Twenty-eighth Annual Conference: Developing Clinical Momentum

PANEL I
A Focus on Transference

Leslie Smith

How is clinical momentum advanced through the transference? This was the focus of Panel I. We heard from presenters Marian Tolpin and Linda Marino, and discussants Evelyn Schwaber and Estelle Shane. Chair Jill Gardner launched the panel with a lovely introduction and moderated with finesse.

Marian Tolpin and Linda Marino together presented Marino's treatment of patient Colleen. Examining pivotal moments in this ongoing analysis, Tolpin demonstrated her central points: 1) In original development, as well as in treatment, forward momentum or the lack of it is a function of the particular dynamic system made up of self-object experiences between child and parents, and later between patient and analyst; 2) Momentum in the treatment creates a "new edition" reviving the patient's thwarted developmental process; and 3) Forward momentum in treatment is bi-directional in nature. It involves a back and forth between "trailing-edge" experiences that threaten self-cohesion and "leading-edge" experiences that invite self-righting and restoration.

Tolpin showed us how Marino's steady empathic approach conveyed understanding, acceptance and recognition of Colleen's experience. In this analytic context, Colleen began to formulate new dreams. The new dreams evidenced the patient's emerging experience of a "safe, resting place", in which she felt increasingly stable and resourceful. Of equal importance were moments of disruption between Marino and her patient. These ruptures created trailing-edge experiences of disappointment, fury, and of "things falling apart." In the working-through process, the ruptures and repairs would contribute to forward movement in the analysis.

The presentation was entitled "The Revival of Normal Development." This title captures Tolpin's concept of therapeutic action, which occurs through "reanimating the tendrils of thwarted developmental strivings" and renewing growth in the forward-edge transference as it is reconstructed.

Discussant Evelyn Schwaber brought her own perspective and challenge. Schwaber understands transference as reflecting perceptions rooted in the patient's historical experiences. She emphasized the importance of listening so as to discover meaning rather than to infer or impose it. She seemed frustrated by aspects of the clinical presentation, specifically by the absence of material evidencing moments of discovery of the patient's own meanings. As she revisited the "pivotal moments" presented, Schwaber repeatedly asked, "How does Dr. Marino know [this]? How does the patient see it? How do we know?" Schwaber questioned, "Is the theory, or the patient guiding the understanding of the patient?" Those familiar with Schwaber's early papers on empathy recognize her familiar insistence on the importance of consistently striving to understand how the patient sees things, without making any assumptions.

Estelle Shane opened her discussion by inviting us to think about how change occurs and how development is understood, both in general, in analysis, and in this particular clinical material. Bringing to bear a dynamic systems perspective, she explained that "change in analysis frequently depends on a state shift in the patient provoked by an unanticipated incident, a spontaneous action, or an experience of surprise, a perturbation in the system out of which something new emerges." Shane stressed how this "something new" must be added to our understanding of development or growth in analysis. She argued that change involves not only the revival of stunted development, or the renewal of growth, but it involves perturbations in the system. In perturbation, there is the emergence of something new, "something that has never happened before, and that therefore can not be reconstructed, but is attributable only to a novel occurrence." Returning to the clinical presentation, Shane identified Colleen's new experiences and related new capacities and new sense of possibilities.

My own experience of the panel was somehow less than cohesive. I appreciated the clinical presentation by Marian Tolpin and Linda Marino as it helped me to grasp more fully the important self-psychological-forward-edge perspective of Marian Tolpin. Evelyn Schwaber raised valuable fundamental questions about how we listen to our patients. And Estelle Shane introduced me to a developmental systems perspective, illuminating a new way to think about growth and change in analysis. Though Tolpin and the discussants each used the clinical material as a springboard, it was difficult for me to experience the panel presentation as a meaningful whole. Instead I experienced it as a collection of valuable, though disconnected parts, somehow lacking in the cohesiveness and flow of the subsequent panels. It made me wonder how future panels could be organized as a more cohesive whole.

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