Review by Jane Peringer
July 2002

When this book, a collection of Betty Joseph’s papers from 1959 until 1988, was first published in 1989, I had recently qualified as an analyst and had already read a number of the papers during my training. I had also heard Miss Joseph giving other papers. I continued to read the papers over the following years, making use of them for teaching purposes, in trying to write papers myself, and for my own education. Hence, when I was asked to write a review, its contents were very familiar to me, including the excellent linking and explanatory chapters by Elizabeth Spillius and Michael Feldman, but I realized I had never read the book as a book, working my way through it, cover to cover as it were. When did so, I found I learnt quite a lot that was new to me about the way Joseph’s thinking had developed and how she had thought for many years about the kinds of problems she writes about in her book.

This book has been reviewed many times, most extensively by Roy Schafer in The International Journal of psychoanalysis. It is a book that is familiar to very many psychoanalysts and psychotherapists but there are always readers new to Joseph’s work who need a brief introduction: Joseph works in the British Kleinian tradition, but what is particularly noteworthy about her writing, and about her work, is the great sensitivity and very close attention she pays to very precise details of the analytic process itself. Following these details carefully and struggling to understand exactly what is going on between patient and analyst at any given moment in a session allowed her to develop an understanding of the ways in which a patient quite unconsciously seeks to avoid emotional contact with the analyst by manoeuvring or sidelining him into a compromised position and thus forcing a defensive transference collusion, often in the most subtle and difficult to notice way. Gradually she formulated in a clearer and clearer way an understanding of a patient’s wish to maintain his psychic equilibrium in the relationship with the analyst, as a defensively motivated and less anxiety-provoking status quo, an active reworking in the present of long laid down and well-established patterns of object relationships, rather than fully encompassing a more anxiety-generating psychic disequilibrium which would leave room for psychic change. This insistence in maintaining psychic equilibrium is despite conscious wishes to the contrary and a conscious wish for emotional involvement with the analyst.

Many Kleinian analysts have written before and after Joseph about the difficulty of maintaining emotional contact with a patient, about psychic retreats, about rigid systems of defences, about perversions and the death instinct and about the difficulty of moving from the paranoid schizoid position and the excessive use of projective identification to the depressive position with its painful emphasis on whole object relationships. However Joseph has a particular straightforward clarity about the way she both writes and speaks, in which she is able to address with the patient right at the moment of its happening exactly what engagement is going on between them.

Speaking to Miss Joseph about her book, I asked her which were her favourite papers. She said there were three: ‘Addiction to near-death’ (1982), ‘On understanding and not understanding: some technical issues’ (1983), and ‘Transference: the total situation’ (1985, but written in 1983). Three papers written in quick succession. She said she liked them partly because they were the ones people most often talked to her about, but partly because these were the ones in which she felt she had managed to get to grips with and express to her satisfaction the complexity of the ideas she had been struggling with. After talking about them for a moment, she added a fourth paper to her favourite list, from a little earlier, 1975: ‘The patient who is difficult to reach’, which perhaps represents something of the development a little less resolved.

Although the book covers many different areas of disturbance and psychopathology, it is in essence the development of a line of thinking about the conceptualisation of the analytic relationship and a way of working with it. Some years after the book was published, when Miss Joseph supervised me as an already qualified analyst, I found the same willingness to struggle with and get to grips with the material I brought for supervision as is apparent about her own work in her book. There is a persistence which means she is not satisfied until not only is something understood but until it is understood clearly. This clarity is very helpful in her writing, but makes the problems she writes about look, at times, deceptively simple.

Let me turn to one of the papers Joseph likes, and which I have always liked too: ‘Transference: the total situation’. In this paper Joseph reminds us of Melanie Klein’s paper ‘On Transference’, in which Mrs Klein points out that for many years transference was understood in terms of direct references to the analyst, and that it was only later on that references to, for example, everyday events were understood as giving clues to unconscious anxieties stirred up by the transference situation. Going on from this, Joseph explores the way in which the patient makes use of the relationship to the analyst to convey and repeat in that relationship whole aspects of their inner world built up from infancy onwards, experiences which are often beyond the use of words. To do this, the patient endeavours in a variety of verbal and non-verbal unconscious manoeuvres to draw the analyst into his defensive system, often only recognizable to the analyst by careful attention to his counter-transference, in the sense of noticing all the feelings aroused in him.

