Holding, Collaborating, Colliding: A Cross Theoretical Conversation

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1 Psychoanalytic Inquiry, 31: , 2011 Copyright Melvin Bornstein, Joseph Lichtenberg, Donald Silver ISSN: print/ online DOI: / Holding, Collaborating, Colliding: A Cross Theoretical Conversation Joyce Slochower, Ph.D. Lester Lenoff s thoughtful article explores the intersection of my work on holding with some core Kohutian ideas. Lenoff offers a respectful consideration of our perspectives their overlaps and their divergences. It s important to preface my response, I think, with a clear acknowledgment of the pitfalls of cross-theoretical conversations. Kohutian theory has its own jargon, quite different from mine. Less immersed in its nuances, I approach it from the outside in and, in so doing, there s the danger of misapprehension, of smoothing out and exaggerating differences, that is, of confusion of tongues. I think of holding my way; you view the selfobject function in yours and as we try to bridge our perspectives, something gets lost in translation. With this caveat, I plunge in, hopeful that dialogue will allow us to refine and delineate areas of overlap and difference. In his discussion, Lenoff refers to Relational theory. Relational theory, like self psychology, has expanded in multiple directions over the years; it is an umbrella term that has many facets and resists reification. For this reason, I prefer to use a small r in discussing it. And because both self psychology and relational theory are really theories rather than unitary positions, I limit myself here to Lenoff s exploration of my writing about holding as it interfaces with his Kohutian perspective. I do not address the broader question of differences between Kohutian thinking and other aspects of relational theory, nor do I consider my overlap with contemporary self psychological models. I begin with a detour into the relational critique of holding and then turn to the relationship between Lenoff s Kohutian theory and my own work. THE HOLDING METAPHOR IN A RELATIONAL CONTEXT By the mid-1950s, Winnicott (e.g., 1955) and other members of the British Middle Group were using the holding metaphor to describe the parallel between maternal care and the analyst-patient relationship. The Winnicottian mother/analyst protected the very vulnerable baby/patient from noxious environmental impingements in an effort to contact early failures and support access to previously hidden true self experience. 1 That idea generated a powerful response. If the analyst 1 Although Winnicott is most frequently associated with work on the holding process, many others have also contributed to the concept of holding or containment, including Bion (1959; 1962, 1963), Little (1960), Loewald (1960), Sandler (1960), Khan (1963), Balint (1968), Kohut, (1971), Bollas (1978), and Sandback (1993). Joyce Slochower is Professor Emerita at Hunter College and CUNY, Faculty at the NYU Post Doctoral Program in Psychotherapy and Psychoanalysis, the Steven Mitchell Center, Psychoanalytic Institute of Northern California, Institute for Relational Psychoanalysis of Philadelphia and the National Training Program of NIP.

2 502 JOYCE SLOCHOWER symbolically can become the mother, the possibility of reworking early trauma is enormously increased; what cannot be remembered can be re-experienced and then repaired; the patient can, in fact, be a baby again, but with a better, more responsive mother. But ideas like regression to dependence and the analyst s holding function collided with social constructivist theory and feminist critiques of the idealization of motherhood (see, e.g., Chodorow, 1978; Benjamin, 1988; Bassin, Honey and Kaplan, 1994). Mitchell (1988), Aron (1991; 1992), Hoffman (1991), Stern (1992), Tansey (1992), Burke (1992), and others challenged the assumption that it s possible for the analyst to function within a holding frame. Critiquing holding s developmental tilt, they emphasized the patient s adult status and the impossibility of replicating the maternal environment in the analytic setting. Neither mothers nor analysts are capable of anything close to perfect affective responsiveness; the analyst cannot empty herself of herself, and it is mystifying and countertherapeutic to pretend otherwise. A collision coalesced between two conceptions of the analytic space one organized around visions of a maternal (Winnicottian) holding environment and the other grounded in the actuality of the analyst s separate subjectivity and the fruitfulness of intersubjective exchange. Embracing the latter model, early relational and interpersonal theorists rejected the holding position as infantilizing of the patient and illusory in its elevated description of the analyst s therapeutic capacity, knowledge, and certainty about the patient s needs. In the relational world, the baby and the maternal/analytic bathwater were fading fast. Coming to relational theory from object relations (Slochower, 1991, 1992, 1994, 1996a, 1996b, 1996c, 1999, 2004), I was fascinated by the relational critique but loath to abandon the holding metaphor. Additionally, my clinical experience did not resonate with the assumption that the analyst s otherness is always useful to the patient. Although my perceptions about and