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Analytic Love: Possibilities and Limitations


In this article, I consider how the psychoanalytic situation functions to facilitate, but also to inhibit, the intimate, loving connection that develops between analyst and patient. The article is a meditation on the intricate interplay of possibility and limitation in psychoanalysis. My thesis is that the very factors that make therapy safe enough, and rich with possibility for the deepest interconnectedness, can also exert a constraining influence on our work. The clinical approach I am most interested in exploring involves an engagement of certain loving capacities, including those of discernment, critical thought, committed challenge, generosity of spirit, and acceptance.

Albee has said that a play, if its good, is an act of aggression against the status quo. Nancy Franklin, The New Yorker, February 19, 2001, page 228. And in the end the love you take is equal to the love you make. John Lennon and Paul McCartney

love can be a disruptive act and experience. Insofar as it engenders change and transforms our perspectives on what we know and expect, it holds hope and promise, but is also unsettling and overlaps with what is dreaded. In psychoanalysis, this loving disorder is engendered by and between patient
Eric Mendelsohn is Faculty and Supervisor, National Institute for the Psychotherapies Training Institute and National Training Program; Postgraduate Programs in Psychoanalysis and Psychotherapy, Adelphi University; Westchester Center for the Study of Psychoanalysis and Psychotherapy.




and analyst, who make love so that the patient can take love, can grow in his capacity to engage others challengingly and deeply, and to love life itself. My focus in this article is on factors that facilitate and limit such experience.

I. Play With Me, Play With Fire Let me begin with a cautionary tale, one that, save for the brilliance of its protagonists, unfolds in ways most analysts will recognize as familiar and hauntingly possible. Its very plausibility engenders considerable uneasiness and disapproval. An accomplished, alluring, and evocatively troubled young woman began therapy in a psychoanalytically-oriented inpatient unit. The use of psychoanalysis as a mode of treatment for her psychotic-like condition was deemed controversial and, like the patient herself, was thought to be intriguingly exotic. Her therapist was a tall, strikingly handsome young analyst, a man whose keen intellect, near clairvoyant perceptiveness, and impressive literary gifts marked him as worthy adversary and soul mate to his patient. Through some combination of their interpretive genius and the stimulation of each others presence, the young womans attentions and energies shifted from the realms of persecutory anxiety, inhibition, and introversion, and she opened to freer and bolder expressions of sexuality and intellect. The analyst, enamored and deeply indentified with his patient, used her case material to develop a series of groundbreaking papers linking unconscious processes to their mythic and personal sources. Their surviving letters and diary entries suggest that their analytic relationship culminated in sexual consummation, retreat, recriminations, reconciliations, family intervention, the threat of scandal, and the analysts disingenuous public disavowals. After some interval of separation and remarkably self-possessed working through, the patient resumed their relationship, now as colleagues. She qualified as a psychoanalyst after completing a paper entitled Destruction as a Cause of Coming Into Being. This essay, in which she contended that sexuality must always encompass both creative and destructive aims, was a continuation of her therapeutic dialogue with her analystmentor. In it, she passionately considered and critically reordered his ideas. The patient was Sabina Spielrein, the analyst Carl Jung, and the events described took place in the first decade of the last century. The JungSpielrein relationship, and the further intricacies of Freuds involvements with them in a complicated, distasteful personal and political triangulation, is the subject of John Kerrs (1993) masterful history of the dawn



of psychoanalysis. His book, entitled, A Most Dangerous Method, dramatically portrays the risks and possibilities of a form of treatment that channels the experience of illness into the arena of the patienttherapist relationship. Kerr highlights the paradoxical and inherently unstable confluence of aims of a therapy that simultaneously gathers psychic anguish into the experience of transference while it builds and maintains the containing structure of the analytic frame. At one problematic extreme, therapy collapses into concretized enactment, at the other it drifts into the ether of intellectualization.1 This narrative highlights basic questions about the psychanalytic situation: How can we create the two essential therapeutic ambiences, those of safety and experience, and fulfill the primary mandates for analytic therapy, those of containment and living through? How can we surrender to the immediacy of emergent experience while maintaining sufficient dispassion and self-reflectiveness to preserve the necessary therapy boundaries (Davies, 1999)? How can we survive uncertainty that borders on chaos, while keeping things safe and even a bit cool? To address these questions, I will first present a conceptualization of the psychoanalytic situation and therapeutic action, then consider love as a quality of relatedness engendered in analysis, and then discuss ways of working that may foster loving relatedness. I will conclude by presenting three case vignettes that illustrate the kinds of intimate, challenging, and loving mutual knowing that can occur in analytic therapy.

II. Sanctuary and Battleground From the time of Breuers improvised analytic therapy with Anna O, one that culminated with Annas hysterical childbirth and Breuers hasty flight from Anna and the field, psychoanalysis has had a compelling complexity
1There is every indication that Speilrein came to know Jung intimately, an example of the type of theraputic possibility explored in this article. A case could be made that she had a deeper, more comprehensive sense of her analyst than he did of her, and that she tried to work therapeutically with him, often in the face of his considerable resistance. In part she was motivated by her need to make him more available to her as analystand perhaps as loverand in part by concern for his welfare. This type of situation may be more commonplace in analytic therapy than we would like to believe. It is interesting, but goes beyond the scope of this article, to consider the ways in which the patients role, which involves considerable license to talk and to be, without concern for therapeutic outcomes, may afford the patient opportunities for the expression of discernment and insights that may be overlooked in many analyses.



