Summary

An attempt has been made to show that the psychoanalytic dialogue is constituted of minute moment to moment transactions that arise from the complex interpersonal emotional matrix of analysand and analyst. To facilitate understanding and clarity, this level of functioning has been artificially frozen into the term Real Time Psychoanalysis. This level of functioning underlies and interacts with both external reality and internal unconscious phantasy. The level and nature of this level of functioning has been explored as well as the fact that it can be observed in real-time in the consulting room.

Real Time Psychoanalysis and Antonino Ferro

ABSTRACT

_This presentation describes an aspect of the psychoanalytic dialogue that is basic to Antonino Ferros work. The fascinating and intricate psychoanalytic dramas that Ferro describes, all take place in real time in the consulting room. So in this paper, the level and nature of psychoanalysis in real time is described, for a better appreciation both of this level of psychic functioning and Ferros work. _

The work of Antonino Ferro is extremely rich and complex. He assumes a familiarity with psychoanalytic work and concepts that many people might not have. Sometimes he uses terms that have previously not been used in psychoanalysis, such as real time. I am not aware of Ferro using the term Real-time Psychoanalysis on any occasion but only about describing psychoanalysis in real-time. The use of the term Real-time psychoanalysis here is not to suggest a different kind of psychoanalysis, but only to focus attention on this level of psychic functioning. The focus on this level of interaction goes back to Klein, and even beyond Klein to Freud, in his first formulations of transference phenomena. So it is not exactly original, but in Ferros hands it assumes significance that is not quite as explicit in the work of his predecessors. This paper describes the real time setting of Ferros work without claiming in any way to be an exposition of Ferros perspective or way of working. Nor am I suggesting that this way of working is somehow confined to Ferro, for he himself regularly quotes his predecessors and contemporaries, whose ideas he uses and develops. Ferro uses and develops many of Bions ideas and in this presentation too I will be using, quite liberally, one of Bions clinical descriptions that details this level of work.

For a proper appreciation of what is meant by real-time psychoanalysis, I will describe it in three stages. First, the level of this kind of work will be investigated. Then the nature of such work will be described and finally what is meant by the term real-time will be delineated.

DEFINING THE LEVEL OF REAL-TIME PSYCHOANALYSIS

Any dialogue conducted within the structure of psychoanalysis is an extraordinarily complex affair, because each transaction of that dialogue takes place at least at 3 different levels. What makes it even more complex is that at each level each transaction can have a number of different meanings. But our task here is to simplify these transactions and to define the three tiers of any and every psychoanalytic dialogue. These three levels are a) the level of real external reality, b) the level of unconscious phantasy and c) the level of the bi-personal transactional field of the analysis. Experience tells us that most probably every transaction of any psychoanalytic dialogue is always simultaneously taking place at all three levels. However we tend not to be aware of all three levels. Our attention is usually focussed on one level, though we are often aware of a second level. Only very rarely do we become aware of all three levels and this awareness usually takes place at a moment of subsequent reflection.

To understand these three levels we could use a concrete and more easily understandable analogy from human biology. From a biological point of view we also exist simultaneously at a number of different levels. I shall select just three by way of illustration. The first level of our biological existence is that of external morphology. All of us can be seen and understood in terms of our height, weight, body shape, skin and hair colour etc, and also in terms of how at any moment each is being expressed, for instance whether we are sitting, walking or running or whether we are dressed or naked and whether we are eating, sleeping or having sex and so on. This is the level that we are most familiar with. It is there for anyone to see, describe and understand in a variety of different ways. The second level is the level of our internal organs. No matter what our external morphology is and how it might be used, simultaneous to it our internal organs are going about there various complex businesses doing their own functions. These functions are determined by what is happening externally, for instance whether the body is resting, exercising or sleeping, which in turn affects the functioning of the bodys internal organs. Sometimes the functioning of the internal organs is also reflected externally such as by flushing or pallor of the skin, trembling of the muscles or bringing up wind from the gastrointestinal tract. Understanding this second level of functioning requires some specialized knowledge of how the various internal organs are constituted and how they function, including how this functioning interacts with and is expressed in first level of external reality. The third level of biological function is the microscopic level. This is of course the most detailed and complex level of functioning and it underpins the other two levels. Nothing can happen externally or in the various organs that doesnt have a microscopic corollary. However, this level of functioning is not open to any observer, for it requires not only specialized knowledge but also highly specialized equipment (e.g. electron microscopes) that allows observation at this level of functioning.

