by Joseph Natterson, M.D. Jason Aronson, Northvale NJ, 1991
Lawrence E. Hedges, Ph.D.
Dr. Natterson’s refreshing new book reflects the growing awareness in our field of the role of subjectivity in the psychoanalyst. Further, it deals with intersub-jectivity in subtle new ways, and the changing role of interpretation as two individuals journeying along together in search of psychoanalytic truth jointly use their subjective lives to shed light on the experiences they come to share together in the psychoanalytic process. “It is also a study of interpretation, which, as the definitive intervention by the therapist, carries the encoded subjective involvement of the therapist in his or her most proximate contact with the subjective experience with the patient” (Natterson, 1991, p. 16).* Rich with compelling clinical vignettes, Natterson’s text illustrates clearly how patient and analyst communicatively achieve an intense oneness and fusion, how subjective features from the analyst’s past come into play in the countertransference, and how at the same time each is able to individuate and differentiate more completely from the experience than either was able to do before their work together.
Natterson’s valuable and scholarly treatise shatters the myth of the value-neutral therapist, exposing it as a fictive assumption. He makes clear that “…all human two-person transactions share fundamental meaning: each party attempts to influence the other with his or her view of the universe to persuade the other of the Tightness of his or her view…this basic power orientation of dyadic relationships makes it natural for moral influences to be invariably significant components of the therapist’s activity” (p. 21f). The interaction of the basic beliefs of patient and therapist are inseparable from the human fantasies and yearnings of each. He holds that every interpretation is a statement of meaning about the nature of the universe and its components, including the subjective life of the interpreter. Each interpretive statement thus inevitably contains a statement of values and is ultimately a moral judgment of sorts. The therapeutic exchange thus, “…results in continuous transformation of these convictions and of their holders; it always has moral meaning” (p. 22). The therapist thus can be seen as providing “…a different belief about the patient and the patient’s world than the one learned from parents” (p. 22). Natterson views the psychoanalytic encounter as a dyadic impingement in which each person influences the other. Then respective fantasies and desiring, values and goals, are engaged in continuous struggle, through which both persons are continuously changing…this intersubjective experience should be regarded as the basic precondition for any theoretical understanding of psychoanalytic processes” (p. 23). “Furthermore, it becomes necessary to define psychoanalysis as an intersubjective dialogue, in which each participant is influencing and being influences by the other” (p. 26).
Natterson’s position on psychoanalytic interpretation is that the optimal therapist is not unbiased, but rather recognizes the inevitability of distorting influences and their possible results, one being flawed interpretation. The therapist needs to real-jze “…not only that every interpretation is significantly flawed, but also that the flaw itself can be a valuable contribution to the therapeutic process” (p. 29).
Two fundamental stages of the interpretative process have been discussed by numerous writers (e.g., Loewald, 1960; Arlow, 1979; Jacobs, 1985; and Kohut, 1984). According to Natterson, the first stage is the passionate event which provides the power and meaning of the interpretation, and the second is the formal construction of the interpretation by the therapist. The mutative force arising from the first stage is subtly shaped and refined by the second stage if it is to attain a beneficial potential. Traditional notions of interpretation have emphasized the logical, cognitive, and dispassionate aspects of the analyst’s formulations. “But interpretation additionally includes the emotional, the unconscious, the sensuous components—as in a musician’s interpretation of a piece of music. Sometimes one aspect prevails and sometimes another” (p. 42). As one example Natterson gives a period of several months during which he took a hard line against a young homosexual man’s indiscriminate and dangerous cruising in a growing climate of realization of the AIDS epidemic. The patient complained bitterly about the loss of the analytic stance and Natterson sought consultation with the result that he opted to maintain the hard line against such clear self-endangering acting out. Once the carelessness and self-destructive potential came under ego control of the patient it was possible for the analyst to resume a more typical role. In light of such considerations, Natterson offers a more liberal but still conventional definition: “…an interpretation is a statement that conveys the latent meanings of the patient’s thoughts, feelings, actions. This communication of knowledge from therapist to patient is more than a cognitive event: it is inseparable from the total therapeutic relationship. The purpose of an interpretation is to enhance the self-understanding and self-awareness of the patient, which then leads to conflict resolution. Interpretation is offered when the patient is ready and receptive—although this may not always be obvious” (p. 53).
