This class is a group supervision experience, in which students respond deeply to each other’s clinical work, and also risk sharing their own clinical work in order to get meaningful feedback.
The course is entitled “The Analyst as Instrument” because the focus is on how the clinician uses his/hers own feelings, thoughts, sensations, and perceptions in each therapeutic session as an avenue to the most acute understanding of their patients (or clients). Students learn through firsthand sharing of clinical struggles what is deflected and projected out from the patient’s internal world. This approach is based on work of generations of object relations theorists, originally derived from the British object relations school.
This approach stems back to Melanie Klein’s concept of projective-identification, Paula Heimann’s understanding of countertransference, Heinrich Racker’s contribution on “concordant” and “complementary” countertransference, as well as on Wilfred Bion’s views on translating concrete unprocessed “beta” elements (enactments) into symbolic “alpha” communication, which involves of processing projective-identifications as an integral part of countertransference phenomenon. Further contributions were made by the representatives of the British school, such as D.W. Winnicott (in his paper on “Hate in the countertransference”) and by the American theorists who wrote about ‘subjective” versus “objective” countertransference (Otto Kernberg, Lawrence Epstein, and Jeffrey Seinfeld).
The basic idea is that everything that a psychoanalytic object relations clinician experiences while in the room with the patient can be mentally (Peter Fonagy’s “mentalization”) and symbolically processed, so that it is understood in terms of core traumas and conflicts within the patient’s internal world, which are enacted upon the therapist, because the patient cannot contain and consciously experience his/her own traumas and conflicts. Whatever is said by the patient is then seen as secondary to what the patient might be enacting at any one moment, especially in relation to a core developmental arrest trauma that disrupted basic self integration and separation-individuation. This approach is critical with character disordered patients, as their psyche does not operate on containing repression; this results in compulsion to propel their own internal experience out into the other they are with, inducing feelings in the therapist of being either the traumatizing parent (part object) or the traumatized child self (part self). Object relations theories help therapists to process those projective-identification experiences, so that they can understand the traumatic disruptions in patient’s core, stemming from the time of the early pre-oedipal parent-child sadomasochistic enactment.
For all patients, it is essential that their analysts understand/feel how to be “in their skin.” In the case of neurotic patients, verbal associations do reflect such feelings in terms of core conflicts. Thus, the understanding of these symbolically meaningful verbal associations and memories allows the therapist to understand the patient’s core conflicts, as they are continually retriggered in the unconscious areas of a repressed psyche. Participants of this course will also benefit from the mere experiential learning of how to process “objective countertransference,” and such concepts as transitional space, transitional object, holding environment, psychic container, and projective identification.