In memory of Lew Aron, psychoanalyst, scholar, teacher and friend.
Mentalization — the effort to make sense of our own and others’ actions, behavior, and internal states — is something we all do. And it is a capacity that all psychotherapies aim to improve: the better we are at mentalizing, the more resilient and flexible we tend to be. In his new book — Minding Emotions: Cultivating Mentalization in Psychotherapy — Elliot Jurist reviews and reconceptualizes mentalization in psychotherapy, focusing on how to help patients understand and reflect on their emotional experiences. The book interweaves clinical vignettes with discussions of memoirs by comedian Sarah Silverman, poet Tracy Smith, filmmaker Ingmar Bergman, and neurologist Oliver Sacks. Read an excerpt from chapter 7, “Mentalized Affectivity and Contemporary Psychoanalysis,” below.
Contemporary mainstream psychoanalysis has remained largely unpolitical and unconcerned with social problems or social justice. An exception is the (American) relational movement, led by analysts who were influenced by the 1960s and have sought to rebel against and restructure the official culture of psychoanalysis. Such relational thinking has made a key contribution to mentalized affectivity and therapeutic action. The first research in this area comprises the work of Greenberg and Mitchell, Aron, and Benjamin. We focus on that first, and then turn to the work of Bromberg and Stern. The relational movement arrived on the scene as a breath of fresh air. It represented a different mentality from the depiction of psychoanalysis found in Janet Malcolm’s Psychoanalysis: The Impossible Profession (1981) and In the Freud Archives (1984). Not only was relational theory open to sources outside of psychoanalysis, such as feminism and postmodernism, it opened a path away from the stultifying influence of psychoanalytic institutions that were dominated by the medical profession. Within the culture of psychoanalysis, the relational movement stands for resisting authoritarianism and establishing more of a democratic spirit on every level — among colleagues, between candidates and analysts, between supervisors and supervisees, and especially between patients and analysts. Greenberg and Mitchell’s (1983) Object Relations in Psychoanalysis is the foundational text of the relational movement, articulating a new paradigm, in sharp contrast to psychoanalytic theories that have a drive structure. Indeed, Greenberg and Mitchell reject any possibility of mediating between the models, specifically discounting the viability of mixed-models thinkers like Mahler, Jacobson, Kernberg, Kohut, and Loewald. For Greenberg and Mitchell, the emphasis placed on knowledge in the drive model is impossible to reconcile with the emphasis on the relationship in the relational model. Arguably, the most important contribution that has emerged from the relational model is in the realm of technique, which has implications for therapeutic action. Greenberg and Mitchell (1983) introduce a new role for the analyst as a participant in the process, not someone who is outside or above it. As Mitchell (1988) argues, “If the analytic situation is not regarded as one subjectivity and one objectivity, or one subjectivity and one facilitating environment, but two subjectivities — the participation in and inquiry into this interpersonal dialectic becomes a central focus of the work” (p. 38, quoted in Aron, 1991, p. 44). The point is not merely that the analyst possesses subjectivity as the patient does, but that the analyst can use his or her subjectivity in order to make therapy more effective. Aron (1992) developed the notion that the analyst’s subjectivity can be fruitfully brought to bear in treatment. He advocates a spirit of “co-participation” between analyst and patient, a “bipersonal and reciprocal communication process, a mutual meaning-making process” (p. 504). As Aron (1991) sees it, this approach more honestly acknowledges the fact that patients are able to mentalize the analyst, regardless of a neutral stance: Patients make use of their observations of their analyst, which are plentiful no matter how anonymous the analysts may attempt to be, to construct a picture of their analyst’s character structure. Patients probe, more or less subtly, in an attempt to penetrate the analyst’s professional calm and reserve. They do this probing not only because they want to turn the tables on their analyst defensively or angrily but also, like all people, because they want to and need to connect with others, and they want to connect with others where they live emotionally, where they are authentic and fully present, and so they search for information about the other’s inner world. An analytic focus on the patient’s experience of the analyst’s subjectivity opens the door to further explorations of the patient’s childhood experiences of the parents’ inner world and character structure. Similarly, patients begin to attend to their observations about the characters of others in their lives. (pp. 35–36) Patients are mentalizing about us whether we are aware of it or not. It is compelling to urge us not to experience a patient’s curiosity in a negative way. Yet, I have trouble accepting Aron’s generic claim because it overlooks the diversity of responses that patients have to their therapists, which includes intense interest, both positive and negative, but should not exclude vague, ephemeral interest, or even actual indifference. After a break from my private practice due to the death of my mother, it was my most psychotic patient who noticed and overtly expressed that something major must have just happened in my life. Yet, I have also had patients who were not so curious about me, and some who, in being encouraged to voice their thoughts and reactions, warmed to the idea, as well as others who retreated from this. In Chapter 5, I describe a patient, Carl, who had a mother with bipolar disorder. Carl needed distance between us and was averse to the expectation that he would engage with me personally. I have also had the experience of talking more about myself than I typically do with a patient who would have been completely content with a tepid transference, as he had with his prior therapist. In the context of suggesting that therapists ought to welcome and value patients’ reactions to them, Aron tells us, “I assume that the patient may very well have noticed my anger, jealousy, excitement, or whatever before I recognize it in myself” (1991, p. 37). This is revelatory, as it supports the effort of relational analysts to level the playing field between patient and therapist, not just on ideological grounds, but simply because patients, like all others, can observe things about analysts that we fail to observe ourselves. In his recent work, Aron affirms the idea of the analyst’s vulnerability, that is, of being capable of mutual vulnerability in his or her relationship with patients, the antidote to the posturing omniscient analyst: “phallic, abstract, rational, autonomous, disembodied, a blank screen, a surgeon” (Aron & Starr, 2013, p. 397). Hiding behind the mantle of a professional identity obscures what we share with patients as fellow human beings. What Aron is saying supports my finding in Chapter 2 that the regulation of emotions often involves others, and my observation in Chapters 5 and 6 that having a therapist mentalizing about you is a spur toward mentalized affectivity.
