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.     

Psychoanalysts' multiple relational perspectives

The specific contribution of the person of the analyst--his or her attitudes, fantasies, and entire range of emotional responses to the patient--have become the subject of much investigation in psychoanalytic literature. This paper describes the phenomenon of distinct and sometimes contradictory self-experiences in analysts that develop as part of the moment-to-moment process of a predominantly adaptive coping mechanism. It is suggested that at any given point, the analyst's perspectives (reflecting various self-states), like those of the patient, are multiple, and that the analyst "choose" to place one such perspective at the center of experience. By choosing a certain self-state, the analyst can adopt, for example, a warm and loving stance with a regressed and demanding patient, or become harsh (e.g., setting boundaries, ending a session) with one who seeks affection and protection. This paper also suggests that the capacity to move between versions of self-states, to see them as complementary even when they are paradoxical, promotes a deeper understanding of paradoxes in the personality of the patient. Only when the analyst maintains a dialogue between various dissociated aspects of his or her analytic experience can a dialogue of this kind begin in the patient.     

The goal as process: music and the search for the Self

This paper explores and compares the processes of music and analysis from the author's experience as a musician, piano teacher and analyst. It explains how the use of music improvisation in analysis (with simple percussion instruments) can powerfully enhance the dialogue between the unconscious and conscious psyche, as well as deepen the relationship between analyst and analysand. This is connected theoretically to Jung's active imagination and Winnicott's concept of play within the analytic encounter. Finally, the question is raised whether analytic trainings could do more to expose trainees to the possibility of using music within the analytic encounter. This touches on the more basic and controversial issue (which often separates analytical psychology and psychoanalysis) of whether expressive therapy should be used in analysis at all.     

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.     

External and internal reality: The impact of the current socio‐economic crisis on the analytic dyad

This paper addresses the impact of the current economic crisis on the psychic functioning of the patient and the analyst, their relationship and collaboration. This intrusion of ‘external reality’ is multidimensional, and thus with multiple meanings. The critical role of the economic factor brings various dimensions of money into play, such as self‐preservation, power as well as aspects of psychosexual development. In addition, the crisis involves symbolic loss of basic ideals such as honesty and social responsibility. Patient and analyst are affected in similar and different ways in their respective roles as well as according to the specific intrapsychic functioning of each. Moreover, unique characteristics of the crisis often create a crisis in the analysis. In order to avoid deformation of the analytic relationship, the analytic dyad must examine and work through the multiple meanings of the crisis as well as the meaning of the impact of the crisis on the analytic relationship for both patient and analyst. This complex transference‐ countertransference interplay poses specific challenges to the analyst. After discussion of these issues, clinical material is presented that demonstrates how they appear in analytic practice today.     

Between the Ability to Imagine and Actually Seeing: The Intersubjective in Reclamation

When working with severely damaged, neglected, and deprived patients, the analyst relies on the faith that the intersubjective analytic space can be the site of a live relationship. In this regard, the unique technique of “reclamation” might be used with patients in a moment of imminent danger or of a sense of psychic death and involves an active response to the sense of emergency in countertransference. Reclamation is based on the analyst/therapist's ability to conduct intersubjective dialogue between the various spaces of internalized object relations, and the author attempts to extend the possibility of its technical application by considering reclamation as intersubjective.     

Another language,another place: To hide or be found?

The author examines some specifi c features of the analytic encounter when both patient and analyst are émigrés from the same cultural and linguistic background. This can result in splitting processes that operate silently and are diffi cult to reach, but can also provide rich material, as they offer the couple the opportunity to work through the pain and the guilt over what is lost—ultimately the lost mother—murdered and betrayed. Working through the split faces the analyst with important technical considerations, bearing in mind that the shared cultural identity can conceal itself in the more undifferentiated features of the couple's psyche and be projected on to the setting. As such, it needs to be put to analytic scrutiny if the treatment is to avoid a stalemate. These are specifi c cultural defences deployed in the problematic existential encounter with the foreigner other within oneself. Using clinical material from two cases, the author shows how the couple's access to a dual linguistic signifying system can enrich the analytic dialogue, but can also result in enactment. Careful monitoring of the transference-countertransference relationship is essential to the progress of the analytic work.     

