Summary
 
The interaction-adaptation-focus will be used to investigate the psychoanalytic discourse. It will be demonstrated that intimidating derivatives and symptom formations, i.e. traumatic coping processes of the patient, can be triggered by relevant interventions of the analyst. Genetic infringements of the child-parent-frame account for the special significance of the analyst’s frame interventions as key stimuli for the traumatic working model of the patient. This hypothesis will be elaborated with the help of the communicative psychoanalysis and with the results of research with infants and illustrated by clinical examples.
 
1. From transference to unconscious perception and the consequent processing

In the epilogue to „Fragment of an Analysis of Case of Hysteria" Freud discussed in 1905 his experiences with Dora from the standpoint that the analytical therapy may cause injury to the patient by existing transferences. He reported how Dora’s father-transference caused her to fear that Freud could be as insincere and deceitful as her father, who „always preferred secrecy and roundabout ways". After the first dream, in which Dora threatened „... to leave the therapy the way she previously left the home of Herr K. ...", Freud reflected in retrospect, whether he should have addressed Dora’s negative transference of Herr K. to himself, saying, „Now... it is from Herr K . that you have made a transference to me. Have you noticed anything that leads you to suspect me of evil intentions similar (whether openly or in some sublimated form) to Herr K’s? Or have you been struck by anything about me or got to know anything about me, which has caught your fancy, as happened previously with Herr K.?" (Freud, Fragment of an Analysis of a Case of Hysteria, 1905).

Freud concluded that he waited too long to bring up Dora's transference statements and that Dora terminated the therapy because she felt deceived and abandoned as a result of her transference fantasies. „She acted out an essential part of her recollections and fantasies instead of reproducing it in the treatment" (Freud, Fragment of an Analysis of a Case of Hysteria, 1905).

If Dora´s derivatives are not understood as statements of transference, but as her unconscious perception of Freud's interventions and her consequent processing of them, we are compelled to reach the following conclusions:

In the analytical discourse, Dora related, displaced to her father and Herr K., that there was something mysteriously overwhelming and compulsory about Freud's interventions so that she felt unconsciously threatened by him and reacted with negative introjects, symptom formations, and later with the termination of the therapy.

Indeed, Freud -- unconscious of the consequences -- had intervened with an infringement and Dora with trauma, because Freud had entered an alliance with Dora's father behind her back. Under these conditions of therapy, which transgress intimacy, neutrality and anonymity, I believe Dora's derivatives are also to be understood as a valid, unconscious perception of Freud's interventions, which generated traumatic reactions.

In addition, Freud reflected intuitively on Dora's subsequent right-sided facial neuralgia in the context of an intervention which violated the secure frame of treatment, specifically the announcement of his appointment to a Professorship in the local newspaper, which Dora had read (Freud, Fragment of an Analysis of a Case of Hysteria, 1905). Dora, genetically inflicted by trauma and therefore especially sensitive to infringements of intimacy, could have perceived and processed this public announcement about her psychoanalyst as a "slap in the face", resulting in symptoms of conversion.

Changing the perspective from transference to the current, unconscious perception gives the basis for the following generalized hypothesis:

I believe, the patient follows and comments on both the verbal interpretations of the psychoanalyst as well as interventions which are personally relevant for the patient. This involves the patient's unconscious intent analysis (Berns, 1994), which is characterized by the primary process and consists of the unconscious perception, the unconscious analysis and interpretation of this perception, and the encoded communication of this analysis.

The patient’s derivatives and symptom-formations bearing a threatening and negative touch in the course of psychoanalytical discourse are possibly encoded messages about how he has been unconsciously perceiving and processing the interventions of the psychoanalyst. In such cases the frame-interventions of the analyst have the utmost significance for the unconscious and possibly traumatic coping processes of the patient. On the one hand, the secure frame makes it fundamentally possible for the patient's genetically rooted, traumatic methods of processing to become apparent. On the other hand, every deviation of the therapist from the secure frame makes the reactivation of similar, genetically traumatic moments possible. In both cases a successful therapy is possible; however, only when the therapist is oriented by principle to the secure frame.

