Applying Current Literature to Clinical Practice
whinny
psychoanalytic.pdf
“THE ANALYST IS PRESENT” Viewing the Psychoanalytic Process as
Performance Art
Alan Michael Karbelnig, PhD South Pasadena, California and New Center for Psychoanalysis,
Los Angeles, California
Since its establishment as a profession, psychoanalytic practitioners have strug- gled with understanding the true nature of their work. Many remain devoted to Freud’s medical model (Freud, 1958) and aspire to establish a logical- positivistic basis for psychoanalysis. Others view the field more broadly, and consider psychoanalysis a distinctively humanistic discipline. This paper sug- gests that the bifurcation may be resolved by focusing on clinical as opposed to theoretical psychoanalysis—an emphasis that illuminates its artistic elements. Psychoanalysts’ work may be likened to performance artists, primarily because they work to create an experience in their patients. In addition, they give with their psyche-somas, reminiscent of how actors use their bodies as instruments; they face each session in a fashion akin to how painters face the white canvas or writers the blank page; and they choose from an infinite number of possible models for coconstructing ways of understanding their patients’ experiences. Regardless of past or future theoretical differences, psychoanalysts provide creative, transformative experiences most accurately described as transforma- tional encounters. Psychoanalysis is a verb, a process. While it alleviates pain caused by various mental disorders, it also assists individuals in discovering their individuality, authenticity, and singularity. In support of the artistic foun- dation of the psychoanalytic process, the paper includes three scenes that demonstrate how patients experience precipitous, essential breaks in their re- petitive, internal dramas, resulting in them experiencing themselves as beings, capable of change. It thereby demonstrates how psychoanalytic practitioners
This article was published Online First July 28, 2014. Alan Michael Karbelnig, PhD, ABPP, Private Practice, South Pasadena, California, and Senior
Faculty and Training and Supervising Psychoanalyst, New Center for Psychoanalysis, Los Angeles, California.
Correspondence concerning this article should be addressed to Alan Michael Karbelnig, PhD, ABPP, 625 Fair Oaks Avenue, Suite 270, South Pasadena, CA 91030. E-mail: amkarbelnig@ gmail.com
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
Psychoanalytic Psychology © 2014 American Psychological Association 2016, Vol. 33, Supplement 1, S153–S172 0736-9735/16/$12.00 http://dx.doi.org/10.1037/a0037332
S153
bring something new to life, further validating how psychoanalysis qualifies as an artistic endeavor.
Keywords: psychoanalysis, transformational encounters, intersubjectivity, hu- manism, hermeneutics
In 1896, when Freud coined the term psychoanalysis (Gay, 1988, p. 103), he created a technique specifically applicable to patients with mental disorders. Consonant with this initial view of the process, the first psychoanalysts treated individuals suffering from such Victorian-era termed disorders as obsessional neurosis, hysteria, and melancholia. Yet, even in those early years, Freud and other practitioners struggled with the actual nature of their work. Some patients presented with distinct symptoms such as anxiety or depression; others sought help for concerns about their work, their relationships, or other, wide- ranging elements of their life experiences. Were these pioneer psychoanalysts actually treating distinct mental illnesses, or were they helping individuals explore the meanings of their lives? By the mid-20th century, the burgeoning controversy regarding the precise aims of psychoanalysis flowed into two distinct streams.
Many psychoanalytic practitioners remained devoted to the exclusively medical vi- sion. They applied techniques such as confronting ego defenses— exposing the emotion- ally painful, unconscious conflicts patients were masking—thereby reducing psycholog- ical symptoms. Using the sine qua non of the psychoanalytic process, these analysts focused on transference as the vehicle for their treatment. Such psychoanalysts typically sought scientifically based sources of information. They pursued observational studies of infants, researched cognition and emotion, conducted outcome studies, and otherwise leaned toward the scientific in an effort to establish an empirical basis for psychoanalysis. They believed the field would persist as one intervention among many, alongside psy- chopharmacology and cognitive– behavioral therapy, in the cadre of treatments for mental illness.
Other psychoanalysts, particularly during the last 50 years, applied their techniques with broader strokes. They utilized their training to help those with difficulties that defied traditional medical categorization, such as persons who felt socially alienated, failed to achieve romantic intimacies, felt personally inadequate, or found their lives meaningless. Although not hostile to science, these psychoanalysts worked, wrote, and researched in more humanistic realms. They sought information outside of their field—in literature, philosophy, and history—to find support for their work. They believed these disciplines offered greater insights into human subjectivity than could the sciences alone. They viewed their work as hermeneutical and exploratory rather than as a process solely intended to cure illnesses. Orange (2011) noted that because of Freud’s “stronger insis- tence on the status of psychoanalysis as a natural science, our awareness of psychoanalysis as hermeneutics has arrived only recently” (p. 2).
Despite its having been tossed and turned by the streams of scientism and humanism, psychoanalysts, regardless of their particular theoretical orientation (Freudian, Jungian, Kleinian, etc.), have consistently relied on, and written about, four foundational tenets: the idea that an unconscious mind exists, that some kind of force or drive motivates human beings, that individuals tend to form repetitive psycho-behavioral patterns (the repetition compulsion), and that these unconscious features tend to be projected onto the psycho- analytic relationship in the form of the transference. The four foundational themes were originally delineated by Freud (1914/1958), and later elaborated on by others including Lacan (1978); Rangell (2006), and Harari (2004). Of course psychoanalysts also have
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S154 KARBELNIG
attended to other signs of the unconscious, such as dreams or parapraxes, but these four elements provided steady points of reference.
Unlike physicians, armed with stethoscopes, syringes, medications, EKG machines, thermometers, and other forms of technology for evaluating and treating patients, psy- choanalysts greet their patients solely with their beings. They bring no interventional technologies to the process. They offer reverie, containment, interpretation, confrontation, empathy, and similar rhetorical or interpersonal influences to promote transformation in their patients. Whereas artistry certainly comprises a component of what other profes- sionals provide, psychoanalysts work entirely within the interpersonal relationship, ren- dering the artful element of their services more central.
The Shorter Oxford English Dictionary (Trumble, Brown, Stevenson, & Siefring, 2002) defines art as “the application of skill according to aesthetic principles, esp. in the production of visible works of imagination, imitation, or design” and as “skillful execution of workmanship” (p. 122). Inarguably distinct from each other, art and psychoanalysis nonetheless share critical features, by definition and by practice. Psychoanalysts apply skills according to aesthetic principles (taking the form of technique arising from theory), produce visible works (evident in the transformational experiences for their patients), and execute their workmanship (through the interpersonal effects just noted). Although they may not formally identify it as such, their artistry may be likened to a form of performance art.
The Nature of the Psychoanalytic Process in Real Time
This paper delves into the psychoanalytic process from the inside, meaning the subjective experience of the session, as it actually unfolds, in real time. Psychoanalysts create and manage intensive interpersonal relationships intended to be transformative for patients. They concern themselves with the beings of patients. Therefore, their clinical work, given its artistic nature, resides in the realm of humanism. For the purposes of this paper, the word humanism—fraught with different and conflicting meanings—refers to constella- tions of philosophical and ethical perspectives that emphasize human subjectivity and privilege the value and agency of human beings. And that returns this discussion of the psychoanalytic process— one that could never be reduced to an equation— back to the arts, especially performance art. The psychoanalytic process requires spontaneity and improvisation by psychoanalysts, rendering it an artistic production. Psychoanalysts have a unique opportunity for responsively and actively treating individuals whose relief from suffering requires a certain kind of change: A transformative experience of enduring significance.
