Altered States of Consciousness in the Analyst

In this article, I explore altered states of consciousness evoked in the analyst during treatment. These altered states include dissociation, depersonalization, feelings of unreality, inattentiveness, boredom, sleepiness, and emptiness (the latter consists of a lack of self-experience affectively, cognitively, and perceptually). In general, altered states of consciousness in the analyst are either defensive in function, or represent a form of identification with the patient. They can be considered part of the wide array of cognitive, affective, perceptual, somatic, and behavioral responses that are countertransferential in nature. For purposes of this inquiry, I am referring to the “totalist” concept of countertransference, which includes the analyst's empathic, identificatory, and idiosyncratic responses to the patient (Racker, 1957, Tansey and Burke, 1989). Freud (1912) suggests that the optimal state of consciousness for the analyst is one of “evenly suspended attention” (p. 111). In this mental state, the analyst's unconscious becomes a “receptive organ” toward the transmitting unconscious of the patient. Freud's description of the relationship between the analyst's and the patient's unconscious connotes an interactive process in which conscious as well as unconscious information is transmitted by the patient, received and retransmitted by the analyst (the converse is also true). In our moment-to-moment communication with patients, we are subjected to an enormous number of stimuli consisting of language, ideation, imagery, feelings, and behavior. This sensory input continually influences the level and quality of our state of consciousness. The latter consists of a continuum ranging from alertness and attentiveness to inattentiveness and sleepiness. As part of the empathic process, we attempt to understand the affective–cognitive–perceptual inner experiences of our patients. This activity involves transient or trial introjections and identifications in response t