CASSORLA, ROOSEVELT M. SMEKE. ‘The analyst’s implicit alpha-function, trauma and enactment in the analysis of borderline patients’, International Journal of Psychoanalysis, 2008, 89, pp.161-180.
IVEY, GAVIN. ‘Enactment controversies: a critical review of current debates’, International Journal of Psychoanalysis, 2008, 89, pp. 19-38.
MORGAN, DAVID. ‘Enactments: moving from deadly ways of relating to the beginnings of mental life’, British Journal of Psychotherapy, 2008, 24, 2, pp. 151-166.
Brazilian analyst Roosevelt Cassorla delineates the parameters of his approach to enactments near the conclusion of his article when he writes, “I am concerned with discussing situations where the professional is involved in the enactment not only due to personal faults but also as a way of reaching deeply into traumatized areas” (p. 177). His approach is analytic in the best sense of the word in that he elucidates an understanding of intense affective eruptions within the analytical relationship as part of the analytic process and not due to some failing in the patient or the psychological make up and approach of the analyst.
Cassorla offers his hypotheses in order “to pose questions and open new pathways, rather than to justify any faults or limitations on the analyst’s part. They represent an attempt to understand them outside of his sphere of responsibility” (p. 178). Primarily using the ideas of Bion Cassorla begins by framing the place of the alpha-function and beta-elements with the analytic process. He posits two analytic extremes of dream and non-dream to set the stage for his paper. When the analytic process takes place and the alpha-function of both participants are activated analyst and patient are involved in a dream-for-two. However, when the patient (Cassorla is addressing work with borderline patients) has inadequate alpha-function, the non dream beta-elements may overwhelm the alpha-function of the analyst. When this happens then analyst and patient exist in a non-dream-for-two state.
Enactments emerge when the analytic dyad is caught in the latter state of mind which is why “discharges” occur that “involve both members of the analytical dyad without their being conscious of the fact” (p. 164). Cassorla suggests that analyst and patient are not aware of the situation and are involved in a form of collusion that he describes as a chronic enactment. The true state of the relationship is revealed in an M Moment during which “the analyst loses control of himself and releases a discharge, an unthought-of action. At once he realizes his mistake and feels upset and guilty” (p. 164). Yet surprisingly the analyst finds that “(a) no harm has been done, and (b) the analytical process has become more productive.” In enactment the analyst, according to Cassorla, is “suffering” in a maternal masochism during the analytic process and deeply concerned about what has happened and by what he has become gripped.
Cassorla moves into the heart of his hypotheses using two case examples and suggesting that the M Moment, an acute enactment, is an eruption from the unconscious to make the analyst and eventually the patient aware of the chronic enactment with which they have been living. Cassorla suggests that the chronic enactment has been a non-dream-for-two “with plugged up anxiety,” a situation in which an underlying traumatic situation in the patient’s life “is frozen and unable to manifest itself openly” (p. 171). At the M moment “the chronic enactment explodes and gives way to acute enactment. This shift indicates a revival of the trauma, which had been frozen, and releases the plugged anxiety, with both seizing abruptly the analytical field” (p. 171).
Cassorla thus sees chronic enactment as serving a protective function within the analytic relationship, offering a kind of interpersonal approach to the self care system Donald Kalsched describes that functions within an individual to help protect from further trauma. The acute enactment serves as a catalyst to move the analytic process forward while revealing that the chronic enactment has been unconsciously established to avoid a revival of trauma, “freezing it and plugging up anxiety” (p. 177). In this state of collusion the analyst is immobilized so he can’t re-traumatize and is needed as a protective shield against trauma. Such a profound unconscious connection between patient and analyst makes it possible to eventually examine traumatized areas. A waiting period is necessary in order to allow adequate time for co-operative work to take place.
Cassorla’s work is engaging and succeeds admirably in providing a workable hypothesis for understanding an enactment that blames neither patient or analyst for such highly charged analytical moments, and offers a way to integrate them as part of the analytic process in a non judgmental way.
