Doubt, Conviction and the Analytic Process

Selected Papers of Michael Feldman

Michael Feldman, Betty Joseph

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781317723370
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this profound and subtle study, a practising psychoanalyst explores the dynamics of the interaction between the patient and the analyst. Michael Feldman draws the reader into experiencing how the clinical interaction unfolds within a session. In doing so, he develops some of the implications of the important pioneering work of such analysts as Klein, Rosenfeld and Joseph, showing in fine detail some of the ways in which the patient feels driven to communicate to the analyst, not only in order to be understood by him, but also in order to affect him.

The author's detailed descriptions of the clinical process allow the reader to follow the actual process that enables the patient to get into contact with thoughts and feelings of which he or she was previously unconscious or only vaguely aware.

Feldman makes the reader aware of the constant dynamic interaction between the patient and the analyst, each affecting the other. He shows how the analyst has to find a balance between doubt, uncertainty and confusion in himself and through this process may arrive at an understanding of what is happening, and by formulating this understanding the analyst can make a significant contribution to the process of psychic change.

This collection of essays not only throws light on fascinating questions of technique, but also reflects on elements that are fundamental to psychoanalytic work. It is essential reading for practising psychoanalysts and those in training, as well as anyone with a general interest in the psychoanalytic relationship between the client and the therapist in the consulting room.

1
The Oedipus complex: manifestations in the inner world and the therapeutic situation

Freud used the concept of the Oedipus complex to represent the central constellation of impulses, phantasies and anxieties that arise out of the conflicts in the child’s relationship with his or her parents. He began to develop the notion that the child internalizes versions of the parental figures, modified by the anxieties and phantasies that attach to them. Such internal figures affect, in turn, the child’s emotional life, and his relations to the world. Building on this model, Melanie Klein substantially developed the concept of the child’s internal world, internal objects built up through the mechanisms of introjection and projection. She described how, in the child’s phantasy, these figures relate to one another in complex ways, and that some of these relationships constitute early versions of the Oedipus complex (Klein 1928, 1932, 1945). Her clinical theories about the nature and the relationships of these internal figures to one another, and the way they were projected into new relationships enabled her better to understand what was being experienced by the child, and what she could observe in the transference.

In this chapter and those that follow I hope to illustrate the way in which it is possible to explore these dynamics within the closely observed framework of the psychoanalytic session. In particular, I believe it is possible to observe the familiar but compelling way in which the patients’ experiences of the figures of their childhood remain alive in their mind and influence their current relationships, including the way they experience and use the analyst.

One of the characteristics of the Oedipal situation, which is reflected in the analysis, is that the participants often find themselves pulled in more than one direction. Each option seems to involve a compromise and may require a blurring or avoidance of aspects of reality that arouse too much pain or guilt. In Sophocles’ play, Oedipus did not make a conscious decision to kill his father and marry his mother; the choices that presented themselves to all the participants seemed to be the best ones at the time, and the marriage had the approbation of the people of Thebes, even though there were those who knew the truth and presumably considered it best to remain silent. The awful reality emerged only slowly, with difficulty, and at considerable cost (Vellacott 1971; Steiner 1985).

I hope to illustrate not only the way in which these subtle dilemmas are conveyed in the analytic material, but also how the analyst often finds himself drawn into a re-enactment of the dilemma that was originally the child’s, but in which the parent has become inescapably involved. The development of our understanding of the processes of projective and introjective identification, which we owe to Klein and a number of research workers who followed, makes it clear that some of these complexities are inevitable. There is often a partial and shifting identification with each parent, and each parent becomes, in turn, imbued with qualities projected into him or her by the child. The drama thus often involves complex reversals, and the analyst’s role vis-à-vis these different figures must reflect some of these complexities.

It is only by careful attention to the dynamics of the session, in particular to the countertransference experience (including the subtle pressure on the analyst to act in particular ways), that some of these aspects of the Oedipus situation can be recognized. They are often derived from a very early period of the patient’s experience and are not represented in his mind in words, but in feelings or actions or impulses towards action. Even if they do derive from slightly later stages of development, they often involve perceptions and interactions with parental figures that were characterized not by verbalization but by uneasy collusions or evasions. I hope to show how this gives rise not simply to problems in understanding the patient, his or her phantasies, anxieties and conflicts, but to technical difficulties for the analyst in knowing how to handle the situation and deal with the pressures that draw him into an enactment of aspects of the Oedipal situation.