I would like to illustrate the aforementioned hypothesis with an example of a female patient, whose primary process coping falsified the foregoing analytical interventions. ("Verbatim patient material omitted")

Apart from the triggering interventions of the analyst, his intruding questions, his unawareness of unconscious perceptions and associated processing (the unconscious analysis intent), the thoughts and reactions of the patient can be interpreted as transference fantasies of a persecuting mother.

From the communicative perspective, the following analogies to the therapist’s intervention asking direct questions are apparent in the derivatives of the patient:

  1. The patient asserted her obstinate resistance to the anal production compulsion in order to restore her autonomy, which the analyst had temporarily disturbed.

  2.  
  3. The dream of the neighbor constituted the patient’s symbolizing commentary, latently analyzing that the inner impression frightening her had a present, external trigger, i.e. the black cat.
  The symptomatic (short-term resistance) and symbolizing processing of the patient can also be described as an introjective identification, in order to adapt the subliminal (and undesired), intrusive element of the intervention, i.e. the false assumption of helping the patient with a further question (comparable to Freud’s hands-on pressure treatment).

Dorpat elucidates the reduction of the patient’s symbolic communication after a therapist’s intervention with reference to Langs (Langs, 1978), who describes three modes of communication:

Type A - predominately symbolic communication

Type B - predominance of projective identification

Type C - Splitting off of every affective meaning

Dorpat states, „My clinical rule of thumb is that, when a patient switches to a Type C mode, one should look for some communication from the therapist occurring immediately prior to the shift that the patient experiences as threatening, disruptive, controlling, or abusive. The most salient aspect of the Type C mode is that it arises out of a defensive need to withdraw from personal and affective relatedness" (Dorpat, 1993, p. 54).

In this example, the patient withdrew herself from the therapeutic alliance after the intervention by concealing her first thought and then relating the dream of someone else. She falsified the preceding intervention by changing her mode of communication and relating a threatening, persecuting introject.

The premise that psychoanalytical interventions have an immediate influence on the unconscious processing of the patient presupposes the communicative paradigm: unconscious perception precedes unconscious fantasy.

The communicative approach „... will use trigger-decoding as the primary means of deciphering unconscious meaning and will append genetic connections to that centre point as they emerge in the material from patients. Formulations will move away from a concentration on the mind of the patient either in isolation or as it responds through fantasy to the interaction with the therapist – the intrapsychically centred paradigm . In its place, there will be a largely interactional-adaptational focus in which the mind of the patient is seen as adapting to the specific interventions of the therapist – first and foremost, in terms of unconscious perception (rather than fantasy), with secondary reactions to these perceptions in the form of adaptive suggestions, models of rectification, genetic stirrings, fantasy formations, and the like." (Langs, 1995, p. 120).

In the context of this interaction-adaptation-focus transference, reactions and transference fantasies are understood as secondary processing of valid, unconscious perceptions of the analyst’s interventions (such as the fantasy of the black cat, symbolizing the persecuting mother), in order to adapt the intrusive intervention of the therapist.

2. Unconscious perception as the essential basis of interactive competence

The results of more recent research with infants (Stern, Lichtenberg, Beebe, Dornes) appear to confirm the interaction-adaptation paradigm of communicative psychoanalysis. The existential necessity of adaptation and interaction, as already demonstrated by the studies of Rene Spitz, finds its parallel in the genetical, human „equipment" for pre- and postnatal interacting with primary objects.

This „equipment" of the competent infant (Dornes 1992) consists principally of the early perception and differentiation capability, the early coordination of different perception modalities, and the early capability of the infant to initiate, direct, and terminate the interaction with his primary objects (Stern, 1992).

What speaks for the hypothesis that the capability of unconscious perception is also innate (Bonac, 1995)?

Lemche draws from the extensive, empirical studies of Beebe, citing an example of „matching" between infant and primary objects: Slow-motion replay clearly reveals how a 3-month-old infant is able within fractions of a second to „guess" which display of affect the mother will take on next and how it immediately rushes ahead with its own display of affects to share the appropriate facial expression with the mother (Lemche, 1995, p. 185).

