Interpretation as Hypothesis

Interpretation

Interpretation has been central to the work of psychoanalysis from the outset, and the approach to it that I have been discussing can be traced back to James Strachey. In his classic paper on the therapeutic action of psychoanalysis (Strachey 1934), he drew attention to how consistently analysts put their faith in interpretation as a vehicle for psychic change. For Freud the work of interpretation carried into the clinical domain his enlightenment-based ambition that the light of awareness would allow repression and disavowal to be lifted. This paralleled his hope that earlier ideas about the mind originating in humanity’s dark prehistory (e.g., ideas derived from religion) would succumb to the more scientific approach held out by psychoanalysis. Like any strategy for change it was inevitable that this would not always be entirely successful, a difficulty that was first approached by considering the forces of resistance that worked against change.

Strachey’s survey of the literature acknowledged the power of resistance as an obstacle to change, often mediated by the superego. He noted that new evidence was beginning to emerge from the analysis of young children (he mentions Melanie Klein), suggesting an infantile origin to superego functioning, which implied even stronger and more irrational opposition to the work of analysis. However, he proceeded to open up the question of psychic change from the opposite direction by asking, What in an interpretation promotes change? Noting that Freud’s clinical method contains “investigation and explanation,” Strachey suggested (1934, p. 129) that investigation focuses on the here-and-now transference relationship, where, once an issue is identified, an attempt can be made to shed light on it. Interestingly, the transference had already been identified as a source of resistance; this work thus presented an opportunity for working on the elements of that resistance.

Strachey illustrates what he had in mind through the example of a patient who appears to harbor an aggressive impulse toward the analyst. He argues that making the patient aware of this impulse in the here and now (which may take time and work, and the patient may need to see evidence for its existence) is necessary before further reflection and work on it can take place. This might help the patient recognize that the aggression is really directed, say, against a parent rather than the person of the analyst. Working from this base Strachey suggests that the mutative interpretation involves two processes he had pointed to in Freud’s method, which he refines and systematizes:

First there . . . is the phase in which the patient becomes conscious of a particular quantity of id-energy as being directed towards the analyst; and secondly there is the phase in which the patient becomes aware that this id-energy is directed towards an archaic phantasy object and not towards a real one [Strachey 1934, p. 143].

Strachey foregrounds the patient-analyst relationship in the here and now. Observations of the transference constitute the raw material for reflection in the second part of the process, when the interpretation is formulated, and he argues that both elements ⁴ are required for an interpretation to be considered mutative. Since patient and analyst are both present in the consulting room, observations made there are capable of verification, unlike material emanating from the past or from the outside world. This meets one criterion for placing the work of generating an interpretation on a scientific footing, where observational evidence is verifiable and the process of attributing meaning to observations is transparent.

In the years following Strachey’s paper important developments in the Kleinian tradition influenced the approach to interpretation I am considering here. Melanie Klein tended to offer detailed here-and-now interpretations that included descriptions of phantasies and what they expressed about the relationship between patient and analyst, ⁵ anxieties arising from them as well as the defenses they mobilized (see English 2023). Klein focused on the transference, making links with the past and the outside world, but her approach to interpretation blurred the distinction between theoretical and clinical domains (as Freud had done), thereby, in the eyes of critics, taking insufficient account of the dangers of suggestion. For Klein herself she was giving voice to phantasies that were alive in the patient’s mind; her critics thought they stemmed from her own theory. This problem can be compounded by a compliant stance on the part of the patient, which can further obstruct full engagement with the analysand’s deepest inner experience (see, e.g., Riesenberg-Malcolm 1990).

