Isabel Luzuriaga's Paper

THINKING ALOUD ABOUT TECHNIQUE

by Isabel Luzuriaga

The title of this paper is "Thinking aloud about technique". Its contents try to be exactly what it says. When I learned that this conference was going to take place, I just sat down and wrote what came into my mind, as if indeed thinking aloud. I did not consult any bibliography; I did not try to make quotations; I did not try to learn better what I already knew about Dr. Bion's work; and I didn't use the words he uses when describing his concepts, but, rather, my "everyday" way of expressing them. I just wrote. And only later did I realize that my intention had not only been to pay a tribute to his memory, but also to satisfy a private need of my own to communicate with him in a personal homage. You can then, perhaps, understand my enormous surprise and fright when, months later, I was told that this private dialogue of mine had been chosen to be read in public. Then, maybe in order to become a bit more relaxed, I tried to think that perhaps the working method I had used might somehow have been the one he would have wanted me to use, by just describing the emotional experience of this dialogue taking place between me and the Dr. Bion I have in my inner self, as a private inner object of my own personality. Had I then perhaps, even in a modest way, approached that enormous effort he expects us to make in our analytical technique, when he asks us to work "without memory and desire"?

I was not, of course, completely comfortable with this optimistic thought. But I did make use of all my courage, and just went on writing realizing, as I did, that mostly I kept on asking questions, but did not offer answers. For me, this was perhaps the best thing to do because, again with Dr. Bion in mind, I do not believe that psychoanalytical technique can be discussed by way of definitions or generalizations, as nothing that happens in one session is ever repeated in any other. The only statement I could now make, in fact, would be that, after Bion, technique has become much more difficult than it was before he came into existence as the psychoanalytical genius he was. We should add, of course, that psychoanalytical practice has also become much richer, more thrilling and perhaps more useful to our patients, which is what really counts. So I thought that the best thing to do would be to limit myself to making a list of a few of the technical problems that to me seem most difficult, and that are due to the advances Dr. Bion has made in understanding human beings, both "normal" and in their most pathological states.

So here is the list:

1. How should we define, after Bion, what, as Kleinians, we first called a "good object" and a "bad object"?

2. The primitive definition of the "good object" is the one who loves, and the "bad" one, the one who hates or is absent (taking into account, of course, all distortions made on them by the projective mechanisms that Klein herself so richly described). But, is this enough to explain completely what could really be called today a "good" or a "bad" object?

3. Perhaps this concept has become a more complex one now, on account of Dr. Bion's investigations, carried on in greater depth than before; and also with more severely-ill patients. To this we could add the concept that could be considered one of its most important functions: that of acting as the container of a content.

4. If this is so, does this function the patient requires of us affect our own capacity to know and to think?

5. In what mental and emotional state of mind are we left after having used this enriched knowledge in our daily practice - for instance, when we take into account Bion's view that, even in the worse kind of massive evacuation of the patient's mental contents there may exist, not only a wish to destroy all kinds of self-knowledge, but also, and in total opposition to this, some amount of the desire to know, which can only find this very primitive and pathological way of expression?

6. Can we really be the containers of such a dreadful mixture of violence, despair and hope, without it destroying our capacity to think clearly?

7. What technical weapons do we have to make use of, in order to be able to discover and to retain even the smallest sign of the patient's wish to live, and to hold on to it before he manages to get rid of it in his indiscriminate evacuation?

8. If we make use of our counter-transference to help us, and by doing so move away from what Mrs. Klein advised us to do, do we stop being "Kleinians"?

9. Also, if we make use of this difficult method of investigation, how can we discriminate not only how, but also when and what to try to reintroject into the patient of what we feel he has projected into us before? Can we do this without running the risk of making a serious mistake by confusing our own emotions with his?

10. Can we then, perhaps, come back again to Klein for help by re-reading the sessions she described when working with very small children? This would give us the opportunity to have before our eyes, ears and the rest of our sensorial perceptive apparatus some knowledge that we may add to our psychic empathy and counter-transference feelings. This would reassure us about the way we are working by getting us nearer to the more concrete and primitive form of expression children use in their play with toys?

