Implications for working through1
[The analyst] should withhold all conscious influences to his capacity to attend and give himself over completely to his ‘unconscious memory.’
(Freud, 1912, p. 112)
Recollecting one's repressed childhood conflicts has been a mainstay of classical psychoanalysis and in "Remembering, repeating and working-through" Freud (1914) discussed how many patients "remember" their early conflicts through actions:
the patient does not remember anything of what he has forgotten and repressed, but acts it out . . . As long as the patient is in the treatment he cannot escape from this compulsion to repeat; and in the end we understand that this is his way of remembering.
(p. 150) [italics in original]
Although these repetitions are a resistance to memory, they simultaneously are a pathway to recovering the forgotten past through the development of a transference neurosis by which the analysand’s illness becomes “not an event of the past, but as a present day force” (p. 151). Thus, Freud regards the inevitable repetitions as an invaluable tool to help the patient work through his infantile past since that troubled history is played out again in effigy through an “artificial illness” (p. 154) in the here and now of the transference neurosis. However, the transference neurosis develops slowly as though it had a timetable of its own and the analyst “has nothing else to do than wait and let things take their course” (p. 155). Freud counsels patience with this process and the analyst must curb any tendencies that distract him from paying exclusive attention to what is on the patient’s mind in the moment. Freud’s advice in this paper elaborates his recommendations two years earlier (1912) that the analyst must adopt a stance in which his unconscious is a “receptive organ” (see Chapter 5) to the analysand’s communicating unconscious and that he, the analyst, ought to give himself over to his “unconscious memory.”
In my view, there are many aspects of Bion’s work that have their origin in ideas that remained inchoate in Freud; partially developed proposals that seeded Bion’s genius and he nurtured in creative and unexpected ways. For example, Bion appears to have been greatly influenced by Freud’s (1911) paper, “Formulations on the Two Principles of Mental Functioning” 2 (Brown, 2009a, 2011a; Legoretta & Brown, 2015), and significantly reworked the concepts of the pleasure and reality principles to promulgate a theory of dreaming that broadened Freud’s first contributions (Bion, 1962b, 1992; Brown, 2012, 2013; Grotstein, 2009c). Similarly, with regard to clinical practice, though Bion does not refer specifically to “transference neurosis,” 3 he writes as though he has taken Freud’s recommendations very seriously and builds on these in unique ways. What is most evident to me in “Notes on Memory and Desire” is Bion’s unequivocal emphasis on the here-and-now of the session that is implicit in Freud’s (1914) notion of the transference neurosis as a “present day force” (p. 151), but which Bion brings into bold relief as the centerpiece of his technical recommendations. Furthermore, where Freud (1912) advises the analyst “to give himself over completely to his ‘unconscious memory’” (p. 112) and “let things take their course” (1914, p. 155), Bion (1967b) speaks of an evolution in the session that emerges effortlessly in which “some idea or pictorial impression floats into the mind unbidden as a whole” (p. 279).
These parallels notwithstanding, Bion parts company with Freud by his seemingly ahistorical approach to the session. Where Freud would stress the important vitality of repetition, Bion (1967b) is concerned that each session should be fresh in order for there to be “less clogging of the sessions by the repetition of material which should have disappeared” (p. 273), resulting in a livelier analytic pace. Furthermore, Bion states that the analyst following his “rules” will notice that
The pattern of analysis will change. Roughly speaking, the patient will not appear to develop over a period of time but each session will be complete in itself. “Progress” will be measured by the increased number and variety of moods, ideas and attitudes seen in any given session.
(p. 273) [italics added]
To my mind, this raises an important dilemma: if, as Bion says, we must unclog the sessions of repetition and that “each session will be complete in itself,” how are we to understand the process of working through? And, if progress is to be assessed solely through evolution within individual sessions, how are we to regard the established analytic practice of measuring progress by the working through of various transference/countertransference configurations over the course of many years? I will now present some analytic material to help us further think about this apparent paradox.
