Analytic impasse and the third: Clinical implications of intersubjectivity theory

The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifi cally, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-refl ection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specifi c modifi cations of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality.     

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.     

The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

Dramatology in life,disorder, and psychoanalytic therapy: A further contribution to interpersonal psychoanalysis

Abstract

Action and interaction, and emotion and thought as the inner wellsprings of action, play a central role in the lives of individuals, families, and society, spanning the continuum between everyday life and disorder. Until now, the narrative tradition has been the main methodology for portraying and formulating human action and interaction, and little has been written about the dramatic approach to life, disorder, and therapy. Since the essence of drama is action, dialogue, character, and emotion, it is time to give drama its due. The author proposes a methodological concept – dramatology – analogous to narratology, to highlight the dramatic method of investigating action and interaction in life, disorder, and therapy. Breuer and Freud presented both aspects of dramatology: dramatization in dream and fantasy, and dramatization in act, focusing on the person. This approach was elaborated by psychoanalysts with an interpersonal orientation, focusing on the person and speech as action. Dramatology is applied to exploring ongoing patient–therapist interactions as reality and as transference. Analyzing unconscious and latent dramatization in dream, fantasy, and enactment with free association is enhanced by utilizing clarification and confrontation, focusing on the manifest and mutually observable expressive form and style of actions and enactments, defenses and resistances, and the discharge and meaning of emotions. Dramatology puts forward a new paradigm for psychiatry, psychotherapy, and psychoanalysis.     

Developmental trajectory of intersubjectivity in the second and third year of life: Study of fixed-population and random-individual effects

Colwyn Trevarthen claimed that babies have an intrinsic motivation to communicate and engage with others that he called intersubjectivity. Around the ninth month of life, this motivation changes and passes from person-to-person dyadic (primary intersubjectivity) to triangulate a person–person–object relationship (secondary intersubjectivity). Despite the scientific consensus on this developmental leap, few empirical studies explore the trajectory of this more complex form of intersubjectivity between the second and third year of life. One hundred and fifteen free play sessions from 27 mother–child dyads (13 girls and 14 boys) between 9 and 37 months were filmed and were categorized based on the Level of Intersubjective Attunement Scale. The data were analysed using a linear mixed-effects model. Results show both a population trajectory of the levels of intersubjective attunement and random individual differences. We discuss these results in relation to the binomial typical developmental route and interindividual variability.     

Taking time: the tempo of psychoanalysis

In this article the author argues that in order to be psychoanalysis, the 'here and now' technical approach needs to be firmly grounded theoretically and technically in a practice that includes the notion of reverie or its equivalent. The author has argued previously that the analyst's theory is the essential 'third' of the two-person analytic situation. She now suggests that it is specifically the theories of temporality and the attitude of 'evenly suspended attention' or its more contemporary development, 'reverie', that are the crucial aspects of that theory. She refers to these essential aspects as the 'theory in practice' in so far as they are more than a technical approach or a theory of practice but reflect directly a particular analyst's internalisation of the whole psychoanalytic theoretical corpus. While she believes this to be an essential component in any true psychoanalysis, in developing her argument the author looks at situations in which the analyst is particularly prone to forgo this temporal aspect, as is the case when patients show an absence of symbolic thinking within the analytic situation. In fact, with those patients reverie and the visual images it produces within the analyst's mind offer perhaps the only hope of a meeting ground between the concrete and the symbolic and the possibility of avoiding an impasse. Impasse, she suggests, has at its root the absence of reverie as a third and temporal element, inevitably giving rise to concrete thinking on the part of patient and analyst and so to a situation that cannot evolve.     

The analyst's theory: A third source of countertransference

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory - because it has no intrinsic relevance to the essential phenomena of individual analytic processes - may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.     

The concept of privilege: a critical appraisal

In this essay, I examine the use of the concept of privilege within the critical theoretical discourse on oppression and liberation (with a particular focus on white privilege and antiracism in the USA). In order to fulfill the rhetorical aims of liberation, concepts for privilege must meet what I term the ‘boundary condition’, which demarcates the boundary between a privileged elite and the rest of society, and the ‘ignorance condition’, which establishes that the elite status and the advantages it confers are not publicly recognised or affirmed. I argue that the dominant use of the concept of privilege cannot fulfill these conditions. As a result, while I do not advocate for the complete abandonment of the rhetoric of privilege, I conclude that it obscures as much as it illuminates, and that the critical theoretical discourse on liberation and oppression should be suspicious of its use.     