But I shall now leave this list of questions and try to add a little more substance.

In point number 4 of the list, I made a passing remark about the possibility of Bion's findings affecting or altering, not only the technique used externally for the formulation of interpretations, but also the internal "technique" with which we usually think or feel ourselves. In many of us, a certain modification has certainly taken place, sometimes to the extent of altering our mental systems at structural level. As far as I myself am concerned, I know that since knowing Dr. Bion, both through his work and personally, I have not been the same person I was before, either as an analyst or as an individual. I believe that many of us have this feeling. He has, for instance, made us more aware of the constant relativity of all knowledge, including, in the first place, psychoanalytical knowledge. Also, of having to bear the certainty that we will fail many times in our task, while, at the same time, being able to keep alive the desire to go on investigating. And also, although both he and Mrs. Klein agree on the notion that both the instincts of life and death affect us all the time, I think only Dr. Bion has managed to make us have the emotional experience of them and of their effect on us when they are acting on us. Mrs. Klein's enormous contribution to Psychoanalysis when she discovered the intricate way in which the projective mechanisms work, when used as defences against self-knowledge, holds a very important place in today's investigations, and Dr. Bion's theories are to a great extent based on them. But, as I said, I believe only he has asked us to live them emotionally by using them in a technique that is based to a high degree on his theory of "container and content".

He tells us how important it is to allow oneself to be penetrated by what has been projected into us, taking well into account, however disturbing this may be, that keeping these emotions inside us without "theoretical memory", may allow the patient later on to make contact with them himself. He tries to make us understand how, during that period of time in which we act as containers, we have the unique opportunity to live, along with the patient, the attack he is making on the contact he may previously have made with himself and with us and, at the same time, the defence that, even the smallest part of his identity may be making against such a contact, because he also wants to live. The level on which the patient is moving then may be very primitive, and perhaps also very pathological; but this modality of behaviour is still alive and functioning inside him. It may even represent the most harmful quality of his identity and his illness, not only because of the distortion he can then make of the perception of both his internal and external worlds, but also, of the distorted view he also produces of himself (about his own self) in others. This can lead us perhaps to make a wrong evaluation of the state he is in, or of the elements of his identity that we may not be able to recognize, but which may be of extreme value both to him and to our task.

Because, as Dr. Bion says, even in states of confusional and massive expulsion of parts of the patient and of his inner objects, with some luck there may be one part of him, however small, that does not feel so utterly desperate. This may permit him to hope, even if it is only for a very short period of time, that these contents that only he can expel, may be picked up by some kind of container (which we ourselves would call an analyst) that is able and willing to take into himself and to hold there for him for as long as necessary until the patient himself feels able to take over. We could remember here, as an example of technique, the extraordinary capacity of Dr. Bion's when, treating psychotic patients, he was able to remember, assemble and give meaning to bits of material from sessions that had taken place years before but came alive in the present. These were composed of small bits of whole objects or of the identity of his patient, that had been mutilated, split and spread apart in time as well as in space, or, on the contrary, condensed into a single word, and that now he could put back together or spread out, as the case might be. (But can anyone but he do this again, I wonder?)

All of which brings us to the next problem: for how long can we, or should we, perform this function of container in a treatment?

Going back to points 1 and 2 of our initial list, the "good object" and the "bad object", taken in relation with what we are dealing with now, could perhaps be called "adequate" or "inadequate" objects. This stresses the importance of the analyst's being capable or not of playing the adequate role for the patient, with him or instead of him as the case might be. Adequate would then be, not only loving him and the task he is performing with him (analysing him), but also becoming the mother-analyst who can bear to be seen and treated as bad, and by so doing, allowing the child-patient to put into her, for as long as he may need, whatever part he himself cannot bear, and which could also be his capacity to love, because love is what makes him suffer. So that the "good loving object" may have become for him a "bad" one, and he cannot take it in.

