(Editors' Note)
On September 1, 2000, Hilde Rapp responded on the
IJPA discussion list to an invitation to suggest
ways of facilitating a process of translation
between different psychoanalytic dialects, and
made a forward of her message to the SEPI list
serve. On the same day Paul Wachtel replied saying
that as "an integrationist, moreover, whose
initial roots and continuing strongest interests
are in psychoanalysis", he had "NOT been persuaded
that Lacan, or even Bion, to take a quite
different example, really have something useful to
contribute", and went on to ask Hilde, since she
cited Bion approvingly, if she could indicate in a
brief way what ideas of observations of his she
thinks are really valuable. On September 2 Hilde
and Tullio Carere responded to Paul's invitation,
pointing up shortly what in their opinion is
valuable in the thinkers quoted, and especially in
Bion. Paul replied that he has nothing to object
to the interesting kinship between the
therapist-patient relationship and the
mother-infant relationship, yet much to object to
the usefulness of the image of a "container" or of
"containing". This gave rise to a huge debate, in
which 26 SEPI members took part. The discussion on
the function of holding or containing was enriched
by that on a related concept, that is projective
identification, introduced into the debate by
Paolo Migone. He said on September 4 that though
put off by Bion's difficult language, he did
appreciate several of his things, for example his
re-elaboration of the concept of projective
identification. He sent then the following day a
long excerpt from a paper of his on this topic.
The concept of projective identification met more
or less with the same reception as the image of
the container: those who distrusted the latter
felt the same distrust toward the former. Two
positions emerged in the discussion. Some thought
that the metaphor of containing/holding was useful
to describe a crucial therapeutic factor,
connected to reparation or corrective emotional
experience. Others did not deny the therapeutic
factor, but took issue with the metaphor, deemed
useless or misleading. A lengthy and passionate
discussion brought to no rapprochement between the
two positions, but we are sure that its reading
will enrich many colleagues. We want to thank all
26 participants, who are the following (listed in
the order in which they intervened): Paul Wachtel,
Tullio Carere,
Hilde
Rapp, George
Stricker, Windy Dryden,
Jack Berkley,
Paolo Migone,
Rebecca Curtis,
Bill Stiles,
Bob Sollod,
Jennifer Hillman,
Robert
Rosenbaum, David Allen,
Luca Panseri,
Nancy McWilliams,
Jim Lindsley,
Arthur Egendorf,
Diana Fosha, Richard O'Connor,
Ana M.
Stingel, Elizabeth
Moraes, Marvin
Goldfried, Diana P. Wais,
Allen Kalpin,
Ava
Schlesinger, Ang Wee Kiat
Anthony.
Fri, 1 Sep 2000, Paul Wachtel
Hilde, I got your recent posting on the SEPI list
serve and felt like I had come in in the middle of the
movie. I gather you were forwarding something from
another list to which you also belong? But there was
no indication how to communicate with that list. Was
there a longer history to the discussion from which
you cited a piece? I was intrigued but puzzled.
I was also made aware that despite being (a) a
staunch integrationist and, hence, someone who
fundamentally believes that any school of thought that
has attracted significant numbers of smart people must
have SOMETHING useful to say that those of us of other
orientations can profit from and use, and (b) an
integrationist, moreover, whose initial roots and
continuing strongest interests are in psychoanalysis,
I nonetheless became acutely aware in reading the
posting that, thus far, I have NOT been persuaded that
Lacan, or even Bion to take a quite different example,
really have something useful to contribute. Bion in
particular has become quite strongly of interest in
U.S. psychoanalytic circles (there's always a time lag
across the pond), and I have frankly been put off
enough by everything I have heard my Bion-citing
students and colleagues say (putting feelings "into"
other people, all the stuff about "containers," the
view of psychic life and of groups as basically
psychotic underneath, etc.) that I have not had the
inclination to read his stuff for myself. That means,
of course, that I speak from ignorance in a sense, so
nothing I am saying here is something I would stand
behind in print. (I don't believe we should spout off
-- except in informal exchanges such as this, that are
designed simply to draw further responses for
consideration -- on matters that we have not examined
seriously and carefully). On the other hand, life is
short, and I barely have enough time to read the
things I KNOW I will find useful, and nothing I have
heard anyone say about Bion thus far has led me to
think that, in the finiteness of life, reading Bion is
a good investment of my limited time.
So, since you cited Bion approvingly, if you could
indicate to me in a brief way what ideas of
observations of his you think are really valuable (and
perhaps whether you think any of them are unique
enough that I couldn't come to them from other sources
who use a less peculiar and off-putting linguistic
style) I would be very appreciative.
I was initially going to send this just to you (along
with a warm hello, which shall remain), but decided to
respond instead to the SEPI list from which it came,
since others on the list may also be able to help me
overcome my resistance to Bion, if that be what it is.
So thanks to any of you who can enlighten me (and, for
that matter, to any of you who share my views about
containers and putting feelings into people, and want
to cure me not by enlightening me but by supporting my
present inclinations). Paul.
Sat, 2 Sep 2000, Tullio Carere
Paul, I put Bion in the same category as Jung and
Lacan, for their capacity to irritate me deeply, but
in the same time to intrigue me enough to get me to
read further. Yet very little of Jung or Lacan has
survived in my present way of working and thinking
(though Jung has been a juvenile love affair of mine),
while Bion's influence is still a corner stone to me.
I understand Bion's thoughts "about containers and
putting feelings into people" as his way to point to
the kinship between the mother/child and the
therapist/patient relationships. As the mother must
hold, contain, and partially work through the
experience that the child cannot yet hold, contain and
work through by himself, so is the therapist to do
with some of her patients, in some moments, or
sessions, or phases of the treatment. When a therapist
relates to her patient in this way, I say that she
acts from the "Maternal vertex" of the field.
But Bion's most decisive contribution is in my
opinion the introduction in the therapeutic field of
the Kantian polarity phenomenon/noumenon, or
knowledge/unknown, or K/O. In the Freudian theory
there is no Unknown (as unknowable), there is only an
Unconscious (that can be made conscious). The Freudian
therapist is therefore bound to make the unconscious
as conscious as possible, but is not helped by his
theory to trust the unknown as such.
There is a substantial difference between Freud's
unconscious and Bion's unknown. The unconscious must
be drained as much as possible, or reclaimed as the Zuider-Zee.
The unknown is the matrix of all generative and
healing powers that all therapists, from the shamans
on, have always drawn upon.
The unconscious has to be conquered (which the
therapist does from the "K vertex" of the field, where
he acts as a scientist) while by the unknown one has
to be inspired (this happens in the "O vertex", where
the therapist acts as an artist). I hope, Paul, I have
not succeeded in supporting your present inclinations
towards Bion. Tullio.
Sat, 2 Sep 2000, Hilde Rapp
Hello Paul, how nice to hear from you. This will be
alas much briefer that I would like- I owe a chapter I
must get down to- but did want to respond quickly: I
think that Bion, the British Kleinians, Lacan,
Kristeva and sometimes Langs, have a style which is
not conducive to communicating ideas or practices.
Rather, what their writings do- I think- is to create
a subjective field, an experience, into which to
immerse oneself- which once one allows it to develop,
recreates certain experiences and feelings which
resemble how one feels when working with - usually -
very disturbed clients.
Jerry (Gold) and Rebecca (Curtis), and George
(Stricker), occasionally describe client work, where
over a time a certain intuition about a client
incubates which slowly forms into a clinical
hypothesis that, say, this person has never really
sepated emotionally from his mother and has , in a
sense no, proper ego boundaries, but 'uses' the
therapists to give some shape and stability to their
sense of being a person at all...
In a way Jerry and George's their Integrative
Handbook does contain chapters which draw on object
relations approaches, which themselves are informed by
this literature. Maybe somebody like Donald Winnicott,
or among contemporaries, Christopher Bollas, or
Patrick Casement has found a more accessible style for
describing how they come to understand and work with
these strange states.
In a way, this whole body of writing is only relevant
for therapists who do a significant amount of work in
long term psychotherapy with people who might be
described as borderline ( but not particularly
impulsive and antisocial- in which case they need
something more like Marsha Lienehan's or Tony Ryle's
approach or straight CBT), narcissistic, fragile self,
with a particularly poor attachment history- who don't
make good use of the therapeutic alliance, or of
relationships in general.
Otherwise it is a body of work- Edna O'Shaughnessy
falls into this category as well, which is more like
literature or a curious amalgam of poetry, mysticism
and philosophy- for which one has to be in the mood.
On this list, Tullio Carere is a good example of
someone who writes - I think- in an accessible way
about issues and themes which are centrally informed
by this body of work.
On the other hand, Diana (Fosha) and Leigh (
McCullough) have a perfectly accessible, contemporary
and emotionally deep and passionate way of doing this
work and writing lucidly about it- so from a
practitioner rather than a historian of idseas
perspective, once can get the clinically insights in a
whole range of styles- so why not choose the one that
speaks to you and that you can relate to and enjoy
reading! Maybe when I have made more progress with my
chapter you might be interested to have a look - it
will draw on some of these author's, or their
influence. Maybe Tullio has time to do some advocacy
for this body of literature meanwhile? Cordially,
Hilde.
Sat, 2 Sep 2000, Paul Wachtel
Dear Tullio and Hilde, thanks for your replies to my
Bion inquiry. Tullio, I am indeed interested in what
you have raised about Bion's less commented upon
contribution (the unknown vs. the unconscious) but
still have a suspicion that Carere would be a more
rewarding source to read on this than Bion. But be
that as it may, I wish to turn to the issue that
continues to puzzle me, the one that spews forth
constantly from my students and colleagues and STILL
doesn't make sense to me. You state that:
<<I understand Bion's thoughts "about
containers and putting feelings into people" as his
way to point to the kinship between the mother/child
and the therapist/patient relationships. As the
mother must hold, contain, and partially work
through the experience that the child cannot yet
hold, contain and work through by himself, so is the
therapist to do with some of her patients, in some
moments, or sessions, or phases of the treatment.
When a therapist relates to her patient in this way,
I say that she acts from the "Maternal vertex" of
the field.>>
My question is not about the interesting kinship
(and, of course, lack of kinship at the same time --
something you are well aware of in your thinking
dialectically) between the therapist-patient
relationship and the mother-infant relationship. My
question is whether -- for either -- the image of a
"container" or of "containing" is useful. My guess is,
apropos Hilde's interesting comment, that it is a
metaphor, a poetic image for some, that resonate with
SOMETHING that people observe or experience. And I
agree with Hilde that basically use whatever sources,
images, etc. that work for you and that different
images will work for different people. But not only
does "container" not work for me, it seems to me to be
an image that is confusing, obtuse, and certainly not
useful for any systematic understanding of the
process. SOMETHING important goes on between mother
and child or therapist and patient, and my guess is
that what you (and others who seem to like Bion's way
of speaking about it) are ACTUALLY picturing or
referring to when you use the word "contain" is
probably quite accurate. But why in the world describe
it as "containing?" I still need enlightenment here,
from the two of you or from anyone else who can help
this poor, troubled soul who just doesn't get it.
Paul.
Sat, 2 Sep 2000, George Stricker
Now that Hilde has mentioned my work, which does
value some of the contributions of some object
relations theorists, I guess I should respond to
Paul's question, and to Tullio's answer. I would not
group Jung with Bion and Lacan - I don't much care for
Jung, for political as well as psychological reasons,
but I do understand him; I can't say the same for the
other two. Over my career, I must have reviewed at
least three dozen books, liked some better than
others, but tried to do a fair job for all. As a
result, when I was sent a Bion book to review, and
after a noble effort, I sent it back without a review,
feeling I could not do a fair review of a book I found
incomprehensible. I should add, although this may be a
different thread, that I find the concept of
projective identification particularly noxious, as it
often is used to exonerate the therapist from
responsibility for his or her behavior and blame it on
the patient. I certainly see the relationship as
central, and at least some of what goes on as
unconscious, but I don't find the language of Bion and
Lacan useful, and the concepts either are not original
or, if original, not understandable, to me at least.
George.
Sun, 3 Sep 2000, Tullio Carere
- Paul, on Sep. 2 Paul Wachtel wrote:
- >My question is not about the
interesting kinship (and, of course, lack of
- >kinship at the same time -- something you
are well aware of in your thinking
- >dialectically) between the therapist-patient
relationship and the
- >mother-infant relationship. My question is
whether -- for either -- the
- >image of a "container" or of "containing" is
useful. My guess is, apropos
- >Hilde's interesting comment, that it is a
metaphor, a poetic image for some,
- >that resonate with SOMETHING that people
observe or experience. And I agree
- >with Hilde that basically use whatever
sources, images, etc. that work for
- >you and that different images will work for
different people. But not only
- >does "container" not work for me, it seems
to me to be an image that is
- >confusing, obtuse, and certainly not useful
for any systematic understanding
- >of the process.
-
- There is a pertinent paragraph in last
Hilde's message of Sep. 2:
- >Jerry (Gold) and Rebecca
(Curtis), and George (Stricker), occasionally
- >describe client work, where over a time a
certain intuition about a client
- >incubates which slowly forms into a clinical
hypothesis that, say, this
- >person has never really separated
emotionally from his mother and has , in a
- >sense no, proper ego boundaries, but 'uses'
the therapists to give some
- >shape and stability to their sense of being
a person at all...
This is very important, in my experience. People who
have been seriously deprived of good enough maternal
care are a considerable share of our clients (or at
least of mine). It is not just a metaphor, but a more
or less accurate description, to say that they have no
"proper ego boundaries". These are the people, if any,
who badly need "corrective emotional experience". They
must find some form of relational containment, if they
are to let go of their defensive (and usually most
expensive) self-containment.
A clinical flash: Year after year, a woman with
character problems improved enough for continuing the
treatment, but not enough for stopping it. At one
point I felt that she had in herself so small a child,
and so furious and desperate, that no talking cure
would do to soothe her. I had to give her what one
would give to a real child: bodily holding. It was a
turning point: in less than a year I could do all the
work that I had not been able to do in many years
before, and the therapy could finally end.
Physical holding is absolutely necessary to children
and, in my experience, also to many a patient. As I
told Ellen and you in New York, I am enthusiastic of
my recent discovery of EMDR because I have found that,
independently of the biphasic brain stimulation, it is
perceived by some as a form of physical holding (they
experience the waving movement of my hand as a hug).
To some patients, especially those with depressive,
obsessive-compulsive, panic attack, or eating
disorders, I often give antidepressant medication for
some time: it is a pharmacological containment that I
find necessary when the pain is intolerable, until the
person is ready for a purely relational containment
(but the administration of a drug is anyway a
relational event: the person feels usually contained
by both the pharmacological action of the drug, and
the very administration of it).
These are a few examples of most basic forms of
emotional containment. For a more general view, I hope
you will forgive me if I quote myself (JPI, 9,
4, 1999):
"The therapist has many ways to meet her patient's
need to feel contained, from the constancy of
space-time conditions to the tone and the choice of
the words. Beyond the specific modes, what is
decisive is the attitude that transmits to him a
message of unconditional acceptance, of
acknowledgment of his worth and dignity
independently of any work, project, or assumption of
responsibility.
One should always recall Gill's warning (though he
himself, as was seen above, did not do so): nothing
in the therapeutic interaction bears a universal
meaning. The couch can be a comfortable cradle to
one person, a Procrustean bed to another. The
silence of the therapist is to some patients a room
in which they feel welcome and free to move as they
like, to others a sign of unbearable coldness and
detachment. It follows that only an inexperienced or
insensitive therapist can impose undiscriminatingly
the couch, prolonged silences or whatever.
The need to find a secure base is very much
variable from patient to patient, both in intensity
and in quality. Some can be contained and guided in
a process of change only in a definitely rigid
setting, while other proceed in a softer and more
flexible environment. What is reassuring to a person
is intolerable to another. There is no way to know
it in advance: only the careful listening to all
explicit and implicit demands, and the unprejudiced
observation of the reactions to any intervention can
serve as a guide in a genuine relation...
In the maternal vertex the therapist receives the
unstructured or chaotic signals that the patient
sends to her, and gives them back to him partially
elaborated, so that he can begin to integrate them
in meaningful connections. This operation, compared
by Bion (1962) to the maternal reverie, is different
from the classic, Freudian interpretation, because
its aim is not to uncover unconscious meanings
(therefore it does not belong to the uncovering axis
of the therapeutic relation), but to meet an actual
inadequacy with the offer of an auxiliary container
for the experience that the other is not yet able to
keep and elaborate autonomously. This kind of
interpretation does not face a resistance, but meets
an incapacity: it is directed to a patient who
"cannot", rather than to one who "does not want"."
(pp. 379-381)
When I wrote of the
different meanings of silence I had quite clear in my
mind the wonderful pages in "Psychoanalysis and
Behavior Therapy" where you described them. I
now see that I forgot to quote you in this paragraph
of the paper. So I have one more thing to apologize
for, beyond the other, much more unforgivable, of
imagining that I have something to teach you. But I dare do so because
you taught me so many invaluable things, that may be
you would accept from me a very small one in return.
Tullio.
Sun, 3 Sep 2000, Tullio Carere
George, I grouped Jung with Bion and Lacan because
they have one thing in common--the special capacity to
evoke in others enthusiastic allegiance or scornful
refusal. If one can avoid the latter, and above all
the former, that is more dangerous (because it
generates followers), one can find a middle way that
leads to some useful places. This was anyway my
experience, as I try to convey in my response to Paul.
But if what seems to me a way seems to you a blind
alley, please don't hesitate to make me know. I may
still be a victim of Bion's dark charm, without
knowing it. In this case I am the one who need
enlightenment. Tullio
Sun, 3 Sep 2000, Windy Dryden
I have found some of the works of Lacan and Bion
extremely useful in clinical practice for my clients
with insomnia. They work like a dream!! Windy Dryden.
Sun, 3 Sep 2000, Jack Berkley
Paul, I did not know
Bion was catching on. Among my Bion friends, I am not
as zealous. Many of my Bion friends about five years
ago were reading a novel Bion wrote. As an old English
major, I knew they had exceeded my devotion. But
devoted they were and i was out of the loop with some
good friends on that. Roger Shapiro and Elizabeth Bott
Spillius (sp?) are wonderful lecturers on Bion, so are
many A.K. Rice associates, which I used to be. Bion
and Klein are central to that work. However, I can confirm
for you that it is not necessary to take limited time
to read Bion. I would not. There are too many good
proponents of his theory who do a better job
explaining it.
Also, you mentioned that students talk about "putting
feelings into". That is a common parlance among
Bion/Kleinian psychologists. It is, like many idioms,
not subject to literal translation. The idiom makes it
sound as if feelings are transported in some magical
or psychic way. Worse, it lends itself to the
misconception that the feelings have nothing to do
with the recipient/container, who can be mistakenly
thought of as an empty vessel filled with material not
his own.
The projective identification process is a
here-and-now, behavioral influencing process. It is a
behavioral process. Let me say again: Its fundamental
mechanism is behavior. This is not shamanism,
mysticism, witchcraft, or anything arcane, though the
language suggests it is. I think the language of this
brand of psychology erects a boundary or shield around
its proponents that makes them appear--often
especially to themselves--in possession of a secret
science, or mystical insight. It is very alluring, and
Bion's writing and Klein's writing lends to this
nether worldly professional penumbra.
Projective
identification is much more worldly, occurs between
two or more persons, and is an identifiable process
with steps. There are different definitions of it so
one needs to clarify. But it is borne of behavior, not
psychic vibrations or thought insertion. Sorry. Ill
stop. I guess there are two ways to ruin a concept, at
least.
Proponents who misuse it, including beginning
sophomoric users and more twisted defensive users, and
those who learn of the concept from such persons and
are turned off more by the misuse than the concept
itself. Jack.
Sun, 3 Sep 2000, Jack Berkley
George and others, some of my responses appear at the
ends of other series of exchanges so they may have
become lost for that reason and for the reason that I
hit the reply button and have only on person's name
listed as the recipient. George I wanted to send the
response below to your attention because it may have
got buried in my response to Paul. The others I just
hope you will want to find. Thanks.
Response: Paul, contain yourself. Jack
P.S.: seriously, hope that is a helpful nudge. By the
way, just bought your book at APA and look forward to
it. Also, container = Latin continere: to hold
together, hold in, to have within, hold, enclose,
bound, to restrain oneself, accommodate. I think of
the term in conjunction with Keats' letter on negative
capability which paraphrased from memory (others may
correct any literary transgression here): the capacity
to be in uncertainties etc. When a therapist can
calmly and genuinely listen to and perceive the
distress of a client, the therapist is receiving
emotional, intellectual, verbal, kinesthetic data into
his or her intrapsychic system and holding it there
and processing it, hopefully without reacting too
precipitously, that is to say while first holding it
within for a time.
Hopefully now, via email, we who find Bion's concept
practical and useful, are "containing" your mix of
dismay about the term which "doesn't work for me" and
your yearning to understand the term in a way that we
do ("I need some enlightenment here"). I think also,
one must in part identify with the capacity of the
most anatomically important human container, the womb
to the extent possible. This is a shift in gender
metaphor, and if one pauses a bit, one can remember
all kinds of issues related to the psychoanalytic
concepts pertaining to phallus and womb. The
therapist's mind is then by metaphor quite a matrix
for processing client inputs. Thomas Ogden uses the
title "the Matrix of the Mind" in a book title. You
can think of containing simply as "processing" in a
complex human way if you like drawing from the
therapist's capacities to receive constructively all
kinds of difficult inputs from the client. In fact
Ogden uses that synonym as do others.
In part, "Under
optimal circumstances, the recipient "contains"
(Bion, 1962a) or "processes" (i.e., handles
maturely) the evoked feelings and ideas, and thus
makes available for reinternalization by the
projector, a more manageable and integrable version
of that which had been projected." (p. 145 of Matrix
of the Mind.)
Now that, with the womb stuff and all that may be
provoked by this kind of talk should lead to plenty to
contain, excuse me, process, handle maturely. Jack
Berkley.
Sun, 03 Sep 2000, George Stricker
- Tullio Carere wrote:
- > But if what seems to me a
way
- > seems to you a blind alley, please don't
hesitate to make me know. I may
- > still be a victim of Bion's dark charm,
without knowing it. In this case I
- > am the one who need enlightenment.
Dear Tullio, I often am in agreement with many of
your conclusions, but I am not certain I see how Bion
(or Lacan) help you to get there. I guess one person's
light can be another's blind alley - I wouldn't
presume to tell you not to attend to anyone you find
helpful, but I for one, get very little from either.
George.
Sun, 3 Sep 2000, George Stricker
Dear Jack, having received several messages from you,
some to the list and others not, I'm not quite sure
what others have seen and what they have not. In any
case, you thought of projective identification as a
valuable concept and also thought that my concern was
with some practitioners rather than the concept
itself. Perhaps.
Perhaps you also can explain how anything of value in
projective identification goes beyond the concept of
empathy, which doesn't encourage the misuse that
concerns me. George.
Mon, 4 Sep 2000, Hilde Rapp
Hello all, most of
us can probably relate to the concept of someone's
being 'self contained' - in the many senses intimated
by Jack.
