) and intersubjectivity (the jointly created unconscious life of the analytic pair--the analytic third). In Part I of this paper, the author discusses clinical material in which he relies heavily on his reverie experiences to recognize and verbally symbolize what is occurring in the analytic relationship at an unconscious level. In Part II, the author conceives of projective identification as a form of the analytic third in which the individual subjectivities of analyst and analysand are subjugated to a co-created third subject of analysis. Successful analytic work involves a superseding of the subjugating third by means of mutual recognition of analyst and analysand as separate subjects and a reap-propriation of their (transformed) individual subjectivities.     

Supervision as oversight: A new era in the history of psychoanalytic practice and training?

Taking its cue from Ekstein's analysis of the history of supervision (1960), this article proposes that there is a new historical era emerging in Britain, a phase that could be characterised as the ‘regulatory phase’. It is argued that in the future the clinical supervisor of psychoanalytic work will be positioned as ‘overseer’, with the consequence that what might be overlooked/not seen in the new regulatory climate is the notion of a psychoanalytically informed practice as a practice of the questioning of knowledge and its effects. Further, it considers how the effect of the proposed regulatory framework for psy-practice in the UK elides the current distinction between ‘practitioner/analyst’ and ‘trainee/candidate’. Thus psychoanalytically informed practitioners are re-positioned as candidates for authorisation as state licensed psy-practitioners. A clinical example, based loosely on Freud's account of his analysis of the young female homosexual, draws attention to the specifics and problematics of the competencies for analytic work and its supervision proposed by the Health Professions Council, Skills for Health and research for University College London, which envisages a future role of supervisors as the overseers of standardised interventions.     

Disruption and Working Through in the Supervisory Process: A Vignette From Supervision of a Psychoanalytic Candidate

This paper describes the author’s supervision of a psychoanalytic candidate, including the development and resolution of impasse in both the supervised analysis and the supervisory relationship. When the author became aware of the degree to which her own anxieties and defenses were implicated, she sought consultation, after which both supervision and analysis moved forward. As supervision continued, work on supervisee’s and supervisor’s interlocking anxieties and defenses, and understanding of their impact on the supervised analysis, deepened. The author concludes that exploring supervisory disruptions allows both members of the supervisory dyad to come to grips with conflicts that subtly distort their work and facilitates a deepening of the supervised analysis.     

Embodying analysis: the body and the therapeutic process

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split‐off complexes of the analysand. The analysty’s own attempt at mind‐body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung’s ‘psychology of the transference’ and the idea of the ‘subtle body’ as an unconscious shared area. The re‐attribution of meaning to pre‐verbal psychic experiences within the ‘embodied reverie’ of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.