Now Streaming: On Unconscious Communications in the Analytic Process

ABSTRACT

In this article, I illustrate the concept of unconscious communication by means of a clinical example in which a patient was able to recover the memory of a key adolescence experience as the result of the interplay of unconscious messages transmitted between himself and his analyst. When the patient spotted the analyst driving an old, beat-up family car, this triggered an unconscious memory of this painful adolescent episode, one that epitomized and stood for his troubled and disappointing relationship with his father. This memory, which was expressed nonverbally, in turn, evoked a memory in the analyst from his own adolescence that put him in touch with the patient‘s traumatic, adolescent experience, material that had come up previously in the analysis but had not been adequately dealt with or worked through. By grasping the meaning of the interplay of these unconscious messages, the analyst was able to help the patient get in touch with, better understand, and work through, an experience that had an enduring impact on his future life.     

Therapeutic action in psychoanalytic therapy with toddlers and parents

Psychotherapy with toddlers and parents can focus on promoting attachment, facilitating development and improving interactions. Some techniques provide guidance to the parents, whereas others interpret to them their unconscious fantasies or ‘ghosts’ contributing to the child’s disorder. A recent paper introduced a psychoanalytically oriented technique, which emphasised the therapist’s interaction with the child in the presence of the parent(s). The child was addressed about his/her unconscious motivations in the session and the feelings towards the therapist. Also, the parent’s transference onto the therapist was seen as a vehicle that might further the therapeutic process and was accordingly addressed. The present paper analyses the therapeutic action in such treatments. Whereas work with the parents resembles that of ordinary psychodynamic therapy, therapeutic action is more difficult to conceptualise regarding the toddler, whose understanding of verbal interpretations and the therapist’s dialogues with the parent is more limited than that of an adult. However, a clinical vignette demonstrates a toddler’s precise and swift reactions to communications from mother or therapist. The paper investigates evidence from neuroscience and psychological research as to which communicative channels – beyond words – toddlers might perceive and comprehend. In addition, it is claimed that the countertransference is key to explaining how the therapist understands such communication.     

Architecture and psychoanalysis. Nathaniel Kahn and the search for the father

Abstract

This text is intended as a contribution to the study of the profound mutual relations between architecture and psychoanalysis. Architecture creates representations that conceal unconscious forms of thought; psychoanalysis helps to explain the meanings of these representations – forms of construction and forms of the psyche. The multifaceted work of psychoanalyst Christopher Bollas – his thoughts on the relationships between psychoanalysis and architecture, on the vitality of objects, on the creative implications of the Oedipal relationship – serves as a critical and decisive instrument for the authors’ inquiry. The issue of the “vitality of objects” as described by Bollas also concerns – but only in part – the architectural “object.” One modern form of architecture with an inordinate capacity empathy has to be Louis Kahn’s. Kahn’s youngest son , Nathaniel, lost his father when he was still a child and hardly had a chance to get to know him. After becoming an adult and an established film-maker, he managed to recover his father in two ways: by discovering him in his works, with their powerful affective impact; and by drawing from those very works of his father to enhance his own creative process in his filmic art. As it turns out, it is this very process that has allowed for an emblematically positive resolution of the Oedipal relationship.     

The day the earth stood still: The presence of trauma in time experience

The experience of time is commonly perceived as developing within the context of the early relationship between mother and infant. The beginning of life occurs in an adapted environment, aimed to protect the child from internal and external disruptions. Through healthy development, the mind acquires a feeling of continuity that gradually becomes a cohesive sense of personal identity. However, in cases of traumatic interruptions to the primary environment, the defensive shield of the self is penetrated and the individual becomes prematurely aware and adapted to the external reality. This forced acknowledgement of time and reality could be manifested in various types of time disturbances, such as disorientation about time or difficulties in following a schedule. In therapeutic relationships, this drama would be enacted in a struggle against the psychoanalytic setting, which disrupts the continuity of being with the therapist. Importantly, these patients express a deep conscious or unconscious fantasy to live in a timeless world, in which they would not be forced to adapt themselves to others’ expectations or needs. Clinical examples are used to illustrate how traumatic history is evident in the patient’s time experience and in the psychoanalytic dialogue.     

