Book Review: Coming to Life in the Consulting Room: Toward a New Analytic Sensibility

Be Ye Who Ye Is

Because if you ain’t who you

Is

You ain’t who you think

You Is

Attention to the intersubjective and relational nature of the analytic encounter in its various forms has come to dominate psychoanalytic clinical practice and theoretical discussion for decades now. Coming to Life in the Consulting Room: Toward a New Analytic Sensibility, is a collection of Thomas Ogden’s distinctive, influential contributions to this field which have appeared over the past 7 years. In them, Ogden summarizes his clinical and theoretical ideas to argue for analysts to embrace a “new sensibility” in order to do more meaningful and effective work with patients. It asks the analyst to move further away from the more traditional and prevailing stance of discerning and tactfully interpreting unconscious fantasy, or, in Ogden’s language, of explaining or understanding what the patient doesn’t get. This “new sensibility” is one which makes essential and primary the analyst’s achieving the best attunement to the patient’s immediate ongoing experience and emotional state. This attunement enables the analyst to avoid staleness and deadness in the encounter and missing what the patient needs most help with. Ogden derives this orientation from the work of Winnicott and Bion; both offered clinical justification for this new approach as well as describing a basis for a theory of mind superseding the traditional Freudian.

Ogden accurately places himself in the wave of this “movement that has been emerging in psychoanalysis in the past few decades toward a new and generative analytic sensibility—toward new qualities of receptivity and responsiveness to what is occurring in the analytic session” (p. xiv). Thus he holds much in common with the thrust of interpersonal, intersubjective and relational trends, although this version is marked by Ogden’s distinctive style of work and retains roots in and partakes of more traditional Freudian/Kleinian psychoanalytic theory and practice to which it is both an appreciation and a radical departure.

Ogden designates this new sensibility as “ontological,” a reference to what is “being” or emerging—“becoming”—simultaneously in the emotional experience of both analyst and patient. It is in keeping with the intersubjective character of analysis, which Ogden has done much to promote: “a co-creation of patient and analyst . . . in which . . . waking dreaming is an indispensable element” (p. xv). “Dreaming the session,” a concept borrowed from Bion (1992) and an essential component of Ogden’s clinical work, is what is simultaneously and unconsciously evoked in both patient and analyst, not only by words but, for example, by dress, tone of voice, posture, affect, gaze, and so forth. Along with Bion, Ogden emphasizes that dreaming while awake—active unconscious processing—goes on all the time. Going further, Ogden recasts the aim of analysis as well: whose “goal . . . is that of facilitating the patient’s ‘experience of creatively discovering for himself, of being and becoming more fully alive, more fully himself’” (p. xiv). This is Ogden’s take of “Where Id was, there Ego shall be” (Freud 1933). Id is not merely or mainly a repository of desire, forbidden or not, but of the entire set of a person’s experiences which have been “buried alive” and need to be brought into awareness for a fuller experience of living to become possible.

In both opposition to and conjunction with the ontological, Ogden poses what he terms the “epistemological,” the traditional analytic stance of uncovering and conveying “meaning,” bringing understanding or knowledge, primarily in secondary process expression, of their unconscious, content-laden fantasies, to the patient. In other words, it is describing to the patient what’s “really going on” in life as in the analytic encounter. In the chapter “Toward a Revised Form of Analytic Thinking and Practice: The Evolution of Analytic Theory of Mind,” Ogden reads Freud, Klein, and Fairbairn as conceptualizing, each in their own way, the mind as an “apparatus” contending with problems it doesn’t know enough about to solve, and the analyst’s job then is seen as “epistemological,” as explaining to the patient what is going on. The focus is exclusively on the patient’s enacted unconscious fantasies and on the analyst as the instrument for discerning and explaining them. But as Ogden sees it (in the above chapter and in “Ontological Psychoanalysis or ‘What Do You Want to Be When You Grow Up?’”), Winnicott (1963, 1967) and Bion (1967, 1987) set off a seismic disruption and take us away from this by conceptualizing mind not as “apparatus” but as “living process,” a process in which the analyst must participate as more than interpreter. The analytic patient is not to be the “object” to be understood; rather the “subject” of the analysis is the whole jointly lived process, the entire set of experiences created by patient and analyst—in themselves and in the “Third”—beginning as soon as they meet and ineluctably evolving as they muddle along. It is in explicit analogy, beyond its use as a speculative metaphor, to the infant/mother relationship. Ogden wants us to regard symptoms or whatever is repressed or dissociated, not as opportunities for explanation, but as “markers” for the analyst to take note of and use to get to the essential buried parts of the personality which disrupt and interfere with a fuller sense of oneself.

