How is Countertransferential Enactment Worked Through?

In response to a question by Larry Josephs in the context of the IARPP colloquium on:

“The Body as Experience, The Body as Experiencer: A Multi-Perspectival Conversation” – Author: Steven Knoblauch (May 11 - May 24 , 2015)

Larry Josephs: “In body work, how is countertransferential enactment worked through? What if the way in which we physically touch a patient implicitly conveys anger, sexual excitement, or perfunctory forms of sympathy and affection that aren’t entirely genuine? To me there seems to be a difference between communicating those emotions through physical touch as opposed to long distance forms of emotional communication such as facial expression, tone of voice, and body posture.”

I responded:

“Larry’s question “In bodywork how is the countertransferential enactment worked through?’ could be one neat way of formulating the unfolding thread of my own development as a body-oriented relational therapist over the last 30 years. Having trained in the 1980s in the UK in holistic psychotherapy in the post-Reichian tradition (as distinct from bodymind therapies or bodywork, like massage, craniosacral, etc), I have pursued and suffered a relational turn over the last 20 years which has turned me inside out and upside down and taken me away from and beyond my original training.

When my second training client walked out after five years of therapy together, saying that this had been an utter waste of time and money, my personal and professional identity felt destroyed, and I went through a period of soul-searching and enquiring into the shadow aspects of both my personal investment in the therapeutic role and my acquired therapeutic identity in the Reichian tradition.

I only felt able to go public with my thoughts on those shadow aspects of the precious tradition I had been trained in about 10 years later, but Larry’s question encapsulates the heart of what bothered me. It took me some years of reading and researching to hypothesise that these tendencies are embedded in the tradition and can be traced all the way back to the personal-professional shadow aspects of our founding fathers and their historical political context, i.e. specifically Reich and his first generations of folloers/students/pupils (who arguable exacerbated these shadow aspects as they introjected them from him).

It is certainly true for myself, but I would venture to assert by association for the bulk of the body-oriented psychotherapies, that traditionally our approach – the whole canon of theories and techniques – was oriented towards minimising, sidestepping or circumventing the countertransferential impact of the transference – in summary, my therapeutic efforts were implicitly designed to avoid or get out of being constructed “as an object”.

At the same time I was fancying that I was involved in a deep transformational process of characterologically ingrained patterns – I constructed my role as a bodymind magician who was being paid to liberate the client from their entrapment in their habitual character defences against their early wounding.

It took me many years to be able to formulate for myself the key insight which constituted the relational turn in the context and jargon of my tradition, which I later refined into the following summary: “It is impossible to pursue a ‘therapeutic’ agenda of breaking through the armour or undercutting the ego’s resistance without enacting in the transference the person whom the armour/resistance first developed against.”

So here Larry’s notion of countertransference enactment is the linchpin on which the whole thing hinges – I began to understand not only the inevitability of enactment, but its paradoxical necessity for therapeutic action: that it is via the manifestation, transformation and containment of enactment that therapy does the work of characterological transformation. It is via the therapist and therapy enacting the wounding that the wounding becomes transformed. I was relieved to find that the same paradoxical understanding was being developed in the community of relational psychoanalysts.

Once a therapist trained in that body-oriented tradition has suffered and can inhabit the relational turn moment to moment in the therapeutic relationship, all the precious embodied faculties, skills and accumulated implicit relational knowing of that tradition can be turned towards a surrender INTO the enactment rather than a strategic (albeit implicit and unconscious) avoidance of it. It is only then that a body-oriented therapist is able to provide the relational space/container which allows the transformative experience to occur.

Traditionally, I would have made it my aim and task to champion that idealised notion of characterological transformation and bodymind integration, unwittingly operating from a hidden ‘one-person psychology’ or medical model objectifying stance, and not only susceptible to but actively precipitating all kinds of countertransference enactments. I might go further and say that the whole therapeutic space I used to generate was one big habitual countertransference enactment, constantly enacting Winnicott’s example of a narcissistic mother who – rather than responding to her child’s gesture – requires a particular expression which the child learns to perform and deliver, thus adapting to and complying with the mother’s fantasy of him or her.

So when we turn all our refined and developed differentiated bodymind awareness towards a surrender INTO the enactment, experiencing the enactment from within it through all our senses, bodymind faculties and doors and channels of perception, how do we contain the enactment sufficiently for it to become transformative?

