Discussion of Matthew Shaw’s “Lulu”

Several things are worthy of attention in this clinical account, but what I find most striking is how it illustrates certain changes that have been taking place, a shift in conception of what we are trying to do in analytic practice, if not yet formalized in our clinical theories. It also gives a sense of what the “turn toward the social” might entail, at least in part.

This change in zeitgeist is captured most vividly when, recounting the arrival of bomba musicians at her party, Lulu and the analyst begin an improvised interaction that gives rise to some wordplay, but is at heart very much a sound-play, a shared rhythmic sonic experience. It is significant that this “bomba moment” (which is really a culmination of the clinical report) is presented to us not as an adjunct or an aid to analytic understanding, but as a piece of analytic work in itself. The improvisational exchange between analyst and patient is not viewed as a support or a prelude to—or a kind of rehearsal for—the real work of analyzing; rather, this joining together in a kind of sensory communion is presented as an analytic realization in its own right, not dependent for its significance on interpretation or insight, nor explained primarily in terms of a change in the transference or object relationships.

Not that the clinical process being described here lacks traditional elements: The analyst tracks and posits possible transference meanings, countertransference is consistently kept in the picture, and the patient’s struggle over identity within the psychofamilial (or oedipal) situation are treated and deeply understood in analytic terms. There is great appreciation for the struggles of adolescence, made more vivid and perhaps more poignant by the cultural, racial, and class dissonances that are so integral to this case report. The working-through of difficult developmental struggles and wounds, both individual and intergenerational, is integral to the case report. All the same, the work being done here has a different center of gravity, reflecting what I think is a new analytic sensibility. While there are rich associational processes at work in the patient and analyst’s thinking, these associational elements do not seem to determine how things unfold. There is a very meaningful level of affective engagement and semantic articulation in the hours, but what moves things forward is the performative quality – the presentation of novel elements, the call and response, the establishment of a rhythmic pattern in the session that opens up a field of play. ¹ Here the therapeutic action lies not just in recollecting the bomba played at the party and in the mother’s singing to the patient, but how it actually plays, as it were, the session—the way it is heard and felt in the prosody in real time. Entering in this way into a shared soundscape connecting patient and analyst is, in fact, far from remarkable; on the contrary, it forms the psychosensory fabric out of which all analytic experience is woven. Viewed in this way, the shift or transition into a kind of sensory communion ² may be considered a vital element in the analytic process, and is presumably occurring (or failing to occur) all the time, even if it does not usually figure in our clinical theories.

It is unlikely that a “bomba moment” would occur simply as a chance event arising from the analyst’s sensitive observation skills. More likely, it is a result and an outgrowth of the analyst’s ongoing way of being and participating in the treatment—his ability to tune in, if you will, at the level of tone and tempo, rhythmic variation, prosody of speech, and psychosensory intuition. This joining together in a kind of sensory symbiosis constitutes the implicit fabric, the warp and weave of the analytic encounter. Being enjoined in this way, as Winnicott suggested in his notion of the holding environment, may constitute the essential condition under which symbolic meanings and associations, transference material and interpretations can fruitfully evolve. For many patients, this tuning-in by the analyst, this engagement at the psychosensory level, is the epitome of what analysis has to offer, yet again it is sparsely described in our clinical theories. This is something we all know in our bones, more or less; I expect almost everyone would readily acknowledge the centrality of this “musicality” dimension of our work, the way we perceive and sense things together, but as it tends to generate less conceptual language and model-making, it remains a stepchild in our clinical theories. Overwhelmingly, psychoanalysis has spent its time describing structures and objects in space rather than the movement, indeterminacy, and transitionality that are truly where we live as psychosensory social beings.