Therefore, in place of the word psychotherapy, or psychoanalysis, I propose the phrase transformational encounters because this more accurately describes what actually occurs in psychoanalysts’ offices. The psycho component of the word psychotherapy or psycho- analysis implies a fixed physiological entity, such as a liver or kidney, while in truth the psyche is more verb than noun. An extremely dynamic entity, psyche arises out of many complex determinants— biological, cultural, historical, social, and more. The therapy component suggests treatment of an illness that represents but one feature of how psychoanalysis can be utilized. In a similar vein, analysis implies a sequential, linear process that fails to account for the dynamism and creativity of actual psychoanalysis.
Individuals, patients, analysands—variously named—seek the assistance of profes- sionals called psychoanalysts for a variety of reasons. Orange (2011) called them “fellow
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S155VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
sufferers” (p. 4), and explained how the word patient derived from the Latin, patior, which means to suffer, to undergo. Once these individuals consult psychoanalysts, they engage in sets of meetings that—precisely because the transference forms the cornerstone of the process— consist of interpersonal encounters intended to achieve a form of transforma- tion. As previously noted, these transformational encounters correspond uniquely and fundamentally with performance art; conversely, these have little in common with clinical procedure as it is currently accepted and defined in medicine.
But one example of the central role that artistry plays in the psychoanalytic process, psychoanalysts make choices about design elements of the space in which they apply their interventions well before meeting their first patient. The more conservative psychoanalyst’s consulting room may tend toward the spare, and appear more traditionally office like. Such strategic choices may ensure that projections are focused more onto the analyst. They reduce possible distractions caused by ornate furnishings. In contrast, psychoanalysts who privilege the relational elements of the process may make decorative choices intended specifically to buttress, even comfort, patients when they experience uncomfortable emotional states. These analysts em- phasize patients’ emotional safety over the potential for distraction. Their walls may be softened by paint, and three-dimensional décor, such as books, lamps, and paint- ings, may purposefully create the feeling of a living room in a comfortable home. Psychoanalysts plan, deliberately and creatively, setting the stage for their transfor- mational encounters. Winnicott, who apparently worked in a rather classical fashion, nonetheless demonstrated a warm personal style in his actual interactions with his patients (Little, 1990). Orange (2011) wrote of Winnicott, “his style, including his office, seems to have been informal, unpretentious, and welcoming” (p. 163).
When the patient enters the consulting room, the curtain lifts. The psychoanalytic performance begins. The patient meets the psychoanalyst, trained in a variety of psycho- analytic theories, having undergone years of psychoanalysis, and ready to receive what- ever patients care to report, describe, or enact. The psychoanalytic process subsequently unfolds in accordance with the theoretical leanings of the psychoanalyst but, more important, in a manner influenced by the unique features of each “therapeutic dyad” (Freedman, 1980, p. 259). Whether the initial session or the 50th one, the psychoanalytic process differs sharply from standard procedures in physicians’ offices. Patients present- ing with a sore throat to a specialist in internal medicine will be subjected to a fairly consistent set of procedures including examining the mouth, throat, and neck and ordering laboratory tests to assess for an elevation in white cells. Patients presenting for psycho- analysis can expect no such standardized procedures. On the contrary, the process will vary, usually quite markedly, depending on the personalities of the participants, their aesthetic styles, and the theoretical orientation of the psychoanalyst.
Patients in psychoanalysis may have similar experiences with psychoanalysts of the same theoretical school. If consulting conservative psychoanalysts, for example, they may well find a commonality in the use of silence, in the frequency of questions asked, and in the generally more passive approach. But even such commonality in technique would vary greatly depending on the specific qualities of each unique psychoanalyst–patient dyad. Psychoanalysts cannot help but use their personal styles to establish an intimacy that is “mutual but asymmetrical” (Aron, 1996, p. 43). Their tools consist of their personalities and styles, a variety of interpersonal influences as noted earlier, and a focus on the four tenets and other signs of unconscious processes. Their work progresses in a fashion analogous to the way a director of modern dance uses choreography, a painter uses brushes, or a writer uses the keyboard.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S156 KARBELNIG
A feature of the first 100 years of its existence, psychoanalysis tended to spawn competing schools that suggested if not required practitioners to adopt certain attitudes and apply certain techniques in conducting their work. Generations of psychoanalysts learned to put their “singularities” (Ruti, 2012) aside to attend to certain proscribed elements of the psychoanalytic process. They might, for example, explore stages of psychosexual development (if Freudian), archetypes and imagery (if Jungian), envy and aggression (if Kleinian), environmental impingements (if influenced by Fairbairn, Win- nicott, or other British object relations theorists), or the subtle dance of interaction during sessions (if self-psychological, intersubjective, or relational).
Their patients, in turn, have as many stylistic variants as their psychoanalysts: Some present with triangular love situations that fit the Freudian model, and others with aggressive fantasies that comport with the Kleinian model. Jungian theory may work well with persons actively reporting dreams, particularly if they have mythological or anthro- pological themes. Some patients are highly emotional; others more cognitive. Some wait passively in silence for their psychoanalysts to speak; others express highly personal, emotionally vulnerable information when first greeted in the waiting room.
As I argue when presenting the performative aspect of psychoanalysts’ actual work, these personal, stylistic features—in psychoanalysts and in their patients—typically prove more significant than the theory guiding the process. Theory results from a collective enterprise featuring argumentation, criticism, and revision. Burke (1954) wrote, “Theory (literally, a looking-at, or viewing) plays a large part, not only in the technique of the physician, but in the patient’s response” (p. 125). Psychoanalysts will continue to elaborate on old, or to develop new, ways of viewing the mind as well as the psychoan- alytic process. I submit, however, that personal styles—influences that have been mar- ginalized in psychoanalytic theory development—are, in truth, crucial elements of the transformational process. (Such styles even influence choice of or comfort with a partic- ular theory). For example, the personality of an extremely gregarious, outgoing psycho- analyst trained in traditional Freudian analysis will arguably have a greater effect on the process than his or her devotion to that theory. A rather cold, emotionally distant psychoanalyst trained in the Relational school may similarly—although immersed in an entirely opposite theoretical perspective emphasizing a more engaging, interpersonal approach— demonstrate more of the neutrality characteristic of the earlier, more conser- vative schools. These ideas resonate with Stolorow and Atwood’s (2002) suggestion that the “impact of the analyst, of his interpretive activity, and his theoretical preconceptions, whatever they may be” (p. 102) must be considered primarily from the viewpoint of the subjectivities of psychoanalysts and their patients.
Psychoanalysts working within certain theoretical viewpoints make spontaneous and highly creative decisions, on a moment-to-moment basis, during each psychoanalytic session—much like artists standing before their canvases and authors sitting before their keyboards. Theory, which risks objectification of psychoanalysts and patients if adhered to excessively, influences the process such as the genre of an artist or a writer influences their craftsmanship. Psychoanalysts devoted to more traditional themes of neutrality and abstinence demonstrate creativity in the way they time their interpretations, suppress certain emotions, such as sympathy, avoid asking questions, and eschew offering reas- surance. Lacanian analysts, steadfastly focusing on linguistic features of the work, make spontaneous decisions about selecting which words to pursue. Self-psychologists, inter- subjectivists, or relationalists similarly make certain strategic decisions regarding em- pathic attunement.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S157VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
Just as artists encounter limitations related to the medium with which they work, that is, the size of the canvas on which they paint or the piece of marble that they sculpt, psychoanalysts face numerous limits including their personhood, the varieties of inter- personal influences already noted, and session length and frequency. Countless creative choices nonetheless exist. In fact, limitations are notorious catalysts for innovation.
