The Enacting Receptivity of the Mind/Body Relational Psychoanalyst: Interacting with an Invaded Patient with Somatic Vulnerability

by António Mendes Pedro*
Universidade Autónoma de Lisboa, Portugal

Author Note

*António Mendes Pedro, PhD, is a Professor of Psychology at Universidade Autónoma de Lisboa and a visiting Professor at Université Paris XIII. He is also the Director of Center Kairos, in Lisbon, Portugal (Psychology, Psychosomatic and Philosophy) and a founding member of the Portuguese Association of Psychoanalysis and Psychoanalytical Psychotherapy.

The article is based on the communication presented at the 23rd Annual International Forum for Psychoanalytic Education (IFPE) Conference, in Portland, Oregon, November 3rd 2012.

Adress correspondence to: António Mendes Pedro, Universidade Autónoma de Lisboa, Palácio dos Condes do Redondo, Rua de Santa Marta, nº 56 – 1169-023 Lisboa; E-mail: amendespedro@netcabo.pt; Phone: +351 96 38 52 164.

 

Abstract

Some people practice psychoanalysis with spontaneity, probably because they are more used to act than to indulge in contemplation. Emphatic enactment and a specific manner of interpretation that characterize those people are all the more relevant in psychoanalysis in those cases where the patient, in the course of their live, did not have the benefit of ability to improvise nor have they acquired the experience of empathy. We will present a case study concerning a psychoanalytical relation that began eight years ago, and within which interactive changes took place, not only on the patient’s side, but also on the therapist’s. We believe it essential to the process of change within the mind/body unity, as well as to the relational style, that both therapist and their pair extricate themselves from transference-countertransference and create, from the very beginning, a relation of a new kind.

 

Keywords: Receptivity; Enactment; Interpretation; Mind/Body; Relational Change; New Paradigm; Creativity. 

Introduction

For the process of change to occur, it is necessary that, from the very first moment of the dyad’s life, the psychoanalyst establishes a Relation of a New Kind, through their enactory receptivity and through the use of interpretation.

Emphatic receptivity (einfühlung), which allows the analyst to apprehend the patient’s world, even where the latter cannot make sense of themselves, stems from the analyst’s availability to let himself/herself be permeated by those minute details (spoken or acted) conveyed by patient that evoke/bring about a body resonance. Emphatic enactment is the emotional-cognitive anticipation that, in the mind of the analyst, organizes itself in the analyst’s body and leads them to almost involuntary action, with metaphor-inducing power.

Gustav Mahler was able to express such creative experience a propos the last movement of his Symphony No. 2, on the theme of resurrection; in the composer’s words, as relayed by Henri-Louis de la Grange, ‘It struck me like lightning, and everything was revealed to my soul clear and plain. What I had experienced on that day, I had yet to put it in sounds. However, had I not already carried that work of art within me, how could I have experienced such a moment? It has always been so in my case: it is only by experiencing the sensation that I can create through sounds, and it is only when I am creating through sounds that I can experience the sensation’.

Emphatic creativity can manifest itself in the therapeutic relation if that relation is centered, not in the patient’s past, but in the small concrete things of the patient’s everyday life – in those things that are performed and experienced in the present. As Husserl put it, subjectivity has to do with ‘the now’.

Interpretation presents thus itself as a powerful means to hinder the setting of transference neurosis, i.e., it is useful as a tool for disassembling and rendering explicit the repetitive relational style that comes from the past and challenges the construction of the New Relation within the analytic pair.

A psychoanalytic encounter that evolves imposing three different rhythms to the relation

To illustrate the change in terms of relational style, we present the psychoanalytical psychotherapy of patient Anna, a therapy that has been developing for the last eight years. Anna’s psychotherapy has inaugural significance to the analyst, for it nurtured the process that led to his rupture with drive theory, in favor of the new paradigm in relational psychoanalysis. The contributions that have ultimately led to that change were: Anna’s relational questionings, which posed problems that were difficult to solve; fruitful exchanges with António Coimbra de Matos, the Portuguese psychoanalyst who developed the theory of New Relation, and who was justly honored on the occasion of the 23rd International Forum for Psychoanalytic Education; and the writings of the Boston Change Process Study Group, which lead to two hypotheses that it is important to put to the test: i) Psychoanalysis is a relational process with enacting action and interaction, experienced in the present, through both conscious and implicit processes; ii) Intrapsychic conflicts and defenses are not the cause, rather the effect, of early developmental relational experiences.

