On "Container and Projective Identification"
(SEPI Forum, Sep.-Nov. 2000)
(Editors'
Note) On September 1, 2000, Hilde Rapp responded on the IJPA discussion
list to an invitation to suggest ways of facilitating a process of
translation between different psychoanalytic dialects, and made a
forward of her message to the SEPI list serve. On the same day Paul
Wachtel replied saying that as "an integrationist, moreover,
whose initial roots and continuing strongest interests are in psychoanalysis",
he had "NOT been persuaded that Lacan, or even Bion, to take
a quite different example, really have something useful to contribute",
and went on to ask Hilde, since she cited Bion approvingly, if she
could indicate in a brief way what ideas of observations of his she
thinks are really valuable. On September 2 Hilde and Tullio Carere
responded to Paul's invitation, pointing up shortly what in their
opinion is valuable in the thinkers quoted, and especially in Bion.
Paul replied that he has nothing to object to the interesting kinship
between the therapist-patient relationship and the mother-infant relationship,
yet much to object to the usefulness of the image of a "container"
or of "containing". This gave rise to a huge debate, in
which 26 SEPI members took part. The discussion on the function of
holding or containing was enriched by that on a related concept, that
is projective identification, introduced into the debate by Paolo
Migone. He said on September 4 that though put off by Bion's difficult
language, he did appreciate several of his things, for example his
re-elaboration of the concept of projective identification. He sent
then the following day a long excerpt from a paper of his on this
topic. The concept of projective identification met more or less with
the same reception as the image of the container: those who distrusted
the latter felt the same distrust toward the former. Two positions
emerged in the discussion. Some thought that the metaphor of containing/holding
was useful to describe a crucial therapeutic factor, connected to
reparation or corrective emotional experience. Others did not deny
the therapeutic factor, but took issue with the metaphor, deemed useless
or misleading. A lengthy and passionate discussion brought to no rapprochement
between the two positions, but we are sure that its reading will enrich
many colleagues. We want to thank all 26 participants, who are the
following (listed in the order in which they intervened): Paul Wachtel, Tullio
Carere, Hilde Rapp, George
Stricker, Windy Dryden, Jack
Berkley, Paolo Migone, Rebecca
Curtis, Bill Stiles, Bob
Sollod, Jennifer Hillman, Robert
Rosenbaum, David Allen, Luca
Panseri, Nancy McWilliams, Jim
Lindsley, Arthur Egendorf, Diana
Fosha, Richard O'Connor, Ana
M. Stingel, Elizabeth Moraes,
Marvin Goldfried,
Diana P. Wais, Allen
Kalpin, Ava Schlesinger, Ang
Wee Kiat Anthony.
Fri, 1 Sep 2000, Paul Wachtel
Hilde, I got your recent posting on the SEPI list serve and felt
like I had come in in the middle of the movie. I gather you were forwarding
something from another list to which you also belong? But there was
no indication how to communicate with that list. Was there a longer
history to the discussion from which you cited a piece? I was intrigued
but puzzled.
I was also made aware that despite being (a) a staunch integrationist
and, hence, someone who fundamentally believes that any school of
thought that has attracted significant numbers of smart people must
have SOMETHING useful to say that those of us of other orientations
can profit from and use, and (b) an integrationist, moreover, whose
initial roots and continuing strongest interests are in psychoanalysis,
I nonetheless became acutely aware in reading the posting that, thus
far, I have NOT been persuaded that Lacan, or even Bion to take a
quite different example, really have something useful to contribute.
Bion in particular has become quite strongly of interest in U.S. psychoanalytic
circles (there's always a time lag across the pond), and I have frankly
been put off enough by everything I have heard my Bion-citing students
and colleagues say (putting feelings "into" other people,
all the stuff about "containers," the view of psychic life
and of groups as basically psychotic underneath, etc.) that I have
not had the inclination to read his stuff for myself. That means,
of course, that I speak from ignorance in a sense, so nothing I am
saying here is something I would stand behind in print. (I don't believe
we should spout off -- except in informal exchanges such as this,
that are designed simply to draw further responses for consideration
-- on matters that we have not examined seriously and carefully).
On the other hand, life is short, and I barely have enough time to
read the things I KNOW I will find useful, and nothing I have heard
anyone say about Bion thus far has led me to think that, in the finiteness
of life, reading Bion is a good investment of my limited time.
So, since you cited Bion approvingly, if you could indicate to me
in a brief way what ideas of observations of his you think are really
valuable (and perhaps whether you think any of them are unique enough
that I couldn't come to them from other sources who use a less peculiar
and off-putting linguistic style) I would be very appreciative.
I was initially going to send this just to you (along with a warm
hello, which shall remain), but decided to respond instead to the
SEPI list from which it came, since others on the list may also be
able to help me overcome my resistance to Bion, if that be what it
is. So thanks to any of you who can enlighten me (and, for that matter,
to any of you who share my views about containers and putting feelings
into people, and want to cure me not by enlightening me but by supporting
my present inclinations). Paul.
Sat, 2 Sep 2000, Tullio Carere
Paul, I put Bion in the same category as Jung and Lacan, for their
capacity to irritate me deeply, but in the same time to intrigue me
enough to get me to read further. Yet very little of Jung or Lacan
has survived in my present way of working and thinking (though Jung
has been a juvenile love affair of mine), while Bion's influence is
still a corner stone to me.
I understand Bion's thoughts "about containers and putting feelings
into people" as his way to point to the kinship between the mother/child
and the therapist/patient relationships. As the mother must hold,
contain, and partially work through the experience that the child
cannot yet hold, contain and work through by himself, so is the therapist
to do with some of her patients, in some moments, or sessions, or
phases of the treatment. When a therapist relates to her patient in
this way, I say that she acts from the "Maternal vertex"
of the field.
But Bion's most decisive contribution is in my opinion the introduction
in the therapeutic field of the Kantian polarity phenomenon/noumenon,
or knowledge/unknown, or K/O. In the Freudian theory there is no Unknown
(as unknowable), there is only an Unconscious (that can be made conscious).
The Freudian therapist is therefore bound to make the unconscious
as conscious as possible, but is not helped by his theory to trust
the unknown as such.
There is a substantial difference between Freud's unconscious and
Bion's unknown. The unconscious must be drained as much as possible,
or reclaimed as the Zuider-Zee. The unknown is the matrix of
all generative and healing powers that all therapists, from the shamans
on, have always drawn upon.
The unconscious has to be conquered (which the therapist does from
the "K vertex" of the field, where he acts as a scientist)
while by the unknown one has to be inspired (this happens in the "O
vertex", where the therapist acts as an artist). I hope, Paul,
I have not succeeded in supporting your present inclinations towards
Bion. Tullio.
Sat, 2 Sep 2000, Hilde Rapp
Hello Paul, how nice to hear from you. This will be alas much briefer
that I would like- I owe a chapter I must get down to- but did want
to respond quickly: I think that Bion, the British Kleinians, Lacan,
Kristeva and sometimes Langs, have a style which is not conducive
to communicating ideas or practices.
Rather, what their writings do- I think- is to create a subjective
field, an experience, into which to immerse oneself- which once one
allows it to develop, recreates certain experiences and feelings which
resemble how one feels when working with - usually - very disturbed
clients.
Jerry (Gold) and Rebecca (Curtis), and George (Stricker), occasionally
describe client work, where over a time a certain intuition about
a client incubates which slowly forms into a clinical hypothesis that,
say, this person has never really sepated emotionally from his mother
and has , in a sense no, proper ego boundaries, but 'uses' the therapists
to give some shape and stability to their sense of being a person
at all...
In a way Jerry and George's their Integrative Handbook does contain
chapters which draw on object relations approaches, which themselves
are informed by this literature. Maybe somebody like Donald Winnicott,
or among contemporaries, Christopher Bollas, or Patrick Casement has
found a more accessible style for describing how they come to understand
and work with these strange states.
In a way, this whole body of writing is only relevant for therapists
who do a significant amount of work in long term psychotherapy with
people who might be described as borderline ( but not particularly
impulsive and antisocial- in which case they need something more like
Marsha Lienehan's or Tony Ryle's approach or straight CBT), narcissistic,
fragile self, with a particularly poor attachment history- who don't
make good use of the therapeutic alliance, or of relationships in
general.
Otherwise it is a body of work- Edna O'Shaughnessy falls into this
category as well, which is more like literature or a curious amalgam
of poetry, mysticism and philosophy- for which one has to be in the
mood.
On this list, Tullio Carere is a good example of someone who writes
- I think- in an accessible way about issues and themes which are
centrally informed by this body of work.
On the other hand, Diana (Fosha) and Leigh ( McCullough) have a perfectly
accessible, contemporary and emotionally deep and passionate way of
doing this work and writing lucidly about it- so from a practitioner
rather than a historian of idseas perspective, once can get the clinically
insights in a whole range of styles- so why not choose the one that
speaks to you and that you can relate to and enjoy reading! Maybe
when I have made more progress with my chapter you might be interested
to have a look - it will draw on some of these author's, or their
influence. Maybe Tullio has time to do some advocacy for this body
of literature meanwhile? Cordially, Hilde.
Sat, 2 Sep 2000, Paul Wachtel
Dear Tullio and Hilde, thanks for your replies to my Bion inquiry.
Tullio, I am indeed interested in what you have raised about Bion's
less commented upon contribution (the unknown vs. the unconscious)
but still have a suspicion that Carere would be a more rewarding source
to read on this than Bion. But be that as it may, I wish to turn to
the issue that continues to puzzle me, the one that spews forth constantly
from my students and colleagues and STILL doesn't make sense to me.