In reporting the case material, Matthew does not claim a special resonance with the patient, nor a personal identification with the patient’s experience. He conducts himself in a particular way that I would describe as a readiness to sense things, to engage at the psychosensory level, see through the same eyes. He is not simply receptive but inductive—he is looking for the tempo and rhythm of contact. At the same time, in keeping with our more familiar models, he remains receptive, makes some transference enquiries, bearing a good deal of anxiety while keeping track of his reveries and countertransference experience, but does not attempt to mine his own thoughts and feelings too quickly. He is positioning himself first and foremost for the possibility of making music, as it were, rather than using the music to make interpretations. This approach would seem to be particularly fitting for this young patient; Lulu, after all, reminds us of how, in adolescence, life may become intolerable where there is no potential space to imagine a life for oneself. Matthew’s approach, however, is applicable to the treatment of a wide range of patients these days.

Finally, this case report raises the question of whether we can give music a proper place in our metapsychology. Any piece of music can and will become a signifier of myriad other things—past events, emotional states, repressed wishes, social affiliations, and so on. But the effect of hearing and feeling music is never essentially just nostalgic or referential. Much more than simply recalling an emotional state or a memory, it invariably changes our psychophysical state (most obviously when it makes us want to dance). Hearing music, whether welcome or not, always to some degree reconfigures our experience of embodiment: It effects our sense of where we are in ourselves, in time and space; it affects our patterns of movement, sensation, and perception. In this sense, music is no ornament or embellishment, but is a vital component in our ongoing psychical formation. What Trevarthen calls “communicative musicality” (Malloch and Trevarthen 2009), because it is instrumental to everything that goes on in the clinical encounter, is for this very reason also a domain of much alienation and misunderstanding between patient and analyst. The analyst’s “music” may be out of sync, obtuse, impossible to fathom. How much of what we do takes place here, in the realm of sensory patterning?

But there is more to the importance of music in psychical life: Not only are we affected by any music we hear at the level of our individual embodied experience, but music also gives crucial access to cultural sources of how to live in a body and how to move in the world. Music continually weaves us into transpersonal, collective aesthetic modes of sensory perception (Blum, Goldberg, and Levin 2023). Matthew’s case description can be seen in this light: What is achieved in this piece of analytic work is less the easing of internal conflict or modification of defensive structure, than it is an expansion of the patient’s embodied ways of being in the world. Certainly there are significant and meaningful developments in the case along other dimensions—for example, in Lulu’s capacity for empathy and understanding toward her mother, and increased maturity in her object relations. But what stands out is her finding a personal way into the world of social relations and cultural affiliations. This is not just an improvement in her ability to relate, to identify, to accept reality: It is an expansion of her sociopsychosensory mobility. Perhaps this has less to do with her improved relationship with her mother or father, or with her analyst, and more to do with her finding her own way of transiting in a complex world. In this regard, analysis may be viewed as a venue for the exploration of transitory states and renewed cultural affiliations—especially important, perhaps, in a time when people are prone to psychosensory isolation, to being cut off from communal sites of sensorial experience.

I think younger generations of analytic therapists intuit this need that so many of our patients have for reacculturation—that beyond addressing intrapsychic and interpersonal conflicts and disturbances, analysis should provide access to ways of being in the world. Our younger gifted practitioners are already practicing this new kind of analysis, which lends itself to an ontological rather than an epistemological orientation (Ogden 2019). This also suggests one way in which we might understand what the “turn toward the social” actually entails in contemporary therapeutic practice—not just the analyst’s conscious ability to heed and explore considerations of cultural, class, and ethnic factors in the clinical situation, but their willingness at the nonconscious level to be affected by different patterns of perception, ways of seeing and feeling, while as far as is possible decentering their own way of seeing and interpreting.

This characterization of the possible social function of analysis, if it is credible, will likely raise a number of questions: Is the idea of entering shared states a mystification, a way of denying the actual conditions of difference and inequity that exist between analyst and patient? Are we genuinely able to expand our ways of seeing and sensing things together? Yet the search for shared perception is powerfully activated whenever we enter into physical proximity with others, and plays a profound role in psychical and social life, as well as in the analytic process.