The therapeutic relationship exists within multiple levels of reality – including that of ordinary life and that of the therapeutic frame. This interplay between these two levels of reality gives rise to paradoxical experiences for both participants. Certain >principles< or >rules< of technique can be understood as a means of enabling the therapist to cope with what is usually referred to as >boundary< issues. It is essential that the analyst or therapist demonstrate capacity to shift playfully from one level of reality to another. The >rule< of abstinence and the asymmetry of desire that exists between the two participants are discussed. Gratification within the therapeutic frame is paradoxical in that gratification at one level of reality leads to privation at another level of reality. These paradoxical experiences for both patient and analyst are examined in relation to projective identification and to the analyst's countertransference.
This article highlights the analysis of the patient's experience of the analyst's subjectivity in the psychoanalytic situation. Just as psychoanalytic theory has focused on the mother exclusively as the object of the infant's needs while ignoring the subjectivity of the mother, so, too, psychoanalysis has considered the analyst only as an object while neglecting the subjectivity of the analyst as the analyst is experienced by the patient. The analyst's subjectivity is an important element in the analytic situation, and the patient's experience of the analyst's subjectivity needs to be made conscious. Patients seek to connect to their analysts, to know them, to probe beneath their professional facade, and to reach their psychic centers much in the same way that children seek to connect to and penetrate their parents’ inner worlds. The exploration of the patient's experience of the analyst's subjectivity represents one underemphasized aspect of the analysis of transference, and it is an essential aspect of a detailed and thorough explication and articulation of the therapeutic relationship. The paper explores controversies regarding the analyst's self-disclosure and countertransference.
The psychoanalytic situation provides many opportunities for people to observe their analysts closely. These observations are inevitably woven into the fabric of patients’ transference experience. Because the observations can be uncomfortable for the analyst, there is a constant temptation to ignore or deny the plausibility of patients’ perceptions. They can be, and often are, quickly reinterpreted as derivatives of sexual or aggressive urges. Psychoanalytic drive theory, with its emphasis on impulse rather than observation as the force behind transference experience, can encourage counter-transferential disclaimers and lead to blind spots. Some technical suggestions are offered to avoid this tendency and are based on a relational understanding of the nature of transference.
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-constructivist 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.
This article presents the author's reactions to a client who saw him for one visit, came 20 minutes late, demanded ideal >parenting,< called during the following two weeks, and one day left flowers in his waiting room. The focus is on the failed meeting, the meeting that did not take place, loss, and longing. The aim is to go beyond diagnostic categories to the place where therapy fails, the edge of what is therapeutically possible. Dwelling with therapeutic incapacity in a full and detailed way – letting >it< speak – may help to stimulate evolution of capacities needed to work with individuals who now slip away from what therapy can do.
>Once upon a time …< is a good start, but once is not enough. Commentary on paper by Beatriz Priel
(1991)
This article explores the nature and determining conditions of the different relationships that may exist in experience between the mind and the body. Various boundaries and relationships forming between the subjectively experienced mind and body are disclosed through an examination of (1) the experience of affect, (2) the phenomenon of concretization, and (3) embodied selfhood and its derailments. It is shown that the analytic approach to such mind-body relationships must take into account the differing intersubjective contexts in which they originate.
A model of gender as a paradoxical and multidimensional structure is proposed. An extended critical reading of Freud's essay on a case of homosexuality in a woman undermines the notion of gender identity and sexual object choice as monolithic categories of experience. The Freud case is considered for its radical model of sexuality and gender, but also for its restrictive use of classical interpretation. Alternative interpretive lines and transference countertransference meanings are considered. With the use of contemporary clinical material, a model of gender identity and sexuality is proposed in which the unconscious and symbolic meaning of bodies and genders, rather than biological sex of the lover and the beloved, carries the interpretive weight.
>Speak! that I may see you< some reflections on dissociation, reality, and psychoanalytic listening
(1991)
Some defenses work so early and so massively that the experiences they lie athwart of or repress are difficult to find in the later transference. This paper deals with a method of reconstructing these by means of a systematic analysis of the analyst's own urges to make interpretations or other interventions. The conceptual foundation for this rationale, a differentiation of experiences when the individual is a member of the couple and when the pair, is provided.
