Vitalization in Psychoanalysis

Perspectives on Being and Becoming

Amy Schwartz Cooney, Rachel Sopher, Amy Schwartz Cooney, Rachel Sopher

• Publisher: Routledge
• Year: 2021
• Topic: Psychology
• eBook ISBN:
  9781000360752
• Subtopic: Mental Health in Psychology
• Index: Psychology

In Vitalization in Psychoanalysis, Schwartz Cooney and Sopher develop and explore the concept of vitalization, generating new ways of approaching and conceptualizing the psychoanalytic project.

Vitalization refers to the process between two people that ignites new experiences and brings withdrawn aspects of the self to life. This book focuses on how psychoanalysis can be a uniquely creative encounter that can aid this enlivening internal process, offering a vibrant new take on the psychotherapeutic project. There is a long tradition in psychoanalysis that addresses the ways that the unique subjectivities of each member of the therapeutic dyad contribute to the repetition of entrenched patterns of relating, and how the processing of enactments can be reparative. But this overlap in subjectivities can also bring to life undeveloped experiences. This focus on generativity and progressive action represents a significant, cutting-edge turn in psychoanalysis. Vitalization in Psychoanalysis represents a deep meditation on this transformational moment in the history of psychoanalytic thought.

Pulling together work from major writers on vitalization from all the main psychoanalytic schools of thought, and covering development, theory and clinical practice, this book will be an invaluable guide for clinicians of all backgrounds, as well of students of psychotherapy and psychoanalysis.

Part I

Vitalization as unconscious action

Enactment, dreaming and emergence

Chapter 1

Vitalizing enactment

A relational exploration

Amy Schwartz Cooney

Introduction

Drawing on her years of experience as a child psychoanalyst, Alvarez (2012) theorized a form of intervention termed “vitalization” in which the analyst reaches out to “reclaim” severely disturbed patients, drawing them from states of near psychic death into live contact. For Alvarez, these active interventions are aimed at the introjection of a new good object and the development of a more enriched sense of self in children whose primary object has been disastrously deficient. I have found Alvarez’s ideas compelling and hopeful, offering a vision of the progressive action of psychoanalysis. I have also found her ideas applicable in a broader theoretical context and with a wider population, particularly in therapeutic impasses that feel inert and with adult patients who struggle to feel alive emotionally.

My project in this chapter is twofold. I consider Alvarez’s notion of vitalization through the lens of relational thought. From this perspective, I regard vitalizing interventions as enactments that can be enriching and transformative in their lived experience rather than in retrospective processing. I also advance a broadened conception of enactment as not only repetitive of old conflicts or expressive of dissociated affect but also opportunities for potentiating new experiences in the analytic dyad. I begin by briefly reviewing Alvarez’s ideas. I then introduce the concept of vitalizing enactment, contextualize this idea theoretically, and present a clinical vignette from my work with a withdrawn and despairing patient to illustrate this chapter’s themes.

Anne Alvarez: interventions at the level of vitalization and reclamation

In her most recent book, The Thinking Heart, Alvarez (2012) articulates three modes of therapeutic intervention that are intended to match her patient’s level of development and the severity of their difficulties. In treating children who are able to make causal linkings, Alvarez works at the explanatory level, using “why–because” interpretations that relate emotions to experience, past to present. For patients who are not yet able to make these kinds of connections, she proposes working descriptively. Alvarez focuses on the “whatness” of experience, helping her patients identify their emotions, naming and amplifying what they are feeling. For children who are chronically dissociated, or “undrawn,” she suggests that treatment may need to focus on vitalization and reclamation, helping the child connect with feeling themselves. Vitalizing interventions involve the analyst using herself actively as an enlivening transferential object: initiating contact, insisting on meaning, reaching out to (re)claim the patient and draw him into the world of objects and feelings.

Alvarez integrates a contemporary Kleinian/Bionian perspective with attachment and regulation theory, proposing that psychopathology results from environmental trauma and failure in the original container. From this standpoint developmental and emotional disturbance is understood in relation to deficits in her patients’ senses of self and in their internal objects. Alvarez is particularly concerned with introjective processes and facilitating the internalization of a good object in cases where the child’s earliest relationships have been severely lacking.

Alvarez (1997) rethinks symptomatology, questioning when defenses are best understood as efforts to mask underlying conflicts and anxieties and when they may represent efforts to overcome and develop new capacities. For example, she distinguishes between omnipotent defenses and nascent efforts to establish a sense of potency. In a similar vein, Alvarez extends Bion’s (1963) concept of the container/contained. Where Bion focused on the analytic function of metabolizing unbearable affects, Alvarez suggests that the container can also hold and make meaning of a range of other unsymbolized mental contents, including joy, efficacy, and a sense of future possibility. When working with severely disturbed children, Alvarez uses herself as a uniquely generative container, metabolizing different kinds of unformulated experiences, negative and positive, in an effort to realize her patient’s capacities.