Edward, a friendless and socially awkward eight-year-old began analysis because of intense panic, which, when he was younger, was manifest as significant separation anxiety. A brilliant student who academically outshone his talented peers, Edward was also a loner whose only reliable companion was his beloved computer. He was eager to display his very impressive knowledge and occasionally I “consulted” him with questions about my computer. One August when he was 11 years old, shortly after my vacation and two weeks before school was to begin, I received a panicked call from his mother that Edward had “melted down.” Indeed, that was an apt term because when I saw him he was so terrified that he was barely able to speak, only able to say, “My computer crashed and I lost everything.” Although he was consciously referring to the computer’s files and documents, the underlying message was clear – that everything holding his world together was gone. I thought, but did not say, that this terror must be the current version of his earlier panic. We were able to talk about how he and his computer were an intertwined unit, like a cyborg that was part human and part machine, and also about his anxiety in starting a new school year. These discussions were very helpful and he was able to regroup emotionally in order to begin school.
I did not share with Edward my association to his earliest separation anxiety for several reasons. Typically, he was exceedingly cerebral and his affects were always muted and/or banished through his impressive intellectual strengths; therefore, finding him in a rare state of emotional vulnerability, albeit one of intense panic, was an opportunity to reach him at a moment of affective aliveness. In addition, more “traditional” interpretations that linked the present with the past were usually dissembled by Edward through arguments that skewered the logical basis of my interventions that had been reduced to a jumble of meaningless words. Thus, I approached each session as a unique experience that enabled the analysis, in certain instances, to be a “lived experience” (Ogden, 2010). Gradually these experiences of “real contact” (Joseph, 1985) in individual sessions accrued over time and created in my mind a more or less coherent sense of Edward’s inner world, i.e., what Ogden (2004a, 2004b) terms “dreaming into existence.”
Now, three years later, I find Edward, a plump and physically immature 14 year old, standing motionless at the threshold between the waiting room and my office when I open the door for the session. He does not appear frozen with anxiety, but rather seems to be casually standing in place. When I ask what is going on, he says “I’m thinking”: he isn’t sure whether he will come into the office or not. I comment that his feet are exactly positioned in the middle of the door frame at the threshold of my office as though he can’t decide what to do. Edward then steps into the consulting room, lies on the couch and I ask what had just happened. He says he is experiencing the same problem at home: that he feels compelled to stand midway at the doorjamb before he leaves one room to enter another; however, he is not feeling anxious but rather, perched in this in-between place, has a sense of calm. I say that we have been talking about how scared he is to “grow up” and that it seems being stuck at the threshold coming in today expresses his worry about moving out of the relative comfort of being young to the frightening mysteries of being a teenager; that he wants me to see with my own eyes how he is stuck. This comment feels obvious to me and Edward says he thinks I am right, though he shows little emotion. Nevertheless, this “symptom” quickly disappears in a few sessions.
Some weeks later, Edward tells me about the powerful and crippling anxiety he is feeling while doing homework. He then collapses into an anxious mass of tormented tears, self-hatred and impotent rage, saying that his life is over. He is terrified because his panic is so overwhelming that it is difficult to read and he is spending six hours or more each night doing his homework. I also am feeling utterly helpless and that I have little to give him: even when I offer interpretations gingerly, Edward pulls himself into a fetal position and weeps loudly, nearly howling in the grip of some unbearable inner torment. He says he is only able to do his homework when his mother sits next to him and I realize he needs my silent presence as a non-intrusive analyst. I suggest that he bring in a book to read in the session for us to try and get some perspective on his difficulty reading. He brings in Plato’s Republic that is assigned in one class and reads a portion about the difference between a leader who is a tyrant and the more munificent Philosopher King and suddenly a pall comes over his face accompanied by a chilling shiver. It is the notion of the punishing tyrant that frightens him, and I say I think he lives under constant threat from a tyrant inside him with no gentle Philosopher King inside his mind to protect him. For the first time in many weeks Edward relaxes and, patting the couch like an old friend, stretches out comfortably with an audible sigh of relief.
