DREAMING THE ANALYTIC SESSION: A CLINICAL ESSAY

This is a clinical paper in which the author describes analytic work in which he dreams the analytic session with three of his patients. He begins with a brief discussion of aspects of analytic theory that make up a good deal of the context for his clinical work. Central among these concepts are (1) the idea that the role of the analyst is to help the patient dream his previously “undreamt” and “interrupted” dreams; and (2) dreaming the analytic session involves engaging in the experience of dreaming the session with the patient and, at the same time, unconsciously (and at times consciously) understanding the dream. The author offers no “technique” for dreaming the analytic session. Each analyst must find his or her own way of dreaming each session with each patient. Dreaming the session is not something one works at; rather, one tries not to get in its way.     

Even More Than the “Something More”: Tronick’s Dyadic Expansion of Consciousness Model and the Expansion of Child Psychoanalytic Technique

Contemporary psychoanalysis considers itself to be a discipline fundamentally concerned with meaning and meaning-making processes. Ed Tronick’s research provides scientific support for the theoretical position that meaning making is a central process in psychological development and in mental health/illness. His work collaborating with psychoanalysts has made major contributions to the psychoanalytic literature on therapeutic action, with a special emphasis on the means by which implicit meanings are activated and modified in analytic treatment—the something more than interpretation. This article is about a different something more, the even more that psychoanalytic theory and technique can evolve through further incorporating Tronick’s important findings. Tronick’s Dyadic Expansion of Consciousness Model will be briefly reviewed—emphasizing his conceptualization of meanings as being composed of multiple commingling layers (biological, psychological, relational, and social) coming together in a nonlinear “messy” mixture of mutually influencing (both bottom-up and top-down) currents. This multilayered model of meaning opens up the reconsideration of an exciting array of technical options—traditionally considered nonanalytic—to be reunderstood as truly psychoanalytic in that they address one or more of the implicit or explicit levels of meaning that a patient makes of his or her self and world. Examples of these interventions include parent work, work with teachers and schools, as well as interventions adapted from other disciplines such as Occupational Therapy. These technical possibilities are illustrated using case material from the psychoanalytic treatment of a nine-year-old boy.     

“Crunches,” “(K)nots,” and Double Binds—When What Isn't Happening Is the Most Important Thing: Commentary on Paper by Barbara Pizer

This discussion compares Pizer's concept of “relational (k)nots” with “crunches” and double bind impasses. It argues that all of these constructs capture what happens when conventional analytic method—the exploration, elucidation, and interpretation of transference—fails to work. In this context a “last-ditch effort” emerges, a necessary crisis of treatment. The situation is a plea that something must occur “now or never” or the “charade of therapy is over.” This plea is extraordinarily challenging since it embodies contradictory elements wherein the patient's very call for involvement with the analyst is embedded in a process that obfuscates their connection. Notably this sets the stage for the “damned if one ‘gets it’ and damned if one doesn't” experience that is a part of the paradox of recognition/mis-recognition that befuddles many analyses.

Extrication from such impasses requires the analyst's recognition that she is colluding in a kind of avoidance or distraction from recognizing their disconnection. Her second act involves meta-communication about their process. That is how their “relational knot” both binds them together while negating their connection. While this observation may be necessary it is recognized as insufficient on its own. Thus her third move out of the impasse requires her to enter into a state of improvisation. That is, to use some part of herself that must surrender from the one-up one-down impasse position of “either your version of reality or mine.” Instead, she must cultivate through her action a third way in which both she and her patient can think about their impasse and do something about it, including something different from what either one might have imagined before.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

Commentary on Paper by Lawrence J. Brown

Brown's historical overview of post-Kleinian psychoanalysis traces key steps in the evolving and diverse practice of working in the psychoanalytic situation while regarding it as a two-person field. The Barangers' “The Analytic Situation as a Dynamic Field” is central to his narrative. I develop my understanding of the originality of their contribution in theorizing a situational unconscious, and of their continuing relevance for thinking about analytic listening and intersubjective collaboration. Brown presents a countertransference dream of his own along with the dream of a patient as an example of the Barangers' concept of the “shared unconscious fantasy” of the analytic couple. A detailed alternative reading of Brown's clinical vignette reveals an absence of fit with the Barangers' views on collaboration in the analytic situation. Some uses of Bion's “dreaming” and “becoming” are implicitly questioned as they risk encouraging the idealization of special states over process.     

