Wednesday, May 30, 2012

Britton & Steiner - Interpretion: Selected Fact or Overvalued Idea?

"We have tried to illustrate the formation of interpretation from the selected fact and the difficulty of differentiating this from an overvalued idea. Before we consider this distinction further it is necessary to describe briefly Bion's notions on interpretation and how they are dependent on his theory of preconceptions, of the container/contained, and of the cyclical movement from the paranoid-schizoid to depressive positions (PS D).

In a situation where meaning is not apparent and facts are accumulating, the relationship of one psychic particle to another is not determined until the analyst's attention is taken by something which thus becomes the selected fact, and there emerges a configuration as the other psychic particles cohere by virtue of their relationship to it.

This configuration of elements in relation to a selected fact is highly specific to a particular patient at a particular moment in his analysis. It provides the substance (the contained) for an abstract form (the container) which already existed in the mind of the analyst, of which this newly emergent configuration becomes the incarnation. This previously empty form or 'state of expectation' (Bion, 1962, was awaiting an exemplary situation to give it life. The 'empty form' was the background theory in the analyst's mind that found expression in this new formulation. These theories or expectant containers accumulate in the mind of the analyst and are derived from his general analytic theories, his own subjectively-based theories about people, his clinical experience of other patients, and his accumulating experience of this particular patient. 'Conception is that which results when a pre-conception mates with the appropriate sense impressions.' In this context it should be the analyst's mind primed with its theories which awaits as a receptacle for its expectations to be fulfilled by experience of the patient. This requires a capacity to wait, and if the analyst is unable to tolerate the uncertainty of not understanding he may turn to his theory as a source of reassurance and look for a patient to act as a container for the theory. Bion emphasises that the analyst's pre-conception has to act as a container for the realisation, and 'NOT' the other way round (Bion, 1962).

Bion's notion is that we move from a fragmentary psychic state (PS) to a coherent psychic state (D), and at each encounter with new experience we traverse this route. In analysis, therefore, both patient and analyst have to face periods of disintegration as new experiences are confronted before they are assimilated and understood. The initial disintegration represents a move towards PS, and this has to be contained before a true integration towards D can result. We think this is only possible where there is a sense of containment already in existence which provides a limit to the sense of fragmentation and incomprehension, so that it is not boundless, nullifying all meaning. Otherwise the experience is of 'nothingness', terrifying 'bottomlessness', or complete 'incoherence'. For many patients, for at least a good deal of the time, the analyst's presence and the setting provide this outer container. When this is not the case the situation is very fraught and often dramatic. Meaning is then sought, not to make sense, but to provide an alternative to the missing container.

We suggest that this is one reason why ideas become overvalued by either patient or analyst. They are used to buttress the fragile sense of stability in psychic space and are therefore required to have the qualities of permanence and substance. In such circumstances, interpretation may become a means of seeking security rather than of inquiry, and its constancy more highly valued than its truth. In this scheme of things there is no waiting for the evolution of the selected fact. The overvalued idea becomes the 'pre-selected fact', which is not emergent but mandatory in every psychic situation, compelling other psychic particles to orient themselves around it as if it were permanently the selected fact....

Two situations would seem likely to give rise to the intrusion of an overvalued idea into the analytic field, thus obscuring or preventing the natural evolution of the session: (1) the patient with an intolerance of uncertainty or doubt, who does not feel adequately contained in the analytic situation, presents material or interprets the analyst's behaviour in conformity with an overvalued idea, thus constricting the analysis within the confines of his existing mainly unconscious beliefs; (2) the analyst who relieves his fear of losing his analytic identity in a situation of uncertainty or confusion by attaching himself to an overvalued idea, for which he seeks confirmation in the patient for the beliefs which, unconsciously, he thinks are necessary for his psychic equilibrium.

