Saturday, April 21, 2007

Rhetoric of the Surface of the Session

In Difference and Disavowal (Stanford UP, 2000), psychoanalyst Alan Bass meditates on the evolution of clinical analysis from content-based interpretation to analysis of “the surface of the session”—the ways in which the patient’s feelings and responses show themselves in the now of the analytic hour and define themselves against the frame of the analytic environment. As analyst and analysand reflect upon these responses, they find themselves discussing and hence valuing questions that are very small: why is the patient inclined to say it doesn’t matter that she is a few minutes late? why does she make or avoid eye contact with the analyst? if it has always bothered her a little to sit by the window, why hasn’t she said so? if she has never said so before but only just now, why just now? if she wants to get up and leave, why does she not do so, given that the contract between analyst and patient promises that there will be no consequence for anything except the expectation to discuss whatever happens? Presumably these questions matter because they are connected to deeply familiar patterns of comfort and discomfort, freedom and obligation, that reflect the environment of the analysand’s early development and so continue to structure decisions, big or small, she may make years after: archaic patterns shape the way she thinks about decision, the assumptions with which she thinks about it (her liability to presume it is possible or impossible). Further, the analyst focuses on the small questions that come up inside the session because they are the ones that are right here right now, and there is therapeutic power to be drawn from the inescapabilitity of a shared present. It doesn’t matter as much where you begin—the more banal, the more nearly neutral the instances, the better, if that makes them concrete and convenient. Yet these assumptions of connection between the small and the large and of the present’s value over that of the past and the future seem not entirely to account for the value the therapy places on any choice, no matter how miniscule, how slenderly connected to something characteristic or consequential.

What can we learn from contemporary clinical discussions of this kind? To describe these small acts, clinical literature tends to refer, not to agency, as literary critics probably would, but to “enactment.” Making eye contact or not, putting your coat down beside you or not, and so on, indeed most interactions with the analyst, are “enacted processes.” A survey of the literature by Gil Katz begins by explaining in its abstract that “enacted processes” are “variously addressed in the current literature by such terms as enactment, actualization, and interaction” (Katz, “Where the Action is: The Enacted Dimension of Analytic Process,” JAPA 46 (1998), 1129-67). The idea of “enacted processes” represents, in Katz’s words, “the conceptual reuniting of Freud’s concepts of transference and acting out” (1129). That is to say that enacted processes are unconscious. This “enacted dimension of analytic process,” Katz continues,

occurs naturally and inevitably, without conscious awareness or intention. It exists alongside, and in concept with, the treatment’s verbally symbolized content . . . . the therapeutic action of psychoanalysis may be considered a function of two interwoven and inextricable treatment processes: transference experienced enactively and insight symbolized verbally. (1132)

The assumption here is that quite conscious decisions and actions are unconscious in what we would call their performative dimension. Katz’s distinction between unconscious enactment and conscious verbalization is qualified by the fact that utterances “as symbolic vehicles” may also be enactments (1129). Nonetheless, the picture of the patient who acts things out and gradually learns to become aware of and verbalize realization gives a priveleged, though not exclusive, emphasis to reflective speech. "Insight symbolized verbally,” while not synonymous with psychic change, is stressed as it is the emergence and acknowledgment of change. In therapy, “change” means getting well, which means in turn being able, at least potentially, to do new things, such as take up a new love object instead of the old dead one.

In this psychoanalytic discourse, this process of psychic change, in turn, is called “action.” The term “action” is reserved for the process of getting well: that’s the only “action” in psychoanalysis, and it is, of course, interaction. (A locus classicus for this concept is James Strachey’s 1934 “Nature of the Therapeutic Action of Psychoanalysis.”) An article by Paul Gray, “The Nature of Therapeutic Action in Psychoanalysis” (JAPA 38 (1990), 1083-97), describes a particular form of attention for observing in a very empirical way a certain kind of communication and inhibition and then supporting the patient’s capacity for self-observation. In the case material Gray claims that a patient’s “regained use of his [own] objective self-observing functions, formerly used by his superego for critical inhibiting purposes only,” enhanced his ability to gain insight from experience and get better: "Eventually, this man learned he could notice these habitual reactions within his mind, without my first having to draw his attention to them; he could observe them as they occurred. Patients at this stage of experience have said 'I can see what’s coming'; 'I saw what I was doing'; 'I know what I’m doing'; 'I’m doing it again'; etc. None of these need be self-critical observations; to the contrary, they may be accompanied by amazement and a sense of self-discovery. For this patient, such observations contributed steadily to both his growing capacity for self-analysis and to further therapeutic action" (Gray, 1093).

So there are different elements at work in the narrative of enactment. First, there are dramatized occasions when agency is called upon to appear: should I tell the analyst I don’t want to talk to him at all today? should I be silent, since I don’t feel like saying anything? should I say something about this feeling? A partly nonverbal, partly verbal exchange through, and about enactment emerges in the course of the sessions; through that exchange, topped by explicitly verbal reflections, there occurs (if all goes well) action. The reflective utterance, we could say. embodies the transition from enactment to action. With a nod to the work of Anne-Lise François (“The Romantic Constative,” paper delivered at Cornell University, October 14, 2005), it seems possible to suggest that this transition from enactment to action is a performative dimension of the constative utterance: movement both reflected in and effected by the uttering of the "is" statement.

