From the category archives:

Preverbal body memories

This column also appears in the May/June, 2011; Volume 23, Issue 3 of The Therapist, published by the California Association of Marriage and Family Therapists (CAMFT).  Abstract page 74.

Abstract:

The capacity to use words and language as symbols of communication is a developmental achievement borne of the elegant and mutually regulating mother-infant dyad.  This paper examines what occurs when emotional catastrophe compromises this sensitive process, and speech and words come to be used instead to defend against annihilation anxiety, dread and psychic “black holes” associated with primitive mental states.  The perspectives of Bion, Ogden, Grotstein and Tustin are used in conjunction with case material to explore these early modes of self-other experience that might be construed as pre-object relations, as they are primarily sensory in nature.   Consideration is given to the ways speech is used as an autistic object/shape engendering isolation rather than as a symbolic mode of communication promoting enhanced relationality and subjective meaning.

Language was the conjurer, indeed the philosopher’s stone, language was a form of alchemy.  It was language that elevated meanness to the heights of art.  Like the irritating particle that bred the nacre of the pearl, language ameliorated the gnawing irritant of existence; it interceded between the wound and the dream. Henry Roth

Laurie’s uninterrupted speech knocked me about like a strong wave slamming into an unwitting swimmer who has unwisely turned her back on the sea to gaze anxiously toward the safety of shore.  She would commence speaking the moment she arrived in my consulting room and, if I didn’t intervene or attempt to interject a comment during the ensuing forty-five minutes, would continue until she departed.  I felt intrusive if I intervened, invisible if I didn’t.

For months I looked for meaning in this verbal splatter, something elemental in her eruptions that I might transform and return as both useful and usable.  I struggled to know her, tried to like her.  Feeling superfluous, I was ashamed to find myself looking at the clock repeatedly during sessions and exceedingly relieved when they ended.

Conceptual imagery and word shapes

Taking shape in my mind, her speech appeared as meaningless glyphs, disenfranchised words comprised of loosely formed letters, their varied sizes and shapes barging forward or receding.  Oblivious of the time frame, Laurie’s sessions began to seem endless, requiring gentle reminders to allow her ample preparatory time to reorganize herself and leave.  Any specific reference to the separation anxiety associated with endings would evoke another gush of speech that was almost impossible to interrupt.  I looked for the needy baby behind the noise.

Our sessions had no discernible beginning or ending, just an ongoing flood of speech.   There were few thoughtful troughs between waves, just endless sets rolling toward shore across the surface of a vast sea of words flooding the room.  For a long time, she and I were lost at sea. When she wasn’t speaking to me (or at me), she was talking on her phone, filling the waiting room with sounds that made me wince, and I felt violated by her incessant vacuity.

Collapsed psychological space

The Mona Lisa

Maternity

When we spoke on the phone, her compulsive speech would begin the moment I greeted her, regardless of the purpose of the call.  Unable to differentiate between a formal phone session and a simple business-related call, she leaked words in a manner that suggested her inability to sustain any sense of foundational boundedness.  She experienced words, thoughts and actual bodily contents as equivalencies and was unable to plug holes in her still rudimentary sense of self.  As Odgen described, she was “creating a substitute for the space between mother and infant in which the infant ordinarily finds a place to live between self and other (Ogden 1989, p.66).

Desperate verbiage filled any potential space in which we might have engaged one another meaningfully.   I felt like a theatrical prop that existed simply to absorb her bizarre recitation of the loosely associated and circuitous events of her life daily life, her errands and shopping excursions, her family irritations and interactions.

She would frequently wander through time leaving me to find links in the massive holes in her narrative.  A present time reference to her sister in once sentence would shift decades in the next, the pronoun “she” no longer representing her sibling but her aunt.  Why are you telling me this? I wondered.  What are you really trying to tell me?

She buried me with words, and any attempt to proffer an empathic interpretation or comment was bulldozed with a quick nod and continuation of her monologue.

Any pause in her continuous production of words seemed to provoke terrible dread and annihilation anxiety.  I began to dread her sessions with equal intensity.  No psychological space (Heller 2010) existed in which she and I might engage.  I frequently felt useless and unnoticed.  Who failed to acknowledge you? I wondered.  Who left you alone?  Who couldn’t or wouldn’t speak your language?

Her capacity to utilize the creative potential of psychological space had collapsed like a weak lung, or perhaps a lung that had never filled.  For many months, there was no space for me to offer anything other than my presence and willingness to be used as a container, an exogenous lung.  I felt suffocated, as if the air were being sucked from the room and experienced uncomfortably deliberate urges to fill my lungs to capacity and inhale great breaths of air.

I was to learn eventually that she had sustained a collapsed lung following a childhood accident, so the lung imagery that arose in the analytic third (Ogden 1994) during moments of reverie* were salient and permitted me to begin to comprehend and decode what she was broadcasting unconsciously.

Behind this blinding white water spew of distraction, I found that for a moment, I could grasp the sand with my toes and withstand the currents.   I listened and attended to her pressured and compulsive speech as if I were caring for a screaming infant.  Using a soothing and modulated tone of voice and carefully paced speech as swaddling, I began to open a small space in which we might initiate and share a relational exchange.

The importance of learning from experience

The repetitious nature of her narratives signified her inability to build upon her own ideas and thoughts or upon the co-constructed foundations of shared interpersonal moments.  She would repeat what appeared to be almost scripted sequences again and again, as if she’d never spoken them and I’d never heard them.  Each narration was isolated and unlinked to any other.  She could not make use of earlier versions to work through, learn from or adapt subsequent renditions.

From a Bionian object relations perspective, Laurie could not think with her thoughts (Bion 1962.) They functioned as impulses to speak, nothing more.