Traumatic, painful, fearful, intolerable experiences of childhood, aspects of the child’s “being,” have been “buried alive” and interrupt and arrest the child’s full emotional development. In his introduction, Ogden writes that through the experience of analysis the person can recognize, reclaim and integrate, as much as analysis (p. 141) makes possible, those aspects that have required “burial” and can resume “growing up,” “[achieving] greater maturity.” These unintegrated alienated “bodies” keep us from feeling fully “alive” and “whole,” and, quoting Winnicott (1963), from “the feeling of real.”

These last words have a great appeal these days but bring along a nebulous indefiniteness; they attempt to describe the indescribable: the subjective experience of the self. I wish they could be more clearly articulated—but maybe that’s asking too much. What does it mean to feel whole, fully alive and real? Is it better known in contrast to its absence? Is it different from undoing the effects of repressed content and how? How do these “buried bodies” of unconscious (unformulated?) experiences get in the way? Does Ogden’s view favoring “being” or “becoming” or coming fully alive versus “explanation” make necessary the sort of analysis and analyst/patient relationship Ogden is suggesting? As he assumes, whoever comes for help in analysis comes suffering with these buried consequential parts of themselves, a legacy of experiences with caretakers, insufficiently “emotionally sensitive and responsive,” which interfere with and diminish full psychological development from which they need to be freed.

Ogden (p. 130) takes the model for gaining this freedom from Winnicott: ‘in a state of “primary maternal preoccupation”. . . no longer . . . separate from the baby’ . . . the mother . . . “can . . . feel herself into her infant’s place” (Winnicott 1956) in such a way that the infant is able to experience an undisrupted state of “going on being” (Winnicott 1949)—where aliveness begins. Analysis for Ogden becomes this corrective experience, requiring the analyst’s quasi-maternal preoccupation. Like the mother, who wants to intuit and respond appropriately to the infant’s playfulness or distress without avoiding, intruding or hostile retaliation, rather to participate and make it tolerable, the analyst may similarly need to be there as a Winnicottian “subjective object,” but only until the patient is ready to move on to destroy that analyst, whose job is to survive in a new form: a separate “objective object.” Most current trends in psychoanalysis emphasize this: The analyst is receiver/container and metabolizer/“holder,” a better version of mother, who can experience and share the patient’s unformulated, unverbalized distress and return it in a way that creates the possibility for the patient to do better than bury it but to advance, come back to life and regain a genuine sense of aliveness.

In keeping with this model—the patient’s/infant’s experience and the mother’s need to respond to the infant’s moment—Ogden sticks close to Bion’s insistence on becoming in the “present moment” (p. 137) and reducing the interference of the analyst’s memory of previously shared experiences with the patient. In his many clinical examples where he describes what is in his mind, Ogden gives sparse accounts of the course of the treatment, his retained experiences of the patient, or how their experience of one another evolved. They are there, but all is in the moment and is becoming. If it occurs at all, the recollection of mutual past experience occurs unconsciously, and only in whatever way it presents itself to the analyst can it serve to address the moment.

I found myself questioning the insistence on such a radical erasure of recalled shared experiences. As I work with patients, my conscious thoughts invariably wander to those shared past experiences which then invariably emerge in the Third. Bion (as Ogden quotes him) would say that if I’m doing this I’m with the wrong patient (Bion 1967).

Coming to life is not meant for the patient alone. It’s the analyst’s job to keep that emergent shared experience of pain and fear from being drawn back into the deadness the patient has been suffering. It is arguing for the analyst to detect, tolerate and render it tolerable to the patient. In his clinical descriptions Ogden reflects on what he has just said to the patient, whether he feels it to be flat or jargon or rather makes for genuine “aliveness,” a genuine point of contact with what is buried.

Aliveness requires the analyst’s own comfort with spontaneity and “naturalness,” so Ogden cautions the reader not to take his particular responses as suggested “technique.” He stands staunchly against making technical recommendations or manualizing responses. This allows for the analyst’s inevitable missteps, and Ogden illustrates this in a clinical example where he spontaneously discloses a daydream he just had, something he typically doesn’t do, and deeply frightens his patient (p. 106). Even at the risk of inevitable mistakes, aliveness trumps sticking rigidly to technique and a treatment that is, in Hamlet’s words, “weary, stale, flat and [ultimately] unprofitable.” As Ogden puts it for himself and us, each analysis should be unique, a reinvention of psychoanalysis.

