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On the development of the ability to contain:
Containment space and double emotional experience
Ami Bronsky, M.A.
Private Clinic, Ramat Hasharon
Telephone: 0545470742 Lachish 17, Ramat Hasharon, 47290 bronskya@015.net.il www.amibronsky.com
Abstract
In order to understand the manner in which a therapist contains the emotions of both his patient and himself, and to understand the universal development of such ability, I propose two concepts: that of a containment space and of double emotional experience. The concept of containment space describes the development of containment ability, beginning in the primary setting in which the environment contains the infant in an “undifferentiated containment space”, then gradually transitioning to an increasingly internalized and differentiated containment. This is the “internal containment space”. Double emotional experience is a concept describing a universal and inborn process in which people identify and experience emotions that arise within themselves and others, while simultaneously containing themselves and others. To illustrate these concepts, I shall end the article with a presentation of a clinical case.
Introduction Throughout the process of dynamic-analytical therapy, a crucial role is played by the therapist's ability to yield to the therapeutic process that he shares with his patient: the process of approaching one another, the risk implicit in loss of control, relinquishing of control and acceptance of the feelings that emerge during the course of the therapeutic journey. In her articles Thoughts on Containment, Identification and the Possibility of Being (1), and from the “Green Woman” to “Scheherazade”: The Becoming of a Fundamentally New Experience in Psychoanalytic Treatment (2), Ofra Eshel builds upon Bion's concept of containment and Winnicott's concept of holding, expanding them to illustrate a deep emotional state of transcendental identification between therapist and patient. It is this fusion of minds that lays the groundwork for change to take place. She describes a synthesis of the idea of containment together with the therapist's personal work on himself and his own feelings. Alongside the task of considering our own emotions, a fundamental part of the process of therapeutic countertransference is the experience of a number of additional occurrences, including: the struggle against this experience, the submission to it, the introduction of experiences into the therapeutic space and mutual learning between therapist and patient while dealing with these components. During the therapeutic process, we find ourselves faced in both an emotional and intellectual capacity with a number of various therapeutic tasks related to the emotional therapist-patient experience: one is the containment of experiences and feelings that the patient brings to the discussion; the second is the internal attentiveness to the feelings that emerge from within us in the therapy room; the third is working with the patient as guided by the internal feelings stimulated within us. Thus, we engage bilaterally, containing emotional experiences.
The Therapist's position and Emotional Coping—a Historical Review The incarnations of the terms employed to describe the manner in which the therapist encounters his own feelings in the treatment room are vast and complex. The most common term used is countertransference, but the range of definitions contained within this word is extremely diverse. Freud (3) coined this term and essentially delineated one extreme in a continuum of meanings, one that he viewed as an obstacle in need of elimination. He asserted that it was the therapist's duty to become aware of any countertransference and overcome it as a precondition to becoming an analyst. Indisputably, the next major milestone was laid by Melanie Klein (4). She described the concept of “projective identification” as the process in which an infant removes or rejects from within himself his own bad splitting experiences, or his aggressive self-image and object, and projects them into an object with which he can identify. Klein considers this process as a pathological expression of an omnipotent fantasy. The term includes the object, the mother figure or the therapist and his internal feelings as part of the analytical conversation and ties them to the subconscious world of the patient, but according to Klein's view, in the patient's fantasy world rather than in an actual sense. Wilfred Bion (5) expanded the concept by including the therapist in the process of projective identification. He regards it as integral to the preliminary communicative process in which the object contains and processes the intolerable and split components that are transferred onto him, while said components are ultimately returned to and processed by him by means of internalized identification. He posits that there is a normal degree of projective identification, such that when combined with internalized identification, creates the foundation upon which normal development hinges. In his article Attacks on Linking, he describes a patient struggling to cope with fear of death, which he experiences as much too intense to contain in his own person. As such, he split his fears and placed them within the therapist, the rationale being that if he were to allow his fears to dwell within the therapist long enough, they would somehow be transformed by the therapist's mind, after which the patient would be able to re-internalize them with confidence. The patient experienced the therapist as being unwilling to accept these parts of his personality and therefore he struggled to place them on the therapist by force, in desperation and with violence that only increased in its intensity. The understanding of this process led Bion to take responsibility for the situation, to “acquiesce” and accept his projections. As such, “the patient feels he is being allowed an opportunity of which he had hitherto been cheated.” In this article, Bion raises two points that serve as the basis in our contemporary analysis, just as Ofra Eshel describes the fusion of minds that occurs between the therapist and patient: One is the patient's rights to the emotional world of the therapist; the other is the therapist's obligation to take responsibility for the manner in which he either agrees