at its core. On the one hand, it is a highly structured, ritualized collaboration between colleagues, each with well-defined and distinct roles, who meet together to address the patients problems in living. In this sense, it is a kind of sanctuary, an impersonally interpersonal setting that requires the suspension of many of the reciprocal expectations that characterize everyday relationships. At the same time, the patienttherapist collaboration inevitably embodies virtually all the ambiguities and conflicts that arise in ordinary intimate relationships. Indeed, we recognize that, were this not the case, analytic therapies would lack the very qualities of verisimilitude and risk required for transformational working through to occur. Thus, the analytic situation is designed to permit, and to focus in vivid ways, the patients most basic and problematic relational tendencies while also functioning to contain and render workable the very experiences it engenders. Given this delicate and ever shifting balance between the poles of safety and danger, and of experience and containment, it becomes apparent that much of the transformational potential of analytic work depends on the individual and interactive tolerances of both patient and therapist. Some dyads will be relatively bold, playful, or even reckless. Others will be cautious, inhibited, or guilt-ridden. This dialectic of safety and risk may be considered in the context of evolving conceptualizations of transference. If the analytic situation is both sanctuary and battleground, what makes it so? Originally, the answer was that the perception of danger was the patients intrapsychic experience. It was, in effect, a distortion, constructed by the patient out of the raw materials of wish and anxiety (Gill, 1982). Freud (1912, 1914, 1915), in his papers on technique, delineated an approach to therapy built upon the analysts opacity and personal abstinence; the goal was to create an analytic field determined as much as possible by the pure culture of the patients conditions for loving. At the same time, however, Freud also recognized that the immediacy and verisimilitude embodied in the transference were essential elements of therapeutic action (Mendelsohn, 2002). Winnicott (1963), in his distinction between an environment mother and object mother, and his articulation of the principles of holding and provision in cases where the management of fragile, highly dependent states figured centrally, proposed an expansion of analytic participation. Although, for Winnicott, the analysts exquisite adaptations to the patients psychic states, were not, strictly speaking, aspects of transference, they were deemed necessary if transferences were to be fully realized. Without appropriate participation by the analyst, transference analysis would remain fo-



cused primarily on a false self level. Other analysts from the British Middle School (for example, Balint, Little, Guntrip) and from the American Interpersonal tradition (for example, Thompson, Tauber, Searles, Singer) advocated increased focus upon, and more expressive uses of countertransference, and a freer, more humanized role for the therapist, thus paving the way toward more interactive, coconstructed models of transference. These writers, and many others, including Racker (1968), contributed to what Hoffman (1983) called social models of transference. In these models, the stream of experience generated by the analysts participation is seen as shaping the patients transference and contributing to its therapeutic fate. Thus, a patients loving hopes and claims will be actualized in decisively different ways in interaction with, for example, an expressive, responsive therapist; a constricted, cautious therapist; a seductive therapist; an obsessionally proper therapist; and so forth. Other theorists (Ferenczi, 1932, 1933; Levenson, 1972, 1983 1991; Wolstein, 1988, 1994; Maroda, 1991, 1999; Ehrenberg, 1992; Wilner, 1998, 1999) have evolved a more fully coparticipatory model of therapeutic action. For these writers, what emerges in the analytic situation is immediate experience that embodies both the analysts and patients core relational tendencies and unique interaction. For these theorists, the analysis of transference and countertransference as distinct categories of relatedness recedes in importance in favor of working with the experience undergone individually and interactively by both participants in therapy. In light of these shifts in theorizing, it is now recognized that the degree to which any analysis is experienced as a setting of safety, danger, caution, risk taking, containment, or instability is a function of the participation, often particularly the unwitting and unattended participation, of both members of the dyad (Mendelsohn, 2005a). For Ferenczi (1929, 1932, 1933), it was this very notion of analytic coparticipation and, more specifically, the idea that the analyst inevitably plays out with the patient versions of the patients traumatogenic experiences, that permits analytic therapy to engender what he termed a feeling of reality and concreteness (1929; p. 119, italics in original). For patients who are plagued by a sense of inauthenticity, fearing that their terrors arise out of overheated imagination, it is the recognition that their analysts actually participate with them in versions of what they most fear will occur, that effects a shift from experience that was heretofore unreal to experience that becomes more tangible and comprehensible. Of course, for this recontextualization to occur, more is required of the analyst, who must also participate with an ethic of personal



responsibility, concern, and self-reflectiveness. These aspects of analytic participation often define the distinction between experience that merely reinforces old hurts and that which manages to be disturbingly familiar, yet different enough to be a basis for change (Mendelsohn, 2002).

III. Love: Real Affect Always Must Imply an Authentic Risk How can love be contextualized within the dialectics of analytic participation? What do we do as analysts to facilitate experiences of loving? To love more fully is a common aim of analytic therapy. Some patients focus on their unlovability, and only later come to appreciate the emptiness that attaches to an inability to love. Others know from the outset that they come to analysis because they feel limited in their ability to love deeply, reciprocally, or enduringly. Thus, to love more fully and, by extension, to enrich ones participation in life itself, are among the most central goals of analytic therapy. In addition, it is recognized that what transpires in the analytic relationship plays a crucial role in achieving, or failing to actualize, these goals, and that the patienttherapist relationship is a forum for the experience of different forms of loving connectedness while, at the same time, it functions to contain the passion and disruption that are part of loving. The interplay of safety and danger, of containment and expressiveness, can be discerned in two instructive commentaries on analytic love which highlight the ways in which the analysts loving participation reflects both critical reflection and direct experience. Consider the following from a brief meditation on love by Roy Schafer (1992). Schafers focus is on the elements of objectivity and direct involvement. Schafer suggests a paradox; that is, that objectivity becomes a mode of direct experience, while the analysts immediate participation arises, and gathers significance, in the context of his dispassion. Schafer (1992) builds upon Loewalds (1960) now familiar model of the analysts ways of loving her patient. Counterintuitively, even ironically, the analysts love and devotedness entail objectivity and perhaps even some measure of detachment yet, at the same time, they require faith. This faith is analogous to the parents loving concern for the childs developmental needs and potentials. The analyst sees where and how the patient might grow, and has faith in his ability to go there. In a sense, the analyst holds and, largely implicitly, conveys an ideal for the patients development. This