In order to cope with powerful conflicting wishes about family relationships, the child may resort to projective mechanisms designed to diminish the extent of the conflict, and the accompanying anxiety and pain. The parent may then experience a disturbing dilemma, resulting in part from the parent’s own Oedipal conflicts and in part from the child’s projections. Because of his or her conscious or unconscious awareness of the intensity of the emotions involved, any course of action has important implications. To take a simple example: a father may be made aware of his young daughter’s sense of exclusion and jealousy, and the intense sexual and aggressive impulses evoked in her by these emotions. His sensitivity to this may arise from his partial identification with the excluded child, and he may have some inkling of the nature of the child’s phantasies regarding him and his relationship with his wife. As a consequence of his conscious or unconscious awareness, he may feel uneasy about taking his daughter on his knee, out of a fear that it might further stimulate her belief in their excited sexual alliance against the mother. If he does not take her on his knee, however, she may experience this as a rejection, perhaps as evidence of his unease about the situation, and thus a confirmation, in a different way, of her Oedipal phantasies.

There is thus no way the father can behave that will not stimulate the child’s aggressive and/or sexual phantasies. What the child needs of him is that he have some awareness of these impulses, yet retain a sure sense of himself as a parental figure (part of which involves experiencing himself as a member of a mature couple), so that the child’s impulses and phantasies (and his own) neither have to be denied nor acted out.

This underlying model is both re-experienced and recreated in the analytic situation and will determine the nature and quality of the transference and countertransference. What I want to illustrate in the clinical material that follows is how the patient’s material and the dynamics of the transference situation can lead us to understand the individual’s experience and allow us to construct a view of the nature of the parental interaction, and the way the patient relates to it.

One important consequence of this view of the Oedipal configurations that exist in the patient’s inner world is that it enables us to study their influence on his basic mental functions. If the patient negotiates the Oedipus complex in a relatively healthy way, he has an internal model of an intercourse that is, on balance, a creative activity. This seems to be directly connected with the development of the patient’s capacity to allow thoughts and ideas to interact in a fruitful way. On the other hand, the phantasy that any connection between himself and another person will create a bizarre or predominantly destructive couple seems to result in damaged, perverse or severely inhibited forms of thinking. In my clinical illustrations, I try to examine the nature of the Oedipal couple existing in the patient’s mind, partly derived from his perceptions and partly distorted by projection. This not only influences the patient’s experience of the transference but also tends to manifest itself by engaging the analyst in a reenactment of the Oedipal conflicts. Finally, I hope to indicate some of the ways in which the patient’s phantasies regarding the nature of these relationships influence his thinking.

First clinical illustration

My first patient was a young man, Mr J, the youngest of four sons, whose parents were both involved in the theatre. His mother was a talented and successful actor. In a session that followed a long weekend, he at first was silent; he then began to speak in a constricted, self-conscious, quite frustrating way. He made no mention of the weekend but referred after a while to a dream he had had. In the dream, he was on a stage, parading himself, dressed in silk underclothes similar to the ones he recalled his mother wearing as she prepared herself for the theatre. There were not many people in the audience, but he particularly noticed an older man, who looked rather dishevelled and who seemed to be tantalized and excited by him. The man was, however, forced to remain on the other side of the footlights, as if separated from him by a pane of glass. The patient said he thought this man was a ‘pure homosexual’. He had linked the figure to myself, and this had been a source of pleasure and excitement. He also seemed to be quite excited while telling me about the dream.

The patient had always felt himself deprived of proper attention and love. While his parents presented themselves as sympathetic and caring (and in many ways did their best for him, I think), the patient never felt properly looked after: he never fully believed in the quality of their care, or that he could properly hold the attention of either parent. He tried to overcome this by offering himself to them as ‘special’ – either he was especially ill or unhappy, especially good, or, sometimes, especially exciting to one or other parent.

With his father in particular, there seems to have been the phantasy of taking the mother’s place, and this was expressed over the weekend by the dream, in which he made himself exciting by getting into her clothes. And yet, in a sad and touching way, he conveyed that he never really believed that any of this would succeed. In his dream the man was a ‘pure homosexual’, which meant someone who had no interest in real women, but who found my patient, dressed in women’s underclothes, tantalizing and exciting. The dream demonstrated the absence of any proper contact between my patient (who was identified with a peculiar, contrived figure) and the man for whom he was parading himself in this theatrical fashion. On the contrary, it makes explicit his sense of being cut off from his objects, as if by a pane of glass.

