How you Play the Game: On Game as Play and Play as Game in the Psychoanalytic Process

This article proposes that all communications of patients in psychoanalytic psychotherapy and psychoanalysis are distributed along two coexisting dimensions which are designated “gaming” and “playing.” It is suggested that these reflect two different aspects of the underlying therapeutic process, both of which are always present but to varying degrees at different times. “Playing” refers to the symbolic play with thoughts and fantasies, occurring during moments of free association and fantasy play with toys. At these times, the transference appears relatively positive and sublimated, and the therapeutic work consists predominantly of recall and reconstruction of anamnestic material often related to neurotic issues. “Gaming” characterizes periods of repetition of repressed conflicts within the transference neurosis, with highly intensified responses to the therapist with whom and around whom fantasies and conflicts, often of a characterological nature, are reexperienced. These are frequently expressed through action including structured games with children, acting in, and acting out. Clinical illustrations from the treatment of an adult and a child are discussed in relation to these processes.