Interpersonal Strategies Used in Resolving Analytic Disjunctions

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Disjunctions between analyst and analysand are ubiquitous in psychoanalysis, the breaches ranging from major disruptions to subtle misunderstandings. This paper describes how analysand and analyst use interpersonal strategies to reengage and restore analytic rapport. The responsibility for initiating these reparative efforts shifts back and forth between analytic partners. While this activity may be unacknowledged analytically, it involves at least two interactive strategies, confrontation and role enactment, both of which communicate the subject’s awareness of a disjunction and the distress and need it elicits. In addition to reviving the analysis, the repair of disjunctions establishes a more complex and enduring personal bond between analyst and analysand.

My analysis ended nearly fifteen years ago. One period especially stands out.

Throughout our work, my analyst remained conventionally mysterious. He said nothing about himself and showed almost no emotion. When, close to the end of the analysis, I received a call early one morning from his wife to say he’d had a heart attack, it was similar. “Dr. Mark will contact you when he can see you again.” That was all.

Six weeks later I saw him again. He motioned me to the couch. I stopped midway and hesitantly asked how he was. He looked sad. “Pretty well, I think.” His eyes were imploring. I took a risk. “Was this your first heart attack?” “Are you worried?” He paused long enough so that his reassurance seemed hollow. In spite of myself, I looked directly at him. I said I was sorry and that I had been concerned about him. I then went straight to the couch.

I stayed there for months, dutifully pretending not to notice his distraction and that he even fell asleep twice. I became entirely occupied with the new risk to our analytic work. The analysis already had been interrupted for six weeks, my confidence in Dr. Mark’s ability to continue was shaken. My solution was to take on both our roles. I became analysand and analyst. It was I who produced much of the energy for the analysis during those months. I introduced and examined issues. I came up with the few significant insights. Previously, I counted on Dr. Mark to help me tie things together. Instead, I carried the analysis on my own, neither of us saying much about his detachment.

During this period, there was a paradoxical harmony between us. I would enter the office and sense his absence. Immediately, I reached for all the analytic tools I had accumulated over the seven years of our work. Typically, I recounted an event or dream from the previous day and associated to it. Dr. Mark might make a comment, usually about guilt and I would recognize it as time-worn. After acknowledging his statement, I would go further, perhaps returning to the dream or following an already started theme.

Dr. Mark appeared comfortable with our arrangement. As far as I could tell he seemed relieved that I was doing both our jobs. Imperceptibly, several months later, his involvement returned. We never discussed his lapse.

There was complicity in our not talking. We acted out roles rather than examining them analytically. Judging from its outcome, however, this activity was successful. I was analytically productive during that period and felt stronger afterward.

Earlier in my training, it would have been blasphemous to imagine that I could take over for Dr. Mark. The idea that I could support us both seemed a dangerous corruption of the analytic process. Yet, it made perfect sense. The analysis was threatened and one of us had to do something. We had made real strides together. Too much was invested in completing the analysis for me to sit by and wait.

Theoretical Considerations

Outside of analytic exploration and interpretation, how do analyst and analysand influence each other to further their analytic work? My particular interest is in the ways analytic partners, and especially the analysand, reenlist one another to revive and sustain the analysis after a disruption. The examples of disruption I present involve a disjunction between the analyst’s and analysand’s understanding of each other or their analytic work. These disjunctions compromise their ability to work together. Both members of the analytic dyad join to recognize and repair disjunctions, not just the analyst. Traditional analysts like Dr. Mark keep their distance.

While I think Dr. Mark cared about me, his “neutral” stance limited the likelihood of directly helpful interactions developing between us (Stone, 1961; Renik, 1995; Gerson, 1996). Against this highly regulated background I uncomfortably made the observation that if I did not compensate for Dr. Mark’s distraction the analysis could be crippled. Dr. Mark conveyed distress to me nonverbally; his imploring glance seemed anguished. I also experienced an inexplicable conviction that he would approve, and even be relieved, if I temporarily took over some of his analyzing functions. I am inferring that these experiences reflected a communication from him to me through projective identification (Ogden, 1986; Tansey and Burke, 1989, pp. 9-37; Jacobs, 1991; Meyerson, 1994; Gabbard, 1995; Goodman, 1995). In his compromised state Dr. Mark responded to my reaching out to him by arranging to have me take over the role of his healthy self. He could reclaim it when he recovered.

In the sequence with Dr. Mark there were at least two processes at work: my recognizing and indirectly confronting the problem we were having; and role enactment. I made the judgement, in part consciously, that I needed to compensate for Dr. Mark’s disability. Dr. Mark responded by supporting a role enactment in which I temporarily became analyst. His nonverbal invitation fit well with my understanding of what our analysis required. I silently accepted his invitation and took on the role of analyst for months, without much analytic reflection.

