Ten Seminal Papers in Relational Psychoanalysis

1.
Stern DB (1983) Unformulated experience: From familiar chaos to creative disorder. Contemporary Psychoanalysis 19(1): 71-99.

The importance of this paper lies in Stern’s presentation of his influential concept of “unformulated experience”. Stern’s thesis, in opposition to classical Freudian views on repression, is that there are no fully formulated thoughts or cognitions kept outside of awareness waiting to be revealed by the analyst. Instead, they appear in an inchoate form that Stern attempts to define in the remainder of the paper. In Freud’s account meaning is fully formulated and available to be put into words if resistance can be overcome.

However, unformulated experience can be defensively kept at the state of a “familiar chaos” (p. 74). Stern does not discount repressed experience either, but argues that for such a thing to be possible, meaning has to be fully formulated in the first place. He traces the concept of unformulated experience back to Sullivan’s observation that “(m)uch of that which is ordinarily said to be repressed is merely unformulated (1940: 185). Subsequently, Stern turns to more recent evidence to support his thesis. We also encounter the use of the term “constructivism” (p. 78), although in this paper it is used within the framework of cognitive psychology, as the current alternative to associationist views assuming equivalence between reality and perception. Constructivism and social constructionism were to become important philosophical positions of many relational analysts.

2.
Ghent E (1990) Masochism, submission, surrender: Masochism as a Perversion of Surrender. Contemporary Psychoanalysis 26: 108-136.

Drawing on a number of Winnicottian concepts, Ghent attempts to clarify the meaning of surrender as a concept distinct from masochism and submission. It refers to the self’s surrender to the ego as the antidote to the false self’s resistance and commitment to the status quo. Submission is an agent of resistance and at best an adaptation of perceived necessity. Ghent speculates on the existence of a wish to for the true self to experience a rebirth, to “come clean” of all the defences in the service of this notion to surrender. This wish that is essentially one of being recognised by the Other. Ghent enumerates some of the characteristics of surrender highlighting its difference from submission. Acceptance is an outcome of surrender, resignation an outcome of submission.

Ghent often references the difference between West and East, defeat and yielding, information and transformation, with a clear position against the limitations of the west. He references Marion Milner’s work on art, and other sources as he attempts to articulate the phenomenology of surrendering, attempting to hypothesise the developmental origins of this phenomenon. He does not see it as an inherent drive towards self-integration, but as a need towards restitution where development has become stunted. It appears as something complex that can sometimes be confused with depression, withdrawal or even psychosis. The wish to surrender occupies a boundary between wish and fear, as it involves facing the dread that originally resulted in the formation of the false self. This “controlled dissolution of self-boundaries is at times sought, not only feared” (p. 116). He likens it to Winnicott’s fear of breakdown, the dread of experiencing a breakdown that has already occurred, but also the wish to remember it.

However, masochism can also masquerade as “the passionate longing to surrender” (p. 115). The fruits of masochistic submission do not fulfil the promise of surrender and in fact Ghent sees masochism as a wished for patterned impingement that echoes an original experience of impingement during infancy. The individual is largely defined by their reactions to the environment rather than “finding” the environment and creating an individual experience. Likewise rape fantasies may conceal such a wish to surrender and orgasmic experience is the most tangible form of surrender.

Furthermore, reckless endangerment of life, as well as the “pull to manifest infantilism and helpless demandingness” (p. 119) are failed manifestations of surrender. Ghent offers two compelling clinical vignettes to illustrate how the expression of surrender is intimately interweaved with masochism (pp. 119-120) and, at least initially, seeks recourse to masochism. Additionally, Ghent sees sadism as the perversion of object usage. The transition from object-relating to object-usage involves the survival of the object and the realization that the object exists in “reality”, outside the self. Sadism is thus seen as a perversion of a wish to penetrate the other in order to know the other. Ghent continues thinking about the dilemma between the wish for and fear of surrender by examining instances of repetition-compulsion.

3.
The first issue of Psychoanalytic Dialogues:

(a) Aron L (1991) The patient’s experience of the analyst’s subjectivity. Psychoanalytic Dialogues 1(1): 29-51.

