The role of the patient’s remembered history and unconscious past in the evolution of Betty Joseph’s ‘Here and now’ clinical technique (1959–1989)

Abstract

The author historicizes one aspect of Betty Joseph’s ongoing technical contributions in terms of its originating London Kleinian context. Early on she drew upon both the patient’s remembered history and unconscious past, linking these experiences in past‐to‐present transference interpretations in order to effect psychic change. In evolving the technique of ‘here and now’ analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part‐object anatomical interpretative language. She gradually set aside directly linking the patient’s past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph’s continuous group workshop for analysts led to an increased understanding of the patient’s projective impact on the analyst’s countertransference responses, and thereby increased the analyst’s capacity with ‘difficult to treat’ narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient’s projected internal object relations in the transference. The analyst works with the patient’s communications and enactments, with a greater emphasis on a more ‘inside‐to‐outside’ understanding of transference in contrast to the earlier ‘past‐to‐present’ work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph’s significant impact on contemporary Kleinian technique by taking up some of Michael Feldman’s work. Now the analyst listens to the ‘past presented,’ the patient’s projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium‐maintaining purposes, as the analyst attempts to effect psychic change by widening the ego’s perceiving functions.

Key words:

• Betty Joseph
• genetic reconstruction
• ‘here and now’
• history of psychoanalysis
• psychoanalytic technique

Acknowledgements

An earlier version of this paper was presented at the ‘Here and Now’ Conference that honored the contributions of Betty Joseph at University College London, 12–14 December 2008. The author also gratefully acknowledges the International Psychoanalytic Association’s Research Advisory Board: through its support in the form of fellowships in the area of the history of psychoanalysis, a number of publications (Aguayo, 2000, 2002, 2008, 2009a, 2009b; Spielman, 2006) as well as research trips have been made possible to the Archives of both the British Psychoanalytical Society and the Klein Archives at the Wellcome Institute in London. I would also like to acknowledge the comments received from various analysts and historians alike: Robert Hinshelwood, David Tuckett, Robert Westman, James Grotstein and the anonymous reviewers of the North American IJP editorial staff. The final responsibility for this manuscript is of course solely the author’s.

Notes

1. In an ‘Interview with Betty Joseph’ (Pick and Milton, 2001, p. 5) she spoke of the importance of weekly candidate seminars with these colleagues – and the lasting impression they made: “Money‐Kyrle would lecture to us on Freud and he’d step off the podium and come with us to candidate seminars. And Bion was in a completely different analytic world from us. We would sit down and have a clinical seminar in which Bion would be discussing, in detail, the transference and exactly how he handled it. None of the younger group of us was yet thinking in that way at all.”

2. Pick and Milton (2001, p. 8) detailed how Joseph during the 1950s became analytically as well as socially acquainted with Melanie Klein, someone whom she found to be a “& person both of real quality and originality and yet also a kind of human simplicity.” Joseph recalled: “As a student of course I went to her lectures and seminars and in time became part of a small group of people who had quite close contact with her, partly connected with the work, case discussions, writing, etc and partly socially. We would have occasional meals or visits to the theater, which she loved. She was always very much aware of people’s work and keen to help them develop.”

3. In Joseph’s continued use of part object interpretations, she also regarded the underlying primary anxieties as organizing the patient into defensive structures to avoid violent and potentially psychotically disintegrating emotional experiences, something very similar to the post‐war work on psychotic states of mind by Rosenfeld, Segal and Bion (Aguayo, 2009a, 2009b). Joseph (1960) had illustrated this theme in a previous publication. Of her analytic work with a psychopathic adolescent, who engaged in petty thievery, she wrote: “This (violent) splitting is now of a diffuse fragmenting type, making one aware of his nearness to schizophrenic disintegration, and his absolute need for the omnipotent defenses that prevent it” (ibid., p. 529). In effect, Joseph here thought her patient negotiated a precarious psychic balance between major criminality on the one hand and psychotic disintegration on the other.

It is also worth noting in Joseph’s (1948, 1960, 1966) treatment of infant, child and adolescent cases that it was a unique training component of the British Society after the Controversial Discussions that all candidates were sensitized to issues in child analysis. In an interview with Betty Joseph, Claudine and Pierre Geissmann (Geissmann and Geissmann, 1998, p. 245) noted that Betty Joseph was a child analyst for some considerable period of time.