Dornes describes the infant’s early capability in the interaction with primary reference persons to distinguish between forced action (for example, hectic behavior of parents as a defense against their own depression) and unforced, temperamental action. He relates as well, how infants adopt manifest and resisted pathological affects of the parents after their unsuccessful attempts to change the parental style of interaction (Dornes, 1995).

While the unconscious perception is accordingly an inborn prerequisite of interactive competence, there are unconscious fantasies evolving as a consequence of initial, interactive experiences with the primary objects: The basis for the psychological development of the unconscious fantasies form the so-called „expectancies". Those are the generalized expectations of prototypical interaction patterns, which, according to the results of Beebes’ research, are already developed within the first six months (Lemche, 1995, p. 185).

Processes that match affects and their feedback in the basal interaction form these „expectancies", which develop further to form a „working model" (Bowlby) with an „evoked companion" (Stern). This working model characterizes the method involved in the intrapsychic and interactive processing of emotionally loaded messages. Presumably, the affect related categories of response-expectancies form the basis of subsequent (psychic) representatives and thereby solve the metapsychoanalytical problem, when the phantasmatical element -- the unconscious wish, the unconscious fantasy -- flows into the constitution of psychic structures (Lemche, 1995, p. 185).

The basal interaction involves the exchange of perceptions regarding affect conditions and the exchange of interpretations of these perceptions, enabling us to speak of a very early double-reality of perceptual-affective experiences.

The empirical results of research with infants allow the following conclusions regarding the interaction-adaptation-paradigm of communicative psychoanalysis:

  1. An infant’s inborn ability of perception, his rushing ahead and „guessing" with regard to affect conditions and to unconscious motives of action in others remain intact as deep, unconscious perception (cf. Bonac, 1995).
  2. The infant’s attempts to change the pathogenic style of the parents’ interaction reoccur, as it were, in encoded messages to the analyst as „corrections" (cf. Langs, Casement, etc.).
  3. Phantasy structures and genetic recollection as further secondary processing of the analyst’s perceptions (the transference component) have their precursors in the infant’s early adoption of (also pathogenic) interpretations about the parents’ perception and interaction, since its own self-regulation is highly dependent on the interaction with the primary objects. This means that the infant must adopt the parents’ resisted, pathological affects in order to maintain the relationship.
  3. Traumatic processing of therapeutic interventions

The empirical results of communicative psychoanalysis and the research with infants lead to the following consideration:

In the analytical discourse, the reproduction of the patient’s pathogenic working model as expressing a poorly regulated (dysregulated) unity with the primary object (Stern) is dependent on the analyst’s intervention triggering it, because the working model also facilitates the adaptation of present interaction experience. Thus, if the patient should develop more or less serious symptoms in the analytical discourse, the analyst should question, whether he or she had intervened traumatically or whether a traumatic component might be contained in his or her interventions.

a) The traumatic working model

Freud’s basic definition of trauma is valid both for the short-term traumatic processing as well as for severe, psychic dysfunction resulting from trauma: „We apply it to an experience which within a short period of time presents the mind with an increase of stimulus too powerful to be dealt with or worked off in a normal way, and this must result in permanent disturbances of the manner in which the energy operates." (Freud, Fixation to Traumas -- the Unconscious, 1917, Vol. XVI, p. 275).

Freud describes the consequences of trauma as a splitting „between the ego and some idea presented to it", leading to a state of incompatibility (Freud, Case Histories of Hysteria: Miss Lucy R., Vol. II, p.122). He designates „the actual traumatic moment" as „the one at which the incompatibility forces itself upon the ego..." (Freud, Vol. II, p. 123) and depicts a „peculiar situation of knowing and at the same time not knowing" (Freud, Case Histories of Hysteria: Frl. Elisabeth von R., Vol. II, p. 165).

Wurmser mentions a short- or long-term disruption of the linkage between the realm of affects and the realm of representatives as a universal phenomenon of traumatic processing (Wurmser, 1995). Sachsse sees the principle consequences of a trauma in the destruction of the ego-functions and of the good object (Sachsse, 1995, p. 58).