Previous Views of Psychoanalysis as Art
When he moved from the suggestive technique to the analytic one, Freud (1905/1953) compared suggestion to painting and analysis to sculpture. He wrote that sculpture “proceeds per via di levare, since it takes away from the block of stone all that hides the surface of the statue contained in it” (p. 260). Loewald (1980), one of the first psycho- analysts to consider his work as primarily artistic in nature, explicitly compared psycho- analysis to drama. He believed that psychoanalysts and their patients together create, produce, and perform a play. He wrote, “in the mutual interaction of the good analytic hour, patient and analyst— each in his own way, and on his own mental level— become both artist and medium for each other” (Loewald, 1980, p. 369). Winnicott (1955) referred to “psychoanalysis as an art” (p. 24). Of him, Orange (2011) wrote, “Both process and spirit embodied a two-person creative aliveness” (p. 162).
Bion (1965) described psychoanalytic work as a “transformation, analogous to the artist’s painting that is a product of the particular artist’s approach” (pp. 8 –9). According to Jacobus (2005), Bion viewed the psychoanalytic encounter as “a site of turbulence, a mental space for further ideas which may yet be developed” (p. 258). Years before Hoffman (1998) presented his dialectical-constructivist model, Bion (1991) had already documented the dual role of the analyst observing and participating, acting as subject and object at the same time. Lacan (1979) viewed psychoanalysis as fundamentally an artistic endeavor, writing, “psychoanalysis is perhaps the only discipline comparable to those liberal arts, inasmuch as it preserves something of this proportional relation of man to himself—an internal relation, closed on itself, inexhaustible, cyclical” (p. 406). Psycho- analytic methods, he added, were “derived from that fundamental art of psychoanalysis . . . constituted by that intersubjective relationship which, as I said, is inexhaustible since it is what makes us human” (p. 406). Szasz (1988) believed that psychoanalysts’ “activities would constitute, and be classified as, art rather than science” (p. 208).
Bollas (1987) described the psychoanalytic process as a performance in the sense that, to find their patients, psychoanalysts “must look for him within ourselves” (p. 202) and added “we are being taken into the patient’s environmental idiom, and for considerable stretches of time we do not know who we are, what function we are meant to fulfill, or our fate as his object” (pp. 202–203). Symington (2002), described how patients engaged in psychoanalysis mourn, wrote, “if the death is photographed, it does not become emotion- ally real; if it is painted, it does” (p. 68). More recently, Ringstrom (2001, 2007, 2008, 2012) explored the role of improvisation in the psychoanalytic process. He contended, as do I, that psychoanalysts must be emotionally present, responsive, prepared to engage with a variety of personalities, and that psychoanalysis may be likened to drama. Ringstrom (2012) believed “the improvisational metaphors of scripts, assigned roles, dramatic arches, and sequences” allow psychoanalysts to “expect (and direct) the other to be in each present moment” (p. 470).
Scholars outside of psychoanalysis have similarly commented on the artistic elements of the field. Burke (1966) argued that not only literary, but all fields of human study, such
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S158 KARBELNIG
as psychoanalysis, cannot understand human motivation without considering its neces- sarily theatrical, dramatic elements. By applying the “dramatistic” (p. 63) lens to any human production or experience, Burke (1966) intended that literary critics, audiences, and professional observers of human behavior, including psychoanalysts, generate heu- ristic or exploratory responses (as opposed to closed, deterministic conclusions). Toward this end, he proposed a “dramatistic terminology (built around a definition of man as the symbol-using, symbol-misusing, symbol-making, and symbol-made animal)” (Burke, 1966, p. 63). Human motivation is performed, he suggested, through the “dramatistic pentad: act, scene, agent, agency, and purpose” (Burke, 1945, p. 538). He wrote that, “the difference between a thing and a person is that the one merely moves whereas the other acts” (Burke, 1966, p. 53).
Writing from a multidisciplinary perspective, Burke (1954) opposed the growing reliance on purely deductive studies in all fields. He thought poetry revealed the “con- centration point” (p. 66) of human desire. Considering scientific approaches to under- standing human motivation a form of rationalization, he recommended a “corrective” (p. 66) in the form of “a rationale of art—not however, a performer’s art, not a specialist’s art for some to produce and many to observe, but an art in its widest aspects, an art of living” (p. 66). Encountering the many varieties of the human experience, psychoanalysts immerse themselves, in their daily work, in their patients’ theatrical constructions of their lives. Their manner of engaging them similarly resides in the realm of the dramatic, as Loewald (1980) also noted.
Butler (1997, 2005) suggested that humans, on some level, perform their actions, their feelings, and their speech. She wrote, “Language is the name for our doing: both ‘what’ we do (the name for the action that we characteristically perform) and that which we effect, the act and its consequences” (Butler, 1997, p. 8). Although referring to identity formation, rather than to the artistry of psychoanalysis, Butler (2005) writes that when we speak of our selves, “we become speculative philosophers or fiction writers” (p. 78). In a similar vein, Orange (2011) observes how psychotherapies, generally, focused on lan- guage. She adds, “language, resonant and heavy with history, is its medium, and the participants inhabit it, as other artists inhabit their media” (p. 22). Psychoanalysts’ utilize elements of literary criticism and applied philosophy, respectively, as they illuminate the ideologies and narratives of their patients. From within psychoanalysis, and from outside the discipline, many scholars compare the psychoanalytic process, and even the experience of being human, to drama or theater.
The Artistic Nature of the Psychoanalytic Process
Hoffman’s (1998) dialectical-constructivist model offers a clinically useful, descriptive view of the psychoanalytic process without adhering to a specific psychoanalytic theory. It clearly acknowledges the artistry inherent in the psychoanalytic process. Unlike Freud- ian or Jungian recommendations for technique, for example, Hoffman’s model invites flexibility in theoretical modeling and in clinical method. The phrase “dialectical- constructivist” concisely if broadly defines the nature of the interpersonal, contractual service called psychoanalysis. The dialectical component of the phrase refers to the manner in which psychoanalysts become engaged in relationship with their patients in dichotomous and paradoxical ways; the word constructivist allows psychoanalysts and their patients to either choose from myriad extant theory or create their own, unique models for explaining recurrent unconscious themes.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S159VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
Beginning with the dialectical component of psychoanalytic work, Hoffman (1998) described a paradoxical process. On the one hand, psychoanalysts receive invitations into any number of enactments propelled by their patients’ unconscious schemata, their own, and the combination of the two—a concept captured by Ogden’s (1994) idea of “the analytic third” (p. 4). Essentially all psychoanalytic theorists have agreed that the uncon- scious inner world or the internal object world—which I prefer to call the internal drama–influences if not possesses the psychoanalytic relationship itself. On the other hand, by virtue of the service they sell, psychoanalysts pull away from their relationships with their patients—immersed as it is with unconscious, dramatic themes—and reflect, plan, intervene. The dialectical component of Hoffman’s model consists of this back-and- forth, this dance of engagement and dis-engagement, of subjectivity and objectivity, of being invited into enactments and then withdrawing to interpret them or intervene in some way.
Regarding the constructivist element, psychoanalysts, in partnership with their pa- tients, create models of what motivates a particular patient, of their internal unconscious drama, of the meaning of the repetition compulsion, or of how those themes map onto the psychoanalytic relationship. They offer interpretations, confrontations, empathic attun- ement, or other ways of engaging patients. The creativity inherent in the psychoanalytic process resides primarily within the constructivist component of Hoffman’s (1998) model.
Psychoanalysis emerged—not from magic or in isolation—from Freud’s early writ- ings. Its roots lie in millennia of writings in philosophy, history, political science, literature, and more. Psychoanalysts use the hand of human history—its humanism—in offering ideas about what motivates patients, how their unconscious internal dramas were forged, the nature of the repetition compulsion, and the “third” element (Ogden, 1994, p. 4) that dynamically possesses psychoanalytic relationships.
