Dimensions of Psychotherapy, Dimensions of Experience: Time, Space, Number and State of Mind (Book Review)

Author:  Stadter , Michael and David E. Scharff
Publisher:  Routledge
Reviewed By:  Marilyn Meyers, Vol. XXVI, 4 (Fall 2006), pp. 52-53

In the Aymara language of the indigenous Amerindian people of the Andes, the word for future is qhipa pacha or timpu. This is translated as “back” or “behind time.” The word for “past” is nayra which literally means, “eye” or “sight” or “front.” When the person speaks of the future, he gestures behind himself and, conversely, when speaking of the past he gestures to the front. To the Aymara people, one can speak of the past as known and, therefore, in front. One speaks of the future as not yet known, therefore, behind. Pretty confusing! The spatial conceptual metaphors that we assume in our culture for time do not apply in the Aymara culture. They are reversed, but totally logical to the mind of the Aymara people (Rafael E. Nunez and Eve Sweetser, 2006).

In the book Dimensions of Psychotherapy, Dimensions of Experience, numerous authors explore the dimensions of time, space, number, and state of mind from a variety of perspectives. The book is divided into four parts, each corresponding to one of the “dimensions of experience.” Within each part are four or more chapters plus an introductory chapter by the editors. The book concludes with an Epilogue by the editors. This complex book challenges the reader to absorb and think about a wide range of ideas. Thus, the themes of the book become much of the reading experience. For example, I found myself struggling with my own limits of time and mental space as I read the book. At points, I think that I felt like a Westerner among the Amerindian people for whom the past is in front and the future is behind. I became disoriented and confused with some of the ideas put forth. At times, I struggled to keep my mind open to some of the more difficult and complex chapters.

The Introduction to the book begins with a simple sentence: “The therapist sits in a room with a patient for a period of time.” The authors point out that this sentence encompasses the elements of time, space, and number. They then go on to state that the book represents an effort to increase our “understanding of the dimensions of psychotherapy by looking at fundamental but usually unexamined elements that constitute the setting and the process in which clinicians engage every day.” I do not agree completely that these elements are usually unexamined, because I think that our literature is replete with explorations of these elements that may or may not be explicit. However, the book is unique in explicitly setting out to examine them in a systematic way. In the Introduction, the editors state that they made no attempt to synthesize a unified theory, but rather invited the contributors to explore these dimensions from their individual perspectives. This results in a richly diverse volume, which can at times, lead the reader to feel a bit out to sea. This feeling is counterbalanced by the stimulation of exploring some previously uncharted terrain.

The introduction to the section on Time sets out to stimulate the reader to think about the role of time in the clinical situation. The chapters in this section are by Kent Ravenscroft (“Time and the Unconscious Life-Cycle”); Michael Stadter (“Time-near and Time-far: The Changing Shape of Time in Trauma and Psychotherapy”); Leslie Johnson (“Bad Infinity: Narcissism and the Problem of Time”); and Lea Setton and Jill Savege Scharff (“Time and Endurance in Psychotherapy”). Stadter describes a typology of time that applies both to the psychotherapeutic encounter and everyday life. He discusses this typology in reference to a rich clinical case, which helps to elucidate the usefulness of his schema. In Stadter’s “time-near” state, an individual is in the moment; whereas, in the “time-far” state, time is either non-existent or distant. Time-far states include sleep, free association, dissociation, and dreams. Furthermore, there is a coexistent relationship between the two states. I found this conceptualization interesting as it also provides an example wherein the dimension of “state of mind” overlaps with the dimension of “time.” Stadter concludes his chapter with some specific recommendations regarding the dimension of time in psychotherapy. The first of these is to “listen for temporal references in the content and associations (therapist’s and patients) and consider their meaning.” This seemingly obvious recommendation enhanced my attention to this aspect of the therapeutic hour in my work and has lead me to explore more deeply ways in which conflict, defenses, and anxiety can be expressed in this area of experience. For example, when a patient recently spoke of wishing he had a “reset” button in his mind in order to wipe out or cleanse himself of difficult experiences and feelings, I pursued and explored this longing with him in a more expansive way than I might have in the past.

The introduction to the section on Space orients the reader by examining three functions of space: as a point of reference, as a possibility, and as a geometric reality. This concept is expanded on by presenting examples of the psychological experience of space within each of these domains. “Your anger pushed me away,” is given as an example of the psychological experience of space as a point of reference. This section of the book consists of six chapters. As with the other sections, some of the chapters are concerned with rather specific concrete aspects of space. In the chapter by Judith Rovner, “Changing Spaces: The Impact of a Change in the Psychotherapeutic Setting,” the focus is on the impact of moving her office from one location to another. She carefully and thoughtfully explores the impact of the move on patient, therapist, and treatment. This is an example of an issue that has been addressed elsewhere, but takes on additional weight by being placed in the context of the theme of the book. In the chapter by Earl Hopper titled “Pandora in Time and Space,” the approach is more theoretical with Hopper examining annihilation anxiety in “difficult” patients. He emphasizes what he sees as the core feature in “difficult” patients as being an oscillation between states of fusion/confusion and fission/fragmentation. Each of these poles serve as a defense against the other and each is associated with its own characteristic anxieties. Hopper emphasized the value of the group in providing space in which he could understand his countertransference

