Understanding and Using Enactments to Further Clinical Work: A Case Study of a Man Unable to Experience Intimacy

Abstract

This article examines the value of working within enactments-affectively charged, unconscious remnants of painful, past experiences played out in the novel context of the therapeutic relationship-to further the work of psychodynamically oriented therapy in the treatment of a HIV-positive Hispanic gay male in his early 30s with a history of relational trauma. Through clinical vignettes, I highlight how relational uncertainty and its vicissitudes-vulnerability, doubt, safety, and trust-have triggered mutual dissociation in the context of enactment. At times, this has disrupted our ability to communicate honestly and relate intersubjectively. By working within affectively charged enactments, we have expanded our capacities to accommodate to relational uncertainty and used the tension of ambiguity within our relationship to permit the emergence of a shared space for recognition and self-discovery.

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.…”

“…This moment 'M' corresponds to a moment when a positive change begins, even though tension is felt at the beginning; or, as Bateman (1998) put it, to a turning point, or sudden break-up (Cassorla, 2001), an 'explosion' (Cassorla, 2008). The participation of the analyst as a narcissistic extension of the patient (a chronic enactment) is interrupted (LaFarge, 2004;Zanocco, De Marchi & Pozzi, 2006;Steiner, 2011;Cassorla, 2001Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Nos, 2014;Tuch, 2015;Coren, 2015).…”

“…The analyst or therapist is able to 'go off stage' and warn of the different roles that are being played, then transmit to the patient the possibility of developing the ability to broaden his insights. The formerly frightening defences against facing the trauma are now recognized and can be better structured (White, 1992;Levine, 1994;Reed, 1997;Katz, 1998;Bateman, 1998;Burnstein & Cheifetz, 1999;Friedman & Natterson, 1999;Allen, 2002;Ivey, 2008;Steiner, 2011;Pagano, 2012;Strauss, 2012;Sapisochin, 2013;Cassorla, 2001Cassorla, , 2008Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Coren, 2015;Tuch, 2015). The understanding of the transference and countertransference is thus broadened (Freud, 1905(Freud, , 1910(Freud, , 1912, as is the awareness of projective identification, defence mechanisms (Klein, 1946) and the communication potential of the relationships established in the analytic field (Bion, 1961;Baranger & Baranger, 1961-62).…”

“…It is this emphasis on the interpersonal perspective that constitutes the most adequate way to enable analysts to deal with the dynamics of transference and countertransference and with thought processes arising in the analytic field. The involvement of analysts and therapists in recognizing and accepting their own feelings and the roles they play will serve as a tool for more effective therapy (Jacobs, 1986;Loewald, 1986;Smith, 1990, McLaughlin, 1991Hirsch, 1992;Levine, 1994;Almond, 1995;Reed, 1997;Feldman, 1997;Bateman, 1998;Friedman & Natterson, 1999;Allen, 2002;Anchin, 2002;Weiss, 2002;Wurmser, 2003;LaFarge, 2004;Ginot, 2007;Ivey, 2008;Bonovitz, 2009;Stern, 2009;Yesrushalmi, 2010;Steiner, 2011;Gilhooely, 2011;Skogstad, 2013;Cassorla, 2001Cassorla, , 2008Cassorla, , 2012Cassorla, , 2013Cassorla, , 2017Bohleber et al, 2013;Safran & Kraus, 2014;Coren, 2015).…”