The Patient’s Experience of the Analyst’s Physicality: It’s What’s on the Outside that Counts

ABSTRACT

In this paper, I explore how patients’ experiences of their analysts’ physicality – conveyed in the concrete aspects of the analyst’s body, clothing, and office – can be a constructive domain of budding intersubjective engagement. This is both generally true, and of specific salience with narcissistically vulnerable patients, for whom states of psychosomatic unity are compromised, and with whom finding ways to be “usable” as objects can be elusive. At the same time, both members of the dyad can resist such inquiries and enactments despite their generative potential. I highlight how we analysts may shy away from pursuing these aspects of our patients’ transferences because of our own anxieties about how we do or do not want to be seen. Such anxieties and vulnerabilities can be heightened in this arena, given that the analyst’s physicality reflects both material constraints and fluid, unstable meanings derived from the shifting intersections between personal construction, relational context, and the broader sociocultural surround, particularly as it informs expressions of gender, race, class, and the like.

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Notes

¹ In this sense, like a number of contemporary theorist-clinicians, I am focused on the progressive, prospective aspect of analytic treatment, and the variety of ways that therapists participate in co-creating new experiences to potentiate foreclosed experiences of self, hope, and futurity (e.g., Alvaraz, 1992; Aron & Atlas, 2015; Cooper, 2000; Davies, 2018; Director, 2009; Grossmark, 2012, Levine, 2016; Schwartz Cooney, 2018; Seligman, 2016; S. Stern, 2019, among others).

² See for example, (Dimen, 1991; Harris, 1997; Hartman, 2006; Lemma, 2014; Orbach, 2003, 2006; Petrucelli, 2008; Sands, 2020; and Schoen, 2014, among others).

³ In fact, there are an array of other answers to Aron’s question, among them developmental histories that make us prone to feeling we must attend to and care for our important Others, and certainly conflicts over voyeurism and exhibitionism may find their roots in these kinds of relational matrices. But Aron’s basic point – that ambivalence about both seeing and being seen is salient among psychoanalysts, perhaps even central to psychoanalytic practice – is a valuable one and worthy of more exploration than I can give it here.

⁴ For some classic examples in the literature in addition to Aron (1991), see Benjamin (1988), Davies (1994), Hoffman (1983); Slavin (2010), and an array of theorists on maternal subjectivity (e.g., Bassin, Chodorow, Dimen, Dinnerstein, Fast, Goldner, Harris, Layton, among others).

⁵ There is a history in psychoanalysis of relegating investments in objects such as clothing, particularly as they are associated with gender, to that of a fetish (e.g., Kaplan, 1991). That said, there are of number of contemporary gender theorists who have been challenging the distinction between surface and depth, and who argue that surface presentations of gender are both constituted culturally and experienced as core aspects of the self (e.g., Butler, 1990, Dimen, 2003, Elise, 2006, Hartman, 2006, Harris, 2006, Roth, 2006).

⁶ Pregnancy is particularly complicated in this regard, in so far as it often (but not always) intimates a welcome or desired event, and can, of course inspire intense feelings in patients of envy, competition, rivalry, and an array of oedipal longings and losses. Yet, it is nevertheless a change that also destabilizes the analyst across many domains (e.g., Fenster et al., 1986/2009).

⁷ Greenberg valuably elaborates these points, articulating both the inhibitions patients encounter in bringing up issues with which they sense their analysts personally struggle, and the ways in which “true negative transferences presuppose a background sense of safety, a conviction that one can see what one sees, tendentiously distorted or not without endangering the analyst of the analytic relationship” (Greenberg, 1991, p. 63).

⁸ See Holmes (1992), and Leary (2000, 2012) on “racial enactments,” for nuanced elaborations of the meaning of differences in skin color in therapeutic dyads in which both patient and analyst are Black, and Suchet (2004) for a moving description of the flow of racial enactments – also clearly mediated by class— between a White analyst and a Black patient.

⁹ Given the interplay of cultural and developmental forces, the integration of sexual subjectify and analytic identity can be particularly difficult for women analysts, not only in working with erotic transferences (e.g., Benjamin, 1994; Celenza, 2010; de Peyer, 2022), but also in helping women patients integrate agency and sexuality into an experience of personal subjectivity (e.g., Baker-Pitts, 2007; Benjamin, 1988, 1991; Elise, 2007; Fast, 1991; Schoen, 2014). Elise (2007) has also specifically addressed the complexity of the analyst’s clothing choices in this regard. All this can make questions about patients’ experiences of their therapists’ physicality seem both more pressing, or potentially more difficult to engage for women analysts. On the other hand, as Burka notes, “every patient is in the room with a therapist’s body,” (1996, p. 257) in ways that both consciously and unconsciously influence the dyadic field and every therapist can attend or in-attend to the patient’s experience of their physicality and the array of meanings with which this can be imbued.

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Sarah Schoen

Sarah Schoen, Ph.D. is faculty at the New York University Postdoctoral Program in Psychoanalysis and Psychotherapy, Training and Supervising Analyst at the William Alanson White Institute; Faculty and Supervisor at White’s Eating Disorders, Compulsions and Addictions Program; and invited faculty at the Columbia Psychoanalytic University Center for Psychoanalytic Training and Research. She is on the editorial board of Contemporary Psychoanalysis and is in private practice in Manhattan’s Flatiron District.