2003).

Psychoanalytic Dialogues, 13:193-205

Crunches, (K)nots, and Double BindsWhen What Isn't

Happening Is the Most Important Thing: Commentary on
Paper by Barbara Pizer
Philip A. Ringstrom, Ph.D., Psy.D.
This discussion compares Pizer's concept of relational (k)nots with crunches
and double bind impasses. It argues that all of these constructs capture what
happens when conventional analytic methodthe exploration, elucidation, and
interpretation of transferencefails to work. In this context a last-ditch effort
emerges, a necessary crisis of treatment. The situation is a plea that something
must occur now or never or the charade of therapy is over. This plea is
extraordinarily challenging since it embodies contradictory elements wherein the
patient's very call for involvement with the analyst is embedded in a process that
obfuscates their connection. Notably this sets the stage for the damned if one
gets it and damned if one doesn't experience that is a part of the paradox of
recognition/mis-recognition that befuddles many analyses.
Extrication from such impasses requires the analyst's recognition that she is
colluding in a kind of avoidance or distraction from recognizing their
disconnection. Her second act involves meta-communication about their process.
That is how their relational knot both binds them together while negating their
connection. While this observation may be necessary it is recognized as
insufficient on its own. Thus her third move out of the impasse requires her to
enter into a state of improvisation. That is, to use some part of herself that must
surrender from the one-up one-down impasse position of either your version of

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- 193 -

reality or mine. Instead, she must cultivate through her action a third way in
which both she and her patient can think about their impasse and do something
about it, including something different from what either one might have imagined
before.
BARBARA PIZER'S FASCINATING PAPER ILLUSTRATES HOW THE MOST important event in
psychoanalytic treatment is often found in what is not happening. The
phenomenon she particularly explores is what she calls the relational (k)not, a
poetically inspired concept that is itself sometimes difficult to tie down. There is a
double entendre that insinuates itself throughout her article, oscillating between
the relational knot that binds the two parties together and the relational not
that negates them through both disengagement and noninvolvement.
The starting point of Pizer's work is her admiration for Paul Russell's concept of
the crunch.1 Though Russell's body of unpublished works has only recently
come to the attention of those outside the Boston community, his importance to
analysts exposed to his ideas (Teicholz and Kriegman, 1998) is clear. The
crunch captures what happens when conventional analytic methodsthe
exploration, elucidation, and interpretation of transferencefail to work, when all
that understanding appears to yield very little of the experience of truly feeling
understood. In this context, Russell argues, necessary crisis of treatment, a lastditch effort, emerges. The situation is a plea that something must occur now or
never or this charade of therapy is over.

The plea is extraordinarily challenging for it embodies contradictory elements.

That is, the plea for involvement is embedded in a process that obfuscates the
treatment dyad's connection. Notably this contradiction sets the stage for the
damned if one gets it and damned if one doesn't experience that is a part of
the paradox of recognition/misrecognition perhaps best originally described
outside psychoanalysis in the literature on the double bind, (Bateson et al.,
1956), a construct that also informs Pizer's thesis. Double-bind theory was well on
its way to what we would likely now incorporate as a relational construct

Slavin and Kriegman (1998) cite Russell's crunch in their discussion of my article on
double bind impasses (Ringstrom, 1998a, b).
1

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which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.
- 194 -

when Palazzoli et al. (1978) argued that the function of its paradox is to negate
family members' ability to define their roles and relationships.
Crunches, relational (k)nots, and double binds share in common
disqualifications among levels of abstraction. Bateson et al., (1956), following
Whitehead and Russell, called such levels logical types. 2 In my examination of
double-bind impasses in psychoanalytic practice (Ringstrom, 1998a), I note that
when the distinction between logical types or levels of abstraction, that is, levels
of communication breaks down, a paradox is generated. (p. 300).
For Pizer, the essential paradox found in both the crunch and relational
(k)not captures something desperately longed for, that is, authentic connection,
simultaneously with a lethal dread of it. What strikes me as crucial to her work
is the recognition that at times these two aims are not simply in conflict but
actually represent levels of abstraction that paradoxically disqualify the meaning
of the other. It is this paradox that makes them exist outside the realm of
straightforward exploration and elucidation, much less interpretation and
negotiation. Pizer's relational (k)not approximates my description of double-bind
impasses in contemporary psychoanalytic work wherein what is perceived as
needed (hoped for) on one level of transference is mutually disqualified with what
is repeated (dreaded) on another level of transference.3 Of course contemporary
psychoanalytic theory recognizes that the analyst is just as organized by her
bidimensional transference of hopes-for and dreads-about the treatment as the
patient is.
When both dimensions of transference disqualify each other, a process of
mutual mystification occurs, which, as Pizer suggests, provokes a host of
questions befuddling analyst and patient alike: Is this me, or is it you? Do I do
this, or was it done to me? Is this moment,

