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Davies contributes to the development of relational theory by formulating and illustrating what occurs during especially difficult moments in an analytic exchange. In understanding enactments, Davies importantly underscores the contribution of both the analyst's and patient's >bad objects.< This author attempts to build bridges between Davies' language and concepts anchored in object relations theory and this author's language and concepts based in contemporary or relational self psychology, including the integration of cognitive psychology. In addition, this author delineates the use of the >empathic,< >othercentered,< and >analyst's self< listening/experiencing perspectives to explicate the case material and to provide alternative understandings and pathways for psychoanalytic work. The thesis set forth is that the use of different listening/experiencing perspectives expands choice for the analyst when working in difficult moments of the clinical exchange.
Replying to eight commentaries on my paper submitted by readers of this journal, I address such disparate issues as matters of training and supervision, theories of regression, the analyst's self-states, the patient's vital purpose, complexities of doing for the Other, and the question of what needs to be spoken (interpreted, formulated, declared) explicitly between patient and analyst. I further explore the meaning of my stating to my patient that I would not hug her in our analytic work ahead. And I respond to questions regarding my concept of the paradoxical analytic triangle.
Stuart A. Pizer's fascinating article explores through a relational lens analytic impasse, and its manifestation through transference and countertransference love. How this love is demonstrated (or not) and the ways in which we provide for our patients will have profound effect on the process (and progress) of any treatment. But, too often, reluctance to >do for< our patients compromises our ability to provide what may be needed in any given moment. Perhaps an expansion of the >doer – done to< dyadic paradigm into a >doer – done for< model might allow more analytic leeway and more possibility of growth within our patients.
This case provides a delicate approach to vital purpose, unconscious pattern, and >emotion recollected in tranquillity.< The author defines, the >paradoxical analytic triangle< to which Pizer refers, as a human quality, an unprecedented level of understanding and comprehension, that lets analyst and patient recognize their own dependence on the object. In so doing, they both gain a quality of presence through recovering the projections that they have attributed to the object. Four aspects are considered important steps leading to this human quality within the analytic process: dissociation leading to impasse sensibility opening to countertransference recollection in tranquillity leading to self-reflexivity and the patient's >vital purpose< – the most salient aspect (the lighthouse) of the whole project.
It seems it would be helpful for all impasses to be >recollected in tranquility.< In the thick of impasses, however, when we are experiencing pressure, defensiveness, vulnerability, and the responsibility to come up with a quick solution, it can be nearly impossible to think clearly. Time may take us to a place of greater calm and fresh awareness. But it may also provide an illusory calm, leaving us stuck circling in old familiar grooves, grooves rimmed by our own unconscious vulnerabilities and limitations. At such times, we may operate in a perceived state of calm, but with a set of powerful, yet ineffective, unseen or outgrown, concretized beliefs and perceptions, creating a perception of calmness. Some of these may even silence or damage the cooperative or struggling patient, who remains or dares to return (out of a longing to connect or make things >right<). I wondered whether what Dr. Pizer's patient said at the end of Rebecca's second therapy with him was true (that she no longer needed a hug from him, finding it more mature to proceed without one), or if this was merely what she felt she should say in order to leave a key relationship she valued – also in peace and tranquillity.
This discussion of the paper by Stuart Pizer focuses on the unconscious forces operating within the analyst that can contribute to a therapeutic impasse. The author discusses a period when she unknowingly skirted interpersonal and transferential interpretations as a result of particular stresses in her personal life. It was not until she was taken to task by one of her patients that she realized the extent to which these stresses had led her to back away from the intensity of the therapeutic relationship. This discussion is offered as a cautionary tale, to remind every analyst of the importance of remaining as aware as possible of one's own circumstances, history, dynamics, and limitations and to be forever watchful of oneself.
This discussion addresses two key points concerning Pizer's thoughtful paper about a long-term, difficult analytic process. First, it responds to Pizer's quest for theoretical and clinical concepts that do not limit the analytic work of mature, experienced analysts to interpretive work, but reconnects them theoretically, clinically, and technically with deeply engaging emotional experiences of life-giving, profound transformation through treatment. The author suggests that the clinical theory of therapeutic regression, which was developed and forged within intense and difficult analytic treatments, brings the critical need for fundamental experiences of the analyst's loving and sustaining provision into the framework of the psychoanalytic process and therapeutic action. The discussion further elaborates on the emotional risking and vulnerability – the venture zone, as the author terms it – that creating psychic change implies for both patient and analyst. This venturing by both of them is illustrated through the clinical example presented by Pizer in his paper.
In our response to Pizer's paper, we underscore the importance of discerning when to more deeply and conjointly explore emergent intersubjective moments in the therapeutic exchange. Pizer states that he would not now proceed clinically in the same way that he conducted his first treatment of his patient Rebecca, which occurred prior to his receiving full analytic training. However, he questions whether the therapeutic engagement would have advanced as well as it did if he had not offered various sponsoring and sheltering provisions to his patient. We believe that a more reflective and self-aware Pizer could have both supplied the provisions that Rebecca so desperately needed and more actively explored the meanings of their experiences together. Further discussion is needed regarding how impasses result when deepening analytic reflection and interpretation are not used to negotiate the multiple and paradoxical relationships that develop in treatment. In addition to training and consultation, we need to identify and utilize various ways to better understand what interferes with our capacity to negotiate the balance between remaining true to our own subjectivity and being enough of what our patients need us to be.