Psychogenetical reasons account for this dysfunction in the realms of perception, affects, representatives, and ego-functions: Constant or predominate, affective (actual) mismatching in the basal interaction (under-or overstimulation) leads to a generalization of the dysregulated unity with the primary object and to a working model characterized by:

  The characteristics of the borderline personality disorder can be classified among the characteristics of a traumatic working model and are described by Sachsse as a result of early and severe traumatizing:   b) Traumatogenic factors in the early parent-child interaction

The following interaction patterns can be considered as traumatogenic with the exception of severe sexual or aggressive infringements or of the early loss of a parent:

  In this sense an early trauma is inflicted by the primary object by psychophysically violating the secure frame, i.e. the conditions and boundaries necessary for the healthy development of a child. The pathogenic memory constellation of the patient’s past is no illusion, no fantasy: „It is, rather, the unconscious perception, by the patient as a child, of the reality of the pathological frame deviation, forced upon the child by parents against the child’s healthy needs." (Bonac, 1995, pp. 25-26). The traumatic working model then facilitates the adaptation of the infringements upon the optimal, interactive child-parent frame.

The reproduction of the patient’s genetically acquired, traumatic working model in therapy is a phenomenon of the therapy frame determining the interaction between patient and therapist.

c) The frame in the analytical discourse

  In the past, Freud and Winnicott especially have considered the „secure realm" (Petersen), „the containing environment" (Winnicott) as the basic condition for a fruitful, psychoanalytical process.  In an article on the psychoanalysis of the psychoanalytic frame („Die Psychoanalyse des psychoanalytischen Rahmens, 1966, reprint 1993), Bleger investigated the relationship of the process and the frame, which he defined as a „non-process" „which, so to speak, represents the constants, within which the process takes place (the variables)" (Bleger, 1993, p. 268). He emphasizes the constancy of the psychoanalytical frame from methodological and psychotherapeutical viewpoints.

First, the constancy of the „non-ego" (the mother) enables the child to develop self („his ego"). „The frame has a similar, supportive function; in fact, it is a primary support, but until now we have been able to perceive it only when it has changed or been dissolved." (Bleger, 1993, p. 271). Bleger suggests that an „ideal standard frame" contains „the arrangement consisting of constant dimensions" and „concrete agreements between two persons about room, time, and money", and he states that the content and process of the psychoanalytical discourse are to be understood solely in the light of their prerequisites -- the frame (Bleger, 1993, p. 271ff).

Körner (1995) bases his concept of the „frame of the psychoanalytical situation" on Goffman’s theory of the frame of the social situation. The frame establishes the explicit and implicit rules of our behavior. „The psychoanalytical situation differs so radically from everyday, social situations that a well recognizable -- and even spectacular -- frame is necessary (Körner, 1995, p. 17).

Körner points out that the frame of the analytical situation has historical significance for the development of psychoanalytical methods. He investigates the transference of the unconscious, relational fantasies of the patient „on the basis" of the psychoanalytical frame. The patient „demands structuring the frame of the psychoanalytical situation in the light of his inner conflicts" (Körner, 1995, p. 22). This means that for the patient the frame has conscious and unconscious implications, which are expressed in his or her transference and relational fantasies and are dependent on the patient’s genetic traumata, personality structure, and psychopathology.

Langs has developed the concept of the „secure frame" (1988, 1989, 1992), differientiated its conditions, and provided evidence with empirical studies, in which many patients validated certain frame conditions as „secure" and „good" with remarkable unanimity (Langs, Smith, Petersen).

The frame is defined as „.... the metaphor for the implicit and explicit ground rules of psychotherapy or psychoanalysis. The image implies that the ground rules create a basic hold for the therapeutic interaction, for both the patient and the therapist, and that they create a distinctive set of conditions within the frame that differentiate it, in actuality and functionally, from the conditions outside the frame. The metaphor requires, however, an appreciation for the human qualities of the frame and should not be used to develop an inanimate or overly rigid conception." (Langs, 1978, p. 632).