Whitehead and Russell's (cited by Bateson et al., 1956) theory deals with principles
governing how logical types are distinguished into classes and members of classes. The
central thesis of their theory is that there is a discontinuity between a class and its
members; that a class cannot be a member of itself; and that one of its members cannot
represent the entire class (Watzlawick, Beavin, and Jackson, 1967, p. 193).
3 Stern's (1994) taxonomy of the needed versus the repeated closely resembles the
phenomena described by Stolorow and Atwood (1994) as the selfobject/developmental
dimension of transference versus the repetitive/resistive dimension of transference, as well
as Tolpin's (2000) concept of the forward versus trailing edge of the transference.
2

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now, or was it then? Ultimately, Can I choose what I feel? All these questions
emerge from communication wrapped up in the plausible denial of the relational
(k)not, which, paradoxically, asserts that I am not saying what I am saying.
Pizer illustrates with alacrity several of these frighteningly common incidents such
as the quandary, Is the patient, or isn't he, actually calling me a whore when he
claims that the charge for a therapy hour comes close to what he'd have to pay
for a good whore?
Because they remain beyond straightforward elucidation, crunches, relational
(k)nots, and double-bind impasses must be enacted. These enactments may seem
to bear verisimilitude to contemporary relational theories about projective
identification, but actually they go a step further. The point of the patient's
unconsciously coercing 4 the analyst into identifying with some aspect of himself
seems less about understanding the split-off, disavowed aspect of himself per se
than about flushing out something about the analyst's authentic identity. It is only
in this manner that the analyst is ultimately found not to be a repetition of the
historically dreaded other.5 Indeed, the analyst represents that she is a new
presence, with new ideas heretofore unimaginable to either party.
While Russell's crunch seems to have emerged from treatment situations
involving too much affectivity, Pizer's relational (k)not arises from virtually the
opposite, that is, from insidious forms of noninvolvement that negate recognition
of either party. Pizer argues that this recognition likely mirrors the earliest
relationship between the caregiver and infant wherein negating or nonrecognizing
messages are preverbally absorbed. This makes sense neurologically inasmuch
as the first three years of life are right-hemisphere dominant. That is, the
caregiver's nonverbal behaviors are the ones that are predominantly tracked and
recorded and come to constitute fundamental relational schemas of self and
other. This version of parent, however, may strongly contradict how each parent
actually sees himself or herself. After age three, as the child becomes more lefthemisphere

Inducing might be a better word, as in unconsciously drawing the other into some set
drama.
5 These ideas bear a remarkable similarity to Weiss and Sampson's (1986) Control Mastery
Theory and, insofar as they arise from disparate sources of theory, tend to externally
validate one another's clinical observations.
4