This, of course, does not mean that the analyst should act out the role appointed to him. But from an emotional point of view, the apparently passive part the analyst is asked to play may cost him an enormous emotional effort because of the quality of the contents he has to hold. Being a good analyst would then entail being able to think clearly while bearing the commotion caused in him by the impact of the contents he is receiving, which could in turn be producing in him a pain as difficult to endure as that from which the patient may be trying to escape.

The defences erected against such difficult counter-transference feelings can sometimes be recognized consciously. But sometimes it is difficult not to fall into making an appeasing interpretation or using an analytical theory in a hurry in order to cancel the emotions stirred both in the analyst and in the "atmosphere" of the consulting room. If the analyst did this, he would perhaps burden the patient with his own anxiety. The "inadequate" analyst would then become yet another edition of the first historical object of the patient's life, thus becoming a real bad object.

Another defence against holding counter-transference feelings can also be hiding behind a silence not adequate to the situation, and rationalizing perhaps this acting-out with the argument that the catharsis of the emotions thrown into him is the only thing that can be done, or is the only thing the patient needs.

Which leads us now, as I said before, to the problem of deciding for how long we should function only as containers. When and how should we "give up" being the "passive good object" he wants us to be and become the "real good professional" whose task is mainly to interpret and thus re-introject the material projected into him before? This, for me at least, constitutes one of the more difficult problems to solve. If the patient is not yet able to become aware of some part of his own identity, he may feel that we have suddenly become somebody or something quite different from what we were before, and who now, instead of understanding him, criticizes, rejects or persecutes him. If, on the other hand, we take too long in centering the contents of the interpretations on the patient himself, instead of what he experiences us to be when we act only as containers, we may, with a greater or lesser consciousness of it, become accomplices to the more regressive or ill parts of himself, keeping up a "pseudo-analysis" in which nothing is really happening, and also leaving aside his healthier part. We would then free him from the suffering that is inevitably produced in the growing-up process and from which he originally ran away, turning instead into some kind of a pathological defence. But we would also be abandoning his healthier part, which is the one that came to us for help. For if it is true that he came asking for a place into which he could expel what he himself could not tolerate, if he is still coming to his sessions, he is also asking for these contents and parts of himself to be placed within his reach. Something in him may have changed and allows him to know, as Dr. John Steiner would perhaps say, that the price he is paying for being caught in what he calls a "pathological defensive organisation" is too high, and costs him now more pain than he was aware of before, and is narrowing or destroying more and more of his psychic abilities.

Being then a real "good object", even to him, might then be, at a given moment, to know when to increase or modify the number and quality of the interpretations, in order to help him endure the confusion that re-introjection also produces. Which is the same as saying to make him more able to come closer to the depressive position. We would then make interpretations more centered on him than on ourselves, who, up to now, have mostly been used as a provisional place of storage.

As Dr. Bion has shown us, psychical change and growth can become something experienced as catastrophic for the patient and re-introjecting too soon can increase this feeling. But even when this error does not produce the exaggerated results it produces in psychotics, even small modifications of our interpretative technique may produce some kind of shock that may have unfavourable effects on the analytical process.

I am not talking, of course, about making drastic technical changes arbitrarily. Some modifications have been taking place all the time from the very beginning of each analysis, caused by the experience of each session and a growing knowledge of our patient. We also know that it is always he who opens the door to the kind of interpretations we may use each day, although he may want to close it immediately. But if it may be true that the rhythm and quality of our interpretative work may change perhaps because the total transference neurosis may be beginning to set in within our reach, it must also be because we may think that the patient has changed sufficiently for us to make more contact with him, and so he may not need to evacuate or project so much.

