Attention and Narration to Micro-Moment Registrations of Embodied Dialogue in the Clinical Interaction: How Are We Doing?

ABSTRACT

This article offers a comparison between two different strategies for clinical attention. The author compares his lens shaped by a musical metaphor of “polyrhythmic patterning” on embodied registrations which he describes as “fluidity” in contrast to a lens of structures or categories of experience. He then contrasts this lens to that offered by Lewis which she describes with the metaphor of an “imaginary camera” with which she creates “snapshots” as representations of unbearable (and often unformulated) trauma shaped by the patient's narrative and her own trauma history. Acknowledging the exquisite connection between analyst and patient, the author uses 2 clinical moments to further illustrate the benefits of each metaphoric lens for possible analytic work.     

From “disciplined subjectivity” to “taming wild thoughts”: Bion's elaboration of the analysing instrument

Abstract

Freud encouraged the analyst to use his unconscious “as an instrument of the analysis,” but did not elaborate on how this should be done. This recommendation opened the door to a consideration of unconscious communication between the analyst and patient as an intersubjective exchange. Both Wilfred Bion and Erik Erikson emphasised the importance of the analyst's intuition, and the author compares and contrasts these two approaches. Erikson advocated a more cautious attitude regarding the analyst's subjectivity, while Bion promoted a broader application of the analyst's various private reactions to the analysand. A brief vignette from the analysis of a five-year-old boy is offered to illustrate the importance of the analyst's reveries, the mutual process of containment and transformation between analyst and patient, and the co-creation of an analytic narrative.     

Moses,Michelangelo and Freud: From an interlacement of stories in history to some suggestions for treatment theory

Abstract

The first part of this paper is inspired by Freud's interpretation of Michelangelo's Moses, which as the author shows, profoundly expresses Freud's subjectivity and personal features. With reference to clinical treatment, when the analyst “reasons” without considering his or her partner's position, the setting is lacking from a relational point of view. The consequence is that the analyst is missing a precious resource, that is, his or her patient and the documental sources he or she transmits in the analytic dialogue. In the second part of the paper, the author analyzes the nature of documental sources. This information pertains to both the patients’ pasts and their histories, expressing their rigid conservative needs, and to their evolution and transformational needs, in view of future possible change. Evolution needs are not visible, because they are implicitly present, and—according to the author—they could be recognized through the method of discrete details proposed by the Italian art critic G. Morelli. A broader vision of analytic listening is also considered: the past should be taken into account with the aim of interpreting the present and the future, as changing spaces. Change in therapy is announced through nonrepressed unconscious signals and by the language of the implicit. In the conclusion, the author exposes the connections of change, implicit, symbol, metaphorical language and waiting time.     

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.     

Momentums of Meeting

ABSTRACT

In this article, I attempt to engage questions about the momentums of the moments of meeting formulated by Lou Sander as propitious for early development. I wanted to portray observations that grapple with the intersection between psychic change and complex dynamics, like imagistic confluence with verbalized interaction, embodied recognition from parent to child, and affecto/libidinal communication between patient and analyst. The focus is on four different directions for comments: (1) Some links to my own clinical practice and research; (2) An instance of “confluence of visual image between patient and analyst”, a moment of imagistic meeting, as understood through self-analysis by an open-minded analyst, including the discovery of “the importance of unsuccessful empathy in learning and growing”; (3) A study of “engrossment,” exemplifying the ways in which the earliest moments of “recognizing” ones infant, can engender joyful, expansive affects, with enhancement of self-image in fathers; and (4) The continuing generative momentum of Lou Sander’s participation within the Boston Change Process Study Group.     

The Impossible Ideal: A Patient-Oriented Therapy

Abstract

Langan R. Proteus Reprised. Int Forum Psychoanal 1997;6:45-49. Stockholm, ISSN 0803-706X.

Proteus was the mythical Greek sea-god able to change his shape at will. In the Odyssey, King Menelaos manages not to release his wrestler's hold on the mercurial trickster, and theory can, at last, return home. The myth has sundry and changing applications to the living experience of what goes on between patient and psychoanalyst. In one sense, the analyst's job is to be like Proteus, escaping the transferential grip whereby the patient tries to pin the analyst into characterological shapes of the past. In another sense, the patient is Proteus, and the analyst's job is to hold firmly to the process of future change, refusing to settle for one fixed version of selfhood. In yet another sense, both patient and analyst become Proteus, experiencing fluidly present senses of self as an inner subjective “I,” as an intimately relational “Thou” with “Thee,” and objectively, as one Other among others. Additionally, the myth insinuates within the psychoanalytic situation a potential transcendence of time.     

