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But at the Same Time and on Another Level

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'This volume describes in detail my impression of specifically how to understand and to interpret in an analytic session. The reader will note that I present clinical sessions in stenographic detail and display complete sessions. It will be noted that I do not include past history but do make reference to it when it is necessary to understand the text. In the sessions of my own analysands and in those of others, I go to great lengths to detail my private observations, reveries, and countertransferences as well as my thinking about how, when, and what should be interpreted.' - From the Introduction

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21 Clinical example 14: dream analysis in an analytic session

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Brief past history

The patient is a 43-year-old married movie producer who had been in analysis for just over a year when this dream occurred (he has come up in some previous case studies). Of importance in the past history is that he recalls often having been beaten by his mother. The parents divorced when he was 10 years old. He had an endless series of torrid sexual affairs with various actresses and, at times, prostitutes. This behaviour ended rather quickly after he had begun his analysis and learned how much this behaviour represented his anger towards—as well as his hidden desire for—his mother.

ADAPTIVE CONTEXT: The patient’s wife has just become pregnant, and he will soon be absent for a week due to his business. He is being seen five times per week. This session is the second in the week.

[Each dream element and activity/action in the manifest content has been identified with a letter; these are explored subsequently.]

Analysand: I had a strange dream last night. I was making (a) a documentary about (b) water. I recall a (c) run-down industrial park with buildings or shacks with (d) corrugated roofs. (e) It began to rain. There was (f) an older woman therea (g) prostitute. I went to get my (h) camera, which, strangely, was in the shape of an (i) iron. (j) I couldn’t find it. (k) The prostitute was not the usual kind. She was (l) “exclusive”: she was like a (m) girlfriend: there only for me. I was fascinated by her (n) breasts. (o) I didn’t have enough money to pay her. (p) I had to go back and make the documentary.

 

22 Clinical example 15

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Albert Mason

Clinical examples 15–18 constitute a “showcase” for the demonstration of comparative psychoanalytic techniques within the Kleinian → post-Kleinian →Bionian spectrum. I invite the reader to pay close attention, not just to these analysts’ interventions, but also to the subtlety of their thinking about their cases.

The brief case presentations in this and the following chapter illustrate how a classical Kleinian works. Albert Mason was trained in the British Institute of Psychoanalysis and was analysed by Hanna Segal, and the reader will quickly recognize that his work belongs in the classical Kleinian oeuvre. I personally have been very influenced by him. He was my first Kleinian supervisor and became, following Bion’s abrupt departure, my analyst. The following two cases are from his as yet unpublished work, “Transference”.]

A28-year-old woman walked rapidly into my consulting room early one Monday morning following a weekend break. She had been in analysis for six months and had come originally fearing a recurrence of a psychotic breakdown that had taken place seven years previously. She walked unusually briskly into the room and, after lying down, started to talk even before I had reached my chair. “It is nice and quiet and peaceful here, and you seem pleased to see me”, she said, “but you have put on weight!”

 

23 Clinical example 16

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Albert Mason

I would like to give another clinical example to demonstrate these ideas.

The patient in question, “Richard”, began the session by talking about his neglect of his work and his failure to bill his clients. I reminded him that he had not paid me and that this was most unusual so late in the month. He said that he had forgotten. “I know, I know”—implying that he knew that this was not accidental and added sarcastically, “You won’t be able to buy a turkey for your lovely family, and your wife will wonder where your money went.” The implication here was that I was doing something illicit. Richard then went on to say that he had telephoned John, his ex-lover, to wish him a happy Thanksgiving, and he had “accidentally” dialled his home number instead of his work number. Predictably, John’s wife answered the phone, and the ensuing ruin of the ex-lover’s weekend was not hard to imagine.

I began to interpret that he could not stand his jealousy of my wife and his ex-lover’s wife, but he interrupted me loudly and angrily to talk about his niece, who was giving up her beloved baby to her estranged husband because he was threatening her and her present lover. Richard almost screamed: “None of them are thinking about the baby and the harm this would do him—only their own selfishness!” He was clearly talking about the husband’s narcissistic jealousy of his estranged wife and her lover. I was reminded of two separations in the patient’s childhood: one after his birth and the other when he was 2½ years old, after the birth of his hated sister. I again attempted to interpret and to link the jealousy genetically when he interrupted once again with a dream he said he had had the previous night: “John was in church with an Asian woman—kissing her. Later, he was skating with me, and his wife and son were watching.” The patient associated that John’s wife was not Asian and that the woman in the church was dark yellowy-brown.

