Stefano Bolognini. Secret Passages: The Theory and Technique
of Interpsychic Relations. Translated by Gina Atkinson. 2011. New York, NY: Routledge, 264pp. Giuseppe Civitarese. The Intimate Room. Translated by Philip
Slotkin. 2010. New York, NY: Routledge, 240pp. Antonino Ferro. Mind Works: Technique and Creativity
in Psychoanalysis. 2008. New York, NY: Routledge, 240pp. Antonino Ferro. Avoiding Emotions, Living Emotions.
Translated by Ian Harvey. 2011. New York, NY: Routledge, 232pp.
The woRk of italian psychoanalysts has increasingly attracted attention in the United States, particularly for its vivid depictions of clinical work with more disturbed patients and the associated creative development of concepts of mental functioning and
psychoanalytic process originated by British and South American post-kleinian
theorists. In particular, the ideas of Bion and the concepts of psychoanalytic field theory have been taken up and used in new ways by the Italians.
In this review of four recent books by three influential Italian
psychoanalysts, I will highlight aspects of this Italian contribution, and explore some of the questions—therapeutic and theoretical—that it raises.
Among the core areas of psychoanalytic theory in which these authors
introduce radical revisions are the nature and use of transference as well as
the essence and purview of the analyst’s work.
The Field in Psychoanalysis
An exploration of the Italian use of the “field” concept requires some understanding of its history. Although a theory of the field has a history
in North American psychoanalysis, through the work of Sullivan and his intellectual descendants in the Interpersonal-Relational schools, this
theory— grounded in a sophisticated approach to interpersonal relations and social context—must be distinguished from the field theory developed in South America, which has been most influential in Italy. This field theory concerned itself not with implicit meaning observed in patterns of
relating, but with unconscious fantasy in the constitution and workings of the psychoanalytic situation. (See Stern, in press, for a fuller differentiation and comparison of the North and South American field models.) The
field theory first articulated in the 1960s by w. and M. Baranger, provides a particular model and way of thinking productively about the significant and organizing unconscious fantasies that are produced by the
interaction of the two minds in the analytic situation. Although most schools of psychoanalysis have long acknowledged and appreciated the
ubiquitous involvement of the unconscious world of the analyst as well as the
patient, this view—different from, but related to, ogden’s (1994) concept of “the analytic third”—seeks to expose and explain the joint production
of meaningful unconscious experience as an inherent aspect of the
psychoanalytic process. Drawing on klein’s notion of projective identification, Isaacs’s understanding of unconscious phantasy, Bion’s insights
into the functioning of groups, and the insights of Gestalt theory and the
phenomenology of Merleau-Ponty, the Barangers saw a new level of complexity in the analytic situation. As eizirik explains in his introduction to their volume, they articulated the idea that “the regressive situation
of the analysis gives rise to a new gestalt, a bipersonal or basic unconscious fantasy of the couple that is different from the fantasies of the patient or those of the analyst considered individually” (Baranger & Baranger,
2009, p. xii). They viewed the analytic situation as a dynamic field, that is, not simply a demarcated realm as in traditional analytic thought. As such, it is conceived of a spatio-temporal structure continuously shaping and
being shaped by the shifting relations amongst its constituent elements— most importantly the minds of the two participants. “The analytic
situation itself has to be understood as a structured whole whose dynamic derives from the interaction of its parts and from the effect of the
analytic situation on both, in reciprocal causation” (p. 53). The kleinian
underpinning of this field model is evident in the further assertion that the cardinal defining element of the field can be thought of as a shared unconscious fantasy. That is, they inferred the existence of a particular fantasy
underlying every analytic engagement. “This structure [the fantasy] cannot in
any way be considered to be determined by the patient’s (or analyst’s) instinctual impulses . . . nor . . . the sum of the two internal situations. It is something created between the two, within the unit they form in the moment of the session.” (quoted in Baranger & Baranger, 2009, p. xii–xiii; emphasis in original). This “wholism” emerges from the idea of the analytic couple as a
functional unit similar to winnicott’s famous description of mother and infant. The Barangers state that “neither the analyst nor the analysand,
once involved in the analytic situation and in the process, can be taken in isolation: they have to be approached as one functioning with the other” (Ba- ranger & Baranger, 2009, p. 53). The concept of the “bastion,” an area
in which a shared unconscious fantasy is born of a coupling of the analyst’s and the patient’s resistances, warding off content disturbing to both, and impeding analytic progress, is one of the most fruitful products of this
way of thinking. one might see such a fantasy structure as a way of
describing from the intrapsychic perspective what might be called enactment when viewed from an interpersonal perspective. It is a shared but unconscious understanding of “what’s happening here,” the underlying idea that
confers a particular kind of sense on an interaction or experience. In explaining the peculiar ability of two minds to create something both unconscious and shared, the Barangers drew not only on the
ideas of klein, Bion, and Gestalt theory. They also drew on their colleague Bleger’s (2013) concept of the analytic setting, understood as a
“symbiosis” that is “constantly being corrected and desymbiotized by the analyst” (Baranger & Baranger, 2009, p. 11). Still working from a perspective
in which a type of analytic reflectiveness is sought and valued, the
Barangers included in their field theory the important concepts of “second look” and “insight.” These provide crucial conceptual footholds for the
analyst’s (always partial) disengagement from and observation of these
complex fantasy structures, which constitute the source of potential analytic change as well as that of blockages to analytic movement. In
describing how such shared structures not only exist but can be analyzed
and resolved, the Barangers emphasized the necessary, transient splits in the ego of each participant that are required for the development of
an interpretation that—when it can be received by the patient—leads to insight. Insight, in their conception, allows for past to be truly
distinguished from present, and so for repetition to give way to creative change.
