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.     

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.     

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.     

“Presence” and “Absence”: Kaleidoscopic Hide and Seek: Reply to Commentaries

In this reply I respond to Cambray’s introduction of the “self-organizing” and “emergent” qualities of telepathic communication, looking more closely at the relationship between dissociation and the emergence of telepathic phenomena. I highlight the creative aspect of such telepathic “intrusions,” viewing the clinician’s capacity for intuitive imagination as key to the emergence of telepathic material. In response to Eshel’s connection between the analyst’s “presence,” “absence,” and the patient’s unmet need for recognition, I examine the roles of co-construction and mutual dissociation in transference-countertransference enactments that generate uncanny phenomena. Verbal interpretation not always being the most viable mode of communication, “absence” can sometimes serve as a co-constructed, unconscious “solution” to the problem of multiple conflicting needs, holding a space for telepathic emergence to express the inexpressable.     

Receptivity,or Going on (Not) Being: Commentary on Paper by Robert Grossmark

“The treatment hinged on my being able to live with him in this ongoing non-existence and know it and tolerate it, and expect no more,” writes Dr. Robert Grossmark about himself and his patient, Kyle (pp. 637–638). This is a key sentence, outlining the core of the enlightening analytic work done. I comment on the linkage between living the ongoing nonexistence and going-on-(not)-being, then reflect about the distinction between what I call the “outward” technique, which is everything Grossmark describes about treating Kyle, and the “inward” technique, which is all that occurred within him, in an inner, hidden, powerful, unconscious dialogue with the patient, and which is only hinted at. In this context, with patients like Kyle, who bring to the analyst physical sensations and actions for dreaming, the analyst's corporeality, by which I mean his experience of his body and his capacity to connect it to emotion, thereby lending it meaning, has a critical importance. I bring, in a nutshell, references to several psychoanalytic writers about the subject of corporeality in analytic treatment and use a vignette from an analysis to demonstrate the point.     

Masks and Faces in the Setting at the Time of Coronavirus

The “health emergency” forced analysts to seek new ways of continuing with analysis. The article focuses, in particular, on the changes brought about in the setting by the presence of the sanitary mask, following a line that begins with the theme of the “mask” in the collective uses of human cultures, and develops through the Jungian concept of persona, as opposed to the “face” that may convey an authentic image of oneself. A clinical vignette illustrates the issues that the mask raises in the setting by obstructing the communication of emotions. When there is no transformative processing of concrete data, “unmasking” can also lead to an uncanny encounter and to moments of darkness and confusion in analysis, when the analyst experiences the kind of “unconscious identity” between therapist and patient that Jung defined as nigredo. The article is intended as a contribution to the analytic community's current reflections on the new and unforeseen challenges encountered in analysis at the time of the Coronavirus. It is possible to learn from these experiences with a view to integrating new elements and thus modify one's own internal setting, the compass with which each analyst orientates himself.     

On the Royal Road Together: The Analytic Function of Dreams in Activating Dissociative Unconscious Communication

I propose a new analytic function of dreams: the use of dreams to activate powerful forms of unconscious affective communication between patient and analyst, which crucially facilitate the transformation of dissociative mental structure. Moments of what I call dissociative unconscious communication serve to “seek-and-find” the unconscious mind of the analyst and open up channels of unconscious empathy. Such analytic dream communications are particularly likely to occur when certain overwhelming experiences are dominating the treatment: (a) the accessing of dissociated early trauma, and (b) the loosening or crumbling of dissociative structure as the patient begins to come alive.     

David and Goliath: What If He Loses?