INTUITING THE TRUTH OF WHAT'S HAPPENING: ON BION'S “NOTES ON MEMORY AND DESIRE”

Bion's “Notes on Memory and Desire” (1967a) is an impossible paper that this article's author has struggled with for decades. He views the paper, only two and a half pages in length, as a landmark contribution. Despite its title—and its infamous dictates to resist the impulse to remember past sessions and desire for “results”—the paper is not, most importantly, about memory and desire. It proposes a new analytic methodology that supplants awareness from its central role in the analytic process and, in its place, instates the analyst's (largely unconscious) work of intuiting the (unconscious) psychic reality of the present moment by becoming at one with it. This article's clinical examples, provided from the author's own work, illustrate something of his ways of talking with his patients.     

Thoughts on the limits of a mutual technique*

Ferenczi’s appreciation of the inherently mutual nature of the analytic encounter led him, and many who followed, to explore the value of mutual openness between patient and analyst. Specifically, Ferenczi saw the analyst’s openness as an antidote to his earlier defensive denial of his failings and ambivalence toward the patient, which had undermined his patient’s trust. My own view is that, while the analyst’s openness with the patient can indeed help reestablish trust and restore a productive analytic process in the short term, it also poses long-term dangers. In certain treatments it may encourage “malignant regression”, where the patient primarily seeks gratification from the analyst, resulting in an unmanageable “unending spiral of demands or needs” (Balint, 1968, p. 146). I suggest that an analyst’s “confessions”, in response to the patient’s demand for accountability, can sometimes reinforce the patient’s fantasy that healing comes from what the analyst gives or from turning the tables on his own sense of helplessness and shame by punishing or dominating the analyst. In such situations, the patient’s fantasy may dovetail with the analyst’s implicit theory that healing includes absorbing the patient’s pain and even accepting his hostility, thus confirming the patient’s fantasies, intensifying his malignant regression and dooming the treatment to failure. When malignant regression threatens, the analyst must set firmer boundaries, including limits on her openness, in order to help the patient shift his focus away from expectations of the analyst and toward greater self-reflection. This requires the analyst to resist the roles of rescuer, failure, or victim—roles rooted in the analyst’s own unconscious fantasies.     

An Elegy,a Love Song,and a Lullaby

In the course of the past decade, I have found himself looking as much to poets and the experience of reading poetry as to the work of other analysts in my ongoing effort to become a psychoanalyst. Both the poet and the psychoanalyst are individuals whose life's work is that of making “raid[s] [on] the inarticulate” (Eliot, 1940, p. 128) in their effort to delve as deeply as possible into what it is to be human and to render that experience in the medium of language. To this end, I offer a reading of Seamus Heaney's (1987) “Clearances,” an elegy Heaney wrote for his mother soon after her death. I explore the ways in which the experience of mourning—whether in a poem or in an analytic experience—is not simply “conveyed” (as if illuminating something already there) but created in the very act of writing/saying the poem or of bringing feelings to life in words in an analytic session.

I begin by presenting a brief biographical account of Heaney not to “explain” his poetry in analytic terms but to allow the reader to create a more imaginative, more human reading of the poem as he or she enters into the conversation between the life of the man and the life of the poetry. Then I discuss the ways in which “Clearances” comes to life as a variety of coexisting forms of love that together shape an experience of grief.     

The Self as a Relational Structure A Dialogue with Multiple-Self Theory

This paper addresses the postmodern critique of unified-self theories that argues that the self is not unified but multiple, not a static entity but in constant flux, not a separate center of initiative but intersubjectively constituted. The author proposes that there are two kinds of division in self-experience: the dissociative divisions of multiple-self theory, and a division, akin to the divisions between Freud's structural agencies, between what are here termed the “intersubjective self” and “primary subjective experience.” In contrast to dissociated self-states, which occur in different moments in time, these two dimensions of self-experience occur simultaneously; indeed, what is most important about them is their relationship. The author suggests that it is this intrapsychic relationship, as it occurs in a given psychological moment, that determines the qualities of self-experience that are emphasized in unified-self theories: such qualities as cohesiveness versus fragmentation; authenticity vs. falseness; vitality versus depletion; optimal versus nonoptimal self-regulation; and agency versus feeling one is at the mercy of others. Furthermore, a major organizer of the intersubjective self is early identifications, especially “identifications with the other's response to the self.” The implications of these concepts for therapeutic action are discussed and illustrated with an extended account of an analytic case.     

