CHEMISTRY AND CONTAINING: THE ANALYST'S USE OF UNAVOIDABLE FAILURES

Certain patients overwhelm the analyst's capacity to contain both the patient and the analyst's own unbearable feelings. Though some such failures of containing may lead fairly quickly to self‐correction and others to clinical impasse, our focus is on an in‐between state in which the analyst's ability to tolerate his inevitable failures and gradually to (re)establish his containing capacities through difficult self‐analytic work can lead to significant change that might not otherwise be possible. The authors argue that this internal psychological work on the analyst's part, which may require considerable time, effort, and suffering, is an important aspect of “good enough” containing. The unique chemistry generated between patient and analyst plays an important role in both establishing and maintaining this kind of productive analytic process.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

Talking With Chameleons: The Role of Language-Games and Setting: Commentary on Paper by Dana Amir

In this paper I take up Dana Amir's concept of the “chameleon language” of perversion considering Wittgenstein's idea of the language-game and the necessity of taking up the context of communication. The setting of psychoanalysis represents a new context for the language of perversion, one that at first implicitly and later explicitly recognizes the bid for tenderness beneath the stealth. I suggest it is the analyst's willingness to risk vulnerability in this game, as much as the interpretation of perverse pacts, that fosters clinical change.     

Cross-Continental Divides Regarding Survival,Play, and Enactment: Reply to Commentaries by Keene,Ilahi, and Coen

The author distinguishes between the ways that the Independent Group and Relational Theorists conceptualize object survival, play, enactment, and mutuality. American relational theory is simultaneously focused on both the patient's and analyst's experience and the patient's inner representational world. Interaction is informed by and informs our understanding of the patient's conflicts including forms of enactment. In contrast, analysts from the Independent Group tend to view the American interest in interpersonal phenomena and perceptual dimensions of the patient's experience as a distraction from unconscious representations. For relational analysts in the United States, maternal functions of reverie emphasized by the Independent Group are seen as one dimension of the analyst's complex subjectivity, which may be used in containment and interpretation. For relationally oriented analysts containment itself is postulated as to some degree porous unlike the notion of analytic functions of reverie emphasized by the Independent Group. The author tries to focus on these points of divergence and overlap between the two theoretical orientations and their application to case material.     

Meditations on Aggression,Loss, Discovery,and Influence in Psychoanalysis

Psychoanalysis requires acts of creative destruction. At the same time that analysts create new ways of being for themselves and each other, old ways are consequently destroyed. Just as parents envision futures for their children, analysts envision futures for their patients, reflecting a desire or effort to change them. Awareness of the destruction inherent in facilitating growth can enrich an analyst's work, but anxiety about being destructive, and being destroyed, can stifle it. This paper presents an analyst's reflections on creative and destructive aspects of psychoanalysis. Autobiographical and clinical data are presented to illuminate this theme.     

Dissociation,the Analyst's Vulnerability,and the Body: Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

This review praises Bromberg's rich and evocative new book for its clinical and theoretical usefulness and elaborates on three broad themes: the analyst's personal role in traumatic enactments, dissociative/addictive uses of the body, and the distinction between life-threatening and developmental trauma. Extending Bromberg's formulations, the author argues that in successful work with trauma survivors, the analyst must be actually (temporarily) traumatized as actual, personal vulnerabilities of the analyst are necessarily engaged. The analyst's vulnerability serves as an internal contact point, opening up a process of unconscious empathy with the patient and providing crucial validation of the patient's experience. The review also explores how bodily processes are used to further dissociation with eating disordered patients and how they become the source of treatment difficulties. When the patient's states of desire have been “detoured” into the body (where they are ruthlessly controlled or attacked) as well as into the relationship with food (where they are temporarily gratified), they are not as available to be mobilized in the analytic relationship. The review also questions Bromberg's assumption that the underlying dissociative mechanisms are the same for life-threatening trauma (or Posttraumatic Stress Disorder) and developmental (or relational) trauma.     

