Journal of Analytical Psychology Volume 56 Issue 2 2011 -The Concept of Analytic Contact- The Kleinian Approach to Reaching the Hard to Reach Patient

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Journal of Analytical Psychology, 2011, 56, 267275

Book reviews

Edited by Marcus West and Patricia Vesey-McGrew

WIENER, JAN. The Therapeutic Relationship: Transference, Countertransference andthe Making of Meaning. Foreword by David Rosen. Texas A & M University Press,2009. Pp x + 150. Hbk. 19.95.

This deceptively slim volume is a gem and a generous gift to all those, of whateverpersuasion, who seek to practise their craft from a psychodynamic perspective.

Beyond that, it is written in such an engaging and lively style, with its terminologyclearly defined, as to make it accessible to the lay-person who may be contemplatinganalysis.

Throughout the book, the author constantly challenges the reader to reviewand re-revision their thinking about transference/countertransference phenomena: avery considerable and courageous challenge to us all, which made me scan mypractice and everything that puzzles me about my work, both in analysis andsupervision.

In the Afterword, Wiener alludes to the mysterious, a word derived from theancient Greek muoI am silent. Reading through this densely packed volume, I kept

on thinking about the mystery of transference in all its manifestations, from everydaylife to the bewildering projections of our everyday work, which can even make us ill inone way or another.

This tour de force is the distillation of many years of reflective practice. Essentially,it seeks to offer a healing of the wounds and damaging splits within the Jungiancommunity, and between Jungians and psychoanalysts. Borrowing her image of atapestry, I feel that she has woven a cloth that embraces poetry, music, fable,neuroscience, emergence and attachment theory, cooking and philosophy, Jungianideas and those from psychoanalysis. Of central importance is her notion of imaginationas a mental space and a mental function both within analyst and patient and between theanalytic dyad and she sees countertransference as a special form of active imagination

(p. 57).There are six clinical vignettes, which include a commentary on Jungs relationship

with Sabina Spielrein and James Astors analysis of the patient K. In one of these,Wiener explores in depth something that we have all experiencedgoing to sleep in asession, even if only momentarily. The account is honest and takes us into the mindof a creative and imaginative analyst, who warily treads the path of when and how towork both with and in the transference.

Her reflections on her clinical and supervisory experience have engendered the keyand innovative concept in her bookthat of the Transference Matrix. Drawing onJungs tussle with the Rosarium Philosophorum, an arcane and abstruse text, a vague

and possibly avoidant approach to intimacy within the analytic relationship, Wienerhas delineated two camps within the Jungian communitythe developmental and the

0021-8774/2011/5602/267 C 2011, The Society of Analytical Psychology

Published by Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.


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classicalwhich could share common ground in the transference matrix, of whichshe writes: [It] is a co-constructed place with structure, form and energy. The termoffers us a framework for thinking about transference, countertransference and themaking of meaning in analysis . . . It has its own energy and power which are greater

than the combination of the two people within it (p. 96). These surface from the Selfand not from the ego, as a special form of active imagination, in which we can tryto take on board the purposive projections of our patients onto ourselves throughaffective, imagistic and somatic sensations. All of this is a far cry from the repressedunconscious and emphasizes a specifically Jungian approach to working with and in thetransference. The transference becomes a symbol, something known and at the sametime unimaginable until both analyst and patient can create a meaningful narrative,a space in which they can both play, and one in which there can be moments ofmeeting.

Throughout the book, which is remarkably transformed from the authors 2006Fay Lecture Series in Analytical Psychology into a text of five chapters which trulyspeak to the reader, Wiener darts between opposing views of theory and practice,making her own synthesis but inviting us to find our own. She questions how we findand create meaning from experience. I think meaning comes later; the problem withso many of our patients is how to offer them a space in which they can experiencethemselves bodily and affectively. These questions are not bypassed, but I found heremphasis on meaning a bit lop-sided. With so many borderline patients, connectednessand affect regulation pose enormous problems for all of us and precede the searchfor meaning. But Wiener does take up the gauntlet of interactive regulation, whichflows both ways and, she calls upon Jung, slightly misquoting him, this bond is of thegreatest therapeutic importance in that it gives rise to a mixtum compositorum of the

doctors mental health and the patients maladjustment. This pathologizes the patientand evades what Wiener is trying to address in her bookmutuality and asymmetryin the therapeutic relationship; yet again, an invitation to transcend apparentopposites.

