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.     

The analyst's insights

The patient's fresh perceptions of himself come through mutative work shared with the analyst in the focused intimacy of their interaction. In finding transferential expectancies realized, the patient can experience these as yet different, providing he has the analyst's optimal participation. In this concurrence of crucial differences he can discount and discard the old perceptions that had shaped his psychic reality, and build out of them fresh insights. The analyst's regressive lapses in his best work are a liability inherent in the compromise formations comprising his work ego, built as it is out of the needs and motives of his own transferential past. The stagnation and tensions his regressive transferences contribute to the analytic work produce vivid actualization of the intrapsychic conflicts of both, now intertwined and mutually reinforcing. The analyst's self-analysis at such times can lead to resolving insights about himself that redress the impasse and restore the analytic work both must do.     

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.     

ACUTE ENACTMENT AS A 'RESOURCE' IN DISCLOSING A COLLUSION BETWEEN THE ANALYTICAL DYAD

The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the 'natural history' of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.     

The wish to regress in patient and analyst

The analyst's wish to regress is used as a paradigm of the "forbidden" topic of what analysts want from their analysands. The aim is to expand the subjective domain of analysts' awareness so that they can analyze better by grasping more of their temptations with patients before enactment can occur. Clinical examples illustrate how the author temporarily joined patients in wish-fulfilling mutual regression. Analytic process is disrupted when the analyst wishes to relinquish the more differentiated role of the containing and interpreting analyst in favor of more childlike relatedness both with the patient and with the analyst's internal objects. The author, expecting a more typical counter-transference, had not anticipated that he might temporarily join these nonpsychotic patients in mutual regression. It is suggested that in the face of analytic impasse analysts should consider whether they might temporarily have joined the patient in mutually regressive wishes that have taken them away from more responsible analytic functioning.     

The play of transference: some reflections on enactment in the psychoanalytic situation

The incessant play of nonverbal activity between patient and analyst actualizes and amplifies the primary verbal data of the psychoanalytic dialogue. Both parties must inevitably register this kinesic level of communication, and react with capacities acquired in and elaborated from earliest childhood. The analyst's apperceptive (unfocused) looking, as part of his freely hovering attentiveness, utilizes these capabilities gradually to perceive and organize patterns combining the verbal and nonverbal data. It is through the recognizing and eventual understanding of these gestalts that the analyst builds up his knowledge of his patients. In these patterns can be identified: (a) conspicuous behaviors, idiosyncratic for the individual, which often yield to psychoanalytic inquiry to reveal their dynamic-historical antecedents; and (b) inconspicuous background kinesics, habitual to the individual, which ordinarily are opaque to analytic exploration, yet hold rich meaning. Observing these small behaviors in relation to verbal content provides evidence of their linkage to, and enactment of, pregenital- and genital-level conflicts over diadic and triadic object relations, even in highly structured personalities. These enactments combine elements of play, miming, and drama to constitute an experiential dimension that actualizes and externalizes the patients' inner life of conflict and relation to objects.     

Prozedurale Faktoren in der psychoanalytischen Behandlung

The traditional concept of acting out was redefined in the context of intersubjective approaches as enactment. When a resistance was previously recognized in the analysis of classical neuroses that had to be resolved for a promising analysis, in enactment the creative preverbal expressions of covert procedural experiences can now be recognized, which become revealed in regressive states and in structural disorders. They create scenes of preverbal communication in which the analyst becomes involved in the inner world of experiences. This has a strong reparative potential. It can be utilized for new experiences and development if the analyst becomes entangled in such scenes as a co-actor, accepts the relationship offer of the patient and contributes to solutions for the entanglement; however, this requires something more comprehensive than the traditional defensive concept of transference. It emphasizes in particular the activity of the analyst and its impact on the formation of the analytical process and recognizes the involvement of the analyst as a constitutive factor in the process of his own transference. Thus, a new definition of abstinence in terms of a selective abstinence is achieved, which is nowadays characteristic of the developmental approach in psychoanalytic treatment.     

