Published in October, 2003 in The Psychoanalytic Quarterly
BEAUTY TREATMENT: THE AESTHETICS OF THE PSYCHOANALYTIC PROCESS
By Susan S. Levine, M.S.S., L.C.S.W.
Psychoanalysts enjoy doing analysis above and beyond its usefulness to patients; one reason for this lies in the aesthetic pleasure the analyst may derive from the analytic process. The author discusses this aesthetic pleasure from the standpoint of meaning making, communication, love, and professional craft. Patients may themselves seek in analysis a certain kind of beauty that is normally a byproduct of good enough empathy and communication. Using Kleinian theory, the author examines the ways in which destructiveness and aggression may be understood in relationship to an aesthetic of psychoanalysis. It is further proposed that the aesthetic and ethical principles of psychoanalysis are indissolubly linked.
Beauty is truth, truth beauty,---that is all
Ye know on earth, and all ye need to know.
--John Keats (1819)
Psychoanalysts love doing psychoanalysis for reasons above and beyond its helpfulness to patients. While it is the responsibility of the analyst by and large to be selfless, to be there for the patient, the analyst is also inevitably and irreducibly present as a subjective being (Renik 1993). There are thus unavoidable narcissistic pleasures (and unpleasures) for the analyst, and it is obviously essential for the analyst to be as aware as possible of what his or her stake in the process may be. One of the most intense pleasures I have experienced is awe of the beauty of the analytic process itself. Aesthetic pleasure is a highly sublimated libidinal satisfaction. The analytic process, I propose, can be understood as aesthetic in that is possesses a form---equivalent to that of artistic objects---that can be evaluated, appreciated, and enjoyed. I will discuss four intertwined components of the analytic process as aesthetic: meaning making, love, communication, and professional work, and I will speculate about the nature and primitive significance of the pleasures analysts derive from these elements.
Why do I even think to apply a concept such as beauty to psychoanalysis? What kind of an object or endeavor is analysis, such that it could be thought to possess a quality such as beauty? To say that analysis is both art and science is to do no more than repeat the tension in the field that others have articulated; and the concept of beauty is alive in both areas, art and science. We regard works of art as intended to be aesthetic objects, and we are not surprised to hear scientists and mathematicians speak of the beauty or elegance of their formulae or discoveries---or even of seeing the handiwork of God in the discovered scaffolding of the natural universe. Ultimately, however, beauty lies in the eye of the beholder, and how we define beauty, what we determine to be an aesthetic object, is an expression of our subjectivity. As Gilbert Rose (1980) notes:
Science and art both create metaphors which make it possible to deal with certain things---metaphors which effect new linkages and reorder the data of experience, according a lasting reality to aspects of the world which before did not exist for us. A creative worker, whether artist or scientist, reorganizes the world in some fresh way---the artist through developing forms, the scientist through new concepts. One mode---be it artistic form or scientific concept---is not more arbitrary than the other. [p. 79]
In my view, psychoanalysis inhabits some sort of middle ground, partaking of both the artistic and the scientific.
Ogden (1994) has written about the analytic third, about the analysis as an object that is neither analysand nor analyst. It is in this sense that I think of an analysis as an object, one that results from an intensely creative process on the part of both participants. The location of the aesthetic experience is not, however, in the object itself, but rather in the meaning given to the experience of the analytic process by analyst and analysand, separately and together. Although I took an aesthetic pleasure in the process of my own personal analysis, I attribute this in part to my professional involvement with the field. Most analysands would not seek or notice aesthetic pleasure in their analyses, and I do not believe that the success of an analysis is predicated upon a conscious appreciation of this aesthetic quality. However, this appreciation of the beauty of an analysis is different from the beauty of empathy or of a good interpretation, and these latter elements are indeed sought or even craved by patients. But what I am addressing in this paper is not primarily the work of the analysis that takes place in the mind of the patient (although my thoughts bear on this), but rather the experience of the analyst.
What is beautiful (or aesthetically pleasing) and what is gratifying for the analyst cannot be entirely separated. I would understand the aesthetic to involve a degree of sublimation that we would not ordinarily expect to find in certain instinctually or narcissistically gratifying experiences. The latter, too, would have a much closer connection to the biological than would be found in aesthetic pleasure. In other words, aesthetic pleasure takes place at a greater distance from purely bodily pleasure. In the analytic process, just as in music, painting, architecture, literature, and other fine arts, the beauty we find is in large part based on our understanding of how this object relates to other similar objects. In other words, our experience is informed by our familiarity with particular traditions and rituals. And thus, the pleasure is indeed based on a sublimation or on a symbolic act, an interpretation of the meaning of the communication between artist and observer. It is in this sense that the gratifications for the analyst (and for the patient) in the analytic process can also be understood to be aesthetic. Although their developmental roots are in the libidinal, these pleasures derive from highly symbolized and interpretive activities.