This freedom may be anxiously liberating, though I think most seasoned analysts work this way. When I underscored what I heard as the benefit from the analyst’s spontaneity in a presentation of some clinical work, a colleague responded, “But you can’t say whatever you’re feeling at the moment,” as though this was endorsing “wild analysis.” As I read him, Ogden doesn’t think of analytic spontaneity in that way either. It is predicated on confidence, gained by the analyst’s personal analysis and clinical experience and that the analyst has the patient in mind, consciously and unconsciously. It acknowledges that this may cause “rupture” and the need for “repair” (as in his clinical example). Ogden isn’t proposing this as therapeutically necessary but is acknowledging the necessary risk. The anxiety of saying something wrong at the expense of “natural” engagement may force the analyst to take shelter in “epistemological” or “secondary process” thinking, a departure from wakeful dreaming and unconscious process. It’s not that Ogden disdains interpretation or explanation, but cautions that they may deaden the moment, that, if offered, they be offered with the ontological sensibility of “being there.” Ogden: “this is not a rigid rule I impose upon myself. Rather . . . how I talk to a patient . . . hinges upon what is happening between this particular patient and me at this particular moment” (p. 58). This “new sensibility” is a technical requirement only in its broadest sense, a caution that explanation or interpretation may serve to protect against therapeutically necessary anxious uncertainty.

The reader might ask, then what is so new about this sensibility? What is different from the admittedly prevalent trend in psychoanalysis for the past half century at least: the use of “countertransference” as a means of understanding the analytic encounter? We’ve come around to considering our total experience—thoughts, emotional responses, physical sensations—to our patients as essential contributions to analytic work. In addition to Ogden’s long-standing and influential contributions to the intersubjective understanding of analytic process and conceptualization of the mutual creation of the “Third,” Ogden pushes the intersubjective envelope further in demanding the analyst focus on his own wakeful dreaming with the patient. The intention not to interpret by some secondary process intervention the patient’s emerging yet still buried experience of parental misattunement makes possible for the patient the unexpected experience of being held by an empathic, loving analyst/mother. Similarly and for example, it is optimally not about the analyst’s use of their countertransference to explain the patient’s aggression toward them, which is to risk losing or “dropping” the patient. Instead it is to direct the analyst toward spontaneously transforming that experience so as to communicate an understanding of the patient’s immediate difficulty; the analyst psychically “holds” the patient through an emerging experience buried when the child needed a parental presence to manage it.

For me the most philosophically stimulating and fun part of the book is Ogden’s grappling with finding words—what else can he do?—to convey what being alive and “real” feels like, what it feels like to be “you,” an attempt to describe the ineffable in a way that doesn’t deaden the reader. It’s a puzzle that Ogden invites you to ponder. He describes it as the part of the experience of the self that paradoxically both wants and doesn’t want to be found, something at the core of what it means to be specifically “you.” In using nebulous terms like “dreaming while awake,” “aliveness,” feeling “real” or “whole” Ogden entices us to embrace and use this ineffable subjective state, to pull us away from thinking of mind as “apparatus” but as process, continuous “dreaming,” toward what poetry or great fiction, music, or art offer access. A great part of the appeal and enjoyment in reading Ogden is that he takes us along in his own admittedly confused and sometimes confusing attempts to conceptualize this “feeling of real” as when he grapples with Winnicott’s papers, “Communicating and Not Communicating Leading to a Study of Certain Opposites” (Winnicott 1963) and “The Use of an Object and Relating Through Identifications” (Winnicott 1967). He wants us to open up to our own unconscious dreaming where he believes we’ll find our own sensual experience of simply being and becoming, of “going-on-being.” That core and mystery of what living feels like has drawn him to Winnicott and Bion, just as they may draw us to him.

It’s not surprising that, from the need to grasp aliveness, the subtext of the book is death and near death. This is explicit in the chapter on two poems—Frost’s “Stopping by the Woods on a Snowy Evening” and Dickinson’s “There’s a Certain Slant of Light”—where Ogden offers a reflection on them as encounters with death. Striving to give language to the ineffable, mystical and mysterious aspects of subjective experience, Ogden never leaves us in the clouds nor ceases to be fully human. He is not only writing, but taking us with him on a trip to better analysis. In doing that he serves as a formidable and liberating guide not only for analytic work but toward what being fully human can feel like.