As the title suggests, Aron see the analyst’s examination of the patient’s experience of the analyst’s subjectivity as a central aspect of the analytic work. Aron starting point is both developmental and feminist critiques related to the precise role of the mother (or presumably the primary caregiver) in the infant’s life. Aron emphasizes a line of thought that argues that seeing the m/other as a “separate” object is insufficient articulation of her role. Additionally, the development of “intersubjectivity (p. 31) refers to a separate developmental line (Benjamin 1988) that concerns the infant’s capacity to perceive the mother as a separate person with her own agency, initiative and desire (Aron 1991: 31). Aron explicitly cites Benjamin’s work as an influence and clarifies that his own understanding of intersubjectivity is different from “Intersubjective Psychoanalysis” (see Stolorow and Atwood’s work).

Aron believes that clinical psychoanalysis has not sufficiently considered the patient’s experience of the analyst as a centre of subjective experience. Traditional psychoanalysis in his view has applied the term countertransference to the totality of the analyst’s responsiveness to the patient. In contrast, he believes that the analyst is not simply reacting or responding to the patient, but can initiate interactions. He believes that the relationship between analyst and patient, although unequal and asymmetrical, is one of “mutual influence” (a topic he would later expand on) as Beebe and Lachmann (1988a, 1988b) have proposed. Aron references previous analytic publications from a variety of authors who argue that the earliest reality of the infant is the mother’s unconscious and that the infant is wired to seek an understanding of the mother’s psychology. This means that the infant, unconsciously, forms opinions about the mother’s own relationship to her own parents and the mother’s attitude towards the infant.

Given the centrality of curiosity about a caregiver’s mind during development, Aron attemtps to transfer the implications of this argument into the analytic situation. One of Aron’s points is that a patients’ resistance is patterned according to their unconscious perception of the analyst’s also unconscious psychology. For a resistance to be successful it has to be tailored to this particular analyst’s psychology. Rather than simply emanating from the patient’s idiosyncratic history, it also includes aspects of the analyst’s personality that the latter is not aware of. The analysis of resistance therefore not only educates the patient about unconscious aspects of their own psychology, but also that of the analyst. Aron continuously emphasizes that the analyst’s psychology refers to more than the countertransference, more than just the analyst’s responsiveness to this particular patient. Consequently, the patient’s insight extends beyond the confines of their own unconscious to encompass an progressive understanding of the analyst’s own repressed or dissociated material. However, because the patient is unconsciously aware that these aspects of the analyst are being kept outside the analyst’s awareness, the patient is likely to communicate about them only directly. Finally, the patients’ desire to know their analysts is not simply viewed as an attempt to control or retaliate, but as a fundamental need to connect with someone important to them.

The clinical implication is that Aron will ask patients to reflect on what had led them to believe that he is acting in a particular way towards them. He stressed that this question needs to be asked in a genuine attempt to learn something that he might not have previously been aware of. Aron believes that the patient may have indeed noticed something about him that he is not aware of yet. However, this is not a technique he recommends to be used out of context as he will often interpret the patient’s curiosity as a defensive maneuver to deflect attention from the patient’s present emotional state. If it is true that the patient’s resistance is partly due to their anxiety to formulating to themselves and the analyst what they perceive to be the analyst’s unconscious material, then the analysis of resistance need to illuminate obstacles to verbalizing these ideas. The patient may be frightened that the analyst will retaliate, withdraw, or collapse if the analyst’s unconscious is exposed by the client.

Another clinical implication concerns self-disclosure. Having been invited or “tantalized” (Aron 1991: 40) to elaborate on the analyst’s experience means that the patients may put mncreased pressure to confirm or refute the patent’s views: As such this line of questioning may be foreclosed due to the analyst’s anxiety about self-disclosure. Additionally, the analyst’s self-disclosure would communicate that the analyst states what he feels of thinks as if he or she is assuming full consciousness of their current mental state.

One of the risks with this approach is that the analyst’s subjectivity could take over the patient’s psychic and analytic space. Furthermore, a central consideration should be that the patient may need to find the analyst as a separate person at their own rate: To be allowed to struggle with ambiguity, lack of resolution, uncertainty, and partial clarity.

4.
(b) Hoffman IZ (1991) Discussion: Toward a social?constructivist view of the psychoanalytic situation. Psychoanalytic Dialogues 1(1):74-105.