Altruistic love in psychoanalysis opportunities and resistance

Many patients manifest a desire to help the analyst. This is usually understood as being derivative of defensive aims or in the service of other primary motivations. This paper argues for the developmental and clinical importance of primary altruistic aims, which are often warded off by the patient because of his or her fears of exploitation or rejection. Several pathogenic beliefs and varieties of psychopathology result from the failure of the patient's caretakers to allow the child to contribute to their welfare, to “take”; the child's “help.”; Similarly, some patients require tangible evidence that they are having a positive impact on their analyst. Ordinary “good‐enough”; technique often reinforces the patient's view that he or she has nothing to offer. A full appreciation by the analyst of the importance to patients of having their altruistic gestures and concerns recognized and accepted can open up possibilities for analytic progress and therapeutic growth. Various sources of resistance to and misunderstanding of these dynamics are explored, ranging from ethical concerns to certain traits that cluster in the personalities of analysts.     

A Century of Psychoanalysis: Critical Retrospect and Prospect

Abstract

The distinction between having mode and being mode would seem to be the basis of the Frommian clinical approach, which finds its main application in the “center-to-center” relatedness between analyst and patient. The analyst can understand the patient because he/she experiences what the patient experiences. The dialogue is based on emotional and conceptual responses and reactions which are reciprocally communicated; both identities come into play. Psychoanalytic treatment which is not inspired by biophilia can only compile an inventory of data upon data, imposing interpretations and reconstructions. Biophilia makes psychoanalysis an art because it is applied to living things. The psychoanalytic session can save itself from the having mode by addressing the patient's living memory, which represents the past relived in the present, according to the being mode. The author comments on a psychoanalytic session.     

Developing a Psychoanalytic Practice

Abstract

This paper examines two methods of developing a psychoanalytic practice. The first is an “internal” approach that helps a patient make the transition from therapy to analysis with the same analyst. This may be accomplished by attenuating the patient's unconscious fears of analysis as a facilitator of an anticipated regressive loss of control and as a reactivator of feared desires and impulses. Increased motivation for analysis may also result from a therapy that leads the patient to an awareness that an ongoing level of distress is internal, together with the experience of a deepened therapy and of the analyst as safe and potentially providing relief. The second method of developing an analytic practice is an “external” approach that provides others, such as analytic, mental health, medical, and academic colleagues, an experience of the analyst as person and some idea of the type of work he or she does.     

The Analyst's Necessary Vertigo

The euphemistic phrase “the difficult to reach patient” often refers to work with patients who have serious difficulties relating. The author examines the basic construct of “reach,” its pitfalls, and potentials. In the author's view, often we are talking about patients who do not fully experience their own subjective existence or the existence of others. This requires unusual efforts to “reach” the patient in order for the patient to consolidate a sense of self and other, creating the possibility of reflective relating. In contrast to views that see such psychoanalytic “reach” as associated primarily with the analyst's needs or pathology, the author views the analyst's extraordinary efforts as responsive to the patient's need to move the analyst into the foundations of the analyst's own being.     

The perversion of language in the analyst's activity: Navigating the rhythms of embodiment and symbolization

Abstract

In this short text, the problem of how “the talking cure” itself can become a perverse relation is considered and illustrated with a brief clinical vignette. Contributions coming from the work of Stern in infant research and Lacan in post-Freudian thought illuminate the potential for experience to be split off through the use of language itself. These perspectives are brought to bear on thinking about representation, splitting, and perversion as a basis for considering a clinical instance in which patient and analyst enact a perverse relation constituted by the way in which the patient uses the analyst's language to construct a sado-masochistic perversion of the treatment process. Within the clinical episode, Stein's reformulation of perversion, informed by Ogden's observations and expanding Stoller's earlier contribution, provides a basis for considering how the analyst was able to use attention to the body-based countertransferential experience to repair a sense of “erasure” that was being accomplished for both analyst and analysand through the enactment.     

One Need Not Be a House to Be Haunted: On Enactment,Dissociation, and the Dread of “Not-Me”—A Case Study

This paper examines psychic trauma as experience so shockingly strange that it exceeds the threshold for cognitive processing and begins to flood the mind with unintegratable affect that threatens to disorganize the internal template on which one's experience of self-coherence, self-cohesiveness, and self-continuity depends. A detailed clinical vignette illustrates how the unprocessed “not-me” experience held by a dissociated self-state as an affective memory without an autobiographical memory of its traumatic origin “haunts” the self. It remains a ghostly horror even in an otherwise successful psychoanalysis unless a new perceptual reality is created between patient and analyst that alters the narrative structure maintaining the dissociation as though the past were still a present danger. The analyst's making optimal use of dissociative processes in an intersubjective and interpersonal context enables the patient more readily to self-regulate affect in those areas of implicit memory where trauma has left its mark; the dissociated ghosts of “not-me” are thus persuaded, little-by-little, to cease their haunting and participate more and more actively and openly as self-reflective, self-expressive parts of “me.”     

