Criticism around analytic anonymity, neutrality, and abstinence were fundamental to the development of relational theory ushering in the ideas of mutuality, asymmetry, and co-construction. A review of how Freud actually practiced, the historical move from an objectivist position to a constructivist one, and the contributions of feminism shed light on the shifts in technique from a relational perspective. A two-person model of mind and therapeutic action necessitates being real with patients including the necessity of dealing with real events in the patient's experience and the unconscious judgments that impair the analyst's ability to do so. However, technical choices must always assess whether the patient can make use of interpretation or the analyst as a separate subject. While enactment and self-disclosure may be more valued by the relational model than other models, this does not necessitate ignoring the role of the unconscious and the interaction of the intrapsychic with the interpersonal. Increased freedom for the analyst to match needed responses to the patient contributes to the growing capacity for the patient to experience self and other as two subjects as well as intersubjectivity.
Henry Friedman has been a generous and generative thinker about psychoanalysis for many years, writing about the shifts in analytic theory and clinical technique for half a century. In his article he reviews the development of analytic theory and traces the modifications of theory around clinical technique and their implications for the analyst as a person. He demonstrates to us through the change in his own thinking the necessity of the analyst moving from what we might now consider a
caricature of psychoanalysis: analytic neutrality, abstinence, and anonymity to a three dimensional, real person who is emotionally engaged with the patient, and emotionally vulnerable in the dyad. Ultimately, he suggests “Once an analyst concludes that the basis for all our theories are indeed theoretical and unable to be either disproven or proven it is possible to face the need to be real with his patients.” I heartily agree and want to add some thoughts about how Freud actually practiced, the historical move from an objectivist position to a constructivist one, and the contributions of feminism to shifts in technique from a relational perspective. I hope to also to touch on the necessity of being real with patients including the necessity of dealing with real events in the patient's experience and the unconscious judgments that impair our ability to do so.
The analyst has always been a real person in the analysis, but was constrained early on by a set of rules necessitating a denial of crucial aspects of being a human in some ways that contributed to the evolution of psychoanalysis, but in other ways also stymied analytic freedom and comfort with intimate engagement in important ways. Freud developed his theory with an eye towards garnering acceptance of psychoanalysis as an objective, scientific inquiry.
This necessitated neutrality, abstinence, and anonymity by the analyst as an objective observer. In addition, as Freud (1912a; 1912b; 1915) discovered that transference was a powerful tool in working through the patient's problems, he proposed that these technical stances of the analyst were necessary to facilitate the development of the analyst as a transference object, to help the analyst maintain an objective stance in conflict between id impulses and superego prohibitions, and to facilitate free association, thereby granting access to the unconscious.
While Freud was busy writing about analytic technique and discovering more about how the mind works, he was also seeing patients. Many of these patients traveled from other cities to have their three or four month analyses, dined with Freud, walked with Freud, and even were privy to his own worries. His dogs were included in the consulting room, and his family was in and out of the home, present for meals and at times befriending patients. A review of forty-three cases Freud analyzed found that in all cases Freud deviated from strict anonymity, expressing his
own feelings, attitudes, and experiences, including his feelings towards his analysands and his personal worries (Lynn & Valliant, 1998). In other words, despite his written theory about clinical technique, he was often engaged outside of the consulting room as a person, sometimes also as a friend, and sometimes as a teacher. These multiple roles undoubtedly made contributions to the transference and the countertransference. So, on one hand, he thought that maintaining a blank slate was necessary for the transference to develop and for the analyst to maintain scientific objectivity, on the other hand he was often quite present as a subject in his own right. We can assume that it was Freud's followers who enshrined the set of rules regarding neutrality, abstinence, and anonymity since it is clear Freud did not follow his own precepts. Also of interest is Freud's motivation for using the couch. He thought it would induce a relaxed state like hypnosis and facilitate free association, but he also hated to be looked at. “I cannot put up with being stared at by other people for eight hours a day (or more)” (Freud, 1913). So even from the beginning of psychoanalysis with all of Freud's brilliant ideas and objectivist scientific orientation, unquestionably Freud as a person is influencing how his theory develops, and we have inherited, introjected, and idealized these aspects of technique.
