As expressed by the Oxford Dictionary, “a boundary is a real or imagined line that marks the limits or edges of something and separates it from other things or places, a dividing line. It is also a limit of a subject or sphere of activity” (2021).
In this paper I would like to attempt to share a look into the frontiers that we face in psychoanalytic work when we need to discriminate the intrapsychic conflicts of the patient, from relational or other conflicts.
My interest in this subject comes from different training experiences, also from research, and my clinical work as a psychoanalyst. I was trained as a social psychologist in Pichon Rivière's perspective, working with groups and with Isidoro Berenstein and Janine Puget, working with couples and family treatments. I also worked at the university hospital on both clinical work and research on mother-infant treatments. There I had my first contact with attachment theory and the developmental research that emphasizes the interpersonal approach based on object relations theory. This subject has also interested me greatly as a researcher, when investigating the mother-baby bond and the underlying patterns of their interaction.
Another important experience in this regard was my work on the IPA Clinical Observation Committee, where we developed the Three-Level Model for Observing Patient Transformations (3-LM) (Altmann de Litvan, 2014; Bernardi, 2014). We organized multiple clinical
Marina Altmann de Litvan, PhD is a full member of the Uruguayan Psychoanalytic Association and the International Psychoanalytic Association. She is a training analyst. She has done extensive research on early infants and she works as a child, adolescent and adult analyst. She was Chair of the IPA Clinical Observation Committee from 2010 to 2017, and Chair of the IPA Clinical Research Subcommittee from 2017 to 2021. She is currently a consultant of the IPA Clinical Observation Committee.
observation groups with hundreds of analysts in the three regions of the IPA, analyzing clinical material from analysts around the world. This model takes into consideration not only the intrapsychic changes of the patients but also the relational ones. I agree with Bernardi that the ideas of Pichon Rivière, but also of Bleger and Baranger, are present in this initiative.
We should start by taking a look at some of the Latin American developments on the concept of vínculo.2 It was Pichon Rivière who showed the way towards an inter-subjective and situational way of thinking. He introduced and developed the concept of vínculo at a time when interpersonal psychology (which today would be called relational) was at the center of the Río de la Plata psychoanalytic thought (in Uruguay and Argentina), while in the United States psychoanalysts were strongly committed to an individual psychology based on intrapsychic conflict (Gabbard, 2012, de León de Bernardi, et al., 2019).
Pichon Rivière underlines that the structural aspects of communication and experiential learning involve more than an individual inner fantasy, as in object relations theory; they entail a complex process, between the individual and different groups, both internal and external, that give feedback to each other. This is connected to Pichon's concept of ECRO (esquema conceptual referencial operativo) (Bernardi & de León de Bernardi, 2012).3
Depending on the context, the Spanish word “vínculo” may be translated into English as “link,” “bond,” or “attachment.” As the entire meaning of the word “vínculo” involves more aspects than these English words, I have decided to keep the original Spanish word of the mentioned authors.
“Conceptual Referential and Operative Schema, known by its Spanish initials of ECRO. By ‘schema,’ Pichon Riviere means a joined-up body of knowledge; ‘conceptual’ relates to the fact that this knowledge is expressed in the form of statements with a certain level of abstraction and generalization as befits scientific discourse; ‘referential’ seeks to establish the territorial boundaries of the object of inquiry; while, lastly, ‘operative’ signifies that our efforts should not be confined to the traditional epistemological criterion of ‘truth’, but should include the idea of the actual production of change – hence the concept of ‘praxis’. In sum, Pichon Riviere's ECRO is defined not only as an instrument for investigat ing a sector of reality, but also entails the conviction that the ‘task’ itself acts as a dynamic and constant process of transformation, both of the object of inquiry and of the inquiring subject.” (Arbiser, , p117–118)
Berenstein and Puget defined the vínculo as an unconscious structure joining two or more subjects, based on a relationship of presence. Although the term was used by several authors, such as Pichon Rivière , Bion , and others, Berenstein and Puget gave a different sense to it, and as Puget has noted, this term is paradigmatic, and it is characteristic of Latin America (Gabbard, 2012).