However, it is sometimes impressive to see the way in which some patients experience this new line of interpretation for the first time, even though we may have been working with an adequate dose of intuition and empathy before. At times, not even we may be able to realize soon enough that we are getting in touch with them more deeply, or in some other way differently from the way we did before. Theoretically, we know that sometimes we may feel that we should "let pass" interpretations of contents we think we recognize, but that the patient may not yet be able to deal with. On other occasions, we do dare make them, taking well into account, of course, the reaction to them. But in some analysis, it is sometimes striking the way in which a patient realizes this "change", as if it were something that had happened suddenly. This he may experience with relief and gratitude because the "modification", although it may cause him some kind of displeasure, also conveys the "good news" that he is moving forward. Simultaneously, it may also cause him fear and the wish to "run away from it all" because the modifications taking place both in him and in the analyst spoil for him the "advantages" sometimes offered by his illness. I shall try to describe later the reactions of two patients of mine who were in this situation of change. (1)

Now I shall try to take into account numbers 4 and 5 of the questions singled out at the beginning.

In some discussions with colleagues I have sometimes found that "being a Kleinian" is a difficult task, and that declaring oneself to be a follower of Dr. Bion's ideas is even more so. Some of the comments I have heard were loaded with an emotional content so out of proportion to the arguments used that they led me to think that we were not involved in a scientific discussion, but facing an emotional problem. But perhaps it would be fair play and helpful to think seriously of the risks we really do run if we become "too Kleinian" or "too Bionian". To be sure, being "too much" of anything means having turned ideas into dogma that leaves no door open to further investigation, and it was Dr. Bion himself who, after a lecture he gave, advised us to forget all the hypotheses he had just made. Only thus could we, he said, have access to a scientific way of thinking that, by the way, I may now add, is as difficult to maintain as it is to place ourselves in the depressive position all the time. The temptation to fall into dogma is always there and we run the risk, like our patients, of not being able to bear seeing the so many points of view of a single situation (vertices) that Dr. Bion asks us to bear in mind. The result is that we may be tempted to come back to a single one, falling again into the paranoid-schizoid position. Also, and again following Dr. Bion's ideas, we have to try to tolerate being aware of the constant influence that the death instinct has on us by attacking, for instance, our ability to learn from experience. But we must also bear in mind that at times, in wanting to discover in our patients these hostile forces that could become extreme violence if not dealt with soon enough, we ourselves may fall into a defence of a paranoid "texture" and that we may want to call being on the "look out" for the negative transference, by thinking that all negative reaction, which may really be our own, is due to feelings the patient has induced in us. This could be a "too much", and by doing it we could be, unconsciously, trying not to admit that we ourselves, like the patient, can be cruel, destructive and vengeful to a degree that may frighten us.

On the other hand, we could also fall into a state of mind resembling that of a melancholic patient by saying that all that goes wrong with the session is only due to our bad method of working, and thus denying the seriousness and the intelligence with which the patient may really be attacking us, the treatment and the state of mind we need to be in in order to work.

It is also difficult to know how to handle technically the knowledge that the patient is always functioning on several levels of evolution, or with two psychic qualities: a neurotic and a psychotic one, as Dr. Bion tells us. Being "too Bionian" in this case could perhaps lead us to pay too much attention to the attacks the patient may be directing against his own perceptive system, and thus, not giving enough importance to the more neurotic part of himself which has aims other than to destroy all possibility of knowledge, as the schizophrenic tries to do. What can we do then with this infinite variety of possibilities in order to work well? The theoretical answer may be to make use of our counter-transference feelings. But even though Dr. Bion himself has repeatedly told us this is a risky path to take, he has nevertheless by taking it himself invited us also to take it. Perhaps, by taking so much into account, he is asking too much of our identities as psychoanalysts. But I also believe that, by encouraging us to take these risky paths of investigation and to make more use of our capacities to think and feel, we may become with some luck more able to see and understand both details and whole patterns of mental behaviour. It may also enable us to be more understanding, compassionate and tolerant at times when we can do no more than wait for things to happen in order to learn about them.

So thank you for your efforts, Dr. Bion.

(1) NOTE: For reasons of confidentiality, the clinical vignettes will only be included on separate sheets of paper or will only be read there in public.

If you would like to get into touch with the Author of this paper to send comments or observations on it, please write to:
Se desidera entrare in contatto con l'Autore di questo lavoro per inviare commenti od osservazioni, scriva per favore a:

Isabel Luzuriaga
Calle del. Segre 20
28002 Madrid
Spain