This special issue of Psychoanalysis, Self and Context draws its papers from the IAPSP Conference, held last fall in Boston and focused on “Critical Clinical Moments in the Treatment Process.” As I reviewed the many wonderful conference papers in order to construct this issue, papers brimming with rich clinical description and creative analytic understanding, work, and dialogue, a familiar question began buzzing in my brain. It is a question that students, candidates, and patients new to contemporary psychoanalysis often ask: “Is there something I can read?” It is also a question that instructors ask as they search for good teaching tools. There is a hunger for writing that clearly explains contemporary analytic process or illustrates a particular idea or captures contrasting formulations and approaches to analytic problems. Therefore, I have edited this issue of Psychoanalysis, Self and Context with this question in mind; that is, I have tried to collect “something that people can read,” which not only contains lively clinical material and commentary, but also furnishes accessible teaching materials that survey contemporary psychoanalytic ideas.
I have winnowed the selection here to five sets of papers, four of which organize around clinical presentations. In these four, the clinical narratives are of primary interest, and theoretical concerns emerge from those narratives. Daniel Goldin and Joe Lichtenberg authored the fifth set of papers, which are theoretical. Yet, although they are primarily theory papers, each author uses specific clinical material to illustrate contrasting theories. I include this set because they are thoughtful and well-written dialogic pieces, ones that underline some dominant but conflicting ideas within contemporary psychoanalysis.
In Group One, Ferguson, Brothers, and Slowiaczek tell clinical stories, each of which challenge the analyst to address her subjective needs, feelings, and responsiveness. Each author holds to the conviction—derived from intersubjective and dynamic systems thinking—that human minds meet, mix, meld, and mutually influence each other. Therefore, all the authors suggest that disowned or dissociated aspects of the analyst’s experience will affect the vitality of the analytic dyad and necessarily limit the depth and breadth of a patient’s therapy. Ferguson’s patient, Heidi, an isolated and emotionally deadened woman, causes Ferguson to confront her own “discomfort with deadness, a familiar countertransference sinkhole, an awakening of my intergenerational ghosts.” Brother’s patient, Lily, forces Brothers to confront her own sorrow about the end of her analysis, as well as the sadness and pain of decrepitude, mortality, and ultimate loss. And Slowiaczek’s “stuck” work with Marta propels the analyst to recognize and deal in her own analysis with vulnerability to aging, disappointed dreams and ambitions, and physical and mental decline. Remarkably, these three papers together underline the centrality of the analyst’s affect and subjectivity and the importance of an analyst’s conscious self-monitoring and self-understanding in advancing analytic intimacy and process. Together, they also convey a particularly feminine take on loss and the consolation of relationship.
Judy Teicholz’s lovely commentary on these three clinical papers is a model of theoretical and clinical acumen, empathic responsiveness, and writing competence. She emphasizes two central tenets of contemporary psychoanalysis that relate to creating a working intersubjective system: (1) the constant influence of the analyst’s effect on the clinical encounter for good or ill; and (2) the paradoxical necessity of attending to and dealing with the analyst’s countertransference while, at the same time, privileging the patient’s subjectivity. Teicholz proceeds to describe how Ferguson, Brothers, and Slowiaczek engage in such fancy and paradoxical clinical footwork. In the course of doing so, she also presents her readers with a skilled contemporary approach to dreams.
In “Word, Images, Dreams and Metaphor: The Analyst’s Embodied Imagination in the Service of Therapeutic Engagement,” Elizabeth Seward argues persuasively for the importance of identifying and cultivating the analyst’s aesthetic capacities. She delineates and promotes the value of the analyst’s non-verbal aesthetic receptivity, particularly to visual, symbolic, and visceral experience. Using five illustrative clinical vignettes, Seward demonstrates some ways in which an analyst’s ability to articulate her receptivity in the dyad can illuminate disowned aspects of the patient and function to expand the patient’s life horizons. In her view, such developed sensate, intuitive, and imaginative capacities open communication channels for understanding and reaching patients, particularly those who have suffered trauma.