Her proto-thoughts existed as beta elements (Bion 1962), sensory bits that had yet to be symbolized and transformed by alpha function and language into meaningful ideas upon which she and I could build.  Paradoxically, Laurie used words not as symbols of communication but as protective amulets to avoid a dark psychic void, a whirling vortex of nonbeing from which she feared she might never return.   As her word waves crashed in, I felt the concomitant pull of dangerous rip tides.

Into the void

Psychic voids represent gaps and fissures in the emotional floor of an infant’s foundational and rudimentary sense of being that expand into gaping and engulfing black holes (Grotstein 1990).  They signify the reverberations of an emotional catastrophe (Tustin 1981) between mother and infant, precipitating what the young child experiences as an endless free-fall in unbounded space.

Despite her mother’s actual presence, Laurie’s needs exceeded what her distracted mother was able to provide.  Lacking adequate maternal protection and containment, Laurie was left to manage confusing and frightening sensory experiences without the aid of her mother, the one person who could symbolize, interpret and transform them into meaningful psychic structure.  Instead, Laurie’s inner landscape was filled with dangerous sensory-affective potholes into which she feared she might trip and fall forever.  She defended against these terrifying threats of annihilating engulfment by filling the holes with meaningless noise and word-spackle.

The autistic-contiguous mode of experience

Evidence of this ancient catastrophe was manifest in Laurie’s default defenses and select mode of experience that reflected presymbolic and sensory rather than more fully mentalized object relations, consistent with what Ogden (Ogden 1989) designated the autistic-contiguous mode of experience.

Lacking a psychological skin (Tustin 1994), Laurie used words as palpable, sensory objects to scab over her flayed emotional self.

While repetitious speech defended against perilous psychic voids, it preserved her stasis in isolation and precluded any viable relational connection.  Like an insect preserved for eons in amber, Laurie was frozen in time and continued to rely on the autistic-contiguous mode of experience with little variation and without the addition of more mature modes that would permit empathy, mutuality and relational engagement.   Once after having learned coincidentally a fact about my personal life, she remarked, “We don’t usually talk about you, do we?”  For a moment, she saw me not simply as an extension of herself but as a separate object with discrete subjectivity of my own.

Working in the transference-countertransference matrix

In response, I experienced potent sensory and somatic countertransference sensations, often feeling drowsy though not bored.  Cringing was my strong response to feeling “tyrannized by an automaton” (Ogden 1989, p.44).  I frequently felt as if I could “crawl out of my skin” or twitch out of my chair as I sat with her, tortured by her inane recitals until I realized that she needed to use my skin and body as a substitute for the psychic skin she lacked.  To contain her unformulated and fragmented self, the beta bits she could not integrate or use, she was trying to burrow under my skin where she might feel shielded by its consistent surface.

And the word-shapes I perceived in reverie* were the autistic shapes (Tustin 1984) that constituted Laurie’s early object relations.  These are sensory, felt “shapes” arising when an infant touches soft objects.  Not yet perceived as separate, they represent the sensory edge of experience whereby warm and sensual contact objects such as bath water and skin or mouth and nipple are experienced by the infant as conjoined.

Surface contact is identified as a soft shape with its own mode of proto-object relations.  This sensory position is operational throughout life but serves a primary function in infancy, preparing a baby to distinguish hard from soft, animate from inanimate, me from not-me.  Imagine the contact friction where the surface of your skin meets the clothes you are wearing as a soft, warm shape representing conjoined rather than separate objects.

Long after the infant acquires the capacity to discriminate self from other and has developed more mentalized modes of experience, the autistic-contiguous mode remains her portal to tactile sensuality and sexuality.   We might think of it as “regression in the service of sensation.”

My countertransference feelings of intrusiveness had their correlate in Laurie’s early life when she felt her infant self to be an unwelcome intruder in her mother’s world.  My feelings of invisibility were linked to Laurie’s experience of herself as ignored and unacknowledged.

Evidence of premature separateness

Before she had acquired the capacity for self or object constancy and a subjective sense of individuality, Laurie’s infant self could only experience premature separateness as annihilating.  Lacking an emotionally attuned mother to modulate and reflect her existence back to her with delight and joy, she felt obliterated.

To bridge the perilous gap between existing and not existing, Laurie made noise.  If she didn’t intrude, she felt herself disperse and disappear into the ethers.  Noise verified her existence.  Though exiled, she was alive.

Laurie’s fall through space was as endless as our sessions often seemed.  I tried to break her fall by acknowledging her sensory needs and bundling her in my psychic skin.  She longed for contact, but had isolated herself behind an autistic, synthesized crust that seemed impossible to penetrate.  Despite the endless topical speech, terrible feelings of isolation and meaninglessness (Grotstein 1990) permeated our sessions leaving me feeling drained and ineffectual.

Laurie’s inability to distinguish between major and minor, foreground and background, significant and insignificant suggested the severe degree to which her sensory-affective experience and nascent thoughts remained conjoined at the surface and undifferentiated qualitatively.  What had originally begun as an early mode of sensory experience, a primitive awareness of self and object-other, had become a concretized and unyielding state in which she was rigidly stuck.

She would talk to a complete stranger just as she talked at me.  Everyone existed to provide archaic psychological functions for her, all interchangeable heads.   I was indistinguishable from a store clerk or gardener or anyone who would listen.

Autistic objects and shapes

Speech served several vital functions for Laurie.  In addition to representing autistic shapes, she also used speech-words as autistic objects (Tustin 1980), sensory dominated object-things used in impersonal and idiosyncratic ways.  Just as individuals with dementia will touch the surface of a nearby table or an edge of cloth as a means of sensory orientation, a feeble attempt to locate themselves in space, Laurie attached herself to objects at a sensory level, using relentless speech as adhesive.  She used speech like sonar to locate herself in proximity to me.  Speech conveyed painful affect not meaningful content.  The significance of my empathic attunement was evident in her choice of words that suggested skin contact and sensation, frequently remarking that something I did or said “touched” her, though she rarely could articulate why.

