CHAPTER THREE
OPEN FLEXIBLE COMMUNICATION IN MOMENT-TO-MOMENT EXCHANGES
In this chapter and the four to follow we describe our approach to clinical work. Throughout these chapters we illustrate our proposal that a spirit of inquiry in the form of exploration or inquisitiveness is an ever-present dimension of communication in psychoanalytic therapy. In chapters 1 and 2 we illustrated that development can be charted as a process of ever-increasing complexity of communication, privately with oneself and between oneself and with others. Abstractions, metaphors, symbols and signs, in fact, all forms of affective information are packaged in this monologue-dialogue that underlies all communicative techniques. In this chapter we sketch the seesaw path of communication in analytic history and present a clinical vignette that describes the nuanced view of an open flexible communication, which we espouse.
In the evolution of psychoanalytic technique, the process of communication originated with a conversational dialogue. Freud made his initial, seminal formulations by “talking” with his patients. A clear illustration is found in his discussion of Katharina, Case 4 in the “Studies on Hysteria” (Breuer and Freud, 1893). Katharina approached Freud as he was resting after his climb up a mountain and asked him about her symptoms. Freud recognized their hysterical origin and wondered privately, “was I to make an attempt at an analysis? I could not venture to transplant hypnosis to these altitudes, but perhaps I might succeed with a simple talk. I should have to try lucky guesses” (p. 127). And so he did. As Katharina struggled to recall the sexual scenes and experiences that were associated with her hysterical anxiety attacks, Freud suggested to her, “if you could remember now what was happening in you at the time, when you had your first attack, what you thought about it—it would help you” (p. 128). At that time, private monologues-dialogues, inquiry and simple talk, provided the foundation for the technique that was to supplant hypnosis.
Quite rapidly, after Freud’s “simple talk,” psychoanalytic technique evolved in an opposite direction, helped along this route by Freud’s technique papers and Glover’s (1955) systematization of psychoanalytic techniques. As Lichtenberg (1994) has pointed out, in his technique papers, Freud, frightened by incidents of immorality around him, primarily admonished analysts what not to do. By implication, avoiding the “don’ts” became a model for good technique as though an analysis would follow a natural course toward the resolution of conflicts so long as the analyst did not gratify or contaminate the transference and fixate the libido onto his person. Based on the libido theory as a model, suggesting or advising (for example, Freud’s own suggestion to Katharina “if you could remember … it would help”) or ordinary talk, might entail libidinal gratifications for the patient. Gratification once unleashed on some occasions could open the door to some compromising behavior on the part of the analyst. Communicative restraint, parsimonious and precise interpretations of the transference manifestations, became the prescribed regimen for analysts. Not to talk and not to reveal became values analysts-in-training had to learn. Patients had to adapt to the silences and repetitive patterns of behavior of analysts as modes of communication while analysts tilted away from their need to adapt to the patient’s mode.
What began as a spirit of inquiry became a rigorous effort by analysts to speak only when interpreting the patient’s associations. Furthermore, interpretations were often only given when the associations revealed primarily oedipal transferences. What began as Freud’s lucky guesses became “unlucky” for those analysands whose analysts considered their interpretations not as “guesses” but as “rock-bottom” truths. In turn, these “truths” were derived from two sources: a model of early development based on reconstructions from the analyses of adults; and a model of the mind based on Freud’s structural theory (Lachmann and Beebe, 1992).
The privileging of silence and abstinence as techniques was based on the premise that the analyst-patient dialogue should originate solely from the patient’s communications. These communications were viewed either as associations or as resistances to associations to the analyst’s interpretations. In the analytic dialogue, the flexible, conversational, “lucky guess” aspects of communication was supplanted by a more rigidly defined interpretive mode that was inextricably tied to the libidinal drive-discharge theory. In this mode of communication, silence came to mean the analyst was waiting for the patient to say the “right” thing for an oedipal (or preoedipal) conflict interpretation.
