Thomas Ogden, “Comments on Transference and Countertransference in the Initial Analytic Meeting” (1992) (II)

Arguably no theme divides the standpoints of classical and interpersonal psychoanalysis as starkly as anxiety: its causes and consequences, its meaning, and its management. From the interpersonal standpoint, anxiety is itself the cause of mental illness and so must be managed with extraordinary care — nothing therapeutic is possible in the absence of that management. This position accounts in large part for the importance of a set of metaphors reflecting the new analytic mandate: “holding,” “containment,” “titration,” and so on. If Ogden in this essay does not reject these analytic functions, he certainly does not underline their importance, either. And indeed, it is difficult to reconcile the importance of analytic “holding” with Ogden’s unreserved defense of analytic “neutrality,” even — perhaps especially — in cases of considerable anxiety:

“Despite the fact that transference anxiety is extremely high in the period leading to the initial interview, I do not view it as the analyst’s job to put the patient at ease in the first meeting. On the contrary, I believe it is his task to help the patient not miss an important opportunity to recognize and understand something about the transference thoughts, feelings, and sensations with which he has been struggling” (229)

Above all, Ogden cautions against the impulse to diminish this anxiety — one that dominates the first interactions — through any number of essentially non-analytic devices, including well-meaning chit chat; explanations of analytic theory and procedure; detailed inquiry; or even, as I noted in the last entry, frank answers to the majority of the patient’s questions. These palliatives, Ogden claims, foreclose precious opportunities for the patient’s self-understanding by imposing the analyst’s agenda (from motivations, further, related to his or her own unanalyzed, counter-transferential anxiety). These devices prevent the patient from spontaneously generating the content of the analysis and shaping the “space” within which it unfolds; and they purportedly establish a misleading precedent regarding the analytic attitude towards anxiety.

As a rule, then, efforts to directly diminish the patient’s anxiety — for Ogden, seemingly all anxiety in the first session is describable as “transferential” — deprive the patient of an opportunity for reflection, interpretation, and insight. But what if a new patient essentially requires, not self-understanding per se, but an experience in which difficult material is safely approached without incurring the disintegrating effects of anxiety? In this case, might Ogden’s approach entail missing another sort “opportunity” — namely, the opportunity to learn, affectively, that difficult material and safety can co-exist?

The title of this section of the article, “Sustaining Psychological Strain in the Analytic Setting” (230-34), conveys a rather different idea: anxiety is not an obstacle to analytic progress but rather its condition of possibility, the guise in which the main stuff of analysis surfaces. To defuse anxiety is therefore to preempt psychoanalysis itself. Ogden specifically objects to the analyst’s casual, “kind” comment that in the moment seems appealing as an anxiety-reducing measure: “‘I hope you didn’t have trouble finding a parking space. Parking is awful around here’” (230). Any such comment broadcasts particular unconscious messages that tilt analysis in a specific thematic direction, and constrain the patient’s “freedom” to initiate and direct the analysis however he or she chooses. But this measure also fatally misrepresents the analytic process — an impression that, Ogden indicates, the analyst will have trouble correcting later on:

“A comment of the type being discussed misleads the patient about the nature of the analytic experience. As analysts, we do not intend to relieve anxiety (our own or the patient’s) through tension-reducing activity, reassurances, gift-giving, or the like…Whether the incident is ever spoken of again, the analysand unconsciously registers the fact that the analyst has granted himself license to handle his own anxiety by means of countertransference acting in” (231, my italics)

This last line suggests another premise. Consider, again, Ogden’s objection: the analyst who helps himself to a casual comment “handle[s] his own anxiety by means of countertransference acting in.” This indicates that a certain mental content — e.g. anxiety — may either be expressed verbally or “acted in” (as opposed to the patient’s “acting out”). According to this tendentious contrast, analysis consists in articulating these contents, bringing them out into the open, where they admit of interpretation. The alternative to imparting discursive form to these contents is their unconscious discharge through action. Such action evades the needed interpretation; in fact, it embodies the exact neurotic “repetition compulsion” that must be analyzed and uprooted. Paul Ricoeur has captured this dimension of the traditional position in his essay, “Psychoanalysis and Hermeneutics”:

“This restriction to language is…inherent to the analytic technique. [The latter] forces desire to speak, to pass through the defile of words, to the exclusion of any substitute satisfaction as well as any regression in the direction of ‘acting out’” (54)

On Ogden’s account, again, the analyst who handles anxiety by acting upon counter-transferential feelings — say, with a “casual” comment — models essentially anti-analytic behavior: he signals that distressing affects (or wishes, ideas, and fantasies) ought to be acted out (or “in”) and precisely not communicated.

But this classical premise, too, has been contested, at least in the form I have given it here. In particular, interpersonalists and relationalists have complicated the tidiness of any exclusive opposition between either expressing a content, analytically, or acting it out, non-analytically. In fact, any action will bear an expressive, communicative, or symbolic dimension (hence need not be avoided entirely, indeed, cannot be), just as, conversely, the verbalizations and interpretations of analysis are themselves in the nature of “actions.” The emphasis on “enactment” in this critical discourse — as something potentially valuable and, in any case, inescapable — should perhaps be understood in this context. The concept of enactment seems precisely to encompass a range of analytically-meaningful behaviors that are neither exclusively discursive nor instances of “acting out.” Rather, enactments contain admixtures of both. And in fact, Ogden himself gestures in this direction. After warning the analyst not to initiate things with an anxiety-dissipating comment to the patient, and thus “burdening him with the analyst’s own unconscious contents before he even sets foot in the consulting room” (231), Ogden concedes, parenthetically: “There will be plenty of time for that later, as the analyst inevitably becomes an unwitting actor in the patient’s unconscious fantasies” (231).