Edward’s anxiety remains very forceful but now, armed with the metaphor of the Tyrant and the Philosopher King, we are able to begin to make sense of what haunts him. Through his tears and panic, he tells me that he only received one B during his school career and all the other grades were As and A+s; now he is terrified that because of his overpowering anxiety his grades will suffer. I say that the tyrant part of him must be very unhappy with that, which brings forth a torrent of plaintive tears and the revelation of his private fear that “it would be the beginning of a slippery slope and I’ll end up living in a card board box.” I say there’s no Philosopher King in his mind to argue against, and protect him from, this cruel tyrant; adding that sitting close to his mother, and reading here with me, gives him the safety and protection he cannot feel when he’s alone. He is palpably calmed by this interpretation and there is a sense in the hour that we have arrived at an important emotional truth (Bion, 1965: Grotstein, 2004). In the months that follow, Edward and I learn a considerable amount about the tyrant part of him and his phantasy of being an omnipotent Philosopher King, themes that once contained devastating emotion but whose meaning we are beginning to come to understand.
My analytic work with Edward illustrates the apparent paradox about how one works through repetitive painful affective patterns when the focus is on the evolution in each session rather than on the overall arc of the analysis. I condensed nearly seven years of analysis and described the various forms in which his anxiety was manifest: Edward’s early separation anxiety, his sheer terror at age 11 when his computer crashed, his getting stuck halfway between the waiting room and my office at 14 years old, and his horror that with one B grade his life would end in ignominy. In my view, there was an important working through during this period of time, but a qualitatively different sort than the classical notion of “working through.” For Freud, it was an infantile neurosis, organized in early childhood and then repressed, that, under pressure from the repetition compulsion, was replicated over and over in action because it could not be remembered. However, in Edwards’ case, there was no structured infantile neurosis but there was instead a periodic destructive threat to his world that looped unpredictably from an unknown corner of the void like an unnamed comet. In this connection, working through consists of a gradual process of helping the patient bring meaning to unrepresented experience in order that, as Bion states, “Out of the darkness and formlessness something evolves” (1967b, p. 272).
Edward’s profound anxiety was simply a powerful affect that made an unstructured appearance at certain periods in his life that loosely had something to do with separations and transitions. I realized early on that offering “traditional” interpretations, such as his anxiety about crossing the threshold into adolescence, were typically met with a bland “that could be right” but with no connection to the overwhelming anxieties which persecuted him. I believe that he took great comfort from being near to me, as he was with his mother at his side during homework, and also that I was a containing companion who helped him bear the unthinkable anxieties that tormented him. It was especially vital that I could tolerate, and could share in, Edward’s paralyzing helplessness when reading was so difficult for him. It was an experience of at-one-ment Bion (1970) describes that the patient senses and is an important step in the transformation of unrepresented affects into meaningful psychic events. In patients like Edward, I believe this is an essential first step that ultimately leads to the later capacity for the working through that Freud discussed, which requires an organized and symbolically formatted template, i.e., the infantile neurosis that prefigures the transference neurosis.
In a series of papers, da Rocha Barros (2000, 2002, 2011) has explored the connection between dreaming and working through. He notes that Freud’s theory of working through was predicated on the assumption that an adequate symbolic capacity was sufficiently intact in the patient to permit the transformation of affects into dream thoughts. Da Rocha Barros (2002) states that
it is through the process of building up symbols in the dreamwork that part of the process of working through takes place . . . [because] fresh symbols are created that widen the capacity of the person to think about the meanings of his/her emotional experiences.
(p. 1085)
However, these “fresh symbols” created through dream-work, or Bion’s (1962b) alpha function,
are not yet thought processes, since they are expressed in images rather than in verbal discourse and contain powerful expressive, evocative elements.
