Psychoanalytic Psychology © 2009 American Psychological Association

2009, Vol. 26, No. 3, 259 –273 0736-9735/09/$12.00 DOI: 10.1037/a0016448

NONINTERPRETATIVE MEASURES IN THE

ANALYSIS OF TRAUMA
Arnold Wm. Rachman, PhD, Margaret A. Yard, PhD,
and Robert E. Kennedy, PhD
The Institute of the Postgraduate Psychoanalytic Society

Psychoanalysis has a long and distinguished history in the use of non-

interpretative measures, first introduced by Freud in the case of the Rat Man
and, then, formalized in the case of the Wolf Man. Freud passed the mantle to
Ferenczi when he declared the future development in psychoanalysis would
center around Ferenczi’s introduction of the role of activity in psychoanalytic
technique. Over the course of his clinical career Ferenczi described a theory of
trauma, the Confusion of Tongues paradigm and experimented with Relaxation
Therapy which included a wide array of non-interpretative measures in order to
successfully treat trauma. Three clinical cases are presented by the authors to
illustrate the use of on-interpretative measures in the contemporary analysis of
trauma. Trauma creates a developmental freeze which interferes with the indi-
vidual’s capacity to mentalize, i.e. create representations which can be stored in
language and thus, symbolize concepts for meaning formation. Arrested devel-
opment of cognition and verbal interaction is stored in the body as a somatic
memory. Non-interpretative measures are an effort to reach the split-off pre-
cognitive and somatic aspects of the trauma.

Keywords: non-interpretation measures, analysis of trauma, Ferenczi, role of

activity

Freud’s Introduction of Noninterpretative Measures

There is a significant history in psychoanalysis for the use of noninterpretative measures

to aid the expression of suppressed affect, as well as to aid the working through process.
Although Freud is considered to be the prototype of “the analyst as interpreter,” it is
seldom recognized that the founder of psychoanalysis pioneered the employment of
noninterpretative measures. Freud’s original introduction of noninterpretative measure
began with feeding the Rat Man (Coltrera & Ross, 1967). After much discussion feeding

Arnold Wm. Rachman, PhD, Margaret A. Yard, PhD, and Robert E. Kennedy, PhD, The Institute
of the Postgraduate Society.
Correspondence concerning this article should be addressed to Arnold Wm. Rachman, PhD,
8777 Collins Avenue, #210, Surfside, FL 33154. E-mail: nancy.rachman@nick.com

259
260 RACHMAN, YARD, AND KENNEDY

the Rat Man was attributed to Freud’s humanism (Boyer & Giovaccini, 1967). In his
pioneering case of the Wolf Man, however, Freud formally introduced four noninterpre-
tative measures: (1) a cure was promised; (2) the patient was treated without a fee; (3)
money was raised for the treatment; and (4) a termination date was set (Freud, 1918/1955).
It was Freud’s clinical acumen that moved him to deviate from his own standard
procedure (Roazen, 1975). The analysis of The Wolf Man could not be conducted, Freud
believed, by only the use of his standard technique. His idea was to match the analysand’s
developmental and real-life needs with meaningful therapeutic procedures. Although it
cannot be said that the noninterpretative measures provided a cure for the Wolf Man, it did
elasticize the concept of psychoanalytic treatment. Freud’s influence continued after his
death, when a series of analysts would journey to Germany during the summer months, to
continue to treat The Wolf Man without a fee (Roazen, 1975).

Ferenczi’s Elasticity Principle

Freud believed the treatment of difficult cases where childhood trauma was evident was
the future of psychoanalysis (Freud, 1919 [1918]/1958). While Freud turned his attention
to the further development of theory, he entrusted the evolution of analytic method to
Ferenczi (Rachman, 1997, 2003a). Ferenczi devoted his career to the study of trauma and
the elasticizing of the boundaries of the analytic method (Rachman, 1997, 2003a, 2007).
In a series of groundbreaking papers, Ferenczi described the expansion of the analytic
method to include a wide array of noninterpretative measures (Ferenczi, 1980a–1980l,
1988). These were measures that allowed the analysts to create a variety of clinical
interactions other than the tradition of interpretation, such as active roles for the analyst
and the analysand; cocreated clinical interventions; clinical empathy; countertransference
analysis; analyst self-disclosure; and mutual analysis (Rachman, 1997, 1998, 2003a, 2004,
2007). The most extensive description of an analysis where noninterpretative measures
were used was Ferenczi’s case of Elizabeth Severn, (R.N. in The Clinical Diary [Ferenczi,
1988]). Ferenczi conducted his analysis with Severn to deal with severe and persistent
childhood trauma (Balint, 1968; Ferenczi, 1988; Rachman, 1997, 1998, 2003a, 2007).
Both Eissler’s idea of “parameters” (Eissler, 1953) and Stone’s concept of “widening
the scope” (Stone, 1954) brought the idea of noninterpretative measure into the domain of
traditional psychoanalysis. In the ensuing years since the Eissler and Stone publications,
noninterpretative measures have been explored, reformulated, extended, and integrated
into the object relations: interpersonal/humanistic, self-psychology, and relational per-
spectives (Rachman, 2003a). The British Object Relations perspective, most notably
Balint (1968) and Winnicott (1965), integrated an active role for the analyst when
“working to the zone of regression” with severe neurotic, borderline, or psychotic
disorders. Balint was a witness to Ferenczi’s extensive use of noninterpretative
measures in the analysis of Elizabeth Severn (Balint, 1968). In fact, one could say that
Ferenczi’s case report about Severn was the first attempt to formally use noninter-
pretative measures to aid in the analysis of trauma (Rachman, 2009). Margaret Little
reported on her analysis with Winnicott and his use of noninterpretative measures
(Little, 1981). Self-psychologists, most notably, Bacal (1990) and Estelle and Morton
Shane (Shane & Shane, 1996), have attempted to expand the traditional Kohutian model
to include noninterpretative measures. Both Bacal and Morton Shane were students of
Balint. Bacal also has integrated object relations ideas into his self-psychology perspective
(Bacal & Newman, 1990).
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 261

