Change in Psychoanalysis: An Analyst's Reflections on the Therapeutic Relationship (Book Review)
Author: Jaenicke, Chris
Publisher: Phildelphia, PA: Routledge, 2011
Reviewed By: Shelley Galasso Bonanno, Fall 2011, 178pp.
The contributing dynamics between the two people involved in the intimate relationship of intersubjective psychoanalysis are eagerly explored throughout Chris Jaenicke's newest book, Change in Psychoanalysis, Volume 34 in the Psychoanalytic Inquiry Book Series. As I complete the final chapter, I am reminded of the Broadway musical Wicked and the lyrics from the poignant song "For Good," in which Glinda and Elphaba proclaim without hesitation, "But I know I'm who I am today because I knew you” and so it can be said by both the patient and the analyst. As Jaenicke notes, "In describing the work with a patient, we are implicitly or explicitly describing ourselves" (p.98), and so he does in his writing.
Change in Psychoanalysis, Jaenicke's reflections on the process of the therapeutic relationship, represents a valuable contribution to further exploration of the intersubjective field. "In the end it is the nature of the encounter between two human beings that counts" (p.178) concludes Jaenicke in the book's final sentence. His journey to that conclusion validates it beautifully. Jaenicke's seemingly effortless ability to reveal himself to the reader as well as his patients allows us a glimpse into the healing process of the intersubjective approach to treatment.
Jaenicke devotes much of the book to three premises that he believes are central to the process of change: "first, the primacy of mutual influencing; second, the primacy of subjectivity; and, as a consequence, the third premise that in psychotherapy the process of change is co-determined and so we can say that both participants are changed" (p.33).
Jaenicke first addresses mutual influences, that is, the bidirectionality of psychoanalysis. He reviews the significant and exciting findings that infant research and neuroscience have contributed to our understanding of the directionality of influences. "Neuroscience supports the contention that human beings are constantly in the state of mutually influencing" (p.22). Psychoanalysis, once considered an exclusive journey for the patient, is a process of change that is codetermined, resulting in change for both participants. Although such an assertion today may seem to be unquestionable, this has not always been acknowledged; in fact, quite the contrary. Early analysts believed it to be an absolute necessity for the analyst to be a tabula rasa, or blank slate, in order for transference to take place. Furthermore, the idea that the analysts' own transferences and countertransferences might positively impact the treatment was not widely accepted. Present-day thinking about the bidirectionality of treatment challenges and broadens our initial beliefs, and as Jaenicke concludes, "There is no unilateral action. Every action, feeling, thought is embedded in the intersubjective field" (p.2).
Jaenicke skillfully addresses the notion that our patients' treatment issues are often closely intertwined with our own strikingly similar conflicts. Citing Stephen Mitchell, Jaenicke notes, "As Mitchell writes, analysts are often struggling in their transference with the same problems the patient is working on in his own transference" (p.56). It is this matched intermix of transferences that allows for powerful change to occur. Reflecting on my own treatment as well the therapy I conduct with patients, Jaenicke's theory resonates, as I am frequently struck by the similarities of our struggles. This intermix of transferences constantly ebbs and flows, albeit initially on an unconscious level. When we allow ourselves to examine and consciously identify the intersubjective influences that are always occurring between ourselves and our patients, life-changing transformations can occur, in both ourselves and our patients.
Addressing the primacy of subjectivity, Jaenicke explains, "Everything we look at is covered by a film of our subjectivity. No thought, no word, no feeling we have or action we take with a patient is not highly subjective" (p.3). One aspect of the book that is at once charming, interesting, and highly instructive is Jaenicke's willingness to bare himself. He even devotes an entire chapter to exploring his own emotional world. Rich, insightful, and deeply emotional, Jaenicke allows us to enter his inner world and explore the impact his own transferences have had on his patients, not only by what he (we) has chosen to interpret but also by what he (we) has unconsciously or selectively chosen to not acknowledge. Jaenicke's notion of two transferences, as an alternative to the traditional concept of transference-countertransference, is particularly intriguing and thought-provoking. In his conception, the process of therapy continues with not one, but two, transferences in the treatment. Considering this, I am again reminded of my own analysis. I reflect on how impasses have been worked through at times by my analyst's courageous acknowledgement of his own transferences, with significant positive change as a result. The authenticity of such self-disclosure by the analyst allows treatment to move forward and flourish in ways previously not consciously explored.
