A Disturbance in the Field

Essays in Transference-Countertransference Engagement

Steven H. Cooper

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781135231859
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

The field, as Steven Cooper describes it, is comprised of the inextricably related worlds of internalized object relations and interpersonal interaction. Furthermore, the analytic dyad is neither static nor smooth sailing. Eventually, the rigorous work of psychoanalysis will offer a fraught opportunity to work through the most disturbing elements of a patient's inner life as expressed and experienced by the analyst - indeed, a disturbance in the field. How best to proceed when such tricky yet altogether common therapeutic situations arise, and what aspects of transference/countertransference should be explored in the service of continued, productive analysis?

These are two of the questions that Steven Cooper explores in this far-ranging collection of essays on potentially thorny areas of the craft. His essays try to locate some of the most ineffable types of situations for the analyst to take up with patients, such as the underlying grandiosity of self-criticism; the problems of too much congruence between what patients fantasize about and analysts wish to provide; and the importance of analyzing hostile and aggressive aspects of erotic transference. He also tries to turn inside-out the complexity of hostile transference and countertransference phenomena to find out more about what our patients are looking for and repudiating. Finally, Cooper raises questions about some of our conventional definitions of what constitutes the psychoanalytic process. Provocatively, he takes up the analyst's countertransference to the psychoanalytic method itself, including his responsibility and sources of gratification in the work. It is at once a deeply clinical book and one that takes a post-tribal approach to psychoanalytic theory - relational, contemporary Kleinian, and contemporary Freudian analysts alike will find much to think about and debate here.

Chapter 1 Introduction

The romance and melancholia of loving psychoanalysis

The title of this book, A Disturbance in the Field, evokes for me the breadth of experience for patient and analyst in relation to transition, disruption, repair, and growth.

This is a book about transitions in clinical work. Some of the transitions are subtle, such as when a patient is able to usefully open new parts of himself in both an old and a new context. Other types of transition relate to points of impasse. Often, the transitions described relate to periods when either or both patient and analyst begin to look at a constellation of experiences or even what are traditionally termed symptoms in a different way. Needs begin to be seen as demands; self-criticism begins to be seen as related to unrealistic or perhaps even grandiose fantasies about the self; patient or analyst begins to see the ways that the analysis itself has been assaulted by unconsciously destructive trends.

I hope that I have been able to paint some pictures of the kind of atmosphere that exists between patient and analyst in relation to these moments of transition. Moreover, I try to talk about the analyst’s imagination as he tries to grasp these transitions and to help the patient to expand his imaginative capacity in integrating the meaning of transition. Despite my strong interest in the mind of the analyst and countertransference as a clinical tool, I do not want to overly valorize the countertransference. In recent years I believe that we run the risk of emphasizing too much the place of the analyst’s subjectivity in clinical work.

The “field” that I aim to illuminate is an intrapsychic and interpersonal field. I am deeply interested in unconscious conflict, unconscious fantasy, and the interpersonal process in analytic work. I cannot decide that one of these surfaces is more important than another. The analyst tries to hold these dimensions of field in his or her imagination and to make it knowable to the patient just as the patient tries to do so for the analyst.

At this point in the history of psychoanalysis, our thinking, our clinical work, and our journals are filled with the interpenetration of models. The insights offered by one analyst are used and incorporated into the vision of another. It has taken us a while, but fortunately we have been able to begin to grow beyond a kind of institutionalized splitting.

This collection of essays reflects my version of the intrapsychic and interpersonal field. I hope that it captures a sense of how I am learning from my patients and learning about psychoanalysis.

In each chapter, I try to demonstrate my use of these various models since I am incapable of stepping back and in strictly theoretical terms to describe how I have done so. I hope that I demonstrate how the concepts of defense, conflict, state shifts, and compromise formation are essential to understanding people and how, for me, it is impossible to utilize these concepts without a two-person model.

I also try to show how we have stretched psychoanalytic concepts such as transference, countertransference, enactment, and projective identification to a kind of limit. I have no solutions to this problem in this book. I think that this book constitutes my personal stretching of these terms to their limit and my limit. What I continue to feel after 30 years of being a psychoanalyst is that there are two major frontiers that are equally important in understanding analytic process: One is unconscious conflict and fantasy, and the other is interpersonal experience and interaction. I offer this collection of essays as my best effort to illustrate how I integrate the two frontiers in my clinical work and my thinking about theory.