Gabriela Mann responds to Seward with several trenchant observations. First, she avers that the analyst’s “evocation of images, body sensations and disclosed dreams are, in fact interpretations and that such interventions … promote potential space and openness to disavowed areas of the mind.” Thus, Mann recruits traditional ideas about interpretation and therapeutic action and transforms them with her contemporary understandings. She also skillfully places Seward’s clinical material into a self psychological and intersubjective frame. Finally, she compares projective identification, enactments, and emotional resonance—all ways to understand Seward’s non-verbal aesthetic dynamics—and, thereby, does a bit of teaching while simultaneously advocating her own intersubjective theoretical take on Seward’s vignettes. Mann accomplishes her several tasks respectfully and without violating the delicacy or complexity of the described clinical interactions. Hers is a model psychoanalytic response. I think this is a particularly strong pair of papers, very well suited to teaching effective dialogue between contemporary perspectives.
Group One’s emphasis on analyst subjectivity and affect, particularly as disavowed and dissociated affects limit and deaden analytic work; Group Two’s concern with the analyst’s non-verbal aesthetic capacities and how they become conscious and useful to the dyad; both groups’ acceptance of intersubjectivity and dynamic system process and their anchoring theory in specific clinical interaction—these important ideas, hallmarks of a contemporary sensibility, are again featured in Group Three’s “Try a Little Tenderness” papers. In addition to presenting “A Tenderness Ethic,” Group Three also expands on Seward’s interest in words, interest, that is, in the tone and connotations of what we say.
Describing what the next three papers term “the ethic of tenderness,” I (Weisel-Barth) argue that the therapeutic stance and the analytic frame have softened and loosened in recent years. To feel internally tender and vulnerable, to feel tenderness for the suffering other, and to tend to the other, sometimes providing new language and provisions in the analytic encounter—these positions are in marked contrast to those of the traditional neutral psychoanalyst. In contextualizing this sea change, as well as Maddux’s and Naiburg’s papers, I draw on the mid-20th century history of psychoanalytic dissidents and also on the ethics of liberation movements, particularly feminism. And in describing the process by which one “tenderizes” oneself toward the other—by which one enters, grasps, and uses the symbol forms and personal culture of the other—I borrow from Clifford Geertz. Geertz describes the process of “thick description,” a method of deep immersion and personal engagement in the world of the other. Thick description requires detailed inquiry and active empathy as one imaginatively burrows into and behaviorally explores the other’s cultural meanings. At the same time, the inquirer brings and retains what is uniquely hers as she explores the other. This is similar to the empathic analytic process that Teicholz describes: an active interactive, intersubjective process that also retains what is unique and different about each participant.
In her paper, Hilary Maddux argues that much analytic language belies the ethic of tenderness. As she puts it, “There is still a strong pull from our own academy to stay within bounds of the proven or provable, the intellectual, the abstract, the theoretical—to exclude the affective from our own discourse.” She advocates a conscious new language of affectivity and inclusion. Naiburg’s paper exemplifies Maddux’s language of tenderness. The paper describes the treatment of Brian, a trauma casualty, homeless, and psychotic, with whom Naiburg developed a loving, facilitating relationship. The tenderness in their relationship, including the analyst’s acts of empathy that stretched the analytic frame, fostered Brian’s growth and development. In order for this to happen, Naiburg was forced to examine her own personal history with tenderness and love and to make important emotional and behavioral changes. About Brian, she tells us, “I couldn’t have known he would teach me an invaluable lesson about speaking the language of love with a patient.”
Group Four is a trio of papers focused again on a trauma case, this time with a decidedly masculine cast. Jim Herzog’s patient, Dolph/Peter, suffered childhood paternal abuse and, then, the loss of the father’s emotional presence after the boy lost a leg to cancer. Peter evidently confused his longing for the father’s lost presence and attention with the excitement of physical brutality; and by the time he reaches Herzog, he has sexualized violence. In the context of three events, the arrival of his first son, a Sado-Masochistic orgy, and a subsequent terrifying panic attack, Peter urgently seeks help from Herzog. Herzog describes his sensitive treatment of Peter—with all the man’s fears, disavowals and dissociations—as the creation and safeguarding of analytic play space (“Spielraum”). It is important to note that this is mostly a one-person treatment:
I am simultaneously invited to help by accompanying (hearing, inquiring. and wondering) and to begin to be the privileged and essential co-holder of the narrative, which has both guided and complicated Peter’s inscape. My job is to respectfully regard all pressures, invitations, and expectations that I will actually participate in … aspects of the sustaining and derailing narrative in a way which safeguards my patient’s play space … while not reducing it to a too sterile operating theater. These functions, this kind of accompanying, and co- holding the narrative, seem to me to be the essential features of psychotherapy as it evolved for Peter in my presence and with my help.