It is in the same way that we can say that first level of the psychoanalytic dialogue, the level of external reality, is easily observable by anyone and it requires no specialized knowledge. Anyone can see and understand the story that is being told at the level at which it is being told, and having seen it they can describe it in whatever way they wish. The second level, the level of internal reality and unconscious phantasy does however require specialized knowledge and training. For it is only on the basis of such training that one becomes aware of say, the symbolic and phantasy level of functioning, which is not readily observable from the story that is being told. It has to be inferred. Once this level of functioning has been understood then the complex ways in which it manifests itself and interacts with external reality can be understood, much as the internal functions of the bodys organs express themselves and interact with external appearance and functioning. The third level of the psychoanalytic dialogue, the level of the transactional field is the most complex and intricate level and it underpins the other two levels for there is nothing that takes place at the other two levels that is not being constantly influenced by what is going on at this level much as the level of microscopic function underpins the other two levels of biological functioning. However, this level of investigation requires not only specialized knowledge but also specialized equipment. At the moment this specialized equipment exists in the form of intuition. Unfortunately this equipment can not be purchased or transferred from one person to another and nor can it be learned. Some of us are blessed with it and some of us are not. However, it is not an all or nothing faculty, for it exists in rudimentary form in most of us and is highly developed in only a few gifted individuals like Antonino Ferro. Even in such gifted persons, this faculty fluctuates, for it is heavily influenced by a number of factors such as the general physical state of the individual, the time of day and most powerfully by the general internal emotional climate of the individual.

These 3 levels of the psychoanalytic dialogue serve to define the level of real time psychoanalysis. It can be seen from this description that real time psychoanalysis takes place at the third level, the level of the transactional interpersonal field.

Before moving on to how this field is constituted it might be useful to illustrate these different levels by a clinical example that shows how these three levels simultaneously exist and how we can clinically understand any piece of clinical material in each of these of three levels. Ferro provides us with an excellent illustration which I will quote in some detail.[i] He starts off with a seemingly simple statement that almost any analysand could make

My mother wont take the dog because she has too much work.

Of course this statement depends enormously on the context of the session, but for our purposes, Ferro takes it fairly generically as a statement that could be made by any analysand at any point in any session. Ferro then picks out the 5 essential elements of this statement. They are 1) my mother, 2) the dog, 3) too much work, 4) the patient telling the story, and 5) the analyst to whom the story is addressed.

Having picked out these elements Ferro then illustrates how this simple statement could be understood at the 3 levels of external reality, internal reality and the bi-personal relational field. He says

Let us consider some of these characters. My mother may be understood as a reference to the real external mother, the dog to a real external dog and the work to the mothers occupation. The patients disappointment at this busy mother who has no time for the dog is implicit.

On another level, the characters could be considered in transference terms as parts of the patient, as projected internal images. The mother might be a projection on to the analyst of the maternal function, experienced as falling short of expectations; the dog the most primitive and animal part of the patient; and the work a form of working on the part of the analyst, felt to be inadequate for her most primitive aspects (the dog).

Yet a third vertex is also possible, in which the communication is seen as a story told from the patients standpoint about the functioning of the analyst and of the patient in the consulting room. The idea here is of an analytic function so far unable to take charge of the most primitive aspects of, let us say, the relationship, because much is still preverbal namely, emotions that must be worked on by the couple.

However, all three models are equally strong. In the first, the characters are understood predominantly as nodes in a network of historical relations, and the narrated facts in turn give rise to feelings, conflicts and emotional strategies, always vis--vis those characters or facts, which, when activated in the present in the intrapsychic dynamic, will be deemed to have virtually taken on an existence of their own.

In the second model the characters are nodes in a network of intrapsychic relations; the facts narrated are basically a communicable disguise of the patients internal reality, which, however, is regarded as already given, pending the presence of an interpreter to clarify its functioning and discover its roots in unconscious fantasies

In the third model the characters are nodes in an interpersonal, or rather inter-group, narrative network, arising like holograms of the present emotional relationship between analyst and patient.

