Repeating the repetitive, altering the alternative
by João Pedro Dias
To my mind, the merit of this paper is to be credited to the patient referred in the clinical example, with whom I learned much of what I know today, and to my dear professors and esteemed friends António Coimbra de Matos and Farrell Silverberg.
Summary: I will present a case of a patient who had already had a previous experience in analysis with another therapist. Presenting imaginary and real dialogues between the three of us, I will posit that the analyst’s ability to change his previous theoretical beliefs into a new mode of thinking, feeling and being in a relationship with a new patient, is a key for the efficacy and sustainability of psychoanalysis.
“Mudam-se os tempos, mudam-se as vontades,
Muda-se o ser, muda-se a confiança;
Todo o mundo é compost de mudança,
Tomando sempre novas qualidades.”
(Luísde Camões, 1524-1580)
“Times change, our desires change,
What we are, and what we believe, is ever changing,
The world is made of change,
And forever takes on new qualities.”
I will begin by presenting a case of a patient who had already had some previous experience in analysis with another therapist before working with me. The patient, Diana, a 30 year old woman who was also a mental health professional, began by informing me about what she had learned and experienced in her first analysis.
Diana–“…I feel little bit anxious,I don’t know why… Perhaps I was expecting an older man, you know, with white hair and glasses on the tip of his nose, like Doctor X (her first analyst).
“… My mother always told me that my father rejected me when I was born.When he found out that my mother was pregnant, they had a fight and he left home. Then he returned, but he only accepted me when I was 3 months of age. Their relationship was never the same again and he betrayed her with other women.Nevertheless, I grew up very attached to him: He was my hero and we’ve never talked about this matter since he had always been a good father to me. I remember him arriving home from work and bringing me presents. It was always something special. I guess he overcame that initial rejection…
“In my first analysis I became conscious of my incestuous passion for him. I learned that because of his rejection, I developed a compulsion to choose men who reject me initially. I lose interest in a man once he becomes interested in me, without me having to fight for him. I was like that, during my adolescence.
“When I was 21 years old, I got married to George, and now we have a 3 year old daughter. Because my father used to have affairs, I find myself tending to be extremely insecure and jealous. Some time ago, George and I had a fight because of my insecurity and jealousy, and he almost left me.
“Thanks to my first analyst, I grew to understand much about the true origins of my jealousies. Although I have good memories of my relationship with him, I have this feeling of having relived a long history of suffering while in treatment with him… At the end, I came to understand that because I felt rejected by my father, I projected on Dr. X my expectations of being appreciated by a father figure. He showed me that my expectations towards him were exaggerated, since in fact he was not my father. That’s why I am also so jealous and too demanding with George. I demand too much attention and I become obsessed with George, just as I was obsessed with my father.
“I learned so much about myself, but I haven’t changed the core of what I am, of what I feel. Now, 3 years later, I still have this vague feeling of emptiness, as if something is missing inside me. The bottom line is that I am unhappy.
“Am I still disturbed by my relationship with my father? Is that the reason why I am still so jealous of George’s relationships with his friends and colleagues?I know that my suspicious fantasies come from my unresolved Oedipus complex…You see, sometimes I accept that my jealousies are a kind of delusion, because I imagine sexual scenes of George with other women. I imagine every little detail…It’s horrible. However, most of the time I am deeply convinced that he really does betray me with other women. Lately, I’ve been thinking about it night and day. So I decided to come back to analysis”.
It took me a long time to fully understand what she meant by coming back to analysis. She never spoke again about her first analysis as explicitly as she did in the first session. However, her manner of talking to me made it seem as if we had been working together for a long time. In her rather idiosyncratic way she told me that she repeats and relives in the present what happened in her past.
Just as she had transferred her infantile expectations to her first analyst, who in turn came to represent her father, she also had a strong conviction, although vaguely unconscious, that she would repeat the same relationship pattern with me. Based in what I learned from classic psychoanalytic theory, I had that same conviction.
I.Repeating the repetitive
According to the classic theory, the psychoanalytic treatment is supposed to begin with the establishment of a transference relationship in which the analyst represents the patient’s original developmental object(s). The transference is considered the impetus for the patient’s psychological changes.
Apparently, this describes what was happening in Diana’s analysis with me. She adhered thoroughly to what I thought – and perhaps to what she thought – the treatment was supposed to be: she freely associated her ideas and recounted many dreams which content, at first, I was able to interpret at the light of her infantile history, of her unsatisfactory marriage and of her transference relationship with me. She still suffered from unrealistic jealousies because she demanded too much attention from her husband.