In the first of these instances, the analyst's task is to discover the undisclosed defining hypothesis of the patient, i.e. the patient's overvalued idea, which may be unconscious. In the second, his task is to recognise his own overdetermined use of an idea and to try to understand his own behaviour. This may be unfinished business in his own analysis or it may be a specific countertransference to his patient, in which case the unravelling of this is part of the patient's analysis and may reveal a re-enactment of an unconscious object relation in the transference.
" (pp. 1076-1077)

Ronald Britton and John Steiner (1994). Interpretation: Selected Fact or Overvalued Idea?. International Journal of Psycho-Analysis, Vol. 75, pp. 1069-1078

Wednesday, May 23, 2012

Christopher Bollas - The Generative Erotic Transfer

"In the generative erotic transference, the analysand is acutely aware of the analyst's body self. Indeed, part of the analysand's agony is the precise erotic interest in that body. Although this relation can and frequently does become a resistance to analysis, in that the patient refuses to freely associate, it may lead to an important presentation of the analysand's instinctual life achieved through transference embodiment, in which the patient erotically cathects the analyst's presence. What is meant by transference embodiment? To love the object is to release one's instinctual capability, which, in turn, gives the body self a new-found authority that I term embodiment.3 The transference relationship quite naturally evokes latent instinctual capacities in the analysand, and, if all goes well, he or she comes into a new-found body-experiencing in the analyst's presence. Although the analysand will suffer a transitional disappointment because the analyst will not agree to the analysand's erotic wishes, the analysand feels instinctually emboldened and proud of his or her ability to represent sexual life in the sessions. It is a relief to find a body that is not merely an internal object, but also a body to love.

In some respects, the localised pathology of the erotic transfer becomes a motive for speech, as the patient partly wishes to engage the analyst through the conviction supplied by erotic passion. And yet it is difficult to cross the boundary between inner relations and external realities. In moments when speaking the internal erotic to the actual object of desire, the patient simultaneously recognises the integrity of the boundary between the internal and the actual. This may allow for a maximum nonerotic representation of the body's relation to the other, because the analysand either explicitly or implicitly indicates that she knows that her erotic is to an internal object that needs its reporting to come to full elaboration. In so doing she will know, however, that any person's narration of the actual other is precarious, and there may be innumerable reasons why the patient does not feel secure representing the analyst's body."
(pp. 574-575)

3 "Embodiment" refers to the individual's pleasure in having or being a body. Transference embodiment is the development of pleasure in one's own body, driven initially by the erotic transference, but ending in a sense of the intrinsic pleasures of bodily existing, as opposed to the world of abstract thought and schizoid inner object relating.

Christopher Bollas (1994). Aspects of the Erotic Transference. Psychoanalytic Inquiry, Vol. 14, pp. 572-590

Saturday, May 19, 2012

Rushi Ledermann - Healthy Aspects of Regression

"Jung, on the whole, takes a favourable view of regression and points out its teleological value. In ‘The theory of psychoanalysis’ (Jung 7) he says: ‘the neurotic's retreat to the infantile level does not mean only regression and stagnation’ (here is the synonymous use of the two concepts which I mentioned earlier) ‘but also the possibility of discovering a new life plan. Regression is thus in very truth the basic condition for the act of creation.’

In my view healthy regression takes place to a greater or lesser degree in the analysis of all patients with neurotic symptoms such as phobias, obsessions, neurotic depression, etc. A different kind of depression, usually called schizoid depression, will be mentioned when I discuss stagnation. Regression may occur spontaneously in a patient or may result from analytic work.

Regression may occur, and be therapeutically desirable, in patients who have missed out in certain areas of their development, such as adolescence or unresolved sibling rivalry, or who could not play as children. Regression may also take place if certain psychic functions, such as feeling or thinking, have remained underdeveloped. Jung in his essay ‘On psychic energy’ (Jung 9) mentions the complementary function of regression. He says: ‘unconscious material activated by regression will contain the … missing function, although still in embryonic form, archaic and undeveloped’.

Equally, regression may occur when a traumatic event, like the death of someone close, could not be worked through at the time it occurred. These gaps in a person's development seem to me to be caused frequently by a defect in the deintegrative/reintegrative processes, which occurred at some time in the past. This defect, if not repaired, may seriously impede the process of individuation. Hence the need to regress to the damaged area of the personality.

As Jung has shown, neurotic symptoms are frequently attempts, albeit unsuccessful ones, to solve neurotic conflicts. They are a way in which the psyche spontaneously tries to repair damage which it has suffered. Thus, if understood correctly, they can serve as signposts for the analyst, indicating to which area the patient needs to regress so that analytic repair can be effected. In our present terminology we could say they indicate where deintegrative/reintegrative processes were impeded. This may have been caused by an innate deficiency in the patient or, more often than not, by an environment which was inimical to successful deintegration. It occurs when the patient could not enjoy a state of healthy dependence on his parents at a time in his childhood when such dependence was an indispensable condition for healthy development.

