Journal of Analytical Psychology, 2014, 59, 309–313

Introduction to three clinical papers Elizabeth Urban, London

A number of recent papers in this journal focus on how to work with patients with entrenched relational problems, whether or not conceived as early developmental deficit. Their contributions are influenced by developmental and neurological research and, equally, are informed by analytic experience. These include pieces by Astor (2011), Bisagni (2013), Colman (2013a and 2013b), Connolly (2013), Knox (2013), Meredith-Owen (2013) and Urban (2013). The three clinical papers in this issue continue this discussion. Richard Mizen is an analyst speaking to the value of maintaining the traditional analytic frame; Richard Kradin is an analyst demonstrating the value of a Jungian spiritual approach as an alternative to traditional work; and K is a patient who describes the effectiveness for him of a direct experience of his analyst’s subjectivity. For Mizen the emphasis is on the analyst bearing the patient’s pain and interpreting his own; for Kradin it is on balancing the patient’s pain with a recognition of the patient’s internal spiritual qualities; and for the patient K it is the relief of pain arising from direct affective contact with the person of the analyst. Despite these differences their experience and thinking overlap in unexpected ways. The title of Mizen’s contribution - ‘On the capacity to suffer one’s self’ - refers to the effect on the analyst of holding to an analytically interpretative stance in order to bring about change in a patient. Referring to the numerous approaches that address underlying faults in the patient’s early experience, Mizen focuses not on causes but on consequences and draws upon what Esther Bick identified as the function of ‘psychic skin’. Those without a psychic skin lack the boundaries to be able to contain psychic experience and thereby to develop through learning from experience (as Bion put it), which can equally be thought of as acquiring authenticity, the ‘truth’ of what one is. Essential to Mizen’s work is the use of projective and introjective identifications and, correspondingly, the need to maintain established analytic boundaries because of the confusion of identities arising from this form of communication. He refers to the muddle and self-doubt evoked by patients in a way that conveys his sensitivity to the critical importance of self-questioning. His point is that the analyst’s uncertainty must be suffered in order to be able to grasp and articulate psychic pain which otherwise remains without words.

0021-8774/2014/5903/309

© 2014, The Society of Analytical Psychology

Published by John Wiley & Sons Ltd,, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. DOI: 10.1111/1468-5922.12079

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At the end of his paper Mizen distinguishes between analytic work and psychotherapeutic work. This might be a means of distinguishing his approach from those described by Kradin and K, although Bion’s distinction between neurotic and psychotic personality organisation seems more relevant here because of the ‘total’ nature of the three patients’ defences. The neurotic personality is centred on the resolution of a conflict in the ego while the psychotic personality struggles with ‘the problem of repair to the ego’ (Bion 1957, p. 272). Kradin and K describe, respectively, the obstacles met with and the subjective experience of these problems of repair. The clinical material of the patient described by Kradin and of K is coincidentally similar: both are middle-aged men who had had twenty years of analytic treatment that failed prior to the experience the authors describe. Kradin regards his patient as obsessional and his treatment is described as fraught with entrenched defences. To avoid these obstructions and in respect for the patient’s intolerance of interpretations, Kradin regards himself as functioning as an ego-ideal while taking a Jungian approach. He interprets the spiritual, less retro- and more pro-spective elements of his patient’s dreams. In doing so he models the treatment on the story of Job; for ‘Job, like K., experiences his vulnerability as shame…’ (Kradin 2014, see below, p. 360). The plight of Job is a narrative of persistent inner persecution, marked by acute pain of inner loss, abandonment and the decimation of internal wealth. As such it is relevant to the patients (‘sufferers’) described in these three papers. The way Kradin describes the shift or transformation from a state of oppression to one of integration combines with essential points in Mizen’s and K’s papers. For instance, Kradin draws a parallel between analytic interpretations and Job’s ‘comforters’ who press Job to search his soul, with the same effect on Job that K experienced in his first two analyses. When God ultimately appears to Job, the latter responds, ‘I have heard of You through the hearing of the ears but now my eyes have seen You!’; this expresses what Mizen means by learning directly from, not simply about experience. God then speaks directly to Job, ‘person-to person’, as K has it. Job’s shame is transcended and, Kradin continues, Job ‘is no longer alone; instead he now has a partner… This levelling of the asymmetric power between the protagonists is a therapeutic factor in Job’s ultimate recovery’ (Kradin 2014, see below, p. 362). This is the therapeutic reaction that K experienced and which underlies his appeal for ‘knowing the real person of the analyst’. Despite his readable style, K may face disadvantages that named and known authors do not. K writes anonymously and this may affect the reader’s trust, but he has a right and reason to keep his identity to himself. Fordham, his second analyst, included K’s material in his late papers. Fordham was careful to protect the anonymity of his patients but, at a time when authors and editors were less meticulous than now about these matters, he did not seek consent to publish their material. He may have published details K would have wished he had not. Some may question whether what K offers is personal and restricted to himself and his own limitations. This overlooks that what analysts write is also,