Some Questions About Divergences and Similarities Between Kleinian and Intersubjective Approaches: Reply to Commentaries

In this response I focus on some key issues raised by the different approaches of Kleinian and intersubjective clinicians. In particular, I raise questions about how the analyst's subjectivity is to be understood, given that the analyst needs to offer something that is over and above her pure subjective reaction. I also discuss projective identification and its implications for understanding the analyst's subjectivity.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Analytic Idealizations and the Disavowed: Winnicott,His Patients,and Us

This paper explores the dynamics of mutual idealization within the analytic dyad. While the subject of idealization is not a new one, very little has been written about the analyst's own participation in patients' idealizations or her vulnerability to idealizing the patient. I use both published and unpublished materials to muse about coconstructed idealizations as they appear to have coalesced in Winnicott's treatment of Masud Khan and Harry Guntrip. Because the notion that we might be involved in being idealized by our patients—or in idealizing them—collides with our professional vision, we tend to be highly resistant to acknowledging these dynamics and often turn to denigration when they are unmasked. I argue for the ubiquity of idealization's dynamics and against the demonization of Winnicott.     

Commentary on Paper by Hilary Hoge

In this discussion the author raises the question of the analyst's freedom to sustain paradoxical viewpoints, specifically with regard to dream interpretation and related links to internal objects and the self as they appear in the transference. Paradox allows for the creation of multiple, coexisting meanings that can be played with by patient and analyst. Paradox also makes possible an experience of decentering and destabilization pursuant to Bion's catastrophic change. The risk inherent in the emotional experience of catastrophic change may limit and at times foreclose both patient's and analyst's freedom to tolerate and sustain the effects of paradox.     

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.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

Self‐analysis and the development of an interpretation

In spite of the fact that Freud's self‐analysis was at the centre of so many of his discoveries, self‐analysis remains a complex, controversial and elusive exercise. While self‐analysis is often seen as emerging at the end of an analysis and then used as a criteria in assessing the suitability for termination, I try to attend to the patient's resistance to self‐analysis throughout an analysis. I take the view that the development of the patient's capacity for self‐analysis within the analytic session contributes to the patient's growth and their creative and independent thinking during the analysis, which prepares him or her for a fuller life after the formal analysis ends. The model I will present is based on an over lapping of the patient's and the analyst's self‐analysis, with recognition and use of the analyst's counter‐transference. My focus is on the analyst's self‐analysis that is in response to a particular crisis of not knowing, which results in feeling intellectually and emotionally stuck. This paper is not a case study, but a brief look at the process I went through to arrive at a particular interpretation with a particular patient during a particular session. I will concentrate on resistances in which both patient and analyst initially rely upon what is consciously known.     

Self psychology and projective identification—whither shall they meet? a reply to the editors (1995)

The concept of projective identification continues to be viewed as alien, even dangerous, by self psychologists. Six aspects of self‐psychology/intersubjectivity theory are explored in an attempt to understand the presumed incompatibility of self psychology and projective identification: 1) the empathic vantage point; 2) the focus on subjective reality; 3) the emphasis on the analyst's personal contribution; 4) the focus on selfobject experience; 5) the disruption—restoration process; and 6) the defining of transference and countertransference as “organizing activity.”; The self‐psychological/intersubjective concepts that come closest to describing the phenomenon of projective identification—that is, empathic immersion, affect resonance, and reciprocal mutual influence—fail to capture at least three of its essential elements 1) the patient's persistent, unconscious intent to communicate certain unformulated aspects of self through the other; 2) the analyst's sense of being “taken over”; by the patient's experience; and 3) the intensely visceral quality of the analyst's experience. It is argued that self psychology ignores this important form of patient communication to its own detriment and that the concept of projective identification needs to be reformulated in terms that are more experience near to self psychologists. It is suggested that there exists a normal, developmental need, a selfobject need, to communicate intolerable, unsymbolized affective experience through the other's experience—a need that remains more pervasive and intense in some of us than in others—and that the longed‐for selfobject response is to have one's communication received, contained, and given back in such a way that one knows the other has “gotten”; it from the inside out.     

