Danger and safety: The analyst as analytic subject

Abstract

This paper considers questions of danger and safety in the analytic relationship in light of the contemporary recognition of analysis as a co-participatory process. In the interest of safety, the psychoanalyst has the responsibility to be persistently curious, particularly about the problems derived from his contact with the analysand. Information about the analyst's impact must be taken to heart; it must be experientially considered. As the process unfolds, the analyst presumes that a portion of its effect will be negative. The analyst aspires not to preempt all negative impact but to create an analytic environment in which the analysand's conscious and unconscious communications about impact may be attended to. The analyst's ability to receive such information is crucial in the establishment of a reliable process capable of addressing and surviving the unanticipated dangers that inevitably emerge and securing the analysand for further self articulation. The analyst can simultaneously attend to being the analyst and being a subject of analysis by regarding all communications from the analysand as representing, at least in part, interpretations of the analyst and the analyst's participation. Illustrative material is presented.     

The body of the analyst and the analytic setting: Reflections on the embodied setting and the symbiotic transference

In this paper the author questions whether the body of the analyst may be helpfully conceptualized as an embodied feature of the setting and suggests that this may be especially helpful for understanding patients who develop a symbiotic transference and for whom any variance in the analyst's body is felt to be profoundly destabilizing. In such cases the patient needs to relate to the body of the analyst concretely and exclusively as a setting ‘constant’ and its meaning for the patient may thus remain inaccessible to analysis for a long time. When the separateness of the body of the analyst reaches the patient's awareness because of changes in the analyst's appearance or bodily state, it then mobilizes primitive anxieties in the patient. It is only when the body of the analyst can become a dynamic variable between them (i.e. part of the process) that it can be used by the patient to further the exploration of their own mind.     

THE PATIENT'S OBJECTS IN THE ANALYST'S MIND

In every analysis, the analyst develops an internal relationship with the patient's objects—that is, the people in the patient's life and mind. Sometimes these figures can inhabit the analyst's mind as a source of data, but at other times, the analyst may feel preoccupied with or even invaded by them. The author presents two clinical cases: one in which the seeming absence of a good object in the patient's mind made the analyst hesitate to proceed with an analysis, and another in which the patient's preoccupation with a “bad” object was shared and mirrored by the analyst's own inner preoccupation with the object. The use and experience of these two objects by the analyst are discussed with particular attention to the countertransference.     

Countertransference and changes in the conception of the psychoanalytic relationship

Abstract

The concept of countertransference has a long history in psychoanalysis. This paper sketches the phenomenon referred to by countertransference and the development of the concept, from being signs of disturbance in the analyst to an important road to knowledge about the patient's inner life. The complexity of the questions discussed today – how to understand the concepts of neutrality, abstinence, and empathy; the relative subjective mutuality and symmetry of the analytic situation; the analyst's enactments and self-disclosure of feelings – reflects the complexity of the contemporary view of the patient–analyst relationship. In conclusion, the author presents a model illustrating the disturbing and informative aspects of countertransference together with the conceptual relationship between countertransference on the one hand and empathy and projective identification on the other. Finally, by differentiating between intuitive and irrational levels of functioning, an integrated model for countertransference is presented, synthesising the essence of the concept as it is used today.     

ADAM SMITH ON THE EMERGENCE OF MORALS: A REPLY TO EUGENE HEATH

In this paper I argue that there is an affinity between Reid and Husserl, or at least between Reid and what I shall call the ‘Austrian’ Husserl as opposed to the ‘German’ Husserl. The first is a realist, the scourge of psychologism, a sober and painstaking analyst of the various kinds of intentional experience, for whom such analysis is just an extension of ontology. The second is a radical idealist, closer to Fichte than to Kant. In describing the structures of ‘transcendental’ consciousness he takes himself to be describing the ‘origin’ of the world and everything in it, including himself as a psychophysical entity. He sees the history of philosophy as being determined by an inner telos, such that it culminates in his own transcendental phenomenology, of which he is the mere instrument.     

