Some notes on the psychoanalytical relationship and its setting Previous item Nedomači vznemirljivi... Next item Problemi edukacije v...

INTRODUCTION

I would like to focus your attention mainly on a partial aspect of the analytic relationship. I will speak about some basic aspects of the relationship, about something that often happens in a silent and implicit way, during an early, but long lasting, phase of the analysis. This however is not of secondary importance. We often see, with some patients, how sessions go on for years in a monotonous way and how interpretations seem to be really not very effective. Unexpectedly something that, at first, we do not catch clearly, matures. The analytic process becomes evident, something is dynamically going on and interpretations become fully effective. Anyway, my present essay will not deal with this second phase, where the interpretative instrument assumes and demonstrates all its might and importance, but with preliminary aspects of the analytic relationship.

From a certain point of view, however schematic, we might locate present psychoanalysts in different intermediate positions between two extremes.

In the first extreme the interpretative activity is considered the fundamental therapeutic factor in the analytical treatment. The setting basically assumes the meaning of a frame, neutral enough, in which the analyst can observe what happens inside the patient, in order to interpret it.

On the other extreme, what is meant to foster the analytical process and its results, is mainly to establish and to develop the relationship between the patient and the analyst, obviously including the interpretative activity. Actually, all the analysts recognise the basic role of interpretation and relationship, varying the stress given to each of them.

Personally, I feel closer to the relational[2] pole than to the interpretational one. From this position it is hard to speak about the setting, without dealing also with the relationship. From this point of view the setting gives its basic connotation and its main effectiveness to the analytical relationship.

Some precise formal conditions of the analytic setting are partly defined when the analytic contract is established. Some of them, being inherent to the analyst’s behaviour are not told to the patient, others will remain implicit and will form the characteristics of the analytical relation itself. We will deal particularly with these last ones.

ABOUT THE SETTING IN GENERAL

Let’s start with the statement, that every relationship among human beings has a motivation and a purpose, which are connected to the satisfaction of specific needs.  A relation lasts until its program and its goal are shared by the partners of the relation itself. When either the aim is achieved or the impossibility to reach it is realised, the relation usually tends to dissolve. The separation of the partners is a complex mechanism, but it can usually be elaborated and overcome.

What is interesting to note for us is, that every relationship inevitably defines its own rules, which are absolutely indispensable for the group or for the couple in order to achieve the pre-established aims, which set up the relationship. The rules are generally the most adequate to reach the pursued aim and to avoid the relationship from deviating towards aims alien to the fundamental common programme.

The group-culture gives us patterns of rules – we could really call them settings – which are accurate and diversified enough, as they control various kinds of relationships (between friends, partners, parent and child, teacher and student, priest and believer, doctor and patient, and as far as we are concerned, between psychoanalyst and patient). Such relations, like all the others, have peculiar and precise rules, which derive from their aim.

Generally speaking and taking into account the common program, which characterises them, we can roughly distinguish human relations into two kinds: relations planned with an end and others foreseeing an everlasting duration. The foreseen length of the program obviously depends on the kind of need on which the relation itself is based.

Relationships with an end are typically those between parents and children, because their aim actually tends to make the former superfluous and the latter autonomous. Other relationships are established on programmes planned to be everlasting (relationships between married couples or among groups of various kinds). We can therefore distinguish relations with an end, that we can name, using a metaphor from building trade relations of “construction or reparation” (growth, recovery from illness), and potentially everlasting relations of “permanent maintenance” (the continuous adaptation to the events of life).

The duration of the analytic treatment is not programmed in advance, but the two members of the analytic relation know from the very beginning that it is not everlasting. After a certain number of years it will come to an end. The analytic relationship is therefore typically a time limited one and the rules of the setting are structured according to this aim. It may become an interminable analysis, in that case the analytic couple has deviated from its original schedule.

Let us mention an example, how a deviation from a setting rule may turn the relation from an end to an interminable one. A sexual intercourse between analyst and patient – as is the case between parent and child – turns the relation to an everlasting one and elaboration of the separation process between the members of the dyad becomes very difficult, if not actually impossible.