The Impact of a Child’s Cancer on the Father’s Relationship with His Spouse in Korea

A father of a child with cancer experiences psychological stress related to his child’s cancer diagnosis and treatment, which may affect his relationship with his spouse. Nevertheless, little attention has been paid to how having a child with cancer affects the marital relationship from the perspective of the father. We examined the impact of the child’s cancer on the father’s relationship with his spouse in Korea. We conducted in-depth interviews with 20 fathers (mean age?=?41.35 years; SD?=?4.49) of children who were diagnosed with cancer before the age of 19 and were within 5 years of the diagnosis. The mean age of the child with cancer was 9.1 years (SD?=?3.68), and the mean age at diagnosis was 6.4 years (SD?=?4.08). The analysis of the interviews revealed the following four themes (and eight subthemes): conflicts between spouses (lack of father’s participation in caregiving, financial and work-related stress), mental suffering (heartbroken, torn between caregiving and work), change in communication (child-focused communication, avoiding communication), and change in the marital relationship (neglected relationship, new trust built in the relationship). A father’s increased conflict in the marital relationship after his child’s diagnosis of cancer was intensified by his limited involvement in child care and parenting responsibilities. An understanding of the change in the father’s relationship with his spouse can inform the development of a psychosocial intervention that may strengthen a father’s emotional intelligence and resilience, which could improve the marital relationship.     

What do psychodynamic therapists make of their reveries in the therapeutic encounter? A constructivist grounded theory study

ABSTRACT

The therapist’s mind can wander to daydreams, fantasies and preoccupations: mental events termed “reveries” in this study. As therapists attend to the current of their thought in the therapeutic encounter, the question of how to approach their reveries can arise. This qualitative study used semi-structured interviews with nine qualified psychodynamic therapists to investigate therapists’ attitudes to reveries. The research design and analysis followed the principles of Charmaz’s [Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London: Sage] constructivist grounded theory. Results showed that therapists experienced diverse reveries sometimes felt to yield deeper clinical understanding. Reveries were also seen to have a “freeing-up” function for the therapist and patient, and to require mental freedom to operate. Implications for theoretical understanding and recommendations for clinical technique are discussed.     

‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum

Children with autism can have a paralysing effect on the clinician’s capacity to associate freely: connections that seem obvious on reflection may be impossible to notice in the child’s presence. The author argues that this situation can be reached by more than one pathway, and that the degree of the child’s bodily and emotional cohesion is an important factor. Children may seek to immobilise the therapist’s thought processes through projective identification, whether to communicate their own experience of paralysis or because these thought processes are equated with a parental intercourse that produces a ‘baby’ (as described by Bion and Britton). Vignettes are offered to illustrate how the therapist may be nudged into overlooking this baby as well as a potentially growing part of the child that is identified with it, with important consequences for development. A second possible pathway appears to involve the much more primitive mechanism of adhesive identification, in which the child’s sense of continuing existence depends on sticking to the therapist’s surface and any movement can lead to a sense of bodily disintegration. In the clinical illustration, the therapist felt physically constrained and unable to recognise links in the material: it is suggested that this was in resonance with the child’s fear that movement, whether physical or mental, meant losing parts of his body and must be avoided at all costs. These levels can mask each other, and it seems essential to attend to both in order to avoid impasse or the overlooking of essential aspects of the child’s experience.     

Surviving Deadness in the Analytic Experience

The transference/countertransference (third space) analysis is considered to be central in the therapeutic effectiveness of the analytic process. Less emphasis has been placed on the actual experiences of analyst and analysand in the conflictual reenactment of third space experience and its resolution. This paper recounts the shared experience of a patient who was silent throughout most of the analysis, and my reaction, in fantasy and enactment, to this disturbing experience—both for him and for myself. I argue that it is the affective re-experiencing of past repressed trauma in the analytic space that has a therapeutic impact, leading to growth in the patient and also the therapist. I contrast Freud’s emphasis on insight, making the unconscious conscious, with Ferenczi’s suggestion that the therapeutic impact lies in the repetition of past traumatic experience in the analysis but with the possibility of a different outcome with a more benign object, leading to symbolic representation of repressed trauma. Re-experiencing and symbolization, in the third space, of past traumatic experience can be an exit point from the endless repetition of trauma in internal and external object relations, leading to a new beginning in the patient’s life. Immersed in the experience of deadness in the analysis, which had become a dead womb, the struggle to remain alive and thinking led to a rupture out of the dead womb, like the Caesura of birth, into aliveness and the ability to mentalize what had previously remained unmentalized.     