Once we get beyond our own habitual avoidance of that enactment experience, we are free to notice that the client’s character pattern is habitually engaged in an equivalent avoidance of the enactment from their end. In other words: whilst sufficiently aware of the enactment to experience it as painful, uncomfortable or symptomatic, the client is bound to only have a limited, partial and fragmented bodymind awareness of the here-and-now reality of the enactment (which is why traditionally in psychoanalysis we subsume it under the general heading ‘unconscious process’).

In recognition of this, the actual nitty-gritty translation of implicit relational knowing into therapeutic responses from within the enactment then boils down to what I call a ‘gathering of the fragments’ – the full bodymind experience of the enactment is being kept in degrees unconscious, dissociated and repressed, leaving available only a fragmented awareness of it. What stops the wounding enactment from resolving or completing itself (and thus being processed or healed), is precisely the fact that it is being kept at bay, dissociated and fragmented – one of the most common fragmentation mechanisms, especially in the talking therapies, is constituted by degrees of disconnection between mental-symbolic-reflective understanding and spontaneous embodied experience.

The fuller and more comprehensive our joint awareness of the enactment (understood as a systemic bodymind two-person psychology configuration), the more obvious it becomes that it always already contains within it emergent processes towards re-organisation of the internal/external relational system.

‘Gathering of the fragments’ is a here-and-now process which invites fuller awareness of the sensations, movements, emotions, breathing patterns, images, thoughts, intuitions and perceptions of the other which constitute the phenomenology of the enactment – it’s no different from Philip Bromberg’s formulation of therapeutic action, but more explicitly inclusive of ALL the aspects and levels of bodymind experience, from the physiological and muscular through feeling, breathing and thinking, explicitly gathering BOTH spontaneous and reflective processes occurring within and between the dyad, where aspects and fragments of the wounded and the wounding objects/subjects, as well as the idealised and the transformative objects/subjects are distributed between and across the two bodyminds of client and therapist.

With both the wounding and the healing dynamics co-enacted and co-emerging, the therapist is aware of how his/her presence and responses both ‘perpetrate’ (doer – done-to) as well as avoid as well as facilitate awareness of the enactment from within the enactment. In experience-near terms that boils down to the question in the therapist’s mind: is the system ripe for emergence of fuller bodymind awareness of the particular enactment(s) we are currently caught in (or not), and who might I become in the client’s unconscious experience when I invite that awareness more explicitly?

I recognise historical precursors of that formulation both in Gestalt’s paradoxical here-and-now theory of change as well as traditional psychoanalytic notions of here-and-now mutative interpretations, but evolved further into a two-person psychology paradigm via the notion of enactment. The crucial addition is that we can attend to all of that now with the benefit of a full bodymind spectrum of awareness that includes the full range of pre-reflexive, spontaneous processes (usually considered ‘subliminal’ because of the the therapist’s own lack of embodiment, both as a person and as a practitioner, i.e. as a person and in role) as well as the full range of reflective processes (both mental and somatic).

What follows from all this is that – as proposed by Larry – “the difference between communicating those emotions through physical touch as opposed to long distance forms of emotional communication such as facial expression, tone of voice, and body posture” simply lies in the therapist’s capacities for embodied presence WITHIN the enactment, and in how prepared, trained and supported they are to maintain pre-reflexive bodymind spaciousness for being both wounded and wounding. In closer proximity and in touch both the enactment of the wounding and the urge for transformation of the wounding become more charged and intense, but the paradoxical principle of transformation via enactment remains the same.

One of the great obstacles to this recognition across the traditions is an idealising conception of touch as predominantly reparative. In my experience, differentiated bodymind awareness of ourselves and the other (as a capacity that can be further developed through training just as relational awareness can be enhanced through practice) allows us to gather the fragments of the enactment within touch in the same way that it is possible at a distance.”

Follow-up:

Bill Cornell also responded to Larry Joseph's question, and here is a central quote from his comment:

"In my original training there was absolutely no attention to countertransference, and it ranks as an understatement to say this was not good.  I found over and over again that I was too active in my interventions, a serious tendency to act upon the bodies of my clients. I went into supervision with a Kleinian analyst to explore my countertransference.  It was a painful, humbling and liberating experience. We worked from transcriptions of sessions. She virtually never commented on anything that I did or said, offered no alternatives. Instead, with virtually every intervention she would ask, “What was going on in you that you chose to intervene just then?” Over & over again.  I learned how often my need to intervene was motivated by my anxiety, first and foremost, at other times by irritation, boredom or theory-driven “therapeutic” goals. After that, my reading of Winnicott and years of consultations with Christopher Bolllas shifted my style of work and very different ways of recognizing and working with my countertransferences within a body-centered approach. I also came to see how often the analytic avoidance of bodily experience and action was also a form of countertransference enactment within the analytic communities.