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at least to some degree, personal to the analyst. Further, as Morley points out in his ‘Introduction’ to The Analysand’s Tale, by far most analyst-authored papers drawing upon clinical material are uncorroborated by the patients to whom they refer (Morley 2007). Published pieces by analyst/analysand pairs are rare, and Astor’s ‘Fordham, feeling, and countertransference’ compatibly alongside K’s ‘What works?’ are amongst these few (Astor 2007, K, 2007). What is known about K through papers by Astor, Fordham and K is that he had two classically oriented, interpretative analyses, each for around ten years, before several years of ‘non-analytic’ sessions with Astor. Fordham and Astor, both eminent and highly experienced, acknowledged K as exceptional, a patient through whom they developed as analysts (Astor & Colman 2013, Fordham, 2013); Astor recently described K as ‘a very unusual, able, interesting person who was in a lot of pain’ (Astor & Colman 2013, p. 691). K’s way of putting words to the crushing power of his pain speaks for others. Whereas analysts face what they typically consider to be their patients’ defences, K relates what it is like not to have defences. His art is the articulation of his feelings; the rawness of repeated longstanding hurt, easily triggered by ‘the other’, especially another bestowed with authority. There are as well episodes of inner lift and life that come from moments of immediate subjective contact with Astor, relating, so to speak, face-to-face rather than darkly through a barrier of interpretation.1 K communicates all this with a clarity that contrasts with the borderlines’ more usual unconscious communications that leave analysts wading through the massa confusa of their introjective identifications, as Mizen describes. Although K’s first two analyses failed to address his pain, his third attempt did not. Thus K came to know from experience what did and what did not work for him. Are his remarks about ‘what works’ corroborated by analysts? There are several examples at hand. K recommended that those like himself need a preliminary period of being related to before analysis can take place (K 2008), and Kradin notes ‘the importance of empathy above interpretation, at least in the early treatment of such patients’ (Kradin 2014, see below, 2014 p. 360, see also Knox 2008). In his 2007 paper K argues the need for the aesthetic to balance against early deprivation of beauty, abuse and emotional ugliness. For his part, Kradin turns to the spiritual as ‘… no amount of “working through”’ was going to resolve his patient’s distress (ibid., p. 358). The aesthetic of Job’s story, ‘the most oft-quoted text of ancient Near Eastern wisdom literature’ (ibid., pp. 359–363) lies in its power to pull one in, drawn by something that holds an inexpressible truth. This is the kind of truth to

1

I note this because initially infants relate literally as well as figuratively face-to-face until developments in consciousness ‘cloud’ their relational experiences with the infant’s-cum-toddler’s inferences/interpretations of the other’s attitudes/intentions towards himself (e.g. shaming, praise) and others (e.g. triangulation, Oedipal conflict). In my view it is not until this point in development that the infant begins to recognise the ‘authority’, or relational ‘status’ of the other (Urban 2003).

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which Mizen gives prominence, and to which K might add, ‘Beauty is truth, truth beauty …’ (Keats 1820). K’s current point, ‘On the need of the analysand to know the real person of the analyst’, was noted in a paper in the first issue of the Journal of Analytical Psychology. Robert Moody’s brief piece centres on a withdrawn, passive five-year-old girl, whose mind was a ‘closed book’ to him. Halfway through the ten-week treatment, Moody abandoned his initiatives to engage her in drawing and play, considering them to be motivated by his own defensiveness. She had before gazed at him wordlessly for long periods and on this occasion he gazed silently back at her. When she brought him a baby doll, ‘I put out my hand towards the doll, which she gave to me. I kissed it and gave it back to her. She smiled at me in a very responsive way…’ (Moody 1955, p. 54). In some ways this is shockingly exposing of the analyst, while equally spontaneous, direct and tender. And effective; the girl’s conflicts resolved soon after. K describes his own spontaneous responses to this kind of personal directness. One example he gives comes in a visual form. This appeared during one his sessions with Astor, when he saw himself – not as his contemporary self ‘but rather myself as a child of perhaps five or six years old’ - raising a vacuum cleaner and ‘hoovering in’ the figure of Astor with ‘boyish enthusiasm’, thereby over-riding a ‘hollow waiting’ and ‘filling himself up’ with this figure (K 2014, see below, p. 335). It is unclear whether Kradin uses the story of Job in his work with his patient but, according to the material described, Kradin’s Jungian spiritual approach ‘works’, as does Mizen’s interpretative analysis and what K describes of his experiences with Astor. ‘What works’ in analysis is what works; ‘the efficacy of an interpretation is best determined by the patient’s response to it’ (Kradin 2014, citing Gill [1983] see below p. 361). What works’ has since Jung been too easily linked to the analyst’s unconscious spontaneity and intuitive response to the patient. This means that working effectively with those rendered acutely vulnerable by early emotional impairments risks undisciplined and imprudent reactions, even inadvertently making matters worse for the patient. What is of interest to me in these recent papers - and what is new - is how they help to refine Jungian thinking about when and how to step outside the structure of analytic work and to ‘work out of the self’, as Fordham termed it (Fordham 1993). ‘Working out of the self’ is the art of what we do, yet any art form requires access to the self and to the discipline of technique that Mizen so well appreciates. Knox, cited in K’s paper, states that the critical issue is what and how much the analysand needs to know about the analyst, and when; K addresses this and adds some helpful considerations. Others who have recently contributed to this question include Astor (‘saying what you mean and meaning what you say’), Colman (analytic work as part of wisdom tradition) and myself (‘the art of what we do’) (Astor 2011, Colman, 2013a and Urban, 2013). All refer to noticeable positive, often immediate transformations when analytic work ‘reach[es] a level of psychic reality not previously accessed by our patients’ (Astor 2011, p. 214). Given the Boston Change Process Study Group’s (2010) discoveries of transformations at ‘moments of meeting’ during infant-parent interactions, these

