Breakdown and Repair
There may be no tenet more important to overcoming this shame and blame in analytic work than the idea that recognition continually breaks down, that thirdness always collapses into twoness, that we are always losing and recovering the intersubjective view. We have to keep reminding ourselves that breakdown and repair are part of a larger process, a concomitant of the imperatives of participating in a two-way interaction. This is because, as Mitchell (1997) said, becoming part of the problem is how we become part of the solution. In this sense, the analyst's surrender means a deep acceptance of the necessity of becoming involved in enactments and impasses. This acceptance becomes the basis for a new version of thirdness that encourages us to honestly confront our feelings of shame, inadequacy, and guilt, to tolerate the symmetrical relation we may enter into with our patients, without giving up negative capability—in short, a different kind of moral third.
Until the relational turn, it seems, many analysts were content to think of interpretation as the primary means of instituting the third. The notion of resolving difficulties remained some version of the analyst's holding onto the observing position, supported by theory, and hence formulating and interpreting in the face of impasse. Relational analysts are inclined to see interpretation as action, and to recognize, as Mitchell (1997) pointed out, that holding onto interpretation could perpetuate the very problems the interpretation is designed to address. An example is when an analyst interprets a power struggle, and the patient experiences this, too, as a power move.
Relational analysts have explored a variety of ways to collaborate with the patient in exploring or exchanging perceptions. For instance, the analyst might call for the patient's help in figuring out what is going on, in order to open up the space of thirdness, rather than simply putting forward his own interpretation of what has just gone wrong (Ehrenberg 1992). The latter can appear to be a defensive insistence on one's own thinking as the necessary version of reality.
Britton (1988, 1998) explicitly considers the way the complementary opposition of my reality and your reality gets activated within the analytic relationship when the presence of an observing third is felt to be intolerable or persecutory. It feels, Britton remarked, as though there is room for only one psychic reality. I have been trying to highlight the two-way direction of effects in this complementary dynamic, the symmetry wherein both partners experience the impossibility of acknowledging the other's reality without abandoning one's own. The analyst may also be overwhelmed by how destructive the patient's image of her is to her own sense of self. For instance, when the patient's reality is that "You are toxic and have made me ill, mad, and unable to function," the analyst will typically find it nearly impossible to take that in without losing her own reality.
I believe that the analyst's feeling of being invaded by the other's malignant emotional reality might mirror the patient's early experiences of having his own feelings denied and supplanted by the parent's reality. The parental response that the child's needs for independence or nurturance are "bad" not only invalidates needs, and not only repels the child from the parent's mind; equally important, as Davies (2002) has shown, the parent is also subjecting the child to an invasion of the parent's shame and badness, which also endangers the child's mind.
Where this kind of malignant complementarity takes hold, the ping-pong of projective identification—the exchange of blame —is often too rapid to halt or even to observe. The analyst cannot function empathically, because attunement to the patient now feels like submission to extortion, and it is partly through this involuntary response on the analyst's part to the patient's dissociated self-experience that trauma is reenacted. Neither patient nor analyst can have a grip on reality at this point—what Russell (1998) called "the crunch," often signaled by the feeling expressed in the question, "Am I crazy or is it you?"
The analyst caught in the crunch feels unable to respond authentically, and against her own will, she feels compelled, unconsciously or consciously, to defend herself against the patient's reality. When the analyst feels, implies, or says, "You are doing something to me," she involuntarily mirrors the you who feels that the other is bad and doing something to you. Therefore, the more each I insists that it is you, the more each I becomes you, and the more our boundaries are blurred. My effort to save my sanity mirrors your effort to save your sanity. Sometimes, this self-protective reaction shows itself in subtle ways: the analyst's refusal to accommodate; the occurrence of a painful silence; a disjunctive comment, conveying the analyst's withdrawal from the rhythm of mutual emotional exchange, from the one in the third. This reaction is registered in turn by the patient, who thinks, "The analyst has chosen her own sanity over mine. She would rather that I feel crazy than that she be the one who is in the wrong."
