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Psychology
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Bion and Psychotherapy
The Mystery of Analytical Work: Weavings From Jung and Bion by Barbara Stevens Sullivan (Routledge)
This book provides an exploration of the clinical practice of psychoanalysis and analytical psychology. It explores the ways psychoanalysts and other clinicians are taught to evade direct emotional connections with their patients. Sullivan, suggesting that relatedness is the basis of emotional health, examines the universal struggle between socially oriented energies that struggle toward truth and narcissistic impulses that push us to take refuge in lies. She maintains that, rather than making interpretations, it is the clinician’s capacity to bring relatedness to the clinical encounter which is the crucial factor.
Examining the work of both Jung and Bion, Sullivan draws on the overlap between their ideas on the psyche and the nature of the unconscious. The book uses clinical examples to examine the implications that these perspectives have for the practising therapist.
Specific areas of discussion include:
- the creative unconscious
- the structure of narcissism
- transformation in analytic work.
New modes of listening and relating that deepen analytic work and greatly facilitate transformative changes are described in easy-to-follow language that will help the therapist to find new approaches to a wide range of patients. The Mystery of Analytical Work will be of interest to Jungians, psychoanalysts and all those with an interest in analytic work.
Recently, I attended a psychoanalytic conference at which a senior analyst presented several clinical hours to an eminent visiting psychoanalyst. In one of the hours he described, the patient came into the hour, her third analytic hour of the week, saying that she was exhausted, manifestly by the previous two days at her work. All she could imagine just now, she said, was going home and pulling the covers over her head. Throughout the hour, the analyst spoke to his patient about her inability to use him effectively for help. When the visiting expert questioned the presenter's rather hammering line of interpretation, the presenter explained that as a leinian he tried to interpret the patient's central anxiety. In this case, he added, since he judged that that anxiety was centered in the transference, he was interpreting it there. I was struck with the way the analyst's theoretical training trumped his human relatedness. He could not hear, apparently, the patient's statement: the previous two hours had used her up; she had nothing left to work with. He could not respond to her. His training told him to interpret the central anxiety and even though the patient was telling him quite clearly (though unconsciously) that she could not hear anything, he needed to keep talking. This particular analyst's training told him to interpret the central anxiety; another analyst's training tells him to interpret the genetic roots of the current difficulty or the archetypal meanings of an image that arises in the hour. The problem is not a Kleinian problem; it is a human problem. It is frightening to be with another person without some kind of professional armor to protect us.
We shall explore the central role of relatedness in emotional health in Chapters 4 and 5, when we look at the structural and dynamic aspects of our anti-related energies. Here, let me just note that people are attachment-seeking creatures from birth on. We all know that infants need to be met by caretakers who can recognize their needs and adapt to them. (After a short time, of course, this adaptation needs to be something less than a hundred per cent, but for a very long time it must be tilted in favor of the more helpless member of the dyad.) A self-centered me-me-me approach to others and to life is not only frowned upon by society; it is also a pathological perspective that indicates the presence of emotional wounding. But a related approach is a vulnerable one, while a selfish stance offers the illusion of safety. Holding one's own perspective along with the other's means accepting a world in which the ground upon which one stands is never reliable. If I remember/believe/perceive such-and-such while you say thus-and-such, a related response will be suffused with unknowing. I cannot take refuge in the assumption that my eyes see clearly while yours are clouded. (If ten of us see one thing and the eleventh another, probably the general perception is reliable, but even this is not always true.) A related approach is dangerous; taking a selfish stance is like living inside a fortress. If I know what is out there because my eyes do not distort, I am safe and secure. You may be crazy, but I am not.