dominant with a burgeoning use of language, he may become irreconcilably

exposed to and coerced into accommodating the version of themselves that the
parents represent in language. The legacy of these irreconcilable versions of his
parents is the maddening sense that whichever version the child attends to will be
wrong. Because the child can not acknowledge that he literally does not recognize
his parent, however, he ends up either behaving wrong or feeling wrong, since
whichever affective response he comes up with is disqualified by the parent.
Stolorow, Brandchaft, and Atwood (1987) argue that one of the crucibles of life is
the conflict between maintaining a vitalizing link to oneself and establishing an
emotional tie to one's parents. I am arguing that, when this ordeal evolves into a
paradox, one can end up living in a world of rampant inauthenticity: I don't really
exist and neither do you. Tragically, we appear to be most ourselves when we
are, in fact, least ourselves.
Pizer notes that this coconstruction is more than the confusion of time [or] a
foreclosure of space; it conflates time and space and erases relationship. Her
work corresponds with similar observations in Benjamin's (in press) negative
third, Ogden's (1994) subjugating third, and Ringstrom's (2001a) noxious
third. All these ideas share the notion that the intersubjective 6 engagement of
the dyad is paralyzed, resulting in one in which neither party is able to think or
speak clearly. All four authors argue that if the intersubjective space of authentic
connection is to be restored, the therapist must first recognize what is going on.

Each author appears to be seeking a reflective state in which the analyst can hold
in mind not only herself, but the mind of the patient. I think that this reflective
state may translate into a sentence something like, There is something about
you that I get, because there is something about me I finally get because of you.
But getting to this reflective state is the first trick.
How do we know we are even in the relational (k)not? Pizer wisely points out
that we often do not know and, what's more, we may not know because we do not
want to know. Analysts can readily participate in unwitting acts of
noninvolvement, especially when what is at stake

I am defining intersubjectivity in this case, as Benjamin (1988), and Stern (1985) have,
as the developmental achievement of subject-to-subject relating, as distinct from Stolorow
et al.'s (1987) definition of intersubjectivity as a field or from system's theory connoting
the permanent influence of the other, present or not, on the subjectivity of a person.
6

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in getting involved presses us into looking at something about ourselves that we

don't wish to see (Ringstrom, 2001b). This is hardly a new idea, given the
psychoanalytic literature on the topic of countertransference. But what may be
different is what we now do with such knowledge.
Our recognition that we are in a relational (k)not coincides with our recognition
of noninvolvement, especially when we have welcomed it. We may become sleepy
or invite distractions, or we may simply let pass moments lacking in clarity; thus
we participate in a kind of collusive obfuscation. At such points, Pizer suggests, we
may say to ourselves Oh, forget about it when we grow tired of trying to make
sense of the merry-go-round, go-nowhere monologue of our patient.
Trying to clarify what is going on may only tighten the knot of obscurity rather
than opening it up for examination, as has been beautifully documented by
Ehrenberg's (1992) leaning into the intimate edge of the therapeutic
relationship. With relational knots, attempting such interventions likely tumbles
the analyst into an abyss of obscurity from which she discovers that there is no
intimate edge against which to lean. The corollary is that there is no boundary
for the disparate subjectivities to negotiate.
What is needed next is similar to my suggestion regarding double-bind
impasses: that the analyst metacommunicate about the relational paradox.
Benjamin (1992) notes that metacommunicating may be a step in reopening the
intersubjective space of analytic thirdness ; Pizer agrees that there appears to
be a need for a statement about the process of what seems to be going on
between themrather than attempts to clarify a particular content. What Pizer's
work has helped me understand is that such a meta-communication may be
necessary but far from sufficient, as it doesn't capture a much greater need for
feeling taken in and understood. As Pizer writes, for this to happen, something
new must occur:
something that speaks to how [the analyst's] separate mind workshow he or she is thinking
about what is going on. The disclosure here is greater than its wordsit is an action,
a jolt to the consciousness of both parties that may catapult the participants out of the
familiar habits of the past. A disclosure here is best characterized as action, often a surprise
to both participants, that may serve as a kind of counterweight to the original actions that
occurred developmentally before the participants were armed with words.
The question, of course, is, how does one do this? Here, Pizer enters a realm
that may be one of the many hallmarks of relational theory: That is, the analyst's
use of her subjectivity to move the treatment along, rather than assiduously
attempting to mask it enigmatically in the psychoanalytic tradition of abstinence.
Pizer joins others in the relational tradition that recognizes that there is no
technique for the use of the analyst's subjectivity to replace the technique of

obscuring it.7 Certainly, as Aron (1996) notes, blindly open self-disclosure is no