Obviously, psychoanalysis differs from the fine arts in two important respects. First, it is an entity created by a twosome formed not to make art but to relieve suffering. It might be said, though, that insofar as there is something beautiful about health and the development of a well-functioning individual, the analytic dyads purpose is to create beauty where it may have been lacking. Perhaps the analytic process can be seen as beautiful in the sense that we find natural phenomena to be so. However, psychoanalysis, unlike a sunset, is a cultural artifact. Second, unlike most aesthetic objects, analysis is always in the process of creation, incomplete until termination. But in some respects, the analytic process is experienced in the way one does a symphony or a novel. I understand the significance of the object I contemplate---that is, any segment of an analysis---in relation to what has come before and to the fact that I anticipate that there is more to come. Any segment is a part of an ongoing narrative. And I have certain hopes about what kind of thing is to come. The difference is that what is to come does not yet exist. The unit I contemplate, however, must have been completed---for how else am I to have perceived it if it is not yet an "it"? As Loewald (1975) notes, "Patient and analyst are in a sense co-authors of the play: the material and the actions of the transference neurosis gain structure and organization by the organizing work of the analyst" (p. 280).
One of my most influential teachers in high school cautioned me that it is very difficult to write what he termed "an appreciation paper." Nonetheless, I proceeded to attempt this (an essay, as I recall, about humor in Sinclair Lewis Arrowsmith) and naturally got a "C" (or some such grade) on it. Thus, it is with some trepidation that I set out to do this in regard to psychoanalysis, to try to explicate why it seems to me to be such a satisfying and ultimately beautiful process---and a process about which I have so much passion. But unlike my Arrowsmith paper, which discussed something almost everybody agrees is pleasurable, my understanding of the aesthetic in analysis is not limited to the positively valenced material. I mean to include in this conception the negative as well---the anger and hatred, the anxiety, enactments, and episodes of disjointedness that are a necessary part of all treatments.
Let me begin my attempt to define something indefinable, the beauty of the analytic process, by describing two very different patients and processes. I will begin not with an ugly process but rather with an absence of process.
A few years ago, I was asked to present a case to a senior analyst from another city. Because of issues of confidentiality, the only case I could present at the time was one that was not going terribly smoothly. The consulting analyst, in a phone conversation before the presentation, commented that I seemed to be quite aware of my own countertransference. I noticed, however, that as I spoke to him, there was a certain aspect of my experience that I could not put into words. I could only capture my feelings with something approaching a groan of complaint or distress. It was so uncharacteristic of me to be unable to put my thoughts into words that I began considering what it was about this case that prompted my feelings, for this was a patient whom I did not dislike.
In a typical hour, Eliza, a teacher, enters the office, lies down, and remains silent for a minute or two. Her anxiety manifests itself in the slight stiffness of her body even before she speaks. She begins to talk about something or other that is on her mind, always something connected with reality. The red thread is often difficult for me to find. My first intervention might be a simple reflection or clarification of Elizas feelings; sometimes, she allows that what I say is true, while at other times, she simply continues with what she was saying, reporting diligently the glory of mundane detail in which she lives (as do we all). Efforts to point out the process to her, that she has ignored what I have said, may result in an irritated compliance, but in the end, she remains aggressively adherent to the reality.
I have come to believe that this attachment to reality, virtually impervious to interpretation, represents a displacement or a foreclosure of internal experience. In one sense, there has been very significant progress: Eliza knows now that what troubles her comes from her own mind, something she did not know at the start of analysis. In addition, her presenting symptoms have significantly abated. Nonetheless, I always have to struggle to get her to understand that reality is not all that it seems and that there exists an equally vital process of thinking within her mind. By the end of some hours, she does seem to glimpse this. But it is gone by the next session. Perhaps a better metaphor here than the red thread would be that of Hansel and Gretel: all the crumbs on the forest floor have been eaten, and the patient and I are lost.
Every few months, there is a session or a series of sessions in which Eliza does seem able to work in a way that I would consider analytic. But often these fruitful sessions are followed by cancellations. And again, the reality issues seem so compelling to her that she has not been able to see that there is a volitional element to these cancellations. Eliza millimeters along, and it is certainly not clear that she is truly analyzable (at least by me at this time). Her attempts to kill meaning making, which I have interpreted, seem themselves to be impervious to interpretation.
It could well be that what I was experiencing with this patient as a process without beauty might have transformed itself into an ugly phase in a process that would later seem beautiful to me, although in this case, it did not. What was missing from the treatment were the elements I consider both beautiful and essential to the analytic process: meaning making, a dialogue (in Spitzs  sense of the term), love reinforced by evidence of ongoing growth and benefit to the patient, and a sense of working effectively with theories and techniques. Analysts have, very appropriately and necessarily, learned to expand into working with "widening-scope" patients. And I would place Eliza in this category, because of her minimal psychological mindedness. But that does not mean that many analysts do not have preferences. It is far better to be open about the pleasures we like to derive from our work than to pretend not to have any hopes along these lines.
It is important to consider the element of time as well as the ratio of interpretability to imperviousness. There are episodes of dissonance and inaccessibility in all analyses, but it is when they persist over an extended time, or when there are no areas in which work is proceeding, that I might begin to think of an analytic process as unattainable. What I am describing is perhaps the absence of another aesthetic element, that of the therapeutic alliance. I am aware that other analysts might consider this absence of process to be the process, and that others might have been able to engage Eliza in a more helpful way. However, I think that I may well have been a good enough analyst for Eliza; there may have been a way in which she was refusing to allow me to be a significant object and refusing to acknowledge this refusal. This amounted to a repudiation of an analytic process. Perhaps my limitation was that I was unable to work within her cultivation of emptiness, which amounted to an aggressive destruction of my analytic function.