The theory was meant to elucidate complex aspects of the analytic situation
—ones crucial in the development of impasses—that had largely gone
unnoticed
and untheorized in traditional thinking. But for these original
psychoanalytic field theorists, the goal of clinical work remained—as in traditional psychoanalytic thinking—the gradual unfolding and analysis of
the complex unconscious fantasy structures that organized and constrained the patient’s experience. Although it may be taken as a general theory
of psychoanalytic process, this concept of the field, as Zimmer (2010)
insightfully articulated, may also be seen as offering a view into a particular realm of psychic functioning, different from and complementary
to the perspectives offered by one- and two-person psychoanalytic models. How to work with the Field: Ferro The principal Italian followers of field theory have included
Francesco Riolo, Antonello Correale, Giuseppe Di Chiara, Eugenio Gaburri,
Domenico Chianese, and Antonino Ferro (Zerla, 2010, p. 304), of whom Ferro is by far the most extensively published in english and the
best known in the United States. These authors have developed a
model distinct from the Barangers’ in important ways. This new field theory,
as illustrated in Ferro’s two newest volumes, Mind Works: Technique and Creativity in Psychoanalysis and Avoiding Emotions, Living
Emotions, and elegantly explained in Giuseppe Civitarese’s book, The Intimate Room, joins the Barangers’ concept to a Bionian1 model of mental
functioning, now enhanced by the theory of linguistic transformations of meaning known as “narratology,” derived from the work of French
structuralist literary theorists and promoted in Italy by the analyst Francesco Corrao.
From narratology, Ferro and colleagues utilize the idea that meaning is generated in the shifting relations of small narrative units called “narremes”—a character, an image, a phrase, etc. Although literary
studies do not concern themselves with the origin of the narremes, focusing instead on the meaning generated by their arrangement, in this
psychoanalytic adaptation of narratology, narremes are understood as conscious derivatives of something unconscious, or perhaps preconscious,
although these are not terms favored by Ferro. Following Bion, he believes
that the mind represents raw sensory data through a process of transformation known as alpha function—a process of unconscious mental digestion or 1 This model emphasizes Bion’s seminal insights into the metabolic
function of dreaming, here expanded into a total theory of technique and therapeutic action,
and constitutes one among many current interpretations of Bion’s work, as Greenberg
(2013) observes.
“dreaming.” Narremes are seen in this context as the conscious
derivatives of alpha elements, digested sensory experience. As Bion observed, the dreaming that occurs at night is only one instance of a mental
activity that actually proceeds continuously during periods of wakefulness as well, what he called “waking dream thought.” This is the constant
process in which the most basic sensory input to the human organism is transformed into “thinkable” experience. This process is related
to what has been called “formulating” (Stern, in press ) or “figurability”
(Botella & Botella, 2005 ). The use of narratology adds another stage to this transformational
process, one that Bion did not address. Ferro, who has previously written about the “storytelling” that occurs in analysis, now calls this stage
“narrative
weaving” (Avoiding Emotions, p. 56). He renames alpha elements in a more experience-near language as “pictograms” to connote
their nonverbal, immediate quality, and their relationship to Freud’s thingpresentations. These pictograms are unknowable in themselves; they are the counterparts of Freud’s latent dream thoughts. It is the derivatives
of these basic mental elements that become conscious and form narremes, which are then “woven” into thoughts, fantasies, images, stories,
memories, and so forth. Ferro observes that this narrative extension of Bion’s theory,
when integrated with the field concept, provides a new analytic tool. when
associations are viewed as narrative derivatives of experience in the context of the field, they are logically seen as telling stories about the
patient’s immediate experience in the moment, and thus are expressions
of the current state of the field. This way of hearing the material
therefore allows for a constant monitoring in the moment of the patient’s
not-yetformulated experience of the analytic process. (Much of the action in this model occurs in the area that might traditionally be termed
preconscious; but because the model of mind is one of emergent formulation
of experience rather than the uncovering of existing repressed material, there is a greater fluidity and ambiguity about status of awareness.)
Ferro and Civitarese seem to see this constant monitoring as not only now possible, but indeed as the desirable main focus of the analyst’s attention.
This is because in their model, the analyst’s job has been radically reimagined.
Although there is some ambiguity here about whether these authors are simply presenting a new way of understanding what the analyst
does in his usual functioning, or are actually prescribing a new role, they
clearly see analysis as above all a method of developing the patient’s own
capacity for more effective dreaming and making narratives.
This is presented
as being in contrast to more traditional ideas about the essence of the analytic process, such as the uncovering of repressed memories,
for example, or revealing of unconscious fantasy. But it also stands in contrast to some relational models, to which it bears resemblances in other
ways, in which the therapeutic action of analysis is attributed to
experiencing of new ways of being interpersonally. In the Italian field model, this process of developing the patient’s
ability to dream is established and nourished by way of the analyst’s
reverie during the analytic hour, understood to be producing narrative
derivatives stimulated by those of the patient, which in turn stimulate further elaborations by the patient and so forth in a ceaseless exchange.