To this day, some forms of body work training  do not, from my point of view, deal adequately with countertransference.  The contemporary approaches of body-centered therapy that position themselves within the relational rubrics do pay much more attention to countertransference."

I then added the following:

"Bill and I have had occasion before to marvel at how parallel our developments have been, without knowing anything about each other across the pond, starting from our training experience in fairly diverse body-oriented approaches, but with very similar underlying assumptions and relational stances, via a series of insights and stepping stones which show an amazing degree of similarity and coherence. So I really get you, Bill, in how you describe the unfolding of your thinking, arriving at exactly the same challenge to both traditions: there are habitual countertransference enactments implied in systematically operating on the body as well as in systematically avoiding the body altogether.

Just a couple of days ago I attended a presentation on embodiment by one of the rising stars of UK psychoanalysis, where in seven years of analysis with a patient who intensely hated his body and his appearance his here-and-now experience of the body in the consulting room of that hatred was never once attended to or enquired into. When I asked about her definition of embodiment, she simply said: the fact that we are not just minds, but act with our bodies. I would prefer to define embodiment as the subjective awareness of the mind-body relationship, the quality of inhabiting the lived experience, very much leaning towards Winnicott’s felicitous phrase of “psyche indwelling in the soma”. The relational quality of my current body-mind relationship, which tends to significantly reflect the way both my body and my mind were handled in early attachment, was never attended to in that analysis, although it constituted the major presenting problem.

In the light of this I would like to clarify a possible misunderstanding inherent in your formulation, Bill, when you say: “I learned how often my need to intervene was motivated by my anxiety, first and foremost, at other times by irritation, boredom or theory-driven “therapeutic” goals.”

A possible conclusion from this might be the idea that initiative and action on the part of the therapist are always inspired by ‘bad’ countertransferential reasons, inclining us then towards the classical analytic attitude that all action is acting out, that reflected action is the pinnacle of maturity, and that we had better think about it very hard before we allow spontaneity (i.e. analytic abstinence and neutrality). When I enquire into my own or my supervisee's therapeutic impulses and what drives them, we do indeed find anxiety, irritation, boredom and supposed agendas. But I would argue that these are the superficial (mis-)mappings and reflections of the deeper engagement, where - in one of the phrases that I use in teaching - the client's conflict becomes the therapist’s conflict, and it is therefore not so clear whom the impulse towards action ‘belongs’ to (leading to the main preoccupation of traditional humanistic supervision: what is the client’s stuff and what is the therapist’s?). However, it seems to me that this way of conceptualising it is still stuck in a pre-‘two-person psychology’ paradigm (or in other words: the dualistic ‘myth of the isolated mind’).

Within the therapist’s countertransferential anxiety we often find projective identifications as well as compassionate impulses based on accurate attunement to the client's character conflict. In opening my heart to the other’s psychological reality, for all the best analytic reasons of neutrality under the sun, I do not want to be stuck in a mentally reflective bystander position - I want to be available to respond spontaneously in body and mind, I want to allow myself to be drawn in (and to my mind that explicitly includes being drawn into enactment and into apparently counter-therapeutic dynamics, in Larry Joseph's terms: "anger, sexual excitement, or perfunctory forms of sympathy and affection that aren’t entirely genuine"). Being available to respond spontaneously in body and mind includes not just empathic thought at a distance, but also action, movement and also touch. However, as per my previous posting and my proposed formulation of the relational turn in body psychotherapy, that impulse towards action inevitably draws me into enactment also. In feeling moved and moving, however accurately attuned and well-intentioned, I will be experienced and received and constructed as an object via the client's character (with the client’s transference understood as a bodymind process including their perception of me).

It's the inevitability of enactment REGARDLESS of whether I'm accurately attuned in my impulse on the one end of the spectrum or pathologically misguided on the other end, which transcends the idea that enactment can be made more manageable by operating on the body or by excluding it from the interaction."