The section on Number presents particular challenges. The section consists of five chapters: “Number Theory, Intersubjectivity and Schizoid Phenomena,” by James Poulton; “Super-vision or Space Invader? Two’s Company and Three Makes for Paranoid Tendencies,” by Carl Bagnini; “Four: On Adding Up to a Family,” by Christopher Bollas; “Dynamic Mathematics in Mental Experience. I: Complex Numbers Represent Psychic Object Relations” by David Scharff and Hope Cooper; and a second chapter by Scharff and Cooper titled “Dynamic Mathematics in Mental Experience. II: Numbers in Motion, a Dynamic Geography of Time and Space.” As is evident from the titles of these chapters, most of them address some aspect of the use of chaos theory as it may be applicable in psychoanalytic theory and technique. In my efforts to understand and form a bridge between chaos theory and psychoanalytic thinking, I turned to a paper by Quinodoz (1997) in which he explored chaos theory and psychoanalytic theory and practice. In that paper he stated at the outset that he is “aware of the distance between the viewpoint of, on the one hand, a physicist or mathematician looking for measurable experimental data and, on the other, that of a psychoanalyst seeking to account for the transformations he observes in the field of his patients’ psychic functioning.” He concluded the paper with a section headed “How worthwhile is all this to psychoanalysis and the psychoanalyst?” This is the very question that I had in my mind as I read much of this part of the book. Quinodoz concluded, “Even if the theory of complex systems as a scientific model is not entirely transposable . . . these ideas open up new perspectives, extending beyond mere metaphors, in our way of exploring psychic functioning.” I came to agree with that perspective as I found myself incorporating some of the concepts of this section in my clinical work.

This, in my view, is the “litmus test” for any journal article or book. Does it enhance, deepen, or expand my way of listening to my patients? One straightforward way in which the ideas in the book entered my mind was in working with a couple in a family in which the husband had been divorced and left with two children whose mother essentially had abandoned them. Together with his second wife, they had a third child. The wife had legally adopted the two children from the first marriage. She wanted to have another baby, and the husband was resistant to the idea. I had worked with this couple earlier as they struggled to integrate the past history of abandonment and loss in the family with their current life. At that time they were forming as a couple and as a foursome with the two children. In the later work, they were a couple with a child of their union and with two children from the first union. I introduce this case because I found myself thinking about their dilemma in a different way than I had previously. In the second chapter by Cooper and Scharff, the authors highlight the difficulties we face when attempting to understand the dynamics of large numbers. They argue that understanding the “dynamics of large numbers relies on different methods of mental processing than for relatively small numbers. Large numbers are understood on different orders of scale.” This helped me as I realized that when working with this couple, I frequently felt mentally confused and in that state of confusion, I sometimes defensively tried to simplify the complexity of the dynamics of the family.

Recognizing this countertransference experience with regard to complex large numbers helped me sustain my empathic connection with the couple. In addition, the chapter by Ravenscroft highlights the interplay between “the innate biological potential and good enough personal experience.” Having read his chapter, I was more open to formulating some of their difficulties in terms of their efforts to negotiate their different places in the life cycle. Specifically, the wife was considerably younger than the husband. She was facing the biological clock of her childbearing years and he was facing issues of aging. This dynamic often took the form of his saying something akin to “been there, done that” while she was saying the polar opposite. I found myself oscillating between both of these poles, identifying with each and being pulled toward both. This chapter helped me to think about this dynamic and contain my countertransference feelings.

The last chapter in the book, in the section on State of Mind, is by Theodore Jacobs (“The Use of the Self Revisited”). Jacobs states at the outset that his aim is to “update, revise and expand” on ideas in his 1991 book (Jacobs, 1991). This chapter provides essentially a review of the history of the notions of countertransference. It elicited in me a feeling of dealing with familiar and comfortable material, which I experienced as something of a relief after having felt so challenged and disoriented by much of the book. On the other hand, this chapter stirred a feeling of wanting to go back to the more difficult chapters to renew my efforts to grapple with that challenge.

In the last paragraph of the book in the Epilogue, the editors pose a question: “Where have these considerations left you, the reader?” My response to that question is that my consideration of the domains of experience has deepened and become more complex having read this book. I am grateful to the various authors and to the editors for tackling these broad and complex ideas. Just as I struggle with comprehending the Aymara conceptual metaphors of time, past, and future, I appreciate the intellectual and clinical rewards of confronting uncertainty and confusion. It is beyond the time and space allotted to this review to fully summarize this multifaceted book. I encourage others to delve into this rich and complex book and thus, reap the rewards that result from that effort.

Marilyn Meyers

References

Jacobs, T. (1991). The Use of the self: Countertransference and communication in the analytic situation. Madison, CT: International Universities Press.
Nunez, R.E. and Sweetser, E. (2006). With the future behind them: Convergent evidence from the Aymara language and gesture in the crosslinguistic comparison of spatial construals of time. Cognitive Science, 30, 1-49.
Quinodoz, J-M. (1997). Transitions in psychic structures in the light of deterministic chaos theory. International Journal of Psychoanalysis, 78, 699-718.

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