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.     

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience-for which both and neither of the members of the analytic pair may claim authorship-in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.     

This art of psychoanalysis

It is the art of psychoanalysis in the making, a process inventing itself as it goes, that is the subject of this paper. The author articulates succinctly how he conceives of psychoanalysis, and offers a detailed clinical illustration. He suggests that each analysand unconsciously (and ambivalently) is seeking help in dreaming his 'night terrors' (his undreamt and undreamable dreams) and his 'nightmares' (his dreams that are interrupted when the pain of the emotional experience being dreamt exceeds his capacity for dreaming). Undreamable dreams are understood as manifestations of psychotic and psychically foreclosed aspects of the personality; interrupted dreams are viewed as reflections of neurotic and other non-psychotic parts of the personality. The analyst's task is to generate conditions that may allow the analysand-with the analyst's participation-to dream the patient's previously undreamable and interrupted dreams. A significant part of the analyst's participation in the patient's dreaming takes the form of the analyst's reverie experience. In the course of this conjoint work of dreaming in the analytic setting, the analyst may get to know the analysand sufficiently well for the analyst to be able to say something that is true to what is occurring at an unconscious level in the analytic relationship. The analyst's use of language contributes significantly to the possibility that the patient will be able to make use of what the analyst has said for purposes of dreaming his own experience, thereby dreaming himself more fully into existence.     

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.     

What the analyst does not hear

In the clinical situation, the analyst fails to hear more than he or she hears and spends much time working in the dark. The author raises questions about how we can take cognizance of that state of affairs in our thinking about analytic work. A clinical example illustrates how, in an analytic atmosphere, a patient will correct an analyst's failure to hear. Some ideas are offered about how to maximize the patient's participation in that effort. The author suggests that the problem may not fall precisely under the heading of technique so much as reflecting the analyst's attitude.     

Thinking with,and about,patients too scared to think: Can non‐interpretive maneuvers stimulate refl ective thought?

Patients incapable of higher-order (symbolic) thinking can often not tolerate evidence of the analyst's separate existence, particularly when that 'otherness' becomes evident in the process of the analyst's refl ecting upon and interpreting how the patient experiences or represents the analyst. The patient's intolerance of the analyst's efforts to think (refl ect upon and interpret) renders the usual psychoanalytic maneuvers employed to stimulate refl ective thought ineffective with such patients. Such patients have to learn to tolerate multiple perspectives before they can allow the analyst, or themselves, to think in the other's presence. The author presents two clinical vignettes that illustrate how the analyst's efforts to think about the patient were experienced by the patient as both intolerably distancing and as rejecting of an aspect of the patient's subjective reality. Working psychoanalytically with such patients requires the analyst to forgo the use of narrow interpretations that elucidate unconscious meanings and motives in favor of alternate technical maneuvers capable of facilitating the development of symbolic thinking and refl ective thought (insightfulness). These maneuvers include a demonstration of the analyst's willingness and ability to withstand (rather than 'interpret away') how he is being psychically represented by the patient, without becoming destroyed by, or lost within, the patient's characterization of him. Beside modeling a tolerance of alternate perspectives of one's self, other non-interpretive maneuvers that help facilitate the development of self-refl ective thought include: stimulating the patient's curiosity about the workings of his own mind by identifying incompletely understood behaviors or reactions worthy of greater psychological understanding, and insinuating doubt about the adequacy of the patient's explanations of such phenomena.     

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 holding function of theory

As multiple theoretical models contend on the American analytic scene, the holding function of theory emerges as a unifying theme. In addition to supplying an intellectual superstructure for the working analyst, theory provides a psychological presence--a sense of conviction, affective stability, reassurance, and self-esteem--that makes effective analytic work possible from the analyst's side. Ideological passions and differences arise from the vital need for the holding function in an intense and inchoate engagement like psychoanalysis. To show how adherents of different models use theory in practice, three clinical cases are reviewed, one from Betty Joseph, one from Lewis Aron, and one from the author. The last example reconstructs the analyst's subjective experience of treatment both in the selected hours and in terms of the analyst's preconscious use of theory.     

