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This article was downloaded by: [University of Sussex Library] On: 16 August 2014, At: 02:56 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Psychoanalytic Dialogues: The International Journal of Relational Perspectives Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hpsd20 The clinical use of the dream in interpersonal psychoanalysis a dream specimen Leopold Caligor Ph.D. a b c a Faculty Member and Training and Supervising Analyst at the William Alanson White Psychoanalytic Institute , b Clinical Professor and Supervisor, Adelphi University Postdoctoral Program in Psychotherapy and Psychoanalysis , c 175 Riverside Drive, New York, NY, 10024 Published online: 02 Nov 2009. To cite this article: Leopold Caligor Ph.D. (1996) The clinical use of the dream in interpersonal psychoanalysis a dream specimen, Psychoanalytic Dialogues: The International Journal of Relational Perspectives, 6:6, 793-811, DOI: 10.1080/10481889609539153 To link to this article: http://dx.doi.org/10.1080/10481889609539153 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions

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Page 1: The clinical use of the dream in interpersonal psychoanalysis a dream specimen

This article was downloaded by: [University of Sussex Library]On: 16 August 2014, At: 02:56Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T3JH, UK

Psychoanalytic Dialogues:The International Journal ofRelational PerspectivesPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/hpsd20

The clinical use of thedream in interpersonalpsychoanalysis a dreamspecimenLeopold Caligor Ph.D. a b ca Faculty Member and Training and SupervisingAnalyst at the William Alanson WhitePsychoanalytic Institute ,b Clinical Professor and Supervisor, AdelphiUniversity Postdoctoral Program in Psychotherapyand Psychoanalysis ,c 175 Riverside Drive, New York, NY, 10024Published online: 02 Nov 2009.

To cite this article: Leopold Caligor Ph.D. (1996) The clinical use of the dreamin interpersonal psychoanalysis a dream specimen, Psychoanalytic Dialogues:The International Journal of Relational Perspectives, 6:6, 793-811, DOI:10.1080/10481889609539153

To link to this article: http://dx.doi.org/10.1080/10481889609539153

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of allthe information (the “Content”) contained in the publications on ourplatform. However, Taylor & Francis, our agents, and our licensorsmake no representations or warranties whatsoever as to the accuracy,completeness, or suitability for any purpose of the Content. Any opinions

Page 2: The clinical use of the dream in interpersonal psychoanalysis a dream specimen

and views expressed in this publication are the opinions and views ofthe authors, and are not the views of or endorsed by Taylor & Francis.The accuracy of the Content should not be relied upon and should beindependently verified with primary sources of information. Taylor andFrancis shall not be liable for any losses, actions, claims, proceedings,demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, inrelation to or arising out of the use of the Content.

This article may be used for research, teaching, and private studypurposes. Any substantial or systematic reproduction, redistribution,reselling, loan, sub-licensing, systematic supply, or distribution in any formto anyone is expressly forbidden. Terms & Conditions of access and usecan be found at http://www.tandfonline.com/page/terms-and-conditions

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Psychoanalytic Dialogues, 6(6):793-811,1996Symposium on Interpersonal Approaches to Dreams

The Clinical Use of the Dreamin Interpersonal Psychoanalysis

A Dream Specimen

Leopold Caligor, Ph.D.

I hope to convey to the reader through the analysis of a dream specimenhow I as an interpersonal psychoanalyst apprehend and process a dreamin the context of an actual session; how the dream evokes in methoughts, images, associations, and affective responses; and how theseare shared in dialogue with the patient. I find the patient's dream impor-tant because it vividly expresses in imagery, affect, and narrative hermodes of coping with interpersonal anxiety by selective inattention anddissociation.

It is my view that this dream was triggered in response to a therapeu-tic impasse. My response to the impasse led to increased activity and aconcordant effort on my part to engage the patient in the here and now,which led to a transference—countertransference enactment representedin the dream. The analysis of the dream allowed the recognition of whatI had until then not been able to perceive.

Sharing with the patient my associations to her dream permitted anin-depth dialogue to take place. I have attempted to reconstruct mypersonal reactions to the dream as they unfolded, the clinical decisions Imade, and why I made them.

This paper is dedicated to Erich Fromm, Ph.D., who encouraged me to go my ownway in working with dreams. It was given as the Presidential Address, Division ofPsychoanalysis, American Psychological Association, in Toronto, Canada, on August22, 1993.

Leopold Caligor, Ph.D. is a Faculty Member and Training and Supervising Analystat the William Alanson White Psychoanalytic Institute and Clinical Professor andSupervisor, Adelphi University Postdoctoral Program in Psychotherapy and Psycho-analysis. He is also Past President of the Division of Psychoanalysis (Division 39) ofthe American Psychological Association, coeditor (with Philip Bromberg and JamesMeltzer) of Clinical Perspectives on the Supervision of Psychoanalysis and Psychotherapy,and coauthor (with Rollo May) of Dreams and Symbols.