These authors conceptualize this dreaming by the analyst not as a mode
of access to the patient’s existing unconscious wishes and conflicts, based on projective identification, but as participation in a process of growing
the mind of the patient. Thus the narrative that emerges—the “stories”
told and elaborated by the patient and the analyst—constitutes the
perceptible substance of the field. Ferro uses the word “hologram” to describe this effect of the ghostly dream elements coming alive in the analytic
situation. Ferro observes that, in disagreement with Freud, he thinks that the basic problem for humans is not the pressure of instincts, but rather
the inadequacy of the human mental apparatus for coping with the barrage of external and internal stimuli it faces. The apparatus develops in
order to cope; it is a machine for the transformation of stimuli into bearable, meaningful experience. Following Bion, Ferro conceptualizes the most
primitive mode of managing sensory stimulation as evacuation, with
the development of alpha function and increasingly complex dreaming as ever more effective methods of management. Ferro and his cohort have a special interest in pre- or extra-linguistic symbolization as a
basic capacity, almost always inadequate or impaired, which can be established or repaired only by the kinds of processes that take place in the
analytic situation. Thus, the development of “pictograms” and elementary
narremes as transformations of basic sensory-somatic experience is a
necessary precursor to the ability to elaborate narratives. Symptoms and
character pathology, whatever their specific origin in an individual, are fundamentally the inevitable manifestations of some degree of faulty mental metabolism. Ferro writes that “this baseline reverie activity
is the cornerstone of our mental life, and our psychic health, illness or
suffering
is determined by its functional or dysfunctional status”
(Mind Works, p. 1; emphasis added). Thus, across the diagnostic board, these authors
are concerned above all with the use of the analytic dyad’s exchange,
at multiple levels of consciousness, to facilitate the expansion of all patients’ capacities of accessing and transforming raw experience. The
content of the exchange is far less important than the process, and the analyst’s close following of the patient at all times, with a view to continually
developing and elaborating, is key. Indeed, Ferro writes—provocatively, some may feel—that when listening to analytic material, “it makes little difference what the story is” because “we focus on the transformation of the patient’s apparatus for thinking (I care little about what)” (Avoiding Emotions, pp. 9, 11). Indeed, as Neri (2009) writes, in this Italian take
on clinical process “the idea of transformation becomes central and, for the most part, absorbs that of interpretation” (p. 59; emphasis added). Because, according to these writers, the goal of analytic work—
especially with more disturbed patients—is the development of the capacity to make such transformations, they argue that traditional transference interpretation is ineffective, indeed counterproductive, in that it
interrupts the transformational process, of which transference is a particularly rich aspect. They imply at times that once this narrative function is
established, there might be other modes of working and interpreting, but they do not explore or illustrate this, leaving the reader to conclude that in most cases, whatever the patient’s difficulty, it is to the development of his narrative function that the analyst must attend. These authors follow Meltzer in considering reconstruction also to be therapeutically
unimportant; creating a narrative of the past is important only as another way of thinking or dreaming immediate experience. This is “a psychoanalysis more interested in extending thinkability than in recovering past events” (Ferro & Basile, 2009, p. 3), or, it might be added, in discerning
and articulating enduring psychic structures. Ferro presents a familiar version of Bionian theory as his model of mind and treatment, although he utilizes his own highly visual
terminology (e.g., hologram, pictograms). As stated in Mind Works, this model is as follows: The initial trigger of the “big bang” represented by the kindling of mental activity in our species is the child’s massive evacuation of protosensory
and protoemotional states. If these evacuations (beta elements) are received, accepted and transformed by a mind that absorbs and metabolizes them
(alpha function), they are gradually transformed into pictograms
endowed with sense (alpha elements). The mind of the person who effects
this transformation not only transforms the protosensory chaos into an emotional figuration endowed with meaning, but also, through the constant
repetition of this operation, conveys the “method” of doing so (alpha function). . . . The constant repetition of this transformational cycle—. . . a kreb’s cycle of the mind—also has other effects: the play of
projection–introjection– reprojection–reintrojection permits the differentiation of a hollow space and a convex space, of a space for reception and a filled out “plenum” space—in a word, container and contained. (p. 134) Furthermore, “alpha elements will arrange themselves in chains
of pictograms that will confer shape and colour on everything that was previously exerting chaotic pressure and will give rise to the sequence of alpha elements that comprises waking dream thought”; thus, “information on waking dream thought [unconscious and inaccessible in itself]
can be obtained from its narrative . . . derivatives” (p. 135). even sexual material is heard primarily not as a description of
conflict and desire but as narrating patterns of mental engagement:
“Sexuality in the analyst’s consulting room could be said to be either a
narrative derivative— that is, a way . . . in which the patient tells us of his mental functioning or dysfunctioning—or a description of something
taking place between the minds of the patient and the analyst” (p. 118).
Ferro goes farther—many might say too far—in situating these ideas in
an unusual classification system for mental interchange, in which generativity is
confusingly and concretely conflated with heterosexuality. As he describes, a potentially infinite number of narrative
derivatives could be produced by the multistep transformation of original
beta elements, thereby conferring individual character on subjective fantasy life. Notably, Ferro is less concerned with the determinants of the choice of narrative derivatives than with the availability of options. He is
interested in the analyst’s role in stimulating and supporting the process of
transformation, and has very little concern with the productions of this process, apart from their role as signs of the effectiveness of the process itself. Continuing to reframe the concept of transference in relation to that of the analytic field, Ferro states that: Transference enters the session in various ways, [including] . . .
through all kinds of stories and a wide range of modes of expression that convey
sensoriality, distress, absence of function or presence of dysfunction. . . .
Absurdly enough—and this is the challenge the analysis must take up—all these characters, stories and procedures relate to the present analytic
situation, or rather to the present analytic field regarded as a multidimensional dream space. (Avoiding Emotions, pp. 140–141) For example, in the patient’s material following a more direct
transference interpretation, the thought of a “natural disaster” appears, signaling to the analyst that his input was experienced as “inappropriate,
invasive and persecutory” (Mind Works, p. 47), and so rather than directly
interpreting this reaction, he modifies his approach, “cooking” the feelings with his reverie, and finds this validated by the patient’s subsequent
associations to his tender nanny. This result, in which the patient cannot be said to have attained insight into his experience of the analyst’s
intervention or into his own defensive processes, is seen as successful in that it is understood to be a step in a process of the patient developing his own capacity to “cook” his emotions, in the culinary metaphor much
favored by Ferro. Ferro argues that much of what we think of as aggression is better understood and approached as the manifestation of an overload
of beta elements, i.e., the natural violence of uncontained anxiety and
untransformed emotional stimulation. The implication is that wishes to hurt, damage, and destroy do not need to be interpreted and understood per se; the improvement of the patient’s function can occur without these being explicitly acknowledged, and that they will melt away as the
stimuli upstream are better managed. Contrasting his model of what constitutes the “seed of recovery” (see Ferro, 2005) with more traditional approaches, which some may
feel he caricatures a bit unfairly, Ferro emphasizes above all “developing the patient’s capacity . . . for producing thought processes and forming
emotions from sensory stimuli of all kinds” (Mind Works, p. 153). Attention to the patient’s evolving creativity is fitting in books that make so many creative leaps in form and style. In addition to the inclusion of numerous illustrations and diagrams that are more evocative than explanatory, Ferro closes Avoiding Emotions with an innovative chapter entitled
“Psychoanalytic exercises,” which is made up of a series of hypothetical vignettes and questions to “stimulate the analyst’s ability to think, to daydream and to play” (p. 179). Reflecting on this style, Ferro observes, “my work . . . lacks a linear structure . . . but I think that the work of the field . . . is
perfectly rendered by images of motion: ebb and flow, undertow, wave following wave” (p. 174). Ferro also states that “every patient tells us constantly how we must be and how we must comport ourselves in order to reach him” (Mind works, p. 167). By “reaching” the patient, Ferro means optimally facilitating the containing process, the transformation of experience into meaning. Ferro takes the patient’s expression as direction and, according to his
understanding of this direction, he responds by modifying his approach and waiting for the next “signal” to inform him about how his modification has been received. Despite the implication of the above statement that the patient “tells us,” Ferro conceives this “signal” as actually coming
not directly from the patient, but from the field. To interpret the signals
directly, he feels, would disrupt the necessary transitional or virtual quality of the analytic setting, and waste an occasion for more directly making use of this feedback to alter the experience itself. The patient’s “stories” are construed first and foremost as signals from the field about the
state of the field, to be responded to by the analyst in his role as
field-repairman (or containing object) with efforts to further or to shift (depending on the signal) the tone, intensity, direction, etc. of the meaning-making process. As he puts it in Mind Works, “the session is constructed in real time in accordance with the constant signals furnished to us by the patient or by any other place in the field (such as the analyst’s countertransference or
reveries, the patient’s or the analyst’s soma, or the setting)” (p. 47).
