In the Analyst's Consulting Room

Antonino Ferro, Philip Slotkin

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781583912225
• eBook ISBN: 9781317710776
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In The Bi-Personal Field: Experiences in Child Analysis, Antonino Ferro devised a new model of the relationship between patient and analyst. In the Analyst's Consulting Room complements and develops this model by concentrating on adults.
From the standpoint of the "analytic field", Antonino Ferro explores basic psychoanalytic concepts, such as criteria for analysability and ending the analysis, transformations that occur during the session, the impasse and negative therapeutic reactions, sexuality and setting. The author explores certain themes in greater depth, including:
* ways in which characters that appear during sessions can be interpreted
* continual indications given by the patient during the emotional upheavals of the field
* the function of "narrator" which the analyst takes on to mark the boundaries of the possible worlds.
Through clinical narrative, Ferro renders Bion's often complex ideas in a very personal and accessible way, making this book invaluable for psychoanalysts, psychotherapists, psychiatrists and psychologists.

Chapter 1
Criteria of analysability and termination

A radical vertex

I should like in this chapter to present some reflections on the particularities of field theories in relation to two key aspects of analysis, namely the decision to begin it and the decision to end it.

I should say from the outset that I am using the term “field” in the widest possible sense, the range of connotations extending from the basic conceptions of Baranger & Baranger (1961–62) and of Baranger, Baranger & Mom (1983) to the complex and sophisticated notions of Corrao (1986).

Corrao’s 1986 contribution includes a succinct specification of the field as “a function whose value depends on its position in space–time; it is a system with an infinite number of degrees of freedom, resulting from the infinite possible determinations assumed by it at every point in space and at every instant in time”. Comprehensive definitions and more detailed information can be found in Bezoari & Ferro (1990a, 1991b) and in Ferro (1993d, 1993f).

At the precise moment when the field takes shape, space–time is affected by intense emotional turbulence in the form of vortices of β elements, which evoke and activate the α functions and thereby begin their process of transformation into α elements – that is, predominantly, into “visual images” (Bion, 1962); the place “where” these images are manifested – whether in the story told by the patient or in the analyst’s reverie or countertransference – is immaterial. (Elizabeth Bott Spillius provides a useful summary of Bion’s ideas in her Introduction to The Bi-Personal Field (Ferro, 1999: x–xii).)

The emergence of images described by Bion is, however, the end-point of complex operations of transformation, which Bezoari and I previously attempted to describe by the metaphor of mills (Bezoari & Ferro, 1992a). I shall summarize this description below.

Two α functions come into play in the analytic encounter. The patient’s recounting of anecdotes, facts and memories imposes heavy demands on the analyst’s α function, which will be involved in the process of alphabetizing and semanticizing the patient’s communication. Let us say that the major part of the work in the analytic field is carried out by two mills, a windmill (for words) and a watermill (for projective identifications). The two mills are fed with large sacks of wheat (β elements), which must then be ground into flour (α elements), kneaded and baked (dream thoughts).

Many sacks of wheat are exchanged between the two mills (projective identifications passing back and forth); a larger number of sacks as a rule travel in the direction patient → analyst, unless the analyst is blocked or overloaded, in which case the flow may be reversed (Ferro, 1987; Borgogno, 1992, 1994a).

The communications between the two mills often tend to be in the raw state, so that they need threshing to separate the grain from the straw. The task of the α function in this case is gradually to grind down these elements to a finer consistency. For example, a high proportion of a given patient’s communications (which are unelaborated or in the raw state) are conveyed on the manifest level (by language) or underground (projective identifications), whereas a small number have already been transformed by the patient’s own α function. As a result of further processing by the analyst, new flour comes into being and the “functional aggregates”¹ produced by the mental work of both parties in narrating what is happening in the field and in the couple will take the stage.

The “character” (the term is used here also in the narratological sense of the main protagonist, so that it may even be an object in the animal or inanimate world) assumes not only the features of a “real external character” or of a “character from the internal world” but also the quality of a “syncretic narrative node”, which concretizes, contextualizes, shapes and names what is happening in the field, thereby allowing it to be visualized in three dimensions.

This is the way in which the emotional–linguistic text of the session is able to express emotions and affects in a processed form capable of being transformed, narrated and shared.