The first two levels described by Ferro are self evident and dont require further comment, but what Ferro says about the third level requires some elaboration. What Ferro is trying to communicate in the third model when he talks about the emerging hologram of the present emotional situation is something like this. At the microscopic biological level things happen in a universe of microscopic functioning. In the same way at the level of the interpersonal field, things are happening in their own universe of function. However the detailed individual functioning is difficult to see, so one sees instead a picture of the emotional relationship, because it is much too primitive to be described verbally. This hologram or picture depicts something without distinguishing whether it is about the analyst or analysand. Please note the simplicity of the communication and the absence of valued judgements like who is to blame and who should be doing what to whom. The interpersonal field implicitly accepts that both parties contribute to and hence constitute the field of their interaction and its pictorial expression. This brings us to the second stage of our description of real-time psychoanalysis, the nature of it.

THE NATURE OF REAL-TIME PSYCHOANALYSIS

As we have seen the level of real-time psychoanalysis is the level of the transactional interpersonal field. From the example that has just been described we saw that the nature of this field is constituted by the emotional interactions between the analysand and analyst. It is therefore constituted by both, but not necessarily equally, either in the degree of contribution or the kind of contribution. Either participant can contribute the major defining elements that dominate the field. However, it is usually the case that even though one participant provides the dominant element, it is usually in response to something that the other participant has brought. This in turn might be a response to something else and so on. Rather than get preoccupied by the nature of such infinite regress, which can never be satisfactorily concluded, it is much more productive to simply state that the interpersonal field is constituted by both participants though not necessarily to the same degree. Likewise the kind of contribution is usually of a different order. Most frequently the form of the contribution is reciprocal. For instance what is being expressed needs a listener or what is big needs someone small, or what is sleepy requires someone to be alert to the sleepiness and so on.

Our understanding of the nature of the interpersonal field relies heavily on the work of Bion and his postulation of alpha functioning. It must be emphasized that this is a theory, not statement of fact. We dont know what the facts of the situation are and lacking facts we substitute with theories. Theories are useful only if they elucidate phenomenon that would be hard to understand and explain without them. So it is with this proviso that we approach the theory of alpha-function, to see if it can be used to facilitate explanation and exploration.

The theory of alpha-function is relatively simple though understanding its implications is extremely complex. First I will outline the bare bones of the theory as described by Bion and then unpack it a bit before moving on to some its implications. Bion states

An emotional experience occurring in sleep does not differ from the emotional experience occurring during waking life in that perception of the emotional experience have in both instances to be worked upon by alpha-function before they can be used in dream thoughts.

Alpha-function operates on the sense impressions whatever they are, and the emotions, whatever they are, of which the patient is aware. In so far as alpha-function is successful alpha elements are produced and these elements are suited to storage and the requirements of dream thoughts. If alpha-function is disturbed, and therefore inoperative, the sense impressions of which the patient is aware and the emotions which he is experiencing remain unchanged. I shall call them beta elements. In contrast with alpha-elements the beta-elements are not felt to be phenomena, but things in themselves. Beta-elements are not amenable to use in dream thoughts but are suited for use in projective identification. If the patient cannot transform his emotional experience into alpha-elements, he cannot dream. Alpha-function transforms sense impressions into alpha-elements which resemble, and may in fact be identical with, the visual images with which we are familiar in dreams, namely, the elements that Freud regards as yielding their latent content when the analyst has interpreted them.[ii]

Bions first sentence, An emotional experience occurring in sleep does not differ from the emotional experience occurring during waking life immediately draws attention to the considerable similarities of waking and sleeping life. The importance of this statement is that we tend to distinguish sleeping and dreaming as being totally separate and different from waking life. But Bion is making quite a radical suggestion by stating that they are very similar, because an emotional experience, whether it takes place in sleep or whether it takes place in waking life, is identical. Further this experience, in either state, is worked on by a mysterious function which he calls quite arbitrarily alpha-function. He uses the term alpha function not only to keep the term free of a penumbra of meanings that other descriptive terms might have, but also because one doesnt actually get to see what this function is. One only gets to see the products of this function, alpha elements, which causes us to theorize that there must be a function that produces the results that we are familiar with. Now if an identical emotion is worked on, either in sleep or wakefulness, by an identical if mysterious function, again either in sleep or wakefulness, then the product alpha-element, must also be identical. He confirms this to be the case when he says alpha-elements which resemble, and may in fact be identical with, the visual images with which we are familiar in dreams