Klein’s more significant clinical contribution, however, was to broaden the concept of transference to what she saw as a “total situation,” in which all aspects of the patient’s inner world are transferred into the treatment setting where, in time, they come alive and are rendered accessible to analysis (see, e.g., Riesenberg-Malcolm 1999). Freud’s conception of the transference was much narrower. By the mid-1980s, some twenty years after Klein’s death, her approach to working with the transference as a total situation was being developed especially by Betty Joseph (1985, 1989) and her colleagues (Feldman 2009; Hargreaves and Varchevker 2004; O’Shaughnessy 2013). This brought far greater detail to Strachey’s first element and opened up a question concerning his second. If work in the here and now could successfully bring to light all relevant aspects of a patient’s mind and allow them to be analyzed in the present, did it remain necessary to link them with the patient’s history as he suggested? At the time there was a lively debate between views of interpretation that, following Klein herself, integrated work in the here and now of the transference with that history—reported, recollected, or reconstructed—as advocated by Strachey (see, e.g., Segal 1982) and others who, following the logic just outlined, began to question the need for such a link given that work with elements of the past that are alive in the present was seen as central to psychic change (Joseph 1989; Riesenberg-Malcolm 1986). Could this work stand on its own as mutative, rather than being seen as the prelude to an interpretation that links with history (Riesenberg-Malcolm 1995)? I think the possibility of approaching such questions afresh was part of the excitement around the discussions regarding here-and-now interpretation that I began with. ⁶ I myself was particularly interested in a further question: with its focus on what happens in the present, how far could the here-and-now interpretation be said to fulfill the demands of a scientific approach to analytic process?

Science, Transference, And Countertransference

From a purely scientific point of view it is desirable for the setting within which data is obtained to be neutral—the equivalent of a sterile laboratory in, say, the biological sciences. In a recent paper considering the topic of analytic neutrality I made the point that the wish for neutrality on our part remains an important aspiration that is, however, impossible to fulfill. In “a meeting between two human beings,” I wrote, “the demand that one party’s subjective thoughts and feelings be totally excluded . . . smacks of omnipotence” (Davids 2022, p. 373). I went on to suggest that the scientific quest for neutrality best translates into the clinical mind-set described by Freud as the state of evenly suspended attention. We listen “composedly, but without any constrained effort, to the [patient’s] stream of associations” for a sense of how to “make use of the material brought to light by the patient” (Freud 1925, p. 25). Later, Bion (1967), working with more disturbed patients, was to describe this state of mind as one in which the analyst attempts to put “memory and desire” to one side in order to be as receptive as possible to whatever emerges from the patient, in an attempt to minimize undue interference in the process from the analyst’s side.

Psychoanalysts have found that, unlike complete neutrality, the state of evenly suspended attention is indeed achievable. However, it is also liable to being disrupted from time to time by powerful forces that impact the analyst, and the question of the psychic origin of these disturbances has been studied over many years. Freud’s discovery of the transference (Breuer and Freud 1895) was the first breakthrough and made sense of the fact that feelings can come alive in patients that originate with primary objects but have an impact on the analyst, which can interfere with evenly suspended attention, especially if these feelings push powerfully for gratification. A second source of interference comes from the countertransference, seen today as responses in the analyst to unconscious communication from the patient (Heimann 1950), usually emanating from preverbal levels. Receiving and understanding the meaning of such communication is now recognized as an important part of an analysis. However, before a disruptive feeling arising in the analyst can be assumed to be a communication, another question must be considered:

Is it a nonverbal response to something emanating from the patient and therefore in need of being understood, as part of deepening the analytic inquiry, or is it something uncontained (“unanalysed”) within the analyst that has found its way into the room and is therefore likely to interfere with the inquiry into the patient’s mind? Although the two can be readily distinguished conceptually, in practice the process of disentangling one from the other can be more difficult; it requires work and can take time (Brenman Pick 1985) [Davids 2022, pp. 374–375; emphasis added].

Attending to intrusions emanating from the transference and countertransference, which can be difficult, time-consuming, and complex, is now considered an essential part of the work of analysis, and when this has been done more or less satisfactorily the state of evenly suspended attention usually returns, indicating that what previously had been disruptive has now been processed and, if appropriate, incorporated into the analysis in accordance with the analyst’s chosen way of working.