or refuses to respond to this right and lend his inner emotional world to the patient. Bion discusses himself and his patient, referring to his own “refusal to accept parts of his personality.” Ogden (6) describes projective identification as incorporating three stages: subconscious projective fantasy in which part of the self is deposited in another; interpersonal pressure exerted upon another to experience himself and behave in accordance with the projected, subconscious fantasy; and finally, the processing of the experience by the “recipient”, the other, and the subsequent re-internalization of the more manageable version of the aspect which the patient had formerly ejected. Betty Joseph (7) emphasizes that the goal of the therapist is to allow himself to experience the patient's anxiety and to formulate an adequate internal response so that he becomes aware of the anxiety and its content and subsequently be capable of interpreting it without having to employ the technique of “acting out”. O'Shaughnessy (8) contends that a certain degree of acting out by the therapist is often inevitable during the early stages of developing awareness of the patient's feelings, and that it further cements the similarities between the therapist's and patient's feelings and behaviors. Ofra Eshel (2) describes how the therapist “must be the type of person who can allow himself to be the one to absorb them [the patient's rejected, intolerable feelings] into himself, who can devote himself to grasping this process, to implement it and utilize it. This process can only occur in a condition of connection with the other—with him and through him—as a space for experimentation, processing and transformation.” Stephen Mitchell synopsizes these processes in his book, Hope and Dread in Psychoanalysis (9), recounting how “psychoanalysis has changed from Freud's day to ours much more radically than is generally acknowledged” and addresses this change in his emotional position of the therapist. However, psychoanalysis has come a long way regarding other aspects besides the emotional state of the therapist. This has also been true for the therapist's curative goals. The psychoanalytic ethos has been based on the therapist’s obligation to provide interpretations to the patient ever since the days of Freud and Klein. Kernberg (10) describes the psychoanalytic treatment as based on interpreting transference relationships as the preferred therapeutic tool in borderline personality disorders as well. Converse to this trend of interpretive psychoanalysis was the development of an alternative stream that dealt with completely different requirements placed upon the therapist in the curative psychoanalytical process. Among the first people to challenge the exclusivity of the interpretive approach was Sandor Ferenczi. In accordance with his theoretical emphasis on trauma and deprivation, he became increasingly convinced of the significance of the analyst's role in providing love and calculated affection rather than sterilely neglecting the patient's needs and wishes (Mitchell and Black) (11). Balint, who was a patient of Ferenczi and his successor, writes that what patients really need, especially patients with severe disorders, is not gratification of sexual or aggressive desires, but rather primitive unconditional love that had been denied in their childhood. The patient comes to rediscover missed developmental opportunities by means of a process called benign regression (12). Winnicott's position is also clear in offering an alternative method to interpretive psychoanalysis. His words are self-explanatory: “It is only in recent years that I have become able to wait and wait for the natural evolution of the transference arising out of the patient's growing trust in the psychoanalytic technique and setting, and to avoid breaking up this natural process by making interpretations. It will be noticed that I am talking about the makings of interpretations and not about interpretations as such. It appalls me to think how much of a deep change I have prevented or delayed in patients in a certain classification category by my personal need to interpret. If only we can wait, the patient arrives at understanding creatively and with immense joy, and I now enjoy this joy more than I used to enjoy the sense of having been clever. I think I interpret mainly to let the patient know the limits of my understanding. The principle is that it is the patient and only the patient who has the answers” (13). He maintains that the role of the therapist is to enable the patient's true self to emerge by preventing him from engaging in impingement during the regressive therapy. The therapist and the analytical situation provide the patient with a sufficiently supportive and safe environment in the places where primary maternal love is lacking. According to him, the compassion and empathetic presence of the therapist are more effective in the healing process than the literal interpretations that come across as intrusive (14). Heinz Kohut, the father of self psychology, sparked a revolution in the methodology of psychoanalysis by characterizing empathy and introspection as the focal point of the healing process (15). He tried to put himself in the shoes of the patient and believed in looking at the issues through the eyes of the patient, as he said: “Empathy is the operation that defines the field of psychoanalysis”. He chooses to describe the act of interpretation as an explanatory process and emphasizes that “during particular phases of many analysis, especially analysis of certain severely traumatized patients, the understanding phase of treatment must remain the only phase for a very long time”. He too posits that providing basic human needs, rather than frustration and interpretation, is the path to genuine healing (16). Psychoanalysis, then, has come a long way: from the role of the therapist as interpreter to his incarnation as a supportive and containing environment willing to provide primary needs; from Freud's model of the scalpel-wielding doctor to a situation in which the patient and therapist create change by means of fusing their emotions. In the legacy of these authors, I have decided in this article to try and conceptualize my own personal interpretation that endeavors to understand the capacity for emotional containment and the development of this skill.
