Psychoanalytic Engagement

The interactive dimension of the patient-analyst relationship received considerable attention in the early work of Ferenczi (1916, 1950, 1955) and Rank (1929) and also in the interpersonal literature, particularly in the writings of Sullivan dating from the 1930s. […] Attention to the analytic interaction is also evident in the writing of Lacan (1936, 1952, 1956, 1961), Winnicott (1947, 1963, 1969, 1971), Little (1951, 1957), Fairbairn (1958), Guntrip (1969) and Searles (1965, 1979)

Although these authors differ in terms of their theories of personality […] they agree that the analytic interaction constitutes a transactional field. I believe this has radical implications for a theory of technique.[…] We are forced to expand the traditional view of transference as the analytic “playground” (Freud, 1914) to recognize that transference and countertransference constitute an interlocking unity, and that all of the transactions in the immediate field of experience constitute primary analytic data. […] In the choice of whether to address the immediate transaction, and to what degree, or not to address it at all, the analyst exerts leverage on the way the relationship will evolve. […] 

The analytic transaction, by its very interpersonal nature, provides unique opportunities for new experiences. […] Focusing on the transactions between patient and analyst, and on what goes on affectively between (and within) each of them, as primary analytic data makes it possible to delineate what is being structured interactively in process. Styles and patterns of bonding, expectations, sensitivities and patterns of responsiveness including tendencies to collusion, or to carrying the emotions of the other can begin to be clarified. 

This allows for disavowed experiences to be reclaimed and for exploring the motivations for the prior disavowal in the context of a new sense of choice, competence, and responsibility. Emotionally significant associations to the past and memories of relevant historical material not available before often then begin to become accessible, allowing new perspectives on the past. This in turn, can open the possibility for a necessary and important process of mourning. 

[…] Many authors have also noted that with more disturbed or primitively organized patients the analyst’s active responsiveness may be essential if any kind of therapeutic change is to be achieved.

 […] Winnicott (1947) focused on the importance of knowing that one can evoke the analyst’s hatred so that one can work through one’s own, and of the opportunity to experience that it is possible for the analyst to withstand and survive one’s aggression[…] Winnicott also notes that the opportunity to discover that one has impact, and what that impact is enable the patient to clarify the limits of his or her assumed helplessness as well as his or her assumed omnipotence in relation to the analyst and that the unflappable analyst may be useless when it would have been essential for the patient to know he or she is able to elicit the analyst’s responsiveness. […] I would also add that is also important to be able to explicitly acknowledge and address the interactive subtleties of what transpires affectively between patient and analyst, including the ways they connect and the ways they lose each other in real time and in real ways, as this shifts from moment-to-moment. 

Stern (1983) notes that certain categories of experience “can never even occur unless elicited or maintained by the actions of another and would never exist as a part of known self-experience without another (p.74) What I am stressing is that certain kinds of experiences simply cannot be achieved if the analyst is not affectively engaged and responsive in particular ways.

[...] Bird (1972) writes that there are times when “our not confronting the patient becomes in itself not merely an unfriendly act but a destructive one. By not confronting the patient with the actuality of the patient’s secret, silent obstruction of the analytic process, the analyst himself silently introduces even greater obstructions (p.249)

[...] There are also times when the analyst must take a stand and set limits to protect the relationship and the work from becoming unduly compromised. Nevertheless, I think that is is not just a matter of setting limits. What is also often crucial is demonstrating our commitment to the process and to the relationship despite the patient’s behaviour and despite our own reactions to it. 

[...]For some patients the new experience that the analyst is willing to engage with them even when it is risky and problematic can be profoundly meaningful. The opportunity this can provide to discover that it is possible to touch and be touched in a positive way, even in the context of negative interactions, and that it is possible to move through a toxic interaction and reach a positive outcome, can constitute an experiential kind of insight that throws old assumptions open to question. […] of course it matters how we engage affectively, how we work with what goes on affectively between patient and analyst and whether we deal with this explicitly and constructively.

Bregman-Ehrenberg, D (2012) Psychoanalytic Engagement In L. Aron & A. Harris (Eds.) Relational Psychoanalysis: Evolution of Process vol. 5, pp. 1-8