Regardless of their theoretical stance, psychoanalysts ideally strive for presence in real time, shoring back natural feelings when they consider what would be most effective in fomenting transformation. Psychoanalysts embody separate professional and personal personas, but their subjective selves persist, of course, across their varied social roles. In some ways, psychoanalysts behave much like actors who similarly manage their emo- tional experiences while performing. Actors’ skills may often be judged in terms of their effectiveness in either hiding their feelings or demonstrating emotional states alien to their authentic selves. Further, they behave differently when on stage. They adjust their theatrical work in reaction to the varied states or styles of different audiences.
In much the same fashion, psychoanalysts occupy a distinct professional role and, regardless of their particular doctrine or style of practice, modify their professional behavior to comport with their patients’ unique styles. Not only psychoanalysts, but also their patients play roles in a way that Butler (2005) called “performative,” affected by what Burke (1966) called their “terministic screens” (p. 44). Exemplifying his concept, and referring to dream interpretation, Burke described a man who
reports his dream to a Freudian analyst, or a Jungian, or an Adlerian, or to a practitioner of some other school. In each case, we might say, the “same” dream will be subjected to a different color filter, with corresponding differences in the nature of the dream as perceived, recorded, and interpreted. (It is commonplace that patients soon learn to have the kind of dreams best suited to the terms favored by their analysts.) (p. 46)
Performances and terministic screens are affected by myriad influences, including of course the multiple elements affecting patients’ internal dramas, and the personal styles and theoretical schools to which their psychoanalysts adhere, as Burke suggested in this
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S160 KARBELNIG
excerpt regarding dream interpretation. Context exerts influence as well. The same patient who openly rages against her parent in the consulting room may remain silent in his or her living room at home. By inference, then, psychoanalysts and their patients, in the course of their conjointly created psychoanalytic process, cause the fourth wall to vanish— consistent with Loewald’s (1980) observations. They engage in a fashion comparable to a theatrical performance.
Psychoanalysis as Performance Art
The term performance art, related to postmodernist traditions in Western culture, emerged during the 1960s and 1970s out of concepts of visual art. Its precursors include work by Antonin Artaud, Dada, the Situationists, Fluxus, installation art, and conceptual art (Goldberg, 2001; Goldberg & Anderson, 2004; Gómez-Peña & Sifuentes, 2011; McEvil- ley, 2012; Parr, 2010). Considered the antithesis of theater, performance art nonetheless features a relationship between performer and audience. If possible, it contains, by definition, an ephemeral and authentic experience for both parties, “an event that cannot be repeated, captured, or purchased” (Parr, 2010, p. 25). Those who consult psychoana- lysts have purchased the experience, but not in the sense meant by scholars of performance art who mean an audience paying for a musical, operatic, or theatrical performance. Performance art, in contrast, consists of an actual experience. Likewise, psychoanalytic encounters create an ephemeral encounter each session, one that cannot be repeated or captured. Gómez-Peña and Sifuentes (2011) would likely consider a psychoanalytic session a form of performance “exercise” (p. 35).
According to a New York Times review (Cotter, 2010), performance artist Marina Abramovic created an emotional reaction in her viewers by asking attendees of her exhibit at the Museum of Modern Art (MOMA) in New York to walk between two nude people. Her performance art piece entitled, The Artist Is Present, asked visitors to choose between walking around or between two naked persons—a decision in- tended to provoke an emotional experience. Psychoanalysts function much as Ms. Abramovic, albeit in a more structured and bounded manner. Like performance artists, psychoanalysts offer experiences. Even more classically oriented psychoanalysts provoke and disrupt. If they do not at least interpret, or interfere with, the repetition compulsion in some way, then they fail to provide the service for which they receive payment. Psychoanalysts may be passive to the extent that they stay attuned to their patients and immersed in their (mutual) projections, but change typically requires an active, often unsettling intervention. Referring to Lacan, Ragland (1995) asserted “the inertia of jouissance . . . makes a person’s love of his or her symptoms greater than any desire to change them” (p. 85). In other words then, transformation in patients requires action by psychoanalysts so as to overshadow their attachment to their problematic unconscious dramas. Psychoanalysts’ professional behaviors resemble performance art in at least three distinct ways.
First, as Lacan (1960, 1979, 2002) observed, psychoanalysts give with their actual beings. In addition to offering patients their words (through interpretations) and their desire (to pursue unconscious themes), psychoanalysts lend their bodies or, to use Winnicott’s (1992) phrase, their “psyche-somas” (p. 185), to the psychoanalytic process. Lacan (2002) wrote, “the patient is not alone in finding it difficult to pay his share,” then added “the analyst too must pay” (p. 216). Psychoanalysts allow their patients to project onto them, using them as receptors, screens, or containers (Bion, 1965). In this sense, psychoanalysts’ art form parallels that of actors whose cliché about their work—“my body
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S161VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
is my instrument”— equally applies. Psychoanalysts use their psyche-somas as their instruments. It is not surprising that psychoanalysts often refer to, and write about, en-act-ments, when describing their clinical experiences.
Their interventions, or better, their provocations, as well as their lending their beings to the psychoanalytic process, creates disorientation, loss, and the possibility for recreation of identity in patients. Of the impact of psychoanalysts’ allowing transference phenomena to possess them, Butler (2005) writes that such an engagement
recreates and constitutes anew the tacit presumptions about communication and relationality that structure the mode of address. Transference is thus the recreation of a primary relation- ality within the analytic space, one that potentially yields a new or altered relationship (and capacity for relationality) on the basis of analytic work (pp. 50 –51, emphasis added).
Here, Butler (2005) describes how psychoanalysts’ beings, as vehicles of transformation, could create different ways of relating to others, ways that transcend the well-worn unconscious pattern manifest in the transference. Phillips (2012) similarly described how psychoanalysts affected the transference by interfering with “our culturally inherited roles or parts or options,” added that “we may not choose them in a way an actor might choose a role, but we may choose them in the way an animal tries to find an environment that works for it” (p. 183). Bollas (2013) writes, “Whereas Freud privileged self- representation, especially through his emphasis on free association, Winnicott and Khan’s praxis was based on self-presentation— on being [emphasis added], or form, as commu- nication” (pp. 10 –11). Bollas similarly privileges the psychoanalysts’ actual existence as a transformational vehicle. These authors unite in their vision of psychoanalysts as giving of their being in doing psychoanalytic work.
Second, much as the way painters describe their apprehension of the blank canvas, psychoanalysts encounter sessions with their patients with at least some trepidation regarding the unknowable meeting that awaits them. Because it’s a common cliché that painters fear the blank canvas and writers the blank page, would not the psychoanalysts’ fear of the pending psychoanalytic encounter represent the same phenomenon? Of course, excessive anxiety early in an analytic process could reveal possible projective identifica- tion, but any sense of certitude about how a particular session will unfold—particularly if based on theoretical conceptions— objectifies patients. (I suggest that my students model their psychoanalytic behavior on the main character in the TV show Columbo—the detective who approached each crime scene as if he knew nothing, as if he was, to use Bion’s, 1970, phrase, “refraining from memory and desire”; p. 31).