In addition to these intrusions, there is a further factor at work within the analyst, which Freud refers to when describing evenly suspended attention:

The analyst, who listens composedly but without any constrained effort to the stream of associations and who, from his experience, has a general notion of what to expect, can make use of the material brought to light by the patient [Freud 1925 p. 25; emphasis added].

I think the “general notion of what to expect” refers to the analyst’s emotional literacy—his or her familiarity with as full a range of human experience as possible, including inner dimensions that will have emerged in the analyst’s training analysis. Simultaneously, these emotional experiences will have been linked with theoretical concepts through the didactic program, and this package—lived experience and allied concepts—internalized into the analyst’s preconscious. In the clinical situation our emotional literacy has two functions: first, to sensitize us, through a bond of empathy, to the clinical terrain that may be opening up in a patient and thus to contain the anxiety inevitably associated with facing what is unknown; and, second, to provide a knowledge base from which hypotheses as to what is going on in the mind of the patient may be generated. Turning these into interpretations requires a shift in focus from theoretical understanding to making links between different here-and-now observations, informed by that understanding, and making these available to the patient.

In the case I will describe more fully below, I used Freud’s model of mourning to inform my understanding of a patient’s depression, but I spoke to her first of hatred she felt toward the abandoning me, making explicit what I saw as evidence for this inference, namely, that between sessions she predictably had furious rows with her unavailable husband. Although skeptical about this link, she began to observe herself more carefully, which brought to light more generalized hatred and anger in her than she had been aware of. Moreover, she observed that the more she accepted her hatred the less depressed she felt. Work in the here and now had helped her discover for herself Freud’s inverse link between depression and object-hatred without my discussing it with her. Instead, I exposed her to interpretation-hypotheses deriving from it, which yielded data that she could observe and feed into the analysis. To her it opened up awareness of herself as someone who hates, rather than being the object of hatred, which ushered in the next step in her personal journey. From my point of view, her response provided support for Freud’s theory of depression in the ordinary scientific way—given an opportunity to look in a certain location in her mind she found the relevant content (hatred) there.

I am therefore drawing a sharp distinction between the work of formulating hypotheses as to what is going on in a patient’s mind, which takes place in the analyst’s mind, and sharing interpretations that flow from these hypotheses with the patient. These two kinds of activity can be thought of as taking place in two separate spaces that exist in the session, one in the privacy of the analyst’s mind and the other in the shared space that exists between patient and analyst.

Joseph Sandler (1983; Sandler and Sandler 1987) suggests that what he calls “private” theory operates in the analyst’s preconscious in a session. Although linked with the “public” theory espoused by our particular psychoanalytic orientation (relational, ego psychological, Kleinian, etc.), our private theory contains reworkings that incorporate our own more nuanced understandings, including of the personal experiences that produce emotional literacy as described above. Sandler thinks that the elasticity of psychoanalytic concepts permits such reworking, leading to what Robinson and Schachter (2023) identify as family resemblances within a given tradition. This preconscious space is where hypotheses that bring together selected clinical facts are formulated, and this is inevitably influenced by the analyst’s private theory ⁷ ; thus, different analysts will generate different hypotheses. This influence of theory on hypothesis generation cannot be eliminated; the best one can do is to be as transparent as possible about one’s theory, which is in line with established scientific practice. In the work I will describe it will become clear, I hope, that my own private theory is located within the British Kleinian tradition. The place of theory, in a session, is therefore in the analyst’s mind, and it reaches into the space shared with the patient through the hypotheses derived from it.