Our language and concepts are indeed too limited. They continually strain under the burdens of categorization and dichotomy. Terms such as negative and positive transference, negative and positive countertransfer-ence, good and bad objects, and new and old objects are as limited as the dichotomies intrinsic to drive theory, such as libidinal and aggressive. If there is anything one learns from doing analysis it is that all experience is varied and layered and holds the complexity of many things at once. Our language in psychoanalysis is still primitive and undeveloped. I wish that I could say that I have redressed this problem in this book. What I have done is try to get at and, no doubt, enact some of what Balint (1968) referred to as the “poverty of interpretation.”

It is after all rather startling that we have one word for “I” or one word for “self” despite the many meanings that these concepts entail. This speaks to the nature of our ancient and impoverished language for getting at these experiences. I suspect that future generations of analysts, particularly generations who do not grow up on the language of dichotomies, will be productive in generating new ways of thinking about analytic process.

Yet, the problems are complicated partly by the fact that we come by dichotomies quite honestly. While gender and identity are multifaceted, there are some elements of dichotomy that are probably influenced by our anatomical dichotomies. We are also either dead or alive, awake or asleep, hungry or satiated, sexually gratified or frustrated, safe or dangerous no matter how much we claim that these experiences or “facts” exist on a continuum.

In the remainder of this introduction, I would like to talk about some less-emphasized aspects of theory since theory frames and holds our language. I want to discuss less the many differences in the content of theory but rather how we each hold our theory. Perhaps this discussion will serve as a backdrop for the largely clinical chapters that follow. First, however, a note on some elements of my overarching approach to clinical work follows.

It may be useful to briefly mention some crossroads, a few intersections where theory relates to clinical work before exploring the ways that the analyst holds his theory. I want to mention briefly the limitation of the two theories that I find most useful and how other theories may help with these limitations. I value most the contributions of relational theory and contemporary Kleinian approaches, and there are also concerns that I hold toward each.

The risks and perils accompanying analysts who term themselves relational is always the valorization of the analyst’s subjectivity to the exclusion of a focus on the patient’s subjective experience. Any well disciplined, well trained, and seasoned analyst of this stripe would object to this concern by saying that we cannot know the patient’s experience except by attuning ourselves to and honoring the analyst’s subjectivity. I agree. Yet it is far too easy to dismiss the problems and hazards in this approach with this statement, just as there are considerable hazards in all approaches to psychoanalysis.

A cartoon that I came across fifteen years ago captured the essence of the problem. A man is dressed in work clothes and is speaking into the phone. The caption reads: “Enough about me, you’re the one who called 911”. The hazard of valorizing the analyst’s subjectivity is remedied by a dedication to the principle that I hold as invaluable—that analysts must devote themselves to thinking about their participation. This self-reflective process about why the analyst is feeling what he is feeling, why he is thinking or not thinking about his patient in particular ways is a way of maintaining a constant check on this hazard. I find invaluable the notion of always considering how I am being recruited to be a particular kind of object by the patient, a mode of disciplined listening that I have learned more about by reading the work of Joseph, Feldman, Steiner, and Britton as well as the work of Mitchell, Bromberg, and Davies. In my view this ability to think about recruitment is the strength, and it is a considerable one, of the contemporary Kleinian and Independent School contributions to psychoanalysis. Self–psychology always provides a useful lens on the matter of how the analyst’s use of his own subjective responses may repeat earlier forms of parental neglect or empathic failure toward the patient. Ego psychology provides a way of thinking about the patient’s shifts from affect and idea that the analyst can’t be aware of if he is too focused on his own subjective reactions, no matter how much they are also informative.

But it is in thinking about the patient’s recruitment of us as objects and our responsiveness to the patient; the patient’s internalization of our experiences and our internalized object representations; the back and forth of this communication between internalized object worlds and interpersonal interaction; the interplay of unconscious fantasy and “reality” that I find both relational and Kleinian worlds indispensable to my work.

Relational Theory is a kind of meta-theory, an assemblage of overarching principles to approach clinical work. It does not provide a theory of technique that can be entirely separated from elements of other approaches. Instead it provides a set of working guidelines: it values disciplined listening but not necessarily a set of prescribed techniques; it considers constantly the analyst’s self-reflective participation (e.g. Mitchell, 1997); it values the dialectic between ritual and spontaneity (Hoffman, 1998), old and new objects (Cooper and Levit, 1998), nuances of interplay of patient experience and analyst’s modes of relating within interpretive positions (Benjamim, 2004); and it focuses on the ubiquity of enactment. It is why I think that relational thinking has been to varying degrees integrated and incorporated into all theoretical orientations.