These presumptions confined the analyst primarily to the role of a responder to the associations and dreams of the patient. But, more to the point, such a bias underestimates the quality and potential variety of the analyst’s participation. It is this participation that we describe as the internal monologue and dialogue that is part and parcel of the analytic encounter. The analyst’s bias would inevitably combine many sources and personal meanings. For example, vivid private associations may prompt especially close listening, or, a patient’s associations may fail to meet the expectations of the analyst. Then the analyst might feel bored, drowsy, and irritated at having to listen again to such “pseudo-associations.” The analyst may even feel deeply moved and in private reveries in which he or she moves associatively in and out of the patient’s life. These communicative connections of the analyst may or may not be revealed to the patient. In that instance the patient may turn to the analyst to try to sense his or her impact on the analyst’s state of mind. In recognition of the complexity of the interaction, both in theory and in practice, contemporary analysts have sought to reconceptualize the ways in which they communicate with their patients.
As different theories evolved, a tower of babel fell on both free association and interpretation. Different psychoanalytic theories organize the patient’s associations differently. Hearing their patients differently, practitioners of these different approaches then come up with a wide range of interventions. One overarching assumption has, until recently, however, remained unchallenged: communication means talking, and other forms of communication, bodily posture, somatic symptoms, and varieties of “acting out” or “enactments,” constituted either resistances to, or pathologies of, free association. Such mavericks needed to be corralled. The analyst needed to bring them into conformity with the expectation that communication referred to a verbal modality. Only then could the “nonverbal” communications be analyzed and interpreted. This formulation is a remnant of the time prior to the recognition of procedural learning as an equal partner with symbolized or episodic memories in the communication between any partners, whether mother and infant or analyst and patient (Lyons-Ruth, 1999; Lichtenberg, 1989; Lichtenberg, Lachmann, and Fosshage, 1996; Stern et al., 1998).
Analysts have long recognized that in the treatment of children, play and nonverbal communication in the form of play (including their own self-involvement) provides the communications required to understand the child’s struggles. Yet even here, the aim has frequently been to translate the knowledge gained from the play with dolls, soldiers, or other fantasy games of traumatic experiences, into verbal interpretations of the unconscious wishes and fears that were talked about outside the pretend world. Without a verbal statement, child analysts feared the playing out of inner turmoil would have little or no effect. Furthermore, the recognition of an extensive idiosyncratic, nonverbal language that was discovered in work with psychotic patients required a reassessment of the limits of verbal discourse as the only relevant mode of analytic communication (Sullivan, 1962; Atwood, 2001).
Of the founders of psychoanalysis, no one was more concerned about its communicative aspects than Ferenczi. His paper “Confusion of Tongues” (1933), on the misunderstandings between children and adults and between analysts and analysands with respect to “intentions,” stands as an example of the spirit of communication to which we subscribe. Using parents’ denial of sexual abuse as a basis, Ferenczi made the telling point that a trauma, however bad, is made far worse by “gaslighting,” that is, corrupting the child’s sense of reality, as for example when the adult pretends that a trauma event never occurred. In this circumstance, the child may have to forfeit his or her own sense of reality to maintain the attachment to the adult.
In the dialectic between the value of an analyst’s nonrevelation to avoid muddying the waters of the transference and the analyst’s self-disclosures, including the acknowledgment of feelings, values, attitudes, actions, and intentions, Ferenczi often weighed heavily on the side of disclosure. Published in 1933, his paper illustrates the direction in which Ferenczi was moving: recognition of bidirectional influence of the analyst-patient relationship. The paper is remarkable in that Ferenczi reconceptualized resistance and the then generally accepted notion that patients resisted getting better because they derived gratification from their adherence to their pathology. Ferenczi wrote, “As the state of the patient, even after a considerable time, did not change in essentials, I had to give free rein to self criticism. I started to listen to my patients when, in their attacks, they called me insensitive, cold, even hard and cruel … I began to test my conscience in order to discover whether … there might be some truth to these accusations” (p. 157).
Ferenczi’s work contrasts his own pioneering efforts with the state of psychoanalytic treatment at the time. Interestingly, the “rediscovery” of Ferenczi’s contributions coincided with the recognition of nonverbal communication as a gold mine for analytic inquiry. Subsequently, procedural memory and nonverbal communication have inched their way toward equal partnership with interpretation and verbal communication in psychoanalytic discourse. As a foremost experimenter with psychoanalytic technique, he was also among the first to pursue, if not yet capture, the spirit of inquiry.
Our view that the analyst-patient dialogue is coconstructed includes affect, empathy, and transference in the communications by both analyst and patient. We recognize that in the service of communication with the patient, an analyst utilizes a variety of approaches. These include silence, neutral mirroring, refraining or participating in a transference enactment, explaining, questioning, advice-giving, and reveries and various forms of personal disclosures.