ideal is actualized through the patients identifications with the analysts wisdom and maturity. Schafer quotes Loewald (1970) as follows: Scientific detachment, in its genuine form, far from excluding love, is based on it. In our work it can truly be said that in our best moments of dispassionate and objective analysis, we know our object, the patient, and are compassionate with his whole being... To discover truth about the patient is always discovering it with him and for him as well as for ourselves and about ourselves...[Schafer, 1992, pp. 307308]. Schafer than shifts his focus to the other pole of the dialectic, the pole of direct participation. He equates love with full, unselfconscious involvement in experience. As a way on conveying this, he quotes the poet Rilke (1907) regarding artistic creation. Rilke contrasts love as an expression of direct experience with a kind of sentimentalizing, decadent substitute he terms talking about love: ...Its natural, after all, to love each of these things [what is painted] as one makes it; but if one shows this one makes it less well, and judges it instead of saying it. One ceases to be impartial; stays outside the work, does not enter it...And thats how the painting of sentiments came about... Theyd paint: I love this here; instead of painting: Here it is... [Rilke, 1907, quoted in Schafer, 1992, p. 308, italics in original]. One sees that Rilkes (1907) impartiality is actually a passionate, determined effort to experience directly, without the buffer of intellectualizing or sentimentalizing. We can substitute psychoanalysis for painting and analogize directly. For love to enter the psychoanalytic setting it must be experienced, not just narrated. In a similar vein, consider Irwin Hirschs (2000b) poignant effort to discern the place of love in the work of Benjamin Wolstein. Hirsch met with Wolstein a few months before Wolsteins death. In the interview, Wolstein referred to the love between analyst and patient, but Hirsch, perhaps in an example of the type of attenuation of emotionally immediate, disturbing experience highlighted in this article, failed to follow up and inquire about what was meant. Hirsch (2000a), in a moving piece of self-analysis, agonized over his lapse, but was able to construct an intriguing scenario regarding the place of love in Wolsteins work and, by extension, in psychoanalysis.



In Hirschs imaginative reconstruction, love became a way of reconciling what appears to be an unbridgeable contradiction in Wolsteins work. That is, Wolstein was so deeply engaged and involved with his patients and students, yet, at the same time, so separate, so singularly attuned to his own psyche. How could it be that an analyst who considered it counterresistant to try, in any way, to understand, relate to, or adapt to the other as a primary aim, could be so connected? One possibility involves love. The idea is that if one is deeply oneself in the presence of the other, one offers oneself in a state of loving. One is not narcissistically preoccupied, and one is not trying to relate, to be there, or to understand. One, rather, is accepting and trusting of whatever emerges. This state implies a kind of receptive and connected impersonality. There are examples that come to mind, in analytic work and other forms of intimacy, of what simultaneously feels like the deepest engagement and the most unencumbered freedom to be. This type of experience draws upon ones capacity for primary process and for what Wilner (1999) calls self-generated, self-moving experience. In this sense, love represents experience that arises without aim or self-conscious goal, yet may be profoundly communicative and meaningful to the other. To love in these ways, an analyst must have faith in her capacities for self-holding, and for what Ghent (1990) calls surrender. Here we are reminded of Ferenczis (1932) trenchant discussion of the analysts need to experience, at least intermittently, some version of a freely associating state. As analysts, we consider love to be both a relational capacity that is expanded and deepened in analysis, and a piece of direct experience that is engendered in a variety of comforting, affirming and challenging ways. Its expressions range from tenderness and deep regard to unsettling confrontation. As we undergo experience with our patients, we recognize that we bear the consequences of involving ourselves in their lives and exposing ourselves to them. For Levenson (1989), the dangers and opportunities of analytic participation are irreducible: Real affect always must imply an authentic risk (p. 549; italics in original).

IV. Speaking of Love: A Plea for a Measure of Concreteness If psychoanalysis is a most dangerous method, surely it is also one that can fall short through failures of appropriate risk taking. Just as Rilke argued that direct representation is far more evocative than self-conscious senti-



mentalizing in art, the transformational potential of analytic therapy can be blunted through an overemphasis on reflective modes of participation at the expense of affectively alive strivings for intimacy. Absent sufficient emotional engagement, analytic reflectiveness becomes a form of intellectualization. Although the analytic situation affords rich opportunities for loving relatedness, these experiential possibilities are too often attenuated. What traditions and characteristics of the analytic setting move us away from intimate engagement? Let us first consider the ways in which verbal representations of experience have been privileged over concretized or action-oriented modes of expression. Traditionally, psychoanalytic technique aimed at discouraging and frustrating patients tendencies to gratify unconscious wishes in the transference in favor of bringing them to consciousness. Freuds (1914) famous formula, that remembering, rather than repeating, was necessary for therapeutic working through, became the foundational rationale for standard technique. In recent work, Owen Renik (1993; 1998) has shown how psychoanalyts attitudes toward their participation in therapy have been decisively shaped by Freuds (1900) reflexarc model of the mind. According to this model, motivations are conceptualized as impulses which are either discharged via motor activity or fantasy. That is, we either act or we think. Although it is true that conscious awareness of heretofore unconscious fantasy and its motives can sometimes temper, or even halt, enactment of the fantasy, there is no evidence whatsoever that acting on something precludes thinking about it, or that thinking ever occurs without some form of enactment. For example, we expect, as a matter of course, that patients and analysts become aware of patients transference fantasies following a process wherein the patient lives them out in therapy yet, historically, we have maintained that analysts can achieve insight through processes that are essentially purely reflective. Acting, reacting, enacting, acting out, interacting, participating, countertransfering, dreaming about ones patient, crying, touching, or wittingly self-disclosing, demonstrate a failure of optimal analytic restraint. Because all these forms of involvement have always occurred, they have tended to be selectively inattended and, to the extent that they have been acknowledged or discussed, they have been imbued with shame, guilt, and the sense that the analyst needs more analysis. In the context of such an understanding of analytic participation, the involvement between analyst and patient has been understood primarily as an expression of the patients wishes and fantasy-based distortions, and the analysts im-