In analysis, regression can last for minutes, for days, for months, or in severe cases for years. If a patient regresses to the pre-verbal period of his life, he will sometimes express his regression in the consulting room by behaving like a baby who has no words to communicate. This may go on for a prolonged period of time. His regressed behaviour may involve screaming, kicking the wall, punching or throwing cushions, hiding under the rug or behind a chair, or simply lying in the position of a baby, with arms raised, or going to sleep in sessions. However, in my experience, this deep regression to infantile behaviour occurs more often than not in patients who have come out of long periods of what I call stagnation. I shall revert to this point in more detail when I discuss stagnation.

The analytic environment with its consistency of place, regularly agreed session times, its couch with cushions and rug, and, last but not least, an analyst who is reliably there for the patient in a consistent and caring way, all create a situation which is inducive to regression, unless, as I shall explain later, the patient is in a state of stagnation.

The analytic setting evokes memories of infancy in the patient, who may relive with the analyst a state of dependence which is not unlike that of a very young child or baby depending on his mother, albeit in analysis it occurs in an entirely non-physical way on a symbolic mother and is helped along by transference interpretations which frequently make the patient conscious of his child feelings.

In my view the need to regress springs up spontaneously out of the patient's psyche. Hence an analyst cannot cause a patient to regress, nor can he necessarily stop a patient from regressing if he wishes to do so. If a patient has regressed to the archetypal layer of his psyche and the analyst fears that a psychosis might develop if the patient stays regressed, all he can do is to cease making further interpretations and try to help the patient to address his problems in the here and now. The analyst may also consider reducing the frequency of sessions. In such a case the analyst must pay special attention to his countertransference: whether or not he has become fascinated by the archetypal material, has unwittingly communicated this to the patient, and has thus contributed to his getting stuck on the archetypal level. However, regression usually occurs when it is necessary for healing and for further growth. As Jung has pointed out, the psyche, like the body, has an innate tendency to heal injury."
(pp. 484-486)

Rushi Ledermann (1991). Regression and Stagnation. Journal of Analytical Psychology, Vol. 36, pp. 483-504

Thursday, May 17, 2012

Lucy LaFarge - Interpretation and Containment

Abstract "The author explores two aspects of the analyst's effort to imagine the inner world of his patient and the way that they are manifest in the clinical moment. The first of these is the analyst's recognition and interpretation of his patient's elaborated fantasies. This current of the analyst's imagination is most often evoked by the patient's communication of whole-object transferences, which occurs largely in his verbal associations. The second is the analyst's reception and transformation of his patient's primitive emotional experience, a process that Bion has called containment. This second imaginative current is most often evoked by the patient's communication of part-object transferences, which occurs largely in affect and action. Interpretation and containment both go on at once in clinical work, although one or the other is usually dominant. Attention to the interplay of interpretation and containment in the clinical moment enables us to identify the articulation of whole- and part-object transferences and to integrate ego-psychological and Kleinian frames of reference in clinical work. In addition, the concept of mutual containment opens Kleinian theory to the possibility of a two-person psychology in which the roles of analyst and patient are more symmetrical than they are usually conceived to be within this frame of reference. The author presents two clinical examples to demonstrate the interplay of interpretation and containment. In the first, these processes operate smoothly. In the second, the process of containment is strained but ultimately successful." (p. 67)