The wish for 'enlightenment' in the conceptual
darkness holds some clue to the nature of the
bafflement evinced by George and Paul:
The body (!) of
literature spawned by Bion's work - and the
predominant predicament of those to whose 'treatment'
his concepts may be applied with profit - relates to a
different information processing system from the
visual: the kinesthetic. It is to do with feel:
texture, skin sensation and contour, sensuality,
shape, form, Bollas' 'first aesthetic', rythms,
postures and positions, balance, temperature,
equilibrium, bodily containment- hence the 'second
skin formation' of Esther Bick, or Didier Anzieu's
'ego skin', Frances Tustin's 'autistic shapes': it is
to do with the Harlow's deprived monkey- wire mother
syndrome- no sense of being 'cradled criss cross' in a
loving mother's arms, who not only coos to the child,
has loving feelings towards the child but also holds
the child in her mind with what Winnicott has
described as 'primary maternal pre-occupation'-
failure of all this, so much recent research suggests,
leads to difficulties in developing a 'theory of
mind'- the ability to hold the wishes, beliefs and
motives of others in mind in order to develop empathic
human understanding-... and of course that 'negative
capability ' Keats first described in his Christmas
letter to his brother George, which is actually the
hallmark of all good integrative psychotherapists ( so
Carlos Mirapeix agrees with me). Now, this body of
literature may be the door through which you Bion
skeptics may find it attractive to pass:
Peter Fonagy, Peter Hobson - good research based,
elegant English, grounded in developmental
psychopathology - relating to attachment and its
failures, the effects of maternal depression, the
effect of lack of proper empathy on the mother's part
(lack of holding and containment of impulsivity in
later life) etc. etc... Hilde
P.S.: There is a previous debate which struggled with
what can be said in plain English and what can only be
hinted at darkly: it raged between the Kabbalists and
the Humanists in 14 century Italy. I think- overall
SEPI-ites tend to side with the humanists- some- I am
certain-are bilingual. Many analysts would side with
the Kabbalists- indeed Freud's technical writings were
originally excluded from publication on grounds of
containing information best reserved for use by
initiates...
Mon, 4 Sep 2000, Paolo Migone
I have to say that I sympathize with Paul Wachtel's
difficulty in understanding Bion (see his mail of
Sept. 1, 2000). Since Bion has gained a lot of
importance in the psychoanalytic community (especially
in my country), in a study group that Tullio knows
well years ago I invited an expert on Bion (a
philosopher who wrote a book on Bion) who gave us some
seminars on this author. I have to say that still I
was not able to be hooked very much by Bion, also
because of his difficult language, which to me is
already a put-off, if not a symptom, because I have
always thought that language must be clear in order to
be able to contain valid ideas.
Still, I appreciated several things by Bion, for
example his re-elaboration of the concept of
projective identification (that I used in my article
on Contemporary Psychoanalysis, 1995/4, about
the bridge between projective identification and
Expressed Emotion [EE] - an effort at psychotherapy
integration that Paul Wachtel, if I am not mistaken,
knows well and used for his students).
At any rate, I had always a difficulty in
understanding Bion's peculiar leap between "mystics"
and "science", but I may be simply ignorant. Also, we
should not forget that Bion had four very different
areas of interest in his life: groups dynamics,
thought functioning, psychoanalysis as science,
psychic growth in analytic treatment.
Tullio says that "In the Freudian theory there is no
Unknown (as unknowable), there is only an Unconscious
(that can be made conscious)", but from what I
understood from Freud, he believed that reality
(internal as well as external) by definition is always
unknowable. What we succeed in knowing is never the
reality per se, which is unreachable. But, again, I
might have not understood what Bion meant to this
regard. Concerning the famous dictum by Bion "Without
memory and desire etc.", I find it paradoxical, on the
one and, and obvious in what it tries to mean
clinically, on the other. My gut feeling, for which I
have no evidence of course, is that the fact that Bion
has become very fashionable today in psychoanalysis is
related to the crisis of psychoanalysis, I mean that
it is an expression of the confusion in our field.
Paolo Migone.
Mon, 4 Sep 2000, Rebecca Curtis
I find the discussion about the idea of a therapist
as a '"container" so stimulating that I'll put off my
end-of-the summer (it is the "Labor Day" holiday for
those of us in the US) swim and the bike ride I've
been looking forward to for two months to comment. Let
me say first, though, that I am upset, as is George,
about the way the concept of projective identification
is used to blame the patient and to allow therapists
not to. take responsibility for their own feelings
which very well may be simply their own. There was a
paper presented at SPR last year (I'll have to check
on the author's name) showing that therapists'
reactions to patients (transcripts) varied enormously
and revealed consistency within each therapist, but
not consistent reactions to particular patients across
therapists.
But back to Bion. First, his book Experiences in
Groups is quite readable, unlike some of his other
writings. I found it helpful knowing he was from
India. The view of consciousness is very different to
begin with. An undergraduate of mine newly arrived
from India began a paper by stating "Before
consciousness was fragmented into a million different
pieces. . . " as if this were accepted fact. So there
is not the beginning with an individual notion of
consciousness. Still, I would like it if someone could
help me appreciate Bion more. I have not assimilated
anything from all of his formulas or diagrams. I think
the concept of containing and holding is interesting,
but I'm happy Paul has raised a question about it.
Doesn't the concept refer to the therapist or parent
not getting anxious? We feel safe and "held" when in
the presence of someone who is not anxious, or anxious
yet conveying a sense of coping.
As for Lacan, his view of unconscious processes is
too language-based for me. Not being a very verbally
dominated thinker, it doesn't resonate with me. But
many people view the world through language more than
I do. I also react very negatively to the centrality
of the phallus for Lacan. Other symbols seem just as
important to me. But perhaps someone could help me
appreciate and use in my work his ideas about the
Imaginary.
Well, my computer is being packed up to return to New
York City, so I look forward to more exchange about
these ideas tomorrow. Rebecca Curtis.
Mon, 4 Sep 2000, Paul Wachtel
Tullio, I'm still confused! (and still very much in
accord with George's message, which came just before
Tullio's on the list serve). Yes, I understand very
well the need for the kinds of clinical operations you
have described, the ways in which maternal deprivation
affects people and so on (though I do have some
questions about whether we too readily assume maternal
deprivation whenever we see severe psychopathology;
clearly *something* went seriously wrong, but any
notions about what happened between mother and infant
in the first year or two is likely to be *very*
inferential, and strongly a product of theory rather
than real observation {even if it may well be good and
accurate theory if we had the vantage point of God and
could really know for sure}). But the main thing is:
How does "containment" capture what you are
describing. How does the "corrective emotional
experience" become relational "containment"? It's not
that I think "containment" is necessarily *wrong*.
It's that it is *unclear.* What *you* mean by
containment may well refer to something useful. But
you can't define containment by saying containment is
when you contain. You have to describe what is *meant*
by containment, and when you do, I think (a) it
becomes a lot clearer than saying "contain," (b) a lot
less likely to be misunderstood because of it odd
usage and unfortunate concreteness, and (c) less
likely to be used as a cliche, as it seems to be all
the time among my students and colleagues.
So I guess my response, Tullio, is that I like what
you do and what you describe, but how in the world is
this well described as "containment?". I await with
interest the next round of our friendly debate. Paul.
Mon, 4 Sep 2000, Paul Wachtel
Jack, perhaps I'm just not educable! I agree strongly
with the idea that the therapist should not act out,
should process the input, etc. But what does this have
to do with the container image. The therapist doesn't
"contain" it, he works on it. And he doesn't put it
back into the patient in more worked through form
after he has chewed on it in his own internal space.
He *communicates* something, which the patient then
deals with in whatever fashion he can at that point
(hopefully, in a better fashion than before by virtue
of that communication -- and others, and the
relationship). If Bionites are saying "yes, that's
what we mean" then, OK, I agree with them on such
points but not on whether their language is a good way
to describe it. If it's NOT what they mean, then what
else is "container" adding? Paul.
Mon, 4 Sep 2000, Paul Wachtel
Jack, here I am very much in accord with what you are
describing (Paul, I did not know Bion was catching
on…). My objection is not with the *clinical
phenomena* that concepts such as projective
identification refer to. It is precisely with the
arcane way -- nicely depicted by you in your message
-- that so many of the proponents talk about it.
Some ways of talking about a phenomenon promote clear
thinking and lead to still further insights about the
phenomenon, and some lead to cultish or superficial
mouthings and DO NOT promote still further clarity.
Instead, they maintain themselves by pointing again to
the very phenomenon, as if the critic hasn't seen the
phenomenon when in fact, much of the time, the critic
(at least this critic) is not overlooking the
phenomenon at all but saying instead that there are
more productive ways to conceptualize and discuss it.
Maybe it's time for the container to be recycled. But
at least it has had the value of filling itself up
with interesting exchanges amongst us. Paul.
Mon, 4 Sep 2000, Jack Berkley
- In a message dated 9/4/00, Paul Wachtel writes:
- <<Jack, perhaps I'm just
not educable! I agree strongly with the idea that
the therapist should not act out, should process
the input, etc. But what does this have to do with
the container image. The therapist doesn't
"contain" it, he works on it. And he doesn't put
it back into the patient in more worked thru form
after he has chewed on it in his own internal
space. He *communicates* something, which the
patient then deals with in whatever fashion he can
at that point (hopefully, in a better fashion than
before by virtue of that communication -- and
others, and the relationship). If Bionites are
saying "yes, that's what we mean" then, OK, I
agree with them on such points>>
Jack: Paul - Yes I think you are on track even though
the language is not your tea. Remember to substitute
'respond maturely' or 'process' for contain and you'll
be fine. You won't experience some of the poetic
substance and the meanings they stimulate, but you are
not looking for that. Social science language in
general doesnt stimulate a lot in me, but I appreciate
its value.
- <<but not on whether their
language is a good way to describe it. If it's NOT
what they mean, then what else is "container"
adding?>>
- Jack: I think here you depart from your
principal stance that if a language means something
to an intelligent thinker then so be it. It is not a
question of whether a term is "a good way to
describe." It is whether the term communicates and
assists practitioners. We don't have to buy and
plant the same botanical species, we don't have to
like the same rivers and mountains, but we're all
working constructively on the environment.
I think what's frustrating to many is that the
language is metaphorical and we all don't respond to
the same poetry. By the way I do not count myself as a
Bionite; speaking of terms I m unfamiliar with that
one. It reminds me of Columbus calling Native
Americans, Indians. I think of myself as a Berkley or
Berkleyian, and you as a Wachtellian. Remember
'process' and 'respond maturely' for contain. Peace,
Jack.
Mon, 4 Sep 2000, Jack Berkley
Paul, this is Jack, the end of your response caused
me to laugh aloud; my responses are contained by
(interspersed within) yours below:
- In a message dated 9/4/00, Paul Wachtel writes:
- << Jack, here I am very
much in accord with what you are describing. My
objection is not with the *clinical phenomena*
that concepts such as projective identification
refers to. It is precisely with the arcane way --
nicely depicted by you in your message -- that so
many of the proponents talk about it.>>
Yes. I think it is a
defensive/aggressive alliance. Many groups lean or
tend to use their language both to communicate within
their group and erect boundaries between their group
and others' groups. I think of it as a characteristic
of human groups. In this instance, I have wondered
whether the language is a defense against anticipated
attack from members of the empiricist religion. If you
cant understand the concept, cloaked in arcane garb,
you cant attack it without looking a bit dense when
the defender counterattacks. Also, it does give a
feeling of specialness or group belonging when one
speaks a language others dont quite get, right? So it
speaks to a need to have a group identity and feel
special, I think. It worked that way for me to an
extent. I'm just more given to the integrationist goal
now, which is still special enough, n'est pas?
Now, I am not attacking Bion people on this count. I
think i see defensiveness in many professional
languages as well as enhanced communication among its
members.
And the term is helpful to some. I found it helpful. I
also am disturbed by the misuse.
- <<Some
ways of talking about a phenomenon promote clear
thinking and lead to still further insights about
the phenomenon, and some lead to cultish or
superficial mouthings and DO NOT promote still
further clarity. Instead, they maintain themselves
by pointing again to the very phenomenon, as if
the critic hasn't seen the phenomenon when in
fact, much of the time, the critic (at least this
critic) is not overlooking the phenomenon at all
but saying instead that there are more productive
ways to conceptualize and discuss it.>>
- Well, yes to a milder form of the the idea of
cultish mouthings, but i think that cult is too
strong or emotionaly loaded a term. I think the
people you seem to be describing are behaving
arrogantly and defensively to the point of offense,
like the best defense is a good offense. Language
has that dual capability I think. In fact you are
getting me curious. not that I expect an answer, but
who are these people and why are they giving you
such a difficult time? That to me is a constructive
focus. Perhaps they fear your capacity to understand
and translate their concepts in an integrative way;
perhaps to them translation is akin to theft. Like
religious groups who fear that if you take their
picture you'll take their soul.
-
- <<Maybe
it's time for the container to be recycled. But at
least it has had the value of filling itself up
with interesting exchanges amongst us. Paul
>>
- This is what made me laugh aloud. the use
of 'recycle' with container makes me think of a
washing machine. Perhaps we should hang these
clothes in the sun , let them dry and see if they
got clean.
Mon, 4 Sep 2000, Jack Berkley
George, all my posts are intended for list
consumption. It has been a while since i engaged a
discussion on any list and I depressed the reply
button without adding the list on some messages.
Well, my question to you--before i answer you--was
what about the concept itself do you feel "encourages"
destructive behavior by therapists, i.e., client
blaming etc. I mean, do you think the term or concept
itself has an influence on otherwise well balanced
practitioners? I guess in a way it could more easily
lend itself to misuse than others, like empathy as you
note, but I still think it is more of a problem with
people rather than the idea. I concede that empathy by
definition restricts the student of the concept to
compassionate meanings, whereas, Projective
Identification is not so restrictive. However, the
term is broader.
Now to your
question: "Perhaps you also can explain how anything
of value in projective identification goes beyond the
concept of empathy, which doesn't encourage the misuse
that concerns me." First, I would say that the concept
of projective identification--pardon me
again--contains the concept of empathy, and includes
other meanings in addition to empathy. Empathy is a form of
projective identification, which as recall is fairly
well described in Ogden's 1982 book "Projective
Identification and Psychotherapeutic Technique."
Now you asked what does Projective Identification
provide beyond the term of empathy. If you restrict
the use of Projective Identification to empathy i
think it is essentially the same and it could be
argued that for many students it does not add anything
of value. For others though, it does add something
because it expands the empathy process and describes
it more fully than the use of empathy usually does,
usually. Essentially though, the issue is whether you
or I are capable of empathy and whether we employ it
to good effect. From that perspective the use of it,
not the selection or promotion of a term is key. I
would advocate for both terms in teaching, but only if
you can empathize with those who find value in it. I'm
serious. I think we have to value the people or their
experience in order to respect and understand their
language.
If you do not
restrict the term to empathy, I think it is clear that
it has many other very constructive uses. One can
projectively identify good aspects as well as
destructive ones for starters. One can project his own
honor or integrity into another (figurative use here)
for safe keeping. There are many other uses. I like Racker's "Transference
and countertransference" and Ogden's 1982 book
among various articles. Jack.
Mon, 4 Sep 2000, George Stricker
- Dear Jack, I'd like to insert some of my responses
within yours for greater clarity. You wrote:
- > Well, my question to
you--before i answer you--was what about the
concept
- > itself do you feel "encourages" destructive
behavior by therapists, i.e. client
- > blaming etc. I mean, do you think the term
or concept itself has an
- > influence on otherwise well balanced
practitioners? I guess in a way it
- > could more easily lend itself to misuse
than others, like empathy as you
- > note, but I still think it is more of a
problem with people rather than the
- > idea. I concede that empathy by definition
restricts the student of the
- > concept to compassionate meanings, whereas,
Projective Identification
- > is not so restrictive. However, the term is
broader.
The idea that Projective Identification involves an
unconscious communication that reaches the therapist
in an irresistible way, and the therapist then
responds unconsciously to this communication, is what
I object to. It is part of our job, after all, to help
the patient to make the unconscious conscious, and in
order to do so, to be aware of our own unconscious
influences on the process. To the extent that
Projective Identification occurs beyond anyone's
awareness, the therapist is left saying "the devil
made me do it" rather than taking responsibility for
his or her own lack of awareness of the
process. I don't dispute that such things happen -
my concern is that giving them the label serves to
sanction them.
[Regarding other passages of your
mail] I still am at a loss as to
what those other meanings are/ I'm well aware that
empathy usually is included within Projective
Identification. I still don't know what else, that is
of value, is.
Mon, 4 Sep 2000, Jack Berkley
George, good idea to intersperse. I see now why you
conclude that the concept itself leads you to dislike
the concept for encouraging abuse. We however part
ways on your definition and description of Projective
Identification, and if my understanding were the same
as yours, then i would of course agree. We don't seem
therefore to disagree on anything, except perhaps how
to define Projective Identification.
First I am not sure what you mean by an unconscious
process reaching the therapist in an "irresistible
way." I do not doubt that you gleaned this from
someone reputable, but it does not contribute to the
understanding of Projective Identification and I don't
recall it from my learning about Projective
Identification, at least not as an essential feature,
absolute feature. At times I suppose it could be
described as irresistible, but I fail to see the
utility of the word irresistible. I have trouble with
it and suggest it be jettisoned regardless of its
source unless the context is different than the one
used here.
Second, more importantly, I could not agree more with
the task of making the Projective Identification
process conscious. This is done via interpretation,
etc. George I cannot imagine any proponent of
Projective Identification taking issue with this. To
employ the concept as a rationalization for
irresponsibility is far out of bounds. I can't
seriously think of anyone I know who employs the term
as describing an unalterable preordained event. Were
it employed this way, I would agree with you; in fact
any time it is used this way, I agree fervently that
it is a malevolent event. (yes, all kinds of things
occur outside awareness, but that is an observation,
not a plan, not an acceptable approach).
To me the term
militates against letting it be unconscious. By
identifying that it happens, and naming it, the task
is to discover it in the immediacy of the therapy
hour, and promote understanding, conscious processing
of it. (If
I need to say, no one would / should attempt to
communicate this using Kleinian language). The term,
as I was taught it within A.K. Rice and the Washington
School family therapy program, exists to encourage its
conscious processing. I do think tough one must be
taught this in live moments and in supervision. I am
discouraged from thinking the term can really be
internalized and employed based on book learning. It
is a skill to experience and identify the process, not
just an idea on pages.
In sum, as you describe it, yes, I agree, it is a
foul, unthinking beast. We are talking about
completely different concepts and completely different
users of the concept. I suggest that the concept and
application you describe is very unflattering to
caring, thoughtful people/therapists. It is inimical
to responsible work. Why would anyone take what you
describe seriously? No wonder you are upset. I hope
you do not associate such practice and thinking with
me. I hope no one does. Sincerely, Jack.
Mon, 4 Sep 2000, George Stricker
Dear Jack, if the confusion about the definition of
Projective Identification is now cleared up, and I
believe we have come to a point of agreement in that
you don't like what I don't like about it either, we
still are apart on my understanding what you do like
about it. What is different and more than empathy
about the concept? George.
Mon, 4 Sep 2000, Jack Berkley
- George, I'm responding to your response below:
- <<I still am at a loss as
to what those other meanings are/ I'm well aware
that empathy usually is included within Projective
Identification. I still don't know what else, that
is of value, is.>>
George, well I said in my last post that one could
project good objects as well, such as in idealization,
except that Projective Identification would invite
further analysis of what in the projector is projected
and the proper use would necessitate an analysis of
what aspects of the recipient resonate with the
idealizing behavioral influencing process. This has
application in therapy obviously; it goes beyond
simply saying someone idealizes their therapist. The
concept and practical employment of it invites the
therapist to identify his/her internal objects that
are activated in response to the projector's behavior.
And to analyze/understand what is occurring within the
client. Now, anyone can do this without the term
Projective Identification. Its not necessary. But as i
have learned and employed it, the concept helps orient
my thinking about such processes. The fruit is in the
further actual applied analysis of the Projective
Identification. The term is merely an aid to examine
preconscious and unconscious interpersonal
influencing, feelings, self aspects, underlying
beliefs, etc. Did you read my posts to Paul?
The Projective Identification term includes so many
intrapsychic-interpersonal experiences that I am hard
pressed to know George how to select examples that you
would find useful. Also, to be frank, since you have
already called the concept "noxious" and seem fairly
convinced that it is used to "blame" patients for
therapist ills, I feel uncomfortable and think we may
be at cross purposes here. I fear I run the risk of
repeatedly offering you examples and not constructing
an example that is particularly meaningful to you
because I do not know you well enough to find such an
example. Also, is that what you want anyway?
1. I mean if the purpose of this discussion is for me
to attempt to convince you that you ought to like
Projective Identification as a concept when you've
already concluded it is "noxious" and is employed
malevolently, I can end that here. I'm sure you have
done swimmingly well without the concept and i and
others have done well with it. Nothing strange there.
2. If the goal is
for you to reify your objections to the term as
noxious and inimical to patients with each effort to
explain it, I defer to a more energetic proponent with
a stronger desire to convince you. Id have to know
that you wanted to meet me half way on this. I'm not
sure you're interested. I lean toward thinking
you're not, are you? I'm sincere, I'm not certain
where you are situated attitudinally in this
discussion.
3. If your goal is to learn Projective Identification
from the point of view of someone who finds it useful
because you want to experience its value as they do,
that is, an empathic joining on the concept, then I am
interested. However, i need more help from you. For
instance, what other kinds of uses would be useful to
you? How do you understand the term now other than the
noxious meanings? Do you have any understanding of the
term that is benign or constructive?
Please answer those questions so I know my audience
as it were. Give me a ball park to play in, otherwise
I just dont know where to begin. Do you have a case,
an example, anything? I think that would be more
useful than my generating a list of examples in the
hopes that I luck out and become helpful to you. Also,
it would help to know what you have read so far.
My task so far has been to assert that Projective
Identification and Containment are useful to me and
many others who are responsible therapists and perhaps
clarify that the understanding of the term that some
folks have would lead any reasonable person to reject
it, me included. Your criticisms are well taken, but
they hit the wrong concept and wrong use as my
experience and training define and employ it. We're
just not talking about the same concept or the same
use of it based on what you've said so far.
Again, I like Racker's 1960 book "Transference and
Countertransference" and Ogden's 1982 book "Projective
identification and Therapeutic Technique" among
various articles; have you read Ogden's book? You'd
only need to read two or three chapters to revise the
description of Projective Identification you have
given so far. Jack.
Mon, 4 Sep 2000, George Stricker
Dear Jack, I have read Ogden, and several others, and
always have been struck by how different writers use
different definitions, making it easy for any
criticism to be met by "That is not what I meant at
all." I appreciate how hard you are working to get
across your meaning, but I'm afraid that everything
that you find useful (e.g., exploring one's own
contribution to an idealizing process) is something
that I do without invoking the concept. If it works
for you, fine, and you seem to use it in a
constructive way. It doesn't work for me, and I'm not
sure there is much profit to be gained in belaboring
it much further. George.
