Originally published in the Journal of Analytical Psychology, vol. 42, no. 1, 1997. Reprinted with permission.
Last Updated on Sunday, 27 October 2013 20:37
Written by David Sedgwick
Originally published in the Journal of Analytical Psychology, vol. 42, no. 1, 1997. Reprinted with permission.
Some Images of the Analyst's Participation in the Analytic Process
by David Sedgwick, Ph.D.
Donald Winnicott said it best, as he often did, when discussing his own participation in the analytic process. In doing psychoanalysis, he said, "I aim at keeping alive, keeping well, and keeping awake. I aim at being myself and behaving myself. Having begun an analysis, I expect to continue with it, to survive it, and to end it" (Winnicott 1962, p. 166).
This is so nicely (and amusingly) put that it may well be the last word. However, what Winnicott said in another paper is relevant to a further direction I would like to talk about today. He wrote, "I guess that the well-behaving professional analyst is easier to come by than the analyst who (while behaving well) retains the vulnerability that belongs to a flexible defence organization" (Winnicott 1960, p. 160).
I'd like to emphasize this idea of analysts retaining their vulnerability (literally, their "woundability," their openness to being moved), and I have tried to present some data on this in a recent book. Aside from vulnerability, the issue Winnicott raised in the first quote is of interest--the issue of the analyst's sanity, or "keeping well." Which brings me to the work of Harold Searles. Like Winnicott, Searles also said something very fine about the aims of analysis, which, when applied to the analyst's participation, shifts the focus toward the analyst's vulnerability in the process. Searles states, "One does not become free from feelings in the course of maturation or in the course of becoming well during psychoanalysis; one becomes, instead, increasingly free to feel feelings of all sorts" (1966, p. 35).
This is deceptively obvious, but sometimes one must state the obvious. I have a lingering idea that analysis--and training analysis, in particular--is supposed to limit (or teach one how to limit) one's out-of-control behaviors and one's out-of-control feelings--of pain, despair, anger, fear, confusion, etc. Certainly analysis can and should do this, when those feelings are unmanageable and life cannot be lived. And for some patients (and for all of us at some time or other, if not all of the time) `getting by' is the most that can be hoped for. Just getting by--in Winnicott's words, "keeping alive," "surviving"--is a reasonable goal in life or in doing analysis. What analysis teaches, however, is that living life more fully--in Searles's words, "feeling feelings of all sorts"--is what actually enables one to get by, and this wider experience of living is, again, what analysis can enable one to do.
So, to transpose Searles's idea a bit and apply it directly to the analyst's participation in the process and to countertransference: in the course of doing analysis, the analyst does not become free from feelings, but becomes, instead, increasingly free to experience feelings of all sorts.
In this context of what analysis can do and what we can do as analysts, Jung also said something simple, axiomatic and worth reciting: "The principal aim of psychotherapy is not to transport the patient to an impossible state of happiness, but to help him acquire steadfastness and philosophic patience in the face of suffering. Life demands for its completion and fulfillment a balance between joy and sorrow" (1943, p. 81).
Again, if we switch this around a bit and apply it to the analyst, we get: the principal aim in doing analysis is not to transport the analyst to an impossible state of happiness, but to help him acquire steadfastness and philosophic patience. Doing analysis demands a balance between joy and sorrow.
I'm not so sure about the joy of it--the sorrow seems more common. But neither is entirely right. Steadfastness and philosophic patience, however, seem correct--participation requires these, perhaps more than anything else. Analysts need to hang in there for the long haul, hoping, perhaps, for relief at the end and survival (as Winnicott notes) and some moments of peace, satisfaction, pride and even humor along the way. This is somewhat like parenting. Regarding good humor, I know of nothing more satisfying than the occasional, genuine laugh one is sometimes, finally, able to share with a patient at some point along the way. That is a special moment of intimacy between analyst and patient and, at times, a mark of progress in the work.