The making of an abuser

This paper investigates how it is that a child has become an abuser, and by what means that process may be deconstructed. We know that abusers generally have a childhood history of abuse, though not necessarily sexual. Since not all children who have been traumatised repeat those patterns, and inflict abuse on others, then something must have happened for these particular children in response to their abuse. The author elaborates the view that there is no such thing, to paraphrase Winnicott, as ‘an abused child’ – no such child, that is, separate from the world of the relationships that formed him. He draws on the conceptualisation by Bentovim of an interlocking set of roles described as a ‘trauma organised system’; this notion reflects the fact that the child is a product not just of his specifically traumatic experiences but of a milieu in which power and control is exerted by someone who has typically succeeded in neutralising any caring function in a family in order to bring about the exploitation of a child. Clinical material is presented from the intensive psychotherapy of a nine-year-old boy, who happened also to be a refugee, for whom abusive family dynamics dominated his internal world. He was found to have identified with the abuser, his own father, in order to escape the pain of his victim self and was threatening to act this out in the treatment, making the therapist into a victim. Management of the treatment setting by the inclusion of a benign parental figure enabled the acting out to be contained. Symbolisation of the child’s inner conflicts became possible through play. As the abuser self was contained so the child’s victim experiences could be processed. The conclusion is drawn that engaging therapeutically with the residues of trauma from the beginning of treatment is essential in working with young people who have abused.     

Écouter les pères,leur ménager une place,une mesure de prévention pour le devenir de l’enfant handicapé et de ses proches

The authors show how the help systems available to disabled children’s parents leave too little space to fathers, sometimes thus leading mother-allied professionals to hinder the fathers in their child-affiliating process. At first, the authors deal with the father’s specific position in the construction of a bond with his child, which questions him as for his position as a man, a lover, a son and a citizen. Then they refer to the way in which a father may be affected by his child’s birth as well as to the part that his wife, the care givers and the child itself may play to transform these sufferings and pave the way for constructing a father–child bond.     

A Child Therapist at Work: Playing,Talking, and the Therapist’s Inner Dialogue

The author reflects on his work with a child patient struggling with affect regulation, loss, and his adoption through a detailed process account of the treatment with a focus on the therapist’s inner dialogue in relation to the child’s play and words—how each affects the other. Drawing from his personal use of clinical theory stemming from multiple theoretical influences, the author shows how his associations, identifications, and tentative formulations inform his work and how the various transference/countertransference matrices influence his inner dialogue. Attention is paid to the movement from the therapist as an object within the patient’s closed system to a system that gradually becomes more open, in which the patient is able to take in the therapist’s own person as they come upon various ways to communicate and build a narrative together.     

René Magritte: coping with loss--reality and illusion

René Magritte was profoundly influenced in his painterly style and in the content of many of his paintings by his mother's suicide when he was fourteen. This paper explores the influence of this traumatic event on his work. My thesis is that the nighttime suicide of Magritte's mother by drowning: (1) had a profound impact on the form and style of his paintings; (2) his paintings represented an effort, mostly successful, to contain and master through intellectual control with isolation of affect the trauma of this experience, which must at the time have evoked helplessness and despair; (3) the contents of a series of his paintings directly reconstruct the traumatic experience under control and in the service of mastery; and (4) there are paintings, mostly painted at the time he clearly developed his own style (1926-1930), that reveal a breakthrough of projected primitive aggressive impulses and unconscious representations of the aggressive mother. In these latter paintings, both form and content are dramatically different from the main corpus of Magritte's work.     

Reflections on coma: Man deprived of his consciousness

In this paper the authors reflect on the phenomena produced by the surprising communication between the unconscious of a therapist and that of a comatose patient. In a particularly disturbing context, when the patient’s sternum is open and exposed, the therapist communicates empathically with the comatose person, identifying the patient’s inexpressible experience and generating signs of a response from him in the form of the blinking of his eyelids. The absence of any reaction to pain, a pathognomonic sign of the comatose condition, could be related to the splitting‐off of the trauma, as if the situation were frozen, through a denial of the sensory and neurological perception of pain – a kind of self‐anaesthesia as a defence against the catastrophic anxieties raised by the threat of the return of the primary trauma. Starting from this encounter a relationship is formed whose guiding thread emerges in the shared illusion of a regression that makes it possible. It involves a process of returning to the past and a re‐actualization of the past that includes the question of its change through representation.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

Ordinary Unconscious Communication in the Therapist/Patient Relationship

ABSTRACT

In this article, I consider the ways in which unconscious communication between therapist and patient is omnipresent in psychoanalytic work. To consider unconscious communication between therapist and patient is to consider psychoanalysis, at its core. The phenomenon of unconscious communication between patient and therapist is a quotidian event. It defines its essential listening stance, with variations associated with different theoretical perspectives. I present several clinical vignettes to illustrate the phenomenon and consider some different theoretical perspectives that bear on the therapist’s uses of self in engaging the ways that one unconscious informs another.     

