Division Review Issue #24

DIVISION A QUARTERLY PSYCHOANALYTIC FORUM

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NO.24 SUMMER 2021

BROMBERG | PETRUCELLI

SEEING MRS. C | WEBSTER / BUCCI / PETROVSKA HANDLE WITH CARE (LACAN) | GHEROVICI “AS IF” WE WERE THERE (BION) | MALATER PENIS ENVY (GRAY) | HOFFMAN

R E S E A R C H O N PSYCHOANALYTIC PROCESS T H E C A S E O F M R S. C OTHERNESS, SEXUALITY (LAPLANCHE) | SILVERMAN TRYING TO FIND SOMEONE (FREUD & KLEIN) | VORUS AN EPISTOLARY REPLY (WINNICOTT) | REIS THE RESEARCH ITCH | BUCCI KAITLIN MAXWELL

P H O T O G R A P H Y

Official publication of Division of Psychoanalysis (39) of the American Psychological Association

EDITOR

Loren Dent

CONTENTS

SENIOR EDITORS

Steven David Axelrod, J. Todd Dean, William Fried, William MacGillivray, Marian Margulies, Bettina Mathes, Manya Steinkoler CONTRIBUTING EDITORS

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Jean Petrucelli

To Philip, with love

RESEARCH ON PSYCHOANALYTIC PROCESS— THE CASE OF MRS. C

Gemma Marangoni Ainslie, Ricardo Ainslie, Christina Biedermann, Chris Bonovitz, Steven Botticelli, Ghislaine Boulanger, Patricia Gherovici, Peter Goldberg, Adrienne Harris, Elliott Jurist, Jane Kupersmidt, Paola Mieli, Donald Moss, Ronald Naso, Donna Orange, Robert Prince, Allan Schore, Robert Stolorow, Nina Thomas, Usha Tummala, Jamieson Webster, Lynne Zeavin BOOK REVIEW EDITOR

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Jamieson Webster,

Seeing Mrs. C: Introduction to the Issue, Part One

Wilma Bucci,

Anna Fishzon

FOUNDING EDITOR

David Lichtenstein

Elena Petrovska

PHOTOGRAPHY BY

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Jamieson Webster

Seeing Mrs. C: Introduction to the Sessions, Part Two

Elena Petrovska

IMAGES EDITOR

Tim Maul

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Patricia Gherovici

Handle With Care: Experiments in Case Transmission

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Evan Malater

“As If” We Were There: Bion and the Recorded Session

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Leon Hoffman

From Penis Envy as Bedrock to Metaphor: A Close Process Examination of the Analysis of Mrs. C

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Doris K. Silverman

Otherness and Our Sexuality: Laplanche Clinically

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Neal Vorus

Trying to Find Someone: A Modern Kleinian Reconsideration of the Treatment of Mrs. C

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Bruce Reis

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Wilma Bucci

The Research Itch: Looking Within the Psychotherapy Process

Jamieson Webster,

Seeing the End

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Kaitlin Maxwell

An Epistolary Reply Addressed to Mrs. C, a Half-Century Following Her Analysis, From a Winnicottian Perspective

Wilma Bucci,

DESIGN BY

Hannah Alderfer, HHA design, NYC DIVISION | REVIEW a quarterly psychoanalytic forum published by the Division of Psychoanalysis (39) of the American Psychological Association, 2615 Amesbury Road, Winston-Salem, NC 27103.

Subscription rates: $25.00 per year (four issues). Individual Copies: $7.50. Email requests: divisionreview@optonline.com or mail requests: Editor, Division/Review 80 University Place #5, New York, NY 10003 Letters to the Editor and all Submission Inquiries email the Editor: lorendentphd@gmail.com, Division/Review 80 University Place #5, New York, NY 10003 Advertising: Please direct all inquiries regarding advertising, professional notices, and announcements to divisionreview.editor@gmail.com © Division Of Psychoanalysis (39) of the American Psychological Association. All rights reserved.

Nothing in this publication may be reproduced without the permission of the publisher.

Elena Petrovska

DIVISION | REVIEW accepts unsolicited manuscripts. They should be submitted by email to the editor: lorendentphd@gmail.com, prepared according to the APA publication manual, and no longer than 2500 words

Guest Issue Editor: Wilma Bucci, Elena Petrovska and Jamieson Webster Editor’s Note: The editors would like to thank the original planning committee for the “Revolutions in Technique” at IPTAR which led to the consideration of Mrs. C: Jeanne Even (Chair), Eva Atsalis, Susan Finkelstein, Anna Fishzon, Judy Ann Kaplan, Masha Mimran, and Carolyn and Steve Ellman; and Michael Peral for the graphs and other general support.

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DIVISION | REVIEW can be read online at divisionreview.com

ISSN 2166-3653

Photography of Kaitlin Maxwell by Tim Maul Late last summer long before this issue was in the planning stages I impulsively photographed my outstretched left hand with my iPhone several yards away from the room I learned to read in.

Having ‘time on my hands’ I confirmed my existence by mapping a fuzzy topography concluding in five worn peninsulas and a thin scar from an 8th grade altercation. We require our hands and fingers more than I imagined we would in this futuristic world where they text, type, and tap screens along with all the sensory fun stuff. A museum devoted to the ‘Hand in Art’ would be vast and one need only to search out the ancient ‘Cueva de las Manos’ (‘Cave of Hands’) in the province of Santa Cruz Argentina for the wondrous, and maybe even pleasurable origins in replicating, here by accurate stenciling, the indexical beauty of the human hand.

In choosing to photograph her family Kaitlin Maxwell steps in and out of the lives (and clothing) of a formidable matriarchy of exceptional women who own every image they’re in. I remain intrigued by the social dynamics in photography differentiated between the observant family member and the embedded outsider who often exploits or tweaks perceived anxieties towards the production of narrative, what portraitists have done for centuries.

Often the initial agreement to be photographed recedes as a group adjusts to the person with a camera. I am no longer sure if ‘trust’ plays the role it once did in today’s image world but clearly Maxwell is granted it through her unflinching images that move between brilliant daylight and interior shadow.

Her blurring of the generations by wearing her Grandmother’s clothing and costume interrogates her own link in this chain of inheritance by literally ‘stepping into someone else’s shoes’, overlapping the written past with the unwritten future.

When visiting Maxwell’s website kaitlinmaxwell.format.com I recommend scrolling through her ‘Hands’ series as encountering them in this context provides a form of respite from the emotionally layered familial tableaus of grooming, offstage trauma, down time, bedside visitation(s) and in the pictures that simply halt the proceedings.

Entering from out beyond the frame Maxwell’s ‘Hands’ are actors cast in plays much larger than themselves. As noted they are barometers of age (but no longer of gender) that may transform into signage, mudras, and even conferring blessings as I believe Maxwell’s pictures sometime do upon towels, boulders or autumn leaves. They are also basic illustrations of use-holding, pointing, touching, or inert as passive extensions or portals to a body in crisis. My eye returns to the edenic act of reaching for apple perhaps by a curious ‘Eve’ in a garden where following one’s desires changes everything forever. You may also pause, as I did, to consider for a moment the hands of the blind. z Tim Maul 3

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To Philip, with love Amidst the many tragedies of 2020, the field of psychoanalysis lost an eminent figure, a cornerstone of contemporary psychoanalysis, when Dr. Philip M. Bromberg passed away of natural causes on May 18th, at the age of 89, two months shy of his 90th birthday. During his professional life, with his prime contributions to our interpersonal/relational field, Philip awakened the dreamer—and more—in many of us, as he illuminated the importance of “minding the gap”, helping us witness “the shadow of the tsunami” of loss, and guiding us as we navigated “potholes in the royal road.1”In writing this, I have the extraordinary opportunity to access memories that I did not remember I remembered about him.

Yet, as I do, I recognize that I can capture just a sliver: Philip made accessible a multitude of spaces for us. His contributions allowed us to tolerate, stand, and flourish in the spaces of our work – spaces that were unknown before he shared them with us— spaces that we could not, without him, have ever conceived as possibilities.

It was the summer of 1969 when Philip M. Bromberg entered the William Alanson White Institute. For over 50 years, he wrote extensively about mental development and the patient/therapist relationship with a focus on the mutual impact of people. He had a deep appreciation of the private domains of experience, the hidden places where personal existence was preserved. His work has both presented and created an interpersonal/relational point of view that emphasizes self-organization, states of consciousness, dissociation, enactment, and multiple self-states.

Philip had a unique vision and those of us who knew and worked with him know that there are countless ways he changed the face of psychoanalysis. His books will be classics for centuries, and he influenced the field in ways that will live forever.

Philip was first and foremost an interpersonal psychoanalyst, focusing on the here-and-now moments and making clinically appropriate use of them, with a forthrightness in what he conveyed. His interests in the various forms of human relatedness as the sources of therapeutic action inspired us to understand the central role of dissociation of both the adaptive and maladaptive kind. His writings and teachings on developmental trauma, dissociation, enactment, multiplicity of self-states, and the process of growth and healing have influenced generations of clinicians throughout the world. Philip was renowned for his incisiveness, as his clinical radar was a finely 1. These are expressions that Philip Bromberg used in the titles of his books and papers.

by Jean PETRUCELLI

tuned instrument with a range of notes that spanned octaves. He insisted on being true to himself and expected nothing less from others, personally and professionally. Philip was a man of many minds, and strongly believed that the truth sets us free. His use of poetry and literature gave visceral impact to his clinical ingenuity. Philip loved to begin his writings with a bridge from literature, poetry, an intimate story from his childhood, a memory, a dream. He was influenced by his mother, a poet. About her, Philip once said, ”what she experienced personally, including through imagination, was what she thought about creatively” (2013, p.324). Among the games they played when he was a child, there was one in which he would choose two creatures unlike each other, e.g., “a giraffe and a mouse” (Ibid) and his mother would then weave a story about these creatures, how they came to know each other by really talking to each other about themselves personally—not through some fictitious event—until they became friends (Ibid). With Philip, it was always about the personal.

The Personal It was 1989. I was a candidate in analytic training when I first met Philip, famous for his cardigan sweaters, his rice paper wallpaper, his wife Margo’s paintings, and the portrait of a man in a library, called The Bookworm (by Carl Spitzweg) which—I discovered—followed him in every office move.

And, uncannily enough, it was a portrait that I had chosen to hang in my office long before I began at White. Mine was vintage oak that opened like a book with two attached portraits at its sides. Philip’s was a stand alone.

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There followed years of notable moments in our relationship from which I will share an exemplary few. For example, when I found out he had been married three times, I asked him playfully about it, wondering, “Who gets married three times?” He answered directly as if we were talking about whether one prefers coffee or tea, “I’m a man who simply likes to be married.” And that was that.

And then he grinned as if he had found a way out of that one, and for the moment, he had.

We once had a fight, and I mean only once.. He said, “ You are in your second year of analytic training, why would you want to get pregnant with another kid?” I had a three year old at the time and I said, “What do you mean: you think as an Italian Jew that I’m only going to have one kid???? Why can’t I have a few kids and do analytic training at the same time? What’s the big deal?” It was at that moment that it became clear he didn’t really know me, and what I could navigate, and I didn’t really know him and what made him anxious. When I told him having kids was part of my life plan and more important than any training could ever be, I was quite taken aback by his opinionated stance. But I also realized this was a man who was not afraid to say what he felt, for better or worse. Much later, after I became a grandmother of two, we would laugh when I would remind him of this “fight.” He’d say, “OK, OK, OK,…” with a twinkle in his eye… .”When I’m wrong… I’m just wrong.” We had fun together.

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Philip influenced my work in so many ways, most notably in my understanding of how the body’s mind speaks, as it has its own affective language, and my sense that the more one can listen to it affectively, without trying to think about it, the more fluent the body’s language becomes in communicating what it knows. Philip supported my thinking about bodily experiences as self-states and he agreed that the term I came up with, ‘body-states’ was fitting as it has to do with embodiment and how one lives in their body at a given moment relative to their felt experience. The idea excited him, and his own enthusiastic self-state was motivational for me. He had the ability to energize those around him, including me and the members of our longstanding clinical supervision group—our ‘Gang of Four’ (Shelly Itzkowitz, Jill Howard and Peter Lessem). Supervision groups were important to him2. In our group, Philip passed on to us the experience of being viscerally in the experience with our patients, which was not simply a way of listening. And it was the mutuality of energy and reciprocity of ideas, for more than 15 years that created a shared momentum in our group. It is relevant that as a candidate at the William Alanson White Institute, Philip had been in supervision with Edgar Levenson, Earl Witenberg, and David Schecter. Although all had had an effect on him, he considered Edgar Levenson’s supervision profound and 2. In his Contemporary Psychoanalysis interview (2013), Philip generously paid homage to his students: “The supervision groups I have run for many years are the main reason I have been able to continue writing over such a long time – not just writing per se. Rather, writing with passion…because I feel energized with newness to my thinking that is constantly being vitalized by a personal interchange of subjective experience, not just of ideas, but what’s clinically transformative. I am most happy because it is reciprocal” (p.332).

transformative, providing Philip with something he did not even know existed before engaging in this extraordinary supervisory encounter. Referring to it, he said, “I became different” (2013, p.330).

Philip had a way of bringing out the best in people and, even in the smallest of exchanges; one would remember what he said. He was a man of consequence, with a soaring intellect, and a commanding presence. His curiosity and imagination were boundless, and whatever he did, he did with conviction. There was never any doubt about his words’ sincerity or truth.

Although he could sometimes be cantankerous and piss people off, he could also make amends. And the mutual connection was always a felt experience as Philip elicited a relatedness that was never superficial.

Philip also had a delicious playfulness, and I, for one, delighted in teasing him. I imagined that I may have gotten away with it more than most, or at least, in my mind, I belonged to the group that did. Here are a few examples (and more later).

When I co-chaired the Division 39 conference with Melinda Gellman, Ph.D. (2008), it seemed a no brainer that Philip should be one of the keynote speakers. His talk was entitled, The Nearness of You: Navigating Selfhood, Otherness and Uncertainty. In my remarks introducing him, I drew attention to his attire that day, since among other things, Philip was known for his working uniform.

I had just mentioned that in this conference we were “branching out into merchandise” promoting a clothing line, selling t-shirts,— and bags. I said, “I’d like to first draw your attention to Dr. Philip Bromberg’s suit….. no it’s not for sale. But… many of you who 5

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know Dr. Bromberg, will notice that his attire today, is a departure from his renowned collection of beautifully coordinated shirts, ties, and cardigans. We are fairly certain he’s not having a not-me experience…in wearing his suit…..However, there is some speculation that the genesis of his work on self-states may have been born out of his closet...perhaps an epiphany that his wide array of cardigans reflect(ed) his varying self states. But, like I said…it’s just speculation.” Philip gave me the smile we all know, the slight head shake, and the nod. I could feel the kvell. But it was also permission and a signal to go on to the serious stuff now, and I did.

Apropos Division 39, Philip was recognized as one of the foremost interpersonal analysts and he was rightly seen as a visionary adept both as a scholar and a clinician. One of the things Philip was most proud of was being among the first members of Division 39 to be appointed a Fellow. His ideas on dissociation were finally being accepted.

For those of us working with Philip, it was important that dissociation had finally found a place on the analytic map, because for over 35 years his writings had explored the clinical implications of dissociative processes in explaining why patients improve and why they don’t. It’s notable that through his ongoing contribution of clinical illustrations and research data, his writings have become gradually assimilated into many different schools of analytic thought. This is especially true of his seminal concept that the nature of the analytic relationship with any patient involves working with trauma and dissociation as an inherent part of it—is now a key element of the contemporary analytic discourse.

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Philip, idiosyncratically, disavowed an interest in theory. He acknowledged this disavowal as a personal preference, yet noted that he chose to frame his contribution simply as a perspective to guide an analyst’s use of him or herself in the transference/ countertransference field while respecting the ever-shifting balance between safety and growth. In Philip’s mind, this back and forth (yin and yang) gave the analyst a way of being with and understanding a wider spectrum of patients, especially those who were previously labeled “difficult” or unanalyzable —such as people termed borderline, schizoid, narcissistic, “addictive,” or dissociative.

He provided another lens through which to look at sometimes intractable clinical phenomena such as “resistance to interpretation” and so-called therapeutic impasses. Philip proposed that, above all, the analyst’s ability to observe, capture, and judiciously share his or her own enacted dissociated experience as part of the analytic work creates a space and a spirit where new and spontaneously fresh ways of thinking and being can emerge. In that 2008 keynote address, Philip conveyed what he experienced as the next phase in psychoanalysis: how we, as analysts, can not only contribute to effective psychotherapy but – more centrally – to our evolution in thinking about the “individual mind” and the “relational mind.” Philip, at age 78, sang to us that morning, a song called, “The Nearness of You,” which was also the title of his keynote.

It was his way of drawing our attention to the ideas and importance of being more aware of when we have gone too far into our own heads, knowing that we will, and have moved away from what the patient is experiencing; the times when we misstep, lose our focus and dissociate the part of our self that knows things personally.

As I said, Philip was playful. For example, again, that morning in 2008 with Division 39 attendees, he asked me to announce that, in case anyone was wondering why he was seated at the table rather than being up at the podium, the answer was that even though it probably had nothing to do with age, he would admit that if he were writing Standing in the Spaces today (in 2008) rather than ten years previously, he might prefer to call it “Sitting in the Spaces.”

Understanding how Philip worked necessitated understanding his treatment of difference without undoing the difference between people. He would try to get inside and understand the other person’s experience---not like a mediator, but more like a trapeze artist who could swing and reach toward the other, offering something to hang onto without compromising his own feelings about the thing itself (meaning the content and process experience in the moment) or imposing meaning. This was done

while holding in mind that as we try to understand the other, the difference between us and within each of us keeps us from truly knowing. And to be clear, Philip never liked it if one attempted to impose one’s own meaning upon him either. It was all about trying, without thinking about success or failure, with an emphasis on sort-of, rather than it is or it is not. The back and forth of effort, without thinking one has to succeed, created the tension that was necessary to hold space for sort-of-knowing as we would attempt to cross the bridge of difference.

Whether as analyst or supervisor Philip’s focus was to listen to clinical process in a manner that revealed how patient and therapist—through their complex, multi-layered relationship—dissociatively enacted some aspects of their immediate experience, the experience that was excluded from cognitive representation and, thus, could not be explicitly addressed. Philip felt the goal was to facilitate increasing sensitivity to the interface between what was affectively enacted as dissociated communication and whatever was taking place consciously and cognitively for each member of the dyad. He modeled this with his supervisees.

Philip, in supervision and in his writing, taught us a way of listening that focused on attuning to the switches in states of consciousness (or, if you will, shifts in self-states) as the overarching channel of therapeutic communication. The idea was to increase one’s sensitivity to the process of enactment, which, as he said, takes place dissociatively.

An enacted switch in a self-state signals its presence mainly through dissociated affect, not through the cognitive content that may be present simultaneously. He reminded us that enacted communication, because it is dissociated, is first experienced by the therapist as an affective disruption in his or her state of mind. Reading Philip or being his students, taught us how to better attune to the content and the context---the hereand-now relationship through which the content is given meaning or – in some cases – is robbed of it. Philip reminded us that no therapist is aware of the shifts right away and, in fact, dissociates them for a period of time.

Once the therapist becomes consciously able to tolerate the disturbingly “not-me” quality of the experience and stops trying to ignore it with one rationale or another, a doorway is cracked open, eventually leading to the patient’s deepest growth and to the analyst’s greater understanding. Philip made it look simple…but it wasn’t.

Some of the difficulties we experienced in working with patients with DID or dissociative tendencies have to do with the fact that many of them were abused during childhood, and sometimes the degree of abuse would cause their mind/ 6

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brain (Philip’s term) to become structured in a chronic dissociative way. As therapists when we bear witness to the unthinkable and the unimaginable, we might find ourselves in positions that often create enactments. A crucial aspect of processing and working through trauma is the requirement that one be fully present with patients as they recall and recount the details of violent physical and or sexual abuse at the hands of a stranger, parent or other close relative. This process is agonizing for both patient and therapist. As the patient confronts the crushing shame, betrayal, and anger at her perpetrator(s) she becomes emotionally overwhelmed. This process can occur as a flashback i.e., for the patient it can feel like the trauma is happening in the here and now, in real time. The patient is not remembering what it felt like to be a small child being raped. She is the young child who is being raped, while simultaneously being the adult woman in her analyst’s office (Itzkowitz, personal communication, 2020).

When this occurs, it is a challenging moment for even the experienced therapist, because being forced to confront the unthinkable tests one’s ability to be fully present. Philip would often witness with us, individually and collectively as a group, becoming so emotionally flooded along with our patient or the patient being presented, that we would lose the capacity to listen and use our empathy and compassion in a healing manner. We learned to remain present and interact with our patients, as we helped our patients remain both with the memory and in the present moment, which was, by the way, also how Philip would work with dreams.

Working this way, allowed our patients to know where they were in the here and now, that they were safe, and that what they were feeling and experiencing happened a long time ago. If we were unable to be present, we ran the risk of inadvertently re-traumatizing the patient, where we, as the therapist, could enact the role of the knowing but uninvolved parent (Davies & Frawley, 1994 ) and the patient could find herself betrayed by both her perpetrator and ineffectual or uncaring therapist/parent. We learned that we could bear witness to the memory, individually, and in the group process, without our minds being under attack by the material.

Philip also taught us how to increase our trust in our subjective experience — to respect our own hunches and our own intuition even when we were not sure of where they were coming from. He believed wholeheartedly that our subjective experience was therapeutically usable because it was potentially sharable, even when it turned out not to lead us where we had hoped or expected.

With this encouragement from Philip we, as

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analysts, can trust the process, and become freer to reveal ourselves.

Working with Philip in the supervision group, I and my colleagues discovered that each of us had a unique affective experience organized through our own repertoire of self-states. Each of us might respond to something that connected with an aspect of the patient’s self but not necessarily to the aspect the therapist was responding to at the time. Philip wanted to see if a group experience would emerge out of our individual responses—whether a group process developed that the individuals allowed themselves to become part of—a process that depended on each of us listening to the presentation affectively and sharing our individual responses to discover the intersections or not. On a certain level, Philip was trying to accomplish with our group, and perhaps with all his groups, the creation of a group or group mind that mimicked the normal multiplicity of the human mind/ brain, by trying to help us achieve a radical intersubjectivity. This meant that our group became a place where we were able to appreciate each other’s perspectives on the clinical moment while simultaneously being able to maintain our own unique/individual perspectives. In this way each of us would maintain our own individual “selves” or “self-state” without the need to dissociate one another. In essence, Philip was striving for us to stand in the spaces with him. He wanted us to be able to shift perspectives fluidly and non-defensively and to appreciate each other respectfully. When I reflected upon this and in discussion with Shelly Itkowitz, an integral member of the Gang of 4, he noted that we were able to do this because none of us were threatened by the other and therefore, we did not need to dissociate any one perspective or any one of us.

We felt as we listened, and our personal affective experience became our primary data.

Sometimes it was tough, even painful, but it became crystal clear that we all learned, grew, and felt inspired to believe in the possibilities.

We stayed until Philip retired; even if some wanted to go we agreed we wouldn’t because aside from having a transformative experience with him, we also knew what it would have meant to him ‘personally.’

A Few More Thoughts about Philip In the spirit of multiplicity of self-states, I have realized in thinking about Philip, that there was “Philip”—and times when we called him “Philip”—and then there was “Bromberg”—and times when we called him “Bromberg.” In our ”Gang of Four” supervision group of 15 years, what we called him often depended on the self-state he brought in that day, and whether we were thinking of him in a playful manner where we could tease

him and get away with it. “PHILIP! Could you say that in English please?” Jocularity would ensue, our self-states jesting. “Philip” was the intimate, friendly way of responding to him, and he loved that, even encouraged it.

Yet, when we were engaging with him in serious analytic terrain, we might refer to him in third person rather than being with him. Then he became “Bromberg,” the man who would offer up something that could leave us deferentially dumbfounded, wondering in awe, how did he get there? “Bromberg” was the academically respectful way of referring to him, and he loved that recognition, too. And those who knew him well also knew never to call him “Phil.” Further, if you were writing his name, don’t forget his middle initial “M”!

Here is another recollection of Philip’s way of thinking about clinical process. In 1994, Philip M. contributed to a panel discussion of the work of Leo Stone, a classical analyst who in 1961 had written a courageous book, The Psychoanalytic Situation, which challenged the classical analytic orthodoxy of the era by arguing that technique must be tailored to the patient. In his discussion, Bromberg wrote: “My addition is that technique is not something the analyst tailors on his own because he thinks the patient needs it, but an intersubjectively and interpersonally negotiated commodity. In other words, what has been added in the past thirty years to Leo Stone’s emphasis on flexibility is the dimension of negotiability” (Bromberg, 1996).

So, let’s talk about negotiability and Philip. When I first asked Philip if he would consider being honored by the William Alanson White Institute with a dinner at the restaurant Bouley, he said “NO! NO! NO!“ So I knew enough to wait for a while.

When I raised the question again, this time showing him the video of a former honoree, the esteemed Edgar Levenson, Philip said, “Well…..That looks lovely, BUT..”

When I added that it was in a test kitchen, he said, “WHO eats in a TEST kitchen??”

So I waited again.

And I asked a third time: “Philip, when have I asked you to do something that you haven’t had a great time and experience doing?” He paused and smiled.

I had him.

I added, “Trust me” (with a sort-of Yiddishy but mostly Italian emphasis).

He did, thankfully, and he let me organize the event, which he truly loved. At the dinner, when I told this story as part of a toast, I thanked everyone who attended for not letting me down. And I thanked Philip, for all the “techniques” on negotiability that he had taught me because sometimes a no is just a no, 7

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but sometimes a no is really a dissociated yes.

A lesson from Philip!

Just one more anecdote, something I observed about Philip in a divergent situation. It goes without saying that Philip was renowned in our community, but it wasn’t brought home to me how widespread his influence was until I presented at a conference in Seattle.

Once the attendees learned of my affiliation with Philip, it was as if I had told them I was hanging around George Clooney, or Bono, or Beyoncé, or the Dali Lama. They kept peppering me with questions: What is he like? He’s my hero. Is he approachable? Would he come speak here? Would he eat in a test kitchen?

You know the usual kinds of questions.

And so, what I walked away with was the idea that even though we may be constantly struggling with ambiguity and uncertainty, there is one thing I can say for sure: rock stars come in all different shapes, sizes and ages.

Philip was assuredly a rock star, but I miss him because he was a loving, nurturing, intensely genuine human being.

In 2013, the editors of Contemporary Psychoanalysis interviewed Philip for an issue dedicated to him and his work. He was asked, “Overall, then, what would you like your psychoanalytic legacy to be?” Here is his answer: “That most of the people with whom I have worked in one way or another, feel more whole as human beings as a result of our connection. But I also hope that these people, including those who are analytic authors, have benefitted enough from what they experienced to feel my presence in the continuity in their own evolution, and in a manner that allows my contribution to be passed on through theirs. In other words, I don’t have much faith that the legacy of anybody in this field, who writes, including me, is going to endure in itself. Ideas fade away and new things replace them. I’d love it, of course, if my work had a longer shelf life than average, but who knows? So what really matters is whether the connections that take place between myself and others makes what I stand for valuable enough to be passed on in some way” (pp.336-337).

Philip is gone but our relationship with him and all that he has given remains and will live on in those whose lives he has both touched and transformed. He created something together with all of us, individually and collectively. I am forever grateful and will remember him lovingly: standing, sitting, and now resting (at peace) in the spaces above. z REFERENCES Bromberg, P.M. (1996). American Psychoanalytic Association panel, May 1994, “Classics Revisited,” Discussions of Leo Stone’s, The Psychoanalytic Situation.

Journal of Clinical Psychoanalysis 5(2):267-282.

Davies, J.; Frawley, M. (1994) Treating the Adult Survivor of Childhood Sexual Abuse: A Psychoanalytic Perspective.

New York: Basic Books.

Greif, D., Livingston, R.H. (2013). An interview with Philip M. Bromberg. Contemporary Psychoanalysis, 49(3) “49(3): 323-355.

THE CASE OF MRS. C

Seeing Mrs. C: Introduction to the Issue, Part One Jamieson WEBSTER, Wilma BUCCI, and Elena PETROVSKA For this special issue of DIVISION/ Review, we have curated a series of commentaries by psychoanalysts from differing theoretical persuasions on the recorded analysis of a woman referred to as Mrs. C, whose database of sessions of her six years of analysis has been the subject of research for decades.

This collection of papers in D/R is itself the partial record of an event held at The Institute for Psychoanalytic Training and Research in November of 2018, marking a year-long investigation on the revolutions in psychoanalytic technique since Freud. Some members of that original panel have changed, and new voices have been added; in addition to these, one of the original researchers, Wilma Bucci, has returned to the case to see how research findings “measure up” to the theoretical speculations of our esteemed analysts, so many years later. What can one say or do or learn from a recorded analysis? You will read about Mrs. C, these sessions, the history of research, and then, seven commentaries on two weeks of analysis (themselves separated by two years) that we chose from the archive: Patricia Gherovici as the Lacanian, Leon Hoffman as the Paul Gray Freudian, Evan Malater as the Bionian, Bruce Reis as the Winnicottian, Doris Silverman as the Laplanchian, Neal Vorus as the Kleinian.

When one begins with Mrs. C, one has to imagine the living, speaking, embodied patient-analyst dyad, visiting one another five days a week for six years, her having a baby, leaving treatment, coming back, those accumulating and culminating August vacations, her struggle with marriage, her sex life, her family and even neighbors, as well as her career; all marked by the expectations of a well-to-do conventional marriage in the 1970s. The doctor is a young, promising, male psychoanalyst in the echelons of a mid-century Manhattan psychoanalytic scene, supervised by a very famous psychoanalyst, together undertaking this impossible project in an already impossible profession. These lives and what we can only call their earnest and important “sexual research” in an intense transferential field, miraculously (or perhaps scrupulously) become a recorded tape, become hundreds of transcribed sessions, become a research database, become a question of efficacy and outcome and process in an embattled field (after all, the 1980s will be the time that psychoanalysis comes under fire with competing short-term treatments and the beginning boom of short-term psychotherapies), become material for theoretical speculation and analytic listening in an age of the multiplicity of theories, become, indeed, this special issue of DIVISION/Review during a pandemic. All of this, after a 50-year span of

time, starts from the voice of Mrs. C, her act of speaking. There is truly something breathtaking, if not dumbfounding, about this project and its vicissitudes.

Being privy to the transcripts of the Mrs. C sessions can feel like a modest voyeuristic thrill. Distant enough, in terms of space and time, and yet exposed to strains of thought which, as psychoanalysts, feel familiar and intimate. At arm’s length, but within reach. This distant yet intimate feeling is reminiscent of the current time we were all living in, during the COVID-19 pandemic, when the editing for DIVISION/Review of these papers was underway. For analysts who switched over to teletherapy sessions during the pandemic, the geographical distance between analyst and patient and the physical proximity of the “third” object, meaning the recorder for Mrs. C and some sort of screen (computer, laptop, tablet, cell phone) for us, is overwhelmingly present. And how comforting this was, given the desperation of the times. We might wonder, particularly as we learn about her later sessions, if the same became true for Mrs. C; if she had hoped to soothe the desperation of a geographic separation from her analyst with a physical reminder of their connection embodied by the idea of the record of her analysis that was being kept “somewhere.”

His voice on the recordings, whether it be significant of his penis (his central metaphor, which they joke about), a lullaby (she wants to listen to the tapes), or something else (her desire not to leave him completely, to hold something of him with her), would be a form of keeping in mind; his keeping of her in mind during those very sessions. In other words, out of sight, but not out of mind.

This “borrowing” of the audio recordings of the sessions is reminiscent of an “accidental” taking or leaving of a lover’s article of clothing or object so as to provide an excuse to see the other again. Mrs. C fears separation; she creates an excuse for an opportunity to return to the analyst because she has something that belongs to him. Except, does she? Who do the tapes belong to? While they are composed of both, they belong to neither, insofar as they now belong to the rest of us, handed over to posterity—the ultimate separation, loss of intimacy, dare we say castration.

We might also wonder about the many meanings of the recordings for the analyst, and the meanings for him of her wish to have them—or copies of them—for herself. To what extent was it a concern for her emotional well-being? To what extent did he entertain the various possible meanings of the recordings for her—and their meanings for him? We might also wonder how the 8

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recordings and their availability played into his relationship with his very esteemed supervisor. We will probably not find answers to such questions in these papers but may find it useful to keep such questions in mind as we learn about their interactions.

The psychoanalysts brought together to comment on these sessions for this special issue of DIVISION/Review are doing so with the opportunity of accessing them at the surface level, which comes with transcribed sessions, but without the privilege of having been her analyst, in the room with her, living her life alongside of her. We cannot see nor hear Mrs. C and her analyst. We can see the words.

As you will read, there are many ways to see Mrs. C, and the audio tapes and transcriptions provide a peculiar afterlife for the sessions; she finds a voice in a way that surpasses the constrictions of time and space. Isn’t this after-life emblematic of what we want for any patient?

What matters is not the “right” lens or way to see these sessions, but the continuation of hearing Mrs. C, this intimate work of analysis that is condensed into her name with the very phrase, “the doctor will see you now,” that seems to echo on for us.

To be seen and remembered, to speak and be listened to, which she knows from the very beginning will be what saves her, to psychologically save herself from hiding underneath a mask (whether it be literal or figurative) of unknown and distorted illusions, is the freedom that she seeks in undertaking analysis. Isn’t that why we all became psychoanalysts? How nice to pick up this thread from the archive and follow its thread all the way back, through a sea of time, towards what, for some of us, was a mythic age of psychoanalysis, especially in New York City.

Background on Mrs. C The case of Mrs. C was conducted about half a century ago by a member of an institute of the American Psychoanalytic Association, who chose to be supervised by a renowned colleague to ensure the quality of the work.

The entire treatment was audio-recorded with the patient’s permission for research purposes. The case has been studied by many researchers ( Jones & Windholz, 1990; Weiss & Sampson, 1986; Spence et al., 1993; Bucci, 1997a, 1997b; Udoff, 1996; Friedman et al., 1994). A volume edited by Dahl, Thomä, and Kächele (1988) included applications of process measures by Merton Gill, Lester Luborsky, and others to a single “Specimen Hour,” the fifth hour of the treatment.

There is a caveat that we need to put front and center in considering this case concerning the feelings of some of us who have studied

treatments from psychoanalysts in Ulm. In the interview he says: This job gave me the unique chance to read and study the research literature on my own. There was not much available at that time in terms of research on psychoanalytic treatment.…I looked for colleagues who would help me to implement a research program. Very early in my job, I wrote letters to Hans Strupp, Lester Luborsky, and Hartvig Dahl asking for advice. Meeting the right people helped me to get involved with and become attached to them…

(Conci & Erhardt, 2013, p.232) The interviewer then says: “As far as we know, the systematic tape-recording of analytic sessions was initiated at that time”; Kächele responds: Yes. It is very interesting that Hartvig Dahl in New York, Merton Gill in Chicago, and Adolf-Ernst Meyer in Hamburg started at the same time as Helmut Thomaä in Ulm with tape-recordings in psychoanalysis. You may call this phase ‘‘From the reconstructed to the observed world of psychoanalysis.’’ To tape-record my first psychotherapy and psychoanalytic training cases from the very start would have been impossible in any other psychoanalytic institution in Germany. Still, the whole psychoanalytic field moved ‘‘from narration to observation.’’ (Conci & Erhardt, 2013, p.232

this case, in the past and in the current discussion. The treatment was carried out by a male analyst in the context of a rigid theory of female sexuality and female psychic organization that may have been generally accepted at the time—namely the idea of penis-envy and Oedipal conflict—but that has been strongly critiqued in the years since. It is not only the specific theory as such that is sharply out of tune with psychoanalysis today, but the general technical context of adherence to a specific theory and to prescribed techniques. Analysts today have gone beyond the assumption of a particular repressed scenario that is guiding the patient’s experience and that can be uncovered through appropriate interpretation, leading to insight where the monopoly of insight is on the side of the analyst.

There is also a challenge that is inherent in this project—what it may be possible to learn today about psychoanalytic process from a case like this. The case has been previously studied by major researchers in the treatment process research field, but these studies were largely carried out more than twenty years ago in a different

psychoanalytic world. One of the basic reasons for focus on this case in those earlier times was its special status as a full recording of a long-term psychoanalysis, meeting all research criteria, including the knowledge and permission of the patient before entering the treatment, and the disguising of identifying features in the transcriptions.

There were few such treatments available in those times, and unfortunately this situation has not improved today. The treatment of Mrs. C is one of several psychoanalytic treatments that were recorded in a period of high hopes for psychoanalytic research.

An interview with Horst Kächele, originally published in the International Forum of Psychoanalysis in 2013, was recently shared at the time of Professor Kächele’s death in July 2020 (Conci & Erhardt, 2013). In response to a question as to how he became interested in empirical research, Kächele described his position working as a research assistant to Professor Helmut Thomä in late 1970 at the University of Ulm, the center of psychoanalytic research in Europe at that time. Dr. Kächele’s task was to analyze tape-recorded 9

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All the colleagues mentioned by Kächele, who had been engaged in the project of collecting recorded treatments and studying the treatment process, and many others including Robert Wallerstein, Lester Luborsky, and Norbert Freedman, are, sadly, now gone. For a variety of complex reasons, including the emphasis on outcome research, as well as the general reluctance of practitioners to record their treatments, the study of the psychoanalytic process has not continued as a systematic, ongoing field.

While outcome research is needed to show that treatments work and to maintain a place for psychodynamic treatment in the mental health field, process research is needed to show just what it is that has an effect and how. As we know, the same treatment category name may cover a range of different types of process, while different treatment categories may converge in including similar ways of working—but we cannot know about any of these differences or similarities without systematic process analysis.

Even where recorded treatments are available, the difficulties involved in carrying out clinically meaningful process analysis on long-term treatments has overwhelmed

THE CASE OF MRS. C

investigators. The systematic exploration of long-term treatments requires extensive sampling and computerized procedures, but for these to be meaningful, they need to be rooted in a meaningful theory of treatment process. Wilma Bucci is trying to move this work forward using new theoretical ideas and new technical procedures.

The referential process database of 23 treatments (see Maskit, 2021) includes sessions from seven psychoanalytic treatments that meet the necessary criteria for research treatments (see Luborsky et al., 2001), in addition to the case of Mrs. C. Several of these were recorded in the same general time period as Mrs. C; several are more recent, but either the number of sessions or the permission for sharing data is limited. The treatment of Mrs. C has been the most widely studied, and that for which the largest body of comparative data from other researchers is available.

The patient was a young married woman, who had been married less than two years to a successful businessman and was the second of four children born to a mother who was a housewife and a professionally employed father. In the interest of disguise, she has been described as an elementary school teacher in some studies and as a social worker in others.

She sought treatment at the insistence of her husband, who had threatened to divorce her if she did not overcome her sexual difficulties.