Mon, 4 Sep 2000, Jack Berkley
- Dear
George, my responses are interspersed: In a message dated
9/4/00, George Stricker writes:
- <<
Dear Jack, if the confusion about the definition
of Projective Identification is now cleared up,
and I believe we have come to a point of agreement
in that you don't like what I don't like about it
either,>>
Except George you describe a concept that contains
noxious elements and these aspect that you attribute
to the concept are alien to me and those from whom I
have learned and with whom I communicate with the
term. I agree that the noxious aspects that you add to
the term are noxious. I just don't agree its part of
the concept.
- <<we still are apart on my
understanding what you do like about it. What is
different and more than empathy about the concept?
George>>
- I guess we'll have to leave it there, for
now any way. I tried and would need more from you to
go further as I said before. Sorry we couldn't work
this out, for now.
Mon, 4 Sep 2000, Jack Berkley
- Dear George, in a message dated 9/4/00, George
Stricker writes:
- << Dear Jack, I have read
Ogden, and several others, and always have been
struck by how different writers use different
definitions,>>
There are different definitions, and this term is not
alone in having multiple definitions in psychology.
Its not as bad as existentialism, but it is diverse.
- <<making it easy for any
criticism to be met by "That is not what I meant
at all.">>
- Well the way you put it, it does make
efforts to differentiate the definitions sound like
immature defense. Ogden does not define Projective
Identification with the characteristics you
attribute to it or describe its use the way you do.
I still don't know who does. You haven't said.
-
- <<I appreciate how hard you
are working to get across your meaning, but I'm
afraid that everything that you find useful (e.g.,
exploring one's own contribution to an idealizing
process) is something that I do without invoking
the concept.>>
- I have been too wordy I think. but I said
a few times that yes you don't need the concept. I
have never said otherwise. I thought I have been
very clear about that.
-
- <<If it works for you,
fine, and you seem to use it in a constructive
way. It doesn't work for me, and I'm not sure
there is much profit to be gained in belaboring it
much further. George>>
- Yes that is what i was questioning in my
last post. I think you are resolved with you view of
Projective Identification concept as noxious, and i
am happy relinquishing the effort to convince you
otherwise. It is just a conceptual tool. I am glad
you afford me the position of someone who at least
seems to use the concept to good compassionate
purpose. I do. I am sorry that you have run into
such misguided and destructive persons who misuse
the concept they way you described: to blame
patients, avoid responsibility, and avoid processing
unconscious material. That's not Ogden, me, or
anyone I can name who understands its use. Jack.
Tue, 5 Sep 2000, Paolo Migone
- On 04/09/2000, Paul Wachtel wrote:
- >Re Paolo Migone's recent
posting on the listserve:
- >I do indeed know Paolo's paper on projective
identification and expressed
- >emotion, and I strongly recommend it to
those on this list serve who share
- >both my interest in psychoanalytic ideas and
my confusion/annoyance re
- >Bion's language. Paolo's paper is the single
most clearly articulated
- >exploration of the concept of projective
identification that I have come
- >across. It is precisely the sort of
clarifying rather than obscuring kind
- >of writing that I wish were common around
these issues.
Since Paul Wachtel
said these nice things on my paper, in case it might
be of interest I send to the list members the part of
this paper (pp. 624-629) in which I talk specifically
of Projective Identification (see below). I thank you for your
attention and I apologize for the length of this mail:
-----------
[From: Paolo Migone, Expressed Emotion and
Projective Identification: A bridge between
psychiatric and psychoanalytic concepts? Contemporary
Psychoanalysis, 1995, 31, 4: 617-640 (pp.
624-629)]:
The concept of Projective Identification was
originally formulated by Melanie Klein in 1946, when
she spoke of the projection of a part of the subject
onto the object, with whom the subject remains
identified, so that he exerts a "control" on him (or
from "inside" of him). When M. Klein had this clinical
intuition and used this term for the first time, she
was somehow dissatisfied with it; subsequently the
concept was refined and further explored by many
analysts (who, incidentally, were working mostly with
schizophrenic patients), to the point that this
concept became of central importance in Kleinian
thought. Currently, it is widely used also by non
Kleinian analysts, and many authors have shown its
usefulness also for patients with less severe forms of
psychopathology. It can be regarded as a "bridge
concept" between classical and interpersonal
psychoanalysis, and a useful theoretical tool for
understanding family dynamics (Zinner & Shapiro,
1972). An in-depth discussion of this concept does
imply an adequate consideration of wider
metapsychological problems (for example the use of
metaphors), and of the relationship between this
concept and other previous conceptualizations (such as
the concept of transference and countertransference).
For this reason, only a brief mention of its principal
clinical aspects will be made here, while I refer to
other papers for a longer discussion of the underlying
theoretical problems (Migone, 1988b, 1989a, 1995a ch.
7). Since the concept of Projective identification
today is used in different ways, and may encompass
various clinical phenomena (Sandler, 1988), I will use
the schema suggested, among others, by Ogden (1979,
1982).
Ogden divides the clinical phenomena of projective
identification in three phases, which somehow overlap
one another: (1) "projection," (2) "interpersonal
pressure," and (3) "reinternalization." (These three
phases are not to be confused with the three
historical phases of the development of the concept of
projective identification described by Sandler [1988],
even if there are some similarities.) The three phases
will be briefly described.
(1) First phase: "projection".
It is assumed that the person who uses projective
identification has first of all an unconscious need to
get rid of a part of himself and to project it onto
someone else. Various reasons may explain why a person
needs to project. Kleinian authors use a
metapsychological (although concrete) jargon, and
speak of bad parts of the self that could be
considered dangerous for the self, or, vice-versa,
good parts that could be in danger of being destroyed
by the bad parts of the self. These, then, need to be
put into someone else in order to be protected and
kept safe. These explanations are scarcely testable,
although the concept of projection is commonly
accepted as an explanation of some clinical and social
phenomena, such as scapegoating, for example. At any
rate, such metaphors may prove to be useful in
understanding complex clinical situations and
overcoming some especially difficult moments
encountered in the course of a therapy. What is
important to know here is that this first phase alone
does not yet involve the use of the term projective
identification; it involves simply the concept of
projection.
Projection can be conceived of as an intrapsychic
phenomenon, not necessarily affecting the object (the
other person), who may be unaware of being the target
of projective identification. In this case, projection
may have defensive functions for the subject, who does
not need to concretely modify or "control" the object.
For a more in-depth discussion of the concept of
projection, with its metapsychological and clinical
aspects, I refer to the classical discussions by
authors of the "Freudian" tradition, on the one hand
(Freud, 1885, 1896, 1911, 1915, 1921, etc.; A. Freud,
1936; etc.), and of the "Kleinian" tradition, on the
other (M. Klein, 1930, 1931; Isaacs, 1948; Segal,
1973; etc.). The most interesting aspect of projective
identification, for our present discussion, concerns
the second phase.
(2) Second phase: "interpersonal pressure".
This phase is the one most directly related to the
psychiatric concept of Expressed Emotion (EE) and to
Greenley's concept of "High Intensity Interpersonal
Social Control." There are two main differences
between simple projection and projective
identification. First, in the latter situation the
person must be involved in an actual interpersonal
relationship with another person, and not simply in a
fantasized one. (In a sense, using EE terminology, we
might say that the length of time spent in
"face-to-face" interactions between the patient and
his relatives may increase the intensity of this
phenomenon.). Second, the person shows an
interpersonal pressure, or control, to make sure that
the other behaves in a manner consistent with the
feeling that he has projected on him. Using Greenley's
words, we might say that the person exerts a "High
Intensity Interpersonal Social Control" because he
needs the other to change his behavior.
Supposedly, if the other does not change his
behavior, he comes to represent a threat for the
projector; therefore the projector continuously needs,
in subtle or open ways, to exert various kinds of
pressure to ensure that the person who received the
projection really is the person that the projector
wanted him to be. In a way, we can also conceive
projective identification as a projection that has not
been completely successful, so that the projector
needs to exert pressure on the object to reassure
himself of the success of this defensive operation. It
is for this reason that some authors (e.g., Kernberg,
1987) conceive projective identification as a
primitive defense mechanism (present mostly in
borderline and psychotics), while projection is
considered to be a more mature and successful defense
(present mostly in neurotics). However, other authors
(e.g., Meissner, 1988) reject the distinction between
projection and projective identification made on the
basis that the latter induces the object of the
projection to respond, claiming that "complementary
pulls" are always at work in all projections occurring
within an interpersonal context. Whether we accept
this equation between projection and projective
identification or not, the presence of an
interpersonal context for phenomena such as
"complementary pulls" must occur. In this article I
prefer to use the term projective identification,
rather than simply projection, because it is the one
that has been the most widely employed by those
authors who have studied these complex interpersonal
phenomena.
The clinical phenomena considered as examples of this
interaction usually are intimate or close
relationships, such as the mother-child relationship
or the patient-analyst relationship. In all these
situations there is some form of dependency of one
person upon another, in some cases because of physical
or psychological needs of survival, similar to those
relationships studied in the framework of the "double
bind" concept (Bateson et al., 1956). Typically, a
therapist who "receives" a projective identification
from a patient may develop a new set of feelings, and
only during later self-scrutiny come to understand
that they, so to speak, "belonged" to the patient.
Furthermore, since this process is unconscious and can
be very subtle, sometimes the therapist, in a way, may
"become" someone else.
Interpersonal
transmission of affect is well known in psychotherapy
(as well as out of psychotherapy), and this mutuality
of emotional response was already illustrated long ago
by the simultaneous psychophysiological recordings of
patient and therapist (Greenblatt, 1959). For this
phenomenon, Redl (1966) suggested the term "contagion"
of mood. Luborsky (1984, pp. 137-139), discussing
this issue, says that there seems to be evidence that
neither extremely field-dependent therapists (who may
be more apt to get caught up by such contagion) nor
highly field-independent therapists (who may be too
uninvolved and unable to form a warm relationship with
the patient) are helpful. He argues that moderately
field-dependent therapists may be more effective, and
that alertness to the existence of this phenomenon
helps to preserve therapist's equanimity.
We may recall that Paula Heimann (1950), in her
pioneering work on countertransference, said that the
feelings of the therapist are a "creation" of the
patient. Actually, long before Heimann's contribution,
it was Helene Deutsch who clearly anticipated the
enlarged view of countertransference in a paper,
published in 1927, on "Occult processes occurring
during psychoanalysis." Indeed, some authors have
linked the concept of projective identification to
phenomena such as telepathy, folie à deux,
Jung's concept of "psychic infection," "Devil's
possession," "evil eye," suggestion, hypnosis, and the
like, all phenomena in which there is a threat to
personal identity and autonomy (Bilu, 1988; Bolko
& Merini, 1988, 1991; etc.).
The interest around the concept of projective
identification started with many analysts when they
were working with extremely difficult or regressed
psychotic patients and felt very uncomfortable with
them, overly "controlled" or under pressure, or
experienced a new set of feelings that were difficult
to index as "countertransference." For them, it was
more clinically useful (and possibly reassuring) to
believe that in those moments they were not
reexperiencing an old (and not well analyzed) aspect
of themselves, but that a new and disturbing feeling
was simply "put into them" by these very sick
patients. This, in my opinion, is the origin of this
concept, and it might explain the increased need to
change the old terminology
"transference/countertransference" into the new one,
"projective identification/projective
counteridentification" (a term coined by Grinberg in
1957). Furthermore, studies focusing on the concept of
projective identification, which ran in parallel to
those concerned with a new "enlarged" view of
countertransference that started in the fifties
(Heimann, 1950; etc), produced many interesting
clinical intuitions, such as the use of the analyst's
own feelings to know and understand the patient's
unconscious, the concept of "evocation of a proxy"
(Wangh, 1962), "externalization" (Brodey, 1965), role
"actualization" and "role-responsiveness" in the
transference (Sandler, 1976), the use of the patient's
feelings on the part of the analyst to know and
understand (or even "supervise" or "interpret")
himself (Searles, 1975; Langs, 1978; Hoffman, 1983),
etc.
(3) Third phase: "reinternalization".
This phase is related to treatment: if it does not
occur, there is no change in the patient's
psychological functioning and consequently he still
needs to use projective identification. In this phase,
through the therapeutic interaction (and in a complex
and not fully understood way) the patient
"reinternalizes" the part that was projected into the
therapist, because he is ready now to keep it inside
of himself. According to the various metaphorical
explanations that have been given to this phenomenon,
the therapist must "digest" or "metabolize" this
dangerous part, and make it ready to be later
"digested" by the patient. In other words, during the
therapeutic interaction this projected part is
transformed by the therapist and made more manageable
by the patient. This process (with the concepts of
"container," "contained," etc.) was first described by
Bion (1962, 1963), who understood it in a concrete
way, and conceived that the child can reinternalize
the bad parts previously projected into the mother
after she has transformed them with her thought
activity, i.e., her "rêverie." (We can see here
also an echo of the concepts of "holding" and "good
enough mother" of Winnicott, 1958.)
According to a nonmetapsychological explanation, and
using a learning model, the patient, in the course of
the interaction with his therapist who (maybe for
months) tolerates the anxieties and fears that have
been projected into himself, learns how the analyst
does it, learns new skills or adaptive behaviors
useful to cope with emotional stressors. For example,
the therapist may show the patient, often through his
own behavior rather than through verbal
interpretation, that it is indeed possible to tolerate
stressful feelings (anxieties, fears, depression,
persecutory ideas, suicidal thoughts, etc.) and to
survive. Winnicott (1958), among others, said that an
important therapeutic experience consists in the
therapist's surviving the patient's destructive
projections and provocations. The therapist may talk
about these feelings, and at times eventually even
look at them with the instrument of irony. The
improvement may occur also because the fears or
anxieties are explained or interpreted - they are
changed into something less dangerous or stressful.
Many authors, instead of emphasizing the cognitive
change through interpretation, underline that most
often the improvement occurs because the therapist
simply does not "discharge" again onto the patient the
projected feeling, and keeps it inside of himself. In
fact, interpretation as such may often be experienced
by the patient as a discharge, and it is the emotional
containment on the therapist's side (silence,
nondefensive attitude, etc.) that breaks the vicious
circle and teaches the patient that it is indeed
possible not to use projective identification as the
only way of functioning. (Incidentally, it is
interesting to note that, even in these recent
investigations, many authors prefer to rely on
concepts, such as "discharge," that remind us of the
old metapsychological terminology of Freudian drive
theory)...
-----------
Tue, 5 Sep 2000, Bill Stiles
I've enjoyed the
exchanges regarding Bion, containers, and projective
identification. I'm appending some excerpts from a
paper, partly because they suggest another way to
think about the phenomenon of projective
identification and partly to call attention to a
published exchange between Anthony Ryle and Mikael
Leiman on this topic that helped me a great deal.
My brief paper was a
commentary on their exchange:
-----------
[From: William B. Stiles, Signs and voices:
Joining a conversation in progress. British
Journal of Medical Psychology, 1997, 70:
169-176]:
With this paper, I am joining a conversation in this
Journal between Anthony Ryle and Mikael Leiman. In two
exchanges, summarized later, Ryle (1991, 1994) has
proposed -- and Leiman (1992, 1994) has then
elaborated and refined -- ways to reconcile Cognitive
Analytic Therapy with Russian ideas about linguistics
and semiotics, represented by Vygotsky and the Bakhtin
circle.
The Second Exchange: Projective Identification
Projective identification refers to the process by
which people induce their feelings in others, so that
the others have those feelings and may act on them.
Roughly, if I feel your feelings and motives because I
want to, that is identification; if I feel your
feelings and motives because you want me to, that is
projective identification.
Projective identification appears to be a primitive
and powerful process and perhaps an element of all
social interaction. Of course, it is possible to stir
people to feeling and action intentionally with words.
But projective identification points more specifically
to doing this non-verbally and without awareness by
either party. Projective identification is common
enough in therapy that experienced therapists often
expect to understand what their clients are
experiencing by attending to their own feelings.
Ryle (1994) suggested that projective identification
can be understood as an example of enacting reciprocal
role procedures, as construed within CAT. As part of
learning to play each role in a relationship, infants
learn to induce the reciprocal role in others. Leiman
(1994) agreed, but took issue with the necessity for
positing, as Ryle (1994) did, that "biologically
programmed attachment behaviours" (Ryle apparently had
Bowlby's, 1982, 1988, conceptions in mind) are a
common precursor to forming reciprocal role procedures
and hence to projective identification. By the same
token, Leiman took issue with Klein's (1946)
attributing to the infant such implausibly complex and
seemingly bizarre fantasies as impulses to "suck dry,
bite up, scoop out and rob the mother's body of its
good contents" (p. 8). The theories' need to posit the
biological programming or the complex fantasies to the
infant, Leiman (1994) suggested, reflect a fallacious
separation of infant from mother. The complex activity
emerges from the joint mother-infant system, rather
than being intrinsic to the infant. The activity
simultaneously involves mother, infant, and the signs
they use to communicate.
In this synthesis, projective identification looks
like a normal part of interpersonal communication, or
more precisely, of goal-directed activity by an
interpersonal system. Whereas Klein saw this breaching
of the mother-infant boundary as exceptional and
pathological, Ryle and Leiman saw it as normal, if
primitive. Leiman's (1994) summary was that projective
identification is "a mode of primitive joint action
mediated by non-verbal signs" (p. 67) . This sounds
not so different from telling somebody else to do
something for you, except that it is done without
being verbalized or brought into awareness, so that
the signs are harder to locate.
Projective Identification as Action Though Others
A complementary way of thinking about projective
identification may help make this more concrete.
Projective identification may be a considered as a way
that voices [i.e., internal traces of previous
problematic experiences] use other people as effectors
for their intentions.
We do not seem to need conscious mental
representations of the mechanics of action in order to
act; we seem to be aware only -- at most -- of the
action's anticipated sensory consequences (James,
1892).[footnote 1] When I move my hand, for example, I
have no conscious awareness of how I do this, other
than anticipating the proprioceptive, visual, and
other effects of the movement.
We do not even seem require that the effectors be
physically part of our bodies, so long as the their
contributions to the sensory consequences of an action
can be reliably anticipated. Thus, tools and machines
easily become extensions of our bodies. For example,
when we have become proficient drivers, we anticipate
the effects (visual, proprioceptive, etc.) of the car
turning left, and this produces the necessary
physiological and mechanical adjustments in our arms
and hands and in the car's steering mechanism,
respectively, all equally out of awareness.
By the same token, other people may become extensions
of ourselves. By inducing our feelings and motivations
in them -- that is, by projective identification -- we
can accomplish our purposes and give expression to our
concerns. We need have no understanding or awareness
of how this is done, any more than we need to
understand the physiology of muscles to move our
hands. Presumably, other people can be enlisted by
signs, including subtle or non-verbal signs, passed
without awareness. We can learn to use other people as
effectors just as we learn to use our bodies or our
tools. The conversants (Ryle, Leiman, Vygotsky, Klein)
agree that elements of this occur very early in life,
as infants induce feelings in their care-givers. (...)
Insofar as the other is a participant, projective
identification is, by this account, joint action. Both
parties to a dialogue simultaneously use each other as
extensions of each other, and the extension involves
not only physical actions, but also feelings and
intentions. Each party's intentions may recursively
use the other as an effector by the same means.
In such an interpersonal system, the distinction
between actor and acted upon breaks down, except as a
linguistic convenience. Put another way, the
distinction between identification and projective
identification does not remain strict or sharp under
close scrutiny.
This account is congruent with the usual
understanding, that projective identification is most
notably a way of expressing problematic unsymbolized
experiences without realizing it (and hence, from some
perspectives, defensive). Put another way, projective
identification describes a means of expression for
otherwise suppressed voices. The use of others as
effectors may not be confined to suppressed voices,
but if the suppressed voices do not have words to
express themselves, their projective identification
seems particularly devious. They express themselves by
projective identification rather than in more explicit
signs because they are painful or problematic, denied
a meaning bridge. At times in therapy, the therapist
may consciously experience more of the client's
problematic unsymbolized difficulties than does the
client. The therapist may be more aware of the
difficult feelings, even though neither party may know
the content.
References
James W. (1892). Psychology:
Briefer course. New York: Henry Holt.
Leiman, M. (1992). The concept of sign
in the work of Vygotsky, Winnicott and Bakhtin:
Further integration of object relations theory and
activity theory. British Journal of Medical
Psychology, 65, 209-221.
Leiman, M. (1994). Projective
identification as early joint action sequences: A
Vygotskian addendum to the Procedural Sequence
Object Relations Model. British Journal of
Medical Psychology, 67, 97-106.
Ryle, A. (1991). Object relations
theory and activity theory: A proposed link by way
of the procedural sequence model. British
Journal of Medical Psychology, 64, 307-316.
Ryle, A. (1994). Projective
identification: A particular form of reciprocal role
procedure. British Journal of Medical Psychology,
67, 107-114.
Footnote:
1. An earlier generation of
psychologists used introspection to describe the
content of intention -- of the will to act. Bearing
in mind the cautions and difficulties attendant upon
such evidence, we can consider the result summarized
by James (1892):
<<An anticipatory image, then, of the
sensorial consequences of movement, plus (on some
occasions) the fiat that these consequences shall
become actual, is the only psychic state which
introspection lets us discern as the forerunner of
our voluntary acts. There is no coercive evidence of
any feeling attached to the efferent
discharge.>> (p. 420)
James went on to conclude that the
"fiat that these consequences shall become actual"
is simply the absence of a contrary or inhibitory
anticipation. The result of James's introspective
analysis thus appears to be that will (understood as
the experiential aspect of action, reflecting what
is happening in the brain as the body moves)
consists of the anticipation of sensory
consequences.
-----------
Tue, 5 Sep 2000, Bob Sollod
I know very little about Bion except for some reading
I did many years ago and have largely forgotten. A
couple of years ago we were having a retreat to sort
out some departmental issues. One faculty member said
that she did not feel she could bring up certain
issues because we did not have a large enough
"container" for them. Some of my colleagues and I
chatted and joked later about this metaphor: Perhaps
we could benefit from a trash can, toilet or garbage
disposal, or maybe we needed a stronger pressure
cooker. We wondered aloud how large a suitable
container would be, where it would come from, etc,
etc, etc.
Now I know - thanks
to the SEPI list, that this metaphor is associated
with an actual theory and theorist. Is anything more meant
by the container allusion than one's adequacy or
ability to handle a given topic? Best wishes, Bob
Sollod.
Tue, 5 Sep 2000, Jennifer Hillman
Hello. I am new to the list serve, and hope that you
will humor my comments as a relatively new member of
SEPI. I have found it helpful to view projective
identification through the lens of neuropsychology.
Recent research has suggested we can glean important
information about others through non-verbal
communication, and that the right hemisphere collects
and culls this information. Because the left
hemisphere, rather than the left, is typically
responsible for language, the right hemisphere often
has a difficult time relaying this collected
information, and sends it to the left hemisphere via
sensations and "feelings" which have been referred to
as "gut feelings," and more recently as intuition. In
other words, I think projective identification exists,
but that it is based in reality (i.e., derived from
observable, non-verbal communication), and that it can
be useful if examined and processed, rather than acted
upon. It also has been my experience that projective
identification occurs when a patient has experienced a
trauma, and is not sure whether they want to reveal
the extent of their pain or suffering. In a way, I
think it represents an initial test to see if the
therapist can handle the patient's strong emotions,
and the therapist's own likely strong,
countertransference. Hence, I think of the ability of
a therapist to manage strong affect in the therapeutic
relationship as the more literal version of Bion's
"container." With Regards, Jennifer Hillman.