All psychoanalysts assume that their theoretical formulations describe phenomena that exist in the patient’s unconscious, and the shared space of the session is where that assumption is put to the test. As I have just noted, this space is distinct from the one where hypotheses are generated, and it may be regarded as a crucible in which the elements of an interpretation are brought into contact with the patient’s unconscious. In order to increase this likelihood it is important to maintain the integrity of the crucible, and I think this can be achieved by confining what we include in interpretations to here-and-now observations, with the hypothesized links between them being made explicit. In this way we may hope to minimize any further influence of our theory on the unfolding clinical process. As I see it, this is consistent with a scientific approach, where theory is restricted to guiding where we look and to anticipating what we might find, but evidence as to what we actually find is allowed to emerge in its own way, independent of theory. In the clinical situation the patient’s response to an interpretation constitutes evidence; a response that deepens the analytic process is usually taken as confirmation that the hypothesis has touched something real in the patient (not necessarily that the interpretation is “correct”). In this case that response becomes further data generated in the here and now that is visible to both analyst and patient, and is fed back into the process of furthering understanding. Interpretations yielding such responses are the ones usually reported in the literature; many others, unsupported by evidence of a deepening process, simply fall by the wayside.

For the patient the overall task of analysis is ultimately to expand self-awareness, and locating this work in the here and now means that it can be built on hard evidence, with the influence of the analyst’s theory playing a necessary but limited role in the choice of focus. Interpretations are hypotheses that address how to understand specific issues in the here and now, and observations and links made between them are transparent. This allows patients themselves to have a view as to their plausibility or usefulness. The data with which to construct and amend their own narrative, deepening it to incorporate elements that were not previously conscious, is therefore available to them.

A Clinical Illustration

Mrs. M., an intelligent professional woman, had been unable to find relief from the deep depression she fell into following the birth of her child four years ago. This began when, after a brief period of statutory paternity leave, her husband returned to work and she felt completely abandoned, trapped alone at home with the baby. She became profoundly depressed and was desperate for him to help her, as he had done previously, when they first met and she was in a deep depression following the end of a previous relationship. Then he was patient with her, which she took to mean that he could tolerate her despite her depression. She credited this with her recovery and it left her convinced that he was the man for her. Now, however, when returning from a full day at the office he would help out with the baby and with chores around the house, but by the time it came to comforting and looking after her he was utterly depleted and thus unable to be there for her. When she spelled out that she really needed him to love, hold, or hug her he withdrew into work on his computer, evidently unmoved by her helpless crying on the other side of the room. She could not believe how cruel he had become. Unlike before, now she felt he despised her depression and hated her pleas for help. This hard-heartedness plunged her deeper and deeper into a depressed hole, and the only thing that kept her going was the thought that once she returned to work things would get better—she was very good at her job, which helped with her self-esteem; and she had a very good nanny lined up to help with the baby. However, because her employers would not sanction the full year of maternity leave she asked for, she had to resign and “start at the bottom” in a new job. The fact that she has not been able to reach her previous level, in terms of seniority status within the company and salary, means that the depression continues to haunt her into the present.

Mrs. M. linked her depression to the fact that her mother was depressed during her infancy. This repeated the situation that her mother herself had been exposed to as an infant, when her mother’s mother had been deeply depressed following her husband’s decision to return to his home country shortly after the birth. She (the patient’s grandmother) could not bear to leave her parental home in the village where she had grown up in order to accompany him there, which he had always wanted. The separation between Mrs. M.’s grandparents proved permanent.

