Crash: What We Do When We Cannot Touch: Commentary on Paper by Meira Likierman

This commentary aims to show the congruence and difference between Likierman's position on recognizing otherness and working with enactment and her relational, intersubjective position. Differences in my reading of the case include stressing the repetition of early attachment trauma, the level of implicit procedural relating, and the patient's contribution to the shared third of rupture and repair. I try to show that enactments arise not merely because the patient is able to pull the patient into forbidden behavior but because the dissociated parts of the patient pull the analyst into dissociation even when the analyst is acting “properly.” The rupture or collision—the “crash”—that the patient helps to formulate represents an opportunity to see the life-giving element in what we, analysts along with patients, inevitably also experience as frightening and even life-threatening.     

When Avoidance Is Mutual Regulation: Disorganized Attachment and Analytic Attunement

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patient together, along with the feelings engendered by “waiting.”     

Los Degradados: Out,down, dead: Transmitted and inflicted trauma as encountered in the analysis of a 6‐year‐old girl1

The author presents the analysis of a precocious traumatized little girl, which reveals the ways in which historical trauma is transmitted and intrafamilial trauma is both disguised and represented. The play as it evolves is seen to simultaneously communicate what the child struggles with and to resolutely try to hide what has actually happened. Analyst and child together participate in play which utilizes displacement, enactment and interactive enactment, the latter play mode being the very hallmark of profound traumatic experience. Carlotta, the child, helps the analyst to follow her quest for meaning making even as the interaction between them adheres to and departs from the deepening pentimenti of traumatic experience, which needs to be unraveled and reconstructed in order that her own developmental progression can be rejoined. The analysis facilitates Carlotta's capacity to play in a more unfettered fashion and to assist her family's recovery as well.     

Working with Enactment: The Analyst’s Willingness to Be Both Confrontive and Vulnerable

ABSTRACT

One of the most fascinating and perplexing expressions of unconscious-to-unconscious communication is enactment. Having been accepted as inevitable, the actual clinical management of enactment remains somewhat vague, as analysts continue the tradition of not often specifying exactly what they say and do in the clinical hour. The fact that enactment involves a mutual conflict, where both analyst and patient feel out of control, contributes to the difficulty in articulating a path forward once enactment has occurred. This article presents a case where 2 enactments threatened to end the treatment and required the analyst to assume a position of being both confrontive and vulnerable.     

“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.     

Whose Who in the Psychoanalytic Situation: Subject,Object, and Enactment in the Relational and Contemporary Kleinian Traditions

The concept of enactment, although it has probably has become an overused term in the Relational literature, is a relatively new one for the Contemporary Kleinians of London. In explicating and synthesizing these different theoretical perspectives (Relational and Contemporary Kleinians), the author's primary focus is to tackle the notion of subject and object, in the context of enactment. The author first delineates the relationship between reality and fantasy, and each theory's notion of enactment. In doing so, the author shows how these differing theories and their related notion of therapeutic action inform the kind of object the analyst sees himself or herself as. The author also addresses the technical implications related to the consequences that arise for the analyst as an object of the patient's transferences and projections, including how the analyst extricates himself or herself from the enactment. Two previously published vignettes are used for the purpose of comparison. The author argues for a complementary technical stance comprising two analytic modes: analyst as subject and analyst as object.     

Looking back,looking forward: A reexamination of Benjamin Wolstein’s interlock and the emergence of intersubjectivity

In this paper the author takes a close look at Benjamin Wolstein’s chapter, ‘Therapy’, from his book, Countertransference, published in 1959. This chapter contains a discussion of what he refers to as the interlock between analyst and patient, or today what we might describe as transference/countertransference enactment. The author shows how Wolstein’s concept of the interlock and its relation to the analyst’s countertransference was radical and innovative for its time. Wolstein’s notion of a transference/countertransference interlock, along with the seminal contributions of Ferenczi and some of the early interpersonal theorists, anticipates the complexities of a two‐person psychology and the entanglement which can occur from the intermingling of unconscious processes of analyst and patient in the experiential field. The author highlights three main ideas. First, the author provides a brief review of enactment with an emphasis on the role of the analyst’s participation as conceptualized by the various theoretical perspectives. An historical context is given for Wolstein’s clinical theorizing. Second, the author explicates Wolstein’s concept of the interlock, with particular attention to the processes involved which account for the complexities it presents. Third, the author examines the ‘working through’ process, including the emergence of intersubjectivity in the resolution of the interlock. The author shows throughout Wolstein’s emphasis on the influence of the analyst’s personal psychology, mutuality, and intersubjectivity, all of which anticipated the gradual interpersonalization of psychoanalysis across the various schools of thought.     

