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Consider Bernard, who paces your office placing items from his pockets on various surfaces—a piece of crumpled paper here, his car keys there—at times baring his teeth and snarling at you. Or consider Ruben, who removes his shirt to show you a massive, roaring lion tattooed on his chest. Bernard and Ruben are two of the memorable patients Robert Grossmark describes to illustrate the thesis of his book, The Unobtrusive Relational Analyst. This book addresses a gap he finds in relational theory and technique posed by patients who seek psychoanalytic treatment but are unable to verbalize their innermost experiences. Their subjective sense of a separate self is either poorly developed or is hidden beneath the veneer of a competent, high-functioning “false self,” perhaps due to early trauma or emotional neglect. Grossmark elaborates on the nature of the regressed1 states of mind these patients present and the conditions needed for their relational analytic treatment.
Grossmark's thesis is that through a stance of unobtrusive psychoanalytic companioning, analysts enter the flow of the omnipresent enactments that pervade a treatment. Together, analyst and patient (in group work, analyst and members of the group) live through a variety of mutually experienced regressed states and dysregulations. Out of the seemingly primordial chaos of somatic sensations, actions, overwhelming anxiety, and confusion, capacities for self-other differentiation, affective regulation, and mentalizing emerge. There is no need for the analyst to interpret, clarify, or in any way impinge upon this flow of enactments, aside from establishing and maintaining a treatment frame and ensuring the patient's safety.
Some readers may be put off by this thesis, and by Grossmark's book. His ideas about the analytic stance and process required for successful treatment of inchoate mental states are engaging and at times provocative,