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.     

The use of the analyst as an autistic shape

In this paper I describe through detailed clinical material the challenges posed by patients who employ entangled autistic defenses. I discuss the complicated nature of treating a patient who employed entangled autistic defenses and utilized my voice in an effort to preserve an undifferentiated state of dual unity. My patient's pursuit of dual unity took a very concrete form in her attempt to mitigate the terror of separateness. This concreteness was expressed via the patient's urgent request that I read letters she wrote to me between sessions. This type of autistic defense placed great strain on my ability to think analytically and I also became increasingly concrete in my response to the patient. Crucial to the analyst's regaining a space in which to think and a sense of separateness is the ability to contact the ground floor of her separate bodily experience. This is just the beginning step in the analyst separating herself from the powerful press to join the patient in a state of dual unity. Interpretation in action (Ogden, 1994) was an effective way to convey the importance of creating and tolerating internal space in myself and begin to create internal space in the patient. Previously such space had been closed down in order to manage primitive fears of annihilation. When a patient is absorbed in an entangling autistic retreat words do not reach the patient on a symbolic level but rather are experienced primarily as an assault on the need for dual unity with the analyst. The patient's need to be wrapped in a sensation based world of dual unity is preferable to a world of spoken words that carry the danger of delineating psychic separateness. In essence there is no self to speak words, only a whirl of an amorphous sensation self lacking definition. I believe with certain kinds of patients it may be necessary to first lose and then work to regain one's analytic mind, as I have powerfully described in the case of Linda. Linda's profound loss of connection to the ground floor of her experience could only begin to be addressed when I worked to extricate myself from ‘our magic carpet ride’ of dual unity, contacting the reality of my bodily experience, and begin to tolerate the terror I felt regarding my separateness from Linda. I also describe the confusing vacillation between entangled and encapsulated defenses in patients like Linda as previously identified by Cohen and Jay (1996). Ultimately, this kind of slow difficult analytic work began to help Linda develop a capacity to think and provided an alternative to the deadened world of her autistic protections.     

Discussion of Holly Levenkron's “Love (and Hate) With the Proper Stranger”

I agree with Holly Levenkron that the value of an intersubjective perspective is pragmatic: It directs the analyst toward more effective technique. Also, I agree with her view that a successful analytic process is a negotiation between analyst and patient. However, I question Levenkron's idea that the analyst must loosen her hold on her own subjectivity in order for the negotiation to proceed. An analyst cannot and need not diminish her subjectivity. Rather, what is required for clinical analytic work to unfold is that the analyst include the patient within the analyst's subjectivity—or, in other words, that the analyst come to love the patient.     

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 Practical Challenges to Renewal: An Answer to Stein and Singer

Years ago, as a young man in Jungian analysis, I suffered an identity crisis. Its catalyst was my discovery that–unlike my own analyst, the majority of my colleagues, and Jung himself I am not an introverted intuitive-thinking type. Rather, I was an introverted feeling-sensation type. Suddenly feeling excluded from the professional world that defined me, I experienced a strong pull to connect, through the natural world, to a deeper aspect of myself.     

Can We Eat Dog Without Dog Eating Us Commentary on Paper by Janine de Peyer

This paper examines a state of fear aroused in the analyst during a session. I suggest that the fear arose from the attempt to enter the patient's mental state—a state that was unfamiliar to the analyst. In entering what was essentially psychically foreign territory, I terrified myself with a version of the patient's experience.     

Thinking Developmentally: Perspectives Following Loewald and Klein

In this article, I explore two perspectives on development that are central to how I think and work as an analyst, one drawn from the work of Hans Loewald and one from Melanie Klein. Loewald turned the usual psychoanalytic way of thinking, rooted in the past, on its head when he theorized that development proceeds by internalization of the parent’s future vision of the child and, by corollary, the analyst’s future vision of the patient. Using a vignette from Klein’s work with 10-year-old Richard, I show how the analyst’s image of the patient’s potential can facilitate growth and development. Melanie Klein also introduced a radical reordering of traditional psychoanalytic theory when she theorized that the mind develops and is structured as positions, not as successive phases. For Klein, the mind is organized in groupings of anxieties, defenses, and object-relations that are in a continuous state of oscillation throughout life independent of chronological age. Through a clinical vignette, I illustrate how one understands a patient differently when development is seen as occuring in momentary shifts between different levels of the personality rather than as stages over time.     