Before one gets there, though, there is the hard work, somewhere between joy and sorrow. This brings us to countertransference. I think it's impossible, and probably pointless, to talk about countertransference without being personal. Countertransference is a personal thing. So I hope you'll bear with me as I present some personal images, global and then more clinical, of how the work feels to me these days.
The overall feeling that comes to me lately, at the end of a working day, has been that I have been in a wrestling match. Analysis as wrestling match. This is what the work feels like, physically, as if I've been grappling hand-to-hand, in not quite total combat but certainly in a total muscular effort. This is not necessarily a bad feeling; it can be like the feeling of having had a really good workout. But, it's wrestling: being alarmingly close to someone, trying to be alert; the patient and I, the analyst, seemingly trying to throw each other, score points for pins and "take downs," applying "holds." Wrestling, I'm sure, is in reality a matter of speed, finesse and balance, but what I see is the participants down on hands and knees, just leaning on each other, straining and pushing. There's something in wrestling, as I recall, called "riding time," which has to do with earning points for just hanging in there; and then there are the so called "reversals" where the opponent suddenly turns it around the other way, winding up on top. It is a total intensity sport, with a whole body effort and full body contact. It takes stamina, and must be the most intimate and exhausting of games.
It's a strain, this analysis/wrestling, but, usually, it's not war; not like boxing, which strikes me as essentially gladiatorial (where people sometimes really get killed, and the idea, literally, is knock someone unconscious). Nor is it like television wrestling--what we used to call in my childhood "`fake wrestling" (though there are probably kinds of fake, or "false self" or "as if" analysis). This wrestling is the real thing: total effort, mano a mano (hand to hand).
The wrestling image comes to me at the end of the day, some days. The other image came as I was writing this, so it's more impersonal. It's a feeling-image of the way things move in analysis, and therefore of the process in which we participate. What happens in analysis feels to me like the movements of huge cargo ships--oil tankers, barges--the largest mobile objects on earth. Some of these ships are the length of three football fields, hundreds of yards long--to change their course, much less dock one, must take hours and hours, and vast areas of space, as they make their wide, excruciatingly slow turns. I would guess that the turning radius of these great, semi-moving objects, and their inertia, are such that you just can't do it quickly; the momentum is too great. So, you need tugboats, to pull them and nudge them slowly about. As with the wrestling metaphor, there's a feeling, for me, of a muscular effort involved, a leaning against, one's shoulder to the wheel. Tugboats struggling to change the heading.
Analysis as wrestling match, patients as huge, cargo-laden barges, analyst as wrestler, analyst as tugboat--let's "block that metaphor," as they say in the New Yorker, and go directly to the analytic experience.
The primary participatory context we seem to have signed up for in doing analysis is, unfortunately, not wrestling or high seas navigation but that of emotional pain--suffering. This is where analysts live and work. This is what we participate in. Our stock, in trade. As Jung said in 1946, "[The analyst] quite literally 'takes over' the sufferings of his patient and shares them with him" (1946, p. 172). With this in mind, I'd like to present a final image, but this time clinical and closer to home.
The image comes from a dream of a patient and will connect us back to Winnicott's statement, mentioned earlier, about the analyst's vulnerability in analysis. Here is the two-part dream, (it is actually two successive dreams, dreamed back to back in one night):
1)Folded up inside my mattress, which I unfold every night, is a hard book/object. At night it becomes my pain. By day it is wrapped up.
2) I go to tell Dr. Sedgwick the dream. He is not interested. I am upset, but confused at what to do at this turn of events. I then take some kids somewhere, which happens to be near his office.
I somehow stop in to the building and briefly meet Dr. Sedgwick's partner, whom I like, and decide I want to talk to. I meet with Sedgwick (nothing) and then as I'm leaving, run into the partner again.
The partner is short, ethnic, a little jovial but also deeply troubled. I like this man. I walk out with him and he tells me about how he has a very small room that drives him crazy. He tells me a story about how Dr. Sedgwick and he rented the rooms together and it just happened that Sedgwick got the large spacious one--pure chance (though I doubt this as I listen). I am interested to hear more, but the story must be broken off at this point, as he must go. I am left alone.