Some Psychological Reflections on the Death of Malcolm Melville*

ABSTRACT: Malcolm Melville died on September 12, 1867, at age 18 from—to quote his death certificate—a “pistol shot wound in [his] right temporal region.” Contemporary designations of the mode of his death changed within hours from suicide, to accident, to death while of unsound mind. Historically, the mode of his death has remained equivocal. In order to approach this enigma a “psychological autopsy” of an equivocal death case as identical to Malcolm Melville's as was possible was conducted as though it were a genuine current “open” case at the Los Angeles Suicide Prevention Center in 1973. That procedure resulted in a near-unanimous judgment by the center staff that the most accurate certification of the death as described was “probable suicide,” which would then be certified as “suicide.” In this paper the assertion is made that Herman Melville himself had been a psychologically “battered child” and, in a way typical for battered children, psychologically battered his own children when it came his turn to be a parent. The further assertion is made that, for Malcolm, his father was suicidogenic; and established this penchant in Malcolm (through his neglect, active rejection, fearsomeness, and his fixed attention to his own writing—Redburn, White Jacke, and Moby Dick) within the first 2 years of Malcolm's life. For Malcolm, the psychological basis of his suicidal state was isolated desperation—a ubiquitous characteristic of most suicides. Malcolm had a deep unconscious feeling of not being wanted by his father; that it would be better if he were out of the way, dead. On the morning of his death, the choice for Malcolm was between the memory of his mother's kiss a few hours before and the terror of (and the need to protect himself against) his father's rage to come.     

Tyler in the Labyrinth: A Young Child’s Journey from Chaos to Coherence

This paper describes the treatment of a young boy who was abused and neglected in infancy. It examines the challenges of working in the intimate territory of early trauma when a child is too fragmented to play. The therapist supported affect regulation to help the child experience a coherent sense of himself. As the boy became more integrated and related, the opening of transitional space became possible, and with it, the emergence of creativity. His growing capacity to play and his discovery of the rich utility of stories are discussed. A children’s book of Greek myths, in particular, the story of the Minotaur and the Labyrinth, held special meaning for him, and for the therapist too. As the child became increasingly related and symbolic, he eventually began to tell his own extraordinary story.     

One form of self-analysis

Beginning with Freud, psychoanalysts have discovered media through which they may achieve a self-analytic experience (for example, by use of dreams, fantasies, reveries, memories, and even visual images). Each of these media is a kind of "fiction" created by the analyst that provides an imaginative space where he or she may gain access to unconscious life. The author demonstrates how a generative self-analytic experience may be accomplished through the medium of psychoanalytic writing: a fictional autobiographical form of writing through which a self-analytic experience is created that has much in common with the analytic experience created by the analyst and analysand.     

Intersubjectively oriented,time-limited psychotherapy with children: how does the therapist evaluate the therapeutic process and what are the therapist’s tasks?

Based on the therapist’s evaluations of three therapies, this research aims to study the therapeutic process in intersubjectively oriented, time-limited psychotherapy with children. A primary objective is to further develop the therapy method. The study comprises therapies with children 6–11 years of age, who had experienced difficult family situations. Each child received 12 therapy sessions. The number of therapy sessions with children and parents was agreed upon beforehand, and the therapeutic objectives were approved by the parents. Each of the therapy processes were evaluated by the therapist by answering three questions and filling in three forms after each therapy session. The forms were: The Feeling Word Checklist; an alliance form for the child; and a process form. The therapeutic alliance and the behaviour of the therapist during the therapy sessions are discussed on the basis of the total material. The following main tasks for the child therapist emerged: structuring the therapy sessions; following the child’s initiatives; participating and cooperating with the child; exploring the child’s expressions; and understanding and regulating emotions.     

Telling a traumatic story through Art: Arshile Gorky’s ‘The Artist and his Mother’

For more than a decade, through re-working a composition based on a sepia photograph, Arshile Gorky (ca. 1904–1948) tried to give form and represent that which by definition defies forms and shatters one’s capacity for representation. Having witnessed the systematic ethnic cleansing of his people as a child, Gorky began a ‘journey’ in his attempt to comprehend his traumatic ordeal through Art. In 1926, with the safety of a constructed name and life, the artist started working on ‘The Artist and his Mother’ series. Focusing on the two versions of Gorky’s early painting and using relevant aspects of psychoanalytic theory, the paper explores his work through a psychoanalytic lens. Psychoanalytic theories on extreme traumatisation along with psychoanalytic notions of temporality will be utilised in an attempt to follow the artist’s struggle to re-create and rework aspects of his traumatic history.