Analytic preparation: the creation of an analytic climate with patients not yet in analysis

The art and science of beginning an analysis has a life of its own and can be considered in many ways quite apart from its later stages. An incremental path forward is smoothed for patients who are not yet prepared to analyze, and builds eventually into something readily recognizable as an analysis. The term analytic preparation refers to this set of processes. Early on, the analyst is concerned less with facilitating an early replica of an idealized analysis than with facilitating the mutual adaptation of patient and analyst as they begin to negotiate a "thought community." Since analytic preparation is not an entity, it does not neatly overlap in real time with the opening phase as usually described, does not have a discrete beginning or end, and does not abruptly shift mid-stream into analysis proper. Some relations between analytic preparation, analytic interaction, and the interpretation of transference are examined.     

The Reconstruction of Psychic Trauma

The author discusses the difficulties that arose in the analysis of a female patient suffering from a delusional disorder, where traditional criteria of suitability for psychoanalytic treatment were initially lacking and had to be established as part of the process. The transference-countertransference interaction came to a deadlock, understood by the analyst as due to the patient’s pathological dyadic relating. She was lacking in her capacity of reflective functioning, and there was no potential space to foster a fruitful therapeutic dialogue between analyst and patient. The analyst adopted a bystander perspective as a vantage point from which to comment on the patient’s narrative, whereby she succeeded in gradually altering the dysfunctional dyadic exchange into an interaction where a triadic perspective was introduced as a means to making possible meaningful communication between patient and analyst. Substantial changes were achieved with this procedure as a point of departure. The case study highlights aspects of dyadic versus triadic functioning of the analytic pair, and serves to illustrate theoretical points pertaining to the ongoing debate between professionals on how the basic structural elements of the analytic relationship should be conceptualised.     

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.     

Playing one's cards face up in analysis: an approach to the problem of self-disclosure

A policy of consistent willingness on the analyst's part to make his or her own views explicitly available to the patient is discussed and illustrated by clinical vignettes. Playing one's cards face up is contrasted with contemporary conceptions of selective self-disclosure by the analyst, especially with respect to the way ground rules for the analytic treatment relationship get established. The objective of the analyst playing his or her cards face up is to create a candid dialogue, thus facilitating maximally effective collaboration between analyst and patient. Concerns about the analyst's self-disclosure foreclosing exploration of the patient's unconscious fantasies and transferences, or intruding upon the patient's autonomy, are addressed, as is the relation between self-disclosure and an individual analyst's personal style.     

Lies and Body Cruelties in the Analytic Hour

Discussing an intensive case study of female sexual dysfunction, this paper studies mutual deregulation and disintegration as it unfolds in the transference–countertransference dyad. I propose that ethical transgressions are potentiated in analytic dyads in which the analyst's hope for either solitude or mutuality is foreclosed. This hope can be foreclosed by the particulars of the therapeutic interaction as well as by the theoretical and clinical aspects of analytic training. The deregulation that both precipitates and follows such transgression can be healed (in the analyst, in the analysis) only by the restitution of the therapist's agency, the reduction of paranoid-schizoid guilt and shame, and the location (in the analyst) of depressive, “I-Thou” remorse.     

Psychic reality in the psychoanalytic process.

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities. Thus, components of the analytic relation--transference/countertransference, alliance, and real relation--are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false-each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

Silent dialogues in the analytic relationship

Abstract

In borderline or even narcissistic patients, the relation to the objects is built on the basis of omnipotent control, so that those patients present difficulties related to mourning for the loss, as well as for the independence, of the objects. Their basic trait is a huge inability to recognize the separateness of others, together with an excessive use of primitive defense mechanisms, such as projective identification. Each experience that contains the danger of re-experiencing the primal separation poses an attack on the analytic setting, in order to avoid such a re-experiencing. Those attacks sometimes take the known form of acting out, whereas other times they are limited to a special use of speech, which lacks any communicational faculty and is used rather as a weapon. This special climate affects the analyst, causing specific countertransferential reactions. Nowadays, we tend to consider such a communication not mostly as an obstacle, but rather as an opportunity, allowing the analyst to comprehend the patient, through his countertransference, and create a meaning to replace the void those patients usually experience. The transference and countertransference enactments, their silent dialogues taking place in the analytic setting, are those which progressively give meaning in this primitive non verbal communication.     