This deterioration of the interaction cannot yet be represented or contained in dialogue. The symbolic third—interpretation —simply appears as the analyst's effort to be the sane one, and so talking about it does not seem to help. Certain kinds of observation seem to amplify the patient's shame at being desperate and guilt over raging at the analyst. As Bromberg (2000) pointed out, the effort to represent verbally what is going on, to engage the symbolic, can further the analyst's dissociative avoidance of the abyss the patient is threatened by. In reviewing such sessions in supervision, we find that it is precisely by "catching" a moment of the analyst's dissociation—visible, perhaps, in a subtly disjunctive focus that shifts the tone or direction of the session—that the character of the enactment comes into relief and can be productively unraveled.
Britton (2000) has described the restoration of thirdness in terms of the analyst's recovery of self-observation, such that "we stop doing something that we are probably not aware of doing in our interaction with the patient." I would characterize this, in accord with Schore (2003), as the analyst's regaining self-regulation and becoming able to move out of dissociation and back into affectively resonant containment. Another way to describe it is that the analyst has to change, as Slavin and Kriegman (1998) put it, and in many cases this is what first leads the patient to believe that change is possible. While there is no recipe for this change, I suggest that the idea of surrendering rather than submitting is a way of evoking and sanctioning this process of letting go of our determination to make our reality operative. To do this— and I think this has been clarified only recently, and insufficiently remarked upon prior to recent relational and intersubjectively informed literature (see Bromberg 2000; Davies 2002, 2003; Renik 1998a, 1998b; Ringstrom 1998; Slavin and Kriegman 1998; Schore 2003; and Slochower 1996)—is to find a different way to regulate ourselves, one in which we accept loss, failure, mistakes, our own vulnerability. And, if not always (as Renik [1998a] contends), we must certainly often feel free to communicate about this to the patient.
Perhaps most crucial to replacing our ideal of the knowing analyst with an intersubjective view of the analyst as responsible participant is the acknowledgment of our own struggles (Mitchell 1997). The analyst who can acknowledge missing or failing, who can feel and express regret, helps create a system based on acknowledgment of what has been missed, both in the past and the present. There are cases in which the patient's confrontation and the analyst's subsequent acknowledgment of a mistake, a preoccupation, misattunement, or an emotion of his own is the crucial turning point (Jacobs 2001; Renik 1998a). For, as Davies (2002) illustrated, the patient may need the analyst to assume the burden of badness, to show her willingness to tolerate it in order to protect the patient. The analyst shoulders responsibility for hurting, even though her action represented an unavoidable piece of enactment. A dyadic system that creates a safe space for such acknowledgment of responsibility provides the basis for a secure attachment in which understanding is no longer persecutory, outside observation, suspected of being in the service of blame. The third in the one can be based on this sense of mutual respect and identification.
As analysts, we strive to create a dyad that enables both partners to step out of the symmetrical exchange of blame, thus relieving ourselves of the need for self-justification. In effect, we tell ourselves, whatever we have done that has gotten us into the position of being in the wrong is not so horribly shameful that we cannot own it. It stops being submission to the patient's reality because, as we free ourselves from shame and blame, the patient's accusation no longer persecutes us, and hence, we are no longer in the grip of helplessness. If it is no longer a matter of which person is sane, right, healthy, knows best, or the like, and if the analyst is able to acknowledge the patient's suffering without stepping into the position of badness, then the intersubjective space of thirdness is restored. My point is that this step out of helplessness usually involves more than an internal process; it involves direct or transitionally framed (Mitrani 2001) communication about one's own reactivity, misattunement, or misunderstanding. By making a claim on the potential space of thirdness, we call upon it, and so call it into being.
