Marco Conci interviews Stefano Bolognini

Abstract

This paper suggests that the understanding of intersubjectivity, which refers to “the dynamic interplay between the analyst's and the patient's subjective experiences in the clinical situation”, is crucial for psychoanalytic work. The analyst's inner experiences, from the first moment that he or she thinks about or meets the patient, belong to an intersubjective situation. Not only are these experiences a valuable channel through which the inner experiences of the patient can be understood, but—as Theodore Jacobs puts it—they are often complementary to that which comes from the patient. The author tries to illustrate the above through the study of the analytic process in the psychoanalytic therapy of a severely disturbed patient. This therapy from its very early phase led to the reawakening of some of the analyst's old conflicts. The patient's difficulties in tolerating the limits of the analytic setting and using free association are discussed, as are his enactments. The analyst's close observation of the interaction between her and the patient, the permanent engagement with her countertransference, and the use of her inner experiences with the patient helped her to contain the enactments, defined the nature of her interventions, and contributed to the analytic process.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

THE VIBRANT CHALLENGES OF CLINICALLY EFFECTIVE PSYCHOANALYTIC MINDEDNESS

In addressing the central challenges of developing and maintaining the analyst's psychoanalytic mindedness, this paper focuses on two particularly challenging core components of clinical effectiveness not so easily developed despite the rigors of the tripartite training model. The first is the analyst's receptivity to unconscious communication, which entails the analyst's curiosity, acceptance of human nature, doubt, restraint, narcissistic balance, and integrity. A brief clinical vignette illustrates this. The second factor is recognizing and managing the inherent disappointments and narcissistic challenges in working psychoanalytically. The author maintains that the ability to lose and subsequently recover one's analytic mind entails discipline, courage, and faith that only experience can provide.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

The body of the analyst and the analytic setting: Reflections on the embodied setting and the symbiotic transference

In this paper the author questions whether the body of the analyst may be helpfully conceptualized as an embodied feature of the setting and suggests that this may be especially helpful for understanding patients who develop a symbiotic transference and for whom any variance in the analyst's body is felt to be profoundly destabilizing. In such cases the patient needs to relate to the body of the analyst concretely and exclusively as a setting ‘constant’ and its meaning for the patient may thus remain inaccessible to analysis for a long time. When the separateness of the body of the analyst reaches the patient's awareness because of changes in the analyst's appearance or bodily state, it then mobilizes primitive anxieties in the patient. It is only when the body of the analyst can become a dynamic variable between them (i.e. part of the process) that it can be used by the patient to further the exploration of their own mind.     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

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’.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

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.     

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.     

WHOSE SLEEP IS IT,ANYWAY? OR ‘NIGHT MOVES’3

The analyst's ‘sleep’ during sessions is a puzzling, troubling, extreme experience, which has rarely been described in the psychoanalytic literature. The author presents a clinical illustration in which her recurring ‘sleep’ during the sessions was approached as an open, central issue. She attempts to explore, understand and integrate this experience theoretically and clinically, first by reviewing and examining the psychoanalytic literature on the subject and on related phenomena, and then, more particularly, by formulating her own explanation of it. She emphasises being in the grip of the psychoanalytic process, and the immersed involvement and converging of patient and analyst, which generate a conjoint state of deep experiential interconnectedness and impact on each other ‐ in particular the impact of the patient's inner world on the analyst. In this context, the author also refers to the notions of ‘the uncanny’, ‘fear of breakdown’ and dissociative self‐states and the mitigation of the patient's dissociative self‐experience via the analyst's vicarious dissociative experience.     

MORTALITY,INTEGRITY, AND PSYCHOANALYSIS (WHO ARE YOU TO ME? WHO AM I TO YOU?)

The author narrates her experience of mourning her therapist's sudden death. The profession has neglected implications of the analyst's mortality: what is lost or vulnerable to loss? What is that vulnerability's function? The author's process of mourning included her writing and her becoming an analyst. Both pursuits inspired reflections on mortality in two overlapping senses: bodily (the analyst is mortal and can die) and character (the analyst is mortal and can err). The subject thus expands to include impaired character and ethical violations. Paradoxically, the analyst's human limitations threaten each psychoanalytic situation, but also enable it: human imperfection animates the work. The essay ends with a specific example of integrity.     

