Inside Out: The State of the Analyst and the State of the Patient

This paper presents my work with a man before and after my undergoing an emergency, life-threatening surgical episode, and subsequent experience of living with a temporary colostomy, that shifted me to a more ungrounded, bodily aware, vulnerable, nonlinear, spontaneous and risk-taking, and affectively intensified “right brain” state. My story represents one instance of how the contingent nature of the analyst's life and existential exposure, and the various chancy life circumstances governing the analyst's self-state, may constitute an impingement on clinical process with potential for inadvertent positive or negative impact on the therapeutic relationship and work. Much has been written about the causes and consequences of shifts in the analyst's self-state induced within the relational dynamics of the transference-countertransference matrix. Here I specifically consider that side of the intersubjective therapeutic equation generated by the effects of the analyst's own state on the patient and the dyad's interactive process.