Power cut in the countertransference

This paper is an attempt to describe and understand a certain type of defence that I shall call a 'power cut' because of its crippling and anti-relational nature. I will take extracts from a baby observation to show how this type of defence can be adopted from the beginning of life, followed by vignettes from my work with a young child and an adult patient which addresses the particular kind of difficulty the analyst has to face with patients who resort to such a defence. I am arguing that while defending from another, the patient is able to destabilize not only the connection between himself and this other, the analyst, but also that between the analyst and the analyst's internal world. I understand this as the violent re-enactment of the patient's uncontained and split off primitive experience. I see recovery from 'power cuts' as the main challenge for the analyst who is helping the patient to recover from an early failure in containment which has led to defective splitting. Only when the unthinkable experience of 'power cut' can become an experience that can be lived through and converted into a deintegrate, may integration be achieved.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

Helplessness and the exercise of power in the analytic session

This paper describes a clinical situation in which the analyst may be provoked to become overactive if he feels that his attempts to reach his patient are frustrated. Lack of tolerance for feelings of helplessness may leave him unable to sustain a receptive stance, and he may be drawn into enactments which lead to a power struggle with his patient.
I will try to describe situations where such enactments were compelling. I will also consider what enabled me to extricate myself from the activity, at least intermittently, to re‐establish an analytic attitude in which understanding and containment were priorities.
From time to time I was able to recognize and accept my helplessness and relinquish my attempts to reach the patient. These moments of recognition led to a shift of atmosphere in which a feeling of sadness replaced the more familiar confrontational mood. In these sadder moods the patient felt I was more available, and he too seemed more able to contemplate loss.
Theoretical ideas that enabled me to recognize some of the mechanisms at play included an understanding of narcissistic mechanisms, a recognition of previous ideas of power and dominance such as Freud’s Bemächtigungstrieb, and the role of dominance in the resolution of the Oedipus complex. My previous work on the dread of humiliation allowed me to be sensitive to the way helplessness can come to be associated with being looked down on and humiliated.     

Now Streaming: On Unconscious Communications in the Analytic Process

ABSTRACT

In this article, I illustrate the concept of unconscious communication by means of a clinical example in which a patient was able to recover the memory of a key adolescence experience as the result of the interplay of unconscious messages transmitted between himself and his analyst. When the patient spotted the analyst driving an old, beat-up family car, this triggered an unconscious memory of this painful adolescent episode, one that epitomized and stood for his troubled and disappointing relationship with his father. This memory, which was expressed nonverbally, in turn, evoked a memory in the analyst from his own adolescence that put him in touch with the patient‘s traumatic, adolescent experience, material that had come up previously in the analysis but had not been adequately dealt with or worked through. By grasping the meaning of the interplay of these unconscious messages, the analyst was able to help the patient get in touch with, better understand, and work through, an experience that had an enduring impact on his future life.     

Destruction reconceived: On Winnicott's ‘The Use of an Object and Relating through Identifications’

‘The Use of an Object and Relating through Identifications’ is a landmark contribution that I find very difficult to write about because so much of what lies at its core is merely suggested. It is necessary for the reader not only to read the paper, but also to write it. In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort. The author presents clinical discussions of analyses in which the analyst survives destruction and is unable to survive destruction.     

Face to Face

In “Face to Face,” I explore my work as a Jewish analyst with a Lebanese woman, Ara, who is strongly identified with the Palestinian cause. As the work unfolded I find myself thrust into a psychic and social space I had not wanted to inhabit, into the Israeli–Palestinian conflict and the turmoil of Jewish identity. Ara and I were in the midst of ghosts of historical traumas, intersecting and interweaving history and identity between us. It was her history and my history and the history of nations, of broken bonds and damaged victims suddenly all present in the room. I will hold together, in tension, the micro and the macro, the intrapsychic and social, the drama of the encounter between Ara and me and between Palestinians and Jews. I ask what it takes to find one's way into an understanding of the other, a recognition of the other and the legitimacy of their suffering when one's own history is suffused with the trauma of centuries of victimhood. “Face to Face” is an exploration of how to inhabit the Other, how to negotiate difference, moving beyond the dynamics of victim and victimizer, beyond that of oppressor and oppressed to what Emmanuel Levinas refers to as a welcoming of the stranger, a transcendent experience.     

