Dramatic Dialogue

Contemporary Clinical Practice

Galit Atlas, Lewis Aron

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351368599
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In Dramatic Dialogue, Atlas and Aron develop the metaphors of drama and theatre to introduce a new way of thinking about therapeutic action and therapeutic traction. This model invites the patient's many self-states and the numerous versions of the therapist's self onto the analytic stage to dream a mutual dream and live together the past and the future, as they appear in the present moment. The book brings together the relational emphasis on multiple self-states and enactment with the Bionian conceptions of reverie and dreaming-up the patient.

The term Dramatic Dialogue originated in Ferenczi's clinical innovations and refers to the patient and therapist dramatizing and dreaming-up the full range of their multiple selves. Along with Atlas and Aron, readers will become immersed in a Dramatic Dialogue, which the authors elaborate and enact, using the contemporary language of multiple self-states, waking dreaming, dissociation, generative enactment, and the prospective function.

The book provides a rich description of contemporary clinical practice, illustrated with numerous clinical tales and detailed examination of clinical moments. Inspired by Bion's concept of "becoming-at-one" and "at-one-ment," the authors call for a return of the soul or spirit to psychoanalysis and the generative use of the analyst's subjectivity, including a passionate use of mind, body and soul in the pursuit of psychoanalytic truth. Dramatic Dialogue will be of great interest to all psychoanalysts and psychotherapists.

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Chapter 1

Generative enactments

This chapter briefly introduces the concept of dramatic dialogue and sets the stage for our use of that concept by presenting several related ideas about enactment and generative enactment. The authors suggest that enactments are not only restrictive and repetitive, with therapeutic benefit resulting from their resolution. Rather, enactments themselves may also be generative and growth-enhancing. A few references to the origin and development of these ideas in psychoanalysis provide historical context to the development of our integrative model of dramatic dialogue.

This book emerged from the playful exchange between two voices, sometimes merged as one, and at other times distinctly different while remaining together in dialogue. As in the therapeutic encounter, we are “two people playing together” (Winnicott, 1971, p. 38), and our voices often mirror each other, merge, or split to hold dissociative and complementary parts of ourselves. We each play a range of characters, our and each other’s internal objects. As intermingled psyches and souls, we enact our internal scenes, dreams, conflicts, and fantasies. We invite you to mingle with us, to experience and re-experience, to feel, to love, and to hate, as we do. Following in Ferenczi’s footsteps, we ask you to enter, with us, dramatic dialogues.

Our model of dramatic dialogues invites the patient’s and analyst’s many self-states onto the analytic stage to dream a mutual dream and live together the past and the future, as they appear in the present moment. We are at play, and metaphorically in a theatrical play, enacting and engaging in the drama of psyches in dialogue.

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This book brings together the relational emphasis on enactment and multiple self-states with the post-Bionian conception of reverie, “becoming-at-one,” and analysis as a co-constructed dream, as it emphasizes a regulatory system that is greater than the sum of its parts. A relational model of multiplicity lends itself to the metaphor of theater, a dramatic model in which multiple self-states, like characters, are dramatized and enacted in the transitional space of the analytic stage. This is our theater of the unconscious.

Psychoanalysis, like the writing of this book, is a collaboration, as patient and analyst dream together and, through reverie and enactment, co-create their own unique idiomatic vision and version of their inner theater. Rather than a talking cure that splits speech and action and emphasizes the analyst’s inferences and interpretations, the analytic process facilitates living and re-living the psychic and relational reality of the session. This conceptualizing of dreaming and drama has, sometimes subtly and sometimes obviously, affected psychoanalytic thinking across schools and traditions in all parts of the world. Hence, a new vocabulary dominates psychoanalytic theorizing. Today’s analysts speak of multiple self-states, enactment, waking dreaming, subjectivity, intersubjectivity, co-creation, and unformulated experience: a new language of psychoanalysis.¹

Our writing reflects the changing style of psychoanalytic exposition, which follows developing trends in theory and practice. It is not surprising that such evolution would be accompanied by changes in professional communication and literature. Contemporary clinical work emphasizes the therapist’s subjectivity and the patient’s experience of the therapist’s subjectivity (Aron, 1996; Kuchuck, 2014). Similarly, current analytic writing features the writer’s subjectivity and the idiomatic use of clinical material. The author’s voice is not dictatorial, narrating from a position of mastery. Authors, even individual authors, are already multiple. Resonant with challenges to the analyst’s authority, the author’s voices are not hegemonic. We imagine the author/analyst as a participant in an ongoing exploration of many levels of knowing and not knowing. In addition, our understanding of enactment and parallel processes includes the realization that writing enacts its content, and in that sense we deliberately invite the reader to experience a version of our realities and to live through the enacted scenes with us.