(2002, p. 1087)
These comments are relevant to the point in Edward’s analysis, during our reading of Plato’s Republic, when the Tyrant and the Philosopher King were discussed in the book. These figures became “powerful expressive, evocative elements” that served as representatives of aspects of his inner object world. In the language of Ferro’s (2002a, 2002b, 2006, 2009b) and Civitarese’s (2005) work, these were “characters in the field” that signified the affects of the here-and-now emotional field in which Edward and I were immersed. The emergence of the Tyrant and the Philosopher King were the outcome of that component of working through that transformed emotions into what Ferro calls affective holograms4 and these characters gave Edward and me a beginning language to continue the working through process of newly defined themes that had evolved “Out of the darkness and formlessness” (Bion, 1967b, p. 272).
In discussing the “Wolfman’s” dream as an example of Nachtraglichkeit by which an earlier childhood experience was given psychological meaning by the later dream at four years old, Freud commented that
Indeed, dreaming is another kind of remembering, though one that is subject to the conditions that rule at night and to the laws of dream formation.
[italics added] (1918, p. 51)
This statement seems to suggest a role for dreaming in bringing emotional meaning to dormant experiences that now, having been given representation through “laws of dream formation” (condensation, symbolization, displacement, etc.), may be “remembered.” Bion’s (1962b) observation that these “laws of dream formation” are continuously active while we are awake and asleep has greatly impacted current psychoanalytic thinking that underscores the omnipresence of a psychic function5 that constantly transforms raw emotional experience6 into meaningful psychological events. However, I think it is incorrect to say that previously unrepresented states, now transformed through alpha function, are “remembered,” as Freud says, but rather that they are made available for thinking for the first time. In this regard, the appearance of the Philosopher King and the Tyrant in Edward’s analysis was a vital step forward because it gave us two meaningful characters (representations) to embody affects that previously were without shape and form, existing only as nameless somato-sensory bombardment. As da Rocha Barros (2002) has stated, these images “are not yet thought processes . . . [but] contain powerful expressive, evocative elements” (p. 1087) that promoted further elaboration in Edward’s analysis.
Freud’s (1914) concept of working through assumed the existence of an organized infantile neurosis constructed from symbolic elaborations of childhood conflicts and compromise formations. Anna Freud (1970) added that
Seen from the developmental point of view, the infantile neurosis can represent a positive sign of personality growth; a progression from primitive to more sophisticated reaction patterns.
(p. 202)
However, in patients like Edward, this “progression from primitive to more sophisticated reaction patterns” has not occurred, leaving the analysand vulnerable to invasions of “nameless dread” (Bion, 1962b). In such situations, I believe that working through occurs on both the macro level over a period of time as well as on the micro level in which “each session will be complete in itself” (Bion, 1967b, p. 273). The analysis must first proceed on the micro basis, inhabiting each session as a seemingly isolated outpost, like a string of islands that are later brought together into a unified nation. From the large-scale vantage point, the analytic work aims at containing the anonymous terrors plaguing the patient and helping to build and/or strengthen the “apparatus for thinking” (Bion, 1962b) necessary for symbolization, i.e., to give a face to the analysand’s fear. Once accomplished, as when Edward offered the characters of the Tyrant and the Philosopher King, the analytic pair can engage more interpretively with each other and collectively face the pain which now has an identity.