Perhaps it is also worth considering that the prospect of emotional intimacy with our patients is both longed for and feared. On the one hand it is enormously gratifying to be invited to explore and engage with the mind and experience of another person, but on the other hand we have all experienced the powerful disruption that such intense involvement can wreak on our own psyches. Thus, for reasons of our own need for self-protection, maintaining anonymity, neutrality, and abstinence can have a certain appeal.
Aron and Starr (2013) in a paper titled “What is Psychoanalysis?” proposed that early on in the history of psychoanalysis three shibboleths emerged to differentiate analytic practitioners as a group from others providing mental health treatment and to create a border or boundary of those who were in the in-group vs. the out-group. These three tenets, well known to all of us in the in-group include 1) the role of the unconscious, 2) the use of dream or depth theory, 3) the centrality of the Oedipus complex. Later when psychoanalysis came to the United States, a further effort to maintain the in-group of the privileged and a monopoly
on psychoanalysis necessitated excluding lay practitioners and requiring medical degrees of those who could be admitted to this exclusive club. These limitations only came to an end in 1998 after a class action suit brought by psychologists against the American Psychoanalytic Association. My point here is to highlight that some of the original rules about technique were not only to establish psychoanalysis as a science and to facilitate analytic process, but ultimately protect the analyst from too many disruptive feelings, and to maintain privilege by limiting membership to those who agreed to practice according to a strict set of rules.
The opening up of this exclusive club coincided with a move away from an objectivist philosophy and the view that the analyst because of his privileged position of knowing more about the patient and being healthier than the patient, could rely on his own observations to be unimpeded by himself. Postmodern theory challenged assumptions of analytic neutrality, objectivity, and certainty from an epistemological position. How do we know what we know?
Of significant import, feminist theory and infant observation had been percolating and raising questions about the accepted binary around gender, the role of power relations, and view of the mother as only an object in the mind of the infant. Briefly, the first feminist critiques challenged the classical model of development as an androcentric model: the normal human is male, the female is defective. Feminist critics highlighted the idea that this view represented a little boy's view on sexuality, overlooked female experience of sexuality, neglected the power differential of men and women in society, thus perpetuated patriarchy (; Thompson, 1953). The second wave of feminism focused on gender difference and critiqued the view of autonomy as the hallmark of emotional maturity. This critique also framed the value of relationship and caring as a separate but equal province of women, unfortunately maintaining and reifying the binary (Dimen, 2013). Fortunately, a third wave of feminism emerged. Gender feminism began with the position that the subjectivity of the mother is unacknowledged by culture (Benjamin, 1998). Instead, the mother is viewed as an object in the world of the child and the greater world, not an autonomous subject who is essential in helping the child develop. Over time, the importance of the mother as a subject emerged, supported by the work of infant observation. Infant researchers like Beatrice Beebe and Frank Lachman (1998), Daniel
Stern (1985), and later attachment theorists noted the reciprocal interaction between mother (main caregiver) and infant. Mothers provide acknowledgement of the baby as a subject, suspending their own needs in order to respond to those of the child. Their ability to do so contributes to the child's capacity to experience the mother as a subject, and to the capacity for mutuality. The recognition of maternal subjectivity and bidirectional interaction with baby initiating and seeking relationship propelled the relational movement in psychoanalysis to move from a one-person model to a two-person model of mind in analytic process. This third step of feminism pressed for a move from dualism to multiplicity, embracing the constructivist position. As a post-modern theory it abandons the belief in an essential, unique, individual identity instead viewing internal life as an historical production, a creation that emerges in a field of power relations and with no set paths around gender and sexuality . Human subjectivity is viewed as contingent upon and constituted culturally and politically through language. The internal world influences the external world, the external world influences the internal world. Intrapsychic functioning influences interpersonal relations, and interpersonal experience influences intrapsychic functioning. Meaning is individually constructed and highly influenced by fantasy. From my vantage point feminism was necessary to usher in the possibility of the analyst functioning as a real subject, not only an object in the analytic dyad.
