In this section I will visit the theories that helped me conceptualize the dynamics of our relationship.
Any narration, seemingly realistic, always tells us as analysts (and only as analysts) of something else: of the patient’s internal world and, in particular, if we are able to listen, of the appropriateness of his instruments (for feeling, dreaming, and thinking). Civitarese and Ferro (2013) remind us that we have to put ourselves into a mental state open to the new and unpredictable, and to think of losing ourselves in the field and re-emerging from it. Ogden considers reverie “a principal form of re-presentation of the unconscious (largely intersub-jective) experience of analyst and analysand. The analytic use of reverie is the process by which unconscious experience is made into verbally symbolic metaphors that re-present unconscious aspects of ourselves to ourselves” (Ogden, 1997, p. 727, in Birksted-Breen, 2012, p. 827).
Everything that goes on in the analyst’s mind during sessions are considered reveries by Ogden. “He includes all kinds of daydreams and fantasies, not just those that seem to be related to their patients. Even the analysts’ physical sensations during sessions are considered to be manifestations of reverie.” (Avzaradel, 2011, p. 850). Odgen’s work (1994 and 1997, in Avzaradel, 2011) suggests that reverie can be thought of as a maternal function. Mothers receive their babies’ communications then metabolize them for their babies. This is similar to Bion’s (1967) hypothesis of an alpha function exercised by the mother when she processes the baby’s projective identification and converts what he calls “nascent sensory data,” including emotional data, or beta elements, into alpha elements (p. 308).
I see now that my reverie, my hearing Paul without words, my losing myself in the field and re-emerging from it, and my impulse to talk about the German conductor, were my ways of saying “I hear you,” as my part in the development of the analytic field.
Scarfone (2010) states how the analyst assists the hearing and welcoming the analysand’s speech without immediately reducing the latter to an assured “I hear you;” it implies allowing the alien-ness that dwells in that speech to run its course, through the analyst’s attempt to depose, if not revoke, his own ego. The analyst’s aural offering denotes a disposition in which attention cannot be exclusively paid to signifiers, insofar as the other’s speech. Attention is to give way to felt experiences in the analyst, leading to perceptible changes in analytic listening. It is a matter of states—the states in which the analyst finds himself/herself. The analyst’s active part in the reinstatement of the original enigma is therefore doubled up by the analyst’s essential passivity-passibility,6 through his/her listening disposition.
My reverie turned out to be a lifesaver for Paul’s treatment. While writing this paper, I became aware of the power of music and the enigmatic, unpredictable way that reverie announced the process of transformation.
Our symphony was developing, and there was a shift in our relationship that lead us to exit the impasse. The music’s themes, its different shades (minor and major) were unfolding like magic. We started to touch the sounds and metaphorically to touch each other.
When I told Paul about the conductor, in a way, I changed the frame and the rules of the analysis. I brought the music (the outside) with my comment about the conductor (part of me) into the frame. I changed the content and moved the frame by sharing my associations, making music part of the frame. This shift in the frame was something like: “Now we can talk about music.”
Goldberg (2017) talks about the frame as a living organism that plays an active role in organizing the perception of, and maintaining psychosensory contact with, the world of objects (both physical and external). The analyst’s contribution to keeping the frame alive, constantly reconfiguring it according to the demands of the encounter, is a mode of engagement in which the analyst implicitly joins the patient in sensing music together. The qualities of this movable frame are constantly micro-adjusting and becoming something new.
Rottura del Impasse [Breaking the Impasse]
Harris (2009) considers Aron’s (1996) statement that impasse in treatment always has something to do with an impasse in the analyst. She said that in circumstances of impasse, there is always a paradox. Deadness and stasis can seem locked in, and the dyad trapped into, polarized complementarities. But within impasse there is always the potential for the use of an object, for a weathering of destructiveness, or a slight shift in the psychic equilibrium of one or both participants. Deadness and a point of optimal turbulence are actually closer than one might imagine. Looking back, I can see now that my contribution in breaking the impasse had to do with my strong need to connect emotionally with the death inside of Paul. The aliveness of music became the vehicle by which we could both begin to mourn the dead and recover from the deadlock of the impasse.
