From the category archives:

Relationships

This column also appears in the March/April, 2011; Volume 23, Issue 2 of The Therapist, published by the California Association of Marriage and Family Therapists (CAMFT).  Abstract page 75.

Abstract:

This two-part series examines the psychological origins and antecedents of terrorism.  Object relations, intersubjective systems theory and contemporary relational psychoanalytic concepts are used to define and highlight the constellation of specific dynamics implicated in terrorist enactments, particularly the ways they replicate salient interactive patterns of early mother-infant communication.  This resonant, harmonic unit, characterized by interactive modes of touch, gaze and projection, establishes the creative sphere wherein an infant comes into selfhood and begins to develop nascent capacities for relationality, empathy and morality.  Emotional terrorism begins when a mother is unable to contain and modify her infant’s projected anxieties or, in reverse, projects her own, initiating a repetitious cycle of terrorist-victim or “doer and done-to.” Clinical and cultural implications of sadism, the perversion of empathy, are also considered.

The Emotional Terrorist Part I examined the psychological origins and attributes of terrorist-victim dynamics and the defensive processes that drive repetitious enactments.  It also explored the ways that sadism represents the perversion of empathy.  The Emotional Terrorist Part II explores case material to further clarify and exemplify these dynamics.

Clinical examples

A patient arrived for a session shortly after experiencing a serious break-up and began by disparaging her lost love object.  He was an idiot.  I never really loved him, anyway.  I’m better off without him. While these appraisals may very well have been accurate, they were also being used defensively to avoid abject feelings of jealousy, loss, loneliness and painful rejection.  These intolerable feelings were more safely managed after being externalized, projected and relocated in the lost object where they could then be attacked.

Poet's Dream

Envy and rage are difficult to tolerate, even by psychologically developed individuals, as they activate unpleasant feelings of inadequacy, incompetency and shame associated with the helplessness of infancy and distasteful dependency needs, traits that conflict with subsequent developmental achievements.

Because these undifferentiated, “not-me” (Stern 2009) self-states are kept out of awareness defensively, they pose unbearable conflicts referred to as the “agony of consciousness” (Tustin 1986, p. 43) when they begin to emerge and are quickly dispatched before they can be sufficiently modulated or integrated.  A state of non-experience is preferable to torment.

Preverbal pockets of early traumata and other unmetabolized self states can only be accessed or experienced initially by the therapist via non-linguistic modes of communication that rely frequently on unconscious projective processes (Ogden 1989).

As therapists, we decode or “read” patient projections by tracking ourselves in the intersubjective matrix of the transference-countertransference milieu, carefully attending to our own sensory reactions, feelings, observations, thoughts and reveries.

Following moment by moment shifts in affect, posture, gaze and relationality, we utilize our own means of empathic projection to access unconscious aspects of both self and other in the intersubjective field.  In this dynamic mode, our simultaneous access to the derivatives our own unconscious processes that would otherwise remain out of awareness help us understand what has yet to be formulated and spoken.

The Alexithymic Patient

During the analysis of a deeply frightened patient whose early environmental failures rendered him unable to access even the most basic language that might enable him to identify or conceptualize his emotional states, I learned to recognize when we had hit a preverbal pocket because he would look at me helplessly and shrug.  His episodic inability to give linguistic shape to the content of his affective self-states conveyed how he used the rapid dissociation of unformulated material to protect himself from terror and dread.

Successful in the trades, he and his wife assumed very traditional marital roles that required very little intimate communication, leaving them compatible but emotionally disengaged.  He said his wife complained of loneliness.  He didn’t know what she wanted.  People hadn’t talked about feelings when he was growing up he often said.  His narcissistic mother had filled him with her own projected terrors, leaving his early object world riddled with engulfing psychic voids (Grotstein 1990) rather than viable maternal representations that could be used to contain his feelings.

He had no inner mother on whom he might rely.  What little paternal comfort he had was lost when his parents divorced and his father moved away.

Invisibility was his shadow companion, and he cringed away from interpersonal intimacy and avoided social gathering that made him feel “put on the spot.”  He had sporting buddies but no real friends.  Rather than reactivating the internalized warmth embedded in early modes of concerned relationality provided by empathic maternal attunement, his unacknowledged and unformulated (Stern 1999) feelings simply backed up and congealed.

He loathed his mother’s visits and spoke of her relentless self-absorption, how her endless talking bombarded him with palpable word-objects.  There was no space for him, so he quietly endured her assaults until she left, leaving him “in peace.”  Unable to recognize his dissociated and projected desires for intimacy in his wife’s requests for contact, he felt helpless as she enacted his desperate pleadings, giving voice to his wordless scream.

Our sessions were characterized by lengthy silences during which I functioned as the container for his disavowed self-states.  He found these silences extremely embarrassing, frequently announcing that he wasn’t coming back again.   I understood this to mean that the conflict posed by the emergence of unspeakable affective states into consciousness was intolerable, so the dissociated terrors remained selectively unformulated and desperately avoided.