Here we need to pause and reflect. Emotional experiences are taking place in all of us at all times and they are being worked on by alpha-function producing alpha-elements. These alpha-elements are identical with the visual images with which are familiar in dreams. But this cannot be the case for dream states are very different from waking states. So what is Bion talking about? This is the crucial part. If we are to accept what Bion is saying then we have to accept that the emotional currents of waking life are also being continually transformed by alpha-function to alpha-elements. However, in waking life we cannot see these alpha-elements, for we see instead what they in turn get transformed to, the thoughts of everyday life. If we could peel back these waking thoughts, then we would be able to see alpha elements. Peeling back is of course a figurative expression, not to be taken literally, for what we are trying to describe is how these thoughts are configured by the alpha-elements that underlie them. Now this seems problematic for waking thoughts are generally formulated in words while dreams are largely visual i.e. they are perceptions in different sense modalities, one auditory and the other visual. How and why does this transformation from one sense modality to another take place? We dont have any definitive answers at this point in time but there are some encouraging suggestions. For very complex reasons that we dont properly understand, the primary sense modality of homo-sapiens, seems to be visual, yet it is the auditory modality, linked as it is to speech, that seems most susceptible to manipulation, expression, mutation and development. It is not at all clear why the visual modality seems primary, but it is reasonably clear that visualization seems to underline much of our thinking, e.g. notice the eyes of a person who is speaking while deep in thought, the eyes keep moving to different quadrants as if seeing something. The primacy of certain sense modalities, on which other more elastic brain functions depend, might be provided by an anatomical analogy. In the human brain that the part of the brain generally associated with memory, again a highly developed and pliable human function, rides on and uses very ancient brain structures that process the sense of smell, a far less pliable sense modality. The reason why we think thoughts ride on visual images is that our minds seem to be constantly producing images, sometimes called day dreams or fantasies which are often, but not always, accompanied by thoughts that can be articulated. These visual images seem to run non-stop like a continuously running film in our minds and as in a film, sometimes the imagery is accompanied by words and sometimes the imagery substitutes for words. As the theory of alpha-function postulates, this imagery is made up of alpha-elements. But these alpha-elements are actually emotional experiences that have been transformed by alpha-function into alpha-elements. Another way of stating this simply is by saying that emotional experiences take place continually, but we are not able to see these emotional experiences. Instead of seeing them we sometimes see the products of their transformation, emotional imagery, or more often their further transformation into verbal thoughts. Since some sort of emotional experience runs through our minds continuously, emotional imagery also runs through our minds continually and it is from this emotional imagery that we derive the thoughts of ordinary everyday life. Ferro calls this process of the transformation of alpha elements into waking dream thoughts a waking mode of dreaming[iii] by which he means that a patient in a session re-narrates what is happening in the session itself. Waking dream thought remain inaccessible to us to us except through reverie (the vivid fantasies or daydreams produced by the analysts mind from the patients projective identifications) and visual flashes (in which one frame from the ongoing film that records the process of dream thoughts is projected and seen externally). In his books Ferro gives beautiful examples of both these unusual occurrences.

As an interesting digression it might be worth mentioning that the theory of alpha-function supports from a totally different direction, Freuds theory of wish-fulfilment that he postulated underlay dreams. For we can see humans, being the creatures that we are, are constantly wanting something or the other. This might be excitement or pleasure but it might equally be a need for security or safety or recognition or fame or power or simply freedom from pain. What we want or need generates a wish for what is wanted or needed. This wishing is thus the driver of our emotional life. We have just seen that emotional experience translates into what can be seen visually, either as dreams during sleep or fantasies in waking life. Thus we can say that the theory of alpha-function supports Freuds theory that wish fulfilments underlies or drives the visual imagery of dreams and fantasy.

To return to the theory of alpha-function, alpha elements should not be equated in all circumstances with dreams or fantasies, for the situation is complicated by the unconscious mind. There are many things that the mind, for various reasons, would prefer not to know. The mind of course knows these things at one level, for emotional experiences continue to take place that are being transformed into alpha-elements, but the mind remains unaware of the significance of these transformations and so remains unaware of the substance of these emotional experiences. It does this by a variety of methods such as seeing the transformations but understanding them differently through various distortions, omissions or rational mis-understandings or simply by seeing them but not experiencing the feeling states that go with them and so on. The unconscious is thus known by the analyst, not because he has some special powers or ability, but only because the analysand places before him all that there is to know, without knowing all the connections, meanings or significance of what is being related. The analyst then makes the links, connections and adds the meaning and significance that has been minimised, dropped, changed or distorted.

