Transformational Processes in Clinical Psychoanalysis

Dreaming, Emotions and the Present Moment

Lawrence J. Brown

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138323926
• eBook ISBN: 9780429835810
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this book, Lawrence J. Brown offers a contemporary perspective on how the mind transforms, and gives meaning to, emotional experience that arises unconsciously in the here-and-now of the clinical hour. Brown surveys the developments in theory and practice that follow from Freud's original observations and traces this evolution from its conception to contemporary analytic field theory.

Brown emphasizes that these unconscious transformational processes occur spontaneously, in the blink of an eye, through the "unconscious work" in which the analyst and patient are engaged. Though unconscious, these processes are accessible and the analyst must train himself to become aware of the subtle ways he is affected by the patient in the clinical moment. By paying attention to one's reveries, countertransference manifestations and even supposed "wild" or extraneous thoughts, the analyst is able to obtain a glimpse of how his unconscious is transforming the ambient emotions of the session in order to formulate an interpretation.

Brown casts a wide theoretical net in his exploration of these transformational processes and builds on the contributions of Freud, Theodor Reik, Bion, Ogden, the Barangers, Cassorla, Civitarese and Ferro. Bion's theories of alpha function, transformations, dreaming and his clinical emphasis on the present moment are foundational to this book. Brown's writing is clear and aims to describe the various theoretical ideas as plainly as possible. Detailed clinical material is given in most chapters to illustrate the theoretical perspectives. Brown applies this theory of transformational processes to a variety of topics, including the analyst's receptivity, countertransference as transformation, the analytic setting, the paintings of J.M.W. Turner, "autistic transformations" and other clinical situations in the analysis of children and adults.

Transformational Processes in Clinical Psychoanalysis will be of great interest to all psychoanalysts and psychoanalytic psychotherapists.

Chapter One
Introduction

To write a book about transformations is a preposterous undertaking, akin to writing about the nature of life on earth. One would begin writing and never finish since the transformations occurring during the process of writing would require additional chapters to address the unanticipated new developments. In a sense, the author would have embarked on a quixotic mission chasing the infinite. This book is about the topic of transformations in psychoanalysis; although this is a considerably narrower focus, anyone who has studied our field soon learns the immensity of scope within the purview of our profession. Indeed, psychoanalysis has always been about transformations, but what do we mean when we say something has undergone a "transformation?" There are many definitions of the word transformation and it is a widely used noun with unique meanings depending on the context: various fields of study such as Linguistics, Biology, etc., have highly specific usages. The general definition listed in the Oxford English Dictionary is "a marked change in form, nature or appearance" and, more specifically, "a metamorphosis during the life cycle of an animal." The meaning in Physics is given as "the induced or spontaneous change of one element into another by a nuclear process." Though there is no official definition of "transformation" in psychoanalysis, it seems to me that these three definitions come closest to what an analyst means when he uses this word.

When Freud (1933) stated “where id was, there ego shall be,” in essence he described “a marked change in form, nature or appearance.” Similarly, when we speak of a child as father to the man we are referencing “a metamorphosis during the life cycle of an animal” and, furthermore, when the analyst experiences a sudden and surprising association to a patient’s material we may say he is experiencing an “induced or spontaneous change of one element into another.” Bion (1965) was the first to propose a very specific psychoanalytic definition of transformation that is derived from the clinician’s observations of the evolution of an emotional experience that arises and then is developed over the course of an individual analytic session. He asks us to be mindful of the metamorphosis of an affect from its unanticipated appearance in the session and through its evolution as the analyst and analysand, by means of their spontaneous associations, “transform” the emotional experience into a narrative. I believe that what is unique to Bion’s contribution is his stance toward those associations: he does not search these to uncover the hidden unconscious meanings, but rather his focus is on the free associations as the transformative process by which meaning is created.