She did not enjoy sex, did not have orgasms, and indeed was reluctant to have intercourse.

She sought treatment as well because of her own general feelings of anxiety and dissatisfaction at work and in her personal relationships. She was unable to relax and enjoy herself, felt tense and driven at work and at home, was very self-critical, and worried whenever she made even a minor mistake.

She experienced herself as emotionally constricted, inhibited, and fearful in her behavior.

She felt that she was unable to hold her own opinions, that she did not have the strength of her own convictions; especially difficult was disagreeing either with her parents or with her husband. She was uncomfortable with her co-workers and her clients, especially her male clients, with whom she believed herself to be overly strict and impatient.

The analysis lasted six years, with five sessions a week, for a total of 1114 sessions.

She became pregnant early in the third year of treatment, delivered a healthy baby girl late in that year, and continued in treatment for approximately three more years. A total of 222 sessions have been transcribed and are available in the referential process database. These include seven blocks of ten sessions each that were studied by Jones and Windholz (1990), beginning with the first ten sessions and representing the entire treatment at roughly corresponding intervals; the first 100 hours transcribed for purposes of a study by Weiss

and Sampson (1986); and additional sessions transcribed for purposes of studies by Udoff (1996) and Friedman et al. (1994), focusing on the pregnancy and immediate post-pregnancy period.

In other studies, Luborsky (1988b) compared the formulations of the case based on the application of the Core Conflictual Relationship Theme method (Luborsky 1988a), the transference theme method of Irwin Hoffman and Merton Gill (1988), and Dahl’s FRAMES approach (1988) to the single hour (Hour 5) that was the focus of the volume by, Kächele, and Thomä (1988).

According to Luborsky, the several different measures converged to some extent in focusing on Mrs. C’s central conflict of asserting wishes to dominate, control, challenge, and yet still be able to get a positive response from the other person.

Early versions of the computerized measures of the referential process were applied to 105 sessions covering the range of the treatment (Bucci, 1997a, 1997b). In addition to providing an overall view of the treatment, this study focused on three sessions selected as representing different phases of the treatment: these were essions 38, 326, and 726.

The latter is included in the sample of two weeks of sessions reviewed by the psychoanalysts for this current project. Session 38, early in the treatment, was characterized by Bucci (1997b) as showing features of the “good hour” described by Kris. Session 326 was the first session of the week in which Mrs. C decides to have a pregnancy test. Session 726 was one of several sessions that occurred in the week prior to the summer break and centered around her wish to have tape recordings of the sessions to take with her during the vacation. Several diverging formulations of the case have been proposed. The perspective that was the basis for the analyst’s treatment plan was outlined as follows: Mrs. C’s difficulties were crystallized after the birth of her brother when she was 6.… She felt that her parents valued her brother more than her, and that her father in particular shifted his love from her to her younger brother. She assumed that her father preferred her younger brother because he had a penis and she did not. She assumed, too, that because she lacked a penis she was doomed to an inferior position in life. Mrs. C’s primary unconscious wish was to redress her castrated state. She envied men and longed to have a penis. She attempted, both in analysis and in life, to obtain a penis of her own, as well as to deny the men in her life their pride in their penises by aggressively withholding admiration and sexual response or by criticizing and attacking them. (Weiss & Sampson, 1986, p.160) 10

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In contrast to this classical view, Weiss and Sampson (1986) presented a formulation based on their unconscious control hypothesis, which was derived to some extent from Freud’s later writings but elaborated beyond these. From this perspective, rather than being driven by unconscious envy, and seeking gratification of instinctual impulses, Mrs. C’s problems arose primarily from unconscious guilt: She perceived her parents as fragile and vulnerable. She believed they would be severely damaged if she held ideas or values different from theirs, or disagreed with them, or led an independent life that was freer, less burdened, and less joyless than their lives. She also unconsciously felt superior and contemptuous toward her parents and siblings, and unconsciously pictured them as weak and envious. She protected herself from hurting them by making herself weak, constricted, and helpless. (Weiss & Sampson, 1986) Further, according to Weiss and Sampson, she wished to separate from her parents and to develop a life of her own but held herself back out of fear of hurting them: “Her conflict was between her wishes to be strong, independent, loving, and uninhibited and her guilt about wanting these things” (p.161).

A third view of the case focused on the pregnancy and immediate subsequent periods of the treatment (Friedman et al., 1994; Udoff, 1995).1 This study of Mrs. C’s treatment, done in collaboration with Richard C. Friedman, was the only one to acknowledge the impact of Mrs. C’s first pregnancy and motherhood on her psychological, emotional, and interpersonal development. These studies used computerized measures of therapeutic process as well as theme measures capturing contents of maternalism, aggression, and erotic sexuality. Udoff suggested that aggression was likely to emerge in pregnancy in the form of maternal protective behavior, as noted by Epstein (1987, 1994). In addition, Friedman et al. and Udoff focused on her unresolved ambivalent feelings toward her mother, starting from the beginning of life, well before the birth of her brother when she was six. These included feelings of yearning as well as painful and angry feelings, which had been defended against, that were likely to emerge at the time of pregnancy and motherhood. Udoff suggests: The breakdown of these defenses as her pregnancy progresses is reflected in the emergence of hostility which Mrs. C often directs towards the baby, perhaps 1. The formulation of the research questions and the development of measures were inspired by discussions with Richard C. Friedman; Dr. Udoff ’s dissertation was supervised by Dr. Friedman and myself.

THE CASE OF MRS. C

representing an extension of herself, rather than towards the analyst. In this way, she attempts to spare the analyst of her anger, as she once did her mother, but at a cost to herself (and the baby).

Competitive strivings, with respect to her mother and other mothers, as well as in relation to the baby, represent still another form of aggression that is expressed by the patient. (Udoff, 1995, p.134) Bucci’s formulation (1997a), similar to those of Friedman et al. (1994) and Udoff (1995), focused on Mrs. C’s ambivalent relationship to her cold and rejecting mother.

As she states: We have identified a central emotion schema of desire for closeness and attachment, with expectation of rejection and consequent feelings of anger toward the object, leading to fear of further rejection. She turns away from her desire for closeness to the object and identifies instead with the powerful, angry person. This pattern characterizes her position from the start… and characterizes the outcome of the treatment as a whole. (Bucci, 1997a, p.303)

interpreted as indicating some improvement within a generally mild symptom range.

Jones and Windholz (1990, p.993) carried out an evaluation of the treatment progress using the Psychotherapy Process Q-set analysis, a psychotherapy process measure using ratings by judges that had been developed

by Jones et al. (1988). Based on this measure, they summarized Mrs. C’s progress as follows: Over the years the patient’s discourse was less intellectualized and dominated by rationalization, and increasingly reflected greater access to her emotional life and a developing capacity for free association. The analyst became more active in challenging the patient’s understanding of an experience or an event, identifying recurrent patterns in her life experience and behavior, interpreting defenses, and emphasizing feelings the patient considered wrong, dangerous, or unacceptable… Our data from the later period of the analysis suggest a resolution of transference resistances, signaled in part by the patient’s greater openness about her desires, feelings, and fantasies, including sexual desires and a need for intimacy. There was, as well, a significant alleviation of the patient’s long-standing feelings of inadequacy, guilt, and anxiety. ( Jones & Windholz, 1990, pp.1007-8)

The discussion of the diverging formulations of the case will be elaborated following the analysis of the trajectory of the case and the selected sessions in the context of the multiple code theory of emotional organization and the more recent computerized measures developed in this framework.

They also reported that the outcome “was considered to be satisfactory, or even very good, by both analyst and patient.”

Outcome Assessment Based on Internal Data Measures of change such as the pre- and post-treatment measures used in current outcome studies were not applied to any of the cases that were collected in the early period of process research. Luborsky and colleagues attempted to fill this gap to some extent based on internal information in the transcripts of early and late sessions (Luborsky et al., 2001). The case of Mrs. C was one of seventeen complete and tape-recorded psychoanalyses included in this study. Two judges with doctorates in clinical psychology independently rated three early and three late sessions using the Global Assessment of Functioning (GAF), Health-Sickness Rating Scale, and Scale for Suicide Ideation. A similar study (in preparation) was carried out by members of our research group, who rated treatments in the referential process database using the GAF and other measures. Both studies showed Mrs. C as beginning treatment with a relatively high GAF score compared to the other treatments in the sample (65 in the study of Luborsky et al., 61 in our group’s recent evaluation), and both showed a GAF of 71 at the close. These scores may be

The Structure of This Project: An Overview This project brings together clinical and research perspectives in a new way. A few remarks on recorded psychoanalysis may help to provide some additional perspective on this project and on the eight sessions that the psychoanalyst consultants for this issue of DIVISION/Review were given to discuss. These recorded cases, as we said, are very rare. There are obvious and not so obvious difficulties in studying analytic treatments through recordings of a small sample of sessions; in another sense, the evaluation of recorded session material is deceptively easy. The difficulties include the third object in the room (namely the recorder) and its effect on transference; the question concerning what it means to be able to hear everything in a way that neither patient nor analyst can do; the lack of external reflections on the material from the analyst; the lack of any synthesis of biographical material or history; the question of how to select a small sample of sessions for close study from a total of 1114 session over a six-year-long process, and what kind of meanings can be drawn from such a sample.

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From another perspective, it is all too easy it is to judge another analyst’s work—we have often felt like dismissing every analyst whose recorded analysis we’ve listened to, and perhaps you have to assume if anyone listened to you, they would feel dismissive towards you as well. There is something almost too intimate, too impossible, maybe even too competitive, when listening to the minutiae of an intense process without access to what either party might say about what was taking place for them. It is important, then, to remember that this was a case that was thought to be successful by the patient, the analyst, and the supervisor; and to have undergone an involved and successful termination process.

This needs to be emphasized: all three seem to have felt good enough about the work that took place over six years.

What you will see is that the analysis is very much a product of its time. It is a classical analysis, very Betty Draper Mad Men style, with great abstinence at times on the part of the analyst (though this stance breaks in interesting ways). The analytic interpretations seem to follow a very particular and traditional kind of Freudian interpretation of castration anxiety and penis envy, attentive to sexual and aggressive conflicts via transference, with insight on the side of the analyst perhaps more explicitly expressed than that of the patient.

However one might feel about this kind of interpretation, what is fascinating are the places that it takes the patient, and perhaps doesn’t take her, as well as where it takes the analyst, and sometimes, sadly, doesn’t take him. By take, we mean the elaboration of the discourse or speech between them. In the end, here, we are only witnessing two small snippets of time in a long treatment, one that we would imagine is marked by periods of euphoria, opening, and historical exploration, and at other times of intense transferential struggle, here and now conflicts, and points of working through. Can we use these two weeks as Freud used his specimen dream, to analyze it, exhaust the reading of it, but understand this is only a part standing in for the whole?

What we do see, irrespective of the analyst, irrespective of our judgements, is the extraordinary reach of Mrs. C’s imagination, fantasies, struggles, conflicts, and her continued willingness to engage in an intense and indepth process, which we should have the grace and gratitude to call psychoanalysis. This very inhibited woman was given a space to speak, which she did, not just five times a week for six years, but to her doctor, about her inner life, in the most extraordinary detail. At the end of the day, I also think what we have here is a very valuable learning tool, a gift from both the analyst and Mrs. C to future generations, and we must be aware that they were perhaps too painfully aware themselves of this gift they were producing for us, together. z

THE CASE OF MRS. C

Seeing Mrs. C: Introduction to the Sessions, Part Two Jamieson WEBSTER and Elena PETROVSKA The analysts were given all eight sessions listed below, provided by Bucci and Maskit for this project: z Session 38: from the first year of treatment z Session 326: early in the third year; from the first session of the week in which she decides to have a pregnancy test z Sessions 431, 432, and 433: later in the third year; from the first three sessions in the week of her return after the birth of her daughter z Sessions 726, 727, and 728: from the fifth year; the week preceding the summer break Bucci presents the basis for this session selection in her paper in this issue, based on the computerized measures and their underlying theory and on her previous work on this case, and discusses the sense in which these sessions may be seen as representative of different phases of this long and intensive treatment. In her close process analysis, she focuses on Session 38, from the first year, which she had presented in an earlier work (Bucci, 1997b), using different computerized procedures, as showing features of the “good hour” (Kris, 1956); Session 433, from the week of her return to treatment, and two sessions from the fifth year: Session 727, which contained a segment selected by the computerized measures as thematically most representative of her underlying emotion structures, and the session following and carrying forward that theme.

While each analyst had access to all of the above-mentioned sessions, they were asked to focus on the two weeks of sequential sessions, {Sessions 431, 432, and 433} and {Sessions 726, 727, 728}, from the third and fifth years. Session 38 was included for reading because it was the one that had the highest referential activity measures and gives a baseline display of patient and analyst working together. Also included was Session 326, the session in which Mrs. C thinks she is pregnant but hasn’t had it confirmed yet. This session, a tumultuous hour before the confirmation of pregnancy, nicely complemented Session 38, the “good hour,” as presenting a critical moment in treatment moving towards the events in the two weeks of continuous sessions. These sessions from the third and fifth years included a wide range of moments for the dyad, including her return to analysis after a maternity break and a build-up to the pause of analysis for her analyst’s August vacation. The themes of these sessions will be described here, from a clinical perspective.

The Golden Hour Session 38 This session begins with a long monologue of Mrs. C describing a pattern of feeling like she has a desire to find “the unhappy face” daily and how she reacts to it. Mrs. C then recalls moments from her older sister’s dance. She mentions that her husband thought she had a good time at the dance but that she believed that she only appeared to have had a good time and recalled feeling somewhat uncomfortable. She then speaks about her sister’s friends and feeling like they only were welcoming towards her due to the connection Mrs. C has to her sister and that they wouldn’t actually have much interest in her as an individual. She continues on to discuss her relationship with her sister’s husband, her brother-in-law, and reports that although she is very rarely around him, whenever she is, she can sense some tension regarding their relationship and isn’t sure whether this is something she’s imagining or if it’s really occurring. Just as with her sister’s friends, she reports feeling that he has very little interest in being around or talking to her. She reflects on this theme she was discussing and says that she thinks that what bothers her is that the relationships with people she meets at parties don’t seem to last and that she fixates on the nature of such superficial relationships, which takes away from her enjoyment of the event.

This leads her to think about some envy she has toward her sister, and she reports feeling like she compares her sister’s friends and husband to that of her own and that her sister has it better than she does in this regard. Mrs. C connects this to why there may be tension while in the presence of her brother-in-law and recalls that she makes the same comparison between her brotherin-law’s friends and her husband’s friends as she does with her and her sister’s friends.

She wonders if her brother-in-law’s friends are engaged in life in a deeper way than her husband’s friends. She then mentions that the dance/dinner was actually at her mother’s house, and that as a result, it felt like her mother’s dinner and that she was only a daughter in the house.

The analyst interrupts to ask a clarifying question about whether the dinner and dance were separate events, to which she replies that they were, because there were several events of the like. Mrs. C continues to say that she was disappointed that the dinner was at her parent’s house because she can’t seem to join in on conversations that her mother is involved in, because she feels ignored by her mother every time she 12

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attempts to join in. She mentions that it happened during one of these dinners too and that she tried joining into the conversation when there was a lull in conversation and her mother ignored her again, which made Mrs. C feel embarrassed, rejected, and even worse when she realizes that other people heard her and could sense her rejection.

She reflects on this feeling like it is aggression and superiority being communicated by her mother, which angers Mrs. C. The analyst then asks whether she left the table, to which she responds that she didn’t but that she just started talking to someone else. The analyst asks her what she would like to do.

Mrs. C responds that she would like to shout something awful, throw or break something, and create a disturbance in hopes of being noticed. She goes on to say that she would like to attack or hurt her back in some way.

She mentions that she does have these thoughts when she feels inadequate in some way during events and wonders if she’s just more comfortable with this image of herself.

She then tells a story of a friendly woman she met at one of these dances, whose husband asked Mrs. C to dance. She mentions that she felt very timid about dancing and that this man was a wild dancer but that she liked this because although he wasn’t as good of a dancer as her husband was, he was “wild enough and strong enough as a leader,” which in turn inspired her to be daring as well. She then reports feeling uncomfortable at the end of the long dance they shared together due to some remarks he was making.

This then leads her to recall a recent dream she had including her analyst. She describes the dream as another dance-like setting, in which she felt a “progressive need to withdraw more and more,” as well as a feeling of discomfort. Mrs. C then mentions that in the dream, her analyst indicated to her that he knew what she was doing and that she better stop. Mrs. C woke up at this point and had the feeling that she could “stop doing it,” and this thought provided her with comfort during the day. She then questions this sense of comfort and feels bothered that she needed this “escape.” She states that this dream felt somehow connected to recent movies she saw, and that movies and novels felt like an escape for her as well. The analyst asks her which movie she saw. Mrs. C says, “Duffy,” and describes the main character, whom she finds to be a sad, yet attractive character who just wanted to be a free spirit, and everyone around her had to accept that. She describes the people in the movie being very fond of this character and accepting and respecting her choices

THE CASE OF MRS. C

and feeling rejected. She is silent for a bit and then states that she now feels like she’s an annoyance for talking so much about the dance and that she doesn’t want to talk about it anymore.

ANALYST: “You said that, uhm, in the dream I said to you, in effect, ‘you know what you’re doing and stop it.’ Right? What was it?”

PATIENT: “I — what you said?”

ANALYST: “Yeah, I mean, what was it that, ah was being referred to? Do you recall?”

PATIENT: “I think I was actually sort of, uhm, gradually hunching up more and more and putting my face in my hands and just kind of hiding my face.”

ANALYST: “Ah, that’s what I was referring to.”

PATIENT: “…I don’t know, it was almost a feeling of being understood and somebody who expected something else from me and yet because they understood what, what I was doing, cared and could be gentle about it. I don’t know, it was, it was, uhm, just a very comforting feeling that I got from thinking of it. But even while I was feeling that, I was also feeling upset that I had a dream that you were in, because somehow, I think even before I started analysis, I was afraid of fantasizing about you and making you something you weren’t and having you take an importance with me that was just fantasy. (silence) But I think also your being in the dream represented something more than, than just you. I mean, it was sort of a feeling that I have about being here and I don’t always have it but that, well, I am feeling more and more that what I am thinking I can say and that at least there’s not any horrible thing happening to me for saying it or any rejection for saying it. I don’t know, I can’t really find words for this feeling but there is a certain feeling of freedom.”

regarding whether or not she wanted to be in a relationship with them and that this lack of responsibility regarding attachment was attractive and saddening. At this point, she pauses for two minutes and then recalls another incident from the dance that upset her at the time and reports feeling like she was working herself up to really feeling rejected by it. She describes this incident as one in which she and her husband were talking to a man and Mrs. C had the “compulsion to

know him well enough so that” she and her husband could see him on their own, apart from the gathering. During their talk, she describes a woman who whisked this man away from her and her husband and that this reminded her of the anger she feels toward her mother when she ignores her. She then mentions feeling jealous of people who are able to leave or end a superficial conversation and that she feels guilty about doing so because she fears being the one left alone 13

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The Session in Which Mrs. C is Contemplating Taking a Pregnancy Test to Confirm Her Suspicions Session 326 Begins with a three-minute silence. Mrs. C brings up feeling angry while she was at work/school and preparing for a school play with one of her colleagues and feeling like her colleague took advantage of something, that she had an advantage over Mrs. C in the first place. This reminds her of feelings as if she’s only out for herself, which feels unpleasant and unfriendly and uncooperative to her. She then continues to speak about the competition she felt between herself and her colleague, as well as how she felt that her colleague was copying her.

Mrs. C continues to discuss her feeling of competitiveness and then brings up wanting to be pregnant or to have a baby at some point. She recalls that over the weekend, her husband said to her that he wanted Mrs. C

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to find out if she is pregnant, and she recalls thinking that she wanted to “put it off for a while.” She speaks about feeling like it was the first time she really did want to know if she was pregnant or not and that before, when she thought about wanting to know, she thought it would be best to wait until school was out for the summer. She says that today, the same thought of wanting to know her pregnancy status was on her mind in a different way, and she reports wanting to ask her analyst about changing their appointment time once school is out. This thought leads Mrs. C to feel that since she’s focusing on what she wants, she appears as more self-centered. This then reminds her of the last Friday session she had, when she was talking about her mother and her feelings of being close to her mother. She brings up a book she’s been reading about “people’s feelings toward their mother and toward nursing.” She mentions that she was mixing nursing up with thoughts about intercourse and stated, “When you’re nursing I—it must seem to a child that it’s the closest you can come to being part of another person, not being alone, being safe and all. And that intercourse is a sort of substitute.” Mrs. C then wonders about her own feelings about her mother and states that although she could feel just like her, and therefore “understand to some extent how she was feeling,” she also has such violent feelings toward her, even though she was better than her father.

She then mentions having many accidents as a child and her mother telling Mrs. C that due to her clumsiness, she didn’t think Mrs. C would live beyond the age of six or so. Mrs. C then recalls only feeling clumsy when she felt insecure or when something else was going on.

She brings up feeling like her sister was antagonistic “from the start” and recalled a memory of her parents having to get rid of the family dog because her sister kept trying to get the dog to hurt Mrs. C. Another memory of when Mrs. C was about five and a half comes to mind, when she and her sister were playing a game and her sister was hiding behind a door. As Mrs. C came in, her sister shut the door out, which in turn cut Mrs. C’s face, and she wondered whether it was malicious or not. She brings up that her sister had this pattern of teasing her, in which Mrs. C would go back for more due to feeling like she deserved it and that her sister was better than her and more favored by their parents.

She then counters this thought with memories of her father’s sister only being asked to take care of her sister and not Mrs. C. She states that her aunt was very angry about that and told Mrs. C’s sister that Mrs. C was favored. She then wonders if her sister acted antagonistic towards her because their aunt told her that Mrs. C was more favored.

Mrs. C then mentions wanting to know what she thought it was like to be nursing and although she can’t exactly remember, she can imagine how her mother might’ve been like. She imagines her mother as being very on schedule and nursing her for a specific amount of time.

PATIENT: “…all I can do is imagine how I think my mother would have been, and I can’t imagine her being anything but very much on schedule, and that the schedule said at this time she nursed me for so many minutes, and that I better be on schedule. no sense of relaxing and just enjoying it, which may be very untrue. (clears throat)” ANALYST: “But it may be explain why it’s important to you to find out, mm (uh), whether I’m going to hold you to your schedule.”

PATIENT: “You mean because I do have that feeling; about (bout) my mother?”

ANALYST: “Well, you say you imagine how important that; that be and that that’s the way she was. and earlier you were wondering, how am I?” Mrs. C says that what the analyst was saying was true and that there was no rational reason as to why she couldn’t ask him, but that she did feel he would have an emotional reaction against her if she asked him for a time change. She mentions that she feels like she would’ve spoken up if her analyst had asked first when she’d like to come in for appointments during the school break, but that she feels it would’ve been presumptuous for her to bring it up herself. She then is reminded of a feeling she had while she was at work at the school and remembers thinking that she didn’t want to be involved with any of the other teachers and that she didn’t want them to ask anything of her. She recalls that this is the exact opposite of what she wants her analyst to feel. She then speaks of always having trouble with the boys using the elevator in school because they can’t stand feeling squashed together and being so close together. With this in mind, Mrs. C mentioned that in an attempt to alleviate even more distress for her male students, she doesn’t like it when even more people enter the already crowded elevator. However, she quickly discounts this thought as selfish. She says, “And I wouldn’t be the one to be squished. It would be the boys, but somehow that was me in that case.”

She continues: PATIENT: “I started thinking about something that happened over the weekend, and; it reminds me, because this is what I was feeling at the time, of, mm (eh), struggle of doing what I want to do and what I don’t want to do, no matter how selfish or unselfish it is and; I mean what I want to do being selfish. and, I don’t know, I I; at this point it’s not a thing that’s hard to say. it just somehow is something I don’t want to think about. It 14

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involves our having intercourse in the end, but I don’t think I’d be holding back on saying it because of that. It’s somehow a feeling I don’t want to feel again.”

She continues to speak about a night in which she didn’t want to have sex with her husband. She reports feeling like she uses her analysis as an excuse for her behavior at home and that she wants to talk academically about why she didn’t respond to intercourse. She says that her husband wasn’t fooled by her and that she voiced to her husband the importance of not repressing any genuine feelings she was having, which angered her husband because she wasn’t taking any responsibility for their relationship. This, in turn, caused Mrs. C to feel badly, which led her to feeling like she didn’t want to be alone. With much hesitancy and resistance, which she acknowledges, she mentioned that as a result, she started to make love to her husband. The analyst points out that she’s lacking detail in her statement about starting to make love to her husband. She responds that she was aware of being so general but that it was possibly because she didn’t want to remember exactly what she did or how she felt, which to her seemed strange because it was a nice feeling. Mrs. C mentions that perhaps she prefers remembering angry or unpleasant feelings. She then brings up a memory of earlier that day when one of their cats was asking for more attention and clawed up a piece of furniture. Mrs. C recalls feeling angry towards the cat and then again remembers wanting to ask her analyst to change the time.

She mentions not knowing whether it was connected with angry feelings that she felt the analyst might have towards her or if she was getting ready to be angry with him if he didn’t change the time. She reports wanting the earliest appointment possible in the morning and feeling like this is such a radical change but that she would feel angry if he refuses. The analyst inquires further, and Mrs. C says that she feels she should have better control over herself and not use her anger as a threat towards her analyst. She says that she feels like she goes through such complex imaginings and never just simply asks to find out and her analyst says that it seems to him that the central thing is that even the idea that he wouldn’t do what she wants makes her mad. She connects this to him charging her recently for a session that she hadn’t attended and reports feeling that her anger now is a continuation of her anger in that occurrence. She then connects this to her relationship to her husband and feeling that by being angry, her husband would become more compliant.

PATIENT: “…men aren’t going to give me something that I want. and they have things I don’t want, or one thing in particular.”

ANALYST: “Don’t?”

PATIENT: “That I, no I don’t know why I said that.”

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ANALYST: “Sour grapes?”

PATIENT: “Mm (hmm) (said laughingly) I don’t know. I was thinking ‘want.’ I don’t know, maybe it is part of this attitude of, ‘I don’t have it, but I don’t need it and I don’t care. I can do just as well without it, and I can compete with men without a penis. I think that’s part of the attitude, too. but then I never really feel I can. And I always feel angry because I’m not getting a penis from some man.”

She then says that she feels like getting her husband to take on some of her “roles as a woman,” such as doing the dishes, was because she felt that he’d “give up some prerogative as a male,” and if he gave it up, she would get it. She is reminded of her mother again and her mother having a baby boy, who was the favorite. The analyst ends the session.

Three Sessions (431, 432, and 433) After the Birth of Her Daughter in the Third Year of Analysis Session 431 Begins with Mrs. C talking about resenting her newly born daughter, but also not wanting to find someone to look after her, in particular so that she can return to analysis, which she also has had mixed feelings about.

She says that she couldn’t really say what was on her mind but knows that if she was coming to analysis, she could know better what was disturbing her. She then reports in session an intrusion of an image or sensation of her daughter doing something, where she imitates it, like if she stretches or yawns, she repeats the gestures and feels as if she feels what she feels, becomes her, though she can’t recall what she was just imitating in session.

She then tells the story of going to her doctor and having an IUD put in, which affected her more than she realized, especially the day of the procedure where she felt as if something horrible was going to happen to her. She and her husband then had intercourse and she was uncomfortable; she’s not sure if it was because of having been stitched up, but it reminded her of their wedding night, where then and this time, she just started crying.

It wasn’t hurting, she says, she doesn’t know why she was crying except “somehow I felt as if something were being taken away from me, or I’d lost something, and he was kind of joking about how I’d lost my second virginity…” She continues saying she was aware of the feeling about herself as a mother, and her husband as her baby’s father, and then having intercourse she couldn’t go around with that image, she has to have another image of herself beyond that. And while having intercourse, she can’t be aware of her daughter, and this felt confusing. Then she breast fed her afterwards, and it was very satisfying, more than usual, and that seemed to have something to do with having had intercourse,

which disturbed her, especially since the sex itself hadn’t been satisfying.

ANALYST: “Did you feel that by not coming back here, that you could avoid these conflicts, and the way uh, mixed feelings you have? Because you said that you had had the mixed feelings about returning.”

She speaks at length about not wanting to come back but connecting this with the question of having sex again with her husband and knowing that she needed to deal with what was “disturbing her,” getting upset with the demandingness of baby also made her feel she should come back since all in all she’s an easy baby. This then leads into reflections on the birth experience, where what she found the hardest was everything they did to her after she was born. She hadn’t taken any medications, and suddenly they were stitching her up, kneading her stomach, and she “felt” as if she was in horrible pain. Then she realized that she didn’t connect her daughter with being pregnant: she knew there was something alive in her, but that somehow wasn’t this baby, and then the IUD was like something foreign again in her. After giving birth she was afraid of intercourse, afraid to touch herself down there, felt squeamish, and she realized she had the feeling that she had “no vagina.”

PATIENT: “I knew I’d been sewed up, but it was almost as if the sewing up was just sort of, well, like cutting a buttonhole and finishing the buttonhole. The sewing up was the finishing part that I-, I-, as if he had just cut my vagina out when she was born, or after she was born, right after. . . and if I still had a vagina, it was less than what I had before… I kept thinking that.”

ANALYST: “Do you remember shortly before we interrupted, before you went into labor, you had among other things thoughts about an operation your mother had after your sibling was born?”

She then clarifies that she asked her mother and in fact she had an operation after her brother was born for hemorrhoids, and a hysterectomy a year later, after her sister was born. She realizes she thought her mother did it after her brother (how could she have had a sister then?) because they just kept having kids till they had a boy. And then she starts thinking about her feelings about having had a girl, they referred to the fetus as he, and when they announced it was a girl at birth, she thought they must be speaking about someone else. The session ends with the feeling of how unreal her baby seems to her sometimes.

Session 432 Begins saying that she had forgotten her babysitter has an exam on Thursday and she had forgotten to talk to her analyst about changing the time and says she has always been hesitant to ask. He says, yes this has 15

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been true, but why now? She speaks about her “father” feelings towards doctors, wanting them to be pleased that she produced this child, think differently of her, approve of her.

The analyst makes a longish intervention.

ANALYST: “You know, it seems possible to me that one of the reasons you didn’t want to ask, was because you’re inhibiting exactly the opposite. As though you really would like to have me change the time as sort of a token of my appreciation and you have passed your test very well, and that I’m pleased by it, and all that. It would indicate that I was giving you something in return to show my appreciation.”

She says it reminds her of how much she wanted her parents to be more affectionate, but then avoided anything that would make her obligated to them, any feeling she owed them. And if he doesn’t do anything for her, then she can feel freer to be angry with him, feelings she doesn’t like having, which she then corrects to “showing.” She says she can’t handle the analyst saying no, but also maybe yes neither. He says, “No wonder you forgot!” then brings up that they changed the hour to this one and wondering if she had feelings about that. She goes on and on about her reluctance to set up the appointments again. In her mind, she imagined being very demanding about the narrow windows of time she would have, but she doesn’t speak with him directly, so she ended up hoping he would do her a favor since she had a baby. And then she speaks about their difficulty finding an apartment. The analyst says something convoluted about her saying she had a strong feeling of wanting his approval and then going on to say she doesn’t have an apartment.

She returns to her parents giving her money, her feeling that everything needed to be sorted out before the birth of the child, but now she doesn’t want to move. And she knows she didn’t react on the phone with him when they set up the time, because she didn’t ask for the Thursday, but then got anxious today. He says that some feeling she still has here is important and ends the session saying he can’t give her the Thursday time.

Session 433 The session begins with her saying she was angry about his not changing the session time and almost thought she made her daughter sick with a cold. She wanted him to know how hard he was making it for her with the baby. She is thinking about how she is dressed in a skirt and had considered wearing pants, but doesn’t wear pants though seeing others in pants, she finds that they look free and casual. She then mentions that the analyst was dressed differently today, not in a suit, and this shocked her. The analyst asks both about her being shocked and what differently means. She says she couldn’t

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look at him. Goes silent for three minutes.

Associates to her difficulties with change, like changing apartments (changing appointment times?), and then talks about how her father seemed indifferent to his clothes, so she likes it when her husband wears something different, but then doesn’t like it when he looks in the mirror because that feels like something a girl does. The analyst then interrupts with a massive intervention which I’ll read at length and then back and forth between them as the session and the analytic week ends.

ANALYST: “You know, maybe it’s time to start to put some of the things you’ve been saying this week, together. For example, you, what you just said in effect is that there’s an exterior sign that really distinguishes men and women. One thing might be clothes and you say, well, I’m dressed differently, and you don’t even dare to say what you see. But then your thoughts go to your husband and the whole idea that if he looks at himself or dresses in a

way that might uh, be different, he becomes almost—he does something a woman does.

Then you mention that you had been tempted to wear pants here, but you didn’t dare.

Because wearing pants is for men to wear.

“And you talked about this fear that you had at the time you were being sewed up when you gave birth. And the idea that your vagina had been cut out, and that you were all sewed up, stitched up. Something vital had been taken away from you. And then you’ve talked about how you have this feeling that’s very strong, that you should be regarded in a certain way now, by your obstetrician and your pediatrician and me, and I presume, others, too, because you have produced a baby. You now have tangible proof of something exterior that says something very important about you and what kind of person you are, and how you should be regarded.

“Now, at the same time that you say these things, this whole issue of who’s in 16

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charge of the appointment time comes up again. And it’s true it comes up ostensibly in connection with real difficulties. But you make it clear that at the same time, they’re not all entirely of your own, that is, you, you have made some contribution to them, by forgetting what the babysitter had told you, for example, as though it were very important for you to keep control over these. And I think that’s part of your shock, if I dress differently. It’s not only what it might mean about male and female, but I’m doing something you don’t have control over, it’s not what you expect. And therefore, you’re troubled by it.

Then you mentioned the idea that you had lost your virginity a second time. Or you said your husband joked about it that way. Now I think all these things add up to one central idea that you seem very preoccupied with and concerned about at the moment.”

PATIENT: (2-minute silence) “Well, the thing I kept thinking while you were

THE CASE OF MRS. C

saying all these things, was I don’t know it seem—it seemed to me almost as if I went in a progression from first thinking I was a castrated male, to then if I’m not a male I have to be a female, and then desperately trying to work out something that I knew would be being a female, and yet not really feeling it. (pause) I’m just reminded that that’s what my father meant, my having to control everything whenever he’d call me a bitch. I would always deny it. But it’s something I’ve been doing all my life, and I don’t know whether it’s part of trying to prove myself as something, because whenever I think of control, I think of that as being a masculine thing.”

ANALYST: “…my hunch is that part of what you’re talking about is, this is your reaction to having a girl. This is the way you’re expressing your disappointment, I mean, to not having a boy, by keeping a tight rein on everything. The patient talks about having a hard time saying her daughter’s name, and then suddenly feels in session as if the analyst laughed at her. She doesn’t know why.”

ANALYST: “You see, I think there’s absolutely no question, at least there’s none in my mind now, but what you have strong feelings about her that you are not really letting yourself have, or, or, or become aware of. See, one of the things for example, that struck me, was when you said now that you couldn’t call her by her name for a long time. It reminds me of how I was very struck by how casually you mentioned her name to me when you first came in this week, not by telling me her name, but by referring to her so exaggeratedly casually.”

PATIENT: “Yeah, I was aware of it, too.”

ANALYST: “And that means you’re hiding something, I’m sure. From yourself.”

PATIENT: (silence) “Uhm, I, I’m remembering just (breathes deeply) the first few weeks at home when I, uhm, I don’t know, just sort of mechanically took care of her. And I, if anything, felt res—, not maybe resentful, but—well maybe resentful. But certainly I wasn’t enjoying her, and I didn’t feel any great warm feeling toward her. And I felt very guilty about it.… I’m enjoying her more now, and I don’t know whether it’s because I’ve repressed whatever the real feelings are… it’s almost like I’ve gone through… convincing myself a girl can be just as nice as having a boy. I think I’ve done that, to an extent.”

ANALYST: “But the need to convince yourself implies the opposite feeling.”

Mrs. C says it is true she wanted a boy and has been convincing herself it’s nice to have a girl. Then says she keeps wondering how the feelings about a girl are linked to her feeling she lost her vagina and problems with intercourse.

PATIENT: “Well I can see having intercourse with him, I’ve always associated intercourse with loss of control. Which makes me almost think that, I mean I, it occurs to

me that then being afraid I’d lost my vagina might be wishful thinking, that I had lost it.”

The analyst speaks to the fantasy about the mother’s hysterectomy and having a boy and it all being over, and the patient remembers having the feeling that she couldn’t go through it all again.

Three Sessions Just Before August Vacation in the Fifth Year of Analysis Session 726 Mrs. C begins the session saying she imagined because the couch seemed wet, that a cat got in and peed on the couch, also because it smells bad. And then wonders why she didn’t consider that it couldn’t have been people, maybe someone sweating. And then mentions that her husband sweats a lot when they make love. Then mentions feeling yesterday and today in a panic about the break, that she needs to make a breakthrough of some kind, “get off the edge,” before the end of the week, and then goes into a set of thoughts that feel to her vague about being antagonistic and not sharing things with the analyst.

The analyst replies.

ANALYST: “Well, maybe we could, uhm, go back to something specific that you started out with today. In effect, what it sounds like is, you’re saying my place here stinks. And then you become rather vague about these other issues (pause) because the fact is that you are, uhm, being antagonistic, or whatever you want to call it, in a whole lot of different ways. One, another way to summarize what you’ve been saying is that I don’t have any effect on you, that you can’t remember things I say. But on the other hand you threaten me by saying if you don’t really break through this before the end of the week all is lost.”

The patient immediately responds that she feels as if she’s asking, not threatening.

And is interrupted by analyst.

ANALYST: “Yeah, to kind of a breakthrough. You are excited in the movie Frenzy.

You had been talking Sunday evening about the women of Bangladesh. The man in the movie was a big challenge, and you ask me to break through. The fantasy behind this seems rather clear. It’s been consistent. You are acting in a way to provoke me to have to really forcefully attack you, kind of mentally rape you, make you do what you want to do. And your fantasy in the movie was that, uh, that would give you an occasion to really fight back. And it’s the details of that fighting that I put into words, and you said yes, that’s true and you have avoided it ever since. So you keep, in one way or another, by your behavior, inviting me to, as you say, break through, to rape you, to attack you, then you’ll have an occasion to fight back and kick me in the groin and destroy me.

And it’s this kind of a fantasy behind all the 17

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things that you’re doing, I think. And now you’re saying, you haven’t got much more time. I, if I’m going to do it, I’ve got to do it this week. Ah, in a way this is very similar to the way you’ve behaved toward your husband for years. It’s been a constant invitation to him to have to force you, sexually and many other ways, to have to break through this barrier you put up. For a long time you felt you always had to have a fight with him.

You even set up your wedding night so that he would, in fact if he did anything sexual, be, in your eyes, raping you. This is an old idea that you are now, in many ways, really living here in indirect form.”

