Exploring the Therapist’s Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy

Abstract

Psychoanalytic psychotherapists, drawing upon intersubjective and attachment theories, recognize that mutual influence impacts the treatment process. Mutual influence generates enactments--emotionally intense joint creations stemming from the unconscious of both therapist and patient--which often leave both patient and therapist feeling confused and stuck. The author presents a case in which the therapist's use of improvisational role play was a critical therapeutic response to an enactment. The therapist's self-expression through the displacement of the role play 1) modeled a safe, affectively genuine engagement in relationship, 2) provided the patient with an unexpected and powerful window into the therapist's emotional world, 3) shifted the patient's fundamental belief that fathers and men are cold and unfeeling, and 4) led the patient to uncover "new" early memories and to become aware of his role as an agent of vitality and intimacy. The author concludes that using improvisation as a flexible response to rigid patterns of enactment may provide a catalyst for therapeutic change.

Conceptual and Technical Aspects of Psychoanalytic Enactment: A Systematic Review

“…This conception is important because the process by which the patient and analyst construct meanings in analysis or psychotherapy is subsequently moulded by enactments. They identify that ‘someone’ exists in the mind of ‘some other someone’ and that, as a consequence, this other is being responsive (Loewald, ; Smith, ; Gabbard, ; Reed, ; Feldman, ; Jones, ; Allen, ; Frank, ; Anchin, ; Gerson, ; Sullivan, ; Ivey, ; Stern, ; Yerushalmi, ; Steiner, ; Gilhooley, ; Pagano, ; Boston Change Process Study Group, ; Skogstad, ; Sapisochin, ; Bohleber et al ., ; Cassorla, ; Coren, ). This content reinforces what some authors refer to when they associate the occurrence of enactments with the possibility of corrective emotional experience through which early unconscious conflicts can be experienced with better resolution in the present (Loewald, ; Friedman & Natterson, ; Varga, ; Sullivan, ; Ivey, ; Pagano, ).…”

“…Many authors characterize enactment as play‐acting (Loewald, ; Jacobs, , McLaughlin, ; Feldman, ; Levine, ; Feldman, ; Hirsch, ; Cassorla, ; Varga, ; Pagano, ; Skogstad, ; Bohleber et al ., ; Coren, ; Bonovitz, ). White () describes how a patient, as ‘protagonist and director’, re‐lives a role from childhood by ‘play‐acting’ on the stage, or in the office of an analyst or therapist, who also plays a role in this dynamic and unconscious performance.…”

“…They also allow comprehension of how reality is perceived by the patient and how this perception is reflected in the attitudes of the analyst or therapist. Many authors refer to the existence of mutual coercive or persuasive influence in the phenomenon of enactment (Jacobs, 1986;McLaughlin, 1991;Levine, 1994;Feldman, 1997;Bateman, 1998;Katz, 1998;Hirsch, 1998;Friedman & Natterson, 1999;Cassorla, 2001Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Allen, 2002;Frank, 2002;Anchin, 2002;Weiss, 2002;Wurmser, 2003;Gerson, 2004;LaFarge, 2004;Zanocco, De Marchi & Pozzi, 2006;Ginot, 2007;Ivey, 2008;Yerushalmi, 2010;Steiner, 2011;Pagano, 2012;Strauss, 2012;Skogstad, 2013;Sapisochin, 2013;Bohleber et al, 2013;Nos, 2014;Kogan, 2014).…”

“…The intensity of the conflict interferes in the understanding of what is happening, and this leads to failures in sublimation. A blockage sets in that results in a reduction of reflective space (Jacobs, 1986;Chused, 1990;Reed, 1997;Feldman, 1997;Bateman, 1998;Hirsch, 1998;Burnstein & Cheifetz, 1999;Friedman & Natterson, 1999;Cassorla, 2001Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Goldberg, 2002;LaFarge, 2004;Varga, 2005;Bonovitz, 2009;Stern, 2009;Ginot, 2009;Pagano, 2012;Strauss, 2012;Boston Change Process Study Group, 2013;Sapisochin, 2013;Bohleber et al, 2013;Nos, 2014).…”

“…Feelings of responsibility may confuse an analyst and lead her to act according to meanings that are not yet clearly identified in the situation, thus weakening her therapeutic posture. Enactments therefore consist of obstructive interactions with collusions or states of impasse, making analytic evolution difficult (Chused, 1991;McLaughlin, 1991;Levine, 1994;Reed, 1997;Feldman, 1997;Bateman, 1998;Hirsch, 1998;Burnstein & Cheifetz, 1999;Allen, 2002;Frank, 2002;Wurmser, 2003;Gerson, 2004;LaFarge, 2004;Zanocco, De Marchi & Pozzi, 2006;Ivey, 2008;Stern, 2009;Bonovitz, 2009;Ginot, 2009;Steiner, 2011;Pagano, 2012;Strauss, 2012;Skogstad, 2013;Sapisochin, 2013;Cassorla, 2001Cassorla, , 2008Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Bohleber et al, 2013;Nos, 2014;Safran & Kraus, 2014).…”