Relational theory maintains that experience is inherently ambiguous and that the analyst as well as the patient is motivated by unconscious processes so that we can never really fully know our own minds nor those of our patients (Davies, 2018). While relational theorists often lean on other theories such as object relations or self-psychology, central to relational theory is the idea that the analyst's subjectivity is always present and influences what happens in the consulting room, whether we want to acknowledge that or not. Furthermore, it suggests that there is mutual and bi-directional influence, both conscious and unconscious, between analyst and patient which contributes to the analytic process in the dyad (Aron, 1991). There are two minds in the consulting room, both conscious and unconscious, even if one of them cannot always acknowledge the presence of the other separate mind. Many years ago, Lucia Tower (1956) suggested that there is unconscious to unconscious
communication between the analytic pair, an idea that seemed radical at the time but has been embraced by many clinicians today. In fact, in this paper she reports challenging her analytic supervisee who was struggling with his erotic fantasies to his patient with the quip, “How do you know that telling her about them might not be helpful to her?”
The de-idealization of the analyst's authority, the ambiguity of experience, the uncertainty of knowing self and other makes the reconstruction of history an impossibility and an unproductive analytic pursuit. More accessible and useful is a focus on the patient's experience of self, other, and self in relation to other, both conscious and unconscious. And concomitantly, an exploration by the analyst of her own experience, both conscious and unconscious of self, other, and self in relation to the patient in the here and now. Admittedly this is a big demand. Merton Gill, a Chicago psychoanalyst with whom I studied before entering my analytic training, always emphasized the piece of reality in each moment of transference and how the exploration of this in the ‘here and now’ would generally lead to the ‘there and then’. A focus on transference and countertransference remains central to relational psychoanalysis, with room to explore both genetic contributions, the role of fantasy, and the real relationship between the patient and analyst (Gill, 1983).
Moving from a reliance upon free association and interpretation, which is not possible with any number of patients, to consideration about what is happening in the room between patient and analyst, relational theorists seek to make use of our own immediate experience of the patient in the context of the patient's history, experience of self/selves, other, and interpersonal schemas. Of course, all of these elements are also present in the room for the analyst as well. Ehrenberg (2010) highlighted this as “the intimate edge” noting that there is no real treatment unless the analyst makes herself emotionally vulnerable and engages in the patient's emotional world. Kleinian theory highlights the role of affect as unformulated experience that begins with bodily sensation which can become thought when held and contained by the analyst and then symbolized in language (Klein, 1923). One of the ways relational theorists engage with patients is by tuning in to their own bodily experience and reverie with
the assumption that they are resonating with aspects of the patient or their own experience and that an exploration of this with the patient is likely to lead to more clarity. With the idea in mind that we cannot know our own unconscious, relational clinicians extend an invitation to the patient to consider what the analyst might be experiencing to contribute to the co-creation of meaning. Critics have suggested that relational theorists are overly focused on, and promote, enactments in order to facilitate exploration and growth. In my opinion this is a mischaracterization of the relational frame. Enactments are prevalent in big and small ways from the beginning of most analytic treatments and the ability of the analyst to take a step backwards to consider her own contribution to these seems essential in order for both patient and analyst to understand what is happening between them. The choice for the analyst is whether to, when to, and how to disclose aspects of the analyst's experience that have contributed to the enactment. Sometimes the analyst has been on the receiving end of a projective identification and must work her way around to see what she has been holding or identifying with that belongs to the patient or the patient's objects. And sometimes the analyst must confront her own conflicts, limitations, and internalized objects that have become mobilized. And most of the time both of these things are true at the same time, sometimes creating a fiery sexy tango and sometimes creating an icy death spiral. In the exploration of what just happened here, the analyst's subjectivity is almost always in the spotlight, under scrutiny by the patient, like it or not.