Considered retrospectively, I am now aware of the frequency with which Laurie referenced geographic and personal space, using them as metaphors for terrifying sensory-affective experience and unmet needs.  She would describe in detail aspects of the homes in which she lived as if she were describing physiological topography, using distance, walls and the impress of small rooms as autistic shapes and objects.  Some rooms felt containing while others did not.

Laurie would occupy herself making mental “shapes” from the lines and holes on the acoustic ceiling tiles on the occasions when I was out of the consulting room and would describe them to me when I returned.  I came to comprehend that these shapes were metaphors for early sensory experience that had never been symbolized.  She was trying to construe something meaningful from the discrete self-states and events in her life that felt random and disconnected.

Young girl dreaming

These “holes” were indicative of primitive mental states associated with sensory experience, particularly touch and the skin.  She entered a very childlike state of reverie associated with bouts of childhood illness when she would lie feverishly in her bed and look for design patterns and shapes in the ceiling above her head.  Neglected for long periods of time by a narcissistic and depressed and disengaged mother, she was left to make meaning of her sensory-affective experiences alone.

Making meaning of trauma and discontinuous self states

Having experienced little continuity of being, Laurie used word-shapes and objects to bridge holes in her discontinuous self states.  Uninterrupted speech served a critical survival function.  It prevented her entire sensory floor from falling away beneath her, pitching her into a dark sea or an engulfing black hole (Grotstein 1990).

Her torrent of words represented the only net she could use to defend against the terror of discontinuity and the nullifying anxiety associated with fathomless psychic voids.  She chattered at the edge of a gravitational vortex she could not overcome any other way.

Instead of suggesting creative potentiality, psychic space (Heller 2010) threatened to devour or engulf her in a state of utter nonbeing.   Unspeakable traumata were smothered in meaningless talk.  Unless her discontinuous self states were tied together with word-strings, Laurie ceased to exist.  Together we worked at the edge of meaning, trying to find symbols to represent unformulated experience.

Speech-noise represented the only girdle holding her together.  She could use words like Lycra, but she couldn’t think with them.  When I once asked who hadn’t cared for her, she stopped talking and wept.

As I began to comprehend her great need for foundational and sensory stability, we began to work at that level, using language that described her bodily and skin sensations in an effort to improve the quality of relatedness and transmute vowels and consonants into psychic scaffolding that might provide a reliably sturdy structure upon which she could rest.  When she initiated a stereotyped recitation, I stopped her and shifted to affect and bodily sensations, and eventually, she began to say, “I feel…”

Using language to create ongoing and increasingly complex stories and narratives from her ceiling picture-shapes and beta elements, she began to acquire the capacity to forge links and symbolize her unformulated experiences rather than simply repeat isolated segments.  Continuity and creativity began to replace abbreviated repetition.

Using my own thoughts, feelings and pictorial imagery as finely tuned instruments to track her unconscious communication in the intersubjective matrix, I learned to gauge her needs.  We worked as alchemists, using alpha function to transform base words into meaningful language.

Every single moment of reflection or reciprocity constituted a decisive achievement, rising like a small island in an otherwise illimitable and unremitting sea.

By slowly symbolizing and linking Laurie’s experiences and self-states over time, using circles of communication (Greenspan 1997) to expand her capacities to both think and relate to me as a discrete other, we began to see a varied and enduring archipelago of meaning emerge from her sensory seabed and coalesce into psychic structure.

 

* Reverie: Bion’s (1962) idea describing the analyst’s state of receptivity to her patient’s unconscious experience that parallels a mother’s receptivity to her infant’s raw, asymbolic or pre-symbolic experience.

WARNING! This text is printed for the personal use of the subscriber to The Therapist Magazine and InsideOutJournal.com and is copyrighted by Mauri-Lynne Heller.  It is illegal to copy, distribute or circulate it in any form whatsoever without the author’s permission.

Citations

Bion, W.R. (1962). Learning from experience. Classic Books. (Locale unknown)

Bion, W.R. (1962). The psycho-analytic study of thinking. International Journal of Psycho-Analysis, 43:306-310.

Greenspan, S (1997).  Training conference, Anaheim, California.

Grotstein, J. (1990). Nothingness, meaninglessness, chaos and the black hole Part I – the

importance of nothingness, meaninglessness and chaos in psychoanalysis.  Contemporary Psychoanalysis, 26:257-290.

Heller, M.L. (2010). Working in psychological space Part I.  The Therapist, volume 22/issue 3, March-April.  Also posted online: Inside Out Journal at insideoutjournal.com

Heller, M.L. (2010) Working in psychological space Part II. The Therapist, volume 22/issue 4, May-June.  Also posted online: Inside Out Journal at insideoutjournal.com

Heller, M.L. (2010) Working in psychological space Part III.  The Therapist, volume 22, issue 5, July-August.  Also posted online: Inside Out Journal at insideoutjournal.com

Ogden, T.H. (1989) The primitive edge of experience. Jason Aronson Inc., New Jersey, London, p.66.

Ogden, T.H. (1994). The analytic third: working with intersubjective clinical facts. International Journal of Psycho-Analysis, 75, pp. 3-19.

Roth, H. (1994). From bondage. Picador USA, New York, p. 77.

Tustin, F. (1980). Autistic objects. International Review of Psycho-Analysis, 7:27-39.

Tustin, F. (1981).  Psychological birth and psychological catastrophe.  In Do I dare to disturb the universe: a memorial to W.R. Bion, ed. James Grotstein, Caesura Press, 181-196.

