What happens before and after acute enactments? An exercise in clinical validation and the broadening of hypotheses

Abstract

This paper seeks to validate clinical facts and theoretical hypotheses that have been discussed before and that address configurations involving chronic and acute enactments. Its validation process compares clinical material from psychoanalytic work in different psychoanalytic cultures - work from South America-Uruguay (Yardino), Europe-Spain (Sapisochin), South Africa (Ivey), Europe-UK (Bateman). It documents clinical facts described in four articles and confirms that during chronic enactments the analytic dyad gets caught up in a dual relationship that veils and congeals the triangular situation because acknowledging it would be traumatic. The lack of triangular space impedes the formation of symbols as well as dreaming and creates non-dreams-for-two. During chronic enactments analysts use their implicit alpha-function to assemble traumatic areas. These areas emerge as a mix of discharges and non-dreams that are dreamed through acute enactments. Acute enactments occur when chronic enactments dissolve and patients experience an abrupt contact with reality. The attenuated trauma is then dreamed alive. The linking of new symbols develops a network of symbolic thought and creates dreams-for-two and broadens the patient's mental universe. The validation process has deepened our vision concerning clinical facts, especially in relation to: (1) the wavering between acute and chronic enactments, (2) analysts' inhibitions and feelings of guilt, and (3) the influence of analysts' personalities on the configurations they describe. These theoretical hypotheses have been confirmed and broadened not only in relation to the vicissitudes of dream work in traumatic areas, but also in relation to defenses such as thin or thick skin, and in relation to listening in countertransferential detours.

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, ).…”

“…The authors most often cited are Jacobs, 18 articles; McLaughlin, 16; and Chused, 13; Feldman and Ivey, 4; Bateman, 3; Levine, 2; Friedman and Natterson, 2; and Frank, 2. Cassorla () is cited by other authors in four articles and Cassorla () is cited in two, while he, on four occasions, cites articles of his own in later publications. It should also be noted that Cassorla is the author who most frequently cites other authors, namely, the following six: Jacobs (), McLaughlin (), Chused (), Feldman (), Bateman (), Ivey () and Sapisochin ().…”

“…Numerous authors stress that enactments are an intersubjective process (Gabbard, ; Allen, ; Frank, ; Anchin, ; Gerson, ; LaFarge, ; Varga, ; Ginot, ; Sullivan, ; Ivey, ; Bonovitz, ; Yerushalmi, ; Steiner, ; Gilhooley, ; Strauss, ; Boston Change Process Study Group, ; Sapisochin, ; Cassorla, ; Bohleber et al ., ; Busch, ).…”

“…In addition, although one periodical on child studies in psychoanalysis is included in the references, the article referred to contains no examples of clinical work with children (White, 1992). Clinical examples taken from cases of children and Cassorla (2001Cassorla ( , 2008Cassorla ( , 2012Cassorla ( , 2013Cassorla ( , 2017 Brazil 5 Chused (1990Chused ( , 1991 USA 2 Hirsch (1992,1998) USA 2 Feldman (1993Feldman ( , 1997 South Africa 2 Ginot (2007Ginot ( , 2009 adolescents are mentioned in other journals, namely, Journal of the American Psychoanalytic Association (Chused, 1990(Chused, , 1991, The International Journal of Psychoanalysis (Feldman, 1993, Cassorla, 2017 and Psychoanalytic Psychology (Bonovitz, 2017).…”

A mismatch of meaning and intentionality between analyst and analysand

“…The term ‘acting out’ currently falls within the concept of enactment which is broader in scope. Enactment is intimately related to the notion of projective identification and is bound up with provocation and manipulation of the object (Cassorla, ; Jacobs, ; Sandler,; Sapisochin, ), and stimulation or inducement to act (Paz, ; Spillius, ).…”