Three Cases of the Use of Noninterpretative Measures in the

Analysis of Trauma

Three clinical examples will illustrate the contemporary use of a relational perspective
informed by Ferenczi and Balint’s ideas (Rachman, 2003a, 2003b, 2007), where nonin-
terpretative measures were employed in the analysis of trauma (Rachman, 2003a, 2004,
2007, 2009). These examples are Margaret Yard’s “Case of Denise,” Robert Kennedy’s
“Case of Patrick,” and Arnold Rachman’s “Case of Winston.” These cases illustrate
elasticizing the boundaries of analytic work to reexperience and work through childhood
traumas unreachable by conventional verbal interaction and interpretation. Noninterpre-
tative measures are seen as a meaningful, and at times necessary, adjuncts to the analysis
of trauma (Rachman, 2004, 2009; Rachman, Kennedy, & Yard, 2005; Rachman, Kennedy,
& Yard, 2009).
Noninterpretative measures should not be viewed as nonanalytic. In the relational
perspective, especially the view that integrates Ferenczi and Balint’s ideas (Rachman,
1997, 2003b, 2009), the use of activity that goes beyond traditional clinical boundaries is
a necessary step toward freeing up associations so that the analysis can reach “rock
bottom” (Ferenczi, 1980l) and work through the “basic fault” of the origin of personality
trauma (Balint, 1968). It is the contention of the authors that noninterpretative measures
may be a necessary and sufficient condition for analyzing trauma. As we have discussed,
Ferenczi profoundly understood this idea based on his commitment to Freud’s analytic
theory and his own clinical acumen. What is more he had the personal courage to cocreate
clinical encounters.
It is clear to any clinician who regularly participates in clinical work with “difficult
cases,” where trauma is at the heart of the difficulty, that flexibility, responsiveness, and
creative clinical encounters naturally evolve in a mutually democratic therapeutic process.

The Case of Denise: (Margaret Yard)

Denise, a 38-year-old grammar school teacher, with a long history of parental rejection,
sought therapy because of a history of lost jobs. Denise had a history of conflict with
supervisors in her teaching positions. She had difficulty accepting direction and was
confrontational with supervisors and teachers. She shared a lack of impulse control and
grandiosity. She wound up being escorted out of schools.
She came to treatment in hope of keeping her new teaching assignment in a small
church-run school. Denise obtained this new job by plagiarizing a referral from a college
friend, rewriting her resume, and editing out her previous job failures. Despite her
elaborate attempts at being hired, Denise continued to jeopardize herself, by showing up
late. Ironically, she took her students’ occasional lateness as a personal affront, with no
awareness that she had herself modeled the boundary-breaking behaviors.
She developed creative lesson plans, but soon procrastinated, lost interest, and had
difficulty executing her detailed and expert class plans. Some perceptive students sensed
her problem with boundaries, experienced her erratic and unpredictable behavior, her
excitability, and began to take advantage of her by purposefully challenging her. Psy-
chodynamically, they mimicked the humiliation Denise felt at home when her mother had
taunted her. Denise thrived on and created the tension of a chaotic and destructive
environment. Doing this, she reenacted the malevolent and unsafe atmosphere of her early
home.
Severely traumatized by her strict, authoritarian mother who was inconsistent, inad-
262 RACHMAN, YARD, AND KENNEDY