THE ANTEROOM: A CAMERA OBSCURA FOR GRASPING ASPECTS INVISIBLE IN THE CLASSICAL SETTING

The anteroom ¹ , ² is not only an architectural space, but also a location in the field where analyst and patient meet in a different frame of mind from the therapeutic attitude that characterizes their relationship in the consulting room. Drawing a parallel with the variations in perception generated by the camera obscura in the experience of a painter, the author investigates how new aspects of the conscious and unconscious relationship between analyst and patient can emerge within a different setting. Observation of these variations suggests the possibility of regarding the setting no longer as an invariant of the field, but instead as one of the factors that can actively mold the analytic relationship.     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

Projective identification,containment and sojourn in the psyche: Clinical notes on a specific type of transference-countertransference interaction

Abstract

This paper suggests that the interplay between transference and countertransference is considered to be a valuable channel of communication. The author puts an emphasis on the containing function of the analyst. The patient strives for an experience of an object (analyst) that tolerates and copes with the patient's projections. There are some moments when analysts feel themselves to be invaded, controlled or abused by their patient's products. As Bion has postulated, this situation takes the form of a sojourn in the analyst's psyche. Clinical vignettes are given to provide support for the ways in which the analyst contains and elaborates the projections of the patients in his or her own mind and the therapeutic role that these processes have.     

The development of a dream from concrete realization to symbolic story

This paper is based on material from an analysis with a girl who was four years old at the time she started analysis. I relate how we worked with her feeling of vacillating, between invading and being invaded by the object, and how she was finally able to let go of her omnipotent control to a higher degree than before. Inspired by Hanna Segal and Donald Winnicott, I trace our progress from; (1) a denial of separation; (2) the analysand establishes a certain sense of separation by creating her own “space”. Through splitting and projective identification, she rids herself of feeling dependent and helpless, feelings that she cannot bear to acknowledge. The analyst receives, contains and names these feelings; to a stage where (3) the relationship established through the agency of projective identification is dissolved, and makes way for an ability to experience dependence as well as a recognition of the analyst as a separate person whom the analysand needs and can use.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.     

Making room: Developing reflective capacity through group analytic psychotherapy – in the analyst and in the group. Part one

Abstract

This paper is in two parts. This, the first part, traces the inter-related development of trainee group analyst and training group during the first nine months of the group's life. The influence that personal group analytic psychotherapy, supervision and theoretical learning have on the trainee are also considered in relation to the development of the group and its members, many of whom suffer from narcissistic and borderline disorders. The metaphor of ‘making room’ is used to explore the efforts of analyst and group to contain the chaotic, confused and unbounded projective identifications of its members. In this way, amidst the crowded turbulence of the group, a space begins to open up in which, slowly and painfully, the capacity for reflection may emerge.     

Two papers by Michael Fordham (d.1995)

The Journal has decided to publish a selection of previously unpublished papers from the Michael Fordham archives, which are being prepared for publication by James Astor and Elizabeth Urban, and of which the two papers published here are the first, both dating from the 1950s. 'Analyst and Priest' seems to be addressed to an audience of mainly religious people who are interested in the relation between psychology and religion and to whom Fordham is introducing some basic Jungian concepts and ways of thinking. The analyst in this lecture is the advocate of a new science, the priest an established figure with a role in society and rituals to perform. As the paper progresses he refines the differences between priest and analyst in terms of individual development versus a philosophy of life. The paper ends with a plea for co-operation between priest and analyst. 'Analyst and Scientist' was a radio talk given in 1956. In this paper Fordham makes the case for paying attention to the irrational. He draws support from Pauli and Polanyi. His theme is to show the scientific value of the subjective. From this he describes the scientific basis for Jung's comparative method and consequently of archetypal psychology.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

