2004 Institute of Psychoanalysis

Freudian and Lacanian approaches to the clinical case:

Listening, interpretation, transference and countertransference1

MARDY S. IRELAND, Reporter2127 Ashby Avenue, Berkeley, CA 94705, USA M7Ireland@aol.com

DANIEL WIDLCHER, Moderator248 bd Raspail, F-75014 Paris, France D.H.Widlocher@wanadoo.fr

Daniel Widlcher introduced this clinical-case panel presentation within the context of furthering a larger IPA discussion of the theory, technique and questions raised by Lacan for psychoanalysis. The second and enfolding contextual question, to which all the panelists referred, was whether it is possible to have a working sense of psychoanalytic community amid todays multiple approaches to psychoanalytic practice. The clinical session No. 152 was taken from the case of Amalie X of the Freudian analysts Thom and Kchele:

Amalie X came to psychoanalysis because the severe restrictions she felt on her self-esteem had reached the level of depression in the last few years. Her entire life history since puberty and her social role as a woman had suffered from the severe strain resulting from her hirsutism. Although it had been possible for her to hide her stigmathe virile growth of hair all over her bodyfrom others, the cosmetic aids she used had not raised her self-esteem or eliminated her extreme social insecurity (Goffman, 1974). Her feeling of being stigmatized and her neurotic symptoms, which had already been manifest before puberty, strengthened each other in a vicious circle; scruples from compulsion neurosis and different symptoms of anxiety neurosis impeded her personal relationships and, most importantly, kept the patient from forming closer heterosexual friendships (1991, chapter sub-sections 2.4.2, 7.2, 7.7, 7.81, 9.11.2).

This four-hour panel was so rich in both its presented material and in the associations made by the panelists and by the audience that this reporter can only hope to offer a partial rendering.

The rst panelist, Racquel Zak de Goldstein, framed the case as one in which the question of seduction, transgression and limits were central and that the work within the dynamic of the transference love and countertransference could be organized around three principal or main sign ers manifest in the clinical materialhirsutism, head and knife.

Emphasizing that we can accept certain of Lacans theoretical formulations but not all of them, without following the technical innovations arising from his theory that nally led him to a deviation from Freudian foundations, Goldstein went on

Int J Psychoanal 2004;85:12515

1Panel held at the 43rd Congress of the International Psychoanalytical Association, New Orleans, USA, 12 March 2004. Panelists: Marilia Aisenstein (Paris), Judith Feher-Gurewich (Cambridge, MA), Racquel Zak de Goldstein (Buenos Aires, Argentina), Patrick Guyomard (Paris), Alain Vanier (Paris).

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to identify that several of Lacans main concepts show their effects on our way of listening clinically and thinking psychoanalysis mirror stage, the three registers (Symbolic, Imaginary and the Real2), the three times of the Oedipus question, and the differentiation between need, desire, and demand of love, that are essential for psychoanalysis, while ruling out any af liation to or validation of the whole of his ideas.

According to Goldstein, in this case the patient could not psychically locate herself in relation to her own desire in the absence of her actual fathers desire playing its role during the third and nal moment of the patients oedipal passage. Thus the patient sought, and was adequately received by the analyst, to get herself into his head and, through a well-handled loving transference/countertransference, the unfolding of the other scene took place. Within this unfolding, as seen in the sessions material, the patient can be seen to be able to begin to address the question of how to take up her own desire as a woman. To summarize Goldsteins Freudian/Lacanian analytic perspective, an effective analytic experience begins, in which the analyst can let himself be taken as an object of support, a promoter of re ection and insight, so that the process of dis-identi cation, dis-alienation, substitutions and subjectivation is installed.

The second panelist, Judith Feher-Gurewich, aimed many of her remarks toward highlighting a Freudian and Lacanian reading of the meaning of penis envy and interlocking questions surrounding sexual difference vs. gender identi cation. Placing her contribution within the North American psychoanalytic scene, Feher-Gurewich pointed out that, The distinction between desire and jouissance3 in particular may explain and resolve the gap between classical Freudian analysis and recent post-Freudian theories where the emphasis on the pre-oedipal have pushed aside the whole question of the oedipal dynamics, in particular the question of penis envy.