equate, and punitive, Denise suffered violent conflict in her home. Her Italian mother
adored Denise’s two older brothers obsessionally, shopping for them, doing their account-
ing, and cleaning for them, even as adults. Yet, Denise states, her mother treated her like
an undeserving stepdaughter, a Cinderella without hope to find her prince. Her symbolic
prince was her father who was loving toward her, but whom her mother banned from her
household when Denise was 4 years old. Developmentally, Denise never obtained a sense
of safety and security from her mother. She both hated and feared her mother’s power in
“driving her father away,” whom she never saw again.
Denise had been unsuccessful in a previous therapy. She complained that the therapists
were always making interpretative statements that made no sense to her and were
unhelpful. In our analysis she immediately challenged the notion of “the analytic frame.”
On her first session Denise could not choose a seat and sit in it. Instead she circled the
room wringing her hands and talking over my voice. I wondered if she could even sit
through a session. That first session, I suggested that she try sitting with the chair at
different distances from me until she felt “right about it.” My suggestion that she move the
chair to her comfort level of distance reassured her. It allowed her choices, and with this
option, lowered her internal agitation enough for her to sit and “save face” by “not giving
in to me,” the female authority. Rather than the designated chair, she chose the “window
sill” as her seat. This choice was an emotionally meaningful compromise for her.
Her internal preoccupation with a perceived insult by me because her boundaries were
frail prompted her, on occasion to storm out of my office. Later in therapy, in a malevolent
transference toward me, she described a game she played called “Russian roulette.” In this
game, she attempted to challenge and unsettle me by disclosing violent and disgusting
material about herself and her family. She was observing whether I was actively listening
and focused on her material and then, immediately deny it, laughing that she had “fooled”
me. When this happened, I struggled with my own countertransferential anger at her
attempts to fool and control me. Yet, beneath her overt behavior, I sensed the turbulent
mental states verging on panic that she was having trouble regulating. This prepared me
to empathize with Denise’s rage and fear.
This kind of primitive emotional game lead me to believe that Denise’s low frustration
tolerance and motor agitation would be best helped by noninterpretative measures. One
such noninterpretative intervention occurred the next time Denise walked out of our
session. When she stormed out, I waited, but left the door ajar. I continued to sit through
the empty session acting as if I expected her to reappear and resume our work. She often
stood outside of the room and waited silently. I did not speak, only left the door obviously
open and sat across from her chair in silence. Soon her waiting outside diminished in time
and she rejoined out session, picking up where she had left off. I did not interpret, nor did
I focus on her leaving. She experienced this as “empathetic silence,” that I was there, I was
waiting, but that I would not intrude on her desire or behavior as her mother had done.
What I experienced, especially in the beginning, was a series of reenactments deriv-
ative from her early attachment ruptures with her mother. Denise lived out an intense
love– hate drama with all significant objects in her life. She exhibited poor affect
regulation and attentional control, which destabilized all her attempts at relationship and
undermined her ability to experience self-coherence. Denise’s history suggested that she
had had a developmental arrest at the preverbal level, as a response to attachment trauma.
She experienced genuine malevolent treatment from her mother’s active rejection in
denying her a place in the family. Her mother’s libidinal fixation on her sons drove Denise
to run away from home when she was 16 years old. Yet, it is incommensurate for the child
to understand that the parent, whom they are wholly dependent upon, is malevolent toward
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 263

him/her (Ferenczi, 1988j). Denise did not recognize the nonloving, jealous, competitive,
and actively destructive intent of her mother. This resulted in Denise remaining dissoci-
ated and fragmented. She suffered from attachment trauma as she had severe deficits in
keeping a connection with another (Beebe, Lachman, & Jaffee, 1997; Bowlby, 1969). As
a result of attachment trauma, Denise had difficulty “holding” another in her mind. She
lacked the means for emotional sustenance and self-soothing, which could be used later
for the development of a positive self-concept and supportive relationships. Because she
lacked “object constancy,” she lacked the “anchoring” function, which helped her in the
perseverance of her relations with others (Winnicott, 1965). Denise’s mentalizing deficits,
that is, her inability to think about her own mental state, and to organize herself, combined
with the lack of background trust that would create object constancy left her at risk for
developing a therapeutic working alliance.
The use of interpretation was counterindicated because Denise had limited ability to
contain an idea or to cognitively reflect on her behavior. Because she had difficulty
containing her feelings and putting them into words, Denise needed a more concrete and
literal model for treatment, one in which behavior and actions contained the therapeutic
message, our instructions in “the here and now.” We enjoined in a “cocreated partnership”
(Fiscalini, 2006), which broke the strictures of aloneness and hostile isolation and allowed
Denise to begin to participate in an analytic relationship. Denise began attending, paying
attention, and interacting in our sessions. Our next goal was to work on her obsessive
preoccupation with her mother, which precluded her ability to reflect on herself. Together,
we talked about how to alleviate her obsessively debilitating negative thoughts, which
retraumatized and consumed her life. Denise wanted to “bury her persecuting thoughts
about her mother and never see them again.” The word “bury” ignited a creative flood in
her, and taking it literally, Denise imagined a full-blown funeral for her mother. I did not
analyze this as a morbid preoccupation with death, or as a sign of regression. Instead, her
new ability in symbolizing her conflicts and entering into a mutually created noninter-
pretative frame allowed her to accept support and empathy from me. The idea of a funeral
would help her cathect her trauma in concrete terms that she could understand. Being
handy in arts and crafts, Denise decided to build a miniature coffin and drape it in black.
In this coffin she put her mother’s letters, mementos, and pictures. She decided to bury her
mother’s effects and imagined a funeral. She went through the following steps: creating
a chapel atmosphere with flowers and arrangements, including condolences written out by
friends and relatives on little cards, placing lit candles all around to create a solemn mood,
addressing prayer cards to her mother, playing Schubert’s “Traumerel,” pacing solemnly
to this slow-measured music, wearing a black dress, gloves, and hat with black lace veil.
She chanted other death dirges and lit the pungent incense used in the Catholic Church in
a background of the “Mea ulpa” of the Catholic mass. She envisioned a long procession
for the burying of mother’s body and effects in a casket in the ground.
After hearing her detailed description, much like a screen play, I offered here a
response that was intended for her to reflect or mentalize on her proposed noninterpre-
tative measure. Denise wanted to bury her handmade coffin with her mother’s effects in
the ground. That act would certainly provide a catharsis for her murderous feelings toward
her mother, and so there would be immediate short-term relief. However, I reasoned that
if she buried her mother’s artifacts in the ground, they would not be able to be retrieved.
They would not be available to her should she overcome her developmental arrest. Denise
at that time understood things only in concrete terms and could not imagine that as she
progressed in therapy she might want to unearth pictures and artifacts of mother to
undergo a symbolic mourning process so that she might finally find some resolve of this
264 RACHMAN, YARD, AND KENNEDY