I could have tried to paraphrase the chapters. I have chosen not to because,within the text, there is the spirit of the Trickster in its most creative form. As areader, I was bounced uncomfortably and unpredictably between ideas, experienceand doubta crossroads encompassing my own work, its meaning for the analyticduo, faith in the process and the never-ending quest for the evanescence of truthin our impossible profession. It is packed with an overview of Jungian andpsychoanalytic thinking on transference and countertransference; and as I haveread and re-read it, I am reminded of Rainer Maria Rilkes letter from Love andother matters: Be patient towards all that is unsolved in your heart. And try tolove the questions themselves. Live those questions now. This is what Wiener hasdone.

I hope that this magnum opus will reach the minds and shelves of everyonepractising psychodynamically, and that it will be translated into many languages. Itoffers the possibility of rapprochement between our fragmented Jungian communityand between us and our psychoanalytic brethren, from whom we have learnedmuch.

There are lacunae in this book, which the author acknowledges: no mention of

the negative, delusional, eroticized, addictive transference and the problems these maypose for a psychodynamic practitioner. I feel inclined to challenge Wiener to produce asequel to this text to address the gaps. All of us should read and peruse this invaluablebook, which could provide reading groups with a text to debate for some years. It is


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rare that I have encountered a text that is so provocative, challenging and lends such atilt towards reflective practice, so quietly and imaginatively. Please read it.

Christopher Perry

Society of Analytical Psychology

WILKINSON, MARGARET. Changing Minds in Therapy: Emotion, Attachment, Trauma,and Neurobiology. New York, London: W. W. Norton, 2010. Pp. 228.Hbk.$ 32.00/22.00.

In his essay The transcendent function (1957), Jung articulated the idea that minds(attitudes) were changed by the collaboration of conscious and unconscious data(1957, para. 167). In the same essay, Jung observes that consciousness is continually

widened through the confrontation with previously unconscious contents (1957,para. 193). Here Jung is imagining connections within the mind and positing amind capable of making those connections. A main point of Margaret WilkinsonsChanging Minds in Therapy is that the conditions that make possible a generativeconfrontation between consciousness and unconscious contents are relational, andmainly have to do with experiences of affect regulation. Drawing on the fields ofdevelopmental neurobiology, attachment and trauma theory Wilkinson shows howpositive early relational experience fosters connection areas within the brain whileearly emotional trauma fosters divisions between the brains various structures. Earlytraumatic interpersonal experience affects what is available to be encoded, as well as theprocesses of encoding and recall of the memories associated with it. . .Such experience

becomes encoded in implicit memory, unavailable to the conscious mind (p. 65). Ifearly relational trauma can alter brain structure influencing how emotional experienceis stored in memory, it can also leave a mind deprived of the structures necessary foradequate affect regulation, thus promoting further divisions in the form of dissociativedefences. The therapeutic challenge of changing a mind thus divided is the main focusof Margaret Wilkinsons Changing Minds in Therapy. Although it is not always easyto distinguish when Wilkinsons clinical remarks are meant to apply exclusively tosituations of early relational trauma or are meant to apply to psychotherapy in general,the emphasis on the therapeutic importance of affective engagement and on deepemotional involvement on the part of the therapist remains consistent throughout thebook.

Wilkinson has written this book for therapists and explicitly states: My aim is toenable therapists to develop ways of thinking about the insights emerging from thefield of neurobiology, attachment and trauma (p. 12). Wilkinson has synthesized amassive amount of research from neuroscience and presents it in a way that makes itaccessible and applicable to the developmental and clinical processes she is seeking toelucidate. Any clinician trying to assimilate the burgeoning data emerging from thisfield owes her a debt of gratitude for the masterful job she has done in presenting thismaterial. The book would have been even more helpful in this regard if instead ofassuming knowledge of brain anatomy it had included an illustration or two to helpwith comprehending some of the denser passages.