Another complication is the fact that the mind has absolute freedom about where to screen the emotional experience. For instance the imagery that might be evoked by the emotional experience of a contemporary situation might be imagery from a past experience. This past experience might in turn be a childhood experience, an infantile experience or an experience from yesterday. Likewise the screening might be located in an event that has never actually taken place but one that is created for the screening by fantasies, which in turn might have elements from past experiences. Or the screening might be in the location of events that are actually taking place at that time.

Amongst the myriad tasks of any psychoanalysis, is the major task of understanding the emotional experiences of the analysand. As we have seen this is no easy matter. But we can use something of what we understand about the transformations of these emotional experiences along the lines that we have been discussing. In his books Ferro gives numerous illustrations.

Ferro uses the term narrative derivatives to describe how the various ways in which a series of alpha-elements can be combined. There can be an enormous range of combinations that communicate similar emotional experiences. For instance he illustrates, if the underlying emotional experience has to do with pain, violence or oppression, the narrative derivative might be I remember once when I was a small, how my father gave me a very painful injection, and then humiliated me in front of everybody because I cried or I saw a film on television in which a girl was assaulted and raped by a hitch-hiker she had given a lift to or Something very unpleasant happened to my aunt the other day: some immigrants tried to mug her because she wouldnt give them what they wanted or A friend of mind came to me in tears because her husband forced her to have violent sex with him with absolutely no tenderness or I dreamt of a Greek god who was pursuing me with spears and wanted to run me through.[iv]

What perhaps needs to be emphasized is that all of these instances (apart from the last) describe events that actually happened. In the psychotherapeutic community there is a tendency to think that when we use these events to understand elements in the transference relationship, we are implying the event described to be a product of phantasy, which we then contrast with reality. The events that are called reality in this way are believed to be events that actually occurred but which are innocent of any transference significance. This is an unfortunate misunderstanding. All, or at least most, events that an analysand talks about actually happened to the best of the analysands knowledge. We do not for a moment doubt that. All we are saying is that the unconscious mind has no language of its own and hence can use no language other than the language of our conscious mind. It is true that the unconscious uses the languages of fantasy and dreams preferentially, but the unconscious is always speaking and it will use whatever experience or memory is at hand, to communicate with. Conscious descriptions and stories are the language which the unconscious mind uses. These descriptions and stories are called by Ferro narrative derivatives and there is no way for alpha elements to be known about except through their narrative derivatives. So this process will use whatever comes to the mind (a real event, a memory, a story, a dream) as a kind of language to communicate the existing emotional state. So every narration of a real event is simultaneously also the language by which another event (an emotional one) that is taking place at that very moment in real time, is also being expressed. Ferro gives numerous examples of how these events communicate unconscious emotional states or alpha elements. Accordingly it misses the point entirely to suggest that some experiences are expressions of unconscious phantasy and some are real. What we need to ask ourselves is, when an analysand talks about something, why is that particular thing chosen? On reflection we will see that there are almost an infinite number of things that could be talked about, yet the mind of the analysand chooses that particular track in that particular way. We can put this in another way by saying, what else is being said upstream in each and every communication. Because from this point of view, anything that is said is not to be taken only as an absolute statement in its own right, because it is also always a communication of what is happening at that moment in the analysis between the analysand and the analyst.

To recapitulate, in attempting to understand the term real-time psychoanalysis we first indicated the level at which this kind of psychoanalysis took place, namely the transactional interpersonal level. Then we explored the nature of such analysis, using the theory of alpha function which transforms emotional experiences into largely visual waking dream thoughts. Now we will attempt to describe what is meant by the term real-time and thereby conclude what is meant by the term real-time psychoanalysis including its patho-physiology.

