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1
Psychoanalytic Engagement*
Darlene Bregman Ehrenberg
I
The Transaction as Primary Data
The interactive dimension of the patient–analyst relationship received considerable attention in the early work of Ferenczi (1916, 1950, 1955) and Rank (1929), and also in the interpersonal literature, particularly in the writings of Sullivan dating from the 1930s (published 1940, 1953, 1954, 1956, 1962), Fromm-Reichmann (1950, 1952), J. Rioch (1943), C. Thompson (1950, 1952), M. J. White (1952), Tauber (1954, 1979), Wolstein (1954, 1959, 1971, 1973), Feiner (1970, 1975, 1979, 1982), Singer (1971, 1977), Levenson (1972, 1974, 1981a, 1981b, 1982a, 1982b, 1983), Ehrenberg (1974, 1975, 1976, 1982), Epstein (1979), and Chrzanowski (1979). Attention to the analytic interaction is also evident in the writings of Lacan (1936, 1952, 1956, 1961), Winnicott (1947, 1963, 1969, 1971), Little (1951, 1957), Fairbairn (1958), Guntrip (1969), and Searles (1965, 1979).
In the classical literature the analytic interaction is considered in essays by Menaker (1942), Gitelson (1952, 1962), Anna Freud (1954), Stone (1954, 1961, 1973, 1981), Tower (1956), Loewald (1960, 1970), Kernberg (1965), Greenson and Wexler (1969), Viderman (1974), Sandler (1976), Lipton (1977), Gill (1979, 1982a, 1982b, 1983) and Klauber (1981).
Writing from a Kleinian perspective Heimann (1950) noted the analyst’s role in provoking the patient’s reactions, and Racker (1957) and Baranger and Baranger (1966) elaborated field models of the analytic interaction. Following the Barangers, Langs (1976, 1979, 1981) made this conception the fundamental consideration in his own extensive publications.
Although these authors differ in terms of their theories of personality, their concepts of health and pathology, their perspectives on technique, and their visions of cure, they agree that the analytic interaction constitutes a transactional field.
I believe this has radical implications for a theory of technique. If we accept the concept of the analytic interaction as a transactional field, we are forced to expand the traditional view of the transference as the analytic “playground” (Freud, 1914) and as the “point of urgency” (Strachey, 1934) to recognize that transference and countertransference constitute an interlocking unity, and that all of the transactions in the immediate field of experience constitute primary analytic data. This view also requires recognizing that even the more classical forms of interpretation and intervention have definite interactive meaning and consequences. It also follows that in the choice of whether to address the immediate transaction, and to what degree, or not to address it at all, the analyst exerts leverage on the way the relationship will evolve.
Since within the transactional framework whatever we do must be viewed as having impact and consequence, the analytic transaction, by its very interpersonal nature, provides unique opportunities for new experiences. The question I would like to explore is whether there are ways to intervene deliberately to facilitate the work.
In earlier papers (1974, 1975, 1976, 1982) I pointed out the value of making explicit the subtle cues sent and received out of awareness and the specific responses to them and how this makes it possible to use the interaction as a diagnostic tool as well as a therapeutic medium. My experience has been that focusing on the transactions between patient and analyst, and on what goes on affectively between (and within) each of them, as primary analytic data makes it possible to delineate what is being structured interactively in process. Styles and patterns of bonding, expectations, sensitivities, and patterns of responsiveness, including tendencies to collusion, or to carrying the emotions of the other, can begin to be clarified. This allows for also clarifying vulnerability to confusion as to what is self-generated or what may reflect some pattern of unconscious responsiveness in a moment-by-moment way. Becoming able to comprehend the ways in which one may be contributing to one’s own mystification, and one’s own resistances to functioning autonomously, allows the sense of helplessness one experiences when one is “mystified” (Laing, 1965) to be mitigated. This allows for disavowed experiences to be reclaimed, and for exploring the motivations for the prior disavowal in the context of a new sense of choice, competence, and responsibility. Emotionally significant associations to the past and memories of relevant historical material not available before often then begin to become accessible, allowing new perspectives on the past. This, in turn, can open a possibility for a necessary and important process of mourning. In this way the immediate interactive process can become a medium of and a locus of therapeutic action.