Wilkinson turns to the fields of neuroscience, attachment and trauma theoryin order to place our clinical approach on a solid developmental foundation.Perhaps most relevant for Jungian practitioners is her emphasis on the interper-sonal, inter-psychic developmental underpinnings of the capacity for symbolization.


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Wilkinson counsels a therapeutic approach that combines affective encounter andinterpretation yet, especially in cases of early emotional trauma, she emphasizes theformer.

Quoting Mancia, Wilkinson makes the point that the defining element of the

therapeutic action of current psychoanalysis appears to be that of transformingsymbolically and putting into words the early implicit structures of the patientsmind (p. 102). This happens relationally and requires deep emotional involvementon the part of the therapist so that the patient can experience a new safe affectiveexperience with another (p. 104). Both in early life and in the clinical setting thedevelopment of psychic structures that allow for mature symbolic capacity arise outof the experience of an affect regulating relationship with an attuned and empathicother.

Wilkinson offers us numerous case examples illustrating this process. One particu-larly moving case which includes a series of paintings by a patient reflecting her progressin psychic integration and symbolic capacity is followed over the course of the book.

Wilkinson has included an informative chapter on supervision, reflecting her concernwith the minds that change minds. Jung was fond of noting that minds that changeminds need to be minds that, in themselves, are open to change. For example, inMemories, Dreams, Reflections, he states that The doctor is effective only when hehimself is affected (1961, p. 134). The capacity for affect regulation is at the verycore of the capacity for psychic integration, since it is largely true that we admit toconsciousness only that which we can tolerate in the realm of emotional awareness.Returning to Jungs idea concerning the widening of consciousness, we might say thatthe circle of consciousness is co-extensive with what we can bear to feel. An ideadeveloped by Allan Schore and included as a diagram in Wilkinsons book is that

of working at the edges of windows of affect tolerance. Here we may note that ananalysands consciousness may not only be limited by his or her window of affecttolerance, but by the analysts window of affect tolerance as well. A point that bothneuroscience and attachment theory underscore is that the window of affect tolerancewithin the therapeutic dyad is an essential factor when considering the process ofchanging minds in therapy.

In The transcendent function Jung writes, the suitably trained analyst mediatesthe transcendent function for the patient, i.e., helps him to bring conscious andunconscious together and so to arrive at a new attitude (1957, para. 146). With its focuson the crucial role of affective engagement in the therapeutic process, and thereforeon the affective competence of the analyst, Changing Minds in Therapy bothplaces the transcendent function in a developmental (interpersonal) framework, andmakes a major contribution to our thinking of what suitably trained actuallymeans.

References

Jung, C. G. (1957). The transcendent function. CW 8. (1961). Memories, Dreams, Reflections. New York: Vintage Books.

Ira SharkeyNew England Society of Jungian Analysts


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HEUER, GOTTFRIED (Ed.) Sacral Revolutions: Reflecting on the Work of AndrewSamuels. London and New York: Routledge, 2010. Pp xxiii + 323. Hbk.60.00/$99.00; Pbk. 22.99/$36.95.

Gottfried Heuer, the editor of this plural bouquet for a birthday celebration in print(p. 1), places Andrew Samuels, as the recipient of the bouquet, in the companyof two well-known names in psychoanalysis. Otto Gross and Wilhelm Reich wereboth pioneers and rebels in the early history of analysis. However, their attemptsto introduce radical political ideas into a movement that at the time only valuedloyalty and conformity met with harsh rejection from which neither recovered (Roazen1974).

It is difficult to place the contributions of Andrew Samuels in the same contextas Gross and Reich. His best-known books, Jung and the Post-Jungians (1985), ThePolitical Psyche (1993), and Politics on the Couch (2001), were published in an erawhen the boundaries between various schools of analysis were beginning to get blurred.When Samuels published the first of his books it had also become acceptable to reviewcritically the ideas of both Freud and Jung and to examine their personal lives with afuller range of available documentation. Instead of being regarded as a pariah of theprofession, as happened with Gross and Reich, Samuels has an impressive resume ofaccomplishments and acknowledgements.