The analyst who has best articulated the import of mutuality in the relational model is Jessica Benjamin. Mutuality between patient and analyst is modeled on the mutuality found in the infant–caregiver relationship. Benjamin’s first book, The Bonds of Love (1988), traces this idea from Hegel, where mutual recognition is threatened by the master–slave dialectic, in which competition and violence prevail over cooperation. Recognition involves both shared experience and acceptance of differences between self and other. Winnicott (1965) and Stern (1985) are invoked as the sources for the idea that the mind is interactive, rather than monadic, and both intersubjectively constituted and inherently social. Benjamin is a complex theorist whose understanding of mutuality has shifted and developed over time (Jurist, 2000). In The Bonds of Love, there was appreciation for the deformation of recognition in the master–slave dialectic, but less focus on the fragility of recognition. In Like Subjects, Love Objects (1995), Benjamin gives fuller expression to the inevitability of breakdowns, affirming Tronick and Beebe’s research with infant–mother dyads that demonstrates continuous disruptions and repairs, and encouraging the relational model to acknowledge creativity and aggression. In her third book, The Shadow of the Other (1998), Benjamin goes further in acknowledging obstacles to recognition, observing that omnipotence “is and always has been a central problem for the self” (p. 85). Benjamin takes pains to explicate that her defense of intersubjectivity, or a two-person psychology, is not at the expense of intrapsychic life, or a one-person psychology. Benjamin’s work has moved on to articulate the idea of the third, a new way to characterize mutual recognition in human relationships, especially between patient and analyst. In “Beyond Doer and Done To: An Intersubjective View of Thirdness,” Benjamin (2004) sketches the aspiration for mutual recognition in relation to the pernicious but pervasive dynamic of “doer versus done to,” that is, where the lure of claiming the status of being a victim prevails over taking responsibility in relationships. The real downside to the doer-versus-done-to dynamic, or what she labels as the “complementary mode,” is that it interferes with conflict being “processed, observed, held, mediated or played with” (p. 9). In contrast, the idea of the third means a kind of intersubjective relatedness that is linked to Winnicott’s notion of potential or transitional space. The fruition of thirdness is shared experience, but shared experience that does not entail the blurring of individual identities. Two distinct kinds of thirdness are specified. The first, the One in Third, stems from early life experience: it is energistic, rhythmic, and naturally entails the accommodation of the other. The One in Third corresponds with infant research that has demonstrated skills like turn taking that are crucial in terms of helping the infant not just to feel connected to the other but to learn from the environment and become acculturated. The second, the Third in One, is a moral stance, where one party is willing to be vulnerable (to say “I’ll go first,” as Benjamin puts it) to help to cultivate reciprocity, but where differentiation from the other is constitutive of the experience. Invoking morality here raise questions, as it is unclear if Benjamin would be comfortable assuming a universal version. Her primary motivation in this essay is to emphasize two different levels of the third: the former is “protosymbolic communication” and the latter is the “symbolic third.”
Both are necessary, however more weighty the Third in One seems to be. Benjamin’s understanding of therapeutic action depends on the analyst’s capacity to be vulnerable, humble, and compassionate, similar to Aron’s. Yet, Benjamin amply appreciates that the virtue of the analyst is no assurance that the third will be sustained. The potential regression from thirdness to twoness in the form of doer versus done is perpetual and does not necessarily come from the patient’s resistance. (Benjamin is devastatingly astute in discerning how therapists tend to blame patients for impasses in the work.) The emphasis on mutual shared experience is crucial, as it pushes the mentalization construct in a new, heretofore unacknowledged direction. Mentalizing is not just about the self or about the other, or even about the self, engaged in trying to make use of the other. It can unfold as a mutual process. Although Benjamin does not focus much attention on affects or emotions (which are not referenced in the index of her books), her sensitivity to the power dynamics between self and other illuminate an aspect of mentalized affectivity that resists models in which the therapist instructs the patient on what and how to feel. From The Bonds of Love, Benjamin has incorporated a social and political commitment in her work. Her argument, affirming the infant–caregiver bond, is a feminist battle cry to rebel against construing this bond as inherently maternal. Benjamin specifically forecasts social change as dependent on men embracing childcare and, more broadly, not defining themselves as spectators of domestic life. Furthermore, the master–slave dialectic, which disrupts mutual recognition, is applicable to gender relations. So, there are parallels between recognition on an interpersonal level and a social level. Benjamin’s idealism is sustained in her notion of the third, and in her commitment to theory as a form of praxis.
Elliot Jurist is Professor of Psychology and Philosophy at the Graduate Center and The City College of New York, CUNY. From 2004-2013, he served as the Director of the Clinical Psychology Doctoral Program at CUNY. He teaches doctoral level courses on Clinical Practicum, Ethical and Professional Issues, Practicum in Supervision and Consultation, Contemporary Psychoanalytic Theory and Psychoanalytic Conceptions of Mind, Character and Agency. Jurist, Elliot. 2018. Minding Emotions: Cultivating Mentalization in Psychotherapy is reprinted with permission from Guilford Press. It is available for purchase on the Guilford Press website here, and on Amazon here. To read an interview with the author, Elliot Jurist, please click here.