Abstract
More and more often analysts work with patients who must develop the capacity to participate in analysis. One such patient, H., conveyed the impression of being “bogged down.” He did not work or study, and at home with his family was prone to violent outbursts; his social relationships were centered around drug use. Concepts from Bion and Winnicott helped H.’s analyst take the risks necessary to create a therapeutic relationship with him. The patient has come to realize the worth of analytic thinking, and its potential to transform his life. Deviance with respect to technique, and collusion between the narcissistic areas of therapist and patient, pose the risk of dangerous slips in the direction of analytic “omnipotence.” Reclaiming the term collusion (from the Latin con-ludere, “to play together”), however, can allow analysts to remain faithful to Freud’s ideas while maintaining a necessary flexibility vis-à-vis the patient. This ludic space can be expanded through Bion’s ideas, which deconstruct a perspective through which we are able to observe “facts,” with particular reference to what occurs in the psychoanalytic situation.
Keywords
The trouble with psychoanalysts is that they are not interested in mental pain, they are only interested in psychoanalysis.
In today’s world, where everything changes so quickly, certain goals that were believed possible in modern society, such as stability and a degree of predictability and coherence, are often difficult to meet. Instead, insecurity, and a sense of vulnerability and general instability prevail. How can psychoanalytic work and thought remain faithful to Freud’s ideas (1923) 1 while maintaining the necessary flexibility vis-à-vis the patient, and not run the risk of colluding with a tendency to take simplistic and narcissistic shortcuts? A continuous challenge arises in our work, and remains perched along the edge of possible collusion. Deviance with respect to technique and collusion between the narcissistic areas of therapist and patient pose the risk of dangerous slips in the direction of analytic “omnipotence.”
I would like to propose that to address this challenge we reclaim the term collusion, returning to its etymological and semantic roots: con-ludere, which in Latin means “to play together.” 2 It is precisely within this transitional metaphoric play space (with “play” understood as space that allows a degree of mobility between two physical bodies) that new possibilities continually arise. In this paper I will try to expand our conception of this space using Bion’s ideas, which deconstruct a perspective from which we are able to observe “facts,” with particular reference to what occurs in the psychoanalytic situation. It is through such observations, derived from a conceptual displacement, that Bion’s work on the idea of caesura was born.
In the paper “Caesura” Bion (1977) holds that “in analysis we are seeing a total personality who has at some time, consciously or unconsciously, chosen a particular view or a particular vertex from which to see the view. This always involves inhibition of the capacity to see the views that one does not want to see. The psychotic patient may be anxious to suppress, be blind to, or unaware of what the sane person is able to see; the character is psychosis minus neurosis, or psychosis minus sanity, or sanity (rationality) minus neurosis or minus psychosis. The important thing is not that the patient is a borderline psychotic, or a psychotic or neurotic, but that he is a total character minus . . .” (p. 52). These reflections help us avoid pathologizing the human condition, calcifying it with terms like psychosis, neurosis, borderline, autism. Through the use of paradox, our perspective widens and becomes more dynamic and complex.
We know how difficult it is to take in and provide a more precise definition of this concept. We also know that it has always been against Bion’s intentions to provide precise definitions for his theories in the psychoanalytic field. It is almost as if he meant to protect the value of “disorientation” and feeling “disoriented,” by way of a veil of vagueness with which to envelop things. Indeed, the caesura may represent at the same time a moment both of rupture and of transition: of rupture because there is actually a passage from one state to another, which entails a high level of intensity; of transition because the rupture provides for its possibility. Using the metaphor of birth, we could say that the “rupture of membranes” anticipates the passage the newborn must with difficulty traverse. Transition and rupture live in parallel.
In Civitarese (2009) we read: “the caesura of birth is a model of birth for every new thought. Just as the caesura of birth renders the persistence of types of consciousness and primitive levels of the mind insensible, so every new idea intuits a new caesura, a barrier, an obstacle relative to the others, which are cast in shadow, if not entirely killed off: an embryonic idea—writes Bion (1990)—can kill itself, or it can be killed, and this is not only a metaphor” (translation mine).