The approach taken to the psychoanalytical relation developed with Anna can be differentiated in three stages: 

1st stage

In our first session, Anna, 27 years old, says that she wants to be analyzed because she wants to develop herself, although she does not wish to abandon her parents, with whom she lives, and who are ill and growing old.

Anna’s bearing and discourse evidence a woman with no significant vitality, with no more than superficial relationships, and who lives focused on her occupation of well-behaved nurse – exactly as her father has compelled her to be. She remains a virgin and, in the course of her life so far, had but one romantic (platonic) relationship, in her teenage years.

She exhibits psychosomatic characteristics and was enuretic until the age of 12 years. Weighting 264 pounds, she is quite obese, with endocrinal alteration, including high levels of prolactin. She also suffers from cutaneous eruptions in her arms and legs, characteristic of a dermatological autoimmune disease.

Anna’s father, a former seminarian, is an authoritarian and stingy man, a man of the old regime – the Portuguese dictatorship that lasted 40 years and ended in 1974. He is the kind of man that speaks to his daughter through her mother; a sulky and ill-humored man; one who favors his son (male offspring) over his daughter (female offspring), but who has nevertheless made his daughter, then entering adolescence, swear to him that she would never leave him. He is, furthermore, a man of incestuous tendency, who never kisses his daughter, but who forced her, when she was about five or six years old, to wear gloves when she went to bed at night, so that she would not masturbate herself, and who also has the habit of trying to press his body against hers when they pass across each other on the stairs of the house where they live.

Anna’s mother, who suffers from an autoimmune pathology – rheumatoid arthritis –, is a subdued and depressed woman who had six or seven miscarriages before Anna was born, and whose relation with her daughter is marked by highly contradictory signs. Anna’s mother also favors the couple’s son, twelve years older than his sister; when she pays attention to her daughter, she does so in a dispersive manner, something that is somewhat absentmindedly done in between her other charges (either required by her illness or concerning her husband), and oftentimes reversing the mother-daughter roles.

Anna’s relation with her parents is thus felt by her as chaotic, in that it is composed of relational patterns that are either invasive, or incestuous, or unpredictable, forcing her to be on a quasi-permanent state of alertness.

During the first stage of therapy, and abiding by the guidelines of the Psychoanalytical Society, the psychoanalytical relation developed at a pace of four sessions per week. This first stage comprehended three and a half years, during which several of Anna’s relational patterns were brought to light:

– A relation mode that is superficial and avoids hypervigilance, where Anna shows to be an exemplary daughter and nurse, sacrificing herself for her parents and patients. Invariably composed and punctual, she makes but casual and flabby conversation. In this context, the first dream she shares takes place in All Saints Church, where Anna is in the company of other nurses and nuns, beside Mother Antoinette. In this, as in everything else, we were led to associate, in transferential repetition, the primary formal resemblance Antoinette/António (the analyst’s given name) and the context of Anna’s childhood, that she was now bringing to the analytic relation.

– Two other patterns that Anna will progressively let emerge in the relation are characterized by love and hate entwined, exclusively directed towards the analyst.  Erotisation manifests for the first time through a dream, almost two years after the beginning of therapy. In that dream, Anna, in a euphoric state, moves along the Lisbon Bridge which, in her dream, is made of hammocks, jumping from hammock to hammock. At that time, rather than reinforcing a return to the past, to a childhood desire, the analyst showed her that the desire expressed in the dream was aimed at the near future, and linked to her own fear of losing herself in it. All flustered, Anna keeps on progressing, taking pride in the fact that she already masturbates herself, but saying that she wants more – she wishes to ‘do things with the analyst’. In that she insists on this point, and because that provokes the analyst’s narcissism, she is then confronted with understanding what psychoanalysis is and entails. Then, overcame by intense feelings of anger and paranoid rejection, she reaches the point of screaming, violently, that she feels persecuted, controlled and abused by the therapist!