The impact of words on children with ADHD and DAMP Consequences for psychoanalytic technique

Children with attention-defi cit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classifi ed. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classifi cation in that the baby forms representations of icons, indices, and symbols.     

'Reverberation time', dreaming and the capacity to dream

In this paper the author suggests that understanding the roots of the subjective sense of time can throw light on the disturbances in psychic time which are found in particular in the more severe pathologies. She introduces the argument that the roots of the development of the sense of time rest on a primitive sense of time she calls 'reverberation time'. By this notion she refers to the particular quality of the earliest 'back and forth' internalized exchange with the mother in which the auditory dimension plays a significant part. Referring to a wide range of literature and clinical examples, the author thus suggests that the subjective sense of time is created by the reverberation between mother and infant. Disturbances in this area will be reflected in the pathological 'arresting' of time which is observed in the different pathologies and, in particular, around the negotiation of the depressive position and the oedipal situation. Extending this argument, the author goes on to suggest that it is the internalization of this experience of 'reverberation' which lies at the heart of the experience of dreaming; she considers that dreaming understood as an internal dialogue points both to its roots in the relationship to the maternal object and to its fundamental role in psychic life. The author concludes that 'reverberation time' is also the building block of a psychoanalysis, leading to 'unfreezing' psychic time and enabling the reconnection of 'here and now' with 'there and then' in a flexible way which promotes open possibilities, and that this takes place via the analyst's reverie, or time of reverberation.     

Reflections on the setting in the treatment of adolescents1

The author focuses on the signifi cance of the setting for the development of the psychoanalytic process, especially in the case of adolescents who request analytic treatment. Her main goals are to specify: a) how the setting is confi gured with this type of patients; and b) to what extent it contributes to the creation of an inner space that may internalize a fi gure with reverie‐a good object that will metabolize the bad and thus enable identifi cation. The setting, which is considered the necessary context for analytic work, is defi ned as bearing two facets: that of the analyst, which must be constant and stable, and that of the adolescent, which will progressively change provided that the analyst maintains a fi rm context that contributes to make the adolescent feel contained and accepted. It is such a feeling that will enable the unfolding of the analytic process. The author emphasizes the importance of the presence of the analyst (his or her voice, the manner of his or her speech, and so on), and the need for the analyst to comply with the rules he or she has established together with the patient. She presents a clinical case to illustrate this conceptualization.     

Creating analysts, creating analytic patients

This paper applies a contemporary, 'two-track'- transformational as well as archaeological - perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst's capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst's confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst's theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non-neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.     

Reflections on the clinical implications of symbolism

We start by stressing the idea that the process itself of constructing the symbol in its different components and its vicissitudes is centrally important to contemporary psychoanalysis as symbols are essential for thinking and for storing emotional experiences in our memory and for conveying our affects to others and to ourselves. Our implicit idea is that internal attacks are not directed only at the internal objects, but also include attacks on the structure or forms of the mental representations before and while they become constituted in symbols. It is by this means that destructive impulses invade the processes of symbolic construction. Symbols can lose their plasticity and thus silence the emotions and therefore cut off the patient from their meanings. Our clinical material allows us to increase our understanding of how the formal qualities of symbols operate in mental life, and how they can interfere in the capacity to work through emotional experiences. Finally, our reflections based on the analysis of a patient with difficulty in relating with the meanings of the symbols he produced will highlight the importance of the analyst's reverie along the process of formulating an interpretation. This paper is also part of a development in the study of the process of reverie.     