Reveries and disclosures are ubiquitous. A clear distinction between a reverie and empathy and introspection is difficult to make since both engage the analyst’s subjectivity and creativity in accessing and conjuring up the experience of the patient. Self-disclosures are a constant, inadvertent by-product of the analyst’s engagement in the analytic process, a topic to which we return later in this chapter.
Communication within any dyad is something that each participant is drawn into or repelled by. The conscious and unconscious wishes and needs of each participant will influence the other. Looked at in this way, at one moment silence may be highly desirable, but at another a limited response like “umm” or a fuller mirroring statement or a logical or cognitive explanation or a spontaneous emotional eruption may be called for.
For the purpose of better understanding the analytic process, we can dissect communication into its verbal and nonverbal elements, although a flow between two particular participants, analyst and analysand, remains the essence of the communication. Thus, in this communicative process, we are less justified in describing the virtues and limitations of, for example, listening, umming, explaining, advising, reassuring, encouraging, or interpreting in the abstract, than we are in recognizing how these modes play out. At any particular time, these modes will benefit or inhibit the process in a particular analysis.
To illustrate different forms of communications by the analyst within himself and between him and his patient, a series of sessions from the third year of an analysis follows. The analysis of Nick has been described in other communications (e.g., Lachmann, 2001) although the material that follows has not been previously discussed.
In several sessions from the treatment of Nick (by FL) we illustrate the variety of interventions that contribute toward clarifying, enriching, and broadening the patient-analyst dialogue. We include the analyst’s internal monologue-dialogue as an integral part of this process of communication.
Selected sessions from the treatment of Nick illustrate the contribution to therapeutic action of a variety of interpretative and noninterpretive interventions, as well as verbal and nonverbal procedural interactions and enactments. Specifically, in this treatment, the focus was on the transformation of Nick’s outbursts of rage and his propensity to withdraw.
Typically, Nick’s rage would burst forth when a salesperson in a store was less than competent or efficient, when a coworker was less than cooperative, or when a boss was unreasonably demanding. When, on purchasing an item in a store, he had to wait while the cashier chatted with another salesperson, Nick yelled at her, “You could do the world a favor if you developed terminal cancer!”
Before and during the initial years of our work, Nick’s hostile outbursts cost him numerous jobs. This level of rage was not expressed toward me in the course of his analysis except in a somewhat muted form.
When he began analysis, on a three-sessions-a-week basis, Nick was 36 years old. He described himself as despondent and socially quite fearful, with outbursts of self-defeating rage. As Nick spoke in our initial meeting, he cried. He said, “I don’t know if I can take care of myself.”
Nick is the fourth of five children in a family that lived an economically marginal existence. His father was a quiet, retiring man. His mother appeared to have been severely depressed and frequently nonfunctional.
In his developing years, Nick was very much a loner, both at home and in the outside world. He felt shunned and mocked by his siblings because he was the brightest and because he was unlike the other family members. He increasingly withdrew into a seething, sullen state.
Nick is homosexual. During his adolescence he tried to emulate the heterosexuality of his older brother by playing high school football. Occasionally he dated girls and had sex with some, but he had no sexual interest in them. In college he became actively homosexual.
In his current life, Nick described pervasive feelings of shame, humiliation, anxiety, and rage, which began in his childhood. Scanning the surround became crucial in predicting and avoiding further humiliations. Nick’s anxiety often reached extremes in which he experienced himself as rageful and out of control. He felt he could not control his bodily and affect states. Affect states were felt as physical, sexual tensions that he could not regulate, either by containing or expelling his feelings. He felt unable to soothe or enliven himself. These difficulties in self-regulation had led to impulsive rageful behavior.
I found Nick to be emotionally open. His anguish was quite palpable. He had a raucous sense of humor, which occasionally broke through his clouds of despair. At those times I would respond in kind and, for a while, we were able to sustain a playful tone in the session.
The sessions that follow were taken from the third year of Nick’s analysis. I believe they were typical and representative of the way in which Nick and I talked with each other. His longing to be accepted by men and his shame at his compliance with his mother’s domination were at the center of our sessions. These themes appeared in the transference in that he was often angry at the extent to which he felt dependent on me.