You state that:
<<I understand Bion's thoughts "about containers and putting
feelings into people" as his way to point to the kinship between
the mother/child and the therapist/patient relationships. As the mother
must hold, contain, and partially work through the experience that
the child cannot yet hold, contain and work through by himself, so
is the therapist to do with some of her patients, in some moments,
or sessions, or phases of the treatment. When a therapist relates
to her patient in this way, I say that she acts from the "Maternal
vertex" of the field.>>
My question is not about the interesting kinship (and, of course,
lack of kinship at the same time -- something you are well aware of
in your thinking dialectically) between the therapist-patient relationship
and the mother-infant relationship. My question is whether -- for
either -- the image of a "container" or of "containing"
is useful. My guess is, apropos Hilde's interesting comment, that
it is a metaphor, a poetic image for some, that resonate with SOMETHING
that people observe or experience. And I agree with Hilde that basically
use whatever sources, images, etc. that work for you and that different
images will work for different people. But not only does "container"
not work for me, it seems to me to be an image that is confusing,
obtuse, and certainly not useful for any systematic understanding
of the process. SOMETHING important goes on between mother and child
or therapist and patient, and my guess is that what you (and others
who seem to like Bion's way of speaking about it) are ACTUALLY picturing
or referring to when you use the word "contain" is probably
quite accurate. But why in the world describe it as "containing?"
I still need enlightenment here, from the two of you or from anyone
else who can help this poor, troubled soul who just doesn't get it.
Paul.
Sat, 2 Sep 2000, George Stricker
Now that Hilde has mentioned my work, which does value some of the
contributions of some object relations theorists, I guess I should
respond to Paul's question, and to Tullio's answer. I would not group
Jung with Bion and Lacan - I don't much care for Jung, for political
as well as psychological reasons, but I do understand him; I can't
say the same for the other two. Over my career, I must have reviewed
at least three dozen books, liked some better than others, but tried
to do a fair job for all. As a result, when I was sent a Bion book
to review, and after a noble effort, I sent it back without a review,
feeling I could not do a fair review of a book I found incomprehensible.
I should add, although this may be a different thread, that I find
the concept of projective identification particularly noxious, as
it often is used to exonerate the therapist from responsibility for
his or her behavior and blame it on the patient. I certainly see the
relationship as central, and at least some of what goes on as unconscious,
but I don't find the language of Bion and Lacan useful, and the concepts
either are not original or, if original, not understandable, to me
at least. George.
Sun, 3 Sep 2000, Tullio Carere
- Paul, on Sep. 2 Paul Wachtel wrote:
- >My question is not about the interesting kinship (and, of
course, lack of
- >kinship at the same time -- something you are well aware of
in your thinking
- >dialectically) between the therapist-patient relationship
and the
- >mother-infant relationship. My question is whether -- for
either -- the
- >image of a "container" or of "containing"
is useful. My guess is, apropos
- >Hilde's interesting comment, that it is a metaphor, a poetic
image for some,
- >that resonate with SOMETHING that people observe or experience.
And I agree
- >with Hilde that basically use whatever sources, images, etc.
that work for
- >you and that different images will work for different people.
But not only
- >does "container" not work for me, it seems to me
to be an image that is
- >confusing, obtuse, and certainly not useful for any systematic
understanding
- >of the process.
-
- There is a pertinent paragraph in last Hilde's message of Sep.
2:
- >Jerry (Gold) and Rebecca (Curtis), and George (Stricker),
occasionally
- >describe client work, where over a time a certain intuition
about a client
- >incubates which slowly forms into a clinical hypothesis that,
say, this
- >person has never really separated emotionally from his mother
and has , in a
- >sense no, proper ego boundaries, but 'uses' the therapists
to give some
- >shape and stability to their sense of being a person at all...
This is very important, in my experience. People who have been seriously
deprived of good enough maternal care are a considerable share of
our clients (or at least of mine). It is not just a metaphor, but
a more or less accurate description, to say that they have no "proper
ego boundaries". These are the people, if any, who badly need
"corrective emotional experience". They must find some form
of relational containment, if they are to let go of their defensive
(and usually most expensive) self-containment.
A clinical flash: Year after year, a woman with character problems
improved enough for continuing the treatment, but not enough for stopping
it. At one point I felt that she had in herself so small a child,
and so furious and desperate, that no talking cure would do to soothe
her. I had to give her what one would give to a real child: bodily
holding. It was a turning point: in less than a year I could do all
the work that I had not been able to do in many years before, and
the therapy could finally end.
Physical holding is absolutely necessary to children and, in my experience,
also to many a patient. As I told Ellen and you in New York, I am
enthusiastic of my recent discovery of EMDR because I have found that,
independently of the biphasic brain stimulation, it is perceived by
some as a form of physical holding (they experience the waving movement
of my hand as a hug).
To some patients, especially those with depressive, obsessive-compulsive,
panic attack, or eating disorders, I often give antidepressant medication
for some time: it is a pharmacological containment that I find necessary
when the pain is intolerable, until the person is ready for a purely
relational containment (but the administration of a drug is anyway
a relational event: the person feels usually contained by both the
pharmacological action of the drug, and the very administration of
it).
These are a few examples of most basic forms of emotional containment.
For a more general view, I hope you will forgive me if I quote myself
(JPI, 9, 4, 1999):
"The therapist has many ways to meet her patient's need to feel
contained, from the constancy of space-time conditions to the tone
and the choice of the words. Beyond the specific modes, what is decisive
is the attitude that transmits to him a message of unconditional acceptance,
of acknowledgment of his worth and dignity independently of any work,
project, or assumption of responsibility.
One should always recall Gill's warning (though he himself, as was
seen above, did not do so): nothing in the therapeutic interaction
bears a universal meaning. The couch can be a comfortable cradle to
one person, a Procrustean bed to another. The silence of the therapist
is to some patients a room in which they feel welcome and free to
move as they like, to others a sign of unbearable coldness and detachment.
It follows that only an inexperienced or insensitive therapist can
impose undiscriminatingly the couch, prolonged silences or whatever.
The need to find a secure base is very much variable from patient
to patient, both in intensity and in quality. Some can be contained
and guided in a process of change only in a definitely rigid setting,
while other proceed in a softer and more flexible environment. What
is reassuring to a person is intolerable to another. There is no way
to know it in advance: only the careful listening to all explicit
and implicit demands, and the unprejudiced observation of the reactions
to any intervention can serve as a guide in a genuine relation...
In the maternal vertex the therapist receives the unstructured or
chaotic signals that the patient sends to her, and gives them back
to him partially elaborated, so that he can begin to integrate them
in meaningful connections. This operation, compared by Bion (1962)
to the maternal reverie, is different from the classic, Freudian interpretation,
because its aim is not to uncover unconscious meanings (therefore
it does not belong to the uncovering axis of the therapeutic relation),
but to meet an actual inadequacy with the offer of an auxiliary container
for the experience that the other is not yet able to keep and elaborate
autonomously. This kind of interpretation does not face a resistance,
but meets an incapacity: it is directed to a patient who "cannot",
rather than to one who "does not want"." (pp. 379-381)
When I wrote of the different meanings of silence
I had quite clear in my mind the wonderful pages in "Psychoanalysis
and Behavior Therapy" where you described them. I now see
that I forgot to quote you in this paragraph of the paper. So I have
one more thing to apologize for, beyond the other, much more unforgivable,
of imagining that I have something to teach you.
But I dare do so because you taught me so many invaluable things,
that may be you would accept from me a very small one in return. Tullio.
Sun, 3 Sep 2000, Tullio Carere
George, I grouped Jung with Bion and Lacan because they have one
thing in common--the special capacity to evoke in others enthusiastic
allegiance or scornful refusal. If one can avoid the latter, and above
all the former, that is more dangerous (because it generates followers),
one can find a middle way that leads to some useful places. This was
anyway my experience, as I try to convey in my response to Paul. But
if what seems to me a way seems to you a blind alley, please don't
hesitate to make me know. I may still be a victim of Bion's dark charm,
without knowing it. In this case I am the one who need enlightenment.
Tullio
Sun, 3 Sep 2000, Windy Dryden
I have found some of the works of Lacan and Bion extremely useful
in clinical practice for my clients with insomnia. They work like
a dream!! Windy Dryden.
Sun, 3 Sep 2000, Jack Berkley
Paul, I did not know Bion was
catching on. Among my Bion friends, I am not as zealous. Many of my
Bion friends about five years ago were reading a novel Bion wrote.
As an old English major, I knew they had exceeded my devotion. But
devoted they were and i was out of the loop with some good friends
on that. Roger Shapiro and Elizabeth Bott Spillius (sp?) are wonderful
lecturers on Bion, so are many A.K. Rice associates, which I used
to be. Bion and Klein are central to that work.
However, I can confirm for you that it is not necessary to take limited
time to read Bion. I would not. There are too many good proponents
of his theory who do a better job explaining it.
Also, you mentioned that students talk about "putting feelings
into". That is a common parlance among Bion/Kleinian psychologists.
It is, like many idioms, not subject to literal translation. The idiom
makes it sound as if feelings are transported in some magical or psychic
way. Worse, it lends itself to the misconception that the feelings
have nothing to do with the recipient/container, who can be mistakenly
thought of as an empty vessel filled with material not his own.
The projective identification process is a here-and-now, behavioral
influencing process. It is a behavioral process. Let me say again:
Its fundamental mechanism is behavior. This is not shamanism, mysticism,
witchcraft, or anything arcane, though the language suggests it is.
I think the language of this brand of psychology erects a boundary
or shield around its proponents that makes them appear--often especially
to themselves--in possession of a secret science, or mystical insight.
It is very alluring, and Bion's writing and Klein's writing lends
to this nether worldly professional penumbra.