By representing her father – which means being and not being the one I represent –, in the transference relationship, her pathological neediness appeared through feelings of being rejected by me, just as she felt rejected by her father.
So, everything was going according to the plan… Except one thing: Probably due to my inexperience, or at least so I thought, the treatment wasn’t working. Unlike her first analyst, I started to feel unable to show her that her frustrated infantile expectations of being appreciated by her father were now, in the transference situation, anachronistic and unrealistic since I was not, in fact, her father.
From a technical point of view everything made sense, but something felt wrong since we seemed to be going in circles. It was evident to me that something in the treatment had to be altered. Except that by the time I came to this realization, she was becoming more and more depressed.
From time to time, she complained that she felt rejected because her husband was withdrawing from the relationship with her. Furthermore, she had a dreadful fear because she thought that George’s betrayal was now imminent and that he was going to leave her and trade her for another woman. However, since we had already created an unconscious collusion between us, we both accepted that her husband’s withdrawal was caused by her affective neediness and excessive voracity. Therefore, we both tended to deflect her attention from her relationship with her husband, redirecting it towards her own psychodynamics and how those played out in the transference relationship.
Session after session, I was hearing her complaints about how miserably unhappy she was. Month after month, I was sensing that both she and I were becoming bored and frustrated (depressed) with the way things were going in her life and in the analysis itself. Here is an example:
Diana – “(After a long silence). I’m thinking that sooner or later you’ll become sick of me and of my complaints and winnings… I am so boring that you probably just want to forget about me in the end of every session, just as my husband also prefers to spend his weekends with his friends. I know: these feelings are stupid because this is your job. This has nothing to do with you directly, but has more to do with my father’s rejection. But… What does this means? It means that I have a lot of things to resolve with him. But what am I going to resolve directly with him? (Starts to cry). We’ve been through this before. When am I going to resolve this, when? Never! That’s when”.
I was listening her and I was thinking that what she was telling me had something to do with her transferential fantasies. Then, during this session – orperhaps during a session similar to this one – in an Ogden-like “reverie” (Ogden, 1997) that occurred during one of her discussions of the futility of her insights, I imagined that she asked me a rather puzzling question and an entire conversation unfolded:
– Would you dare to think otherwise?
– Excuse me?–I replied.
– Well, through what is commonly known as “transference interpretations”, you have been thinking – and thereby helping me to convince myself –that I feel rejected and frustrated, not because of my husband’s actual rejection, but because I transfer my unrealistic expectations to you.
– Yes… So?–I asked.
– So, I am asking you: would you dare to think otherwise?
– I am not sure if understand what you mean…
– Well, as you see, I am right about your feelings: You’re actually bored with me. So, if I’m right about you, could I also be right about George? … You don’t need to answer that question. It’s just a rhetorical question…
– Then she continued– …What I am trying to say to you is that I don’t know if my suffering has to do with my father, or with my mother. Actually, I don’tneed someone who can symbolically represent my mother or my father (or both). What I need is someone who could give me an alternative perspective of myself and of my life. A complementary view, different from that of my mother and different from that of my father. An unsaturated view of myself and of my own world. A view stripped of preconceptions, that would allow me to remain open to new perspective and to establish new affective connections, thereby enhancing my will to be who I am and my freedom to evolve continuously… Except that I cannot do it alone. In order to achieve this goal, I would need a real partner and not a symbolical, imaginary one.
– What do you mean?
– Since you are a slow learner, I’ll give you an example. Can you really learn to play tennis simply by throwing the ball against a wall? No, you need someone who collaborates more actively with you on the pursuit of that objective. What I mean is that I need someone who could actually recognize me as the idiosyncratic person and woman that I am.
– Well, I don’t know if that’s possible.
– Of course you don’t know. First of all, that would be possible only if your responses to me would convey a genuine congruence between what you are as a person, what you think as a therapist and what you feel while you’respeaking and not speaking to me. Second, psychological changes are impossible because, according to my first therapist, I will begin by repeating – by transferring –, and then I will become aware that I am repeating and finally I will give up repeating. As if the awareness of the repetition could contain in itself, and by itself, the potential to develop into a new, alternative mode of thinking, feeling and being… This is unsustainable. – She summarized.
– Would change be possible if, instead of thinking like your first analyst, I would dare to think otherwise?