This article analyzes and critiques the construct of gender as a psychoanalytic and cultural category. Without succumbing to a nonpsychoanalytic notion of androgyny, the argument developed here challenges the assumption that an internally consistent gender identity is possible or even desirable. Beginning with the idea that, from an analytic perspective, the construct of >identity< is problematic and implausible, because it denotes and privileges a unified psychic world, the author develops a deconstructionist critique of our dominant gender-identity paradigm. It is argued that gender coherence, consistency, conformity, and identity are culturally mandated normative ideals that psychoanalysis has absorbed uncritically. These ideals, moreover, are said to create a universal pathogenic situation, insofar as the attempt to conform to their dictates requires the activation of a false self system. An alternative, >decentered< gender paradigm is then proposed, which conceives of gender as a >necessary fiction< that is used for magical ends in the psyche, the family, and the culture. From this perspective, gender identity is seen as a problem as well as a solution, a defensive inhibition as well as an accomplishment. It is suggested that as a goal for analytic treatment, the ability to tolerate the ambiguity and instability of gender categories is more appropriate than the goal of >achieving< a single, pure, sex-appropriate view of oneself.
This paper reinterprets the historical problem of penis envy, that is, the girl's wish to be masculine, in terms of a developmental need to identify with father. Many of the problems posed by earlier analyses of femininity can be clarified by recognizing that before the girl >turns< to the oedipal father as love object, she looks to the rapprochement father for identification. Identification is not merely an internal structure, it is a relationship in which the subject recognizes herself or himself in the other. In rapprochement, love of the father, who symbolically represents the outside world, takes the place of the practicing toddler's >love affair with the world.< This identificatory love of the father, initially noticed in boys by Freud and later authors, is often frustrated by the father's absence or inability to recognize the daughter. This frustrated longing takes the penis as its symbol of likeness. The pre-oedipal over-inclusive phase of identification with the other sex parent is not superceded by the oedipal constellation, but is integrated with it. Thus identification becomes an important basis of the love of the other: it is not so much the opposite of object love as an important precursor and ongoing constituent of it. Case material illustrates the multiple possibilities of identificatory love and use of phallic symbolism to represent them.
The fantasy self-image of the hero is common to many men. When these men come to psychotherapy, they present a variety of symptoms that may be linked to this self-image. These include grandiosity, the need to control the therapist, empty depression, and a preoccupation with the imagery of death and battle. These patients tend to evoke in the therapist emotional responses that the patients subsequently deny. These characteristics are so pervasive among men that they may be endemic to manhood. The heroic model of manhood is an attempt to strengthen and stabilize the gendered self-representation. Because fathers tend to be absent from the nurturing matrix, their sons have little early experience in an affective, preverbal relationship of mutual influence with another who is essentially like themselves yet outside their omnipotent control. Men, therefore, are raised with a pervasive experience of >otherness,< their infantile experience and affectivity forever trapped in the world of women. Although the yearning of men for their fathers is recognized in psychoanalytic theory, the wish for the nurturing father has been underemphasized. The underemphasis causes the f nalyst to miss, or misunderstand, important transferential constellations.
Apparently a straightforward elaboration of anatomical difference, >gender< is symbolically tied to many kinds of cultural representations, which, in turn, set the terms not only for understanding the relations between women and men but for organizing self-experience. Consequently, problems of self may come to be coded in terms of gender, and those of gender, in terms of the self. Using a clinical example, I speak of gender less as a determinate category than as something resembling a force field, that is, as a set of complex and shifting relations among multiple contrasts or differences. This multiplicity, in turn, generates some technical recommendations about gender and splitting. Recapturing split-off parts of the self therefore requires inhabiting its transitional spaces, including that in which gender is not a given but is in question. Moreover, I suggest, counterintuitively, that gender identity both seals the package of self and preserves all the self must lose and thus bridges undifferentiated archaic depths and selfhood. In transference and countertransference, both patient and analyst must also enter this paradoxical space, where they alternate between being gendered and being gender-free.
A clinical moment
(1991)
The capacity for personal isolation is as critical to psychological health as is the capacity for object relatedness. In this paper, the notion of personal isolation is expanded to include a form of isolation in which the infant replaces the mother-as-environment with his own sensation matrix. This form of experience is not conceived of as a phase or stage of development prior to object relatedness rather, it is viewed as an ongoing facet of all human experience that serves as a buffer against the continual strain of being alive in the world of human beings. The understanding of this primitive dimension of personal isolation provides a way of thinking about the differences between the elaboration of universal >autistic-contiguous< forms of experience and the development of pathological autism.