She responds saying that yes, she wants to be forced, and in the movie, it is to destroy the man, but that in the end, she wants to be overcome by her husband. Here, it’s the same: “Force me to understand and overcome the things I’m resisting understanding.” The analyst comments that she’s being very nonspecific. And she replies that she may be avoiding the feeling that she’s already destroyed both of them, gotten rid of them, can do it on her own. And when her husband goes away on a trip, she sometimes fantasizes this. This leads her to say her mother and father aren’t in the same place and maybe she enjoys being freed from him but has a good excuse so it doesn’t appear to be what it is. Analyst repeats this—wiping him and her husband out. She speaks about a fight her husband and her get in about her getting up and dressed on Sundays, and then finds herself trying to go back over what the analyst said and maybe everything that’s been said and feeling like she has a recording in her mind when she leaves; if she can’t do that, she won’t have it when she leaves. He asks what the recording brings to mind. She says that he has a recording.

He asks what the connection is between his having a recording and her destroying him?

She says that he has it, and she won’t. And also thought of his having a penis and her not. Analyst again says, she wants to defeat him because he has a penis. This is always the fight (more or less). She says she feels resistant to this.

Session 727 She starts speaking about worrying about a wart that has come and gone and wondering if she caused it. She returns again to her preoccupation with this moment that she wanted to share something and cut it off, and the antagonism from last session.

And then says she wants him to tell her the time for the fall, maybe to hear that he wants her back, and if she’ll get the earlier time that she prefers but she has kind of accepted the later time. He confirms it’s the later time. She says that’s what she thought and says she doesn’t like it. She is thinking of

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changing her life, and analysis is the major thing of her day, and she wanted to break that. The analyst says she was still hoping he’d make it more convenient for her and is also not bringing up some of the major things from the previous session. They go back and forth again about the recording.

She says she can’t think about it and is suddenly thinking about her daughter falling.

He says she is thinking of him getting hurt.

She says she was thinking of taking his voice away with her, maybe his penis. But also that she can’t remember things without being in analysis, can’t concentrate, forgets everything. And in terms of fights the analyst was talking about, in terms of her forgetting everything, she wants to say to him, “Doesn’t this drive you crazy that I go forward a bit, and then go back more?” The analyst laughs, she joins. He asks her if it is as transparent to her as it feels to him? She says, “Yeah, well I wanted to drive you crazy!” He says, “Of course!” “But I also wanted you to say, ‘Oh no’ or ‘I understand’ or something.”

ANALYST: “Yeah, it’s part of your whole way of rendering all my efforts useless, rendering me impotent. You’re showing me what you think of the things I say. You forget them. You destroy them. And you really would like to drive me up the wall, frustrate me totally. (silence) (cough) See, the equation, I think the recording comes in because you made it plain a while back that you think for me the important thing about, you know, is that, is research and experiment, what you were told at the beginning. And eh, if you can make me fail then you have really hurt me where you think it hurts most. And that’s really for you equivalent to castrating me. It’s an indirect way to do what you’d really like to do, which is what you would like to have done to that guy in the movie. It’s what you’d like to do to me, it’s what you’d like to do to your husband and most men, as far as I can tell. And you’re doing it in all these indirect ways every day.”

She replies that while she fights and resists and gets very close to it, and it seems like that’s what she wants, she doesn’t really want it. She doesn’t know if that’s resistance, but it feels against her interests in the end. He replies that nonetheless, it’s very satisfying to her. She says she finds that hard to admit, but she’s reading a mystery right now, and this person creates a plan to kill himself in revenge against the man who is sleeping with his wife, who he would trap as his murderer. And this person was madly triumphant, enjoying the thought of destroying this other person, and yet has to destroy himself in the process. If she’s trying to castrate him, she’s refusing the help she came for. And she says she’s been thinking that she used the analysis to keep a balance, maybe fighting with him helps, and wonders what will happen in summer. Then

imagines coming in fall and having a hard shell around her and it will feel like starting all over again. He says she is really vivid when she talks about these movies and stories, which show her interest in murder, rape, and destruction, and she uses the analysis to keep all this stuff cool. She talks about someone who killed their husband, and she feels like it’s not on her mind, at the same time that it is. Wonders if she can do this, but then says to herself that she’s not thinking about murdering her husband or any man. He says, you do these two things at once, like being obedient and then thwarting me. She says, “Well, you are trying to make me give something up that I think I want to hang onto.”

Session 728 They start with her saying she can’t remember if he said they begin on the fifth or sixth. And she says she must be thinking of her leaving, his leaving, and her leaving because he’s leaving, because if he was going to be here next week, she would have stayed… silence… she goes on about some other mothers and being annoyed with how they were thinking about school choices. He asks her why this might be on her mind now. She says it’s the last day, maybe she’s thinking it’s too late, or has this idea something needs to get done, but probably she was anticipating the feeling she has now, which she has when he goes away of just closing up.

ANALYST: “Yeah, as though, eh, somehow, ah, if you don’t come to see me you really don’t seriously think about yourself, or question yourself or examine your motives or wonder what you’re doing, or anything. It’s only if I keep a whip on you and then under protest and with great dragging of feet.”

She says (lengthy) she’s worried that she’s going to get tied up in knots while he’s gone. He says, “What can’t you handle besides murder and rape?” She laughs, and says, “your penis,” and then says maybe she is worried about being alone with her husband and upsetting a balance she’s achieved to a degree.

They have a back and forth about whether she’s worried about not successfully hiding her unhappy feelings. She says she’s worried about feeling them. Last summer, her parents were there, and it was an old feeling, she almost gets lethargic, all energy is gone, and also, she doesn’t dare do anything: “It’s awful.”

And at the tail end she had this burst of energy, as if to come back to analysis, but then still resisted it. She’s been panicking about all of that. She talks about feeling like she’ll want “anal” empty routines to help her get settled. And she then returns to the recording, saying she doesn’t feel like she needs it, she can recall things, even though she wonders if she’ll keep thinking about the analysis, and she likes the process very much, and it has to stop now, and she feels like she also finds it 18

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reassuring to forget and remember, so she’s not sure if it’s simply antagonistic.

She then thinks about an article about Bangladesh women who would be raped and the husband forced to watch, who were either destroyed by the experience or also killed, and the women became outcasts, and then she returns to the book she was reading and this idea of destroying yourself in revenge, that maybe she was thinking the same thing with these women, that they did this to get back at their husbands even though it would destroy them. And then says the neighbors came over and told a story of their brother-in-law who said he was leaving his wife and was going to another woman but then stayed, and she wonders why she didn’t just kick him out. The analyst says it’s now time for him to kick her out. z REFERENCES Bucci, W. (1997a). Psychoanalysis and cognitive science: A multiple code theory. New York, NY: Guilford Press.

Bucci, W. (1997b). Patterns of discourse in “good” and troubled hours: A multiple code interpretation. Journal of the American Psychoanalytic Association, 45, 155-187.

Bucci, W., Maskit, M., & Murphy, S. (2016). Connecting emotions and words: The referential process. Phenomenology and Cognitive Science, 15(3), 359-383. https://psycnet.apa. org/doi/10.1007/s11097-015-9417-z Conci, M., & Erhardt, I. (2013). Interview with Horst Kächele. International Forum of Psychoanalysis, 22, 228-243.

Dahl, H. (1988). Frames of mind. In H. Dahl, H. Kächele, & H. Thomä (Eds.), Psychoanalytic process research strategies (pp.51-66). New York, NY: Springer-Verlag.

Dahl, H., Kächele, H., & Thomä, H. (Eds.). (1988).

Psychoanalytic process research strategies. New York, NY: Springer-Verlag.

Friedman, R., Bucci, W., Epstein, A., & Udoff, A. (1994).

Maternalism: A new view of female sexuality. Symposium presented at the annual meeting of the American Academy of Psychoanalysis, Philadelphia, PA. Hoffman, I. Z., & Gill, M. M. (1988). A scheme for coding the patient’s experience of the relationship with the therapist (PERT): Some applications, extensions, and comparisons. In H. Dahl, H. Kächele, & H. Thomä (Eds.), Psychoanalytic process research strategies (pp.67-98). New York, NY: Springer-Verlag.

Jones, E., & Windholz, M. (1990). The psychoanalytic case study: Toward a method for systematic inquiry. Journal of the American Psychoanalytic Association, 38, 985-1015.

Luborsky, L. (1988a). The assessment of transference by the CCRT method. In H. Dahl, H. Kächele, & H. Thomä (Eds.), Psychoanalytic process research strategies (pp.99-108).

New York, NY: Springer-Verlag.

Luborsky, L. (1988b). A comparison of three transference related measures applied to the Specimen Hour. In H. Dahl, H. Kächele, & H. Thomä (Eds.), Psychoanalytic process research strategies (pp.109116). New York, NY: Springer-Verlag.

Luborsky, L., Stuart, J., Friedman, S., Diguer, L., Seligman, D. A., Bucci, W., Pulver, S., Krause, E. D., Ermold, J., Davison, W. T., Woody, G., & Mergenthaler, E. (2001). The Penn Psychoanalytic Treatment Collection: A set of complete and recorded psychoanalyses as a research resource. Journal of the American Psychoanalytic Association, 49, 219-234.

Maskit, B. (2021). Overview of computer measures of the referential process. Journal of Psycholinguistic Research, 50, 29– 49. https://doi.org/10.1007/s10936-021-09761-8 Spence, D. P., Dahl, H., & Jones, E. E. (1993). Impact of interpretation on associative freedom. Journal of Consulting and Clinical Psychology, 61, 395–402.

Udoff, A. (1996). Maternalism in psychoanalysis: An empirical study [Doctoral dissertation, Adelphi University].

Dissertation Abstracts Internal, 56(6), 3468B. Weiss, J., Sampson, H., & the Mount Zion Psychotherapy Research Group. (1986). The psychoanalytic process: Theory, clinical observation, and empirical research. New York, NY: Guilford Press.

Zhou, Y., Maskit, B., Bucci, W., Fishman, A., & Murphy, S. (2021). Development of WRRL: A new computerized measure of the reflecting/reorganizing function. Journal of Psycholinguistic Research, 50, 51-64.

THE CASE OF MRS. C

Handle With Care: Experiments in Case Transmission Psychoanalysis is a practice whose theory is shaped by experience. How can a skill or knowledge that is only acquired through the process of being involved in one’s own analysis, an experience so unique that it cannot be duplicated, be transmitted to others? By contagion. The story is well known: Jacques Lacan claimed he had personally heard from Carl Gustav Jung’s lips a revealing anecdote about Sigmund Freud’s expectations concerning the dissemination of psychoanalysis (Lacan, 1966/2006, p.336). Upon entering the New York Harbor in 1909, during his first and only visit to the United States, Freud turned to Jung and said that their hosts were not aware that they were bringing them the plague. For Freud, psychoanalysis could expand epidemically

even if it meant by frightful contagion. After the COVID-19 pandemic, the idea that psychoanalysis is a highly infectious disease, and that the analyst, rather than curing an illness, is spreading it, appears somewhat ominous.

We know that even with the occasional communication by contact, Freud’s feared vast propagation of psychoanalysis was more a wish than a reality. Despite its early moment of popularity that peaked in the 1950s (a popularization realized at the cost of a severe distortion, reducing it to a medicalized sub-specialty), psychoanalysis has remained a fragile endeavor, always under the threat of disappearance. Each analysis remains one of a kind, unique in its idiosyncrasy, untranslatable, and almost uncommunicable. Let me

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Patricia GHEROVICI

ask again, how can one share the unrepeatable experience of an analysis? Or, furthermore, how can one transmit the specificity of the clinical practice?

A few years ago, I gladly participated in an experiment in the challenges of transmission in psychoanalysis. On January 10, 2015, I was invited to “Without History: An Experimental Case Presentation” organized by Das Unbehagen’s Ezra Feinberg, Evan Malater, Olga Poznansky, Jason Royal, Olga Hannah Wallerstein, and Jamieson Webster. With David Liechtenstein and Muriel Dimen, I was one of three analysts who were presented with the same sparse case material: just a few pages of an ongoing psychoanalysis conducted by an anonymous clinician. We had access to a set of process notes, without any case history or other information about the case. No one in the audience had any information about the case.

In medias res we, as well as the audience, were invited to respond to the case material not knowing much about the case. This setup was created to replicate the experience of how clinical listening itself works, since the analysts intervene from a position of “not knowing” or “docta ignorantia” (learned ignorance or a wise ignorance as systematized

by Nicholas Cusanus). What became clear in the discussion was that every time we meet a patient, in the beginning or while continuing the treatment, we encounter something about which we know nothing. Patients, however, suppose that we know them, or at least that we know something about their symptoms that they do not. It became evident through this experiment in transmission that analysts move from an initial position of ignorance to one in which they progressively know, and in fact reconstruct, the case. As the organizers made explicit, the theme of that first experiment could be summed up as evenly suspended listening versus knowing, and the dialectic between these two.

While the analyst operates in a place of wise ignorance, the analysand’s initial idealization because of transference to the analyst, which is a precondition to the progress of the treatment, will eventually let the analyst fall from the position of subject-supposed-toknow; then the knowledge contained in the symptom will emerge, not from the analyst’s expertise or knowledge but from the analysand’s unconscious. This shift requires that the analyst should direct the cure toward the supersession of illusions among which the illusion of the analyst’s knowledge will also be given up. This experience has transformative effects that introduce a new social link not regulated by a Master’s model but by the analyst’s desire for difference, offering not only

THE CASE OF MRS. C

a new relation to one’s unconscious but also a restitution of the knowledge from which the analysand had been alienated.

In the talking cure, a treatment made up of words and silences, when some knowledge emerges, or when a truth is revealed, they manifest themselves by issuing from the only material we have to work with— what the analysand says. Lacan insisted on the importance of speech in order to understand transference and resistance, or more succinctly, “what happens in analysis” (Lacan, 1966/2006, p.386) in his attempt to clarify the precepts of the practice. “To know what transference is, one must know what happens in analysis. To know what happens in analysis, one must know where speech comes from. To know what resistance is, one must know what blocks the advent of speech…” (Lacan, 1996/2006, p.386).

Transference moves analysands to speak; resistance silences them. Importantly, transference and resistance are fundamental, and without them there is no analysis. Lacan’s emphasis on the function of the symbolic (language) allows us to go beyond the constraints of the subject’s individuality and the imaginary traps of the analytic dyad, where transference can easily become an obstacle in the progression of the treatment, that is, a resistance. By focusing on the underlying structure, Lacan foregrounds a method of reading: what is said in the session, like with a dream, is interpreted as a rebus. Freud explains that the dream is the telling of the dream, what the analysand says about the dream, how they interpret it. Similarly, like a rebus, the session is a picture-puzzle to decipher, a pictorial composition in which each separate element (a syllable or a word) is put together in a manner that may be nonsensical or poetical. Freud’s method emphasizes language’s phonemic qualities, whatever their oneiric figurations may be. The analyst’s deciphering does not require looking very far because the meaning is written, readable, and accessible. One can thus productively make use of whatever the analysand says and emits. Sessions, like dreams, like writing, should be read, and as soon as they are read, they are exposed as phonemic and phonetic, part of that bountiful text woven with whatever comes to mind.

Two years later, I was invited to participate in another experiment in transmission.

I was meant to confront a very peculiar text: this time, the transcription of eight analytic sessions dating from 1968 to 1972. My first reaction was surprise when I saw verbatim transcriptions of entire sessions. This attempt at objectivity transforms the reader into a fly on the wall of the consulting room and gives the same value to every utterance in the analytic text. This democratic ideal of equanimity, however, does not apply to clinical practice.

When we talk about giving primacy to the signifier in the session, it does not mean that every signifier counts equally, but rather that we look at one particular signifier whose equivocal value and potential for ambiguity and equivocation creates a shift capable of producing a revelation of truth, which might then, hopefully, introduce a change in the patient’s discourse. Equivocation is the only weapon at our disposal in the practice. This weapon often entails the operation of cutting—a “cutting off ” of “meaning,” which reconnects the text in a different, unexpected way. Like someone saying for example, “I hate my boss, Mr. Shit, sorry, Mr. Smith,” or like the joke goes: “Isn’t a Freudian slip where you say one thing but mean your mother?” ShitSmith-Mother-Other: By uncovering these connections, something can happen.

The case material of “Mrs. C’’ is meticulously recorded. I imagine it is the transcription of tape-recorded sessions, which at some point in the sessions are referred to in the plural as “the recordings’’ and whose ghostly presence haunts the process of the analysis. Since the transcription covers four years of treatment, the style of the transcription varies. Because of gaps in the text (the occasional overlapping of voices replaced by a blank space, for example), I conclude that the transcription of the sessions was not done by the analyst but by someone else. We might say that we have a minimum of three analysts here: the one in the room and the other two that emerge in the stylistic changes in the writing up of the case—the transcriber and the transcribed. I make this claim because in the transcription emerges a process similar to that of what one might call “punctuation” in a session. What Lacan called “scansion” was a device that was a key to energizing the practice of psychoanalysis (it would lead to his conflict with the International Psychoanalytic Association and his eventual expulsion). Scansion consists of punctuating, interrupting, or cutting a patient’s productions. This mode of intervention—akin to an enigmatic interpretative gesture—aims to put the unconscious to work; to disrupt the defensive productions of the ego; and to, potentially, mobilize, extend, and support the transference.

The transcriptions present, moreover, subtle differences in style that make me think that there is an implicit interpretative gesture in the rendition of the sessions; that might have had productive potential, had the analysand be granted the opportunity of hearing that “return.”

Here are some examples.

Session 726: PATIENT: (Three-minute silence) “Well, the (clears throat) first thing I thought 20

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when I came in, I, uhm, I don’t know, I (sighs) I feel sort of silly, I guess, thinking that I’m ha—, it was sort of imagining something, and, uhm, it occurred because of the odor I noticed in here which made me think of cat urine. And so I began imagining that somehow, which I knew much be impossible, cats have gotten in here and urinated on the couch.

And then I have to lie in it. […] (pause) […]

But, uhm, (pause, sighs) I don’t know, the, the, uhm. […] (two-minute silence)” If only the analyst would have underlined “I have to lie,” it could have made the equivocal meaning of the phrase open up a space for truth, as it does, in interstices in the succession of uhms and sighs. The analyst misses here an opportunity to productively exploit misunderstandings, alliterations, and perhaps, by underlining only the beginning, the middle, or the end of a word, or repeating an unfinished utterance, or interrupting a signifier, to create a punctuation and scansion.

In psychoanalysis, the most productive moments are when we work with the “refuse” in an analysand’s speech, using productively the hesitations in spontaneous speech such as ums and uhs that we dismiss in everyday communication to transform them into opportunities for new meanings to emerge that could lead to a dynamic revelation.

From Session 728: PATIENT: (silence) “Well (clears throat) the thing that’s on my mind is, uhm, that I don’t, I don’t know…”

I was, however, quite appreciative of the fact that the transcription of the sessions included “humms,” “mmms,” “silence,” “clears the throat,” “sniffs,” and so on. I was happy to see recorded every verbal production and emission of the patient produced in transference, including tics, babble, giggles, coughs, throat clearing, slips of the tongue, hesitations, pauses, expressions of doubt, stuttering, and so on, which can be taken as readable text ready to capture the free-floating attention of the analyst. This attention to all that happens in the session, in the interstices between words and silences, foregrounds the analyst’s position as reader and addressee, which calls up Freud’s use of the German word gleichschwebende, often mistranslated as “free-floating,” when in fact it means “evenly suspended” (Lacan, 1996/2006, p.394; see also Freud, 1912/1958, p.111). Unhappily, the analyst here seems not to notice any of those productions with great potential. One great originality of psychoanalysis is that of making productive use of the refuse of everyday speech. The most productive moments in the session happen when analysands can discover something in their broken words, vacillations, mistakes, doubts, confusions, when they stop in the middle of a sentence, when they stammer, stutter, or cannot find

THE CASE OF MRS. C

a word. When the analysands stumble, or sigh, or are inconsistent between their sayings and their acts, this is the moment when something new can happen, because what is enacted in the analytic session is the “babbling being” (as proposed by P. Quignard), the staging of the speaking subject split by their unconscious.

I found myself wishing at the end of many sessions, which most likely finished exactly at the 50-minute analytic hour mark, that the session would have continued right exactly when it ended. I was frustrated by the fact that the end of the session arrived in a meaningless manner mandated by the clock just at a moment when something interesting was about to be produced. Let us recall that Lacan’s use of the “variable duration session” means changing the length of the session. In my own practice, variable sessions tend to be longer rather than shorter in duration, so as to counter the fact that an analysand may have the session prepared in advance and offer the most interesting material 50 minutes into the session, that is, around the time a traditionally timed session would have ended.

In most of the sessions of Mrs. C, the end of the session feels arbitrary or working in the service of resistance, since it often happens exactly when an important issue is brought up by the analysand. For instance, Mrs. C is exploring her transference feelings while questioning the veracity of what she is saying, something that may have been elided in the blah, blah, blah of soliloquy of the session until that moment. But the session ends abruptly at the scheduled hour without much being done about what Mrs. C said.

Ending of Session 38: PATIENT: “I also wonder sometimes if I don’t subtly do things to, uhm, make up for all the horrible things I’m saying about myself here, to counteract that in your mind.

And if maybe having you in a role of being nice to me, so that then I can talk about you in a nice way, in a sense isn’t my way to sort of, you know, make up for all these things that I’ve been saying about myself. and as if, well, in any relation to another person part of what you do with them is, is to be nice to them and oh, it’s almost like giving you a present or something, I don’t know. I don’t really know whether this is something I do do, but it just struck me that, that so many times you find that you are fooling yourself with what you’re thinking and the reasons for it—just makes me distrust everything that I do now, I think.”

ANALYST: “Well, our time’s up.”

And Another One [Ending of Session 727]: PATIENT: “Well, I just thought of a question that I think I’ve been feeling it sometimes lately but not, I didn’t even think of it quite this way—uhm, when you’ve

pointed out other things being just for that purpose that I’m doing, uhm, the question I just thought of now I think was, uhm—and maybe I’m doing two things again uhm, and, and I keep trying to think is it one or the other—but, uhm, whether this is thwarting of you, in effect not letting you have any influence, if just to fight you the way I want to fight any man or it it’s because you’re trying to make me give up something that I keep thinking I want to hang on to. But I guess it’s really part of the same thing.”

ANALYST: “Well, our time’s up.”

Again, in another session, when Mrs. C is talking about just having given birth to a baby girl, Mrs. C qualifies the experience of being pregnant and having a child, or even having another child afterwards as “unreal.”

The end of the session is so abrupt that it feels almost dismissive of the preceding material.

Ending of Session 431: PATIENT: “[…] I mean, I suppose it takes a while to really feel the reality of, of a new baby. But, uhm, this is unreal in another way. And it, it’s almost as if I can’t be aware of anything except for myself. And so I can’t be aware of her. And therefore she is unreal, except that she is there and I’m feeding her and I’m changing her, and so forth. But in some ways, she is unreal to me. And, and then, and then, the whole thing of being pregnant and having a baby seems unreal, and the whole possibility of even happening again seems unreal.”

ANALYST: “Uh, this Friday we’re going to be closed again. So I have to cancel. And our time’s up.”

Ending of Session 326: PATIENT: (pause) “…but I just started thinking of, again, a thing that puzzled me Friday, because at one point you pointed out that the two feelings I was having at that time; it was earlier than when I started talking about my mother in particular. and you’d mentioned that, I can’t remember how I was describing the feelings, but on the one hand; I mean it wanting to be a male and wanting to be a female and; you talked about, here my mother had had a baby and yet the baby was a boy and; the baby was; the boy was the favorite, or it seemed so to me and (exhales) I kept thinking, well that was right around that age of being six. But then when I started talking about feeling the way my mother feels, I couldn’t put that together with the other two things and that feeling became feeling like my mother, became much more real. And must have started much earlier.

And that left me not knowing is that a third feeling, or does it work with the other two I’d been talking about or, I don’t know, I just felt confused by that.

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ANALYST: “Well, our time’s up.”

These examples show the lost potential of intervention when not using variable length sessions. Maybe the issue of when and where to “cut” the session is not unrelated to issues of what Freud calls the bedrock of analysis: the castration complex. When Freud writes about the termination of analytic work in “Analysis Terminable and Interminable” (1937/1964), he mentions that even when an analysis is completed, a residue connected with “the riddle of sex” (p.252) will remain, eternally unfathomable, and will always cause discord. In other words, even at the end of analysis there is a deadlock, something that will never be fully resolved between subjects and their sexual being. Freud called this impossibility an “underlying bedrock” stemming from “the repudiation of femininity” (1937/1964, p.252), or otherness, an impasse for people of any gender.

Since this foundational repudiation has to do with the being of those who happen to be sexual, let us call it the bedrock of castration, or, better said, the bedrock of death, since a fundamental feature of the unconscious is a belief in its own immortality, and yet we are all condemned to death, and this “castration” is universally repudiated. “Castration” has to do with the acceptance of our own mortality, a fact often related to the desire to become a parent. Reproduction proves the mortality of the individual. One does not “duplicate” in sexual reproduction, as we often think. We do not buy a share of immortality by having children; quite the contrary. Sexual reproduction means that “the living being, by being subject to sex, has fallen under the blow of individual death” (Lacan, 1981, p.205). Reproduction does not guarantee immortality through replication; rather, it shows the uniqueness (and death) of each individual.

This bedrock of death is often heard in the clinical practice, and at times presents itself behind sexual issues.

Since for the unconscious there is no inscription of sexual difference, I wish in this case the analyst would have been less focused on penis envy and would have explored more a fragment of a session I found very intriguing dealing with issues of sexual identity. The session contains a meditation of Mrs. C that seems to anticipate Judith Butler’s Gender Trouble (1990), a first book appealing to a notion of authenticity and reducing gender to performance, to an imitation for which there is no original. Mrs. C is talking about whether or not to wear pants to the session, and the sartorial discussion continues; she has noticed her analyst wearing a casual outfit instead of the usual suit. She then comments on how uncomfortable she is when her husband pays attention to how he dresses and most importantly, to how he looks.

THE CASE OF MRS. C

From Session 433 PATIENT: (sniff ) “Because somehow, that’s, that’s the kind of thing a woman does.

And it’s alright for a woman, but it’s not alright for a man. (pause, sniff, silence) Mm, I’m not sure if my reaction to how you’re dressed fits into this, but it just seems that somehow my feeling about the way people dress that I’m close to, like with mscz [name concealed] fits into a feeling I have about, uhm, there being a distinction between, I mean, sort of exterior type distinctions between men and women that maybe have nothing to do with masculinity or femininity, except I don’t know, somehow by having those exterior distinctions, then it seems to me you become masculine or feminine. And, and then I feel more confident, or something. And, I, I don’t know, I guess it makes me think I’m, I’m not really sure what being masculine or feminine is. And so then I need those differences as, or ways people dress or something like that, as a crutch. And, and then that’s what makes the difference, or makes you masculine or feminine, which instead of just being a sign, it becomes being it, itself. (pause)” This session follows immediately after one quite interesting session when Mrs. C discusses the idea that after giving birth to her daughter and having had an episiotomy, she felt that she had lost her vagina entirely. She is first talking about fearing being sick with cancer and later she adds she was putting off having sex with her husband.

From Session 431: PATIENT: “…I was different, because I’d been stitched up. and actually, well, it took me a long ti-…I was very afraid to touch myself there at all. I found it very hard after I went to the bathroom, to wipe myself, or uhm, to bathe myself, or anything. I just didn’t want to touch myself, and I, I suppose that came partly that at first it was sore, because of the stitches. But I kept on feeling very m…, I mean, I, I think I still do feel squeamish. And then I began, when finally I was healed and there was no problem, I think I was curious to know, because I really felt I must be different. And the feeling I had, I think, was I had no vagina.”

ANALYST: “You say, you’d been sewed up, you mean?”

PATIENT: “Uhm, it was almost like, it wasn’t I mean, I knew I’d been sewed up, but it was almost as if the sewing up was just sort of, well, like cutting a buttonhole and finishing the buttonhole. The sewing up was the finishing part that I, I, as if he had just cut my vagina out when she was born, or after she was born, right after. Although I don’t, I don’t remember, of course I don’t know if I’d know, because there was so much that you think and feel at that time. But I don’t know whether that’s the beginning of when I felt that way,

or not. (pause) Or, if I had a vagina, then it was as if it had moved and it was in a different (sniff ) I don’t know, somehow a different, different shape, and, but I think the feeling was if I still had one, it was less than what I had before. And [husband] kept thinking that, and I kept denying this, I don’t know whether it’s uh, uhm, sort of emptying the Nile, but at one point I asked him if it felt any different to him. Because I really had this feeling that somehow I’m different. And he said no.

And he, he kept thinking I was worried that I couldn’t satisfy him. And that, somehow I would lose a certain aspect of my femininity if I couldn’t. And I suppose that’s uh, part of it. But I didn’t feel as if that was what really concerned me. Somehow, what concerned me had nothing to do with him. I assumed if he, if we had intercourse he could be satisfied. but yet on the other hand, I was feeling I didn’t have a vagina, and, and, seems kind of crazy, because how could I, if I didn’t have one. (sigh, sniff, pause) because that’s another thing that I, I mean it must have been on my mind. Because I know that, I mean when she, right after she was born, because uh, well, I was aware when he cut, but I did, it didn’t really bother me. I, I suppose partly because it was so fast, and at that point anyway, a-all I was thinking about was the sensations of wanting to push, and they kept telling me I had to wait. And uhm, I just didn’t; they were trying to arrange the mirror and I, and actually, they never were able to, because things were happening too fast. But I know I, my one thought was, when I knew he was about to perform the episiotomy, that I didn’t want to see it. If they did get the mirror arranged, I certainly wanted to be not looking at the mirror at that time. And uh, but then when he started sewing me up, and I had, I knew what I’d had and I don’t know if I’d seen her yet, or not. But anyway, I wasn’t going to s-, uh, I think they were doing th-, whatever they do to babies when they’re born. So I couldn’t see her right then. And I immediately I think, asked him something. I can’t remember my question exactly now but it was something to with would what he was doing now, sewing me up, have any, be affected at all by my first operation, when I’d had to be sewed up. And I don’t know, I gu-, maybe, or maybe I was wondering if he could tell where it was. Or anyway, the time when I’d fallen on the stick and had be to sewed up, came to my mind right then. And it’s almost as if I, I, I think it’s almost as if I were, just from the way I remember my question; I think of this as sort of a progressive thing that whatever happened to my, in my vagina then, was just a little bit making it not right, or bad, or abnormal, or something. and then, this time it would be a little bit more. And (pause)” ANALYST: “Do you remember shortly before we interrupted, before you went into 22

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labor, you had among other things thought about an operation your mother had after [daughter] was born?”

PATIENT: “Hmm.” ANALYST: “For some reason that occurs to me now.”

PATIENT: “Because that, that’s kind of funny, actually. (chuckle) because my mother came down after [daughter] was born, to uhm, help me in my first week home. And I’d been, I w-, that was on my mind then too, because I was wondering just what had happened. Why had she had a hysterectomy then, or something? And it turned out that that operation was a year after he was born.

And that particular operation, which I was recalling, was an operation for hemorrhoids, not a hysterectomy. Although, and so then I was thinking [husband] and I were laughing about it because, uhm, at first I was wondering, well did she ever have a hysterectomy.

And then later on, uhm, she said something and, and, and said, “when I had my hyster-” Oh, I know, we were talking about appendix and appendicitis and she said, “Well, when I had my hysterectomy, they took my appendix out, too.” So I, now I don’t even know when that was. But yet that’s how I thought of it.

And it was a year after mlwz, not right after. (pause) Well, I think, uh, I know I’m sort of dodging some of the connections in, in thinking of that operation. and then my feeling about s-, my vagina being cut away slowly, or taken away completely. But uhm, I was just thinking that the, I was thinking the reason I must have assumed that’s when she had the hysterectomy, whenever I knew she had had one, the thought of it was that I was always feeling that they were just having children until they had a boy. And once they’d had a boy, my mother didn’t mind having an operation so she couldn’t have any more. And that she would have had this at anytime, after she’d had a boy. That was my feeling. I know, because that makes me wonder too, of how much I’m not admitting my feelings about the fact that fso was a girl. And uhm, all the time I was pregnant, well, we referred to the fetus as ‘he’, because I guess you do if you don’t want to refer to it as ‘it’. And that I think made it another thing that made it very hard to connect her with my being pregnant, among all the things that probably make it hard. And wh- when she was born, somebody said it was a girl. And I had, my immediate feeling was, oh, who are they talking about, who else is in the room having a baby? Because I, I don’t know, I just, it didn’t connect with me at all in my mind.

And I think I was disappointed, but then I immediately tried not to admit I was disappointed. (pause) I guess what right now, what I was thinking about, the fact that I connected this operation my mother had that particular time, which is the only one I’ve recalled, and thought of it as a hysterectomy when it was

THE CASE OF MRS. C

a hemorrhoid operation, it made me think of the fact, I’ve been sort of suspicious, and [husband] sort of joked me about this, too. That uhm, I’ve well, recently, I, I do have hemorrhoids now. I don’t know when I got them or how long I’ve had them. But uhm, and I’ve had problems with them; I still am. And I, I don’t know how much you can kind of keep them going. But again, it’s almost like it’s another thing to concentrate on so I don’t have to concentrate on something else. because uhm, well they got really bad and, and I got a prescription from my doctor, which took care of them. And then they started up again. And I just wonder if they really would have started up again, except that maybe I want them to for some reason. But in the hospital, I kept asking if I had any, and they—because I felt as if I had them, but I’d never had them before, so I didn’t know. And the nurses kept, or whoever, I don’t even, I think I even asked my doctor one time. And anyway, a-anybody I asked, said no. And so for awhile when I was home, things weren’t very bad. I mean, I wasn’t that comfortable, but they weren’t that bad. And, and yet I kept thinking about it, wondering if I got them. So it’s almost as if I wanted to have them. (silence) Because I, I, again I think of uhm, you pointing out that I was thinking of this operation of my mother’s before, and then these feelings I’ve had about myself after fso’s birth. And it makes me think again of something I’ve been aware of off and on, ever since she’s been born. How, I don’t know, at times I just feel she’s so unreal, in a way….”

Mrs. C thinks she had lost her vagina and starts talking about a buttonhole. She may have lost her vagina but she thinks that she has hemorrhoids. She moves from the genital back to the anal, slightly disappointed for having had a daughter and not a son.

Many sessions later, analyst and analysand discuss penis envy, castrating the analyst, but miss the truly idiosyncratic elements like the “buttonhole,” (butthole?) and the recurrent repetition of the pronoun “I” that could reveal Mrs. C’s uniqueness, her subjectivity as deployed in the fantasies about femininity triggered by the birth of a daughter.

I will conclude by saying that despite the missed opportunities, something promising happens in this analysis. Perhaps the frame of analysis that has been rigorously followed here is more effective at producing results than the analyst’s interventions. The analysand, Mrs. C, starts questioning herself, asking whether or not she can wear the pants, wondering about what is a woman and drawing questions about the difference between femininity and masculinity, moving from talking about sex with her husband as “intercourse” to “making love” later. She explores what is satisfying to her, talks about loss: losing her virginity, losing her vagina, about the buttonhole of lack allowing desire to exist, something about the penis

of the analyst becoming just the voice she will take away, the portable object that moves metonymically from one object to another, all the while as we see her gradually assuming responsibility about her choices of jouissance, when she admits that she wants to feel as if she was raped and thus perhaps hide her own desire. Here I will present the last fragment of the session just before the summer vacation, where we see the analyst playing with humor, which brings to mind Lacan’s observation that the closer psychoanalysis gets to being funny, the closer we are to real psychoanalysis.

From Session 728: PATIENT: “…And, uhm, well, the, the way I think of it I have this feeling if I don’t close up all this now, then I’ll go away and then I’ll get myself all tied up in knots. So I don’t want to have anything that I don’t think

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I can handle, I think that’s it.”

ANALYST: “What can’t you handle?

Besides murder and rape?”

PATIENT: (laughs) “Your penis…” z REFERENCES Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY and London, England: Routledge.

Feinberg, E., Malater, E., Webster, J., Royal, J., Poznansky, O., & Wallerstein, H. (2015). Without history: An experiment in case presentation. DIVISION/Review, 13, 32-36.

Freud, S. (1958). Recommendations to physicians practising psycho-analysis. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 12, pp.109-120). London, England: Hogarth Press. (Original work published 1912) Freud, S. (1964). Analysis terminable and interminable.

In J. Strachey (Ed. And Trans.), Standard edition (Vol. 23, pp.209-254). London, England: Hogarth Press. (Original work published 1937) Lacan, J. (1981). The Four Fundamental Concepts of Psychoanalysis: The Seminar of Jacques Lacan, Book 11 (ed. J. A. Miller, trans. A. Sheridan). New York: Norton.

Lacan, J. (2006). Écrits: The first complete edition in English (Bruce Fink, Trans.). New York, NY: W.W. Norton & Co. (Original work published 1966.)

THE CASE OF MRS. C

“As If” We Were There: Bion and the Recorded Session The archive comes to us and calls to us.

Preceded by a disclaimer, “please treat this as if it were private patient material,” this document is indeed “as if ” private. If it is patient material, what matter of material is it? Maybe its materiality is precisely what is at stake, captured on a document that can be printed on paper or read on a laptop or iPad; all possibilities that the patient, known as Mrs. C, could not possibly know about any more than those who conceived this experiment in recording and archivization did. What did those who conceived this project want from this experiment? What do we do with their apparent wishes to hold and contain something through microphone, tape, and transcription that would otherwise have escaped?

You might imagine the transcript to contain the raw report, the blow-by-blow of a he said/she said, refreshingly free of professional commentary from those who know better after the fact, and to some extent, that is true.

But the transcript also includes the gravitas of parenthetical numbers at regular intervals as well as the numbered turns of the analyst and analysand in each session, marking the text as a document to be pondered, cited, and recited with reference to these numbers. These markings transmit to the reader a subtle demand to undertake a serious study through reading and re-reading. To start with, this is something I want to resist, although I know that eventually I will heed the desire that I imagine I am inheriting, that the text be read and studied.

If I am honest, I have to admit that I do want to return to the text, to re-read it, to honor these oddly preserved exchanges from so long ago. But before I do, I want to allow for my impressions from my one and, so far, only reading of the sessions of Mrs. C to be inscribed. In doing so, I may be trying to recreate the materiality of the session “as if ” it were patient material, spoken and imperfectly recalled, but not recorded or subject to precise capture such that each moment can be replayed at will, as if Mrs. C were always ready to tentatively suggest that the schedule of sessions was becoming a bit much with the addition of her recent baby, only to be always duly denied an adjustment, most memorably in the final moment of the session, by this analyst with a clear talent for harshly forbidding endings. (“I cannot make that schedule adjustment and we are out of time.”)