– A fourth pattern evidenced by Anna over those first years of analysis is characterized by a strong anxiety that occasionally dominates her during sessions, where terror and stress seem to overpower her; on those occasions, she halts communication with the analyst, sulks and either becomes aloof or begins, in a frenzy, to make calls on her cell phone.

Those years of therapeutic relation are abruptly interrupted when Anna eventually admits to her tyrant father that which she could not bring herself to allow, namely, that she was in love with her analyst. Anna decides then to put a stop to her psychoanalysis.

2nd stage

A second stage of our psychoanalytic relation, a stage that will last three years, will then begin, where the relation becomes secret, for Anna keeps on assuming before her parents, as well as before friends and acquaintances, that she has ceased to be analyzed. We keep the therapeutic relation on a fortnightly, sometimes weekly, basis, with the singularity of our encounters being decided by Anna a la carte – a format I acquiesce to explore.

Anna seems to wish to circumvent the promise she made to her father and, in fact, it will be in this context that she effects some actual changes in her life: She moves out of her parent’s house, moving to a town 100 km away; She quits her former occupation, thus renouncing to the professional activity chosen by father, and takes a secretarial job, that of executive assistant in a company located in the town she has moved to.

Little by little, Anna accedes to a more assumed and more constant relational style, with less abrupt alternations. Such style, while still marked by erotomania, allowed her to experiment, in a virtual manner, those forms of romantic intersubjective relationship that she had been very much afraid of, that she had never lived in the context of an actual relation, that her father had forbidden her to experience. Her fantasies become now those of feeling enveloped, as if by an octopus, by the analyst’s embrace, and she figures herself in siren’s songs, seducing Ulysses.

As the psychoanalyst gains room in her mind, Anna seems less prone to anxiety; on the other hand, brutal reactions of depressive detachment begin now to dominate her, occasionally inhibiting her from lying down on the couch. When this happens, from the moment she arrives and until she leaves, she does not say ‘hello’, she does not make eye contact with the analyst, she does not say ‘goodbye’.

One day, however, a period begins marked by anger, rebellion and hatred against her brother, who, until now, Anna always adored, as much as her parents. Such hatred shifts progressively into a generalized and assumed diatribe against all men (with the exception of her father), in that she feels deeply humiliated in her image as a sexed woman, for, as she put it, ‘I don’t care for men and men don’t know how to appreciate me!

Gradually, that same anger becomes directed towards women, who are all described as jealous, two-faced and hypocritical. Anna’s anger towards women is her anger towards her mother, who adores Anna’s brother – it is not, therefore, and contrary to the classic paradigm, an oedipal issue.

The procedure where aggressiveness is directed towards external targets does not prevent Anna from episodically putting her psychoanalyst in the mix, blaming him – accusing him of being responsible – for the circumstance of her having no man in her life and for forcing her to get herself one!

At last, Anna lets it come to the surface her intense depression of neglect with feelings of emptiness. She attempts to react with romantic fusional signs, by sending telephone messages, namely on Sundays – the day when she feels lonelier – and the analyst suggests that they can meet on those Sundays, should they both be available to do so. There begins a period where Anna alternates heart-felt handshakes (at the beginning and end of sessions) with arriving late, or taking an inordinate amount of time counting and recounting the money with which she pays for the session. She needs her analyst controlled and seduced, at her disposal, so that she may face, and not let herself be engulfed by, her massive depression.

In enacting empathy with Anna (who expects her analyst to be an object of anaclitic nature, a support she can lean on) the analyst, who sees her movements and suffering, and wants for her what she wants for herself, acts outside the classic guidelines.

It is then, and only then, that Anna comes to revisit her rage against the family intoxications of her childhood. Confidently leaning on her own curiosity, she begins researching her past, and comes to realize her complete lack of relationships with other children when she was little. She rebels against the solitude that her family forced her to endure; against the nonchalance that surrounded the choice of her given name; against the fact that she was not christened before she was six years old; ‘They were waiting for Anna to die!’ – the analyst bringing here to the surface her implicit intuition. Anna begins thus to think, and to elaborate, on her horrid pool of depressiveness, of which she had been hitherto unaware.