As I write about my surprising intervention regarding the German conductor, I think it was my unconscious way of encouraging Paul to express his hidden feelings in words. This thought lead me to Levine (2008) who asked: “How do we determine, moment to moment within the session, when we may ‘analyze as usual’ as opposed to when we should wait for the inspired moment of formal regression that will unconsciously and spontaneously allow us to perform “the work of figurability?” (p. 646). I cannot fully answer that question but I can think of my need to bond with Paul and help him verbalize his inner world as one reason for impulsively sharing that information with him. At that time, I also remembered going to visit my grandmother who was listening to classical music. This was a memory that I had not had for a long time. I realized that even though I knew that classical music was an intrinsic part of me, those feelings became more vivid and alive in my relationship with Paul. I remembered my grandmother, Paul remembered his stepmother, both memories were associated with music. For both of us, music is a soothing experience, in Paul’s unconscious and mine. Music also allowed us to remember. We had a “meeting of minds” (Aron, 1996) in that two separate subjectivities allowed the emergence of a third, here was music, an intersubjective field of emerging experience.
I also thought of Stern’s et al. (1998, in Civitarese, 2019) “moments of meeting” or what Bion calls moments “at-one-ment” (1967). Bion proposes, based on the model of the mother–child relationship, to consider the shared emotion of the session as the first element for aesthetic growth of the mind. Mother and child understand each other perfectly even when the latter cannot yet speak. Clearly between the two there is a communication system based on the intensity of exchanges, their duration, and nonverbal language. More specifically, the event that promotes psychic growth is the emotional at-one-ment.
Comunicazione Non Verbale [Non-Verbal Communication]
Reflecting on the musical connection between mother and child, Trevarthen (2009) observed that communication with a newborn can be mediated in silence, but it is always moving and rhythmic, and the sense of hearing leads and enriches what is seen. The mother has a powerful intuitive feeling for what the baby will respond to, and soon she finds the right pitch and quality of voice. Her infant directed speech is a message of affection and respect for the infant’s feelings, and the infant attends preferentially to the loving qualities of her message. As time went on, my accent and the rhythmic ways in which we started to move in the sessions allowed Paul to hear me as a reliable mother. I now believe that this transference allowed him to start the mourning process with somebody who was not leaving him. However, different elements that appeared later in the transference (fear of losing me) indicated that I might not have been such a safe object. The shared music connected us in a special (dangerous?) way.
Oggetti Morti e Vivi [Dead and Alive Objects]
For Baranger (2009) unmourned dead/alive objects crowd out the vitality of internal object life and produce bastions of resistance to growth. This is particularly likely in situations of trauma. Baranger’s idea of dead/alive objects reminded me of Green’s (1986) concept of the “dead mother.” Green described an infant’s reactions to the emotional withdrawal of the mother due to depression. The mother’s abrupt detachment from her infant, is experienced by the child as a catastrophe; because without any warning signal, love has been lost in one blow. This carries in its wake, besides the loss of love, “the loss of meaning” (p. 150). According to Green, after failed efforts at repair and reunion, the child will both withdraw emotionally and identify with the mother’s blankness, becoming her mirror image, meeting absence with absence as the only way to connect with her. Green advised the therapist to: (1) think of his/her work as providing a transitional space; (2) maintain an aliveness and vitality that the patient can internalize; and (3) consciously avoid being a dead object, so that ultimately, this may help the patient mourn his/her early losses. In these ways, Green underscores a major conflict that prevents one from mourning: the requisite transition from living with absence, to being present and living with loss (Green, 1986, in Rubinfine, 2016). Actually, at times, I felt that I had to bring Paul to life.
Stein (2004) with the notion that denial or similar defense mechanisms are prototypical components of the mourning process, suggests that music can be thought to function as an object of transitory identification, in that the aesthetic reverie evoked by listening to it implements a fantasy in which the painful reality of loss is denied or disavowed.
Deutsch’s explanation for the lack of mourning is that children can display a “heartless” response following the death of a loved one because “the ego of the child is not sufficiently developed to bear the strain of the work of mourning and … therefore utilizes some mechanism of narcissistic self-protection to circumvent the process” (Deutsch, 1937, quoted in Stein, 2004, p. 796).The most extreme expression of these mechanisms is the omission of affect. Perhaps this may explain why Paul was emotionally detached.
