Robert S. White, M.D.

Psychiatry and Psychoanalysis

Editorial Work

Publications

Papers

Transformations of Transference, Psychoanalytic Study of the Child, 47: 329-348 (1992).

Full text of the article

Transformations may come from a variety of analytic efforts. In this paper, I am presenting a type of transference that produces a flash of insight. This is experienced as a mutual sense of transcendence. For the patient, a sense of new vistas suddenly opens up and invites exploration. The analyst, too, can empathize with the patient's excitement as well as relook at his own conflicts and memories. Slow and patient interpretation of details of transference themes producing a gradual transformation may be more common. There are two parts to the transformation, a vivid experience of the transference repetition, the "true regresssion", and the simultaneous experience of a "new and novel" relationship with the analyst.

...In general, it is easier to understand entering into a transference enactment; it is the result of the traditional work of analysis of transference resistance. Resistance to resolution of the transference might more broadly be seen as the mutual effort of patient and analyst to work out of the transference enactment; that is, the resolution of the transference repetition and the recognition of new interpersonal aspects in the relationship with the analyst. How the patient can work out of the enactment is more mysterious. The aim of the resistance at this point is to maintain the repetition and the enactment. The patient is under the full sway of the transference repetition and yet must grasp that it is a distortion of what is possibel and available in the current analytic relationship. The concept of the enactment suggests a way out of this dilemma. The patient as protagonist and director assigns a role to the analyst and expects a certain response. When the analyst reacts differently than expected, the patient is surprised. It is the analyst's ability to step out of the play and call attention to the various roles being played out, gradually teaching the patient to develop a similar ability (the split between the observing and experiencing ego). It is often this element of surprise that starts the process of the patient pulling away from his role.

Psychoanalytic Process and Interactive Phenomena, Journal of the American Psychoanalytic Association, 44:699-722 (1996)
Translated into Dutch for the journal Psychotherapie, 2:165-187 (1998)

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Using psychoanalytic technique, transference and resistance are activated and studied intensively within the psychoanalytic situation. I would understand the press toward actualization (Boesky, 1982) as an inherent aspect of all transference and resistance. Freud (1920) had this concept in mind when he stated: “the ‘repressed’—offers no resistance whatever to the efforts of the treatment. Indeed, it itself has no other endeavour than to break through the pressure weighing down on it and force its way either to consciousness or to a discharge through some real action” (p. 19). From the patient's point of view, there is always a push within the interactional field for transference and resistance, first to activate intrapsychic conflict into a fantasy about the interpersonal relationship with the analyst, and then to move toward fulfillment of that fantasy. Actualization is a movement from thought to action. The actions that result from this activation can either be inhibitory or activating ... In the interactional field of the psychoanalytic relationship, we cannot just speak of the patient's transference relationship to the analyst. The analyst has a similar psychological organization, which is generally kept relatively muted and unintrusive and is not the object of study (Loewald, 1970; Leavy, 1980). The analyst is subject to the forces of his own transference and resistance, which invariably leak out into the psychoanalytic process. I would suggest that the analyst develops both transference and countertransference toward his or her patient. Transference is the externalization of the analyst's internal conflicts, while countertransference is the analyst's emotional reaction to the patient's projected transference (Loewald, 1986). In practice, it is usually not possible to separate these two modes and they are often understood together as countertransference. In a similar way, the analyst may express resistance or counter-resistance. I see the interpersonal transference as a joint production of the two participants (Compton, 1990;Hoffman, 1991; Renik, 1993; Gill, 1994). There is a joint activation of transference-resistance and countertransference-resistance in both the patient and analyst: noisy, open, and controlling on the patient's part, quiet, restrained, and receptive on the analyst's part, reflecting the asymmetrical relationship of the two participants. The patient, too, develops countertransference reactions to his or her experience of the analyst's transference, as well as the analyst's personality and way of conducting the analysis. Every patient interprets the analyst's behavior from his or her own unique perspective. Countertransference and counterresistance are continuous for both participants. What we call transference is really a product of the person's transference and countertransference. We could describe transference as a highly selective attention to certain aspects of the other's transference. The resulting transference would be composed of elements drawn from one person and pulled toward the other person. The experienced transference becomes a constructed meaning for the patient-analyst pair, highly unique and fluid (Hoffman, 1983). Both the patient's and the analyst's transference and countertransference contribute to the interactional field that always develops... I think that the analyst's contribution is not only inevitable and useful, but is essential to the process. To the extent that the analyst is receptive to the patient's transference projections, there will be an inevitable activated countering response from the analyst (both the analyst's transference and countertransference), providing a feedback loop to the patient, activating the interactional field. The absence of such a countering response from the analyst would signal to the patient that the analyst was not available and would lead to the patient's withdrawal. Freud's concept of the unobjectionable positive transference, various alliance concepts, and the concept of the holding environment are all variations of the patient's need to be responded to (Gill, 1994)... I would suggest that the ideal position for the patient-analyst pair along a continuum of actualization is a joint activation of transference and resistance to a level of fantasy about the other, where the push toward action is, as yet, minimal. Internally, the analyst, when he or she is receptive to the patient's transference, is pulled into the same actualized level as the patient. The analyst must have the personal freedom to passively allow himself or herself to resonate with the patient, much as the overtones among strings in a piano or violin. At the same time, the analyst actively attempts to be as open as possible to his or her own feelings and fantasies. What is different between patient and analyst is the expression of the actualized transference and resistance. The patient is encouraged to verbalize his or her fantasies about the interaction, which then serve to further the press toward actualization. The analyst, on the other hand, does not verbalize his or her fantasies, but thinks about them and uses them to understand the nature of the interaction...