This ameliorative action may be thought of as a practice that strengthens the third in the one—not only the simple, affective resonance of the one in the third, but also the maternal third in the one, wherein the parent can contain catastrophic feelings because she knows they are not all there is. I also think of this as the moral third—reachable only through this experience of taking responsibility for bearing pain and shame. In taking such responsibility, the analyst is putting an end to the buck passing the patient has always experienced—-that is, to the game of ping-pong wherein each member of the dyad tries to put the bad into the other. The analyst says, in effect, "I'll go first."6 In orienting to the moral third of responsibility, the analyst is also demonstrating the route out of helplessness.
In calling this the moral third, I am suggesting that clinical practice may ultimately be founded in certain values, such as the acceptance of uncertainty, humility, and compassion that form the basis of a democratic or egalitarian view of psychoanalytic process. I am also hoping to correct our understanding of self-disclosure, a concept that developed reactively to counter ideas about anonymity. In my view, much of what is misunderstood as disclosure is more properly considered in terms of its function, which is to acknowledge the analyst's contribution (generally sensed by the patient) to the intersubjective process, thus fostering a dyadic system based on taking responsibility, rather than disowning it or evading it under the guise of neutrality.
Let me briefly illustrate with an example presented by Steiner (1993), which touches on the analyst's difficulties with feeling blamed. Steiner cites an interaction in which he went too far in his interpretation, adding a comment with a "somewhat critical tone to it which I suspected arose from my difficulty in containing feelings …anxiety about her and possibly my annoyance that she made me feel responsible, guilty, and helpless" (p. 137, italics added). In supervising and reading, I have seen numerous examples of this kind of going too far, when the analyst thinks he has managed the discomfort of suppressing his own reality and reacts by dissociatively trying to insert it after all (Ringstrom 1998). Despite this aside to us, his colleagues, in the actual event, Steiner (1993) dismissed the patient's response to him as projection, because he felt that "I was being made responsible for the patient's problems as well as my own" (p. 144). He does not seem to consider the symmetry between his reaction and her reaction—which was to feel persecuted because he "implied that she" (that is, she alone) "was responsible for what happened between us" (p. 144). So, rather than "disclosing" that indeed he was feeling responsible and that he had gone too far, he rejects the possibility of confirming her observation that "over the question of responsibility, she felt I sometimes adopted a righteous tone which made her feel I was refusing to examine my own contribution ... to accept responsibility myself" (p. 144).
While Steiner accepts the tendency to be caught in enactment, and the necessity for the analyst to be open minded and inquiring in order to be helped by the patient's feedback, he insists that the analyst must cope by relying on his own understanding, just as he insists that the patient is ultimately helped only by understanding rather than by being understood. Both analyst and patient are held to a standard of relying on individual insight, the third without the one, rather than making use of mutual, albeit asymmetrical, containment (Cooper 2000). Steiner's definition of containment excludes the possibility of a shared third, of creating a dyadic system that contains by virtue of mutual reflection on the interaction. Thus, he rejects use of the intersubjective field to transform the conflict around responsibility into a shared third, an object of joint reflection. And he dismisses the value of acknowledging his own responsibility because he assumes that the patient will take such openness as a sign of the analyst's inability to contain; the analyst must engage neither in "a confession which simply makes the patient anxious, nor a denial, which the patient sees as defensive and false" (Steiner 1993, p. 145).
But what is the basis for assuming that the patient would be made anxious or perceive this as weakness rather than as strength (Renik 1998a)? Why would it not relieve her to know that the analyst is able to contain knowledge of his own weaknesses, and thus strong enough to apologize and recognize his responsibility for her feeling hurt? It seems to me that it is the analytic community that must change its attitude: accepting the analyst's inevitable participation in such enactments, as Steiner seems to do, also implies the need for participatory solutions. The surrender to the inevitable can be the basis of initiating mutual accommodation and a symmetrical relation to the moral third—in this case, the principle of bearing responsibility ("I'll take the hit if you'll take the hit").
Accommodation, Co-Creation, and Repair
I will illustrate this creation of shared responsibility in a case of breakdown into complementarity, a prolonged impasse in which any third seemed to destroy the life-giving oneness.