The coming of history: Heidegger and Nietzsche against the present

Heidegger’s 1938–1939 seminar on Nietzsche’s On the Utility and Liability of History for Life continues Heidegger’s grand interpretation of Nietzsche as a metaphysical thinker of presence. Nietzsche’s conceptions forgetting, memory, and even life itself, according to Heidegger, are all complicit in the privileging of presence. Simultaneous with his seminar, Heidegger is also compiling the notebook, Die Geschichte des Seyns (The History of Beyng), 1938–1940, wherein he sketches his own conception of history. Examining Heidegger’s criticisms of Nietzsche in the light of his contemporaneous notebook allows us to articulate Heidegger’s concern for history and for “what has-been” (das Gewesene) as a thinking of the “coming” of being. For Heidegger, to exist historically is to exist as something sent, something arriving, as something that “comes” to us. This coming of history is an ontological determination of all that is, no longer construed as present-at-hand objects, but as always arriving, relational beings. After presenting Heidegger’s view of the coming of history, I return to Nietzsche’s Utility and Liability of History to draw attention to an aspect of his text that is neglected by Heidegger, that of the political. The concluding sections of Nietzsche’s text confront the politics of the present, in both senses of the genitive, in order to rally against the closure of society. In the conclusion to the paper, I turn to the political dimension of Nietzsche’s thinking of history with an eye to how it might elude Heidegger’s interpretation.     

Review Essay: Constructivism with a Human Face

Irwin Hoffman's book Ritual and Spontaneity includes, but goes well beyond, his series of seminal papers—written over the past several decades—developing a psychoanalytic, constructivist perspective. A new, existential framework depicts what Hoffman calls the “psychobiological bedrock” at the core of the human process of constructing meaning—the lifelong effort to create a livable, subjective world in face of our ever present sense of loss, suffering, and, ultimately, mortality.

This review describes Hoffman's encompassing, existential perspective and discusses how, within this framework, he uses his dialectical sensibility to frame our understanding of both parenting and analysis as “semisacred” activities. The “dialectic of ritual and spontaneity”—the vital clash between disciplined adherence to the analytic frame and personally expressive deviations from it—represents the creative tension between the “magical” dimension of analytic authority and the healing influence of a genuinely expressive human relationship. Hoffman's perspective on the self-interested, “dark side” of the analytic relationship is compared with Winnicott's views on the vital, therapeutic role of “hate” and the paradoxical process by which the patient comes to “use” the analyst.

Unlike most postmodernist “constructivists,” Hoffman openly reveals his underlying belief in certain “transcultural, transhistorical universals”—his “psychobiological bedrock.” In acknowledging these “essentials” (assumptions about human nature) that in some form are integral, yet often hidden, elements of any system of thought, Hoffman saves his own dialectical constructivism from falling into dichotomous (constructivist vs. essentialist) thinking.     

“Hall of Broken Mirrors”—Enactment in an Analytic Group of “Difficult Patients”

This article focuses on the transformation of dissociated self-states as a curative factor in an analytic group of “difficult patients.” Foulkes (1964) referred to the analytic group as a “curative hall of mirrors.” I would like to integrate group analytic theory with relational psychoanalytic concepts. I propose that when dissociated self-states are expressed in a group, this creates a “broken mirrors” experience that is sometimes expressed through enactment. I develop this idea, and argue that the group mirrors to the patient his image—distorted and defective—and forces him to cope with his “not me” states. I demonstrate, through three clinical vignettes, how dissociated states hinder the reflective space and create a “hall of broken mirrors” experience. I would argue that in a safe space, the patients’ “not me” states can be transformed, and the hall of broken mirrors can turn into a curative hall of mirrors.     