Bion’s concept of truth is relevant here; I agree with Correale (2015) “that Bion sees the ‘truth’ in terms of the courage to have our own thoughts, where ‘thoughts’ are products of our mind, as bizarre, unusual, or unwelcome they may be. This idea of having courage to think our own thoughts includes at least two further concepts. The first is about specificity. Bion strongly believes in the individual as the receiver of thoughts, and in not deferring to pre-constructed ideas or to the widespread, pacifying assumptions of common sense. Bion’s invitation to the truth is an invitation to have the courage to be ourselves, where to be ourselves means, mostly, not to retreat from what appears in our mind [I might say to live ‘the’ or ‘through’ the ‘caesura’]. The products of the mind are always the outcome of a meeting between the individual and that which is external to him—which can never be completely defined, but always leaves room for elements of surprise, of the unknown, of doubt” (pp. 21–22).
We could define this conflict as “necessary conflict,” seen as a possibility to develop thought in its irreducible aspect, occurring in the encounter with the “other.”
Correale says that for Bion “to practise psychoanalysis . . . always involves discovering the other that is in us, the intrinsically extraneous dimension of the personality. He quotes Freud’s famous dictum that we are not masters in our own home. Inside ourselves, there is always something that we do not know, ready to scare and surprise us, to make us feel confused and disoriented. From the acceptance and the development of this confusion the thought can be born and our self-knowledge can develop; without conflict between the known and the unknown, the growth of knowledge is impossible” (p. 24).
As analysts we increasingly find ourselves working with patients for whom analysis is not the method of intervention, but only one among a number of possible treatments. Here I will use notes from a clinical situation to define these assonances, these cross-references between clinical experience and theory. I will also try to show how it is possible to proceed in the analytic process, and how it is possible to navigate the risks of either a “breakup,” understood as the fragmentation of a unitary thought, or a “breakdown,” understand as complete collapse. In either situation, it is important to remain aware that the human being and his or her psyche are not immune to taking up these challenges and that consequently we too are not exempt, as individuals or as analysts.
The Case of H.
H. is in his early twenties, a handsome young man with a disdainful face. He has chosen to enter therapy because of deep psychological distress characterized by feelings of inappropriateness and bouts of painful rage. From the first few sessions it is evident that he finds himself in a phase of prolonged stalemate. He appears stalled; neither working nor studying, he exhibits violent outbursts within the family context, and his outside relationships involve mainly meeting with peers to engage in drug use.
Despite my doubts about the possibility of analyzing the presenting situation, I start to work, not falling prey to prejudicial prognostic constraints or saturating nosographies. From the outset, and on various occasions during the treatment, H. repeats the story of his birth. These are tales of tales, which include a homemade memory in which his mother tells him that he nearly died when he was about to be born. It had been necessary to perform an emergency C-section, and due to complications following the surgery she had gone into a coma, with the baby being put in an incubator for over a week. This tale, or better, the echo of this tale, seems to indicate that, even though there was not an actual fetal death, the conditions conspired to create a forced “splitting” and a stalemate vis-à-vis his mental birth. The entire emotional constellation presented in this analysis would always refer back to “that moment” of his life, defined as a kind of confusion between the animate (the breast, feelings) and the inanimate (the incubator) that had allowed him to live but that had also led him to see life as something to put up with. Even now, a passive object of his own living, he would spend a long time at home just sleeping, and he described waking up as a “nuisance”; as a matter of fact, waking up meant thinking, and thinking was exactly what he didn’t want to do.