Mrs. M.’s understanding of her depression as conveyed in the above presentation and my own emerging understanding of it differed. Mrs. M. had a model of transgenerational transmission to account for her difficulties: Her depression repeats her mother’s during her own infancy, which reprises her grandmother’s depression when her mother was an infant. This in turn had its origin in her grandmother’s loss of her husband. Mrs. M. recognized that this understanding, which she and her mother shared, did not resolve her depression, which she looked to the analysis to do. In this regard I suggested that Mrs. M. hoped that, unlike her husband (in relation to her post-puerperal depression), I would be able to bear the depressed her, an interpretation she accepted with relative ease. In my own emerging understanding, I noted that her depression, the onset of which coincided with the loss of her first boyfriend, remained a prominent feature in her life, suggesting that the object relations implicated in it were alive in her mind and thus potentially accessible in the here and now. I saw the prominence of infancy in her account as indicating that an infantile part of the patient was involved, and in this regard I noted that I found myself liking Mrs. M. Was this a countertransference response to a positive infantile attachment to me in the transference? If so, the infant in her would have found in me not a depressed mother but one properly attuned and responsive to her. This suggested that her depression, as visible at this stage of the analysis, might be a consequence of the loss of a loving object rather than the presence of a depressed one. I kept these observations, based in the countertransference, to myself but with this formulation in mind my attention turned to how she experienced the loss of her sessions.

In the beginning the patient attended thrice weekly and she returned each time deeply depressed, convinced there was no real help to be had for her depression. On exploration, however, it turned out that she left sessions feeling much better, which was usually followed by a good day at the office, from which she often returned to good quality time with her daughter. However, when her husband returned they invariably ended up in arguments, which readily turned bitter, over his emotional unavailability. At this early stage of our work together I interpreted that the gaps between sessions were too long for the infant in her to keep hold of the good feeling generated by the sessions. She was interested in this idea and observed herself over a few weeks before indicating that she considered it a plausible account for why she lost the feeling of being helped by the time she returned to the next session, and on this basis agreed to attend daily. This brought about an immediate improvement during the week—confirming my interpretation—when she began to be able to turn a blind eye to her husband’s emotional unavailability. However, this now came to the fore over weekends. I interpreted that he was the external manifestation of a cruel inner figure, labeling this as the absent me who withheld sessions over the weekend, which I contrasted with the me of the sessions that left her with a warm glow. The patient found the first part of this interpretation difficult to accept, insisting that her husband’s cruelty to her was real and not a product of her imagination. I said that she was moving to protect me from any possible complaint, but she insisted that she did not look to me for anything beyond what she received in sessions, for which she was very grateful. She explained that she had come to analysis only for help with her depression but found that my tolerant and patient attitude toward her had had a profound impact. It meant that she was not as hateful and unattractive, on account of being depressed, as she had always assumed she was. She therefore felt validated in turning to her husband for love, including physically, which she clearly would not look to me for. Indeed, part of his cruelty to her was to withhold sex for months at a time, even in the face of her repeated advances.

By this stage of the treatment, around eighteen months in, her depression had mostly lifted (including over weekends but not over longer breaks). Although she attributed this to my tolerance of the depressed her, viewed from my own theoretical framework her improvement flowed from my analyzing her depression by naming hatred against (the absent) me that I thought had been turned inward, making her feel nothing but a miserable, depressed wretch. As I indicated, she could not accept the idea that there was hatred in her toward me, but she kept in mind that I thought this existed, and she could not fail to notice that working on this theme in the sessions brought relief. From her point of view, the work opened her eyes to the possibility that she did not have to remain mired in being hated on account of her depression. This led to her feeling emboldened to seek something better from her husband—their wedding vows gave her this right. Thoughts of leaving him should he be unwilling to meet her need for love began to emerge, and it became possible for her to acknowledge feeling hatred toward him for the way he treated her. Given the prominence of the theme of hatred in our work, how was I to understand the patient’s powerful resistance to linking hatred explicitly with the absent me?

Acknowledging hatred toward the object for failing us is a central element in mourning, for both Freud (1917) and Klein (1940), and the failure to mourn can be a feature of depression. Within my frame of reference I take this as established theory with a sound evidence base. Freud went on to suggest that excessive hatred toward the object, prior to the loss, can be the factor that obstructs mourning, and my focus therefore turned to trying to understand the nature of her relationship with me at a deeper level. I wondered whether, in this case, excessive hatred might refer to an infantile level of our relationship, occurring when the ego was not yet sufficiently developed to apprehend, let alone feel, it. Had it therefore been projected back into the breast, creating the depressed mother of infancy, in unconscious phantasy?

