(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 the same way that a teacher, police officer or psychiatric nurse may contain a violent person by providing a physical means of restraint or safe keeping (containment).

The intention is always to protect the frightened or angry person from harming themselves or others. The whole point of psychoanalysis is to attempt to achieve the transformation of a physical activity into a symbolic activity. Language is the medium of choice to achieve this. We encourage people in our society to say that they are angry rather than to hit out. In order to achieve this, they must learn to 'contain' their angry feelings.

We all know that there is something we as therapists do which has to do with will power, self control, empathic understanding, professional poise, keeping time boundaries, physical/sexual/financial boundaries, and so forth. This, together with the capacity to put our perceptions and understanding into words in a warm, firm and respectful manner, is meant by the technical term 'containment'- that is, as I understand it and use it.

For Bion, and perhaps yourself, the spiritual dimension of being open to experiencing the presence of an Other as a 'containing' presence is also significant: Marion Milner, for instance has written a moving book called : 'In the Hands of the Living God'- which is a superb clinical account of the treatment of a borderline psychotic woman, which illustrates what is meant by 'containment' beautifully.

The person who facilitates this 'containment' has, it seems, unhelpfully, been described as a 'container'- and indeed- to follow on from your joke, actually a 'toilet-breast' by the controversial Kleinian analyst Donald Meltzer. Dealing with 'mad' states in therapy evidently can lead to a somewhat 'mad' use of language- perhaps a bit like the extremely black humor sometimes current amongst medical students. At the same time you might argue that the function of what we do, which we may choose to describe as 'being a container' for the patient's anxieties, is providing a symbolic equivalent for adults of what was ( more often was precisely not!, or was not experienced as having been!) previously provided by the mother's lap, her enfolding arms, her soothing voice, her breast and her love- or its substitutes or alternatives.

I am aware that there are many circumstances where a cruel neuropsychological condition such as autism, a mismatch in temperament, a breakdown in feeding and sleeping rhythms, or other factors internal to either child or parent lead to people needing psychological help. I am not reducing all adult 'psychopathology' to parental failures - adults can make bad life choices with disastrous outcomes even though they have had perfectly adequate childhoods... etc. - so no parent blaming and no reductionism intended!

We as therapists do get frightened, overwhelmed, confused, driven half mad in some of this work and we too need some coping mechanisms- bizarre vocabulary is one way of coping which is in keeping with our task: to symbolize what can be symbolized. We need to find ways of supporting and challenging one another in the ways indicated in some of these contributions to own up to our own vulnerabilities too so that we don't misperceive our clients' feeling states, behavioral signals and verbal communications and inappropriately defend ourselves against our own feelings of fear etc. I hope this takes us a step further in this dialogue and I apologize for spelling out the obvious in the search for clarity and dialogue. All best wishes, Hilde.

Wed, 6 Sep 2000, Paolo Migone 

On 06/09/2000, Paul Wachtel wrote that Jennifer Hillman's comment

>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.

I agree that Weiss & Sampson's theory could be another valuable explanation of a correct therapeutic handling of so called projective identifications. Also learning theory could be an explanation, maybe the simplest one. To this regard, and since many colleagues appreciated the posting of my article, I want to quote another passage of it, with added bibliography:

-----------

[From: Paolo Migone, Expressed Emotion and Projective Identification: A bridge between psychiatric and psychoanalytic concepts? Contemporary Psychoanalysis, 1995, 31, 4: 617-640 (pp. 632-633)]:

...The first comment is related to the well-known theory of psychotherapy of the "San Francisco Psychotherapy Research Group" led by Weiss and Sampson (Weiss, Sampson & the Mount Zion Psychotherapy Research Group, 1986; Weiss, 1993). According to this model, called "Control-Mastery Theory," the patient improves only if the therapist passes a "test" that the patient unconsciously asks him to pass. In the transference process, the patient repeats past relationships, and may induce the therapist to behave like previous transference figures. This theory, however, does not give emphasis to repetition compulsion or drive discharge, but highlights the patient's unconscious plan to test the therapist, in the patient's hope that the therapist will behave differently than was expected. An interesting aspect of this model is that it represents an autonomous theory of therapy, with few metapsychological concepts (Eagle, 1984, ch. 9; for a discussion of Control-Mastery Theory from the point of view of cognitive science, see Migone & Liotti, 1998). There are various kinds of tests, and some of them might be very similar to the tests that have to be passed by therapists when they are the target of a patient's projective identification. For example, as Ogden (1982, pp. 83-84) has also observed, if a patient realizes that his therapist is capable, after all, to "survive" or not feel too angry or depressed, despite the many attacks, criticisms, and depressive ideas the patient unconsciously throws onto him, he may feel relieved, and may start to believe that it is indeed possible to tolerate very disturbing feelings without being destroyed by them, or he may learn some adaptive skills from his therapist by unconsciously identifying with him, and so on.

References

Eagle M.N. (1984). Recent Developments in Psychoanalysis. A Critical Evaluation. New York: McGraw-Hill.

Migone P. & Liotti G. (1998). Psychoanalysis and cognitive-evolutionary psychology: an attempt at integration. International Journal of Psychoanalysis, 79, 6: 1071-1095. The paper, the Internet discussion, and the review by Paul Williams can be downloaded from the web site http://ijpa.org/archives1.htm. (A shorter version of this article, authored by Paolo Migone, was presented as an invited paper at the panel "Psychic reality and pathogenic beliefs: the patients' theories about themselves and the relational world", at the 39th Congress of the International Psychoanalytic Association, San Francisco, July 30-August 4, 1995).

Ogden T.H. (1982). Projective Identification and Psychotherapeutic Technique. New York: Aronson.

Weiss, J. (1993). How Psychotherapy Works. Process and Technique. New York: Guilford.

Weiss J., Sampson H. & the Mount Zion Psychotherapy Research Group (1986). The Psychoanalytic Process: Theory, Clinical Observation, and Empirical Research. New York: Guilford.

-----------

Wed, 6 Sep 2000, Tullio Carere 

Dear Hilde, I applaud your superb handling of the 'containment' issue in standard (non poetic) English. I endorse it word for word. I love poets who can speak and write non poetically, when this is the case. Tullio

Wed, 6 Sep 2000, Robert Rosenbaum 

I was reading & enjoying the discussion on projective identification, & noticed it focused almost entirely on the therapist-client interaction. I think it's worth remembering some of the roots of the concept lie in its function as a defense against affect (a point made by several contributors to the list). In my first year of training, I encountered an example which has struck with me as a pithy way of clarifying the process. I was seeing a patient in a high-security prison. It was Christmastime, and I commented how it must be difficult to be in prison at this time of year. He replied:

"Yeah, I've been feeling lonely lately....so I called my wife to cheer her up."

I find this poignant. This is a person who is struggling to relate and connect to others but having difficulties tolerating his own emotions, being a separate person and seeing others as whole human beings with their own feelings. Is it possible part of the therapeutic response to Projective Identification as therapists is not just as "containers" to hold or process the client's feelings, but simply with empathy knowing the client's pain, loneliness and groping toward relationship? That the therapeutic effect comes, once again, not so much from a technique (in this case, of "processing" or "metabolizing" emotions) but simply from the continued offer of relationship -real relationship as connected-but-separate beings -- even in the face of the difficulties the client tends to invoke? Bob

Thu, 7 Sep 2000, Bob Sollod 

Projective identification has some roots in imitation learning or "one-shot" learning. This means of learning involves seeing another do something and then imitating that person. This can be found in the animal kingdom as well (at least re mammals and birds). This is an important means of learning that fits into an evolutionary psychological model pretty well as it speeds and a facilitates learning that would otherwise be more time consuming if not impossible. Best wishes, Bob Sollod.

Thu, 07 Sep 2000, David Allen 

To all: I prefer the conceptualization of projective identification as an interpersonal process rather than an intrapsychic one. It can be thought of as a process by which individuals in a relationship attempt to induce one another to behave in ways that are consistent with their cognitive role relationship schemata. One could also look at it from a TA perspective in that individuals are naturally inclined to enlist others to help them act out their "script." Dave Allen.

Thu, 7 Sep 2000, George Stricker 

Dear Hilde, I know I don't have to tell you about Tony Ryle's work, which fits the description perfectly. I imagine you also are familiar with my writings with Jerry Gold, but I'll provide references if you wish them. Finally, watch for a forthcoming issue of Journal of Psychotherapy Integration, which will provide a special issue that Stan Messer and Jerry Gold put together on assimilative integration. George.

Fri, 8 Sep 2000, Tullio Carere 

Bob, yes, the "offer of relationship -real relationship as connected-but-separate beings -- even in the face of the difficulties the client tends to invoke" is what relational therapy (psychotherapy) is all about. It is correct, but too vague. A science of therapy (if you agree that there should be one) is to specify what sort of (real) relationship is suitable for what conditions. We relate quite differently to a person who says "I would like to understand why such small things upset me so much", and to another (obviously angry) who says "You are angry, I am not". In the two cases our response should be real and genuine (though not disdaining relational techniques, when appropriate), but different. Tullio.

Fri, 08 Sep 2000, Robert Rosenbaum 

Tullio, agreed in all aspects....except perhaps the science part; I think there is some different model we strive for -- neither science nor art, but with aspects of each -- which describes/defines/creates/predicts the therapy process. But more on this later. Bob.

Sun, 10 Sep 2000, Luca Panseri 

Dear Paul, I am Luca Panseri, an Italian psychotherapist. I'm moving my first steps in the psychotherapy integration field, and, of course, I view your work and your thought as a very important reference. I have just read your article: "Transference, Schema, and Assimilation: The Relevance of Piaget to the Psychoanalytic Theory of Transference" posted on the SEPI web page. I have appreciated it very much for the originality of your reflection and the interesting perspective it highlights. As Tullio writes in his last message on the SEPI list :"The concepts of assimilative and accommodative integration allow for a new understanding of the basic integrative processes".

Moreover, "these concepts may prove useful to evaluate the process of the discussions among integrative therapists". Then Tullio asks a question :"How much are the partecipants (to the SEPI discussion list) capable or willing to accommodate to their interlocutors' view, beyond just trying to assimilate them to their own"?

Paul, I would like to know your opinion because I think the above question is specially pertinent in the ongoing debate on Bion that you started. You began the discussion asking Hilde and others to indicate to you which, among Bion's ideas or observations, they thought were "really valuable". The answers that followed were very pregnant.

Hilde, through her evocative style, enlightened us on what the term 'containment' refers to and gave us lots of references in literature, showing how impressive the research in this field is.

Tullio noticed that Bion's thought is "a way to point the kinship the mother/child and the therapist/patient relationships" but above all that "Bion's decisive contribution is the introduction in the therapeutic field of the Kantian polarity phenomenon/noumenon, or knowledge/ unknown, or K/O".

Reading these contributions I felt happy to have colleagues of so profound learning and I appreciated SEPI mailing list for its formative function. To my surprise, you seemed dissatisfied instead. You have been repeating that the word 'containment' wasn't necessarily *wrong* but that it was *unclear* and often used as a useless cliché. You ended your last mail saying: "(the container metaphor) has had one useful function for me, however- to get me into interesting conversation with a number of SEPI colleagues".

At the end of this mail I would like to ask you if you think that a real dialogue unfolded during the discussion, that is : "has every participant been capable to accommodate to the interlocutors' view?" Paraphrasing the title of one of Bion's books : has every participant "learned from experience"? Or, was the debate only an "interesting conversation" with a prevalent assimilative feature in which every participant tried to assimilate the other to her/him own? Thank you very much for your attention. Luca Panseri.

Sun, 10 Sep 2000, Nancy McWilliams 

As an interested observer of the discussions going on in the SEPI list-serve, especially re: Bion and projective identification, I can't resist adding a couple of thoughts about individual differences, which is my own area of concentration.

First, I've noticed that therapists who are attracted to Bion (and to other writers, including Jung, who try to capture in metaphor the kinds of preverbal processes that are very resistant to secondary-process language description) tend to have a strong schizoid component in their personality, whereas those people who find such writers incomprehensible or obscurantist tend to have more obsessional styles. I'd be curious whether other people have noticed the same thing.

Second, it's interesting to me that it's Hilde who is the main explicator of the more impressionistic, metaphorical ways of describing psychotherapy, as I have also observed that women tend to be less either-or than men about whether they embrace the more preverbally resonant theorists. Eleanor Maccoby told me recently that one of the most robust sex differences has to do with cognitive bias (not her word, but I think that was the gist of what she was describing), namely that men are more likely to want to sharpen up differences and women are more likely to be automatically synthetic and integrative. The question was raised a while ago about why more women weren't active on the list or in SEPI generally, and I found myself wondering whether women aren't more naturally integrative and therefore not particularly drawn to conversations and controversies about whether and how to do it. Another idea that I'd be interested in people's thoughts about.