Conclusion: "In this paper, I contrast two aspects of the analyst's interchange with his patient. At one pole, I have placed the analyst's recognition of his patient's elaborated fantasies, often communicated by the patient in his verbal associations. The analyst feels this material to arise mainly from the patient, rather than from the analyst's own subjective experience. I have argued that this pole of the analytic situation often reflects the patient's experience of the analyst as a whole object and is often best understood within an ego-psychological frame of reference, in which interpretation is the chief therapeutic agent. At the other pole, I have placed the analyst's imaginative transformation of material that he feels mainly as arising within himself, as a shaping or a disturbance of his own subjective experience. I have argued that this second pole of the analytic situation often reflects the patient's experience of the analyst as a part object, conveyed in the patient's affects and actions rather than words. I have argued that this pole is often best understood within a Kleinian, or more specifically, a Bionian frame of reference, in which containment is an important therapeutic agent. From a theoretical standpoint, it might be argued that both the polarisation of two kinds of listening and the use of two theoretical frames, is unnecessary. As I have noted, the two poles rarely occur in pure form. The skilled analyst, whatever his theoretical frame, tends to draw upon both kinds of data, and to blend them in his formulations. And it has often been argued that a good analyst who puts either of the two frames of reference that I attempt to integrate to full use will get a good clinical result. Nevertheless, I think that the teasing out of these two aspects of analytic material, and the effort to understand them as different, is useful, both in elucidating the extreme cases, where one pole or the other strongly predominates, and in helping us to see, in the more common, middle range where both kinds of material are intertwined, those aspects of the clinical situation which are more evident from one vantage point than from the other." (pp. 81-82)

Lucy LaFarge (2000). Interpretation and Containment. International Journal of Psycho-Analysis, Vol. 81, pp. 67-84

Friday, May 11, 2012

Jean Knox - The Fear of Love

"In this paper, I have explored the consequences when the development of a fully mature and reflective sense of self-agency is inhibited and how this gives rise to a fear of love and relationship. I have suggested that these linked problems emerge when parents are fearful of their infant's separation-individuation process and need the infant to remain as a psychic mirror for themselves. As the infant grows, he or she then both fears all subsequent relationships as potentially destructive of his or her subjectivity and also that his or her own individuation process will threaten his or her objects.

The underlying fear of allowing oneself to exist as a subject rather than as an object can contribute to any of the patterns of insecure attachment-avoidance, ambivalence or disorganization and to a whole range of clinical problems. Impenetrable defences of the self can be expressed in bland non-relationship or in cycles of intense attempts at merger and fusion with the analyst, followed by violent attempts at separation, often fueled by self-harm in the form of alcohol or drug abuse or self-injury. What I have attempted to show with this particular clinical example is the developmental inhibition of self-agency which underpins the fear of love. It is rooted in the person's experience that relationship is always coercive, that one person is directly controlling and dominating another. This experience is maintained by the predominance of an indexical form of communication, in which words are controlling actions, not truly symbolic communications.

In analytic work, it is therefore vital for the analyst to be demonstrably open to the possibility of alternative meanings in any exchange between analyst and patient, rather than trying to impose a particular view of the patient's unconscious intentions on him. Otherwise an analytic impasse is inevitable, in which analytic work deteriorates into a battle in which both analyst and patient are fighting for survival, the analyst for survival of his or her analytic function and the patient for his or her very psychic existence. Indeed, the analyst's countertransference feeling that his or her own survival as an analyst is at stake can alert him or her to the fact that, for the patient, the analyst is another parental figure who requires total subjugation to his or her needs and the annihilation of the patient's own self-agency.

In spite of the fact that some degree of enactment of this impasse may be inevitable, an analyst who is open to explore multiple symbolic meanings and to understand the material from the patient's perspective, rather than impose his or her own, offers a new experience within which the patient can gradually relinquish his or her defensive mindlessness. The projection of the controlling devouring parent can gradually be withdrawn as the analyst demonstrates again and again his or her own reflective function, the awareness of the patient as a separate psychological and emotional being. This experience is gradually internalized, activating the compare and contrast process of the transcendent function, allowing the patient to begin to relate to his own mind as a separate and symbolic psychic space which can integrate conscious experience, unconscious symbolism and the sense of self."
(pp. 559-560)

Jean Knox (2007). The Fear of Love: The Denial of Self in Relationship. Journal of Analytical Psychology, Vol. 52, pp. 543-563.

Tuesday, May 8, 2012

Jeanine Vivona - Loewald: Language as the Bridge to Lived Experience

"Hans Loewald (1978) heralded a new psychoanalytic era with his theory of the nature of language and its operation in treatment and in life. For Loewald, language "ties together human beings and self and object world, and it binds abstract thought with the bodily concrete-ness and power of life" (p. 204). In Loewald's view of development, the infant is "embedded in a flow of speech that is part and parcel of a global experience within the mother-child field" (p. 185). From the beginning of life, language, especially the mother's speech, surrounds the child as part of the sensual, lived world. As the child begins to understand the semantic meanings of the words, the realms of lived experience and language come to be differentiated, so that the child is able to interact with the world and within the self in two distinct yet interconnected and mutually enriching modes, primary process and secondary process. Throughout life, these two modes are bridged by language: "In the word primary process and secondary process are reconciled" (p. 204). For Loewald, then, there is no strain of human experience that is purely nonverbal, even during infancy. Language becomes increasingly semantic as development progresses.

