Book Review: Secret Passages: The Theory and Technique of the Interpsychic Relationship

Psychoanalysis did not become a socially significant phenomenon in Italy until the 1969 IPA Congress in Rome. In an introduction to Stefano Bolognini’s paper on empathy (a version of which appears as chapter 8 of the book under review ¹ ), Marco Conti (2011) helpfully contextualized his colleague’s work by telling us that in Italy, “lacking important pioneers such as Anna Freud, Melanie Klein, Donald Winnicott, or Heinz Hartmann, it took many years for us to get a good idea of what psychoanalysis and its many points of view were all about.” Italian analysts spent many years studying and absorbing the various schools, and meeting with and being supervised by foreign colleagues. Thus their work is inevitably pluralistic. Bolognini has studied North and South American perspectives, as well as British and French authors, and has integrated this reading into his own unique voice.

The book is divided into three parts. The first, “Three Prefaces to the Discussion,” contains three short essays that introduce readers to the author’s way of thinking. In chapter 1, “Freud’s ‘Objects,’” he writes, “The discussion . . . I will develop is not in favor of a generic theoretical-clinical eclecticism, but . . . it is in favor of the recognition of plurality and complexity of our contemporary utilizability in interchanges among colleagues and in the privacy of daily theoretical-clinical reflections” (p. 10). Later he elaborates: “I understand our ‘post-modernism,’ in short, as the following: a substantial familial appreciation, humanizing and not idealizing, of our original psychoanalytic objects, in full recognition of our received heritage” (p. 24). These quotes will perhaps serve to demonstrate Bolognini’s writing style: discursive, complex, striving for completeness. That is, he tries to include as much as possible, but with a distinct slant toward qualifying and elaborating in the interest of clarity of thought.

Chapter 2, “Proposal for an Alternative Review of Therapeutic Factors: In the Margins of Gabbard and Westen’s ‘Rethinking Therapeutic Action.’” In this chapter, written in response to Gabbard and Westen’s 2003 article, he summarizes their achievement and goes on to present his own view of therapeutic action, with the caveat that “every barrel yields the wine that it contains, and every colleague will sing a different song from that of others” (p. 27). His list of what he would add to his interlocutors’ North American essay includes attention to the setting, derived from Winnicott, Balint, and Searles, which he emphasizes as not only a necessary precondition for treatment but as a constituent of therapeutic action. Because of its completeness, and in this instance quite straightforward presentation, I think this chapter would be a very useful teaching tool in analytic institutes, a comprehensive review of what potentially constitutes therapeutic action. I can imagine candidates debating and usefully thinking about what falls under this category of our work.

Throughout the book Bolognini, who besides being a clinical psychoanalyst is also a creative writer, poet, and film aficionado, is much given to allegory, analogy, and metaphor. In this chapter he introduces an “aquatic interlude,” a metaphor he is quite fond of. He likens the first session of an analysis to the patient’s going into the water, becoming acclimatized to a new environment, and learning one can float. “In this phase, the instructor’s basic assistance is decisive. With empathic perception, he synchronizes himself with the pupil’s level of alarm, and—partly by example, partly by appropriate instruction—he permits the pupil to reach, a little at a time, a certain level of confidence with the practicability of the aquatic medium” (p. 37). Some readers may find this charming; others will object to the analogy of teacher and pupil, and its educative implications.

But Bolognini then uses the metaphor to open a discussion of the preconscious and the unconscious: “In the deep unconscious no swimmer will ever move experientially or in real time. . . . but to see the marine floor some meters down from the surface is already in itself a great event” (p. 39). Moving directly from the ocean floor and the view of the preconscious, Bolognini addresses therapeutic action. “In my chapter on the recognition and decontamination of internal object relations [chapter 5, “Interpret-action”], the analyst’s availability/willingness to find himself again involved in split experiences relative to the relationship with the patient’s internal objects is selected as a specific therapeutic factor in contemporary analysis” (p. 39)).

Bolognini concludes chapter 2 with a reference to Ogden’s “analytic third” and a European version of this co-created space “as a paternal equivalent with separate functions pushing toward the recognition of reality”; this enters the session when the patient realizes he has been reached in a way that is “respectful . . . not paternalistically and not seductively, by a confirmation . . . directed not at his narcissism but at his work” (p. 42). It is hard to imagine a working analyst who would not agree with this.

The third chapter of this introductory section, a brief statement about the relationship between words and things, emphasizes the problem of working too intellectually.

The book’s second part—“Interpsychic Passages”—addresses the promise of the title and is the heart of the book. The first of its six chapters, “The Intrapsychic and the Interpsychic,” allows Bolognini to lay out his definition of the interpsychic, which he does in his characteristic style, first laying out what it is not. He begins by establishing an axis along which analysts must locate themselves, favoring an intrapsychic or an interpsychic view of how therapeutic change comes about. He promises “right from the start” that he is “not going to deal with the caricatures proposed by each of the opposite extremes to describe the other”; he does, however, state that theoretical views are moving toward an appreciation of the interpsychic. Bolognini uses three lovely clinical vignettes to demonstrate work that is, respectively, primarily intrapsychic, primarily interpsychic, and somewhere in between. These vignettes, clear and accessible, reveal how he thinks about these issues.

