Int J Psychoanal 2006;87:989–1003

Clinical implications of Bion’s thought

ANTONINO FERRO
Via Cardano 77, I-27100 Pavia, Italy — hmdfe@tin.it
(Final version accepted 2 February 2006)

The author focuses on some clinical implications of Bion’s thought. He takes

into particular consideration the great technical importance of Bion’s concept of
‘waking dream thought’. He also proposes some developments of Bion’s thought.
Psychoanalytic exercises like those suggested by Bion are presented along with
clinical material in order to render the author’s theoretical–technical ideas as clear
as possible. Furthermore, he deals with the fertile connection between Bion’s theories
and the field concept in psychoanalysis.

Keywords: waking dream thought, Bion, projective identification, reverie,

α-function, narrative derivatives, bipersonal field, interpretations, transformations,
pictograms

I discuss the impact and the consequences of Bion’s thought on clinical practice and
on the theory of technique in our daily psychoanalytic work.
Bion’s thinking is so rich, articulate and complex that any attempt to clarify and
develop it would be useful per se, but I think that focusing on the clinical implica-
tions of a certain approach to his thought, and its possible developments, would be
even more relevant.

I) The ‘waking dream thought’

I believe that the ‘waking dream thought’ (Bion, 1962) is the most significant
and important of his concepts. Aside from the night dream, our mind, through
its α-function, constantly creates a continuous operation of alphabetization of all
the sensory stimuli and proto-emotions which we receive. The end point of this
operation is the formation of α-elements, which, when we put them into sequence,
produce the waking dream thought.
This is extremely important for several reasons:
a) it allows a constant monitoring of the analytic field: the analyst can thus receive
information as to how his interpretation has been taken in, rejected, understood, and
consequently modulate his interpretative interventions;
b) it solves the problem regarding external reality, since all that we should be
concerned with, as analysts, is what goes on in the consulting room (Ferro, 2002a,
2005a, 2005b). The essential question is how the analyst and patient function or
do not function together. Both the most abstract and the most concrete form of
communication can be understood as ‘narrative derivatives’ of the waking dream
thought, in the process of being formed at any one time;

©2006 Institute of Psychoanalysis

990 ANTONINO FERRO

c) it shifts the analyst’s attention from the contents to what generates the dream itself.
The focus is no longer on a psychoanalysis that aims to remove the veil of repression
or to integrate splittings, but on a psychoanalysis interested in the development of
the tools that allow the development and creation of thought, that is the mental
apparatus for dreaming, feeling and thinking.

II) The constant interplay between projective identifications and reverie

The constant interplay between projective identifications and reverie becomes one
of the essential functions on which an analysis hinges. Aside from words and inter-
pretations, what matters is what is ‘produced’ in the consulting room. By ‘produced’,
I mean the result of the ongoing encounter between the analyst’s and the patient’s
minds. Projective identification is considered to be a basic activity of the human
mind, necessary for communication. The majority of projective identifications go
from patient to analyst, but it is not necessarily always like this: at times, the flow
can be reversed. In this case, a tired, defended, unavailable or suffering analyst
can evacuate his anxiety into the patient’s mind, a mind which will become the
containing–dreaming pole. This continuous interplay is what will lead to the forma-
tion of the container and the development of the contained, as well as the constant
oscillation between the schizoparanoid position and depressive position (PS↔D).
That is between non-aggregated and raw emotional states (the artist’s palette with
all his colours) and elaborated and well-defined states of mind (the canvas to which
the artist gives life with his colours).
Another equally precious oscillation is that between the ‘negative capability’,
that is, the capacity to remain in a mental state open to doubt and uncertainty [as
Borges (1941) does in his story ‘The garden of forking paths’], and ‘selected fact’,
that is, the capacity to work through the mourning for all possible stories and to opt,
as Diderot (1999) does in ‘Jacques the fatalist and his master’, for the story that
urges to be told.

