To Dream, Perchance to Think: Making Use of the Analyst's Reverie to Help a Disturbed Patient Symbolize His Experience

Throughout my early years as an analyst, I have been interested in the question of how the analyst is able to understand and communicate with her patient. As I became more able to perceive the multiple levels of meaning presented in an analytic hour, my question now has more specifically become: “How can I articulate ‘findings’ which do not arise from patient statements or actions, but from an odd place, almost unlocatable in my mind?” In this paper, I will write about “evidence” in the analytic hour, how it is likely to appear when working with a disturbed patient, and the analyst's response to working in this unique atmosphere. I offer these ideas in the context of describing my learning to develop understanding with a disturbed patient.

Analytic evidence has been the subject of much discussion in psychoanalytic literature. Spezzano (2001) describes three types of evidence: associations, reverie, and dramatic enactment. In working with a disturbed patient, each type occurs for both patient and analyst. However, with a disturbed patient, I have found that effective communication is far less possible when discussing thoughts, or even actions. Because the disturbed patient often communicates internally as well as externally with meaningless symbols, it is those very “pre”-symbols which hold the potential meaning for the analysis. To make contact with the patient at the level of those “pre”-symbols is the primary challenge in analyzing a very disturbed patient.

One form of contact which has been described by a number of authors (Ogden, Bion, Harris, Reich, Spezzano) is “reverie.” In Ogden's earlier writings (1994), he described reverie as a process of making use of his own internal musings, which in his descriptions resembled daydreams. Ogden seemed to distill the meaning from these daydreams by first experiencing them, then taking a step back, and ultimately finding the particular meaning for his patient with whom he had this reverie. The meaning becomes clear as the a