A patient whose early years in analysis provided an experience of being understood and safely held began to shift into traumarelated states of fearing that any misunderstanding—that is, any interpretation—would be so malignant that it would catapult her into illness, despair, and desolation. Aliza, a successful musicologist, had fled Eastern Europe as a child and had suffered a series of catastrophes with which her family had been nearly unable to cope; among them was Aliza's having been left by her mother with strange relatives who barely spoke her language. After several years on the couch during which Aliza experienced me as deeply holding and musically attuning, a series of misfortunes catalyzed the appearance of catastrophic anxieties, and my presence began to seem unreliable, dangerous, and even toxic.
My efforts to explain this turn appeared to Aliza as blind denial of her desperation, as dangerous self-protection, evasion of blame. My adherence to the traditional third, the rules of analytic encounter, began to seem (even to me) a misuse of the professional role to distance myself from her agonies and to withdraw as a person, in effect dissociatively shutting the patient out of my mind. Any effort to explain this awful turn, even when Aliza asked it of me, could turn into a means of shifting the blame onto her, or clumsy intellectualization that broke the symphonic attunement of our early relationship (an example of the right-to-left brain shift described by Schore [2003]). This problem was exacerbated because Aliza often wanted to show she could be an intact adult in talking about her traumatized child self, but that self then felt angry and excluded. What had been a subjectively helpful third now seemed to be a dynamic built on a dissociative or blaming form of observation, rather than on emotional resonance and inclusion.
I began to be overcome by classic feelings of complementary breakdown: the need to defend my reality, my own integrity of feeling and thinking, and the corresponding fear that this would lead me to blame and so destroy my patient. When Aliza objected to my formulations as too intellectual, I was reminded of Britton's (1988, 1998) descriptions of how the shaky maternal container is threatened by thinking. But it did not seem to me to be the "father" who broke into the soothing maternal dyad, but rather a sanity-robbing and terrifying denial that represented the dissociated, disowned, "violent innocence" of Aliza's mother (Bollas 1992, p.165), who responded to any crisis or need with chaos and impermeability. It was this mother whom neither of us could tolerate having to be. Our complementary twoness was a dance in which each of us tried to avoid being her—each feeling done to, each refusing to be the one to blame for hurting the other.
At the same time, from Aliza's point of view, the feeling of blame was my issue; her concern was that she literally felt as if she were dying and that I did not care. I began to fear that she would leave and we would thus recapitulate a long history of breaking attachments. In consultation with a colleague, I concluded that I would tell her that what she wanted me to give her was not wrong or demanding, but that I might not be able to give it to her. In the event, I surprised myself. I had prepared for the session by trying to accept the loss of Aliza as a person I cared about, as well as my failure as an analyst. I thought that our hopeful beginning, when we had created a deeply attuned dyad, would be at best overshadowed by our ending. I knew we both felt love for each other and that I could identify with the pain she was experiencing—alongside my feelings of frustration, impotence, and failure.
As planned, I began by telling Aliza that her needs were not wrong, yet I might be unable to fulfill them, and I would assist her in seeking help elsewhere if she wished. But I also found myself telling her spontaneously that no matter what she did, she would always have a place in my heart, that she could not break our attachment or destroy my loving feelings. This reassertion of the indestructibility of my love and my willingness to bear responsibility dramatically shifted Aliza's view of me. But it also shifted my receptivity to her because, paradoxically, my acceptance of my inability to find a solution alleviated my sense of helplessness. It enabled me to return to the analytic commitment not to "do" anything, but rather to contact my deep connection to her. She responded by recovering her side of the connection and feeling, with me, the loss of my importance to her. This shift allowed us to open the door to the dissociated states of terror and aloneness that the patient had felt I could not bear with her, and she recovered memories and scenes of childhood we had never reached before. Yet we were still haunted by the specter of the destroying mother, and after a period of this heightened reliving, Aliza said that she would never fully regain her trust in me. She chose to leave in order to protect our relationship, a third she could not imagine would survive.