Nick said, “I had a dream Friday night. I felt it strongly on Saturday, like it really happened. Going into the back door of Uncle Joe and Aunt Franny’s house. They were not unhappy to see me. Aunt Franny left. I had come to see her. She told Uncle Joe and me to have a good lunch. I hadn’t planned on that. She assumed I had come to see Joe and I had actually come to see her. I felt good around him. She was happy to see me, too.”
I thought about Aunt Franny turning him over to Uncle Joe and his entering the back door of their house. Imagery and references to anal penetration were relatively easy for Nick to speak about, so I did not think that asking him about this image would lead to new material. During the previous week, however, I had made an error that had enraged him. I had stated that a certain event, a visit from his mother, had occurred on his birthday. It had not. His birthday had been several months earlier. He had been furious at me for forgetting his birthday but also afraid to say so lest I would then not like him. Forgetting the day of his birth had reminded Nick of the numerous ways in which he was “forgotten” in his family. It made me no different from his sister, mother, and all those who failed to inform him of family events. I wondered to what extent his disappointment in my having forgotten his birthday and the thrust of the previous sessions with respect to his ambivalent feelings about his parents were salient in the dream. Referring to Nick’s comment that Aunt Franny was happy to see him, I responded with a question, “She was?”
Nick continued in a somewhat lighter tone, “It’s unusual for me to visit someone and expect them to be happy to see me. But I was comfortable with their awkwardness, not bothered by it.”
In my question, “she was?” I also conveyed to Nick that I was not questioning his account. Was his lighter tone his relief that I had avoided other, more conflicted and painful material? Or was his lighter tone his response to my having passed a test (Weiss and Sampson, 1986), that I had not fallen into a trap and found pathology or criticized as he had anticipated based on his experience in his family? In his response, Nick seemed to address two issues, his appreciation that he was in a family that welcomed him and was “happy to see him,” and that their acceptance of him was direct and personal. It did not entail any preconditions, as was the case in his family.
The discomfort of Aunt Franny and Uncle Joe reminded Nick of his own social anxiety. He felt this diminished the distance between him and them. I also thought that my discomfort with having forgotten his birth date may have also assured him that I, too, am subject to feelings of vulnerability, regret, and guilt. To keep his associations going, I mirrored his expressed affect state. I said, “You felt more socially at ease and a comfort that you have longed for.”
Nick said, “Yea, the kind of closeness I always wanted in my family. I felt it from Uncle Joe, sometimes. He liked the theater, being gay. He wasn’t gay but he could have been.”
I sensed an increased comfort with me, implied by his comment about Uncle Joe. Nick now brought up a new theme: the extent to which he felt his homosexuality had isolated him in his family. I had not anticipated this direction. Having kept a low profile until now may well have contributed toward providing the ambience of safety that enabled Nick to proceed in this direction on his own.
I wondered whether Nick might have been referring to his fear of betraying his mother by entering Uncle Joe and Aunt Franny’s house through the back door. I also realized that Nick and I might be moving into, and even enacting, a twinship transference. That is, having sensed my vulnerability, Nick now felt more comfortable with me. He concretized his attachment, his shameful dependent attachment, by imagining that Uncle Joe could be gay, and by extension, I assumed, that I could be gay, like him. To let this theme develop further, I said only, “Umumm.”
Nick continued, “Uncle Joe and Aunt Franny had a more ideal household world that I wanted. They were always neat. Uncle Joe was interested in intellectual things, reading books, going to plays. They valued the things I wanted. I didn’t feel out of place. There was this big incident. The summer after my freshman year at college, I used to go out at night and play tennis with Uncle Joe and Uncle George. Then my sister said that my mother was upset because I was going out every night. I really enjoyed it but I couldn’t say ‘no’ to my mother. I stayed home, that horrid place, watching TV. I wasn’t allowed to have contact with my father’s family. My aunt was everything that my mother wasn’t, and my mother resented her. She insisted that I have the same attitudes as she, and not associate with my father’s family, the enemy. I’m angry that I didn’t tell my sister to shut the fuck up. I sat around the whole summer doing nothing. I didn’t associate with my own friends.”