The link is more clearly seen in the perspective of intrapsychic phenomena such as, for example, Bion has developed. We can also see from the infant development research the characteristics of the intersubjective encounter and the installation of the we (Emde, 2009).
These understandings bring technical innovations that call upon the analyst to distinguish, in analytical listening in the session, that which belongs to the intrapsychic from that which corresponds to turns of everyday language that have to do with terms of the social subjectivity that is put into play.
It is of value to note that vínculo is developed along the process of analysis with its different affects and feeling that may be expressed in mind, body or unconscious actions, as well as on different levels of symbolization. To be worked through in analysis, we need vínculo to have sufficient thickness of representations (words, metaphors, etc.).
I find it interesting that with the concepts introduced by Bion in 1970, he states that there are relationships in which each subject promotes the other, with mutual growth, as well as relationships that do not promote growth. The bond can be established as love, hate, knowledge, and in turn bonding can have different forms that can be symbiotic, parasitic, and so on.
There are relationships that cause affective damage. The content is so forced that it tears the container, or the container is so strong and inflexible that it constrains by compression the contained element. This psychoanalytic discussion involves a consideration of the subject, the place of the other and its difference from the internal object projected on to an external object; internal reality and its relation to external reality; and similarity and alienness in the bond between subjects—the ‘multiplicity of the subject’ (Hinshelwood, 1989, p. 246).
As Werner Bohleber (2013) states, quoting Brown, “Bion's theory of transformations defines intersubjectivity as “largely an unconscious process of communication and meaning making between the two intrapsychic worlds of the patient and the analyst that results in changes between, and within, each member of the analytic pair” (Brown, , p. 109). Above all, communication, which takes place unconsciously, forms the “deep wellspring of intersubjectivity” and enables creative co-construction within the analytical dyad. The communicative process takes place by means of projective identification (Bohleber, 2013, p.813).
There is a bipersonal character of this intersubjective encounter. There are two separate self-activating systems that coexist, with different unconscious phantasies, each specific to each system. Analyst and patient can both give birth to a new idea. In Bion's words, thinking becomes a relational process of mutual growth (Bohleber, 2013).
Berenstein and Puget conceptualize this kind of relationship as vínculo. Encounter is a relationship of presence, first experienced as fleeting immediacy, then leading to a “new inscription of the other” which has no inner precursors. Vínculo is defined as “an unconscious structure joining two or more subjects, whom it determines on the basis of a relationship of presence” (Berenstein, 2001, p. 143). For the subject the otherness of the other represents something alien, inaccessible and new and, as such, inflicts a narcissistic wound. If the encounter and the otherness, i.e., the alienness of the other as experience, are avoided, the relationship remains on the level of a represented object relationship and the specificity of the other as subject is obliterated .
Puget stated that what differentiates their theory is the fact that it was based on presentation, the effect of the present subject on the other, and not on representation.
There is a different logic between the individual and the bond with the other, with its own mechanisms. Presence is that quality of the other that impacts powerfully on me as a subject. In turn, my presence has an impact on the other, impresses a mark, and modifies both me and the other. It includes a space that originates a new signifier in the bond between the two subjects. ‘New’ means that the subject did not have it prior to its inclusion in this vínculo.
Berenstein & Puget distinguished two fields, on the one hand, the object relationship, and the vínculo between subjects on the other. This space has particular mechanisms and conflicts: imposition and freedom to choose. Imposition is a defensive action when the partners of the vínculo cannot tolerate the modification of their subjectivity by the fact of belonging to this relationship, and therefore resort to excessive imposition in order to abolish the alienness and turn it back into similarity.
Presence is distinguished from externality; it is not only what is perceived as outside rather than inside the ego (judgement as to existence) but also what will not allow itself to be transformed into absence or to be registered as an object.
The relationship with the alien establishes a new form of functioning, because it cannot be incorporated as something belonging to the ego, nor can it be rejected and accommodated outside the ego, in accordance with the pleasure-unpleasure principle (judgement of attribution).
Presence opposes the judgement of attribution. The alien is governed by the judgement of presence and decides whether the other can become absent, can disappear as alien or, if present, needs to do something in order to modify it as a subject. If that which is alien to the ego and that which is outside are identical (as the bad) for the primal pleasure ego (cf. ), we shall now say that the alien may be a source of pleasure and/or pain and that it is the engine of the bond.
