Summer 1999, Vol. 1, Issue 1.
Holding the fear of (not) being: radical thoughts on therapeutic work with marginalised adolescents 
David A. Leary
What does it mean to be an adolescent who is marginalised from family and community? What impact does such a wide-ranging experience have on the emotional and social world of the individual? What does it mean to be a therapist within the midst of such overwhelming experiences?
At its core and for a therapist, it means dealing with intense and volatile emotions, desire and ambivalence, openness and impasse: both within the person and the therapist. These complex, terrifying and inviting experiences, in theory and practice, are the subjects of this paper. They will be considered within the context of a youth counselling service. What is of greatest significance in this exploration is that they will be examined from a perspective that acknowledges the essentially dialogical nature of the encounter. The therapist can never be an uninvolved objective observer. This understanding is not just core to good practice; it is core to an ethical and just practice.
Understanding is a crucial element of being-in-the-world, and of working with the person. Part One of this paper will deal briefly with an examination of how we come to understand, and of the role of the hermeneutic process in that endeavour. Part Two of the paper will consider three pertinent social environmental issues and a psychoanalytic perspective on the experience of the adolescent in psychic retreat. Part Three will briefly examine a therapeutic encounter. Part Four of the paper will examine the implications of viewing the relationship of person and the therapist via psychoanalytic and hermeneutic thinking. The philosophical works of Charles Taylor and others will be considered as will the thinking of the British Object-Relations school. The fundamental focus of this paper is the significance of dialogical conversation as the goal of therapy and central tool for the therapist.
Particular thought in a particular place
This paper is about particular, sometimes unthinkable, thoughts in a particular place. It is about a therapist trying to work and sometimes fight with, a young adult who is ambivalent about thinking and about life itself. This thinking occurs within a community-based youth resource and counselling centre. In such a setting, psychoanalysis is not what takes place. What occurs is that a therapist attempts to think about messiness within individuals via a particular framework originating from a number of sources. Psychoanalysis is one of those sources.
Why is an analytic framework chosen as a dominant reference point when it is so closely aligned with such a structured and reductionist form of clinical intervention? The choice is based on a number of experiences that have developed into pillars of practice:
The major area of challenge in this way of thinking within the current therapeutic context is the experience of transference. For transference to be usefully pondered and dealt with, the environment into which it is projected must be capable of a degree of holding designed to prevent uncontainable acting-out behaviour by either the person or the therapist. That is hard where the person's intrapsychic and external environment is so negatively powerful and the therapeutic setting is less than tight (as can often be the case within a youth centre).
Without proceeding to resolve this dilemma, the answer lies in and at the end of the thinking process. If holding difficult thoughts is possible, then resolution is possible. If the therapist is able to think rather than apply a static model or theoretical framework, then growth is possible within the encounter. Creativity accompanied by thought: a path through an apparent impasse. As Bion (1978) has indicated:
We learn these theories...and try to get them absolutely rigid so as to avoid having to do any more thinking. But we cannot make a conscious and deliberate attempt to help the process of development if we start by being mentally fossilised (p. 6).
What is required in therapy with marginalised adolescents is not analytic work but analytic thinking that is as dynamic and variable as the next person we see. The aim is to consider the internal and external world, the good and the bad , the strength and the weakness, the past and the future as well as the immediacy of the present that is never more evident than in the life of a homeless or marginalised adolescent.
What I seek in therapy and in this exploration is a disposition of openness within me and to the whole person. In psychoanalytic and hermeneutic terms, in order to achieve that end, there must be a critical level of transparency and reflexivity within the therapist.
This paper is about that joint endeavour to seek growth and understanding within the turmoil of life. Dialogical conversation (Taylor, 1991) is what I seek. It is a dialogical conversation about the fear of (not) being. It is a fear that exists within both the person and the therapist.
"The search for truth, certainty and understanding in research and therapeutic workOther-understanding is always in a sense comparative. That is because we make the other intelligible through our own human understanding ... In a sense, we only liberate the others and "let them be" when we can identify and articulate a contrast between their understanding and ours, thereby ceasing in that respect just to read them through our home understanding, and allowing them to stand apart from it on their own." (Taylor, 1995a , p 150)
"There can be no objective understanding free from the life-relations in which one finds oneself." (Martin & Thompson, 1997 p. 641)
The focus of this paper can be summarised in the following question. What does it mean to intervene with a homeless adolescent where their external and intra-psychic reality is characterised by acute, paralysing and intransigent levels of transition and ambivalence often leading to a confusing series of approaches and withdrawals? In such a scenario what we seek, in the first instance, is understanding within and for both the person and the therapist. What we seek is a way of understanding the question, why this impasse?
Although an examination of these issues is very much at the centre of this paper, such an exploration (either generic or particular) is not the place to begin. My starting point will be to examine what it means to understand . Only after such an examination can we return to an appreciation of the issues associated with an impasse within the narrative of one person.
The person within the scientific endeavour of psychology
For centuries in philosophy, there has been considerable debate regarding the nature of truth and certainty. It is not understating the issue to say that it has been central to the whole philosophical endeavour. Discussions in this area date back to Aristotle (Jonsen & Toulmin, 1988; Thomson, 1953). Even at that early stage, it was held that in "practice fields we grasp particular facts of experience more clearly, and have more certainty of their truth, than we ever do about the general principles that we may use to account for them" (Jonsen & Toulmin, 1988, p.26).
Although a late starter in the search for truth and certainty, psychology entered the fray and, as Progoff indicated in 1956, it "began as an unconscious search for meaning in a civilisation whose traditional meanings had been destroyed" (in Richardson & Woolfolk, 1994, p. 205).
In the century or so of its existence, psychology has gained a number of protagonists from a variety of schools of thought regarding the nature of truth and certainty. However, that debate has largely centred on epistemological rather than ontological issues. In other words, the concentration has been on how we know the subject-matter of psychology rather than on attempts at comprehending the very being or existence of the person as the subject-matter of psychology. Although some may argue that the two are intimately intertwined, the distinction between the epistemological and the ontological is imperative if we are seriously to tackle methodological issues (Blackburn, 1996; Martin & Thompson, 1997; Ricoeur, 1981; Taylor, 1985).
In the later part of the twentieth century, the aim of the dominant paradigm in psychology has been to find truth and certainty in explaining human behaviour. The methods for achieving that end largely relied upon, and have their origin within, the physical sciences. This has been so "on the assumption that such faithful adherence inevitably will bear the fruit of prediction and control of human behaviour, if not the seeds of understanding and explanation of human experience" (Martin & Thompson, 1997, p. 630; Geertz, 1994; Shand, 1993; Solomon, 1988).
But the all-important question is about whether the person can be 'explained' by such a process. Does such a methodology miss the mark because its origin excludes an adequate ontological examination of the subject matter in focus? According to the hermeneutic tradition, which itself is a developing area, explanation and understanding are different. Psychology is not the same as the natural sciences and to assume or act so, can lead to a form of scientism: an over-valuing of science as a project (Harvey, 1990; Martin & Thompson, 1997 ).
Having stated such a proposition, some justification must be advanced. It is argued that there are three features of the person that distinguish him from the subject matter of the natural sciences (Martin & Thompson, 1997 ). It is these that constitute a need to radically vary any approach that seeks understanding.
First, human experience and action is located in and contextualised by social and personal factors, apart from which, the subject-experience can neither be conceptualised nor understood (Richardson & Woolfolk, 1994).
A second constitutive feature relates to the inherent uncertainty of human beings in their experience and actions. Because the person has and holds intention, he is capable of creating a variable future based on past experience, current perceptions and ideals, all of which operate within the social construction of the person's immediate and broader world ( Neimeyer, 1993 ; Steenbarger, 1991 ).