These “isolated outposts” are the building blocks from which the analytic pair can construct a narrative of the patient’s emotional life. The initial linking together of these elements occurs within the mind of the analyst as a sort of construction (Freud, 1937), a working hypothesis about who the patient is, i.e., “dreaming the patient into existence” (Ogden, 2004a, 2004b). For example, at the beginning of Edward’s analysis, I knew from his history that he had been frightened of separations as a young child, but there was no way to access this in the sessions until one hour in which I needed to leave my office for a minute to get some more paper for drawing. Edward grew terrified and asked me not to leave, but he did not know what frightened him. I was able to give a name to the fear, “people going away,” that enabled us to speak about it and it was the start of our developing a narrative about his psychic life. Later on, when his computer crashed, I could add that he felt like a cyborg, which was another denotation of his inner experience of himself. Further on in the analysis, when he was stuck in the threshold of my waiting room and office, I added that change was very frightening to him; however, my comment did not have any meaning to Edward emotionally. Nevertheless, it registered quite profoundly for me as I witnessed his paralysis in the moment that facilitated a more complex view in my mind of what was overwhelming him, which could best be described as, “Edward, now heading into adolescence, frozen and terrified of change and separation that could lead to his complete and utter collapse.” However, his apparatus for thinking thoughts was still too impaired to tolerate the affects associated with my inner view of him, so my “dream” of him, of necessity, remained my speculation.
Edward’s capacity to represent his internal world through reference to the Tyrant and the Philosopher King was a significant leap forward in his growing ability to use symbols to convey his emotional inner life and illustrated da Rocha Barros’ (2000) observation that
What is felt as internal pressure must be transformed at first through images, and then into a broader channel of expression made up of words, in order to become part of our process of thinking.
(p. 1097)
It is important to note that these characters (the Tyrant and Philosopher King) were Edward’s creation: he brought them into the session and these represented two different emotional currents that initially were “felt as internal pressure” but now signified two discreet internal objects that prefigured later transference manifestations. This forward movement also resulted in the growth of a more deeply enriched analytic process in which both Edward and I were engaged in an unconscious intersubjective exchange (Brown, 2010, 2011a) that spontaneously created new meanings. Thus, he had evolved to a point at which he could form the emotionally evocative image of fearing that he would collapse and end up living in a cardboard box.
Edward’s figures of the Tyrant and Philosopher King comprised a vital instance in the analysis and it brought to my mind the work of the Boston Change Process Study Group7 (henceforth, “Change Group”) (2010, 2013) that places great emphasis on analytic encounters that create now moments described as
short subjective units of time in which something of importance bearing on the future is happening in the dyad . . . Clinically and subjectively, how analyst and patient know they have entered a new moment, a moment distinct from the usual present moments . . . is that these moments are unfamiliar, unexpected in their exact form and timing, unsettling or weird.
(2013, pp. 735–736)
These moments typically produce some turmoil in the on-going mood of the analytic dyad that initiates an action by the analyst, whether an interpretation, an enactment or even a response of silence. The Change Group views such moments as opportunities for change, though the analytic pair may at first wish for a return to the status quo; however, the analytic situation at such times is ripe for the emergence of new patterns of relating that have advanced in a nonlinear way. Indeed, the appearance of the Philosopher King and Tyrant signaled such a pregnant moment that catapulted Edward and me into a new terrain: the emergence of a greater capacity for symbol formation and a “broader channel of expression made up of words” that da Rocha Barros (2000) described.
Much of what the Change Group sees as essential in analysis is consistent with the ideas that I have been discussing, though there are some important differences. Their concept of now moments is a significant contribution that I would relate to Bion’s ideas of the importance of the here-and-now as well as his concept of the caesura (Bion, 1977; Aguayo, 2013), which marks the sudden change from one mode of being/relating to another; creating an experience of newness and even disorientation. Similarly, Bion’s (1966) notion of catastrophic change, the calamitous fear that a situation has suddenly and dramatically been altered, appears to link with the Change Group’s emphasis on how unsettling the appearance of new ways of relating may feel. In addition, the Change Group’s underscoring of nonlinearity is consonant with the perspectives offered in this chapter; however, there are some major differences in how these two points of view diverge – the role of unconscious processes, an appreciation of the subtle intersubjective exchanges that account for the emergence of “now moments,” a recognition of different gradients of representations and their role in therapeutic change. I (Brown, 2010, 2011a) have been outlining a model of change that first and foremost hinges on a constant unconscious communication between the psyches of patient and analyst that either aims to uncover repressed unconscious contents or to transform unrepresented affective experience into symbolized and emotionally meaningful experience. Projective and introjective processes are the thoroughfares along which unconscious to unconscious communication travels and alpha function in the analyst and patient is responsible for encoding and decoding unconscious messages. In my view (Brown, 2009a), this process is at work constantly but, since it is unconscious, it is difficult to access except through dreams, one’s reveries and countertransference phenomena. Furthermore, working through involves changes in the unconscious, which is comprised of phantasies that may be “registered” as somatopsychic events and exist as yet-to-be-processed emotional experience.
