(2003). The Role of Enactments.

Psychoanalytic Dialogues 13: (5) 677-687

The Role of Enactments
Judith Fingert Chused, M.D.
In this paper the author discusses the multiple ways in which enactments emerge in the
course of an analysis. She presents several clinical examples in which enactments were
used to further the analytic process as well as an example in which the work of the
analysis was temporarily stalled following an enactment.
Psychoanalysis is a Wonderful Profession. by Providing Us With constant stimulation,
frequent doses of high affective arousal, and surprises, it keeps us thinking and feeling.
We are continually learning more, about ourselves and about our patientsalthough, of
course, sometimes we learn things we do not want to learn.
One of the benefits of having practiced psychoanalysis for over 30 years is seeing how
much the field has changed for the better. I have been able to witness the growing
understanding of the role of action and enactments in analysis and an acceptance of the
analyst's inevitable subjectivitya recognition of the impossibility of complete
objectivitythat has enabled analysts to become more tolerant of their being human.
We now are more accepting of our affects and thoughts that are not nice, more accepting of behaving in ways that sometimes are not helpful to patients.
This acceptance of our humanness, our imperfections, has allowed us to use even our
undesired behaviors and affects in our work. Rather than suppressing rage, sexual
arousal, or envy, we allow ourselves to experience these and other affects and use them
to further our understanding of the analytic interaction. Now, when we inadvertently
- 677 gratify a patient's wish for reassurance, when we speak a bit too seductively or angrily,
we examine our behavior and the interaction it generated and learn from it. Enactments,
rather than being something to be ashamed of, have become another source of
information about patients and ourselves.
Before I examine the role of enactments, let me offer you my definition of the term,
which may differ from others'. Not that there is a right definition, but when analysts
define a concept differently from one another and do not state clearly how they
understand it, they often have trouble understanding what each other is saying.
I think of an enactment as occurring when a patient's behavior or words stimulate an
unconscious conflict in the analyst, leading to an interaction that has unconscious
meaning to both. Conversely, an enactment occurs when an analyst's behavior or words
stimulate an unconscious conflict in a patient, productive of an interaction with
unconscious meaning to both. Enactments occur all the time in analysis and outside our
offices. They contribute to most of the things we do or say. At the same time, they are
not the only determinants of an action, and sometimes their contribution is quite
insignificant. Some of the most significant enactments in analysis occur, however, when
an analyst's behavior has deviated from her conscious intent by unconscious motivators,
and it feels wrong when scrutinized.
For example, my conscious reason for accepting the invitation to contribute this
response to Margaret Black's paper was that it was an opportunity to learn something
new. However, I also know that every time I agree to speak publicly, in part it is
because of a desire to show off. Thus, I suspect the mild anxiety I feel each time I begin
to present is the result of an unconscious conflict about that desire. My co-panelists also
have both conscious and unconscious reasons for their participation in our discussion of
enactments. As our desire to learn is the primary determinant, we remained cordial;
however, were conflicts about exhibitionistic or competitive impulses significantly
stimulated, the audience might have witnessed a major enactment.

Similarly, each time I begin working with a patient, I do so with the conscious intent to
help him1 deal with internal interferences in his life. To the extent the unconscious
determinants of my wish to be
1 Unless otherwise specified, the masculine pronoun is used to refer to patients of both
genders, and the feminine pronoun is used to refer to analysts of both genders.
- 678 helpful are problematic (a reaction formation against sadistic wishes to torture; a desire
to connect, in effigy, with a lost parent; a wish to make reparation for competitive and
destructive impulses), my patient's awareness of my wish to help and his desire to
thwart me could lead to an enactment that significantly interferes with the analytic
work. In fact, enactments grounded in an analyst's overdetermined need to help or
cure are a frequent cause of negative therapeutic reactions. Fortunately, in most
instances, our wish to help, even when partially determined by the ghosts of the past,
does not interfere with the work. One of the benefits of analysts having their own
analyses is that the pressure to fulfill unconscious wishes or defend against forbidden
impulses is lessened as more adaptive compromises are made and wishes and impulses
become better integrated into conscious experience.