Projective identification is much
more worldly, occurs between two or more persons, and is an identifiable
process with steps. There are different definitions of it so one needs
to clarify. But it is borne of behavior, not psychic vibrations or
thought insertion. Sorry. Ill stop. I guess there are two ways to
ruin a concept, at least.
Proponents who misuse it, including beginning sophomoric users and
more twisted defensive users, and those who learn of the concept from
such persons and are turned off more by the misuse than the concept
itself. Jack.
Sun, 3 Sep 2000, Jack Berkley
George and others, some of my responses appear at the ends of other
series of exchanges so they may have become lost for that reason and
for the reason that I hit the reply button and have only on person's
name listed as the recipient. George I wanted to send the response
below to your attention because it may have got buried in my response
to Paul. The others I just hope you will want to find. Thanks.
Response: Paul, contain yourself. Jack
P.S.: seriously, hope that is a helpful nudge. By the way, just bought
your book at APA and look forward to it. Also, container = Latin continere:
to hold together, hold in, to have within, hold, enclose, bound, to
restrain oneself, accommodate. I think of the term in conjunction
with Keats' letter on negative capability which paraphrased from memory
(others may correct any literary transgression here): the capacity
to be in uncertainties etc. When a therapist can calmly and genuinely
listen to and perceive the distress of a client, the therapist is
receiving emotional, intellectual, verbal, kinesthetic data into his
or her intrapsychic system and holding it there and processing it,
hopefully without reacting too precipitously, that is to say while
first holding it within for a time.
Hopefully now, via email, we who find Bion's concept practical and
useful, are "containing" your mix of dismay about the term
which "doesn't work for me" and your yearning to understand
the term in a way that we do ("I need some enlightenment here").
I think also, one must in part identify with the capacity of the most
anatomically important human container, the womb to the extent possible.
This is a shift in gender metaphor, and if one pauses a bit, one can
remember all kinds of issues related to the psychoanalytic concepts
pertaining to phallus and womb. The therapist's mind is then by metaphor
quite a matrix for processing client inputs. Thomas Ogden uses the
title "the Matrix of the Mind" in a book title. You can
think of containing simply as "processing" in a complex
human way if you like drawing from the therapist's capacities to receive
constructively all kinds of difficult inputs from the client. In fact
Ogden uses that synonym as do others.
In part,
"Under optimal circumstances, the recipient "contains"
(Bion, 1962a) or "processes" (i.e., handles maturely) the
evoked feelings and ideas, and thus makes available for reinternalization
by the projector, a more manageable and integrable version of that
which had been projected." (p. 145 of Matrix of the Mind.)
Now that, with the womb stuff and all that may be provoked by this
kind of talk should lead to plenty to contain, excuse me, process,
handle maturely. Jack Berkley.
Sun, 03 Sep 2000, George Stricker
- Tullio Carere wrote:
- > But if what seems to me a way
- > seems to you a blind alley, please don't hesitate to make
me know. I may
- > still be a victim of Bion's dark charm, without knowing it.
In this case I
- > am the one who need enlightenment.
Dear Tullio, I often am in agreement with many of your conclusions,
but I am not certain I see how Bion (or Lacan) help you to get there.
I guess one person's light can be another's blind alley - I wouldn't
presume to tell you not to attend to anyone you find helpful, but
I for one, get very little from either. George.
Sun, 3 Sep 2000, George Stricker
Dear Jack, having received several messages from you, some to the
list and others not, I'm not quite sure what others have seen and
what they have not. In any case, you thought of projective identification
as a valuable concept and also thought that my concern was with some
practitioners rather than the concept itself. Perhaps.
Perhaps you also can explain how anything of value in projective
identification goes beyond the concept of empathy, which doesn't encourage
the misuse that concerns me. George.
Mon, 4 Sep 2000, Hilde Rapp
Hello all, most of us can probably
relate to the concept of someone's being 'self contained' - in the
many senses intimated by Jack. The wish for 'enlightenment' in the conceptual darkness
holds some clue to the nature of the bafflement evinced by George
and Paul:
The body (!) of literature spawned by Bion's work
- and the predominant predicament of those to whose 'treatment' his
concepts may be applied with profit - relates to a different information
processing system from the visual: the kinesthetic. It is to do with
feel: texture, skin sensation and contour, sensuality, shape, form,
Bollas' 'first aesthetic', rythms, postures and positions, balance,
temperature, equilibrium, bodily containment- hence the 'second skin
formation' of Esther Bick, or Didier Anzieu's 'ego skin', Frances
Tustin's 'autistic shapes': it is to do with the Harlow's deprived
monkey- wire mother syndrome- no sense of being 'cradled criss cross'
in a loving mother's arms, who not only coos to the child, has loving
feelings towards the child but also holds the child in her mind with
what Winnicott has described as 'primary maternal pre-occupation'-
failure of all this, so much recent research suggests, leads to difficulties
in developing a 'theory of mind'- the ability to hold the wishes,
beliefs and motives of others in mind in order to develop empathic
human understanding-... and of course that 'negative capability '
Keats first described in his Christmas letter to his brother George,
which is actually the hallmark of all good integrative psychotherapists
( so Carlos Mirapeix agrees with me).
Now, this body of literature may be the door through which you Bion
skeptics may find it attractive to pass:
Peter Fonagy, Peter Hobson - good research based, elegant English,
grounded in developmental psychopathology - relating to attachment
and its failures, the effects of maternal depression, the effect of
lack of proper empathy on the mother's part (lack of holding and containment
of impulsivity in later life) etc. etc... Hilde
P.S.: There is a previous debate which struggled with what can be
said in plain English and what can only be hinted at darkly: it raged
between the Kabbalists and the Humanists in 14 century Italy. I think-
overall SEPI-ites tend to side with the humanists- some- I am certain-are
bilingual. Many analysts would side with the Kabbalists- indeed Freud's
technical writings were originally excluded from publication on grounds
of containing information best reserved for use by initiates...
Mon, 4 Sep 2000, Paolo Migone
I have to say that I sympathize with Paul Wachtel's difficulty in
understanding Bion (see his mail of Sept. 1, 2000). Since Bion has
gained a lot of importance in the psychoanalytic community (especially
in my country), in a study group that Tullio knows well years ago
I invited an expert on Bion (a philosopher who wrote a book on Bion)
who gave us some seminars on this author. I have to say that still
I was not able to be hooked very much by Bion, also because of his
difficult language, which to me is already a put-off, if not a symptom,
because I have always thought that language must be clear in order
to be able to contain valid ideas.
Still, I appreciated several things by Bion, for example his re-elaboration
of the concept of projective identification (that I used in my article
on Contemporary Psychoanalysis, 1995/4, about the bridge between
projective identification and Expressed Emotion [EE] - an effort at
psychotherapy integration that Paul Wachtel, if I am not mistaken,
knows well and used for his students).
At any rate, I had always a difficulty in understanding Bion's peculiar
leap between "mystics" and "science", but I may
be simply ignorant. Also, we should not forget that Bion had four
very different areas of interest in his life: groups dynamics, thought
functioning, psychoanalysis as science, psychic growth in analytic
treatment.
Tullio says that "In the Freudian theory there is no Unknown
(as unknowable), there is only an Unconscious (that can be made conscious)",
but from what I understood from Freud, he believed that reality (internal
as well as external) by definition is always unknowable. What we succeed
in knowing is never the reality per se, which is unreachable. But,
again, I might have not understood what Bion meant to this regard.
Concerning the famous dictum by Bion "Without memory and desire
etc.", I find it paradoxical, on the one and, and obvious in
what it tries to mean clinically, on the other. My gut feeling, for
which I have no evidence of course, is that the fact that Bion has
become very fashionable today in psychoanalysis is related to the
crisis of psychoanalysis, I mean that it is an expression of the confusion
in our field. Paolo Migone.
Mon, 4 Sep 2000, Rebecca Curtis
I find the discussion about the idea of a therapist as a '"container"
so stimulating that I'll put off my end-of-the summer (it is the "Labor
Day" holiday for those of us in the US) swim and the bike ride
I've been looking forward to for two months to comment. Let me say
first, though, that I am upset, as is George, about the way the concept
of projective identification is used to blame the patient and to allow
therapists not to. take responsibility for their own feelings which
very well may be simply their own. There was a paper presented at
SPR last year (I'll have to check on the author's name) showing that
therapists' reactions to patients (transcripts) varied enormously
and revealed consistency within each therapist, but not consistent
reactions to particular patients across therapists.
But back to Bion. First, his book Experiences in Groups is quite
readable, unlike some of his other writings. I found it helpful knowing
he was from India. The view of consciousness is very different to
begin with. An undergraduate of mine newly arrived from India began
a paper by stating "Before consciousness was fragmented into
a million different pieces. . . " as if this were accepted fact.
So there is not the beginning with an individual notion of consciousness.
Still, I would like it if someone could help me appreciate Bion more.
I have not assimilated anything from all of his formulas or diagrams.
I think the concept of containing and holding is interesting, but
I'm happy Paul has raised a question about it. Doesn't the concept
refer to the therapist or parent not getting anxious? We feel safe
and "held" when in the presence of someone who is not anxious,
or anxious yet conveying a sense of coping.
As for Lacan, his view of unconscious processes is too language-based
for me. Not being a very verbally dominated thinker, it doesn't resonate
with me. But many people view the world through language more than
I do. I also react very negatively to the centrality of the phallus
for Lacan. Other symbols seem just as important to me. But perhaps
someone could help me appreciate and use in my work his ideas about
the Imaginary.
Well, my computer is being packed up to return to New York City,
so I look forward to more exchange about these ideas tomorrow. Rebecca
Curtis.