These conversations have been very stimulating, by the way, and although I've been a silent party to them, I've printed a number of them out because they were so beautifully explicated. Nancy McWilliams.

Sun, 10 Sep 2000, George Stricker 

We seem to be entering a new and interesting variant of this discussion. In response to Nancy, I would hesitate to diagnose others, but for me, I certainly think obsessional fits better than schizoid (and man better than woman). However, I also think I tend to see similarities more readily than differences, and to seek convergence, not only in psychotherapy but also in the science/practice debate. Putting the two dimensions together, though, I do strive for some intellectual basis for the convergence/integration rather than accept it as a given. This echoes a millennia-old debate in philosophy and religion about whether knowledge should be based on rational understanding or faith. Consistent with my wish for integration, I have thought that these are two different types of knowing and that we need not choose between them. However, if I was forced to choose, I clearly would opt for rational understanding. I also want to be clear that they are two different types of knowing, one is not superior to the other, but they are helpful for different purposes. This may lead into Luca‚s question about assimilation and accommodation.

I found the projective identification debate very helpful, and thought that the articles posted by Paolo Migone and Bill Stiles were very useful and well-done.

Hilde's explanation also was lucid and very helpful to me, as were Tullio's comments. Did it result in my changing my mind (accommodation)? Yes and no. Yes, I did get more of an appreciation of why people use such terms and what they mean to them, and expect that I may be less impatient with the language in the future. But no, it didn't lead to any more likelihood that I would use that language, or that my understanding of my own work was changed. And, like Paul, I did value the opportunity to exchange ideas with valued colleagues. George.

Sun, 10 Sep 2000, Paul Wachtel 

Dear Luca, thank you for your comments about my article and also for your effort to ensure that we all continue really not just to talk to each other but to listen. I understand your feeling that I have been resistant, so to speak, to what my colleagues say they value in Bion's work and in the idea of containment. I meant it when I said that I initiated this dialogue because I WANTED to find a way to understand and use ideas that colleagues I respect find useful. But at the same time, although that wish was a sincere one, I also have to be sincere about whether I have been persuaded -- or better yet, because persuasion isn't really the issue -- whether I have been able to CONNECT with what people are describing and advocating. I will keep trying, but so far I still have the feeling that people are saying that "if you agree that there are useful phenomena that we are describing, and if you have been in touch with your patients' deepest experiences as we have, then you must be saying you agree with the concept of containment." But for me, so far I would say that yes, I have seen the phenomena and yes I do THINK I have experienced the same kinds of deep connections, but no, talking about that as containment still doesn't feel -- for me, at least -- like a useful way to TALK ABOUT those experiences. I will continue to listen respectfully to what my colleagues have to say, and will continue to reflect on these issues, but thus far I still think there are better ways to talk and think about the phenomenon, and that it is not just a matter of aesthetics or personal preference, but of how different ways of thinking about lead one to behave clinically.

Perhaps we have reached the point in this dialogue where the next fruitful step will be not via the necessarily brief exchanges on this list serve and instead via a more extended exploration in symposia at forthcoming SEPI meetings, where there will be chance for more clinical illustrations and more back and forth immediate conversations.

Again, Luca, thank you for your comments about my paper and for participating in our dialogue. It is always welcome to be able to discover new voices in our exchange. Paul.

Mon, 11 Sep 2000, Bob Sollod 

Hi, Piaget has two main points that are of use in our work in psychotherapy. They apply equally to our understanding of the client or patient and of ourselves.

The first is the schema idea - with the associated concepts of assimilation and accommodation. What are our operative schema? To what extent are they fixed and to what extent to they change to adjust to the new reality of the client? Likewise for the client. To what extent are his/her schema (based on past learning) fixed and to what extent do they accommodate to new realities (including therapy itself)?

The second part of Piaget has to do with the quality or level of of the mind or of mental operations. Each schema is embedded in a matrix of other schemata and a certain level of mental functioning. Some therapeutic approaches have the consequence of helping the client move from a single perspective or an egocentric perspective to a more decentered perspective or awareness of many perspectives. This, à la Piaget, is considered a structural changes.

Interestingly, it is this type of cognitive development which SEPI itself often engenders in its members. It is precisely our own cognitive development in the area of psychotherapy and personality theory that is of interest and concern to many of use SEPI-ites. Not to mention the examination of our current schemata and the value of incorporating new ones (such as the controversial 'container') Best wishes, Bob Sollod.

Mon, 11 Sep 2000, Hilde Rapp 

Dear all, I had written a long message putting in context how Luca's question, Nancy's observation and Paul' answer. I agreed with George that there are different ways of kwow-'ing' as well as know-'ledge', and that these relate to specific and diverse needs for information about, understanding of and evaluating clinical phenomena.

I set out how these different ways of knowing are also grounded in fundamental values. I think, shared by most SEPI members is the humanistic commitment - so beautifully spelt out in Art Bohart's special issue ( see also Barry Duncan's work), to respecting the client's meaning system and to developing wherever possible and active partnership for insight and change with the client.

I discussed how - as Stan Messer and Mike Basseches have frequently pointed out- that certain assumptions more common amongst analysts- especially regarding developmental tasks and the analyst's special expertise in managing how the client might achieve these - could get in the way of that humanistic commitment.

I briefly described a compromise I have personally found which allows me to work in active partnership- prizing the client's capacity for self healing and self management, while at the same time providing acceptance of dependency needs which the client has not yet got the resources him or herself to manage in a mature way. I pointed towards ways of providing realistic balance between support and guidance and challenges to develop appropriate insights, adult coping strategies and more mature ways of relating to others.

I then re-described what Bion means by 'container' in a language which relates the analytic understanding of the phenomena to humanist approaches to working with them.

I then suggested tongue in cheek: It would require an exercise in Stan Messer's assimilative integration if Paul wanted to find a way of making use of Bion's theoretical concepts to inform his way of working without doing violence to the integrity of his own approach, but that there would have to be a clear need for such a concept identified by a well defined gap in Paul's current theoretical approach to meet the needs of specific clients.

I hazarded a guess that no such gap currently exists and that Paul's current repertoire is therefore not in need of adaptation. So it would only be intellectual curiosity competing with other opportunity costs which could motivate a continuing interest in Bion's work...

Alas- this was on the way to becoming a mini paper - I fear - and my email system, in collusion with my internal editor, wiped the whole message irretrievably. By way of a jeu d'esprit here is my reconstruction of the guts of the previous message ( please ignore change in font- I can't get rid of it. Cordially, Hilde.

Tue, 12 Sep 2000, Jim Lindsley 

I have enjoyed the discussion of projective identification, a process that has both puzzled and interested me and which has led me to the following thoughts. It has seemed to me that as social creatures we are constantly engaged in trying, with varying degrees of open directness/indirectness, conscious-awareness and its absence, to influence one another. For many reasons we wish to influence the behavior of others: to draw them closer to us or move them further away; to obtain their favor or other goods from them; to win their regard or to get their animosity; etc. We also engage in many acts to learn about others through the various "test" hypothesized by Weiss in the therapeutic relationship, as well as the tests of love, commitment, acceptance, etc., so common in personal relationships. We also act to bring out the best and worst in others out of our needs for them to be certain ways for us and for social comparison needs.

With regard to getting others to feel or behave badly, we might do it for reassurance that we aren't the only one who behaves so (e.g. seeking accomplices in crime or guilt so to speak); to feel superior to them (without it entailing necessarily a part of ourselves we wish to disavow); to upset them out of a punitive anger; to see how they manage such feelings (passive-into active tests); to manipulate their behavior for our own needs (e.g. to have reasons to end a relationship); in the hopes they don't behave badly after all (transference test); etc. Such a list of interpersonally influential goals and processes could easily be extended. As well it seems to me that we are often conscious when we do these things. But that is not my main purpose here.

Rather, in this context, I have a couple of concerns about an emphasis on projective identification. The first is that it may function as a kind of procrustean bed, preventing us from an appreciation of a much vaster range of interpersonal influential processes. The second is that it strikes me as one of the less common forms of interpersonal influence and, though it is likely my own fault not to have searched more diligently for them, I feel I am presented with few convincing examples of it in operation or of an explanation of the mechanisms by which one actually pulls it off.

Personally I would appreciate some convincing examples of Projective Identification differentiated from similar but different processes such as I have referred to above, along with the mechanisms by which it succeeds in influencing another; and as well thoughts about where Projective Identification fits into the more general context of interpersonal influential processes that I have referred to above. Jim Lindsley.

Wed, 13 Sep 2000, Hilde Rapp 

Jim, Yes: Most interpersonal phenomena such as Projective Identification can be redescribed as mutual cueing through words, gestures, postures, facial expression, tone, rhythm etc. - and I prefer to do this first off ( and have written various things to this effect). Academic research into mother infant relationships, social psychological work into body language etc gives us rich pickings here. NLP has described some of the micro processes in convincing detail. Etc.

And: Something else happens too which is more difficult to capture. Morphic fields, mass hysteria, trance states, state dependent perception and memory hypnotic induction and related phenomena and other sorts of altered states of consciousness are the sort of 'labels' under which much of this body of literature is collected- and we seem to have a dawning understanding of some of the neurophysiological and neurochemical processes which might serve as partial explanations for we observe.

And: Descriptions/experiences of witchcraft and sorcery as described in much of the literature from social anthropology is even harder to redescribe in ordinary scientific ways.

Projective Identification is probably a combination of all three types of phenomena, and we tend to circumscribe rather than describe, to use evocative language to 'point' in the sort of direction where the reader/ listener may be able to connect with some experience of their own. Imagine- remember- meeting a person you experienced as 'evil'- what do you mean by this- what made meeting this person make you feel - use imagery ( 'sensing'- focusing- a la Gendlin) concentrate on bodily sensations 9 hair pricking up, etc" difficult stuff to talk about rationally - but I certainly have such uncanny experiences with certain patients.

Eric Berne, when working as an army psychiatrist with the task to assess in 1 1/2 minutes whether a soldier who had been hospitalized as shell-shocked was ready to return to the field, reported:

<<I tried to develop some image of this person, drawing on my intuition - I would see a baby with wet nappys between his legs - this soldier isn't ready...>>

Whatever he did is similar to what we do, and what we call countertransference- when we 'receive an unconscious message' from a client about their own inner feeling state which they can't or won't articulate to themselves or to the therapist ( for whatever 'defensive' reason). So, I suppose there will always be phenomena which defy rational scientific description - but resorting to this should really be our last resort and not our first choice - unless we are deep into a conversation where all the scientific work has already been done and we have got to white bit of map... Hilde.

Thu, 14 Sep 2000, Arthur Egendorf 

Paul and others, more than once I've had an impulse to jump into this series of exchanges along the lines that Bob Sollod did (recalling a colleague who regretted the lack of an adequate container, only to have images of toilets and so on leap to his mind). Only I'd say more explicitly, "Hey, Paul. I know what you mean!".

In North American English, as I speak it, a container could be a large steel storage bin that goes on 'container ships,' or the aluminum packaging for loose tea, or some other object of that sort.

To my ears, there is a strange or maybe estranged frame of mind that lies implicit in the choice of such a word by Bion and his champions. Maybe one would have to be raised in a place where people have been "queuing up" for longer than anyone cares to say. Or, where, at least until recently, a "stiff upper lip" would be considered a virtue. No ethnic aspersions implied. Just a nod to the fact that British English is a distinct tongue, and one not altogether accessible to those of us who speak the one that keeps careening in odd ways on these shores.

But I also mean to sympathize with anyone who hesitates to use nouns to fix into roles what can only be done, or practiced, as a more or less improvisational activity. I would tease this point out further, but it has already been done better than I could hope to by Wittgenstein, then taken up by Austin (oh yes, the irony: British linguistic analysis produced this critique most pointedly), and then brought into our field at book length more than two decades ago by Roy Schafer in his 1976 book "A New Language for Psychoanalysis."

So, at least "containing" would draw us a bit closer to the action. But Jack Berkley did considerably better with "mature responding" if I recall his phrase correctly. Maybe we need a name for this kind of situation, where as Paul admits:

<< yes, I have seen the phenomena and yes I do THINK I have experienced the same kinds of deep connections, but no, talking about that as containment still doesn't feel -- for me, at least -- like a useful way to TALK ABOUT those experiences. >>

How about "different wording for more or less similar experiences/phenomena"? And then, "wordings that not only differ but make a significant difference for their users"? Arthur Egendorf.

