Standing in the Spaces

Essays on Clinical Process Trauma and Dissociation

Philip M. Bromberg

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317714521
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Early in these essays, Bromberg contemplates how one might engage schizoid detachment within an interpersonal perspective. To his surprise, he finds that the road to the patient's disavowed experiences most frequently passes through the analyst's internal conversation, as multiple configurations of self-other interaction, previously dissociated, are set loose first in the analyst and then played out in the interpersonal field. This insight leads to other discoveries. Beneath the dissociative structures seen in schizoid patients, and also in other personality disorders, Bromberg regularly finds traumatic experience -- even in patients not otherwise viewed as traumatized. This discovery allows interpersonal notions of psychic structure to emerge in a new light, as Bromberg arrives at the view that all severe character pathology masks dissociative defenses erected to ward off the internal experience of trauma and to keep the external world at bay to avoid retraumatization. These insights, in turn, open to a new understanding of dissociative processes as intrinsic to the therapeutic process per se. For Bromberg, it is the unanticipated eruption of the patient's relational world, with its push-pull impact on the analyst's effort to maintain a therapeutic stance, that makes possible the deepest and most therapeutically fruitful type of analytic experience. Bromberg's essays are delightfully unpredictable, as they strive to keep the reader continually abreast of how words can and cannot capture the subtle shifts in relatedness that characterize the clinical process. Indeed, at times Bromberg's writing seems vividly to recreate the alternating states of mind of the relational analyst at work. Stirringly evocative in character and radiating clinical wisdom infused with compassion and wit, Standing in the Spaces is a classic destined to be read and reread by analysts and therapists for decades to come.

1

INTRODUCTION

“What is the use of a book,” thought Alice, “without pictures or conversations?”

—Lewis Carroll, Alice’s Adventures in Wonderland

I’ve always been wary of words—a perhaps curious opening remark when one considers how many are to follow. As far back as grammar school my stubborn refusal to substitute the grownup language of “real reality” for the felt reality of my inner experience would get me into no end of trouble with the people whose job it was to educate me. My report cards, for example, invariably contained the anticipated note from my teacher: “Philip appears to be very bright but he seems to live in his own world. I never know where his mind is, and nothing I do or say seems to change that.” My parents, who knew first hand what my teacher was talking about, would nod their heads with both recognition and resignation because they didn’t know how to deal with it either. To the adults who were trying to help me “pay attention,” my ability to disappear “inside,” as if in another world, was clearly a bad habit I needed to change. I, of course, never thought about it that way and couldn’t understand why it seemed so important to everyone else. So I continued to do it, and apparently to such an extent that my mother hit upon the strategy of making me repeat what she said, hoping thereby to defeat my efforts to tune her out. I can still recall the day she realized that her “technique” didn’t work. Standing in front of me, hands on hips, she growled; “You never listen to me. You never hear a word I say! I’m going to tell you something right now, and I want you to repeat it to me exactly.” She then told me whatever the “something” was, and I did indeed repeat it word for word, exactly as she said it. She looked at me with a strange combination of bemusement and consternation. “I don’t know how you did it,” she said, “but I know that even though you were listening you still didn’t hear it. I don’t know how you did it, but you did it!” She was, needless to say, absolutely right about my not processing what I was taking in while I was being “educated,” but more importantly, her sense of humor about it probably contributed a great deal toward my feeling more or less comfortable with my “insideness” as I got older. As Langan (1997, p. 820) wryly put it, “What is one to do with the fractionating discovery that, as the poet Allen Ginsberg remarked, ‘My mind’s got a mind of its own’?” And who knows? Perhaps it was because of this that I am now able to find humor in similar moments with patients—moments that might otherwise hold a potential to become grimly adversarial as our realities collide.

I begin with this vignette from my own childhood because it touches what may be my earliest awareness of what I hold to be the heart of personality growth—the paradox of being known but still remaining private, of being in the world but still separate from it. This paradox is often as confounding to psychoanalysts as it was to the adults in my early life. The acquisition of new self-experience is a process that is not mediated by language alone. There must be communication with an “other” at a felt level of personal validity in order for linguistic content to be integrated pleasurably and safely as self-experience. The analytic situation is designed as a negotiated therapeutic relationship to bring about this integration.