Mon, 4 Sep 2000, Paul Wachtel
Tullio, I'm still confused! (and still very much in accord with George's
message, which came just before Tullio's on the list serve). Yes,
I understand very well the need for the kinds of clinical operations
you have described, the ways in which maternal deprivation affects
people and so on (though I do have some questions about whether we
too readily assume maternal deprivation whenever we see severe psychopathology;
clearly *something* went seriously wrong, but any notions about what
happened between mother and infant in the first year or two is likely
to be *very* inferential, and strongly a product of theory rather
than real observation {even if it may well be good and accurate theory
if we had the vantage point of God and could really know for sure}).
But the main thing is: How does "containment" capture what
you are describing. How does the "corrective emotional experience"
become relational "containment"? It's not that I think "containment"
is necessarily *wrong*. It's that it is *unclear.* What *you* mean
by containment may well refer to something useful. But you can't define
containment by saying containment is when you contain. You have to
describe what is *meant* by containment, and when you do, I think
(a) it becomes a lot clearer than saying "contain," (b)
a lot less likely to be misunderstood because of it odd usage and
unfortunate concreteness, and (c) less likely to be used as a cliche,
as it seems to be all the time among my students and colleagues.
So I guess my response, Tullio, is that I like what you do and what
you describe, but how in the world is this well described as "containment?".
I await with interest the next round of our friendly debate. Paul.
Mon, 4 Sep 2000, Paul Wachtel
Jack, perhaps I'm just not educable! I agree strongly with the idea
that the therapist should not act out, should process the input, etc.
But what does this have to do with the container image. The therapist
doesn't "contain" it, he works on it. And he doesn't put
it back into the patient in more worked through form after he has
chewed on it in his own internal space. He *communicates* something,
which the patient then deals with in whatever fashion he can at that
point (hopefully, in a better fashion than before by virtue of that
communication -- and others, and the relationship). If Bionites are
saying "yes, that's what we mean" then, OK, I agree with
them on such points but not on whether their language is a good way
to describe it. If it's NOT what they mean, then what else is "container"
adding? Paul.
Mon, 4 Sep 2000, Paul Wachtel
Jack, here I am very much in accord with what you are describing
(Paul, I did not know Bion was catching on
). My objection is
not with the *clinical phenomena* that concepts such as projective
identification refer to. It is precisely with the arcane way -- nicely
depicted by you in your message -- that so many of the proponents
talk about it.
Some ways of talking about a phenomenon promote clear thinking and
lead to still further insights about the phenomenon, and some lead
to cultish or superficial mouthings and DO NOT promote still further
clarity. Instead, they maintain themselves by pointing again to the
very phenomenon, as if the critic hasn't seen the phenomenon when
in fact, much of the time, the critic (at least this critic) is not
overlooking the phenomenon at all but saying instead that there are
more productive ways to conceptualize and discuss it.
Maybe it's time for the container to be recycled. But at least it
has had the value of filling itself up with interesting exchanges
amongst us. Paul.
Mon, 4 Sep 2000, Jack Berkley
- In a message dated 9/4/00, Paul Wachtel writes:
- <<Jack, perhaps I'm just not educable! I agree strongly
with the idea that the therapist should not act out, should process
the input, etc. But what does this have to do with the container
image. The therapist doesn't "contain" it, he works on
it. And he doesn't put it back into the patient in more worked thru
form after he has chewed on it in his own internal space. He *communicates*
something, which the patient then deals with in whatever fashion
he can at that point (hopefully, in a better fashion than before
by virtue of that communication -- and others, and the relationship).
If Bionites are saying "yes, that's what we mean" then,
OK, I agree with them on such points>>
Jack: Paul - Yes I think you are on track even though the language
is not your tea. Remember to substitute 'respond maturely' or 'process'
for contain and you'll be fine. You won't experience some of the poetic
substance and the meanings they stimulate, but you are not looking
for that. Social science language in general doesnt stimulate a lot
in me, but I appreciate its value.
- <<but not on whether their language is a good way to describe
it. If it's NOT what they mean, then what else is "container"
adding?>>
- Jack: I think here you depart from your principal stance that
if a language means something to an intelligent thinker then so
be it. It is not a question of whether a term is "a good way
to describe." It is whether the term communicates and assists
practitioners. We don't have to buy and plant the same botanical
species, we don't have to like the same rivers and mountains, but
we're all working constructively on the environment.
I think what's frustrating to many is that the language is metaphorical
and we all don't respond to the same poetry. By the way I do not count
myself as a Bionite; speaking of terms I m unfamiliar with that one.
It reminds me of Columbus calling Native Americans, Indians. I think
of myself as a Berkley or Berkleyian, and you as a Wachtellian. Remember
'process' and 'respond maturely' for contain. Peace, Jack.
Mon, 4 Sep 2000, Jack Berkley
Paul, this is Jack, the end of your response caused me to laugh aloud;
my responses are contained by (interspersed within) yours below:
- In a message dated 9/4/00, Paul Wachtel writes:
- << Jack, here I am very much in accord with what you are
describing. My objection is not with the *clinical phenomena* that
concepts such as projective identification refers to. It is precisely
with the arcane way -- nicely depicted by you in your message --
that so many of the proponents talk about it.>>
Yes. I think it is a defensive/aggressive
alliance. Many groups lean or tend to use their language both to communicate
within their group and erect boundaries between their group and others'
groups. I think of it as a characteristic of human groups. In this
instance, I have wondered whether the language is a defense against
anticipated attack from members of the empiricist religion. If you
cant understand the concept, cloaked in arcane garb, you cant attack
it without looking a bit dense when the defender counterattacks. Also,
it does give a feeling of specialness or group belonging when one
speaks a language others dont quite get, right? So it speaks to a
need to have a group identity and feel special, I think. It worked
that way for me to an extent. I'm just more given to the integrationist
goal now, which is still special enough, n'est pas? Now, I
am not attacking Bion people on this count. I think i see defensiveness
in many professional languages as well as enhanced communication among
its members. And the term
is helpful to some. I found it helpful. I also am disturbed by the
misuse.
- <<Some ways of talking about a phenomenon promote clear
thinking and lead to still further insights about the phenomenon,
and some lead to cultish or superficial mouthings and DO NOT promote
still further clarity. Instead, they maintain themselves by pointing
again to the very phenomenon, as if the critic hasn't seen the phenomenon
when in fact, much of the time, the critic (at least this critic)
is not overlooking the phenomenon at all but saying instead that
there are more productive ways to conceptualize and discuss it.>>
- Well, yes to a milder form
of the the idea of cultish mouthings, but i think that cult is too
strong or emotionaly loaded a term. I think the people you seem
to be describing are behaving arrogantly and defensively to the
point of offense, like the best defense is a good offense. Language
has that dual capability I think.
In fact you are getting me curious. not that I expect an answer,
but who are these people and why are they giving you such a difficult
time? That to me is a constructive focus. Perhaps they fear your
capacity to understand and translate their concepts in an integrative
way; perhaps to them translation is akin to theft. Like religious
groups who fear that if you take their picture you'll take their
soul.
-
- <<Maybe it's time for the container to be recycled. But
at least it has had the value of filling itself up with interesting
exchanges amongst us. Paul >>
- This is what made me laugh aloud. the use of 'recycle' with container
makes me think of a washing machine. Perhaps we should hang these
clothes in the sun , let them dry and see if they got clean.
Mon, 4 Sep 2000, Jack Berkley
George, all my posts are intended for list consumption. It has been
a while since i engaged a discussion on any list and I depressed the
reply button without adding the list on some messages.
Well, my question to you--before i answer you--was what about the
concept itself do you feel "encourages" destructive behavior
by therapists, i.e., client blaming etc. I mean, do you think the
term or concept itself has an influence on otherwise well balanced
practitioners? I guess in a way it could more easily lend itself to
misuse than others, like empathy as you note, but I still think it
is more of a problem with people rather than the idea. I concede that
empathy by definition restricts the student of the concept to compassionate
meanings, whereas, Projective Identification is not so restrictive.
However, the term is broader.
Now to your question: "Perhaps
you also can explain how anything of value in projective identification
goes beyond the concept of empathy, which doesn't encourage the misuse
that concerns me." First, I would say that the concept of projective
identification--pardon me again--contains the concept of empathy,
and includes other meanings in addition to empathy. Empathy is a form of projective identification,
which as recall is fairly well described in Ogden's 1982 book "Projective
Identification and Psychotherapeutic Technique."
Now you asked what does Projective Identification provide beyond
the term of empathy. If you restrict the use of Projective Identification
to empathy i think it is essentially the same and it could be argued
that for many students it does not add anything of value. For others
though, it does add something because it expands the empathy process
and describes it more fully than the use of empathy usually does,
usually. Essentially though, the issue is whether you or I are capable
of empathy and whether we employ it to good effect. From that perspective
the use of it, not the selection or promotion of a term is key. I
would advocate for both terms in teaching, but only if you can empathize
with those who find value in it. I'm serious. I think we have to value
the people or their experience in order to respect and understand
their language.
If you do not restrict the term to empathy, I think
it is clear that it has many other very constructive uses. One can
projectively identify good aspects as well as destructive ones for
starters. One can project his own honor or integrity into another
(figurative use here) for safe keeping.
There are many other uses. I like Racker's "Transference and
countertransference" and Ogden's 1982 book among various
articles. Jack.
Mon, 4 Sep 2000, George Stricker
- Dear Jack, I'd like to insert some of my responses within yours
for greater clarity. You wrote:
- > Well, my question to you--before i answer you--was what about
the concept
- > itself do you feel "encourages" destructive behavior
by therapists, i.e. client
- > blaming etc. I mean, do you think the term or concept itself
has an
- > influence on otherwise well balanced practitioners? I guess
in a way it
- > could more easily lend itself to misuse than others, like
empathy as you
- > note, but I still think it is more of a problem with people
rather than the
- > idea. I concede that empathy by definition restricts the
student of the
- > concept to compassionate meanings, whereas, Projective Identification
- > is not so restrictive. However, the term is broader.