793 © 1996 The Analytic Press

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ALL SCHOOLS OF PSYCHOANALYSIS PAY HOMAGE TO FREUD'S GREAT

discoveries that are linked with The Interpretation of Dreams—the structure and interpretation of dreams, access to uncon-

scious processes, transference, and free association—because they arethe very building blocks of psychoanalysis. Interpersonal psychoanalysisadds to and builds on Freud's seminal contributions. Originating in afield theory, interpersonal psychoanalysis posits that human personalitygrowth—normal, pathological, and therapeutic—takes place in aninterpersonal field. In psychoanalysis, the therapist as a participant-observer apprehends the individual empathically and cognitively, usingthe shared intersubjective and interactional context to allow themutual construction of new self-meaning to be incorporated into thepatient's capacity for creative human relatedness.

Growth and changes in self-concept and in the subjective experi-ence of self and other, both in life and in the analytic dyad, are view-able through the patient's dream life. With this understanding, thedream is central in permitting insight into transference, countertrans-ference, the therapeutic alliance, and dissociated domains of the self, sothat the clinical relationship more easily lends itself to being an ongo-ing medium for dissociated self-experience, expressing aspects of selfthat are attempting to achieve fuller recognition. We know that earlydevelopmental processes that are interrupted are resumed in theanalytic dyad. Through intersubjective negotiation, modeling, identifi-cation, and introjection, development proceeds. All this is reflected inthe patient's dreams, which afford us the opportunity to see how thepatient "takes in" aspects of self and other that both patient andanalyst may be failing to recognize and sufficiently engage.

By now, most schools of psychoanalysis agree that the patient'stransference is always present, as is the analyst's countertransference,as part of a unitary field. With the collaboration of the analyst, thepatient can examine his or her productions, that is, his or her ownpainful material, which includes warded off perceptions of himself orherself and warded off perceptions of the analyst in a single context.The dream is a central mode through which is revealed the variety of apatient's unconscious or preconscious representations of self and otherand his or her ways of engaging others, including the analyst, throughtransferential enactment.

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Clinical Use of the Dream 795

Also represented in dreams is the patient's need for a reparative rela-tionship beyond the historic-repetitive transferential enactment. Thepatient actively seeks elements of relatedness that were thwarteddevelopmentally and are needed for growth to continue. He or shedoes this by evoking these in the analyst's countertransference via anenactment in which transferential and reparative modes of relating goon simultaneously. In the process of focusing, understanding, andworking through the transference and the evoked countertransference,the patient also seeks to enable the analyst to recognize and providethe relational responsiveness needed to get beyond his or her replayingof historically fixed interpersonal patterns.

Above all, I am respectful of the patient's ownership of his or herdream. Any approach that does not attend to the patient's free associa-tions, but emanates primarily from the analyst, destroys the patient'screative process and renders the patient impotent in coping withthe omniscient analyst. All in all, I see dreams during psychoanalysisas being in the service of mastery, integration, and working through;dreams are basic communications to be explored in the analyticdyad as links between the patient's subjective reality and that of theanalyst.

The following discussion is based on the dream of a patient withinthe context of its analytic session, and will discuss how I understoodthe dream, how I handled the dream, and why. I speak from thevantage point of an interpersonal psychoanalyst who interfaces withother "schools" of the relational matrix: object relations and self(intersubjective) psychology. Clinically, my frame of reference is therelational-conflict model.

The Patient and Treatment to Date

The patient was an attractive 26-year-old woman who was welleducated and doing responsible work. A presenting problem, amongothers, was her shyness with men. In the company of males she becameflooded with anxiety, physically tense, and found it difficult to talk andto think. She was raised by a mother who tended to be silent, unavail-able, and easily flooded affectively in sustained personal contact. Her

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mother was described as having a symbiotic, nonverbal relationshipwith her own mother, the patient's grandmother, who was always inpain, suffering in good form, but remote, avoidant, and reclusive. Thepatient and her mother spent much time together, close in feeling, withminimal mutual activity, little talk, and almost no acknowledgment ofone another's subjectivity. The patient was quite merged with hermother and had "taken in" (internalized and introjected) her mother'spain as her own—all very early developmental^ and without a verbalor cognitive context that gave it meaning. Her father, a kind man,somewhat remote but warm, was experienced by the patient as lovingbut ill at ease with people and largely unavailable to her. She had abrother several years older who was quite verbal, aggressive, andmocking, and with whom she could not compete.

