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Psychoanalysts may or may not be surprised (or even perhaps may or may not be interested) in an ongoing debate among some philosophers as to whether meanings are in the head or else are best thought of as involving a wide system of environmental interactions (Pessen and Goldberg, 1996, p.xviii). As a rule, analysts are prone to thinking of the mind as the depository of meanings and therefore the mind somehow rises out of the brain (and necessarily is fairly well limited by and enclosed by one's skull with its accompanying anatomy). Psychoanalysts do allow for object relations of sorts, but some like to put all objects back into the head as representations which take on a rather active internal life as in the creation of meaning. Daring or creative analysts focus upon relationships between people, but at least some of those "interpersonalists" prefer putting everything back inside the head. This is exemplified by those who claim that patients change because of the treatment, and this change is then internalized and structuralized (Greenberg, 1996, p.36). So back into the head it goes. A more recent variation on the problem of the proper place for meanings is formulated by the "intersubjectivists" who would probably (I think) put meaning in the shared co-constructed field created by those participating in its formation. This last meaning place tends to leave the individual person for the most part, or even entirely, out of the picture. The claim that there are no isolated minds tends to make meaning somewhat more of a social phenomenon and this conception is perhaps more compatible with those philosophers who feel that meanings are communal or environmental products.
The philosophical quandary about situating meanings does have relevance for psychoanalysis not so much in terms of a solution for our location decision, but perhaps more as an opportunity to try out various models to see what might make the best sense for us. The one that I prefer to employ is the selfobject model which does not confine the mind and its meanings to one individual but rather extends the mind or the self to include others who function as part of that individual and his mind. Self psychology is a one person psychology in that it employs others as selfobjects and thereby allowing meaning to emerge from this wider concept of mind. Therefore, not only are meanings not in the head but neither is the mind. In the self psychoanalytic model, a self is expansive beyond an individual's skin, and the mind is expansive beyond an individual's skull. One must, of course, wrest the mind away from a supposed identity with the brain. So, think of mind more as a form of activity than primarily as a location. One immediate advantage that accrues from the suspension of concern with the place of the mind is the relief of having to transpose all of the furniture of the world from the outside to the inside. We can look at an apple or a person, think and feel what that percept means to us, and not have to miniaturize it and find a place for it in our heads. Our meanings do not demand a representation which we contemplate but only an engagement with the things of the world which move us.
The usual and ordinary conceptualization of meanings in the head consists of seeing the brain as a complex computer which operates on internal representations or symbols in order to deliver new complex symbols. These symbolic printouts are the meanings. The alternate consideration of meaning sees it as lying in the web of activity or the interactions of persons in their environment. One should not be moved to thinking of the one theory or the other as more truthful or more accurate but rather as having more usefulness and ease of explanation.
I should like to explore this open model of meaning making in a presentation of clinical experience which I hope will to be better understood by way of this model. The central point of seeing the mind as composed of one's psychological life is that it allows us to see transference and countertransference as lived out in treatment as opposed to it being something which is struggled with inside of individual psyches. For example, any reader of the Dora case can see the transference and countertransference issues that are products of a continual and continuing feedback process which may be unknown only to the participants. The observer or reader is able to see what two persons mean to one another, and this is accomplished by a recognition of the enactments occurring between Freud and his patient. Meanings move us, and it seems but a small step to claim that these movements are the enactments of analysis. These are not confined to those of overt and striking behavior but essentially to the entire composition of an analysis. Everything that goes on between patient and analyst is an amalgam of conscious, preconscious and unconscious meaning. Thereby we put aside any concern with the conflict-free sphere and direct our attention to assuming that the unconscious is ever-present. There is no dividing line between enactment and neutrality, inasmuch as silence and immobility carry as much meaning, i.e., unconscious content, as sound and fury. It is all action, and so nothing is meaningless.