Spaces of Containment Containment is an act performed by the mother, providing basic primitive experiences for the infant contained within it. Bion (17) portrays the mother as a container who makes sense of the transferred content that the infant is incapable of bearing or containing within himself. This is done by means of emotional and cognitive processing in which she engages, according to her intuitive understanding and a technique of daydreaming he terms reverie. Margaret Waddell (18) discusses Bion's concepts in the context of the maternal experiences and coping toward her infant, which becomes generalized in the experiences between a therapist and his patient. Bion contends that the infant feels a need to know and understand the truth about his own experience while conversely rejecting this truth, similar to a patient in a therapeutic setting. The pathway to truth lies in achieving a hold on the experience, in the sense that the infant can remain in touch with it, as hard as that may be, instead of simply rejecting it or bypassing it. Bion refers to this mother's ability to simultaneously contain the infant and his anxiety, while still managing to function and think by the term “reverie”. Internal states of unrest and distress can be understood and contemplated—that is to say, it is possible to be self-aware of the truth in personal experience—as long as they are approached in a basic way with the external reality. At its root, this type of response must come from the mother or from the caregiving figure. The opportunity to lend meaning to our own feelings can only arise once they have been given meaning by another cognizant person who has undergone reverie with us. I propose that the ability to contain develops and matures in a lengthy and gradual process parallel to the personal developmental maturation process of emotions as described by Kernberg (10). Just as there exists the mental processes of developing identity and developing a sense of reality from an undifferentiated state to a differentiation and separation, so too does one develop the skills for emotional containment from a state of undifferentiated containment to a state of differentiated containment.
Several central writers, among them Edith Jacobson, Kernberg and Winnicott, expound upon to the primary developmental state, in which no differentiation exists between the infant and the object nor between the internal and external realities. Jacobson (19) describes “primary narcissism”, an undifferentiated state of development, in which occurs a cathexis of “the primary psychophysiological self” brought about by the stimulation and depression of physical stress. In “secondary narcissism”, the libidinal investment is directed at the undifferentiated representation of the self and the object. Later, when a gradual differentiation occurs between the self and the object, differentiation of the libidinal investment will also occur. Winnicott (20) uses the concept of illusion to describe the primary developmental phase in which the breast is regarded as part of the infant, and which is seemingly subjected to its magical control. When the infant suckles, he does so from a breast that is part of himself. Gradually, via transitional objects and transitional phenomena, he develops the ability to accept the world around him as reality, a task that continues for the rest of his life. In accordance with these examples, the idea of containment can be understood. Similarly, there exists conditions in which the infant lacks the ability to contain as his environment contains him in a manner that I shall designate as an “undifferentiated containment space”. This is an external containment space in which the containment of emotions hinges on the existence of an external object. As the ability to contain progressively develops, it becomes increasingly internalized, personalized and differentiated. In a state of external undifferentiated containment in the early developmental stages, in pathological or regressive situations, the emotions cannot be contained within the personal space of the individual; they are overwhelming and unbearably overpowering in their intensity. Whoever finds himself in the vicinity of the infant/person feels these emotions in their raw intensity. An example to illustrate this is the severe and overwhelming pathological conditions, which require a therapeutic community beyond that which can be provided by a single therapist, since the therapist himself has also become overwhelmed by the raw emotional experience and is unable to singlehandedly contain these powerful emotions. Thus, he must solicit the assistance of a larger containment space in the form of additional therapeutic figures (such as in cases of treating borderline disorders in hospital wards). Thus, just as a person develops the ability to achieve separation and differentiation between the self and the object, and just as he develops the ability to formulate a proper grasp of reality, so too does an individual develop the ability to achieve distinct emotional containment, i.e. the ability to increasingly hold emotions internally and to assign them meaning. The process in question is a developmental sequence for the purpose of achieving the capacity for containment. This process begins as an external, undifferentiated containment space and then progressively develops into an internal, differentiated containment space. Owing to the therapeutic process which recreates primal stages of development, in which the therapist enables the patient to engender and recreate early needs, we can designate the therapist's function in the emotional terms of containment. The therapist's role is to be present within the undifferentiated containment space, outside the patient, and internally contain his turbulent, confusing