My term role enactment, refers to the repetition of internally proscribed roles played out between two people. The interaction is experienced as an event in the present. In the repair of an analytic disjunction, the role enactment may function to distress the alienated member of the dyad and alert him that the analytic bond is threatened. Alternatively, it may provide a missing analytic function for one or both members of the analytic pair, as it did with Dr. Mark when I took over as analyst. The roles can originate from within each participant, or both roles can begin within one of them, with one role transferred to the other person through projective identification.

It seems to me that analysands regularly initiate the restoration of disrupted or threatened analytic work. Analysands usually want the analysis to succeed, whatever their competing need to defeat it. They subtly inform the analyst when he is off. They help him see what he has missed or misinterpreted. They stay with and direct him as he finds his way. This influence by the analysand may happen noisily or quietly (Searles, 1975; Langs, 1978; Casement, 1985; Blechner, 1995; Bader, 1996). Often it is masked by an agreed upon view that the analyst is the expert, even when the analyst appreciates the intersubjective nature of psychoanalysis (Hoffman, 1992).

Judged more broadly, the interaction I am describing is part of a reciprocal analytic process. The experience is relational and the product is a more attuned, less distorted bond between the two analytic partners:

  1. Emphasizing this interdependence, psychoanalysis is described as “intersubjective.” That is, what happens involves complex, personal contributions from both analyst and analysand (Stolorow et al., 1987; Emde, 1990; Rabin, 1995). No analytic event occurs without one partner influencing the other. At points where mutuality is absent, either the analyst or the analysand may have the greater influence in reestablishing rapport.
  2. The non-verbal aspect may be emphasized. For example Jacobs (1991) states, “To emphasize issues of technique may, in important ways, miss the heart of the matter. This, in my view, lies in the nature of the communications – conveyed through speech and silence, tone and syntax, manner and gesture, movement and posture – that are transmitted between analysand and analyst” (p. 4).
  3. A number of interpersonal psychoanalytic perspectives point toward a view of psychoanalysis as a “genuine mutuality” (Levenson, 1993). Analysis is broadly conceived as “a two-way participant or co-participant interpersonal field” (Fiscalini, 1994, p. 191).
  4. Others offer a developmental view. Winnicott (1963), for example, pictures the analyst and analysand like the “good enough” mother and her child, collaborating in the analysand’s development of a self.
  5. Several authors conceptualize transference and countertransference as joint creations (Bird, 1972; Boesky, 1990; McLaughlin, 1991; Sandler, 1976 and 1993). Analyst and analysand involve each other through transference-countertransference enactments, at times painful, and by seizing part of the other’s experience through projective identification.

The process of recognizing and resolving disjunctions I describe in this paper is best explained by mechanisms in this last category. Analysand and analyst alternately, and at times cooperatively, take responsibility for restoring analytic rapport (Frankel 1995; Beebe, Lachmann and Jaffe 1997; Knoblauch 1997; Schore 1997). The effort can be deliberate and involve analytic exploration, or spontaneous. Natterson’s (1991) description of mutuality in analysis provides a clinical framework for some of these concepts. He uses Winnicott’s holding environment as a metaphor to frame his view of the analytic situation. “Each person symbolically becomes parent to the other in a therapeutic holding environment. In his role as the child, the therapist explores and enlarges his own inner world as it resonates in reasonable – but not perfect – harmony with the analysand-mother” (p. 212).

My view of the analytic process goes beyond Natterson’s and emphasizes reciprocal restorations of each partner’s involvement by the other. Analyst and analysand attend carefully to the other’s needs and communications. The analyst has no inherent reason to discount the analysand’s perception. At points the analysand becomes a trusted, sometimes brutal, guide. She sees most clearly what the analysis needs and where the analyst has failed. [*In the end, the contributions of both partners weave a ever stronger interpersonal and analytic fabric.]

To study the role of the analysand in restoring analytic work and rapport I reviewed thirty-six three to six month segments from twelve different analyses, all of which I conducted. For about 10 years I have taken detailed process notes during and after analytic hours, writing down everything I notice including my own mood and responses. I only restrict note taking in the session if it interferes with my ability to pay close attention to the analysand and to my own responses. I want to minimize the distortions in recall when notes are recorded after clinical events occur.

Later, I randomly select clinical excerpts from each analysis and review them to identify which influences lead to change. I choose sequences by opening my notes to any point and reviewing them for a predetermined interval. One other psychoanalyst or psychoanalytically trained psychotherapist also reviews these notes. I make use of his or her impressions together with my own.

Obviously, this effort does not constitute a formal research project. I study only my own work. My analytic work, note-taking, and review are influenced by my personal biases and reactions. However, this method of note-taking and review is effective for reassessing one’s clinical work. I was repeatedly surprised by how the notes could move me beyond the perspective I developed while I was conducting the analysis.

In the following example from this group of clinical sequences, the analysand took an active role in reengaging me after I became defensively unresponsive. Each of us was always affecting and responding to the other. There were invitations, accepted and rejected; emotional seductions; moments of psychological sadism. Most often we were unaware of these occurrences. Still they powerfully affected the course of the analysis. This approach to case illustration does not primarily focus on formal analytic activity. As a result, it has the advantage of magnifying clinical events that are otherwise overlooked.