A final distinguishing feature of the person is the moral character contained within human action and experience. This reflects choice and accountability, and represents, not just need and desire within the person, but also a capacity to judge and decide between values and relative goods. These influence the way we relate to the world and the level of respect we afford the other ( MacIntyre, 1968 , 1985 ; Maritain, 1966 ; Mulhall & Swift, 1996; Singer, 1993 ; Taylor, 1992 ).
So the task before us is about explanation and understanding, which in order to be approached, must appreciate and rely on the meaningfulness of: historically-based, changeable, agentically controlled and contextual narratives. The idiosyncratic nature of these various forms of expressions and experience refer to and convey the meaning of the other ( Craig, 1997 ; Hermans, 1992 ; Hillman, 1996 ; Martin & Thompson, 1997 ; Ricoeur, 1976 ; Taylor, 1985 ).
A view from somewhere - the place of the interpreter
Most researchers in the physical sciences see the process of their work as being a singly interpretative manner of study. We observe a process occurring before us and we analyse that process, make judgements and then come to conclusions. It is a one way process of observation, judgement and learning. This description is relevant for most of the physical sciences although such a stance is coming under increasing scrutiny ( Geertz, 1994 ; Martin & Thompson, 1997 ; Taylor, 1985 ). It is interesting to note that although Geertz is supportive of the basic notions held by hermeneuts and political philosophers such as Taylor, he is also critical of an oversimplification of this point ( Geertz, 1994 ).
In the human sciences and in psychoanalysis, there is a form of relativism that is by definition, quintessential to gaining understanding and so, at the heart of each endeavour. As Martin and Thompson (1997 , p. 636) indicate, both the subject matter and our way of studying it are "artifacts of human construction", where understanding is developing in both the researcher and participant or the therapist and the person ( Tappan, 1992 ). Therefore the process is interpretive within all participants of both endeavours. It is, in fact, a "double hermeneutic" where there is an inescapable dialogical interplay between the "meaning-laden events" of the person and the "interpretative framework of the investigator" ( Richardson & Woolfolk, 1994 , p. 209; Paterson, 1996 ; Taylor, 1991 ). In therapeutic work, I am not, and can never be, the objective bystander or "disengaged first-person-singular self" that I may have previously believed ( Taylor, 1991 , p. 307). As Taylor has indicated:
The aim of understanding should not be to surmount or escape our own point of view, in order to "get inside" another ... separating ourselves from our own perspective as such, in order to come as close as possible to "the view from nowhere". ( Taylor, 1995a , p. 148)
To undertake such a dislocated task, Taylor argues, is impossible because it denies an essential quality of human understanding. To make others intelligible, he argues, "we have to rely on a kind of understanding of human affairs which sets the forms and limits of intelligibility" which is "woven very deeply into our lives" ( Taylor, 1995a , p. 148). This understanding which we rely on is, by and large, inarticulate. It is there, highly influential and active but nonetheless unspoken. For much of our existence, it is "taken for granted, just relied on" ( Taylor, 1995b , p. 167). Thus it may be considered a form of pre-understanding.
So the first step to achieving understanding of the other is not to "surmount or escape" from our own point of view but to bring to consciousness the "model or models that penetrate" our thought and action ( Richardson & Woolfolk, 1994 , p. 222). As Wittgenstein has indicated, "what determines our judgement, our concepts and reactions is not what one man is doing now , an individual action, but the whole hurley-burley of human actions, the background against which we see any action" (in Baron, 1996 , p. 51).
A necessary dialogical movement
Wittgenstein's point is of major concern at this stage. It is this "hurley-burley" created by the melding of human experience, some of which is articulated and much of which is inchoate, that is the field from which rises, an understanding of the one and the many .
Gadamer also indicates that understanding arises from the fusion of "horizons supposedly existing by themselves" (Gadamer, 1989, p. 306). So, it is not a single horizon, a single interpreter, a static encounter, an objective bystander or any other solo performance out of which understanding develops. It is a fusion, with all the incumbent confusion of which it speaks, that is where understanding begins to develop. By far the clearest exposition of this crucial point comes from Taylor when he indicates that:
The general feature of human life that I want to evoke is its fundamentally dialogical character. We become full human agents, capable of understanding ourselves and hence of defining an identity, through our acquisition of rich human languages of expression ... covering not only the words we speak but also other modes of expression whereby we define ourselves. No one acquires the languages needed for self-definition on their own. We are introduced to them through exchanges with others who matter to us ( Taylor, 1992 , pp. 32-33)
The development of the self, of relationship and of understanding can never be seen as a monological act. It occurs via dialogical actions where the background or horizons of both subjects are intimately incorporated into the process. It is conversation : the hermeneutic place where misunderstanding gives way to understanding (Ricoeur, 1981 ).
In the end, the search for truth and certainty in relation to the person is neither a simple nor perhaps an achievable goal; at least to a level of absolutism or certainty aspired to by some of the physical sciences and imitated by some schools of thought within the human sciences ( Symington & Symington 1996 ; Elliott & Frosh, 1995 ). For a therapist working within a context marked by the marginalisation of persons, such an understanding of their field of work is essential if intervention is to be credible, ethical and just.
Therapeutic impasse and psychic retreats examined
The desacralisation of life, a society of emotional disconnection: killing is a kind of dream-sequence video. Conscience is disconnected from trigger finger. Child is disconnected from future. Bullet is disconnected from gun muzzle and, once fired, can never be recalled . (in, Eckersley 1992 , p. 1)
We have come to understand that obstacles to contact and obstacles to progress and development are related, and that they both arise from the deployment of a particular type of defensive organisation by means of which the patient hopes to avoid intolerable anxiety. ( Steiner 1993 , p.1)
Some may argue that engaging in a philosophical discussion as a prelude to an examination of practice issues is misplaced philosophising and inappropriate to the psychological task at hand. It is my contention that such a position is false and that, in fact, we have no choice but to begin in such a manner. If we fail to comprehend fully the complexity inherent in any process of understanding, we miss the mark in our endeavour to understand the person. As Minuchin indicated in 1984:
"Many family therapists today are versed in technique but don't understand families. Sometimes I see marvellous interventions that are incorrect because they are not related to a basic understanding of the family in a social context, but only to the therapist's repertory of interventions" (in Aponte & Winter 1987 , p. 87)
Likewise, it must be said than any therapeutic impasse is personified and contextual. It is an internal experience, but it is also located in the external world of the person: a social environment or context to which it strongly relates. Of great significance is the unavoidable reality of that context.
In this part of the paper, limited consideration will be given to the three elements within the external experience of marginalised adolescents: homelessness, suicide and resilience. Following that, a theoretical understanding of the intra-psychic response to impasse in the lives of marginalised adolescents will be examined. In a later part of this paper, consideration will be given to the therapist within the person's context.
A matter of the individual within a subculture
A worrying phenomena within Australia in the late twentieth century has been an increase in homelessness among our youth: the loss of family, education, employment and social support structures being aspects of this complex experience. With that broad social experience comes a multitude of personal stresses and strains that also seriously impact on the health and well being of those adolescents. In 1989, the (Australian) Human Rights and Equal Opportunity Commission published the findings of a significant national inquiry into the problem of youth homelessness ( HREOC, 1989 ). In the report, the commissioners had this to say regarding the extent of homelessness among Australian children:
Sufficient research has now been completed, however, to enable the Inquiry to estimate that there are at least 20,000 to 25,000 homeless children and young people across the country. We stress that we consider this to be a conservative estimate. Dr. Fopp's considered conclusion, based on all the evidence available, was that the likely figure is actually 50,000 to 70,000 children and young people who are homeless or at serious risk. ( HREOC, 1989 , p.69)
Leaving aside the methodological issues associated with counting homeless people, either set of figures paints an alarming picture that is only partially represented by the notion of homelessness. In their work analysing quantitative data on homelessness and risk, Chamberlain and MacKenzie (1998) indicate it is possible to make a number of useful generalisations regarding homelessness. In the typical city school, with 1000 students, approximately 10-14% are likely to be at risk of homelessness with 4-6% likely to be seriously at risk. In a typical country school of 500 students, it is likely that 10-14% of students will be at risk of homelessness while within this group, 4-6% of students will be seriously at risk of homelessness (Chamberlain & MacKenzie, 1998, pp. 98-99).