His characteristic life patterns are apparent in the enactment of the analytic situation. One can clearly perceive how H. tends to make one think on his behalf, the extent to which his refusal of reality prevents him from having an impact on it, and the way he is stuck between perceiving his need of others and denying it. It is in fact through constant observation of his associations that our encounters become more and more a space for such thinking. Little by little, the stasis of “that moment” begins to transform itself in analysis into something sharper and more focused on himself. This in turn necessitates a shift in point of view and a tolerance of frustration, which is not possible yet. His use of drugs (dependence on the object) would have helped me understand his difficulty tolerating frustration—analysis is frustration too. Here I turn to Bion’s ideas regarding “excessive” inability to tolerate frustration and how it impedes preconceptual development, particularly the ability to “create thoughts.” Thus, in Bion’s view (1967), the newborn has a preconception of the breast, which, when it finds the real breast, becomes the notion of the breast. When frustrated, the infant is then able to generate the thought “no-breast.” However, if the capacity for frustration tolerance is inadequate, the thought of no-breast becomes a bad object (pp. 111–112). All of us, as human beings, undergo the experience of pain and pleasure, but we also know that if the experience of pain is too much, this is then evacuated through an excessive use of projective identification.
As Correale (2015) reminds us, “The role of the analyst is therefore to help his patient to access this bearable sorrow, so that the loss of the familiar objects is not turned into an internal persecutory object. Bion called it an absence that becomes a no-thing, a cruel and intolerant superego figure. If the sorrow is made bearable through an internal dialogue, the absence becomes a productive opening, a possibility of discovery” (p. 30).
We do not have to confuse thoughts with topics, or things; a session is not an empty container, but rather one that holds the potential for and possibility of thought—in other words, it has content. H. therefore gradually begins to see that the topics he seems to be seeking never seem to be right; they belong to the world of things, whereas we are interested in the possibility of thought itself, not so much in terms of specific thoughts, but rather the possibility that thoughts themselves might emerge. Thus, through free association and analysis of the transference that has begun to take place within the analytic space-time, caesuras begin to follow one another, gradually acquiring defined outline. “Sometimes, being able to see a patient experiencing sensations that are equivalent to intrauterine life, like a fetus inside the amniotic cavity of the analytic room, would instead mean being blinded in front of the evidence of the conversation between adults that is taking place . . .” (Civitarese 2009; translation mine). H. had always remained absorbed inside global relationships but now, through transitive thought and transience as a structural aspect of the analytic condition, he can limit his falling into pieces and sinking into the “void”; he can now traverse progressive organizations of the personality. H. is becoming aware, at least in part, that analysis, and with it the activity of thinking, is really useful in life. It can be a way of moving forward. This can happen through free associations, which become expressions of transient thoughts. Relating to the psychoanalytic experience, Corrao (1998) reminds us that “a free association, which reveals a consistent theme, is already influenced by the anxiety, so that the consistency of ideas can be considered a defense organization. At times the patient needs the analyst to notice the lack of meaning, typical of ‘a peaceful mental state’ without communicating it, that is, without the need to organize such lack of meaning. The organization of the non-meaning is an exception, just like the organized cosmos is a denial of chaos. . . . It is only here, in this unintegrated state of the personality, that what we call the creative and the cognitive can appear. When the creative, and the inventive, can be mirrored and only if they can be mirrored, they can become part of an identified, organized personality . . .” (p. 48).
As Bion’s characters say in A Memoir of the Future (1991), “Look at your facts. Respect them even if you do not like them. The mists may clear and reveal a pattern which is so disagreeable. . . . Or so deep a void, so black, so astronomical a hole that you regret the price you have to pay” (p. 462). These are inevitable passages for growth, although the birth of the mind offers no shortcuts. It is no different for H. He starts the process of coming to terms with himself, of feeling/sensing/perceiving himself; and the experience of feeling together in the analytic work allows him to be himself more and more: to be able to move, to take on responsibilities, and to make his own decisions. He is more involved in every man’s history, in the possibility of becoming an individual who, through the problem of truth/falseness, regression/evolution, is able to have emotional contact with his own internal objects by way of his mental growth.