Clinical Illustration

Karen came from a wealthy Austrian family. She sought analysis at age 40 because of her unrelenting rage whenever she felt betrayed. For example, she entrusted the care of her daughter to a psychiatrist who underestimated her daughter’s eating disorder. Karen never forgot. As a second instance, Karen’s husband liked being the life of the party. Karen saw this as a weakness, reflecting his insatiable need for admiration. If he was so corruptible how could she trust that he would stick by her when things got tough?

Karen’s father was a judge, admired by people outside the family and hated by his children for his harshness and infidelity. Her mother was self absorbed, fostering envy and competition among her children. She inventoried and devalued all her childrens’ accomplishments and possessions. She tried to ruin their relationships outside the family, especially love relationships.

Karen had two special agendas during adolescence. She wanted to impress her father through academic success and her skill at acting. She also secretly formulated plans to escape her family’s oppression by emigrating to the United States.

The following sequence occurred during the third year of analysis. Karen’s life had changed dramatically. At the start of analysis, she struggled under the load of an always full answering machine and overstuffed social calendar. Everyone depended on her. Now she had a job. She had been appointed to the board of trustees of her daughter’s college, and was selective about friends and social engagements. She credited the analysis with these changes.

Enticement leading to misalignment:

Karen’s commitment to analysis was unwavering. Her husband objected to her religious-like devotion to it. She had only one other relationship like this earlier. She and her father had raised dogs for show when Karen was age 11. Then, she had times of perfect harmony with her father. He liked her work with the dogs. She was captivated by his enthusiasm. Now, she was performing for me, hoping, I thought, for a similar experience of mutual admiration.

Soon her sexual feelings entered the picture. She dreamt of our being naked and looking at and touching each other’s bodies. In her dreams, we would gaze at each other for hours. Again, perfect harmony. Karen insisted there was nothing sordid in this picture. It made her ecstatic with pleasure.

And she impacted me. I liked her admiration, and could feel the enticement to respond to her invitation. Analytically, I had to manage the two tensions: one, was for me to experience these feelings, hers and mine, long and intensely enough to become familiar with them, to understand them; the other was to resist them and not let them become real.

As I struggled, opposing thoughts developed in my mind. No one could be as flawless as the image she invented of me. I knew the fall from that pedestal was a long one. As I thought about her sexual fantasies, I found myself growing detached and a bit disgusted. While generally there was something beautiful about the notion of our gazing one at another, there was something crass in her presentation.

She told me about her “unlimited” sexual energy, how she could have three or four powerful orgasms in a row. She described her body as voluptuous, especially as compared to other women. She listed the names of several men who could not keep up with her ardor. By implication, I would be different from all the others: she and I would set sexual records. I pictured myself in a Charles Atlas body building clinic, with the world looking at my hormone enhanced muscles from behind a glass barrier. I was training for an Olympic sex-a-thon and would perform world class sexual acts.

The force of being thrust into her world of fantasy was countered with a compelling need to maintain my sense of self, and my identity as an analyst. At first, I worried I would enjoy Karen’s attributions of unbridled sensual power to me. I tried to put my observations into words. I made statements about her wish for a perfect, even exaggerated, love relationship and her picturing of me in that role. But, mainly, I pulled back emotionally with a force equal to the power of her apparent lure. I found my mind wandering during analytic hours. I intended to explore the pull I was experiencing to act with and against her, but became distracted and matter of fact instead. I was mostly unaware of this shift.

I experienced my retrenchment as analytically purposeful. Karen disagreed. My withdrawal was painful and confusing for her. As she later told me, it amounted to the abandonment she anticipated if she opened up with me. She had tested me assiduously and concluded she could let down her guard further. Karen’s first response to my detachment was to do what she could to revive my interest. She worked hard at this. She came to our sessions, had dreams and memories, brought me little offerings of photographs she had taken of idyllic European scenes. When my remoteness became too much for her to bear she pulled away and, ultimately, retaliated. However, even as she definitively detached, she continued to alert me that our connection was failing, hoping I would act to stop the deterioration.

My shift from analytic sophistication to vacuousness was probably unconsciously arranged by Karen through projective identification. In this role, I seemed as ambitious and mindless to her as her sexually stimulating father in childhood. Still, she maintained another subtle objective during this period. Even when she finally became angry with and wanted to hurt me, there was always a part of her that pushed us toward reconciliation. Her attacks on me were aimed at alerting me that something was wrong. I emphasize Karen’s efforts now because at that point in the analysis I was unaware I was involved in an enactment and undermining our rapport. Instead, I felt I was doing the right thing by restoring an analytic focus to our work.

