Recontact with the analyst following termination: a survey of seventy-one cases

A questionnaire was sent to graduate members of the Denver Psychoanalytic Society asking for their experience with patients making contact with them after the analysis. They reported that within three years after termination two thirds of "successfully analyzed" patients had recontacted them. Seventy-one cases were surveyed. Most contacts were brief and did not seem to be the result of incomplete analysis. Rather, they aimed to satisfy ongoing needs for: the continuing deidealization of the analyst, the reactivation of the self-analytic function, and the restructuring of self- and object representations by reporting developmentally significant accomplishments to the former analyst. The analyst's acknowledgement appears to be an integral part of the restructuring. This is work which either cannot be done before termination or the need for which has not been recognized during the analysis.     

Mourning analysis: the post-termination phase

One hundred twenty-one analytic candidates who had completed training analysis responded to a survey about their post-termination experience. Seventy-six percent of respondents experienced a mourning process that lasted on average between six months and a year, while 24 per cent experienced no discernible sense of painful loss. Twenty candidates were interviewed to obtain a deeper understanding of the mourning process that follows analysis. During the post-termination phase, the analysand's self-analytic capacity is tested in the struggle to contain and understand feelings about the loss of the analyst, as well as transference reactions triggered by that loss. After a "good-enough analysis," the analysand internalizes not only the analyst's functions and attitudes toward him or her, but also a sustaining, positive internal image of the analyst. Four cases illustrate unexpected difficulties that may emerge during the post-termination phase when the loss of the analyst is experienced as a repetition of earlier, traumatic losses or as a rupture of an unanalyzed, selfobject transference.     

On becoming a psychoanalyst

One has the opportunity and responsibility to become an analyst in one's own terms in the course of the years of practice that follow the completion of formal analytic training. The authors discuss their understanding of some of the maturational experiences that have contributed to their becoming analysts in their own terms. They believe that the most important element in the process of their maturation as analysts has been the development of the capacity to make use of what is unique and idiosyncratic to each of them; each, when at his best, conducts himself as an analyst in a way that reflects his own analytic style; his own way of being with, and talking with, his patients; his own form of the practice of psychoanalysis. The types of maturational experiences that the authors examine include situations in which they have learned to listen to themselves speak with their patients and, in so doing, begin to develop a voice of their own; experiences of growth that have occurred in the context of presenting clinical material to a consultant; making self-analytic use of their experience with their patients; creating/discovering themselves as analysts in the experience of analytic writing (with particular attention paid to the maturational experience involved in writing the current paper); and responding to a need to keep changing, to be original in their thinking and behavior as analysts.     

On psychoanalytic writing

Analytic writing constitutes a literary genre of its own. It involves the linking of an analytic idea (developed in a scholarly manner) with an analytic experience created in the medium of language. What makes this literary genre so demanding is that experience-including analytic experience-does not come to us in words. This fact generates a paradox that lies at the core of analytic writing: analytic experience (which cannot be said or written) must be transformed into 'fi ction' (an imaginative rendering of experience in words) in order to convey to the reader something of what is true to the emotional experience that the analyst had with the patient. The author discusses a clinical passage from one of his recently published papers in an effort to demonstrate some of the conscious and unconscious thinking that goes into his writing. He then looks closely at the way the language works in a successful piece of theoretical analytic writing. The paper concludes with a discussion of a number of facets of the author's experience with analytic writing including the psychological 'state of writing', which is at once a meditation and a wrestling match with language; experimenting with the form (structure) of an analytic essay; and the question of originality in analytic writing.     

Destruction reconceived: On Winnicott's ‘The Use of an Object and Relating through Identifications’

‘The Use of an Object and Relating through Identifications’ is a landmark contribution that I find very difficult to write about because so much of what lies at its core is merely suggested. It is necessary for the reader not only to read the paper, but also to write it. In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort. The author presents clinical discussions of analyses in which the analyst survives destruction and is unable to survive destruction.     