In the continuity-discontinuity relationship, attention is always on the present of the analytic situation, on the continuous shift from one mental state to another, as one part of oneself is allowed to die in order to give birth to a space of “thinkability” or cognition. That which both unites and separates, and which simultaneously separates and penetrates different dimensions, refers to the question Bion poses in “Caesura”: “Can any method of communication be sufficiently ‘penetrating’ to pass that caesura in the direction from post-natal conscious thought back to the pre-mental in which thoughts and ideas have their counterpart in ‘times’ and ‘levels’ of mind where they are not thoughts or ideas? That penetration has to be effective in either direction. It is easy to put it in pictorial terms by saying it is like penetrating into the woman’s inside either from inside out, as at birth, or from outside in, as in sexual intercourse” (p. 45).
Just as difficulties had characterized H.’s process of emergence during the analysis, so difficulties appeared in his entering and coming once he was inside the analytic space. The difficuly of “coming to the session” (he would regularly miss one of his weekly sessions, usually the Monday hour) seemed to go hand in hand with coming inside a woman (he could not ejaculate during sexual intercourse or, if he managed to, “didn’t feel a thing”). Analyzing the anesthesia accompanying both situations allows us to better observe what happens inside him and to replace his defensive anesthesia toward fear and anger with an ability to deal with thoughts and feelings. This means not simply being able to recognize thoughts as his own and the importance of that, but also, through a process of successive integration, being able to say words that little by little become decreasingly things.
H. gives the appearance of someone who has never been experienced as having a body of desire, a body that would come about from being able to feel oneself in thought as free and independent, free to think and be. He appears to have experienced his body as imprisoned in someone else’s thoughts.
His refusal of reality prevents him from having an impact on this or from using it for himself. He lives in limbo while feeling the need of others and denying it. This is why he seeks my help, simultaneously transferring the sense of its overwhelming impossibility. I perceive the risk of being drawn into a perverse game, becoming trapped myself in a double sense of impotence and omnipotence.
All this emerged from encounters that took place in the creation and re-creation of the conditions for analytic work, in which I constantly kept my attention on the psychic reality of the here and now of the session. The setting and its construction represented both the possibility of providing a dynamic container and, together with ongoing observation of the transference and the offer of support, a sort of psychic spine or frame for the new tissues that were constantly developing. Just as the spine is made up of small segments and caesurae, so too our being together was experienced inside the fragmentation of time and space within an analytic process that gradually progressed from a dreamless sleep (a type of sleep that does not allow for the processing and metabolizing of emotional experiences) to the restoration of a sleep/dream/waking rhythm, without falling apart or collapsing into dread of the void, a shift from an “exoskeleton” to an “endoskeleton.”
In one session H. stretches out and remains silent for a long time. He appears to be sleeping, exactly as he does at home. “You talk,” he says. “Otherwise I’ll fall asleep.”
I feel the weight of his silences, which function not as a way of unwinding into the possibility of thought, but as a goad to make me act, to force me to think for him.
“When do you think I’ll begin to speak about my things?” he says. “Maybe I’m very interested in what other people think.”
It’s clear to me that he’s trying to force me to play the role of his mother, who is always “on top of him,” and who thinks for him. This creates a very delicate situation—not a true stalemate, but rather a micro-advance along a sharp yet delicate edge. We proceed in this manner for several months during which I do my best to control my impulse to intervene, at which I do not always succeed.
In another session, H. says, “If I’m going to get a job I need to find something that I want to buy . . . so I would be motivated by the money . . . but I need something that would really motivate me . . . maybe a car.” I reply, “You could buy freedom of movement . . . independence . . . even your analysis.” He responds: “I just thought of buying a lamp to grow marijuana. . . . I don’t smoke that much, but when I do I like to smoke good quality stuff . . . not just for the high.”
I think that he wants to put good things inside himself, but knows there is a risk. The same risk as when he said, “If it was up to my mother I would come here all the time.”
Each of us has to take responsibility for himself, I for myself, he for himself.
I continue to think of that lamp as an Aladdin’s lamp, the lamp of desire.
