James S. Grotstein - But at The Same Time and On Another Level... - Volume 2, Clinical Applications in The Kleinian - Bionian Mode-Karnac Books (2009)

“. . .
BUT AT THE SAME TIME

AND ON ANOTHER LEVEL . . .”
VOLUME TWO
“. . . BUT AT THE SAME TIME AND ON ANOTHER LEVEL . . .”
VOLUME ONE
Psychoanalytic Theory and Technique in the Kleinian/Bionian Mode
VOLUME TWO
Clinical Applications in the Kleinian/Bionian Mode
“. . . BUT AT THE SAME TIME
VOLUME TWO
Clinical Applications
in the Kleinian/Bionian Mode
James S. Grotstein
KARNAC
First published in 2009 by
Karnac Books
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London NW3 5HT
Copyright © 2009 James S. Grotstein
The rights of James S. Grotstein to be identified as the author of this work have
been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents
Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the prior written
permission of the publisher.
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A C.I.P. for this book is available from the British Library
ISBN: 978–1–85575–760–8
Edited, designed, and produced by Communication Crafts
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www.karnacbooks.com
I dedicate this work to Wilfred Bion, Ronald Britton,
Albert Mason, Thomas Ogden, and Antonino Ferro, each of whom
has been inspirational to me in countless ways in writing this work.
I also dedicate it to my wife, Susan, who has long and patiently
endured being a “literary widow” while I was engrossed in writing it.
I am profoundly grateful to my patients from across the years, to those
whom I have helped and especially—but regretfully—to those I have
not. It was the latter who helped push me to reflect upon myself (with
four psychoanalyses and many elective supervisions) and to consult
many different schools of analytic thought, until I became immersed
in the Kleinian—and now post-Kleinian—as well as the Bionian,
while still honouring and using the wisdom of the other schools in
which I had been trained and/or to which I had been exposed. My
professional journey has been an exciting one, but it is constantly
informed by the need to make reparation for my failures and then
rededicate myself to the psychoanalytic task once more.
CONTENTS
ACKNOWLEDGEMENTS xi
PREFACE xiii
ABOUT THE AUTHOR xvi
PART I
Psychoanalytic technique
1 The consultative interview:

initial session 3
2 The analysis begins:

establishing the frame 6
3 Recommendations on technique:
Freud, Klein, Bion, Meltzer 20
4 How to listen and what to interpret 29
5 Termination 60
vii
viii CONTENTS
6 The psychoanalytic treatment of psychotic

and borderline states and other primitive mental disorders 65
7 Basic assumptions of Kleinian/Bionian technique:

a recapitulation 73
PART II
Case presentations
Introduction 81
8 Clinical example 1 83
9 Clinical example 2 113
10 Clinical example 3:
brief case illustration
of the predominantly “Bionian” mode of technique 134
a patient analysed in the style (my version)
of the Contemporary Kleinians 137
12 Clinical example 5: “bicycles”

presented by Shelley Alhanati, supervised by JSG 148
13 Clinical example 6
presented by a supervisee, supervised by JSG 156
presented by a colleague 167
presented by a colleague 176
fragment of a session from a colleague’s case 185
CONTENTS ix
from a colleague 193

psychoanalytically informed psychotherapy
from a colleague 207

dream analysis in an analytic session 213
Albert Mason 218
Albert Mason 222
Ronald Britton 225
Ronald Britton 228
Antonino Ferro 234

“The woman who couldn’t consider”
Thomas Ogden 240
Epilogue 263
REFERENCES AND BIBLIOGRAPHY 265
INDEX 275
ACKNOWLEDGEMENTS
I
am in debt to many individuals for this work. I certainly am in debt
to my personal analysts, Robert Jokl, Ivan Maguire, Wilfred Bion,
and Albert Mason, and to my supervisors and teachers at the Los
Angeles Psychoanalytic Society/Institute and to many others, Klein-
ian, post-Kleinian, and Bionian. I also wish to offer my gratitude to
the following supervisees and colleagues who have graciously either
proffered me invaluable aid in writing this text or allowed me to use
their case material. I am especially indebted to Ronald Britton, Thomas
Ogden, Antonino Ferro, Albert Mason, and Shelley Alhanati for their
inspiration and graciousness in allowing me to use examples of their
clinical work;
to Thomas Ogden and the Editor of the Psychoanalytic Quarterly for their
gracious permission to publish his “The woman who couldn’t con-
sider” (Psychoanalytic Quarterly, 1997, Volume 66: 567–595);
to Antonino Ferro and the Psychoanalytic Quarterly for their gracious
permission to reprint portions of “Marcella: the transition from ex-
plosive sensoriality to the ability to think” (Psychoanalytic Quarterly,
2003, Volume 72: 183–200).
I am also indebted to Raquel Ackerman, Joseph Aguayo, Afsaneh
Alisobhani, Elizabeth Clark, Edmund Cohen, Jeffrey Eaton, Michael
Eigen, Daniel Fast, Maureen Franey, Eugenie French, Sandra Garfield,
Janis Goldman, Martha Joachim, Jude Juarez, Eugenie French, Andrea
xi
xii ACKNOWLEDGEMENTS
Kahn, Leila Kuenzel, Jennifer Langham, Howard Levine, Robert

Oelsner, Murray Pepper, Lee Rather, Paulo Sandler, Kirsten Schwanke,
David Tresan, and Lisa Youngman.
I wish to offer my apologies and deep regrets to all those friends,
colleagues, and supervisees who generously gifted me with the manu-
scripts that I requested from them but which I could not use ultimately
owing to lamentable and painful consideration of space limitations.
PREFACE
I
n Volume One my wish was to review selectively Kleinian
(mainly traditional) and Bionian theory in such a way so to
present the more prominent aspects that underlie and inform
their clinical technique. It is not meant to be a textbook on theory per
se. I have also included some theoretical ideas that I believe consti-
tute hidden orders of their technique, such as “the once-and-forever
infant of the unconscious”.
In Volume Two I describe in detail my impression of specifically how
to understand and to interpret in an analytic session. The reader will
note that I present clinical sessions in stenographic detail and display
complete sessions. It will be noted that I do not include past history
but do make reference to it when it is necessary to understand the
text. In the sessions of my own analysands and in those of others, I go
to great lengths to detail my private observations, reveries, and coun-
tertransferences as well as my thinking about how, when, and what
should be interpreted.
I wish to reiterate what I stated in the Preface to Volume One with
regard to the focus of this text in connection with “classical” infantile,
part-object Kleinian thinking as more and more differentiated from
the later post-Kleinian emphasis on the analytic process (transference/
countertransference) in the here and now—all conceived in a whole-
object perspective.
xiii
xiv PREFACE
This work was written during the heyday and then twilight of
“classical” Kleinian theory and technique, which deals with infantile
states of mind accompanied by part-object designations and focuses
on the analytic text of the analysand’s associations and on reconstruc-
tions. The Contemporary London post-Kleinian oeuvre has arisen in
the meanwhile. Their followers have gradually differentiated them-
selves from that classical oeuvre and have begun to think, speak, and
interpret in a newer argot—one that focuses on the complexities of the
transference/countertransference process in the “here and now”, with
emphasis assigned to enactments by either analysand or analyst. It is
a whole-object perspective—not a part-object one. As I point out later
in the text, to me it closely resembles a serious theatrical passion play
in which analysand and analyst often play out hidden roles, which
Sandler (1976) long ago adumbrated and which are now the focus of
attention of the Betty Joseph Workshop (Hargreaves & Varchevker,
2004).
Notwithstanding this subtle but substantial change in theory and
technique and in the language with which to express them, it is my
understanding that they, the Contemporary London post-Kleinians,
are trained in and thus well-versed in classical part-object, infantilis-
tic theory, and that it effectively occupies the background, if not also
often the foreground, of their thinking and of their interpreting styles.
I believe, in other words, that it constitutes an important part of their
basic psychoanalytic training before they put it aside for their new
orientation.
I wish at this juncture to offer a caveat. In Volume Two I focus
closely on concepts of psychoanalytic technique. My recommendations
constitute both my version of what I believe are generally accepted
views and my own personal suggestions. I suggest that the reader,
consequently, should view what I present as suggested guidelines from
both sources with the understanding that clinically bidden situations
might frequently require justifiable departures.
Caveat. In my original version of this work I attempted to even out

gender use by employing multi-gender pronouns like “(s)he”, “his/
her”, and “him/herself”. I was, however, told by many of those to
whom I have given this text to critique that such terminology, though
accurate and appropriate, is found to be disturbingly cumbersome and
uncomfortable for readers to read. I have therefore reluctantly resorted
to employing the masculine pronouns and adjectives at the expense of
the feminine, for which I ask for the latter gender’s pardon. Psycho-
PREFACE xv
analysis was once dominated by males. Now the trend is towards

female domination. The predominant patient population, then as well
as now, may well have been and still be feminine. Thus, my apologies
all the more, and my regrets!
ABOUT THE AUTHOR
James S. Grotstein, M.D., is Clinical Professor of Psychiatry at the

David Geffen School of Medicine, UCLA, and training and supervising
analyst at the New Center for Psychoanalysis and the Psychoanalytic
Center of California, Los Angeles. He is a member of the Editorial
Board of the International Journal of Psychoanalysis and is past North
American Vice-President of the International Psychoanalytic Asso-
ciation. He has published over 250 papers, including, “The Seventh
Servant: The Implication of the Truth Drive in Bion’s Theory of ‘O’”
(International Journal of Psychoanalysis), “Projective Transidentification:
An Extension of the Concept of Projective Identification” (International
Journal of Psychoanalysis), and, most recently, “Dreaming as a ‘Cur-
tain of Illusion’: Revisiting the ‘Royal Road’ with Bion as our Guide”
(International Journal of Psychoanalysis). He is the author of many books,
including, Who Is the Dreamer Who Dreams the Dream: A Study of Psychic
Presences (2000) and A Beam of Intense Darkness: Wilfred Bion’s Legacy to
Psychoanalysis (2007). He is in the private practice of psychoanalysis in
West Los Angeles.
xvi
“. . . BUT AT THE SAME TIME
VOLUME TWO
It is the cleverest achievement of art to keep itself undiscovered.

John Dryden
Memory knows before knowing remembers.

William Faulkner, Light in August
And, as imagination bodies forth

The forms of things unknown, the poet’s pen
Turns them to shapes, and gives to airy nothing
A local habitation and a name.
Theseus in A Midsummer Night’s Dream (Act V, Scene 1)
PART I
PSYCHOANALYTIC TECHNIQUE
CHAPTER 1
The consultative interview:

initial session
W
hen interviewing the prospective analysand for the first time,
experience seems to suggest that it may be better for the
analyst not to confuse the consultation with psychoanalysis
itself. Etchegoyen (1991) believes that a marked distinction should be
made between the realistic, face-to-face consultation and the future
analysis so as to allow the prospective analysand to develop a sem-
blance of the reality of the analyst’s presence—at least as much as he
can glean during the consultation. Klein and her followers, including
Bion, seem often to do otherwise. They consider that the analysis has
already begun with the beginning of the consultative interview and,
while interested in past history, do not especially ask for it but allow
for it to emerge of its own accord. In other words, they follow the pro-
spective analysand’s free associations and interpret transference from
the beginning. The latter was my experience in my Kleinian (Albert
Mason) and Kleinian/Bionian (Bion) analyses. Yet Mason (personal
communication) has made the point that he likes to take some history
of the analysand’s past so as not to be surprised by the emergence of
psychosis, addictions, and other disorders of this kind.
The consultative interview allows for an evaluation for the pro-
spective analysand’s suitability for analysis and constitutes the best
opportunity for the analyst to explain the nature of the analytic pro-
cedure, the rationale for the use of the couch, the setting of fees, the
3
4 VOLUME TWO: CLINICAL APPLICATIONS
schedule of appointments, and the presentation of the analyst’s policy

on absences.
I have also found it useful on some occasions to extend the consul-
tation over as many as six consecutive sessions for further evaluation,
principally for suitability for analysis—with me. I vary from prospec-
tive analysand to prospective analysand about taking a detailed his-
tory. Generally, I prefer not to—I would rather see the history as it
emerges during the analysis. At other times, however, I may in fact
focus on history because I believe at the time that I need to: or, to coin
an apocryphal Bionian joke: “It’s alright to take a history as long as
you quickly forget it!”
Once psychoanalysis has been agreed upon and I suggest that op-
timally they should come five times per week, analysands-to-be may
be shocked and frightened, especially by associating this frequency
with the degree of their psychopathology. I explain that the frequency
has nothing to do with their illness but constitutes the nature of the
procedure that works optimally under these conditions. I go on to say
that when the analysand is seen that often, then emotions and thoughts
that an analytic session may evoke can then be dealt with in the fol-
lowing session and/or sessions. Otherwise, they would return to the
unconscious and not be dealt with.
The analysand will soon learn, once the analysis is under way,
that the frequency results in the establishment of a “rhythm of safety”
(Tustin, 1990, p. 160): an invariant cycle that corresponds to the in-
fant’s experience of the optimal congruence of two cycles: (a) the com-
ing and going of his appetitive neediness, and (b) the coming and
going of mother to satisfy his neediness. When there are alterations
or breaks in the schedule, the “rhythm of safety” is ruptured (“cata-
strophic change”: Bion, 1970): this experience represents an important
aspect of the adaptive context1 (Langs, 1976a, 1976b) and/or the analytic
object2 (Bion, 1965).
Formerly, also, the use of the couch was recommended only for
four- to five-times-per-week treatment. Currently, many psychothera-
pists as well as psychoanalysts use the couch for once-, twice-, and
three-times-per-week sessions. I believe that each analyst or therapist
must use his own discretion about this issue and also may seek consul-
tation—but that, irrespective of frequency, the analyst and/or therapist
must assume and preserve the analytic stance with the patient.
In my own practice I explain the use of the couch as follows:
Freud seemed to have thought that he was a cryptographer of
sorts for the secret code of the unconscious as it emerged in the
analysand’s free associations. He found himself to be so intensely
concentrated on the cryptographic function that he felt intruded
THE CONSULTATIVE INTERVIEW 5
upon when the analysand, who was sitting opposite him, stared at
him. He thereupon, for his convenience, instituted the procedure of
having the analysand look the other way, and while he was doing
so, they might as well lie down so as to be more comfortable. Freud
had no idea at the time that, by positioning the analysand in such
a way, i.e., eyes averted and assuming the supine position, he had
actually uncovered right cerebral hemispheric functioning, which is
non-linear, less organized, field-oriented, and more emotional and
day-dreamy in nature. [Grotstein, 1995c]
My experience informs me that suggesting the use of the couch should
not be dogmatic. I have come across analysands in whom I have seen
poor attachment, and they often seem to prefer to sit up so that they
can use their eyes to attach to the analyst. I think one should bear this
caveat in mind.
I also explain to the prospective analysand how he is to proceed
once the analysis commences: that the fundamental rule (Freud, 1913
[1912–13], p. 207) requires him to say everything that comes to mind, no
matter how seemingly irrelevant or embarrassing. With regard to how
I shall proceed, I explain that my task is to listen to his freely formed
utterances until I have an idea about what the unconscious part of his
personality is trying to convey to us. My interventions will mainly be
interpretations—that is, my impression at the moment of what their
own “interpretations” about themselves seem to be. I may also ask
questions about information that is not at my disposal. Sometimes I
may try to clarify. I also explain that their own questions to me are to
be considered as free associations and may therefore not necessarily
be answered directly or perhaps even at all, that this practice is not
evasive or rude on the part of the analyst but is due to the fact that a
thought, statement, or phantasy had been operant before the question
was posed, and that this forerunner of the question (why was this ques-
tion asked?) takes precedence for analytic consideration.
Notes
1. The adaptive context connotes any or all the factors in the external environ-
ment and/or in the analysis to which the analysand is adapting (Langs, 1976a,
1976b). Any “emotional turbulence” (Bion, 1965, p. 157) due to “catastrophic
change” (Bion, 1970) becomes part of the adaptive context.
2. The “analytic object” (Bion, 1962b, p. 68) constitutes the quintessence of the
patient’s maximum unconscious anxiety, i.e., it represents the expression of the
analysand’s principal underlying narrative theme of the session. It is detectable,
according to Bion, through “sense, myth, and passion”, by which I believe he
means observation, unconscious phantasy—or personal myth and the general myth
to which it may correspond (i.e., Oedipus myth, and the felt emotions associated
with the theme.
CHAPTER 2
The analysis begins:

establishing the frame
The analytic frame (setting):

establishing, managing, and patrolling it
B
ion established the connection between the contact-barrier1 and
the analytic frame. Put succinctly, the analytic frame, which me-
diates the relationship between analysand and analyst, is the ex-
ternal counterpart to and extension of the intrapsychic contact-barrier,
which, in turn, mediates the protective separation between Systems Cs.
and Ucs. (Bion, 1962b, p. 17).
Following longstanding psychoanalytic tradition, I advise the ana-
lyst not only to observe the analytic frame but also to “become” the
frame. One of the components of this recommendation is the following:
when the analyst enters the waiting room to greet and summon the
analysand, he should be courteous and return greetings but should not
enter into conversation or discussion with the analysand. He should
wait for the analysand to occupy the couch and begin to associate
before he speaks. The analyst should also deal with an analysand’s
tendency to enter the consulting room with coffee, bottle of water,
and/or mobile phone (cellphone) in hand.
Frame categories
The concept of the analytic frame seems to have at least four different
dimensions:
6
THE ANALYSIS BEGINS: ESTABLISHING THE FRAME 7
A. The “background frame” refers to the contour of the analytic set-

ting—that is, the adaptive context of the session, the appropriate-
ness of both analysand’s and analyst’s manners and behaviour in
the session, suitable dress worn by both, the importing of coffee,
water, or the like by either, the use of mobile phones by the analy-
sand, the analyst answering the telephone during the session, and so
on. One feature of the background frame deserves special mention.
Tustin (1990) coined the term “rhythm of safety” for the predictability
of the regularity of analytic sessions for the autistic child (p. 160).
This concept may be a subset of the need for infants, children, and
analysands to have a preset schedule for their activities, and I be-
lieve that it is most apposite for the experience of all infants and
children in general and particularly all analysands.
B. The interpretative stance of the analyst is the analyst’s focus on the
frame of the analytic relationship between the analysand and him-
self in the transference ↔ countertransference ↔ reverie situation:
that is, he must “frame” both the analytic setting and the analytic
process and function within it. He must, in the final analysis, with
some legitimate exceptions, conduct the analysis by (a) allowing it
spontaneously to unfold and intervene only by way of interpreta-
tions, in the broad sense of the term, which would include confron-
tations, questions (if necessary), and so on. If at all possible, the
analyst must not converse with the analysand. In other words, the
analyst must vouchsafe the analytic atmosphere. Should the analyst
ask questions? This seems to be a controversial issue. I believe that,
as a rule, questions should, if possible, be avoided unless the analyst
feels the need for information from the patient about one or another
of his associations or about unknown aspects of his past history. The
analysand’s associations themselves generally furnish the sought-
after answers. One typical question analysts and/or therapists often
put to their analysands is: “Why is it that you always find men (or
women) of this character type?” This kind of leading question forces
the analysand to become his own analyst. There is another reason
for the interdiction against questions, however. The analyst may
legitimately and innocently ask a question but may fail to realize
that his “innocent” question may be heard by the analysand as a
criticism, recommendation, or command—because of the presence
of the transference, particularly a superego transference.
C. The “conditional frame” includes those legitimate circumstances in
which the analyst feels, according to his best judgement, compelled
to alter the frame. These might include the judicious use of tele-
phone analysis for some sessions if the patient is out of town or out
of the country and really needs to continue the analysis, or other

legitimate exceptions that might warrant the analyst allowing for
a “conditional frame”. However, these expansions of the frame do
still constitute frame violations—that is, parameters—and must be
analysed.
D. The “covenant” that unconsciously exists between analysand and
analyst specifies that each of them, individually and collectively, is
responsible for the optimum caretaking of the “once-and-forever
infant of the unconscious”: the “analytic subject”. I think of the frame
as a part of the “covenant” that ethically binds analysand and analyst
in their joint and individual mandate to preserve the integrity and
continuity of the analysis.
What Bion (1962a, 1962b) was later to uncover as the “container-con-

tained” phenomenon had been intuited by Freud as the psychoanalytic
setting, which ultimately became the psychoanalytic frame—the frame-
work or container within which the psychoanalytic process takes place.
The establishment of the rules of the frame by the analyst with the
analysand, along with the latter’s acceptance of them, is what I think
of as a covenant between them. This covenant holds analysand and ana-
lyst responsible for their attendance, deportment, consideration, and
responsibility for the care and welfare of their mutual “infant/child”:
the “once-and-forever infant of the unconscious”.
The frame as the guardian of the analytic passion play

Unlike most psychoanalysts, past and present, I believe that psycho-
analysis can be thought of as essentially constituting a “passion play”—
something that is both inclusive of and beyond the drives (unconscious
motivation) and internal and external object relationships. I personally
believe that the concept of drama or play (playing as an actor-self in the
play) transcends traditional considerations of drive and object theory
and reconfigures the practice of psychoanalysis and psychotherapy in
the aesthetic domain (Bion, 1965, p. 52). The rules that apply to the
maintenance of the analytic frame find a curious parallel with the rules
actors use when they are in a play or a film (Stanislavski, 1936), or with
the rules children instinctively follow when they play games (Opie &
Opie, 1959). The actor must use his persona while subordinating his
normal personality in order to conform to the role he is expected to
play. This subordination of his normal personality can be equated with
what the analyst must do when conducting an analysis—and similarly
with the analysand. When the psychoanalytic experience is thought
of as an improvisational passion play, one can then conceive that the

analysand’s unconscious creates, writes, directs, produces, and presents
a cryptic scenario consisting of free associations (Grotstein, 2000). In
other words, it is one thing to recommend abstinence with the idea
in mind of barring the enactment of the drives so that they may be
harnessed in words and thoughts. It is quite another to recommend it
in order for the “analytic play” to be performed.
These “free” associations are really, I suggest, the encoded myster-
ies of the unconscious that a preternatural presence—the “ineffable
subject of the unconscious”, the “dreamer who dreams the dream”, the
“dramaturge”—chooses to reveal because of their potential importance
and current relevance. From this perspective the rules of the analytic
frame are required to vouchsafe the capacity of the two analytic part-
ners to participate with suspension of disbelief in the drama of the passion
being uncovered. Another consequence of regarding psychoanalytic
treatment as a play or drama is that the concept of analytic resistance
becomes modified and marginalized. From the dramatic perspective,
in other words, everything the patient says or reveals in his behav-
iour—including resistance—is being shown or presented to become
understood by becoming dramatically obvious to the analyst as well as
the analysand. Perhaps this is what Freud (1900a) had in mind when
he spoke of that quality of dream-work that requires the unconscious
to show “conditions for representability” (p. 335).
Conatus (Spinoza, in Damasio, 2003, p. 36; Hampshire, 2005, pp.
67–68) is the principle by which all living organisms, including man,
unconsciously (reflexly) seek to maintain the selfsameness of their core
identity in the process of change (“catastrophic anxiety”, Bion, 1965,
pp. 8–11).
A supervisee presented a clinical case to me of a middle-aged pa-
tient who was suffering from bipolar illness (Axis I of the DSM)
and a primitive mental disorder (Axis II). For quite some time the
patient would characteristically listen and respond positively to the
analyst’s interpretations and then go to sleep or enter into a twilight
state. The supervisee complained to me that “the patient was dead
in the session!” I replied, “No, the patient was not dead. She was
dramatically displaying her wish to be dead at that moment in order
to avoid the anxiety of the changes that would occur if she fully
digested your interpretations.” The supervisee agreed.
Thus, if psychoanalysis is considered to be an improvisational passion
play, then what we traditionally label resistance on the part of the
analysand can be thought of instead as a revelation of conative anxiety
heralding the anticipation of a catastrophic disruption of the self.
The analytic frame as the guarantor and facilitator

of liberation
I have become aware during many psychoanalyses of a need to re-
think the rules of the analytic frame—rules that I had taken so much
for granted from my psychoanalytic training that they had become
an unthinking catechism. Having reflected on the subject, I have de-
veloped considerations of my own. When the analytic frame (setting
with boundaries) is intact and vouchsafed by the analyst’s demeanour,
the unconscious seems to feel freer to surface and express itself. It
is as if the unconscious knows that psychoanalysis is a special form
of play in which the boundaries must be in place for the sacred and
most personal drama to emerge to be played out. It finally occurred
to me during the analysis of a young woman who was in an erotized
transference to me that the boundaries had to be in place and the rule
of abstinence in effect so that she could experience the fuller nature of
her libidinal self without the interference of her self-discovery by the
actuality of intercourse. In other words, it is as if there are two forms
of sexual intercourse: the form that takes place between two real lov-
ers in the external world, and the other, which can only take place in
psychoanalysis—in the internal world in the reveries of the analysand
and analyst over the sacred network guarded by the rule of abstinence.
The rule of abstinence and the covenantal protection offered by the
analyst’s maintaining the frame provide the optimum opportunity for
the analysand to experience the full range of sexual entelechy (inher-
ent potential).
Other considerations of the frame

Frame issues that the analyst must spell out meticulously at the begin-
ning of the analysis include such matters as the time and frequency of
the sessions (thus the regularity and symmetry), the amount of the fee,
when the fee is to be paid, the analysand’s responsibility for absences,
and when vacations or holidays should be taken. Analysts have gradu-
ally become aware that the analytic frame imposes a sense of constancy
for the analysand and becomes Tustin’s (1990) “rhythm of safety”. It
represents an invariant in the psychoanalytic process against which,
or within which, the psychoanalytic variables—impulses, affects, life
circumstances—contend.
It has gradually become clear over time that once the frame is estab-
lished, much of the analyst’s activity is engaged in preserving, moni-
toring, and/or patrolling it. As it represents a mutually established
covenant between the analytic couple, it becomes important for the
analyst also to adhere to the frame. That means that he must guarantee
his attendance at the sessions, be appropriate in dress and demeanour
during them, discuss issues of possible confrontations with the analy-
sand outside the sessions (this caution is apposite especially in training
institutes), and, in all respects, conduct himself as an analyst.
The meaning and interpretation of this last feature has begun to
change over time. Earlier, it meant that the analyst should be neu-
tral and objective but considerate and not personal—that is, should
not loosely converse with the analysand and should not engage in
self-revelations. I will not go into the current debates over analytic
empathy and the issue of self-revelation by the analyst. I respect the
fact that every rule has its justifiable exceptions, but the desirable rule
that is still currently followed is that the analyst should be engaging,
that is, what Alvarez (1996) terms “live company”: responsive but
without collusion, and properly discrete in maintaining the frame.
After my analytic experience with Wilfred Bion and then with Albert
Mason, both of whom, I felt, approached the ideal for the conduct of
an analysis, I would recommend that the analyst should confine his
interventions mainly to interpretations—as much in the transference
as possible—and avoid explanations or educative remarks.
The breaking of the frame on the part of the analysand can occur
in various ways, for various reasons. A common form it may take is
for him to be late and/or not show up for sessions. Others are seek-
ing to “borrow” magazines from the analyst’s waiting room, giving
presents, attempting to touch or hug the analyst, continuing speaking
on their mobile phones as they enter the consulting room, refusing to
leave when the session is over, and so on. Obviously, these wayward
enactments require attention and interpretation as the unending task of
the analyst to monitor and maintain the frame. Often it is the analyst
who may break the frame in a variety of ways for a variety of coun-
tertransference reasons, one of the most prominent of which may be
his idealization of the analysand or his desire to become idealized by
him; conversely, it may arise from the analyst’s discomfiture about or
dislike of the analysand.
When a folie à deux situation occurs, it could be because the analy-
sand is presenting a theme from his unconscious in the form of a phan-
tasy that not only matches up with the same or similar phantasy held
by the analyst, but also causes the analyst to collude with the patient in
the need to preserve the fiction of the phantasy (Mason, 1994; personal
communication, 2005). One common example of this folie à deux occurs
in psychoanalytic training: the analyst who has a vested interest in the
tenets and beliefs of his particular school may try to convert his ana-
lysand-in-training to the same beliefs. Conversely, the analysand may
present himself in such a way that the analyst may begin to idealize
the analysand as a “messiah” or omnipotent child who will save the
analyst or the psychoanalytic group to which he belongs. There is, of
course, also the specific type of folie à deux in the treatment of patients
who enter into negative therapeutic reactions or psychic equilibria.
I recall a highly intelligent, extremely well-read, articulate “wunder-
kind” who entranced me with his gifts many years ago. I found myself
idealizing him and then realized that our roles had become switched.
My self-analysis of the situation was as follows: Before I had entered
medical school to become a psychoanalyst, I had wanted to pursue a
career in English literature. After my career change, I still continued
to feel that I had lost something in my life, and I looked upon my
erstwhile career choice with fondness. The analysand represented my
abandoned career in English literature. Unconsciously, I had been liv-
ing vicariously through my analysand and thus failed to analyse how
he was using his field as an analytic resistance. I had been in a folie à
deux with him. Once I realized my vicarious involvement with him
and his career, I was able to become separate from him and to offer
meaningful interpretations to help end the analytic stalemate.
Bion and the frame

I have written about Bion’s use of the frame elsewhere (Grotstein,
2007). An example of it from my analysis with him shows him in action:
Once, during a moment of negative transference, I criticized Melanie
Klein (his analyst). Bion’s response was as follows: “Oh, did you know
Melanie Klein? How did you know her?” Bion was not being sarcastic:
he was showing how completely he maintained the frame in the ses-
sion. Rather than directly interpreting my negative transference at that
moment and seeing that I was emotionally and epistemically closed
up—that is, couldn’t think, only rail at him—he sought to open me
up in order to clear an empty, unsaturated space for thinking. He was
indirectly reminding me that I had not known Melanie Klein, because
I had never met her, let alone analysed her!2
Frequency of sessions
The requisite frequency of sessions for psychoanalysis has long been
and continues to be five times per week, although gradually four times
has become officially acceptable. There used to be a sharp cut-off point
between psychoanalysis and psychotherapy if sessions were less fre-
quent than four times per week. The rationale for four or five times per
week has to do with what is believed to be the necessary frequency to
evoke a deep enough regression for analytic work to be done and for
a sufficient frequency to attend to the results of that regression. If the
analysand is being seen five times per week, then there are only two
days when he is not being seen, and hence this frequency and ratio is
optimal for the unconscious to feel safe in remaining open and thereby
allowing for a sense of unconscious continuity. If the patient is being
seen, say, twice a week, on the other hand, then they are on their own
for five days a week, thereby compelling the unconscious to adjust to
all those days when it will not be processed. The result of this lesser
frequency may well be that the patient, without the additional support
of the analyst’s presence, unconsciously returns to his usual defence
mechanisms and becomes discontinuous with himself.
The use of the couch

and a reassessment of its use in psychoanalysis
The use of the couch for the treatment of mental disorders has a history
that long antedates Freud. The ancient Greeks apparently practised an
equivalent form of psychoanalysis, which was characterized by the use
of the couch, dream analysis, and the employment of rhetoric, dialectic,
and catharsis (Entralgo, 1970; Simon, 1978). It is not clear what their
rationale was for the use of the couch. As we all know, Freud’s sug-
gestion that the patient use the couch was largely for personal reasons:
He did not want to be observed while thinking about the patient’s free
associations, and he also believed that the patient, by feeling more
comfortable lying down, would be able to tap into deeper layers of
preconscious phantasies.
Freud apparently never realized that he had, in effect, discovered
the functioning of the right cerebral hemisphere! A person who is ly-
ing down and is not in eye contact with the person with whom he is
in discourse seems to activate a cerebral hemispheric shift in terms of
modes of data processing from the left to the right in right-handed
persons and conversely for left-handed persons. Interestingly, research-
ers in infant observation also noted that there was a considerable dif-
ference in infant alertness when the infant was observed sitting up as
contrasted with lying down. This shift in the alertness of conscious-
ness corresponded to electroencephalographic changes and also to a
hemispheric shift, from a highly controlled, organized, linear, abstract
mode to a looser, more free-flowing, somewhat more desultory, field-
dependent mode. The term field-dependent suggests a state of mind
in which the subject is dominated by and organized around emotions
and phantasies and, as a consequence, searches for those objects in the
environment, internally and externally, that seem to support or confirm
that mental state. This “right-brain” shift in the lying-down position in

analysis would be demonstrated by the nature of the patient’s associa-
tions, which would be “free”—that is, optimally disconnected from
“left-brain” editing, censorship, and control—and would instead be
organized by the unconscious. The use of the couch dramatizes, exag-
gerates, and allows the unconscious to select. One can conclude from
this that lying down facilitates a shift from the real to the imaginative,
phantasmal, and/or illusory world.3
While it is well known that the stoic aspects of psychoanalytic
technique issue from Freud’s rationale that the discharge into action of
the instinctual drives should be thwarted in order to allow for a verbal
transformation, one can also hypothesize that another perspective of
the stoic rationale is to facilitate the emergence and enhancement of the
dramatic aspects of one’s inner life so that they can become recognized.
The unconscious demands the security of the protection of the frame
so as to ensure that a suspension of disbelief can occur. Thus, when
psychoanalysis is thought of from the perspective of dramaturgy, one
can see that a play is being enacted: one that is improvisational vis-à-vis
consciousness but seems, nevertheless, to have already been prepared
for revelation by the unconscious. Patient and analyst are enabled to
participate in this “play” by the austerity and discipline of their respec-
tive roles and in how diligently each “plays the role”. The sitting-up,
face-to-face position vitiates the intensity and credibility of the per-
formance of this “play”. Further, by lying down, it only seems that the
patient is speaking to the analyst. He is, on a deeper level, participating
in an act of discourse with himself through the analyst as channel—La-
can’s (1975) “Other”—that is, his unconscious is discoursing with itself
through the analyst, but the impact and recognition of this refraction
through the other upon the ego constitutes the methodology of psycho-
analysis. When we lie down, consequently, the boundaries between our
conscious and unconscious and between ourselves and the other (and
others) become more fluid and therefore more revelatory. The patient
on the couch feels freer to retrieve his deeper feeling states, to immerse
himself in them, and to ponder them.
The relationship between the use of the couch and the unusual na-
ture of psychoanalytic discourse evokes yet another rarely addressed
point. In ordinary conversation, as well as in psychotherapy, we engage
the other person or patient one-on-one: that is, we listen and speak
directly to the other person as a person (“I–thou”). In psychoanalysis,
on the other hand, the analyst, strictly considered, listens, not just to the
speaking patient, but also to the text of associations from the patient’s
unconscious, for which the patient’s conscious speech (free associa-
tions) are merely the “channel”. Likewise, when the analyst interprets,
he speaks to the unconscious through the conscious ego, not just to the
consciousness of the patient per se. The use of the couch facilitates this
unique dialogue (Grotstein, 1995c).
It is well recognized that the very act of lying down on a couch in
the presence of another person—a professional “stranger”—is awk-
ward and even potentially embarrassing. It is felt as, to say the least,
unreal. Beginning patients frequently fear falling asleep, entering into
states of dissociation, and being abandoned. They feel self-conscious
and naked. The illusory world begins imperceptibly to emerge. One
patient, having recently changed from chair to couch, put it as fol-
lows: “This is an awkward and even an eerie situation. When I’m ly-
ing down, my image of you seems to change. You become awesome,
intimidating, and larger than life. When I get up to leave and am able
to face you, you seem to shrink down to human size.”
Another aspect of this hallmark position is worthy of note. Ly-
ing down facilitates the attainment of that brain state known elec-
troencephalographically as theta rhythm, which corresponds to what
Bion (1959) terms reverie—the state that characterizes the receptivity
of a nursing mother and of the receptive state of her infant during the
nursing—that is, sleepy wakefulness. It corresponds to a trance state
of optimal receptivity to impulses from within and from the external
world—with a minimum of defensiveness. In this state of reverie the
mother’s alpha-function, which Bion (1992) had termed dream-work
alpha in his personal, hitherto unpublished diary, is enabled to function
optimally. It is important to realize that this term, which can be thought
of as daydreaming or, more precisely, the continuation of the dreaming
process in wakefulness, offers a new dimension to psychoanalysis.
Thus the analyst, like the mother, receives the patient’s associations
in a daydream state and then processes them cognitively. The same is
true of the patient who, like the infant, takes in the results of mother’s
“digestion” of his reported experiences also in a state of reverie (when
the resistances to the attainment of this state have been uncovered
and removed). Consequently, the phenomenon of analytic insight has
a dimension in which the patient experiences his interpreted truth,
as revealed to him by the analyst, not only consciously (cognitively),
but also preconsciously and even unconsciously emotionally. Perhaps
we have overestimated the importance of the ego in psychoanalysis,
especially as it seems to have been privileged at the expense of the id.
What is of relevance here, however, is that through Bion’s conception
of the optimal mutuality of dream-work alpha psychoanalytic treat-
ment not only involves itself with the unconscious but may be a more
“inter-unconscious” and “intra-unconscious” discourse than we have

hitherto realized—and if so, the requirement that the patient lie down
on the couch has found a new rationale.
Yet another aspect of the use of the couch involves the matter of
the patient’s trust of the analyst as well as its reverse, the analyst’s
emotional willingness to bear the patient and to allow him into his
dream life, to continue Bion’s idea. This intimate relationship can be
understood as analogous to bonding and attachment (Bowlby, 1958,
1969, 1973, 1980) but also harkens back to Freud’s (1905e) conception
of cathexis [Besetzung], which is best translated as “personal invest-
ment in” or “belonging to”, or even “mattering”. Elsewhere I have
described this under the rubric of the “dual-track theorem” as the
“transference–countertransference neurosis”, which is the return of the
repressed infantile neuroses of the patient and analyst both as separate
and inseparable phenomena, as following a “Siamese-twinship” para-
digm (Grotstein, 1986, 1988, 1993a, 199b). The patient’s lying down and
facing away from the analyst corresponds with the freedom offered to
the latter to think his own thoughts without intrusion by the putatively
invasively concerned eyes of his patient, allowing each to follow their
respectively assigned “roles” optimally—but this involves trusting one
another.
Some patients seem to compromise their analytic posture by sitting
on the couch and looking at the analyst. On occasion I have found
patients to seek items to talk about that seem to justify their sitting up
and facing the analyst. One of the basic considerations for the use of
the couch is the therapist’s judgement as to whether the patient is ca-
pable of adaptive regression in the service of the ego or might descend
headlong into a cataclysmic regression, in which case the use of the
couch is generally considered to be contra-indicated. Considerations
of this anxiety about regression often lurk behind the manoeuvres of
the patient to sit on the couch—or in the chair. The patient may feel
that his gazing at the analyst is a protective measure that will arrest
the danger of a deeper regression in the treatment.
It is interesting to note how often patients who return for brief con-
sultations or follow-ups, even after many years’ absence, will instantly
head for the couch as if it were their childhood room. For them, the
couch seems to have become a ritual.
The concept of the couch as a ritual has yet another dimension:
that of its being generally considered as a formal requirement for the
psychoanalytic procedure. Frequently a great deal of pressure is placed
on candidates in training to persuade their patients to use the couch,
and many “tricks” are employed by them and by seasoned analysts as
well to lure their patients to the couch. I myself have opted for a rou-
tine procedure that seems thus far to be successful. As soon as I have

finished the consultation and obtained the patient’s consent to begin
analysis, I impose this, as follows:
“Now that we have agreed upon the advisability of your entering
analysis, I wish to introduce you to how it is conducted. One of
the procedures is the use of the couch. Have you any ideas or feel-
ings about its use? The rationale for its use began with Freud and
his discomfort in being observed while immersed in his thoughts
about the patient. Further, he thought that the patient would feel
more comfortable lying down. He did not recognize that he had in
effect discovered the right hemisphere, an alternative brain that is
switched on as the other switches off when someone lies down in
the presence of another person without being able to observe them
with their eyes. This data processing system is sensitive to emo-
tions, phantasies, illusions, and the like and is less concerned with
logic or continuity than the other one. I think you may be able to
see this for yourself.”
Once we remove the ritualized aspect of the use of the couch, then we
may ponder such considerations as:
A. Should the analytic patient be restricted to the couch throughout the
analysis? Or might he be able, or even encouraged, to sit up from
time to time or on clinically indicated occasions—and, if so, what
are those occasions?
B. Should psychotherapy patients be encouraged to use the couch?
This is a cogent issue at present since so many psychoanalytically
oriented or informed therapists are currently using couches for
a wider and wider group of patients who are not in formal—or
perhaps even legitimate—analysis. The issue pertains especially,
however, to those who are in legitimate training and/or have gradu-
ated from approved institutes. We need to review the indications
and contraindications of the use of the couch in light of the trends
in current practice.
C. With the preceding in mind, can the couch be justified or even
indicated in doing psychotherapy at frequencies of less than three
times a week? I myself frequently suggest the couch for many psy-
chotherapy patients who come less often than four times a week.
They are, in each case, potentially analysable in my opinion but
cannot come more frequently because of money, distance, or other
external factors. One of my most meaningful and successful cases
was that of a young woman whom I treated on the couch once a
week for three-and-a-half years. Put more succinctly, the rationale
for the use of the couch in analysis and in psychotherapy is in need

of reconsideration.
D. Another interesting aspect of the issue of the couch lies in the nature
of newer furniture. Some therapists have placed two rotating lounge
chairs of Swedish make in their offices, thereby allowing the patient
to lie down, sit up, or rotate away from or towards the therapist. Is
this yet another consideration that deserves our attention?
The following clinical vignettes reveal individual reactions to the use
of the couch:
Clinical vignette 1. This patient is a psychotherapist and consequent-
ly entered treatment with knowledge and preconceptions about the
couch, which were dealt with at great length sitting up in the initial
stages of the therapy. Once I thought he was ready for the use of
the couch, I indicated that he might now move over to it. He did so
and then quickly became aware of a sense of mystery and awe—one
in which he felt small and considered me gigantic and forbidding
and with a preternatural bearing. The transference aspects of this
defensive idealization of me consequent upon the infantilization
of him that were precipitated by his moving from the chair to the
couch were interpreted and brought relief.
Clinical vignette 2. This patient is an actor who had been adopted
when he was an infant. The lying-down position was equated by
him with his birth mother leaving him. It took us some time to work
through this fear. He was terrified in the meanwhile about any si-
lence on my part, silence being equated with abandonment.
Clinical vignette 3. I have had two patients who had suffered from
similar problems who had similar reactions to the use of the couch.
Each demonstrated a marked schizoid tendency in his personality.
I introduced each to the couch at the beginning of the analysis,
only to encounter the same reaction of feeling lost, abandoned,
dissociated, fragmented, and alone. I then had each sit up in the
chair and conducted the analysis face-to-face for a couple of years,
by which time each spontaneously asked to be allowed to use the
couch once more. The spontaneity of the requests was interesting.
Not only had they acquired sufficient ego strength in the meantime
to be able to use the couch, but they had also become gradually
dissatisfied with what they felt was the superficiality of the sitting-
up treatment. They seemed to have discovered the difference and
eventually longed to return to the couch “to go deeper”.
Clinical vignette 4. LG is a patient who also is a psychotherapist.
She is not a psychoanalyst herself and uses the sitting-up position

for her own patients. I began seeing her twice a week at the start
of the treatment and also used the sitting-up position. As we pro-
ceeded, it became apparent that there were deeper issues that she
felt needed to be contacted, so she asked for the use of the couch,
and I acceded. Later she started formal analysis with me and came
four times a week. As time wore on, she developed the pattern of
starting the analytic session by sitting up on the couch, reporting
her “diary” day residue—as if to “debrief” herself to me and then
would ask, “Do you want to do a little bit of analysis?” I ultimately
came to realize that she needed and wanted analysis but was afraid
of its regressive pull and sought this ritual in order to “break her
fall”, so to speak. We came to realize that the “fall” was into an in-
ner “black hole”.
Clinical vignette 5. There are a few patients whom I have seen once
a week—the infrequency of sessions being due entirely to external
reasons (money and/or distance)—where I employed the couch.
In these particular cases I believe that I have been able to conduct
psychoanalysis quite satisfactorily and to achieve significant re-
sults. It was remarkable to me how each of these patients was able
to achieve transference neuroses and to carry over the unconscious
themes from one week to the next.
Telephone and video-conferencing:

analysis and psychotherapy
I have had some modest experience with telephone and video-confer-
ence psychotherapy and analysis. I have found that once per week on
the telephone did not produce optimum results for the patient, but my
experiences with greater frequency (five times per week) worked out
quite well. It is a procedure that needs more research to establish both
its validity and its shortcomings.
Notes
1. It is important to remember that Bion’s contact-barrier differs from Freud’s
(1915d) concept of repression.
2. For an elegant discussion of this quality and style of Bion’s technique see
Ogden, 2004).
3. The right hemisphere “speaks” analogically in terms of sense impressions,
especially visual. Its mode is generally the visual, which, in turn, subserves the
functions of imag(e)-ination, as well as phantasy and illusion.
CHAPTER 3
Recommendations on technique:
Freud, Klein, Bion, Meltzer
F
reud’s (1912e) recommendations on psychoanalytic technique are
as apposite today as when he first formulated them. In reading
them, one sees the origin of many of Bion’s ideas on technique. I
advise the reader to re-read this invaluable trove of recommendations
on technique in Volume 12 of Freud’s Standard Edition (pp. 111–171).
I have extracted a very brief portion of the beginning of his contribu-
tion:
Freud’s recommendations
to physicians practising psycho-analysis
The first problem confronting an analyst who is treating more than
one patient in the day will seem to him the hardest. It is the task of
keeping in mind all the innumerable names, dates, detailed memo-
ries and pathological products which patient communicates in the
course of months and years of treatment, and of not confusing them
with similar material produced by other patients under treatment
simultaneously or previously. . . .
The technique, . . . consists simply in not directing one’s notice
to anything in particular and in maintaining the same “evenly
suspended attention” (as I have called it) in the face of all that one
hears. In this way we spare ourselves a strain on our attention which
could not in any case be kept up for several hours daily, and we
20
RECOMMENDATIONS ON TECHNIQUE 21
avoid a danger which is inseparable from the exercise of deliberate

attention. For as soon as anyone deliberately concentrates his
attention to a certain degree, he begins to select from the material
before him; one point will be fixed in his mind with particular
clearness and some other will be correspondingly disregarded,
and in making this selection, if he follows his expectations he is in
danger of never finding anything but what he already knows; and
if he follows his inclinations he will certainly falsify what he may
perceive. It must no be forgotten that the things one hears are for
the most part things whose meaning is only recognized later on.
It will be seen that the rule of giving equal notice to everything
is the necessary counterpart to the demand made on the patient
that he should communicate everything that occurs to him without
criticism or selection. . . . The rule for the doctor may be expressed:
“He should withhold all conscious influences from his capacity
to attend, and give himself over completely to his ‘unconscious
memory’”. Or, to put it purely in terms of technique: “He should
simply listen, and not bother about whether he is keeping anything
in mind.”
What is achieved in this manner will be sufficient for all
requirements during the treatment. Those elements of the material
which already form a connected context will be at the doctor’s
conscious disposal; the rest, as yet unconnected and in chaotic
disorder, seems at first to be submerged, but rises readily into
recollection as soon as the patient brings up something new to
which it can be related and by which it can be continued. [Freud,
1912e, pp. 111–112]1
Klein’s recommendations on technique:

infantile transference from the beginning
Perhaps the most rewarding place to glean Klein’s recommendations
on technique is in the numerous case studies she has published. Ar-
guably the most rewarding of these is her Narrative of a Child Analysis
(1961)—particularly her footnotes, which, for me, constitute a textbook
of their own. Meltzer (1967) has elucidated Klein’s technique for child
analysis, and, more recently, Spillius (2007) has searched the Melanie
Klein Archives and was successful in locating many of Klein’s un-
published works on technique. From the Narrative we learn that Klein
believed that the infantile transference begins even in the first session and
should be interpreted—not only the negative transference but the posi-
tive transference as well. After pondering the rationale for her advising
interpreting the positive transference as well as the negative, I came up
with the idea that she was seeking to protect the healthier cooperative
part of the analysand’s personality from the negating part: the latter
would be more clearly differentiated from the positive. In other words,
the negative part of the personality is being placed in “quarantine”.
What is of utmost importance, however, is that the Kleinian analyst is
always seeking to locate the unconscious dependent infant and track
him and his anxieties throughout the session.
Interpretation of the maximum unconscious anxiety

Klein believes that one should interpret the maximum (not necessar-
ily the deepest) unconscious anxiety along with the defences against
them. It became clear to me upon reading the Narrative that Klein (1961)
was analysing unconscious anxiety as much as unconscious impulses,
which she often felt were defences against them. Her therapeutic stance
was interesting. When classical Freudian analysts first interpreted the
defences, they thought these guarded against the drives. Furthermore,
they saw the analytic task as interpreting the defences so that the re-
pressed could become conscious. In a way it seemed that the analysand
was the actual analyst and that the nominal analyst was a surgical
midwife who removed the defensive adhesions to the emergence of
the unconscious (Glover, 1931; Fenichel, 1941; Greenson, 1967). Klein,
on the other hand, believed that defences were mainly erected against
unconscious anxiety associated with relations with internal and exter-
nal part-objects and whole objects.
Interpretation of relationships with part-objects

Klein advocated analysing the infant’s or infantile portion of the
adult personality’s relationship to part-objects before whole objects,
the main difference being that the latter are already separate and in-
dividual whole objects, whereas the former are split-off projections of
and by the infant. More to the point, Klein emphasized how the infant’s
image of the whole (real) object becomes fundamentally altered by the
projection of part-objects, including parts of the infant’s own body
(“urine”, “faeces”, “saliva”) or mind (hate, love, greed, envy).
The consummate importance of unconscious phantasy

Even more than Freud, Klein emphasized the importance of in-
terpreting the analysand’s unconscious phantasies, which are the im-
aginative scenarios of the his unconscious relationships within himself
and between himself and his objects, particularly in the transference.
The ontological, phenomenological, and epistemological

experience of being in the paranoid-schizoid
and depressive positions
Klein originally used the autoerotic scheme of development laid
down by Freud (1905d) and Abraham (1924). Her discovery of infantile
depression alerted her to yet another overarching theme: the ontologi-
cal and phenomenological experiences—like rites of passage—that the
infant is fated to undergo, from persecutory anxiety (narcissism) to
depressive anxiety (object-relatedness) in terms of their relationship to
their caretaking objects.
The importance of the defences against anxiety

The analyst is always looking for how the infantile portion of the
personality defends itself against persecutory (projected) anxieties by
the schizoid defences (splitting, projective identification, denial, and
idealization) and against depressive anxieties (awareness of depend-
ency and of attacks against the depended on object) by the manic de-
fences (triumph, contempt, and control), finally yielding to reparations
of the damaged object out of gratitude.
The importance of envy, greed, and love

versus destructiveness
In every analysis envy, greed, and destructiveness will inescapably
enter the scene and hatefully compete with the infant’s propensity to
love the object. Klein assigns this dialectic to rivalry between the life
and death instincts.
The constellating importance

of the archaic Oedipus complex
Klein brought the timing of the archaic Oedipus complex to the
second oral stage (biting), which was coeval with the emergence of
the depressive position. It is the constellating mythic theme that gives
structural containment to all the unconscious phantasies that arose
during the paranoid-schizoid and depressive positions. Uniquely, its
setting or landscape is the infant’s phantasy about the insides of moth-
er’s body and the paternal phallus and the “unborn children” who
dwell there.
Bion’s recommendations on technique: an epitome

Very succinctly, Bion offers five suggestions in relation to technique, as
I previously outlined (Grotstein, 2007):
A. Use sense, myth, and passion when conducting an analysis.
Sense refers to the use of keen observation by any and/or all
the senses. Myth refers to the particular mythic template that
may be found to organize and join together the analytic object,
the O of the session, which in Kleinian terms is the maximum
unconscious anxiety. Bion (1992) suggests that the analyst search
for and store myths as the equivalent of a scientific deductive
system with regard to psychoanalysis (p. 238). Myths also sub-
tend conscious and unconscious phantasies. Passion designates
the analyst’s fluctuating emotional state in resonance with the
emotions of the patient. As we shall see, Bion recommends the use
of two forms of observation by the analyst: emotional and objective.
B. Abandon memory, desire, understanding, and the use of precon-
ceptions. Each session constitutes the first day—again—of the
analysis. Do not remember previous sessions. Let them remem-
ber you spontaneously. Do not desire to cure the patient.
C. Descend into a state of reverie (“wakeful dream thinking”) so
that you can be optimally receptive to your (the analyst’s) un-
conscious emotional resonance with the patient’s emotions and
be able optimally to recruit them. The analyst must not proffer an
interpretation that he does not feel. The patient will know. Fur-
thermore, the analyst must not repeat an interpretation. Every
interpretation should be a surprise both to the analyst and to the
patient (personal communication over the years of my analy-
sis).
D. Freely employ speculative imagination and speculative reason-
ing.
E. The analyst must “dream” the analytic session—that is, he
must “dream” the patient’s as yet undreamed or incompletely
dreamed emotions (O at large).
Bion’s exhortation to the analyst to eschew (abandon) memory and
desire (1970, p. 30) has become his hallmark, but it was prefigured
by Freud (1912e) in his lectures on technique. What it presages is
the analyst’s capacity for reverie, for “becoming” the analysand, a
technique adumbrated by Freud but explicated far more fully by
Bion. What Bion means by this is for the analyst to not confuse his
imaginative creation of the image of the analysand with the real
analysand—and be able to help the latter to do the same with him.
[pp. 82–83]2
Night-time vision as a model for wakeful dreaming

As one reads Bion’s works, particularly his recommendations for
analyst’s stance in experiencing his patient, one gets an impression of
the use of the mental counterpart to night-time vision. During the night
the rods of the retina, rather than the more proximal cones, become the
effective receptors of light, and they lie off-centre in the eye. In night-
time vision, consequently, the subject is compelled to look somewhat to
the side of the object (stars, for instance) that he is gazing at. I suggest
this phenomenon constitutes an analogue model for Bion’s suggestion
to “cast a beam of intense darkness”.
Sense, myth, and passion

Bion believed that during the analysis the analyst must employ
sense, myth, and passion (Bion, 1963, p. 11). By sense he meant percep-
tion or observation. By myth he meant the apposite unconscious phan-
tasy and its mythical template. By passion he means the experience of
emotional suffering. This troika of psychoanalytic tools is used by the
analyst to fathom what is transpiring in the patient. Thus, the analyst
must observe the patient in light of the relevant phantasy and then
myth, all with his left-hemisphere listening, then experience his own
counterpart suffering of his own internal version that corresponds to
the patient’s emotional suffering with his right-hemisphere attention.
Then the analyst interprets. As soon as the analyst has appropriately
intervened, the patient experiences the result of the analyst’s use of
sense, myth, and passion and now feels safe enough to experience his
emotion. If it is safe for the analyst to detect and experience his version
of the patient’s emotional experience of O, then this act vouchsafes
the patient’s ability to experience his own O. That is what is meant by
container/contained, reverie, and the analyst “becoming” the patient
and “dreaming” the session.
[T]he analyst must have a view of the psycho-analytic theory of the Oedi-
pus situation [my italics]. His understanding of that theory can be
regarded as a transformation of that theory and in that case all his
interpretations, verbalized or not, of what is going on in a session
may be seen as transformations of an O that is bi-polar. One pole is
trained intuitive capacity transformed to effect its juxtaposition with what
is going on in the analysis and the other is in the facts of the analytic
experience that must be transformed to show what approximation the re-
alization has to the analyst’s preconceptions–the preconception here being
identical with Taβ as the end-product of Taα operating on the analyst’s
psycho-analytic theories [italics added]. [Bion, 1965, p. 49]
Readers who are only casually familiar with Bion’s recommendations

to use intuition by eliminating “memory and desire” may not be fa-
miliar with “left-hemispheric” Bion, the psychoanalytic observer par
excellence and disciplinarian who also recommends that the analyst
should be so well versed in the Oedipus complex (both the Freudian
and the Kleinian versions) as well as with Klein’s concepts of splitting
and projective identification and the movement from the paranoid-
schizoid to the depressive position that he can take them for granted.
In addition, it becomes important to realize that the analyst’s thinking
about and applying his theoretical knowledge involves a transformation
(personalized version) of those theories.
Attention in reverie: “listen to yourself listening to the other”

When I was in analysis with Bion, he frequently emphasized that I
may be in danger of thinking of him as the authority and of his inter-
pretations as authoritative. I should, instead, he cautioned, “Listen to
yourself listening to me. Your emotional response to what I say is the
authority”. For Bion, the quintessence of technique is for the analyst to
pay exquisite “attention” (listen) to him or herself in the act of passively
listening to the analysand. That is what he really means by “reverie”.
There is something more to be said about the subject of reverie,
however. In the state of reverie the analyst is deliberately vulnerable
and unguarded so as to be taken over by the dramaturge (Grotstein,
1981b, 2000) or “subjugating third intersubjective subject” (Ogden,
1994), who, like an unconscious “ventriloquist”, remotely (projectively)
controls the receptive mind of the analyst. This phenomenon is also
called “folie à deux” (Mason, 1994). Mason advises us that we should
differentiate between the positive, beneficial use of “folie à deux” and its
pathological misuse. In the former the analyst maintains his separate-
ness and enters a “pretend state”. In the latter the analyst enters into a
state of fusion with the analysand.
Eaton (2008), writing from this perspective of Bion’s, distinguishes
four different levels of reality in the analysand’s emotional experience:
(a) the interpersonal, (b) the intrapsychic, (c) the intersubjective, and
(d) the impact of O on both personalities in the session.
Meltzer’s recommendations on technique

Meltzer (1967), in his recommendations for child analysis, offers the
concepts of (a) the “gathering of the transference”, (b) the “sorting
of geographical confusions” in the infant, and (c) the sorting of zonal
confusions in the mother. In applying is concept of “the gathering of

the transference” to adult analysands, I believe Meltzer would recom-
mend that, as transference—and now we would say countertransfer-
ence as well—appears as early as the first session, the analyst should
selectively and exclusively interpret in the transference from the begin-
ning. This has the effect of alerting the analysand’s unconscious that
it is being heard in a special way. The analysand’s unconscious will
respond accordingly.
The concept of “zonal” and “geographic confusions” is uniquely
Meltzer’s. “Zone” refers to the active relational aspects of the infant’s
body, such as mouth, genital, and anus–rectum, and “geography” re-
fers to the corresponding relational aspects of mother’s (and, later, fa-
ther’s) body, such as breast, genital, and anus-rectum. Mother’s breasts
can also be equated with her mind. The genital of each can be thought
of as either procreating or soiling. An example of “zone-to-geography
confusion” would be the following:
A young, single male physician had difficulties with intimacy.
We were able to learn that every time he had intercourse with a
woman, he rapidly turned away from her afterward and depre-
cated her to himself. We learned that, for him, intercourse was
not truly “love”-making, it was evacuating his emotional urgency
(emotions as “urine” evacuated by anus or genital being used for
urination) (and/or “faeces”) into her as a “toilet-breast” (Meltzer,
1967, p. 20).
In erotic transferences, the analysand confuses her mouth with her
genital and the analyst’s breasts (mind) with his genital.
The analyst’s stance

The analyst’s stance is one of disciplined, watchful, bimodal wait-
ing:
A. Undertake an evenly hovering attention—suspension of memory,
desire, understanding, and preconceptions—while awaiting the ar-
rival of the “selected fact” (Poincaré, 1963), the unique association
that gives meaningful coherence to the preceding and following
ones.
B. Simultaneously or alternatively “parse” each successive association
and try to intuit the links between them (which I also consider to
be “selected facts”).
C. Anticipate the emergence of the presence of the “unconscious
infant”, which I have earlier introduced as the “once-and-forever

infant of the unconscious”, the agonal subject who experiences the
“analytic object”, the current symptomatic anxiety
D. Gather the transference.
Gathering the transference—

along with the countertransference and reverie
Meltzer (1967), in his book on the technique for child analysis, rec-
ommends that the analyst should “gather the transference”. By this he
means that the analyst should exclusively listen for and interpret posi-
tive and negative transferences as they appear—from the beginning of
the analysis in the analysand’s associative derivatives. In this way the
analysand’s unconscious learns to adjust its “language” to the new
“language” it must speak in order to be understood by the analyst. A
blend between them will soon occur as a mutual accommodation. The
question is: would the analysand present as much transference material
if it were not gathered in this way? My answer is that all psychoanalytic
material constitutes transference and that the patient’s unconscious
feels safer and more understood when it is so singly addressed. I also
believe that the analyst should also closely monitor what countertrans-
ferences (by using his reverie) occur to him as he proceeds.
Notes
1. I thank Ronald Ricker for reminding me of this portion of Freud’s “Recom-
mendations”.
2. For a more expanded view of Bion’s recommendations on technique, see
Grotstein (2007), pp. 82–97.
CHAPTER 4
How to listen
and what to interpret
Monitoring the analytic text

I have learned from my own experience and from that of my col-
leagues and supervisees that the act of monitoring the analysand’s
text has become more complicated over the years. Freud (1912b, pp.
11–12) suggested that the analyst should listen with even hovering at-
tention to the analysand’s manifest content until he is able to discern
a pattern that he feels able to interpret. Bion (1970, p. 31) suggests the
same with his idea of abandoning memory, desire, understanding, and
preconceptions. In fact, Bion often suggested, following a letter from
Freud to Lou Andreas Salomé (1966, p. 45), that one should “cast a
beam of intense darkness into the interior so that something hitherto
obscured by the dazzling illumination can glitter all the more in the
darkness” (personal communication,1 1974). I advise the beginning
psychoanalyst and/or psychotherapist to respect this intuitive mode
of listening but not to follow Freud’s and Bion’s advice strictly until
they are far enough along in their training and experience. Freud’s
and Bion’s advice is based on their taking for granted that the analyst/
therapist had already been schooled and drilled in the basics aspects
of analytic theory. A tennis professional recently informed me that, in
his opinion, to attain proficiency with my backhand stroke, I would
have to hit 2,500 consecutive backhand strokes before I could “forget
it and take it for granted”. The same principle applies to conducting
psychoanalysis and psychotherapy: Yes, one must forget theory—but
29
only once one has learned and mastered it! One cannot forget a theory
one has not yet learned!
Active listening (observation)

I believe that the analyst/psychotherapist should, first of all, “read”—
that is, “track” or “parse” (as in grammar, when one tracks a sentence
into its components)—the analytic text that emerges from the analy-
sand’s utterances, prosody, and behaviour, paying special attention to
the initial associations and then equally close attention to the sequence
or succession of subsequent associations. The practice of reading or
tracking the living text corresponds to what I term “left-hemispher-
ic monitoring” and involves the use of classical Aristotelian logic or
Cartesian logic, in which a separation exists between subject and ob-
ject—and constitutes one use of Bion’s Grid as an analytic instrument.
One might, loosely though accurately, compare this technique with
cryptography, in which a code is being deciphered. Additionally, the
left-hemisphere-directed analyst must attend to the injunctions of Gray
(1982, 1994) and Busch (1995a, 1995b, 1997) and closely follow the
subtle affective shifts that occur as the analysand freely associates.
This monitoring can take place on at least two levels. The level that
Gray and Busch seem to me to be working on is that of the System
Pcs./Cs. frontier, whereas the Kleinian/Bionian analyst works more on
the System Ucs./Cs. frontier and discerns more hidden affects by the
revelations of the ongoing unconscious phantasies.
Passive listening—reverie and intuition

Simultaneously with “right-hemisphere” listening, the analyst/psy-
chotherapist should also do his best to enter into a state of meditative
reverie—a waking dream state—that is, allow himself to enter a hyp-
notic spell, so as to become totally immersed in his own experience of the
analysand’s total presence and being as his (the analysand’s) associa-
tions are flowing. Bion (1962b, p. 15) varyingly calls this latter process
“dreaming the session” or “becoming” the analysand. They belong to
the broader concept of containment of the contained (Bion, 1962b, p. 91).
The concept of “becoming” the analysand—a notion that I believe he
borrowed from Plato’s Theatetus (Jowett, 1892, Vol. 2, p. 155)—requires
some elucidation.
It is my belief that many of Bion’s terms suffer from condensation
and from being stated in veritable shorthand. When he says, for in-
stance, that the mother must “become” her infant or the analyst must
HOW TO LISTEN AND WHAT TO INTERPRET 31
“become” his analysand, it is my belief that what he really means is

that the mother must allow her own pertinent, relevant, symmetrically
(contingently) corresponding unconscious emotions and object experi-
ences, which are her own O (native to her), to resonate with the O that
she experiences to be present in her infant—after having introjectively
partially counter-identified with the infant’s distress. When her own O
is thus selectively summoned, the mother’s native O is found to be
symmetrical and resonant with that of her infant (Grotstein, 2004a)
(Schore, 2003a, 2003b) refers to this process as “right-hemisphere- to
left-hemisphere” communication (p. 76).
A similar transaction takes place between analysand and analyst.
In other words, I think it was Bion’s belief that neither the infant’s nor
the patient’s projective identifications had left the actual boundaries
of the projecting subject nor entered the actual object. “Something
had to be added” to the projective process to render it interpersonal:
gesture, evocation, provocation, “priming”. I call this broader inter-
personal projective phenomenon “projective transidentification”. In the
meanwhile, what the analyst really experiences in the act of “becom-
ing” is “becoming more and more him or herself”—the finite analyst
becomes incarnated by his infinite self (O), which is the ultimate act of
empathy.
Right-hemispheric listening has two major components that over-
lap. One component is Bion’s emphasis on the analyst’s use of his
reverie to determine the “selected fact”—that is, to be emotionally and
intuitively sensitive and ready to detect the mysterious revelation, the
key to what the analysand’s unconscious is emitting. Another compo-
nent—one that has been emphasized by Betty Joseph (1989) and her
followers—is that of the detection of ongoing “here-and-now” trans-
ference ↔ countertransference—and I would add ↔ “reverie”—situ-
ation in continuing efforts to detect: (a) what roles the analysand is
unconsciously imposing on the analyst to play out for him; (b) what
role or roles the analyst is unbidden and/or reactively playing out for
the analysand; and (c) the unconscious intersubjective engagement as
a unit.
Taking notes
The taking of notes is problematic. Bion exhorts analysts not to take
notes because the very act of note-taking is honouring memory, which
Bion eschews. The only justification for taking notes is for supervision
or for research, such as publishing or presenting a clinical paper—or
even for the sake of one’s being able to take a “second look” at what
had happened that one had missed. Analysts and psychotherapists,

however, are now mandated by state practice laws to take notes for pro-
tection against malpractice and/or for the sake of third-party insurance
companies. It is an open question. My own point of view is that one
should not be forced to take notes, but should voluntarily do so only if
one feels the need or desire to, strictly for one’s own purposes.
“‘Dreaming’ (‘becoming’) the analytic session”