early traumatic experience. If she went ahead and buried the objects, I reasoned, she would
have restricted her opportunity to work out her conflicts.
I made the suggestion to store her mother’s things in a storage rental box, so that she
could “revisit” her past and retrieve it when she wanted. This degree of personal efficacy
appealed to her. It also had the value of giving Denise the clear message that I intuitively
felt that with intense work and commitment she had the potential for making change in her
life.
I became aware that I had a countertransference reaction to Denise’s burying her
mother’s material in the ground. My countertransference analysis revealed my reaction
was related to not being able to reach my own mother, unavailable to me with Alzheimer’s
disease. My projection on Denise’s desire to get rid of the noxious mother who “disap-
peared on her,” was, in part, a countertransference reaction to preserve my connection
with my own mother and not bury her, so she would not disappear in my life. Denise’s
mother was alive and had an intact sensorium, she did not have Alzheimer’s disease. On
a compassionate note, I realized that Denise had an opportunity to grieve the bad treatment
she had experienced from her mother. On an intellectual and experiential note, I concur
with the clinical utility of the concept of mentalizing and the working through of traumatic
and developmental psychopathology (Fonagy, Gergely, Jurist, & Farget, 2001).
The noninterpretative measure of the funeral and burying the mother’s contents proved
effective. After performing her “funeral” at the storage box company, Denise began to
focus more on understanding her conflicts and enactments. She experienced relief from
past persistent traumatic material. As time went on Denise spoke again of her “mother’s
funeral” and the space it made in her life so that she could “put the trauma behind her.”
Her negative obsessive thinking about her mother diminished, as did her frequent
nightmares. During the first year of analysis, Denise began taking continuing education
courses to enhance her teaching credentials. The following year she began teaching again
in a concentrated and organized manner. During the third year of analysis, Denise began
a deep process of reflection and was curious enough to want to reopen the casket of
mementos from her mother, to examine them, and to retrieve the photo of her mother to
place in her home. This then, was the beginning of the working through process.
In retrospect, Denise reflected on her analysis over her other therapy experiences. The
funeral measure helped her cathect her strong “unresolved” feelings so she could go on.
She stated that the differences was that I allowed her to feel her stress had a legitimate
source and that she herself was an authentic, but troubled person. I believe this insight
would have never come to actualization without the very concrete and active noninter-
pretative measures taken.

The Case of Patrick (Robert E. Kennedy)

Patrick was a 50-year-old Catholic priest, born of Irish American parents. He came to
analysis to fulfill the requirement for training as a pastoral counselor. Although he was
aware of his basic personal issues, he was not aware of the depth and scope of a specific
early trauma. Patrick had been a child who was emotionally neglected. As an adult, this
trauma was manifested as an insensitivity and lack of empathy to the suffering of
particular groups, such as the British, the Scots-Irish, and the Jews. All of these groups
were identified by his parents as different and antagonistic to the Irish Roman Catholic
belief system. The indifference to his needs by his family paralleled the training he
received as a priest, which lacked an empathetic response to the trauma of other groups.
There was a historical and familial background to Patrick’s emotional deprivation. The
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 265

