Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

Danger and safety: The analyst as analytic subject

Abstract

This paper considers questions of danger and safety in the analytic relationship in light of the contemporary recognition of analysis as a co-participatory process. In the interest of safety, the psychoanalyst has the responsibility to be persistently curious, particularly about the problems derived from his contact with the analysand. Information about the analyst's impact must be taken to heart; it must be experientially considered. As the process unfolds, the analyst presumes that a portion of its effect will be negative. The analyst aspires not to preempt all negative impact but to create an analytic environment in which the analysand's conscious and unconscious communications about impact may be attended to. The analyst's ability to receive such information is crucial in the establishment of a reliable process capable of addressing and surviving the unanticipated dangers that inevitably emerge and securing the analysand for further self articulation. The analyst can simultaneously attend to being the analyst and being a subject of analysis by regarding all communications from the analysand as representing, at least in part, interpretations of the analyst and the analyst's participation. Illustrative material is presented.     

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.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

The Role of Psychoanalysis in the Conflict of Interpretations

This paper describes how the temporary illness of the analyst affects the analytic work when it breaks the habitual analytic setting and exposes the analyst to countertransference reactions. The illness stimulates different meanings and reactions in the analysand. The paper describes how the fostering of the habitual analytic work helps the analysand to make use of the event, i.e., to integrate it into the transference. In the light of the patient cases, it would seem that corporeality is the key: the crucial question is what it means not only to the analyst him/herself but also to the analysand, that the analyst's body remains unchanged, secure, living and stable and does not require any particular attention.     

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.     

Silence and communication: nonverbal dialogue and therapeutic action

The subject of this article is silence as communication, with the starting point in the silences of three patients in treatment—in one of them his silences lasted up to a year. Silence is also seen as a specific dimension linked to speech, as the treatment of a third patient shows. The nonverbal interaction between patient and analyst is illustrated. This interaction led to a developmental process in each of the patients, characterized by fusion and separation processes, which included a development of three-dimensionality. The curative process taking place in each of the three, not through verbalisation but through the relation, is understood in the light of Modell's (1990) concept of “dependent/containing transference”. The treatment results demonstrate that the “dependent transference” is curative in itself when the therapeutic setting is maintained. The analyst's inner work during the dependent transference is described: a form of nonverbal participation and joint creativity in the intersubjective field.     

Analytic process and dreaming about analysis

Dreams about the analytic session feature a manifest content in which the analytic setting is subject to distortion while the analyst appears undisguised. Such dreams are a consistent yet infrequent occurrence in most analyses. Their specificity consists in never reproducing the material conditions of the analysis as such. This paper puts forward the following hypothesis: dreams about the session relate to some aspects of the analyst's activity. In this sense, such dreams are indicative of the transference neurosis, prefiguring transference resistances to the analytic elaboration of key conflicts. The parts taken by the patient and by the analyst are discussed in terms of their ability to signal a deepening of the analysis.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

The arms of the chimeras

This article seeks to compare the approach developed in 1974 by Michel de M'Uzan to the concept of the ‘chimera’ with Thomas Ogden's ( 1995 , 2005 ) reflections on ‘the analytic third’. This comparison shows that in spite of the different theoretical approaches, unconscious to unconscious communication – a subject of interest in contemporary psychoanalytic research – makes it possible to grasp the intersubjective data deployed in the field of the session. After reviewing M. de M'Uzan's conception of the ‘chimera’ – a product of the unconsciouses of patient and analyst alike, and which emerges during a process of depersonalization in the analyst – the author proposes her hypothesis of the chimera as a particular intersubjective third whose creation, in a hallucinatory state, makes it possible to gain access to the bodily and emotional basis of the trauma. The author describes the chimera as a mental ‘squiggle’ between the two members of the pair which finds expression in different forms; further, she considers that the chimera that seizes the analyst is underpinned by the unconscious affinities of traumatic zones in both protagonists, which permit the grounding, configuration and sharing of the territories of suffering, as apprehended in this paper.     

From acting to communicating: The analysis of a boy with a pathological organization1

The author presents the analysis of an 8 year‐old boy prematurely born after a high‐risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non‐productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school‐both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make‐believe as well as the intense projective mental functioning.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

Field of Vision: Radical Uncertainty and the Analyst's Conduct: Commentary on Paper by Donnel B. Stern

There is a relationship between biography and theory. The analyst's ideas or formulations about his patients—theories really—must be determined, to some degree, by the certain and uncertain impact of his own history. Harry Stack Sullivan brought psychoanalysis squarely into the ambit of the relational/historical world by insisting that the mind is thoroughly and inherently social. In doing so, he staked a claim for the link between history, that is, social experience, and personhood. Our personalities and our theories are social-historical constructions. In relation to this, some differences between the interpersonal/relational and Bionian concepts of field theory are provided. One important difference pertains to the role of the analyst's conduct. Two meanings of conduct—to behave or to organize behavior—are at the center of what distinguishes the interpersonal/relational view of the analyst's position in the field from the Bionian view. For the relational analyst, action in the analytic field, including enactment, is conduct, and conduct is always bidirectional. The analyst, then, is a medium to alter, to reconstruct the self. He does not provide experience, he is experience. The form of an analytic exchange gives shape to the field and its content.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in the analytic process.     

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.     

Two ways of listening to the patient

This paper highlights the tension between, on the one hand, listening to the patient's associative flow with evenly suspended attention, and, on the other hand, the vigilance and alertness required of the analyst when interpreting the transference through the patient's projective identifications. With reference to the work of Christopher Bollas, it is held that there is a fundamental ambiguousness about analytic work which in fact is desired, but that work with free associations to a large extent has unfortunately become obsolete.