Tue, 5 Sep 2000, Jack Berkley
Paul and Paolo, thanks for the paper; I did not have
the energy to locate and post one. I notice you cite
Zinner and Shapiro. They were two who taught me
Projective Identification among others. I am convinced
by this exchange and previously, that Projective
Identification has to be taught in supervision during
and immediately after live sessions preferably with
two way mirror work. It is best if the supervisor
conducts the sessions and allows the student to
observe and then analyzes the Projective
Identification that occur during the session that the
student has observed. The supervisor can report
his/her feelings, perceptions, experience. There is
the one-body two-body dichotomy of Projective
Identification, Klein representing the former. I think
Ogden offers a nice explanation, which you cite; I
like your choice. Jack.
Wed, 6 Sep 2000, Tullio Carere
Paul, firstly, I strongly agree on relying as much as
possible on real observation and not on theories. The
concept of containment or holding is useful to me not
because I *assume* early maternal deprivation (even if
I do assume it), but because I *observe* in the
session precise signs of breaches in the "ego
boundaries"--i.e., a prevalence of evacuative versus
elaborative behaviors (which can also be observed in
dreams: Grinberg, 1987), incapacity of tolerating
minimal levels of conflict and frustration, presence
of stiff armors to protect a tender core, and similar
phenomena.
Secondly, I also agree that one cannot "define
containment by saying containment is when you
contain". As a basic definition I would give the
following: The holding function of psychotherapy (the
maternal vertex of the field) is a set of actions and
attitudes inspired or derived by the bio-psychological
prototypical container--the womb. (Remember Freud,
1926: "between intrauterine life and first childhood
there is much more continuity than one would suspect,
after the striking cut of birth"). The womb has
basically two functions: it offers a protected
environment where the child grows *by herself*, and
provides essential nutrients.
You ask why in the
world we should use "container" and related words to
refer to operations better described in terms of
ordinary communication. My answer is that there are
people who cannot properly function outside a
psychological container. Either they evacuate thoughts
and emotions, or they are closed in their shells. In
the first case the containing function of the
therapist is well described by Paolo in his excerpt:
"Many authors, instead of emphasizing the cognitive change
through interpretation, underline that most often the
improvement occurs because the therapist simply does
not "discharge" again onto the patient the projected
feeling, and keeps it inside of himself. In fact,
interpretation as such may often be experienced by the
patient as a discharge, and it is the emotional
containment on the therapist's side (silence,
nondefensive attitude, etc.) that breaks the vicious
circle and teaches the patient that it is indeed
possible not to use projective identification as the
only way of functioning." In the second case, the
patient is implicitly or explicitly invited to
substitute the relation for his/her shell. Sometimes I
find it necessary to offer, as I said in my previous
message, a bodily holding, more often a mental holding
is enough.
Many times I have the experience that I "pass the
test" if I can show them that I can accommodate them
inside the space of the relation. I don't have to do
much: just be a "good enough" container, i.e. strong
enough as not to be damaged or seduced by them, and
patient enough as to respect the times of their
self-healing, without intruding or pressing them.
- Paul, I agree with you that all I have said could
be rephrased avoiding the words you dislike. But
why? George wrote (20 May):
- >for character problems... I
do think that we have a parenting role
- >to play - I prefer the term reparenting, as
that acknowledges
- >that the patient already has had a parenting
experience, and that may even
- >serve as an obstacle to our success. This
reparenting often takes the form of a
- >corrective emotional experience, which I see
often as being at the heart of good treatment.
Let me ask you a couple of questions. Do you agree
with George that many times we have a reparenting
(maternal plus paternal) role to play? Do you agree
with Freud that the maternal role is very much in
continuity with the first container? If you have
answered "yes" to both questions, what is the problem
in accepting that many times we have to play the role
of a container? Tullio.
Wed, 6 Sep 2000, Paul Wachtel
- Jennifer, welcome to SEPI and to the list serve.
Glad to have your contribution. I was struck that
your description of Sep 5, 2000:
- "It also has been my experience
that projective identification occurs when a
patient has experienced a trauma, and is not sure
whether they want to reveal the extent of their
pain or suffering. In a way, I think it represents
an initial test to see if the therapist can handle
the patient's strong emotions, and the therapist's
own likely strong, countertransference.
- Hence, I think of the ability of a therapist to
manage strong affect in the therapeutic
relationship as the more literal version of Bion's
"container."
is very reminiscent of Weiss & Sampson's views
about the therapist passing tests. Have you thought
about it in those terms? And if so, do you see Bion's
notions as adding something additional? It's good to
have a neuropsychological perspective added to our
mix. Paul.
Wed, 6 Sep 2000, Paul Wachtel
Tullio, I know we won't be able to REALLY talk this
thru together until we are once again sitting together
on the same continent, with the luxury to talk (and
talk, and talk). But for now, let me respond only to
the final questions you posed. (I will print out
Tullio's entire message at the bottom for those who
may be coming in in the middle of this discussion. (I
also made sure to write "containing" in the subject
section so that those of you who have had enough of
this topic could delete my message without reading
it!)
You asked: Let me ask you a couple of questions. Do
you agree with George that many times we have a
reparenting (maternal plus paternal) role to play? Do
you agree with Freud that the maternal role is very
much in continuity with the first container? If you
have answered "yes" to both questions, what is the
problem in accepting that many times we have to play
the role of a container?
My answers: (a) I do think something LIKE reparenting
is often an important part of therapy, but therapy is
also in crucial ways rather different from parenting
as well; (b) No, I actually don't think there is much
about psychotherapy that has any resemblances to being
in (or being) the womb, which may be part of why the
container metaphor continues to be one I personally do
not find useful. It has had one useful function for
me, however -- to get me into interesting
conversations with a number of SEPI colleagues. Paul.
Wed, 6 Sep 2000, Hilde Rapp
Dear Bob, it is not
so much that 'more' is meant by 'containment', but
rather that the term has a more technical meaning. It
has become used loosely in the sense you indicate,
and, as this discussion shows, this does not seem to
be helpful.
In the more technical sense, 'containment' refers
specifically to the ability of the mother of a very
young infant- and by extension and analogy- of (
usually) the psychoanalyst of a very disturbed
'patient' -to remain calm and self contained in the
face of the baby's or the patient's extreme anxiety (
terror), ( murderous) hate, ( extreme) frustration,
and (violent) aggressive feelings and behavioral
intentions.
In the case of actual 'acting out' of these feelings,
physical restraint will become necessary- although-
especially in work with disturbed children- analysts
and child therapists will often tolerate a certain
amount of physical violence without themselves
exercising physical restraint, but rather putting
words to what they think is going on for the child at
the time, restating verbally what the therapeutic
boundaries are.
The predicament of
the baby/patient is that they do not at this point in
time have the resources to tolerate their own
feelings. They do not have the resources to remain in
touch with what they feel without needing to defend
themselves against the psychic pain via either
physical violence, or emotional shut down. The therapeutic task is
to help them to find ways of tolerating frustration
without hitting out or damaging themselves, etc. and
without shutting off their feelings.
The notion of
'container' is meant to indicate that the mother (
caretaker) / analyst will allow the baby/patient to
'project' some or all of these intolerable feelings
into them. This means simply that they initially
accepting in a non defensive manner the baby's/
patient's sincere but erroneous conviction that it is
the mother/analyst, and not themselves who are angry,
hateful or violent. Otto Kernberg has written much
about all this and how to work with such situations
clinically- especially if the distortion in the
patient's perception of reality is of a nature which
would commonly be labeled as 'clinical paranoia'.
In this act of
acceptance the mother/analyst helps to 'contain' (
keep in, rather than 'act out') some of the extreme
feeling states. I this way they help to contain the
baby/ patient, emotionally, rather in the same way
that a teacher, police officer or psychiatric nurse
may contain a violent person by providing a physical
means of restraint or safe keeping (containment).
The intention is always to protect the frightened or
angry person from harming themselves or others. The
whole point of psychoanalysis is to attempt to achieve
the transformation of a physical activity into a
symbolic activity. Language is the medium of choice to
achieve this. We encourage people in our society to
say that they are angry rather than to hit out. In
order to achieve this, they must learn to 'contain'
their angry feelings.
We all know that there is something we as therapists
do which has to do with will power, self control,
empathic understanding, professional poise, keeping
time boundaries, physical/sexual/financial boundaries,
and so forth. This, together with the capacity to put
our perceptions and understanding into words in a
warm, firm and respectful manner, is meant by the
technical term 'containment'- that is, as I understand
it and use it.
For Bion, and perhaps yourself, the spiritual
dimension of being open to experiencing the presence
of an Other as a 'containing' presence is also
significant: Marion Milner, for instance has written a
moving book called : 'In the Hands of the Living God'-
which is a superb clinical account of the treatment of
a borderline psychotic woman, which illustrates what
is meant by 'containment' beautifully.
The person who facilitates this 'containment' has, it
seems, unhelpfully, been described as a 'container'-
and indeed- to follow on from your joke, actually a
'toilet-breast' by the controversial Kleinian analyst
Donald Meltzer. Dealing with 'mad' states in therapy
evidently can lead to a somewhat 'mad' use of
language- perhaps a bit like the extremely black humor
sometimes current amongst medical students. At the
same time you might argue that the function of what we
do, which we may choose to describe as 'being a
container' for the patient's anxieties, is providing a
symbolic equivalent for adults of what was ( more
often was precisely not!, or was not experienced as
having been!) previously provided by the mother's lap,
her enfolding arms, her soothing voice, her breast and
her love- or its substitutes or alternatives.
I am aware that there are many circumstances where a
cruel neuropsychological condition such as autism, a
mismatch in temperament, a breakdown in feeding and
sleeping rhythms, or other factors internal to either
child or parent lead to people needing psychological
help. I am not reducing all adult 'psychopathology' to
parental failures - adults can make bad life choices
with disastrous outcomes even though they have had
perfectly adequate childhoods... etc. - so no parent
blaming and no reductionism intended!
We as therapists do
get frightened, overwhelmed, confused, driven half mad
in some of this work and we too need some coping
mechanisms- bizarre vocabulary is one way of coping
which is in keeping with our task: to symbolize what
can be symbolized. We need to find ways of supporting
and challenging one another in the ways indicated in
some of these contributions to own up to our own
vulnerabilities too so that we don't misperceive our
clients' feeling states, behavioral signals and verbal
communications and inappropriately defend ourselves
against our own feelings of fear etc. I hope this takes us a
step further in this dialogue and I apologize for
spelling out the obvious in the search for clarity and
dialogue. All best wishes, Hilde.
Wed, 6 Sep 2000, Paolo Migone
- On 06/09/2000, Paul Wachtel wrote that Jennifer
Hillman's comment
- >is very reminiscent of Weiss
& Sampson's views about the therapist
- >passing tests. Have you thought about it in
those terms? And if so, do you
- >see Bion's notions as adding something
additional?
- >It's good to have a neuropsychological
perspective added to our mix.
I agree that Weiss & Sampson's theory could be
another valuable explanation of a correct therapeutic
handling of so called projective identifications. Also
learning theory could be an explanation, maybe the
simplest one. To this regard, and since many
colleagues appreciated the posting of my article, I
want to quote another passage of it, with added
bibliography:
-----------
[From: Paolo Migone, Expressed Emotion and
Projective Identification: A bridge between
psychiatric and psychoanalytic concepts? Contemporary
Psychoanalysis, 1995, 31, 4: 617-640 (pp.
632-633)]:
...The first comment is related to the well-known
theory of psychotherapy of the "San Francisco
Psychotherapy Research Group" led by Weiss and
Sampson (Weiss, Sampson & the Mount Zion
Psychotherapy Research Group, 1986; Weiss, 1993).
According to this model, called "Control-Mastery
Theory," the patient improves only if the therapist
passes a "test" that the patient unconsciously asks
him to pass. In the transference process, the patient
repeats past relationships, and may induce the
therapist to behave like previous transference
figures. This theory, however, does not give emphasis
to repetition compulsion or drive discharge, but
highlights the patient's unconscious plan to test the
therapist, in the patient's hope that the therapist
will behave differently than was expected. An
interesting aspect of this model is that it represents
an autonomous theory of therapy, with few
metapsychological concepts (Eagle, 1984, ch. 9; for a
discussion of Control-Mastery Theory from the
point of view of cognitive science, see Migone &
Liotti, 1998). There are various kinds of tests, and
some of them might be very similar to the tests that
have to be passed by therapists when they are the
target of a patient's projective identification. For
example, as Ogden (1982, pp. 83-84) has also observed,
if a patient realizes that his therapist is capable,
after all, to "survive" or not feel too angry or
depressed, despite the many attacks, criticisms, and
depressive ideas the patient unconsciously throws onto
him, he may feel relieved, and may start to believe
that it is indeed possible to tolerate very disturbing
feelings without being destroyed by them, or he may
learn some adaptive skills from his therapist by
unconsciously identifying with him, and so on.
References
Eagle M.N. (1984). Recent
Developments in Psychoanalysis. A Critical
Evaluation. New York: McGraw-Hill.
Migone P. & Liotti G. (1998).
Psychoanalysis and cognitive-evolutionary
psychology: an attempt at integration. International
Journal of Psychoanalysis, 79, 6: 1071-1095.
The paper, the Internet discussion, and the review
by Paul Williams can be downloaded from the web site
http://ijpa.org/archives1.htm.
(A shorter version of this article, authored by
Paolo Migone, was presented as an invited paper at
the panel "Psychic reality and pathogenic beliefs:
the patients' theories about themselves and the
relational world", at the 39th Congress of the International
Psychoanalytic Association, San Francisco,
July 30-August 4, 1995).
Ogden T.H. (1982). Projective
Identification and Psychotherapeutic Technique.
New York: Aronson.
Weiss, J. (1993). How
Psychotherapy Works. Process and Technique.
New York: Guilford.
Weiss
J., Sampson H. & the Mount Zion Psychotherapy
Research Group (1986). The
Psychoanalytic Process: Theory, Clinical
Observation, and Empirical Research. New York:
Guilford.
-----------
Wed, 6 Sep 2000, Tullio Carere
Dear Hilde, I applaud your superb handling of the
'containment' issue in standard (non poetic) English.
I endorse it word for word. I love poets who can speak
and write non poetically, when this is the case.
Tullio
Wed, 6 Sep 2000, Robert Rosenbaum
I was reading &
enjoying the discussion on projective identification,
& noticed it focused almost entirely on the
therapist-client interaction. I think it's worth
remembering some of the roots of the concept lie in
its function as a defense against affect (a point made
by several contributors to the list). In my first year of
training, I encountered an example which has struck
with me as a pithy way of clarifying the process. I
was seeing a patient in a high-security prison. It was
Christmastime, and I commented how it must be
difficult to be in prison at this time of year. He
replied:
"Yeah, I've been feeling lonely lately....so I called
my wife to cheer her up."
I find this poignant. This is a person who is
struggling to relate and connect to others but having
difficulties tolerating his own emotions, being a
separate person and seeing others as whole human
beings with their own feelings. Is it possible part of
the therapeutic response to Projective Identification
as therapists is not just as "containers" to hold or
process the client's feelings, but simply with empathy
knowing the client's pain, loneliness and groping
toward relationship? That the therapeutic effect
comes, once again, not so much from a technique (in
this case, of "processing" or "metabolizing" emotions)
but simply from the continued offer of relationship
-real relationship as connected-but-separate beings --
even in the face of the difficulties the client tends
to invoke? Bob
Thu, 7 Sep 2000, Bob Sollod
Projective identification has some roots in imitation
learning or "one-shot" learning. This means of
learning involves seeing another do something and then
imitating that person. This can be found in the animal
kingdom as well (at least re mammals and birds). This
is an important means of learning that fits into an
evolutionary psychological model pretty well as it
speeds and a facilitates learning that would otherwise
be more time consuming if not impossible. Best wishes,
Bob Sollod.
Thu, 07 Sep 2000, David Allen
To all: I prefer the conceptualization of projective
identification as an interpersonal process rather than
an intrapsychic one. It can be thought of as a process
by which individuals in a relationship attempt to
induce one another to behave in ways that are
consistent with their cognitive role relationship
schemata. One could also look at it from a TA
perspective in that individuals are naturally inclined
to enlist others to help them act out their "script."
Dave Allen.
Thu, 7 Sep 2000, George Stricker
Dear Hilde, I know I don't have to tell you about
Tony Ryle's work, which fits the description
perfectly. I imagine you also are familiar with my
writings with Jerry Gold, but I'll provide references
if you wish them. Finally, watch for a forthcoming
issue of Journal of Psychotherapy Integration, which
will provide a special issue that Stan Messer and
Jerry Gold put together on assimilative integration.
George.
Fri, 8 Sep 2000, Tullio Carere
Bob, yes, the "offer of relationship -real
relationship as connected-but-separate beings -- even
in the face of the difficulties the client tends to
invoke" is what relational therapy (psychotherapy) is
all about. It is correct, but too vague. A science of
therapy (if you agree that there should be one) is to
specify what sort of (real) relationship is suitable
for what conditions. We relate quite differently to a
person who says "I would like to understand why such
small things upset me so much", and to another
(obviously angry) who says "You are angry, I am not".
In the two cases our response should be real and
genuine (though not disdaining relational techniques,
when appropriate), but different. Tullio.
Fri, 08 Sep 2000, Robert Rosenbaum
Tullio, agreed in all aspects....except perhaps the
science part; I think there is some different model we
strive for -- neither science nor art, but with
aspects of each -- which
describes/defines/creates/predicts the therapy
process. But more on this later. Bob.
Sun, 10 Sep 2000, Luca Panseri
Dear Paul, I am Luca Panseri, an Italian
psychotherapist. I'm moving my first steps in the
psychotherapy integration field, and, of course, I
view your work and your thought as a very important
reference. I have just read your article:
"Transference, Schema, and Assimilation: The Relevance
of Piaget to the Psychoanalytic Theory of
Transference" posted on the SEPI web page. I have
appreciated it very much for the originality of your
reflection and the interesting perspective it
highlights. As Tullio writes in his last message on
the SEPI list :"The concepts of assimilative and
accommodative integration allow for a new
understanding of the basic integrative processes".
Moreover, "these concepts may prove useful to
evaluate the process of the discussions among
integrative therapists". Then Tullio asks a question
:"How much are the partecipants (to the SEPI
discussion list) capable or willing to accommodate to
their interlocutors' view, beyond just trying to
assimilate them to their own"?
Paul, I would like to know your opinion because I
think the above question is specially pertinent in the
ongoing debate on Bion that you started. You began the
discussion asking Hilde and others to indicate to you
which, among Bion's ideas or observations, they
thought were "really valuable". The answers that
followed were very pregnant.
Hilde, through her evocative style, enlightened us on
what the term 'containment' refers to and gave us lots
of references in literature, showing how impressive
the research in this field is.
Tullio noticed that Bion's thought is "a way to point
the kinship the mother/child and the therapist/patient
relationships" but above all that "Bion's decisive
contribution is the introduction in the therapeutic
field of the Kantian polarity phenomenon/noumenon,
or knowledge/ unknown, or K/O".
Reading these
contributions I felt happy to have colleagues of so
profound learning and I appreciated SEPI mailing list
for its formative function. To my surprise, you
seemed dissatisfied instead. You have been repeating
that the word 'containment' wasn't necessarily *wrong*
but that it was *unclear* and often used as a useless
cliché. You ended your last mail saying:
"(the container metaphor) has had one useful function
for me, however- to get me into interesting
conversation with a number of SEPI colleagues".
At the end of this
mail I would like to ask you if you think that a real
dialogue unfolded during the discussion, that is :
"has every participant been capable to accommodate to
the interlocutors' view?" Paraphrasing the title of
one of Bion's books : has every participant "learned
from experience"? Or, was the debate only an "interesting
conversation" with a prevalent assimilative feature in
which every participant tried to assimilate the other
to her/him own? Thank you very much for your
attention. Luca Panseri.
Sun, 10 Sep 2000, Nancy McWilliams
As an interested observer of the discussions going on
in the SEPI list-serve, especially re: Bion and
projective identification, I can't resist adding a
couple of thoughts about individual differences, which
is my own area of concentration.
First, I've noticed that therapists who are attracted
to Bion (and to other writers, including Jung, who try
to capture in metaphor the kinds of preverbal
processes that are very resistant to secondary-process
language description) tend to have a strong schizoid
component in their personality, whereas those people
who find such writers incomprehensible or obscurantist
tend to have more obsessional styles. I'd be curious
whether other people have noticed the same thing.
Second, it's interesting to me that it's Hilde who is
the main explicator of the more impressionistic,
metaphorical ways of describing psychotherapy, as I
have also observed that women tend to be less
either-or than men about whether they embrace the more
preverbally resonant theorists. Eleanor Maccoby told
me recently that one of the most robust sex
differences has to do with cognitive bias (not her
word, but I think that was the gist of what she was
describing), namely that men are more likely to want
to sharpen up differences and women are more likely to
be automatically synthetic and integrative. The
question was raised a while ago about why more women
weren't active on the list or in SEPI generally, and I
found myself wondering whether women aren't more
naturally integrative and therefore not particularly
drawn to conversations and controversies about whether
and how to do it. Another idea that I'd be interested
in people's thoughts about.
These conversations have been very stimulating, by
the way, and although I've been a silent party to
them, I've printed a number of them out because they
were so beautifully explicated. Nancy McWilliams.
Sun, 10 Sep 2000, George Stricker
We seem to be
entering a new and interesting variant of this
discussion. In response to Nancy, I would hesitate to
diagnose others, but for me, I certainly think
obsessional fits better than schizoid (and man better
than woman). However, I also think I tend to see
similarities more readily than differences, and to
seek convergence, not only in psychotherapy but also
in the science/practice debate. Putting the two
dimensions together, though, I do strive for some
intellectual basis for the convergence/integration
rather than accept it as a given. This echoes a
millennia-old debate in philosophy and religion about
whether knowledge should be based on rational
understanding or faith. Consistent with my wish for
integration, I have thought that these are two
different types of knowing and that we need not choose
between them. However, if I was forced to choose, I
clearly would opt for rational understanding. I also
want to be clear that they are two different types of
knowing, one is not superior to the other, but they
are helpful for different purposes. This may lead into
Luca‚s question about assimilation and accommodation.
I found the projective identification debate very
helpful, and thought that the articles posted by Paolo
Migone and Bill Stiles were very useful and well-done.
Hilde's explanation also was lucid and very helpful
to me, as were Tullio's comments. Did it result in my
changing my mind (accommodation)? Yes and no. Yes, I
did get more of an appreciation of why people use such
terms and what they mean to them, and expect that I
may be less impatient with the language in the future.