Sat, 16 Sep 2000, Diana Fosha 

Dear all, a couple of small comments in this mega-conversation:

--- Though for the most part not blessed with the patience or inclination to devote myself to Bion, it did occur to me that from the vantage point of being SEPI-ites on the cusp of the millennium, "container' is a woefully inadequate word. However, if the context is blank screen (for projection, etc.) then going three dimensional and taking something in and holding it, rather than bouncing it right back, then (at least at the time), we've come a long way

--- On phenomena and terminology: over time, a particular word becomes a shorthand for a collection of related phenomena. With time, different understandings unfold to account for those phenomena, and with the new understandings, different terms, more accurate to those new understandings, come to mind. However, there is a dilemma: on one side, there is a concern that by deciding to err on the side of accuracy (and go with the new language), the tie with fondly held history/tradition will be lost, one will lose connection with valued allies, etc. On the other side, there is the concern, that by staying with the old language, one has to live with baggage (another type of container) that one would rather do without. [When writing, this is a huge existential dilemma]

--- Finally, on the analytic/integrative, male/female, rationality/faith dichotomies, there is another one: clarity vs. opaqueness or explicitness vs. deliberate mystification. On that last one, I CLEARLY align myself with lucidity. Like Wittgenstein said, Anything worth saying can be said clearly (Arthur, correct me if I misquote). There is to me little more thrilling than someone writing about complex a-rational, non-linear, non-cognitive, even "weird" phenomena and doing so clearly. Witness William James writing about religious experience. As to all the other dichotomies, I quote the main character from Rose Tremain's brilliant, poetic, idiosyncratic and uncannily lucid novel "Sacred Country:"

"Cord said brass rubbings were ghostly things in two senses and everything important in life was dual, like being and not being, male and female, and that there was no country in between. I sat on the toilet at [the brass rubbing of] Sir john and he looked at me with his empty eyes and I thought, Cord is wrong, there is a country in between, a country that noone sees, and I am in it."

With much regard and many regards, Diana Fosha.

Sun, 17 Sep 2000, Jim Lindsley 

Dear Hilde: I appreciate your response to my letter with your extension of various types of interpersonal influence, as well as hints at the mechanisms of things such as Projective Identification.

As for the judgments and feelings we may have about the character, internal feelings, intentionalities of others, subsumed under counter-transference, I am quite wary. Although we often do accurately 'read' or infer on some other basis something about the inner state of others, it has also been in my experience to mis-judge others until they more directly reveal themselves to me, as well as to be mis-taken by others. I also see in my work with couples how often people misread one another.....so I wonder how good a job Berne did.... Anyway I shall enjoy the stimulation to my ponderings and observations engendered by your influence. Jim.

Mon, 18 Sep 2000, Tullio Carere 

Diana Fosha wrote:

>if the context is blank screen (for projection, etc.)

>then going three dimensional and taking something in and holding it, rather

>than bouncing it right back, then (at least at the time), we've come a long way

Yes, the containing/holding metaphor may not be very elegant, but if it is seen as a three dimensional development of the blank screen (thank you Diana for this enlightening observation), it is a great improvement anyway.

Everybody knows that the blank screen is never really blank, but maybe we all agree that a basic function of the therapist is to make it as blank as possible--that is, to interfere as little as possible with what the patient needs to stage. The therapist is never "neutral", but s/he can decide to neutralize as much as possible his/her personal/emotional contribution to the relation, if s/he understands that what the patient needs at the moment is just to be mirrored back.

But if we don't take it for granted that we know what the person before us needs right now, we may realize that sometimes s/he needs a clean, smooth, and impersonal mirror (as an orthodox psychoanalyst would try to offer all the time), other times s/he needs a therapist who is not afraid to take part personally in the drama. And maybe one of the dramatis personae the therapist is asked to play is "the good enough mother", that is one capable of (in your words) "taking something in and holding it, rather than bouncing it right back" (and maybe giving it back later, after a little elaboration). Tullio.

Mon, 18 Sep 2000, Diana Fosha 

In a message dated 9/18/00, Tullio Carere writes:

<< Yes, the containing/holding metaphor may not be very elegant, but if it is seen as a three dimensional development of the blank screen (thank you Diana for this enlightening observation), it is a great improvement anyway.

Everybody knows that the blank screen is never really blank, but maybe we all agree that a basic function of the therapist is to make it as blank as possible--that is, to interfere as little as possible with what the patient needs to stage. The therapist is never "neutral", but s/he can decide to neutralize as much as possible his/her personal/emotional contribution to the relation, if s/he understands that what the patient needs at the moment is just to be mirrored back. >>

Dear Tulio, Paul, all, now we are getting somewhere. And possibly we have opened the door to genuine, substantive divergence, rather than quasi-arguments based on differing hormones bathing the brain and dictating (more or less) gender, or level of patience in the face of frustration, or theoretical allegiance based on accidents of geography, or what have you.

Tullio as usual is eloquent and elegant: "Everybody knows that the blanc screen is never really blanc, but maybe we all agree that a basic function of the therapist is to make it as blanc as possible--that is, to interfere as little as possible with what the patient needs to stage." It is my guess that, most likely, we do not all by any means agree that the basic function of the therapist is to make the screen as blanc (I like this spelling) as possible. Maybe we all agree that we see our function to as best as possible provide what the patient needs, but I think we construe "need" quite differently.

If one really takes to heart, like I do, a two person rather than a one-person understanding of clinical phenomena -- and by that I do not only mean the therapeutic relationship, but also the phenomena we call psychopathology or character or psychic functioning-- then not only is it not possible to be a blanc screen (or, for that matter, a featureless container), but, more importantly, it is not desirable. In a two person relationship, two PERSONS are needed. That does not mean that the relationship need be symmetric or anything else that suggests equal, only that it be mutual. The partner with greater flexibility (or expertise, or experience, or power, or wisdom -- cf. Bowlby's defining attachment as the need for contact with another, "viewed as older or wiser"--) can be concerned with fostering the development of the partner who is more vulnerable (or younger, or sicker, or more primitive, or less flexible). And in the process of fostering that growth (or healing, or becoming, or unfolding), s/he might at times have to be more in the background or more in the forefront as her/himself, but s/he needs to be there as her/himself. Though we all have different selves, which get engaged and transformed in different relations we construct with different people, there is experiential meaning to the experience of "being oneself" at a given moment. Winnicott said, The mother "has a special function, which is to continue to be herself, to be empathic toward her infant, to be there to receive the spontaneous gesture, and to be pleased" (Winnicott, 1963, p. 76). The essential nature of the mother needing to be herself is in no way rendered less essential by the fact that there are times when it is best that she keep herself subdued in the interest of what the child might need at a given moment.

The other favorite quote that comes to mind that is of relevance in this discussion comes from Ferenczi:

"One gets the impression that children get over even severe shocks without amnesia or neurotic consequences, if the mother is at hand with understanding and tenderness and (what is most rare) with complete sincerity" (Ferenczi, 1931, p. 138).

To bring this to a close -- as it is time to wake up my daughters and get the day going for all three of us -- I believe that it is in the context of concepts like "spontaneity" and "sincerity" that terms like "container" -- for all the clinical wisdom that they contain -- leave something to be desired. To be continued... Ciao, Diana.

Mon, 18 Sep 2000, Richard O'Connor 

I'm brand new to SEPI so please forgive me if these comments don't advance the discussion, but I can't resist putting in my two cents. I have been trying to figure out why so many of my depressed patients seem to find themselves in situations where they really do get rejected, ignored, treated sadistically, etc. Sometimes it's very difficult to see that there's anything the patient actually did to contribute to the situation, it just feels like more bad luck. And if you push too hard to analyze the situation, the patient feels like you're saying it's his fault somehow.

I had thought of Paul Wachtel's notion of "recruiting accomplices" as useful in understanding this phenomenon, but also thought of projective identification as the actual mechanism at work, so I'm interested to see that Paul has reservations about Projective Identification as a process. I think that Projective Identification, recruiting accomplices, whatever, are our imperfect attempts at understanding what is a very real but also very mysterious phenomenon.

-----------

Anyway, here's a contribution. This is from a book I've been working on, "Active Treatment of Depression," coming out from Norton:

Projection and Projective Identification, Splitting and Repetition Compulsion

These are some of the skills of depression which make relationships with the depressed person so difficult and problematic. Projection is understood to be a process whereby painful feelings or ideas originating in the self are experienced as emanating in someone or something else. Incorporation is the reverse, when aspects of another are attributed to the self. Incorporation is usually thought of as a comforting process in grief whereby we take into ourselves aspects of the lost object. However, we may also incorporate aspects of another that we dislike, as Freud argued in Mourning and Melancholia.

Trying to resolve a conflict with someone who is projecting is fruitless, and to say "you're projecting" only raises the stakes and makes matters worse. When the therapist hears about repetitive disputes in the patient's life, he should consider whether a projection process is occurring, and whether it might also be getting played out in the transference. The therapist should then focus on the patient's felt experience: It seems like you feel that I'm attacking you. I'm trying not to, but maybe I'm not aware of something that's going on here. Can we talk about this? It is, of course, usually hate, rage, rejection, disapproval that is split off and attributed to the therapist or object. These are feelings the patient may have initially experienced from the parent or other lost object, which have now become internalized, perpetuating the vicious circle of depression.

Projective identification is a major element in recruiting accomplices into the patient's stable, dysfunctional interpersonal world. It involves others correctly understanding the subtext of the patient's messages, the unconscious expectations he has that people will reject him, ignore him, treat him with contempt or sadism. When the therapist finds himself experiencing some of these feelings about the patient, we may understand it to be part of a process of projective identification, but to interpret it to the patient as such is merely acting out sadistically. It's your fault that I'm rejecting you. This is a major stumbling block for many patients with depression, who will hear any suggestion that they change their behavior as an accusation that their problems are all their own fault. Tact, timing, and patience, a willingness to look openly at the therapist's contribution to all misunderstandings, and a determination to solve the problem in the face of doubt and uncertainty-these are required elements in the therapist.

It is easy for the therapist to come to participate in the irony of depression. If, for instance, we consistently point out how the patient puts himself down, we are putting him down; if we keep emphasizing how he minimizes progress, we also are minimizing progress. The patient can come to believe that he is not a good-enough patient, just as he believes he is not good enough in other aspects of his life. Instead of always pointing out the defense against feeling good, it may be better to ignore it sometimes and get back to what caused the good feeling in the first place. If there is a healthy give-and-take in our relationship, the patient will come to the time when he can explore what is so anxiety-provoking about feeling good; but if he expects that we too are never satisfied with him, he will just acknowledge that it is difficult and blame himself. Especially if the general thrust of the patient's efforts has been in a positive direction, for us to keep pointing out the negatives verges on therapeutic sadism.

The patient comes to the therapeutic relationship with a kind of fatalism, expecting that this once again will be a relationship that will fail to satisfy him, to cure the "basic fault." At the same time, he wishes and hopes that this will be a different relationship. The therapist's task is to prevent the patient's self-fulfilling prophecy from repeating itself. The therapist is only human, and will be influenced by the patient's projective identification and by his own unconscious motivations, but he must work hard at clarifying ambiguity and moving the process in a direction that addresses the patient's expressed wishes. The depressed patient can resist engagement in many ways-by rejection, by dependency-but the hallmark of depressive resistance is withdrawal, tuning out, refusing to come out and play with the therapist. This attitude leads, pari passu, to the therapist's frustration or giving up on the patient; the patient sees this even when the therapist is unaware of it, and (not aware of his own contribution to the dance) concludes that the therapist is but one more in a long line of people who have disappointed and rejected him. But when the opposite happens, when the therapist jumps on the patient's withdrawal, persistently points it out, brings it to the patient's awareness and the two of them collaborate on figuring out what it means, the opportunity is there for a new "mental representation" (Fonagy et al., 1993) to develop. A new nexus of affect, relationship, behavior, and hope can be laid down.

What is experienced as rejection depends greatly on the uniqueness of the patient. Ehrenberg (The Intimate Edge, 1992) reports her embarrassment at becoming drowsy during a patient's sessions and her surprise when he reported experiencing it as comforting. To the patient, it meant that she felt safe with him, a man who did not feel safe with his own impulses, and it reminded him of comforting, intimate nap times with his mother who was otherwise anxious, unstable, and threatening.

But therapists are prone to some forms of acting out that clearly betray a rejecting component: forgetting appointments, starting the appointment late or ending it early, not giving notice of vacations and interruptions. On a micro level, finding ourselves distracted or bored, losing the thread, sighing, yawning, changing the subject-depressed patients are infinitely sensitive to these insults, always looking to the therapist for signs of loss of love and approval. We may in fact be feeling bored by the patient, or angry at him for a reason we might not be able to identify; we might simply be feeling overwhelmed, sorry for ourselves, needing a non depressed patient who can perk us up a little; or we might not know why we are rejecting the patient. Regardless, if ever we are confronted by the patient, the worst thing we can do is deny what we are doing, try to disconfirm the evidence of his own senses. It is far better to acknowledge what's happened, explore the patient's reactions, explain the meaning from our perspective insofar as we know it, and mutually explore the implications for the relationship.