passioned connection to her patient became a love that dared not speak its name (Shaw, 2003). Along similar lines, psychoanalysis has historically been regarded as the talking cure. This designation has two meanings. The first refers to the ways in which psychoanalysis concerns itself with understandings as a means of ameliorating problems in living. This focus distinguishes it from other therapies that are more action oriented. Medical, behavioral, or socializing therapies act in relatively direct ways on symptoms and problematic behaviors. By contrast, psychoanalysis is one that favors reflective modes of therapeutic action. The second meaning refers to different modes of talking within the psychoanalytic situation. This is reflected in privileging interpretation and clarifying inquiry over more expressive forms of verbal participation. Thus, the kind of talk that has been most strongly sanctioned involves relatively formulated conjectures and understandings more than it has the analysts less organized musings which, particularly when made explicit to the patient, have traditionally been thought of as a form of acting out.2 In contemporary theory, the categorical distinction between words and acts has been deconstructed. Sullivans (1953) notion of the therapists participantobservation takes for granted that everything the analyst says influences the field of study. For Sullivan, what we say is an aspect of what we do, and what we do makes or breaks the therapy. Levenson (1972, 1983, 1991) has stressed the performative aspects of language. For Levenson, even the formal Sullivanian detailed inquiry becomes a powerful means of interacting with, and influencing, the patient. As Levenson (1989) reminds us: To talk with someone is to behave with him (p. 550; italics added). And yet, even with this recognition, we remain ambivalent, at best, about our own affective and interactive participation; that is, although we accept the fact that we dont just talk, and that, even when we talk we also do, we are concerned to carefully delimit what we do. In an exchange between Roy Schafer (1999) and Owen Renik (1999) about erotic transference and countertransference, Schafers reply to a question about intense countertransference feelings was to essentially say he did not have them.
2It is true that Freud, in advocating the analysts evenly hovering attention, created space for a mode of participation that integrated the analysts affective and associational capacities with his secondary process. Despite this, the freedom and spontaneity embodied in the analysts receptive resonance with the patient was, traditionally, rarely communicated openly. Inevitably, what cannot be said, cannot be fully experienced (Wilner, 1998).



Even allowing for hyperbole inspired by the presence of an audience, and for the equanimity that attaches to years of experience, one senses in Schafers response the distinct message that his tranquility was not regarded as a recent achievement. There is still the ideal; good analysts dont get embroiled. Schafers position is especially intriguing in light of his perspective on analytic love, discussed earlier. It seems that Schafer acknowledges the inevitability and therapeutic functions of loving participation, but favors a relatively specific form for that participation. It is objective and detached, yet lovingly attuned to the patientobject. Schafers position entails a striving for a kind of ideal; one that requires sublimations of the more narcissistic and impassioned aspects of the analysts relatedness. My view is that constructing and promoting this kind of ideal may render key aspects of the analysts experience less accessible to both participants. Historically, along with a privileging of reflective modes of participation and inattention to the analysts passions and self-regulatory needs, there has been an emphasis on self-awareness. It has been assumed that, with self-monitoring, comes increased control and an enhanced capacity for choice. The idea is that the more we see and know, the more self-directed and less reactive we become. Although in many respects this is unarguable, there are realms of activity in which self-awareness, or even focused reflectiveness, interferes with the flow of experience and performance (Wilner, 1998; Levenson, 2001). As examples, athletics, dancing, and lovemaking come to mind. But the antagonism between self-awareness and full involvement is not confined to the realm of physical acts. A certain suspension of critical monitoring can be an important component of talking freely, and of emotional expressiveness. Indeed, it seems likely that some intricate interplay of self-awareness and unselfconscious participation is involved in all complex activities and experiences. Yet, insofar as consciousness and self-awareness are privileged in psychoanalysis, spontaneity and passion are likely to be attenuated and/or regarded with discomfort. Similarly, a tendency to favor abstract thought over sensorimotor intelligence, and to associate the latter solely with its infantile expressions, causes us to overlook that, to a considerable degree, we continue to learn through doing. The tilt toward verbally mediated, reflective, and affectively restrained modes of discourse has been complemented by a particular skewing of the patienttherapist relationship. The necessary asymmetrical apportionment of roles (Aron, 1996) has led certain aspects of relatedness in analysis to be foregrounded; others are either less developed or less noticed. In previous papers (Mendelsohn, 1996; 2002) I have argued that the patienttherapist



roles incline both participants to see the patient as relatively dependent, self-absorbed, needy, tendentious, and so forth. Psychoanalysts, by contrast, tend to be seen, for the most part, as parental, wise, generous of spirit, self-accepting, and the like. Similarly, the ways in which analysts participate defensively, self-servingly, willfully, anxiously, and so on, tend not to be noticed, let alone highlighted and dealt with as subjects of inquiry. It follows, then, that the analysts more impassioned, possessive, expectant, self-involved, but also moving, provocative, and evocative ways of loving, may be attenuated and inattended. Moreover, such foreclosure of the analysts participation tends to limit the intensity of the patients involvement as well (Mendelsohn, 2005a). As a result, relatively denatured, cautious ways of experiencing and thinking of love will be foregrounded and more fully actualized. This bias, which reflects the fear that things will go too far in analysis, and in life outside the consulting room, often defines the limits and possibilities of therapy more decisively than does the complementary concern, that opportunities for fuller participation will be missed. We tend to worry more that things will get out of hand than we do that life will not be lived. The foreclosing of risk and experimentation, in a setting designed to allow the emergence of workable disorder, is linked to our primal myths of incest and hubris. Our cautionary tales, involving the collapsing of roles and boundaries in therapy, like the story of Jung and Spielrein, our foundational core complexthe Oedipus myth, the stories of eating from the Tree of Knowledge, opening Pandoras box, and Icaruss disregard of his fathers cautions, establish as bold and seemingly unassailable precedent the notion that we transgress at our grave peril. At the same time, if therapy lacks sufficient deconstructive thrust, we run the risk of engendering relatively denatured, decadent versions of love.

V. A Most Dangerous Method? What happens when we participate more expressively and spontaneously, and when we invite our patients to notice, respond to, and reflect upon what they see and sense about us? Are we then, like moths to the flame, abandoning restraint and giving ourselves over to desire and extinction? Do we move so far in the direction of behaving unreflectively that we abandon our analytic roles? Or are there ways that we can court danger while keeping things safe enough, and engender intimacy while maintain-