To defend myself against the imagined demand to study, read, and re-read, at least for a while, I will rely on Bion’s writing on memory and desire, texts that I will ironically read and re-read to theoretically bolster my disinclination to do the same to the case transcripts. In “Memory and Desire,” Bion (2014)

makes it clear that he is no fan of the case presentation in general. He regards case presentations as inevitably distorted by the desires of the practitioner and the audience that receives it. He objects to the way such presentations assume the use of everyday memory aided by note taking, which he contends is precisely the sort of conscious processing that psychoanalysis should eschew. To take notes, to tell a story of what happened, to retell it as if to transmit it, is to rely on images, sensual and emotional manipulation—what Lacan referred to as the imaginary.

But isn’t this objection the exact reason why recordings are so necessary? What better means can we devise to oppose the long history of distorted, if not self-serving, narratives? With a recording, we can finally hear the patient speak in her own words, in her own voice. Indeed, reading the transcripts of Mrs. C is a singular pleasure and one I am glad to have had the chance to experience.

Reading one session after another, it is not too much to claim literary value for the resulting text. Mrs. C is nothing if not a master of free association, and her analyst deserves credit for creating the conditions that allowed for this. While others may confess exhaustion or irritation at following the meandering flow of her associations, I was charmed, amused, and delighted at the skill of her performance, if I may call it that. This is not to insult Mrs. C: one truly gets the sense that she performs her role with unparalleled intuition regarding the desire of the analyst, that she performs her desire to castrate him, to irritate him, to ignore him, to wish him dead. The culmination of the comedy is that while she does her best to wish her analyst dead, she confesses that even this is only a way of killing her husband in effigy. Her analyst is doubly murdered by her consistent indifference to him.

This too is a tribute to the analyst, who is so self-effacing, so minimal in his enunciations, so willing to make patently goofy interpretations that we can only respect his effort and the results it produced, a stream of consciousness that is what I imagined Ulysses to be like until I read Ulysses.

What then is the problem? Perhaps my Bionion critique is not against the practice of recording sessions as such, but more a caution against the temptation to regard them as the thing itself, the actual session. By this, I am not making claims for some quasi-mystical benefit of body language, voice tone, or any other sensual thing that is missing that we should wish was present. The answer is not a modern high-definition version, possibly a virtual reality recording of a session that would supplement what is missing with the most modern technology. The Bionion 24

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caution is that this recording already presents us with too much, and that this too muchness is what allows us to imagine we are receiving anything but an echo of something that once passed between these two people. It is too much, but perhaps it would not be too much if it didn’t already meet a compelling pre-existing desire to avoid subjectivity, castration, and loss. In fact, Bion’s caution goes further than my own in refuting the use of memory devices and case summaries of all kinds, seeing them as devices in service of the analyst’s anxiety rather than in service of preparing one to face patients in all their unpredictability.

He writes, Now, I want to remind you of the conventional view which crops up where there is a tendency to feel that it is important to remember what takes place in an analysis; that it is important to find some method by which you record it—to write notes or use a recording machine and so forth—and the more critical the situation becomes—the more important it is felt to be to be able to remember what took place today in that patient’s analysis, what took place yesterday, and so on. The view that I am wanting to put is that this view is entirely mistaken. And not only mistaken, but positively bad for your analytic work.

(Bion, 2014) While I would not go so far, I do agree that the presence of a recording might lend itself to specific transferential effects that are easy to miss in view of the apparent facticity and sense of objectivity suggested by a recording. In fact, a common reaction from analysts who have read or heard portions of the transcript is anger, sometimes even accompanied by a fantasy that they should like to have a chance to address Mrs. C herself, to apologize to her for her analyst on behalf of modern psychoanalysis or that we might find her, bring her to speak in the present, so that we would not only have her transcripts but herself, in person, ready to refute her old-fashioned classical analyst and embrace the promise of today’s more attuned and emotionally intelligent generation. Doesn’t this suggest the possibility that far from a more objective analysis, exposure to the recording tempts us to fantasize constructions based on the seeming objectivity of a recording? This seductive form of apparent objectivity threatens to distract us from the presence of something crucial for psychoanalytic thinking: the presence of unconscious fantasy.

Jamieson Webster aptly notes that she has never read or heard a recording of a session without hating the analyst. There seems

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to be a double movement of identification and refutation in effect, perhaps similar to our hatred of hearing any recording of our voice. This is me? This cannot be me! That double movement reappears in the context of the Mrs. C transcripts as, “This is an analyst?

This cannot be an analyst!” And yet, we have no evidence whatsoever that Mrs. C would want an apology for her analytic experience, nor that she would consider any other analyst capable of rendering it even if she did.

What if instead Mrs. C. were to say that her analysis was a great help to her? Or worst of all, what if she did come to address all the analysts who have read these transcripts and met their rapt curiosity with the admission that after all, this was a long time ago, that it was probably helpful, maybe frustrating, but overall, forgotten, gone in the dustbin of discarded memories. Wouldn’t this be the most appropriate response to the disavowed heart of the case, the struggle to avoid loss that is rendered as so many discussions of scheduling and penises?

Indeed, I read and receive Mrs. C’s discourse as a moving meditation on loss, but beyond this, about what Bion might call the O, the ultimate reality of the case: the actual recording and the desire inherent in the project that led to it. It seems possible to say that what the project was doing was not only what it thought it was doing. While the intention is to preserve for research a part of the past, what we actually ended up getting is, arguably, a piece of the future that is now our present. The project of the recording is the ultimate project of technology in our times, to record it, to have it all at hand for research, analysis, and enjoyment without loss in time or space. The recording can now be seen as a relic of the internet-to-come. As such, our reading of it should also be not a reading of what has been, but rather of what these transcripts will become. At the same time, in beckoning towards the future, this transcript is itself an impossibly rare object. In a time where everything is available to everyone all the time, this document is seen by very few, for understandable clinical reasons that nevertheless situate the text at a precise crossroad between past and future. For example, we can now read the text not only as a meditation on loss, but also in a more contemporary vein about the loss of loss in the social imaginary.

That is to say that following the early utopian hopes for the Internet, today we face the loss of loss engendered by the realization that we do not actually have everything, that in making everything ready at hand, what is lost is what we had when we did not have everything. For his part, Bion also emphasized the question of the future as a question of training techniques. How, he asks, can we possibly train analysts to face the patient they will see tomorrow by reviewing an already known and

summarized case of a patient that was seen yesterday? This is a situation he equates with training to play tennis, a game that features a rapidly moving object, by practicing golf, a game that features a static object.

That being said, my intention here is not to follow Bion’s advice to the letter, but rather to read Bion against Bion. If we find ourselves with a golf ball on the tennis court, perhaps we can still play ball. The question is not whether we should embrace or reject the recording—such judgments rarely have a place in psychoanalytic thinking—but rather what kind of game we want to play with it.

My suggestion is that we read the transcripts in the way that Bion advises we approach the session, without memory or desire, not with a wish to grab hold of the thing itself or to imagine ourselves as witnesses to a private space with all of the primal scene fantasies that suggests. In particular, I am most interested to read the O of the sessions as concerning the ultimate reality of a largely avoided discussion of the desire to record, a desire that informs the analyst, but which precedes him as the desire of other analytic others. If we proceed in this manner, it is not necessary to literally avoid re-reading or studying the text as long as we avoid confusing that with the presence of the actual session.

The point of saying that the recording is the O of these transcripts is not simply to affirm the reality of the situation (i.e., that it was recorded) or to say something as banal as the fact that recording the session no doubt has effects on the experiences of both patient and analyst. Rather, what is striking and moving in this transcript is the manner in which the discussion of the recording contains so much that helps us interpret what otherwise seems to be an ongoing analysis of aggression and castration or penis envy. If the patient indeed disavows her aggression (actually she seems rather happy to confirm her wish to kill both analyst and husband), so too does the analyst seem to disavow his own fear of forgetting.

Nowhere is this more apparent than in the scene in which he confronts the patient for her continual forgetting, the way in which what he said only the prior day seems absolutely forgotten as she starts the next session.

His frustration is palpable as it is puzzling, since this is hardly a radical state of affairs in psychoanalysis; it is more the rule. It is as if this all too familiar state of affairs is rendered intolerable by the background presence of the tape, that which would assure memory. While some forms of forgetting are no doubt based in resistance, it is as if there can be no other forgetting than that which can be redeemed or transformed via defense interpretation.

But what of the forgetting that is simply and inevitably truly forgotten and beyond recovery? As Lacan states, the only resistance is the resistance of the analyst, here presented as a 25

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resistance to forgetting along with the reality of death and absence it portends.

How would we hear what is being said by both analyst and analysand about forgetting if we listened through Bion’s impossible imperative to the analyst to forgo both memory and desire? Whether one accepts or refutes Bion’s still controversial notions, his radical stance on memory and forgetting must be considered. Simply put, there is no way to consider a project of memory through recording without taking into account a theory that not only allows for forgetting, but in some ways desires it, even as it goes on to desire the suspension of desire as well.

Session 431 offers a stunning stream of associations elaborated by Mrs. C; orbiting around an initial question of why she has come back to analysis (and why she resisted coming back), we find a series of images in dynamic transformation. The occasion of return to analysis is seen on another level to be the scene of a painful labor, as her associations go from this return to treatment to another treatment, the recent birth of her daughter. At stake are the various forms of labor she undertakes as mother, as lover, as patient. Following her labor, which, according to her, was not hard, which might have been easy, in which she resisted any pain medication, she was stitched up. They offer a mirror, but she refuses to see it, the cut was made, she didn’t see it, she refused to look in the mirror, and it was done. Later, she wonders what happened. A series of images contrast a sense of absolute loss with a coexisting sense of something excessive and foreign placed inside her. Her vagina might be gone, stitched up sadistically as if she had become a masochist in a scene from de Sade. Then again, she wonders if her vagina has changed through a series of blows and injuries, in which case this change would not be a sudden and radical removal, but the constant presence of foreign objects poking and prodding her through the years till the final vaginal change sets in, till her vagina is cut and lost, a vaginal castration, the loss of loss, not of her husband’s penis, which she dutifully receives in “intercourse” described as painful and bad (“…I wasn’t, wasn’t upset that it had been bad in itself ”) nor of her analyst’s penis, which comes up with alarming regularity, but of her non-penis, her vagina which doesn’t feel the same, which might be gone altogether.

Mrs. C finds herself quite disturbed by sex after her daughter’s birth, which her husband jokes is “the loss of my second virginity.” (“I couldn’t understand why I was crying, except somehow I felt as if something were being taken away from me, or I’d lost something and he was kind of joking about I’d lost my second virginity, which maybe, I, I, I, I…”). What really bothers her is the pleasure she takes in breastfeeding her new daughter after a session of intercourse with her husband, which she describes

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as bad and uncomfortable. Previously, she had rarely taken pleasure in breastfeeding her new daughter, whom she admits she thought was a boy when she was pregnant. In the midst of this, her associations veer back to the analysis, that other form of hard work that she resists, while presenting a series of compellingly legitimate practical obstacles to resuming analysis which don’t even convince her, (. . . “I can’t see wh-, what I think the problem is, so it must be I just don’t want to face things, because I don’t want to keep feeling, well, for one thing, as I did when (my husband) and I were having intercourse . . .”). The analysis again morphs into the scene of labor. She pushes, she tries so hard, (“I couldn’t push, and, and I wanted to extremely badly, and I found that hard. But I, that sort of is faded in the, my memory, and I hardly remember it now”). She gets stitched up. She had a girl, but she thought all along it was a boy, but it was not, it was something else (“it was almost as if I knew there was something else entirely than [my daughter]”).

Impossible excess vies with absolute absence, the loss of the son she thought of, the loss of the vagina, which is sewn up, which is itself the loss of the penis she never had. Thoughts of loss turn to thoughts of when she had her IUD put in, the son she never had, like the IUD (“. . . there was this foreign thing in me. Now I don’t think about it much, though I still do though, and th-there’s no feeling”), is a foreign object, something inside her that does not belong. Talk of something that does not belong becomes talk of cancer, another image of impossible, destructive excess, which again becomes talk of her fear that she lost her vagina. As we have seen, all of this is woven into a series of thoughts on why she comes back and why she resists therapy, as if the answer is nothing that can be answered without this overdetermined imagery, which explains why she has come back. There is no doubt that her analysis is all of it: the labor, the intercourse, the insertion of the foreign object, the numbness and the birth of a child that seems to be the wrong child and most of all, the remembering and the forgetting, the loss and the loss of loss.

Little Pieces of Yesterday The sessions go on, the wheels of the recorder go round and round, recording these sessions, maybe making the slightest sound or maybe one only imagines that they make a sound, even if they manage to operate with complete silence and stealth. It is not clear when the analyst hits the record button; probably before she comes in. Probably the stop button is pushed after she leaves. That’s how I imagine it happened anyway. It is hard to stop thinking about the recorder or to know what to do with its presence. At some point, the sessions seem to circle around the recorder, first implicitly with its countless concerns about forgetting.

From Session 726, fragments: PATIENT: “…it just seemed to me that yesterday was just, uhm, things I felt I was understanding yesterday were just vague enough, or, uhm, out of my reach enough so that I was losing it. And, and just the feeling that I have that I have to be coming here in order not to lose it.”

PATIENT: “…it was to do with the feeling that I couldn’t share and how antagonistic I guess it was that, that I decided I couldn’t but, but that, that is a very specific thing, too, that I was questioning yesterday.

And, and I didn’t feel I was quite getting it.

And now I f- don’t feel I have it at all. I keep remembering little pieces of yesterday.”

What gets inscribed and what is lost, what is necessary to make an impact, to remember, what is necessary to inscribe the analyst in her memory, to shatter her shield of apparent indifference. The analyst is pushing against her block against inscription, against recording, against recording him. He says, ANALYST: “…the fact is that you are, uhm, being antagonistic, or whatever you want to call it, in a whole lot of different ways.

One, another way to summarize what you’ve been saying is that I don’t have any effect on you, that you can’t remember things I say. But on the other hand you threaten me by saying if you don’t really break through before the end of the week all is lost.”

He continues: ANALYST: “[T]he fantasy behind this seems rather clear. It’s been consistent. You are acting in a way to provoke me to have to really forcefully attack you, kind of mentally rape you, make you do what you want to do… uh, that would give you an occasion to really fight back.

And it’s the details of that fighting that I put into words and you said yes, that’s true and you have avoided it ever since, so you keep, in one way or another, by your behavior, inviting me to as you say break through, to rape you, to attack you, then you’ll have an occasion to fight back and kick me in the groin and destroy me.”

Mrs. C replies, veering away from the question of her wish to destroy her analyst and her husband, which she acknowledges in a rather matter-of-fact way in passing, instead brings the focus to the tape; she doesn’t force the analyst to rape her, she doesn’t provoke him into letting her kick him in the groin. She does get him to allow her to talk about the tape: PATIENT: “…and I’m not sure, uhm, (sighs) but something led me to, uhm think back to what you had said that got, got in the way that I am right now. And I don’t know, it’s as if I’m, what I’m trying to do is replay exactly what you said and then everything that’s been said since then uh, as if it’s a recording in my mind so that when I leave here I’ll have it. And if I can’t do that then I won’t have it when I leave here.”

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You will recall that these transcripts, should you receive a portion of them to review, carry a reminder, “Please treat this as if it were private patient material.” Mrs. C, in turn, now tells us that her session feels “as if it’s a recording in my mind.” How can we understand, outside the tape and the transcript, the transmission of this “as if ”? We are in the presence of both a recording and something that is “as if ” a recording, just as we are in the presence of something that is patient material and as-if patient material. This “as if ” eludes memory and desire; it can’t be fully recorded or remembered. In any case, Mrs. C has gotten the analyst to speak of the tape, as if there is both session and recording of session. The analyst replies, “Yeah, what does recording bring to mind?”

Mrs. C replies, “Well, that you’ll have a recording. Well, I don’t know, I mean there must be something more than that you would and I won’t. (pause)” A recording brings to mind that he will have a recording. And she will not. A recording brings to mind what he can bring to mind that she cannot. He has it and that is all. A recording brings to mind that he has a recording. He has the recording, all of it. It is as if he has it all. She continues: PATIENT: “[W]hen I was beginning to think all of this I was wondering am I just feeling this kind of feeling that—uhm, will I be able to hang on to what I’ve just been thinking about it I’m already forgetting it and uhm, it hasn’t really made that much of an impression on me, or something like that, and I’m not sure because the feeling I had when I was thinking of it, was really trying hard to recall everything that was said and, and, uhm, sort of get a mental recording and, uhm, yet why would I suddenly think that in the middle of thinking what I was?”

These sessions are not ordinary sessions. Existing as they do, uniquely, as a document of a completely recorded analysis, they are sessions that proceed with a desire to find something real about the practice of psychoanalysis. In doing so, these sessions inevitably return to the instruments of listening, remembering, and forgetting. It is about the tape, but it is not about the tape. It is as if about the tape, as if about the recordings. The analyst tries to reorient the discussion away from the tape. Since she says that the tape is what he has that she has, he tells her, of course, that the tape is his penis. She is rather unimpressed by this. It is not that it is untrue. The tape is his penis, of course. It is what he has that she doesn’t have. But the analyst has not heard clearly enough. The tape is as if the analyst’s penis. The recording is as if patient material.

It is not surprising that a psychoanalyst would so quickly translate the matter of the tape recording to a case of penis envy

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and aggression, but it is more than that. The matter of the tape recording brings us to Bion’s writing on the place of memory and desire in analytic technique—for him, there is no place for either as far as the analyst is concerned. Unfortunately, Bion’s advice on memory and desire is rarely taken up in a serious way. Instead, it is often seen as a fascinating Zen-like koan and left at that. But

Bion’s concern was not esoteric or mystical; in fact, it is the essence of practicality. He helped articulate the possibility of a defensive use of memory and desire (for theory, for the cure) to defend against an element that is troubling and unknowable in the psychoanalytic encounter. It is this which I see at play in the excerpts from Mrs. C’s analysis and this which causes us to imagine that we

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can render judgment on these sessions from the words that resound so many years later, as if they were patient material. z REFERENCES

Bion, W. R. (2014). Memory and desire. In Complete works of W. R. Bion (Chris Mawson, Ed.) (Vol. VI, p.11). London, England: Karnac.

THE CASE OF MRS. C

From Penis Envy as Bedrock to Metaphor: A Close Process Examination of the Analysis of Mrs. C Leon HOFFMAN

In this clinical discussion of Mrs. C, I discuss selected sessions from several time periods. Interspersed among the clinical material, I highlight various issues, particularly referable to the methodology utilized when the analyst proffered an intervention in contrast to what I might have said in the present. Mrs. C was in a “classical” analysis in the late 1960s and early 1970s. From the classical perspective, this was a period before the development and recognition of Paul Gray’s close process monitoring. Gray’s first paper was published in 1973. I highlight Gray’s perspective, in contrast to other theoretical perspectives, because he worked within the “American classical tradition,” and his is a technique with which I am intimately familiar. Gray promoted an important technical recommendation, which he considered to be an extension of Anna Freud’s basic work on the importance of defense mechanisms. Gray (1982) noted that his contributions undid the lag in psychoanalytic technique. He maintained that traditional psychoanalysts did not focus enough on defensive maneuvers by the patient as they appeared in the analytic sessions. He contrasted his version of defense analysis with what he called “traditional analysis” (Gray, 1996). Among the many distinctions between the two approaches, he highlighted a central differentiation: In preparing for interpretations, traditional analysts turn their attention to awareness of their own “free associations” to the material. This may mean creative ways of resonating to their own unconscious (this is a listening capacity that cannot be taught) or drawing rapidly on their memory of acquired knowledge of hypothetically relevant dynamics or meanings.

In preparing for interventions, analysts practicing close process attention focus consistently on patients’ verbal/vocal flow of material. Analysts’ comprehension and memory of what they are observing in this manifest field is of central importance, but they do not use their own unconsciously influenced “free association.” This is a form of analytic listening that can be taught.

(Gray, 1996, p.94) As a child and adolescent analyst, I have valorized Gray’s perspective of staying close to the analytic material and giving priority to what has been called “experience-near” interventions (Bornstein, 1949; Hoffman, 2008, 2014; Hoffman et

al., 2016, 2017). With such interventions, whether in psychoanalysis or psychotherapy, the analyst stays close to the analytic surface as much as possible, usually pointing out to the patient how he or she avoids certain thoughts and feelings. Addressing this avoidance enables the patient to continue free associating, or playing in the case of children, without the analyst “putting words” into the patient’s mouth, that is, promoting certain themes.

In a perusal of Mrs. C’s sessions, it is not difficult to ascertain that the analyst was working within a traditional classical model: addressing wishes, defenses, and unconscious fantasies, allowing his own fantasies to have free reign, and without a close process perspective. In addition, it is important to note that this analysis took place before the re-evaluation of Freud’s concept of female sexuality since Freud’s (1932) elision of Karen Horney’s (1924/1967, 1926/1967, 1933/1967) conception of female sexuality, including the defensive nature of penis envy.

Horney’s early ideas were eventually revived (discussed by Hoffman, 1996). In this vein, the works of Grossman (1976) and Grossman and Stewart (1976) are particularly important because they were members of a group of classical analysts re-examining concepts of feminine psychology. Their central contribution involved a reconceptualization of the construct of penis envy to be not an immutable truth about women, but rather a metaphor or manifest content with various underlying determinants. The manifest content of penis envy needed to be analyzed, and the underlying meanings and fantasies to be understood.

Session Material Explication of Penis Envy Session 326 In this session, many themes emerged.

Mrs. C discussed her wish/ambivalence about getting pregnant and her plan to find out if she was pregnant. She compared intercourse to the close bond between a mother and a nursing baby. She thought of her connection to her mother and the rivalry with her older sister and how the sister must have felt when she was born. At one point, Mrs. C brought up that she had made love with her husband. She fairly quickly shifted to describing being angry with her cat that day and returned to her obsession as to whether she should ask the analyst to change the session time when her school semester ends [she was a teacher]. She ended this sequence with the following: 28

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PATIENT: “Because somehow I should have better control over myself or I should not use it as a threat to you that I might be getting angry if you don’t do it or; I think I somehow connect it with my feelings about paying you or not when I don’t come.

Because I think sometimes the thought has occurred to me then, too, that if I’m having a problem over it, that you decide to charge me, because how am I ever going to work out the problem, if you don’t. And then it, then I start wondering why I’m thinking this now, if maybe it’s not another strategy which I’ll; just makes me think about the fact that I’m trying to outguess you. Or, I don’t know if outguess you is the word, but just guess before I say anything or do anything what your reaction will be. And I go through such complex imaginings about it that I never just simply ask and find out.”

The analyst responded: ANALYST: “Well, it seems to me the central thing is that, mm (uh), the very idea that I wouldn’t do what you want makes you mad.”

In a particularly important piece of self-reflection, the patient asked herself, “Why I’m thinking this now?” The analyst responded quickly and definitively. He said that if he did not do what she wanted, she would be mad at him. With a close-process monitoring technique, an analyst might have said, “You ask a very good question, why did you start worrying right now, whether I could change the session times or not charge the fee. You know, we started to talk about your difficulty with telling me, in words, about your sexual activity. Then you told me how you got angry with the cat and now with me. Did you shift from talking about lovemaking to feeling angry because talking about making love was too difficult?”

Interestingly enough, the analyst focused on the patient’s aggression qua aggression and not as a defense against emerging sexual feelings; certainly towards the husband, and perhaps towards the analyst in the transference. Considering the analyst’s authoritative stance, one has to wonder whether he knew that her central issue involved her anger. He communicated this forcefully and with self-assurance; that is, he communicated that he possessed the expertise to know.

One could consider that this authoritative stance by the analyst provided a safety zone for the patient as she had earlier described in connection to her dream: that she needed a benevolent controlling figure. This approach can certainly, in my opinion, be considered one of the common factors. The analyst’s comment led the patient to elaborate her

THE CASE OF MRS. C

aggressive feelings towards her husband and, peripherally, the analyst. This line of thought, then, led to the theme of penis envy.

PATIENT: [regarding husband] “…he’d become more compliant. (pause) Somehow that; again I was thinking about talking about my mother’s feelings, mainly because I was feeling them. And, especially this idea that she has always wan; been sort of a castrating female like I know often I’ve felt like being and; it seems that this feeling of anger, that I’m very aware of today is part of it.

Just feeling that men aren’t going to give me something that I want. And they have things I don’t want, or one thing in particular.”

ANALYST: “Don’t?”

PATIENT: “That I, no I don’t know why I said that.”

ANALYST: “Sour grapes?”

In this small section, the analyst implied that the patient denied defensively

that she wanted what the man possessed.

The analyst’s use of the words “sour grapes” highlighted her defensive denial and her anger. That is, the analyst was sure that the patient suffered from penis envy and wanted to castrate her husband (and obviously perhaps the analyst too).

PATIENT: “mm (hmm) (said laughingly). I don’t know. I was thinking ‘want.’ I don’t know, maybe it is part of this attitude of, ‘I don’t have it, but I don’t need it and I don’t care. I can do just as well without it, and I can compete with men without a penis.’ I think that’s part of the attitude, too. But then I never really feel I can. And I always feel angry because I’m not getting a penis from some man.

I mean he’s just not giving up his masculinity to me. And, and in any way that it means that I think that’s one reason why I get angry at [husband] and that that whole feeling of trying to make him take on my roles as a woman,

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doing dishes and that all that kind of thing, because he’d give up some prerogative as a male, that he doesn’t have to. And somehow if he gave it up, I would get it. And I don’t know how I’d work that out, but; well, I’d be more managing. I decided that he was going to do the dishes, so I guess that would be it. (pause) But I just started thinking of, again, a thing that puzzled me Friday, because at one point you pointed out that the two feelings I was having at that time; it was earlier than when I started talking about my mother in particular. and you’d mentioned that, I can’t remember how I was describing the feelings, but on the one hand; I mean it wanting to be a male and wanting to be a female and; you talked about, here my mother had had a baby and yet the baby was a boy and; the baby was; the boy was the favorite, or it seemed so to me and; (exhales). I kept thinking, well that was right around that age of being six.

But then when I started talking about feeling the way my mother feels, I couldn’t put that together with the other two things and that feeling became feeling like my mother, became much more real. And must have started much earlier. and that left me not knowing is that a third feeling, or does it work with the other two I’d been talking about or, I don’t know, I just felt confused by that.”

How can we judge the patient’s emotional conviction of her associations leading to the expression of castrative wishes towards a man in order to overcome her penis envy? Clinically, that is unclear. In a transcript, we can read the patient’s and the analyst’s words, but we do not hear the tones expressed in the sessions. On its face, the patient seems very comfortable in following the analyst’s lead in focusing on her aggression, although she ends the session with a statement that she is confused.

The analyst, in essence, labeled the emotion as “anger.” Did the patient’s conscious emotional experience of anger simply subside, as she seemingly, in a matter-of-fact way, verbally expressed potentially painful subjects?

Affect labeling increases prefrontal, that is, cognitive, activity and decreases amygdala reactivity (Burklund et al., 2014). Bucci et al.

(2016) contrast the dampening of emotions by affect labeling with the intensification of emotions during story-telling. The degree of emotional intensity of the narrative can be assessed by utilizing the linguistic measures associated with the referential process.

What would have emerged had the analyst addressed the defensive meaning of the aggression? Would a more emotionally rich narrative have ensued, allowing the patient to deal more fully, in greater depth, with both her aggressive and sexual wishes? Gray (2000) notes that the traditional method of psychoanalysis, by repeated content interpretations instead of defense interpretations,

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has a suggestive effect on the patient via reinforcing the patient’s superego to essentially submit to the analyst. The traditional classical technique, thus, can block access to an indepth exploration of the patient’s conflicted aggression (and libidinal wishes). It is important to note that throughout the session material, overtly sexual or loving transference feelings were absent, even though one can

infer the consciousness of those feelings just below the surface within the patient.

Is there a particular personality structure that allows a patient to respond positively to an analyst’s assertive communication? When an analyst communicates an expertise about the meaning of the patient’s productions, which patients accept those ideas fairly readily? And, conversely, are there some patients

who respond more positively to a more open-ended, less directive approach? Sidney Blatt proposed that introjective patients require different techniques as compared to anaclitic patients (Blatt & Shahar, 2004).

Blatt’s distinction is the only avenue of which I am aware that attempts to systematically judge the relative efficacy of different psychotherapeutic techniques. Whether Blatt’s distinction is relevant to Mrs. C requires further study. However, it is clear that many such issues need to be evaluated for the field to progress.

After the Birth of a Daughter Sessions 431-433 Early in the first session of this triad, the analyst interpreted the defensive meaning of the patient’s delaying return to the analysis after the birth of her child, that is, avoiding her conflicting emotions. The issues that emerged included issues related to motherhood conflicting with sexual desires; worries about damage to or even loss of her vagina from the episiotomy; and disappointment that she had a girl instead of a boy. While the patient was discussing her fears that she no longer had a vagina, the analyst communicated his associations from before the interruption that her mother had an operation after a sibling was born: ANALYST: “Do you remember shortly before we interrupted, before you went into labor, you had among other things thought about an operation your mother had after [a sibling] was born? For some reason that occurs to me now.”

This is an example of what Gray identified as one of the problems with the traditional technique: the analyst communicating his free associations to the patient.

Mrs. C went on to remember that her mother had a hysterectomy after the brother was born (they had children until she gave birth to a boy). This was associated with her disappointment that she had a girl and not a boy. In the second session of this series, she continued to discuss various themes: difficulty in asserting herself and wanting approval from her father and the analyst that she had given birth. The analyst pointed out how her expression of pride in giving birth was quickly erased by something she did not get. Mrs. C went back to her anxiety about whether he could change the time of the Friday session; the session ended with the analyst noting that he could not.

In the next session (session 433), the patient begins: Patient: (4-minute silence) “It was, sort of two things are on my mind and uhm, I hadn’t thought one was really directly con-, well I mean, it is connected with you. But as I’ve been quiet, I, I see it differently than

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THE CASE OF MRS. C

I did when I thought of it. And it was uh, I was thinking about tomorrow, and, and also my reaction yesterday when you said you could not change the time, and I think I was angry then. Even though I was trying to tell myself I had, that, it was a very reasonable thing that you might not be able to. I still, I think, felt angry, and uh, then when I got home, I, I even wondered if I sort of made her get a cold, just because of the way I’ve sometimes gotten colds. But I had thought she was getting a cold for the last two days. And when I got home yesterday, I felt pretty sure she was, so I called the doctor and found out what to do. And then it was, by evening it was very obvious she was sick. And uhm, so one of my solutions, which would have been taking her somewhere else, I don’t really want to do now. And so then I, when I came in here, I was thinking about just saying I didn’t know yet. I’m trying to get a baby sitter two different ways. One is through my, who said he might be able to find somebody. And then, I was given a name of somebody else who might be able to. And I haven’t been able to reach her yet. And I was just thinking of telling you I didn’t know definitely yet if I had a baby sitter, and then it just occurred to me, there’s not really I mean, I’m not telling you anything until I know definitely, which I could do tomorrow, I suppose. So (sigh) I don’t know, it seemed like maybe I was thinking of it because then then I wanted you to know how hard you’d made it for me by not changing. And I don’t know whether, w-, I, I, this was something that was on my mind while I was waiting, so it might have even been on my mind because I don’t wear, I haven’t, well, when I was pregnant I was just wearing maternity clothes of I almost well, they were mostly one length. But this is practically the only thing I have. I have one other thing that’s the longer length, and so I suppose it was on my mind because I put this skirt on today. But uhm, when I was outside, I was thinking about clothes because I still haven’t lost enough, so I can’t fit into most of what I had, or have. And I was wondering what I could wear here. And one thing I was thinking of wearing was pants.

And I saw two people go by with pants on, so that, that sort of made me think of it. But then I was finding it very hard to think I could really do it when I came here. And I don’t know, I mean pants are just worn by so many people today, I don’t know why I feel that way, unless it is a switch from what I usually do, in, in my training, which was always you put on a skirt when you go anywhere. Or a dress. And . . .”

ANALYST: “What does wearing pants mean to you?”

At the beginning of session 433, the patient started with a four-minute silence, indicative, to me, that it was difficult for her

to begin to express what she was feeling.

This silence followed the analyst’s comment about not being able to change the Friday session at the end of the last session. Mrs. C then spoke at length about her anger and disappointment with the analyst about his not being able to change the session and whether she would be able to get a babysitter and attend the session. Mrs. C then shifted and spoke about her clothes and whether she should have worn pants, which was unusual for professional women, including teachers, at the time . The analyst asks about the meaning of pants. This question is very striking to me, reminding me of the earlier sequence when the patient shifted from her sexual activity to anger with her cat, and the analyst focused on her aggression.

Rather than point out the defensive shift away from her anger and disappointment with the analyst, the analyst asked about the meaning of pants. Presumably, penis envy and the rivalry with men was on the analyst’s mind. As in the earlier session, the analyst focused on content that he prioritized and, in a sense, cut short the elaboration of the patient’s affect. Just as in the previous sequence, the patient continued to elaborate on the penis envy theme, highlighting her rivalry and envy of men.

At one point, the analyst went on to make an exceptionally long interpretation ending with the comment, ANALYST: “Now I think all these things add up to one central idea that you seem very preoccupied with and concerned about at the moment.”

The patient then responds: PATIENT: “Well, the thing I kept thinking while you were saying all these things, was I don’t know it seem, it seemed to me almost as if I went in a progression from first thinking I was a castrated male, to then if I’m not a male I have to be a female, and then desperately trying to work out something that I knew would be being a female, and yet not really feeling it. (pause) But then I think of having to control things, and wanting to control the time here, and uhm, I don’t, I don’t know if that fits in. Except I’m just reminded that that’s what my father meant, my having to control everything wh-, whenever he’d call me a bitch. And uhm, I would always deny it. But it’s something I’ve been doing all my life, and I don’t know whether it’s part of trying to prove myself as something, whatever it is. Because whenever I think of control, I think of that as being a masculine thing.”

ANALYST: “Yeah, I think that’s clear.

You do. And that’s why you didn’t dare wear pants. Because that’s what you want, and you were trying to deny it by not wearing pants. And my hunch is that part of what you’re talking about is, this is your reaction to having a girl. This is the way you’re 31

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expressing your disappointment, I mean, to not having a boy.”

This sequence is reminiscent of Grossman and Stewart’s (1976) discussion: In many cases the “wish for a penis” is but one highly condensed representation of these critical concerns. We have been told of other cases in which the interpretation was made that what the patient “really wanted was a penis, a penis of her own,” in which the envy of men hid a sense of deprivation, worthlessness, and fear of abandonment.

These feelings and the experiences that led to them were the critical issue. The interpretation of penis envy, even when it referred to real experiences, reduced the multiple sources of dissatisfaction to a single cause. Whether intentionally or unintentionally, a clinical metaphor was thus created. It is particularly and more significantly true in patients such as ours, whose envy is conscious and where the narcissistic injury and fear of aggression are more central to the illness. (Grossman & Stewart, 1976, pp.204-205) In a sense, all of Mrs. C’s disappointments with herself, her mother, her father, her husband, and her analyst, were reduced, as Grossman and Stewart posit, to this one metaphor: penis envy. In particular, Mrs. C was angry and disappointed by possibly missing tomorrow’s session. That issue of disappointment was effaced by the analyst and replaced by a focus on penis envy and her castration wishes towards the man. This theme was replayed at the end of an analytic year as described below.

The Last Three Sessions of an Analytic Year: Addressing Separation Anxiety Replaced

by Focusing on Penis Envy Sessions 726-728 The last three sessions of an analytic year can be summarized with a very short statement. Mrs. C was clearly anxious about what would happen during the summer break and whether the analyst would see her the following year. At a couple of points, he very cursorily told her the time of next year’s sessions.

The analyst continued to stress her castrative wishes towards him and never made any comments about her missing him during the summer. In fact, a word search of the three sessions revealed that the words “miss” or “missing” were totally absent. It seemed as if the analytic dyad had to repeat an ongoing sadomasochistic struggle. I will simply highlight two vignettes from the two penultimate sessions. These are interesting vignettes not only because they address the general topic of selection of intervention, but also since these are the only instances in this protocol where the recording of the analysis comes up.

THE CASE OF MRS. C

Session 726 PATIENT: “I’m trying to do is replay exactly what you said and then everything that’s been said since then uhm, as if it’s a recording in my mind so that when I leave here I’ll have it. And if I can’t do that then I won’t have it when I leave here.”

ANALYST: “Yeah, what does recording bring to your mind?”

PATIENT: “Well, that you’ll have a recording. (Yeah?) Well, I don’t know, I mean there must be something more but I didn’t get further than that you would and I won’t. (pause)” ANALYST: “That’s the connection between thinking of I have a recording and you’re destroying me?” [Destroying the analyst had been a theme the analyst pursued earlier in the session] PATIENT: “Well, I mean, when I think of your having it and I won’t I, I also think of your having a penis and I don’t. But, I don’t really see—I mean I know sometime—well, uhm, (sighs) well, I mean, I think, well, then maybe it means that I’m feeling you have control and I don’t. Except somehow I don’t quite see how in this particular instance that would work that way. (pause) Well, I don’t know if I—because I just started thinking about part of what I was thinking when—I’m not sure I said this uhm, because it might have been something I was going to say after I talked about the feeling that I wanted to take away a recording. But, uhm, when, when I was beginning to think all this I was wondering am I just feeling this kind of feeling that—uhm, will I be able to hang on to what I’ve just been thinking about, or was I really trying to say to you, even though I’ve just been thinking about it I’m already forgetting it and, uhm, it hasn’t really made that much of an impression on me, or something like that. and I’m not sure because the feeling I had when I was thinking of it, was really trying hard to recall everything that was said and, and, uhm, sort of get a mental recording and, uhm, yet why would I suddenly think that in the middle of thinking what I was?”

ANALYST: “Well, the recording for you is equivalent to—it’s my penis. I have it and you don’t and you want it. And that’s what the fight is about. That’s what you want to get revenge for. That’s why you’re trying to defeat me, frustrate me. That’s what you want to do to the guy in the movie, it’s what you’d like to do to [husband]. That’s why you’re thinking this.”

These comments are very striking. The analytic year was coming to an end. The patient worried about functioning during the analyst’s absence. This loss is reminiscent of the prior sequence where she was worried about missing a session. She worried that she wouldn’t remember all that has transpired in the sessions and wanted a recording of the

sessions in her mind. The association to the real recordings came up. The analyst had a real recording of her, and she wanted one of him. In my reading, it seemed obvious that the negative emotions about separation were uppermost on her mind. The analyst continued his interpretive line that she wanted his penis, that the recordings represented his penis. As Grossman and Stewart might have said, that is true. She wanted a prized possession of his—the recording, the penis. Yet, the trigger for these fantasies at this point involved her wish to make up for losing him during the summer.

This theme continued in the next session.

Session 727 ANALYST: “What really strikes is how the things you’re now talking about completely ignore some of the things that we were talking about yesterday and what I said.”