Recently I was reading a biography of Basho (Reichhold, 2013), the great Japanese poet who originated haiku, which the author stated “capture[s] both the momentary and the eternal in a small poem” (p. 9) and it struck me that the same may be said about an individual psychoanalytic session. A single clinical hour is a snapshot of a moment together uniquely shared by a particular analyst with a particular patient, colored by the shadings of affects that enliven the hour, which in turn are generated by the unconscious communications between their respective minds; each psyche populated by the unique demographics of their personal representational worlds (Brown, 1996). Thus, the “snapshot” aspect of the session also opens to experiences that border on the eternal and I believe that we can say the same about an analytic hour that Freud (1900) said about a dream:

There is often a passage in even the most thoroughly interpreted dream which has to be left obscure; this is because we become aware during the work of interpretation that at that point there is a tangle of dream-thoughts which cannot be unraveled and which moreover adds nothing to our knowledge of the content of the dream. This is the dream’s navel, the spot where it reaches down into the unknown.

(p. 525)

But what is the session’s navel which in Freud’s view about a dream may be approached but never fully grasped? Following Bion (1965), it is an unknown emotional experience from which the associations of the patient and analyst emanate; furthermore, each association in itself is a link in the process of transformation that occurs within each member of the analytic dyad. That is to say that the analyst and patient are equally affected by the ambient emotion of the session but that each partner transforms it through his own storehouse of personal experiences and internal objects. Bion (1965) distinguishes between the process of transformation and a representation which is the endpoint of that process. In my view, a free association in the patient or the analyst is a point in the transformational process that yields a representation of the shared emotional experience alive in the clinical hour at a particular moment. When the patient and analyst are actively engaged in an analytic encounter, what we call an analytic process, their minds are generating mutual associations that aim to represent, and give meaning to, the here-and-now emotional atmosphere. The respective associations of analysand and analyst draw from an undercurrent of projective and introjective processes and activation of areas in each that resonate with the emotional experience being transformed; thereby creating a complex skein, “a tangle of [waking] ¹ dream-thoughts which cannot be unraveled,” but about which the analyst may offer an approximated guess, i.e., an interpretation.

Some foundational assumptions

This book rests on five basic concepts that underpin most or all of the chapters. I will review each of these briefly in the following paragraphs and these concepts will be further developed in the various chapters. In my previous (2011a) book, Intersubjective Processes and the Unconscious: An Integration of Freudian, Kleinian and Bionian Perspectives, I related Thomas Friedman’s (2005) publication, The World Is Flat, which captured the interconnectedness of the world made smaller by globalization and the internet, to intersubjectivity in psychoanalysis. It struck me that Friedman’s discussion of the inescapable impact of nations on each other paralleled the realization in analysis of the inevitable psychic interdigitation between analyst and analysand. In his most recent (2016) work, Thank You for Being Late, Friedman goes beyond the “flat world” and addresses the sense in Europe and North America that our world is accelerating rapidly, leaving many people feeling that it has already spun out of control. A potent combination of ever-advancing technology, financial markets on a hair trigger and the quickening effects of climate change are frighteningly unsettling.

I put “accelerating rapidly” in italics to denote the first underlying assumption for this book in order to accentuate the incredible speed with which the mind transforms emotional experience into meaningful representations. In my clinical work, I have been increasingly impressed with the alacrity that new associations are created and may appear in a surprising flash of reverie, an unexpected spontaneous interpretation, a quip or joke, the appearance of a long-forgotten memory or a night dream that brings further meaning to something left unfinished in the remains of the day’s session. All of this happens unconsciously and presents the analyst with a valuable ally if he or she can train oneself to attend to these experiences which often seem “irrelevant” or mental jetsam. However, in my view these phenomena are the products of our “unconscious psychological work” (Ogden, 2009, 2010), which are produced spontaneously and in a microsecond.