ABSTRACT

Infant’s volition has not been explored in healthy development. Our research conducted on the environmental response to infant’s initiatives (Hoffmann, Popbla, and Duhalde, 1998) shows that maternal attitude has a direct correlation with successful development of initiatives in infants aged 4 to 12 months, having implications for the capacities of infants to unfold as much as endowments allow. The opposite also is true. Infants who are more thwarted in the development of their potential initiatives show greater reactivity and conflict in early relationships with the caregiver, impacting the development of a healthy self. These claims will be discussed with proposals made in recent decades by some authors who have focused on the coming together of a self in the first year of life. The ramifications of this early start in one’s life can be credited to Lou Sander, whom we honor in this issue. Sander was gifted with a capacity to see with a “relational eye” and to state it in everyday language, while simultaneously using very sophisticated inventions to validate his assumptions. This work has made it possible to solve the riddle of the David and Goliath story that is part of the miracle of life over death, of love over hate, of health over sickness, which makes (most) mothers able to become good enough or whatever defines a progressive meeting between the infant’s doings with the doings of mothers.     

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.     

A Response to the Contributors

Abstract

In my “response to the contributors” I emphasize that I was moved to write my book in response to the question “Why are so many well-trained colleagues, young and old, having so much difficulty developing satisfying analytic practices?” To answer that question I proposed to explore my experience successfully developing and maintaining an analytic practice.

In attempting to answer the question I inadvertently stumbled upon a revolutionary (with a “small r”) answer to the problem. I discovered, in my attitudes and in my way of working in a consultation and the early phase of an analytic collaboration, a new “concrete puzzle solution” to the problem of how to help a prospective, often reluctant collaborator give analysis a “try.”

My book emphasizes my view that courses on “analyzability” and differential diagnosis are based on psychiatric rather than psychoanalytic diagnostic schema and may interfere with candidates' ability to learn how to create analytic patients.

Since I was a candidate, courses on analyzability have always seemed to me to resemble an exclusive club, deciding whom to exclude and whom to admit, rather than a procedure based on sound clinical experience. Analytic experience has demonstrated that it is not possible in a consultation to predict accurately the outcome of an analysis. To make matters worse, it is probable that an analyst whose mind is focused on the task of evaluating a prospective analysand contributes to creating an environment in which certain patients are experienced as sicker than they might otherwise be.

In spite of the fact that it is not possible in a consultation to predict accurately the outcome of an analysis, many experienced “senior” analysts believe an analyst can and should be evaluative and selective. In their discussions of the subject, they focus primarily on characteristics of the patient rather than the match.

In my book I emphasize that in a consultation there are advantages in focusing on the patient's responses to the idea of engaging in a trial of analysis. The issue of the match and the particular time in their lives are significant from my perspective. The analyst's gender, age, personality, and related state of mind may be as important in effecting the outcome of a trial as any feature of the patient's mind.

My book shifts the emphasis of the focus of inquiry in a consultation from the patient to the analytic couple. It offers a different way of teaching candidates to work with prospective collaborators.     

In dialogue with Daniel Stern: A review and discussion of The Present Moment in Psychotherapy and Everyday Life

Abstract

Daniel Stern's concepts of “present moment” and “now moment,” with impending kairos, are described. In the latter, the patient demands the authentic presence of the analyst. If the analyst can open himself to the patient, he proposes that this will result in more profound changes in the patient's implicit knowing than verbal interpretations in the narrative domain would lead to. The value of intersubjectively relating and dwelling more in the phenomenal than in the narrative dimension is highlighted. A similarity to the works of the existential psychoanalyst Harold Kelman is shown. The author agrees with, but also problematises, a tendency to favour the implicit, devaluing verbal understanding and interpretation, which may result in the patient not seeing the primitive levels in his inner life. For this purpose, works from D. W. Winnicott, Jessica Benjamin and Christopher Bollas, as well as others, are used. The author concludes that object relations and intersubjective theory need to complement each other that further, there is a need to give words to the middle-ground between the phenomenal and narrative dimensions.     