Patient and analyst continued on the theme: that wanting the recording was equivalent to wanting the analyst’s penis and hurting him. Mrs. C then continued: PATIENT: “Yeah, I think what I first thought of, too, was, uhm, well, that if I could take a recording away I was thinking of it one way, but really probably is another uhm, it would be like taking because it would be of your voice it would be like taking something of you away. But then that could either be because I don’t want to leave you so therefore I want to take something of you away, like your voice, or it could be simply that it’s, it is true that I associate it or substitute it in my mind for your penis. And, uhm, then, but I don’t know, I just thought of this now, that it’s almost as if the way I’ve been thinking well, yesterday and I think I was sort of thinking that way, uhm, well, I guess it was earlier yesterday when I had thought of the day before yesterday, uhm, that feeling of I had to be here in order to remember things or to be able to think of them and concentrate on what we’d been talking about and to retain any understanding I got. And then I thought of, well, this recording would be the way to do it….”

The patient elaborated further on the theme of trying to find a substitute for the absence of the analyst. She became confused.

The analyst did not respond during this long narrative. Eventually, the patient said: PATIENT: “Doesn’t this drive you crazy, that sort of I go forward a bit and then go back more? uhm, and I suppose at first I was thinking that.” (analyst laughs first and she joins) ANALYST: “Is that as transparent to you as it is to me?”

PATIENT: “Yeah, well, I wanted to drive you crazy.” (laughs) ANALYST: “Of course!”

PATIENT: “But first I was thinking, oh, 32

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I wanted you to say, ‘oh no!’ sort of, ‘I understand,’ or something.

The session ends.

In this segment, there was a brief discussion equating the recording to the analyst’s penis. However, the patient explicitly said that she wanted to hear the analyst’s voice when they were together during the summer. It is striking that only when the patient agreed with the analyst that she wanted them to fight did the analyst interact with her, albeit in a light moment. The session ended with the patient asking for more from the analyst. Interestingly enough, in the last session (Session 728), the patient and analyst were talking about people being kicked out. His last line of the session was ANALYST: “Well, this is time for me to kick you out, then. Our time’s up.”

Even if this was heard as a joke, should it have been made to a patient who is suffering from low self-esteem and will miss the analyst very much?

Discussion Mrs. C underwent a recorded analysis a half century ago, during a time when classical analysis, including considering penis envy a bedrock attribute of feminine psychology, was the primary theoretical approach to technique.

In the sessions that were highlighted, the analyst consistently focused on penis envy and the patient’s counter-aggression in the form of castrating wishes towards men. Throughout my close process examination of the clinical material, I highlighted a potential alternative approach utilizing Paul Gray’s close process monitoring, which, of course, was not available at the time. In the reformulation of feminine psychology, that a woman was not considered to be un homme manqué (Hoffman, 2017) only came to be understood well after this analysis took place.

An interesting technical question involves understanding the major mutative agents in any psychotherapeutic work: common factors or specific technical maneuvers or a combination. We have been told that the analysis of Mrs. C was considered to be successful by both analyst and analysand. Is it possible that the analyst’s absolute fidelity to, and certainty about, his theoretical perspective was an important therapeutic factor? Such fidelity and conviction of the theory and the technique, which was part of the tenor of the times, may have provided a sense of safety for the patient. In fact, in the dream reported in the early part of the analysis, she associated that she felt safe with a benevolent controlling father figure. In addition, she knew pretty well what the analyst was going to say, and at times, even spoke the words before he did. Perhaps there was also sado-masochistic gratification enacted and expressed in the penultimate session of the analytic year.

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I have one questionable technical criticism, which should have been as applicable then as it is now. There were two instances where a break in the analysis caused Mrs. C great consternation. One was prompted by the analyst’s inability to change a session time. The second, and more important, break in the analysis occurred as a summer vacation approached. For reasons that puzzle me, in both situations, the analyst avoided dealing with deep emotions about the separation. Instead, he continued his tack of addressing the patient’s penis envy and retaliatory aggressive castrative wishes.

He did not address her sense of loss of the analyst and, prior to the summer, her concern whether he would take her back the next year. Why he did not address the loss for her, even when she directly addressed the loss, is a puzzle. The analyst ignoring the significance of the separation for the patient is uncannily reminiscent of a failed case from the 1950s, which we examined clinically and linguistically (Hoffman et al., 2013). In that communication, we wrote:

In short, as in the first session of the analysis and unlike the May sessions, in July the analyst focuses simply on the patient’s aggression without noting the attachment, love, and sexual feelings he has toward the analyst, or his defenses against those feelings. This lack of focus on feelings of missing the analyst continues in September. (Hoffman et al., 2013, p.553) What inferences can we make from this coincidence of two analysts avoiding dealing directly with the analysand’s close feelings and simply addressing the analysand’s aggression in what can be seen to be a somewhat hostile manner? z REFERENCES Blatt, S. J., & Shahar, G. (2004). Psychoanalysis—With whom, for what, and how? Comparisons with psychotherapy. Journal of the American Psychoanalytic Association, 52(2), 393-447.

Bornstein, B. (1949). The analysis of a phobic child— Some problems of theory and technique in child analysis. The Psychoanalytic Study of the Child, 3, 181-226.

Bucci, W. (2013). The referential process as a common factor across treatment modalities. Research in Psychotherapy: Psychopathology, Process and Outcome, 16(1), 16-23.

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Bucci, W., Maskit, B., & Murphy, S. (2016). Connecting emotions and words: The referential process. Phenomenology and the Cognitive Sciences, 15(3), 359-383.

Burklund, L. J., Creswell, J. D., Irwin, M., & Lieberman, M. (2014). The common and distinct neural bases of affect labeling and reappraisal in healthy adults. Frontiers in Psychology, 5, 221.

Cooper, A. M. (2008). American psychoanalysis today: A plurality of orthodoxies. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 36(2), 235-253.

Freud, S. (1932). Female Sexuality. International Journal of Psycho-Analysis, 13, 281-297.

Gray, P. (1973). Psychoanalytic technique and the ego’s capacity for viewing intrapsychic activity. Journal of the American Psychoanalytic Association, 21, 474-494.

Gray, P. (1982). “Developmental lag” in the evolution of technique for psychoanalysis of neurotic conflict. Journal of the American Psychoanalytic Association, 30, 621-655.

Gray, P. (1996). Undoing the lag in the technique of conflict and defense analysis. The Psychoanalytic Study of the Child, 51, 87-101.

Gray, P. (2000). On the receiving end. Journal of the American Psychoanalytic Association, 48(1), 219-236.

Grossman, W. I. (1976). Discussion of “Freud and female sexuality.” International Journal of Psycho-Analysis, 57, 301-305.

Grossman, W. I., & Stewart, W. A. (1976). Penis envy: From childhood wish to developmental metaphor. Journal of the American Psychoanalytic Association, 24(5 Suppl), 193-212.

Hoffman, L. (1996). Freud and feminine subjectivity. Journal of the American Psychoanalytic Association, 44 Suppl, 23-44.

Hoffman, L. (2008). Book review: Psychoanalysis or mind and meaning. By Charles Brenner. New York: Psychoanalytic Quarterly, 2006, 140 pp., $25.00. Journal of the American Psychoanalytic Association, 56(3), 1016-1027.

Hoffman, L. (2010). The first century of psychoanalytic ideas: Toward greater scientific empiricism: One Hundred Years of Psychoanalysis, a Timeline: 1900—2000. By Elisabeth Young-Bruehl and Christine Dunbar. Designed by Isabelle Roussel. Toronto: Caversham Productions, www.cavershamproductions.com, 2009, 24 pp., $29.95 (Canadian). Journal of the American Psychoanalytic Association, 58(2), 349-357.

Hoffman, L. (2014). Berta Bornstein’s Frankie: The contemporary relevance of a classic to the treatment of children with disruptive symptoms. The Psychoanalytic Study of the Child, 68, 152-176.

Hoffman, L. (2017). Un homme manqué: Freud’s engagement with Alfred Adler’s masculine protest commentary on Rosemary Balsam’s “Freud, the birthing body and modern life.” Journal of the American Psychoanalytic Association, 65, 99108. https://doi.org/10.1177/0003065117690351 Hoffman, L., Algus, J., Braun, W., Bucci, W., & Maskit, B. (2013). Treatment notes: Objective measures of language style point to clinical insights. Journal of the American Psychoanalytic Association, 61(3), 535-568.

Hoffman, L., Rice, T. R., & Prout, T. A. (2016). Manual of regulation-focused psychotherapy for children (RFP-C) with externalizing behaviors: A psychodynamic approach. New York, NY: Routledge.

Hoffman, L., Rice, T. R., & Prout, T. A. (2017).

Addressing defenses against painful emotions: Modern conflict theory in psychotherapeutic approaches with children.

In Chris Christian, Morris Eagle, and David Wolitzky (Eds.), Psychoanalytic perspectives on conflict (pp.223-241). London, England: Routledge.

Horney, K. (1967). On the genesis of the castration complex in women. In H. Kelman (Ed.), Feminine psychology (pp.37-53). New York, NY: Norton. (Original work published 1924) Horney, K. (1967). The flight from womanhood: The masculinity complex in women as viewed by men and by women.

In H. Kelman (Ed.), Feminine Psychology (pp.54-70). New York, NY: Norton. (Original work published 1926) Horney, K. (1967). The denial of the vagina: A contribution to the problem of the genital anxieties specific to women.

In H. Kelman (Ed.), Feminine Psychology (pp.147-161). New York, NY: Norton. (Original work published 1933) Jones, E. E., & Windholz, M. (1990). The psychoanalytic case study: Toward a method for systematic inquiry. Journal of the American Psychoanalytic Association, 38, 985-1015.

Marmor, J. (1955). Validation of psychoanalytic techniques.

Journal of the American Psychoanalytic Association, 3, 496-505.

Masling, J. (2003). Stephen A. Mitchell, relational psychoanalysis, and empirical data. Psychoanalytic Psychology, 20, 587–608.

Mulder, R., Murray, G., & Rucklidge, J. (2017). Common versus specific factors in psychotherapy: Opening the black box. The Lancet Psychiatry, 4(12), 953-962.

Sandler, J. (1969). Towards a basic psychoanalytic model. International Journal of Psycho-Analysis, 50, 79-90.

Young-Bruehl, E., & Dunbar, C. (2009). One hundred years of psychoanalysis, a timeline: 1900-2000. Toronto, Canada: Caversham Productions.

THE CASE OF MRS. C

Otherness and Our Sexuality: Laplanche Clinically I comment first on the analyst’s agreement to record the analysis he conducted with Mrs. C. It was the rare analyst in the 1970s, and currently as well, who was willing to tape record an entire analysis. This was an analyst who considered the researchable features of psychoanalysis. Analytic recordings allow us to look at the data from many perspectives. It also means that the analyst’s work is subject to evaluative commentary, which is never easy for any of us. Thus, my thanks for this aspect of this analyst’s work.

Why have I chosen to focus on Laplanche and his theoretical perspective; or, to present this question in a Laplanchian way: What does Laplanche’s theory want of me? I am working to understand Laplanche because of his focus on sexuality (Silverman, 2001, 2015, 2017). Like Freud before him, he asserts that sexuality is a powerful force in our conscious and unconscious lives and that we need to recognize, as Freud did, the formidable features and urges associated with our infantile sexuality. The life of the body and its needs, its skin, its senses of taste, smell, touch, sight, its mucous membranes and its bodily cavities and organs are potentially stimulated by excitations that induce painful/pleasurable sensations (Freud, 1905/1953). Freud’s normalization of infantile sexuality as part of our psychic experience was shocking and unacceptable to his contemporaries, and currently there is once again some disregard for its presence. Freud’s psychosexuality has become minimized and demoted in our dialogue (Fonagy, 2008; Silverman, 2017). What Laplanche added to Freud’s initial conception of the infant is the recognition that our minds are organized intersubjectively. The seductive otherness of early experience opens the door to increased possibilities around images, fantasy, and their potential meanings for the infant as well as the future patient.

Laplanche Laplanche (1970, 1987, 1999, 2011, 2006) is a scholar of Freud’s work. His writing is not transparent and requires intense study to understand his complex ideas. He has never presented clinical work or a case discussion. I remain a hermeneut, using this case material of Mrs. C to extrapolate from Laplanche’s theory to a clinical presentation. However, by contrast with what I am offering, for Laplanche there is only one hermeneut in the analytic space, and that is the patient. Only she can translate her received enigmatic communications, and there can never be a direct translation. She must be left alone, without the analyst’s interpretations, to perform this task.

Laplanche is deeply committed to Freud’s ideas but recognized at times that Freud “went astray,” and when he did, Laplanche (2011, p.35) developed a new way of conceptualizing Freud’s theory. For example, the ubiquitous nature of primal fantasies (Urphantasien) was Freud’s position (1915/1957a, 1915/1957b).

He believed that such ideas as the knowledge of the primal scene, Oedipal fantasies, castration anxiety, penis envy in females, were all phylogenetic. We are born with such fantasies, and they are part of our unconscious life.

Laplanche, living in later times with access to genetic information, and thereby knowledgeable about the problematic position of inherited fantasies, realized that Freud had “gone astray” here. Laplanche recognized the power of the ties between a primary caregiver and her offspring and acknowledged the intersubjective feature of this tie. Mother’s caregiving seduces the newborn into this bond, which initiates the child’s unconscious and her beginning infantile fantasy life. Laplanche understood that verbal, non-verbal, and procedural communications occur between a mother and her infant; the latter, initially, in a helpless, dependent position vis-a-vis her mother. Laplanche labeled this typical relationship as the “fundamental anthropological situation.” Laplanche asserted that the mother’s unconscious infantile sexual fantasies are injected into the fertile field of her infant’s mind. Since infants are meaning makers, they experience the need to make sense of the mothers’ verbal, non-verbal, and fragmented unconscious communications. Such bits and pieces of the mother’s unconscious that were implanted within the infant needed to be translated, and the infant, with her limited capacities, initiated primitive sexual fantasies. When intersubjective feelings and images cannot be translated by the infant, they become repressed. However, as sexually repressed imagery, they continue to propel toward translation. It is a chronic, internal experience of feeling one’s unconscious tensions and alien sensations within that evokes the need to make sense of such enigmatic communications.

When intense, excitable stimulations from the other occur interactively, it is wounding, but it is incomprehensible, “unassimilated and unprocessed” (Fletcher, 2007, p.1245), lacking the young child’s cognitive understanding; it is, in Laplanche’s language, untranslatable. Both Freud and Laplanche posed the need for an unbidden and/or a forbidden later exciting experience that stirs the first experience, inducing and repeating the traumatic experience. In this second experience (après-coup) by the older youth, who now feels the sexual stimulation, it is an unsettling, traumatic experience because its erotic 34

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stirrings are understood. If this second occurrence is insufficiently translated, it produces symptoms. The repeated second incident, labeled as Nachträglichkeit by Freud and translated by Strachey as “deferred action,” occurs at a subsequent period in the child’s life but stirs the first experience. Freud didn’t develop his idea of Nachträglichkeit. Laplanche renewed this idea and developed it extensively by labeling it après-coup. This term “afterwardness” implies both “action moving from the past to the present and from the present to the past’’ (Browning, 2018, p.780). Unlike Freud’s Nachträglichkeit, in which the second experience stirs up the first, Laplanche’s idea is that it works in both directions.

The infant, who lacks adequate understanding of the intense stirrings within her of her mother’s oblique, perplexing communications, unknown to the parent herself, attempts to make more sense of them as she ages and has achieved symbolic as well as procedural understanding of interactions.

These procedural attempts, these translations; they are the working over of enigmatic messages in memory, updating them and giving new meaning to them.

Translations were very much what Freud considered essential as well. Freud described memory as a “transforming, reorganizing process” (Oliver Saks [2017] quoting Freud, pp.96-97). It is a creative process in which memory is constantly updated and recategorized. Writing to Wilhelm Fliess in 1896 (Masson, 1985), Freud used the word Nachträglichkeit to describe the brain’s action of calling up a memory and revising it according to current circumstances. Freud posited different levels and different “stratifications’’ in our mind and that an earlier stratification experience can emerge in our memory and be translated with new and different meanings.

Freud wrote further that he had come to explain psychoneurosis “by supposing that this translation had not taken place with certain material” (Freud to Fliess, 1896 [in Masson, 1985]). I understand this to mean that we can understand that psychological health depends on our constant “retranscription” (Modell, 1993) of new meaning, to refashion our memory. If we are unable to make such revivifications, because of our habitual pathological interactions, such early memories become rigidified, and pathology results.

The idea of translation, re-transcription, new construction, and new narration is what Laplanche takes up and expands upon.

Laplanche recognized the prescient nature of Freud’s very early insight into the workings of memory and mind and continued to elaborate it as a necessary feature of change.

Laplanche’s emphasis on the potentiality of

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translations and the re-finding of additional new meanings for enigmatic messages can offer endless possibilities for altering one’s experiences in life.

What does Laplanche mean by “Mother’s seductions?” Seductions occur in connection with the tending and nursing of the infant—the ardent intimacy of breastfeeding, the tightly connected holding of the baby, the coddling closeness, the cleansing of the genitalia, the massaging of the baby’s body, the rocking, bathing, the “violent caresses” (Freud, 1910/1957), the fervid fondling, and

passionate kissing are all part of the exciting sexual stimulation for the infant. I assume that when Laplanche uses such terms as “implantation” by a parent, it arises as a function of these interactions, and its sexual nature occurs because of the stimulation of the various sensual parts of the infant’s body.

Unlike Laplanche, I would add that when there is such stimulating excitation, starting early in our lives, it stirs us all in wishing for mind-bending, embodied, powerful sex. Such exciting stimulation becomes our never-ending quest for immoderate sexuality filling up

all our orifices. It is our typical wish for polymorphous, perverse experiences. Such experiences can occur where different body parts are involved. When an individual has such strong feelings, it can readily transform into sexual excitation. As excitation increases, in multiple orifices, and can be tolerated, the experience that one patient has reported is that she loses her connection to reality. There is a loss of consciousness, a lack of a sense of self, an experience of nothingness except extreme pleasure. It is a limitless sensation that can be experienced as ecstatic.

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Of course, there are also the everyday caregiving interactions between mothers and infants that are not typically ardent.

Nonetheless, such experiences are also the occasion of “parasitizing of the communications involved by the unconscious of the mother or caregiver” ( Jonathan House, personal communications, 2019). Here, we might consider mother’s slips of the tongue, sudden jolting distractions, scowls, flashes of gritted teeth, grimaces, and other small anxieties, which also reflect, without her being aware of it, the mother’s injection of her unconscious sexuality.

Laplanche utilizes Freud’s economic model of binding and unbinding of psychic energy in the manner of Freud’s early considerations, when Freud’s focus was on libidinal energy. The ego binds uncontrollable excess into more organized, disciplined, rational secondary processes. For Laplanche, these are our sexual life drives. Unbinding evokes destructive, chaotic, searing, painful/pleasurable, and unmanageable primary processes, what Laplanche labels as the sexual death drive. It is the “diabolical” quality of the sex drive that is its “radical tendency to unbind.”

The Case of Mrs. C A Laplanchian point of view would pose the question for Mrs. C: “What does this analyst want from me?” Translations are always difficult, and they are never exact. It is how the patient organizes her fantasies, images, cultural inputs, and personal myths in interaction with her analyst that leads to her emergent translations. However, the ambiance of the analytic relationship can enhance such translations. Mrs. C’s attempt to understand and to translate communications she received is difficult in this case because this analyst is a remote figure, neutral to a fault, minimally responsive; a distant, inaccessible figure who presented interpretations in an autocratic manner. He was often heedless of Mrs. C’s emotional distress.

When he did make interpretations, they were never contextualized, which may have provided understanding of the social-cultural features that dominated the patient’s life and shaped her sexuality. There were minimal dialogical interactions. Even one of her sexual fantasies, as she reports in one of her early analytic sessions, is a conscious fantasy of believing that she and the analyst will have intercourse at the end of her analysis. This statement is not queried by her analyst. His lack of responsiveness, or lack of curiosity, or probably his technique, appears to inflame her desires, which seem to intensify during her treatment. She gives the impression that her analyst’s unconscious wish is only concerned with her sexual fantasy life.

Undoubtedly such a belief/suggestion can influence her communications. The analytic ambience is organized, as Laplanche would have it, as an après-coup.

Indeed, her sexual fantasies dominate and proliferate. She is uncomfortable describing them. Her speech is “general,” “non-specific,” “she is careful with her words,” and she masks her feelings because she fears the emergence of her unconscious sexual desire. She displaces her sexual feelings onto her sister, her mother, cats, and the other, and, of course, her mind is dominated by her wishes and fantasies about her analyst. The analyst needs to piece together her fragmentary hints from her dialogue, which is often confused, “mixed up,” and challenged

by Mrs. C’s work at her own understanding.

She struggles with her need to address her infantile polymorphous perverse fantasies.

Using Freud and Laplanche’s language, I will be demonstrating her oral, anal, and phallic eroticism, her narcissism, her scopophilia, and her sadomasochism. Remember, I am piecing together small, subtle communications that manifest her impatience, her exigence, her chronic sexual preoccupations, and her hostility. The analyst would need to capture these anarchic unconscious fantasies or, in a more Laplanchian manner, to provide enough of an interactive facilitative setting so that the patient sustains a sense of associative openness, candor, and lack of restriction.

Such a Laplanchian approach offers a different emphasis than Mrs. C’s analyst, with his rigid adherence to a set of fixed theoretical ideas and their repetitive interventions. This orientation minimizes the patient’s desire to understand the enigmatic otherness of her analyst and to emerge with her new understanding of her psychic unconscious. Nor is Laplanche focused on the communication of the analyst’s subjectivity, or on the analyst’s self-disclosure, or on the use of constructions. Such features limit what is critical for Laplanche: an analytic atmosphere that fosters an emergent self who can give free expression to her feelings, imagery, and primal fantasies.

In her dialogue, Mrs. C communicates her wishes to control and demand compliance, to satisfy her desires without needing to say anything. In contrast to her social conformity, she dreams of being a free spirit, to experience a sense of freedom and abandon, with no ties and restraints (Duffy movie, Session 38). This implies her wish for the violation of boundaries, to be a breaker of taboos, to engage in transgressions, and to indulge in forbidden, forceful, sensual experiences, which is the unbinding of her sexual death drive. She imagines herself as selfish, greedy, grasping (Session 326), clawing, hitting or being hit, whipping or, more likely, being whipped, insistent about her amatory needs. She is partial to the distinctive odors of her eroticism—the sweaty, urine-soaked fervor of impassioned sexuality. She is dominated by a frenzied craving for her lover 36

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abetted by her insatiable needs. If they are not met, fantasies of violence, destruction, and castration follow. Thus, the lovers need to be crushing close, he needs to get inside her body, to pierce and impale her. They need to cleave to one another harshly and brutally for her sexual pleasure. It is a frenzied craving to be possessed and penetrated. Thus, as she imagined violent sexuality, they tightly squeezed each other, causing bodily pain.

Rape fantasies burgeon and flourish. Men bind her, knot her up, rape her while her husband is forced to watch, and she enjoys that this scene destroys him. There is vengeance towards men. Consciously, she feels she can’t handle her analyst’s or her husband’s penis, handle having dual meanings (Session 728).

Unconsciously, she will possess his penis. It will become hers. In this violent, turbulent, sexual fantasy, she deals with the two genders she knows, male and female; however, in her fantasied sexual act, the two become one and genital differences disappear or, at least, who owns the penis is unclear. Mrs. C uses the cultural stereotypes of her time and surrounds what Laplanche calls the “mytho-symbolic” characteristic of translation, the myths, tales, cultural ideas that prevail. Thus, she states, men wear pants, women wear skirts and dresses, and consciously, she adheres to what she considers a proper dress code, splitting male and female by their cultural attire. She forces her husband into feminine roles, to tend to household duties, do the dishes, and other culturally mandated female chores. Castration fantasies exist, which feminize her husband. Then he represents the hateful mother whom she wishes to destroy. (There may also be Oedipal feelings toward her non-responsive father, but most of her vengeful, competitive, highly critical feelings are addressed toward women.) She is flirtatious with men.

Laplanche understood such frenzied sexuality as emanating from our ubiquitous infantile fantasies, which are perverse and polymorphous, but a natural part of our sexuality. Sadomasochism is inherent in Mrs. C’s fantasy life. Both Freud and Laplanche maintain that it is an essential part of not only our sexuality, but our humanity. It begins with the birthing experience (see Kristeva, 2014).

Laplanche suggests, as well, that the very experience of the mother’s unconscious sexuality invades an “openness and dependency” of the child—what he calls an “effraction”—a breaking into the child’s unconscious life (1999, p.44).

The intervention of the other with the intrusions and co-excitations of his or her gestures is necessarily traumatic in that the breaking in is characteristic of pain, the breaching of a limit or boundary both in its initial impact and its deposit.…

(Laplanche, 1999, p.44)

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This is inevitable, early, and original sadomasochism (Laplanche, 1999, p.212). It is also inherent in sexuality when dominated by the extreme of increasing excitation, which induces pain, suffering, and pleasure.

Why, for Mrs. C, is there so much hatred toward women? The patient reported how little attention was paid to her recognition of her needs by both parents, but her venom was directed toward her mother. She was a second girl-child born to her mother.

As an infant, she sensed her mother’s disappointment in her gender and her mother’s lack of responsiveness to her. This experience was Mrs. C’s first dysregulation. She picked up subtle cues and gestures that unconsciously communicated her mother’s wishes. Thus, she believed her mother was fantasizing the arrival of a boy baby. What a disappointment for her mother upon her arrival, and the infant felt it. She felt “dropped, abandoned, tossed out” when her baby brother arrived.

Thus, early painful, thwarted experiences existed. When her brother was born and favored by her mother at the cost of her own wishes, a trauma occurred in this second experience. This second scene is Laplanche’s après-coup. Mrs. C, as a young child, needed recognition, appreciation, and care. Such experiences with her mother were minimally caught up, as she was with her male child, and unfortunately, her father was not very available either. Although for Freud (1915/1957a, 1916/1963) and Laplanche, sexuality is invariably filled with libido and destructive rage, Mrs. C’s sexuality was especially intensified and became defensively inhibited. One of the few ways that Mrs. C appeared able to get enough responsiveness from her mother was through her frequent accidents. Thus, a sadomasochistic orientation (Laplanche’s sexual death drive) was added and developed over time (see also Freud, 1905/1953).

Another early sexual trauma was her falling on a stick, which penetrated her vagina; another one of her possible masochistic accidents. She needed medical attention to cleanse and sew up the wound. She was probably young when this traumatic experience occurred. It was an early invasion of her genitals, which produced sensations that were confusing, punishing, frightening, and damaging and because of her young age, not understood. When she gave birth and needed an episiotomy, it stirred her earlier traumatic wounding. In this second occurrence, she believed she lost her vagina. It makes sense to understand that damage occurred in both instances. Her fantasy was to restore her phallus, lodged in her vagina that was destroyed earlier. She had a replacement wish when she hoped for a boy baby, only to be traumatized yet again with the birth of her daughter. Here, we can see Laplanche’s concept of après-coup in the double trauma for each harrowing

sexual event. First, when she experienced the fantasy loss of her mother’s love and responsiveness when she, a girl, arrived. Without a penis of her own, both she and her mother were disappointed. In the second event, she felt that she lost her vagina. Without a male baby, she had nothing inside, a traumatic loss, now including additional losses, the feeling part of herself, her self-esteem, and a sense of joy and happiness.

The Transference-Countertransference Matrix Laplanche (1999) describes analysis as a “method of access to unconscious processes” (p.230); however, it is the very alterity of the analyst that stirs the enigmatic in the analysand and the need, once again, to translate the traumatic features of the analyst’s intrusive message. What facilitates this possibility is the benevolent milieu, an attentive constancy of the analyst’s presence, an experience of the analyst’s flexibility, a sense of openness for free speech, a place where fantasy, the sexual drives, and their derivatives can be brought into play through speech. The offer of analysis incites the “re-establishment of the situation of the primal seduction and its relation to the originary enigma of the other” (editor’s note, Laplanche, 1999, p.226).

Whereas the transference is shaped by the analyst’s interpretations in this case, there is material from early in her analysis that provides evidence of how she experienced her analyst and its similarity to her original experiences. In an early session (Session 38), her transference preoccupation emerges with clarity.

PATIENT: “when I’m near my brotherin-law I’m very rarely with him—but around where he is I get a feeling of tension about our relationship and I can’t tell whether I am imagining his reaction to me or if something is really happening there but it always seems to me that he has very little interest in being around me or talking to me or knowing, or well just exchanging ideas with me but I can’t tell if that’s it or if it’s that he basically doesn’t like me, which in itself makes me uncomfortable.”

Here are a number of issues worth considering in this interaction. Although Mrs. C is discussing her brother-in-law, by displacement, it is clear she is also talking about her analyst as well. Whereas her feeling rejected and found indifferent by others stems from her early history, as she reports, in this early session: PATIENT: “my mother always ignores… She acts like I’m not there when I speak during a lull in the conversation at dinner. She’ll just start talking as though I’m not there, it’s embarrassing, and I feel rejected.

It’s aggressive on her part. It gives her power and superiority to ignore somebody.”

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This belief has become a marked transference experience for Mrs. C. Reading the transcript of early sessions, one notes that her analyst does not engage her over her feelings towards him. Toward the end of this session, her feelings become more explicit about her analyst as she tells him about a dream she had that reflected her sense of isolation, discomfort, and rejection.

PATIENT: “We were sitting around and talking, and you were there. And I can just remember feeling a progressive need to withdraw more and more and I don’t know, just a greater feeling of discomfort and then at one point you sort of indicated that you knew what I was doing and that I could stop doing it.”

She indicates that she is comforted by his comment. However, the analyst does not help her focus or understand her discomforting/comforting dream about him.

Paraphrasing Freud (1912/1958) in his paper, “The Dynamics of Transference,” he commented that if someone’s need for love is not satisfied (the complaint of Mrs. C), she will approach the analytic situation with anticipatory ideas that will emerge from her erotic unconscious. Then, even more relevant, Freud (1913/1958) comments in “On Beginning the Treatment”: It remains the first aim of the treatment to attach the patient to her analyst. If one assumes a serious interest in her, carefully clear away the resistances that crop up at the beginning and avoid making certain mistakes, she will form such an attachment, and her analyst will be experienced as the one imago who treated her with affection.

(Freud, 1913/1958, p.139) When her analyst does make interpretations, Mrs. C does not resonate with them.

She is generally unsure, challenging, questioning, and intellectualized about the intervention. In fact, as her analysis progresses, one sees even less emotional involvement and increased doubting and intellectualization. We typically expect when interpretations hit the mark that the patient is responsive by providing additional relevant material or dream commentary, and other remarks that reflect the productiveness and usefulness of the intervention. A new translation of past fantasy can take place. This does not happen, but the analyst persists in his narrow understanding of her motives. It removes the pleasure from engagement with others, including her analyst.

We know through repeated empirical testing that the importance of a good, caring, trusting, emotional interaction between analyst and patient accounts for the major source of variance in treatment, that is, it carries the major feature of a positive outcome. This was not the case between these two. Mrs. C is always unsure

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about her feelings and whether she is judging reality accurately. Since her analyst rarely joins with her in a discussion of her feelings, she is left to ponder alone and feel confused, therefore reactivating her typical approach to interactions. Because she is so unsure of what she feels and knows, suggestions can often come into play to address her associations.

For example, she is hoping for a later session when her baby is born to accommodate her new nurturing schedule and having enough nanny coverage when she is away.

Sessions later in the day would help her with her time management problem and her concerns about her new baby. Her analyst lets her continue to be anxious about this problem without intervening. He fails to recognize the aggression on his part when he allows her to stew for many anxious sessions. He appears indifferent to her worries about childcare for her first child and interprets that she doesn’t want to disrupt her life or be inconvenienced.

What about inconvenience for the analyst?

In the final session of notes, which is also a final session prior to their summer vacation, she continues to talk about her anxiety about the loss of her analytic experience and loss of her analyst and wanting something sexual to happen. Her disappointment in her analyst’s lack of responsiveness to her anxious state leads to a final talk about a friend’s potential divorce from a troubled marriage, and she wonders why the friend doesn’t aggressively kick him out. Her analyst’s last comment in Session 728 is, “Well this is time for me to kick you out, our time’s up.”

I mention the analyst’s managing of their interactions because along with her intensely sexual preoccupation with her analyst, she passionately longs for a tender, caring, soothing, analyst, whom she needs in her treatment—an analyst who demonstrates Kristeva’s “resilience,” the need for a binding, loving tie. She often communicates her fragility, feeling she cannot manage her life on her own. He interprets only her murderous, aggressive, and sexual wishes, and her penis envy. The analyst’s tropes represent the language of patriarchy and traditional stereotyped normativity for females, that is, women as inferior, defective, and unequal.

Her wish to be recognized, to have equivalent power, to be acknowledged for her competence, and to be appreciative of her vulnerability are untheorized. In contrast, what Laplanche insists on is the importance of love; “alongside an anarchical, autoerotic, and unbound sexuality there exists another solidly bound to the love of the object”( Laplanche, 2006, p.169). He and Kristeva talk about how the unbinding needs to become bound so that the libido becomes unified, synthesized, symbolized, and the loving part flourishes. With the binding of the component instincts, there is love of the object and love of the self. Binding enhances and sustains both in love. Thus, the ambience of treatment is

significant and can lead to the fostering of the patient’s associations and transcriptions, and the self is augmented.

Like Loewald (1973/1980) before him, Laplanche’s ego is an emergent intrapsychic concept. In an abstract manner, Laplanche writes that the ego is the surface of the other projected into us—“the corporeal envelope of the other human, as it is our own corporeal envelope… The skin of the ego which comes from the skin of the other” (Laplanche, citing Anzieu, 2006, p.58; see also Anzieu, 1989).

What Anzieu is communicating is the skin eroticism of mother and infant as she cares and nurtures her child. The soft skin of her breast, when the child imbibes and handles, “brings jouissance to the life instincts—the pleasure in participating in its creativity—gives rise to gratitude.” However, jouissance leaves the child with insatiable, unfulfilled desire, which has a destructive edge as well (Anzieu, 1989, pp.36-45). In addition, Laplanche offers the notion that the birth of the ego is the birth of self-love. “The ego is the object of love and is only able to love because it is the object of love; it is the love object of the individual himself of his erotic drives” (2006, p.57).

Initial enigmatic, untranslated experiences readily lead to repression. However, the demonic power of one’s infantile sexual feelings inevitably seek gratification. The child’s ego not only restricts, but, through early identification and internalizations, surges toward enhancement and fulfillment (Laplanche, 2016; Loewald, 1973/1980). It may be overwhelming, but it is also likely to take the route of fantasy and/or budding sublimations that serve one’s desire.

Conclusion Laplanche offers an innovative psychoanalytic perspective when engaging with his theoretical positions. Laplanche wants us to refocus on Freud’s “Three Essays” (1905/1953) and the “drivenness” of infantile sexuality. He re-challenges us (après-coup) to pay attention to the importance of embodied sexuality derived from his “fundamental anthropological position” and the normalization of its perverse and polymorphous features in our imagery and fantasy life.

The puzzle of enigmas both for the significant caregivers and the child is re-experienced in the analytic situation. Unlike Freud’s goal, for Laplanche, it is not a lifting of repression and the emergence of the primal fantasy; it is a new translation that can occur when engaged with the other. When translations are effective for the individual, it provides an increasing sense of agency and personal authority over one’s life. It allows for further development of new meanings, that is, re-categorizations in an on-going manner. Transference for Laplanche has a cyclic character, a potential spiral that provides movement (Laplanche, 1999, p.231).

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Sometimes, in a rut, we return to the same translation, which is inevitable in order to allow for retranslations in which a new image emerges, which leads to a new train of associations, and thus, the self is enriched.

This is an ever-evolving, on-going experience even when analysis is terminated. The analysand’s translations create a sense of expansion, an enlargement of the patient’s experience, an awakening sense of one’s inner life; a spirit of self enhancement. z REFERENCES Anzieu, D. (1989). The skin ego: A psychoanalytic approach to the self. New Haven, CT: Yale University Press.

Browning, D. (2018). Laplanche and après-coup: Translation, time and trauma. Journal of the American Psychoanalytic Association, 66, 779-794.

Fletcher, J. (2007). Seduction and the vicissitudes of translation: The work of Jean Laplanche. Psychoanalytic Quarterly, LXXVI, 1241-1291.

Fonagy, P. (2008). A genuinely developmental theory of sexual enjoyment and its implications for psychoanalytic technique. Journal of the American Psychoanalytic Association, 56, 11-36.

Freud, S. (1953). Three essays on the theory of sexuality. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 7, pp.123-246). London, England: Hogarth Press. (Original work published 1905) Freud, S. (1957). Leonardo Da Vinci and a memory of his childhood. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 11, pp.57-138). London, England: Hogarth Press.

(Original work published 1910) Freud, S. (1958). The dynamics of transference. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 12, pp.97108). London, England: Hogarth Press. (Original work published 1912) Freud, S (1958). On beginning the treatment. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 12, pp.121144). London, England: Hogarth Press. (Original work published 1913) Freud, S. (1957a). Instincts and their vicissitudes. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 14, pp.109140). London, England: Hogarth Press. (Original work published 1915) Freud, S. (1957b). The unconscious. In J. Strachey (Ed. and Trans.), Standard edition (Vol. 14, pp.159-215). London, England: Hogarth Press. (Original work published 1915) Freud, S. (1963). Introductory lectures on psycho-analysis. Part XIII The archaic features and infantilism of dreams.

In J. Strachey (Ed. and Trans.), Standard edition (Vol. 15, pp.199-212). London, England: Hogarth Press. (Original work published 1916) Kristeva, J. (2014). Reliance, or maternal eroticism.

Journal of the American Psychoanalytic Association, 62, 69-85.

Laplanche, J. (1970). Life and death in psychoanalysis.

Paris, France: Flammarion.

Laplanche, J. (1987). New foundations for psychoanalysis.

Paris, France: Press Universitaires de France.

Laplanche, J. (1999). Essays on otherness. New York, NY and London, England: Routledge.

Laplanche, J. (2006). Après-coup, time and the other, temporality and translation. Paris, France: Presse Universitaires de France.

Laplanche, J. (2011). Freud and the sexual: Essays 20002006. New York, NY: International Psychoanalytic Books.

Loewald, H. W. (1980). Ego organization and defense. In Papers on Psychoanalysis (pp.174-177). New Haven, CT: Yale University Press. (Original work published 1973) Masson, J. M. (1985). The complete letters of Sigmund Freud to Wilhelm Fliess, 1887-1904. Cambridge, MA: Belknap Press.

Modell, A. (1993). The private self. Cambridge, MA: Harvard University Press.

Saks, O. (2017). The river of consciousness. New York, NY: Knopf Doubleday Publishing Group.

Silverman, D. K. (2001). Sexuality and attachment: A passionate relationship or a marriage of convenience?

Psychoanalytic Quarterly, LXX, 325-358.

Silverman, D. K. (2015). Review of Freud and the sexual: Essays, 2000-2006 essays by Jean Laplanche. Psychoanalytic Psychology, 32, 678-683.