What this Festschriftreminds us of, apart from the undeniable status of its recipient,is in fact how far analytic ideas have travelled and in such a multitude of directions:from exploring attitudes towards religion and family systems to new research in scienceand politics, there are now many topics that are open to analytic explorations. Samuelstopic is politics and his own politics, although never explicitly stated, are probably a

bit left of centre.The birthday bouquet consists of40 contributions from different analysts, scholars,

researchers and writers. They all give testimony to how Samuels in his career hastaken great pride in building bridges and worked towards integrating the oftencompeting strands of analysis. Many of the contributors are Jungian colleagues whodescribe their work with Samuels, mostly on the international scene. Others present amore local and English perspective of Samuels work. Some are from more academiccircles.

A theme throughout most of Samuels writings is the insistence that we all, in ourneed for social and relational roots, are political animals and that psychotherapistsand analysts are no exceptions. Most of this manifests in the way we do businessin our trade, in the professional societies we belong to, although we seldom nameit politics. However, Samuels (2001) insists that we also commit political acts withour patient/clients. Even when we are confessing to a credo of not imposing ourown opinions, the entire enterprise has inherent and fundamental values, be it thesanctity of the personal self, or its seeming opposite, the freedom to have a voice in ourcommunity.

As several of the contributors describe, Samuels has taken the latter commitment afew steps further than most practising clinicians. At times, he has advocated for waysthat psychotherapists could help improve political life by bringing about a generaltransformation of politics by translating psychotherapeutic understanding into tools

for the political dialogue (Samuels 2001). In this pursuit, he has served as a politicalconsultant and was the co-founder of Antidote, a psychotherapy think-tank. At othertimes, he has described how depth psychology could also help understand leadership,its seductive as well as its sufficient good enough sides.


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One of the contributors to the book, Lynne Layton, describes how politics may enterinto a psychotherapy relationship when working on dreams and how they may leadthe patient to recognize strong political passions. Samuels would probably approve ofthis approach. In Politics on the Couch he cites a similar process, albeit with a very

different kind of client. The 35-year-old Italian businessman had a dream of a beautifulmountain lake with deep, crystalline water and his associations moved from the lakebeing a symbol of his soul to pollution of the Adriatic coast where he grew up. Samuelswrites:

Then the client posed the question: who owns the lake? Who should control accessto such a scarce resource? Who was responsible for protecting the lakes beautyfrom pollution? From personal issues, such as how his problems interfered withthe development of his potential, he moved to political issues such as pollution,environmental despoliation and the degradations of mass tourism. And he then movedback again from the political level to the personal one. The dream played a part inRicardos choice to return to Italy, tell his parents that he was gay and, in his words,get involved in some kind of politics.

(Samuels 2001, p. 13)

This, to Samuels, is working these forbidden zones and to himand possiblyhis celebrantsa necessary questioning of conventional boundaries. Perhaps suchquestioning is what his friend and editor, Gottfried Heuer, means when he comparesSamuels work to that of Gross and Reich and by quoting from Gross: The psychologyof the unconscious is the philosophy of the revolution. Then, again, the revolutionGross and Reich may have had in mind was at the time a threat to the existing social

order, not merely a questioning of conventional thinking.

References

Roazen, P. (1974). Freud and His Followers. New York: Da Capo Press.Samuels, A. (2001). Politics of the Couch: Citizenship and the Internal Life. London:

Profile Books.

Sren EkstromNew England Society of Jungian Analysts

BOGART, GREG. Dreamwork and Self-Healing: Unfolding the Symbols of the Uncon-scious. London: Karnac Books, 2009. Pp. xix + 304. Pbk. 21.99.

This is a rich and enthusiastic book about dreams in clinical practice. Greg Bogartstates on his website that his work combines psychoanalytic, existential, Jungian,Buddhist and transpersonal approaches to psychotherapy. It appears, however, thathis approach to dreams is inspired mainly by the classical and archetypal Jungiantraditions.