In other words, the analyst (like the mother) must allow him or herself
to enter into a wakeful dream state so that in his daydreaming he can be-
come so immersed in the atmospherics of the analytic session—includ-
ing the analysand’s essence, being, and affects—that he can, in her or
his meditatively protected emptiness (unsaturated “no-thought” place)
allow himself to become suffused with his own native reconstruction of
his experience of the analysand. The reader will notice that I emphasize
reconstruction within the self of an experience with the other rather
than introjection, except for the initial step: introjective counteridenti-
fication, and I even suspect that: because, following Llinás (2001) and
Damasio (1999, 2003), I have come to believe that introjection—and, for
that matter, projection as well—are illusions! What Llinás and Damasio
believe really happens is that the subject artistically reconstructs and
reassembles the likeness of the stimulus object within himself. I would
add that we then alter the reconstructed or reassembled image second-
arily by our affects, this latter process being tantamount to what has
come to be known as projective identification. Behind this argument
is the consideration that psychoanalysis is divided into theory and
clinical practice: thus, we must consider such phenomena as introjec-
tion, projection, and many other mechanisms and phenomena as being
divisible into experiential and metapsychological considerations. My
conclusion is that the patient (and the analyst) believes experientially
that he has introjected or projected an object, but metapsychologically
he has either reconstructed the image of the object within himself (in-
trojection) or displaced emotional cathexis from his self-representation
to his object representation (projection) (Jacobson, 1964).
Bion’s concept of “dreaming” the analytic session can be associated
with his other concept of the analyst’s “‘becoming’ the analysand”, not
identifying or fusing with but exquisitely and intimately simulating the
analysand’s emotional state. In other words, “becoming” is not the
same as at-one-ment, fusion, or identification! One must be separate
from the object one empathizes with (becomes) so that one’s separate
mind can function.
Ogden (2001) and Ferro (1999, 2002a, 2002b, 2005), more than most,
have taken Bion’s (1962a, 1962b, 1965, 1970) ideas about container/con-
tained and reverie and his radical concept of “dreaming” seriously in
their own recommendations about technique. In reading Ogden’s ele-
gant and eloquent clinical material, we find ourselves entering into the
midst of Ogden’s dream state in which he is “dreaming” his patient. He
also lets us in on how he might have arrived at some of his dream frag-
ments. Ferro (2002a, 2002b) likewise seems to enter a waking-dream
state and spontaneously conjures narratives for the analysand. Using
a clinical example, he comes up with the following:
Rigid-vertex and oscillating-vertex models
“My mother won’t take the dog because she has too much work.”
“My mother” may be understood as a reference to the real
external mother, the “dog” to a real external dog and the “work” to
the “mother’s occupation”.
On another level, the characters could be considered in
transference terms as parts of the patient, as projected internal
images . . .
Yet a third vertex is also possible, in which communication
is seen as a story told from the patient’s standpoint about the
functioning of the analyst and of the patient in the consulting room.
The idea here is of an analytic function so far unable to take charge
of the most primitive aspects of . . . the relationship, because much
is still preverbal—namely, emotions that must be worked on by
the couple . . .
I should now like to present a contrasting fourth model, which
is characterized by the instability of the listening vertices and
therefore includes all the possible stories which become narratable on
the basis of the patient’s statement and whose freedom of narrative
combinations is positively exponential. . . . Message decoding is
no longer possible, but only the construction of a story–which
will have the characteristic of being necessary to those two minds.
[Ferro, 2002a, pp. 33–34]
One is reminded here of an elegant application of Bion’s theory of
dreaming in which the analyst, with the patient’s participation, be-
comes a story-teller. One is also reminded of Winnicott’s (1953, p. 108;
1968) Squiggle game that he played with his child patients. Ferro and
Ogden, each in his own way, seem to be dreaming for the patient.
Ferro quickly eschews what he believes to be the formulaic aspects
of Kleinian interpretations and accentuates the concept of dosage and
suitability for the particular patient in the present moment. Both Ogden
and Ferro demonstrate versatility in their “dreaming” approach.
I greatly admire both their approaches and believe that Bion him-
self—though possibly not Klein—would have been pleased. While
agreeing with them and their approach to the point of enthusiastically
recommending it, I should also like to add another point of view about
Bion’s theory of dreaming—one that would be more in accord with Bi-
on’s being Kleinian. To my way of thinking, every interpretation about
an unconscious phantasy constitutes a postulation and confirmation
of the very existence of that phantasy and thus constitutes dreaming.
In other words, when the analyst listens to the analysand’s free asso-
ciations and transforms them in his mind into a phantasmal narrative
that he believes the analysand’s associations authentically indicate,
he is dreaming the analysand’s text—or, more properly, is completing
the incompletely dreamed and thus symptomatic text—and thereby ratify-
ing the phantasmal network that underlies and supports System Cs.
Interpretation of phantasies or dreams is dreaming and also simulates
story-telling. Bion often spoke about the necessity for analysts to collect
phantasies and myths: he felt they were highly useful as mediating and
transforming containers.
What I am essentially saying is that the act of being “Kleinian”—or,
for that matter, “post-Kleinian”—does not mitigate Bion’s injunction
to be spontaneous and empty, at any given analytic moment, of theo-
retical preconceptions. Bion himself believes that the analyst must be
armed, as it were, with such concepts as the Oedipus complex (Kleinian
and Freudian versions), the relationship between the paranoid-schiz-
oid and depressive positions, and the mechanisms of splitting and
projective identification (Bion, 1962b, p. 76). What Ferro, after Bion, is
getting at, however, is spontaneity and the ability to be surprised. Too
often analysts of all schools, including the Kleinian, may be predis-
posed to offer stale, predictable interpretations about, say, the weekend
or vacation/holiday break, about omnipotence, destructiveness, and
so on. The interpretation should, if possible, emerge from surprising,
unpredictable sources and be a surprise to the analysand as well as
the analyst. The analyst’s predicable, prosaic, formulaic interpretations often
unconsciously indicate to the analysand that the former has become saturated
with and is now vulnerable to O.
Having been analysed by Bion, I am familiar with how he inter-
vened with me, but I was not privy to his state of reverie, nor did I
know when he entered and/or left it. I give some examples of my own
reverie states with analysands as I proceed.
The nature of analytic interventions

The types of analytic interventions include interpretation, comment,
question, probing, exploring or opening up, clarification, and confron-
tation. The ideal of analytic technique is to confine one’s interventions
to interpretation. Yet each individual analysis may bring up many
problems where the analyst may feel constrained to use the other tech-
niques—and yet others in addition to those. One of the problems about
using comments is that, because the transference situation (mainly of
the superego type) may be predominant, the analysand is in perpet-
ual danger of misinterpreting the analyst’s innocent and, presumably,
neutral comments as apodictic, authoritative commands from himself.
Questioning, except for seeking information that the analyst believes
is important for him to know, runs the risk of interrupting the ana-
lysand’s analytic trance and also of intimidating. “Why is it that you
always choose to get close to that kind of person?”, for example, puts
the analysand on the defensive. The danger of confrontation is similar
but is often necessary. Probing and clarification are frequently useful.
Interpretations by the analyst ideally come after the patient’s un-
conscious invitation. I should like to repeat what I have already stated
earlier with regard to the difference between classical Kleinian and
contemporary (post-) Kleinian technique. As I see it, the overt differ-
ence seems to be whether to interpret the patient’s material from the
perspective of day residue and past history or that of the unconscious
interactions between patient and analyst in the present moment. My
view is that the former (day residue) is but a displacement from the
latter, which is all too intimate.
The activity of the analyst/therapist:

“attachment/bonding” → “weaning”
As the analysis progresses, the psychoanalyst or psychotherapist will
find himself in two major roles: those of providing (a) a “holding environ-
ment” (Winnicott, 1960b), and (b) a “container” (Bion, 1962a, 1962b) for
the analysand’s uncontainable emotions. Although these roles overlap,
there are important distinctions between them. The holding object can
be thought of as a “background object” or “presence” (Grotstein, 1981a,
2000)—the sort of thing that happens in figure–ground perspectives.
The sole purpose of the holding object2 is to foster and facilitate the
development and maturation of the infant’s (analysand’s) self. What
characterizes these objects is their function for the infant or analysand
without the mother, or the analyst, being important as individuals
in their own right. They are facilitating (part-)objects whose task is
to foster the growth and development of the independent autonomy
of the infant or analysand, according to Winnicott. One might refer
to this facilitation as part of the mother’s or analyst’s attachment and
bonding process with the infant or analysand either prior to or simulta-
neously with their becoming containers—that is, “weaning”, “separat-
ing”. Ferro’s (2002a, 2006) technique in technical attachment during a
session is to use “story-telling”: with vulnerable patients, rather than

interpreting transference themes immediately, he lets them linger for
a while on manifest-content themes, and he joins in elaborating the
theme as a story.
My own suggestion is that, as the analyst listens to a patient, he
should respect his conscious—known or unknown—narratives and try
to put himself into the patient’s shoes, so to speak. That place is, after
all, where the patient is “consciously” located. Then, at the appropriate
clinical moment, the analyst may say: “What you say may be true, and it
is important, but at the same time and on another level I believe . . .”
The Kleinian ↔ Contemporary (“Post”-)Kleinian ↔ Bionian ana-
lyst may initially join the patient in discussing he dynamic, emotional
aspects of the latter’s experiences with external (“whole”) objects, but
all the while he is doing that he must keep in mind that the objects
mentioned are only displacements—projective identifications—from
the patient’s internal world. In the final analysis these objects are but
“players” chosen by the “casting director” of the unconscious to play
out certain needs or conflicts that need to be analysed. Dealing with
these objects as real may be part of the initial phase of the session in
which the analyst feels justified in conducting obligatory psychotherapy
prior to doing formal analysis with them.
In Kleinian/Bionian analysis the analyst is now generally consid-
ered as a container–object: one whose activity is metaphorically in front
of the analysand, who is the obvious object of need and desire, and
whose purpose is to calibrate the analysand’s emotional development
in terms of the way the latter uses—or misuses—the object. One can
effectively condense virtually all of Kleinian theory in the following
apothegm: “One becomes what one believes one has done to one’s objects.”
From this perspective the roles of appreciation of and gratitude to-
wards one’s objects, as contrasted with one’s greedy, envious, and
hateful attacks against them, become fatefully defining.
“Abandon memory and desire”

What does Bion’s injunction require of the analyst? I believe that it re-
quires him to become a virtual “exorcist” for the analysand by “becom-
ing” his symptom (beta-elements)—by absorbing them and partially
identifying with them as his own—in fact, resonating with them from
within himself. In so-called “interpersonal” or “intersubjective projec-
tive identification”, which I term “projective transidentification”, the
subject never projects into the object, only into his image of the object.
When the object actually becomes affected, it is because the subject
has additionally subtly evoked, provoked, or “primed” the object to
experience what was already latent and dormant within the latter.
Thus, the analyst is required to become an active participant—another
actor in the analytic passion play, if you will—and participate in the
analysand’s suffering. Following Bion, Ogden (1994) conceived of a
variation on this theme in which he first thought of the concept of a
“third subject of analysis”—the analytic relationship itself—and then
the “subjugating third subject of analysis”, a projected conflation of the
subjectivities of analyst and analysand that is now alien to and uncon-
sciously controlling of each. I consider this concept a very valuable and
useful analytic instrument.
In my own work I closely approximate Ogden’s ideas, but with
some differences, as I propose the concept of a “dramaturge” (the
producer and director of the psychic play), a numinous psychic pres-
ence situated solely within the analysand who directs the phantasmal
actions of the analytic passion play (Grotstein, 2000). Normally, the
analysand’s dramaturge asserts hegemony and directs the play. In the
instance of a countertransference neurosis, one may find that the ana-
lyst’s own dramaturge—the “dreamer who dreams the dream”, the
“dreamer who understands the dream”, and the “dreamer who makes
the dream understandable” (Grotstein, 1981b, 2000)—is active.
“Right-hemisphere” processing (reverie),

“left-hemisphere” processing (tracking), “combined
hemisphere” (stereoscopic) synthesis (reconciliation)
Text versus process monitoring in the analytic session
The methodological rationale for distinguishing between the “left-hemi-
spheric” and “right-hemispheric approach” (my terms) is as follows:
the former technique involves “parsing” (as in grammar) or tracking
the text of the analytic session—that is, the sequence of associations and
their relationship to each other. The latter technique presupposes the
analyst’s intuitive understanding of the transference ↔ countertrans-
ference ↔ reverie process of the session. The arrival of the experience of
the “selected fact” (indication of coherence in the analysand’s associa-
tions) in the analyst’s reverie signals the union of the two approaches
in the form of a more “stereoscopic” interpretation.
Interhemispheric tracking
I have referred to two major forms of analytic data-processing: one
in which the analyst listens to his analysand with evenly hovering
attention while in a state of reverie—with consummate patience until
the seemingly random or disconnected associations settle into a recog-

nizable configuration to constitute what Bion (1962b), after Poincaré
(1963) terms the “selected fact” (pp. 67, 72)—that is, a recognizable and
meaningful pattern. This might be termed “right-hemispheric process-
ing”. The other is the traditional left-hemispheric, Cartesian mode of
“minding the thoughts”—that is, focusing on them. In the first mode the
analyst enters into a preparatory state of reverie in anticipation of what
is to emerge from within him that matches up with what the analysand
is experiencing. As mentioned earlier, the analyst must listen without
memory (of previous sessions3) or desire (to make progress with the
patient or to cure him). In other words, the analyst must descend into
a state of meditative reverie and observe himself listening to himself
listening to the analysand (Bion, personal communication, 1974). What
this means is that the unconscious, like the right cerebral hemisphere
with which it is associated, functions non-linearly—that is, chaotically,
and synchronically (all associations occurring at the same time, as
in dreams)—and is field-dependent. The analysand’s associations are
uttered linearly, but their meanings are still encoded synchronically
until translated by interpretations into linear narrative. In the right-
hemispheric mode of listening the analyst listens to the synchronically
produced associations but, after experiencing the selected fact, switches
to a linear way of processing or translating what he has experienced.
Left-hemisphere monitoring: attention to the text

In the left-hemispheric mode, on the other hand, the analyst linearly
processes each association as it emerges sequentially, paying close at-
tention to the links between successive associations. One may see this
process as being similar to the parsing of sentences in grammar. The
melody of meaning occurs in the space (the links) between the notes of
the melody, according to Poincaré. What I recommend is more specific:
that all the while the analyst is processing his analysand’s associa-
tions from the right-hemispheric perspective, he should also conduct
a silent running monologue with himself in which he does his best to
process each association and its antecedent and succeeding links by
freely engaging in “imaginative conjectures” (Bion, 1980, p. 24) about
them. At first one’s silent associations may seem wild, but, as the
analysand continues to associate, the analyst’s “wild thoughts” (Bion,
1997; López-Corvo, 2006) become more and more shaped and pruned
by the analysand’s associations, and a harmony or resonance between
them begins to develop. In effect, one is creating a “speculative tree of
inference”. Ultimately, the analyst will experience a sense of conviction
about the truth of what he is hearing that resonates with what he is

feeling, and an interpretation may then be given.
The tasks of the listening stances are as follows: in the left-hemi-
spheric approach (tracking of the succession of the associations) the
analyst seeks to understand how each association carries the theme of
the previous association(s) and continues as a transformation in the
following association, ad infinitum. When the analyst becomes puzzled
by any new associational trend, he must first review all the previous
associations to find the thread of thematic continuity. In the right-
hemispheric stance (state of reverie) the analyst anticipates becoming
“impregnated” with elements of the analysand’s unconscious theme
(the “analytic object”). The results of this anticipation may be either
(a) themes that the patient is unconsciously transmitting to the ana-
lyst’s unconscious (Schore, 2003a, pp. 58–63) and/or (b) unconscious
or even conscious pressure that the analysand imposes on the analyst
to gratify his wishes for an enactment (Hargreaves & Varchevker, 2004).
Ogden (1994) designates the “subjugating third subject of analysis”
as the instigator of this function, which occupies the third subjective
space (potential space) of the analytic dyad and is common to both
analysand and analyst. Ogden terms this subjectivity as subjugating
because it seems to dominate, direct, and control the subjectivities of
both analysand and analyst.
My own view is close to Ogden’s. I think this “subjugating” function
belongs to the “director of the analytic passion play”—the one located
within the analysand’s unconscious. This “director, producer, and/
or playwright” is synonymous with the concept of the “dramaturge”
(Greek: “architect of the drama”) and is subsumed under the concepts
of the “ineffable subject of the unconscious” and/or the “dreamer who
dreams the dream (Grotstein, 1981b, 2000). Moreover, if we consider Bi-
on’s (1962a, 1962b) concept of “container/contained” as being situated
within the infant (analysand) as well as the mother (analyst), we might
say that container/contained acts as a sender as well as a receiver and
qualifies as a suitable alternative for this so-called subjugating role. I
personally prefer the concept of the “dramaturge” because it suits the
idea that the psychoanalytic process is essentially a passion play and
that all the internal and external objects that participate in the play’s
unfolding are actors in repertory whose actions are so conceived that
they reveal the hidden order of the unconscious theme of the moment
for clarification. “The play’s the thing wherein I’ll catch the conscience
of the king” (Hamlet).
One can envision the process as if the subjugating third or the dram-
aturge is a virtual presence or intelligence (homunculus or demon)
either within the analysand (dramaturge) or within the third subject of

analysis, which embraces both participants as a single virtual subjectiv-
ity. This virtual presence or demon (in the sense of a numinous and
ineffable intelligence, a Kantian primary category) directs the analytic
passion play by performing as if it were a ventriloquist and/or pup-
peteer who manipulates and projects its thematics into each participant
and directs them to enact the theme hidden within the analysand—the
theme that is most pressing and needs to be understood. It is not un-
like the game of charades in which the analysand gestures in language
(manifest content) as well as recruits the analyst first to enact and then
to understand what is being gestured.
The ideas I have just expressed belong to my belief, already alluded
to earlier, that the psychoanalytic session constitutes a theatrical pas-
sion play as well as a generator (broadcaster) of emotional information
that has to be played out in narrative themes (Ferro, 2006) in order to
become apprehended and realized.
Having stated the above, it is clear that I am recommending a para-
dox: that the analyst should “read” the analysand’s associations as a
text with his left-hemispheric mode of comprehension while listening
to the associations with his right-hemispheric mode of understand-
ing—all the while closely following the affective shifts—and then syn-
thesizing all the above! I further recommend that the analyst, in his
training, become so schooled and disciplined in “reading” the text that
ultimately he will be able to do it naturally and will, consequently, not
feel overwhelmed by the need to perform both tasks. Like the tennis
player who needs to hit 2,500 consecutive backhand strokes before he
can take his backhand stroke for granted and not have to be conscious
of it, so, I believe, does the therapist need to practise “reading the text”.
It has been my experience both as a therapist and personally that tak-
ing Freud’s and Bion’s recommendations prematurely at the expense
of not paying due diligence to the “reading” puts therapist and analyst
at risk of making wild, factitiously “intuitive” interpretations. Britton
and Steiner (1994) discuss this phenomenon in their paper, “Intuition
or Over-Valued Ideas”.
In support of my “binocular” or dual-track recommendation, let
me cite Bion (1992):
Freud had described the value of a state he calls benevolent neu-
trality, a kind of free-floating attention. Poincaré4 would appear to
desiderate an absorption in logical mental processes that, if not in
themselves mathematical, at least issue ultimately in mathematical
formulation.5
For convenience, I propose to call this state, which is neither
the paranoid-schizoid position nor yet the depressive position but
something of each, the Positions. I shall further suggest that the

process of discovery or selection of the harmonizing fact or. I
should prefer to regard it, its ideational counterpart cannot be
initiated or maintained without the mobilization of the mental
process of dreaming.
It must not be supposed that I am setting this up in contrast
with, or as an alternative to, what I conceive to be the logical or
mathematical absorption that Poincaré had in mind; nor am I
suggesting that the analyst should go to sleep. But I believe that
the analyst may have to cultivate a capacity for dreaming while
awake,6 and this capacity must somehow be reconciled with what
we ordinarily conceive of as ability for logical thought of the
mathematical kind. [p. 215]
The manifest content, as it would be called if we were discussing
dreams in Freud’s terms, is a statement that . . . α-elements are
constantly conjoined; that being so, it is in every way analogous
to the selected fact, which is to display the constant conjunction of
elements characteristic of the paranoid-schizoid position, and it has
the property of showing to be related. We shall have to consider . . .
how the manifest content of a dream (a narrativised collection of
visual images) and a mathematical formulation such as an algebraic
calculus can come to be fulfilling an apparently identical function
when they are in every respect so different from each other. [p.
233]
I take the above to mean that Bion, the psychoanalytic dreamer and
psychoanalytic mathematician, recommends both techniques. Bion as
an analyst was highly disciplined. If he daydreamed during my analy-
sis, I was never aware of it. I was aware, however, of his studiously
monitoring my free associations.
The analyst’s silent monitoring of the text:

allowing a “tree of inference” to develop
Freud (1912b, pp. 111–112) suggests that the analyst should listen with
evenly hovering attention, and Bion without memory and desire. What
they mean is that the analyst should not have theoretical preconcep-
tions in mind and he should listen and observe with an open mind.
They both assume, as I mentioned above, that the analyst is already
both well trained and well analysed. I wish to underline that pre-
conception. The analyst must be so self-disciplined as well as well
trained and well analysed that he can take his training reasonably for
granted and thus be able to suspend them while processing the analy-
sand’s material. If we take Bion’s injunction, for instance, one cannot
abandon memory or desire if one has not learned what he should forget
or forego desiring.
My own recommendation involves a paradox. I advise following
Freud’s and Bion’s injunctions to listen meditatively in a state of rev-
erie but also to do just the opposite: not in terms of memory, desire,
or preconceptions, but allowing oneself to have “wild thoughts”, “im-
aginative conjectures”, which time and patience will transform into
“rational conjectures” (Bion, 1980, pp. 23–24). In other words, I rec-
ommend a dual-track, binocular listening/processing that combines
the meditative right-hemispheric approach with the left-hemispheric
approach: reverie on the part of the analyst—that is, entering a sleepy
wakeful dreaming (meditative state) so as to allow the patient’s impact
on him to evoke his (the analyst’s) own matching emotional state so as
to achieve a state of “connected reverie”—with the analyst’s focus wide
open, all the while narrowly and intently focusing on each successive
association, having the adaptive context of the session in mind (the
conditions to which the analysand’s unconscious is responding in the
text: the day residue, the status of the analytic frame) and imagina-
tively assigning transient meanings to them. In so doing the analyst
constructs an ongoing “tree of inference”.
As the analysand continues to associate, his associations will help
shape the analyst’s tree. The initial associations generally constitute the
prelude to the analytic symphony. A line of unconscious causal con-
nectedness runs, I believe, as an Ariadne’s thread through the whole
session. The analyst should ponder: (a) the syntagmatic scale (the me-
tonymic horizontal narrative scale designating sequences across time)
and (b) the paradigmatic scale (the metaphoric vertical scale of the mo-
ment referring to all the possible synchronic associations), while al-
lowing input from the right-hemispheric mode, and then let them
synthesize. It is like deciphering a code. The analyst does not have to
be concerned about being a “wild analyst”. He is not yet speaking to
the analysand. As the analyst plays with the possible meanings of the
associations as they proliferate, he is logically processing them precon-
sciously as well as consciously.
Ultimately, the moment that can be considered the arrival of the
“selected fact” will spontaneously arrive, when the yields from the two
approaches seem to converge and the analyst thereupon feels justified
by his use of “common sense” (Bion, 1962b, p. 50)—the consensus of
different vertices of observation—to offer an interpretation. This is akin
to Bion’s (1977) Grid, the polar-coordinated concept that encompasses
the progression and evolution of thoughts on the vertical axis and of
epigenesis of thinking itself (the mind that thinks the thoughts) on the
horizontal axis. Bion stated that it should not be used by the analyst
during the analytic session, only afterwards, but I believe that this
is what analysts constantly do during the session but without being
aware of it. The Grid, in my opinion, constitutes a model for nor-
mal Aristotelian thinking, or what Matte-Blanco (1988) calls “bivalent
thinking”, as opposed to “bi-logic”, which characterizes unconscious
thinking. The analyst’s “wild thoughts” constitute what Bion (1962b, p.
67) calls “definitory hypotheses”: that is, unknown elements from the
unconscious; a beta-element has been alpha-bet-ized (mentalized by
alpha-function) into an alpha-element in the analyst’s mind by having
been baptized with a name (having become a constant conjunction).
What to interpret
Generally, the analyst (psychotherapist) is silent much of the time, his
silence being part of the technique: it creates a speech vacuum that the
analysand feels compelled to fill. The analyst may intervene when he
detects inconsistencies in the narration, a rise in emotional display, or
blind spots. It has been the tradition of Kleinian analysts since Klein
herself, however, to focus on the maximum (not deepest) unconscious
anxiety, that is, the unconscious anxiety that irrupts, in my opinion,
across the System Ucs./Pcs. frontier, to be inferred or intuited by the
Kleinian analyst from the unconscious phantasies. The classical ana-
lyst, on the other hand, would await the result of irruptions across the
System Pcs./Cs. frontier. Bion (1965) reconstructs Klein’s “maximum
unconscious anxiety” as the “analytic object, O” (p. 17) and states that
it is apprehensible through “sense, myth, and passion” (1963, p. 103).
Thus, anxiety—and the defences against it—constitute the objects of
interpretation. Klein (1961) states in Narrative of a Child Analysis:
In the first of these two sessions I have clearly aimed at analysing
the conscious and unconscious anxiety. . . . This would suggest that
my first aim in analysing a child . . . is to analyse the anxieties [my
italics] that are activated. However, this needs qualification. For it
is impossible to analyse anxieties without recognizing the defences
which operate against them and which in turn must be analysed.
[pp. 26–27]
The fact that, by making unconscious material conscious through
interpretation, anxiety is somewhat diminished . . . is in keeping
with a well-established principle of technique. Nevertheless, I have
often heard doubt expressed whether it is advisable to interpret and
make manifest to children (and for that matter to adults) anxieties
of such a deep and painful nature . . .
It is in fact striking that very painful interpretations . . . could

have the effect of reviving hope and making the patient feel more
alive. My explanation for this would be that bringing up a very deep
anxiety nearer to consciousness, in itself produces relief [my italics]. [pp.
99–100]
Klein’s preference for the interpretation of anxiety

However, in reading Klein’s Narrative, one can see over and over
again that even though Klein had stated that the defences should be
analysed along with the anxieties, she seems to have highlighted the
analysis of anxieties. It is striking, too, that to Klein impulses may
themselves constitute defences against anxieties (except for the death
instinct), whereas in classical thinking defences defend generally
against the drives. Bion (1963) conflated the drives with emotions, and
the latter thereupon became the content of the repressed.
Contemporary (post-)Kleinians, however, seem to focus on the un-
conscious aspects of the transference ↔ countertransference (and, I
would add, ↔ “reverie”) situation in the “here and now” in the context
of the “whole analytic situation”.
L, H, and K versus O
Psychoanalysts of all schools have traditionally focused on the text
of the analysand’s associations. The emergence of interest in the posi-
tive as well as negative influence of countertransference ultimately led
to a change of focus to the psychoanalytic process—the ongoing imme-
diate intersubjective interaction between analysand and analyst. The
psychoanalytic text corresponds (Bion, 1962b, p. 62) to L, H, and K links
to objects. These links are emotional and thus sensory and are thereby
limited as sensory (saturated) “facts”. One observes the beginning of
this change in Bion’s contributions on container ↔ contained (Bion,
1962b) and on transformations in O (Bion, 1965, 1970). His emphasis
on the current analytic process was then taken up by Betty Joseph
(1989) and by the London post-Kleinian school generally (Hargreaves
& Varchevker, 2004).
To sum up: it is preferable, I believe, following Klein (1961), initially
to interpret anxiety (maximum unconscious) and the defences it mo-
bilized to offset it. These defences may either be impulses or defences
proper. At times—especially with analysands suffering from addiction,
perversion, or severe narcissism—it may be necessary to confront the
defences first.
Suggestions on how to interpret

The following recommendations represent my distillation of my analy-
ses with Bion and Mason, my supervisions, and my own experience as
an analyst as well as my reading from many textbooks and papers.
First of all, following Freud and Fenichel, I would say that, gener-
ally speaking, the only thing an analyst should express is his opinion
as to what the analysand may be preconsciously and consciously ex-
periencing—that is, thinking and feeling. Otherwise his own opinions
do not belong to the analysis.
My recommendations for how to interpret are the following:
A. The rules for the frame should be spelled out at the very beginning
of the analysis; the analyst, who is the guardian of the analytic
setting, must protect the frame from infractions from either partici-
pant—in other words, analyst and analysand share responsibility
for the “analytic covenant”.
B. The analyst is advised to prepare himself to direct his whole person
to the task by utilizing both “left-hemisphere” and “right-hemi-
sphere techniques” of apprehending the analysand’s associations:
his attention (attentiveness) must be broadly and narrowly focused
either simultaneously or alternately.
C. An interpretation should constitute a formal procedure that has struc-
ture and that, in light of that idea, an interpretation consists of:
(1) a search for the location of the unconscious presence of the “once-
and-forever infant-of the unconscious”, the “virtual subjective infant”
in the unconscious who experiences emotional pain and who may
have become lost within the object within himself in order to evade
the pain (this concept of the “infant” includes the possibility of the
implicit memories of actual infancy as well as those of the ongoing
infant state of mind through mature development, and it may also
include an infant state of mind that is without memory—a “born-
again infant”, if you will—who paradoxically seems to come alive
“for the first time again” each analytic session);
(2) reconstructing the unconscious phantasy that is symptomatically
operant at the clinical moment: that is, the analyst’s estimate of the
nature of the maximum (main) unconscious anxiety, O, or sense of
current endangerment;
(3) the nature of the defences and/or impulses—which are generally
defences against anxiety in their own right—that should include
unconscious motives;7
(4) the sacrifice or cost to the ego for having had to resort to those
defences in the first place.
D. While tending to all the above recommendations, the analyst must
simultaneously realize that he has become a participant in an uncon-
scious passion play in which the analysand unconsciously recruits
him to play out any of a number of themes that the patient has
unconsciously assigned to him or to become the kind of person who
would yield to the patient’s analytic and counter-analytic wishes,
most often disingenuously, to create an analytic stalemate or equi-
librium. The analyst detects this ploy through his reverie and then
pulls himself out of the play in order to interpret it.
Ferro (2009) emphasizes the clinical and theoretical importance
of the “analytic field” (Baranger & Baranger, 1961–62), a concept that
not only expresses the unity of the transferencecountertransference
[I deliberately left out the hyphen] but also transcends it as an au-
tonomous entity in its own right. I understand Ferro to be stating
the following: The analytic field is an unconscious independent
entity, one that seems to have a life of its own. As the analyst and
the analysand converse, their dialogue registers within the analytic
field and stimulates its independent activity, which is the generation
of informative and healing dream narratives (unconscious phanta-
sies?). More to the point, the optimal way the analyst addresses the
analytic field is via unsaturated (incomplete) interpretations, sailing
between the Scylla of interpreting too much and too deeply and
the Charybdis of interpreting too little. The analyst’s ultimate goal
is to “tweak” the analytic field so that it can generate the analytic
text—that is, unconscious narratives and further free associations.
It constitutes the authentic “analytic third” (Ogden, 1994).
E. In addition to the interpretation, I also recommend the use of “scroll-
ing” back in one’s mind to the beginning of the session and reciting
the sequence of the abbreviated associations silently to oneself—or
at times, when indicated, aloud to the analysand for him to hear
as well, as if he were “invited into consultation” for collaboration
on the possible meaning of the session (when this is done, either
participant may be stimulated to think of how the associations come
together and may be inspired to think of fresh ideas. It is also a way
of getting around the defences.
F. Although I believe that the analyst should seek to interpret the
analysand’s maximum unconscious anxiety first, often there are
times when he may be confronted with justifiable exceptions to this
rule. When the infantile aspect of the analysand has been virtually
“kidnapped” by a pathological organization (psychic retreat) or a
manic defence, it is important to confront the defence first so as to

allow the analysand access to the depressive position for healing
(Albert Mason, personal communication):
A 27-year-old single male analysand had long been fighting the
awareness of his dependency needs by minimizing the impor-
tance of the analysis and the analyst (me). He also treated his
relationship with his girlfriend in a similar way. He reported
an incident in which, while he was angry with her, he drove
his car, with her sitting next to him, at a dangerous speed that
frightened her.
I confronted his recklessness in the following way: “I believe
that not only were you sadistically trying to scare and dominate
A (his girlfriend), but you were also defiantly demonstrating
your contempt for me and control over me by relating the inci-
dent to me in which you were using A as a hostage to show me
how impotent I am with regard to you. But I also think that, at
the same time, you’re frightened that I won’t be able to handle
that demon in you that has control over you.”
After a few moments’ silence the analysand said: “I either
can’t stand myself or can’t stand you and A. I’m afraid of sur-
rendering. But I hear you to say that I’ve already surrendered to
my own demon.”
The “rules of engagement”:

when should the analyst intervene?
A word needs to be said on the subject of who should “have the
floor” and when: in other words, “How are the analyst and analysand
to proceed?” The analyst introduces the fundamental rule that the
analysand should say everything that comes to his mind via free as-
sociation. The analysand speaks and the analyst listens. But when should
the analyst intervene? Orthodox Freudian analysts would generally
listen quietly for most of the session and then interpret towards the
end (Greenson, in reference to his analysis with Fenichel, personal
communication). The rule they followed was only to interpret negative
transference that was being used as a resistance, not to interpret positive
transference (Fenichel, 1941). Winnicott (1969) believes that the ana-
lyst may either co-construct the analysis with the analysand (as in the
“Squiggle game”, Winnicott, 1953, 1968) or, conversely, be a silent and
supportive “facilitating” object that allows the analysand to explore his
own creativeness with as little interference as necessary on the part of
the analyst.
Bion (1997) seems to offer similar recommendations to the analyst

with regard to allowing the analysand to be able to appreciate his own
“wild thoughts”. Klein and her followers, on the other hand, conduct
the analysis along the model of an ongoing conversation between the
infantile part of the analysand’s personality and the analyst. Kleinians
interpret earlier in the session and more frequently than other analysts
largely because they value associations that are derivatives or displace-
ments of unconscious phantasies. Classical analysts, on the other hand,
seem to elect the analysand to be the “analyst” and allow him to in-
terpret his own unconscious as it becomes conscious, as facilitated by
the real analyst’s having cleared away the resistances to the expression
and free flow of the analysand’s associations. Realistically, all the above
procedures are valid, but not all the time.
“The dosage of sorrow”: issues of dosage and timing

There was a great difference between my initial training in orthodox-
classical analysis and my introduction to Kleinian/Bionian techniques.
In my former training I learned to have an almost phobic respect for
the unconscious, and I was reluctant to intervene interpretatively until
I was really sure of the accuracy of the interpretation. The operative
thinking of classical analysts was that, in effect, the analysand’s uncon-
scious was really the authentic analyst, the one who knew the truth and
who was always urgent in its need to reveal itself, whereas the analyst
of record was more of a midwife whose task it was to clear away the
analysand’s resistances and defences so that his unconscious could
speak for itself. Thus, I feel that I was trained to accept that in classi-
cal analysis the process consisted of a monitored soliloquy: I was not to
intervene precipitously and was especially to encourage the analysand
to arrive at the proper meaning of his associations after I, the analyst,
had cleared away the resistances.
In Kleinian analysis, on the other hand, I was trained to envisage
that an unconscious dialogue was taking place between an infant and
its internal mother as projected into the analyst, that the unconscious
was informative but blind—that it needed the eyes of the analyst—as
an auxiliary pair of “eyes”—to help to make things clear, that the un-
conscious was resilient and appreciated the analyst’s attempts to reach
it, that it was working overtime to produce derivatives that I as analyst
needed to attempt to meet half-way with tentative interpretations as
soundings. Thus, an outsider listening to a Kleinian analysis would
hear more “chatter” than in a classical one. Moreover, Kleinian analysts
are more grateful for what the unconscious has to offer as derivatives
and thus intervene earlier with more interpretations.
The issue of dosage (see Grotstein, 2000) follows along similar lines.
Generally speaking—and there are exceptions to this—when the un-
conscious presents a sufficient number of derivatives, the analyst is
justified in making an interpretation—and, if at all possible, it should be a
reasonably complete one! In this regard, Ferro (2005) says the following:
I am concerned . . . mainly with the qualities the other’s mind must
have: the capacity to receive, to leave in abeyance, to metabolize,
to return the elaborated product to the subject and, in particular, to
“transmit the method”. This is achieved by returning the product
in unsaturated form [my italics] and allowing the subject’s mind as it
were to learn its trade in the workshop of the other’s. [p. 16]
Ferro’s suggestion of offering an interpretation in an “unsaturated

form” seems to constitute his way of applying the “dosage of sor-
row” to the patient in proportion as the patient has the capacity to
hear it and work with it. The complete interpretation is not generally
offered. Room is left (unsaturation) for the patient to work with the
interpretation. Another way of saying this is that that Ferro is always
mindful of his estimation of the patient’s alpha-function capacity. If I
understand Ferro correctly, I have great admiration for the delicacy
of his technique. In the course of writing this present work, however,
I have strongly recommended that the analyst should, to the best of
his ability, offer a complete interpretation—one that begins with the
maximum unconscious anxiety and then continues with the defences
(including impulses) against the experience of this anxiety, followed,
if possible, by the “cost” of using those defences. The interpretation
should also include the motive for defending against anxiety in that
particular way. An interpretation that begins with the analyst’s state-
ment about the anxiety is much more credible, empathic, and sparing
than one that begins with an interpretation of the defence—and does
not compromise the integrity of the interpretation.
On the whole, I also believe in giving complete interpretations
because (a) they respect the patient and his mind, which is generating
the free association that I can interpret, and (b) by being able to give
a complete—or nearly complete—interpretation, I am creating a con-
taining atmosphere of confidence that the analysand’s experience of O
is comprehensible, thereby restoring a sense of coherence and serenity
to his mind; (c) by being able to interpret O—that is, conduct a trans-
formation of impersonal O to personal O (TO → K)—I have served as
a model for the analysand that O need not be overwhelming. I believe,
in other words, that the analyst should demonstrate the courage to
offer an interpretation when the clinical evidence is compelling and
without compromise or dilution—or unnecessary delay. On the other hand,
the analyst may properly decide to withhold interventions when he

believes that his analysand needs or desires to “play alone” with his
associative thinking and claim ownership of his imaginative creative-
ness (Winnicott, 1958). Ultimately, the complete interpretation offers
optimal containment.
Analysis as drama (passion play)

If one considers the psychoanalytic event to correspond to a dramat-
ic passion play (as I do), one arrives at a strangely different perspective
of the analytic process. I believe that when we consider what gener-
ates the energy and momentum of an analysis, we traditionally think
ultimately in terms of the instinctual drives as the prime motivators.
I have come to think of the origin of analytic motivation as deriving,
instead, from the anxiety aroused by experiencing the truth instinct or
drive (Grotstein, 2004b) and from the aesthetic organization of the mind
(Bion, 1965, p. 38). I believe, in other words, that there is a truth drive
ensemble that is associated with one’s aesthetic capacities and includes
curiosity (the “seventh servant”), which, in turn, seeks to elucidate the
truth about one’s suffering. I cannot help thinking of the relevance of
Oedipus’ relentless search for the truth behind the pollution in Thebes.
The truth drive, in my opinion, sponsors an improvisational passion
(suffering) play in which the analysand (via transference) and analyst
(via reverie and countertransference) are assigned roles to play out
(“The play’s the thing/wherein I’ll catch the conscience of the king”:
Grotstein, 2009b) (Grotstein, 1981b, 2000, 2008a, 2008b; Ogden, 1994,
p. 105). McDougall (1985) states: “Whether we will it or not, our in-
ner characters are constantly seeking a stage on which to play out our
tragedies and comedies” (p. 4).8
With this idea in mind we can now conjecture that the analysand is always
motivated to be analysed and that even when he may seem resistant, he is
dramatically demonstrating his resistance as an analytic object—hoping
that his analyst understands the seriousness of the charades of his enactments
and can decipher them meaningfully.
Conscious ↔ unconscious topographic considerations

in the analytic process
In this section I summarize Bion’s (1965, 1970, 1992) and my own
ideas about the relevance of Freud’s (1915e) considerations of mental
topography and the psychoanalytic situation. Bion believed that the
analytic object of any session is O, the symptom, the unknown. The
origin of O is twofold: (a) one aspect is represented by the sensory
stimuli of emotional experience—that is, stimuli (beta-elements) from

external reality, consciousness, which are then processed by alpha-
function and the selectively permeable contact-barrier between Sys-
tems Cs. and Ucs., finally to lodge in System Ucs. Another source lies
in the emotional stimuli (including the drives) that emerge from within
System Ucs. itself; (b) the combined sensory input from (a) evokes the
emergence of inherent pre-conceptions (Plato’s Ideal Forms, Kant’s
noumena) to incarnate the stimuli for them to become real-ized as a
personal experience.
It is my impression that Bion uses the concept of the unconscious
in three separate ways: (a) the unrepressed (collective) unconscious, the
source of Plato’s Ideal Forms and/or Kant’s noumena; (b) the dynam-
ic or repressed unconscious, the domain of unconscious memories and
phantasies; and (c) the pre-conscious, System Pcs, the seat of reverie
(unconscious wakeful thinking). These three subsystems of the un-
conscious are both opposed (but not necessarily conflictual with) and
apposed to System Cs. Bion (1962b) believed that sensory experiences
from the external world, System Cs., cross the selectively permeable
contact-barrier and end up in the dynamic or repressed unconscious
after passing through System Pcs. Stimuli (emotions and drives) from
the internal world may originate either in the unrepressed or the re-
pressed unconscious. In either case they course through the contact-
barrier (System Pcs.) for processing by alpha-function and are relocated
in the dynamic or repressed unconscious. The inherent pre-conceptions
originate in the unrepressed unconscious, course through the contact-
barrier, and end up in the repressed unconscious. Finally, it seems to
me that what Bion (1962b, p. 17) means by the contact-barrier corre-
sponds exactly to what Freud means by System Pcs. For me, System
Pcs. constitutes the “search engine” and “command control centre” for
all unconscious and conscious mental activity. It is the locale of alpha-
function and dreaming.
In the analytic session analysand and analyst converse in an invis-
ible, metaphoric “coaxial cable” model in which the text of the conver-
sation always constitutes a double entendre—that is, a conscious and a
pre-conscious text: all the while the two are speaking to one another,
they are each speaking to the other’s System Pcs., which has connec-
tions to the repressed unconscious and input from the unrepressed
unconscious. I recall the occasion when an analysand seemed puzzled
by my interpretation, and I found myself uttering, “You thought I
was speaking to you when I was really trying to engage your uncon-
scious.” It seemed to have a salutary effect. In other words, in order
for an interpretation to become effective, the analysand’s System Pcs.
must be permitted to “swallow” it so that this System can process it
and relay its felt truth to the other subsystems—and then selectively
back to System Cs.
The significance of the “selected fact”

From early on Bion (1962b, 1963, 1965, 1992) referred to the “select-
ed fact”, a concept he borrowed from the mathematician Poincaré
(1963):
I have used the term “selected fact” to describe that which the
psycho-analyst must experience in the process of synthesis. The
name of one element is used to particularize the selected fact, that
is to say the name of that element in the realization that appears to
link together elements not hitherto seen to be connected. The rep-
resentations of the selected facts may then be seen to have a similar
coherence if the appropriate representation for a number of selected
facts can be found. The selected facts, together with the selected
fact that appears to give coherence to a number of selected facts,
emerge from a psycho-analytic object or series of such objects, but
cannot be formulated in accordance with the principles governing
a scientific deductive system. Before such a system can be created
the selected facts have to be worked upon by conscious rational
processes. [Bion, 1962b, p. 87]
By selected fact I mean that by which coherence and meaning is
given to facts already known but whose relatedness has not hitherto
been seen. [1963, p. 83]
Before such a system [a scientific deductive system] can be created,
the selected facts have to be worked upon by conscious rational
processes. Only then can the representation be formulated that will
bring together the elements of coherent selected facts in a scientific
deductive system. [1962b, p. 86]
In other words, the patient’s free associations as well as his behaviour
have unconscious meaning but are presented in a disguised form. The
analyst may have to wait patiently for quite some time before he can
see the meaning behind the associations and behaviour. What he is
waiting for is his ultimate perception of the selected fact of the session,
which, according to Bion, represents the arrival of a single association
that retrospectively gives coherence, meaning, unity, and perspective to
all the preceding as well as succeeding associations and behaviour:
The selected fact is a discovery made by the patient or individual and
is the tool by which he ensures the constant progression, the very
essence of learning and therefore of growing. This is represented
by the sequence: paranoid-schizoid position, selected fact (precipi-
tating coherence of the elements of the paranoid-schizoid position)

ushering in the depressive position, which then instantaneously
reveals yet vaster areas of hitherto unrelated elements belonging to
domains of the paranoid-schizoid position which were previously
unrevealed and unsuspected-a revelation that contributes to the
depression peculiar to the depressive position. The selected fact then
is an essential element in a process of discovery. [p. 252]
The interpretation then is a word or phrase that must be an α-ele-
ment, must be interchangeable with a visual image, and must be
capable of the functions of the selected fact. To this must now be
added that it has, when it comes to any attempt to produce in psy-
cho-analysis the counterpart of reduction of a high-level hypothesis
to formulation in terms of empirically verifiable data, the resistant
qualities of a scientific deductive system in which the lowest mem-
bers in the hierarchy are statistical hypotheses. [Bion, 1992, p. 253]
Here Bion reveals an important clinical hypothesis: the selected fact
separates P-S from D (paranoid-schizoid position from the depressive
position). The patient is kept from entering the depressive position
by the barrier of his unconscious awareness of the presence of the se-
lected fact. On the other hand, when the analyst, who is in D but also
experiences being in P-S, is finally able to see the selected fact, he (the
analyst) has himself undergone an evolution from P-S to D, is thus able
to experience the emotional Truth that inheres in the selected fact, and
can then reveal it to the patient. It is my understanding that the selected
fact represents the hidden but salient or key emerging emotional theme
of the session. Bion’s thoughts on the selected fact apply to his concept
of transformation in O, empathic intuition, which occurs when the
analyst is listening via the right-hemispheric approach.
Britton and Steiner (1994) and Feldman (2007a) have studied Bi-
on’s concept of the selected fact and urge the analyst and therapist to
be careful to distinguish between a selected fact and an “overvalued
idea”. The latter may be arrived at instead of the former because of
impatience or narcissistic investment on the apart of the analyst. I
think another explanation is the ability of the patient to unconsciously
manoeuvre the analyst’s unconscious to select a decoy association and
overvalue it so as to throw him off guard. I would add another cau-
tion to those of Britton, Steiner, and Feldman—that of the undervalued
fact—that is, that the analyst may, for whatever reason, fail to note a
selected fact that is presented to him clearly enough. Yet another aspect
of the “overvalued fact” is that it may in fact be overvalued or even
undervalued because of critical impatience on the part of the analyst.
Bion (1992) seems to have anticipated Britton’s, Steiner’s, and Feld-
man’s caution, however:
It means then that in the chaos of unconnected incoherent facts I

see “the point”—the selected fact. If I am wise, I reject it and reas-
sume chaos. I select another fact, or the same one. I reject it and
reassume paranoid-schizoid position. And may not this also give
rise to situations in which the patient appears enviously to reject an
interpretation that he accepted the day before? (Melanie Klein, Envy
and Gratitude, p. 69.) That is to say that as well as envy it may be
an example of failure to return to paranoid-schizoid, and a wish to
make the analyst do so; he has to feel that the whole of the mass of
discrete objects has again lost its coherence and cohesion. [p. 186]
Bion says that “the observer must be separate from the elements that
constitute the selected fact”, yet also that the observer must “minimize
his inner tensions”—surely a cognate of “abandoning memory and de-
sire”. While he seems to suggest that the selected fact is independent of
the observer, elsewhere he seems to me to imply, though without actu-
ally saying so, that a pre-registration—that is, an inherent or acquired
pre-conception or an unconscious anticipation of the potential selected
fact—must already be dormant within the analyst’s own unconscious,
like the two (or more) scattered bits of knowledge that finally reunite
to become the symbol (as in Plato’s “Androgyne”). In other words, the
pre-conception of the selected fact exists within the analyst both as a
result of the analysand’s salient association and as an inherent and/or
an acquired pre-conception (training, life experiences), and it is ready
to incarnate its realization from its anticipated counterpart in the pa-
tient’s associations: to form a symbol—that is, conception.
The aim of Bion’s exhortation to the analyst to “abandon memory
and desire” is to help him to empty his mind of all mental encum-
brances, knowledge, theory, as well as L, H, and K so as to become
“virginally” empty and optimally receptive to the “wild thoughts”
native to his own internal repertoire of experiences or inherent pre-con-
ceptions that might resonate with what she or he is experiencing from
the patient so as to conjure up a correspondence of experiences—as
Stanislavski (1936) suggests for the training of the method actor. One
or more of these wild thoughts contains the analyst’s unconscious ver-
sion of the selected fact.
The relationship between P-S↔D and the selected fact

Bion has told us that the selected fact stands between P-S and D. In
other words, once the selected fact has become selected and known by
the analyst, he experiences himself undergoing an evolution from P-S
to D. This means that it is now safe to be in D because the unknown
impediment that was anxiety-evoking enough to warrant being in P-S
(splitting, projective identification, idealization, and magic omnipotent

denial) now feels contained by the newfound coherence that the revela-
tion of the selected fact affords. The analyst, via his reverie and use of
alpha-function, is now able to offer this transforming interpretation to
the analysand to enable him to proceed from P-S to D as well.
An alternative approach to understanding the selected fact

I should like to present my own alternative conception of the selected
fact. In Bion’s conception, following that of Poincaré, the selected fact
seems to comprise a single element, which is differentiated from the
other elements and functions like a veritable “Rosetta Stone” to give
meaning and coherence to the appearance of randomness in the hith-
erto emerging associations. I myself see the progenitor and status of the
selected fact as follows: unity, coherence, and meaning are embedded in
each and every association (seen collectively), but we as analysts may
have to wait perhaps for a more saliently signifying association to be
able to see the whole picture retrospectively—an act that Freud called
“Aha Erlebnis”. In other words, coherence or organization are from the
beginning inherent in the patient’s free associations and behaviour. I
base my ideas in this regard on complexity and chaos theory, the latter
of which offers us the concept of the “strange attractor” that organizes
chaos (Sparrow, 1986, p. 122). In other words, chaos knows its own co-
herence from the start, but mortals—that is, external observers—have
to wait until they are able to discern its pattern. If we presume that
chaos knows its own coherence from the start, then perhaps we can
invoke Bion’s (1965, 1970) theory of transformations in O, “binocular
vision” (1962b), and “reversible perspectives” (1962b, p. 2) to suggest
that, although we can never know O, O alone knows its own coher-
ence. Thus, from this perspective, the selected fact constitutes the more
salient aspect of the associational landscape but is always continuous
with and located within each of its derivatives (beta-element as well
as alpha-element).
In other words, the selected fact, in my alternative view (additional,
not instead of) is always inherent and embedded in the relationship
between each of the elements of the analysand’s free associations. The
first association is the “parent” who “gives birth” to the second, the
first and the second associations give birth to the third, and so on. In
the clinical situation, each association constitutes its own solipsistic
cosmos or universe. The analyst must put the second universe of as-
sociations together with the first to see where a key of one may fit the
lock of the other—that is, where they may credibly connect—then the
same procedure with the result and the third association, and so on. I
demonstrate this alternative manifestation of the “sequential selected

fact” in the clinical case material. In the meanwhile a brief case example
demonstrates Bion’s version:
A 42-year old single attorney who had been in analysis with me
for several years came into the consulting room one day looking
sombre and depressed, which was unusual for him when I see
him. He spoke about difficulties he was having with this business
partners, misunderstandings with his girl-friend, and conflicts with
some of his clients. While listening to him, I was ever watchful for
transference implications, but I could not find any as yet except
for the previous weekend break. During my reverie I began to feel
compassion for the analysand and also began to experience him as
a little boy who wanted me to hold him on my lap to soothe him in
his struggle with “bullies”. He ultimately mentioned in passing that
his father was coming to town for a visit. Although he reports that
he never really felt close to his mother, he almost solely relied on his
father. The mention of his father’s visit became the selected fact.
It seems to me that there are three different aspects of the analyst’s
apprehension of the selected fact:
A. Conscious, deliberate, active, and what I call a “left-cerebral-hemi-
spheric” linear, close-focused search for the selected fact: when it
seems to have arrived, select it as the relevant fact. This “fact”,
chosen with careful scrutiny, is subject to proper scepticism (Bion’s
[1977] Grid Column 2). Selected facts that are consciously chosen
are immediately subject for consideration as potentially overvalued
facts [see above]—but one should also be concerned about under-
valued facts.
B. A preconscious, passive, effortless availability to be “selected” on
the part of the selecting fact—that is, for one’s non-linear attention
to become the selected one unbidden for the revelation or emergence
of the corresponding symbolic half-piece dormant within the ana-
lyst. This form of apprehension corresponds to the right-cerebral
hemispheric form of listening. Thus, this aspect of the selected fact
selects the analyst’s attention on its own. “Wild thoughts” can never be
overvalued initially, according to Bion. Each one may be a gem in its
own right. One might call this phenomenon the “selecting fact”.
C. The harvest from both sources, now published (revealed), is then
subjected to the mental (secondary-process, alpha-function) scru-
tiny of common sense and correlation as well as processed through
the gratings of the Grid, which represents what Freud called sec-
ondary process and Bion alpha-function, for Notation, Attention,

Inquiry, and then Interpretation.
As a consequence of the above, the analyst may be impeded at any
given moment with any patient in his detection of the selected fact
because what is emanating from the patient may be, not so much an or-
chestral symphony of synchronic messages or harmonious fugues, but
a disturbing cacophony of sounds that cancel each other out, thereby
precluding the transmission of meaning or the emergence of revers-
ible perspectives that imitate but succeed in bypassing authentic com-
munication. Ogden’s (1994) “subjugating third subject” (p. 101) is a
concept that conflates the subjectivities of analysand and analyst and
then projects its unconscious influence on both. My own version of
this is the “dramaturge”—the unconscious instigator of the analytic
passion play and of its themes (Grotstein, 2000). It is fundamentally
located within the analysand’s unconscious but eventually evokes its
counterpart within the analyst, whereupon they conflate and behave as
a subjugating third subject, as Ogden suggests. Clinically, this means
that in the transference ↔ countertransference experience a defensive
or resistant sub-personality within the analysand may unconsciously
ensorcel, manipulate, or mislead the analyst to choose a “decoy” as-
sociation so as to overvalue it as if it were the authentic selected fact.
The “negative selected fact” and the aesthetic vertex

From my experiences doing supervision I have developed the no-
tion that the ability to detect the selected fact is enhanced when the
supervisee is artistic, musical, or poetic. I have also noted that artists,
musicians, and others in similar disciplines seem to have a special
ability to use and to integrate both cerebral hemispheres and become
unusually keen detectors of flaws in the Gestalt of their productions. A
musician with perfect pitch may all too easily detect flaws in the timbre
and sound of a musical note. Thus, if aesthetically gifted analysts can
more easily detect the selected fact in their analysand’s associations,
then they can also, like professional artists and musicians, detect what
I should like to call “negative selected facts”: flaws or disharmonious ele-
ments within the analysand’s text that betray disruptive or disturbing
thoughts that knock on the door of otherwise symmetrical associations.
They constitute the “fly in the ointment”.
An analysand who is a film director by profession often comments
that he has to use both hemispheres in his work. He uses a soft, wide-
angle focus on the whole movie set ambiently while simultaneously
keeping a sharp lookout for the ongoing details of the shooting of the
film, and he frequently detects oddities in the surroundings that, upon
investigation, turn out to be details that would have become important
distractions for the progress of the film. He also mentioned that he
was being interviewed on television along with other film celebrities
on a certain occasion. As he was looking out at the audience, he noted
something peculiar. He saw the face of one of the individuals in the
audience gazing in a strange way, and he made a mental note of this.
A few minutes later this individual suddenly got up from his seat and
ran menacingly towards one of the other celebrities on stage, but he
was quickly intercepted by police security. Another patient, a gifted
cellist who also has perfect musical pitch, shared with me that when
she hears a note that is off tonally, her ears become pained.
In the psychoanalytic session the negative selected fact subtly mars
the symmetry and coherence of the patient’s associations. The direc-
tor I mentioned above offered another example. While discussing his
marital life, I noted that he was rubbing his left thumb against his left
index finger. I immediately thought to myself that is was a masturba-
tory soothing ritual. We had been discussing his affairs and learned
that he had entered affairs as a distraction from the pain of empty mo-
ments—that is, the dread of boredom. He had been abused—frequently
beaten—by his mother when he was a child. He had now given up
having affairs and had become faithful to his wife. I was able to in-
terpret to him that his thumb was having a distracting—and therefore
soothing—“affair” with his index finger because of lurking terror of
aloneness that he contemplates over the weekend break.
Notes
1. Bion (1970) elsewhere recorded it as follows: “Freud said that he had to ‘blind
myself artificially to focus all the light on one dark spot’” (p. 57). I am indebted
to Michael Eigen for this reference. I believe that “beam of darkness” more closely
represents Bion’s exhortation to “abandon memory and desire”.
2. Winnicott’s “holding object” is the source of Kohut’s (1971) “mirroring”,
“idealizing”, and “twinship” “selfobjects”.
3. While memory of previous sessions is interdicted by Bion, he does “allow”
for spontaneous, unbidden irruptions of memory.
4. Poincaré (1963), a famous French mathematician, is frequently cited by Bion,
not only because of his introducing the intuitive factor into mathematical op-
erations, but also because of his contribution of the concept of the “selected fact”,
which designates the arrival of a sense of unifying certainty and coherence on the
scene of previous disorder.
5. I infer that, by “mathematical”, Bion is implying a linear, “left-hemispheric”
scientific approach to listening to the analysand. Elsewhere in his work he specifies
what this means: in part: a knowledge of the Oedipus complex (Kleinian as well
as classical Freudian versions) and Klein’s theory of the paranoid-schizoid and
depressive positions.
6. This recommendation, by contrast, represents a non-linear, intuitive approach
deprived of memory, desire, or preconceptions (including theory).
7. It is my impression, speaking from the Kleinian/Bionian perspective, that
impulses, which are revelations of unconscious intentionality, that are reported or
detected during the analytic session almost invariably constitute defences against
anxieties emerging either from the paranoid-schizoid or the depressive position—as
opposed to extra-analytic life, when impulses can be spontaneous. Analysis, we
must remember, is like a poultice that draws the purulence of unconscious anxiety
to the surface for expression.
8. I am indebted to Gemma Corradi Fiumara (2008, fn. 26) for this reference.
CHAPTER 5
Termination
M
uch has been written about termination, but as I believe that
the jury is still out on the criteria that would justify this event,
I refrain from examining the literature on the subject. I draw
upon my own recent psychoanalytic experiences in terminating four
analyses and from other experiences in bringing analyses to termina-
tion with supervised cases. There are many factors to be considered. I
wonder, first of all, what the ratio is between the number of analysands
who have gone through formal termination and those who began anal-
yses and interrupted or terminated prematurely, and what criteria were
used in the former category. I also believe that criteria may possibly be
different in cases where it is psychoanalysts and psychotherapists who
are in analysis. They are mandated to enter and then re-enter analysis
when significant countertransference problems or blind spots develop
in the treatment of their own patients.
Most of the analyses that I am familiar with that have been formally
terminated showed the following characteristics:
A. The analysand had significantly progressed from the hegemony
of the paranoid-schizoid to that of the depressive position—mean-
ing that he used schizoid mechanisms—splitting, projective iden-
tification, denial, idealization—and manic and obsessive defences
less and was more prone to being introspective with regard to his
internal world, had assumed more of a sense of responsibility for
himself, and had achieved a sense of individuation of self along with
60
TERMINATION 61
separation from objects. The assumption of healthy boundaries is

another way of saying the above.
B. The analytic themes had become more and more repetitive and the
themes increasingly redundant.
C. As a terminating patient aptly put it: “This is my life and this is my
place in life. I must accept it as it is. My omnipotent expectations of
being great are sadly melting away. I have come to accept myself as
I am wherever that is in life’s pecking order.”
D. A diminishment of the superego taken place (Strachey, 1934). A ter-
minating patient had a dream in which a tricky policeman was chasing
him, but he, the policeman, turned out to be the murderer. This patient
also reported that he was sadly becoming more realistic about me,
that I had become demystified, which made him feel somewhat
encouraged and also disappointed. In another dream I had become a
big, friendly whale and then a smaller but helpful dolphin.
E. One of the results of a successful analysis is that the analysand has
incorporated a great deal of understanding of himself. The more
traditional way of putting this is that the analysand has introjected
his analyst. I would put it, following Bion, that the analysand has
“become” more nearly completely himself, has achieved much of his
entelechy, and has significantly evolved as a result of the impact of
the influence of the analysis and the analyst. He is then better able
to do some moderate form of self-analysis.
F. Often in the terminal phase of an analysis I have found an interest-
ing phenomenon: The patient begins to experience painful and/or
shameful memories from the remote as well as from the recent past.
We are always averse to those shameful memories that wash ashore
on the beaches of our consciousness that seem to have a homing
instinct to return to us so that we may rescue our lost, alienated
undead, alter selves from the dungeons of memory.
Careful analysis of these phenomena most often reveals that these pain-
ful or shameful memories are the insisting voices and intrusive images
of discarded self-images—split-off or even repressed—because at the
time of their occurrence the subject could not bear to be identified with
those aspects of him or herself. What seems to be stimulating this “re-
turn of the repressed” is the need to come to peace with oneself, to in-
tegrate with one’s lost parts, to reconcile with oneself, to acknowledge
that one has not become as famous as one would have wanted to be,
to accept one’s final position in life’s hierarchy as the fulfilment of his
moira—and display a kinder mien towards the ever-flowing pageant
of painful—as well as fulfilling—memories.
The question often arises as to whether the analysand (patient)

and the analyst can, some time after termination, enter into a social
or collegial relationship. My own experience is that, whereas transfer-
ence may be lessened during termination, it never ceases. It is always
operant. The issue is whether or not the analyst should hold himself in
abeyance in preparation for the possibility for the analysand’s return
in the future. Training analyses of psychoanalytic candidates squarely
confront this issue because of the closeness of the relationships in an
analytic society/institute and the inevitability of enforced familiarity
between analysand and analyst. Ideally, however, I believe that an
analyst is best advised to hold himself in abeyance—and/or refer his
former analysand who happens to return for analysis to a colleague.
Brief clinical case example

RW, a man now in middle age, had been in analysis for 15 years. He
first entered analysis for intimacy issues with women. After many
years of working on this issue we were finally able to confront the
emotional claustrophobic anxiety he experiences with women by
forging a constant conjunction (Bion, 1967b, p. 148) between the
impulsivity of his archaic dependency needs and his fear of being
emotionally suffocated once he got close to them. Upon accepting
this realization he was able to marry a woman whom he was able
successfully to love and continue to love. The analysis dealt with in-
numerable themes, many of them around his all-too-close closeness
with his mother and distance from his father. Although closer to his
mother, he was ambivalent towards her because she had returned
to work as a salesperson in a department store when he was four
months old, leaving him with nannies, one of whom abused him
sexually when he was two years old or perhaps even earlier. A
second constant conjunction was then made between his clinging
dependency towards objects that were always leaving him.
The analysand was a screen writer by profession and demon-
strated many of the same anxieties mentioned above when he was
at work. Gradually these, too, were worked through. During the
progress of the analysis he grew more mature in his relationships,
more forthright in his personality, and more appreciative of his
wife, children, and the analysis, as well as the analyst. In the final
year of his analysis he had the following dream:
I was a young child riding in the back seat of an old automobile. There
were two other persons (a man and a woman) in the car also, but I was
somehow driving the car from the back seat because my hands somehow
TERMINATION 63
were on the steering wheel. After driving for a while, we came to a tunnel
that we’d have to drive through. I became very frightened. I was afraid to
continue. Suddenly, without my realizing it, we were in the tunnel, and
even though I was anxious, I seemed to be O.K. Finally we came to the
end of the tunnel and were continuing to drive on the road, but I suddenly
realized I was a grown-up and was the only one driving. My anxiety had
begun to diminish. As I continued, I looked around at the landscape. It
reminded me of K, where I was born and raised. I felt homesick for my
old home. As I continued to glance at the landscape, something strange
happened! I suddenly began to feel that the landscape was turning flat,
two-dimensional, and then I saw a border a around it. Beyond the border
on my left side, I saw an audience of people watching me.
The analysand associated as follows:
The dream was a scary one at first but somehow I got used to
it and felt better. I was frightened when I saw myself as a kid driv-
ing an automobile and then coming to a tunnel. I wondered when
I awoke if I wasn’t meeting up again with my old claustrophobic
anxiety. I didn’t recognize the man and woman in the car. I almost
wept when I saw what I thought was my old neighbourhood in
K.
My interpretation was: Your driving the automobile from the
back seat as a child makes me wonder if that wasn’t a way of talk-
ing about the beginning of your analysis when you were so anxious
that you were reduced to using omnipotence1 to pretend you were
“auto-nomous”. The man and woman in the automobile may have
been your mother and father in your infancy and childhood and I
as your mother and father in the transference. You were driving the
course of your analysis from the beginning to what you have reason
to believe is its end. The tunnel may—you’re right—represent your
erstwhile claustrophobic anxiety and may have constituted a test to
see if you have mastered it. The visualization of your old K land-
scape seems to have been a brief sentimental journey, with grati-
tude and longing, to your old home, maybe even the womb—if not
the breast and your father all combined—to retrace your steps to
maturity from the beginning but in a new and more solid way. The
landscape turning into a backdrop for a theatre or screen perform-
ance makes me think of the scene in The Wizard of Oz when Dorothy
sees the magician’s shoes underneath the curtain, thus ending her
fairy story of Oz. In other words you, like her, have emerged from
the phantasy and become real. There is a further point. The analysis
can be thought of as a sacred play that has to be played out so that
your inner world can reveal your issues—as a play. Finally, I have
reason to believe that you think that this is a dream that heralds a
confident termination.2
The analysand first wept, then was silent for a while, and then
said: “You mean you’re going to let me go? I’m scared and ecstatic
at the same time.”
Note
1. When I was in analysis with Bion, he frequently interpreted that I was “re-
duced to omnipotence”, to get across to me that it was a desperate defence against
my anxious helplessness.
2. A monograph on analytic termination has been published just as this vol-
ume goes to press. I find it quite useful for understanding the termination process
(Fosshage & Hershberg, 2009).
CHAPTER 6
The psychoanalytic treatment

of psychotic and borderline states
and other primitive mental disorders
T
he analytic treatment of psychotic states has an illustrious but
brief history, brief because of new understandings about schizo-
phrenia, manic-depressive illness (currently known as “bipolar
illness”), and borderline conditions, and brief also because of the rise of
psychopharmacology. I should like to preface my discussion with what
I believe is the key importance of differentiating clinical states from
personality traits. The latter are generally untreatable by medications
and are thus, in my opinion, approachable only by psychotherapy,
especially psychoanalytically informed psychotherapy. The latter may
also, however, be able to complement pharmacotherapy for psychotic
or other primitive affect states.
The pioneers in the psychoanalytic treatment of psychotics and
borderline patients include Harry Stack Sullivan, Harold Searles, Peter
Giovacchini, L. Bryce Boyer, Frieda Fromm-Reichmann, Hanna Segal,
Herbert Rosenfeld, Wilfred Bion, Otto Kernberg, Peter Fonagy, Mary
Target, and many others. Rather than extensively reviewing the count-
less contributions on this subject, I merely summarize some guidelines
for the treatment of these disorders.
First, however, I should call attention to a landmark contribution
to the concept of the psychoanalytic treatment of schizophrenia by
an admirable proponent of it. In The Center Cannot Hold, a success-
fully treated schizophrenic patient, Elyn Saks, who is a psychoanalyst,
65
professor of Law, and adjunct professor of psychiatry at the University

of Southern California, poignantly describes her journey through mad-
ness and her rescue by psychoanalytic treatment (Saks, 2007; see also
Garfield & Mackler, 2009).
Regression and the contact barrier

Whereas higher-functioning patients tend to regress in the service of
the ego (Kris, 1950), patients suffering from primitive mental disor-
ders seem prone to experiencing precipitous and cataclysmic regres-
sion, often resulting in a transference psychosis or even a delusional
transference. The Ariadne’s thread that seems to me to run through
the psychopathology of psychoses and the primitive mental disorders
generally is the failure of these patients to have developed a competent
contact-barrier (Bion, 1962b, p. 17), the selectively permeable membrane
that separates Systems Cs and Ucs and mediates the transfer of emo-
tional information between the two systems so that the subject can be
able to differentiate between sleep and wakefulness and the inside of
the mind from the outside world. These distinctions are vital for the
subject’s capacity to contain (Bion, 1962b, p. 88) his thoughts so that he
can think them and think about (reflecting on) them. The contact-barrier
also mediates the descent of the analytic regression—that is, an orderly
one (in the service of the ego) rather than precipitous and chaotic or
cataclysmic.
Notes on the aetiology and course of illness