This corresponded very closely to the patient’s experience in the past, when he felt doubtful about being able to engage his parents’ attention properly, whatever he did, and his experience in the analysis, where he often felt he had to produce something that would really grip my attention. At times he seemed to believe, or at least half-believe, that he could succeed, but at other times he had to produce more and more bizarre actions, which might even then not have the desired effect.

I thought the patient had dealt with the experience of the long weekend, my absence, and his feelings of loneliness, jealousy and frustration by projecting, in his phantasy, the feeling of being left out, excited and tantalized. By reversing the roles, he replaced me and became a figure who paraded himself in this provocative way. Moreover, this was not simply a phantasy that relieved him during the weekend, but one that was partly enacted during the session. The patient’s initial silence, his hesitant and provocative way of speaking, and the sense of being in possession of exciting and provocative mental underwear – his dreams or sexual phantasies, that I would be interested in – made this real in the session. He always tried very hard to judge what would interest me and what would affect me, and hence make him special for me. He was touchingly preoccupied with the need to be the patient who I was most interested in or excited by, or the patient who understood me best, was most sensitive to my state of health, or my state of mind. At other times, he seemed to want to be the patient who unsettled me the most, who caused me the most concern, the one with whom I would remain preoccupied between sessions.

However, as I have indicated, this often failed in its desired effect, and rather than evoking curiosity, jealousy or excitement, he was more likely to provoke feelings of sympathy, concern or at times even despair.

There are various ways of understanding the nature of the countertransference experience with this patient. It often seemed that when he was in possession of intense and disturbing feelings he was not properly able to employ projective mechanisms to reach his object. Thus, some of the problems in his early relationship with his parents might have resulted from his failure to communicate with them properly by means of projective identification, making it difficult for them actually to know what was going on in him, as they did not properly feel the impact of his needs and his anxieties. One could see the pane of glass in his dream as a concrete representation of this difficulty. In the sessions, this often made it difficult for me to reconcile what the patient was saying with what he was communicating about the nature of his experience.

The other aspect of this concerns the way in which his objects were perceived and experienced. Bion (1959) described the situation in which the infant is confronted with a parental figure who responds dutifully to him without being able to receive or tolerate the infant’s projections, which then become more and more violent and disordered, giving rise to a hopeless, vicious circle.

My experience in the transference convinced me that there the patient had very little conception of a parental object capable of containing what he might project into it, or of a healthy Oedipal couple, engaged in a creative intercourse – which implies, of course, the relation of container and contained. Instead, there was a couple who went through the motions of being linked, while actually separated by the footlights or by a pane of glass.

This could be the product of his envious attack on such a couple, which as a consequence presented itself to his mind as a bizarre, combined parental object, such as that described by Melanie Klein (1932). Alternatively, he might have had a perception or an intuitive sense of the parental couple as being, in fact, damaged – a pathetic, confused combined figure. Although they presented themselves to him as healthy and exciting, as if meaning to evoke his envy and jealousy, they largely failed to do so, and he was actually confronted with a more disturbing situation. He thus re-created in the analysis the Oedipal situation in which there was a bizarre figure, composed of elements of mother and father, which was meant to arouse a great deal of excitement and jealousy, but which had a much more awful effect in that it evoked pity and a feeling of hopelessness.

For much of the time, the two of us were felt to constitute such a bizarre, uncreative couple. Sometimes he would perceive me as posturing as a healthy, vigorous object, one that he knew to be peculiar and damaged and hence indistinguishable from himself. There were other times, however, when he seemed able to recognize a difference between us, and this allowed us to do real analytic work for a time, which was accompanied by a sense of relief and gratitude. It was striking that at such times his own thinking acquired a different quality – it was more coherent, and he seemed to have a real sense that things in his world had meaning. At times like this, there was much less vagueness, excitement and fragmentation in the way his mind worked. However, such periods of constructive work were short-lived and stimulated a desperate, destructive envious attack.