Reiteration: The ‘Imperative of the Word’ and Echoing the ‘Significative Terms’

Abstract

The act of reiteration is viewed as a therapeutic reply that is especially responsive in the face of what Lacan (1977) and Heidegger (1927/1962) respectively refer to as “empty speech” and “idle talk.” By hearing and selecting those key signifiers and phrasings that bear the client's story of distress, the act of reiteration allows us to focus and address the “subject who speaks” rather than the commonsense storyline itself. As an active and continuing punctuation of the client's direct discourse at the level of the word, the act of reiteration is only the first moment of a more complete narrative reply. But in keeping the therapist ever grounded in the client's direct expressions, it is this first moment of reiteration that leaves the therapist positioned to be responsive to the client's discourse of “rhetorical displacements,” of intimation and allusion, as these “echo” from “elsewhere.”     

Interior experience within analytic process

In this paper, I consider the feeling of interiority as it evolves within the treatment relationship. A capacity to access and sustain one's interiority reflects a sense of personal solidity within which the validity of subjective process and privacy is taken for granted. When this capacity is relatively undeveloped, individuals rely on the “other”; (including the analyst) to help them contact, elaborate, or manage their affective experience. Quite paradoxically, the analyst's active investigation of dynamic or intersubjective process may obfuscate rather than clarify this core difficulty. I suggest two alternative approaches to the treatment situation that stand in some tension and yet also complement each other. One emphasizes the “active”; investigation of dynamic and dyadic process, wherein the analyst works interpretively and/or around relational issues. The other is organized around the “interior”; dimension of the treatment experience, emphasizing the patient's need to develop or manage her affective process in the relative absence of input from the analyst. Two clinical situations are described, the first illustrating the use of silence with a patient whose difficulties involved affect articulation, and the second involving a patient whose need for affect regulation made her highly dependent on the analyst for soothing.     

Breakdown in communication: On finding the child in the analysis of an adult

SUMMARY

In this paper a patient is described in whom communication with parts of herself and with her objects, internal and external, had broken down. I suggest that her way of communicating was achieved by projective identification, as described by Klein (1946) and Bion (1962). The only way she could deal with and communicate her own very “bothered” feelings was to “put them” into the analyst. In this way she “bothered” the maternal or analytic mind in such a way as to make the analyst experience feeling like a “bothered” child.

I have tried to show how the analyst holds or contains these feelings, and to show the gradual establishment in the patient of a different way of communicating with the analyst and with the more primitive parts of herself.     

RUPTURES IN THE ANALYTIC SETTING AND DISTURBANCES IN THE TRANSFORMATIONAL FIELD OF DREAMS

This paper explores some implications of Bleger's (1967, 2013) concept of the analytic situation, which he views as comprising the analytic setting and the analytic process. The author discusses Bleger's idea of the analytic setting as the depositary for projected painful aspects in either the analyst or patient or both—affects that are then rendered as nonprocess. In contrast, the contents of the analytic process are subject to an incessant process of transformation (Green 2005). The author goes on to enumerate various components of the analytic setting: the nonhuman, object relational, and the analyst's “person” (including mental functioning). An extended clinical vignette is offered as an illustration.     

Listening to Somatosensory States in Psychoanalysis: Body,Trauma, and Poetry

ABSTRACT

The author starts from the apparently outdated James-Lange theory of emotion to rediscover elements of modernity for contemporary psychoanalysis: from James’ bodily-sensory dimension to Damasio’s “feeling of what happens,” to Bucci’s attention to the patient’s visceral narrative in session. William James stated that bodily sensations are the first elements on the path toward consciousness. Damasio emphasizes that “Consciousness is rooted in the representation of the body”. Bucci presents a framework for identifying linkages between bodily and symbolic states and to observe the various degrees of patients’ “visceral speech” in session. These parallels support a sensibility to listen to language as the voice of the body: the relationship between the patient’s narrative and the bodily-sensory dimension can be grasped through the patient’s “imagery” which may reference earlier somatic experience. Particular emphasis is given to the story-telling of trauma.     

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.     

The Symbiosis between a Mother and Her Schizophrenic Son in a Group Therapeutic Process

Abstract

In psychoanalytical practice important, but less studied, transformative functions are performed by verbal comments which do not correspond to the classic model of mutative interpretations proposed by Strachey. The Authors describe some characteristics of such clinical situations, without coming into the better known categories of variations in technique. Such enunciations seem not to have a “strong”, (already clearly defined) meaning in the mind of the analyst, but contain rather a “weak” semantic potential, which can only develop with the active cooperation of the patient. In the light of these experiences, the Authors reconsider the general nature of psychoanalytical interpretation and emphasize the intersubjective and dialogical nature of the interpretive work carried out in analysis.