long history of the brutalization of the Irish people had created his family’s solidarity and
painful victimhood. That environment isolated Patrick and gave him little encouragement
or opportunity to develop empathy for others. As the priest grew to manhood he lacked
confidence in his own ideas. Instead, he developed a naive and excessive loyalty to his
own clan, church, and family, which he took to be a virtue. This blinded him to the
sufferings of others.
If Patrick’s family was matriarchal and hierarchical, the Catholic Church was even
more so. His religious education stressed sermons over discussion. Catechism had to be
memorized, the priest was not to be questioned, and cooperation with non-Catholics was
not encouraged. Patrick’s education taught him to be loyal and faithful. It taught him to
be wary of liberal influences outside the protective embrace of the Church.
One day, a group of friends invited Patrick to join them on a week-long pilgrimage to
the Auschwitz-Birkenau Concentration Camp ruins to bear witness to the suffering of the
Jewish people. Patrick never intended to go to Auschwitz. He had read about the
Holocaust and he was not particularly emotionally moved by what he had read. He was
not motivated to investigate it further. He went on the trip to please the group with which
he had a strong affiliation.
Once he began the concentration camp journey, step-by-step, Patrick’s struggle with
empathy was revealed. The many “silent dead” brought him to a sensitivity to others he
had never imagined possible. Patrick was personally exposed to material and graphic
evidence of the suffering of the Jews for the first time in his life. He was emotionally
moved by their suffering. The exploration of the trauma of indifference to the suffering of
others, although explored in psychotherapy sessions, never produced any emotional
insight.
This case is an example of early trauma projected on latter objects, for example, from
the family to the Catholic Church. The original trauma of maternal deprivation was then
reenacted on the journey to the sites of Jewish suffering. The bearing witness of the
suffering of the Jews occurred through a series of intensive emotional experiences, such
as the viewing of the concentration camp; the platform where Jews were separated; the
barracks for the children and women; the ash pit where remains of people were dumped;
the museum where hair and clothes were kept; the gas chamber and crematorium. Bearing
witness was intensified by group discussions about the experience, the films of the actual
running of the camps, the reading of the names of the people who died in the camps, the
living presence of the Jewish witnesses and relatives of survivors. These activities of
viewing the aspects of the concentration camp and group discussions about the experience
constitute an intensive emotional experience outside the consultation room, which became
an adjunct noninterpretative measure to his analysis. The immersion in this active and
emotionally intensive experience lessened Patrick’s defense system so that an empathic
response was possible. Patrick’s experience at Auschwitz-Birkenau was reviewed in his
analysis. The analysis of the emotional experience at the concentration camp encouraged
change in four ways: his self-understanding, his relationship with his analyst, and his
relationship with others, for example, friends, students. First, there was a change in his
self-understanding. Patrick saw that his celibate priesthood was a way of evoking affection
and esteem from people without having to take personal responsibility for them. No matter
how hard Patrick worked for them to believe that he loved them there was an antiseptic
quality to his love that kept him separate and safe from their suffering. Patrick was taught
that this “freedom” from domestic entanglement was a necessary quality in a priest, but
he realized it was also a way of being untouched and finally irresponsible. He initially
found himself walking through Auschwitz-Birkenau as a spectator viewing a car wreck
266 RACHMAN, YARD, AND KENNEDY

involving “others.” He learned to grieve for his shallowness and lack of humanity, but this
was only a halfway house. The final gift of Auschwitz-Birkenau was the ability to grieve
not for himself but for the suffering of others who neither loved nor esteemed him.
Second, his experience at Auschwitz-Birkenau changed his relationship with his
analyst. He had prided himself on his good working relationship with his analyst, but there
was always present a subtle note of competition and a need for reciprocity. The element
of competition with the analyst could take various forms: a verbal sparring match so as not
to be defeated or taken over by an opponent, or a fear of being emotionally dependent on
him, or a need to win his approval. The element of reciprocity with the analyst showed
itself in Patrick’s need to have the analyst change. If the analyst wanted him to grieve for
the lost Jews, Patrick wanted the analyst to grieve also for the lost Irish. Patrick wanted
his analyst to actively acknowledge that the Irish had been brutalized by the British. He
resented the analyst’s claim that his sufferings were unique or special. At Auschwitz-
Birkenau all thoughts or competition or reciprocity were swept away. When his analyst
told him he wept at Yad Vashem, Patrick wept with him.
Third, in his group analysis with other analysands Patrick experienced his own
defensiveness and resistance to change. For example, Patrick saw or rather experienced
that in a group of equals he became a silent observer. Stripped of clerical privilege Patrick
was forced to converse with men and women not as students but as equals who could more
than hold their own with him and were not afraid to correct him. He felt envious of the
women who flourished in open conversation and felt fear of the men whose anger flashed
for reasons buried in their own past and as yet unanalyzed.
Patrick listened more carefully to fellow priests at their dinner conversation, realizing
that his fellow priests and he himself were “storytellers.” Telling a story kept them from
any personal self-revelation. Tales of ancient history were often repeated as safer topics
then revealing their loneliness, depression or doubt about the value of their common
religious enterprise. Good storytellers also wielded the power to determine what topics
would be admitted to the conversation and which ones would be dismissed. Patrick saw
that some of the clerical conversation that he experienced was competitive to ensure that
no one would stand out above the significant others, such as fellow priests or members of
the hierarchy. Men without wives or children often found their identity in the small
recognition and promotion that the clerical state afforded. Such men ran the risk of being
frozen in an adolescent posture of high school boys with their endless teasing and putting
each other down.
Although the changes discussed seemed genuine, I was concerned that he was learning
to deflect anger by pleasing the Jews, pleasing the analyst, pleasing God. Clearly Patrick
needed deeper understanding and insight if he were to become anything more than a good
boy who pleased everyone out of unconscious fear. We needed to revisit his childhood
trauma. He insisted that his mother was a good person, strong and self-giving. He said his
siblings felt no such deprivation and they said his feelings toward his mother were
“preposterous.” He wanted to take the blame for his feeling deprived on himself. He
believed he was the weakest of his brothers and said if he were just stronger, he would
only achieve more, and if he did all this then maybe he too would be loved.
At this point my countertransference to Patrick was intense in two ways. First, I
wanted to rescue him the way a parent will rush into the ocean to save a drowning child.
Second, I was not sure it was in Patrick’s interest to continue analysis. In his present state,
Patrick was a successful teacher and a beloved priest, although with a touch of melancholy
and loneliness. The next stage would bring Patrick to confront his darker sense of self and
his priesthood.
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 267