Vitalizing Enactment: A Relational Exploration

Drawing from her extensive work with deeply disturbed children Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst actively reaches out to contact and “reclaim” her most inaccessible patients, engaging them in the world of emotions and relationships. In this paper I consider Alvarez’s ideas through the lens of Relational thought, reconceptualizing vitalization as a unique form of enactment that can draw the analytic dyad from deadened impasse into enlivened contact. In vitalizing enactment embryonic affects, hopes, and longings find expression and are potentiated for patient and analyst alike. This is a view of enactment as a progressive and creative lived experience, rather than an unconscious collision to be survived and symbolized. I contextualize vitalizing enactment in relation to Alvarez’s original formulations as well as relevant contemporary theories and present a clinical vignette to illustrate this paper’s themes.     

From Dead to Alive: Desire,Dissociation and Passion in the Analytic Dyad

When patients present in a deadened state, the analyst may feel a sense of futility and shame in his efforts to have impact. This may cause him to withdraw and contribute to an enactment in which both participants purge themselves of wanting anything from the other, sapping the treatment of purpose and aliveness. The author presents a model in which the analyst can reawaken his desire for recognition and connection and utilize it to introduce the patient to his or her own dissociated longings. This involves fortitude on the therapist’s part, since he must withstand the rejection that had caused him to withdraw in the first place, and also be sensitive to the patient’s fear of retraumatization. But if the analyst can do this, he can not only break through the impasse, but enliven the patient and infuse the treatment with a sense of purpose and hope.     

Cyberpassion: E-rotic transference on the Internet.

While psychoanalysis has generally been regarded as "the talking cure," written communication from patient to analyst commonly appears within the analytic setting. In our electronic age, e-mail communications from patient to analyst have become commonplace. This paper describes a case of erotic transference conveyed primarily through e-mail messages, and discusses their multiple meanings as an enactment. The unique features of e-mail communication are explored and contrasted with verbal discourse in the analytic dyad.     

Going Deep,Going Wide

Contemporary theories of psychoanalytic action have for the most part shifted from an archeological model—analyst as objective scientist/detective in search of patients’ deeply repressed affective experience—to analyst as often unwitting co-participant in a relationship ultimately designed to broaden patients’ awareness and acceptance of their varied internalized self-other configurations. These sometimes dissociated configurations often emerge in the context mutual enactments between patient and analyst.     

The day the clock stopped. Primitive states of unintegration,multidimensional working through and the birth of the analytical subject

This paper is based on one idea and built around one clinical experience that helped me to broaden my comprehension of it. The idea, underlying the work of several authors, is that when the analytic field is saturated with primitive and unintegrated mental contents, the analyst’s somatic countertransference is a precious indicator of a deep, dissociated form of communication. The clinical experience concerns the difficult elaboration of a complex, multifaceted countertransference that took place during the early stages of the analysis of a sensitive patient who used to communicate in a very dissociated way and that I found hard to contain. This experience, closely described in the article, led me to formulate the clinical idea that the transference field may be made of distinct layers (psychoid, affective, verbal), and that each one of them may potentially convey dissociated, even contrasting bits of information. The corollary of this is that the analyst should be ready to accept contrasting sensations, feelings and thoughts at the same time, as they might be the basic ingredients of a complex reverie. The analyst could find himself/herself in front of his/her own internal unelaborated multiplicity before a symbolic image may emerge to link the scattered pieces of the experience. Nevertheless, the heart of this paper is not about suggesting an idea, but in the sharing of a complex working through, which fostered the birth of a new, more human relational perspective: the capacity of being together in time, in a transitional space where there is neither total separation nor fusion.     

Working at the “Intimate Edge”: Intersubjective Considerations—Comments on “A Case Study of Power and the Eroticized Transference–Countertransference”

Working from the premise that as analysts we are always vulnerable to unconscious collusion and enactment, and that this has radical implications for how we conceive of the analytic process, I try to illustrate how the process of working at the “intimate edge” of the analytic relationship, and explicitly engaging what goes on intersubjectively between patient and analyst expands the analytic process and the analytic possibilities. I especially focus on how deconstructing interactive enactment can help to access unconscious aspects of what might be in play in relation to the issues of power and eroticized transference–countertransference under discussion here, and how this process itself can become the medium of the work and the focus of therapeutic action.     