The patient went away to boarding school and college, where shealways had "close" girlfriends with whom she played a passive-depen-dent role. During college, she had no significant relationships withmen, other than occasional dating that would go nowhere. Therewould be sex, with the patient participating in a passive, frightened,"going along" way. When she graduated from college, she came hometo New York City and lived with her parents, not having lived withthem since boarding school. Before long, she became quite anxious,frightened, and undecided about work, and it was at this point that, onthe recommendation of a friend, she came for a consultation.

She was quite soon able to form a therapeutic alliance, quell herfright somewhat, and mobilized herself to share an apartment with twowomen, although the passive quality of her relating was still there. Shealso managed to get a job in her field, where she worked hard, was wellliked, and never "made waves." Still, she did very little dating and whatlittle dating she did, was arranged for her. On these dates the patientreported feeling frightened, silent, uncomfortable with the silences, andpassive.

Patient and Analyst

The analytic hour and the dream I present here occurred in the fourthmonth of treatment, the patient being seen three sessions per week on

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Clinical Use of the Dream 797

the couch. In her usual way of relating at this point in treatment, shewas shy, quiet, passive, hesitant, sparse in speech, and her voice wasanxious; she was the "good girl" who never initiates and neverdisagrees. She had mild chronic anxiety, which was expressed physi-cally: flushing easily, shallow breathing, voice tremor—all especiallynoticeable with the build-up of anxiety. She was alert and aware of mypresence, movements, and voice, although she did not directly initiatecontact or dialogue. She appeared as a trusting but shy and frightenedchild. For my own part, in whatever contact took place I felt heranxiety and fright. I sensed my tendency to speak too soon to alleviateher mounting anxiety and often felt that my very wish for contact wasmore than she could bear. Nevertheless, I felt we were very aware ofeach other, sometimes painfully so.

Occasionally she entered into a second pattern of relating thatseemed to follow periods in which contact with me felt especiallyfrightening to her. In this second pattern, she showed no observableanxiety and there was no interpersonal traction between us. We weretwo people of the same species, aware of each other but not connect-ing. Her face would take on a kind of ethereal look and beatific smile.Her anxiety would seem to disappear and would be replaced by whatappeared to be inner reverie. Her silences would be long, with herdemeanor conveying a peacefully bemused quality, without anxiety.When she was in this reverie, I would tend to get bored or restless,sometimes to the point of getting drowsy and attempting to overcomeit by attempting to engage her in looking at what might be taking placebetween us. It was this latter type of interaction that in fact became thetransition point for the next phase of treatment, a phase that wasushered in by the analytic hour and dream to be discussed in theremainder of this paper.

The Session and the Dream

The session started with the patient appearing upset. When I asked herabout my perception, she could give no specific reasons why. Duringthe first 10 minutes she seemed near tears, anxious, confused or diffuse,and avoidant. My queries were not responded to, muted into silencesthat she obviously found uncomfortable.

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After a time I asked the patient what she was feeling. She answeredthat she felt scared and scattered but did not know why; I urged her to"stay with the feeling." After a silence, she said, "This is a feeling Iknow I have often." After another pause, she spontaneously started totalk, and recalled an association that felt to me in the service of mov-ing away from the intensity of the anxiety she was experiencing withme at that moment. She said that she had been out on a date with aman the night before and described him as attractive, bright, ratheralive, and interested in her. However, as the evening progressed, shebecame shy and anxious. She reported that she was short of breath, herthoughts were scattered, her conversation was sparse, and that thesilences were uncomfortable. My sense was that she was not aware thatshe was having the same reaction with me at that moment.

I asked her to try to get even closer to her experience of dinner lastnight to see if she could recapture the feeling. After a short period, shestated that she knew she had had these feelings before with men sheliked and that this is a feeling she had during her childhood. She wenton to say how painful silences had always been for her, how she blamedherself for them, how after a while she expected to be rejected ormocked, and how she would get anxious and could not speak.

I asked if she had any dreams to relate, knowing that she typicallyneeded to wait passively to be asked about her dreams before sharingthem. She related the following dream: "It is dusk like. I am in a boatwith an Oriental-looking man. He drives the boat into a dark area, anenclosed boat berth, and closes the door. It is near pitch dark. I amfrightened that he will assault me. Suddenly there is a circle of intenselight upon the water. The light has dark dust specks throughout it sothat I cannot see fully clearly. In the circle is a beautiful fish, trapped inthe circle of light."

When I asked about the feeling in the dream, she answered "Fright."I asked if anything had happened the day or night before the dreamthat came to mind, and she mentioned the date with the young man.(As is often the case, the patient will narrate relevant material prior tothe telling of a dream so that the dream reflects the intertwined subjec-tive perceptions of both current reality and history.)