From this point of view, we can consider the incest taboo, which produces the Oedipus scenario, a basic rule for the family group setting. In fact, it allows the achievement of the aim: the mental development of the children and their individuation-separation process.

But let’s get over these considerations, which are too phenomenological for our refined analytic taste and try to enter the levels that we are used to deal with.

THE AIMS OF THE ANALYTICAL RELATIONSHIP  

Let us try to formulate an assumption about one of the possible aims of the analytical relationship. We will then have to structure the relation in a particular way using such rules – the setting – which are the most adequate to achieve this aim.

Freud brilliantly got rid of the concrete contents of the experiences told him by his first patients, guessing that their fantasies were not mere representations of actually happened facts. Then, through the fundamental discovery of transference, he revealed the double reality that the patient lives in analysis: the re-experiencing of his past relations and the actual relation with the analyst in the present.

Now we recognise the ubiquity of transference, defined so clearly by the lapidary words of Loewald (1980) “There is neither such a thing as reality nor a real relationship without transference”. Every object to which we relate is situated on different levels at the same time. (The wife is a real person, but on a symbolic level may be a mother, too.)

While dealing with the symbol Winnicott said, how fundamental the existence of the paradox is (by which, for the child, the mother is and also is not that piece of cloth, as also the wife for her husband is and is not his mother). For Winnicott (1971) the paradox and the symbolic thought are strictly related to playing. Playing is a fundamental aspect of mental life, to such a point that, Winnicott says, the analyst’s task is to lead the patient from a state, where he is not capable of playing to a state where he is.

Kafka (1989) maintains that it is important for a child’s correct mental development that the mother is able to tolerate the ambiguity of meanings, the paradox (i.e. the simultaneity of contrasting meanings), and to transmit to the child this same capacity,  which in turn helps him to live multiple realities, giving him a strong hold on one reality, together with the capacity of considering more realities.

Therefore, the setting is necessary to establish a space to stage an illusion on (transference) and where it is possible at the same time to verify the illusion of what is on stage. Just to make more evident the difference between reality and transference, the setting is structured in a way that strengthens the illusory lived experience, i.e. the externalisation of the internal object relationships. Such a strengthening is the transference neurosis.

Therefore, to move easily among multiple levels of reality is a vital need for human beings. It is of great importance to be able to introject aspects of the relations with external objects and to project the inner object relations on the external objects, without losing the capacity to distinguish what is of the external origin from what is an internal origin.[3]

 It is fundamental for human beings to be able to elaborate mourning, because losses inevitably occur throughout life (and the analytic setting unavoidably reproduces that). To elaborate mourning we must have reached an adequate capacity to use symbolic thought, in terms of distinguishing the object from its mental representation. Only so we can emancipate from concrete thought, which blocks in a symbolic equation the solution of conflicts, strengthening more levels of reality into one.

There is an unbreakable connection between the achieving of separateness and the birth of symbolic thought. This happens with the constitution of the fundamental potential space between the subject and the object, between mother and child (when the child begins to feel separate from his mother). In this space the child can produce the representations of the object, when the level of frustration (i.e. absence of the mother) is optimalin an atmosphere of reliability. They make it possible to tolerate the distance from the object – the separateness. The development of symbolic thought starts. It involves the capability of distinguishing between symbol and reality (in analysis it means between transference and the real relationship, between the lived again past and present as such). This capability is a basic requirement to face and solve psychic conflicts. Only this gives to the interpretation its full effectiveness.

Those aspects of the analytical relationship and of the setting, that structure and foster the development and functioning of symbolising (i.e. reading what is happening on different levels of reality at the same time) will be therefore of primary importance.

Now let us try to see what the elements of the setting necessary for this aim are, that is to make the analytic relationship able to foster the development of symbolisation. Two of these elements are: reliability and optimal frustration.