The events in the sequence of Karen’s withdrawal were as follows: Karen was asked by Andrew, an acquaintance of her friend Charles, to plan a tennis tournament and dinner for Andrew’s social club. She had done something similar previously and it was an unqualified success. In our session the next day Karen seemed removed and haughty. She talked about Andrew’s wealth. She referred to the hall at which this event was to occur as “the most exclusive in the area.” I found myself feeling irritated and sleepy. In contrast, Karen seemed excited. I forced myself to remain focused on her success. She added that she was now seriously thinking about leaving her husband, whom she considered unreachable emotionally. Uncharacteristically, it did not occur to me that she was really referring to her disillusionment with me.

Still, she must have hit her target. I felt mildly clumsy, and socially unsuccessful during the remainder of the session. A thought kept intruding that Karen’s friends were impressive, and mine were more lackluster. In retrospect, the resonance between our experiences was striking. As I withdrew, Karen felt cut off from me. As she teased me with details of her allegedly glamorous life, I experienced being left out and humiliated.

In the first session following the tournament Karen seemed warmer. She described her organizing role in detail. She seemed more excited than boastful, expounding on the etiquette she learned as a child. She was taught to anticipate every move when entertaining people. She remembered greeting historically important people at family functions. The atmosphere between us became alive. Momentarily, our rapport was restored.

Then Karen told me she was agitated and depressed following the event at Andrew’s club. She was not sure why she felt this way. She wanted my opinion. I think she was hoping to draw me even closer. She wanted to create an opening to reestablish our rapport after punishing me for my withdrawal.

Karen was using a variety of tactics to keep our affiliation alive. In these few sessions she tried to rouse me by punishing and devaluing me. When that didn’t work, she entertained me. I kept my distance. With regard to her depression following the tournament, I suggested it might reflect guilt about succeeding so well in her organizing role. I was still recoiling from her earlier seduction, as well as from my powerful sense of repulsion, and needed to deflect us from that subject.

Over the next several sessions, Karen definitively withdrew. She discussed her 21-year-old daughter, who received several Ds on her final examinations. She was indirectly criticizing me by bringing up this topic since I had recommended the educational counselor she used for her daughter. While Karen received more compliments about the tournament and dinner, she shared fewer of them with me.

Karen’s disaffection with her husband continued. It was now intensified by his decision to stop psychotherapy. She considered his therapy essential for the survival of the marriage. When he refused to continue, she lost faith in him. Karen mentioned critically that her husband and Charles’ wife were “wall flowers” at a party they attended. Her metamessage was a warning about her limited tolerance for my obtuseness, an obtuseness that did not allow me to hear even this message.

She then, shockingly, revealed she was thinking about having an affair on a trip to Austria in a few weeks. She seemed cold and measured as she talked, as if she had been withholding this information from me all along. I was stunned. Having an affair, I thought, would be disastrous to her sense of dignity. I couldn’t picture Karen living with that kind of secret. I asked Karen to think over her decision with me. I felt quite worried, but made my statement in a lackluster way. Again, Karen was managing to disable me. First, she did it by making me omnipotently powerful and sexual. Now, I was being rendered impotent by her vindictive withdrawal and threat to have an affair.

Karen asked how I would feel if she had an affair. I turned the question back to her, fearing that anything I said would bring an angry response. She continued: she had thought it out carefully, an affair would be both “safe” and “helpful,” considering her growing disappointment with her husband. She added that she would be happy at the moment to be rid of all of us, including, and probably most particularly, me. Karen was finally retaliating in full force for my withdrawal (even though she, in part, engineered it). She was also protecting herself from further humiliation. However, her threat to have an affair had another critical purpose. It was an urgent communication to me: Karen wanted to wake me up. At this point, she hoped I would stop the analytic process from deteriorating any further.

To the extent that was its purpose, it worked… But not immediately.

Reattunement and Repair:

Karen’s father was resurrected in her other-worldly picture of my prowess and malevolence. Now he was actively wrecking violence in reverse through Karen’s threat to do to me what she felt I, and earlier in her life he, had done to her. His womanizing left Karen’s mother immobilized and tormented his children. She wanted to beat him, make him stop, and leave home. Now she was doing that to me in punishment for my withdrawal following her sexual enticements.

I had not seen Karen’s anger building. I still did not understand it. Certainly, I was not aware of causing it. I had been aware only of trying to contain and analyze her idealization and sexualization of our relationship.

What I neglected was my underlying devaluation of Karen, in response to her seductive behavior. Since I was uncomfortable with her feelings and mine, I hid them from myself, rationalizing my behavior as analytical. Karen was accurate when she accused me of being sadistic like her father in my backtracking. She remembered the shock when he called her a “shameless whore” after a boy telephoned her. On the same day, a dog she had raised for her father finally won a coveted medal. Her current threat to have an affair and leave me feeling anxious and rejected, accurately reversed her experience of me as maliciously withdrawing. Whatever the transference meaning of her reaction, I actually was devaluing with her.

