Dissociative processes operate in both patient and analyst as a dynamic element in the therapeutic relationship, an observation that, traditionally, has been made only with reference to the treatment of extreme psychopathology or severe dissociative disorders. I am suggesting, however, that this statement is true as a general phenomenon of human behavior and relevant to any therapist working with any patient within an analytically informed frame of reference, regardless of theoretical persuasion.
In this regard, a series of thoughtful papers has emerged from the Anna Freud Center in London on the developmental relevance of mental states in determining analytic “technique.” Peter Fonagy (Fonagy, 1991; Fonagy & Moran, 1991; Fonagy & Target, 1995) has offered a perspective on the relationship between conflict and dissociation that places both phenomena within a clinical model that incorporates developmental and cognitive research, object relational thinking, and a postclassical interpersonal sensibility. “We take the position,” Fonagy writes (Fonagy & Moran, 1991, p. 16), “that the greater the unevenness in development, the less effective will be a technique which relies solely upon interpretations of conflict, and the greater will be the need to devise strategies of analytic intervention aimed to support and strengthen the child's capacity to tolerate conflict.” Similarly, and even more to the point (Fonagy & Target, 1995, pp. 498-499; italics added), “Interpretations may remain helpful but their function is certainly no longer limited to the lifting of repression and the addressing of distorted perceptions and beliefs. . . . Their goal is the reactivation of the patient's concern with mental states in himself and in his object.”
Pathological dissociation is a defensive impairment of reflective capacity brought about by detaching the mind from the self—what Winnicott (1949) called the “psyche soma.” In the analytic relationship, such patients (individuals dedicated to the avoidance of reflection) are in need of “recognition” rather than understanding (Bromberg, 1991), but if an analyst is to help someone who is dedicated to the avoidance of reflection, it is necessary for him to accept that his “act of recognition,” both developmentally and therapeutically, is a dyadic process—a two-way street of mutual regulation (Beebe & Lachmann, 1992; Beebe, Jaffe, & Lachmann, 1992). Consider what Fonagy and Target (1995) have to say about this.
We believe that the developmental help offered by the active involvement of the analyst in the mental functioning of the patient, and the reciprocal process of the patient becoming actively involved in the analyst's mental state, has the potential to establish this reflection and gradually to allow the patient to do this within his own mind. . . . The critical step may be the establishment of the patient's sense of identity through the clarification of the patient's perception of the analyst's mental state. . . . It seems that gradually this can offer a third perspective, opening up a space for thinking between and about the patient and the analyst (pp. 498-499; italics added).
A space for thinking between and about the patient and the analyst—a space uniquely relational and still uniquely individual; a space belonging to neither person alone, and yet, belonging to both and to each; a twilight space in which “the impossible” becomes possible; a space in which incompatible selves, each awake to its own “truth,” can “dream” the reality of the other without risk to its own integrity. It is, above all, an intersubjective space which, like the “trance” state of consciousness just prior to entering sleep, allows both wakefulness and dreaming to coexist. Here, in the interpersonal field constructed by patient and analyst, such a space is opened in the service of therapeutic growth, wherein the implacable enemies, “hope and dread” (Mitchell, 1993), because they can each find voice, can potentially find dialogue. How is this phenomenon possible? My answer, in its most general and oversimplified form, is that the reciprocal process of active involvement with the states of mind of “the other” allows a patient's here-and-now perception of self to share consciousness with the experiences of incompatible self-narratives that were formerly dissociated.