ing the necessary asymmetry? I believe that, in general, we aim to construct this kind of intricate balance, and approximate it, and fail, in ways unique to each dyad. What follows is a set of perspectives on analytic love and intimacy, and suggestions for ways of working that, hopefully, can render analysis challenging and vivid enough to be unmistakeably part of real life, while holding experience in ways that provide sufficient safety and preserve loves consolations. Several things about the psychoanalytic situation seem particularly salient. First, patient and therapist must work with, and in spite of, each other (Mendelsohn, 2005b). Like all intimate partners, the analytic couple observes, senses, and responds, making spontaneous moves that express the unique individuality of both, moves which immediately become finely adjusted to the other. I believe that our patients, from the first moments of interaction, begin to sense what goes and what doesnt, what can be negotiated easily and what will have to be paid for, what will be grasped and what will be missed. The same goes for the therapist, of course, with the patient, but this part of things is what we customarily attend to in therapy, and our technique aims to amplify and make explicit at least some portion of this. When this part of the work goes well, an intimate and loving connection is engendered, insofar as the patient comes to be known, warts and all, and the anlyst has the thrill and satisfaction of having achieved a special kind of loving acceptance of another person. However, if the therapy goes this far and no farther, if it omits the recognition and detailed exploration of the analysts participation, the opportunity for a fuller, more reciprocal kind of loving is attenuated. After all, the patient needs to see as well as be seen, know as well as be known, understand as well as be understood, give as well as take, confront as well as be taken to task, and hurt as well as suffer. When this part of the work is absent or significantly limited, only the patients spouse, or his next analyst, ever gets to hear about the patients experience of the therapist. This aspect of the work is of inestimable value because only in the context of this kind of exploration will the patient begin to grasp what he does and what is done to him. So, the first recommendation is to consider it a given that the patient is in a position to know the analyst deeply, and to look for, and actively invite the patients observations and integrations regarding the analysts participation. Second, the intricate adaptations of patient to analyst and analyst to patient tend to follow a sequential course. They are established, and take hold in constructive and confining ways, limits and impasses are reached, crises



ensue, adaptive accommodations break down, and the dyad either breaks apart or continues, now with a new set of mutual accommodations (Mendelsohn, 2005b). In successful analyses, these progressive relational reconfigurations engender greater expressive freedom, a more varied and flexible range of interactions, and more integrated, articulated ways of loving and hating (Greenberg, 1995). Thus, the second technical suggestion involves an expectancy, a preparedness for impasses, for breakdowns of mutual accommodation that signal both disruption and opportunity. From this perspective, treatment disruptions and crises can be expected and even welcomed as important and necessary components of therapeutic action (Mendelsohn, 2002; 2005b). Third, mutual knowing and analyzing play themselves out within boundaries defined by the capabilities and limits of both participants. In developing his distinction between asocial and social conceptualizations of transference, Hoffman (1983) critiqued what he termed the naive patient fallacy, the idea that patients believe their therapists do what they do for transparent and knowable reasons. He asserted that patients intuitively recognize that they influence their analysts, ongoingly and deeply. The complement to the naive patient fallacy would be the omniscient therapist fallacy, the belief that the analyst can discern, more or less unerringly, the patients, and his own, unconscious motives. We now recognize that the patient is not naive and the analyst is fallible. By the same token, neither is the patient omniscient nor the analyst naive. Just as the patients observations and interpretations should not be dismissed as distortions, neither should they be automatically credited with incisiveness and accuracy. Moreover, much of the time, analysts are able to see a great deal. How, then, can we conceptualize the insight and fallibility of both patient and analyst? We can aim to credit both with discernment and interpretive potency while taking into account their respective (and often divergent) interests, needs, and blind spots. We can try to piece together, in light of who we are with each other, how we come to see what we see. The third suggestion, then, is to seek out and utilize, but question, the interpretive acumen of both patient and analyst, and to recognize that neither can ever keep pace with the ongoing, mutually generated flow of experience. Fourth, we know that psychoanalysis encompasses the nonverbal and experiential, in addition to what can be spoken and subjected to reflective review. Indeed, we know that the very act of self-reflection is, itself, partially beyond our ability to observe or think about. Thus, psychoanalysis is being, experiencing, feeling, and living, as well as it is a talking cure. In this



sense, psychoanalysis is experience in its own right, and for its own sake, as well as it is a therapy designed to ameliorate problems in living. Of course, this very open and emergent quality can itself be seen as therapeutic, as contributing to the attainment of such important capacities as greater spontaneity, expressive freedom, and appreciation of novelty and surprise (Mitchell, 2001). The fourth suggestion, then, is to let go, play, relax, be, take chances, expect to make mistakes, and dont analyze everything, especially not in the narrow, self-conscious, explicit way we sometimes feel obligated to do (Hoffman, 1998). In psychoanalysis, love is engendered through the particular type of intimacy created within the psychoanalytic situation. In a setting that is a kind of sanctuary and yet is inescapably real, patient and analyst have the opportunity to come to know each other deeply, and to transform each other, for better and worse. An intimate, deeply respectful appreciation for the struggles and integrity of the other can emerge (Shaw, 2003). A world of experience is created, undergone, and examined, and both participants are there to be seen, within the inevitable limits defined by what Masud Khan (1974) termed the privacy of the self. Love, in its consoling, inspiring and challenging forms, arises from the shared experiences of disruption, persistence and repair that characterize analytic work. The fuller the involvement of each participant, the more likely will the other be emboldened. How can this sort of intimacy be established and deepened? For the therapist, there must be a tolerance for being exposed and vulnerable for considerable periods of time, a willingness to recognize how she has indeed played a role in actualizing what the patient most fears and hopes, and a sufficient sense of groundedness and self-knowledge to tolerate relatively free, spontaneous, and playful ways of participating (Mendelsohn, 2002; 2005b). These forms of expressive participation and self-recognition are most likely to be watered down when the analysts depressive anxieties are engaged. Although therapists dread remaining isolated and failing to connect with their patients, they fear, as much or more, connecting and making a difference because, when they do, they must grapple with the disruption and impassioned relatedness they can, and do, engender. Even when things go well, therapists, through the fulfillment of their roles (Hart, 1999) and in the unique relationship formed by each dyad, become participants in the actualization of their patients, and to some degree their own, most problematic relational scenarios (Mendelsohn, 2002; 2005b). Analysts, under-



standably, have a hard time recognizing and tolerating these forms of participation, and yet, awareness and acceptance of their inevitability, along with active efforts to survive, make reparations, and maintain respectful separateness, is the stuff of loving intimacy.