As Eckersley (1993) and others ( Bashir, 1993; HREOC, 1989, 1993; O'Connor, 1989; Reynolds & Rob, 1988; TPCA, 1995) have indicated:
The young suffer in such circumstances. They face the difficult metamorphosis from child into adult, deciding who they are and what they believe, and accepting responsibility for their own lives. It is a transition best made in an environment that offers stability, security and some measure of certainty. Yet modern western culture, for all the complexity of our way of life, offers no firm guidance, no coherent or consistent world view, and no clear moral structure to help them make this transition (Eckersley, 1993, p. 16).
The development of life-threatening elements within this amorphous mass of social upheaval has only recently forced us to rethink what it is we are doing within our society and to question the values that underpin our apparent progress ( Eckersley, 1988, 1992, 1993; Solomon et al., 1991). Although it is by no means a new phenomenon or one restricted to this country, suicide and its concomitant experiences is quickly becoming the most tangible litmus test of the health and well-being of Australian adolescents (Eisenstein, 1993; Goldney, 1993; HREOC, 1989; O'Connor, 1989).
In Australia over the last thirty years, we have experienced major increases in the rate and extent of adolescent suicide. In 1986, there was one adolescent suicide every 70 hours ( Eckersley, 1988 ). In 1995, there were 350 young male suicides and 84 young female suicides. These deaths represent 25% of all young male deaths and 17% of all young female deaths. Rates of suicide per 100,000 head of population show that since the 1960's, the rate of young male suicide has almost tripled. The rate of young female suicide has doubled (Dudley et al., 1992; Eckersley, 1988 , 1993 ; Goldney, 1993 ; TPCA, 1997 ).
Studies have shown that children and adolescents who engage in suicidal actions have significant levels of depression and other internalised and externalised symptoms (Bettes & Walker, 1986; Cantor & Baume, 1997; Goldney, 1993 ; Howard, 1981 , 1992b, 1993 ; NHMRC, 1997; Raphael, 1993 ).
For every completed suicide, there are many attempts. Although the numbers are small, children as young as 12 years of age are attempting suicide (Bettes & Walker, 1986). Accurate figures are hard to gain, but hospital admissions indicate that for every death resulting from suicide, there are ten admissions to hospital for attempted suicide ( TPCA, 1997 ). Suicide rates for Aboriginal people are even more sharply highlighted among young men than is the case for the general community ( Brady, 1992a , 1992b , 1993 ; TPCA 1997 ).
For young males in Australia, between 1979 and 1995, there has been a fivefold increase in deaths arising from hanging (Cantor et al., 1996). The highest incidence of youth suicide occurs in rural and remote areas where firearms are the most prominent means of suicide. In urban settings, self-poisoning is much higher. It is clear that in rural and remote areas, the incidence of completed suicides is much higher partly because of the lethality of the means used (Cantor et al., 1996; TPCA, 1997 ).
Behind the statistics is the largely covert and often silent story of despair that researchers and practitioners alike point out as a dangerous zone of puzzlement ( Taylor, 1995a ) within both individuals and groups of adolescents. It is this state of being where the unspoken or confusing stories and experiences lead to increased psychic pain, isolation, self-harm and a generalised and contagious playing around with notions and experiences of a premature end to life (Alvin, 1993; Bettes & Walker, 1986; Eckersley, 1988; HREOC, 1989 , 1993; O'Connor, 1989).
However within part of that same zone of puzzlement exists the experience of resilience typified by the question, why is it that some adolescents survive and grow through the trauma of their developing years, despite involvement in self- and other-destructive behaviour? It is the question of resilience that is of critical importance in terms of engaging with a person experiencing unspeakable internal and external chaos that brings with it, "the anxiety of death and annihilation" ( Becker, 1973 , p. 66). For within those adolescents somehow remaining alive, there is a connectedness they have consciously or unconsciously developed which aids in their sometime ambivalent struggle to remain alive ( Brennan, 1993 ; Howard, 1997b ; Raphael, 1993 ; Resnick et al., 1993 , 1997 ; Rutter, 1985 ).
Therapy can never be immune to the world in which it is located. It cannot be considered a monological project. To intervene in the life of a person necessarily means engaging with the whole of their being; their internal and external world, their potentially fatal flaws, the social environment and their fortitude or resilience. This means engaging with the exigencies of their everyday existence. To engage in therapeutic action requires openness to a contextualised person. What is most challenging to a reductionist view of therapeutic action is that this encounter is also and necessarily dialogical ( Taylor, 1992 ).
Impasse and psychic retreat in the marginalised adolescent
It is evident that the age period fifteen to twenty-five is one that presents major concerns for the therapist. Not coincidentally, it is also the period where the young adult grows in their awareness and need to take control of their existence and carve out a future. Marginalised adolescents and young adults also experience this urge and often seek out more specialised assistance with their emotional needs. The positive movement contained within the 'seeking out' is not exempt from the ambivalence born of past trauma, separation and loss. Invariably, it is this experience that causes acute anxiety, fright and flight. It is here that a potential impasse to dialogical movement arises.
Whatever it is that causes such acute anxiety and flight, it cannot be talked about and so it is extremely difficult to understand. Inherent in the contact is a palpable frustration that at times is almost unspeakable and sometimes unbearable. Steiner, (1993) summarises the dilemma when he indicates that:
Patients who withdraw excessively to psychic retreats present major problems of technique. The frustration of having a stuck patient, who is at the same time out of reach, challenges the analyst, who has to avoid being driven either to give up in despair or to over-react and try to overcome opposition and resistance in too forceful a way. ( Steiner, 1993 , p. 131)
So what is this psychic retreat that feels and appears like an impasse ? It is a defensive posture developed by the person so that a level of relative peace may be achieved in the face of perceived psychic threats arising from contact with significant individuals within the person's life ( Steiner, 1993 ). It is a reaction/response that has its origin within those most significant of relationships but is seen in its starkest contrast within the therapeutic relationship. In that context and despite the request by the person for support and assistance, the encounter is perceived as threatening and a retreat is necessary in order to restore that relative peace. Not withstanding the retreat, the person also expresses a desire to remain in therapy ( Steiner, 1993 ).
The inevitable cost of the retreat is isolation and a standstill regarding development, both of which may be viewed by the person as distressing but "preferable to even worse states which the patient is convinced are the only alternatives" ( Steiner, 1993 , p. 2). What is critical in an understanding of this phenomenon is that it involves an organisation of defensive processes against a fundamental and primitive fear of death or annihilation ( Becker, 1973 ; Klein, 1946/1986 ; Mitchell, 1993 ).
For marginalised adolescents and young adults, this fear of destructiveness is closer to reality because of the presence of destructive external experiences that are introjected, becoming part of the person's belief structure regarding self. As Steiner indicates:
Traumatic experiences with violence or neglect in the environment leads to the internalisation of violent disturbed objects which at the same time serve as suitable receptacles for the projection of the individual's own destructiveness. ( Steiner, 1993 , p. 4)
This painful and distressing proximity to deadly internal and external things objects calls for holding or at least for the anxious state to be pacified. The psychic retreat, which to the therapist appears as an impasse , is such an endeavour ( Bion, 1967 ; Symington & Symington, 1996 ; Winnicott, 1964/1989a ). Symington & Symington (1996) draw attention to the important distinction between Bion and Winnicott in this area. Where holding (Winnicott) relates to both the internal and external world of the person and is designated as a positive notion, Bion's notion of container/contained is internal, nonsenual and can be both positive and negative.