In providing the background to a pivotal session, Stuart Pizer reveals his clinical work as an unsupervised neophyte, prior to his own analysis and analytic training. These early therapeutic efforts were flawed, leaving Pizer at times >grimacing with mortification 26 years after the fact.< But they were also extraordinarily helpful to the patient. Schaffer discusses the challenge of supervising similarly talented beginners: how does one teach psychoanalysis without desiccating a treatmen? How does one teach a relational approach, with no >basic model< and few rules, to a beginning analyst infused with an unformulated, yet often passionate, sense of what is >curative<? Pizer recognizes that were he to meet the same patient today, he would not conduct the same treatment. Now trained and analyzed, not to mention more cautious and >worldweary,< Pizer would not do what he did then. But what if he were the supervisor then? Schaffer concludes her discussion by asking Pizer how he, now a seasoned analyst, would supervise his early therapist self.
This article examines a debate concerning the exegesis of the story of the garden of Eden and the tree of knowledge, as told in Genesis. Two contradictory interpretations of the garden narrative are examined, the first as the story is elucidated by the psychoanalyst and social theorist Erich Fromm and the alternative interpretation by the Talmudic scholar and philosopher Rabbi Joseph Soloveitchik. This article compares and contrasts their exegeses and the respective implications of each view. The controversy, which has profound implications, reflects differences in world views concerning the good life, autonomy and relatedness, assertion and submission, will and surrender, obedience and rebellion, independence and interdependence, subjectivity and intersubjectivity. Links are drawn to a variety of contemporary psychoanalytic theories, developments, and controversies.
The progress of psychoanalysis and psychotherapy depends on our capacity to study, in a scientific manner, the process of therapy. Since a study of this kind involves charting the waxing and waning of something as elusive as the sense of personal existence, the task has, in the past, been seen as virtually impossible. However, words, or more particularly, the way words are used, manifest such shifting states. Sophisticated linguistic analyses are available, providing the means to conduct these necessary studies. This article suggests that an ongoing sense of personal existence, which William James called >self,< is multilayered, in the manner of the poetic, and that indices of such layering will reflect beneficial change. The description of this zone of experience, which might be called the synchronic, depends on contributions from Marcel Proust, Virginia Woolf, Henri Bergson, and Ferdinand de Saussure. An illustration of the value of a consideration of the minute particulars of the therapeutic conversation is given by means of extracts from therapy sessions seven months apart.
Freud's theory of melancholia has lately experienced a renaissance among those interested in the creative potentialities of the psyche. In this essay, I consider the ways in which melancholia can contribute to the actualization of these potentialities by preparing the ground in which inspiration can later take root. I also outline the circumstances in which the melancholy subject's refusal to abandon its lost objects represents an entirely valid response to loss. At the same time, I propose that if the subject is to develop an affirmative and imaginatively supple relationship to its psychic history, it must in the end move from melancholia to meaning production. Insofar as melancholia signals the psyche's inability or stubborn unwillingness to move forward, its powers by necessity remain dormant until the subject is able to exchange its sadness for the versatile meaning-making capacities of the signifier. I moreover argue that it is only when the subject is able to transcend its melancholia enough to begin to desire new objects that it can develop loving and responsible relationships with others – that it can begin to welcome others in their own terms rather than reducing them to its own narcissistic image.
Burton's response to discussions by Krystal and Khantzian addresses the manifestation and engagement of aspects of bad objects in addictions treatment and acknowledges the broader relationship between compulsive behaviors and dissociation. In addition, Burton presents thoughts on cross-disciplinary communication and an emergent relational metapsychology and its potential impact across schools of psychotherapy.
Commentaries by Edward Khantzian and Henry Krystal allow me to elaborate the role of dissociation in addictive disorder, and its misguided place in the design of many therapeutic strategies to overcome it. Promising direction for the treatment of the characters and symptoms of drug-dependent patients lies in the application of developments in current analytic theory and technique. Such developments include familiarity with enactment, dissociative and projective processes, and work in a two-person frame to enable treatment to encompass and reach more of the patient.
The two papers on the psychoanalytic treatment of addiction are important contributions and provide us with newly organized tools and techniques. Emphasizing the dissociative reactions in this area also highlights the issues we encounter in the analysis of the addictive type of personality. Both the transferences and the countertransferences need special attention because they are difficult for every patient and analyst. Thus we are alerted to these individuals' great neediness and dependency and their desperate defenses against confronting the core problems. After all, their personalities are dominated by their need to escape, deny, or block their lifelong misery. Hence, the burden is for the analyst to deal with his or her own feelings of boredom or helplessness, and the challenge is to handle the patients in a supportive and yet interpretive way in the interactional and relational cooperation. These new insights and review of old principles will reward the reader.
The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation – integration, helplessness – omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.
Relational perspectives on the nature of self and the unconscious have transformed how we can understand addictions and substance use problems. Addictions have received little attention in the contemporary literature and therapeutic approaches outside of psychoanalysis have been skeptical of psychoanalytic approaches. It is my contention that viewing substance use problems through the lens of a relational/multiple self-state model offers new clinical possibilities resulting in greater success in treating these patients. In this model, addictive behavior is seen as embedded in dissociated self-states. Therapy focuses on helping the patient to move from dissociation to a true multiplicity and a decreased dependence on substances.
An assumption made in this paper and explored for its clinical implications is that an act of chronic drug use often marks or serves to implement an underlying omnipotent self-state. Psychoanalytic work with substance users, as compared with other approaches, trains attention on these omnipotent states and makes use of the transferential exchange as a therapeutic tool. States of omnipotence are particularly examined here in the context of recent attention to dissociation as an organizing force in the personality, and in the configuration of the transference – countertransference of the treatment relationship. A case illustration is used to apply current thinking on dissociative and projective processes, and their role in enactment in the therapeutic exchange, to illuminate the frequent interplay of omnipotence and helplessness in analytic work with substance-using and other patients.