Bakhtin and Winnicott on dialogue,self, and cure

This paper develops a Bakhtinian dialogical perspective on the psychoanalytic discourse in general and on the concepts of true and false selves (Winnicott, 1960b) in particular. Bakhtin's assumptions about the origins of dialogicality in children's development are compared to Winnicott's ideas about the origins of true‐ and false‐self processes. This comparison leads to a characterization of the false and true selves as different genres of the narrated self—the epic and the novel—each with its specific configurations of experience and temporality. Moreover, psychoanalysis is conceived as a unique phenomenon that centers on the internal and most of the time simultaneous dialogues that take place in each of the two participants. This perspective underscores the impact of the analyst's subjectivity on the analytic process as well as the multiplicity of the patient's and the analyst's selves. In this context, therapeutic change can be seen most of the time as a transformation of genre and not necessarily as a modification of contents. Free association allows for the transgression of the basic rules of narrativity, thus facilitating a generic shift. A dialogical relation between the openness of free association and narrativity's coherence is suggested.

Life by its very nature is dialogic. To live means to participate in dialogue [Bakhtin, 1963, p. 293].

A word like “self”; naturally knows more than we do [Winnicott, 1960a, p. 158].     

The Dignity of Creating: The Patient's Contribution to the “Reachable Enough” Analyst

Through the defining power of words, the phrase “difficult-to-reach” patient reflects the extent to which the analyst inverts the patient's will to change and makes the analyst the subjective agent of treatment progress. If making a constructive contribution to another person's life engenders a sense of creative agency, the traditional dichotomies of analyst/helper who gives and an empty patient who receives may not be useful. I trace the evolution of a 23-year-long psychotherapy from a parent–child dynamic through to more uncertain relational terrain in order to illustrate how the analyst's own evolution may have clashed with the patient's ambivalence toward change and endings. I raise questions of how the dignity of making a creative contribution to the “reachable enough” analyst's life may enable the patient to work through gratitude, attain a sense of belonging, and terminate with good conscience.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Coming to Terms With Invisible Disability—Beyond Empathic Resonance: Commentary on Paper by Lauren Levine

For the clinician as for any parent, having a child with cognitive disabilities heightens one's sense of vulnerability and insufficiency. One is confronted with unbearably intractable limits, which generates doubt about one's therapeutic potential. The ability to empathize with a parent's distress is crucial, but only the starting point in treating a patient whose child is disabled. What may be most constructive is the dialectic between the analyst's relative detachment (involving compassion but also a willingness to dredge up disavowed negative feeling) and the parent's attached dismay. Lacanian and existentialist theories remind us that, whether normal or handicapped, we are all existentially in a state of lack. This perspective provides a useful touchstone for analyzing the experience of disability in one's own life and that of one's patients.

In further response to Lauren Levine's paper, it is argued that it is tricky to prove (beyond showing that a training analysis promotes maturation in the broadest sense) that a given aspect of an analyst's own personal analysis resulted in the capacity to heal a particular patient. The point can be made most persuasively when the actual analytic exchange, messy and circuitous as it may be, is offered in great detail.     

A mismatch of meaning and intentionality between analyst and analysand

In this paper, I will consider a type of misunderstanding in the analytical dialogue and the possible unconscious motivations underlying this. I will also make reference to the patient's use of the analyst's words for the purpose of narcissistic enactment and will explore the extent of the analyst's involvement in this. The subjects of misunderstanding and narcissistic enactment will be dealt with in relation to a patient's way of processing certain interpretations at the beginning of analysis and the concealment of her way of processing the analyst's words. By contributing dreams and other significant material in the sessions, the patient gradually revealed her phantasies which enabled the analyst to uncover the possible factors which determined her particular attribution of meaning to the analyst's words and her retention of information about how she had initially construed his interpretations.