Touching Limits in the Analytic Dyad

Interpretation: Voice of the Field

To patients, the most memorable moments in psychoanalytic treatment are seldom the contents of the analyst's interpretations, but the feeling of being understood. Interpretations are most meaningful not because of what they say but because each one is evidence that the analyst, who generally becomes someone of great significance to the patient, knows the patient more than before the interpretation was made. As a result of this process of "witnessing" patients not only know and feel-they also "know and feel that they know and feel." They can feel their roles in authoring their own experience. Therapeutic action results: patients "come into possession of themselves." Interpretations are the outcome of shifts in the interpersonal field, which reveal this new freedom to think and feel. This new freedom allows the creation of the analyst's interpretations, which therefore serve as a sign of a new way of being in one another's presence that has now become possible between analyst and patient. Field shifts are jointly created, without conscious intention, and interpretations arise from these shifts. Thus, interpretations are not really created independently by the mind of the analyst, but are instead the voice of the field. A clinical vignette illustrates these ideas.

The Analyst’s Trust and Therapeutic Action

The analyst's trust, a neglected topic in psychoanalytic discourse, participates in therapeutic action--through the analyst's emotional openness, "unobjectionable positive counter-transference" (see Fox 1998), the holding environment, and the promoting of adaptive internalizations, among other ways. When the analyst's trust--in the patient, in the analyst's self, and/or in the psychoanalytic process--fails, crucial interactions may occur, capable of destroying treatment, or alternatively, of restoring mutual regulatory functions and potentially leading to important mutative processes. Patients benefit from analysts' becoming sensitive to, having useful ways of thinking about, and working with their states of trust and distrust. The author presents clinical examples to illustrate these points.

Enactments in Psychoanalysis: Therapeutic Benefits

The therapeutic benefits of enactments are addressed. Relevant literature reveals disparate conceptions about the nature and use of enactments. Clarification of the term is discussed. This analyst's theoretical and technical evolution is addressed; it is inextricably related to using enactments. How can it not be? A taxonomy of enactments is presented. The article considers that enactments may be fundamental in the evolution from orthodox to contemporary analytic technique. Assumptions underlying enactments are explored, as are guidelines for using enactments. Finally, the article posits that enactments have widened the scope of analysis and contributed to its vitality.

The analyst's trust in psychoanalysis and the communication of that trust in initial interviews

Aspects of the analyst's person may facilitate or, conversely, inhibit the establishment of analytic contact. The author argues that the analyst's trust in psychoanalysis as a method, which is a component of analytic identity, is a crucial element in the analyst's functioning during the initial interviews. Trust is here distinguished from belief After a historical outline of the transition from indication to the initiation of psychoanalyses as an interactive process, trust as an analytic concept is discussed, both in general terms and with specific reference to the initial interviews. An extended clinical vignette is provided for illustration.

Screen memory: its importance to object relations and transference

A screen memory of an obsessive and narcissistic man, reported early in psychoanalysis, both represented and disguised the patient's oedipal conflict, incestuous wishes, and sibling rivalry. It symbolized for him his relationship with his mother and was treated by him, in a repetitive and fetishistic manner throughout treatment, as the reason for his bitterness toward life, his sense of entitlement, his narcissism, and his distrust of women. In the transference, the memory-far from being inert- constantly played an active role in his wishes and disappointments regarding the analyst, and in his fantasied oedipal triumph over him. As the analysis progressed, and after years of treatment, the encapsulated nature of this memory began to give way to the patient's growing awareness of his oedipal wishes, the full range of his feelings toward his mother, and his sense of abandonment by her. The nature of screen memory is explored, including how it relates to a patient's personality and use of the past in general, how it may figure in the development of a person's object relations, and the decisive role it may play throughout a treatment.

Getting cold feet, defining "safe-enough" borders: dissociation, multiplicity, and integration in the analyst's experience

This paper attempts to explore the fate of the analyst's multiple self/other organizations during times of heightened countertransferential enactment. It is suggested that such countertransference activity involves the "de-homogenization" of otherwise indecipherably integrated self/other constellations, evoked independently or in response to, but always in interaction with, the patient's own unique organization of multiple centers of psychic awareness and unconscious receptivity. An extended clinical example is used to illustrate the theoretical conceptualization.

The role of the preconscious in psychoanalysis

The analytic process inevitably involves the interdigitation of the intrapsychic structures of both patient and analyst. This interplay is expressed in transference-countertransference interactions. Drawing a dichotomy between intrapsychic and interpersonal factors as central agents of psychic change is a faulty construction. Affective, behavioral interchanges between patient and analyst reflect their individual intrapsychic organizations and their interplay, which influence the form and nature of psychological change. The safer both patient and analyst feel in relation to each other, the more freely will they relax their customary cognitive controls and permit the emergence of preconscious responses. Preconscious resonance between patient and analyst is likely to facilitate the lifting of repressive barriers and the emergence of unconscious material in both participants. The integration and reworking of old conflicts then becomes possible. The role of the preconscious in facilitating the analytic process is illustrated. Creative use of preconscious processes requires the analyst's self-discipline to preserve the analytic role and keep the treatment safe for both participants.