"There is no way for the analyst to know, with certainty, what course to pursue with respect to the balance between spontaneous, personal responsiveness and adherence to psychoanalytic rituals at any given moment, nor can the balance that is struck be one that the analyst can completely control. The basis for the patient's trust is often best established through evidence of the analyst's struggle with the issue and through his or her openness to reflect critically on whatever paths he or she has taken, prompted more or less by the patient's reactions and direct and indirect communications." (Hoffman, 1998, p. 225)

Many depressed patients will never complain, no matter how much we abuse them. Some will drop out, and some will settle into a masochistic "therapeutic" relationship that can become the most important relationship in the patient's life and last for many years. Just as the patient continually scans us for signs of disapproval, we must be alert for subtle indications that the patient isn't happy with the way things are going. Dreams of rejecting parents, lovers, or bosses, complaints of careless treatment at the hands of others, usually have plenty of basis in reality but also may be a communication from the patient's unconscious about the therapist. A simple comment like There are so many experiences in your life when you are made to feel inadequate, I wonder how often it happens in here but you don't feel comfortable mentioning it may open a door.

-----------

Tue, 19 Sep 2000, Tullio Carere 

On 18-09-2000, Diana Fosha wrote:

>It is my guess that, most likely, we do not all by any means agree that the

>basic function of the therapist is to make the screen as blanc (I like this

>spelling) as possible. Maybe we all agree that we see our function to as best

>as possible provide what the patient needs, but I think we construe "need" quite differently

>If one really takes to heart, like I do, a two person rather than a

>one-person understanding of clinical phenomena -- and by that I do not only

>mean the therapeutic relationship, but also the phenomena we call

>psychopathology or character or psychic functioning-- then not only is it not

>possible to be a blanc screen (or, for that matter, a featureless container),

>but, more importantly, it is not desirable. In a two person relationship, two

>PERSONS are needed. That does not mean that the relationship need be

>symmetric or anything else that suggests equal, only that it be mutual.

Diana, I agree that neutrality is not *the* basic function of the therapist: In fact I said it is *a* basic function of his/hers. As you know, the triad interpretation, transference analysis, and technical neutrality (to the exclusion of all interpersonal and intersubjective deliberate action) is still today the hallmark of mainstream psychoanalysis (Kernberg, 1999). Do you think that the therapist's neutral stance could have survived for more than a century, and still be a must in mainstream psychoanalysis, if it were just a mistake? It is not likely. One-person psychology is still alive and well. Listen what Warren Poland said a few days ago on the JAPA discussion list:

"'Freudian monism' provides a technique for coming most fully to seeing an other in that other's own right. Therefore one person psychology, when not used defensively, may be the realization of the most successful mastery and integration of the truths of intersubjectivity. Practicing psychoanalysis involves the use of one's self in the service of the other. Relational psychology has cast vast and vastly needed light on the analytic process.

Ted Jacob's substantial contribution on the analyst's use of the self has been a major enrichment of our modern understanding of the psychoanalytic process. Yet all of this matters as it leads us back to the purposes that brought patient and analyst together to begin with. The analyst is there in the service of the other."

One-person psychology is not at odds with two-person psychology: it is just one of the person's ways to relate to another person. It is a person's way to get out of another person's way. Provided it is not used defensively, Poland says, it may be "the most successful integration of the truths of intersubjectivity". I expect us SEPI-ites to be at least as much integrative as a JAPA-psychoanalyst.

>The other favorite quote that comes to mind that is of relevance in this

>discussion comes from Ferenczi: "One gets the impression that children get

>over even severe shocks without amnesia or neurotic consequences, if the

>mother is at hand with understanding and tenderness and (what is most rare)

>with complete sincerity" (Ferenczi, 1931, p. 138).

>To bring this to a close -- as it is time to wake up my daughters and get the

>day going for all three of us-- I believe that it is in the context of

>concepts like "spontaneity" and "sincerity" that terms like "container" --for

>all the clinical wisdom that they contain-- leave something to be desired.

Sincerity (or spontaneity) can be a virtue or a vice, it depends. Compulsive sincerity (or spontaneity) is obviously a vice. Sincerity per se has nothing to do with being a mother, on the contrary (to me Ferenczi is wrong in this respect). The mother is the greatest source of (beneficent) illusion. It is not that she is a liar. It is that her primary role is to protect her child from whatever is intolerable to her/him, included all truths that the other is not ready to face. Optimal disillusionment is more a father's (oedipal) affair. Of course both optimal illusion and disillusionment are administered by both parents, though the former is deemed to be more the mother's competence, as the latter is more the father's. Tullio.

Tue, 19 Sep 2000, Jim Lindsley 

I appreciate Diana's opening up of the ways as therapists we might be useful to our clients. I think Weiss and the Control-Mastery people have done a nice job of delineating the various lessons about others and self in relation to others that clients can learn through the experience of the therapeutic relationship. Personally I would go beyond the parenting role to include, though these might also be seen as parenting functions, a whole host of other lessons. Just off the cuff, for example, these could include experiencing that there is another/are others: who can understand the client's experience through similar experience, even in some sense on a peer basis; who can be safely disagreed with; who can be given to; who can appreciate the client's social presence; who models certain positive ways of functioning; who can be simply a mere mortal; etc. Jim.

Wed, 20 Sep 2000, Ana M. Stingel 

Hi Diana, Ciao Tulio. Just a sneak into your exchange. Tullio wrote:

>Sincerity per se has nothing to do with being a mother, on the contrary (to me Ferenczi is

>wrong in this respect). The mother is the greatest source of (beneficent)

>illusion. It is not that she is a liar. It is that her primary role is to

>protect her child from whatever is intolerable to her/him, included all

>truths that the other is not ready to face.

As it reminded me of a foolish (of me) episode with my daughter (that I think I had mentioned to you, Diana, when you were here in Brasil), I'd like to share it with you, wondering whether it would be a case of compulsive sincerity(maybe that's why I'm writing just to the two of you): She was something between 4-6yo , and she was crying before sleep. I went in to sooth her, and she kept on thinking about the fact that, one day, I was going to die(it wasn't the first time she'd mentioned her concern). How was she going to live without me? I told her it was going to take a loooong time, I was healthy and she would be a grown up and prepared, that it happens to everybody and it is a normal fact of life, nothing did the trick. She just would not calm down. So then, out of despair, I said:

- Dear, I guarantee you then, as you insist, that I will NEVER die!

- Sure?

- Sure, I am telling you.

She seemed pretty happy with it and went to sleep. Just then, it downed on me I was concerned with my lying (and my dying!), not with what she needed then...She never returned to the subject, ever. And I lived long enough for her to process it (she's 13 now)! Tchau and thanks for being and writing! Ana S.

Fri, 22 Sep 2000, Diana Fosha 

Dear Ana, Tullio, all, Ana's story is a beautiful one, and like Tullio says, "The mother is the greatest source of (beneficent) illusion. It is not that she is a liar. It is that her primary role is to protect her child from whatever is intolerable to her/him, included all truths that the other is not ready to face." And that is when child and mother can have the pleasure of being able to preserve illusion.

However, Ferenczi, in the passage I quoted, is writing about what happens in the face of trauma, when the unspeakable has happened, when more than just illusion has been shattered, and when the mother's failure to protect the child from the unbearable and the intolerable is already the case. It is in the wake of trauma (severe shock) that he writes "One gets the impression that children get over even severe shocks without amnesia or neurotic consequences, if the mother is at hand with understanding and tenderness and (what is most rare) with complete sincerity" (Ferenczi, 1931, p. 138)." It is then that her tenderness and her sincerity are non-discretionary and then, sincerity has everything to do with being a mother. Sweet dreams to Ana's daughter. Diana.

Sat, 23 Sep 2000, Tullio Carere 

On 21-09-2000, Ana M. Stingel wrote:

>So then, out of despair, I said:

>- Dear, I garantee you then, as you insist, that I will NEVER die!

>- Sure?

>- Sure, I am telling you.

>She seemed pretty happy with it and went to sleep.

Dear Ana and all, beside being beautiful, your story may be helpful to those, like Paul and George, who admit that the therapist does have a reparenting role to play, but don't appreciate the containing/holding metaphor. Once one has accepted the reparenting role, the next step is to divide it into its maternal and paternal sides. One simple way is to define the maternal as holding (reassuring) and the paternal as confronting (reality testing). However, as I see that "holding" (or "containing") has to some an invincibly repelling quality, the couple "holding/confronting" may be usefully replaced by "optimal illusion/disillusionment", which thanks to its more ethereal quality might be more palatable and digestible.

But your story may be precious for one more reason. Your daughter finally succeeded in making you understand that she did not want to let go of her faith in immortality. The idea of immortality, if applied to a mortal being, is obviously an illusion, but one that a child may not be ready to give up. Therefore you were very wise to preserve it. However, a question remains: what happens to our need for infinity, when it is no longer illusorily identified with a finite thing? Is it a question that we'd better leave to art and religion, or is there a place for it in our discipline too? My answer is that there must definitely be a place for it in our discipline. If the need for infinity is superficially identified with infantile omnipotence, one risks to throw the baby away with the bathing water, as it is not seldom the case in mainstream psychoanalysis.

You may remember that the debate on containing and projective identification, which seems to be coming to an end, started when Paul asked if anybody could "indicate to me in a brief way what ideas of observations of his (Bion) you think are really valuable". I answered that I appreciated Bion's ideas about a maternal role of the therapist, but in my opinion his most decisive contribution was to be found in another vertex of the therapy field, the one that is epitomized by Bion's formula "Faith in O". This is where the need for infinite is properly listened to. Maybe when the containers & Projective Identification question is definitively exhausted, a little room in this forum will be found for the (to me) more interesting part of Bion's work. Tullio.

Sat, 23 Sep 2000, Tullio Carere 

On 22-09-2000, Diana Fosha wrote:

>However, Ferenczi, in the passage I quoted, is writing about what happens in

>the face of trauma, when the unspeakable has happened, when more than just

>illusion has been shattered, and when the mother's failure to protect the

>child from the unbearable and the intolerable is already the case. It is in

>the wake of trauma (severe shock) that he writes "One gets the impression

>that children get over even severe shocks without amnesia or neurotic

>consequences, if the mother is at hand with understanding and tenderness and

>(what is most rare) with complete sincerity" (Ferenczi, 1931, p. 138)." It is

>then that her tenderness and her sincerity are non-discretionary and then,

>sincerity has everything to do with being a mother.

Dear Diana, Ana, all, for the sake of clarity we'd better distinguish the mother as a person from the mother as a role. The role is what is more characteristic, typical or proper of a given function. From the person we expect that she be up to her role, but we also hope that she will be able to go beyond it, when necessary (for instance, we hope that the mother will be a "good enough father", when the father is weak or absent).

The case of "severe shocks without amnesia" seems to me precisely one of those in which the mother may be required to do something that is beyond her ordinary competence. Not necessarily, though. Ana's daughter seemed to be in a condition of shock, yet she was cured precisely by her mother's capacity for reinstalling illusion.

Besides, I wouldn't say that the alternative to preserving or reinstalling illusion is always sincerity. As Francine Shapiro (I will never thank you enough, Diana, for inviting her to the Washington Conference) has extensively shown, the common practice of confronting a traumatized person with the "truth" of his/her trauma (whether this is done by a mother or by a therapist) can easily result in a re-traumatizing experience. Sincerity can help, as it can also encumber reprocessing of a traumatic experience. I would say that [1] reprocessing is not always the first choice (reinstalling illusion may be preferable), and [2] if reprocessing is the choice, "sincerity" is not always the best way (Rapid Eyes Movements--the way of dreams--may be better).

>sweet dreams to Ana's daughter. Diana

Yes, dreams are great healers, sometimes the greatest Tullio.

Sat, 23 Sep 2000, Diana Fosha 

Tullio, Ana, all, how does one preserve faith in the infinite and the illusion of immortality in the face of the all-shattering shock of trauma? Diana.

Sat, 23 Sep 2000, Diana Fosha 

Tullio (just saw your reply, after dashing off my previous e-mail), Re: your:

"if reprocessing is the choice, "sincerity" is not always the best way (Rapid Eyes Movements--the way of dreams--may be better)."

a) let's not be overly concrete about "sincerity"

b) to my mind, EMDR, like all experiential treatments, is the way of "truth," meaning the way of emotional truth, and it is there that maybe dreams and reality (IN THE SENSE, AND ONLY IN THE SENSE, OF EMOTIONAL REALITY) ARE NO LONGER SUCH DIVERGENT EXPERIENCES. Diana.

Sat, 23 Sep 2000, Diana Fosha 

P.S.: In my mind, the opposite of sincerity is neutrality, not illusion Diana.

Sun, 24 Sep 2000, Elizabeth Moraes 

Diana, I understand "preserve faith in the infinite and the illusion of immortality in face of trauma" as a metaphor to one's capacity to maintain the zest for life while living in the everyday traumatic reality. In this sense closeness, intimacy, sharing and the support of others are the vital elements that feed the soul and preserve the faith. Best regards. Elizabeth Moraes.