We are both at risk. Either we are together inside a room and accomplish real work, accepting its consequences, or else we light up, not quite a peace pipe, but rather to put our hearts at rest with hallucinogens.
In any intervention model there is the need to carefully avoid collusion. This is a problem, as Bolognini (2013) reminds us, “that can be formulated even in technical terms and which bears on the substantial difference between projection and a projective identification.” In other words, when a patient “does not limit himself to projecting a fantasmic profile on the therapist, altering his own perception of the object, but makes him/her actually feel and be so! This means giving rise to an experience that is far from casual and clearly established as capable of pervading the other either fully or in part, whether or not the other is aware of this. If the other remains unaware, he unwittingly becomes the projected character and forgets himself: he loses his own Self. Why does this matter? Because the analyst who ‘becomes’ the idealized/persecutory object of the patient without realizing it can be secretly pleased by being endowed with so much power, even by the ‘terribleness’ that on the one hand conveys omnipotence but on the other makes him lose contact with his own Self. . . . I know that every analyst is nonetheless tempted, during his professional experience, to indulge in fantasies of omnipotence, especially when he is stimulated in that direction— and sometimes unconsciously contaminated and pervaded by strong projective identifications with the patient. What I feel compelled to stress, in such an insidious process, is the second part of it, its consequences on the analyst’s contact with his own Self. If the projective identification moves from being communicative and partial to being pervasive, and if that actually happens, the analyst loses contact with his own Self: one indication of that could be no longer being able to accept with humility the idea that—in part and in diverse proportion—the patient’s anomalies have become or are present in him/her too” (p. 32).
In a session at the beginning of the week, H. comes in announcing he has a job: “I came to tell you that I won’t be able to come tomorrow, because I have to start working. What can we do? We’ll have to see each other once a week. I’m going to be installing air conditioners. . . . My parents took the call. I’ll be working part-time. We need the money. I’m doing it for my parents. I’m not really interested in having a job. I’m not interested in anything.”
I think back on the times he skipped sessions over the past year. Now he comes to tell me that he won’t be able to come. But he’s also expressing something else, a disembodied activity, literally disembodied by “my parents.” Once again there is an implied question: “Do you know what would be good for me?” We are back to the question of responsibility.
“Lately,” he says, “I’ve been feeling a little down . . . my parents have been bugging me about the marijuana lamp. . . . At first my father said no way, but then he said it was okay.”
I am struck by the change that is taking place: “I’m taking the money to my parents”; “They’ll let me have the lamp—maybe!” I feel left out, tertium non datur—there is no room for me here!
Directing a great deal of attention to what we may be able to do given the change in his situation, we agree not to meet during the next few days and that we will be in touch once he knows more about his work schedule. He has taken a temporary job, just for the summer, installing air conditioners. We consider seeing each other once a week for the rest of this month, the month just before the summer, in order to take stock of the situation as soon as possible. I remain available as a temporary standby, keeping in mind that analysis is an activity, and that if there is no activity there will be no analysis; it is not an hallucination, and it is not a lamp to for growing marijuana.
I am aware of and take responsibility for my role in relation to the object, which is the analytic treatment. I defend and preserve the treatment without imposing it, but I attempt to keep open a precious channel of communication, in a moment of turbulence. I have decided that it would be useful to combine the strongest possible firmness with a good dose of latitude, whether thinking of an adolescent tendency to suddenly quit therapy and the necessary elasticity that it requires, or as a reflection of my own internal experience with respect to continuity and my sense of responsibility.
I feel this all the more keenly since I myself, in the course of my own analytic journey, was once compelled to defend my choices under adverse conditions, and to value the importance of faithfully waiting within one’s own internal “setting,” while outside there was turbulence.
If all this turns out to be true, if there is a natural need to be aware of emotional experiences, we might state that the same applies to psychoanalysis: psychoanalysis itself is based on truth. “The analytic relationship is based on a love of truth,” Freud (1937) wrote, “that is, on the recognition of reality—and . . . precludes any sham or deceit” (p. 248). Bion (1965) continues this line of thought: “healthy mental growth seems to depend on truth as the living organism depends on food. If it is lacking or deficient the personality deteriorates” (p. 38).
