Embodied Attunement and Participation

The Musical Semiotics of Voice in Distance: Some Reflections on the Question of Teleanalysis

Within the context of the debate over teleanalysis, I wish to reintroduce the discussion of voice as the primary link between analyst and patient, a link present in analysis on the phone. Far from questioning the importance of the in-person analysis, I aim to emphasize the voice, the musical semiotics of emotions, as a critical, if not the most vital, aspect of psychoanalysis as a "talking cure" and an art of listening. Insofar as the speaking is instituted in the body, the body is present through voice, even in the virtual analytic room in teleanalysis. I argue that the need for the presence of the material bodies in the session is one aspect of the analytic rituals that, along with the room, the couch, and other power objects, set the stage for the continuous projection of the role identities of the analytic couple. In teleanalysis, the seductive nature of the analytic situation and the status differential are more salient in the analyst's office turf than in the patient's room.

Aches, Pains, Rumbles, and Stumbles: Applying Somatic Countertransference and Body Reactivity in Clinical Work and Teaching

Recognizing somatic countertransference reactions is an essential tool for the psychodynamic clinician. Although the analyst's bodily reactivity has been written about throughout the history of our field, contemporary neuroscience, multiple code theory, and nonlinear system dynamics provide scientific buttressing to understand embodied phenomena. Patients often speak with and about their bodies, and the clinician who pays attention to these communications, as well as those emanating from his or her own body, has an additional resource to help the patient. Elvin Semrad's classic but largely unremembered "tour of the body" is one tool that can assist clinicians in how to receive and process body reactions that may be unconsciously split off, consciously withheld, or felt dangerous or beguiling. Three examples are used to illustrate embodiment and somatic countertransference as important clinical guides. An argument is made that these concepts should be taught and integrated into psychodynamic curricula.

Defining Clinical Attunement: A Ubiquitous But Undertheorized Aspect of Palliative Care

Attunement, the process of understanding and responding to another's spoken and unspoken needs, is a fundamental concept of human development and the basis of meaningful relationships. To specialize the concept of attunement for palliative care, this article introduces clinical attunement. This term accounts for how palliative care clinicians must repeatedly balance patients' readiness to talk about the future with the cadence of the illness and need for medical decision making. Using the case of Gloria, an example patient living with cancer, this article discusses three skills to foster clinical attunement: asking, repairing disconnections, and offering containment. It is the fourth in a series exploring the psychological elements of palliative care.