Sun, 24 Sep 2000, Hilde Rapp 

Dear all, Winnicott insists that, when working and hate and other forms of extreme negative transference phenomena- usually at least in part sequelae of earlier trauma- the therapist's greatest chance of being useful to the client lies in his ability to survive: That could be read as a good therapist NEVER DIES. In this sense, your story Anna, and your comments, Diana and Tullio, link some of the work of the maternal to some of the work of a good therapist.

Regarding the bigger picture: Survivors of the holocaust and victims of torture insist that it is a duty to defy 'evil' by surviving and even more, to make new life and to celebrate life so that the forces of darkness do not win out (Many female survivors yearned to make babies...).

I think we are here concerned with the triumph of the 'spirit' over adversity. Even as the body is broken, and our physical mortality is incontrovertible, and even if there is no belief in an afterlife in the sense of some continuity of individual experience after death as a 'soul' with an identity, there is, for most of us that something that Bion calls 'O'.

If nothing else, 'O' relates to our sense of being connected into a larger order of holons, which in itself confers upon us our sense of shared humanity, of being of the same kind, belonging to the same species ( from speculum: mirror), being a holon in an unfolding order of creation or evolution, an enfolding and unfolding order which ist best thought of as infinite - at least in its potential... Just a glimpse of the manifold... Tullio - over to you! Hilde.

Wed, 27 Sep 2000, Tullio Carere 

Hilde, I wouldn't call Bion's philosophy humanistic. I would rather call it uebermenschlich, that is pre-human and over-human. "O" is the noumenon of all phenomena, or the infinite out of which all finite things come to an ephemeral existence. One need not read Bion if one does not like him, but all finite beings had better come to terms with the infinite that grounds and surrounds them on all sides. Schleiermacher said that the feeling and intuition of infinite is what religion is all about. With "Faith in O", Bion forced a religious wedge into psychoanalysis (what Meltzer and the other Kleinians did not forgive him). Either he was wrong (because we feel pretty well at home in our finite selves and worlds, having recovered from the infantile illness of infinite), or he was right (because we still don't feel at home in our finite selves and worlds, and only find peace and joy when we succeed in reconnecting to our infinite ground).

To put it into clinical terms, most or all of our patients suffer from wishes that will never be fulfilled by any finite object. In the course of the treatment they will have to learn to fight their way to whatever they can reach, to give up what they cannot reach, and to tell the difference between the two. For reasonable that this program may sound, it rests on the implicit assumption that I will renounce my unrealistic pretences, once I see that they are unrealistic. This realization is indeed necessary, yet not sufficient. For a true resolution to take place, one more condition is required. Nobody will really let go of his/her endless quest for love, peace, and power, however wrongly directed, until s/he learns how to draw upon an endless source of these goods--until s/he learns F in O, in Bion's terms. Tullio.

Sun, 15 Oct 2000, Marvin Goldfried 

Paul, as a behavior therapist with a very long-standing interest in learning from colleagues of other orientations, I must confess to having had difficulty with the recent exchanges in question. I simply didn't understand what was being said. Perhaps I should have made a comment on this earlier. Instead, I used my delete.

The issue of jargon has always been a problem, and I suspect it served to exclude some others from these exchanges as well. If there is a true interest in having someone from another orientation listen in and dialogue, then the exchanges would have to be in a common language--ordinary English. This is not always easy to carry off, especially since many of us are often not even aware that we're using our theory-based jargon. Those people who have written articles for IN SESSION--which has a no-jargon policy--know how difficult this can be. Marv.

Wed, 18 Oct 2000, Tullio Carere 

Marvin, I remember that when I mailed my first message to this list, a couple of years ago, you were the first to greet me back channel. There was between us a consonance on the basis of the common factors approach, which we share. Then I remember your workshop in Miami, last year, with its leitmotiv: Corrective emotional experience is the most effective factor in therapy (you compared it to the wheelbarrow, which nobody pays attention to because everybody looks at what it carries). Of course a corrective experience is needed when the original experience was somehow defective--therefore it seems justified to say that most or all corrective experience is a form of reparenting.

The functions of one of the parents, the mother, have been extensively studied, among others, by three authors: Winnicott, Bowlby, and Bion. Bion, in particular, compared the maternal function to a container for whatever the baby is not yet ready to hold in his/her mind. As clients not seldom seem incapable to tolerate some frustrating experiences, which they deny or act out or act in, the therapist is obviously to hold what the client cannot yet hold. This holding or containing function can take the form of different behaviors (from a bodily holding to an interpretive holding), none of which can be tracked down in the original, Freudian psychoanalysis. Therefore all deliberate behavior on the part of the therapist, aimed to produce a corrective experience, is shunned in mainstream psychoanalysis.

I understand the eschewing of any maternal/holding behavior by a psychoanalyst trained in the ego psychology tradition (it seems to me that most American psychoanalysts are trained in that tradition), but it is more difficult to me to understand what is wrong in a discussion on this theme for a behavior therapist interested as you are in the therapist's wheelbarrow (a container, by the way). Besides, I am not aware of what sort of English I am using. I thought I was writing in the only English I know, that is poor English. Please enlighten me. Tullio.

Tue, 17 Oct 2000, Diana P. Wais 

Dear Tullio, as one of Marvin's students, I have been exposed to his teachings, however, not (yet) to Bion's. I am thus a little bit confused about how this beautiful metaphor of "containing for the patient what his / her mind cannot yet hold" translates into specific actions or cognitions or emotions on the part of the therapist or the client that will affect the therapy process? And if it does affect the therapy in what way and through what mechanisms? How can I use "containment" to better assess or produce change in my client?

I do not think that there is anything wrong with your English, you do indeed express yourself very eloquently. I think it has more to do with some people (like myself) who are less trained in psychoanalytic ways of communicating in metaphorical terms having a hard time translating this into concrete and specific terms. Is this possible? Diana Wais.

Wed, 18 Oct 2000, Hilde Rapp 

Dear Diana, Marvin, Tullio, George, Diana, Ana, and everyone who has particularly energetically fuelled this debate

<<< >>> marks headlines. Thank you Diana and Marv!

<<<Redescribing concepts in terms of client and therapist behaviours>>>. Perhaps one possible reframe would be to think of 'containment' as the therapist's generic response to dealing with the client's barriers and defenses to knowing about himself, and hence his resistance to treatment.

The first step might be to identify specifically what kind of blocking, barrier, defense, resistance, avoidance, maladaptive behavior, unfinished business- however different orientations describe this well known clinical phenomenon-is giving rise to a therapeutic impasse.

The next step might be for the therapist to define their core preferred repertoire of ways of working therapeutically with this difficult experience.

<<<Look for descriptions in the JPI!>>>. Many past journal have explicitly or implicitly made this the focus of debate. The whole point of psychotherapy integration is to look for common themes on the one hand, and for ways of expanding one's repertoire on the other- see Stan Messer's forthcoming issue of the SEPI Journal on 'assimilative integration'.

<<<Some examples of translating terms: 'containment' (noun versus verbs) 'tolerating being frustrated through being asked for help, and pushed away at the same time'>>>. In psychoanalytic terms, some of these ways in which the client does not let the therapist work with the material which is perhaps pivotal in 'effecting a cure', 'working productively in partnership' etc..., whatever description people give to the therapeutic block, may require, what Bion, Tullio and I mean by what we sometimes choose to call 'containment': i.e., in psychoanalytic terms, 'containment' is tolerating the frustration of being stuck, fended off and yet implored to respond with urgency to the client's need at the same time.

In integrative terms, it is the capacity to tolerate ambivalence and uncertainty ('negative capability' as the poet Keats called it, and as it has since entered the therapeutic literature... including a paper by SEPI-ite Carlos Mirapeix).

This negative capability allows the therapist to develop an acceptance of the client's inner conflict, and at the same time allows him/her the strength to 'hold' the client and to 'help him/her to 'contain' his or her 'psychic pain' which arises from the simultaneous wish to act 'out' impulsively ( cognitive behaviorists certain know this one), or to 'run away' and avoid the situation altogether ( cognitive behaviorists know about this one too).

<<< defining your core repertoire of therapeutic interventions>>>. Whatever you then do as therapist to prevent the client from either acting impulsively ( and probably aggressively), or from maladaptively avoiding challenge and change, is what analysts mean by 'holding' and containment'.

This includes whatever you do that allows you to continue to work patiently with the client on reducing his or her fear to move forward despite their anxiety, and their fear to try a new behavior. ( you probably have a change phobic person on your hands, probably with an underlying depression, and probably with some form of personality disorder).

'Containment' is a therapist factor - it is the therapist's capability to tolerate frustration and pain in order to help and support a client.

<<< Defining the main ways in which the client makes emotional demands on you and how the client blocks your interventions from reaching them>>>. Whatever it is the client does which challenges the therapist to offer 'containment' as a therapeutic intervention, is a client factor.

If therapist and client can find a middle path they can together formulate the 'problem', and by definition, every problem has a solution, otherwise it is not a problem, but a headache... Therapy converts headaches into problems, and anxiety and terror into ordinary fear of something to which an adaptive response is possible.

<<< Matching type of core client need to types of therapeutic styles>>>. There are vastly different styles of therapist- responding: For example- and these are gross caricatures - apologies to Leigh, Allen and Prof. Davanloo (who of course are much more complex and sophisticated as real people).

Leigh MCullough tends to go the 'maternal' path and offers some 'holding and containment'- where as Prof. Davanloo goes the 'paternal way' and challenges the patient very assertively to dare to face the truth and to try out a new behavior with him. Allen Kalpin has found a middle path.

<<< Therapist and client response style match>>>. I suspect that there is good deal of client response style and therapist response style matching going on here.

Clients who might get seriously damaged by working with Davanloo may thrive with Leigh or Allen, and clients who may not move forward with Leigh may eventually respond dramatically with Davanloo>>>Research please!

<<< Focus on challenge versus focus on support>>. Cognitive-Behavior therapists tend on the whole to work slightly more with challenge and slightly less with support then analysts, but of course there is a wide spectrum within both traditions.

So it may be that a discourse that focuses on the intricacies of how to use 56 varieties of support in order to prepare a client for challenge, is of marginal interest to therapists, who see the relationship as sufficient support to develop 56 varieties of challenge! Ah, but to be bilingual and to know when and whom to challenge and when and whom to support!!! Perhaps this way of reframing the debate makes it more inclusive and accessible? Cordially, Hilde

Wed, 18 Oct 2000, Marvin Goldfried 

Tullio, I have no problem with your English. Like Diana (no surprise, I "brainwashed her!"), the difficulty I have is with the theoretical jargon. I fully agree that one aspect of therapy, regardless of whether a therapy approach acknowledges it or not, is to provide reparenting. What I still don't fully understand. however, it what is meant by being a "container." I have all sorts of associations to this metaphor (ranging from providing personal support to a place where toxic wastes are stored), and therefore need to have it specified/operationalized more clearly. What thoughts, actions, feelings and intentions should I have when I serve as a container for a patient? Marvin.

Wed, 18 Oct 2000, Allen Kalpin 

Hilde, you really know how to draw lurkers out of lairs. Here are some of that statements you make about containment:

'tolerating being frustrated through being asked for help, and pushed away at the same time

[resistance]...may require, what Bion, Tullio and I mean by what we sometimes choose to call 'containment':

'containment' is tolerating the frustration of being stuck, fended off and yet implored to respond with urgency to the client's need at the same time.

Whatever you then do as therapist to prevent the client from either acting impulsively ( and probably aggressively), or from maladaptively avoiding challenge and change, is what analysts mean by 'holding' and containment'.

'Containment' is a therapist factor - it is the therapist's capability to tolerate frustration and pain in order to help and support a client.

It seems to me that you are describing a combination of:

1. The activity of keeping your cool or staying centred when when the client pushes your buttons. In CBT terms this might be phrased as not being controlled by your own maladaptive schemas that might get activated by the patient.

2. The activity of being a good coach -- setting limits, pushing for better effort, etc., that the patient is not doing adequately for herself.

These are essential therapist common factors. But how does the word "containment" describe them? To me "containment" implies either:

(a) the therapist "receiving and holding" something that comes from the client that the client cannot yet hold; This of course, ties in with the previous discussion of projection, that gave birth to the discussion of containment.

or (b) the therapist "containing herself," meaning controlling one's reactions.

If one important component of containment refers to the allowal of the client to "project" his feelings onto the therapist, then we will have to return to that discussion and operationalize that phenomenon using common language . Allen.

Thu, 19 Oct 2000, Bob Sollod 

I have had a hard time containing m y s e l f while reading all the posts on being a therapeutic "container". I can hardly contain m y s e l f regarding the postings on "container". Best wishes, Bob Sollod.

