Abstract
To read The Possible Profession: The Analytic Process of Change is to take a master’s class in the art of psychoanalysis taught by a consummate clinician and theorist in matters of therapeutic action and technique. Jacobs also displays his skills as an accomplished writer and storyteller able to create an entertaining, at times compelling reading experience that powerfully resonates with the communicative matters at the heart of his work. The clinical vignettes with which this volume is replete are both exquisitely personal and at the same time scholarly as he embraces the central debates and controversies of the psychoanalytic times in which he has lived.
In his 1991 book, The Use of the Self: Countertransference and Communication in the Analytic Situation, Jacobs charted the territory that has continued to occupy his professional thought and writing for these succeeding two decades. That book collected in one volume the groundbreaking contributions he had published between 1973 and 1990, works that opened new vistas in the understanding of therapeutic communication in clinical psychoanalysis. The volume now at hand traces the rich elaboration of those seminal ideas, which to a significant degree have been on the leading edge of contemporary psychoanalytic dialogue. A classically trained analyst in the ego psychological tradition, Jacobs has challenged many tenets once sacrosanct, always with an eye to the therapeutic aims of the analytic endeavor. He has been a pioneer in the study of the intersection of the intra- and intersubjective dimensions of the psychoanalytic encounter, while at the same time asking us to consider whether the current emphasis on interaction and intersubjectivity is taking us away from the heart and core of analysis: “Clothed in modern, sophisticated terms, does this focus actually disguise and rationalize the basic tendency in all of us—the ever-present wish to avoid both the anxiety, the pain, and the disruption that inevitably accompany immersion in the unconscious of another and the arousal within us of the dark forces of aggression and sexuality that accompany such immersion” (p. 214).
Each of the papers in this collection presents a particular facet of Jacobs’s abiding focus on the meticulous observation of the clinical encounter. Rather than being arranged chronologically, in order of their publication between 1993 and 2012, the volume is organized thematically in such a way as to provide a veritable text in therapeutic communication, with an emphasis on what is transmitted nonverbally and unconsciously. In the first section, “Interaction and the Inner World,” he elucidates his central concerns as they reverberate in the clinical work itself. The second section, “Questions, Controversies, Explorations,” addresses at a more theoretical level various dilemmas related to questions of intersubjectivity and self-disclosure. Included in the third section, “Reflections, Extensions, Historical Perspectives,” is one of the most thorough historical reviews of the evolution of the concept of countertransference and its associated controversies available in the analytic literature. Also included here are several other gems, papers in which his central preoccupations continue to reverberate in reflections on how he was influenced by Charles Brenner and Hans Loewald, in a discussion of the adolescent neurosis, and in his exploration of the relationship between creativity in the writer and the analyst.
Throughout his work, Jacobs consistently focuses on that quality of attunement that he sees as the heart and soul of the analytic enterprise. He challenges conventional notions of analytic empathy as purposeful attempts on the part of the analyst to consciously or imaginatively put himself in the patient’s place. In raising this challenge, he assiduously attends to the creation of an atmosphere facilitative of unconscious transmissions between patient and analyst:
For the kind of unconscious transmissions I’m speaking about to be grasped by the analyst, then, the analytic instrument must be set right. When it is, the conditions for a special kind of connection are in place and, unlike the unhappy couple in the Chinese proverb who are lying in the same bed dreaming different dreams, analyst and patient, each in their place, are daydreaming dreams that are, in fact, connected. And it is this connection, the special relationship of two minds, that allows for a level of empathy and attunement that is in touch with the imaginative creations of the mind that are not only outside of awareness, but beyond the level of empathy that we ordinarily refer to when we use that word [p. 171].
To establish this generative atmosphere Jacobs expands the fundamental rule to include actively educating the patient about the means of attaining a state of mind that will promote reverie and daydreaming.
While Jacobs acknowledges recent advances in practice achieved through a focus on the here and now, enactments, and the interaction of patient and analyst and attention to implicit memories that reveal themselves in specific behaviors in the analytic hour, he sounds his familiar cautious note: “this advance has come at a price—in my view, quite a heavy price—for often it requires a focusing of the mind, a keen awareness of the moment, that precludes the kind of regressive movement, the slight alteration of consciousness, the loosening of bonds, that allows the analyst to be in a creatively receptive place” (p. 172). He is concerned that for many analysts the technique of evenly hovering attention “has given way to the kind of presence, the kind of attentiveness that is characteristic of conversation and dialogue” (p. 172).
From the outset of his career, Jacobs has systematically studied and expanded our appreciation of observing and understanding nonverbal behavior in both patient and analyst. In the papers collected here, he further describes the development of his capacities to decipher these postural expressions of the transference-countertransference dance. He also explores resistances to the analyst’s awareness of nonverbal communication due its resonance with primitive associations to frustrated yearnings, helplessness, and the repressed gratifications of infancy. He sees such receptivity as something that must be studied and taught under the guidance of a skilled teacher, able to instruct in use of the eyes in a way analogous to analytic use of the ears (p. 120).