Thus it is not surprising that faced with the terrifying depths of the psyche and told to contain those depths and transform them, therapists hang onto their theoretical instructions as though they were life preservers. It is dangerous to face the suffering patient as one person to another, where both of us are subject to confusion and error, and the therapist's "mental health" is not presumed superior at any given moment. Plain relatedness seems too simple, although this assessment is a defense against the reality: it is harder for a clinician to sit with a patient and share his distress than to imagine that she can zap away his pain with transformative interpretations. To sit still and hear the patient's pain means to recognize that emotional pain like the patient's can overcome her, too. It also means accepting that in the face of pain the practitioner is helpless to do anything to make it go away. It is much more comfortable to hang onto a theoretical bible and to imagine herself strong, capable and mentally healthy, healing her disturbed and needy patient.
At the heart of this book is my attempt to raise therapists' consciousness about the nature and importance of relatedness. It is widely accepted in the depth theoretical world that the self exists only in relationship. Winnicott (1952) suggested that in the absence of a mother, there is no such thing as an infant. As we shall explore in the pages of this book, the human being cannot think or feel (the prerequisite for the self's existence) in isolation. The self exists only in relationship and the self varies from one relationship to another. I am a different person with my husband than I am with my best friend or my daughter or any given patient. There is no "me" in isolation. The quality of each relationship structures who it is possible for me to be. The quality of the therapeutic relationship determines how much the patient will be able to grow inside its container. We certainly know that the quality of the parent's bond with his or her child is infinitely more important than what bedtime she sets or the age at which she allows her daughter to wear make-up. The teacher who adjusts her way of being to accommodate her student's idiosyncratic learning style will be much more successful in facilitating his intellectual development than will the teacher who approaches all her students in one standard way. Why should it be such a leap to recognize that the quality of the analytic bond rather than some standardized analytic approach is the most important element in psychotherapy, too?
My dictionary (Gove, 1993) defines "relate" and "relatedness" in rather solipsistic terms. "Relate" is "to be in relationship" or "to have meaningful social relationships." "Relatedness" is "the state or character of being related" or "a particular manner of being related or of being constituted by relations" These self-referential definitions indicate how elusive and subtle these terms are, for they refer to something as fundamental for the psyche as air or water is for the body. The definition of "related" is slightly more suggestive: "having relationship," "allied by kindred," or "having similar properties." It is the last phrase that evokes a taste of the dangerous aspect of being related: if my patient and I have "similar properties," it implies that emotional fissures and wounds exist in me as well as in him. Inside or outside the analytic situation, a related approach opens one to the other's pain and stirs one's own. Relatedness hurts. And then it nourishes. First the pain of embodied existence is experienced and then the compassionate atmosphere of relatedness assuages the pain. But often the looming danger of the pain thrusts aside the healthy related energies and constellates the narcissistic anti-related forces of the psyche.
The etymology of "relate" is also interesting. It comes from the Latin relatus, from re- ("back, again") and latus, the past participle of ferre ("to bear"), thus meaning "carried or borne back." In a parallel fashion, relationem, the source of "relation," means "a bringing back, restoring." "Relationship," then, implies that two substances have been brought back together after being separated, as though the relationships that we form with strangers are actually connections that existed once before. I believe that this particular etymology developed from the fact that when we are in relationship to another, parts of ourselves that we have lost touch with are carried back into connection with us. And if we add to this the Greek talantos ("suffering, bearing"), which is also connected to the Latin latus, we have the implication that a relationship with another arouses suffering — intense emotional distress — for it brings us face to face with aspects of ourselves that we have disowned.
Although "relatedness" rests on sensitivity to the other's subjective experience, in therapeutic work it does not imply attempting to create a "nice" experience for the other, especially since the other's unconscious immediate experience must be included in the analyst's understanding of the present. But an attempt to adapt to the other's experience in the most related way possible is a most important dimension of the practitioner's approach. In the unique container of the therapeutic relationship a "loving" approach will lead to behaviors that might seem quite unloving in other situations. But when a related therapist behaves in ways that her patient finds disturbing, she tries to soften that, to speak to it, at least to hold in her awareness the central importance of the patient's distress. Too often the more depth-oriented the clinician's training, the less it concerns itself with this dimension and the more it values clinical behavior that adheres to the particular school's theoretical orientation. Behavior that accommodates itself to this peculiar patient's receptive channels may be criticized as "unanalytic" instead of being analyzed. How is the therapist's unusual behavior impacting this person's process at this singular moment? While the same behavior might often cover up or avoid something difficult, perhaps just now it is opening up something that needs attention.
