Authenticity in the Psychoanalytic Encounter

The Work of Irma Brenman Pick

Irma Brenman Pick, M. Fakhry Davids, Naomi Shavit, M. Fakhry Davids, Naomi Shavit

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780815385462
• eBook ISBN:
  9781351201490
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Authenticity in the Psychoanalytic Encounter brings together Irma Brenman Pick's original contributions to psychoanalytic technique. Working within the Kleinian tradition, she produces vivid clinical narratives that succeed in shedding a humane light on the struggles that patients – and, indeed, all of us – face in recognising, in an authentic way, our need for, and the contribution of, others in our lives.

Brenman Pick is interested in the infantile antecedents of conflict in her patients, and the book demonstrates the attention needed to sense how these may be present in the patient's clinical material. This involves an ability to understand the complex and sophisticated unconscious phantasies that are alive in the patient's mind. She combines this with a creative clinical imagination that allows her to address these expertly in the here-and-now of the analytic encounter. A particular feature of this is the way Brenman Pick uses the analyst's countertransference to bring in ways in which the struggle over authenticity also extends to the analyst. The focus on authenticity runs through the book and brings an interesting and original perspective to the topics discussed, which include adolescence, sexual identity, stealing and its relationship to the acknowledgement of dependency, the experience of uncertainty, concern for the object, destructiveness, creativity and the striving towards integration.

These contributions will prove invaluable to psychoanalysts, psychotherapists and other mental health professionals interested in deepening their understanding of the complex relationships that can arise in the consulting room.

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Part I

COUNTERTRANSFERENCE

Editors’ introduction

Brenman Pick makes an important observation concerning the psychoanalytic encounter: ‘If there is a mouth that seeks a breast as an inborn potential, there is, I believe, a psychological equivalent, i.e. a state of mind which seeks another state of mind’ (Chapter 1, p. 16). Based on this assumption, she has made significant contributions to the way in which the countertransference is understood and worked with.

The notion of countertransference recognises that projections from the patient are lodged in the analyst and may affect him or her. In the Kleinian tradition, Bion and Rosenfeld stressed the importance of the analyst being willing to receive and process these projections. Brenman Pick elaborates:

the patient does not just project into an analyst but instead patients are quite skilled at projecting into particular aspects of the analyst . . . into the analyst’s wish to be a mother, the wish to be all-knowing or to deny unpleasant knowledge, into his instinctual sadism, or into his defences against it. And above all he or she projects into the analyst’s guilt or into the analyst’s internal objects.

(p. 23)

The chapters in this section explore this theme from different angles.

Chapter 1, ‘Working through in the countertransference’, first published in 1985, explores in detail Brenman Pick’s understanding of the complex ways in which aspects of the patient’s mind may find a path into the analyst’s countertransference. In order to make sense of these, it is essential that analysts are willing first to feel the impact of the patient’s projections, and then to work with the resulting inner disturbance at a deep level. This inner work, which Brenman Pick thinks of as working through in the countertransference, lays the foundation for speaking to the patient in an emotionally genuine and grounded way; the patient has indeed succeeded in ‘getting through’ – a theme that she takes up explicitly in her later papers on authenticity. This chapter illustrates beautifully the creative way in which Brenman Pick works through the complex material the patient brings, and how the elegance of her interventions succeeds in conveying something of the depth of the analyst’s involvement with, and understanding of, the patient.

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Chapter 2, ‘Breakdown in communication: On finding the child in the analysis of an adult’, also first published in 1985, presents a detailed case study that illustrates further the points made in Chapter 1. The patient discussed uncomfortable, indeed unbearable, states of mind: the analyst could only know about these feelings by experiencing them herself, and then finding ways of putting those experiences into words for the patient. Brenman Pick shows how these dynamics emerged in the countertransference, and how important it was for the analyst to be aware of the feelings aroused in herself, to ‘hold and scrutinise them in order to be able to formulate for the patient the nature of the experiences that the patient had been avoiding having, and thoughts she had been avoiding thinking’ (Chapter 2, p. 31). She demonstrates how identification with this real, containing analyst is central to the patient’s recovery.

Chapter 3, ‘The emergence of early object relations in the psychoanalytic setting’, first published in 1992, outlines the Kleinian theory of the early split between idealised and denigrated objects, and two types of difficulty that may arise in integrating them. On the one hand, there is the frustration from failures on the part of the object to help the infant psychologically; on the other, there is destructiveness that emanates from inner sources. In this paper, Brenman Pick brings these considerations to the forefront, and they are foundational for her later work on the question of parental failure. She then provides detailed accounts of how these difficulties emerge in the analysis of an adult and a child patient – a particularly moving account of a child with autistic features who responds to her attempts to understand his struggles to find and hold on to his object. She shows how these struggles are sensed in the first instance in the countertransference – ‘the way the patient sees the analyst influences the way the analyst sees the patient’ (personal communication) – and how work based on that understanding helps towards integration.