Natterson writes that while “countertransference” has never been a warmly received member of the family of psychodynamic concepts because of its pathological connotations, nevertheless it has been a useful concept, and has gradually broadened into general acceptance as a normative phenomenon. Due to the various conflicting ways in which the term has been used, Natterson calls for clarification. “The basic issue is whether the therapist’s psychological involvement in therapy is spontaneous and initiating or reactionary and secondary. The way in which it is defined, named, valued and approached will flow from how it is perceived. The purely intrapsychic theory of psychoanalysis deliberately excludes the human transactional component, insists that the optimal analyst only reacts to the analysand, and maintains that idiosyncratic phenomena in the analyst are essentially reactive to the analysis, and need to be kept to a minimum. This point of view justifies the term, counter-transference, and it preserves the intrapsychic theory of cause and cure” (p. 59).
Natterson’s extended consideration of the contradictory ways in which analysts have viewed countertransference demonstrates that, on the one hand, analysts are expected to have their unconscious attuned to the patient as a subjective organ for receptivity; but on the other hand, analysts are supposed to provide more or less aseptic or objective mirroring of the patient. Natterson presents a thorough exposition on the phases through which the term “countertransference” has passed: From (1) disruptive, destructive with its detection’and elimination being necessary to relieve the blockage of the therapy; through (2) negative and potentially damaging if not analyzed and eliminated or reduced—but often providing therapeutic understanding of basic importance; to (3) a normative phenomenon—every therapist has idiosyncratic responses to every patient which play a fundamental part in the shaping and course of the therapeutic process. “Countertransference as a concept is still too tightly linked to its original meaning of an unconscious pathological response of the analyst to the analysand. Therefore, new terms which acknowledge that the analyst initiates as well as reacts, are now required. The language of intersubjectivity seems best suited to meet this current need. In this way, countertransference will continue to be a useful term, but within the limits of its original meaning” (p. 67).
In an interesting discussion of “intersubjectivity versus self-psychology,” Natterson is critical of the intrapsychic point of view which remains implicit in the work of Kohut and the group of his adherents who call themselves self-psychologists. Paying particular note to the way Robert Stolorow and his associates have come to use the term “intersubjective” to describe their version of self-psychological work, Natterson still believes that they “…conflate counter-transference and intersubjectivity, limiting their interest in intersubjectivity to the pathological aspects of the therapist’s reciprocal interaction with the analysand. They implicitly disregard the intercritical periods of the therapy, during which the singular unconscious life of the therapist continues to be a significant influence on the treatment, even if no countertransference complication has arisen” (p. 78). While he regards the work of Stolorow and his associates as important, he feels a “…low level of positivism seeps into their position” (p. 78). Unlike the patient, they present the therapist as initially relatively relaxed and neutral. With time, the patient’s subjective turbulence activates the therapist’s relevant subjective potentials which results in a conjunctive or disjunctive response. Natterson views this formulation as not yet free of the basic intrapsychic format of the past, which gave rise to the concept of countertransference as reactive, whether pathological or normal.
Natterson champions the contributions of Schafer (1983), Gill (1982), and Levenson (1983) as fostering “…the possibility of a more complete intersubjective explanation of interpretation” (pp. 78ff). Whether the analyst’s reactions are viewed as being pathological or not, the reactive view always implies that “…during intercritical, non-neurotic periods of analytic activity, the unconscious life of the therapist does not help shape the therapeutic process” (p. 78). Natterson’s position, in contrast, is that “…the therapist’s unconscious contributions are continuous and always relevant to the therapeutic process…Nothing short of a complete inclusion of all psychological input and reactions of both participants will permit optimal understanding of the issue” (p. 79). Commenting on Freud’s countertransference as manifest in his interpretations to Dora (Freud, 1905), Natterson believes that interpretation is a much more complex process than has generally been thought. He believes that had the role of intersubjectivity been more clearly recognized earlier in the history of our field, the dominance of the intrapsychic model in psychoanalytic theorizing would have been greatly reduced, and our theory would now be “…in greater conformity with clinical realities and would have promoted gradual, non-polemical progress toward sound psychoanalytic theory and technique” (p. 91).
