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p. 1058. Unconscious dramaslocked

  • Daniel Pick

Abstract

‘Unconscious dramas’ considers the ideas of transference, counter-transference, and enactment. Technique in analysis has increasingly been modelled around the recognition and exploration of transference, which may be used too formulaically, or even abused. The term ‘counter-transference’ means the feelings or even behaviour unconsciously induced or amplified in an analyst by the actions of a particular patient. Enactment, or ‘actualization’, is used to describe those moments in analysis when something is unconsciously happening between the participants. It concludes with a summary of a case involving analyst Peter Giovacchini and an assessment by another analyst, Priscilla Roth, who proposes four levels of interpretation.

Transference

Technique in analysis has increasingly been modelled around the recognition and exploration of transference; hence many analysts now would seek, as a matter of course, to make direct observations about the patient’s unconscious attitudes towards them, even as the session proceeds. Much has also been written on how patients unconsciously ‘nudge’ their analysts to fit in with required roles, and how the clinician might stand in for someone else. Freud opened up this path, recognizing, for instance, that when patients seemed to fall in love with him a powerful emotion was actually transferred on to him from elsewhere.

This idea of transference can, admittedly, be used too formulaically and reduced to mantra, so that every interpretation becomes a banal attempt to show the patient, when talking of others, that it is really the analyst they have in mind, or conversely that when they address the analyst in a mood of affection, hate, or grievance they are in fact unconsciously relating to someone else.

There is also a risk of abusing the transference, just as there is in medical practice or an educational setting. Some clinicians, unfortunately, have taken advantage, exploiting patients’ vulnerabilities to being bullied, seduced, or commanded by a p. 106charismatic figure. (A sad and troubling case that came to light of a talented and substantial contributor going off the rails was Masud Khan, a senior member of the British Psychoanalytical Society. His increasingly erratic behaviour with patients and colleagues ultimately proved impossible to ignore. The scale of his meltdown was to become a cause célèbre when exposed after his death by a former patient, Wynne Godley, in 2001.)

Freud had seen more than enough ‘acting out’ by colleagues, and he was alert to how unconscious factors were at work in their behaviour, as well as in the patient’s. Indeed, the fact that powerful unconscious forces exist in all of us, and at times can break through to undermine the work, even shatter proceedings, was exactly what Freud’s theories had anticipated and what analysis, supervision, the presentation of work at clinical seminars, and so on are designed as far as possible to contain.

Freud’s own realization of the power of transference had first been brought home acutely with ‘Dora’, around the same time that The Interpretation of Dreams appeared. Dora had experienced him in much the same way, he concluded, that she had responded to another man, Herr K, with whom she had close family connections. Herr K had made a pass at her; she felt him to be indecent and intrusive, and pushed him away. How far Dora had secretly desired Herr K is another question. Some feminist commentators have built on Freud’s own later recognition that her desire might have been for Herr K’s wife (a possibility he had not sufficiently taken into account at the time of treatment). Herr K’s interest was especially troubling to Dora because her father was apparently having an affair with Frau K. Dora suspected that her father was putting her in Herr K’s way to distract and compensate him for the affair. Dora reacted extremely negatively when she felt pushed by Freud. The respective actions of Herr K and Freud in the case of Dora were not the same—her analyst was not seducing her—but the pressure she experienced in her treatment evoked in her a similarly claustrophobic and indignant reaction.

p. 107Initially, Freud had tended to think of transference as a nuisance, an unwarranted interference to overcome so that analyst and patient could continue to work unencumbered on, say, a dream. Yet he came to realize that understanding the transference was key to the work itself, or at least another important route into the study of the unconscious.

Counter-transference and enactment

Later on some analysts, especially in Britain, came to consider more fully the counter-transference, meaning the feelings or even behaviour unconsciously induced or amplified in an analyst by a particular patient. Some of those who developed the idea were colleagues of Klein, who in effect challenged her to rethink. Klein seemed sceptical about the value of the concept, fearing it risked self-indulgence, as Freud would probably have agreed.

Evidently the analyst also has his or her own transference to the patient (confusingly this is also sometimes referred to, more loosely, as counter-transference); but in addition to that, what always requires consideration, advocates of this approach now argued, is the unconscious response or feeling that may be prompted in the clinician by something in the patient’s own character, style, and inner world.