I must have been terribly threatened by Karen’s absolute censure of me. On some level, I probably picked up the murderous quality of her rage at me. Since her behavior reflected my own sadism, I was particularly unnerved by it. Altogether, the power of Karen’s devaluation of me was the polar opposite of her original idealization. I retraumatized her by eliciting her idealization and then failing to follow through with consistent interest in her. More deeply, the clinical picture at that point appeared to be organized around the longing and sadism inherent in Karen’s original experience with her father. These themes were being replayed as traumatization and retraumatization within the analysis. My defensive indifference reflected the sadism that was set up through this reenactment, concurrent with my need to control, reduce, and deny it. This detachment was also based on my defensive undoing of the powerful attraction I originally felt to Karen’s titillations.

In my analytic behavior, I then became astoundingly vacant. Rather than exploring the theme of her plan to have an affair and the reactions I was having to it, I deflected our attention onto Karen’s pessimism about her husband. As soon as she mentioned her disappointment in him in the next analytic hour, I asked her to tell me more about it. That discussion took up the better part of the session. In the end, I said that the decision about leaving him would be a difficult one and that I hoped she would discuss it further with me. In effect, I preferred to shift our focus onto her threat to leave her husband and away from her fury with me.

Karen began the next session with a “report” about receiving more compliments about the tournament. I found myself feeling bored, I think because she was once more keeping her distance. In part to combat my detachment, I asked her how she was feeling at that moment. In response, Karen became tangential. I pushed. Was she having feelings about me – perhaps about my response to the possibility of her having an affair? She agreed, “You disappointed me. I lost respect for you.” She went on to explain that my response indicated I had little interest in the ethics of her behavior. I was “obviously” willing to let her do something that she would regret. She sounded dead earnest, completely detached from me.

I tried to understand the intensity of Karen’s feelings. However, this exercise in self-reflection barely stopped the abrupt sense of disorientation that began to overtake me. Up to this point I believed our rapport was at least satisfactory. Suddenly, as I was confronted with Karen’s immense well of anger at me, this assumption collapsed.

In retrospect, I am impressed by how long it took me to become aware of Karen’s rage. Only Karen recognized the seriousness of the disruption in our rapport. She attempted to confront me with it earlier, but I was not able to hear her.

The following several sessions were dedicated to my coming to terms with our disjunction. At first, I found myself wanting to argue that Karen’s rage at me was transferential: she needed me to fall in love with her and was angry when I did not. I pictured myself as thoughtful and analytical with her.

Ultimately, I had little choice but to recognize I had pulled back and that my attitude toward Karen was contemptuous. Whatever Karen’s contributions, transferential and realistic, to the murderous atmosphere that developed in the analysis, she was justified in being gravely hurt by with my withdrawal from her. Karen confirmed that my distancing was unnerving. She recalled her father’s pleasure in humiliating her. He would beat her nightly when her homework was not perfect. He teased her mercilessly about her developing breasts during her adolescence. She remembered losing respect for him when she witnessed him “womanizing.” These memories were combined with the thought that it might be better to have a “more mechanical analysis,” perhaps with an analyst like the one her husband had seen. She was clear she intended to finish analysis, but maybe not with me.

Karen held her ground for several sessions. I felt helpless; my effort to explore and resolve our disjunction stalled. Still, I struggled to understand and mitigate her angry feelings. My response was intuitive and, like Karen’s effort earlier, based on my interest in reviving our relationship. I concentrated on each of her words. I spoke in consoling tones. I wanted to repair the breech that I helped create. In addition to interpretative statements about our enactment of the sexualized and traumatic experiences she had with her father, I said she was right: I did pull away and was rejecting. I wanted to understand how that kind of interaction could have developed between us. I felt badly for perpetrating it, and hoped to undo any damage I caused. I wanted my self reflection to stand in stark contrast to her father’s brutal arrogance.

There was little movement. I began to wonder if repair was possible. I wistfully thought back to her earlier admiration of me. Those sessions seemed years ago. As we reached the end of one session, I mentioned she had not again brought up the subject of her phone message of the previous week, my bill and her intention to cut back on sessions.

There was little time and this topic needed to be brought forward to the next session. To my amazement, she said that since her husband was stopping treatment she could continue the analysis without cutting back. Regarding financial issues, she was exploring the possibility of using money she had invested to finance the analysis. She would do this, even though she had some concern about her financial independence if she divorced her husband.

Over the next few sessions, Karen explained what had really happened. She certainly was excited by the notion of a personal and sexual involvement with me. However, she never contemplated acting on any of these fantasies. She actually hoped for the opposite. It was her father’s infidelity that was so painful for her as a child. Her mother’s incessant focus on sexual competition from other women only made matters worse. What she wanted from me was integrity. I needed to care about, even cherish her, but be free from sexual designs. Her disappointment with me was that I misconstrued her wishes. I took her blatant sexual fantasies as if they were an invitation, rather than a subject to be understood, controlled, and eliminated from our interaction. In response, I withdrew. Instead, she wanted me to care and be the voice of containment.