I now began to look into the details of how she related to me. For example, on days when she was working from home she often came to her session in figure-hugging gym attire. One morning this particularly caught my eye, which I raised with her, describing what I, an older man, was confronted with on the couch before me. I asked what I was to make of it. She laughed (I thought more in relief than embarrassment), saying that her husband had asked, unusually for him, “Are you going to your analysis like that? Is it not too provocative?” Sex had by now become a contentious issue between them, and her immediate retort was, “Are you surprised? You don't want me.” I interpreted that perhaps she was trying to stir sexual desire in me so that she didn’t have to know too much of what went on inside of her, beneath the surface, when I did not want her. Who am I am to her, really, and what it is that she wanted from me?

Several weeks after this interchange she brought the following dream:

She is with a very nice man in a restaurant or bar. There is a lovely feeling and his way of being with her makes her feel completely comfortable and at ease—nothing happens between them, she adds quickly. However, she seems to know that he’s part of a cocaine gang or something like that. She is on her guard, and yet she can almost feel herself being drawn in by his allure, all the while aware that if things between them do go further she will become involved in the murky world of cocaine. But nothing happens [she laughs in relief]—even in the dream it is only in her mind.

Her association was to another dream where she was with an Arab man in a hookah bar with a very similar, unsavory atmosphere. The Arab man, she thought, stood for me. In my own understanding, which I kept to myself, this dream revealed the confusion felt by the infant within her in relation to the breast—her attachment and the desire flowing from it are both clear, but the breast that feels so comfortable and alluring was not a good object but one infused with primitive destructiveness that made dependency a dangerous and precarious prospect. The nature of the breast that she was dependent on had to be more fully investigated before aggression associated with its loss could be safely explored; Klein (1946) argued that the good breast had to be securely installed internally before it could be successfully given up. This provided a direction for further studying Mrs. M.’s difficulties—in her analyst’s mind. In the work of the sessions the focus was now on her desire in relation to me, and trying to shed light on what made me such an unattractive partner, something she herself was interested in. The means by which that inquiry would be pursued was, as before, observation in the present, followed by here-and-now interpretation offered as hypothesis, followed by further observation to reveal whether the interpretation deepened what emerged from the patient’s mind.

In this account, interpretation—which began with the patient’s depression, presented as a bad object residing inside her, impervious to influence from others—first directed attention to the fact that her depression was associated with the withdrawal of analytic care and a need for more frequent sessions. Next, detailed observation revealed previously minimized aggression and hatred which, when more fully acknowledged, lessened her depression. By now the infant inside her had been identified, which she developed a more compassionate attitude toward, turning to her husband to gratify its needs. In the event, he came to embody the depriving object, protecting her analyst from her fury at his neglect. Interpreting the split revealed powerful defenses holding it in place, suggesting that the split was felt to be vital. Following Freud’s logic in “Mourning and Melancholia” (1917), this led to a new line of inquiry, into the nature of her object attachment. I did not share this with Mrs. M. but relied on my state of evenly suspended attention for relevant observations that I might work with. I became aware that she might be trying to stir desire in me, an observation I shared with her and she confirmed (through her husband). I interpreted this as an attempt to relocate her desire in me, in order that it not be known as part of her. The next significant development was her response to this interpretation, in the form of the dream that revealed the object of her desire to be one in which good and bad elements are fused, creating difficulties with relinquishing it (during my absences). This state of affairs would be unraveled in the next stage of her analytic journey.

An Illustration Relating To Psychoanalytic Model Building

In Mrs. M.’s case I was drawing on established theory available in my preconscious during her analysis. I now want to describe a situation where there was no established theory on the theme that arose. In such a situation it is even more important to work systematically, using interpretation as hypothesis, so that we can ensure that whatever formulations we arrive at are based on solid evidence as to what exists in, and emerges from, the patient’s mind rather than on our own predilections.