2The Real refers to human experience that is unmediated by our symbolic capacity. It is, in other words, all that is in excess of, lies outside of or is beyond what the symbol can represent. The Real also includes a dimension of the impossiblefor example, elements of acute or cumulative trauma that can never be completely drained away by our symbolizing it, however much it helps to do so. The Symbolic order refers to the human web of language and speech. In the Symbolic register, there is no one-to-one correspondence between the signi er (the word or gesture) and any object or meaning to which it refers. Linguistic signi ers may have multiple meanings depending upon the surrounding signi ers, and this meaning can only really be formed when one reaches the period at the end of the sentence. The Imaginary register of experience is associated with how ones original sense of body ego or narcissistic integrity is formed through an identi cation with an external other (the mother who is both object and locus of symbolization). There is no third position from which two different peopleyou and Ican be recognized at the same time. The Imaginary is a psychic space or inner theater created by the intervention of the Symbolic upon the biological (Real) body of the infant in so far as his/her needs are symbolically interpreted by an other.3Symbolization does not entirely capture (nor will it ever capture) the whole of human experience. That which is uncaptured by representation, and therefore left over as energy/drive remaining in the body, is named jouissance. Jouissance is multifaceted, for example, an excess of jouissance in the body that manifests as somatic symptoms marks places where the body ego envelope has not been adequately psychically constructed, in that sensory experience (i.e. Bions -elements) has not been symbolically processed or transformed adequately (i.e. into -elements).

1253FREUDIAN AND LACANIAN APPROACHES TO THE CLINICAL CASE

Noting that the analyst in the case appeared to equate Freuds penis envy with the patients wish to be a man, she restated Freuds position that the unconscious does not really know sexual difference and that sexual difference itself always remains an enigma for each individual. For Freud, at the level of unconscious sexual difference is only registered in terms of being active (masculine) and passive/receptive (feminine). Not withstanding the importance of gender identi cation, Feher-Gurewich, following Lacan, highlighted that the question of being a woman or a man is secondary to the question of whether one is psychically operating as if one can be an object of desire versus an object of jouissance. In other words, the critical distinction for the patient (indeed for us all) is: What is the difference between being able to allow ones self to passively/receptively be loved (to be an object of desire or feminine position; in contrast to actively desire an object or masculine position) vs. allowing an Other to omnipotently use or abuse one at his/her will (to be an object of jouissance)?

Second to differentiating being the object of jouissance vs desire is the question of gender-identity formation. Citing gender identi cation as a retroactive formation that also occurs during the oedipal passage, Feher-Gurewich stressed that A core gender identity is constituted on the Imaginary plane (of unconscious fantasy) through the attributes and masquerade offered by the social sphere to distinguish a man or a woman. Stressing that the enduring enigma of sexual difference will necessarily be dressed up by the residues of experiences and memories of a man or woman, they should not be (always) interpreted along those lines.

Pointing to a difference in theory and technique concerning the analyst supporting the patients identi cation with the analyst (in this case, what the analyst thinks in his head what a woman is or should be), Feher-Gurewich noted that perhaps the Lacanian analyst may have more freedom to speak than is provided by other perspectives. To summarize then, Feher-Gurewich suggested that the point of analysis is not to be loved per se by the analyst, nor to identify with the analyst, but to nd the secret formula that has organized the patients desire and how such a formula has produced a fundamental mis-understanding and unnecessary suffering. Panel comments were that the patient is forming questions about female and maleness, but is not yet at the oedipal level. Widlcher also questioned the possibility of there being a secret formula within the unconscious given the complexity of unconscious fantasy.

Alain Vanier began his remarks by saying he was here to verify the notion that there is a psychoanalytic community and that one need only to experience the cure (a successful psychoanalysis) to lead one to Freuds conviction that treatment is about truthunconscious truth. He stressed that for himself there is no one Lacan and that he uses Lacan to account for what is being done in analysis. For Vanier, the notion of jouissance is located conceptually in Freud, but it took Lacan to decode it.

If, according to Freud, transference is what drives the analysis, the analyst must always ask, Who am I to the patient now? In the presented case the importance of Lacans idea of the Imaginary highlights how much aggression is central to the treatment and Vanier wondered clinically speaking if there might not be too much

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emphasis on the Imaginary phallus (vs. Symbolic phallus) thus promoting more anxiety than necessary (i.e. the signi er head is very organizing of this analysis in that it refers to both Imaginary and Symbolic planes regarding penis envy).

Concerning the theme of transference, Vanier wished to stress that in transference there is not only repetition, but also that there can and should be something new that occurs via the analysis. De ning transference love in Lacans terms as an opening and closing of the unconscious in the Imaginary, it is important to add that it also includes (an aspect of) the Real object and it is from this bit of the Real that the something new may arise. Every patient must come to see himself in the face of the analyst (to be found in the head of the analyst)to discover how he has been the object of jouissance for the Other. The Other that is felt lost via separation-individuation includes also the irrevocably partial lost Real object of jouissance demanded by symbolization itself and the patient must always come to his/her own particularity in these terms. In the session material presented, the Real object within the Imaginary transferential landscape appears as a scopic onethe eyes of the analyst.