III) Modulation of interpretative activity

This is one of the most significant consequences. Bion (1978, 1980, 1987, 2005)
pays great attention to the fate of an interpretation and to whether it promotes
growth or becomes persecutory. ‘Any interpretation’, he writes, ‘can be given
six days, six months or six years after its been thought’. He adds that sometimes
certain interpretations have the same usefulness as somebody who launches
himself into a lengthy explanation of the functioning of the digestive system to an
infant. Furthermore, with his famous statement that an interpretation must have
an extension in the domain of meaning, myth and passion (Bion, 1963), he also
indicates that we can interpret something that in some ways has already been
experienced on a sensory level by analyst and patient (to pull the rabbit from the
hat, the ears must at least be visible or somehow perceivable). Bion also tells us
that interpretation need not decode, but extend to a mythical narration, that is,
to transpose into a script, narrative or filmic form, which actualizes and renders
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 991

visible what is being said. Lastly, he talks about ‘passion’, indicating that an inter-
pretation must imply a warm and alive relationship between the analyst’s mind
and what is being interpreted.
I would say that, from this perspective, the classical concept of interpretation
is often replaced by the activities of the analyst, which activate transformations in
the field, transformations which can also derive from the changing of the analyst’s
mental state, from minimal interventions that function almost as enzymes. Needless
to say, amongst the possibilities of intervention, which the analyst can use whenever
it seems useful, remain the saturated transference interpretations, by which to make
explicit the transference in the here and now.

IV) The mind of the analyst

The mind of the analyst, to which the entire Attention and interpretation (Bion,
1970) is devoted, becomes a variable of the psychoanalytic field. The analyst’s mind
becomes a precious and very delicate laboratory, which necessitates continuous
maintenance (Ferro and Basile, 2004).
In Cogitations, Bion (1992) states that even the number of hours of sleep the
analyst gets imply a different functioning of his mind at work.
In particular, the analyst’s mind needs to maintain that basic attitude, previously
described as ‘negative capability’, that is, the capacity to remain in doubt and in an
unsaturated state, without needing to find exhaustive answers too quickly.

V) Similarities in the analysis of adults, adolescents and children

This is the last consequence, which I address only briefly. If attention is shifted to
mental functioning, to dream thought and to elements that form dream thought,
every analysis has the same characteristics. The languages, the means of expression,
change, but the salient characteristics remain the same. Consider a field saturated
with β-elements that are then expelled violently; they could find embodiment in the
history of a child suffering from enuresis, bouts of vomiting or encopresis, or in the
history of an adult who rids himself of thoughts and feelings with violent acts, or
personality-disordered behaviour.
While the plot essentially stays the same, what varies is the narrative thread and
modules.
I have devised, and often utilize, a training device in which I give students a
session of child analysis; they must rewrite it, stressing that the same basic themes,
albeit expressed in a different language, appear in a session with a young adult or
with an old lady.
I now try to present some clinical situations or some psychoanalytic games
which allow me to illustrate what I have abstractly treated, in the concreteness of
the analytic situation of the consulting room.

‘When I was a child …’

‘When I was a child, my father never took me by the hand. He expected me to
do well at school and, if I didn’t, he organized endless private tuition for me and
992 ANTONINO FERRO