From Resistance to Analytic Truth

“Resistance” in psychoanalysis from its inception has meant the patient’s opposition to and interference with the analytic process that must be followed to resolve the patient’s neurosis. This concept of “resistance” implies the analyst possesses an objective truth about the patient and the therapeutic action of the process. Without that assumption, the concept itself is meaningless. It is argued that the concept of objective truth is inapplicable to any study of the human process, such as psychoanalysis, so resistance is not a defensible concept for the field. However, the commonly proposed alternative, relativism, leads to solipsism and therefore is also not a viable epistemology for psychoanalytic investigation. The concept of analytic truth is proposed as a third way that avoids the pitfalls of both objectivism and relativism. It is argued that when the patient opposes what the analyst regards as a self evident truth, an especially difficult type of enactment is occurring. The clinical approach to extricating the analytic pair from the strangulated enactment of clashing viewpoints is illustrated with the case of a young man who “never got angry.”     

The educational boundary1

In this contribution, the authors defi ne and discuss the educational boundary in analytic training, which they believe is an often neglected and useful concept in psychoanalytic education. The framework on which their discussion rests includes the recent attention of psychoanalysts to issues of boundaries and ethics. Their understanding of how clinical work affects the mind of the analyst educator, as well as the ways the personalities of various analysts affect their dealings with faculty peers and students, are the other cornerstones of their discussion. The authors contend that many of the institutional problems encountered in the training of analysts can be better understood when viewed through the prism of the educational boundary. They present examples which illustrate several of the ways psychoanalytic educators complicate the training experience of candidates, offer specifi c explanations as to why analysts struggle as they try to manage their educational interventions, and indicate in a discussion of potential remedies that those behaviors might be avoided if the educational boundary is in focus. They also provide an example of how the educational boundary can be more effectively managed.     

Privacy, reverie, and the analyst's ethical imagination

The author illustrates varying ways of using and thinking about forms of analytic reverie and the analyst's privacy. He discusses a few different registers from which the analyst can illuminate points of transference-countertransference enactment. The modality by which the analyst communicates these formulations of unconsciously held object relations and defenses varies and includes verbal interpretation through symbolic speech, interpretive action (Ogden 1994a), and, at times, interpretations that involve a construction of the analyst's subjectivity put forward to enhance the patient's understanding of enactments of the transference-countertransference. The author develops a concept, the analyst's ethical imagination, defined as the ways in which we consider and anticipate the implications of our interpretations.     

Enactments: an intersubjective perspective.

We offer a critique and synthesis of classical and interpersonal views of enactment. From an intersubjective standpoint, the study of enactment leads to a reconsideration of the nature of the psychoanalytic process. And enactment becomes virtually synonymous with the psychoanalytic process. Enactments are interactions of analysand and analyst with communicative and resistive meanings that lead to valuable insight and can constitute corrective emotional experiences. Enactments that are recognized and defined become valuable dramatizing moments that have condensing, clarifying, and intensifying effects upon consciousness. The inevitable participation by the analyst in enactment is compatible with appropriate analytic discipline. A case will demonstrate these points.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in the analytic process.     

Elements of analytic style: Bion's clinical seminars

The author finds that the idea of analytic style better describes significant aspects of the way he practices psychoanalysis than does the notion of analytic technique. The latter is comprised to a large extent of principles of practice developed by previous generations of analysts. By contrast, the concept of analytic style, though it presupposes the analyst's thorough knowledge of analytic theory and technique, emphasizes (1) the analyst's use of his unique personality as reflected in his individual ways of thinking, listening, and speaking, his own particular use of metaphor, humor, irony, and so on; (2) the analyst's drawing on his personal experience, for example, as an analyst, an analysand, a parent, a child, a spouse, a teacher, and a student; (3) the analyst's capacity to think in a way that draws on, but is independent of, the ideas of his colleagues, his teachers, his analyst, and his analytic ancestors; and (4) the responsibility of the analyst to invent psychoanalysis freshly for each patient. Close readings of three of Bion's 'Clinical seminars' are presented in order to articulate some of the elements of Bion's analytic style. Bion's style is not presented as a model for others to emulate or, worse yet, imitate; rather, it is described in an effort to help the reader consider from a different vantage point (provided by the concept of analytic style) the way in which he, the reader, practices psychoanalysis.     

