Difficulties in the Analytic Encounter

John Klauber

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429912733
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book represents an odyssey through the career of a thoughtful and serious psychoanalyst. John Klauber, a strong and articulate member of the middle or "independent" group of the British Institute of Psycho-Analysis, was President of the British Psycho-Analytical Society at his untimely death in August 1981. This volume, which he fortunately lived to see published, turns out to be a legacy of his psychoanalytic and personal thinking and feeling, and contains ten papers spanning the tewnty years of the 1960s and 1970s. It conveys, in a fashion which compels reading, the mind of the author which was the essence of the man.

I

Difficulties in the Therapeutic Situation

1

Reporting Dreams in Psychoanalysis (1967)

Why patients report dreams on one day and not on another is a question which does not seem to have been asked before in the psychoanalytic literature. The answer is that a repressed wish has come near enough to consciousness to demand a solution in life. To report a dream means that the patient is seeking the analyst’s help in integrating the conflict between psychic structures. It is because a repressed wish is seeking fulfillment that dreams in all ages have been regarded as foretelling the future.

A dream is a private work of art. Like all art it is, in Picasso’s phrase, a fiction that brings us nearer reality.

* * *

No general explanation seems to have been achieved of why patients report their dreams on some occasions and not on others. It is true that we commonly refer the failure to report dreams, as we do the failure to suggest associations to them, to the patient’s resistance, that is, to a disturbance as a result of anxiety of the synthetic function of the ego. The absence of a positive theory of the significance of reporting a dream is especially surprising when we consider that a dream has been regarded as an important psychic event throughout the history of mankind.* If the evidence of the literature were taken alone, dream interpretation might seem to have been the cornerstone of Freud’s technique for as long as twelve years; but Freud discusses the psychology of the dream process and its relationship to the remembered fragment of the manifest content, rather than the psychology of reporting dreams and the question of why patients report them when they do. In 1913 Ferenczi referred, as though to a commonplace, to the psychoanalyst’s knowledge that people tell their dreams to the person to whom their contents refer. If this also holds true of the fragment of the dream life reported in analysis, then its clinical implication would be that all dreams in analysis concern the psychoanalyst. Though many analysts regard all the phenomena of the session primarily from the standpoint of the transference, I do not recall any statement that all dreams in psychoanalysis refer directly to the analyst; for instance, Rosenbaum, in his paper “Dreams in Which the Analyst Appears Undisguised” (1965), drew only the cautious conclusion that dreams in which the analyst appears undisguised in the manifest content may well be concerned with an aspect of the patient’s real relationship with him.

In recent years the operation of the ego in the dream process has been given increased recognition. In 1954 Erikson emphasized the reflection of the dreamer’s total situation on every level of the manifest dream. Kanzer (1955) stressed the communicative function of the dream and offered a reconciliation of this function with the theory of the narcissism of sleep. Kris (1956) included the solution of problems in dreams as an example of the integrative work of the preconscious, and Lewin (1958) illustrated the constructive use of dream regression in the formulation of creative ideas. Examples of dreams selectively told to individuals who were less likely to understand them than the psychiatrist to whom they referred were cited by Whitman in 1963. The theory that dreams are to be understood essentially as problem-solving activities was put forward by French in 1954 and again by French and Fromm in 1966. However, the conceptual standpoint of French and Fromm appears to give a dynamic role to the ego which is not easily integrated with other psychoanalytic concepts.

There are few phenomena of analysis which can be relied on more consistently to arouse the interest and expectation of both patient and analyst than the patient’s report of a dream. My aim in this paper is to suggest explanations for the high valuation accorded to the reporting of dreams in the light of modern psychoanalytic theory.

For instance, does this feeling of expectation in itself allow any conclusion to be drawn about the function of a dream— or, rather, of remembering and reporting a dream? Affects are regarded as responses of the ego, and Freud’s view of 1900 that they are less plastic than ideation remains a fundamental postulate of psychoanalysis. An important step forward in the integration of metapsychology and technique was taken when Heimann drew attention, in her paper of 1950 “On Countertransference”, to the importance of the analyst’s affective reactions as indicators of the patient’s unconscious mental processes. Whether one subscribes to her equation of the countertransference for the purposes of her paper with the totality of the analyst’s responses, or prefers, like Little (1957), another designation, or, like Hoffer (1956), attempts some degree of distinction between appropriate and inappropriate responses by the analyst, a new source of clinical information was introduced and made respectable by her contribution, and a new dimension defined for the study of clinical interaction.