Tracking my own subtle reactions, I was able to apprehend his unformulated and dissociated feeling states and sought to find symbols and words that might describe them.  Once when talking about the drought, I shared my reverie of a quiet and pristine pool of water, describing his inner world as an aquifer waiting to be tapped.  This was the first symbol he’d ever linked to what had always been an unnamed part of himself.

As we sought descriptive language together, his unspeakable and amorphous feelings of annihilation dread found an outlet in discourse, and he began to formulate his own emotional language and a concomitant capacity to depict his inner world.  Congealed emotional terrors began to liquefy.

Spousal victim and victimizer

In clinical practice, we observe this terrorist dynamic of doer and done-to (Benjamin 2004) most floridly when working with couples.

Repetitiously terrorizing volleys might be construed as representing a game of hot potato with dissociated emotional projectiles and bad objects.  Both “bad me” and “not-me” aspects of self states are launched back and forth like missiles.  Disavowed and unformulated self-states are projected and subsequently attributed to the partner where they are more easily attacked.  Affect often alternates between self-loathing and rage toward the partner.

The patient whose emotional fragility feels too dangerous and alien to claim, projects it onto his spouse.  “She’s too emotional,” an emotionally blunted husband said of his wife.   The nascent emergence of strong conflictual feelings threatened the cohesion and regulatory aspects of his self-image, activating unwelcome dependency needs that made him feel small, needs that chafed against his branding as an autonomous adult.  So, he rid himself of conflict by projecting his needs, locating them in his wife and criticizing her.  In turn, she attacked his remote implacability.

Rather than experiencing the full spectrum of their sensory-affective selves, they terrorized each other with projected aspects of self states that would otherwise pose intolerable conflict. Each spouse representing one half of a broken plate (Stern 2009), they enacted in turn invariable roles of terrorist and victim.  Doer and done-to.

As therapists, we feel it most acutely when a couple closes ranks and directs its combined projective animus at us.  You don’t care about me.  This isn’t working.  You’re only here for the money.  Oh, I think we can talk to each other without you. Feelings of incompetence have been located within us, temporarily relieving a couple from experiencing the abrasive conflict required to resolve them (Stern 2009).

The Mona Lisa

Maternity

These feelings of incompetence that are experientially and dialectically incompatible with mastery can be evaded routinely by patient and therapist, compromising treatment, until the clinician is able and willing to examine conflictual aspects of her own “bad me” and “not me” self states first.

The clinical clue uncloaking a stealth projection of helplessness is a strong countertransference feeling of utter ineptitude.  We must be able to claim our own “not-me” states of ineffectuality.  If we disavow them, we have no option but to project them right back.  Like a juggler with several balls in the air, we must take care not to throw them.

Children and families

Projective dynamics are a bit more complex when working with children and adolescents.  Just as our therapeutic relationships begin to bear fruit and an attachment has been formed, the parents may pull the child from treatment, proffering transparent and superficial excuses.  Some affluent parents would actually prefer that we believe they are impoverished rather than frightened.  The Container-contained dynamics (Bion 1962) have been reversed, and the child is serving a psychological function that the parents will not relinquish.

The emergence into consciousness of their inner terrors would elicit unmanageable and threatening psychic conflict.  Therefore, any therapeutic effort to return projections to their rightful parental owners will be resisted to maintain the homeostatic benefit of selective avoidance.

Paradoxically, enduring change and growth require a willingness to tolerate in titrated doses the anxiety-provoking affective experience and self-states so strenuously avoided.

A patient I’d seen for many years, arrived for her appointment one afternoon and told me a remarkable story about a dinner conversation she’d recently had with her mother, a very anxious woman prone to massive denial.  My patient, a skilled sailing enthusiast who was very comfortable in the water, had experienced intermittent but recurrent nightmares about being engulfed by tidal waves since childhood.

Red boat with blue sails

While sailing, she often experienced intrusive and distressing images of being tossed from a sinking ship into turbid and roiling seas with nothing more than a flimsy kickboard for support, ostensibly to swim for help as her mother clung to the ship’s railing helplessly.  While we explored this imagery thoroughly, we could never quite plumb it to the psychological seabed satisfactorily.  Something elemental always seemed to be absent.  Her mother provided the missing link.

Having dinner together in a seaside restaurant with a lovely view of the bay and its sleek boats, her mother casually remarked that she’d experienced recurrent nightmares about tidal waves throughout her life.  My patient was stunned to realize that she’d been carrying her mother’s projected anxieties and nightmares since early childhood, beginning at a time when the family lived substantially removed from the sea.  Having reversed the container-contained dynamic (Bion 1962), her mother had flooded her daughter with dissociated self-states and annihilation anxiety in which her daughter was drowning.