Understanding the place of unpalatable experience
It is reasonable to say that the use of psychic retreat is a normal part of functioning. It is a response to anxiety which, when the anxiety dissipates, ceases to be of use and is therefore relinquished in favour of a more transparent and dialogical form if relating. In the person whose anxiety relating to death and annihilation is more dominant, the need to retreat is more constant and the organisation of defences dominates in the person's everyday life ( Winnicott, 1963/1989b ).
What of this person? What is it that is occurring when the psychic retreat is the mainstay of the relating style? To answer this question, the person's manner of relating must be understood. In the case of the therapeutic relationship, the content of the transference is the focal point for understanding the dynamic within the psychic retreat ( Steiner, 1993 ; Strachey, 1969 ; Symington, 1986 ).
Earlier, it was indicated that "traumatic experiences with violence or neglect in the environment leads to the internalisation of violent disturbed objects" ( Steiner, 1993 , p. 4). This is particularly the case with marginalised adolescents whose early relational experiences are often permeated by abandonment, neglect and blame. It is the resultant sense of badness that becomes overwhelming and that must be projected outwards from the person in order that survival may be ensured. Steiner (1993) and others (Solomon, 1995; Symington, 1986 ) describe projective identification as the process whereby:
a part of the self is split off and projected into an object, where it is attributed to the object and the fact that it belongs to the self is denied. The object relationship which results is then not with a person truly seen as separate, but with the self projected into another person and related to as if it were someone else. (p. 6)
Far from being an abnormal process, projective identification is also part of the normal process of human relating out of which empathy for the other arises ( Steiner, 1993 ). However, authenticity for the self and the other largely depends on the person's capacity to take back the split-off bits of the self, to withdraw the projection, thereby allowing the other to exist in their own right ( Klein, 1946/1986 ; Segal, 1988 ; Taylor, 1991 ; Winnicott, 1970/1989e). Where this is not able to be done, the world of the person becomes an intolerable place of "nameless dread" ( Bion, 1967 , p.116):
a world of heroes and villains, of persecutors and victims; a world in which object ties are often addictive in nature, and loved objects are tantalising and unattainable; a world in which introjects are omniscient and conduct unrelentingly critical narratives of one's phantasied and actual behaviour. ( Ogden, 1989 , p.85)
It is often the case with marginalised adolescents that they find the terrifying and destructive memories and images they store, far too harsh to tolerate and so projection and psychic retreat is considered to be imperative. This is so even while such an approach is unsatisfying and painful. Where withdrawal occurs, the defence mechanism has become highly organised, the splitting personified, with a number of objects (other persons) becoming incorporated into the defensive purpose to "bind destructive elements in the personality" ( Steiner, 1993 , p.8). A terrifying and yet unmovable isolation results.
Thinking and growth
How then does growth come about? It is only possible where the person is able to take back the split-off bits, hold painful and disturbing thoughts and experiences without constantly being paralysed by the memory of loss associated with that which has been desired ( Bion, 1977 ). As Alvarez (1992) has indicated:
"I would suggest that a thought becomes thinkable often by a very slow gradual process, a process that cannot be rushed. The implications for the question of how the abused child may be helped to come to terms with his abuse may be that the 'remembering' may involve a million tiny integrations taking place, each one under conditions where other aspects of the abuse, can afford to be forgotten. The abuse may have to be explored one aspect at a time". (p. 153)
Knowing and understanding what has been projected; taking back the split-off parts of the self; the experience of holding; the suspension of memory and desire; tolerating thoughts and thinking: these are the key elements in the journey of growth for the person and the therapist.
What is at stake is an understanding of what the person needs and wants. It is clear that the therapist wants to assist the person with this process - to overcome the impasse and be available in the therapy. However, it may be that the person is ambivalent, arriving for a similar goal but dominated by the need to maintain order and equilibrium. As Steiner indicates, perhaps the therapist wants to impart understanding while the person wants to be understood ( Steiner, 1993 ). With adolescents, this distinction is of critical importance. So waiting is of critical importance. The process of growth cannot be rushed and although the therapist may wish for the pain to ease and for the person to experience positive change, such can never be achieved at the rate and by the timing of another.
By saying this, the agenda for the remainder of this paper is set. Not only must I consider the action and thought of the person. I must also consider what it is that operates within the therapist, for an impasse can be the product, not just of what the person brings, but also of what resides within the history and present emotional experience of the therapist ( Steiner, 1993 ; Symington, 1986 ).
As Winnicott (1989d) indicated late in his life, perhaps it is useful to ask of the person who seeks help, why it is he cannot move forward, however, it is of far greater significance, that the therapist asks himself the question, why it is that he cannot wait!
Working with "James" in retreat
The irony of man's condition is that the deepest need is to be free of the anxiety of death and annihilation; but it is life itself which awakens it, and so we must shrink from being fully alive. ( Becker, 1973 , p. 66)
It appals me to think of how much deep change I have prevented or delayed ... by my personal need to interpret. If only we can wait, the patient arrives at understanding creatively and with immense joy, and I now enjoy this joy more than I used to enjoy the sense of having been clever. ( Winnicott, 1968/1989d , p. 219)
James was fourteen years of age when he was first referred to our Centre by another young person with whom I also had contact. He is now twenty four years of age. The first period of our contact was fraught with difficulty; suspicion, a limited capacity to approach for help, considerable withdrawal and great distrust. Despite his youthfulness and the danger to which he was constantly exposed, he sought out assistance only on his terms and rejected contact that required any form of negotiation.
For most of our early contact, he received only limited practical assistance and my assessment was that we were of little significance to him. However, contact occurred over a long period of time and what he did receive from various workers at the Centre was non-abusive, flexible, open and reasonably consistent. We tolerated his mistrust and contained within ourselves, the anxiety and pain that was projected by him (Salzberger-Wittenberg, 1970 ). So he received some experience of holding and this both excited and repelled him. It was the perfect scenario for the development of an idealised and somewhat flawed container for severe and debilitating anxiety responses to early loss and separation ( Sroufe, 1997 ; Steiner, 1993 ; Symington, 1986 ; Symington & Symington, 1996 ).
During most of his adolescent years, he made his way around Kings Cross and the beach areas of the eastern suburbs. The person who introduced him to the Centre became his mentor and confidant. Once James had been discovered, the mentor provided accommodation, food, guidance, excitement, a sense of intimacy and a form of holding that replicated and substituted for his ideal of family. He kept James away from mainstream assistance, a situation that suited their needs and desires. Under his tutelage James tried most drugs and became addicted to a number of them including amphetamines, cannabis, cocaine, heroin and alcohol. In the midst of all this he was able, for periods, to drag himself away from the mire that was this relationship and the inner city. An uneasy string of productive periods saw him complete the Higher School Certificate : in the midst of much chaos, an indicator of some considerable resilience ( Raphael, 1993 ; Resnick et al., 1997 ).
Within the family
His immediate family consists of his mother and younger sister and a stepfather, with his biological father living nearby, very much involved in the daily life of the family. James moves in and out of the family environment, spending short periods living with either parent then leaving because of internal conflict or after a fractious incident. His relationships within the family are close but enmeshed and marked by disappointment on all sides. There are five or six other houses where James spends time with friends, bringing about only a temporary cessation to his semi-permanent transience.
James grew up in the outer suburbs of Sydney and was an only child for the first nine years of his life. During those early years, his father also worked at night attempting to establish a career as a musician. This left James and his mother alone on many nights, an experience that eventually led to the breakdown in their marriage. Although there were difficulties during these early years, it is clear from their manner of relating and their capacity to tolerate ambivalence that there is a high level of connectedness within the family, the source of much resilience within James ( Resnick et al., 1997 ).