Even though the analyst does not ordinarily share his or her fantasies with the patient, it is necessary that the patient can sense the analyst's participation to sustain the activation. It would seem to me that this is accomplished by two parallel channels of communication. At an unconscious level, in spite of the analyst's efforts to contain transference and resistance, it inevitably and spontaneously leaks out into the interpersonal field, communicated through choice of verbal imagery, verbal slips, silences, and countless nonverbal ways. Because of the patient's activated transference needs, he or she will tend to understand everything that the analyst says or does (or doesn't say or do) as an action or indication of intention. The patient is unconsciously tuned into the analyst's emotional state and, to the extent that the patient can counter the analyst's transferences, will sense the analyst's level of actualization.

The Interpersonal and Freudian Traditions: Convergences and Divergences, Journal of the American Psychoanalytic Association, 49:427-455 (2001)

Full text of the article

Freud (1930) made an observation about group and cultural life that is a subtext of this essay: "The advantages which a comparatively small cultural group offers of allowing this [aggressive] instinct an outlet in the form of hostility against intruders in not to be despised. It is always possible to bind together a considerable number of people in love, so long as there are other people left over to receive the manifestations of their aggressiveness...I gave this phenomenon the name of 'the narcissism of minor differences'".
With the benefit of hindsight, we might well apply this observation to the psychoanalytic wars in New York City in the early 1940s. What seemed to be huge differences at the time - about drives, about interaction, about structures in the mind - no longer seem so unbridgeable. Freud emphasized group cohesion as the advantageous aspect of the narcissism of minor differences, but we could equally well cite self-esteem and a lessened vulnerability to narcissistic injury. The psychoanalytic community in the 1940's was small and insecure in its professional status. Greenberg and Mitchell (1983) believe that interpersonalists and Freudians coexisted in relative peace until the influx of newly arrived Europeans fleeing the war in Germany. There is no better way to create group solidarity than to form an idealized orthodoxy and expel the deviants. This, I believe, is one of the dynamics that caused Karen Horney to be expelled from the New York Psychoanalytic Institute in 1941 and led eventually to the formation of the interpersonal school as distinct from, and hostile to, the Freudian tradition.