Before dealing with them, I would like to recall briefly another basic characteristic of the analytical relationship, that is asymmetry. Actually, the analytical relationship is not based on equal terms. Many aspects of the contract and of the setting emphasise asymmetry: the analyst is seated, the patient is lying down and he doesn’t see the analyst, but he is seen by him, the patient pays, the analyst speaks only when he considers it necessary etc. Both parts admit that the patient needs the analyst more than vice versa.

This condition could be dangerously shaken, if, for example, the analyst feels an excessive need for the patient. The need may be connected with finance (the analyst doesn’t have enough patients), with affection (the analyst is too lonely and his affective life is unsatisfying), with narcissism (he needs the admiration of the patient because of his low self-esteem), with research (he is doing an important research on the patient’s pathology), with his analytic training (the candidate urgently needs a patient for his training supervision) etc.

Only towards the end of the analysis this gap decreases, together with the diminishing need of the patient for recovery. Therefore, it is not unusual to pass, for a short time, before the end of the analysis to vis a vis sessions.

RELIABILITY

Winnicott (1954) described the setting: ” Let us now glance at Freud’s setting. I will enumerate some of the very obvious points in its description.

1. At a stated time daily, five or six times a week, Freud put himself at the service of the patient. (This time was arranged to suit the convenience of both the analyst and the patient.

2. The analyst would be reliably there, in time, alive, breathing.

3. For the limited period of time prearranged (about an hour) the analyst would keep awake and become preoccupied with the patient.

4. The analyst expressed love by the positive interest taken, and hate in the strict start and finish and in the matter of fees. Love and hate were honestly expressed, that is to say not denied by the analyst.

5. The aim of the analysis would be to get into touch with the process of the patient, to understand the material presented, to communicate this understanding in words. Resistance implied suffering and could be allayed by interpretation.

6. The analyst’s method was one of objective observation.

7. This work was to be done in a room, not a passage, a room that was quiet and not liable to sudden unpredictable sounds, yet not dead quiet and not free from ordinary house noises. This room would be lit properly, but not by a light staring in the face, and not by a variable light. The room would certainly not be dark and it would be comfortably warm. The patient would be lying on a couch, that is to say comfortable if able to be comfortable, and probably a rug and some water would be available.

8. The analyst (as is well known) keeps moral judgement out of the relationship, has no wish to intrude with details of the analyst’s personal life and ideas, and the analyst does not wish to take sides in the persecutory systems even when these appear in the form of real shared situations, local, political, etc. Naturally if there is a war or an earthquake or if the king dies the analyst is not unaware.

9. In the analytic situation the analyst is much more reliable than people are in ordinary life; on the whole punctual, free from temper tantrums, free from compulsive falling in love, etc.

10. There is a very clear distinction in the analysis between fact and fantasy, so that the analyst is not hurt by an aggressive dream.

11. An absence of the talion reaction can be counted on.

12. The analyst survives.”

The regular succession of sessions helps to create a sense of continuity and safety in the patient’s feelings. (That’s the reason why it is so important to determine fixed sessions and not change the time table of the sessions unless under exceptional circumstances). More and more aspects of the relationship of the setting sink into something taken for granted and the unthought, going to form a background on which the relationship will develop.[4]

With this background the patient slowly creates a relationship like this with the mother-environment, from which a mother-object will take shape progressively. In this way the patient could relive with the analyst his early object relations.

Bleger (1967) deals with the symbiotic parts, that progressively deposit themselves on what he calls the frame of the analysis. He says that “the setting forms the most perfect compulsion to repeat… (and is going to represent) that part of the patient’s body scheme, which is not yet structured and differentiated”. While existing, the setting seems inexistent and it is recognised only when it’s lost, because it is a mute symbiosis. Bleger also says, that “the steady or immobilised relations (the non-absences) are those, which organise and maintain the non-Ego and form the base on which the Ego is structured in function of the frustrating and the gratifying experiences”.

But the reliability is not given just by the mute presence of the analyst, but also by other important rules, which are implicit in the analytical relationship and which are not expressed in the initial contract.