sometimes beat me.’ Depending on the analyst’s prevalent model, such a state-
ment could be understood as the recollection of a childhood scene which can
help to reconstruct the family romance. It could also be taken as the expression
of an unconscious persecutory phantasy regarding an internal object, cold and
forbearing (which in some circumstances could be ‘projected’ on to the analyst
and thus interpreted), or even as the close description from the patient’s vertex of
what is occurring in the consulting room in that given moment.
In a radically relational perspective, this could be interpreted as referring to
the here and now. However, in my opinion, this would flatten the analytic scene,
‘compressing’ it on a present level, and rendering it two-dimensional.
In my current way of thinking, I would see such a statement in the context of
the here and now, deriving from the waking dream that the patient is having in that
relational instant, but I would, however, ask myself several questions:
• How can I intervene to bring about a transformation that would allow me to stop
being perceived as an unfeeling father who sternly considers nothing but school
grades?
• How should I modify my interpretative style, my approach or even my internal
state so that this transformation can begin to occur?
• Where does the patient’s perception of me come from?
This perception comes from the patient’s ‘history’ and it can involve a ‘role-
assumption’ on my part; it comes from his projective identifications; it comes
from enactment; in any case, it does come from my behaviour or my approach
with him.
Having said this, I will opt for an apparently ‘reconstructive’ interpretation, or
for an interpretation that refers to the ‘unconscious phantasy’ or to the ‘relationship’,
or which might simply be ‘enzymatic’, and I will focus most of my attention on
the patient’s ‘answer’ after my intervention. For example, I might say, ‘Being near
a father like that must be a constant worry and put you in no condition to enjoy
studying’.
Obviously, I’m ‘serving up’ a transference interpretation: ‘If my way of being
with you is the same, surely I’m not making it easy to work in this study [consulting
room]’.
The patient might then answer: ‘Yesterday, I went to a photography exhibition
but, in my opinion, the photos weren’t very clear’; my first thought would be that
my interpretation was lacking in ‘incisiveness’ and I should therefore try to ‘focus’
better on the issue.
If, however, the patient were to answer: ‘Yesterday, I went to lunch at my aunt’s
house, where the food is always good but I always eat too much and it takes me
all day to digest’, then I should deduce that the wording, which I had previously
deemed sufficiently light and unsaturated, was still ‘too heavy’ for the patient.
Alternatively, at a different time in the analysis, I might have deemed useful a
‘strong’ and explicit reference to the transference, such as: ‘You see me as unaffec-
tionate, more interested in the progress of your analysis than in you, and you think
that I will not leave you in peace until these analytic projects come to fruition’.
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 993

Again, here the patient could answer in many different ways, from ‘it was nice
when I felt understood by my father’ to ‘I saw a documentary on the television on
how they make fois-gras: they force feed some poor ducks with a funnel until their
liver becomes huge’.
I mean to say that, if these signals are taken in, they allow progressive adjustments.
Of course, the analyst has the possibility to make many different types of inter-
vention to the patient’s initial statement, from ‘we now understand one of the roots
of the study inhibition you felt’ to ‘well, of course you prefer to study with Maria
today, who never hurries you and allows you all the time you need’.
Sure enough, the paths and the ‘worlds’ which can be opened are infinite.

Livio and the exclusion

After some analytic work which enabled him to have more space to experience
and think about his emotions, my patient Livio, just before a short analytic break
which coincides with a momentary loss of emotional contact during the last session,
resumes the analysis after a few days and begins by telling me about his two year-
old son, Luigi. One night, Luigi had come to sleep in his parents’ bed and then,
waking up in the morning and seeing his parents hugging, he had silently climbed
out of bed and had gone into his own room. The patient had secretly followed him
and had seen him sitting on the carpet, looking dejected. The child had then taken
his dummy and was looking around the room, appearing lost. The patient had then
stepped in and, understanding his sadness, had picked up his son and carried him
back to the parents’ bed, where he had stopped looking sad and absent and had given
Livio a big smile.
Soon after, the patient reports a dream which he had that same night. In the
dream, he had gone to a party with his friend Stefano, who kept moving away from
him and eventually abandoned him, leaving him feeling angry and excluded. What
made things worse was the autumnal climate—leaves were falling and he saw happy
couples going home, while he was left alone, getting drenched by the rain. After a
while, Stefano returned, but he did not know how to behave, whether to show happi-
ness at his return or to remain angry. He then tells me after recounting the dream
that the evening before he had telephoned his father, who had not answered, perhaps
because he was sleeping.
I believe that it is clear how Livio, who had, in the past, presented an allergic
symptomatology, has now become more able to experience his emotions and to tell
and retell them in three different scenarios: that of his son, that of the dream, that of
his father.
Livio was not aware that the three different stories present in his narratives were
proposing the same theme. This has been a product of the interpretive work.
It is evident that the sequence of the α-dream (waking dream thought) is always
the same, only articulated in three different stories.
Livio felt excluded, put to one side, due to the imminent analytic break, but
also because in the last session I had been ‘hugging’ on to one of my problems,
and this had distanced me from him. This had provoked feelings of anger, jeal-
ousy, isolation and then, once again, the possibility of remaking contact occurred.
994 ANTONINO FERRO

We can imagine Livio has twofold ability: the first is that of putting the proto-
emotions, which had been inflamed by the frustration caused by the break and
my increased distance, into images (to form α-elements). We can imagine that
these images could have been those in Figure 1, to indicate the sequence: exclu-
sion, anger/jealousy, reconciliation. Or, in more detail, Little match-seller can
be paired with distanced, isolated, lost, dejected Stefano; Hurricane with angry,
jealous Stefano; Sun through the branches with possibility of renewed contact
with Stefano. These images can therefore be represented as pictograms in his
waking dream thought.

