Taking time: the tempo of psychoanalysis

A butterfly painting its own colours: Enactment, visualisation and differentiation

The clinician's emotional and somatic responses to patients are an essential source of information, but how can we disentangle what belongs to whom? A certain blurring of boundaries is inevitable in psychoanalytic work, with oscillations between more and less differentiated states of mind↔body, patient↔clinician and patient-clinician dyad↔wider institutional setting. In one sense, psychoanalytic work can be conceived as a cycle of repeated regressive enactments, followed by elaboration and differentiation après-coup. Referring to two clinical vignettes with pubertal/young adolescent patients, I reflect on the role of the clinician's visual imagination in this process. Accessing an internal, dimensional space can re-establish a boundary, while simultaneously processing a communication, thus forming a bridge between somatic reaction and thought. The particular relevance of this in relation to working with young adolescent patients is considered.

On the Belatedness of Psychoanalytic Clinical Writing

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness. The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup, which brings to light new meanings in an afterwardness of time. Aspects of analytical writing dynamics are discussed as equivalent to those of nachträglichkeit. Analysts also deploy thirdness in constructing presentations of clinical material. This could be an intrapsychic third or an external figure representing an internal introjected third. A clinical vignette demonstrates the enhanced understanding achieved by writing. It specifically assisted in exploring the analyst's enactment relating to change in the setting, the background for which was a move to online analysis. This evoked infantile anxieties and painful confusions about loss. Historically, the patient had to navigate a path through miasmic ambiguities between reality and phantasy, truths and lies. A conclusion is reached, arguing that analytic processes extend beyond the duration of sessions, and that the processes of clinical writing can provide a significant contribution.

Working with patients with disruptions in symbolic capacity

This article focuses on understanding and working with patients who have poorly developed symbolic capacity, or for whom symbolic capacity has been disrupted due to trauma, particularly as it pertains to the use of reverie and interpretation in the analytic process. Many patients who present for Jungian analysis will initially present with deficits in symbolic functioning. This situation results in necessary limitations or modifications in utilizing traditional Jungian techniques such as dream analysis, active imagination, sand tray and other expressive art techniques. The initial phase of analytic work with these patients requires a focus on developing their symbolic capacity before traditional Jungian techniques can be utilized effectively. During the paper Jung's concept of 'the symbolic attitude' will be examined as well as the conceptual models of Wilfred Bion and other post-Bionians who outline theories and method for cultivating symbolic capacity and reflective functioning in patients for whom these capacities are impaired or poorly developed.

Music beyond sounds and its magic in the clinical process

This paper highlights the role of music in psychic change through a clinical case. A patient, who was initially distant and cold, started to talk about music. An enactment around the analyst’s comment about a famous conductor, started an exchange of music “notes” that changed the course of treatment. For the analyst, it brought old memories and musical reveries. For the patient, music allowed him to be in touch with undiscovered parts of himself and losses that had not been mourned. There was a mutual personal transformation and expanding awareness of self and other for both participants.

Psychic time as occasion for enactment

The author focuses on enactments in the temporality of the analytic process, taking place around analytic breaks. Being part of the rhythm of psychoanalysis, breaks can be experienced as disruptions, with increased anxiety. Threats to the integrity of the frame provide points of vulnerability and challenge to containment that may result in enactment. This is especially so when related to the patient's unique psychic time, touching on depth of disturbance that is unmetabolised and cannot find verbal expression. Enactments are discussed as representations of unconscious material, to be contained retrospectively by analytic thinking, at specific points of the patient's psychic readiness. Only after an "unthought-out action" on the part of the analyst does he/she become alive to it. Guilt and shame are often experienced following enactments. These feelings can be utilised for understanding the enactment events and their underlying affects, in the intersubjective arena, potentially furthering the analytic process. A clinical illustration is presented of a mental enactment combined with a disruption to the frame around a break, which coalesced with the patient's internal unique timing. Being an expression of the patient's unconscious readiness for transformation, the enactment is understood as occasioned in the conjunction between psychic time and analytic time frame.

