Richard Almond

The Analytic Role: A Mediating Influence in the Interplay of Transference and Countertransference

Recognition of the analysts subjective involvement has led to profound reconsideration of the nature of mutative process. How is it that the analyst can be personally involved in an unconscious way, yet also be an “objective” participant in the relationship? The paper proposes that the analysts subjectivity is mediated by his or her role. The analytic role conditions how the analyst listens, experiences, and behaves, leading to interactive outcomes different from that expectable from unmodified subjectivity. The paper describes the analytic role in terms of contributions from metapsychology, clinical theory, and tactics. Each affects the function of the analyst-at-work in a different way. The analytic role, learned during training, is maintained by a combination of internalization and ongoing involvement in psychoanalytic activities. A clinical illustration demonstrates how a typical transference-countertransference enactment is influenced by the analytic role. The vignette suggests ways in which the concept of role modifies the effect of subjectivity. Three recent viewpoints-those of Renik, Ehrenberg, and Hoffman-that challenge previous theories of mutative process are discussed in terms of the analytic role. In each case, consideration of role clarifies the nature of the innovative technique or view, and seeming contradictions between it and existing clinical theory.

The holding function of theory

As multiple theoretical models contend on the American analytic scene, the holding function of theory emerges as a unifying theme. In addition to supplying an intellectual superstructure for the working analyst, theory provides a psychological presence—a sense of conviction, affective stability, reassurance, and self-esteem— that makes effective analytic work possible from the analysts side. Ideological passions and differences arise from the vital need for the holding function in an intense and inchoate engagement like psychoanalysis. To show how adherents of different models use theory in practice, three clinical cases are reviewed, one from Betty Joseph, one from Lewis Aron, and one from the author. The last example reconstructs the analysts subjective experience of treatment both in the selected hours and in terms of the analysts preconscious use of theory.

The patient's part in analytic process: the influence of the analyst's expectations.

The psychoanalysts expectations of the patient are complex and crucial to the work of analysis. These expectations, operating at a level generally outside the consciousness of patient and analyst, are part of the `microstructure` of analysis, the interactional give-and-take that brings about change. The view taken here is that analytic process is necessarily interactive, as well as intrapsychic. In addition to transference-countertransference motivations, both parties to an analysis operate in a social context that prescribes a range of desired and undesired behavior. The analyst brings to the interaction professional analytic attitudes about how to listen and act, and a set of expectations of the patient. These attitudes and expectations modulate subjective reactions to the patients transferentially driven actions, and influence the expression of countertransference. The mutative process of psychoanalysis involves the action of these attitudes and expectations on the patient, both in ways specific to individuals and in more general ways. Such expectations lie behind analytic tactics and, though not often written of, are part of the oral tradition of psychoanalysis. Here the expected patient role is described in terms of five bipolar continua: (1) reporting and editing; (2) transferring and containing; (3) thinking about oneself and thinking about the analyst; (4) regressing and listening/self-observing; (5) initiating trial action and mediating among inner states. The activity and thinking of the dyad move constantly along these continua. A clinical example from the beginning of an hour illustrates how these expectancies emerge in analytic work.

Reading Freud’s “the Dynamics of Transference” one Hundred Years Later:

Freud’s technical papers, “The Dynamics of Transference” in particular, established most of the basis for a century of clinical psychoanalytic work. A contemporary reading of that paper illustrates both the power of the original presentation and how far we have come. Close readings are given of crucial passages, including retranslations where Strachey’s English arguably distorts Freud’s language or intent. More broadly, Freud’s conclusions are examined to reveal correspondences with current thinking or its foreshadowing. Although Freud drove toward unifying conclusions, he at the same time described a disparate array of clinical phenomena. The paper’s central points are situated historically, both in Freud’s evolution and in the subsequent evolution toward the pluralistic clinical theory of today. Freud encountered many of the challenges we face, noting them in ways both clinically useful and fruitful for other theorists. The use of the paper’s central tenets is traced historically, showing how ideas that provide a radical, liberating, and facilitating guide for analysts can over time devolve into hackneyed rules. Finally, it is noted how transference phenomena are increasingly being discussed as a specific type of dyadic human experience. The task in the coming century is to develop theory and vocabulary for comprehending these phenomena and integrating them with Freud’s intrapsychic concepts.