Little match-seller Hurricane Sun through the branches

Figure 1

The second ability, no less important than the first, is that which permits the
creation of the three different narratives (the tale of his son Luigi, the recounted
dream, the incident with his father) which put into word the emotions which are
now free to circulate. As Livio says, some can circulate with a passport (the dream),
others with a green card (his son), others more clandestinely (his father), in a scale
which goes from most clear to most cryptic.
This can happen, now that Livio’s past years’ analytic work has led to a devel-
opment of his α-function (the capacity to generate images) and of his capacity to
contain (♀).
This also happens when Livio allows himself to recognize the importance of the
bonds with his loved ones, an experience from which he previously ran away, trying
to elude the emotions that the vicissitudes of a relationship entail.
Figure 2 summarizes what happens in a sufficiently well-functioning mind or
in a well-functioning analysis. Up until this point, I have left this diagram implicit.
It obviously retraces Bion’s thoughts on the matter and my developments on his
conception.
The earliest activity which provides the spark for the Big Bang—the switching on
of the human mind—is given by the baby’s massive evacuation of proto-sensorial or
proto-emotional states. If these evacuations (β-elements) are taken in, contained and
then transformed by a mind which absorbs and metabolizes (α-function), they will
be gradually transformed into meaningful pictograms (α-elements). By pictograms,
Rocha Barros means ‘a translation of ideas into figurative and symbolic scenes …
to refer to very early form of mental representation of emotional experiences, fruit
of the alpha function, which creates symbols by means of figurations for dream
thought’ (2000, p. 1094).
The mind that brings about this transformation does not only transform the proto-
sensorial and proto-emotive chaos into affectively meaningful representation, but,
through the constant repetition of this mental work, it also transmits ‘the method’
employed to achieve this (α-function) (Bion, 1962, 1963, 1965, 1987).
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 995

Sensations – proto-emotions – β-elements

α functions

Sequence of α-elements

α α α

narrative derivatives (ND)

ND1

ND2

ND3

NDn

Figure 2

The continuous repetition of this transformative cycle—a true mental Krebs

cycle—also produces other effects: the interplay of projection, introjection, reprojec-
tion and reintrojection conveys the differentiation of the cave space from the convex
space, the receptive space from the full space, and, in short, allows the differentiation
of the container (♀) from the contained (♂). The earliest interaction of ‘projective
identification’ with ‘reverie’ is in fact the first sexual relationship of one mind with
another mind, and this forms the foundation of man’s creative capacity. From this
moment onwards, the α-elements constitute the ‘waking dream thought’. Direct
996 ANTONINO FERRO

access to this dream thought is usually unavailable. We can gain information on

‘waking dream thought’ through its ‘narrative derivatives’, including drawings and
play (Ferro, 2002b, 2004). For example, the proto-sensorial and proto-emotional
stimulations which carry such states of mind as irritation, anger and brightening up
could be transformed by the α-function into the affective pictograms of Figure 3.