Our dialogue expanded. Although the basic themes in this material were not new—his embarrassment at his mother’s disheveled appearance and at the messiness of their home—these details had not been presented before. In addition, there was a new emphasis on the extent of his capitulation to his mother and the extent to which he sacrificed tennis playing with his uncles to TV-watching with his mother. Going through the back door now took on the more specific meaning of avoiding being seen by his mother as he fraternized with her enemies. More generally, he began to distinguish among her views, her expectations that he share them, and his own views. The dream and the associations were presented in a coherent manner and I underscored the dominant message of the dream. I said, “In the dream you defy your mother’s ‘no.’” I thought of adding, “although you go through the back door” but I decided against this comment since his affect and the spirit of the session were going in another direction: his regret that he had not been more assertive with his mother. That is, he went there on his own. Although I could see the connection between his “back door” image and his regret at his lack of assertion, I was glad I did not lead him to that door but rather followed his lead.
Nick said, “Yeah, doing what I want. Same feeling I had playing tennis. My uncles enjoyed seeing me.” Nick continued with wanting to be in a place where he would feel welcomed.
I realized that many transferential themes operated in this dream and his subsequent associations, but I did not know which one to pick up. It seemed to me that Nick was moving tentatively toward a twinship transference and I did not want to steer him away from that. I therefore inquired, “With your uncles you briefly enjoyed feeling valued and that you were wanted. You enjoyed the contact. These are not feelings you usually have about yourself. How come you recalled them now?”
Nick paused for a while and then shifted to numerous familiar topics. He described torturing himself for not working up to his expectations at his job. Then, after another pause, he cried, “I thought more about your not remembering when my birthday is and my reaction to it. I’m pretty enraged. Makes me not want to express that to you. Exposes me as petty. I should be as unconcerned about it as you are. Then I’d be OK. Wouldn’t be so nuts as I am. I don’t want to talk to you about anything. I don’t want to be connected with you. I don’t want to be near you, or close to you. I want to find a new shrink I could just hate, one that I wouldn’t have to be connected to. Someone I could hate from the outset and not worry about hating them.”
Nick returned to my having forgotten the date of his birth, but in a vastly different affective context. He regained a feeling of trust and comfort with me which contributed to his increased self-reflection and as his continuing associations reveal, liberated his sense of humor and his now modulated and transformed aggressive outbursts (Lachmann, 2001). Of course, I recognized the irony in his comment but did not address it. I believed that, had I addressed it, I might have undermined his regained sense of trust and stirred up his ever-present self-criticism. I stayed with his manifest comment, “What makes you worry about hating me?” Nick responded, “Then you’ll hate me and then I won’t be connected to you,” and laughed. I said, “Yeah, that sucks.”
Nick laughed, and said, “Therapy is so hard. I want to tell you that and you don’t give a shit. You can’t even remember my birthday. I want to congratulate myself for going through this and I want you to say it!”
The foregoing interchange captured a slowly evolving procedure in our relationship. Humor, irony, and playful exaggeration characterized our unique personal communication and our connection. From my perspective I disclosed my comfort with, and even liking for, a lighter, playful, even intimate tone. I believe that, from Nick’s perspective, he found the kind of “home” in the atmosphere of the sessions that he dreamed about and longed for in his visit to Uncle Joe and Aunt Franny. It was also the kind of atmosphere in which “forgetting” his birthday is not a big deal because, as depicted in his dream, its hurtful impact is ameliorated by his feeling welcomed. In contrast, in his family, being forgotten meant that he was excluded and not wanted. Nick’s attachment to me was furthered without his sinking into shame-ridden feelings of dependency that inevitably would lead him into a cycle of self-loathing, rage, and then increased shame. Through our dialogue, which went beyond traditional interpretations, Nick was able to access increasingly more shame-filled memories. Furthermore, in our playfulness we moved toward a twinship transference as well as toward an expansion of the themes that Nick had introduced in the course of the sessions and that he continued in the subsequent sessions.
When Nick lay on the couch, he faced one of my bookcases, the one that held my copies of The Psychoanalytic Quarterly. The theme of his shame at his ready capitulation to his mother led to his feelings of shame about his sexual curiosity. At the same time his connection to me remained a central issue. With his concern about his sexuality he wondered what I do in my office when I’m alone. He spoke of his “jerking off” and imagined me in my bathroom “jerking off with The Psychoanalytic Quarterly.” I said, “Oh, you mean because it has all those pictures?” I deliberately did not want to pathologize his “fantasy.”