The Dora Case
A careful reading of Freud and Dora allows one to employ a variety of interpretations to the goings-on. Over the years, more and more attributions of meaning have been brought to the case. However one should be cautious in claiming that one particular meaning, for example what Dora meant for Freud, was residing in his mind or head at the time that he saw her. Rather we say that we now can formulate a new interpretation that gives new meaning to that particular interaction. Thus a further step must be taken away from any static sense of meaning. Added to the mix of what Freud and Dora meant to one another is that of what the reader or observer interprets as meaning. Analogous to this is the patient telling her life story to the analyst, while the listening analyst changes the particular meanings of that life as it is told. And each telling of the story in its own inexplicable way seems to make for a different story. This is one product of an unrestricted concept of mind, i.e., each person incorporates his or her surround in the resulting psychology. Thus our minds and our meanings can reach out to the world around us and become literally constituted by that world. Thus it follows that the analyst not only cannot hide behind some shield of neutrality but must ever be struggling to recognize how he impacts the patient as well as how the patient impacts him.
No matter how we may conceptualize it, this idea of mutuality is familiar to most of us but it takes an unusual form in a group of patients whom we have recently been studying. These are patients who suffer from what we call behavior disorders. As a convenience, we divide these patients into three subgroups which a reader or listener may readily see as forms of countertransference, but this labeling need not be given any negative appellation. Rather the entire scenario, one of action, is best read as the workings of the patient's mind operating in this particular context of treatment. Together, analyst and patient make meanings.
The Behavior Disorders
The first group consists of those patients who seem to silently, or perhaps implicitly, conspire with their analysts to become involved in an enactment to live outside the immediacy of the treatment. The famous Dora case of Freud is well-known to most students of psychoanalysis and it is generally agreed that Freud uses Dora to illustrate the theory that he championed: the theory of the unconscious sexual content of dreams. The case reveals what some may call the countertransference of Freud in his rather clear exploitation of this young girl (Ornstein, 1993, p.47) to further his theoretical claims. Yet one should be cautious in describing the encounter in terms of projection or internal representations or indeed of countertransference. Dora was an adolescent girl who felt exploited by her father and Herr K., and inexplicably revisited this exploitation with her newly assigned psychoanalyst. The reader of the Dora case may or may not choose to characterize this analytic encounter as that of a mutual enactment, but would we be allowed to make a claim that Dora somehow merely elicited an unconscious response from Freud appropriate to her particular pathology? It seems more felicitous to say that each character was living out very individual and meaningful scenarios with the other. Indeed, when one examines similar episodes of mutual action in analysis, one sees behavior that can only be understood as split-off from the main theme of engagement between patient and analyst, i.e., behavior which is disavowed.
One striking case in our study which illustrates this silent conspiracy is that of a celebrity, an actress of note, who had asked her analyst for permission to enter and leave his office by a side door so that she would not be seen by other patients in the waiting room. The analyst complied in a matter-of-fact way. Later when he felt the treatment at a stalemate he went to see a supervisor about his case. He felt that he meant nothing to his patient, that he had no impact on her. In his accounting of the case, he told his supervisor of his patient's illicit affairs. These extramarital affairs were kept from her husband through their being carried on in secret at distant hotels and motels. These clandestine meetings were made more exciting by their secretiveness than by the romance of the moment. She claimed little interest in her husband and even at times in the encounters with her lover(s) which she claimed were often equally bland. When the supervisor pointed out the parallel activity of secret comings and goings both by a special side door and in out-of-the way motels, the analyst was stunned. What may seem obvious to an outside observer is often experienced as almost shocking to someone who is disavowing. The recognition that followed this new vision of the patient-analyst interaction could not easily be integrated into a form that made sense to the analyst. Although he readily believed it to be obvious and telling as well, it seemed both unnerving and foreign to him.
One can imagine all sorts of explanations for this state of affairs between analyst and patient, but at no time could it be said that the analyst was not conscious of what he was doing and/or allowing. Rather, in the classical sense of Freud, this reality was disavowed and, even after acknowledging its possible negative effect on the treatment, the analyst seemed unable to completely integrate this knowledge. Our first group of these complex situations is composed of these split-off and mutual actions that remain either unexamined or are allowed to persist in spite of attention being called to them.