A stinging nettle A roaring lion The sun rising between

the clouds

Figure 3

This sequence of α-elements, which had remained inaccessible, could generate

an infinite number of narrative derivatives in a variety of different literary genres,
drawing or play. In other words, it could become an associative chain, which can be
expressed through:
• a childhood memory: when my father’s friend came to dinner and told my father
that he had run into me in the street during school time, I felt strongly annoyed;
I would have liked to hit him, but my father’s calm face reassured me;
• a scene from everyday life: yesterday, I saw some kids harassing an immigrant
and it filled me with anger; I was about to go and reproach them, but the arrival
of a policeman broke it up;
• a scene from a film: I remember a film sequence in which the protagonist is
visibly enraged when he sees his wife, with her back turned, hugging another
man. He is about to tear the two apart when he realizes that she is, in fact, hugging
their son, who had just returned from military service. How he’d grown!
• A sexual scene: Having just got back from a long trip, I wanted to make love to
Carla but she did not want to, which made me angry and wish to leave. But I
then discovered that our friends were waiting in the lounge, having organized a
surprise party for me.
We could add to these narrative derivatives, further derivatives which are
expressed through playing, drawing or even movement and action, for example:
• a game in which the big Red Indian chief gets angry with the pale-skin’s general
who had failed to bring the supplies which he had promised. The chief unearthed
his battle axe, until he understood that the delay in the delivery was due to a
sudden bout of snow;
• a drawing in which a wolf, enraged by the thorn stuck in his leg, tries to attack
anything that comes anywhere near him, until he recognizes David the Gnome
(a cartoon character), who is a well-known vet in the forest;
• an acting in the session: after the cancellation of his session, the boy bumps his
head on the study door and starts to cry and kick it, only calming down when the
analyst tells him they will be able to reschedule the missed session.
I could go on, but I would also like to add a dream to the list of narrative deriva-
tives, because I feel it is important to stress that, aside from being the royal road
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 997

to the unconscious, a dream can also be considered a narrative derivative of the

sequence of α-elements, if contextualized within the narrative at the time of the
narration. Therefore, the scene mentioned above can also be told in the following
way: I dreamed of being stung by something which, to me, in the pitch darkness,
seemed to be a scorpion. I was furious with all those who had assured me that mine
was to be a safe journey, but I then realized that it was only the thorn from a plant.
The narrative derivatives (ND1-NDn) of the sequence of the waking dream
thought can therefore be numerous. It is not easy to describe all the transitions,
often necessary, which lead from the manifest text of the patient’s narrative to the
final interpretative formulation, which is the end product of the mental interaction
between patient and analyst (Ferro, 2003).
• A first level could be to gather what the patient has said and to summarize
synchretically.
• A second level might add to the above description that it could have emotional
implications.
• A third level consists in defining and naming these emotions, let’s say jealousy
and anger.
• On a fourth level, one should wonder, together with the patient, whether these
feelings of ‘jealousy’ and ‘anger’ might also shed some light on what happens
between him and X when … (using the patient’s narremes).
• On a fifth level it is possible to bring in the transference.
• A sixth level could consist in locating the previous interaction within the patient’s
internal world.
• A seventh level might entail a possible historic reconstruction.
• Finally, on an eight level, it might be possible to introduce considerations on the
intergenerational transmission.

The depression of the … wife

A patient tells me of the depression of his wife, who came with him to Pavia from
the distant city where they live.
At first, I conceive this depression as belonging to a place in the field called Wife
(top line of Figure 4). I then show the various aspects of this depression (the lower
three boxes).

Wife Depression

'UILT'

!NGER!

Pain (P)

Figure 4
998 ANTONINO FERRO

Only through doing this, will we be able subsequently to cook up G, A and P into
something which can more easily be swallowed by the patient directly.