Waiting
During the next few days there is no communication. Finally, on the following Monday, H.’s father shows up at the time of his appointment.
He seems to take for granted that I am there waiting and tells me that even though the due date for his son’s monthly payment is long past, he does not believe he should pay me directly. Instead he believes it would be more “educational” for H. and “increase his sense of responsibility” for H. to do this himself. When? Er…. In a kind of ad limitum, an implied “You can live perfectly well without money”!
Our meeting provides no additional information, and I try to keep it as short as possible. I remind him that it is important for his son to communicate with me directly and that I am waiting.
Reflections from the Front
I feel besieged, imprisoned, as if surrounded by a tight group. When I see H.’s father approach, I have the fantasy of an old Mafia movie, from the title of that film, which I think is called Le Solitaire (released in English as The Field Marshal). That association brings me to H.’s “family,” which keeps me in place and at the same time accomplishes its own form of trafficking.
As to the responsibility for paying my fee, I weigh the risk of the “educational” element, with its double message that “I (H.’s father), on the pretext of teaching my son responsibility, begin by not taking responsibility myself,” with its implied, “Go ahead and pay yourself!” During the following days I feel that I need to think this situation through, almost as if I had to raise its metabolism. The thought occurs to me that I am being kept in line like a puppy or, even better, that I am being used as a horseshoe or amulet or some other good luck charm while waiting for a total disconnect. When the father came at his son’s appointment time, without informing me in advance, I felt as if I were being seen more as a function than as a person.
I wonder what the prevailing gestalt is in me, and I try to gauge my margins of tolerance, both from the financial point of view and in terms of my growing resentment. (Am I at risk of adopting my patient’s tactics to protect myself? And how, on the other hand, can I consider this time useful, and make use of it for myself, to develop something or do something else or even simply to experience it as an unproductive stretch of time? How can I develop his narcissistic request for omnipotent collusion without calling into question my own omnipotence (or desire for it) and sense of collusion? It’s as if he were saying, “You treat me without needing the money and without my offering anything in exchange.”
The boundary between narcissism and masochism is very blurred. “You’re so cool. We can fuck you every which way and you don’t even notice or maybe you even enjoy it.”
I note that H. has succeeded in his attempt to possess me for a while, but my feeling of being surrounded tells me that there is an internal limit. This is what makes me distinct. I recognize “them” (H. and his parents) as a mutually parasitic group activated by a meta-individual organization that is playing a game. In this game I don’t know how to “play ball”; I don’t know how to follow their rules. Two of them are outside my hitting range. If H. comes, the setting will have to be renegotiated. We need to continuously monitor emotional distance and ask ourselves, as Bion does, “Where does my personality end, and where does someone else’s begin? Where does the analyst end? And where does the patient begin?” (1974, p. 182).
And once again Bolognini weighs in: “What we can develop today, within ourselves and in our clinical work, is the capacity to maintain a correct technical structure, open and neutral in its suspension without losing our internal contact with ‘that part of us that resonates’ when we are touched by the problematic points of the patient’s humanity” (p. 37).
So I need to reaffirm the critical importance of direct, unmediated contact between the two of us, avoiding as much as possible the use of an answering machine (I had received several messages from him on my machine, return calls to several of my attempts to reach him).
My freedom of mind is the condition for carrying out an analytic project: I can discover what it feels like to be trapped, but not stay trapped!
In a session after H. has resumed therapy, a new element is introduced into the setting. Someone rings the bell to my office constantly during our session, and I continually have to get up to open the door. I tell these people firmly and bluntly that they have come at the wrong time and that they cannot stay in the waiting room. Even though the door is closed, H. feels something is going on.