In this book, I explore a variety of points of view concerning the nature of the psyche, how it processes emotional experience and how it develops. My central focus is on using whatever understanding we can muster to enhance the clinician's effectiveness in the consulting room. Because the most fundamental determinant of the patient's capacity to use his analyst constructively is the quality of their relationship, one core question that this book asks is, "what makes the therapeutic relationship therapeutic?" Here, I am suggesting that it is the degree to which the clinical relationship is permeated with relatedness. The analyst, of course, is only half the equation; how related she is able to be will depend on how related her patient can be as well as on her own capacities. What does relatedness look like in the analytic consulting room and how might it differ from social relatedness? Can we approach our patients therapeutically without forgetting everything that we know about how to approach people with the compassion and respect from which love can develop?
The first section of this book looks at the nature of the human psyche. What hunches can we develop about the unconscious, the foundation on which everything else rests, given that we can never have direct access to it? Remembering that unprocessed emotions destroy the possibility of rational thought, what can we say about how the psyche processes emotions? What underlying templates structure the emotional woundedness we each carry and how does the tension play out between someone's healthy, growing side and her resistant, injured aspect? Developing ideas about these issues provides a ground from which we can approach our patients in a related fashion. In the second section of the book, we will look explicitly at how these understandings will guide us in interacting with our patients.
In the early years of this century, while on vacation in Costa Rica, I read A Pattern of Madness (1983) by Neville Symington. I had, of course, been working on myself in various ways, so that Symington's ideas fell on fertile ground — I was ready for them. Reading the book burst open my psyche in a way I had never imagined a book could. This supposedly intellectual experience set in motion a fruitful train of development that has led me to a new level of integration in my work. From Symington's inspired work on narcissism, I was drawn into the work of W R. Bion, a British psychoanalyst, whose perspective informed Symington's. Bion's utterly original point of view has now strongly influenced my thinking. If I could summarize Bion's creative perspective, I would say that he has helped me to see that people are verbs rather than nouns.' Reality is a verb; truth is a verb. Like the universe, every object, living or non-living, is in constant motion, both developing and deteriorating all the time. Bion communicates an ability to swim in the new order that his work illuminates, an ability to keep one's head above water in an endlessly mysterious and always shifting world. Who I am changes from moment to moment; my history is unknowable and my understanding of it
moves from one version to another as I develop and find new vantage points from which to view it. The other is similarly volatile. We must find new ways to think about what any of our realities consist of, for every "fact" we know is at most an approximation of reality. Perhaps we can be certain of the year in which the Boston Massacre occurred. But how it was triggered, what emotional or material elements "caused" it we can never know in any definitive sense. Everything and everyone is always moving and changing. We will explore many aspects of this radical perspective in the following pages, seeking to imagine how it impacts our work with individual patients.
One element of that exploration involves my attempt to integrate Bion's point of view with that of C.G. Jung, for the two men share a deeply congruent vision of the nature of the psyche and of reality. Like Bion, Jung describes a largely fluid universe, where the laws of science, the facts of history or politics, and most especially the human beings working to understand them, can never be known in any definitive sense. Instead, exploring reality becomes endlessly fascinating; mysteries proliferate, opening new lines of investigation rather than leading to firm solutions or understandings. Bion's work grounds Jung's in the clinical situation, for although Jung wrote a great deal about psychology, he wrote very little about psychotherapy, and his most valuable work on the analytic situation (1946) is hard to understand. Just as Bion's work expands the reach of Jung's, Jung's perspective illuminates Bion, making this impenetrable writer more comprehensible. Finally, taking a stance that is developed from integrating the philosophical outlooks of both men opens up the clinical situation dramatically. The clinician's capacity to hear is greatly enhanced and new implications and levels in the patient's material are revealed, thus expanding the therapist's capacity for relatedness. And, of course, these two geniuses had differences. Often their differences can fertilize our thinking about the analytic or therapeutic ,1 situation.