While most patients validate the conditions of the secure frame as predominately good, the secure frame can lead to an unbearable increase of split off anxieties in patients who have suffered early trauma by some death, loss, or serious illness. Paradoxically, the therapist’s frame intervention aimed at security becomes the „key provocation", opening the traumatic wound and causing the unprocessed, unbearable affects to resurface. This paradox comes about because the secure therapy frame triggers claustrophobic or paranoid anxieties in the patient at the point where his genetic child-parent frame was violated. ( Bonac, 1995 )

Two illustrative cases:

I. Unprocessed traumatic fear of doom
    (Note: Patient material omitted from text.)

II. Unprocessed traumatic fear of the loss of self
    (Note: Patient material omitted from text.)
 
The introjected, parental resistance to death and total loss of both patients had been thrown into serious doubt by the secure frame. Thus, the secure frame produced temporary traumatic implications for the patients, resulting in the danger that their anger and panic affects might activate an aversion and a negative feedback against the therapy, which had just begun. I think, an analytical interpretation of a patient’s interpretive analysis of his or her coping with the therapist as someone persecuting, intrusive and traumatizing, would be useless without consideration of the triggering intervention.

„Children who have suffered repetitive childhood traumas of seduction and/or physical and severe psychological harm appear to configure minds that can carry out only minimal amounts of mental processing. Their emotion-processing systems tend to bypass mental coping and metabolizing in favour of discharge through maladaptive actions that tend to be quite harmful in nature." (Langs, 1995, p. 137). The traumatic implications of a secure frame can therefore be interpreted as the result of the therapist’s attempts to „tune in" to the patients needs in order „to disturb" he patient’s pathological arrangement and thus stimulate the development of a new working model.

The claustrophobic or paranoid fear of the secure therapy frame creates impulses in patients to leave this secure, yet by their experience, threatening frame and ultimately to depart from it. Bonac describes these impulses as the patient’s transference, which she defines as „a function of the frame", and „... is therefore an interactional phenomenon, rather than an intrapsychic pathological need." (Bonac, 1995, p. 25). Whenever the therapist violates the secure frame or departs from it, he can be expressing his counter-transference.

d) Deviance from the frame

In psychoanalysis „deviance from the frame" refers to all of the therapist’s interventions which deviate from the secure therapy frame. These refer to interventions containing a change of the frame (cancellation due to vacation or holidays, changes of room and time), interventions related to a premature securing of the frame (when the therapist cannot „contain" the projective identification of the patient), or interventions shifting unresolved, affective conflictual tension to the patient.

Searles is convinced that borderline-phenomena are parts of the general, human constitution. In his book he calls attention to how often the patients’ material communicates unconscious perceptions, especially about their analyst’s unconscious anxieties, wishes, and affects as well as about the analyst’s projective identifications. ( Searles, 1986 )

This implies that not only major deviances from the frame, but especially subliminal messages of the analyst can have undesired, traumatizing implications for the patient. Therefore, the analyst should check emerging negative introjects and worsening symptoms in the patient’s material with regard to this negative effect.

The following examples illustrate how two patients perceived my interventions unconsciously and communicated with their derivatives encoded messages about these interventions, the one in the sense of a seductive boundary infringement, the other in the sense of an aggressive, subliminal, traumatizing infringement.

1. (Note: Patient material omitted)

With the reference to Richard, the Lionhearted, the patient initiated, I believe, a precise, primary process intent analysis of my intervention in the form of my mutual laughter and the preceding change in my facial expression. She analyzed my interventions as naive and as infringing on both the therapy frame and my „container function" (i.e. therapy fortification), on which function homosexually seductive impulses are based.

At the same time, her commentary contained an encoded correction: When a battle or conflict is imminent, seduction has an annihilating character. My intrusive intervention incited intimidating introjects in the patient, whereby her reflection was closer to conscienceness and represented the triggering intervention: „What’s going on here is pseudo-therapy".