better a solution to the original problem of analytic opaqueness than is
abstinence.
Nevertheless, inasmuch as crunches, relational (k)nots, and double-bind
impasses are coconstructions, it is incumbent on the analyst to find something of
herself that will release the dyad of its crimped analytic space. Several
relational authors are examining this issue. Ghent (1990), Benjamin (in press),
and Davies (2002) have all been exploring the analyst's surrender either by
trying to dominate the situation (e.g., by invoking the rank of theory) or by
submitting to it (e.g., by simply accommodating the patient's subjective
rendition of the impasse). For Benjamin, the analyst's surrender to the space of
analytic thirdness potentially reanimates intersubjectivity, or we might say
that the third is that to which we surrender, and thirdness is the mental space
that facilitates or results from surrender. Surrender allows that there is more than
just me or just you, there is the us of mutual recognition, which is much more
than either of us alone, that keeps getting lost and found, created and destroyed,
and so on.
In the face of the suffocation of clashing binary principles such as those found
in crunches, relational (k)nots, and double binds, Mitchell (1993) advocated the
use of an outburst that forced him to explore his dilemma out loud moving both
himself and his patient out of positions of either this /or that or either you or
me. Like Russell and Pizer, Mitchell recognized both the necessity and the
advantage of getting caught in sets of unacceptable binary options, that is,

Challenging the very idea of practice based on technique or technos, Orange, Atwood,
and Stolorow (1997) argue for phronesis, that is, practical wisdom over technique.
7

- 199 -

unacceptable relational constructions. Mitchell's outbursts became a kind of

metacommunication that would recontextualize the participants' struggle as a
kind of This is about us; we're in this together, not all alone (see Aron, this
issue). His gift was to elevate the pair out of the constriction and collapse of
unacceptable opposites into a third, alternative way of thinking that fostered
intense curiosity about their dilemma. In this manner, I think, Mitchell created a
semantic third space.
All these modes of intervention strike me as belonging to the realm of the
improvisational that I (Ringstrom, 2001c, d) and others (Knoblauch, 2001;
Meares, 2001; Nachmanovich, 2001) have been exploring. Cultivating the
improvisational in psychoanalytic treatment is particularly of merit in reopening
and revitalizing the collapsed intersubjective space of the treatment dyad.
Improvisation stands on the shoulders of others' ideas, such Stern's (1990, 1998)
courting surprise and Hoffman's (1998) dialectic of ritual and spontaneity. In
effect, all relational authors are asking, How do we both break the psychoanalytic
frame and preserve it too? We grasp that when treatment does not involve such
paradox, it likely does not get very authentically deep into the psyches of either
party.
Improvisational theater as a metaphor in treatment, therefore, becomes a way
to think about all this. As I illustrate shortly, I think it is a fruitful way to think
about how Pizer arrived at the personal story she told her patient Simon that both
captured his unspoken dilemma and effectively loosened their relational (k)not.
Thinking improvisationally is always ensemble work. It is founded on you and
me, seldom you or me, unless the latter becomes a kind of play in itself, much
like the sparring in an adversarial selfobject function (Wolf, 1988).
Improvisation is quintessentially a process of mutual surrender and mutual
recognition; it is the essence of Benjamin's (in press) and Ogden's (1994)
versions of the psychoanalytic third. For the play to work, there is a recognition

that my mind cannot do this without involvement in yours, nor can yours do this
without involvement in mine. Any scene in life in which we engage, will be
more enhancing and vitalizing to both of us if we bear this in mind. Conversely, a
cloying act of reciprocating dominance and submission is liable to unfold to the
extent that we do not keep this advice in mind. Absent our nascent sense of
improvisation, we are grotesquely confined at best to politely mannered rules of
turn-taking, frequently bereft of enlivened engagement.
- 200 -