Shortly after the terrorist attacks of September 11, 2001, Aliza returned for a number of sessions, having worked in the interim with another therapist. She reported that she had become aware of anger and the feeling of being surrounded by others who refused to acknowledge their own relation to the disaster. Believing that she was commenting on my relation to her and linking this to the way in which she had experienced me in the past, I noted the following: "Everything I said seemed to be my distancing myself, another experience of the blank faces in your family. When disaster struck, they acted as though nothing bad had happened at all. Whenever I told you anything I saw, it wasn't my having a subjective reaction to the same disaster as you—it was my seeing something shameful in the intensity of your reaction."
Aliza then spoke of guilt at having "battered" me, and I replied that she was troubled by this at the time, but could not help doing it. She said that she had "tricked" me by eliciting formulations and explanations from me that felt distancing and had so angered her. Likewise, she had often demanded that I tell her what I felt, but had been angry if I did so because then it was "about you."
I acknowledged that in being drawn into these interactions, I often did feel very bad and as though I were failing. I said that in my view, what was important was that, even though she knew this was happening, it felt to her that she had to accept the onus, all the blame, if she let herself acknowledge any responsibility— a "loser-takes-all" situation. This seemed to me related to why she had left when she did. I raised the question of whether she felt that I, too, could not bear the onus, that whatever I would have to admit to for us to continue would be more than I could bear; that I was not willing to take that on in order for her not to be crazy. I suggested, "You couldn't rely on me to care enough about your sanity to bear blame for you."
Aliza replied, "Yes, I saw you as being like the parent who won't do that, would rather sacrifice the child." We considered how every effort I had made to acknowledge my role in our interaction was tainted by Aliza's sense that she was required to reassure the other. She was sure she had to bear the unbearable for her mother (or other), while reassuring her that she was "good" for her. It seemed there had been no way for me to assume responsibility without demanding exoneration—thus, the limits of any form of disclosure or acknowledgment became clear to both of us.
In later sessions, we explicated this impossibility as we arrived at a dramatic picture of Aliza's mother's way of behaving during the horrifying events of the patient's early childhood. I was able to say what could not be said earlier: how impossibly painful it was for Aliza to feel that she, with her own daughter in the present, in some way replicated her mother's actions. But it was likewise impossible for me to bear the burden of being that mother, because then I would pose a terrifying threat to her.
Aliza responded to this description of her dilemma with shocked recognition of how true it felt, and also how it foreclosed any action on my part, any move toward understanding. She was amazed that I had been able to tolerate being in such a frightening situation with her. Again, I was able to reiterate my sadness about having been unable to avoid evoking the feeling of being with a dangerous mother who denies what she is doing. Aliza's response was to spontaneously reach an intense conviction that she must, at all costs, assume the burden of having a sanity-destroying mother inside her. She was aware of a sense of deep sorrow for how difficult it had been for me to stay with her through that time.
Indeed, her response was so intense that I felt a moment of concern—was I forcing something into my patient? However, when she returned after a two-month summer break and throughout the following year, Aliza spoke of how transformed she felt, so much stronger after that session that she often had to marvel at herself and wonder if she were the same person. Now she had the experience that her love survived the destructiveness of our interaction, my mistakes and limitations.
As the process of shared retrospection and reparation continued, Aliza and I re-created an earlier mode of accommodation, which brought into play our previous experiences of being in harmony. She was able to reintegrate experiences of reverence and beauty in which my presence evoked her childhood love of her mother's face, the ecstasy and joy that had confirmed her sense of my and her own inner goodness (Mitrani 2001). We created a thirdness, a symmetrical dialogue, in which each of us responded from a position of forgiveness and generosity, making a safe place between us and in each of our minds for taking responsibility. The transformation of our shared third had allowed both of us to transcend shame, to walk through disillusion, and to accept the limits of my analytic subjectivity. Nonetheless, I hope I have made clear that disclosure is not a panacea, that the analyst's acknowledgment of responsibility can take place only by working through deep anguish around feelings of destructiveness and loss.