As we learned from Margaret Black's excellent case example, enactments that
temporarily disrupt the course of analysis can be used to further the work. Certainly that
has been true for me. I am reminded of a recent hour with a 32-year-old woman,
professionally successful, but painfully lonely, paralyzed by her inability to make a
commitment to a man. During her hour, noises could be heard from another area of the
house in which I have both my office and my home. In reaction, the patient stated,
rather forcefully, that she wanted a discount for domestic disturbances. She then said
that she had gotten a new evening gown that did not look right and that she was very
angry with her personal shopper. She went on and on about how she had paid good
money to the shopper and to me and we were not doing our jobs right.
I was used to her complaining, her perception that the cup was half empty. Nonetheless
this time she got to me (perhaps because I didn't like being compared to a personal
shopper), and, feeling irritated, I blurted out, You can't pay for my skill. She
responded that, of course, that was exactly what she was paying me for. To which I
said, Yes, you are paying me to use my skill to help you, but the skill is mine,
developed by me, and it is put in the service of helping you because I wish to help you.
She was silent for several minutes and then said I sounded angry. I agreed I was angry.
She again was silent; then said she guessed she had hurt me. She had never thought
about me as having feelings that could be hurt. She had always thought that if she had
money she could get whatever she wanted, though somehow she was always
- 679 disappointed by what she bought. It was only when she was alone, when she did things
herself and could really control her environment, that things were exactly as she wanted,
but then she felt so lonely. With this hour began an exploration of the intense sense of
vulnerability that accompanied the experience of the other, the discomfort
accompanying an internal awareness that there is another person in the room.
I suspect each reader will have his own thoughts about what led to this enactment. I
thought my irritation was due to my genuine liking for her and my narcissistic injury
and anger that she did not recognize that we had an intimate relationship based on far
more than money. My patient was not aware of the determinants of my participation,
my sensitivity to rejection, but she used what she learned of herself and of me to further
the work.

Another useful enactment followed our talking about her mother and the patient's
growing sense that her mother had cared for her but had been able to express it only
through criticism and rather cruel attempts to shape her into a better student. In a quiet,
somewhat shaky voice, she spoke of a friend of her mother's telling her, Of course,
your mother would do anything for you. She said she had not known that when she
was young, but she now suspected that her mother had been unable to express her love
directly, that to do so would make her feel too vulnerable, just as she, the patient, found
it difficult to admit when someone was important to her.
At that moment, my next patient, a somewhat rebellious teenager, could be heard
singing to himself as he entered the waiting room. The patient, seemingly unaware of
the noise, did not comment on it but became silent. After about five minutes, she said
that she could tell I disagreed with what she had said about her mother and was
probably trying to think of a nice way to tell her she was wrong. I was surprised for, in
fact, I had been impressed with her new way of seeing her mother. I then realized that I
had been silent for a while, trying to deal with my irritation at the teenager outside. At
this point I asked the patient whether the noise from the waiting room had made her feel
that she was not important to me, whether, rather than being angry at me for not
silencing the intruding voice, she had felt put down, imagining that I was critical of her.
I added that I had been bothered by the noise but was not able to do anything about it.
She responded, But you could have told him to be quiet.
- 680 It was clear she was right. As she spoke I realized that my inaction had been due to my
feeling torn between wanting to protect her hour and not wanting to engage in a
sadomasochistic exchange with the provocative teenager in the waiting room, who, in
my reluctance to silence him, had continued to sing loudly (I suspect he was wearing
earphones). I had rationalized that to leave my patient and go to the waiting room would
have hurt her by leaving her alone, so I had done nothing. However, rather than share
with her my conflict, I simply said that she was right; I could have silenced the intruder.
She then said that the incident reminded her of her father, that he had made a couple of
feeble efforts to get her mother to act nicer, but then had just given up. Her mother
favored her brother above everyone else in the family, that was clear, and her father just
retreated whenever there was a family conflict. The hour ended with her saying that, as
a teenager, she had always felt alone.