I assume that Nick’s humor with me as well as mine with him, as in our comments about my use of The Psychoanalytic Quarterly, was coconstructed. My respect for and enjoyment of Nick’s humor and his expectation that we might play with it, I believe, enabled Nick to make that comment. From other therapeutic approaches a response to the literal meaning and analysis of his fantasy might have been offered. For example, challenging: “what makes you think that I jerk off?” or confronting: “depicting me with The Psychoanalytic Quarterly in this way, is a derogatory way of describing me and my work, what is that about?” Even, at this point, interpreting “you want to make me similar to you” might have been a betrayal of the spirit of our ongoing communication. I would have suddenly left my somewhat ambiguous position in a “play space” with Nick and differentiated and distinguished myself as the analyst.
The various interventions I just described constitute inquiries with an agenda or an authoritarian edge. They are not conducted in the spirit of further understanding, rather they impart an opinion and criticism without so stating. But, most important, they delineate a gulf between therapist and patient. Such a difference is of course always present. It is at best in the background, especially at times when the patient, for compelling developmental purposes, is striving to establish a twinship transference. It seemed to me that this was the direction in which Nick and I were moving. At such times, the therapist can succumb to the danger of sending the patient a metacommunication: we are not alike and it is hostile on your part to depict us as fellow masturbators. We would thereby have been repeating in the analysis just the kind of experience of shame, rage, and social isolation that Nick lived through in his family. We would have been repeating in the analysis what Ferenczi (1933) described as “professional hypocrisy” (p. 159), no different from the hypocrisy that prevailed in his family that was implicated in the organization of his dread, “I don’t know if I can take care of myself.” To this dread we could now add, “I don’t believe anyone else would care about me unless I comply with what they want of me.”
In the subsequent session, Nick expressed his curiosity about his parents’ sexual life. He had felt convinced that they never had sexual relations. He then wondered when my birthday was which I explained as his curiosity as to when my parents had sex. In contrast to his preoccupation with sex, he had believed that his parents were asexual and he was now investigating this issue with respect to my parents and, I thought, ultimately with me. I now interpreted to him that his imagining that we both jerked off was his way of making a connection with me in a way that had felt shameful. He was daring to find similarities between us. I added that it seemed important to him that sexuality occupies similar places in our lives. It made him feel connected with me, less different, less alone.
Although I had refrained from making such interpretations earlier lest they sound injurious and potentially pathologize his sexual feelings, I believe that eventually such interpretations are necessary. They addressed his pervasive sense of shame about his sexuality. For Nick and me to have a twinship transference based on a shared feeling of shame about sexuality would not have furthered the treatment.
Nick’s analysis lasted 11 years. The themes outlined in the sessions from the third year of his analysis, as well as other issues having to do with his difficulties in self-regulation of affect and arousal dominated much of the analysis.
After termination of the analysis, Nick wrote me a letter in which he analyzed an element from his last dream. In it he depicted a woman toward whom he did not behave so compliantly. His dream contained an image of a woman picking his pocket in a police station. He wrote that she “was not inside me. I realize of course that the contents of the dream are all, in a sense, inside me. But what the dream was showing was this women outside of me, not internalized. She was separate. Yes, she still tries to cling to me, attempting to grab what is mine when I’m not paying attention. However, she’s clearly seen as a separate person. It’s also clear to me what’s mine—and not hers. She is separate from me without my having to destroy her, which of course has long been the only alternative I considered possible (doing damage mostly to myself in the process).
“This realization made me feel very happy and added to the confidence I feel about what and who I am and what I possess. This woman is still a problem in the dream. I have to be vigilant to keep what’s mine. But she’s become more the nuisance, than the threat to existence she had been (or so it seemed to me). She’s like traffic in the big city—an annoyance but not the defining element of life. And, like traffic, the police do little to solve the problem. Just thought you might enjoy hearing these additional thoughts.”
I enjoyed the touch of irony in his dream, that the woman “is like traffic in the big city.” In addition, his last comment reflected the extent to which our connection still held and to his benefit. He could reflect on his dream with a sense of pleasure and curiosity.
As a whole, the portion of Nick’s analysis that has been presented illustrates the ebb and flow of our interactions, our process. Nick’s expectations that he would be abandoned and shunned unless he behaved compliantly were gradually disconfirmed. Continued attention throughout his analysis to his propensity to withdraw angrily, increased the range and flexibility of his participation. His complaints about whether or not I cared about him became less intense and somewhat less frequent.