A relational interpretation of vitalization as enactment

Alvarez’s work resonates with a sense of hope, compassion, and a vision of the progressive action of analysis. She concerns herself both with what has been damaged and lacking and what has not yet taken form. To my reading, Alvarez’s unique personal involvement and willingness to work with her subjective responses have the feel of relational psychoanalysis. In this chapter I suggest that the enlivening interactions Alvarez describes in her efforts to connect with acutely “undrawn” children can be creatively reconceptualized and applied to relational work with despairing adults in deadened impasse.

For example, in illustrating vitalization and reclamation, Alvarez (2012) presents her work with an autistic child named Robbie who has become increasingly inaccessible and unreachable in advance of the summer break. “Desperate” to make contact, “to say good-bye and consider the possibility of remembering each other” (p. 22), Alvarez is stirred by what she describes as “countertransference urgency.” She writes,

Nothing reached him. I felt more and more worried that I had lost him for good. I found myself moving my head into his line of vision and calling his name. He suddenly looked at me in surprise, like someone surfacing from the deep and said “Hello–o–o” wonderingly and sweetly, like someone greeting a long lost friend.

(p. 22)

In the clinical process that follows, Alvarez shows how her patient moved from his “undrawn” state into contact with her and the world of feelings. “Here Robbie came verbally, musically and dramatically to life” (p. 22).

In this extraordinary interaction she seemed to breathe life into Robbie, his objects, and the treatment. I imagine this moment was meaningful and vitalizing for Alvarez as well. I understand the analyst’s “countertransference urgency” as an expression of her subjectivity. Alvarez’s response reflected the unique and inchoate ways that this relationship had touched her and created intrapsychic disruption within her. This Robbie was her Robbie. While doubtless other clinicians would have been moved differently, Alvarez’s reactions emanated from her psyche and her connection to this boy and to some part of herself that was stirred by him. Robbie’s responsiveness was also specific to this relationship and his dynamics as they emerged with this analyst.

Through my own relational lens I am conceptualizing this moment as an enactment in which patient and analyst met in a way that was progressive and alive. This encounter was an enactment in that it was an unconsciously driven, spontaneous, and seismic action. While clearly asymmetrical (Aron, 1996), this was a mutual exchange between two people, two minds meeting, touching, and transforming one another. The interaction between Alvarez and Robbie led to intrapsychic movement, which in turn altered the relational field for patient and analyst alike. While mindful of the unique characteristics and parameters of psychoanalytic work with children, I suggest that the analyst’s enlivening use of herself in such moments of therapeutic crises can be usefully generalized to work with adults and considered as enactments.

Vitalizing enactment

I am proposing that vitalizing enactments are interactions in which the analyst reaches out to draw the patient from their most necrotic zones, enlivening the treatment and generating new experiences. These enactments are distinct in that they can potentiate underdeveloped affects and capacities for the patient and analyst alike. Vitalizing enactments represent efforts to progress consciously and unconsciously rather than to re-create old pathological patterns or manifest dissociated experience. In working with such enactments the emphasis is on creating novel feelings and ways of being rather than interpreting what Alvarez (2012) describes as the “why–because” or “whatness” of the experience. Narratizing, reflecting on process, or linking old to new may follow as different “grammars” develop (Alvarez, 1997). In vitalizing enactment the action is in seizing the moment and creating something new.

The concept of enactment has generally been understood as a repetition of aspects of the past. Jacobs (1986) first identified “enactment” as an unconscious countertransferential action that occurs in response to the patient’s psyche and the pulls of the relationship. Since then and across theoretical orientations enactment has widely been regarded as ubiquitous and been seen as more or less problematic (see Aron, 2003, for discussion). It has alternately been conceptualized as an unconscious replaying of past trauma, troubled internal processes, or dissociated experience (Benjamin, 1990; Bromberg, 1998, 2006; Davies & Frawley, 1994). Enactments have come to be understood as high-risk encounters that hold the potential for great rewards if they can be survived and processed (Bass, 2003).