I then asked about the boat. She described that as an adolescent shehad taken a boat ride with a boy who unexpectedly drove the boat intoan enclosed berth and closed the door. It was dark, and she was pan-

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Clinical Use of the Dream 799

icked. He tried to get her to remove her bathing suit. She was fright-ened and did not speak; although nothing happened, she was quiteupset and avoided one-to-one contact with boys for a time afterward.She spelled out that it was dark and she felt trapped and small. She wasable to explore feeling that the man was powerful (he stood over her)and she was small (seated), helpless, and felt trapped. She went on tosay that she felt like that fish—trapped, looked at, unable to get away.She added, "Fish cannot speak." (Note: The patient had dreams ofbirds in cages with stuffed mouths—structurally quite similar to the fishin the circle of light: trapped, aesthetic, but helpless, inarticulate, andisolated).

I noted that in the dream the man in the boat was Oriental'looking,and the patient recalled a class party during her childhood. There wasan Oriental man, a guest, who did not speak any English. He madeorigami gifts for the children—paper birds for her. His gifts were mostprecious to her, yet he was strange and different. She knew he likedher, but she could not talk with him. She liked him, but was frightenedof him. I asked when she had experienced this "fright" before, and shestated that she knew her father liked her; he was—is—loving, but thereis never any real talk or contact between them.

As she told of the mounting panic in the boat berth, I sensed herpanic from the content, her affect, her hesitant voice, and her slightbody quiver. 1 was able to "taste" them; the patient was fully there as inthe dream and I could experience her fright-panic as she was experi-encing this panic with me.

She then made a sudden switch in manifest content and place: theterror of the dark boat berth suddenly gave way to a beautiful fish in acircle of light. I noted the disappearance of her body tension and theobservable quiver of anxiety. I was looking at her, but "she" was nolonger there. She had withdrawn and I felt no contact between us. Ifelt shut out as she seemed relaxed—with a beatific smile, as thoughshe was savoring the image. To me, this sudden switch was remarkable.My thoughts were as follows: (1) Is this what she does with men thatmakes them leave—either silent, sustained panic-anxiety or a state ofbeatific disconnectedness? (2) This is probably a learned pattern withher mother: she experienced her mother as looking at her and sheneeded to insulate herself from her mother's deadness and simultane-ous need for contact; to contain the panic evoked in trying to process

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(think about) the impossibility of what was taking place betweenherself and her mother, she learned to escape by dissociating. (3) In theface of possible true intimacy, where she does not or cannot flee, doesshe experience this mounting panic? (4) Do not be too warm nor toocrowding nor too supportive! I sensed my need to be soothing or reas-suring to alleviate her anxiety, and also, because her painful silenceswere difficult for me to experience, I became aware of my impulse tospeak too soon or ask her to think about what was happening betweenus.

As I listened to the dream, I recognized that her experience of panicwas being stimulated by the ongoing intimacy with me. This wouldhave to be worked out with me in the transference-countertransfer-ence. The analysis, I felt, must be the growing edge of understanding,and must contribute to her gradually developing the ability to tolerateanxiety while learning a new, open, undefended way of relating withincreasing self-awareness and safety with me. I wondered to myselfwhere I was affectively, symbolically, and visually located in the dream.Also, where and how I was already entering the dream with her as aparticipant and how to make best use of my recognition. I knew mypatient's pattern on entering my office: keeping her distance, appearingflustered, avoiding contact. She sort of circles me, wears a slightanxious smile, goes to the window and with her back to me looks out atthe river. She looks out for several moments—I think to composeherself—turns, the same smile, flustered, no eye contact, no talk,keeping her physical distance. She has frequently mentioned theshimmer of light on the ceiling above the couch—light reflected fromthe river.

The significance of the boat berth scene pertaining to the boy andthe Oriental-looking man, I believed, was fairly obvious to both of us,at least metaphorically, with regard to our immediate relationship. Mythought was: a beautiful fish in a circle of light; spatially, the same asmy sitting behind her, peering down at her, and she is on the couchbathed in a circle of light. I believed this beautiful fish in a circle of lightwas a symbolic (imagistic) statement she was making to me about us.The dream dealt with her panic over intimacy with me and with herway of disconnecting. I believed this dream was communicating pre-logically her way of experiencing herself in an "impossible" situationwith me not unlike that which characterized her relationship with both

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Clinical Use of the Dream 801

her mother and her father in parallel but different ways. Her fright andpanic were visually and symbolically portrayed in the dream withoutclear cognitive awareness of their connection to the analysis itself, butas frightened as she was, there was still an inner push to raise theseissues to awareness and dialogue with me.

