Wednesday, July 4, 2012

Michael Miller - The Emotionally Engaged Analyst

"The analysis of the meaning of a patient's symptoms, conflicts, transferences, and resistances has been at the heart of psychoanalytic treatment since its inception. In recent decades psychoanalytic theorists have added to the ways in which we appreciate a patient's conflicts and transferences the narrative meaning that patients consciously and unconsciously construct to understand and to contextualize their subjective experience and their relationships to others (Schafer, 1976, 1992; Spence, 1982). Modern psychoanalytic thinkers advanced the analysis of meaning still further by contributing the idea that the analyst participates in the construction of the patient's narrative (Gill, 1982; Loewald, 1960; Mitchell, 1988). Indeed, the ways in which the analyst contributes to the analytic interaction have occupied center stage in the literature for many years.

One aspect of the analyst's contribution to the analytic matrix that has resisted clear elaboration has been the analyst's emotional reactivity. Nearly every school of psychoanalysis today recognizes that the analyst's emotions play a role in the analytic interaction and contribute to the meanings derived from the patient-analyst dialogue. Nevertheless, controversy exists as to the nature and extent of that role. Although most psychoanalysts will acknowledge that the analyst's emotional reactions contribute to his or her empathy with the patient, providing the analyst with a window into the patient's subjective experience, some practitioners, such as Gray (1993), believe that the analyst's empathy should be restricted to informing the analyst about the patient's state of being, the patient's readiness for an interpretation, or the most affectively meaningful point of intervention. Schwaber (1981, 1996), reinforcing Gray's perspective, conceives of the analyst's empathy as a tool with which to identify a patient's subjective experience within the coconstructed matrix of the analytic interaction. Schwaber (1981) emphasizes that the analyst's empathy is a "mode of attunement which attempts to maximize a singular focus on the patient's subjective reality, seeking all possible cues to ascertain it" (p. ). She cautions the analyst to vigilantly guard against the imposition of his or her point of view.

Other psychoanalysts opine that the analyst's empathic resonance with a patient's subjective experience is a crucial transformative element in psychoanalytic treatment (Aron, 1996; Kohut, 1959, 1971; Lichtenberg, 1981; Schore, 1994, 2003b). These theorists believe that the analyst's emotional responsiveness goes beyond simple empathy with the emotional states of the patient. They argue that the analyst's expression of his or her emotional reactions provides a context of understanding within which patients feel safe and open to the analyst's interventions (Gedo, 1979; Kohut, 1977; Sandler & Sandler, 1978; Stolorow, Brandchaft, & Atwood, 1987). Indeed, Gill (1982) sees the analyst's emotional participation as an essential component in the patient's formation of the transference.

Some contemporary psychoanalytic theorists, however, counter that an analyst's emotional engagement of a patient is an expression of the analyst's unconscious emotional conflicts (e.g., Chused, 2003), or that the analyst's emotional reactivity leads to a traumatic reification of the patient's unconscious fantasies and fears (e.g., Schafer, 1999). Relational analysts, on the other hand, strongly advise that the analyst's emotional engagement of the patient is an essential element of analytic treatment. Aron (1996), Davies (1998), Jacobs (1986), Levenson (1983), Mitchell (1988, 1993), Ogden (1995, 1997), and Renik (1996) posit that unless the patient and the analyst enter one another's emotional world, as active participants in creating and interpreting one another's lived experience, the relational matrix that constitutes the curative element in psychoanalytic treatment fails to emerge. Without an emotionally engaged analyst, treatment is never fully realized.

This essay aims to clarify the nature of the contribution that the patient's and the analyst's emotional reactivity makes to the psychoanalytic enterprise. The theory of emotion to which we as analysts implicitly or explicitly subscribe is a key factor influencing the way we understand what the role of our affective experience in psychoanalytic treatment is. The way we conceptualize emotion determines in great measure what we can conceive of doing with a patient's emotional experience as well as our own. I will show that with each successive advance in our theoretical understanding of emotion the analyst's emotional participation becomes more central to the analytic process, opening new avenues of therapeutic relatedness and intervention. I will explain how the meanings that the patient and the analyst employ to interpret their subjective experience and their interaction are determined in significant ways by the exchange of emotions between them. To this end, I will review two major contemporary theories of emotion (the cognitive appraisal approach and the functional/discrete analysis) and describe their influence on modern psychoanalytic theory and practice. I will then introduce a new approach to emotion based on dynamic systems theory
." (pp. 3-4)

"With each advance in our knowledge about the nature of emotion, psychoanalysts' understanding of the role of emotion in the psychoanalytic practice has progressed. As analysts came to understand the relationship between the schemas of emotion and the schemas of declarative knowledge, practitioners began to use their emotional reactivity and their empathic resonance with the patient in new ways. They saw their own feelings and reactions to the patient's emotional states as windows into the patient's subjective, emotional experience, much of which was developmentally unformulated, defensively sequestered, or not well articulated. In symbolically representing in images and words the analyst's empathic resonance and emotional reactivity, the analyst transforms the patient's emotions into meaningful feelings. These feelings in turn not only inform the patient about the meaning of his or her emotional experience but also about the nature of his transferential connection to the analyst.

As the adaptive function of emotional behavior became more clearly articulated, psychoanalysts became aware of the way their own emotional behavior affected the emotional states of the patient. Analysts began to regulate, contain, and metabolize the patient's emotional experience through the way they themselves emotionally processed and expressed their experience of their own and the patient's emotional behaviors. The exchange of emotional behaviors between the patient and the analyst was now recognized as the context within which the meanings that characterize the nature of the therapeutic interaction emerged.

Dynamic systems theory casts emotion in a truly interactive context, enabling analysts to appreciate the coconstructed nature not only of the meanings attributed to the analytic interaction but also of their own and the patient's emotional states as well. Psychoanalysts can now trace the emergence of their own and the patient's emotions from the exchange of emotional behaviors between them. As the emotions of the patient and the analyst self-organize in reference to the emotional behaviors of the other, the ways the patient and analyst constitute, regulate, and interpret their emotions directly impact the construction of emotion in both persons. As the patient and the analyst work to optimally adapt to the nature of their relationship, the emotional states and behaviors of each of them are simultaneously impacted and changed. Concurrently, their emotional exchange gives their relationship an emotional tone that in turn constrains the emotional states and behaviors accessible to them, the meanings available to interpret their emotional relationship, and the types of therapeutic interventions and transformations open to the analyst. The analyst can now formulate his or her interventions and interpretations to take advantage of the ways in which emotion, meaning, relationship, and context interact in the formation of subjective experience. Mutative change is always systemic, effecting changes in all components that constitute the emotional relationship between the patient and the analyst. The emotional engagement of the patient and the analyst thus constitutes the essence of the therapeutic action in psychoanalysis.

The context within which the analyst works, from this dynamic systems perspective, is a complex emotional system that is both stable and constantly in flux. As the analyst manages the multiple interacting influences on the analytic process and on the emotional states and interpretations that carry the analytic dialogue while simultaneously experiencing the effects of his or her own adaptations to the patient's emotional behavior, new ways of monitoring, influencing, and interpreting the patient-analyst interaction are required. These therapeutic processes, configured in a dynamic, interactive, and continuous manner, form the analytic context to be illuminated with clinical material in the companion paper to this essay (Miller, in press)
." (pp. 19-20)

Michael L. Miller (2008). The Emotionally Engaged Analyst I. Psychoanalytic Psychology, Vol. 25, pp. 3-25

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