Afterwards, Anna begins to take a somewhat loving and caring interest on her herself. In her new occupation, she begins to show herself competent in the eyes of others. She shows that she is capable of living on her own, in an apartment she herself has rented. She begins to arrange for spending time with workmates (female and male) outside office hours. She shows up at sessions with a confident and hopeful smile; her own voice becomes more pleasant to hear. She values her sexual self-image. She begins attending a gym so as to loose weight. The furuncles on her arms, that prevented her from wearing short-sleeve tops, disappear. In other words, she makes progresses as to the idiomorphic identification with herself, and that process of self-identification becomes central both in her relational process with others and for her mind/body unity.

Anna becomes pleasant, ‘I like you’, she says, ‘you are warm and understanding. You care about me … I like our relationship’. She fears, however, that she may be no longer recognized and thus makes successive tests.

Our relation advances towards complementarity, for we are now sharing points of view on a variety of subjects. We begin to use colorful metaphors. There is an enthusiasm that emerges in our relation.

3rd stage

She eventually suggests that our meetings should go back to take place according to a regular schedule, that of one session per week.

In this third stage, initiated a little over one year ago, her father becomes the total object. Anna begins to accept, without violent outbursts, the interpretive explanations concerning her father that are put forward by the analyst; she herself will at one point accuse him of being ‘incestuous’, and of ‘disliking women and being gay’. She adds, ‘I’m no longer afraid of him; I don’t take him, nor what he says, seriously’. Always highlighting her mother’s age and illness, Anna continues to fail to identify with her, albeit acknowledging that her mother has always been a good housekeeper.

The creative aspect of our relation begins now to lead Anna to elaborate on her strong inferiority depression, an elaboration that will allow her to get closer to men, particularly to a certain nurse.

Comment:

We can change – both Patient and Psychoanalyst!

Throughout the first stage of our psychoanalytical relation, Anna relives and updates the relational style of dyadic exchanges she experienced when she was a baby and a small child. Anna acts and reacts through the incorporation of unpredictable relational patterns, at times excessive, other times superficial, because her parents – one, depressed; the other, incestuous – have treated her according to such invasive and inconstant relational patterns. For this reason, Anna’s strategies only stabilize either in the form of superficial relations or in depressive disorganization marked by a state of permanent alertness – in positive correlation with her immune and somatic vulnerability.

As to the romantic relation with strong erotomaniacal manifestation, the analyst has deemed it, not an instance of classic resistance, rather a transitive process – a building metaphor of Anna’s mind/body unity, where, in a confused way, Anna was able to distance herself from her incestuous father and practice (in virtual fashion) the possibility of developing romantic attachments with other men.

That said, in the first stage of our analytic relation, while developing the context of transferential repetition, here illustrated by Anna’s identification with her mother and by the significance ascribed to dreams, the analyst made a serious mistake: that of hindering the patient’s possibility to accede to the New Relation. Only later did he understand that, by placing herself in a therapeutic relation, Anna was looking for her analyst to be the opposite of what her parents had provided to her, viz., the shoulder to lean on, the anaclitic object that would allow her to get closer to men. Building on the enacting empathy of the analyst, Anna was able to retake her development, until then suspended due to anaclitic want.

As Novalis has said, ‘Every beloved object is the centre of a paradise. Perhaps because of that, the analyst let himself be led by infra-verbal and verbal details conveyed by Anna, namely her tentative instances of rebellion that, in actual fact, represented her ability to escape, and to practice her opposition, to the dominant influence of her father, in the absence of a mother that stood by her side. And thus, instead of treating Anna as an irritant alexithymic psychosomatic patient with hysteric traits, the analyst sought to be continuingly receptive to each and every movement of life and vital affection Anna would let on. She was thus able to show that she was more sophisticated than she appeared to be, and accordingly express and develop unexpected and spontaneous emotions and feelings. Enactment consisted here in the analyst allowing himself to be led by Anna, courageously and without fear, rather than with sloppiness (which would have been schmaltzy and conducive to regression) – in fact, with genuine tenderness, in the sense of Sullivan’s theorem of tenderness.