The basis of this conceptualization is the “waking dream thought” – that is, the continuous “dreaming-in-order-to-be-awake” constantly accomplished by the α function when it forms α elements, which are placed in the appropriate sequence, out of all the sensory, perceptual and emotional afferences reaching us at every existential and relational instant (Bion, 1962).

Waking dream thought continuously separates the conscious from the unconscious and prevents us from being captured by the latter, allowing us to live the experiences we are having without being overwhelmed by them, and to metabolize them in real time. Night dreams enable us to view the outcome of an ever ongoing process (Bion, 1962).

We perceive our waking dream thought through the “near narrative derivatives” of the α elements, which are at all times also signals of the emotional–linguistic text of the session.

The text signals become perceptible whenever our chosen vertex is that of listening to what comes from anywhere in the field (the patient’s story or dream, our countertransference, our own dreams, projective identifications, etc.) as a live renarration of the emotions and movements of the field and of the success or failure of transformations of the field in the only therapeutic direction, namely β → α.

These field signals are like markers that enable us to keep up the tension of β → α transformation, calling our attention to any departure from this mutative direction as a dysfunction of the field.

The field signals, which are the moment-by-moment resultant of the emotional forces of the field, are a highly significant approximation to the emotional truth of the field (the “O” of the couple); they stem from the mental functioning of the patient and the analyst and from their interaction and vicissitudes.

Of course, these characters can be seen from other vertices present in the field in accordance with alternative models which assign them to external or internal reality. The models in the field are in a state of mutual oscillation and are self-confirming from every theoretical vertex of observation.

Let us now consider the phenomena of analysability and termination by an approach that emphasizes the use of field signals.

Analysability or capacity to endure

There is a conspicuous disparity between the abundance of literature on the criteria of analysability and the scant measure of agreement exhibited by the relevant authors.

What strikes one first is the fundamental inconsistency between the development of the models and the broadening of the criteria themselves: the analysts who have contributed most to advancing our knowledge of analysis of serious pathologies are found to have concerned themselves only marginally with criteria of analysability.

It is in my view more useful to invoke the criterion of capacity to endure, in the sense that every analyst ought to be conscious of the point to which he feels he can be pushed to analyse, on the basis of his own analysis, mental functioning and tolerance of risk and frustration. This consciousness should take account, too, of the endurance of the analyst’s model: there is often a process upstream of repression that permits the construction and formation of the “apparatus for thinking thoughts” (Bion, 1962) before these thoughts can be processed, and sometimes even allows a hitherto seriously deficient α function to develop.

For a re-examination of the principal literature on the subject, it is worth consulting the comprehensive review by Limentani (1972), its later supplement (1988b), and the excellent review by Etchegoyen (1986).

It should, I think, be noted that authors on this topic have substantially tended to transfer their attention from the characteristics of the patient to those of the couple and to the interaction between a given individual patient and a given individual analyst.

At the same time the concept of analysability (understood as the possibility of a cure, seen as the end-point) has been supplemented and largely replaced by those of suitability for analysis (based more on the capacity to tolerate being in an analytic setting and to experience a process of transformation) (Limentani, 1972) and accessibility to analysis (where the only possible distinction is between readily accessible patients and patients who cannot easily be reached) (Joseph, 1985).

Again, many analysts have a sense of “alarm” at the possibility that an analysis might be broken off (as if “analysable” status guaranteed a process that would culminate in the completion of an expected terminal phase); however, the situation ought perhaps rather to be seen in terms of an analysis pursued as far as it can go (by the specific couple at work), in which case the analyst would have to accept, as Bleger (1967) puts it, that one analysis may end successfully whereas others might begin.²

Another cause for alarm is interminability, experienced as a defeat rather than indicating that the treatment cannot be ended owing to the particular pathology of the patient and the field – for such an analysis–dialysis may on occasion also be necessary.

I have only twice turned down requests for analysis (assuming that I had a vacancy). In the first of these cases, dating back to the beginning of my analytic career, the patient confronted me with emotional and existential material similar to that which I had only just worked through in my own analysis, which I did not yet feel solid enough to tackle in another person. The second patient, again in the early days of my work as an analyst, was a tall and bulky man who, while “I was following him” as he told his story, informed me that while driving his car he had sometimes felt “followed” and, if his suspicion was confirmed, he had stopped and beaten up his pursuer; this seemed to me sufficient reason “not to follow him”.