– Only you can answer that question… – She replied – … You were my first analyst.
– What do you mean?!
– Well, as you see… You’re not really having this conversation with me, but with yourself.
This imaginary dialogue illustrates the way I felt that Diana, with her clear thinking and lucid questioning – when compared to my own obscure theoretical preconceptions –, it also helped me to understand the core issue that was blocking the development of a genuine therapeutic relationship.
II.Altering the alternative
The main problem was that I had been thinking, feeling and being – from the beginning – like an old, ancient analyst, “with white hair and glasses on the tip of my nose.” For Diana to be able to change, first of all it was I who had to be able to change my previous theoretical beliefs into a new mode of thinking, feeling and being in my relationship with her.
Only then I started to understand her anxiety when we met in the first session.If I were an “older/outdated” analyst, more similar to what she expected, then I would try to convince her that her suffering derived mainly from her misplaced fantasies and pathological neediness. Otherwise, I would understand that no one persistently fantasizes about being rejected if they haven’t been actually rejected at a critical time in their life; or, at the very least, if they haven’t been strongly threatened with rejection or abandonment.
A real rejection or threat of rejection had to have happened (and not necessarily on her father’s part). But a real rejection was also actually happening in the present analysis if I refused to entertain the possibility that Diana’s fears were realistic.
Having started to doubt the thesis that her problems came mainly from her“distorted sense of reality”, I also started to really listen to her and, at the same time, I insisted that she would listen to herself. Moreover, I insisted that she would observe the reality that appeared to be in front of her eyes…I was more than a little surprised to realize that she was very reluctant to do so. Actually, by that point, she was the one who more tenaciously refused to believe that her own great and profound conviction could be true… Or even possible.
When I saw what was there for me to see right from the beginning, then I came to realize the way she affirmed – and at the same time denied – her own conviction that her husband didn’t love her and was having an affair. What if her conviction about her husband’s betrayal were true? What if her former analyst was wrong to dissuade her, and misguided to redirect her to assume that it was her own insecurities and repetition instead, and what, most importantly of all, if I were joining in this folly?
The analytic relationship went along smoothly, albeit not necessarily productively, until the day I suggested that she could be right. Then she started to get a little bit angry with me.“You are really getting on my nerves”, she told me in one of those occasions. No doubt, we’re now travelling on uncharted waters. The sympathetic, adequate, depressed and apparently very masochistic woman, gave place to a more vivacious, active and even rebellious person – but only from time to time, since most of the time the internal forces of repression and denial inside herself seemed to prevail.
Surprisingly, from then on she started to avoid talking about her relationship with her husband. She complained vaguely about her feelings of inadequacy and of her shortcomings as a woman, conveying that she was the one to blame for herhusband’s affective withdrawal. A year went by in this mode before something changed. It all began with her reporting a dream, and unlike the reverie I reported earlier in this article, this dream was actually reported by the patient. And, as it turns out, the patient’s dream provided me with an opportunity to apply what I had gleaned from that previous reverie and from the treatment up to this moment.
THE TRANSFERENCE WITHIN THE “TRANSFERENCE”
Diana – “George travelled to Lisbon yesterday. During the Christmas holidays he spent more time with his friends and was called several times for business meetings…). Today I had a dream: I arrived earlier for a session. When I was in the waiting room I started to listen through the wall. A woman was accusing you of betraying her. Then I decided to go back home, but when I was halfway there I felt intensely curious and I decided to come back to see who would come out of your office. Except that the road signs were wrong and I got lost on the way. When I woke up I felt very anxious. I guess this dream represents the fact that my father used to betray my mother and that I’m transferring my fear of being betrayed by George to you,isn’tit?(…)During the holidays, my friend Isabel told me that she is leaving the office where we worked together for a long time… I ended up feeling rejected and very angry… Oh, of course that these feelings had nothing to do with her.They have to do with your absence during the holiday interruption…
JPD – Yes,what you’re saying has something to do with me. But, moreso, I think that you’ve been feeling both physically and emotionally abandoned by your husband. And you seem to have a strong suspicion about him… (Pause). But the transference, since you insist on mentioning it, is that you refuse to share with me your true feelings and intuitions because you are afraid that I will interpret them as the other therapist did. That’s the real transference: you fear that I think of you as delusional, a s silly person…
Diana – (Surprised). Well… Don’t you (think of me as crazy)?… (Silence). I guess you’re right. Actually, there was something weird about the dream that I forgot mentioning. There was a woman in the waiting room, sitting behind a desk. I thought the she could represent your wife and that in this dream I was reliving my mother’s suffering, caused by my father’s betrayals… This is pretty elaborated, isn’t it? (Laughs)… I feel that what you told me is much more true… Yes, I just remembered that when I woke up from the dream… I thought immediately that, unlike you, my former analyst did have a secretary working for him. Now that I think about it, I used to feel that he thought of me as being a silly, crazy girl… But if you don’t see me as silly, how do you see me?