Nick’s participation in the process of treatment tilted the therapeutic process toward repetition of patterns that were familiar to him, specifically rageful compliance. However, my presence challenged this repetition. From a systems perspective, it provided a “perturbation” to our interaction (Thelen and Smith, 1994). Thus, the therapeutic process could move away from following his longstanding expectations, familiar experiences of feeling criticized and in danger of abandonment and humiliation if he did not produce or comply.
The way in which Nick and I spoke and listened to each other attests to the inseparability of self and interactive regulation. Clearly Nick and I each had a preformed mode of communication, unique and personal, like a fingerprint, which we brought to the analysis. In addition, we learned how to adapt to each other in the course of the sessions. In the background of our interplay was our joint spirit of inquiry, a desired mutual expansion of consciousness (Tronick et al., 1998). I varied my participation although, at any given moment that participation was more often preconscious rather than deliberate and thought through. Many of my interventions were thought about prior to my offering them, but my playfulness and humor were spontaneous. I was cognizant of a necessary “discipline” to my interventions. I did not want to “upstage” Nick or turn the treatment into a showcase for my humor. On the other hand, I would not want to be party to a dry, pedantic exercise that sometimes passes for a “good” analysis.
When the analyst departs from the “patient-talks–analyst-listens-and-interprets” model, the therapeutic ambience can certainly on occasion be lighter. However, when the windows of the analytic consulting room are opened to fresh air, sometimes a moth or mosquito can fly in. It is for this reason that we (Lichtenberg, Lachmann, and Fosshage, 1992) have written about “disciplined spontaneous engagements.”
I have always kept in mind a patient of Ralph Greenson’s (1970) who dreamed that he was in a clothing store in which he wanted clothes that were “tailor made.” He complained to Greenson that he received from him interpretations that were pulled off the “ready-to-wear” rack. The intervention I made to Nick’s “masturbating with the Psychoanalytic Quarterly” was “tailor made” just for him. At those moments he signaled his readiness for “something more” (Stern et al., 1998) by shifting to a directly challenging and metaphoric form of communication. I joined his readiness for further transformative rather than repetitive experiences. He felt more capable of taking care of himself, which reflected his increased confidence in his self-regulation in the context of our interaction.
Although the entire treatment was conducted in a spirit of inquiry, there were specific inquiring moments in the course of the session. As for example, my question, “she was?” about being welcomed by Aunt Franny. Even in this two word question, affect and intonation convey important information about our relationship. This was also true of the occasional silences and umms that characterized the flow of our dialogue. These were times when I not only wanted to give Nick the opportunity to expand on what he had been saying, but I also needed the breathing space to organize and clarify my own understanding, and to sense the direction into which Nick and I were moving.
The flow of the sessions was maintained, primarily, by an ambience of safety that Nick and I had constructed. Nick felt that I clearly was determined to understand him in the context of his life. As best I could, I conveyed to Nick that I did not fear being linked or connected to him, or that conversely, I needed to distance myself from him to protect myself or my analytic persona.
In describing these sessions, it is easier to do so with respect to our verbal interactions than along a nonverbal dimension. The two most obvious nonverbal, affective communications were Nick’s crying when he spoke about his worry that he would not be able to take care of himself, and our shared laughter. In the first instance, I was certainly moved, but not to tears. I remained silent for a while and then acknowledged his concern and that we would be addressing it over the course of his treatment. But, when we laughed, we laughed together.
Pauses in the course of a session were opportunities to switch (or not to switch) to a new track. When Nick paused after I inquired how it was that he recalled his pleasure at being welcomed by his uncle, he moved into a new area. My silence at that time reflected my appreciation of Nick’s private struggle. This enabled him to find his own way through his material. I think this illustrated a judicious use of my silence. In contrast, in an earlier session when Nick had spoken about a visit from his mother, silence, rather than trying to place that visit on his birthday, would have been more judicious.
When I reflected on this lapse of mine at a later time, I thought that I may have been pushing for greater intimacy than was called for. I think I was trying too hard to show Nick how well I knew him. I did not reveal this to Nick since a relevant transference configuration “you are like my family who forget me” had been organized. When it comes to self-disclosures, I have no difficulty in disclosing my style, humor, even a variety of interests, but my personal motives are another matter. Often they can be inferred from the interaction, but what I have just revealed in my write-up, I am unlikely to include in the treatment. I believe it is often difficult to ascertain the therapeutic necessity of an analyst’s self-disclosure. Is a fair depiction of the analyst’s private world, crucial for the progress of the treatment, specifically required to extricate the treatment from a stalemate? Or, is the self-disclosure by the analyst self-serving, self-promoting, or self-aggrandizing? Is it offered to further the spirit of inquiry or does it cut off inquiry into aspects of the transference that the analyst prefers to circumvent?