Karen’s explanation entirely revised my understanding of our analytic process. I realized the distortions causing our disjunction were initiated by me. I thought they had been introduced by Karen as an inducement for a personal involvement. True, Karen made powerful demands early in this sequence. In retrospect, these apparent enticements repeated her traumatizing experience with her father. Adulation and exaggerated sexuality came out early in all of her intense attachments. These were a problem for her. However, in this case, it was my misconstruing them as an invitation for an actual involvement that was the primary distortion. Karen wanted me to join with her to analyze these developments, not assume she wanted a personal relationship.

Karen began the following session on an entirely different note by asking if I believed Charles’ interest in her might be romantic or even sexual. She and her husband had been to a party with him. He made sure to seat them at his table, then insisted they join his family on a weekend retreat. He was also mildly disparaging with his wife.

Rather than explore the question, I gave Karen my opinion. I said I could not really tell what Charles’ motives were. They had known each other for a long time and nothing sexual ever occurred between them. My guess was this history made sexual designs less likely. I asked why this idea might come up now?

It was only when I reviewed my notes that I realized why I responded to her question so quickly and directly. Primarily, I was reinforcing the aspect of our affiliation that was free of sexuality. I was saying in so many words, “No, Karen, I have heard you. I do not have sexual intentions. Finding you exciting is one thing. Behaving as if I might act on it is another. You really do not have anything to worry about.” Secondarily, I think I did this because I was relieved at her renewed interest in relying on me. My tone was placating and reassuring.

Karen’s response was strikingly self-reflective. She immediately offered the opinion that her suspicion about Charles might be a distortion. She realized Charles probably sat her at his table after she hinted she might like to sit with him. She thought her manner with him could have been mildly seductive. I told her I was interested and impressed by her ability to think this through. I asked about her flirting with Charles. She said she probably did it in retaliation for feeling overlooked by me. It was Karen who provided the interpretation here.

After listening, I gently asked Karen whether her flirtation with Charles might also reflect other feelings about me. As was often true, I became aware of the tone of my statement only in retrospect. Karen again said that, as with me, she hoped Charles did not have sexual designs. She reiterated that what disturbed her most about me was the impression that I did not care if she had an affair. She wanted me to be opposite to her father, who was sexually irresponsible. Now, she quietly and uncharacteristically began to sob, describing how disappointed and infuriated she had become with me. I told her how I was beginning to understand how upsetting this experience was for her. I was struck by how unaware I had been of her feelings. I hoped she would tell me more.

In the next session Karen said she was feeling much better. She talked about her excitement about visiting Austria, and about Charles and a lawyer, for whom she worked, named Ed. Like me, both were very special to her because they had so much regard for her and would not bring sexuality to the relationship. Also, they each had a “love of life,” like her father when he was at his best.

Discussion

How to understand the relational structure of this analytic sequence? After being tantalized by Karen, I defensively withdrew from her. She became aware of a disjunction between her expectation of me and my disengagement. After attempting to cautiously re-enlist me, she arranged a confrontation. During this time our understanding continued to deteriorate. Karen persisted until she was certain I recognized our rift and understood her communication. She then transferred most of the responsibility for restoring the analysis back to me.

Karen’s efforts were of two kinds. The first was direct: she worked planfully to reengage me. For example, she made a point of her excitement about arranging Andrew’s party. She talked about it with some pressure, insisting I listen. Later, to make it interesting to me, she embellished her description with facts about receiving dignitaries as a child. Second, she unconsciously and consciously arranged interpersonal scenarios to force my reinvolvement. For example, when I created distance between Karen and myself at the beginning of our disjunction, Karen tried to hook me with Andrew’s impressive qualifications. It worked. I felt a mild sense of resentment and humiliation. For a brief period, I became the jilted suitor, and she my callous tormentor. Later, she forced me to wrestle with issues of morality as she threatened to have an affair. I was concerned that an affair would produce an irrevocable crisis of conscience for Karen. Also, I worried about her vindictiveness should I disappoint her by not taking a stand. She might punish me for my personal and ethical failure like a strict parent. Later, she continued to experience me as untrustworthy and threatened to repudiate her connection with me and find another analyst. I remained on trial for weeks: I became the abandoned child, and she, the leaving parent.

Karen and I were often unaware of these role enactments as they occurred. Most were neither understood nor interpreted by me. Much later, by reflecting on my discomfort within these roles, I was able to recognize the extent of Karen’s disappointment and rage. I also could progressively understand the importance to her of my regard and the part my disengagement played in provoking our disruption.

These role enactments forced me to notice and worry about Karen’s disaffection. Each experience also drew me into her life in a new way. They brought us closer, because they involved powerful interpersonal experiences. While they took some of their shape from the past, they were always felt as events in the present. When I was being punished for my alleged moral laxity, I had an acutely painful experience of Karen’s disapproval. At those moments Karen had the upper hand, and I suffered.