One of these important elements is the feeling of safety, that the patient must find in his relationship with the analyst. Modell (1988) says that the patient must feel protected against “any threat to the integrity of the Self”. Because, if the analyst is not empathic enough or is too intrusive or does not respect the autonomy and the patient’s separateness, it could raise terrible fears that the sense of his Self could be shattered and broken up. Especially in the early phases of the analysis, the need for safety urges the patient to test the analyst and to stress how he is able to protect him, also from his own (patient’s) destructivness and his incapability to mantain a relation.        

The non-intrusiveness of the analyst is maybe what today most of all we analysts mean by the word neutrality[5], which has nothing to do with impassibility (“indifferenz”) and is connected to the concept of abstinence. This refers more to the fact that the analyst must avoid acting. The anonymity is connected to the rule, that the analyst’s private life should not enter into the analytical relationship.

The analyst’s basic ethical attitude – human and professional – is fundamental and is something completely different from a harmful moralism. I am referring to the analyst’s natural attachment to truth (and his refusal of lie), a deep respect of the patient’s person (and his refusal of any kind of manipulation). It includes confidentiality and professional secrecy, a sincere pursuit for the good of the patient, respect for the terms of the contract and the tendency to avoid everything that could damage or make less effective the therapeutic analytical relationship. (Therefore, the analyst must also accept that sometimes his theoretical points of view could not correspond to the clinical reality of the patient.)

It is also implicit that the analyst should have and maintain a sufficient and genuine human interest (not only professional, theoretical or connected to research) for the patient as a person. If he is not able to feel it with a certain patient, he shouldn’t take him into analysis. If he is not able to feel it with a lot of patients, it is better for him to go back into analysis himself, or to look for another job.

Here is an important question: the analytical relationship is an artificial situation, where only phenomena that are technically managed happen or it is – like I think it should be – a human relation, warm and vital, not lacking some spontaneity, too. It is actually difficult to imagine that the patient could rely on a cold and inhuman analyst. The other question is if and how is the analyst going to feel affection for the patient and how to put this together with the rules of the analytical setting.[6]

Concerning this, we should first recognise that there is no room for falseness. The analyst who acts or simulates feelings is condemned to failure. On the other hand, a complete lack of feelings leads to failure too, because all human relationships are established through an affective communication. Therefore, the analyst can’t avoid feeling and in a certain way showing (and this is a really delicate problem) love and hate. A certain amount of what the analyst feels will be perceived anyway by the patient, who is very sensitive in perceiving the fundamental disposition and the emotions of the analyst through the transference relationship.

This argument is long and complex, that’s why I should limit myself to some fundamental statements.

The analyst should never introduce into the relationship with the patient any of his own affective experiences, which derive from situations that are external to the analytical relationship.

Concerning those that were born inside the analytical relationship, the analyst should try to be aware of them, to never act them, to modulate them through an adequate use of the emotional distance-proximity, to explicit them with moderation and only when this could be useful to the patient and to the analytical process.

If the analyst is cold and unconcerned, the patient might search desperately for signs and points in common to re-establish contact. A too cold analyst might cause a split between an empty verbal-rational relationship on one side and a mute symbiosis, impossible to elaborate on the other.  In this way the analyst would actually impose on the patient his own narcissistic transference!

On the contrary, if the analyst is too warm and satisfies too intensively the affective needs of the patient, either overextended fusional areas might be opened or, more frequently, a scared retreat of the patient may happen. A break in the analytic treatment may then occur. Both events determine problems of elaboration on the symbolic level. In fact, we must keep in mind, that the capacity for symbolic thinking is never definitely acquired and that overloaded affections can easily obstruct it, causing a regression towards concrete thought and acting. This tends to happen more often in the patient, but the analyst too is not free from it. The setting protects them both. Throughout the analysis is present a constant danger, that the distance between the levels of transference and that of the real relationship, in the analyst’s mind too, could collide. This sometimes happens, but it is the analyst’s task to realise it and re-establish the proper analytical position.

