A Conversation with Betty Joseph

Frankiel: Your papers about the sometimes tiny and always subtle shifts in transference and countertransference within the analytic hour have heightened analysts' sensitivities to these issues. How did you come to develop that sensitivity and sensibility in yourself?

Joseph: I remember one of the earliest papers is “The Patient Who Is Difficult to Reach.” That was really a kind of bridge point. For some time, I had been terribly dissatisfied with making interpretations that seemed to be correct, but somehow didn't really get through to the patient. I didn't feel there was any proper resonance, and therefore I got more and more interested in what was going on in the room and how to get to some part of the patient that I could talk to. I think that from this dissatisfaction with my work there grew a need to attend from moment to moment to what was going on, so far as I could tell, first in the patient. Later I became more aware of how it was resonating in me.

Frankiel: Would you elaborate on your idea of resonance and nonresonance?

Joseph: Even though I could feel what was going on, I couldn't get any feeling that the patient was reacting emotionally to what I said. He was only reacting with his mind. Something was not going right, something was not resonating, wasn't being reached within the patient and reflected back to me.

Frankiel: You've written about your treatment of a series of patients who had a great deal of trouble making use of the analyst and the analytic process. This has helped many of us to face the feeling of heaviness or deadness that comes over us when we sit with certain patients. Your work shows a way to be more alive in the hour by attending to the process in detail, even though the message from the patient is that he or she needs us to be rather unavailable.

Joseph: I think that has something to do with the fact that I always start from the point of view that there are two people in the room and that it is therefore impossible that things are not going on, though they may not be going on intellectually. One then becomes particularly interested in patients who are prepared to be rather dead, boring, or nonresonating. It poses a tremendous challenge to one's awareness of the idea that something is going on if only one can tackle it. Much of the earlier analysts' work must have been done on an explanatory intellectual level. Once one starts to bother seriously about the notion of two people who are reacting to each other in the room, something shifts in one's approach to the work.

Frankiel: It is noticeable around the issue of asking questions. When Michael Feldman was in America, he quoted Herbert Rosenfeld's aphorism, “When you ask a question, all you get is an answer.” And it seems that embedded in what you're saying is a whole attitude toward asking questions that needs to be considered.

Joseph: Yes, I think that's because usually, when one asks a question, it means that one is stuck, one can't see what's happening, and somehow one expects the patient to help. What usually happens is, the patient replies with his conscious intellectual ideas, and it takes us farther from the unconscious material, which is what needs illuminating. There are times, of course, when one needs to ask for elaboration; for instance, if a patient brings in a bit of history or external material that one feels has an importance in terms of the transference, it's helpful to get the patient to expand it a bit. That is different from what we mean by asking a question. Because asking a question nearly always pushes both analyst and patient into intellectualizing. Then you get two people discussing and explaining things to each other, which doesn't really take them any further.

Frankiel: The patient's personal history and how you make use of it is relevant here, isn't it?

Joseph: I think personal history is important and interesting, but only when it turns up in the present. For example, when being very delicate with a patient and very sensitive and careful, one starts to wonder why one is doing it, and then it is very interesting to see whether the analyst is unconsciously manipulated by the patient into being so oversensitive and thus living out a piece of history. The mother may not in fact have been overcareful and solicitous, but this appears to be how the patient experienced her, and this is the role that the patient unconsciously seems to be getting the analyst to play. There, I am interested in the history, but primarily insofar as it turns up in the relationship with the analyst. I'm not interested in the history if it is used to explain the patient in a secondary way.

Frankiel: That clarifies a major dimension in the way you think about the past and how you see it in the immediate present, which leads us to projective identification. You have defined it indirectly just now, haven't you?

Joseph: Not exactly. I've just shown one aspect of it. When one has the feeling that the patient is somehow doing something to the analyst unconsciously, pushing the analyst into acting in a certain way, that would be one type of projective identification. One could see what I've described in another way, which is that the patient is projecting an internal mother, his internal picture of the mother, into the analyst and reacting as if the analyst were like that. But often he actually does manipulate the analyst so that the analyst for the moment acts like that, is overcareful, is very delicate in her interpretations. Once one is aware, then one can show the patient that he expects us to react in such and such a way. The analyst has learned, having found herself or himself nearly or actually behaving in the unconsciously expected way.

So much of our work now is based on the idea that when the patient talks to us about his external world, there are two ways of looking at it. One way is to take how he sees his external world as his way of asking us to help him cope better with it. Another way of considering it is that it illuminates what is going on in the relationship with the analyst, so that elements that he talks about can be seen as bits telling us about his unconscious ideas about the analyst or as referring to split-off parts of the self. Now, this does not mean that I would not also pay attention to the reality of the external things mentioned. If he tells us he is unhappy with his wife in such and such a way, I would take this extremely seriously and hope that the work would, in fact, help him deal with things better. I would assume that this would be much more likely to take place if I could understand how it was reflecting what was going on in the relationship

with the analyst and if I could work it out with him there. Then he will probably better understand what was going on at home.

Frankiel: Could you say something about the difference between projection and projective identification?