As I have indicated, there seemed to be a relationship between the quality of the patient’s thinking and the nature of the Oedipal couple represented in phantasy and reflected in the transference at any given time. The patient usually found it extremely difficult to make proper connections in his own mind, to do any thinking for himself. Instead, his ‘thinking’ often consisted of the agglomeration of two ideas in a peculiar way, with no meaningful link between them. As we saw in his dream, he would often present this bizarre conjunction as if it were desirable, even exciting. Just as he found it difficult to tolerate any knowledge of the disturbing quality of the parental relationship (and felt his parents could not tolerate it), so he found it painful and frightening to face what went on in his own mind, and he was driven into making these peculiar, desperate combinations, which were often accompanied by excitement and always by a sense of isolation.

Although I thought he was not properly able to use projective mechanisms to communicate his feelings and anxieties, at times he felt driven to project these more desperate and disordered functions into his object. In the countertransference I experienced them in the form of a pressure to make banal interpretations or to link things in a way that would ‘do’ but did not feel right, and which I knew to be of no use. The effect of doing this was to relieve both of us temporarily, while increasing an underlying feeling of frustration and despair.

When I was able to resist this pressure to enter into the world of the dream and retain my capacity to think in a different way, even though this was sometimes difficult and painful, it seemed to strengthen the patient’s contact with reality and with his own internal world.

Second clinical illustration

I would now like to turn to a second case, that of a young woman, Ms N, in whom the Oedipal couple was represented very differently, with a different set of phantasies and anxieties structuring the transference. The patient’s thinking was affected by her need constantly to provide internal reassurance against her fears of being rejected or attacked, and there was a corresponding pressure on the analyst to fit in with this.

The patient’s parents had separated when she was very young, and her childhood had been dominated by a painful and difficult relationship with her mother, a very disturbed woman. Her mother criticized and denigrated the absent father, blaming him for everything, always putting herself completely in the right. My patient was under considerable pressure to accept this version of events, and any attempt to question the truth of what was presented to her was liable to produce an angry and violent response. She gradually became aware of the degree of her mother’s disturbance and the elaborate web of lies and distortions with which she had grown up, but she was always too frightened to challenge this.

At the same time she entertained secret phantasies of her father returning to rescue her. It was important for her to imagine that he would see that she had done her very best; it was she who had not only done well at school, but also tidied up the house and cooked the meals; her mother had been bad, cruel and neglectful. He could hardly fail to take her side and take her away with him. The alternative scenario, which she hardly dared contemplate, was that her mother and father would ‘gang up’ against her, identify her as aggressive, nasty and dirty and get rid of her.

In the session prior to the one I will describe in detail, the patient had brought up familiar difficulties in the relationship with her partner, in which she often felt painfully rejected. She was quite defensive about her contribution to any of the problems, and it took some time before she was able to acknowledge her own hostility and resentment. As the session proceeded, she became less defensive, and a more complex, real picture of their interaction began to emerge. She seemed to feel that something important had been addressed and to experience some relief.

She arrived a few minutes late for the next session, and she carefully explained how she had been delayed by things that were quite beyond her control. She then said that something had happened the previous day that she felt tempted to push away, but then thought she ought to talk about it, especially as there was nothing else she could think of to say.

She described how busy she had been with a variety of tasks and emphasized how well she had coped. She had been able to remain very patient and calm with all the people she had had to deal with. Her partner had had a meeting to attend in the evening, and as he was very short of time, she had prepared a nice snack for him to eat in her car. She had been very patient and understanding and had raised no objections to his going out, even though she had seen very little of him.

From the way she was speaking, I had a fairly good idea that the story would turn out in a familiar way, with my patient let down, hurt and disappointed.

When her partner returned from his meeting, he was very tired and just sat in front of the television. He said he wanted to hear the news, and she did not mind, although she had heard it herself an hour before. While sitting there, he dozed off, which I knew often irritated her.

Then his friend Peter telephoned, and he spoke to Peter for about half an hour. It was nothing urgent or connected wit...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Preface
• Introduction
• Acknowledgements
• 1 The Oedipus complex: manifestations in the inner world and the therapeutic situation
• 2 Splitting and projective identification
• 3 Projective identification: the analyst's involvement
• 4 The dynamics of reassurance
• 5 The illumination of history
• 6 Manifestations of the death instinct in the consulting room
• 7 Envy and the negative therapeutic reaction
• 8 Addressing parts of the self
• 9 'I was thinking . . .'
• 10 The defensive uses of compliance
• 11 Grievance: the underlying Oedipal configuration
• 12 Filled with doubt
• 13 The problem of conviction in the session
• References
• Index