This anxious and helpless woman, clinging to the railing of her psychologically sinking ship, had tossed her daughter into the vast sea of her own restless and unplumbed unconscious where she was engulfed by projected existential terrors.  My patient had been colonized and terrorized by her mother’s dissociated anxieties.  Soothed by the insight that her tiny kickboard provided the only psychological defense her child-self could summon against the titanic force of her mother’s fierce projections, she renounced it, and her nightmare has not recurred.

Conclusion

In conclusion, terrorism might be construed less as an act of “evil” volition and more as an enactment of unconscious proportions, a psychological trespass that has less to do with discrete ideology, deities or politics and everything to do with mother-infant dynamics and the defensive management of strong, presymbolized affective states.

Its wounds are two-fold.  The initial emotional impingement invades the sensory-affective foundations of the vulnerable infant’s body-mind as a kind of implicit soul piracy.  Occurring long before the infant has developed any capacity to comprehend or object, the trauma exists as terrifying, unspeakable pockets of unformulated and dissociated experience.  If this disavowed material is projected rather than linked to word-symbols where it can be understood and integrated, emotional terrorism ensues as a repetitious series of doer and done-to (Benjamin 2004) enactments.

Until they are mentalized and attain linguistic symbolization, these nameless sensory chards of “beta elements” (Bion 1962) are experienced as chaotic and remain selectively dissociated where they can be safely avoided.  Often these unprocessed elements feel as if they have acquired actual mass and become embedded deeply within the flesh, and the need to expel these uncomfortable psychic elements is urgent.  I often hear patients describe a compelling need to vomit or purge something that feels hard, solid and alien, to “get it up and out.”

The therapist’s state of receptivity to her patient’s unconscious experience is similar to that of an empathically attuned mother’s receptivity to her infant’s presymbolic and pre-linguistic experience (Ogden 1989).  From within the encircling safety of the therapeutic relationship, terrorizing self-states derived from ruptures or deficiencies in early mother-infant exchanges may finally begin to acquire meaningful shape and form where they can be understood, integrated and defused.

WARNING! This text is printed for the personal use of the subscriber to The Therapist Magazine 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.

Benjamin, J. (2004). Beyond doer and done to: an intersubjective view of thirdness. Psychoanalytic Quarterly, 73:5-46

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

Grotstein, J. (1990).  Nothingness, meaninglessness, chaos and the “black hole” I – the importance of nothingness, meaninglessness and chaos in psychoanalysis.  Contemporary Psychoanalysis, 26:257-90.

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

Stern, D.B. (1999).  Unformulated experience: From dissociation to imagination in psychoanalysis.  In: Relational psychoanalysis, the emergence of a tradition.

Hillsdale, HJ: Analytic Press. (Original work published 1983)

Stern, D. (2009). Partners in thought. New York, N.Y., Routledge.

Tustin, F. (1986).  Autistic barriers in neurotic patients. London, Karnac.

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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.

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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

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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…]

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This column also appears in the Orange County Register.

As dropped cell phone calls become a daily irritation, the jarring experience of losing a conversation in mid-sentence has become routine.  The ugly wart on the nose of wireless communication, what once served as the triumphant but rude ending to an angry conversation has become a daily frustration.  The original hang-up technique, signifying an almost monarchical dismissal, that harsh bang sending combatant lovers to their corners, now seems rather quaint by comparison. [click to continue…]

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This column originally appeared in the Orange County Register.

In response to the queries of persistent readers who have been awaiting a new column since late June, I thank you for your notice and offer this little essay in response.  In case you’ve ever wondered, the English word essay comes from the French word essayer, meaning “to try.”  An essay represents an effort to formulate and communicate ideas.  An essay, therefore, is a writer’s attempt to use language to forge a connection with a reader. [click to continue…]

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This column originally appeared in the Orange County Register.

The recent California judicial decision upholding Prop. 8 has inflamed very strong emotional reactions all along the socio-political spectrum regarding the relationship between civil liberties and the private realm of sexuality. [click to continue…]

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This column originally appeared in the Orange County Register.

America, in its relative youthfulness, still perceives itself as morally, politically and militarily invincible, devoid of the stabilizing historical context that might actually insure the retention of its truly consequential status. [click to continue…]

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This column originally appeared in the Orange County Register.

Most of us would agree that balanced concern for self and others constitutes a measure of psychological maturity and health.  While other, mostly mammalian, species share our capacity to live cooperatively and care for one another, only human beings are able to reflect consciously upon this attribute, to develop it and direct it purposefully. [click to continue…]

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This column originally appeared in the Orange County Register.

One more time…

Once again, thin veneers of public pose have cracked exposing very private lives.  So common as to be utterly prosaic, another powerful politician has been caught in an extramarital tryst with a political groupie, a less dominant woman aroused by power. [click to continue…]

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