Regulation and standards for psychoanalysis: The place of the Other in psychoanalysis and its teaching

In numerous Western countries, psychotherapies have come under increasing governmental regulation. A more recent development is the increasing scrutiny given to psychoanalysis in the United Kingdom, in France, and in the United States. This paper examines a particular document that was created by four professional psychoanalytic organizations that are based in the United States. The document called Standards of Psychoanalytic Education aims to develop criteria that would guide accreditation and the organization of psychoanalytic institutes. The document is part of a set of concerns and actions related to the state regulation of psychoanalytic practice, its professional status, and the protection of those who seek its services. The essay examines the putative theoretical neutrality of this document by unfolding its tenets in terms of Lacanian psychoanalysis, a school of psychoanalysis that would take exception to many of the ideas suggested in the document's template for psychoanalytic education. The paper follows one line of argumentation throughout: what is the place of the Social Field, the Symbolic Other, within psychoanalytic process and as a recourse for professional legitimization that stands outside of psychoanalysis? As a practice of particularity, what relation does the discipline bear to other mental health fields and to the norms and knowledge systems of the mental health professions? Using a Lacanian orientation, two senses of the Other are discussed, and the specificity of psychoanalysis is asserted. This specificity is contrasted with some of the goals and constraints that are introduced by current approaches to regulation.      

Self and Other in Communication and Cognition: The Role of Auto-Communication and Intersubjectivity in Autopoiesis of Psychic Systems

By referring to Niklas Luhmann’s theory of self-referential systems, Aldo Mascareño (2008, submitted for publication) gives an account of system-environment interrelatedness, explaining how social and individual constitute each other through the process of communication and co-creation of meanings. Two possible extensions to his account are discussed. Firstly, auto-communication within the system that happens without any external reference needs to be taken into account while describing the existence and constant re-creation of psychic systems. Secondly, in order for the system and environment or two systems to communicate, an imagined and temporary intersubjectivity between the two needs to be assumed.     

Enactment controversies: a critical review of current debates

This critical review of the current disputes concerning countertransference enactment systematically outlines the various issues and the perspectives adopted by the relevant psychoanalytic authors. In the light of this the 'common ground ' hypothesis concerning the unifying influence of contemporary countertransference theory is challenged. While the existence of enactments, minimally defined as the analyst's inadvertent actualization of the patient's transference fantasies, is widely accepted, controversies regarding the specific scope, nature, prevalence, relationship to countertransference experience, impact on the analytic process, role played by the analyst's subjectivity, and the correct handling of enactments abound. Rather than taking a stand based on ideological allegiance to any particular psychoanalytic school or philosophical position, the author argues that the relative merits of contending perspectives is best evaluated with reference to close process scrutiny of the context, manifestation and impact of specific enactments on patients' intrapsychic functioning and the analytic relationship. A detailed account of an interpretative enactment provides a context for the author's position on these debates.     

The development and organizing function of perversion: the example of transvestism

Perversion had been viewed as oedipally determined and in a reciprocal relationship with neurosis. In our widening scope, however, pre-oedipal and traumatic contributions have been increasingly emphasized. While both perspectives represent aspects of clinical reality, the tendency has been to overlook sexual and aggressive drive derivatives, with their related conflicts, object representations, and symbolic enactments, even though they may make significant contributions to the analytic situation. These latter, 'classical' patients have what I consider 'organized' perversions: complex, evolved, neurotic-level, stable psychopathological formations that may be distinguished from borderline or near psychotic syndromes enlisting perverse mechanisms to ward off disorganization. This paper will review Freud's work, briefly consider some recent trends in conceptualizing perversion and perverse mechanisms, characterize organized perversion, and present clinical material to illustrate its evolution, clinical manifestations, and analysis. Transsexualism, overtly similar to transvestism but not functioning as an organized perversion, will serve as a point of contrast.     

The ‘too muchness’ of excitement: Sexuality in light of excess,attachment and affect regulation

This paper brings together contemporary thinking about early attachment and affect regulation with our clinical and theoretical understanding of the problems of adult sexuality. In addition to recent theories of affect regulation and attachment, we incorporate Laplanche's idea of ‘excess’, which was an important transitional concept integrating real experience with fantasy in sexuality. We elaborate the idea of excess –‐ ‘too‐muchness’ –‐ to illuminate the early overwhelming of the psyche that affects the formation of sexuality. Linked to recent theoretical developments, this idea helps to grasp the relationship between sexual excitement and early affect regulation, showing how excitement becomes dangerous, thus impeding or distorting desire. The ‘too‐muchness’ of excitement recalls the experience of being a stimulated, overwhelmed, unsoothed child and influences later inability to tolerate sexual arousal and the excitement affect. A clinical case illustrates this connection between attachment trauma, anxiety about sexuality, as well as shameful experiences of gender identity as an area of trauma. We emphasize the importance of working through the terrors and desires of the mother–baby relationship as they emerge in the transference–countertransference in order to develop the ability to hold excitement and stimulation without experiencing the too‐much as the intolerable. This includes the working‐through of ruptures related to overstimulation as well as the delicate balance of attention to fantasy and intersubjective work in the transference.