Both ‘wanting to be’ (identification) and ‘having to be’ (imposition)—in the infantile as in the present-day situation—have a powerful sociocultural constitutive effect, resulting in the creation of the social subject.
The internal world, the world of others, and the social world are three distinct entities that are alien to each other. Subjectivity is produced by the three of them.
The changes in technique imply that the analyst is placed in the space of two present subjects. Puget states that “it is different to speak to an ‘other’ who is invested with his own or historical qualities than to speak to an ‘other’ who is always alien, who imposes something that exceeds the subject” (Puget, 2015, p. 21). While in one there is a subject-object
relation, the representational world is activated and in the other the representational and the presentational are activated together.
Alienness strongly characterizes the other and the presence of the other in a significant relationship. This is the intrinsic, constitutive paradox of the bond. The other, too, is unable to incorporate the alienness of the subject himself, and the failure of the attempt is suffered as a narcissistic wound. In the vínculo, which we may also call the subject relationship, as distinct from the object relationship, the subject not only pre-exists the relationship but is also constituted by it (Berenstein, 2001).
The three areas (intrapsychic, intrasubjective and trans-subjective) have a synchronic existence in which each one has its potential to produce a specific suffering. When the analyst produces inaccurate interpretations, it may have a confusing effect on the patient. An example of this may be when the analyst takes as an intrasubjective conflict one that corresponds to the area of the inter- or trans-subjective or vice versa, or if he dismisses any of them as not pertinent. A patient may have associations of conflicts with his father, mother, son or sister; and this may refer to different types of relationship, either intrapsychic (self object) or to a bond conflict with another subject, or it may refer to a problem with the other and with himself in regards to a space where prescriptions and prohibitions arise.
In the transubjective world, sociocultural meanings (values, laws, ethical rules, as well as the social discourse in which they are included) pervade both the internal and the relational world. They impose their significance sometimes with a traumatic quality and sometimes through the feeling of obligation to accept them, through which the self experiences its sense of belonging (Bernardi et al., 2019).
As Bernardi et al. (2019) state, the concept of bond (vínculo) allows us to think about the intersubjective without losing sight of the unconscious depth of the object, also giving the interpersonal and social dimension a hierarchy that is often not sufficiently recognized by the theory of object relations, as well as ensuring a greater integration between aspects that in other approaches appear separate or opposed to being unilaterally stressed.
For Pichon-Rivière “Every vínculo, as a mechanism of interaction, must
be defined as a Gestalt, which is two bodies but three persons (Gestalt as Gestaltung, introducing the temporal dimension into it)” (Pichon Rivière, 1988, pp. 14–15, quoted in Bernardi & de León de Bernardi, 2012).
These visions brought technical innovations that led to the discovery of the bond (vínculo) potentiality, as a device but not a setting. This calls upon the analyst to distinguish, in analytical listening in the session, that which belongs to the intrapsychic from that which corresponds to turns of everyday language that have to do with terms of the social subjectivity that is put into play.
The emphasis on the presence of the other was also underlined by Bowlby in his development of attachment theory, but in a different context of discovery. The English word he uses in his first papers, which are found in the International Journal of Psychoanalysis, is “tie,” not “link” or “bond,” when he starts working on the object relationship. Afterwards he shifts to the concrete and dramatic experiences with maladjusted boys and the maternal deprivation—and the origin of affectionate bonds—to underline the importance of the presence of the other. Later (1979, 1980, 1987) he suggests that different patterns of attachment reflect differences in the individual's degree of access to certain kinds of thoughts, feelings and memories. During the late 70's and 80's, attachment research came to be increasingly concerned with child maltreatment, and physical and sexual abuse. He emphasizes the role of external environment.
Hinshelwood (1989) points out “the ambivalent complexity of a bond between two subjectivities” and the relevance of this concept in relation to the various current attempts to understand the intersubjectivity of the analytical environment.