The main aetiological factors behind these disorders are:
A. Patients’ inability to tolerate frustration and thus their inability to keep
their minds open and active in the absence of the object, in contrast
to closing their mind with concrete transformations of the object to
fill holes of intolerable emptiness.
B. Their inability to tolerate frustration may, in turn, be due to insuf-
ficient tolerance of their affect display as infants by mothers who
could not be able containers, which is also a way of saying that they
were subject to disorganizing attachment to their objects.
C. As a result of the preceding the potential patient, hounded by an
obstructive object or “super”ego (Bion, 1962b, p. 97), is forced to
use excessive splitting as well as excessive projective identification to
attempt to rid himself of intolerable anxiety.
D. As a result of the excessive splitting and projective identification
PSYCHOTIC AND BORDERLINE STATES 67
the patient is compelled not only to split off and project his emo-
tions, impulses, internal objects, and so on, but also the mind itself,
the result of which is the formation of bizarre objects, which then
agglomerate and surround the hapless patient as a beta-screen Bion,
1962b, p. 23), often persecuting him in the form of hallucinations.
The beta-screen, I hypothesize, is the psychotic equivalent of the
psychic retreat (Brown, 2006; Grotstein, 2007; Steiner, 1993). The
activity of this beta-screen perpetuates psychoanalytic stalemates
in the form of the negative therapeutic reaction.
E. The activity of the obstructive object (“super”ego) attacks the sub-
ject’s links with good, helpful objects, thereby preventing him from
internalizing the good objects for mental growth and impeding on
his capacity to learn from experience (think). Furthermore, Bion (1965)
asserts that in the case of the infant who is fated to become psychotic
the “super”ego develops before the ego, and when the ego does
emerge, it is tyrannized by the “super”ego.
F. As a consequence of the above the patient is, by default, compelled
to mobilize his death instinct to attack his remaining contact with
objects because of the pain of their being tantalizing reminders of
necessary and desirable objects that he cannot internalize or me-
tabolize.
G. Patients suffering from severe primitive mental disorders, especially
psychotic patients, may operate from at least two differing aspects of
the psyche—a psychotic and a non-psychotic personality—a situation
that is generally characterized by an effective dissociation between
the two (Bion, 1967a). This is of importance therapeutically because
(a) the analyst or therapist may be treating the patient as if he were
neurotic (non-psychotic), only to find later that this personality
screened a deeper, psychotic personality, and (b) the analyst or
therapist may realize that he is treating a psychotic personality,
only to find that the psychotic self screens a more normal, neurotic
personality that tries to become therapeutically engaged.
H. The clinical course of the psychotic patient may begin with acute
confusional agitation and then gradually become reorganized in a
pathological way (Freud, 1911c). Bion (1962b) refers to this patholog-
ical reorganization as “alpha-function in reverse”, which designates
“method in the patient’s madness”. When the beta-screen organiza-
tion acquires alpha-function in reverse, the resistance capacity of the
patient becomes formidable and redoubtable.
I. Bion (1967a) speaks about the phenomenon of “reversible perspec-
tives” in psychotics. This is a special kind of resistance in which
the patient seems to be listening to the analyst’s interventions but

actually shifts the context of the intervention. Bion uses the example
of a figure of a vase in which a reversible perspective would reveal
two faces confronting each other. What this manoeuvre implies is
that the patient has switched the background or backdrop context
of the communication to avoid the impact of the foreground mean-
ing. The following example demonstrates this idea: I interpreted to
a (psychotic) patient that he was anxious about my being absent
during a forthcoming holiday and may be demonstrating this by
his feeling of apathy. He replied that he and his family had often
gone on vacations when he was young. He kept the literalness of
the meaning of my interpretation and then reversed its context by
generalizing its background—the holiday.
J. Bion (1967a) also describes another syndrome he found in psychotic
patients, characterized by the occurrence, either together or apart,
of three factors in the patient’s clinical material: arrogance, curiosity,
and stupidity. As with the phenomenon of attacks against linking,
this syndrome occurs in psychotic patients who, as infants, had ex-
perienced an infantile catastrophe because of a mal-nurturing rearing
environment in which the mother, not able to contain (attune) her
infant’s emotional experiences, rejected them and thereby “projected
in reverse” back to her now frantic infant. Arrogance denies the
acceptance of the dependent state of normal incompleteness. The
infant’s normal curiosity has been smashed and co-opted by the
obstructive object (combination of an internalized real, hateful and
destructive whole object modified by the infant’s projection of his
hateful attacks against it, to which we also must add omnipotence).
Thus, in proportion as the infant or patient is identified to be under
the control of this malignant object, he feels stupid. In proportion
as he feels identified with this object, he feels arrogant and doesn’t
need curiosity because he is omnipotent and thus epistemologically
complete. If the analyst becomes the obstructive object in the pa-
tient’s transference, then he (the analyst) is felt to be attacking the
patient’s curiosity.
One of the manifestations of this syndrome is the often witnessed
clinical experience of the psychotic patient beginning to reconstruct
his personality after the psychotic break. Such patients seem to rally
after the acute confusional excitement of the break with reality and
form a new reality (alpha-function in reverse) and experience a sud-
den delusional certainty about the meaning of their relationships to
the world—that is, where they are the centre of interest and persecu-
tion by objects. The patient becomes ingeniously imaginative about
the conspiratorial ties between these objects. The analyst, confronted

by this sudden outbreak of delusional wisdom, tends to feel stupid,
dismayed, and overwhelmed.
K. Psychotic patients often hallucinate, usually auditorily but not in-
frequently visually. The hallucination represents the patient’s need
to evacuate sense impressions, needs, and emotions into an object
rather than accept them and seek contemplatively to transform
them—that is, denying them their capacity for realization and thus
conceptualization (Bion, 1958, 1965, p. 83). My own way of under-
standing the onset and clinical course of transformations in hallu-
cinosis is to imagine the patient, seemingly projecting, but actually
withdrawing from his ego boundary along with its sense organs
(capacity for attention), into an inner fortress (beta-screen, psychic
retreat) as a now insensate self. Yet the abandoned sense organs,
acting now like externalized internal objects in a manner one might
call déjà vu, seem omnipotently to command and control the now
destitute and imprisoned patient. In other words, the sense-organ
self that the patient had split off and abandoned has itself retained
its connection with the abandoning self (ego) and now haunts,
persecutes, and controls it.
L. Lacan (1966) speaks of the foreclosure of the “law of the father” in
psychosis, by which I believe he means that the psychotic fails
to develop and resolve his Oedipus complex from which internal
boundaries (the “law of ‘no’”—negation) emerges. The failure of the
development of boundaries predisposes the psychotic to be unable
to differentiate System Ucs from System Cs and thus at risk of mas-
sive id irruption.
M. Balestriere (2007) speaks about the importance of the development
of sensoriality and the sensory images that it inspires. These sen-
sory images or pictograms are the Anlage for the development of
representations, the content of thinking. The compromise of the
psychotic’s sensorial capacity predisposes him to have enormous
difficulty in transforming and internalizing incoming stimuli.
The use of the couch

The analyst or therapist must evaluate the use of the couch individually
for each patient. Borderline patients and especially psychotics, as well
as patients suffering from post-traumatic stress disorder, are frequently
poorly attached and tend to need to bond to the therapist with their
eyes. Others may do well on the couch.
Frequency of sessions
The prescribed frequency of sessions for these patients depends on
many factors. A paradox exists with this issue. Whereas the analyst
may require frequent sessions (ideally five times per week) to help the
patient on an ongoing basis with the analytic attunement of the latter’s
emerging emotions, he (the analyst) is also the ongoing stimulus for the
patient’s regression. The final decision as to the frequency of sessions
must consequently be made by the analyst on an individual basis—and
may change from time to time during the analysis.
Stability of caretaking environment

As any analyst or psychotherapist will surely confirm, there must be
relatively stable background support for the psychotic or borderline
patient so that the latter is not totally alone between sessions. This
background support system includes family, friends, or half-way hous-
es that specialize in the care of these patients.
Patient-centred and analyst-centred interpretations

Steiner (1993) found that analysts generally interpret what they believe
to be the patient’s inner thoughts and phantasies, but that in patients
suffering from primitive mental disorders it may be necessary to ad-
dress the patient’s belief of what the analyst was thinking. For example,
the analyst may interpret to the patient: “I think you are angry with me
for my being absent and not being available to you over the weekend”
versus: “I think that you think that I didn’t want to be here with you
over the weekend.”
The rationale behind the necessity to offer analyst-centred interpre-
tations is, in my opinion, twofold: (a) Patients with poor ego function-
ing tend to suffer from a severe imbalance in the relationship of their
superego (severe) to their ego (frail). Since transferences, whatever
comprises them otherwise, invariably constitute superego transfer-
ences, any comment or interpretation by the analyst is bound to be
misunderstood by the patient as a demeaning criticism. (b) These pa-
tients, as stated above, suffer from an impoverished ego and a lack of
good, effective, nurturing, but mainly containing internal objects. As a
result they do not possess an inner containment surface on which to
handle and manoeuvre (process, transform) incoming stimuli—that
is, interpretations. They require external objects to become their thinking
surfaces—that is, containers with alpha-function.
Brief case example

MJ was a married woman in her mid-twenties who had recent-
ly immigrated to the United States, having married an American
who lived in Los Angeles. The analysis progressed in the expected
way. She seemed to be suffering from what we would call neurotic
problems: insecurity as a foreigner, self-consciousness, and general
anxiety.
About eighteen months into the analysis, the patient appeared
in my consulting room in a state of acute confusional excite-
ment—psychotic! Her husband had suddenly left her for another
woman, and she, my patient, was now stranded and alone in a for-
eign country. This abandonment recapitulated traumatic abandon-
ment memories from her childhood. Her symptoms were so severe
that she required hospitalization. She became depersonalized and
derealized, and I had become alienated from her. I had become a
stranger she remembered she had once known. I recall giving her
the following interpretation when she complained to me about be-
ing hospitalized: “I think that you believe that I wanted to be rid
of you, so I sent you away from me to the hospital as you felt that
your father did when you were three years old and he sent you
away to your grandparents.” The patient seemed very moved and
relieved by that interpretation.
I continued the analysis during her hospital stay, but she also re-
quired a “managing psychiatrist”—who was also an analyst in his
own right—to oversee her in-hospital needs. It wasn’t long, how-
ever, before this psychiatrist became included in the transference as
a split-off aspect of me and became experienced by the patient as
an obstructive object, someone who wouldn’t let her think or act
for herself, someone who continuously interfered with her living
her life. Meanwhile, the patient became quite regressed and seemed
like a little, helpless waif. As she improved somewhat, I was at first
optimistic about her having recovered, only to learn sadly that her
“fracture had healed badly”. On one occasion she ran away from
the hospital and showed a great deal of cleverness (alpha-function
in reverse) in arranging this. She did respond to my interpreta-
tions, however, which included her disappointment in me that she
had fallen apart “on my analytic watch” (I hadn’t been watching
over her closely enough) and that she was reliving her childhood
breakdown when she was taken away from her grandparents when
she was six years old (her interim “parents” because she was taken
away from her mother and father because they had divorced, and
she was resettled with her father’s parents in a distant location).
The obstructive object that beset her seemed to have originated

with her father (really, how she internalized him) because he had
been the one to cause her dislocation by divorcing her mother. I was
identified with the helpless, impotent mother who was powerless
to stop the obstructive object from making her an orphan.
When I spoke with her after she recovered, she revealed that
her normal personality had been with her throughout the psychotic
episode, was attentive to what was happening, but was powerless
to let itself become known (thanks to the obstructive object and the
beta-screen).
CHAPTER 7
Basic assumptions
of Kleinian/Bionian technique:
a recapitulation
B
efore moving on to specific clinical applications, I should like to
remind the reader of the basic assumptions that in my opinion
inform Kleinian/Bionian technique.
A. The analytic session is to be considered as equivalent to a dream.
Consequently, transference (and countertransference) is pervasive.
Furthermore, individuals mentioned in the text of the session do
not exist in their own right within the psychic reality of the analytic
session. They are signifiers or displacements for (projective iden-
tifications of) objects of the analysand’s internal world and mani-
festations of the transference, including the analysand’s conscious
and/or unconscious experiences of the analyst’s countertransfer-
ence.
B. The analysand’s free associations, while spontaneous and con-
sciously improvisational, are carefully crafted and “scripted” by
what I believe to be a numinous Intelligence within System Pcs., an
Intelligence or resident daimon, homunculus, or phantom (which
I have elsewhere called the “ineffable subject of the unconscious”
or the “dreamer who dreams the dream”—Grotstein, 2000). This
Intelligence, which represents the unconscious itself, is incomplete.
It needs the subject’s (analysand’s) consciousness (with the assist-
ance of the analyst) as a container to complete its message and
give it personal meaning—and, later, objective meaning. There also
73
exists, I believe, another unconscious Intelligence, the “unconscious

dreamer who understands the dream” or the “phenomenal dreamer
of consciousness”, the one who gives its imprimatur to the dream
and/or who affirms the correctness of the analyst’s interpretation.
C. Psychoanalysis is like a poultice that draws the purulence of emo-
tional pain to the surface for experience and expression. The pain
of the session is what Klein terms “the maximum (not necessarily
the deepest) unconscious anxiety”, or what Bion calls “the analytic
object”, O. The analyst detects the analytic object by the use of sense,
myth, and passion as triangulating vertices in his quest for the se-
lected fact, the associative key to the lock of the session’s mystery
and by detection of the selected(ing) fact. Sense corresponds to the
left-hemispheric approach—observation—with focused attention.
Myth designates the key myth and unconscious phantasy that is
operant. Passion designates both the suffering the patient is un-
dergoing unconsciously and/or consciously and the emotionally
experienced containment capacity of the analyst (right-hemispheric
approach).
D. Transference and countertransference should always be looked for
(Klein, 1961):
Views among analysts differ about the point in the transference
at which the material should be interpreted. Whereas I believe
that there should be no session without any transference inter-
pretation, my experience has shown me that it is not always at
the beginning of the interpretation that the transference should
be gone into. When the patient is deeply engrossed in his relation with
his father or mother, brother or sister, with his experiences in the past
or even in the present, it is necessary to give him every opportunity to
enlarge on these subjects. The reference to the analyst then has to come
later. On other occasions the analyst might feel that, whatever the
patient is speaking about, the whole emotional emphasis lies on
his relation to the analyst. In this case, the interpretation would
first refer to the transference. Needless to say, a transference inter-
pretation always means referring back the emotions experienced towards
the analyst to earlier objects. Otherwise it will not fulfil its purpose
sufficiently . This technique of transference interpretation was dis-
covered by Freud in the early days of psycho-analysis and retains
its full significance. The intuition of the analyst must guide him
in recognizing the transference in material in which he may not
have been mentioned directly. [p. 22, fn.; italics added]
The horizon of transference interpretation has changed immensely
since Freud’s first mention of it. Initially, transference was con-
ceived of in the one-person model. Currently, it is conceived of as
KLEINIAN/BIONIAN TECHNIQUE: A RECAPITULATION 75
inseparable from countertransference (reverie) in the two-person

model. Also, transference refers not only to the classical notion of
“displacements of past object cathexes” but also to projective iden-
tifications and projective transidentifications as well as projective
counteridentifications in the here and now. Melanie Klein conceives
of the whole session as transference, and today we would add
countertransference, as I have suggested at the beginning of this
section.
E. The movement of the content of the session proceeds both from the
paranoid-schizoid to the depressive position and the reverse, P-S ↔
D, in a forward as well as backward spiral progression.
F. But this movement from P-S to D depends on the patient’s being
able to present the selected fact and the analyst’s ability to detect it.
The selected fact first constitutes a barrier between the two positions
but, once located, opens the door between the two. Once the analyst
believes he has found the selected fact, he must then reflect upon it
so as to make sure it is not an overvalued fact—that is, a prematurely
valued fact (Britton & Steiner, 1994; Feldman, 2007a)—and he must
also be on the lookout for a tendency to undervalue associative
facts.
G. The transformation of beta-elements into alpha-elements and the
progressive sophistication of the alpha-elements as they evolve
from being rudimentary, inchoate, and concrete to becoming more
and more abstract, have their converse, which I consider to be
of enormous importance: the regressive transformation of incho-
ate alpha-elements into beta-elements, or what I term “rogue” or
“discarded” alpha-elements (as in denial, splitting, and projective
identification).
H. The analyst is faced with the constant detection of the emergence
of sub-personalities both within the patient and within himself and
also—generally within the reverie/countertransference—of varying
kinds of pressures for role enactments the patient is projecting into
or upon the analyst.
I. The analyst needs to search for the selected fact that reveals the co-
herence and meaning behind the associations and either designates
a single association that gives coherence to all the other associations
(Bion’s view) and/or functions as the common denominator, the
“Ariadne’s thread” that runs through each individual association
to render them into a necklace of meaning.
J. Ideally the analyst should remain watchful for the presence of mys-
tery—that is, the ever-present unexpected aspects of the session. He
should give complete interpretations when possible, which should

generally—though not always—address the analysand’s anxiety
first of all. The analyst should not be predictable or prosaic or fall
back on clichés—such as the weekend or vacation (holiday) breaks.
Bion advises us that ultimately we may never know the source of
the analysand’s anxiety. It is not to be known. It is O. The analysand
can only “become” what he may never really know, O. The best one
can hope for, according to Bion, is to achieve an approximation of
the source (K) and be relieved at what it is not—the effect of nega-
tion [Column 2 of the Grid] as rescuing meaning from the void of
infinity, O.
K. A fundamental hidden assumption of Kleinian technique is the
focus on psychic reality: that is, that the psychoanalytic text is a
solipsistic one in which the analysand is indirectly reminded that the
events of his life, though of the utmost importance in his formation,
play a secondary role to the consideration of how he experienced the
event in his internal world—a concept that predicates his sense of
psychic responsibility for his experiencing of his experiences.
L. Kleinian theory and technique have, from the beginning, empha-
sized the prime, organizing importance of the death instinct and its
manifestation as destructiveness and then eventually as the source
of anxiety: in other words, the infant is anxious by virtue of its
attempt to deal with the irruptions of its death instinct. I do not
disavow the importance of the death instinct, but I question the way
Kleinians traditionally view it. First of all, the death instinct does
not “think” or act peremptorily. If the infant feels himself to be in
a state of unbearable terror, his death instinct may be summoned,
as a function of the principle of conatus, to attack his attachment to
what are felt to be endangering objects or endangering associative
thoughts or emotions. This is an adaptive function, though it may
turn out to become maladaptive.
Conatus is the organizing principle that seeks to guarantee
the survival of the subject’s sense of identity and selfhood when
undergoing “catastrophic change” (Bion, 1970). I consider many of
the properties that have been assigned to the death instinct to have
turned out to be misguided attempts for the subject to deal with
the ever-changing terms that fate presents to him for his survival.
Envy, for instance, which can be deadly and certainly has inherent
roots, has less to do with the death instinct than with a possible
perversion of the life instinct (“I cannot live with myself in the
presence of mother because the goodness of her breasts reminds me
of my littleness, helplessness, incompleteness, and abject depend-
KLEINIAN/BIONIAN TECHNIQUE: A RECAPITULATION 77
ency; I want to level the playing field by pretending that she isn’t so
good or so important, so that I can avoid shame and humiliation”).
Secondly, since Bion’s (1965, 1970) formulation of O we might say
that conatus recruits the death instinct to attack or to mediate the
subject’s experience of O, including the latter’s associative links.
M. Finally, I should like to say a word about the conception of the
analysand’s experience of the weekend and holiday breaks both
from the strictly Kleinian perspective and from the Bionian vertex.
Kleinian theory presupposes that as soon as the good breast–mother
(part-object) leaves the presence of the infant, the latter immediately
experiences not an absence, but the phantasy of a bad, persecuting
mother. The experience of the pure absence of the object must await
the infant’s attainment of the depressive position. The explanation
for the development of this persecutory phantasy is the infant’s
projection of his hateful feelings into his image of the good mother,
thereby transforming her good image into a bad, hateful, persecut-
ing one. I believe that this formulation is a valid one. An alternative
possibility is one that I have inferred from Bion’s conception of
O: Put succinctly, when the good breast–mother leaves, the infant
may suddenly or gradually experience the dread of impending O.
Not having mother there for the moment as a container, the initial
void he experiences is quickly filled by infinity-endowed inherent
pre-conceptions of alien archetypes (“bogeymen”). When mother
returns, she “exorcises” these demons.
N. Finally, I should like to say a word about the focus of the Con-
temporary London post-Kleinians. In both Volumes One and Two
I have emphasized (my impression of) the tenets and practices of
traditional Kleinians, as well as Bionians, in order to introduce the
reader to the fundamental basis of Kleinian and Bionian thinking. I
have included many aspects of Contemporary post-Kleinian think-
ing but have not emphasized it enough to do justice to it. My pres-
ent enterprise focuses on Kleinian/Bionian thinking as a beginning.
I reserve the task of properly addressing the other for the future.
Contemporary post-Kleinian practice differs from traditional
Kleinian practice and resembles, rather, some aspects of Bionian
thinking by its change of focus from its consideration of the analytic
dialogue as text to one of process in the here and now. While they
do not interdict analytic reconstruction, they are more focused on
how the past plays out in the here and now. Their interpretations
tend be less on infantile part-object relations and more on cur-
rent emotional processes. Another difference is the consideration
that transference and countertransference are indissolubly linked,
as well as their conception that the analytic session constitutes an

unconscious force field in which the analysand seeks to importune
the analyst in a number of ways, often disingenuous, so as to subtly
arrest the progress of the analysis.
PART II
CASE PRESENTATIONS
Introduction
The clinical case material that follows is not presented using the nar-
rative approach, where the case is presented over time, giving the
background history and discursive comments about the analysand
and his relationship with current whole objects—that is, the con-
ventional psychodynamic point of view. Instead, I follow Bion’s in-
junction (a) to ignore—actually, suspend for the moment—any active
remembering of the analysand’s past history or current relationships,
while nevertheless allowing the spontaneous emergence of past or cur-
rent remembrance; (b) to abandon—suspend—the desire to cure the
analysand or to desire progress in the analysis; (c) to abandon—sus-
pend—any preconceptions that may have accrued in the analyst’s
mind either about his characterization of the analysand (i.e., “This
is the kind of patient who . . .”) or about his analytic background in
analytic theory; and (d) to avoid the temptation to “understand” the
analysand, because the very act of understanding categorizes the anal-
ysand as a characterization, an image or icon; while this may sym-
bolically represent the analysand as an image, it absolutely evades the
living being who is always in a state of unpredictable flux and who,
in the final analysis, always remains extraterritorial to categorization
or characterization—static nouns that cannot reveal ongoing being in
constant transition.
81
Consequently, the clinical case material is presented as detailed pro-
cess notes from clinical sessions in order to convey the impression
that this is the first analytic session again paradoxically—not unlike
a “rebirth”—of the analysis, and that thus the session is ahistorical.
The reader is invited to join the analyst in a “wilderness training ex-
ercise”, without the traditional guidelines and having to depend on
observation and intuition—the voice inspired by faith and discipline
(the ability to tolerate frustration), until the selected fact of the ses-
sion becomes revealed, giving coherence to hitherto scattered asso-
ciations. Intuition is akin to a “global positioning satellite” that is
unconsciously responsive to hidden cues. Past history of immediate
relevance is presented at the proper moment as the session unfolds.
82
CHAPTER 8
Clinical example 1
I
have previously dealt with some of the significant extensions that
Bion has added to Kleinian as well as Freudian theory and tech-
nique. In what follows, when I present my own work and those of
colleagues and supervisees, the reader may see the traditional Klein-
ian influence but wonder where Bion—or, for that matter, the London
Contemporary (post)-Kleinian influence—may be. They are there, to
be sure, but I on the basis of personal experience strongly believe that
analysts and psychotherapists who are not well trained and disciplined
in the Kleinian → Contemporary (post-)Kleinian → Bionian oeuvre do
well to master the “Kleinian basics” before immersing themselves in
their later, more sophisticated techniques. (I have it in mind to follow
this present work with another that will focus on these techniques.)
However, in terms of technique, Bion’s main influence on me is
in his right-hemispheric listening approach: container, reverie, alpha-
function, wakeful dreaming. His other influences may go unnoticed:
the suspension of memory, desire, preconceptions, and understanding
(categorization: “this is the kind of patient who . . . ”). Ultimately, Bion
is the silent analytic coach on my shoulder, ever alerting me to be
available for the unexpected, to respect the mystery that is buried in
the obvious aspects of the session. In other words, to be “Bionic” (he
would have hated that term) is to keep him in mind while listening to
the patient.—NO! Don’t look for him. Allow him to incarnate you!
83
Clinical presentation:
Case 1 (predominantly in the classical Kleinian mode)
I state “predominantly in the classical Kleinian mode” because this first

analysis took place many years ago, in the early stages of my Kleinian
orientation and thus before I was able to “translate” what I had gleaned
from my analysis with Bion and before I became aware of the contem-
porary post-Kleinian change of emphasis in technique.
Before presenting the case, I give the adaptive context of the session.
This invaluable concept, which Langs (1967a, 1976b) introduced into
the psychotherapy literature, basically refers to all the “atmospher-
ics” of the treatment situation that constitute defining and organizing
contexts to which the analysand’s unconscious must adapt. Its older
name is the “day residue”. The subsequent analytic text reflects these
adaptations. Typical examples of adaptive contexts are analytic frame
issues such as cancellations, vacation or holiday breaks, third-party
payments, or any major upheaval in the analysand’s current life (or
perception of the analyst’s life) to which the analysand’s unconscious
might be adapting/adjusting. It also includes unfinished or yet unproc-
essed analytic themes from the immediately preceding sessions.
I present two consecutive sessions—a Monday and a succeeding
Tuesday session—and then a Thursday session from the following
week.
Monday session
ADAPTIVE CONTEXT: This analysand is being seen five times per week.
I had been gone for a planned absence for the previous Thursday and
Friday.
Analysand: Were you out of town? We were out of town too over the
weekend. We were visiting V and her new husband in Arizona.
There is a scandal in the community about her. She left her hus-
band, Bert. Before I get into it, I want to tell you about a medical
dilemma that we have. A (his daughter) may possibly have chick-
enpox, or at least she was exposed to it, therefore we cannot take
our planned flight to Bermuda. Chickenpox can be a deadly threat
on airlines. They will not let a child aboard who has chickenpox,
especially with those who have immune suppressants. It’s too much
of a gamble. Also, she would have to be locked up at our port of
entry. We have therefore decided to take our vacation locally. We
decided not to risk the airplane trip. Also, we shouldn’t get stuck in
CLINICAL EXAMPLE 1 85
Bermuda if she does come down with chickenpox. It is a practical

matter. She has not yet come down with it, however. I believe it’s
a good decision not to go there. The other thing about me: because
of the rain, there has been a lot of pollen. I have hay fever and have
been coughing, and also have conjunctivitis. I have been taking
heavy doses of antihistamines. All of these medical issues seem to
be floating around us.
My reverie (“right-hemispheric processing” of the analytic process): When
the analysand asked the question about my having been out of town, I real-
ized that it was uttered in a perfunctory way: I wasn’t called on to respond,
yet I did feel a little importuned at that moment. His initial question and
subsequent associations were, however, expressed with an urgency and
rapidity in which his anxiety seemed to betray itself, and I became a little
anxious myself. I felt the presence of a pleading little boy who wanted me
to recognize him after my absence. It was as if he could not wait until I
returned from my vacation and was filling me with all his unsorted post-
poned emotions—but lovingly and respectfully as well as eagerly. I also
felt that he was hastily summarizing all the difficulties I had left him to
solve in my absence. I began to experience some guilt feelings and felt an
urgency to put things right. (I elaborate on the significance of this guilt in
my discussion.) The medical doctor in me also felt alerted. My tentative
guilt experience signalled my intuitive grasp of the selected fact, his anger
at me as well as his terror for my having abandoned him and my need as
an analytic parent to acknowledge my responsibility. I found that he was
able to communicate his anger at me by trying to control me by causing
me to feel guilty—and also the need to greet him by enthusiastically em-
bracing him.
My “tracking” the text (“left-hemispheric processing” of the analytic
text): the first association, the question of my having been out of town,
became the indicator for me of the adaptive context and implied the source
of the anxiety he was subsequently to relate. For me, it therefore became
the “selected fact” that was to help me organize and make coherent all the
subsequent associations.
“We were out of town too over the weekend” suggested to me that
he had partially alleviated his anxiety about being left by also being able
himself to leave the analysis, thereby becoming projectively identified with
me, the one who left initially, and thus being able to deny his being-left-
infantile-needy self.
“Visiting V and her new husband in Arizona” suggested meeting
someone or something new: defence against being left (left out of the ana-
lytic parental intercourse). The continuing thread (the selected fact) seems
to be his feelings about my absence.
“A scandal in the community about her” and “left her husband, Bert”
suggested to me that the scandal was, in his unconscious phantasy, my
having broken up with my “husband” (the specifics of the transference
seemed to indicate that I was his analytic mother)—that is, that he has
succeed in breaking into the primal scene and causing a rent in it that
would end in a scandal. The selected fact seems to continue in terms of
the theme of my having been away from home and involved in the primal
scene, which he is attacking.
Then he seemingly breaks the narrative to inform me about “a medical
dilemma”. His daughter may have come down with chickenpox, which
would countermand his and his wife’s taking off (reminder of me and
my analytic “husband’s” taking off). The daughter’s chickenpox threatens
those who are vulnerable (who take immune suppressants)—that is, the
parents who have already been weakened by his unconscious attacks.
She would have to be locked up at the port of entry, which would tie
the parents to her there. “Even though she has not come down with chick-
enpox, I believe it’s a good decision not to go there.” I now feel that he is
identified with me and is trying to avoid claustrophobic anxiety with the
infant him who has invaded me—who he suddenly becomes in the next
associations: “pollen, hay fever, coughing, conjunctivitis . . .”
The above-mentioned initial associations also alerted the left-hemi-
sphere me to the continuing selected fact. The question about my having
left town, followed by his having left town, and then the reference to
scandal in the community, and the near abandonment of their own child
because of chickenpox alerted me early on to the underlying meaning of
his subsequent associations: his anguish about my having left him, his
anger towards me as a result, and his attempting to make me feel guilty
about it.
Note the continuity and development of the putative theme of the
session, the selected fact that ran from the first association and followed
through in succession through each of the others.
Analyst [interpretation]: I think that when you said, “Were you out of
town?” and also talking about a “scandal in the community” and
then talked about a child coming down with a contagious infection,
and then feeling “locked up” [Thus far, scrolling]. . . . I think you are
reflecting the anxiety [maximum unconscious anxiety, analytic object,
O] of the prolonged weekend break in which you felt left out of
the parental couple’s enjoyment of each other. There was also an
unconscious desire to join up with me [unconscious defences] by in-
fecting me with your chicken-pox-child–self [unconscious motive] so
as to offset the sense of separation by infective contact and fusion
actually with the now scandalized parental couple. You may also
have wished for me to leave my “husband” and return to you. At

the same time there was the experience of feeling stuck inside me
(Bermuda) and the fear of not being able to get back to yourself
and to the separate and helpful me [cost of using the motives and
defences].
I arrived at these interpretations by employing (a) the bimodal (inter-
hemispheric) approach and (b) Bion’s (1963, p. 103) clinical instruments:
“observation: sense, myth, and passion” and reverie (transformations in O,
Bion, 1965, 1970). (c) I was especially alert to what role the analysand was
unconsciously attempting to recruit me for. I detected that his complain-
ing mood was an attempt to seek my comforting and reassuring of him
as well as my feeling guilty for having abandoned and therefore having
neglected him.
Caveat: I analysed this analysand many years ago. My interpretative style
may strike some as too vigorous. Although the outcome of this analysis
was successful, I think that, were I to see the analysand today, I might have
waited longer for him to “debrief” before I intervened. I see in retrospect
that I might have been overwhelmed by what he was projecting into me
and perhaps should have been more aware of that and been more patient.
After a clinically suitable time I might have said something like this:
“I think you’re telling me a lot happened since we last saw each other,
and you missed me and the analysis very much. You seem to have mixed
feelings about me now: you’re so relieved that I’m back, but you’re also
seem angry and hurt with me that I hadn’t been available to you when so
much was happening to you inside as well as outside.”
Analysand: That’s just the way I felt when my parents went away so
often and left my brother and me home with our nanny and the
maids. L (his wife) is more sensitive when I get testy or hostile with
her in public. V, as you remember my telling you, was one of the
top models in the world. We were in her new husband, D’s, home in
the desert. I was being dismissive and contemptuous of L. She said
that the holiday of Passover is set by the placement of the moon in
the sky. I told her that she was wrong. It’s set by the sidereal solar
cycle at the vernal equinox. Actually, we were both right: I was be-
ing condescending and dismissive. She felt slighted and attacked
by me. I guess it was because I was feeling inferior around D and
V. I feel more comfortable to have someone to put down when I feel
inferior to others’ achievements.
My reverie: The analysand appeared calmer after my interpreta-
tion. When he then abruptly seemingly shifted to another theme, one
about how he bullied his wife at the party, I found myself becoming
disappointed in him. His diminishment of her had been an issue we of-

ten discussed. I began to have the feeling that he was subtly provoking
me to attack him as a passive–aggressive reaction to me following the
effects of my interpretation. He also appeared to me to portray himself
as grand and all-knowing but covered his tracks with his confession.
Furthermore, he was switching roles by identifying with the glamorous
V (his mother was described by him as beautiful), and he projected his
“dumb” needy self into his wife as a manic defence against his depend-
ency frustration. Ultimately, I felt that he had only been partially relieved
by my interpretations. Another aspect of him may have felt bullied by
my interpretation. Still another aspect of him continued his hateful at-
tacks against me by identifying with me followed by his splitting-off and
projecting his left-behind-and-needy self into his wife, against whom he
felt triumph and disdain (the manic defence). This latter transaction ex-
emplified the here-and-now transference ↔ countertransference ↔ rev-
erie situation in the context of the “whole situation”.
He also reveals a highly important aspect of his past history. His moth-
er and father had gone on a six-week vacation almost immediately after
his birth and left him with a nanny and the house-maid. They repeated the
abandonment after his brother was born, when he was three.
My tracking (observation): The analysand appeared to accept the ac-
curacy of the interpretation and began to confirm it with details from his
past history. He continued the story of his past history in the immediately
following projective transformations—that is, he projected himself into the
idealized parents, especially mother (who was also me), who had left him
and had projected his unattractive infant–self into his wife (who once was
he) and diminished her. He then “confessed” to using his wife as a scape-
goat for his sense of inferiority—to V, the beautiful model who reminded
him of his beautiful mother—and me, the “beautiful”, idealized analytic
mother who had left him. We note that the adaptive context of abandon-
ment continues in elaborations on different levels and thus constitutes the
selected fact of the session—or what I would term, the “selecting fact”.
Analyst [interpretation]: V and D were associated with your analytic
parents as well as with your own parents once upon a time. It is as
if time stood still and we were the parents leaving you and your
brother behind. When you were admiring V, I think you felt intense
envy of her beauty and of her elusive separateness and mobility.
I think I am identified both with V and with D as your beautiful
mother especially—so you put yourself into me so as not to be left
behind as my ugly child, and you placed your felt ugly, left-behind
self into L, and then sealed it there with your contempt for and criti-
cism of her as the babysitter I left you with. L may stand, in other
words, for the ugly nanny and the maid who took care of you when
your parents left. They become your scapegoat. I think you were
also placing your chicken-pox-pollution-self into her and quaran-
tining her so that she can’t hold you back (agoraphobia). When you
were a child you felt stuck with the nanny, who is now L.
Analysand: I think you’re right. My fear was in being trapped by my
daughter in Bermuda, but I also hear what you’re saying about my
being trapped with the nanny and your being away. (The analysand
was visibly relieved.)
My reverie and tracking: The patient seemed “restored” to his more
nearly normal self and seemed for that moment to have shifted from the
paranoid-schizoid to the depressive position, but transiently reverted to
the paranoid-schizoid position in his attempt to triumph over his wife
(and thus me).
Analyst [interpretation]: You are now the parent being trapped by
the child where once you were the child who wanted to trap the
parent.
My reverie and tracking: Here I was clarifying and extending my inter-
pretation.
Analysand: Yes, I have always had a fear of infants. It runs in my family.
L feared that she’d be left behind with A and I’d go off with S (his
son from a previous marriage).
My reverie and tracking: The analysand appears to be continuing his co-
operative stance, but I could not help noting his statement, “It runs in my
family.” I initially smiled at this ironic and truthful observation—but then
slowly realized that he may also have been satirizing me passively–ag-
gressively.
Analyst [interpretation]: You got rid of your fears by splitting off your
awareness of them and unconsciously assigning them to L.
Analysand: I guess you’re right. I attacked her to feel more secure.
My reverie and tracking: I believed that this portion demonstrated his
continuing positive participation in the analysis and also revealed that
the L part of his personality had become anxious about a split developing
in his personality over the break. Yet I began to wonder if he were not
disingenuously humouring me.
Analyst [interpretation]: She is the split off me that you feel safer in
attacking. You could never attack your beautiful mother, only her
split-off representatives, the nanny and the maids—and the same
for me, for fear of being abandoned by me altogether. [Here I was
taking up the issue of his fear of really experiencing and expressing his
anger towards me.]
Analysand: That makes a lot of sense. If I’m angry with you then I
can attack her, and also because you’ve promoted her the way my
mother set me up with the nannies and maids. I was left with the
undesirable ones. Also, do you remember what we were talking
about last week about my rage and the black hole? V and D had a
friend come over named T, who offered us pot. I had a cough so I
turned them down, but I can’t smoke pot any more anyway—not
after that LSD experience I once had. L smoked pot then, however,
and got stoned. I was angry with her for getting stoned without
me.
My reverie and tracking: I believed that this portion demonstrated his
continuing positive participation in the analysis (depressive position) and
also revealed that the L part of his personality had become anxious about a
split developing in his personality over the break. The issue of his anxiety
about abandonment comes up again, but his time in terms of his wife, L.
Past history: His reference to pot and the “black hole” refer to a highly
traumatic incident in his earlier life. After he graduated from university, he
went into the American Foreign Service and was billeted in a remote area
in Africa. One day he unknowingly drank wine that had been laced with
LSD. He suffered a severe delirium in which the walls of this room melted
away in his mind and he was the only person left on Earth. He grieved for
the loss of his parental family.
Analyst [interpretation]: Once again the issue of being left behind comes
up in the context of someone you’re close to that is enjoying some-
thing with someone else and leaving you out, but it also reminds
you of your painful LSD trip and your experience of cosmic aban-
donment.
Analysand: It heightens my sense of alienation. It occurs to me that I
need a L to be a victim so that I can survive.
Analyst [interpretation]: L seems to be your hostage vis-à-vis me under
your control. You control me by controlling her—by victimizing
her; therefore, I cannot leave you without being concerned.
My reverie and tracking: My statement that L was his hostage (and
therefore my representative within him), under his control, is my reference
to my concept of the “depressive defence” in which the analysand can tri-
umph over me and control me by abusing himself or victimizing his wife,
with whom he is identified as well as being identified with me.
Past history: He met his present wife after his divorce from an unhappy
marriage with a “beautiful woman” (like his mother). When he first met
L, he was put off by her because she allegedly wasn’t physically beautiful.
After considerable analysis he did marry her, but not until the importance
of the equation “physical beauty equals having beautiful mother equals
not being an abandoned loser” was analysed. When I said that I could not
leave him behind without being concerned, I was referring to older mate-
rial in the analysis as well as the material in this session with regard to his
use of the depressive defence (corresponding to the manic defence)—that
is, he could control me by abusing himself or someone who was identi-
fied with him—whom I was, through the analysis, instrumental in his
marrying.
Analysand: Hmmmh. You mean this is my sneaky way of gaining con-
trol of you.
END OF SESSION
The analyst’s silent processing of the session afterward

As the patient lies down on the couch and begins the session, I
am aware of the adaptive context: that I had been gone for a planned
absence for the previous Thursday and Friday, and thus this was a
prolonged weekend break. His first association was, “Were you out of
town?”, which was then immediately countered with a symmetrical
statement that “we were out of town too over the weekend”. I im-
mediately thought that the anxiety he had about my being away from
the session was countered by his projectively identifying with me by
also going out of town so as not to be left behind. However, I reasoned
that, if I left the analytic infant, and if he, the analysand, also left the
analytic infant, then the analytic infant was doubly deserted. He then
talks about where he and his wife went when they went out of town.
They were entertained by a famous model and her husband in Arizona
and learned that there was a scandal in the community about her, that
she left her husband.
I immediately tied this to the first two associations and the un-
conscious anxiety of abandonment that, I felt, underlay those associa-
tions—that his anxiety about my absence had turned to anger at the
analytic parental couple and that he attacked them by attacking their
connection (link), and the wife–mother scandalously left her husband,
which is equated with my leaving my analytic mate (because of his
attack on the union of the analytic couple). He then talked about a
medical dilemma with regard to his daughter and their planned trip
to Bermuda. Apparently, the issue of chickenpox came up and her
needing to be in quarantine for her feared-to-be chickenpox, which is
communicable. She would have to be locked up at the port of entry.

Then he stated, “We have therefore decided to take our vacation locally
rather than leave town.” I felt this was advice to his analytic parent, me,
not to leave town but to stay put and not leave the baby quarantined
with chickenpox without a parent to look after him (her). He also said
that “We shouldn’t get stuck in Bermuda if she does come down with
chickenpox.” This gave me an indication that he had unconsciously
entered his image of me through projective identification, as I assumed
earlier in my silent thoughts, and became stuck inside, creating claus-
trophobic anxiety for him.
The claustrophobic nature of his anxiety produced the symptoms of
allergy, hay fever, and coughing as well as conjunctivitis (congestion,
fusion)—the cost of entry into projective identification in order magi-
cally to hold on to the fleeing parent, me. I then gave my interpretation,
which attempted to run a thread economically through all his associa-
tions and spell out his maximum unconscious anxiety. My interpreta-
tion constituted a partial scroll of his associations, after which I made
an interpretation that began with what I believe was the maximum
unconscious anxiety, then the defences against it, followed by the cost
of using those defences. It also represented for me the selected (-ing)
fact, the indicator of the O of the session. The selected fact could also
be detected as the Ariadne’s thread of continuity that ran through the
session with increasing credibility.
His response to my interpretation was a confirmation in which
he recalled how his parents had often left him and his brother—thus
the associations from the very beginning up until now seem to fol-
low each other, where each seems to be defined by the preceding and
successive associations, and the successive association predicating its
successor. Thus, the chain of associations devolves into a necklace of
coherent meaning. He then immediately talks about his wife’s being
sensitive when he gets hostile with her, following which he discusses
an argument they had had while they were visiting their friends in
the desert. The argument had to do with the holiday of Passover and
the placement of the moon in the sky. I then felt that he was picking
the argument in order to use another defensive manoeuvre to offset
his pain of being left behind by projectively identifying one aspect of
himself with the beautiful model and her husband, which I believe
represented me and my mate (who were out of town) and projectively
identified his own left-behind self into his wife, using her as a scape-
goat for his discarded dependent self. Again, I made an interpretation
that included his anxiety about being left out, the defences against it,
the consequences of using his defence, and the transference aspects
involving his secret resentment of me and attacks against me and my
mate. He again seemed to corroborate my interpretation by acknowl-

edging that he did fear being trapped with his daughter in Bermuda
and also trapped with his nanny when he was young—when his par-
ents had left him.
Somewhat later, he says that he has always had a fear of infants and
humorously comments that it seems to run in his family, indicating that
his mother and his father had the same problem, but also implicating
me. He acknowledges that his wife was afraid that he would leave her
behind with their daughter and he would go off with his son (by a pre-
vious marriage) thus confirming the interpretation of dividing himself
into two, projecting one into the idealized parents and another into
the maid and the nanny—lowly caretaker entities, which his wife now
comes to represent. I made an interpretation that the wife is a split-off
me whom he feels safer in attacking because of his anger at me and
the anguish I caused him when I left him behind. I then make a genetic
interpretation linking me with his beautiful mother whom he always
idealized and that he used the maids as scapegoats.
He again acknowledged the correctness of the interpretation. He
also acknowledged the correctness of another aspect of my interpreta-
tion, which suggested that he attacks his wife as my representative
and because she is his hostage with regard to me. This had to do with
earlier work after his divorce from his first wife and when he met his
second wife and initially rejected her because she wasn’t beautiful like
his mother or like his first wife—even though he couldn’t stand his
first wife. Thereafter, he identifies me with her as being on her side.
So one of the ways he attacks me is to attack her. I then restate my
interpretation in another way—that “once again the issue of being left
behind comes up in the context of someone you’re close to enjoying
something with someone else and leaving you out”. He acknowledged
that by stating that it heightens his sense of alienation, and he also
acknowledged that he needed his wife to be his victim. After his ac-
knowledgment of that, I was able to make the interpretation that she
was his hostage under his control and that he believes he controls me
by controlling her.
Though seemingly quite cooperative in the analysis, the analysand
was, as the reader may gather, also subservient and passive–aggressive
with regard to his anger, assertiveness, and aggression towards me. It
is difficult to demonstrate it with the material presented, but it was my
belief, later confirmed, that this cooperative “Abel” was continuously
haunted by a ruthless “Cain” twin, one who had been cursed by not
having received his parents’ blessing and who had, in unconscious
phantasy, become trapped in a psychic retreat or pathological organi-
zation (Steiner, 1993)—trapped by his fear of his rage and trapped by
his need for psychic safety, for which he had to pay the price of the
forfeiture of pleasure and emotional development and growth. In other
words, it was almost as if he had unconsciously made a pact with the
devil for his safety without reading the small print (Grotstein, 1979,
2009c).
I cannot leave my discussion of this session without revealing my
feelings about the analysand. From the very beginning until the end of
the session I felt the yearnings of a plaintive little voice that wanted me
to know how hurt and how frightened he felt while I was gone. While
also being aware of his muted anger and protest and of the aggressively
protective devices he employed, I was most aware of a feeling that he
wanted to crawl back inside me-as-mother and to suck my penis-as
father for comfort, warmth, acceptance, and guidance—perhaps his
experience of the “deadness” of his phobic and narcissistic mother had
propelled him headlong and prematurely to father’s penis as a better
breast than mother’s. But father, too, was neglectful. In short, I felt that
I was in the presence of an “orphan” who wished to be adopted and
comforted. Yet I also realized that I had to “wear” the negative trans-
ference in two ways: (a) that which I myself had incurred by leaving
him for a prolonged weekend break, and (b) that which was projected
forward from his past history with his parents. Bion (1965) calls the first
of these “projective transformations” and the second “rigid-motion
transformations”, the latter conveying that his previous relationship
with each of his parents was displaced intact into the present transfer-
ence relationship with the analyst.
“Exorcism” and the “Pietà transference ↔ countertransference”

As I have stated earlier, the act of analytic containment is more
complex than is ordinarily realized. Here is how I understand it: The
infantile portion of the analysand’s personality uses projective identifica-
tion to communicate to the analyst. The analyst uses containment: that is,
he absorbs the pain, then becomes it, one aspect of which is the analyst’s
agreement to be it—that is, to “wear” it as his transformed subjective
identity so that the analysand can see that it has “travelled” in psychic
space from the subjectivity of the analysand to that of the analyst, while
all the while the analyst is dreaming it with alpha-function (processing
or “metabolizing” it). An “exorcism” is taking place. As Donald Melt-
zer (1992) tells us: “The truest meaning of transference is the transfer
of mental pain from one person to another.” I, following Bion, say that
this transfer(-ence) cannot take place unless the analysand is able to
perceive pain in the analyst—that is, experience the movement of the
mental pain across the intersubjective gap. This transfer of mental pain
(which I call the “transfer of demons”) constitutes for me “psychoana-

lytic exorcism”.
One aspect of psychoanalytic exorcism is what I call the “Pietà
transference ↔ countertransference situation”. Just as the hidden order
of the Oedipus complex is human sacrifice (of the son, the father and
the mother), and just as it is the explicit order (in terms of the son) in
the Crucifixion and the rite of the Eucharist, it also constitutes the hid-
den order of the transference ↔ countertransference situation, in this
way: The analysand’s mental pain must be projected into (transferred
to) the analyst, he who is innocent must be experienced as guilty (by
default) so that his innocence can, like the Paschal Lamb, become able
to absorb—and to become—the projected demon. I use he term “Pi-
età” to indicate Mary’s (the self’s and/or the parent’s) guilt in their
interrelationships. Mary, aside from being dolorous at the sight of her
son’s dead body, was nevertheless guilty for agreeing to bear a child
that was destined for martyrdom. Christ had to become the pure and
innocent one who could absorb the guilt of others. In practice what
this means is that the analyst, the innocent archetypal “scapegoat”
(Girard, 1972, 1978, 1986, 1987), must absorb the analysand’s demons
and experience the guilt of the patient and/or of his truly neglectful
or abusive objects. The analyst must feel the guilt and the sorrow that
the objects could not feel.
In the case just presented I felt the guilt that the analysand attrib-
uted to his mother and father. I felt the sorrow of not being an attentive
parent and of not being a willing playmate—as he showed by his clear
devotion to his own children.
Tracking (“parsing”) of the links between

the associations of the session
Analysand:
(1) “Were you out of town?”
(2) “We were out of town too over the weekend.”
(3) “We were visiting V and her new husband in Arizona.”
The “were you out of town” association must be considered to be a cosmic
entity unto itself, having syncretistic radiations to infinity, by which I mean
(a) that it possesses infinite possibilities of meaning (if one considers the
association to be a point, then an infinite number of lines can be drawn
through it). (b) The association has an empty receptor that will allow its
mysterious counterpart within the second (sequential) association to at-
tach in order to make a tentative conjunction. This conjunction pulls the
first association from its infinite possibilities and bestows finite meaning
to it retrospectively. (c) The analyst must attempt to find the key to the
correspondence (the selected fact) between the two associations in order to
ascertain this meaning. In so doing, the analyst is silently developing a tree
of inference in his mind and will continue to make imaginative as well as
rational conjectures (Bion, 1980, p. 22). The analysand’s continuing associa-
tions will trim the analyst’s tree of inference. (d) As this parallel process
progresses, the analyst is also allowing himself to suspend memory, desire,
preconceptions, and understanding so as to become sensitively aware of
his own unconscious emotions → feelings that harmonically resonate with
the analysand’s emotions that perfuse his associations and being. (e) “C”
represents the left-hemispheric listening approach and “d” the right-hemi-
spheric approach. (f) When the two hemispheric approaches, which can
be thought of as a binary-opposition structure, begin to resonate with the
analysand’s utterances, the “analytic object” (the maximum unconscious
anxiety of the session, the “O”) has been located—that is, the “selected
fact” has been ascertained. (g) At this point the analyst, having evolved
from P-S to D, will feel sufficient confidence to offer an interpretation to
the analysand.
Note that the analysand added “too” to the initial question. This ad-
dition conveys what later will turn out to be the inception of his defence
against his anxiety at having been left behind for the long weekend
break.
A tentative link between (1) and (2) might be that the patient is
guardedly calling my attention to the fact of the long weekend break in
his analysis. He copes with his emotions about the break—the loss of
the analyst—with a manic defence; that he, too, went out of town to see
friends of his own and was therefore not a left-behind, dependent infant.
(3) continues with the same link as that between (1) and (2).
(4) “There is a scandal in the community about her. She left her
husband, B.”
The links between (1) and (2), and now with (3), while demonstrating a
continuity, now attract an additional emotional valence—that is, (4), “scan-
dal” and V leaving her husband. “Scandal” may constitute an infantile
or childish projective identification of disgust at the primal scene of the
analyst–mother and his mate over this long weekend. The putative effect
of this attack was the breaking apart of the analytic couple. The theme as
originally conjectured—that the analysand is primarily concerned with (a)
my having been gone, (b) the emotions that my absence evoked in him,
and (c) what measures he took to alter his psychic reality in order to cope
with it (use of the manic defence)—now seems tentatively to be tracking
with narrative consistency.
(5) “Before I get into it, I want to tell you about a medical dilemma
that we have.”
(6) “A (his daughter) may possibly have chickenpox, or at least she
was exposed to it, therefore we cannot take our planned flight
to Bermuda.”
Having attacked the analytic couple’s primal scene, the analysand, in un-
conscious phantasy, seems to have become unconsciously aware (5) of the
cost of this manic attack in the now handicapping” medical dilemma (6),
which, we may further speculate, may have been the consequence of the
analysand’s fear of the analyst’s retaliation against the analysand’s own
primal scene (going on a holiday of his own with his wife and children),
which is now stymied by his daughter’s sudden illness.
(7) “Chickenpox can be a deadly threat on airlines.”
(8) “They will not let a child aboard who has chickenpox, especially
with those who have immune suppressants. It’s too much of a
gamble.”
(9) “Also, she would have to be locked up at our port of entry. We
have therefore decided to take our vacation locally. We decided
not to risk the airplane trip.”
(10) “Also, we shouldn’t get stuck in Bermuda if she does come down
with chickenpox. It is a practical matter.”
(11) “She has not yet come down with it, however.”
(12) “I believe it’s a good decision not to go there.”
(13) “The other thing about me, because of the rain, there has been a
lot of pollen. I have hay fever and have been coughing, and also
have conjunctivitis. I have been taking heavy doses of antihis-
tamines. All of these medical issues seem to be floating around
us.”
The content of excerpts (7) through (13) seem to continue the theme of
the analysand’s unconscious phantasy of the analyst’s retaliation, the
consequences of which devolve into the latter’s counterattack against the
former’s primal scene and against the former’s children. One begins to
suspect that the attack against the children might indicate the analysand’s
invasive attack in unconscious phantasy against the insides of mother’s
body, as described by Klein (1928) in her version of the archaic part-object
Oedipus complex.
In the meantime, the theme begun earlier seems to continue. Perhaps
we can see the development of the theme in the metaphor of an evolv-
ing tree, in which the forward growth continues both directly and in-
directly—that is, in the formation of limbs and branches. This pattern of
direct as well as indirect continuity of the major theme of the session is

what I believe is an alternate version of Bion’s “selected fact”.
[Analyst’s interpretation]
(14) “That’s just the way I felt when my parents went away so of-
ten and left my brother and me home with our nanny and the
maids.”
Following the analyst’s interpretation the analysand revealed important
memories of his past history (14)—memories that seem to close the circle
of this whole session by revealing the parallel between his being left by
me in the present and by his parents in the past.
(15) “L (his wife) is more sensitive when I get testy or hostile with
her in public.”
(16) “V, as you remember my telling you, was one of the top models
in the world. We were in her new husband’s, D’s, home in the
desert.”
(17) “I was being dismissive and contemptuous of L. She said that the
holiday of Passover is set by the placement of the moon in the
sky. I told her that she was wrong. It’s set by the sidereal solar
cycle at the vernal equinox. Actually, we were both right I was be-
ing condescending and dismissive. She felt slighted and attacked
by me. I guess it was because I was feeling inferior around D and
V. I feel more comfortable to have someone to put down when I
feel inferior to others’ achievements.”
The analysand is again taking a seeming detour (15) from the major theme,
but a detour that is relevant to the theme. The analysand has projected his
left-behind, vulnerable, dependent self into his wife, L, who becomes sen-
sitive. The manic aspect of him now becomes identified with the putatively
superior couple and the aggressor–analyst–mother, who shows “testy”
contempt for the left-behind him, identified with L (16). The beautiful
model, V, reminds him of his beautiful mother, from whose love he had
always felt excluded. D and V are interchangeable both with his parents
and with me and my mate in the transference (17).]
(18) “I think you’re right. My fear was in being trapped by my daugh-
ter in Bermuda, but I also hear what you’re saying about my
being trapped with the nanny and your being away.”
The analysand accepts the interpretation about his double use of projec-
tive identification and about the unconscious motive for it, as well as its
genetic links (18).
(19) “Yes, I have always had a fear of infants. It runs in my family.
L feared that she’d be left behind with A and I’d go off with S”
(his son from a previous marriage).
(20) “I guess you’re right. I attacked her to feel more secure.”
The content of (19) and (20) represents an acknowledgement of the previ-
ous interpretations.
(21) “That makes a lot of sense. If I’m angry with you then I can
attack her, and also because you’ve promoted her the way my
mother set me up with the nannies and maids. I was left with
the undesirable ones.”
The analysand seems to have accepted my interpretation that when he
attacks his wife, L, he is not only attacking an aspect of himself that has
become projected into her, but he is also attacking me who, he believes, is
on her side—since we both represent different aspects of his “proper” or
“legitimate” partners, L in his external world and I in his internal world.
(22) “Also, do you remember what we were talking about last week
about my rage and the black hole? V and D had a friend come
over named T who offered us pot. I had a cough so I turned them
down, but I can’t smoke pot any more anyway—not after that
LSD experience I once had. L smoked pot then, however, and got
stoned. I was angry with her for getting stoned without me.”
The theme from (21) continues and leads back to the major theme of the
session: his criticism for a mother–analyst–wife who leaves him for her
own pleasure, thereby evoking deep, black-hole rage within him.
(23) “It heightens my sense of alienation. It occurs to me that I need
L to be a victim so that I can survive.”
The analysand completes the cycle of meaning of the session with what
I believe is a good example of Bion’s concept of the “selected fact”, the
organizing association that coheres all the others that have come before.
(24) “Hmmmh. You mean this is my subtle way of gaining control of
you.”
[Further confirmation.]
Note the two manifestations of the selected fact, one implicit within and
between each association in the continuity of their precise sequential un-
folding and the other installed in a single association.
Tuesday session (2 of 5)
Analysand: Yesterday we talked about my insecurities—how I beat up

on L when I feel intimidated or abandoned by you and others. I
feel inferior to others and depressed. Last week we talked about my
buried anger and my “black hole”. I get angry, deny my anger, and
fall into the black hole—I’m afraid of exploding, so I close down. I
have a hard time balancing my feelings of inadequacy.
My reverie: I felt that the analysand had digested and worked with
yesterday’s insights and seemed self-reflective and open—thus far. I did
not attempt to recall yesterday’s session. It occurred to me spontaneously
from his associations.
My tracking: I believed that the analysand had worked with (“dreamed”
or had “become”, in Bion’s terminology) yesterday’s processed material.
He made progress in his reflections by linking his “black-hole” (depres-
sion) anxieties with his fear of his anger and his feeling inferior.
Analyst [interpretation]: When you feel inadequate in the presence of
another person, such as myself, who is important to you, one on
whom you depend but who has the autonomy to leave you, an
autonomy that the infant–you does not yet have—you doubly with-
draw, you join the departing me and withdraw into yourself and
also split off and attribute what you feel to be your inferior self to
L, intimidating yourself as her.
Analysand: I’m too scared of my anger. If it’s a self-defence mechanism,
why do I turn it against myself? I must have felt impotent as a child
with my parents. I was exhausted and humiliated and had gotten
no response from them.
My reverie and tracking: The analysand seems to have grasped the
thread of meaning of yesterday’s and today’s session and finally realized
one of the reasons that he is afraid of his anger: his fear of its being inef-
fective and therefore humiliating for him to experience and to express—as
well as the dread of his anger’s aftermath and destructive effect on his
objects. His mood now seemed pensive and bitter. However, the part of my
interpretation that referred to his involuted (introjected) anger—that he
attacks himself who is identified with the object, that he attacks the object
by attacking himself—was not understandable to him yet.
Analyst [interpretation]: Your fear of your anger and your rage is not
only because of their destructive powers but mostly because of
their impotence. When you are angry, you reveal how much you
care—and, when there is no positive effect, you feel humiliated and
shamefully ineffective. You’re afraid of being angry with me also for
fear I’ll analyse it rather than my being affected by it.
Analysand: Boy, are you right. Yes, and worse than that, you could talk
me out of it. Then I’d really feel foolish. I’m thinking now of my LSD
experience when I was in the American Foreign Service. I remember
how angry I felt about being abandoned. I was in a rage about that.
It was a deadly situation—and I was all alone.
Analyst: That was an example of your rage being so great that you felt
that you’d “killed” your family, and then you were stuck being an
orphan and also your fear that your rage could kill me for having
been gone—as if you were trying to show me how I killed you off
by being gone.
My reverie and tracking: The analysand is now really working on the
links between abandonment, anger, inferiority, and humiliation. He seems
enthusiastic in a way.
The reference to LSD and abandonment, to which he—and I—had
already alluded in the previous session, is as follows: he served in the
American Field Service in the jungle of a remote country overseas. A
couple who had befriended him had invited him over for a drink one af-
ternoon. He later came to realize that the drink was laced with LSD, from
which he suffered a dreadful experience. The walls of the room melted,
and then he believed that his family back home had all perished. A short
time later he entered the couple’s bedroom, where they were having sex.
Although he did not feel sexual, he asked them if he could crawl into bed
with them. They refused and sent him away. His being sent away in the
face of his family’s dying constituted the nadir of his LSD experience.
These memories suddenly came back to me spontaneously as he alluded
to LSD.
Analysand: And guilty for their murder. Self-assertion is not a starting
place for me. I don’t think I can assert myself in the world. Dys-
lexia was no help. I couldn’t assert myself in school. Almost as if
dyslexia had an inner connection with my feelings of impotence
and helplessness.
My reverie and tracking: The analysand seems depressively self-reflec-
tive and continues to work with the thread of the session—that of aban-
donment, anger, and humiliation, with his dyslexia and his failure to
achieve success in life now thrown in.
Analyst: Dyslexia seems to be, from the point of view of your associa-
tions, an attacked and attacking pair of parents, including analytic
parents, who wound up inside you, attacking your ability to ar-
ticulate—as a retaliation for your “murder” of them and now me
and my mate.
Analysand: I never thought of that. You mean my anger at my parents
causes me to have dyslexia?. . . . We also talked about A and the
effect of her chickenpox, its effect on S’s desire to scuba dive in the
Caribbean. I mentioned alternatives, but he was very upset. I’m
torn between wanting to go away with S, leaving L and A behind.
Or leaving A with babysitters, which disturbs S. Both S and L feel
abandoned by me, the way I must have felt as a child. Mother
called—said we didn’t need a vacation. My mother was angry at
my spending on my family and not working.
My reverie and tracking: The analysand seemed incredulous—and con-
crete—about my metaphoric linking of anger against his parents (and me
as an analytic couple, who leave him out of their/my intercourse) and his
dyslexia. He continues the theme in the derivatives with his daughter A
as himself and the effect of her chickenpox, curtailing his son’s vacation
plans. He then returns to his adult self, who wants to split from his fam-
ily. I feel now that he has reverted back to the paranoid-schizoid position
from the depressive position—but instead of a reversion, it may be a pro-
gression to what Britton (1998a) terms “P-S (n+1)”, the P-S that follows
the earlier D rather than being the original P-S. I believe that reliving
the memories of his abandonment experiences was too painful for him
to bear, so he reverted to projective identification to become the parent
who left him, the son. His mother had called and berated him for taking
a vacation with the family’s trust-fund money. This suggested to me that
the analysand–mother–conscience was critical of him for greedily misap-
propriating family funds for his own personal use and therefore confirmed
my interpretation about the phantasied existence of an envious and hostile
parental couple within him that attacks him and his life with his own fam-
ily (wife and children).
Note that the analysand does not seem fully to understand some of my
interpretations, but his unconscious (pre-conscious) seems to, as verified
by his subsequent associations.
Analyst: You seem to equate your mother with your conscience, which
convinces you that you are greedy and do not deserve to have a
vacation because of your anger at me for having taken my vacation.
S is equated with a vicarious idealized you, whom you can safely
invest with your pleasure-desiring self. L and A are equated with
the you who is left behind when others are on holiday—the ugly
one. I think you are asking what a father of a family is to do in this
situation when the father is also felt to be the child who puts the
father-self into his son.
Analysand: There must be a shift in S’s expectations. We must go some-
where nearby together. My own family and I went on spring breaks
together to Florida when I was very young. I remember the time
though that father left mother behind at the airport in Florida. There
was not enough room on the airplane. Father took F and me and
left mother behind. Mother got hysterical at airports.
My reverie and tracking: My interpretation helped the analysand to
withdraw his projection of his pleasure-desiring self from his son S and
become more separate and individuated—and reasonable. Now S would
have to become more reasonable and practical about his vacation. He
seemed more mature then and more in the depressive position. The situ-
ation recalled a memory, however, of his childhood family having taken
a holiday when his mother and father had come to be split apart, and
he and his brother returned home with his father, leaving his mother
stranded in Florida. This suggested to me that his hold on the depressive
position was highly tenuous—that he immediately reverted to the para-
noid-schizoid position because he still felt imprisoned in the abandon-
ment-parent-splitting scenario—that is, that it still held too much anxiety
for him.
Analyst: I think there is a deep concern about being left behind by
the needed parent—the way I, the needed parent–analyst, left
you behind last week for a long weekend break. I think you
could understand and “collude” with why I would want to leave
behind an ugly child–you who also is infected with childhood
diseases—so you become a middle-man—a double agent, so to
speak—who could both join up with me and could also leave
your ugly child–self behind in L and A. Now we also have S,
your son, who may also be equated with your brother, F, who,
you believe, is preferred by your father, so you can identity with
the father who then dotes on F who also is treated as a father as
well as the ideal son.
Analysand: No wonder I’ve been confused all my life. I don’t know
whether I’m coming or going because I now realize I’ve been do-
ing both. I guess you can say, “I’m beside myself” in two separate
ways at least.
END OF SESSION
Analyst’s silent processing of the session

I have already elucidated in the notes of the session what I believe
to be its principal psychodynamics. The material presented by the
patient seems to follow closely that from the preceding session. The
analysand’s unconscious relationship to me throughout the session
seems still to be a deferential one. I feel imprisoned by his idealization
of me, despite my having attempted to analyse this factor in previous
sessions. I think that what is behind this, from what he tells me, is
that he was unusually neglected by both parents and has latched on
to a needed ideal me to counterbalance the longstanding effect of his
experience with his parents. On the other hand, his idealization of me
seems to camouflage his envy of me as someone whom he needs but
who is not always available. What I mostly feel from him, in particular
during this session but in other sessions as well, is his desire—really,
his appeal—for my love, affection, and attention. I experience it as be-
ing primal.
I didn’t comment on the selected fact because I believed that the
patient’s emotions were close to the surface and readily available for
observation and interpretation. I may have been wrong, however, and
may consequently have missed something.
Thursday session (3 of 5), following week

