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Part I
Therapeutic Action
The relational turn has reverberated across multiple dimensions of psychoanalytic theory and technique and has left its mark on our theory of mind, our models of development, our understanding of psychopathology, and, perhaps most especially, on our theory of therapeutic action and its related implications for psychoanalytic technique. In this section we feature a collection of articles that have been influential in reframing questions of the analyst’s role and the analytic process.
What kind of object is the analyst to be? What is the nature of analytic participation? How does our interest in the analyst’s subjectivity and the patient’s experience of the analyst’s subjectivity lead to modifications in our views of analytic participation? How does relational theory change the way we think about conflict and resistance? What is the nature of the analyst’s personal involvement in the work? What are the implications of the relational turn for contemporary psychoanalytic education and supervision?
Taken together, these articles highlight a significant shift in clinical psychoanalysis toward a greater appreciation of the analyst’s personal responsiveness, spontaneity, and playfulness. There is now a greater emphasis on nonverbal communication and the affective link between patient and analyst and a new appreciation for the analyst’s authenticity, vulnerability, personal openness and directness, as well as professional restraint and analytic discipline.
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The Intimate Edge in Therapeutic Relatedness
(1974)
Darlene Bregman Ehrenberg
Editors’ Introduction
While this book has largely drawn together contributions from the very recent psychoanalytic literature, this article by Darlene Ehrenberg is the notable exception, going back to an article first published in 1974. Ehrenberg has long been an innovator in psychoanalysis, and her work is often associated with a radically interpersonal approach to technique that features the analyst’s use of self-disclosure. A careful examination of her work, however, reveals that she draws equally from both the interpersonal tradition and from Winnicott, Guntrip, and British object relations perspectives. We chose this article for inclusion because it set the tone for much of her future work, conveys the essential themes of Ehrenberg’s writings, and highlights what we believe to be essential elements in a relational approach.
In a long series of publications, culminating in her 1992 book, The Intimate Edge, Ehrenberg demonstrated why, regardless of theoretical orientation, the recognition of the interactive nature of the analytic field has profound and radical implications for one’s thinking about analytic technique. In this article, Ehrenberg begins by drawing on Martin Buber’s philosophy of dialogue, which, much like Winnicott’s psychoanalytic vision, relies on “the realm of the between.” Ehrenberg sees patient and analyst as “observing-participants” who are engaged in a truly mutual, authentic, collaboration. Ehrenberg has gone on to show how working at the intimate edge of relatedness can extend the benefits of psychoanalysis to patients formerly considered unanalyzable and may be used to resolve clinical stalemates and situations of impasse.
In this article, Ehrenberg clearly states her radical position, namely, that the intimate edge is honed if analysts are willing to be open about their own reactions to the analytic field of mutual, shared experience. She elaborates a number of rationales for analyst self-disclosure including validating patients’ perceptions, encouraging openness and directness, minimizing unnecessary hierarchy and authoritarianism, and avoiding an overreliance on idealization of the analyst. As always, Ehrenberg presents gripping clinical vignettes that illustrate her therapeutic principles.
Stephen Mitchell in 1997 pointed out that, whereas some analytic theorists and practitioners recognize the value of the analyst’s disclosing carefully considered and highly processed reactions, Ehrenberg, by contrast, sees great value precisely in sharing her unprocessed, immediate reactions to her patients. For Ehrenberg, writes Mitchell, “We are what we do with others, and to withhold the analyst’s reactions from the patient is to deprive the patient of precisely the insight she might find most helpful in understanding their experience” (p. 149).
Ehrenberg’s work is characterized by several themes that have become identified with relational psychoanalysis across schools, including spontaneity; the unique value of playfulness; the role of authentic engagement in the process of working through; the therapeutic value of the analyst’s openness, self-disclosure, and directness; and, perhaps most significant, the significance of mutuality and reciprocity between patient and analyst as they move toward the intimate edge of relatedness.
The Intimate Edge In Therapeutic Relatedness*
I
A clear conceptualization of the therapeutic process and of what in a relationship contributes to therapeutic outcome remains somewhat elusive and certainly controversial in the psychoanalytic literature. Despite Sullivan’s note that interpersonal acts are “reciprocal” and “transformative” (Mullahy, 1945), Laing, Phillipson, and Lee (1966) remark that “psychoanalytic theory has no constructs for the dyad as such” and despite its importance, “the relationship between persons is undeveloped theoretically.”