Quite clearly, revealing what I like and do not like is tantamount to defining my limits as an analyst. We need to discover under what conditions we will feel adequate gratification in our work. It was through analyzing my frustration and dissatisfaction with the work with Eliza that I came to realize that the intense pleasure I was experiencing with my other analytic patients was also suspect. The intensity of my pleasure with other patients, this countertransference "symptom," diminished significantly after I interpreted to myself the aesthetic aspect of the pleasure, and simultaneously, my discomfort and sense of paralysis in the hours with Eliza lessened. I took this as confirmation of the accuracy of my self-analysis and hypothesis.
Let me describe a very different hour.
Dorothy, a recent college graduate, is twelve minutes late, a typical occurrence. She begins by saying that she got very tired on the drive to my office and is feeling a little headachy. Then she tells of an old friend who is in town for a visit. She was very glad to hear from her, but when Dorothy mentioned to her that she is still in analysis four times a week, the friend said, "You still go?" The patient then speaks about how bad she feels about this, even though she knows why shes coming to treatment.
I comment that she does seem to be clearer than shes ever been about what she wants to accomplish here, but that it is also hard for her to hold onto this in the face of her friends exclamation. Dorothy nods as I speak and says that it is hard for her to believe that its okay. She goes on to say that she realizes she sets up encounters like this one in which she knows the other person will question the analysis. She wonders if she does this in order to punish herself.
I say that perhaps it might be to save herself from the pressures and uncertainties of feeling so good about herself. Dorothy replies that she hadnt thought about it in that way before, that it might be to protect herself. Basically, she says, it is hard for her to be happy about anything, to be okay with something. She brings up that in yesterdays session, she talked about looking at job listings in the classified advertisements, even though she loves her new job.
I comment that its hard for her to stick with something when she feels other people dont understand it or have a different opinion. The patient observes that, as I was speaking, she was thinking of how her parents opinions always prevail over her own, that her ideas arent taken seriously and dont matter. This has happened for so long that she starts to think that maybe her parents are right, and so she doesnt stick with her own feelings. She guesses that maybe it isnt such a surprise that she acted that way with her friend. Then she pauses, turns on her side, and speaks about how tired she is, how heavy her mind feels, and that it is becoming an effort to talk. She says she could fall asleep right now, but notes that she doesnt usually get this tired at the end of a regular work day, so it must be something shes doing to herself.
I wonder aloud why this might be happening. Dorothy replies that it is because she isnt just talking about difficult things, but rather that the deeper stuff is happening "live," because she doesnt want to be here today. (This expression refers to a dichotomy that the patient and I have used to distinguish material that seems live and in color from what seems rehearsed.) She doesnt want to talk, but feels she is supposed to be talking.
I comment that Dorothy seems to feel here the way she feels with her parents, that their opinion matters and hers does not. She is assuming that I want her to talk, and it is hard for her to imagine that it would be okay with me if she did not. She first replies that it would be pointless to be here in silence, pauses, and then says that she doesnt think she could ever be comfortable doing that. She is not used to quiet; it makes her nervous.
I remind the patient of something she said the previous day: that she thought it was kind of cool that she was experiencing with me the conflicts she has elsewhere in her life. I say that because analysis is about talking, maybe it isnt a surprise that that would be the medium carrying some of the issues here, between us.
Dorothy says, "So were dealing with something live here," and I say that I think we are. She then speaks about how she struggles not just with talking versus not talking here, but that it is hard for her to talk to me about what happens here. She yawns, pauses, then comments that thats another reason shes sleepy: shes fighting with herself because it is uncomfortable to experience things live and because shes not comfortable with not talking.
I comment that being quiet has other meanings for her, related to how chaotic and noisy her home is. She says again that quiet makes her nervous, feels threatening. There are never any uncomfortable silences at home because she always has something to say. She talks about her best friends family, how respectful they are to each other. She comments that the friends mother would never wake her by doing aerobics in the next room at 6:00 a.m., with the television on high volume, as her own mother does. She says that this drives her nuts, but that mother cant stand for anyone to be sleeping once she is awake. Dorothy says that quiet might be boring, but it would be nice once in a while.
I say, "I wonder if it feels here as though Im going to intrude on you in some way if youre resting while Im not." Dorothy answers that shed never had that thought before, but adds immediately, "I guess so---like youre going to say, Dorothy, talk!" (The last words were spoken loudly and forcefully.) She continues by saying that whenever mother is awake, its her time, and that Dorothy always has to be doing something for her parents. She says she has been trained to feel this way, that it is very hard to break the cycle when it is still being reinforced. Its getting better lately, she adds, giving the example of having recently watched television with mother and wondering if it was really okay to be relaxing; she did not want to jinx it by asking, so she just enjoyed it while it lasted.
I comment that its like she wants to do that here, but is scared to. She says, yeah, it is relaxing not to talk, but what if she fell asleep? She wouldnt do that; its too weird. She describes seeing mother take a nap and wonders if she could do that, too. She then speaks about wanting to make the best of her time here, not to waste it by saying and doing nothing. If she did that, shed be mad at herself.
I comment, "Apparently saying and doing nothing here would really be quite something." She giggles and says it would indeed be a breakthrough for her. She wonders what it would feel like, then says again that it would really be a waste of her time and mine. She pauses before remarking that she thinks this whole time thing is really important.