The risks and perils of Kleininan theory are those that relate to the analyst’s vulnerability to minimize his own participation in enactment and the impact that his participation has on his patient. I find invaluable the Kleinian consideration that the analyst is complicit in the various ways in which he is being recruited by the patient’s internalized object world (e.g. Sandler, 1974; Feldman, 1997). But there is not enough consideration of how the patient is receiving the analyst’s participation and the ways in which enactment is constant (e.g. Mitchell, 1997; Cooper, 2008; Smith, 2000; 2008), not intermittent. The Kleinians are correct to have concerns that various elements of analyst-disclosure (ie. disclosure used to make interpretations) may enact collapses of therapeutic space or even violate boundaries in repetitive self and object patterns developed earlier in the patient’s life. So too, I agree with Caper (1997) that the analyst must have a mind of his own. But I believe that relational perspective might be very useful to Kleinian analysts in helping them to understand better a subject matter of great interest to them: the patient’s access to the analyst’s mind. In my view the patient’s internalized object relations and unconscious fantasy itself is always being influenced by the interaction with the analyst (e.g. Bonovitz, 2004; Chapter 5 in this book). Elements of relational theory provide ways of understanding a dialogic structure that can help the patient to have access and make use of the analyst’s mind, his formulations and experience (e.g. Benjamin, 2004; Davies, 2005).

HOW DO WE HOLD OUR THEORY?

I think that how the analyst holds his or her particular theory is at least as important as the analyst’s choice of theory. I have a strong bias toward not letting our love of analysis or love of a particular theory become a “usurping self” (Coleridge, 1834) in the form of fixed ideas about how things are supposed to unfold in analysis. Love involves surrender and a willingness to give up or reconfigure parts of self in the service of an ideal, such as getting closer to another, protecting another, or honoring another. In analysis, surrender is related to the goal of helping someone understand himself more fully. The valorization of a theory or an idea about how analytic work is supposed to go, in contrast to surrender, involves the obliteration of another person or of self, a usurping self. The theory is a success, but the patient dies.

Even more important, I think what helps people in psychoanalysis in large degrees is the experience of knowing oneself and learning about oneself in the presence of another self. If the analyst is absorbed by his or her method and theory, too much in love with those objects, as it were, then the analyst will not have enough left over to engage with and learn from the patient. One chapter in this volume is devoted to the analyst’s countertrans-ference to the method of psychoanalysis.

I am interested in how the analyst holds a romantic or melancholic embrace of his or her favored theory. Is the romantic version burdened by idealizations? Is the melancholic version burdened by nihilism? Is the analyst capable of holding a breadth of attitudes toward his or her theory— openness to change or a capacity to stand by this theory in difficult times?

Our relationship to theory is a particular kind of object relation. Some analysts are more monogamous with regard to their theory, while some love many. Some are more devout, while others are more “flexible” in their practice. We have particular responsibilities in relation to what theory we choose and how we practice with that theory.

I suggest two broad categories to distinguish the analyst’s relation to theory: the romantic and the melancholic. I do not use the distinction between romantic and melancholic to refer to the content of different psychoanalytic theories. For example, Strenger (1989) beautifully distinguished between romantic and classic aspects of different psychoanalytic theories. Kohut (1969) discussed varying ideological traditions implicit in Freudian theory as “guilty man,” while self-psychology was characterized as “tragic man.” Many authors, including Hoffman (1998) and Mitchell (1993), have addressed whether there are romantic versus tragic visions of human psychology emphasized in theories such as those proposed by Freud, Ferenczi, Balint, Guntrip, Loewald, and Kohut. But, my focus is much more on the analyst’s relationship to his or her own theory, not the romantic or melancholic content of the theory itself.