The evocation of the psychoanalyst’s interest by the dream accords well with older as well as with newer theories. If a dream represents the attempted fulfillment of a repressed wish, it becomes comprehensible—in a sense almost axiomatic—that affect is stimulated in the analyst, though the mechanism of this process still lacks full definition. When we recall that for the first time there is a possibility that their dreams will be consciously understood, the fact that patients often recall dreams with greater facility in analysis also becomes comprehensible. Moreover, even remembered dreams from the past acquire a special significance as communications to the analyst and do so in different ways according to the phase of the analysis. It would seem justifiable to conclude that the evocation of the particular interest that accompanies the report of a dream indicates that a communication of particular importance is being attempted. Often, of course, we understand little, or nothing, of a dream, and it is forgotten. It is, however, also true that a dream of which little has been understood may remain with the analyst as a recurring memory. I believe the theory that a special communication with the analyst is being attempted can be given prima facie support. It seems usually to be possible to relate significantly at least some fragment of the session to the dream recounted—perhaps only a mode of defense, perhaps a reference to a past event which will later emerge as a cover memory, perhaps the foreshadowing of an impulse to be expressed in action, but also, and not altogether rarely, perhaps the clarification of the session’s transference or of a life problem.

To sum up, the patient’s report of a dream may mean that some new problem of communication with the analyst is becoming acute. The partial breakthrough of a repressed wish in a dream gives to the dreamer an urge to communicate it, since impulses no longer under the full control of the ego must seek discharge. The verbalization of the dream, like the dream itself, represents a substitute discharge. With verbalization, this discharge is brought within the conditions of object relationship and reality and no longer remains purely endopsychic. What is added to the general conditions governing the report of a dream in the conditions of psychoanalysis is an achievement by the ego of a new relationship to its libidinal object, since, as has been indicated, for the first time the dreamer has acquired the possibility of being consciously understood.

If it is true that the report of a dream in analysis represents a crisis in the attempt to make a new communication, then this implies that some act of integration has been achieved by the ego of elements of the id or superego, which were previously inaccessible through defense. To formulate this further, the report of something so structured as a dream may indicate the mobilization of endopsychic conflict in such a way that the ego attempts to define an acceptable attitude to the conflict. This formulation would only be in line with the age-old view of mankind that dreams have a special meaning. Why this meaning has been held to be that of foretelling the future will be considered later.

I propose to examine two dreams in the light of this theory. The first has been chosen because it was the first dream of a patient who had spent some months in treatment without consciously dreaming. The transition to the reporting of dreams often illustrates the ego’s achievement of a new capacity for integration very clearly. The only dream of this kind currently available to me was reported by a man, Mr. A, who had been in twice-weekly psychotherapy with me for about five months. (Geographical difficulties prevented his coming more often.) He sat in a chair, but, as far as these limitations allowed, my technique with him was analytic. Of working-class origin, conceived before marriage by an extravagant mother of bad sexual reputation and a father whom he suspected of having made her pregnant in order to secure her, he had made a remarkable success of his life. He had been unable to allow himself to capitalize his talents, however, until he was in his twenties. Recently he had been promoted managing director of a specialized engineering firm. He presented with complaints of panic attacks in situations in which it could be divined that the responsibilities of his new position weighed on him, and of anxiety for his future on their account. He told me that another psychiatrist had made a diagnosis of depression, but he was at a loss to understand either the precipitation or the meaning of his symptoms. He could list three events which his intellect told him might have had a connection with them. The first was his appointment as managing director three months before the full emergence of his symptoms. This had been “a body blow” to him because it meant that he replaced a superior who had helped him in his career and had recommended that he should succeed him when he himself was resigning owing to differences within the firm with which he was no longer willing to contend. Secondly, the appointment had involved a not very welcome move of his home and place of business and a great deal of overwork. Thirdly, his wife had reacted with unexpected hostility to finding herself pregnant for the third time after an interval of eight years, had vomited throughout the pregnancy, and, although she had previously opposed abortion for any woman in any circumstances, had repeatedly demanded that she herself be aborted. In fact she had borne the child, and her emotional state was “almost” back to normal. He regarded his marriage as exceptionally happy.

For several weeks before the dream, the patient had been telling me of his feelings as an eight-or-ten-year-old when he had been left by his parents to look after the other children, including a baby sister, while they went out drinking. He described in particular his panic one night when the baby cried continuously and they had failed to return until late. He emphasized his mother’s bad reputation both sexually and as a household manager and described in particular a row that his parents had had after his mother had disappeared from a pub and his father had found her at the back of it with a man. At the same time, he told me casually that his wife had had an affair with a friend of his not long before she became engaged to him—and indeed that one of the reasons that this affair had broken up was that his friend’s parents had objected to her— but the only parallel he had drawn between his mother and his wife was that there was a definite similarity of physical appearance between them.

On his return from a business trip, he reported the following dream: He had been to a hotel and slept with the receptionist. A little while later he found that his friend had done the same. I did not interpret the dream to him in terms of his feelings about his wife, as I considered that her failure to accept their third child rendered his feelings of rejection by her too painful for my intervention. I therefore related my interpretation of the problem to its expression in the transference. I suggested that the dream referred to his anxiety over having missed sessions owing to his trip and to his jealousy over what other patients I might have been seeing in his hours. Two sessions later, however, he started the session by looking at me and smiling, and said “I’ m beginning to see what all this is about.” There followed an event which was rare in his marriage; he had a violent row with his wife over her insistence that on Sunday morning, instead of playing tennis, he should look after the children and allow her to sleep. This was followed by a reconciliation after a couple of days, but there was a decisive change in the type of his associations. Not only did he bring much more information about his wife’s hysterical temperament and about his use of the withdrawal technique in sexual intercourse (more in accordance with his parents’ social position and generation than with his own), but he started to report the fantasies which occurred to him about the consulting room—he saw bloodstains on the frame of the picture above the fireplace— and to speak much more freely about his feelings about me. He told me how he longed for a comfort from me which I refused him: for instance, I should say I was sorry for him and give him a prescription. At the same time, he said he was feeling better.