4. While Feldman and Spillius (1989, p. 48) pointed out that ‘C’ also used projective identification to distort his perceptions of his analyst as well as to organize “& the analyst to act in a manner appropriate to his unconscious perception &”, this theme of ‘role responsiveness’ (after the work of J. Sandler [1977]) I think was in 1971 also a reflection of Bion’s earlier work, in which he discussed how patients can and do recruit the analyst to play important roles in their interior psychic landscapes. Apropos of the countertransference impasses in which the analyst could be entangled, Bion (1955, p. 446) had earlier on written: “The experience of countertransference appears to me to have a quite distinct quality that should enable the analyst to differentiate the occasion when he is the object of a projective identification from the occasion when he is not. The analyst feels that he is being manipulated so as to be a part, no matter how difficult to recognize, in someone else’s phantasy.”

5. After Joseph’s (1971a, 1971b) two papers became known, there was a response within the London Klein group itself to this new focus on the analyst’s more present‐tense encounter with his patient. For analysts who took Freud’s line that reconstruction was premised on present conflicts representing a therapeutically valuable recapitulation of the past, their task was to help the patient remember. Brenman (1980, pp. 53–4) took this line while also agreeing that the immediacy of the transference first had to be established. Once the patient accepted the analyst’s help to bear what was unbearable about the past, its repetition in the transference could be transformed into recollection. Brenman (ibid., p. 57) wrote: “Reconstruction can uncover both constructive and non‐constructive interactions with past objects. The bringing alive of past creative interactions and integrating these with creative constructions in the analysis and giving up past grievances of negative relationships is the analytic work and life work – the value of reconstruction.” Other Kleinian analysts, for example, Spillius (1988, p. 15) also defended the value of retrospectively drawing upon the remembered and unconscious past after the immediacy of the transference in the here and now had been established: “There is one set of (Kleinian) analysts who think that, although the first objective should be to clarify and make conscious the past in the present through analysis of the patient’s ‘repeating,’ his acting‐in &. But once the emotional experience has become real in the present, reconstructions and links with the past can consolidate it.”

6. In a paper that contrasts Joseph and Segal’s mature views on the immediacy of unconscious truth, be it in the ‘here and now’ or in unconscious phantasy, Rachel Blass (2010, in press) has written: “It is a paradoxical blend of immediacy and distance – whereby what is unconscious, beyond the reach of the mind is both most immediate (in that it is repeated or manifested in our actions) and distant (in that it cannot be adequately thought of) – that is most essential to the analytic notion of truth.” While I basically agree with Blass’s position, I would also add that there has been some confusion over the distinction between ‘early’ and ‘deep’ versions of unconscious phantasy, the former tied by Segal (1964) to a specific developmental point when the paranoid–schizoid position dominated, then gave way to the depressive position. The recent usage of the term ‘unconscious phantasy’ pertains to a deep but immediately inaccessible structure governing the patient’s functioning.

7. To the point of some members of the London Klein group putting aside the direct use of part‐object interpretative language: while in agreement with what I would term the ‘reconstructionist’ group of Kleinians (e.g. Brenman, 1980; Segal, 1964; Spillius, 1988), Riesenberg‐Malcolm (1986) also took the critique of the ‘past‐in‐the‐present’ in another direction. Riesenberg‐Malcolm in effect agreed with Joseph’s questions about the problematic nature of part‐object interpretative language as reflected in Klein’s use of the unconscious past. Riesenberg‐Malcolm’s critique was three‐fold: “First, it employs repetitive words, on the meaning of which both patient and analyst believe there is mutual understanding but which in fact lose the quality of specificity which should belong to each element of the session. Therefore, these terms stand in the way of further exploration of the material in the transference. Second, it is an artificial language that hinders ordinary communication and renders itself open to idealization. Third & Using symbolic language bypasses the depths of the transference experience. It destroys live contact between analyst and patient, and turns the analysis into talking about unconscious phantasies, rather than experiencing them in their crude impact” (Riesenberg‐Malcolm, 1986).

8. At the very end of the ‘Near Death’ paper, Joseph addressed the issue of the early history of narcissistic patients, almost as a speculative afterthought. Perhaps her patients as infants ‘&have withdrawn into a secret world of violence, where part of the self has been turned against another part, parts of the body being identified with the part of the offending object, and that this violence has been highly sexualized, masturbatory in nature and often physically expressed.’ (Joseph, 1982, p. 455) However evocative these types of explanations were in her clinical thinking about her patients, Joseph now neither explicitly linked the past‐to‐present nor made part‐object interpretations.