Karen’s communications ultimately worked. As I understood her message, I could once more take the lead in the analytic work. My shifts were often intuitive and conveyed in gestures or subtle changes in my tone of voice. I apologized for not being more empathic about my objection to her having an affair. I acknowledged her powerful re-affirmation of the analysis in re-allocating money to pay for it, in addition to examining its transferential and countertransferential meaning. My tone became gentle when I asked how her flirtation with Charles reflected her feelings about me. I complimented her on her ability to think through her role in having excited Charles. We could then discuss her erotic feelings toward me, and her wish for my help in comprehending and managing such frightening feelings.

Understanding this analytic segment with Karen, makes my experience with Dr. Mark more comprehensible. In the work with Dr. Mark, I, as the analysand, had a major part to play in restoring a troubled analysis. The difference from the segment with Karen was that the resolution of that disjunction was instigated by both of us: I was aware that Dr. Mark’s distraction threatened our analytic work and I reacted by compensating with extra energy and initiative. At the same time, Dr. Mark seemed to provide a subtle invitation to relieve him of responsibility (communicated through his imploring glance, for example). I responded by becoming both analyst and analysand. I gave him the rest he needed. We participated in an unacknowledged role reversal. He could be left to heal, while I temporarily took over many of the analyst’s functions.

The illustrations I have used in this paper emphasize confrontation and role enactments as devices for achieving reengagement in the disjunction process. On closer view there are a number of additional steps in this sequence from detachment to full reinvolvement. Individual sequences may differ, with one or more of the steps I identify missing, for instance, in my interaction with Dr. Mark there was no period of overt collaboration.

  1. The analyst or analysand seizes the other’s attention directly through interpersonal pressure (confrontation) and more subtly by arranging role enactments.
  2. The analyst becomes confused as he realizes he does not understand the events at this point in the analysis.
  3. Analyst and analysand struggle to comprehend their experience. Part of the exchange is likely to be non-verbal. Both participate collaboratively in this information seeking sequence. As part of this process, the analyst moves partially outside the enactment. From here, he attempts to make sense of the confusion he experiences as he also exists within it.
  4. The analyst learns enough about his place in creating the disjunction so he can make his subsequent behavior more constructive. Whatever understanding he and the analysand arrive at, he tries not to replicate the behavior of people who, in the past, have been injurious to the analysand.

These last two steps are familiar components of analytic intervention (Weiss, 1993; Renik, 1995). On the other hand, interpersonal pressure and role enactments are usually linked with pathological interactions. The perspective offered in this paper challenges this view. I contend that these devices work to reengage either of the partners who are caught in an analytic disjunction.

One more thought about dealing with distressing role enactments, such as those orchestrated by Karen. It is analytically imperative that the analyst be drawn in as a fully engaged participant in these enactments. Unless the analyst allows for this kind of involvement, his appreciation of the analysand’s experience will lack precision. Also, the analysand will not feel fully understood and the disjunction will persist or deepen. The analysand has to be sure she has delivered her message; then, collaboration and resolution can proceed.

The Interpersonal Dimension

Psychoanalysis is dialectical. What the analysand does for the analyst, the analyst returns, through his own initiative. The same is true for the analyst’s contribution. In this intricate choreography where analysand and analyst alternately or simultaneously take responsibility for restoring the integrity of the analysis, understanding is only part of the process. The tension caused by rifts in the analysis needs to be tolerated and contained, ultimately by the analyst. His or her whole-hearted willingness to understand the meaning and work through the consequences of these disjunctions, follows. In our sequence, Karen incrementally increased the seriousness of her threat until I could finally hear her. Then I regulated the tone and content of my comments to let her know I cared and was contrite. Only when she could trust me again, could we explore the disruption in our work and the opportunity it offered for our shared progression.

According to this view of the analytic process, the analysand’s contribution to reviving and sustaining the analysis is often as important as the analyst’s. In my opinion, the analysand’s role has generally been under-appreciated. This is true even with the current groundswell of psychoanalytic literature on symmetry and self disclosure (Aron, 1992; Hoffman, 1992; Burke, 1992; Gill, 1993; Goodman, 1995; Gerson, 1996). One outcome of these linked movements between analyst and analysand is that each has a profound personal affect upon the other. They both struggle through difficult and exciting episodes of being parent and child, friend and enemy, imagined lovers. Always, they work to recognize, comprehend, and resolve their differences. In addition to improving their understanding of the analysand, they grow more deeply connected as human beings.

In my view, emotionally demanding involvements such as these are integral to progress in psychoanalysis (also see, Ghent, 1995). The analyst who allows himself to feel the pain the analysand inflicts, and then struggles to find out why the analysand must do this, will gain a particularly intimate understanding of the analysand – and his own failings. He is also likely to discover the personal legitimacy of the analysand’s communication. He gets to know the human aspect of the analysand’s struggle, not just her psychopathology. Through a parallel process, the analysand discovers an analyst different, more complex and fallible, than the one she began with. Analyst and analysand together grow in their involvement with one another. Each is deeply influenced and transformed by the other.