Nevertheless, there are times when even more may be required to facilitate those reparative (B. Ehrenberg, 1980) and restorative (Feiner, 1982, 1983)or corrective experiences (Loewald, 1960, 1970; Winnicott, 1963; and Gill, 1982b) that may be necessary for further change to occur.
II
The Nature of the Analyst’s Engagement
Most of the literature on countertransference (as of 1984) advises that analysts monitor their reactions as a “clue” to better understand the nature of the treatment issues, and as a means of identifying subtle transference phenomena (See Epstein and Feiner, 1979, for an overview). This is in the tradition of Heimann (1950) who warned against the analyst’s undisciplined discharge of feelings, to avoid the evident dangers of acting out, wild analysis, manipulation, or the intrusive imposition of the analyst’s residual pathology. Such caution seemed warranted in light of the fact that some of the early explorations of more direct participation by the analyst, such as the early radical endeavors of Ferenczi (see Jones, 1957) and Alexander (1956), raised legitimate concern that active participation by the analyst might eventually compromise the integrity of the analytic work. Later efforts in which the analyst participated by assuming a “supplementary” role in relation to the patient’s “faulty ego” (see McLaughlin, 1981) helped clarify that this often interfered with achieving analytic goals. For these reasons direct participation came to be considered controversial by analysts of all points of view. (McLaughlin, 1981; and Witenberg, 1976).
Nevertheless, despite the evident potential angers, there is a growing literature from all psychoanalytic schools of thought suggesting the possibility that the analyst’s more direct affective engagement can be constructive in advancing the analytic effort without compromising its integrity. Such participation need not involve the “lending of egos,” acting out, manipulation, seduction, mystification, nor any other non-analytic gesture. Many authors have also noted that with more disturbed or primitively organized patients the analyst’s active responsiveness may be essential if any kind of therapeutic change is to be achieved. This body of work includes the papers of J. Rioch (1943), Winnicott (1947, 1969), Little (1951, 1957), Fromm-Reichmann (1952), Tauber (1954, 1979), Stone (1954, 1961), Tower (1956), Nacht (1957, 1962), Wolstein (1959), Gitelson (1952, 1962), Searles (1965, 1979), Singer (1971, 1977), Levenson (1972, 1983), Bird (1972), Stein (1973), Ehrenberg (1974, 1975, 1976, 1982), Sandler (1976), McDougall (1979), Feiner (1979, 1982, 1983), Bollas (1983) and Hoffman (1983).
In the vanguard emphasizing the value and importance of the analyst’s explicit affective reactions was the seminal work of Winnicott (1947). He focused on the importance of knowing that one can evoke the analyst’s hatred so that one can work through one’s own, and of the opportunity to experience that it is possible for the analyst to withstand and survive one’s aggression. Addressing the experience the patient needs with his analyst he wrote: “If the patient seeks objective or justified hate he must be able to reach it, else he cannot feel he can reach objective love” (p. 199).
Winnicott (1947, 1969) also notes that the opportunity to discover that one has an impact, and what that impact is enables the patient to clarify the limits of his or her assumed helplessness as well as his or her assumed omnipotence in relation to the analyst and that the unflappable analyst may be useless when it would have been essential for the patient to know he or she is able to elicit the analyst’s responsiveness. He or she also cautions that there are moments when the analyst’s assumption of a non-responsive stance may foster the patient’s mystification or, at the extreme, provoke a suicide.