Importantly, for Loewald the process of differentiating words and experiences in infancy is an interpersonal one. "The emotional relationship to the person from whom the word is learned plays a significant, in fact crucial, part in how alive the link between thing and word turns out to be" (p. 197). Hence, not only can words summon their interpersonal sensorimotor histories; the interpersonal relationships within which language is learned animate the connections between words and the things they signify. In these ways, the feeling of that early relationship, its aliveness or its deadness, is memorialized in language. Speaking and listening, understanding and being understood, are inherently interpersonal processes potentiated by, through, and in language. Language, then, in both semantics and structure, offers a connection to lived experience in the present and embodies memories of relationships in the past, including the early maternal relationship.

Loewald went beyond recognizing that speech is action, that speech has both semantic and sensorimotor qualities, that speech potentiates connections within oneself and between people. Loewald's vision was that semantic language develops out of an initial sensorimotor-linguistic unity comprising words and lived experience and consequently maintains potential connections to sensorimotor experiences, present and past. Interestingly, the developmental process he proposed is analogous to Winnicott's contemporaneous vision (1951) that a self develops out of an initial mother-baby unity. In both views, two entities begin as an undifferentiated one and over time, under the right conditions, within the right kind of interpersonal relationship, become differentiated, while remaining connected. If conditions are not right, then either the entities do not become differentiated or their connection is severed. In terms of language, the failure to differentiate leads to psychotic or otherwise regressive speech, in which the distance between thing and word is collapsed, such that words are mere things and speaking is mere action. At the other extreme, intellectualized speech results when the connection between thing and word is severed; then words take on a life of their own, disconnected from the experiences they signify and might otherwise evoke. Winnicott (1967) wrote that the differentiation of baby and mother "is not a separation but a form of union" (p. 98). In Loewald's view, language, too, is a form of union.

Loewald (1970, 1978) proposed that psychoanalytic talking can be transformational because language is a conduit to lived experience, because it is infused with affective interpersonal relationships, and because it joins human beings to one another. In psychoanalytic treatment the task of the analyst is to mobilize the power of language to reinstate an adaptive balance of primary process and secondary process, either by reactivating sensorimotor states, especially as experienced in the therapeutic relationship, or by quieting them with reflective, secondary process thought. An effective interpretation, in particular, evokes lived experience via the words contained within it, potentiating new ways of being. Loewald (1978) quoted Paul Valéry to articulate the "essential function" of language: "It enjoins upon us to come into being much more than it stimulates us to understand" (p. 204); being happens in and by virtue of language, particularly during the psychoanalytic hour.

Certainly Loewald's developmental theory infused his clinical theory, as evidenced in his elaborations of the similar developmental contributions of mothers and analysts. Yet Loewald (1970) remained cognizant of the limitations of such metaphors, including the unavoidable risk of leaving important aspects of a complex problem unarticu-lated. In other words, he did not take his metaphor literally. He did not confuse the analyst for the mother; on the contrary, he emphasized that, to be transformational, the therapeutic relationship must have "the substantiality and the evanescence of a play" (1977, p. 373) as opposed to actuality. And he did not confuse the patient for the baby; on the contrary, he asserted that "psychoanalysis is an adult undertaking" (1977, p. 380), impossible in the absence of the patient's adult capabilities for verbalization, ref lection, frustration tolerance, and restraint. Thus, Loewald evoked development not to explain, but to give form to previously unformed notions, to draw attention to neglected phenomena by giving them a familiar face....
" (pp. 881-883)

"As Daniel Stern's developmental model is invoked to explain the therapeutic action of psychoanalytic treatment with adults, two related false assumptions about language are imported into psychoanalysis: that language is primarily abstract, linear, disembodied, and thus inadequate for understanding lived experiences of self and relationships with others; and that nonverbal aspects of adults' lived interpersonal experiences are organized without language and thus are largely inaccessible to language, including the language of the psychoanalytic conversation. Stern's conceptualizations of verbal and nonverbal experience underestimate the potential power of language in treatment and in life, including the life of the infant. Because these conceptualizations limit the extent to which we may nurture or notice the integration of words and lived experience in psychoanalytic treatment, they have necessitated a search for nonverbal treatment mechanisms to access the presumedly separate nonverbal realm, fueling debates over therapeutic action within psychoanalysis.