VI. Case Vignettes A word about the clinical material. I have selected examples that seemed poignant and interesting in ways that, for me, are representative of the kinds of intimate, disruptively loving connections forged in analytic work. I do not consider these narratives unusual in terms of intensity or form of participation, although each is challenging in its own way. Like most therapy work that takes hold, each case has proceeded uncertainly, anxiously, and movingly. These vignettes illustrate the kinds of efforts at mutual knowing, and of respectfully challenging mutual transformation, that embody analytic love. In the first year of work with a somewhat dispirited, middle-aged woman, Rita and I discussed, in a curiously distant way, her erotic transference. Indeed, we talked about her transference more than we experienced intensity of feeling within our relationship. In dreams and enactments, I was the rescuer and energizer of a reluctant, but covertly excited, damsel in distress. Our discussions, however, about these experiences focussed primarily on patterning derived from the historical past, namely her role as the object of her fathers obsessive, morally toned, sexualized attentions. I was, presumably in some uncomplicated way, the stand-in for father. We were, however, unable, or unwilling, to identify factors in our personalities and relationship that inclined us toward this type of interaction. The question of why we were involved in this way was not explored. During this time, Rita grew increasingly depressed and agoraphobic. When I suggested a medication consult, she grew indignant and accused me of distancing myself, and abandoning the analytic position she wanted me to maintain. I found her reaction encouraging and enlivening, and began to reconsider what was going on between us. I realized that by focussing on transference as displacement and projection I was, in effect, enjoying a freebie. Ironically, I was behaving like her father; like him, I was participating in sexualized interactions in a split off way, protecting myself from the guilt I felt about my voyeuristic and incestuous tendencies. By ad-



hering to my limited interpretive line, I was reinforcing Ritas sense of badness and contributing to the worsening of her depression. Following Ritas challenge to me to be more involved and, in effect, to have more confidence in both of us, we were able to address these interactive issues. As the work moved forward, Ritas depression lifted. Several years later, after terminating and then resuming therapy, the following session occurred. In this second phase of therapy, Rita was dealing in more direct ways with issues concerning her marriage and sexuality. On the day of this session, she was looking particularly attractive. There was some tension at the start of the hour, an awkwardness about who would start. During the initial exchanges, I was preoccupied by her attractiveness and felt distracted and guilty about enjoying this. Rita said she was having a hard time recalling the previous session. Shed had difficulty getting to my office; the traffic was particularly bad. In what was surely a case of the pot calling the kettle black, I said she seemed uncomfortable. Generously, she said she appreciated my saying that. She then talked about how she tends to pathologize herself, which I heard as a commentary on her defensive response to the issues before us. After noting her tendency to feel insecure in contexts in which she might otherwise focus on romantic or sexual stirrings, she said, I think something about this makes you uncomfortable, theres something here thats your issue. Then, immediately, not obviously following from her previous statement, but uncannily close to home: What do you think of me? You dont have to answer right away. You could take a week, write notes. E: (Feeling pressured and amused) Youre very discerning about me but, more than the first time we worked, you give me more space. R: Oh, thats intellectualized. What do you really think about my discomfort being looked at? E: Theres this process between us again. I feel under scrutiny too. R: Your dance, pardner routine. (Referring in familiar shorthand to an image we had introduced into our work some time ago; coercion Western-movie style.) E: (Warming up in response to Ritas handling of my resistances.) I sometimes feel like a voyeur with you. R: I think that makes you uncomfortable. You have guilt for being a voyeur. E: Maybe so. But then again, I can often enjoy it. Its part of the fun of being a therapist. But with you I do feel particularly guilty, sort of



inhibited about commenting on your appearance or talking about your body. Rita then referred to a long ago interaction with a previous therapist who had asked Rita what she thought about her own appearance. That question had suggested to Rita that the therapist had some personal interest she was not revealing directly. R: You asked me the same question last week. E: Yes, I was indirect. You know, were talking about whos at fault here. R: Yes (long pause). You know my mother recently said, and she was being critical, that as a child I never sang and danced. E: (Still blaming, but now shifting to mother.) Youd think shed feel that was a reflection on her, but she said it like she was blaming you. R: Yes, I said to her, maybe I didnt sing because you were looking too hard. At this point, my thoughts turned to her father staring at her. Father had been in musical theater. R: I was always having to perform. (Rita must also have been thinking of father, because she then referred to a ritual shed mentioned before, but which she now described in greater detail. She would go clothes shopping with mother and then, at home, like a model on a runway, try on the clothes for father, changing just barely out of his sight in the next room. To this day she enacts a version of this ritual with her husband.) I think I hate men. E: Maybe this is whats being played out between us. Im looking at you, being a voyeur, but I cant enjoy it because I sense your hatred. (This, of course, leaves out my own inhibition and guilt, focusing exclusively on the induced countertransference.) You sense my reserve and feel judged. R: You cant know what its like to be a woman. Walking down the street. Men staring. It happened all the time when I was a teenager. I hate it. I dont think Ive ever been in touch before with how strongly I feel this (tearful, and surprised). I believe that one of the essential elements, both in the resolution of the impasse during the first phase of therapy, and in the collaboration that de-



veloped in this session, was Ritas persistence in recognizing my resistances to more open participation, and her resourcefulness in helping me work them through. (I should note that our ability to focus on my resistance did not preclude focussing at other times on other, less endearing, less helpful aspects of Ritas persistence.) In this case material, Ritas active role in the working through process can be clearly discerned. Although in most cases this aspect of the patients participation is not as obvious, I think it is commonplace in analytic work that patients contend with the limitations of their analysts personalities and must devise means to engage and work them through (Cooper, 2004). By the same token, of course, much of what handicaps us as analysts derives from corresponding limitations in our patients. In some instances patient and analyst can, partly serendipitously and partly intentionally, work their way out of such transferencecountertransference interlockings. It is in the intimacy of encountering, suffering, and transforming the personhood of the other that analytic love is engendered. Dawn has bipolar disorder, severe dissociative states, and several chronic, potentially life threatening, medical conditions. She has attempted suicide, has had several psychiatric hospitalizations, and often injures herself. These self-injuries, relentless and cruelly diabolical in their inventiveness and industry, and her suicidality have contributed to an ongoing sense of burden and dread during our years of work. Dawn most typically injures herself in dissociated states, which is to say, she does not feel pain and is often unaware of hurting herself. Indeed, she often does not think of what she does as hurting herself. In many respects, Dawn lives more fully than when we began. She has completed undergraduate and professional degrees, and has developed a greater capacity to delineate boundaries and express differences of opinion with others. As a result, Dawns relationships with friends and, most particularly, with her troubled adolescent son, are transacted with more freedom and healthy assertion than was possible in the past. Nevertheless, Dawn still sometimes wants to die. Her yearnings for freedom, control, and escape have kept alive the option of suicide. Her newfound ability to entertain ideas previously unthinkable for her comes at a price. Unable to envision ever really transcending her torment, still helpless to resist the pull of automaton-like enslavement to her lifelong project of excusing her mothers neglect and contempt, Dawn despairs and longs for release. To relieve tension, she cuts and burns herself.