Though his main focus was not on the psychoanalytic situation, a notable effort to grapple with these questions is reflected in the work of Martin Buber (1957a, 1958), who wrote, “Distance provides the human situation, relation provides man’s becoming in that situation.” Buber believed that “Human life and humanity come into being in genuine meetings” and that the “inmost growth of the self” can be accomplished “between the one and the other, between men.” For him the most profound growth and change in the treatment situation can only occur in the context of this kind of “personal relation.” This involves what he labels an “I-Thou” relation in contrast to an “I-It” relation. It requires mutual confrontation, and he calls its unfolding the “dialogical,” that condition of genuine dialogue which involves bringing oneself fully into it, without reduction or shifting ground and without holding back relevant thoughts or withdrawing. In Buber’s framework the meaning of the interhuman is “to be found neither in one of the two partners, nor in both together, but only in the dialogue itself, in this ‘between’ which they live together” (italics added).
As in art, he states, it is the “realm of the between” which has become a form. Yet the processes of this “between,” particularly as they must occur in the psychoanalytic situation, to facilitate the specific kinds of work that psychoanalysis requires, have never been clearly articulated.
The importance of this “between” and an effort to delineate its dimensions is also reflected in the seminal work of Winnicott. Winnicott (1971) writes of a “potential space” which is “at the interplay between there being nothing but me and there being objects and phenomena outside omnipotent control.”
He comments about the “place where it can be said that continuity is giving place to contiguity” in the potential space “which initially both joins and separates the baby and the mother.” He states, further, “this potential space is a highly variable factor (from individual to individual), whereas the two other locations—personal or psychic reality and the actual world—are relatively constant, one being biologically determined and the other being common property” and adds that this potential space “depends on experience which leads to trust. It can be looked upon as sacred to the individual in that it is here that the individual experiences creative living.”
Winnicott cautions that the psychoanalyst should not clutter up this space even as he helps enlarge or create it, by filling it with interpretations, which in effect are from the analyst’s own creative imagination and not the patient’s. He is less explicit about the processes that maximize the therapeutic possibilities of what goes on in this potential space.
In my own struggle to conceptualize the therapeutic process, and how the therapeutic relationship can be used to facilitate maximum growth, I have arrived at a concept which I call the “intimate edge” in relatedness. This paper is directed toward an elucidation of this concept and an elaboration of the therapeutic possibilities that I believe aiming for this “intimate edge” generates in the psychoanalytic situation.
By “intimate edge” I mean that point of maximum and acknowledged contact at any given moment in a relationship without fusion, without violation of the separateness and integrity of each participant. This point is not static, and may fluctuate from one moment to the next, so that being able to relate at this point requires ceaseless sensitivity to inner changes in oneself and in the other, and to changes at the interface of the interaction, as these occur in the context of the spiral of reciprocal impact. (My concept thus encompasses spatial as well as temporal dimensions.) More often than not this optimal point is over- or undershot so that there is some kind of intrusion or else overcautiousness. In either case there is a failure on the part of psychoanalyst and patient to meet at the “intimate edge.”
The concept is similar to what Winnicott (1971) refers to as the “continuity-contiguity moment” in relatedness. What distinguishes my conceptualization is the necessity for acknowledgment and explicitness since I believe the process of acknowledgment increases its dimensions, and changes the nature of one’s experience of it. Ideally, the “intimate edge” thus becomes a point of maximum self-expression and maximum awareness of the individuality and boundaries of self and other for each participant. It is the point where each participant becomes acutely aware of his own active participation in a particular interaction, the choices he makes, and of where he ends and the other begins. The “intimate edge,” over time, thus becomes the trace of a constantly moving locus, for each time this is identified it is also changed; as it is reidentified, it changes again. In a sense I am speaking of a kind of engagement in which both individuals are “observing participants” (in contrast to Sullivan’s concept of the therapist as “participant observer”) with a particular point of focus.
In the analytic situation studying moment-by-moment shifts in the quality of relatedness and experience between analyst and patient, permits exploration of individual patterns of reaction and particular sensitivities. Decisions to become increasingly involved or to withdraw can be studied in process. The feelings and associations surrounding these can be examined and can be used as the basis for fantasies and associations, and responded to by the analyst as he (or she) might respond to a patient’s dream. The patient’s associations to the immediate experience indeed become the metaphoric articulation of his unconscious hopes, fears, expectations, including the elucidation of the transference.