reactions to a patient were sometimes worked with usefully, at other times they caused sustained derailment that seemed anything but therapeutic in effect. In general, it was my healthier patients who worked well intersubjectively. Others, more vulnerable and reactive or less able to sustain interior experience did not. The case of Karen illustrates the latter clinical situation and describes my attempt to find a different therapeutic point of entrée. It was this kind of process that took me toward a modified version of Winnicott s holding frame. Holding helped establish a containing and affectively resonant space, a thicker buffer against evidence of my separateness that limited derailment and facilitated self-exploration. But how to address the relational critique of holding? I underscored the analyst s limited power to function with the maternal metaphor while retaining a (partial) developmental perspective. Articulating a theme that is, I am sure, familiar to self psychologists (despite our different lexicons), I argued for the importance of holding as one analytic thread while reformulating its dynamics and introducing the idea of analytic bracketing. Holding does not require holding back, i.e., deleting one s reactions as relational critiques (e.g., Bass, 1996) suggested; the holding analyst struggles to bracket that is, to sustain contact with her subjectivity without actively introducing it into the therapeutic dialogue. The purpose of this bracketing process is to create a (partially) protected space within which to access and articulate her experience. By introducing the concept of bracketing, I attempted to bridge two positions: One emphasizes the analyst s irreducible subjectivity; the other, the patient s need not to know what the analyst thinks or feels about her (or anything else). The concept of bracketing embodies the

3 HOLDING, COLLABORATING, COLLIDING 503 there-but-not-there quality of analytic subjectivity within a holding frame and makes room for leakage, i.e., ways in which the holding analyst inevitably fails to hold. I extended my ideas about holding s developmental function beyond Winnicott s notion of regression to dependence and explored how it might function in work with patients expressing intense but nonresonant affect states such as hate, envy, and self-involvement (narcissism). Here, holding means refraining, as much as possible, from expressing one s disjunctive subjectivity while attempting to remain within the patient s experiential sphere. Whether the analyst attempts to hold hate, envy, dependency, or other affect states, the holding frame establishes a temporary illusion of analytic attunement within which the patient s experience of the analyst remains unchallenged. It is possible that the analyst will represent a maternal, nurturing figure. However, the holding illusion sometimes organizes around the patient s experience of the analyst as nonretaliatory, alive, and firm, consistently able to recognize and tolerate her patient s intense reactions. It s also worth noting that, although the patient in a holding frame may feel deeply understood, the illusion of attunement can also be experienced as absence (of threat, of the other) or as aliveness and space. I think the latter characterized Karen s experience of me in the middle phase of our work. When I work within a holding frame, I pay particular attention to my patient s reaction to my otherness. Can she sustain access to her experience of self and other while also recognizing and responding to difference? Or does she negate one of these, for example, dismissing or ignoring my input or abandoning her own perspective on herself? Of course, there are plenty of times when what I do or don t do doesn t fit neatly into either of these two frames, when it s unconsciously motivated, colored by the pull of an enactment, etc. I think this is true of all of us, whatever our theory. In extending holding beyond the realm of tender affective resonance, I emphasize the patient s (unconscious) expectations of the analyst s response to her more than the (related) shift in the patient s self-organization. In my relational view, the object, subjectively perceived, takes a more central place than in a Kohutian model. The latter focuses more on how the patient s experience of self shifts in response to the analyst as experienced. I held Karen because I accepted her (hateful) view of me as someone who could not understand and who was in danger both of destroying and being destroyed. I did not challenge or try to get under this view i.e., find the vulnerability against which she defended. Nor did I speak to Karen about herself, i.e., as someone who is angry or hurt, who couldn t stand my understanding or who feels all alone with herself. I spoke to her only about her experience of me. In this clinical context, the illusion of resonance shifted away from the (Kohutian) subject to the (relational) object (me). Of course, implicit here is a recognition of the subject (Karen) and her experience; nevertheless, my tilt was in the other direction. In my view, holding often exists in dialectical tension with interpretive or interactive work. However, it s worth noting that there are moments when the holding function is embedded within the analyst s interpretations and even in her self-disclosures. This is most likely to happen when my understanding (or my self-disclosure) feels expected and resonant, easily folded into the patient s subjective state. As you read these paragraphs, do you think, So maybe she s a Kohutian after all? You may hear a self psychological goal translated into another language: I struggled to find a nonthreatening way of being with Karen and in so doing, potentially provided, in Kohutian terms, a selfobject experience. This clinical stance invites the elaboration of self-experience and tilts away from a