At the time his parents separated, they also moved closer to the inner city. James reacted by running away from home returning to stay with friends in his suburb of origin. He was 10 years of age at the time of the separation and his sister was newly born. By the time he was twelve, he was a regular user of cannabis and was sexually active. He left home at 13 years of age and began living in refuges. This lasted until he was nearly 15 years of age, at which point he was living somewhat feral, seeking time in refuges only when life had become too chaotic. It was at this time that his mentor discovered him.
His natural father is caring but unsure about how to provide direction and containment in their relationship. His mother is articulate and exudes a sureness of position and purpose that dominates most discussions. There is an obvious intimacy between James and his parents with a particular intensity in the relationship with his mother. They have fought in their relating since he first began to develop a sense of independence at around eleven years of age. To the extent that such is possible, his level of connection within the family occurred within and around such encounters. Fighting followed by a sullen and self-destructive withdrawal became a template for intimate relations.
When James and I have attempted to talk of their contact, the discussion is overwhelmed with anger and frustration, a desire for closeness and immense sorrow, remorse and a pervading sense of guilt. It appears that he cannot find himself within these encounters. When we are together and discussion turns to these emotions, the desire within him to run is palpable within the room.
The parent-child relationship appears to possess some Oedipal qualities: a mother hungry for companionship with a sequence of unsatisfying adult partners; an attractive and charismatic son wishing to destroy that which stops the satisfaction of his hunger. An intense relationship develops between mother and son that is symbiotic. There is a sense that his emotional being is attached to his mother and yet is cut off, stunted and stultified. As Winnicott (1988) has indicated, punishment for such desire and action comes in the form of an emotional castration or blindness that is indicative of "repressed unconscious" (p. 49; Malan, 1979 ).
The bond and need experienced by James and his mother appears to preclude the development of understanding regarding how their relationship functions. They talk at each other and rarely with each other. This produces both fright and flight within him and a reaffirmation of purpose and direction in his mother. James indicates that this is where he experiences an impasse. One can surmise that where separation and individuation is difficult, running is the only option and the conclusion is a loss of access to the good things present within the family. Ambivalence and impasse are the results; an experience shared by all.
Whether positive or negative in form, the relationship to those outside of him is dominated by projective identification. It is a dynamic process that leaves him bereft of integrative force and with a diminished capacity to believe he could tolerate both good and bad ( Segal, 1988 ; Steiner, 1993 ). Such a posture raises questions regarding his parent's capacity to hold and understand their own and his earliest projections so that he could learn the art of tolerating good and bad thoughts and experiences ( Bion, 1967 ; Winnicott, 1969/1989c ).
Having said that, his perception of a lack of space within the family also possesses a 'darker' and more hidden side producing fear and panic within him: feelings not simply arising from within his family experience. The beginning may well have been a maternal intimacy expressing maternal need and desire. What is of equal significant is an early sexualisation while at home and upon leaving. His somewhat naive involvement with a mentor gradually unfurled a sexual desire towards James that continues to disturb. Involvement in prostitution is yet another complex and perplexing experience for him. All in all, what we face together is an unrelenting mix of confounding thought and emotion. In the face of such tumultuous material, it is not surprising that James withdrew into more serious drug usage and occasional suicidal behaviour. It is also not surprising that he experiences acute ambivalence towards his therapist.
The therapy and the therapist
Some weeks after a serious and life-threatening car crash, James returned to live with his mother. He was in mid twenties. The crash occurred under the influence of a cocktail of drugs and there appeared to be a level of suicidal ideation and gesturing associated with the event. The magnitude of the accident produced both fear and resolve within James. It was again a chance for him to reconnect through incapacity, at home and within the therapy. He requested more regular and structured contact and for a period of four months attended weekly sessions, struggling with conversation .
Despite a desire for consistent contact, his tolerance for conversation was limited and he often reported feelings of shock or fright while in the room, followed by some level of internal disintegration after the contact. This was eventually externalised resulting in a watering-down of his resolution not to use drugs. In the face of such clear and present torment within James, it was a time within the therapy where I felt a constant questioning within me of what I was attempting to be with him.
It is interesting to note that this four-month period of consistent contact coincided with a significant physical disability resulting from the car crash. His jaw, which was shattered by the accident, was wired throughout the four-month period. His intake of nourishment was structured, controlled by access to others and specially prepared so as to be easily received and ingested. Injuries to his legs also meant he had restricted movement. The retreat back into significant drug and alcohol use occurred at the time he regained his physical freedom and a capacity to control the level and texture of his own nourishment. I am left with many questions regarding emotions in the lives of marginalised adolescents: of how unpalatable and intolerable they are, and of how sensitive the therapist must be to the experienced and acted-out but rarely articulated paralysing fear so often associated with emotions.
What James was able to articulate was a desperate need to survive. He was aware of the destructiveness to himself and others. He was also aware that his life was 'disappearing' before him. His use of drugs had consumed much of his adolescence and he was acutely aware of an inability to seize control of his future. Regular work seemed impossible and attempts at completing any tertiary education or training had failed. The agenda seemed clear.
Despite this apparent external clarity, as he continued to attend, an increasing level of confusion and anxiety began to reign both within him and in the therapy. In essence, two pivotal points arose, both of which caused him great anxiety: the first being his relationship with his mother, the second being his feelings for the therapist. Of the first relationship, he increasingly spoke in angry terms. Of the second, he found himself to be speechless, overwhelmed by the intensity of confused desire and past memories associated with his mentor experience.
Efforts to communicate with him about his feelings were met with increasing resistance. Attempts to cool down the transference, to make it more bearable by diffusing the focus within the therapeutic relationship, were thwarted. The dominance of thoughts and feelings relating to both pivotal points made the development of a focus on the here and now quite impossible. When we were able to focus momentarily on the more practical and solution focussed issues, James indicated that he couldn't 'get the other stuff out' of his head.
When we attempted to talk about the relationship with his mother, he became burdened by a sense of guilt, which he justified by reflection on his 'bad behaviour'. When he attempted to talk of his feelings about the therapist, he was distressed by thoughts he might be homosexual and then became riddled with guilt because of past experiences of prostitution or of breaching chosen sexual boundaries with friends. Thoughts such as these became too much to hold.
With a belief structure clearly indicating that goodness is external and that badness, although pushed towards others, is really internal, remaining with the other is impossible. The idealisation is overwhelming because the internalised badness is soul-destroying. Flight is a necessity.
A basic dilemma and a major fear
The fear for James is that of the Pandora's Box : contact with an apparently good enough person (object) turns sour because of its transition into an uncontrollable flood of memories and desires which cannot be tolerated or limited in any fashion ( Bion, 1967 ). For James, it is a fear based on solid evidence: abandonment, naive reliance on a 'caring' mentor , the horrible discovery that everything is a fraud.
Herein lies the basic dilemma for James as growth can only come with a capacity to tolerate thinking. This demands a lessening of the reliance on control and a greater experience of faith in the capacity of the therapeutic relationship to contain the experience, maintain some limits, and be thoughtful about both the transference and countertransference. As Bion (1978) indicates, "... choosing what I am going to pay attention to also involves not choosing what I am not going to look at or talk about" (p. 7).
There seems little doubt that James needs and wants change. But the fear that arises when he has thoughts of not being able to stop the thinking or control the subject of thought is most overwhelming for him. I can only ever have an opaque understanding of what this means for James. What is crucial is that I contain my own thoughts and desires in order that I am able to remain with him "while growth tendencies are given a chance" (Winnicott, 1986, p. 107)
A glimmer of hope - trying to think and hold 'good' and 'bad'
In the midst of what appears to be a continuing chaos, even in his withdrawal and absence, there arose a glimmer of hope. On one occasion James arrived unannounced and wanted to talk. The unexpected nature of the contact threw me and I requested that he wait for a minute. He had missed a number of weeks in a row and my frustration at holding time and chaos on my own, was very present. As I came back and headed towards him and my room I said, with humour and candour (I thought), 'What am I going to do with you James?' I could sense a loss of my own containment.