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Throughout the book, and as Atlas (2016) elaborates in The Enigma of Desire, we use the term therapeutic tales, instead of speaking of cases or case presentations, in order to stress our understanding of these experiences as both subjective and intersubjective events. To “tell a tale” has different connotations than to “present a case.” Even though we received patients’ permission to write and publish their stories, we treat these as fiction or narrative, as we believe our creation is a translation of the conscious and unconscious, internal and external reality, not a mirror of it. The tales we write about our patients’ lives and about their minds are sketches filled with our own psychology as it is played out in the unique interaction with a specific patient. For that reason, we do not aim for a neutral presentation and instead add our personal voices and our dialogue, so as to enact the existence of two unconscious voices in the room and elaborate the zone of mutual vulnerability (Aron, 1996). This is our attempt to demonstrate through the writing itself the use of the intersubjective space, to deepen the clinical work and understanding of the unconscious.

In describing our own dramatic dialogue, we wish to evoke the spirits of Freud and Breuer (1895), who in the very first psychoanalytic book wrote about their own collaboration:

If at some points divergent and indeed contradictory opinions are expressed, this is not to be regarded as evidence of any fluctuation in our views. It arises from the natural and justifiable differences between the opinions of two observers who are agreed upon the facts and their basic reading of them, but who are not invariably at one in their interpretations and conjectures.

(pp. xxiv–xxv)

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Ferenczi’s clinical innovations

By the late 1920s, Ferenczi had been continuously experimenting with clinical technique for many years. He was interested in clinical outcome and clinically grounded theory rather than in abstract or removed theory. He dared to experiment with a range of clinical approaches and was encouraged in such experimentation by Freud himself, who was not averse to clinical variation so long as the findings did not challenge his major theoretical conclusions. In 1931, Ferenczi published a ground-breaking clinical paper, “Child-Analysis in the Analysis of Adults,” in which he suggested that the classic approach of free association kept the patient’s thoughts overly directed by consciousness and that the analyst’s delivery of interpretations about these associations was not the best way to deepen the treatment. While Ferenczi himself had not practiced child analysis, he independently concluded that it was play that was the most promising vehicle for psychoanalytic transformation. He encouraged his patients to relax and played with them, referring to his procedure as the playing of games. As his experimentation unfolded and his clinical experience grew, he began to believe that the patient benefits from emotionally re-experiencing the early crucial moments of life in the presence and with the active participation of his devoted and caring psychoanalyst. Only then could the patient turn his neurotic difficulties into personality strengths and assets. As Ferenczi no longer relied exclusively on interpretation, what would substitute in its place? What would the analyst contribute if not explanations of the patient’s dynamics and resistances? Ferenczi proposed that what the analyst does is enter a form of play engaging in a “dramatic dialogue” (De Forest, 1942, p. 121).

Here is the key example that Ferenczi used to illustrate his use of dramatic dialogue. A patient who had worked with Ferenczi for some time overcame profound mistrust and was trying to remember early childhood scenes. Having known the patient well, Ferenczi understood that the patient was identifying him in the transference with his grandfather:

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Suddenly, in the midst of what he was saying, he threw his arm round my neck and whispered in my ear: “I say, Grandpapa, I am afraid I am going to have a baby!”

Thereupon I had what seems to me a happy inspiration: I said nothing to him for the moment about transference, etc., but retorted, in a similar whisper:

“Well, but why do you think so?”

(1931, p. 471)

In speaking to this patient, Ferenczi used the personal intimate form of the pronoun, thus dramatizing and enacting the intimate relationship in the dialogue. Ferenczi himself calls this a “game of questions and answers” (p. 471). We will show that this prototypical example has been rediscovered in their own clinical work by later analysts from many psychoanalytic schools of thought around the world, and has inspired a model of therapeutic action rooted in dramatic play and generative enactment.

Through the course of this book, we intend to rework the notion of dramatic dialogue as a model of therapeutic action and therapeutic traction. We transform the concept into a heuristic model of contemporary clinical practice that articulates how multiple self-states and internal object relations are dramatized and brought to experiential life on the analytic stage. As we will demonstrate, through generative enactments, parts of the patient come to live inside the analyst and parts of the analyst get to live inside the patient, thus the analytic encounter becomes a stage where analyst and patient come alive, working through the past and toward the future. We portray how analyst and patient learn to sustain the achievement of suffering, as this collaborative unconscious process is reflected in a two-person, relational, intersubjective context. Here we call for a return of the soul or spirit to psychoanalysis and for the generative use of the analyst’s subjectivity.

In our view, and as we elaborate throughout this book, a contemporary psychoanalytic approach emphasizes experience along with insight, intuition as much as awareness, becoming rather than exclusively understanding, dreaming-up, enacting, dramatizing more than interpreting. As Bion said in his Los Angeles seminar in 1967, becoming is more significant than understanding, “because by the time you are able to give a patient an interpretation which the patient understands, all the work has been done” (Aguayo & Malin, 2013, p. 11).