The romantic version of an analyst’s relationship to theory emphasizes how much the theory is helpful to the analyst in his or her understanding of the patient. It refers to the analyst’s romance with his or her theory or theories. As a totality, the theory helps the analyst to organize disparate parts of analytic experience. It helps the analyst to explain how he finds himself thinking and working. Thus, it is an explanation that, to some extent, emanates from the sense of a natural fit. The theory also organizes the analyst’s identity as an analyst and sustains the analyst through periods of uncertainty and ambiguity intrinsic to the work. This identity for those who wish to identify themselves as a Kleinian, ego psychologist, relational or self-psychologist, also probably involves a mode of presentation to the outside world, a way to be recognized and a way that the analyst wishes not to be recognized. Many analysts prefer not to think of themselves or to be called a this or a that.

Within the more romantic dimension of the analyst’s approach to theory, the analyst may or may not idealize his or her theory. I view the idealization of one’s theory as a degraded form of relationship to theory. Idealization implies the sacrifice of individuals (patient or analyst) to concepts or principles and is anathema to the notion of disciplined experimentation and growth that are at the heart of productive analytic work. The analyst’s idealization of a theory is also fundamentally solipsistic, not “relational.” Idealization of theory is dehumanizing since, in Adorno’s (1950) terms, the human is degraded and subjugated to fallibility unless it serves to prove the tenets of the theory. Idealization trucks only with humans who fulfill its predictions and descriptions of how things are supposed to go. Rarely does it truck with understanding patients.

A melancholic position emphasizes that every theory is a theory waiting to be rendered limited or problematic by clinical work with a particular patient. Melancholic positions make the analyst lean toward a more pragmatic approach to theory. It may also make the analyst lean toward a pluralistic openness, a willingness to utilize a variety of theories in helping us to understand clinical work. Melancholic positions allow the analyst to make vigorous use of one theory with a particular patient with a sense that it may prove to be limited in its helpfulness in analytic work with another patient.

The melancholic position also provides a vantage point from which to consider or at least acknowledge that to some extent there is a kind of manic phase in the development of each new psychoanalytic theory. Each theory arises in the context of solving a problem or limitation posed by a previous theory—Klein’s response to the undeveloped object relations dimension of Freudian theory; Ferenzci’s and his descendant’s (e.g., Balint, Guntrip, Fairbairn, and American relational theory) response to Freud’s more limited focus on the neuroses; the development of ego psychology as an elaboration of the importance of ego functions and the yet-to-be-developed elements of defense analysis in Freudian theory; the failure to take into account a healthy narcissistic developmental line in Freudian theory elaborated by self-psychology; and the failure of much of early psychoanalytic theory to account for the person of the analyst addressed by interpersonal and relational theory. Each of these new theories represents an attempt to redress limitations in previous theories.

The degraded version of the melancholic relation to theory is a kind of theoretical nihilism. This is not a healthy, functional use of pluralism but rather a despairing one. In this version, no theory is really good enough for very long, and we move from theory to theory when we reach the limitations of each theory. In this type of object relation to theory, essentially the analyst is unable to be held and framed by a particular theory. The analyst is theoretically parentless and somewhat privately self-sufficient. The analyst wanders from theoretical home to theoretical home. He or she is lonely.

Martin Cooperman, a beloved teacher for many years at Austen Riggs, had this comment attributed to him: “The patient comes to analysis with symptoms and the analyst comes to analysis with a theory. If things go well they each give up what they initially brought to analysis.” I think that a part of what Cooperman meant is that no theory can “understand” a unique person. Each theory is too general, too much a composite of observations gleaned from many patients—a kind of affective and ideational summary or average of working with many patients. And, each theory represents a more distant perch than the way that patient and analyst come to know each other. Cooperman’s statement is a good example of the melancholic relationship to theory. It reminds me of the way that Winnicott and Lacan in different ways spoke of the analyst’s willingness to be used and discarded by the patient, not unlike the good enough parent.

I view Cooperman’s position as distinct from those that claim not to use theory. I do not believe that there is such a thing as not using theory; a more productive way to frame the question involves the degree to which the analyst is aware of his or her theory and the ideals and ideas that direct the analyst’s decision making.

I have been strongly influenced and continue to be influenced by strands of Freudian, Kleinian, self-psychological theory, and in the last 20 years relational theory. My relationship to theory is decidedly melancholic. I use a variety of theories to help me understand my patient and the limits of my approach. I like to think about the value in standing outside our theory and trying to think about clinical work in various ways. I use the term the pluralistic third to help describe how I work with various theories to investigate some the decisions that I make. Each theory requires of the analyst a level of personal responsibility related to thinking about what the analyst is seeing and not seeing from the analyst’s particular vantage poi...