The analyst's style and its impact on the analytic process: overcoming a patient-analyst stalemate.

Analysts have characteristic styles in working with their patients. At times of crisis or stalemate, an alteration in style may facilitate the progress of the treatment. To illustrate the impeding effects of an analytic style at a particular phase of analysis, I describe a stalemate in the analysis of a severely self-critical patient. Recognition of the limiting effects of style on the treatment became apparent in a countertransference enactment, influenced by the patient-analyst match. Self-analysis and alteration in the characteristic style of the analyst resolved the stalemate and enabled the analytic work to progress.     

The quality of the analyst's attention

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951, and 1952. Further lectures in this series will appear in subsequent issues of the Journal.     

The patient's part in analytic process: the influence of the analyst's expectations.

The psychoanalyst's expectations of the patient are complex and crucial to the work of analysis. These expectations, operating at a level generally outside the consciousness of patient and analyst, are part of the "microstructure" of analysis, the interactional give-and-take that brings about change. The view taken here is that analytic process is necessarily interactive, as well as intrapsychic. In addition to transference-countertransference motivations, both parties to an analysis operate in a social context that prescribes a range of desired and undesired behavior. The analyst brings to the interaction professional analytic attitudes about how to listen and act, and a set of expectations of the patient. These attitudes and expectations modulate subjective reactions to the patient's transferentially driven actions, and influence the expression of countertransference. The mutative process of psychoanalysis involves the action of these attitudes and expectations on the patient, both in ways specific to individuals and in more general ways. Such expectations lie behind analytic tactics and, though not often written of, are part of the oral tradition of psychoanalysis. Here the expected patient role is described in terms of five bipolar continua: (1) reporting and editing; (2) transferring and containing; (3) thinking about oneself and thinking about the analyst; (4) regressing and listening/self-observing; (5) initiating trial action and mediating among inner states. The activity and thinking of the dyad move constantly along these continua. A clinical example from the beginning of an hour illustrates how these expectancies emerge in analytic work.     

Hearing voices: the fate of the analyst's identifications.

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.     

A patient's transference to the analyst's supervisor: effect of the setting on the analytic process

A case is presented in which the patient's transference to the analyst's supervisor became evident just prior to the switch from clinic to private patient status. The patient experienced the supervisor as a restraining father figure who protected her from acting on her erotic wishes toward the analyst. Analysis of this led to the recall of previously repressed memories of sexual wishes toward her brother, and the sense of protection from these wishes that she had gotten from the presence of her father. The literature on transference involving the supervisory constellation and the training setting is reviewed, and the concepts of split and institutional transference are examined. Factors inhibiting the analysis of patients' fantasies about the analyst's status as trainee, including the presence of the supervisor and the institute, are discussed.     

The analyst's participation: a new look

Over the past fifteen years or so, advocates of a relational theory of psychoanalytic process have developed a compelling challenge to the classical approach to clinical work. Their critique of a fixed "standard technique," applicable across the board to all analyzable patients, has been particularly effective. The new approach opens the possibility of tailoring technique to individual analysands, negotiating the best way of working within each unique analytic dyad. But despite the openness of relational theory, many of the most influential clinical vignettes in the recent literature emphasize the analyst's risk-taking, engaging patients in a highly personal way that breaks the traditional analytic frame. Various implications of the tendency of relational analysts to emphasize this sort of intervention are discussed, and questions raised about the way this may affect how relational thinking is received.     

The patient's transference experience of the analyst's gender: Projection,factuality, interpretation,or construction

The constructivist/relational perspective has challenged the analyst's emotional superiority, her omniscience, and her relative removal from the psychoanalytic dialogue. It at first appears to be antithetical to treatment approaches that emphasize the analyst's holding functions. In this essay I examine the holding model and its resolution from a relational perspective. I propose that the current discomfort with the holding function is related to its apparent, but not necessarily real, implications. I discuss the analyst's and patient's subjectivity during periods of holding. I believe that the holding process is essential when the patient has intensely toxic reactions to “knowing”; the analyst and is therefore not yet able to stand a mutual analytic experience. During holding, the patient experiences an illusion of analytictic attunement. This requires that the analyst's dysjunctive subjectivity be contained within the analyst, but not that it be abandoned. Ultimately, it is the transition from the holding position toward collaborative interchange that will allow analyst and patient explicitly to address and ultimately to integrate dependence and mutuality within the psychoanalytic setting and thereby engage in an intersubjective dialogue. The movement toward mutuality will require that the analyst of the holding situation begin to fail in ways that increasingly expose her externality and thus her subjectivity to the patient.     

The analyst's Rorschach: gateway to opening the dialectical field

The author offers an account of his evolving relationship with the Rorschach test which for over 20 years as a private practice psychologist, he used in his clinical practice with the intent of mining patients’ psyches for useful information about personality organization and functioning . Coinciding with having found himself on the homestretch of analytic training and during a time when he desired clarity on how Rorschach assessment and Jungian analysis could fruitfully merge, there was an unexpected shift in emphasis wherein the Rorschach suddenly became a method for looking at himself as well. This challenge to identify and integrate aspects of self hitherto neglected was found to enrich his clinical practice. An historical perspective on this experience is offered which highlights the enigmatic relationship that existed between Carl Jung and Hermann Rorschach. The proverbial question of ‘What might this be?’ has been asked when administering the Rorschach for nearly a century. From an analytic perspective, the question is more fully and meaningfully asked when the person doing the asking has also been willing to step in, look around, and take notice of what happens.     

The analyst's narrative function: Inventing a possibility

This article describes a psychic function common to analysts that was gradually revealed through clinical work with children. It is a psychic quality derived from function α, which involves analysts’ capacity for reverie – their narrative function. The author presents two clinical situations where this function developed in the analytic field in relation to patients’ difficulty in symbolizing. In the first case there was an early traumatic experience unavailable for representation. The analyst lent the patient her ability to represent and produced a narrative that made it possible to create a world of phantasies and transform nightmares into ‘dreamable’ dreams. In other words, she removed the quality of unbearable, irrepresentable reality that characterized those raw experiences encrypted in the psyche. In the second case the analyst's narrative function sought to connect with the isolation, the shell that housed a child suffering from an autistic disorder whose ability to represent had not been established. The analyst provided meaning for the patient's repetitive, stereotyped play, thus weaving the child's subjectivity and gradually introducing a notion of alterity. The author seeks to show how this function, in the thematic construction of the session, facilitated both the working‐through of a traumatic situation (with the ability to share representations) and the constitution of the psychic fabric.     

The relevance of the analyst's character and attitudes to his work.

This paper is intended to sensitize analysts to the role of their character in analytic technique. The relation of character to countertransference, its role in analytic style, in the introduction of parameters, and in transference neurosis, will be elaborated. The problem of matching and of accounting for our failures will illustrate the complex meshing of character with more traditional factors.