There is a notable and, I think, unacknowledged ambivalence in Ferro’s work about the role of the analyst’s emotional experience. Although he refers to it as one among the many sources of the field’s signals, it is evident from his many intriguing and incisive clinical vignettes that it is a less interesting and valuable source for him as compared with the verbal
narrative material of the patient’s and analyst’s “stories.” He provides few
illustrations of the analyst experiencing strong feelings or organized fantasies about the patient, for example, instead focusing on images and sensations that occur to the analyst while he is with the patient.
Narratological Underpinnings: Civitarese Those who are used to working in analysis by trying to move as
flexibly as possible among levels or realms of experiencing—who listen
and respond to the patient’s utterances also as communications to us as people
about whom they have complex feelings and attitudes, and as
expressions of compromise formations—may be perplexed by Ferro’s
maintenance of the rather restricted focus of analytic listening and the fixed position of analyst as function, even as he himself characterizes
his approach as one marked by flexibility. Here Civitarese’s explanation will be helpful (if not necessarily persuasive). As an author “deeply involved in semiotics . . . whose relational perspective involves a strong
emphasis on how we communicate and what it means to understand another’s
thinking process” (Colombo, 2012, p. 1110), Civitarese gives us a more thorough, if not exactly systematic, explication of the way that narratology informs this viewpoint. The point of the analytic situation, as described by both Ferro and
Civitarese, is to create an area bounded by a frame, within which something that can be designated as a fiction, that will be constructed by the minds of analyst and patient together. This is to say, as in other
schools of analysis, the events of the analytic situation have a special status
demarcated from everyday reality, but these authors prescribe a particular and unvarying approach to understanding material that is manifestly about the world outside of the frame: this material is to be heard as
a narration of the current events of the hour, with “characters” and scenarios that represent emotional states. This Italian version of field theory is linked to a radical interpretive strategy. The events of external reality, reported by the patient, must not be heard as such by the analyst: this would amount to a defensive capitulation to a “Siren’s song” meant to protect the analyst and/or the patient from discomfort. At the same
time, an explicit interpretation of this material as pertaining to the
transference is to be avoided as an interruption in the narrative. Instead, analysts are recommended to “speak the language of reality while accepting the
illusionistic status of the session’s characters (who transport emotion not yet recognizable)” (Civitarese, p. 17). Civitarese discusses the rationale for this approach in a chapter called “Fire at the Theater,” in which he examines Freud’s metaphor about the erotic transference in order to discuss the special tension between the “polarities of real and imaginary” that must obtain in the analytic
situation. There is a necessary ambiguity and “paradoxicality” in analytic work that is disrupted when any transference phenomena are ascribed either exclusively to external or to internal reality, and Civitarese argues that this ambiguity is best maintained and accounted for in a model of the field that applies “a rigorous adoption of the dream paradigm” (p. 3).
Although externally stimulated perceptions and sensations are always entering the field through the subjectivities of the participants, he reminds us that they are constantly being filtered through the process of dream work, which must remain our focus. Moreover, the field itself is understood as a container in the Bionian sense, digesting the primitive emotions and giving them more organized forms of representation. The field’s functioning as a container is
protected by the analyst’s management of the frame and his exclusively dream-oriented listening stance. It is by way of this long-term, intensive, bounded, dyadic, fiction-constructing process that the patient’s capacity to use his mind, to symbolize, to convert raw experience into feelings and ideas, is gradually enhanced. Therefore, in this view, it is of utmost importance to stay within the fiction most of the time, to work not with the patient’s ego, but with what Civitarese, following Bleger (2013), calls the “meta-ego,” the wellspring of important meaning-generation, and not to encourage the ego function of self-observation. In contrast, in
the Barangers’ model, the events of the field constantly undergo reflection and interpretation as part of the “desymbiotizing” function of technique. This non-ego aspect of the mind, evocatively named the “agglutinated nucleus” by Bleger (2013), is understood as an unintegrated remnant of the most primary level of experiencing, prior to self and object
differentiation. (Civitarese is less interested in the aspect of Bleger’s theory that calls attention to the role of the frame as a foil for and support to the ego.) In emphasizing the importance of deeply experiencing the emotional reality of the session and the eschewing of intellectualizing and overly theory-driven approaches to analysis, this approach has affinities with ideas endorsed by analysts of many schools. But these authors take such an attitude a step farther. As Ferro and Basile (2009) have noted, “[f]ield theory . . . breaks for the first time with the idea of making the here-and-now explicit in the session and of consequent transference interpretation” (p. 2). These authors for the most part eschew such interpretations, which establish what, in the terms of narratology, Civitarese calls “metalepsis” (p. 50)—a
breaching of the level of the fiction established within the transference with a
commentary about it. Instead, they strive to intervene only within the setting’s “reality.” Thus, in the many reported clinical interactions, analyst and patient appear much of the time to be conversing superficially about ordinary matters in the patient’s life, while, it is suggested, the verbal material is
being heard and processed by both participants mainly at a different level, one in which the gradual containment of unintegrated emotional states is the primary activity. The authors advocate hearing every
utterance of the patient as a kind of expression of his experience of the process at the moment, a transformation by the patient’s mind of his actual experience, such that the “conversation” is simultaneously about
ordinary matters on the surface and about the evolution of immediate
experience. Civitarese observes that this approach, which holds the analytic
interaction strictly apart from “reality,” aims at “satisfying a poetics and an
aesthetics of emotional involvement as well as a poetics and an aesthetics of (epistemological) disenchantment” (p. 74). As Ferro and Basile (2009) explain, “[n]arration here
[in field theory] is used in a much different manner from the way it has been