I find that the Change Group tends to underemphasize the role of unconscious processes in their work8 and that when the unconscious is mentioned (though rarely), it is a different notion than the one promulgated in this book. Instead, they speak of “nonconscious” happenings, “implicit relational knowing” and “implicit relational exchanges”; the latter concept referring to the
assumption that the patient and analyst are generally working hard to intuitively grasp each other’s implicit intentions and directions. Conversation between them occurs continuously.
(Change Group, 2013, p. 729)
This quote conveys an impression that accentuates conscious dialogues, though the wording “implicit relational knowing” seems to suggest an unconscious aspect. Similarly, the Change Group refers to
Implicit experience [that] is not necessarily dissociated experience, unformulated or repressed, and the goal of working with it is not to transform it into an understanding within the reflective verbal sphere.
(p. 734)
If an experience is not dissociated, unformulated or repressed, then the only other option is that it is a conscious experience or, perhaps, “non-conscious,” but it is not clear what the authors mean.
The term, “implicit relational knowing” derives from cognitive psychology and is “one variety of procedural representation . . . [which is about] how to proceed, how to do things” (Change Group, 2010, p. 166), including interactions with others. Procedural representations are not conscious phenomena and neither are they part of the dynamic unconscious, but are non-language based automatic ways of behaving. The Change Group is describing procedures like “knowing how to joke around, express affection and make friends” (ibid, p. 166), but this emphasis seems to leave out so much that is central to the ideas about what constitutes a meaningful psychoanalytic engagement as I have outlined in this book. For instance, as we have seen in Chapter 10, the capacity to tell a joke is an extremely complex intersubjective event; thus, “joking around” is an important development achievement that depends on the successful maturation of several interconnected factors, most of which occur unconsciously.
This chapter has explored the impact on our understanding of the process of working through of Bion’s emphasis that each session is an entity unto itself and that the analyst ought to approach each clinical hour without memory and desire. I have suggested that working through, especially when dealing with unrepresented experience, occurs on a micro and macro basis. The micro basis involves working in the immediacy of the clinical here-and-now moments with the assumption that, over a period of time, themes in individual sessions will cohere into meaningful narratives. Working on the macro basis, on the other hand, involves the analyst being mindful of the overall arc of the analysis with an eye on developing transferences and countertransference over a long period of time. Clinical material from Edward’s long analysis was discussed to illustrate the process of working through from both points of view – micro and macro. Finally, some similarities and differences between the model proposed in this chapter and the standpoints of the Boston Change Process Study Group have been examined.
1 Expanded version of a paper given at the International Psychoanalytic Association Congress, Prague, 2013.
2 This work is cited more than any of Freud’s other papers.
3 What Bion (1965; Chapter 4) would term a “rigid motion transformation.”
4 Or affective pictograms according to da Rocha Barros (2000).
5 Alpha function.
6 The reader is referred to the recent book, Unrepresented States and the Construction of Meaning: Clinical and Theoretical Contributions, edited by Levine, Reed and Scarfone, for a more detailed discussion of these processes.
7 This group consisted of Nadia Bruschweiler-Stern, Karlen Lyons-Ruth, Alexander C. Morgan, Jeremy P. Nahum, Bruce Reis, Daniel Stern and Louis Sander.
8 The concept, “unconscious,” is not listed in the Index of the Change Group’s Change in Psychotherapy, a Unifying Paradigm (2010).