But no, it didn't lead to any more likelihood that I
would use that language, or that my understanding of
my own work was changed. And, like Paul, I did value
the opportunity to exchange ideas with valued
colleagues. George.
Sun, 10 Sep 2000, Paul Wachtel
Dear Luca, thank you for your comments about my
article and also for your effort to ensure that we all
continue really not just to talk to each other but to
listen. I understand your feeling that I have been
resistant, so to speak, to what my colleagues say they
value in Bion's work and in the idea of containment. I
meant it when I said that I initiated this dialogue
because I WANTED to find a way to understand and use
ideas that colleagues I respect find useful. But at
the same time, although that wish was a sincere one, I
also have to be sincere about whether I have been
persuaded -- or better yet, because persuasion isn't
really the issue -- whether I have been able to
CONNECT with what people are describing and
advocating. I will keep trying, but so far I still
have the feeling that people are saying that "if you
agree that there are useful phenomena that we are
describing, and if you have been in touch with your
patients' deepest experiences as we have, then you
must be saying you agree with the concept of
containment." But for me, so far I would say that yes,
I have seen the phenomena and yes I do THINK I have
experienced the same kinds of deep connections, but
no, talking about that as containment still doesn't
feel -- for me, at least -- like a useful way to TALK
ABOUT those experiences. I will continue to listen
respectfully to what my colleagues have to say, and
will continue to reflect on these issues, but thus far
I still think there are better ways to talk and think
about the phenomenon, and that it is not just a matter
of aesthetics or personal preference, but of how
different ways of thinking about lead one to behave
clinically.
Perhaps we have reached the point in this dialogue
where the next fruitful step will be not via the
necessarily brief exchanges on this list serve and
instead via a more extended exploration in symposia at
forthcoming SEPI meetings, where there will be chance
for more clinical illustrations and more back and
forth immediate conversations.
Again, Luca, thank you for your comments about my
paper and for participating in our dialogue. It is
always welcome to be able to discover new voices in
our exchange. Paul.
Mon, 11 Sep 2000, Bob Sollod
Hi, Piaget has two main points that are of use in our
work in psychotherapy. They apply equally to our
understanding of the client or patient and of
ourselves.
The first is the
schema idea - with the associated concepts of
assimilation and accommodation. What are our operative
schema? To what extent are they fixed and to what
extent to they change to adjust to the new reality of
the client?
Likewise for the client. To what extent are his/her
schema (based on past learning) fixed and to what
extent do they accommodate to new realities (including
therapy itself)?
The second part of Piaget has to do with the quality
or level of of the mind or of mental operations. Each
schema is embedded in a matrix of other schemata and a
certain level of mental functioning. Some therapeutic
approaches have the consequence of helping the client
move from a single perspective or an egocentric
perspective to a more decentered perspective or
awareness of many perspectives. This, à la
Piaget, is considered a structural changes.
Interestingly, it is this type of cognitive
development which SEPI itself often engenders in its
members. It is precisely our own cognitive development
in the area of psychotherapy and personality theory
that is of interest and concern to many of use
SEPI-ites. Not to mention the examination of our
current schemata and the value of incorporating new
ones (such as the controversial 'container') Best
wishes, Bob Sollod.
Mon, 11 Sep 2000, Hilde Rapp
Dear all, I had written a long message putting in
context how Luca's question, Nancy's observation and
Paul' answer. I agreed with George that there are
different ways of kwow-'ing' as well as know-'ledge',
and that these relate to specific and diverse needs
for information about, understanding of and evaluating
clinical phenomena.
I set out how these different ways of knowing are
also grounded in fundamental values. I think, shared
by most SEPI members is the humanistic commitment - so
beautifully spelt out in Art Bohart's special issue (
see also Barry Duncan's work), to respecting the
client's meaning system and to developing wherever
possible and active partnership for insight and change
with the client.
I discussed how - as Stan Messer and Mike Basseches
have frequently pointed out- that certain assumptions
more common amongst analysts- especially regarding
developmental tasks and the analyst's special
expertise in managing how the client might achieve
these - could get in the way of that humanistic
commitment.
I briefly described a compromise I have personally
found which allows me to work in active partnership-
prizing the client's capacity for self healing and
self management, while at the same time providing
acceptance of dependency needs which the client has
not yet got the resources him or herself to manage in
a mature way. I pointed towards ways of providing
realistic balance between support and guidance and
challenges to develop appropriate insights, adult
coping strategies and more mature ways of relating to
others.
I then re-described what Bion means by 'container' in
a language which relates the analytic understanding of
the phenomena to humanist approaches to working with
them.
I then suggested tongue in cheek: It would require an
exercise in Stan Messer's assimilative integration if
Paul wanted to find a way of making use of Bion's
theoretical concepts to inform his way of working
without doing violence to the integrity of his own
approach, but that there would have to be a clear need
for such a concept identified by a well defined gap in
Paul's current theoretical approach to meet the needs
of specific clients.
I hazarded a guess that no such gap currently exists
and that Paul's current repertoire is therefore not in
need of adaptation. So it would only be intellectual
curiosity competing with other opportunity costs which
could motivate a continuing interest in Bion's work...
Alas- this was on
the way to becoming a mini paper - I fear - and my
email system, in collusion with my internal editor,
wiped the whole message irretrievably. By way of a jeu
d'esprit here is my reconstruction of the guts
of the previous message ( please ignore change in
font- I can't get rid of it. Cordially, Hilde.
Tue, 12 Sep 2000, Jim Lindsley
I have enjoyed the discussion of projective
identification, a process that has both puzzled and
interested me and which has led me to the following
thoughts. It has seemed to me that as social creatures
we are constantly engaged in trying, with varying
degrees of open directness/indirectness,
conscious-awareness and its absence, to influence one
another. For many reasons we wish to influence the
behavior of others: to draw them closer to us or move
them further away; to obtain their favor or other
goods from them; to win their regard or to get their
animosity; etc. We also engage in many acts to learn
about others through the various "test" hypothesized
by Weiss in the therapeutic relationship, as well as
the tests of love, commitment, acceptance, etc., so
common in personal relationships. We also act to bring
out the best and worst in others out of our needs for
them to be certain ways for us and for social
comparison needs.
With regard to getting others to feel or behave
badly, we might do it for reassurance that we aren't
the only one who behaves so (e.g. seeking accomplices
in crime or guilt so to speak); to feel superior to
them (without it entailing necessarily a part of
ourselves we wish to disavow); to upset them out of a
punitive anger; to see how they manage such feelings
(passive-into active tests); to manipulate their
behavior for our own needs (e.g. to have reasons to
end a relationship); in the hopes they don't behave
badly after all (transference test); etc. Such a list
of interpersonally influential goals and processes
could easily be extended. As well it seems to me that
we are often conscious when we do these things. But
that is not my main purpose here.
Rather, in this context, I have a couple of concerns
about an emphasis on projective identification. The
first is that it may function as a kind of procrustean
bed, preventing us from an appreciation of a much
vaster range of interpersonal influential processes.
The second is that it strikes me as one of the less
common forms of interpersonal influence and, though it
is likely my own fault not to have searched more
diligently for them, I feel I am presented with few
convincing examples of it in operation or of an
explanation of the mechanisms by which one actually
pulls it off.
Personally I would appreciate some convincing
examples of Projective Identification differentiated
from similar but different processes such as I have
referred to above, along with the mechanisms by which
it succeeds in influencing another; and as well
thoughts about where Projective Identification fits
into the more general context of interpersonal
influential processes that I have referred to above.
Jim Lindsley.
Wed, 13 Sep 2000, Hilde Rapp
Jim, Yes: Most interpersonal phenomena such as
Projective Identification can be redescribed as mutual
cueing through words, gestures, postures, facial
expression, tone, rhythm etc. - and I prefer to do
this first off ( and have written various things to
this effect). Academic research into mother infant
relationships, social psychological work into body
language etc gives us rich pickings here. NLP has
described some of the micro processes in convincing
detail. Etc.
And: Something else happens too which is more
difficult to capture. Morphic fields, mass hysteria,
trance states, state dependent perception and memory
hypnotic induction and related phenomena and other
sorts of altered states of consciousness are the sort
of 'labels' under which much of this body of
literature is collected- and we seem to have a dawning
understanding of some of the neurophysiological and
neurochemical processes which might serve as partial
explanations for we observe.
And: Descriptions/experiences of witchcraft and
sorcery as described in much of the literature from
social anthropology is even harder to redescribe in
ordinary scientific ways.
Projective Identification is probably a combination
of all three types of phenomena, and we tend to
circumscribe rather than describe, to use evocative
language to 'point' in the sort of direction where the
reader/ listener may be able to connect with some
experience of their own. Imagine- remember- meeting a
person you experienced as 'evil'- what do you mean by
this- what made meeting this person make you feel -
use imagery ( 'sensing'- focusing- a la Gendlin)
concentrate on bodily sensations 9 hair pricking up,
etc" difficult stuff to talk about rationally - but I
certainly have such uncanny experiences with certain
patients.
Eric Berne, when working as an army psychiatrist with
the task to assess in 1 1/2 minutes whether a soldier
who had been hospitalized as shell-shocked was ready
to return to the field, reported:
<<I tried to develop some image of this
person, drawing on my intuition - I would see a baby
with wet nappys between his legs - this soldier
isn't ready...>>
Whatever he did is
similar to what we do, and what we call
countertransference- when we 'receive an unconscious
message' from a client about their own inner feeling
state which they can't or won't articulate to
themselves or to the therapist ( for whatever
'defensive' reason). So, I suppose there will always be
phenomena which defy rational scientific description -
but resorting to this should really be our last resort
and not our first choice - unless we are deep into a
conversation where all the scientific work has already
been done and we have got to white bit of map...
Hilde.
Thu, 14 Sep 2000, Arthur Egendorf
Paul and others, more than once I've had an impulse
to jump into this series of exchanges along the lines
that Bob Sollod did (recalling a colleague who
regretted the lack of an adequate container, only to
have images of toilets and so on leap to his mind).
Only I'd say more explicitly, "Hey, Paul. I know what
you mean!".
In North American English, as I speak it, a container
could be a large steel storage bin that goes on
'container ships,' or the aluminum packaging for loose
tea, or some other object of that sort.
To my ears, there is a strange or maybe estranged
frame of mind that lies implicit in the choice of such
a word by Bion and his champions. Maybe one would have
to be raised in a place where people have been
"queuing up" for longer than anyone cares to say. Or,
where, at least until recently, a "stiff upper lip"
would be considered a virtue. No ethnic aspersions
implied. Just a nod to the fact that British English
is a distinct tongue, and one not altogether
accessible to those of us who speak the one that keeps
careening in odd ways on these shores.
But I also mean to sympathize with anyone who
hesitates to use nouns to fix into roles what can only
be done, or practiced, as a more or less
improvisational activity. I would tease this point out
further, but it has already been done better than I
could hope to by Wittgenstein, then taken up by Austin
(oh yes, the irony: British linguistic analysis
produced this critique most pointedly), and then
brought into our field at book length more than two
decades ago by Roy Schafer in his 1976 book "A New
Language for Psychoanalysis."
So, at least "containing" would draw us a bit closer
to the action. But Jack Berkley did considerably
better with "mature responding" if I recall his phrase
correctly. Maybe we need a name for this kind of
situation, where as Paul admits:
<< yes, I have seen the phenomena and yes I
do THINK I have experienced the same kinds of deep
connections, but no, talking about that as
containment still doesn't feel -- for me, at least
-- like a useful way to TALK ABOUT those
experiences. >>
How about "different wording for more or less similar
experiences/phenomena"? And then, "wordings that not
only differ but make a significant difference for
their users"? Arthur Egendorf.
Sat, 16 Sep 2000, Diana Fosha
Dear all, a couple of small comments in this
mega-conversation:
--- Though for the most part not blessed with the
patience or inclination to devote myself to Bion, it
did occur to me that from the vantage point of being
SEPI-ites on the cusp of the millennium, "container'
is a woefully inadequate word. However, if the context
is blank screen (for projection, etc.) then going
three dimensional and taking something in and holding
it, rather than bouncing it right back, then (at least
at the time), we've come a long way
--- On phenomena and terminology: over time, a
particular word becomes a shorthand for a collection
of related phenomena. With time, different
understandings unfold to account for those phenomena,
and with the new understandings, different terms, more
accurate to those new understandings, come to mind.
However, there is a dilemma: on one side, there is a
concern that by deciding to err on the side of
accuracy (and go with the new language), the tie with
fondly held history/tradition will be lost, one will
lose connection with valued allies, etc. On the other
side, there is the concern, that by staying with the
old language, one has to live with baggage (another
type of container) that one would rather do without.
[When writing, this is a huge existential dilemma]
--- Finally, on the
analytic/integrative, male/female, rationality/faith
dichotomies, there is another one: clarity vs.
opaqueness or explicitness vs. deliberate
mystification. On that last one, I CLEARLY align
myself with lucidity. Like Wittgenstein said, Anything
worth saying can be said clearly (Arthur, correct me
if I misquote). There is to me little more thrilling
than someone writing about complex a-rational,
non-linear, non-cognitive, even "weird" phenomena and
doing so clearly. Witness William James writing about
religious experience. As to all the other dichotomies,
I quote the main character from Rose Tremain's
brilliant, poetic, idiosyncratic and uncannily lucid
novel "Sacred Country:"
"Cord said brass rubbings were ghostly things in
two senses and everything important in life was
dual, like being and not being, male and female, and
that there was no country in between. I sat on the
toilet at [the brass rubbing of] Sir john and he
looked at me with his empty eyes and I thought, Cord
is wrong, there is a country in between, a country
that noone sees, and I am in it."
With much regard and many regards, Diana Fosha.
Sun, 17 Sep 2000, Jim Lindsley
Dear Hilde: I appreciate your response to my letter
with your extension of various types of interpersonal
influence, as well as hints at the mechanisms of
things such as Projective Identification.
As for the judgments
and feelings we may have about the character, internal
feelings, intentionalities of others, subsumed under
counter-transference, I am quite wary. Although we
often do accurately 'read' or infer on some other
basis something about the inner state of others, it
has also been in my experience to mis-judge others
until they more directly reveal themselves to me, as
well as to be mis-taken by others. I also see in my
work with couples how often people misread one
another.....so I wonder how good a job Berne did....
Anyway I shall enjoy
the stimulation to my ponderings and observations
engendered by your influence. Jim.
Mon, 18 Sep 2000, Tullio Carere
- Diana Fosha wrote:
- >if the context is blank
screen (for projection, etc.)
- >then going three dimensional and taking
something in and holding it, rather
- >than bouncing it right back, then (at least
at the time), we've come a long way
Yes, the containing/holding metaphor may not be very
elegant, but if it is seen as a three dimensional
development of the blank screen (thank you Diana for
this enlightening observation), it is a great
improvement anyway.
Everybody knows that the blank screen is never really
blank, but maybe we all agree that a basic function of
the therapist is to make it as blank as possible--that
is, to interfere as little as possible with what the
patient needs to stage. The therapist is never
"neutral", but s/he can decide to neutralize as much
as possible his/her personal/emotional contribution to
the relation, if s/he understands that what the
patient needs at the moment is just to be mirrored
back.
But if we don't take it for granted that we know what
the person before us needs right now, we may realize
that sometimes s/he needs a clean, smooth, and
impersonal mirror (as an orthodox psychoanalyst would
try to offer all the time), other times s/he needs a
therapist who is not afraid to take part personally in
the drama. And maybe one of the dramatis personae
the therapist is asked to play is "the good enough
mother", that is one capable of (in your words)
"taking something in and holding it, rather than
bouncing it right back" (and maybe giving it back
later, after a little elaboration). Tullio.
Mon, 18 Sep 2000, Diana Fosha
- In a message dated 9/18/00, Tullio Carere writes:
- << Yes, the
containing/holding metaphor may not be very
elegant, but if it is seen as a three dimensional
development of the blank screen (thank you Diana
for this enlightening observation), it is a great
improvement anyway.
- Everybody knows that the blank screen is never
really blank, but maybe we all agree that a basic
function of the therapist is to make it as blank
as possible--that is, to interfere as little as
possible with what the patient needs to stage. The
therapist is never "neutral", but s/he can decide
to neutralize as much as possible his/her
personal/emotional contribution to the relation,
if s/he understands that what the patient needs at
the moment is just to be mirrored back. >>
Dear Tulio, Paul, all, now we are getting somewhere.
And possibly we have opened the door to genuine,
substantive divergence, rather than quasi-arguments
based on differing hormones bathing the brain and
dictating (more or less) gender, or level of patience
in the face of frustration, or theoretical allegiance
based on accidents of geography, or what have you.
Tullio as usual is
eloquent and elegant: "Everybody knows that the blanc
screen is never really blanc, but maybe we all agree
that a basic function of the therapist is to make it
as blanc as possible--that is, to interfere as little
as possible with what the patient needs to stage."
It is my guess that,
most likely, we do not all by any means agree that the
basic function of the therapist is to make the screen
as blanc (I like this spelling) as possible. Maybe we
all agree that we see our function to as best as
possible provide what the patient needs, but I think
we construe "need" quite differently.
If one really takes to heart, like I do, a two person
rather than a one-person understanding of clinical
phenomena -- and by that I do not only mean the
therapeutic relationship, but also the phenomena we
call psychopathology or character or psychic
functioning-- then not only is it not possible to be a
blanc screen (or, for that matter, a featureless
container), but, more importantly, it is not
desirable. In a two person relationship, two PERSONS
are needed. That does not mean that the relationship
need be symmetric or anything else that suggests
equal, only that it be mutual. The partner with
greater flexibility (or expertise, or experience, or
power, or wisdom -- cf. Bowlby's defining attachment
as the need for contact with another, "viewed as older
or wiser"--) can be concerned with fostering the
development of the partner who is more vulnerable (or
younger, or sicker, or more primitive, or less
flexible). And in the process of fostering that growth
(or healing, or becoming, or unfolding), s/he might at
times have to be more in the background or more in the
forefront as her/himself, but s/he needs to be there
as her/himself. Though we all have different selves,
which get engaged and transformed in different
relations we construct with different people, there is
experiential meaning to the experience of "being
oneself" at a given moment. Winnicott said, The mother
"has a special function, which is to continue to be
herself, to be empathic toward her infant, to be there
to receive the spontaneous gesture, and to be pleased"
(Winnicott, 1963, p. 76). The essential nature of the
mother needing to be herself is in no way rendered
less essential by the fact that there are times when
it is best that she keep herself subdued in the
interest of what the child might need at a given
moment.
The other favorite quote that comes to mind that is
of relevance in this discussion comes from Ferenczi:
"One gets the impression that children get over
even severe shocks without amnesia or neurotic
consequences, if the mother is at hand with
understanding and tenderness and (what is most rare)
with complete sincerity" (Ferenczi, 1931, p. 138).
To bring this to a
close -- as it is time to wake up my daughters and get
the day going for all three of us -- I believe that it
is in the context of concepts like "spontaneity" and
"sincerity" that terms like "container" -- for all the
clinical wisdom that they contain -- leave something
to be desired. To be continued... Ciao, Diana.
Mon, 18 Sep 2000, Richard O'Connor
I'm brand new to SEPI so please forgive me if these
comments don't advance the discussion, but I can't
resist putting in my two cents. I have been trying to
figure out why so many of my depressed patients seem
to find themselves in situations where they really do
get rejected, ignored, treated sadistically, etc.
Sometimes it's very difficult to see that there's
anything the patient actually did to contribute to the
situation, it just feels like more bad luck. And if
you push too hard to analyze the situation, the
patient feels like you're saying it's his fault
somehow.
I had thought of Paul Wachtel's notion of "recruiting
accomplices" as useful in understanding this
phenomenon, but also thought of projective
identification as the actual mechanism at work, so I'm
interested to see that Paul has reservations about
Projective Identification as a process. I think that
Projective Identification, recruiting accomplices,
whatever, are our imperfect attempts at understanding
what is a very real but also very mysterious
phenomenon.
-----------
Anyway, here's a contribution. This is from a
book I've been working on, "Active Treatment of
Depression," coming out from Norton:
Projection and Projective Identification, Splitting
and Repetition Compulsion
These are some of the skills of depression
which make relationships with the depressed person so
difficult and problematic. Projection is understood to
be a process whereby painful feelings or ideas
originating in the self are experienced as emanating
in someone or something else. Incorporation is the
reverse, when aspects of another are attributed to the
self. Incorporation is usually thought of as a
comforting process in grief whereby we take into
ourselves aspects of the lost object. However, we may
also incorporate aspects of another that we dislike,
as Freud argued in Mourning and Melancholia.
Trying to resolve a conflict with someone who is
projecting is fruitless, and to say "you're
projecting" only raises the stakes and makes matters
worse. When the therapist hears about repetitive
disputes in the patient's life, he should consider
whether a projection process is occurring, and whether
it might also be getting played out in the
transference. The therapist should then focus on the
patient's felt experience: It seems like you feel that
I'm attacking you. I'm trying not to, but maybe I'm
not aware of something that's going on here. Can we
talk about this? It is, of course, usually hate, rage,
rejection, disapproval that is split off and
attributed to the therapist or object. These are
feelings the patient may have initially experienced
from the parent or other lost object, which have now
become internalized, perpetuating the vicious circle
of depression.
Projective identification is a major element in
recruiting accomplices into the patient's stable,
dysfunctional interpersonal world. It involves others
correctly understanding the subtext of the patient's
messages, the unconscious expectations he has that
people will reject him, ignore him, treat him with
contempt or sadism. When the therapist finds himself
experiencing some of these feelings about the patient,
we may understand it to be part of a process of
projective identification, but to interpret it to the
patient as such is merely acting out sadistically.
It's your fault that I'm rejecting you. This is a
major stumbling block for many patients with
depression, who will hear any suggestion that they
change their behavior as an accusation that their
problems are all their own fault. Tact, timing, and
patience, a willingness to look openly at the
therapist's contribution to all misunderstandings, and
a determination to solve the problem in the face of
doubt and uncertainty-these are required elements in
the therapist.
It is easy for the therapist to come to participate
in the irony of depression. If, for instance, we
consistently point out how the patient puts himself
down, we are putting him down; if we keep emphasizing
how he minimizes progress, we also are minimizing
progress. The patient can come to believe that he is
not a good-enough patient, just as he believes he is
not good enough in other aspects of his life. Instead
of always pointing out the defense against feeling
good, it may be better to ignore it sometimes and get
back to what caused the good feeling in the first
place. If there is a healthy give-and-take in our
relationship, the patient will come to the time when
he can explore what is so anxiety-provoking about
feeling good; but if he expects that we too are never
satisfied with him, he will just acknowledge that it
is difficult and blame himself. Especially if the
general thrust of the patient's efforts has been in a
positive direction, for us to keep pointing out the
negatives verges on therapeutic sadism.
