“With you I’m Born Again”: Themes and Fantasies of Birth and the Family Circumstances Surrounding Birth as These are Mutually Evoked in Patient and Analyst

Themes of birth and rebirth, being born and born-again, can be readily observed in clinical psychotherapy and psychoanalysis even as they remain undertheorized. A clinical case is presented that traces the first four years of an analysis as seen through the lens of four consecutive supervisory experiences. This paper explores the central importance of fantasies and narratives of one’s origins and birth and the observations, fantasies, and expectations generated by one’s family circumstances at the time of birth. The paper examines birth narratives, fantasies, and myths of origination by following a clinical case across four supervisions. The patient’s birth-related fantasies are shown to interact with the analyst’s concordant and complementary fantasies as the analyst interacts with a series of supervisors in the process of being born as an analyst. The analyst’s personal birth narrative is linked to his fantasies about being born professionally as an analyst, and these are shown to interact with the patient’s birth fantasies. The paper suggests the ongoing significance of unconscious fantasy within the framework of contemporary relational psychoanalysis.     

Self-criticism and unconscious grandiosity: transference-countertransference dimensions

The problems posed in understanding and working through the patient's layers of self-criticism are challenging for both patient and analyst. In particular, this paper explores some countertransference phenomena related to underlying grandiosity embedded in self-criticism. For patients who are self-critical, analyzing grandiose elements may create further grounds for self-reproach or open up new modes of self-experience and freedom. The paper tries to focus on how the analyst's experience of the patient's self-criticism often shifts over the course of analytic work. It is important for the analyst to not be crippled by a fear of considering the relevance of underlying grandiosity in relation to self-reproach. Understanding this dimension of self-reproach can help elucidate why it is so durable and refractory to interpretation. The patient has a stake in holding on to this self-punishment because it perpetuates self-regulatory fantasies. These fantasies sometimes relate to the feeling that the patient will be more successful or better loved by holding on to aspects of self-reproach. Sometimes these fantasies are based in competitive or dominant strategies related to winning out or retaliating over parents or siblings.     

Psychoanalysts' multiple relational perspectives

The specific contribution of the person of the analyst--his or her attitudes, fantasies, and entire range of emotional responses to the patient--have become the subject of much investigation in psychoanalytic literature. This paper describes the phenomenon of distinct and sometimes contradictory self-experiences in analysts that develop as part of the moment-to-moment process of a predominantly adaptive coping mechanism. It is suggested that at any given point, the analyst's perspectives (reflecting various self-states), like those of the patient, are multiple, and that the analyst "choose" to place one such perspective at the center of experience. By choosing a certain self-state, the analyst can adopt, for example, a warm and loving stance with a regressed and demanding patient, or become harsh (e.g., setting boundaries, ending a session) with one who seeks affection and protection. This paper also suggests that the capacity to move between versions of self-states, to see them as complementary even when they are paradoxical, promotes a deeper understanding of paradoxes in the personality of the patient. Only when the analyst maintains a dialogue between various dissociated aspects of his or her analytic experience can a dialogue of this kind begin in the patient.     

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.     

On ugliness

Ugliness results from the emergence into consciousness of certain fantasies that alter the person's aesthetic sense in such a way that the formal qualities of the experience, the shape, texture, and color, appear to become the sources of our most disturbing and repulsive feelings. This paper reviews the psychoanalytic writings concerning the problem of ugliness and offers a psychoanalytic model of this universal phenomenon. Clinical vignettes illustrate key points. The paper closes with a discussion of how ugliness can be an opportunity for both the analyst and the artist--he or she confronts ugliness, and through the analytic and creative process, brings form and perfection to disintegration and disorder.     

The Imp in the iPhone

ABSTRACT

A case vignette involving contemporary communications technology—an iPhone, a computer, digital photos, and Skype—suggests that unconscious communications are not only repetitions of the patient’s ongoing experience and dynamics, but may also be prospective, expressing emerging emotional and psychological potentials that were previously unavailable to the patient. These communications may also provide direction for the treatment via the analyst’s countertransference fantasies and responses. It is also suggested that these bidirectional communications are shared between patient and analyst through an unconscious field akin to what Jung posited as a collective unconscious.     

The Analyst's Anticipatory Fantasies: Aid and Obstacle to the Patient's Self-Integration

In this paper I explore instances of enactment related to the analyst's feelings and fantasies about how analysis will proceed. As I discuss a patient who was developing a new capacity to experience conflict, I explore how the analyst's fantasies about the impact of his interpretations may be utilized in helping him to elaborate and understand the patient's unconscious fantasies and identifications and unintegrated feeling states. In so doing, we sometimes discover how we are unwittingly influencing or avoiding understanding our patient's own version of their psychic catastrophe. As we develop language where there was previously no integrative language for the patient's internalized and interactive version of catastrophe, we always project particular kinds of expectations into the therapeutic situation.     

