Surrender to the drama: The enacted process in the psychotherapeutic relationship: A systematic literature review with clinicial illustrations
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This dissertation is a systematic literature review, with clinical illustrations. The interpersonal phenomenon of enactment in the psychotherapeutic relationship is explored with the aim of producing phenomenological, or rich description to inform clinical practice. This is a relatively contemporary topic in the psychoanalytic literature. Not every aspect of the therapeutic relationship can be symbolized in language from the outset. A communication occurs which becomes manifest in action and this has a strong feature of surprise, feeling unusual to the therapist, as if she is unwittingly taking part in a drama. This emerges from within the transference-countertransference matrix. The therapist can be engaged in fulfilling a wish, repeating an old pattern, generating a new, nurturing response to the patient, or in enacting their own conflicts, sometimes leading to negative therapeutic outcomes. Being ‘recruited in’ to feel a difficult or overwhelming feeling engendered in the relationship, (often hitherto dissociated affect), the therapist is in a position to regulate and/or moderate for the patient, and thereafter to articulate a more conscious understanding. Classical and relational therapists note the ubiquitous nature of enactments, and also hold different views as to the therapist’s subjective involvement, ranging from the solipsistic to the mutual. In reviewing the literature, it emerges that ‘enacting’ is regarded by some clinicians as ‘living in the second best of worlds’, (where interpretation is preferable to taking part), and again by others as signaling turning points in a therapy, enabling the greatest of affective communication, and leading to dynamic change. A clinical illustration in the form of a vignette of an enactment is central to the dissertation, drawn from the author’s own practice. The powerful unconscious projective and intersubjective process is examined for its component parts. Deep empathy for the patient unfolds in this drama, and the consequent therapeutic action is described. In conclusion, it seems that enactments offer a potent means by which to engage another affectively – perhaps to bring to life (i.e. with feelings) that which has been split off in traumatic times. Allowing such powerful processes to touch us as therapists can be uncomfortable, and can release the potential for deep therapeutic benefits.