‘Go and have some more analysis!’ So Paula Heimann (author of a seminal paper on counter-transference in 1950) was apparently advised when she suggested that she was powerfully affected by irrational feelings with certain patients. But Heimann’s contribution proved lasting: analysts do indeed find such phenomena in themselves an important compass, a way of understanding what particular patients may evoke in, or project on to, them.

The problem for the analyst here is to acknowledge, differentiate, and make use of their feelings and experiences, and to try and sift out what belongs to whom. In a 1985 paper, ‘Working Through in p. 108the Countertransference’, the analyst Irma Brenman Pick described situations where a patient caused her to lose balance, touching off acute feelings or inducing particular anxieties. Thus one patient arrived, clearly unwell, saying ‘I was determined to come, even if that risks you getting my illness’. The analyst was thereby agitated and felt vulnerable to his ‘infection’; perhaps this very feeling of helplessness was part of what the patient was seeking to stir up. On another occasion she found herself feeling rather flattered by the patient who commented effusively about how well she had managed a public meeting at which he had been present. Immediately thereafter he expressed ‘concern’ that he had seen her smoking. She noticed her own immediate ‘up and down’ mood, upon that combined message—the praise and then the solicitous ‘concern’ and implicit criticism. These mood swings were congruent with the patient’s own oscillations, and that ‘fit’ could be part of what the patient concerned may have aimed at inducing.

Another very ill person, whose analysis continued during her time in mental hospital, would turn up at the precise moment of the end of the appointment, leaving the analyst feeling maddened and despairing. On another occasion that patient arrived dishevelled, with a powerful bodily odour, apparently quite without conscious awareness of the impact of this. A key aspect of the task for the analyst is to process these feelings as best she can. And the patient, meanwhile, may well be monitoring, consciously or unconsciously, how the analyst is struggling to deal with emotions too—for instance defensively, omnipotently, honestly, or painfully.

It is always open to question how far the analyst’s passing moods in the consulting room are of a patient’s making, so the idea of counter-transference requires sensitive handling to ensure it is not just a catch-all. Yet patients can be very skilful at touching off sensitive areas in the analyst without appearing to do so. Perhaps a patient is subtly winning over or needling in a way that leads the practitioner to feel or to act in, say, an emollient, triumphant, or p. 109angry fashion, even though unaware of this at the time. On other occasions it may be the apparent absence of feelings or a mood of complacency that is striking. In other words, the clinician, alert to this model, tries to take heed of what is more extreme than usual, or perhaps a manner of talking that is not really ‘being herself’, and then considers how it may be relevant.

A further term, ‘enactment’ or somewhat similarly ‘actualization’, is used to describe those moments when something is unconsciously happening between the participants. Enactment connotes the process where an analyst and patient seem to be caught up in a particular scene that expresses a phantasy, albeit played out between both parties. Enactments where analyst and patient waltz off together into some seriously inappropriate set of actions (commonly known as ‘boundary violations’) are ruinous to the analysis. Often, however, more subtle versions can become food for thought, retrievable and open to exploration within the treatment.

A patient crippled by a severe superego might find some pleasure in cruelty for instance, enjoying a certain ‘sacrificial’ position with sadistic sexual partners, and then produce echoes of this pattern in the analysis. This tendency may become apparent in a scenario where an analyst, normally restrained, finds herself almost ‘haranguing’ her patient, only to hear the latter breathe a contented sigh. We might suspect that something here has been played out that reflects the patient’s unconscious, masochistic script. Such enactments can then be ‘caught’, and perhaps understood, potentially becoming an important vehicle for psychic change.

Finally, consider this moment in the treatment of a young woman who recalls to her male analyst a dream of herself at a dance. This account was published in a book by the analyst in question (Peter Giovacchini) and was further considered by another, Priscilla Roth. It is worth dwelling upon it now as a coda to this discussion of transference, counter-transference, and enactment.

p. 110The patient reports a hazy dream featuring a grey-suited man who asked her to dance. She adds how they moved around the room, whereupon her partner steered her to a corner and pressed himself against her. She could feel his erect penis. The analyst, in writing about the case, adds his own thoughts for the reader’s benefit, observing that he often wore grey suits and the transference was erotic—the material providing an allusion ‘to her sexual feeling toward me’.