The idea that Projective Identification involves an unconscious communication
that reaches the therapist in an irresistible way, and the therapist
then responds unconsciously to this communication, is what I object
to. It is part of our job, after all, to help the patient to make
the unconscious conscious, and in order to do so, to be aware of our
own unconscious influences on the process. To the extent that Projective
Identification occurs beyond anyone's awareness, the therapist is
left saying "the devil made me do it" rather than taking
responsibility for his or her own lack of awareness
of the process. I don't dispute that such things happen - my concern
is that giving them the label serves to sanction them.
[Regarding other passages of your mail] I
still am at a loss as to what those other meanings are/ I'm
well aware that empathy usually is included within Projective Identification.
I still don't know what else, that is of value, is.
Mon, 4 Sep 2000, Jack Berkley
George, good idea to intersperse. I see now why you conclude that
the concept itself leads you to dislike the concept for encouraging
abuse. We however part ways on your definition and description of
Projective Identification, and if my understanding were the same as
yours, then i would of course agree. We don't seem therefore to disagree
on anything, except perhaps how to define Projective Identification.
First I am not sure what you mean by an unconscious process reaching
the therapist in an "irresistible way." I do not doubt that
you gleaned this from someone reputable, but it does not contribute
to the understanding of Projective Identification and I don't recall
it from my learning about Projective Identification, at least not
as an essential feature, absolute feature. At times I suppose it could
be described as irresistible, but I fail to see the utility of the
word irresistible. I have trouble with it and suggest it be jettisoned
regardless of its source unless the context is different than the
one used here.
Second, more importantly, I could not agree more with the task of
making the Projective Identification process conscious. This is done
via interpretation, etc. George I cannot imagine any proponent of
Projective Identification taking issue with this. To employ the concept
as a rationalization for irresponsibility is far out of bounds. I
can't seriously think of anyone I know who employs the term as describing
an unalterable preordained event. Were it employed this way, I would
agree with you; in fact any time it is used this way, I agree fervently
that it is a malevolent event. (yes, all kinds of things occur outside
awareness, but that is an observation, not a plan, not an acceptable
approach).
To me the term militates against
letting it be unconscious. By identifying that it happens, and naming
it, the task is to discover it in the immediacy of the therapy hour,
and promote understanding, conscious processing of it.
(If I need to say, no one would / should attempt to communicate this
using Kleinian language). The term, as I was taught it within A.K.
Rice and the Washington School family therapy program, exists to encourage
its conscious processing. I do think tough one must be taught this
in live moments and in supervision. I am discouraged from thinking
the term can really be internalized and employed based on book learning.
It is a skill to experience and identify the process, not just an
idea on pages.
In sum, as you describe it, yes, I agree, it is a foul, unthinking
beast. We are talking about completely different concepts and completely
different users of the concept. I suggest that the concept and application
you describe is very unflattering to caring, thoughtful people/therapists.
It is inimical to responsible work. Why would anyone take what you
describe seriously? No wonder you are upset. I hope you do not associate
such practice and thinking with me. I hope no one does. Sincerely,
Jack.
Mon, 4 Sep 2000, George Stricker
Dear Jack, if the confusion about the definition of Projective Identification
is now cleared up, and I believe we have come to a point of agreement
in that you don't like what I don't like about it either, we still
are apart on my understanding what you do like about it. What is different
and more than empathy about the concept? George.
Mon, 4 Sep 2000, Jack Berkley
- George, I'm responding to your response below:
- <<I still am at a loss as to what those other meanings are/
I'm well aware that empathy usually is included within Projective
Identification. I still don't know what else, that is of value,
is.>>
George, well I said in my last post that one could project good objects
as well, such as in idealization, except that Projective Identification
would invite further analysis of what in the projector is projected
and the proper use would necessitate an analysis of what aspects of
the recipient resonate with the idealizing behavioral influencing
process. This has application in therapy obviously; it goes beyond
simply saying someone idealizes their therapist. The concept and practical
employment of it invites the therapist to identify his/her internal
objects that are activated in response to the projector's behavior.
And to analyze/understand what is occurring within the client. Now,
anyone can do this without the term Projective Identification. Its
not necessary. But as i have learned and employed it, the concept
helps orient my thinking about such processes. The fruit is in the
further actual applied analysis of the Projective Identification.
The term is merely an aid to examine preconscious and unconscious
interpersonal influencing, feelings, self aspects, underlying beliefs,
etc. Did you read my posts to Paul?
The Projective Identification term includes so many intrapsychic-interpersonal
experiences that I am hard pressed to know George how to select examples
that you would find useful. Also, to be frank, since you have already
called the concept "noxious" and seem fairly convinced that
it is used to "blame" patients for therapist ills, I feel
uncomfortable and think we may be at cross purposes here. I fear I
run the risk of repeatedly offering you examples and not constructing
an example that is particularly meaningful to you because I do not
know you well enough to find such an example. Also, is that what you
want anyway?
1. I mean if the purpose of this discussion is for me to attempt
to convince you that you ought to like Projective Identification as
a concept when you've already concluded it is "noxious"
and is employed malevolently, I can end that here. I'm sure you have
done swimmingly well without the concept and i and others have done
well with it. Nothing strange there.
2. If the goal is for you to reify
your objections to the term as noxious and inimical to patients with
each effort to explain it, I defer to a more energetic proponent with
a stronger desire to convince you. Id have to know that you wanted
to meet me half way on this. I'm not sure you're interested.
I lean toward thinking you're
not, are you? I'm sincere, I'm not certain where you are situated
attitudinally in this discussion.
3. If your goal is to learn Projective Identification from the point
of view of someone who finds it useful because you want to experience
its value as they do, that is, an empathic joining on the concept,
then I am interested. However, i need more help from you. For instance,
what other kinds of uses would be useful to you? How do you understand
the term now other than the noxious meanings? Do you have any understanding
of the term that is benign or constructive?
Please answer those questions so I know my audience as it were. Give
me a ball park to play in, otherwise I just dont know where to begin.
Do you have a case, an example, anything? I think that would be more
useful than my generating a list of examples in the hopes that I luck
out and become helpful to you. Also, it would help to know what you
have read so far.
My task so far has been to assert that Projective Identification
and Containment are useful to me and many others who are responsible
therapists and perhaps clarify that the understanding of the term
that some folks have would lead any reasonable person to reject it,
me included. Your criticisms are well taken, but they hit the wrong
concept and wrong use as my experience and training define and employ
it. We're just not talking about the same concept or the same use
of it based on what you've said so far.
Again, I like Racker's 1960 book "Transference and Countertransference"
and Ogden's 1982 book "Projective identification and Therapeutic
Technique" among various articles; have you read Ogden's
book? You'd only need to read two or three chapters to revise the
description of Projective Identification you have given so far. Jack.
Mon, 4 Sep 2000, George Stricker
Dear Jack, I have read Ogden, and several others, and always have
been struck by how different writers use different definitions, making
it easy for any criticism to be met by "That is not what I meant
at all." I appreciate how hard you are working to get across
your meaning, but I'm afraid that everything that you find useful
(e.g., exploring one's own contribution to an idealizing process)
is something that I do without invoking the concept. If it works for
you, fine, and you seem to use it in a constructive way. It doesn't
work for me, and I'm not sure there is much profit to be gained in
belaboring it much further. George.
Mon, 4 Sep 2000, Jack Berkley
- Dear George, my responses
are interspersed: In
a message dated 9/4/00, George Stricker writes:
- << Dear Jack, if the confusion about the definition of Projective
Identification is now cleared up, and I believe we have come to
a point of agreement in that you don't like what I don't like about
it either,>>
Except George you describe a concept that contains noxious elements
and these aspect that you attribute to the concept are alien to me
and those from whom I have learned and with whom I communicate with
the term. I agree that the noxious aspects that you add to the term
are noxious. I just don't agree its part of the concept.
- <<we still are apart on my understanding what you do like
about it. What is different and more than empathy about the concept?
George>>
- I guess we'll have to leave it there, for now any way. I tried
and would need more from you to go further as I said before. Sorry
we couldn't work this out, for now.
Mon, 4 Sep 2000, Jack Berkley
- Dear George, in a message dated 9/4/00, George Stricker writes:
- << Dear Jack, I have read Ogden, and several others, and
always have been struck by how different writers use different definitions,>>
There are different definitions, and this term is not alone in having
multiple definitions in psychology. Its not as bad as existentialism,
but it is diverse.
- <<making it easy for any criticism to be met by "That
is not what I meant at all.">>
- Well the way you put it, it does make efforts to differentiate
the definitions sound like immature defense. Ogden does not define
Projective Identification with the characteristics you attribute
to it or describe its use the way you do. I still don't know who
does. You haven't said.
-
- <<I appreciate how hard you are working to get across your
meaning, but I'm afraid that everything that you find useful (e.g.,
exploring one's own contribution to an idealizing process) is something
that I do without invoking the concept.>>
- I have been too wordy I think. but I said a few times that yes
you don't need the concept. I have never said otherwise. I thought
I have been very clear about that.
-
- <<If it works for you, fine, and you seem to use it in a
constructive way. It doesn't work for me, and I'm not sure there
is much profit to be gained in belaboring it much further. George>>
- Yes that is what i was questioning in my last post. I think you
are resolved with you view of Projective Identification concept
as noxious, and i am happy relinquishing the effort to convince
you otherwise. It is just a conceptual tool. I am glad you afford
me the position of someone who at least seems to use the concept
to good compassionate purpose. I do. I am sorry that you have run
into such misguided and destructive persons who misuse the concept
they way you described: to blame patients, avoid responsibility,
and avoid processing unconscious material. That's not Ogden, me,
or anyone I can name who understands its use. Jack.