emotions as part of the experience of this developmental process. In line with Winnicott's statement (20) that the development of the ability to objectively perceive the world is a process that is never complete, so too is the development of emotional processes. A person will always feel reliant on another to contain his feelings, to aid him in his containment and to serve as part of his containment space. A containment space will never be perfectly internal and differentiated. Just as a person possess the ability to satisfy another's various individual needs, so too can a person provide emotional containment for another and constitute part of his containment space. My proposal is that this process is universal among people, who emotionally contain one another. Just as every person needs another to serve as part of his containment space, he too possesses the capacity to provide a containment space for another person. To illustrate this concept, I will describe as an example the phenomenon of “dual emotional experience”.
Dual Emotional Experience: Of the Self and of the Other This concept, which I shall describe experimentally in order to better understand emotional and containment processes, relates to the basic process in which individuals identify and experience their own emotions as well as the omissions of others. This ability is the basis which allows for the occurrence of the process of containing the feelings of another. If a person can effectively feel the emotions of another, he can then relate to these feelings, devote himself to them and grasp them; in other words, he can experience the other in a containing capacity. Eckman and his colleagues expound upon this idea in their research (21, 22), promoting the notion that the ability to identify another's emotions is universal and occurs in a manner similar to an individual's recognition of his own inner emotional experience. Later studies exploring neurological processes and identification with the behavior of others revealed a phenomenon termed “mirror neurons” (Cattaneo and Rizzolatti, 23). This phenomenon occurs when the brain imitates the behavior of another, not only for the sake of imitation but for the purpose of understanding another's motives. Studies performed on the topic of mirror neurons and empathy reveal that while observing and imitating the emotional facial expressions of others, the entire network of mirror neurons as well as other related systems that are responsible for processing emotion kick into gear (Iacoboni and Dapretto, 24). These studies reinforce the basic principle of this article, of a neurological explanation for the way in which we experience and understand the feelings of others. Ruth Stein (25) examines the increasing theoretical recognition of the importance of the infant-caregiver relationship, as well as the emotional signaling function that connects the infant's needs, intentions and satisfaction, which drives and provides indications and reinforcements, not only for the sake of satisfying needs but also for the purpose of education, love and exploration. According to her research, the emotional availability of the infant's caregiving figures is regarded as the central factor in encouraging growth in the initial therapeutic experiences. This state of “we-ness”, or emotional calibration and adjustment, is a crucial element in emotional development. Emotional adjustment is an extremely complex and nonverbal process that relies on a variety of sensory characteristics in an array of forms, such as intensity, duration and rate, which translate into feelings. These processes occur between a mother and child to a degree and between any two individuals who interact with each other (Stern, 26). The notion that people are so proficient in detecting, absorbing and understanding the emotions of another and then subsequently convey those feelings back to that person in an subconscious interaction spanning fractions of a second, has earned a central position in contemporary neuroscience, as evidenced by imaging techniques as well as observing the nonverbal interactions between parents and their infants (Bebe and Lachman, 27). My intention is to move Ekman's notion of universality one step forward and to expand its scope beyond the sphere of emotional recognition: to the area of emotional experience. The significance of this hypothesis is that people have an innate, universal ability to sense another's emotional experience. Containment, according to this principle, is a universal process occurring between people who contain one another emotionally. I surmise that both of these emotional processes—an individual’s ability to emotionally experience his own feelings as well as his ability to experience the emotions of another—occur hand in hand in what is virtually a double emotional experience. Experiments have shown us that when we are exposed to a person who has encountered intense experiences or is driven by emotions, whether positive or negative, we very quickly formulate an emotional experience towards him. While we feel as though we are formulating feelings in relation to the person in front of us as a response to his behavior, we are also simultaneously sensing his virtual emotional state within ourselves. The mother senses the anxiety that her infant feels as well as his rage or his elation (Bion, 5). According to this principle of double emotional experience, even when we are unaware of it, we experience both complementary and parallel emotions. The feelings that arise within us in relation to the other, such as anger, rejection, compassion, attraction, affection, etc., constitute complementary emotion. Parallel emotion is the same feeling and experience that the other person is experiencing. The difference between these two types of