I would add that it is also important to be able to explicitly acknowledge and address the interactive subtleties of what transpires affectively between patient and analyst, including the ways they connect and the ways they lose each other, in real time and in real ways, as this shifts from moment-to-moment; and just as for some patients the opportunity to experience that one can get into a toxic interaction and move through it to a positive place can become a revelation and the medium of “working through,” for others, the discovery that neither participant need be damaged or diminished by expressions of positive feelings and experiences of closeness is equally important.
Searles (1965) and Singer (1971) note the beneficial consequences a patient derives from the experience of his ability to give to the analyst, to feel useful, relevant, appreciated. Searles (1965) also describes how some patients need consensual validation so as to remain convinced of the reliability of their own perceptions (particularly those perceptions of the therapist). He describes the ego-fragmentation that can occur if this is not provided.
Stern (1983) notes that certain categories of experience “can never even occur unless elicited or maintained by the actions of another and would never exist as a part of known self-experience without another” (p. 74).
What I am stressing is that certain kinds of experiences simply cannot be achieved if the analyst is not affectively engaged and responsive in particular ways.
Several authors have stressed that when the patient’s resistance takes the form not simply of detachment, but of an effort to render the work useless, dealing with this in a constructive and effective way is essential if the patient’s growth in the analytic relationship is to remain possible (Fromm-Reichmann, 1950; Tower, 1956; Winnicott, 1947, 1969; Nacht 1957; Bird, 1972).
Bird (1972) writes that there are times when “our not confronting the patient becomes in itself not merely an unfriendly act but a destructive one. By not confronting the patient with the actuality of the patient’s secret, silent obstruction of analytic progress, the analyst himself silently introduces even greater obstructions” (p. 249).
I agree that, while we cannot always avoid the negation of ourselves, violations of the process, or even our own collusion in these violations, we must be able to address these issues and that there are also times when the analyst must take a stand and set limits to protect the relationship and the work from becoming unduly compromised. Nevertheless, I think that it is not just a matter of setting limits. What is also often crucial is demonstrating our commitment to the process and to the relationship despite the patient’s behavior and despite our own reactions to it.
In this kind of process the goal is not to stay outside the danger zones, and protect against toxic developments or to simply survive them but to help identify the danger zones and to find ways to safely enter them and deconstruct (and demystify) the interactive subtleties so that the potential time bombs can be defused once and for all. For some patients the new experience that the analyst is willing to engage with them even when it is risky and problematic can be profoundly meaningful. The opportunity this can provide to discover that it is possible to touch and be touched in a positive way, even in the context of negative interactions, and that it is possible to move through a toxic interaction and reach a positive outcome, can constitute an experiential kind of insight that throws old assumptions open to question. Fears of contact as being inevitably dangerous to self, to other or to both, or conflicts about contact, can be worked through as they are challenged by the live new experience of the moment. If there is no possibility of emotional contact, this kind of process simply cannot occur.
Acknowledging that a patient has been able to scare us or arouse our anger also can be crucial. Some patients have told me explicitly that had I not reacted and shown that I was vulnerable when they threatened me or acted out in destructive ways, they would have kept upping the ante until they were able to provoke my reaction. The point here is that deconstructing and defusing potentials for escalating toxicity in the crucible of the actual lived interactive experience in a moment-by-moment way is not simply a way of creating the conditions for constructive work; in itself it becomes an important medium of the work. This allows for clarifying the ways power and responsibility may be disavowed without conscious awareness and also for discovering that it is possible to make reparations and to have them be accepted when one has failed the other in some way (Fromm-Reichmann, 1950). In addition, establishing that one need not be bound by the limitations of the other, and that one cannot use the limitations and failings of the other to exempt oneself from responsibility for one’s own behavior, can also be profoundly important.
What I am stressing is that the analyst’s more direct affective engagement not only can be constructive, but may also be essential. Of course, it matters how we engage affectively, how we work with what goes on affectively between patient and analyst, and whether we deal with this explicitly and constructively.
Clinical Examples
My focus is on the analyst’s...