A second foundational principle of this book is the notion of unconscious work and the speed with which it is achieved. This concept itself links with unconscious phantasy, dream work, alpha function, free association and reverie; processes that do their “work” within the blink of an eye. Theodor Reik (1927, 1934; Chapter 5) was a pioneer in advocating the analyst have his mind receptively open to “surprise,” a product of our unconscious work. Later, in the early 1950s, Kleinian analysts inspired by the work of Paula Heimann (1950) 2 promoted the use of countertransference as an “instrument of research” into the patient’s unconscious. 3 North American analysts, beginning in the 1970s through their studies of enactments (Jacobs, 1986, 1999) and intersubjectivity, highlighted the role of the analyst’s unconscious in co-constructing joint narratives, though these approaches did not attend to the detailed and instantaneous unconscious work always at play beneath these more conscious phenomena. I hope that the readers of this volume will come away with an appreciation of the ubiquity of these processes: the nature of unconscious work in the analyst and analysand that gives meaning to emotions operative in the session, the speed with which this occurs and the therapeutic utility of learning to use these phenomena in one’s clinical work.

A third guiding principle in this book is the concept of intersubjectivity and the related perspective of intersubjective field theory, both of which comprise a broad area of study that has been written about extensively from various points of view. In my (2011) book on this topic I emphasized the unconscious processes that underpinned intersubjective manifestations: unconscious to unconscious communication fostered by mutual projective and introjective identifications between analyst and patient that serve to bring meaning to emotional experiences evoked by their therapeutic encounter. In this present study, I advance these ideas further by expanding on the concept of unconscious work as the spontaneous production of symbols and metaphors that transform and represent the emotions active in the session. Since these occurrences unfold spontaneously in the session, the analyst must train himself to attend to reveries, random thoughts, etc., and learn to use these “messengers” as an instrument of his or her clinical technique. Intersubjective field theory that combines the notion of the unconscious intersubjective connection between the analyst and analysand with a study of the emotional field that arises from that interconnection. The concept of an analytic field denotes the creation of a third psychic presence from the unconscious intersection between the minds of patient and analyst, like a child born to two parents who, though carrying the lineage of each parent, is its own psychic agency that has a subsequent impact upon the parents.

Furthermore, a fourth fundamental principle inherent in what I have been saying is the centrality of affect. Where classical analysts placed greatest importance on listening for drive derivatives as revealed when reading between the lines of the patient’s associations, many contemporary analysts follow the twists and turns of emotional experience in the session. 4 I find focusing on the evoked affects of the session and how these are given meaning by the analyst and patient through their respective transformations of those emotions in the immediacy of the clinical hour to be an additional way of approaching the clinical data separate from the classical technique of ferreting meaning from the patient’s associations. Bion (1965) stated this difference when he said:

For a greater part of its [psychoanalysis] history it has been assumed that a psycho-analytic interpretation has as its function the rendering conscious of that which is unconscious ... [and that] The differentiation I wish to introduce is not between conscious and unconscious, but between finite and infinite.

(p. 46)

Finally, a fifth guiding premise is the importance of the process of dreaming, whether awake or asleep. Freud’s (1900) comprehensive study of dreams and the process of dreaming addressed night dreams and in many respects this colossal work was the core for much of his later writings. Similarly, Bion (1962b, 1992) formulated the notion that the processes of dreams described by Freud also operated constantly, whether we were awake or asleep, and this theory was a primary kernel from which many of his subsequent contributions developed.

An analytic session

A patient began a session by saying he had seen his old lover on the street and was pleased to no longer experience the deep agony that pained him after their break-up. His mood took a nostalgic turn as he mournfully spoke of her irresistible beauty and sculpted body: even at her age, no longer young, her body is perfection for him. He remembered how peaceful he felt being with her during their good moments. He pinched the tips of his fingers together, brought them to his lips and then quickly pulled them away in an audible kiss as though saluting her magnificence. I think of his recent life-threatening illness and say that her youthful perfection must have felt like it helped to repair his frightening brush with death, like a fountain of youth. He goes on to tell me of her allure, that no one could resist her. Suddenly I find myself in a reverie, thinking of a scene from the movie, Interview with the Vampire, in which Christian Slater, a reporter who interviews Brad Pitt’s vampire, begs to be turned into a vampire after hearing about the cruel beauty of that world to which he has now been seductively drawn.