A step further along the continuum are actions which become part of the analytic discourse and are thereby struggled over. The meanings constructed in the first group exist without interference and live on in the split-off arena. The difference of the second group is illustrated by the simple story of a patient, not one of a behavior disorder in this particular example, who usually came to his analytic hours a few minutes late. Although this was regularly brought up for discussion, it seemed to persist and, over time, the analyst found himself using these few minutes to replenish the coffee that he had poured earlier in the day. As the analytic work deepened, the work focused more and more on the transference and the patient announced one day that his late comings were efforts to allow the analyst the leisure of getting hot coffee. The analyst was upset. He felt that he was totally innocent in this scenario which was clearly orchestrated by the patient. Yet there was no escape from the reality of his participation. When brought into the discussion and interpretation, the action was seen to represent the patient's effort to please (in this instance) his father at the expense of his own well-being and personal needs. Much like Dora, he had promoted a situation of exploitation with an accomplice who "went along" in a manner that combined transference and personal convenience. This was an example of a split-off arena that could be brought into the minds of both patient and analyst.
Our study of behavior disorders has shown that the most colorful and pathological sorts of behavior or misbehavior manage to become recreated in analysis with the cooperation of the analyst. Indeed, the successful treatment of such disorders seems to require the compliance of the analyst, inasmuch as the meaning that comes alive in the treatment is a product of a union, an interaction. It does not lie hidden in the depths of the patient's psyche waiting to meet the light of day as much as it presses for expression in a behavior which commands a setting for its realization. The analyst becomes a ready foil in this setting and only her awareness, not her prohibition, allows for a satisfactory interpretation.
Our third group of analytic characterizations of the action seen in behavior disorders goes beyond the disavowal that is unrecognized and remains split off, beyond the disavowal that is interpreted and worked through, to the arena of the reactions of the analyst which can only be classified as rationalizations for the retention of positions of power. I say this about power because the relinquishment of the analytic position of knowing more, along with a relative detachment from the immediacy of the interaction, allows an entrance into the mutual production of a meaningful experience. These are the necessary ingredients to achieve a proper analytic intervention. However, we regularly see how analysts are unable to relinquish this position. For example, one of our group who agreed to sign disability waivers for a patient who insisted upon this in order to continue in analysis claimed that someone else would do it if he did not, used this rationalization to avoid investigating the meaning of that request. Others who engage in a variety of boundary violations that may or may not be ethical or moral issues are able to give a variety of reasons for what they do or do not do, and thus avoid a pursuit of inquiry. However, some of the most resistant forms of rationalization are defended by an appeal to theoretical principles and convictions; psychoanalytic sophistry is used in defense of behavior that is left to reside in an area split off from recognition.
At the risk of being contentious, I offer a case from the literature that involves a clear presentation of action on the part of both analyst and patient, along with a claim that the analyst's mind has been penetrated by the patient (Anderson, 1999). This latter declaration is popular amongst Kleinian theorists who employ a theory involving the projection of the contents of one mind into that of another. An alternative theory might see both the actions of the analyst and the feeling of penetration more as rationalizations that obfuscate the power struggles that exist and remain uninterpreted.