The patient then described, displaced to herself and the tom cat, the implications of my facial expression and laughter, saturated with counter-transference: My treatment of her was not appropriate, i.e. not therapy appropriate. I was not keeping the proper distance to her; I was satisfying my „cuddling needs" on her and was triggering fusion desires, including her reactionary, aggressive symptoms (the bite in the nose). At the same time, her derivatives contained a personal component: The patient, along with her parents, suffered from a rapid change in dependency needs and aggressive offenses, which accounted for their social isolation.

2. (Note: Patient material omitted)

I had incited her overwhelming fear of greed and excess by my intervention confronting her, especially with the concept „suppressed". The patient experienced me as intrusive, just as with the lady managing her house. She was latently enraged and therefore felt compelled to relieve me (that I did not really mean that she had to reduce weight). By her reflection, displaced to the house manager, her valid perception of me became clear as someone trying to place something aggressive in her. She processed this perception selectively, distorting it on the basis of her anorexic and compulsive personality structure („you must let your fat be cut away"), because she had to introject it in order to achieve balance. The transference component was the secondary processing (I demanded that you lose weight) of her distorted perception that I was angry about the fact that she kept her spontaneous reflection to herself instead of disclosing it to me.

In contrast to the two preceding cases in which patients were able to process and communicate the latently traumatizing implications of my interventions with their derivatives, i.e. as symbolically encoded messages, the following example deals with a gross frame deviance, which caused an acting out of the patient to his own detriment.

3. (Note: Patient material omitted)

It is evident how directly the patient introjected my gross infringement and the accompanying aggression and directed it against himself. At the same time, I understood his symptomatic acting out as an unconscious intent analysis of my intervention: I had robbed him of a session and had let myself be caught in our accidental encounter. The warning was an encoded correction: I should not continue this way, or else a destructive, vicious circle would follow.

After his symptomatic acting out had been explained, the patient finally realized that the guilt feelings associated with his acting out had been triggered by my intervention, which had affected him traumatically. He was greatly relieved, unburdened, and returned to the modus of symbolized communication.

4. Frame and frame-deviant interventions as key triggers of traumatic processing

The foregoing considerations and examples make it evident that therapy interventions function as key stimuli in the analytical discourse, which can incite the patient’s own individual, traumatic process of coping. The patient’s derivatives and his unconscious intent analysis indicate whether or not and to what extent therapy interventions have relevant, frame-deviant implications for his trauma. Examples of such trauma-relevant implications are the following:

If the therapist has understood the patient’s specific traumatic coping process in the context of the interventions having triggered it and explained it to the patient, the patient will unconsciously validate the therapist’s explanation with his derivatives and symptom changes immediately following the interpretation.

Accepting an analytical attitude which views and analyzes the patient’s threatening derivatives, symptoms and acting out as results, even though distorted, of deviant interventions, conflicts with our therapeutic, idealistic self-image and leads to guilt feelings and defense reactions. Bettighofer calls this the „analyst’s compromise avoiding disgust" (Bettighofer, 1994). Such compromise promotes projective, alleviating interventions, interpretations isolated from the integration context, theoretical clichés, and the establishment of psychoanalytical ideologies. Even though the therapist’s traumatogenic interventions are resisted in the form of unconscious idealization, a pathogenic, analytical discourse arises, manifesting a negative therapeutic reaction or a maligne regression of the patient.

The findings of research with infants and of communicative psychoanalysis enable us to view the analytic discourse as an interactional spiral, in which the patient, from the first contact on, verifies or falsifies the psychoanalyst’s interventions in or with the derivatives and symptoms which are relevant to the patient.

The therapist’s interventions, especially his frame interventions, are the key to understanding the patient’s traumatic working model, which offers insight into the patient’s present, unconscious processing of the psychoanalytical discourse. The patient’s processing can be linked with his genetic experience. This insight provides the patient and his psychic processes with a unique plausibility. His present, unconscious, valid perception is thereby distinguished from the further processing of that perception in the form of unconscious fantasies, memories, and symptom formations and is thus made apparent.
 

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    (Note: This paper is based on a lecture delivered on September 16, 1995, during the 1995 annual convention of the DGPT in Travemünde, Germany.)

    (Note: Clinical material illustrating the subject of the above article is available from the author upon personal request.)