Gabbard (2012) mentions a difference with object relations theory that emphasized the internalization of a relationship, and not merely the internalization of an object, and the Latin American view. For the later, the internal drama had to be viewed as playing out in the external relationship with the analyst and with others. Hence the ideas of Bion (1962) and Racker (1953) came into play—namely: that there are reciprocal influences within the dyad, and a dialectic between the internal and the external. “In fact, the very essence of analytic working through is to
identify these linkages as they emerge in the transference and outside the transference in order to shed light on who we actually are in light of these linkages and in spite of them. As noted, some of these connections are unseen by us. Afterall, self-deception is an inescapable part of the human condition (Gabbard, 2012, p.584).
I would like to present an example to illustrate this. Rodrigo is a successful man of 47 years old, who is in a relationship, committed to his partner but he experiences problems with her. He describes himself as being “always alert.”
I noticed different levels of problems in his different bonds. He can't manage to live together in his daily life with his partner, although they share the fantasy of “building a family together.” They have a good time together, but he finds difficulty in understanding his partner's perspective.
The vínculo is sometimes threatened by the difficulty in understanding “the otherness” or the needs of the other. If otherness is the foundation of the vínculo, then curiosity has to be the engine to overcome the unknown of otherness.
In addition to his difficulties with the otherness, he has intrapsychic conflicts, such as a low tolerance for frustration.
He tells me about an episode during a weekend vacation with his partner. They went to the cinema and he was surprised when he saw that they had to wait in line. This situation made him very anxious and impatient, and he wanted to leave. Because of this she skipped the line. He didn't understand her attitude and he started shouting at her because he found her attitude intolerable. He said he couldn't tolerate her “Argentine behavior” of skipping the line.
Here it's necessary to explain that an “Argentininan behavior” or “Argentinian characteristic” when people intend to take a personal advantage in some situation. Although this is not really a general attitude, for some reason it's included as such in popular speech.
I tell him that his partner was eager to calm his uneasiness and he could not see her gesture toward him, and that he was inclined to think about himself only. This promoted an important insight in the session. Not
only had he failed to consider the presence of the other, but he had also failed to detect the care that she was providing him for him.
This dramatic moment, when I could understand the failed scene of exchanges between these two subjects, could not be understood only intrapsychically. It required a kind of intervention that showed what was going on in that vínculo, outside the session.
I also showed him something he does repeatedly: when he is approached, he runs away. Of course, this other intervention has more to do with the avoidant model of attachment.
Why did he introduce “Argentineness” in this exchange? In his projective outbursts, he introduces the identity, her social belonging, and the characterization of some of the social representations of identity: a tendency to take personal advantage as opposed to thinking about the community and to have an anarchic behavior, avoiding respecting the rules.
We work on what this belonging represents to him. I associate that he feels in some way proud of bringing the national features into his work, but at the same time this social belonging has some aspects he rejects. Then, we know that this is important for him, although we do not know its real significance yet. This is something related to the bond with the others.
Benjamin anchors the process of recognition in human development and understands the capacity for mutual recognition as a separate trajectory from the internalization of object relations. Her solution is the so-called ‘third’: an intersubjective mental space co-created by both subjects, allowing each a certain letting go of the self, and each to adopt the view of the other and perceive things from their perspective. Benjamin distinguishes this form of relationship from the complementary relationship in which the subject-object principle prevails. One acts, the other is its object, i.e., both partners are located in the “orbit of the other's escalating reactivity” (2004, p. 9).
This difference between repetitive aspects and the new aspects that the vínculo brings, installs a new inscription that modifies the previous field, and I believe it is key to understanding the transferential dynamics and the types of interpretations. In Rodrigo's example, that intervention
opened a new stage in the different modes of relationship of Rodrigo with his partner. All his interpersonal bonds started flowing in a different and new way. It also triggered the beginning of memories of previously unseen aspects of his story, related to his parental figures, which were hard and cold. The emergence of aspects of his mother, that he describes as “poisonous” and that he experiences himself as having been inoculated with by her since he was a child. Let us note that this enabled the opening of a possibility to work on these massive depositions, which he constantly acted out and projected in his interactions with his partner.
I believe that, in this case, an intrapsychic intervention would have shown his phobia and the fear that the fantasy of being trapped by the other represents to him, his defenses and anxieties, and the resulting projective identification denigrating the object. In contrast, an interpretation that takes the intersubjective into account includes the scene of the other as a real presence, and what happens to the patient when he is with a real other.