I associated my reverie with the analysand’s longing and, knowing that he enjoyed the cinema, said that as he was speaking a scene from the film Interview with the Vampire came to mind, which I think was my mind’s way of depicting something about the pining he felt in the moment, and I shared it with him. He quickly talked about how he enjoys his time alone though he also values and needs intimacy, but the romance with his girlfriend came with a very high price tag. He went on to elaborate his longing and his thoughts then turned to seeing his favorite nephew who was coming to town the next day; he’s like a son. However, his thoughts soon returned to his ex-lover and the painful intimacy between them. I thought of the word “sublime,” which in Romantic period art was viewed as a mixture of awe, beauty and terror, and said that he was telling me he felt helplessly drawn to the mixture of awesome beauty alongside terror that she evoked in him. My comment elicited many more associations from the patient about the mixture of awe and fear of his former paramour and it was at this point that I felt we had made emotional contact, which I did not especially feel during the earlier part of the session.

The reader will note that this session is presented shorn of history, age of the patient, details about his lover, review of the analytic relationship, which transferences are active, etc., and instead consider it in its raw form. The idea here is for the analyst to start each session, as both Freud (1912) and Bion (1965, 1967b) have suggested, with a clear mind free of any particular agenda in order to achieve a state of mind that is maximally receptive (Brown, 2016a, Chapter 5) to communications from the analysand and/or from within the clinician. I think this may be what Basho was getting at when he wrote:

old pond:
a frog jumps into
the sound of water

(1681–1682)

An “old pond” may be seen as the stilled listening surface of the analyst’s mind awaiting a “frog” thought, emanating from within himself or from the patient, to impact that surface; or, perhaps, how repetitive “old pond” material requires the emergence of something new, a “splash” or unexpected shock to animate a stagnant surface. 5 I experienced such a surprise when the Interview with the Vampire reverie crossed my mind: until that point much of what the patient had to say was dynamically accurate, reflecting important insights gained during the analysis, but now deployed repetitively as an infertile “old pond.” Why did this particular reverie spring to mind at this moment or, put another way, what emotions were being transformed by this reverie? It is unusual for me to reference vampires since they carry little interest to me: there are many other films I might have unconsciously employed instead, such as Black Widow about a woman in serial marriages to wealthy husbands who “mysteriously” die.

On reflection, my unconscious could not have come up with a more accurate representation of what the patient and I had been lulled into ignoring by his paeans to his former lover. The analysand began the session announcing that he was pleased to have seen his ex-girlfriend and was not overly upset; however, his longing for, and idealization of, her body upended his calm. I found his pining for her both charming and sad: after his initial comment about feeling free of her, he was drawn back into the familiar orbit of worshipping her beauty. Feeling somewhat frustrated, I tried to cajole him out of this ensorcelled state by interpreting its defensive ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• ACKNOWLEDGEMENTS
• SERIES EDITOR'S FOREWORD
• A PREFACE AND SOME "FROG" THOUGHTS
• CHAPTER ONE Introduction
• CHAPTER TWO From countertransference to Transformations
• CHAPTER THREE Bion's discoveiy of alpha function: the engine of transformations
• CHAPTER FOUR Bion's Transformations and clinical practice
• CHAPTER FIVE The analyst's receptivity: evolution of the concept and its clinical application
• CHAPTER SIX Ruptures in the analytic setting and disturbances in the transformational field of dreams
• CHAPTER SEVEN The unbearable glare of living: the Sublime, Bion's theory of "O" and J. M. W. Turner, "Painter of Light"
• CHAPTER EIGHT Three unconscious pathways to representing the analyst's experience: reverie, countertransference dreams and joke-work
• CHAPTER NINE Autistic transformations I: from ashes to ashes: the heroic struggle of an autistic boy trying to be born and stay alive
• CHAPTER TEN Autistic transformations II: the capacity to tell a joke: reflections from work with Asperger's children
• CHAPTER ELEVEN "Notes on memory and desire": implications for working through
• CHAPTER TWELVE Conclusion: on Freud's "The question of a Weltanschauung" a world of perpetual transformation?
• REFERENCES
• INDEX