Intersections of Philosophy and Psychoanalysis, TAP, 36:3, 2002

Freud, although knowledgeable about Western philosophical traditions, was ambivalent about the role of philosophy in psychoanalysis and claimed that philosophy had little influence on psychoanalysis. When Ernest Jones asked Frued how much philosophy he had read, Freud replied, "Very little. As a young man I felt a strong attraction toward speculation and ruthlessly checked it." Freud, in fact, had a classical education in philosophy, and there are numerous citations of Plato, Aristotle, Kant, and others in his papers. Through his studies with Brentano, Freud was likely more knowledgeable about contemporary philosophy than he acknowledged. In this age of hegemony of neuroscience, of what use is philosophy to psychoanalysis? Philosophy, literally "love of wisdom", connotes the love of exercising one's curiosity and intelligence. One definition of philosophy: That department of knowledge which deals with ultimate causes and principles of things.
What, then, is ultimate reality.

Introduction - Psychotherapy Training Programs, TAP

Societies and institutes of the ApsaA have been offering psychotherapy training since the first program was established at Boston in 1977. Even at that time, there had been a progressive reduction in long-term psychotherapy training in all disciplines and an increasing emphasis on alternative therapies and psychopharmacology. This trend has accelerated in recent years. A second motivation for starting such programs was that the majority of psychologists and psychiatrists were ineligible for full psychoanalytic training. By 1999, there were 19 programs for adult psychotherapy training and 5 programs for child psychotherapy training. Today, the situation is even more dire. Many training programs in psychiatry, psychology and social work offer little or no training or supervision in psychodynamic psychotherapy. Psychoanalytic societies and institutes may become the guardians of this important art.

We want to focus in this special section on problems in development of psychotherapy training programs. In talking with training directors around the country, there is a remarkable similarity of concerns and developmental problems. In starting programs, typically, there are fears that psychotherapy training programs will drain off candidates for full training. There are fears of increased exposure to litigation and fears that graduates will pass themselves off as analysts. In fact, none of these have proved to be major problems. In fact, psychotherapy training programs have become a major source of new candidates. Perhaps a more fundamental barrier is confusion and controversy about the relationship between psychoanalysis and psychotherapy. As the article by Saporta and Pollack discusses, we are not clear if psychotherapy is a type of watered down psychoanalysis, or a discipline in its own right. As a parallel, there is a tendency to see teaching psychoanalysis to candidates as more prestigious than teaching psychotherapy. Often, teaching psychotherapy courses is viewed as a career development toward institute teaching, rather than valuable in its own right.

The article by Lightbody highlights typical problems in the evolution of training programs. Beginning programs struggle with the question of whether to offer an educational experience or training. Full training would include supervision, evaluation of students and often requires personal therapy or analysis, in addition to courses. Programs must clarify if their primary purpose is to be a feeder program for full training or to improve the practice of psychotherapy in the community. There is often a competition for faculty with institute faculty. There are questions about what professions to accept, what level of experience to aim for and how to integrate a variety of students. There are various problems in recruitment and marketing. Many programs experience shifts in enrollment over time.

Another major difficulty for societies and institutes is the fate of graduates of programs. Graduates typically form strong identifications with the training program and wish to retain some affiliation. How welcoming are societies to non-analytic clinicians? There are varied solutions around the country. These include inclusion in general membership, formation of allied associations for psychoanalytic thought, ongoing study groups, and use of some graduates as teachers in the training program.

The article by Schmidt illustrates that child training programs face many of the same tensions as adult training programs. One can see the same thread of conflict between the goals of psychoanalytic and psychotherapy training.