Tustin, F. (1984). Autistic shapes. International Review of Psycho-Analysis, 11:279-290.

Tustin, F. (1994). Autistic children who are assessed as not brain-damaged. Journal of Child Psychotherapy, 20:103-131.

 

 

{ Comments on this entry are closed }

This column also appears in the online edition of the July-August, 2010 issue of  The Therapist Magazine, the publication of the California Association of Marriage and Family Therapists.

Abstract:

Adapted from a presentation to the CAMFT Orange County chapter, this third in a three-part series examines the ways applied contemporary psychoanalytic theory, particularly Intersubjective Systems Theory, with its focus on recognition and mutuality, has refined and expanded our understanding of mental processes and clinical interaction, modifying therapeutic dynamics in ways that promote therapist-client resonance.  Exploring the intersubjective matrix of transference-countertransference engagement, specifically the various modes of therapist-client communication, readers will begin to think innovatively about the shared psychological space in which we work.

Part III

Enactment is the language of lived experience, that which has not yet been mentalized and articulated linguistically.

In Part II of this three part series, we explored the use of the analytic third and therapist reverie as specific ways of accessing and understanding the unconscious communication transpiring in the transference-countertransference milieu.  In this final column, various modes of client-therapist communication will be explored.

Spoken Language:

Spoken language, its idiomatic usage and accompanying vocal sounds are modes of communication that convey much more than simple content.  By paying very close attention to these elements, we gain significant clues to unconscious processes.

Jacques Lacan, the French psychoanalyst, proposed that the unconscious was actually structured like a language (Lacan 1973) and that only language could promote psychological change.

Poet's Dream

He also suggested that we are impacted by language before we are born, and this is certainly an accurate assessment of the ways familial organization or beliefs and cultural schemata embedded within our environmental surround begin to sculpt and impress our identity long before we have the capacity to begin to define ourselves.

The following clinical example explores the meaning behind the use of a common idiom.  A patient recently used the phrase “threw me for a loop” several times during the course of a forty-five minute session.  The first time she said it, I simply noticed that she selected that particular idiom instead of a number of others she might have chosen.   When she used it a second time, I began tracking it seriously.

She was describing a distressing recurrent dynamic in which she found herself once again unwittingly embroiled and caught off guard.  “It just threw me for a loop,” she said emphatically and paused briefly before continuing with her narrative.

The third time she used the phrase to describe her subjective experience of surprise, I understood what she was telling me and interpreted, “I think you are telling me that you are going in circles and are caught in a loop that you feel you can’t escape.”  By linking a commonly used idiom to a very personal aspect of her inner world, we arrived at a new understanding that shifted us to a place in the session where we could speak more consciously and precisely about the feelings of circularity and constriction that were deeply embedded in early childhood dynamics.  In that shared moment, unformulated content that had existed on the edge of consciousness had acquired linguistic form.

Another patient arriving for our first session sat in the waiting room filling out forms.  Blah, blah, blah, he read quietly until he reached the paragraph about fees and panicked.  I’d left my inner office door open and invited him to come in when he’d finished.

Anxious that his narcissistic defenses wouldn’t contain his shame, he bleated out to me, “How much are you going to charge me?”  Finding out shortly thereafter that he had been in the military, I decoded his remark to mean that he was really asking are you going to charge at me?  Will you wound me (like my mother)? Will you hurt me? This became an ongoing theme of his year-long, four times a week analysis in which withholding of fees predominated.

Somatic language:

Very early, infantile experience is preverbal, unformulated and encoded somatically.  The capacities to think and use language are developmental achievements acquired over time.

The psychoanalyst Wilfred Bion (Bion 1962) suggested that infants begin to think in order to cope with thoughts, the nascent, unformulated impulses that constitute early mental life.  The infant has not yet learned to use his thought-impulses for thinking.  They are, therefore, encoded and subsequently communicated somatically via projective processes that replicate one of the primary modes of communication used by a mother and her infant.

In a state of maternal preoccupation (Winnicott 1963, 1965), when a new mother has adapted herself entirely to her infant’s needs, she is in a state permitting her to be exquisitely attuned to her baby’s projections.  Decoding them as only she can, she responds empathically by making necessary environmental adjustments, providing the desired warmth, food, holding, touch or gaze.  As the baby develops and acquires more direct means of communication, maternal preoccupation concomitantly subsides.

The Mona Lisa

Maternity

The most profound clinical example of somatic communication that conveyed infantile annihilation anxiety occurred during the analysis of a functionally psychotic and autistic young man.  Imprisoned in his own solipsistic mental isolation, he was capable only of incorporating others into his own tortured mental schema.  My reveries in the analytic third enabled me to gather his (preverbal) imagery and projections, organize them and return them to him in explanatory bite-sized pieces that he could ingest and assimilate.

As he lay supine and still on the couch, speaking in flat, unemotional monotones about superficial concerns, I often found myself filling with unspeakable and wordless dread and terror.  After one such session, I went to the restroom and, as I was washing my hands, felt the building begin to roll and shake.  Recognizing an earthquake, I grabbed the counter edge to steady myself until the temblor passed.  When I regained my balance and could walk, I went directly outside expecting to see other folks congregating.  But I saw no one.

There had been no earthquake, other than the somatically projected transmission of abandonment, the non-verbal communication of what it had been like for this individual to have been discarded at six months of age.  His world fell apart.  Whatever developmental balance or stability he had initially achieved rolled out from beneath him.  My next step was to find ways to articulate this shattering experience that reverberated through every moment of this young man’s life, so that we might speak of it directly, so that we might arrive at new ways of being together.