When we continue the session, I realize that my protection of the setting has worked; H. is grateful for it, as if he were telling himself, “He’s aggressive too, and he’s used it to defend me.” He goes on to tell me about his fear of letting himself go, of “coming inside,” of losing control or “getting someone pregnant.” I connect it to the fear of “coming here,” of “getting pregnant and giving birth to something.” Then he says, “Before, when I liked myself even less, I was even more afraid of having a child. It made me ‘paranoid’—the way they grow!”
There is a disparity in the way H. speaks. Evidently my interpretation that “we can do something creative here” was not expressed completely enough. It leads him to say, “I can become a father,” which surprises me and makes me afraid (can I imagine him as a responsible adult? can he?).
Once again I am aware of the need to bring H. back to the fact that “we are talking about thoughts,” and to separate the symbolic aspect from the concrete. He needs to understand that “thoughts that cross his mind at the moment” constitute the desire to do something new. The fear I see in him has to do with his reluctance to put his family dynamics up for discussion. H. is allowing himself to think things that otherwise he wouldn’t think, things having to do with his independence. Together we observe the presence of an element within him that tells him: “You must not grow.” This is where I must be very careful. While I convey these things to H., I try to make clear to him that when we speak about “parts of oneself” that doesn’t mean we shed our responsibilities. In fact, we should be careful to avoid concluding that “because it happened once” it will “therefore happen forever.”
In another session, he is able to speak about his pain. “I don’t feel so great,” he says; “I dreamt that I ‘came.’ . . . Then there was another dream, kind of like a horror movie, where I was up on a roof with a bunch of girls and boys. . . . I began to jump, like off the moon, without gravity. Then I got into a fight with a guy who wanted to throw me off the roof. I came down, flying, swooping in great leaps. I knew how to fly and I was showing off.” (No associations are forthcoming, and after a short silence I ask him in what order his thoughts occurred.)
“In the dream of jumping,” he replies, “the colors were on the dark side; someone wanted to hurt me.”
While H. speaks of his jumps, I recall an interpretation that was made to me during my own analysis having to do with my father. It was linked to the image of a cork bobbing in the water, and at the time I had considered the interpretation particularly apt.
But back to H.’s dream. “Maybe here too,” I say to him, “there is a kind of struggle between someone who wants to make someone put his feet on the ground, and thus you ‘skip’ (jump) your sessions; but we both know that if you want to walk you have to keep your feet on the ground!”
After a prolonged silence he answers: “I’m not feeling very well . . . physically. I’m thinking about leaving, and that thought is the only thing that makes me feel better.”
“Some thoughts,” I say, “can make us feel bad, and others can make us feel better; some of the ideas I’ve suggested to you about your dream have been painful for you. It’s understandable that you feel worse, but that also means that you’re more open to showing these things, which allows us to see them and overcome them.” (Today his “I’m coming / I’m not coming” has become “I’m coming even though I feel bad.”) He leaves looking a little battered.
Later I think back on the two images H. brought to session and noticed they could be seen as referring to me. On the one hand, I could be seen as someone “throwing him off the roof,” while on the other, I was working with him to understand what is going on. I realize how much my own image of the cork has to do with the importance of our work and of his having an analyst who tells him something appropriate. All this “makes him feel bad” but also “makes him feel and move forward.” Much of this has to do with things we can do and experience together, while I remain sufficiently authoritative as not become one of his “dealers.”
That our relationship is continuing makes me think that on the one hand H. might have magical expectations along the lines of “Save me,” but that on the other hand he might have realistic though burdensome thoughts like “It’s time for me to change and that can’t happen through someone else’s decisions; I have to commit to doing it myself.”
There is no traumatic despair in all this but rather the fear that trauma could arise from unhappiness. The ability to experience displeasure does not have to have a traumatic effect.
This way of “feeling himself” has become increasingly structuring: it enables him to get things done and is something he has experienced through his analysis.