Vita e Morte [Life and Death]. Anch’io Sono Diventato Vivo [I Became Alive Too]
Thinking of how Paul and I became alive when talking about music lead me to Odgen and Odgen (2012) who illustrate the centrality of the experiences of aliveness and deadness to the analytic process, and demonstrate how the quality of aliveness—an aliveness of language, of self-awareness, of waking dreaming, of conscious thinking and feeling—is, from a certain point of view, a goal of analysis.
Qualities of aliveness and deadness are qualities of self-experience that not only include the nature of the interplay of conscious and unconscious aspects of mind but also encompass a great many other facets of an individual’s experience, for example, qualities of imaginative thinking, dreaming, falling in love, of “getting lost” and “being found” in the course of conversation with a friend or with one’s analyst (Ogden & Ogden, 2012, p. 251).
Altri Pensieri [Other Thoughts]
(a) Atlas and Aron (2018) state that we unconsciously “look forward” (p. 22) to future possibilities as the mind anticipates, prepares, shapes, and constructs. They underscore “how our unconscious hopes and dreams, our goals and ends, pull us towards our destiny and how we unconsciously anticipate and dramatically rehearse for that future” (p. 22). I wonder if Paul was looking into the future in a more optimistic light in view of his self-discoveries.
(b) Thinking about Mahler and Paul, I came to acknowledge that Mahler was the third in our interactions. Gerson (2004) views thirdness as a recognition that is not first constituted by verbal speech; rather, it begins with the early nonverbal experience of sharing a pattern, a dance, with another person that presents itself in the earliest exchange of gestures between mother and child, in the relationship that has been called oneness. With Paul, I felt as if we both had Mahler in the sessions with us. Not only his music, but all three of our losses: Mahler’s, Paul’s, and mine. We had all struggled with close relationships, death, and fear of loss.
(c) Steiner (1993) describes patients who are in “psychic retreat,” with such a defensive structure that the ability to achieve contact can be very difficult. This defensiveness is constructed in an attempt to avoid intolerable anxiety and unbearable pain. The patient who has hidden himself in retreat often dreads emerging from it because it exposes him to anxieties and suffering which is precisely what had led him to deploy this defense in the first place. I think that shame had also played a role in Paul’s “psychic retreat.” Steiner (2015) talks about how recognizing shame, may help the analyst support his patients’ capacities to tolerate the discomfort of being seen so that the conflicts about seeing can be worked through. I wonder if Paul’s guilt (internal bad object) over not mourning his mother and stepmother was expressed in his defensive stance manifested by his apparent coldness and distance.
(d) Civitarese & Ferro (2013, p. 195) point out that “the field is delimited; it is a container. As such it is in a dialectical relationship with what is outside it that is with other, broader containers (social groups, institutions, ideologies, etc.).” Like the bow of a violin, our exchanges moved up, down, sideways, transforming us and transforming the field. The sounds came also from a place of vulnerability. For Paul it was his initial tentative verbalizations about music. On my part, it was my cautiousness and wish to connect with him. At the same time, music was a place of pleasure. This shared experience of music dissolved the distance that he had created at the beginning of treatment. I started to become the loving stepmother. By transforming me into her, I realized that my reverie had announced (without my knowing it at the time), themes of sexuality and seductiveness, transference and countertransference, that became elaborated allowing both of our transformations to take place.
It is not at all clear what was said that lead him to take the risk and start talking about music. Nor is it clear what he sensed in and about me. That question is not resolved. I look back and perhaps it was my body language that indicated that I was interested. I also remember that in our initial session he commented on my accent (music again? sound?) and he told me that he felt it was charming. Our music started then, without my realizing it. These waves of rhythmic, tonal, and lyrical patterning, evoking emotional responses, sometimes subtle, sometimes powerful, started to become part of the sessions when Paul invited music to be with us. What seemed like deadness of absence was transformed in deadness of mourning and becoming alive.