In this hour, my inaction was, consciously, a result of my doing what I thought was the
best compromise between two patients' needs, and unconsciously, doing what was most
comfortable for me. I recognized that the patient's assumption that I was critical of her
was a response to my not protecting her time from the intrusive noise; what created the
enactment was her readiness to feel rejected and my guilt, made manifest by my
claiming I could not prevent the noise. I felt guilty for not protecting her, a guilt that she
wanted to elicit (it was a way to feel connected to me in a regressed sadomasochistic
mode). What alerted me to my participation in an enactment was my denial of
culpability, my defensive reaction. What allowed us to move forward was not an
interpretation, but my acknowledgment that she was right. By agreeing with her, I
ceased participating in the sadomasochistic loop of victim and victimizer/accused and
accuser. And when we stopped enacting, she began to remember.
Of course, there are times when enactments are not useful. With the same patient, in the
first year of our work, I can remember becoming increasingly irritated with her
complaints about the inconvenient time when we met, the charge for missed sessions,
and the lack of progress. I knew, intellectually, that she was frightened by her growing
attachment to me and the associated vulnerability; but nonetheless, her attacking

comments, her insistence that I was unprofessional and self-serving, got to me. Like
many, when I am irritated and try to suppress it, the softness in my voice, the steady,
- 681 somewhat monotonous rhythm of my speech, are clear signs that I feel enraged. Having
picked up on this pattern, my patient increased her complaining, only now with an
excited pitch to her voice. The hour ended unresolved.
The next day, after a long silence, she said she was bored, that she guessed I was
invested in the analysis, but she wasn't sure whether it was for my benefit or hers. Her
disengagement continued for several weeks, and it was not until I referred back to her
attack, acknowledged that she had angered me, which gave her a sense of control but
made her uncomfortable and made me seem worthless, that we were able to break the
stalemate. Again, it seemed that, for this woman, my tolerance of my vulnerability,
without attack or withdrawal, allowed her to begin to tolerate her own. In this instance,
as in others, I found that my tolerance of my vulnerability could convert an enactment,
what the Boston group on the process of change (Stern et al., 1998) refer to as now
moments into moments of meeting, with significant therapeutic benefit.
In each instance, affects were the signal that alerted me to the occurrence of an
enactment, that told me I had withdrawn into silence, spoken flirtatiously or with
irritation, pushed an idea or denied a projection. It is the internal oops, the sensation
of anxiety when I find myself behaving in ways that are not helpful, that tells me I have
enacted. And, when I have the impulse to ignore the enactment, I know something
important has taken place that I need to understand and address.
Of course, many enactments take place outside of awareness that may influence the
course of analysis; however, as long as they remain outside of awareness, I can neither
use them nor measure their effect. In addition, there are enactments that I may notice
that have little significance for the patient at that moment, having more to do with my
own unconscious processes than with the patient's, as when I caught myself bragging
(very subtly, I hasten to add) to a patient with whom I was competitive. These
enactments I try to address when they become relevant for the patient, not when my
primary aim is to relieve my guilt.
One of the problems in our field that followed the recognition that enactments could be
useful was that enactments began to be glorified. Some analysts even went so far as to
insist that there is no movement in an analysis except following an enactment. I see
enactments as only one of the multitude of interactions that occur in an analysis. I
- 682 have found that most often it is the exploration of the enactment, rather than the
enactment itself, that is mutative, just as it is the use of the analytic relationship, not
simply the fact of a relationship, that is therapeutic. Of considerable value are those
moments when an analyst catches herself about to participate in an enactment and,
rather than enact, subjects her affects and thoughts to scrutiny, and then pursues some
other course of behavior rather than enacting. Awareness of our inevitable subjectivity,
not just acting on that subjectivity, is our goal.