As noted earlier, some patients present experiencing intensive competition with their fathers, others fill entire sessions with dream material, others feel the envy and rage described so poignantly by Klein and her followers, and still others experience hungry deficits of the type described by such theorists as Winnicott (1965, 1992), Balint (1979), Kohut (1977), and Brandchaft (2002). If excessively invested in one particular psycho- analytic model, psychoanalysts may well at least miss the subtleties of their patients’ presentations or, at worst, and as just noted, objectify or even violate them. I recently began psychoanalysis with a patient who terminated treatment with his prior analyst, a well-known adherent to the Kleinian school, after she insisted that the patient’s dream represented his feeling envious of her. After repeated protests, and even mature efforts to respectfully disagree with the psychoanalyst, the patient terminated treatment, concluding that the analyst in question was not “seeing” him. Openness to what emerges in real time is the artistic foundation of the psychoanalytic attitude. Psychoanalysts may be the most
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S162 KARBELNIG
artistic in the way they use their presence in this fashion. This personal process emerges in real time as the performance art of psychoanalysis plays out.
Finally, psychoanalysts and their patients choose from an infinite number of possible ways of understanding the phenomena they explore together. Psychoanalyst–patient dyads discover widely divergent ways of viewing unconscious internal dramas, of what drives patients, of the meaning of compulsively repeated themes and of the transference. Grotstein (1990) recommended psychoanalysts “become immersed in the language of the patient,” resulting in the
formation of a virtually imperceptibly different “third language,” that of reciprocity or of a reconciliation between the two languages to comprise a most optimal and benevolent form of “folie à deux,” the third language of the therapeutic alliance. (p. 182)
What could be more spontaneous and artistic than developing a shared language with patients, one unique to each psychoanalytic relationship?
Psychoanalysts’ freedom to select from such a broad palette— consistent with Hoff- man’s (1998) model—further supports the fundamentally artistic nature of their endeav- ors. They are tasked with helping patients animate models of self that are varied, mobile, and capable of continuous revision, especially beyond the consulting room. These new narratives ideally show sufficient resilience to resist the controlling forces patients face in their daily lives. In general, patients’ spouses, relatives, or coworkers will be invested— consciously and unconsciously—in patients’ identities remaining static. They will be prone to continue to view them through their previously held, likely rigid “terministic screens” (p. 44) to use Burke’s (1966) phrase. If possible, patients will successfully resist these influences. As a result of their repetitive and transformational experiences in the consulting room, patients become persons, enacting an authentic self that exercises its right to be, and to be anew, across various social contexts.
Three Performance Pieces
Lacan (1960, 1979, 2002) ended psychoanalytic sessions whenever he felt his patients felt the most moved, the most emotionally provoked—whether this was after 5 min or 5 hr. Bouchard, Normandin, and Séguin (1995) used the phrase “urgency point” (p. 729), as did Paniagua (2008), when describing key, here-and-now moments in the psychoanalytic encounter. Baranger and Baranger (1979/2009) utilized precisely the same phrase to described points in analysis when themes came alive in actual here-and-now experience (p. 50). Godbout (2005) wrote of “the importance of detecting an urgency point and . . . of letting oneself be impregnated by it” (p. 89) when at crucial transformational moments.
I eschew categorizing my approach to transformational encounters into any psycho- analytic school, viewing such identifications as a form of reductionism that in turn objectifies. Some readers may interpret the following excerpts as suggesting that I work in an intersubjective or relational fashion. However—and consistent with the thesis of this article—that style, if present, reflects mostly the specific psychoanalyst–patient dyads I am presenting rather than my adherence to any particular psychoanalytic theory.
I offer these three psychoanalytic scenes to exemplify how psychoanalysts work to achieve transformation through the performance art called psychoanalysis. They enter their sessions free of memory and desire (Bion, 1967), utilize various means of interper- sonal influence, utilize the four basic tenets or other signs of unconscious processes, and ready themselves for spontaneity and improvisation while simultaneously monitoring their
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S163VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
professional boundaries. Depending on an essentially infinite number of variables, psy- choanalysts may interrupt their patients’ discourse or they might not. They may attune intensely to patients emotional states at some points and distract them at others. They may ask questions at times and avoid doing so at others. They may comment on a transference theme at some points but at other times they will wait. They may explore drive or motivational forces at some times but not at others. Of course this listing of psychoanalyst behaviors must necessarily be incomplete because the multiple variables in motion, all dynamically and temporally in interaction with one another, preclude developing any definitive and predictive algorithm.
Burke’s (1945, 1954, 1966) scholarship on the dramatistic nature of human motiva- tion, and Butler’s (1997, 2005) work on the performative elements of identity, provide support for the artistic, theatrical nature of psychoanalysts’ work from outside of the field. The dialectical-constructivist model and similar ones from within psychoanalysis also support the idea that psychoanalysts perform in a certain unique fashion. These case examples, fictionalized to protect their identities, nonetheless represent what actually occurred with these patients.
First Scene
A particularly startling point of urgency occurred after treating Mr. A, a young man who was 17 years of age, toward the end of the first year of psychoanalytic psychotherapy. He consulted me, at his parents’ request, on a twice-weekly basis for 2 years. I felt I made no progress in helping him during the first year. In school he was acting out in a highly destructive but predictable way. He refused to do homework assignments. He challenged the authority of teachers who he disrespected. The most obvious feature of his personal history surrounded his having two likely sources of rage, both of which he consciously denied: He had an autistic younger brother, his only sibling; and he felt that this brother had taken much of his parents’ attention away from him. He adamantly opposed any suggestion that these situations had a negative impact on him, saying, “my parents love us both equally.” He yearned to serve in a law enforcement role, specifically for the Department of Homeland Security. His parents were physicians. Mr. A believed that his career choice would either demean him, his family, or both. When I interviewed his parents right after the treatment started, I found no evidence of their judging him for what appeared to be his sincerely authentic interest. On the contrary, they both seemed to be supportive of him.
Toward the end of that first year of the psychotherapy, I began to feel anxious that his parents would feel angered at his lack of progress. That image entered my psyche-soma at that point, creating tension, conflict, and irritation. The acting out that had brought him to my attention continued unabated. Mr. A and I had discussed, repeatedly, the potential meanings of his anger, the way his behavior at school impacted others, the underlying need to for him to be in control (and therefore not vulnerable), and his general lack of empathy. He entertained these theories intellectually, but quickly rejected them. He regularly distracted me from the analytic process by asking about my work. He particu- larly enjoyed asking me pointedly about other patients he saw in my waiting room.
One day, and without warning, Mr. A was speaking about his future when he made this simple parapraxis, “I’m not sure that I’ll ever have money because I’ll just be working as a cop.” Because of my own anxiety at his intransigent symptoms, and my guilt regarding his parents’ expectations of my work with their son being dashed, I heard that slip of the tongue like a clap of thunder. Here is our exchange:
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S164 KARBELNIG
ANALYST: Did you hear what you just said?
MR. A: I don’t think so. I only said that I wouldn’t make that much money.
ANALYST: You qualified your statement with a “just.” That was the first time I’ve ever heard you devalue your plans for your life.
MR. A: What do you mean? [He seemed defensive.]
ANALYST: Mr. A, you know what I mean. You said it. [I felt irritated.] You put yourself down. It’s not your parents you need to worry about. It is you.
MR. A: Holy shit. [A long silence ensued].
ANALYST: Yes . . . you see that now.
MR. A: [Another long silence occurred.] Oh my god, oh shit . . . I’ve never felt it like that, like I’m bad in some way. I could never get your point because I expected that it came from my parents, but it doesn’t. It comes from me. It’s the way I feel about me.
ANALYST: Yes, exactly that, you feel as if you are bad in some way. And, sadly, that has become your creation.