 

24 Clinical example 17

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Ronald Britton

Ron Britton is one the foremost representatives of the London Contemporary post-Kleinian School, as well as being unique in his views. He was one of the original members of Betty Joseph’s Workshop.

Clinical examples 17 and 18 have been extracted from Britton’s unpublished paper, “The Baby and the Bathwater”. The main theme of this paper is that of “models” of thinking in theory and in practice. One is aware of Bion’s (1962b) use of models as instruments of thinking that are analogues external to the object being studied. Britton uses the term “model” in that sense theoretically, but he also uses it clinically to indicate a patient’s personal belief system.

Models in clinical practice

A meeting ground for scientific models and personal models is the psychoanalytic consulting room, and I would like to illustrate that from two actual cases.

Clinical presentation

This case exemplifies how one might find a familiar clinical model in working with a patient. The case was one I supervised of “Peter”, a man with a severe stammer that had been treated to no avail by a variety of psychiatric methods and speech therapy and so had won his way to psychoanalytic psychotherapy in the NHS. He did not work; he was married but did not have sex, and he remained asocial most of the time. He avoided talking to his mother on the phone and wrote typewritten letters to her. The model that I describe emerged first in my mind, and I communicated it to the analyst, who kept it at the back of her mind, I think, but was only convinced when in his own terms the patient described just such a model of his own daily experience. It was that of Herbert Rosenfeld’s narcissistic organization in which the individual is forbidden to become deeply attached to or communicate freely with any external object by an internal figure, or gang, that meets out punishment and offers solipsistic solace [italics added; JSG].

 

25 Clinical example 18

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Ronald Britton

This brief case material also comes from Ronald Britton’s unpublished paper, “The Baby and the Bathwater”.

This case refers to events across several generations that appear to have shaped a psychic model that slowly emerged in the course of an analysis of a young woman patient of mine. Unlike the first case, this is not the emergence of a clinical pattern resembling a familiar theoretical model, but one peculiar to the patient. It evolved in my mind from fragments of material scattered through several years of analysis. In this way it conforms to Bion’s notion of the selected fact. Bion adopted Poincaré’s concept of “the selected fact” to describe his approach to analytic material. Poincaré described the choice of one “selected fact” among an accumulation of unsorted facts that arrests the attention of the scientist in such a way that all the other data fall into a pattern shaped by their relationship to this fact. He makes the point that once this is selected, previously apparently unconnected references and described events crystallize around it. The selected fact I am referring to in this analysis is “someone disappears”, but I was not to reach that conclusion until two and half years of the analysis had passed.

 

26 Clinical example 19

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Antonino Ferro

Antonino Ferro has begun to emerge as one of the most significant contributors to the application of Wilfred Bion’s contributions to clinical technique, as well as the concept of the “psychoanalytic field” formulated by Madeleine and Willi Baranger (1961–62). The reader should look closely at his use of the connection between alpha-elements and narremes → narratives.

In this extract from “Marcella: the Transition from Explosive Sensoriality to the Ability to Think”, the author discusses an analytic case in which it was necessary to first address the patient’s need for containment of her protoemotions—her sensoriality—before the analysis could proceed along more standard lines, with interpretation of the transference, work on displacement and aspects of her childhood history, and so forth. Prior to treatment, the patient had resorted to a sort of affective autism in order not to experience dangerously overwhelming emotions, and her emotional lethargy in sessions at first engendered similar feelings in the analyst, making progress impossible until a container was established for her projective identifications.

 

27 Clinical example 20: “The woman who couldn’t consider”

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Thomas Ogden

This fragment of an analysis focuses on three consecutive sessions at the beginning of the sixth year of an analysis conducted five times per week. I present it at greater length than the previous “showcase” contributions because of the way Ogden shows and then comments on how he uses his mind and body as unfailing analytic instruments.

My stomach muscles tensed and I experienced a faint sense of nausea as I heard the rapid footfalls of Ms B racing up the stairs leading to my office. It seemed to me that she was desperate not to miss a second of her session. I had felt for some time that the quantity of minutes she spent with me had to substitute for all of the ways in which she felt unable to be present while with me. Seconds later, I imagined the patient waiting in a state of chafing urgency to get to me. As she led the way from the waiting room into the consulting room, I could feel in my body the patient’s drinking in of every detail of the hallway. I noticed several small flecks of paper from my writing pad on the carpet. I knew that the patient was taking them in and hoarding them “inside” her to silently dissect mentally during and after the session. I felt in a very concrete way that those bits of paper were parts of me that were being taken hostage. (The “fantasies” that I am describing were at this point almost entirely physical sensations as opposed to verbal narratives.)

 

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