And I am implicated. Painfully aware of how the evocation of virtually any affectively laden memory, the expression of controversial sentiments, or the experience of anger can provoke an onslaught of self-injury and suicidal despair, Dawn and I struggle to negotiate the intricacies of control and boundary in our interaction. She jokes that I am the one person she knows whose sense of guilt even remotely resembles hers, but she cannot really embrace the notion that the very therapy relationship she clings to as a lifeline also causes her no end of suffering. At times, our dilemma assumes the most elemental form. Over a period of years, Dawn has tried to persuade me to sanction her suicide. We know that, despite years of therapy with me and others, and despite availing herself of adjunctive therapies, including DBT, medications, support groups of every stripe, and hypnosis, Dawn continues to experience a degree of distress that, at times, borders on the unsustainable. Although it still may be possible that, in her most despairing and determined moments, Dawn could kill herself without my sanction, as the therapy has proceded, it seems increasingly less likely that she would do so. Now more mindful of the devastating impact her suicide would have on her adolescent children, and no longer rationalizing that they would fare better if they were spared her presence, Dawn must also wrestle with the knowledge that, not only can I not sanction her suicide, I would also suffer if she were to kill herself. I have made it clear that I understand how trapped and tormented she feels, and can appreciate, on a deep level, the sense of freedom and control associated with the suicide option. Nevertheless, I tell her, I find it impossible to partner her in what would, in effect, be assisted suicide. I have acknowledged that my motives are, in part, self-serving, that my concern is partly driven by worry over professional liability and the personal toll such an outcome would take. But, I also believe that her children and husband would, indeed carry the scars of her suicide, that she can contribute professionally and personally in meaningful ways, and I see that, despite everything, she laughs, loves and participates in ways that matter to others and often feel good to her. More than once, I have insisted she get rid of some supply of pills she keeps around for the occasional overdose. I know my doing so has many meanings to Dawn. While I am intervening to preserve her life and health, I am also depriving her of a sense of control, a means of self-comfort, and what even can be thought of as medicine for a serious illness. (Her mother refused her treatment for the severe asthma she suffered as a child.) In some ways our relationship has become Dawns albatross. Once, as a way out of this di-



lemma, she proposed quitting therapy. Dawn pointed out that if she subsequently killed herself, at least it would not be on my watch. I replied that I could not see that as a solution to our problem. I would, of course, find out and would blame myself for having partnered her in terminating therapy under these circumstances. I said that, for better or worse, or maybe for better and worse, the connection had been forged between us. It was too late to undo it. So Dawn and I struggle, in our sessions and in the phone calls she makes between sessions. I place limits on the duration of the calls, bill her for the time, and make it clear when I am and am not available. I find these boundaries prevent Dawn from feeling unduly guilty and keep me from feeling more resentful than I can handle. I do not know whether our efforts will ever enable Dawn to emerge from the hell she inhabits on a daily basis. But, in the intimacy of our work, and in the confrontation with what is most basic in our personal commitments and values, we have already had a profound effect upon each other. Recently, on Valentines Day, Dawn gave me a card with this handwritten message: Dear Eric, I know you call it our connection, but I think of you as a friend that I care a lot about...Im so thankful that youre a special person in my life. Love, Dawn Dawn and I both care for, and feel burdened by each other. At times we can acknowledge this, but at times the recognition of the love and bondage feels too threatening to face. Daniel was finished with love. He was a handsome, engaging man in his forties, gracious and funny in a self-deprecating way, a terrific conversationalist, wonderful company, a good man. Yet his love life was that of a tentative, oddly naive adolescent. Women were forever rejecting him, and their unattainability seemed to intensify his blind determination to win their love. He always chose partners, it seemed, who could never quite overcome their reservations about him. Often there was another man lurking in the background and, when the inevitable break-up occurred, the news was delivered with the womans tearful yet liberating realization that Daniel was not the one she loved the most, after all.



The love of Daniels life was Carol, a woman hed known since high school. Their latest, and most tortured, interlude was an affair she kept strictly compartmentalized. She would only see him at certain times; he could never stay the night, despite the passion and tenderness of their lovemaking, and, of course, there was another man. He was an offhandedly contemptuous Hollywood producer who kept Carol at his beck and call. She stayed with him despite having to share his bed with his other girlfriend, who happened to be Carols best friend. Daniel got to hear about this in unsparing detail, and, for some years, tried to pry Carol away. Finally, with a crushing sense of defeat, he gave up. Daniel then made a fateful decision. Since, he reasoned, he had failed so miserably at romantic love, he must now choose a partner for purely pragmatic reasons. If he were not attracted to her, all the better. So, he married Susan. She was an outspoken, decidedly unpoetic woman who was pleasing to look at, but who had a thin-skinned, embittered quality. One night she gazed at him admiringly. That moment so contrasted with previous experiences of rejection that Daniel decided to marry her. The marriage was a misery. After 2 years, Susan became pregnant. Somewhere, at the edges of his awareness, Daniel knew that he had married in order to have a child. But now, even beyond the bad bargain of a marriage, there was a further problem. Daniel expected to die, not inevitably as we all must, but soon. And this expectation was linked to becoming a father. His own father had died suddenly of a heart attack at 34, when Daniel was less than a year old. Daniel felt he had killed his father, and now he expected his son would be the death of him. Some years earlier, Daniel had written a short story. A boy and his father were playing baseball, Daniels favorite game. The boy swung hard and sent a towering fly to the farthest reaches of center field. His father turned and ran, the ball far over his head. Even as he raced back father shouted praise to his son, who lifted his arms in triumph. At that moment father reached for the ball and fell over, dead. When Daniel began therapy, he felt doomed. He loved his son, but had a presentiment of death. He was miserable in his loveless marriage and considered himself a failure in a career he had pursued indifferently and had chosen in much the same manner as he had married; he had picked a line of work that was the sensible alternative to the less secure artistic pursuits he loved. A talented, creative, and loving man, he had worked himself into a corner. Well, not entirely. Daniel, it turns out, is a prolific dreamer. In our years of work, his dreams have functioned as a fascinating, richly detailed diary,



