Searching for a Sensitive Way of Working Through*

This work intends to present aspects of clinical work in which the Ferenczian proposition of neo-catharsis, as re-emergence of repressed affective experience in the transference and countertransference presents itself as a challenge to the analyst, since a standard, classical technical approach results in repetition of past trauma with the analyst as perpetrator. A deviation from standard technique—free association, the principle of abstinence in transference, and interpretation—involving empathic listening, and affective sharing contains the patient’s suffering. The re-emergence of suffering and terror, which represents the repressed affect associated with the traumatic past, but with a sympathetic and sensitive analyst, sharing their experience, is crucial in working through and healing.     

Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address

This paper will attempt to broaden the conception of witnessing in analytic work with traumatized patients by extending the idea to incorporate the patient’s developing and varied capacity for witnessing, as well as a witnessing that occurs within the analytic relationship itself. Actions occuring as part of traumatic repetition are understood to represent memory phenomena and are distinguised from dissociated self‐state experience. These experiences are not therapeutically intended to be symbolized, but rather lived‐through with the analyst, thus transforming the patient’s own relation to the experience. I suggest that the scene in which this living‐through takes place is the transference–countertransference matrix, and that it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction. A clinical vignette illustrates the turning of trauma’s imperative for witnessing into an address in the analytic encounter.     

Silence as the Voice of Trauma

Silence is a key to the unspoken world of the patient. Rather than interpreting silence as a defensive maneuver, the analyst may understand this disruption as a royal road to the patient’s traumatic experiences. The author proposes to recognize traumatic silences in the analytic process and the transference as a re-experiencing of past, unpredictable traumatic affective states and memories. Silences in this context are both a repeat of a disconnecting experience as well as a manifestation of a silencing identification with the original silencer. The clinical material illustrates effects of a German mother’s World War II (WWII) personal traumata and collective shame-based silence on her daughter’s self and good object development. In the daughter’s analysis, the patient and the analyst, who herself experienced similar WWII traumata, face the pain of trauma recovery and un-silencing. The author suggests that the deadening effect of past traumata may be reversed by an analytic process of re-membering and re-speaking for both the patient and analyst. This allows for a more transparent, subjective experience in the transference and a verbal integration of ego functions.     

Space and time in psychoanalytic listening1

The analytic situation is by definition traumatic because it evokes hilflosigkeit, the state of helplessness of the newborn infant, which is the prototype of the traumatic situation, and at the origin of the experience of anxiety. The author addresses the chain of associations between the state of helplessness, repetition compulsion, trauma, infantile sexuality, pleasure and displeasure, which lie at the core of the transference experience, and which find their ultimate expression in the analyst's listening. The discovery of the compulsion to repeat instituted a paradigmatic shift in Freud's formulations, emphasizing the process of repetition of trauma, and instituting a link between the network of concepts indicated above. In the clinical example discussed, the author defines the psychoanalytic process by the primacy of sexuality, the erotic passivation in the transference that evokes the traumatic childhood sexual scene. Sexuality and sexual phantasies are at the centre of the elaboration of meaning. Furthermore, the author distinguishes between two types of interpretations, namely ‘open’ and ‘closed’.     

Beyond the what, when, and how of transference: a consideration of the why.

Transference has generally been discussed in terms of its operating to distort the way in which a current relationship is dealt with and experienced because of one's past. In the present paper, emphasis is placed on that aspect of transference which operates as a defense, and which is called into play in response to signal anxiety associated with a "pathogenic complex" and is based on (1) a traumatic experience of stimulus overload or (2) an intrapsychic conflict stemming from instinctual drive pressure which in turn threatens a repetition of the traumatic experience. Clinical illustrations are presented in which both traumatic experience and drive-conflict forces are prominent, leading to a discussion of the here-and-now versus reconstruction of the past, as well as affective/cognitive and interpersonal/intrapsychic factors.     

Making Good Use of Combined Therapeutic Modalities: Discussion of “Somatic Experiencing”

A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well.     

Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

When Avoidance Is Mutual Regulation: Disorganized Attachment and Analytic Attunement

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patient together, along with the feelings engendered by “waiting.”     

A Psychoanalyst’s Contexts

You only remember what you feel.¹

This is an experiential journey through some of the significant experiences that have played a part in shaping my professional identity. An analyst’s work consists of accompanying the patient in a double function of observer and participant with the aim of easing mental pain and facilitating emotional growth that has been partially blocked by past traumatic experiences. Shame is considered to be a central affect appearing in the intimate space of analysis. The subjectivity emerging in the analytic dyad is the principal focus of study for contemporary psychoanalysis. Validation and recognition of the development of subjectivity in the analytic process is the base of psychic change. The psychoanalytic experience transforms the patient’s self-experience at the same time as enhancing those mental functions deriving from good personal development, such as tolerance, mental flexibility, and the capacity of considering others.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

Traumatic effects of political repression in Chile: A clinical experience1

The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally signifi cant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply ‘technique’ rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at fi nding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being.     