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Chapter 4, ‘Working through in countertransference revisited’, first published in 2012, adds a further dimension to Brenman Pick’s previous work on this theme. She presents work that explores how analysts in supervision may bring into their relationship with the supervisor unprocessed, unconscious communications of the patient. This may shed light on the fact that patient and supervised analyst correspond too closely in some aspect of unbearable feeling. It is interesting to note that she is drawing attention to the fact that difficulties occurring in the patient–analyst couple emerge in the analyst–supervisor couple as well; this may echo the theme of transgenerational transmission discussed in other psychoanalytic contexts.

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1

WORKING THROUGH IN THE COUNTERTRANSFERENCE¹

In this chapter I am going to explore something about the complex interaction that takes place between analyst and analysand in our everyday work. Wilfred Bion made the succinct remark that when two people get together they make a relationship whether they like it or not; this applies to all encounters, including psychoanalysis.

James Strachey (1934), in his now classic paper on the mutative interpretation, spoke of a true transference interpretation being that which the analyst most feared and most wished to avoid, yet later went on to say that in receiving a transference interpretation, the patient has the experience of expressing murderous impulses towards the analyst and of the analyst interpreting these without anxiety or fear. Strachey is clearly implying that the full or deep transference experience is disturbing to the analyst, but conveying an interpretation in a calm way to the patient is necessary. The area I wish to address is this ambiguous problem, this walking the tightrope between experiencing disturbance and responding with interpretation that does not convey troubling anxiety.

While earlier understanding regarded countertransference as something extraneous rather than integral, Paula Heimann (1950) showed the use of the countertransference as an important tool for psychoanalysis and differentiated this from the pathological countertransference response. Although this differentiation is an essential part of our psychoanalytic endeavour, I wish to show how problematic it can be, in clinical practice, to make this differentiation. Indeed, I would suggest that there is no such absolute separation, only a relative movement within that orbit.

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It was Roger Money-Kyrle (1956) who considerably furthered our understanding of this issue by showing how closely the analyst’s experience of the patient’s projections may be linked with the analyst’s own internal reactions to the material. For example, he showed that in a difficult phase of an analysis the projection by the patient into the analyst of his incompetent self became mixed up with the analyst’s own feelings of professional incompetence in not understanding the material quickly enough, and these issues had to be disentangled.

Investigating this problem in its more ordinary manifestations, Money-Kyrle said:

If the analyst is in fact disturbed [and here it is implied that the analyst is inevitably disturbed in the sense of affected], it is also likely that the patient has unconsciously contributed to this result, and is in turn disturbed by this. So we have three factors to consider: first, the analyst’s emotional disturbance, for he may have to deal with this silently in himself before he can disengage himself sufficiently to understand the other two; then the patient’s part in bringing it about; and finally, its effect on him. Of course, all three factors may be sorted out in a matter of seconds, and then indeed the countertransference is functioning as a delicate receiving apparatus.

(1956, p. 361)

Indeed, in so far as we take in the experience of the patient, we cannot do so without also having an experience. If there is a mouth that seeks a breast as an inborn potential, there is, I believe, a psychological equivalent, i.e. a state of mind that seeks another state of mind.

The child’s or patient’s projective identifications are actions in part intended to produce reactions; the first thing that happens inside a living object into whom a projection takes place is a reaction. The analyst may deal with this so quickly as not to become aware of it: yet it is a crucial factor. The encounter is an interaction, and if it is being dealt with that quickly, we may have to ask whether the deeper experience is in fact being avoided.

A patient reported the following: when she was born, her mother was advised to send away her 18-month-old brother – in the event, to relatives far distant – so that the mother would be free to take proper care of the new baby. When the boy returned home six weeks later, the mother was horrified to find that he did not recognise his parents, and said that ‘wild horses would not keep them apart’ after that.

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I am struck by the metaphor and its relation to psychoanalytic practice. The advice contained in Freud’s metaphor of the mirror, or the analyst as surgeon, implicitly suggests that in order to take proper care of the patient’s unconscious, the analyst’s emotionality should be sent as far away as possible. The consequences of this attitude do result in the non-recognition of essential areas and the danger that when the split-off emotionality returns, ‘wild horses won’t keep it apart’ – with all the dangers of acting out. To imagine that this split-off emotionality won’t return is contrary to the very theories we hold in relation to mental life.

Unless we are to say that psychoanalytic function takes place in a conflict-free autonomous zone of the ego, we have to allow for the problems involved not only in digesting the patient’s projections, but also in assimilating our own responses so that they can be subjected to scrutiny. The analyst, like the patient, desires to eliminate discomfort as well as to communicate and share experience – both ordinary human reactions. In part, the patient seeks an enacting response, and in part, the analyst has an impulse to enact, and some of this will be expressed in the interpretation. This may range from an implicit indulgence, caressing the patient with words, to responses so hostile or distant or frozen that they seem to imply that the deprivation of the experience the patient yearns for is of no matter; a contention that a part-object mechanical experience is all that is necessary.