Further to this, it can be seen that the analytic relationship is an alive one, with the responses of both patient and analyst resonating in the other and moving the situation on from one moment to the next, according to the nature of patient’s prevalent anxieties at that moment in the session.

In this paper, the first example is of an analyst presenting to a clinical seminar some apparently sensitive clinical work with a patient but with which she, the analyst, was dissatisfied. The seminar group produced a number of explanations and ideas with which it was also dissatisfied, until gradually the group felt it came to understand something of the patient’s experience as an infant. They felt that, perhaps, as a child the patient had been in a situation that she couldn’t understand and couldn’t make sense of, and in the presence of a mother who couldn’t make contact with her child or make sense of her child’s feelings either. In response to this, it was suggested, the child, and the mother, resorted to a kind of pretence at understanding conveyed by logical thought but which convinced no one, although it silenced the experience of incomprehensibility. It was suggested by the seminar group that this was in danger of being repeated in toto in the analysis, with the analyst in danger of making a pretence of understanding.

The point in giving this example is to show how, if the analyst runs around following details of the material and giving explanations and interpretations about what the patient is saying, then a repetition of the childhood situation will occur, a pseudo-making sense of the incomprehensible. Joseph suggests that this may often be easier for the analyst to comply with, because of the relative lack of anxiety involved in thinking one is sure about what one understands. However what will help the patient in this situation and allow in the long run for true psychic movement, is making contact with the patient’s experience of living in an incomprehensible world, rather than getting stuck on individual associations to the patients material. Here the analyst’s counter-transference feeling of being very pressurized to understand made more sense in the light of the patient’s wish to involve the analyst in the ‘total situation’ of her infancy.

The projective identification involved here – in which the analyst is cast in a role as one of the characters in the replay of the drama of the patient’s childhood, including at times aspects of the patient herself – is deeply unconscious and not verbalized, either to the analyst, or within the patient herself. Joseph goes on to say that it seemed that in this case the relationship between the, at root, uncomprehending mother and uncomprehended infant forms the bedrock of the personality. If this is not grasped in the analysis and only the rather later experience of an overlay of pretend understanding attended to, while there may be some shifts in the material, it is unlikely that lasting psychic change will occur. The important thing from the analyst’s point of view is that what is really needing to be understood is communicated through pressure brought to bear on the analyst rather than by words.

Joseph goes on to elaborate a more detailed clinical example of her own, but in both the one I have detailed above and the one she mentions next, I think it is easy to read through her words and believe, rather like the example itself, that one understands or agrees, or that it all makes logical sense. Unfortunately however, like her example, I have found that the process of getting to grips with what she says is actually very much more easily said than done, and I think this is what makes her paper so admirable: she has managed to capture in fairly simple language enormously complicated ideas about moments of contact with feelings which are by definition only at best on the borders of consciousness, which are fleeting, elusive, transient. The to-ing and fro-ing of transference and counter-transference feelings in the way she suggests and which relate to the patients earliest infantile experiences makes clear sense once she has written it for us, but make no mistake, she is talking about very difficult work for the analyst to maintain.

In this paper, although Joseph is using particular examples, she is addressing the issue of the total situation of the transference in all patients, whatever their psychopathology. The phenomenon in question is the nature of transference itself, and the way the analyst can, or can fail to, make use of it. In the two papers before this one, Joseph is covering the same area - that of the way a patient unconsciously chooses to communicate with his analyst – in relation to particular groups of patients but is also addressing in addition more details about the psychopathology of particular patients and the way they characteristically make use of the analyst. In her very well known paper ‘Addiction to near-death’, she is writing about a group of self-destructive patients whose addiction to a masochistic way of relating to themselves and their objects seems hell-bent on creating despair in themselves and, in the transference, in their analyst. Joseph carefully goes through the ways this is silently manifested in the transference relationship, by creating a sense of hopelessness about the endeavour in the analyst, and the importance of the analyst’s being able to distinguish between actual anxieties and the exploitation of anxieties for masochistic purposes. As in the paper mentioned above, her emphasis is on the necessity of being able to demonstrate to the patient how their perpetual involvement with misery and despair has a very gripping and perversely exciting quality. This precludes the analyst ordinarily addressing an apparent anxiety with any hope of relief ensuing: the analyst’s understanding turns out to be unusable and therefore largely irrelevant, because the addictive nature of the masochistic involvement far outweighs in the patient’s mind - the unconscious mind at least - any relief which would be gained by accepting ordinary understanding in the context of the ordinarily helpful analytic relationship. Unless this sadistic attack within the patient himself and with the analyst can be understood for what it is, the apparent passivity of the masochistic stance cannot be budged. The emphasis here is on the apparent passivity, which is in fact unconsciously a very much more active process designed to involve the analyst in an ongoing scenario of despairing criticism and hopelessness.

