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The joy of the session (notes from the pandemic quarantine)
Abstract
Caught in the unforgiving bind of maintaining an analytic private practice while caring for two young children at home during the coronavirus pandemic quarantine, the author locates his clinical work as a site of heightened vitality and connection against a background of extended periods of challenging, draining, parenting demands. What to make, he wonders, of his reliance upon his remotely conducted practice for his psychological well-being during this period of not-enough-me-time? A mode of countertransferential confession yields to consideration of a need for heightened self-vigilance. Also considered is the possibility that the analyst's dispositional shift may in fact prove to be facilitative to some treatments. The author seeks to bring as much good-humoured grace and humility to his inevitable discombobulation as he can. "Rolling with it" may be the best one can hope for whilst doing clinical work under such strained conditions.
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In this interview by email, Gillian Isaacs Russell, author of the influential Screen Relations: The Limits of Computer‐Mediated Psychoanalysis and Psychotherapy , responds to a set of questions from the BJP . The interview focuses on the impact of remote working during the coronavirus epidemic, starting with the question of whether an effective therapeutic process can occur without physical co‐presence. Isaacs Russell shares her immediate thoughts about the virtually overnight changes to our practice that came with the epidemic, and the work of the American Psychoanalytic Association's Covid‐19 Advisory Team, on which she sits. Her responses are informed by recent cross‐disciplinary and neuropsychological research on the digital age. She considers what happens to free association, evenly suspended attention and reverie when working by phone or online; the loss of the consulting room as a containing physical space for both clinician and patient; the relationship between place and time; and whether (and how) we can maintain a focus on transference and countertransference in the presence of the threat of death. The interview ends with her thoughts on whether we should assume that the landscape of analytic therapy will be permanently altered by Covid‐19, and with her hope that general awareness of the impact of trauma on our mental health has been raised.
Dramatic Dialog refers to a conceptualization of therapeutic action derived from the legacy of Sándor Ferenczi that articulates how internal object relations and multiple self-states are unconsciously dramatized and brought to experiential life on the analytic stage. The terms dramatic and dramatology imply live dialog in the here-and-now. The metaphors of playing, dramatizing, dancing, and dreaming with the patient are all ways of describing how the analyst joins with the patient in a system of mutual regulation. We define generative enactment as the affirmative and creative dimension of repetition, played out in the intersubjective system and influencing it from the inside out. This article presents an intersubjective and relational perspective on dramatic dialog as a model of therapeutic action and therapeutic traction with case material presented for illustration and discussion. The article samples a wide range of clinical theorists, across schools of thought, geographical regions, and extending over many decades, who view therapeutic action as constituted by dramatic dialog and generative enactment.
Drawing from her extensive work with deeply disturbed children Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst actively reaches out to contact and “reclaim” her most inaccessible patients, engaging them in the world of emotions and relationships. In this paper I consider Alvarez’s ideas through the lens of Relational thought, reconceptualizing vitalization as a unique form of enactment that can draw the analytic dyad from deadened impasse into enlivened contact. In vitalizing enactment embryonic affects, hopes, and longings find expression and are potentiated for patient and analyst alike. This is a view of enactment as a progressive and creative lived experience, rather than an unconscious collision to be survived and symbolized. I contextualize vitalizing enactment in relation to Alvarez’s original formulations as well as relevant contemporary theories and present a clinical vignette to illustrate this paper’s themes.
In Beyond Doer and Done To, Jessica Benjamin, author of the path-breaking Bonds of Love, expands her theory of mutual recognition and its breakdown into the complementarity of "doer and done to." Her innovative theory charts the growth of the Third in early development through the movement between recognition and breakdown, and shows how it parallels the enactments in the psychoanalytic relationship. Benjamin's recognition theory illuminates the radical potential of acknowledgment in healing both individual and social trauma, in creating relational repair in the transformational space of thirdness. Benjamin's unique formulations of intersubjectivity make essential reading for both psychoanalytic therapists and theorists in the humanities and social sciences.
Review of book: Irwin Hoffman. Ritual and Spontaneity in the Psychoanalytic Process: A Dialectical Constructivist Point of View. Hillsdale, NJ: Analytic Press, 1998, 288 pp. Reviewed by Arnold D. Richards.
Winner of the 2009 Goethe Award for Psychoanalytic Scholarship! Irwin Hirsch, author of Coasting in the Countertransference, asserts that countertransference experience always has the potential to be used productively to benefit patients. However, he also observes that it is not unusual for analysts to 'coast' in their countertransferences, and to not use this experience to help treatment progress toward reaching patients' and analysts' stated analytic goals. He believes that it is quite common that analysts who have some conscious awareness of a problematic aspect of countertransference participation, or of a mutual enactment, nevertheless do nothing to change that participation and to use their awareness to move the therapy forward. Instead, analysts may prefer to maintain what has developed into perhaps a mutually comfortable equilibrium in the treatment, possibly rationalizing that the patient is not yet ready to deal with any potential disruption that a more active use of countertransference might precipitate. This 'coasting' is emblematic of what Hirsch believes to be an ever present (and rarely addressed) conflict between analysts' self-interest and pursuit of comfortable equilibrium, and what may be ideal for patients' achievement of analytic aims. The acknowledgment of the power of analysts' self-interest further highlights the contemporary view of a truly two-person psychology conception of psychoanalytic praxis. Analysts' embrace of their selfish pursuit of comfortable equilibrium reflects both an acknowledgment of the analyst as a flawed other, and a potential willingness to abandon elements of self-interest for the greater good of the therapeutic project.