The Unobtrusive Relational Analyst

I describe an unobtrusive relational approach to the psychoanalytic treatment of nonalive and nonspeakable states and ways of being. I build upon a contemporary relational sensibility that values the intersubjective engagement of analyst and patient and the enactment of dissociated and unformulated states, together with the concepts of regression and the unobtrusive analyst central to the work of the British independent analysts, with a special focus on Michael and Enid Balint. I stress that in being unobtrusive, the analyst is not neutral or abstinent, but deeply engaged and becomes the analyst the patient needs. A case is offered as an account of analytic work that was enhanced and made possible by my engaged but unobtrusive presence, and the privileging of the patient's own idiom, object relating and early developmental needs. I offer a contemporary rendition of regression that encompasses mutuality, regulation and accompaniment. I suggest a concept of “benign regressive mutual regulation” and outline and differentiate some of the influences from the contemporary psychoanalytic field.     

The unfolding and healing of analytic boundary violations: personal, clinical and cultural considerations

Jungian analysts are not exempt from an unconscious engagement in a group complex. The author hypothesizes that there is a silent, dark legacy of belief in the superiority of men's judgment and the inferiority of women's, left by Jung, that has had a wounding impact on some Jungian analysands. Conscious and public mourning may be needed to heal our cultural complex. The author, a woman, traces the origins of her own patriarchal complexes and reveals how in her first analysis these mingled with the patriarchal complex shared by Jungian institute, her two male analysts and their former analyst, a pillar of the institute's community. Her first analyst aborted her analysis to begin a personal partnership with her. Her second analyst unconsciously colluded with the first analyst in not exploring this outcome as a violation. This resulted in a second compromised treatment. The senior analyst who had been these two analysts' own analyst was consulted, and he too failed to address the transgression. After experiencing severe symptomatology, the patient entered a third analysis with a woman where transference and regression were the focus. Eventually, meaning was found in the confrontations with the particular Jungian organization and its ethics committee, who acknowledged the first analyst's behaviour to be unethical. The author sees this process as a paradigm for the enactment and healing of a group complex.     

Transcendence,transmission and transformation: the transcendent function in infant observation

Abstract: This article discusses the activation of the transcendent function as it operates through a series of complex parallel processes occurring within a Tavistock Model Infant Observation Group whose location is Palo Alto, California. We follow the observer, a seasoned female analyst, through her final two observations as she is caught initially in the central family complex that does not allow for a conscious ending to this three‐year observational period. Subsequently through the work of the transcendent function within the group, a discussion of the observer's ensuing paradoxical enactment takes place as we watch how this observer becomes able to help the family reach a termination not previously possible. Moving within a dynamic field that includes the infant observation group, the observed baby and his family, we experience the numinosity of the transformation that is activated. We will explore the ongoing encounter between the group mind, the observer and the observed as mutations within this dynamic field enable a genuine experience of mourning that has a profound effect on the observed baby and family.     

Field of Vision: Radical Uncertainty and the Analyst's Conduct: Commentary on Paper by Donnel B. Stern

There is a relationship between biography and theory. The analyst's ideas or formulations about his patients—theories really—must be determined, to some degree, by the certain and uncertain impact of his own history. Harry Stack Sullivan brought psychoanalysis squarely into the ambit of the relational/historical world by insisting that the mind is thoroughly and inherently social. In doing so, he staked a claim for the link between history, that is, social experience, and personhood. Our personalities and our theories are social-historical constructions. In relation to this, some differences between the interpersonal/relational and Bionian concepts of field theory are provided. One important difference pertains to the role of the analyst's conduct. Two meanings of conduct—to behave or to organize behavior—are at the center of what distinguishes the interpersonal/relational view of the analyst's position in the field from the Bionian view. For the relational analyst, action in the analytic field, including enactment, is conduct, and conduct is always bidirectional. The analyst, then, is a medium to alter, to reconstruct the self. He does not provide experience, he is experience. The form of an analytic exchange gives shape to the field and its content.     

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience-for which both and neither of the members of the analytic pair may claim authorship-in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.     

Self‐disclosure,trauma and the pressures on the analyst

This paper argues that self‐disclosure is intimately related to traumatic experience and the pressures on the analyst not to re‐traumatize the patient or repeat traumatic dynamics. The paper gives a number of examples of such pressures and outlines the difficulties the analyst may experience in adopting an analytic attitude – attempting to stay as closely as possible with what the patient brings. It suggests that self‐disclosure may be used to try to disconfirm the patient's negative sense of themselves or the analyst, or to try to induce a positive sense of self or of the analyst which, whilst well‐meaning, may be missing the point and may be prolonging the patient's distress. Examples are given of staying with the co‐construction of the traumatic early relational dynamics and thus working through the traumatic complex; this attitude is compared and contrasted with some relational psychoanalytic attitudes.