I say, "And speaking of time..." She laughs. The hour is over.
Why did I experience satisfaction in this hour with Dorothy? What is the nature of the pleasure I experienced? I came to define the pleasure as aesthetic because it seemed to have to do with form, complexity, elegance---qualities supraordinate to the specific clinical content or therapeutic achievement. This aesthetic quality has two sides, one affective and the other intellectual. These categories are roughly comparable to the division between art and science and their respective gratifications. On the affective side, important elements have to do with what it means to me to create meaning and understanding where there has been confusion or even an absence of thought; with what it means to be contributing to the relief of suffering; with the significance of being involved in an effective process of communication; with joy in my own creativity; with watching the patients mind become more complex; and with watching the patient take pleasure in her own understanding. On the intellectual side (and, naturally, there is no firm distinction between the affective and the intellectual), I think my sense of the process as aesthetic derives from the way a theory or set of theories can help me know what to say and to predict how a patient might respond. It also has to do with pleasure in ones own intellect, a kind of Funktionslust, that I believe all analysts experience (whether acknowledged or not).
Kris (1956) emphasized that the good analytic hour did not refer only to those characterized by positive transference. It is noteworthy that it was an art historian who articulated this idea of the goodness that I am now linking to an aesthetic quality. Kriss conception, however, places almost exclusive stress on the role of insight, and specifically, insight in the patient. I am concerned in this paper more with the experience of the analyst than with the experience of the patient (though it is probably more difficult for the analyst to have a pleasurable experience with a patient who is not making progress, however the analyst may understand this). Those patients who demonstrate what Kris terms a "gift for analytic work" (p. 451; e.g., Dorothy rather than Eliza) facilitate the development of what the analyst may come to experience as an aesthetic process.
It is possible for some patients to experience the process as an aesthetic object, and my guess is that this occurs most commonly in analytic candidates and other mental health professionals. (However, Dorothys comment on how "cool" it is that all the issues she has with others are happening between us, despite her extreme fear of this very occurrence, indicates something approaching an aesthetic appreciation of the process.) While ultimately, the success or failure of analysis is determined by what has taken place within the patients mind, analysis is in my view a process that takes place via the analytic relationship; thus, the nature of the analysts pleasure will inevitably have an impact on the patient. For instance, although I devoted much effort to maintaining openness and optimism in my work with Eliza, she spoke from time to time of the ways in which some of her own students tried her patience. She was able to acknowledge, briefly and in an intellectualized way, that she thought she might be frustrating me.
This acknowledgment of Elizas suggests that what I referred to earlier as a cultivation of emptiness may have been something with larger metapsychological significance---an aesthetic of death or destructiveness. When I use the term aesthetic as a noun, I mean to invoke several concepts, psychoanalytic and ordinary: repetition compulsion, unconscious phantasy, Weltanschauung. The American Heritage Dictionary (2000) includes the following definition of aesthetic: "An underlying principle, a set of principles, or a view often manifested by outward appearances or style of behavior." An aesthetic can thus be understood as ones preferred mode of presentation, comportment, or display, as well as the ways in which one creates these preferred conditions through enactments with external objects. What we think of as character could also be considered a reflection of the personal aesthetic. In fact, one might think of one of the goals of analysis as replacing one aesthetic with another; and, as we know from experience, what is most difficult for patients to give up is indeed what gives them pleasure.
Returning to Eliza, might an analyst who was better able to derive pleasure from her own sadism and masochism than I am have been better able to enter Elizas aesthetic and thus to help her? It is an unanswerable question. We know all too well that this dynamic characterizes many relationships, including mother--child, husband--wife, and analysand--analyst. Each partner becomes for the other an object of sadism rather than of love, and hatred becomes the coinage of the connection. It might be possible, I suppose, to say that such an aesthetic might yet partake of a larger aesthetic of beauty, insofar as it would fall within the capacity of psychoanalytic theory to explicate and perhaps even predict its occurrence. One might be able to say that once the cultivation of hatred can be understood, it can become beautiful (or, perhaps more accurately, sublime). But I think that to try to subsume destructiveness under beauty would minimize the fact that sadism and masochism are powerful and independent mental tendencies. Regardless of why they exist---as reflections of a destructive drive, or as byproducts of empathic failures or of having had to love a sadistic object---they do exist. In saying that the analyst should cultivate or permit an aesthetic of destructiveness only as a means to the end of helping the patient enter an aesthetic of love, I am addressing not only the aesthetics of psychoanalysis, but also its ethics.
THE AESTHETICS OF MAKING MEANING: INTERPRETATION
In the hour with Dorothy described above, the emphasis on making meaning is apparent. Through a process of clarification and interpretation, the patient and I come to understand more about her. There is an unimpeded movement in this session between present and past, transference and external life. The repetition of the past in the present and the vitality of the transference reinforces the patients conviction about the validity of the new understanding. I do not need to explicate at any great length the various elements of psychoanalytic theory that lead to my technique: the importance of transference interpretation, the principles of ego defenses, the use of empathy. But certainly, all of them together work elegantly and effectively to further the therapeutic process and to relieve the patient of another increment of suffering. I find an almost tangible beauty in sessions such as the one described above, typical in the work with Dorothy. No particular theoretical stance dominates here, but clearly, it is a specifically psychoanalytic theory that informs and animates the process and the result. What I cannot capture in mere words, of course, are the excitement, pleasure, and relief that Dorothy expressed.