>Knowing one's patient inside out< is a metaphor that is intended to capture the paradoxical quality of the intersubjective field that we call the analytic relationship. The interface among trauma, dissociation, and regression is discussed in the context of unconscious communication as a transferential enactment of unsymbolized experience.The view is offered that for certain patients in particular, past experience is not so much unconscious as >frozen in time< and that a key element of the psychoanalytic relationship is bridging dissociated aspects of self through the creation of a dyadic experiential field that is both >inside< and >outside.< The writings of Michael Balint, D. W. Winnicott, and several other British object relational theorists are explored in the context of a contemporary interpersonal psychoanalytic perspective.
A letter from Karl Menninger
(1991)
The silent patient is defined as one who speaks for less than 10% of the entire analytic treatment period, and for many sessions, not at all. This article derives from the author's experience in the analyses of eight such patients during her working life as an analyst (30 years). After a brief discussion of some basic theoretical issues that are usually kept in mind in the early stages of such analyses, there follows an examination of the particular technical problems presented by extended silence short clinical vignettes, illustrative of these problems, are woven into this part of the text. Special emphasis attaches to the detailed study and use of the countertransference, probably more valuable in these cases than in any others. The qualities that are desirable, even necessary, in the analyst are discussed, among them the capacity for love, a subject still approached gingerly in our literature. Reference is made to two eccentric forms of silence: absence and sleep. Notes on the study of body language and the uses of humor are discussed briefly. There is a special interest inherent in the work with silent patients, and some thoughts on its rather mysterious quality close the article.
A Little Psyche-Music
(1991)
This paper evaluates Kohut's selfobject concept by reviewing the historical context of its origin and the gradual substitution of an emphasis on experience for the ego psychological emphasis on function. When viewed as a dimension of experience, a selfobject experience has the affective quality of vitalization. This modification and extension of Kohut's original concept derives from infant research, especially Stern's revision of affect theory and Lichtenberg's concept of five motivational systems. The paper concludes with an application of the theory of selfobject experience to pathological states, especially those involving addiction.
In this paper, we present a model for conceptualizing the etiology of boyhood gender identity disorder. We illustrate the model with a specific case of a three-year-old boy who developed a gender identity disorder in reaction to his mother's depression after she had an abortion. We describe how the temperament of the child, his reaction to a psychic trauma during a sensitive period of mental representational development, and multigenerational transmission of psychodynamics lead to a gender identity disorder. We view the cross-gender fantasy as a compromise formation for the management of separation anxiety and aggression, and we view its enactment in behavior, in part, as a defensive attempt to understand an unmetabolizable experience of aggression. This case offers an unusual window into understanding how interpersonal experience, particularly in the face of severe anxiety, becomes transformed into intrapsychic phenomena and how pathological beliefs both encode experience and construct psychic reality.
A Profile of Erich Fromm
(1991)
A biography of German psychoanalyst Erich FROMM, beginning with the influence of an intensive Jewish religious education, which was an admixture of philosophy, mysticism, socialism, psychoanalysis, and traditional rabbinical wisdom. It is argued that this early training is evidenced in FROMM's assertion that character can change throughout life, and that prevailing social character has a profound impact on the developing individual, regardless of family idiosyncracies or misfortunes. FROMM typified a Jewish synthesis of rationalism, mysticism, and love of tradition, combined with a prophetic element of radical protest. Also discussed are his progression through religious and sociological doctoral studies and analytic training from Freud loyalists. It is contended that FROMM emerged from the turbulent 1930s and 1940s to become one of the most prolific psychoanalytic authors of the twentieth century, and that his impact on the humanities and social sciences 1950-1970s is unparalleled. Alleged weaknesses in FROMM's work that suggest drawbacks for the clinician are discussed, including the complexities created by his deliberate policy of making minimal use of case histories and clinical vignettes, his tendency toward overstatement, inconsistency in his emphasis on the cultural and economic determinants of mental disturbance, and his purported reversion to a pre-Freudian psychology.