I felt that the beautiful fish in a circle of shimmering light was mybest way to enter into a dialogue about (and with) the dissociatedaspect of the "dreamer" and ultimately into a safe dialogue about its.After a silence that she found uncomfortable, I brought her back to thecircle of shimmering light. I ventured that she often had mentionedduring sessions the shimmer of light on the ceiling, that we hadfrequently seen this together. At that point, there was an extendedsilence. She again became uncomfortable with me. She flushed andappeared somewhat tense: there was no talk. I asked her what she feltwas going on between us. She described feeling frightened and said "Ican't find words." I wondered how she saw me. She said: "I know withmy head that you are not hostile to me, yet I have this panic going onin me." I encouraged her: "It's good that you can experience this panic,and yet have your head work. In the past, when this feeling wouldstrike, its impact would be so strong that you could not think, and thenthere was no way out of the feeling." She said that she had been terri-fied of this feeling: "I could never know why it happened or when. Itwould come and there was nothing I could do about it. I couldn't thinkand my body would ache. It would just build up and not go away." Itold her we would stop at that point. The hour ended and she got upfrom the couch—flustered, anxious, and silent. She left, keeping herdistance from me, avoiding eye contact, and wearing an uncomfortablesmile.

I feel it important at this juncture to underline the fact that thesession and dream represent a point very early in treatment, and I wishto make clear that the way I approached the session analytically wasnot by a prescribed technique of relating but by responsiveness tointerpersonally shared experience, including the history of how well weknew one another. In other words, my wish to adapt to her state ofmind as carefully as I did was not simply stylistic, but reflected the factthat she did not yet experience a history of knowing that I am commit-ted to protecting her need for safety. Similarly, I myself had insufficienthistory with her to enable me to be more spontaneous without the

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danger of my image in her mind switching traumatically to that of adangerously exciting (Oriental-looking) stranger.

I would like to share my personal reactions to the dream, the clinicaldecisions I made, and why I made them. My aim is to show that as Iattempted to use the dream to gear my therapeutic interventions, thepatient's sensitivity to her self-experience deepened. I will begin bypresenting my own associative responses to the dream elements as Iexperienced them, without an attempt to sort or organize them, as thepatient is expressing symbolically, and in narrative, her subjectiveexperience of me as strange, in control, crowding her, and dangerous.She is feeling increasingly trapped, panicked, and helpless withmounting terror in the intimacy with me.

1) dusk'like—a touch of depression, impressionistic, subtle, soft.2) Oriental'holdng man—seeing men as strange, unfathomable, diffi-

cult to understand.3) in a boat with an Oriental man—he drives the boat, is in control.4) dark area—depressed (now more than dusk).5) enclosed berth—further encapsulation and entrapment, helpless-

ness.6) closing the berth door—even more encapsulated, entrapment, and

mounting.7) now near pitch dark—increasing depression with intimacy and

increasing fright.8) I am frightened that he will assault me—with increasing intimacy,

the patient experiences assault, and, I think, near panic at herown feelings of helplessness.

9) suddenly there is a circle of intense light upon the water—the affect isprobably too intense, so she "switches" to a dissociated self-state.A dissociation occurs—she substitutes the fish trapped in a circleof light, which is the same symbolic content. However, the inter-personal anxiety is gone or much less intense.

10) the light has dark dust specks throughout it so that I cannot see fullyclearly—the patient nearly sees something (perhaps her fright incontact and her retreat?), but does not quite see because of thedusk specks. "I cannot see fully clearly," she states. The juxtaposi-tion of light and dark dust specks—shimmering opposites—volatile, unfocused, unstable.

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Clinical Use of the Dream 803

11) A beautiful fish is trapped in the circle of light—she now experiencesherself as the fish in the circle of light being looked down atrather than the trapped girl in the dark boat basin with intensefright. I noted the nonverbal aspect, the mute aspect, entrap-ment, emphasis on a no-people narcissistic resolution as thebeautiful fish in a circle of light—small, harmless, helpless,aesthetically a "good girl" and in every sense pleasing. I have thethought that her resolution is a narcissistic position. There is asurrealistic quality—complete silence, slow motion, removal ofpersons, and a substitute of a beautiful fish in a circle of light.Everything is now visual—is this sensory, aesthetic, imagisticresolution only narcissistic? There is something too intense in theway the contrasts are strongly juxtaposed—the dark and the lightdo not mix, blend, or either one diminish. The dark dust specksare contained in the circle of light, yet each is intense. Is thispatient's difficulty located in her inability to modulate the inten-sity of affects or imagery enough to think about them reflectively?When the patient's affects ignite, I know she has difficulty inturning them off or modulating them.