Tue, 5 Sep 2000, Paolo Migone
- On 04/09/2000, Paul Wachtel wrote:
- >Re Paolo Migone's recent posting on the listserve:
- >I do indeed know Paolo's paper on projective identification
and expressed
- >emotion, and I strongly recommend it to those on this list
serve who share
- >both my interest in psychoanalytic ideas and my confusion/annoyance
re
- >Bion's language. Paolo's paper is the single most clearly
articulated
- >exploration of the concept of projective identification that
I have come
- >across. It is precisely the sort of clarifying rather than
obscuring kind
- >of writing that I wish were common around these issues.
Since Paul Wachtel said these
nice things on my paper, in case it might be of interest I send to
the list members the part of this paper (pp. 624-629) in which I talk
specifically of Projective Identification (see below).
I thank you for your attention and I apologize for the length of this
mail:
-----------
[From: Paolo Migone, Expressed Emotion and Projective Identification:
A bridge between psychiatric and psychoanalytic concepts? Contemporary
Psychoanalysis, 1995, 31, 4: 617-640 (pp. 624-629)]:
The concept of Projective Identification was originally formulated
by Melanie Klein in 1946, when she spoke of the projection of a part
of the subject onto the object, with whom the subject remains identified,
so that he exerts a "control" on him (or from "inside"
of him). When M. Klein had this clinical intuition and used this term
for the first time, she was somehow dissatisfied with it; subsequently
the concept was refined and further explored by many analysts (who,
incidentally, were working mostly with schizophrenic patients), to
the point that this concept became of central importance in Kleinian
thought. Currently, it is widely used also by non Kleinian analysts,
and many authors have shown its usefulness also for patients with
less severe forms of psychopathology. It can be regarded as a "bridge
concept" between classical and interpersonal psychoanalysis,
and a useful theoretical tool for understanding family dynamics (Zinner
& Shapiro, 1972). An in-depth discussion of this concept does
imply an adequate consideration of wider metapsychological problems
(for example the use of metaphors), and of the relationship between
this concept and other previous conceptualizations (such as the concept
of transference and countertransference). For this reason, only a
brief mention of its principal clinical aspects will be made here,
while I refer to other papers for a longer discussion of the underlying
theoretical problems (Migone, 1988b, 1989a, 1995a ch. 7). Since the
concept of Projective identification today is used in different ways,
and may encompass various clinical phenomena (Sandler, 1988), I will
use the schema suggested, among others, by Ogden (1979, 1982).
Ogden divides the clinical phenomena of projective identification
in three phases, which somehow overlap one another: (1) "projection,"
(2) "interpersonal pressure," and (3) "reinternalization."
(These three phases are not to be confused with the three historical
phases of the development of the concept of projective identification
described by Sandler [1988], even if there are some similarities.)
The three phases will be briefly described.
(1) First phase: "projection".
It is assumed that the person who uses projective identification
has first of all an unconscious need to get rid of a part of himself
and to project it onto someone else. Various reasons may explain why
a person needs to project. Kleinian authors use a metapsychological
(although concrete) jargon, and speak of bad parts of the self that
could be considered dangerous for the self, or, vice-versa, good parts
that could be in danger of being destroyed by the bad parts of the
self. These, then, need to be put into someone else in order to be
protected and kept safe. These explanations are scarcely testable,
although the concept of projection is commonly accepted as an explanation
of some clinical and social phenomena, such as scapegoating, for example.
At any rate, such metaphors may prove to be useful in understanding
complex clinical situations and overcoming some especially difficult
moments encountered in the course of a therapy. What is important
to know here is that this first phase alone does not yet involve the
use of the term projective identification; it involves simply the
concept of projection.
Projection can be conceived of as an intrapsychic phenomenon, not
necessarily affecting the object (the other person), who may be unaware
of being the target of projective identification. In this case, projection
may have defensive functions for the subject, who does not need to
concretely modify or "control" the object. For a more in-depth
discussion of the concept of projection, with its metapsychological
and clinical aspects, I refer to the classical discussions by authors
of the "Freudian" tradition, on the one hand (Freud, 1885,
1896, 1911, 1915, 1921, etc.; A. Freud, 1936; etc.), and of the "Kleinian"
tradition, on the other (M. Klein, 1930, 1931; Isaacs, 1948; Segal,
1973; etc.). The most interesting aspect of projective identification,
for our present discussion, concerns the second phase.
(2) Second phase: "interpersonal pressure".
This phase is the one most directly related to the psychiatric concept
of Expressed Emotion (EE) and to Greenley's concept of "High
Intensity Interpersonal Social Control." There are two main differences
between simple projection and projective identification. First, in
the latter situation the person must be involved in an actual interpersonal
relationship with another person, and not simply in a fantasized one.
(In a sense, using EE terminology, we might say that the length of
time spent in "face-to-face" interactions between the patient
and his relatives may increase the intensity of this phenomenon.).
Second, the person shows an interpersonal pressure, or control, to
make sure that the other behaves in a manner consistent with the feeling
that he has projected on him. Using Greenley's words, we might say
that the person exerts a "High Intensity Interpersonal Social
Control" because he needs the other to change his behavior.
Supposedly, if the other does not change his behavior, he comes to
represent a threat for the projector; therefore the projector continuously
needs, in subtle or open ways, to exert various kinds of pressure
to ensure that the person who received the projection really is the
person that the projector wanted him to be. In a way, we can also
conceive projective identification as a projection that has not been
completely successful, so that the projector needs to exert pressure
on the object to reassure himself of the success of this defensive
operation. It is for this reason that some authors (e.g., Kernberg,
1987) conceive projective identification as a primitive defense mechanism
(present mostly in borderline and psychotics), while projection is
considered to be a more mature and successful defense (present mostly
in neurotics). However, other authors (e.g., Meissner, 1988) reject
the distinction between projection and projective identification made
on the basis that the latter induces the object of the projection
to respond, claiming that "complementary pulls" are always
at work in all projections occurring within an interpersonal context.
Whether we accept this equation between projection and projective
identification or not, the presence of an interpersonal context for
phenomena such as "complementary pulls" must occur. In this
article I prefer to use the term projective identification, rather
than simply projection, because it is the one that has been the most
widely employed by those authors who have studied these complex interpersonal
phenomena.
The clinical phenomena considered as examples of this interaction
usually are intimate or close relationships, such as the mother-child
relationship or the patient-analyst relationship. In all these situations
there is some form of dependency of one person upon another, in some
cases because of physical or psychological needs of survival, similar
to those relationships studied in the framework of the "double
bind" concept (Bateson et al., 1956). Typically, a therapist
who "receives" a projective identification from a patient
may develop a new set of feelings, and only during later self-scrutiny
come to understand that they, so to speak, "belonged" to
the patient. Furthermore, since this process is unconscious and can
be very subtle, sometimes the therapist, in a way, may "become"
someone else.
Interpersonal transmission of
affect is well known in psychotherapy (as well as out of psychotherapy),
and this mutuality of emotional response was already illustrated long
ago by the simultaneous psychophysiological recordings of patient
and therapist (Greenblatt, 1959). For this phenomenon, Redl (1966)
suggested the term "contagion" of mood. Luborsky (1984,
pp. 137-139), discussing
this issue, says that there seems to be evidence that neither extremely
field-dependent therapists (who may be more apt to get caught up by
such contagion) nor highly field-independent therapists (who may be
too uninvolved and unable to form a warm relationship with the patient)
are helpful. He argues that moderately field-dependent therapists
may be more effective, and that alertness to the existence of this
phenomenon helps to preserve therapist's equanimity.
We may recall that Paula Heimann (1950), in her pioneering work on
countertransference, said that the feelings of the therapist are a
"creation" of the patient. Actually, long before Heimann's
contribution, it was Helene Deutsch who clearly anticipated the enlarged
view of countertransference in a paper, published in 1927, on "Occult
processes occurring during psychoanalysis." Indeed, some authors
have linked the concept of projective identification to phenomena
such as telepathy, folie à deux, Jung's concept of "psychic
infection," "Devil's possession," "evil eye,"
suggestion, hypnosis, and the like, all phenomena in which there is
a threat to personal identity and autonomy (Bilu, 1988; Bolko &
Merini, 1988, 1991; etc.).
The interest around the concept of projective identification started
with many analysts when they were working with extremely difficult
or regressed psychotic patients and felt very uncomfortable with them,
overly "controlled" or under pressure, or experienced a
new set of feelings that were difficult to index as "countertransference."
For them, it was more clinically useful (and possibly reassuring)
to believe that in those moments they were not reexperiencing an old
(and not well analyzed) aspect of themselves, but that a new and disturbing
feeling was simply "put into them" by these very sick patients.
This, in my opinion, is the origin of this concept, and it might explain
the increased need to change the old terminology "transference/countertransference"
into the new one, "projective identification/projective counteridentification"
(a term coined by Grinberg in 1957). Furthermore, studies focusing
on the concept of projective identification, which ran in parallel
to those concerned with a new "enlarged" view of countertransference
that started in the fifties (Heimann, 1950; etc), produced many interesting
clinical intuitions, such as the use of the analyst's own feelings
to know and understand the patient's unconscious, the concept of "evocation
of a proxy" (Wangh, 1962), "externalization" (Brodey,
1965), role "actualization" and "role-responsiveness"
in the transference (Sandler, 1976), the use of the patient's feelings
on the part of the analyst to know and understand (or even "supervise"
or "interpret") himself (Searles, 1975; Langs, 1978; Hoffman,
1983), etc.