VI) The concept of field

The concept of field is very difficult to describe. We owe its basic formulation to
Baranger and Baranger (1961–2): analyst and patient jointly form nuclei of resist-
ance, which need to be worked through by the interpretative work of the analyst.
The analyst fully participates in the formation of the couple’s blind spots, while at
the same time holding on to the specificity of his role—the interpretation—whereby
he can resolve these areas of resistance, called bulwarks. The continuous oscillatory
movement of formation of the bulwarks and their dissolution constitutes the analytic
work.
This concept has been rendered progressively more complex by a number of
authors who often referred to their group work. These authors treat the session as
a sort of meeting place for the multifaceted aspects of the patient’s and analyst’s
personalities (Corrao, Gaburri, Neri, Riolo).
Strong reference to Bion’s work and, in particular, his concepts of the α-function
and waking dream thought adds further complexity to this theoretic perspective.
Projective identifications—hopefully to a greater extent from patient to analyst,
activation of the α-function(s) and flurries of β-elements: they all operate within the
session.
The α-functions of the field begin to generate a field ‘waking dream thought’,
which however remains unknown.
This generates narrative derivatives.
The patient’s transference which transmits β-elements (balpha) and α-elements
has an impact on the mental functioning of the analyst, at once generating a two-
person group situation—a situation in which it is the field itself which is continually
dreamed and re-dreamed. Through a kind of diffraction, the transference breaks up
into a multitude of different narrations and characters, who are internal ‘chimeras’
of the ‘there and then’, but also of the ‘here and now’, as well as of the interaction
of the two minds.
If we think that the field dream functioning is at work from the start, consequently
all communication needs to be seen as something that concerns and activates the
field itself.
Even facts which are apparently more soundly based on reality have the capacity
to become ‘narrative links’, whose function it is to bring us closer to the dream
thought and to understand its meaning. Even the most subjective elements, such as
the patient’s dreams, belong to the field in order to signify and indicate the move-
ments of the waking dream thought, referred to the moment in which the dream is
narrated.
If a patient tells of her daughter who cannot bear to be touched; of her son, younger
than his sister, who loves receiving affection; of her father who is never genuinely
available; then of one of her friends who is very depressed, who has a friend whose
wife’s leaving him left him furious; and, finally, of a film seen on television in which
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 999

a husband attempts to kill his unfaithful wife, etc., she is describing the emotions
that are alive in the field. These could be gathered in a transference interpretation,
but it would be like serving up at the table all the week’s shopping still uncooked,
including all the still frozen foods.
The field permits us to describe, gather and group these emotions, clarifying
and putting them into focus, using the characters as ‘pot holders’ which allow us to
get close to the burning hot content. This intermediary stage is often necessary even
if the analyst is certain that the patient’s communication is a diffractogram of the
current situation of the field, whose ingredients, yet to be put into focus, transformed
and digested, are connected with intolerance to contact (perhaps resulting from ♀
inadequacy in relation to hypercontended), areas of growing feelings of tenderness,
of depression, of rage and fury, of jealousy, of murderousness, etc.
These emotions can be ‘cooked’ through their narrative transformation, with
unsaturated interventions and always ‘sampling’ the patient’s answer, to know
which ingredients we need to add to enrich or lighten the dish … of course, it is a
story of jealousy, abandonment, anger, fury, tenderness and rejection. Some of these
narrative-emotional elements are already ‘cooked’, already utterable, ‘of course
Lino’s wife leaving must be so painful for him that he is full of rage’, rather than
‘Lino’s anger is understandable, even Medea when …’, in other words employing
peripheral interventions which further cook, sort and create links with what the
patient expresses. But sometimes there is a small amount of food which remains
frozen and which needs to become thinkable. If, for instance, the patient moves his
hand rhythmically as if brandishing a dagger, we might introduce something along
these lines: ‘when one is badly hurt, it seems only revenge can bring peace’ … in
other words we represent proto-emotions, which were as yet unnamed.
The pictographing of the proto-emotional states consists in naming something
which was previously unnamed; ‘revenge’ for example can be represented as ‘a
sword-wielding pirate’.
Whereas, in other instances, ‘narremes’ are already narrative derivatives intro-
duced by the patient.

Guido and immigrants

At the beginning of the analysis, Guido talks about a prison setting where he is
working as a medical consultant. Most of the inmates are Arab immigrants and
Guido often finds it difficult to understand them. I will not even try to interpret this
comment both in terms of the difficulty he feels in coming into contact with the
yet undiscovered aspects of his self, and from the difficulty in understanding what
I say. Instead, I deem it more appropriate to help him develop a discourse on these
‘Arabs’, and, as we proceed, every individual Arab becomes gradually more recog-
nizable and remarkable for his own characteristics. The analytic work continues by
articulating the story and helping Guido to focus on the different emotions of which
each individual Arab is the ‘carrier’.
The claustrophobic experience of the beginning of the sessions shifts towards an
agoraphobic register as the sessions draw to a close: the fear that an Arab terrorist
group may strike underground, when he is on his tube journey (Monday to Thursday:
1000 ANTONINO FERRO