Her symbols evoke a spectrum of images in my mind. The patient isin a boat (uterus) in the water (la mer); a closed boat berth (birth); sheis trapped and prenatal, the fish is phylogenetically primitive (undevel-oped). There is fright at interaction and flight from it. Will she experi-ence my queries or attempts to make contact as probing, putting her inthe spotlight, or perhaps trapping her or assaulting her? Does she seeany movement or attempted contact as potentially assaultive? Or doesshe unconsciously welcome them as supporting her narcissisticdefenses? Does the inquiry turn her into the beautiful trapped fishthrough the nonverbal mood established by the work on the dream? Isthere a way to talk about these questions with her without the inquiryitself becoming a catastrophic enactment? I decided to focus structurallyon the patient's toleration of the painful affect without her "headmelting," that is, to increase cognition by diminishing affect in interper-sonal contact. I decided to focus content-wise on the transferenttal viewof the man while her experience of painful affects with the man werestill vivid. In other words, I chose to keep the focus of the dream on herexperience of self in her interaction with men, in keeping with what I

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felt to be the best use of the dream in understanding her fright of malecontact.

The nonintegrated dark specks and the intense light bothered me assomething unstable and volatile. The patient started the boat scenewith dusklike imagery, then shifted to the dark area of the boat berth,and finally to near pitch dark when the berth door was closed. All thisincreased the darkness, with mounting feelings of anxiety, entrapment,helplessness, fright, and panic in forced intimacy. The panic was toogreat to contain. Then, near pitch dark suddenly gave way to a circle ofintense light upon the water. There was a vivid switch in imagery (thepatient and the Oriental man in the darkened closed boat berth),ideation (of being assaulted), and affect (fright-panic). It was as if thefilm had been ripped out of the projector and the light was still on, butthe dream censor was operating so that sleep could continue.

The patient then retreated to a beautiful fish in a circle of light as anarcissistic resolution. Note that the dark dust specks are an affectiveresidual of the black cluster and reflected the patient's experience ofherself in interpersonal contact. I also believe that the "intense light"symbolized the patient's early merged relationship with her mother.Later in the analysis, she gave associations to the fish as Christ, and thelight from above as God shining upon him as depicted in Renaissancepaintings. She also noted that her mother is a very devout Catholic, aswas the patient in her education and in her childhood and adoles-cence. They both shared the same religious commitment. The fish is inthe water (mother, la mer) and is "trapped" in a "circle of intense light"(narcissistically enveloped, and merged with mother), and, I might add,free from any real differentiated interpersonal anxiety.

Transference-Countertransference as Growth Matrix

The patient was easily frightened in interpersonal contact and I did notwant to dominate the shared space between us by too much activity,energy, words, or here-and-now process. I felt from the dream that shehad already had more of this than she could handle and needed me toknow it. I did not want to blindly force her again into the dissociated"circle of light" as a further repetition of her dissociating in the service

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of coping with potentially traumatic contact that the other person iseither unable or unwilling to modulate. My impression is that she feltunderstood and even encouraged to participate with greater safety inthe here and now. In the process, she tolerated more interpersonalanxiety than she could previously bear, and began to verbalizeher experience of the interaction, albeit timorously and needingencouragement.

The patient, while in touch with her fright-panic with me, waslearning to maintain empathic connectedness while verbalizing herexperience and feelings. I am aware that I encouraged this mode ofrelating, but I also sense that the patient evoked this in me. Learning tofeel safe in a relationship with a man is one aspect of what she neededfrom me, but she also needed me to accept her as she was. I therefore felt Ihad a responsibility to actively but gently initiate and help her main-tain connectedness and dialogue. This shared need—mine to havecontact and dialogue and hers to permit and evoke them to happen inthe session—was the qualitatively new growing edge for the patient'sunderstanding of her relationship with men.

Although early in psychoanalysis, there was enough established rela-tionship between the patient and me to permit a working alliancestrong enough so that many of her dissociated thoughts and feelingscould be looked at by both of us together. At one level, our initialworking alliance probably had a large element of her being "under-stood" in the narcissistically gratifying way her mother "understood"her and was used to escape from the more differentiated frighteninginterpersonal anxiety with me.

After she reported the dream, I asked about the "day residue" to findout what triggered the dream, and then carefully explored her associa-tions to the dream with her, in terms of both the content and theaffects. I attempted to structure the session and my understanding ofthe dream in response to the mood and behavior with which sheentered the session. I was aware of her heightened anxiety anddiscomfort with me. With this particular patient it was necessary tokeep making suggestions to encourage her to express herself and tokeep her anxiety level manageable. In this regard, the deeper aspects ofher self-concept, and introjects from her mother, were not exploredduring this session. That is, experiencing herself as frightened, mute,vulnerable, small, helpless, trapped, and submerged, suffering anguish,

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pain-fright feelings that she could not adequately turn off, lack ofinterpersonal vitality, experiencing fright and submission rather thanrage or anger. The merged symbiotic relationship of the patient withher mother, so aesthetically stated in the symbol of the beautiful fish inthe water in a circle of light, I registered for future use.