Therapist memory and reverie: implications for the clinical setting

In this work, the author considers reveries to be ‘dream-like-memories’. In the course of a session they appear as proto-memory – the therapist’s early traumatic object relations that are recorded in the unconscious at an almost bodily level (a type of unthought known) and which are resurrected between therapist and patient when a similar traumatic subject arises between them. The therapist’s reveries are recollections in the form of dream-like allusions to his past experience. A clinical vignette from the psychotherapy of a child whose father suffered from PTSD (following a wartime experience in Afghanistan and Iraq) is discussed. Dissociative dynamics were repeated in the therapeutic relationship, in the form of an obsessive game intending to preserve the state in which there was no need to remember what had been unconsciously transmitted to the child: his father’s wartime experience. The projection of the primary elements which had been silenced evoked in the therapist allusions to his unconscious identification with his ancestor’s post-traumatic experiences. These allusions helped in overcoming the dissociated state. The role of memory in child psychotherapists’ receptivity of trauma is revisited.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

Affective spectrality in therapeutic space

Spaces for therapy and counselling are haunted spaces, spaces whose physical characteristics can manifest past inhabitation and cue connections to trauma. This paper explores findings from a research project which aimed to understand the perceptions of spatiality of individuals who self harm, and the role of the built environment in supporting therapeutic processes and experience. The data collection and analysis were designed to preserve the integrity of the voices of mental health service users who self harm and communicate their self-reported spatial perceptions. Comparisons between lived/embodied experiences, analysis of intrinsic properties of accounts and exploration of therapeutic sites underpinned the findings relative to the psycho-cognitive geographies of experiences. This paper explores how individuals who self harm experience particular connections between physical and psychological spaces, how their self-reported encounter with interior space is overlaid with the inhabitation of past occupants and memories, which reduces opportunities for access to the therapeutically supportive dimensions of the space, and exercises in self production. This paper first defines ‘haunted space’ ‘trace’ and ‘trauma’; secondly reviews existing literature on affective spectrality, atmospheres and materialites; thirdly discusses the methods used in the study reported in this paper; and finally, explores the relationships between sensory encounters, affective traces, signifiers, felt architecture and the therapeutic function for which spaces are designed. The paper concludes with implications for future research and practice.     

Memory in dreams1

In this paper the author discusses a specific type of dreams encountered in her clinical experience, which in her view provide an opportunity of reconstructing the traumatic emotional events of the patient’s past. In 1900, Freud described a category of dreams – which he called ‘biographical dreams’– that reflect historical infantile experience without the typical defensive function. Many authors agree that some traumatic dreams perform a function of recovery and working through. Bion contributed to the amplification of dream theory by linking it to the theory of thought and emphasizing the element of communication in dreams as well as their defensive aspect. The central hypothesis of this paper is that the predominant aspect of such dreams is the communication of an experience which the dreamer has in the dream but does not understand. It is often possible to reconstruct, and to help the patient to comprehend and make sense of, the emotional truth of the patient’s internal world, which stems from past emotional experience with primary objects. The author includes some clinical examples and references to various psychoanalytic and neuroscientific conceptions of trauma and memory. She discusses a particular clinical approach to such dreams and how the analyst should listen to them.     

Therapeutic implications of counselling psychologists’ responses to client trauma: An interpretative phenomenological analysis

The past two decades have seen a surge of interest in the impact of working with trauma survivors on therapists’ psychological well-being. Existing literature assumes that therapists’ strong subjective responses to traumatic material adversely influence the therapeutic process. However, this has not yet been directly researched. Nine counselling psychologists were interviewed regarding the clinical impact of their responses to the disclosure of traumatic material. Interpretative Phenomenological Analysis showed that significant challenges are experienced in the use of self in therapy with trauma survivors, including making sense of horrific human actions, negotiating complex interpersonal dynamics and responding to ethical dilemmas in therapy. Results emphasised the importance that therapists attached to the development of their therapeutic use of self in therapy with trauma survivors, the value of learning from others and reaching a place of acceptance and hope when working with trauma survivors. Finally, specific training and development implications are proposed.     

Witnessing across time: accessing the present from the past and the past from the present

We are used to the idea that trauma in the past interrupts our capacity to grasp the present. But present or recent trauma can have a similar dissociative effect on our capacity to experience the more distant past. Contemporary trauma can rob the past of its goodness, leaving one feeling as if the past is gone, dead, separated from the present. The vitalization of the present by the past or the past by the present requires that experiences be linked across time. These links are created, in both directions, via categories of experience characterized by shared affect (Modell 1990, 2006). Such categories are created, in turn, by metaphor; and the construction of these metaphors across time requires that one be able to occupy self-states in both the past and the present that can then bear witness to one another. Trauma can result in the dissociation of these self-states from one another, leading to a disconnection of present and past.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

The absence of a future: the effect of past experience and current developmental conflicts on a midlife analysis

The four-year analysis of Mr. T, a highly intelligent, successful professional who entered analysis primarily because of a depression is presented; he had had no previous therapeutic experience but was very curious about analysis. The analytic work led to the discovery of a deeply held unconscious conviction of premature death that was related to interaction among the effects of a traumatic parental divorce during childhood, estrangement from both parents prior to their deaths, and signs of aging and illness in midlife. Before this analytic work the patient was unable to conceptualize, let alone plan for, late-life developmental experiences such as retirement and grandparenthood. Transference-countertransference themes are discussed, as is the importance of an understanding of midlife developmental concepts to successful analytic work with patients in this age group.