4 504 JOYCE SLOCHOWER focus on interpersonal/intersubjective elements of the therapeutic interaction. But in my view, there are also some important differences. I consider holding to be a crucial way of working in response to a specific therapeutic dilemma. Holding does not represent my overarching model or analytic frame, and I don t always locate the selfobject function at the center of therapeutic action. To a considerable degree, my clinical stance, and thus my frame, is differently shaped in response to each patient s necessities and capacities; with most patients, there are moments when I work intersubjectively and other moments when I hold. My relational orientation may also be found in what I view as the limits of my capacity to deliberately take a particular clinical position. On one level, I choose to hold, on another, I m pulled in and out of this stance as a function of unconscious communications on my patient s and my part. There s something enacted (cocreated) in the move toward (and away) from holding, and these enactments don t always represent useful selfobject failures. For, try though we may, we cannot leave our separateness at the consulting room s door; the analyst s subjectivity is irreducible (Renik, 1993). As Kohut also recognized, aspects of the analyst s separateness inevitably infiltrate the clinical space and confront the patient with something of her otherness. I push this envelope a bit by theorizing how the analyst s inevitable misses sometimes do not result in the experience of a selfobject failure: To protect herself from disruption, the patient unconsciously establishes a buffered space, partially excluding those aspects of the analyst s presence that are incompatible with the holding illusion. By bracketing the analyst s variability, reactivity, and the ways in which she is unable to hold, the patient sustains the needed holding experience. In this view, the analyst does not hold alone; holding is a coconstructed phenomenon in which the patient participates. In line with contemporary intersubjective self psychological theories, I m pointing toward the space between i.e., to the way that patient participates with the analyst in establishing and maintaining a protected space. A pregnant supervisee who has been struggling with how to broach this topic with her patients reminded me of a particularly striking and, I believe, familiar example of this kind of bracketing. Many years ago, very pregnant with my third child, I waited in vain for John, a rather narcissistic patient, to show some sign that he was aware of this intrusion on our relationship. None came. I heard no references, oblique, unconscious, or otherwise, to my growing belly. When, approaching seven months and looking a bit like an overripe tomato, I finally told him as gently as I could that I was pregnant, he did a stunned double-take and stepped backward into a chair, shocked. He had not noticed a thing. His need to see us as a duo, together and alone in the world, had led him to utterly exclude the reality of my pregnancy, despite his ordinarily very sensitive awareness of actuality. Holding, then, takes two. But analyst and patient do not only construct a holding space together, they also negotiate its edges. These negotiations most often reside at the procedural level, remaining unarticulated and implicit. Yet they are crucial in creating the necessary conditions to sustain the holding experience. And these negotiations cut both ways: the patient (deliberately or unconsciously) lets the analyst know what she needs to feel sufficiently held while the analyst also establishes the limits of her capacity to remain within the holding space. Let me illustrate Donna, a patient, highly sensitive to rejection, became acutely disrupted if I ended our session without giving her a kind of countdown, signals warning her of the upcoming

5 HOLDING, COLLABORATING, COLLIDING 505 disruption. I was aware that she could not articulate this need directly because of intense feelings of shame about her sensitivity and that, were I to say any of this aloud, Donna would feel acutely humiliated. Sensing also that these signals could not be verbal, I somewhat unconsciously began to indicate the upcoming session s end with progressive movement in my chair, shifts in voice tone, etc. In response, Donna began to relax and became progressively more able to use our time usefully. We couldn t talk about any of this directly for quite a long time. Yet, despite Donna s need for near-perfect attentiveness and predictability, she also seemed to encompass some non-negotiable aspects of my own subjectivity without undue distress. Donna tended, for example, to get quite anxious and upset in anticipation of even a one-day