From my point of view, this implies changes in the position taken by the analyst and also in the way of interpreting. It demands showing that situations are not a projection but instead interpreting the real presence of the other, making sense of the actions of the other in the relationship. It implies bringing the other person as a real subject, who is in a situation of interaction. These situations often escape awareness if the analyst only works with the internal world of the patient.
Stern (2004) states that intersubjectivity is not solely an interpersonal process, but a discrete primary motivational system similar to that of attachment or sexuality. As such, it regulates the psychological feeling of belonging as well as of being alone. The human mind is, then, no longer considered independent and isolated. Likewise, we are no longer considered the sole owners, masters, and guardians of our subjectivity. Instead, we find ourselves constantly in dialogue with other subjects and their consciousnesses, and our mental life is “co-created.”
Stern (1985, 2004) refers to this continuous co-creative dialogue as an “intersubjective matrix,” which he defines as “the overriding crucible in which interacting minds take on their current form” (p. 78). The basic
unit of this intersubjective matrix, formed by intersubjective consciousness, is the “present moment,” which stages the intrapsychic event in which two subjects encounter each other.
The interactive process has been identified by Beebe & Lachman (2002) in their model, whose aim is to reframe psychoanalysis within a system view of interaction consistent with infant and adult research (p.XV). In this model, subject and object, self and other, are no longer conceptualized as unities, but rather as “processes of relatedness per se.” According to these authors, it is not the self that interacts with the other; they reconceptualize autonomy and relatedness in terms of interactive processes of regulation.
How it is co-constructed and how mutual regulation takes place is included in this intersubjective matrix that is not present in other views. These interactive processes establish different “ways of being with” or patterns of relating.
The patterns of interaction, these “ways of being with,” were described by attachment theory, as “working models” (Bowlby, 1973), underlying structures of interaction (Altmann de Litvan, 2015). Their internalization occurs at a presymbolic level, prior to the ability to create images or verbal representations of the object. Thus, the first forms of representation are not of words or images; they are of relational procedures governing the “how to do” or what Stern et al. (1998) have called “relational implicit knowledge” (Lyons Ruth et al, 1998, Lyons Ruth, 2000).
This description of relational implicit knowledge seems to be anchored in what Bucci (1997) calls “subsymbolic processing”; it does not include sensory symbolizing processing. From my perspective, the “ways of being with the other” introduce unconscious aspects, sometimes difficult to access for the analyst, but which I consider essential to be able to access for a therapeutic change, since they are part of the Self of the person.
We should also consider the studies of neurobiology on intersubjectivity, a discipline that is rapidly accumulating new knowledge. These studies involve basic nonconscious functioning and have major implications for psychoanalytic work. As Gallese puts it, research shows that evolution has provided us with brain mechanisms for a “‘we-centric space’ … grounding our identification and connectedness to others” and that
“social identification, empathy and ‘we-ness’ are the basic ground of our development and being” (Gallese et al, 2007, p. 520). The self is a social self. Moreover, research indicates that from infancy, innately given brain processes support social reciprocity and the development of “we-ness” (Emde, 2009).
The analyst must then be able to grasp the patterns (ways of being with) from which to see the different underlying structures of the patient's relationships, which as a backdrop give us indications of the path from which the analyst can formulate interpretations, so that they are more effective. The modes of being with become more visible to the analyst in situations of separation or facing an important crisis.
As an example, in the case of another patient, a woman who adopted two children after many attempts to get pregnant, different conflicts arose that we based in the desire of both parents to start a family and the impossibility of getting pregnant, and the unconscious pact of the family project.
The subject of adoption came up in the analysis. What does “adopt” mean for these two people? It is a double choice. “When we finished the subject of the treatments to get pregnant and we started to talk about adoption, it was a very serious commitment. I was the most reluctant one about adoption. We wanted to build a family. I wanted him as the father of my children and he wanted me as the mother of his children. It is a double choice. As double as it is to get to adopt a child. When you adopt a child, it's not an accident, it's not an oversight, it's a child that you want very much. It is related to the most basic things of human beings, their instinct of procreation, of perpetuating themselves, of blood, atavistic things, like animals, the instincts of life”.
