Fresh Glimpses of the Patient

Writing on the interweaving of the intrapsychic with the intersubjective, André Green holds that “the essence of the situation at the heart of the analytic exchange is to accomplish the return to oneself by means of a detour via the other” (Green, 2000, p. 12, italics in the original). Such a trajectory, of course, concerns both analyst and patient and is determined by transference–countertransference dialectics.

Regarding the analyst, an important factor in this trajectory is his receptivity to the patient and to what the patient brings. This issue is not new. Freud himself, as early as 1912, advised the analyst “to turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient” (Freud, 1912, p. 115). However, receptivity is not necessarily a given for the analyst. Ferenczi was the first to draw attention to analysts’ lack of attention “to the highly emotional character of the analysand's communications, often brought out only with the greatest difficulty” (Ferenczi, 1932, p. 1).The reason for this could lie first in the unavoidable “disturbance that is sparked in the analyst by his interaction with the patient” (Lia, 2017, p. 85). Michael Parsons believes that analytic work “arouse[s] powerful inward responses in all analysts throughout their careers” (2006, p. 1183), obviously due to this interaction.

Listening to one’s own feelings and listening to the patient are of course regarded as a prerequisite of analytic exchange. Nevertheless, they also represent the fruit, if not the goal, of a long, perhaps lifelong, effort on the part of the analyst. In their article “Searching for Bion: Cogitations, a new Clinical Diary à la Ferenczi?,” Franco Borgogno and Silvio Arrigo Merciai follow W.R. Bion in his personal journey towards “a kind of listening more authentically centered on his own thoughts and emotions and those of the patient during the analytic encounter.” The authors believe that this struggle evolved together with Bion’s “struggle for identity,” aiming for emergence from the impasse of one-sided adherence to a position emanating from belonging to a group that was “treating with great suspicion any expression of the analyst’s subjectivity”. They consider that in Cogitations (a posthumous collection of some of Bion’s manuscripts), Bion exposes aspects of this struggle and its impasses with much honesty; and it is from such a point of view that they see it as a work comparable with Ferenczi’s Clinical diary – in which Sandor Ferenczi speaks openly of the detrimental effects of the analyst’s one-sidedness on the patient (Ferenczi, 1932).

It is common knowledge that, in his late work, Bion offered a fresh glimpse of the analytic exchange and of the patient. He writes:

When two personalities meet, an emotional storm is created. If they make sufficient contact to be aware of each other, or even sufficient to be unaware of each other, an emotional state is produced by the conjunction of these two individuals, and the resulting disturbance is hardly likely to be regarded as necessarily an improvement on the state of affairs had they never met at all. But since they have met, and since this emotional storm has occurred, the two parties to this storm may decide to “make the best of a bad job.” (Bion, 1979; 1994, p. 321)

As for the patient, he notes that he is “the best and most valuable collaborator we have in analysis” (Bion, 1991, p. 91).

The theme of the patient as a valuable collaborator in analysis is taken up and developed in Dimitris Anastasopoulos’s article: “The analysand’s potential contribution as a supplementary therapist in the analytic process.” Anastasopoulos ponders mainly on the contribution of the analysand to the analytic process; he sustains that, in many cases, the patient temporarily takes over the analytic situation, facilitating in this way its continuation. The author also believes that the patient can, in some cases, use the analyst’s psychic presence as a starting point for transformations that may surpass the analyst’s abilities.

Moving the focus from patient to analyst, Hanoch Yerushalmi, in his article “Influences on patients’ developing mentalization,” attempts to fathom the effects of the therapist’s temporary failure to be receptive and to provide reflexivity patterns for the patient. This author, too, considers the patient as an important collaborator in analysis, since he sustains that “optimal reorganization of the therapist’s self-reflexivity patterns will occur if the therapist chooses to disclose to the patient that their reflexivity patterns were undermined and to explain how they have reorganized these patterns in their mind.” He thinks that the sharing of these reflexive patterns, as well as of the analysts’s conclusions on the patient’s mentalization, with openness and honesty may serve as a model for the patient; and also that the exploration of the patient’s feelings of abandonment by the therapist in the moments of reflexivity failure is of importance.

The issue of attunement when the therapist is treating a traumatized patient constitutes, as I see it, the main thread of thought in Sachiko Mori’s article “Memories of sexual abuse previously shrouded in darkness: Intersubjective exchanges involving joint attention.” The author puts stress on achieving with her patient a state of “joint attention” in a shared safe mental space. The building of this space has to go through the therapist acknowledging a potentially traumatizing overestimation of her patient’s ability to endure psychic pain, and the patient acknowledging her adherence to somehow being forced to recall painful experiences.

Such a joint experience may suggest that, when working with traumatized patients, “what eventually is to be found as a good experience, is one that survived being used to represent the worst in the patient’s internal world” (Casement, 2003, p. 77) in the here and now of the analytic exchange. In this case, the analyst becomes a surviving object for the patient.

According to Clara Mucci, both the analyst and the severely traumatized patient are two survivors meeting in the space of the analytic encounter. In her article “Psychoanalysis for a new humanism: Embodied testimony, connectedness, memory and forgiveness for a ‘persistence of the human’,” she compares concepts such as witnessing, testimony, and memory as redemption, as formulated by Holocaust survivor and Nobel Prize winner Eli Wiesel, with Sandor Ferenczi’s idea of the therapist as benevolent witness. A point of major importance in Clara Mucci’s thought is the responsibility of the analyst. Responsibility emanating from knowledge is to be opposed to indifference, in a time of peculiar threats for society, which seem to dominate the new millennium.

Active social involvement, in the frame of a troubled period in European society, a time of “traumatic dissolution of pre-existing forms and styles of life,” marked the youth of the “father of the Ferenczi Renaissance” that is André Haynal. His fascinating book of memories Encounters with the irrational: My story, reviewed by Carlo Bonomi, contains a long interview by Judit Mészáros, and apart from the valuable historical and cultural documentation it offers, it gives a testimony of a troubled, but also “instructive, exciting, stimulating” (Haynal, 2017, p. 5), life experience. It is also an account of the reorganization of psychoanalysis in postwar society – and it contains two chapters on fanaticism and depression, both areas of André Haynal’s important contributions to psychoanalysis, philosophy, and culture.

Modern culture is marked by cinema, a form of art that introduces us “to unconscious optics as does psychoanalysis to unconscious impulses” (Benjamin, 1939/2000, p. 306). In his book Moving images, Andrea Sabbadini, psychoanalyst and director of the biannual European Psychoanalytic Film Festival, reflects on 23 films, from Pabst’s Secrets of a soul to Z. Sophia’s Mila from Mars, discussing through his approach to their moving images significant psychoanalytic topics as psychoanalysis itself, prostitution, children, adolescence, love, and scopophilia. Andrea Sabbadini is also the author of Boundaries and bridges. Perspectives of time and space in psychoanalysis. In this original book, which consists of 11 chapters, time and space form the basis mainly for the exploration of phenomena occurring in the minds of analyst and patient in the analytic encounter. Both books are reviewed by Marco Conci, Coeditor-in-Chief of this journal.