Finding Sandra: Dr. Beebe’s Second as Analytic Third: A Discussion of “A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback”

Abstract

Larry Sandberg and Beatrice Beebe (this issue) offer a moving account of their work with Sandra, a gaze-averse woman with a painful and traumatic childhood history. Drs. Sandberg and Beebe describe their work together in the context of an innovative conjoint treatment model including psychotherapy, video feedback consultation, and dance movement therapy. Dr. Beebe’s Interventions at the sensorial, bodily, and affective register facilitated Sandra’s movements from being in the grips of a terrifying object world, to an experience of companioning with Dr. Beebe, giving her a greater sense of holding and emotional security. Further, “Dr. Beebe’s Second,” an image from Dr. Beebe’s own reverie offered Sandra an “emotional third”; a new found internal experience of herself-with-others that helped her lift her gaze to the future.

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A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback

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Notes

¹ Ann Alvarez (2010) identifies three points on a continuum of levels of analytic work and levels of meaning. Dr. Sandberg’s interventions were primarily aimed at a level that emphasizes symbolic meaning. Dr. Beebe’s articulations are at a level most resonant to patients whose introjective capacities are limited, and suffering is experienced at the level of self or internal object. According to Alvarez, at this register, it can be helpful for the therapist to slow down the work to a more purely descriptive level to try to hold understanding. For Alvarez, this is the work at the “foundation of human relatedness” (pp. 859, 875).

² According to Donald Winnicott (1960/1965), The term “holding” is used here to denote not only the actual physical holding of the infant, but also the total environmental provision prior to the concept of living with. In other words, it refers to a three-dimensional or space relationship with time gradually added. This overlaps with, but is initiated prior to, instinctual experiences that in time would determine object relationships. It includes the management of experiences that are inherent in existence, such as the completion (and therefore the non-completion) of processes which from the outside may seem to be purely physiological but which belong to infant psychology and take place in a complex psychological field, determined by the awareness and the empathy of the mother (p. 589).

³ Dr. Beebe offers an image that Sandra makes as her own. For Aulagnier (1975, as described by Miller, 2015), “the pictographic representation is not connected to language and is an attempt to represent and find meaning through the figurative use of bodily, sensory ‘images’… It is an early precursor of what will become the mother—object…Piera Aulagnier’s way of depicting the earliest version of an internal object” (pp. 1359, 1365). Birksted-Breen (2012) describes how a visual image offered by the analyst’s reverie that arises from the analyst’s capacity to create a sensorial quality…to dream, “acts as a third element that is felt to belong to some extent to both parties or to neither, as Winnicott describes with his notion of transitional space.” For Birksted-Breen, the image is easier to tolerate than that which directly represents the Oedipal situation. In operating as a third element, “the pictorial image coming from the analyst’s reverie fosters a greater psychic space and the necessary triangulation for the development of symbolization” (Miller, 2015, p. 831).

⁴ For Winnicott (1953), there is a wide variation to be found in a sequence of events which starts with the newborn infant’s fist-in-mouth activities, and that leads eventually on to an attachment to a teddy, a doll or soft toy, or to a hard toy. Many other important things can be studied, and they include:

• 1. The nature of the object.

• 2. The infant’s capacity to recognize the object as “not-me.”

• 3. The place of the object—outside, inside, at the border.

• 4. The infant’s capacity to create, think up, devise, originate, produce an object.

• 5. The initiation of an affectionate type of object relationship.

I have introduced the terms “transitional object” and “transitional phenomena” for designation of the intermediate area of experience, between the thumb and the teddy bear, between the oral eroticism and true object-relationship, between primary creative activity and projection of what has already been introjected, between primary unawareness of indebtedness and the acknowledgment of indebtedness (“Say: ta!”).

⁵ Andre Green (1997) highlights that Winnicott develops an alternative to Freud’s theory of drive that emphasizes a “journey” or movement in space linked with time. A dynamic movement in which “the future subject is in transit, a transit in which [s]he takes possession of a created object in the vicinity of a real one, before he has reached it” (p. 1073).

⁶ In Masud Khan’s (1975) “Introduction” to Winnicott’s Through Pediatrics to Psycho-Analysis, Khan says: “What I want to single out for special comment here is what Winnicott calls “the period of hesitation Because even a cursory look at the material presented in Therapeutic Consultations in Child Psychiatry will reveal all too vividly how the essence of the squiggle game is how Winnicott creates a space, a transitional space, where this “period of hesitation has not only full scope but is also facilitated by him to emerge toward a creative gesture, namely the squiggle itself. This is also an important concept for psycho-analytical theory in general and our clinical work with adults in particular. The concept of the ‘period of hesitation’ adds something new to the classical concept of resistance, as we know it in Freud’s work. Quite often in analytical writings one comes across interpretation of resistance to a patient where in fact the reality is that the patient is in the ‘period of hesitation’ or in other words the patient is groping to find ‘a kind of intimacy’ in the analytical situation where he can gradually make his first verbal or gestural contribution” (p. xvii).

⁷ For Winnicott (1967) “the feeling of the Mother’s existence lasts x minutes. If mother is away more than x minutes, then the imago fades, and along with this the baby’s capacity to use the symbol of the union ceases. The baby is distressed, but this distress is soon mended because the mother returns in x + y minutes. In x + y minutes the baby has not become altered. But in x + y + z minutes, the baby has become traumatized. Trauma implies the baby has experienced a break in life’s continuity, so that primitive defenses now become organized to defend against a repetition of ‘unthinkable anxiety’ or a return of the acute confusional state that belongs to disintegration of the nascent ego structure” (p. 369). Perhaps Dr. Beebe’s Second can serve to reverse the movement toward z (Sandra’s abyss) by offering an image that increases time and space.

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Celeste Schneider

Celeste Schneider, Ph.D., is a Supervising and Training Analyst at the San Francisco Center for Psychoanalysis, Faculty at the Psychoanalytic Institute of Northern California, and California Pacific Medical Center. She is an adult psychoanalyst and child psychotherapist in private practice in San Francisco. Relevant publications include Discovering New Ways of Seeing and speaking about psychotherapy Process with Children (2009, Routledge Press), and “A ‘Motion Portrait’ of a Psychodynamic Treatment of an 11-Year-Old Girl” (2011, Journal of Infant Child and Adolescent Psychotherapy).