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Blog Discussion: Enactments and Related Phenomena, Concepts of Judith Chused

 

Judith F. Chused, MD

Judith F. Chused, MD

The purpose of this blog is to encourage participation in discussion of concepts and clinical procedures that will be presented by Judy Chused, M.D. during her visit to Cleveland on April 5-6.  “Talking” about some of her ideas ahead of time can prepare us for more useful discussion of her presented paper on Friday and of her several papers on enactment and related phenomena that will be the background of discussion during the 10:15 to 12:15 discussion on Saturday morning.

Her Friday evening paper is titled “The Analyst as a Transference Object, New Object, Real Object,” a title which will resonate for child analysts who have struggled for years with the triple task of recognizing that they are invariably a transference object (from primary objects of the past), new object (a fantasy laden person of the present) and a real object as well to their child patients.  I don’t know the content of the paper but expect that her case example, a child, will serve to help us better understand the place of these three levels of “object” that we have in the life of our child patients and, more often than we appreciate, in the lives of our adult patients as well.

But the emphasis I hope to bring to this blog concerns the Saturday discussion from 10:15 to 12:15.  I have promised Dr. Chused that we will not coerce her into another clinical presentation but will enter, with her, into a discussion of some important and complex subjects related to enactment.  She has recommended three papers for this discussion:

Chused, J.F. (1991). The Evocative Power of Enactments. J. Amer. Psychoanal. Assn., 39:615-639.

Chused, J.F. (2003). The Role of Enactments. Psychoanal. Dial., 13:677-687.

Chused, J.F. (1996). The Therapeutic Action of Psychoanalysis: Abstinence and Informative  Experiences.  J. Amer. Psychoanal. Assn., 44:1047-1071.

The first two, from 1991, which brought the whole subject of enactment into the mainstream of psychoanalytic thinking, and from 2003, which reviews the place of enactment in contemporary psychoanalysis, are bursting with ideas which were controversial when first stated and still are often misunderstood.

The third paper, from 1996, introduces a startling idea, “Informative Experiences” and a new take on a very old idea, Abstinence.  The paper cannot easily be summarized, suffice it to say for the moment that it is VERY thought provoking.

I’m going to stop at this point for the time being.  Before closing, should any of you not have PEP and therefore are unable to download the three papers listed above, let me know at asdowling@gmail.com and I’ll email you a reformatted version of each of them.

Please join with me in “talking about” these papers. I’ll try to get something up on the blog each day. But what we really want is your ideas, your thoughts, your reactions.            SCOTT DOWLING

Posted in Psychoanalytic Treatment | Tagged , , , , | 5 Comments

5 Responses to Blog Discussion: Enactments and Related Phenomena, Concepts of Judith Chused

  1. Judith Chused says:

    I want to thank Scott and others for inviting me to talk with you about enactments, psychoanalysis, and the process of working with patients. I am very much looking forward to returning to Cleveland. Judith Chused

    • Joanne Naegele says:

      I like thinking about the concept of “enactments” in modern day analytic work, where we are used to using what we experience in our countertransference to inform us. When what we are feeling has to do with a projective identification, and we receive it, let it touch us and inform us, the art is to formulate an interpretation in time which is useful to the patient. In this regard I especially like Irma Brenman Pick’s paper, entitled “Working through in the Countertransference” published in the book edited by Roy Schaefer (1997), The Contemporary Kleinians of London. She quotes Bion’s remark “that when two people get together they make a relationship whether they like it or not; this applies to all encounters including psychoanalysis” p. 348.
      The extremely useful idea in this paper is, “The patient does not just project into an analyst, but instead patients are quite skilled at projecting into particular aspects of the analyst. Thus, I have tried to show, for example, that the patient projects into the analyst’s wish to be a mother, the wish to be all-knowing, or to deny unpleasant knowledge, into the analyst’s sadism, or into his defenses against it. And above all, he projects into the analyst’s guilt, or into the analyst’s internal objects.” p. 358. I think that when the analyst finds herself the recipient of such a communication and is so moved to respond in an out of the ordinary way, at the point of realizing that this has happened, it is here that a meaningful communication with the patient can begin.

  2. Alexander Scott Dowling says:

    The topic of enactment immediately opens up a more general question: How do we communicate and what are the relationships of the various modes of communication with each other.
    Those of you who have heard me talk about infancy know that the intimate, unselfconscious entrainment of an infant’s movements with his mother’s speech helps cement their relationship. But is this communication in the sense of sending a personal message to the other? I think not … though entrainment of infant movement to the cadence of mother’s voice is an inborn capacity that contributes to the eventual capacity to communicate. Communication implies a specific message that is sent and is accurately received.
    I think we would all agree that within the first year there is extensive, non-verbal communication, a language of movement and sound that communicates needs, wants, and a multitude of affective states to caretakers. None of these needs, wants or affects are represented or experienced in language by the infant and the reciprocal response by the caretaker is neither formulated nor received as language.
    Does it make sense to think of the unconscious enactments of analysis and of daily life as continuations into later childhood and adult life of those earlier, non-verbal forms of communication? I am NOT suggesting that they are consciously directed or that they are regressive phenomena, more “primitive” than language, but simply as one of several modes of interpersonal communication that continue throughout life.
    By bringing the topic of enactments to our attention, Dr. Chused is also reminding us of the ubiquitous and many faceted modes of human communication. Those modes include facial expression,eye movements, body movements, non-verbal sounds, autonomic changes (blushing, sweating)and tone of voice. She also reminds us that both patient and therapist use these modes of communication.
    I’ll break off at this point..to continue later. If these comments stir a response.. add it to the commentary by Leaving a Reply… SD