I have studied the psychology of racism extensively, and in my view the absence in this literature of a satisfactory psychoanalytic theory, founded on clinical evidence, was a major drawback. I was interested in exploring this issue whenever possible and now want to describe opening clinical interchanges when an opportunity to do so arose. I will then describe a recent exploration that provided further evidence supporting the theoretical formulation I had arrived at through earlier work. I am bringing these examples to illustrate the use of here-and-now interpretation as a research tool.

The first patient whose analysis I want to give a brief account of is described more fully elsewhere (Davids 2011). Mr. A. was a seriously disturbed young man who had had a breakdown at university from which he never fully recovered. He came to analysis as a last resort, having made several unsuccessful attempts to obtain less intensive help. He presented with powerful and robust intellectual defenses that served him well, keeping emotional contact with me at bay in his first two sessions, where he gave a very smooth account of his history, including the history of his difficulties. The account contained no affect whatsoever, and he was able to effortlessly thwart every attempt on my part to make emotional contact with him. In his third session, however, this changed as he described his fear of an explosion. Several years earlier, while driving a new car, he heard a strange noise coming from the engine. Fearing it would explode, he stopped, got out, and dropped the keys down a drain (lest he have second thoughts and return to the car). I was mindful of how difficult it had been to touch him emotionally, and so thought carefully about how to respond. Eventually I interpreted that he had an explosive rage inside him, which he needed me, his new therapist, to be aware of. Instead of reassuring him, however, the interpretation succeeded only in stirring up that rage as he exploded in the session, laying into me with such force that I was left reeling. Unable to feel or think, I could not orient myself to what had hit me, and it was only at the end of the day, as a police car sped by, that I was overcome by a feeling that matched what I felt, but could not name, in his session: I had felt racially attacked. On detailed reflection, however, I could find no hint of anything racist in his material and concluded that this response to the patient’s attack sprang from my own mind, rather than being a countertransference response to something racist in him (Brenman Pick 1985).

By the following session he had pulled back completely, speaking as if the attack was something we had both heard about rather than been involved in. I suggested that this spoke of a fear that, following the attack, he could no longer trust me. He denied this but a little later revealed that since the last session he did wonder where I was from and where I would lead him. If he were in treatment with the referrer he would have no worries about this, as the latter is clearly English. His mention of the referrer’s ethnicity made me revisit my earlier conclusion regarding my association between police racism and the attack, now seeing this as a countertransference response—something racial clearly did exist in his mind, though I knew not what. I had little sense of “what to expect,” to use Freud’s term for the emotional literacy that usually guides a clinician in such situations. I therefore suggested tentatively that his attack may in some way have been connected with my being a dark-skinned foreigner. I intended this hypothesis as exploratory, but it closed things down as he replied instantly, “So you are accusing me of having made a racist attack on you.” From that moment on he became convinced that I meant him harm, thereby revealing the underlying illness that brought him to analysis. In the course of the long analysis that followed he went on to be hospitalized and made a serious attempt on his life, both of which proved analyzable. In the end he recovered and felt considerably helped by analysis.

The attack, it became clear, was a desperate attempt to shore up a defensive organization; once robbed of it, his underlying illness lay fully exposed. The interpretation that provoked it, which identified something explosive in him and named his need of me, came from a secure place in my mind where emotional literacy guided the formulation of a here-and-now intervention designed to make contact with emotion. It did so very powerfully, and I survived the ensuing onslaught, gradually through the course of the day recovering my capacities. My follow-up interpretation in the next session, involving race, was different. Without a model tied to the experience of racism in my preconscious, I had little sense of what to expect and therefore had to proceed with caution, framing my interpretation as an open-ended exploratory hypothesis. Nevertheless, it completely stripped him of his defenses. Had I known then what I know now about how racist defenses work, I would have had more choice over whether to offer an interpretation at all or, if I did, how to frame it. One consolation is that this turn of events brought the patient into a long analysis, which provided the evidence needed to conceptualize the racist defensive structure that was in place in his mind and from which his attack sprang.