The patient struggles, he notes, to defend herself against these impulses. He asks her to associate to the dream and then observes that she largely ignores this invitation, inclined to pursue other topics. She only hesitantly considers some elements in response to his prompt, such as the dream’s obscurity. Her analyst then directs her back to the grey-suited man. Silent for a minute, the patient then becomes extremely anxious, reporting a sense of fogginess and the couch spinning. Gradually these feelings subside and she continues to talk but makes no reference to the dream.

Here the analyst becomes ‘immensely curious’, interrupts her and asks about the dream. To which she answers: ‘What dream?’ To his astonishment she has forgotten it. He repeats the details, brings her attention back to the man; once more she feels the couch turn furiously and seems to have wiped the dream from her memory. This ‘dance’ around the dream continues, with him even attempting a third pursuit of her associations, with the same results. As she experiences spinning sensations once more, she describes a vortex sucking in her thoughts.

We might well want to consider not only a patient’s dream, in the manner that Freud did, but also what the patient is doing with the dream—in this case handing it over to her analyst and then apparently forgetting all about it. Moreover, given that analysts are well known to be particularly interested in such things, might it be that a particular patient, anxious to please or to repair things after a stormy session, might offer a dream as a kind of gift or p. 111peace offering, or even seductive gesture? Might it be used at times to provide analyst and patient with a mutually satisfying project, perhaps distracting them from something else? Thus one could approach in umpteen ways the function and manner of the telling of a dream, or of working on it in a session, alongside the specific issue of its contents and the associations that follow.

Levels of interpretation

Commenting on Giovacchini’s report, Roth points to four levels of interpretation that might be made of the particular sequence just described. Most immediately (the first level), all of this could relate to the patient’s father; perhaps he is the ‘grey-suited’ figure, by which one must include crucially not just the actual father, but the paternal figure that she has in mind. No doubt other material would inform such an assumption too, but let us assume ‘grey suit’ captures something of her father. Roth makes a link to Freud’s Dora case, and how that patient experienced her father and Herr K in their dealings with her. The analyst could then have said to this young woman, as perhaps Freud might have done to Dora, ‘Your dream is about your father; you are afraid to know you have these thoughts about your father’. One might also perhaps explore here the thoughts she believes her father has about her.

At a second level, an interpretation might focus directly upon the analyst: ‘you are afraid of your dream because your dream is about me’. As Roth puts it, ‘What [Giovacchini] shows us is an analyst in a session, trying to talk to his patient … about thoughts she had about him in the middle of the night called a dream.’ The analyst has observed all of this to himself already, so could say: ‘I often wear grey suits, the man in the dream wore a grey suit—in the middle of the night you had this fantasy about me.’ This would be an interpretation about the transference of specific qualities, presented in a discrete fashion, and dealt with by the analyst from some distance.

p. 112At still another level, the analyst might ask what is happening here and now, and perhaps could say to the patient: ‘There is something going on in this session in which I, interpreting to you, am being perceived as the man in the dream. It is as if the dream were repeating itself here.’ So now the woman in the session, the woman who is having the dream and the woman in the dream are brought together as one. This interpretation could enable the analyst and patient to grasp how the same configuration has emerged in the session as in the dream.

Yet there is a fourth level too, where, as Roth puts it:

we might consider the ways in which some combination of the patient’s pressure and the difficulties this stirs up in the analyst lead to an unconsidered response by the analyst, to create the very situation at stake: an internal relationship is in fact being enacted within the session, an enactment in which both analyst and patient are taking part.

Some awareness of the possibility that this fourth level is in play could cause the analyst to reflect internally before speaking at all. This self-questioning about his counter-transference might then enable him to ask himself: ‘Why do I find myself repeatedly pushing the patient into a corner? Why am I pressing my question on her?’ The analyst here would first try to gain some kind of purchase upon this process before addressing the patient. Having done so he might be better able to consider how to make an interpretation without simply re-enacting the very process of ‘pressing’, as he is speaking. The analyst, in other words, could thereby think aloud with this patient and observe what keeps happening between them. In Roth’s words: ‘we seem to have arrived at a situation in which I am repeatedly pursuing you, or pushing you into a corner in a way that frightens you, as in your dream’.