One of the goals in an analysis is for the patient to be able to develop a more or less coherent narrative of how she came to be the way she is. I think it would be accurate, too, to say that this is one of the values that most analysts hold, that it is a good thing to be able to understand oneself in this way. It is the patients narrative rather than the analysts that is ultimately necessary, but one of the ways in which the patient can develop this is via the reconstructions and interpretations proposed by the analyst. (The insurmountable fact of suggestibility, however, blurs the line between the narrative of the analyst and that of the patient; but as we know, the analysts interpretations, too, are a product of both members of the dyad.) Thus, my light bulb moments in an analytic session constitute another tentative building block in the coherent image of the patient that I form in my mind and then gradually offer to the patient for her consideration, confirmation, rejection, or emendation. But to me, this is where the relationship of psychoanalysis to science also emerges, in the search for the patients confirmatory associations, memory, or emotional resonance with the interpretation. The element of science in this is the check with reality, the experiment that takes place when the patient tries on an idea or a feeling to see if it fits.
Embedded in this goal of creating a coherent narrative are standards that are remarkably similar to the ways in which one attempts to evaluate works of art objectively. Most art criticism can be understood to address the degree of unity of a work (level of organization, formal perfection, possession of an inner logic of structure and style), the degree of complexity of a work (the largeness of scale, richness of contrasts versus repetitiveness, subtlety, or imagination), and finally, the intensity of the work (its vitality, forcefulness, beauty, and emotional type or genre) (Beardsley 1958, p. 462). With rather little imagination, we can apply these notions to the ways in which we critically evaluate the depth and quality of an analytic process. I would translate the criterion of unity in terms of the extent to which the transference, present and past, is understood as connected. Complexity and intensity can be applied to analysis, I think, as they have been described above. And if we consider knotty epistemological problems (e.g., narrative versus historical truth), it may make sense to evaluate the coherence and quality of the narrative more in the manner we do with a work of art than in the way we do with a newspaper article.
Psychoanalytic aesthetics appear on the surface to violate one of the oldest standards, that of the Greeks, who looked for the three unities of time, place, and actions in their dramas. (I say appear because in the unconscious, the need for these unities does not exist, as all things coexist at all times.) In analysis, I think we replace this with another threesome: we hope that the patient will move freely between present real life, transference, and the past. (Perhaps we could think of this as the architectural structure of psychoanalysis---the rooms of the house through which we wander.) Another way of thinking about this is that there is always unity of time, place, and action in a patients narrative, and it is the job of the analyst and the patient to discover it. Recall, too, that in the formation of dreams, logical considerations of representability are one of the disguising and defensive element of the dream work. If we look at a work that straddles the border between literature and psychoanalysis, Freuds Dora (1905), we can see the struggle to create a new genre that respects the aesthetic of the unconscious in which there are no such divisions. This tension---between a traditional aesthetic or logic of narrative and the aesthetic or logic of the psyche---may account for many of the difficulties that some analysts experience in writing about their cases.
But to shift from aesthetics back to psychoanalysis, let us wonder why a coherent narrative may seem so beautiful a phenomenon to contemplate. In fact, it is not a coherent narrative that I contemplate in my vignette of Dorothy, but rather the potential for one; one could say, perhaps, that it is the movement from less to more coherence that is as much the aesthetic object as the narrative itself. And it is this that I am aiming at here, the process of making meaning as the aesthetic object rather than simply the meaning itself. In other words, it is perhaps movement in the direction of truth, rather than truth itself (which may be unknowable), that constitutes the beauty I find in the psychoanalytic process. In addition, I would like to stress the aesthetic pleasure of the narrative provided by psychoanalytic theory itself. While it is not a predictor of any specific clinical event with any specific patient, -psychoanalytic understanding may nonetheless include even events that surprise the analyst. As the patient and I create or discover his or her narrative, we are simultaneously discovering or contributing to the elegance of psychoanalytic theory itself.
Segal (1952) has argued that our pleasure in contemplating an aesthetic object may derive from its representation of the achievement of the depressive position, that is, from the internalization of whole as opposed to part objects. She points out that once we have attained the depressive position, what we fear is no longer an attack by persecuting objects, but rather the loss of the actual loved object and of the mental representation of that object. Repeated experiences of loss and regaining of the object lead to a more secure establishment of the object. Segal feels that aesthetic objects represent attempts to re-create lost objects, and that these lost objects are what we see and identify with as we contemplate aesthetic objects. It is the movement from chaos to order, from ugliness to beauty, from the paranoid-schizoid part object to the depressive whole object, from the death instinct to life, that explain the appeal of the aesthetic object.
Likierman (1989) argues that the aesthetic experience does not, as Segal says, emerge from the achievement of the depressive position, but rather that it is an attribute of the positive pole of the splitting characteristic of the paranoid-schizoid position. "Far from being an illusion, the ideal is an aspect of reality which is integral to any experiencing of goodness" (p. 139). Likierman particularly emphasizes the global nature of infantile affect and experience, noting the importance of light as one very early aesthetic experience. (Note that in this paper, I have already used metaphors of light.) In the adult world, we often associate light with understanding, and I would read Likiermans argument accordingly---as shedding light on the primacy of insight, thus supporting the views of Kris (1956).