The Wisdom of Sharing a Frame: Commentary on Papers by Anthony Bass and Ilana Laor

In this discussion I agree with Anthony Bass, who shows how the analytic frame has properties that involve both the process and the structure, and I suggest replacing the term structure with the term constraints. Bass considers analytic frames as contexts: Different frames organize different contexts of experience. He says that the frame is cocreated by patient and analyst and evolves over time. I think that Dafna's case presented by Ilana Laor is a good example of this aspect. I agree with Laor, who shows how the frame reflects the negotiation process between patient and analyst, emphasizing that this process itself is therapeutic. Following Bass I emphasize that a polarization between stability versus flexibility should be replaced by the dialectic between stability and flexibility. I conclude wondering how Bass's and Laor's “wisdom” regarding flexibility and elasticity can be passed over to younger psychoanalysts who are beginning their clinical work.     

The Black Man and the Mermaid: Desire and Disruption in the Analytic Relationship

This paper considers the impact of desexualization of the maternal on the development of female sexuality. A “chance encounter” revealing a desire in the female analyst, previously unsuspected, disrupts a female patient's prior sense of homoerotic immersion with the analyst. I argue that a girl's would-be oedipal competition is encased within a patriarchal structuring of sexuality where the mother is rendered solely reproductive and preoedipal, not erotically sexual. I examine the meanings for a patient of internalizing a female figure, her analyst, who is viewed as both maternal and sexual. I suggest that a female sense of genital inadequacy and inferiority may have a component of not being able to link the mother's (and in the transference, the analyst's) use of her genitals with her use of her mind/maternal function. I unfold a thesis regarding maternal desexualization that I believe, given mother–infant symbiosis, has rather extensive applicability, and that can lead to viewing any third party as a “dark” interloper.     

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.     

The Immigrant Analyst: A Journey From Double Consciousness Toward Hybridity

In this paper I utilize the concept of “double consciousness” as a framework for theorizing the subjectivity of the immigrant analyst. I invite the reader to journey with me as I deconstruct my experiences as an immigrant analyst in North America in order to depict how “double consciousness” shapes subjectivity. I show that I developed a binary, bifurcated analyst self, despite my wish to become a multicultural analyst who could “stand in the spaces.” This subtly clouded my clinical judgment causing me to side with the immigrant boyfriend of an American patient and to ignore significant differences between myself and a French patient because he too was an immigrant. When I named and processed my “double consciousness” I experienced resignification, my subjectivity was reconfigured, I was able to experience a panoply of selves, a hybrid “me-ness,” and I could recognize and address “double consciousness” in my immigrant patients.     

Credo

If I were asked to reduce my “Credo” to two sentences they might be the following: I believe that what we call the therapeutic action of psychoanalysis is a self/other negotiation that takes place between and within analyst and patient at the interface of dissociation and the capacity to hold internal conflict. It is a nonlinear process that endows both their relationship and their individual self-states with an ever-evolving experience of wholeness that is the primary source of healing and growth.     

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.     

The Symbolic Object

Abstract

The term “symbolic object” is introduced as a way to understand the moments between analyst and patient where “something” new and dynamic emerges within the dyadic relationship. The symbolic object is the bridge between the idealized, all-good object and symbolization proper. The intrapsychic atmosphere between self and object representations is in a relatively non-conflicted state during this process. By reformulating the Nirvana principle and the principle of constancy as ways in which the organism economically strives for the most organized and homoeostatic state possible, the infant or adult can be seen to be searching for the position of lowest unpleasure possible. This is the optimum balance between the libidinal and aggressive forces in the self and object representational field. These moments of “truce” between often highly conflicted phantasies usher in a more refined use of projective identification as a form of intrapsychic/interpersonal communication. This is a particular atmosphere from which both parties, within the projective/introjective, back-and-forth dyadic world, can begin to co-create and rediscover assorted amalgams of self and object functioning. This newly awakened psychic entity is the symbolic object. This outgrowth of something fresh to the dyadic orbit is a mutative moment that propels the relationship into a different direction. Within the pairing of minds, a novel and mutual understanding is produced. Both parties share this new symbolic object and each is shaped by it.