The Dwelling Places of Self-Experience

Instead of dichotomizing psychic life as either intrapsychic or interpersonal, I suggest we think in terms of a continuum of self-experience from the most private or interior to the most public or exterior. I articulate four “domains”—phenomenologic, intrapersonal, interpsychic, and interpersonal—that constitute this spectrum of self-experience. Each domain lends a specific quality to one's internal life, and together (but in varying proportions) they constitute the psychic dwelling place unique to a given individual. This article illustrates how the variability among our patients in their habitual dwelling places may explain their diverse responses to differing analytic stances, interpretive approaches, and indeed, different analysts. A clinician's awareness of his or her own personal proclivity toward a more interior or more exterior orientation helps promote optimal contact with the patient's psychic life.     

„Ich möchte an Sie glauben können!“

During daily psychoanalytic treatment something happens that can be described with a term from the Old Testament: “to know”, giving psychoanalytic praxis a religious dimension. The author illustrates this thesis with a case report. First he tries to show how an interpretation of the casuistic material appears in the scope of the well-known concept of religion as an expression of dissoluble narcissistic conflicts. Then he applies Winnicott’s idea of “potential space” as a new scope for interpretation of the case. The conception of the “destruction of the object” according to Winnicott will be related exemplarily to the history of Jesus’ death on the cross and the miracle of his survival. By heeding the world of ideas of Klein and Bion, the author comes to the conclusion that religiosity is an anthropological constant, which cannot be reduced to a pathologic narcissistic event.     

威廉·斯特恩的儿童人格发展观及其历史效应

威廉·斯特恩是被历史遮蔽的现代儿童发展心理学的重要创建者,对儿童人格发展理论作出了原创性卓越贡献。他以批判人格主义为哲学基础提出了人文科学取向的儿童人格发展观,主要表现在整体论、过程论和情境论三个维面。他认为儿童人格发展是多元统一的整合性发展,是主动、动力、辩证、独特和开放的过程性发展,是内在于生活世界的情境性发展。他的观点为奥尔波特和勒温、维果茨基、皮亚杰、彪勒及里格尔等人的儿童发展理论提供了直接或间接思想来源。     

Standard Dominance Versus Creation of Interludes of Equalization of Power in the Psychoanalytic Situation: Discussion of Case Presentation by Joseph Newirth

Joseph Newirth tells us that it is his aim in the analytic work to facilitate a “symmetrical dialogue [that] involves an equalization of power, [and] a radical view of mutuality and of self-disclosure in the analytic relationship.” My thesis here is that the process falls short of that objective. Instead, it is characterized by an enactment in which the analyst is always dominant. Several examples of “power plays” are presented in which the analyst, in a manner partially institutionalized as standard psychoanalytic practice, repeatedly gains the upper hand in the analytic relationship. One important aspect of this enactment entails a systematic bias in favor of interpretations that attribute neurotic, primitive, or regressive motives to the patient at the expense of hearing and taking seriously the patient's more mature perceptions and judgments, including those focused on the analyst himself.     

“What If” Dimensions of the Analytic Field: Imagination,Object Vitality,and Psychic Growth

This paper considers the role of imagination in the context of Bionian Field Theory. Expanding on Hanna Segal’s idea of “what if” dimensions of the analytic process, it is argued that “what if” states engage evocative and vital aspects of objects. They set up particular tensions in the analytic field that trigger “imaginative work.” The processes at work share many similarities with the artist’s creative process. For this reason, William Kentridge’s reflections on his own creative process are used to elucidate “imaginative work” as an esthetic, creative and agentive process. Three case fragments are used to illustrate some of these ideas in the clinical setting.     

Working in the Metaphor Commentary on Paper by Stephen Seligman

This paper expands on Seligman's ideas about mentalization and the challenges of working with patients who cannot mentalize. Seligman's clinical presentation demonstrates that much valuable analytic work takes place without explicit reference to the transference. Drawing on Britton's notion of the triangular internal space that allows for reflective thought, we propose that analytic interest in an external object, discovered through the relationship and meaningful to both patient and analyst, helps create the same kind of space. The difference-within-sameness of shared contemplation can increase receptivity to divergent perspectives. Likewise, the “third object” can become a therapeutic metaphor, open to various meanings without being limited to any one interpretation. We trace how Seligman and his patient use a series of third objects in their work together. In this process, the patient moves from a transitional relationship of minimal differentiation to an increasingly secure sense of her own separateness, beginning to accept, and even enjoy, having a motivated mind of her own. Finally, we discuss how Ferro's concept of the analytic field offers a theoretical rationale for the effectiveness of this process.