This unique moment represented a turning point in this young man’s life. The ensuing year was markedly different from the first. Mr. A’s defenses became more pliable. He was more emotionally vulnerable. He was intrigued about the type of relationship he had with himself. He felt the pain of his own self-attack. These developments led to another year of sessions characterized by his working through his self-judgment and his pain at that internal assault. Gradually, he retracted his projections onto his teachers back into himself, causing him to experience less anger and a greater sense of peace as these conflicting parts of himself integrated. In the same vein, he became much more engaged in his work with me. The distracting commentary regarding patients he met in the waiting room abruptly stopped. The process ended with his experiencing a greater appreciation for his parents’ positive qualities, and a new found, viscerally experienced realization of how he had unconsciously felt inadequate in reaction to his living with two highly achieving parents. In due course, he terminated the treatment with greater self-respect and cessation of the acting-out behaviors that led to his referral for psychoanalytic-psychotherapy in the first place.
Second Scene
This example also features an urgency point that similarly altered the course of the analytic process and the patient’s life. In stark contrast to Mr. A, Dr. B—an African American professor of anthropology— had an extremely negative experience with her parents, particularly her mother, during her childhood years. A highly intelligent, attrac- tive 40-year-old woman, Dr. B sought formal psychoanalysis for treatment of chronic depressive symptoms. She consulted me four or more times each week. She was the second of three children, the only daughter. Her father, a constitutional attorney often away at work, was critical and narcissistic. Her mother, a thoracic surgeon, seemed to compete with her from infancy. Dr. B has many early memories of her mother calling her “stupid,” “ugly,” and “foolish.”
Dr. B’s mother practiced with another prominent surgeon, a male who molested Dr. B first when she was 4 and 5 years of age, and then again when she was 14 years old, when he attempted an actual sexual assault. The mother, who was having an affair with this same medical colleague, defended him. When Dr. B told her mother these stories, she
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S165VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
insisted that Dr. B had fabricated them. The causation of the chronic mental pain in Dr. B—namely extreme feelings of emptiness, emotional insecurity, and a phobia of intimacy—was unusually clear. Equally so was her terribly negative image of herself, a self-valuation that contributed to her compulsion to repetitively choose abusive romantic partners.
This particular interchange occurred about 2 years into the psychoanalysis, after many layers of defense had been penetrated, and while we together intensely scrutinized the transference.
DR. B: If you continue to move that close to me, to follow me so well, to know me, I will hurt you.
ANALYST: How?
DR. B: Remember that dream I had, of the glass window with the wooden frame around it? And I am on a grass field, lying down, covered by it?
ANALYST: Yes.
DR. B: I’m now imagining nothing but the glass. The frame is gone. As I try to stand, the glass shatters. You are there, trying to help me up, but the shards of glass are pointing toward you. [She began sobbing intensely.]
ANALYST: And you fear I will be hurt.
DR. B: More than just hurt—bloodied and killed.
ANALYST: You feel fury to the point of violence toward me. You believe you could kill me.
DR. B: [She entered a semipsychotic state and appearing agitated.] It is real. I’m stabbing you right now. [She sobbed again.] The glass is cutting you up.
ANALYST: [I kept silent for a minute or two.] You feel like your being itself is dangerous.
DR. B: Because it is. I will poison you for sure, and you won’t see me anymore. You will vanish. You will not have me as a patient.
ANALYST: [I remained quiet for another minute or two.] Dr. B, we are here, together, at the core of your open wound. I’m sitting right here, listening to you, listening to your fury.
This exemplifies a transformational encounter, to use my phrase, or a “transforma- tion,” to use Bion’s (1965, p. 2). According to Jacobus (2005), Bion would have viewed the scene just described as occurring at the “site of turbulence” (p. 258). The relationship between Dr. B and myself had fallen into an extremely regressed state, one in which Dr. B experienced, in the anguished present, as the enraged infant experiencing homicidal affect toward caregivers projected onto me. I contained her painful emotion and aggres- sive thoughts.
In the ensuing weeks, I interpreted how her childhood trauma had understandably elicited rage. I further suggested that the multiple psychological injuries she sustained led to the conviction that she was an unworthy child deserving of criticism and neglect. In time, I successfully competed with Dr. B’s attachment to her internal objects (referring here to Fairbairn’s, 1952, idea that all psychoanalysts compete with their patients’ relationships with their internal objects). Intersubjectivists or relationalists may have not stayed with the patient’s aggression for as long as I did. Perhaps they would have reassured her, or stayed empathically attuned until the anger dissipated. These respectable differences in personal style, and theo- retical approach, lend further support for my contention that psychoanalysis has a foundation- ally artistic nature. Other psychoanalysts may have helped her as much as I did. Perhaps they
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S166 KARBELNIG
would have been more effective. In any case, I did stay closely present with Dr. B during this session, but she left in a state of rage. She remained infuriated with me, and full of terror, over the course of several subsequent sessions.
Dr. B’s depression lifted for several weeks after this period of rage at me subsided. In the subsequent months, we were able to reenact these encounters at such depth and intensity—“shattering” describes them best—that the chronic depression ended for longer periods of time, revealing that, to use Fairbairn’s (1952) own words, the “bad” (p. 66) self was being “exorcised” (p. 70) by the then-deepened process.
Third Scene
After three uninterrupted years of psychoanalysis for four or five sessions per week Dr. C, a tall, thin, 35-year-old Native American psychiatrist/psycho-pharmacologist was making slow progress altering a problematic unconscious internal drama. She was handsome, in an unusual, angular way. She behaved in an intensely loving manner toward her two daughters and her friends. She had a strong sense of intuition, bordering on the prescient. She would, at times, lapse into a “dream world” that she described as having a “magical quality.” And yet Dr. C took little ownership of her loving nature, her appearance, or her intuition. She considered herself a “messy person.” She viewed herself as excessively “needy,” particularly in regards to men.
The formation of Dr. C’s identity brings to mind Butler’s (2005) ideas regarding the performative elements of self-concept. Butler described how individuals “make a se- quence and link one event to another, offering motivations to illuminate the bridge, making patterns clear, identifying certain events or moments of recognition as pivotal, even making certain recurring patterns as fundamental.” (p. 66). It also brings to mind Burke’s (1945, 1954, 1966) famous concept of how humans use symbols, but symbols also use humans. He wrote,
An “ideology” is like a god coming down to earth, where it will inhabit a place pervaded by its presence. An “ideology” is like a spirit taking up its abode in a body: it makes that body hop around in certain ways and that same body would have hopped around in different ways had a different ideology happened to inhabit it (Burke, 1966, p. 6).
The way I just described Dr. C as presenting herself dovetails with Burke’s ideas well, that is, Dr. C’s failure to acknowledge her own capacities for love or her intuitive abilities represent a certain negative, self-hating ideology that ruled her. Referring to the way in which identity is constructed through a form of performance, Butler (2005) wrote,
I also enact the self I am trying to describe; the narrative “I” is reconstituted at every moment it is invoked in the narrative itself. That invocation is, paradoxically, a performative and non-narrative act, even as if functions as the fulcrum for narrative itself. I am, in other words, doing something with that “I”— elaborating and positioning it in relation to a real or imagined audience—which is something other than telling a story about it, even though “telling” remains part of what I do. (p. 66)
Butler’s (1997, 2005) conception, as applied to identity, differed substantially from my conception of the performative aspects of the clinical psychoanalyst. Burke’s (1945) “dramatistic pentad” (p. 538) came closer to illuminating the psychoanalytic process in which “act, scene, agent, agency, and purpose,” (p. 538) dynamically unfold throughout each psychoanalytic encounter. In the course of the psychoanalytic process, both psychoanalysts and patients perform, but how they act, their purposes, their responsibilities, their roles, and their objectives diverge. In the psychoanalytic
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S167VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
encounter, and to borrow Abramovic’s phrase, “the analyst is present” (Cotter, 2010), the unfolding, dynamic relationship between psychoanalysts and patients serves as the bedrock that facilitates patients’ transformation. Each encounter is unique. Psycho- analysts’ performances, in conjunction with their patients, can be neither duplicated nor mechanized.