The patients often ask what the analyst’s feelings for them are: is he really fond of them or is he just pretending, acting on the basis of an analytical theory? This kind of question is frequent, especially when the patient experiences feelings in a primitive and omnipotent dimension of all or nothing, where what is not unlimited and total love is equivalent to nothing.  The analyst might not be able to cope with primitive feelings of this kind and feel inadequate and guilty in his countertransference. This could raise painful doubts over his capacity of loving or over the inadequacy of the analytical instrument and the setting to satisfy the needs of the patient. At this point the danger is that the analyst colludes with the patient to break the setting. If a good enough setting stands up against this, the patient will discover – even after a certain amount of time – that after all he didn’t have a real need for the total love of the analyst and on the other hand he will discover how precious the analyst’s affectionate presence was.

The affection of the analyst is therefore indispensable, but not in large quantity apt to fill the deficiencies the patient had through his life. There are necessary just low doses in order to establish reliability, empathy and a genuine channel of communication, to make the common mental space work.

The analyst has to avoid or control especially the pregenital components of love, which would push him towards an attachment, a desire for exclusiveness, which would prevent the development of the patient. It is better for the analyst to feel a more parental affection (because it includes the presence of other affections, the beginning of autonomy for the patient and the end of the relationship and does not include sexual contacts). A partner (wife-husband) type of affection is not useful (falling in love does not tolerate other affective presences, it does not provide an end to the relationship and it requires sexual relations).

OPTIMAL FRUSTRATION

I would like to point out once more, that frustration does not always help growth. It does only if it is optimal. If it is excessive it becomes traumatic and it can hinder or even block the development, and the analysis too.

The analytical situation is without any doubt frustrating, especially for the patient, often also for the analyst. Every tendency for action is inhibited a priori and in the same way the majority of satisfactions. Everything is predisposed to stimulate expression mostly on symbolic levels.

The rules of the setting are indeed imposed by the analyst, but he himself should also regard them. He is forced to do so not just by the Psychoanalytical Association to which he belongs, but also by reality itself: if he crosses it, he will not reach the results he planned and he will not cure the patient. The setting is therefore also something external, “the rule”, “the third party”, the reality, that forces the couple analyst-patient to give up – at least in part – the illusion of an almighty union. It is reality that prevents the analyst to adhere completely to the requests of the patient, who is therefore often forced to live with the absence of an answer, a frustration. This produces a feeling of separateness, which allows the opening of the potential space, where the patient may form symbols. But this is possible, as I said before, only if reliability is acquired too. It is a paradox that the setting, apart from giving frustration, also provides reliability.

An example will probably render the idea. A mother holds her child in her arms and, telling him off, she takes away sweets from him for the hundredth time, which he wanted to put in his mouth. In this situation the child feels, that the mother is frustrating his oral need, that she is an extraneous, out of his control: she is definitely a separated and hostile object for him! At the same time he feels the arms of the mother holding him tightly, preventing him from falling down. A fundamental message is implicit in this holding: “I am devoted to you, I take care of you, I will not abandon you, we are as one!” He can feel the mother as a reliable presence tightly fastened to him, who on a different and more clearly thought level appears in that moment bad and frustrating. Thanks to the arms that hold him, the frustration doesn’t seem intolerable.

The image, that is the symbolic representation of the good mother-object, even if it is temporary obscured by the image of the bad mother-object, continues to exist in the internal world of the child thanks to the support given by the undifferentiated mother-environment, by the arms that hold him.

If we transpose the elements of the example into the analytical situation, we can say that the atmosphere of safety and reliability established by the setting makes the patient feel a background of reliable presence, strictly linked to him, partly unthought, which allows him to tolerate better what is happening on a more manifest level, where he perceives the frustrations of his desires, imposed by the setting itself in the relationship with the analyst.

One of the patient’s basic fantasies is that of an omnipotent and completely satisfying union, which reproduces the fantasy of the primary narcissistic relationship with the mother. He tries to carry it out and in this sense he feeds an illusion, grasping the elements of the setting which allow him to do so. It would be a total fusional union, a narcissistic nirvana without any needs, because they would be instantaneously satisfied – but also a condition where thought is lacking. More or less consistent fragments of this kind of illusionary living persist in every human relationship, but are particularly intensified in the analytical regression. Transferring on the relationship with the analyst the precocious parental relations means in fact also transferring with them a huge amount of this primordial illusion.