Through the many detailed accounts of his patients dreams (and some of his own) he

explores how relationships, archetypal themes, complexes, persona and shadow, animaand animus, individuation, synchronicity, spirit and body are expressed in dream work.The clinical vignettes, containing several series of dreams (such as the Twenty Dreamsof a Young Artist), demonstrate the evolving therapeutic process as facilitated by


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dreams and reflected in them. They are used to reaffirm the opening statement of thebook: Dreams are healing symbols of the unconscious. . . they have a unique capacityto promote healing from within (p. 3).

The author makes an original contribution to Jungian Dreamwork by introducing

a technique he has developed over the years called The Dream Mandala. Bogartbelieves that every dream reflects the Mandala principle, even when it does notexplicitly contain symbolism of the circle or the centre point. He argues that everydream can be depicted as a mandala, a totality consisting of images that portray theconflicts and divisions within the psyche. He recommends representing the dream as acircle. This is followed by plotting the dreams different characters, scenes or feelingsalong the periphery of the circle, depicting the paired oppositions that constitute theconflict and tension of that moment. He then suggests drawing lines between pairedopposites.

According to Bogart: Mapping the Dream Mandala gives rise to an experienceof the Self, where we experience the centre point within the psyche, where we arepoised between the opposing inner forces (p. 221). The book is dotted with theseDream mandalas, which Bogart suggests we meditate upon: As we meditate upon thecompleted Mandala, he further says, we identify all of its contents as parts of ourinterior reality and absorb it into ourselves. We become the wounded healer who ismade whole through melding the fractured pieces of our souls into a multifaceted jewel(p. 228). The dream mandalas that Bogart draws actually do look like jewels/diamonds.Diamonds are a perfect solid structure which is rigid and static as opposed to theconstant gentle movement of psyches butterfly wings.

Bogart believes that meditating on the opposing forces within us generates immensedynamism (p. 221). Contrary to that I found myself wondering, with some concern,

whether adhering too much to these perfect symmetrical diagrams might generatethe opposite effect, freeze the fluidity of psychic processes. Another danger is that offascination and idealization of dreams. This tendency is reflected in the last statementof the book: Amplify each dream, and polish it to a gem. Then the dream becomesa philosophers stone, the refracted light of an infinite sun (p. 288). Idealizing theunconscious might lead to ignoring the risk of being exposed to its contents when theego-self axis has not yet been consolidated. For example, in the chapter on archetypalthemes Bogart discusses the following dream of a 46 year old man (p. 92):

I am at work. I go outside to a parking lot, but I cant find my car anywhere. I haveto go, give a presentation so I need to find my car. I notice some people driving carsoff a steep ramp into deep water. Some resurface; others do not

. . .

[this is only partof the dream].

Bogart suggests that the cars that do not resurface might represent the needfor a prolonged immersion in the unconscious. However he appears to over-look the possibility that the car/ego might be drowned/swallowed by the sea/unconscious.

I thought that the book could have benefited from an additional brief chapterabout the limitations and the pitfalls of working with dreams, and the limitationsof the do it yourself self-healing approach. Bogart also does not explore in depth the

role the therapeutic relationship, the transference and the countertransference play infacilitating and at times inhibiting dream work. His focus seems to be mainly on thedreams content. Some therapists may feel uncomfortable with the freedom in whichBogart shares Jungian terms and jargon with his patients.


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Having said that, Bogarts passion, respect and devotion to working with dreams ispalpable throughout the book and so is the therapeutic, healing effect his approach hason the patients presented in the book.

Yoram InspectorThe New Israeli Jungian Society/

The Society of Analytical Psychology

WASKA, ROBERT. The Concept of Analytic Contact: The Kleinian Approach to Reachingthe Hard to Reach Patient. London & New York: Routledge, 2007, Pp. xvi + 247.Pbk. 22.99/$42.50.

