The analyst's body as tuning fork: embodied resonance in countertransference

Abstract: This paper examines the phenomenon of embodied countertransference: where the analyst experiences a somatic reaction rather than the more common countertransference responses of thoughts, feelings, images, fantasies and dreams. Discussion of clinical material considers neurotic and syntonic aspects. The analogy is made of resonance with a tuning fork. Several questions are posed: Why does countertransference resonate in the bodies of some analysts but not all? Why do those analysts who are sensitive to this, experience it with some patients but not with others? And what are the conditions which are conducive to producing somatic responses? It proposes that somatic reactions are more likely to occur when a number of conditions come together: when working with patients exhibiting borderline, psychotic or severe narcissistic elements; where there has been early severe childhood trauma; and where there is fear of expressing strong emotions directly. In addition another theoretical factor is proposed, namely the typology of the analyst.     

The patient's part in analytic process: the influence of the analyst's expectations.

The psychoanalyst's expectations of the patient are complex and crucial to the work of analysis. These expectations, operating at a level generally outside the consciousness of patient and analyst, are part of the "microstructure" of analysis, the interactional give-and-take that brings about change. The view taken here is that analytic process is necessarily interactive, as well as intrapsychic. In addition to transference-countertransference motivations, both parties to an analysis operate in a social context that prescribes a range of desired and undesired behavior. The analyst brings to the interaction professional analytic attitudes about how to listen and act, and a set of expectations of the patient. These attitudes and expectations modulate subjective reactions to the patient's transferentially driven actions, and influence the expression of countertransference. The mutative process of psychoanalysis involves the action of these attitudes and expectations on the patient, both in ways specific to individuals and in more general ways. Such expectations lie behind analytic tactics and, though not often written of, are part of the oral tradition of psychoanalysis. Here the expected patient role is described in terms of five bipolar continua: (1) reporting and editing; (2) transferring and containing; (3) thinking about oneself and thinking about the analyst; (4) regressing and listening/self-observing; (5) initiating trial action and mediating among inner states. The activity and thinking of the dyad move constantly along these continua. A clinical example from the beginning of an hour illustrates how these expectancies emerge in analytic work.     

A patient's transference to the analyst's supervisor: effect of the setting on the analytic process

A case is presented in which the patient's transference to the analyst's supervisor became evident just prior to the switch from clinic to private patient status. The patient experienced the supervisor as a restraining father figure who protected her from acting on her erotic wishes toward the analyst. Analysis of this led to the recall of previously repressed memories of sexual wishes toward her brother, and the sense of protection from these wishes that she had gotten from the presence of her father. The literature on transference involving the supervisory constellation and the training setting is reviewed, and the concepts of split and institutional transference are examined. Factors inhibiting the analysis of patients' fantasies about the analyst's status as trainee, including the presence of the supervisor and the institute, are discussed.     

The analyst's style and its impact on the analytic process: overcoming a patient-analyst stalemate.

Analysts have characteristic styles in working with their patients. At times of crisis or stalemate, an alteration in style may facilitate the progress of the treatment. To illustrate the impeding effects of an analytic style at a particular phase of analysis, I describe a stalemate in the analysis of a severely self-critical patient. Recognition of the limiting effects of style on the treatment became apparent in a countertransference enactment, influenced by the patient-analyst match. Self-analysis and alteration in the characteristic style of the analyst resolved the stalemate and enabled the analytic work to progress.     

The analyst's anxieties in the first interview: Barriers against analytic presence

To answer the questions: why don't more people enter analysis and how do we get more people to do so? Attention is drawn to anxieties in the analyst that become obstacles to the initiation of analysis. The main focus of the paper is how to understand why analysts, irrespective of patient characteristics, seem to have resistances against embarking on analysis. Being a meeting between strangers the consultation activates strong emotional reactions in both parties. One way of coping is defensively to diagnose, assess and exclude instead of being present as an analyst. The analytic frame of a consultation is ambiguous, and a secure analytic function is needed in order to meet the openness and unpredictability of this frame. A fragile psychoanalytic identity is seen as central to analysts' failure to create an analytic practice; it takes years to develop and maintain a robust analytic function, and analytic work continues to cause disturbing emotional reactions in the analyst. Analysts' vulnerable identity is also linked to the history of psychoanalysis that has fostered an ideal of analytic practice that is omnipotent and impossible to reach. Therefore it is no wonder that attempts to reach a convinced recommendation of analysis can become diverted in the process of consultation. Confronting these inner impediments in order to strengthen the analytic identity is suggested as a better way to get more analytic patients than to keep looking for so‐called analysability in patients.     

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.     