It is often said that in treatment, our patients are continually moving toward us or away from us, and we are undoubtedly continually moving toward and away from our patients. Jaenicke provides us with vivid and detailed clinical examples of his own work in which he address not only his patients' transferences, but also his own transferences. Jaenicke without hesitation addresses analysts' apprehensions and uneasiness about allowing themselves to be emotionally vulnerable to their patients. He identifies patients' and analysts' common fears. He allows us to reflect on our own vulnerabilities. He allows us to reflect on our relationships with our own patients. The ease with which Jaenicke addresses his own vulnerability speaks to a relational style reminiscent of influential analysts such as Stephen Mitchell and Jody Messler Davies, who Jaenicke cites throughout. Jaenicke offers no apologies about being mutually influenced, and concludes, "The only protection we have is the hard-earned years of experience in dealing with the fact that we all wear the same crown of thorns" (p.19).
Jaenicke's third core premise concerns the "codetermined nature of change" (p.13), that is, the idea that analysis changes both participants in the interest of the patient. "To change, we have to let ourselves be changed" (p.14). Jaenicke postulates the idea that not only does mutual influencing occur at "high speed and subtlety on nonverbal, preconscious, and unconscious levels" (p.22), but also that "much of what happens occurs under the radar of our ability to comprehend, or is subject to delays in our capacity to understand" (p.22). Although he acknowledges the inevitably intersubjective nature of treatment, Jaenicke does not suggest that both the analyst's and the patient's contributions to the intersubsubective field are on equal footing. He does not propagate mutual analysis and steadfastly expresses the ongoing goal of psychoanalysis to be, without question, the cure of the patient.
Jaenicke spends time discussing theory as well as clinical practice. For example, in Chapter Two, he explores aggressive impulses from various points of view including relational, relational-feminist, Motivational Systems, Intersubjective, and Kleinian. I find Jaenicke's writing on theory to be some what tedious and less inviting. Jaenicke tends to be at his best when writing about his patients, while simultaneously revealing himself in the process.
An analyst and journal editor at a recent conference I attended spoke about the sparseness of material regarding analysts' willingness to write or speak about their own mistakes and/or failed treatments. Jaenicke is certainly an exception to this observation. Throughout his clinical examples, Jaenicke highlights both his successes and his failureswith patients. Jaenicke's willingness to reveal himself as genuine albeit flawed and human allows him to "go the bottom" (p.29) along with his patients and also with his readers. Jaenicke adds, "Patients mostly have fine antennae for our emotional availability and will open themselves accordingly. For the process to proceed, both participants will have to jump over their shadows and shed emotional skin" (p.30).
Although Jaenicke's book, as noted in the title, consists of his reflections regarding the process of change in psychoanalysis, it more importantly offers the reader an exciting opportunity to simultaneously reflect and grow. The value of this book is not in the prose, but in the deeply meaningful personal exploration that Jaenicke brings to his narrative. Jaenicke's writing encourages the reader to reflect not only on Jaenicke's therapeutic work, but also on their own. Analysis is a profoundly intense, deeply intimate relationship. "Are we seen, are we meant, and are we loved?" asks Jaenicke (p.100). Jaenicke bravely addresses his own analysis, even asking his own analyst whether the analyst loves him. "In the end, it is the nature of the encounter between two human beings that counts" (p.178), concludes Jaenicke, undoubtedly reflecting not only on his relationship with his patients but also on his relationship with his own analyst. Pausing for reflection, I am fondly reminded of my many hours with my own treating analyst. I feel an embracing warmth, and I smile. Genuine unconditional love offered by an individual who is able to acknowledge his own human vulnerabilities cocreates a poignantly transformational therapeutic experience.
"But I know I'm who I am today because I knew you."
Shelley Galasso Bonanno, MA is a psychoanalytic psychotherapist in private practice in the metropolitan Detroit area. In addition to psychotherapy, she conducts forensic assessments including child custody evaluations and comprehensive psychological assessments of children and adults. Her poem, The Time Machine, about the depth and importance of the transference experience, was published in the Fall, 2010 issue of The American Psychoanalyst.
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