The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness”

I define the analyst’s generous involvement as inherent to human encounter and a necessary element of therapeutic process. When the analyst’s generous involvement goes missing, it can be read as a sign of disengagement and disconnection. Using as metaphor H. S. Sullivan’s concept of the “tension of tenderness,” I argue that the analyst’s recognition of a need or affect state in the patient evokes an internal tug constituting the analyst’s need to provide for what has been recognized. I elaborate on what the analyst’s generous involvement is, and what it is not, including countertransference pitfalls and corruptions that may masquerade as generosity. I engage a relational conversation with the radical ethical ideas of Emmanuel Levinas. An extended clinical vignette illustrates the challenges and conflicts entailed in the analyst’s finding an analytically useful form of expressing the tug of generous involvement in the immediate moment.     

The Analytic Encounter,a Scene of Clashing Cultures

Three wars (WWII, the Vietnam War and the Iraq War) as well as the experience of immigration impacted on the analytic situation as described in this paper. A first generation immigrant patient, who was also a Vietnam veteran, and the immigrant analyst came together in harmony and in discord, around the issues of their common experiences of war and being an immigrant. The onset of the Iraq war brought these issues into a sharp focus in the mid-phase of an on-going analysis. The paper explores how countertransferential experiences of war and immigration were used to further analytic work. It is often assumed that analogous external experiences can give rise to greater empathic understanding on the part of the analyst. In this paper,I hope to demonstrate that there are both advantages and serious pitfalls in experiential overlaps between the cultural experiences of the analyst and patient.     

Ordinary Sadism in the Consulting Room

The analyst’s retaliatory sadism can be construed as a perversion of the wish to penetrate, just as masochism can be viewed as a degradation of the desire to surrender. When a patient refuses to speak any other language but that of domination and submission, ordinary attempts for communication and recognition fail. In her attempt to reach the patient, to reinstate herself as an active agent and subject, and also to dislodge the patient from a rut of despair, passivity, or malignity, the analyst may escalate to a sadistic response, even if she suspects that this might cause the patient pain. This type of sadomasochistic enactment can gather strength when disowned self-states of analyst and analysand are activated. In this process, an analytic interpretation, seemingly legitimate, can be used as a knife, a weapon, an instrument of retaliation and sadistic control. The disastrous potential of the analyst’s sadism is easy to imagine. Through a couple of clinical vignettes I will demonstrate that even something as lamentable as the analyst’s sadistic retaliation can lead to growth as long as such sadism can enter the analytic dialogue and the patient is allowed to perceive and reflect upon the analytic misbehavior, and the analyst is willing to join the patient in the quest to understand their co-created predicament.     

On gratitude and gratification

Expressions of gratitude from the patient may be regarded by the analyst as a much-needed validation or affirmation of competence. The analyst's need for gratitude may be a relatively silent presence when things are going smoothly or when the analyst's efforts are openly appreciated by the patient. Ungrateful patients, however, are likely to force the analyst to confront his or her unconscious background wish to enact a longed-for mode of relatedness as part of the daily work of psychoanalysis. The analyst's wish for a specific form of object relationship involving a selfless, devoted helper and an appreciative patient who acknowledges having been helped may be thwarted by certain patients at every turn, knowing they are depriving the analyst of a particular form of gratification in their work. For patients of this type, failure may mean success. The implications of this particular form of clinical stalemate are outlined, and a clinical example illustrates some of the challenges encountered in psychoanalytic work with ungrateful patients.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).     

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 Analyst’s Bodily Sensations as Important Information in Clinical Work

ABSTRACT

Analysts use many different methods and therapeutic tools to understand the associations and struggles of their patients. This article suggests that, in addition to other matters we pay attention to for this purpose, it is useful for analysts to also pay attention to physical sensations that they might experience either during a session, or at other times when they are thinking about their work with the patient. I believe that the analyst’s solid familiarity with her own life history and conflicts, helps the analyst understand why her body experienced particular sensations when it did, and what, if anything, this adds to her understanding of her patient. Such understanding can then be shared with the patient, to deepen and enhance the analytic work. I also caution against a casual misuse of such a process.