Robert Waska is a contemporary Kleinian analyst from San Francisco, California. He is

a prolific writer with numerous articles published in a variety of psychoanalytic journalsand seven other books in print. Although Waska writes from a Kleinian orientation, headopts a refreshingly pragmatic position which emphasizes the primacy of the clinicalexperience over theory. Waskas pragmatic approach is reflected in his choice of clinicalexamples, which often include patient material which would typically not be consideredpsychoanalytic in nature. For example, in addition to patients seen multiple times perweek on the couch, he intentionally and frequently amplifies his ideas about analyticcontact with samples from patients being seen in short-term therapy, patients seenevery other week, couples therapy casework, and patients with addictive, behavioural,or characterological issues. Waska utilizes these situations involving less than optimalpsychoanalytic conditions to illustrate the clinical robustness of the concept of analytic

contact. This approach effectively conveys the power of the analytic methodology fora wider population and Waskas pragmatic position does not detract from the depthof the analytic work presented.

Waskas primary exposition of the concept of analytic contact occupies the first fourchapters of the book, although he continues to expand on the concept throughout.By analytic contact he refers to a process in which transference and defence analysistake precedence, self-object relating is examined and interpreted, and an explorationof unconscious phantasy states occurs. He prefers to utilize the term analytic contactin place of analytic process and describes analytic contact as being inclusive of theprinciples of psychoanalytic psychotherapy (to include psychoanalysis) but proposesthat the idea of analytic contact also includes the experience of a close intimate bondand psychological touching of minds that must be a part of the transference-counter-transference relationship (p. 204). Because most patients will attempt to avoid analyticcontact and create a situation of less analytic focus, it is the analysts task to try tosustain analytic contact in the face of the patients efforts to diminish analytic contact.For Waska, issues such as frequency of sessions, use of the couch, and diagnosticsuitability, are of secondary importance and merely serve to enhance or facilitate themaintenance of analytic contact rather than define it.

Holding Waskas concept in mind results in a subtle shift in ones fundamentalorientation to the patient, specifically a shift away from macroscopic thinking whichsteers us toward questions like Is this analysis? or Is this an analytic patient?.

Focusing on the maintenance of analytic contact facilitates an emphasis on findingthe essence of the analytic on the microscopic levele.g., what is happening in theanalytic moment, what response to the moment is required to shift in the directionof analytic contact, and a consideration of how the patient might be attempting to


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defend against analytic contactall ultimately resulting in a deepening of the analyticexperience with most patients.

In other sections of the book Waska examines how the maintenance of analyticcontact comes into play with regard to addictions, psychic mutilation, psychic

fragmentation, and loss. He also explores other themes such as the patients resistanceto change, the analyst as translator of the patients experience, and the fragility ofanalytic contact. Interspersed throughout the volume are explanations of fundamentalKleinian concepts such as the paranoid-schizoid and depressive positions, the centralityof unconscious phantasy and psychic reality, splitting and projective identification,and the primacy of transference/countertransference interpretation. Waskas articulatedepiction of clinical vignettes provide compelling support for his ideas about analyticcontact as it ebbs and flows throughout psychoanalytic treatment, with contact beingestablished, eroded, and re-established repeatedly during the course of an analytictreatment and within the confines of individual sessions. He also effectively incorporateshis analytic missteps to illustrate the therapeutic pitfalls associated with the analystsfailure to maintain analytic contact.

To my Jungian sensibilities, Waskas interpretive conceptualizations soundedsomewhat mechanical, pre-determined, or repetitive at times, especially in the sectiondealing with addiction. Waskas material also was less effective or persuasive whenhe incorporated illustrations from his extra-analytic life and in his use of illustrationsfrom two films. However, this volume effectively communicates how the patientsinterior world is revealed through the transference/countertransference field. Thereader of this volume, new to Kleinian ideas, will gain an appreciation of the utilityand sweep of projective identification as a vehicle for understanding and processingclinical interactions. Overall, depth psychologists of any persuasion will find much to

appreciate in this book.

Mark WinbornInter-Regional Society of Jungian Analysts

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Journal of Analytical Psychology Volume 56 Issue 2 2011 -The Concept of Analytic Contact- The Kleinian Approach to Reaching the Hard to Reach Patient