Joseph: I think that very often we use the words interchangeably because projective identification always involves projection, splitting off parts of oneself. The way I see it is that projective identification always implies the existence of an object into which are put the parts that have got split; the object may be internal or an actual external object. In this way, depending on the feelings that have been projected, the object may be felt as identified with the self, for example as very loving or very hostile. I remember a child who had to keep the good bits separate from the bad. He would build a wall in which the good parts were kept away from him. An alarm rang when the “goodies” came, not when the “baddies” came, as if he dared not bring together the good and the bad parts of the self and had to keep the good parts in his object—outside of himself.

Frankiel: What made that necessary?

Joseph: If he brought the good and bad parts together, his fear was that his violence would be so powerful that it would overwhelm his love and affection. He had to keep the goodness out of himself as the bad child.

Frankiel: Your special contribution, over and above what you have contributed to the literature, is the way in which you've influenced a generation of younger analysts who have studied with you very intimately for a long time. They have stayed in your study group and worked with their very detailed clinical material and got more and more able to use these concepts in their own way—

Joseph: And developed them in their own way.

Frankiel: Yes. That seems to me to be a very particular aspect of what you've accomplished. How did that happen?

Joseph: This way of working in which we pay very, very careful attention to what is going on in the room, by reporting material in detail, or supervising in detail, allows us to show our students what is going on. This doesn't demand intellectual knowledge. It becomes interesting for people to work in a very detailed way, and they start to enjoy it. What is interesting is to see the freshness of the ideas that have been developing in the last decade. I think one should be careful, however, not to speak as if this way of working is in any way essentially different from any other analytic work. I don't think it is. All I've suggested is to try to refine one's listening so that one becomes more sensitive to the immediate to-and-fro between analyst and patient. I don't think there's anything essentially new in this. It's a development in analytic work I was lucky to be around for and help develop. It's not more than that. I think it's very much in the air.

Frankiel: It is certainly true that a number of people have approached this, but what seems to me special is the way that this work has generated tributaries of work, or tributaries of thought. You mentioned a minute ago that there are a number of people you think have gone on to unfold aspects of this in their own terms, and based on their own knowledge. Here we are perhaps most familiar with John Steiner's and Michael Feldman's papers. I'm sure that there are others whose names we'll come to know as time goes by. Next I'd like you to describe your work with children.

Joseph: In the early days of child analysis, it was assumed that what the child needed was to have a chance to play or to act, say, his aggression or his affection. Particularly since Melanie Klein's work with children, there's been greater attention to the details of a child's play and an attempt to interpret what the child is feeling. Why, for example, was he disturbed or frightened by the analyst, and what was the nature of the anxiety and impulses? Was he afraid of the analyst because he'd just done something dangerous and therefore thought that the analyst was hurt and upset, or was he afraid that the analyst was going to hurt him back and become a kind of enemy? One of the important shifts in both child and adult analysis involves paying great attention to the depth, but being careful also to link one's interpretations about symbols with what is going on with the analyst. I trained as a child analyst, then did very little work with children for some years, and recently decided that the technique of adult analysis was leaving child analysis behind. I had the opportunity of taking on a very young child with very little speech, and decided to do so both for the child's sake and for my own. I wanted to see whether my work with a child could correspond to my recent work with adults.

Frankiel: I remember in one of your papers an incident in your treatment of a child patient in which he became frightened of a plant outside the playroom window.

Joseph: This was a child of about three or four who developed a terror of a bush growing outside the window. He was convinced that it was going to come through the window and grab and clutch at him and at myself. He was so frightened that he changed where he usually sat. Instead of sitting with his back to the window, he changed his place and sat on the other side of the table so that he could watch the bush and protect himself when it moved. He brought me a dream. Then he pointed to a minute mark on his leg and said, “The tree did it.” I could see that the child's fear was that the plant would come through the window and scratch and bite him, and that when he had a dream he could not distinguish between a dream and reality. I don't think for a moment that he knew what a dream was; to him it had actually happened.

Frankiel: Could it have been a fantasy?

Joseph: I don't think it was, because his mother told me that he had awakened during the night in a panicky state and rushed into their room. This child used to tear and bite and scratch at me at times, at my body, but if I tried to show him that he believed the tree did to him or would do to him what he did to me, that connection could not be made, because things were too concrete and too real. This is very important because one would now realize that just to interpret the biting, clutching dream as a projection of his own impulses was quite useless. It was much more useful to stay with him discussing his anxieties, and only much later, as he gained sufficient trust and capacity to distinguish between fantasy and reality, attempt to show him it was a projection or projective identification of part of himself. One of the reasons why it was so interesting to take a very young child for treatment is that the problems that one sees with adults must be there in statu nascendi. It was extremely interesting to see if one could handle them in a very young child, where so much was being done in action and not in words. He didn't say he was frightened of the tree: he pulled away to the other side of the table or held on to me.

Frankiel: Let's talk about your own development as an analyst in more personal terms. You qualified in the middle of the Second World War, didn't you?

Joseph: Oh, no! Much later. I didn't come to London till 1945.

Frankiel: I see. You were born and lived in the Midlands?

Joseph: Yes. When I was ready to start work, I decided that I would only take a post where there was a university and an analyst, and there were only two or three analysts outside of London, so I took a job in a child guidance clinic in Salford, which is next door to Manchester, where I lived and had analysis, with Michael Balint. He suggested I should train to be an analyst. I was then interviewed and accepted, and then I came to London and trained. That was in 1945, and I must have attended lectures and seminars for about four years. I qualified in 1950 in my early thirties.