The patient comes to the therapeutic relationship
with a kind of fatalism, expecting that this once
again will be a relationship that will fail to satisfy
him, to cure the "basic fault." At the same time, he
wishes and hopes that this will be a different
relationship. The therapist's task is to prevent the
patient's self-fulfilling prophecy from repeating
itself. The therapist is only human, and will be
influenced by the patient's projective identification
and by his own unconscious motivations, but he must
work hard at clarifying ambiguity and moving the
process in a direction that addresses the patient's
expressed wishes. The depressed patient can resist
engagement in many ways-by rejection, by
dependency-but the hallmark of depressive resistance
is withdrawal, tuning out, refusing to come out and
play with the therapist. This attitude leads, pari
passu, to the therapist's frustration or giving
up on the patient; the patient sees this even when the
therapist is unaware of it, and (not aware of his own
contribution to the dance) concludes that the
therapist is but one more in a long line of people who
have disappointed and rejected him. But when the
opposite happens, when the therapist jumps on the
patient's withdrawal, persistently points it out,
brings it to the patient's awareness and the two of
them collaborate on figuring out what it means, the
opportunity is there for a new "mental representation"
(Fonagy et al., 1993) to develop. A new nexus
of affect, relationship, behavior, and hope can be
laid down.
What is experienced as rejection depends greatly on
the uniqueness of the patient. Ehrenberg (The
Intimate Edge, 1992) reports her embarrassment
at becoming drowsy during a patient's sessions and her
surprise when he reported experiencing it as
comforting. To the patient, it meant that she felt
safe with him, a man who did not feel safe with his
own impulses, and it reminded him of comforting,
intimate nap times with his mother who was otherwise
anxious, unstable, and threatening.
But therapists are prone to some forms of acting out
that clearly betray a rejecting component: forgetting
appointments, starting the appointment late or ending
it early, not giving notice of vacations and
interruptions. On a micro level, finding ourselves
distracted or bored, losing the thread, sighing,
yawning, changing the subject-depressed patients are
infinitely sensitive to these insults, always looking
to the therapist for signs of loss of love and
approval. We may in fact be feeling bored by the
patient, or angry at him for a reason we might not be
able to identify; we might simply be feeling
overwhelmed, sorry for ourselves, needing a non
depressed patient who can perk us up a little; or we
might not know why we are rejecting the patient.
Regardless, if ever we are confronted by the patient,
the worst thing we can do is deny what we are doing,
try to disconfirm the evidence of his own senses. It
is far better to acknowledge what's happened, explore
the patient's reactions, explain the meaning from our
perspective insofar as we know it, and mutually
explore the implications for the relationship.
"There is no way for the analyst to know, with
certainty, what course to pursue with respect to the
balance between spontaneous, personal responsiveness
and adherence to psychoanalytic rituals at any given
moment, nor can the balance that is struck be one
that the analyst can completely control. The basis
for the patient's trust is often best established
through evidence of the analyst's struggle with the
issue and through his or her openness to reflect
critically on whatever paths he or she has taken,
prompted more or less by the patient's reactions and
direct and indirect communications." (Hoffman, 1998,
p. 225)
Many depressed patients will never complain, no
matter how much we abuse them. Some will drop out, and
some will settle into a masochistic "therapeutic"
relationship that can become the most important
relationship in the patient's life and last for many
years. Just as the patient continually scans us for
signs of disapproval, we must be alert for subtle
indications that the patient isn't happy with the way
things are going. Dreams of rejecting parents, lovers,
or bosses, complaints of careless treatment at the
hands of others, usually have plenty of basis in
reality but also may be a communication from the
patient's unconscious about the therapist. A simple
comment like There are so many experiences in your
life when you are made to feel inadequate, I wonder
how often it happens in here but you don't feel
comfortable mentioning it may open a door.
-----------
Tue, 19 Sep 2000, Tullio Carere
- On 18-09-2000, Diana Fosha wrote:
- >It is my guess that, most
likely, we do not all by any means agree that the
- >basic function of the therapist is to make
the screen as blanc (I like this
- >spelling) as possible. Maybe we all agree
that we see our function to as best
- >as possible provide what the patient needs,
but I think we construe "need" quite differently
- >If one really takes to heart, like I do, a
two person rather than a
- >one-person understanding of clinical
phenomena -- and by that I do not only
- >mean the therapeutic relationship, but also
the phenomena we call
- >psychopathology or character or psychic
functioning-- then not only is it not
- >possible to be a blanc screen (or, for that
matter, a featureless container),
- >but, more importantly, it is not desirable.
In a two person relationship, two
- >PERSONS are needed. That does not mean that
the relationship need be
- >symmetric or anything else that suggests
equal, only that it be mutual.
Diana, I agree that neutrality is not *the* basic
function of the therapist: In fact I said it is *a*
basic function of his/hers. As you know, the triad
interpretation, transference analysis, and technical
neutrality (to the exclusion of all interpersonal and
intersubjective deliberate action) is still today the
hallmark of mainstream psychoanalysis (Kernberg,
1999). Do you think that the therapist's neutral
stance could have survived for more than a century,
and still be a must in mainstream psychoanalysis, if
it were just a mistake? It is not likely. One-person
psychology is still alive and well. Listen what Warren
Poland said a few days ago on the JAPA discussion
list:
- "'Freudian monism' provides a technique for
coming most fully to seeing an other in that
other's own right. Therefore one person
psychology, when not used defensively, may be the
realization of the most successful mastery and
integration of the truths of intersubjectivity.
Practicing psychoanalysis involves the use of
one's self in the service of the other. Relational
psychology has cast vast and vastly needed light
on the analytic process.
- Ted Jacob's substantial contribution on the
analyst's use of the self has been a major
enrichment of our modern understanding of the
psychoanalytic process. Yet all of this matters as
it leads us back to the purposes that brought
patient and analyst together to begin with. The
analyst is there in the service of the other."
One-person psychology is not at odds with two-person
psychology: it is just one of the person's ways to
relate to another person. It is a person's way to get
out of another person's way. Provided it is not used
defensively, Poland says, it may be "the most
successful integration of the truths of
intersubjectivity". I expect us SEPI-ites to be at
least as much integrative as a JAPA-psychoanalyst.
- >The other favorite quote that comes to mind
that is of relevance in this
- >discussion comes from Ferenczi: "One gets
the impression that children get
- >over even severe shocks without amnesia or
neurotic consequences, if the
- >mother is at hand with understanding and
tenderness and (what is most rare)
- >with complete sincerity" (Ferenczi, 1931, p.
138).
- >To bring this to a close -- as it is time to
wake up my daughters and get the
- >day going for all three of us-- I believe
that it is in the context of
- >concepts like "spontaneity" and "sincerity"
that terms like "container" --for
- >all the clinical wisdom that they contain--
leave something to be desired.
Sincerity (or spontaneity) can be a virtue or a vice,
it depends. Compulsive sincerity (or spontaneity) is
obviously a vice. Sincerity per se has nothing to do
with being a mother, on the contrary (to me Ferenczi
is wrong in this respect). The mother is the greatest
source of (beneficent) illusion. It is not that she is
a liar. It is that her primary role is to protect her
child from whatever is intolerable to her/him,
included all truths that the other is not ready to
face. Optimal disillusionment is more a father's
(oedipal) affair. Of course both optimal illusion and
disillusionment are administered by both parents,
though the former is deemed to be more the mother's
competence, as the latter is more the father's.
Tullio.
Tue, 19 Sep 2000, Jim Lindsley
I appreciate Diana's opening up of the ways as
therapists we might be useful to our clients. I think
Weiss and the Control-Mastery people have done a nice
job of delineating the various lessons about others
and self in relation to others that clients can learn
through the experience of the therapeutic
relationship. Personally I would go beyond the
parenting role to include, though these might also be
seen as parenting functions, a whole host of other
lessons. Just off the cuff, for example, these could
include experiencing that there is another/are others:
who can understand the client's experience through
similar experience, even in some sense on a peer
basis; who can be safely disagreed with; who can be
given to; who can appreciate the client's social
presence; who models certain positive ways of
functioning; who can be simply a mere mortal; etc.
Jim.
Wed, 20 Sep 2000, Ana M. Stingel
- Hi Diana, Ciao Tulio. Just a sneak into your
exchange. Tullio wrote:
- >Sincerity per se has
nothing to do with being a mother, on the contrary
(to me Ferenczi is
- >wrong in this respect). The mother is the
greatest source of (beneficent)
- >illusion. It is not that she is a liar. It
is that her primary role is to
- >protect her child from whatever is
intolerable to her/him, included all
- >truths that the other is not ready to face.
As it reminded me of a foolish (of me) episode with
my daughter (that I think I had mentioned to you,
Diana, when you were here in Brasil), I'd like to
share it with you, wondering whether it would be a
case of compulsive sincerity(maybe that's why I'm
writing just to the two of you): She was something
between 4-6yo , and she was crying before sleep. I
went in to sooth her, and she kept on thinking about
the fact that, one day, I was going to die(it wasn't
the first time she'd mentioned her concern). How was
she going to live without me? I told her it was going
to take a loooong time, I was healthy and she would be
a grown up and prepared, that it happens to everybody
and it is a normal fact of life, nothing did the
trick. She just would not calm down. So then, out of
despair, I said:
- - Dear, I guarantee you then, as
you insist, that I will NEVER die!
- - Sure?
- - Sure, I am telling you.
She seemed pretty
happy with it and went to sleep. Just then, it downed
on me I was concerned with my lying (and my dying!),
not with what she needed then...She never returned to
the subject, ever. And I lived long enough for her to
process it (she's 13 now)! Tchau and thanks for
being and writing! Ana S.
Fri, 22 Sep 2000, Diana Fosha
Dear Ana, Tullio, all, Ana's story is a beautiful
one, and like Tullio says, "The mother is the greatest
source of (beneficent) illusion. It is not that she is
a liar. It is that her primary role is to protect her
child from whatever is intolerable to her/him,
included all truths that the other is not ready to
face." And that is when child and mother can have the
pleasure of being able to preserve illusion.
However, Ferenczi, in the passage I quoted, is
writing about what happens in the face of trauma, when
the unspeakable has happened, when more than just
illusion has been shattered, and when the mother's
failure to protect the child from the unbearable and
the intolerable is already the case. It is in the wake
of trauma (severe shock) that he writes "One gets the
impression that children get over even severe shocks
without amnesia or neurotic consequences, if the
mother is at hand with understanding and tenderness
and (what is most rare) with complete sincerity"
(Ferenczi, 1931, p. 138)." It is then that her
tenderness and her sincerity are non-discretionary and
then, sincerity has everything to do with being a
mother. Sweet dreams to Ana's daughter. Diana.
Sat, 23 Sep 2000, Tullio Carere
- On 21-09-2000, Ana M. Stingel wrote:
- >So then, out of despair, I
said:
- >- Dear, I garantee you then, as you insist,
that I will NEVER die!
- >- Sure?
- >- Sure, I am telling you.
- >She seemed pretty happy with it and went to
sleep.
Dear Ana and all, beside being beautiful, your story
may be helpful to those, like Paul and George, who
admit that the therapist does have a reparenting role
to play, but don't appreciate the containing/holding
metaphor. Once one has accepted the reparenting role,
the next step is to divide it into its maternal and
paternal sides. One simple way is to define the
maternal as holding (reassuring) and the paternal as
confronting (reality testing). However, as I see that
"holding" (or "containing") has to some an invincibly
repelling quality, the couple "holding/confronting"
may be usefully replaced by "optimal
illusion/disillusionment", which thanks to its more
ethereal quality might be more palatable and
digestible.
But your story may be precious for one more reason.
Your daughter finally succeeded in making you
understand that she did not want to let go of her
faith in immortality. The idea of immortality, if
applied to a mortal being, is obviously an illusion,
but one that a child may not be ready to give up.
Therefore you were very wise to preserve it. However,
a question remains: what happens to our need for
infinity, when it is no longer illusorily identified
with a finite thing? Is it a question that we'd better
leave to art and religion, or is there a place for it
in our discipline too? My answer is that there must
definitely be a place for it in our discipline. If the
need for infinity is superficially identified with
infantile omnipotence, one risks to throw the baby
away with the bathing water, as it is not seldom the
case in mainstream psychoanalysis.
You may remember that the debate on containing and
projective identification, which seems to be coming to
an end, started when Paul asked if anybody could
"indicate to me in a brief way what ideas of
observations of his (Bion) you think are really
valuable". I answered that I appreciated Bion's ideas
about a maternal role of the therapist, but in my
opinion his most decisive contribution was to be found
in another vertex of the therapy field, the one that
is epitomized by Bion's formula "Faith in O". This is
where the need for infinite is properly listened to.
Maybe when the containers & Projective
Identification question is definitively exhausted, a
little room in this forum will be found for the (to
me) more interesting part of Bion's work. Tullio.
Sat, 23 Sep 2000, Tullio Carere
- On 22-09-2000, Diana Fosha wrote:
- >However, Ferenczi, in the
passage I quoted, is writing about what happens in
- >the face of trauma, when the unspeakable has
happened, when more than just
- >illusion has been shattered, and when the
mother's failure to protect the
- >child from the unbearable and the
intolerable is already the case. It is in
- >the wake of trauma (severe shock) that he
writes "One gets the impression
- >that children get over even severe shocks
without amnesia or neurotic
- >consequences, if the mother is at hand with
understanding and tenderness and
- >(what is most rare) with complete sincerity"
(Ferenczi, 1931, p. 138)." It is
- >then that her tenderness and her sincerity
are non-discretionary and then,
- >sincerity has everything to do with being a
mother.
Dear Diana, Ana, all, for the sake of clarity we'd
better distinguish the mother as a person from the
mother as a role. The role is what is more
characteristic, typical or proper of a given function.
From the person we expect that she be up to her role,
but we also hope that she will be able to go beyond
it, when necessary (for instance, we hope that the
mother will be a "good enough father", when the father
is weak or absent).
The case of "severe shocks without amnesia" seems to
me precisely one of those in which the mother may be
required to do something that is beyond her ordinary
competence. Not necessarily, though. Ana's daughter
seemed to be in a condition of shock, yet she was
cured precisely by her mother's capacity for
reinstalling illusion.
Besides, I wouldn't say that the alternative to
preserving or reinstalling illusion is always
sincerity. As Francine Shapiro (I will never thank you
enough, Diana, for inviting her to the Washington
Conference) has extensively shown, the common practice
of confronting a traumatized person with the "truth"
of his/her trauma (whether this is done by a mother or
by a therapist) can easily result in a re-traumatizing
experience. Sincerity can help, as it can also
encumber reprocessing of a traumatic experience. I
would say that [1] reprocessing is not always the
first choice (reinstalling illusion may be
preferable), and [2] if reprocessing is the choice,
"sincerity" is not always the best way (Rapid Eyes
Movements--the way of dreams--may be better).
>sweet dreams to Ana's daughter. Diana
Yes, dreams are great healers, sometimes the greatest
Tullio.
Sat, 23 Sep 2000, Diana Fosha
Tullio, Ana, all, how does one preserve faith in the
infinite and the illusion of immortality in the face
of the all-shattering shock of trauma? Diana.
Sat, 23 Sep 2000, Diana Fosha
Tullio (just saw your reply, after dashing off my
previous e-mail), Re: your:
"if reprocessing is the choice, "sincerity" is not
always the best way (Rapid Eyes Movements--the way
of dreams--may be better)."
a) let's not be overly concrete about "sincerity"
b) to my mind, EMDR, like all experiential
treatments, is the way of "truth," meaning the way of
emotional truth, and it is there that maybe dreams and
reality (IN THE SENSE, AND ONLY IN THE SENSE, OF
EMOTIONAL REALITY) ARE NO LONGER SUCH DIVERGENT
EXPERIENCES. Diana.
Sat, 23 Sep 2000, Diana Fosha
P.S.: In my mind, the opposite of sincerity is
neutrality, not illusion Diana.
Sun, 24 Sep 2000, Elizabeth Moraes
Diana, I understand "preserve faith in the infinite
and the illusion of immortality in face of trauma" as
a metaphor to one's capacity to maintain the zest for
life while living in the everyday traumatic reality.
In this sense closeness, intimacy, sharing and the
support of others are the vital elements that feed the
soul and preserve the faith. Best regards. Elizabeth
Moraes.
Sun, 24 Sep 2000, Hilde Rapp
Dear all, Winnicott
insists that, when working and hate and other forms of
extreme negative transference phenomena- usually at
least in part sequelae of earlier trauma- the
therapist's greatest chance of being useful to the
client lies in his ability to survive: That could be read as a
good therapist NEVER DIES. In this sense, your story
Anna, and your comments, Diana and Tullio, link some
of the work of the maternal to some of the work of a
good therapist.
Regarding the bigger picture: Survivors of the
holocaust and victims of torture insist that it is a
duty to defy 'evil' by surviving and even more, to
make new life and to celebrate life so that the forces
of darkness do not win out (Many female survivors
yearned to make babies...).
I think we are here concerned with the triumph of the
'spirit' over adversity. Even as the body is broken,
and our physical mortality is incontrovertible, and
even if there is no belief in an afterlife in the
sense of some continuity of individual experience
after death as a 'soul' with an identity, there is,
for most of us that something that Bion calls 'O'.
If nothing else, 'O'
relates to our sense of being connected into a larger
order of holons, which in itself confers upon us our
sense of shared humanity, of being of the same kind,
belonging to the same species ( from speculum:
mirror), being a holon in an unfolding order of
creation or evolution, an enfolding and unfolding
order which ist best thought of as infinite - at least
in its potential... Just a glimpse of the manifold... Tullio -
over to you! Hilde.
Wed, 27 Sep 2000, Tullio Carere
Hilde, I wouldn't call Bion's philosophy humanistic.
I would rather call it uebermenschlich, that
is pre-human and over-human. "O" is the noumenon
of all phenomena, or the infinite out of which all
finite things come to an ephemeral existence. One need
not read Bion if one does not like him, but all finite
beings had better come to terms with the infinite that
grounds and surrounds them on all sides.
Schleiermacher said that the feeling and intuition of
infinite is what religion is all about. With "Faith in
O", Bion forced a religious wedge into psychoanalysis
(what Meltzer and the other Kleinians did not forgive
him). Either he was wrong (because we feel pretty well
at home in our finite selves and worlds, having
recovered from the infantile illness of infinite), or
he was right (because we still don't feel at home in
our finite selves and worlds, and only find peace and
joy when we succeed in reconnecting to our infinite
ground).
To put it into clinical terms, most or all of our
patients suffer from wishes that will never be
fulfilled by any finite object. In the course of the
treatment they will have to learn to fight their way
to whatever they can reach, to give up what they
cannot reach, and to tell the difference between the
two. For reasonable that this program may sound, it
rests on the implicit assumption that I will renounce
my unrealistic pretences, once I see that they are
unrealistic. This realization is indeed necessary, yet
not sufficient. For a true resolution to take place,
one more condition is required. Nobody will really let
go of his/her endless quest for love, peace, and
power, however wrongly directed, until s/he learns how
to draw upon an endless source of these goods--until
s/he learns F in O, in Bion's terms. Tullio.
Sun, 15 Oct 2000, Marvin Goldfried
Paul, as a behavior therapist with a very
long-standing interest in learning from colleagues of
other orientations, I must confess to having had
difficulty with the recent exchanges in question. I
simply didn't understand what was being said. Perhaps
I should have made a comment on this earlier. Instead,
I used my delete.
The issue of jargon has always been a problem, and I
suspect it served to exclude some others from these
exchanges as well. If there is a true interest in
having someone from another orientation listen in and
dialogue, then the exchanges would have to be in a
common language--ordinary English. This is not always
easy to carry off, especially since many of us are
often not even aware that we're using our theory-based
jargon. Those people who have written articles for IN
SESSION--which has a no-jargon policy--know how
difficult this can be. Marv.
Wed, 18 Oct 2000, Tullio Carere
Marvin, I remember that when I mailed my first
message to this list, a couple of years ago, you were
the first to greet me back channel. There was between
us a consonance on the basis of the common factors
approach, which we share. Then I remember your
workshop in Miami, last year, with its leitmotiv:
Corrective emotional experience is the most effective
factor in therapy (you compared it to the wheelbarrow,
which nobody pays attention to because everybody looks
at what it carries). Of course a corrective experience
is needed when the original experience was somehow
defective--therefore it seems justified to say that
most or all corrective experience is a form of
reparenting.
The functions of one
of the parents, the mother, have been extensively
studied, among others, by three authors: Winnicott,
Bowlby, and Bion. Bion, in particular, compared the
maternal function to a container for whatever the baby
is not yet ready to hold in his/her mind. As clients
not seldom seem incapable to tolerate some frustrating
experiences, which they deny or act out or act in, the
therapist is obviously to hold what the client cannot
yet hold. This holding or containing function can take
the form of different behaviors (from a bodily holding
to an interpretive holding), none of which can be
tracked down in the original, Freudian psychoanalysis.
Therefore all
deliberate behavior on the part of the therapist,
aimed to produce a corrective experience, is shunned
in mainstream psychoanalysis.
I understand the eschewing of any maternal/holding
behavior by a psychoanalyst trained in the ego
psychology tradition (it seems to me that most
American psychoanalysts are trained in that
tradition), but it is more difficult to me to
understand what is wrong in a discussion on this theme
for a behavior therapist interested as you are in the
therapist's wheelbarrow (a container, by the way).
Besides, I am not aware of what sort of English I am
using. I thought I was writing in the only English I
know, that is poor English. Please enlighten me.
Tullio.
Tue, 17 Oct 2000, Diana P. Wais
Dear Tullio, as one of Marvin's students, I have been
exposed to his teachings, however, not (yet) to
Bion's. I am thus a little bit confused about how this
beautiful metaphor of "containing for the patient what
his / her mind cannot yet hold" translates into
specific actions or cognitions or emotions on the part
of the therapist or the client that will affect the
therapy process? And if it does affect the therapy in
what way and through what mechanisms? How can I use
"containment" to better assess or produce change in my
client?
I do not think that there is anything wrong with your
English, you do indeed express yourself very
eloquently. I think it has more to do with some people
(like myself) who are less trained in psychoanalytic
ways of communicating in metaphorical terms having a
hard time translating this into concrete and specific
terms. Is this possible? Diana Wais.
Wed, 18 Oct 2000, Hilde Rapp
Dear Diana, Marvin, Tullio, George, Diana, Ana, and
everyone who has particularly energetically fuelled
this debate
<<<
>>> marks headlines. Thank you Diana and
Marv!
<<<Redescribing
concepts in terms of client and therapist
behaviours>>>. Perhaps one possible
reframe would be to think of 'containment' as the
therapist's generic response to dealing with the
client's barriers and defenses to knowing about
himself, and hence his resistance to treatment.
The first step might be to identify specifically what
kind of blocking, barrier, defense, resistance,
avoidance, maladaptive behavior, unfinished business-
however different orientations describe this well
known clinical phenomenon-is giving rise to a
therapeutic impasse.
The next step might be for the therapist to define
their core preferred repertoire of ways of working
therapeutically with this difficult experience.
<<<Look for descriptions in the
JPI!>>>. Many past journal have explicitly or
implicitly made this the focus of debate. The whole
point of psychotherapy integration is to look for
common themes on the one hand, and for ways of
expanding one's repertoire on the other- see Stan
Messer's forthcoming issue of the SEPI Journal
on 'assimilative integration'.