The case in which we are interested involves a patient who made a number of requests for schedule changes with which the analyst complied. The dreams of the patient about the weakness of the analyst which followed the analyst's compliance led her (the analyst) to feel that she must refrain from further compliance. It is not very relevant at this point to question the wisdom of this conclusion, since I wish to focus on the fact that both the compliance with the schedule changes and the later withdrawal of compliance qualify equally as examples of enactments on the analyst's part. In this particular presentation, the analyst focused upon the changes that occurred after her new posture of non-compliance. She insisted upon attributing these changes to virulent projections from the patient of cruelty, rigidity and insensitivity which then obliterated her capacity to think. Following a series of theoretical explanations about envy and hate, this analyst concluded that complying with the patient's request was a defensive reaction of hers which guarded against her own fear of being cruel. She concluded with a warning that enactments are best seen as defenses on the part of the analyst. Of course, she seemed to confine the definition of enactment to being giving or liberal while allowing the refusal to comply with requests to constitute correct technique. Indeed she claimed that an enactment was a response to a "terrorist threat". She seemed thereby to privilege the emergence of anger on the patient's part (which followed her refusal) over the feelings of the patient about the analyst's weakness (which the analyst saw in the early dreams).
As long as an analyst sees the issues in analysis as composed of contents which reside within the patient, she can conveniently explain away any and all reactions by one or another version of "the patient made me do it." As long as an analyst sees the analyst and patient as separate entities, the resultant behavior can be seen as lying outside both of them--either in the relationship or in an intersubjective field. My preference is to see both compliance and refusal as shared states of meaning within a partially shared mind. By ignoring one aspect, say the compliance, in favor of the other – the refusal – we split off or disavow part of our shared mind. Both patient and analyst utilize this split, feeling each alternately. If as analysts we comply with the patient's request we need to understand and interpret the results of that action; if we then move to refusal, that then becomes the focus of our analytic work. To claim a superiority of non-compliance in order to elicit the patient's hate as was the case in the above mentioned vignette, the analyst is required to split off and disregard her own wish to comply, which joins with that of the patient. Alternatively, going along with the patient's wish is to split off one's own wish to be rigid and to insist upon the rules. Unless we are able to see this mutuality we shall be forced to use one or another set of theoretical platitudes to rationalize our behavior.
Imagine that both patient and analyst share a set of feelings that involve the patient readily getting his schedule changed along with a parallel set that consists of his needing to conform to the analyst's schedule. There are parallel sets alive in both patient and analyst. To gratify one, say compliance, elicits feelings in both patient and analyst, perhaps those of guilt for the patient and weakness for the analyst. To gratify the other could readily make the analyst feel guilty and the patient enraged. Each recognizes the feelings aroused in the other. This complex mixture is the seat of meaning, because this complex mixture is also active in the minds of both participants. Therefore, rather than claim that the patient has penetrated your mind or that you have established something that is between the two of you, it might be profitable to examine what each of you means to the other, all the while recognizing that that "other" is now a functional part of you, i.e., he is "in your mind" in the true sense of the term. Our minds do indeed include others.
It is not necessary for us to burden our explanation with other theoretical terms, but it may be necessary to underline how the analyst escapes from recognizing the mutuality of meaning by the use of theoretical terms. Agreeing to schedule changes is really no different than being rigid about schedule changes. Each has no inherent meaning until it is joined to and by the patient. The response to the analyst's stance, whatever that stance may be, ranging all the way from the very liberal to the inflexible, makes for the emergence of meaning. My having a rigid schedule means something to me before I see my patient, and that meaning probably changes with each and every patient. That is especially true in psychoanalysis, because we engage our patients in depth and these connections necessarily resonate throughout our joined psyches. If I feel strongly about an inflexible schedule, I would do well to consider how that impacts upon a patient who feels the same as I do and then upon a patient who feels quite otherwise. Since we can regularly succeed in getting our patients to conform to our personal needs regarding times and fees and the other minutiae of treatment, we can just as regularly fail to see how we sidestep an engagement that might facilitate an understanding of what all these issues mean to our patients. The patient who asks for schedule changes needs an analyst who herself can be torn about both compliance and rigidity. Indeed there is no chance of a successful analysis if this request is seen as part of a "terrorist threat". Rather it must be seen as an invitation--an invitation to inquiry. From this inquiry comes a nascent meaning which achieves its life by way of engagement with another person who completes its form.