First, I think it is difficult to take a dream out of the context of an ongoing treatment situation. But I'll try. These are both well-crafted, well-manicured dream segments--to the point of almost not sounding like dreams. There's nothing fantastic in them, except the creation of the book and this alternative analyst. This two-part dream is a statement: about the "unfolding of pain," this patient's pain, and about this other analyst--the man the patient wants to see, or needs somehow to see.
There are many possible points of view on this dream, from the dream as projection of this patient's own splits, to the dream as a projective identification phenomenon (for I myself began to feel anxious, defensive, then puzzled in response to it), to the more classically Jungian "objective interpretation" (also, perhaps, the Langsian view?) that the dream is speaking the objective truth, focusing on the analyst's personal shadow or the repression thereof. We might also add, here, a self-psychological or intersubjective view that speaks specifically to the issue of the patient's sense of empathic failure on the analyst's part and the sources of it.
All these interpretive angles are possible; they would all have some truth in them. In terms of today's topics--countertransference and participation--it is my feeling that the dream can be seen as an effort to get the therapist to participate in a certain way in the process. I think it's clear that the issue of this patient's concealing his pain is central--this refers to dream segment one, where it's kept well-wrapped under his bed. What's also clear is that a similar process either is or needs to be taking place in the analyst. This is dream segment two. For our purposes today, what I would say is this: there is something about the analyst's vulnerability which is intimately tied up with this patient's vulnerability. That is, the analyst, in this case me, needs to come to grips with this tendency toward repression in a real way, in himself. The main thing is this participation by the analyst in a parallel way. I consider this not an impasse, but an opportunity.
From this perspective, it matters little whether I in fact am the way his unconscious sees me in this dream, or if he is more that way. In this stance, I am following the attitude of self psychology, which strives, as I understand it, to always orient itself empathically toward the subjective feeling experience, right or wrong, of the patient. However, I am also adding something, namely, that the analyst often needs to be drawn into the patient's pathology, drawn in by and with his own pathology. In other words, the analyst also gets to "participate" in the analytic process, gets to wrestle with the patient's `pain' as also manifested in himself.
This "deeply troubled" analyst is the analyst this patient wants to see. How he gets to meet him is another question. Not directly, I don't think, by the analyst's saying "I'm vulnerable," "I'm troubled," "I have similar issues." It may come more through a presence in the room, a background figure in the office, given equal space. That figure becomes manifest via the analyst's struggle within himself with the very issues the patient's unconscious prescribes. With this particular patient, the participation of the "deeply troubled" analyst is also required. Call him "The wounded healer."
The idea that this kind of engagement with all or, particularly, very disturbed patients is exhausting does have truth in it. But even if treatment is not a perpetual struggle, there do seem to me to be key moments or phases when everything in the analysis kind of drops into place--grounds, as it were--in the kind of therapeutic interaction where the analyst is caught up in the problem.
So, with this patient, I would be called on to privately acknowledge in some way, this tendency or capacity in myself, a tendency I had felt was alien or at least relatively mastered in me. This makes for a burdened state in the analyst and naturally raises questions I can't go into here about when, how and even if one interprets these phenomena to patients. It is my feeling that they are lived through privately and simultaneously with the patient.
Jung's ideas about the unconscious being infectious fit with all this, as well as his important statement that "A good half of every analysis that probes at all deeply consists of the analyst examining himself" (1951, p. 116)--which is, I feel, a prescription for countertransference. What I have been describing is how I understand these statements from Jung, who left to his followers the challenge and opportunity to give them shape in a concrete way.
In summary, then, my paper presents, from Winnicott, the ideas of surviving and of the analyst's vulnerability; from Searles, the idea of feelings of all sorts; and from Jung the idea of steadfastness; then there are two feeling-based images, of wrestling and, more distantly, of barges and tugboats; and finally, there is a third image, of the patient's need for the "deeply troubled" analyst, which relates back to the analyst's vulnerability.
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