She was aware that her associations to the exciting-dangerousOriental man, whom she liked and feared but with whom she could notcommunicate, described what she has been feeling with me in oursessions, and she also was aware that she felt this way with her fatherwhen she was a child. She acknowledged that she still feels awkwardwith him and finds it hard to talk to him—a transference reaction thatwas observable by me in the psychoanalytic sessions in her tone ofvoice, her body tension and movements, and her physical restlessness.The image of the fish poignantly communicated to me and to thepatient some of her most personal feelings. She had unconsciouslyselected the fish as her symbol—a beautiful creature in a primitive stateof evolution—and said she felt like that fish: focused upon, trapped,inarticulate, looked down on, immobilized, and unable to evolve.

The patient brought these feelings to her encounters with men andinevitably reexperienced them. Unconsciously she evoked a repetitionof her fantasy expectations by her behavior. In the therapy sessions, ourwork was progressing toward bringing this to awareness. Her integrativecapacities were getting stronger. The patient's anxiety was no longer asintensely obliterating her capacity to think. She was learning to toler-ate the anxiety and understand it better, which was preparing her toopen to new experiences outside of the therapy relationship and toopen deeper levels of self-exploration in the psychoanalysis.

Afterthoughts

Consider, in the context of this dream and session, the following screenmemory reported by this patient. Freud has noted the centrality ofthese early recalls as timeless—progressive and retrogressive—andreflecting aspects of the person and his or her experience in thepresent. In a screen memory the patient selects an affect, a percept, acolor, a setting, and brings them together. These fragments of earlyreality are subject to the dream laws of condensation and displacement

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and hence can be treated as dream material. To an interpersonalpsychoanalyst, screen memories represent the patient's earliest experi-ences of subjectively perceived self and other. This is the rudimentaryself around which the personality clusters in its early interpersonalfield, much as a speck of dust in an under cooled glass of water causes acrystal to form. To repeat: These subjective experiences of self andothers are core, dissociated, and alive in the present.

The Patient's Screen Memory of Age Three

The family had a big black cat that the patient associates with hermother. The cat has its paw in a fish bowl. The water is all churned up,pinkish. The fish is in a panic and bleeding. The water is murky andreddish. The patient said, "I was terrified and paralyzed. I could notscream." I believe the patient was symbolically stating the relationshipwith her mother and what has been internalized. We noted the simi-larity between the cat and fish in the bowl (the screen memory) andthe dream (the aesthetic fish in a circle of intense light with shimmer-ing dark specks). Also, we noted that in the analysis I sit over her as shepeers into the shimmering light on the ceiling. But only in the screenmemory was the affect one of terror and helplessness, with the patientexperiencing intimacy as destructive and annihilating and flight asimpossible. She was of course describing her feelings of entrapment andfright, of being overwhelmed and flooded by a very depressed, enraged,and ever-present mother. Was this her definition of human relatedness,her deepest experience and expectation of intimacy? Is this what shefeared would come alive with the young man and with me in thetransference?

The Analyst's Impact on the Therapeutic Relationship

I believe the impact of my actual behavior and personality style on thetherapeutic relationship at this point in treatment was more or less asfollows: In contact with me the patient moved from a state of barelycontained anxiety to a dissociated state of affective deadness; thepersona she presented to me was as somebody in a reverie. I respondedto her deadness with increased activity and efforts to engage her in thehere and now at those moments. I believe that the engendered enact-ment in the transference-countertransference field led to the dream. It

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was shaped by a scenario in which she was being traumaticallyimpinged upon by a "stranger" who, because he was thinking about hisown subjective needs, forced her to enter a dissociated state ofconsciousness so as to escape this terror that could not be acknowl-edged by her mind. Unable to process this experience cognitivelywithin the ongoing enactment, she communicated it through a dream.The analysis of the dream allowed the enactment to include my recog-nition of what I had not been able to perceive until then. The mannerin which I responded to what I then perceived she was telling methrough the dream was organized by the fact that I was attuned to thesimultaneous presence of disparate states of mind in my patient, eachof which needed to be respected. At this early phase of treatment I wasparticularly engaged with her fear of re -traumatization. I thus becamehighly attuned to her implied accusation that I was not sufficientlyprotecting her dissociative adaptation as "the good girl," through whichshe had early in life preserved her survival as a self. When I heard thedream and we began to explore it, I increasingly realized I had beenthreatening the existence of her dissociative solution by maintaining astance that too insistently forced her to "look at" (think about) herhere-and-now experience with me regardless of her dread. During thesession I was able to communicate through my response to the dreamer(not just to the dream) that I understood the dissociative significanceof the "fish trapped in the circle of light." She, in turn, was able torecognize that I perceived my negative impact without being threat-ened by her accusation inasmuch as I stayed involved while adaptingmy need for direct exploration in the here and now to her ability toprocess it. Gradually, she became increasingly able to "feel" what wastranspiring in the analytic field and think about it at the same time.Until that happened, she could only do one or the other and it wasbecause I was able to "adaptively respond" to the message in the dreamwhile working with it that the here and now of the analytic fieldultimately became a "usable" interactive context.