Richard Geist recasts Herzog’s Winnicottian/Object Relations stance into a self psychology frame, and Janna Sandmeyer hones in on the issues of analyst subjectivity, the intersubjective field, sex and gender, and the forward edge. Geist writes that empathic processes underlay the healing interactions between Peter and Herzog and that “the empathic bond catalyzes affective regulatory capacities and strengthens the sense of self.” That this case easily demonstrates the fragmentation of self, corrective selfobject experience, forward edge attention, relational protectiveness, heightened affective moments, and the rekindling of thwarted developmental needs makes it a terrific learning tool, a kind of self psychological primer.
Similarly, Sandmeyer approaches the material from a relational self psychology position with an added emphasis on gender and sexual issues. Although appreciative of Herzog’s sensitive work—especially his use of forward edge interpretations—she highlights two problems with his presentation: first, the absence of ongoing attention to the analyst’s subjectivity and, second, the masculine tilt in the narrative. For example, except for his panic attack, we know almost nothing about how interaction with Peter affects Herzog’s emotional life or how his own subjective reactions may, in turn, influence the analytic process. And all we know of Peter’s mother, wife, and three daughters is that they seem to be minor players in his emotional life without their own subjectivities. The wife, particularly, has little agency or standing. She has endured Peter’s physical abuse and abandonments, is willing to move her life for his psychoanalysis, and, in Herzog’s telling, functions simply as Peter’s supportive person. For teaching purposes, I think Sandmeyer presents a fine example of expanding a case discussion through the identification of missing elements and the insertion of a differing perspective.
The final two papers, Goldin’s and Lichtenberg’s, address many contemporary issues: enactments, implicit relational processes, the importance of verbal articulation, dissociation, intrapsychic versus and dynamic systems explanations of psychic process and change, the nature and foundation of a sense of agency, and the ubiquity of disavowal in analytic unfolding. I chose this pair of papers for their intellectual heft and for the way a sharp and deeply informed short response can enlarge an already solid exploration.
Goldin contrast two views of enactment, the Boston Change Process Study Group’s (BCPSG) and the relational school’s. Using a dynamic systems model, the BCPSG views enactments as a system event in the here and now but prepared for over time. The enactment reflects incremental interactional shifts over time, shifts which finally cross a threshold to produce “now moments” and system reorganization. In contrast, the relational school views enactments as expressions of unarticulated dissociated psychic material. The patient and/or the analyst and/or the dyad may bear responsibility for creating, maintaining, or resolving the enactment, but its source is in the patient. Goldin sees both models as viable and useful, but as emanating from two different perspectives: the BCPSC observes interacting system influences from above; the relational school views historically situated dissociated material arising in the individual. He suggests that it is clinically useful to see these two perspectives as existing in separate domains and operating in oscillation, one with the other.
Lichtenberg in a short space restates Goldin’s understanding with his usual clarity and, then, adds a few pearls of his own. His additions do not change but they enlarge Goldin’s piece. For example, his first clinical story presents a wonderful little enactment that illustrates both of Goldin’s perspectives on enactments. The patient’s anger may be a reflection of inadequate “fit” in the therapeutic relationship or an eruption of a disowned aspect of her self experience in relation to others, but it may also simply represent the patient’s projected misunderstanding of the analyst’s ongoing annoyance. That is, Lichtenberg seems to caution us against too heavy reliance on the enactment story—or, at least, too much certainty about our particular enactment stories. In another place, he reminds us that the stuff of enactments does not always become manifest in an analysis but sometimes remain “an enacted sensual hum or ambiance or a continued state of puzzlement that never becomes an event but is none the less an influence.” The final Lichtenberg pearl I will mention is his insistence on the importance of verbal articulation of experience in the form of affective narrative. Lichtenberg understands that a languaged story is the great cognitive achievement of human beings, and that how a story is told and felt may convey more meaning than its content.
I, now, commend these papers to you for the pleasure of their good story telling, incisive thinking, usefulness in clinical work, and helpfulness in teaching contemporary psychoanalysis.