break, whether for a planned vacation, conference, or unexpected illness. I was thus surprised to note that she did not seem particularly upset when I canceled in advance for the Jewish holidays (she was not Jewish). Was this because Donna unconsciously recognized but bracketed the limits of my ability to hold, i.e., the presence of my non-negotiable (Jewish) separateness? Was there some unconscious compliance at work here? Avoidance (of disruption, difference, conflict)? Or was this a (relational) gift was Donna giving me this time off because we had, as Lenoff aptly puts it, co-organized a relationally specific approach that included in it aspects of the non-negotiable for each party? So what s the down side? Within an illusion of analytic attunement, my patient s selfexperience and sense of the other remain relatively unchallenged. As a subjective, more than an external object, I am more or less unknown, protected from and deprived of the reality of my externality as an object and a subject. A high price is paid for this degree of protection, for it leaves my patient at the mercy of my affective evenness, without much resilience vis-à-vis my inevitable variability. In my view, a central clinical goal thus involves a gradual movement away from a need for holding and toward a capacity to both tolerate and enjoy intersubjective engagement. Although patient and analyst may feel some loss (of the intimacy of a holding experience), there is also release involved. Both of us become freer to be to express our different reactions to and perceptions about a (separate) other. I am suggesting, then, that there is a developmental trajectory inherent in the move from holding toward collaboration. However, I don t view this trajectory as altogether unidirectional. The need for holding experiences pervades both the life span (Slochower, 1993) and the analytic process. It reemerges at times of emotional crisis, and thus remains a crucial dimension of human experience. In this sense, my developmental perspective on the holding function is a relative one; I don t believe we grow out of such needs, but instead, that across the treatment process (and the lifespan), we acquire a fuller capacity to shift relatively fluidly between moments of holding and intersubjective engagement. Having argued so passionately for the value of holding within a relational frame, I sometimes feel that I ve been stereotyped, indeed, branded with the H word. So, it s quite important to me to underscore that, in my view: (1) holding is not enough and (2) my work and thinking has moved on since the 1990s, when I wrote Holding and Psychoanalysis (1996a). To my eye, there s lots more to psychoanalysis than holding, even relational holding. My more recent writing (Slochower, 2006) focuses on the analyst s confrontation with what I ve called psychoanalytic collisions. These represent, in a sense, the underbelly of the holding experience, i.e., the ways in which the professional vision to which we aspire clashes with the actuality of our failure to function within, for example, a holding metaphor. We may embrace a psychoanalytic ideal

6 506 JOYCE SLOCHOWER organized around the vision of ourselves as a bountiful, resilient holding analyst, capable of tolerating attack, and so on. But our desired way of functioning will inevitably clash with aspects of our less-than-ideal analytic selves. These collisions emerge out of the space between our professional ideal whatever its clinical particulars and the actuality of our very human subjecthood. Our capacity to struggle with these moments of collision deserves study rather than censure for they are crucial in shaping clinical outcome. WHO S HOLDING WHAT? Lenoff (this issue) picks up on a collision between his theory and my own when he characterizes my position as revolving around conflict between the analyst s material reality and the internal objects that populate [the patient s] world. Lenoff (this issue) contrasts my conflict model with Kohut s deficit model: Slochower s theory revolves around conflict between the analyst s material reality and the internal objects that populate Karen s subjectivity.... The crux of these problems is that the external objects, the significant others in Karen s life have a real existence that resists her perception and control. Within the analysis, the task is twofold. There is the goal of collaborative negotiation directed at separating those constituents of the analytic object that reflect material interactions from those reflecting Karen s pre-existing representations of significant others. Here, Lenoff suggests that I distinguish between what is real (the analyst s perception) and illusory (the patient s distorted view), aiming for a shared or negotiated recognition of the analyst s material reality. I don t see things this way; I don t believe that the analyst s material reality is intrinsically more material or more real than the patient s (I m actually not sure Kohut did, either). Indeed, from my perspective, reality is not especially relevant in the clinical situation. I aim to focus on my patient s experience of herself and of me with the assumption that both our subjective realities are meaningful and require understanding. When they clash (I prefer this term to conflict), I see the analyst s task as