Joseph explains how the same process that goes on between patient and analyst also goes on in the patient’s mind. She calls it chuntering – an activity in which the patient spends a lot of time doing something which he is likely to call thinking, but which is in fact a gratifying involvement in the mind in an ongoing and very repetitive circular phantasy of a self-destructive kind. As in the transference, the addictive and involving nature of this chuntering makes it very hard for the patient to see that what they are involved in as they chunter (rather than as they think, in the sense of thinking being something productive) is a pervasively perverse activity, and for them to give up on it to gain more ordinarily productive help from human relationships counts for very little in comparison.

Following on from the theme of projective identification in the transference, Joseph explains why she thinks it is so difficult for patients to move on from such an addiction to near death: as well as the undeniable perverse excitement gained from such a masochistic stance, she feels that healthier parts of the patient, sane and life-giving parts with an interest in healthy development and progress, are projected into the analyst, who is then responsible for moving the patient on, and may find himself nudging on a patient who constantly retreats back into masochistic paralysis. Once again, if the analyst persists in pursuing the line of nudging the patient into progressing, rather than seeing what is happening, a major piece of the patient’s psychopathology is acted out and thus avoided. From the point of view of the patient, relatively devoid of his life instincts which are currently to be found within the analyst, he is in a horrible position which he needs understood: he has an addiction, but no means to combat it.

In her paper ‘On understanding and not understanding’, Joseph is further developing the theme of the way particular groups of patients, those broadly operating within the paranoid schizoid position, make use of the analyst to try to avoid understanding the nature of their anxieties, object relationships and defences. It is in the nature of the paranoid schizoid position, with its extensive use of splitting of the self and the object and of projective identification, to be against understanding (in addition to any element of aggressive or envious attack on understanding which may also be operative). Even projective identification can be used as a method of unconscious communication but there is an entrenched way in which it can be used to split off and constantly project out parts of the self which must be inimical to understanding. Here, Joseph gives some very elegant examples of ways in which patients who apparently want understanding and to be understood nevertheless demonstrate by the way they respond in the transference how anti-understanding they actually are. If the analyst can understand what unbearable experience the patient is getting rid of by projection, the analysis has some hope of moving on: one vivid example is of a child who attacks his analyst, puts bits of chewing gum on him and ties him up with string, sticky tape and glue, just before a holiday. The analyst, of course, felt attacked, but more importantly for the analysis, was his coming to understand that what was being projected into him was an experience of the child’s, of being left desperate, hopeless, messy and immobilized as a baby. This distress, if understood by the analyst, had potential to help the child despite his wish to get rid of the experience as concretely as possible, and in the most straightforward way, being anti-understanding.

In contrast to this group of anti-understanding patients is the group of depressive position patients who can use understanding in a different way and make less use of projective identification. Joseph focuses less on this group, whose analyses are hopefully more straightforward - although there are difficult anti-understanding times in every analysis - but she is also in a way hopeful about the other, addicted-to-near-death, paranoid-schizoid-dominated group: she believes that however dominated they apparently are by death instinct driven self-destructiveness, somewhere around, even if it is located in the analyst, is a life instinct which they might in time be able to access. This is a very forward looking and enlivening aspect of her work, and one which I would like to end with: although the book is in many ways about patients with too much death instinct, so to speak, there is always the hope that this can be modified by access to the life instinct.


REFERENCES

Schafer, R. (1991). Book Review. Int J. Psychoanal., 72:169

Jane Peringer
July 2002

Memories of Melanie Klein: Part 2
     Interview with Betty Joseph: 23 November 2001