used by American psychoanalysts . . . who [focused on] constructivism and
relativism of the narrative function” (p. 59). In joining narrative to dream and play, as that which gives shape to and represents emotions,
Italian analysts are after something quite different. Their use of narratology derives most immediately from the work of Francesco Corrao, who also, it has been argued, “was the force that shaped Italian psychoanalysis
toward a Bionian theoretical framework” (Di Donna, 2005, p. 45). Civitarese makes clear, for instance, that this view of narration explicitly reframes
the patient’s communications as not “symbolic” in the usual sense; thus he avoids “interpretation” on that basis. That is, one thing is not understood to stand for another; rather, it represents a transformation wrought upon the original thing. Two of Civitarese’s favored concepts from narratology are metalepsis, as described above, and mise en abime. Mise en abime, best illustrated
by such phenomena as a play within a play, or a painting in which the
painting itself is represented, leads to hearing the material of the session as a transformation of the session. In Civitarese’s interpretation, these ideas lead to a relative devaluation of the symbolic meaning of associations, and, instead, to an emphasis on association by affect, with metaphor serving the mind’s perpetual quest for identity, for sameness, for the bridging of past and present experience. A key idea is that this very
phenomenon, which in Civitarese’s view is the elementary mechanism of the mind for the generation of meaning, produces metonymy in language, displacement in dreams, and transference in the analytic setting. Civitarese provides a somewhat idiosyncratic account of the history and current state of American analysts’ approach to transference, in
order
to show how varied and theoretically unjustified are some of the many contemporary approaches to defining and using transference. From this critique he develops a more rigorous definition and use of the concept rooted in the study of literary texts, showing that transference is but one manifestation of a basic function of a mind confronting the challenge of temporal experience (the search for identity in difference). Civitarese uses these concepts to build a more complex understanding of the nature of the transformations generated in the analytic session,
at the same time providing a rationale for interpretation as radically
ambiguous, skeptical, and nonauthoritative—simply a “gift to the guest” (p. 175). This designation emphasizes the role of the analyst’s interventions as offerings, bits of scaffolding on which the patient/guest is encouraged to construct a larger imaginative edifice, or nourishment with which to fortify his developing mind for the ongoing conversation, something like winnicott’s use of the “squiggle” (winnicott, 1971). In what the Italians call (after Bion) “unsaturated interpretations” (which bear a resemblance to what in ego psychology has been
conceptualized very differently and called “interpretation in displacement”), the analyst’s comments deliberately allow for the possibility of multiple levels of meaning, rather than attributing to the patient’s words one particular meaning. Interpretations are oriented toward joining in the constructing of the patient’s “story” rather than observing what it may be “about.” In Civitarese’s view, much pathology of the mind reflects a “collapse” away from flexible use of multiple modes of psychic organization toward a single mode of organization (a single position, in kleinian terms), and a kind of pathology of the analytic situation results from a collapse toward privileging of external reality, a sign that transformational processes have ceased. Civitarese’s use of literary theory allows for a precise naming and
categorizing of the kinds of associations and links that minds make. Yet it seems to me that his treatment of transference as a function evades the question of how its organization is determined in any individual case. Concepts such as repetition and nachträglichkeit, which he relies upon, presuppose structures that, although modifiable, have a tendency to en- dure. Perhaps he, like Ferro, minimizes the extent to which the mind’s associations and links take on highly individual and often rigid qualities, shaped by the idiosyncrasies of individual fantasies developed over
years of living and experiencing. Civitarese’s omnivorous interest in other fields, including not only liter
ary theory but also cognitive and computer science, provides him with ample opportunity to plumb the insights these disciplines offer by
analogy. An extended discussion of the comparative uses of hypertext and virtual reality in the construction of computer games, and their
application to conceptualizing the links made by the analyst’s interventions, is particularly interesting and helpful in clarifying and enriching Ferro’s
frequent use of the term “hologram.” Although models of the mind that focus on content and structure and those that focus on process and function are clearly complementary— lenses that focus on different aspects of a complex system—they
lead in somewhat different directions when mobilized in clinical work. Italian field theorists, like many in relational traditions, have little apparent
inter-est in concepts of the self, of stable organizing fantasies,
or in questions of identity; instead, they focus on an idea of the mind as a set of
simultaneous functions, viewing the analyst as facilitator of the development of and access to these functions. All psychopathology, from severe to mild disturbance, is seen as stemming ultimately from some failure in this
basic capacity. As Neri (2009) puts it, “the reference to narration is
connected to the possibility of grasping, giving shape and therefore making something, which is present only in an implicit way or only at an
emotional level, representable or thinkable” (p. 60). In this emphasis, they are in sync with a widespread current psychoanalytic interest in
mentalization, trauma, and the effort to capture and include in the analytic process experiences that have eluded the mind’s capacity to represent. These authors focus on the reciprocal movement that is enabled in analysis between narration and emotion (signifying this movement
with a double-headed arrow), such that condensed experiences are given more usable representation, and the representations evoke and permit greater access to experience. Yet intermediate stages in the creation
and maintenance of pathology, such as the elaboration over time of stable, organizing, unconscious fantasies or the construction of enduring
compromise formations—which many view as defining features of neurotic misery and character pathology—are not considered, because all
understanding and therapeutic effort is concentrated on this underlying framework. The narration function is understood to improve by virtue of the containing interaction with the analyst, and it is implied that such inter- mediate stages will reorganize themselves naturally and
spontaneously, with improved functioning of the narration function, without requiring direct analysis and explicit working through.