<<<Some examples of translating terms:
'containment' (noun versus verbs) 'tolerating
being frustrated through being asked for help, and
pushed away at the same time'>>>. In
psychoanalytic terms, some of these ways in which the
client does not let the therapist work with the
material which is perhaps pivotal in 'effecting a
cure', 'working productively in partnership' etc...,
whatever description people give to the therapeutic
block, may require, what Bion, Tullio and I mean by
what we sometimes choose to call 'containment': i.e.,
in psychoanalytic terms, 'containment' is tolerating
the frustration of being stuck, fended off and yet
implored to respond with urgency to the client's need
at the same time.
In integrative terms, it is the capacity to tolerate
ambivalence and uncertainty ('negative capability' as
the poet Keats called it, and as it has since entered
the therapeutic literature... including a paper by
SEPI-ite Carlos Mirapeix).
This negative capability allows the therapist to
develop an acceptance of the client's inner conflict,
and at the same time allows him/her the strength to
'hold' the client and to 'help him/her to 'contain'
his or her 'psychic pain' which arises from the
simultaneous wish to act 'out' impulsively ( cognitive
behaviorists certain know this one), or to 'run away'
and avoid the situation altogether ( cognitive
behaviorists know about this one too).
<<< defining your core repertoire of
therapeutic interventions>>>. Whatever you
then do as therapist to prevent the client from either
acting impulsively ( and probably aggressively), or
from maladaptively avoiding challenge and change, is
what analysts mean by 'holding' and containment'.
This includes whatever you do that allows you to
continue to work patiently with the client on reducing
his or her fear to move forward despite their anxiety,
and their fear to try a new behavior. ( you probably
have a change phobic person on your hands, probably
with an underlying depression, and probably with some
form of personality disorder).
'Containment' is a therapist factor - it is the
therapist's capability to tolerate frustration and
pain in order to help and support a client.
<<< Defining the main ways in which the
client makes emotional demands on you and how the
client blocks your interventions from reaching
them>>>. Whatever it is the client does which
challenges the therapist to offer 'containment' as a
therapeutic intervention, is a client factor.
If therapist and client can find a middle path they
can together formulate the 'problem', and by
definition, every problem has a solution, otherwise it
is not a problem, but a headache... Therapy converts
headaches into problems, and anxiety and terror into
ordinary fear of something to which an adaptive
response is possible.
<<< Matching type of core client need to
types of therapeutic styles>>>. There are
vastly different styles of therapist- responding: For
example- and these are gross caricatures - apologies
to Leigh, Allen and Prof. Davanloo (who of course are
much more complex and sophisticated as real people).
Leigh MCullough tends to go the 'maternal' path and
offers some 'holding and containment'- where as Prof.
Davanloo goes the 'paternal way' and challenges the
patient very assertively to dare to face the truth and
to try out a new behavior with him. Allen Kalpin has
found a middle path.
<<< Therapist and client response style
match>>>. I suspect that there is good deal
of client response style and therapist response style
matching going on here.
Clients who might get seriously damaged by working
with Davanloo may thrive with Leigh or Allen, and
clients who may not move forward with Leigh may
eventually respond dramatically with
Davanloo>>>Research please!
<<< Focus on challenge versus focus
on support>>. Cognitive-Behavior therapists tend
on the whole to work slightly more with challenge and
slightly less with support then analysts, but of
course there is a wide spectrum within both
traditions.
So it may be that a
discourse that focuses on the intricacies of how to
use 56 varieties of support in order to prepare a
client for challenge, is of marginal interest to
therapists, who see the relationship as sufficient
support to develop 56 varieties of challenge! Ah, but
to be bilingual and to know when and whom to challenge
and when and whom to support!!! Perhaps this way of
reframing the debate makes it more inclusive and
accessible? Cordially, Hilde
Wed, 18 Oct 2000, Marvin Goldfried
Tullio, I
have no problem with your English. Like Diana (no
surprise, I "brainwashed her!"), the difficulty I have
is with the theoretical jargon. I fully agree that one
aspect of therapy, regardless of whether a therapy
approach acknowledges it or not, is to provide
reparenting. What I still don't fully understand.
however, it what is meant by being a "container." I
have all sorts of associations to this metaphor
(ranging from providing personal support to a place
where toxic wastes are stored), and therefore need to
have it specified/operationalized more clearly. What
thoughts, actions, feelings and intentions should I
have when I serve as a container for a patient?
Marvin.
Wed, 18 Oct 2000, Allen Kalpin
- Hilde, you
really know how to draw lurkers out of lairs.
Here are some of
that statements you make about containment:
- 'tolerating
being frustrated through being asked for help, and
pushed away at the same time
- [resistance]...may require, what Bion, Tullio
and I mean by what we sometimes choose to call
'containment':
- 'containment' is tolerating the frustration of
being stuck, fended off and yet implored to
respond with urgency to the client's need at the
same time.
- Whatever you then do as therapist to prevent the
client from either acting impulsively ( and
probably aggressively), or from maladaptively
avoiding challenge and change, is what analysts
mean by 'holding' and containment'.
- 'Containment' is a therapist factor - it is the
therapist's capability to tolerate frustration and
pain in order to help and support a client.
It seems to me that you are describing a combination
of:
1. The activity of keeping your cool or staying
centred when when the client pushes your buttons. In
CBT terms this might be phrased as not being
controlled by your own maladaptive schemas that might
get activated by the patient.
2. The activity of being a good coach -- setting
limits, pushing for better effort, etc., that the
patient is not doing adequately for herself.
These are essential therapist common factors. But how
does the word "containment" describe them? To me
"containment" implies either:
(a) the therapist "receiving and holding" something
that comes from the client that the client cannot yet
hold; This of course, ties in with the previous
discussion of projection, that gave birth to the
discussion of containment.
or (b) the therapist "containing herself," meaning
controlling one's reactions.
If one important component of containment refers to
the allowal of the client to "project" his feelings
onto the therapist, then we will have to return to
that discussion and operationalize that phenomenon
using common language . Allen.
Thu, 19 Oct 2000, Bob Sollod
I have had a hard
time containing m y s e l f while reading all the
posts on being a therapeutic "container". I can hardly
contain m y s e l f regarding the postings on
"container". Best wishes, Bob Sollod.
Thu, 19 Oct 2000, Tullio Carere
Marvin, I am happy to know that you and Diana W. have
no problem with my English. I probably have one (with
my English), because in my poor English the words
holding and containing were precisely meant as a way
of avoiding theoretical jargon. In fact in my Merriam
Webster Collegiate Dictionary I find: To contain
(transitive verb): to keep within limits, as restrain,
control--(intransitive verb): to restrain oneself. The
therapist's operations that Bion (and Hilde, and I)
indicate with these words correspond exactly to what
these words mean in ordinary English:
"Whatever you then do as therapist to prevent the
client from either acting impulsively ( and probably
aggressively), or from maladaptively avoiding
challenge and change, is what analysts mean by
'holding' and containment'." (Hilde)
When the client literally *cannot* contain
him/herself (i.e., acts impulsively or maladaptively
avoids challenge), the therapist must be able to
contain what the client cannot. This may mean bodily
holding (to hug a person who is desperate like a baby:
Ferenczi), or speaking in a soft and soothing way, or
just keeping calm and cool in the face of rage or
provocation, or giving tentative words (reverie or
interpretive holding, a verbal container) to emotions
to which the client does not yet know how to give a
proper verbal form.
In the cognitive science they often translate "to
contain" with "to keep in one's working memory". I
personally feel perfectly at ease with "working
memory", but I still prefer holding and containing,
precisely because (to me) this is ordinary English,
while working memory is theoretical jargon. Tullio.
Thu, 19 Oct 2000, Allen Kalpin
The act of making a
couple of replies to the list about the containment
issue has stimulated me to think about it more
carefully.
"Containment" and "container" are metaphors. Metaphors
have advantages and disadvantages. Some advantages of
the use of a metaphor are that one easily remembered
image can bring to mind a huge amount of "data." It
can "contain" thoughts, images, beliefs, emotions,
motivation, etc. It is a very efficient carrier of
large amounts of "information." On the other hand, the
problem is that this information in not precisely
defined, and is difficult to operationalize. Diana
asked,
"I am thus a little bit confused about how this
beautiful metaphor of "containing for the patient
what his / her mind cannot yet hold" translates into
specific actions or cognitions or emotions on the
part of the therapist or the client that will affect
the therapy process? And if it does affect the
therapy in what way and through what mechanisms? How
can I use "containment" to better assess or produce
change in my client?"
It seems to me that in the efforts that Hilde and
Tullio have made so far to address this that there is
something that gets lost in the translation; that the
whole is greater than the sum of the parts. I appears
to me (but they are the ones who could best address
this) that when they think in terms of containment
during a psychotherapy session that it is associated
with a mind-set that is helpful to them and to their
work, that is beyond the descriptions of activities of
limit setting, etc. The cognitive-behavioral side of
me wants to impatiently say, "Why use the term,
"containment? Why not just talk about limit setting,
encouraging change, keeping oneself centred, etc.?"
But, on the other hand there must be reasons why they
find meaning and importance in this broad metaphor.
So, this is a bigger issue than just the discussion
of what containment means. If there are going to be
successful discussions between, for example, people of
psychoanalytic and cognitive-behavioral orientations,
then a way must be found to bridge this gap -- the gap
between the power and usefulness of metaphorical and
symbolic language and concepts, and the precision of
scientific language. Allen.
Fri, 20 Oct 2000, Paul Wachtel
Allen, Marv, Diana, Tullio, Hilde, and others, now
we're speaking SEPI, the language that cuts across the
divides. True, we're still only speaking SEPI as well
as I speak Spanish, which, as my friends in Spain and
Latin America know, is very rudimentary. But, as with
my espanol rompido, at least it's a start. What I'm
referring to is the turn in our dialogue about
containment and containers from an "internal"
conversation within psychoanalytically oriented
members to a discussion BETWEEN people of different
orientations.
I've found Allen's comments especially helpful, but
do want to interject one small difference. I don't see
"container" as a term that, in one to one fashion,
psychoanalysts are comfortable with and behavior
therapists are not. I, for example, am still rooted
primarily in the psychoanalytic viewpoint, and I
still, after all our exchanges, find the term
problematic. Here's why:
Tullio: I have little objection to the way you
described it, but (a) as you yourself note if I recall
correctly (the "back" button on my internet explorer
isn't working properly at the moment so I can't go
back and check without losing this in the middle), you
are using the term container for a set of actions and
attitudes that could be described or labeled with a
quite different term. So why use "container"? I think,
if you and others who use the term look closely, the
preference for THAT term to describe certain phenomena
-- say, restraint on the therapist's part instead of
acting out or helping THE PATIENT restrain himself (a
different matter, as I'll mention below) -- is because
of the link between the term containment and something
quite other entirely, something that is NOT so easily
and comfortably agreed with by therapists of other
persuasions, just using a different word. That
something other is (here we go again) the idea of
projective identification.
"Container" is the preferred word for certain
analysts because they are also (consciously or
unconsciously?) signaling that this all has to do with
the patient trying to put his feelings into another
person. The therapist then has to not just "contain
himself" in the ordinary English sense but contain the
"stuff" that the patient has "put into him." That is
why all the jokes about recycling, tin cans, plastic
bags, etc. are really not so far off after all.
So, one reason I don't like "container" -- EVEN
THOUGH I do think we sometimes need to "contain
ourselves" instead of screaming back at the patient,
getting depressed because the patient describes a
situation in such hopeless ways, etc.; and EVEN THOUGH
I also think that we sometimes have to help the
patient CONTAIN HIMSELF, helping him restructure his
thoughts, encouraging delay, etc.; and EVEN THOUGH we
even sometimes may have to do so via touch and holding
and, so to speak, "containing," I nonetheless do not
think it is useful to describe those activities in
ways that surreptitiously (or intentionally for that
matter) link them to what I think is a way of thinking
about people (they "put their feelings into you") that
is often accusatory and demeaning, and that is also
too vague and inaccurate (because it seems to have
finished wiht the matter when it should be just
beginning -- asking HOW the patient stirs certain
feelings in the therapist or in other people more
generally. The patient doesn't "put them in," he
EVOKES them, and often, indeed, he does so ironically
and inadvertently, stirring feelings he DOES NOT wish
to stir. "Projection" and its cousin "projective
identification" by their very nature imply INTENTION
(albeit often unconscious). I do in fact think that
something like projection sometimes does occur, but
the language we are using in this realm is
extraordinarily vague and misleading, and separating
out what is what is hampered by a one-size-fits-all
conceptualization that is all contained (sorry!) in
one word.
One final related point, alluded to in several places
above -- we add still further confusion when we use
the same term to describe THE THERAPIST's "containing
himself" and the therapist helping THE PATIENT to
"contain himself." A careful analysis reveals these
are not the same thing at all. And whatever kind of
containing is involved in putting one's arms around
someone comfortingly is still something else. Without
a differentiated vocabulary we are bound to have
theoretical hash. (And if, on top of that, we accuse
the patient of slinging the hash onto us, that makes
it still worse).
So....my main point is that just like you don't have
to be Jewish to love Levy's rye bread (for those of
you outside the US, that was a popular advertising
slogan for that brand of bread a few years ago), you
also don't have to be outside the psychoanalytic
community to hate "container" as a theoretical
concept. So, one more triumph for SEPI. I may not be
correct in all that I have just said, but at least I
have shown, a la SEPI, that dividing therapists along
rigid theoretical lines doesn't work. Our insights or
our errors cross the barricades all the time. Ciao to
all, Paul.
Tue, 24 Oct 2000, Tullio Carere
- On 20-10-2000, Paul Wachtel wrote:
- > ...the language we are using
in this realm is extraordinarily
- >vague and misleading, and separating out
what is what is hampered by a
- >one-size-fits-all conceptualization that is
all contained (sorry!) in one word.
Paul and all, it sounds like we have made the
container a container for all sorts of vague and
disparate things. Let me try to clarify a few things.
1. I am writing this mail on a monitor capable of
producing images in millions of colors using only
three primary colors (RGB, red/green/blue). I can then
print such images with an ink-jet machine that prints
virtually all colors using again only three primary
colors (CMY, cyan/magenta/yellow), that are
complementary to the other three.
2. We see everyday patients who bring to the therapy
relationship millions of expectations, which most
likely are combinations of a very small number of
basic psychological/spiritual needs. We then give
millions of responses, which most likely are
combinations of a very small number of basic
therapeutic factors, complementary to the needs to
which they respond.
3. It is obvious that if we can detect (devise or
discover) something like an RGB/CMY system for
psychotherapy, we could avail of a universal code for
describing virtually all that transpires in any
therapy interaction. I know that some dislike very
much this idea, because to them psychotherapy is and
must remain an ineffable thing. But in my opinion the
search for this universal code is what SEPI is all or
most about.
4. Twenty years ago Marvin wrote a paper I like very
much, where he suggested that "the possibility of
finding meaningful consensus exists at a level of
abstraction somewhere between theory and technique
which, for want of a better term, we might call
clinical strategies". He went on offering "as examples
two such strategies that may very well be common to
all theoretical orientations: (a) providing the
patient/client with new, corrective experience, and
(b) offering the client direct feedback."
5. Marvin is a behavior therapist, but many analysts
say something very similar. They say that there are
two basic levels in all or most therapies, which they
call pre-oedipal and oedipal, where respectively
defective and conflictual issues predominate. The
analyst responds to defect-driven and conflict-driven
problems respectively with remaking (reparenting) and
uncovering attitudes.
6. I have observed that both these levels can be
represented as axes uniting two poles. For the
reparenting (horizontal) axis these two poles are
obvious: they are the maternal and the paternal poles
or vertices of the field. As everybody on this forum
(container-haters included) accepts that the therapist
has to take on some reparenting functions, the next
step is to "operationalize" these functions in a
trans-theoretical language.
7. If we can succeed in operationalizing at least one
of these functions, the rest of the work would surely
follow more smoothly. But the first step is not easy.
I understand that I have to drop the hope that the
idea of holding/containing could be the equivalent of
a basic color. But I don't drop the hope of finding
anyway one for the maternal vertex, to begin with.
8. I withdraw then the unfortunate container, and try
with the next offer.
Please consider this definition: The therapist takes
a maternal vertex attitude in response to the
(biologically coded) need for secure attachment, which
is signaled by disorders of the basic trust. She does
so in the first place by disconfirming the patient's
expectation for her to be an unreliable (unresponsive,
unempathic, etc) mother, which maintains the insecure
or disorganized attachment patterns. Besides
disconfirming the unhealthy expectation, she in the
second place confirms the healthy one, which the first
step reactivates. How does she do that? I hope you
will allow me to copy here the list of my last message
(maybe if it is no longer a container, but a way to
offer secure attachment, I will pass the test): "This
may mean to hug a person who is desperate like a baby,
or to speak in a soft and soothing way, or to keep
calm and cool in the face of rage or provocation, or
to give tentative words to emotions to which the
patient does not yet know how to give a proper verbal
form." Tullio.
Thu, 26 Oct 2000, Luca Panseri
Dear Paul and
colleagues, I would like to share with you my
experience after taking part in the EMDR level I°
training in Milan (Italy) three days ago. It was a
very interesting and useful course. The trainer, Dr.
Roger Solomon, was very clever and communicative. He
was nicely ironic about some Italian habits but he
actually appreciated the wish of learning of all the
participants. Moreover he seemed to me a real integrative
therapist.
During the training I was very impressed by Dr
Solomon's frequent use of the words CONTAINMENT,
CONTAINING, TO CONTAIN in Hilde and Tullio's meaning .
Indeed EMDR is a very containing approach too.
I couldn't help thinking about the ongoing
debate in our SEPI list. So I made a little
investigation among the people attending the course
asking if they could easily understand the meaning of
the above words. I was always given the same answer : "Yes, of
course".
In my experience most therapists consider the
containing function as fundamental in the
psychotherapeutic process.
For this very reason Paul, I can't understand your
rejection and "hate" for containment as a word and a
theoretical concept. Doing so, in my opinion, you do
not seem to consider that both the word and the
concept have received wide acceptance and have entered
into the common trans-theoretical therapeutic
language. Shouldn't we as SEPI-ites be highly
appreciative of such spontaneous integrative
phenomena?". Thank you for your attention. Luca
Panseri.
Fri, 27 Oct 2000, Hilde Rapp
Dear Paul and
everyone else participating in this multilogue: Sorry
this post is a bit long: it addresses several of
the previous posts and dialogues which waxed and waned
around 'containment', 'translation', 'identification',
'projective identification', inclusiveness,
exclusiveness, and more or less passionate
personal/professional debates between several
individuals.
Tullio, you suggested that all these contributions
were somehow taking place in 'one container'- so this
contribution is in one piece instead of being in
several pieces. (Integration of some sort, perhaps?
Or, Paul, is it yet more theoretical hash?
Paul, I have an idea why you say: "Without a
differentiated vocabulary we are bound to have
theoretical hash." Apart from your own answer: ('And
if, on top of that, we accuse the patient of slinging
the hash onto us, that makes it still worse'). do you
think that the way Allen Kalpin, Tullio, yourself,
Marv, and I have sort of started on a back translation
might be one way of avoiding more 'theoretical hash':
Should we ask each other something like:
- #do you mean by concept x what A means by y, D
means by z...?
- #how do you use this concept to inform your
clinical decisions- 'discuss'?
- #Do you actually use any compatible interventions
anyway
- # how is x different from y or z?#if not why
introduce a new term which seems to be redundant and
duplicates a perfectly good one?
- #if it does add something new, what's your
evidence base that concept x adds anything useful?
- #etc. (I think that Stan's forthcoming volume on
assimilative integration takes us in this direction
too)
- To me this is what SEPI is all about:
- # honest, warm, open, collegial debates (style)
- # in which we fiercely, passionately defend our
most dearly held values) (Commitment)
- # where we argue with intellectual precision,
vigour and frankness about the meaning of those
words which express most accurately what in our view
most truly represents both the art and science of
what it is we do that we believe is healing.
Ana and Ava, I agree with you and everyone who feels
that it would be more fruitful to stick with the best
of SEPI tradition, which mainly consists in
illustrating how it may help a therapist to move on in
a therapy by discovering how a colleague from a
different orientation works with a similar 'case'.
This can lead to adjustments to one's own particular
way of thinking or doing things, and result in
responding differently to both one's own feelings and
to those of one's client.
I would however incline to Stan Messer's caveat
(see his forthcoming issue) that it is probably quite
important to think through how any such new element
might be integrated coherently into one's own
theoretical and practical framework (see also below).
Tullio, at the same time I do set store by
discussions which help us to analyze, to take apart,
and to pare away unnecessary ambiguity in the way we
choose words to put boundaries around fields of
meaning.
Paul, your example of feeling either irritated (
hate) or sort of amused by laugh at) words such as
'projection', 'projective identification' and
'container', and 'containment' seem to me to
illustrate very clearly how words are not only linked
to a particular tradition in psychoanalysis, but they
are also strongly indicative of the underlying theory
of person, personality, child and adult development
and indeed of what brings about change.
Hermeneuticists might go as far as saying that seem to
betray a certain IDEOLOGY, GROUNDED IN CERTAIN VALUE
SYSTEMS. I think our passion comes from our VALUES,
not our theories ( see Alvin Mahrer on this too).
I hope you don't
think that what follows is self indulgent self
exposure! It's
meant to be a 'theoretically' (rather than clinically
)'indicated' mini case history of how a therapists
gets to assimilate certain ideas, and rejects certain
others:
If I may, I will
use my own 'relationship' to these words, the
concepts, the ideology and their eventual usefulness
as an example: For years I was utterly 'allergic' to the work
of Klein and her followers. I believed, also, in view
of the name of her approach 'OBJECT relations theory',
that her own personality, her tragic personal history,
and the fact that she was a woman, and, furthermore,
engaged in bitter disputes with Freud's daughter Anna,
infused all her clinical writing with a particular
worldview:
I saw this as akin
to the 'tragic vision' (I hope I don't misuse this
word too badly in Jerry's and Stan's eyes): human
beings are the play things of powerful forces working
deeply in our unconscious, pulling us into
entanglements with profoundly sadistic or masochistic
impulses, murderous fantasies, desperately seeking for
some point of attachment, safety and reparation.( In
analogy to ancient fatalistic word views of the Greeks
and many other cultures of 2000 years ago). Although heavily
influenced by, and temperamentally inclined towards
psychoanalysis, Klein's work in those days was not for
me.
My values and my worldview had , among other things,
been shaped by humanistic and existential influences:
politically, intellectually, philosophically, and
therapeutically. Much of my philosophical 'upbringing'
was in a post Hegelian, post Marxist hermeneutic
tradition, deeply suffused with a commitment to
emancipation and clear understandable communication.
Mystifying arcane jargon, used in public, was usually
critiqued as the hallmark of exclusiveness and the
veiling of truth in order to exert power over others
without proper authority. (when arcane language was
used in previous centuries by 'emancipators' it was
veiled in order to protect authors from persecution.)
I firmly held the belief that human beings are
responsible for what they do. Emancipation meant that
we are to be 'SUBJECTS' in the sense being 'persons'
with a sense of identity and concern for others ,
capable of moral action. We are not to remain passive
'OBJECTS', ( or 'subjects', in the sense of being
subjected to the political will of others, forced to
be bystanders in relation to our own destiny. However
we are vulnerable to social trends and to persuasion.