Comparative Clinical Method: A New Way of Studying Psychoanalysis Article in the Western New England Psychoanalytic Newsletter, Fall 2009

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The Non-verbal Unconscious: Collision and Collusion of Metaphor. Psychoanalytic Inquiry. 31:147-158, 2010

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Adopting the Lakoff and Johnson view that conceptual systems of the mind are inherently metaphoric and embodied, I examine theoretical metaphor in psychoanalytic theory as an example of the use of metaphor more generally in the mind. I have chosen concepts of the non-dynamic unconscious to explore representative metaphors. These include the theories of W. Bion, C. and S. Botella, and D. Stern. This essay first outlines recent interest in the non-dynamic unconscious and then examines the theories of Bion, the Botellas and Stern in detail. Differences and similarities among the theoretical metaphors are explored. I suggest that theoretical metaphors progress both through the attempted destruction of existing metaphor and reshaping of existing metaphor into new meanings. I am interested in finding among the metaphoric collisions that there may be hidden collusions that can potentially lead to unifying concepts.

Bion and Mysticism: The Western Tradition, American Imago. 31:147-158, 2011

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Bion is widely acknowledged to be an innovator in the Kleinian tradition responsible for drawing attention to the communicative aspects of projective identification, introducing the container/contained, and postulating the existence of an undifferentiated unconscious. His late writings concerning O, F, and K, however, are generally dismissed or ignored by contemporary Kleinians. The author argues that these writings are coherent if we understand Bion’s aims and sources. Bion’s aim is to find a method to understand what is unsymbolized and exists only in fragments, so as to transform these fragments into words that can be interpreted to the patient. The author likewise suggests that Bion’s technical language of O, F, and K is derived from philosophical and theological sources, most notably Plato, Plotinus, Eckhart, and Kant. He proposes that the unease felt by many in reading the late Bion stems from his belief in transcendence and the existence of Platonic Forms.

Hansel and Gretel: A Tale of Terror, Psychoanalytic Quarterly, 84:893-920, (2015).

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In the analysis of a women with multiple childhood traumas, the fairy tale 'Hansel and Gretel' figured prominantly. The author discusses the use of the fairy tale in this case at various levels. He suggests an interplay between a national myth, the fairy tale, and a personal myth -- the patient's psychodynamics. The fairy tale can be used to illuminate personal meaings derived from it. In the experience of childhood trauma, the repeated reading of a fairy tale can help organize and defend against terrifying anxiety.

Three Early Pioneers in the Psychoanalytic Study of Fairy Tales, J. American Psychoanalytic Assoc., 65:705-728, (2017).

Full text of the paper

Fairy tales have a raw power to transport the hero or heroine out of everyday life into an enchanted space of transformation. Such crossing is frequently prompted by a problem—what to do with an unwanted child; how to find a wife; who will succeed to the throne—but it may also be an adventure of a more transgressive fear or seeking of forbidden knowledge: incest, abandonment, or murder. The magical space may be located in the outer world or in secret interior places: the woods, the depths of the earth, etc. Within this quest, however, primitive and raw emotions are encountered and mastered, and the hero or heroine emerges having grown psychically and socially. Forbidden and repressed conflicts (involving, e.g., incest, cannibalism, envy, sibling rivalry, sexuality) are taken up and worked through for resolution and psychic growth

Peter Pan, Wendy, and the Lost Boys: A Dead Mother Complex, JAPA, in press.

Winner of the second annual Deanna Holtzman prize from the Michigan Psychoanalytic Society, 2020

Reviews

Discussion of Kandel's "A New Intellectual Framework for Psychiatry", Bulletin fo the Association for the Advancement of Philosophy and Psychiatry, 7:11-12 (1999)

Kandel notes the tension between the philosophical and the scientific. One line of argument, originating with Freud, is that psychoanalysis is a prescientific discipline. Both the biology of Freud's day needed to advance and psychoanalytic methodology would evolve toward real science. Kandel is arguing this point of view. Many analysts have energetically looked at this interface. Another opposing point of view has arisen in recent years. It holds that psychoanalysis is inherently hermenuetic or narrative and can reveal only relative truths about any one individual. More recently, psychoanalysis has become interested in relational theories, extending intrapsychic concepts into intersubjective spaces. These points of view holds that psychoanalytic data is uniquely subjective and cannot be translated directly into scientifically verifiable hypotheses.