In this book I develop a clinical perspective based on my understanding of psychological growth. In the fifty-minute hour, the therapist is under constant pressure to respond to the patient's distress, even if that distress lies well under the surface. Two personalities come together in a first hour and "an emotional storm" ensues (Bion, 1979). We know that the patient is caught in an emotional storm; if he were not, he would not have called a therapist. We also know, though we are often tempted to forget, that the therapist or analyst, no matter how "thoroughly analyzed" (whatever that might mean), is also 4 tossed about inside by tempests that she knows less about than she likes to imagine. We have all seen our colleagues behave in startling ways. If we are honest with ourselves, we must know about clinical choices of our own, perhaps choices taken with considerable thought, which proved in retrospect to have been imbued with, even dominated by, unconsciousness, sometimes of a wondrously creative nature, but also sometimes destructive. These "choices" that prove on reflection to have been determined by forces outside the therapist's awareness can manifest as transformative interpretations that the therapist did not know she had, or as obviously problematic enactments, or in subtle and unconscious ways: a murmured "umm" at exactly the right moment versus silence when that "umm" is needed; an intuitive understanding of the patient's emotional state based on no obvious data versus the acceptance of a patient's decision when a question is called for. We know so little about what we know and what we feel at any moment! Truly, it is as though the therapist is called upon to perform brain surgery during a double earthquake where one of the earthquakes' epicenters is in his own core.
No one is immune to severe distortions in his or her ability to think. All therapists and analysts make serious mistakes in any therapeutic venture. The issue must be seen not as an attempt to achieve perfection in technique, but rather as a continuous struggle to work with one's errors, to turn dross into gold. It is widely accepted in the world of depth therapy that the patient (a category that always includes the patient inside the therapist as well as the outer patient) grows through two kinds of experiences. In one kind, the therapist functions well, in the other she functions reparatively vis-à-vis situations in which she functioned badly. Following Winnicott (1965), we call this "good-enough" treatment. It is the best available.
Just as we must accept the fact that our clinical thinking must be distorted by inner emotional upheavals about which we have only glimmers of awareness, in writing this book about how to approach clinical work, I must begin by acknowledging that my ideas have been shaped by pressures outside my awareness as well as by conscious considerations. Nothing I say should be taken to imply that I am describing the "right" way to approach the work. I am describing my thoughts about how to approach the work. Each clinician must work out his or her own thoughts, and if thoughts of mine are helpful to a reader in sorting out what he or she thinks, that is all I can hope for. I would take that as definitely good enough.
And beyond this caveat, what I am describing is my approach. It is a reflection of who I am, and each therapist must be him- or herself Beyond any question of technique looms the issue of being authentically oneself. As Jung emphasized, the person of the analyst, rather than his technique, is the core issue. An emphasis on the person of the analyst is a crucial counterweight to the therapist's yearning for "rules" to support herself in the turbulent sea of the consulting room. But it is a distortion of this good idea to imagine that the person of the therapist alone, regardless of technical competence, is enough. While I can describe only my approach to the work, I do hope that my thinking will be relevant to others. While there is certainly no right way, there are ways that are, if not simply wrong, deeply problematic.' I hope that the perspective I offer on how to think about what we do will help others to decide what they think.
What is analysis?