This highlights another important aspect to the analyst's presence as a person being an essential and inescapable participant in the process. Instead of assuming an objective and neutral position, the analyst is always revealed in one way or another as a vulnerable human being. There was more protection around this when the analyst could function as a mainly detached authority and maintain allegiance to the set of rules around anonymity, neutrality and abstinence. But increasingly, we are pressed, pulled, or even consciously choose to reveal ourselves as vulnerable people who, like the patient, can be hurt, angry, sad, disappointed, envious, etc. Instead of this necessarily derailing the transference and the possibility of insight, our patients have the possibility of finding a new object, and a separate subject, one who is open to looking at herself, curious about the patient's experience, and one's own, and a model of how to
contain one's own emotional response while holding the other in mind. The efforts of the analyst to understand the patient at a deep level and to explore the multiple possible meanings of what has happened between patient and analyst becomes a central avenue of therapeutic action. In this manner the analyst provides recognition of the patient's experience and facilitates self-reflection for the patient. And hopefully having engaged in thinking about what just happened with the patient, including the unconscious contributions from the analyst, the patient will develop more capacity for recognizing the analyst as a separate subject, as well as develop more capacity for recognizing intersubjective experience.
I think it is fair to say wherever your theoretical inclinations lean, we can agree that there is no longer any one model of psychoanalysis that fits all analysts or is usable by all patients, and that we have generally moved in the direction that the analyst is not and cannot be the arbiter of the patient's reality, or for that matter, of her own experience. Most modern theory seems to embrace the view that the subjectivity of the analyst influences the choices that the analyst makes in terms of interventions, and that it is not possible to check either our theory or our unconscious at the door to the consulting room. Each major analytic theory has highlighted this from a particular vantage point. Modern classical theory while still focused on “an attempt to build complex preconscious representations from simple unconscious representations and presentations…has expanded to incorporate greater attunement to and use of countertransference reactions, understanding the importance of analysts empathic attunement, the role of analyst as co-contributor to the analysis” (Busch, 2023). Irma Brenman Pick (2018) highlights the view from object relations theory that close attention to the countertransference and the analyst's working through of it enables the analyst to experience the patient's inner world, digest it, formulate it, and interpret with authenticity. Self-psychology moved from the view of optimal frustration as the cornerstone of therapeutic action to the view that optimal responsiveness of the analyst is curative (Bacal, 1985). And more recently, Steve Stern (2017) with a self-psychological relational bent has proposed that progressive fittedness between analyst and patient enables the co-created conditions that facilitate the conditions for the patient's growth. He also highlights the necessary improvisational freedom of the analyst to find this path.
Another factor pressing the analyst to make use of herself as a subject relates to major cultural shifts in our world. Increasingly we are confronted with the reality that external events such as ongoing racism or white privilege, class differences, fluidity of gender and sexuality, culture, religion, climate change, and increasing political hostility and divisions are imbricated in psychic and interpersonal life. Alive and well (not always so well) in the consulting room. The real world influences the internal world. Thus, it is inevitable that the real world experiences of the analyst make their imprint on both conscious attitudes and unconscious experience, just as they do on our patients. We must acknowledge the ways these factors become imbricated in analytic practice and the analytic relationship. Our patients rightly feel pressed to tell us that we do not and perhaps cannot really understand their experiences of discrimination, being othered, alienated, assaulted, silenced, judged from our positions of privilege. And we are forced to turn the eye on ourselves and to acknowledge painful aspects of our patient's and our own unconscious, their mutual influence and the impact of realities on intrapsychic and interpersonal functioning. In this model the “goals of psychoanalysis become authenticity, freedom of expression, expanded relatedness rather than acquisition of insight, although insight is still important it is not privileged over these goals” (Stern, 1988).
“Being real isn't how you are made, it's a thing that happens to you.”