ADAPTIVE CONTEXT: I had missed Wednesday’s session because of a
psychoanalytic conference. He had heard about it from a friend in the
profession, and he had learned from him that I had been one of the
presenters at this conference.
Analysand: I had dinner with a friend of a friend of yours. DS is my
friend who discovered that wonderful medication, and now he is
rich and famous. He has also become a famous novelist. He is also
very short. He’s friends with M, the author of . . . (a book written
by a Nobel-Prize laureate who, the analysand had learned seren-
dipitously, was a friend—actually, an acquaintance—of mine). He
talked about a scientific conspiracy in the sixteenth or seventeenth
century. He and V got on famously, and her husband was very
jealous. M’s book is on my night-table. The Jaguar Glows in the Dark.
One book is on top of the other book. I had an argument with L.
She wants to go to Italy alone with me—and A, but wants to leave
S here.
My reverie and tracking: His having dinner with a friend-of-a-famous-
friend-colleague of mine allowed him to have the unconscious phantasy
that he had evaded the experience of separation from me on the Tuesday

session and could also, consequently, avoid experiencing his anger at me
for my unavailability. His extolling of my friend, DS, now seems to turn
into a manic defence against his relationship with me. He is now joined up
with someone famous, and L (now I) is jealous of his alliance with this fa-
mous man. The “scientific conspiracy” association caused me to think that
he thought of my being at a scientific convention—a fact he had learned
from our mutual friend-of-a-friend—amounted to a conspiracy on my part
to leave him out, and of an ancient conspiracy in which his parents had left
him out. The analysand seems coy and tricky. He then refers to a Nobel
laureate, his friend’s friend, who, he believes is a friend of mine and who
has written a well-known book that has “Jaguar” in the title. The analy-
sand connects him with me (we spoke on the same program recently—and
thus he thinks that we are friends), and the analysand also knows that I
drive a Jaguar automobile. His having the two books stacked together on
his night table, and one glowing in the dark, suggested he was collecting
and cherishing transitional-object reminders of me. Then he announced
that he had had an argument with his wife.
Analyst [interpretation]: My being gone yesterday and your believing
that I attended an important scientific meeting with our mutual
friend and a really important scientist, a Nobelist, may have caused
you not only to feel left out but also to feel very unimportant to
me. I had more interesting and more worthwhile people to relate
to than you, you felt. I also think that you tried to comfort yourself
by a make-believe phantasy that, if you stacked the books together
that were written by these other two important men who are asso-
ciatively connected with you, you could pretend that you were not
left out and were also important. Being left out occurred again when
your wife asked you to accompany her alone on vacation and leave
your son, S, with whom you are closely identified, alone—like you
here now with regard to me. I feel that you are angry with me at the
present moment, not just because I abandoned you but because you
feel that I’m not sorry about it. I’d rather be famous and socialize
with famous people than stay at home and take are of you.
Note in passing: The seasoned psychoanalytic reader may wonder why
my interpretations are often, but not always, lengthy. I have found over the
years that I have been more effective with analysands when I “spell out”
the details of their unconscious phantasies and do not leave out ideas that
are to be taken for granted. In other words, I now disapprove of “short-
hand” comments and tend towards complete interpretations, which do not
necessarily need to be lengthy, only complete. The virtue lies, not in their
length, but in their aim towards thoroughness.
Analysand: I recall my mother’s excuses on my parents’ trips. Mother

used to blame father: “Your father doesn’t want it!” I want to go
with S; otherwise, I feel that I’m rejecting him. It’s unfair to her,
though, she told me.
My reverie and tracking: I was a little confused by the analysand’s re-
sponse at first and then began to think that he had been put off by my
interpretation and concretely believed that I had been trying to justify
why I was away—as his mother did with him with regard to father’s be-
ing the culprit.
Analyst [interpretation]: It’s felt that I failed you by not taking you along
with me on this second “educational” break. I never even bothered
to ask you if you wanted to come along—and I’m felt to be trying
to justify it by telling you it’s “scientific”.
My reverie and tracking: It seems that the analysand offered me a grudg-
ing affirmation but returned to the concrete issue of his anxiety about leav-
ing his son, S, behind on his wife’s and his forthcoming vacation.
Analysand: Well, at least I hope you had a good time. Usually L is right
about these things. I understand L’s apprehensions. I feel that I’m
being legitimate this time, however.
Analyst: I believe that you are still anxious about being coerced by L,
and somehow by me, into believing that it’s all right for parents to
take a vacation without their children—and if you don’t go along
with this, it’s you who is attacking the parental union, and you’re
on the outs with them and me.
Analysand: I fucked up again, huh?
Analyst: You seem to have taken my interpretation as an attack on
your point of view, possibly because of the way I presented it. You
thought that I thought you were selfish and wrong. If so, then I can
understand your “confession”, which I believe was really a submis-
sion, underneath which must be a lot of anger and a feeling of my
not having understood you. What I was trying to say was that you
remain identified with S as the one left out. It isn’t that you want
to separate me and my scientific partners or your parents of once
upon a time (Note: I think I finally got it!), but that you don’t want
to be left out, abandoned, which is both frightening and humiliat-
ing to you. But the cost of not allowing for your parents, past and
present, to be alone is that you mysteriously, unconsciously absorb
separated–apart parents into your internal world who then disal-
low your thinking your own thoughts clearly–that is, who don’t
leave you alone with your own thoughts and unconsciously cause
you to split your own family.
Analysand: You’re right. I did feel put down. I guess it is harder than I
thought to get rid of this issue about being left behind.
END OF SESSION
Comment
After reading these three annotated psychoanalytic sessions, the reader
may wonder: (a) how faithfully the accounts represent Kleinian tech-
nique as it is currently understood; (b) which parts represent what
might be called “Bionian technique”; and (c) what aspects are applica-
ble to “psychoanalytically informed psychotherapy”?
The answer to the first and the second question is, in part, that there
is no such thing as “Kleinian” or “Bionian” technique really.1 What is
called “Kleinian”—or even “Freudian” or “classical”—technique really
means that an analyst who has been immersed and trained in one or
more of these schools, has absorbed their canons and wisdom, and has
had experience in being supervised by those who speak and think from
those respective points of view, is then able to take all this for granted
and allow the clinical material from the analysand or patient uncon-
sciously to summon their theories of technique to the surface of their
minds selectively. From another point of view, each analyst is a distinct
individual with a distinct personality and analytic style (Ogden, 2009)
who will breathe his own idiosyncrasies into his technique. This is a
way of saying that no two Kleinians or Freudians are alike; they may,
however, appear similar enough to each other to justify the term “Klein-
ian” or “Bionian”—for that moment. In my analysis with Bion, I all too
often found him to be un-Bionian.
Psychoanalysis itself is an organic, vitalistic entity in its own right
and ineffably evolves in mysterious patterns over time. Post-Klein-
ian analysis as generally practised in London today differs in many
ways from that practised by Klein herself or her contemporaries. The
Kleinian analysis practised in South America will also show many
differences in emphasis from what is currently practised in London,
but it is no less “Kleinian”. The same principle applies to the United
States—one of the last countries to have become “in-Kleined”. One
will notice different emphases, however. Over the years the British and
Continental philosophical, political, and historical temperament had,
in my opinion, deeply infiltrated and profoundly but subtly affected
Kleinian analytic thinking and practice in London.
The same principle applies to South American, North Ameri-
can, Australian, and southern European Kleinian practices. I myself
have undergone two separate Kleinian analyses, both of the classical
Kleinian variety: one by Wilfred Bion, who had been analysed by Klein
herself, and the other by Albert Mason, who had been analysed by
Hanna Segal. Bion’s influence continues today through Betty Joseph
and her followers, who emphasize the “here-and-now” and mature
whole-object interchange between analysand and analyst in the “to-
tal situation” of the transference–countertransference. It would seem,
ironically, that the London post-Kleinians may be in danger of losing
their de facto franchise on Klein by virtue of their very success in dis-
persing her ideas as well as their own.
In short, what I have just clinically elucidated represents my way
of being a Kleinian- and Bionian-informed psychoanalyst. In his own
unique way Bion often said to me, “I am not a psychoanalyst, you
know. I am only trying to become one!”
As for the issue of the Bionian influence in the clinical material:
first of all, I addressed the analysand’s associations not only from the
perspectives of the day’s residues (immediate past) and of reconstruc-
tion from the remote past, but also—and here is Bion’s (and Joseph’s
influence)—from the perspective of the here and now: that is, what is
going on between us right now.
The reader will notice that my interventions focused on the analy-
sand’s unconscious and conscious anxieties. Klein would have under-
stood them as having been derived ultimately from the death instinct.
Bion, without having formally disputed that notion, began to empha-
size that anxiety in the psychoanalytic session comprised the “analytic
object” (Bion, 1962b, p. 68) and was ultimately a manifestation of O, the
Absolute Truth about Ultimate Reality, the noumenon, infinity. In other
words, when the “analyst–mother” leaves the infant–analysand, the
latter may either experience her absence as a concrete, absolutely nega-
tive “no-breast” that negatively saturates (pretends to fill the absence),
or he may have developed enough trust and faith that the mother
who leaves always returns (as in a circle as opposed to a straight line:
Frances Tustin, personal communication). The space that faith and
trust (hope) allows the infant to leave open is attended by tolerable
suffering of her absence, as opposed to the former infant’s enduring her
absence. The fate as opposed to the destiny of the infant’s capacity to
think hangs in the balance. Analysand and analyst repeatedly traverse
this dichotomy during the course of the analysis.
I should like to follow up on the differing concepts that explain the
formation of the concrete, negative, destructive “no-thing”. In Kleinian
theory the moment when the good breast–mother (part-object) leaves
her infant, the bad mother instantly appears (unconsciously). What
accounts for this negative transformation? According to my reading
of Kleinian theory, it is explained by an unconscious phantasy in the

deserted infant in which the latter suddenly begins to hate mother be-
cause, if she knew how much he needed her to remain with him, she
wouldn’t have left. The fact that she did leave means that she hates the
infant and sadistically wants to torment him with her absence—to prove
how omnipotent and desirable she is by making him suffer. My reading
of Bion seems to suggest that he agrees, but there is another part of his
theory that offers an alternative explanation. Every human experience
predicates the dual or bimodal operation of O intersecting the infant’s
emotional frontier: (a) the experience of incoming sensory stimuli, and
(b) the emergence of the Absolute Truth about an infinite, impersonal
Ultimate Reality—that is, the infinite Ideal Forms or noumena. In other
words, the unattended infant experiences the raw, inchoate things-in-
themselves without maternal mediation. This event may constitute an
infantile catastrophe. The infant may then, defensively, seek to master
the situation by assuming an ad hoc sense of agency and use his hatred
or rage as a default strategy to “own” (autochthonously, solipsistically,
self-creatively) in order to stave off catastrophe. I believe that this is
exactly what happened to this analysand as an infant and was repeated
in his LSD experience and in the analysis.
Bion also contributed the idea of “container ↔ contained”. Through-
out these sessions I felt myself as a protective presence to be embracing
the “analysand-as-helpless-infant” and trying to detect (“left-hemi-
sphere”) and absorb (right-hemisphere) the hidden emotions that the
analysand was trying to convey to me. In the course of so doing, I
found myself entering into a state of reverie (wakeful dreaming) in
which I had meditatively suspended all my analytic knowledge to al-
low my inner consciousness to be unsaturated so that, in turn, I might
be all the more available for as well as inspired by the analysand’s as-
sociations and arrive at his O and be able to conduct a transformation
of it to “K”—knowledge about himself that would be useful for him.
I was aware of wakefully “dreaming” the session, the analysand, and
his anxieties. I was using my alpha-function to synchronize with his
so that our unconsciouses could resonate.
Bion’s (1970) concept of “faith” (p. 32) offers an alternative hypoth-
esis for the infant’s dread of abandonment. Faith is justified—I believe
Bion is saying—because of the developing trust in the caretaking object
(container) and by allowing oneself to be contacted by his rich uncon-
scious resources: that is, the Ideal Forms and the things-in-themselves.
In other words, by being in contact with them, the infant is reassured
to an extent that a potential category exists that can anticipate, encom-
pass, and thus contain the unknown.
The “obligatory psychotherapy” I offered in the above three ses-

sions included references to his real parents, wife, and children before
I then used them as displacements from them to him or me.
Earlier in this work I have presented the idea that psychoanalysis
can be thought of as a demonstration of sacred improvisational drama.
The analytic patient is like an actor unconsciously auditioning for the
analyst to: (a) be able, as in the game of charades, to assign coherent
meaning to the analysand’s encrypted messages from his unconscious,
and thus (b) to include him or her in a rewritten script to replace or
compensate for the original one that has already happened. In the case
I have just presented it is easy to see that the analysand was, in effect,
dramatizing (with hyperbole) his feelings of helplessness, neediness,
and abandonment for me to disencrypt but also to become personally
and emotionally affected by—that is, to experience—the appropriate
guilt for having abandoned him, (c) to experience that the analyst is far
from indifferent to the analysand’s anguish and thus comports himself
as if he is sorry vicariously—and now is infested with the analysand’s
demons (containment is equated with successful “exorcism”).
Scrolling
Earlier, I alluded to the technique of “scrolling” the text: by this I
mean the process in which the analyst summarily recites either aloud to
his patient or silently to himself the sequence of the successive associa-
tions. I have found that this technique may be useful both to the analyst
and to the analysand when the former is unsure about the meaning of
the analysand’s material and doesn’t know what to interpret, or is rea-
sonably certain, but the analysand, upon receiving the interpretation,
doubts its value. Here is how I might have scrolled the last session:
“You report that you had had dinner with a mutual friend of ours,
an analyst who knows me and who is also a fiction writer, who him-
self is a close friend of another famous writer and scientist whom
you also associate with me and who has also written a popular
book with the icon ‘Jaguar’ on the cover that glows in the dark in
your bedroom at night. You also connect ‘Jaguar’ with the car you
know I drive. Our mutual friend talks with you at dinner about a
scientific conspiracy in the sixteenth or seventeenth century. Then
you report an argument you had with your wife, L, about whether
or not your son, S, would accompany you and your wife on holiday,
you preferring that he does. I think the issue seems to be one of
the dread and humiliation of being left out. You seem to have de-
fended against my absence yesterday by associating yourself with
two famous men who were associated with me, but you do men-
tion an ancient scientific conspiracy: perhaps my meeting yesterday
reminded you of what you felt was your parents’ conspiracy, leav-
ing you out of their pleasure. This same issue continues with your
identification with your son, S, whom you do wish to be left out of
your vacation fun.”
The effect of scrolling aloud to patients often produces interesting re-
sults. They then begin to realize that the analyst’s interpretations are
the direct result of their free associations (shades of Bion). They had
hitherto underestimated how fecund their unconscious was in creating
such helpful associations. It makes them feel more like a respectable
and resourceful analytic partner. It is also useful to the analyst. He may
be able to detect the selected fact of the session by being able to shift his
focus from each indivisible association to a lower power of observation
(“soft, overall focus”, Ehrenzweig, 1967, p. 23), whereby he is able to
see more of the whole picture.
I now ask a question of the reader that is posed in Volume One:
To which part of the analysand are interpretations directed? And as
a corollary, is it necessary for the conscious ego to understand them?
My analysis with Bion suggests that, as in hypnosis, it may be advan-
tageous analytically to interpret to the preconscious mind. That was
my experience with Bion. I didn’t always clearly understand what he
was saying, but I always found myself responding appropriately and
gaining unusual clarity.
Some afterthoughts
Although this analysis was conducted in my version of the
classical Kleinian method, I should like to call attention to the follow-
ing: First of all, I have already alluded to how I might have changed
my style, were I to analyse this analysand today. Second, I would
like to say a word about the part-object-laden nature of my erstwhile
interpretations. When I interpreted his part-objects—such as his in-
fection as a way to invade me and become a part of me—he was, in
my opinion, using me as a whole object in a part-object manner. Put
another way, the part-object is not a stand-alone entity. It is the only
way that the infantile portion of the personality can (narcissistically)
utilize the whole object, which is there all along, only to become re-
morsefully and regretfully recognized in retrospect in the depressive
position. Third, analysing the text was really my way then of analys-
ing process. Analysands may speak of day residue, but what they are
really doing, according to Bion (personal communication), is uttering
their immediately current transformations in the here and now of im-

mediate and remote past history.
Fourth, I keep using infantile referents in my interpretations. I

should like to say a word about this. In Volume One I wrote about
“the once-and-forever infant of the unconscious” as being a hidden
order of Kleinian theory and technique. I think, with respect to post-
Kleinian thinking, that the “infant” within the adult can be thought of
as a “virtual infant”—really not an infant at all but the most vulnerable,
defenseless, and ageless subject, the one who most consummately feels
the way a helpless infant must once have felt.
Note
1. In other words, the principle of self-organization ultimately wins out over the
principle of co-creation in the analyst’s technique.
CHAPTER 9
Clinical example 2
T
his analysis took place many years after Clinical example 1. The
reader may see some changes in my technical approach. The
analysis I am presenting is a good example of the negative thera-
peutic reaction (psychic equilibrium).
Session
ADAPTIVE CONTEXT: Monday session, one of five sessions per week.
Analysand: You know, I was kind of down most of the weekend, but
not terribly so, just a little bit, and then in the evening, after we’d
put all three kids to bed, I went out to the store to get some milk.
As I was driving back, I realized that I was hungry and that I had
been hungry all weekend. It was hard to stay on the diet. Then I
had a memory of saying that I was hungry for the wrong things, or
of you saying that I am hungry for the wrong things.
My private feelings: I recognized feelings of guilt and defensiveness in
me while the analysand was speaking. Noting that this was the first ses-
sion following a weekend break, I recognized that the patient was dram-
atizing how he neglected himself the way he felt I had neglected him.
In other words, I thought I heard the depressive defence: he was attack-
ing me by projecting guilt into me by his suffering neglect—not caring
113
properly for himself in my absence. In other words, I felt that he wanted

me to feel guilty and responsible for his distress. I also had the gut feel-
ing that he was trying to pull me into believing that he was conducting
the analysis on his own: first presenting typical weekend complaints and
then affecting to proffer the interpretations he would have expected me
to give.
Analyst: You were hungry for anaesthesia, not hungry for nurture. You
were hungry for anaesthesia against ungratified neediness because
of your feeling unable to take care of yourself on your own, so, if
I can cheat on you by going away and taking care of myself, then
you can cheat on me by neglecting the infant you, especially since
I was away on Friday. You became your image of me neglecting
you. But I also heard you say that you felt I’d be critical of you for
cheating, which I think may be your attributing your criticism of
me into me. But I also have a feeling that you’re subtly showing
your righteous independence of me by assuming the role of the
would-be analyst–me.
Analysand: I think you’re right. I tried to get things done, too. I did
some aerobics on Saturday, no, on Sunday, and then this morning I
got up early and I got on the Nordic track for the first time in many,
many months. And I remembered last night that if I could get up
at 4 o’clock in the morning to go work out when I had a trainer, I
should certainly be able to get up like at 5:30 to get on the Nordic
track. And I can usually count on B (his younger son) to wake me
up around that time. Then I got afraid over the weekend that be-
cause of whatever this is, whether it is getting back at you for not
being there or whatever else, I’m going to let good things slip away
from me. But that would be stupid. I’d like to make more money.
My work keeps me away from home so much that I don’t know
whether or not I’m part of my family. I don’t know; you may be
right that I was trying to replace you with me.
My private feelings: The analysand’s associations altered from being
dour and complaining to his becoming enthusiastic about caring for
himself collaboratively following my interpretation. I was witnessing a
shift from P-S to D. My earlier feelings of tentative guilt continued, but I
also developed feelings of compassion for the analysand’s expression of
abandonment and isolation from me and from his own family. However,
his statement with regard to belonging or not belonging in his family as
well as my analytic family struck me as being the selected fact of the ses-
sion.
Analyst: You’re comparing your having to be away so much from your
own family so as to make a living with my being away from you

over the long weekend as well as between sessions. You feel as im-
material as a consequence to them as you are indirectly informing
me that I am becoming immaterial to you and that I made you feel
immaterial to me. Yet you are also aware that for me to analyse you
I have to leave my family, which may cause you some concern.
Analysand: I can’t hover around being four years old and assume that
everything in my adult life will go well. I don’t know about being
guilty that I take you away from your family.
My private feelings: This was a condensed association that referred, I
believed, to his long-standing resentment of his birth family for allegedly
neglecting him. I felt that he needed some help here in reconciling or sur-
rendering his vendetta against them—now me, because it was imprison-
ing him in martyrdom: that is, the depressive defence. I also felt that my
interpretation that he was guilty about taking me away from my family
was incorrect. Note that what I had already analysed belonged to the adap-
tive context or day residue. I hadn’t yet approached what was going on
in the room at the present moment, except for alluding to the possibility
that he was trying to become me. I came to believe that he resented me
because I wasn’t really “getting him”. I also felt that he wanted me to feel
sorry for him.
Analyst: I think what may be behind what you’re saying is that you’re
waiting for the parents of your childhood to realize the error and
the terror of their ways that had affected you, and to correct them,
and to ask for your forgiveness and set things right. In other words,
I think you want justice to take place so as to achieve redemption.
The parents should first correct themselves, then the child–you can
grow up from them safely. But I, your analytic mother-and-father,
stand in for them. It is me whom you want to feel guilty and re-
sponsible for my negligence—and for my just not getting it. Yet I
also think you’re angry with me for helping analytic progress to
take place, depriving you of hopes to stay an infant.
Analysand: Right (feelings of obvious relief). On Friday we had dinner
with friends. They have two little girls. One is four like F (his older
daughter) and the other one is two-and-a-half. They’re both nice
people, the parents, but they don’t get along very well, it seems.
We were watching the daughter. She started crying over every-
thing—like, tantruming over everything—and they just sort of hung
around helplessly, the poor thing. You know, poor thing, whatever.
She’s begging for a limit, and it is just not coming from them. But
F (one of his daughters) does pretty well there. She cooperates well.
She fights well. Then it occurred to me that C (his wife) and I may
have done pretty well as parents, all things considered.
Analyst: Earlier this session you put me in the same category as your-
self in our ignoring of our respective families. Now you seem to
compare yourself favourably with me in so far as your children
seem to do well because of good parenting, but the child of the
other family had needy crying fits. This may relate to your need
for boundaries in my absence, but I’m more prone to think that
it’s the crying-infant–you right now who feels I am cheating you
out of being an infant by imposing analytic boundaries—as if I’m
force-weaning you.
Analysand (laughs): On Saturday, on his birthday, my nephew, B, goes
to San Diego and has decided to rent a two-bedroom apartment
with three friends. The conviction of my brother and my mother
is that he rented a place that’s way too expensive for him because
he wanted to go along with people who are of a higher class. What
they are trying to do is to give him an ad for an apartment of similar
size, but much cheaper, and R (his wife) was saying: “Well, have
you gone and taken a look at these places? You know, it is down-
town San Diego.” They may have some truth, but B also may have
some truth, but it turns into who was right and who was wrong,
like my mother trying to hint that, you know, sometimes it is im-
portant to consider who you are living with and can you keep up
and are there other considerations that can be entertained. All like
pussyfooting. I was really uncomfortable. It felt like it was none of
my business, so I didn’t feel like it was my place to say anything,
but I wish that somebody would say, you know, this is what you’ve
got, this is what you don’t. You want this, fine.
Analyst: I wonder if you’re not talking about the positive you who
appreciates boundaries and desires a parent–me to respect your
growing up, while at the same time you seem to transfer over the
tantrummy baby to your friend’s daughter and to your own family
and your brother.
Analysand: I never thought of that (said with relief).
Analyst: So maybe what you are saying is that you were greatly af-
fected when you were, in effect, being abandoned that month when
your parents and older brother left you with your grandparents—
and didn’t take you into consideration (a momentous incident that
took place when he was 4 years old). They didn’t consult you or
ask how you would feel or whether you would have liked to go
along—and the same with me. I arbitrarily leave, do not consult

you, and give you only a short warning. So wanting to remain a
baby is your way of being defiant and coping with your terror about
being so helpless.
Analysand: R has asked if I’ve had a sense of what has changed in me
in the last year, and I said, you know, it is sort of hard for me to
assess over like what I was like a year ago or up to now. I know
something is different, but I can’t really put my finger on it. And
she said, “You know, you used to like all this shameful stuff that I
don’t feel very much from you any more.” You know, I was terrible,
that I didn’t deserve things—and it is true. I mean, it is clearly still
there, but it doesn’t have the same prominence.
My private thoughts: Once again, I believed that the analysand had
shifted from P-S to D in response to my interpretation, which was accepted
on a deeper level as my applying the “law of the father”—not to wallow
in pity. Yet, at this point I didn’t know whether my interpretations had
actually given him relief or whether he submerged his negative feelings
towards me and, instead, hoisted the flag of analytic progress in order to
placate me. But ultimately I believe that the analysand is using day residue
to express what is happening here and now in the analysis. I believe that
he is still too self-conscious to be a conscious “I–Thou” dialogue, which is
the goal of the analysis.
Analyst: I think you are the child who is looking for boundaries as
well as the infant who is fighting boundaries out of anger and
hopelessness about the foreclosure of the possibility of hav-
ing your infancy made up for. Yet the other you is looking for
meaningful, loving boundaries now carried forward to today in
the analysis with me. And as you try to establish boundaries with
your own three children, a monstrous conscience develops in you.
But suddenly another point strikes me. You just informed me of
out of nowhere, seemingly, of how much progress you have been
making. I wonder now, all of sudden, if that might not be your
way of trying to appease me after holding me responsible for be-
ing a negligent analyst–parent—and also seduce me into ignoring
the infant–you who defiantly and desperately does not want to
try to grow up.
Analysand: I think you’re right. I need for someone to be where
the buck stops, but I’m afraid of the consequences of confront-
ing you. With my family it was never in the form of, you know,
the buck stops here. It was always in the form of if you have any
consideration for the people, this is what you would do. If you are
a good boy, this is what you would do. It was like this hinting that
if you are a moral, righteous person, then you need to read other
people’s minds and do what they want you to do.
Analyst: Yeah—rather than drawing limits and being real.
Note: He seemed to ignore the second part of my interpretation—about
not wanting to grow up.
Analysand: Right. And I guess I did. It is not so much that I intuited
what they wanted. I think it is more that I intuited what they didn’t
want, and I didn’t do it.
Analyst: Yes. That makes an awful lot of sense, and that helps ex-
plain your behaviour with some of the executives at your firm—the
way you talk about your relationship to F and V (his bosses at the
firm)—aside from their own hang-ups, but you are always wonder-
ing what is it that they want and don’t want from you.
Analysand: Right. Is what I am doing too much?
Analyst: Right. Or not enough.
Analysand: Right.
Analyst: I’m sure you are that way with me.
Analysand: I’m sure I am. I mean, I am scanning all the time. I mean,
I don’t know whether it’s I’m picking up or not picking up—I feel
like I am scanning all the time. The radar is always going.
Analyst: Rest assured you are not meeting my expectations, and you
know why?
Analysand: Why?
Analyst: Because I have none.
(Laughter.)
Analysand: So I am meeting them just fine.
Analyst: Exactly.
My private thoughts: I had the feeling that the “abscess” had been
pierced and was now draining. We both felt relieved. He understood that
we were both answerable to the covenant of our relationship. But I felt
something was amiss. He all but ignored my addressing his “failure-to-
thrive”–self’s undermining the progress of the maturing, responsible self.
Analysand: It is interesting—with my brother’s wife, who drew the
discussion to a close (laughter), you know, somebody who is not
blood-related to anybody in the room.
Analyst: It’s funny that you said “my brother’s wife”—you didn’t say
“my sister-in-law”.
Analysand: Because there have been so many of them. (Laughter.) I’d
have to distinguish the current one from the former ones.
Analyst: I get you, so it is really not that significant, then.
Analysand: Umm, well, maybe it is. Maybe what it is, is that I don’t
include her in the family.
Analyst: She is your landsman (Yiddish term for countryman), some-
body else who isn’t in the family. Maybe your martyr-infant–self is
not to be included in your family of today.
END OF SESSION
Session
ADAPTIVE CONTEXT: Monday session (one of five).
Analysand: As I was coming here this morning, a thought was spinning
in my head. I don’t know if it was guilt, resentment, or responsi-
bility, but it was about B’s (his second daughter) suffering at her
birth. Whatever happened, I was there in the hospital with her.
She seems pretty happy now—almost as if nothing happened. Yet
I have these awful thoughts that I want to destroy her and rob her
of her existence.
My private feelings: I felt that his hatred was also meant for me as the
transference representative of his parents. I had another thought as well:
that he deeply envied his daughter for her blessings—that both parents
loved her and protected her, unlike how he felt he was raised.
Analyst: The care you gave her when she was in peril after birth only
reminds you now, after a weekend break from our relationship,
that you felt imperilled over the weekend, as in your infancy, and
that I was not available to help you. Further, when you say that
you want to “destroy B and rob her of her existence”, I wonder if
you don’t mean that you want to destroy the B who reminds you
of how different your own early life was by comparison with hers
and how you’d like to rob her of the very blessings you and your
wife give her, and then retrospectively apply them to yourself. In
other words, I wonder if you are not envious of her entitlement to
the kind of care that you want to have after the fact—and that the
violence of your hatred is directed towards the mother–me, who
pushed you out of infancy too soon.
I realize that this interpretation, like so many of my others, is lengthy, but

I felt impelled to make it in order to present a complete one. Let’s see how
the analysand responded.
Analysand: I think you’re right. I want, I guess—what got to me this
morning is . . . sigh . . . it’s stolen—so much—sigh—I was just sob-
bing as I was driving here. I guess I don’t feel it so acutely now
but—leading her life so happily every day—her happy life as a
reminder to me of what didn’t happen in mine—what didn’t and
won’t happen—and that they get to have it, and I don’t—and I’m
the one offering it. I find it unacceptable—at least at the moment.
It’s not okay with me that it didn’t happen for me. It is not okay
with me that I didn’t get to be a kid. It is not okay with me what I
did to myself. It is not okay with me that my parents couldn’t do
what they needed to do, and it is not okay with me that there is
nothing you can do about it—that there is nothing that anyone can
do about it. I’m not ready to grieve it. I want my childhood back!
I want another chance!
My private thoughts and feelings at this moment: From the moment the
analysand entered the consulting room this day and showed me his face,
I realized that he was in great anguish and turmoil. As he began speak-
ing, I found myself phantasying that I was a rabbinical judge (he and I
are both Jewish) at an ecclesiastical court in which my analysand was
Job and that God was on trial for what He had done to my analysand.
Then, as my phantasy continued, I slowly began to realize that I was on
trial, and I began to experience feeling guilty and on the defensive. In
other words, I felt drawn into what seemed to be an unanswerable ethi-
cal–religious dilemma and was required both to adjudicate it—find the
answer to the unanswerable wrong—and also acknowledge my counter-
transferential guilt and my responsibility for it.1 What stood out most for
me, however, was my experience of the analysand’s anguish—and my
counter-feelings of wanting to make it right for him. In other words, it
was my unconscious task to become—that is, “wear”—the projected ob-
jects and experience the horror, guilt, and contrition that the analysand
wanted his actual parents to feel and to express: to say they’re sorry!
This aspect of the transference ↔ countertransference situation is not
unlike an “exorcism” of bad demons, a situation in which the innocent
analyst must transferentially become the analysand’s demon—and must
also feel contrite about it.
The transference ↔ countertransference engagement between us was
characterized by (a) a conflict within him between his actively maturing
young self, the one that collaborated with the analysis (the “healthy analy-
sand”), and the “stuck”-infant–self who was represented by two opposing
twins: the helpless one who had apparently suffered from an infantile ca-
tastrophe (he now believes his mother suffered from Asperger’s disorder),
one who feels he cannot grow and is therefore fated to be left behind,
and his twin, the rejecting martyr–self who has rejected his helpless twin
and joined up with a severe, pathological superego object—Bion’s (1970)
“obstructive object”—and acquired the illusion of protection of a redoubt-
able psychic retreat (Steiner, 1993), the latter of which offers “protection”
at a price: no escape; and (b) a conflict within me about the conduct of the
analysis: On the one hand, I tried to maintain my analytic stance through-
out the analysis, and did so throughout its duration. Yet I also became
aware of another me who I retrospectively realized felt maternal towards
him and even had phantasies about holding an infant–him in my arms. I
learned later from the analysand that neither his mother nor his father had
ever held him as an infant or child. In short, I began to realize that I felt the
desire to offer him a “corrective emotional experience” (Alexander, 1956).
Additionally, I had begun to feel guilty towards him, not just vicariously
representing his mother and father, but also as the analyst who was “wean-
ing” him into maturity—that is, I was “colluding” with the collaborative
infant at the expense of the hopeless, stuck infant, the one who believed
he could never grow: it was too late. I was endangering him by helping
the other one progress by causing a dangerously expanding rift between
them, leading to the fear of a psychotic break.
Whereas the specific nature of my interpretative stance may not seem
to be clearly delineated in what follows, I should like to present an epitome
of the ideas that inform it. The analysand is the youngest of four siblings
of a Jewish family from Western Europe who just barely survived the
Holocaust. Consequently, the “stars in my analytic compass” became: (a)
the trauma that his family had, individually and collectively, experienced
before he was born, but which was handed down to him in the family
“atmospherics” (Ferro, 2005, p. 4); (b) the specifics of putative neglect
by them in terms of an alleged lack of sufficient emotional attunement
and care with regard to developmental milestones; (c) the analysand’s
unconscious phantasies with regard to his own idiosyncratically excessive
nature (“too needy”, “too greedy”) as his own autochthonous (solipsistic,
self-referential) way of accounting for the first two factors. I consider the
last as the proper focus for analytic intervention until the analysand has
achieved the depressive position, at which time and only then will he
be able to work through his allegedly justifiable reasons to critique his
family’s parenting of him objectively, because it is only then that he will
be sufficiently separate from his objects (mother, father, and his analyst)
and be individuated enough to be able to distinguish his own contribution
from the objective reality which they represent (to be able to distinguish
between the “persecutor” and the “enemy”.
Analysand: I’m not ready to grieve it.

Analyst: Which means you’re not yet ready to let go of it.
Analysand: Right. I’m not there. Well, maybe this is the beginning of it,
I don’t know, but I want to say, “I object!” (Crying.) Let’s say that I
had a right to what B and my other children are getting. Of course,
I had no such right, but I want to say that I did. (Sigh.) I’m sorry
that there is nobody to blame. I can blame my parents. They can
blame theirs. They can blame Hitler, and Hitler can blame whoever
he came from. There is something cruel in the demand for justice.
I’m so hung-up on morality—on doing things virtuously and right.
I dreamt about it last night, or something. I’m remembering some
kind of exchange, but I don’t know that it happened. (Silence.) He
(his father) is hung up on something. My mother’s insistence on
virtue and justice has always been sort of inane to me. It seemed
crazy. What the fuck was she talking about? (Silence.) It will be dif-
ferent for my children to know that the world isn’t all pretty, but
they’ll also know that Mommy stands by them.
Analyst: And Daddy?
Analysand: And Daddy. Daddy really stands behind Mommy in my
family. (Long silence.) . . . What I feel most acutely is that something
that neither they nor R (his wife) have to feel—that there is no safety
net. Maybe that’s what I knew from the beginning. Maybe that’s
why I couldn’t be a kid.
My private feelings: I had long felt this inner vacuum that the ana-
lysand experienced since childhood. It was as if he had always been a
tired old man, since childhood—and alone! I felt his aloneness and the
tentative guilt for my quasi-alienation from him—but I also believed that
he had unconsciously “orphaned” himself by psychically “divorcing” his
birth family and his adult family, as well as me, for vengefully envious
reasons.
Analyst: There was no safety net to protect your sense of innocence
about yourself and the world you were living in at the time and
even currently with regard to my lapses in being protective for
you.
Analysand: No, no safety from them, and the flood that ruined our
home (at age 14) was the confirmation. To the degree that I felt I
could count on my parents, it was there, and to the degree that I
couldn’t count on them, it wasn’t. The place where it hits me the
most is when I need to show initiative. R tells me that, if I wish to
build up a better legal practice, I have to do more outside work,
give lectures, do lunches with businessmen, and so on. I need to

prepare better. I’m too disorganized—something about starting a
project and making it my baby. I can’t do it.
Note: In previous sessions I had interpreted that he unconsciously be-
lieved that he had been an unwanted baby because of what he, conscious-
ly, surmised from letters between his parents, and unconsciously, from his
belief that he had been too needy a baby for his parents in the past and for
me in the present. As a result of this belief he emotionally “divorced” his
family as an infant, unbeknownst to them—and, as a matter of fact, to him-
self—and had been an “orphan” ever since: and was one with me as well,
especially when I leave him for weekends and vacations. Following this,
we came upon the “orphan” him who had become split off from the more
adaptive child who was able to progress. Since that split unconsciously
took place, any progress made by the adaptive and dependent self came
at the peril of the “ungrown, undevelopable, unsalvageable infant” (the
analysand’s phantasy). To this latter infant growth means a foreclosure of
its rights and an implosion of its very being and the despair that it/he can
never “make up” and be restored ab origine. This conflict constitutes one
of the sources of his negative therapeutic reaction.
Analyst: Shepherding it through its development, as a parent with a
child. It seems that today it isn’t so much that you don’t know how
to do it as you won’t do it because if you do it, then you are confirm-
ing that it hadn’t been done for you. What you seem to hate is the
reminder of what you feel you missed.
Analysand: Absolutely right.
Analyst: As if you are still waiting forever for it to be made up to you
before you can rejoin your other self and your current family and
then move on.
Analysand: Well, not at this juncture, but I guess I am still waiting for
a make-up. There is no question that I’m waiting.
Analyst: So you dare not do it for yourself, because that would cheat
you out of it’s being made up to you and for you.
Analysand: Right. I think there are two meanings. I know it, but I can’t
let myself know in my heart of hearts that it won’t happen.
Analyst: There’s a dread of foreclosure.
Analysand: Yeah. It’s done. It’s a done deal.
Analyst: Like declaring bankruptcy.
Analysand: A done deal. The record is there and it is unalterable. (Tears.)
And I’ll die without ever knowing what it would have been like.
I was filling up at a gas station and suddenly remembered my

great-aunt. I guess it was something she used to say. She used to
be like really sharp (sigh), like sharp as in both smart and kind of
acerbic, with an edge to her. And there was something very kind
of honest about her—also very cold, but real—and then I suddenly
realized, wait a minute: She’s dead. I am thinking about her as if
she still exists. She was alive a moment ago in my mind, but now
she’s gone, just as I will be one day. A figment of my imagination.
A combination of that (sigh) . . .
Analyst: The transience of life.
Analysand: Yeah, not only of life, but of every bit of life.
Analyst: You were there, and you turned around, and she was gone.
Analysand: I didn’t even notice.
Analyst: That’s seems to be the point. You’re waiting endlessly for a
magical restoration of your stolen portion of life, your infancy and
childhood, and all the while that you are waiting, your life is pass-
ing—slipping away—like your aunt’s has already. It’s gone.
Analysand: You’re right. I was speaking to my mother yesterday, and
she said that her best friend, who lives in Vancouver, had a stroke,
and that he is 80 years old. I exclaimed: He’s 80?! And she laughed,
and she said, you keep imaging that we’re young. Your Dad is
77. It kind of shocked me. I thought he was 70, and Mom was 65.
Whoops!
Analyst: In other words, there is a fear that time will pass on so rapidly
and those who can repair the damage, theoretically, will die before
they can make it up to you and for you—and that goes for me too.
Furthermore, you, too, will die, and that infant will not have become
redeemed, and all that time will have been wasted.
Analysand: You’re right there. Like they fucked up with my sister, and
that they did better with me. (Sigh.) Take it all away. Now! I was
thinking this morning—what am I doing here? What am I trying
to do? You can’t undo what happened. You can’t make up for it. If
you are present, you can give me a better life now, but it feels like,
if I give up on this, it’s like agreeing to a suicide.
Analyst: Accepting an infant–child amputation.
Analysand: In a way I got spoiled. I got over-protected in some ways,
but I wouldn’t get to play with other children very often. I’d get to
be an aristocrat, but I didn’t get to play. You know: I got royal treat-
ment. It is royal treatment that kind of works against me because
the world is not interested in treating me as royalty. I’m just another

ant. The kids demand that I learn to play—and each time that I do,
I know that I can, and I know that I haven’t. What’s been killed is
not the playing. What has been killed is the opportunity. There is no
Messiah coming for those. (Sigh.) And I know that in the meantime
that I am killing off opportunities now.
Analyst: Which will never come again because you are getting older.
Analysand: Life hates me, I hate you, I hate my parents, life. You know,
I have to tell myself, shit or get off the pot. I mean, you’ve got to
shovel the horseshit. Can’t have one without the other. But I can’t
buy it. My objection becomes louder than everything else. (Sigh.) I
still don’t accept that if this is part of the price. I respectfully return
the ticket.
Analyst: Apparently not so respectfully.
Analysand: Or disrespectfully return the ticket. I’m a kid. (Teary.) You
know, in the Book of Job,2 at the end (sigh) Job gets a whole new
family—a new wife, new kids. See, in the book it makes it sound
like he’s O.K. with it—but he wasn’t—it is so unnatural for killing
the first bunch—and there is no way around it—I can’t look at it
any other way. I need your help. I need your help speaking out of
the whirlwind, I need your help around the revelation, and noth-
ing helps.
My private thoughts: The analysand vacillates between trying to be-
come rational about his dilemma and becoming recalcitrant, martyred,
anguished, and hopeless. The pressure I experience from him to offer him
redemption as a “make-up” (to be made whole) is enormous. He is having
a profound effect on me. I find myself feeling guilty about the blessings of
my own life, past and present.
Analyst: I think probably Job comes closest. I think you are telling me
that children are to be raised with the illusion that fairness exists.
Analysand: I wasn’t.
Analyst: Until they are ready and old enough to deal with life’s real
unfairness.
Analysand: I want a make-up!
Analyst: I think you think that there was—that everyone else got it,
and you didn’t.
Analysand: Some get protected from it.
Analysand: I wanted Santa Claus.
Analyst: I think you can see it the other way ’round. You got too early
a preview of coming “unattractions”.
Analysand: When R (wife) buys F (eldest daughter) a present—not a
present, but clothes or shoes—she’ll wait until F falls asleep, and
then lays them out on the floor in front of her bed. So she knows.
So she gets to wake up to this amazing surprise.
Analyst: You are looking at the happy adulthood you are not enjoy-
ing.
Analysand: What is there to enjoy?
Analyst: Happiness for a good wife, wonderful children, and things
seem to be going right.
Analysand: Things are going right except I feel constantly like I am
under a fucking curse.
Analyst: You didn’t get what you wanted once upon a time, and now
feel permanently handicapped, even though you have the grown-
up family with wife and children you want, because you are still
fighting a battle that’s been lost a long time ago. A revolution, isn’t
it? It never was supposed to be fair. It was never fair. Furthermore,
I wonder if you don’t feel that you are cursed because once upon a
time you made a sinister bargain with a demon within you to pro-
tect you from life, and now you’re suffering from that bargain.
Analysand: There is a book: it has that for a title, Without Guilt or Jus-
tice.
Analyst: Without “guilt or justice”—how appropriate to our theme.
Analysand: I ought to have had what was my right, my God-given
right.
END OF SESSION
My unspoken thoughts on the session

The analysand is dealing with an issue that I have come to real-
ize has universal elements contained within it: the belief that one has
had an incomplete, and therefore “unsuccessful”, infancy and child-
hood—as if there should have been a protected field of innocence
encircling oneself and the world around one, and a prescribed dura-
tion of protected and stimulated events with loving parents and other
grandparents, as well as proper shepherding through all one’s infant
and childhood milestones, and so on. Trauma in infancy, however it is
defined, and however it occurs, whether it originates in the caretaking
environment and/or is worsened by negative traits in the infant—that

is, envy, greed, projective identification, manic defences, and so on—
mitigates against the formation and development of a secure attach-
ment between infant–child and parent.
The result of this failure often devolves into a splitting between an
infant who believes he or she cannot grow or develop, on the one hand,
and an infant who can accept his dependency on imperfect objects
and “make the best of a bad job” (Bion, 1979), on the other. Winnicott
(1960a) has arrived at a similar but somewhat different construction
with his “true”- and “false-self” dichotomies. In my experience the
“ungrown—ungrowable infant” sabotages the attempts of the other
actually growing and developing infant to progress, fearing the de-
velopment of a greater and greater cleavage in the personality leading
to fragmentation. Furthermore, I consider it to be one of the principal
factors in the development of a “pathological organization” or “psy-
chic retreat” (Grotstein, 2002, 2005; Steiner, 1993). Finally, the issue of
“curse” and “bargain with the devil” is entering the analysis.
In the here and now of the session I began feeling like a “cheer-
leader” parent who was trying to coax a deeply troubled child out
of his anguish. I also felt bad that I could not provide him with the
make-up that the unanalytic me (my maternal instinct) wanted to give
him (my enactment).
Session
ADAPTIVE CONTEXT: First session of five in the week. I am leaving for a
ten-day vacation.
Analysand: The cat destroyed the mocking-bird’s nest by our house,
along with eating up the fledglings. There was one little one that
survived, so R (wife) and D (daughter) put him into a little box
and put some seeds in there and fed him some worms, but I guess
with the shock of the attack it wasn’t doing so well. It died over-
night. It was sad, but that’s how it goes. It’s sad . . . it would have
been so miraculous if he had made it. The cat is now on our shit
list for doing what comes naturally. She’s so cuddly with us, but
that doesn’t mean she is not a predator. I remember when R was
pregnant with D, we were walking to a concert at B and it had just
rained, and there was a worm that crawled out onto the sidewalk,
and we passed him and thought, you know, he’s probably not go-
ing to make it on the sidewalk, and so we walked an additional
half a block and then we both had to return. We came back and we
moved him to where the brick was, and on our way back, again
both of us were sort of compelled to take a look at the place where

we left him . . . there was something about saving the worm, saving
the fledgling. I guess I was also startled about the fact that birds no
longer wanted their fledgling it if already had the mark of death on
it. They knew something that we didn’t want to know.
My private thoughts in beginning to build a “tree of inference”: The
adaptive context is in place—my forthcoming vacation. The analysand is
identified with the baby sibling birds that were eaten by the predator–cat
and with the transiently surviving fledgling, which later died. The analy-
sand may also be more deeply identified with the predator–cat itself that
invades mother’s insides and devours her “internal babies”. This all hap-
pens because I am leaving him alone in a vulnerable, helpless state when
I depart on my vacation. He also shows me how he wants to be treated
by me when he saw the endangered earthworm and returned to place it
in a safe place. I experience that he is projecting guilt into me, and I am
feeling it. But there was something else—his accepting life’s indifference to
living creatures while at the same time not shrinking from his protective
humanity to an earthworm. He had achieved the depressive position and
had come face-to-face with O (Bion, 1965, 1970) without faltering—that is,
the achievement of what Bion calls a “transformation in O” and what I call
“achieving the transcendent position”.
Analyst: I wonder if you’re still in contact with being a “fledgling”
who felt abandoned to predators over the weekend break as well
as contemplating my forthcoming vacation—and also recalling how
your parents, along with your sister, went on a prolonged vacation
and left you with your grandparents—and you weren’t ready for
it. Maybe you felt they left you—as I left you—because you have a
stigma, a sign on you of being an “unsuccessful baby”, one that is
to left to the predators because of something being unaccountably
wrong with you, like being so very needy. Furthermore, I think you
not only identify with the fledgling but also reluctantly with the
predator–cat, can’t bear it, and are also envious that she is able to
be true to her nature.
Analysand: Well, I did wonder if this baby was alien to his parents. I
guess I really identify with the bird. R was saying that the battle
must have gone on for a couple of hours, because she remembers
the commotion when she went to go nap, and then she woke up
an hour and a half ago, and it was still going on, and then she
and D walked out about half hour or an hour later, and then they
figured out what was going on. The mother and father bird were
dive-bombing the cat, but the cat had found the nest. There were
feathers everywhere, and this little birdie was sitting there just sort
of paralysed with fear. And the parents were sort of a few feet away,
standing around squealing at the cat. It’s so weird when something
changes in the appearance, just from the separation, where it’s no
longer recognizable—had become alien to its parents.
My private thoughts: The inability of the parent birds to save the fledg-
lings strikes him initially, but then he adds the term “alien”. He seems
to be saying that the parent-birds did not save this fledgling because it
had become “alien”—alien because of the change in the status of the nest
caused by the predator–cat. The transference implications were obvious:
He feels alienated from me when I leave, and then he projects this aliena-
tion into me, resulting in my considering him alien.
Analyst: Well, you see, I think that you have become American, and
your family remains foreign.
Analysand: What do you mean?
Analyst: They’re still ___, and you’re not.
Analysand: Oh, right.
Analyst: Something must have changed your appearance for them. You
learned English and speak it virtually like an American, but, from
what you have told me earlier, your parents and your older sisters
speak with an ___ accent.
Analysand: Oh, yeah.
Analyst: So you’re the only one in the family without an accent, the
alien . . .
Analysand: I guess I am the alien.
Analyst: But I think you have always felt like an alien and even feel
like an alien with me.
My private thoughts: The concept of his being an alien is now being
developed by him and me.
Analysand: Yeah, but I betrayed them on a whole variety of levels. I
didn’t pick my partner based on family blessing. I didn’t listen to
them when I chose my wife. I didn’t ask for their blessing—mean-
ing they didn’t do the picking. You know, I betrayed their beliefs
and customs. I betrayed the family life. I’m a traitor. It’s so hard to
see this, to see it clearly. I mean, I arrive at my parents’ house, and
I know I hate them, and with that it’s so hard to kind of back off
and just look at it. Hate them, maybe, for being different from me.
Hate them for having their life, for fitting together—even though
I don’t want that fit. I want a fit but I don’t want that fit. I don’t
want it, but I envy it. Well, they already had a family, a son and
two daughters, and then I came along much, much later. I think
it was more than what they could deal with. It was all peace and
quiet until I came along ten years later. I guess I’ll never know why
I was born. I wonder if she made this—her decision—on her own. I
guess in some way I wonder if you’re leaving because you thought
you had made a mistake in taking me on.
My private thoughts: I now get the notion that his alienation from his
family started very early. Because of how he may have experienced the
bonding and attachment situation to each of the members of his family
and to his family as an entity unto itself, he may have unconsciously “di-
vorced”—that is, alienated himself—from them and then projected this
alienating process into them towards him, and into me so that I would be
inclined to alienate myself from him. I also thought then of the phantasy of
the “changeling”, where the devil kidnaps the good baby and substitutes
his own diabolical baby.
Analyst: I think you believe that I’m leaving because I made a mistake
in giving birth to you—because you’re an alien to me, a “change-
ling”, and now I’m retracting my desire to be your analytic mother.
Maybe you feel like the victim fledgling to conceal being the preda-
tor, and that is why I’m felt to stay away.
Analysand: You know, I actually don’t know how I felt at the time, but
I wonder when they left for that one month whether I had a similar
kind of reaction as this.
Analyst: That must have been so painful for a little four-year-old boy,
but I wonder if there might not have been another factor, similar to
one between you and me. I wonder if, early on, you did not react
to being left alone by unconsciously alienating from them; and in
the next moment thought of them as alienated from you, the way
maybe you feel towards me—that I am alienated from you, thus I
am going on vacation.
Analysand: “Very interesting possibility.” It wasn’t that I was too young
but that I was a pain in the ass, that’s why they left me behind. I
would have been high-maintenance under the circumstances. I sort
of feel like I’m in a dream. I don’t quite know what the dream is.
My private impression: The analysand confirms that his alienation might
be due to his having been a “prodigal son”, but he also confirms the organ-
izing importance of that prolonged family vacation without him—and its

transference implications.
Analyst: Well, maybe the dream has to do with whether or not you
believe you survived. Maybe you’re identified with the fledgling
bird who did not survive who reminds you of your own fate.
Analysand: You know, I’ve also had this life-long identification with the
Holocaust. And it’s sort of like feeling disconnected, but I feel like I
shouldn’t have lived. I should have been that bird. It’s weird how so
much of this stuff comes to me not as a feeling but like images . . .
Sort of like the stuff I described before—like an organic slime inside
of something with ridges and something that clearly has muscles
that contract that used to be alive.
Analyst: A weird and scary animal?
Analysand: Yeah. Enormous. Sort of like the three blind men and the
author. I can’t quite grasp what it is I am interacting with, but it feels
like it’s something that might eat me up or crush me. Like being a
plank from under a whale. I think that’s why when R got pregnant
for the first time she freaked me out, because she reminded me of
something like that. Yeah, not like buzzards, but caterpillars. You
know, that molten stage? So, something was weird. She was trans-
forming into something, and I could have no idea where it was go-
ing to end. I mean, I knew where it was going to end, but it didn’t
feel that way. It felt like some sort of crazy metamorphosis. I guess
like how you would watch an alien life form.
Analyst: That alien life form is really your own life from which you
have departed, alienated yourself. And now it represents the life
that you’re not supposed to have because you forfeited it. You now
feel like the “man without a country”, actually, without a self.
My private thoughts: The analysand seems to be undergoing a virtual
phylogenetic, certainly atavistic or primitive, regression because, presum-
ably, of the terror of his being isolated and alone—alienated. He is also
rationalizing—justifying—why his family once upon a time and I in the
present should abandon him.
Analysand: You know, the first thing that came to mind is, if I have it,
I’ll kill somebody. I don’t know how much of this is cultural and
how much of it is my family, but there was always this thing that,
if you let somebody worry, they’re going to have something terri-
ble happen to them. You don’t worry about anybody because they
could have a heart attack or they could have a stroke or die.
Analyst: There’s no difference between the words themselves and the

deed.
Analysand: Like when my grandfather was supposed to be told that his
brother had died. They gave him Valerian3 drops because the worry
was that he would not be able to bear it. That’s what my guess is.
They couldn’t bear to watch him trying to bear it.
My private thoughts: It seems that the analysand is confirming that he
believes that unconsciously he contains a sense of badness.
Analyst: It appears that you are confirming my earlier interpretation
that your identification with the victimized fledgling bird defends
against a fear of being a murderer, that you feel identified with a
primeval sloth–whale–predator and that it is only safe for me as
well as for you for you to be the alienated one. It is better to be
abandoned than confirmed as sloth–murderer.
(The analysand was silent but appeared very relieved as the session
ended. As he left, he looked back and said, “Thank you”.)
Comment
Although much of this session reflected the here-and-now transfer-
ence with regard to the weekend break and especially to my forthcom-
ing vacation, these elements served as reconstructive evocations of
significant traumata in the past, when he, the youngest in his family,
was left behind with his grandmother while the rest of the family
left for a month’s vacation. He was four at the time. The phantasies
that emerged from today’s session represent current editions and re-
visions of what he must have gone through emotionally/psychically
at the time. My own reverie ↔ countertransference feeling was guilt
for abandoning him. This feeling, I have come to realize, while ap-
propriate to me under the circumstance of my forthcoming vacation,
additionally belongs, I believe, to what I have elsewhere termed the
“Pietà transference ↔ countertransference situation” (Grotstein, 2000):
one in which the analysand, much as in the ritual of exorcism, projects
guilt—as destructive demons—into the analyst and wishes the analyst
to experience and acknowledge the guilt that his parents did not feel
or acknowledge.
Notes
1. In the midst of experiencing this phantasy I had forgotten the paper I had once
written where I put forth the idea of the “Pietà transference ↔ countertransference”
in which the analyst, who is innocent, must be thought of by the analysand as ac-
cepting the guilt and responsibility for past wounds which the parents, who are
nominally guilty, failed to do. Yet the moment described above is a good example
of it, I realized afterwards (Grotstein, 1997a, 1997b).
2. What synchronicity that I apparently anticipated the analysand’s reference to
Job in my earlier private thoughts!
3. Valerian was an anxiolytic medication that was used in Europe in the nine-
teenth and early twentieth centuries.
CHAPTER 10
Clinical example 3:
brief case illustration
of the predominantly “Bionian” mode
of technique
A 24-year-old recently married woman, who had just emigrated from

a Central European country, had begun psychoanalysis with me about
four months prior to the episode I am about to report (this analysand
has been mentioned previously in clinical vignettes). I assessed her to
be high-functioning but suffering from, among other things, culture
shock in her new country, with extreme homesickness. She entered
analysis on a five-times-per-week basis. The analysis proceeded quite
well, and she dreamed profusely.
Suddenly one day she entered my consulting room appearing

strange—almost as if she were sleep-walking, or at least in a trance.
She walked towards the couch, lay on it for a second or two, and
then sat up and relocated herself in a chair facing me. Her demeanor
was ominous, mysterious, eerie. While all this was in progress,
I found myself becoming more and more uncomfortable, to the
point that I became anxious, but I didn’t know about what. Then I
found myself becoming terrified! In the meanwhile the analysand
remained silent. Actually, she had been silent for about 20 minutes,
which seemed like a lifetime to me at the time. I then began to feel
that I was dying! I knew that I wasn’t, yet I really felt that I really
was. When the feeling became almost unbearable, she suddenly
and unexpectedly broke the silence and uttered: “You’re dead!”
134
What emerged was a significant part of her past history that

I had never had been fully enough aware of. Her parents had
divorced when she was 3 years old. As was the custom in that
country at the time, the father, being a male, automatically ob-
tained custody of his daughter (their only child). He took her
away from her mother, far away to his own parents, who lived
in the Alps. Her grandparents thereafter became her functioning
parents—until age 7, when her father came to get her to relo-
cate her in her native city, so that she could attend school. When
the analysand told me that I was dead, she then related this
story: She recalled the railway train, the station platform, and her
and her grandparents’ tearfully waving goodbye. She never saw
them again. She claimed that they both died soon after—of bro-
ken hearts. The date of this analytic session was an anniversary of
that fateful train departure.
Now that the analysand had broken the silence—and so mean-
ingfully—I recovered my composure and tried to sort out all that
I had heard and experienced. At first thought I that she had pro-
jected into me her experience of her grandparents’ deaths. I had
intended to interpret that, but this is what I mysteriously heard
myself saying instead: “I believe that, when you waved goodbye
to your beloved grandparents on that fateful day, you ‘died’ as a
self and have remained emotionally dead up until this time. The
anniversary of its happening seems to have brought the event
back to life for you. You gave to me your intolerable feelings of
your emotional death and the death of your grandparents be-
cause you could not bear to experience them, but now hoped that
I could bear them for you and ultimately with you.” She then ex-
claimed, “Yes! Yes! Yes!” and cried. This session became a turning
point in her treatment.
Comment
In short, a powerful emotional event took place between us in
which I became both dreamy—in a spontaneous state of reverie—and
“dreamed” (Bion, 1992, pp. 120, 215) what the analysand could not
yet process (“dream”). When I presented the interpretation to her, she
experienced immediate relief, not only because of its correctness, but
because of what I have now come to believe was my own courage to bear
her ancient unbearable agony, suffer it as if it were mine, and then formulate
it for her in a way that was tolerable. Ultimately, as she was able later to
point out, she could not have faced her feelings—what I would call her
personal truth—then if I had not had the courage to go through this
momentous scene with her.
I became aware of the selected fact for this session only once the ses-
sion was over. It emerged from my unconscious through my reverie
when I believed that I was dying. That experience gave coherence to
the whole session.
CHAPTER 11
Clinical example 4:
a patient analysed in the style (my version)
of the Contemporary Kleinians
T
he patient, JW, is a 45-year-old married film-maker from a South
American country, who has lived in this country for the last 12
years. His wife is pregnant with their first child. Both parents are
still living in Z. He has a sister who is two years older and a brother
four year, older, both of whom also reside in Z. He first consulted me
for depression and for feeling that he was a “loser” in life, in his pro-
fessional world, and in his marriage. He had many affairs but felt bad
about this behaviour of his, especially now that is wife was pregnant.
I recommended analysis after the second consultative session, and he
accepted. He began analysis at a frequency of five times per week and
used the couch from the beginning. Of note, aside from his depression
and his affairs in his current life, was his having suffered severe beat-
ings by his mother when he was a child and adolescent. He reported
that his father never rescued him from her assaults.
Session
ADAPTIVE CONTEXT: First session of the week; he contemplates return-
ing Friday to his distant home for a week to see his family, particularly
his father, who is seriously ill.
Analysand: You don’t look well. Are you suffering from something I
should know about?
137
My countertransference reverie: The following were thoughts to myself

before deciding whether or not to answer him with an explanation or
an interpretation, or say nothing and wait: In fact, I had been ill of late.
He had in passing inquired about me the previous week, but in a more
solicitous way. I began to think that he was being ever so slightly critical,
perhaps because my illness might prevent me from being totally avail-
able to him this session, especially since it is close to a week break. It also
reminded him of his father’s illnesses in the past and the putatively seri-
ous one now. I began to believe, consequently, that his question and the
way he presented it suggested to me that he was affecting indifference to
his perception of my suffering. Actually, I was feeling quite well enough
to conduct the analysis. I felt, in other words, that he was ever so subtly
goading me to put my suffering aside: I should stop being narcissistically
involved and give all my attention to him. I felt somewhat assaulted by
his question, and somewhat guilty as well. After I self-reflected at length,
I believed I could not let his question remain unanswered.
Analyst: I thank you for inquiring. Am I right in picking up a trace of
gruffness in your manner? I wonder if you may not be suppressing
your deeper feelings of concern about my health because of your
resentment—as well as your fear—of my being ill on your time and
therefore compromising our preparation for your departure for a
long break.
Analysand: I don’t know. J (his wife) called me yesterday afternoon
while I was working. She kept me on the phone for over and hour.
She was worried about me. I resented it because I had a tight sched-
ule and needed time to pack, get a visa, and do a host of other things
in preparation.
My countertransference reverie: The analysand consciously avoided my
interpretation (maybe it was off) but unconsciously seemed to have con-
firmed it: J’s needs are holding him up, as he believes my illness does.
He seems to be anxious about not having enough time—for what? I won-
dered.
Analyst: I gave you an interpretation, and you seemed to ignore it, yet
you then went on to reveal how annoyed you were that J had taken
so much of your time on the phone—similar to how you feel my
illness would cost you analytic time. I wonder if you are trying to
cut me off as well as J so that you can be emotionally unencumbered
over the holiday break—so that you can travel light and catch up
on time—and are wanting me to approve of it.
More reverie: While I arrived at this interpretation, I began to feel that
I had become his mother, whom he did not look forward to visiting, and
I felt that my previous interpretation had been incomplete. I now believe

that he saw me as his weak, hypochondriacal father who couldn’t protect
him against his still frightening mother. I simultaneously began to un-
derstand his shortage-of-time concern. He experienced deep dependency
feelings towards me. I then spontaneously recalled how he had lately been
complaining about how long the analysis is taking. (It was the third year.)
When would he ever finish and acquire his “grown-up” visa? Dependency
feelings caused him to feel smaller, and this made him feel more vulner-
able, especially when he is with his mother or with a mother–me in the
transference.
I then interpreted the above results from my reverie to him as fol-
lows:
Analyst: You seem to be edgy, maybe both about your holiday break
from the analysis and from being with me, and also about going
into the “lion’s den”—with your mother in particular. Maybe you
have to diminish me by attributing your weak dependent self—as
well as weak father to me—so that you can feel yourself to be in-
dependent and strong when you arrive home.
Analysand (heaved a sigh of relief—a change in the atmosphere in the
room was palpable): Yeah, I will miss being here, and I hate leaving
J, especially now that she’s pregnant.
My countertransference reverie: No sooner had I given my interpretation
and the analysand his response than I began to realize that I may have
missed an important transference theme: when the analysand curtly asked
about my condition at the beginning of the session, I now feel that he was
trying to manoeuvre me to “straighten up, stop thinking of yourself, be
my strong advocate”.
Analyst: I now have another idea about the nature of your inquiry
about my health at the beginning of the session. You may have
been acting like a top sergeant attempting to rally me from my
self-indulgent illness. Maybe, because you recognized that I was ill,
you felt the need either to rally me or diminish me and be strong
on your own.
Analysand (raised his right hand, thumb up, and seemed relieved with
the interpretation): It reminds me of when I was a child and had an
imaginary companion. He would be my make-believe older brother
who would protect me from bullies—especially my mother. I guess
that’s what I use you for, my protector . . .
(Silence for two minutes.)
My countertransference reverie: The emotional atmospherics silently
and almost imperceptively seemed to change. I suddenly experienced a

draft of cool air—as if someone had opened the door of the consulting
room and either left-or entered! I was puzzled but could only wait for
further developments.
Analysand: I had a dream last night. I was in my house with a lot of surveil-
lance cameras. I was with my wife in the future baby’s room. Somebody
secretly steals in, I go for my gun. They (the burglars) had a gun. They
were handling it as if they knew what they were doing in terms of work-
ing with the lock.
Associations: I’m afraid to leave J now, especially since she’s pregnant. I
feel bad that I can’t be there to protect my wife and child to be.
Analyst (I was mindful of my countertransference reverie above as he
spoke; I interpreted): I think we may see the dream on one level as
corresponding to your concern about your wife’s safety in your ab-
sence. On another level, the burglars that threaten your home with a
gun and who appeared to know how to manage the lock seemed to
hint that the burglary was an inside job: you as the burglar threaten-
ing your home with your affairs. The you in the dream who was
with your wife may correspond to the analysand–you who wishes
to make progress in the analysis, whereas the burglar may be your
negative “protector” twin who wishes to attack progress in the
analysis. The surveillance cameras may be your conscience on one
level, and the defence against the analysis on another.
Note: The knowledge about the affairs had not, to my knowledge, been
mentioned in the text, but I had a sudden flash remembrance of them at
that very moment—and I also had some second thoughts about his using
me as his invisible twin-protector, split off from his dependency on his real
mother and father as a child.
Analyst (continuation of the interpretation): Yet I believe that yet another
level may be operant. The burglar may represent me, as your negat-
ing twin’s view, the burglar-intruder into your mind to find him out
and unlock his—really your—omnipotent hold on you so that you
can become free to progress.
My countertransference reverie: I felt that my sensory “illusion” (intui-
tion, transformation in O) about someone leaving as someone was enter-
ing the consulting room bore fruit. The cooperative analysand left as the
resistant one entered. My “dreaming” his dream, his associations, and my
countertransference reverie seemed to confirm my suspicions.
Analysand: Doc, that’s really neat. That really ties it up. I wish I could
use you as one of my writers. I feel I’ve made a lot of progress here
despite the fact that I sometimes want to hurry up and leave so that
I won’t be left behind. I’ll miss being here; I think I’ll write down
my dreams while I’m away.
My countertransference reverie: His praise of my interpretation seemed
hyperbolic and insincere. I felt that I was in the presence of the disingenu-
ous twin. I decided not to respond now, just wait.
Analysand (continuing after a significant pause): Oh, yeah, I’ve been
meaning to tell you I got my Mastercard statement Monday. My
spending is over the top. I’ll have to ask my father for more mon-
ey. The trouble with me is that when I see something beautiful
and shiny I can’t resist it. I was in the Century Mall some time
ago and saw this beautiful Apple Mac. It cost a bundle, but I had
to have it.
My countertransference reverie: I believed that the analysand had qui-
etly accepted my interpretations (in a similar session in the past I had
gently called him “a secret eater”), felt confronted, and decided to change
the narrative focus of his associations with the aim of appeasing me, reas-
suring me that he was a good and dutiful analysand. I was now dealing
with the disingenuously compliant one. He now offers me thoughts that he
has reason to suspect that I would be pleased to interpret to him. In other
words, I had a notion that he was setting me up for a cliché interaction,
an analytic compromise in mind—that is, a “treaty” between his progress-
ing self and his anti-progressing self. I believed this because he had once
attended a lecture I had given (unbeknown to me at the time) on Bion’s
Learning from Experience, in which Bion discussed the situation in which
an infant may have had all his bodily needs met by his mother, but not his
emotional needs. These infants then transfer their emotional investment
into non-human objects. I sense that the patient was trying to pull me into
giving him that interpretation so that we could be on the same team, to
enter into an enactment with him and enter a state of folie à deux.
Analyst: I think that you wish me to be pleased with your progress in
analysis, with you for having made it, and with myself for conduct-
ing it. The dream about your house and the surveillance cameras
give me to believe that they are the searchlights for an inner for-
tress that protects a twin you from deep analytic investigation. The
you speaking to me now is his proxy and thus a double agent. I
believe that you unconsciously still hide out in that fortress with
your twin to escape beatings from the cruel voices within you. It
is where you lick your wounds when you felt assaulted, terrified,
and alone. You’re wanting me to be a more realistic and potent
protective twin for you.
Analysand (Long silence. I noted tearing. He extended his right hand

back to me indicating his wish for me to offer him some tissues: I
took this as a good sign): I guess the only one I ever trusted was my
imaginary twin. He was my teddy-bear who would keep me safe.
If I hear you correctly, Dr G, somewhere down deep I don’t trust
anyone, not even myself. I have to fake it with people, I guess even
with you, and I don’t know at the time that I’m doing it. I recall
how I used to run away and hide somewhere where she couldn’t
catch me. I would masturbate to calm myself.
My countertransference reverie: I was deeply moved by his response. I
believed he had gone from the paranoid-schizoid to the depressive posi-
tion, from –K to +K. I was relieved for the moment and then wondered if
this analytic “enlightenment” was a tactical ploy from his inner defensive
self.
Analyst: I wonder if there’s a connection between your trauma, your
exciting and soothing masturbation, and your compulsion to have
affairs with women who not only had been damaged as you had
been but also reminded you of your mother. And I also wonder if
I’m not one of those women you wish to join up with excitedly to
pretend you’re safe from mental beatings.
Analysand: You mean, I’m still trying to work it out with Mom and
escape from her at the same time? This must have something to do
with my trying to escape from J, except she’s the most innocent and
truly loving of any of them. (Followed by tears.)
END OF SESSION
Discussion
The now well-known technique of Betty Joseph and her Contemporary
post-Kleinians has become well accepted and established. It is charac-
terized by the analyst addressing the “here-and-now” in an acceptably
mature, not infantile, language and attempting to intercept the analy-
sand’s transference machinations to manoeuvre him into enactments,
which at base are aimed at effecting stalemates, psychic equilibria,
and/or states of folie à deux—all variants of a negative therapeutic
reaction. In the past Kleinian analysts as well as those of other schools
have focused on interpreting the analytic text: the linear, sequential nar-
rative of the analysand’s free associations. With the rise of the values
of irreducible transference ↔ countertransference and various forms
of intersubjectivity,1 there has been a movement from the one-person
to the two-person practice of psychoanalysis. One may conceive of
this difference in the focus of technique as the difference between the

vertical ordinate and the longitudinal axes of polar-coordinated space.
The traditional Kleinian technique as espoused by Segal may include
Joseph’s focus on the here-and-now but will give more attention to his-
tory, including immediate past history—that is, day residue. Her tech-
nique can therefore be considered as being mainly linear. He term that
describes it is text. Joseph’s technique is largely vertical and focuses
almost entirely on the emotions generated in the present moment. Her
technique can be described as the analysis of process.
I prefer to oscillate between these two styles (three styles, if we
add Bion) of listening and thereby participate both in the immediacy
of here and now and that of unconscious phantasy. Then I would put
them aside, waiting to discover which technique or techniques the
analysand’s associations beckon. I hope that I have demonstrated the
importance of oscillating between these two styles.
There is yet another point I should like to make. It is my belief
that all the while the analysand “speaks” linear text, he is really using
the components of the text as convenient retrospective displacements
about how he feels at this “here-and-now” moment.
From the text perspective it would seem that the analysand is plan-
ning his internal object equipage for his ambivalent journey home. He
was bothered by the depth and tenacity of his analytic regression and
felt that it was emasculating him vis-à-vis his anticipated confrontation
with his mother and his need to be a “grown-up” with regard to taking
care of his father’s illness. The latter’s illness may be why he had been
irked by mine. His wife is also an object with whom he feels devoted
and regressed, but now he has to face being an adult once more in terms
of his soon-to-be-born infant. From the process perspective he seemed
to warn me to rally and acted in that regard in an almost military man-
ner to get me back to full duty. He wished to go on his holiday with a
strong internal me to fortify him, and this wish seemed to have come
from the cooperative analytic twin. On the other hand, the analysand
sought to reassure me that he was devoted to me to defend him against
some danger. Thus, the distinction between the anti-analytic and the co-
operative twins became clearer. The former was connected to the trau-
matized child self who refused parental help for obvious (legitimate)
reasons and became a hermit associating with women of the demimonde
who had backgrounds such as his. The language in which I addressed
him was mature and “analysand-friendly”, and I refrained from using
primitive infantile part-object words or ideas. Events from his past his-
tory were brought into the immediacy and “here-and-now”ness of the
current transference ↔ countertransference situation in which each of
us was under pressure to detect manipulation in the other.
Session
ADAPTIVE CONTEXT: This session took place midweek about two-and-
a-half years later. A highly important contextual feature is the analy-
sand’s need to be absent from the analysis for all the following week
because of work-related issues. In the meanwhile, we had worked ex-
tensively about his history of being repetitively beaten by his mother.
He would try to avoid her as much as he could during his childhood
when he had to live at home. From a very young age he would hide
in his room and masturbate to sooth himself. He explained to me that
he was puzzled by his obsession to have affairs—with beautiful but
emotionally damaged and childhood-traumatized women, especially
when his wife was so wonderful, loving, and beautiful herself. We
then began to work on the two lives he has habitually lived: an overt
and a covert one. My previous interpretations in which I linked myself
(a) with his mother, by virtue of my “beating” of him with analytically
forced recollections, and (b) with his father, who didn’t protect him
against them and her weren’t very effective with him. I figured that
maybe my interpretations weren’t apposite enough at the time.
Analysand: My film work parallels some aspects of my life. I feel like
I’ve been two people. . . . The other is very, very young. As R (his
son) got older, he was even more attached to his mother, and I felt
shoved aside by her—like going to an orphanage. The feature I am
working on has to do with children being sent to an orphanage,
which also reminds me of the movie “Orphanage”, which came
out many years ago. In the film a woman who had been an orphan
grew up and returned to run the same orphanage. I forget the older
picture, but in mine there is a similar story, but the orphans of
long ago still haunt the orphanage. There is also a story line in the
picture I’m working on in which a very young child is so sad that
he gives up on himself—literally. He imagines himself throwing
himself down a well, into oblivion. Later he is haunted by a ghost
who taunts and frightens him. Sometimes it plays hide-and-seek
with him. After a while, the ghost softens its behaviour and con-
tinued its hide-and-seek behaviour in a friendlier, but still teasing
and tantalizing way, but it still keeps hiding. It is afraid of everyone,
even while it is playful. “You want me? Come find me!” it would
playfully but challengingly shout.
My countertransference reverie: The analysand had said a great deal.
While I understood the manifest theme clearly enough, I found it difficult
at first to come up with the unconscious theme. I “massaged” his acknowl-
edgement of being a walled-off and dissociated self, as well as finding him-