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clinical papers might be seen as studies into the transcendent function at the physiological as opposed to the symbolic end of the archetypal spectrum. As such they mark not a departure from, but an extension of a longstanding Jungian recognition of the transformative qualities of the self.

References Astor, J. (2007). ‘Fordham, feeling, and countertransference: reflections on defences of the self’. Journal of Analytical Psychology, 52, 2, 185–205. ——. (2011). ‘Saying what you mean, meaning what you say: language, interaction and interpretation’. Journal of Analytical Psychology, 56, 2, 203–216. Astor, J. & Colman, W. (2013). ‘James Astor in conversation with Warren Colman’. Journal of Analytical Psychology, 58, 5, 677–697. Bion, W. (1957). ‘Differentiation of the Psychotic from the Non-Psychotic Personalities’. International Journal of Psycho-Analysis, 38, 266–275. London: Routledge. Bisagni, F. (2013). ‘On the impact of words: interpretation, empathy and affect regulation’. Journal of Analytical Psychology, 58, 5, 615–635. Colman, W. (2013a). ‘Reflections on knowledge and experience’. Journal of Analytical Psychology, 58, 2, 200–218. —— (2013b). ‘Bringing it all back home: how I became a relational analyst’. Journal of Analytical Psychology, 58, 4, 470–490. Connolly, A. (2013). ‘Out of the body: embodiment and its vicissitudes’. Journal of Analytical Psychology, 58, 3, 636–656. Fordham, M. (1993). ‘The Jung-Klein hybrid’. Free Associations, 3, 4, (No. 28): 631–641. ——. (2013). ‘End notes: two unpublished presentations. Commentary by E. Urban’. Journal of Analytical Psychology, 58, 4, 454–469. ‘K’. (2007). ‘“What works?”: response to James Astor’. Journal of Analytical Psychology, 52, 2, 207–231. ——. (2008). ‘Report from the borderland: an addendum to “What works?”’. Journal of Analytical Psychology, 53, 1, 19–30. ——. (2014). ‘On the analysand’s need to know the real person of the analyst’. Journal of Analytical Psychology, 59, 3, 347–363. Keats, J. (1820). ‘Ode on a Grecian Urn’. In The New Oxford Book of English Verse, ed. A. Quiller-Couch. Oxford University Press, 1939. Knox, J. (2008). ‘Response to “Report from borderland”’. Journal of Analytical Psychology, 53, 1, 31–36. Knox, J. (2013). ‘“Feeling for” and “feeling with”: developmental and neuroscientific perspectives on intersubjectivity and empathy’. Journal of Analytical Psychology, 58, 4, 491–509. Kradin, R. (2014). ‘Converting a Freudian Analysis into a Jungian one: obsession, addiction and an answer from Job’. Journal of Analytical Psychology, 59, 3, 347–366. Meredith-Owen, W. (2013). ‘Are waves of relational assumptions eroding traditional analysis’? Journal of Analytical Psychology, 58, 5, 593–614. Moody, R. (1955). ‘On the function of Counter-Transference’. Journal of Analytical Psychology, 1, 1, 49–58. Morley, R. (2007). The Analysand’s Tale. Karnac: London. The Boston Change Process Study Group. (2010). Change in Psychotherapy: A Unifying Paradigm. W. W. Norton: London. Urban, E. (2003). ‘Developmental aspects of trauma and traumatic aspects of development’. Journal of Analytical Psychology, 59, 3, 510–529. ——. (2013). ‘Reflections on research and learning from the patient; the art and science of what we do’. Journal of Analytical Psychology, 58, 4, 510–529.

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