(3) Third phase: "reinternalization".
This phase is related to treatment: if it does not occur, there is
no change in the patient's psychological functioning and consequently
he still needs to use projective identification. In this phase, through
the therapeutic interaction (and in a complex and not fully understood
way) the patient "reinternalizes" the part that was projected
into the therapist, because he is ready now to keep it inside of himself.
According to the various metaphorical explanations that have been
given to this phenomenon, the therapist must "digest" or
"metabolize" this dangerous part, and make it ready to be
later "digested" by the patient. In other words, during
the therapeutic interaction this projected part is transformed by
the therapist and made more manageable by the patient. This process
(with the concepts of "container," "contained,"
etc.) was first described by Bion (1962, 1963), who understood it
in a concrete way, and conceived that the child can reinternalize
the bad parts previously projected into the mother after she has transformed
them with her thought activity, i.e., her "rêverie." (We
can see here also an echo of the concepts of "holding" and
"good enough mother" of Winnicott, 1958.)
According to a nonmetapsychological explanation, and using a learning
model, the patient, in the course of the interaction with his therapist
who (maybe for months) tolerates the anxieties and fears that have
been projected into himself, learns how the analyst does it, learns
new skills or adaptive behaviors useful to cope with emotional stressors.
For example, the therapist may show the patient, often through his
own behavior rather than through verbal interpretation, that it is
indeed possible to tolerate stressful feelings (anxieties, fears,
depression, persecutory ideas, suicidal thoughts, etc.) and to survive.
Winnicott (1958), among others, said that an important therapeutic
experience consists in the therapist's surviving the patient's destructive
projections and provocations. The therapist may talk about these feelings,
and at times eventually even look at them with the instrument of irony.
The improvement may occur also because the fears or anxieties are
explained or interpreted - they are changed into something less dangerous
or stressful. Many authors, instead of emphasizing the cognitive change
through interpretation, underline that most often the improvement
occurs because the therapist simply does not "discharge"
again onto the patient the projected feeling, and keeps it inside
of himself. In fact, interpretation as such may often be experienced
by the patient as a discharge, and it is the emotional containment
on the therapist's side (silence, nondefensive attitude, etc.) that
breaks the vicious circle and teaches the patient that it is indeed
possible not to use projective identification as the only way of functioning.
(Incidentally, it is interesting to note that, even in these recent
investigations, many authors prefer to rely on concepts, such as "discharge,"
that remind us of the old metapsychological terminology of Freudian
drive theory)...
-----------
Tue, 5 Sep 2000, Bill Stiles
I've enjoyed the exchanges regarding
Bion, containers, and projective identification. I'm appending some
excerpts from a paper, partly because they suggest another way to
think about the phenomenon of projective identification and partly
to call attention to a published exchange between Anthony Ryle and
Mikael Leiman on this topic that helped me a great deal. My brief paper was a commentary on their exchange:
-----------
[From: William B. Stiles, Signs and voices: Joining a conversation
in progress. British Journal of Medical Psychology, 1997, 70:
169-176]:
With this paper, I am joining a conversation in this Journal between
Anthony Ryle and Mikael Leiman. In two exchanges, summarized later,
Ryle (1991, 1994) has proposed -- and Leiman (1992, 1994) has then
elaborated and refined -- ways to reconcile Cognitive Analytic Therapy
with Russian ideas about linguistics and semiotics, represented by
Vygotsky and the Bakhtin circle.
The Second Exchange: Projective Identification
Projective identification refers to the process by which people induce
their feelings in others, so that the others have those feelings and
may act on them. Roughly, if I feel your feelings and motives because
I want to, that is identification; if I feel your feelings and motives
because you want me to, that is projective identification.
Projective identification appears to be a primitive and powerful
process and perhaps an element of all social interaction. Of course,
it is possible to stir people to feeling and action intentionally
with words. But projective identification points more specifically
to doing this non-verbally and without awareness by either party.
Projective identification is common enough in therapy that experienced
therapists often expect to understand what their clients are experiencing
by attending to their own feelings.
Ryle (1994) suggested that projective identification can be understood
as an example of enacting reciprocal role procedures, as construed
within CAT. As part of learning to play each role in a relationship,
infants learn to induce the reciprocal role in others. Leiman (1994)
agreed, but took issue with the necessity for positing, as Ryle (1994)
did, that "biologically programmed attachment behaviours"
(Ryle apparently had Bowlby's, 1982, 1988, conceptions in mind) are
a common precursor to forming reciprocal role procedures and hence
to projective identification. By the same token, Leiman took issue
with Klein's (1946) attributing to the infant such implausibly complex
and seemingly bizarre fantasies as impulses to "suck dry, bite
up, scoop out and rob the mother's body of its good contents"
(p. 8). The theories' need to posit the biological programming or
the complex fantasies to the infant, Leiman (1994) suggested, reflect
a fallacious separation of infant from mother. The complex activity
emerges from the joint mother-infant system, rather than being intrinsic
to the infant. The activity simultaneously involves mother, infant,
and the signs they use to communicate.
In this synthesis, projective identification looks like a normal
part of interpersonal communication, or more precisely, of goal-directed
activity by an interpersonal system. Whereas Klein saw this breaching
of the mother-infant boundary as exceptional and pathological, Ryle
and Leiman saw it as normal, if primitive. Leiman's (1994) summary
was that projective identification is "a mode of primitive joint
action mediated by non-verbal signs" (p. 67) . This sounds not
so different from telling somebody else to do something for you, except
that it is done without being verbalized or brought into awareness,
so that the signs are harder to locate.
Projective Identification as Action Though Others
A complementary way of thinking about projective identification may
help make this more concrete. Projective identification may be a considered
as a way that voices [i.e., internal traces of previous problematic
experiences] use other people as effectors for their intentions.
We do not seem to need conscious mental representations of the mechanics
of action in order to act; we seem to be aware only -- at most --
of the action's anticipated sensory consequences (James, 1892).[footnote
1] When I move my hand, for example, I have no conscious awareness
of how I do this, other than anticipating the proprioceptive, visual,
and other effects of the movement.
We do not even seem require that the effectors be physically part
of our bodies, so long as the their contributions to the sensory consequences
of an action can be reliably anticipated. Thus, tools and machines
easily become extensions of our bodies. For example, when we have
become proficient drivers, we anticipate the effects (visual, proprioceptive,
etc.) of the car turning left, and this produces the necessary physiological
and mechanical adjustments in our arms and hands and in the car's
steering mechanism, respectively, all equally out of awareness.
By the same token, other people may become extensions of ourselves.
By inducing our feelings and motivations in them -- that is, by projective
identification -- we can accomplish our purposes and give expression
to our concerns. We need have no understanding or awareness of how
this is done, any more than we need to understand the physiology of
muscles to move our hands. Presumably, other people can be enlisted
by signs, including subtle or non-verbal signs, passed without awareness.
We can learn to use other people as effectors just as we learn to
use our bodies or our tools. The conversants (Ryle, Leiman, Vygotsky,
Klein) agree that elements of this occur very early in life, as infants
induce feelings in their care-givers. (...)
Insofar as the other is a participant, projective identification
is, by this account, joint action. Both parties to a dialogue simultaneously
use each other as extensions of each other, and the extension involves
not only physical actions, but also feelings and intentions. Each
party's intentions may recursively use the other as an effector by
the same means.
In such an interpersonal system, the distinction between actor and
acted upon breaks down, except as a linguistic convenience. Put another
way, the distinction between identification and projective identification
does not remain strict or sharp under close scrutiny.
This account is congruent with the usual understanding, that projective
identification is most notably a way of expressing problematic unsymbolized
experiences without realizing it (and hence, from some perspectives,
defensive). Put another way, projective identification describes a
means of expression for otherwise suppressed voices. The use of others
as effectors may not be confined to suppressed voices, but if the
suppressed voices do not have words to express themselves, their projective
identification seems particularly devious. They express themselves
by projective identification rather than in more explicit signs because
they are painful or problematic, denied a meaning bridge. At times
in therapy, the therapist may consciously experience more of the client's
problematic unsymbolized difficulties than does the client. The therapist
may be more aware of the difficult feelings, even though neither party
may know the content.
References
James W. (1892). Psychology: Briefer course.
New York: Henry Holt.
Leiman, M. (1992). The concept of sign in the work
of Vygotsky, Winnicott and Bakhtin: Further integration of object
relations theory and activity theory. British Journal of Medical
Psychology, 65, 209-221.
Leiman, M. (1994). Projective identification as early
joint action sequences: A Vygotskian addendum to the Procedural Sequence
Object Relations Model. British Journal of Medical Psychology,
67, 97-106.
Ryle, A. (1991). Object relations theory and activity
theory: A proposed link by way of the procedural sequence model. British
Journal of Medical Psychology, 64, 307-316.
Ryle, A. (1994). Projective identification: A particular
form of reciprocal role procedure. British Journal of Medical Psychology,
67, 107-114.
Footnote:
1. An earlier generation of psychologists used introspection
to describe the content of intention -- of the will to act. Bearing
in mind the cautions and difficulties attendant upon such evidence,
we can consider the result summarized by James (1892):
<<An anticipatory image, then, of the sensorial consequences
of movement, plus (on some occasions) the fiat that these consequences
shall become actual, is the only psychic state which introspection
lets us discern as the forerunner of our voluntary acts. There is
no coercive evidence of any feeling attached to the efferent discharge.>>
(p. 420)
James went on to conclude that the "fiat that
these consequences shall become actual" is simply the absence
of a contrary or inhibitory anticipation. The result of James's introspective
analysis thus appears to be that will (understood as the experiential
aspect of action, reflecting what is happening in the brain as the
body moves) consists of the anticipation of sensory consequences.