self in a reverse Oedipal situation in which he has become, in unconscious
phantasy, the exiled father, and his son the proud over-lord of his mother’s
body and affection—for the moment. Finally, I was ensnared by “You want
me? Come find me!” I had become so fascinated by what he was saying
that I felt like an eager participant in a tantalizing game. He was trying to
excite me to play this one-sided game with him, probably to avoid facing
the pain of his self-imposed isolation and his guilt towards his wife and
son with regard to the resumption of the affairs. That was my cue.
Analyst: I think that ordinary life seems to be your orphanage, and you
hide as a ghost down your protective well with it, where you ex-
iled—and keep exiling—yourself. The exiled self, the one to whom
I think I just spoke, is trying to tease and tantalize me with “You
want me? Come find me!” . . . “But you never will!”
Analysand: I’ve never felt so alone or so bad. My producer commented
on how I always seem to cast wild girls. I have everything to live
for: a wonderful, loving wife, a wonderful lively little boy who
adores me and climbs all over me, I’m advancing in my work—and
yet I’m miserable. . . . (Silence for three minutes.) . . . I have an as-
sistant who has been working for me for many years, and I respect
him. I unselfishly recommended him for a better job that suited his
abilities. My son resonates with the me who wants to be lovingly
taken care of and made a big fuss over. Cake—he demands it. He
wants what he wants when he wants it. He just wants the stimula-
tion.
My countertransference reverie: Is he trying to make obviously unself-
ish amends for his affairs? Or is he trying to impress me with his contri-
tion: is he purging himself so that he can sin again, like a good Catholic
at confession? The theme of selfishness and unselfishness seems to be
emerging.
Analyst: You say you resonate with your son’s demandingness and
his need for stimulation. Stimulation is like being loved, soothed,
and satisfied: what you feel you missed as a child and miss every
time you have to leave me and the analytic “family hearth”. You
were showing me your unselfishness with regard to your assistant.
I also felt that your generosity was meant for me to appreciate so
that I would think well of you, to offset your guilt about the affairs.
I wonder, though, if there is yet another reason: The orphan you
might be envious of the happy family that indulges its child with
stimulation, soothing, and cake. So maybe you would also like to be
like your innocent and loved son, the one who could have his cake
and eat it too. You can continue your affairs, confess them to me,
feel absolved, and enter a state of grace, and then do it again.
Analysand: I never had the option to be selfish when I was a child. Now
as a grown-up I handle it in two ways: on the one hand I show
myself to be frugal and generous. I think that you would think that
my affairs show my selfishness. (Three minutes of silence.) I had a
dream the next day: There was a gala birthday party for one of the stars
in the movie. Hundreds or even thousands of people were there at a huge
lodge. He was flown in by helicopter, with fanfare. Everyone was on one
side—the opposite side of the lodge, behind a rope rail. I wanted to cross
over and be on the other side. There was lots of dancing and famous chefs at
elaborate food stations. It was chaos, but everyone was having a good time.
An almost beautiful woman began flirting with me. She was aggressive.
I looked down and realized that I wasn’t wearing my wedding ring. She
wanted to get pregnant. I couldn’t talk to her about being pregnant.
Associations: I’m working a lot, but that gets in the way of my
work here in the analysis. Analysis is protection for me from my
compulsions. Oh, yeah, I was working late last evening and went
to get a pizza in the dining room. The funniest thing happened. A
fat woman saw me coming and hid all the pizzas.
Analyst: It seems that you’re dealing with issues of selfishness, gen-
erosity, and unselfishness. I get the feeling that one you wishes to
get whom he wants when he wants her. That you wants me, who
knows about all your past suffering, to give you permission to be
with her or at least acknowledge that you’re right in satisfying
your demands. The more cooperative you desperately wants me
to help free you from this obsession, which seems to have control
over you.
Analysand: You’re right! You’re right! But how am I ever going to get
free?
END OF SESSION
Discussion
Selfishness and its ramifications seem to be the “selected fact” of the
session. The analysand wants very much to allow himself exclusive
family love with his wife and child, and he desperately wants freedom
from being confined in his obsession. His use of me in the transfer-
ence ↔ countertransference includes two contrasting wishes: The anti-
analytic twin seeks to co-opt me into his service to grant him his self-
ish wishes because he has suffered enough and is now entitled to a big
party of girls. The other twin is well aware of the value he has in his
present family and wishes to protect it.
Note
1. See R. Blass’ defining contribution (2208) where she actually compares Segal’s
textual technique with Joseph’s process technique.
CHAPTER 12
Clinical example 5:
“bicycles”
presented by Shelley Alhanati,

supervised by JSG
T
his case presentation is an example (albeit my version) of the
application of standard Kleinian technique—with intimations of
Bion—with regard to the analysis of a man who alternated be-
tween the paranoid-schizoid and depressive positions but largely dwelt
in the former. The second and third presentations demonstrate more of
Bion’s (1962b) reverie, which constitutes both an extension and a trans-
mutation of Kleinian technique. Shelley Alhanati, who was trained at a
Kleinian institute in Los Angeles, whose own training analyst had been
analysed by Bion, and whose formal institute superior I was, is one
who utilizes her own unconscious somato-psychic “alpha-function”
in a state of reverie with her analysands to enable her to transform her
analysands’ “beta-elements” (raw, inchoate, unmentalized proto-emo-
tions) into her own personal O—that is into her own corresponding
personal emotions—and from there once again into useful, tolerable
knowledge (“K”) as interpretations to her analysands.
To achieve this, Bion advises us that the analyst must “abandon
memory and desire” (1962b, p. 30)—as well as understanding and
preconception, and that he must be aware of being anxious during each
analytic session, by which Bion seems to mean that that the analyst
should always be prepared to anticipate the relentless intersections of
O, both within the analysand and within him or herself: the analyst
must feel the analysand’s pain. Moreover, the analyst must be prepared
148
to “become” (not “identify with”) the analysand, much as the mother

must “become” her infant, an unconscious act that transcends “under-
standing” and identification (Bion, 1970, pp. 26, 36).1
Case presentation:
“bicycles”
It is Friday (fifth of five weekly sessions). The patient, a male, walks
into my office, lies down on the couch, and starts the session talking
for about 15 minutes in a laborious and detailed way about different
types of antique bicycles. I am having a difficult time making sense of
this. I am bored, and I can’t figure out what emotional relevance any
of this has to anything. Suddenly, I notice a very sharp, intense pain
in my ear. It is now at the point of being unbearable, and I am con-
templating whether or not I should interrupt the session and leave the
room. I am trying to think of how to phrase this to the patient when,
as if out of nowhere, he says, “When I was born, I had to have surgery in
my ear. They say I was screaming for hours.” As he says this, the pain in
my ear disappears.
There is a long silence.
Then he starts convulsing and trembling.
Analyst: What is happening?
Analysand: I feel sick . . . my head is killing me . . . I’m sweating . . .
my head is going to explode . . . I never talked about the surgery
before . . . I never really thought about it. (Then he falls asleep for
about 5 minutes.) I dreamt my mind was all cluttered. Then you
started to talk to me. I don’t remember what you said, but it calmed
me down.
Analyst: My words were reassuring to you?
Analysand: The sound of your voice. (Long silence.)
[My countertransference response: At first, the atmosphere seems quiet
and reflective, but after a while, I start to feel disconnected and impa-
tient. He also seems to be getting frustrated. I feel he is desperately
trying to communicate something but can’t get through to me.]
Analysand: Close your eyes.
[My countertransference response: I do and I find that I am put in touch
with a different dimension of the experience. I begin to feel the atmos-
phere in the room. I notice how cool it is, and I begin daydreaming
about holding him like a little baby, rocking him, cuddling him. In the
daydream, we are floating in some kind of liquid, as if the air in the
room is made of oil, like baby oil or something. I decide to try to see
if this daydream has anything to do with what he is trying to com-
municate.]
Analyst: Wanting to be held?
Analysand (looks relieved): Now you understand . . . I had a dream
that I asked you to sit next to me, and you did, and you held me.
I don’t know how to explain this, but we were kind of blurry, like
liquid.
Analyst: Your body flowing into mine and mine flowing into yours—
like we are one.
Analysand: Yes, like you are a part of my soul.
Analyst: And you are a part of mine?
Analysand: I hope so.
Monday
(Thirty minutes of silence, patient lies down and puts a pillow over
his eyes)
Analysand: I didn’t know if it was Sunday or Monday.
Analyst: You didn’t know if you would see me today.
Analysand: Yes.
[My countertransference response: I don’t have much to say, but I feel he
has lost touch with something that would enable him to communicate
with me, and he needs me to help him find it, so I try to at least put
this feeling into words.]
Analyst: Afraid you’ve lost me, hoping I will come find you.
Analysand: Yes. Could you take this pillow?
[My countertransference response: I hesitate, wondering whether it
would be more helpful to interpret here or go along with his request. I
remember other times when the mood was similar to this and in which
he seemed to short-circuit when I tried to interpret, so I decide to go
along with it.]
Analyst (I take the pillow, he starts shaking; it is clear that he can’t
speak): Are you afraid?
Analysand: Yes, I can’t control the silence.
Analyst: Can’t control my silence?
Analysand: No.
Analyst: Can’t control your silence?

Analysand: Yes.
Analyst: Wanting me to take away the pillow that silences you on the
inside?
Analysand: Yes. Once it starts, I can’t control it. I don’t know why I’m
feeling that way. I wasn’t feeling that way when I came in. I don’t
know what makes it go that way.
Analyst: Maybe you start to feel that way when you’ve lost me. When
you lose confidence in my continuing presence, it shifts from a
comforting silence to an anguished silence.
Analysand: Yes, that could very well be. It starts when I withdraw. I
don’t know what makes me go inside like that.
Analyst: Maybe start to go inside when you can’t be sure of my being
here outside, want to be inside me, but then start to suffocate inside
the silent-pillow-me inside you.
Analysand (seems thoughtful here): I think you could be right.
[Analyst: In retrospect, I notice that at certain points I omitted the
pronoun “you”. I think I was unconsciously matching the form to
the content in that the “you/me” distinction was disappearing be-
tween us.]
Thursday
(Patient comes in, lies down, folds his black jacket over his eyes,
and is silent. I can’t tell what this silence is about.)
Analyst: Allowing your thoughts to settle?
Analysand (shakes his head “no”).
Analyst: Trying to keep the light out?
Analysand (shakes his head “no”).
Analyst: Feeling the heaviness or the pressure?
Analysand: Yes!! (Pushes his face inside the jacket.)
Analyst: Pushing your face inside the jacket, like pushing your face
into your mother.
Analysand (nods “yes”).
Analyst: Wanting to press yourself into me?
Analysand: Yes. (Pushes his foot into the pillows of the couch.)
Analyst: Pushing your foot inside a mother?
Analysand: No.
Analyst: Feeling the texture?
Analysand: Yes.
[My countertransference response: At this point, I begin having a phan-
tasy about his jacket, which is black, and the blanket on my couch,
which is purple. I am imagining that my blanket is covered in blood,
and that he is suffocating. I have an image that he and I are both float-
ing up over our bodies, like an out-of-body-experience—looking at
this scene with our bodies covered in blood. I am then reminded that
this is similar to his actual birth experience, in which both he and his
mother underwent extensive emergency surgery, and that his father,
who is a surgeon himself, was present in the delivery room and actu-
ally saved his life.]
Analyst: Like the rough texture of your Father’s beard?
Analysand: Yes!! (nodding vehemently).
Analyst: Wanting to be comforted by your father’s presence. Needing
to feel safe and protected.
Analysand: Yes!!
Analyst: Afraid to be left alone with a mother who is dying.
(No response, no movement. There is a sort of paralysis for approxi-
mately 20 minutes.)
Analyst: Are you withdrawing?
(No response.)
Analyst: Does it feel not safe anymore to talk to me?
(No response.)
Analyst: We have to stop.
(Analysand didn’t move; it took him about five minutes for him to
get up.)
Monday
(Thirty minutes of silence).
Analyst (countertransference response: I don’t really have anything
to say, but I just start to talk, kind of free-associating). Afraid of
death?
Analyst: Afraid you will hurt me if you allow yourself to be born in

here?
Analysand (presses his lips together very tightly).
Analyst: Afraid to let any words out—as if the words were a baby-you
being pressed out and born from your lips.
Analyst: As if the words will kill you or me if they are let out.
Analysand (at this point, he spoke very clearly): Yes.
Analyst: I think that being born was an extremely traumatic experience
for you, and that a part of you felt like it died on that day.
Analysand: Yes.
Analyst: I think you felt that you had killed your mother on that day
and a part of you tried to undo the damage and imagined that you
went back inside her and became unborn and saved her life.
Analysand: Yes! (nodding several times).
Analyst: And I think that a baby–you is trying to remain unborn here
with me, to protect me.
Analysand: Yes.
Analyst: But that the you who died inside is also hoping that I can
revive you.
(No response.)
Analyst (I was clearly off on this last part, so I tried to readjust it to
fit better): That you can be reborn in here with me, and that I will
survive it.
Analysand: Yes! (Nods vehemently.)
Alahanti’s discussion
In his paper “Orphans of the Real”, James Grotstein (1995a, 1995b),
who, happened to have been the supervisor on this case, very poign-
antly describes the experience of certain patients who have had a pre-
mature awakening from what he calls “the protective blanket of innocence”
either because of a hypersensitivity indigenous to the patient, perinatal
factors, a traumatic abruption, or whatever. He feels that these patients
were prematurely and traumatically born into the “Real” (“O”) and so
were never able to symbolize, fantasize, or otherwise create their sub-
jective worlds. [This is similar to Winnicott’s (1971) concept of magic
and the moment of illusion.] In other words, these patients had been
robbed of their contact with the ordinary magic of infancy.
I want to say something about supervision here. I don’t think I
could have entered into this space with the patient had it not been for
the parallel experience that I was having on an unconscious level in
supervision at the same time. The question, “Is it you or is it me?” is
irrelevant when we are working in this dimension. Both the patient and
I were being held and contained in a very profound way. It felt like
we were both being born and coming alive through this experience.
I have always thought of this patient as “our” patient. On the day I
stopped going to supervision, the patient had a dream that someone
had died.
Before I had this experience, I really had no idea that people could
change this much. It changed my entire conception of what is pos-
sible. Making contact through these largely nonverbal, often uncanny
phenomena, which were stimulated, in part, by deep silence was a
crucial factor that facilitated the move forward into first, integrating
the senses, becoming embodied, and then, gradually, coming alive
into more intimate and dimensional human relationships. An essential
type of communication that occurs between the mother and her fetus
or newborn was able to occur between the patient, the analyst, and
JSG, and a deeper kind of holding was taking place. The practical was
joining up with the magical.
Conclusion
I have tried to present an example of a case in which the heart of
the work was being done—and had to be done—in the space between
the words, in the music, in the atmosphere, in our bodies.
JSG’s comment
The experience of supervising this and other cases presented to me by

Shelley Alhanati was a rare privilege. She has that gift of “second sight”
brought to our attention by Winnicott (1956) in his concept of primary
maternal preoccupation, and by Bion, in his concept of maternal rev-
erie (1962b) and transformations in O (1965, 1970), and which has helped
launch the intersubjective revolution in psychoanalysis—quite apart from
its later parallel development in the United States. Alhanati works peril-
ously close to the intuitive, mystical borders of what seems like telepathy.
I have been witness to many of her fantastic clinical experiences along
that line. Are some individuals born that way? The experiences Alhanati
is talking about transcend our concept of intersubjective projective tran-

sidentification (Grotstein, 2005). Is this a gift that most mothers and infants
are privy to quite early on, as in Winnicott’s (1956) concept of “primary
maternal preoccupation”? And does it then generally submit to repression
a few weeks post-partum? This form of “telepathy” may be related to
the new discovery of the “mirror neuron”, which allows us to be open to
some degree to the emotional life of the other (Decety & Chaminade, 2003;
Eisenbud, 1946; Gallese, 2001).
Alhanati’s work, which constitutes an application of Bion’s concepts
of maternal reverie, container/contained, and transformations in O (Bion,
1962b, 1965, 1970), must also be seen in the light of Daniel Stern’s (2004)
pioneering work on “the present moment” and the similar work of his
group, the Boston Change Process Study Group. Alhanati’s technique is
unbidden. She is not aware that she is using technique. Body feelings spon-
taneously just happen to her. One is reminded here of Thomas Ogden’s
(1997a) Reverie and Interpretation, where he also follows Bion’s technique
of reverie by following his own free-associational verbal flow, and of Julia
Kristeva’s (1941a, 1941b) concept of “le sémiotique”: the sensorimotor lan-
guage of primary process.
Note
1. Case presentations presented to me by Shelley Alhanati while I was her con-
trol supervisor at the Psychoanalytic Center of California (PCC) many years ago.
CHAPTER 13
Clinical example 6
presented by a supervisee
supervised by JSG
A
DAPTIVE CONTEXT: Creativity blocked; mother visiting next
week. Friday session, fifth of five weekly sessions.
Analysand: I called the bank today to see which account I should
write your cheque on. I was planning to write your cheque in the
waiting room but then I realized I didn’t have my chequebook. I
guess I’m going to just have to keep watching this. . . . I thought I
had a handle on it, but . . . the handle slipped out of my hand. About
an hour ago I started to get agitated. I thought of calling about five
different people, but then I thought, oh, it’s about you, and it’s
Friday, and I needed to eat. I called John (the boyfriend who has
just broken up with her), but then I just hung up. I really don’t like
Fridays. And I don’t like this aspect of the work. The bill—why do
I have to pay, anyway? The Friday thing and feeling vulnerable. It
is so much compared to my pay cheque. I feel deprived. Five times
is not enough and two times used to feel way, way too much. Now
nothing is enough.
JSG’s impressions: The indecision about which bank account to use to
write her check to the analyst conveys a state of confusion as well as a
reluctance to pay the analyst—because the money is real and reminds her
of the day when she has to separate from her analyst for the weekend—all
suggesting a regressed infantile transference with its concomitant expres-
sion of a desire for unconditional (free) love and a hatred of “weaning”.
156
The state of confusion suggests that the analysand has entered into a state
of projective identification with the analyst in order to avoid the emo-
tional experience of separation. “The handle slipped out of my hand. . . .”
suggests further projective identification into the handle that is being
split off from her. In other words, she is splitting off and projecting her
sense of competence and responsibility for herself to the analysis and the
analyst into the analyst for the latter thereafter to administer. “It’s about
you, and it’s Friday, and I needed to eat” suggests a sense of urgency and
frenzy—that she realizes that this is the last session of the analytic week (“I
thought of calling . . . five different people”) and contemplates prolonged
emotional hunger and feelings of abandonment over the weekend. “Why
do I have to pay, anyway?” confirms my earlier idea about an infantile
transference in which she wants total care without responsibility or the
awareness of separateness (unconditional love).
“It is so much (the bill) compared with my pay cheque” conveys to me
the idea that the analyst is greedy and exploitative of the analysand: she
has projected her own infantile neediness into the analyst, and now a new
reason emerges for her forgetting her chequebook—to prevent her being
exploited and greedily emptied by the now-perceived-as-demanding ana-
lyst. Her feeling deprived seems to confirm that. “Five times is not enough
and two times used to feel way, way too much” again confirms that she is
dealing with feelings of extreme neediness turned to greediness (five times
is not enough) because she does not appreciate and mentally digest what
she gets from the analyst five times per week as it is. “Two times was too
much” suggests that she again entered a defensive mode and projected her
needy greediness into the analyst, after which: “Now nothing is enough”
seems to indicate her re-ownership of her distressing neediness.
So far I have enumerated my “left-hemispheric” tracking of the asso-
ciations in the analysand’s text. Now I attempt to capture the analysand’s
affective shifts and my counter-responses. I am handicapped, of course, in
doing this, because I was not there as her analyst: thus, I am not within
the emotional loop with the analysand. I detected, however, that the analy-
sand was petulant and complaining. I felt her pleading with a Mommy–me
not to introduce her yet to “weaning” in the broadest, most metaphorical
sense. I tentatively felt bad for feeling responsible for her displeasure,
guilty for charging her a fee, and guilty for sending her, unprepared,
into the weekend. In other words, I became the container for and the
complementary introjective identification of her protesting attacks, which
rendered me tentatively guilty and concerned about an infant–her who is
frightened by the spectre of aloneness or having to have any responsibil-
ity for herself in my absence. I also felt that she was pleading with me to
hold her and soothe her.
What I, JSG, might have interpreted: “It seems that you’re anxiously
anticipating the weekend break from the analysis and me in which you
feel you’ll be left all alone to starve and be uncared for. The feelings are
so painful that you seem to split them off and assign them to me, who
you then think is taking advantage of you. You also avoid your needy
feelings by surrendering your ability to cope as a separate person—‘the
handle slipped out of my hand’—resulting in your being even less able
to handle the weekend break. The chequebook painfully reminds you of
our separateness as well, and you thus enter into a state of confusion to
avoid that fact.”
Analyst: Are you confused, disturbed by that change?
Analysand: Well, I actually think it indicates progress. Like how I miss
John vs how I couldn’t wait to get away from Anthony (ex-hus-
band). It’s not balanced, though. It’s like two extremes. Our con-
nection is very different now, and I experience your presence very
differently. This is pleasant now, and I don’t want it to end . . . or
John to end . . . I even experience Anthony differently now. Could
I just say, “Damn, there is that bill again.” It’s not at the right time.
(She looks in her purse again.) I called the bank three times. It just
feels really unpleasant! Should I call John or not. I’m overwhelmed
with anxiety. But then if I sit with it . . . it’s just a bad feeling. Maybe
next time I’ll know what to say or do. I’ll try to stay focused.
JSG’s impression: I tentatively assume that a split has taken place be-
tween a now suddenly emerging and progressing dependent infant in
contact with a still remaining good analyst (John) and a bad one (Anthony,
ex-husband–ex-analyst?)—“like two extremes” (polarization). “Your pres-
ence is pleasant and I don’t want it to end”: but the awareness of the bill
suddenly breaks up the good feeling—at a bad moment, just as she is
entering the weekend separation. “Should I call John or not?” suggests
that the bill did come between her and the analyst and created a split
in her feelings about her. “I’m overwhelmed with anxiety”—now that
I’ve attacked my link with John (the analyst). But then she seems to be
reconciled to the loss of the analyst over the weekend: “It’s just a bad feel-
ing”—but not the end of the world—“I’ll try to stay focused”, sounds as if
she has completed the restoration of the lost linkage with the analyst and
is reconciled to accept her separateness over the weekend and honour the
covenant between them.
From the right-hemispheric intuitive angle I experience the analysand
as relenting a bit and trying to contact me, the analyst. I feel relieved but
wary.
What I, JSG, might have interpreted: “Both the weekend break and your
having to pay me my fee remind you of being left alone, feeling depend-
ent, vulnerable, and separate from me. It feels so painful, apparently, that
you seem unconsciously to have split me into a tentatively still-remaining-
good-analyst and an ex-analyst (ex-husband)–me. But it seems the good
me has developed a good track record with you, and you wish to hold on
to your good feelings about that me. But the idea of the bill—the cost of
being reminded of being separate and dependent at the same time—feels
hard to accept. However, you seem to be able to balance the good feelings
with the bad and thereby permit the good image to remain. As a result you
feel you will be more able to stay focused over the weekend.”
Analyst: I’m thinking about the three important things you are talking
to me about. The bill, the Friday, and no John. I think all three signal
to you the limitations in the relationship. The bill reminds you that
our relationship is a business one, and that means you pay me and
you don’t see me on the weekend; the Friday signals this separation
and limitation. John reminds you of the reality of the limitations in
that relationship vs the fantasy you held in your head about it.
Analysand: Yes. Hmmm. I called my daughter, I only got her answering
machine. But maybe she was screening her calls and didn’t want to
talk to me. I called Leslie too, but I think she was seeing her analyst
at the time. So yes, you are right. There are limitations in all these
relationships.
JSG’s impressions: The analyst interpreted in her own way what I have
already suggested above, and the analysand confirmed her interpretation
in her response in which she acknowledges the limitations of relationships.
I feel that the analysand is conceding her need to accept her separateness
but is not happy about it. I still feel cautiously and hesitantly relieved.
Analyst: It is as if an aspect of you experiences an aspect of me, the
analysis, and these others who you hold so close to you, as an ex-
perience of going on being . . . being held, being fed . . . of overall
nourishment, and Friday signals it will all stop. You must want to
keep on eating and part of you feels you won’t be fed again for
three days.
Analysand: Yes! My relationship with you and with John has limita-
tions. . . . But I guess everyone had to wait until the next feeding.
Everyone’s mother had to go to the bathroom or take something off
the stove. Do we all go through that? If Leslie doesn’t like some-
thing, she tells you straight up! And if Anthony wants to know
something, he asks straight out. I have all this shame and guilt
and feel like I have to be little Miss perfect. In this decade, in this
room, I can finally say, “I don’t like that bill!” It feels wrong that
there is no oceanic caring. Maybe that is God. Maybe I’ve been
looking for God my whole life. But I want it from significant oth-
ers, unconditionally, no effort. You should just know when I need
you telepathically. It seems all wrong. You’re not there 100 per cent
of the time. And you’re not 100 per cent permissive and giving ei-
ther! I feel there is blame—someone must be blamed. I pushed you
away, I was inattentive, I should have known something, I have bad
breath, I messed up, I forgot, I was angry and you knew it, you like
someone else better than me. I’m more trouble than I’m worth, I’m
all wrong. I messed up, I missed a cue, I should have known! (Very
distraught.) It’s not just that we are not here together on Friday and
Saturday—oh, I meant not here on Saturday and Sunday.
JSG’s impressions: After acknowledging her analyst’s interpretation
about limitations, she tries to reconcile with the inescapable truth of its
normal occurrences and is even able to esteem those who can accept sepa-
rateness and speak up for themselves. But she then returns to her major
theme: the need for absolute and unconditional love. She feels cheated out
of not having received it and is repeating her anguish and protest about
it in the transference. She also is solipsistically (narcissistically) rational-
izing why her analyst refuses her this unconditional love—because “I’m
all wrong. I messed up”, and so on. Then she makes a slip of the tongue,
which might indicate that she is missing the very Friday session she is in
because of her protest.
I feel closer to the analysand now. I feel she is engaged. I feel her pain
about her belief that she prematurely lost emotional and physical contact
with mother. I experience the impulse of wanting her to jump up on my
lap and hold her.
What I, JSG, might have interpreted: “I believe you feel torn between a
wish to cooperate with me and accept separateness during the weekend
break, on the one hand, and a reluctance to do so because it means for-
feiting forever your longed-for hopes of ever making up for the uncondi-
tional at-one-ment with mother—in this case, a mother–me—you felt you
never received. You appear to have been so conflicted that you psychically
missed today’s session, which you’re still involved in. Could that same
thing have happened once upon a time?”
Analyst: There may be some truth to that slip you just made. It is true
that you are here being very honest with yourself today, yet perhaps
another part of you feels that by focusing so much of your time in
Friday’s session about being anxious on the weekend, you actually
miss your Friday session.
Analysand: Well, I certainly missed my morning. That fact that I expect
everything to be so predictable IS my mother!! Her whole life was
the punctual clock. Part of me is horrified with that life, but part of
me wants it and expects the same thing. It DOES help me to know
when I will see someone. I didn’t like the vagueness of John . . .
never knowing when the next call or visit would be. I think it is
why I love any kind of Twelve-Step meeting: They start promptly
on time, they are the same steps, and the words never change. A
timer goes off, then you start, then stop, every three minutes a timer
goes off, it’s very predictable. My Mom only liked food that was
familiar to her. But I’ll try anything, and I am dancing again—I am
different from her.
JSG’s impressions: The analyst effectively addressed the analysand’s pre-
vious associations, and the analysand acknowledges that she missed the
morning session she was in. In her next series of associations, however, she
sheds light on her early and continuing relationship with what appears to
be a compulsive mother who, like the analyst, is punctilious about when
she can be seen and when not. She reveals that she has become projectively
identified with this mother’s character. She then reveals her addictive past
by her allusion to “Twelve Steps”. Between her negative reference to her
mother—and perhaps, by innuendo, her analyst—she switches to a posi-
tive, trustworthy aspect of punctiliousness. She then favourably compares
herself with mother, who only likes food that is familiar (cannot stand
separateness and differences). I suspect that the analysand has just now
projected her fear of separateness into her mother, really her analyst–moth-
er, and has now become the analyst–self who can countenance differences
and who is now free to dance.
I continue to feel the analysand’s closeness. I feel her anguish about
being un-held.
What I, JSG, might have interpreted: “I think you remain anxious about
being separate and are now trying to handle it another way. We were just
speaking of your thwarted desires for a make-up for unconditional love
and addressing how feelings of separateness banish your hopes for this
make-up. It seems that you feel that your mother’s punctiliousness about
time may have been a factor that cheated you out of a beautiful experi-
ence of timeless moments with her—and me, here, now. Then, in the next
moment in your associations, mother becomes the you who cannot stand
separateness in the form of differences (in terms of food), and you become
the mother–me who achieves separateness and freedom enough to dance.
A switch may have taken place.”
Analyst: Perhaps you are wondering what degree of difference of sepa-
ration is allowed between you and your mother, I’m speaking to
the unconscious agreement between you and your Mom, just how
much separation/otherness is allowable.
Analysand: It’s like what you always point out in here, how I make
myself like others. To be not like you is dangerous and to be like
her horrified me. So, am I still holding on to the parts of her I have
left? My Mom liked to dance too. (Long pause.) I keep wanting to
ask you a question about me and Mom. (Long pause.) Just how bad
do you feel the breakdown was?
JSG’s impressions: The last portion of the interpretation I earlier sug-
gested now seems incorrect, but the analysand does seem to confirm that
she is aware of entering defensively into states of projective identification
with her mother in the past and with the analyst–mother in the present.
Finally, she is concerned about whether or not there was in fact a break-
down in the attachment-bonding relationship to mother in her infancy. I
suspect that she is now feeling hopeless, perhaps because she habitually
chose projective identification (becoming some else and “un-becoming”
herself as a separate, growing self)—albeit compelled to so, she might
believe, because of an unavailable mother.
The analysand is now really reaching out and repeating a series of
ancient neglectful traumata and begging the analyst (analytically) not to
abandon her. I feel closer than ever to her.
Analyst: Breakdown?
Analysand: With the bonding and attachment and the separation. I feel
something was broken. It seems as though it was pretty bad. Every-
one’s Mom has to go to the bathroom. . . . I’m not sure I know what
I’m asking you for. Do I want you to say, “Yes, it was pretty bad”,
or “No, we all go through it, this is just your version.”
JSG’s impressions: Here, I became favourably impressed by how ear-
nestly the analysand is working and trying to achieve meaning. She ap-
parently re-experienced an early, and now deep, moment in her life when
she gave up hope. She seems to be asking the analyst to reassure her that
she and her depression are analysable and that the analyst is up for it.
Now the analysand is pressing the point about hoping she can trust the
analysis and the analyst.
What I, JSG, might have interpreted: “I think you have just reached a
dark night of your soul that resonates back to infancy, down to your most
inner self, and forward in anticipating the end of the session and the week-
end break. You are wondering if I will be able to analyse you—that is, to
bear your pain with you and remain connected. You worry that I might
repeat what you feel was your mother’s pattern, but on another level you
may be concerned that, just as you abandon yourself to avoid pain, you
might perceive me as the same as you towards you: abandoning.”
Analyst: As an infant you lost your mother’s body when your father
wanted you out of their bed and put into a separate room, you lost
your mother’s breast when the doctor told your mother you were
getting too fat and so she stopped breast-feeding you abruptly. I
think all of your mother’s scrutinizing and displeasure with your
body throughout your life helped you to create a story that would
explain to yourself your painful experience of early loss.
JSG’s impressions: Important past history has just been revealed. The
analyst’s reconstruction of the putative reasons for the alleged breaking of
the bond with mother is now explainable. The associations that bore this
revelation constitute the “selected fact” of the session because this revela-
tion gives coherent union and meaning to all the other associations. My
view is that this alleged past history is being repeated right now in the
transference ↔ countertransference. The analysand autochthonously (sol-
ipsistically, narcissistically) believes that the analyst chooses her husband,
“father”, over her for the weekend because he is better-looking (“hair”, in
the next association) and that she, the analysand, is such a greedy infant
(in her estimation) that mother–analyst cannot possibly satisfy her so has
given up trying.
Analysand: Oh!! So the bad hair was the lost breast! I thought I lost it
because I smelled bad, or I didn’t poop on time, or I lost my jacket.
In the same way, I tried to keep John: by having the right hair and
right disposition and by being very orderly.
Analyst: We all make up stories to make our experience make sense.
Analysand: I think that is what I wanted you to say, that it is my version
and that we all have our versions.
JSG’s impressions: The analysand seemed quite relieved that the analyst
remained an analyst and analysed her anxious question about the possibil-
ity of a broken attachment rather than trying to confirm it. Reconstruction
of the past, when done at all, must emerge from interpretations about the
analysand’s “interpretations” (phantasies, beliefs) about what might have
occurred once upon a time.
I believe that the analysand feels relieved. Her analyst–mother did not
desert her. I feel that they are in good contact with one another and that a
progression from P-S to D has taken place.
Additional remarks
I was not the original supervisor on this case. The reader will observe
that in my “JSG’s impressions” I associate freely to the analysand’s
free associations and begin to develop a tree of inferences that will be

shaped (confirmed and/or discarded) by the analysand’s continuing
associations. Many of my “wild thoughts” will end up on the “cutting-
room floor”, while others will become confirmed and will remain. The
reader will note that some past history was presented as it emerged
in the course of the session. The reader is in the same position I was. I
read it fresh, without memory, desire, or preconception—in the Bionian
tradition—and thereby allowed the past to be “re-present-ed” in the
present analytic moment.1
I hope I have demonstrated the importance of the continuity and
succession of the analysand’s string of associations and how they con-
stitute a compact “necklace of meaning”: my version of the “selected
fact”, as well as the sudden shifts in the analysand’s sense of self oc-
casioned by splitting and projective identification. The psychoanalyst
and/or psychotherapist reading my proposed interpretations may be-
lieve they are too long. First of all, I am trying to demonstrate what I
believe is a complete interpretation—one that includes: (a) the maximum
unconscious anxiety or sense of endangerment of the moment—that
is, the “analytic object”, (b) the defences and or impulses set in play
to ward off this anxiety or experience of danger, (c) the psychic conse-
quences of employing those defensive measures, and (d) the delinea-
tion of the specific unconscious phantasy that serves as an unconscious
explanatory cause of the anxiety and/or endangerment. All the above
components are to be considered in the light of (e) the adaptive context
of the session. Furthermore, one must remember that during each ses-
sion the analyst or therapist is well advised to (f) seek the whereabouts
in the associations of the “unconscious infant” (the “once-and-forever-
infant or subject of the unconscious”), who is always seeking the object
with hope as well as eluding the object because of hate or dread.
My interpretation may also include only parts of what I have writ-
ten. The length of an interpretation is not the main issue. The cogency
and ultimate completeness of it is. Completeness—or “due diligence”,
as it is known in business—is, to my way of thinking, the obligation of
the analyst/therapist as container in order to contain the content that
presents itself as uncontained.
JSG’s micro-analysis of the first nine associations

ADAPTIVE CONTEXT: Creativity blocked; mother visiting next week. Fri-
day session, fifth of five weekly sessions.
Analysand:
(1) “I called the bank today to see which account I should write your
cheque on. I was planning to write your cheque in the waiting

room but then I realized I didn’t have my chequebook.”
The analysand reports an enactment on her part in which she has neglect-
ed or forgotten to bring her chequebook to the analytic session to pay the
analytic fee at the expected time.
(2) “I guess I’m going to just have to keep watching this. . . . I
thought I had a handle on it but . . . the handle slipped out of
my hand.”
The analysand is consciously aware that this was an enactment.
(3) “About an hour ago I started to get agitated. I thought of calling
about five different people, but then I thought, oh, it’s about you,
and it’s Friday, and I needed to eat.”
She realizes that this is a Friday session, the last of five sessions for the
week. Because of it, she anticipates going hungry for the weekend break.
(4) “I called John (the boyfriend who just broke up with her) but
then I just hung up.”
She realizes that she is so anxious about the break that she desires to con-
tact an ex boyfriend to fill the gap, but then decides against it.
(5) “I really don’t like Fridays.”
Calling her ex boyfriend may have constituted an acting-out against the
analytic covenant: to attempt to tolerate the anxiety over the break. In her
enactment she was in P-S. When she acknowledged that she was anxious
and that it was due to its being Friday, she entered D.
(6) “And I don’t like this aspect of the work. The bill—why do I have
to pay, anyway?”
Her question gets to the heart of the matter, the “selected fact” of the ses-
sion so far—the hatred of any reminders of separateness, which the Friday
session and the fee represent. She is longing for unconditional love and
feels the rules of the analytic frame cheat her out of it.
(7) “The Friday thing and feeling vulnerable.”
(8) “It is so much compared to my paycheque. I feel deprived.”
Not only does she feel cheated out of unconscious love; she is also being
deprived because of the fee, which may represent her greed projected into
the analyst as the large fee.
(9) “Five times is not enough and two times used to feel way, way
too much. Now nothing is enough.”
The analysand is in touch with her sense of enormous neediness.
JSG’s comment
In this chapter I only “parsed” the analysand’s first nine associations. Each
association, as I have mentioned previously, constitutes an independent
cosmos of infinite, syncretistic associations, only a limited number—or
maybe only one of which—may fit as a lock or key to the previous and
successive associations. I have tried to demonstrate how the very order
of the sequence of the associations generates progressive expanding and
deepening meaning to the text.
Note
1. I hasten to caution the reader that I do take the analysand’s history so that
I can be apprised of counter-analytic data. However, once the history is taken, I
recommend forgetting it and allowing it to return as the return of the repressed in
the transference.
CHAPTER 14
Clinical example 7
presented by a colleague
A
DAPTIVE CONTEXT: Fifth of five sessions. Creativity blocked (she
is a writer); mother visiting next week.
Analysand: This could be a very good day—writing seminar,
hike, seeing my grandchildren—but I’m afraid to let go of my pain
and paralysis. Can’t let it go! Had a dream last night. Can’t remem-
ber it. When I woke up I thought it was a critical dream that I must
tell you. Then it evaporated. Can’t retrieve it. Maybe I was doing
some kind of therapy on others. I was a therapist, some kind of
strange therapy, something primitive like a primal scream. Don’t
know why, a peculiar image that makes no sense. People almost as
if in a box, lying on their sides, all black.
Analyst: What does that image bring to mind?
Analysand: Sort of fetal-like position, so primitive and so, don’t know,
sexual or shameful. Maybe I feel all these feelings I’ve been feeling
are so childish and primitive, absurd and shameful. Delving into
feelings of childhood. So frustrated. Wanted to be noticed. I wanted
encouragement. I was ignored or ridiculed or just stupid the way
my fears would take over like when I ran hurdles in high school.
I couldn’t jump over the hurdle. Gym teacher and coach angry
and frustrated. Able to do it before but then not when they were
there. My confidence and excitement would evaporate. It was like
167
something from the pit would reach up and snatch my excitement

away . . . replace it with fear and self-loathing.
JSG’s private thoughts: It seems that the analysand experiences being
enslaved and her behaviour and thoughts controlled by what appears to
be a powerful and disdainful superego. “It could be a good day, but why
try? There’s no hope anyway”, she seems to be saying. She is afraid to let
go of her pain and paralysis. This sounds like more than just masochism
or depression. It sounds like an ongoing battle being waged in her inter-
nal world between her and a critical superego. Then a dream is reported
in which she is a therapist doing some form of therapy. She mentions a
“primal scream” and some black or blackened people lying on their sides
in a box or enclosure. I do not yet have a good feel for what is happening,
but I suspect that the “therapy” she is conducting is other than analysis
and is painful and destructive. I am picking up something about severe
inhibition, but it is not clear yet whether the analysand experiences being
the inhibited, the inhibitor, and/or both. On the other hand, I am aware
that this is the fifth and last analytic session for the week. Could it be that
the negative aspect of the analysand is attempting to discourage her ana-
lyst–mother and leave her despondent over the weekend break—that is, to
deposit her disappointed and disappointing self, in a concrete unconscious
phantasy, inside the departing analyst–mother so as to evade separation
and to control her with her complaints?
Analyst: You feel up against a hurdle with your painting now. Perhaps
you fear that I’ll be angry and shame you if you can’t get over it.
Analysand: Maybe, but I would include Jake (seminar leader). I just feel
paralysed. No reason for it. Why am I so different now? Where is all
the energy and excitement I had last year? My energy filled the halls
and bounced people over, including Jake. Now I feel shrivelled and
shameful of the way I feel. And ashamed of being fearful. I don’t
want to write. I want to retreat and be a baby. I want someone to
reach in and pull me out of this, to encourage me ’til it goes away.
Afraid of being abandoned in this state, left to rot. I want Mommy,
Daddy to come along and say . . . long to hear them say: “You are
smart, talented, and capable. We’re proud of you. Do more won-
derful things!” Had someone had just said: “You’re smart. You do
so well!” But there was no one there. So hard when you exist in a
void. No one on your side. How can you be like the other kids if
there is no one on your side? It’s a wonder that I learned to walk,
to speak. I learned by copying people, observing them, observing
others in class, teachers, adults. I was mostly trying to learn how
to avoid any negative attention.
JSG’s private thoughts: It is now clearer that the analysand feels inhib-
ited, almost to the point of paralysis, and experiences great shame about
her feelings of helplessness and also about her unwitting and unwilling
participation in it. When she states that she wishes someone would reach
in and extract her from her paralysed state, I begin to think that she
has, out of some as yet unknown anxiety, projected her sense of author-
ity and agency (“power of attorney”, as it were) into an internal object
(pathological organization?) and is trapped within that object in uncon-
scious phantasy. Moreover, I am wondering whether the analysand feels
trapped because she is projectively and then introjectively identified with
the analyst whom she is attempting to trap with her complaints. “I want
to retreat and be a baby” sounds not only like desperate resignation but
maybe also an even deeper conflictual wish to regress to an infantile state
and be taken care of.
JSG’s proposed interpretation: “I realize how bad you feel about your
paralysed state in which you feel like a helpless victim who has lost
contact with her valuable talents and how painfully ashamed you feel
about your condition. I wonder, however, if there might not be another,
unconscious infant–you who feels so desperate about and ashamed of her-
your-dependency (on me) feelings, then compare yourself with what you
believe to be a grown-up, competent, practicing analyst–me that you may
unconsciously be competing with me, enviously attacking me internally,
and thereby rendering me a blackened victim trapped in your black hole
with you rather than being able to leave you freely and creatively for my
weekend break. So, the more handicapped you experience yourself to be,
the more I become handicapped.”
Analyst: I wonder what negative attention you fear from me.
JSG’s private thoughts: The analyst’s dreaded retaliation!
Analysand: I’m afraid I’m too demanding. I shouldn’t need to see you
every day. You’ll get fed up with this infantile person who doesn’t
make progress. You’ve tried year after year, and I’m still in a funky
black hole, not coming out, not trying. You’ll get fed up with my
negativity. You’ll say if I can’t say anything positive then don’t say
anything at all. All I have to offer is my negativity . . . that’s who I
am . . . a minus.
JSG’s private thoughts: I get a hint from her statement, “You’ve tried year
after year, and I’m still in a funky black hole” and also by her claims to
be a too-demanding infant–patient—that she is employing the depressive
defence (Grotstein, 2000) to combat and triumph over the analyst–mother
by being a loser. The depressive defence (not position) is the converse of the
manic defence and is characterized by the analysand’s triumph, contempt,
and control over the object with which they are identified by being the
victim or martyr—that is, harming the self is equated with triumphing
over the object with which one is identified. To me that is the transference
configuration that at present seems to be operant. But when one thinks
about self-defeating experiences, one inescapably thinks of unconscious
envy: perhaps the analysand is chronically being sabotaged by her envious
superego, the origin of which may have been her earlier envious attacks on
her mother’s (creative) breasts when she was an infant. On another level,
however, the analysand’s statements here seem to have a false ring to them.
Perhaps she is attempting to coerce the analyst to reassure her of her posi-
tive feelings towards her—that the therapeutic alliance is intact.
Analyst: I think you’re afraid that I’m like your mother and father . . .
shame you for feeling negative, be impatient when you are feeling
this.
Analysand: Yes! And be mad when I can’t recite my speech, not do my
homework. I almost got to think that that was what people expected
of me. People didn’t like me when I didn’t do anything but would
have liked it less if I did different. This way I didn’t merit any no-
tice, didn’t compete with anyone. I could always say I was worse.
They would say I was not worth noticing, that I didn’t exist.
Analyst (said something about another competitive person).
Analysand: My mother was the most beautiful woman I knew, and
was so smart. She got all As in school, in the best private schools. I
went to the same schools, had the same teachers. Her teachers said
bad things about me. Must not compete with her. I was a beautiful
and smart little girl but so unhappy and so needy. She needed all
the attention and admiration. If she felt good, home felt safer. But
mostly she didn’t feel good.
JSG’s private thoughts: The analysand’s unconscious experience of envy
has now come on stage in an undeniable way. We can now equate the
beautiful, selfish mother with the analyst. The analysand projected her
own feelings of selfishness into her mother (even if she were projecting
into reality). The analysand was a beautiful and smart girl who, out of
envy, idealized her mother to hide her envy and projected her beauty and
smarts into her, only to envy her all the more and thereafter institute the
depressive defence to control her and triumph over her. Her mother be-
came the repository of the child who needs the admiration.
JSG’s proposed interpretation: “I wonder if the analysis, in bringing out
your deep, infantile dependency feelings, causes you to experience a grow-
ing discrepancy between a littler and ever more dependent and seemingly
less competent you, on the one hand, and a bigger and seemingly more
accomplished and dependable me, on the other. Maybe, when I give you
interpretations that appear to help you, you may believe that I’m ‘flashing’
my superiority, which may cause you to feel shamed by comparison. If it
is true that you may feel that way, then I can understand how you might
seek to redress the difference in an unconscious, clandestine way. When
you are unsuccessful and experience that you disappoint me, I wonder
if you secretly triumph over me by using my analysand—you—as your
hostage.”
Analyst: It took a lot of effort to maintain a sense of safety at home.
Had to tuck a lot of your self inside.
Analysand: Yes! It’s so telling when she’s at my home. She yells, “Why
are you always so absorbed in your God-dammed writing?!” She
wants me to be there for her! Worst thing happened: I became
beautiful, and she aged and shrivelled. I’m richer than she is. I
have the husband she wanted. It’s dangerous. She once said that
I was so lucky to have something to do because she has nothing.
I took everything from my mother. I sucked life from my mother.
She’s a living corpse, a tragic figure with no one to love her. She’s
waiting to die!
Analyst: I wonder if you fear that if you move ahead with your writ-
ing, move out more into the world, that it will impact me in some
way.
JSG’s private thoughts: The analysand confirms what the analyst has
interpreted, which had to do with a putatively real aspect of her past and
continuing-into-the-present relationship with her mother. While I believe
that the patient is reporting an actual, painful aspect of her relationship
with her mother, I believe that she is also projecting infantile, envious
aspects of herself into her mother, who is now the container of her own
enviability and the analysand’s envious and narcissistic-entitlement emo-
tions as well. Those aspects that belong to the mother must be worked out
when the analysand attains the depressive position—that is, can become
individuated and separate enough from her mother so as to be able to
distinguish what belongs to whom. When she quotes her mother as say-
ing: “She once said that I was so lucky to have something to do because
she has nothing. I took everything from my mother. I sucked life from
my mother. She’s a living corpse, a tragic figure with no one to love her.
She’s waiting to die!” I would hear that as not only the truth of what the
analysand had heard but also as a revelation of the latter’s belief that it
is true, not just because her mother says so, but because the analysand
has unconscious reason to believe that it is phantasmally true that she
“scooped out” her mother’s talent and beauty and re-owned it for herself.
Thus, she cannot use her creativity because it has been stolen, and she
is afraid of mother’s (analyst’s) retaliation. Consequently, there are now
three reasons for the analysand’s handicap: (a) an attack on her creativity
by an envious superego that is due to the projective identification of her
own envy of her mother’s beauty and creativity into her mother and intro-
jected as an envious superego; (b) the results of a greedy attack against her
mother’s beauty and creativity and stealing them for herself—with fears
of retaliation; and (c) the use of a depressive defence in which she affects
to identify with the aggressor-superego but secretly designs to thwart the
superego–mother–analyst by disappointing her.
JSG’s proposed interpretation: “I think it must be all the more difficult for
you to tolerate what appears to be your petulant, nagging, and accusatory
mother, not just because it is unpleasant on the surface of things, but also
because you may unconsciously perceive her as an aspect of yourself as
well as her. Because a you remains in her, it is difficult to get distance from
her so as to be only annoyed rather than persecuted.”
Analysand: Yes! If I don’t need you any more, you’ll be angry. Maybe
you will not have enough money. Maybe I won’t be able to express
my gratitude adequately. Someone else will come and take my
place. You’ll forget me.
JSG’s private thoughts: The analysand has just confirmed my proposed
interpretation. Her autonomy will incite the analyst’s anger, why?—be-
cause her autonomy had been unconsciously stolen from her by the
analysand as infant (in unconscious phantasy). The analysand seems to
be aware that she has unconsciously appropriated her mother–analyst’s
autonomy without paying the requisite price of gratitude or appreciation.
Furthermore, she fears that the analyst will replace her—by projective
identification. As the analysand achieves autonomy and separation, she
projects into the analyst that she will also separate from her and show her
own autonomy by having another child (analysand). I wonder now if the
analysand had younger siblings.
JSG’s proposed interpretation: “I believe that we may now have an idea
of a couple of reasons why you might feel paralysed and cannot exercise
your artistic gifts. It is as if you feel you unconsciously stole them from
your mother–me without appreciation or even acknowledgment as pay-
ment, which you believe angers a mother–me. Moreover, if you do go off
successfully on your own, then you feel that I ostracize you. You can’t
come home again, and I replace you with another infant–analysand.”
Analyst: I think you’re afraid that if you jump the hurdle, I’ll get angry
and pull away.
Analysand: Maybe you’ll grow old and, like my mother, be in a wheel-

chair with the life out of you.
Analyst: You’re afraid your need for me will deplete me.
Analysand: Yes! I took the life out of my mother. She had everything
she wanted but I always had youth compared to her. The awful
thing was to become more beautiful than her. Her beauty was the
only thing that gave her worth. What happened to her friends? No
husband any more. Greedy cousins who control her and her money.
We’re like two sides of an hourglass. In the beginning she had it
all. She lost it all, and I gained it all. She’s empty. Everything I got
depleted her. As I matured, she aged. As I became more beautiful,
she became less so.
Analyst: I wonder if you fear that your rage towards your mother for
all her failures did her in.
Analysand: Yes. I think she’s been punished . . . my anger . . . her
spouse’s anger. The biggest betrayal was when we gathered (gath-
ering of siblings) and said she was a crummy mother.
Analyst: You began the session saying it could be a good day but that
you were afraid to let go of your pain and paralysis. It seems that
a part of you needs to feel bad for mother/me.
Analysand: She’s coming soon for Easter. She’ll stay with me. They
fired her companion of years. Taking her money. She was good.
Earned a lot of money, sometimes stole from her. Treated her gently.
Who can put up with someone who calls her a black bitch? Spoke
with my cousin yesterday—you know, the troubled one. She told
me that they’ve hired another woman to replace her. I think mother
will be abusive and the helper will abuse her back, beat her.
Analyst: Perhaps an expression of your rage towards your mother.
Analysand: Ouch, yes.
Analyst: Going back to the dream. You were the therapist. I think you
fear that your need for the mother–me and your anger towards
the mother–me will stimulate resentment and abandonment. You
become your own therapist in order to take care of yourself.
JSG’s private thoughts: So far the analysand’s associations seem to follow
in train with what I proposed above. The analyst’s last interpretation, how-
ever, brought in a new perspective about the analysand’s earlier reported
dream about her being a therapist. I hadn’t thought of it, but it makes a
lot of sense.
Analysand: I know. I know that I’m supposed to take you in, to inter-
nalize you, but I’m afraid I’ll suck you dry. The image. I take you
in, and what’s left . . . you’re a shell. Every child feels that. Maybe
it comes from breast-feeding, taking from mother, suck her dry. She
gets smaller, and me the baby gets bigger, like a vampire.
Analyst: Fear that you will suck me dry comes from a conviction that
I have a very limited supply.
Analysand: Yes! Mother certainly had a very limited supply. She didn’t
have enough for herself. She never felt secure, loved, popular, rich,
safe enough.
Analyst: Fear the same with me. Fear you can’t give enough love and
gratitude to sustain me.
Analysand: Yes! I’ve grown to think of myself as negative, so full of
negative feels, so full of poison.
Analyst: You keep these feelings to yourself. They grow more powerful
inside and you feel like poison. You keep inside your fears that your
needs will suck me dry and that your anger will blow me away.
Analysand: What if I get recognized as a writer?! What if I get a career?
Will you be jealous of me?! Mother was so jealous of me! I’m afraid
to make anyone jealous of me!
Analyst: Your thoughts about how I would become jealous of you.
Analysand: You wouldn’t like it if I got a career, if I got reviews. You
wouldn’t like it if I got strong, if I didn’t need to keep coming to
you. If I publish, you would think I was ungrateful. Jenna once said
that stronger than a serpent’s tooth is the tongue of an ungrateful
child. Everything was poison in my family, anger and jealousy. No
nurturing of people, no pride in growth. Crush children, not want
child to have what she had. Not want child to have more.
Analyst: It seems that one reason you have been unable to jump over
the hurdle is that you fear that I would resent your growth, your
strength, your development, and that you fear I would shrivel if
you do not need me any more.
Analysand: Yes, yes, yes.
Analyst: Today is Friday.
Analysand: I’m frightened to go away for the weekend. Part of me loves
it. I’ll have time with my daughter and grandchildren, but I won’t
see you for two full days. I wonder how you will spend this week-
end . . . probably working. You looked tired on Monday. probably
working all weekend.
Analyst: You fear that I’ll resent your pleasant weekend, that my life
is occupied with work, busy work, little else (depleted, sucked dry,
drained).
Analysand: I feel so guilty. You work so hard on behalf of others, and
all I do is take, take, take.
Analyst: Afraid that your need for me drains me.
Analysand: Yes! Will you be here when I come back? You resent me,
the happy me. It’s so hard to believe that you ski. I can’t imagine
you in blue jeans. See you only in professional clothes. Fear you are
dark with nothing pleasant on weekends.
Analyst (did not make a note of what I said).
JSG’s comment
The analyst ably and sensitively interpreted all the themes that I suggested
earlier. She knew her analysand, and I did not. She dealt with the requisite
“psychotherapy” aspects earlier and the analytic aspects later, appropri-
ately. Earlier, I stated that the actual, reported history or troublesome cur-
rent event should be handled when the analysand attains the depressive
position (which can occur transiently in any analytic session). I should like
to modify that statement now. I believe that the analyst may profitably
deal with the analysand’s sense of his reality early on—because that is
where the analysand is emotionally situated at the moment. Then, as the
session progresses, the analyst may say either to the patient or silently to
her- or himself, as the analyst did in this case: “But at the same time and
on another level, . . .”
Now to return to my statement that the effects of reality must await
the analysand’s attainment of the depressive position. In my experience in
the analysis of trauma, that is, of the actual impingement of reality, past or
present, I believe that the analyst must ultimately await the analysand’s
ability to become separate enough from his objects—to withdraw his pro-
jective identifications into the object that have caused him or her to have
become confused with the object, so that she or he is then, and only then,
able to plead his own case against the realistically offending object—to the
original object or, later, to the analyst.
CHAPTER 15
Clinical example 8
presented by a colleague
A
DAPTIVE CONTEXT: Continuation of Clinical example 7. Third of
five sessions. The analysand is writing vigorously after a long
dry spell. This week, after a long delay, she followed through
on her contacts with writing agents. It seems that she is on the verge
of publishing her work. (The analyst, unbeknownst to her, is preparing
to teach a course on dreams.)
JSG’s private thoughts: The reader will undoubtedly recall the previ-
ously reported session of this analysand. I therefore ask the reader to sus-
pend his memory and pretend, not only that this is the first time they have
encountered this analysand’s associations, but that this is, paradoxically,
the first session of the analysis again! This state of mind is required of the
analyst, according to Bion, to allow for the surfacing of the ever-emerging
unknown, O.
Analysand: It feels like I have nothing to say, can’t think of anything
to say (unusual for her). (Long pause.) Oh! I had a bit of a dream:
I’m in a summerhouse. There’s a shortage of something, but I’m
exempt. I don’t know what the shortage was. Maybe something
like mobility. It doesn’t make any sense.
[Spontaneous associations]: Jim (husband) received a renewal of his
handicapped-parking card. We can park in places without charge,
in others for a small charge. It’s so convenient, but I feel somewhat
guilty. We’re going out to dinner this evening with Janet. She keeps
176
hitting on me for a contribution to her cause (charitable). Irritates

me. I don’t want to give her anything, but maybe I should. (She
discusses all the annual charitable donations she makes.) I give . . .
dollars each year, that’s a lot! I have my causes, and she has hers,
but maybe I should. I do want to continue our friendship. We have
so many homes. (She discusses the effort and costs of maintaining
many homes.) But it’s worth it. I love summer vacations with my
kids, my grandchildren! (She laughingly recounts the frequent ap-
pearance/meaning of “summer or vacation homes” in her dreams
for the past year or so, which we have come to understand as repre-
senting the patient, the overly generous/bountiful “mother/breast”
who wants to, but cannot, curtail the all too-abundant flow of milk.)
I gave L (son) and his wife $1,000 each to celebrate their anniversary.
They told me this week that their weekend will cost $1,500 each
and asked for more money. I don’t know what to do. I’m irritated.
I think $1,000 is enough, but then it wouldn’t hurt me to give them
more. My daughter needs a new car. R (son-in-law) makes $130,000
each year. We give them a lot each year for clothes, therapy, tuition,
plus, but it doesn’t seem to be enough. I don’t know if I should buy
her a new car.
JSG’s private thoughts: I couldn’t help thinking after I heard the rest of
the initial associations that the analysand’s initial silence may have been
due to a desire to withhold from the analyst. She seems to be complacent
about having the accoutrements of wealth but seems anxious with regard
to those around her who are needy—her friend, her children, and her ana-
lyst—who may prey upon her. One suspects that she believes that she un-
consciously “stole” her wealth from an object upon whom she depended
and is now awaiting retaliation.
Analyst: In the dream, there’s a shortage of something, but you are
exempt.
Analysand: I talked with D yesterday (a young man who resides in a
small bungalow on the patient’s property in exchange for assist-
ance in caring for the property). He’s down and out. His market
(freelance graphic artist) has dried up. Don’t know how he will
pay for food, and so on. I felt so sad when we spoke. I feel guilty
that I have so much.
Analyst: You’re exempt from financial struggles. You give very gener-
ously to others but still feel guilty.
Analysand: I have more money than my mother now, my poor sick
mother (mother is quite wealthy).
JSG’s private thoughts: The source of the analysand’s persecutory
anxiety (uneasiness) with regard to her wealth is now becoming clearer.