But before we begin, it seems important to try my hand at describing what I think depth-oriented clinical work — analysis — is. At times, definitions that seem simply silly have been offered, as though lying on a couch rather than sitting in a chair or coming four times a week rather than three is the determining factor. For a procedure that explicitly seeks meaning and substance in the psyche, definitions that avoid dealing with meaning and substance make no sense. But nothing I can say will capture the infinitely proliferating issues that come up in any analytic venture. On the one hand, the analyst or therapist is consistently enjoined not to fall into enactments with her patient; on the other, enactments are ubiquitous and the couple's work disentangling and sorting out an enactment is often the most dramatically transformative work. But still: the therapist should try not to enact unconsidered patterns with her patient. I am presenting here my idea of the stance an analyst should strive for. An attempt to take any stance will always fail some of the time; working through analytic failures is the most fertile process that occurs in clinical work.
A person consults a therapist or an analyst because he is subjectively caught in emotional distress. The two individuals spend their first forty-five or fifty minutes together deciding whether they believe that talking with one another has the potential to bring the patient emotional relief; if they do feel sufficiently sanguine about that possibility, they set up a regular schedule of appointments and proceed to develop a relationship with one another based a on the verbal and non-verbal aspects of the conversations that occur between them. The resulting relationship may be based on relatedness, or it may be deeply imbued with anti-related energies. The most fundamental goal of working with the transference is the transformation of anti-related strivings into relatedness. One of the major ways that the therapist approaches this 1 is by noticing and working with her own anti-related energies as they are constellated in this particular dyad. While words, rather than actions, must remain the only form of interaction in analytic work, offering the patient a cup of tea or a glass of water, shaking his or her hand and similar minor non-verbal forms of connection do not determine whether or not what is occurring is analysis: the individual practitioner works out his or her own preferences in these areas.
Neither frequency nor posture nor the practitioner's certificates and
memberships determines whether a given therapeutic relationship is analysis. There are two areas that reflect what I consider to be the basic issues.
Taking a symbolic attitude
A symbolic attitude means that the therapist holds the patient's communications in the way a dream is held. "I saw this guy treating his little boy as though he was an amusing toy instead of a person," does not primarily refer to the father and child the patient saw on the subway. It is an image that the patient has taken from his daily life to express something about the way he treats himself, the way he feels treated by other important people in his life, and also about the experience he is having at this moment in his relationship with his therapist or analyst. But in this imaginary example we do not know what his image means about the therapeutic interaction. Perhaps he is unconsciously feeling that he is treating his therapist like a thing; perhaps he feels objectified by the therapist; perhaps he is asking the therapist for help in recognizing his membership in the human race. We need to sense the emotional currents that seem to be present at the moment that the image comes to mind in order to have a solid hunch about what it might mean to the patient. Communications that refer to important people in the patient's outer life do truly refer to his experiences in his interpersonal relationships but they are also symbolic images that describe the patient's inner world and that capture something about the way he experiences himself in relation to his therapist in the immediate moment. His experience of his analyst can as easily be accurate as distorted. Perhaps the analyst is thinking about him as a thing rather than as a person.
When the therapist falls into listening concretely to the "facts" that her patient is telling her, the question is whether she can bring herself back to a symbolic attitude in a reasonable length of time. Participating with the patient in the most personal and sensitive layers of his development, all therapists get swept into the manifest emotional meaning of the patient's stories. This is a necessary connection to the patient's life even though it also pulls the therapist away from symbolic thinking. We certainly do not want to rid ourselves of concern for the patient's objective outer situation; we want to make space also to wonder, sooner rather than later, about the story's symbolic meaning in the moment.