In a rush to try and re-establish some order, I launched into a monologue of one or two quite powerful but uncontained statements. 'I've been considering whether or not we should be seeing each other!'; 'This just doesn't seem to be working for you'; 'I don't want to end up having the same sort of thing happen here that occurs between you and your parents'. James immediately said, 'I understand that and I know you have other commitments'.
He appeared to shrug off my comments, agreed to come back and talk and we proceeded briefly to discuss the issue that was preoccupying his thoughts: a court case resulting from the car accident. He then left and I felt confused and unhappy with how I had handled the sudden arrival followed by my sudden 'you bastard!' type reprimand/evacuation.
Despite the apparent understanding he showed and the desire he expressed to come back and talk, he wasn't able to break the retreat. Some weeks later, he again contacted by telephone, a situation I find too confusing but into which I invariably stumble with James, often because of latent life-threatening thoughts and behaviour within and around him. He said that he was furious about our last conversation, that he didn't understand why I would contemplate 'finishing' and threw out at me, 'you said you wouldn't act like my parents!'.
I felt a degree of panic and, realising that we probably wouldn't talk again for some time, tried to process the original and subsequent conversations. I finished the phone call feeling as though I had clarified my position and regained some order. He sounded stable and understanding. I have learnt that this is no indicator of true form. Later I realised this was a precious moment that I had defended against rather than welcoming. In my defensiveness, I felt I had missed the moment. Instead of trying to engender some dialogical elements to our contact at this moment, it became a defensive monologue. Some weeks later he contacted and was quite sullen and somewhat morose. He blamed himself for the last contact and subsequent telephone call. Because of those feelings, he felt loathed to return. He felt bad that he had persecuted 'someone who is good and naturally frustrated with the situation'.
So what was that precious but missed moment and what had transpired between us in those disparate encounters? It was a glimmer of hope in his staggering growth. In that angry phone call he had, just for one moment, allowed himself to be angry at the object he had previously idealised. For the first time, anger and love were co-existent. The split-off bits of him were brought together and there appeared to be some capacity to tolerate both good and bad feelings about the therapist; a real struggle for a person who cannot hold both good and bad thoughts as coexistent.
For me, but only in retrospect, it was a case of projective identification. I had become the good enough but frustrated parent who is overwhelmed and fearful of the encounter with a ungrateful son. My attempt at restoring a correct understanding was more defensive and bullying than an encounter characterised by an opacity for memory and desire ( Bion, 1977 ). It was a lost moment because I focussed on my need for order in chaos rather than being available to what he brought to the conversation. If I could have held his thoughts at that moment, he may have been confronted within, by thoughts of the therapist who is both good and bad. Although this is confronting and confusing, to tolerate such juxtaposition is to tolerate growth. It is a movement away from a more paranoid-schizoid position towards a more depressive position. From there, and if the juxtaposition can be sustained, an essential mourning can begin. This is the quintessence of growth ( Bion, 1977 ; Steiner, 1993 ).
The intensity of the experience for him combined and some inability on my part to contain my own thoughts, contributed to a movement back to a more paranoid-schizoid position with idealisation being the dominant projection. A physical and psychic retreat resulted and contact was suspended. But something had occurred. In this encounter, we were both in there attempting to deal with difficult memories and thoughts and even though it was fleeting, the possibility in James of holding both good and bad ideas regarding the therapist is a positive sign. Hope tells me that we will walk that path again.
It is tempting to cast an eye over such a predicament, with its inherent repetitive nature, and consider that nothing is occurring, that little is possible and that time waiting and time spent is not therapeutic. Marginalised adolescents require of us that we break the moulds that traditionally have them isolated from assistance. We must begin to think about them in different ways. Even the transitory and apparently messy encounter contains the possibility of change and growth if it can be held and thought about . The attempt at holding and remaining with the struggle contains inherent therapeutic value.
And of my effort to hold, think and understand? A psychoanalytic way of seeing can assist in this endeavour, for it places great emphasis, not just on what the person brings to the room but, just as important, what the therapist brings. It is this final hermeneutic point that is the focus for the remainder of the paper.
The therapist, thinking and the dialogical conversation
"The self neither preexists all conversation, as in the old monological view; nor does it arise from the introjection of the interlocutor; but it arises within conversation, because this kind of dialogical action by its very nature marks a place for the new locutor who is being inducted into it." ( Taylor, 1991 , p. 312)
"It is important to recognise that the analyst is never able to be an uninvolved observer since he is always to a greater or lesser degree enlisted to participate in enactments in the transference." ( Steiner, 1993 , pp. 3-4)
"It's by talking nonsense that one gets to the truth! I talk nonsense, therefore I'm human. Not one single truth has ever been arrived at without people first having talked a dozen reams of nonsense, even ten dozen reams of it, and that's an honourable thing in its own way. Talk nonsense to me, by all means, but do it with your own brain, and I shall love you for it. To talk nonsense in one's own way is almost better than to talk a truth that's someone else's; in the first instance you behave like a human being, while in the second you are merely being a parrot." ( Dostoevsky 1865-66/1991 , p. 251)
Therapy is a process whereby a person attempts to place before and with another, the mess of their existence, in the often-desperate hope that some sense of clarity, order and joie de vivre may be achieved or restored. It is a puissant encounter easily given to a transfer of power, authority and the creation of anxiety and vulnerability, all of which are much to be considered in the person and the therapist ( Satir, 1987 ).
Many therapists would hold that the core of healing within therapy exists in the relationship established: its capacity to contain, the skill of waiting, understanding the transference and of interpretation; the facilitation of growth ( Baldwin, 1987 ; Hardham, 1996 ; Omer, 1994 ; Winnicott, 1968/1989d ). More is required.
To be the good enough therapist requires a capacity to face, hold, play-with and tackle, with ongoing fortitude, the vicissitudes and angst of the therapist's own psychic and external world. If the dialogical movement is to be containing, ethical and just in orientation, then engaging in the art of transparency is imperative; the quintessence of the therapist's world.
In the room, the therapist needs to be circumspect about acknowledging his own needs and desires. This is not so in the process of his own self-reflection and analysis. Under whatever guise this process comes, such transparency is at the core of a just and ethical, contextualised, dialogical and containing therapeutic process. The remainder of this paper fleshes out the meaning of this approach in the context of my work with James.
Understanding in the countertransference
Klein (1986) and others ( Bemporad & Gabel, 1992 ; Giovacchini, 1992 ; Salzberger-Wittenberg, 1970 ; Segal, 1988 ; Steiner, 1993 ; Symington, 1986 ) have indicated that countertransference refers not just to that which is triggered within the therapist by the projections of the person but to all of the emotional responses triggered: within the person and of the therapist. Far from feeling gratified by James' idealisation, what was evident after our encounters was a feeling of separation, frustration, anguish, and isolation. There is no doubt that some of this emotion is of me as well as of James. I come to the room as an individual and with emotion. That is only too clear from the clinical vignettes presented. What is critical in my work with James is that this potent reality not be ignored.
A number of questions must be posed to try and untangle the experience of countertransference: to establish as much as it is possible, what is of me and what is of James. Are the feelings I register while with him, already present in me before I enter the room? In other words, did I bring this sense of anguish or isolation with me as a part of me or was it primarily what I soaked up while in the room with James? Did those emotional states remain with me after the contact with James, with a focus within me or was the focus diffuse and external?
