On Seeing What Is Not Said: The Concrete Mode of Psychic Functioning and the Development of Symbolization

This paper examines the difficulties that arise with patients who experience a compromised capacity in working on a symbolic level when ensnared in specific transference/countertransference entanglements. In these kinds of situations, patients often operate in what is referred to as the concrete mode of psychic functioning in which there is an inability to think psychologically about their own mind, as well as the minds of others. Similarly, the analyst often has trouble thinking with the patient in processing the actions between them, unable to recruit the patient’s mind in becoming a thinking couple together. Having exhausted conventional technique and interventions in trying to observe the enactment with the patient, the author argues that the analyst’s ability to grab hold of fleeting associations and memories that have not been fully processed not only expands his own mind but also facilitates symbolic functioning in the patient’s mind. By using the imagistic and sensorial substrates of these remembrances to further symbolize personal experiences, the analyst may gain entrée into the patient’s mental life.