Although this implication may itself suggest some notion of
identification, that is not made part of the argument. Indeed, the mechanism by which repeated experiences lead to the development of a function is not addressed. Moreover, the notion of conflict or of motivation in
the individual or the couple to avoid such narration—an important element in the Barangers’ crucial notion of the bastion in the field—is strikingly
absent. The only hindrance acknowledged is an incapacity or inadequacy of function. Models of psychic development in which the experience of adequate containment by a parent (or analyst) is viewed primarily as simply
facilitating ego development often “neglect the complex, shaded fantasy
elaboration that is associated with the child’s experience of being imagined by the parent . . . [and] the idea that the analyst who imagines
well acts solely as a new object for the patient poses the danger of a split in
the transference” (laFarge, 2004, p. 618). This critique applies to many process-focused theories of analysis, including Italian field theory, in which containment by the analyst/setting (and the associated
development of the patient’s capacity for autonomous metabolization) is
emphasized as therapeutic in itself, without explicit attention to the kinds of transferences and resistances that this experience may generate. Another way of putting this might be to note that the analyst, in the Italian field model, may be used as a figure in the stories created
in the field, but the fact that patients speak not only about the analyst but also to him, as someone other than “field manager,” seems not fully to be taken into account. Thus, it is interesting to note this is a relational
theory that—while explicitly privileging the intersubjective—is in many ways more fully intrapsychic than many traditional theories. That is, in the
context of the analytic hour, this model does not recognize the interpersonal or social as modes of experience important in their own right, viewing these instead as manifestations of a mental process of dreaming
and making narratives. I wonder whether this approach does not run the risk of subtly restoring an unwarranted level of authority—the old assumption of “objectivity”—to the analyst’s private interpretation of the patient’s communication, an authority explicitly disavowed by Ferro and
Civitarese. In their schema, the analyst checks out his understanding with the patient only within the virtual context, relying for confirmation on his own relatively uninterrogated experience of the patient’s response. A more traditional approach in which an interpretation might be made verbally, allowing the patient to join the analyst at a different vertex of
observation and giving the patient a measure of access to thought
about himself, may offer more opportunity for the patient to gain an
experience of participation in what he and the analyst are jointly creating.
In part, this opportunity recognizes that—while engaged in the virtual reality of the analytic setting—the patient relates to the analyst not only as a
function, a container, but also as various kinds of objects at multiple other levels of ego organization. The multitude of coexisting, relatively
stable transferences—in which the patient experiences and expresses feelings about the analyst as a person, not only as a container—seems to
be missing in this approach. In thinking about the developmental model on which it is based, we might observe that part of the way in which mothers provide containment for their infants is by direct verbal engagement of the baby’s developing ego and sense of self, for example with
statements such as: “You want me to give you a cookie,” or “You don’t like wearing this hat.” That is, containment occurs not only through
verbalization of a feeling state or wish, but also in the articulation of a “you” in contact with the mother as a particular object. Although Ferro refers to times when a “saturated” transference interpretation may be
necessary or appropriate, he does not tell us how he identifies these times, and
generally does not seem interested in them. with the deemphasis on this aspect of interpersonal experience, the sense of a strong interpersonal chemistry as analyst and patient come together and create a field is
somewhat lost in the work of these authors. In clinical vignettes, the analyst and patient can often seem like shadows who meet in the presence of vivid imaginative forces larger than themselves. But Ferro believes that it is only by disregarding these other
levels of transference that the patient can be helped to internalize the
container– contained relationship so essential for the processing of emotional
experience and the development of thought. The addition of the narrativizing function to Bion’s model of thinking, and the recognition that this is a layer always present to be heard in the material (patient’s and
analyst’s) of the analytic hour is invaluable, particularly in work with more
disturbed patients who may lack the differentiation required to make use of transference interpretations. But Ferro calls for a “psychoanalysis of
instruments” instead of an “analysis of contents, conflicts or deficiencies” (Avoiding Emotions, p. 86), and it seems to me that when the
development of the narrativizing function is made the sole focus of the analyst’s work, other layers of experience can easily be missed. Thus, it might be said that this Italian version of field theory, while contributing greatly to
our ability to listen in a particular way to the material, threatens to
lead to a constriction rather than an expansion of the original idea of the field. Exchange and Communication: Bolognini As with the multitude of culinary and artistic delights that Italy has
offered the world, the Italian sensibility allows for variety in psychoanalytic viewpoints. The work of Stefano Bolognini offers another way of
looking at analytic interaction that many Americans may find more flexible than field theory. In an interview (Conci, 2006), he explicitly declared his
lack of interest in the literary approach incorporated by Ferro and
Civitarese, and in this respect his work may be more accessible to Americans.
In Secret Passages: The Theory and Technique of Interpsychic Relations,
Bolognini, who has written extensively about psychoanalytic empathy, contributes with great originality on two additional, related topics: psychoanalytic pluralism and what he terms “interpsychic” phenomena. He links these to each other in his early chapters by noting that communication between minds is essential to human life, and that, optimally, the
pluralism of our field results in a greater number of “internal interlocutors” for the use of the working analyst. Bolognini opens Secret Passages with the language of objects—riffing on Freud’s need for his familiar archaeological objets around him
to represent something that did not yet exist for him, but which we in the 21st century have in abundance: a psychoanalytic tradition, embodied in the voices of those who have taught us and gone before us, as well as in a community of peers. Bolognini explores the nature of the analyst’s self and analytic identity, with a plea for us to look at our collegial
experiences in the era of pluralism as opportunities for a “recognition of the existence, of the consultability and dignity, of the various
psychoanalyses,” thus allowing Freud the felicity of truly “becoming a grandfather” (p. 22, italics in original), rather than an intimidating, forbidding oedipal father. The main thrust of Secret Passages comes in its section on interpsychic processes, in which—as in Ferro’s work—a markedly Bionian view
predominates. Bolognini observes that there is wide variety in the relative emphasis placed by different psychoanalytic theories, schools,
and individuals on what happens within one mind, versus what happens and how it happens in the exchange between two minds. Yet he points to the general convergence of psychoanalytic interest in and emphasis on the kinds of processes he is describing.