In this volume, Traumatic Narcissism: Relational Systems of Subjugation, Daniel Shaw presents a way of understanding the traumatic impact of narcissism as it is engendered developmentally, and as it is enacted relationally. Focusing on the dynamics of narcissism in interpersonal relations, Shaw describes the relational system of what he terms the 'traumatizing narcissist' as a system of subjugation – the objectification of one person in a relationship as the means of enforcing the dominance of the subjectivity of the other.
Best known for his contributions to the development of contemporary intersubjectivity theory, Bernard Brandchaft has dedicated a career to the advancement of psychoanalytic theory and practice. Continually searching for a theoretical viewpoint that would satisfactorily explain the clinical phenomena he was encountering, his curiosity eventually led him to the work of Heinz Kohut and the then-emerging school of self psychology. However, seemingly always one step ahead of the crowd, Brandchaft constantly reformulated his ideas about and investigations into the intersubjective nature of human experiences.
Over the course of a 50-year career, James T. McLaughlin has sought to open the playing field of psychoanalytic exploration by treating unconscious processes as the very material from which we fashion meaningful lives. His unique, iconoclastic perspective, which challenged the conventions of his time and professional milieu, not only engages the creative tension between the stance of the analyst and the stance of the healer, but also contains striking intimations of contemporary relational and interpersonal models of psychoanalytic treatment. The Healer’s Bent, which thematically integrates published and unpublished papers and contains three chapters of heretofore unpublished autobiographical reflection, bridges analytic practice and other psychotherapeutic modalities. It will make McLaughlin’s distinct approach to clinical theory and practice widely available to a broad and receptive readership. © 2005 by The Analytic Press, Inc., Publishers. All rights reserved.
The question of how gender and trauma may impact one another is explored through detailed clinical material from the author’s work with a patient contemplating, and then beginning, a transition from female to male. The author explores what happens when a mind is colonized rather than mentalized. The term colonize is used to describe the unconscious use of a child’s mind to store unprocessed trauma from an earlier generation. The author describes destabilizing feelings of uncertainty, shame, and anxiety in both patient and analyst at various points in the treatment.
This paper examines transference-countertransference convergences contributing to an impasse in the treatment of a patient with a history of being bullied and neglected. Issues of power and control saturate the patient’s intrapsychic and interpersonal worlds and impact the countertransference of an analytic candidate, eliciting shame, doubt, confusion, and alienation. To what extent do these feelings reflect empathic immersion in the patient’s world? To what extent are they byproducts of a budding analyst’s struggles with his own internal objects and with growing pains associated with choosing a theoretical orientation and developing one’s analytic voice in a pluralistic landscape? Clinical material is offered, tracing a clinical process in which the analyst’s varied attempts to engage with the patient culminate in a holding stance that is sometimes potentially defensive but ultimately facilitative.
The area of faith is distinguishable from operations which primarily emphasize ego mastery and introjection-internalization processes. Faith is implicit in Winnicott's transitional experiencing and carried forward in object usage. In Bion faith is linked with openness to O or the (unknowable) ultimate reality of a session and is the operative principle of the psychoanalytic attitude. This paper emphasizes the play of faith in Winnicott's object usage and Bion's O. A certain faith is also required to tolerate the movement of meaning in Lacan's Symbolic order. Faith as a fundamental dimension is in tension with the defensive use of mastery and introjective-projective representational networks. In its various forms this complex tension is part of the structure of human life and constitutes the arena in which faith may evolve.
In work with certain kinds of patients in psychoanalysis who hyperbolize a particular form of object seeking, and in our analysis of certain features of western culture, I think we can isolate the trace in the adult of the earliest experience of the object. The infant's first experience of the object is as a process, rather than a thing in itself, but he perceptually identifies his experience of the object (an experience of psycho-somatic transformation) with the maternal object. For this reason I have termed the first object the transformational object, as I want to identify it with the object as process, thus linking our notion of the object with the infant's subjective knowing of it. Before the mother is personalized to the infant as a whole object she has functioned as a source of transformation, and as the infant's own nascent subjectivity is almost completely the experience of the ego's integrations (cognitive, libidinal, affective) the first object is identified with the alterations of the ego's state. This ego experience remains as an unconscious memory in the adult who relives it through his adamant quest for a transformational object: a new partner, a different form of work, a new material acquisition, an ideology or a belief. The most vivid memory of the earliest object relation occurs in the aesthetic moment when the person feels in deep rapport with the aesthetic object. Such moments are notable for their evocation of the affective memory of the earliest object relation. It is important for psychoanalysts to understand that the psychoanalytic setting and process invites the patient to remember the earliest object relation, so that a patient's expectation that the analyst will perform a transformational function is not necessarily either a wish or a resistance to the analytic work, but may, in fact, be the patient's response to the regressive invitation of the psychoanalytic space.
Every aspect of an analyst's clinical activity is determined in part by his or her personal psychology. The implications for our theory of technique of taking the analyst's subjectivity fully into account--which we have tended not to do--are discussed.
Analytic work based on the intersubjective view of two participating subjectivities requires discipline rooted in an orientation to the structural conditions of thirdness. The author proposes a theory that includes an early form of thirdness involving union experiences and accommodation, called the one in the third, as well as later moral and symbolic forms of thirdness that introduce differentiation, the third in the one. Clinically, the concept of a co-created or shared intersubjective thirdness helps to elucidate the breakdown into the twoness of complementarity in impasses and enactments and suggests how recognition is restored through surrender.
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