The following chapters are a selection of clinical essays written over the last twenty years. They can be read simply as a book of collected papers, or they can be read, simultaneously, as the unfolding of a clinical perspective—a series of reflections on the analytic relationship with its own implicit order, its own progression of ideas, and its own internal dialectic. My hope is that most readers will find this latter approach more congenial to their taste. How a reader reads will partially depend, of course, on the extent to which the growth of his own clinical experience and the historical development of his own ideas share some common ground with the evolution of mine over the past two decades. Writers need readers. In her 1996 novel, Hallucinating Foucault, Patricia Duncker argues that what writers have for centuries referred to as “the Muse” is none other than the reader for whom they write. Through the voice of her protagonist she puts it this way:

I have never needed to search for a muse. The muse is usually a piece of narcissistic nonsense in female form.… I would rather a democratic version of the Muse, a comrade, a friend, a traveling companion, shoulder to shoulder, someone to share the cost of this long, painful journey. Thus the Muse functions as collaborator, sometimes as antagonist, the one who is like you, the other, over against you.… For me the Muse is the other voice. Through the clamoring voices every writer is forced to endure there is always a final resolution into two voices.… But the writer and the Muse should be able to change places, speak in both voices so that the text shifts, melts, changes hands. The voices are not owned. They are indifferent to who speaks. They are the source of writing. And yes, of course the reader is the muse [pp. 58–59].

As I now contemplate the “otherness” of my own reader-muse, I wonder whether much has changed from the years when I would say to a supervisor, “I’ll tell you about the last few sessions, but you really had to have been there.” I find myself once again trying to oppose the constraints of language, felt here even more keenly in the written than in the spoken word, and unwilling to accept the inevitability that the “right” words to represent the “wholeness” of this book will be inadequate to express the individual personalities of its chapters and the range of my own clinical states of consciousness that went into birthing them. I yearn to impart a taste of the multiple experiential meanings that fueled my writing of the individual chapters at the time they were originally created, each a unique event that, like an analytic session, was most meaningfully “itself” when it happened. Perhaps my attempt to introduce this volume in such a fashion embodies my hope to overcome the limitation I do not want to accept, by evoking in the reader a heightened awareness of his own inner voices as we each struggle to grasp the phenomenon of two people, patient and analyst, purposefully confronting and engaging the multiplicity of nonlinear realities (their own and each other’s) that organize the relationship we call psychoanalytic treatment.

“When I was young,” Mark Twain wrote, “I could remember anything, whether it happened or not.” Inasmuch as we have supposedly lost this capacity in growing up, the ability to relish Twain’s humor is a remarkable human achievement. As adults, we like to call it “imagination.” But as analysts, we know that this kind of logical impossibility, both in our patients and in ourselves, is the stuff of conundrum and, worse, impasse. Yet on the other hand, as analysts we also grasp that just “knowing” reality is not what growing up is all about. We are all well aware from our work that “knowing” reality can be a disastrously grim experience for many people. If a child is routinely allowed comfortably to retain his subjective experience while engaging with his parents in his own way as they tell him about what is “really” happening, he stands a pretty good chance of growing into an adult who, like Mark Twain, always has a child along for the ride.

Central to the growth of psychoanalytic theory has been a continuing effort to formulate a working model of the analytic relationship that is clinically flexible and developmentally sound. All attempts, including those of Freud, have necessarily rested upon a set of explicit or implicit assumptions about the nature of reality and how human beings come to understand what is “real.” These assumptions have to do with the way in which one’s capacity to see things as others see them develops, stabilizes, and coexists with one’s values, wishes, fantasy life, impulses, and spontaneity; in other words, these assumptions concern the conditions through which subjective experience of reality (including reality about one’s self) is freed to move beyond the limits of egocentrically conceived personal “truth.” In this regard, the psychoanalytic relationship is an interpersonal environment that frees patients’ potential and appetite for a creative dialectic between their internal reality and the presentation of external reality as represented by the analyst as an independent center of subjectivity.

To the extent that analytic theory is not embedded in imagination, I tend to approach it mainly as an intellectual adventure, similar to my fascination with taking apart clocks during preadolescence—to see how they worked. In other words, I don’t think it is necessary to have a concrete theory in order to work effectively, and in fact I suspect that too great a preoccupation with theory can interfere with the process of therapy in the same way that taking apart clocks can become a substitute for full involvement in the business of living. If full involvement in “living the psychoanalytic relationship” does indeed require imagination, then the soul of the process might in a certain way be seen as a return to the basics of childhood. To put it more lyrically, is there an analyst who, as a child, did not believe with Eugene Field (1883) that “Wynken, Blynken, and Nod one night sailed off in a wooden shoe,” even though “some folks thought ‘twas a dream they’d dreamed”?

