Surprise, Shock, and Dread, and the Nature of Therapeutic Action*

The nature of therapeutic action is described in the experience-near terms of surprise, shock, and dread, and more theoretically in terms of dissociative processes. Dissociated experience is not available through the ordinary analytic process of uncovering and exploration because it cannot be reflected on and is inevitably incompatible with the treatment relationship as it stands. It can only find expression through enactments and, in the process, obliterates other perspectives or realities that are likely to have been hard-won by the analytic couple. I suggest that in the course of an analysis, when patient and analyst achieve deep mutual trust, a special set of circumstances evolves in which there is a change in the way the patient uses dissociation. The patient actively seeks out those aspects of the analyst's behavior or person that permit reexperiencing of the traumatic past and dissociates the other aspects of the analytic relationship involving confidence, goodness, and trust. This is not a defensive use of dissociation and in fact, if we know how to work with it, is potentially the conduit through which new experience becomes available within the transference. Working with it successfully entails the analyst encountering the shock of being altered in entirely unanticipated ways and the dread of it being permanent. A detailed case example is used to elucidate these ideas.