Earlier, I posited the possibility of her phantasy of having greedily robbed
her mother of her emotional wealth. Now I perceive the possibility that
the patient feels rivalrous with her mother and projects feelings of rivalry
into her in order for her, the analysand, to feel triumphant.
Analyst: I think that all of the supplies you’ve worked so hard to ob-
tain, your recent accomplishments, your career about to take off,
have brought back your fears of punishment from the “mother-
inside”. J (husband) is short of supplies and envious of you. Your
mother has an even greater shortage of supplies. You are exempt
from this shortage and fear that this will stimulate her envious rage
and retaliation.
JSG’s private thoughts and proposed interpretation: The analyst is cor-
rect, I believe, but I think I would have been more daring and suggest to
the analysand that her feelings of exemption are tentative, and that she
feels that her own once disowned feelings of neediness and rivalry (envy)
are now returning to haunt her in the guise of her friend, husband, and
children.
Analysand (a long monologue follows about her mother’s raging at-
tacks upon her while growing up . . . her beauty, disparagement
of needs, her accomplishments, her relationships, and so on, and
so on; more recently, attacks upon the patient’s devotion to her
career): My mother is a spider—a deadly spider with a poisonous
tongue. She’s all shrivelled up in a wheelchair in Chicago and still
has power over me. I can’t believe how much power she still has.
Maybe I put my mother’s face on all these “have-nots”.
JSG’s private thoughts: In addition to the themes I addressed in my pre-
vious remarks, I am now detecting a force in the analysand’s voice urging
the analyst to side with her and protect her against her monster–mother,
who is the other side of the analyst in the transference.
JSG’s proposed interpretation: I wonder if the power you fear from your
mother is not the power you have invested her with unconsciously—as if
your mother knows something about what you believe you have done to
her in unconscious phantasy.
Analyst: It’s hard for you to draw lines. You give very generously to
others out of the conviction that you’ll be loved only if you remain
the all-bountiful mother. When you draw a line, you’re afraid that
you’ll be seen as the withholding and punitive mother. It’s hard
for you to believe that you are enough to be loved when you draw
lines.
Analysand: Oh . . . there’s more to the dream: There was a pool at the

house. My mother was there. I wanted to swim, but the pool was empty.
When her back was turned, I filled the pool and turned on the heater. I
stepped into the pool—it felt wonderful. I hired a babysitter to patrol the
sides of the pool.
Analyst: You hired a babysitter to patrol the sides of the pool.
Analysand (laughs): I bet that’s you. You’re helping me to draw lines.
And I’m getting better. My aunt asked for X thousand dollars to
send her daughter to college. I’ve already given her thousands of
dollars. Her daughter is eligible for a scholarship, but she still hits
on me. I’m not giving her any more money. (Pause.) I haven’t want-
ed to tell you this, but my daughter’s analyst charges more than
you. I’m afraid you’ll raise your fee.
Analyst: You’re afraid that I will suck you dry unless you give more
to me. It feels risky to have pleasure and success unless my back
is turned.
Analysand: Well, I do worry about how you will feel when I finally
exhibit. How will you feel when I become a successful artist? You
work so hard all day every day. I’m not in my studio for that many
hours. Your car is nice but looks old. My guess is that it’s about
nine or ten years old.
Analyst: You’re afraid that the mother/me envies you, resents all that
you have, and will angrily demand more and more of you.
Analysand: Here we go again.
JSG’s comment
The conflict is now being unmistakably played out in the transference. As

a classically trained analyst I would have been aware of the roots of rivalry
between the analysand and her mother as a sexually based one in the pa-
triarchal (whole-object) Oedipus complex as elaborated by Freud, whereas
as a Kleinian I would, while keeping the former in mind, be more disposed
to consider the roots of her rivalry impulses to date back to her envious re-
lationship to her mother’s breasts (part-object). Greed is certainly another
factor. Nevertheless, even though Kleinian and therefore more disposed
to giving priority to the analysand’s unconscious phantasies, I also real-
ize that the actual behaviour of the real mother towards her infant and
child—and father as well—has a great deal to do with our understanding
of how greed, rivalry, and other painful conditions become permanent
rather than disappearing with good containment (Bion, 1959, 1962b).
CHAPTER 16
Clinical example 9
supervised by JSG
A
DAPTIVE CONTEXT: The analysand comes four times per week. I
had to switch her time. I’m going to be out of town tomorrow
(Thursday), just for the day, to take a quick trip, so she usually
comes Tuesday, Wednesday, Thursday, and Friday. This is the second
of four session of the week. The analysand lies on the couch.
Analysand: This is my last day of summer. I’ll guess I’ll just have to
see how this all is going to fit, and if I get to do what I really want
to do.
Analyst (countertransference remarks by analyst to JSG: I had that same
feeling of being tired as I did last week with her when I was com-
ing over here today to see you. Before, when I was getting ready to
come, when we talked it about last week, I told you that I said to
her: “You probably would prefer just falling asleep here in my arms
and not having to face the anxiety about starting school and fitting
everything in to school.” She felt it—well, I made reference to it,
because she made reference to the fact that she felt it on Friday, and
I made reference to the fact that she wanted to sleep in my arms,
not having to face that break, and the anxiety about starting school,
and fitting everything in.)
Analysand: I don’t know if this is going to cause me more stress or if
it is really what I want.
180
JSG: I think that that was right on. She said, “I don’t know if this is going
to cause me more stress.” I would then have made the interpretation: “I
think I know what you mean about the stress in terms of the schedule, but
I wonder on a different level if you are not also talking about the conflict
of going to ‘analytic school’ as well as graduate school, which represents
growing up and going away from home and mother and father.” It is
one conflict in the external world, and it is another conflict in the internal
world.
Analyst (I also have to think about, to be able to say on a different level,
to comment on what she said, but to say on a different level: the con-
flict of growing up, of leaving home or being here with me and get-
ting more in touch with the baby self): “You are not sure whether
analysis is going to cause you stress or bring you comfort.”
Analysand (nodded, agreeing): I didn’t go to Shabbat dinner on Friday
night, but my parents did. I wrote my brother a really nice note
for my Mom to give him, explaining why I didn’t come. My Mom
called the next day and said it was really nice, that it was really
low-key, that they just went in, sat through Shabbat services, and
then had dinner. It wasn’t like I expected.
Analyst: Well, what did you expect?
Analysand: She thought it would be just the four of them staring at each
other, with N (her drug-addicted older brother) across the table,
having nothing to say or just directing everything to him.
JSG: “She is going off to school and N, the older brother here, becomes
the younger brother—the younger sibling. She’s going off to school and
then leaving her would-be privileged position in Mommy’s arms.”
Analyst (Yes, I feel her rivalry, her envy of her brother. She went back
to talking about N). He has responsibilities for the Shabbat dinner
at the detox centre, like stacking chairs and putting things away.
Mom asked him how he was doing, and he said he was doing well.
He asked about her. She said that in a very sarcastic way. She really
liked that—like that was all about her. “N asked about my Mom,
what she was doing, and my Mom really liked that.” But the way
she said it, it was like—that’s what my mother loves, you know. She
said that mother wants me to ask about her and to show that I care
and don’t want to give her that because that’s what Mom wants.)
JSG: “That’s also the way of talking on a deeper level in the internal
world about her going off to school, now having an affair, getting close
now to her younger brother, and now she has projected her own desire to
be cared for into mother needing to be cared for.”
Analysand: I wrote in a note to them that I didn’t want to come this

Friday when my parents were there. I would come for Shabbat this
week, but now I get a notice that now they’re going. I saw them
twice this weekend, my parents. I went over on Tuesday and Mon-
day, and I was loading an anti-virus onto my computer, so I took
my laptop and was doing it there. My Dad was doing something
with the TV in the other room and asked me to come in and help.
I did, but when we were finished, he asked me, well, how are you
doing, what’s going on? Why don’t you sit down and let’s talk.
And I thanked him for asking, but I said no, I can’t. I have to go do
this that I was in the middle of doing something and needed to sit
in front of the computer to finish it. My mother came home from
getting the groceries for dinner, and the first thing I heard her say
to him was, did J notice the new piece of furniture. She said, I can’t
believe she would ask such a stupid question. She said, I heard
him say, “I asked her to help me, and she didn’t.” She said, “What
did J say about our new TV console?” That was the first thing she
wanted to know. Then I heard them in the kitchen and heard my
Dad say that he had wanted me to stay out there with him, and I
had said no.
Analyst (“She never says no to them, but she felt like they really wanted
her then.”)
JSG: In other words, I think this has to do with the child being aban-
doned—she has projected the child into them, and they are being aban-
doned by her going off to school. She has to steel herself to be a child going
off to school and not allow herself to have feelings of sentimentality. She
becomes the pseudo-mature grownup who is going off to school and leav-
ing the baby behind with them, and doesn’t want anything to do with the
baby. They (as the projected infant–her) seem to be trying to seduce her
back into babyhood—that is, accepting her regressive infant self.
Analysand: I am so glad that the J thing is over. I think he went back
to San Francisco today. I haven’t heard from H. I haven’t called
him either. We haven’t spoken since a week ago last Saturday. No
E-mail. I guess I’ll just see when I get there, but I am angry for the
way he has treated me. It’s like what we were discussing about K
and H being rejecting figures. I guess I sought them out.
Analyst: I think they represent rejecting parts of yourself.
JSG: “I think you’re right, because she just rejected her baby part in her
parents. Now they retaliate, as do K and H, in rejecting her, which is also
the shadow of you rejecting her next Thursday. In other words, your miss-
ing the Thursday session becomes the organizing factor. She then projec-
tively identifies with you as the departing (off-to-school) one, and projects
(abandons) her infant self into her parents and brother.”
Analyst (private thoughts: It happens a couple of times, her ambivalence
of analysis and her wish that I would take a more active role with
her. I felt like she was wanting me to take a more active role in
keeping her committed to the process. She’ll ask me questions,
and she wants me to answer, to sort of be the Mommy who tells
her what to do.)
JSG: I believe that what the analyst is concerned about here is her recog-
nition that the analysand has developed a transference that demonstrates
a narcissistic or pathological form of dependency—one in which the ana-
lysand is disavowing her own sense of responsibility (executive function)
for herself and is projecting into the analyst. Now the infantile aspect of
her can treat the analyst as a nanny or servant who is obligated to and
responsible for taking care of the analysand—under the latter’s control.
Analysand: I had two dreams over the weekend. The first was Friday
night. I dreamed that I was in New York with H, and everything was
as it had been. I felt like I needed to tell him about the way he has been
treating my feelings and his own feelings, but I was reluctant. I woke up
feeling good, which is confusing to me.
Analyst (“I believe that she was talking about her analysis and that the
work of the early relationship and the connection with me, and the
containment, and that now she was reacting to the loss of seeing
my face and how the communication feels different to her, with the
separations and the disruptions.”)
JSG: “And now she is going off to school. So maybe you ought to reflect
that she, as an H–she, is not acknowledging her feelings. The H–she is not
acknowledging her infant feelings, which she has already projected into
her parents. But there is a she who feels bad about that and wants to be
acknowledged at the same time, but it is under the threat of going off to
school. She has to close down on her infant, needy, feeling self. She feels
she is not ready to go off to school, so she has to harden herself.”
Analyst (“Her second dream was that she had gone to New York for this
friend of hers’s wedding, and that L had gotten really fat and had cut her
hair off. She said: I woke up realizing that it was a dream about
me and not L—maybe that something I didn’t expect was going to
happen to me.”)
JSG: Maybe she is experiencing separation anxiety as she is leaving home
for school and that it is also like growing up and getting married and so
on—the more she denies her infant feelings, the more they catch up with
her, unexpectedly, as her being fat—the needy, out-of-control infant reveals

herself in her fatness. Then the hair is marring her adult beauty and reveal-
ing that she is just an unqualified little child—not ready to marry and be
in the grownup world.)
Analyst (“Then she said: ‘I went to the beach with O on Saturday.’ [O
is the other patient I have. They were friends, and I didn’t know it
until her analysis had already started].”)
Analysand: You know, when we get together, there is so much obsess-
ing about food, lunch, what we are having for lunch, what we are
having for dinner, and it just stirs up all my anxieties about eating.
Remember, when I was in high school, I got very very skinny, and
I became really obsessed with my body and my weight and totally
focused on that and got very anxious, and in college I stayed that
way, and then I started to let it go; when I am with O, like when
we were in Italy, that’s all the focus—on food.
Analyst (“Then I said something about that she was scared that she
would devour me and blow up.”)
JSG: My take on it is that she is still talking about the major theme of
leaving home and going off to school; therefore the more she tries to deny
the existence of her infant self, the more the latter keeps returning, whether
it be the girl in the dream who was married but suffered because of hav-
ing unflattering hair, or her parents with their infantile demands, or now
P, with her infantile obsession with food. She seems to feel that growing
up means getting rid of the infant–child altogether and becoming a total
grownup rather than keeping in contact with the infant’s healthy needy
self while she is growing.
Analysand: Then I had a third dream: I dreamed that S’s (another friend)
grandmother killed someone. I don’t know where that came from but
S, her Mom, P, and I saw a movie Saturday night—the one about
“From the Castle”, or something. I think the father kills the mother
or something. I don’t know where that came from. We had seen this
movie, and maybe that was what stimulated the dream. Yeah! That
S’s grandmother was a murderer. I don’t know why I would think
that. She is such a lovely woman.
JSG: “Well, I wonder if she is talking about killing off the child. She is kill-
ing off her internal objects and her dependency objects in order to become
a grownup. All in all, I am gathering that this analysand easily regresses
in the transference but is experiencing a growing split between what may
amount to a ‘pseudo-adult’ self and a firmly rooted infantile self who
seems anxious about assuming any traits of autonomy.”
CHAPTER 17
Clinical example 10
fragment of a session from a colleague’s case
A
DAPTIVE CONTEXT: The patient is a married man in three times/
week analysis, on the couch, for many years. He comes Tues-
day, Wednesday, and Thursday. This session is a Tuesday, the
second week back after a long summer break. His vacations often oc-
cur outside the times when I am away. This session follows his cancel-
lation of the last Thursday session and also looks forward to the next
week, when there will be a missed session because of the upcoming
Jewish holiday. He has a long commute to my office from his home
and an even longer commute from my office to his office. When he
cancelled last Thursday, it was because of severe weather, which in the
past has caused significant time delays in his getting either to his ses-
sion or to work. In the two sessions before the cancelled Thursday, he
revealed that he had begun an affair over the summer break and had
imagined substituting time with his girlfriend for the analysis.
Tuesday (second of three weekly sessions)

[He’s looking tense and tentative when I meet him in the waiting room.
I find myself wondering if he will want to flee after all these years.]
Analysand (spoken haltingly, with many pauses): Sorry about cancel-
ling last Thursday. I woke up, and there was a huge storm going
on. I wasn’t expecting it. I was kind of confused. I’ve got this empty
185
feeling now. I’m afraid that you’ll be mad at me for not coming.
(Long pause.) I started second-guessing myself. Was it resistance?
Was there really a storm? [Describes what sounds to me like confu-
sion about what was or wasn’t real.] By the time I got to work, the
storm had passed. [Here he goes on, seeming to question if his per-
ception of the storm was real or imagined, but he reassures himself.]
“Everyone at work had been talking about the storm.”
Analyst: What were you thinking when you saw it?
Analysand: About the traffic and how hard it would be to get to work,
to get here. I was tired. Later, I thought that I was right. There was
no way that I could have gotten here and then gotten to work on
time.
JSG: The analysand had been absent from the analysis, contemplated
being absent again the following week, and had cancelled the previ-
ous session because of an alleged—though probably authentic—storm.
I would understand the “storm” to represent the intrusive force of his
accumulated emotions from not having been processed in the analysis. I
would understand his confusion as being due to his entering into projec-
tive identification, in unconscious phantasy, with his analyst in order to
offset his frightening emotions of being separate and without his analyst’s
availability.
JSG’s proposed interpretation: “I believe that your feelings from the
weekend break became piled up on top of all the other absences, those just
past and those that are immediately forthcoming next week. Your painful,
needy emotions accumulated and became a ‘storm’ within you. Since I
wasn’t available, you did the best you could by seeking to disappear into
your image of me for safety. I think that maybe you cancelled yesterday’s
session not only because of the real storm but also because you found
the ‘cure’ for the emotional storm within yourself by disappearing—but
also you may have been concerned about coming here and opening up
and then leaving yourself open and unprotected again for next week’s
absence.”
Analyst: What I think must have made it confusing was that you’d
been talking about feeling you could have the affair with L, but it
had to be kept separate from the analysis.
Analysand: Thursday was the afternoon that I saw L. Another way of
separating the two was skipping analysis. I decided I didn’t want to
do the Wednesday night thing with her. At least not for a while.
[The week before, he had been thinking of spending Wednesday nights
with L, telling his wife that he was staying overnight in town to get to
his early-morning analytic appointment and then cancelling his Thurs-
day appointments to sleep in with L. When he told me that last week,

I felt a bit hurt and annoyed. He could have his affair if he wanted to,
but why did it have to be either/or for the analysis?]
Analyst: What went into that decision?
Analysand: My relationship with L and how I want it to be. It’s still
getting worked out. It was awkward Thursday with her. She is sad
and lonely. She said that I was holding myself back from her. And
I was. You and I have been talking about my need to take care of
a woman. My mother. I felt that with L. So we’ll go out on Thurs-
days and have dinner, but I won’t spend the night with her. That’s
enough for me right now. It’s pacing things with her. Seeing what
happens. I have this sense that in L, I’m getting involved with some-
one whose problems are bigger than my own. (Pause.) But, then, if
they didn’t have problems, why would they have an affair? (Pause.)
(He stops his thoughts about L here and asks about the schedule,
confirming that there will be a missed Thursday session next week
for Rosh Hashanah.)
JSG: My previous interpretation did not include the affair with L since
I was analytically unaware of it: that is, even though the analyst had in-
formed us at the beginning, it was not yet in the analysand’s associations.
Now that it has surfaced, I would amend my previous interpretation by
adding the following:
“I wonder if your having the affair with L instead of coming to your
analytic session was not a way not only of finding a rapid, emergent, erotic
soothing of yourself, like masturbation would be for a child, but also it
may have offered you the opportunity to get rid of your gnawing depend-
ency feelings and being able to deposit them in L.”
Analyst (I offer him the possibility of a Friday morning time instead
of Thursday.)
Analysand (he thinks about the offer, the schedule, and says that al-
though he’d like to take me up on that, it’s too difficult, and so he
declines the offer.) It just sucks getting up so early to come here.
Analyst [thinking consciously that he doesn’t really express his anger
or dissatisfaction with me directly enough]: Either it’s taken you a
long time to notice that, or you just haven’t been talking about it
directly. [I was also thinking that perhaps a lot of his withdrawal
and “spaciness” has been an angry, passive protest or expression of
discontent. In retrospect, this comment felt abrupt and is one that I
wished I could have kept to myself.]
Analysand: I thought that I’ve been talking about that. (Pause.) Oh,
by the way, my sister has been in analysis for three or four years
now. She doesn’t respect her analyst or feel connected. She’d been
in analysis before in the past in (another city) and that went well. I
don’t think that this is her issue. I think that her criticism of him is
correct. She was complaining to me about it, and I told her that she
ought to get a consultation. I suggested that she get one with you.
Her analyst almost never offers her anything new to think about;
anything that’s illuminating. She first consulted him about some
problems with one of her kids. He briefly saw the child in therapy,
and then began seeing my sister in therapy and then analysis. I get
the idea that he just wanted to create a patient because of his own
need to have someone in analysis.
Analyst [I hear his riff about the sister as a response to my offering
him a make-up hour]: You know, just a few minutes ago, I offered
to make up the missed Thursday next week on Friday, and here
you find yourself telling me about an analyst who is grasping and
neglecting his patient, trying to use his patient for his own selfish
needs.
Analysand: Huh! I don’t think that’s it’s you that is self-serving. It was
nice of you to offer the Friday time. I always have that conflict about
what I should do, but don’t want to do. I know it would be better for
the analysis to come here next Friday, but I won’t get home until late
on Thursday because of L and then I’ll want to see my kids. I don’t
want to have to get up at 5:30 to get here on Friday after that. Last
Thursday, when I cancelled, I wondered, “Am I doing something
bad to you? Is there some glee in that for me?” (Long pause.) I’ll be
missing the Tuesday of the week after next. That’s when my wife is
having her (minor) surgery.
(Pause [during which I find myself aware that he has, uncharacteristi-
cally, not yet paid his last bill].)
JSG’s private comments: The analyst offers the analysand a make-up ses-
sion, which the latter rejects with “It just sucks getting up so early to come
here”—seemingly a rude rejection of the analyst’s offer and a critique of
the worth of the “sucking” analysis. An interchange follows in which the
analyst appears pleased at the apparently new openness of the analysand
with regard to his expression of his negative feelings. The latter responds
to the former’s statement by a reference to his sister’s purportedly bad
analytic experience with an analyst who is allegedly holding her captive
because of his neediness.
JSG’s proposed interpretation: “I wonder now if, in addition to protec-
tively and projectively divesting yourself of those painful, unattended to,
needy feelings, that you sought additional relief in depositing them into
your analyst–me who is now devalued in your mind—so now the analysis
really does ‘suck’, and you appear justified in not coming to it. You may
also believe that the ‘sucking’ will only worsen, since you haven’t yet paid
me what you owe me.”
Analysand: I went to a family Bar Mitzvah last Saturday. My wife didn’t
go to the party later that night. I was glad that she didn’t go, but
I felt lonely, sad. Other couples were there together, dancing, and
I was alone.
Analyst [I’m aware that this story of preferring to be alone and then
feeling the loneliness follows the talk of cancellations and his re-
fusal of the Friday session.]
Analysand: Also, I have the sense that while L is nice, she’s not “the
one”. I’m not in love with her. (Silence.) I wonder is it mother? Me?
I think of the old song, “If you can’t be with the one you love, love
the one you’re with.” Phew! I’m thinking it’s hard to be satisfied
here. Phew! (Pause.)
Analyst: Can you spell that out?
Analysand: It’s the wanting, achy, hungry feeling. Wanting to be filled
up, I guess. (Silence.) Getting candy, like in my secretary’s office.
She has a dish of candy on her desk, and my patients go in there
for candy.
Analyst: It sounds like a terrible dilemma. L doesn’t feel like the right
person, but you get something concrete from her: sex, the physical
contact. I may feel more like the right person, but what you feel
that you get from me may seem more elusive, not what you are
looking for or need.
Analysand: What can I get from you?
Analyst: Exactly!
Analyst (long silence, punctuated with slow, twisting body movements
on couch, grunts and sighs) [I wonder if I have overloaded him
with too direct, perhaps homosexual-sounding interpretation. What
I was trying to get at was the concreteness of his experience of need
and the problem of whether a symbol can hold up to the need for
something concrete?]
JSG’s private thoughts: I think that the analyst’s own private thoughts
are correct.
JSG’s proposed interpretation: “No sooner do you get rid of your pain-
fully needy self and deposit in L and me than you become sad, lonely, and
perhaps guilty for having betrayed those you depend on, your ‘proper
mates’, your wife and me, and then the wanting, achy, hungry feelings
return.”
Analysand: Oomph. This chest feeling.
Analyst: The aching?
Analysand: Yeah. (Pause.) Ooph. It’s hard to stay here.
Analyst [he’s beginning to “space out”, which has been a significant
problem for the analysis for about three years now]: I think you
may be reacting to what I said about it’s being hard to feel that
you’ve got the right person and the right kind of transaction with
them at the same time.
Analysand: Is it that it’s hard to feel it or that it doesn’t happen?
JSG’s private thoughts: I think he may have spaced out—that is, re-
entered a state of projective identification—once his painful, achy, needy
feelings returned.
JSG’s proposed interpretation: “I wonder if your spacing out doesn’t
have something to do with the cycle you experience of suffering your
needy feeling, then getting rid of them into those on whom you depend,
then you feel empty of self, having got rid of so much of yourself, then
you feel guilty, and then feel the feelings all over again, and then space out
again. I wonder if the feelings are painful in the first place because these
breaks in the sessions remind you all the more of how seemingly cruel the
analysis is in reminding you of them—of even recruiting them—and yet
how important the analysis is in helping to understand them and resolve
them. I wonder if you don’t hate me because of my part in this, and if your
hatred causes you to depreciate the analysis and me. A depreciated analyst
may be like a pain in the chest, and how can you make analytic progress
when you can’t appreciate what you receive from it and me so that it can
appreciate on its own inside you.”
Note: The interpretation took the form of a scroll that revealed the cycle
of the analysand’s approach–avoidance consequences of relating to the
analytic breast.
Analyst: That’s a good point. Is it hard to feel, or is it that it doesn’t
happen?
Analysand: I was spacing out. What was that you said? (Long pause.)
There’s this sense of splitting things up between you and L and
my wife.
Analyst: Uh-huh. (Long pause.) Not putting all your eggs in one bas-
ket?
Analysand: Yeah, but it’s real.

Analyst: Real?
Analysand: I do get something from each of you that’s distinct. With
my wife it’s the household; with L sex and fun; and here, working
on the connection. There’s no switching it around in terms of what
I can get from each of you. Each of you is limited. I can feel this.
(He goes on a bit and then switches back to his sister). At first I was
thinking that I’m not feeling competitive with my sister. That it’s
nice that she asked me for help and that it would be OK if she saw
you in consultation. We are getting along now. (Pause.) Hmmm. If
she saw you in consultation, would I feel that she’s horning in on
me? Competing? I didn’t feel that.
Analyst: That’s probably important to take note of, given how competi-
tive your relationship with her has felt in the past. Your offering to
have her see me to try to help her must be an important gesture.
[I’m thinking here that his gesture towards the sister felt genuine
to me and that it would mark an important reparative effort on his
part. I’m also aware of the extent to which it could be an appease-
ment or a reparative offering to me to make up for the missed ses-
sion and the refused make-up session.]
Analysand: I also felt good that I don’t have those issues with you. And
that I knew what I was talking about with her; that I had something
to offer. (Pause.) My mother and her husband were at the Bar Mitz-
vah, and I didn’t want to see her. (Mother and father divorced when
he was in college, and both have subsequently remarried.) I had this
sense of not getting anything from her. (Silence.)
Analyst: Our time is up for today. See you tomorrow.
JSG’s private thoughts: What I had missed earlier in the session was
the analysand’s tendency to split his objects. These later associations
graphically show how he splits them and must split himself accordingly
to conform to them. What is of overriding importance, however, is that, in
splitting them, he is using them as objects of convenience, not as objects of
emotional neediness whose relationship to him he can appreciate and from
whom he can gain. What is missing is his emotional commitment.
JSG’s proposed interpretation: “You complain that your wife doesn’t sat-
isfy your marital needs. Perhaps that has a lot to do with those devalued
aspects of yourself that you put into her and that she then becomes in your
eyes. The same appears to be true with me. Maybe even the same with L.
You seem to have to divide up your dependency needs and separately al-
lot them to different agents—as if they were routine services that could be
separately dealt with by service helpers, with no emotional appreciation

or exchange from or with you. At the end of the day you have collected
your laundry and dry-cleaning but feel empty and alone because you do
not emotionally belong to anyone. You are afraid to acknowledge that
you need someone, your wife on one level and me on another, because
you would feel trapped, little, helpless, and vulnerable. You dare not ap-
preciate love from those who look after you so you cannot emotionally
self-appreciate within yourself.”
[Yet again I acknowledge that my (proposed) interpretations seem to be
lengthy. In practice I may present only small parts of them at a time. What
I am presenting here is a generic model for a complete interpretation: in
general, and length notwithstanding, the more nearly complete the inter-
pretation, the greater the relief for the analysand—because I am revealing
to him that the source of my interpretations are in his associations.]
CHAPTER 18
Clinical example 11
from a colleague
A
DAPTIVE CONTEXT: Five-times-per-week analysis. Friday, 7 June:
last of the week, and when I leave on vacation.
(The analysand was 15 minutes late.)
Analysand: Why am I late? Am I trying now to do to you what you’re
going to do to me? Actually, I had a 45-minute jog on the beach
and then lunch with an old friend in Venice. She was very upset
because her husband wants a divorce. I was able to give her some
general advice, including the name of a good lawyer. I felt really
good about that. She commented about how different I was and that
she admired how I’ve moved on.
Analyst: I think it’s much easier and more satisfying to speak to your
friend from a position of expertise, to be able to give her helpful tips
and be in a position of knowing, than to come here and examine the
you who needs help and who doesn’t know everything.
JSG’s private thoughts and proposed interpretation: The analysand
seems to be a seasoned one so was able to anticipate what she believed
her analyst would have said by saying it first. I would have interpreted the
associations about her friend who is being left by her husband as follows:
“I wonder if your coming late is your way of divorcing me as I am felt to
be divorcing you, not only for the weekend break but for the vacation. One
bad divorce seems to deserve another.”
193
Analysand: There are two things I want to talk about. My file is dam-
aged. It is actually frozen. As soon as I started to write the story, it
froze. I have to ask for help. I have to face what I did. Why did I
do that? The other thing is—M is at a play-date with G. I have four
more hours now to play with. G’s parents said they are no longer
going to allow him to play in the public parks, probably because
of all the kidnappings and accidents with kids lately. I really take
issue with that! But they have a huge backyard—the kind of yard
that kids can really run around in. They don’t really need the park.
My backyard is pretty small. Kids can play there, but not really run.
I feel very critical of these people, and I don’t really understand
why.
JSG’s private thoughts: I believe that after her “divorce” scenario, which
represented a modest rebellion against the analyst’s forthcoming depar-
ture, the analysand recovered contact with her authentic dependent self by
uttering that her “file” was frozen and that she needed to ask for help. “I
have to face what I did” sounds like an authentic acknowledgment and a
plea for help. “Please don’t leave me”, she seems to be saying to her ana-
lyst. M being at a play date with G and G’s parents no longer wanting to
use the park for their child suggest to me that the analysand is generalizing
the abandonment scenario. She is being left alone unwatched, vulnerable
to kidnappers and accidents, and feels not well off (only a small backyard
to play in).
JSG’s proposed interpretation: “I think that your dependent self has
returned from your ‘divorce’ and is now saying, ‘Please don’t leave me
alone in my small backyard! Don’t poop me out into the cold. Everybody
seems to have somebody to play with, and you’re going off to play with
your family. I hate you!’”
Analyst: I think you’re telling me that you’re critical of them because
they seem to have everything they need (because of their backyard
they don’t need the park). You, in contrast, don’t seem to have eve-
rything you need, so being critical evens the score, or even makes
you feel superior to them [envy].
Analysand: I think I have feelings that they can provide something I
can’t. My internal critic of them bothers me. What is that about?
Analyst: I think you must feel very critical of me who can go away
wherever I want, with no real explanation. I seem to have every-
thing I need and can go off and leave you, and if you criticize me
in your mind, there obviously isn’t so much to need. Who needs
her, anyway? I think this kind of devaluing out of envy freezes
your file.
JSG’s private thoughts: The analyst correctly took up the issue of her ana-
lysand’s envy. I also believe, however, that the analysand was experiencing
the other side of envy—that is, shame—shame for being so little, helpless,
and undesirable—no one wanted to play with her. Why else would the
analyst have left her?
Analysand: I think I do that a lot with L. He seems so self-sufficient
sometimes that I do feel left out, and I do get pretty angry and
start picking away at him. I was just jogging past S (a hotel) where
L and I had our first date. I’d like to get married there. I’d like to
really think about that. Some of the same feelings are coming up
now that came up around my former marriage to F. I was really
feeling panicked before marrying F! Now I feel—again, well, good,
this is it! That’s really scary. I’m not as panicked as I was before, but
I am concerned that he’ll want me to work full-time like he did S.
I’d rather see myself poor economically rather than work full-time.
Something happened last night that really bothered me. I was alone
and I hadn’t made any plans to see him. I called L on his cellphone
and said, “Why don’t I bring dinner over?” He didn’t call back. I
didn’t hear from him until this morning! I was going to be angry
with him over the phone, but decided not to. After all, I could have
called him at home, and I didn’t. At a certain point, I think I was
actually okay with just going to sleep.
Analyst: And on another level I think you are angry at me for being
out of touch, but for certain reasons have avoided voicing it. I think
you’re also protesting about the amount of work you feel you’re
asked to do here.
JSG’s private thoughts: I believe that the analyst’s interpretation was
correct. The analysand had acknowledged her envy of L, standing for the
analyst. She seems to imply that her call to L on his cellphone was not
legitimate, especially when he didn’t answer and she could have called
him on his home phone. I don’t know if she is referring to cutting corners
and not being serious about contacting L. I think the situation amounts
to this: the analysand does not want to be abandoned with her shameful
and envious feelings, but she also resents being a member of the analytic
dyad because of the hard work that is required—the issue that the analyst
correctly identified.
JSG’s proposed interpretation: “I feel that you are anxious about my
leaving you with your shameful feelings of littleness and being unwanted,
without anybody to play with, but I think it is also difficult for you to
reach out and ask me for help for fear of what I will ask of you—to be a
fully working analytic partner, to be in charge of the analytic infant in my
absence. For reasons we don’t yet know, this seems to be hard for you, so
you only half-heartedly reach out (calling L on his cellphone but not on
his home phone) and crawl up into yourself alone.”
Analysand: Maybe because my feeling being angry with you is un-
called-for. L asked me to check out how soon after his operation
he would be able to travel. I found myself saying how surprised I
was that he hadn’t already checked it out. I guess that’s being criti-
cal. Sneaky-critical. I didn’t come right out and call him negligent
or irresponsible, but I implied it. Story about her vacation plans,
and she doesn’t know where H is going with his Dad prior to her
vacation with him, so she doesn’t know whether he’ll need to rest
before he goes on another flight, and so on. F’s need for secrecy
or privacy is so irritating. I don’t know how long his trip is, and I
don’t know how to plan.
Analyst: Again, I must say I think you are also talking about my up-
coming trip. Perhaps you feel it’s irresponsible of me not to tell you
what I’m doing and where I’ll be. Maybe you don’t know how to
plan for the absence.
JSG’s private thoughts: While I agree with the analyst’s interpretation, I
also suspect that the analysand’s anger at L for his passivity and apparent
irresponsibility for his welfare may be a way of her being irritated with
an aspect of herself now lodged in L in her mind. The rest of her remarks
seem to be more clearly transferential.
Analysand: Mmm. I just saw my son’s therapist. M will be terminating
soon! It seems she didn’t have a definite plan, but his camp time
seemed as good a time as any. So she’ll stop just before he starts
camp, and she wants him to return to her when he starts third
grade. I liked her more today. Maybe that’s because I feel better
about myself. And maybe it’s because I’m not so anxious about my
own parenting skills. She was telling me how much she has enjoyed
M, and how easy it has been for her because I always get him there
on time and am so involved. I can’t open my book file. I’m going
to get some help. The file froze when I tried to save something. But
I’m aware I could write anyhow. I don’t really need the file to write.
Something keeps getting in the way.
Analyst: You want to create something, and something mysterious is
getting in the way. Something has been getting in the way of your
analysis as well. I think what stands in your way here is your low
self-esteem, which can cause you to attack the analysis and me.
When you open your analytic file and feel that it is of value, I think
your envy comes out and freezes it—stops the process of going
forward.
JSG’s private thoughts: I believe the analysand accepted the analyst’s
interpretation and seemed then to be better disposed towards herself as
she acknowledged being better disposed towards her son’s therapist. She
returns to the frozen computer file, but this time seems less thwarted by
it—she can write anyway. There is hope. The analyst calls attention—and
correctly so, I believe—to envy, which is the “freezing” agent, but I would
have additionally called attention to how she had gained from the previ-
ous interpretation and found hope that she could circumvent the frozen
file.
Analysand: I’ve been reading a book about Martha Stuart. She seems
so powerful and inexhaustible. I’m exhaustible. Look what she’s
created; look at her empire! I feel like I haven’t created anything.
JSG’s private thoughts: I believe that these associations constitute a direct
negative response to the analyst who only called attention—again—to
her envy and not to her having progressed from the interpretation. In my
opinion, she is using the “depressive defence”, the converse of the manic
defence, in which she introjects the object, identifies with her, and attacks
the object internally as an identification with herself.
Analyst: It seems that you idealize Martha Stuart and compare yourself
to her and feel you are nothing in comparison, or else you devalue
someone—me, for instance—and feel you are of no value by iden-
tification; if I’m of no value, then you’re of no value either.
JSG’s private thoughts: The analyst was correct about the devaluation
but failed, I believe, to mention the causative anxiety. To repeat what I have
stated earlier in this text, I believe that, with some legitimate exceptions,
every interpretation, to the best of the analyst’s ability, should identify
the anxiety, pain, threat, or danger that might have initiated the defence
(including impulse. Having said that, however, there are many occasions
when the analyst may conceive of the anxiety but choose not to state it
because of “letting the analysand off the hook”, so to speak, and deflect
their awareness of their guilt towards their objects, thereby preventing
them from approaching the depressive position.1
Analysand: I feel bad about myself. I have no capacity for insight. I
don’t have enough insight to continue, whether the file is frozen
or not.
JSG’s private thoughts: It is now apparent that a breach has been created
in the transference ↔ countertransference situation. This is a disruption
that needs repair.
Analyst: I think the feelings of inadequacy and frustration about in-

adequacy come in when you have thoughts that you don’t know
as much as I do. You have thoughts and feelings that my insight
can come out of. But you feel you are no Martha Stuart, and your
thoughts freeze.
JSG’s private thoughts and proposed interpretation: The analyst is push-
ing the envy interpretation yet again. I would have said: “I think you
responded positively to my earlier interpretation and hoped that you
could circumvent the real freezing of your file. But I failed to take that into
account when I reinterpreted that your envy was the agent that froze your
file, and once again you lost hope.”
Analysand: Yeah. I never thought about it like that. I’m sort of killing
what I write before it even comes out. So I don’t have a chance to
work on it and make it better. I was just thinking about M’s Thera-
pist. Why was I so comfortable today? I wasn’t critical of her the
way I usually am. I was listening to myself speak to her, telling her
this that; I was making sense. I felt perfectly fine being there.
Analyst: Perhaps because M is stopping, or perhaps because she was
complimenting you, you weren’t feeling competitive with her.
JSG’s private thoughts: Maybe, but I don’t think so. I think the analysand
is identifying with the analyst-as-aggressor in terms of “I never thought
about it like that.” But then she seeks to defend herself from the analyst-
as-critical-superego by showing that she has made progress, and she
demonstrates this with regard to her improved relations with her son’s
therapist.
Analysand: The reason I’ve been uncomfortable with her is because
I’m a therapist. I’m always wondering what she thinks of me as a
mother, knowing that I’m also a therapist. Today she let me know
she appreciated me and that she knows I care and I get him there
on time. Things like that. M doesn’t appreciate what I do for him
because he takes it for granted. I’m always there. I think he would
only notice if I would take myself away. M was writing to his pen
pal who also comes from a divorced family. The boy was naming all
the special things his Dad did with him and asked M, “What does
your Dad do with you that’s special?” M said, “Nothing, occasion-
ally movies”, and then he thought about how his Dad puts him to
bed each night. It’s so habitual that he takes it for granted.
JSG’s private thoughts: The analysand states: “M doesn’t appreciate
what I do for him because he takes it for granted. I’m always there. I think
he would only notice if I would take myself away.” I believe M stands for
the analyst, by whom she doesn’t feel appreciated.
Analyst: I think you’re also telling me that you don’t particularly ap-
preciate the help you get from me; you take it for granted because
it’s so habitual—four times per week. Perhaps next week you will
notice because I’m taking myself away.
JSG’s private thoughts: The analyst chose to appoint the analysand rather
than herself as the ingrate and persists in being what appears to be critical
of her. The former says, I think self-righteously and defensively, “Perhaps
next week you will notice because I’m taking myself away.” (“All right
for you!!”). I believe that a countertransference enactment-disruption has
occurred that needs repair by the analyst.
Analysand: I was thinking that you have a family emergency.
JSG’s private thoughts: The analysand’s response was forced by the
analyst’s mis-step, I believe.
Analyst: A family emergency would prove that I don’t have a perfect
life.
JSG’s private thoughts: The analyst is persisting in her defensiveness. I
believe that her negative countertransference might be due to the analy-
sand’s earlier employment of the “depressive defence”2 in which she, in
unconscious phantasy, trapped the analyst inside her, where she is being
internally persecuted.
Analysand: No, no—it wouldn’t prove that. To me, it would mean that
you have a family—a close family. It would mean something good.
That would still go along with an idealized picture. Maybe I have
some grief about having to do with the question of “is that all there
is”? Do I just want a big bang? I think crises remind me that I’m
alive. So if you have a crisis, that’s also good because it’s exciting
in some ways. If life is crowded enough, one doesn’t have to think.
If I don’t have to think, I’m not left with a lot of aloneness.
Analyst: It sounds as if you’re trying to put a positive spin on any
scenario in order to get away from feeling bad.
JSG’s private thoughts: The analyst seems still to feel wounded and de-
fensive and is persisting in being critical of the analysand.
Analysand (silence): I was talking to M’s therapist about communica-
tions from F. He only communicates by fax or E-mail. That way he
can tell you what he wants to tell you and that’s it! He asked to
take M to a party on Saturday—pick him up at 8 a.m. and take him.
That’s my custodial day, and if I don’t take M to the party, there’ll
be no reason to go. It’s F’s party for M. I asked M, “Do you want
me to come?” He said he didn’t know if I was invited. I asked him
again, and he said he did want me to come. I had already tried to

communicate to F that M wanted me to participate in the party.
Well, it just got dropped. All my questions got dropped.
JSG’s private thoughts: I am now more certain than ever that the analy-
sand feels rejected by her analyst and is appealing for a repair. Her latest
associations seem to be a clear indication of a bad, unilateral, arbitrary
communication—actually, a breakdown in communication.
Analyst: On one level, you’re thinking about F’s way of communicating
with you. I think you’re also saying that I often communicate to you
in a fax-like or email-like way. If it has to do with me, plans, I just
tell you what I want to tell you, and your questions get dropped.
JSG’s private thoughts: The analyst is right for the wrong reasons: she is
missing the microscopic tracking of the text.
Analysand: That’s true! I have lots of questions, but I know you’ll just
turn them around and make them about me. It’s no use asking
my questions. Like—is it graduation time? Are you partnered with
someone who has grown children and you are off to Brown to at-
tend their graduation? Or have you been diagnosed with something
you need treatment for? L’s son is graduating from fifth grade, and
his mother tells me that M and L shouldn’t attend his graduation
or take part in his and L’s holiday.
JSG’s comment
The analysand is calling attention to the arbitrary and unilateral nature of

the analyst’s communication with her and is trying to be reasonable about
it. In all fairness to the analyst, I believe that she may be suffering from
a clandestine (unconscious) attack upon her by the analysand that she
didn’t see coming—the depressive defence, which, in turn, was the analy-
sand’s way of defending herself against what she might have felt was the
analyst’s dismissive attitude towards her. I know the analyst in this case
very well and have found her to be competent to the point of being gifted,
not just as an analyst, but also in her capacity for intuition and empathy.
I believe that my knowledge of her, consequently, justifies my suspicion
that she fell victim to an unconscious transference ↔ countertransference
enactment.
This brings up yet another idea. I have found from my experiences
with unconscious transference ↔ countertransference enactments that
there exists an unconscious and highly sensitive and sentient “supervisor”
in the analysand who is able to gauge whether the analyst is on the mark
and is correctly tracking the analysand’s associations and the transfer-
ence ↔ countertransference emotionally and content-wise—even though

considerable leverage is allowed for the analyst’s own school and idi-
osyncratically personal style. It is as if the analysand’s unconscious plays
charades: it knows what needs to be dealt with but can only present parts
of the puzzle for the analyst to fill in the other pieces. More to the point,
this “supervisor” is highly sensitive to the nature of the analyst’s involve-
ment with the analysand—that is, honesty, concern for the analysand, and
concern for the truth. These are the parameters of “transformations in O
and from O to K” (Bion, 1965, 1970; Grotstein, 2000, 2004a).
Notes
1. I am indebted to Albert Mason for this advice.
2. The “depressive defence” is the reverse of the manic defence and is an in-
ternalization of it. It is not to be confused with the depressive position (Grotstein,
2000, p. 172).
CHAPTER 19
Clinical example 12:

psychoanalytically informed psychotherapy
supervised by JSG
A
DAPTIVE CONTEXT: (a) Christmas/New Year’s holidays coming.
(b) Prior session discussion regarding twice-week therapy.
(c) Soon to graduate from university.
FRAME: Once a week.
Patient: I had a weird reaction just now. I don’t know what to make of
it. It must have been the caffeine. My arms were shaking, and I was
light-headed. Maybe I drank it too fast. This has never happened
before. I don’t know what to make of it. (Pause.) I’m not sure what
to talk about. Oh, yeah, there is one thing! I wanted to ask—if we
could meet Monday instead of Tuesday next week.
JSG’s impressions: I suddenly (spontaneously) remember from past ses-
sions with this patient that she frequently asks for changes in sessions. I
then formed the opinion that she may have been demonstrating claustro-
phobic anxiety.
Therapist: Tell me why you would like this change.
Patient: I wanted to do the following stuff Tuesday: Christmas shop-
ping, spend time with a friend from high school, and I want to do
some decorating with my mother.
JSG’s impressions: Her answer seems to confirm my hypothesis about
claustrophobia. My inclination would be to discuss the appointment-
202
change issue with her, but perhaps later in the session, when I can contex-
tualize it with the theme of the session.
Therapist: Yes. That will be fine.
Patient: Perfect. (Silence.) I’ve been doing ok, but I’ve been depressed
and I was crying last night for no good reason. I was talking to A
(boyfriend). He asked why I was crying. I told him perhaps it was
the last paper that I completed. Maybe it was a release of tension.
It was weird yesterday. I slept enough, but I was dragging. My eye
muscles were sore. It was hard to keep my eyes open last night,
and this weird caffeine reaction today. Maybe it was the last school
commitment today. Maybe that’s what it was. I think I have been
spending too much time with my mother. I need my own space. I’ve
decided to go to Mexico for a week with A during the break. Last
night it was the talk with A. The day before there was a party where
my aunts continued to question me about the future. What now?
What job? Did you buy a new suit for interviews? Very intense
questions. Graduation is still six months away. Earlier that same
day, my mother filled out Christmas cards. She signed my parents’
name and mine, but not my brother’s name, because he is married.
She said that is now his business. I joked that I would never marry,
so I would not have to do my own. My mother said, “Oh no, next
year you are doing your own. You are an adult now.” Then today
the professor was talking about endings and graduation. We still
have six months to go.
JSG’s impressions: When the patient stated, “I need my own space”, she
confirmed my hypothesis about feeling claustrophobic. It seems that the
patient’s desire to change the session times now is to afford her some reas-
suring sense of control over her life, which is now threatening to get out
of control. She is about to graduate from university and enter her career.
This also means leaving home and becoming a self-declared “grown-up”,
who “can’t go home again”.
JSG’s proposed interpretation: “I believe that the holiday breaks conjure
up the permanent breaks for you—from your parents’ home, from child-
hood, and from me, your therapist. I think you are trying to push back the
dawn because there still may be a little girl inside you who doesn’t feel
ready yet to be on her own. As a result you seek to hide from it, hibernate
within a mother–me—almost as if you’re unconsciously returning to the
womb, and then feel stuck inside and then want to escape so you can have
your space.”
Therapist: Tell me a little more about the caffeine reaction.
Patient: When I drank the coffee at 7 a.m., I felt normal. Later in class
I actually felt wiped out. Then, while I was walking down to your
office, I got anxious. But I did other things on the way down here.
I went to the store on the way.
Therapist: I’ll tell you what I think.
Patient (interrupts therapist): I know what you are going to say. It will
be about me, about my mother, and probably about you in there,
too.
Therapist: You begin with the weird caffeine reaction. Then you ask
for a change in the therapy schedule. You ask for the change so
you can spend more time with your mother. You say you have
been depressed and crying, and rationalize the tears as a release
of tension because the school term is ending. Yet you go on to say
that it is very difficult to keep your eyes open and that your eyes
hurt. You mention closeness with your mother and the holidays. I
think this has to do with the growing insight about and the pain of
possible separateness. It is very painful for you to keep your eyes
open to the insight. You feel rushed by your family, your mother,
your aunts, and your professor to grow up when there is a you that
wishes to remain close to your mother and remain a pseudo-adult
self. I think you are telling me that the holidays are coming and you
are facing the difficult decision of choosing between mother and
boyfriend, mother and vacation, and mother and me. The thought
of losing time with either is anxiety provoking. I think this is what
hit you when you walked down to my office. You were walking
down to the therapy, which is making you acknowledge the pain
of this separateness.
JSG’s comments: I find this to be a wonderfully crafted and well-honed
interpretation. Its structure is what I call a “scroll”—a concept that I taught
this therapist and that consist of “scrolling” back to the beginning of the
session and repeating the sequence of the patient’s associations to show
how the very sequence becomes a compelling and telling narrative of
meaning.
Patient: I think you are right, until the last part. Now, regarding the
change from Tuesday to Monday, I wanted to come up with a good-
enough reason. I wanted to say anything other than that it was for
my mother. I’m hypersensitive about my time with my mother.
(Smiling silence.) You are too good. You know me too well. You
know what I’m trying to do. I don’t want to have less of a relation-
ship with my mother, nor do I want to have more of one with her.
I want to avoid seeing either too much.
Therapist: This is the “sore eyes”. I also think this: We have been talking
about therapy twice a week. It’s difficult for you to come twice a
week. I think the idea of no therapy for two weeks was anxiety-pro-
voking for you today as you walked down to my office, wondering
if I would agree to the change. You don’t want to get any closer, nor
do you want any less of a relationship with me either.
Patient: You are right about all of it. It is all very interesting. Much of
this has to do with this: I’m looking for your approval. My need
is to make you feel like I’m changing. I want to be a successful
patient of yours. But I am struggling. I don’t know how to. I don’t
know how not to be close to my mother. I’m clear on the problem.
I’m too close to my mother. But I’m worried I can’t change. I can’t
change for myself. I can’t change for you. I realize it is ridiculous.
In a perfect world, I would not care what you think, but I do.
JSG’s impressions: The therapist once again skilfully tracked the patient
and got to the heart of the matter: her parasitic relationship with her
mother, which is due to her use of massive projective identification of
her grown-up coping functions into mother and her subsequently feeling
trapped there on the one hand and immature and unable to cope with the
grown-up world on the other.
Therapist: Tell me about that.
Patient: It does matter to me. It matters to me to make a change. But
I’m stuck in the same place. There are two parts. One wants to
change. The other has its arms crossed and doesn’t want change.
Yeah, you are right. I have been nervous about asking you for
the change for two weeks. Last week I asked you for the answer:
how I would change. You didn’t give me an answer. I’m glad you
didn’t. I was not ready. In the past I tried to pull away from my
mother with an ex-boyfriend. He could almost substitute for my
mother. My present boyfriend certainly can’t replace my mother.
But part of me wants to do this now with you. It’s the perfect
time. I don’t have another person. I will have to rely on myself.
I can learn to be happy on my own—to feel more secure on my
own. I want to change on my own rather than filling in the hole
with someone else. I want it to be done here with you. I want to
understand with you.
Therapist: It sounds like you are now very hopeful and positive about
the therapy.
Patient: I don’t know if twice a week will be enough. I don’t want to
make you into the person to protect me. This will become more
intense. You will become more a part of my week. I wonder if twice
a week will be enough. I don’t want you to replace my mother,

because this will eventually end.
JSG’s impressions: The therapist did a very good piece of work. His
scrolling and subsequent interpretation cleared the scene for the emer-
gence of her feelings of claustrophobic entrapment in her mother and in
the therapist, which mitigates her being able to mature. Of special inter-
est is the patient’s awareness of needing more frequent sessions—despite
the danger of experiencing even more infantile dependency and claustro-
phobia.
CHAPTER 20
Clinical example 13
from a colleague
A
DAPTIVE CONTEXT: First session of three, after a four-day
break
Analysand (she comes in visibly irritated and throws her jack-

et on the couch): I am mildly irritated today, actually quite
irritated, so maybe I’ll write you a cheque to use the time to quiet
down. (Whips her chequebook out, writes, shaking her head, puts
the cheque on my desk.) I got a headache coming over here. Took
some painkillers that actually help. I am in the middle of four
projects, three of which don’t go well. I mean, there is a lot of confu-
sion—grants being written and being granted, but with the stipula-
tion that the money be used in a different way than was the grant’s
proposal. I hate to be in projects that are just not good—I mean, I
know I am very central to these projects, and I can do more than
anybody there. I know I am good, but I just do need more. It’s just
so much friggin’ work to explain what is important, to not step on
people’s toes, to not make them feel stupid, and at the same time
get my point across.
Analyst: So, then you come here, and you feel you have to do the same
friggin’ job with me, get your point across and be so very, very care-
ful and still get something from me. You complain about being in
the middle of four projects.
207
Analysand: Not to mention to be entertaining! Yes, no wonder I feel

irritated coming here.
Analyst: You carry such anticipation—or, rather, conviction—that you
will not be met, that I will not be there for you.
Analysand (smiles): Yes, that fits, actually that fits in all these situa-
tions that I find myself in, over and over again. (Looks puzzled. . .
Pause.) I remember, I had two guy friends, two Jewish friends in
grad school on the East Coast. We had so much fun together. We
would just go and go with ideas. They would get things. I never
had that again with anybody. They were so bright, and we would
be amazingly creative together. But here, when I get excited, I talk
and talk, and end up bulldozing people, blowing them out of the
water, and then I feel stupid and like a failure in the end, and ar-
rogant on top of it.
JSGs tracking of the meaning of the text: The analysand is obviously
distressed—perhaps because of not having had access to the analysis and
the analyst over the weekend break. She is in the middle of four projects,
only one of which is hopeful. I note the numbers 3 and 4. She comes three
times per week. Is she asking for four, or does 4 refer to the number of days
in the week that she does not come? Is she complaining about too much of
a load the analyst placed on her to take care of over the weekend, and is
she asking to be restored to four times per week—or even 5?
The grant people seem to be disappointing her by reneging on their
fiscal responsibilities, and they seem also to be using her inappropriately.
She also seems to be vigorously asserting her self-esteem. She states: “I
am very central to these projects, and I can do more than anybody there. I
know I am good, but I just do need more. It’s just so much friggin’ work
to explain what is important, to not step on people’s toes, to not make
them feel stupid, and at the same time get my point across.” Is she as-
serting her self-worth as a protest to the analyst (grant official) because of
feeling exploited by her analyst over the weekend break because she feels
that the analyst prefers to be with her own children over the weekend
and, to top it off, she has to pay for the treatment besides and is crying
“unfair”? Another feature of her associations that caught my attention was
her mentioning how much she once enjoyed being around bright friends
(who welcomed her “curiosity”?), followed by the use of such words as
“arrogance”, and “stupidity”. One wonders—as Bion (1967b) cautions us
to consider when we encounter the triad, “arrogance”, “stupidity”, and
“curiosity”—whether or not the analysand might have experienced an
infantile catastrophe and was left with an obstructive internal, ruthless
“super”ego object that stands athwart her good object relations and at-
tacks her links with them. I would keep this imaginative conjecture in the
back of my mind for later but surely not interpret it now. I would have felt
confident enough at this time, however, to interpret all that I stated prior
to these last ruminations.
JSG’s reverie: At the opening of the session I felt like a guilty moth-
er–analyst whose baby had been neglected. She projected her anger into
me for me to feel guilty, guilt being a derivative form of container ↔
contained—that is, to create a passive-aggressive controlling relationship
with me. She then made me feel inadequate when she informed me (I am
using myself here in place of the actual analyst) that she treated herself
successfully with painkillers. “Middle of four projects” makes me feel even
more guilty for my compelling her by my absence to be the “babysitter”
for the analytic infant in my absence. It’s all she could do to keep up with
the proliferation of her unattended emotions while I was gone. “But I do
just need more” constitutes a poignant plea to me to show her my uncon-
ditional love, for me to repair the damage to her feelings. But she is afraid
to step on toes—which makes me feel even more guilty—that she cannot
trust that I can handle her negative feelings with equanimity.
Analyst: I imagine you get very anxious when you get excited, that
you disconnect from your excitement and then become intellectu-
ally convincing.
JSG: Note “disconnection”: an attack against linkages and self?
Analysand: Yes, then I lose myself and babble, ending up feeling awful
about myself, feeling bossy and arrogant.
JSG: My premonition seems to be emerging and almost becoming vali-
dated. She is also saying that she feels that she cannot express her excite-
ment to the analyst, whom she now perceives as a threatening superego
figure, which makes the analyst–me feel guilty and misunderstood.
Analyst: It feels too vulnerable for you to stay connected to your ex-
citement.
Analysand: Yes, doesn’t that fit with my mother’s stuff!!! (Dramatic
shift in mood, leans back. Pause.) On the weekend, I went out with
H (husband). We went to a not-so-cheap restaurant. You know,
that is out of character for me. He even ordered a bottle of wine. I
calculated all the expenses in my head. It helped me that he got a
free dinner, because they were serving him so late. Anyway, I al-
lowed this to happen. I actually didn’t drink much, but we had a
pretty good time. (Looks more vulnerable.) Then, to top it off, we
went to a place afterward—like a desert place—I have been curious
about for a long time. I mean, we both ordered a dessert, I chose it,
and H even had a cognac. This was the first time we’ve ever done
something remotely like that. (Looks quite vulnerable.) I even said
to H that I had been looking forward to sitting next to him. (Pause.)
I mean, it’s a sad state of affairs that this should be special, but it
was. (Looks at me, and I just smile.). I mean, I really enjoyed it and
ate my dessert. I finished it all. (Pause.) [History of anorexia.]
JSG: “Mother stuff” suggests that her relationship to her mother was
one in which her natural excitement and curiosity had been thwarted by
an envious or depressed mother who may arguably have been a negative
container (projection-in-reverse of her daughter’s painful emotions back
into her). I also begin wonder about addiction.
Analyst: You know, as I am thinking about the beginning of our ses-
sion, your irritability coming in today. I now think you might have
been quite anxious to tell me about this.
Analysand: Yes, I was, I am . . . You know . . . this is connected, trust
me. I am not going away from my feelings. We have these jour-
nals in the office, Peoples’ Magazine, junk like that [talks about how
she deals with the conflict about this with her colleagues], but
then there was Psychology Today, and I saw the title, something
like “Can Lust Last”, or something like that, and of course I was
very interested in that. And then there was an article on love be-
tween patients and therapists. (Blushes.) That was just such a crap
article! [goes into a long justification of her perspective.] But, then,
what do I know? (Reads my face carefully as she talks about this.)
It is just so trite and one-dimensional, the way they talk about
this. Somebody even mentions that in some states you can marry
two years after termination—as if that is the issue. So stupid, and
then to reduce it all to the issue of incest. I don’t know what you
think about Psychology Today, but anyway it is a very limited ar-
ticle. (She looks right at me, and then covers her face, tears run-
ning.) I wish I could have told Dr D (previous therapist, who had
left the country) about this weekend
JSG: I believe she is expressing her desire for mirroring and approval
from analyst–me, wanting me to be proud of her, but guards against get-
ting too close because of a fear of making herself vulnerable to “intimacy
abuse”, as happened with her previous therapist.
Analyst: You so wish Dr D could know you this way.
Analysand (cries silently, covering her face): You know, I was so damn
good, I never did something inappropriate, except that one time
when I googled his wife’s name. I never stalked him, or begged
him. You know how hard this was!!!??? (Unusually open with her
feelings, feels like something cracked open.) And I would want
something back. (More tears.)
Analyst (feeling very moved and leaning forward).
Analysand (moves back and becomes more guarded): Acceptance and
laughing, . . . like when he made the comment: “I feel tempted to
lick you.” (She chuckles, gets up—it is the end of the session—still
talking as she puts on her jacket, turns around.) I will see you to-
morrow.
END OF SESSION
JSG’s comment
This poignant session began with a hidden protest against the analy-
sand believing in unconscious phantasy that she was both shut out and
exploited. The adaptive contexts are the weekend break and the change
in frequency of sessions from four to three. A transformation in her emo-
tional relationship to her analyst occurred when the analysand moved
from being a testy outcast to revealing her desire for close intimate con-
tact with her. She “incestualizes”—that is, sexualizes—her dependency,
which seems to be difficult for her to acknowledge directly. Her earlier
statement—“Doesn’t that fit with my mother’s stuff!!!—suggests that she
had had bad experiences as an infant and child with her mother. We
hear hints of her once having suffered from anorexia. Addiction is also
hinted at. An infantile catastrophe is suspected. In terms of technique,
I think I would have listened to her complaints empathically—as the
analyst did—and then I would have interpreted her anxiety about her
shameful as well as angry and protesting feelings about having been
left in the lurch over the weekend and having lost her fourth session. I
would have connected those feelings to her other feelings that she feels
misunderstood, diminished, and exploited by the analyst. She has to
write a cheque to pay the analyst, who does not offer her unconditional
(free) love. I would also have interpreted that she may be afraid to reveal
her loving and needy feelings because she has “crossing-the-boundary”
anxieties: that her love needs are so powerful that she overwhelmed and
compromised her former analyst and might do it again with her present
one—as revealed by the actual situation in which her previous analyst
seems to have wanted her and himself to ignore the analytic bound-
ary. I would have taken this issue up about her not being able to trust
me—her present analyst—because of her dread of her capacity (through
projective identification) to overwhelm me, as she might have felt she
overwhelmed her previous analyst. I find myself melting towards her,

and I feel relief from my borrowed guilt and shame.
(Note that my interpretations of what I believe are her unconscious
phantasies in no way blame her for the unfortunate trauma with her
former analyst. The actual fault is clearly his. The analysand’s unconscious
may have another opinion, however.)
CHAPTER 21

dream analysis in an analytic session
Brief past history
T
he patient is a 43-year-old married movie producer who had
been in analysis for just over a year when this dream occurred
(he has come up in some previous case studies). Of importance
in the past history is that he recalls often having been beaten by his
mother. The parents divorced when he was 10 years old. He had an
endless series of torrid sexual affairs with various actresses and, at
times, prostitutes. This behaviour ended rather quickly after he had
begun his analysis and learned how much this behaviour represented
his anger towards—as well as his hidden desire for—his mother.
ADAPTIVE CONTEXT: The patient’s wife has just become pregnant, and
he will soon be absent for a week due to his business. He is being seen
five times per week. This session is the second in the week.
[Each dream element and activity/action in the manifest content has
been identified with a letter; these are explored subsequently.]
Analysand: I had a strange dream last night. I was making (a) a documen-
tary about (b) water. I recall a (c) run-down industrial park with buildings
or shacks with (d) corrugated roofs. (e) It began to rain. There was (f) an
older woman there—a (g) prostitute. I went to get my (h) camera, which,
strangely, was in the shape of an (i) iron. (j) I couldn’t find it. (k) The
213
prostitute was not the usual kind. She was (l) “exclusive”: she was like a
(m) girlfriend: there only for me. I was fascinated by her (n) breasts. (o)
I didn’t have enough money to pay her. (p) I had to go back and make the
documentary.
Dream associations
Analysand: I woke up from the dream and began to recall the whole
series of (q) affairs I had had since I married. I had pursued some
of them almost (r) deliriously. (s) One seemed to stand out. When
visiting my wife, who was then working in New York, I called
this girl. She was (t) different from other prostitutes. She was very
young (19) and acted as if she was a girlfriend rather than a pros-
titute. As a matter of fact, she really began to develop feelings for
me and stopped charging me. I looked her up on the Web today
just to find out if she was still around. She was. She had gone out
of the business for a while and returned to her family in New Jersey
and went into the family business for a while. But apparently she
had returned to prostitution. (u) I read what her clients posted on
the Web about her. It was weird, reading their accounts. Their ex-
periences with her were similar to mine. (v) It reminded me of my
affair with R. She was once in a movie in which she was married to
a much older man. (w) The man meanwhile had made friends with
a younger man, whom he had taken under his wing, as if he were
the younger man’s mentor. The younger man and the wife became
lovers (x), and both came to a bad end at the end of the movie.
Analyst: Water?
Analysand: (y) A neighbour’s pool was making noise all night and al-
most woke me up. [(z) Neighbour’s pool?] Oh, God, yes. (Yesterday
the patient told me that his neighbour’s home was up for sale. She
had only recently been a lover of his. She was leaving the neigh-
bourhood to be married.)
Deconstruction of the dream

One of the functions of the dream-work (alpha-function) is to en-
code or encrypt (transform) the evocative stimuli (O) threatening the
analysand’s sleep (y, z) with physical (pool motor) and psychic (the
neighbour with whom he had recently had an affair) stimuli. Dream-
work seeks to encode (transform) the evocative stimuli (O), which are
occurring simultaneously (vertical axis of the Grid—Bion, 1977) and to
relocate in aesthetically transformed narrative sequences on a horizontal
axis—so as to bind the potentially disturbing stimuli (O) by mythifica-

tion into unconscious phantasies.
• “Making a documentary” (a, p) and “camera in the shape of an iron”
(h, i) → voyeuristic compromise in order to be visually included in
the primal scene. “Iron” may refer to a mother and/or wife who irons
(domesticity?) and also to the analyst, who will hopefully “iron out”
(sort out) his worries.
• “Sound of the neighbour’s pool motor”, “water”, and “rain” (b, e, y, z)
→ the painful reminder of an affair with someone who lived too near
him for comfort—and his relief that she was moving away.
• “Run-down industrial park” (c), “corrugated roofs” (d) → wife’s and
mother’s womb and vagina—all suggestive of his concerns about his
wife’s pregnancy and many other related associations from the past
as well as the present.
• “Older woman” (f)—“prostitute” (g, k, l, and m) his retroactive desire
that his mother should be his “prostitute”, i.e., cheat on father and
proffer him unconditional love, which is enacted via displacement in
his forbidden affairs.
• “The breasts” (n) come into play because of his wife’s pregnancy. He
fears losing exclusive access to the breasts because of sibling rivalry
with his soon-to-be son.
• “I didn’t have enough money to pay” (o).
All the above “alpha”-“bet(a”)ized categories lie on the vertical (meta-
phoric) axis. The task of interpretation is to narrativize them with ad-
vanced alpha-function (Bion, 1962b) onto a horizontal (metonymic)
axis—in the form of an interpretation. The interpretation constitutes
the results of the undoing or reversal of the dream-work.
Dream interpretation (reversal of dream-work)

(alpha-function)
Analyst: Your sleep was threatened by your neighbour’s “pool mo-
tor”, which is related to the sound of the water and the rain in
your dream. “Neighbour” suggests the ex-lover and your relief that
she is leaving the neighbourhood. You mentioned that you were
interested in the prostitute’s breasts. Your wife is pregnant with a
young being who threatens to take her attention and her breasts
away from you, so you seek comfort with the breasts of the prosti-
tute, whom you cannot afford. The prostitute is me, who you wish
would be like the one who ultimately didn’t charge you—to show
her love: my love. The iron: things getting ironed out, but also an
iron would symbolize housekeeping—perhaps mother. Her name
was like mine. Making the documentary seems to have voyeur-
istic overtones: an effort to control forbidden sexuality with your
eyes. The industrial park suggests your wife’s and your mother’s
womb—with the corrugated roofs, like the vagina. The reference to
R and the movie she was in which she was married to an older man
suggest your anguish at being left out of the mother–father sexual
relationship when you were young and perhaps currently with me
and my mate, as you are going away from the analysis to go on
location. You not only felt left out of the father–mother relationship,
you also felt left out of the intimacy with your mother as an infant
[Background: he was not breast-fed as an infant. His mother, by her
own account, suffered from post-partum depression. Her depres-
sive irritability resulted in many episodes when she scolded and
physically battered the analysand.]
Analysand: I think you’re right. I am grateful to for your having saved
me and my marriage.
Some points worthy of mention about dream analysis

