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The inevitability of analytic enactments, defined as symbolic interactions between patient and analyst, is discussed. Clinical material from the psychoanalysis of a latency-age child is presented to illustrate the role of enactments and to demonstrate their usefulness in furthering the analytic work.
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The analyses of two children and one adolescent were presented to illustrate the concept that the neutrality of the analyst can be used not only to (a) establish a working, analyzing, and observing alliance, (b) permit the development, recognition, and working through of the transference neurosis, but also to (c) develop a sense of autonomy and self-esteem which had been contaminated by the neediness and lack of true empathy of the primary objects during the practicing and rapprochement phases of separation-individuation. For the patients discussed above, many ego functions which should have had a degree of secondary autonomy were either inhibited, enmeshed in conflict, or experienced as nongenuine, part of a "false self." It was as if the experience with the neutral analyst permitted an "autonomous practicing" that had not been possible during the period of separation-individuation.
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In recent years a number of analytic concepts have been subject to scrutiny, with the value of interpretations, the usefulness of abstinence, the possibility of neutrality, all questioned. One reason for the skepticism about interpretations, in particular, is that before a patient can use an interpretation for psychic change, his perceptual frame must change, a process that is rarely initiated by the verbal content of an interpretation alone. Instead, alterations in perception usually require experiences which are discordant with expectations. In this paper the author demonstrates how the nonverbal elements of an intervention, the action communications, provide informative experiences, creating the dissonance between expectation and eventuality which makes psychic change possible. Case vignettes are presented to illustrate this point as well as to support the idea that when nonverbal experiences contribute to lasting change within a patient, the therapeutic benefit does not accrue primarily from the gratification provided by the experience, but from how the experience informs the patient about his mode of thinking, perceiving, and reacting.