Although psychoanalysts may ascribe to formal theories, no theory will be performed the same way because the participants’ singularities (Ruti, 2012) vary. An analyst’s subscribed theory combined with that same analyst’s personality, and that of the patient, plus whatever dynamic contextual features exist, renders every performance unique. (Even carefully written theatrical scripts are never performed never the same way twice.) Using their various forms of interpersonal influences as brushes, or like choreography, and utilizing their creative interpretation of the work of analysts past, psychoanalysts perform their transformational work.
I relied mostly on Lacan’s (1960, 1978, 1979, 2002) distinction between ego and subject in my work with Dr. C. As occurred in the two prior scenes, the urgency point involved a live, emotional element of our interpersonal relationship, one centered on her perception of her criticizing me. Dr. C’s ego, particularly early in our work together, consisted of the self-perception just noted—an unattractive, “messy person” with exces- sive interpersonal needs and little appreciation of her unusual capacity for intuition and insight. For perhaps one full year before this scene occurred, I helped Dr. C in her discovery of the origins of these unconscious themes, with rejection by a narcissistic mother being significant, but sexual objectification by her father being the most impactful. Just as Dr. C entered adolescence, her father made a sexual remark about her breasts. She could “never forget” her father’s statement. She came to understand that it fomented her retreat into negativity regarding her appearance. Further, she had understandably equated attractiveness with vulnerability and danger.
This encounter represented a milestone in her taking ownership of several positive elements of her authentic self, and her beginning the process of relinquishing her unfounded, excessive self-criticism.
DR. C: Joel [a colleague with whom she had been intimately involved for 6 months] told me that I have “coercive needs.”
ANALYST: I wonder what you think he meant by that.
DR. C: [With irritation.] It’s obvious, don’t you think? He’s just caught on to how demanding I am, the same needy way that pushed away men before him, the same demands that annoy you.
ANALYST: How do you see me as annoyed by you?
DR. C: When I am critical of you, like when I tell you how that pile of papers on your desk is always so fucking neat, I feel you tense up.
ANALYST: Yes, I think you’re right.
DR. C: [Pauses for a long while.]
ANALYST: I’m thinking now of all we’ve discussed about your intuition, that intuition you reluctantly call “magical,” and how you deny its power. You quickly sense a reaction in me when you comment on my desk, or my bookshelf, but here’s how I experience it. I feel nervous about me, not about your criticizing me. I feel self-conscious about my neatness. Can you see you how you immediately translate that into a negative judgment of you?
DR. C: I guess. [Another long pause passed.] or at least I’ll take your word for it. [She sounded irritated.]
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S168 KARBELNIG
ANALYST: You seem to be shrugging my perception off. You seem convinced that I seem annoyed because of you.
DR. C: Yes, I sense your discomfort. I hate doing it to you.
ANALYST: I know you can sense it. This makes me think of the “magic” you tell me about. You are highly sensitive to me, but you then project a reaction that seems to be more about you than about me. How ironic! You worry about being not neat enoughI worry about being too neat!
DR. C: I always think you will think me strange, like I sound like a sorceress or something.
ANALYST: And so what if you are? Call it what you want, it is such an unusual quality. I’m reminded now of those images of the orbs that you have in your dreams and your imagination.
DR. C: And what about my “coercive needs”?
ANALYST: [Being ironic.] As you know, I’ve just felt so overwhelmed by your infantile demands these long 3 years together. You’ve always asked for so much, crisis calls, extra sessions, discounted fees. Need I go on?
DR. C: [Laughing.] So you have no sense of me as having “coercive needs.”
ANALYST: No, I never have, ever, but clearly you see yourself that way, or at least you fear that you’re that way, and Joel’s using that phrase lit you up.
This excerpt dramatizes Dr. C’s initial effort to invite me, with words and affect, into an enactment that emphasizes the various ways she negatively values herself. I declined the invitation, shared my subjective experience of shame at my own compulsivity, and proposed an interpretation that her sense of me as angry constituted a projection. We shared an opportunity for her to experience, in real time, the power of her intuition—as evidenced in her sensitivity to my emotional reaction to her critiques. She appeared to experience relief that she could reveal herself as an unusually sensitive and intuitive subject. Toward the end of that short piece of dialogue, I used humor to facilitate the expulsion of the self-criticism fomented by her partner’s criticism of her.
Readers will likely interpret my interactions with Dr. C display as reflecting my working in an intersubjective or relational style with her. As I witnessed our relationship evolving over time, and also observed her personal style, I concluded that the broadly defined interventions suggested by these schools of thought would be most beneficial for Ms. C. But then again, as I just noted, I relied on many Lacanian ideas when discussing her unconscious themes. Were the interpersonal dynamics different, or if I had adopted a more conservative Freudian or Kleinian stance, I would not have offered up such vulnerable self-disclosures. For reasons relating to our respective subjectivities, I inter- vened in a fashion quite different than how I had with Dr. B, with whom I encouraged her aggression to linger.
Conclusions
Psychoanalysts are neither research scientists objectively observing interpersonal pro- cesses, nor are they medical practitioners applying procedures. They are, instead, vulner- able human beings engaged in a profession— one most unusual and rare in an era when all that cannot be measured, weighed, or quantified in some fashion tends to be viewed as lacking legitimacy. They offer help that primarily takes the form of exploring unconscious schemata, personal motivation, and repetitive psychobehavioral themes. They focus on
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S169VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
how these map onto the psychoanalytic relationship. Their work or, more accurately, their performances with their patients, are nonlinear, dynamic, and unpredictable.
From its earliest formation, psychoanalysis rebelled against the profession to which it was bound. It would not be strictly medicine. It would become a field of its own. It would continue to evolve away from other traditional, more linear definitions characteristic of most professions in the world, certainly far from the typical services provided by industrialized health care.
Psychoanalytic practice resides firmly in the realm of humanities, specifically art, and more specifically performance art. It is no accident that Freud pulled Oedipus from a staging of Sophocles’s Oedipus the King. First performed in Greece, c. 429 BCE, and highly popular with Western European audiences in Paris and Vienna in the early 20th century, these theatrical productions led numbers of philosophers and psychoanalysts— not just Freud—to develop ideas concerning the transformative power of art and perfor- mance.
This more artistic vision of psychoanalysis will likely require further cultural accom- modation. By definition, art brings something new into being. The English word, create, derives from the Indo-European root, ker, kere, which means to grow, to make, to create (Weiner, 2000, p. 41). Typically, new and different things in the field of psychoanalysis encounter, at least initially, skepticism and resistance to change. Perhaps Toynbee (1962) put it best when he wrote, “A fatuous passivity toward the present springs from an infatuation with the past” (p. 261). It may be difficult for psychoanalysts to embrace the primarily artistic nature of their clinical work.
Psychoanalysts manage an intimate, asymmetrical, bounded relationship that com- prises the medium of the service they sell. They strive to help individuals who consult them to grow, to create, and to come into being. The psychoanalytic project would be best served by relinquishing its infatuation with the past and breaking with reductionist comparisons to science or, more specifically, to medicine. In truth, psychoanalysts, in conjunction with their patients, practice performance art, bringing relief to suffering that defies description through language alone.