Freud (1911e) recommends that we should treat dream interpretation
no differently than the analysand’s other free associations during the
session (pp. 92–94). Bion’s (personal communication) version of this
suggestion is that what we normally call “dreams” occur in our sleep
and are visual transformations of dream elements that are comprised of
displacements of external as well as internal objects. Furthermore, Bion
believes that the whole process of perception—the processes whereby
we observe objects—inescapably involves transformational alterations
of our experience of the object stimulus—and thus constitutes dream-
ing. I derive from Freud’s and Bion’s conceptions that if dream analysis
is to be considered as isomorphic with the analysis of free associations
(and that the reported dream is but another association constituting a
link in a chain with other associations), then: (a) every analytic session
constitutes a dream, and a dream that is reported in the session now
becomes a “dream within a dream”; (b) if the foregoing is true, then all
objects, particularly external ones, that are reported in the analysand’s
free associations are virtually without exception only displacements
(signifiers) of aspects of the analysand’s internal world, and are not to
be accorded the status of equal standing as interacting persons. They
are “dream elements” incognito.
The dream is an articulation of the importance of the adaptive context
(Langs, 1976a, 1976b, 1981a, 1981b) or day residue (Freud, 1900a) as an

expression of current concerns about the psychic effect of imminent
“catastrophic change” (Bion, 1970). The function of dreaming is to
ensure sleep and conscious attentiveness by day. Restful sleep is the
function of an ineffable dream organization (“the dreamer who dreams
the dream”, Grotstein, 1979, 1981b, 2000), a living Presence, daimon (in
the ancient Greek sense), or homunculus, who employs one’s aesthetic,
perceptual, and cognitive capacities to weave a linear narrative that
temporarily binds one’s anxieties (O) and places them in a “ready
room” for further thinking via sorting out and reflection.
CHAPTER 22
Clinical example 15
Albert Mason
Clinical examples 15–18 constitute a “showcase” for the demonstra-

tion of comparative psychoanalytic techniques within the Kleinian
→ post-Kleinian →Bionian spectrum. I invite the reader to pay close
attention, not just to these analysts’ interventions, but also to the
subtlety of their thinking about their cases.
The brief case presentations in this and the following chapter illus-
trate how a classical Kleinian works. Albert Mason was trained in the
British Institute of Psychoanalysis and was analysed by Hanna Segal,
and the reader will quickly recognize that his work belongs in the
classical Kleinian oeuvre. I personally have been very influenced by
him. He was my first Kleinian supervisor and became, following Bi-
on’s abrupt departure, my analyst. The following two cases are from
his as yet unpublished work, “Transference”.]
A
28-year-old woman walked rapidly into my consulting room
early one Monday morning following a weekend break. She
had been in analysis for six months and had come originally
fearing a recurrence of a psychotic breakdown that had taken place
seven years previously. She walked unusually briskly into the room
and, after lying down, started to talk even before I had reached my
218
chair. “It is nice and quiet and peaceful here, and you seem pleased
to see me”, she said, “but you have put on weight!”
Without more ado, she launched into a dream she had had the
night before her session:
“I was in a boat in the morning approaching an island through a mist.
There were two beautiful round hills in the distance on this island. The
boat was going too slowly, and I decided to swim so I could get there faster.
(I thought of her rapid entry into my room and her not waiting for
me to sit before she spoke.) I dived into the water, cleaving its surface.
When I came up from the dive, I saw twin boys on top of the hills with
daggers in their hands. I knew now that I should not go there. I thought
that I might be killed.”
I waited no more than a minute or two to see if the patient had
anything to add, or any associations to the dream, “Have you fallen
asleep?” she asked sharply. I began to speak, provoked into a banal
response—something like, “Have you any ideas about the dream?”
when she interrupted with, “When you are sarcastic like that, I can-
not hear a word you say!”
Two details from the patient’s history then occurred to me: (1) She
had been weaned after two weeks because, according to her mother,
“breast-feeding didn’t agree with her”. She had suffered from persist-
ent vomiting and did not gain weight. (2) From the age of 16 to about
20 she had an eating disorder that took the form of severe anorexia. In
this session a pattern now seemed to be emerging, linking the patient’s
dream, her history, her enactment in the session, the context of the ses-
sion (Monday morning) and the transference. I believe that any one of
these elements can be interpreted in a multitude of ways and that we
must wait for several coinciding themes to emerge that afford us the
luxury of evidence from which we can fashion something called an
interpretation. Separation from this patient’s primary object seemed to
bring about an unbearable feeling of anxiety, deprivation, or hunger,
which resulted in the patient projecting herself into her object. One
consequence of this defence demonstrated by the preceding vignette
was paranoia. Feelings of separation and deprivation were stimulated
by the gap between the Friday and the Monday session represented
in her dream in which the hills were distant and the boat was slow to
reach them.
The unbearable feeling seemed to be related to separation from a
good object, as the patient initially perceived me to be: quiet, peaceful,
and welcoming (I was pleased to see her). She could not wait—that is,
contain her feelings of impatience—as the boat was too slow. She en-
tered my room rapidly, provoked me into replying prematurely to her
question “Have you fallen asleep?” and interrupted when I did speak.
Her projection into her object was illustrated by her impatient dream
dive into the water, cleaving its surface, just as she dived into my mind
with her sharp question, momentarily disrupting my capacity to stand
back and reflect on the material.
The paranoia produced by her sharp intrusions took many forms.
In the dream the round hills had metamorphosed into nipples that
were masculine, that is, penetrating and dangerous (the twin boys
with daggers). Historically, she had vomited her mother’s milk as an
infant and was phobic about food as a teenager. The breast and all its
later derivatives had become dangerous. My interpretation had also
transferentially become cutting (sarcastic), and she couldn’t hear what I
had to say. My food for thought suffered the same fate as her mother’s
milk and the hills in the dream.
Klein advised that an interpretation should be addressed to the
point of maximum urgency or the most serious presenting anxiety.
Here I felt that the patient’s paranoia needed to be addressed first, for
this paranoia would have distorted all other interpretations and would
have resulted in the patient feeling misunderstood at best and attacked
at worst. So I interpreted: “It must be very frightening how suddenly
someone you care about or need can become hurtful.” I could also point
out that that was what had happened here between us. The patient
became visibly calmer and talked about how often men she had liked
had let her down or deceived her. The part the patient played in these
abortive relationships could gradually, over a period of some months,
be teased out, using the dynamic illustrated by the vignette. Just as the
patient had originally intruded into the breast and me transferentially,
so her jealous, possessive, and intrusive behaviour with men caused
them to feel trapped and controlled and to break away.
I wish to convey with this vignette some idea of how I think and
work and how I use the transference. I try to pay close attention to
the here-and-now of the session—to what the patient is saying, however
trivial or unrelated it may appear—believing that every reality comment,
whether it be about the weather or the crowded parking lot, contains
unconscious content and phantasy. With her discovery of play therapy,
Klein drew to our attention that whatever a child did (and this applies
equally to the child part of the adult personality) was also a reflection
of his inner world of phantasy and never random or meaningless [italics
added—JSG]. I also pay attention to the actions of the patients: how
they come in, use the couch, pay their bills, arrive late or early. I pay
attention to what the patient does with the analytic frame, for the frame
is unconsciously synonymous with the analyst . . .
JSG’s comment
I italicized some of Mason’s principal points. One can see how he listens
for the patient’s maximum unconscious anxiety in the session and how he
interprets in terms of infantile part-object relationships with objects of the
past and the analyst in the present, re-contextualizing the patient’s past
history with a new emphasis on the here-and-now transference. One also
sees how he uses his own emotions as an analytic instrument. I should
like to say more about how he, as a Kleinian, demonstrates how he views
reconstruction. In classical Freudian analysis the analyst might say (as I
was taught): “I (the analyst) remind you of your father” [moving from
the present to the past]. A Kleinian would say: “When you speak of your
father, I think you are also speaking of me now” [moving from the past
to the present].
CHAPTER 23
Clinical example 16
Albert Mason
I
would like to give another clinical example to demonstrate these
ideas.
The patient in question, “Richard”, began the session by talking

about his neglect of his work and his failure to bill his clients. I
reminded him that he had not paid me and that this was most unu-
sual so late in the month. He said that he had forgotten. “I know,
I know”—implying that he knew that this was not accidental and
added sarcastically, “You won’t be able to buy a turkey for your
lovely family, and your wife will wonder where your money went.”
The implication here was that I was doing something illicit. Richard
then went on to say that he had telephoned John, his ex-lover, to
wish him a happy Thanksgiving, and he had “accidentally” dialled
his home number instead of his work number. Predictably, John’s
wife answered the phone, and the ensuing ruin of the ex-lover’s
weekend was not hard to imagine.
I began to interpret that he could not stand his jealousy of my
wife and his ex-lover’s wife, but he interrupted me loudly and an-
grily to talk about his niece, who was giving up her beloved baby
to her estranged husband because he was threatening her and her
present lover. Richard almost screamed: “None of them are thinking
about the baby and the harm this would do him—only their own
222
selfishness!” He was clearly talking about the husband’s narcissistic

jealousy of his estranged wife and her lover. I was reminded of two
separations in the patient’s childhood: one after his birth and the
other when he was 2½ years old, after the birth of his hated sister.
I again attempted to interpret and to link the jealousy genetically
when he interrupted once again with a dream he said he had had
the previous night: “John was in church with an Asian woman—kissing
her. Later, he was skating with me, and his wife and son were watching.”
The patient associated that John’s wife was not Asian and that the
woman in the church was dark yellowy-brown.
I finally managed to formulate an interpretation about Richard’s
jealousy of my wife, who took me away from him on Thanksgiving
as well as the impending Christmas break. This jealousy led to a
reactivation of his jealousy of John’s wife and children, whom he
tried to hurt over Thanksgiving by his “accidental” telephone call.
His dream illustrated how his jealousy of his ex-lover’s wife and
hatred of their union—the kissing in church—made the woman yel-
lowy brown: an infantile attack with urine and faeces. I reminded
him of the late payment of his bill, his comment about the turkey,
and how this was intended to spoil my Thanksgiving and make my
wife suspicious of what I was doing with him or with my money. I
added that perhaps my wife would feel that I was treating him for
free, out of love. I also pointed out that he skated off in phantasy
with John while his wife and child watched, no doubt filled with
the jealousy and rage he had put into them. Just as he attacked
John’s intercourse with his wife in the dream and with his phone
call in reality, he interrupted me in the session when I was attempt-
ing to have intercourse with his mind.
The patient shouted at me: “You are spitting all over me as you
speak, and I can smell that you have farted!” I then reminded him
of the yellowish-brown woman who was devalued as the result
of his attacks with urine and faeces, as the baby–him must have
attacked his sister Sylvia and his mother when they went off to
Atlanta and left him when he was 2½ years old. He now felt that
I was the parent attacking him back by pissing and shitting all
over him with my interpretations. Somewhere in the session I also
pointed out that his rage at the parents for harming the baby was
connected with his denial of the harm he had done the baby part
of himself—the part that needed analytic nourishment—by his
attacks on me and the analytic process. There was a long silence
before Richard responded rather quietly, “I like it when you listen
to everything I say.”
Kleinians believe that object relations begin at birth and probably be-
fore. From the beginning, the dominant conflict is between love and
hate. Two important consequences of this conflict are anxiety and guilt
lest hateful destructiveness overpowers loving or libidinal impulses
and the objects they are directed towards. Splitting of the object and the
self into good and bad are seen as necessary developmental achieve-
ments that to some extent preserve the good object. When integra-
tion of the splits occurs and one becomes conscious of whole objects,
recognizing that one’s hate is directed towards the same object that
one loves, then guilt and remorse set in. When development proceeds
well, reparative impulses and activities occur; in less fortunate circum-
stances, manic defences against guilt and ambivalence dominate. These
changes are also influenced and affected by external situations where
bad—frustrating and depriving—experiences increase hate, and good
experiences encourage love.
JSG’s comment
Once again we see how Mason diligently focuses on the part-object rela-
tions between the patient and himself in the contexts both of the current
frame (weekend and holiday absences) and of revived memories from past
history. We see here, as in Clinical example 15, how whole-object images
become transformed into phantasmatically altered part-object images. I
hope the reader will appreciate how Mason emphasizes the clinical rami-
fications of projective identification, splitting between the good and bad
part-object, and the manic defences. Note how, overall, Mason balances his
attention between the material from the text of free associations and his
emotional radar to detect projective transidentifications sent covertly by
the patient, and also how he demonstrates the difference between projec-
tive identification as an evacuation of discomfort by the infantile portion
of the patient’s personality into the image of the object and projective
transidentification (Grotstein, 2005) employed as a communication with
the analyst (Bion, 1962a, 1962b).
CHAPTER 24
Clinical example 17
Ronald Britton
Ron Britton is one the foremost representatives of the London Contemporary

post-Kleinian School, as well as being unique in his views. He was one of
the original members of Betty Joseph’s Workshop.
Clinical examples 17 and 18 have been extracted from Britton’s un-
published paper, “The Baby and the Bathwater”. The main theme of this
paper is that of “models” of thinking in theory and in practice. One is
aware of Bion’s (1962b) use of models as instruments of thinking that
are analogues external to the object being studied. Britton uses the term
“model” in that sense theoretically, but he also uses it clinically to indicate
a patient’s personal belief system.
Models in clinical practice
A
meeting ground for scientific models and personal models is
the psychoanalytic consulting room, and I would like to illus-
trate that from two actual cases.
Clinical presentation
This case exemplifies how one might find a familiar clinical model
in working with a patient. The case was one I supervised of “Peter”,
a man with a severe stammer that had been treated to no avail by a
variety of psychiatric methods and speech therapy and so had won
225
his way to psychoanalytic psychotherapy in the NHS. He did not

work; he was married but did not have sex, and he remained asocial
most of the time. He avoided talking to his mother on the phone and
wrote typewritten letters to her. The model that I describe emerged
first in my mind, and I communicated it to the analyst, who kept it
at the back of her mind, I think, but was only convinced when in
his own terms the patient described just such a model of his own
daily experience. It was that of Herbert Rosenfeld’s narcissistic organi-
zation in which the individual is forbidden to become deeply attached to
or communicate freely with any external object by an internal figure, or
gang, that meets out punishment and offers solipsistic solace [italics add-
ed; JSG].
Peter stammered his way through his sessions and in an undeclared
way developed a strong positive transference to his woman analyst.
The countertransference also was positive and included a good deal
of concern, with unexpected images of unspoken violence and fears
of suicide. In our supervisions we elaborated a model of the patient trying
to make contact and being attacked from within by a narcissistic organiza-
tion that mutilated his speech [italics added—JSG]. The analyst had little
opportunity to say much to Peter, who despite his stammer filled the
sessions with his talk. As time passed, he became more confiding, and
he let her know the full extent of his secrecy and how much he had
never divulged to anyone, including her. It was, he said now, “one
chance in a lifetime”—he had never, ever, let anyone know what was
in his mind. His mother used to ask him what he was thinking, but,
he said, “I would rather cut my hands off than let her know”. As we
were to discover, being touched had to be avoided, both physically
and metaphorically.
His secrets emerged, and we learnt that he talked fluently out loud,
without a stammer, to himself when he was alone and that he also
never stammered when talking to children or animals. From the age
of 14, he told her, there had been a voice in his head that ordered him
not to speak and not get close to anyone. This “other Peter”, as he now
called it, was punishing him after his sessions, particularly when they
had been pleasurable. The analysis went through a difficult period for
the analyst as Peter was tempted to harm himself at times by cutting
and contemplating suicide. The willingness of his analyst to know all
this while remaining attentive and available eased the analysis into
less troubled waters.
I cannot do justice here to this case in all its complexity: I only want
to illustrate the usefulness of the Rosenfeld model in understanding the
patient. But before leaving it, I would like to illustrate the transform-
able nature of models from thought, to speech and action.
Peter always arrived two minutes before his session and was ad-
mitted by the receptionist into the waiting room, from where the
analyst collected him. On one particular day she arrived on the
doorstep at the same time as Peter and therefore opened the door,
and, as she thought, led him into the clinic. When she hung up
her coat and went to collect him, he was not there. Alarmed, she
looked out of the window to see him driving his car out of the car
park; she was, naturally, puzzled and dismayed. A few moments
later the receptionist announced her patient was waiting for her.
He had driven out, waited a moment before returning, and started
again, thus arriving in the clinic in the usual way, being let in by the
receptionist. His initial rationalization was that he had to re-park
his car as it had to be a certain minimum distance from any other to
avoid touching. Later he acknowledged that being within touching
distance of his analyst had unnerved him. His stammer, always of
a hesitant, repetitive type, had now been reproduced in action and
demonstrated how it regulated proximity and immediacy in an
impulsive man afraid of defying his other self by making passion-
ate contact. Following this, he spoke of a painful pattern in his childhood:
every Sunday morning he and his brother would lie in their beds listening
to their parents making love next door; then the door would open and his
father would come in, saying, “and now it’s your turn”, taking the slipper,
and beating them on their bottoms. This unfolds another story, deepens the
analysis, and hints at a trans-generational model [italics added—JSG].
JSG’s comment
This was a supervised case so one does not get a clear image of how the
analyst intervened. What is of note, however, is how Britton thought about
the case, how he gradually conceived of a model to embrace the patient’s
troubled and troubling inner self. This model presupposed that the patient
had a belief system in which he was forbidden to have contact, physically
or emotionally, with anyone on the outside. Also of interest here and in
clinical example 18, is Britton’s recognition of the factor of infantile and
childhood trauma—and how he deals with it as a ruthlessly possessive
and forbidding internal structure.
Note
I wish to express my gratitude to Ron Britton for his gracious permission to let
me quote from his paper “The Baby and the Bathwater”.
CHAPTER 25
Clinical example 18
Ronald Britton
This brief case material also comes from Ronald Britton’s unpublished
paper, “The Baby and the Bathwater”.
T
his case refers to events across several generations that appear to have
shaped a psychic model that slowly emerged in the course of an
analysis of a young woman patient of mine. Unlike the first case,
this is not the emergence of a clinical pattern resembling a familiar
theoretical model, but one peculiar to the patient. It evolved in my
mind from fragments of material scattered through several years of
analysis. In this way it conforms to Bion’s notion of the selected fact.
Bion adopted Poincaré’s concept of “the selected fact” to describe his
approach to analytic material. Poincaré described the choice of one
“selected fact” among an accumulation of unsorted facts that arrests
the attention of the scientist in such a way that all the other data fall
into a pattern shaped by their relationship to this fact. He makes the
point that once this is selected, previously apparently unconnected
references and described events crystallize around it. The selected fact I
am referring to in this analysis is “someone disappears”, but I was not to reach
that conclusion until two and half years of the analysis had passed.
The manifest problem that brought this young woman into analy-
sis, at her mother’s urging, was an inability to start things: procrastina-
228
tion afflicted her relationships, her living arrangements, and her work;
she also could not conclude things. This meant not being able to end
unsatisfactory relationships; not being able to stop one thing in order to
start another; and not being able to reach conclusions. She could not de-
cide what she should do, because she could not decide what she really
thought or what she really felt. Behind this series of manifest problems
were, I was to find in the course of analysis, two principal phenomena.
One was that she could not sustain her own line of subjective thought on any
subject if any other person’s line of thought crossed it. This was not a simply
a matter of yielding to contradiction: her own point of view disappeared. The
second was an existential anxiety: she was afraid she would cease to exist as a
person in some sense that she could not really describe [italics added—JSG].
In adolescence she had been very phobic of mirrors.
She was in her early twenties, with a sister two years older. My
patient was 4 years old when the family came to England from Israel,
and all her schooling was at local English schools. Unlike her parents,
her English is totally unaccented, fluent, and can be literary or idi-
omatic. She took a very successful degree in theatrical studies, with the
aim of becoming a theatre director. She dreaded, however, ever having
to appear on stage. Her sister is a successful literary agent. Her links
with Israel have remained strong through a network of cousins and
life-long friends and her maternal grandmother, with whom she was
particularly close.
To a considerable extent her history was recalled by the patient in the
sessions as if its recollection was a commentary on the interpretation of the
transference and of current events in her life. For quite a long time the
patient’s initial contribution to analysis was silence; and I found that
the way I worked was shaped by the patient and my response to her
communications and lack of them. It is true that I have often said that
my approach is different with different patients, but in this case it was so to an
unusual degree [italics added—JSG]. Certainly a number of my patients
and former patients would not have recognized it. Being so atypical
of myself did give me qualms at times, but when looking back on it
after two and half years, I did not regret it. Material then emerged that
made sense of some of my earliest observations. Two years does seem
quite a long time to wait to get confirmation of an interpretation, and
what surprised me was my own lack of impatience, given my usual
character.
This is an extract from our second session:
She began, “I spent last night rubbishing Monday’s session in my
mind—I won’t be any good at this.”
I said: “So the two of us were given a hostile reception by the critics for
our performance.”
Silence for five minutes, then she says: “It’s OK today” (silence for 2
minutes), then: “but I don’t see the targets.” (Despite this sentence,
which seemed to negate the value of what had been acknowledged,
the silence that followed was comfortable and relaxed. I let it con-
tinue for 5 minutes before speaking.)
I said, “You spoke of targets—a word that could bring two different im-
ages—one is specified goals measuring achievement, something a third
person might want for us, or another like archery targets, where you might
make a hit or miss completely.”
She grunted—“that’s freefall” (free fall was a phrase she used in
her consultation to describe a fear of falling). [I was thinking of the
small amount of material and the large amount of silence and my
efforts to hit the target.]
I said, “A target would seem to be a small thing to hit surrounded by very
large space—so you have little hope of your words hitting home, or mine,
and if we missed you would be in free fall.” (We both remained silent
for quite some time—she seemed relaxed, and I felt comfortable and
neither bored nor sleepy.)
Pt.: “I was at Ronnie Scott’s Jazz Club last night and I thought—mu-
sic is the answer—only it is intangible.”
I said, “You say intangible, but music is very physical, is it not?”
She said, “Is it?”
I said, “I thought you were describing music as going straight through
your ears to your feelings; you can’t touch music nor can you see it, but
you hear it and it has a language. You seem to give such dominance to sight
that the rest of your perceptions don’t count. It is as if you were saying
that anything happening here in the way of experience isn’t any good if
you don’t see the point.”
(Silence for 5 minutes.)
Pt. “You know, I said on Monday ‘if I don’t speak I am invisible’.”
(She had said this in the context of her family when all present “if
I don’t speak I am invisible”.)
I said, “So you think you cannot just exist here; only what you say will
get you regarded or justify you.”
She said, “Otherwise it sounds like indulgence.”
I said, “so if you were a baby lying there just beginning to exist someone
would say to you, ‘when are you going to do something to show your
alive’.”
(She laughed and was silent for a couple of minutes, then) “I was
thinking of this idea of presence—I remember the first time I real-
ized on a zebra crossing that it really was one—a car stopped for
me, and I thought ‘so that’s alright then, I can carry on’.”
I said, “It seems you think I am sufficiently aware of your presence, like
the car driver, to stop and give you time to complete your thoughts—to
cross to the other side of the road.”
Pt. “Yes—and then you would be on your way” (tone surprisingly
sharp).
“It is near the end of the session” I said, “and after this you expect me to
be on my way and there is quite a gap to the next session.”
(Silence for the remaining five minutes.)
I would like now to give you the session two and a half years later that
I thought illuminated this very early session. Shortly before it she had
brought a dream where she and her sister were by a river that she could
not cross. It was raining heavily on her and she was soaked, but on her sister
it was raining not water but boats.
The session was on a Monday, after a week in which she had for the
first time in analysis attended all four of her sessions.
She began, “I had a dream—I was bleeding—I thought it was a
period but the bleeding didn’t stop—I realized that it wasn’t going
to stop—that it would just go on and on—my mother was there
somewhere in the background and is very disturbed. When I woke
up I began to feel very disturbed and told Barbara (her friend).”
I asked, “Were you disturbed in the dream or only when you woke
up?”
“That’s right! I wasn’t disturbed in the dream, I was just drifting
away, but I felt very anxious as soon as I awoke; I thought it won’t
stop. It was Friday night—it was the anniversary of my Grand-
mother’s death a year ago, and it was the anniversary of Barbara’s
mother’s death 12 years ago.”
[Barbara’s mother was killed riding a bicycle near the school while
they were together in class, and the patient was with Barbara when
she heard the news; she always treated this as if it had been her
own mother.]
“It was Valentine’s day when I woke up. The bleeding in the dream
reminds me of two brothers I saw yesterday—one of them had a
nose bleed—they are so different—the one who had the nose bleed
is so diffident and his brother is very decisive.”
I said, “You are afraid that if something really starts you will never be able
to stop it, whether it is a haemorrhage of feeling for someone or whether
it is tears that will never stop or thoughts of someone that will never end.
This is the first week you have managed to come to all four sessions and it
appears to have frightened you with thoughts that you will never be able
to stop coming here unless death intervenes.”
(Silence for a few minutes, then) “The two brothers are like my
sister and me—you know she is cut-and-dried about everything;
she doesn’t have thoughts, she makes decisions.”
I said, “I was reminded of your dream of you and your sister by the river
crossing where it rained boats on her. Not tears, like rain, but decisions—
vehicles for crossing the river whereas you seemed to feel that you would
only have an endless rain of tears and no boats, no means of crossing the
river to the other side of any experience.”
“When my grandmother was dying I was the last person she spoke
to on the telephone—she spoke Hebrew which was so surpris-
ing—it was like children’s Hebrew—like mine” (her grandmother,
unlike her mother, spoke German as her first language). (Long
silence.) “Oh! I had another association, something else happened
the day before the dream—but there isn’t time to go into it now.”
(There was about two minutes to the end of the session.)
I said, “But there is time to tell me what it was.”
“I met my friend from Paris with her new boyfriend who comes
from Riga. It was the train to Riga that my grandmother’s mother
took, and she never arrived—she got diverted to Auschwitz; she
left from Prague and never arrived in Riga.”
I was to hear more of this piece of family history the next day. Her
grandmother had left Prague at the beginning of the Second World War
as a member of a youth group sailing to Palestine, where she entered a
Kibbutz. Meanwhile her mother, my patient’s great-grandmother, who
was a widow, took the train from Prague to Riga with her new husband
to meet his family. She never arrived, and the patient’s grandmother,
now in Palestine, knew nothing of what had happened to her mother,
except that she had disappeared. Seven years later she was told that
her mother had never arrived in Riga and was presumed to be one of
those taken off the train in Poland and sent to Auschwitz.
This model of unexpected disappearance has re-emerged from time
to time in the analysis, and each time it offers an opportunity for
“working through”: that is, first realizing and then relinquishing the
latest version of the “model”. Not long ago—that is, four years after
that session—it manifested itself in a dream about an old friend from
her early schooldays who actually disappeared permanently when he
was 15: a mystery that has remained unsolved; she believes he is dead.
In the dream he appeared as a ghost. It was not difficult to link this to
anxieties about her own one-year-old baby boy. She told me then that
she had spent that night repeatedly checking that her baby was still
breathing and that she has from time to time a conscious phantasy of
she and her husband attending her son’s funeral. She blurted out, “If
I lost him, I would never cease searching!”
It was not difficult for us to link this to a discussion we had in the
previous day’s session about a future date for the ending of analysis.
Now we are planning to do so in the relatively near future, and work-
ing towards that has meant addressing the difference between ending
an analysis and disappearing: between termination and annihilation.
It brings together an old family history of her great-grandmother’s
disappearance, her own mother’s recurrent anxieties about her disap-
pearance as a child, her own lifetime of phantasied losses, a preoccupa-
tion with her own existential disappearance as an adolescent, her fears
about some future loss of her child, and her anxiety about my death
coinciding with the end of her analysis.
JSG’s comment
The clinical material eloquently speaks for itself. Britton tells us that it took
years for his ongoing reverie to harbour the “selected fact” until it was able
to crystallize in the revelation of a family transgenerational tragedy. One
observes how Britton, who is much closer to Bion than most Contemporary
Kleinians, suspends aspects of his own general clinical style to adapt to the
ongoing emotional states of the patient. He also follows Bion with regard
to the “selected fact”, the calibrating association that organizes and coheres
all the others. One appreciates his patience all the more as we learn that it
took years of reverie for the selected fact to make its debut.
Note
I wish to express my gratitude to Ron Britton for his gracious permission to let
me quote from his paper “The Baby and the Bathwater”.
CHAPTER 26
Clinical example 19
Antonino Ferro
Antonino Ferro has begun to emerge as one of the most significant con-
tributors to the application of Wilfred Bion’s contributions to clinical tech-
nique, as well as the concept of the “psychoanalytic field” formulated by
Madeleine and Willi Baranger (1961–62). The reader should look closely
at his use of the connection between alpha-elements and narremes → nar-
ratives.
In this extract from “Marcella: the Transition from Explosive Sensoriality
to the Ability to Think”, the author discusses an analytic case in which it
was necessary to first address the patient’s need for containment of her
protoemotions—her sensoriality—before the analysis could proceed along
more standard lines, with interpretation of the transference, work on
displacement and aspects of her childhood history, and so forth. Prior to
treatment, the patient had resorted to a sort of affective autism in order
not to experience dangerously overwhelming emotions, and her emotional
lethargy in sessions at first engendered similar feelings in the analyst, mak-
ing progress impossible until a container was established for her projective
identifications.
Introduction
W
ith some patients, a lengthy portion of the analysis must
consist of the patient’s consent to, and cooperation in, the
development of the capacity to think by building a “place” in
234
which to “hold” not only his emotions, but also the analyst’s interpretations
[italics added—JSG]. This task must be accomplished before one can
work with displacement and on the reconstruction of childhood his-
tory, using classical interpretations.
In the case I present here, that of Marcella, the pivotal part of
the analysis consisted of this work that I would define generally as
the establishment of containments [italics added—JSG]. This aspect of
the analysis took priority over its actual content, since it provided the op-
portunity for a transformation to take place—a transformation of Marcel-
la’s turbulent protoemotions and whirling sensoriality into emotions and
thoughts that she could begin to manage as they took shape in her psy-
che. As long as she was not able to do this (a situation Bion [1962b]
might have defined as a lack of the alpha function and of the container),
her psychic activity consisted either of continuous evacuation, or of a
deep drowsiness—a sort of hibernation of her protoemotional states and
an emotional and existential deadening. These ways of functioning
served as a sort of emotional levelling that impeded the formation
of protoemotional states, which the patient would have experienced
as a source of danger because she could not contain them; she did
not know how to transform them into experienceable emotions or thinkable
thoughts [italics added—JSG].
It has taken me a long time to organize my thoughts on the work I
have done and what remains to be done with Marcella. In such cases,
when clinical work becomes bleak and obscure, when the patient’s
maladaptive patterns of psychic functioning appear unmodifiable, and
when there is no visible means of exit, I have found it necessary to rely
on all the patience I can muster. Many of the major steps I describe in
my work with Marcella took on special significance only after the fact.
Furthermore, a primary feature of the analysis was my own mental function-
ing in sessions: for a long time it was necessary for me to compensate for
the patient’s inability to live her own emotions and thoughts, until I
gradually managed to pass on this skill so that Marcella could do it for
herself [italics added—JSG].
Marcella s “apartment below”

For a long time, the main feature of my sessions with Marcella, a young
woman who worked as an office clerk, was boredom—an atmosphere
of boredom that seemed gradually to fill the room and to take over
my mind. Physically Marcella was neither pretty nor ugly, and intel-
lectually she had no interests whatsoever: nothing attracted her or got
her involved. She had come to analysis because of an undefined and
indefinable state of malaise. Very soon, I started to perceive the work
with her as heavy going and boring, and I found myself unable to make
interpretations in the transference, almost as though I did not want to
“touch” her. I noticed that once I had been listening to her for a while,
my thoughts seemed to become disconnected; I tended to lose contact and
would stop following even the manifest level of what she was saying
[italics added—JSG].
This all changed when Marcella told me about a dream. In it, she
was opening the drawers of a chest near her bed, and they were full
of spools of thread, all different colours mixed together. She shut the
drawers quickly, frightened by the idea of how hard it would be and
how much patience she would need to sort out all those tangles. In as-
sociating to the dream, Marcella remembered that as a child, she used
to play at the home of her grandmother, who was a seamstress. But my
mind suddenly lit up with the idea of another meaning of the Italian
word for a spool of thread, spoletta [author’s italics]: it also signifies a
fuse, of the type used to ignite explosives. This thought immediately re-
minded me of a child I had had in analysis who used to cover pictures
of fierce animals that frightened him with a thick layer of Plasticine,
and I suddenly understood why for so long I had not been able to reach
Marcella on an emotive level with my interpretations: it was because I
was afraid she would “explode”. At that point, I was able to transfer with
the patient to her grandmother’s workroom and to uncover her terror
of the tangled, explosive emotions she had kept shut away in drawers
by means of her boredom [italics added—JSG].
The “spools” started to unwind as Marcella’s “stories”. However, I felt
that these stories could not be interpreted in any way, either in their real
sense or in the transference, and that there was not even any point in
trying to do so because we were immersed in a concrete setting. I there-
fore focused on the manifest level of the narration, sharing what Marcella had
to say and trying to make my interpretations highly “unsaturated” (Ferro,
1996a, 2002b)—that is, tentative rather than conviction-driven. Above all, I
had to recover my ability to think—which, when I was with Marcella, tended
to dissolve, leaving me confused, disoriented, and unable to make meaningful
connections [italics added—JSG].
I recall a period during which renovations in the apartment below
my office, which had been ongoing for a long time, started to assume
significance in our work together, and Marcella began to nose around
that floor of the building. This was the point at which I realized that two
levels of communication were taking place between us: one superficial—to-
tally shallow—and another carried out via projective identifications, which
had the effect of numbing my ability to listen even to the manifest text of
her speech during sessions. As mentioned, these projective identifica-
tions seemed to disconnect my own thought processes and made me

aware of an undercurrent of protoemotions so absolutely primitive that
they were either evacuated or became tangled up in boredom [italics
added—JSG].
And so stories surged up from the apartment below. Marcella
talked about the pastina [author’s italics] on the walls, referring to the
rough plaster mix used by the workmen. In response to a comment
of mine, she added that “pastina on the walls” reminded her of a very
angry child. It came out that she had had childhood tantrums when
her soup, which contained tiny pieces of pasta [pastina], was not the
right temperature for her, and she had chucked the whole plate at
the nearest wall, splattering the contents. Here I recall my difficulty in
agreeing to backdate the problem to her childhood, instead of finding an
easy, straightforward relational explanation—for example, one relating to
the way in which the patient reacted every time an interpretation seemed
too hot or too cold, and how she liked to “splatter” the contents of interpre-
tations [italics added—JSG].
The same was true of the Turkish divan that Marcella described
having in her bedroom, which was something like a “bed with a back-
rest”, bringing us back to the analyst’s couch. This was not associated
by the patient to certain aspects of herself that were foreign to her and
whose language she did not understand, but these meanings were not
lost when perceiving her remarks from a field viewpoint (Baranger, 1983;
Ferro, 1992). Such meanings are always present in the analyst’s office if they
are present in the analyst’s mind, waiting either to turn into plots that can be
shared or to open up fresh space in which to permit new thoughts to become
thinkable [italics added—JSG].
An emotion takes shape

After a further period of analysis with Marcella, I started to feel
that I was dealing with a sort of squid, the kind that shoots out ink when
threatened. Every attempt to get closer to the patient or to make even
the most cautious interpretation was met with a shower of “ink”. The
only resource I could use was my patience. This stance was eventually
rewarded, as affective relationships gradually started to come to light
in our workplace, alongside what Marcella called her “office connec-
tions”—stories about her work as an office clerk [italics added—JSG].
In one session, when I had managed to help establish a serene at-
mosphere with only minimal persecutory feeling, infantile memories
began to surface. These included one memory—Marcella did not know
whether she actually remembered it, or whether her mother had told
her about it—in which she was in a sort of baby walker, in a long corri-
dor with three doors opening off it. (It seems hardly necessary to point
out that Marcella was coming to three sessions a week at that point.)
In the memory, she was running faster and faster until she violently struck
the wash-basin in the bathroom at the end of the corridor. This tale brought
our session to an end, and I felt pleased that this deeper, more personal
level had finally started to emerge.
One day, in the ten-minute break I allow myself between one pa-
tient and the next, I was struck by a violent headache. I wondered why,
since I do not usually suffer from headaches. I started to worry about
how I would deal with my “new” patient in the next hour. I felt it
had something to do with Marcella, and suddenly I grasped the way
in which my headache, the next hour, and the “new” patient were all
linked. A change had taken place in my work with Marcella—not in the sense
of a massive identification with the patient, but, rather, a change that had been
brought about by the arrival of a strong emotion, a mental pain, in the field.
This psychic suffering would eventually allow a leap to occur in Mar-
cella’s mental growth. I could see only its precursor at that point, but
once such a presence takes hold in the field, it is never long before the patient
accepts it. It later became clear that the pain appeared in response to an
upcoming weekend break, as well as to the break revealed when I told
Marcella of my vacation dates. I feel it is significant that I was the one
to live Marcella’s first strong emotion, so to speak, and to receive it and
organize it as a thought [italics added—JSG].
Some time afterward, Marcella arrived for her session a quarter of
an hour late. She was normally punctual, even though she came from
out of town, but on this occasion she told me that her train had been
delayed when the controller (ticket collector) had seen a young drug ad-
dict lock himself in the toilet, and had tried to get him to come out and
get off the train. The ticket collector finally managed to get the boy to
disembark, but the boy then got back onto the train—whereupon all
the train doors were locked, and only then had the boy been success-
fully sent away. The whole procedure had taken 15 minutes [italics
added—JSG].
A scholastic interpretation would have been easy to make (“it is a part of
you that made sure you were late for the session—indicative of the extreme
need you feel of analysis”), but I felt that such an interpretation would have
come too much from me alone. It would have been in –K, as Bion (1965)
might have put it, and it would not have fit the patient. Furthermore,
this type of interpretation would not have produced insight and might
even have caused a sense of persecution in the patient and a resultant
loss of contact [italics added—JSG].
JSG’s comment
I urge the reader to pay close attention especially to what I have itali-
cized, in order to follow the patient’s progress and the development of
Ferro’s thinking. It is important to note that, unlike Kleinians, he refrains
from offering formal interpretations, especially of transference, when he
believes that the patient lacks a capacity for internal containment—that
is, to contain her emotions and the analyst’s interpretations. When that
happens, Ferro performs a “re-analytic narrative preparation” by empha-
sizing and elaborating upon the patient’s free associations. When I first
became aware of his “narrative preparatory technique”, I recalled that
received wisdom in analytic training when I was a candidate was that
many patients had to be prepared to be analysed by undergoing initial
psychotherapy. Kleinians do not believe this as a rule. I began to wonder
as I thought about this what psychotherapy could accomplish that analysis
could not (Wallerstein, 1986). While unable to come to a conclusion about
this dilemma, it occurred to me that perhaps what is really behind it is
that psychoanalytic—especially Kleinian—interpretations seek to enable
the infantile portion of the patient’s personality to undergo “weaning”
(separation) from the caretaking object, whereas psychotherapy, especially
supportive, would facilitate attachment to the object. Ferro seems to be
saying that one cannot give separating interpretations until the patient
feels securely attached.
Another aspect of Ferro’s oeuvre is his use of the concept of the “psy-
choanalytic field” (Baranger & Baranger, 1961–62)—a concept that finds
a parallel with Ogden’s (1994) “intersubjective third subject”. Both these
ideas spring not only from the development of the irreducibility of the
transference ↔ countertransference phenomenon, but the recognition is
also more than just the transference ↔ countertransference itself. If I read
Ferro correctly, it would seem that his patience in dealing with a concrete,
withdrawn, “boring” patient paid off as soon as she felt connected to him
in the transference ↔ countertransference or intersubjective field.
Note
From Antonino Ferro, “Marcella: the transition from explosive sensoriality to the
ability to think.” Psychoanalytic Quarterly, 72 (2003): 183–200. I wish to express my
gratitude to Antonino Ferro as well as to the Editor of the Psychoanalytic Quarterly
for their gracious permission to republish portions of this work.
CHAPTER 27

“The woman who couldn’t consider”
Thomas Ogden
This fragment of an analysis focuses on three consecutive sessions at the

beginning of the sixth year of an analysis conducted five times per week.
I present it at greater length than the previous “showcase” contributions
because of the way Ogden shows and then comments on how he uses his
mind and body as unfailing analytic instruments.
M
y stomach muscles tensed and I experienced a faint sense of
nausea as I heard the rapid footfalls of Ms B racing up the
stairs leading to my office. It seemed to me that she was des-
perate not to miss a second of her session. I had felt for some time that
the quantity of minutes she spent with me had to substitute for all of
the ways in which she felt unable to be present while with me. Seconds
later, I imagined the patient waiting in a state of chafing urgency to
get to me. As she led the way from the waiting room into the consult-
ing room, I could feel in my body the patient’s drinking in of every
detail of the hallway. I noticed several small flecks of paper from my
writing pad on the carpet. I knew that the patient was taking them in
and hoarding them “inside” her to silently dissect mentally during and
after the session. I felt in a very concrete way that those bits of paper
were parts of me that were being taken hostage. (The “fantasies” that
I am describing were at this point almost entirely physical sensations
as opposed to verbal narratives.)
240
As Ms B, a 41-year-old divorced architect, lay down on the couch,

she arched her back, indicating in an unspoken way that the couch
made her back ache. (In the course of the previous months she had
complained on several occasions that my couch caused discomfort to
her back.) I said that she seemed to be beginning the hour by register-
ing a protest about her feeling that I did not care enough about her to
provide a comfortable place for her here. (Even as I was speaking these
words, I could hear both the chilliness in my voice and the reflexive,
canned nature of the interpretation. This was an accusation disguised
as an interpretation—I was unintentionally telling Ms B about my
growing frustration, anger, and feelings of inadequacy in relation to
our work together.) Ms B responded to my comment by saying that
“that is the way the couch is”. (There was a hardness to the fact that
the patient said “is” rather than “feels”.)
The patient’s bitter resignation to the fact that things are the way
they are brought to mind her conviction (which she treated as a fact)
that she had been an unwanted baby, “a mistake”, born almost a dec-
ade after her older brother and sister. Her mother had been advanc-
ing quickly in her career in the federal government when she became
pregnant with the patient and grudgingly took a leave of absence for
the first few months of the patient’s life. Ms B felt that her mother had
hated her all her life and had treated her from the beginning with a
mixture of neglect and disgust while at the same time fiercely insisting
that the patient be a “miniature version” of herself. The patient’s father,
a shadowy figure in the analysis, was also part of the unchangeable
“given” to which the patient felt resigned. He was described as a be-
nign but ineffectual man who seemed to have emotionally withdrawn
from the family by the time the patient was born.
I said to Ms B in carefully measured tones that she must feel that
she perennially accommodates to me—I must seem to her not to have
the slightest intention of accommodating to her.
Both the patient and I knew that what we were talking about was
a major struggle in the transference-countertransference: the patient’s
intense anger at me for not giving her what she knew I could easily
give her if I chose to—a magically transformative part of me that would
change her life. This was familiar territory and had been acted out in
innumerable ways, including, most recently, her performing fellatio on
a friend and triumphantly swallowing his semen, consciously fantasied
to be his strength and vitality. I suspected that unconsciously Ms B
fantasied the semen to be the magically transformative milk/power
stolen from her mother and from me. The patient’s attempts to steal a
magically transformative part of me engendered in me a feeling that
it was impossible to give her anything in the way of compassion or
concern, much less affection or love, without feeling that I had sub-
mitted to her and was passively going through the motions of a role
scripted by her.
Ms B then spoke about events that had occurred earlier in the day
involving a longstanding dispute with a neighbour about a dog whose
barking the patient found “unnerving”. I recognized (with only a touch
of amusement) that I was identifying with the neighbour’s dog: it
seemed to me that the dog was being asked to be an imaginary dog (in-
vented by Ms B), one that did not make the noises dogs make. Despite
the fact that I might have interpreted something about the transference
displacement onto the neighbour’s dog, I decided not to attempt such
an intervention. I had learned from my experience with Ms B that a
good deal of the effect being created by her monologue about the dog
was the unstated demand that I point out to her something that she was
already fully aware of (i.e., that when she was talking about the dog,
she was also talking about me). For me to do so, I imagined, would
be experienced by the patient as a momentary victory in her effort to
get me to “sting” her with an interpretation that reflected my anger at
and interest in her. She would in fantasy passively and gleefully swal-
low the stolen (angry) part of me. My experience with Ms B had also
taught me that my succumbing to the pressure to make the demanded
“stinging” interpretation was disappointing to her, in that it reflected
my inability to hold on to my own mind (as she had found it almost
impossible to do while with her mother). I also conceived of the pa-
tient’s effort to evoke an angry response from me as an unconscious
attempt to bring me (in the paternal transference) out of the shadows
and into life. This, too, had many times been interpreted.
On the other hand, I could expect that if I were not to make an in-
terpretation, Ms B would become increasingly withdrawn and move to
another topic that would feel even more devoid of life than the session
currently felt. In the past, under such circumstances, she had become
somnolent in a way that was experienced by both of us as angrily
controlling, and at times she had fallen asleep for periods of up to 15
minutes. When I interpreted her withdrawal into sleep as a way of pro-
tecting herself and me from her anger (and mine), my experience had
been that the patient would treat my words as precious commodities
to be hoarded (like the scraps of paper on the carpet) rather than used
to generate her own ideas, feelings, and responses. Similarly, interpre-
tation of the patient’s “use” of my interventions in this way had not
been productive. Earlier discussions with her concerning this form of
analytic stalemate had led her to quip that Oliver Sacks should write a
story about her and call it “The Woman Who Couldn’t Consider”.
As Ms B was speaking and as I was mulling over the dilemma just
discussed, I began thinking about a scene from a film that I had seen
the previous weekend. A corrupt official had been ordered by his Mafia
boss to kill himself. The corrupt official parked his car on the shoulder
of a busy highway and put a pistol to the side of his head. The car
was then filmed from a distance across the highway. The driver’s side
window in an instant became a sheet of solid red, but did not shatter.
The sound of the suicide was not the sound of a gunshot, but the sound
of uninterrupted traffic. (These thoughts were quite unobtrusive and
occupied only a few seconds of time.)
Ms B went on without a pause or transition to speak about a date
that she had had the previous evening. She described the man by
means of a collection of disjointed observations that were quite devoid
of feeling—he was handsome, well-read, displayed anxious manner-
isms, and so on. There was almost no indication of what it had felt like
for the patient to have spent an evening with him. I was aware that
although Ms B was talking, she was not talking to me. It may have been
that she was not even talking to herself, in that it did not seem to me
that she was the least bit interested in what she was saying. I had many
times interpreted this sense of the patient’s disconnection from me and
from herself. I decided not to offer that observation as an interpretation,
in part because I felt that it would have been experienced as another
“sting”, and I did not feel that I had a different way of talking to her.
As the patient continued, I was feeling that the hour was moving
extremely slowly. I had the claustrophobic experience of checking the
time on the clock and then some time later looking at the clock to find
that the hands seemed not to have moved. Also, I found myself playing
a game (which did not feel at all playful) of watching the second hand
on the clock across the room make its silent rounds and finding the
precise place in its movement that the digital clock on my answering
machine next to my chair would transform one digit to the next. The
convergence of the two events held my attention in a way that was
oddly mesmerizing, although not exciting or fascinating. This was an
activity I had not previously engaged in during sessions with Ms B or
with any other patient. I had the thought that this mental game may
have reflected the fact that I was experiencing the interaction with Ms
B as mechanical, but this idea seemed rote and wholly inadequate to
the disturbing nature of the claustrophobia and other poorly defined
feelings that I was experiencing.
I then began (without being fully aware of it) to think about a
phone call I had received several hours earlier from a friend who
had just had a diagnostic cardiac catheterization. Emergency bypass
surgery would have to be performed the next day. My thoughts and
feelings moved from anxiety and distress about the friend’s illness and
imminent surgery to imagining myself being told the news that I re-
quired emergency bypass surgery. In my fantasy of being given this
news, I initially felt intense fear of never waking up from the surgery.
This fear gave way to a sense of psychic numbness, a feeling of de-
tachment that felt something like the onset of emotional dulling after
rapidly drinking a glass of wine. That numbness did not hold: it quietly
slid into a different feeling that did not yet have words or images as-
sociated with it. This feeling preceded any thought or image—the way
one sometimes awakes from sleep with intense anxiety or some other
feeling, and only several seconds later remembers the events or the
dream with which the feelings are connected.
In the instance I am describing in the session with Ms B, I realized
that the new feeling was one of profound loneliness and loss that was
unmistakably connected with the recent death of a close friend, J. I
recalled what I had felt while talking with J shortly after she had been
diagnosed with a recurrence of breast cancer. During a long walk on
a weekend morning, we were both “figuring out” what the next step
should be in the treatment of her widely metastasized cancer. There
was, during that walk (I think for both of us), a momentary respite from
the full intensity of the horror of what was occurring while we weighed
alternatives as if the cancer could be cured. As I went over parts of the
conversation in my mind, it seemed in retrospect that the more practi-
cal we became, the more make-believe the conversation felt—we were
creating a world together, a world in which things worked and had
cause-and-effect relationships with one another. It was not an empty
sense of make-believe, but a loving one. After all, it is only fair that 3
plus 8 equals 11.
Embedded in this part of the reverie was not only a wish for fair-
ness, but a wish for someone to enforce the rules. At that point in the
flow of reverie, I became aware, in a way that I had not previously
experienced, that the make-believe world that J and I had been creating
was a world in which there was no such thing as “we”: she was dying;
I was talking about her dying. She had been alone in it in a way and to
a degree that I had never dared feel before that moment in the session
with Ms B. I felt a very painful sense of shame about the cowardice that
I felt I had displayed in having protected myself the way I had. More
important, I felt that I had left J even more isolated than she had to be
by not fully recognizing the extent of her isolation.
I then refocused my attention on Ms B. She was speaking in a
rather pressured way (with an exaggerated lilt in her voice) about the
great pleasure she was deriving from her work and from the feeling
of mutual respect and friendly collaboration she experienced with her
colleagues in her architectural firm. It seemed to me that only thinly
disguised by the idealized picture being presented were feelings of

loneliness and hopelessness about the prospect of her ever genuinely
experiencing such feelings of ease and closeness with her colleagues,
her friends, or me.
As I listened to Ms B’s pressured description, I was aware of feeling
a combination of anxiety and despondency, the nature of which was
quite nonspecific. I was reminded of the grim satisfaction I had felt ear-
lier in tracking the convergence of the precise, repeatable location of the
sweep of the second hand of the clock and the instant of movement of
the digital numbers on the answering machine. I thought that perhaps
the fact that there was a place and a moment where the second hand
and the digital clock “squared” may have represented an unconscious
effort on my part to create a feeling that things could be named, known,
identified, located, in a way that I knew that they could not.
Ms B began the following session with a dream:

I was watching a man take care of a baby in an outdoor place of some sort
that might have been a park. He seemed to be doing a good job of attending
to it. He carried the baby over to a steep set of concrete stairs and lifted the
baby as if there were a slide to place it on, but there was no slide. He let
go of the baby and let it hurtle down the stairs. I could see the baby’s neck
break as it hit the top step, and I noticed that its head and neck became
floppy. When the baby landed at the bottom of the steps, the man picked
up its motionless body. I was surprised that the baby was not crying. It
looked directly into my eyes and smiled in an eerie way.
Although Ms B often began her sessions with a dream, this dream was
unusual in that it was disturbing to me. This led me to feel a flicker
of hopefulness. The patient’s dreams in the past had felt flat and did
not seem to invite inquiry or discussion. Ms B made no mention of the
dream and immediately began to talk in an elaborately detailed way
about a project at work with which she had been involved for some
time. I interrupted her after several minutes and said I thought that
in telling me the dream, she had attempted to say something that she
felt was important for me to hear and at the same time was afraid to
have me hear it. Her burying the dream in the noise of the details of
the project made it appear that she had said nothing of significance to
me.
Ms B then said (in an earnest, but somewhat compliant way) that as
she was telling me the dream, she at first felt identified with the baby,
in that she often feels dropped by me. She quickly (and unexpectedly)
went on to say that this interpretation felt to her like a “kind of a lie”
since it was like a “tired old refrain, a knee-jerk reaction”. She said that
there were several very upsetting things in the dream, beginning with
the fact that she had felt “immobilized” and unable to prevent what she
saw unfolding. (I was reminded of the shame I had felt in the previous
session in connection with the thought that I had shielded myself from
J’s isolation and in a sense had looked on in an immobilized manner.)
Ms B said that even more distressing to her was her sense of herself as
both the baby and the man in the dream. She recognized herself in the
baby’s act of pointedly looking into her eyes and smiling in a detached,
mocking way. She said that the baby’s smile felt like the invisible smile
of triumph that she often inwardly gives me at the end of each meeting
(and at various junctures during the meetings), indicating that she is
“above” or “immune to” psychological pain and that this makes her
much more powerful than I am (despite what I may think).
I was moved by the patient’s conscious and unconscious efforts to
tell me (albeit indirectly) that she had some sense of what it had felt
like for me to have had to endure her defiant claims not to need me
and her triumphant demonstrations of her capacity to occupy a place
above (outside) human experience and psychological pain.
Ms B then told me that she was very frightened by how easy it is
for her to become the man and the baby in the dream—that is, how
easily she enters into a “robotic” mode in which she is fully capable of
destroying the analysis and her life. She was terrified by her capacity
to deceive herself in the way that the man seemed to believe that he
was placing a baby on a slide. She could easily destroy the analysis in
this mindless way. She felt that she could not at all rely on her ability to
distinguish real talk that is aimed at change from “pseudo-talk” that is
designed to make me think she is saying something when she isn’t. She
said that even at that moment she couldn’t tell the difference between
what she really felt and what she was inventing.
I will only schematically present elements of the subsequent meeting

in an effort to convey a sense of the shape of the analytic process that
was set in motion by the two sessions just described.
The next meeting began with Ms B’s picking a piece of loose thread
from the couch and, in an exaggerated gesture of disdain, holding it
in the air between her thumb and forefinger and dropping it on the
floor before she lay down. When I asked her what it felt like to begin
our meeting as she had, she laughed embarrassedly as if she were
surprised by my inquiry. Sidestepping my question, she said that she
had been in a compulsive cleaning frenzy from early that morning. She
had awakened at 4:00 A.M. in a state of great agitation that seemed to
be relieved only by cleaning the house, particularly the bathroom. She
said that she felt she had failed in life and in analysis and that there
was nothing to do but to control “the ridiculous things” she had it in

her power to control. (I could feel her desperation, but her explana-
tion seemed textbookish.) She went on to fill the first half of the ses-
sion with ruminative thinking. My efforts to interpret the compulsive
/ruminative activities as an anxious response to her having said too
much (made a “mess”) in the previous day’s meeting were given only
perfunctory notice before she resumed her ruminations.
While the patient was in the throes of her defensive ruminations,
I found myself watching the play of sunlight on the glass vases near
one of the windows in my office. The curves of the vases were lovely.
They seemed very feminine, resembling the curves of a woman’s body.
A bit later I had an image of a large stainless-steel container in what
seemed to be a factory, perhaps a food processing plant. My attention in
the fantasy was anxiously riveted on the gears at the end of one of the
containers. The machinery was clanking loudly. It was not clear what
was frightening me, but it seemed that the gears were not working as
they should and that a major malfunction with catastrophic results was
about to occur. I was reminded of the extreme difficulty Ms B’s mother
had had with breast-feeding. According to her mother, the patient bit
the mother’s nipples so hard that they became inflamed, and breast-
feeding was terminated.
I had the thought that I was experiencing a sensuous and sexual
aliveness with Ms B but had been made anxious by it and had turned
her femininity (her breasts in particular) into something inhuman (the
stainless-steel container and its nipple/gears). It seemed I was feel-
ing that catastrophic breakdown would follow closely on the heels of
sexual desire for, and sensual pleasure with, Ms B. These desires and
fears came as a surprise to me since, to this point, I had felt no sexual
or sensual attraction to Ms B, and in fact had been aware of the aridity
and boredom that had resulted from the stark absence of this dimen-
sion of experience. I thought of the way in which Ms B had arched her
back two sessions earlier and for the first time experienced the image
of her arching her back on the couch as an obscene caricature of sexual
intercourse.
With about 20 minutes remaining in the session, Ms B said that she
had come today wanting to tell me a dream that had awakened her
during the night, but that she had forgotten it until that moment:
I’ve just had a baby and I’m looking at it in the bassinet. I don’t see any-
thing of me in its face which is dark, heart-shaped, Mediterranean. I don’t
recognize it as something that came out of me. I think, “How could I have
given birth to such a thing.” I pick it up and hold him and hold him and
hold him, and he becomes a little boy with wild curly hair.
Ms B said, “In telling you the dream, I was thinking of the fact that
what comes out of me here doesn’t feel like me. I don’t take any pride
in it or feel any connection with it.” (I was aware that the patient was
leaving me out of the picture, a fact that was particularly striking, given
that my hair is curly. I was also struck by the aliveness of the dream
in the hour and the way this seemed to be in part generated by the
patient’s telling it in the present tense, which was unusual for her.)
I said to the patient that it seemed true that she felt disgusted by
everything that came out of her here, but that in telling me the dream
she was saying something more to me. I said she seemed frightened
of feeling or letting me feel the love she felt for the child in the dream.
I asked if she had experienced the change of feeling when she shifted
from referring to the child as a “thing” or “it” to using the word “him”
when she said that she had picked it up and held him and held him
and held him. She fell silent for a minute or two, during which time
I had the thought that I may have prematurely used the word “love”,
which was a word I could not at that moment remember either of us
ever having used during the entire course of the analysis.
Ms B then said she had noticed that change in telling me the dream,
but she could feel it as a feeling only when she listened to me saying
her words. She told me that while I was speaking, she felt grateful to
me that I had not let that part of things be “thrown away”, but at the
same time she felt increasingly tense with each word that I spoke, fear-
ing that I would say something embarrassing to her. She added that it
was as if I might undress her, and she would be naked on the couch.
After another silence of almost a minute, she said that it was hard to
tell me this but the thought had gone through her mind as she was
imagining being naked on the couch that I would look at her breasts
and find them to be too small.
I thought of the agony surrounding J’s surgery for breast cancer and
became aware at this point in the hour that I was feeling both a wave
of my deep love for J, together with the sadness of the enormous void
her death had left in my life. This range of feeling had not previously
been part of my experience while with Ms B. Now I found myself
listening and responding to Ms B in quite a different way. It would be
an overstatement to say that the feelings of anger and isolation had
disappeared, but they were now part of a larger constellation of emo-
tion. No longer was the isolation simply an encounter with something
that felt nonhuman: rather, the isolation felt more like an experience of
missing the humanness of Ms B that I viscerally knew to exist but was
only being allowed to glimpse fleetingly from afar.
I told the patient that I thought her dream and our discussion of it
also seemed to involve feelings of sadness that large parts of her life
were being unnecessarily wasted, “thrown away”. I said that she began
telling me the dream by saying “I’ve just had a baby”, but a great deal
of what followed was about the ways in which she prevented herself
from living the experience of having a baby. (In the course of the
analysis, she rarely had fantasies or dreams of having a baby, and only
twice had she discussed the question of whether she might ever want
to have children.) There were tears on her face but no sound of crying
in her voice as she said that she had not previously put the feeling into
words, but a good deal of her shame about her breasts is that they feel
like boys’ breasts that could never make milk for a baby.
Discussion
I began the presentation of the first of three sessions in the sixth year
of Ms B’s analysis with a description of my response to hearing the
patient’s footsteps on the stairs leading to my office. I find it invaluable
to be as fully aware as I can of what it feels like to meet the patient each
session (including the feelings, thoughts, fantasies, and bodily sensa-
tions experienced in anticipation of that particular meeting). Much of
my response to Ms B that day, both in listening to her approach and
in encountering her in the waiting room, was in the form of bodily
responses (“phantasies in the body”—Gaddini, 1982). From the outset
I was anticipating (in fantasy) being physically and psychologically
invaded by the patient: my stomach muscles tensed as I unconsciously
anticipated receiving a blow to the abdomen, and I was experiencing
nausea in preparation for evacuating a noxious presence that I expected
to experience inside of me. These feelings were elaborated in the form
of fantasies of the patient’s chafing to “get to me” (to get into my of-
fice/body) and fantasies of her cannibalizing me through her eyes as
she took parts of me hostage in “drinking in” the scraps of paper from
my notebook that she noticed on the carpet.
Clearly, this reverie, occurring even before the patient had entered
the consulting room, reflected a set of transference–countertransfer-
ence feelings that had been growing in intensity and specificity for
some time and yet were not available to either the patient or to me for
reflective thought or verbal symbolization. This aspect of the analytic
relationship was largely experienced by both of us as simply the way
things were.
I experienced Ms B’s arching her back only as a complaint and was
not at that point able to entertain the possibility that the gesture had
other meanings. My initial interpretation addressed the idea that the
patient was angrily protesting my unwillingness to provide a comfort-
able place for her in my office. I could hear the chilliness in my voice
that transformed the interpretation into an accusation. I was at that

moment feeling unable to be an analyst with the patient and instead
was experiencing myself as angry, at sea, and rather helpless to alter the
course of events. The “canned” nature of my interpretation alerted me
to my own emotional fixity in relation to Ms B and to my inability at
that point to think or to speak freshly or to render myself open to new
possibilities for understanding and experiencing what was occurring
between us. These realizations were deeply unsettling.
Although aspects of the patient’s experience of her parents went
through my mind, I was very little able to bring that context to bear on
the present situation in a way that felt real. Moreover, the constellation
of ideas about the transference-countertransference that had evolved
in the course of this period of analysis (for example, the idea that the
patient was relentlessly demanding magically transformative milk/se-
men/power) had lost most of the vitality that it once had held. These
ideas had become for both the patient and for me stagnant formu-
lae that largely served as a defence against feelings of confusion and
helplessness and against the experience of a fuller range of feelings
(including loving ones).
Perhaps the disturbing awareness of the way my anger was inter-
fering with my ability to offer usable interpretations allowed for the
beginnings of a psychological shift to occur in me. This was reflected
in my ability to see (and feel) the humour in my identifying with the
neighbour’s dog, which was (I felt) being asked not to be a dog but,
rather, to be the patient’s imaginary, invented creature. This led me to
be able to refrain from offering still another intervention of the chilly,
clenched teeth (“carefully measured”) variety and instead to attempt
to listen.
It was after this affective shift that reverie of a more verbally sym-
bolic (less exclusively somatic) sort began. The reverie that occurred
at this point in the session consisted of images and feelings derived
from a film in which a corrupt official commits suicide in such a way
that the sound of the suicide is not that of the report of a gun or the
shattering of glass, but the uninterrupted sound of traffic oblivious to
this solitary human event. Although these images were emotionally
powerful, they were so unobtrusive, so barely available to self-reflec-
tive consciousness, that they served almost entirely as an invisible
emotional background.
The experience of this reverie was nonetheless unsettling and con-
tributed to the creation of a specific emotional context for the un-
conscious framing of what followed. Ms B’s account of her date the
previous night was experienced differently than it would have been
otherwise. The principal effect on me of her talk was the creation of
a painful awareness of the feeling of not being spoken to, a sense of

words filling empty space, words not spoken by anyone to anyone
(even to herself).
Feeling at a loss to know how to speak to the patient about her not
talking either to me or to herself, I continued to keep silent. Again I
found my mind wandering, this time to a brief immersion in the mental
“game” of observing the precise place and time of the convergence of
movement of the digital time of the answering machine and the sweep
of the second hand of the clock across the room. In part, this served to
relieve the claustrophobia I was experiencing in feeling trapped alone
with Ms B. I hypothesized that both the reverie about the suicide and
the “game” involving the workings of two timepieces may have reflect-
ed my sense of the mechanical, nonhuman qualities of the experience
with Ms B, but this idea seemed superficial and hackneyed.
The reveries that followed reflected a movement from a rather rig-
id, repetitive obsessional form to a far more affect-laden “stream of
thought” (James, 1890). I felt distressed in recalling a phone call from
a friend who had been told he needed emergency open-heart surgery.
Very quickly I protected myself from the fear of his dying by narcis-
sistically transforming the event in fantasy into a story of my receiving
this news. My own fear of dying was expressed as a fear of never wak-
ing up. The idea of not waking up was at this juncture unconsciously
overdetermined and in retrospect seems to have included a reference
to the oppressive “living death” of the analysand as well as to my own
anesthetized state in the analysis, from which I unconsciously feared
I would never awake.
In all of this there was a rapidly growing sense of being out of
control in relation both to my own body (illness/sleep/death) and to
people I loved and depended upon. These feelings were momentarily
allayed by a defensive withdrawal into emotional detachment, a psy-
chic numbness. My unconscious efforts at emotional detachment did
not hold for very long and gave way to a form of reverie in the shape
of vivid images of a time spent with a very close friend, J, in the midst
of her attempting to wrestle with imminent death. (Only for want of a
better word would I refer to the creation of these reverie images as “re-
membering”, because the idea of remembering too strongly connotes
something fixed in memory that is “called up to consciousness again”
[re-membered]. The experience in the session was not a repetition of
anything, not a remembering of something that had already occurred;
it was occurring for the first time, an experience being generated fresh-
ly in the unconscious intersubjective context of the analysis.)
In the course of the reverie of the conversation with J (in which
make-believe but desperately real efforts were being made to “figure
out” what next to do), an important psychological shift occurred. What

began in the reverie as a wishful insistence that things should be fair
and “make sense” became a painful feeling of shame regarding my
sense that I had failed to appreciate the depth of isolation that J was
experiencing. The symbolic and affective content of the reverie was
barely conscious and did not yet constitute a conscious self-awareness
of isolation about which I could speak to myself or from which I could
speak to the patient. Nonetheless, despite the fact that a conscious,
verbally symbolized understanding of the reverie experience did not
take place at this moment, an important unconscious psychological
movement did occur, which, as will be seen, significantly shaped the
subsequent events of the hour.
In “returning” the focus of my attention to Ms B, I was not going
back to a place I had been in the session but was going to a new psy-
chological “place” that had not previously existed, a place emotionally
generated in part by the reverie experiences that I have just described.
Ms B was speaking in an anxiously pressured, idealizing way about
relationships with colleagues. The reverie experiences discussed above
(including my experience of defensive psychic numbing) had left me
acutely sensitive to the experience of psychological pain disguised by
reliance on manic defence, particularly the pain of efforts to live with
terrible loneliness and in isolation with one’s feelings of powerless-
ness.
The “clock-game” reverie that had occurred earlier in the hour took
on new meaning in the emotional context of what was now taking
place.1 The “earlier” reverie was in an important sense occurring for
the first time, in that the act of recalling it in the new psychological
context made it a different “analytic object”. The “mental game” as I
experienced it at this point was filled not with boredom, detachment,
and claustrophobia, but with desperateness that felt like a plea. It was
a plea for someone or something to rely on, some anchoring point that
could be known and precisely located and would, if only for a moment,
stay put. These were feelings that in the hour felt “multivalent”, that is,
they seemed simultaneously to have a bearing on my feelings about J
(not “old” feelings but feelings taking shape in the moment) and about
the evolving analytic relationship.
The affective movement just described is not accurately conceptual-
ized as the “uncovering” of heretofore “hidden” feelings in relation to
my past experience with J. It would be equally misleading to reduce
what was occurring to a process in which the patient was helping me
to “work through” my previously unresolved unconscious conflicts in
relation to J (a process that Searles [1975] referred to as the patient’s
serving as “therapist to the analyst”). Rather, I conceive of the reverie ex-

periences generated in this hour as reflecting an unconscious intersubjective
process in which aspects of my internal object world were elaborated in ways
that were uniquely defined by the particular unconscious constructions being
generated by the analytic pair. The emotional change that I experienced in rela-
tion to my (internal object) relationship with J could have taken place in the
way that it did only in the context of the specific unconscious intersubjective
relationship with Ms B that existed at the moment [italics added—JSG.]
The internal object relationship with J (or with any other internal
object) is not a fixed entity: it is a fluid set of thoughts, feelings, and
sensations that is continually in movement and always susceptible
to being shaped and restructured as it is newly experienced in the
context of each new unconscious intersubjective relationship. In every
instance it will be a different facet of the complex movement of feeling
constituting an internal object relationship that will be most alive in the
new unconscious intersubjective context. It is this that makes each un-
conscious analytic interaction unique for both analyst and analysand.
I do not conceive of the analytic interaction in terms of the analyst’s bringing
pre-existing sensitivities to the analytic relationship that are “called into play”
(like keys on a piano being struck) by the patient’s projections or projective
identifications. Rather, I conceive of the analytic process as involving the crea-
tion of unconscious intersubjective events that have never previously existed
in the affective life of either analyst or analysand [italics added—JSG.] Ms
B’s experience of and participation in the unconscious intersubjective
movement that I have been describing was reflected in the dream with
which she began the second of the three sessions presented. In that
dream the patient was watching a man take care of a baby. The man
placed the baby on an imaginary slide and allowed it to fall down a
concrete staircase, breaking its neck in the process. At the end of the
dream, as the man picks up the silent, motionless baby, the infant looks
directly into the patient’s eyes and smiles eerily.
After reporting the dream, Ms B went on as if she had not said
anything of significance about her dream life or any other part of her
life. I found (without planning it) that the wording of the interpreta-
tion I offered drew upon both the imagery of my reverie of the traffic
noise covering the solitary suicide as well as the emotional effect on
me of the absolute silence that framed the patient’s dream (no spoken
words, cries, screams, thuds, occurred in her account of the dream). I
commented on the way the patient had used words as “noise” to talk
over (drown out) something of great importance that she both hoped
I would hear and was trying to prevent me from hearing in telling me
the dream. The question of where my reveries stopped and the patient’s
dream began was not possible to determine in any meaningful way at

this point. Both my reveries and the patient’s dream were created in
the same “intersubjective analytic dream space” (Ogden, 1996).
Ms B’s response to my interpretation was more direct, self-reflec-
tive, and affectively coloured than had been the case for some time.
Despite a note of compliance, it was clear that the analytic relation-
ship was in the process of changing. After beginning by saying that
she saw herself as the baby that was being dropped by me, she was
able to observe that the interpretation was a “kind of a lie”, in that
it felt stale and reflexive. She then spoke of feeling “immobilized” in
her inability to prevent what she was observing from happening. My
reverie from the previous session involving my sense of shame associ-
ated with the feeling of being an immobilized observer of J’s isolation
led me to wonder whether shame and guilt were important aspects of
the patient’s distress in relation to the dream as well as in relation to
her treatment of me. Ms B’s next comments seemed to bear out this
understanding: she told me indirectly that she was frightened of her
capacity to isolate herself and me through her claims to be “immune
to” psychological pain.
As Ms B spoke about her use of the “eerie smile” with me, I was
not certain whether she was conscious of her efforts to relieve me of
my feelings of isolation while with her. This session concluded with the
patient’s speaking to me about her fear of her capacity to become so
mechanical that she is capable of destroying the analysis and her life. In
her experiencing her inability to distinguish real feeling from deceptive
“pseudo-talk”, Ms B, without fully recognizing it, was talking to me
about the only things that she could know in any visceral way to be
real—her frightening awareness of not knowing what, if anything, is
real about her and the feeling of being fully entrapped in her.
The following meeting began with a theatrical acting-in, in which
Ms B fastidiously removed a piece of loose thread from the couch. It
had been a longstanding pattern for the patient to anxiously withdraw
after sessions in which it had felt to me that we had spoken to one an-
other in a way that reflected a feeling of human warmth. Nonetheless,
the imperious, detached quality of the patient’s gesture left me with a
distinct feeling of disappointment that the connection I had begun to
feel had again been abruptly brought to an end. I felt that I was being
dropped with about as much concern as she was feeling towards the
piece of thread that was being dropped to the floor.
It seemed that she, too, was experiencing disappointment in herself,
feeling herself to be a failure in life and in analysis. She was also ap-
parently feeling frightened and embarrassed that she had (in fantasy)
soiled herself and me and was feverishly engaged in cleaning up the
spilled bodily contents/feelings (the dirty bathroom mess). My efforts

to talk with her about what I thought I understood of the way her
current feelings and behaviour represented a response to what she
had experienced with me in the previous meeting were systematically
ignored.
During the bulk of the session, while the patient was ruminating,
my own reveries included a sensuous enjoyment of the feminine lines
created by the play of sunlight on the vases in my office. This was
followed by an anxiety-filled set of reverie images of malfunctioning
gears on containers in a factory that may have been a food-processing
plant. There was a strong sense of impending disaster. These images
and feelings were connected in my mind with the patient’s description
of the very early termination of breast-feeding that had resulted from
her “excessive” desire (her biting her mother’s nipples so hard that
they became inflamed).
It felt to me that despite the fact that I had not previously experi-
enced any hint of sexual or sensual aliveness while with Ms B, I was
now beginning to have these feelings and was experiencing anxiety
about the catastrophe that such feelings would in fantasy bring on.
I was reminded of Ms B’s arching her back at the beginning of the
session earlier in the week and recalled how the gesture had held no
sexual force for me at the time. That bodily movement now seemed to
me to be a denigrating caricature of sexual intercourse: that is, both an
expression of sexual desire towards me and the simultaneous denigra-
tion of that desire.
The thoughts as well as the reverie feelings and images served as
the emotional context for my listening and responding to the dream
that the patient presented in the second half of the hour. In that dream,
Ms B had just given birth to a baby that felt alien to her. On holding
him and holding him and holding him, he turned into a little boy
with wild curly hair. Ms B quite uncharacteristically offered her own
interpretation of the dream, saying that she felt it reflected the way
in which she feels no connection with what comes out of her in the
analysis. I acknowledged that this did seem to capture something she
had felt for a long time, but (influenced by the feeling residue of my
reveries) I told her I thought that she was telling me more than that
in telling me the dream. I said that I thought it was frightening to her
to openly experience affection for her child. (I chose to defer until a
later session interpreting the idea/wish that the curly haired baby
was “ours” because it seemed necessary that the patient first be able
to genuinely experience her own connection with him [me/herself/the
analysis].) I then asked if she had felt the way in which, almost despite
herself, she had allowed the baby to become human (and loved) as she
moved mid-sentence from referring to the infant as “it” to using the

word “him”.
After a silence that felt both thoughtful and anxious, she told me
that she had felt grateful that I had not “thrown away that part of
things”. I was aware that she was using vague language (“that part of
things”) instead of using the word “love” (as I had done), or introduc-
ing a word of her own to name the feeling that was “not thrown away”.
She went on to tell me that she had been afraid that I would embarrass
her with my words (in fantasy, undress her) and that her breasts would
be revealed and that I would find them too small.
I then experienced, in a way that I had not been able to feel in the
course of the analysis, the intensity of the love that I felt for J as well
as the depth of my feelings of sadness and loss. It was only at that
juncture that I began to suspect that the feelings of shame I had felt
during the reverie about J in the earlier session had served to protect
me from experiencing the pain of that love and the feeling of loss. I
suspected that Ms B’s shame regarding the fantasy of my finding her
breasts too small similarly served a defensive function in relation to
the more frightening wishes to be able to love me and to feel loved by
me (as well as the accompanying fears of my contempt for her and her
contempt for herself for having such wishes). This fearful, defensive
contempt had been expressed in her imperious gesture at the start of
the meeting.
The reveries and thoughts that I have just described (e.g., the rever-
ies involving an anonymous suicide, the effort to control the passage
of time, the inability to fully grieve the early death of a friend, the
anxiety associated with foreclosed sexual and sensual aliveness and
relatedness) strongly contributed to my saying to Ms B that I felt there
was a sadness in what we were talking about which had to do with the
feeling that important aspects of her life were not being lived (were be-
ing “thrown away”). In referring to the sadness of a thrown-away life,
a life unlived, I was thinking not only of the way she had not allowed
herself to have the experience of being the mother of her (our) baby in
the dream, but also of the way in which (to varying degrees) she had
not allowed herself to live the experience of being in analysis with me
and had not allowed herself to live the experience of being a daughter
to her mother or of having a mother.
Ms B responded to what I said by crying in a way that felt to me
that she was experiencing sadness with me as opposed to dramatizing
for me an invented feeling. She elaborated on the idea that much of her
life had not been lived by telling me that she had, to a large extent, not
experienced her life as a girl and as a woman since she had not had a
sense of herself as having had a female body. As a result she felt she
would never be able to “make milk for a baby”. Implicit in this final
statement of the hour was the patient’s fear that she would never be
able to fully experience being alive as a sexual woman with me and
experience (in imagination) being the mother of our baby.
JSG’s comments
The quintessence of Ogden’s intersubjective approach
in this case presentation
I conceive of the reverie experiences generated in this hour as re-
flecting an unconscious intersubjective process in which aspects
of my internal object world were elaborated in ways that were
uniquely defined by the particular unconscious constructions be-
ing generated by the analytic pair. The emotional change that I
experienced in relation to my (internal object) relationship with J
could have taken place in the way that it did only in the context
of the specific unconscious intersubjective relationship with Ms B
that existed at the moment. The internal object relationship with J
(or with any other internal object) is not a fixed entity; it is a fluid
set of thoughts, feelings, and sensations that is continually in move-
ment and always susceptible to being shaped and restructured as
it is newly experienced in the context of each new unconscious
intersubjective relationship.
Ogden’s statement clearly reflects Bion’s injunction for the analyst to listen
to himself listening to the analysand (Bion, personal communication). His
technical style is characterized by his allowing stray thoughts from his
body, mind, and environment to enter his full attentive consciousness and
then—and this is the quintessence of his style—allow them to pull him
into a veritable fugue state, much like a “clarinet run” in music where the
clarinettist performs a long solo and the rejoins the orchestra (or band) on
key: “on key” because he is grounded to the orchestra score all along.
Ogden brings a dimension to psychoanalysis that is rare. As the reader
can easily see, he writes as if he were an extraordinarily creative novelist
as well as an imaginative thinker. His unusual sensory (bodily) and emo-
tional sensitivity to his analysand’s subtle emotional fluctuations reveals
how deeply and how extensively his psychoanalytic soul can reach—and
be reached—to maintain exquisitely intimate contact with his analysands.
His native gifts were enhanced by his long contact with the late L. Bryce
Boyer, who was legendarily gifted in his uncanny use of countertransfer-
ence ↔ reverie with his analysands. It was only natural, consequently, that
Ogden would later become influenced by the similar style of Bion. He has
applied Bion’s concepts of transformations in, from, and to O (reverie) in
profound and meaningful ways. This present work is closely honed to the
Bion idiom. It constitutes the quintessence of “Bionian” analytic technique.
What Ogden shares with Bion is what I call “grounded imagination”—
“grounded” denoting that his left-brain discipline is intact, suspended in
the preconscious, but always anchoring the right-hemispheric flights of
imaginative conjecture. Through Ogden’s words we vicariously experi-
ence his lonely but exciting odyssey charted by reverie. When I was ana-
lysed by Bion, I could not tell when he went on an odyssey and when not,
but I do recall that his time was occupied by many profoundly thoughtful
interpretations and that he was always “on point”—that is, attentive to
the here and now but often intercalating his observations’ resonances to
appropriate allusions to the Forms.
“The subjugating third subject”

