How Does Change Occur Within the Psychoanalytic Encounter?

On November 6, 2002, Dr. James Fosshage delivered the following talk at a Clinical Training Conference held at the Blanton-Peale Institute. The Clinical Training Conference at Blanton-Peale provides experiential and conceptual resources to support the therapist-in-training in the context of his/her professional identity. The training conference is attended by candidates of all phases of the Psychoanalytic Program, the Pastoral Psychotherapy Program, and the Marriage and Family Program, as well as faculty members, administrators, staff, and interns of the institute. The residents were asked to review three articles written by Dr. Fosshage in preparation for his presentation: Toward Reconceptualising Transference: Theoretical and Clinical Considerations, International Journal of Psycho-Analysis (1994) 75 (2): 265–280; Countertransference as the Analyst's Experience of the Analysand: Influence of Listening Perspectives, Psychoanalytic Psychology (1995) 12 (3): 375–391; and Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness, Conversations in Self Psychology: Progress in Self Psychology, (1997) 13: 33–55.     

Race and Countertransference: Two “Blind Spots” in Psychoanalytic Perception

In this paper I propose an approach for the evocative use and resolution of racial and countertransferential manifestations in the treatment situation. When addressed with the interest they warrant, these phenomena can become powerful tools for the advancement of the treatment, rather than blind spots. The therapist's own treatment is offered as the most likely means through which the evocative and pernicious effects of race and countertransference can be mastered.     

The Unreal Child1

Unrepresented mental states lead to an impaired ability to feel emotions and trust in oneself, one’s history and in the world. The article explores the question of how representations of oneself and the relevant other, the mother, become possible in the course of therapy when dissociative processes previously made this impossible, and what role unconscious communication plays in the analytic realm. This question will be explored by examining the theories of André Green, Philip Bromberg, and Howard Levine.     

I am I:A/M—The Therapist as Personification of Hopper's Fourth Basic Assumption

The group therapist often and perhaps necessarily personifies Incohesion and displays its predominant defenses of contact-shunning Aggregation, and merger-hungry Massification. Hence, I am I:A/M. In Hopper's group example, and in each of three of this author's groups, the therapist displayed aggregative and massified defenses, countertansferential duals of basic assumptive transferences. In any therapeutic interaction, it is possible to find elements of incohesion, dependency, pairing, and fight/flight. The incohesion concept has significant clinical utility. A theoretical question remains, whether Hopper's proposed axis of experience and defense merits the special status, basic assumption, or whether incohesion may be collapsed into the existing triad of basic assumptions.     

Providing a Transcultural Genetic Counseling Service in the UK

This paper uses a broad definition of culture to explore the practice of transcultural genetic counseling through three case studies. The first case involves a White genetic counselor seeing an Asian family, the second, an Asian genetic counselor seeing an Asian family and the third, a hearing genetic counselor seeing a culturally Deaf client. Boundaries, transference and countertransference reactions are considered within each transcultural encounter and the author of each case reflects in detail on their role in the client interaction and their impact on the transcultural dynamic. The cases are used to illustrate some cultural beliefs or characteristics that may challenge the genetic counselor’s expectations. The value of identifying and interpreting these differences to facilitate useful clinical work is considered. The paper debates, where possible, whether it is helpful to culturally match genetic counselor and client.     

Countertransference as active imagination: imaginative experiences of the analyst

Active imagination is at the heart of Jung's elucidation of depth psychology. Yet, in the discourse of present day analytical psychology theory it is not always given the serious attention accorded to some other Jungian concepts. Active imagination emerges spontaneously within the 'third' area--the imaginal or dynamic field--in-between patient and analyst. It is commonly regarded as the patient's experience but I am proposing that, looked upon as the analyst's experience as well, active imagination offers a distinctly Jungian way of understanding some forms of countertransference. I am describing what I think many present-day analytical psychologists already do in their clinical practice but, as far as I know, it has not been theorized in quite this way before. The intention is to exploit the unique contribution of our Jungian heritage by reframing certain profoundly symbolic countertransference-generated imagery as active imagination. In this article these are differentiated from other less complex forms of imaginative countertransference through examples from clinical practice. The point is that such countertransference experiences may activate the symbolic function in the analyst and thus contribute to the mediation of emergent consciousness in the analysand.     

Fordham, feeling, and countertransference: reflections on defences of the self

This is a paper about the difficulties we as analysts get into when we find that a patient has activated something in our unconscious which we cannot resolve in our work with them. Fordham described at the end of his life, in a number of papers, his difficulties and discomfort at not being able to resolve an impasse with one of his patients. From the conversations we had about this situation I knew this caused them both a lot of pain. After Fordham's death his former patient consulted me. Arising from these consultations I describe how I have understood the impasse to have arisen between Fordham and his patient. This paper links character and clinical interests, personality and impasse, developmental failures and defences of the self. It is a personal statement in which I have struggled to represent the meaning in the pain these two men suffered during their analytic engagement, which lasted more than ten years. The theme of fathers and sons was central to the problem.     

The analyst's countertransference when supervising: friend or foe?

This paper explores transference and countertransference dynamics in the supervisory relationship and their impact on the task of supervision. The development of analytic theory in relation to supervision is described and the value-and ambiguity-of the concepts of 'mirroring', 'parallel process' and 'reflective process' are discussed. The impact of organizational dynamics on the supervisory relationship is investigated in relation to four main unconscious forces: a) organizational defences, b) power and authority, c) accountability and responsibility, d) ethical concerns. Clinical situations which illustrate these issues are described and explored and used as a basis for examining the role of the supervisor's countertransference in supervision. The different framework of practice in supervision, as opposed to analysis, is described in terms of its focus, the supervisor's ways of responding and the dynamic process, and the concept of refracted countertransference is introduced and explained.     

The day the clock stopped. Primitive states of unintegration,multidimensional working through and the birth of the analytical subject

This paper is based on one idea and built around one clinical experience that helped me to broaden my comprehension of it. The idea, underlying the work of several authors, is that when the analytic field is saturated with primitive and unintegrated mental contents, the analyst’s somatic countertransference is a precious indicator of a deep, dissociated form of communication. The clinical experience concerns the difficult elaboration of a complex, multifaceted countertransference that took place during the early stages of the analysis of a sensitive patient who used to communicate in a very dissociated way and that I found hard to contain. This experience, closely described in the article, led me to formulate the clinical idea that the transference field may be made of distinct layers (psychoid, affective, verbal), and that each one of them may potentially convey dissociated, even contrasting bits of information. The corollary of this is that the analyst should be ready to accept contrasting sensations, feelings and thoughts at the same time, as they might be the basic ingredients of a complex reverie. The analyst could find himself/herself in front of his/her own internal unelaborated multiplicity before a symbolic image may emerge to link the scattered pieces of the experience. Nevertheless, the heart of this paper is not about suggesting an idea, but in the sharing of a complex working through, which fostered the birth of a new, more human relational perspective: the capacity of being together in time, in a transitional space where there is neither total separation nor fusion.     

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.