Dream language:

Freud’s royal road to the unconscious is still paved with gold.  Dreams have always permitted us to clothe the invisible man of the mind in accessible, meaningful and personal ways.

Some patients have more access to dreams than others, and it’s interesting to track the arc of dream content and meaning across the period of treatment, observing how they shift.  With my patient’s permission, I will recount one of her dreams as an example.  What follows is a nearly verbatim record of her dream narrative:

I was in L.A. in a house. It was more a shelter.  A man was there with me.  There was a tornado in the desert –and strong winds.  I was trying to keep the door shut.  My foot is in it.  And then we were blown to smithereens.  I wasn’t afraid, though.  There was a huge light and everything evaporated.  I was very calm.  Like I ended up in a different place and time.

As she spoke, I tracked my own feelings, thoughts, images and reveries in the third.  As she alternated between present and past tense, I was aware that this dream had retained its potent sense of primary process immediacy.  We shifted back and forth in time and dream space.

My first spontaneous idea was that this dream used birth trauma imagery to convey the dreamer’s transition from one psychic space or place to another, from a desiccated and dry place to somewhere else.  I also considered that the desert might symbolize her emotional desertion and neglect as a young child.  Her foot in the door represented a feeble attempt to defend against retraumatization and the emergence of strong affect and memory.

Her quiet response to this interpretation was that the light was calming.  I ceased to exist on one level.  I existed in the light but was invisible. This was the way she described what it felt like to step into psychological space and engage unformulated experience.  Expecting a repetition of past trauma, instead she found calm.  She hadn’t quite yet created a new symbolic form to represent her unformulated content but was in transition and able to tolerate the uncertainty and necessary of creative disorder (Stern, 1983) whipped up and represented by the tornado.  This was also a dream about finally surrendering to authenticity while releasing stringent defenses.  Her foot in the door was an insufficient defense against the more compelling need to give birth to herself.

Because the man in her dream was familiar but mostly unseen, an accompanying entity, we imagined that he represented a deeply held transitional object (Winnicott 1953) supporting her during her psychological travels.  A transitional object, often a blanket or toy, is designated by the young child as the talisman that will accompany her during nascent and experimental forays into transitional (psychological) space.

Helping her individuate from the mommy-baby unit status of early infancy, the baby creatively imbues this object with sustaining elements associated with the nurturing mother.  This is why these poignantly tattered and beloved objects manage to find their way into college dormitories years later.  It is regarded with esteemed affection by parents and children.  Recognized by the infant as not-quite-me and not-quite-mom, it represents transition.

Transferentially, this image might also have represented the active (male) strength our relationship has provided for her in addition to the more feminine aspects of empathy.  Dream images are frequently condensed, and these represented aspects of self that she was beginning to integrate.

Her narrative continued, and she spoke of feeling stuck as she prepared for the state bar exam, dejected that she had lost meaningful direction and purpose.  Tired of giving her talents away, she experienced this dream as a means of redirecting herself.

This patient dreams of houses and rooms frequently, and these are symbols of mind, self and object world.  Transferentially, these motifs may also symbolize my office and her analysis and my capacity to hold and contain her affect, to provide ego strength when needed, to inspire curiosity and help her self-regulate.

My final interpretations were based on my reverie in the analytic third in which I envisioned the scene in the Wizard of Oz when Dorothy and her house are flying through the eye of the tornado, also a metaphor for vaginal birth contractions, in this instance auguring psychological birthing.

I shared my image with her, adding that this leitmotif also illustrated how she was looking for a psychological home.  Someplace to land without killing someone beneath her as a result.  In fact, outworn elements of her inner object world would, indeed, have to die.

Because she has worked with criminals, I added that she was trying to escape her internal prison.  This is a potent dream we’ve revisited several times and will continue to reexamine over the course of her analysis.

Enactments:

Enactments represent the behavioral language of lived experience dramatically expressed within the therapeutic dyad.  They represent unmentalized experience that has yet to be linguistically articulated where it can be examined, understood and altered.

The classical analytic position holds that enactments are indicative of poor treatment or the therapist’s inability to maintain her stance as neutral observer, while more contemporary thinking conceptualizes enactments as not only inevitable, but necessary and creative opportunities for growth.  They portray with immediacy exactly what is transpiring within the therapeutic dyad and are the road maps to mutative interventions.

The blue circus

From an intersubjective position, enactments in the clinical setting represent the co-constructed participation of both therapist and client.  Raymond Friedman and Joseph Natterson (Friedman, R., Natterson, J. 1999) suggested that enactments are “intersubjective inevitabilities” with the therapist as an active participant-observer rather than a more remote neutral observer.

While enactments represent the continuous living out of mostly unconscious fantasy within the therapeutic relationship, they can be identified as brief or extended (Friedman, R., Natterson, J. 1999).  An example of an extended enactment might crystallize around a client’s unconscious need for sponsorship and a therapist’s unconscious wish to be helpful.

The therapist’s contribution represents much more than a simple countertransference response to a client, but the activation of the therapist’s own unconscious material.  As the therapist begins to understand the meaning of the specific dynamics unfolding dramatically, they become useful elements employed in the service of furthering the clinical work.

Deleterious enactments lead to therapeutic impasse and the cessation of relational generativity that facilitates change and growth.  They often have a repetitive and stagnant aura, a scripted feel, and both therapist and client feel like they’re being acted upon by the other.  Reciprocity feels absent.   Jessica Benjamin (Benjamin 1999) described this coercive clinical stalemate “complementarity.”

Within the dyad, impasse enactments are often identified by the mutual feelings of misunderstanding, isolation and frustration they produce.  They can, however, be equally stimulating, as they reveal the near-conscious aspects of the analytic experience that can be more closely examined and interpreted.

