The Concept of Enactment and Theoretical Convergence

"Constitutive-intervention"- structuring primal psycho-physical space

This paper describes a specific type of therapeutic intervention relevant to therapeutic communication with patients exhibiting non-symbolic autistic defenses or traumatic characteristics. The paper focuses on clinical manifestations of developmental deficiencies and communication problems that stem from a primal psychophysical space that is unmatured, traumatized, deformed and/or chaotic. The concept of the body-container is presented as a proto-scheme of primal psychophysical space, organizing the intersections of one's anatomical structure and potentials for intersubjectivity.This conceptual context allows the therapist to conceive the patient's non-representational and non-communicative physical actions in the therapeutic setting as presence-in-action. Such presence is discussed as a crucial invitation for the emergence of the therapist's intuitive pre-symbolic creativity, which may eventually crystallize into a perceptually-presented 'constitutive intervention'. This unique kind of intervention is designed to support the patient's creative capacity for pre-symbolic realization of this multi-dimensional psychophysical proto-scheme. Various constitutive interventions, utilizing concrete gestures that involve the therapist's body and the physical aspect of the therapeutic environment, are examined theoretically and illustrated through clinical vignettes.

Enactment: A necessary conceptual review

Enactment as a psychoanalytic concept was coined by Jacobs in 1986. Since then, it has developed within the psychoanalytic community as a concept. Originally, enactment described an aspect of countertransference expressed through subtle actions within the analytic process, as distinct from noisier performances that fall within the spectrum of "acting out". Nowadays, the concept of enactment poses some difficulties that should not be ignored. As a theoretical concept, enactment has a complex epistemological position, and as a clinical concept it sheds light on contemporary psychoanalytic practices. This paper explores the results from an empirical and conceptual research work, focusing on the history, translations and usages of the term "enactment", and its comparison with related terms. It will also consider the epistemological perspective regarding the current status of enactment as a scientific concept and its relationship with the psychoanalytic theoretical field.

The Presence of The Analyst in Lacanian Treatment

Transference implies the actualization of the analyst in the analytic encounter. Lacan developed this idea through the syntagm presence of the analyst. In the course of his seminars, however, two completely different presences emerge, with major implications for how the treatment is directed. In the light of Lacan's idea that the transference is constituted in Real, Symbolic, and Imaginary dimensions, it can be seen how in his early work the analyst's presence is a phenomenon at the crossroads between signifiers and images. From the 1960s onward, however, the analyst's presence comes to necessarily involve the Real. This means it points to the moment at which symbolization reaches its limits. The clinical implications of this later interpretation of the presence of the analyst as incorporating the Real are manifold and affect psychoanalytic practice with regard to the position and the interventions of the analyst. Specifically, interventions targeted at provoking changes in defenses against experiences of excess or senselessness are discussed and illustrated with case vignettes and a published case. With transference considered "the navel of the treatment," the necessity that traumatic material will emerge in relation to the analyst becomes clear.

THE DIALOGICAL SELF IN PSYCHOANALYSIS

This paper describes the shift that appears to be taking place in contemporary psychoanalysis, as reflected among intersubjective approaches, from a monological conception of the self to a dialogical one. The monological self emphasizes the separation between mind, body, and external world, focusing on the representational and descriptive/referential function of language. In contrast, the dialogical self emphasizes practices, the permeable nature of relationships between subjects, and the constitutive function of language. This paper attempts to explain the growing emphasis on the dialogical self, understood from a theoretical, metatheoretical, and technical point of view, using contemporary intersubjective approaches to illustrate this shift.

The analyst's way of being: recognizing separable subjectivities and the pendulum's swing

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference-countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference-related roles to which he is assigned, patient-ascribed attributions, or projection-drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.

Slippery when wet: the imperfect art of interpretation

When pursuing a line of psychoanalytic interpretation, there are many factors that need to be considered. Interpretation is always a provisional exercise in which the analyst's proposes something to the patient to consider and then wait to see his or reaction. Whether or not the interpretation is correct is not as important as the patient's reaction to it. Does it cultivate insight, does it spur defensive reactions, does it feel helpful, does it leave the patient hurt or misunderstood, or does it aid the patient in facing their anxieties and exploring them in a way that might facilitate change? These are just some of the possibilities when analysts voice their opinions about what might be happening at an unconscious level in a patient's immediate experience. Interpretations may be correct and address the patient's phantasies and transference state, but they can also be part of a pathological projective identification system. In other words, it can be a collusive acting out that not only helps patients to grow but also serves their defensive structure and thus helps them to retreat at the same time. The author explores clinical moments in which interpretive enactment or interpretive acting out occur. The constantly shifting emotional states produced by transference, countertransference, and the dynamics of projective identification make the interpretive process prone to instability, fallibility, and uncertainty. The unavoidable pros and cons of interpretive acting out are examined through the lens of one complex psychoanalytic treatment.

Analysts' observing-participation with theory

The author summarizes some of the literature's critiques of psychoanalytic theory, which have noted its constrictive quality and failure to take into account the vicissitudes of treatment within each analytic dyad. Such postmodern reactions have given rise to a countertheoretical trend toward psychoanalytic pluralism, leading the author to suggest that a single, standard psychoanalytic technique no longer exists. The interpersonal tradition, which tends to prioritize praxis over theory, is discussed in the light of its emphasis on an intersubjective model of participant-observation, and two clinical vignettes are presented to illustrate the author's way of utilizing this model.

The interpersonal and Freudian traditions: convergences and divergences

The traditional Freudian and interpersonal schools of psychoanalysis diverged during the psychoanalytic wars in New York in the 1940s. Each has developed from a different set of assumptions concerning the mind, especially the role of structure and the role of interaction. Recent developments in both schools in the last twenty years suggest a convergence and overlap in theory and technique. The relevant history of the divergence is examined and the work of three contemporary interpersonal writers explored in depth. That work is contrasted with contemporary developments in traditional Freudian psychoanalysis.

Counteridentification, comprehensive countertransference, and therapeutic action: toward resolving the intrapsychic-interactional dichotomy

Two dichotomous trends in thinking about countertransference and therapeutic action can be delineated historically as well as in clinical practice: the intrapsychic and the interactional. The author proposes a new usage of the concepts of counteridentification and comprehensive countertransference to help transform these dichotomizing tendencies into more useful, integrative therapeutic action across the broad spectrum of psychoanalytic treatment for patients from the neurotic to the most severely disturbed.