The analyst's anxieties in the first interview: Barriers against analytic presence

To answer the questions: why don't more people enter analysis and how do we get more people to do so? Attention is drawn to anxieties in the analyst that become obstacles to the initiation of analysis. The main focus of the paper is how to understand why analysts, irrespective of patient characteristics, seem to have resistances against embarking on analysis. Being a meeting between strangers the consultation activates strong emotional reactions in both parties. One way of coping is defensively to diagnose, assess and exclude instead of being present as an analyst. The analytic frame of a consultation is ambiguous, and a secure analytic function is needed in order to meet the openness and unpredictability of this frame. A fragile psychoanalytic identity is seen as central to analysts' failure to create an analytic practice; it takes years to develop and maintain a robust analytic function, and analytic work continues to cause disturbing emotional reactions in the analyst. Analysts' vulnerable identity is also linked to the history of psychoanalysis that has fostered an ideal of analytic practice that is omnipotent and impossible to reach. Therefore it is no wonder that attempts to reach a convinced recommendation of analysis can become diverted in the process of consultation. Confronting these inner impediments in order to strengthen the analytic identity is suggested as a better way to get more analytic patients than to keep looking for so‐called analysability in patients.     

Sandplay in Jungian analysis: matter and symbolic integration

Jung described a way of thinking, tied to sensations and feelings, that is a thought connected to the body. Again in The Archetypes and the Collective Unconscious, Jung (1954) speaks of the symbol as a 'live body', corpus et anima. If the mind cannot credit itself with the discomfort that manifests through the body, this is a sign of a separation between mind and body. A consequence of all this is the literalization of the discomfort which makes it impossible to have a symbolic dimension. Therapy activates a process in which the patient can move from a stage of separation to a possible connection between mind and body, resulting in changes in the level of communication and of awareness. The mind opens itself to symbolization and the body becomes a field for a common language. From our reflections we have come to ascertain that we can speak of analysis only when an imaginary space is achieved, an intermediate space between the patient and the analyst, a space that is created from the intertwining of the symbolic capability of the patient with that of the analyst. Focusing our attention on the use of sandplay in analytic therapy, we know that one puts in the sand box objects that are marks of our psyche, visible traits that contain actions, corporeal movements and feelings. When one focuses on the overall representation built, one can go beyond the literal image and the analyst, keeping alive the image through his symbolic capability, opens the possibility of a dialogue with the symbolic dimension. The imagination as a symbolic thought is the humus that allows the analyst to maintain the intermediate symbolic level open by activating a symbolic process within the dialectic of the analysis.     

Paying Attention and Feeling Puzzled: The Analytic Mindset as an Agent of Therapeutic Change

The Relational turn has affirmed emotional interaction without losing sight of the complexities of the internal world, thus reforming psychoanalysis. This paper, however, is concerned that this well-justified enthusiasm for interaction may be distracting us from opportunities offered by analysts’ special aptitude for an open, quiet, focused mind in the midst of intense emotional and interpersonal activity. This special orientation is considered in relation to the analyst’s tolerance for ambiguity and even confusion. The effects of the analyst’s reflective concentration as a change factor in the analytic field are discussed, using nonlinear dynamic systems theories and a phenomenological perspective.     

Mourning analysis: the post-termination phase

One hundred twenty-one analytic candidates who had completed training analysis responded to a survey about their post-termination experience. Seventy-six percent of respondents experienced a mourning process that lasted on average between six months and a year, while 24 per cent experienced no discernible sense of painful loss. Twenty candidates were interviewed to obtain a deeper understanding of the mourning process that follows analysis. During the post-termination phase, the analysand's self-analytic capacity is tested in the struggle to contain and understand feelings about the loss of the analyst, as well as transference reactions triggered by that loss. After a "good-enough analysis," the analysand internalizes not only the analyst's functions and attitudes toward him or her, but also a sustaining, positive internal image of the analyst. Four cases illustrate unexpected difficulties that may emerge during the post-termination phase when the loss of the analyst is experienced as a repetition of earlier, traumatic losses or as a rupture of an unanalyzed, selfobject transference.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.