Wednesday, September 27, 2017

More about the co-creation of transference

In teaching and learning more about the co-creation of ‘transference’ in our Intro to Psychoanalytic Concepts I course, we used papers by Fosshage and by Slochower to further our discussion. While Fosshage helped the class rethink anonymity and abstinence from a more contemporary view, and nicely explicated a more contemporary idea of transference as an organizing activity from the classical displacement model of transference, the candidates and I agreed that the distinction between pathological and non-pathological forms of transference may not add to our clinical experience. Regardless of its form, we agreed that transference is always co-created.

A lovely example came, again, from a candidate. The candidate described that her patient had insulted her, the analyst’s, competence, then the patient additionally complained that the analyst was a ‘blank screen.’ The candidate-analyst found it “harder to hear” that she was viewed by her patient as not so human (capable of feeling) than to hear she was not so skilled as a therapist. The candidate then explained to her peers [who had heretofore failed to see the co-creation of the patient’s latter comment] how she, the therapist, had “refused the discomfort” of the insult to her competence and so had remained unmoved. “I did not feel my anger” so “my answer was not human.” The patient, having expected hurt or anger, or some response, and having read -right brain to right brain-  the therapist’s dissociation from uncomfortable human feeling, then complained about the ‘blank screen.’  

This segued nicely into Slochower’s paper where we see Slochower on the cusp of struggling to recognize her own contribution to the patient’s ‘hateful’ness, and struggling to ‘wear the attributions’ of incompetence, manipulativeness, and greed as she negotiates with her patient an attempt at a mutual understanding. A second candidate noted aloud how Slochower’s interrogation of ‘Why would I want to do that?” nonetheless leads to a deeper revelation about the patient’s fears: “Obviously, to get as much money from me as possible.” Slochower gives us an illustrative case example of just how very hard it is for analysts to see our own contribution and acknowledge it to patients and, thus, validate the patients’ experience of us. This is one way our patients are our best supervisors.

Slochower, J. (1992). A Hateful Borderline Patient and the Holding Environment. Contemp. Psychoanal., 28:72-88.

Wednesday, September 20, 2017

When transference stinks

What we learn first stays with us the longest. 

In beginning a new cycle of first year courses this semester, TBIPS, in its Intro to Psa Concepts I, starts with a contemporary point of view. Asking candidates and students to think about what are some possible components of a psychoanalytic process, someone includes ‘transference.’ We have read for today’s class a paper by Lew Aron and one by Irwin Hoffman.

A psychoanalytic candidate expresses scepticism about the relational concept of mutual influence in the transference: ‘Doesn’t the patient bring things in her head that have been there before she ever met you?’ Of course the patient brings things that had nothing to do with the therapist, but what emerges with the therapist is constitutive of being with the therapist. The candidate gives an example: ‘I open the door to a first time patient and she says, “your building smells.” How could that not have come from her alone?’ I am curious. The candidate says this particular patient had had a traumatic past and had been physically disfigured-- her face, her gait-- in a fire. I inquire: what was his experience at the moment he opened the door to this patient whose face had been thus scarred. The candidate said that the film The Exorcist had come to his mind, her face horrifying, terrible.

Since microexpressions can be non-consciously communicated, right brain to right brain, and since horror can look like disgust, and disgust akin to bad smells, was it possible that this new patient recognized her new therapist’s look of disgust and her right brain registered it as ‘something stinks around here’? Maybe. The patient did not return after the initial consultation. What might have happened had the therapist spoken aloud to the trauma this patient endured as evident from her facial scars and, more important, had inquired about what it was like to see the initial shock of them on his face?

The class is inordinately grateful for this candidate’s example which helped us illustrate a more contemporary view-- that of mutual influence-- of transference. His example speaks to the readings:

From Aron:
The analytic situation is constituted by the mutual regulation of communication between patient and analyst in which both patient and analyst affect and are affected by each other. The relationship is mutual but asymmetrical.”
“the patient’s experience of the analyst’s subjectivity needs to be made conscious”
It is often useful to ask patients directly what they have noticed about the analyst, what they think the analyst is feeling or doing, what they think is going on in the analyst, or with what conflict they feel the analyst is struggling.”       
The exploration of the patient's experience of the analyst’s subjectivity represents only one aspect of the analysis of transference.”  

From Hoffman:
“For Langs what is wrong with the classical position is that it overestimates the prevalence of relatively pure, uncontaminated transference.”
“the implications of the patient's ability to interpret the analyst's manifest behavior as betraying latent countertransference.”

Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1(1):29-51.

Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.