On other occasions when I have had time, I have never said no to a patient because I felt that he was unanalysable or that his pathology was too severe – even if I have sometimes paid dearly in toil and mental suffering for this decision, which, however, also made it possible to venture beyond already “mapped” territory.

An air of mystery – albeit perhaps slight – surrounds the situation when the analyst says yes despite not having a vacancy:³ the patient’s material happens to dovetail with the analyst’s theoretical and often practical interests at the time, so that the analyst too sets off to explore mysterious, obscure or otherwise insufficiently negotiated areas of his own mind (Meotti, 1987).

Alternatively, the analyst may fear a deterioration in the patient’s condition. This could indicate that the technique used is inappropriate to the patient’s needs or capacity (as demonstrated by psychotic transferences, negative therapeutic reactions and broken-off analyses; cf. De Masi, 1984; Gagliardi Guidi, 1992; Conforto, 1996), or it might be a necessary corollary of efforts to allow slumbering or encapsulated states of mind to be worked through.

Puget & Wender (1987) consider analysis to consist in the activation – often in extreme situations – of a psychoanalytic function capable of facilitating “the understanding and semanticization of what has been unconscious, uncomprehended and unthought up to that moment – a relief to mental pain”.

The analyst must, of course, look closely into his own general availability for accepting a new patient into analysis, and subsequently for accepting a given individual patient; he may find himself saying no to a particular individual patient because there is no place for a new patient.

As stated above, the opposite may also happen: although the analyst may not have a vacancy for a new patient, he may find a place for a particular individual patient. From the classical point of view, a thunderbolt of this kind would be a good reason for not taking on a patient who arouses such countertransference feelings, but how can one resist, and why? There will be time enough to regret it during the course of the analysis – just as, conversely, with patients accepted only because one had a vacancy, the analysis sometimes turns out to be very exciting. In my view, this only serves to confirm the infinite range of meanings that may be opened up, and of worlds that may be activated, in an analysis.

The first meeting might be imagined as the most neutral of all, taken up mainly by listening to the patient’s history or internal world. However, this idea is naive in the extreme: from the time of the first telephone call, or even before, patient and analyst begin to construct “couple” fantasies, which crystallize from the very first meeting (as Baranger & Baranger, for example, say). What is more, the listening model, if applied without consciousness, structures the field and ultimately confirms the analyst’s theories through a hallucinosis of microtransformations in which theory distorts the patient’s communication by the imposition of a single “reading”. Interpretative colonization then creates the domain of the non-existent, avoiding the painful and frustrating experience of confrontation with the void of not knowing, of the doubt aroused by prolonged dwelling in PS, pending activation by the field – the “true matrix of possible histories” (in accordance with the emotional genomes of patient and analyst and with their capacities for transformation) – of a “history” that cannot so readily be foreseen. From the very first meeting, there is in my view a continuous oscillation between two analytic functions. The first is the analyst’s “negative capability” (Bion, 1970), which includes an ability to remain in doubt, in PS, thereby allowing the emergence of an infinite range of potential histories (or meanings). In the second, the analyst opts for the “selected fact”. This entails the strong choice of an interpretative hypothesis born of an emotion which aggregates what was scattered in PS into a Gestalt that forecloses certain meanings in favour of a single prevailing one, while unequivocally reorganizing from a specific vertex what has formed in the field; this is an operation that takes place in D and involves mourning for that which is not.

This corresponds to the narratological concepts of the “open work” and of the “narcotization” of possible histories to allow the development of a single history, a practical demonstration of which is Diderot’s Jacques le Fataliste (Eco, 1979; Ferro, 1992).

Here is a brief example.

Carmen: her orgasm and her school report

Carmen was a young non-Italian woman whose first communication was that she was unable to attain orgasm with penetration. I specifically noticed that this was the first thing she told me during our meeting.

She went on to tell me of her present rather unsatisfying life and of the family she had left behind in a European town. After recou...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures
• Foreword
• 1 Criteria of analysability and termination
• 2 Exercises in style
• 3 The analytic dialogue
• 4 Interpretative oscillation along the PS–D axis in the field of transformations
• 5 The impasse
• 6 Sexuality and aggression
• 7 The “narrator” and fear
• Postscript
• Bibliography
• Index