Both involve treating people as if they were OBJECTS
in some invidious power game. I was grateful that
observation, deep social, economic and political
analysis, together with cultural and philosophical
interpretation, helped us to devise more and more
approaches to understanding how such forces work on
us.
I believed that
psychoanalysis and psychotherapy are ways of learning
to embrace, accept and work on our humanness - to work
on our capacity to create and overcome like Mandela,
and on our capacity to dominate, torture, and murder,
like Hitler. (I still hold most of these view now.).
Melanie Klein was a 'victim' and 'survivor' of the
holocaust - I grew up in its aftermath, surrounded by
both 'perpetrators' and 'survivors'. I was strive to
find a way to 'live' a full life. I could not afford
to adopt the 'tragic vision'. In those days, words like
'projective identification' sounded like the
'projectile vomiting when exposed to indigestible and
unpalatable input- be this food in the casa of
babies') or truth ( in the case of certain adults): A
physical reflex action, not a thought through human
response...
(Indeed, the origin of Klein's work was with babies
and young children, many of whom were orphaned
survivors of the holocaust, others were traumatized by
their parents inability to 'digest' their own
experiences- of having lived through the holocaust.
Many, children and adults, first survivors of the
holocaust, later survivors of abuse and neglect often
can't put into words what frightens them 'out of their
wits' so they would have to get it out of the system
some other way- it s really a cry for help- or,
usually, worse, a cry of pain- beyond hope of help).
Inevitably, sooner than I thought, I found myself
working with clients whose evident despair and equally
deeply unpleasant way of communicating their pain,
threw me into deep turmoil. I felt they had some how
been brainwashed to view themselves as hapless
powerless objects. I was still concerned that, what I
then believed to be the Kleinian approach, would
actually collude with this subjective sense such
clients had of who they are.
However, desperate to find a way to help, I re-read
Klein, Bion, Kernberg, and as much of of the work of
authors within this genre, as I could manage ( they
would make a VERY long list!) And now and then I found
clinical descriptions in which I recognized my own
struggle. So, was they way 'in', to tolerate this
ghastly lack of self esteem, this Sisyphus like
seemingly certain knowledge that the task was
hopeless. To for an hour ant at time- and sometimes
for weeks at a time- to sit with these clients in
their darkness, felling and believing what they did
WITH THEM- and sometimes , as if FOR them. Dante
called this 'purgatory'- living death.
I searched eagerly
for more descriptions. Slowly some of the surrounding
Kleinian theory also made a particular kind of sense.
It somehow helped me to tolerate the pain. I still miss the total
lack of any recourse to social, political, economic
every day reality. To work purely on the distorted
inner reality of a person who is so entirely cut off
from normal human feeling and interaction still seemed
extraordinarily like collusion with - if they exist -
early maternal preoccupation - felt like a sort of folie
a deux.
Also most of my clients had just enough social
functioning not to have social work support unlike
many of Melanie Klein's 'patients'.(When working with
ADULT patients, Masud Khan's practice nurse would
organize a taxi to collect a patient to come to the
consulting rooms, take care of the patient, getting
her to rest after the session, and then put her in a
taxi, from which her housekeeper collected her- of
course he could focus entirely on transference work,
re- presenting inner experience... except- but this
would be telling tales...)
Slowly I made SOME of the Kleinian ideas and ways of
working my own. Once I realized that my being
connected with the every day world in a very ordinary
way as a person, made it both possible and safe to
allow some of the processes involved in reparenting
someone whose 'developmental defects' occur so early,
and are reinforced by maladaptive behavior on the
mother's side for so long. I do not now work with
children ( usually)
Kleinan theory in itself does not help me to know
whether I am fiddling while Rome burns!-it is not
designed to do so, and I don't rely on it to do so.
Unlike early Kleinians, whose clients usually had
social work support, I must be aware of how much or
how little practical support a client has, to make
therapy a safe undertaking.
I most certainly need to frame many sessions where I
work with 'unconscious feelings' ( this needs
unpacking) with a transition phase, both before and
after the session in which matters of safety could be
discussed and appropriate steps taken- including
hospitalization or similar).
I only need Kleinian theoretical concepts to help me
decide whether
- 1. the client is heading for psychosis now
- 2. whether he is reproducing early learnt
behaviors with me.In this case I must 'pass the
test' ( Weiss and Sampson- see previous debates) and
be as sane as possible.
- 3. whether one or other of his parents/relatives
may have been very disturbed, possibly psychotic.
These are three very different possibilities, and
they would impact very differently on what it is
safe to do in therapy.
I also work outside
the transference and I therefore ask pertinent
questions. I surmise that some, or maybe even most,
Kleinians do so also. Some clients will have a psychiatrist who
monitors all the 'outer world' safety issues, in which
case there is probably a social worker uninvolved as
well- and both these fellow professionals provide
"containment" so that I can focus more on 'inner
experience'. I THINK THESE CONTEXT FACTORS ARE CRUCIAL
TO WHAT WE CAN AND CAN NOT OFFER SAFELY.
Above all, increasingly, as therapy progresses, and
the 'patient' can tolerate more pain, because they say
they feel I have given them a small opportunity to
recover a little, by carrying some of their pain with
them (helping them 'contain it'), I will teach them
how to protest- to want to become emancipated.
I suspect the pure Kleinian way work very well for
some people- who get to the desire for being a SUBJECT
by themselves. But it is very expensive in time and
money - and I am willing to see whether to integrate
humanistic and other elements in this work does reduce
the enormous cost - both in time and money. Tony Ryle
who has borrowed a lot from this corpus, and with , I
think, quite similar reservations ( see review of his
book on working with Borderlines in the latest JPI)
is actually doing some research into this right now.
He has also gone a long way towards operationalizing
and proceduralizing what can be spelt out in plain
language.
There are many clients I work with, where I
practically never find any thing of clinical value in
the 'Kleinian' corpus, but, instead, I gather
whatever I know about working cognitive-behaviorally,
or cognitive-analytically. Other clients would, and
will say so openly! leave therapy at once, at the
suggestion of cognitive behavioral work. Instead they
turn out to thrive with very client focused creative
alliances in which they become co-therapists- or even
their own therapist- where I feel like supervisor
Barry Duncan, Art Bohart etc come to mind...) And some
of these clients will in the end do the much needed
cognitive behavioral work after all- once they trust
me. AND SO
ON FOR OTHER APPROACHES AND OTHER CLIENT GROUPS.
I could never be a true Kleinian,( because I am an
integrationist) but I increasingly appreciate what
this corpus has to offer when working with SOME very
disturbed clients. ( I could probably give a back
translation into other therapeutic languages of what
this 'thinking or working differently' consists in,
and what I mean by 'some'.
George, Shlomo, Arthur, ...I personally do not seek
one unified theory. I seek a meta-framework which
allows me:
- # to compare
- # to translate/ transpose fields of meaning from
one theoretical language into another- se previous
dialogues about Wittgenstein and Quine - The late
Oxford philosopher Gareth Evens has made some
interesting advances here...)
- # to discuss in the nearest thing to a common
natural language which most of us understand,what we
do in practice- what interventions we use, with what
rationale and outcome,
And to me that is what happens at every sepi
conference in so many really illuminating
presentations: Two years ago Marv, and, I think, you,
Paul, borrowed Les Greenberg's slides to have the same
meta-framework, and then you talked us through in
different theoretical languages! And that why I am
writing this at 2 am instead of... Cordially, Hilde.
Fri, 27 Oct 2000, Paul Wachtel
Luca, I appreciate your effort to keep trying to
clarify this issue, and to relate it to how clinicians
are actually thinking. On the other hand, I write this
response with trepidation -- I don't want to drive
anyone else off the lists by keeping this topic as a
trauma they need to "contain."
So here, briefly this time, I hope, is what troubles
me about the term (did I really say "hate" or is that
an interpretation?): First, it feels "trendy" and
seems to be used, at least by my students, often more
as a way to show they "belong," that they are up to
the latest lingo, etc. But even more, it feels very
imprecise -- Do I contain by MY not reacting too
emotionally? Do I contain by actively helping the
PATIENT not to react too emotionally? Do I contain by
EMBRACING the feeling and hence do the OPPOSITE of
helping the person suppress the emotion? Etc. One can
say "all of the above," but then we are using one word
for many meanings, and that does not aid precision.
Even more troubling is the association with other
aspects of Bion's theorizing. It seems awfully
concrete and, I must say, bizarre. The patient "puts
the feeling into me." Then I rework it, metabolize it,
make it grow and mature and make sense. And then I
"put it back into him?"
But -- uh oh! -- I'm getting started again! If I
don't "contain" myself this will turn into another of
those overly long messages. So thank you and ciao,
Paul.
Fri, 27 Oct 2000, Bob Sollod
It seems to me that
a major meaning of this term is that the therapist is
aware of some problem or issue of the client and is
not rattled, upset, or overwhelmed by it. I can understand why the
term is thrown around a lot by therapists in training.
It sounds trendy, as Paul says, and it also indicates
that the budding therapist is up to dealing with a
client's difficult issues, emotions, etc. This is
often problematic for beginning therapists.
Fri, 27 Oct 2000, David Allen
Everyone: While I am definitely an advocate for
precise, operational definitions in psychotherapy, I
also believe that some human experiences are best
described through the use of metaphors. "Containment"
I think, is a metaphor, and as such can be
over-reified. On the other hand, the trouble with
metaphors is they call forth a plethora of different
associations, both within the mind of a given
individual and across individuals. It's important for
those who use metaphors to make sure they are on the
same page as another person with whom they are having
a conversation, rather than assuming that they know
what the other person is talking about. In the past,
psychoanalytic concepts have been too fuzzy, while
cognitive-behavioral formulations have not captured
the richness of human experience. Maybe in SEPI we can
have a happy medium, dialectically speaking! David
Allen.
Fri, 27 Oct 2000, Bob Sollod
The emphasis on the
term "container" indicates the Apollonian (as opposed
to Dionysian) emphases in many of our therapeutic
approaches. Overwhelming
emotion and expression of it is considered a no-no in
many therapeutic forms that promote rational control
over emotional expressions. For the therapist to be
emotionally expressive is mostly taboo. Much of this is, of course, culturally
based, and has more to do with preferred styles of
self-expression than with mental health per se. Best
wishes, Bob Sollod.
Fri, 27 Oct 2000, Paul Wachtel
David, Nicely put. Incidentally, I am a LOVER of
metaphors, and am even working on a paper right at the
moment in which I play with how much I love metaphor
before addressing the potential ambiguities in another
metaphor very commonly used, that of depth. So the
balance in your comments seems to me very apt. Paul.
Fri, 27 Oct 2000, Luca Panseri
Paul, you asked me: <<did I
really say "hate" or is that an
interpretation?>>.
Here is what you wrote on 20 Oct: << So… my main point is
that just like you don't have to be Jewish to love
Levy's rye bread... you also don't have to be
outside the psychoanalytic community to "hate"
container as a theoretical concept >>.
Your thought is very clear: the word and the
concept "containment" mustn't be used for the many
reasons you said. So I'm asking you: Do you agree that there is
something like a 'maternal vertex' of the field (one
pole of the reparenting axis), as Tullio suggests in
his last mail? If you do, do you agree that it
corresponds to the offer of a "secure base"
experience, for the development of a secure attachment
pattern? If you do again, how would you describe the
basic attitude of the therapist in this vertex,
avoiding the words 'containing' and 'holding'?.
About your worry "to drive anyone else off the list
by keeping this topic as a trauma they need 'to
contain'". I'm not worried about this. As a matter of
fact there may be someone who can't tolerate the
"trauma" of confronting different visions and putting
ideas and positions at stake. If s/he avoids any
confrontation by asking to be "cancelled from the
list", may be that SEPI isn't really the right place
for her/him. Ciao, Luca.
Fri, 27 Oct 2000, Allen Kalpin
One implication of
this discussion might be the following: "Container" is a good
metaphor if you like it. If you don't, then it is not.
We do not all have to
use the same terminology. But we do need to be able to
translate well. This discussion is good practice.
Allen.
Sat, 28 Oct 2000, Paul Wachtel
Luca, I largely
agree with you about driving people off the list,
although I do feel that it is important to be aware of
people's tolerances and sensitivities and not to
overload them in a way that seems to skew the focus of
the list. Some of the discussion could be pursued back
channel if we get feedback from people that they are
tired of this topic. But we do need the feedback.
I guess I should have
left out Levy's Jewish Rye, since indeed it did open
me to being perceived as "hating" containment as a
concept. I do, obviously, have real difficulties with
the concept, but my Levy-Jewish-love-hate comment was
meant facetiously.
As to your main and substantive question, I think it
merits a more full and serious consideration than can
be offered right now in this venue.
Perhaps we can pursue it at a SEPI meeting. Suffice
to say right now that I think the functions to which
Tullio refers can indeed be described without the
words containment or hold, but that also I have no
objection to the words per se -- obviously they are
words that in themselves are useful in a wide variety
of contexts (I would certainly worry if a mother did
not ever HOLD her baby. But whether this kind of
holding, for example, is the same as the THEORETICAL
holding is another question. It's not the words that
trouble me. They are fine English words and I'm sure
they have their fine Italian equivalents. It's the way
they are used by theorists to imply something more,
and a something more that is both vague and
portentous, that I object to. As to the maternal and
paternal vertices which Tullio discusses, here I would
say something a little different, which I remember
discussing with Tullio at a lovely dinner gathering at
my home -- the functions he describes as "maternal"
and "paternal" seem to me very important but I wonder,
since Tullio correctly notes that mothers can be
"paternal" and fathers "maternal", whether those names
are the best. But that too is an issue probably best
pursued at a forthcoming SEPI meeting. I would be very
interested to participate in such a discussion. Thanks
for joining us, Paul.
Sat, 28 Oct 2000, Ava Schlesinger
Hi All, in a
back-channel post, Tullio responded to my desire for
more clinical references and at the same time
suggested I react to the following. In a moment of
bravery, and because I am feeling somewhat confused
about the topic, I thought I would take Tullio's
challenge. In a message dated 10/28/00, Tullio Carere
writes:
<<So I'm asking you: Do you agree that there
is something like a 'maternal vertex' of the field
(one pole of the reparenting axis), as Tullio
suggests in his last mail? If you do, do you agree
that it corresponds to the offer of a "secure base"
experience, for the development of a secure
attachment pattern? If you do again, how would you
describe the basic attitude of the therapist in this
vertex, avoiding the words 'containing' and
'holding'?>>
My confusion about the "reparenting" aspect
of psychotherapy is due to the vast controversy among
so many respected colleagues. On one hand my right
brain wants to believe it exists and that by creating
a "secure base" if you will, the parenting process and
attachment can be reprocessed in a healthier, adaptive
way. The idea that the therapist takes on "maternal
functions," as Tullio suggests, feels quite natural
and inviting to me. On the other hand, my left brain
has been most recently inundated with suggestions
regarding the implausibility of this process.
Anecdotal clinical reports from both client and
therapist, speak to the potential for harm, especially
where strict boundaries between patient and client
become blurred; contemporary neuro-psychological
exploration seems to be heading in the direction of
showing that one's capacity to "attach" may be
dictated by areas of the brain that suffer
IRREVERSIBLE damage when deprived of "good enough"
environments in infancy and early childhood. And even
in my own belief in and desire to engage in a
reparenting process, I question the logistical
possibility of reparenting in a time frame of 1-2 or
even 3 hours per week. So these are the just some of the issues (I
have more, but wanted to keep this short) standing in
the way of my completely embracing the concept of
reparenting.
I guess I am
mostly full of questions rather than answers.
Psychotherapy as an art is much more comfortable to me
than as a science, however, I do believe it needs to
be a combination of both. Respectfully, Ava Schlesinger.
Sun, 29 Oct 2000, Diana Fosha
- Recently, Bob Sollod and Allen Kalpin wrote
two commentaries which I found intriguing. First Bob Sollod:
- "The
emphasis on the term "container" in dictates the
Apollonian (as opposed to Dionysian) emphases in
many of our therapeutic approaches.
- Overwhelming emotion and expression of it is
considered a no-no in many therapeutic forms that
promote rational control over emotional
expressions. For the therapist to be emotionally
expressive is mostly taboo.
- Much of this is, of course, culturally based,
and has more to do with preferred styles of
self-expression than with mental health per se."
And Allen Kalpin: "One implication
of this discussion might be the following:
"Container" is a good metaphor if you like it. If
you don't, then it is not. We do not all have to use
the same terminology. But we do need to be able to
translate well. This discussion is good practice."
I very much liked Allen's comment, putting the issue
in terms of almost aesthetic preferences in one's
metaphors. And separating that from the importance of
the clinical issues being discussed. His point about
gaining facility in translating back and forth between
the languages of different models is also apt. I think
specialized terminology is extremely important and
ought not to be discarded (here I have a disagreement
with Marv Goldfried) for it is in the very
specialization of the language that progressive
knowledge reflecting deepening based on previous
achievements is contained. But at the same time,
translating technical terms into ordinary language
allows one to really consider again what is really
contained (no pun intended) in the terms in question.
It is precisely why teaching others is the best way to
sharpen one's own learning.
Thank you Bob for introducing the
Appolonian/Dyonissian distinction. It allowed me to
realize why I have stayed out of the recent dialogue:
my own ideas about the essential nature of the work
revolve around issues of facilitation and fostering
and deepening of emotional experience and expression;
placing the "container" debates in the Appolonian
realm produced the relief and relaxation that comes
with understanding the reason for a discomfort/unease
I did not even know I was feeling until after I got
rid of it. Good intervention with the experiential
payoff! Diana.
Sun, 29 Oct 2000, Tullio Carere
A brief comment on the Apollonian/Dionysian issue.
Bob Sollod saw an Apollonian quality in the emphasis
on the term "container", that is a sort of bias
towards rational control over emotional expression.
Diana Fosha felt relieved as the "container" debate
was placed in the Apollonian realm, because it allowed
her to realize why she had stayed out of the recent
dialogue.
Bion, maybe the most Dionysian psychoanalyst in the
history of psychoanalysis, would be surprised. To him
mental growth is only possible, if a person can
tolerate to live "in the middle of a mental
breakdown": "We have to be reconciled to the feeling
that we are on the verge of a breakdown or some kind
of mental disaster; we have to have a certain
toughness to stand this continuing experience of
mental growth....So you can take your choice: mental
stagnation and decay on the one hand, or perpetual
upheaval on the other - like living in the middle of a
mental breakdown, without being clear whether one is
breaking up or breaking down" (I owe this quotation
from The Brazilian Lectures to the courtesy of
Larry Wetzler).
Now, breakdown
(temporary) can result in breaking up (growth) or
breaking definitively down (madness): it depends
whether or not an "apt container" is available. It is
true, the container is the form, the Apollonian. But
it is brought to bear only at the top of the emotional
upheaval (the formless, the Dionysian), not at all to
prevent it. On
the other hand, if the debate has underscored the
Apollonian containing, to the detriment of the
Dionysian emotional upheaval, Bob & Diana's
critique is in order. We'll have to take it into
account. Tullio.
P.S.: And what about Hilde's message? Wasn't it
Dionysian enough, to your taste?
Sun, 29 Oct 2000, Diana Fosha
Tullio, re: the Dionysian emotional upheaval: Now
you're talking.
Sun, 5 Nov 2000, Tullio Carere
Ava, Luca, Paul, and all, after so many discussions
it seems to me that we generally agree that in therapy
we do something on the maternal-paternal line, as we
also do something on the scientific-artistic line. It
seems we also agree that although none of these
functions can be transplanted as such into therapy--we
cannot be real mothers, as we cannot be real
scientists--there is nonetheless a kinship between
therapy as a profession, and ordinary relationships.
It seems that the same therapeutic agents are to be
found across different therapies, as across natural
and educational relationships, and they are to be
meant as universal responses to the basic
psychological and spiritual human needs.
But when it comes to define these general therapeutic
agents, problems arise. For instance, everybody agrees
that the therapist's (or the mother's) first duty is
that of providing a safe environment for the client's
(or the child's) growth. But how does the therapist or
the mother do that? Half the world to describe the
basic reassuring function in operative terms makes use
of words like "empathy" and "holding". The other half
of the world categorically rejects these words as
confusing or misleading. Now, if we cannot find a
minimal agreement at this very basic level, one can
imagine what happens if we try to define what
"science", or "art" are.
Where is the problem? I have a hypothesis. It is not
mine, it is Hegel's. Hegel pointed out that problems
always arise when we try to grasp things by the way of
positive definitions. Every thing is intimately
constituted by the relation with whatever it is not.
Every thing is defined by what it is not, and in the
same time it is what it is only in relation with its
opposite. For instance, it would be impossible to
define the maternal principle without putting it in
dialectical relation with its opposite, the paternal
principle: acceptation vs confrontation, or
unconditional vs conditional bond. If Hegel is right,
we should not try to define the basic therapeutic
agents as isolated factors, as we would get nowhere.
But we should try to identify the *basic polarities*
of the therapy field. This should be our primary task.
Does anybody have a better hypothesis? Tullio.
Mon, 6 Nov 2000, Ang Wee Kiat Anthony
I find Hegel's dialectical perspective helpful in
therapy and training. In our discussion regarding what
is useful and what is not in therapy, we each have our
preference as to how we would like to look at the
therapeutic factors. Some prefer to think in terms of
factors associated with being a good therapist; others
find it more comfortable to know the kind of helpful
actions to take (Being: Doing). To me, the essence of
therapy is about becoming-in-relating.
The findings of science offers some interesting
insights into the dialectical aspects of Hegel's
thinking. One of the curious limitations of science is
captured in the uncertainty principle (ie the
impossibility of describing the position and velocity
of a particle with the same degree of certainty at the
same time). The other paradox is how the nature of
light can be viewed both as wave and/or particle.
Applied to therapy, the moment we seek to accurately
observe and describe what goes on in therapy sessions
we will find something happening to our
becoming-in-relating with the client/patient. We have
to accept that focusing on being/doing as two
complementary perspectives can be helpful at different
points in time. I feel that an important, though not
often articulated, function of psychotherapy
supervision is to help psychotherapy trainees
appreciate this inherent paradox. The desired
consequence is that practitioners would experience a
degree of flexibility and freedom to relate to their
clients/patients rather than be fixed in a certain
posture to maintain the delicate balancing act between
the various polarities in therapy.
I like the idea of thinking in terms of basic
polarities in therapy (e.g., paternal:maternal;
supportive:interpretive; eastern:western; etc). On
closer examination, however, each pole is not merely
the opposite of the other but takes the other to a
slightly different plane. (To put it another way, East
is opposite of West only on a flat surface. On the
3-dimensional globe, each leads to the other and yet
both disappears into the North and South poles.) I'm
suggesting that one fundamental polarity is that of
being:doing and how it has been helpful to me when I
take it as a step in the direction of
becoming-in-relating. It moves me from theoretical
discussions to clinical work and from private thoughts
to sharing with a community of persons. Anthony Ang.