I am reminded of an hour with a young man in his second year of analysis. An
executive in a major organization, he was complaining bitterly of his wife's behavior,
reflective of her fear of a robbery or physical attack. She had insisted on their buying a
new house, completely of brick, had demanded he install an elaborate security system
with a safe room, and refused to leave the house keys with a neighbor while they were
on vacation. Her demands made him angry, even while he understood the origin of her
fear (for which she also was in treatment). As he complained about his wife, he
suddenly became alarmed at my movement in the chair behind him and had the thought

that I would hit him. I was tempted to point out that his apprehension about me was an
echo of his wife's fears and reflected his own aggression, which he was scared to
express (we had spoken in past hours of his difficulty setting limits for his children or
making requests of his staff at work). However, rather than saying any of this, I asked
him if he knew why I wanted to hit him.
With great embarrassment he said that he knew it was silly, but he had had a flash
thought, just when I moved, of how beautiful his wife was, how good in bed, and he
wondered if I were jealous of their sex life and his pleasure. He said he realized it was
ridiculous, that I had achieved so much and here he was just beginning his career and
family. Now this was far from true, for already, in his early 30s, he was head of a
division of more than 40 employees. I associated, silently, to his family history, the
dysfunctional interactions and physical abuse that had marked his childhood. He was
the only one of six siblings who had left home, and, even from a distance, he took care
of them all, his parents as well as his siblings. I think his fear that I would hit him,
occurring in association with his positive thoughts about his wife, reflected his
apprehension that he would be punished for his successes and competitivenessa
competitiveness that was just emerging in the transference. I believe he was defending
against his competitiveness
- 683 with me by giving me the opportunity to make a brilliant interpretation about the
projection of his aggression. By my not enacting the role of brilliant analyst to nave
patient, by my permitting him to come to an understanding of his fear at his own pace,
we were able to move to an exploration of competition, an area that had been
assiduously avoided for two years.
How did I recognize that my impulse to interpret was a potential enactment? First, it felt
too easy; we had been there before, and he was aware of his fear of aggression and did
not need me to speak of it again. Second, he did not seem to be fully engaged; it was as
if he had thrown me a line and was waiting to see what I would do with it. Both feelings
were vague sensations, but I have learned to listen to my affects, for they are often
signals that something new is happening. I never can tell, initially, whether my signal
affect primarily reflects my own psychology or whether it relates to what is transpiring
between me and the patient; thus, along with my scrutiny of the patient's association, I
simultaneously try to scrutinize my own silent associations. Of course, often the signal
becomes more than a signal, and then enactments occur.
Enactments can be embarrassing for an analyst. In the old days we used to think of
them as mistakes, and analysts felt guilty when they acted on unconscious conflicts or
when their impulses leaked through, outside their control. Fortunately, with an
acceptance of the analyst's irreducible subjectivity and the inevitability of the
unconscious asserting itself, to enact is no longer considered shameful. Nonetheless,
analysts often feel guilt when they enact.
A technique I have found useful (as do my students) for minimizing the distress
associated with being caught in an enactment is to narcissistically decathect myself.
This allows me to regain my capacity to think (as Margaret Black has described so
well); it helps me stop participating in the enactment and enables me to use it for
therapeutic gain. By narcissistically decathecting myself, I mean I try to listen to a
patient's perceptions as if they were my own. I take a step back from my subjective
experience to join the patient in his experience of the analysis and of me. It is as if I
were doing play therapy, using toys as displacement objects, except I am the toy, the
displacement object.

When I do not agonize over the injustice in being perceived as a witch, abuser, or
castrator, or become captivated by a patient's idealization or seduction, I can explore the
patient's fantasies and transference perceptions without an interfering defensiveness.
Thus,
- 684 along with the internal work of narcissistically decathecting myself, I may, when
appropriate, engage the patient in analyzing the analyst. I may invite the patient to
speculate on what is motivating me to behave as I am perceived. By not using even the
subtle denial contained in, Do you have any thoughts about why you experience me as
angry (or sad or seductive), and instead asking, Do you know why I am angry, sad,
seductive? I am giving the patient license to elaborate on his underlying fantasy,
knowing that his experience will be taken seriously. This technique, when it is
successful, leads to an understanding both of the unconscious determinants of the
patient's perception of me and of those characteristics of mine that he has noted but has
not been fully comfortable addressing.