What is the analyst's role in this asymmetrical dyadic process that permits such a space to open? Because of the way dissociation functions interpersonally, unsymbolized aspects of the patient's self are routinely enacted with the analyst as a separate and powerful channel of communication in the clinical process—a channel that is multifaceted and continually in motion. One dimension of the analyst's listening stance should therefore be dedicated to his ongoing experience of the here and now at the same time his focal attention may be elsewhere. That is, no matter how “important” the manifest verbal content appears to be at a given moment, the analyst should try to remain simultaneously attuned to his subjective experience of the relationship and its shifting quality. Optimally, he should try to be experientially accessible to (1) the impact of those moments in which he becomes aware that a shift in self-state (either his own or his patient's) has taken place, and (2) the details of his own self-reflection on whether to process this awareness with his patient or to process it alone—and if with his patient, when and how to do it. Is he reluctant to “intrude” upon his patient at that moment? Does he feel protective of the patient's need for safety and vulnerability to traumatization? Does he feel pulled in two directions about whether to speak? Does he feel strangely paralyzed by being unable to move in both directions simultaneously, as if he must somehow choose between his own selfexpression and his patient's vulnerability? If so, can he find a way to use this very experience of his felt constriction of freedom? Would the act of sharing this entire sequence of thought, along with the moment that led to it, be a useful choice in this instance? I believe that, at any point in time, the questions themselves are of greater value than the answers, as long as the analyst remains open to exploring the impact of his choice, rather than seeing his choice as either “correct” or “wrong.” In my own work, I find that even when I choose not to share openly my experience, my conscious awareness of the shift in the intersubjective field, because it changes my mode of processing what is being heard, is invariably picked up by my patient, and eventually becomes “usable” because I am no longer hearing the patient's words and my own in the context I was hearing them before the shift. I am now experiencing their meaning being shaped by the participation of another aspect of the patient's self that has been engaged with an aspect of my own self in enacting something beyond what the words had earlier appeared to be conveying.
The analytic situation is an ever shifting context of reality that is constructed by the input of two people. Smith (1995, p. 69) has commented that “as long as there are two people in the room each with multiple points of view, there is likely to be no shortage of surprises,” thus echoing the words of Theodor Reik (1936, p. 90) who claimed that the “royal road to the unconscious” is the experience of surprise, in that it allows an analyst “to find something new which will then create its own technique.”
Take, for example, such a moment of surprise in my work with Max. Max was a twenty-four-year-old male patient, a first generation American Jew, an only child raised in a close-knit, upwardly mobile family. Because his mother could speak only Yiddish, he spoke Yiddish to her, but only to her, an issue that became significant to his personality development. As he reached adolescence and began to search for his place in the world, he gradually disavowed all connection to his “Yiddish self” (cf. Harris, 1992; Foster, 1996), which had been shaped in the context of his mother's illusion that his substantial intellectual gifts included a more sophisticated command of the English language than he actually possessed. His mother, whom he deeply loved, idealized him as her contribution to the American intellectual community, and despite his efforts to live up to her image of him, or perhaps because of his efforts, he would frequently embarrass himself in public by stretching his use of language beyond the point of his actual familiarity with the words themselves, and would manage to undermine himself in situations where he most wished to shine. In short, he was given to putting his foot in his mouth. He was seemingly unable to learn from these experiences, and was always shocked when he ended up being flooded with shame. My view of Max had been that had been that he was unable to accommodate his mother's image of him into an acceptance of himself as a human being with limitations as well as assets, and that he continually enacted a dissociated self-representation in which he presented himself as who she said he was, while simultaneously demonstrating to himself, in every other possible way, that he was not who she said he was, and that he was simply a “typical American boy doing his own thing.” To put it another way, because his “Yiddish self” was felt by him as uncontainable within any relationship other than that with his mother, he couldn't begin to negotiate a cohesive sense of identity that represented the creative participation of all of his selves. He dissociated from the self-reflective involvement in living that enables someone to state, with a feeling of personal agency, “this is who I am.” He was stuck with being able to state only “this is who I am not,” and having to live with the “not-me” experience of his disavowed “Yiddish self” finding a voice through his so-called blunders.