If psychoanalysis moves toward embracing developmental models 899 such as Stern's, we accept a shrinking role for language in the talking cure. We risk ignoring important verbal and nonverbal contributions of talking. We risk limiting or even sacrificing the therapeutic power of language. Hans Loewald illuminated the fact that language offers us the capacity to integrate lived experience and verbal understanding, to bring self and other together in meaningful conversation. If we remember and use these capacities of language to bridge both separate individuals and separate inner states, we more fully mobilize the therapeutic potentials at the heart of psychoanalysis." (p. 899)

Jeanine M. Vivona (2006). From Developmental Metaphor to Developmental Model: The Shrinking Role of Language in the Talking Cure, Journal of the American Psychoanalytic Association, Vol. 54, pp. 877-902

Friday, May 4, 2012

Robert Segal - Participation Mystique in the Thinking of Lucien Lévy-Bruhl and C.G. Jung

"For his knowledge of ‘primitive’ peoples, C. G. Jung relied on the work of Lucien Lévy-Bruhl (1857-1939), a French philosopher who in mid-career became an armchair anthropologist. In a series of books from 1910 on, Lévy-Bruhl asserted that ‘primitive’ peoples had been misunderstood by modern Westerners. Rather than thinking like moderns, just less rigorously, ‘primitives’ harbour a mentality of their own. ‘Primitive’ thinking is both ‘mystical’ and ‘prelogical’. By ‘mystical’, Lévy-Bruhl meant that ‘primitive’ peoples experience the world as identical with themselves. Their relationship to the world, including to fellow human beings, is that of participation mystique. By ‘prelogical’, Lévy-Bruhl meant that ‘primitive’ thinking is indifferent to contradictions. ‘Primitive’ peoples deem all things identical with one another yet somehow still distinct. A human is at once a tree and still a human being. Jung accepted unquestioningly Lévy-Bruhl's depiction of the ‘primitive’ mind, even when Jung, unlike Lévy-Bruhl, journeyed to the field to see ‘primitive’ peoples firsthand. But Jung altered Lévy-Bruhl's conception of 'primitive’ mentality in three key ways. First, he psychologized it. Whereas for Lévy-Bruhl ‘primitive’ thinking is to be explained sociologically, for Jung it is to be explained psychologically: ‘primitive’ peoples think as they do because they live in a state of unconsciousness. Second, Jung universalized ‘primitive’ mentality. Whereas for Lévy-Bruhl ‘primitive’ thinking is ever more being replaced by modern thinking, for Jung ‘primitive’ thinking is the initial psychological state of all human beings. Third, Jung appreciated ‘primitive’ thinking. Whereas for Lévy-Bruhl ‘primitive’ thinking is false, for Jung it is true—once it is recognized as an expression not of how the world but of how the unconscious works. I consider, along with the criticisms of Lévy-Bruhl's conception of ‘primitive’ thinking by his fellow anthropologists and philosophers, whether Jung in fact grasped all that Lévy-Bruhl meant by ‘primitive’ thinking." (p. 635)

Robert Segal (2007). Jung and Lévy-Bruhl. Journal Analytical Psychology, Vol. 52, pp. 635-658

Tuesday, May 1, 2012

Susan Thau - Ferenczi's "A Dialogue of Unconsciouses"

"Studying Sandor Ferenczi's therapeutic explorations, I have a keen interest in the process of communication between the analysand and the analyst. Ferenczi proposed the existence of "a dialogue of unconsciouses" (1) as an ongoing part of the therapeutic process. I will further expand on this concept of the dialogue with emphasis on the transmission of affect from an attachment perspective. Transmission refers to the sending and receiving of emotionally based material, while attachment refers to the primary connection that forms between two people who provide security and comfort for each other. This perspective includes findings from the emerging field of developmental neuropsychobiology which describes the process of affect transmission between the analyst and analysand as it affects the brain and body even when there is no conscious awareness. All of this relates to the analysand's efforts to communicate a deeply felt need for a stabilizing relationship, a longing that must often be camouflaged because of fears of the impossibility of this desire.