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The proposal that psychoanalysis proceeds through the enactment of a dramatic dialogue, rather than being understood narrowly as only “a talking cure,” requires several related changes in our understanding of mind, development, and in our theory of therapeutic action, and thus we must consider some associated concepts and demonstrate their interrelatedness with the notion of dramatic dialogue. First, we will take up the idea of enactment and show how this concept has become central to so much of contemporary psychoanalysis. We propose that one function of enactment, one particularly affirmative² way of viewing enactments, emphasizes their constructive value, the way in which they are pregnant with future possibility. We call this dimension of enactment generative enactment (Aron & Atlas, 2015). Clearly, in its slant toward the future, toward giving birth to our future selves, creating our destinies, this concept already hints at the Jungian idea of a “prospective function,” to which it is closely related. In the next chapter, we will examine the prospective function, reworking it within the context of generative enactment in contemporary psychoanalysis. The prospective function and generative enactment are related terms in that they both emphasize our working toward the future, in addition to our working through the past, with the analyst engaging the patient in a dramatic dialogue, a notion that we will explore in detail in Chapter 3. The mutuality that is central to the prospective function, the promising aspect of enactment that we call generative, and the dramatization that we highlight in our reworking of the notion of dramatic dialogue, are all deeply related to what Winnicott (1971) simply called play (Benjamin, 2015).

We will begin with enactment, move onto generative enactment and the prospective function, and then return to dramatic dialogue to see how these ideas convey the spirit of contemporary clinical practice. But first let’s begin with a clinical tale.

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Enactment

Daniel, an experienced psychoanalyst, decided to start supervision again when he felt like he was “committing a crime.” He told his supervisor about Rebecca, his 38-year-old patient, who he has been seeing for the last four years.

“She is married with two young children and in fact she made a lot of progress in the years that we’ve seen each other.”

But something bothered Daniel. More than bothered. Something haunted him.

“It’s not uncommon for me to go online and Google my patients,” he said with some embarrassment. “I especially like to check out new patients to see what is available about them online. But with Rebecca it feels different,” he said and immediately explained. “At the end of every session I have an impulse to open Rebecca’s family website and look at their pictures. It’s usually late at night. I do it and I feel like a criminal, a voyeur, even a rapist. I feel that it’s completely wrong but I can’t stop myself.”

“Do you look at these pictures from home too?” the supervisor asked.

“No. Only after our sessions,” Daniel stated.

“And do you find it sexually exciting?” she asked.

“I don’t think so, not necessarily. I mostly see pictures of her husband and their children, their family trips, their birthday parties.”

“How did you even know about this website?” the supervisor wondered.

Daniel thought for a moment. It seems like he almost forgot how he learned about it.

“Well, I think maybe about a year ago, Rebecca started telling me about the pictures she took. She got me really interested, but I can’t tell exactly how. There was something about the way she talked about it that made me curious. She is my last patient on Tuesday nights, and when she left I opened my computer and Googled her and I found that website.”

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Discussing this case, they suspected that the exciting and dangerous aspect was not in the content of the pictures, but that there was an enactment related to the looking itself, the fact that the therapist was secretly spying on her, invading her privacy, and that she didn’t know about it. Daniel was embarrassed, and they tried to think together about the meaning of that act for this specific treatment and for Daniel himself.

But little did they know.

Enactments are powerful unconscious forces, and here they were not fully certain what was going on. In what way is this related to Rebecca’s psychology? Or maybe, as the supervisor wondered, it was Daniel’s form of perversion that came to the surface. But why then with this specific patient and not with others? The fact that Daniel sought supervision and was so upset by his conduct but still couldn’t stop or control himself was especially concerning.

Daniel told his supervisor about his childhood and how he used to miss his mom when she was away at night, and wait for her at the window. “When I saw her walking into the building, I quickly ran into my bed and made believe I was asleep.”

They wondered if looking at Rebecca’s website was his way of managing his own separation anxiety at the end of the session, secretly looking at her from the window when she was leaving.

It was almost winter break, and his patient was about to take a two-week vacation. The supervisor asked him how he felt about that. Daniel said he was mostly in touch with his own need for a vacation and that he was happy he was going away with his family.

When they met again two weeks later, Daniel was shaken but also relieved. He started the session by telling his supervisor, “When Rebecca came in after the break, the first thing she told me was that her son was injured while skiing. I listened to her telling me all the details about how her son fell and how scared she was when they went to the hospital and the many decisions they had to make.”

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“Thank God he is fine now,” she said. “I was so scared.”

“And how is his leg now?” Daniel asked.

Rebecca looked at him and didn’t answer. She looked confused, as if he asked something inappropriate.

“How did you know it was his leg that was broken? I never told you that,” she said quietly.

Daniel paused the story for a second, looked at the supervisor and said, “Can you believe that? You can only imagine how I felt when she asked me that. I think my face was so red that I scared her. And then I just told her the truth. I told her that right before our session, I looked at her website and saw a picture of her son with a cast on his leg. I told her that I was questioning my own interest in her family pictures and I asked her how she felt about it.”

Rebecca ...

Table of contents

• Cover Page
• Dramatic Dialogue
• Relational Perspectives Book Series
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• 1 Generative Enactments
• 2 The Prospective Function
• 3 Dramatic Dialogues
• 4 Therapeutic Action and Therapeutic Traction
• 5 The Truth of the Session
• 6 Theatrical Engagement
• 7 At-one-ment, Mutual Vulnerability, and Co-suffering
• 8 The Prequel
• References
• Index