Silverman, D. K. (2017). The sexiness of Marilyn Minter’s oeuvre and its relationship to Laplanche’s theorizing.

DIVISION/Review, 17, 9-12.

THE CASE OF MRS. C

Trying to Find Someone: A Modern Kleinian Reconsideration of the Treatment of Mrs. C This set of sessions offers a window into a classical psychoanalysis from the early 1970s, and in my view, it vividly demonstrates the limitations of the standard Freudian approach of that period. The patient is a young married schoolteacher, and the sessions we are discussing take place shortly after the birth of her daughter. The material addresses one of the most contentious ideas in the history of our field—penis envy and related assumptions about gender and development. So for that reason alone, this material seems worth revisiting from a contemporary vantage point. But more relevant to our present task is that this material demonstrates not just a technique for conducting analysis (which it certainly does), but a particular set of assumptions about the psychoanalytic process itself. In my paper, I hope to illuminate those assumptions and then contrast them with a contemporary perspective rooted in a blend of modern Freudian and Kleinian ideas.

I will begin by briefly considering an early session of the treatment, highlighting the major themes as well as the quality of the patient-analyst interaction in the early phase of the treatment. I will then turn to the patient’s initial sessions back to analysis following the birth of her daughter and will consider some of the changes that begin to appear in that material and their possible meaning. I’ll take a brief foray into those aspects of Kleinian theory that I see as relevant to this case. Afterwards, I’ll turn to the later sessions, with a particular focus on how we might make sense of what is beginning to develop between patient and analyst from our current standpoint, and how we might intervene differently today.

An Early Session: Session 326 The patient, Mrs. C, is a married schoolteacher who is several months into a fiveday-per-week analysis. She begins the session with an extended discussion of her suppressed anger toward another teacher, whom she sees as taking advantage of her willingness to defer to others. Mrs. C then associates these competitive feelings to the possibility that she is pregnant, and to the fact that she has not, so far, taken a pregnancy test. She is not yet clear why she is avoiding this. Mrs. C associates the possibility of being pregnant with the need to change the time of her sessions, as well as her reluctance to make this request of her analyst because it seems “self-centered.” Mrs. C then associates this self-centeredness with feelings of closeness with her mother, or rather, the possibility of such closeness. She states, “I feel such funny

feelings about my mother… because on the one hand I could feel just like her, and therefore understand to some extent how she was feeling, and yet on the other hand have such violent feelings against her.”

Mrs. C then associates these feelings to a high number of “accidents” when she was younger, as well as her frequent experience of being attacked by an older sister and Mrs. C’s tendency to respond masochistically. She further associates to wishing she could recall what it was like to nurse at her mother’s breast—all that she can imagine is that her mother would probably want to keep her on schedule; she wouldn’t be able to relax and enjoy the experience.

Mrs. C then begins to talk about her own preoccupation with control. She talks of not wanting to be involved with other colleagues and all of their demands. She describes claustrophobic feelings while riding the elevator with schoolchildren who are squirming around. She associates immediately to her reluctance to have sex with her husband; Mrs. C wants to avoid everything connected to intercourse, but at the same time wants to remain connected to her husband and not be alone. She thinks of her cat, who made her angry, then again about her analyst, and the worry that he won’t make the requested schedule change and it will make her angry at him. And she worries he would then further refuse to change the schedule as retaliation for her anger.

All of this leads Mrs. C to a topic that becomes central in the later sessions: her anger at her husband and wish to emasculate him, which she sees herself playing out in a variety of ways. In her words, “I always feel angry because I’m not getting a penis from some man. I mean, he’s just not giving up his masculinity to me.” She then associates this wish to her desire to be in control, her hope that her own child will be a boy, and the fact that her brother was the favorite in the family. All of this in one session!

Clearly, Mrs. C covers a tremendous amount of ground in this session. More importantly, she does so in a way that has a truly free associative quality, moving freely from topic to topic without an overriding need to consciously filter and organize. The analyst appears to be working along mainly 1970s classical lines. For the most part, he is silent, occasionally pointing out moments of resistance and sometimes making connections to the transference. But for the most part he stays out of the way, and the patient is working productively.

The remaining sessions all follow the birth of Mrs. C’s daughter. And while the 39

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patient continues to work free-associatively and articulate areas of conflict, there is present throughout a greater degree of resistance on the part of the patient and, from my point of view, greater enactive participation on the part of the analyst. The patient and analyst appear increasingly locked in a power struggle of some kind, and this is especially evident when you read the analyst’s interventions.

First Postpartum Session: Session 431 In this first session back from maternity leave, the patient begins by saying, “I was thinking about trying to find someone.”

Which is an odd way to start the first session back, following the birth of a child. She says nothing at first about the child, the birth experience, or her feelings about being back with her analyst. Just, “thinking of trying to find someone.” It is only somewhat later that it becomes clear that she is talking about finding a nanny for her daughter. In my own work, I notice that the first words of a session are often a highly compressed representation of the patient’s experience of the analysis at that moment. In my reading of these sessions, I’ve come to think of those particular words as expressing something crucial that never gets taken up by the analyst, but instead finds expression enactively between patient and analyst. I will come back to this shortly.

In this session, the patient is voicing concerns about her shifting relationship to her daughter; at one moment she feels deeply identified, the next she feels resentful, angry, focused on regaining a sense of control. She associates to having an IUD put in, and “horrible” feelings about the device that she has trouble understanding. She associates further to her reluctance to having intercourse with her husband in the period following the birth of their daughter, as well as to feeling disturbed afterwards when they eventually did have sex. She ends up confused about what she is saying, which the analyst interprets as resistance to returning to treatment. Mrs. C acknowledges this resistance, then states that one thing she hadn’t anticipated about giving birth was her reaction to the doctor “stitching me up,” which was much worse than the episiotomy itself. She felt that she had become different through the stitching up; she “had the feeling that [she] had no vagina.” Mrs. C said she felt that the doctor had “cut [her] vagina out,” or if she still had one, it was “less than what [she] had before.” There were then associations to her mother’s hysterectomy after the birth of Mrs. C’s brother and, again, her disappointment with having a daughter, not a son. The experience of having a

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daughter and its many associations becomes a focal point in the remainder of the sessions.

There is one more set of associations in this session that, in my view, are particularly important in making sense of the material and that remain unexplored by the analyst. In connection to her upsetting response to getting stitched up, Mrs. C described her difficulty connecting the present actuality of her daughter with her earlier experience of being pregnant, in that her experience of pregnancy was one in which there was “something alive” inside of her that was fully part of her. She then says, “when I put the IUD in, it was bothering me that there was this foreign thing in me.” Her daughter, as a separate object, is a foreign thing, like the IUD. This is unsettlingly different from the experience of pregnancy, wherein there was no sense of a foreign presence, there was nothing inside that didn’t belong. The fantasied loss of her vagina is simultaneously a closing up (“stitched up”) and an experience of unexpected, disturbing otherness where before there had been only unity.

Theoretical Interlude Before going further into the material, I’d like to take a brief foray into aspects of Kleinian theory that I think help to illuminate what begins to emerge between patient and analyst in the remaining sessions.

I’ll begin with a couple of foundational Kleinian ideas. First, Klein (cf. 1932/1975a, 1935/1975b) long held the view that introjective and projective mechanisms serve as the primary motor of development from birth onwards. From her perspective, young infants relate to the world primarily by taking in and projecting out: introjecting good objects and projecting bad ones. She saw the primary developmental task as the secure establishment of a good internal object, an outcome constantly challenged by inevitable frustration and anger, which often led the child to fall back on primitive defenses involving splitting and projection.

You never end up with a good internal object if you are constantly chopping it up and spitting it out when it starts to feel bad, and this is exactly what happens with children who are overwhelmed by feelings of frustration and hatred.

Now if you look at Klein’s clinical writings (especially Klein, 1957/1975c), her primary focus in treatment was on interpreting the patient’s anxiety about the consequences of all this aggression, because as these anxieties are relieved, the patient relies less on splitting and expulsion and makes more use of defenses that facilitate taking in and holding onto a whole good object (i.e., moving from paranoid-schizoid to depressive modes of functioning). One limitation in Klein’s writing is that she never offered a clear understanding of how interpretation

reduces anxiety. Why does naming the unconscious fantasy reduce anxiety? In my view, it is Wilfred Bion (1962) who finally addressed this question in a satisfying way, and his answer really lies at the heart of his contribution. According to Bion, it isn’t interpretation, per se, that modulates anxiety; interpretation is just the tip of the iceberg.

Bion’s view was that it is really the mind of the other (i.e., the analyst), functioning as a container and processor of the patient’s unbearable experiences, that has therapeutic effect (see Grotstein, 2007). In short, it is the experience of being understood, being known, that is truly the active ingredient in treatment (Vorus, 2011).

I’d like to turn, now, to the modern Kleinian perspective. There are two features of the modern Kleinian approach that I think relate to this case: 1) whereas earlier Kleinian interpretations were heavy on bodily part-object language (e.g., attacking or repairing breast, penis, etc.), modern Kleinians, following Bion, tend to emphasize the psychological functions served by these part objects (e.g., seeing, hearing, thinking, understanding); and 2) modern Kleinians pay particular attention to fluctuations in the emotional contact between patient and analyst (Schafer, 1997). This is especially evident in the writings of Betty Joseph (1989), whose papers offer exquisitely detailed examples of the myriad ways that patients evade real emotional contact with the analyst, instead provoking the analyst, for example, to get involved in ways that are false and shallow, or become diffuse and disengaged. This kind of focus clearly follows from Bion’s (1959) understanding that early failures in containment result in the internalization of not just bad objects, but anti-containing objects, objects that function to attack and destroy the very possibility of understanding. Modern Kleinians applied this observation, which Bion culled from his work with psychotic patients, to the more subtle ways in which all sorts of patients defensively interfere with the kind of understanding connection they most desperately need. This is usually done as a way of defending against painful dependency needs—dependency needs made painful due to a background of early failure of parental containment. So, from a modern Kleinian perspective, the primary clinical focus is on the patient’s experience of the analyst in the “total situation” of the transference, wherein the analyst begins to discover, starting from the very first session, the particular way patients draw us into complex defensive systems that serve the purpose of preventing real emotional contact and therapeutic understanding from taking place (see Vorus, 2017).

More Mrs. C Let me now go back to the clinical material with this theoretical background in 40

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mind. Remember that Mrs. C is particularly focused on issues related to self vs. other, or whether something is part of her (her baby in utero) or a foreign invader (the IUD, her husband’s penis). She has been, throughout, concerned about her ability to control what is inside of her, to control what comes in and goes out, but particularly what comes in.

I’m not quite sure what her analyst makes of all of this material, as he doesn’t have much to say about it; his focus is mainly on penis envy, which is certainly part of the picture.

But from my point of view, the analyst could be hearing much more in this material, and possibly intervening in a way that addresses the patient’s anxieties about whether the analyst is capable of understanding parts of her experience or whether, instead, he will be implanting interpretive IUDs into her.

You hear the sense of hope at the beginning of the session, “I was thinking of trying to find someone.” We’ll see in subsequent sessions whether the hoped-for understanding is realized.

The second session following her return from maternity leave (Session 432) begins with Mrs. C ruminating about her conflict over asking the analyst to change the time.

Unlike the earlier sessions, the patient’s associations are somewhat hard to follow and have an obsessional quality as she circles around details of various babysitting arrangements.

She then begins to divulge the fantasy that her analyst will feel proud of her and change the schedule as an expression of his appreciation. The analyst responds by interpreting her resistance to saying all of this more directly (she was a bit indirect). This response from the analyst initiates the start of a new quality in the patient’s speech, which characterizes much of the remaining sessions—a vaguer and more distant, less reflective and organized way of speaking. Mrs. C associates to wishing her parents had been more affectionate, but the analyst does not pick up on this wish as it relates to the transference. The session ends with the analyst saying, rather abruptly, that he is unable to change the time.

At the start of the following session (Session 433), the issue of control takes center stage, first in discussion of the patient’s (partially acknowledged) anger that the analyst could not make the requested schedule change, then associations to her fantasy of wearing pants to the session. She states that she was reluctant to do so, as it would feel like crossing a line (remember, this is 1971). Mrs. C associates pants with both freedom and masculinity, and then notes that the analyst is not wearing his usual attire (coat and tie).

It remains unclear from the transcript exactly what he is wearing (maybe a sweater?), but what the patient says, repeatedly, is that it is the difference from what she expected that alarms her. His appearance is different from

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what she is used to, from what she imagines in her mind when she thinks of her analyst.

And, vaguely, she insinuates that this is different from what she might consider masculine. At this point the analyst picks up on the word “difference” or “differently,” says it is “vague,” and asks, rather critically, what she is “hiding behind it.”

It is at this point that you begin to see an increasingly confrontational approach from the analyst, something not so evident in the preceding sessions. Unfortunately, we are not privy to his countertransference (nor, perhaps, is he). One possibility is that following the analyst’s failure to pick up on her wish for approval and acceptance in the previous session, Mrs. C is now unconsciously projecting into the analyst her own experience of feeling vulnerable and weak, and fantasizing the appropriation of his power and imperviousness by the wearing of pants. At the same time, she may be subtly provoking the analyst into the more critical, intrusive stance of a non-containing parental figure, in effect, pushing the analytic interaction into sadomasochistic terrain and away from the greater vulnerability behind “trying to find someone.”

It seems to me that what is left unaddressed by the analyst is the patient’s desire, not just for the analyst’s penis (and all that

symbolizes), but also his approval and receptivity. The patient is quite circumspect about openly expressing these desires, anticipating from the start that there will be no willingness to respond to her needs, no special approval, no love from this symbolic father.

For some reason, the analyst appears deaf to this material, as if there is no place in his conceptual framework for considering the patient’s perception of the analyst’s feelings about her, real or imagined. For example, when Mrs. C is puzzling over the fact that the analyst is dressed “differently” and “like a different person,” she is potentially referring to her perception of who he is as a person, including his subjectivity. He immediately points out the ambiguity and interprets defense, “I find myself wondering what you are hiding behind it.” Another approach would be to convey interest in what the patient is imagining about the analyst, and what she imagines may have changed. From my perspective, this approach gets at the heart of the whole analytic enterprise, this question of who the analyst is, and whether the patient can trust and rely on the analyst to take in and accurately understand her experience.

For Mrs. C’s analyst, those questions don’t seem so relevant. Instead, his focus is strictly on how the patient is relating to him as an

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object of desire and hatred, as well as her resistances against acknowledging such feelings. The relationship of these resistances to the perceived subjectivity of the analyst is nowhere considered.

Later Sessions: Sessions 726, 727, and 728 The next group of sessions takes place about a year and a half later, and the quality of the interaction has changed. Whereas in the prior sessions Mrs. C showed some degree of freedom to think and associate, here she is increasingly vague, repetitive, and at times rambling in her speech. She starts one session (Session 726) reporting that the couch has an unusual odor, reminiscent of urination and/or sex. She complains of the feeling that things are just out of reach; she is on the verge of something but is having trouble holding onto the material of the sessions.

Rather than addressing her difficulty thinking and remembering, the analyst responds as follows, “You’re saying my place stinks… you can’t remember things I say, but on the other hand you threaten me by saying ‘if you don’t really break through this by the end of the week all is lost.’” The analyst further interprets the patient’s vagueness as intended to “provoke a forceful attack on you, kind of mentally rape you.”

THE CASE OF MRS. C

In this interpretation, the analyst is disregarding the patient’s conscious sense of being unable to think without the analyst’s help.

Much of the remainder of the session is spent discussing the patient’s need for her analyst and her husband, and at the same time, defended-against wishes to destroy both analyst and husband. By the end of the session, it becomes clear that the analyst is continuing to pursue his interpretive line—the “one central idea”—that Mrs. C’s fundamental problem is penis envy. She acknowledges experiencing envy of this sort; she associates penis with control, but she also associates it with the analyst’s tape recorder, which has to do with remembering. In effect, she experiences her difficulty thinking and remembering as equated with the absence of a penis.

The analyst’s insistent focus on Mrs. C’s wish to castrate him leaves quite a few of the patient’s associations to the side, unattended. The patient is complaining of difficulty with thinking, remembering, and making connections, which the analyst seems to be interpreting as an attempt to frustrate him, to provoke him into some kind of attack. In fact, the analyst’s responses to the patient are increasingly authoritarian during this session; defenses are attacked vigorously, and certain meanings are insisted upon, really forced onto (or into) the patient at some moments, and she occasionally disagrees but more often appears to submit (I found myself thinking again of “interpretive IUDs”).

For the analyst, the accent is on the hidden aggression and the defenses against it, and this is perhaps not so different from the approach of earlier generations of Kleinians.

What this may leave out is the larger developmental context. This patient has been “trying to find someone” who can help her manage her inner life, help her think and remember. The suppressed rage, castration wishes, and sadomasochistic fantasies are all comprehensible within the context of her anticipated rejection from the needed object.

One way we might understand this material is that Mrs. C is struggling to think and understand partly because those very capacities are split off and projected into the analyst, specifically into her fantasy of his penis, as a way of defending against awareness of her dependency on him as a person. If this were a modern Kleinian analyst, this is the dynamic he would help her to recognize—rather than just focusing merely on the aggression, he would help her see that her castration wishes are her way of managing anxiety related to dependency needs that have likely intensified as the vacation approaches.

Instead, we see the analyst growing increasingly confrontational as we move through the later sessions. His interpretations become sharp and penetrating, actualizing Mrs. C’s fear of being attacked for

expressing her wishes and, at the same time, justifying her hostility toward him. He shows no recognition that his way of responding to the patient is part of the picture, that he is a participant in a drama, and that the quality of his participation is a sure indicator that there is something being communicated that he doesn’t yet understand.

In the final session (Session 728) of this set of transcripts, the last before the August break, the patient begins by reflecting on her difficulty with recalling the date of the first session back in the office. She notices that she is paying more attention to this question than to the separation about to take place at the end of the session. She then associates to the question of preschool for her daughter and conversations with neighbors on this topic.

The analyst wonders, why is she telling him about this? Mrs. C responds that she feels the need to close up because it is the last day. To this, the analyst responds that it seems that she can’t consider or think about anything seriously unless he “keeps a whip on [her], and then under protest and with great dragging of feet.”

Mrs. C responds that she feels a need to control her feelings when she is not coming regularly to analysis, because she might think of difficult things and lose perspective, get tied up in knots, and feel unable to handle it.

The analyst responds, “What can’t you handle? Besides murder and rape?” The patient acknowledges that her difficulty often has to do with destructive feelings, including the wish to castrate. But her main concern has to do with a sense of balance that she strives to maintain in the face of all these thoughts and feelings. The analyst responds that what she means is that she’ll have to deal with “what’s real coming out, instead of being able to successfully hide it and mask it.”

This back and forth continues throughout the session. The patient again returns to the tape recorder (associated with the analyst’s penis) and clarifies its meaning for her; the analysis enables her to think clearly, to remember, to tolerate conflict, and she wishes she could hold onto those capacities during the break.

The analyst continues to make comments that reflect his ability to hear this material only in terms of defense against aggression, not as reflecting her way of warding off feelings of dependency. After a long series of associations related to Mrs. C’s pleasure in being able to remember and think and experience more in the analysis, the analyst says, “So, in any case… you are worried what would happen when you are left alone with [husband] without me to be here to… be a buffer.”

And so it goes to the end of the session.

By this point, the limitations of the classical approach appear obvious (at least to me). On the one hand, the patient has clearly been able to use the treatment, at least during certain phases, to tolerate a fuller range of conflicting 42

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thoughts and emotions, and the analyst’s interpreting of resistance and defense appears to have been helpful in this regard. On the other hand, the analyst seems unable to recognize and acknowledge those aspects of the analysis that serve a regulatory function for the patient, nor can he see the way she defends against the more infantile and needy parts of herself through splitting and projective identification. Perhaps most importantly, he doesn’t recognize the impact of those defenses on his own participation and the way he gets drawn into actualizing her defensive system. A clearer recognition of these dimensions would allow the analyst to intervene in a way that would help the patient recognize what is going on within the analytic couple in a way that might ultimately help the patient feel more fully understood, more able to bring into the analysis the vulnerable parts of herself that had been split off.

In summary, these transcribed sessions offer a good demonstration of how an analysis unfolds when conducted from a theoretical standpoint that envisions the analyst strictly as an object of the patient’s transference distortions, or, at certain moments, as a source of interpretive knowledge, but not as a person whose emotional involvement in the analytic process needs consideration. As a result, this analyst never appeared to consider the therapeutic role that his receptivity to the patient’s experience (or not) played in the treatment, nor did he seem aware of his participation in enactments that functioned to defend both patient and analyst from a deeper awareness of her dependency on the analysis. As a result, I have attempted to demonstrate how a different set of analytic assumptions might have contributed to a different sort of process with this patient. z REFERENCES Bion, W. R. (1959). Attacks on linking. International Journal of Psychoanalysis, 40, 305-315.

Bion, W. R. (1962). Learning from experience. London, England: Karnac.

Grotstein, J. (2007). A beam of intense darkness: Wilfred Bion’s legacy to psychoanalysis. London, England: Karnac.

Joseph, B. (1989). Psychic equilibrium and psychic change: Selected papers of Betty Joseph. London, England: Routledge.

Klein, M. (1975a). The psycho-analysis of children (A. Strachey, Trans.). New York, NY: The Free Press. (Original work published 1932) Klein, M. (1975b). The psychogenesis of manic-depressive states. In R. Money-Kyrle (Ed.), The writings of Melanie Klein, vol. 1: Love, guilt, and reparation and other works 19211945 (pp.344-369). New York, NY: The Free Press. (Original work published 1935) Klein, M. (1975c). Envy and gratitude. In R. MoneyKyrle (Ed.), The writings of Melanie Klein, vol. III: Envy and gratitude and other works 1946-1963 (pp.176-235). New York, NY: The Free Press. (Original work published 1957) Schafer, R. (1997). The contemporary Kleinians of London.

Madison, CT: International Universities Press.

Vorus, N. (2011). Cultivating meaning space: Freudian and neo-Kleinian conceptions of therapeutic action. In A. Druck, C. Ellman, N. Freedman, and A. Thaler (Eds.), A new Freudian synthesis: Clinical process in the next generation (pp.201-218). London, England: Karnac.

Vorus, N. (2017). Kleinian and post-Kleinian perspectives on conflict. In C. Christian, M. Eagle, and D. Wolitzky (Eds.), Psychoanalytic perspectives on conflict (pp.91-105). New York, NY: Routledge.

THE CASE OF MRS. C

An Epistolary Reply Addressed to Mrs. C, a Half-Century Following Her Analysis, From a Winnicottian Perspective Bruce REIS

Dear Mrs. C, Thank you for allowing us to use the transcripts of your treatment. Your willingness to let us do so gives us a window not only into your internal world, but also the era during which your analysis was conducted. These sessions from the late 1960s and early 1970s are imbued with a cultural moment in American history.

We can see it more clearly now, some 50 years on; how you, a young social worker and heterosexual, newly married woman became a mother during your analysis; and how your analyst, a man who wears a suit to conduct the treatment, was an opaque, authoritarian, and strikingly unresponsive presence, a man who seemed to follow an a priori narrative of what would occur. The set-up is the very caricature of classical analysis that has undergone radical change over the last half-decade.

Mrs. C, I had the fantasy that as a consequence of your analysis, you, a young social worker, became an analyst yourself. Perhaps fate even led you to the Institute for Psychoanalytic Training and Research. If that were so, you’d be about 70 years old now, and you may be in the room today. Madam, if you’re here, I hope you’ll see our discussion today as an effort at healing, both for you and for our profession. There does seem to have been much that went on in your analysis that needs careful discussion, thought, and even apology. As a colleague, I know you’ll recognize that things have changed within the profession; perhaps you, yourself, have contributed to that change. However, it is still important to understand what happened in your treatment, and also what didn’t seem to happen.

Your analysis took place before psychoanalysts in this country fully embraced a

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developmental model of the psychoanalytic process. This is reflected in the sessions under consideration, in which there is precious little to nothing about your childhood development, or your childhood relations with your parents. In one mention, from Session 38, you described your feeling as an adult of being ignored by your mother during a dinner party conversation.

PATIENT: “…it was when I addressed her, it was times when she could not have not heard me. Or at least it seemed to me that, if I had done the same thing with anybody else I just know from experience that they would have acknowledged what I said. Because it was during a lull in conversation. And then she’d just start talking again as if she never, as if I weren’t there. And it’s just this feeling that I’m not there and then sort of an embarrassment

THE CASE OF MRS. C

a baby seems unreal, and the whole possibility of it ever happening again seems unreal.”

Your relation to your mother was such that you felt unheard, rejected. Your analyst sat quietly during Session 432 while you agonized over the inconvenience of the time of your analytic hour on Thursdays and your hope that he would consider changing that time to accommodate your schedule better.

Rather than take up the matter as a transference-countertransference phenomenon having to do with your wish to be heard, to be acknowledged, to risk feeling rejected in the therapeutic relation, your analyst replied at the very end of the session, “Well, I won’t be able to change Thursday. And our time’s up.”

Then, at the end of another session (Session 728), your analyst joked, “Well, this is time for me to kick you out, then. Our time’s up.”

With the decades that have followed these sessions we can see, in hindsight, the wooden nature of your analyst’s neutrality expressed in a kind of callous disregard for what was occurring between the two of you in the treatment setting. Viewing this material now, it’d be good to remember that all this took place before Steven Ellman’s (2010) writing on the affective interpenetration that occurs between analyst and patient; before Andrew Druck’s (2011) focus on the subjectivity of the analyst having an impact on the patient; before Gil Katz’s (2013) work on the enactive dimension of the transference; and before Shelly Bach’s (2006) persuasive writing on the centrality of analytic love.

I am by nature an optimist, Mrs. C, and I can’t help but wonder whether in the midst of your treatment you picked up the recently published book by Donald Winnicott (1971c), Playing and Reality. And whether you read in that book his short piece on the ‘”Mirror-role of Mother and Family in Child Development” (1967/1971b), wherein he describes what an infant and child needs from the mother in order to create a sense of self, a sense of reality, and a sense of meaning.

Rather famously, at this point, he wrote in that essay,

that I keep on making this remark and, and am rejected in a way, I suppose.”

It is both remarkable and not so remarkable how often that dynamic repeated in your analysis, how in this same session, as you discussed your fear of rejection and being left alone, “I’m always afraid of being left and being in a situation where I’m obviously there alone, rejected,” your analyst met you only with silence; and how in a later session (Session 431), when you spoke of feeling

your baby was unreal and that you were unreal, you said: PATIENT: “I just feel she’s so unreal, in a way…But, uhm, this is unreal in another way. And it, it’s almost as if I can’t be aware of anything except for myself. And so I can’t be aware of her. And therefore, she’s unreal, except she’s there and I’m feeding her and I’m changing her, and so forth. But in some ways, she’s unreal to me. And, and then, and then, the whole thing of being pregnant and having 44

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What does the baby see when he or she looks at the mother’s face? I am suggesting that, ordinarily, what the baby sees is himself or herself. In other words, the mother is looking at the baby and what she looks like is related to what she sees there.

All this is too easily taken for granted. I am asking that this which is naturally done well by mothers who are caring for their babies shall not be taken for granted.

(Winnicott, 1967/1971b, p.112) For Winnicott, the mother’s face is a mirror that reflects the mother’s view of the child. In the situations Winnicott is saying that we too often take for granted, the

THE CASE OF MRS. C

mother’s face reflects back a loving picture, imbued with warmth and positive regard.

Winnicott wrote of this as the mother’s function of giving back to the child her own self. The child internalizes a sense of herself as loved, valued, attended to. Indeed, this model of the mirror formed the basis of his approach to his work as a psychotherapist.

Winnicott wrote, Psychotherapy is not making clever and apt interpretations; by and large it is a long-term giving the patient back what the patient brings. It is a complex derivative of the face that reflects what is there to be seen. I like to think of my work this way, and to think that if I do this well enough the patient will find his or her own self, and will be able to exist and to feel real. (Winnicott, 1967/1971b, p.117) For Winnicott, this relation is fundamental to the patient’s ability to feel real, which he distinguishes from the patient’s merely existing—elsewhere, he wrote, -With the care that it receives from its mother each infant is able to have a personal existence and so begins to build up what might be called a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being; instead the personality becomes built on the basis of reactions to environmental impingement. (Winnicott, 1960) Often, you did not feel real, Mrs. C, not an individual to be listened to or seen, not someone who could exist. What face was reflected back to you in the mirror stage of your own nursing experience? At that time, when issues concerning identification are uppermost, and when narcissistic identification and the sense of self are joined together, what did you see as a reflection of your own internal and emotional state? Normally what the infant sees in the mother’s face is a reflection of supportiveness as a double. Mother attunes emotionally to her infant, with whom she identifies and whose internal states she shares in her own way (Winnicott, 1958).

Normally, this experience is an aesthetic, sensory, and emotionally rich one that involves not only the mother’s face, but her whole body, in communication with the infant’s.

Psychologically, your relation to self and to your baby often felt derealized, as you found it difficult to give back to her what was not given back to you. For those babies whose mothers could not function as a mirror, Winnicott wrote, “there are consequences” (1967/1971b, p.112). Those babies have difficulties consolidating a self, relating to others,

feeling real. Difficulty with going-on-being.

When you imagined what your own experience of nursing must have been like, Mrs. C, you imagined (Session 326) a mother who was barely related to you, who worked by the clock in a stiff and lifeless manner.

PATIENT: “…and all I can do is imagine who I think my mother would have been, and I can’t imagine her being anything but very much on schedule, and that the schedule said at this time she nursed me for so many minutes and that I better be on schedule. No sense of relaxing and just enjoying it, which may be very untrue.”

Your analyst did not speak the language of development or of arrest with you. He did not reflect what is there to be seen, but engaged in a discourse of resistance and interpretation, of what he supposed must lie behind your words, what he felt you were “hiding” from yourself and from him. Like the nursing mother you imagined, your analyst worked very much on schedule, for so many minutes, at times he determined, and expected you to conform to that schedule. No sense of relaxing here, no sense of enjoyment.

Instead of an appreciation for your pre-Oedipal needs, your analyst’s focus was on finding what you had “hidden” behind a veil of repression, what he already knew was back there: intense aggression and penis envy. At times, your analyst accused you of a kind of Kleinian destructiveness, “[I]t’s part of your whole way of rendering all my efforts useless, rendering me impotent. You’re showing me what you think of the things I say. You forget them. You destroy them.” He told you these were your efforts to castrate him; packaging your own initiative and agency as antagonism against him and the process. In its most repugnant moments, your analyst declared, “The fantasy behind this seems rather clear,” not searching for meanings personal to you, Mrs. C. Your analyst’s privileged access to the state of things he already knows exist led him to make interpretations that enacted the very abuse he was accusing you of desiring (Session 726).

ANALYST: “You are acting in a way to provoke me to have to really forcefully attack you, kind of mentally rape you, make you do what you want to do… you keep, in one way or another, by your behavior, inviting me to, as you say, break through, to rape you, to attack you, then you’ll have an occasion to fight back and kick me in the groin and destroy me.”

You were not an attacking patient, Mrs. C., not what has become known in psychoanalytic parlance as a “difficult patient,” yet you were treated that way. If you disagreed in your treatment, then you were aggressively refusing the help you came to the analyst for; you were rendering your analyst impotent, castrating him. What could he do but force on you an interpretation that you were the 45

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one who wanted him to break through your resistances. Your analyst enacted the very mental rape he accused you of desiring. To be clear, I don’t feel this interpretation would always be out of line. It is imaginable to me that in particular transference-countertransference configurations, the analyst could cleanly make this interpretation.

But the interpretation as it is presented here is not supported by evidence in the transcript and thus seems the analytic equivalent of the analyst uttering the words, “You know you wanted it.” A Winnicottian may have approached the situation quite differently, understanding your wish to be found behind a false self, a compliant configuration, for it is a joy to be hidden and a disaster not to be found.

Given the little we know of your experience with your mother, the Winnicottian analyst may have wanted to hear from you rather than already presume knowing. That analyst may have sought to help build and develop over time a personality that was still rather provisional so that you could become yourself. In my opinion, just the opposite occurred in this treatment, where your analyst’s pressure towards compliance resulted in your adopting his language by referring to yourself as castrating. I can only imagine what sort of lasting psychic injury was created and perpetuated from this experience. I think what has happened is that you formed a masochistic transference to your analyst that reflected the original attachment with your mother and that it was never analyzed, but enacted over and over again, creating a certain gratification but not growth of the personality. The irony here, of course, is that this analyst, who was always talking about the patient’s penis envy and his own castration, was caught in the enactment of a negative maternal transference.

Maybe, after having these experiences, you heard you had recently missed Donald Winnicott’s lecture at the New York Psychoanalytic. And maybe you heard enough about what he said there that you bought his book, Playing and Reality (1971), shortly after it came out in the United States.

Perhaps you began reading about what he felt babies need in terms of responsiveness from caretakers, what they need to grow selves and to relate to the world and to feel real.

Utilizing a developmental model, Winnicott understood the development of feminine identity and feminine sexuality to rest on identification with the mother and with what he called the “feminine lineage” of which the experience of maternity was a central aspect.

Rather than respond to the visible signs of excitement of a young girl’s genitals, Winnicott wrote that “the true female genital functioning tends to be hidden, if not actually secret” (Winnicott, 1988, p.46). This focus on the experience of interiority led him to theorize

THE CASE OF MRS. C

that feminine fantasies often revolve around themes of collecting, secrecy, and of hiding. So here we have another way of addressing the “hiding” your analyst repeatedly accused you of, Mrs. C. Perhaps what was in play here was a burgeoning sense of feminine identity and interiority.

But in order to exist as either male or female, one must first have a continuous sense of existing at all. Your analyst’s words belie an analytic orientation that assumed you had reached the genital stage of development, wherein you would have associated your own sense of a consolidated identity with one gender or the other and sought out pleasure through sexual contact with others.

Clearly that developmental achievement had not been reached, or was not fully realized.

In Session 431, you spoke of feeling like a mother. You were connected to your infant, in the way that Winnicott wrote of there being no such thing as a baby, only a nursing couple. You empathize with her: PATIENT: “I see FSO doing something and it might ev-, it might be just stretching or a way she breathes, or something like that.

And then I’ll find later on, either I want to imitate it, or else I’m breathing in such a way that it makes me think of the way she does.

And then I almost feel as if I know exactly h-, the sensation she has when she does the same thing… it’s almost as if I become her.”

You spoke of a great satisfaction from the experience of breastfeeding your infant, and feeling like, “it’s almost as if my feeling about myself was, or my image was very much I am a mother, I have a baby, and I don’t know, MSCZ just sort of there as the baby’s father.”

In this passage, we see your struggle with derealization. We see how a new experience is trying to emerge, one in which you are differentiated and can almost feel real.

It’s almost as if you’re a mother, almost as if you have a baby, and almost as if MSCZ is that baby’s father. It is interesting to note, in accordance with not assuming that you have reached a genital stage of development by this time in the treatment, that you didn’t refer to MSCZ as your husband, just as the baby’s father. Your role as a mother to your child was not considered simultaneously as a triangular relation to that of your role as a wife to your husband. There is a dyadic cast that defines a pre-Oedipal emphasis here, and forecloses an adult sexual relation keeping you identified with your infant (Session 326).

PATIENT: “I keep thinking about that and then mixing up with (deep breath) thinking about intercourse and, oh thinking about the fact that when you’re nursing I—it must seem to a child that it’s the closest you can come to being part of another person, not being alone, being safe and all, and that intercourse is sort of a substitute.”

An understanding of this sort would help to explain why you found little fulfillment in a sexual life with your husband, Mrs. C. Not having negotiated the genital stage leaves you feeling more erotically satisfied by breastfeeding than by intercourse.

PATIENT: “…the next feeding I felt it was a more, I felt a more satisfying feeling from breast feeding her than I don’t know, it seemed, a grea-, to be a greater satisfaction than often. And, and I had a feeling it was directly connected with the fact that I’d had intercourse with MCSZ.” I assume that my colleagues who will be discussing the same case material will focus a great deal on your confusion over what is masculine and what is feminine, and your experience of having and not having a vagina.

From a Winnicottian perspective, I believe one would wish to be careful about this material, and not assume we know what it means.

Already, your analyst assumed he knew what was what for you, and he insisted on this point of view. Hence, I caution us from making the same error of utilizing whatever descriptive scheme holds sway presently.

What I’ll offer then is a perspective, one from a Winnicottian vantage, that is less concerned with identity than with the process of the development of identity. I take it to be reflective of your degree of self development, Mrs. C , at that time of the treatment, and would approach this material with the proviso I stated a little earlier: that in order to exist as either male or female, one must first have a continuous sense of existing at

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all. That you didn’t experience yourself in a continuous manner as either male or female, I understand to reflect a basic deficit in the development of the self and self experiencing.

So much of your experience was derealized and deadened that it comes as little surprise that you had no strong feeling after giving birth and feel threatened by the loss of control during the experience of intercourse.

The male figures in your life had taken over from your mother in providing you little room to express the idiom of your own existence, your own subjective preferences and orientation, your voice. Your husband threatened to divorce you if you didn’t start putting out. You’d have liked to sit around on Sundays and read the paper, doing nothing, and not getting dressed, but your husband didn’t like doing that kind of thing, so you didn’t do it. Your analyst had his own version of not allowing you your voice. From the issue of the requested time change, to not responding to your concerns about feeling alone and rejected, to interpretations based more in his theory than in your speech or concerns. You were ignored in a manner very like you described your mother having ignored you. Wouldn’t it make sense then that the aggression that did show up in session is the result of this, rather than your inborn wish to castrate a man; that you’d wish to mitigate some of his authority over you, even assume some of that authority, in an apparent identification with your mother and how she seemed to you to have co-opted masculine control and authority. But at the same

time, you knew that was not a solution; given your experience of your mother, you didn’t want to become the rejecting object yourself, and you resisted an identification with the aggressor. My sense is that you were not trying to be more of a man, but were trying to find a female paradigm other than the one you observed your mother occupying. To this point, with regard to your analyst’s interpretation that you’d have liked to castrate him and your husband, you said (Session 727), “I really wouldn’t like to have that power.”

When your analyst suggested that the recordings of your sessions are his penis, which you would have liked to have, you did respond (Session 726), “I still feel very resistant to thinking I’ve made an equivalent of your penis and the recording. Because it just seems ridiculous.” In the next session (Session 727), you reasserted your wish for an earlier meeting time, and you told your analyst that maybe it wasn’t his penis you wanted to take with you (during a break in the treatment) but his voice, “because I don’t want to leave you so therefore I want to take something of you away.”

To take up my point about not assuming that we know what the material about genitals refers to, I would suggest that the recording may have represented a wish for a transitional object for you, Mrs. C, and that separation from your analyst was difficult for you in a way he didn’t quite understand.

Recall that in the idea of the “transitional object,” it is not so much the object which is important as the term “transitional” (Dethiville, 2008, p.32). “It is not the object (thing) itself that I am referring to,” wrote Winnicott (1953/1971a, p.5), “but how it is used.” What a pity, then, that the discussion regarding the tape could not take place in the intermediate space of the third area defined by Winnicott.