Mit Imagination an Albträumen arbeiten

According to Jung fantasies appear during sleep as dreams and while awake, they appear as more or less conscious fantasies. He understood fantasy as an activity of the psyche itself. Fantasy is that which simply occurs without any effort on our part and is always present. Imagination is what we call fantasy when we concentrate on it, i.e. perceive it and do something with it. Due to the close relationship of dreams, fantasies and imagination, the more they are consciously observed and perceived, the more it is possible to use imagination with dreams to better understand them. This is especially true for nightmares so that through imagination helplessness can be overcome and self-efficacy can be stimulated. Steven Starker already proposed using imagination for working on nightmares in 1974 and he also showed how the style of the nocturnal dreams changed as a consequence. In a clinical vignette I show how this technique can be used and what an influence it has. The analyst and analysand are in a communal space of visualization, framed in the beginning by the nightmare. This space is considered as a space of interaction and of potential transformation. The analyst is a part of the process, offering ideas in a symbolic form and reinforcing the analysand’s ideas which lead to stress-reducing behaviour and images that provide an opening for the future. There are pauses in the imaginative work to talk together about the experiences, to link the situation in the imagination to biographical material, and to understand the resources opening up in the material, through the analysand herself. The goal of working with imagination is to ban the anxiety in the dream and to let the dreamer experience the fact that dreams and imagination are not only determined by the anxious feelings but it is also possible to transform these kinds of energy into creative fantasies.     

On Time and Deepening in Psychoanalysis

The metaphor of depth has most often been used in analytic thinking to denote extension in space or time. Depth, and its companion term deepening, may also be used to describe quality rather than distance; something is deep when it is serious or important. The deepening of analysis is linked to temporality but not in a linear way. Analysis deepens as it sets in motion a series of changes in the experience of time: The past comes alive and is worked through. Past and present come into a new relation with one another. The analytic frame and the rhythm of the exchange between patient and analyst also bring to life past experiences and fantasies to do with time. Both patient and analyst must enter a fluid time-state in order for deepening to occur. Clinical examples illustrate these dimensions of temporal experience and the way they emerge in the deepening analytic process.     

No Turning Back

ABSTRACT

It has been 16 years since the publication of my article, “Infertility in the age of technology: From frozen sperm to egg donation.” Today I would title it simply “Fertility in the age of technology.” In that article, I presented Diana, an analytic patient in her middle forties, who became a mother through implantation of a donor egg. Her journey to parenthood was fraught with physical and emotional trauma partly as a result of ever more high-tech and invasive treatments. The purpose of my 2000 article was to discuss the anxieties that the then new biotech treatments caused for both patient and analyst. I stated, “What makes this unique for the analytic process is that we analysts must confront our own anxieties and the underlying fantasies stimulated by the new procedures at the same time as we are helping our patients analyze theirs. Patient and analyst alike become inextricably linked in an exploration that will ultimately have a profound impact on both participants. Regardless of theoretical position, we become a part of the process, willingly or not” (Blum, 2000, p. 1543). Now, in this article, I look beyond the consulting room. I reflect upon the relationship between societal influences and technological advances and their integration into psychoanalytic theory.     

What’s So Great About Authenticity Anyway? The Therapeutic Function of an Analyst’s Lie

How can we understand moments when the analyst lies to her patient? When it’s not the patient’s lying at issue but the analyst’s? When we suddenly find ourselves being deliberately disingenuous in the analytic hour? When our commitment to authenticity conflicts with the patient's need to create and sustain certain fantasies about us? Psychoanalytic literature typically focuses on the dynamics of the patient’s lie but rarely is the analyst's authenticity questioned. Are there times when the analyst might choose to lie in order to preserve herself, as well as, the relational bond? The complexity of this “choice” is explored and the erosion of an analyst’s authenticity unpacked during the final days of a difficult treatment.     

Perverse modes of thought

Subtle, nonpsychotic disturbances in thinking may cause significant impairment of intellectual functioning and interfere with a patient's capacity to make use of psychoanalytic treatment. As these come under interpretive scrutiny, the intellectual exchange between patient and analyst may emerge as a theater for the enactment of perverse sexual fantasies. In this paper, the author describes these disturbances in thinking and proposes a model that explains their underlying structure and their link to the associated fantasies. Interpretation and working through of the condensed part-object and whole-object transferences that emerge in the analysis of these forms of thinking may lead to some measure of clinical improvement.     

Paranoid character and the intolerance of indifference.