(e) Bion’s understanding of unmentalized experience, and the Botellas’ (2005, in Levine 2008) work on the symbolization of experience and mental states without representation, describe the symbolic experience as potential that has not yet been actualized in symbolic form. Ferro (2009, in Stern, 2013) describes the creation of symbolic experience as transformation. The Botellas call it “the work of psychic figurability,” (Kirschner, 2007, p. 303; and Stern, 2013) and referred to it as the process of formulating experience since words construct the experience that has not been articulated before. Unconscious communication progresses from unconscious perception to figurability and reverie. Empathy is the condition of unconscious communication in the analytic pair, according to Bandeira (2017).
Eshel (2012) reminds us that:
Patient and analyst thereby forge a deep experiential-emotional…process where-by the analyst interconnects psychically with the patient, and they become a new, two-in-one entity that goes beyond the confines of their separate subjectivities and the simple summation of the two, an entity (unit or being) of interconnectedness …that transcends the duality of patient and analyst: two-in-oneness (p. 151).
and allows for transformation in analyst and patient. Music being a non-verbal, a primitive form of sensory human connection, the sound in the room allowed for transformation in both of us.
(f) Following Levenson (2017),
To the psychoanalyst, the phenomenon of change is as mysterious and elusive as the unicorn. Difficult to describe or define, unpredictable in its moments and forms of appearance, almost impossible to quantify in the hard-data style dear to the hearts of statistical research psychologists, it is nevertheless an article of faith, the very essence and purpose of psychoanalytic effort. Change may follow a formulation of the therapist, sometimes a reactive feeling of the therapist (not necessarily appropriate) (p. 17).
Later on he stated that “Like the mystical or the aesthetic, the psychoanalytic experience is capricious and unreliable” (p. 18). Thinking now about my abrupt intervention, reminded me of Gabriel García Márquez’s statement about his writing of his novel Love in the Time of Cholera: “I’m very curious, as I’m writing this book, to see how the characters go on behaving…I could almost say that one writes the novel to see how it will turn out” (Márquez, quoted in Simons, 1985, p. 18). Garcia Márquez is telling us that the characters of his book are capricious and fickle, certain responses of the analyst can be too, like in my case. My spontaneous response about the German conductor can be considered in this category of unpredictable interactions. It was sudden, unexpected, and had a jolting sense of having been totally impetuous. As Hoffman (1983, quoted in Stern, 1991, p. 414) stated “The analyst’s uncertainty has […] to do with his inability to know, in advance, how much his own countertransference will govern his response to his patient .…” Odgen (2019) sheds light on this phenomenon by differentiating what he calls epistemological psychoanalysis, having to do with knowing and understanding, and ontological psychoanalysis, having to do with being and becoming. Epistemological psychoanalysis principally involves the work of arriving at understandings of unconscious meaning; by contrast, the goal of ontological psychoanalysis is that of allowing the patient the experience of creatively discovering meaning for himself, and in that state of being, becoming more fully alive (p. 661). He further says that:
…therapeutic action characterizing ontological psychoanalysis involves providing an interpersonal context in which forms of experiencing, states of being, come to life in the analytic relationship that were previously unimaginable by the patient… (p. 667).
(g) Bion’s first models of the mind (1967) were firmly within the scientific and mathematical domain. However, we see him gradually moving away from his preoccupation with science towards an aesthetic explanatory conception of psychoanalytic thought with analogies from the visual arts and literature. Bion stressed that it was the visual sense which lies at the core of unconscious fantasy and he describes more the phenomenology of the analytic encounter in terms of visual and aesthetic analogies. He believed that it is the love of truth, coupled with an aesthetic sense, coupled with the analyst’s personality, his training and experience, that are the focus of the analytic encounter (Glover, 1998).
Civitarese (2014) states that great value is given to the intensity of the experience undergone by the analyst and the patient in their encounter. The emphasis on passion as an indispensable dimension of the elements of psychoanalysis, but also on the senses and on the fictional dimension of the analytic setting all serve to concentrate on what is alive in the here and now of treatment. For “passion” Bion means that the analyst must pass through a transformation of his own self, must let himself be impregnated by the patient’s suffering—in his terminology become the O of the patient, or “of the session” (Civitarese, 2014, p. 1077). In this paper, the term aesthetics refers to music with its sounds, cadencies, and verbal and non-verbal expressions. It was through our shared passion for this aesthetic experience that stimulated Paul’s treatment to change its course.