Next Bolognini does the necessary work of distinguishing the interpsychic, the interpersonal, and the intersubjective. This is an important section: Bolognini has a special interest in the preconscious. He likens the preconscious work in analysis to the “cat-flap” door found in medieval Italian houses, a device that allows the cat to go back and forth between the castle and the outside without drawing the attention of those using the main door. I will quote at length, as I think the metaphor captures much of what Bolognini wishes to convey here: “it is a good symbol,” he writes, “for a structural (it is part of the door) and functional (it was specifically designed so that the cat can carry out its function of catching mice inside and outside the house) device that is not only intrapsychic but also interpsychic. The cat-flap is quite distinct from the door, which allows the passage of people, and from incidental cracks, which allow the passage of mice, clandestine, parasitical guests that harm the community/interpsychic-relational apparatus. . . . I conjecture that the cat-flap device corresponds topically to a preconscious mental level, and relationally to an interpsychic level. . . . A distinction must be made, therefore, between interpsychic, interpersonal and intersubjective: interaction is the phenomenological, common denominator among these three concepts, but the interpsychic is a more extended psychic dimension compared to the other two. The interpsychic is a level of ‘wide-band’ functioning, in that it allows the natural, uninterrupted, and not dissociated coexistence of mental states in which the object is recognized in its separateness, alongside others in which this recognition is less clear” (p. 66).

Having established the role of the preconscious in greater detail than I have space to describe here, and emphasizing the preconscious as an interpsychic phenomenon, he writes that Italian psychoanalysis is strongly characterized by its emphasis on this aspect of the work. He includes a number of authors and references for those wishing to pursue this topic.

Chapter 6, “My Dog Doesn’t Know Descartes,” is a charming narrative about dogs and the preconscious that showcases his ability to write in a lyrical narrative mode, and that allows him to elaborate his ideas on preconscious communication. It will appeal most to those who share his love of dogs.

Chapter 8, “The Complex Nature of Psychoanalytic Empathy: A Theoretical and Clinical Exploration,” reflects Bolognini’s long-standing interest in empathy, a subject he has pursued for more than twenty years and has more fully explicated in Psychoanalytic Empathy (2002). This chapter, more than any other in this volume, gives a clear view of how Bolognini thinks and works. He cites those who have gone before him (Kohut, Modell, and Schafer, among others) and gives a brief history of the development of the concept. He credits Schafer in particular for having “located empathic situations in the conscious-preconscious zone and unequivocally distinguishing them from phenomena of identification. The latter are unconscious by definition and, since they are intrinsically unthinkable, are if anything diametrically opposed to empathy, with its rich capacity to be thought” (p. 121). Bolognini’s definition of psychoanalytic empathy (as opposed to ordinary empathy) includes “a condition of conscious and preconscious contact characterized by separateness [and] complexity. . . . above all, it constitutes a progressive shared and deep contact with the complementarity of the object, with the other’s defensive ego and split off parts, no less than with his ego-syntonic subjectivity” (p. 123).

Much of the chapter is devoted to “A Session with Monica,” a lengthily presented session that gives a real window into the mind of the author as both clinician and theoretician. The chapter ends with a brief for the role of training in the capacity for empathy, which Bolognini insists is not a voluntary act, but a method; it must come as a surprise from a mind content to be in suspension: “The unconscious cannot be tamed on demand, and the preconscious is intolerant of too purposeful an attitude on the analyst’s part” (p. 120). It is in this chapter that Bolognini is at once most clear and accessible and also at his most passionate.

The final chapter in this part, on dreams, is a further explication of his method in the arena of dreams, and he expands his discussion to issues of representability.

In the third and final part of the book, “From Transpsychic to Interpsychic,” Bolognini explores in three chapters the area of primitive mental functioning and work with severely disturbed patients. He acknowledges that his work builds on Winnicott, Bion, and Ferro, in particular, as well as on Ogden and Grotstein. He argues that his contribution is “aimed at the importance of an antecedent formative phase of the container, in a certain sense more primitive . . .” (p. 162). This formative phase involves attention to the creation of internal space, without which no interpretation is possible. I am not sure that this is an entirely new contribution, but Bolognini develops his idea with abundant and compelling clinical material, and elaborates how he works technically during this phase of treatment.

What I found seriously lacking in this section was any discussion of the contemporary Kleinians of London, who have done so much to develop the concepts of projection and projective identification and to theorize work with primitive mental states. Bolognini alludes to their contribution—“No psychoanalytic school has described these processes as well as the Kleinian one . . .” (p. 188)—but he refers only to Rosenfeld’s work. There is no mention of the work of Betty Joseph, Michael Feldman, John Steiner, or any of their colleagues. It would have been useful and informative to have a clear delineation of how Bolognini’s work both resembles theirs and diverges from it.

Bolognini’s writing reflects his training in a classical Freudian mold and the influence especially of Winnicott and Bion, along with that of his Italian colleagues, as well as the work of North American analysts interested in exploring the commonality of the different analytic approaches. He is familiar as well with the work of contemporary French writers. While this breadth of knowledge is a real accomplishment, to me his references seem idiosyncratic and personal, rather than comprehensive. But the real mission of this book is for Bolognini to introduce his ideas on the interpsychic. “Very cutting edge,” a colleague remarked, dryly, when I told him I was reviewing this book. While I am not sure this wine is new, it is certainly in a new bottle. The book is written with a distinctive voice, and would be a welcome addition to any analyst’s library. Reading it in whole or in part will reward any reader who would like to be immersed in the clinical and theoretical thinking of our Italian colleague, whom I have had the good fortune to hear speak in New York. Bolognini is well served by his translator, Gina Atkinson, who has ably translated others of his works.