It only strikes me now that your analyst didn’t ask you what the meaning of the tape was to you. That process and the creation of a space of indeterminacy were foreclosed by interpretive certainty.

I want to thank you again, Mrs. C, for allowing us this view into your treatment so long ago. I don’t know that you could have appreciated at the time how important it would be for us, fifty years later on, to understand that you were not one woman, but many; many Mrs. Cs being told by their analysts that they desired to be raped by them, that what they really wanted was to castrate the men in their lives, that they were not to resist but to lay down in submission to the authority of their husbands, and their analysts. Winnicott’s developmental emphasis on the centrality of the infant-mother relationship went a long way toward mitigating the pernicious effect of these sorts of “treatments,” the effects of which we can no longer deny, diminish, or ignore. z

REFERENCES Bach, S. (2006). Getting from here to there: Analytic love, analytic process. New York, NY: Routledge.

Dethiville, L. (2008). Donald W. Winnicott: A new approach. London, England: Karnac.

Druck, A.B. (2011). Modern structural theory. In A. B. Druck, C. Ellman, N. Freedman, & A. Thaler (Eds.), A new Freudian synthesis. London, England: Karnac.

Ellman, S. (2010). When theories touch. New York, NY: Routledge.

Katz, G. (2013). The play within the play: The enacted dimension of psychoanalytic process. New York, NY: Routledge.

Winnicott, D. W. (1958). The capacity to be alone. In The maturational processes and the facilitating environment (pp.2936). Madison, CT: International Universities Press, Inc. Winnicott, D. (1960). The theory of the parent-child 47

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relationship. International Journal of Psychoanalysis, 41, 585-595.

Winnicott, D. W. (1971a). Transitional objects and transitional phenomena. In Playing and Reality (pp.134). London, England: Routledge. (Reprinted from The International Journal of Psychoanalysis, 1953, 34, 89–97) Winnicott, D. W. (1971b). Mirror-role of mother and family in child development. In Playing and reality (pp.111118). London, England: Routledge. (Reprinted from The predicament of the family: A psycho-analytical symposium, by P. Lomas, Ed., 1967, London, England: Hogarth Press and the Institute of Psycho-Analysis) Winnicott, D. W. (1971c). Playing and reality. London, England: Routledge.

Winnicott, D. W. (1988). Human nature. London, England: Free Association Press.

THE CASE OF MRS. C

The Research Itch: Looking Within the Psychotherapy Process The psychoanalysis of Mrs. C, lasting six years, was carried out and recorded for research purposes about half a century ago, at the beginning of what has been termed the “golden age” of psychoanalytic process research, as noted in the introduction to this issue. It is unfortunate for the field that this period of strong interest in process research was also a period in which psychoanalysis was dominated by views of theory and technique that are widely seen as rigid and limiting today. The field has become broader and more flexible in the intervening years, but the clinical advances have coincided with a diminished focus on treatment research.

We can identify several reasons for this decline in process research. Researchers have turned to studies of treatment outcome to hold the place of psychodynamic treatment in the mental health field. There is increased interest in neurological and biological factors—and, of course, more funding available in those areas. It is also true that it is difficult and time-consuming to do systematic and reliable process studies with adequately large samples, using ratings by judges. Some kinds of automatized measures are needed to enable sufficient sample sizes for statistical power, but in order to provide useful results, the measures need to be understood within a systemic theoretical framework, and the results that are produced have to concern dimensions that are of interest to clinicians. We feel it is now becoming possible to meet these needs, with new ideas concerning psychoanalytic theory and the new measures available today.

The computerized linguistic measures applied in studying this case were developed in the theoretical context of multiple coding and the referential process and derive their clinical significance from that framework (Bucci, 1997a, 2021a, 2021b). The approach that is offered in this issue, looking at the same session material through the lenses of different clinical perspectives as well as research measures, also represents a way in which clinicians can help to shape process research to meet their interests. Such a combined approach, applied here to this quite orthodox treatment from the past, can potentially be applied to contemporary treatments as well.

Earlier versions of the methods that will be used in this study were applied to the case of Mrs. C in several papers, as summarized in the introduction (Bucci, 1997a, 1997b), as well as in several dissertations. I hadn’t looked at this case in the intervening period until Dr. Webster asked for a recorded treatment from our database for her project.

On the one hand, I was reluctant to return to the case because of the issues of theory and technique that had troubled my students

and myself at the time. On the other hand, the case is the longest and most well-studied recorded treatment available to us; and in addition, I had a curiosity—a research itch—to see what we could learn about the case using our current measures, compared to the measures applied in previous studies.

In this paper, I’ll briefly present the multiple code theory and the functions of the referential process, then introduce the linguistic measures developed to measure those functions. Using these measures, I will compare the treatment as a whole to other psychoanalytic treatments in our referential process database and look at variations in the process of this treatment over time. I’ll then discuss four individual sessions selected on the basis of the research measures: one each from the first and third years, and two from the fifth year. The research measures can then be compared to the evaluations by several clinicians representing a range of different perspectives.

Multiple Code Theory and the Referential Process The Multiple Code Theory The multiple code theory is a general theory of emotional and mental functions, their organization within people, and their communication between people—not a “psychoanalytic” theory as such. The concepts of the multiple code theory are based on current work in related fields including cognitive psychology, psycholinguistics, and neuroscience, particularly social and affective neuroscience. The concepts are applicable to many forms of human functioning and many forms of communication, including written communication, as well as to the process of psychotherapy.

The basic divisions of functions within multiple code theory are between subsymbolic and symbolic processes. Symbols are discrete entities that refer to other entities and may be images or words. Language has particular powers of organizing experience within oneself and carrying experiences across to others.

Images can operate as transitions between the flow of subsymbolic experience and the abstract, discrete elements of the verbal code.

Subsymbolic functions are analogic and continuous in form, and include sensory, somatic, and motoric processes that may be well organized within their own systems and operate effectively without connection to language.

These include highly complex functions in the arts, in sports, and in science, as well as most of the functions of our daily lives and our relationships with other people. All these processes may occur within and outside of awareness and may be more or less intentional.

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In some situations: where a tennis player needs to change their serve motion; where a painter is dissatisfied with a color or a line and needs to analyze its features; or where something is going wrong in our interactions with others or in our feelings about ourselves, connection of the flows of subsymbolic experience to the symbolic verbal system may be required. Such connection can potentially enable focus on particular elements of experience and activity; can help to develop new meanings for experience and redirect how we act; and can be central in sharing experience with other people. The somethings that go wrong in emotional experiences and in relationships are what bring people to therapy. The goals of therapy involve changes in meanings and changes in behavior; different forms of therapy emphasize different processes and different goals.

The Referential Process The verbal communication of experience requires connecting the analogic and continuous functions of the subsymbolic system to the discrete elements of the verbal code. This connecting function, which underlies the psychoanalytic process (or the process of any “talking cure”), is characterized as the referential process, and includes the three basic functions of Arousal, Narrative Symbolizing and Reflection/Reorganizing. These occur in all forms of therapies to different degrees and in different ways.

Arousal Arousal is the activation of an emotion schema that is currently salient in the patient’s life and that is being addressed in the treatment. Emotion schemas are particular types of memory schemas that include clusters of sensory and bodily experiences associated with the central people in one’s life; the schemas are formed and reformed in memory from the beginning of life. The instance of a schema that is activated in a session may be in subsymbolic form, in which the sensory and bodily components are dominant, yet not able to be connected to words.

Narrative/Symbolizing Narrative/symbolizing is connecting this flow of subsymbolic experience to language in the form of a narrative or a description of an image. If this function is effective, the patient will be reliving the experience at the moment—she will “be there”; the words to describe it will come from somewhere to enable her to tell the experience in a form that has the power to evoke corresponding emotional experience in a listener or reader. The therapist can then potentially understand

THE CASE OF MRS. C

the experience that is being expressed in the context of their own experiences. This kind of emotional communication is also the power of great literature. The narrative may be a fantasy, a dream, a memory of a past or recent experience, a story from a movie or a book, or an event in the treatment itself, or the schema may be communicated as a vivid, evocative image, without narrative form. A central claim of the theory is that such a narrative or description of an image carries the theme of the dominant emotional schema that has been activated in the session. A value of the free association process is that the patient will often tell stories or describe images without being aware of their emotional significance; this can open connections of which they are not aware and which they might have chosen to avoid.

al., 2016). Here, we present only those measures that will be applied in this study. The measures are applied using the Discourse Attributes Analysis Program (DAAP), which provides numeric and graphical data at several levels of discourse, including individual turns of speech within sessions, as well as overall data for each speaker for sessions as a whole and treatments as a whole (Maskit, 2021).

Reflecting/Reorganizing The patient, and the patient and therapist together, can reexamine the stories and images that have been shared, and new meanings can be found. Freud talked about interpretation of dreams as the royal road to the unconscious; interpretation of any form of narrative can fulfill the function of explicating emotional meaning that may never have been previously formulated.

The goal of therapy is change in troubling or dysfunctional emotion schemas. The change requires the activation of instances of the schema in the session and occurs through the entry of new experiences into the schema, thus changing its structure. These new experiences may involve events of current life, dreams, past events drawn from memory and now seen in a different way, as well as events in the therapeutic relationship. The process known as “working through” involves the activation of multiple instances of a schema, leading to continuing and expanding changes in its overall structure. The change in structure of the schema may be seen as a change in the structure of the narratives that are told; that is, in change in the meanings of emotional events as the process continues to unfold.

The Arousal Function The basic indicator of the Arousal function that will be applied here is the Disfluency (DF) measure, which is generally interpreted as planning and organizing one’s ideas and searching for thoughts and words (See Bortfield et al., 2001). In some instances, the exploration may also lead to painful thoughts that the speaker will wish to avoid. For DF, DAAP counts incomplete words, repeated single words, lexical items such as “um” and “uh,” and disfluent usage of the words “like,” “mean,” “well,” “kind,” and “know.” Here is an example of language that showed a high level of DF from the case of Mrs. C: PATIENT: “…and I think, well, I mean, I, I basically just when, when I think of that particular feeling, I don’t like, I mean the, the a, that kind of unhappy feeling is, is just one I like to avoid whenever possible, I guess. which is, I gu- , i, I think somehow I think that’s what I’m doing by, uhm, thinking I should start closing everything off right now. and, uhm, but then, well, a part of it is that, that really right now, makes me feel just I’d want to avoid it if I could is, uhm, I don’t know…”

Rates of disfluent language tend to average about 6% in spontaneous spoken language (Bortfield et al., 2001). The example above, from session 728 of Mrs. C’s treatment, shows a much higher DF rate of 15%.

New measures of Arousal are also in development that address this function more directly.

In future work, measures will also be developed that include pausing, speech rhythms, and other paralinguistic indicators as well.

Measures of Language Style The basic premise underlying our research is that language style provides an observable indicator of underlying modes of experience, applying across variations in the contents of speech (or writing). Language style depends to a large extent on the use of words that are not intentionally chosen, as I have discussed elsewhere. Computerized measures of language style have been developed to represent each of the functions of the referential process. The methods used to develop these measures of language style differ from the methods used traditionally to develop computer-assisted content dictionaries (Bucci & Maskit, 2006; Bucci et

The Symbolizing Function The Symbolizing function is represented primarily by the Weighted Referential Activity Dictionary (WRAD), which assesses the vividness and immediacy of language. This measure has been validated in many studies as representing the degree to which a speaker is able to connect to their own inner experience, including emotional experience, and to express it in a form that is likely to activate corresponding experience in a listener or reader; the WRAD has been widely applied in both clinical and experimental research. Some of this work is summarized in Bucci and Maskit (2021) and Bucci et al. (2016).

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Reflecting/Reorganizing In this study, the Reflecting/Reorganizing (RR) function will be assessed using the Weighted Reflection/Reorganization List (WRRL). (See Zhou et al. [2021] for a description of this measure.) WRRL represents processes involved in mentally stepping outside of experiences that have been described—to look at them, perhaps to find new emotional meanings and connections not previously seen. Both the Symbolizing and Reflecting/Reorganizing functions will be illustrated in the discussions of individual sessions below.

Measures of Affect In addition to the language style measures, several dictionaries have also been developed to represent types of affects. These differ from language-style measures in representing the manifest contents of discourse rather than language style and were developed using standard procedures for the construction of computer dictionaries (Stone et al., 1966; Pennebaker et al., 2003). The measures to be applied in this study are categories of words representing Negative Affect (AN) and Positive Affect (AP). Subcategories have been defined within these overall affect categories; the subcategories of Negative Affect are Depression, Hostility, Pain, and Fear. In this paper, we focus on the subcategory of Hostility, which has been applied in previous studies. (See Maskit [2021] and our website, http://thereferentialprocess. com, for more detailed descriptions of these measures and applications.)

The DAAP system also allows the construction of several derived measures, including covariations among the measures and indicators of relative intensity, which enable a closer examination of the treatment process.

The covariation of two measures indicates the extent to which the functions represented by the measures are simultaneously high or low. The covariation of WRAD and WRRL is the most widely used; the level of the negative covariation of these two measures is the closest that we have to a direct measure of the degree to which the referential process is operating in a session. This would involve a period in which the speaker is engaged in telling narratives or describing images and is immersed in the experience that is being represented, indicated by high WRAD and low WRRL, separated from (and ideally followed by) a period in which the speaker steps somewhat out of the experience and looks at it from a different perspective, indicated by high WRRL and low WRAD. Another derived measure that will be applied here is the RA Intensity Index, the Mean High WRAD (MHW); this is the average amount by which the speaker’s smooth WRAD function exceeds the neutral value of 0.5 and may be understood as an indicator of

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What Do the Measures Tell Us About This Treatment? An Overall View and Comparison With Other Treatments As noted, the DAAP system has the capability of analyzing the language of patient and therapist at embedded levels: within a session, in sessions as a whole, and in treatments as a whole. The referential process database includes samples of sessions from 23 treatments, of which eight are classified as psychoanalytic treatments. Of these eight, four (including Mrs. C) are from the late 60s and 70s; the others are somewhat more recent. Table 1 shows averages of language style and content measures for the treatment of Mrs. C compared with seven other psychoanalytic treatments.

her use of language indicating reflection on her material was more dominant, indicated by her high WRRL—the highest of the eight psychoanalytic patients. Her average DF was the lowest of these patients; she tended to organize what she had to say before speaking, rather than letting her struggles show. (This tendency to organize and plan before speaking was also seen in long silences, frequently as long as three or four minutes, particularly at the beginning of her sessions. These are marked in the transcripts but not shown on the graphs.) Her tendency to reflect on her experience was indicated by her high WRRL level. However, her use of reflective language was somewhat less likely to occur as part of the referential process, indicated by her rank of six out of eight on the W/W covariation.

The overall picture of Mrs. C as a therapy patient, based on her language style measures, is of a thoughtful woman, who tended to plan what she said before she spoke, to keep the wattage of her discourse turned fairly low, and to emphasize the reflective rather than experiential functions. This picture changed somewhat over the course of the six years of treatment, as will be discussed.

While the analyst spoke very little, his language was vivid and specific when he did

The treatment was extremely low in average number of interactions (turns of speech) per session, with an average of about eight turns per session compared to more than 30 for the seven other psychoanalytic treatments.

Mrs. C spoke an average amount, ranked five among the eight psychoanalytic treatments for word count; the analyst ranked seven among the eight treatments. Her language was generally not very vivid and specific, indicated by her relatively low referential activity measures both for Mean WRAD and the MHW, while

intervene, as indicated by his rank of one for MHW. His other language style measures were generally in the mid-range for our sample of psychoanalytic treatments. (We generally do not compute covariations for analyst speech because their utterances are usually too brief for reliable assessment of this variable.)

The affective quality of their language was noteworthy for both participants, particularly for the analyst. The level of AP expressed in the discourse was noticeably low

how high the Referential Activity is when it is high. This measure tells us how intensely the speaker is engaged in the Symbolizing function, involving processes such as narrating an incident or describing an image. The W/W covariation and the MHW measure will be illustrated in the individual sessions to be presented below.

Treatment and Session Measures for Language Style and Affect

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for both participants, ranked the lowest of the eight analytic treatments. The analyst’s speech showed the highest level of negative affect characterized as hostile (ANH) in our sample. The patient was at the mid-range level for both AN and ANH. Changes in the Measures Across the Treatment The 222 transcribed Mrs. C sessions in the Referential Process (RP) database represent the range of the six-year treatment. Our database includes Sessions 1-101 from the first year of treatment; Sessions 258-269 from the second year; Sessions 316-332 and 427438 from the third year, which include the early pregnancy and immediate post-pregnancy periods; Sessions 596-607 from the fourth year; Sessions 726-776 from the fifth year; and Sessions 933-946 and 1000-114 from the sixth year, not covered in this study.

The patterns of change in the major language style and affect measures listed in Table 1 are shown visually in Figures 1 and 2.

Mrs. C’s words per session were relatively flat over the first four years of the treatment, then increased in the fifth year, and remained high with a slight decline in the sixth and last year.

Her average WRAD level, indicating connection to emotional experience and capability for sharing this in the session, showed a slight decline in the first four years, increased in the fifth year, then declined in the sixth year to its lowest level in the treatment. The Mean High WRAD (not included in these figures), which provides a measure of the intensity of emotional connection expressed in language, showed a similar pattern. Her average WRRL level, the measure of her degree of Reflecting/Reorganizing of experiences, decreased slightly over the first five years and showed a minor increase in the sixth year.

Her Disfluency measure was essentially flat for the first two years of treatment, then increased consistently over the next four years. This pattern suggests that Mrs. C became freer to search for expression and to reveal this search; less committed to planning her discourse before entering the session or during silent periods. By the sixth year, her Disfluency level reached 0.056, slightly above the mean of the seven other analytic treatments, which itself was at the general mean for spoken language. This change is notable and can be seen as an indicator of change in the nature of the therapeutic relationship, suggesting that she had become more able to struggle for ideas and expression in the presence of the analyst—more willing to share her Arousal function with him—perhaps also more likely to avoid expressing thoughts that were coming to mind. The results showing variation in the WRAD measures over the six years do not support the claim of Jones and Windholz (1990) that her discourse

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the treatment, then declined for the remainder of the treatment with the exception of some increase in the fifth year. Her hostility level was relatively low throughout the treatment. The analyst’s affect word categories all showed high levels in the fourth and to some extent in the fifth year.

indicated greater access to emotional experience in the course of the treatment.

Analyst Language Style The analyst spoke little throughout the treatment, and most of his style indicators were relatively flat, indicating little change in his mode of interacting compared with that of the patient. An interesting exception was the relatively high level of Mean WRAD in the third and fourth years of the treatment, as high as that of the patient, which was unusual for analytic treatments as represented in our database. He was apparently more connected

to his emotional experience and expressing it in his interventions during these years. The analyst’s Mean WRAD and MHW both decreased in the fifth year, as the patient’s levels of these measures increased.

Patient and Analyst Affect Measures Mrs. C’s use of positive affect words declined from the first year to her lowest level in the fourth year, then increased in the next two years, never quite reaching its initial level.

In contrast, the analyst’s positive affect words were highest in the fourth year. Her negative affect measures were high in the beginning of

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Summary of Major Change Patterns Overall, the results point to notable changes in the fourth and fifth years of Mrs. C’s treatment for both participants. The change is particularly notable in the increase in the analyst’s WRAD and in his use of both positive and negative affect words. The most notable changes for Mrs. C were increases in amount of speech, WRAD, and negative affect in the fifth year. We’ll return to these observations in the discussion of the individual sessions. Some of these patterns returned to earlier levels in the sixth year, possibly as an effect of the approaching termination, not discussed in this study. Her Disfluency showed a consistent pattern of increase throughout the treatment.

While our sample is three times the size of the sample studied by Jones and Windholz (1990) and covers a wider range of the treatment, these results are nevertheless based on only about one-fifth (222 out of 1114 sessions) of this very long treatment, with unequal numbers of sessions over several years.

Nevertheless, our sample is sufficiently large to show a trend in the treatment and to point to directions for more detailed exploration.

Looking Within the Sessions: Major Themes and Indicators of Change In the previous sections, I have presented summary measures for the treatment of Mrs. C compared to other psychoanalytic treatments and have shown the patterns of change in these measures across the treatment as a whole. The measures can also be applied on a micro level, to examine the process within sessions, including the interactions between the participants and the themes that are expressed. According to the theory of the referential process, the major themes that are activated in a session would be represented as segments of high WRAD followed, in some cases, by those with high WRRL. Changes in these themes may be interpreted as changes in underlying emotion schemas; this is the type of outcome that is most relevant to studies of the effectiveness of psychoanalytic or psychodynamic treatments.

To illustrate the micro level of application of the measures, I’ll show four sessions from the sample of sessions that were discussed by the clinicians participating in this study: Session 38 from the first year of treatment; Session 433 from the third year, the third session in the week in which she returns to treatment after the birth of her daughter;

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and Sessions 727 and 728 from the fifth year.

The sessions are presented in graphic form, showing the flow of the measures for each participant and their interaction. The patient’s speech is represented by a thin line, the analyst’s by a thick line; each measure is presented in a separate panel, with WRAD on top, WRRL in the middle panel, and DF below. Lines representing the midpoints of the WRAD and WRRL scales, which are both 0.5, and the average level of patient DF for the eight psychoanalytic treatments in the database, which is 0.05, are shown as reference points within each panel.1 Instances of the referential process are identified as a WRAD peak followed by a WRRL peak; i.e., as utterances of 50 words or more above the WRAD midpoint followed by WRRL utterances meeting a similar criterion. In both parts of the process, the peak in one of the measures is accompanied by a trough in the other, yielding the mirror image pattern of these measures that is the visual indicator of the RP—indicated statistically by a negative covariation. In addition to the representations of these measures, the graphs as presented here are coded to mark regions noted by the clinicians representing their perspectives on the sessions.

Session 38 First Referential Process. In this session, shown in Figure 3, the first RP concerns incidents at a dinner hosted by Mrs. C’s mother prior to a dance and her reflections on these. The numbers in the text show the correspondence to the graph: PATIENT: “…the people who were giving the dinner we [940] were attending were unable to have it at their house and so my sister asked my mother to have the [960] same dinner at her house. And so it just seemed like it was my mother’s dinner, [980] my mother’s party and that all I was was a daughter in the house. and so then I was [1000] Mrs. H’s daughter and Mrs. H was the one giving the party for these other people.”

The analyst intervenes briefly with a neutral information question as to whether the dinner and dance were separate. She explains and continues reflecting on her experiences at such events.

PATIENT: “…if I want to join a [1200] conversation that my mother’s involved in, I just can’t seem to do it.… I always try to join through my mother and she always ignores me.…when this [1640] happens, it makes me feel not only upset that she would do this but it also makes me feel very [1660] angry.

And I always just have to withdraw from the conversation, just completely leave it or withdraw completely from the [1680] table or, depends on the conversation after that, and be realizing that I’ve been rejected from it,

1. The DF, which is not a weighted dictionary, does not have a natural midpoint.

how strong the [1700] feeling is, but I can’t stand to even be listening.”

This is the peak of the WRRL measure and the close of the first RP. None of the analysts reading this session focus on the material in the WRAD peak.

Doris Silverman, writing from the perspective of Laplanche, describes her associations leading up to this process, and Bruce Reis, writing from a Winnicottian perspective, emphasizes the beginning of the reflection phase.

Silverman describes Mrs. C’s mother’s rejection of her as aggressive, and how ignoring her gives her mother “power and superiority.” Reis points out how often the dynamic expressed here, her fear of rejection and being left alone, repeats in her analysis. We note that the Disfluency measure is quite low during this early part of the session, perhaps suggesting previous thinking about these events, as well as immersion in talking about them.

Second Referential Process. There is a brief second period of WRAD above the midpoint that is not well defined and is accompanied by high Disfluency, suggesting perhaps some period of Arousal at this point and perhaps some avoidance. She describes an incident at the dance: there was someone she felt timid about dancing with because “he was sort of a wild dancer.” She was “just petrified” about his asking her to dance, but

with this dance. And, I don’t know, we [2720] were sitting around talking and you were there, and I can just remember in the dream feeling a progressive need [2740] to withdraw more and more and, I don’t know, just a greater feeling of discomfort. and then, at one [2760] point you sort of indicated to me that you knew what I was doing and that I’d better stop [2780] doing it. And I think I woke up then, but I had the feeling that I could stop doing it. [2800] And just somehow thinking about that during the day was very comforting to me and I didn’t get nearly [2820] as nervous as I thought I would before the dance. (clears throat) But then it bothered me that I was kind of [2840] using fantasy to escape in and it just did seem like an escape to me.”

She then associates from the dream report to a movie centered around a girl whom she found attractive; this leads to the second RP marked here.

PATIENT: “…she was somebody who just wanted to be a free spirit, [3000] I guess you’d say. and just be. And everybody that she had any kind of relationship with had to [3020] accept that she didn’t want any ties, that she was just going to be. And so people were all [3040] very fond of her. She was an attractive type of character, and, and they did all accept this. And I [3060] think there was, I don’t know, something almost paternal

“he was wild enough and strong enough as a leader so it made [2300] me do things that I might not have dared to do otherwise.” She also mentions a dream; she can’t remember much of it, the details are vague: PATIENT: “but somehow [2700] it was a gathering of people that had something to do

in, in their reaction to her, which I liked, as [3080] if they were amused by her and would enjoy her when she was there. And then if she felt she [3100] didn’t want to continue the relationship that was alright, they’d accept it. And then if she wanted to [3120] come back they’d accept that. (pause)”

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The description of the movie with high WRAD is followed by a long reflection phase that continues essentially to the end of the session and provides the mirror image pattern of falling WRAD and increasing WRRL that is characteristic of the referential process. She talks about how she felt somewhat sad about the girl, “that in a way she really wanted to, well, need somebody, I guess, and she wouldn’t let herself,” then about other incidents at the dance, anger towards a woman who didn’t respond to her comments; this reminds her of her feelings of anger towards her mother. These associations occur with high Disfluency (along with several long silences marked on the transcripts, not seen on this graph) and a sharp decline in WRAD. We can see the Laplanchian theme— the power of the silent analyst—as operating in this phase as well. She says she is getting herself tangled up and knows it. She says, “I sort of have the [3980] reaction that I’d like to just not talk about it anymore.” He intervenes then, in response to what seems to be an explicit calling out to him: ANALYST: [Turn 10] “You said that, uhm, in the dream I [4000] said to you, in effect, ‘you know what you’re doing and stop it.’ Right? What was it?”

PATIENT: [Turn 11] “I—what [4020] you said?”

ANALYST: [Turn 12] “yeah, I mean, what was it that, ah was being referred to?

Do you recall?”

PATIENT: [Turn 13] “I think I [4040] was actually sort of, uhm, gradually hunching up more and more and putting my face in my hands and just [4060] kind of hiding my face.”

ANALYST: [Turn 14] “Ah, that’s what I was referring to.”

PATIENT: [Turn 15] “…sort of gradually, yeah. But beyond that, [4080] what feelings I was feeling that was making me do that, but it wasn’t a harsh kind of a [4100] thing. I don’t know, it was almost a feeling of being understood and somebody who expected something else from [4120] me and yet because they understood what, what I was doing, cared and could be gentle about it. I don’t [4140] know, it was, it was, uhm, just a very comforting feeling that I got from thinking of it.”

There are two major themes in this session, as expressed in the narratives of the referential process, and an implicit theme as well. The first concerns her very ambivalent feelings toward her mother; she wants to be recognized by her mother, her mother is cold and excludes her, she is angry and wants to attack her. The second theme concerns her wish for a feeling of freedom; she is beginning to find that in a new way through the analytic situation and their interaction. There is also an underlying theme in the story of the girl who wanted to be a free spirit: Mrs. C also “felt somewhat sad about the girl, that in a way she really

Session 433 This is the third of a sequence of three sessions in the week after Mrs. C returns from a long break following the birth of her daughter, late in the third year of treatment.

She has one instance of a referential process early in the session. The analyst also shows the pattern of the referential process in an extended utterance in the middle of the session providing his summary of her associations

into the WRAD peak, her highest WRAD of the session. The baby is sick; she had a problem getting the right babysitter; the analyst is making it hard for her by not changing the appointment time.

PATIENT: “I had thought she was getting a cold for the last 2 days. And when I got home yesterday, I [160] felt pretty sure she was, so I called the doctor and found out what to do. And then it was, [180] by evening it was very obvious she was sick. And uhm, so one of my solutions, which would have been [200] taking her somewhere else, I don’t really want to do now.”

She has a small increase in WRRL, barely above the midpoint, closing this brief RP. PATIENT: “…and then it just occurred to me, there’s not really, I mean, I’m not telling you anything [320] until I know definitely, which I could do tomorrow, I suppose.

So (sigh) I don’t know, it seemed like maybe [340] I was thinking of it because then I wanted you to know how hard you’d made it for me [360] by not changing.”

Her DF increases, and he doesn’t intervene. She shifts to the next thing on her mind, which is about wearing a skirt rather than pants: when she was pregnant, she was just wearing maternity clothes; nothing fits now, she was thinking of wearing pants, but she always wears a skirt when she goes out.

during this week. (The identification of the pattern of the referential process in the therapist’s speech is unusual in our investigations thus far.)

Following a four-minute silence, somewhat long even for her, she begins by saying she has two things on her mind; then moves

He then speaks for the first time, at word 664; he asks: “What does wearing pants mean to you?” Hoffman, writing from a Grayian perspective, notes that the analyst is here turning from her concern about her baby and her anger and disappointment with him to the content that has priority for

wanted to, well, need somebody, I guess, and she wouldn’t let herself.” The wish to “need someone” (and by implication to have the person she needed be available to care about her) and the wish to feel more free are implicitly in conflict here—perhaps associated with her ambivalence towards her mother, in ways not addressed here.

Silverman notes the material leading up to and included in the WRAD peak as continuing the dynamic of the analyst’s choosing—or not choosing—to speak as repeating her mother’s control over her by this means.

Mrs. C’s reflections continue as part of this process, which is focused on their relationship and its conflictual meaning to her. Gherovici, writing from a Lacanian perspective, notes that she seems to allow herself to become more open to exploration in this, and other sessions, just as time is about to be called.

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him, the penis envy theme and her rivalry with men. She responds with utterances that remain low in WRAD and relatively high in WRRL. Vorus, writing from a Kleinian perspective, notes that he becomes increasingly confrontational as she struggles with these themes, including the idea of his being “dressed differently” today, not in his usual suit, and what that means.

Gherovici, writing from a Lacanian perspective, discusses the high WRRL passage at the close of this series of associations as relating to issues of sexual identity contrasting with the analyst’s focus on penis envy.

PATIENT: “I [1940] guess it makes me think I’m, I’m not really sure what being masculine or feminine is. And so [1960] then I need those differences as, or ways people dress or something like that, as a crutch. And, and then [1980] that’s what makes the difference, or makes you masculine or feminine, which instead of just being a sign, it [2000] becomes being it, itself. (pause)” The analyst intervenes at length here, following Mrs. C’s extended period of reflection and relatively high Disfluency, to present his summary of the three sessions since her return to treatment. He refers to her view of clothes as an exterior sign that distinguishes men and women, then turns to her fear at the time when she was being sewed up, when she gave birth, that her “vagina had been cut out,” and “she was all sewed up, stitched up.

Something vital had been taken away” from her. Then, in the high WRRL component of the process, he interprets the meaning of these events for her.

ANALYST: “…that’s very strong, that you should [2200] be regarded in a certain way now, by your obstetrician and your pediatrician and me, and I presume, others, too, [2220] because you have produced a baby. You now have tangible proof of something exterior that says something very important about [2240] you and what kind of person you are, and how you should be regarded. Now, at the same time that [2260] you say these things, this whole issue of who’s in charge of the appointment time comes up again.”

He realizes that there may be real difficulties but perhaps she has made some contributions to them; perhaps what is important to her is to retain control.

In his summary here, and subsequent comments, he has turned the focus of the treatment from the feelings of becoming a mother for the first time, as well as basic feelings of what it is to be a woman, to issues of control, conflict, and their relation to her sexuality. Hoffman, writing from a Grayian perspective, notes that his interpretations here reduce “all of Mrs. C’s disappointments with herself, her mother, her father, her husband, and her analyst… to this one metaphor: penis

Sessions 727 and 728 I’ll focus here on Session 727, the middle of the three sessions that occurred in the fifth year of treatment, in the week preceding the summer break, and then talk briefly about Session 728, the last session before the break.

In this session, as well as Session 726 preceding

During this early period of struggle, her WRRL and her Disfluency are both relatively high. She seems to be trying to make sense of what she is experiencing or what is happening between them, but without much success, leading to a burst of very disfluent language around word 2001.

PATIENT: “I [1960] think I was sort of thinking that way, uhm, well, I guess it was earlier yesterday when I had thought [1980] of the day before yesterday, uhm, that feeling of I had to be here in order to remember things or [2000] to be able to think of them and concentrate on what we’d been talking about and to retain any [2020] understanding I got. And then I thought of, well, this recording would be the way to do it. And, uhm, [2040] ah, I’m losing what I was thinking. But anyway it’s almost as if, uhm, well, I mean, on [2060] those terms clearly for me to feel I’m getting anywhere to have the recording but then it would be, [2080] if it is symbolic of your penis, then it would be, uhm, I guess, uhm, well I don’t know, [2100] it just sounds terr- , I mean I thought of it but then now it just doesn’t make sense. Uhm, [2120]”

this, she talks extensively about her wish to have recordings of the sessions to listen to during the break. I selected Session 727 to discuss more closely because of its particular language qualities. While this session ranks very low in Mrs. C’s Mean WRAD (220 out of 222) and high in her DF, it is the highest in the MHW, ranked first in that variable throughout the treatment.

After a long period of struggling without being able to connect and express her experience, she produces what the measures show as the most vivid and immediate narrative of the 222 sessions studied here.

She continues in this way, talking about how she forgets some of the things they talk about and can’t put it together again. Her struggles lead to his long intervention beginning around 2450.

ANALYST: “…yeah, it’s part of [2460] your whole way of rendering all my efforts useless, rendering me impotent. You’re showing me what you think of [2480] the things I say. You forget them. You destroy them. And you really would like to drive me up the [2500] wall, frustrate me totally. (silence) (cough) See, the equation, I think the recording comes in

envy.” These and related themes of loss, envy, and resentment dominate the remainder of the session, and, I would suggest, are dominant in the remainder of the treatment.

The longitudinal measures support the analysts’ comments in pointing to this period as a turning point in the analyst’s activity in this treatment. These include the increase in the analyst’s WRAD level in the third and fourth years, as well as the subsequent increase in negative affect, particularly hostile affect, as expressed in his speech in the fourth and fifth years. The nature of the interactions in these sessions following the birth of her child signal this shift in his interventions and in their interactions and can be seen more directly in the sessions from the fifth year.

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THE CASE OF MRS. C

because you made it plain a while [2520] back that you think for me the important thing about, you know, is that, is research and experiment, what you [2540] were told at the beginning. And eh, if you can make me fail then you have really hurt me where [2560] you think it hurts most and that’s really for you equivalent to castrating me.”

She continues her struggles in responding to this intervention.

PATIENT: “I don’t know, I [2840] wasn’t thinking specifically what would it be like if I actually was able to castrate you and (husband) and [2860] any man I came across. But, but somehow I just had this feeling I really wouldn’t like having well, [2880] I don’t know whether maybe it’s just the fear of what if I actually did do that. But [2900] it seemed to me it was more just thinking I really wouldn’t like to have that power. Uhm, except [2920] I al-, I always go around wanting to fight and, and resist and get as close as I can to [2940] it except I don’t really want it. And then, I think and by fighting and resisting and so forth, [2960] I’m, I don’t know, well, I’m not following my best interests. And, uhm (pause)” The analyst intervenes briefly here.

ANALYST: “Nonetheless, it’s very [2980] satisfying to you.”

Emergence of a Symbolizing Phase. We can see her struggles to this point as part of the Arousal phase of the referential process that finally takes shape here. She agrees with his comment, saying PATIENT: “…yeah, I find that very hard to admit but I think it’s true because I, every [3000] once in a while get sort of a, uhm, a moment where I’m not controlling my thoughts enough…”

This brings her to a story of a mystery she has been reading: PATIENT: “Well, what I th-, what I think of as a comparison is, uhm, in this [3040] mystery I’ve been reading, uhm, I’m not sure if there’s going to be another twist to it [3060] that isn’t clear to me right now, but apparently, as, as it’s turning out right now, the person [3080] who was killed, killed himself as a tremendous plan of revenge against somebody… he built up this terrific hatred for the man. And his killing himself [3140] was part of trying to trap the man into being caught as his murderer… the man actually was able to save himself because he saw this person’s [3200] face as he drove off…. he [3220] was sort of madly triumphant and, uhm, enjoying the thought of this kind of revenge and of destroying this other [3240] person. And yet, he’s going to destroy himself to do it.”

Following the story, her WRAD goes down, her WRRL increases. She sees a number of different ways to interpret the story in relation to what she is doing in the treatment:

maybe she is trying to castrate him; maybe she is refusing the help she came for; maybe she gets pleasure out of this; she’s not sure.

She struggles to explain these thoughts, as reflected in her high Disfluency. Here is part of her reflection on this story.

PATIENT: “I think, been thinking this too today every once in a while, which maybe is just [3380] another way of saying you’ve made no effect on me, I don’t know, I think of it somewhat [3400] differently… because I keep thinking of well, if I go away…I will be able to stop myself from doing this or whatever, uhm, [3460] then I anticipate that the summer will be, uhm, without coming here, just uhm, well, I don’t know how [3480] to think of it except sort of, I, I, somehow I’m pulling very much in myself and, uhm, and [3500] keeping a and, uhm, and [3500] keeping a balance that will keep (husband) happy.

But, uhm, well, I don’t like the image…but then I imagine [3680] coming in the fall and being very, I don’t know, having a very hard shell around me. And, uhm, [3700] as if it will be starting all over again. (pause)” Some Clinical Perspectives. Several of the clinicians discuss her struggling, disfluent, reflective associations in the early part of the session, and in the other two sessions from this period of the treatment, preceding and following this session. As Hoffman notes, in the middle of the session, Mrs. C can see different ways of viewing her wish for the recording: was it to take something away from him and hurt him, or would it be “because I don’t want to leave you so therefore I want to take something of you away, like your voice.”

Is it that “I associate it or substitute it in my mind for your penis” or is it that she has: PATIENT: “…to be here in order to remember things or to be able to think of them and concentrate on what we’d been talking about and to retain any understanding I got and…this recording would be the way to do it.”

The analyst seems open to only one.

Bruce Reis, writing to Mrs. C as from Winnicott, discusses her experience of herself and her relationship with her mother and her husband in some depth. His sense here is that she is resisting an identification with the aggressor, she doesn’t want to become the rejecting object herself. In a way related to Gherovici’s introduction of her search for sexual identity, his sense is that she is not trying to be a man but is trying to find a way to be a woman, other than the model her mother provided.