Readers will be interested in Natterson’s comprehensive filling-in of his earlier (Natterson, 1986) views on interpretation. He holds to his earlier classification of interpretations: (1) Past-present interpretations, (2) intellectualized interpretations, (3) empathic interpretations, (4) transference interpretations, (5) interpretations linking therapeutic reality and transference, (6) interpretations of resistance, and (7) affect laden interpretations. In this monograph on subjectivity, Natterson is able to fill out our understanding of each of these clinical categories with rich clinical illustrations.
Beyond Countertransference contains a rich and original contribution to dreams and dreaming, which vividly demonstrates Natterson’s view of the essentially initiatory activity of the analyst’s subjectivity rather than reactivity, as he shows that analyst’s dreams are interpretive of the process as well as of the other person in the process.
Natterson concludes by providing a number of considerations regarding when and how much a therapist should decide to follow his or her own subjective reactions. He feels the therapist must begin by recognizing “…that a quintessentially personal involvement develops between patient and therapist. The therapist, then, should develop a method of achieving and maintaining continuous effective contact with his own subjective experience of the therapy” (p. 175). He asks whether analysts tend to overidentify with patients or lose their sense of professional boundaries. While his answer is a regretful “yes,” he maintains that “…the more ample the therapist’s awareness of his subjective experience, and its extended meanings, the less is the likelihood of destructive developments” (p. 177). He believes that any subjective elements of the therapist, no matter how extreme or unconventional, can constitute valuable input. The outcome depends upon how the therapist processes his or her fantasies and feelings.
Natterson suggests that “…perhaps the therapist can be regarded as the spokesperson for the unitary consciousness shared hy the patient and therapist. Thus, the therapist’s turning his or her attention to either person’s subjectivity does not constitute neglect of the other, since the unified concept implies continuing presence and importance of the sector which is not momentarily in focus” (p. 179). This view highlights the therapist’s capacity for “holistic consciousness” as a variant of Winni-cott’s notion of the “holding environment” in which the therapist perceives the patient and himself as a psychological unit. “The ability to achieve this perception arises from a precognitive capacity to appreciate subjectively the trans-subjective unity, which in turn derives from a relative fluidity of boundaries and from a powerful shared emotional intimacy” (p. 179). He believes that the unity and shared experience lend to enhance independence of thought and feeling rather than to diminish it. Each symbolically becomes a parent to the other in the therapeutic holding environment. Natterson’s purpose is to reclaim from the historical movement of psychoanalysis the therapist’s subjectivity in a detailed and comprehensive way which can illuminate the intersubjective foundation of therapeutic action. He believes that the next effect will be an enlarged understanding and enhancement of the psychoanalytic process. He sees three benefits accruing from the alteration in focus which he proposes:
1. Therapists achieve a continuous self-monitoring function that addresses the therapist’s ongoing psychological experience both as an originating and a reacting phenomenon.
2. The simplistic search for a neat linear understanding of the therapeutic process can be set aside in favor of enjoying a richer sense of reciprocal contribution.
3. The enriched consciousness of the basic fantasy interplay of patient and therapist enables the analyst to enlarge his database for interpretation, and to establish a useful mediating ambience for effective conveyance of interpretations.
Subjectivity is essential to the therapeutic role. ‘The truth about the relevance of our subjectivity has been repressed. Therefore it has manifested itself in numerous displaced and disguised forms. It is now time ‘ to explore this vital area and recover the lost territory of therapist subjectivity as a powerful resource for well-being” (p. 193).
* Page numbers refer to original manuscript.
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