Patrick stopped making light of his trauma and accepted the dissociative power of
deprivation. Auschwitz was a mirror that brought him to accept his own deprivation and
become less dissociated from his own pain. For the first time, Patrick experienced that he
had never grieved for himself. And coming out of his own dissociated condition, he was
able to grieve for the victims at Auschwitz. At a deeper and more painful level, Patrick
grasped that his maternal deprivation led to a defensive response on his part in which he
sacrificed his own identity. The integrity of his own self was diminished and replaced by
the aggressive demands of his mother. He dissociated himself from his own aggression
and embraced his mother to save his life. The most painful realization was yet to come.
Patrick had always prided himself that his priesthood had nothing to do with his mother.
She had not suggested that he choose this way of religious service. In the end, however,
Patrick knew his mother did not have to suggest it. His power of independent choice had
long since withered under his anxiety-ridden introjection of his mother’s way of life; for
example, devoutly Catholic, self-sacrificing, and deferential to authority. Having accom-
plished this much it was a small step for Patrick to see and accept the narcissistic disorder
in his priestly personality: his need for admiration, his sense of entitlement, his lack of
deep empathy for the feelings of others.

The Case of Winston: (Arnold Wm. Rachman)

The difficulties in the case of Winston were connected to the intense personal and
interpersonal psychopathology developed from childhood traumas such as being domi-
nated and controlled by his mother, sexual seduction, emotional distance from the father,
and social isolation. These traumas encouraged a series of disturbing feelings and
thoughts, for example, intense anger, fantasies of murder and dismemberment, paranoid
ideation, and social isolation.
The analysis began in a traditional way. The first 4 years of our interaction was
characterized by the analysis of dreams, early recollections, fantasies, and transference/
countertransference reactions. In fact, Winston brought in hundreds of dreams for anal-
ysis. The analysis of these dreams were greatly aided by his superior intelligence, ability
for eidetic imagery, and extensive capacity for analyzing puns, puzzles, anagrams, and
symbols. The content of the dreams and the analysis of the associations to them revealed
a childhood of severe traumas and the development of a false self. A fundamental maternal
trauma occurred during the first 4 years of his childhood: for example, his mother had
sexual contact with him; his mother was intensely manipulative, domineering, and
intrusive.
After a period of 4 years of analysis, Winston spontaneously expressed a desire to add
an active dimension to the analysis. He felt he had gained significant insight into his basic
emotional issues, which were unknown to him before analysis. But, he felt that he needed
help taking the next step in the working through process. Specifically, he said, “I’ve
analyzed hundreds of dreams from my early childhood experiences and the fantasies I
have had through the years. I understood myself better, but I need help to change.”
A significant aspect of Winston’s psychodynamics was the intensive feelings of
powerlessness that developed during early childhood because of maternal seduction,
manipulation, dominance, and intrusion. What is more, he was convinced that his
mother’s strong will and desire to force herself into “every cell of my mind and body”
produced a pathological sense of passivity and defeat.
A prototypical experience of passivity and defeat was recalled during the first stages
of analysis. His capacity for eidetic imagery allowed a vivid recall of this event:
268 RACHMAN, YARD, AND KENNEDY

I am sitting in a corner of my playpen, my back to my mother. My mother is looking at me

with a gaze only she has. Yes, it’s like she’s trying to control me with her look. She wants me
to do what she wants. I am playing with large blocks, making a structure. As soon as I made
the block structure she came over and knocked it down. I built the structure two more times.
After she knocked down the structure for a third time I crawled into a far corner and rolled
up into a ball.

These events became known as “the building block trauma.” All his adult life he was
haunted by this childhood event, which he viewed as a prototype for his mother’s
domination, control, manipulation, and emotional seduction of him. Our analysis of this
prototype event as well as data revealed in dreams and interpersonal experiences rein-
forced the intense feeling that he was defeated in his pursuit of self-definition and felt his
negative material experiences had destroyed his creativity, sapped his capacity to act, and
made him powerless. He was desperate for help to release his creative impulses. He
longed to become emotionally free to creatively express himself.
It should be made clear, at this point, that the individual analysis was successful in
uncovering the basic traumas, working out their psychodynamics and beginning the
working through process. It was the analysand’s expressed need for activity and the
analyst’s willingness to empathically attune to this need that helped to develop a period
of activity characterized by noninterpretative measures.
A Ferenczian view of resistance is seen as an opportunity for empathic understanding
and, if necessary, elasticizing the analytic situation (Ferenczi, 1980i). Rather than auto-
matically assuming that a request for activity is a resistance to exploring the unconscious,
expressing a desire to act out, or a negative transferential reaction, the analyst explored the
need for activity and its meaning for the analysand. Winston was very clear he was very
satisfied with the analysis of dreams, fantasies, and early recollections. In asking for
greater activity he was expressing his need to work through his sense of powerlessness
forged by maternal control manipulation, seduction, and narcissism. I experienced him as
expressing a developmental need for a positive empathic parental figure who could affirm
his need for expressing a sense of power. Noninterpretative active measures were
employed to meet these needs (Rachman, 1998).
I did not suffer a narcissistic wound when Winston wanted activity, nor did I feel it
was a criticism of me and my work. It was seen as a way to expand and to jointly improve
the clinical boundaries of our therapeutic work to satisfy unfulfilled developmental needs
thwarted by trauma. In fact, one could view the analyst’s inability to satisfy the need for
activity, whether through theoretical prejudice or clinical rigidity, as a sign of a counter-
transference reaction.
The more we analyzed this childhood trauma, the more convinced he became that he
needed an active measure in the here-and-now of our analytic relationship to create a
“reparative therapeutic experience” (Rachman, 1998). First, in a series of preparatory
sessions, we reviewed his childhood trauma of being thwarted in his playpen by his
mother’s intrusive behavior. Winston wanted an active measure that would help him
release his anger toward his mother and liberate his suppressed creative impulses.
We cocreated a “reparative therapeutic experience” (Rachman, 1998), with the “build-
ing block trauma” as the “basic fault experience” (Balint, 1968). The following nonin-
terpretative measure was created to address the issue during a time extended individual
session:

The lights of the room were darkened. The blinds were drawn. The phone in the office was
turned off. (Outside stimuli were reduced to a minimum to encourage a focus inward and
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 269

heighten the here-and-how experience). Using large pillows from the office sofa a symbolic
playpen was created. Winston sat in a corner of the playpen with his back to the analyst. He
was given small pillows to use as building blocks. He readily became engrossed in building
a structure. He appeared very happy. When the structure was finished the analyst went over
and pushed it down.

Winston made some irritated sounds when the structure was toppled. After a moment
or two, he resumed building the structure. A moment or two later, the analyst entered the
symbolic playpen again knocking down the structure. Then Winston began murmuring to
himself. He pulled at his hair and began rocking back and forth. Finally, he assumed a fetal
position. Then the encounter was stopped.
Directly after this event, we analyzed the experience. Winston became aware of his
mother’s need to have the emotionally/interpersonal focus be exclusively on her. She was
jealous that her son was more interested in building a structure than paying attention to his
“loving mother.” His mother’s angry possessiveness led her to destroy his building block
structure, an activity that took him away from her. We also discussed the “intense”
feelings of anxiety, dread, and fear of annihilation that the building block measure had
aroused in him. As a result of the reenactment, he was frightened he would regress and
become so emotionally vulnerable that he would withdraw into social isolation. His fear
was transitory, and he did not withdraw. After Winston expressed the anxiety, dread and
fear of annihilation stimulated by the noninterpretative measure, the analyst wondered
whether his participation as the “intrusive mother” both added to his anxiety and interfered
with his feelings of me as a therapeutic agent. He responded in an interesting way, which
seemed to verify the emotional relevance of the noninterpretative measure. He said that
once we began the experience he became so emotionally absorbed in it, he felt as if, “his
mother knocked over the ‘building blocks,’ not the analyst.” When the experience was
ended, the analyst allowed for a period when Winston could emotionally return to his
natural functioning. When he indicated he was ready, we began the analysis of the
experience. Winston indicated that he was able to separate the role playing of the
“intrusive mother” from the ongoing therapeutic functioning of the analyst.
Winston reported a dream that literally brought a ray of light into his existence:

I am an architect working on a model of a building that has been commissioned. I am working

in my office on the top floor of a townhouse which contains a skylight. The light is shinning
through the room. I am very happy.

Winston interpreted the dream as meaning the building block encounter had freed up
his anger and frustration toward his mother and allowed him creative self-expression. I
offered the interpretation that the light had never gone out on his creativity; rather, the
light had been dimmed.
Winston became eager to immediately translate his newfound feeling of creative
potential into action. He saw the “architect dream” as a desire to fulfill a lifetime dream
of being an architect. As a first step toward fulfilling the dream he enrolled in a draftsman
course. Unfortunately, he suffered frustration and severe disappointment. He did not have
the skill of coordination necessary to produce the drawings necessary for the course. Once
again, he went through a period of depression and withdrawal, rekindling the feeling that
he had lost the capacity for creative expression. At this point, Winston interpreted the
“building block encounter” and the “architect’s dream” as a momentary flickering of the
creative light before it went out for good. He thanked me for the good effort.
We spent the next months reanalyzing the original trauma to understand and repair the
270 RACHMAN, YARD, AND KENNEDY

damage it had done. We explored his inability to produce architectural drawing, which
may be because of cognitive/eye/hand coordination, rather than a lack of creativity. He
consulted a neuropsychologist and confirmed that he had cognitive issues. In addition, I
continued to affirm his capacities to be creative in language, fantasy and thought. What is
more, I affirmed his creative capacity in cocreating the building block encounter.
In a matter of months, after the use of the noninterpretative experience and the
subsequent analysis of its effects on his functioning, Winston resurrected an abandoned
interest in photography. He became devoted to taking photographs. These photographs
expressed his own idiosyncratic preoccupations (Rachman, 2003a). During a 3-year
period after the noninterpretative experiences, he received a degree in photography, was
part of a photography exhibition, and had his work reviewed in an art journal.

