Juan-David Nasio: Dr. Ornstein, what is the position of the psychoanalyst, his role, his place in the transference, in your clinical practice? And in this context I’d like to try to make a distinction between the way we conceptualize the role of the analyst and the way you do. I’d like to know if you would agree with me that the selfobject in reality corresponds to the position of the analyst as the other—the “other” with a small “o,” that is, an imaginary other who makes it possible for me, through his reflections and through what he gives back to me, to consolidate my being, or rather my ego, my self.
In my practice there are moments, with a patient, in which I have to do the same sort of thing you did with Dr. White, for example to send back to him a series of images. In other words, I place myself in the imaginary schema, so that I can share his psychic pain. But what you don’t say is that this position of the analyst as the imaginary other is possible only if he can also be present as the objet a that isn’t imaginary.1 That is to say, the structural formation of the transference is essential for us. I can’t share Mr. White’s psychic pain even if I try to understand, even if I’m empathic, except on condition that my role, my place—even if I don’t necessarily have to occupy that place—on condition that in the transferential relationship there is a place for an object that serves as motor for the fact that the patient is there, that I am there, and that the transference exists. As you see, these are two different schemas. The first is the structure of the unconscious, where we recognize the place of the object as the motor behind the treatment, and the other schema, which the first one makes possible, is the one where I can function, at certain moments (carefully chosen, of course) as the imaginary other. If I understand you correctly, it’s there, as imaginary other, that you locate the selfobject in the transference.
Anna Ornstein: One way to answer some of the questions would be to tell you how I understand your concept of the unconscious, and how we think about the unconscious. Once we have settled that, maybe it will be easier for us to talk about the issue that Dr. Nasio just mentioned: What is the place of the analyst? How does the analyst experience the patient’s transferences? You understood the selfobject concept very well. That’s what transference is, and was for Freud: The patient creates the transference, so the position we take is wherever the patient happens to put us. However, since there are many roles, many identities that the analyst assumes, obviously it is very difficult to know at any one time where the patient has put us. We bring to the patient’s transferences our own ideas of the way the mind works. We bring our theories about the model of the mind, about personality development, about psychopathology, and with all that we develop a theory of cure.
So what is our notion of the unconscious? The longer I listen to my Lacanian colleagues, the more it seems to me that the way you think about the unconscious is the way Freud formulated it in the topographic model—as a system, “the” unconscious. Now in my own training, and whatever I’ve learned since then in American psychoanalytic theory, this is not the way that we think of the unconscious—as a structure, and now, with the Lacanians, as structured according to the rule of language. This is totally new and foreign to us. We think of unconsciousness, which is a quality of the psyche. In other words, what we are experiencing at one time can indeed be unconscious, but it has the potential of becoming conscious, which was, in the topographic model, only accorded to the preconscious. So we see a line coming from deep unconsciousness, if you wish, to—depending on the context, the situation—a time when things indeed can become more conscious, which is very different from your views.
Because of the way I see a difference between a system unconscious and a quality unconscious, I might as well stay on the subject of fantasy, a very important psychic phenomenon. I found here in France a very big difference in the way the concept is used. Some of the most important work on unconscious fantasies was done in the States by Jacob Arlow. He links them to the vicissitudes of the drives. In other words, the unconscious fantasy is the product of the conflicts and difficulties that arise in relation to the various developmental phases that a child cannot master for whatever reason. It is a deeply endopsychic notion. In self psychology, once Kohut no longer considered drive vicissitudes as being the motor behind development and symptom formation, many other things in our psychoanalytic terminology had to be reconceptualized. When Marcianne Blevis gives fantasy an organizing and essentially curative role, that is the way that I would like to consider it. So for self psychologists unconscious fantasy is associated with drive vicissitudes, while fantasy, the way that patients report about it and we all experience it, does not have to be considered as a defense, as in traditional psychoanalysis, but indeed as a way in which the patient is trying to get well.
What also comes into our dialogue is the difference in the way we view symptoms, which I now begin to compare to the way you view language. We view symptoms—the way, for example, that my patient had suffered from deep melancholia that contained the cruelty, and from anorexia—as a kind of language, a communication. This was the final common pathway that this man had found, over his lifetime, to deal with the various anxieties, including rage experiences, that he could not master any other way. So while you deconstruct language, in order to find your way to “the” unconscious, we deconstruct symptoms to find meaning.
Dr. Blevis raises the issue of what Dr. White really wanted to do with the symptom; did he want to deny the presence of rage, or did he want to communicate to the people around him how he was suffering? Now if you think of a symptom—complex, anxiety, defense, anxiety, defense—then you get a conglomerate in which the patient found a place for the sadism, for the longing, for reaching out, for withdrawing. This is the work of the psyche, like dreams, but now we have the symptom, which can be conceptualized in much the same way. So when the patient presents with a symptom, and the process of therapy or analysis begins, and the symptom becomes deconstructed, in a way, and more of the elements become obvious, then maybe I am no longer thinking in terms of “where is my space as an analyst?” I have been asked why I place such importance on the patient’s feeling understood, since (it is argued) that should be just the ambiance, the context, in which a lot of other work is done. But our empathic capacity lays the groundwork for what the interpretive work has to accomplish.
This is our therapeutic stance, and you may say this is not an analytic stance, because a Lacanian analyst will want to get into the death instinct and you want to name everything that is in the unconscious. But what we are trying to do is have the patient feel that I make an effort to understand. And I will not fully understand; we never understand each other fully. But if they experience me as making an effort to understand, this is when one of the self object transferences will be established, as Dr. Nasio said. Where is the analyst in this? In the place in which the patient can now begin to experience himself. Because when my patient, Dr. White, has this experience with the mother and the child, it is not what he sees that is important to us, not the perception, because that’s an external observer’s perspective. What is important to us is what the patient felt. The patient felt envy and jealousy. And that is what was articulated by him and was recognized by us as a very important motive for his withdrawal and for his rage reaction. So understanding, or making an effort to understand, has the function of providing the patient with an experience of relative self cohesion in this very safe environment that is now offered by the analyst. It is under these circumstances that the patient can begin to look at himself and ask those different questions: “Where is my rage coming from? Why am I so angry?” and so forth.
1. Editor’s note: Objet a is the ultimate object of desire, but one that eventually turns out not to exist.