Of course the answer is quite complex and ever-changing. There is a level of discomfort and angst resident within all. It is definitional to the human state. So it is inevitable that some of my feelings are triggered by those within James, particularly given the intensity of the emotion he projects. Perhaps this is the key to understanding their origin. Their intensity is indicative, more of his emotional state than of mine, even though some of his experiences are, in a milder form, mirrored within me.
The critical point is not that I am able, in some artificial sense, to devoid myself of feeling during the therapeutic process. On the contrary, my emotions are, in part, tools of the trade whereby I am able to understand him more fully by listening to that which is transferred into me as the therapist. But as Steiner, (1993) has indicated:
"counter-transference also has its problems when we come to try and use it in practice, perhaps most of all because the analyst's introspection is complicated by his own defensive needs ..." (p. 140)
Steiner, (1993) and others indicate that it is the countertransference reactions that remain unconscious that require attention ( Kottler, 1993 ). So added to the tool of countertransference must be a developing insight arising from transparent collaboration, clinical supervision and consultation with peers ( Aponte & Winter, 1987 ; Steiner, 1993 ).
Thinking and the dialogical movement
Pre-eminent in the tasks required to achieve a dialogical movement, transparency and (therefore) an ethical practice, is a capacity for thinking . By this I don't simply mean having thoughts, but rather, (or as well as) having a capacity for holding and pondering those thoughts: of bringing thoughts into being ( Bion, 1967 ). This coincides with the primary task of the therapist in the therapeutic action. If the therapist can allow the projections of the person to wash in and around, if in that process of holding (Winnicott) or containment (Bion) of mental pain, thinking can take place, then understanding is possible ( Flaskas, 1996 ; Symington, 1986 ).
What does the person gain from this action? An understanding that what is projected is not that intolerable. The person may see that the destructive elements of his being which may normally be projected can be tolerated, understood and that annihilation of self or other is not the necessary outcome. What can also be experienced is the possibility of withstanding the frustration associated with holding mental pain rather than evacuating unwanted anxiety at the first sign of psychic distress.
As Bion, (1967) has indicated, what we learn from our observation of human development is that developing a "capacity for tolerating frustration thus enables the psyche to develop thought as a means by which the frustration that is tolerated is itself made more tolerable" (p. 112). It is this learning to hold-onto, the containment of anxiety, and the thinking-about painful thoughts and experiences which makes growth possible because it deals with the fear of bad-things-inside and of the very real anxiety of death and annihilation ( Becker, 1973 ; Bion, 1967 ; Salzberger-Wittenberg, 1970 ).
Does not then this same action or process apply to the therapist? Is it not critical that the therapist understand how to deal with the anxiety that comes both from within as well as from the projections of the person? Learning how to think thoughts, to modify, not evade frustration: this is likewise, a critical task of the therapist ( Bion, 1967 ). If the therapist is able to think , even in the presence of powerful and murderous thoughts, then the person experiences the therapist and the environment as facilitating (Winnicott 1989a). This is a critical task in work with adolescents as the projections and felt anxieties are inevitably so strong.
The conjunction point between the hermeneutical task and the project of the therapy is in the dialogical movement that brings about understanding. In the therapeutic task, this occurs in acts of reverie ( Symington & Symington, 1996 ). A capacity for reverie in the therapist means being able to cast aside preconceived theories about what is going on within the person so that the current experience and feelings of the person can be projected and contained, held and understood. This occurs without the therapist losing a sense of authenticity or personhood and it can only come about where the therapist is able to believe in his or her worth which is ratified by the capacity to think ( Symington, 1986 ). Thus, therapy may also be described as a hermeneutical task, a place of unfolding and interpretation: a dialogical conversation where there is a clear recognition that growth and understanding are occurring within both interlocutors ( Taylor, 1991 ).
The recognition of this double hermeneutic allows for the transference action to be a positive and just experience for the person because both the person and the therapist are working at the development of understanding, which for the person and the therapist provide new possibilities and complex challenges. As Symington (1986) has indicated:
"The patient transfers onto the analyst responsibility for emotional development in a failed area. One aspect of this process is that the patient needs to transfer on to the analyst his or her bad inner objects; the other aspect is that the patient requires an emotional capacity in the analyst in the particular area where there has been developmental failure." (p. 112)
It is for this reason that transference is seen to be the place where understanding and healing is located in therapy. But if understanding and healing come about in the person because the therapist provides an emotional capacity where there has been developmental failure, it also holds that this is where the inherent difficulty in countertransference exists, principally because of the emotional demands and the therapist's own needs ( Symington, 1986 ).
Bion, (1967) has indicated of Klein's notion of excessive projective identification that it not only refers to the frequency of its occurrence but also to an excess of belief in omnipotence contained within the projection. James is a very powerful character and his family of origin exudes power and control. The force and strength of James, tightly held within his projections, contains a power capable of internal and external havoc. Although I have no desire to believe that it cannot be contained, the reality is also, that, for a substantial period of his life, attempts at containment have been less than useful to him.
Thinking about repetitive themes?
In thinking about the strength of his projections, I become aware of the existence within me, of a fear of the omnipotence of others. It is a fear of what impact their internal desire and angst will have on me. There seems no doubt that much of the instability within the therapeutic relationship is because of what James brings. However, it is equally clear that this excessive projective identification stirs me enough to rattle my capacity to contain his acting-out behaviour.
A further comment is of importance in the analysis of this impasse in and around James. There have been a number of young adults with whom I have worked where their experience of a psychic retreat has been dominant over many years. While each situation possesses significant difference, there is nonetheless a commonality that allows them to be grouped in some fashion. They desire contact but experience an ambivalence of unclear origin. Where there is a withdrawal, their return is marked by guilt and remorse. When they remain, there is an intensity of emotion within the contact they find hard to tolerate. The result invariably contains an externalised and internalised disorder or chaos.
This leads me to ask a number of questions regarding me within the process. Is it the case that I attract or am drawn to these types of young adults? If that is the case, what is the dynamic that is occurring within me? Is there something within the process of therapy that I am doing that contributes to the fright and flight from consistent and helpful contact? The posing of and wrestling with such questions, although somewhat painful, is central to the hermeneutic or therapeutic task.
Unresolved transference and work with James
In the most recent period of my contact with James, it became clear that some action needed to be taken to cool the transference: to dilute the experience so that it could be tolerated by him and thought-about by me. It had become an impasse no degree of patient waiting seemed able to resolve. I was providing a space for him to bring thoughts to and he was only rarely taking up this offer. It appeared to me that the mere offer of time and space was provocative, unhelpful and maintaining me within a relational loop where, while he was riddled with guilt, I was simply experiencing the frustration of not being able to at least converse about the problem. I made a decision to withdraw the offer of regular time and space while at the same time indicating that when he felt ready to come back, 'we could talk'.
By creating a more bearable distance, questions arose and thinking again became possible for me. Connections began to be made between the impasse being experienced by James and my own experience of confusion in this therapeutic process. In particular, I began to connect with early experiences of familial non-conversation and of not being able to resolve conflict with parental figures. This was again revived when I felt a searing inability to resolve a transference impasse in my own therapy.
It is clear that one of the unconscious movements in the countertransference for the therapist is the resolution of early impasse experiences, with the un-thought-about desire to relive and remake those experiences in a more positive manner ( Bemporad & Gable, 1992 ). The distance created by a silent father provides an on-going focus for the unconscious movement within me. The desire to experience reparation is very powerful and the neurotic child of the silent father can often work overtime both to repair the damage and create sustained chaos, particularly in the face of continuing silence. This unconscious reparative and yet destructive effort finds an outlet at a point and place where some control is possible. My own work with others is the obvious place where acting-out may occur.