Working to access, decode and understand the meanings conveyed by even the most rigid enactment permits the unfolding of significant growth and change.  Irwin Hoffman (Hoffman 1983, p. 73) suggested that enactments may be “paradoxically integral to the emergence of new understanding and of new ways of being in the analytic relationship and in the world.”

However, all enactments unfolding within the clinical setting between therapist and client or patient share in common a subtle blending of old and new features, old because they draw upon unconscious elements from both the patient’s and therapist’s unconscious histories and lives and new because the current dramatization being enacted is unique to them and a specific moment in their relationship.

The patient who had been abandoned as an infant reenacted his lethal rupture scenario in every relationship he ever had.  None had ever lasted more than a few months, and that included work relationships.  This individual was unable to hold a job and was frequently unemployed, impoverished and homeless.  He was dramatizing and communicating that an infant without a mother is homeless.

The salient and tragic feature was that he was reliving the scenario, not changing it.  Living in his truck was a metaphor for mother loss.  He had no psychological or actual home.  Psychological space was for him a terrifying psychic void; he had no inner mother there to support him.

Within a few weeks of beginning a year-long analysis, he began his malignant enactment by canceling or missing appointments, making excuses and arriving late.  His unconscious need for mothering and my unconscious need to fulfill those needs set the stage for the enactments that followed, as he prepared to leave me before I could leave him.

Had I simply pitted my will against his within a rigid dialectic about frame, I would have created a therapeutic impasse, a situation of complementarity from which he would have fled, once again trying to leave mother before she could leave him.  Instead, I used the dramatization as an opportunity to comprehend and convey my empathic understanding of his experience, his terror, his loss and grief.  Enactments permit us to say, “Oh, now I see what happened to you.  Now I understand.  You’re showing me what your life has been like.  We’re experiencing it together, and now we might change the outcome.”

Countertransference:

We are made aware of these unconscious elements by tracking our own feelings, sensations and thoughts.  Our sensory awareness responses are clues to what our client’s are experiencing within themselves and within the shared psychological space of the intersubjective matrix.  The psychoanalyst, Avedis Panagian, once remarked at a conference that we access our patient’s lives and traumas by activating our own.  This is why our reveries, feelings and thoughts, even when they seem unrelated are so vitally important to our work.  They represent an overlapping experiential juncture in the third “we” space, the analytic third (Ogden 1994).

Copyright Warning: This text is printed for the personal use of the subscriber to InsideOutJournal.com.  It is illegal to copy, distribute or circulate it in any form whatsoever.

Benjamin J (1999). Afterward. In: Mitchell S, Aron L, editors. Relational psychoanalysis: The emergence of a tradition, p. 201-10. Hillsdale, NJ: Analytic Press. 496 p.

Bion, W.R. (1962). The Psycho-Analytic Study of Thinking. International Journal of Psycho-Analysis, 43:306-310.

Friedman, R., and Natterson, J. (1999).  Enactments, An Intersubjective Perspective.  Psychoanalytic Quarterly, 68:220-247.

Hoffman, I. (1999). The patient as interpreter of the analyst’s experience.  In: Relational psychoanalysis, the emergence of a tradition. Hillsdale, N.J. The Analytic Press.  (Original work published in 1983.)

Lacan, J. (1973) The four fundamental concepts of psycho-analysis. New York. W.W.  Norton & company.

Ogden, T.H. (1994). The analytic third: working with intersubjective clinical facts. International Journal of Psycho-Analysis, 75:3-19.

Stern, D. (2003).  Unformulated experience: from dissociation to imagination in psychoanalysis. The Analytic Press, Inc. Hillsdale, N.J.

Winnicott, D.W. (1953). Transitional objects and transitional phenomena—a study of the first not-me possession. International Journal of Psycho-Analysis, 34:89-97.

Winnicott, D.W. (1963). Dependence in infant care, in child care, and in the psycho-analytic setting. International Journal of Psycho-Analysis, 44:339-344.

Winnicott, D.W. (1965). The maturational processes and the facilitating environment. London: The Hogarth Press and the Institute of Psycho-Analysis.

{ Comments on this entry are closed }

This column also appears in the online edition of the May-June, 2010 issue of  The Therapist Magazine, the publication of the California Association of Marriage and Family Therapists (CAMFT).

Abstract:

Adapted from a presentation to the CAMFT Orange County chapter, this second in a three-part series examines the ways applied contemporary psychoanalytic theory, particularly Intersubjective Systems Theory, with its focus on recognition and mutuality, has refined and expanded our understanding of mental processes and clinical interaction, modifying therapeutic dynamics in ways that promote therapist-client resonance.  Exploring the intersubjective matrix of transference-countertransference engagement, specifically the co-created space identified as the analytic third and the use of reverie, readers will begin to think innovatively about the shared psychological space in which we work.

Part II

Christopher Bollas: In order to find the patient, we must look for him within ourselves.

Preverbal Experience:

Given that much of what transpires in psychological space is unconscious (because after all, as Donnell Stern suggested (Stern 2003), all thought originates unexpectedly from somewhere beyond consciousness, distinguishing what is kept out of awareness defensively and volitionally from what has simply not yet taken form is axiomatic), we can work on both these levels.

There is a difference between not wanting to know something and simply not knowing it yet.  Donald Winnicott (Winnicott 1975/1945) distinguished between unorganized and disorganized mental configurations.  The individual whose mental life is unorganized has yet to congeal whereas the disorganized individual’s mind was once organized and has come undone.  The former may be ego-syntonic, while the latter ego-dystonic.

These unconscious elements existing as unformulated experience are often preverbal, meaning that they are linguistically inaccessible.  The patient struggling to formulate verbal constructs for affective experience has hit such a preverbal pocket.  This material does not exist as a fully developed notion waiting simply to be discovered like a vein of gold within a mountain.

