Analyst and patient occasionally arrive at moments of heightened meaning and aliveness. These moments can be transformative and lead to psychic change in the patient. They give life and arouse hope, and feel "real" in a new way, though often entailing emotional turbulence. Specific internal work must be done by the analyst to allow for and foster these experiences. This involves a kind of mourning process in the analyst that allows for "presence" and "availability" as described by Gabriel Marcel, and for the "at-one-ment" described by Bion. These transforming moments can be viewed in an aesthetic realm, along the lines of Keats's "Beauty is truth, truth beauty." This embodies the analytic value of emotional truth. These moments are shared and their emergence is an intersubjective creation. Clinical illustrations show how the internal work of mourning by the analyst through directed introspection allows for presence and availability, and then for shared moments of beauty with the patient.
I propose a view of the treatment process with adolescents which places interactive play at the center. The adolescent plays by creating a highly charged interpersonal drama with the analyst to work out specific developmental conflicts. These conflicts involve struggles for greater autonomy and the formation of a solid sense of identity in the face of regressive pulls. The analyst unwittingly is taken up in the play and uses his or her sense of involvement as material for interpretation to further the play or resolve periods of strain when play falters.
The analyst’s embodied attunement and participation arises within an embodied analytic relationship. Understanding this “deep structure” of the interaction and attention to this level of interaction opens up new modes of engagement and therapeutic action. The importance of embodied attunement is supported by recent research and theories that the developing mind is shared and dialogical through bodily communication, by rhythms of cadence, tone, intensity, and movement. The analyst’s embodied awareness of two bodies together and their interpersonal rhythm is the “tool” used to gauge the pulse, vitality of connection, and particular rhythmic qualities of a uniquely shared world. This provides a read on the most elemental way the dyad shares emotional experience (or fails to). The analyst’s embodied participation is interpretation in another mode. Clinical examples illustrate how embodied attunement and intentional participation work in the session, and their therapeutic effect. Failures of attunement are also discussed in terms of how the analyst recognizes these failures and his internal process of reattunement.
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