a kind of autobiography that organizes the drama of Daniels past, the legacy of his partly relinquished romanticism, and the ongoing experience of our relatedness, into narratives of novelistic sweep. We share a pleasure in considering his dreams, even when, as is often the case, we can more marvel at them than understand them. In Daniels early dreams, there was a sense of disintegration and terror. Walls crumbled, private acts were exposed to humiliating public view, murderous intruders threatened, and often Daniel woke screaming from nightmares that seemed scarcely less dreadful than his waking reality. At the same time, we were taken with the passion of the dreaming itself, linking it with Daniels abandoned creative efforts. We also noted that the dreams, with their imagery of violent entry and crumbling barriers, suggested, albeit in a catastrophic way, a move toward liberation. Actually, the way I just stated this was not quite how things seemed in the early phases of the therapy. The sense that Daniels dream life was a wellspring of creative potential, and that the dreams themselves expressed the destabilizing but liberating aspects of love, were constructions that took shape over time. Our sense of things in the moment was far more fluid and ambiguous. In the early days, we were preoccupied with how the dream imagery seemed to signal a disintegrative process, and our anxiety about that colored our more hopeful interpretations. We worried, had Daniel tapped into a current of genetic and psychic fatedness? Were we needing to deny the severity of his disturbance? Might he decompensate, or die? What was most dreaded, living or dying, loving or despair? Although these questions could never be resolved in any categorical sense, our hopefulness and resolve were bolstered by Daniels second fateful decision. After about a year of work, and a couples therapy that only clarified their sense of estrangement, Daniel and Susan decided to divorce. In the next months, Daniel felt desolate and anticipated the chest pains that would herald his fatal heart attack. He tortured himself over his decision to marry a woman he did not love. In desperation, he resolved to call Carol and try, yet again, to rekindle the flame that had burned for 30 years. I thought he was acting out of despair, heading for another predictable disaster, overcorrecting for his mindless pragmatism and deadening compromises by moving blindly into an alluring but doomed affair, and told him so. He thoughtfully but unambiguously rejected my counsel and called anyway. He said he loved her, he felt alive and funny with her, and he would be a fool not to try. This time, Carol responded as if she had been waiting for Daniels call. They came together joyfully and seemingly without reservation. Their only



regrets were for the years that had passed and the child they would never conceive. I do not think I have ever been witness to such delight. With the gratitude of those who had wandered the desert but continued to seek the promised land, Daniel and Carol embraced with a passionate abandon that still left space for the patience and thoughtfulness needed to become a parental couple to Daniels son. Daniel has worked enthusiastically and unflaggingly, yet the therapy has unfolded in ways that, for me, are unusual and a bit counterintuitive. The kind of intimate knowing of the analyst that I have said I look for, and try to engender, has not occurred, or perhaps it has in ways that elude me. Daniel has, for the most part, represented me in his dreams as incompetent, indifferent, crudely self-involved, and sleazy. He has professed bafflement at this because, he says, he finds me quite caring and skillful. As with my advice not to call Carol, he brushes aside my earnest attempts to make the transferential shoe fit. He dreams me as a fool, but he loves me, he says, and that is that. Daniel has speculated that these representations of me may be a form of play. He points out that it is not good to take anything too seriously and that he is, in effect, pulling both of our legs in his dreams. He says his knowing me, in this instance, does not involve literally thinking that I am a charlatan, but anticipating that these representations will provoke me. Beyond this, perhaps the chance to experience himself as connected to a father has included an element of aggression or a need for progressive disillusionment; perhaps putting me down in these ways has facilitated a process of becoming bolder and freer, more secure as a lover and dad, and more connected to his talents. And maybe what has been important is that the Eric he tells these dreams to is caring and competent, and that he has me as an interested, loving receiver of his dreams. Perhaps also, the earnestness of my inquiry has deflected him away from his criticality. Or, maybe, I must accept the limits of my prized theories of therapeutic action and come to terms with the fact that we have ended up working more his way than mine. This, too, is not uncommon. We have our ways of working, and then our patients take us to different places. It has been a joy to be a part of Daniels happiness. He has connected to the father he lost by taking up jazz piano and guitar, loves of his fathers, and by a return to the writing he abandoned years ago. He now teaches his son piano, coaches his baseball team, and chases his home runs. Some mornings, Carol walks Daniel to his sessions and I hear them laughing and dancing outside my window. Sometimes I feel we have made magic and



conquered death in the way people can when they dare to involve themselves deeply in each others lives. When Daniels mother died recently, he sat alone, composing her eulogy. His son, who was seven, asked what he was doing and, when Daniel explained, his son wondered if it was hard. Daniel said it was, because he realized it was the last thing he would ever do for his mom. His son said, No, its not, Dad, youll keep doing things for her all your life. I heard Daniel, Daniels dad, and my voice, as well, in what his son said. Through the power and persistence of his dreams, and the delight of his loving, Daniel has taught me about renewal and our wonderous ability to connect across the barriers of solitude and time.

VII. Coda The psychoanalytic situation affords unique opportunities to engender intimacy. Optimally, this means the patient loving as well as being loved, knowing as well as being known, giving as well as receiving, and hurting as well as being hurt. For these parts of the patients being to be engaged and actualized, the analyst must be prepared to be seen, moved and transformed, and for these experiences to become subjects of analytic exploration. The failure to love and hate with our patients results in decadent, denatured forms of analytic experience, our sins of omission. The possibilities for challenge, growth, and loving connectedness, for both patient and analyst, are limited only by the mortal constraints that define the boundaries of all that we do.

Acknowledgments I am grateful to Theresa Claire and David Newman for their helpful comments and suggestions.

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