I recall a particular session just after I had returned from summer vacation, when I was sitting, saying nothing, hoping to regain my “memory.” My patient, from the couch, said: “You sound very silent today.” My first internal response was “What does that mean?” If she had said, “You are very silent today,” I could have connected to that at once. But how can I sound silent? As I started to think about what she was feeling, something happened; I “knew” what she meant. Not conceptually—I already knew conceptually. I knew in a different way because the words “sounding silent” no longer felt alien, just as she no longer felt alien to me. It’s tempting to just give this a name—to say I knew “experientially” or that I made contact with her “empathically” or something of the kind. Even though I do think in exactly this kind of way, I also believe that despite the understanding contributed by these terms we have barely begun to comprehend “what makes this clock tick.” Something fascinating goes on in the process of human communication which continues to be the heart of what we rely upon clinically, as well as being the one genuine subject of all analytic theory no matter whether the vocabulary we use prefers to speak of transference-countertransference, enactment, projective identification, intersubjectivity, dissociated self-states, or even the phenomenon of “imagination.”

As you might anticipate, my writing is more process driven than theory driven, and you will find that the aesthetic progression of the chapters, particularly during the last decade, is configured more and more by clinical vignettes as the context for my evolving point of view as an interpersonal/relational analyst. Although I touch on existing arguments in the literature and attempt to provide, here and there, challenges and what I believe to be corrections, I am basically trying to communicate a point of view with regard to the clinical phenomena and an approach to working with them. In other words, the theoretical formulations that arise out of my contemplation of the clinical material are for the most part responsive to the phenomena rather than an inside-out attempt to theorize them ahead of time.

How is it possible for psychoanalysis to work? Like the bumblebee, it shouldn’t be able to fly; but it does. It is the issue that always percolates slightly beneath the surface of my clinical work, sometimes conscious, sometimes not, but always informing the sense of wonder with which I participate in the process of analytic growth with a given patient. How can a therapeutic link be constructed between seemingly irreconcilable needs of the human self; stability and growth; safety and spontaneity; privacy and commonality; continuity and change; self-interest and love? Asking oneself how it is possible for psychoanalysis to work is not the same as asking how psychoanalysis works. The former question comes from a clinician’s more querulous and unsettled state of mind—the living part of an analyst’s self that swims with his patient in more or less raw clinical process and has not been subsumed by his self-reflective consideration of how to conceptualize it. Trying to come to grips, clinically, with how it is possible to relate to a human being in a way that will enable him to accept dismantling the protection of his hard-won character structure in order to achieve gains that may or may not be realized, is perhaps the underlying motif throughout this book.

Safety and Growth

The drastic means an individual finds to protect his sense of stability, self-continuity, and psychological integrity, compromises his later ability to grow and to be fully related to others. Thus, a person enters treatment dissatisfied with his life and wanting to change it, but as he inevitably discovers, he is his life, and to “change” feels, paradoxically, like being “cured” of who he is—the only self he knows. “Can I risk becoming attached to this stranger and losing myself?” “Is my analyst friend or foe, and can I be certain?” Ernest Becker (1964, p. 179) considered this paradox “the basic problem of personality change” and asked trenchantly: “How is one to relinquish his world unless he first gains a new one?” Becker’s question leads inevitably to a close examination of the kind of human relationship that allows a psychoanalytic process to take place. How does a relationship between patient and analyst come to exist that gets beyond the patient’s having to make the impossible choice between being himself and being attached to and thus influenced by the analyst? (See also Mitchell, 1997b.) How does the relationship ever come to transcend the patient’s determination to protect his own feeling of selfhood, and what does the analyst contribute that enables this transcendence to take place?

In my view the answer lies in the therapeutic creation of a new domain of reality in which coexists a hope of the “yet to be” and a dread of the “not me.” No matter how great the pain of being trapped within one’s internal object world, and no matter how desperate the wish to break free, it is humanly impossible to become fully alive in the present without facing and owning all of the hated, disavowed parts of the self that have shaped and been shaped by one’s earliest object attachments. “Cure me of my blindness, but do not leave me in a void while I am learning to see. If I may come to know, finally, that seeing is not illness, will I exist at all?”