Contrary to common worries, undertaking an improvisational attitude in

psychoanalytic treatment is not a ramshackle, shoot from the hip, anything
goes proposition at all. Improvisation is critical to the relational canon because it
provides relationalists a sensibility for understanding that the analytic frame
never disappears but is always a coconstruction, improvisationally changing
throughout the course of treatment. This analytic attitude varies from the
traditional one of a fixed-treatment frame, one captured perhaps in the metaphor
of classical theater. More traditional approaches prescribe a fixed role for the
analyst, his scripts (theory), and his stage (the analyst's use of the physical
space of the analysis). These are all taken as givens, set up for the drama of the
analytic enterprise to take place.
In contrast, the cocreated frame of improvisation is apt to shift as the
cocreated scene evolves. Under the circumstances of improvisational
engagement, the most authentic experiences of analyst and analysand emerge
from scene to scene, that is, from session to session. It is not that there is no
frame, but that the frame inevitably is created and broken, recreated and broken
over the life of the treatment. As in improvisational theater, roles are assumed,
played with, but also change, reworking old scripts, replacing them with evolving
new ones. In so doing, they intermittently redefine the rules of engagment,
including the use of the analytic space. This is scary business to many and likely
accounts for the desire for a static frame. The improvisational attitude appears to
jibe well with Bromberg's (1998) quip, Psychoanalysis is a good profession for
someone who wants to do something dangerous without leaving the office (p.
237).
Let us return to Pizer's case of Simon. Pizer, capturing exquisitely their
relational (k)not, writes, As I look back, I can see that Simon (unconsciously)
sought for me to become involved enough in his dilemma to keep him
uninvolved. Simon repeatedly engaged Pizer in I-am-not-saying what-I-amsaying kinds of communication that she tactfully let slide until she gradually
became discomforted and confused by what they were not talking about. Were
they talking about Pizer's feelings about Simon's wife, Joanne, or Simon's feelings?
Who was Simon referring to when he powerfully lamented his inability to make a
relationship work? Was he referring to Pizer, to Joanne, to someone else? Was this
about someone new, as yet unspoken of? I believe that at such times the analyst
improvises or else the treatment dies, because in a case like Simon's, normal
pathways of inquiry recurrently break down.
- 201 -

At such times, I have noted (Ringstrom, 2001c), the analyst must consider
whether or not she will engage in these dramas interpersonally or hold them
within our own state of reverie (Ogden, 1997a, b). I believe that there is
considerable efficacy in both applications, with the understanding that the context
of engagement (Orange, Atwood, and Stolorow, 1997) in the moment is the
best dictate as to which path to take (p. 745).
From her state of reverie, Pizer instantaneously understood what was going
on, although it was never clearly disclosed, and that, for inexplicable reasons, it
must remain unspoken. She writes, I did not need any more words to

comprehend that this man was actually telling me that he had fallen in love with
another woman, while simultaneously telling me the whole thing was
impossible. In the context of being grilled for answers to questions that Simon
was actually not askingand certainly without necessary background information
about his affairPizer suddenly recalled herself as a child being comparably
grilled, by her father, being intimidated and yet filled with admiration for his
intelligence. All this reverie led to a story she spontaneously shared about her
father's advice to a friend ensnared in an affair. 8 It was not advice about what to
do so much as like one of Mitchell's (1993) outbursts advice about a way of
thinking that could help another make up his own mind about his dilemma. Her
story nevertheless loosened the relational (k)not suffocating both Pizer and her
patient and enabled him to take actions to try to sort things out on his own.
In summary, Pizer's article on relational (k)nots, adds to our understanding
of relational moments in psychoanalytic treatment that can no longer simply be
categorized as the patient's resistance. They entail complex bidimensional
transferential themes of need and fear, hope and dread, that capture something
about both analyst and patient. These moments create treatment dilemmas
exacerbated by their not being recognized, which entails the analyst's collusion in
preserving their blindness.
These moments evolve into crunches, relational (k)nots, and double-bind
impasses that require the analyst to do something: first,

Pizer's shared anecdote recalls Jacob's (1991) comparable disclosures of ghosts from his
past, which captures in their telling something salient about the patient's life.
8

- 202 -

to recognize what is happening to her; second, to metacommunicate about their

process; and, third, ultimately to improvise, that is, to use some part of herself
that must surrender from the one-up, one-down impasse position of either your
version of reality or mine. Pizer's work weaves well into the tapestry of fellow
relational authors, all seeking new ways to respond to the quandaries that
traditional psychoanalysis has excluded as belonging to the realm of the
unanalyzable.

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