Thu, 19 Oct 2000, Tullio Carere 

Marvin, I am happy to know that you and Diana W. have no problem with my English. I probably have one (with my English), because in my poor English the words holding and containing were precisely meant as a way of avoiding theoretical jargon. In fact in my Merriam Webster Collegiate Dictionary I find: To contain (transitive verb): to keep within limits, as restrain, control--(intransitive verb): to restrain oneself. The therapist's operations that Bion (and Hilde, and I) indicate with these words correspond exactly to what these words mean in ordinary English:

"Whatever you then do as therapist to prevent the client from either acting impulsively ( and probably aggressively), or from maladaptively avoiding challenge and change, is what analysts mean by 'holding' and containment'." (Hilde)

When the client literally *cannot* contain him/herself (i.e., acts impulsively or maladaptively avoids challenge), the therapist must be able to contain what the client cannot. This may mean bodily holding (to hug a person who is desperate like a baby: Ferenczi), or speaking in a soft and soothing way, or just keeping calm and cool in the face of rage or provocation, or giving tentative words (reverie or interpretive holding, a verbal container) to emotions to which the client does not yet know how to give a proper verbal form.

In the cognitive science they often translate "to contain" with "to keep in one's working memory". I personally feel perfectly at ease with "working memory", but I still prefer holding and containing, precisely because (to me) this is ordinary English, while working memory is theoretical jargon. Tullio.

Thu, 19 Oct 2000, Allen Kalpin 

The act of making a couple of replies to the list about the containment issue has stimulated me to think about it more carefully. "Containment" and "container" are metaphors. Metaphors have advantages and disadvantages. Some advantages of the use of a metaphor are that one easily remembered image can bring to mind a huge amount of "data." It can "contain" thoughts, images, beliefs, emotions, motivation, etc. It is a very efficient carrier of large amounts of "information." On the other hand, the problem is that this information in not precisely defined, and is difficult to operationalize. Diana asked,

"I am thus a little bit confused about how this beautiful metaphor of "containing for the patient what his / her mind cannot yet hold" translates into specific actions or cognitions or emotions on the part of the therapist or the client that will affect the therapy process? And if it does affect the therapy in what way and through what mechanisms? How can I use "containment" to better assess or produce change in my client?"

It seems to me that in the efforts that Hilde and Tullio have made so far to address this that there is something that gets lost in the translation; that the whole is greater than the sum of the parts. I appears to me (but they are the ones who could best address this) that when they think in terms of containment during a psychotherapy session that it is associated with a mind-set that is helpful to them and to their work, that is beyond the descriptions of activities of limit setting, etc. The cognitive-behavioral side of me wants to impatiently say, "Why use the term, "containment? Why not just talk about limit setting, encouraging change, keeping oneself centred, etc.?" But, on the other hand there must be reasons why they find meaning and importance in this broad metaphor.

So, this is a bigger issue than just the discussion of what containment means. If there are going to be successful discussions between, for example, people of psychoanalytic and cognitive-behavioral orientations, then a way must be found to bridge this gap -- the gap between the power and usefulness of metaphorical and symbolic language and concepts, and the precision of scientific language. Allen.

Fri, 20 Oct 2000, Paul Wachtel 

Allen, Marv, Diana, Tullio, Hilde, and others, now we're speaking SEPI, the language that cuts across the divides. True, we're still only speaking SEPI as well as I speak Spanish, which, as my friends in Spain and Latin America know, is very rudimentary. But, as with my espanol rompido, at least it's a start. What I'm referring to is the turn in our dialogue about containment and containers from an "internal" conversation within psychoanalytically oriented members to a discussion BETWEEN people of different orientations.

I've found Allen's comments especially helpful, but do want to interject one small difference. I don't see "container" as a term that, in one to one fashion, psychoanalysts are comfortable with and behavior therapists are not. I, for example, am still rooted primarily in the psychoanalytic viewpoint, and I still, after all our exchanges, find the term problematic. Here's why:

Tullio: I have little objection to the way you described it, but (a) as you yourself note if I recall correctly (the "back" button on my internet explorer isn't working properly at the moment so I can't go back and check without losing this in the middle), you are using the term container for a set of actions and attitudes that could be described or labeled with a quite different term. So why use "container"? I think, if you and others who use the term look closely, the preference for THAT term to describe certain phenomena -- say, restraint on the therapist's part instead of acting out or helping THE PATIENT restrain himself (a different matter, as I'll mention below) -- is because of the link between the term containment and something quite other entirely, something that is NOT so easily and comfortably agreed with by therapists of other persuasions, just using a different word. That something other is (here we go again) the idea of projective identification.

"Container" is the preferred word for certain analysts because they are also (consciously or unconsciously?) signaling that this all has to do with the patient trying to put his feelings into another person. The therapist then has to not just "contain himself" in the ordinary English sense but contain the "stuff" that the patient has "put into him." That is why all the jokes about recycling, tin cans, plastic bags, etc. are really not so far off after all.

So, one reason I don't like "container" -- EVEN THOUGH I do think we sometimes need to "contain ourselves" instead of screaming back at the patient, getting depressed because the patient describes a situation in such hopeless ways, etc.; and EVEN THOUGH I also think that we sometimes have to help the patient CONTAIN HIMSELF, helping him restructure his thoughts, encouraging delay, etc.; and EVEN THOUGH we even sometimes may have to do so via touch and holding and, so to speak, "containing," I nonetheless do not think it is useful to describe those activities in ways that surreptitiously (or intentionally for that matter) link them to what I think is a way of thinking about people (they "put their feelings into you") that is often accusatory and demeaning, and that is also too vague and inaccurate (because it seems to have finished wiht the matter when it should be just beginning -- asking HOW the patient stirs certain feelings in the therapist or in other people more generally. The patient doesn't "put them in," he EVOKES them, and often, indeed, he does so ironically and inadvertently, stirring feelings he DOES NOT wish to stir. "Projection" and its cousin "projective identification" by their very nature imply INTENTION (albeit often unconscious). I do in fact think that something like projection sometimes does occur, but the language we are using in this realm is extraordinarily vague and misleading, and separating out what is what is hampered by a one-size-fits-all conceptualization that is all contained (sorry!) in one word.

One final related point, alluded to in several places above -- we add still further confusion when we use the same term to describe THE THERAPIST's "containing himself" and the therapist helping THE PATIENT to "contain himself." A careful analysis reveals these are not the same thing at all. And whatever kind of containing is involved in putting one's arms around someone comfortingly is still something else. Without a differentiated vocabulary we are bound to have theoretical hash. (And if, on top of that, we accuse the patient of slinging the hash onto us, that makes it still worse).

So....my main point is that just like you don't have to be Jewish to love Levy's rye bread (for those of you outside the US, that was a popular advertising slogan for that brand of bread a few years ago), you also don't have to be outside the psychoanalytic community to hate "container" as a theoretical concept. So, one more triumph for SEPI. I may not be correct in all that I have just said, but at least I have shown, a la SEPI, that dividing therapists along rigid theoretical lines doesn't work. Our insights or our errors cross the barricades all the time. Ciao to all, Paul.

Tue, 24 Oct 2000, Tullio Carere 

On 20-10-2000, Paul Wachtel wrote:

> ...the language we are using in this realm is extraordinarily

>vague and misleading, and separating out what is what is hampered by a

>one-size-fits-all conceptualization that is all contained (sorry!) in one word.

Paul and all, it sounds like we have made the container a container for all sorts of vague and disparate things. Let me try to clarify a few things.

1. I am writing this mail on a monitor capable of producing images in millions of colors using only three primary colors (RGB, red/green/blue). I can then print such images with an ink-jet machine that prints virtually all colors using again only three primary colors (CMY, cyan/magenta/yellow), that are complementary to the other three.

2. We see everyday patients who bring to the therapy relationship millions of expectations, which most likely are combinations of a very small number of basic psychological/spiritual needs. We then give millions of responses, which most likely are combinations of a very small number of basic therapeutic factors, complementary to the needs to which they respond.

3. It is obvious that if we can detect (devise or discover) something like an RGB/CMY system for psychotherapy, we could avail of a universal code for describing virtually all that transpires in any therapy interaction. I know that some dislike very much this idea, because to them psychotherapy is and must remain an ineffable thing. But in my opinion the search for this universal code is what SEPI is all or most about.

4. Twenty years ago Marvin wrote a paper I like very much, where he suggested that "the possibility of finding meaningful consensus exists at a level of abstraction somewhere between theory and technique which, for want of a better term, we might call clinical strategies". He went on offering "as examples two such strategies that may very well be common to all theoretical orientations: (a) providing the patient/client with new, corrective experience, and (b) offering the client direct feedback."

5. Marvin is a behavior therapist, but many analysts say something very similar. They say that there are two basic levels in all or most therapies, which they call pre-oedipal and oedipal, where respectively defective and conflictual issues predominate. The analyst responds to defect-driven and conflict-driven problems respectively with remaking (reparenting) and uncovering attitudes.

6. I have observed that both these levels can be represented as axes uniting two poles. For the reparenting (horizontal) axis these two poles are obvious: they are the maternal and the paternal poles or vertices of the field. As everybody on this forum (container-haters included) accepts that the therapist has to take on some reparenting functions, the next step is to "operationalize" these functions in a trans-theoretical language.

7. If we can succeed in operationalizing at least one of these functions, the rest of the work would surely follow more smoothly. But the first step is not easy. I understand that I have to drop the hope that the idea of holding/containing could be the equivalent of a basic color. But I don't drop the hope of finding anyway one for the maternal vertex, to begin with.

8. I withdraw then the unfortunate container, and try with the next offer.

Please consider this definition: The therapist takes a maternal vertex attitude in response to the (biologically coded) need for secure attachment, which is signaled by disorders of the basic trust. She does so in the first place by disconfirming the patient's expectation for her to be an unreliable (unresponsive, unempathic, etc) mother, which maintains the insecure or disorganized attachment patterns. Besides disconfirming the unhealthy expectation, she in the second place confirms the healthy one, which the first step reactivates. How does she do that? I hope you will allow me to copy here the list of my last message (maybe if it is no longer a container, but a way to offer secure attachment, I will pass the test): "This may mean to hug a person who is desperate like a baby, or to speak in a soft and soothing way, or to keep calm and cool in the face of rage or provocation, or to give tentative words to emotions to which the patient does not yet know how to give a proper verbal form." Tullio.

Thu, 26 Oct 2000, Luca Panseri 

Dear Paul and colleagues, I would like to share with you my experience after taking part in the EMDR level I° training in Milan (Italy) three days ago. It was a very interesting and useful course. The trainer, Dr. Roger Solomon, was very clever and communicative. He was nicely ironic about some Italian habits but he actually appreciated the wish of learning of all the participants. Moreover he seemed to me a real integrative therapist. During the training I was very impressed by Dr Solomon's frequent use of the words CONTAINMENT, CONTAINING, TO CONTAIN in Hilde and Tullio's meaning . Indeed EMDR is a very containing approach too. I couldn't help thinking about the ongoing debate in our SEPI list. So I made a little investigation among the people attending the course asking if they could easily understand the meaning of the above words. I was always given the same answer : "Yes, of course". In my experience most therapists consider the containing function as fundamental in the psychotherapeutic process.

For this very reason Paul, I can't understand your rejection and "hate" for containment as a word and a theoretical concept. Doing so, in my opinion, you do not seem to consider that both the word and the concept have received wide acceptance and have entered into the common trans-theoretical therapeutic language. Shouldn't we as SEPI-ites be highly appreciative of such spontaneous integrative phenomena?". Thank you for your attention. Luca Panseri.

Fri, 27 Oct 2000, Hilde Rapp 

Dear Paul and everyone else participating in this multilogue: Sorry this post is a bit long: it addresses several of the previous posts and dialogues which waxed and waned around 'containment', 'translation', 'identification', 'projective identification', inclusiveness, exclusiveness, and more or less passionate personal/professional debates between several individuals.

Tullio, you suggested that all these contributions were somehow taking place in 'one container'- so this contribution is in one piece instead of being in several pieces. (Integration of some sort, perhaps? Or, Paul, is it yet more theoretical hash?

Paul, I have an idea why you say: "Without a differentiated vocabulary we are bound to have theoretical hash." Apart from your own answer: ('And if, on top of that, we accuse the patient of slinging the hash onto us, that makes it still worse'). do you think that the way Allen Kalpin, Tullio, yourself, Marv, and I have sort of started on a back translation might be one way of avoiding more 'theoretical hash': Should we ask each other something like:

#do you mean by concept x what A means by y, D means by z...?

#how do you use this concept to inform your clinical decisions- 'discuss'?

#Do you actually use any compatible interventions anyway

# how is x different from y or z?#if not why introduce a new term which seems to be redundant and duplicates a perfectly good one?

#if it does add something new, what's your evidence base that concept x adds anything useful?