The impact of intrusive identification in the analytic process: Some implications of real trauma and phantasy1

In this paper, the author aims to show a possible understanding of very primitive identifications, especially intrusive identifications, when associated with traumatic situations and expressed through current phantasies related to these experiences. At first glance, this understanding could be considered quite straightforward. However, the original contribution offered by the author is the participation of this special kind of combination in the formation of the primitive intrusive identifications and its association with the imprisonment inside the primitive object of identification, especially the mother. The author proposes the amplification of the clinical use of the concept of ‘life in the claustrum’, originally described by Meltzer, moving beyond persecutory claustrophobic situations. He illustrates the phenomenon with the analytic work carried out with a patient whose narcissistic and intrusive character was structured on the basis of primitive intrusive identifications and phantasies related to the claustrum inside the mother. The patient's imprisonment inside the maternal compartments has, as its background, the phantasies related to the infantile traumatic experience of the death of the patient's brother, which are reproduced in the analytic relationship.     

Leonardo's phantasy and the importance of Freud's slip: The role of the analyst's phantasies in applied psychoanalysis and in the analytic relation

In his paper on Leonardo, Freud made a slip. Referring to the bird which, according to one of Leonardo's memories, tossed its tail into the painter's mouth many times when he was a child, Freud replaced 'kite' with 'vulture'. It is widely accepted that this slip doesn't signifi cantly damage the whole of Freud's constructions on the paper, nevertheless, the part of his considerations relating to the meaning of 'vulture' should be discounted. In the author's view, this part of the Leonardo paper is necessary. Thanks to the slip Freud was able to reach a comprehension which otherwise would have been unattainable. Interpretation based on the vulture made possible the confi guration of a mother as 'daughter of the wind', as was the case not only with Leonardo's mother but also with Freud's. Interpretation of Leonardo's phantasy was achieved through Freud's unconscious identifi cation with Leonardo and the slip adequately interpreted becomes the evidence of this. Through identifi cation, Freud succeeded in making sense of Leonardo's memory but also in realising an indirect virile possession of his own 'winged' mother. Freud's position as interpreting subject in his paper on Leonardo also has more general value: the analyst's knowledge about the 'other' has a very important basis in the indirect expression of his unconscious wishes within the fi eld of sense. The author uses clinical material in order to show how the analyst's phantasies play an important role in analytical interpretive work.     

Agency vulnerability,participation, and the self-determination of indigenous peoples

Development, understood as a process of social and economic change, can be a source of great freedom. But when individuals and groups have little or no control over that process, it can be a source of vulnerability as well. This paper proposes the concept of ‘agency vulnerability’: the risk of being limited in one's ability to control the social and economic forces that propel one into change. All individuals and groups are susceptible to harm, but indigenous groups often face the gravest constellation of such threats. In particular, indigenous peoples struggle against both individual and societal vulnerabilities and often have the least control over processes of change that affect them. The language of human rights is frequently used to justify policies aimed at reducing vulnerability. For indigenous peoples, this often takes the form of a right to self-determination, a right in part intended to reduce agency vulnerability. This paper draws a distinction between the process and the substantive aspects of self-determination, and identifies participation as a key component of the process aspect, defending its importance in decision-making in any residual areas of shared rule between indigenous and non-indigenous groups or entities. Finally, it proposes a framework for evaluating the extent and quality of participation of indigenous (or any other) peoples in decisions that affect them.     

On the measurement of preferences in the analytic hierarchy process

In this paper we apply multiattribute value theory as a framework for examining the use of pairwise comparisons in the analytic hierarchy process (AHP). On one hand our analysis indicates that pairwise comparisons should be understood in terms of preference differences between pairs of alternatives. On the other hand it points out undesirable effects caused by the upper bound and the discretization of any given ratio scale. Both these observations apply equally well to the SMART procedure which also uses estimates of weight ratios. Furthermore, we demonstrate that the AHP can be modified so as to produce results similar to those of multiattribute value measurement; we also propose new balanced scales to improve the sensitivity of the AHP ratio scales. Finally we show that the so-called supermatrix technique does not eliminate the rank reversal phenomenon which can be attributed to the normalizations in the AHP. © 1997 John Wiley & Sons, Ltd.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

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.     

Exploring a patient's shift from relative silence to verbal expressiveness: Observations on an element of the analyst's participation

By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

Measurement scales and scale independence in the analytic hierarchy process

One approach to evaluate the relative performance of decision alternatives with respect to multiple criteria is provided by the analytic hierarchy process. The method is based on pairwise comparisons between attributes, and several numerical measurement scales for the ratio statements have been proposed. The choice of measurement scale is re‐examined, and new arguments supporting the measurement scale of geometric progression are derived. Separately from the measurement scale considerations, the effects of the scale parameter in geometric measurement scale are also studied. By using a regression model for pairwise comparisons data, it is shown that the statistical inference does not depend on the value of the scale parameter in the case of a single pairwise comparison matrix. It is also shown when the scale independence of statistical inference can be achieved in a decision hierarchy. This requires the use of the geometric‐mean aggregation rule instead of the traditional arithmetic‐mean aggregation. The results of the case study demonstrate that the measurement scale and the aggregation rule have potentially large impacts on decision support. Copyright © 2000 John Wiley & Sons, Ltd.