The second dream is also a short one, reported by a woman, Mrs. B, who had been coming at first four times, then five times a week for nine months. Since the death of her mother twelve years before, this patient had listened to her voice every day in her imagination, discussing the details of her life with her and tending to remonstrate with her. During the same period the patient had quarreled increasingly with her husband, whereas previously she had got on well with her husband and quarreled with her mother. The analysis had begun when she moved to London. She had undertaken it in an effort to save the marriage and decided that she must give up her lover of three years’ standing with whom she had for the first time experienced sexual satisfaction. She had just returned from a seaside holiday. Her husband had pleased her by spending a few days with her and the children. She reported that during the holiday she had had the following dream: The stone of a gold ring like her mother’s was dropped and was lost in the sand.

I have assumed that the capacity to report a dream in analysis indicates that the ego is attempting to formulate an attitude to the underlying conflict. More accurately, the report of a dream indicates an abortive attempt by the synthetic function of the ego to integrate the psychic structures. The ego, which cannot formulate its thought according to the reality principle, is endeavoring to formulate it by a mixture of primary and secondary processes in an attempt to communicate with the analyst and obtain his assistance. If this is so, the ego’s statement will be concerned with the patient’s current reality, with his relationship to the analyst, and also, since the dream is the attempt to fulfill a wish, with his relationship to the future.

In Mr. A’s dream of the hotel receptionist, these elements were almost manifest. The dream portrayed some of his reflections on the repetition of his childhood emotions of disappointment and suspicion in his relationship with his wife and with me and adumbrated an acceptance of his resentments and a reevaluation, on the whole favorable to her, of his wife’s character. At the same time, his increased freedom of communication showed an increased trust in me.

I should like to examine in greater detail Mrs. B’s dream of the stone of a ring being dropped. At the time of telling me the dream, Mrs. B had an immediate dread: her sister was coming on a visit. Her sister invariably quarreled with her, trying to undermine her confidence in herself and in the way she arranged her life. Her particular concern was to conceal from her that she still had a lover. She told me how proud Mrs. B’s mother had always been of her as opposed to her sister and how her mother had always loved to show her off. In fact, I interpreted, how she had always been her mother’s gem. But how frustrated, Mrs. B went on, she had always been by her mother’s perpetual habit of keeping her waiting or of having her nose in a book. That is to say, Mrs. B as a child had been the stone that was displayed but also lost. Mrs. B had told me of an anxiety attack she had once had when left waiting in the street for her mother. In other words, the dream crystallized Mrs. B’s unconscious realization that she might not be the stone firmly set in her mother’s ring, or indeed the only pebble on the beach in relation to her husband, who also perpetually kept her waiting, especially by not coming home from the office until late in the evening. This she tried to deny both with her first associations about her mother’s pride in her and, subsequently, by acting in the transference relationship. She had told me that her lover intended to visit her but had not presented this as imminent. The next day my receptionist reported that Mrs. B had telephoned with a short message that she was unable to come for two days. She had therefore suddenly dropped out of my ring. On the third day, she telephoned me to say that although she had intended to come, she did not think it would be possible to get back in time after seeing her lover off at the airport. Something in her manner made me ask what time the plane left, and I could show her that she could, in fact, get back in time. I was forced in this way to show her that I valued her, that she was my gem who had been lost and found again, in spite of her illicit absence with her lover. On her return, she told me that she was ill, her lover was a tranquilizer. She had just heard that her elder daughter was bottom of the class, and she feared that she had passed on to this daughter her own difficulty in adapting.

The attempted formulation in the dream could now be better understood. It was that her dependent relationship with her mother, as displayed in her symptom of listening to her voice, covered an essential incompatibility; that she could not deal with her ambivalence either by her attempts to deny her husband’s neglect of her and interest in other women or by her idealization of her relationship with her lover. She showed the same struggle in relation to me by acting out and by the oscillation between listening to me with bated breath and the inability to accept the slightest frustration of her material demands on me which characterized the months that followed. The dream also hinted at an incipient realization that it was her jealousy of her sister that had caused her to form such a relationship of hostile dependency with her mother. This attempted formulation by th...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgments
• Introduction: Arriving at Solutions
• Part I Difficulties in the Therapeutic Situation
• II Difficulties in Technique
• III Difficulties in the Analyst
• Appendix A: On the Dual Use of Historical and Scientific Method in Psychoanalysis
• Appendix B: The Psychical Roots of Religion: A Case Study
• Index