In analysis, like in past relations, reality tends in small doses to break this illusion and to make the analyst appear like he is in reality, without the illusionary clothes that the patient tends to dress him in. This is reality in its most frustrating aspect, which makes emerge the mother-analyst-object, from the foreseen and obvious and therefore unthought analyst-mother-environment. Those elements of the setting, confirming the so often frustrating real relationship with the analyst, are of particular importance: the limited time of the sessions, the relational language with the use of the formal “You”, the payment, the existence of other patients, the existence of the analyst’s private life, evidenced particularly by weekend and holiday interruptions, etc. The patient often tries to deny or remove these aspects. The analyst knows that they are frustrating for the patient, that’s why he makes him face them with tact and delicacy, but will not give them up and will never collude with the need of the patient.

The presence at the same time of reliability and optimal frustration, which are included in the structure of the setting, are therefore conditions that favour the development of the possibility of thinking symbolically, to live multiple levels of reality at the same time.

THE  MULTIPLE  LEVELS OF INTERPRETATION

I would like to consider now how multiple levels (which could be in harmony with each other, but also in conflict) unavoidably exist also in interpretation.

Let’s see one of the many frustrations imposed by the setting: the prohibition of physical contact.

An early rule of the family setting, which is later extended to become a general rule of relationships between human beings, is the prohibition to touch. Anzieu (1985) describes the basic and structuring prohibition to touch, which comes before and anticipates the oedipal prohibition. With some prohibitions the child is progressively incited to substitute touch with sight and hearing – in the receiving function of the relation – and to use words, which have to become symbolic equivalents to touch – in the transmitting function – in order to re-establish, under a symbolic form, the primary tactile communication.

Although in a limited way, also after the establishment of this prohibition, in adult life the function of skin contact continues to exist (to shake hands, demonstrations of affection, sexual contacts) to favour more intimate relationships, which have a more intense fusional component. These various kinds of touching have quite precise and rigid rules in the different “settings” of human relations. Anzieu writes: “The primary prohibition to touch is opposed in detail to the drive of attachment and clinging… it imposes on the human beings… separateness.” It imposes with the external objects a modality of relation, which has a major component of separateness (and it therefore favours symbolisation) and a minor fusional component.

Touching is therefore substituted by sight, hearing and speech. Having in mind the analyst’s room, we are obviously particularly interested, in the voice as a function of communication, equivalent to touching. Anzieu says that “the verbal exchange, which defines the field of therapy, is effective only because it reproduces on a new symbolic level, what has been exchanged before on a tactile and visual level”.

Speech, substituting touch, is a factor of separateness. But it remains at the same time also a powerful means of sensorial contact. From the beginning of life (and also in foetal life) the new-born is in fact immersed in a “bath of sounds which… produces: a common space-volume which allows bilateral exchange… and a real link of fusional contact with the mother…” (Anzieu). Modulation, tone and warmth of voice and all the other infra-verbal or meta-verbal aspects are always unavoidably present in the analyst’s speech. They are a means of sensorial and affective messages, mostly automatic and unconscious and controllable only in a limited way. These elements can confer to the speech, and therefore also to the interpretation, apart from their manifest content, a concrete value, which is similar for example to a caress, a slap, a moving away or an approach, etc.

It could be a hard technical problem for the analyst to choose the amount of signals he can transmit to the patient (a smile upon entering, the tone and rhythm of the voice, the frequency of the fatidic “Hm!”, the quantity of sounds and other noises, etc.).