I recall my own therapy and my manner of leaving that tumultuous but steadying journey that extended over many years. I remembered the various accidental contacts I had with him subsequent to me leaving therapy. Desire, discomfort and the nagging lack of resolution dominated those brief encounters. On each of those occasions, I thought of returning, to give the possibility of resolution one last chance. After a significant number of years in therapy, intimacy, the (apparently) passive therapist, and facing the possibility of internal and external collapse remained painful issues. Within me, they were often met with a psychic and sometimes a physical retreat from the room. I finally terminated the therapy convinced of, and saddened by, my inability to resolve a quite unbearable transference.
The transference was characterised by a longstanding but unfulfilled desire for intimacy in contrast to a silent and distant parental authority. A fear of annihilation arose, but did not originate, within the therapy. The good enough therapist, a facilitating environment and a baffling and painful therapeutic distance: these were the elements that excited the transference, producing anxiety, rage and a desire to run. This internal primal experience supplanted thoughts and any capacity to think . Tolerating frustration was dumped in favour of evasion ( Bion, 1967 ; Symington, 1986 ; Symington & Symington, 1996 ).
Even with the passage of time and ongoing work, I am keenly aware of the aliveness of this unresolved transference and from time to time become aware of its power in the therapeutic relationships that are established in my work. The mode of resolution of those primal fears and early parental experiences around silence, intimacy and annihilation, and the manner of resolving the transference from the therapy: both remain an ongoing project to which I remain attentive. Such a stance is imperative if I am to think about James. Again, posing and wrestling with such questions in a transparent fashion is the quintessence of my work.
Within this current context, another question must be dealt with in order to further an understanding of the impasse experienced by both James and me. What is the trigger that ignites my inability to think about and resolve conflict within my current therapeutic practice? Apart from my own variable level of need, it is the idealisation from the person. It is his silent pain, the acute desire for intimacy, and the need for protection and nurturing. And it is most certainly his withdrawal from contact. It is the mirrored experience of non-conversation. At this point, the triggered desire is for symbiosis while the triggered fear is of an acute loss of boundary and identity.
As Steiner, (1993) among many others ( Alvarez, 1992 ; Salzberger-Wittenberg, 1970 ; Symington, 1986 ; Winnicott, 1988 ) indicates:
"[In] projective identification, a part of the self is split off and projected into the object, where it is attributed to the object and the fact that it belongs to the self is denied. The object relationship which results is then not with a person truly seen as separate, but with the self projected into another person and related to as if it were someone else." (p.6.)
For James, the projections are of a need and desire that are idealised but cannot ever be satisfied. The countertransference I experience is equally unreal. Notwithstanding that unreality, they are nonetheless powerful entities evoking much emotion and some psychic pain. They touch and play with the need and lack of contentment within the therapist that is sometimes felt to be a chasm in desperate need of being filled.
This is where the importance of thinking and containment (in Bion), and holding (in Winnicott) are imperative. Countertransference is a powerful experience within the therapeutic encounter and one that is indicative of psychic realities within both the person and the therapist ( Salzberger-Wittenberg, 1970 ). Despite the intensity and vulnerability associated with dealing with such an experience, failure to attend adequately to this experience means that the thoughts become more dangerous in reality than the fantasy I have of their capacity to annihilate. As Symington and Symington (1996) indicate, "the pain of absence, the pain of no-breast, if not thought about, is projected into an object which becomes persecuting" (p. 83). That happens readily from the person to the therapist. It is also my experience that this can happen from the therapist to the person. At that point, the therapist can feel intense persecution from the lack of appreciation in the therapeutic contact ( Teyber, 1992 ).
It is his inability to tolerate thinking that is the source of the retreat in James. This is also where countertransference can become unmanageable. If I am not also to retreat or retaliate, then I must be able to think about the unthinkable in the life of James and, most importantly, in my own life. In the therapeutic contact with James, his impasse then is also my impasse. Its resolution is a shared responsibility.
Great care needs to be exercised so that I am not seduced or rather, allow myself to be seduced into a relationship of unreality where his psychic need is for an ever- playful , ever- responsive, ever- understanding , ever- communicating father and mother ( Tacey, 1997 ). It is imperative that his projection does not go un-thought-about and therefore run the very real prospect of translating into thoughts of James as persecutory. Such a situation would necessarily become quite a bitter and unhelpful experience for him, and the therapist ( Symington, 1996 ).
To withdraw or not
We are in an age where issues of power, justice, the law and ethics are before us all the time. Because I do not want to replicate the dysfunction or remain caught within an unproductive relational loop, I have, at times, seriously considered withdrawing from the contact because the running appears to make the therapeutic contact unbearable for him and mostly impossible for the therapist.
Having said that, I am then influenced by other values and therapeutic ideals which indicate that attempting to stay while not becoming overwhelmed by the messiness of his beliefs and behaviour may well be a productive approach in the long-run (Kerr & Bowen, 1988; Miller & Baldwin, 1987 ; Steiner, 1993 ; Symington, 1986 ; Winnicott, 1964/1989a). As Freud (in Symington, 1986 ) indicated in 1915:
"[the therapist] knows that he is working with highly explosive forces and that he needs to proceed with as much caution and conscientiousness as a chemist. But when have chemists ever been forbidden, because of the danger, from handling explosive substances, which are indispensable, on account of their effects?" (p.108).
In remaining and not withdrawing, a level of courage and transparency is required. The explosive substances exist not simply within the person but also within the therapist. This must be acknowledged and dealt with, within the supervision process and with our peers, in order that the inherent explosiveness of the therapeutic relationship may become a cause for growth rather than psychic morbidity.
There are many elements to the process of understanding and, in particular, of understanding James that have not been dealt with in this paper. If time and space permitted, a more detailed analysis of James within his family of origin and those he has adopted, would be of benefit both to James and the therapist.
This paper has been about the notion and the experience of understanding. It has been an attempt to set out and explore some principles regarding understanding and then to implement those principles. It is a circular experience. The paper begins with a theoretical examination of how we come to understand. It then takes the hermeneutic notions of the background and of the dialogical self as key indicators of understanding and seeks to flesh those out in the person of James. His experience is contextualised in broad and then personal terms.
The final hermeneutic act has been to consider the narrative of the therapist as a key element in this dialogical movement. Asking difficult and often painful questions of the therapist is central to the therapeutic task. It completes the hermeneutic circle. The therapist seeks understanding. This can only come about where the person and the therapist are carefully considered within their own context as well as within the dialogical movement that is therapy.
What I have learnt from this process is that it is relatively easy to speak with some eloquence about theoretical issues. However, when it comes to the difficult task of engaging in the hermeneutic process of reflexivity, then words always fail to tell the story. Like James, I face the fear of being and of not-being: sometimes in silence but mostly with staccato-like and incomplete sentences that will only ever partially contain the narrative that is me.
At the end of such a written work, the inevitable question for the writer is, have I completed the task? In this written work, within this frame of thought, this environment, and with this person and this therapist: the answer must be an emphatic, no! But there is a clear conclusion. In therapy, we must learn to relish, value and honour the endeavour, not just the end point!
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[ 1 ] ACKNOWLEDGEMENTS: A early 'work in progress' version of this paper appeared in The Child Psychoanalytic Gazette (10)1999, a discussion bulletin of the Child Psychoanalytic Foundation (Australia). Many thanks to Margot Schofield, Kerry Gee, Peter Blake, Dan Aalbers and the anonymous reviewers, all of whom provided useful comments on earlier versions of this paper.
Biographical Note: David A. Leary is currently a Ph.D. Student Centre for Critical Psychology, School of Cultural Histories and Futures at the University of Western Sydney, Nepean, (Australia). He is also Senior Counsellor and the Director of the Come In Youth Resource Centre, Paddington, NSW, Australia, 2021. Correspondence: PO Box 662, Randwick, NSW, Australia, 2031. [email: firstname.lastname@example.org]