Reveries: Reflections on Psychoanalytic Work

On travel:

It is a psycho-urban myth that if someone knocks on your door, rings your bell, asking to start a psychoanalytic process, ethically you should issue a warning, ‘Do so at your peril – it is a hazardous journey’. Some people, sensibly perhaps, run for the hills and go on screaming; others lie down and get lost in the mountain ranges of internal work that an analytic process is.

This Zen teaching reminds us of the power of projection and the ‘madness’ of the transference in the psychoanalytic process.

“When you start on a long journey, trees are trees, water is water and mountains are mountains.

“After you have gone some distance, trees are no longer trees, water is no longer water, and mountains are no longer mountains.

“But after you have travelled a great distance, trees are once again trees, water is once again water, and mountains are once again mountains.”

TS Eliot’s overused but brilliant quote describes this too:

“We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.”

On/In the body:

Talking of hazardous, challenging journeys…one of the most has to be with the psychosomatic patient. Age-old, [think Freud and hysteria], these patients are getting more and more thought-time in current analytic literature. There are increasing and often confusing distinctions made in the different literature between conversion disorders, hysteria, psychosomatics. This is a terrain where you, the therapist, can easily go down the wrong path. One of the most useful and descriptive articles to begin with is Joyce McDougall’s The Psychosoma and the Psychoanalytic Process (1974).

A concluding comment:

“The baby who cannot internalize the breast, who cannot create within himself his mother’s image to deal with his pain is a lonely island. One way out is to turn oneself into a rock. Thus many psychosomatic patients continue on their unwavering tight-rope, ignoring the body’s signs and the mind’s distress signals. This invincibility invades the analytic situation. The stifling of feeling, the breaking of associative chains, the attack upon the analyst’s attempts to make symbolic links may give the analyst the feeling that his patient is unanalysable. And it may be so. The upsurge of emotion is often felt like a ‘crazy’ intrusion into the mind and words may acquire the hypercathectic charge of psychotic objects if they become infused with fantasy.

“Much of the success or failure of the analysis of the psychosomatic dimensions of the personality depend on the extent to which the transference is able to bear the coming alive of archaic instinctual impulses, and consequent ego perturbation. Perhaps the limits of the analytic process in these cases are the limits of the analyst. One does not always ‘survive’ as an inner object for one’s patients and then the mother-nursling failure is repeated once more and the psychosomatic defences hold firm. On the other hand the analytic process can produce overwhelming change even though to do this it may lead the rock to feel great pain and the island to cry for many years to come.”

On the garden path:

Talking of success and failure and going down the wrong garden path…brilliant teacher and psychoanalyst Coralie Trotter recently ran a workshop entitled: Andre Green: The Greening of Psychoanalysis. Her exploration of ‘the second paradigm’ and the ‘work of the negative’ provided participants with a fortune of learning…but a realisation of the perilous seas we sometimes find ourselves in.

Says Coralie: “The negative…could be because the object wasn’t present or not registered as present. This results in a non-representation. With no representation you have to do something else with the drive, e.g. decathexis of the object or somatising. So in this paradigm, you have a hole, a non-thing. It’s not about the loss of the object or the loss of the love of the object, it’s about the loss of meaning.

“If you’re working with someone in the one paradigm and actually their identification is with a non-object, then you’ll be barking up the wrong tree for years. Are you working with the loss of meaning or with the complexity of relating to an object?”

Both Joyce McDougall and Coralie Trotter remind us of the importance of on-going learning. Belonging to clinical and reading groups; going to lectures; attending workshops; listening to presentations on the Calabash – are all imperative if you are to offer your patients the best help that you can. It is interesting how, as we grow as therapists, so too do our patients. When we have a growth spurt, so usually do our patients. They put their trust in us and we need to take this seriously. It is ongoing and demanding work. But it can make the world of difference.

On time:

An interesting book Why Time flies: a mostly scientific investigation (2017) by New York staff writer Alan Burdick is ‘a layered rigorously researched, lyrically narrated inquiry into the most befuddling dimension of existence [time]’.

It makes one think about the discomfort and discomposure both we, the therapist, and our patients, can feel about silence and long pauses in sessions. According to Burdick our experience of time has a central social component – an internal clock inheres in our capacity for intersubjectivity, intuitively governing our social interactions and the interpersonal mirroring that undergirds the human capacity for empathy.

On empathy:

Empathy came up in psychoanalyst and neuropsychologist Mark Solms’ presentation Is Beauty in the Eye of the Beholder. Is it all about Me? at the South African Psychoanalytical Initiative’s 2017 Education Day. He talked of ‘feeling your way into the thing’. A concept linked often to aesthetics – a feeling in the subject, which has to be felt into the object. Think about looking at a work of art. In effect you project yourself into a painting in order to appreciate its qualities. The feeling is in the viewer, there is no feeling in the painting.

However, says Mark, in psychology, we have to feel our way into our patients’ mental states. This is different from the painting, because others do have feelings, whereas paintings don’t. However, it’s similar because you can’t actually know another’s feelings, you can only know your own. The mind is a subjective state.

“You can get it wrong when you are empathising. It’s a developmental achievement, to be truly able to recognise a mental state of another, rather than what you’ve projected into it.”

FYI: Mark Solms does not believe that ‘beauty is in the eye of the beholder’.

On silence:

“If we had a keen vision and feeling of all ordinary life, it would be like hearing the grass grow and the squirrel’s heart-beat, and we should die of that roar which lies on the other side of silence.”

George Eliot

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