emotion may be very difficult to distinguish at times, since our conscious minds largely tend to view our emotions as complementary emotional experiences based on the way we feel toward another person. These two types of emotional experience are discussed in Racker's article, “The Meaning and the Uses of Countertransference” (28). he differentiates between the two types of countertransference: The first is concordant countertransference, in which the therapist identifies his own ego with that of the patient, and similarly, with the other elements of the patient's personality, the id and the superego; the second model of countertransference occurs when the therapist's ego identifies with the inner objects of the patient, which he terms complementary countertransference. It can thus be stated that the double emotional experience is a universal, natural and physiological process that enables us to experience emotions outside of our own experiences, those belonging to others. However, amid the ability to emotionally experience these feelings and the ability to relate to the other and his emotional experiences while containing it, lies the question: To what extent does the ability to contain develop? To what degree is a person's containment space internal and differentiated, or conversely, external and undifferentiated? In an interaction, as both sides containment spaces—that of the container and of the contained—grows less differentiated and more externalized, one can assume that their emotional experiences will be rawer and more intense. Why so? On the one hand, the subject relies upon the other to be available as a containment space, as he struggles to contain his own feelings internally and distinctly. On the other hand, the object's ability to relate to the emotional experiences of the other is also limited. The more differentiated, internal and distinct both parties' containment spaces are, we may assume that their emotional experiences will be increasingly contained internally within themselves and will be infused with greater personal meaning. Then, the subject relies upon the other to serve as part of his containment space, but not in an extreme way. The object, on the other hand, would be more available and possess a greater capacity to relate to the emotional experience of the other, to experience it and to participate in it. I propose that we utilize the prism of the development of emotional containment ability to examine two central concepts in the area of interpersonally occurring emotional experiences: projective identification and empathy. The more distinct, external and other-oriented the containment space is between two people who are interacting, the emotions of the object and subject -the container and the contained- are more raw and intense. The containment space cannot successfully hold all of these feelings within itself. We call this process projective identification. This is due to the principle of double emotional experience, in which the object experiences the other's raw, intense emotions in a similar manner. This process does not stem from the act of depositing emotions in the other, rather from the involuntary containment and acceptance of them borne of a developmental position of external containment space. The individual feels the intensity of the other, originating in the interaction of both parties' limited emotional containment abilities. They 'merge' into one undifferentiated and indistinct container. Thus, in these cases, the emotions will be raw and fractured. Similarly, based on this principle, as long as either of the two individuals is engaged in interaction, it becomes increasingly differentiated, internal and personalized, or the emotions are kept inside and are experienced in a more restrained and meaningful way, due to the internal and differentiated containment process that it undergoes. Even if only one of the partners possesses an internal containment space, he will experience the intensity of the other person's uncontained emotions in a significant and comprehensible way, which will evoke empathy towards the other. Empathy is the testament to the fact that the object feels, understands and contains the other, and is not emotionally impervious to him, does not disconnect from him, and is neither attached nor overwhelmed in the presence of his partner's emotions. When the patient has also achieved a high capacity for external containment, it will be easier to contain him and to relate to him in an empathetic manner. The challenge, of course, is when the therapist who tends toward internal, differentiated containment, must relate to another person whose containment tendencies are fundamentally external. What results is neither an “invasion” nor a projection of uncontained emotions onto the other; rather, in practice, it is an actual and sometimes extreme testing of the object's ability to contain without necessitating the other to contain him and without requesting or expecting the patient to serve as his external container. The therapist must contend with this containment test. To him, the statement “He inserted in me” may be a way to express “this is difficult for me to contain,” which is a natural challenge in a therapeutic setting. On a fundamental level, this is the same process laid out on a continuum. On one extreme of the continuum is the confrontation of two undeveloped mental states, held by the therapist and the patient, a phenomenon which is then regarded as “projective identification”, which is basically external containment. On the other extreme of the continuum, in which the therapist and patient relate to each other in a manner that at least one of them is in a more highly developed emotional state, the phenomenon is one of empathy, which is basically internal containment.