Implications
If meanings cannot be lifted out of a patient's head for examination, if meanings cannot penetrate into the analyst's head and thereby take possession of it, and if meanings cannot themselves form an intermediary field of co-construction, are they so elusive as to defy our comprehension and understanding? In our study of behavior disorders we dealt with patients who were involved in all sorts of aberrant behavior, ranging from addictions to perversions. Our aim in this study was to find out about the meaning of the behavior no matter how much we felt it to be undesirable or obnoxious. The patient who requests a private entrance or who arrives a few moments late or requests a schedule change is hardly comparable to our collection of thieves and stalkers. Yet the comparison may be a valid one, inasmuch as the study did allow us to concentrate upon the analyst's participation in the unfolding of meaning.
Although our study did not and could not involve a very large group of patients, we did seem able to reach some conclusions which we felt were both generalizable to behavior disorders and to the supposed trivial enactments noted above. The first of these patients demanded an analyst who was able to participate to some extent in the misbehavior: thus the mutuality of meaning. Simply put, a thief is best helped by an analyst with a bit of larceny in his own character. This, more often than not, manifests itself in some sort of action which may exist for a time outside of the treatment. For example, one of our patients had had a previous analysis without once mentioning to the analyst that he regularly stole books from his university bookstore. His second and successful analysis was with an analyst who seemed much more comfortable with this form of delinquency. To bring this misbehavior into the treatment, the analyst must himself struggle with its meaning and must himself experience this delinquency. Complete disapproval is of no help, while complete approval is folly. Thus another conclusion that we reached – one that will surprise no one – is that the behavior must be understood as very necessary for the patient but as a bit less so for the analyst. Most of our patients resort to these behaviors to ward off intense depressive affect, and for an analyst to conceptualize these issues as only ethical and/or boundary problems is of little help except to the analyst.
To properly conceptualize the nature of shared meanings, we need only consider the routine employment of empathy, the means by which we are able to take up residence in another person's mind. Our empathic connection with our patient, our reading of our patient, resonates with the patient's reciprocal reading of us. That, of course, defines the self-selfobject relationship. This union of empathy and the commonality of its inevitable struggle to all of our patients was a striking phenomena in our misbehaving patients, who found themselves in us just as we could did in them. The added, and often, troubling phenomena in behavior disorders is the frequent accompaniment of disavowal of those behavior aspects that could not be tolerated. Once we could recognize the disavowal, we could usually recognize our compliance in its status: either outside the treatment or enacted in the treatment. Either way, the mutuality of meaning was brought home to us.
Conclusions
If we are able to divorce the concept of meanings from that of a word or image standing in for something significant, we can move on to meaning as an activity of a person, with all of its unconscious and pre-conscious elements. Therefore an apple or a textbook or a mother has no meaning in the static sense of an internal representation, but rather its meaning lies in the active sense of how it moves us. That word "move" can range from silent contemplation to overt activity but the apple or book or mother must impact the person in order to gain meaning. One of the peculiar and wonderful things about psychoanalysis is that it goes both ways. Analysts no longer objectively observe any more than they mirror or love their patients. Rather, their task is to interpret the meanings that capture and envelop each of the participants in this very unique conversation.
REFERENCES
Anderson, M. (1999), The pressure toward enactment and the hatred of reality. Jour. Of the Amer. Psychoanal. Assoc., 47/2:503-518.
Greenberg, J. (1996), Psychoanalytic intervention. Psychoanalytic Inquiry, Vol. 10[1]: 25-51. Hillsdale, NJ: The Analytic Press.
Ornstein, P. (1993), Did Freud Understand Dora? Freud's Case Studies. Self-Psychological Perspectives. Edited by Barry Magid. Hillsdale, NJ: The Analytic Press.
Pessen, A. and Goldberg, S. (1999), The Twin Earth Chronicles. Armerk, NY, London, England: M.E. Sharpe.
Stolorow, R. and Atwood, G. (1992), Contexts of Being: The Intersubjective Foundations of Psychoanalytic Life. Hillsdale, NJ: The Analytic Press.
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