Review of the “International Journal of Psychoanalytic Self Psychology” (Volume 11, Number 2, 2016)

Review by Roman for Sept Newsletter
for ICP+P’s September 2016 Newsletter

The issue features a number of interesting and thought-provoking discussions, but I would like to focus on the three-article conversation between Joye Weisel-Barth and Steven Stern, regarding the “reality” and “boundaries” of relational analytic therapy.

The conversation begins with Weisel-Barth’s article, in which she discusses the question of boundaries in the co-created relational space in the example of her own work with a patient. This case highlights a shared love for animals between her and a female patient, which created a stabilizing factor in an otherwise “long and volatile” therapeutic relationship (p. 121). However, one day, the patient brings two abandoned animals into the room, and Weisel-Barth ends up adopting one of them. This action “began an enactment that ended in a therapeutic disaster” when – through an unthinkable turn of events, the patient learned of a sacrifice Weisel-Barth had to make in her personal life that was related to her decision to adopt one of the animals. A period of angry calls and emails leads to the termination of their therapy – “the rugged sundering” that echoes the patient’s “long history of ragged endings” (p. 123) – although Weisel-Barth does report a positive email exchange with her patient several years later.

Weisel-Barth acknowledges inevitably feeling “some love and/or, tenderness, and/or passion” for all her long-term patients (p. 116). Using the feelings that emerge in the relational analytic space can “change patterns of relational expectations” and “open new behavioral possibilities” – in other words, “they expand repertoires of interaction and connection inside and outside of the therapy” (p. 116). However, positive emotions and the experiences of pleasure and healing may carry a threat of danger and pain. One reason for this possibility stems from the fact that, however ‘real’ the therapeutic space may feel (and be), it still may be “shockingly separate” from “the reality of other life contexts” (p. 117). Weisel-Barth’s clinical example highlights the “analytic hurt” resulting from the discrepancies between the co-created analytic space on the one hand, and the external realities of both the patient’s and the therapist’s lives on the other.

Weisel-Barth points out that, in the traditional psychoanalytic mode, boundaries tend to be clearer than they are in relational analysis, where they “can be cloudy and damnably confusing” (p. 121). And yet, in some ways, relational work invites more ambiguity because it is a transitional play space, laden with unconscious forces and fantasies. Nonetheless, this lovely space carries a significant risk of the therapist becoming lost alongside the patient “in the illusory, ‘as if’ nature of the play space” (Weisel-Barth, p. 118). And the case discussed by Weisel-Barth represents an instance of the therapist having lost her therapeutic stance in the ambiguous analytic space.

In the following article, Stern discusses the relational therapist’s “greater participatory freedom” (p. 126) in the example of Weisel-Barth’s case. One of the perspectives in Stern’s discussion highlights the concept of the mutuality – asymmetry dialectic. According to Stern, Weisel-Barth’s case exemplifies the undermining of the asymmetrical frame of therapy, where the therapist should remain “at all times, the member of the dyad responsible for shepherding [the process] in which the patient’s therapeutic needs and interests are privileged” (Stern, p. 128). In addition, Stern argues that the dyad’s mutuality dimension was also affected by Weisel-Barth’s choosing to make – unilaterally – a sacrifice that was very meaningfully related to both of them. And, because both dimensions of the mutuality – asymmetry dialectic were compromised, the imbalance in asymmetry could not be rescued by a potential increase in mutuality.

Another perspective employed by Stern is related to the “as-if” quality, or “the necessary ambiguity,” of the therapeutic relationship. While the therapist’s relationship with the patient is fully real, there should remain a sense of ambiguity “in which everything that occurs is simultaneously a product of, and subsumed within, the constantly evolving therapeutic process” (Stern, p. 130). In Stern’s view, Weisel-Barth’s actions brought forth the loss of this necessary ambiguity – and even talking about this loss could not remedy the situation, since such conversation would require Weisel-Barth to disclose numerous elements of her own, real life outside the therapy room.

Lastly, Stern makes a comparison between the Boston Change Process Study Group’s relational model – which privileges “the implicit, non-verbal interchanges” as primary in the therapeutic action – and the contemporary Bionian model – which focuses on the “collaboration (conscious and unconscious) between patient and analyst in pursuit of the patient’s truth (and the truth of the analytic moment) through verbal articulation” (p. 132). Stern then suggests that Weisel-Barth’s act of accepting one of the abandoned animals may have represented “a defensive foreclosure of posing and trying to answer the question, ‘What is going on here with our shared … enactments?’” (p. 133; emphasis in original). Although it can be argued that Weisel-Barth’s actual participation could have constituted a “benign, self-selfobject, developmental” enactment, it is also possible that this enactment prevented the opportunity to open up other aspects of the patient’s experience – such as, anger and volatility – thus resulting in “actually going in less close” (p. 133; emphasis in original).

In her response, Weisel-Barth addresses some of the points raised by Stern, yet focuses mostly on the issue of telling and retelling case stories. She points out how complex and extensive our clinical narratives are, and how reduced and obscured they can become when we tell and retell (and print) them. Weisel-Barth also reminds the reader that enactments “sometimes proceed for a long time underground; and … an unexpected confluence of interactive factors may bring them to sudden and surprising conscious life” (p. 139). To dissect a story that happened in the past; to attempt negotiating it with the other person’s ‘truth’ – when an enactment that used to be hidden is suddenly so apparent now – may enrich our understanding of our theory and work, but is likely to fall short in presenting a definitive analysis of a particular therapeutic relationship.

Echoing Weisel-Barth’s point about narratives, I invite our readers to take a few moments to read this fascinating discussion. I – for one – found it tremendously enjoyable and enriching.