Book Review: Forms of Knowledge: A Psychoanalytic Study of Human Communication, by Anna Aragno, PhD. (Baltimore, Publish America, 2008)
JAPA 57:1020-1025, 2009.

Full text of the book review

This is not a book for the ordinary clinical analyst. Anna Aragno comes to psychoanalysis after a career as a prima ballerina. Thus, she should be well suited to know something about non-verbal communication. Her musicality shows through in the use of a musical symphony as a metaphor for listening at different semiotic levels. She has organized the book into a four movement classical symphony. Surprisingly then, the book is written in a highly dense and verbal academic style, full of philosophical terminology and history, as well as linguistics and semiotics. Here is a typical sentence: “We look to ontogenesis to analyze the micro-sequential stages in the mediation of natural expression by verbal semiotic means.” (p. 101). I would translate this sentence as follows: we use the organic growth of a living organism as a model for the detailed stages of human expression of meaning through signs and symbols in words.

This is an ambitious book. Aragno states that we lack a unified theory of affects, of the unconscious, of learning. How do we know what we know? What are the diverse forms of information and channels that are assimilated and understood? She has the aim of a general psychology. She wants to unify theory and develop an interpretive master-method. She proposes to weave into a synthesis ideas and information from the various schools of psychoanalysis and allied disciplines.

Does she succeed in her aims? The answer is mixed. I am in great sympathy with her aim to develop a topography of the unconscious and in this I think she largely succeeds. However, I do not think a general psychology of psychoanalysis is possible at this time. Other points of view, especially a theory of drives and internal structures, remain important. The style of the writing is loose and wandering and often hard to follow. I believe the book could be edited down considerably to make it more coherent. She touches on many other points, especially ideas about supervision, but I will focus here on what I consider her original and clinically important thesis of unconscious communication.

Book Review – Thinking for Clinicians: Philosophical Resources for Contemporary Psychoanalysis and the Humanistic Psychotherapies by Donna Orange. New York: Routledge, 2010 J. American Psychoanalytic Assoc., 58:809-817, (2010)

Full text of the Review

Book Review - The Suffering Stranger: Hermeneutics for Everyday Clinical Practice by Donna Orange, New York: Routledge, 2011 J. American Psychoanalytic Assoc., 61: 1044-1051, (2013).

Book Review - The Way of the Negative by Andre Green. New York: Free Association Books, 1999. J. American Psychoanalytic Assoc., 65:1119-1126, (2017).

Full text of the Review

Book Chapters

Metaphor and Fields (ed. S.M. Katz),Routledge, 2013 Chap. 7 Metaphor in Three Psychoanalytic Perspectives, pp. 67-78

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This chapter is a reprint of the paper, The Non-verbal Unconscious: Collision and Collusion of Metaphor.

Wilfred Bion: A Piercean Semiotic Reading, in Making Our Ideas Clear, P. Rosenbaum, editor, New York: Information Age Publishing, (2014).

Full text of the chapter

A Report on Paula with No History, in Time for Change, M. Altmann, editor, London: Karnac, (2014).

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Discussion and Talks

Talk with illustrated slides: Gelassenheit, from Three Points of View, given as a Gardner Lecture at the Whitney Humanities Center, Yale University, on May 7, 2009

Full text of the talk with illustrations integrated into the text

Wilford Bion suggested that we approach our patients “without memory or desire”. How is this possible? To explore this question further, I propose to start with the late work of Bion and his mystical turn. Rather than dismiss these writings as incoherent as many psychoanalysts have done, I will explore Bion’s mystical sources. Gelassenheit is a German word that can be translated as releasement or letting-be. It was used by Meister Eckhart as a central move in the mystical journey. Gelassenheit was later picked up and secularized by Martin Heidegger. In a parallel process, Zen Buddhism elaborated on a similar concept. I will use these three traditions to comment and illuminate Bion’s mysticism. I will finish the talk with my integration of Bions’ ideas in my clinical practice.

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