Max and I had been engaged in a struggle around what he felt, I think accurately, to be my somewhat unsympathetic determination to pry him loose from having to be who his mother said he was. He insisted that he was not under his mother's spell, and that his tendency to use the wrong words when he did not really know their meaning, was simply a matter of insufficient familiarity with the dictionary rather than an unconscious loyalty to his bond with his mother. I had been giving him my “favorite” interpretation in different ways for a long time, and he had consistently (but deferentially) rejected this view, politely protesting that he is his own person, that he also loves his mother, and that there is no opposition between the two. I was in the midst of delivering the “truth” once again, when he said to me, in a tone of benevolent exasperation, “I really want to accept what you are saying about me, because I respect you, but I just can't, and I feel caught between . . . between . . . Sylvia and the chiropodist.” I exploded with laughter, and when I calmed down and wiped the tears from my eyes, I looked up apprehensively, expecting him to be hurt, shamed, or angry at my response. He was neither. Max looked genuinely bewildered. So, I explained why I was laughing, and told him what the actual expression (Scylla and Charybdis) was. He replied, hesitantly, “What's that?” and I then told him the myth. I found myself unable to omit a single detail. I included Jason and the Argonauts, the Straits of Messina, the monsters, the rocks, the whirlpool, the whole thing. When I had finished, he paused, tellingly, and allowed that he was “immensely appreciative” because, as he put it, “you just told me something I needed to know all my life.” I was astounded not only that he could let himself use sarcasm with me, but that he could hear it so clearly. I was also shocked (and slightly embarrassed) at having been so unaware of my shift in role. But I was totally unprepared for the moment, as we spoke, when he suddenly recognized that his remark was not only an act of shaming but was simultaneously an authentic expression of appreciation. He could feel that he had indeed learned something new and that he was excited about it. Max and I had each discovered, by sharing the experience, that being “exposed” in the other's eyes was complex but not traumatic. Max got something more than a lesson in Greek mythology; he got the joke. When we began to laugh at it together and talk about it together, different pieces of Max's reality and different pieces of my reality could start to be negotiated. Until then, language had little impact in symbolizing his dissociated self-experience because, as Bruner (1990, p. 70) has put it, “being ‘exposed’ to a flow of language is not nearly so important as using it in the midst of ‘doing.’”
Obviously, there are many different ways to formulate this event. In my own way of thinking about it, to one part of him I was his beloved mother (whose name, disappointingly, was not Sylvia) for whom he had to be bright, deferential, and without flaw, already possessing all that he might be expected to know. To another part of him I was the chiropodist—the doctor trying to separate him from his painful “handicap.” But in my determination to cure him of his “corns” (his perception of who he “really” is), he hadn't experienced the hope of a “better” reality coming out of our relationship until he made his slip, and I responded with more of my own selves hanging out than I had anticipated. Each of us, in the various self-states that comprised our identities at that moment, unexpectedly made intimate contact and felt acknowledged by the other person; an example, perhaps, of Levenson's (1983, p. 157) reminder that “participant-observation should not be delegated to the therapist: it is a mutual effort. Catching the therapist in a self-serving operation may do more for the patient's sense of competence than a lifetime of benevolent participations.”
For Max, it was a transformational experience, in that he became increasingly free to experiment with multiple ways of being within a single relationship. He began to feel less convinced that he would have to tradeoff his self that was constructed through his relationship with his mother in order to become more fully “his own person”—in this case, a bright guy who didn't have to be ashamed of not knowing everything.
As an interesting note, it was shortly after this session that the oedipal dynamic of his rivalry with his competitive father surfaced, because it was now safer to challenge me. This included his more fully questioning whether my decision to “enlighten” him about Greek mythology might have included not only professional interest, but also some personal one-upsmanship. He even seemed to remember some slight perception that my hilarity over his slip lasted just a bit too long, and that I may have been just a bit too eager to play the role of the educator. And so it went, with his becoming more and more able to hold in a single state of consciousness, without dissociation, complex interpersonal events that contained feelings toward another person that formerly would have collided traumatically and thus would have been too incompatible with his ongoing self-definition to allow self-reflectiveness and the experience of resolvable intrapsychic conflict. Max and I were able to go back and take a new look at historical ground we thought we had covered earlier; but what was more significant is that in the process we went back over our own relationship and looked together at events we told ourselves we had addressed, but which represented a collusion to dismiss or placate a voice that was silently crying for recognition. Most importantly, he engaged and broke out of the residue of the dissociative mode of relating that masked a shame-ridden young man who was foreclosed from fully living his own life because he was dedicated to disavowing a dissociated aspect of his own selfhood. His ability to accept this part of himself allowed the work we had already done (including reconstructive work) to feel authentic, because he could then more comfortably “stand in the spaces” between realities and between past, present, and future, without having to lose any of them.
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