the journey from the end of one week’s sessions to the start of the next week’s first
session), or the fear of ‘not seeing his close friends any more’. Again, here, I do
not propose any decodifying interpretations, preferring to accompany Guido in the
focalization, modulation and metabolization of his anxieties regarding separations,
while always ‘apparently’ remaining within his manifest text.
At this point, I would like to add that I consider the manifest text just like the
inside of a trolleybus: although inhabited by various characters who interact
amongst themselves, in my opinion the trolleybus gets its driving power from the
thread of thought present in my mind (the thread of transference interpretation),
which allows me to fill the trolleybus with ‘characters’, comments and interlo-
cutions. These permit narrative, dialogical transformations within the manifest
meaning, which for many patients need to be respected as such for a long time.
In any case, the narrative transformations which take place through the weaving
of the analytic dialogue do not imply a lesser degree of transformation compared
to the more decodifying interventions. Such interventions give a more explicit
sense but often provoke intolerance in the patient’s acceptance of the analyst’s
contribution.

Luca and the wine cellar

There are many moments in an analysis when the patient indicates a newly acquired
capacity to be receptive to the analyst’s interpretation, even if this then entails the
necessity of constant monitoring its modulation. For a long time, Luca had not toler-
ated any closeness in the transference. When it was strictly necessary he referred to
me and himself in the third person (‘my analyst’ and ‘Luca’). At a certain point, Luca
becomes able to accept, and even make use of my explicit interpretative activity, as
long as it is modulated by a simultaneous containment through narrative transforma-
tions. This is a sort of oscillation between a decodifying, interpretative register and a
containing, transformative register, which solely employs the manifest plane.
With the particularly long Christmas break drawing near, Luca relates that he
has bought a special saucepan which keeps stirring cooking polenta even if one is
not physically present to manually stir it, and then that he wishes to buy a special
kind of walkie-talkie which is able to transmit and therefore stay in contact even at
a great distance. He also tells me that he bought four cases of oranges, which should
last him for the whole of the Christmas break.
I feel able to say that the days seemed long gone when, during separations,
he would need to plug in his Duracell batteries which would assure him complete
autonomy, whereas he can now equip himself for the holiday, making use of a series
of instruments which allow us to stay in contact. At the same time, he has the ability to
build up supplies. He seems to amiably accept this interpretative proposal—although
he immediately begins to talk about his mother-in-law, whom he detests, and who
had once entered his wine cellar without asking and had uncorked some of his wine
bottles (the meaning is not yet ready to be uncorked!). To make things worse, his
mother-in-law had been very oppressive, talking to him relentlessly, when his wife
was at work (possibly another representation of the interpreting analyst?) and could
therefore not look after their children who cried endlessly, wanting their mother.
 CLINICAL IMPLICATIONS OF BION’S THOUGHT 1001

By taking in his uneasiness, caused by the intrusive presence of his ‘mother-in-

law’, in a narrative sense, and therefore renouncing the possible interpretation on the
analyst as the mother-in-law who uncorks meanings, a new character is introduced
by the patient, namely his mother, with an affectionate and well-timed phone call.
The point I have just made may be related to Ekstein and Wallerstein’s (1956)
ideas about ‘interpreting within metaphor’ and to the effect of applying Winnicott’s
(1971a, 1971b) understanding of the ‘transitional’ space’ to technique; somewhat
the same that happens with the squiggle game where a shared meaning is co-built
by the two players.