JPD – How do you see yourself?
Diana–As a silly girl, or woman… I don’t know! This is a dead end: I can’t believe in my own intuition because I consider myself crazy.
JPD – I think you prefer to consider yourself crazy so that you don’t have to believe in your intuition. You don’t want to read “road signs,” you prefer to say they’re wrong, so you end up getting lost.
The dream was not just a transference dream as she supposed, but more importantly, was a translation of what she felt was going on in her life. Over the following weeks two changes occurred. The first one was that the therapeutic relationship became therapeutic, in the true sense of the word. It gained the genuine intersubjective dimension that was missing, although perhaps it was not entirely absent from the beginning. I will elaborate on this matter later on.
The development of a richer intersubjective dialogue between us, gave place to a second change: The creation of a more secure psychological environment allowed her not only to accept her own feelings and intuitions, but also to explore them more freely, to grasp more accurately their true origins and to pursue less fearfully their possible consequences. She had already gathered an extensive amount of plausible indications that her husband was, in fact, having an affair. However, she still refused to extract from those signs what seemed to be the more obvious conclusion. The session presented below was very important.
THE “EGAR ALLAN POE SESSION”
Diana–George traveled to Lisbon. On the weekend I found again in George’s mobile phone some messages to one his female colleagues. The messages reveal too much intimacy between them (Starts to cry). I have a strong suspicion but, then again, it doesn’t allow me to conclude anything… I think I am very attentive to every little detail: I check his phone; I look for perfume odors in his shirts… But I don’t know, I feel lost.
JPD – As I was listening to you, I thought of something that might be of interest. Do you, by any chance, know the Edgar Allan Poe’s story of the “Purloined Letter”? … It happened in the Austro-Hungarian Empire and had to do with a search for a stolen letter. This letter, stolen by a Minister, contains compromising information about a Prefect of police. The prefect does a thorough investigation inside the Minister’s office: He checks behind the wallpaper, under the carpets, he even examines the tabletops with microscopes and probes the cushions with needles. He finds nothing. Do you know where the letter was? … It was on the table, “hidden in plain sight.”.
Diana was almost completely silent for the rest of the session. That same night she left her daughter with a friend and she went to Lisbon to do some investigating of her own. She found her husband in a hotel room –at the same hotel where he said he would be – and he was in the hotel room with one of his female colleagues. She returned home and a couple of months later divorced him.
From then on, she started to question much of what she thought she already knew. Particularly, she questioned if her emotional difficulties were actually just imaginings that were derived from the so-called rejection on her father’s part. She discovered that this belief was more a myth, co-constructed but strongly fueled by her mother, a woman with deep narcissistic injuries who unconsciously tried to maintain Diana’s dependency. Diana understood that her mother’s behavior of presenting herself as victim, was due to her own need to be cared for and loved.
Thus, Diana discovered and opened her own narcissistic wound, which had been concealed by a relationship with her supposedly perfect mother. Since Diana’schildhood, her own narcissistic rage and guilt had been masochistically deflected towards herself. During the following years of the analysis, she was able to expel and redirect her own unconscious rage towards her mother.
From the analytic work that continued long after the Edgar Allan Poe session she also developed a more consistent trust in her own experiential knowledge and intuition. This had a major impact in her self-esteem and consequently in all dimensions of her psychological and interpersonal life.
III.The true psychoanalytic encounter
Loewald (1960) introduced the idea of the analyst as a new developmental object. This means that the analyst can be:
– Not just a transference object with whom the patient can only repeat endlessly the once failed experience with the original developmental object;
– But also a real and new developmental object.
However, as I understand it, the full potential of this important idea has yet to be fully explored. After all, there is still a prevailing notion in much of the field that the psychoanalytic treatment begins and is built through the establishment of a transference relationship, which can, during the course of the treatment, “miraculously”mutate into a new developmental relationship.