How Do We Bridge the Gap? Commentary On Luyten, Blatt, and Corveleyn

T “gap” within psychoanalysis traces its roots to Freud’s complex identity as a generalist—a scientist, as well as a physician; a psychologist, but also a writer and humanist. Similarly, psychoanalysis has been located in different places—in the academy, in medical schools, and in autonomous professional networks. As a result there are psychoanalytic researchers, psychoanalytic humanists, and pure psychoanalytic clinicians. Working in different peer settings, answering to different funding sources, the analysts involved have come to speak different languages and hold different values. We are only too familiar with disagreements among analysts around theory; Patrick Luyten, Sidney Blatt, and Jozef Corveleyn draw our attention to another important division—one between the “two cultures” of humanism and science. In psychoanalysis this division takes the form of controversy about the relevance of research on one hand, and the limitations of hermeneutics on the other. Luyten, Blatt, and Coveleyn, analysts and research psychologists, develop and discuss this gap in sophisticated, detailed, and persuasive terms. I would like to extend their discussion in two ways, inf luenced by my own perspectives. These perspectives are those of a full-time practitioner doing analysis, therapy, supervision, and teaching, with an earlier career in social psychiatry and a continuing peripheral relation to psychoanalytic research. Each of these experiences leads to a line of response to Luyten, Blatt, and Corveleyn’s paper. As an analytic practitioner, I am aware of just how distant the research enterprise and its publications can seem. As an observer of the current research scene, I am aware of how demanding it has become—its scientific standards, ja p a

Slicing the Psychoanalytic Pie: Or, Shall We Bake a New One? Commentary on Greenberg

J ay Greenberg’s “Therapeutic Action and the Analyst’s Responsibility” uses the idea of “fictions” or “controlling fictions” to develop a number of significant points in the ongoing discussion of psychoanalytic pluralism: What is the epistemological status of our theoretical models? Greenberg’s answer: they are powerful fictions, shared among communities of believers, controlling our thought and action. These fictions contend as equals in the marketplace of ideas. We value our fictions because they tell us how to act with patients—though there is always a tension between our preferred fiction and the immediate press of an actual patient. Ultimately, psychoanalytic experience is so dense that we cannot hope to know which is best, more “right,” among contending fictions. I will look at Greenberg’s theses in the context of our current literature and my experience. My discussion will demonstrate the heuristic value of Greenberg’s paper, though I have strong disagreements regarding his conclusions, and with his view of the state of psychoanalytic knowledge. Greenberg’s ideas about psychoanalytic fictions are powerful and in some ways familiar statements about psychoanalytic theory and process,

Book Review: THE PRESENT MOMENT IN PSYCHOTHERAPY AND EVERYDAY LIFE. By Daniel N. Stern. New York: W. W. Norton, 2004, xxi + 283 pp.,

The relational nature of mind and therapeutic process is suggested by the increasingly generative collaboration between developmental researchers and clinicians. Close observation of infant-parent interaction provides new hard data on which to base hypotheses about therapeutic process. Relational ideas, especially from these sources, have often been less immediately obvious to clinicians. Sitting in the relationship, the clinician finds it hard to experience the relationship as much as he or she experiences the patient. Intrapsychic models tend to make sense from the analyst’s vantage point. With the model of early infant-parent interactions, relational patterns become more intuitively obvious, understandable, and compelling. This is what Daniel Stern and his colleagues (Sander, Nahum, Harrison, Lyons-Ruth, Morgan, Bruschweiler-Stern, and Tronick)— as well as others in the relational/developmental movement like Lichtenberg, Seligman, and Beebe and Lachmann—have been trying to help us with, conceptually, over the past two decades. In his latest book, The Present Moment in Psychotherapy and Everyday Life, Stern attempts something akin to Freud in the Project—a model of intersubjective consciousness and interactive behavior, based on biological research findings. In effect, Stern is going back to fill in scientif ically and conceptually around ideas presented in his contributions with the Boston Change Process Study Group, beginning with the widely read “Non-interpretive Mechanisms in Psychoanalytic Therapy: the ‘Something More’ than Interpretation” (Stern et al. 1998). Many of us read this paper, saying, “Of course, we always knew there was another channel of communication. Glad to have someone point it out.” But Stern was saying something more radical, that the second channel is at least as important as the verbal, interpretive one. In the 1998 paper Stern proposed that alongside the familiar processes of free association, resistance, transference, and interpretation there exists another set of experiences and interactions contained in nonverbal and paralinguistic realms. Patient and analyst move along, affecting each other in complex ways, cuing each other, and coming together more intensely for brief periods he calls “now moments.” Even more intense engagements—ones that permanently alter both parties as B o o k R e v i e w s