as the hidden order of psychoanalysis
Let me share a phantasy I had while reading Ogden’s paper: As the
analysand entered the consulting room, he immediately took the pulse of
his countertransference ↔ reverie towards his analysand and prepared
himself to become “impressed” (affected) by her. I say “impressed” as Bion
used the term: to designate impressions—as mental indentations—on the
individual’s emotional frontier by O’s continuing intersections. I was also
moved to think how much Ogden’s style fitted into Winnicott’s (1956) con-
cept of “primary maternal preoccupation” with its intimations of virtual
telepathic resonance.
My phantasy continues: Psychoanalysis is a passion play that seeks
to externalize and thereby reveal a hidden conflict through dramatiza-
tion. In order for this dramatization to happen, the analysand’s initial
infantile neurosis (the neurosis of one) must be converted (transformed)
into a transference neurosis, which today we would call a “transference �
countertransference neurosis” (the commingled neuroses of the two) par-
ticipants. This analytic moment and its continuation are directed by the
“subjugating third subject”, the unconscious “dramaturge” who “writes”,
“scripts”, “produces”, “casts”, and “directs” the roles, emotions, and be-
haviour for the two participants, who themselves, for all the world, believe
they are both being analytically spontaneous (improvisational theatre).
Ogden’s self-assessments that result from the transaction of the emotional
contact between them are what Bion (1965, 1970) called “transformations
in O”. Further, one can see the ghost of Stanislavski (1936) and his sug-
gestions for actors learning “method acting”: finding within oneself that
which the assigned role calls for.
The subjugating third is a component function of what Ogden calls
the “third subject of analysis”—an entity that overarches and includes the
subjectivities of analysand and analyst, respectively. Thus, this mysterious
third “subjugates” their individual subjectivities and unconsciously as-
signs roles for them to play out—so that something from the analysand’s
unconscious can become known and clarified. It is almost as if each partici-
pant, according to my reckoning, unconsciously realizes his and her role
assignment (Sandler, 1976) and signals cues to the other: as if the “dreamer
who dreams the dream” (Grotstein, 1987b, 2000) within the analysand
engages her counterpart within the analyst, and the aesthetic dream or-
ganizations within both become activated, or like children playing (Opie
& Opie, 1959) what they intuitively realize is a game—without the need
for a referee to establish limits—so as to achieve a theatrical atmosphere
of suspended disbelief to enable the play to go on and a hidden truth to
surface, be dramatized, be recognized, and be realized! “The play’s the
thing wherein I’ll catch the conscience of the King.”
The question arises: Does the exquisitely sensitive role Ogden plays as
the analysand’s holding, containing, and transforming (Bollas, 1987) ob-
ject constitute an effective “corrective emotional experience” (Alexander,
1956) for the analysand—in addition to helping her to more success-
fully “dream” her troubled past and prepare her to mourn the loss of her
uncompleted infancy and childhood? I leave the question unanswered
because it is unanswerable, yet I should like to invoke my concept of
the “once-and-forever-and-ever-evolving infant of the unconscious”: the
“virtual infant” in unconscious phantasy who paradoxically represent the
infant of actual, self-limiting infancy and an infant who continues to evolve
and mature without “growing up”. In so far as the actual self-limiting in-
fant is considered, mourning her unfortunate past deprivation is the only
alternative, but if we also play in the “once-and-forever . . . infant” (the
“immortal infant” born from infinity, O), we may be able to entertain the
possibility of a retroactive corrective emotional experience—perhaps.
To return to Ogden’s preconscious use of “grounded imagination”—
this can be shown in two examples:
(1) “My stomach muscles tensed and I experienced a faint sense of
nausea as I heard the rapid footfalls of Ms B racing up the stairs
leading to my office.”
Here Ogden’s right-hemispheric processing can be understood as premo-
nitions of his own persecutory anxiety of anticipation/preparation (P-S)
for being projected into him by his analysand before the formal analysis
commenced.
(2) “As she led the way from the waiting room into the consulting
room, I could feel in my body the patient’s drinking in of every
detail of the hallway. I noticed several small flecks of paper from

my writing pad on the carpet. I knew that the patient was taking
them in and hoarding them “inside” her to silently dissect men-
tally during and after the session. I felt in a very concrete way
that those bits of paper were parts of me that were being taken
hostage.”
Ogden is experiencing his own unique and highly personal version of
what he believes is the analysand’s unconscious phantasy involving pos-
sessive cannibalistic impulses. We now invoke the adaptive context. We
have already been alerted to the fact that this is the first of three sessions
in this week. We therefore have reason to speculate that the patient had
just experienced such neediness over the weekend break that it may
have become virtually “cannibalistic”. She then projected this into Ogden
and feared his retaliation. Without going any further, what this shows is
that Ogden had all the while been preconsciously aware of the Kleinian
underpinnings of the session (P-S, evacuation of accumulated persecu-
tory anxiety into the analyst). When Bion states, “Abandon memory and
desire”, it must be implicitly understood that he believes that the analyst
must have such a command of psychoanalytic theory that he can forget
it—assuming then that it will not forget himself. In summary: Ogden
seems, to me, to demonstrate the emergence of right-hemispheric imagi-
native “dream-work”, but this imaginative activity is of necessity tightly
“grounded” (and thus mediated), I believe, by his left-hemispheric com-
mand of Kleinian theory. In other words, Ogden quietly develops a tree
of inference in both hemispheres, but highlighting the right—awaiting the
proper time to intervene.
Yet we also detect another Kleinian mode in Ogden’s thinking and
in his technique: that of the post-Kleinian propensity for working on the
whole-object level in an irreducible transference ↔ countertansference
engagement in which the feelings, impressions, and desires of each partici-
pant are minutely examined by Ogden as the whole situation in the here
and now—as intersubjective process. At any given moment one is hard put
to differentiate between Ogden’s Bionian influence and the post-Kleinian
techniques advocated by Betty Joseph and her followers—possibly be-
cause there is little difference except, perhaps, with terminology—that is,
“dreaming” and “transformations in O”, in particular.
There is something else that Ogden does that is unique. In his more
recent work he has stepped out of the loop of conventional analytic dis-
course to become a “literary critic”, as it were, of the works of poets and
novelists as well as of the works of psychoanalysts. He terms this new
trend of his the “close reading” of the subjects’ productions and utter-
ances. In reference to a current work of his on Borges, Ogden (2009) states
in a personal communication to me: “It is a great pleasure to notice the

ellipsis in Borges’ Library of Babylon as a most subtle of suggestions that the
reader does not really know who the writer of the text is. The language (in
this case, the punctuation) is not a carrier of meaning, it is the meaning.
Similarly, in psychoanalytic work, one doesn’t listen for what is behind or
underneath the words or silences or bodily sensations; meaning is in the
words, the silences, the bodily sensations.”
In my own attempt at a close reading of Ogden’s statement I feel the
following responses emerging: Close reading heralds a new age in psycho-
analytic thinking and technique. It presupposes that with regard to one’s
experience of an object, consciousness and the unconscious are indivisibly
bound. As a corollary of the preceding postulate the analytic technique
of observation is intimately bound to intuition. Close reading consti-
tutes a microscopic and an inductive (dreaming). Psychoanalytic meaning
around, behind, or underneath the expressions that are being closely stud-
ied is to be found solely within the words and utterances. When one reads
Ogden’s other recent works, one gets a “feel” for this radically new way of
apprehending the dormant as well as obvious meaning ensconced within
all forms of communication (Grotstein, 2009d; Ogden, 2009a, 2009b).
Notes
T. Ogden (1997b). Reverie and interpretation. Psychoanalytic Quarterly, 66 (1997):
567–595. I wish to express my gratitude to Thomas Ogden as well as to the Editor of
the Psychoanalytic Quarterly for their gracious permission to republish this work.
1. The unconscious movement brought about by the reverie might be thought
of as the outcome of the unconscious “understanding work” (Sandler, 1976) that is
an integral part of dreaming (and reverie). Dreaming and reverie always involve
an unconscious internal discourse between “the dreamer who dreams the dream
and the dreamer who understands the dream” (Grotstein, 1979). If there were no
such unconscious discourse (if there were no unconscious “understanding work” in
relation to the unconscious “dream work”), we would have to conclude that only
the dreams (or reveries) that we remember have psychological value and contribute
to psychological growth. This is a view to which few analysts would subscribe.
Epilogue
W
e have now come to journey’s end. I hope that no reader has
lost his way or has “jumped ship” on this long epistemic
adventure. I will spare the reader a summary of what has
gone down thus far. I merely wish to say that I have practised psycho-
analysis for over 50 years and felt the need to document and share my
experiences and help chart the landscape of psychoanalytic technique
from my view of the Kleinian/Bionian perspective. But this work is
only a beginning. I plan to publish more in-depth clinical work in the
future—with the help of others. I say goodbye on one last note: that
psychoanalysis works in part because it is a therapeutic play, and the
analysand and analyst are its ever-improvising stars.
263
REFERENCES AND BIBLIOGRAPHY
Abraham, K. (1924). A short study of the development of the libido. In: Se-
lected Papers on Psycho-Analysis (pp. 418–501). London: Hogarth Press,
1948.
Alexander, F. (1956). Psychoanalysis and Psychotherapy: Developments in The-
ory, Technique and Training. New York: Norton.
Alhanati, S. (2002). Silent grammar. The emergence of the ineffable. In:
Primitive Mental States, Vol. II: Psychobiological and Psychoanalytic Per-
spective on Early Trauma and Personality Development (pp. 111–140). Lon-
don: Karnac.
Alhanati, S. (2005). “Silent grammar: Additional Case Presentations.” Pa-
per presented at the Conference on Conjuring Presences: Contributions
of Fetal, Infantile, and Pre-verbal Communications to Transference and
Countertransference, sponsored by the Psychoanalytic Center of Cali-
fornia, Los Angeles, California (10 June).
Alvarez, A. (1996). Live Company: Psychoanalytic Psychotherapy with Autis-
tic, Borderline, Deprived and Abused Children. London: Tavistock/Rout-
ledge.
Balestriere, L. (2007). The work of the analyst in the field of psychosis. In-
ternational Journal of Psychoanalysis, 88: 407–422.
Baranger, M. (1983), The mind of the analyst: From listening to interpreta-
tion. International Journal of Psychoanalysis, 74: 15–24.
Baranger, M., & Baranger, W. (1964). El insight en la situacion analitica. In:
Problemas del Campo Psicoanalitico. Buenos Aires: Kargieman.
265
266 REFERENCES AND BIBLIOGRAPHY
Baranger, M., & Baranger, W. (1961–62). La situación analytica como campo

dinámico. Revista Uruguayo de Psicoanálisis, 4: 3–54.
Baranger, M., Baranger, W., & Mom, J. (1983). Process and non-process in
analytic work. International Journal of Psychoanalysis, 64: 1–15.
Bion, W. R. (1958). On hallucination. In: Second Thoughts: Selected Psycho-
analysis (pp. 65–85). London: Heinemann, 1967.
Bion, W. R. (1959). Attacks on linking. In: Second Thoughts: Selected Papers on
Psychoanalysis (pp. 93–109). London: Heinemann, 1967.
Bion, W. R. (1962a). The psychoanalytic study of thinking. International Jour-
nal of Psycho-Analysis, 43: 306–310. In: Second Thoughts: Selected Papers on
Psychoanalysis (pp. 110-119). London: Heinemann, 1967.
Bion, W. R. (1962b). Learning from Experience. London: Heinemann.
Bion, W. R. (1963). Elements of Psycho-Analysis. London: Heinemann.
Bion, W. R. (1965). Transformations. London: Heinemann.
Bion, W. R. (1967a). Notes on memory and desire. Psychoanalytic Forum, 2:
271–286.
Bion, W. R. (1967b). Second Thoughts. London: Heinemann.
Bion, W. R. (1970). Attention and Interpretation. London: Tavistock Publica-
tions.
Bion, W. R. (1977). Two Papers: The Grid and Caesura. Rio de Janeiro: Imago
Editora.
Bion, W. R. (1979). A Memoir of the Future, Book III: The Dawn of Oblivion.
Perthshire: Clunie Press; also in: A Memoir of the Future, Books 1–3. Lon-
don: Karnac, 1991.
Bion, W. R. (1980). Bion in New York and São Paulo, ed. F. Bion. Strath Tay:
Clunie Press.
Bion, W. R. (1992). Cogitations, ed. F. Bion. London: Karnac.
Bion, W. R. (1997). Taming Wild Thoughts, ed. F. Bion. London: Karnac.
Blass, R. (2008). On the immediacy of unconscious truth: Understanding
Betty Joseph’s “here and now” through comparison with alternative
views of thinking. Paper presented at “Here and Now Today” Confer-
ence, University College London (12–14 December).
Bollas, C. (1987). The Shadow of the Object: Psychoanalysis of the Unthought
Known. London: Free Association Books.
Bowlby, J. (1958). The nature of the child’s tie to his mother. International
Journal of Psychoanalysis, 39: 350–373.
Bowlby, J. (1969). Attachment and Loss. Vol. I: Attachment. New York: Basic
Books.
Bowlby, J. (1973). Attachment and Loss. Vol. II: Separation Anxiety and Anger.
New York: Basic Books.
Bowlby, J. (1980). Attachment and Loss. Vol. III: Loss: Sadness and Depression.
New York: Basic Books.
Britton, R. (1998a). Before and after the depressive position: Ps(n)→D(n)→

Ps(n+1). In: Belief and Imagination: Explorations in Psychoanalysis (pp.
69–81). London & New York: Routledge.
Britton, R. (1998b). Belief and Imagination: Explorations in Psychoanalysis.
London: Routledge.
Britton, R., & Steiner, J. (1994). Interpretation: Selected fact or overvalued
idea? International Journal of Psychoanalysis, 75: 1069–1078.
Brown, L. (1987). Borderline personality organization and the transition
to the depressive position. In: J. S. Grotstein, J. F. Solomon, & J. A.
Lang (Eds.), The Borderline Patient: Emerging Concepts in Diagnosis, Psy-
chodynamics, and Treatment. Vol. 1 (pp. 147–180). Hillsdale, NJ: Analytic
Press.
Brown, L. (2006). Julie’s Museum: The evolution of thinking, dreaming and
historicization in the treatment of traumatized patients. International
Journal of Psychoanalysis, 87: 1569–1585.
Brown, L. The Transitional Position. Unpublished ms.
Busch, F. (1995a). Neglected classics: M. N. Searl’s “Some Queries on Prin-
ciples of Technique.” Psychoanalytic Quarterly, 64: 326–344.
Busch, F. (1995b). Do actions speak louder than words? A query into an
enigma in analytic theory and technique. Journal of the American Psycho-
analytic Association, 43: 61–82.
Busch, F. (1997). Understanding the patient’s use of the method of free as-
sociation: An ego psychology approach. Journal of the American Psycho-
analytic Association, 45: 407–423.
Damasio, A. (1999). The Feeling of What Happens: Body and Emotion in the
Making of Consciousness. New York: Harcourt Brace.
Damasio, A. (2003). Looking for Spinoza: Joy, Sorrow, and the Feeling Brain.
New York: Harcourt.
Decety, J., & Chaminade, T. (2003). Neural correlates of feeling sympathy.
Neuropsychologia, 41: 127–138.
Eaton, J. (2008). The Tasks of Listening. Unpublished manuscript.
Ehrenzweig, A. (1967). The Hidden Order of Art: A Study in the Psychology of
Artistic Imagination. Berkeley: University of California Press.
Eisenbud, J. (1946). Telepathy and problems of psychoanalysis. Psychoana-
lytic Quarterly, 15: 32–87.
Entralgo, P. L. (1970). The Therapy of the Word in Classical Antiquity, tr. L. J.
Rather & J. M. Sharp. New Haven, CT: Yale University Press.
Etchegoyen, R. H. (1991). The Fundamentals of Psychoanalytic Technique (pp.
318–346), tr. P. Pitchon. London: Karnac.
Feldman, M. (2007a). “The Problem of Conviction.” Paper presented for
the Seventh Annual James S. Grotstein Conference on Psychoanalysis
around the World, Los Angeles, California (19 February).
Feldman, M. (2007b). Addressing parts of the self. International Journal of

Psychoanalysis, 88: 371–386.
Fenichel, O. (1941). Problems of psychoanalytic technique. Psychoanalytic
Quarterly: 1–70, 98–122.
Ferro, A. (1992). The Bi-Personal Field: Experiences in Child Analysis, tr. P.
Slotkin. London: Routledge.
Ferro, A. (1996). In the Analyst’s Consulting Room, tr. P. Slotkin. Hove: Brun-
ner-Routledge.
Ferro, A. (1999). Psychoanalysis as Therapy and Storytelling, tr. P. Slotkin.
London: Routledge.
Ferro, A. (2002a). In the Analyst’s Consulting Room, tr. P. Slotkin. Hove:
Routledge.
Ferro, A. (2002b). Seeds of Illness, Seeds of Recovery: The Genesis of Suffering and
the Role of Psychoanalysis, tr. P. Slotkin. Hove: Brunner-Routledge, 2005.
Ferro, A. (2005). Which reality in the psychoanalytic session? Psychoanalytic
Quarterly, 74: 421–442.
Ferro, A. (2006). Clinical implications of Bion’s thought. International Journal
of Psychoanalysis, 87: 989–1003.
Ferro, A., & Basile, R. (2009). The Analytic Field: A Clinical Concept. London:
Karnac.
Fosshage & Hershberg (2009). Loving and leaving: A reappraisal of analytic
termination. Psychoanalytic Inquiry, 29 (2).
Freud, S. (1900a). The Interpretation of Dreams. S.E., 5: 339–630.
Freud, S. (1905d). Three contributions on the theory of sexuality. S.E., 7:
125–245.
Freud, S. (1905e). Fragment of an analysis of a case of hysteria. S.E., 7:
3–124.
Freud, S. (1911b). Formulations of the two principles of mental functioning.
S.E., 12: 213–226.
Freud, S. (1911c). Psycho-analytic notes on an autobiographical account of
a case of paranoia (dementia paranoides). S.E., 12: 3–84.
Freud, S. (1911e). The handling of dream-interpretation in psycho-analysis.
S.E., 12: 91–96.
Freud, S. (1912b). The dynamics of transference. S.E., 12: 97–108.
Freud, S. (1912e). Recommendations to physicians practising psycho-anal-
ysis. S.E., 12: 109–120.
Freud, S. (1913 [1912–1913]). Totem and Taboo. S.E., 13: 1–64.
Freud, S. (1915a [1914]). Observations on transference-love (Further recom-
mendations on the technique of psycho-analysis, III). S.E., 12: 157–171.
Freud, S. (1915c). Instincts and their vicissitudes. S.E., 14: 109–140.
Freud, S. (1915d). Repression. S.E., 14: 141–158.
Freud, S. (1915e). The unconscious. S.E. 14: 159–215.
Freud, S., & Andreas-Salomé, L. (1966). Letter dated “25.5.16.” In: Letters,
ed. E. Pfeiffer, tr. W. Robson-Scott & E. Robson-Scott. London: Hogarth

Press, 1972.
Gaddini, E. (1982). Early defensive fantasies and the analytic process. Inter-
national Journal of Psychoanalysis, 63: 369–388.
Gallese, V. (2001). The “shared manifold” hypothesis: From mirror neurons
to empathy. Journal of Consciousness Studies, 8: 33–50.
Gallese, V., & Goldman, A. (1998). Mirror neurons and the simulation
theory of mind reading. Trends in Cognitive Science, 2: 493–501.
Garfield, D., & Mackler, D. (2009). Beyond Medication: Therapeutic Engage-
ment and the Recovery from Psychosis. London: Routledge.
Girard, R. (1972). Violence and the Sacred, tr. P. Gregory. Baltimore: Johns
Hopkins University Press.
Girard, R. (1978). Things Hidden Since the Foundation of the World, trans. S.
Bann & M. Metteer). Stanford, CA: Stanford University Press, 1987.
Girard, R. (1986). The Scapegoat, trans. Y. Freccero. Baltimore: Johns Hopkins
University Press.
Girard, R. (1987). Job: The Victim of His People. Stanford, CA: Stanford Uni-
versity Press.
Glover, E. (1931). The Technique of Psycho-Analysis (pp. 261–304). New York:
International Universities Press.
Gray, P. (1982). Developmental lag in evolution analytic technique. Journal
of the American Psychoanalytic Association, 30: 621–656.
Gray, P. (1994). The Ego and Analysis of Defence. Northvale, NJ: Jason Aron-
son.
Greenson, R. (1967). The Technique and Practice of Psychoanalysis, Vol. I (pp.
372–376). New York: International Universities Press.
Grotstein, J. (1978). Inner space: Its dimensions and its coordinates. Interna-
tional Journal of Psychoanalysis, 59: 55-61.
Grotstein, J. (1979). Who is the dreamer who dreams the dream, and who
is the dreamer who understands it? Contemporary Psychoanalysis, 15 (1):
110–169.
Grotstein, J. (1981a). Splitting and Projective Identification. New York: Jason
Aronson.
Grotstein, J. (1981b). Who is the dreamer who dreams the dream, and who
is the dreamer who understands it? (revised). In: Do I Dare Disturb the
Universe? A Memorial to Wilfred R. Bion (pp. 357–416). Beverly Hills, CA:
Caesura Press.
Grotstein, J. (1986). The dual-track: Contribution toward a neurobehavioral
model of cerebral processing. Psychiatric Clinics of North America, 9 (2):
353–366.
Grotstein, J. (1988). The “Siamese-twinship” of the cerebral hemispheres
and of the brain–mind continuum: Toward a “psychology” for the cor-
pus callosum. Psychiatric Clinics of North America, 11 (3): 399-412.
Grotstein, J. (1993a). A reappraisal of W. R. D. Fairbairn. Journal of the Men-

ninger Clinic, 57 (4): 421–449.
Grotstein, J. (1993b). Towards the concept of the transcendent position:
Reflections on some of “the unborns” in Bion’s “Cogitations.” Journal of
Melanie Klein and Object Relations, 11 (2): 55–73. [Special Issue: “Under-
standing the Work of Wilfred Bion.”]
Grotstein, J. (1995a). Projective identification reappraised: Projective iden-
tification, introjective identification, the transference/countertransfer-
ence neurosis, and their consummate expression in the Crucifixion,
the Pietà, and “therapeutic exorcism”. Part II: The countertransference
complex. Contemporary Psychoanalysis, 31: 479–510.
Grotstein, J. (1995b). Orphans of the “Real”: I. Some modern and post-mod-
ern perspectives on the neurobiological and psychosocial dimensions
of psychosis and primitive mental disorders. Bulletin of the Menninger
Clinic, 59: 287–311.
Grotstein, J. (1995c). A reassessment of the couch in psychoanalysis. In:
Issue on the relevance of the couch in contemporary psychoanalysis
(issue ed. G. Moriates). Psychoanalytic Inquiry, 15: 396–405.
Grotstein, J. (1997a). Integrating one-person and two-person psychologies:
Autochthony and alterity in counterpoint. Psychoanalytic Quarterly, 66:
403–430.
Grotstein, J. (1997b). “Internal objects” or “chimerical monsters?”: The de-
monic “third forms” of the internal world. Journal of Analytical Psychol-
ogy, 42: 47–80.
Grotstein, J. (2000). Who is the Dreamer Who Dreams the Dream?: A Study of
Psychic Presences. Hillsdale, NJ: Analytic Press.
Grotstein, J. (2002). We are such stuff as dreams are made on: Annotations
on dreams and dreaming in Bion’s works. In: C. Neri, M. Pines, & R.
Friedman (Eds.), Dreams in Group Psychotherapy: Theory and Technique
(pp. 110–145). London & Philadelphia: Jessica Kingsley.
Grotstein, J. (2004a). The light militia of the lower sky: The deeper nature of
dreaming and phantasying. Psychoanalytic Dialogues, 14: 99–118.
Grotstein, J. (2004b). The seventh servant: The implications of a truth drive
in Bion’s theory of “O”. International Journal of Psychoanalysis, 85: 1081–
1101.
Grotstein, J. (2005). Projective transidentification as an extension of projec-
tive identification. International Journal of Psychoanalysis, 86: 1051–1069.
Grotstein, J. (2007). A Beam of Intense Darkness: Wilfred R. Bion’s Legacy to
Psychoanalysis. London: Karnac.
Grotstein, J. (2008). “Innocence versus Original Sin: ‘The Myth of Cain and
Abel’ and the Moral Dilemma within Psychoanalytic Technique.” Paper
presented at the Eighth Annual James S. Grotstein Conference, David
Geffen School of Medicine, Los Angeles, California (9 February).
Grotstein, J. (2009a). Dreaming as a “curtain of illusion”: Revisiting the

“Royal Road” with Bion as our guide. The International Journal of Psycho-
analysis. In press.
Grotstein, J. (2009b). “The play is the thing wherein I’ll catch the conscious
of the king!” Psychoanalysis as a Passion Play. In: A. Ferro & R. Basile
(Eds.), Italian Annual Book of the IJPA. Rome: Edizioni Borla.
Grotstein, J. (2009c). Voice from the crypt: The negative therapeutic reaction
and the longing for the childhood that never was. In: J. Van Buren & S.
Alhanati (Eds.), Protomental States, the Unborn Self and Meaning Without
Words. Routledge. In press.
Grotstein, J. (2009d). Review of Ogden’s (2009) “Rediscovering Psychoanal-
ysis: Thinking and Dreaming, Learning and Forgetting” (London &
New York: Routledge). Psychoanalytic Quarterly. In press.
Hampshire, S. (2005). Spinoza and Spinozism. Oxford: Clarendon Press.
Hargreaves, E., & Varchevker, A. (Eds.) (2004). In Pursuit of Psychic Change:
The Betty Joseph Workshop. Hove: Brunner-Routledge.
Jacobson, E. (1964). The Self and the Object World. New York: International
Universities Press.
James, W. (1890). The Principles of Psychology. Cambridge, MA: Harvard
University Press, 1981.
Joseph, B. (1989). Psychic Equilibrium and Psychic Change. London: Rout-
ledge.
Jowett, B. (trans.) (1892). Theatetus. In: The Dialogues of Plato (pp. 143–220).
New York: Random House, 1937.
Kant, I. (1787). Critique of Pure Reason (revised edition), trans. N. Kemp
Smith. New York: St. Martin’s Press, 1965.
Klein, M. (1928). Early stages of the oedipus conflict. In: Contributions to Psy-
cho-Analysis, 1921–1945 (pp. 202–214). London: Hogarth Press, 1950.
Klein, M. (1961). Narrative of a Child Analysis. New York: Basic Books.
Kohut, H. (1971). The Analysis of the Self: A Systematic Approach to the Psycho-
analytic Treatment of Narcissistic Personality Disorders. New York: Inter-
national Universities Press.
Kris, E. (1950). On preconscious mental processes. Psychoanalytic Explora-
tions in Art (pp. 303–318). New York: International Universities Press,
1952.
Kristeva, J. (1941a). Tales of Love, trans. L. S. Roudiez. New York: Columbia
Universities Press, 1987.
Kristeva, J. (1941b). Desire in Language: A Semiotic Approach to Literature and
Art, ed. L. S. Roudiez; trans. T. Gora, A. Jardine, & L. S. Roudiez. New
York: Columbia University Press, 1980.
Lacan, J. (1966). Ecrits: 1949–1960, trans. A. Sheridan. New York: W. W.
Norton, 1977.
Lacan, J. (1975). Le Séminaire XX. (1972–1973). Paris: Seuil.
Langs, R. (1976a). The Bipersonal Field. New York: Jason Aronson.

Langs, R. (1976b). The Therapeutic Interaction. New York: Jason Aronson.
Langs, R. (1981a). Interactions: A Realm of Transference and Countertransfer-
ence. New York: Jason Aronson.
Langs, R. (1981b). Modes of “cure” in psychoanalysis and psychoanalytic
psychotherapy. International Journal of Psycho-Analysis, 62: 199–214.
Llinás, R. (2001). I of the Vortex: From Neurons to Self. Cambridge, MA: MIT
Press.
López-Corvo, R. E. (2006). Wild Thoughts Searching for a Thinker: A Clinical
Application of W. R. Bion’s Theories. London: Karnac.
Mason, A. (1994). A psychoanalyst looks at a hypnotist: A study of folie à
deux. Psychoanalytic Quarterly, 63 (4): 641–679.
Matte Blanco, I. (1988). Thinking, Feeling, and Being: Clinical Reflections on the
Fundamental Antinomy of Human Beings. London: Routledge.
McDougall, J. (1985). Theaters of the Mind: Illusion and Truth on the Psychoana-
lytic Stage. New York: Basic Books.
Meltzer, D. W. (1967). The Psycho-Analytical Process (pp. 1–52). London:
Heinemann.
Meltzer, D. W. (1992). The Claustrum: And Investigation of Claustrophobic Phe-
nomena. Perthshire: Clunie Press.
Ogden, T. (1994). Subjects of Analysis. Northvale, NJ: Jason Aronson.
Ogden, T. (1997a). Reverie and interpretation. Psychoanalytic Quarterly, 66:
567–595.
Ogden, T. (1997b). Reverie and Interpretation. Northvale, NJ: Jason Aronson.
Ogden, T. (1996). Reconsidering three aspects of psychoanalytic technique.
International Journal of psychoanalysis, 77: 883–900.
Ogden, T. (2004). An introduction to the reading of Bion. International Jour-
nal of Psychoanalysis, 85: 285–300.
Ogden, T. H. (2009a). Rediscovering Psychoanalysis: Thinking and Dreaming,
Learning and Forgetting. London & New York: Routledge.
Ogden, T. H. (2009b). Kafka, Borges, and the creation of consciousness.
Part I. Kafka: Dark ironies of the “gift” of consciousness. Psychoanalytic
Quarterly, 78: 343-368.
Ogden, T. H. (2009c). Kafka, Borges, and the creation of consciousness. Part
II. Borges: A life of letters encompassing everything and nothing. Psy-
choanalytic Quarterly, 78: 369-396.
Ogden, T. (2001). Conversations at the Frontier of Dreaming. Northvale, NJ:
Jason Aronson.
Opie, L., & Opie, P. (1959). The Lore and Language of School Children. Oxford:
Oxford University Press.
Poincaré, H. (1963). Science and Method. New York: Dover.
Saks, E. R. (2007). The Center Cannot Hold. New York: Hyperion.
Sandler, J. (1976). Countertransference and role responsiveness. Interna-

tional Review of Psycho-Analysis, 3: 43–47.
Schore, A. (2003a). Affect Regulation and the Repair of the Self. New York: W.
W. Norton.
Schore, A. (2003b). Affect Dysregulation and Repair of the Self. New York: W.
W. Norton.
Searles, H. F. (1975). The patient as therapist to his analist. In: Counter-
transference and Related Subjects (pp. 380–459). New York: International
Universities Press.
Searles, H. F. (1987). The development in the patient of an internalized
image of the therapist. In: J. S. Grotstein, M. F. Solomon, & J. A. Lang
(Eds.), The Borderline Patient: Emerging Concepts in Diagnosis, Psychody-
namics, and Treatment, Vol. 2 (pp. 25–40). Hillsdale, NJ: Analytic Press.
Simon, B. (1978). Mind and Madness in Ancient Greece: The Classical Roots of
Modern Psychiatry. Ithaca: Cornell University Press.
Sparrow, C. (1986). The Lorenz equations. In: A. V. Holden (Ed.), Chaos (pp.
111–134). Princeton, NJ: Princeton University Press.
Spillius, E. B. (2007). Encounters with Melanie Klein: Selected Papers of Eliza-
beth Spillius, ed. P. Roth & R. Rushbridger. London: Routledge.
Stanislavski, C. (1936). An Actor Prepares, trans. E. Reynolds Hapgood. New
York: Routledge, 1989.
Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic,
Neurotic and Borderline Patients. London: Routledge.
Stern, D. (2004). The Present Moment in Psychotherapy and Everyday Life. New
York: W.W. Norton.
Strachey, J. (1934). The nature of the therapeutic action of psycho-analysis.
International Journal of Psychoanalysis, 15: 127–159.
Tustin, F. (1986). Autistic Barriers in Neurotic Patients. New Haven, CT: Yale
University Press.
Tustin, F. (1990). The Protective Shell in Children and Adults. London: Kar-
nac.
Wallerstein, R. S. (1986). Forty-Two Lives in Treatment. New York: Guilford
Press.
Winnicott, D. W. (1953). Symptom tolerance in paediatrics: A case history.
In: Collected Papers: Through Paediatrics to Psycho-Analysis. New York:
Basic Books, 1958.
Winnicott, D. W. (1956). Primary maternal preoccupation. In: Collected
Papers: Through Paediatrics to Psycho-Analysis (pp. 300–305). London:
Tavistock Publications; New York: Basic Books, 1958.
Winnicott, D. W. (1958). The capacity to be alone. In: The Maturational Pro-
cesses and the Facilitating Environment: Studies in the Theory of Emotional
Development. New York: International Universities Press.
Winnicott, D. W. (1960a). Ego distortion in terms of the true and false

self. In: The Maturational Processes and the Facilitating Environment (pp.
140–152). London: Hogarth Press; New York: International Universities
Press, 1965.
Winnicott, D. W. (1960b). The theory of the parent–infant relationship. In:
The Maturational Processes and the Facilitating Environment (pp. 37–55).
London: Hogarth Press; New York: International Universities Press,
1965.
Winnicott, D. W. (1968). The Squiggle game. In: C. Winnicott, R. Shepherd,
& M. Davis (Eds.), Psycho-Analytic Explorations (pp. 299–317). Cam-
bridge, MA: Harvard University Press, 1989.
Winnicott, D. W. (1969). The use of an object through identifications. Inter-
national Journal of Psychoanalysis, 50: 711–716.
Winnicott, D. W. (1971). Playing and Reality. London: Tavistock.
INDEX
abandonment, 18, 71, 86, 88, 90, 91, history of, 3

101–103, 114, 157, 173, 194 unknown aspects of, 7
dread of, 109–110 idealization of, 11
Abraham, K., 23 suitability for analysis, 3
Absolute Truth, 108, 109 analysis:
about Ultimate Reality, 108 analysand’s suitability for, 3
abstinence, rule of, 10 as drama/passion play, 50
active listening (observation), 30 frequency of, and “rhythm of safety”,
adaptive context, 5, 7, 42, 84, 85, 88, 91, 4
115, 128, 164, 216, 260 suitability for, 3, 4
adaptive regression, 16 telephone, 19
addiction(s), 3, 44, 210 video-conference, 19
aesthetic vertex, 57 analyst:
Alexander, F., 121, 259 ability of to be surprised, 34
Alhanati, S., 148–155 analysand’s reluctance to pay, 156
alienation, 90, 93, 99, 122, 129, 130 asking questions, 7
alpha-bet-ization, 43 collusion of, with analysand, 11
alpha-element(s), 41, 43, 53, 55, 234 containment capacity of, 74
discarded/rogue, 75 interpretative stance of, 7
alpha-function, 43, 49, 51, 55–57, 70, 83, mind and body of, as analytic
94, 109, 148, 214, 215, 235 instruments, 240–262
maternal, 15 silent monitoring of text of session,
in reverse, 67, 68, 71 41–52
Alvarez, A., 11 use of containment, 94
ambivalence, 183, 224 analytic atmosphere, 7
anaesthesia, 114 analytic boundary, 211
analysand: analytic containment, 94
emotional experience of, levels of analytic empathy, 11
reality in, 26 analytic field, 46
275
276 INDEX
analytic frame (setting): see frame, autism, 7

analytic
analytic insight, 15 background frame, 7
analytic interventions, nature of, 34–35 Balestriere, L., 69
analytic object, 5, 24, 28, 39, 43, 52, 74, 86, Baranger, M., 46, 237, 239
96, 108, 164, 252 Baranger, M. & W., 234
as O, 50 Baranger, W., 46, 239
analytic passion play, 37–40, 46, 50, 57, “becoming” the analysand, 24, 30
258 beta-element(s), 36, 43, 51, 55, 75, 148
frame as guardian of, 8–9 beta-screen, 67, 69, 72
analytic process, 7, 44, 50, 85, 223, 246, binocular vision, 55
253 Bion, W. R.:
analytic resistance, 9, 12 abandoning/suspending memory
analytic session as dream, 73 and desire, 41, 54, 58, 81, 83, 148
analytic setting, 7, 45 and understanding and
analytic stance, 4, 121 preconceptions, 24, 29
analytic subject, 8 alpha-function, 57
analytic third, 46 in reverse, 67, 68, 71
see also: subjugating third subject of analysis begins with consultative
analysis interview, 3
Andreas-Salomé, L., 29 analyst listening to himself listening
annihilation, 233 to analysand, 257
anorexia, 210, 211, 219 analyst must “dream” the analytic
anxiety(ies) (passim): session, 24
catastrophic, 9 analysts’ need to collect phantasies
causative, 197 and myths, 34
claustrophobic, 62, 63, 86, 92, 202 analytic object, 5, 24, 28, 39, 50, 52, 74,
conative, 9 96, 108, 164, 252
“crossing-the-boundary”, 211 O, 43, 86
defences against, importance of, 23 analytic reverie, 24
depressive, 23 attention in reverie, 26
interpretation of, 44 “becoming” the analysand, 24, 30
intolerable, 66 “binocular vision”, 55
persecutory, 177, 259, 260 “cast a beam of intense darkness”,
projected, 23 25, 29
unconscious, 45, 59, 74, 91 “catastrophic anxiety”, 9
maximum, interpretation of, 5, 22, “catastrophic change”, 4, 5, 76, 217
24, 43, 46, 49, 86, 92, 96, 164, 221 concept of “dreaming” the session,
archaic Oedipus complex, constellating 30, 32–34
importance of, 23 conception of O, 77
archetypes, alien (“bogeymen”), 77 concepts of transformations in,
Aristotelian logic, 30, 43 from, and to, 257
Asperger’s syndrome, 121 contact-barrier, 19
attachment, 5, 16, 35, 76, 127, 130, 162, and analytic frame, connection
163, 239 between, 6
and bonding, 35 container–contained, 8, 39, 44, 109,
disorganizing, 66 209
poor, 5 “definitory hypotheses”, 43
“attachment/bonding” ↔ “weaning”, dream-work alpha, 15
35–37 “emotional turbulence”, 5
attack(s) against linking, 68, 209 evenly hovering attention, 29
INDEX 277
forms of observation by the analyst: analytic, 211

emotional and objective, 24 Bowlby, J., 16
frame, use of, 12 breast (passim):
Grid, 30, 42, 43, 56, 76, 214 cancer, 244, 248
“imaginative conjectures”, 38, 42 –mother, 77, 108
interpreting to preconscious mind, mother’s, 179
111 British Institute of Psychoanalysis, 218
as Kleinian, 34 Britton, R., 40, 53, 75, 102, 225–233
maternal reverie, 154, 155 Brown, L., 67, 200
models as instruments of thinking, Bryce Boyer, L., 65, 257
225 Busch, F., 30
“obstructive object”, 66, 67, 68, 71,
72, 121 cannibalistic neediness, 260
projective identification(s) remain Cartesian logic, 30
within boundaries of projecting cataclysmic regression, 16, 66
subject, 31 catastrophic anxiety, 9
“projective transformations”, 88, 94 catastrophic breakdown, 247
psychotic patients, characteristics catastrophic change, 4, 5, 76, 217
of, 68 catharsis, 13
“rational conjectures”, 42 cathexis [Besetzung], 16, 32
recommendations on technique, causative anxiety, 197
24–26 Chaminade, T., 155
reverie, 15 chaos theory, 55
as “wakeful dream thinking”, 24, childhood trauma, 227
25 claustrophobia, 202, 206, 243, 251, 252
“reversible perspective”, 55, 67 claustrophobic anxiety, 62, 63, 86, 92,
“rigid-motion transformations”, 94 202
selected fact, concept of, 53, 55, 98, 99 claustrophobic entrapment, 206
sense, myth, and passion, 5, 24, 25, combined hemisphere (stereoscopic)
43, 74, 87 synthesis (reconciliation), 37–41
speculative imagination and conative anxiety, 9
speculative reasoning, use of,24 conatus, 9, 76, 77
“super”ego, 66 conditional frame, 7, 8
theory of dreaming, 33, 34 connected reverie, 42
transformations in O, 258 conscious ego, 15, 111
wakeful dreaming, 25 conscious ↔ unconscious topographic
“wild thoughts”, 38, 42, 43, 48, 54, considerations
56, 164 in analytic process, 50–52
bipolar illness, 9, 65 constant conjunction, 41, 43, 62
bivalent thinking, 43 consultative interview, 3–5
bizarre objects, 67 contact-barrier, 19, 51, 66
Blass, R., 147 intrapsychic, 6
blind spots, 43, 60 container and contained, 8, 25, 33, 39, 44,
Bollas, C., 259 109, 155, 209
borderline states, psychoanalytic containment, 23, 30, 50, 70, 74, 110, 183,
treatment of, 65–72 234
boredom in analysis, 235 analytic, 94
Borges, J. L., 260, 261 of contained, 30
Boston Change Process Study Group, establishment of, 235
155 good, 179
boundary, 69 internal, capacity for, 239
278 INDEX
Contemporary London Kleinians, 35, depression, 53, 100, 137, 162, 168, 216
36, 44, 83, 137–147, 233 infantile, 23
Contemporary London post-Kleinians, depressive anxieties, 23
35, 36, 44, 77, 83, 84, 225 depressive defence(s), 90, 91, 113, 115,
core identity, 9 169, 170, 172, 197, 199, 200, 201
Corradi Fiumara, G., 59 depressive position, 23, 34, 40, 47, 53,
corrective emotional experience, 121 59, 60, 75, 77, 89, 90, 102, 103,
retroactive, 259 111, 121, 128, 142, 148, 171, 175,
couch, use of, 3–5, 13–19 197, 201
with primitive mental disorders, 69 movement from paranoid-schizoid
countertransference (passim): to, 26
enactment, 199, 200 derealization, 71
gathering the transference, 28 desire to cure, abandoning, 24, 81
negative, 199 disorganizing attachment, 66
negative influence of, 44 displacements, 36, 48, 73, 75, 110, 143,
neurosis, 16, 37, 258 216
problems: dissociation, 15, 67
blind spots, 60 “dosage of sorrow”, 48–50
idealization of analysand, 11 drama/passion play, analysis as, 8–10,
covenant, analytic, 8, 10, 45, 118, 158, 37, 39, 40, 46, 50, 57, 110, 258
165 “dramaturge”, 9, 26, 37, 39, 40, 57, 258
creativity, 172 dramaturgy, 14
curiosity, 50, 68, 208, 210 dream(s) (passim):
analysis, clinical example, 213–217
daimon, 73, 217 analytic session as, 73
Damasio, A., 9, 32 manifest content of, 41
daydream(ing), 15, 32, 149, 150 narratives, 46
day residue, 19, 35, 42, 84, 111, 115, 117, organization, ineffable, 217
143, 217 -work, 9, 214, 215, 260
death instinct, 44, 67, 76, 77, 108 alpha, 15
Decety, J., 155 “dreamer who dreams the dream”, 9, 37,
defence(s), 23, 43–49, 59, 86, 87, 92, 127, 39, 73, 217, 259, 261
164, 224 “dreamer who makes the dream
against anxiety, importance of, 23 understandable”, 37
depressive, 90, 91, 113, 115, 169, 170, dreaming, 15, 41, 51, 94, 140, 216, 260,
172, 197, 199, 200, 201 261
interpretation of, 22 analytic session, 24
manic, 23, 127, 224 of analytic session, 25, 30, 109
mechanisms, 13 as becoming, analytic session, 32–34
schizoid, 23 function of, 217
definitory hypotheses, 43 wakeful, 25, 42, 83, 109
delusional transference, 66 dyslexia, 101, 102
demons, 77, 95, 110, 120, 132
denial, 23, 60, 75, 223 eating disorders, 219
magic omnipotent, 55 Eaton, J., 26
dependency: ego functioning, 70
awareness of, 23 Ehrenzweig, A., 111
feelings of, 139, 170, 187 Eigen, M., 58
infantile, 170, 206 Eisenbud, J., 155
depersonalization, 71 “emotional turbulence”, 5
INDEX 279
emotions, use of as analytic instrument, as guardian of analytic passion play,

221 8–9
empathic intuition, 53 rules for, 8, 45
empathy, 31, 200 violations, 8
analytic, 11 free association(s), 3–5, 9, 13, 14, 34, 41,
enactment(s), 11, 50, 75, 142 46–49, 52, 55, 73, 111, 142, 164,
countertransference, 199, 200 216, 224, 239
Entralgo, P. L., 13 frequency of sessions: see sessions,
envy, 22, 54, 76, 88, 104, 127, 130, 172, frequency of
178, 181, 194–198 Freud, S., 4–5, 8, 13–24, 28, 40–42, 45, 51,
destructiveness, 23 55, 56, 58, 67, 179, 217
unconscious, 170 abandoning memory and desire, 24
erotized transference, 10 autoerotic scheme of development,
Etchegoyen, R. H., 3 23
evenly suspended attention, 20, 27, 29, concept of repression, 19
37, 41 dream interpretation, 216
exorcism, 94, 110, 120, 132 dream-work, 9
psychoanalytic, 95 evenly hovering/suspended
explosive sensoriality, transition from, attention, 20, 29, 41
to ability to think (clinical mental topography, 50
example), 234–239 recommendations to physicians
practising psycho-analysis,
false self and true self, 127 20–21
family transgenerational tragedy, 233 transference interpretation, 74
father, law of, 69, 117 use of couch, 17
fee(s), 3, 10, 165, 179, 207, 211 Fromm-Reichmann, F., 65
analysand’s reluctance to pay, frustration, inability to tolerate, 66
156–158, 188, 189 fundamental rule, 5, 47
setting, 10
Feldman, M., 53, 75 Gaddini, E., 249
fellatio, 241 Gallese, V., 155
Fenichel, O., 22, 45, 47 Garfield, D., 66
Ferro, A., 32, 33, 34, 35, 40, 46, 49, 121, gathering of transference, 26, 27, 28
234–239 genetic interpretation, 93
analytic field, 46 geographical confusions in infant,
field, psychoanalytic, concept of, 234, sorting of, 26
239 Giovacchini, P., 65
Fonagy, P., 65 Girard, R., 95
foreclosure of the “law of the father”, Glover, E., 22
69 Gray, P., 30
Fosshage, J., 64 greed/destructiveness, 23
frame, analytic (setting), 42, 84, 165, Greenson, R., 22, 47
220, 224 Grid, 30, 42, 43, 56, 76, 214
analyst to “become”, 6 grounded imagination, 258, 259
establishment of, 6–19 guilt, 85, 95, 110, 114, 119–122, 126, 132,
background, 7 133, 145, 159, 209, 212, 224, 254
breaking of, 11 projection of, 113, 128
conditional, 7, 8
as guarantor and facilitator of H (hate), 54
liberation, 10 vs. O, 44
280 INDEX
hallucinosis, 67, 69 of anxiety, 44

Hampshire, S., 9 classical, 235
Hargreaves, E., 39, 44 complete, 49, 50, 76, 105, 164, 192
here-and-now, 44, 75, 77, 108, 111, 117, of defence(s), 22
127, 142, 143, 258, 260 formal, 239
transference, 31, 88, 132, 221 genetic, 93
Hershberg, S., 64 infantile referents in, 112
history: of maximum unconscious anxiety, 5,
analysand’s, 3, 7 22, 24, 43, 46, 49, 86, 92, 96, 164,
unknown aspects of, 7 221
taking, 4 patient-centred and analyst-centred,
holding environment, 35 70
holding object, 35, 58 of relationships with part-objects, 22
holiday/vacation break, 68, 76, 77, 84, transference, 74
87, 92, 97, 98, 103, 110, 143, 185, interpretative stance of analyst, 7, 87,
200, 203, 224 121
anxiety about, 34, 138, 139 “intersubjective analytic dream space”,
Holocaust, 121, 131, 232 254
homunculus, 39, 73, 217 intersubjective approach, 257
hypnosis, 111 intersubjective projective identification,
hypnotic spell, reverie as, 30 36
intersubjective third subject, 239
Ideal Forms (Plato), 51, 109 interventions, analytic, timing of, 47–
idealization, 11, 18, 23, 55, 60, 104 48
identity, sense of, 76 intolerable anxiety, 66
imagination, grounded, 258, 259 intrapsychic contact-barrier, 6
imaginative conjectures, 38, 42 introjection, 32
imaginative creativeness in analysis, 50 introjective counteridentification, 32
“ineffable subject of unconscious”, 9, introjective identification, 157, 169
39, 73 intuition, 26, 30, 53, 74, 82, 140, 200, 261
infancy, unsuccessful, 126
infant: Jacobson, E., 32
observation, 13 James, W., 153, 251
–patient, 169 Joseph, B., 31, 44, 108, 142, 143, 147, 260
“virtual”, 112, 259 Workshop, 225
infantile catastrophe, 68, 109, 121, 208, Jowett, B., 30
211
infantile dependency, 170, 206 K (knowledge), 49, 54, 63, 69, 76, 109,
infantile depression, 23 125, 148, 182, 201
infantile neurosis, 258 –K, 142, 238
infantile transference, 157 vs. O, 44
from first session of an analysis, 21 Kant, I., 40, 51
regressed, 156 Kernberg, O., 65
inhibition, 168 Klein, M., 12, 20, 33, 48, 54, 59, 75, 97,
insight, analytic, 15 107, 108, 220
interhemispheric tracking, 37–38 analysis begins with consultative
internal figure or gang, 226 interview, 3
internal object(s), 67, 69, 70, 143, 169, autoerotic scheme of development,
184, 216, 253, 257 23
interpretation(s) (passim): concept of projective identification,
accuracy of, 48, 88 26
INDEX 281
constellating importance of the LSD experience, 90, 99, 101, 109

archaic Oedipus complex, 23
consummate importance of Mackler, D., 66
unconscious phantasy, 22 manic aspects, 98
envy, greed, and love versus manic defence(s), 23, 47, 60, 88, 91, 96,
destructiveness, 23 105, 127, 169, 197, 201, 224, 252
importance of the defences against manic-depressive illness, 65
anxiety, 23 masochism, 168
infantile depression, 23 Mason, A., 3, 11, 26, 45, 47, 108, 201,
interpretation of anxiety, 44 218–224
interpretation of maximum maternal reverie, 154, 155
unconscious anxiety, 22, 43, 74 Matte Blanco, I., 43
interpretation of relationships with maximum unconscious anxiety,
part-objects, 22 interpretation of, 5, 22, 24, 43,
Narrative of a Child Analysis, 21, 43 46, 49, 86, 92, 96, 164, 221
paranoid-schizoid and depressive McDougall, J., 50
positions, ontological, Meltzer, D. W., 20, 21
phenomenological, and recommendations on technique,
epistemological experience of, 26–28
23 transference as transfer of mental
recommendations on technique, pain, 94
infantile transference from the memory and desire:
beginning, 21–23 abandoning/suspending, 24, 26,
unconscious phantasy, consummate 36–37, 41, 54, 58, 148, 260
importance of, 22 and preconceptions, and
Kleinian technique, 35, 76, 107, 143 understanding, 29, 96
standard, 148 method acting, 258
Kohut, H., 58 mirror neuron, 155
Kris, E., 66 model(s):
Kristeva, J., 155 as instruments of thinking, 225
psychic, 228
L (love), vs. O, 44 mother (passim):
Lacan, J.: parasitic relationship with, 205
“law of the father”, 69, 117 motives, unconscious, 45
“Other”, 14 myth(s), 5, 24, 25, 43, 74, 87
Langs, R., 4, 5, 84, 217 analysts’ need to collect, 34
law of father, 69, 117
learning from experience, 67 narcissism, 23, 44
left-hemisphere processing, 25, 30, 31, narcissistic organization, 226
45, 86, 109 narrative preparatory technique, 239
Cartesian, 38 re-analytic (Ferro), 239
listening, 25 narremes, 234
mode of comprehension, 40 neediness, 4, 110, 114, 157, 165, 178, 188,
monitoring, 26, 30, 37–42, 58, 74, 85, 191
96, 157, 260 cannibalistic, 260
tracking, 37–41 negation, 69, 76
life instinct, 76 negative countertransference, 199
Llinás, R., 32 negative selected fact, 57, 58
loneliness, 189, 244, 245, 252 negative therapeutic reaction, 12, 67,
López-Corvo, R. E., 38 113, 123, 142
love/destructiveness, 23 clinical example, 113–133
282 INDEX
negative transference, 12, 21, 47, 94 Opie, L., 8, 259

neurosis(es): Opie, P., 8, 259
countertransference, 16, 37, 258 oral stage (biting), 23
infantile, 258
of one, 258 paradigmatic scale, 42
transference–countertransference, 16 paranoia, 219, 220
notes, taking in session, 31 paranoid-schizoid position, 34, 40, 41,
noumenon(a) (Kant), 51, 108, 109 52–54, 59, 60, 75, 89, 102, 103,
numinous and ineffable intelligence, 40 142, 148
movement to depressive position,
O, 26, 34, 43–45, 63, 74–77, 86, 96, 108, 26
109, 125, 153, 176, 184, 214–217 ontological, phenomenological, and
as analytic object, 50 epistemological experience of,
Bion’s conception of, 77 23
bi-polar, 25 part-object relations, 77, 224
experience of, 25, 49, 77 interpretation of, 22
analysand’s, 49 passion play/drama, analysis as, 8, 9,
impersonal, 49 37, 39, 40, 46, 50, 57, 258
transformation of to personal, 49 passive listening, 30
infinity, 76, 259 paternal transference, 242
intersections of, 148, 258 pathological organization, 46, 93, 127,
and L, H, and K, 44 169
at large, 24 persecutory (projected) anxieties, 23,
mother’s native, 31 177, 259, 260
of session, 24, 92 personality traits, 65
transformations in, 25, 44, 53, 55, 87, personal truth, 136
128, 140, 154, 155, 201, 258, 260 “phantasies in the body”, 249
from, and to, 257 phantasy(ies):
object cathexes, displacements of, 75 preconscious, 13
obsessive defences, 60 unconscious, 34, 43–48, 74
obstructive object, 66, 67, 68, 71, 72, 121 analysand’s, interpreting, 22
Oedipus complex, 25, 26, 34, 59, 69, 95, analysis of, 30
179 in clinical examples (passim)
archaic, constellating importance consummate importance of, 22
of, 23 containment of, 23
archaic part-object, 97 dream narratives as, 46
Oedipus myth, 50 interpreting, 34, 43
Ogden, T., 19, 32, 33, 50, 107, 155, 239, intuition from, 43
240–262 and myths, 24, 25, 74
“intersubjective analytic dream reconstructing, 45
space”, 254 sense, myth, and passion as, 5
intersubjective approach, 257–262 pharmacotherapy, 65
intersubjective third subject, 239 “phenomenal dreamer of
subjugating, 26, 37, 39, 57, 258 consciousness”, 74
third subject of analysis, 37, 39, 40, phobia, 48, 94, 220, 229
46, 259 Pietà transference ↔
omnipotence, 12, 34, 55, 61, 64, 68, 109, countertransference, 94, 95, 132
140 Plato, 30, 51, 54
once-and-forever infant of the Poincaré, H., 27, 38, 41, 52, 55, 58, 228
unconscious, 8, 28, 45, 112, 164, positive transference, 21, 47, 226
259 post-traumatic stress disorder, 69
INDEX 283
pre-conceptions, 51, 54, 77 psychic equilibrium, clinical example,

abandoning, 81 113–133
pre-conscious (System Pcs), 51 psychic model, 228
preconscious mind, interpreting to, 111 psychic retreat(s), 46, 67, 69, 93, 121, 127
preconscious phantasies, 13 psychoanalysis as sacred
primal scene, 86, 96, 97, 215 improvisational drama, see
primary maternal preoccupation, 154, drama
155, 258 psychoanalytically informed
primary process, sensorimotor language psychotherapy, 65, 107, 202–206
of, 155 Psychoanalytic Center of California
primitive mental disorders, (PCC), 155
psychoanalytic treatment of, psychoanalytic field, concept of, 234,
65–72 239
procrastination, 228 psychoanalytic stalemates, 67
projecting(ion), 22, 31, 32, 68, 69, 75, 77, psychopharmacology, 65
87, 88, 93, 103, 113, 128, 157, 170, psychosis(es), 3
171, 183, 210, 219, 220, 253 aetiology of, 66–69
projective counteridentification(s), 75 psychopathology of, 66
projective identification(s), 32, 55, 60, transference, 66
73, 92, 96, 102, 169, 172, 175, 190, psychotherapy:
205, 211, 236, 253 obligatory, 36, 110
as actors in analytic drama, 34 psychoanalytically informed, 65, 107,
analysand’s communication through, 202–206
94 telephone, 19
and analysand’s sense of self, 164 video-conference, 19
with analyst, 186 psychotic patient(s), 67, 68, 70
to avoid separation, 157 psychotic personality, 67
and mother, 162 psychotic states, 65
clinical ramifications of, 224 psychoanalytic treatment of, 65–72
container for, 234
double use of, 98 questions, analyst asking, 7
infantile, 127
intersubjective, 36 rational conjectures, 42, 96
Klein’s concept of, 26 re-analytic narrative preparation
remain within boundaries of (Ferro), 239
projecting subject, 31 regression, 13, 70, 143
rogue/discarded alpha-elements adaptive, 16
in, 75 cataclysmic, 16, 66
as schizoid defence, 23, 66 precipitous, 66
projective transformations, 88, 94 in service of ego, 16, 66
projective transidentification(s), 31, 36, virtual phylogenetic, atavistic, or
75, 224 primitive, 131
intersubjective, 155 repressed, return of, 16, 61, 166
“protective blanket of innocence”, 153 resistance, 47, 50, 67, 186
protoemotional states/protoemotions, analytic, 9, 12
234–237 return of repressed, 16, 61, 166
primitive, 237 reverie, 7, 25, 33, 34, 39, 44, 50, 51, 56, 75,
P-S ↔ D, 53–55, 75, 96, 114, 117, 163 83, 87, 88, 109, 132, 136, 138, 148,
and selected fact, 54–55 233, 244, 249–258, 261
P-S (n+1), 102 analyst’s capacity for, 24
psychic equilibria, 12, 142 analyst’s spontaneous state of, 135
284 INDEX
reverie (continued): alternative approach to

analytic, 24, 28, 30, 31, 37, 38, 46, 55 understanding, 55–57
meditative, 30, 38 negative, 57, 58
attention in, 26 and P-S ↔ D, 54–55
connected, 42 sequential, 56
gathering the transference, 28 significance of, 52–57
as hypnotic spell, 30 self-harm, 226
maternal, 15, 154, 155 selfobjects, 58
passive listening, 30–31 self-organization, principle of, vs.
and rule of abstinence, 10 principle of co-creation, 112
wakeful dream thinking/state, 24, 30 “sense, myth, and passion”, 5, 24, 25, 43,
reversible perspective, 55, 57, 67 74, 87
“rhythm of safety”, 7, 10 sensoriality, 69, 234, 235
and frequency of analysis, 4, 7, 10 explosive, transition from, to ability
Ricker, R., 28 to think (clinical example),
right cerebral hemisphere, 13, 25, 30, 31, 234–239
38, 45, 109 sensorimotor language of primary
approach, 42, 53, 74, 96, 158, 260 process, 155
attention, 25 separation, feelings of, 219
flights of imaginative conjecture, 258 sequential selected fact, 56
“to left-hemisphere” communication, session(s):
31 frequency of, 4, 10, 12–13
listening, 30, 83 with primitive mental disorders,
mode of understanding, 40 70
processing (reverie), 37–41, 85, 259 setting, analytic, 45
techniques, 45 establishment of, 6–19
rigid-motion transformations, 94 “Siamese-twinship” paradigm
rivalry, 23, 178, 179, 181, 215 analyst–analysand, 16
Rosenfeld, H., 65, 226 signifiers, 73, 216
rule of abstinence, 10 Simon, B., 13
Sparrow, C., 55
Sacks, O., 242 “speculative tree of inference”, 38
sacred improvisational drama Spillius, E. B., 21
psychoanalysis as, 110 Spinoza, B., 9
Saks, E. R., 65, 66 splitting, 23, 26, 34, 55, 60, 66, 75, 88,
Sandler, J., 259, 261 89, 103, 127, 157, 164, 190, 191,
schizoid defences, 23 224
schizoid mechanisms, 60 Squiggle game, 33, 47
schizoid tendencies, 18 stammer, 225, 226, 227
schizophrenia, 65 stance, analytic, 4, 121
Schore, A., 31, 39 Stanislavski, C., 8, 54, 258
scrolling, 46, 86, 204, 206 Steiner, J., 40, 53, 67, 70, 75, 93, 121, 127
aloud to patients, 111 Stern, D., 155
concept of, 110–111 story-teller, analyst as, 33, 34, 36
Searles, H. F., 65, 252 Strachey, J., 61
secondary process, 56 “stream of thought”, 251
Segal, H., 65, 108, 143, 147, 218 subject, analytic, 8
selected fact, 27, 31, 37, 38, 41, 42, 74, 75, subjugating third subject of analysis, 26,
82, 85–88, 92, 96–100, 104, 111, 37, 39, 57, 258–261
114, 136, 146, 163–165, 228, 233 intersubjective, 26
INDEX 285
suicide, 124, 226 psychosis, 66

anonymous, solitary, 243, 250, 251, superego, 70
253, 256 as transfer of mental pain, 94
Sullivan, H. S., 65 transferencecountertransference, 46
superego, 7, 35, 121, 198 transformations in O, 25, 44, 53, 55, 87,
aggressor-, 172 128, 140, 154, 155, 201, 258, 260
diminishment of, 61 transgenerational trauma/tragedy, 121,
envious, 170, 172 131, 233
figure, threatening, 209 transidentification, projective, 31, 36,
powerful and disdainful, 168 224
transferences, 70 intersubjective, 155
“super”ego, 66, 67 trauma, 121, 142, 212
object, 208 analysis of, 175
supervision, 31, 57, 154 childhood, 227
symbolizing(ization), 153, 216 transgenerational, 121, 131, 233
syntagmatic scale, 42 tree of inference, 38, 41–52, 96, 128, 260
System Cs. and System Ucs, protective truth:
separation between, 6 concern for, 201
instinct/drive, 50
Target, M., 65 personal, 136
telepathy, 154, 155 Tustin, F., 4, 7, 10, 108
telephone analysis, 19 twin-protector, 140
termination, 60–64, 210, 233, 255
theta rhythm, 15 unconscious (Ucs):
third subject of analysis, 37, 39, 40, 46, dynamic or repressed, 51
259 secret code of, 4
subjugating, 37, 39, 57, 258–261 unrepressed (collective), 51
“toilet-breast”, 27 unconscious anxiety, 45, 59, 74, 91,
tracking of text of analytic session, 30, maximum, interpretation of, 5, 22, 24,
37, 39, 85, 96, 157, 200 43, 46, 49, 86, 92, 96, 164, 221
training institutes, 11 unconscious constructions, 253, 257
transcendent position, 128 “unconscious dreamer who
transference (passim): understands the dream”, 37,
↔ countertransference, 31, 44, 57, 94, 74, 261
95, 120, 132, 142, 143, 146, 163, unconscious envy, 170
197, 239, 258 unconscious motives, 45
enactment, 200 unconscious phantasies:
neurosis, 16 analysand’s, interpreting, 22
↔ reverie, 7, 37, 88 analysis of, 30
delusional, 66 in clinical examples (passim)
displacement, 242 consummate importance of, 22
erotized, 10 containment of, 23
gathering of, 26, 27, 28 dream narratives as, 46
here-and-now, 88, 132, 221 interpreting, 34, 43
infantile, 21, 157 intuition from, 43
regressed, 156 and myths, 24, 25, 74
interpretation, 3, 74 reconstructing, 45
negative, 12, 21, 47, 94 sense, myth, and passion as, 5
paternal, 242 unconscious wakeful thinking, 51
positive, 21, 47, 226 undervalued fact, 53
286 INDEX
vacation/holiday break, 34, 68, 76, 77 113, 119, 128, 132, 158, 160, 162,
anxiety about, 34, 138, 139 165, 168, 169, 186, 193, 208, 211,
in clinical examples, 84–111, 127–132, 218, 238, 260
138, 139, 143, 185, 193, 196, 200, wild thoughts, 56
203, 224, 238 analyst’s, 38, 42, 43, 48, 54, 164
Varchevker, A., 39, 44 Winnicott, D. W., 58, 153
video-conference analysis, 19 holding environment, 35
violence, 119, 226 imaginative creativeness in analysis,
“virtual infant”, 112, 259 50
primary maternal preoccupation,
“wakeful dream thinking”/wakeful 154, 155, 258
dreaming, 25, 30, 42, 83, 109 Squiggle game, 33, 47
meditative state, 42 true and false self, 127
reverie as, 24
Wallerstein, R. S., 239 zonal confusions
weaning, 35, 116, 121, 156, 157, 239 in mother, sorting of, 26
weekend break, 56, 58, 86, 91, 94, 96, 103, zone-to-geography confusion, 27

James S. Grotstein - But at The Same Time and On Another Level... - Volume 2, Clinical Applications in The Kleinian - Bionian Mode-Karnac Books (2009)

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“. . .

BUT AT THE SAME TIME

Copyright © 2009 James S. Grotstein

All rights reserved. No part of this publication may be reproduced, stored in

British Library Cataloguing in Publication Data

Edited, designed, and produced by Communication Crafts

Printed in Great Britain

1 The consultative interview:

2 The analysis begins:

4 How to listen and what to interpret 29

6 The psychoanalytic treatment of psychotic

7 Basic assumptions of Kleinian/Bionian technique:

9 Clinical example 2 113

12 Clinical example 5: “bicycles”

19 Clinical example 12:

21 Clinical example 14:

27 Clinical example 20:

REFERENCES AND BIBLIOGRAPHY 265

Kahn, Leila Kuenzel, Jennifer Langham, Howard Levine, Robert

Caveat. In my original version of this work I attempted to even out

analysis was once dominated by males. Now the trend is towards

James S. Grotstein, M.D., is Clinical Professor of Psychiatry at the

It is the cleverest achievement of art to keep itself undiscovered.

Memory knows before knowing remembers.

And, as imagination bodies forth

The consultative interview:

schedule of appointments, and the presentation of the analyst’s policy

The analysis begins:

The analytic frame (setting):

A. The “background frame” refers to the contour of the analytic set-

of the country and really needs to continue the analysis, or other

What Bion (1962a, 1962b) was later to uncover as the “container-con-

The frame as the guardian of the analytic passion play

of as an improvisational passion play, one can then conceive that the

The analytic frame as the guarantor and facilitator

Other considerations of the frame

Bion and the frame

The use of the couch

that mental state. This “right-brain” shift in the lying-down position in

“inter-unconscious” and “intra-unconscious” discourse than we have

tine procedure that seems thus far to be successful. As soon as I have

for the use of the couch in analysis and in psychotherapy is in need

She is not a psychoanalyst herself and uses the sitting-up position

Telephone and video-conferencing:

avoid a danger which is inseparable from the exercise of deliberate

Klein’s recommendations on technique:

Interpretation of the maximum unconscious anxiety

Interpretation of relationships with part-objects

The consummate importance of unconscious phantasy

The ontological, phenomenological, and epistemological

The importance of the defences against anxiety

The importance of envy, greed, and love

The constellating importance

Bion’s recommendations on technique: an epitome

Night-time vision as a model for wakeful dreaming

Sense, myth, and passion

Readers who are only casually familiar with Bion’s recommendations

Attention in reverie: “listen to yourself listening to the other”

Meltzer’s recommendations on technique

confusions in the mother. In applying is concept of “the gathering of

The analyst’s stance

infant”, which I have earlier introduced as the “once-and-forever

Gathering the transference—