This “ambiguity” of speaking – and interpreting – is therefore similar to the one I described before concerning the setting itself. The interpretation is in fact active on more levels: the one which we usually refer to, on which we communicate with the patient in a figurable way –  and often in a optimally frustrating way – what we think is happening on his unconscious level. Another level is where the sound and tone of our voice form messages of reliability (“I am here and I am interested in you”) or of fusion (“I feel what you are feeling and therefore I am part of you”), etc. This second level, on which the interpretation is active too, may be particularly important during the first phases of the analysis.

CONCLUSIONS

I would like to emphasise how useful it is for the therapist to be conscious, how the setting represents and expresses different levels of reality.

One is more primitive, undifferentiated, neither thought nor mentally represented, rich in symbiothic-fusional aspects, based more on concrete aspects (the physical contact with the sofa, the real and silent presence of the analyst, etc.) and implicit aspects (for example the aspects connected to reliability).

The other level is more differentiated, distinct, thought (consciously or also unconsciously), objectual, based on explicit aspects of the analyst as separated from the patient and including those aspects of the transference that reproduce relations with more differentiated-separated objects.

The setting, with its mute symbiotic part, less represented and thought, is the base without which the more thought and differentiated level, that is interpreting, isn’t effective.[7]

I would like to end by stressing again, that every human relationship does necessarily occur on more parallel levels, which have to remain distinct. The analytical setting is a powerful instrument to re-establish such a modality of relationship, where it has been lost or where it has not been acquired enough.

FINAL NOTE

After all these arguments, the impression starts to take shape, that in reality the preservation of an absolutely correct setting is a utopia to aim for, rather than a defined reality. An absolutely correct setting would mean one lacking concrete contacts (but let us think about the tone of the voice), or lacking more or less conscious, though small, actings of the analyst (but let us think about the amount of non-explicit meanings conveyed by every interpretation). The question therefore could be: to do the most to keep the setting completely purified from every acting, or, taking for granted the presence of a cluster of small “impurities”, to try to be conscious of it? In this second case we will take care mostly of the mental state of the analyst, the interiorized setting, believing that in this way we will better avoid the disturbing actings and the most uncontrollable messages. A setting, which is characterised by an obsessive and thorough respect of purely formal and superficial rules could result in the manifestation of a pseudoadult false-Self (Golinelli, 1995). This could sometimes happen on the part of the patient or on the part of the analyst and it is dangerous if the obsessivity of both of them colludes in it.

We can say that the optimal setting is something around which we oscillate continuously, which we have to conquer at every session, because this conquest is never definite. More than a perfect setting in a defined dimension, it is important for the analyst to keep a mental and relational attitude, and, although recognising the unavoidable impurities, the analyst is deeply convinced that the correct setting is necessary to help the patient. An internal need will then grow in him to achieve an optimal setting, where the analytical dimension of the relationship could develop to its best and he will feel uneasy every time he leaves its boundaries. This inclination, which will characterise his – conscious and unconscious – presence in the relationship, will transpire and will be perceived at all levels by the patient. He will then feel that he is inside a real and “living” setting, which forms the most genuine analytical relationship. This internal tension of the analyst, perceived by the patient, will become for him a powerful propulsive push towards growth, towards recovery.

REFERENCES

ANZIEU, D. (1985). Le Moi-peau. Bordas, Paris 1985.

BLEGER, J. (1967). Psycho-analysis of the psychoanalytic frame. Int.J.Psychoanal., 48: 511-519.

BOLLAS, C. (1987). The Shadow of the Object: Psychoanalysis of the Unthought Known. Free Association Books, London 1987.

BORDI, S. (1995). Lo stato attuale del concetto di neutralità analitica. Riv. Psicoanal., XLI,3: 373-390.

GOLINELLI P. (1995).  Setting. Paper read in Zagreb, 18.3.1995.

KAFKA, J.S. (1989). Multiple Realities in Clinical Practise. Yale University Press, London 1989.

LOEWALD, H.W. (1980). Papers on Psychoanalysis. Yale University Press, New-Haven 1980.

MODELL, A.H. (1988). The Centrality of the Psychoanalytic Setting and the Changing Aims of Treatment: A Perspective from a Theory of Object Relations. Psychoanalytic Quarterly, 57: 577-596.