building a bridge, with the patient, between patient and analyst s subjectively perceived experience without privileging one perspective as more material than the other. In working to deepen my patient s understanding of her own process, her experience of people in her life and her impact on the other, I especially attend to affective shifts that coalesce around our interaction, tracking (as much as I can) my patient s response to my interventions and trying to study the space between her experience of me as it coexists with my response to her. I most often keep the latter to myself, but it serves as a point of investigative entrée. When my patient can enter this space and explore (rather than simply accept) her experience, I d say there are two of us in the room, and that we are engaging collaboratively. With some patients, it is possible to explicitly negotiate around our subjective realities. But with most, this process evolves implicitly as the safety of the analytic setting makes space for deepened self-reflectivity and a developing tolerance for difference. With a few (those who remain within a holding frame over long periods), there s virtually no room at all for negotiation; the analyst works to contain difference and remain within the patient s subjective experience (with the patient s unconscious participation). Lenoff (this issue) emphasizes the explicit collaborative element:

7 HOLDING, COLLABORATING, COLLIDING 507 This collaboration encourages exploration of the analyst s subjectivity, along with that of the patient. Working collaboratively, Slochower might, for example, contradict the insistence that she is, not in Karen s perception, but in fact, incompetent and greedy. Patient and analyst would negotiate the reality of each other s presuppositions and conclusions about their relationship. This collaborative engagement would allow Karen to take perspective on her interpersonal expectations, which reflect her internal object relations. Had Karen been able to engage with me in this way, we would have come a very long way. Indeed, this kind of open, explicit intersubjective interchange is something that we move toward and away from and rarely sustain, even in our personal lives. Certainly, it s great when it happens. I want to emphasize, however, that I don t define collaborative process as an active focus on the nature of the therapeutic relationship. I think of collaboration as reflected in a capacity to entertain alternative ideas or views (rather than facts) of oneself even when they bother or disturb without serious and prolonged derailment. Thus, my patient and I may well be collaborating when we re not talking about us. When my separateness derails, I sit up, therapeutically speaking. But I don t immediately turn to holding. I first ask myself whether I might be off base, emotionally or dynamically, whether we re involved in a problematic reenactment. Is my patient reacting to my being too much like old objects or too different from them? I ask these questions (of myself) because I assume that I don t have a lock on truth. The same distinction applies to the concept of negotiation. Certainly, there are times when I explicitly share my subjective experience with a patient and negotiate a third, overlapping construction of our relationship, but this kind of interaction is not my emphasis. Far more often, I view these kinds of negotiations to be more implicit than overt. My subjectivity might be expressed in a raised eyebrow or the smile that accompanied a response (I was that awful, huh?). My limits are probably similarly embedded for example, in my tone (more or less regretful, conflicted, firm) as I announce a fee raise. And, of course, my tone is itself shaped by both my own feelings (guilt, pleasure, necessity) and responsive to my anticipation of my patient s experience of, and reaction to, that announcement. HOLDING AND THE SELFOBJECT FUNCTION In an important book, Teicholz (1999) explores and compares a number of different models of self psychology, as well as their overlap and divergences from what she calls the moderate postmoderns (pp. 7 8). She details the readings (and misreadings) of Kohut as a one-person theorist. As Teicholz notes, my argument that some patients cannot tolerate the intrusion of the analyst s subjectivity into the treatment setting is close to Kohut s emphasis on the analytic selfobject function. Teicholz suggests that my position corrected the excesses of the early relational theories as Kohut corrected the excess mechanization and objectification of early classical theories of the analytic role. Although I see myself as very much a two-person theorist, my concept of holding is located in the territory of Kohut s vicarious introspection. To hold, I try to imagine my way into my patient s experience. My aim is to meet her, as much as possible, where she is, and this sounds a lot like a selfobject function (to the degree that it is experienced in this way by the patient). I attempt