South African analyst Gavin Ivey’s article offers a broad survey of enactment theory. Ivey seeks to evaluate theoretical differences in the current understanding of analytical enactments and to challenge recent assumptions that theoretical differences are now diminished due to common attention to the transference/countertransference field. He concludes that, “A critical review of the literature shows that, rather than reconciling previously divergent countertransference perspectives, the phenomenon of enactment has rather provided a new platform for opposing theoretical and technical approaches” (p.35). Ivey “proposes a methodology for evaluating competing claims, grounded in the close scrutiny of the specific intrapsychic and interpersonal processes preceding, manifesting and following particular enactments.”
Ivey addresses six important controversies that he identifies among the various theoretical approaches to enactments. They are in brief: (i) Are enactments typically benign opportunities for growth and insight, or do they have negative consequences? (ii) Is enactment behaviorally inevitable countertransference or can countertransference be experienced without being enacted? (iii) Do enactments always precede and provide prerequisite conditions for countertransference awareness and resolution? (iv) Are enactments intermittent disruptions in the treatment of disturbed patients, or continuous throughout the work with most patients. (v.) What role does the analyst’s subjectivity play, and (vi) How should enactments be addressed in the course of analytic work? (p. 20)
Ivey discusses this array of issues through the lens of one case example, in which an interpretive enactment took place. The patient was struggling with the decision to end a relationship with a woman who could not be present to him as needed, much as in the case of his mother. At a critical moment out of the analyst’s mouth comes an interpretation that had more of the tone of the patient’s negative father complex and changed the tone of the analytic process. The patient claimed not to have been negatively affected by this comment, but the analyst’s reflection on the moment suggested otherwise and he brought his concerns into the work.
Ultimately Ivey realized long after the enactment had taken place that the source of his comment, while stirred by the unconscious of the patient, was related to a forgotten component of own psychology. Ivey’s case example not only serves as a path through the enactment literature he surveys, but also as a reminder that any understanding of analytical enactments ultimately resides in the psyche of the analyst and not only that of the patient. Even with his own thorough analytic work Ivey realized, “Clearly, I had unconsciously identified with my patient and subjected him to the same criticism that I, at some level, still felt toward myself” (p. 33). From his experience as well as literature survey, Ivey astutely observes that “The cherished image of analysts, as self-transparent, swiftly apprehending their enactment participation while isolating and comprehending the contribution played by their conflictual residues, is a regrettable fiction.” “This implies that the analysis of the countertransference is as important and, indeed, inseparable from the analysis of the transference” (p.34). Ivey’s succinct conclusion avoids the “patient made me do it,” mentality that can leak into our work, to remind us that an honest piece of analytic self-reflection can teach us more clearly of our own lingering complexes.
While British analyst David Morgan uses enactments in his title, his article is best described by his subtitle, “moving from deadly ways of relating to the beginnings of mental life.” Morgan’s contribution is essentially two case studies in which the patients “both employed actions to evacuate feelings of discomfort, one through enuresis and the other through violence and perversion” (p. 151). Morgan demonstrates how the analyst in these cases was able to assist the patients “to move from powerful forms of concrete thinking and enactment to the beginning of thinking for themselves” (p. 152). Through his case examples he succeeds in showing “the importance of the analyst bearing these feelings of discomfort at a physical and emotional level” (pp. 151-52). However, he does not show how analysts are caught in the unconscious web created in the patient/analyst relationship and pulled to enact themselves as Cassorla and Ivey do in their articles. Morgan does demonstrate how the relationship history of each patient challenges the analyst to engage the patient and transform defensive and destructive relationship patterns, the antidote to enactment patterns. While not depicting analytical enactments, he does primarily present case material, and not theory, to help amplify the transformative aspects of the analytic process that hinges on analysts “understanding that they themselves are also work in progress” (p. 151). His methodology is one that Ivey suggests best serves us in understanding the issues that analysts confront in their work.
Reference
Kalsched, D. 1996. The Inner World of Trauma.London: Routledge.