This patient had many difficulties in making the marks of interaction her own (De Litvan, M. A., 2007) and sometimes she erased them or blurred them. In their interaction, the child explicitly shows that he finds a mother in her. However, the mother didn't acknowledge herself as a mother through her interaction with this child, because of her internal conflicts and her representations of what being a mother was. She was not able to notice the place of the other, the place of her baby, who was bringing new events.
To her, being a mother meant having a child who came out of her womb and she ignored all the other elements that constituted their mother-baby relationship.
The conflict, the psychic work that is inherent in the adoption process, is carried out in the appropriation that “day by day” the parents make of the bond and of the relationship with their child. It is important to show the mother what it is that she gives to her child, but also what it is that the child gives to her and takes from her.
Mothers who adopt usually idealize giving birth, the mark of origin implied by the myth of being born from the mother's womb. But the other marks, which are established in everyday life, are also ways of appropriation, of marking, which often appear erased or blurred in adoptive parents. Here we see that there are different ways in which the relational or the relational vínculo can be inscribed.
Analysts must grasp the strength of relational patterns. Infant research and neuroscience suggest that, in addition to conscious symbolic elaboration, the patient and analyst must simultaneously work at an implicit relational level to create forms of collaborative dialogue (careful attention to the other's state, acceptance of a wide range of affects, more inclusive levels of dialogue, joint struggle and intersubjective negotiation in periods when the other's mind is changing and new ways of relating are needed). In order to produce changes in the analysis, the psychoanalyst will have to capture the “way of being with” that patient, because this is the gateway that will allow them to go through different narratives, dreams and fantasies. Elaboration should take place at both symbolic and procedural levels.
The mother creates, by mirroring the baby's feelings and reactions, the possibility of a third opening up a mental space for the thought and the possibility of experiencing mutual recognition. This also happens in the analytical treatment.
In my experience of working with patients with the 3-LM model I found that in general analysts are unaware of this unconscious relational level and the unconscious representations of belonging. Sometimes there are
changes in patients that occur more at the intrapsychic level, there are other patients we observe changing their relational patterns with different figures in their environment and, despite this, we find that they have changed dimensions such as their awareness of illness, their ability to symbolize and dream, for example, but they are still not empathic enough to understand what happens to them in some situations with people close to them. Does they manage to regulate their need of self-esteem when facing internal and external demands? To what degree are they able to achieve an adequate balance between their own interests and the interests of the other people in their lives? Is the patient able to adequately regulate their impulses, affects, and self-esteem? Do their ideals and values help them handle their emotions? These questions correspond to one of the aspects of mental functioning in the 3LM: affect regulation.
Here I present a clinical vignette that will illustrate this.
A patient entered psychoanalysis in his late 40's, “depressed” and “alienated.” His parents and grandparents had immigrated to the US from Eastern Europe before World War II. “I know almost nothing about my origin providence. I know my grandparents came here from Hungary, all four of them, and I have asked my parents about the reasons for that and the circumstances surrounding that and I have gotten sketchy stories but I don't have any sense of the past beyond that. I have no idea who my great grandparents were, what they did and so the past just ends pretty much with their arrival here in the US or it begins, however you want to look at it, there's nothing beyond that.” (Fitzpatrick Hanly, M.A., Altmann de Litvan, M. & Bernardi, R. Eds., 2021)
He grew up in a poor neighborhood and entered the Marines shortly before graduating from college, with a plan to leave as a conscientious objector, so as not to go to the Vietnam war. The cruel treatment of some enlisted men in the Marines affected him deeply. He had “drifted” around the country, after college and after getting out of the Marines, for almost thirty years, writing short pieces on sports and travel, and one story/script that was filmed. He tried, without success, to write other stories that would sell as film scripts.
His way of getting out of going to war seems to have been an act (in his
mind) that defied the conservative military ideals of his immigrant father and uncle who fought in WWII.
Three years later, the analyst interpreted his envy and hatred of those who have power and riches, which seemed to lead to some insight. This was the only direct interpretation of aggressive affects in the eight sessions.