    • Joanne Naegele says:

      Non verbal modes of relating are bedrock, in any relationship, analysis included. And of course it all goes back to the first year of life, when non-verbal communication is the way we relate to gestures and to words. This certainly continues into adult life.
      In Chused’s paper “The Therapeutic Action of Psychoanalysis” I like how she frames what she calls the “pivotal questions for psychoanalysis, specifically: How does a patient learn about himself? What initiates the process of self-discovery? And finally, to what extent is action within the analytic dyad, as opposed to the trial action of thought and feeling, an essential ingredient for analytic change?”
      The analytic frame is important, seeing the patient at a regular time 4 or 5 days/week. Being there and “available,” meaning attentive and interested in whatever is brought, is “healing.” For many this is a new experience. As M. Katan used to say, “You eat what the patient serves…”
      The analysis of “slips” within the analysis remain a rich source of information when analyzed, revealing phantasies and often have transference meanings which when looked at with a patient can often lead to looking a something differently, “with new eyes.” The patient is sometimes moved to a different place within himself when this occurs.
      I rely on interpretation as being an important way to facilitate change.I would feel like I had one arm tied behind my back if I did not have this tool of communication. But the timing is so crucial, and to have the patient “with you” when you make an interpretations is essential.
      This is not to underestimate the importance of being with the patient through “thick and thin”–listening to everything in a non judgemental way, accepting what the patient brings and having a chance to bring it into the light of day. This is healing as well. Split off parts of the personality can be looked at and re-integrated.
      Psychoanalysis is an art form–and one we profit from thinking about what we do and how we do it. This makes it constantly interesting and challenging.

  3. Murray Goldstone, MD says:

    Dr. Chused has been one of my favorite analytic thinkers for years. Her work on patient-analyst interaction beginning with small group discussions (with Dr. David Raphling) on “the analyst’s mistakes” and her re-working those thoughts into the emerging concept of enactments stands as an important, clearly described and thought-through study of the concept, and as a fruitful avenue for joining our American analytic approach with relational, interpersonal and object-relational perspectives on analytic work. In reading the papers in preparation for her visit I realized that I had not read her 1996 paper on “The Therapeutic Action of Psychoanalysis: Abstinence and Informative Experience”; and I found that she had grappled mightily with the issue of how analysis works, a subject that continues to intrigue me.
    I see her answers to that question as very similar to mine, although I find her more ready than I to compromise with what we were taught. She’s clear that the important impetus to the patient’s self knowledge comes from “experiences” during the analysis, not from the analyst’s interpretations. She uses her work with children to see that “by the time a child can hear an interpretation, analytic change has already begun.” Then she says that for “interpretation-resistant” patients who need something more, the “something more these patients need is not a ‘better’ interpretation but the opportunity to make their own observations and alter their own perceptions autonomously”. I absolutely agree, except that I find all patients to be “interpretation-resistant”. This comes from my observation that I myself am interpretation-resistant (students I have worked with would probably say that I become tiresome on that point). I think that Dr. Chused is reluctant to throw out a concept that seemed to identify analytic thinking for much of the 20th Century, even though she doesn’t use it. She says “Let me make it clear that I am not devaluing interpretations.” Then she goes ahead – as well she should – and does exactly that. She goes on to say “…..the content of an interpretation rarely initiates change”. So much for the old idea of the “mutative interpretation”.
    Then she considers what does lead to change, and comes up with the terrific concept of “the informative experience”. “Experience” in the analysis– which may be words (but not interpretive), acts, non-acts, any “dissonance…between psychic and external reality”. She adds that the dissonance may be in the patient, the analyst, or both. These are the charged moments in analyses that cause both participants to become aware and then, hopefully, to think. When there is as good an analyst as Dr. Chused in the dyad, such experience can be noted with minimal defensiveness and a continued attempt to study – to think about – and, perhaps to put into words what just happened or is currently happening.
    It’s here that I find Dr. Chused again feeling that she must stick with the concepts she was taught. She correctly observes that the important work of the analyst in dealing with informative experiences requires her to continue to study, to observe, to think about and sometimes to comment about the experiences. Some call this “maintaining the analytic field”. It requires that an analyst have a continuing concept of her attitude and function, and it’s aided by the analyst’s own analysis. My problem is that Dr. Chused describes this important requirement as “abstinence.” This word has taken on in our culture a sense of disengagement, of accent on control of one’s emotions and actions that easily becomes – in the work of analysts less comfortable with their field – a caricature. That’s why I have used words like “study”, “observe”, “aware”, “not defensive” rather than “abstinent”. I find that Dr. Kanzer’s description of abstinence as “a non-verbal negative intervention” is the more accurate portrayal of the stance as it’s taken in psychoanalysis.
    These are small quibbles in what I think of as a very important paper. Wish I’d read it 17 years ago; I could have referred students to it as one which explains my thoughts much more clearly than I can put them.
    Murray Goldstone, M.D.

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