The Analyst’s Role in Therapeutic

Action: Bion’s Theory of Container/Contained

Presenter: Kay Long, Ph.D.

Discussant: Anne Schlachter, M.A.

How does psychoanalysis facilitate psychic change, and what is the analyst’s role in this? We’ve been debating these linked questions for a long time. The arguments fall into two camps: either change comes through internalization of the relationship with the analyst, who relates to the patient in more benign ways than did the patient’s primary objects; or change occurs through interpretations that help the patient understand his or her archaic patterns of object relating and the unconscious fantasies that underpin them. By now, most analysts would agree that both mechanisms contribute to therapeutic action, although different schools of thought emphasize one more than the other, and so the debate continues. (Blatt and Behrends, 1987; Gabbard and Westin, 2003; LaFarge, 2000). Less frequently discussed, but I believe just as important, is the patient’s theory of therapeutic action, that is what the patient believes to be the analyst’s role, which exerts its own pressures and powerfully influences the analyst.

In this paper I wade into this debate by trying to unpack a common clinical pitfall. In the case I will present, the patient appeared to be internalizing a positive relationship with the analyst, which served to reduce certain anxieties. However, I came to recognize that what seemed to be his internalization of me as a positive figure was better understood as the reenactment of an early pattern of object relating (unconscious fantasy), which served to defend against deeper, more desperate anxieties. When I could interpret this reenactment in terms of the immediate experience in the transference, it allowed for movement in the hour of the kind that I believe has the possibility to lead to real psychic change.

Kay Long, Ph.D. is a psychologist and psychoanalyst in private practice in New Haven. She is an Associate Clinical Professor in the Psychiatry Department of the Yale School of Medicine, and a Training and Supervising Analyst at the Western New England Institute for Psychoanalysis. In addition to clinical work, she is active in teaching and supervising in the Yale Psychiatry Department and at the Western New England Institute for Psychoanalysis, where she currently serves on the Education Committee and as Director of the Scholar’s Program. Her current teaching and writing interests involve neo-
Kleinian approaches to therapeutic process and change.

Anne Schlachter, M.A. graduated as a Clinical Psychologist in Johannesburg, where she held a teaching post in the Psychology Department at the University of the Witwatersrand. Thereafter she spent three years in the Child and Adolescent Department of the Tavistock Clinic in London. She graduated from the Chicago Institute and serves on the faculty. Currently she teaches in the Core Program, and is in private practice.

Educational Objectives:
1. Recognize when apparent internalization of the analyst as a helpful figure is better understood as a defense against deeper anxieties.
2. Better tolerate being drawn into roles that feel disturbing to analyst and patient alike, through understanding when the “containing” function of the analyst requires being receptive to a wide range of emotional experience.
3. Recognize when the temptation to become benevolent antidotes to our patient’s early difficult relationships may actually reinforce existing defenses. While this can restore a sense of equilibrium, it may forestall opportunities for psychic change.

Target Audience: Psychoanalysts, other interested mental health professionals, and members of the community.