8 508 JOYCE SLOCHOWER to enter my patient s subjective experience, using my own study of myself in the process. But I emphasize, more than Kohut, my inability to fully immerse myself in the patient s experience, and I thus focus more on what I do with myself while trying to hold. This perspective clashes with the idea that the analyst actually can enter the patient s subjective space, a theory that Stolorow, Atwood, and Orange (1999) call a doctrine of immaculate perception (p. 386). There is a tension inherent in my view of the analyst s subjectivity I view it as a vehicle for understanding, but also as a formidable obstacle to complete empathic immersion. For this reason, I give weight to analytic self-holding and also emphasize the analyst s push toward a mutual, dialogic position more, I think, than a Kohutian point of entrée would require. Further, I focus less on the experience of self, per se than on the ways that my patient s sense of herself and of the other is informed, shaped, and reshaped in response to explicit and implicit relational dialogue. That dialogue contains elements of both old and new ways of experiencing the other. These are, in my language, the reenactments that are an intrinsic part of every analytic relationship. How I work with them depends on whether my patient can tolerate examining both my contribution and her own. HOLDING KAREN I turn now to the case of Karen. As Lenoff notes, holding Karen involved holding her rage rather than her neediness. Climbing inside Karen s hate, Lenoff imaginatively plays with its sources and shape. He describes my use of Winnicott s distinction between object relating and object usage as it parallels the analyst s move toward holding or collaborative work, locating Karen s rage in the entitlement that is a part of the infant s experience of object relating. Lenoff s way of articulating my point of view has stimulated a process of internal clarification for me. As I read his conceptualization, I thought to myself, No, that s not quite right. Yet, as I followed his quotation of my own words, it seemed to be what I had said. Aspects of my own assumptions, clear to me but implicit rather than articulated, took him down a slightly divergent path from the one I would have drawn and has opened an opportunity for dialogue. On one level, Karen resided in the realm of object relating (Winnicott, 1969); she could not bear my otherness or examine her own experience with an eye toward alternative understandings. And so, when Lenoff (this issue) suggests that Karen feels entitled to provision, and requires action rather than understanding, he is following the logic inherent in my use of the maternal metaphor. But this isn t how I saw or felt it. Karen did not demand. And I actually never experienced her as entitled, but rather as bitter, angry, and extraordinarily defensive. Her request that I explain my theory to her seemed at once provocative, hopeful, and despairing, an expression of her desperate need for help and her angry doubt that she could be helped. My empathic responsiveness felt toxic to Karen. On one hand, I might penetrate her defensive independence, and on the other, if she succeeded in neutralizing my therapeutic potential she feard I would become enraged and retaliate (to reverse my helplessness). Holding Karen thus meant remaining separate, alive, and well in a way that simultaneously confirmed my resilience and her impact. Some evidence for this might be found in a pattern wherein when I withdrew or momentarily gave in to the feeling that I was no good, both Karen s attacks and signs of depression seemed to escalate.

9 HOLDING, COLLABORATING, COLLIDING 509 I don t think that Karen s massive rage erupted because I resisted gratifying her request. Actually, I don t view analytic process as instinctually gratifying (no, I don t believe in the death instinct either) and I don t think that her rage reflected a deeper dread of inactivity in the fact of increasing tension (Lenoff, this issue). This formulation puzzles me because I read it to be devoid of, or in any event unlinked to, dynamic content. I believe, instead, that Karen experienced the whole therapeutic endeavor as a highly threatening attempt to enter her subjective world. The presence of a potentially knowing, powerful m/other (me in this instance) put her on high alert. Were Karen to open up, frightening longings for a maternal connection on one hand, and exposure (of her vulnerability and her hate) on the other, would be exposed. I read her two-year rage as a desperate attempt to ward me off and avoid exposure of underlying vulnerability while testing my capacity to stay near but also far away. My clinical problem was not with her entitlement, but with the consistent way in which Karen obstructed any attempt on my part to make contact with her. I couldn t say this (or much of anything else) to Karen without provoking her intense defensiveness and, then, a counterattack. Similarly, I view Karen s rageful sarcasm not as a functional disability, but rather as extreme defensiveness that reflected the profound disruption she experienced when I broke into the very tenuous illusion of self-sufficiency with which she protected herself. Karen could not engage in a mutual way with me because she couldn t tolerate the idea that I existed as a vulnerable, separate other. In declaring me to be greedy and incompetent, she blocked those possibilities. As Lenoff notes, my reaction to Karen s unremitting attacks became increasingly intense over time. I m not entirely certain that he thinks it was a good thing that I became furious with