Likierman also makes an interesting argument about the negative side of the pole. "Hunger is not the absence of food, but the presence of deprivation and pain which fill the infant to capacity and are registered at a psychic level as a present bad breast" (1989, p. 141). I would see this as in line with Kernbergs (1976, 1992) schema of early development. We could postulate that the positively valenced units of object-affect-self experience would have an aesthetic quality. The bodily ego is so prepared to receive these experiences with enjoyment that it is almost as if light (as well as nourishment and other physical comforts) might be intrinsically beautiful. I would maintain, however, that the aesthetic quality is in the experiencing and the meaning rather than in the object itself. Constitutional differences may influence the degree to which one develops an aesthetic sense. That adults find aesthetic qualities in aggression and destructiveness may suggest that we have all needed to learn to cultivate that which we originally had to learn to tolerate---pain and unpleasure.
Light, however, is sometimes illuminating and sometimes blinding. Let me take up here my earlier point about my ideas of aesthetics not being limited to what is facile or "pretty." Although it is certainly not pleasant to be the target of a patients rage, I find a beauty in the process of containing and perhaps metabolizing these feelings. There is also a way of conceiving of these episodes as parts of a whole rather than as free-standing, complete in and of themselves. In contrast to the conclusions reached by many of the speakers who addressed the question of the modes of therapeutic change and good, bad, and ugly hours at a recent conference, it is my sense that even certain ugly or bad hours can partake of the beauty of psychoanalysis in that they are a part of a larger whole. (Earlier, I noted this possibility in regard to Eliza.) Experiences of satisfaction are defined not simply by their tension, but also by the unit of tension and release of tension. When what has misfired can be righted, there will come into being exactly the movement from paranoid-schizoid to depressive that Segal (1952) describes as constituting the aesthetic.
Naturally, there may be a defensive quality to my thinking here, or this may be my way of seeking to transform the paranoid-schizoid fragment into the depressive whole---for the patient and for me. As we know, the units of meaning in analysis do not occur in neat, 45-minute segments. Rather, there are different strands of various themes in each session, and it is up to patient and analyst to create the frames, to determine which elements belong together as a unit. The analytic pair is delineating the contours of the portrait even as it is being painted, or the movements of the symphony even as it is being performed. It is a miraculous opus, for its organization and key can be revised retroactively and with almost infinite variations. Dissonant chords or even entire movements need to be understood in relation to the whole.
There is beauty in the violence of a volcanos eruption as long as one observes it from a position of safety; being able to keep the "as-if" quality present even during the intensity of the moment, when it is all too real to the patient, allows the analyst this safety of distance. The patients growth and his or her creation of the new necessarily entail the destruction of old adaptations. This makes destruction a necessary component of the psychoanalytic process---and the valuing of this destruction a necessary component of an aesthetic appreciation of that process. The therapeutic alliance and the patients observing ego provide the position of safety. It should also be stressed that not all aggression is hostile (Parens 1979).
THE AESTHETICS OF COMMUNICATION AND THE THERAPEUTIC ALLIANCE
The aesthetics of communication---the sine qua non of psychoanalysis---can be understood in at least two ways. First, there are the ways in which the material that is communicated in analysis and the manner of its communication resemble artistic communication. Beres (1957) points out the similarities between communication in art and communication in psychoanalysis:
The themes which appear in the analytic session are those of the mythmakers and poets: of birth, death, love, hate, incest, sex, perversion, parricide, matricide, destruction, violence, castration, hunger, greed, jealousy, ambition, dependence. They are themes of the forbidden, the unattainable, the repressed---and the techniques of the artist are required to present them to consciousness, even in their disguised forms. In the artistic act and in the analytic situation, the forbidden and the repressed are re-created. [p. 415]
Although his article focuses primarily on the experience of the patient, Beres speaks as well of the requirement of the analyst to participate more than passively in the creative process---through receptivity to the patients unconscious communications, through the ability to form creative thoughts of his or her own while hearing this material, and through the willingness and ability to respect the patients individuality. This latter, Beres says, derives from the analysts success at "having lived through a creative experience in his own analysis" (p. 419).
Beres makes another important point (1957, p. 420) about the ways in which the psychoanalytic process resembles a work of art, such as in the need for a suspension of disbelief. We immerse ourselves in fiction or drama by pretending that it is real, but at the same time preserving the understanding that this is not really happening. It is in this way that the experience can be cathartic or therapeutic, because we know we can come back from these other emotions even as they are evoked in us; this is the safe distance from the erupting volcano. Similarly, both analysts and patients depend on this "as-if " quality in the therapeutic relationship. As analysts, we experience empathy for our patients, feel their pains and pleasures as though they were ours, yet we know with confidence that we will return to our own minds. And we depend on our analysands to be able to experience the transference intensely, but also in an "as-if" fashion. Finally, Beres emphasizes that unlike the situation of works of art---in which the unconscious material remains unarticulated---it is the goal of psychoanalysis to bring as much of the unconscious as possible into the realm of the conscious world of language (p. 421).
The second way in which the subject of communication can be understood is according to its developmental significance for both patient and analyst. Likierman (1989) and Mitrani (1998) have addressed the ways in which the experience of beauty is an integral part of infantile life. Mitrani, in particular, writes of the mothers responsibility to allow her child to find her beautiful and indeed awesome. (This is a primitive form of what Kohut  described as the childs necessary idealization of the parents.)