No matter what we say—and we say plenty—about diagnosis, nosology, severity of pathology, and psychoanalytic technique, it could be reasonably suggested that our clinical approach to any given patient is most broadly outlined by whether that person possesses the developmental maturity to conceive of asking the question: “Why am I living this way?” I’m not speaking about whether he has ever thought about what “this way” means or whether he has ever seriously attempted to answer the question. Some individuals come into treatment tortured by the question, having asked it for years without feeling any closer to an answer, while others have never asked it because, for them, the concept of “why am I living my life this way?” has no personal meaning. It is as if they have been able, somehow, to disprove Socrates’ time-honored opinion (Plato/Jowett, 1986, p. 22) that “the unexamined life is not worth living,” and seem to live it anyway, but invariably in great pain.

For them, the question of “why” is inherently unaskable, and no matter what we may say diagnostically about such an individual when they choose to enter treatment with us (usually in search of some relief from their pain), the initial phase of therapy either succeeds or fails depending upon whether it enables the person to reach a point where that question becomes in fact askable. Unless this point is reached, analyst and patient will have very different images of the “reality” in which they coexist and the purpose of what they are doing, and in my experience, some of the “inevitable” treatment stalemates and failures in working analytically with such patients are created by each partner trying, futilely, to force his own “treatment reality” into the mind of the other.

Dissociation and Conflict

Increasing a person’s capacity to question the way in which he is living his life requires a clinical process that expands the development of self-reflectiveness. Self-reflectiveness, traditionally referred to as the presence of “an observing ego,” has been the most often cited criterion of analyzability. It allows a patient fully to exist in the moment and simultaneously perceive the self that is existing. The ability of the human mind to adaptationally limit its self-reflective capacity is the hallmark of dissociation, a phenomenon that, in both its normal and pathological forms, is being taken increasingly seriously by most contemporary schools of analytic thinking. As a defense, dissociation becomes pathological to the degree that it proactively limits and often forecloses one’s ability to hold and reflect upon different states of mind within a single experience of “me-ness.” It is my view that this burgeoning of psychoanalytic interest in dissociation as basic to human mental functioning, and equally powerfully, in the phenomenology of mental-states, reflects an even more central shift that has been taking place with regard to our understanding of the human mind and the nature of unconscious mental processes—toward a view of the self as decentered, and the mind as a configuration of shifting, nonlinear states of consciousness¹ in an ongoing dialectic with the necessary illusion of unitary selfhood.

In my writing over the last two decades I have been developing a clinically-based perspective increasingly focussed on the central role of dissociative processes in both normal and pathological mental functioning, and its implications for the psychoanalytic relationship. Data from many sources, both research and clinical, underline the fact that the human psyche is shaped not only by repression and intrapsychic conflict, but equally, and often more powerfully, by trauma and dissociation. My thinking evolved initially from my treatment of patients suffering from personality disorders, but I believe it to be applicable to any therapy patient regardless of diagnosis. The traditional analytic view of the therapy relationship is that of a process technically designed to facilitate the lifting of repression and the expansion of memory through the resolution of intrapsychic conflict. It is my argument that this view at best underestimates and at worst ignores the dissociative structure of the human mind and has forced us to omit from our clinical theory a central element in how personality growth occurs—an element that is present in every psychoanalytic treatment that is mutative and far reaching—the process through which the experience of intrapsychic conflict becomes possible. I am referring to the interpersonal process of broadening a patient’s perceptual range of reality within a relational field so that the transformation from dissociation to analyzable intrapsychic conflict is able to take place.

When I first began to publish analytic papers, I wrote quite a bit about the “schizoid personality” and almost nothing about “dissociation,” but I’ve never really surrendered my interest in the concept of “schizoid,” either conceptually or clinically. I think, however, that you get a richer picture of people who are schizoid if you take into account that they also have a personality structure that is extremely dissociative yet so rigidly stable that the dissociative structure tends to be noted only when it collapses (see chapter 13). I first began to touch upon this (Bromberg, 1979) in a paper which addressed the fact that the term “schizoid” started as a concept that defined a tendency towards disintegration and was nearly synonomous with “pre-schizophrenic,” but was actually much more interesting as an idea designating a stable character structure—at least it was to me. What intrigued me was that, apart from its dynamic origins as a mode of escape from certain...