Set this house on fire: the self-analysis of Raymond Carver

The convergence of features of Raymond Carver's short-story oeuvre and of psychoanalytic methodology suggests that Carver's writing served as the fulcrum and focus of a self-analytic experience. Within this model, his stories function as container and mirror of myriad aspects of the writer's self. Tracing the developmental arc of the contextual meanings of one motif--fire--through six stories and their ur-texts demonstrates gains comparable to certain analytic goals, including enhanced integration, accountability, and self-awareness. Over time, Carver's narratives of rage, impotence, and despair give way to a new story: of mourning, forgiveness, and the rekindling of hope.     

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.     

Monsters,dreams and madness: Commentary on ‘The arms of the chimeras’

Considering Freudian and Post‐Freudian approaches to the intersubjective Beatrice Ithier puts the work of Michel de M'Uzan and Thomas Ogden in comparison. To this comparison I add a consideration of the work of Christopher Bollas. The highly creative clinical approaches these three theorists take is shown to be informed by their elaborations of the Freudian notion of unconscious communication and by new approaches to the issue of identity. Attention is paid to differentiating traumatic from fanciful chimeras; and to the experience of the analyst undergoing the sorts of transformations requisite to entering this psychic space marked by fluid exchanges of being and becoming, wherein analyst becomes patient, new subjects are created through shared dreams, and through which monsters appear.     

Narrative Writing and Soulful Metaphors Commentary on Paper by Barbara Pizer

The author posits that Pizer's use of both narrative and lyrical style is not typical in psychoanalysis, whose scholarly tradition tends to favor a denser, more academic style of writing. The ways in which psychoanalysts read these two forms of writing are mirrors of one another. Both kinds of reading are forms of discipline; both forms of writing are necessary in psychoanalysis. The author also writes that Pizer's “nonanalytic third” does not have to be a “good” thing like a poem; it can be almost anything important to the analyst. The nonanalytic third is a soulful metaphor that can be used to create alternatives to rigid experience. Because rigidity in psychoanalytic relatedness is usually the result of problematic unconscious involvements between analyst and patient, the nonanalytic third can be significant in the negotiation of enactments.     

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.     

Talking about medication

With the increasing use of psychotropic medication concomitant with psychoanalysis, attention must be given to the challenges created by complaints of medication side effects. When confronted with these side effects, analysts may experience specific, uniquely actualized countertransference anxieties that can prompt the abandonment of transference analysis. Particular countertransference fantasies that arise in combined treatments are examined, as are the reasons for the analyst's suspension of curiosity and openness and its clinical consequences. In these situations, effective analysis requires the analyst to be "bilingual," to hold in mind both the analytic and the pharmacological model.     

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.     

Obstacles facing the psychoanalyst when interpreting narcissistic pathologies: Characteristics of the authoritarian patient

This paper explores the unconscious agreements between patient and analyst that promote some aspects of conflict to be excluded from the content of the interpretations. This generates an experience of exerting omnipotent control over the analyst, which subsequently consolidates a narcissistic phantasy. A stagnation of the analytic process is established in the course of the analysis but this remains hidden by areas of partial progress in the patient. Clinical material is provided in order to show the vicissitudes of the interrelationship between patient and analyst. It also demonstrates the working through by the analyst of a situation of both transferential and countertransferential conflict. This leads to an inhibition on the part of the analyst in his interpreting function. The use of projective identifications, which are mutually contradictory and incompatible, is also under discussion. This, as a result of being expressed simultaneously, constitutes a paradox, which may lead the analyst to confusion and an experience of paralysis. The subsequent confusional anxieties are considered. Additionally, authoritarianism is discussed, including its attendant difficulties of establishing boundaries between the self and the object. Finally, under consideration is the risk one takes in formulating authoritarian interpretations, which, in certain cases, can impose criteria on the patient.     