Neither Likierman nor Mitrani makes reference to Spitzs (1965) notion of "the dialogue," a concept closely related to their arguments and to mine. Spitz describes " the dialogue" as follows:
By far the most important factor in enabling the child to build gradually a coherent ideational image of his world derives from the reciprocity between mother and child....The dialogue is the sequential action-reaction-action cycle within the framework of mother--child relations. This very special form of interaction creates for the baby a unique world of his own, with its specific emotional climate. It is this action-reaction-action cycle that enables the baby to transform step by step meaningless stimuli into meaningful signals. [p. 42]
The dialogue is not of neutral emotional valence; rather, it is exactly what Likierman describes as beautiful, insofar as it contributes to the creation of coherence, light, and understanding. It is thus an aesthetic experience. In my view, this is the second crucial feature of communication in psychoanalysis that justifies thinking of it as an aesthetic process. Regardless of the content of the communication, whether at any given moment there will be an insight, growth, or relief for the patient, the very fact that responsive communication exists qualifies it as a version of the dialogue, reminiscent for both participants of a well-working mother--infant dyad. The dialogue in analysis can be thought of as a corrective emotional experience, in the best sense of the term---not as a contrived cure-all, but rather as an outgrowth of a good enough analysts listening and responsiveness; perhaps it is not inappropriate to describe psychoanalysis as a treatment by beauty.
THE AESTHETICS OF LOVE
Whether or not we analysts can be said to love our patients in the ordinary sense of the word, our desire to help, to relieve suffering, to promote understanding, and to enhance patients ability to pursue happiness all reflect some form of love. Just as analysts cannot (and should not, in my view) be neutral in this regard, so, too, can this non-neutrality be understood in larger terms. Lear (1998) has argued that the human mind has been structured by love, by a good enough environment. While love certainly can signify closeness and connection, in another sense, love leads to greater differentiation and complexity. In other words, it is the good enough nature of the earth that permitted humans to evolve from single-celled creatures, and it is the same force of good enoughness that was and is the midwife of the mind. In the same sense that light (and later, understanding) can be thought of as possessing an aesthetic quality, so too, I believe, can love.
To return to my patient Dorothy:
Dorothy begins a Monday session by describing an experience she had over the weekend. She is thinking about something that came up in a session the previous week, her restlessness and tendency to want to move on to something else in her school and work, asking herself what was behind this feeling. She said, "It just came to me, it was weird. I just kind of felt like my head cleared. Wow! When I say it to you, it wont sound like a revelation [spoken shyly], but I came to it myself. What I was thinking---the thing that was so cool was that it really hit my feelings, I knew that was how I felt---I think when I look for something else, it gives me a guarantee that I wont be stuck somewhere. Thats what Im afraid of, that Ill be stuck." And she continues to explore this fruitfully.
The very fact that Dorothy was describing with textbook clarity what an accurate interpretation should feel like provided me with aesthetic pleasure (in the sense of being an example of the elegance of this aspect of psychoanalytic theory). However, what caused me to smile from my seat behind her was the fact that she had achieved this on her own, that this represented a very significant piece of self-analytic work. Dorothy came to analysis with a natural inquisitiveness, but she had been unable to utilize it in regard to herself for two reasons. First, she was constantly overwhelmed by her feelings and did not know where to begin; and, second, she had a sense that she was not important enough to spend time understanding herself, that her needs always came last. In this vignette, I saw that she had been able to internalize my interest in her, a reflection of my love, caring, and my view that she was worthwhile. This resulted in greater differentiation in Dorothys mind, a greater capacity to make meaning, and greater individuation born out of the connection with me.
Psychoanalysis, to me, is the opposite of soul murder (Shengold 1991), and ultimately, it is an expression of love. I see its greatest beauty in just this, its potential to generate soul, to create, to give life to the mind. In my view, this is closely related to the way in which Donnel Stern asserts that what turns analysts on is the potential for freedom they sense in their patients (Stern 1999). The concept of freedom is, for me, embedded in the notion of giving life. And this brings me back to Segals (1952) argument:
Re-stated in terms of instincts, ugliness---destruction---is the expression of the death instinct; beauty---the desire to unite into rhythms and wholes, is that of the life instinct. The achievement of the artist [and, I would add, the analyst] is in giving the fullest expression to the conflict and the union between those two. [p. 505]
My emphasis is not only on the altruism of the analyst, his or her vicarious pleasure for the patient, but also on the aggressive, libidinal, and narcissistic satisfactions the process provides for the analyst---on the pleasures and beauty of loving ones patients within the bounds of this peculiar and wonderful discipline of psychoanalysis. This, to me, is where the work of analysis most resembles the experience of parenthood, of loving, holding, admiring, differentiating, and letting go. Parents and analysts hate their children and patients, too, but when parents and analysts are good enough, this hatred does not impinge upon the central task of generating or celebrating their childrens and patients souls. When parents do not let their children individuate, for example, or when analysts do not reflect on and manage any excessive enjoyment of power over their patients, they are falling short of fulfilling their roles in an ethical manner.