Another way to think about this asks, "What is the practitioner's attitude toward symptoms?" Does she focus on trying to rid the patient of his symptoms or on trying to hear what the symptom is telling the suffering individual; can she wonder about the implications and meanings contained within the painful symptom? A symbolic attitude asks that we not get caught in the illusory concreteness of life and that we remember that nothing is "only this;" everything else again, implying infinite
Yet another way to think about the question asks, "Is the analyst/therapist trying to accompany and understand the patient rather than to help her?" The patient wants to be "helped" and the clinician has undoubtedly chosen this work out of a conscious wish to help people. But as the beginner therapist matures and learns more about how people develop, he will come to see that people grow when they are seen and accepted as they are (Sullivan, 1989). The woman whose violent attempt to force her child into this or that shape may frighten or horrify the therapist, causing him to try to "help" her become a better parent. But until the terrors that are impelling the mother into a destructive posture have been recognized, accepted and patiently held by her therapist, the mother will not be able to make a consistent change. It may look, on the surface, as though the therapist's advice helps the parent, but I believe this is deceptive. The therapist's advice can be taken in only if the therapist compassionately holds the mother's distress, even if he is only partly aware of the emotional pressures he unconsciously accepts. In other words, if, in objective reality, the therapist's advice is discharging his not fully conscious horror, it is extremely unlikely to have any positive impact; if, on the other hand, the therapist truly holds his distress and empathically understands the mother's pain, child-raising advice that is really just advice may be helpful. But improving the patient's parenting skills will never be the core focus of a depth perspective. The analytic task is to help the person to become as much of herself as is possible. The analyst's job is to get to know the patient, a task that can never be completed. As we shall see, when we imagine that we "know" someone, we have closed off the space to continue to be curious about that person's infinite depths, with all their surprising and unmappable twists and turns. Getting to know him, on the other hand, an endless process that supports the therapist's curiosity, is the job of the depth therapist. As this process unfolds, the frighteningly difficult mother of our example will inevitably become a better parent because we treat others as we treat ourselves. If the patient can take up the therapist's curious and compassionate attitude toward her, she will be able to open herself to her children and to other intimates, as well.
This core attitude was articulated by Winnicott (1971) when he described analysis as a long-term giving back to the patient what he has brought. Advice is not called for because the depth therapist is not trying to "cure" the patient; she does not assume that there exists a desirable shape into which people should be molded. Rather, she assumes that this particular person has a natural shape, which is unique to him, that he needs to spend his life becoming. This does not actually mean that we give up all thought of emotional health. As I indicated above, by focusing on her own capacity for relatedness vis-à-vis this particular patient, the therapist is working to create a healing relationship with him. To the extent that this relationship develops, the archetypal process of emotional growth that I outlined above will be set in motion and the patient will grow. The patient will move in the direction of becoming all of himself and will develop more of an ability to choose what to do with the truth of who he is. We have nothing to say about who we are, but it is possible to have a great deal of say about how we behave. So Winnicott's attempt is to reflect back to the patient who he is today, without judgment about what he wants to do with that.
A concrete example of this stance imagines a patient who typically discharges emotional tension by shopping. In this situation, the therapist may be tempted to tell the patient that his behavior is not good for his growth. "A lot of painful stuff has been uncovered this hour," she might say, "and it would be good if you could resist discharging your distress by shopping and instead stay with your pain." This is an anti-analytic comment. Speaking in an accepting manner about the anti-growth energies that grip the patient is an entirely different animal. "I think that this painful material might be hard for you to bear after you leave me and are all alone. And I'm remembering that we talked about the way you sometimes go shopping when you're in pain. Do you think you'll be tempted to run away from your distress when you leave me today?" is a very different comment. The practitioner is not telling the patient how to behave, she is wondering if he can notice a link that has been discussed before. If the link has not been made before, this may be an opportunity to make it: "I can see how painful this new material is for you. Sometimes I have the impression that you turn to shopping to soothe yourself when you're in pain. Do you think there might be a link there? Maybe we could together pay attention to how you will manage your pain when you leave here." How could the therapist not want to help her patient? But the patient will not grow through the therapist's attempt to cure him; he will grow if a spark of curiosity about himself can be ignited.