This quote from The Velveteen Rabbit (Williams, 1922) highlights for me a fundamental truth: we come into the world as infants and while we are real biological beings, we need the recognition of the other to develop a mind, and relational theory suggests for the baby to develop the capacity to acknowledge two minds and the possibility of intersubjectivity. This recognition includes having a parent who can attend to our emotional states by imagining their way into our experience and by responding with emotional regulation, containing, and trying to ascertain what we need as infants. In this manner the parent is able to transform raw affect into thought, such as, “Oh, you must be hungry! Let me sit down to nurse you.” Friedman (2023) highlights that what analysands recall as most important during analysis were “the small moments of unexpected human exchange with the analyst.” In other words, it was not a genetic, defense, or transference interpretation, but when the analyst intuited what the patient needed and responded in a way that conveyed
recognition and caring, and perhaps an openness to engage emotionally. In an earlier paper, Friedman suggested that it is the relational depth, “one that senses the mutuality between analyst and patient, the caring, the responsiveness, the presence of each other's minds and emotions that results in interpretations not of drive derivatives but of life experiences and the dynamics of relating.”
Increasingly we are seeing patients who cannot make use of interpretation, whose early trauma and developmental experiences make them very vulnerable to experiencing interpretation as an assault or a criticism. Even though we try to make assessments of analyzability and capacity for self-reflection at the start of analysis, we can only learn by trial and error what each patient can and cannot use and how we need to be real to facilitate each patient's growth. To be real, and sometimes to become real and usable for the patient, we must, like the parent, rely on some aspect of our emotional resonance or identification with them to discover and recognize what they need. This does not necessitate self-disclosures of our own conflicts and traumas, as many critics of relational theory have imagined, but an openness to considering how we are contributing unconsciously and consciously to the analytic process that evolves with our patients, and remaining open to learning from the patient what they might see about us that has been unconscious for us.
I worked with a middle aged woman who functioned very well at work, but who had great difficulties sustaining intimacy with her partner. She reported that her friends could not believe that she, of all people, needed analysis since they thought she was the most together person they knew. During the first six months of analysis, I made a number of transference interpretations based upon derivative material to which she would exclaim, “What are you talking about? I was telling you about my interaction with my friend. This has nothing to do with you!” Only after several such interactions and a consultation was I able to understand that she did not experience me as a separate person, but needed me as a self-object. When I moved to a mainly empathic and exploratory stance and began to name feelings she did not know she had, our work progressed. Considerable material emerged about her role as her mother's confidante, her father's need for her to achieve success and status in his occupation, and the relative lack of parental interest in the patient's inner life. Through more affirmative interventions such as, “It's understandable
that you try so hard to please me and worry about whether you are a good patient, given how much you had to take care of both your mother and father,” she was able to look more at her conflict between asserting her own needs, and fears that to assert them in her relationship would result in rejection and abandonment. Throughout much of the analysis I was idealized or experienced as a twin. The patient offered me small gifts such as homemade cookies at holidays, flower bouquets from her garden. Because I did not see these actions as interfering in our work, or as defensive efforts around aggression or erotic overtures, I accepted these gifts without interpretation or exploration. I understood they represented both her appreciation of our work, our real relationship, and her tendency towards accommodation. Over time we were able to talk about how much she wanted my approval and love and how this replicated her relationship with her mother and contributed to her denial of her own needs and feelings in favor of accommodation. Aspects of negative transference later emerged, but mainly in a derivative manner. At times, she complained that the plants in my waiting room appeared neglected, that one even had a hole in the leaf with a sharp sticker punched through it. These observations were easier for her to explore than her more immediate reactions to our interpersonal interaction. It seemed clear that her comments about the plants were related to transference concerns about whether I could be consistently attentive to her needs as well as her fears that I might hurt her not only by neglecting to care for her, but by being too aggressively probing her inner life. My approach to these events was not much different from what I think most analysts might take, that is to explore her fantasies about me as caretaker of the plants and her psyche, to consider what was happening between us that might have felt neglectful or dangerous. A more classical position might have addressed her defensive avoidance of her aggression or mine, of her tendency to accommodate rather than to assert herself. But for a good part of the analysis, she needed me to be more of a container or a self-object and the injection of my own ideas about her would have been experienced as empathic ruptures. I thought that most of the time she needed me to help her understand and to validate her experience, to help her identify her emotions, and to better regulate her states of tension. These seemed like essential building blocks to help her grow in her capacity to find a more authentic self, and to be able to engage with another person with more freedom, including moving to a recognition that each person
Much later, towards the end of her analysis, when she referred to me by my husband's last name, one I had never adopted, I bristled, saying “I don't think I have ever used my husband's name.” Feeling temporarily unrecognized and perhaps diminished too as the separate person I wanted to claim in retaining my own name. In an effort to own my real experience I disclosed, “I guess you hit a sore spot with me.” I shared that it had always been important to me to retain my own name and independence and asked her how she experienced my petulant reaction. She was able to express her recognition of the importance of this to me, and to comment that we had elected different paths in terms of choosing or rejecting our partner's last names. I thought this was an important step for her to acknowledge that we were different and we had made different choices, and commented that she was correct about having touched a nerve in me. Over time I noted her growing ability to make space for me as a separate subject who could offer an idea about her conflicts that she could not see, and her increasing curiosity about me, signs that now there could be two people in the room, not just one. But first as Slavin and Kriegman (1998) highlighted, the therapist had to change! During the termination phase my patient shared, “I love you. You have been such a help to me.” With no hesitation, I shared, “I love you too and I am so happy to see how much you have gained from our work together.” Two people in a real relationship, speaking their truths to each other.