Stefano’s receptivity
Some years have gone by since the beginning of Stefano’s analysis, yet, even now,
every excessive interpretative approach can sometimes provoke homosexual anxiety
(contained forcing an unavailable container—that is, another content which needs
instead the analyst’s receptivity to be able to share its burden. Utilizing the graphic
signs proposed by Bion relative to the container (♂) and contained (♀) this could be
expressed by the following formula: ♂♂ which asks ♀← ♂).
The day after a run of productive sessions, I am expecting Stefano and, on
hearing the intercom, I open the door and wait (my consulting room is on the third
floor of an apartment block and there is no lift). Hearing the clacking of high-heeled
shoes on the stairs, I have the distinct sensation that it is, in fact, not actually Stefano
ascending the stairs, but a woman. I grow progressively certain of this (thus having
an auditory-visual reverie). I hear the doorbell ring. To my amazement, when
I open the door, there stands Stefano. I follow him into the consulting room and
wonder—immediately this time—about the reverie which I had experienced (the
marked perceptive characteristic strikes me).
Initially, I feel puzzled and perplexed. The first movement was that of cancelling
this thought as an interference to be eliminated. In a second moment, I felt the
urgency to find an interpretation that could anyhow free me from this disturbing
experience. And finally I opted to rely on my negative capability until a new meaning
arose spontaneously: now I realize that my reverie was how I represented to myself
a new receptive capacity in Stefano. At this point in the session, I make a number of
transference interpretations which he accepts and ‘savoured’, using them to develop
new associative paths.
At this point (here I take into account and make allowance for Stefano’s residual
difficulty with containment), I add, ‘And please don’t come and tell me tomorrow
that your son has had an allergic reaction!’, referring to what had been for a long
time his response to my previous tentative interpretations. Laughing, the patient
says, ‘But you shouldn’t pre-empt my moves!’
The next day, Stefano firstly tells me about a colleague of his who had had
enough of the hospital consultant’s overbearing arrogance and was on the verge
of quitting his job. He then tells me about his son, whom his wife feared might
have swallowed a pin, so they took him to casualty. He finally tells me about the
consultant who had decided to exponentially increase his patient’s treatment without
considering all the possible side-effects.
1002 ANTONINO FERRO

I could have thus interpreted all this as a response to my poor interpreta-

tive containment, but I preferred instead to adjust the distance and timing of my
interpretation.

Translations of summary
Klinische Implikationen von Bions Denken. Der Autor konzentriert sich auf bestimmte klinische
Implikationen von Bions Denken. Er untersucht insbesondere die hohe technische Bedeutung von Bions
Konzept des „Wachtraumdenkens“ und formuliert überdies Weiterentwicklungen des Bionschen Denkens.
Psychoanalytische Übungen wie jene, die Bion selbst empfiehlt, werden zusammen mit klinischem Material
beschrieben, um die theoretisch-technischen Überlegungen des Verfassers möglichst klar darzustellen.
Darüber hinaus beschäftigt sich der Autor mit der fruchtbaren Verbindung zwischen Bions Theorien und
dem Feldkonzept in der Psychoanalyse.

Implicaciones clínicas del pensamiento de Bion. El autor trata de poner en evidencia algunas implicaciones
clínicas del pensamiento de Bion. Presta particular atención a la gran importancia técnica de su concepto
de ‘pensamiento del sueño diurno’. También propone algunos desarrollos del pensamiento de Bion, y
sus implicaciones técnicas consiguientes. Propone junto a un material clínico determinados ejercicios
psicoanalíticos, como los que recomendaba Bion, para mostrar con la mayor evidencia posible las ideas
teórico-técnicas del autor. Además aborda la fecunda conexión entre las teorías de Bion y el concepto de
campo psicoanalítico.

Implications cliniques de la pensée de Bion. L’auteur s’intéresse à certaines implications cliniques de

la pensée de Bion. Il prend particulièrement en considération le concept de Bion « pensée onirique de la
veille », qui est d’une grande importance technique. Il propose également quelques développements de
la pensée de Bion. L’exercice psychanalytique tel que suggéré par Bion est présenté à travers le matériel
clinique de façon à rendre les idées théoriques - techniques de l’auteur aussi claires que possible. En outre,
il se penche sur la connexion fertile entre les théories de Bion et le concept de champ en psychanalyse.

Implicazioni cliniche del pensiero di Bion. L’autore cerca di mettere a fuoco alcune implicazioni cliniche
del pensiero di Bion. In particolare considera la grande ricaduta tecnica del suo concetto di ‘pensiero
onirico della veglia’. Propone anche uno sviluppo del pensiero di Bion con le relative implicazioni cliniche.
Esercizi psicoanalitici - come quelli raccomandati da Bion - sono proposti assieme a del materiale clinico
per rendere con la maggiore evidenza possibile le idee teorico- tecniche dell’autore. E’ evidenziato anche il
fecondo innesto tra il pensiero di Bion e il concetto di campo psicoanalitico.

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