A common theme in these papers by Modell, Aron, and Greenberg is an emphasis on the importance of the personal presence and participation of the analyst in the psychoanalytic process. A real, personal relationship of some kind is thought to develop inevitably. The only options have to do with whether or how the patient and the analyst attend to it, choices that will, in turn, affect the quality of the experience for both participants. (Hoffman 1991:75)

Although this paper is a commentary to articles by Aron and Modell published in the same issue of Psychoanalytic Dialogues, it is an influential and often cited paper because it addresses RP’s emerging ontological and epistemological shifts that were beginning to form a distinct emphasis in American analytic thought. Hoffman clarifies that he is not commenting on a the shift from a drive to a relational model, but a move from positivism to contructivism/perspectivalism: This was, at the time, a germinal and somewhat implicit thesis underlying Aron’s, Model’s, and Greenberg’s attention to the patient’s experience of the analyst, and the “real” relationship that eventually develops in the analytic situation. Hoffman sees such a position as the only real acknowledgment of the analyst’s involvement in the analytic process:

(a) The analyst’s participation affects his understanding of the clinical process. (b) The analyst participates with the totality of his personality, conscious and unconscious. (c) As a result of (a) and (b) the analyst’s understanding is only a perspective at any one given moment and one that is vulnerable to distortions from the analyst’s unconscious resistance. (d) Likewise, the patient’s perspective is subject to the same conditions. It is not simply fantasy, but the outcome of the realisation of “unformulated experience” (Stern 1997).

The next part of the paper is an elaboration of Hoffman’s view that relational does not equate social-constructivist. “Any divorcing of the intrapsychic and the interpersonal is unacceptable in this model (p. 82). He references different parts of Aron’s, and Greenberg’s papers, teasing out elements that appear to illuminate his understanding of what actions are in line with a constructivist paradigm, whilst also acknowledging that often analysts act differently to their public theories.

5.
Davies Messler J (1994) Love in the afternoon: A relational reconsideration of desire and dread in the countertransference. Psychoanalytic Dialogues 4: 153-170.

This paper is particularly interesting because it negotiates a particular kind of self-disclosure by the analyst, that of sexual feelings and fantasies to the patient. A case vignette is presented where an otherwise inhibited young man discusses his sexual fantasies towards the analyst, but appears to shut down just at those moments that the analyst is about to speak and comment. Davies reports having tried to address this issue for a long time and in many ways without success, until she decides to share with her patient that she too has fantasies about him. Of particular interest is the idea she proposes that expecting a patient to take a risk and express something despite the anticipated fear of humiliation or abuse can sometimes become ineffectual if the analyst is not prepared to take the same risk. She emphasises that it is particularly with patients that have fallen victim to child sexual abuse that the need to acknowledge what has happened becomes of central importance. The implication is that honesty and integrity from the analyst can become catalysts in the working through of such past traumas.

6.
Ogden TH (1994) The Analytic Third: Working with intersubjective clinical facts. International Journal of Psycho-Analysis 75: 3-19.

Although usually considered a relational psychoanalyst, Ogden put forward a highly influential paper that has enriched the understanding of intersubjectivity as understood in relational circles. This is a subject that Ogden has been writting about since the 1970’s, and his starting point is British psychoanalysis. Ogden starts from Winnicott’s notion that there is no such thing as a baby, but only a maternal couple. Ogden presents a clinical example that details his own free associations during his patient’s speech. He emphasises how events, ideas, recollections, bodily sensations, though part of Ogden’s own psychology and history, are created anew as analytic objects cathected with a significance that belongs to neither analytic participant, but emerge as the outcome of the couple’s intersubjective meeting. In other words, whatever the analyst thinks about during the analytic hour is bound to not only be affected by the analysand, but actually carry meaning about the nature of the unfolding analytic relationship.

7.
Bromberg P (1996) Standing in the spaces. Contemporary Psychoanalysis 32(4): 509- 535.

The starting point for this paper is that even in “normal” people personality is not unitary but shaped by dissociation, repression and intrapsychic conflict, a view that echoes Fairbairn’s views about the centrality of splitting in the Ego (ref). In contrast, multiplicity holds primacy over unity in human beings and unitary selfhood is a healthy illusion. Bromberg discusses how this illusion exists in a dialectic of multiple self-states, the latter being in formation from the earliest days of infancy an observation that in other circles may be advanced as the context dependence of personality or in fact the fallacy of assuming a consistent self or personality in human beings. Bromberg notes that integration and linear development have often been assumed to be the normative courses in human development. However, he cites Winnicott’s distinction between true and false self as a potential precursor of the current challenge to linearity. Bromberg (p. 514) proposes the following conceptualisation of normal multiplicity of self-states:

An individual has a healthy illusion of a coherent self. One is only momentarily aware of the existence of individual self-states. Each self state has its own reality: Values, beliefs, feelings, and perspectives. Each self-state functions optimally without loss of communication and negotiation with, and information from other self-states. It is ordinary for self-states be in conflict with each other. Ordinary healthy dissociation involves cognitive and affective immersion in one self-state. It is unusual for a self-state to function outside the sense of “me-ness”. When the illusion of coherence is threatened by traumatic disruption that leads to intense conflict, this illusion becomes a liability if the conflict cannot be processed symbolically. When the illusion of coherence is perceived to be a liability, dissociation develops into a defence mechanism that ensures one will not be in a position of complexity where conflict can be perceived.

The concept of “standing in the spaces” (p. 516) alludes to the healthy capacity to occupy a metaphorical position between realities and make space for experience that is not readily accommodated by the experience of me-ness of that moment. In contrast, dissociation serves an investment to maintain the separateness of self-states that does not allow the simultaneous perception of different self-states: One believes that this state of affairs has the capacity to create unbearable conflict.

The function of analytic work is to promote conflict where dissociation previously operated. In this case repression becomes possible as function of the total personality and traditional interpretative work can occur. Interpretations that address conflict and what has been repressed as a result of that conflict are not very helpful if the patient first need to be assisted in tolerating conflict, which entails a willingness to perceive mental states in oneself and others. This involves validating the patient’s experience of observing and reflecting on self-sates that he potentially hates. The paper contains a number of clinical examples aimed at illustrating the phenomenology of dissociation and the emerging capacity to hold different states of self in consciousness simultaneously.

8.
Spezzano C (1998) Listening and interpreting – How relational analysts kill time between disclosures and enactments: Commentary on papers by Bromberg and by Greenberg. Psychoanalytic Dialogues 8(2): 237-246.

This article is part of an issue of Psychoanalytic Dialogues that explored the issues of clinical judgment in relational psychoanalysis. Given that relational psychoanalysts have emphasised the importance of self-disclosure and enactment, and given their interest in newer developmental insights that privilege the emergence of intersubjectivity before subjectivity, Spezzano attempts to clarify what he sees as some misconceptions held about relational psychoanalysis.

He asserts that relational analysts do assume that childhood representations affect the way a patient perceives the world and others and they do indeed interpret these as they manifest in the analytic relationship. However, they also assume that what emerges in the analytic space is a co-construction. The analyst is also a spokesperson for the analytic community and interested in how a patient relates to analytic discourse as well as the analyst. Spezzano continues by further examining the issue of self-disclosure and contrasts clinical examples that may highlight the more classical technique of concentrating on the patient’s mind during a transference reaction, as opposed to acknowledging the potential utility of the analyst disclosing an aspect of his or her subjectivity. He proposes that the analyst must constantly be asking how much self-disclosure can serve the analytic function of understanding and containment and how much it allows the client to experiment with different relational styles.

9.
Benjamin J (2004) Beyond doer and done to: An intersubjective view of thirdness. The Psychoanalytic Quarterly LXXIII(1): 5-46.

This is one of Benjamin’s newer papers where her previously articulated concepts of the “third” and “mutual recognition” are used to advance understanding of intersubjecitivty and challenge classical analytic assumptions about technique. She defines intersubjectivity as a relationship of mutual recognition (Benjamin 2004, 2009). Mutual recognition refers to the perception and acknowledgement of another person as a subject who has a similar and yet separate mind. This is in contrast to the perception of one participant as a subject that “does” something to the other, who is then left feeling as an object that has been “done to” (Benjamin 2004). The difference between a subject-subject and a subject-object relationship is the difference between reciprocity (two-way directionality) and complementarity (one-way directionality). A subject-subject relationship in Benjamin’s view (2004) requires the position of a “third”: This is not an object (such as the analyst’s theory), but a sort of mental space that Benjamin likens to Winnicott’s potential space. “Surrendering” to the third implies achieving a state of freedom involving accepting connectedness and difference rather than occupying a position of control and coercion.