THE AESTHETICS OF PROFESSIONAL CRAFT
Art is created or performed for an audience, and we analysts perform not only for the patient, but also for the internalized audience of our peers, mentors, students, and personal analysts. Through our analytic and other clinical training, we have learned which kinds of interventions evoke applause. We have both applauded and frowned upon our colleagues; we have learned to be humble about our work (if we are wise); we have figured out that our own instincts with patients are generally good enough (at the very least). Consensual validation from our peers has helped us develop the confidence that we know how to perform in a particular genre, that we know how to play by the rules. Even in the isolation of our offices, we carry a sense of twinship and camaraderie with other professionals; we feel ourselves a part of a community of like-minded people who take pleasure in certain things and commiserate about others.
I would like to address the intervention in the longer vignette described above in which I wondered whether Dorothy feared that I would intrude on her if she was resting when I was not. I like this interpretation, and I think it was effective. But as to the particular mixture of all the elements operative at that moment, I cannot say, for instance, exactly why I decided to draw the patients attention to the transference. Like the performance art of great cuisine, psychoanalysis is also a disappearing act that is savored, simultaneously vanishing even as it becomes a permanent part of each participant. And unlike the performance art of a symphony, in which the number and types of instruments can be specified, the art of interpretation can never be practiced under anything remotely approaching controlled conditions. (I am thinking of instruments here not as analysts often speak of themselves as the analytic instrument, but rather as the various elements that can be combined in order to form an interpretation.) To carry the music metaphor a bit further, one could think about the oscillation between major and minor, the tones, percussive episodes, slow and fast movements, solos, duets, choruses, and so forth by which an analysis could be characterized.
Do I choose to use the form of a statement or a question? What is the mix of affect, drama, humor, seriousness, and logic in my language? When do I decide to be playful, as I did at the end of the session described earlier? To what extent do I decide to use the patients idioms? And what tones and cadences will my voice assume when I speak? Will I be matter-of-fact? Gentle? Firm? When do I focus on transference and when on extratransference material? And, perhaps above all, when do I decide to try to communicate my understanding to the patient?
I do not mean to suggest that my work is unusual in these respects; rather, I am offering this as an example of the potentially aesthetic judgments that analysts make all the time---and of the aesthetic pleasure they may experience as a result of those judgments. I bring up these issues, familiar to every analyst, in order to stress the degree of creativity and artistry embedded in each interpretation. Loewald (1960) addresses this point: "Language, in its most specific function in analysis, as interpretation, is thus a creative act similar to that in poetry, where language is found for phenomena, contexts, connexions, experiences not previously known and speakable" (p. 26). At every point of speaking, an analyst must consider what will be digestible, palatable, or even pleasing to the patient. A remark that is too bitter may well be rejected, while a spoonful of sugar, on the other hand.... And just as for the chef, the goal for the analyst is to be familiar enough with a variety of recipes and genres so as to be unimpeded by those tools while in the act of cooking.
Although both patient and analyst consume the same material, taste buds are different, so the experience is different. In fact, perhaps part of what goes into the recipe for an interpretation is the analysts having the patient in her mind (Levine 2000) to the degree of being able to imagine which flavors and textures will be palatable and digestible at that particular moment. We choose sweet or salty, bitter or tangy, garlic, peppermint, or even jalapeño for our audience of one. Just as a ballerina must manage to achieve self-expression within the bounds of choreography and music not of her own composition, so, too, do we analysts do this in our listening, our attention to our inner responses, and our utilization of both inner and outer as we craft our utterances. And let us not neglect to acknowledge the aggression inherent in and necessary to these activities (Raphling 1992), as well as the role of the analysts fantasies of creation (Levine 2001).
What was most striking---and aesthetic in quality---to me about this hour with Dorothy was the paradox about the meaning to the patient of talking and not talking. To be able comfortably to remain silent would represent simultaneously both a resistance and a developmental achievement for Dorothy. This kind of tension or ambiguity---a not uncommon characteristic of psychoanalytic work---I experienced as both unsettling and awe inspiring. To me, this was like the story of the lady and the tiger, Manets Bar at the Folies Bergère, an Escher drawing. It was unsettling because I did not know what to do with it, and also awe inspiring because I did not know what to do with it. Seeking the truth---what was the meaning of not speaking?---I was forced to acknowledge that there was no single meaning here.
Just as there are tensions that animate works of art, I felt as though I was contemplating the tension that makes up the mind itself. That there are no negatives in the unconscious, that the mind operates according to the principle of multiple function---these are commonplace observations for an analyst. To consider such an irresolvable conundrum is to contemplate the ultimate source of the aesthetic: the complexity and elegance of the mind itself, its mechanisms and creativity and unpredictability. The profound satisfaction of helping, of making meaning, of contributing to another persons capacity to find peace and self-knowledge---in sum, the privilege of being able to express and enact ones values in ones work---these are, to me, the analysts unavoidable gratifications, the beauty in the sometimes elusive and painful truths of psychoanalysis and in the structure of the psychoanalytic process.
The author wishes to thank Michele Berlinerblau, M.D.; Charles Brice, Ph.D.; Stanley Coen, M.D.; Glen Gabbard, M.D.; Erik Gann, M.D.; Barbara Gray, Ph.D.; Steven Levine, Ph.D.; Sydney Pulver, M.D.; Arnold Richards, M.D.; Arnold Rothstein, M.D.; and Barbara Shapiro, M.D., for their beauty tips. She would also like to express appreciation to the anonymous reviewers of this journal for their thoughtful comments.
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