Karen (though it was certainly good that I could reflect on it). I don t think it was good either, but I do think it was inevitable and probably useful; as the object (and subject) of rage, I became aware of the kind of (active, almost aggressive) holding that Karen needed. Had I not tasted my own rage first hand, I suspect I would have moved toward a softer position with her, communicating my understanding of her feeling of helplessness and terror and thereby intensifying her sense of vulnerability and then her rage. My anger did, as Lenoff suggests, have personal as well as interpersonal roots. Karen got me where it hurt around my therapeutic competence, and her sarcastic dismissiveness also struck some old chords in me. Yet there were also intersubjective (reenacted) aspects to this dynamic: In attacking me, Karen and I played out, in reverse, some of the affect storms to which she had been exposed and I got a taste of the kind of helplessness that fueled her massive defensiveness. Lenoff suggests that Karen may well have known (at least unconsciously) that I was enraged with her at times. I suspect he s correct. In discussing Karen s need for holding as a prelude to collaboration, Lenoff (this issue) states, Karen has to tolerate the object s perceived existence as separate, beyond her own immediate perception and control. Accordingly, Slochower s concern is first with this separateness and then with the constituents of Karen s internal representations. First, I think it s important to differentiate separateness, a broad term often used to invoke notions of autonomy and ego strength, from a capacity to recognize that there is more than one way in which a given experience can be interpreted. I consider the latter reflective of engagement in a wider intersubjective space, as the basis for collaborative exchange (not a Kohutian goal). Lenoff suggests that collaboration is where I m aiming to go with Karen, and he s theoretically correct, although that aim seemed so remote that I m not certain I allowed myself to entertain it. I couldn t imagine engaging intersubjectively with Karen because she was unable to access,

10 510 JOYCE SLOCHOWER sustain, and elaborate on her interior experience. Terror about what would emerge, along with the risks of exposure, disorganization, and regression, left her closed off, intensely defensive, and unable to use the therapeutic process. Karen violently rejected all input, shutting down in response to the double fears of imploding and of destroying. Because difference was so utterly disruptive, I eventually turned to holding. I think the holding space functioned primarily as a barrier against influence, a buffer that helped Karen feel intact in my presence while simultaneously providing evidence that I remained present and uninjured by her. As Lenoff suggests, Karen didn t want to think about it and needed a space that gave her room not to. Lenoff further characterizes Karen s experience from his Kohutian frame as a psychoeconomic crisis that disrupted self-stabilization. He suggests that the analysis of Karen s rage would begin with the recognition of the chronic psychoeconomic imbalance with which she contended because overwhelming excitation overloads the capacity to contain it (Lenoff, this issue). Lenoff here refers to Kohut s early use of drive theory, a perspective that is not, I believe, resonant for many contemporary self psychologists (e.g., Fossage, 2003). Nor is it for me. I don t believe that the individual operates as a hydraulic psychic model wherein excess stimulation disrupts psychic balance. To my eye, this description depicts a content-less, one-person process; in my view, there s dynamic content to the crisis, and it involves two. The therapeutic crisis with which Karen contended organized, I think, around the symbolic threat embodied in the experience of me as someone who could both understand (and penetrate her illusion of self-sufficiency; see Modell, 1975; Gruenthal, 2010) and who could fail to understand and thereby unmask the dependency or alternatively, in Kohutian terms, selfobject needs she strenuously defended against. Karen certainly had enormous difficulty with self-stabilization, but I believe its source lay in the desperation and self-hate with which she struggled. I locate our relationship limited though it was at the center of this therapeutic shift because, as Lenoff notes, I view it to be the lens through which old self and object experiences could be relived and worked through. In that context, it s clear that I was less impressed by the push within Karen toward cohesiveness than by her need to express her rage toward an object whose survival could be tested. As Lenoff describes, an alternate route to self-stabilization can often be found via the experience of being understood (e.g., by the analyst). This is a central characteristic of therapeutic process with many patients, but it was not true with Karen. For her, being understood was profoundly destabilizing even when I used her own words to communicate that understanding. FINAL THOUGHTS I thank Lenoff for his generous exploration of my work and for this opportunity for dialogue. And so, what s the take-away? To my eye, Kohutian theory is somewhat more optimistic about the cohesive, forward-moving potential within the individual than am I and less focused on directly engaging themes of hate and destructiveness. I focus more on the range of affective experiences that can characterize holding, expanding, perhaps, a more narrowly defined view of the selfobject function. Although Lenoff recognizes the analyst s participation in the dynamic interplay between patient and analyst, I think that I locate participation as more central in the work and particularly emphasize the role of joint bracketing processes in sustaining a holding experience. I emphasize the enactment of embedded object relational patterns more than a Kohutian might, i.e.,