MODELL, A.H. (1990). Other Times, Other Realities: Toward a Theory of Psychoanalytic Treatment.  President and Fellows of Harvard College, Harvard 1990.

WINNICOTT, D.W. (1954). Metapsychological and clinical aspects of the regression in the analytical situation. In: Through Paediatrics to Psychoanalysis. Tavistock Publications, London 1958.

WINNICOTT, D.W. (1971). Playing and reality. Penguin, London 1971.


[1]  Paper presented at the German-Chinese Psychoanalytic Seminar in 2006 in Shangai.

[2] The relational approach developed particularly after the Fifties, when more and more frequently the role of the affective contents of the preverbal states of the development was pointed out. This put under question the role of interpretation as the only instrument of the analytical treatment and it introduced the function of the analyst-environment, whose most evident expressions correspond to the constants of the setting. An increasing attention was placed on the non-verbal aspects and the fusional experiencies of the relationship. These aspects form the fundamental experience, which then allows more evolved levels of integration and also a more effective use of the interpretative instrument.

The setting, as meant from a relational point of view by Balint, Winnicott, Bleger, Kohut, Modell and others – however with consistent differences among them – is not basically different from that brilliantly invented by Freud. Nonetheless another fundamental function of it was discovered, which could allow a more conscious and effective use of it. It is basically an integration and an enrichment, and not a distortion.

[3] This capability is fundamental, because life is basically a sequence of unavoidable separations and when external objects are lost, the two components have to be re-distinguished, what happens during the mourning elaboration. If the subject is not able to make this distinction, the loss brings an unbearable concretely felt “extirpation” of the introjected parts (undistinguishable and inseparable from his own parts fused with them), and an as much unbearable “amputation” of his parts, which were projected into the object (and partially fused with the representation of it). In such a context, the lost object leaves a “black hole”, a void which can’t be filled and which becomes a source of everlasting pain.

If, on the contrary, this distinction is possible, when the external object disappears some of its symbolic representations, that were previously introjected into the subject, can be maintained as normal identifications and they may ease the void left by the real object. The subject is also able to take back and save his parts, that were projected into the object in their symbolic dimension and they will be on his disposal, to be re-projected on another external object, when this is available. (The parts of the inner relationship with the mother that were projected into the relation with the wife, after the loss of her, could be recovered and re-projected into a new partner).

Every concrete relationship transforms us in some way and every separation causes a restructuring, which usually goes through the elaboration of the mourning. This is a fundamental process for the growth and for the structuring of the Self through the process of identification.

[4] Bollas (1987) describes the “unthought known”.

[5] Bordi (1995), referring to Gill and Modell, points out, that the neutral position gives the analyst the capability to learn the ways the patient organizes his experiences, how he builds them and uses them to exercise his influence over the analyst.

[6] Concerning this, Modell (1990) says that “the question is not if these affections are false, but that they happen inside a context, that is different from that one of everyday life, which means the inside of a different level of reality”. This is true, but I think it does not solve the problem completely, because different levels of reality, although separated, are not fully isolated from each other. If this were true, we would have to deal with pathological splits of the analyst, while the patient could not move the experiences of the analysis into external life.

[7] At the beginning of the analysis the experience of discontinuity of the sessions tends to have for certain patients the value of a non-relationship. After the patient has sufficiently experienced the regular sequence of the sessions, a sense of continuity tends to be stabilised, which ends up dissolving into the symbiotic and atemporal dimension of the relationship. Only in a third phase the discontinuity is again perceived as a succession of events in time, which assumes also an end, but it is  possible only on the basis of the symbiotic atemporality already acquired. In this way the possibility of living two parallel realities is achieved: that of the symbiotic-fusional dimension and that of the objectual dimension of separateness. This is possible because the patient has acquired in the analytical process the ability to move between different levels of reality, to symbolise, to play.

It is only at that point that the interpretations can be perceived more completely on both levels at the same time: the one more represented and thought and the other more primitive of sensoriality (for example the tone of voice).