A Clinical Case A. is a twenty year old bachelor living with his parents. The clinical case that I shall present here occurred about five months after beginning the therapy process. The main feeling that was evoked in me was of extreme caution, reservation and wariness, as if I was “walking on eggshells”. After guided counseling, I understood that in the initial months of treatment I staged a number of attempts to relate to the content that A. presented to me and I felt as though I was faced with intense rejection that was subconsciously evoked within me. I was afraid to freely and spontaneously relate to the topics he raised, to the point where I found myself echoing his words while offering him little else. At one of the sessions, A. expressed frustration and boredom. He felt that he could identify with the tragic life story of a certain famous classical music composer. Since the therapeutic interventions I tried to present had evoked rejection and withdrawal in the patient, I tried to reach him by expressing interest in his relationship with classical music, which played a significant role in his life. This interest is also close to my own heart, and a lengthy discussion about music ensued. For the first time in a long time, I felt that this had been an intimate and significant discussion. At the same time, during our conversation, I felt a sense of scorn and arrogance on his part being directed at anyone who did not share his own discerning appraisal of music. The following session, after a brief period of silence, he expressed his desire for me to be more active, to engage him more and to answer him in detail when he asks me how I am doing. His tone of speech was increasingly sarcastic and cynical, and he appeared to be in elevated spirits to the extent that he could not contain himself. I brought up the topic of his cynical tone in the discussion in light of my own feeling, which I had shared with him, that I had felt that our previous conversation had drawn us closer together. His response was one of intense anger that I had yet to see him express until then. He said that any intimacy between us was out of place and became angry at even the insinuation of it. I felt how difficult it was for me to be attacked while simultaneously continuing to help him clarify his own feelings and to be aware of what he was evoking in me. I asked him how he had felt in our previous meeting when we spoke about music, an important element in both of our worlds. He felt as though I had been engaging him from a distance, as if I could never truly be close to him. The following session, he spoke about a possible trip abroad and expressed his wish that we could travel together on vacation. After we spoke about his desire to become closer to me, I reflected back to him what I had felt he was expressing: that sometimes he wanted our relationship to be different, non-therapeutic. Once again, he grew cynical, literally acting out an imaginary therapy scene in which he was the therapist, saying, “Tell me what you think about that. Please elaborate.” Again, I felt his aggression as he rejected me and my therapeutic relationship to him. I felt myself resisting the urge to joke around with him and to change the subject. In the past, I would have taken a step back from my role as a therapist at this point, but this time I stood true to his expressed preference for us to enjoy a close relationship with each other and asked him if he felt difficulty in seeing himself as my patient and me as his therapist. Finally, he grew silent. He sunk into the chair and into himself, looking as though he was trying to listen to me. He said that perhaps he did not know what it means to be a patient. I offered the idea that perhaps he did not recognize the feeling of somebody taking care of him. I tied this in to what we had spoken about in the past, to his constant tendency to adapt himself to others in order to find favor in other people's opinions of him. I felt as though my words were finally reaching him, the session drew to a close and he sat up in his chair and said, smiling this time, “I suggest that you think this over for next time.” At the next meeting, he brought up the same topic again. He said that he felt that it was not his responsibility to be the patient, rather it was my responsibility to treat him and teach him how to be a patient. For the first time, he expressed genuine helplessness, telling me that he did not know how to be a patient and that he needed help. When I asked him to tell me what help he needed, he brought up the severe dependence that he develops in his relationships, his obsessive attachments and tendency to get carried away, all the while accompanied by a deep sense of helplessness. I was then able to understand how he used cynicism and facades of confidence or occasionally aggression as a defensive tactic against his longing for a close, meaningful and perhaps intensive relationship. His admission of this and his expression of his dependency was very difficult for him. At this stage in the therapy, I too had felt a withdrawal into a position of avoidance that stemmed from a sense of injury, and even when I tried to contend with it with the aid of guidance, I was once again met with that same sense of injury and shame in admitting that I had needs of my own with A, which in this case was the desire to recognize the legitimacy of my own love and reverence of music. When I tried to come close to him via this area, I felt a very strong sense of rejection. Through guidance, I managed to contain this feeling, to survive his aggression and to genuinely