From this frame of reference there is no single transference reality that can be spoiled or contaminated by making a “technical” error. The analyst, guided by the patient and by his own experience of personal authenticity, allows himself to form relationships with each of the patient's selves or self-states to the degree the patient allows it, and in each relationship he has an opportunity to creatively utilize a range of his own states of consciousness. Often, a particular self-state of the patient has never before been drawn out in its own terms so that it can, without shame, communicate to another human being its unique sense of self, purpose, personal history, and personal “truth.” In my own work, this experience has at times led directly to the source of a symptom or behavior pattern that until then has been “resistant” to change, as for example, in the case of a patient who had suffered many years with an eating disorder, and then revealed one day that she had finally discovered why she binged. “I do it,” she said, “because I feel my brain trying to switch to another consciousness and I want to stop it—so I eat or drink something cold to stimulate me in the moment. I need to stay awake, to stay grounded, and sometimes, when I'm afraid I'm not going to be able to, I eat something heavy like pasta or bagels.”
The interplay between confrontation and empathy is interesting and especially relevant when working from the perspective of multiple real relationships rather than “a real relationship and a transferential relationship. "Each of the patient's dissociated self-states has its own reason for existing—a single “truth” that it tries to act upon—and will not rewrite its reality to suit an analyst's personal belief system of what defines “growth.” The analytic relationship is, in this light, a negotiated dialectic between attunement and confrontation, or (to express it in a slightly different frame of reference) between “empathy and anxiety” (Bromberg, 1980). There is no way that one's personal narrative of “who I am” ever changes directly; it cannot be cognitively edited and replaced by a better, more “adaptive” one. Only a change in perceptual reality can alter the cognitive reality that defines the patient's internal object world, and this process requires an enacted collision of realities between patient and therapist. The analyst's struggle with his own confusion—his ability to make creative use of contradictory realities within a single analytic field, without unduly inflicting his need for clarity of meaning upon the patient—plays as much of a role in the analytic process as do empathy or interpretation individually. In other words, for a patient to develop confidence in his growing ability to move from dissociation to intrapsychic conflict, he must engage with the analyst in what I have called the “messy” parts of the analytic relationship (Bromberg, 1991). As the analyst furthers the capacity of the patient to hear in a single context the voices of other self-states holding alternative realities that have been previously incompatible, the fear of traumatic flooding of affect decreases, along with the likelihood that opposing realities will automatically try to obliterate each other. Because there is less opposition between aspects of self, there is less danger that any individual self-state will use the gratification of being empathically supported in its own reality simply to further its individual sense of “entitlement” to priority within the personality. Translated into the traditional metapsychology of “pathological narcissism,” a patient's investment in protecting the insularity of a so-called grandiose self (see Bromberg, 1983) diminishes as the need for dissociation is surrendered and replaced by increased capacity to experience and resolve intrapsychic conflict.
Fonagy (1991) labels the capacity to symbolize conscious and unconscious mental states in oneself and others as the capacity to “mentalize” (p. 641) and writes that “‘wholeness’ is given to objects only through an understanding of the mental processes that provide an account of the objects' actions in the physical world. Before mental states are conceived of, the mental representation of the object will be, by definition, partial, tied to specific situations . . . since the vital attribution of mental functioning is absent” (pp. 641-642). Consequently, Fonagy argues, “the distortion of mental representations of objects through projection is unavoidable at this early stage. . . . Until the point is reached when mental states may be confidently attributed to the object there can be no capacity to limit this projection” (p. 642). He goes on to state that “in individuals where the capacity to mentalize is severely impaired, dealing with this aspect of the transference may be considered a precondition of analytic treatment. . . . [F]ailure to achieve this may lead patients to treat interpretations as assaults and analytic ideas as abusive intrusions” (p. 652; italics added).
Psychoanalysis is at its core a highly specialized communicative field, and what constitutes a psychoanalytically “meaningful” moment is constantly in motion with regard to one's experience of both reality and temporality. The shifting quality of time and meaning reflects the enactment of self-states in both patient and analyst that define the multiplicity of relationships that go on between the patient's selves and the analyst's selves, only some of which are being focussed on at any given moment. I would thus agree with Loewald (1972) who wrote that “the individual not only has a history which an observer may unravel and describe, but he is history and makes his history by virtue of his memorial activity in which past-present-future are created as mutually interacting modes of time” (p. 409). As an analyst opposes, is opposed by, affirms, and is affirmed by each dissociated aspect of the patient's self as it oscillates—in its cycle of projection and introjection—between his own inner world and that of his patient, the energy the patient has used in sustaining the dissociative structure of his mind will be enlisted by him in vitalizing a broadening experience of “me-ness” as simultaneously adaptational and self-expressive, rather than certain self-states remaining as “on call” watchdogs that, suddenly and unexpectedly, seem to become possessed by an “irrational” need to make a mess.
One final note. Grotstein (1995) wrote that projective identification “saturates the manifest and latent content of all psychoanalyses in its role as projected ‘alter egos,’ which are signifiers of the self at one remove” (p. 501). He stated that “the analytic relationship, like any couple relationship, constitutes a group entity in its own right as well as a relationship between two individuals. As a consequence, the couple is subject to the laws of group formation” (pp. 489-490). What Grotstein calls “alter egos” is not very different from what I call multiple self-states, or with some patients, multiple selves.
I find Grotstein's observation both astute and interesting, and from time to time I've even had the thought that by experiencing the analytic process in this way, it begins to overlap in a funny way with certain elements of doing couples therapy—sort of like treating a couple (or sometimes a family) in a single body. For instance, in the early phase of couples therapy, it is virtually impossible for the therapist to make statements about the couple as a unit, to which both parties can be responsive. The therapist has to develop a relationship with each member of a couple individually, while dealing with their problems that pertain to the couple as a single unit. If this complex task is done with skill, it becomes possible to slowly speak to the couple as a unit, even though each member sees things differently, because there is a context that has been created (the individual relationships to the therapist) that allows the individual subjectivity of each “self” to be negotiable. Through this, each reality can begin to negotiate with other discrepant realities, to achieve a common goal.
Used judiciously, an approach that addresses the multiplicity of self is so experience-near to most patients' subjective reality, that only rarely does someone even comment on why I am talking about them in “that way.” It leads to a greater feeling of wholeness (not dis-integration) because each self-state comes to attain a clarity and personal significance that gradually alleviates the patient's previously held sense of confusion about who he “really” is and how he came, historically, to be this person. And for the therapist, it is not necessary to work as hard to “figure out” what is going on, what has gone on in the past, and what things “mean.” He engages in a dialogue with that self that is present at the moment, and finds out from that self, in detail, its own story, rather than trying to approximate it. All told, it facilitates an analyst's ability to help his patient develop increased capacity for a life that includes, in Loewald's (1972) language, a past, a present, and a future as mutually interacting modes of time.
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