Reflections on knowledge and experience

As analysts become more experienced, theoretical knowledge becomes more integrated and implicit and is gradually transformed into the practical wisdom (phronesis) described by Aristotle. While this leads to greater freedom in ways of working, it remains conditional on the consistent disciplined practice represented by the analytic attitude. In the context of my own development as an analyst, I suggest that increasingly the analyst works from the self rather than the ego and link this with Fordham's account of ‘not knowing beforehand’. Some implications for boundaries, enactment and the use of personal disclosure are discussed in relation to clinical material. I compare analysis with the wisdom traditions of religious practice and suggest that analysis is concerned with a way of living rooted in humane values of compassion and benevolence.     

Impervious and intrusive: The impenetrable object in transference and countertransference

The author describes an internal object that he calls the ‘impenetrable object’ which has two characteristics: being impervious to the projections from the patient and being intrusive, i.e. projecting into the patient. It arises out of an early relationship with a mother who may be generally disturbed or traumatized so that she is unable to take in or tolerate the child's projections and may use the child as a receptacle for her own projections. He links the concept of an impenetrable object with other concepts such as Williams's ‘reversal of the container–contained relationship’ and Green's ‘dead mother’. If such an object dominates the patient's internal world, it can lead to severe difficulties in the analytic process. Interpretations may be experienced as violent projections from the analyst which the patient has to ward off and the analyst may enact an impervious or intrusive object in various ways. The author describes a case in which such dynamics played a significant role. He argues that intensive work in the countertransference is required to detect subtle enactments and allow a shift in the analyst, which in turn can enable change in the patient. He gives clinical material that demonstrates such work by the analyst and illustrates the shift from an impenetrable object to a more permeable one in the patient's internal world.     

The case of Marcello: transference and the unfolding of the analytical relationship

The analytical process of a male patient is herein described, the main focus being on the phase when the transference develops and transference projections are modified, leading to a transformation of the personality, which was previously characterized by severe obsessional defences. The specific aim of the discussion is to evaluate when and what to interpret, in relation to the importance of the transferential patterns and with regard to the role of the analyst as a container.     

Some Thoughts on Supervision

Quite often we have the experience that adolescents do not accept an offer of treatment, in spite of the fact that they feel miserable. Or, that they do start in treatment and then change their minds and break off contact. The author reflects about factors and conditions contributing to these analytic failures. He discusses elements of analytic method, setting, neutral position, analytic relationship, and how the frames are put under pressure in work with adolescents. He thereafter presents some vignettes and examples of analytic work, where intuitive interventions and interpretations appear against a background of ordinary psychoanalytic method. For the analyst, these interventions can feel unexpected, incidental, like ideas out of the blue. On second thoughts, we may sometimes be able to trace and understand how these intuitions are based on non-conscious processes, like counter-transference feelings, an understanding of the patient still unclear and unarticulated for the analyst or perhaps a last desperate attempt to reach the patient and get in contact at a decisive or critical moment. Finally, the author reflects on the double face of psychoanalysis: both a contemplated, carefully described and systematic method and a craft with elements of intuition, creativity and, sometimes, inspiration.     

A Psychoanalytically Oriented Approach as Primary and Secondary Prevention: Discussion of Joy Osofsky's “Psychoanalytically Based Treatment for Traumatized Children and Families”

Violence prevention programs can help children cope with trauma if effective strategies are developed to address youth victimization and children's exposure to domestic violence and trauma. Psychoanalysts are in a unique position to develop such primary and secondary prevention programs for children for whom violence is part of everyday life. An intense long-term relationship is an essential treatment ingredient for these profoundly troubled youngsters. In such a relationship, the therapist/analyst cannot react automatically to the inevitable hostile, destructive aggression that emerges in the treatment of severely traumatized children. A particularly key contribution by Osofsky is her discussion of the ubiquity of “countertransference every day in people who work with traumatized children.” Here I provide a clinical example of a failure that resulted from my own countertransference.