Deconstructing Enactment

Here is an excerpt from Chapter 5 of my new book, "The Analyt's Vulnerabiliy: Impact on theory and practice. I published this chapter in the journal Psychoanalytic PSychologiy last year, even though it was written for the book because I disovered there was enormous interest in a thorough discussion of the term "enactment" and its clinical applications. The chaper is a dense and diverse one. This excerpt comes from the middle of the paper, following definitions and controversies.

...Incorporating some of my previous points, we do not seriously consider that while we cannot avoid all enactments, we could effectively minimize them through self-awareness and deliberate disclosure of countertransference emotion. I make this point not because I have discarded the potential benefits of enactment.?Certainly, they exist.?Nor do I lack the understanding that patients who have little access to their feelings frequently instigate enactment because it is simply the only way for them to express themselves.?Rather, I am responding to what I believe has become an over-reliance on enactment for tapping into primitive feelings.

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A close read of case examples of enactment reveal that the analyst was well aware of burgeoning negative feelings toward the patient, and the treatment, prior to enactment. And it was the suppression of these emotions that led to the enactment. The problem addressed here is one that has confounded analysts for decades: How do we harness negative countertransference emotions in the interests of furthering the treatment??There is no simple answer to this question.?But I believe that we have not focused enough on identifying the analyst’s negative feelings and working toward a model for constructive disclosure.?Perhaps this is because of the guilt and shame associated with these feelings, and the fact that is at odds with our persona of “good enough mother.”

?I find it useful to think about what is occurring prior to enactment.?What are the conditions that set the stage for enactment??First, and foremost, of course, is the analyst’s persistent negative emotions.?Often these emotions are shared.?

?In working toward what precedes an enactment, it seems to me that as negative feelings toward the patient, or in response to sharing the patient’s affective state, are repeated over time, a gradual emotional withdrawal occurs.?The analyst may be aware of not wanting to see the patient, falling into feelings of helplessness, feeling thwarted when interventions do not produce the desired results.?From my clinical experience, and in reading the case reports of others, disengagement typically precedes enactment.?It is defensive, seeking to avoid threatening stimuli from the patient and internal conflicts over guilt and shame (a point made by Chused, 2003). It is often, or perhaps always, a repetition for both analyst and patient.

?If we think about enactment as expressed mutual projective identification, you may recall that the purpose of projective identification came to be seen not as a “dumping” of intolerable affect on the analyst, but rather as a way to communicate unacceptable feelings for the purpose of emotional engagement.?Once we realized that projective identification was mutual, however, much of this discussion of its dynamic function faded.

In other words, enactment may well be the unconscious effort by one or both parties to re-engage after withdrawal.?And I think this may be why we have increasingly embraced enactment.?It succeeds in stimulating deep feeling, essentially forcing renewed emotional engagement. We can accept this positive mechanism, yet still strive to minimize enactment, for the simple reason that the outcome is not always good.?Many enactments create new problems, especially if the analyst is out of control in the moment, or expresses such strong negative feelings that the patient has trouble feeling safe again.?If we think of enactment as the unconscious effort to re-engage, then it is possible to think about observing disengagement, regardless of the reason, and attempting to re-engage without relying on enactment. Doing so also models affective awareness and expression for the patient. From my perspective, this requires a high degree of self-awareness, something we presumably cultivated in our own analysis, and the willingness and skill to disclose negative feelings constructively to our patients.?

?I think we cannot look at the current use of the term enactment without a closer look at its definition as well as why it holds so much appeal.?Why does enactment speak to us in such a profound way??My own opinion centers on the fact that it necessarily involves an emotional encounter between analyst and patient and often comes on the heels of an emotional drought that is draining energy from the relationship.?But is enactment necessary to resolve these emotional disengagements? As Ivey (2008) asks, “Do enactments always precede and provide prerequisite conditions for countertransference awareness and resolution?” (p. 19).?Or, could analyst and patient become more engaged without an enactment taking place, thereby minimizing the damage done by some enactments??As stated previously, it appears that deliberate emotional engagement (rather than waiting for enactment) remains controversial.

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