A framework and two sketches concerning psychoanalytical training and practice

The author discusses the mode of knowledge production in psychoanalysis based on a reflection on the psychoanalytical education and its relationship to clinical practice. She points out that there is a risk in a form of clinical activity found in our education, which, under the fascination of the analyst's power of operating in the metaphorical domain of words, loses sight of the material dimension of the clinical action. In other words, this form of clinical activity loses sight of the meeting with another human being, of the repertoire of theories and experiences that informs this action and the patient's and the analyst's concrete life situation. The author highlights the role of writing as a privileged way of dealing with the material and immaterial facts that constitute the clinical action and reflects on some of the forces that structure nowadays the reception of knowledge production inside the psychoanalytical field. She uses the notion of 'minor literature', by Franz Kafka, to express the possibility that a live circuit of writings exchanged among psychoanalysts can offer to an interchange of experiences and ideas that is the live expression of the history of the psychoanalytical groups. A clinical session is presented in order to promote considerations about the psychoanalytical education, theory and practice.     

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.     

Pains and gains: a study of forced terminations

The forced termination of psychoanalysis, such as occurs when the analyst makes a geographic move, uniquely disrupts the analytic setting. This paper recounts the author's experience of terminating a full-time private practice of psychoanalysis and psychoanalytic therapy for such a move. The limited literature on the subject is reviewed with a focus on the use of technical variation in the forced termination situation. The author delineates three areas of interaction with patients where technical variation proved in her experience to be of value: dealing with countertransference and counter-reaction, providing information about the move, and the consideration and process of referral for continued therapy. As opposed to what would be predicted from a classical psychoanalytic perspective, the use of such technical maneuvers seemed to facilitate rather than impede analytic work. These variations in technique served at crucial times to maintain the analytic alliance, to preserve the patient's capacity to recognize and make use of transference, and to provide avenues for resolving past traumas in the transference and the actual loss of the analyst. The concept of the analyst as a new or useable object is proposed as providing a theoretical framework for understanding these observations.     

The role of the analyst in the analytic cure during times of chronic crises

The role of the analyst in psychoanalytic treatment during periods of chronic crises is illustrated with material from two case studies. The first clinical vignette shows an analyst able to stay with fears evoked in the patient by the traumatic external reality, even as the analyst tried to explore with the patient an inner universe that handled this reality in unique ways. The second case study focuses on how the analyst's countertransference during this period of chronic crises, which she was experiencing along with the patient, made it difficult for her to contain the patient's fears and anxieties, because of the threat to her own existence, as well as to her identity as an analyst. In this second case the analyst, out of denial of the external situation, focused blindly on the patient's internal reality in order to counteract her own sense of passivity and helplessness in the confrontation with death and destruction. She clung to "classical" analysis by trying to analyze the patient's defenses, work them through, etc., thus making so-called analytic interpretations rather than staying with the patient's fear, as well as her own, and helping the patient more directly. A turning point came with the birth of the analyst's granddaughter; fear for the new arrival's safety made the analyst sharply aware that it is impossible to ignore external reality, that it must be given a place both in everyday life and in analysis. This awareness enabled the analyst to contain the patients' fears, which helped him feel more supported and facilitated change.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

Patient-therapist match: revelation or resistance?

Patient-therapist match is a relatively new yet frequently invoked concept within psychoanalysis. Despite Freud's appreciation of the influence of the analyst's past to his or her work within the analytic setting, psychoanalysts have historically held varied opinions about the degree to which the analyst's personality and conflicts affect the analytic process. As analysis was reconfigured as a two-person system, attention focused on the fit between patient and analyst. The literature on patient-therapist match is reviewed, and the conclusion reached that this intuitively appealing concept suffers from a lack of rigorous definition and operationalization. Many authors invoke match in ways that imply that it is real, static, external to the domain of analytic inquiry, and unaffected by analytic process. In its present form, the concept of patient-therapist match obstructs rather than facilitates analytic exploration and obscures rather than clarifies what happens between analyst and analysand in psychoanalysis. By suggesting that match exists as a reality outside the domain of transference and countertransference, analysts may overlook the importance of psychoanalytic technique in creating a sense of match. Analysts may attribute stalemated or limited analyses to a bad match, rather than tenaciously exploring the transference-countertransference configurations that remain at the heart of analytic work.