Discussion: Toward a social‐constructivist view of the psychoanalytic situation

The three papers by Modell, Aron, and Greenberg are discussed in terms of their relationship to a new paradigm for understanding the psychoanalytic situation. The paradigm is called social‐construct‐ivist to capture both the idea of the analyst's participation and the idea of construction of meaning. It is argued that these theorists, as well as many of the authors they cite as part of a broad movement in the field, do not consistently meet the criteria for this paradigm, although they seem to be aiming for it. An important source of inconsistency and confusion derives from the confounding of the two axes: drive‐relational and positivist‐constructivist. Many relational theorists who hold fast to the idea that analysts can grasp the truth of both their own experience and that of the patient are no closer to the constructivist point of view than was Freud. The call by Aron and Greenberg for greater attention to the patient's resisted experience of the analyst's subjectivity is discussed in terms of its potential benefits and problems. The ritualized asymmetry of the psychoanalytic situation is said to have important functions, including prevention of excessive involvement and protection of the unobjectionable positive transference and of a degree of idealization. Modell's notion of paradox, which makes the therapeutic relationship seem “real”; and “unreal”; at the same time, is seen as a special instance of the always precarious social construction of reality. It is argued, moreover, that the social and individual aspects of experience are interdependent. Neither is reducible to the other, and both should be understood, like many other issues in the new paradigm, in terms of a dialectical interplay of figure and ground in experience.     

Remember Where You Come From: Dissociative Process in Multicultural Individuals

Psychoanalysts participate in the internal constructs and the external exigencies of the people with whom they work, sitting where society and individuality cross paths. Yet, much of psychoanalytic writing mutes culture's bass line from the self's composition, even though every gesture—not to mention every word—evinces the cultural world in the analyst's room. Psychic disconnection takes place as the analyst decontextualizes an individual's personality from cultural reality in a dissociative process that compromises the analytic work. Cultural truths are very much a part of that work's mutuality. Social history underscores the motivations of the seekers and the providers of psychoanalysis and psychotherapy. Interpretations, enactments, and the relationship's construction unconsciously replicate unexamined tenets of analysts' cultural belief system. If analysts don't connect the dynamic process in which they work to social influence, they and the people who consult with them will inevitably wall off access to transformative meaning. Increased consciousness about how culture affects the therapeutic relationship inspires change. This paper presents three clinical examples in which culture was openly acknowledged as another actor in the psychoanalytic relationship. Two persons working together from and within cultural history create a common language: the dream of a better life.     

Shades of Mark Twain: Commentary on Paper by Steven H. Cooper

The author considers Cooper's notion of the pluralistic third from several angles as Cooper's use of the term covers a range of applications from that of an internal supervisor to the use of ideas from psychoanalytic traditions other than one's own in evaluating one's clinical work. The impression created of the American situation is contrasted with the institutionalized pluralism of the British Psychoanalytical Society since the Second World War. The author believes that the theoretical question of the analyst's accountability to a professional authority is overdetermined in the paper because the clinical material is dominated by the patient's problems in facing up to parental authority. A crucial enactment is seen as starting at the analyst's first contact with the patient, which seems to subvert the analyst's capacity to be an authority figure. The analyst finds a working relationship with his own psychoanalytic authority in the second session of the analysis but seems to lose it through an overextension of the ideas of “play,” self-questioning, and the seeking of agreement between patient and analyst. The author considers the clinical material from the point of view that his peer supervision group would take.     

Comparing Field Theories

While in broad agreement with many of the observations made by Donnel B. Stern, this essay emphasizes certain differences in how BFT in general and the work of Nino Ferro in particular are seen. These begin with the very meaning of the term, field, and include a less authoritarian view of the analyst's “knowing” the degree to which the analyst's unconscious and subjectivity are implicated in the creation of the field, and the nature and degree of the analyst's unconscious contribution to the creation of the field.     

THE ANALYST'S APPROACH AND THE PATIENT'S PSYCHIC GROWTH

Psychoanalysis, which shares many functions with other therapies, is built upon its unique concern for the unconscious forces active behind a patient's symptoms and difficulties. What defines psychoanalysis is the analyst's approach as a disciplined engagement in the service of exploring those forces and their roots, an approach that is the product of curiosity working in the service of the other. As a result of the analyst's actualizing this approach, the patient comes to benefit not only from whatever specific declarative interpretations and insights have been explicitly opened, but also, importantly, from observing and taking in the unspoken underlying psychoanalytic mental processes. In this light, the patient's significant capacities for empathy, a subject often neglected, are also discussed. ¹      

Characters on the Stage. Ibsen's “Life-Lie” Revisited

The authors inquire as to how far psychoanalysis uses its inherent capabilities to decipher the inner structure of subjectivity in present-day psychoanalytic practice and thinking. They maintain that in psychoanalytic practice, the analyst's unresolved neurotic conflicts cause him to create conscious mystifications of his own unconscious situation, thus distorting his understanding of the patient's unconscious in a systematic manner.