This paper suggests that aspects of paranoid character are structured around fantasies of magical and concrete connectedness to objects; these fantasies serve to avoid the terrors of object inconstancy. The authors describe how these fantasies are expressed in the psychoanalytic situation and explore their relation to common paranoid phenomena. The paranoid person must maintain these fantasies of connectedness at all cost or risk experiencing unbearable indifference between self and object. Paradoxically, the sacrifice of self and object boundaries inherent in these fantasies makes object constancy even more difficult to achieve because of the secondary defensive use of anger mobilized to protect the boundaries of the self.     

Playing one's cards face up in analysis: an approach to the problem of self-disclosure

A policy of consistent willingness on the analyst's part to make his or her own views explicitly available to the patient is discussed and illustrated by clinical vignettes. Playing one's cards face up is contrasted with contemporary conceptions of selective self-disclosure by the analyst, especially with respect to the way ground rules for the analytic treatment relationship get established. The objective of the analyst playing his or her cards face up is to create a candid dialogue, thus facilitating maximally effective collaboration between analyst and patient. Concerns about the analyst's self-disclosure foreclosing exploration of the patient's unconscious fantasies and transferences, or intruding upon the patient's autonomy, are addressed, as is the relation between self-disclosure and an individual analyst's personal style.     

The other between fear and desire – countertransference fantasy as a bridge between me and the other

This paper attempts to show how unrepresented rupture/injury of primary expectations of the early relationship is reactivated in the analytic process. This becomes perceptible especially as unconscious fear and a specific defence described as ‘living behind a glass-wall’. The author, however, postulates the existence of an inherent dialogical-dyadic principle in the psyche, which she calls archetypal hope, and shows how this principle may become active in the analytical space. These aspects of analytical treatments are sketched with two vignettes, in which unconscious processes of exchange cause the analyst to experience unrepresented states. The author describes how the analyst is gradually able to experience and understand this, and how this understanding finally – without first becoming explicit – becomes effective in the analytical space. Special attention is given to the analytic attitude. A readiness to accept and move into regression and a receptivity to attune to the early sensory experience of the analysand is regarded as essential. Through this the analyst gains access to the inner space of the analysand and, through bodily experience and pre-symbolic processes, the unrepresented may thus become figurable. The reverie and countertransference fantasies are understood as a bridge: they connect the analytic pair. However, the reverie also creates the transition between that which was not – the absent representation – and that which wants to emerge. It thus bridges the personal unconscious (implicit expectation) and the archetypal (the archetypal hope). Through this, the space of hope may become a space of possibility, and help bridge the chasm between the experienced and the hoped-for.     

Das Drama des begabten Kindes und die Suche nach dem wahren Selbst

The clinical material for this study of female fantasies stems from a specific psychoanalytical situation where the analyst and the analysand are pregnant at the same time. The impact of this situation is powerful. The emergence of archaic fantasies is facilitated in transference and countertransference. Fantasies of damage to the baby or to the procreative function may emerge very vividly in the double pregnancy setting and working through these fantasies becomes possible. It is suggested that these fantasies are typical female castration fantasies and manifest the fear of the mother's revenge and punishment for forbidden oedipal wishes. The double pregnancy setting may sensitize the analyst to her pregnant analysand's unconscious communication and yet blind the analyst in some areas to the protection of her own baby. The duality of phallic strivings in the girl's psychosexual development is discussed. They may be employed as a defense against specific feminine anxieties, such as fear of retaliatory attacks on her inner space and its fertility: the female castration anxiety. They may also be constituents of her sexuality, coexisting with inner genital strivings. The co-existence of phallic and inner-genital strivings in the female psyche is always conflictual.     

Individuation: finding oneself in analysis--taking risks and making sacrifices

This paper looks at some of the processes that are at work in finding oneself in analysis. It explores Jung's unique contribution to our thinking about the self and its dynamic of individuation. The author attempts to show how the Self, in its quest for consciousness, requires the surrendering of ego inflation--the narcissistic delusion that the ego is the self. A case is made for seeing analysis as an individuation process which offers the opportunity for experiences of a more authentic sense of oneself. Jung stated that individuation requires the ego to enter into service of the Self. For this to happen, the author argues that both patient and analyst must be prepared to make sacrifices and take risks. Using clinical examples, he illustrates that, although purposive, the Self can be experienced as violent and destructive if the ego is unable to facilitate its expression. This may result in an individuation crisis for both analyst and patient. The paper demonstrates how impasse in analysis can evoke the transcendent function, which also requires sacrifices to be made and risks to be taken for analysis to proceed.     

The imaginer and the imagined

A transference of the imaginer and the imagined, arising from largely unconscious fantasies of the way parent and child interact to construct a view of reality, is present in all analyses. For narcissistic patients, primitive fantasies of the imaginer and imagined form an enduring organization, and the enactment of these fantasies in transference and countertransference distorts the way analyst and patient construct meaning. Clinical material demonstrates the deepening that occurs when these fantasies are interpreted.