express my own feelings and employ them as a way to make space for all of these feelings within him. At this stage in the therapy, A. spoke much more openly and directly about the relationships that he had created. Something significant had changed in the way he listened to my feedback in regard to his relationships as well as in regard to the relationship between us. In the context of double emotional experiences and containment spaces, I can understand my struggle with the aid of guidance. My role is to listen, to open myself and to fully experience all of the emotions I feel, which I now understood had originated in his own and my own emotional worlds as one, as a double emotional experience. Thus, I succeeded in remaining close and vulnerable instead of retreating and withdrawing as an expression of my attempt to permit myself to become part of his containment space, being able to contain the emotions for him instead of him. The ability to contain the feelings of longing, rejection and vulnerability in contrast to my initial instinct to defensively avoid those feelings ultimately provided the pathway for us to cultivate a more meaningful therapeutic dialogue. At this critical juncture, even though I anticipated that he would continue to regard me in an aggressive and hurtful way, the knowledge that I was sensing his vulnerable experience in a manner that increased my sense of vulnerability enabled me to survive his attacks and continue my therapeutic dialogue with him. Gradually, he also became able to contain and express his emotions in the therapeutic setting. At this stage in the therapy process, he was able to openly and candidly express his basic needs for recognition, dependency and intimacy.
Discussion The purpose of this article is to offer the therapist insights into the emotional processes that he encounters in the therapy setting and in relationships with his patient, and to lend an additional layer of meaning to the processes with which he struggles. I believe that our ability as therapists to understand the source and nature of the myriad emotions we experience in the context of therapy helps us advance in our therapeutic missions. The therapist's stance and function in the therapeutic process are liable to be extremely perplexing. On the one hand, we serve as a supportive and containing environment for the patient, representing a caring figure in the mother-child model, with our role playing out in the patent's world as a figure who is neither real nor separate. On the other hand, the development of contemporary approaches to therapy increasingly views the therapist as someone with a real, unique and meaningful existence in his own eyes and in the eyes of the patient. This shift from a virtually nonexistent figure—be it one who is transparent or one who is like air, essential but invisible—to a significant personality for the patient that I am attempting to explain and understand in the context of the notion of containment spaces. At the initial developmental stages of infancy and during the early stages of treatment, our presence serves as an external, undifferentiated containment space that is part of the patient's world in which we have been absorbed. Developments in therapy, namely the separateness and distinctiveness in the existences of the therapist and patient transforms us as therapists into a smaller part of his containment, whereas the patient has an increasingly internalized containment space in which to increasingly self-contain. In terms of the emotional experience, a combination of feelings are evoked within us. Some of them are our own feelings in relation to ourselves and the patient; some are the patient's feelings. Understanding what happens in the therapy setting, in the emotional world of the patient and well as that of the therapist, can be a means to finding meaning in our experiences within therapy. Understanding these processes in experiential terminology relating to our abilities to feel our own emotions or those of another, is in my opinion, crucial in dealing with these emotions. Understanding emotional containment as it exists in the space formed between a therapist and patient, demonstrates the basic human experiences of interpersonal intimacy or distance, the willingness to draw close to another, to be present for another, to devote oneself, to connect and to give oneself over. These actions that we perform as part of basic human behavior can also serve as a model for patients who will later relate to their own selves in the same way that the therapist figure had behaved toward them.
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Abstract
In order to understand the manner in which a therapist contains the emotions of both his patient and himself, and to understand the universal development of such ability, I propose two concepts: that of a containment space and of double emotional experience. The concept of containment space describes the development of containment ability, beginning in the primary setting in which the environment contains the infant in an “undifferentiated containment space”, then gradually transitioning to an increasingly internalized and differentiated containment. This is the “internal containment space”. Double emotional experience is a concept describing a universal and inborn process in which people identify and experience emotions that arise within themselves and others, while simultaneously containing themselves and others. To illustrate these concepts, I shall end the article with a presentation of a clinical case.
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