The analysis yielded sufficient detail about his inner world to allow me to consider where that attack had sprung from, and this work yielded a model of internal racism. In brief, he had a defensive structure in his mind, organized around the ethnic difference between us, that protected him from his dread of dependency, which he evaded by projecting all need into me, the immigrant. When I pointed to his need for me to know about his explosive inner rage, this deprived him of a vital defense, and he attacked me as if his life depended on it—rightly so, for without this defensive system his underlying paranoid illness lay fully exposed.

The second set of interpretations on this theme is from a more recent piece of work (Davids 2020). Dr. B. believed that being raised as the only person of color in his world had a profound effect on him. Previous analysts had not addressed the race element, and this led to him abandoning these treatments, so it was clear this would need to be addressed. Having a model of what internal racism involved in my preconscious enabled me to investigate systematically what might lay beneath an erotized, psychotic presentation that emerged once the patient lay on the couch. He could not get comfortable and writhed around to such an extent that I had an association to him having a brick inside his abdomen. This was linked in my mind with racists hurling bricks through windows, which I took to be an association in the countertransference suggesting that something racist was at work. In light of Dr. B.’s aborted earlier analyses, I felt it important to address any relevant racial elements in this early presentation. I therefore observed him especially closely.

At first I noticed that the expletives that issued forth from this gentleman, uncharacteristically, all involved the word “fuck,” and I interpreted that what was going on in his abdomen was unbearable to him, which he confirmed, imploring me to “do something.” When I did “nothing” the f-word became more prominent, and now I interpreted that he wanted to be rid of the unbearable thing inside by “fucking” it out of him. He agreed with this, the thrusting of his hips intensified and shortly afterward the word “shit” joined his expletives. I now made a fuller interpretation, namely, that he regarded the part of him that suffered unbearable pain as shit, which could be expelled through his anus. This patient was familiar with the equation made in some psychoanalytic writings between black skin and the color of feces, and he immediately sobbed in pain at being accused of treating the part of him that suffered as black shit, just like white people do.

Unlike the situation with Mr. A., by now I had a model of internal racism available in my preconscious, which allowed me to generate interpretations systematically, following the evidence as it emerged, and these succeeded in bringing to light a dynamic in Dr. B. that he identified as racist. In this early sequence he takes the position of a racist perpetrator, which he himself brought into the open. With his internal racism identified explicitly, it proved possible to engage him in a ten-year analysis in which many of these themes could be explored more fully and be contextualized within his overall functioning.

Conclusion

I have tried to focus here on one aspect of the here-and-now interpretation, namely, its potential to place the psychoanalytic endeavor on a scientific footing. James Strachey, in his discussion of the mutative interpretation, separated out its two elements: identification of relevant observations of the transference (which are made available to the patient) and generating a psychoanalytic understanding of their meaning. I have suggested that when we work well we keep the two processes separate, the first becoming the domain of discourse with the patient and the second a private domain within the analyst’s mind. Doing so allows the work done with the patient to revolve around evidence that is verifiable and the drawing of inferences to be transparent, two requirements of science. I have considered what takes place in the analyst’s mind, focusing on the analyst’s emotional literacy and its link with psychoanalytic theory, and suggested that this is the space where hypotheses as to “what is going on” are generated, directing our attention to where the inquiry into the patient’s mind is headed, guided by unconscious forces. This is kept separate from the patient, thereby minimizing the risk of suggestion, and is translated back into the language of lived experience when formulated as an interpretation. Interpretations aim to deepen patients’ involvement with their unconscious, and hence to deepen the analysis.

This way of working can be used to push clinical inquiry forward in a systematic, evidence-based way. It can also be used when our theories need to be modified or supplemented, when data must be collected in a systematic and transparent way.