References

  • Aron, L. (1992) Interpretation as expression of the analyst’s subjectivity. Psychoanal. Dial., 2:475-508.
  • Bader, M. (1996) Altruistic love in psychoanalysis: opportunities and resistance. Psychoanal. Dial., 6:741-764.
  • Beebe, B., Jaffe, J., and Lachmann, F. (1997). Mother-infant interaction structures and presymbolic self and object representations. Psychoanal. Dial., 7:133-182.
  • Bird, B. (1972) Notes on transference: universal phenomenon and hardest part of analysis. J. Amer. Psychiat. Assn., 20:267-301.
  • Blechner, M. (1995) The analysand’s dreams and the countertransference. Psychoanal. Dial., 5:1-26.
  • Boesky, D. (1990) The psychoanalytic process and its components. Psychoanal. Quart., 59:550-584.
  • Burke, W. (1992) Countertransference disclosure and the asymmetry/mutuality dilemma. Psychoanal. Dial., 2:241-271.
  • Casement, P. (1985) Learning from the analysand. New York: Guilford Press.
  • Emde, R. (1990) Mobilizing fundamental modes of development: empathic availability and therapeutic action. J. Amer. Psychoanal. Assn., 38:881-913.
  • Fiscalini, J. (1994) The uniquely interpersonal and the interpersonally unique: on interpersonal psychoanalysis. Contemp. Psychoanal., 30:114-134.
  • Frankel, S. (1995) Intricate Engagements: The collaborative basis of therapeutic change. Northvale, New Jersey: Aronson.
  • Frankel, S. The analyst’s role in the disruption and repair sequence in psychoanalysis. Contemp. Psychoanal. (in press).
  • Frankel, S. (In press). Interpersonal strategies used in resolving analytic disjunctions.
  • Gabbard, G. (1995) Countertransference: the emerging common ground. Internat. J. Psycho-Anal., 76:475- 486.
  • Gerson, S. (1996). Neutrality, resistance and self-disclosure in an intersubjective psychoanalysis. Psychoanal. Dial., 6:623-646.
  • Ghent, E. (1995) Interaction in the psychoanalytic situation. Psychoanal. Dial., 5:479-491.
  • Gill, M. (1993) Interaction and interpretation. Psychoanal. Dial., 3:111-122.
  • Goodman, A. (1995) Containing and responding. Contemp. Psychoanal., 31:557-574.
  • Hoffman, I. (1992) Some practical implications of a social-constructivist view of the psychoanalytic situation. Psychoanal. Dial., 2:287-304.
  • Jacobs, T. (1991) The uses of the self in psychoanalysis. New York: International Universities Press.
  • Knoblauch, S. (1997). Beyond the word in psychoanalysis: the unspoken dialogue. Psychoanal. Dial., 7:491-516.
  • Langs, R. (1978) The Listening Process. New Jersey: Jason Aronson.
  • Levenson, E. (1993) Shoot the messenger: interpersonal aspects of the analyst’s interpretations. Contemp. Psychoanal., 29:383-396.
  • McLaughlin, J. (1991) Clinical and theoretical aspects of enactment. J. Amer. Psychoanal. Assn., 39:595-614.
  • Meyerson, P. (1994) Expressions of countertransference and the curative process. Contemp. Psychoanal., 30:213-235.
  • Natterson, J. (1991) Beyond counter-transference. Northvale, New Jersey: Aronson.
  • Ogden, T. (1986) The Matrix of the Mind: Object Relations And the Psychoanalytic Dialogue. Northvale, New Jersey: Jason Aronson.
  • Renik, O. (1995) The ideal of the anonymous analyst and the problem of self-disclosure. Psychoanal. Quart., 64:466-495.
  • Sandler, J. (1976) Counter transference and role responsiveness. Internat. Rev. Psychoanal., 3:32-37.
  • Sandler, J. (1993) On communication from analysand to analyst: not everything is projective identification. Internat. J. Psycho-Anal., 74:1097-1109.
  • Schore, A. (1997). In: Moskowitz, M., Monk, C., Kaye, C. and Ellman, S. eds., The Neurobiological and Developmental Basis for Psychoanalytic Intervention. Northvale, N.J.: Jason Aronson, pp. 1-72.
  • Searles, H. F. (1975) The patient as therapist to his analyst. In: Tactics and Techniques of Psychoanalytic Therapy, Vol. 2, ed. P. Giovacchini. Northvale, New Jersey: Aronson, pp. 95-151.
  • Stolorow, R.D., Brandschaft, B. and Atwood, G. (1987) Psychoanalytic treatment: an intersubjective approach. New York: The Analytic Press.
  • Stone, L. (1961) The Psychoanalytic Situation. New York: International Universities Press.
  • Tansey, M., & Burke, W. (1989) Understanding Counter-transference. New Jersey: Analytic Press.
  • Weiss, J. (1993) How psychotherapy Works: Process and Technique. New York: Guilford.
  • Winnicott, D. (1963) Communicating and not communicating leading to a study of certain opposites. Presentation to the British Psycho-Analytical Society, May 1963.

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