Preverbal elements have yet to be articulated and are generally experienced as amorphous affects – impulses, feelings, urges, fears, shadowy elements, etc.  They are the sensory bits like Lego pieces that are yet to be consciously molded and integrated linguistically.  Wilfred Bion (Bion 1962) called these unformed elements “beta bits.”  He also proposed that thinking is a way to deal with thoughts – these sensory, inchoate impulses that require formulation and linguistic articulation.

Artists are extremely adept at making use of unformulated experience, though all of life is essentially a work of art.  The poet, Sharon Olds, begins writing when “a poem has formed itself, or its beginning, within me, and it’s time to get a pen and notebook and sit over there on the rocking chair next to the window and try to bring forth that which is within.”

It’s not that the poem was hiding in its complete form in her unconscious; it began as an amorphous, inchoate impulse that she then mentalized and shaped into linguistic form.  The awareness of this urgent sensation represents the welcome but often inconvenient inclination that initiates every act of creative generativity.  It’s a stirring that compels creative action.

Shared Experience:

When we work clinically in psychological space, we are talking about co-creating a shared mind-body experience, a conjoint psychological space wherein we overlap in an attempt to access and understand each other’s subjective world.

This is another feature that distinguishes contemporary psychoanalysis from its more traditional relative.  Rather than simply adhering to a doctor-patient hierarchy, where the latter has all the questions and the former all the answers, we now conceptualize two subjectivities involved in the act of co-creation.  Ideally this relationship is defined by bi-directionality and mutuality, though it necessarily remains asymmetrical.  This interactive dynamic defines the intersubjective matrix or field.

The Analytic Third and the languages of psychological space

The body-mind speaks many languages from the behavioral to imagery to words.  Within the intersubjective sphere of the transference-countertransference milieu, we work to access and decode the many communications that we receive in the service of our clients and patients.

Thomas Ogden (Ogden 1994) defined this working, overlapping “we” space as the “analytic third.”  In his seminal paper, Ogden described how he tracks the moment-by-moment interplay of the oscillating therapist-patient engagement in this intersubjective matrix.  Its prototype is the mommy-baby unit of infancy described by Winnicott (Winnicott 1960) and the emergence of transitional space, yet it is more nuanced and complex, because while we are interacting with what we call the “analytic baby,” the more archaic components of self, we are also with the more intellectually developed adult.  We have to track on all levels.  There is no such thing as an analyst apart from the relationship with the analysand (Ogden 1994).

Beginning to work in the transference-countertransference milieu

We begin to work by attuning ourselves to the paradox our clients and patients bring to us, primarily the hopeful longing for some new relational experience appended like a barnacle to the dreaded expectation that nothing and no one will ever really be different.

The hope that maybe this person will understand is quickly quashed by the fear that the therapist will be just as disappointing as everyone else has been.  And this often includes prior therapists.  And so the transference-countertransference dance begins to develop in psychological space.

Our goal is to decode, organize and clarify the unformulated bits and pieces we receive, to apprehend in our well-trained nets the clues that help us begin to understand and formulate interventions.  We sit with a client, listening and observing with all our sensory organs until we begin to grasp something.  What we experience isn’t yet fully formed; in fact, it may be as unformed as our client’s subjective experience.  In truth, as Bollas suggested (Bollas 1994), we find our client within ourselves, within the greater context of the intersubjective field.

We scroll through the session without knowing what we will find, without preconceived expectations, as Bion (Bion 1970) suggested “without memory or desire,” until we begin to form our own associations.  We have an impulse, a strong feeling, an aversion, a sensation.  And this is how we begin to work in psychological space, the place where you and I overlap and become “we.”  This is the transference-countertransference milieu.

Accessing psychological space

It is impossible to know the unconscious or unformulated directly.  We can only access its derivatives, as they are like clothes on the psyche’s invisible man.

The analytic third is the overlapping psychic sphere wherein discrete subjectivities mingle and exchange communications.  It is the realm where unconscious meets unconscious.

Louis Aron (Aron 2006) has also written about this third space extensively: “What is meant by ‘the third’? The third is a concept that has become popular across a variety of schools of psychoanalysis. It has been developed and extended by some of the leading theorists of psychoanalysis, including Ogden, Green, Benjamin, and a variety of Lacan-influenced writers, but it is often defined ambiguously and inconsistently across schools. For some, the third refers to something beyond the dyad, a context within which we emerge; for others, the third is an emergent property of dyadic interaction, and yet for others, the third is a dyadic achievement that creates the psychic space necessary for reflexive awareness and mentalization.”

Jessica Benjamin (Benjamin 2004) wrote: “My interest is not in which “thing” we use, but in the process of creating thirdness—that is, in how we build relational systems and how we develop the intersubjective capacities for such co-creation. I think in terms of thirdness as a quality or experience of intersubjective relatedness that has as its correlate a certain kind of internal mental space; it is closely related to Winnicott’s idea of potential or transitional space.”

So the third is many things, a space in which communications are exchanged and reformulated, a function of relationship-building and a theoretical concept open to diverse interpretations.

Elements of Intersubjective communication

Reverie and Imagery:

Reverie and imagery give visual, if not palpable, shape and form to elements that swirl in this dynamic and interdependent field of intersubjectivity, particularly crystallizing communication that drifts from unconscious to unconscious, bypassing awareness.  This is the live edge of clinical work, the place where analyst and patient, therapist and client intersect, clothing the unseen communications in ways that make them accessible and amenable to articulation in language.

Mother and child in a boat

This kind of communication best describes the ways a mother intuits the needs of her baby.  Receiving her baby’s projections, she organizes and returns them in tolerable and digestible doses.  Did you ever have to put on a sweater because your mother was cold?