References
Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. New York, NY: Analytic Press. Balint, M. (1979). The basic fault. London, England: Tavistock. Baranger, M., & Baranger, W. (2009). Spiral process and the dynamic field. In L. G. Fiorini (Ed.),
The work of confluence: Listening and interpreting in the psychoanalytic field (pp. 45–61). London, England: Karnac. (Original work published 1979)
Bion, W. R. (1965). Transformations. London, England: Tavistock. Bion, W. R. (1967). Notes on memory and desire. International Forum of Psychoanalysis, 2,
271–280. Bion, W. R. (1970). Attention and interpretation. London, England: Tavistock. Bion, W. R. (1991). A memoir of the future. New York, NY: Karnac. Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. New York,
NY: Columbia University Press. Bollas, C. (2013). China on the mind. New York, NY: Routledge. Bouchard, M. A., Normandin, L., & Séguin, M. (1995). Countertransference as instrument and
obstacle: A comprehensive and descriptive framework. Psychoanalytic Quarterly, 64, 717–745. Brandchaft, B. (2002). Reflections on the intersubjective foundations of the sense of self. Psycho-
analytic Dialogues, 12, 727–745. doi:10.1080/10481881209348703 Burke, K. (1945). Grammar of motives. Berkeley: University of California Press.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S170 KARBELNIG
Burke, K. (1954). Permanence and change: An anatomy of purpose (3rd ed.). Berkeley: University of California Press.
Burke, K. (1966). Language as symbolic action: Essays on life, literature, and method. Berkeley: University of California Press.
Butler, J. (1997). Excitable speech: The politics of performance. New York, NY: Routledge. Butler, J. (2005). Giving an account of oneself. New York: Fordham University Press. doi:10.5422/
fso/9780823225033.001.0001 Cotter, H. (2010, March 12). Performance art preserved, in the flesh. The New York Times, p. C25. Fairbairn, W. R. D. (1952). Psychoanalytic studies of the personality. New York, NY: Routledge. Freedman, N. (1980). On splitting and its resolution. Psychoanalytic Contemporary Thought, 3,
237–266. Freud, S. (1953). On psychotherapy. In J. Strachey (Ed. & Tran.), The standard edition of the
complete psychological works of Sigmund Freud (Vol. 7). London, England: Hogarth Press. (Original work published 1905)
Freud, S. (1958). Remembering, repeating, and working-through: Further recommendations on the technique of psycho-analysis II. In J. Strachey (Ed. & Tran.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12). London, England: Hogarth Press. (Original work published 1914)
Gay, P. (1988). Freud: A life for our time. New York, NY: Norton. Godbout, C. (2005). The “economic problem” of interpretation. Canadian Journal of Psychoanal-
ysis, 13, 77–93. Goldberg, R. (2001). Performance art: From futurism to the present (3rd ed.). New York, NY:
Thames & Hudson. Goldberg, R., & Anderson, L. (2004). Performance: Live art since the 60s. New York, NY: Thames
& Hudson. Gómez-Peña, G., & Sifuentes, R. (2011). Exercises for rebel artists: Radical performance peda-
gogy. New York, NY: Routledge. Grotstein, J. S. (1990). The contribution of attachment theory and self-regulation theory to the
therapeutic alliance. Modern Psychoanalysis, 15, 169 –184. Harari, R. (2004). Lacan’s four fundamental concepts of psychoanalysis: An introduction. New
York, NY: Other Press. Hoffman, I. (1998). Ritual and spontaneity in the psychoanalytic process: A dialectical-
constructivist view. New York, NY: Routledge. Jacobus, M. (2005). The poetics of psychoanalysis: In the wake of Klein. London, England: Oxford
University Press. Kohut, H. (1977). The restoration of the self. Madison, CT: IUP. Lacan, J. (1960). The seminar of Jacques Lacan, Book IV: The ethics of psychoanalysis (D. Porter,
Tran. & J. A. Miller, Ed.). New York, NY: Norton. Lacan, J. (1978). The seminar of Jacques Lacan, Book XI: The four fundamental concepts of
psychoanalysis (A. Sheriden, Tran. & J. Miller, Ed.). New York, NY: Norton. Lacan, J. (1979). The neurotic’s individual myth. Psychoanalytic Quarterly, 48, 405–425. Lacan, J. (2002). Ecrits (B. Fink, Tran.). New York, NY: Norton. Little, M. I. (1990). Miss Alice M and her dragon. Free Associations, 1U, 7–48. Loewald, H. W. (1980). Psychoanalysis as art and the fantasy character of the psychoanalytic
situation. In Papers on Psychoanalysis (pp. 352–371). New Haven, CT: Yale University Press. McEvilley, T. (2012). The triumph of anti-art: Conceptual and performance art in the formation of
post-modernism. Kingston, NY: McPherson. Ogden, T. H. (1994). The analytic third: Working with intersubjective clinical facts. International
Journal of Psychoanalysis, 75, 3–19. Orange, D. (2011). The suffering stranger. New York, NY: Routledge. Paniagua, C. (2008). Id analysis and technical approaches. Psychoanalytic Quarterly, 77, 219 –250.
doi:10.1002/j.2167-4086.2008.tb00340.x Parr, A. (2010). The Deleuze dictionary. Edinburgh, Scotland: Edinburgh University Press.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S171VIEWING PSYCHOANALYSIS AS A PERFORMANCE ART
Phillips, A. (2012). Missing out: In praise of the unlived life. New York, NY: Farrar, Straus & Giroux.
Ragland, E. (1995). Essays on the pleasures of death: From Freud to Lacan. New York, NY: Routledge.
Rangell, L. (2006). An analysis of the course of psychoanalysis. Psychoanalytic Psychology, 23, 217–238. doi:10.1037/0736-9735.23.2.217
Ringstrom, P. (2001). Cultivating the improvisational in psychoanalytic treatment. Psychoanalytic Dialogues, 11, 727–754. doi:10.1080/10481881109348640
Ringstrom, P. (2007). Scenes that write themselves: Improvisational moments in relational psycho- analysis. Psychoanalytic Dialogues, 17, 69 –99. doi:10.1080/10481880701301303
Ringstrom, P. (2008). Improvisational moments in self-psychological relational psychoanalysis. In P. Buirski & A. Kottler, Eds., New developments in self psychology practice (pp. 223–238). Lanham, MS: Aronson.
Ringstrom, P. (2012). Principles of improvisation: A model of therapeutic play in relational psychoanalysis. In L. Aron & A. Harris, Eds., Relational psychoanalysis (pp. 447–478). Harris, NY: Taylor & Francis.
Ruti, M. (2012). The singularity of being: Lacan and the immortal within. New York, NY: Fordham University Press. doi:10.5422/fordham/9780823243143.001.0001
Stolorow, R. D., & Atwood, G. E. (2002). Contexts of being: The intersubjective foundations of psychological life. Hillsdale, NJ: Analytic Press.
Symington, N. (2002). A pattern of madness. London, England: Karnac. Szasz, T. (1988). The myth of psychotherapy. Syracuse, NY: Syracuse University Press. Toynbee, A. (1962). A study of history (Vol. 4). London, England: Oxford University Press. Trumble, W. R., Brown, L., Stevenson, A., & Siefring, J. (Eds.). (2002). Shorter Oxford English
dictionary (5th ed., Vol. 1). Oxford, England: Oxford University Press. Weiner, R. (2000). Creativity and beyond. Albany: SUNY Press. Winnicott, D. W. (1955). Metapsychological and clinical aspects of regression within the psycho-
analytical set-up. The International Journal of Psychoanalysis, 36, 16 –26. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in
the theory of emotional development. London, England: Hogarth Press. Winnicott, D. W. (1992). Through paediatrics to psycho-analysis. New York, NY: Brunner-
Routledge.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
S172 KARBELNIG
- “THE ANALYST IS PRESENT”
- The Nature of the Psychoanalytic Process in Real Time
- Previous Views of Psychoanalysis as Art
- The Artistic Nature of the Psychoanalytic Process
- Psychoanalysis as Performance Art
- Three Performance Pieces
- First Scene
- Second Scene
- Third Scene
- Conclusions
- References