Power cut in the countertransference

This paper is an attempt to describe and understand a certain type of defence that I shall call a 'power cut' because of its crippling and anti-relational nature. I will take extracts from a baby observation to show how this type of defence can be adopted from the beginning of life, followed by vignettes from my work with a young child and an adult patient which addresses the particular kind of difficulty the analyst has to face with patients who resort to such a defence. I am arguing that while defending from another, the patient is able to destabilize not only the connection between himself and this other, the analyst, but also that between the analyst and the analyst's internal world. I understand this as the violent re-enactment of the patient's uncontained and split off primitive experience. I see recovery from 'power cuts' as the main challenge for the analyst who is helping the patient to recover from an early failure in containment which has led to defective splitting. Only when the unthinkable experience of 'power cut' can become an experience that can be lived through and converted into a deintegrate, may integration be achieved.     

Narratives at work: the development of career identity

Well-developed career stories are becoming increasingly important for individuals as they navigate an unstable and unpredictable labour market. Existing narrative approaches in career guidance do not yet clearly identify the learning process by which career stories are created. In this article, a model of transformation-through-writing will be introduced to help explain the learning process that occurs when narratives are used for constructing career stories. We propose that this learning process occurs stepwise in four cognitive stages: sensing, sifting, focusing, and understanding. To progress through these stages, an internal (with oneself) as well as an external (with relevant others) dialogue is needed. The case study used to illustrate the process is a story of unemployment and effectively shows how narratives can be created through expressive and reflective writing and how such a process may foster career learning in response to a boundary experience.     

Full and empty spaces in the analytic process2

In this paper the author discusses two categories of patients which differ in terms of the impact they have in the countertransference. On the one hand, there are patients who create an empty space in the analyst's mind. The response they provoke is a kind of depressive feeling that remains after they leave. The patient may bring dreams and associations, but they do not reverberate in the analyst's mind. The experience is of dryness, a dearth of memory, which may‐at times‐leave the analyst with a sense of exclusion from the patient's internal world. At the other extreme, there are patients who fill the consulting room. They do that with their words, dreams and associations but also with their emotions and their actions. The experience is that the analyst is over‐included in the patient's world. They have dreams that directly refer to the analyst and the analyst feels consistently involved in the patient's analysis. The pathway through which the analyst can understand both these types of patients is via the countertransference or, to put it another way, the analyst's passion. In ‘Analysis terminable and interminable’ Freud suggested that the bedrock of any analysis is the repudiation of femininity. The author believes this statement may be viewed as lying at the crossroads of the discussion about the limits of the theoretical and clinical psychoanalytic formulations which she refers to. In the examples presented the author relates the repudiation of femininity in its connections to the gaps implicit in psychoanalytic understanding.     

Making Music Together: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Finding life in our patients is a common goal for analysts. Historically this project had been defined as one of freeing unacceptable impulses from their imprisoning defenses with the analyst, via interpretation, then contrasting the patient’s internal fantasied reality with “actual” reality. Untangling fantasy from reality could free the impulses to provide energy for more realistic projects. This imagery stands in stark contrast to the fluidity of a contemporary relational conceptualization of human experience where our inner experience is now understood to be the lens through which we construct our vision of external reality, always a subjective perception. Clinical change—finding life—now depends more on the activation of a generative intersubjective process between patient and analyst, which contributes to the expansion of the patient’s subjective experience. Gianni Nebbiosi’s use of music and of mime to help him feel his way into his patient’s and ultimately into his own similarly defended experience demonstrates the creativity and idiosyncratic clinical approaches that emerge from a contemporary relational orientation. This orientation recognizes the analyst’s subjectivity as a fundamental tool of clinical change—a vehicle through which any theoretical approach will necessarily be shaped. Differing approaches to a clinical situation do not always simply reflect theoretical disagreements; they may also reflect the expression of the particular subjectivity of the analyst.