#etc. (I think that Stan's forthcoming volume on assimilative integration takes us in this direction too)

To me this is what SEPI is all about:

# honest, warm, open, collegial debates (style)

# in which we fiercely, passionately defend our most dearly held values) (Commitment)

# where we argue with intellectual precision, vigour and frankness about the meaning of those words which express most accurately what in our view most truly represents both the art and science of what it is we do that we believe is healing.

Ana and Ava, I agree with you and everyone who feels that it would be more fruitful to stick with the best of SEPI tradition, which mainly consists in illustrating how it may help a therapist to move on in a therapy by discovering how a colleague from a different orientation works with a similar 'case'. This can lead to adjustments to one's own particular way of thinking or doing things, and result in responding differently to both one's own feelings and to those of one's client.

I would however incline to Stan Messer's caveat (see his forthcoming issue) that it is probably quite important to think through how any such new element might be integrated coherently into one's own theoretical and practical framework (see also below).

Tullio, at the same time I do set store by discussions which help us to analyze, to take apart, and to pare away unnecessary ambiguity in the way we choose words to put boundaries around fields of meaning.

Paul, your example of feeling either irritated ( hate) or sort of amused by laugh at) words such as 'projection', 'projective identification' and 'container', and 'containment' seem to me to illustrate very clearly how words are not only linked to a particular tradition in psychoanalysis, but they are also strongly indicative of the underlying theory of person, personality, child and adult development and indeed of what brings about change. Hermeneuticists might go as far as saying that seem to betray a certain IDEOLOGY, GROUNDED IN CERTAIN VALUE SYSTEMS. I think our passion comes from our VALUES, not our theories ( see Alvin Mahrer on this too).

I hope you don't think that what follows is self indulgent self exposure! It's meant to be a 'theoretically' (rather than clinically )'indicated' mini case history of how a therapists gets to assimilate certain ideas, and rejects certain others:

If I may, I will use my own 'relationship' to these words, the concepts, the ideology and their eventual usefulness as an example: For years I was utterly 'allergic' to the work of Klein and her followers. I believed, also, in view of the name of her approach 'OBJECT relations theory', that her own personality, her tragic personal history, and the fact that she was a woman, and, furthermore, engaged in bitter disputes with Freud's daughter Anna, infused all her clinical writing with a particular worldview:

I saw this as akin to the 'tragic vision' (I hope I don't misuse this word too badly in Jerry's and Stan's eyes): human beings are the play things of powerful forces working deeply in our unconscious, pulling us into entanglements with profoundly sadistic or masochistic impulses, murderous fantasies, desperately seeking for some point of attachment, safety and reparation.( In analogy to ancient fatalistic word views of the Greeks and many other cultures of 2000 years ago). Although heavily influenced by, and temperamentally inclined towards psychoanalysis, Klein's work in those days was not for me.

My values and my worldview had , among other things, been shaped by humanistic and existential influences: politically, intellectually, philosophically, and therapeutically. Much of my philosophical 'upbringing' was in a post Hegelian, post Marxist hermeneutic tradition, deeply suffused with a commitment to emancipation and clear understandable communication.

Mystifying arcane jargon, used in public, was usually critiqued as the hallmark of exclusiveness and the veiling of truth in order to exert power over others without proper authority. (when arcane language was used in previous centuries by 'emancipators' it was veiled in order to protect authors from persecution.)

I firmly held the belief that human beings are responsible for what they do. Emancipation meant that we are to be 'SUBJECTS' in the sense being 'persons' with a sense of identity and concern for others , capable of moral action. We are not to remain passive 'OBJECTS', ( or 'subjects', in the sense of being subjected to the political will of others, forced to be bystanders in relation to our own destiny. However we are vulnerable to social trends and to persuasion. Both involve treating people as if they were OBJECTS in some invidious power game. I was grateful that observation, deep social, economic and political analysis, together with cultural and philosophical interpretation, helped us to devise more and more approaches to understanding how such forces work on us.

I believed that psychoanalysis and psychotherapy are ways of learning to embrace, accept and work on our humanness - to work on our capacity to create and overcome like Mandela, and on our capacity to dominate, torture, and murder, like Hitler. (I still hold most of these view now.). Melanie Klein was a 'victim' and 'survivor' of the holocaust - I grew up in its aftermath, surrounded by both 'perpetrators' and 'survivors'. I was strive to find a way to 'live' a full life. I could not afford to adopt the 'tragic vision'. In those days, words like 'projective identification' sounded like the 'projectile vomiting when exposed to indigestible and unpalatable input- be this food in the casa of babies') or truth ( in the case of certain adults): A physical reflex action, not a thought through human response...

(Indeed, the origin of Klein's work was with babies and young children, many of whom were orphaned survivors of the holocaust, others were traumatized by their parents inability to 'digest' their own experiences- of having lived through the holocaust. Many, children and adults, first survivors of the holocaust, later survivors of abuse and neglect often can't put into words what frightens them 'out of their wits' so they would have to get it out of the system some other way- it s really a cry for help- or, usually, worse, a cry of pain- beyond hope of help).

Inevitably, sooner than I thought, I found myself working with clients whose evident despair and equally deeply unpleasant way of communicating their pain, threw me into deep turmoil. I felt they had some how been brainwashed to view themselves as hapless powerless objects. I was still concerned that, what I then believed to be the Kleinian approach, would actually collude with this subjective sense such clients had of who they are.

However, desperate to find a way to help, I re-read Klein, Bion, Kernberg, and as much of of the work of authors within this genre, as I could manage ( they would make a VERY long list!) And now and then I found clinical descriptions in which I recognized my own struggle. So, was they way 'in', to tolerate this ghastly lack of self esteem, this Sisyphus like seemingly certain knowledge that the task was hopeless. To for an hour ant at time- and sometimes for weeks at a time- to sit with these clients in their darkness, felling and believing what they did WITH THEM- and sometimes , as if FOR them. Dante called this 'purgatory'- living death.

I searched eagerly for more descriptions. Slowly some of the surrounding Kleinian theory also made a particular kind of sense. It somehow helped me to tolerate the pain. I still miss the total lack of any recourse to social, political, economic every day reality. To work purely on the distorted inner reality of a person who is so entirely cut off from normal human feeling and interaction still seemed extraordinarily like collusion with - if they exist - early maternal preoccupation - felt like a sort of folie a deux.

Also most of my clients had just enough social functioning not to have social work support unlike many of Melanie Klein's 'patients'.(When working with ADULT patients, Masud Khan's practice nurse would organize a taxi to collect a patient to come to the consulting rooms, take care of the patient, getting her to rest after the session, and then put her in a taxi, from which her housekeeper collected her- of course he could focus entirely on transference work, re- presenting inner experience... except- but this would be telling tales...)

Slowly I made SOME of the Kleinian ideas and ways of working my own. Once I realized that my being connected with the every day world in a very ordinary way as a person, made it both possible and safe to allow some of the processes involved in reparenting someone whose 'developmental defects' occur so early, and are reinforced by maladaptive behavior on the mother's side for so long. I do not now work with children ( usually)

Kleinan theory in itself does not help me to know whether I am fiddling while Rome burns!-it is not designed to do so, and I don't rely on it to do so. Unlike early Kleinians, whose clients usually had social work support, I must be aware of how much or how little practical support a client has, to make therapy a safe undertaking.

I most certainly need to frame many sessions where I work with 'unconscious feelings' ( this needs unpacking) with a transition phase, both before and after the session in which matters of safety could be discussed and appropriate steps taken- including hospitalization or similar).

I only need Kleinian theoretical concepts to help me decide whether

1. the client is heading for psychosis now

2. whether he is reproducing early learnt behaviors with me.In this case I must 'pass the test' ( Weiss and Sampson- see previous debates) and be as sane as possible.

3. whether one or other of his parents/relatives may have been very disturbed, possibly psychotic. These are three very different possibilities, and they would impact very differently on what it is safe to do in therapy.

I also work outside the transference and I therefore ask pertinent questions. I surmise that some, or maybe even most, Kleinians do so also. Some clients will have a psychiatrist who monitors all the 'outer world' safety issues, in which case there is probably a social worker uninvolved as well- and both these fellow professionals provide "containment" so that I can focus more on 'inner experience'. I THINK THESE CONTEXT FACTORS ARE CRUCIAL TO WHAT WE CAN AND CAN NOT OFFER SAFELY.

Above all, increasingly, as therapy progresses, and the 'patient' can tolerate more pain, because they say they feel I have given them a small opportunity to recover a little, by carrying some of their pain with them (helping them 'contain it'), I will teach them how to protest- to want to become emancipated.

I suspect the pure Kleinian way work very well for some people- who get to the desire for being a SUBJECT by themselves. But it is very expensive in time and money - and I am willing to see whether to integrate humanistic and other elements in this work does reduce the enormous cost - both in time and money. Tony Ryle who has borrowed a lot from this corpus, and with , I think, quite similar reservations ( see review of his book on working with Borderlines in the latest JPI) is actually doing some research into this right now. He has also gone a long way towards operationalizing and proceduralizing what can be spelt out in plain language.

There are many clients I work with, where I practically never find any thing of clinical value in the 'Kleinian' corpus, but, instead, I gather whatever I know about working cognitive-behaviorally, or cognitive-analytically. Other clients would, and will say so openly! leave therapy at once, at the suggestion of cognitive behavioral work. Instead they turn out to thrive with very client focused creative alliances in which they become co-therapists- or even their own therapist- where I feel like supervisor Barry Duncan, Art Bohart etc come to mind...) And some of these clients will in the end do the much needed cognitive behavioral work after all- once they trust me. AND SO ON FOR OTHER APPROACHES AND OTHER CLIENT GROUPS.

I could never be a true Kleinian,( because I am an integrationist) but I increasingly appreciate what this corpus has to offer when working with SOME very disturbed clients. ( I could probably give a back translation into other therapeutic languages of what this 'thinking or working differently' consists in, and what I mean by 'some'.

George, Shlomo, Arthur, ...I personally do not seek one unified theory. I seek a meta-framework which allows me:

# to compare

# to translate/ transpose fields of meaning from one theoretical language into another- se previous dialogues about Wittgenstein and Quine - The late Oxford philosopher Gareth Evens has made some interesting advances here...)

# to discuss in the nearest thing to a common natural language which most of us understand,what we do in practice- what interventions we use, with what rationale and outcome,

And to me that is what happens at every sepi conference in so many really illuminating presentations: Two years ago Marv, and, I think, you, Paul, borrowed Les Greenberg's slides to have the same meta-framework, and then you talked us through in different theoretical languages! And that why I am writing this at 2 am instead of... Cordially, Hilde.

Fri, 27 Oct 2000, Paul Wachtel 

Luca, I appreciate your effort to keep trying to clarify this issue, and to relate it to how clinicians are actually thinking. On the other hand, I write this response with trepidation -- I don't want to drive anyone else off the lists by keeping this topic as a trauma they need to "contain."

So here, briefly this time, I hope, is what troubles me about the term (did I really say "hate" or is that an interpretation?): First, it feels "trendy" and seems to be used, at least by my students, often more as a way to show they "belong," that they are up to the latest lingo, etc. But even more, it feels very imprecise -- Do I contain by MY not reacting too emotionally? Do I contain by actively helping the PATIENT not to react too emotionally? Do I contain by EMBRACING the feeling and hence do the OPPOSITE of helping the person suppress the emotion? Etc. One can say "all of the above," but then we are using one word for many meanings, and that does not aid precision.

Even more troubling is the association with other aspects of Bion's theorizing. It seems awfully concrete and, I must say, bizarre. The patient "puts the feeling into me." Then I rework it, metabolize it, make it grow and mature and make sense. And then I "put it back into him?"

But -- uh oh! -- I'm getting started again! If I don't "contain" myself this will turn into another of those overly long messages. So thank you and ciao, Paul.

Fri, 27 Oct 2000, Bob Sollod 

It seems to me that a major meaning of this term is that the therapist is aware of some problem or issue of the client and is not rattled, upset, or overwhelmed by it. I can understand why the term is thrown around a lot by therapists in training. It sounds trendy, as Paul says, and it also indicates that the budding therapist is up to dealing with a client's difficult issues, emotions, etc. This is often problematic for beginning therapists.

Fri, 27 Oct 2000, David Allen 

Everyone: While I am definitely an advocate for precise, operational definitions in psychotherapy, I also believe that some human experiences are best described through the use of metaphors. "Containment" I think, is a metaphor, and as such can be over-reified. On the other hand, the trouble with metaphors is they call forth a plethora of different associations, both within the mind of a given individual and across individuals. It's important for those who use metaphors to make sure they are on the same page as another person with whom they are having a conversation, rather than assuming that they know what the other person is talking about. In the past, psychoanalytic concepts have been too fuzzy, while cognitive-behavioral formulations have not captured the richness of human experience. Maybe in SEPI we can have a happy medium, dialectically speaking! David Allen.