-----------
Tue, 5 Sep 2000, Bob Sollod
I know very little about Bion except for some reading I did many
years ago and have largely forgotten. A couple of years ago we were
having a retreat to sort out some departmental issues. One faculty
member said that she did not feel she could bring up certain issues
because we did not have a large enough "container" for them.
Some of my colleagues and I chatted and joked later about this metaphor:
Perhaps we could benefit from a trash can, toilet or garbage disposal,
or maybe we needed a stronger pressure cooker. We wondered aloud how
large a suitable container would be, where it would come from, etc,
etc, etc.
Now I know - thanks to the SEPI list, that this metaphor
is associated with an actual theory and theorist.
Is anything more meant by the container allusion than one's adequacy
or ability to handle a given topic? Best wishes, Bob Sollod.
Tue, 5 Sep 2000, Jennifer Hillman
Hello. I am new to the list serve, and hope that you will humor my
comments as a relatively new member of SEPI. I have found it helpful
to view projective identification through the lens of neuropsychology.
Recent research has suggested we can glean important information about
others through non-verbal communication, and that the right hemisphere
collects and culls this information. Because the left hemisphere,
rather than the left, is typically responsible for language, the right
hemisphere often has a difficult time relaying this collected information,
and sends it to the left hemisphere via sensations and "feelings"
which have been referred to as "gut feelings," and more
recently as intuition. In other words, I think projective identification
exists, but that it is based in reality (i.e., derived from observable,
non-verbal communication), and that it can be useful if examined and
processed, rather than acted upon. It also has been my experience
that projective identification occurs when a patient has experienced
a trauma, and is not sure whether they want to reveal the extent of
their pain or suffering. In a way, I think it represents an initial
test to see if the therapist can handle the patient's strong emotions,
and the therapist's own likely strong, countertransference. Hence,
I think of the ability of a therapist to manage strong affect in the
therapeutic relationship as the more literal version of Bion's "container."
With Regards, Jennifer Hillman.
Tue, 5 Sep 2000, Jack Berkley
Paul and Paolo, thanks for the paper; I did not have the energy to
locate and post one. I notice you cite Zinner and Shapiro. They were
two who taught me Projective Identification among others. I am convinced
by this exchange and previously, that Projective Identification has
to be taught in supervision during and immediately after live sessions
preferably with two way mirror work. It is best if the supervisor
conducts the sessions and allows the student to observe and then analyzes
the Projective Identification that occur during the session that the
student has observed. The supervisor can report his/her feelings,
perceptions, experience. There is the one-body two-body dichotomy
of Projective Identification, Klein representing the former. I think
Ogden offers a nice explanation, which you cite; I like your choice.
Jack.
Wed, 6 Sep 2000, Tullio Carere
Paul, firstly, I strongly agree on relying as much as possible on
real observation and not on theories. The concept of containment or
holding is useful to me not because I *assume* early maternal deprivation
(even if I do assume it), but because I *observe* in the session precise
signs of breaches in the "ego boundaries"--i.e., a prevalence
of evacuative versus elaborative behaviors (which can also be observed
in dreams: Grinberg, 1987), incapacity of tolerating minimal levels
of conflict and frustration, presence of stiff armors to protect a
tender core, and similar phenomena.
Secondly, I also agree that one cannot "define containment by
saying containment is when you contain". As a basic definition
I would give the following: The holding function of psychotherapy
(the maternal vertex of the field) is a set of actions and attitudes
inspired or derived by the bio-psychological prototypical container--the
womb. (Remember Freud, 1926: "between intrauterine life and first
childhood there is much more continuity than one would suspect, after
the striking cut of birth"). The womb has basically two functions:
it offers a protected environment where the child grows *by herself*,
and provides essential nutrients.
You ask why in the world we should
use "container" and related words to refer to operations
better described in terms of ordinary communication. My answer is
that there are people who cannot properly function outside a psychological
container. Either they evacuate thoughts and emotions, or they are
closed in their shells. In the first case the containing function
of the therapist is well described by Paolo in his excerpt: "Many
authors, instead of emphasizing
the cognitive change through interpretation, underline that most often
the improvement occurs because the therapist simply does not "discharge"
again onto the patient the projected feeling, and keeps it inside
of himself. In fact, interpretation as such may often be experienced
by the patient as a discharge, and it is the emotional containment
on the therapist's side (silence, nondefensive attitude, etc.) that
breaks the vicious circle and teaches the patient that it is indeed
possible not to use projective identification as the only way of functioning."
In the second case, the patient is implicitly or explicitly invited
to substitute the relation for his/her shell. Sometimes I find it
necessary to offer, as I said in my previous message, a bodily holding,
more often a mental holding is enough.
Many times I have the experience that I "pass the test"
if I can show them that I can accommodate them inside the space of
the relation. I don't have to do much: just be a "good enough"
container, i.e. strong enough as not to be damaged or seduced by them,
and patient enough as to respect the times of their self-healing,
without intruding or pressing them.
- Paul, I agree with you that all I have said could be rephrased
avoiding the words you dislike. But why? George wrote (20 May):
- >for character problems... I do think that we have a parenting
role
- >to play - I prefer the term reparenting, as that acknowledges
- >that the patient already has had a parenting experience, and
that may even
- >serve as an obstacle to our success. This reparenting often
takes the form of a
- >corrective emotional experience, which I see often as being
at the heart of good treatment.
Let me ask you a couple of questions. Do you agree with George that
many times we have a reparenting (maternal plus paternal) role to
play? Do you agree with Freud that the maternal role is very much
in continuity with the first container? If you have answered "yes"
to both questions, what is the problem in accepting that many times
we have to play the role of a container? Tullio.
Wed, 6 Sep 2000, Paul Wachtel
- Jennifer, welcome to SEPI and to the list serve. Glad to have
your contribution. I was struck that your description of Sep 5,
2000:
- "It also has been my experience that projective identification
occurs when a patient has experienced a trauma, and is not sure
whether they want to reveal the extent of their pain or suffering.
In a way, I think it represents an initial test to see if the therapist
can handle the patient's strong emotions, and the therapist's own
likely strong, countertransference.
- Hence, I think of the ability of a therapist to manage strong
affect in the therapeutic relationship as the more literal version
of Bion's "container."
is very reminiscent of Weiss & Sampson's views about the therapist
passing tests. Have you thought about it in those terms? And if so,
do you see Bion's notions as adding something additional? It's good
to have a neuropsychological perspective added to our mix. Paul.
Wed, 6 Sep 2000, Paul Wachtel
Tullio, I know we won't be able to REALLY talk this thru together
until we are once again sitting together on the same continent, with
the luxury to talk (and talk, and talk). But for now, let me respond
only to the final questions you posed. (I will print out Tullio's
entire message at the bottom for those who may be coming in in the
middle of this discussion. (I also made sure to write "containing"
in the subject section so that those of you who have had enough of
this topic could delete my message without reading it!)
You asked: Let me ask you a couple of questions. Do you agree with
George that many times we have a reparenting (maternal plus paternal)
role to play? Do you agree with Freud that the maternal role is very
much in continuity with the first container? If you have answered
"yes" to both questions, what is the problem in accepting
that many times we have to play the role of a container?
My answers: (a) I do think something LIKE reparenting is often an
important part of therapy, but therapy is also in crucial ways rather
different from parenting as well; (b) No, I actually don't think there
is much about psychotherapy that has any resemblances to being in
(or being) the womb, which may be part of why the container metaphor
continues to be one I personally do not find useful. It has had one
useful function for me, however -- to get me into interesting conversations
with a number of SEPI colleagues. Paul.
Wed, 6 Sep 2000, Hilde Rapp
Dear Bob, it is not so much that
'more' is meant by 'containment', but rather that the term has a more
technical meaning. It has become used loosely in the sense you indicate,
and, as this discussion shows, this does not seem to be helpful.
In the more technical sense, 'containment'
refers specifically to the ability of the mother of a very young infant-
and by extension and analogy- of ( usually) the psychoanalyst of a
very disturbed 'patient' -to remain calm and self contained in the
face of the baby's or the patient's extreme anxiety ( terror), ( murderous)
hate, ( extreme) frustration, and (violent) aggressive feelings and
behavioral intentions.
In the case of actual 'acting out' of these feelings, physical restraint
will become necessary- although- especially in work with disturbed
children- analysts and child therapists will often tolerate a certain
amount of physical violence without themselves exercising physical
restraint, but rather putting words to what they think is going on
for the child at the time, restating verbally what the therapeutic
boundaries are.
The predicament of the baby/patient
is that they do not at this point in time have the resources to tolerate
their own feelings. They do not have the resources to remain in touch
with what they feel without needing to defend themselves against the
psychic pain via either physical violence, or emotional shut down.
The therapeutic task is to help
them to find ways of tolerating frustration without hitting out or
damaging themselves, etc. and without shutting off their feelings.
The notion of 'container' is
meant to indicate that the mother ( caretaker) / analyst will allow
the baby/patient to 'project' some or all of these intolerable feelings
into them. This means simply that they initially accepting in a non
defensive manner the baby's/ patient's sincere but erroneous conviction
that it is the mother/analyst, and not themselves who are angry, hateful
or violent. Otto Kernberg has written much about all this and how
to work with such situations clinically- especially if the distortion
in the patient's perception of reality is of a nature which would
commonly be labeled as 'clinical paranoia'.
In this act of acceptance the mother/analyst helps to 'contain' (
keep in, rather than 'act out') some of the extreme feeling states.
I this way they help to contain the baby/ patient, emotionally, rather
in |