In the session material, the analyst softens or takes the edge off a superegoic transference and this initiates a chain of events related to jouissance. The analyst strives to get the patient to stand upto take up her own position on desire in his imagined knife ght. The signi er knife functions here as a phallic signi er where the analyst is playing his needed role to help the patient differentiate and stabilize fantasy vs. realityas Winnicott would say. It is not the job of the analyst to verify an identity for the patient, but to help her/him de-identify. In other words, to move the patient through the analysis of the transference to the place of If no one can tell me who I am what do I want? (Widlcher offered Vaniers commentary as a description of the case on the Symbolic plane and that the use of the father to open the space for thinking (i.e. What do I want?) speaks to the importance of freedom of thinking provided by the oedipal passageor, as Segal said, It is a matter of thinking.)

Patrick Guyomard followed up on the theme of jouissance, noting that jouissance is the reintegration of the body and the object with the rejoinder there are different jouissances which could not be further elaborated due to limits of time. Weaving the themes of jouissance, transference and interpretation, Guyomard said that one of the most interesting questions of the session was that of creativity. Can you create something new in analysis? Thinking of symbols/signi ers, knife is a symboland a symbol can be interpreted in many different ways. What is important in analysis is to generate something new in the repetition so there is creativity and innovationleaving the patient free to make use of them. He therefore cautioned that the analyst has to be careful not to reduce the symbol to one meaning. Nor should the analyst ever consider his interpretation as the last word, but rather that the patient can make use of it in their own way.

Lacans three registers are useful in listening in analysis, Guyomard said, because words/signi ers are both Symbolic and Imaginary. This means it increases the reading we can have in the breakdown of the cure The analyst must ask himself, Did I say it wrong? It is not just the content either, but it could be concerning a signi er that the analyst has introduced rather than the patient. For

1255FREUDIAN AND LACANIAN APPROACHES TO THE CLINICAL CASE

example, knife may be one the analyst introduced here in this session, but that is OK because the patient had already dreamed the word. By using Lacans three registers we as analysts can understand things from different registers at the same timeso it then becomes possible to frame any given moment in the session. For example, the patient introduces identity as a woman in terms of space and this needs to be addressed in the transference more. Guyomard reminded us from Freud that within sexual drive (regardless of feminine or masculine position) there is inevitably a lack of satisfaction and a residue that has to undergo sublimationleading us back to an organizing theme within the panel of the role of creativity in analysis.

Moderator Daniel Widlcher offered that the looking at differences in listening that impact clinical technique can be complementary. For example, could not the question of penis envy in this case be understood in Kleinian terms of projective identi cation and introjection? Is there a unique Lacanian point of view wherein pulling on a primary signi er like hirsutism refers to the external hair as well as the central con ict of sexual identity. However, Widlcher noted not everyone would agree with this as it implies a level of symbolic castration in the patient that other analytic perspectives may not see as yet established in the patient.

Marilia Aisenstein summarized important themes of the overall panel. She described her sense that she has found a Lacanian in uence in French psychoanalysis affecting the entire theory and technique of interpretation, and even implicitly in the realm of countertransferencea theme elaborated greatly in recent decades. Her feeling was that there is indeed a psychoanalytic community because there are often meetings she attends with both non-Lacanians and Lacanians. She noted the sharp controversy between Lacanians and non-Lacanians concerning the usefulness of the concept of countertransference. She also addressed Lacanian elds criticism of there being too much interpretation of the transference in other approaches to psychoanalysis. In contrast, however, Marilia stressed that interpretation of the transference is far less a problem than that of the analysts own object preventing the erotic investment of the patient to come to reside in himself. Aisenstein felt that despite the resistance of the analyst and the patient to such an erotic investment, this has to come because of the issue of differentiating jouissance and desire in the patients analyses.

In conclusion, Aisenstein offered perhaps an apt conclusion to this rich panel presentation when she said, If you have ten painters painting the same scene, ten different paintings will always be the resultand so it is with analysis. The issue of this panel has been not who paints better, but how can the exploration of todays panel positively affect the creativity of the analyst whose work has been on display today.

Reference

Thom H, Kchele H (1991). Psychoanalytic practice. Vol. 2: Clinical studies. Heidelberg: Springer.

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