Fri, 27 Oct 2000, Bob Sollod 

The emphasis on the term "container" indicates the Apollonian (as opposed to Dionysian) emphases in many of our therapeutic approaches. Overwhelming emotion and expression of it is considered a no-no in many therapeutic forms that promote rational control over emotional expressions. For the therapist to be emotionally expressive is mostly taboo. Much of this is, of course, culturally based, and has more to do with preferred styles of self-expression than with mental health per se. Best wishes, Bob Sollod.

Fri, 27 Oct 2000, Paul Wachtel 

David, Nicely put. Incidentally, I am a LOVER of metaphors, and am even working on a paper right at the moment in which I play with how much I love metaphor before addressing the potential ambiguities in another metaphor very commonly used, that of depth. So the balance in your comments seems to me very apt. Paul.

Fri, 27 Oct 2000, Luca Panseri 

Paul, you asked me: <<did I really say "hate" or is that an interpretation?>>.

Here is what you wrote on 20 Oct: << So… my main point is that just like you don't have to be Jewish to love Levy's rye bread... you also don't have to be outside the psychoanalytic community to "hate" container as a theoretical concept >>.

Your thought is very clear: the word and the concept "containment" mustn't be used for the many reasons you said. So I'm asking you: Do you agree that there is something like a 'maternal vertex' of the field (one pole of the reparenting axis), as Tullio suggests in his last mail? If you do, do you agree that it corresponds to the offer of a "secure base" experience, for the development of a secure attachment pattern? If you do again, how would you describe the basic attitude of the therapist in this vertex, avoiding the words 'containing' and 'holding'?.

About your worry "to drive anyone else off the list by keeping this topic as a trauma they need 'to contain'". I'm not worried about this. As a matter of fact there may be someone who can't tolerate the "trauma" of confronting different visions and putting ideas and positions at stake. If s/he avoids any confrontation by asking to be "cancelled from the list", may be that SEPI isn't really the right place for her/him. Ciao, Luca.

Fri, 27 Oct 2000, Allen Kalpin 

One implication of this discussion might be the following: "Container" is a good metaphor if you like it. If you don't, then it is not. We do not all have to use the same terminology. But we do need to be able to translate well. This discussion is good practice. Allen.

Sat, 28 Oct 2000, Paul Wachtel 

Luca, I largely agree with you about driving people off the list, although I do feel that it is important to be aware of people's tolerances and sensitivities and not to overload them in a way that seems to skew the focus of the list. Some of the discussion could be pursued back channel if we get feedback from people that they are tired of this topic. But we do need the feedback. I guess I should have left out Levy's Jewish Rye, since indeed it did open me to being perceived as "hating" containment as a concept. I do, obviously, have real difficulties with the concept, but my Levy-Jewish-love-hate comment was meant facetiously.

As to your main and substantive question, I think it merits a more full and serious consideration than can be offered right now in this venue.

Perhaps we can pursue it at a SEPI meeting. Suffice to say right now that I think the functions to which Tullio refers can indeed be described without the words containment or hold, but that also I have no objection to the words per se -- obviously they are words that in themselves are useful in a wide variety of contexts (I would certainly worry if a mother did not ever HOLD her baby. But whether this kind of holding, for example, is the same as the THEORETICAL holding is another question. It's not the words that trouble me. They are fine English words and I'm sure they have their fine Italian equivalents. It's the way they are used by theorists to imply something more, and a something more that is both vague and portentous, that I object to. As to the maternal and paternal vertices which Tullio discusses, here I would say something a little different, which I remember discussing with Tullio at a lovely dinner gathering at my home -- the functions he describes as "maternal" and "paternal" seem to me very important but I wonder, since Tullio correctly notes that mothers can be "paternal" and fathers "maternal", whether those names are the best. But that too is an issue probably best pursued at a forthcoming SEPI meeting. I would be very interested to participate in such a discussion. Thanks for joining us, Paul.

Sat, 28 Oct 2000, Ava Schlesinger 

Hi All, in a back-channel post, Tullio responded to my desire for more clinical references and at the same time suggested I react to the following. In a moment of bravery, and because I am feeling somewhat confused about the topic, I thought I would take Tullio's challenge. In a message dated 10/28/00, Tullio Carere writes:

<<So I'm asking you: Do you agree that there is something like a 'maternal vertex' of the field (one pole of the reparenting axis), as Tullio suggests in his last mail? If you do, do you agree that it corresponds to the offer of a "secure base" experience, for the development of a secure attachment pattern? If you do again, how would you describe the basic attitude of the therapist in this vertex, avoiding the words 'containing' and 'holding'?>>

My confusion about the "reparenting" aspect of psychotherapy is due to the vast controversy among so many respected colleagues. On one hand my right brain wants to believe it exists and that by creating a "secure base" if you will, the parenting process and attachment can be reprocessed in a healthier, adaptive way. The idea that the therapist takes on "maternal functions," as Tullio suggests, feels quite natural and inviting to me. On the other hand, my left brain has been most recently inundated with suggestions regarding the implausibility of this process. Anecdotal clinical reports from both client and therapist, speak to the potential for harm, especially where strict boundaries between patient and client become blurred; contemporary neuro-psychological exploration seems to be heading in the direction of showing that one's capacity to "attach" may be dictated by areas of the brain that suffer IRREVERSIBLE damage when deprived of "good enough" environments in infancy and early childhood. And even in my own belief in and desire to engage in a reparenting process, I question the logistical possibility of reparenting in a time frame of 1-2 or even 3 hours per week. So these are the just some of the issues (I have more, but wanted to keep this short) standing in the way of my completely embracing the concept of reparenting.

I guess I am mostly full of questions rather than answers. Psychotherapy as an art is much more comfortable to me than as a science, however, I do believe it needs to be a combination of both. Respectfully, Ava Schlesinger.

Sun, 29 Oct 2000, Diana Fosha 

Recently, Bob Sollod and Allen Kalpin wrote two commentaries which I found intriguing. First Bob Sollod:

"The emphasis on the term "container" in dictates the Apollonian (as opposed to Dionysian) emphases in many of our therapeutic approaches.

Overwhelming emotion and expression of it is considered a no-no in many therapeutic forms that promote rational control over emotional expressions. For the therapist to be emotionally expressive is mostly taboo.

Much of this is, of course, culturally based, and has more to do with preferred styles of self-expression than with mental health per se."

And Allen Kalpin: "One implication of this discussion might be the following: "Container" is a good metaphor if you like it. If you don't, then it is not. We do not all have to use the same terminology. But we do need to be able to translate well. This discussion is good practice."

I very much liked Allen's comment, putting the issue in terms of almost aesthetic preferences in one's metaphors. And separating that from the importance of the clinical issues being discussed. His point about gaining facility in translating back and forth between the languages of different models is also apt. I think specialized terminology is extremely important and ought not to be discarded (here I have a disagreement with Marv Goldfried) for it is in the very specialization of the language that progressive knowledge reflecting deepening based on previous achievements is contained. But at the same time, translating technical terms into ordinary language allows one to really consider again what is really contained (no pun intended) in the terms in question. It is precisely why teaching others is the best way to sharpen one's own learning.

Thank you Bob for introducing the Appolonian/Dyonissian distinction. It allowed me to realize why I have stayed out of the recent dialogue: my own ideas about the essential nature of the work revolve around issues of facilitation and fostering and deepening of emotional experience and expression; placing the "container" debates in the Appolonian realm produced the relief and relaxation that comes with understanding the reason for a discomfort/unease I did not even know I was feeling until after I got rid of it. Good intervention with the experiential payoff! Diana.

Sun, 29 Oct 2000, Tullio Carere 

A brief comment on the Apollonian/Dionysian issue. Bob Sollod saw an Apollonian quality in the emphasis on the term "container", that is a sort of bias towards rational control over emotional expression. Diana Fosha felt relieved as the "container" debate was placed in the Apollonian realm, because it allowed her to realize why she had stayed out of the recent dialogue.

Bion, maybe the most Dionysian psychoanalyst in the history of psychoanalysis, would be surprised. To him mental growth is only possible, if a person can tolerate to live "in the middle of a mental breakdown": "We have to be reconciled to the feeling that we are on the verge of a breakdown or some kind of mental disaster; we have to have a certain toughness to stand this continuing experience of mental growth....So you can take your choice: mental stagnation and decay on the one hand, or perpetual upheaval on the other - like living in the middle of a mental breakdown, without being clear whether one is breaking up or breaking down" (I owe this quotation from The Brazilian Lectures to the courtesy of Larry Wetzler).

Now, breakdown (temporary) can result in breaking up (growth) or breaking definitively down (madness): it depends whether or not an "apt container" is available. It is true, the container is the form, the Apollonian. But it is brought to bear only at the top of the emotional upheaval (the formless, the Dionysian), not at all to prevent it. On the other hand, if the debate has underscored the Apollonian containing, to the detriment of the Dionysian emotional upheaval, Bob & Diana's critique is in order. We'll have to take it into account. Tullio.

P.S.: And what about Hilde's message? Wasn't it Dionysian enough, to your taste?

Sun, 29 Oct 2000, Diana Fosha 

Tullio, re: the Dionysian emotional upheaval: Now you're talking.

Sun, 5 Nov 2000, Tullio Carere 

Ava, Luca, Paul, and all, after so many discussions it seems to me that we generally agree that in therapy we do something on the maternal-paternal line, as we also do something on the scientific-artistic line. It seems we also agree that although none of these functions can be transplanted as such into therapy--we cannot be real mothers, as we cannot be real scientists--there is nonetheless a kinship between therapy as a profession, and ordinary relationships. It seems that the same therapeutic agents are to be found across different therapies, as across natural and educational relationships, and they are to be meant as universal responses to the basic psychological and spiritual human needs.

But when it comes to define these general therapeutic agents, problems arise. For instance, everybody agrees that the therapist's (or the mother's) first duty is that of providing a safe environment for the client's (or the child's) growth. But how does the therapist or the mother do that? Half the world to describe the basic reassuring function in operative terms makes use of words like "empathy" and "holding". The other half of the world categorically rejects these words as confusing or misleading. Now, if we cannot find a minimal agreement at this very basic level, one can imagine what happens if we try to define what "science", or "art" are.

Where is the problem? I have a hypothesis. It is not mine, it is Hegel's. Hegel pointed out that problems always arise when we try to grasp things by the way of positive definitions. Every thing is intimately constituted by the relation with whatever it is not. Every thing is defined by what it is not, and in the same time it is what it is only in relation with its opposite. For instance, it would be impossible to define the maternal principle without putting it in dialectical relation with its opposite, the paternal principle: acceptation vs confrontation, or unconditional vs conditional bond. If Hegel is right, we should not try to define the basic therapeutic agents as isolated factors, as we would get nowhere. But we should try to identify the *basic polarities* of the therapy field. This should be our primary task. Does anybody have a better hypothesis? Tullio.

Mon, 6 Nov 2000, Ang Wee Kiat Anthony 

I find Hegel's dialectical perspective helpful in therapy and training. In our discussion regarding what is useful and what is not in therapy, we each have our preference as to how we would like to look at the therapeutic factors. Some prefer to think in terms of factors associated with being a good therapist; others find it more comfortable to know the kind of helpful actions to take (Being: Doing). To me, the essence of therapy is about becoming-in-relating.

The findings of science offers some interesting insights into the dialectical aspects of Hegel's thinking. One of the curious limitations of science is captured in the uncertainty principle (ie the impossibility of describing the position and velocity of a particle with the same degree of certainty at the same time). The other paradox is how the nature of light can be viewed both as wave and/or particle. Applied to therapy, the moment we seek to accurately observe and describe what goes on in therapy sessions we will find something happening to our becoming-in-relating with the client/patient. We have to accept that focusing on being/doing as two complementary perspectives can be helpful at different points in time. I feel that an important, though not often articulated, function of psychotherapy supervision is to help psychotherapy trainees appreciate this inherent paradox. The desired consequence is that practitioners would experience a degree of flexibility and freedom to relate to their clients/patients rather than be fixed in a certain posture to maintain the delicate balancing act between the various polarities in therapy.

I like the idea of thinking in terms of basic polarities in therapy (e.g., paternal:maternal; supportive:interpretive; eastern:western; etc). On closer examination, however, each pole is not merely the opposite of the other but takes the other to a slightly different plane. (To put it another way, East is opposite of West only on a flat surface. On the 3-dimensional globe, each leads to the other and yet both disappears into the North and South poles.) I'm suggesting that one fundamental polarity is that of being:doing and how it has been helpful to me when I take it as a step in the direction of becoming-in-relating. It moves me from theoretical discussions to clinical work and from private thoughts to sharing with a community of persons. Anthony Ang.

 

 

Return to Cyberpsych.org Index Page    |   Return to SEPI Index Page