Self-Coherence and Mutuality in the Analytic Dyad: Commentary on Michael Shoshani (Rosenbaum's) Dare to be Human

Michael Shoshani (Rosenbaum's) book Dare to be Human lays bare Michael's emotional relationship with his patient Daniel. Initially, Michael's early childhood relational behavioral patterns are evoked by Daniel's extreme emotional detachment and rejection of Michael as a person. Both analytic partners experienced extreme boundary violations as children in the form of violent beatings, Michael by his father and Daniel by his mother. Michael's mother was overbearing like Daniel's. Both, highly sensitized to intrusions and perceived slights by the other, remain locked in a doer/done to dynamic until Michael successfully breaks through the enactment by learning to stay with Daniel's distress, contain and regulate his own hurt feelings, and provide more space in the relationship by shifting to four times a week and moving Daniel to the couch. Through this process both analytic partners feel safer with each other, deepen their understanding of their own internal object world, and feel intimately engaged with each other. Daniel's life outside the analysis parallels his success in the analytic relationship.     

Begin the Beguine: Relational Theory and the Pluralistic Third

Different clinical theories valorize particular aspects of clinical understanding. The author describes the need for analysts to hold themselves accountable through thinking about the blind spots that result from prizing these particular lenses. He explores the concept of the pluralistic third, which aims to think about clinical work with the use of theory external to our own. In examining the very beginning phase of an unusual analysis, he tries to examine particular aspects of his work including survival as an object for the patient, analytic play, and enactment. Even among relational analysts there are profound differences in how we interpret and make use of countertransference, particularly our disjunctive subjectivity from that of our patient. These differences point to the value of asking particular questions regarding how to hold ourselves accountable within the analytic process.     

“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 ‘living dead’ — Survivors of torture and psychosis

Regardless of all differences between patients who have suffered from psychotic breakdowns and those with the sequelae of torture, our experience have shown that some common features can be recognized. We can attempt to understand patients' experience of being ‘living dead’ in terms of regression to the ‘psychotic core’ in the personality, and in terms of actualisation and enactment of archaic relations to primary objects. The major difference between thee two categories of patients deals with a located, limited, and concrete traumatic event in the life of the torture-survivor, whilst in the schizophrenic individual the trauma also emanates from within through own destructiveness and rage. Regressive forms of relations toward distorted, aggressively cathected and persecutory primary objects are reestablished in both cases, leading to a more or less stable reorganisation of the ego. Difficulties in psychotherapy with schizophrenic patients and torture-survivors are here discussed as a consequence of the patients' persistently holding onto the distorted and regressive forms of relating to primary objects, when the projections of the patients' own destructiveness and hate is followed by a strong tendency to symbiotic merging.     

Anerkennung als interaktionelles Moment der Psychoanalyse*

After having developed a theory of appreciation in more detail in an earlier article (Daser 2003), the author examines now the phenomenon of appreciation in the practice of therapy. First, appreciation is presented as a value-ascribing act, strengthening the self-confidence of the patient and lowering his relationship-anxiety, thereby allowing him to reduce his defence and to get involved into the analytic process. Appreciation seems to be on the one hand an effect of the analytic method, but on the other hand it may be connected to interventions which seem to contradict this method. Such interventions assume therefore a fostering quality for the self-experience of the patient and, consequently, for the analytic process. This effect will be demonstrated here on several examples. Further, the importance of appreciation for empathy is elaborated on an example of “play” between analyst and patient as an element allowing the transition from re-enactments to new forms of enactment. At last, the concept of appreciation is related to concepts of Stern as well as of Weiss and Sampson. Appreciation turns out to be an element of that “something more”, Stern requires in his analytic therapy beyond the interpretation. But this “something more” is not only adjuvant for emotionally paving the way to interpretation. Existential appreciation is, in contrast to pedagogic praise, rather a result of triangulation and, therefore, processually correlated with interpretation. Appreciation and interpretation appear as complementarily interconnected moments in the process of self-experience, the formation of the relationship and the moment of insight being inseparably intertwined.