whereas Ferro primarily treats minds as points in the analytic field, Bolognini visualizes minds as spaces. The internal space in which
imaginative activity may be elaborated is one that has many points of entry and egress, with a multitude of opportunities for access to and from other minds. Bolognini explores a wider range of dyadic functioning than do many Italian analysts; specifically, while allowing for and even
privileging what he calls “the interpsychic,” he does not exclude the
intersubjective, or even the interpersonal, as areas where analytic process can take place. Thus, in his approach, there seems to be more room for the
patient’s experiences of the analyst as an important person rather than as just a function. He prefers “interpsychic” to “intersubjective” or
“interpersonal” because it takes account of the variety of states of organization that can be present in a mind, such that it cannot always be assumed to
constitute a whole subjectivity or a person in its interaction with an other. He uses “interpsychic” to denote the complex, mutually regulatory, and
communicative processes that are constantly occurring in everyone on the preconscious level. A dyad’s functional level is always based on the
simultaneous presence of various organizational modes. In a useful taxonomy of the ways in which minds may interact, he
contrasts these ubiquitous and generally benign interpsychic processes with “transpsychic” processes, in which “the receiver’s transformative
mental apparatus is bypassed” (p. 65) He uses the creative metaphor of
the “catflap” to elaborate this idea. whereas conscious, interpersonal exchanges of thoughts and feeling are like the movements of persons occurring through a regular door to a house, interpsychic exchanges move
through a cat door, which in its ordinary function exists in order to allow the
separate and necessary comings and goings of the cat (i.e., preconscious
exchanges) to occur without requiring attention from the (conscious) people of the house. He then likens the “transpsychic” to the movement of vermin—unwanted and destructive intruders—through cracks, that is, unprotected, unintentional openings in the walls. Bringing this metaphor back to the action of analysis, Bolognini argues that part of the task of analysis is to “construct a cat door
[for the patient’s mind] and coach the cat (i.e., the patient’s preconscious) in how to use it” (p. 67). That is, the patient must develop access to his own
preconscious. By using the natural currents fostered by the setting, regression
and a certain familiarity with the transitional area, the analyst can gain access, nei
ther furtively nor traumatically, to the interpsychic and can therefore
– on rare and privileged occasions—enter the “dream vault”. . . “heart” of the relationship shared with the patient. Through this internal mental
coexistence, the analyst may produce changes more effectively by reactivating or in some cases generating and bringing to flower the necessary functions— containing, representational, symbolizing, narrative, communicating and elaborating—initially lacking in those who entrust themselves to his care (p. 79). He adds that “this ideal picture of the analytic situation should take into account endless negotiations with the defensive ego of the patient, who often fears interpsychic sharing.” This mention of the defensive ego and acknowledgment of its dialectical relationship with the mind’s dreaming functions is characteristic of Bolognini and part of what makes his work feel more “North American” than that of Civitarese and Ferro, who mostly work without concepts of conflict and structure. But in keeping with the interests of his countrymen, Bolognini focuses his attention on the role of analysis in developing a set of mental functions over that of bringing to light patterns of relating or motivating and organizing unconscious content. In elaborating on his previously published ideas about empathy,
Bolognini highlights the importance of the body’s mucous membranes to psychic life, an importance stemming not from the membranes’
sensory potential, as traditional drive psychology would have it, nor even from their involvement with self-preservative biological functions, but from their role as boundaries: that is, they are the sites of interchange
between individuals, where substances from the interior of each can potentially meet and be exchanged. Following a kleinian path, Bolognini observes that interpsychic exchange can be experienced as, or unconsciously equated with, intimate coupling, desired or accepted, whereas the
transpsychic is often experienced or psychically represented as forced or traumatic sexual or physical contact. This idea has resonances with Ferro’s way of hearing sexual material as an expression of the immediate
experience of mental coupling, but Bolognini uses it more flexibly, as a possible meaning rather than a necessary one. Bolognini’s follows out this idea in an interesting way, suggesting that a prerequisite for empathy is a mental “lubrication,” analogous to the vaginal or oral lubrication,
emanating from a desire for emotional contact and exchange, and facilitating its fulfillment.
Bolognini notes—appreciatively and pluralistically—that the formulations of ego psychology are useful in removing some of the mysticism from the analytic use of empathy. He cites Schafer’s work in particular, and helpfully contrasts identifications, which are by definition
unconscious, from empathy, which is a conscious/preconscious experience. The kleinian concept of projective identification helps us to understand the mechanism of empathic experience. He offers an illuminating case example in which he describes listening to a patient recount a socially disturbing and uncomfortable experience, and notes the various
elements involved for him in sharing the experience, attempting to defensively distance himself from it and eventually managing to represent it. He argues effectively that psychoanalytic empathy involves the
recognition of the defensive ego. In this book, Bolognini turns to a favorite topic of Italian analysts, with their extensive immersion in the work of Bion: dreams and dream work. He advocates a new term, “oneiric working through,” to distinguish the Bionian understanding of the metabolic function of dreaming from the Freudian, expressive view of dreams. He does not view the one as
overthrowing the other, but feels that the Bionian view offers the analyst a better vantage point from which to develop a helpful attitude
(not decoding, but elaborating), and allows us to understand the dream and the subsequent analytic work with it—the processes rather than the
contents— as therapeutic in themselves. Here Bolognini provides a helpful example of a dream in which there was a disguised representation of a transference experience. He
observes that one could, following Freud, primarily focus on the disguise and on the patient’s anxiety about experiencing the transference more
consciously and directly, or one could focus on the way the dream allowed the patient to begin to represent an unconscious experience. He
demonstrates a way of talking with patients about their dreams in which he uses very general remarks (like those called “unsaturated” by Ferro) rather than asking for associations, to create a jointly elaborative environment. like his field theory compatriots, Bolognini too draws on the work of Meltzer, discussing the need for the creation of an “internal space” as a primary task specifically in the analysis of more disturbed patients. He notes “the importance of an antecedent formative phase of the
container” (p. 162; emphasis in original) prior to its transformative function, which allows a patient to accept and tolerate something from outside.