Musicality in the consulting room

I describe the ubiquity of the musical-non-metaphorical, actually musical-dimension in the psychoanalytic encounter. I point out that this needs underlining since, strangely, it has been neglected in psychoanalytic literature until recent years, which I suggest is a legacy of Freud's aversion to music. I look at a wide range of psychoanalytic literature which invokes music metaphorically while neglecting its literal musicality. I also explore the possible musical dimension of texts which explore non-verbal emotionality. I consider the long-term effects on internal object relations and personality of pre-verbal, infantile musicality and also of musicality within the womb. I conclude with an extended clinical example.

Searching for the analyst's reveries

Over the last 20 years the post-Bionians have begun nothing less than to spell out the beginning of the metabolizing process (reverie) in the analyst's mind that takes place with under-represented mental states. This bold attempt leading to new discoveries, and its many possibilities for understanding patients, seems to have obscured differences amongst leading post-Bionians with regard to how they see the forms of reverie, and how they might best be worked with. With Bion's perspective as a background, this paper explores three approaches, and how they differ with regard to whether one follows the views of early or late Bion. Technical issues associated with these views are raised. A clinical example is offered as one way to use reverie.

The patient's objects in the analyst's mind

In every analysis, the analyst develops an internal relationship with the patient's objects-that is, the people in the patient's life and mind. Sometimes these figures can inhabit the analyst's mind as a source of data, but at other times, the analyst may feel preoccupied with or even invaded by them. The author presents two clinical cases: one in which the seeming absence of a good object in the patient's mind made the analyst hesitate to proceed with an analysis, and another in which the patient's preoccupation with a "bad" object was shared and mirrored by the analyst's own inner preoccupation with the object. The use and experience of these two objects by the analyst are discussed with particular attention to the countertransference.

Countertransference before Heimann: an historical exploration

Received wisdom on the history of countertransference rests on two assumptions: Freud said little about countertransference, and what he did say focused on its role as an impediment to analytic work; the emergence in the 1950s of a conception of countertransference as a crucial beneficial component of psychoanalysis was revolutionary and innovative. Both assumptions are questionable. Detailed examination of Freud's public and private discussions of countertransference reveals that he recognized much of its potential value, as well as its pitfalls, and suggested that the analyst's contributions should be based on spontaneous affect, measured out consciously. He was aware of the problematic nature of countertransference, calling for a paper on countertransference even while cautioning against its public presentation. His remarks, particularly in letters, taken together with the work of Ferenczi and other early contributors, show that the pre-1950s literature on countertransference prefigured much current debate on the topic.

Eating disorders as autisticlike defenses: unmentalizable experiences in primitive mental states

Autisticlike symptoms have been acknowledged in several fields; thus it cannot be claimed that they encompass a delineated pathological organization. The authors argue that in primitive mental functioning, eating symptoms-both bulimic and anorexic-can be used as autisticlike defenses in which the altered body becomes an objectified protective shell providing shelter from intolerable anxieties that derive from unmentalized and unmentalizable experiences. The role of the psychoanalytic third, rising from the analyst's reverie, as a possible meeting ground between the concrete and the symbolic is discussed. Drawing on case material from the analysis of two patients with eating symptoms used as autisticlike defenses clarifies some of the theoretical aspects of eating disorders.

Tactics and empathy: defences against projective identification

In this paper the author argues that interpretations made when the analyst has not done the emotional work of recognising and bearing what kind of object she has become in the patient's psychic reality will be experienced as empty tactics - even lies - rather than interpretations of integrity. However, interpreting from a position of bearing the truth of the patient's perception will be technically difficult and indicate turmoil as the analyst struggles to take in the patient's view of her. If the analyst avoids integrating her own picture of herself with the patient's picture (despite giving voice to the patient's picture) the split inside the analyst will be felt and intensify the patient's need to split. Vignettes demonstrate how the analyst, believing she is trying to understand, may become a projective-identification-refusing object and the issue of the analyst's disclosure of her countertransference is examined. Ultimately, the author argues, a capacity to receive and bear projective identification requires empathy with both patient and analyst-as-patient's object, engaged in a process about which both are ambivalent.