With another analysand, our treatment began with a series of efforts by the patient to set the fee and the times of the sessions. This patient presented a paucity of material, frequently remaining silent and rejecting most explorations I attempted about the meaning of the silence and the efforts to set the frame. As you might imagine, this was a rather challenging way to start. I knew that in a previous analytic endeavor, the analysis ended when the analyst interpreted these issues as resistance, and ultimately the analyst refused to continue the work.
In the first year there were multiple disruptions: arriving late for appointments, disrupting sessions to take phone calls, to speak with others in the home. For the treatment to go forward I had to find a way to listen to him, to manage my own feelings of frustration and helplessness, to
contain both my own disruption and the patient's fear of opening up in the treatment. In a reverie during the patient's silence one day, I recalled my own feelings of helplessness around caring for my premature daughter who was colicky for seven months, and the pain of not being able to soothe her except by nursing. I was too young or too immature to appreciate that being able to tolerate her dysregulated states was what she needed, an acceptance of all of her emotional states without me believing I could always make her happy. Musing about this enabled me to work at staying emotionally present in these silent times. Staying real with him became much easier as the picture of a young boy abandoned by his father, and controlled by a critical, dominating mother, very slowly began to emerge. In other words, wrestling with my own sense of vulnerability and helplessness enabled me to help him to get in touch with his enormous vulnerability and to remain in an empathic state, at least more of the time. Sometimes we have to remind ourselves that holding, containing, managing tension states, is an essential part of treatment and represents not just a technical activity but is fundamentally a needed human response.
About a year into this analysis there were two enactments that proved to be generative. The day before the first occurred I had informed the patient of several upcoming sessions I needed to cancel. At the time he did not share any reaction, nor did I hear any derivative communication about it. But during our next online session the patient received a text and asked me if it was okay to answer it. I wondered with the patient about both his question and the urgency of the text. The patient explained that he had earlier sent a text asking someone to help repair his computer and he didn't want to make this person wait, adding that he hates to wait. In an effort to grant the patient some autonomy I told the patient it was his decision what to do. The patient chose to temporarily shut off the video and audio on Zoom to send the text. I was aware of feeling irritated as there had been many such intrusions in the analytic hours: food deliveries, time out for conversations with the roommate, arriving late to appointments due to poor planning, and also as mentioned above, a resistance to engage by remaining silent and rejecting explorations of these events. But most of this was not really in my awareness when I said to the patient, “I'm wondering what felt so urgent for you to choose disrupting our session to return that text?”
My patient told me that he thought he had asked for permission and that I had left it up to him so he didn't understand why I seemed to be irritated or even mad that he had chosen to do so. I asked the patient what he might imagine I was experiencing, but this was not productive, and as often happens we were at the end of the session and could not process it further that day.