His detailed clinical descriptions of the nuances of these phenomena are unparalleled in the literature:
Mr. V’s right hand moves from his side to his abdomen and he begins to palpate that area. Then the grasps his belt buckle, entwines his fingers around it, and makes a tugging motion with it. Observing him, I feel myself making parallel movements. My right hand, too, is at my waist and, without my realizing it, I have hooked my thumb behind my belt. I notice this and wonder about it. As I do, I think of two swimmers engaged in the art of synchronized swimming, moving in perfect harmony, each mirroring the other. Then another image presents itself. I see Mr. V as a young child lying on a table, his abdomen tightly bound by gauze bandages. Immediately I realize that I am remembering a piece of my patient’s history. . . . he was, in essence, remembering a bodily trauma. . . . another memory arises. I see myself as an 8-year-old boy, my nose bleeding profusely. . . . I realize that Mr. V’s childhood trauma is linked in my memory to a trauma of my own. . . . this memory has surfaced, I realize, as an expression of the resonance that I feel with Mr. V [pp. 42–43].
Inevitably, Jacobs’s focus on unconscious communication brings matters of countertransference and self-disclosure into bold relief. He describes a multilayered countertransference response wherein the accurate recognition of a particular countertransference can nevertheless serve as a shield to a deeper, more conflicted countertransference or enactment. He is concerned that the problematic side of countertransference is often overlooked in the current atmosphere that views countertransference not only as facilitative but at times as the central vehicle of therapeutic action. He particularly highlights how uncomfortable personal shortcomings and the analyst’s need to regulate his own self-esteem can subvert the work. He includes here problems with acknowledging the impact of our petty faults, his enumeration of which reads like a Yom Kippur confession of sin: “our moments of meanness, of spiteful retaliation, of boastfulness, of greed, of inattention, of self-justification, of small-minded competitiveness with colleagues” (p. 66). Further, he expands the concept of negative therapeutic reaction to include a patient’s accurate perceptions of covert, often nonverbal and unconscious communications from the analyst serving defensive purposes as potentially explanatory of a patient’s negative reaction to interpretations that on the surface seem correct.
Jacobs’s exploration of countertransference includes a discussion of the related concept of enactment, a term often cited as having been coined by him. He feels that in present discourse this concept is so frequently and at times thoughtlessly employed that it has lost its clarity. He is alert to the ways that certain aspects of currently promulgated theories of therapeutic action and technique, with their emphasis on enactment as the be-all and end-all of therapeutic action, can short-circuit and shortchange the clinical endeavor.
Related to the discussion of enactment, Jacobs makes his own contribution to the highly charged and controversial debates focused on issues of self-disclosure, a matter that he himself has played a central role in bringing to the forefront of attention. He notes that for some patients empathy needs to be conveyed not only in words but by the open communication of resonant feeling states. In support he cites recent discoveries in the field of infant observation demonstrating that a child’s development of a self-representation depends on the view of the child held by its mother. He considers analysis a neo-developmental process in which internalization of the analyst’s view of the patient, as selectively disclosed in the course of the analytic work, aids in the development of a more realistic self-representation, as in the development of the child’s self-reflective capacities (p. 164).
Jacobs takes pains, however, to not oversimplify the question of self-disclosure. He is alert to the dangers of rationalizing self-disclosure from a technical standpoint when unconsciously it serves certain needs of the analyst. He is mindful of the potentially inhibiting aftereffects of self-disclosure of which the analyst may never become aware. His clinical vignettes illustrate the great care that precedes his decision to confirm the accuracy of the patient’s perception and differentiates the very limited nature of his own self-disclosures from the approach of some writers of the relational school.
This judicious use of self-disclosure in his clinical work stands in sharp contrast, however, to the perhaps unprecedented degree of self-disclosure/exposure of his personal history and its contribution to his own intrapsychic landscape and conflicts that are evidenced in his writing. He is, of course, aware that what he writes about himself is potentially available to his patients. This matter, however, receives scant attention and leaves the reader wondering how it manifests in and influences his clinical work.
With the opportunity this most recent collection provides to experience the breadth and depth of Jacobs’s contribution, it is striking at this juncture in our history that the matters of unconscious nonverbal communication between patient and analyst that are at the heart of his study are not more systematically integrated throughout psychoanalytic training in the curriculum of our institutes. Jacobs in effect provides a syllabus and text for the development of such a curriculum.
Fittingly, Jacobs concludes this volume with a new contribution, “On Hope in Analysis and for Analysis.” He notes that hope and hopelessness are central but rarely discussed aspects of the analytic enterprise. He elaborates on the crucial contribution that a shift toward hopefulness makes in the beginning phase of treatment. Similarly, he notes the neglect in the literature of a sufficient appreciation of the contribution made by the analyst’s overall attitude of deep caring and concern for the well-being of his patient: “Like certain delicate plants, to truly take root and flower, they require an environment characterized by warmth, caring, a vision of the patient’s potential for growth, and an attitude on the part of the analyst of realistic hopefulness that, through the analytic work, he will ultimately be able to obtain achievable goals” (p. 290).
Extending these attitudes to the state of psychoanalysis itself, he compares the new generation of analysts, with their increased focus on research and collaboration with the neurosciences, with the original analytic pioneers whose dedication in the face of an adverse atmosphere opened new vistas in the understanding of the human mind. His own life’s work stands as an inspiration to those who might actualize this vision.