The focus is less on what originates where but on interpersonal co-creation of elements in the overlapping psychological space of the analytic third.

An example from my own practice is my awareness of surrounding airport sounds.  My office is very near the runway, so the sounds of jets taking off are generally background noise.  I only become aware of them distinctly when I sense that my patient’s thoughts or feelings are defensively taking flight, or perhaps they don’t yet have a (linguistic) place to land.  At those moments when I envision planes lifting off the runway, I may ask what thought or feeling just took off, and I will invariably receive a germane answer.  If the answer is “I don’t know,” we collaborate to discern what it might be.  I attempt to put words to mental pictures I receive, and we try them on for size together.

A more imagery-laden example of processing in the third derives from my work with a man who grew up in an Eastern Block country, though has lived in the States for many years.  He’s lost the fluidity of thinking and speaking in his native language yet struggles to express himself precisely in English.  Not only is this frustrating, but it pushes him back to a more archaic means of image-laden, unconscious communication.

Therefore, I experience lots of imagery in the third when we’re together.  On several occasions, I’ve “seen” a winter scenario of cold earth, frozen beneath soggy, fallen leaves and bare trees.  Translating this into emotional language, I offered him the interpretation that he felt like his feelings were suspended in permafrost.  Indeed, they were.  He has always identified himself as being emotionally cold.

Therapists often confuse their random but meaningful thoughts or countertransferential reveries with intrusive distractions that should be discarded, and sometimes they very well may be.  But even that is significant.

The question begging an answer is why did I need to distract myself at that particular moment?  What didn’t the client want me to know or what did he want me to avoid?  What couldn’t I bear to witness?  What must always be left unacknowledged, unformed, unsaid or isolated as dissociated material?  What was too painful to feel?  What really longed to be understood?  Most usually those very thoughts and images have something to do with what is going on within the client’s mind-body.

Recently while sitting with a patient, I beheld in my mind the image of a child prostitute and asked her if she felt like hooker in her marriage.  Indeed, she did, but that was the first time she’d been fully aware of her feelings.  She had communicated this unthought known (Bollas 1987) to me via imagery.  Now we speak of it explicitly, and it is amenable to change.

I frequently tell patients that split off aspects of themselves have lives of their own outside awareness revolving like isolated moons with no way to reconnect.  Our job is to set up a linguistic satellite system so that the moon can communicate with the mother ship.  You can’t enact a lunar landing if you don’t even recognize that a moon exists.

What makes this way of working with unconscious material contemporary are the ways in which it differs from Freud’s schema of the unconscious as the return of the fully-formed repressed, conceptualizing that insight and awareness were sufficient to illuminate the issues and produce change.

More current schemata suggest that unconscious elements are not simply inaccessible as a result of defenses, but unformed.

While insight is valuable, it is equally imperative that we attempt to access and comprehend what is unformulated, thereby facilitating the creative process whereby mental Lego pieces can be assembled and used.  Reverie and the analytic third provide a means for us to achieve that goal.

Aaron, L. (2006). Analytic Impasse and the Third: Clinical implications of intersubjectivity.  International Journal of Psycho-Analysis, 87:349-368.

Benjamin, J. (2004).  Beyond Doer and Done To: An Intersubjective View of Thirdness.  Psychoanalytic Quarterly, 73:5-46

Bollas, C. (1987). The Shadow of the object: psychoanalysis of the unthought known. Columbia University Press, N.Y., N.Y.

Bion, W.R. (1970). Attention and interpretation: a scientific approach to insight in psycho-analysis and groups, 1-130.  London: Tavistock.

Bion, W.R. (1962). Learning from experience. London: Tavistock.

Bion, W.R. (1962). The Psycho-Analytic Study of Thinking.  International Journal of Psycho-Analysis, 43:306-310.

Ogden, T.H. (1994). The Analytic Third: Working with Intersubjective Clinical Facts. International Journal of Psycho-Analysis, 75:3-19.

Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. International Journal of Psycho-Analysis, 41:585-595.

Winnicott, D.W. (1975). Primitive emotional development. In: Collected papers:

through paediatrics to psycho-analysis. (pp. 145-156). (Original work published 1945). Basic Books. Locale unknow

{ Comments on this entry are closed }

This column also appears in the online edition of the March-April, 2010 issue of  The Therapist Magazine, the publication of the California Association of Marriage and Family Therapists.

Abstract:

Adapted from a presentation to the CAMFT Orange County chapter, this first in a three-part series examines the ways applied contemporary psychoanalytic theory, particularly Intersubjective Systems Theory, with its focus on recognition and mutuality, has refined and expanded our understanding of mental processes and clinical interaction, modifying therapeutic dynamics in ways that promote therapist-client resonance.  Exploring developmental factors and transitional space, the origins of creativity and an expanded definition of the unconscious to include unformulated experience, readers will begin to think innovatively about the shared psychological space in which we work. [click to continue…]

{ Comments on this entry are closed }

On several occasions I’ve written about the ways in which we begin to come into being as unique persons from within an interpersonal mommy-daddy-baby matrix.  The impact of these early interactions are so vital and long-lasting, they inform our behavior and beliefs about relationships for the remainder of our lives. [click to continue…]

{ Comments on this entry are closed }

This column originally appeared in the Orange County Register

A screenwriter friend gave me an article discussing the salutary aspects of sadness and the ways in which our contemporary culture tends to quickly erase it or prematurely foreclose upon its gritty psychological usefulness in a quest for perennial cheery happiness.  As if happiness were a concrete object one could hold instead of a transitory state of being, one of many, that links specific inner notations of experience with external ones. [click to continue…]

{ Comments on this entry are closed }