Analysis of Trauma and Reparative Therapeutic Experiences

Our aim has been to explore efficacious ways to use noninterpretative measures to expand
the boundaries of the analytic method for treating trauma. When trauma occurs at an early
age, it arrests the development of cognitive and verbal interaction and is stored in the body
as somatic memory. Noninterpretative measures are an effort to reach the split-off,
precognitive and somatic aspects of the trauma. Originally, the tradition of psychoanalysis
had been verbal interaction and interpretation of the clinical data. But, since Freud’s
pioneering work on activity (Freud, 1919 [1918]/1958), and Freud’s endorsement of
Ferenczi’s clinical experiments on active analysis (Ferenczi, 1980a, 1980b, 1980c, 1980d,
1980e, 1988), the boundaries of the analytic method have been elasticized (Rachman,
1997, 2003a, 2003b). The present discussion is a further attempt to elasticize the bound-
aries of analyzing trauma by including data that has been stored in a split-off way not
amenable to direct verbal interpretation.
Trauma creates a developmental freeze that interferes with the mind’s capacity to
mentalize; that is, create representations that can be stored in language and thus, sym-
bolize concepts for meaning formation. We now have neuroscientific evidence indicating
that the trauma is stored in the brain (Allen & Fonagy, 2006). Therefore, these findings
present evidence that trauma can be retrieved (Van der Kolk, 1994).
We have tried to demonstrate in the three clinical examples presented a way to
integrate noninterpretative measures within the analytic process in order to analyze
deep-seated childhood traumas. In the “Case of Patrick,” Robert Kennedy presented an
example of significant emotional change that occurred outside the consultation session,
where the changes were built upon the analytic work of individual analysis. The analysand
was emotionally challenged to experience his childhood trauma by going through a
firsthand viewing of, and group discussion about, the attempt to annihilate a particular
group of people. This immediate experience, which occurred over a period of a week,
became an intensive noninterpretative measure that emotionally softened his defenses and
opened him up to an empathic response. In fact, he reported being emotionally trans-
formed by the experience. His understanding of himself and others was significantly
changed. The analysand developed insight, empathy, and a capacity for intimacy.
In the “Case of Denise,” Margaret Yard believed that the most salient method to help
an individual with severe childhood maternal trauma who lacked the capacity for self-
soothing, object constancy, metabolizing verbal interpretation, and self-reflection was to
consider a more concrete and literal mode for clinical interaction. Together, analyst and
analysand created a way to “bury” the negative traumatic thoughts and feelings about her
 NONINTERPRETATIVE MEASURES IN THE ANALYSIS OF TRAUMA 271

mother, which were haunting the analysand. The analysand suggested a symbolic funeral,
including a coffin, to put to rest the manifestations of her childhood maternal trauma. Of
particular importance was Yard’s receptivity to entering into a joint venture with the
analysand so they both created the reparative therapeutic measure. The analysand not only
contributed to the technique but also contributed relevant interventions to her trauma.
Such interaction extends Ferenczi’s idea of mutuality (Ferenczi, 1988) into the notion
of “affirming the psychic wisdom” of analysands. Trauma survivors develop an emotional
sensitivity to their needs based upon the frustration, abuses, and defects caused by their
negative childhood experiences. They develop a “psychic wisdom” about what has been
missing in their development and how these deficiencies can be fulfilled. There are two
issues in the analytic encounter relevant to the expression of psychic wisdom. They are:
Can the analyst provide an empathic climate that fosters the analysands full disclosure
about their needs? Can the analyst respond positively to the analysand’s stated needs?
Psychoanalysis as we have outlined in our introduction has struggled with this issue of
accepting the analysand’s stated needs as real, rather than as resistance or acting out.
In Arnold Rachman’s “Case of Winston,” the analysand’s stated need for greater
activity was seen as a response to an unfulfilled developmental need. Overwhelming
maternal intrusion and dominance produced a profound sense of helplessness, a suppres-
sion of creativity and an inability to act. A cocreated noninterpretative measure, the
“building block encounter” stimulated a reexperiencing of the material trauma as well as
providing a reparative therapeutic experience which aided working through toward the
development of a satisfying creative outlet.
As a final note to our discussion, we would like to address the issue of countertrans-
ference when employing noninterpretative measures. Deviating from a traditional clinical
stance can stimulate countertransference reactions since the analyst is placing him/herself
in a more emotional and interpersonal vulnerable stance. In Robert Kennedy’s “Case of
Patrick,” it was necessary for him to analyze his feelings of inadequacy as an analyst and
to accept that the individual treatment could not help Patrick work through his trauma. A
real life experience outside the consultation room could become an important vehicle for
emotional confrontation and personality change. Margaret Yard’s “Case of Denise,”
evoked a countertransference reaction of anxiety, dread, and fear during the development
of the “funeral and burying of the maternal objects.” She confronted the emotional origins
of this anxiety in her dread about the death of her ailing mother. Burying Denise’s mother
would be akin to prematurely burying her own mother. Arnold Rachman’s “Case of
Winston” evoked the issue of control, manipulation, and dominance so prominent an issue
in Winston’s psychodynamics. Clinical interaction with Winston necessitated an analysis
of Rachman’s needs for control, manipulation, and dominance as he presented the clinical
dimensions of the noninterpretative measure of the “building block encounter.” When
Winston made it clear it was essential that they both needed to cocreate the clinical
experience, Rachman became aware of the enactment of maternal control that was evoked
in him.
All three analytic cases we believe demonstrated the necessity to become flexible in
theory and technique in dealing with clinical trauma. Noninterpretative measures present
this opportunity for flexibility and innovation.

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