For Benjamin (2004, 2009) a crucial component of the analyst’s surrender translates in practice into acknowledging their own feelings as well as their own responsibility for the state of an enactment. Benjamin (2004) criticises the position often taken by object relations theorists who try to discern “who does what to whom” in the analysand’s narrative and transference, an outcome of the theoretical position that the analysand’s mind is populated by internal objects that “do” to the analysand and the analysand “does to them”. These object relationships, the related affects and thoughts, the defences against these affects constitute at any time the analysand’s unconscious phantasy, expressed in the here and now of the analytic encounter. In contrast Benjamin (2009) argues that, at least some of the time, the analyst’s taking up a position of observation can constitute a dissociative distancing from the way that the analyst inevitably wounds the analysand in the process of helping him or her. When the analyst’s conduct has shamed or wounded in some way the analysand, the analyst struggles with their own shame and guilt. Benjamin argues for the importance of the analyst remaining in touch with these feelings in the service of undergoing a process of mutual self-regulation with the analysand. Like many other relational analysts Benjamin (2009) considers that hurting the analysand is an inevitable part of the work, i.e. enactment of some sort is unavoidable. She considers that “moments of excess that fail to evoke a mirroring knowledge can serve instead to signal the unformulated, undifferentiated malaise, despair or fear” (Benjamin 2009: 441). In other words enactment is the only way to access dissociated parts of the self. However, the analyst’s capacity to forgive himself or herself is an important part of the work.

10.
Beebe B and Lachmann A (2002) Organizing principles of interaction from infant research and the lifespan prediction of attachment: Application to adult treatment. Journal of Infant, Child & Adolescent Psychotherapy 2(4): 61-89.

The struggle to symbolize the implicit action level can be seen as one of the major goals of psychoanalysis (Bucci 1985, 1997). The nature of the symbolization can then potentially affect the implicit action level. However, therapeutic action proceeds in both these modes, whether or not they are integrated� Attachment researchers share the assumption that mental models of relationships are open to revision. However, they differ in emphasizing personal continuity versus dyadic transaction and transformation; they differ in the degree to which these mental models are seen as co-constructed, transformational processes, organized as a function not only of the individual, but of the relationship pattern. (Beebe and Lachmann 2002: 65).

Beatrice Beebe and Frank Lachmann (Beebe and Lachmann 1988a, 1988b, 1994, 1998, Lachmann and Beebe 1996) have developed a model of change based on the microanalysis of on moment-to-moment mother and infant interactions as well as a non-linear dyadic systems theory. Patient-therapist interactions, like mother-infant exchanges, are co-constructed, resulting in a relationship that may be asymmetrical, but that involves each partner “regulating the other”. Self-regulation refers to an individual’s capacity to modulate their states of arousal, that is to self-comfort/self-sooth and organise one’s behaviour in predictable ways. Interactive regulation is seen as an ongoing process that is constructed moment-by-moment by both participants. Both patient and therapist affect the process of interactive regulation based on their own capacities for self-regulation at the time that are specific both in style and range.

In this more recent and oft cited paper, Beebe and Bachmann investigate (a) vocal rhythm co-ordination, (b) facial mirroring, and (c) distress regulation. The authors’ thesis is that these three processes mediate all attachment based/intimate relationships across the lifespan from infancy onwards: They predict attachment patterns at one year of age, and attachment patterns at that point predict adult attachment. In this article, Beebe and Bachmann recapitulate their theory of (a) mutual regulation and (b) implicit relational knowing. The first concept flows from a “dyadic systems” view. All interactions between mother and infant, patient and analyst are co-constructed. Mutual influence involves each participant regulating his or her own self and the self of the other, and these forms of regulation are integrated. This process of mutual influence is not necessarily equal or symmetrical, and that is unambiguously the case for the analytic relationship. Beebe and Lachmann underscore that “bi-directional coordination refers to the probability that one person’s behavioral stream can be predicted from that of the other, and vice versa” (p. 64). The clinical implication of this model is that both patient and analyst affect each other and each participant’s subjectivity is an emergent process.

Implicit relational knowing involves interpersonal expectations that become represented at an implicit-procedural level starting from infancy, and long before explicit-symbolic representations develop. These expectations arise out of the infant’s capacity to influence and be influenced by the mother and to therefore regulate his or her own self and that of the mother. This results in developing sense of self as agent able to influence and predict the behaviour of others and also their own. The implication of these concept is that “rhythms of dialogue” involving the expectation of particular patterns of facial, voice, rhythm and orientation recognition between two partners. They are procedurally encoded action sequences. These operate alongside and outside of the explicit symbolic realm unless differentiated from and integrated with each other in psychoanalysis.