We, i.e., both Anna and the analyst, have learned to surf the waters, in spite of dealing with wavy and unknown tides, in that we have gradually distance ourselves from psychoanalytical grids:

a) Our relation came to be developed at the level of everyday small things, which allowed for intersubjectivity;

b) Current local and concrete experiences constituted themselves as small discoveries of real meaning in the relational context. Such discovery of meaning has incrementally replaced deep-rooted global verbal contents: in Anna’s case, that of a family Catholic religious mystique; in the analyst’s case, that of psychoanalytic ideology.

c) Rather than focusing on analyzing a remote past, we decided to consider nocturnal and diurnal dreams, taking the projects and fancies they were made of as states of awareness, capable of exploring and anticipating the near future.

The psychoanalytic relation had inaugural significance, not only because, in its course, the analyst progressively realized the importance of enactment, which stems from a bodily non-verbal process and moves towards building meaning, but also because, in that which is relationally experienced in small scale and in everyday life, there occurred seriously critical moments that allowed us to jump farther:

– When, one day, our paths crossed by chance in a café and we acted circumspectly, Anna reacted with anger because, as she put it, ‘we behaved ashamedly’. This event was the final drop that led us to definitively break from the neutrality and transference-countertransference model.

– When we realized that, in the session that followed some particular interpretation, Anna became violent, we started paying much more attention to the implicit in the relation. Enactment made the analyst decide to go and welcome Anna at the landing that led to the office’s door when he felt Anna was especially suffering. We began to look at each other with a genuine look at the end of each session – an essential moment that resonated emotionally with what had took place during the session. It was by that time that Anna began to relate – ‘There is something different about you now; you are a different person’.

Changes began thus to emerge, because we began to feel complementarily. There was a probing of what reverberated in the other; there was a common desire to widen the field of our relation.

In his notebook, the analyst started to register, less the content of the communication developed with the patient, and more prominently the intentionality of that which reverberated infra-verbally, and the acting movements to which both therapist and patient were compelled.

Interpretation ceased to be a magic process based on the psychoanalytic grid (Oedipus complex; classic interpretation of dreams; childhood sexuality;original ghost ) and it started rendering explicit those implicit aspects that occurred in the relation. The interpretation focused on dismantling forms of pathogenesis that were set in our relation and on dismantling pathogenic relations that Anna experienced in her everyday life. Although unsystematically, it would also focus, on a third stage, in dismantling Anna’s childhood relational styles.

What we gained by following this course of action was the setting and the development of the New Relation.

Conclusion

1 – The finding of meaning does not stem from the symbolic or from stereotyped theoretical models; it stems from the intentionality of one’s actions, so that, as human beings, we act and react on the basis of significations that are generated within us in the context of our relations with others.

2 – Particularly, dreams, which are always random in their significance, for they are invariably based on an association of continuity, similitude and contiguity, are not necessarily to send us back to childhood desires. The meaning of nocturnal and diurnal dreams is not hidden and turned towards the past, despite it being an obvious training program, in a virtual reality, that, based on association of causality, purpose and signification, plans for action and anticipates creativity in wakefulness – be it with the aim of preserving the status quo due to fear, be it with the aim of experimenting the desired relational change.

3 – From the mind/body unity perspective, thought is not a by-product of an inhibition of action; it is, rather, dependent on gestures and emotions, on movements and actions. Therefore, the deepest level of the analytic situation is the interactive relational level, lived in the present and directed towards the future. Because this is so, the field of the new psychoanalysis should be designated by new concepts.

4 – The purpose of psychoanalytic treatment is thus that of a transformation process on the relational style, where Interpretation deconstructs everyday and childhood pathologic relations and where the analytic pair creates a New Therapeutic Relation, as if in a laboratory. This new Relational Model is eventually integrated, and will work as representation scheme for life experienced outside analysis and after analysis is completed.

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