What I am suggesting here is a different take. Just as Alvarez (1997) posited that the container can be a medium for the transformation of a range of feelings, I am suggesting that in enactment a range of unconscious experiences can also emerge. I am building on the assumption that the unconscious is a repository for negative feelings and fantasies as well as positive and embryonic affects and that the analytic couple is in continuous unconscious dialogue (Ferenczi, [1932] 1988) in multiple ways from the start. It follows that patient and analyst can respond to each other from unconscious areas that contain nascent feelings of love, joy, and hope as well as conflict and painful dissociated affect. All of these interactions can be intense, spontaneous, and destabilizing; all of these meetings can be forms of enactment. From this perspective enactments need not inevitably be repetitive and problematic. Enactments can also be progressive and can lead to the creation of novel feelings and capacities in the here and now. Consistent with this view, enactments need not be seen as problems to which the solution is enriching. The enactment itself can be transformative for patient and analyst, bringing to life experiences that have been submerged or unborn.

Theoretical convergences and expansions

Aron and Atlas (2015) proposed a conception of enactment as generative: a way of practicing novel possibilities that can subsequently be lived out in the evolving future for both partners in the analytic dyad. Building on Jung’s notion of the prospective function, they suggested that through enactment we can anticipate, envision, and construct new possibilities, paving the way for their subsequent realization. My notion of vitalizing enactment shares with Aron and Atlas’s work a view of enactment as potentially creative and forward moving. But our conceptualizations differ because in vitalizing enactment the action is in seizing the moment and creating something new rather than in rehearsing future outcomes.

Lisa Director’s (2009, 2016) recent work is also relevant. Extending Alvarez’s thought, Director has proposed that the relational analyst can function as an enlivening object, catalyzing intrapsychic change within the patient. Director (2009) is centrally concerned with intrapsychic development in patients whose “curtailed object relations confine them to primitive forms of engagement” (p. 120). I am interested in an expanded conceptualization of enactment as carrying the potential for vitalization and in exploring the interplay of intrapsychic and intersubjective processes in the analytic dyad that can potentiate such creative transformations.

Newirth’s (2003) work on the “generative unconscious” also relates to the concept of vitalizing enactment. He has theorized that the unconscious can be a source of creativity and energy rather than only a site of pathological conflict. Stern (2003) proposed that, as dissociations are lifted unformulated experiences can emerge that not only are defensive but also can be creative and lead to joint discovery. Echoing both of these theorists, I’m suggesting that vitalizing enactments involve the creation and emergence of novel and enriching experiences through analytic interaction.

Stephen Mitchell has advanced a theoretical shift in psychoanalysis from a model of damage and cure to one of mutual growth and enhancement of subjective experience. His exploration of the creation of new meaning rather than reworking old tapestries is spelled out in his chapter “Penelope’s loom” (1988) and in his explication of analytic intention (Mitchell, 2000). He emphasized the mutative potentials in the analytic relationship as a different form of interacting in the here and now. Similarly, in vitalizing enactment the focus is on the creation and enhancement of experiences for both partners in the analytic dyad.

Loewald’s (1960) focus on growth, development, and the dimension of the future is germane, as is Cooper’s (2000) work on the role of “futurity” in the analytic process. As with vitalizing enactment, these ideas go to the progressive potentials of the therapeutic relationship. Hoffman’s (2009) advocacy of “passion in the countertransference” relates to vitalizing enactment in his notion of the analyst’s active role as a new good object, particularly against the looming inevitabilities of loss and mortality. Vitalizing enactments, however, involve developing nascent capacities and new object experiences rather than confronting malevolent introjects in the manner Hoffman has advanced.

The idea of living though, rather than interpreting, vitalizing enactment jives with several strands of analytic thought. For example, in recent work Grossmark (2012) explored the value of being in rather than directly interpreting the “enactive flow” when working with patients who do not experience themselves as psychically alive. Similarly, Black (2003) has suggested that at certain moments it is the shared experience of the enactment rather than subsequently processing it that is transformative. Fiscalini’s (1988) work on the transformational role of “living through” new experiences in the interpersonal matrix of the analytic dyad is also resonant. From an object relational perspective, Rosenfeld (1987) and Williams (2010) have each explored the importance of interpretive restraint, particularly when working with vulnerable patients who may find verbal interventions shaming or invasive. These are some of the formulations that animate my understanding. In the vignette that follows I illustrate and explore these ideas further.

Clinical vignette

Joel was a middle-aged man who came into analysis to treat chronic insomnia, anxiety, and depression, explaining that he was disaffected in every area of his life. Handsome, educat...

Table of contents

• Cover
• Endorsement
• Half Title
• Series Information
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• Introduction
• Part I Vitalization as unconscious action: Enactment, dreaming and emergence
• Part II The analyst’s vitalizing use of self: Love, play and provision
• Index