In the interpretive sequence in response to Nick’s dream about his visit to Aunt Franny and Uncle Joe, I interpreted the leading edge (Lachmann, 2001; Miller, 1985; Tolpin, 2001) what Nick was attempting to achieve. Through this intervention Nick apparently felt safe enough to venture into a new area. In addition, in this instance, I refrained from offering a trailing edge interpretation, what Nick was defending against, the back-door reference. In retrospect this was a good idea since Nick proceeded productively in that direction on his own. Whether or not a trailing edge interpretation would have temporarily closed off further inquiry and associations, cannot be known. However, I believe that such trailing edge interpretations, when ill timed, can lead to transference enactments that repeat the shaming and humiliating experiences that marked Nick’s childhood.
There has been an accumulation of analytic literature on the myth of neutrality. Silence, ummumming, or mirroring are all open to a wide range of meanings. They are co-constructed and open to a variety of interpretations on the part of the patient (or, from the analyst’s perspective, sometimes misinterpretations). In essence, all of these responses are designed to keep the patient’s communications going. In the sessions presented these interpretations all appear but certainly not repetitively. Although designed to keep the session going with a minimal, suggestive influence from the analyst, their accumulation in a session will have an impact of its own. In the session presented, these interventions were all used at a time when Nick was working on material and searching for a direction to pursue. I would not use them as such if I felt Nick was stuck, unsure of where to go, or waiting for a response or signal from me. At such times rather than remain silent, I have told Nick that I agree that a response on my part would be helpful here, but I do not yet feel clear about what to offer. Such responses, in lieu of literal and injudicious silence on the part of the analyst, enables the patient to continue his or her work, without the additional burden of feeling that the analyst is using silence as a “technique.”
To participate or not to participate in a transference enactment is the analytic counterpart to Hamlet’s question. It is probably rarely resolved on a conscious level. However, cognition contributes to the analyst’s choices to restrain or to energize the treatment. In my intervention to Nick, “because it has all those pictures,” I simultaneously did and did not engage in a twinship transference enactment. We were twin humorists if not necessarily twin masturbators. These two sets of twins are not identical, but it was close enough. The enactment constituted an unverbalized bond, an intimacy. It expressed my readiness to be engaged on a personal level with Nick, and his readiness to relinquish his tendency toward trigger-like, rageful withdrawal.
There are probably more frequent occurrences of spontaneous emotional eruptions on the part of analysts in the course of treatments than the published analytic literature reflects. In my “yeah that sucks” response, I joined Nick’s dilemma that he wanted to hate me but couldn’t because if he did, I would not be connected to him. This dilemma, although presented with humor, was quite real for him. My joining him in the humorous contradiction acknowledged the horns of the dilemma on which he was caught without trivializing it. I believe that this interaction constituted another instance which furthered our connection without making him self-conscious. In these instances, the analyst can participate in an enactment, avoid participation by interpreting the patient’s wish to draw the analyst into an enactment, or describe the process and these two options to the patient. When the analyst tries to avoid being drawn into an enactment, he or she may well be drawn into another kind of enactment: a playful, fun-loving, teasing patient with a sourfaced, spoilsport analyst.
If the model “patient talks, analyst listens and interprets” is rigidly adhered to, then that danger of repeating the original trauma in the analysis is ever present. The analyst will then appear to be similar to an unresponsive or uncaring caretaker. However, if the treatment moves too far in the direction of a friendly relationship then the danger is that analyst and patient have a good relationship that is so different from the patient’s original experience that the patient’s childhood is essentially left intact outside of the treatment. Moreover, the joint pursuit of analytic understanding can be diminished. These are the Scylla and Charybdis that the analyst negotiates in this process. And to engage in such a complex navigation, a number of variations of the traditional analytic intervention model are required. For this reason a modicum of enactments is crucial for the analysis to be alive and to capture relevant childhood experiences. A process of open flexible communication such as this produces the alterations of rough seas and smooth voyages that characterized this treatment, and that characterize treatments so frequently.