11 HOLDING, COLLABORATING, COLLIDING 511 I focus a bit less on repair and a bit more on repetition. But we share a sensibility that balances the impact of the analyst s subjectivity against the patient s need for space and affective resonance. And we are very closely aligned in believing that the capacity to tolerate the other s otherness is a developmental achievement rather than a given. The Kohutian focus on empathy and vicarious introspection is clinically close to my ideas about holding (despite differences in our overarching theory). And, perhaps, an acid test that carries more weight than clinical quibbles, I had a great treatment with a self psychologist. Need I say more? REFERENCES Aron, L. (1991), The patient s experience of the analyst s subjectivity. Psychoanal. Dial., 1: (1992), Interpretation as expression of the analyst s subjectivity. Psychoanal. Dial., 2: Balint, M. (1968), The Basic Fault. London: Tavistock. Bass, A. (1996), Holding, holding back, and holding on. Commentary on paper by Joyce Slochower. Psychoanal. Dial., 6: Bassin, D., M. Honey, & M. M. Kaplan eds. (1994), Representations of Motherhood. New Haven, CT: Yale University Press. Benjamin, J. (1988), The Bonds of Love: Psychoanalysis, Feminism and the Problem of Domination. New York: Pantheon. Bion, W. (1959), Attacks on linking. Internat. J. Psycho-Anal., 40: (1962), A theory of thinking. Internat. J. Psycho-Anal., 43: (1963), Elements of Psychoanalysis. London: Karnac, Bollas, C. (1978), The transformational object. Internat. J. Psycho-Anal., 60: Burke, W. F. (1992), Countertransference disclosure and the asymmetry/mutuality dilemma. Psychoanal. Dial., 2: Chodorow, N. (1978), The Reproduction of Mothering. Berkeley, CA: University of California Press. Fosshage, J. L. (2003), Contextualizing self psychology and relational psychoanalysis: Bi-directional influences and proposed syntheses. Contemp. Psychoanal., 39: Gruenthal, R. (2010), A view of the disengaged patient as already engaged. Psychoanal. Dial, 20: Hoffman, I. Z. (1991), Discussion: Toward a social-constructivist view of the psychoanalytic situation. Psychoanal. Dial., 1: Khan, M. R. (1963), The concept of cumulative trauma. Psychoanal. Study Child, 18: Kohut, H. (1971), The Analysis of the Self. New York: International Universities Press. Little, M. (1960), On basic unity. Internat. J. Psycho-Anal., 41:637. Loewald, H. W. (1960), On the therapeutic action of psychoanalysis In: Papers on Psychoanalysis, ed. H. W. Lowewald. New Haven, CT: Yale University Press, pp Mitchell, S. (1988), Relational Concepts in Psychoanalysis. Cambridge, MA: Harvard University Press. Modell, A. H. (1975), A narcissistic defence against affects and the illusion of self-sufficiency. Internat. J. Psycho-Anal., 56: Renik, O. (1993), Analytic interaction: Conceptualizing technique in light of the analyst s irreducible subjectivity. Psychoanal Quart., 62: Sandback, T. (1993), Psychoanalysis and maternal work: Some parallels. Internat. J. Psycho-Anal. 74: Sandler, J. (1960), The background of safety. Internat. J. Psychoanal., 41: Slochower, J. (1991), Variations in the analytic holding environment. Internat. J. Psycho-Anal., 72: (1992), A hateful borderline patient and the holding environment. Contemp. Psychoanal., 28: (1993), Mourning and the holding function of shiva. Contemp. Psychoanal., 30: (1994), The evolution of object usage and the holding environment. Contemp. Psychoanal., 30: (1996a), Holding and Psychoanalysis: A Relational Perspective. Hillsdale, NJ: The Analytic Press.. (1996b), Holding and the evolving maternal metaphor. Psychoanal. Rev., 83: (1996c), The holding environment and the fate of the analyst s subjectivity. Psychoanal. Dial., 6: (1999), Interior experience in analytic process. Psychoanal. Dial., 9: (2004),But what doyou want? The location of emotional experience. Contemp. Psychoanal., 40:

12 512 JOYCE SLOCHOWER. (2006), Psychoanalytic Collisions. Hillsdale, NJ: The Analytic Press. Stern, D. (1992), Commentary on constructivism in clinical psychoanalysis. Psychoanal. Dial., 3: Stolorow, R., G. Atwood, & D. M. Orange. (1999), Kohut and contextualism: Toward a post-cartesian psychoanalytic theory. Psychoanal. Psychol., 16: Tansey, M. J. (1992), Psychoanalytic expertise. Psychoanal Dial., 2: Teicholz, J. (1999), Kohut, Loewald, and the Post-Moderns. London: Routledge. Winnicott, D. W. (1955), Metapsychological and clinical aspects of regression within the psychoanalytic relationship. Internat. J. Psycho-Anal., 36: (1969), The use of an object. Int. J. Psycho-Anal., 50: West 75 th Street, Apt. 8B New York, NY joyce.slochower@gmail.com

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