Many therapists and analysts might disagree with this perspective. Many practitioners orient more centrally to being helpful rather than to understanding. In my opinion, attempts to help will inevitably limit the clinician's capacity to receive the fullness of the patient in this moment. In order to grow, we need the space to be destructive and to learn from our mistakes. An affair that destroys a marriage need not be "a mistake." If the individual can learn from it and grow, it may prove to be a constructive step in development. Certainly an affair is not the best possible way to end a marriage, but sometimes the marriage needs to end and it may be the only possible way out for this person at this time. Knowledge can be passed on, but wisdom must be earned anew by each individual; and wisdom emerges from reflecting on our errors, not from being helped to do things the "right" way.
The relationship is central
Although I do not differentiate in this work between "therapy" and "analysis," it is important to distinguish between depth and surface orientations. In addition to the symbolic attitude that seeks always to glimpse what lies under
the surface and to include that in any understanding of the situation, an analytic point of view will be centered in a recognition that the interpersonal relationship between practitioner and patient is the core container for the patient's development. A contemporary understanding of the therapeutic relationship begins by recognizing that we do not exist as unitary selves. In working to know my patient, I must begin by knowing myself. But such knowing does not imply a fixed understanding developed in the past. Thomas Ogden's (1994) "analytic third" describes the "us:" the unconscious life that patient and analyst share. Patient and therapist each hopes to find more of themselves than existed before the work began. As the practitioner works to know the "us" that has been born in this unique therapeutic relationship and to get herself sorted out from it, she begins to develop ideas about who her patient might be.
This implies that the analyst holds the transference relationship in mind as much of the time as is possible. This focus has little to do with what the practitioner should say to the patient. When a comment on the relationship has the potential to bring the two people emotionally closer, a comment is called for. But often the issue will be for the therapist to find ways to approach her patient in a more related way that does not include telling the patient what the problem is. It can be difficult to keep a firm grasp of the centrality of the relationship in therapeutic situations that do not allow the therapist to talk much about it. But no matter what else is happening and no matter what the manifest content of the conversation may be, an emotional experience of the interpersonal relationship evolves at every moment. It seems intuitively inescapable that that emotional experience impacts the patient more powerfully than any cognitive content being discussed. Symbolic listening is one stance that helps the analyst imagine what the patient's emotional experience might be. Internal symbolic listening that fosters recognizing her own emotional experience similarly helps the analyst imagine what the patient is working on at the moment.
The analyst must try to take responsibility for her own feelings. This means that she will not immediately decide that her emotional state falls under the rubric of "syntonic countertransference" (Fordham, 1978) — a subjective state brought up inside the therapist in direct response to the patient's internal psychological structures. If I feel envious of my patient, it may be that I am replicating his mother's envious attitude (a syntonic countertransference reaction), but my relationship to my own envy will also impact what happens with envy in this clinical relationship. The therapist must take a humble attitude, working to open herself to whatever emotional currents are stirred inside her rather than attempting to deny them, and to use whatever understanding of her subjective state she can muster in intuiting her patient's subjective state. The practitioner has to try to contain her needs, her personal distress, her judgments, holding an awareness of her feelings in consciousness without discharging them into action. It is never possible to do so perfectly. It may not even be possible to do it very well. We hope to manage it well enough.
The therapist wants to stay curious about the impact of her behavior on the patient rather than getting caught in trying to behave "correctly." Can she recognize her "errors" without getting thrown into frightened attempts to undo them and take away their impact? Can she be curious about the ways she makes "mistakes" and remember that everything always goes wrong, including her own efforts? People do not grow in sterile containers with perfect analysts; they grow in messy human relationships, with analysts who try their best to do right by their patients but whose best must frequently consist of reparative efforts vis-à-vis the difficulties they have created.
A depth perspective recognizes that analysis is a mutual endeavor. Whether it helps the patient to become more of himself and to live a fuller, richer life depends on mysterious factors that we can only hold as hunches. In the transference relationship, each person is both growing and resisting growth in ways that neither one can ever hope to pin down definitively. The depths of the developmental process are infinitely mysterious; the rest of this book circumambulates that mystery, exploring it from one perspective after another.