Discussion

I am respectful of the history and riches of the classical contributions topsychoanalysis: an understanding of unconscious processes and howthey work, a comprehension of intrapsychic structure, a profound

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respect for developmental history, and a commitment to the under-standing of a patient's internal reality. I believe equally, however, thatall of this must be seen not in terms of a one-person model but within atwo-person field both in the normal development of a person and inanalysis.

An interpersonal approach must take the patient's needs for safetyinto account as a responsibility, considering this above all else. Myeffort is to experience and relate to the patient through verbal interac-tion and by my willingness to modify my analytic stance, facilitating ourability to negotiate the interpersonal field, both consciously andunconsciously. A patient must know that you are thinking about his orher safety and ability to use you in the right way, and that you aretaking equal responsibility for this experience by not deciding on yourown what constitutes a therapeutically useful interpersonal experience.

To use Winnicott's concept, I don't want to crowd the space with"me," which may be in the service of technique or theory but makesthe therapist or technique more important than what the patient iscommunicating that he or she needs at that point in his or her owndevelopment. This is in accord with Sullivan's original sensibility,which enabled him to be exquisitely attuned to the patient's capacityfor interpersonal contact and need for safety at any given moment andto give it equal weight (responsiveness to a gradient of anxiety) to theneed for analytic inquiry.

The analyst struggles to understand what the relationship is betweenthe patient in the session and the dreamer. The analyst must relate toboth of these aspects of the patient, and to facilitate their integrationinto the patient's internal world. My effort was to find a way with thepatient to bridge the gap between the two—to relate to the dreamer bymy willingness to protect her vulnerability by interactive restraint andto relate to the verbally presented "patient" by speaking to her abilityto symbolize experience through language. If I were to have tried onlyto relate to the self that was in the session with me, then the dream wasdreamt to no purpose. I would have been relating only to the patient'scharacterological armor but not to who she was in her dream. Were Ito have done that, I would have forced her to relate to me onlythrough the more adaptive self, and I might have ended up thinkingthat I was having an authentic dialogue, but the voice of the patientwho had the dream would have been lost.

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I had to encourage this patient to let that voice be heard becauseeven though speaking with that voice was frightening for her and shewas feeling she was going to experience the anticipated trauma, shealso could feel the potential for something new taking place. But whatwas most important was for the patient to feel secure enough to feelher own space safely with me. If I did not provide her with this oppor-tunity, she was capable of behaving "as if she was using therapy but infact would be functioning in a dissociatively adaptive manner whereshe would not be "all there." My goal was to enable her to tolerate thefright-panic affects experienced in the transference-countertranfer-ence while cognitively maintaining dialogue so that she could use hermind and her feelings simultaneously.

Conclusion

This paper is intended to exemplify an interpersonal stance in whichthe analyst tailors his approach to a patient who cannot work interac-tionally in the here and now, and is communicating powerfully,including in the dream, that intimate contact is not only frighteningbut traumatizing. The analyst had to attempt to find a way to relate tohis patient without making her unduly anxious, and enable her tocomprehend simultaneously that he "gets" the message of the dream bynot simply enacting the trauma all over again. My own approach is aneffort to (1) relate adaptively to the self-state the patient is in whilewith me in the session and (2) within this context, try to enable anegotiated process to take place that will open an avenue for examina-tion of the here-and-now interactive field itself, as data.

I hope that I have conveyed to the reader through the analysis ofthis dream specimen how one interpersonal psychoanalyst apprehendsand processes a dream; how the dream evoked in me thoughts, images,associations, and affective responses and how these were shared in thedialogue with the patient. I have tried not to over organize theaccount. The clinical material speaks for itself. It would lose its imme-diacy and authenticity if forced into a cognitive grid.

The clinical process with any patient is a complex happening. Itis always incomplete, shifting, inconclusive. This particular patient's

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communications to me and to herself through the dream images, sym-bols, affects, and storyline are what I have tried to tell you about. Shehas intricately involved me in her dream. Entering her dream world, Iempathically attempted to grasp who she is and what she did to me. Inthis way, I was participating with her in her subjective experience ofherself and her relationship with me. At the same time, I, the analyst,was observing and understanding.

175 Riverside DriveNew York, NY 10024

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