For example, I always have fresh flowers in my office, which I usually arrange on
Sunday to be ready for the work week beginning on Monday. Not infrequently I am out
of town over the weekend, and, with little time to spare, I put out flowering plants rather
than arrange cut flowers. Some patients notice this change; some don't. Among those
who notice is one patient who angrily expresses her thoughts and feeling about what the
difference in flowers represents. However, rather than imagining that I have been out of
town, her fantasies are sexual, usually that I had a passionate sexual adventure over the
weekend and did not have time to arrange flowers. Well, she's right about not having the
time.
What do I do with her fantasy? I certainly acknowledge there are plants in the office
rather than cut flowers and may even acknowledge that there were time limitations. But,
in framing my intervention, I speak of the sexual adventure in the same way I speak of
the time limitation. That one is a vision of reality I share, and the other does not enter
into my initial interventions. More specifically, I might say, You are able to tell when I
am short of time on the weekend by the flowers you see Monday morning. What does it
mean to you that I was so sexually aroused over the weekend that I didn't have time to
arrange flowers?
The task as I see it is to speak to the patient's psychic reality, the world as the patient
sees it, and try to understand the experience of that world as well as how and why it
came to be. To say to a patient, What makes you think I was so caught up in sexual
activity that I didn't have time to arrange flowers? is to challenge the reality of the
patient's perception, to say, in essence, it is only in your thoughts that I was so involved.
And as soon as I have done that, I have lost my
- 685 connection to the unconscious elements that contributed to the patient's fantasy. They go
underground, hidden by my covert suggestion that only in her head did I have sex. So
whatever a patient's perception, I try to accept it nondefensively and, using myself as a
displacement object, accept whatever she projects onto me as the reality we will
explore.
The analyst's defensiveness is often a major factor in the creation of an enactment.
When a patient has induced guilt in an analyst, leading the analyst, resentfully, to
provide special treatment, the resentment leaks through. When a patient makes the
analyst uncomfortable, the analyst's movements behind the couch, the change in her
speech pattern can make her discomfort evident. But if the analyst then recognizes the
enactment, the resultant change in her behavior, without words, may help the patient

understand the scenario he has helped create. For enactments can occur with or without
words, just as an understanding of them may be communicated verbally or nonverbally.
Similarly, at a later time, the analyst's ability to articulate their interaction may
nonverbally communicate her tolerance for her participation in the enactment; that is,
the act of speaking rather than the words themselves may be what is beneficial.
Although it may seem to complicate matters, it is important to note that the act of
speaking about an enactment may in itself be another enactment, depending on the
unconscious intent of the speaker. As we know, meaning is conveyed not only by the
content of words but also by the conscious and unconscious intent of the speaker and
her affect.
When dealing with enactments, I remind myself that my participation in an enactment is
the result of my unconscious conflicts, impulses, and desires, and, though they may be
induced by the patient, enactments still originate within me. An analyst needs to
examine her own experience of the interaction with a patient to function effectively, to
work through her conflicts sufficiently to regain analytic capability. We cannot forget,
however, that it is the patient's experience of the interaction, not the analyst's, that will
affect him, that is potentially mutative. Ultimately, the focus must be on the patient's
experience, for that is what he takes with him when he leaves. For no matter how
steadfastly we devote ourselves to listening to our patients, all is for naught unless we
can help our patients to listen to themselves. I believe our reaction to enactments, our
tolerance of enactments, is a model that patients can use in learning to listen to
themselves.
- 686 References
Stern, D., Sander, L. W., Nahum, J. P., Harrison, A. M., Lyons-Ruth, K., Morgan, A.C.,
Bruschweilerstern, N. & Tronick, E. Z. (1998), Non-interpretive mechanisms in
psychoanalytic therapy: The Something more than interpretation. Int. J. Psycho-Anal.,
79: 903-921.[]IJP.079.0903A
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