Based in my own experience and based on what I understand from authors such as Winnicott (1975) and Fairbairn (1952), and especially in the work of Coimbra de Matos(2002)…I would dare to think otherwise.
The psychoanalytic relationship begins with and evolves from a true psychological encounter between two real persons –this is very different from what defines and characterizes the transference relationship.
The transference is a byproduct of the failed developmental relationship,which was not just pathological, but also pathogenic since it was internalized and therefore reproduced by the patient –whenever the relational circumstances (or the intersubjective context) favors its reproduction. The analytic relationship is always inter-subjectively co-constructed by the patient – the first subject – and by the analyst – the second subject, who, because of his knowledge, has a greater responsibility in the quality of the analytic relationship. (In my opinion, thepatient’s evolution is more attributable to the patient’s merit; while the patient’s stagnation or his involution is more attributable to the analyst’s limitations).
In other words, the transference is a symbolical repetition, in which almost everything the patient says or does, during the analysis, is interpreted as if it included – supposedly – some“implicit” reference to the analyst. For example, the patient is angry because he got fired, but the analyst tells him that he is angry because the analyst delayed the beginning of that session (or because the analyst didn’t agree in lowering his fees last month). Similar examples – although not so caricatured or grotesque – are not unusual.
Instead, a more meaningful psychoanalytic encounter focuses:
– On the analysis of the patient’s present relationships;
– On how the present difficulties on those relationships are related to past interactions;
– And, last but not the least, on the development of the patient’s psychological potentialities.
At the beginning, the analyst does not symbolically represent – nor does he try to represent during the course of the treatment –the patient’s internal object(s) (i.e., the patient’s original object). Of course that, from the non, developments and manifestations of transference and/or counter-transference are almost always inevitable. Nevertheless, they represent missteps and occasional incidents that may, or may not, be noticed, interpreted and used to collect useful guidelines and probabilistic information about what may have happened in the patient’s infantile interactions.
In other words: the new developmental relationship can, when mismanaged –as in the case presented earlier in this paper – , mutate transitorily or definitely into a transference / counter-transference relationship.
These different relational qualities/tracks – i.e., the innovative (and alternative) development versus the repetitive (and pathological) relationship – are not easily identifiable and discriminable during the therapeutic process. This idea can be figuratively illustrated by the following example. When we breathe, we cannot differentiate between oxygen and carbon dioxide; nevertheless, we feel immediately the difference between inhaling fumes from toxic waste and breathing fresh air.
A true psychoanalytic encounter began to take place between Diana and myself when she started to feel, implicitly (Stern, 2006), that I was able to feel what she was feeling. This simple psychological event gave legitimacy to the existence and to the acceptance of her own true feelings. We can designate this event as the founding moment of intimacy: The moment when we find that our most unspeakable feelings have space and existence inside the mind of the other person, in this case the analyst, with whom we are intimate.
This intimate dimension of our analytic relationship came to life, but only because it was not entirely absent in the beginning of the treatment. Otherwise, it would have been impossible to unfold and transform the transference into a new, non-repetitive form of relationship.
To conclude, my impression is that a true psychoanalytic encounter:
1) Is born and develops outside the realm of the transference/counter-transference.
2) Starts when the patient begins to sense that the analyst’s main “guideline” is the patient’s actual benefit, measured in terms of psychological freedom to think, to feel and to be in the analytic relationship.
3) Arises implicitly, in an almost unnoticeable manner – as in the case I described above – at the moment the true encounter is embraced by the analyst, although its potential was there right from the beginning of the treatment… Or, if never embraced by the analyst, the true encounter remains lost to the patient and to the analyst,no matter how long psychoanalysis lasts.
- Coimbra de Matos, A. (2002). Psicanálise e Psicoterapia Psicanalítica. Lisboa: Climepsi Editores
- Fairbairn, W. R. D. (1952). Psychoanalytic studies of the personality. London: Routledge.
- Loewald, H. W. (1960). On the therapeutic action of psychoanalysis. International Journal of Psycho-analysis, 41:16-33.
- Ogden, T.H. (1997). Reverie and Interpretation: Sensing something human. Northvale, NJ: Jason Aronson.
- Stern, D. (2006). The present moment in psychotherapy and everyday life. New York: Norton Press.
- Winnicott, D.W. (1975). Through paediatrics to psychoanalysis. London: The Hogarth Press
If you would like to contact João Pedro Dias, his email is firstname.lastname@example.org.