Yet an interpretation and the act of giving an interpretation, is not a part-object selection of a number of words, but an integrative creative act on the part of the analyst. It will include unspoken and, to some extent, unconscious communication about what has been taken in, and how it has been taken in, as well as information about what has not been taken in.

The patient receiving an interpretation will ‘hear’ not only words or their consciously intended meaning; indeed, some patients only listen to the ‘mood’ and do not seem to hear the words at all. Joseph (1975) has shown vividly that we may be misled by the patient’s words; the mood and atmosphere of the communication may be more important. The patient may operate with the same accent, listen to the analyst’s speech in the same manner. His perceptions may be considerably dominated by his internal configurations and phantasies, but I believe, following Klein’s account, that

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In the young infant’s mind every external experience is interwoven with his phantasies and . . . every phantasy contains elements of actual experience, and it is only by analysing the transference situation to its depth that we are able to discover the past both in its realistic and phantastic aspects.

(Klein, 1952, p. 437)

Inevitably, the patient too will take in, consciously and unconsciously, some idea of the analyst as a real person. When we speak of the mother giving the baby the nipple, we do not consider a simple nipple–mouth relationship; we recognise that the baby takes in a penumbra of experience. There is always something in excess of the actual process. We see reported ‘The patient said . . . and the analyst interpreted’, yet the complexities are enormous. To address the question of how the analyst features in the internal world of the patient, we not only need to move into the paranoid-schizoid internal world of the patient, but also require some flexibility in tolerating and working through the tensions between our own conscious and unconscious impulses and feelings towards the patient.

Constant projecting by the patient into the analyst is the essence of analysis; every interpretation aims at a move from the paranoid-schizoid to the depressive position. This is true for both the patient and the analyst, who needs again and again to regress and work through. I wonder whether the real issue of truly deep versus superficial interpretation resides not so much in terms of which level has been addressed, but rather to what extent the analyst has worked the process through internally in the act of giving the interpretation.

A patient, Mr A, had recently come to live in London; his first analysis had taken place abroad. He arrived for his session a few hours after having been involved in a car accident in which his stationary car was hit and badly damaged – he himself just missed being severely injured. He was clearly still in a state of some shock, yet he did not speak of shock or fear. Instead he explained with excessive care what had taken place, and the correct steps taken by him before and after the collision. He went on to say that by chance his mother (who lives abroad) phoned soon after the accident, and when told about it responded with ‘I wouldn’t have phoned if I’d known you’d have such awful news. I don’t want to hear about it’. He said that thanks to his previous analysis, he knew that he needed to understand that his mother could not respond in a different way, which he accepted. He was, however, very angry with the other driver, and was belligerent in his contention that he would pursue, if necessary to court, a claim for the damages.

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He conveyed very vividly his belief that he would have to bear alone or be above the immediate shock, fear and rage generated both by the accident and the mother’s response to it. Not only did he believe that his mother did not want to hear the awful news, but that his analyst did not want to hear the awful news of there being a mother/analyst who does not listen to or share pain with him. Instead, he felt he had been taught to ‘understand’ the mother or listen to the analyst, but was left with an angry underlying resentment that the mother/analyst would not listen to his distress. He went along with this, pulled himself together, made a display of behaving correctly and became a so-called ‘understanding’ person. He replaced the distress of bearing pain with a competence in doing the right thing, but let us know that unconsciously he would pursue his grievances to the bitter end.

Although he moved quickly from vulnerable victim to perpetrator of competent cruelty (consciously against the other driver, unconsciously against the mother and previous, and current, analyst), I also experienced an atmosphere that led me to believe that there was space for a more genuinely creative relationship to develop. In the countertransference I felt that what I was asked to bear was not excessive, and that while there was a patient who did not want to know, I could also rely on there being a patient who shared wanting to know with me.

Now let us consider what took place in the session. The patient made an impact in his ‘competent’ way of dealing with his feelings, yet he also conveyed a wish for there to be an analyst/mother who would take in his fear and his rage. I interpreted the yearning for someone who will not put down the phone, but instead will take in and understand what this unexpected impact feels like; this supposes the transference onto the analyst of a more understanding maternal figure. I believe, though, that this ‘mates’ with some part of the analyst that may wish to ‘mother’ the patient in such a situation. If we cannot take in and think about such a reaction in ourselves, either we act out by indulging the patient with actual mothering (this may be done in verbal or other sympathetic gestures) or we become so frightened of doing this that we freeze and do not reach the patient’s wish to be mothered.

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Yet already I had been lured into either admiring the sensible, competent approach, or appearing to condemn it. I found that I was having the experience of feeling superior to and judging the mother, the previous analyst and his own ‘competence’. Was I being party to taking them all of them to court? I then needed to reflect about the parts of himself and his internal objects that did not want to know. These too ...

Table of contents

• Cover Page
• Authenticity in the Psychoanalytic Encounter
• The New Library of Psychoanalysis
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgements
• Introduction
• Part I Countertransference
• Part II Authenticity
• Part III Adolescence And Sexuality
• Part IV Further Clinical Themes
• References
• Index