Although the last crisis (the period leading up to the summer break) tried my patience both within and without the analysis (my collaboration with his family), I believe that it can be inserted into a broader initial process of subjectivization, and the whole problematic it entails. In this process, attempts to escape may give way to a “This is really me,” and that can happen without increased pressure, even with a sense of relief, of self-mastery. It is clear that problems don’t just disappear, but they do take on other possibilities. We can see the problems together, and we can also have a little laugh together about them. As a result, even rules once experienced as imposed from outside increasingly reinsert themselves as a sense of responsibility coming from within.
By this process, I mean the establishment of a differentiated psychic space. Indeed, I stress that a sort of “caesura” or “limit” comes to insert itself between what we could call the intrapsychic and the intersubjective. Such a limit becomes a privileged place for processing and is thus a limit that has its own “thickness” within the analytic work. It becomes a limit and a container at the same time, because it has a space inside, a space established in the patient-analyst dyad. It finds in the setting, in particular the analyst’s internal setting, the champion of the process itself.
There is also the problem of how to convey to the patient, or help the patient himself to grasp, his own sincerity (sin-cera, “without wax”; here construed as a metaphorical protective coating), and to help him remove the mask without being overcome by fear. The ability to sense the reality of the other (transference) and of one’s own (countertransference) becomes important. Each has to sense the other in order to know him- or herself, above all in a relationship like the analytic one. The concepts of transference and countertransference can be considered inside a movement of caesura, which temporally follows space. They do not remain exclusive of any one component of the analytic couple, but become representative of a transitional space or protomental, transindividual area of experience.
Working in analysis is working on the activities of life itself—on the unsuspected possibilities that invite and allow the therapeutic couple to navigate by sight. It is a process that on the one hand takes into account the enormous and indispensable value of countertransference “points.” To see these points allows us to indulge in speculation, fantasy, displacement, and creative new points of view.
All this does not imply that we are “drifting” or “adrift,” but rather plays on the word drift in Italian (deriva), which means to slip or slide but is also the part of a boat (the keel) used to stay on course. Precisely for these reasons, if I had to give a title to my narrative it would be “Ars longa, vita brevis!” (or “From Addiction to Neurosis!”). And with this evocation of the sea, and of navigation by sight, I would like to end these brief reflections with the words of the great Spanish poet Antonio Machado (1912; translation by Magda Bogin): Everything passes and everything stays, But we are here to journey, To journey making pathways, Paths upon the sea . . . Your footprints are the path, Traveler, and nothing more; Traveler, there is no path, The path is made oar by oar. Traveler, the only path Is the wake behind us in the sea.
It takes a great deal of tact to work on such a complex situation in analysis. There needs to be a certain flow, a certain sensibility that, along with tact, is essential for perceiving the otherness of the other.
To conclude, let us return to the concept of con-ludere, “to play together.” It seems to me that adding a ludic element to the more technical consideration of the analytic process enhances its value as experience. Taken in its broadest sense, play, like Eros, revitalizes relationships. And this is true, in a particular way, even in the analytic dyad, where the opening toward the unknown should be supported and sustained by the interaction of the analytic couple. We know how much Eros, as it weaves through events (and weaves events together), entails destabilization. But we also know that without this physiological destabilization, the world would be bare of life. We must dare to risk!
Footnotes
Professor, Martha Harris School of Psychoanalytic Psychotherapy, Bologna; Lecturer, Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padua; Consultant, Paychoanalysis and Law Committee, International Psychoanalytical Association.
1
“Psycho-analysis is not, like philosophies, a system starting out from a few sharply defined basic concepts. . . . On the contrary, it keeps close to the facts in its field of study, seeks to solve the immediate problems of observation, gropes its way forward by the help of experience, is always incomplete and always ready to correct or modify its theories” (
, p. 253).
2
“Winnicott introduced the . . . notion of transitional phenomena. Transitional objects are the first material objects that are both surrogates for the mother and extensions of self, existing midway between inner and outer, baby and mother, real and illusionary. . . . This transitional object is the first symbol, the first mediator between the baby’s needs and the outer world, the first thing that ‘stands for’” (, p. 154).