In surface of the session analysis, the theater of what we call “agency” is occupied mostly by inhibition and enactment. It’s interesting to realize that everybody has enormous difficulty with the very tiny decisions and actions on the surface of the session. The neutrality of the analytic frame would paralyze anybody. At first it seems all the more strange that this happens even though it’s agreed that there is no consequence for anything—the analyst will not retaliate. As long as the analyst is competently trustworthy, this would seem to guarantee that inhibition is a matter of fantasy during the analytic session. Gray, whose case material focuses on an intelligent guy defending against homosexual impulses, notes that "the patient had become aware that the conflicts he experienced while trying to free-associate were significantly influenced by the presence of various, usually at first preconscious, fantasies of incurring some risk at my hands, because of what he might reveal. These intimidating images came to include: my not respecting him; my laughing at or ridiculing him; especially my judging him ineffectual, weak (small)" (1088-89). Gray goes on to interpret that

these inhibiting images arose during those hours or moments associated with the patient’s need to turn away from some active or aggressive line of thought or feeling toward someone other than himself. He could thereby achieve an inhibition of the feared thoughts by reaching for a transferred image that would threaten to put him on the receiving end of some kind of aggression. (1089)

Gray’s interpretation is noncontroversial: the inhibition of agency (what we would call agency) is based in the fear of one’s own aggression; the overcompensating defense against aggression, perhaps bound up with an omnipotent overestimation of one’s own power (the fantasy that the exposure of one’s desire would overwhelm and kill the analyst), inhibits action more broadly for good measure. The dynamic of the session, however, also reveals something else: the form of “enactment” shows the formal pressures of stated preference and of having something to say. Outside the session, it’s legitimate to anticipate the responses of the other up to a point. We do of course fantasize such responses even when we do not know what they may be. But we often do know something about them, and our conscious task is to factor this knowledge into a new and more complete representation of what we want to do given the other’s position—to navigate in relation to a potential constraint that we have gauged as accurately as possible. Is this what we want to call “agency” (action we feel we have defined our right to)? In the session, without the other person’s desires in the picture, decision becomes vertiginous preference. The literary representation of preference in existentialism and French New Wave cinema portrays this sort of “free” decision, its high perplexity, and often, arguably, its relapse into enactment. Tolerating one’s own preferences to the point of true spontaneity in a kind of psychic version of respect for useless aesthetic value—perhaps visible in Lacan’s slogan “Never cede your desire” (no desire left behind!)—is a nearly impossible goal of sheer being-here-now with affinities to stoic meditation. If the logic of transgression works with a notion of negative agency (freedom from the impositions of another), existentialism and the assumptions of the surface of the session figure a purely positive agency that is harder to achieve the more neutral the conditions are and the smaller and more inconseqential the questions. Without a context of mutual consequence, there is nothing to choose and everything to prefer; and to prefer is far harder than to choose. Further, enactments diffuse the anxiety of something that cannot be said. As choosing is easier than preferring, doing is easier than saying. Here we see how enactment extends “acting out.” The term of art “enactment,” however, signals a shift in which “acting out is no longer seen simply as a discharge product opposed to transference and impeding the treatment,” as Katz explains: "contemporary psychoanalytic interest has shifted away from the mostly external motor actions generally referred to be the term acting out, and is now attending to more subtle forms of action occurring within the analytic dyad. Concepts like 'enactment,' 'actualization,' 'reliving,' and 'living out in the transference' have increasingly replaced 'acting out' in psychoanalytic discourse" (Katz 1131).

This means not only that analysts now think they should be neutral about a mode of communication as well as its content, but that they think so because enactment, as communication, has something in it that tends toward therapeutic action: that is, verbalization and with it psychic change. When we recall how very hard it is to say things, inhibition on the surface of the session is not particularly fantastic. The analysand faces no consequence except to talk about whatever happens—but talking is the worst thing that can happen, the worst thing to the extent that it brings action.

Where no desire is too small to be left behind, inevitably no action of the analyst, no matter how correspondingly small, will fail to count as possible retaliation—a shift in the seeming expression of an eye will count, not simply criticism or laughter. Analysts acknowledge this, and the acknowledgment is part of the picture of the hyperbolically self-conscious narrative going on inside the analyst during the session, which features prominently in the genre of the case study. Analyst Owen Renik has written in defense of the productiveness of what would usually be considered mistakes by the analyst, so long as they are reflected upon and folded back into the conversation. Renik once tells a patient, “It’s as though you thought you were the only person who’d ever been weaned from the breast!” In Renik’s experience, confronting the countertransference of such an outburst can accelerate understanding for all concerned. Respondents to this article of Renik’s, however, opine that his analysis survived the outburst because of his skillful reactions afterward (skill that could just as well have been applied to a different purpose) rather than profiting by the outburst as such. I go into this to point out that the analytic profession’s assumption of the extreme fragility of the patient registers the great pressure the analytic frame places on him or her so much as to belie its claim that inhibition inside the session is based on fantasy. (See also Renik, “The Patient’s Anxiety, the Therapist’s Anxiety, and the Therapeutic Process,” in Anxiety as Symptom and Signal, ed. Steven P. Roose and Robert A. Glick [Analytic Press, 1995].)

It might be interesting to critical theory that in the discourse of the surface of the session, there is no “agency” between inhibition and action. Rather, enactment is the compromise between inhibition and action, and the incremental dialectic between enactment and symbolization produces psychic change. This is not a Pascalian model: you don’t effect psychic change simply by repeating difficult-to-state facts or facts in which you want to believe; repetition is necessary but not sufficient. The statements don’t count—much as performative utterances themselves don’t count unless they’re uttered by someone who has the authority to make them—unless they have been prepared incrementally in dialogue with inhibition. “Agency” may not capture this incremental nature of action.

[Acknowledgment: Thank you to Mia McIver.]

Image: Hiroshi Sugimoto, Pacific Ocean, Oregon, 1985

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