The clinical observation groups found an “over-involvement” of the analyst and “countertransference blind spots”: core conflicts which (unconsciously) neither analyst nor patient wanted to address, and were directly avoided.
The patient's metaphors of “fighting… struggle… chaos… clashing… planetary destruction” used in his descriptions of the outside world, also describe his inner world and unconscious fantasies. These images of war are mirrored in his fragmented speech, full of attacks on his own thoughts, making his speech difficult to follow and to interpret.
Countertransference blind spots to unconscious rage and aggression in the patient contributed to the impasse. The analyst told the moderator about an incident which occurred one day when the patient ran over the analyst's cat in the driveway of his home office. The analyst knew his old cat often ‘got out’ and ‘might be run down.’ So, when the patient entered the session saying, “your cat is probably dead in the driveway,” the analyst went on with the session. Afterwards, he felt that this may have deepened the patient's sense that the analyst “did not care.” Going to see if the cat was dead or alive, and asking the patient how he felt about running over the cat, would have been an alternative intervention.
The analyst does not include things that happen outside the session. He eliminates in the relationship the impact that the event may have on the patient and his own feelings about it.
From the contributions of research on early development, we know the weight of emotional regulation. In this sense, we bring concepts that come from the work of what was seen in the analysis of early bonding, of attachment. It is one thing to regulate emotions and it is another thing to regulate attachment and impulses. So, the work with 3-LM includes both types of conflict: intrapsychic and relational.
In this patient we can see the intrapsychic conflicts related with sadism and aggression, but also the intergenerational conflicts, related to his belonging, his place in the generational chain, his problems that arise with the immigration of his family. The otherness of these Hungarian grandparents left a mark and the patient could not elaborate what it represented for him. An issue was what society imposed on him. These impositions were linked to values and rules that passed through social discourse, with a traumatic quality. The internal struggle affected his creative process. Those intersubjective links of the transgenerational chain could not be understood only from the model of object relations. He felt that by belonging to the army he fulfilled the mandates of belonging, both belonging to the country and to his father and grandparents.
The patient brought the issue to the analysis but the analyst did not interpret in terms of social subjectivity. His social belonging has an important place, the analyst takes it only in terms of the identifications of the father and the mother but there is also an identification of social belonging. This conflict and struggle is very clear in him and it is a completely different conflict.
In this paper I brought up how from different situational perspectives the vínculo (developed by Pichon Rivière, Janine Puget and Isidoro Berenstein) is a significant contribution allowing the analyst to help patients in deeper layers of their conflicts.
In clinical work we face a great complexity of conflicts that emerge in the frontiers between the intrapsychic and relational spheres, the bond and the social bond. I believe that in order to understand it better, the concept of vínculo introduced by Pichon Rivière, Janine Puget and Isidoro Berenstein, which distinguish the two fields of the object relationship and the bond between subjects, is useful.
The analyst that will be most helpful to the patient will bear in mind the distinction of internal and bonding conflicts and will know which conflict is a priority in each moment. The analyst who has this clear, is able to choose the right interpretation to help the patient better at each moment of the analytical process.
When working with patients, we may address the individual as a social subject or focus on the subject and his bonds. All schools of analysis have embraced interactive concepts, each one with their specific meanings and interpretations. Examples of these concepts are: countertransference, enactment, and projective identification. The Latin American concept of vínculo differentiates projections from real relationships.
From infant development research other concepts appear (intersubjective encounter, mutuality, moments of meeting, mutual recognition, authenticity, and spontaneity, among others) that are useful to understand the patterns of interactions with relevant others. Although these concepts arise in the context of infant development, they are useful to understand the patterns of adult interactions.
In the context of the work with the 3-LM, we found out that all these concepts can be traced in clinical material. The model has a specific dimension to observe how the intersubjective aspects affect the patient, how the analyst works with them, if they constitute blind spots, and how they change during analysis.
Intrapsychic, intrasubjective, and intersubjective areas have a synchronic existence and should all be considered in our understanding of the patient and our interpretations. This way of following the patient's experience as part of a jointly constructed intersubjective field shifts the interpretation. The analyst shows the way the patient interacts with the others and with him. Consequently, the dynamics of the unconscious resistance are different.