Gherovici notes that this session, like others, closes at a point at which she is trying to open up with reflections on their interactions; indicated by our measures as a rising level of WRRL. PATIENT: “…the [4320] question I just thought of now I think was, uhm, and maybe I’m doing two things again uhm, and, 55

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[4340] and I keep trying to think is it one or the other but, uhm, whether this thwarting of you, in [4360] effect not letting you have any influence, is just to fight you the way I want to fight any man [4380] or if it’s because you’re trying to make me give up something that I keep thinking I want [4400] to hang on to. But I guess it’s really part of the same thing.”

It is interesting that none of the clinicians focused on the theme of the WRAD peak in discussing this session. This is not unusual in our research comparing clinicians’ observations with the research measures.

Particularly in a session in which the patient is clearly struggling, clinicians are likely to focus on relational aspects of the treatment and on reflections and interpretations of the experiences that are described.

Session 728 We can carry this investigation forward to look at the themes in the subsequent session, the last before the break. She has difficulty recalling the date of the first session back, she focuses on general plans for her return in the fall, her teaching contract, and her child-care arrangements. In response to the analyst’s question as to why she is talking about this, she responds that she feels the need to close up because it is the last day. She feels a need to retain a sense of balance when she is not meeting regularly with the analyst.

Vorus, writing as a Kleinian, notes that the analyst’s comments “reflect his ability to hear this material only in terms of defense against aggression, not as reflecting her way of warding off feelings of dependency.”

Her WRAD peak in the middle of the session involves her parents being with her at their summer place, and her unhappy feelings, feeling of lethargy and feeling paralyzed, like she used to have with them and that she wants to avoid. None of the clinicians referred directly to this, although Vorus’s comments seem to support this point and her subsequent associations and ruminations: wanting a recording, keeping the process going while she is not seeing him. She understands that forgetting is an antagonistic thing towards him and maybe that’s what she is regretting; but her wish to recall might have several meanings.

PATIENT: “…but, well, there was something I liked about being [3600] able to recall things again here after I’d forgotten. It’s somehow again, reassured me or something.

And I, [3620] I just, I guess I just don’t know whether it’s all part of doing something very antagonistic or [3640] if it’s something else also. (pause)” He intervenes briefly at this point.

ANALYST: “…so in any case for eh, at least a little while here you eh, [3660] are worried what would happen when you’re left alone with (husband) without me to eh, be a buffer.”

THE CASE OF MRS. C

This leads her to two referential processes. We can follow the progression of themes in the narratives of the WRAD peaks.

First Referential Process. The first brief narrative concerns a book she has read about women who were raped in Bangladesh.

PATIENT: “The, ah, husband, or some male member [3980] of the family, but I guess it was usually the husband, was forced to watch while the woman was raped. [4000] And then either he was terribly upset over having had to watch and being restrained in that way, or else [4020] they killed him, but that they made him watch first.”

She reflects briefly on this: PATIENT: “and, uhm, I’m sure I’m thinking of something [4040] else about the raping, but it almost seems like the way I’m thinking about is, that is another way [4060] to castrate a man. And so it’s almost like I’m welcoming the idea of being raped and having [4080] (husband) have to watch because that would be another way to destroy him.”

Second Referential Process. In her narrative here, she returns to the book she had spoken about the previous day.

PATIENT: “…as it turned out, uhm, the man had not killed himself. [4200] He had been planning to wound himself and somebody had seen him with the gun and had struggled to get [4220] it away and then realized that he was going to be killed by the man.

Because his whole plan involved, [4240] uhm, having nobody know he’d done it to himself.

And so the person struggling with him actually ended up [4260] killing him. But it seemed, the thing that seemed most real to me is that in his plan for revenge, [4280] he would have been willing to destroy himself.”

She then brings the themes of the two narratives together in a high WRRL segment.

PATIENT: “…and it’s almost like, I mean I know these women didn’t [4300] choose this, but it’s almost as if the way I’m thinking of it, again, is that that [4320] would be a kind of destruction for me, but it would be worth it to have (husband) have to watch [4340] and therefore be destroyed.”

Third Narrative. This brings her to a narrative concerning a friend whose sister’s husband says he is leaving her; he’s found someone else. But he apparently is staying at home and not moving out. Mrs. C wonders why the woman’s sister doesn’t “just kick him out and be very aggressive.” She doesn’t have time to reflect on this theme or to relate these three narratives to one another; the analyst takes charge here and ends the session.

ANALYST: “Well, this is time for me to kick you out, then. Our time’s up.”

Hoffman (channeling Gray) makes a related point to that of Vorus, the Kleinian, and that seems to sum up the problems identified by the other clinicians viewing this material from their manifestly different perspectives.

As Hoffman says, referring to this intervention: “It is striking that only when the patient agrees with the analyst that she wants them to fight, does the analyst interact with her, albeit in a light moment.” As he also notes: “Even if this was heard as a joke, should it have been made to a patient who is suffering from low self-esteem and will miss the analyst very much?”

Some Conclusions About the Research Methods and Results The measures have allowed us to look at 222 sessions sampled across the treatment— about a fifth of the treatment. We have compared the treatment as a whole to seven other psychoanalytic treatments, looked at changes in the course of the treatment, and looked in some depth within four sessions from different phases. The overall measures provide general trends; if the goal of psychoanalytic treatment is change in emotion schemas, then we also want to identify major themes and changes in them.

Based on the narratives in the highWRAD segments, we can map some changes in Mrs. C’s focus from the first to the fifth year of treatment. In Session 38, in the first year, the narratives primarily concerned her conflicted feelings about her mother, her need to be recognized by her and her anger towards her, as well as a wish to feel more of a sense of freedom in her relationships. In the session from the third year, Session 433, her opening narrative concerned her worries about her baby and some criticism of the analyst for not recognizing her needs; the analyst did not respond to this but emphasized issues of control and its relation to sexuality. Issues of control and sexuality emerged more directly in relation to 56

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destructive wishes in her narratives in Sessions 727 and 728, in the fifth year. The emphasis on self-denigration remained through the five years; the goal of her self-harm seemed to change from protecting others, focusing primarily on her parents, to destroying others, focusing now on her husband.

These patterns can be related to previous formulations of the case, as discussed in the introduction to this issue. According to the unconscious control hypothesis of Weiss et al. (1986), based on 100 sessions in the first year of treatment, Mrs. C’s problems arose from unconscious guilt; as they said, “She protected herself from hurting them (her parents) by making herself weak, constricted and helpless.” Their analysis of the early sessions clearly points to a mechanism of selfharm in the psychic domain, with the goal of protecting, rather than hurting, the other.

Friedman et al. (1994) and Udoff (1996) focused on her unresolved ambivalent feelings toward her mother, starting from the beginning of her life, well before the birth of her brother when she was six—thus not stemming directly (or primarily) from envy of her brother. These included feelings of yearning as well as painful and angry feelings, which have been defended against.

According to these authors, the multi-faceted qualities of her feelings emerged strongly in the sessions following her return to treatment after her daughter was born, but were not explored. Her failure to focus on her own feelings in the service of maintaining a relationship with the analyst is another expression of psychic self-destruction. She attempts to spare the analyst her anger, as she once did her mother, but at a cost to her feelings about herself and her child.

THE CASE OF MRS. C

The theme of psychic self-destruction continues in the fifth year, but now with the goal of hurting the other (manifestly her husband) rather than sparing the other.

To my knowledge, this continuing theme of self-destruction with different objectives has not been discussed in previous writings about this case. Its various forms and its significance remain to be examined more fully.

Summary and New Directions What We Have Been Able to Learn About This Case The assessment of change in this long and complicated treatment has involved a combination of automatized measures and impressionistic judgment of themes, from a range of clinical perspectives. I’ve noted some general changes based on summary measures of language style. Mrs. C appeared willing to think and speak somewhat more freely in the moment, in the presence of the analyst, rather than planning her utterances before the session as the treatment proceeded, indicated by a substantial increase in her Disfluency measure; on the other hand, perhaps, this increase may have reflected a tendency to avoid some unwanted thoughts that might be intruding in her mind. In terms of content, the language style measures have pointed to particular narratives that are likely to represent instances of emotion schemas that were activated in the sessions. Changes in the themes of these narratives can be seen as indicators of underlying emotional organization.

While the language style measures are automatized, and have been validated as indicators of emotional experience, the characterization of underlying themes given here is impressionistic. The ability to locate major themes using automatized procedures is a major step forward in our research; what is needed now are systematic and reliable methods, which may be automatized or based on judgment, or a combination of both, to characterize the contents of these themes.

A major value of this project was the inclusion of the comments of analysts representing different clinical perspectives examining these sessions. These have been marked on the session graphs to show their relationship to the language measures. The narratives in the WRAD peaks were noted in the two earlier sessions by several of the clinicians. It is interesting that the dominant narratives in Sessions 727 and 728 were not explicitly noted by any of the clinicians reviewing that session, but their contents were reflected in the interactions in the sessions that were noted by them. What we see over and over in these sessions is the patient seeing two (at least) pathways of interpreting her feelings: only one of these (which may

diminish her) will earn the analyst’s response—and yet she knows the other paths are there as well.

The measures used in evaluating this case suggest that Mrs. C does come to see herself and her world differently, but that the value and nature of this change, and how it came about is unclear. This might be clarified to some extent by an examination of the process in the sixth year, including her developing relationship with her daughter and its relation to Mrs. C’s own relationship with her mother; as well as by examination of the termination process, where the structure of the entire treatment may be seen in a new way.

What is the Value of This Type of Research?

The question arises as to whether, or in what way, such a project of comparing clinical and research perspectives is of value to the field, other than because of its possible intrinsic interest. Here we come back to the basic question with which I began this paper—why did the analyst record this treatment? Why did his colleagues at the time, about half a century ago, feel it was important to engage in process research?—and to the corollary questions of whether, how, and why there is a need for process research in the psychodynamic field at this time.

There is now—after several decades of the declining status of psychodynamic treatment, and psychoanalysis in particular, and attempts by psychodynamic researchers to address this decline—increasing recognition that the battle to show the special value of the psychodynamic approach can’t be won on the outcome field alone. The best results of psychodynamic outcome researchers to date have primarily shown that their treatments do as well as the various behavioral forms in terms of the outcome measures in general use. Since there are fewer psychodynamic studies, and these have achieved less widespread recognition, the behavioral forms remain dominant in the public view as empirically supported treatments.

As many researchers have recognized, what we need to show is not that psychodynamic treatments do as well as behavioral treatments, or have the same effects as such treatments, but that the psychodynamic approach does something different that has particular and special value. The psychodynamic approach in its various forms, at its various levels, can potentially enable the patient (or client) to see herself and the world differently, not only to act differently in particular situations, and this kind of change in the meaning of experience can have valuable effects.

What is needed is for comparative outcome studies to include a study of underlying processes and mechanisms, so that the basis for differences and similarities in outcomes can be understood.

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I suggest that a systematic process component is necessary for many reasons—not only to improve the public view of these treatments, but to feed back to improve the work itself. Maybe the availability of systematic process measures would have been useful to Mrs. C’s analyst (and his supervisor), and to the cohort of researchers and analysts working at the time. Maybe the application of research measures can prove useful to therapists working today—just as the perspective of contemporary clinicians can be useful in the development of new and more relevant research approaches. z REFERENCES Bortfield, H., Leon, S. D., Bloom, J. E., Schober, M. F., & Brennan, S. E. (2001). Disfluency rates in conversation: Effects of age, relationship, topic, role, and gender. Language and Speech, 32, 229–259.

Bucci, W. (1997a). Psychoanalysis and cognitive science: A multiple code theory. New York, NY: Guilford Press.

Bucci, W. (1997b). Patterns of discourse in “good” and troubled hours: A multiple code interpretation. Journal of the American Psychoanalytic Association, 45, 155-187.

Bucci, W. (2021a). Emotional communication and therapeutic change: Understanding psychotherapy through multiple code theory. London, England: Routledge.

Bucci, W. (2021b). Development and validation of measures of referential activity. Journal of Psycholinguistic Research, 50, 17–27. https://doi.org/10.1007/s10936-021-09760-9 Bucci, W. & Maskit, B. (2006). A weighted dictionary for referential activity. In J. G. Shanahan, Y. Qu, & J. Wiebe (Eds.), Computing attitude and affect in text (pp.49-60).

Dordrecht, The Netherlands: Springer.

Bucci, W. & Maskit, B. (2021). Concluding notes and future directions. Journal of Psycholinguistic Research, 50, 231– 237. https://doi.org/10.1007/s10936-020-09741-4 Bucci, W., Maskit, M., & Murphy, S. (2016).

Connecting emotions and words: The referential process. Phenomenology and Cognitive Science, 15(3), 359-383. https://doi.org/10.1007/s11097-015-9417-z Friedman, R., Bucci, W., Epstein, A., & Udoff, A. (1994).

Maternalism: A new view of female sexuality. Symposium presented at the annual meeting of the American Academy of Psychoanalysis, Philadelphia, PA. Jones, E., & Windholz, M. (1990). The psychoanalytic case study: Toward a method for systematic inquiry. Journal of the American Psychoanalytic Association, 38, 985-1015.

Maskit, B. (2021). Overview of computer measures of the referential process. Journal of Psycholinguistic Research, 50, 29-49. https://doi.org/10.1007/ s10936-021-09761-8 Pennebaker, J. W., Mehl, M. R., & Niederhoffer, K. G. (2003). Psychological aspects of natural language use: Our words, our selves. Annual Review of Psychology, 54, 547-77.

Stone, P. J., Dunphy, D. C., Smith, M. S., & Ogilvie, D. M. (1966). The general inquirer: A computer approach to content analysis. Cambridge, MA and London, England: The MIT Press.

Udoff, A. (1996). Maternalism in psychoanalysis: An empirical study [Doctoral dissertation, Adelphi University].

Dissertation Abstracts Internal, 56(6), 3468B. Weiss, J., Sampson, H., & the Mount Zion Psychotherapy Research Group. (1986). The psychoanalytic process: Theory, clinical observation, and empirical research.

New York, NY: Guilford Press.

Zhou, Y., Maskit, B., Bucci, W., Fishman, A., & Murphy, S. (2021). Development of WRRL: A new computerized measure of the reflecting/reorganizing function.

Journal of Psycholinguistic Research, 50, 51–64. https://doi. org/10.1007/s10936-021-09762-7

THE CASE OF MRS. C

Seeing the End

Jamieson Webster, Wilma Bucci, Elena Petrovska

What does one see in transcribed sessions? What can be seen when the verbal becomes tangible? Do we see pieces of our own analysis between the lines, or perhaps even parts of ourselves, as analysts? Do we see Mrs. C, or do we miss Mrs. C? Even further, what can be seen (and missed) in a computer analysis of the transcripts that allows a different kind of vision—being able to scan in an instant hundreds of sessions, and to see the patterns of interaction in a particular session at a glance.

When reading through all the papers written for this issue of DIVISION/Review, it can feel like one has opened the door to not one but several analyses. Like an Ingmar Bergman movie, we are left to witness Scenes from an Analysis. Who is on the couch? Mrs. C, the analyst, or the reader? Perhaps these sessions are nothing more than a projective identification test in disguise. It is perhaps also tempting to imagine a recording of our own analyses and what we might make of others reading our play-by-play.

“All the world’s a stage,” wrote Shakespeare, “And all the men and women merely players/They have their exits and their entrances/And one man in his time plays many parts…” Mrs. C and her analyst have played and continue to play many parts, and rarely the same one twice. They become who the listener, or better yet, reader, wants and needs them to be. This re-reading of a confidential, transcribed, psychoanalytic session is a means to an end, to explore how one might listen to Mrs. C, differently from her analyst, or might supervise this analyst with respect to intervening, or hearing something important in what she is saying that he, at least on the surface, seems to miss.

Certainly, for an analysis to happen, there needs to be a patient who speaks and an analyst who listens and who perhaps, from time to time, thoughtfully responds. Both parties are also encouraged to be fully alive and present in the room, and the transference and countertransference are invited to unfold in the analytic hours. In a time when we are surrounded by and heavily reliant on technology, especially during a pandemic, without the continued bodily presence of the patient-analyst dyad, and with elevation of the pressure of continuous speaking, the intimacy and dedication of the experience feels under threat. Even in such times, we still need to ask the important question that our seven authors and our researcher ask: what do we listen for as psychoanalysts, and how can we best respond to our patients?

Applying the referential process measures to eight sessions, while also looking at the material the seven psychoanalysts reacted

to most directly, we see that the listening ear of the consultants and the computerized measures of language were attending to different parts of the session in some instances, while agreeing in others. The analysts frequently homed in on material that foregrounded leaps in the Referential Activity measure of symbolizing (the Weighted Referential Activity Dictionary [WRAD]) or on interactions that led to disfluency and withdrawal by Mrs. C. In a way, the analysts seemed to anticipate what the computerized measures picked up, regardless of how variable their explanations might be for what was going right and what was going wrong.

The computerized analysis of symbolic processes shows that Mrs. C, over time, became more free to talk spontaneously in the session. Paradoxically, this can be seen in the increase in her disfluent and halting speech, an indicator that she was more willing to engage with her analyst and with her own experience in the moment, without preparation.

She was in fact more open and more free with him, even when talking about her fears of losing this feeling of freedom. We can see in-

In a time when we are surrounded by and heavily reliant on technology, especially during a pandemic, without the continued bodily presence of the patient-analyst dyad, and with elevation of the pressure of continuous speaking, the intimacy and dedication of the experience feels under threat.

stances in which this period of disfluency and struggle seemed to lead to key moments in the treatment, as indicated by the Referential Activity peaks. We can also see instances in which this struggle pointed to experiences she may have been trying to avoid.

There is so much to glean about Mrs. C from the rich material she brought to her sessions, especially about her body, the birth of her first child, and her rich phenomenological descriptions of her relationship to her new baby, as well as her fantasies about the analyst, her feelings about the tape-recorder 58

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and their separations, and her fascination with masochistic self-destruction as a powerfully articulated negative transference, on the brink of an August vacation. An interesting dissociation between the computer’s eye view and that of the clinicians emerges in the differences in their focus in the middle session of this period (Session 727). As the graphs of session 727 on p.54 shows, several clinicians focus on the interactive material during the middle and closing parts of Session 727 and leave unmarked the WRAD peak that Bucci sees as carrying the clue to an emotion schema that has been activated in this session—that tells us what she was doing in the session, and what she may have been doing over and over again in her life.

The peak contains a vivid story about someone who destroys himself as a means of destroying another person, but it turns out that the other is not hurt. This is the highest WRAD peak of the 222 sessions included in the referential process database, and it takes us some distance in understanding what she did in relation to her parents (particularly to her mother), to her husband, and in her interactions with the analyst. As Bucci points out, it is not a big step from the physical self-destruction in the story to the psychic self-denigration and self-harm that preserved the other and her image of the other that was so important to her.

The same theme emerges in two WRAD peaks in the following session (Session 728); again, the clinicians seem to focus on the material that leads to the emergence of the theme, rather than to the theme itself.

Iatrogenic to the task at hand, what was of major import for our observers was to keep track of the dyad and ask a question about technique and efficacy; to look at how this analytic couple got stuck, missed one another, how they kept circling the same difficulties without seemingly breaking through them, how they gave way to what might seem like enactments as well as trying to construct what was helpful within the sessions themselves—to put their theory to the test with and against that of Mrs. C’s analyst.

Most analysts picked up the focus on aggression and defense endemic to an ego-psychological approach in several of the sessions, including those not discussed in detail here.

Indeed, there is an undeniable immediate aggressive intensity in their constant haggling about the times of the sessions and the obsessional meta-conversations about what is happening with their scheduling difficulties with one another, as well as in their, at times, very abrupt endings. These entry and exit points and their effects on the sessions were on the mind of every observer as speaking to

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THE CASE OF MRS. C

the transferential climate, but also a problem potentially introduced by the analyst’s theory and preoccupation with the patient’s supposed penis-envy and wish to castrate her analyst. What do we make of this?

Well, as several observers point out, by the end, Mrs. C was able to make a joke of it, throw it back in her analyst’s face when, after a long, rich description of her masochistic fantasies, saying to him that she can’t handle the upcoming August vacation, he asked her what she can’t handle besides rape and murder, answering, “Your penis!” You almost jump out of your seat in applause of her… and then, begrudgingly perhaps, of him (see Session 728, lines 1500-1510).

And the richness of her depiction of her conflicts is a point on both their score cards.

Is this a moment of contact? Him acknowledging the wildness of her fantasies and sexuality? Her acknowledging his repetitive interpretations?

For Bucci, however, while one might applaud her playing the game well, she was playing his game on his terms, and it would have been better for her to set the parameters herself. In fact, that is just what she tried to do; after following his cue and delivering the line he has set up for her, she looked for a way back to her own concerns. It was not only rape and murder and his penis that she couldn’t handle, but her feelings of frustration as well. Maybe her feelings were connected with her fascination with destructive things, but she was also worried that she would upset a balance that she had achieved in the analysis up to that point and wouldn’t get through the summer. They talked about what it meant to upset the balance; he focused on her problems in relation to her husband. This led to a brief WRAD peak that concerned not her relationship to her husband, but her feelings towards her parents over the summer the previous year, when her husband was away.

This peak was not considered by Bucci as part of a referential process in her discussion of the session because it was not followed by any reflection; instead, there was a spike in disfluency as she talked about the way she “used to feel so much at home,” the kind of unhappy feeling she likes to avoid whenever possible.

PATIENT: “the way I’d get almost, uhm, well, lethargic [2320] isn’t quite it and paralyzed isn’t it, it’s something in between.

But, uhm, I mean on the [2340] one hand it’s as if all my energy is gone and on the other it’s as if I [2360] don’t dare do anything anyway. And, uhm, well, I don’t know, it’s just an awful state. (pause)” She was thinking of it again, “really feeling almost a panic that I [2540] might start feeling that way again this summer,” but with her very disfluent language following the peak, she was working hard to avoid talking about such feelings in the room.

Reading this now, she seemed to be describing a depressive state; she didn’t say she expected to feel depressed or sad; this description is more clinically significant. The analyst didn’t respond to this, didn’t intervene for a long period as she talked on. Reading the session at this point, we could see her trying to take care of herself. Maybe it will be alright this summer; the first two weeks they’re up there her parents won’t be there at all; maybe she will be able to establish some kind of routine with her husband that will make her feel more secure. She continued for the long middle period of the session with very disfluent language. He intervened only when she returned to the topic of the recording and its meaning for her in relation to her angry and destructive feelings towards him and towards her husband.

PATIENT: “…maybe it’s because I, I understand that forgetting is an antagonistic [3580] thing toward you and maybe that’s what I’m regretting. but, well, there was something I liked about being [3600] able to recall things again here after I’d forgotten. It’s somehow again, reassured me or something. and I, [3620] I just, I guess I just don’t know whether it’s all part of doing something very antagonistic or [3640] if it’s something else also. (pause)” ANALYST: “So in any case for eh, at least a little while here you eh, [3660] are worried what would happen when you’re left alone with (husband) without me to be a buffer.”

His intervention led her to several narratives that carried the theme of self-harm in the service of hurting the other, but her feelings of depressive paralysis weren’t relevant to her analyst, and she would push her fear of them aside.

We can also see the nature of the treatment in a different way in the third year, in the sessions following her extended absence during the birth of her baby and her early weeks of motherhood. She began by announcing that she had two things on her mind: the first, appearing as a WRAD peak, involved her problems in caring for her baby, who had a cold, and how the analyst was making it more difficult for her by not changing the appointment time; the second concerned wearing pants or a dress. The analyst bypassed the first topic in favor of the second, which he could turn to fit his own theme. This session also featured the unusual occurrence of an analyst producing his own referential process in the middle of the session, his summary of the three sessions since her return to treatment.

Bucci sees this period as a turning point in the treatment, with his driving the direction of the associations—they became less and less free. These sessions could be a topic for another project that could also look for repeated patterns in sessions concerning her 60

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relationship with her mother and compare these to her sessions in the last year of treatment, not studied here. In such a study, we could also examine how these patterns may apply—or not apply—or be distorted—in her relationship with her baby daughter, and how they played out in the termination process.

This project raises the question as to what is the nature of the understanding we can glean from a transcript or from the measures concerning the place or the nature of the contact between the two individuals? Is it easier to see disruption and absence than to know when or how or even what emotional contact has actually taken place? This is a very difficult question and one that haunts this project. The computerized measures show a tendency in Mrs. C to restrict herself that is commensurate with what she said about herself and about her marriage, and that is a large part of what she came seeking analysis to address. Bucci, who has been able to look at the case in its entirety, points this out as a red thread in the case.

Bucci points to a theme of psychic self-destruction that takes different forms throughout the several years studied here, with the goal of the self-destruction moving from sparing the other (her parents, the analyst) to hurting the other (particularly her husband). The forms of self-restriction/ self-destruction are discussed by several of the analysts commenting on the case. Mrs. C turned away from exploring her feelings as a mother—of connection, of resentment, other feelings that remain unnamed, unformed, and from her search for her identity as a woman—to try to follow the path that he, to some extent implicitly, to some extent explicitly, marked out for her with respect to her “aggression.” While this was no doubt important for a woman who felt so restricted, so critical and self-critical, and unable to experience pleasure or stand up for her own convictions, why did it have to be at such a cost to these other emergent moments of her experience of herself ?

Reading the sessions, we see that Mrs. C did not necessarily fight her analyst outright about what he was saying, and often became compliant but passive aggressive. Or she stayed very intellectual about his interpretations, all too often abandoning threads of thinking that seemed important to her in order to follow him, as we saw in Session 728. This is one of the more painful aspects of the treatment to read because there is a richness on the side of her associative mind; many of our consultants were touched and dismayed by what was seemingly left to the side in the overwrought attention to her wish to “castrate”—whatever that even means. On the other hand, Mrs. C did work enormously hard to make use of his interpretations, to elaborate on his line of thinking, and he too, sometimes did a lot of work for her.

THE CASE OF MRS. C

We can see this in his long and active interventions in Session 433, focusing on her fear of the loss of her vagina in the stitching up following childbirth; feelings of the loss of control associated with intercourse; and all these and other associations connected with disappointment at having a daughter rather than a son. While many took issue with these interpretations, the analytic couple here seem to be working for and with one another, no doubt under the dominance of a transference, dare we say transference-fantasy, that was only beginning to find articulation.

She was able to run with the very long interpretation by the analyst, and they ran off on a train of thought together. In doing this, she left behind some of the rich descriptions of both her daughter and her closeness with her, which she connected to breastfeeding, not liking intercourse with her husband, and difficulties thinking about her daughter in the analyst’s presence—a reticence she didn’t yet understand. Here, she opened the door to another set of themes that Bucci as well as some of the analysts see as potentially central for her, but the analyst didn’t follow her, and the door shut again. In a way, she and the analyst consummated their “psychoanalytic” relationship again, just as she and her husband consummated their sexual relationship again after the maternity break, both events seemingly leaving her daughter behind, no less her new identity as a mother, making her wonder about her vagina being sewed shut, wondering what was lost or gained.

Whether we interpret this move that directed the patient to her penis-envy and disappointment with her daughter as the analyst’s misogyny, lack of attention to the reality of new motherhood, inability to understand femininity and feminine sexuality, inability to play along with the patient’s mind, or difficulty with staying close to her intense bid for and terror of intimacy, is this not in fact an instance of over-closeness— perhaps to the point of suffocation of parts of herself—and not simply one of disjunction, rupture, and distance? Didn’t they get into their exciting analytic tete-a-tete, which they both knew so well, as a way of recommencing their time together? And isn’t this what we see them doing in a more fulsome manner two years later in their conversations saturated with rape, murder, and castration?

Do we imagine a different interpretation that would somehow stay closer to what Mrs. C was saying, that would be able to encompass the transference-countertransference dynamics, and that would also point to what was a repetition in the hereand-now, but would not reduce the analytic work simply to a relationship on his terms, while maintaining the boundaries and renunciations appropriate to the setting? That may or may not seem like a lot to ask—but

then doing the work of listening is a lot to ask. Meanwhile, what we are left with is a sense of the powerful cat-and-mouse game played in both directions. The points of contact continue to seem elusive but may in fact be very close to the moments in which we think we see an absence. Presence and absence as psychic functions are strangely structured entities in psychoanalysis, shaped through a texture of language, symbolic processes, and the strange asymmetrical dialogue of analysis. The texture of the object that begins to appear, sometimes appears as what is missing, is not obvious, is not even objectively there, but is, as we understand it, constructed over time.

This is most certainly what Mrs. C circled, as some of our consultants point out, with her attention to what feels real and unreal, what feels like it’s closing up, her anticipations of separation and feelings about what she could carry with her from the analysis in his absence. Perhaps the richness of this texture is gleaned best not simply in the case itself, or in Mrs. C’s words, but in all the material gathered for this special edition of DIVISION/Review, which shows us just how complicated analytic work is, and the careful attention of all the analysts to the shape of absence and loss, the sexual fantasies that stir and whir like a tape recorder, in these inevitable gaps. All in all, the “objective” comparison of the converging—and diverging—foci between our consultants and the computerized analysis is quite a fascinating finding.

The computer can show us what, and show us how this “what” comes about through the dialogic interaction of the pair; when we turn to the transcript and look at these intervals, moment by moment and then cumulatively, we get another sense of this “what” that has been measured.

On the other hand, without the computer measures, how would we know where to look in a treatment that lasted six years, five times a week, a total of 1114 sessions, more than four thousand words per session, for a total of about five million words (Do the math!)? The computerized measures guided the choice of the eight sessions that were used in this study, looking for sessions with contrasting interaction patterns representing different phases of the treatment; thus, the clinicians could then read and experience the changes and the contrasts that occurred. Here, we’ve compared the clinical and research measures in only four of the eight sessions; many points of convergence and divergence remain to be discussed.

Going into the sessions themselves doesn’t necessarily tell us definitively “why,” which still requires, at the very least, a construction. The computerized measures open up for us a graphic depiction of the fluctuations of a complex process of symbolization 61

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in a transference-countertransference matrix, allowing us to dig in deeper. Conversely, the powerful clinical insights, such as were given in this study, have the potential to guide the researchers in developing new and more useful measures that can begin to distinguish between the nature of the relational interactions and the nature of the contents that are carried within them, and to provide more useful information about both. As Bucci has said elsewhere, the psychoanalytic situation provides the best available opportunity not only for research on the therapy process, but also for basic research on the interaction of bodily experience, emotion, and language as this plays out in a relational context. The contrasting focus that was made possible in this project has given us some indication of how and why theory, clinical work, and scientific research can keep expanding, modifying technique along the way—potentially even contributing to revolutions in technique.

Perhaps the history of disruptions and revolutions within the unfolding of psychoanalytic knowledge mirrors Mrs. C and her analyst, who had to keep renegotiating the analytic frame at every meeting, with varying degrees of success, and who tried so hard to hold onto their experience and knowledge, which was being put to the test. There was so much pressure from all sides on this case, making the risk of disappointment all the steeper, of course for Mrs. C (already quite disappointed), but also for the analyst, the analyst’s esteemed supervisor, the researchers and the research institute sanctioning the project, and all the analysts of the future who would come to listen.

What else can we say about our seven interlocutors and their fascinating converging and diverging views on the sessions?

Theories are funny things—they predispose one to listen for some things and not others, to do some things and not others, while they are also meant to help open the ear and invent new ways of working with patients. One might want to make a comment at this point about the line between the creativity of the analyst and dogma, while others might want to protect the rigor of theory, maintaining a certain frame with a patient, worried about psychoanalysis being exposed to a kind of free-for-all. In a way, one might like to combine by nuclear fission all seven of our readers into the perfect psychoanalyst and add the basic theory of the connection of bodily experience, emotion, and language to this convergence. In this wish, we stumble upon one of the most basic psychoanalytic truths: wish is born from loss, which is as inevitable as displeasure, discontinuity, and death. What better testament to psychoanalysis than this unique assemblage of text, work, analysis, reading, and research? z

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Editors: Kerry Kelly Novick, Jack Novick, Denia Barrett, & Thomas Barrett Parent Work Casebook This casebook brings together the voices of 40 psychoanalysts from around the world to illustrated contemporary views about whether and how to work with parents. The ideas proposed in the model of dynamic concurrent parent work are illustrated and explored here through clinical vigne�es, commentaries from experienced child and adolescent analysts, and reflec�ons by the volume’s editors. The value of parent work is affirmed as a substan�ve contribu�on to pragma�c, effec�ve, and life-changing child and adolescent psychoanalysis.

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Arnold A rn Wilson, P Ph.D. hh..D.

“Ours is an age of rage. Rag e ag ainst abuse, inequality, injustice, prejudice. Shame and fear, oppression's instruments, will silence suffering women no more. Can psychoanalysis eradicat e its own biases and inspire creative foment? In a passionate essay, Arlene Kramer Richards stimulates a vibrant exchange w i t h o t h e r p s y c h oa n a l y s t s l o ok i n g t o p r om o t e i n d i v i d u a l f r e e d o m o f e x p r e s s i o n a n d t h e c r e a t i o n of a more just societ y. The lively back and forth between Dr. Richards and her discussants itself demonstrates h ow a n o p e n e x c h a n g e c a n f os t e r m u t u a l g r o w t h . ” —S A N D R A B U E C H L E R , P h D , T r a i n i n g A n a l y s t , W i l l i a m A l a n s o n W h i t e author, Psychoanalytic Reflections: Training and Practice

Arnold Wilson Paradigms and Processes: Selected Papers of Arnold W ilson, PhD

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NOTES ON CONTRIBUTORS Wilma Bucci, PhD is Professor Emerita, Derner Institute, Adelphi University; Honorary Member of the American Psychoanalytic Association (APsaA), the New York Psychoanalytic Society and Institute (NYPSI), and the Institute for Psychoanalytic Training and Research (IPTAR); Visiting Professor in Psychoanalytic Research, University College, London; Faculty of the International Psychoanalytical Association Research Training Programme; Co-Director of Research at the Pacella Research Center; author of Psychoanalysis and Cognitive Science: A Multiple Code Theory (1997); Emotional Communication and Therapeutic Change: Understanding Psychotherapy through Multiple Code Theory (2021), and many clinical,theoretical and research papers.

Patricia Gherovici, PhD is a recipient of the 2020 Sigourney Award for her clinical and scholarly work with Latinx and gender variant communities. ​ Her single-authored books include The Puerto Rican Syndrome (Other Press: 2003) winner of the Gradiva Award and the Boyer Prize, Please Select Your Gender: From the Invention of Hysteria to the Democratizing of Transgenderism (Routledge: 2010), and Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference (Routledge: 2017). She edited with Manya Steinkoler: Lacan On Madness: Madness Yes You Can’t (Routledge: 2015) and Lacan, Psychoanalysis and Comedy (Cambridge University Press: 2016). Most recently, she co-edited with Chris Christian Psychoanalysis in the Barrios: Race, Class, and the Unconscious (Winner of the Gradiva Award and the American Board and Academy of Psychoanalysis Book Prize; Routledge: 2019.)

Leon Hoffman, MD, Psychiatrist and Child and Adolescent Psychiatrist; Training and Supervising Analyst in adult, child, and adolescent analysis, co-Director, Pacella Research Center at NYPSI (New York Psychoanalytic Society and Institute); faculty Icahn School of Medicine at Mount Sinai; Chief Psychiatrist/Psychoanalyst, West End Day School in NYC. He is author of Manual for Regulation-Focused Psychotherapy for Children with Externalizing Behaviors (RFP-C): A Psychodynamic Approach, co-written with Timothy Rice and Tracy Prout. Among several papers from this work, findings from a pilot study have been published in the American

Journal of Psychotherapy in 2019. He has written about the impact of Berta Bornstein’s ideas on contemporary treatment of children with disruptive behaviors and the value of the utilization of Wilma Bucci’s linguistic measures for understanding the process in psychotherapy and psychoanalysis. He has taught courses and written on the regulation of emotions and affects, adolescent development and emerging adulthood, including college students, both for professional and general audiences.

Evan Malater is a psychoanalyst in private practice in New York City.

Elena Petrovska, MA, PhD candidate, is a therapist at various community clinics, Teaching Assistant, and Research Assistant. She has written for PublicSeminar.org, the Journal of Writing and Democracy, the Journal of the American Geriatrics Society, and the International Journal of Environmental Research and Public Health.

She published a collection of poetry, titled On My Period. Elena has been a guest editor for the D/R special issue, Anybody, Any Body.

Bruce Reis, PhD, FIPA, is a Training and Supervising Analyst and Faculty Member at the Institute for Psychoanalytic Training and Research, New York; an Adjunct Clinical Assistant Professor in the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis; and a member of the Boston Change Process Study Group. He is Regional North American Editor for the International Journal of Psychoanalysis as well as the North American book review editor. He has previously served on the editorial boards of The Psychoanalytic Quarterly, and Psychoanalytic Dialogues. He is the co-editor (with Robert Grossmark) of Heterosexual Masculinities and author of Creative Repetition and Intersubjectivity (2020).

Doris Silverman, PhD is currently President of IPTAR and she is a training, supervising, and teaching analyst at IPTAR. She is a faculty member and supervisor at the NYU Postdoctoral Program for Psychotherapy and Psychoanalysis. She is also a fellow, teacher and supervisor at the International Psychoanalytic Association as well as a number of other training institutes in New York City and throughout the country.

She serves on the editorial boards of a number 64

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of psychoanalytic journals and has extensively reviewed articles for potential publication.

She is the former Editor of the Newsletter and Newsmagazine of the International Psychoanalytic Association. She reviews papers for meetings sponsored by the International Psychoanalytic Assn, as well as reviews financial grant applications for this group. In addition to co-authoring the book, Changing Conceptions of Psychoanalysis: The Legacy of Merton M. Gill, Doris Silverman has written widely on a variety of psychoanalytic topics including infant research and its relevance for psychoanalysis, symbiosis, female development sexuality and gender, the attachment system for secure and insecure individuals, and the use of empirical data to augment our therapeutic skills. She is the recipient of the Scientific Scholar Award of the American Psychological Association in 2007. She has also received the Linda Neworth Memorial Award.

Dr. Neal Vorus is a Training and Supervising Analyst and Faculty Member at the Institute for Psychoanalytic Training and Research (IPTAR) and Adjunct Assistant Clinical Professor at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. He has written a number of papers on the integration of Contemporary Freudian and Modern Kleinian perspectives, and is the book review editor of the journal Psychoanalytic Psychology. Dr. Vorus is in private practice in Manhattan, where he treats adults, adolescents, and children.

Jamieson Webster is a psychoanalyst in private practice in New York City. She is the author of The Life and Death of Psychoanalysis (2011) and Conversion Disorder: Listening to the Body in Psychoanalysis (2018); she also co-wrote, with Simon Critchley, Stay, Illusion! The Hamlet Doctrine (2013). She writes regularly for Artforum, The New York Review of Books, and Spike Art Quarterly. She teaches at the New School for Social Research.