What does it mean to think about the dialogue of our unconsciouses? How do we actually speak to each other if we do not use words? Are we in communication at all times or only when we are speaking? Sandor Ferenczi thought about this dilemma when he began writing about technique in his efforts to understand what happens in the therapeutic processes. He was well aware that he and his patients were conversing on multiple levels simultaneously. He was fascinated by what he called this form of "receptivity" (1), or "thoughttransference" (1). Ferenczi laid the foundation for an early interest in this intense form of non-verbal communication, giving it legitimacy by poetically describing the presence of this phenomenon between himself and his patients. But that was just the beginning, and it is now time to develop a further appreciation for the magnitude and complexity of this process.

Let us start by considering the dialogue and the analysand/analyst relationship. My patients, wanting to engage my attention, describe in exquisite detail the conditions, and the circumstances, that have caused so much psychic pain. Understanding that this communication is for a purpose, I know that I must make sense of what the patient is trying to convey that may not even be part of their own conscious consideration. What is communicated through the dynamics of the therapeutic process may be more revealing than the content of actual words. Implicit in this communication, at all times, are the patient's feelings about the nature of their therapeutic relationship. Ferenczi was concerned about the inherent inequality in all analytic relationships. Because of the actual condition of inequality, patients need to feel safe and trusting that the analyst will not use his or her position without regard for the patient himself.

Analytic guilt consists of the doctor not being able to offer full maternal care, goodness, self-sacrifice; and consequently he again exposes the people under his care, who just barely managed to save themselves before, to the same danger, by not providing adequate help. (Ferenczi, Clinical Diary 1: 52-53)

From reading how he explores his own process in the Clinical Diary, I now believe that my attitudes and subjective perspectives, whether critical of the patient or not, whether fully examined or not, will be transmitted to my patients, regardless of my intentions and whether or not these perspectives are actually spoken about in words. In addition, the patient is not just a passive recipient but is actively engaged and trying to make sense of his feelings about the therapeutic relationship even when he is not aware of trying to do this. This stance compels me to conscientiously consider how I can be more sensitive to what my patients may be trying to convey regarding our relationship, especially because of the possible aversion to recognizing their negative feelings due to their inherent dependency on me. The paradox of this therapeutic relationship is that dependency, while rarely acknowledged, to some degree is always present. Trying to grapple with this problem, D.L. Smith developed an approach which he calls "communicative psychoanalysis" (2). Smith states that we must be aware that our patients are constantly evaluating our behavior as therapists. By getting underneath the spoken word, it is possible to begin understanding more about how the patient holds the idea of the therapy as well as the nature of the attachment or the lack of it between patient and therapist. It is almost as if the patient's presentation, worded and unworded is like pieces of an enormous jigsaw puzzle that must be carefully reconstructed in order to see the larger picture. Smith believes that because of the inherent inequity in the patient-therapist relationship, inevitably the patient will try to signal the therapist regarding the difficulty of dealing with this unacknowledged control and dominance. He advocates listening to the patient's narrative for the themes having to do with connection and attachment, recognizing that these themes can then be linked back into the current therapeutic relationship.

Moving from this exploration of inequality, I would like to address the area where inequality is embedded but quite illusive. I am proposing that this inequality is a frequent component of the unconscious dialogue, the dialogue that is not spoken but which is communicated between analyst and patient. I do this out of the belief that as analysts we must develop a more attuned sensibility to the tone, nuance, cadence and choice of spoken word, as well as noting the body posture and facial expressions as a means of understanding what patients are trying to communicate about themselves and their feelings about their relationship with us as analysts. There is no question that we can learn from our patients about aspects of ourselves which are revealed through the complex interaction of attunement, disruption and possibly repair. The latter refers to the possibility of an emotionally healing experience where a process of disruption is turned into one of mutuality and regard (3)." (pp. 114-115)

Susan Thau (2004). Dialogue of Unconsciouses: Conversations We Have Without Our Knowledge. International Forum of Psychoanalysis, Vol. 13, pp. 114-120