I went to bed ruminating about what had happened and my sleep was very disrupted. I knew that I was feeling anxious, particularly disturbed. When I woke up I remembered that I had a dream about the patient, but the only thing I could remember was this sentence, “For a change, I was able to be patient.” My first thought was that this was a self-reprimand; you should be more patient. Then I wondered if I felt myself in this interaction to be the patient, the one who like the actual patient could not wait, and who felt frustrated and abandoned too frequently in the analysis, a concordant identification. Next I asked myself, aside from what you know about yourself in these regards, what had happened recently in the analysis that might have contributed to this unconscious enactment in which I gave the patient the space to choose what to do, and then criticized him for doing so. I considered that I was conflicted between wanting to give the patient autonomy in making the decision and wanting the patient to remain emotionally engaged in our analytic relationship. I thought about whether I was on the receiving end of a projective identification in which the patient was unconsciously asking me to hold his impatience and or abandonment or if I was in this moment in the position of his critical and controlling mother. Maybe any or all of these things. But what to do about all of this?
The patient made no reference to this enactment snafu at the beginning of the session but remained tight lipped and disengaged. After waiting five or so minutes to see what might emerge, I suggested that it seemed like there was an elephant in the room related to the last session and I hoped we could explore it together. The patient initially stated that he had already said what he had to say about it yesterday. I nudged him a bit saying, “I'm wondering how you felt about my irritation regarding the texting and what you made of it?” My patient responded by saying that it was important to him to have my approval that he was a good patient and he hoped I could understand that he just really needed to respond to that text. He was worried that I was angry at him. I shared that I was more
irritated and frustrated about the disruption than angry, as it seemed to be a more frequent occurrence than was optimal for our work. I offered that it seemed the patient was in conflict, one part of him wanted the analysis, the help it might offer, and my approval, and another part of him seemed to absent himself from the analysis through frequent silence, disruptions in the hour, etc. In what may have been a second enactment, I stated that part of my frustration was that I wanted to get to know more about his experience and to better understand him and it seemed that this was scary to him. Since these interventions had not been well received previously I was very surprised when my analysand offered that he thought I was right about that; in fact, it was very scary to open up for fear of criticism, attack, and abandonment. I was able to frame this experience not only to what had just happened in our interaction but also to the previous failed analysis, and early experiences with his controlling mother and abandoning father. Then I wondered out loud if my having shared the day before the snafu that I would be missing a few sessions in the upcoming two weeks had something to do with the patient absenting himself from our work to return the text. The patient again surprisingly considered that perhaps as much as he enjoyed saving the fee during my absence, he did feel abandoned, so he might have wanted to leave me because he was angry that I could just leave when I wanted to. “Why might I want to leave you?” I asked. “Maybe because I am after all not such a good patient.” he responded. I felt a door was opening in our work to consider more about the patient's resistance as an effort not only to be in control but also to protect himself from his conflict around the wish for closeness and fear of it, and his fears about his own aggression. Being real with him about my irritation, and my wish to know him at a deeper level seemed crucial to this shift. The two enactments, the first one of my unconscious criticism about his returning the text, and the second of my effort to engage with him emotionally, proved generative.
In closing, I hope psychoanalysis will continue to evolve and that we can make space for using a variety of theories of therapeutic action since no one theory is useful for every analytic dyad. Fred Busch (2023) likens this view to a psychoanalytic forest where the resources flow from the oldest and biggest trees (classical theory) to the youngest and smallest (later theoretical models), but I think it also worth considering that all trees must make adaptations over time in order to survive. New ways of
thinking about analytic theory and clinical process are always emerging and enriching the core of psychoanalysis. The realities of our cultural diversity, gender and sexuality diversity, political conflicts, and crises and traumas will also impact the directions that theories and techniques evolve. Our job as teachers, supervisors, and clinicians is to champion the analytic inquiry, not to hold tight to ideas about the right way to do analysis. It is no longer possible or desirable to hide behind theory and a set of arbitrary rules which tend to dehumanize the analytic relationship rather than reinvigorate the joy of emotional engagement and facilitate the depth of psychic exploration.
was a separate subject with their own feelings, thoughts, and needs, and the capacity to find joy in the creation of intersubjective experience.