The notion of the moral third is thus linked to the acceptance of inevitable breakdown and repair, which allows us to situate our responsibility to our patients and the process in the context of a witnessing compassion. This notion seems to me intrinsic to embracing the intersubjective necessity, the relational imperative to participate in a two-way interaction. If involvement in the interaction cannot be avoided, then it is all the more necessary that we be oriented to certain principles of responsibility. This is what I mean by the moral third: acceptance (hopefully within our community) of certain principles as a foundation for analytic thirdness —-an attitude toward interaction in which analysts honestly confront the feelings of shame, inadequacy, and guilt that enactments and impasses arouse. In this sense, the analyst's surrender means accepting the necessity of becoming involved in a process that is often outside our control and understanding—thus, there is an intrinsic necessity for this surrender; it does not come from a demand or requirement posed by the other. This principle of necessity becomes our third in a process that we can actively shape only according to certain "lawful" forms, to the extent that we also align and accommodate ourselves to the other.
In recent decades, the relational or intersubjective approach has moved toward overthrowing the old orthodoxy that opposed efforts to use our own subjectivity with theories of one-way action and encapsulated minds. It is now necessary to focus more on protecting and refining the use of analytic subjectivity by providing outlines in the context of a viable discipline. As Mitchell (1997) contended, transformation occurs when the analyst stops trying to live up to a generic, uncontaminated solution, and finds instead the custom-fitted solution for a particular patient. This is the approach that works because, as Goldner (2003) put it, it reveals "the transparency of the analyst's own working process … his genuine struggle between the necessity for analytic discipline and need for authenticity" (p. 143). Thus, the patient sees in the analyst a vision of what it means to struggle internally in a therapeutic way. The patient needs to see his own efforts reflected in the analyst's similar but different subjectivity, which, like the cross-modal response to the infant, constitutes a translation or metabolizing digestion. The patient checks out whether the analyst is truly metabolizing or just resting on internalized thirds, superego contents, analytic dictums.
I experienced a particularly dramatic instance of this need to contact and be mirrored by the authentic subjective responses of the analyst with a patient whose highly dissociated experiences of her parents' homicidal attacks materialized as a death threat toward me. After I told her that there were certain things she absolutely could not do for both of us to safely continue the process, she left me a phone message saying that she had actually wanted me to confront her with limits, as she never had been before. In effect, she was searching for the symbolic third, what Lacan (1975) saw as the speech that keeps us from killing. This third had to be backed up by a demonstration that I could participate emotionally, that is, could identify with her feeling of sheer terror and survive it.
The patient added in her message that she needed me to do this from my own instincts, not out of adherence to therapeutic rules. I came to realize that she meant that I had acted as a real person, with my own subjective relationship to rules and limits. And that this had to be demonstrably based on a personal confrontation of the reality of terror and abuse, not on dissociative denial of it. She needed to feel the third not as emanating from an impersonal, professional identity or a reliance on authority, such as she had felt from the church in which she had been raised, but from my personal relation to the third, my faith. At the time, I felt how precarious the analyst's endeavor is, the risk of the trust placed in me: could I indeed reach into myself and be truthful enough to be equal to this trust?
All patients, in individual ways, place their hopes for the therapeutic process in us, and for each one, we must use our own subjectivity in a different way to struggle through to a specific solution. But this specificity and the authenticity on which it is based cannot be created in free fall. Analytic work conducted according to the intersubjective view of two participating subjectivities requires a discipline based on orientation to the structural conditions of thirdness. It is my hope that this clinical and developmental perspective on co-created, intersubjective thirdness can help orient us toward responsibility and more rigorous thinking, even as our practice of psychoanalysis becomes more emotionally authentic, more spontaneous and inventive, more compassionate and liberating to both our patients and ourselves.
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