He argues that the most primitive defense is to evacuate intolerable parts of the self
into an object, and he suggests that this evacuation is necessary in order to create a “concave” mental space. (This image of a primal space into which mental contents can be placed, and within which mental
transformations take place, is a common one in many psychoanalytic conceptualizations of the mind, though here it may seem somewhat reified to some readers.) Bolognini cites a familiar experience from clinical practice in which a patient who cannot “take in” anything from the analyst rages until the analyst retreats and offers less, consciously out of impotence and
frustration, whereupon the rage continues until it burns out, and is replaced by a state which Bolognini sees as depressive in character, in which the
patient can now take in something. By accepting the rage with his own “concavity” (rather than responding with interpretations that
prematurely return the patient’s mental contents to him), the analyst has
permitted the patient to “empty out” bad material and to create an internal space for allowing good to come in. He likens this to the need to vomit a toxin before taking in good food. Bolognini further elaborates this idea, stating that in such situations the analyst then perceives a drop in “internal pressure” in the patient. He goes on to characterize such patients as suffering from a lack of internal transformative space (in another model, we might see the patient as
lacking a transforming function, or as having faulty ego functioning). Here the author recurs to the question of what makes it possible for the
analyst to do this work; he concludes that, regardless of theoretical orientation, analysts are trained not only to sniff out obscure emotional experience, but also to tolerate—in the context of their work—a high level of tension without responding defensively. This tension tolerance, he argues, is the specific condition required to allow the space to empty out and become hollow and receptive. In ordinary life, he explains, such a space is
immediately refilled with its own rejected projections and further defensive projections from its objects. Moreover, Bolognini points out, the patient may have “narcissistically invested—and perhaps eroticized—his own evacuative defenses and . . . way of attacking both the other and the work” (p. 174). In line with this theory of therapeutic action, Bolognini is an enthusiastic proponent of analytic restraint; waiting is almost always preferable to interpreting. Bolognini makes the interesting point that the very restraint that permits this kind of development can, at times, actually be “the most refined of all the forms of vengeance” by the analyst (p. 174), and that the nega
tive countertransference may thus be exploited in the service of a
technical goal. This is an instance of a more general process that he provocatively terms an “ecological tendency” (p. 87) in our field. He argues that we often make use of the “breakdown products” of our theories; rather than discarding them, we recycle them into valuable concepts that further our understanding of the complex process in which we are engaged (e.g., transference, countertransference, enactment). Acknowledging that these are tricky waters to navigate, due to the universal tendency to
defensiveness and self-deception, Bolognini recurs frequently to the topic of the analysts’ need for frequent exchanges with colleagues, which he felicitously calls “assisted elaborative containment” (p. 176). In the last two chapters of this volume, Bolognini tackles the topic of fear and panic, and in doing so, brings together his emphasis on mental function with his appreciation for the role of structure and organization. He conceptualizes panic as “for some, a bill paid all at one time by
someone who does not want to pay small debts” (p. 215). In other words, he refers to those who cannot tolerate experiencing the lower-grade
anxieties that occur in everyday life, and in particular those that threaten a needed sense of self. with this definition, he dissociates himself from those who would offer a more traditional formulation based on
personality organization and dynamics, instead observing that many kinds of
people end up in this final common pathway of panic, and that panic is a symptom of complex and multiple derivation. He provides several
fascinating case examples involving fear and panic that, resolved as analytic work, yielded greater structuralization of the self. “Panic presents
as a persecutory event lacking in meaning on the part of pseudo-mature
people who have lost or never achieved internal contact with important part of the self” (p. 225). Here we see the characteristic focus of the
Bionian analyst on the need for inchoate experience to be made meaningful,
but also the idea, less discernible in the work of the field theorists, of a
self that gradually becomes more integrated through analysis. The Italian sensibility what, if anything, in the work of these three gifted and original
clinicians, is particularly Italian? Di Donna (2005) observes, “one psychoanalytic theory with a standard fixed technical model never dominated Italy” (p. 43). Perhaps in part, this has to do with the late start that
organized psychoanalysis got in Italy:
Prior to world war II, there was limited knowledge of Freud or of
psychoanalysis in Italy. . . . In part . . . the result of the opposition that psychoanalysis encountered from Italian Fascism and from the Roman Catholic Church. [Moreover] the entire Freudian corpus was not translated and
published as one collection until as recently as 1980, by Cesare Musatti. Prior to that time, the divergent translations of Freud, while perhaps
contradictory and confusing, may have also cultivated an acceptance of diversity and controversy in Italian psychoanalysis. (Giuliani, 2009, p. 318) And Neri (2009) observes that, in an “old tradition . . . Italian
psychoanalysts have been trained to monitor each and every moment of what occurs in the session: particularly the modification of sensation, atmospheres and bodily experiences” (p. 47). Perhaps these historical factors as well as a more general and wellknown current of hospitality in the Italian sensibility are a common thread in the work I have discussed here. Although much of the thrust of this work is consistent with international trends in psychoanalysis toward more relational models of mind and treatment, I think that these authors present formulations and approaches that depend upon and cannot be entirely separated from the distinct emotional flavor that is embodied in Civitarese’s metaphor of a “gift for the guest”—a psychoanalytic
hospitality for the patient, in Bolognini’s friendliness toward colleagues in other countries, and even in the ubiquitous culinary metaphors of Ferro. And although it is obvious that much is gained for psychoanalytic clinical practice and theory, not to mention for collegial relations, through this attitude of hospitality, I also wonder whether it may be tied to the subtle reemergence in the work of Ferro in particular of a certain attitude of authority—the quiet authority of the magnanimous host—that, in
valorizing emotional intuition over self-interrogation, in important ways actually runs counter to the expressed ideology of the analysts who embody it.
In contrast, Bolognini’s emphasis on the importance of collegial exchange suggests one potential method of balancing the analyst’s inherent
limitations in self-awareness. But perhaps it is also the case that when we find ourselves lost in the welter of indistinct emotions and half-formed thoughts that constitute many an ordinary analytic session, this
deferential authority of the host—offering rather than asserting, exquisitely attuned to the ambience of his home and to the way his offering is received— is a kind of authority we can tolerate and at times even welcome. while reading these authors, an encounter of my own with Italian hos
pitality came to mind: on an Italian vacation years ago, driving around the Tuscan countryside, my companion and I lost our way one afternoon en route to the medieval walled city of San Gimignano. while he waited in the car, I went into a roadside cafe armed with a map and a very primitive capacity to express myself in Italian. A group of three
intimidating (to my eye) older men sat around a table in the otherwise empty, darkened restaurant, drinking wine and conversing. Frustrated, nervous, and not knowing how to ask anything very specific, I pointed at the map and stammered none too graciously, “Non so dove sono.” “Aha, so—you don’t know where you are.” with an amused tone, in thickly accented english, one of the men translated my stumbling words back to me. Immediately, I was no longer anxious; this fellow knew
what my problem was, spoke it back to me in my own language, offered
me a bite to eat and helped me figure out where I was and where I
needed to go. In these four creative, challenging, and controversial books, three more generous Italians show us how they do it, and help us to get our bearings in their world. Acknowledgment. The author thanks Gina Atkinson, M.A., for her
contribution to this essay’s content about Italian psychoanalysis and its
history.
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