Actually even when the “intimate edge” is missed the process of aiming for it, the mutual focus on the difficulties involved in achieving a meeting, can facilitate such a meeting. The effort to study the quality of mutual experience in a relationship, the interlocking of both participants, as distinct from examining either participant separately, including a mutual focus on the failure to touch or on inauthenticity or collusion, can become the bridge to a more intimate encounter.
Such an engagement permits distortions in the perceptions of self and other, which result from false projections,1 to be corrected through a dialectical interaction process in which clearer perceptions of the other force clearer perceptions of the self, and vice versa. Both percepts become more veridical. The necessity to engage in such distortions becomes available for analytic exploration once they cannot be successfully acted upon in the transference, and can be integrated into the self percept as one’s own need to distort rather than accepted as an accurate view of reality. This kind of shift encourages clearer perception of the “interpersonal space” and simultaneously allows for clarification of the structure and dimensions of “inner space”; and for a shift form feeling victimized or helpless, stuck without any options, to the fresh experience of one’s power and responsibility in relation to multiple choices. This also encourages the discovery of untapped individual potentialities, and the emergence of clearer self-definition in consciousness.
Guntrip (1969) states that “what is therapeutic when it is achieved, is ‘the moment of real meeting’ of two persons as a new transforming experience for one of them” and that “transference analysis is the slow and painful experience of clearing the ground of left-overs from past experience, both in transference and countertransference, so that therapist and patient can at last meet ‘mentally face to face’ and know that they know each other as two human beings.”
What I am suggesting is that Guntrip’s idea of a “moment of real meeting” is not the end, but is itself an important starting point, and of continuing leverage in the analytic process.
Focusing on the interface of the analyst—patient interaction is not the same as focusing on the transference or countertransference. Rather, the focus is on the nature of the integration, the dialogue, and the quality of contact. Associations to the moments of contact are as useful as associations to the moments when this kind of meeting is not achieved. Analytic work does not stop when contact is made. It takes on new dimensions. I believe that an effort for a sustained and enduring, increasingly developing intimacy over time, not isolated somewhat discrete moments of meeting, ultimately becomes the condition for maximum growth; and that the “intimate edge” is the point from which such intimacy can develop. Guntrip remarks that “psychotherapy is a progress out of fantasy into reality, a process of transcending the transference” and “All this cannot go on unless the therapist is a ‘real’ person himself, giving the possibility of a ‘real’ relationship in the treatment situation, over and above the transference relations.”
However, it is not simply a matter of enlarging, but also of analyzing this, so that ultimately each participant learns to know himself better through the immediate interactive experience. Focusing on this “real” interaction is analytically crucial, Wolstein (1959, 1971) stresses the importance of making this field of “shared experience” the focus of psychoanalytic inquiry. I am suggesting a particular way of focusing on this “shared experience.”
In aiming toward the “intimate edge” instead of focusing on the content of distortions, projections, or transference, one must focus on the patterns of distorting. For example, if a patient drifts into a fantasy that figuratively takes him out of the room the content of the fantasy may indeed be meaningful, but the wish to be out of the room cannot be neglected. In fact, helping to identify what triggered the fantasy (and the content of the fantasy can provide useful clues) may be significant in helping the patient grasp the patterns of his own experience. Guntrip writes of the “sense of a gulf which the patient cannot cross but which perhaps the therapist can and does if he shows the patient that he knows about it” as being of the highest importance in treatment. I agree, and further suggest that the process of mutual and explicit focus on the very gulf between is exactly what transforms it into an “intimate edge.” This involves a reversal of figure and ground, in which the space between becomes the focus, rather than the two individual participants or either of them or their fantasies separately. As in art, one can treat the “ground” or the “between” as a form that can be negotiated in its own right. The process of articulating this ground simultaneously defines more clearly the figures that shape it and makes vivid the fact that both participants in an interaction do actively shape the space between them. Winnicott (1971) refers to a conversation with Marion Milner in which she conveyed to him “the tremendous significance that there can be in the interplay of the edges of two curtains, or of the surface of a jug that is placed in front of another jug.” In the case of two individuals, where each makes active choices at every moment, the situation becomes infinitely more complex.
The articulation of the “intimate edge,” particularly when the quality of contact is minimal, validates the fact that each participant does make choices about how involved he wants to be. Winnicott (1965) points out that there are healthy uses of non-communication in the developing child. In his words, the development of the self may involve “a sophisticated game of hide and seek in which it is a joy to be hidden but a disaster not to be found.” I believe that in the therapeutic situation it is important for the patient to consciously realize he is playing hide and seek if this is the case. Often the whole process is out of awareness. Making this explicit permits the recognition that o...