**DEFINING REAL-TIME IN PSYCHOANALYSIS **

The term real-time has come to mean being able to see events at the actual time that they take place, such that even distal movements, say on the stock exchange, can be seen in the actual or real time that they take place. Thus real-time psychoanalysis means being able to see psychoanalytical events, as they are actually taking place right in front of us. The term real-time psychoanalysis might seem odd, if it is not appreciated that psychoanalysis since its very inception, has been steadily moving in this direction. In his first descriptions of the transference Freud demonstrated that events that had taken place distally in the analysands past could actually be seen in the contemporaneous present. Klein, through her clinical acumen, was able to describe these events as they actually took place in the consulting room as expression of internal unconscious phantasy. Ferro, through his interpretive elaboration of Bion, reveals the emotional currents in the form and way in which they originate, transform and develop at every moment in the psychoanalytic dialogue.

So we might understand the meaning of real time, but what does psychoanalysis in real time really look like? Ferros books are full of dozens of very rich examples of analysis in real time and I hope I have whetted your appetite to have a look at them for yourselves. Here I would like to give an extremely unusual example, from Bion. This is an illustration about the production not of alpha, but of beta elements in the session. In this session, Bion with extreme intuition, is able to see beta elements in the form of hallucinations, actually taking place in real time, right before him. It is a rather lengthy description but any significant abbreviation will I think distort the essence and significance of his description. This quotation is from a paper by Bion called On Hallucination.

I cannot say now what it was in the session that first made me realize that the patient was hallucinated. It may have been that he was so manipulating the analysis and myself that I felt I was not longer an independent object, but was being treated by him as an hallucination. My suspicion was that when he said he had placed his gramophone on the seat he was denying my life and independent existence in the analytic chair and treating my interpretations as auditory hallucinations. I did not immediately interpret this, but said that it appeared that he was reactivating a state of mind which, we must assume, it had now become important to him to preserve as a good object. His response to this was to move his head and eyes as if my words were visible objects which were passing over his head to become impacted on the opposite wall. On previous occasions I had interpreted his behaviour to mean that he saw my words as things and was following them with his eyes. He had shown relief, almost amounting to amusement, and he appeared to agree that my words were seen as evacuated objects like bits of faeces. It had seemed to me then that the hallucination had a reassuring quality in that my interpretations, felt as persecutory objects, were seen to be passing harmlessly overhead. I said that he was again seeing objects passing overhead and reminded him of the previous occasion. This time he became anxious and said, I feel quite empty. Better to close my eyes. He remained silent and very anxious and then said, somewhat apologetically I thought. I have to use my ears. I seem to hear things all wrong. This association brought it to my mind that that he was not observing a direct relationship between myself and the opposite wall, as I had supposed to be the case on earlier occasions. My interpretation was being taken in by his ears, but in a way which he felt to be all wrong that is to say, cruelly and destructively. If so, the interpretations were being taken in and transformed by his ears and ejected by his eyes. This seemed so extraordinary that it was a moment before the explanation flashed upon me. I gave it in the following interpretation: You, I said to him, are feeling that your ears are chewing up and destroying all that I say to you. You are so anxious to get rid of it that you at once expel the pieces out of your eyes. I reminded him that when he had wished greedily to take something in, he did so through his eyes, because his eyes could reach a long way to things he could not possible touch with his mouth. I went on , You are now using your eyes for the opposite reason, that is to say, to throw these broken bits of interpretation as far away from yourself as you possible can. The patient seemed extremely frightened, yet there was relief in his voice when he agreed. I drew his attention to his fear. He replied that he felt too weak to go on, I am fading out. I suggested he was afraid of me because he felt he was destroying me as well as my interpretations and also afraid because he could not get enough interpretations to cure him He then said, All sounds turn into things I see around me. I interpreted that he was again turning my interpretations into sound and then evacuating them through his eyes, so that he now saw them as objects surrounding him. He replied, Then everything around me is made by you. This is megalomania. After a pause he said, I like your interpretation very much. In parenthesis I must add that from this time onward I was able to recognize how very common it was for the patient, when he received an interpretation which for some reason was unwelcome, to give evidence of becoming hallucinated.[v]

This is a very dramatic and powerful description of real-time psychoanalysis. However in many ways this is a bad example because it is extremely atypical. Real time analysis, as we have been talking about it here and as largely described by Ferro, is about alpha elements and alpha function. This is an example of beta elements in real time. This is also a bad example because it seems to suggest that real-time psychoanalysis is something as extraordinary and dramatic as this description might suggest, rather than something much more mundane which occurs quietly and almost constantly in any psychoanalytic session. Besides which, this example does not illustrate the usual way in which we learn about real time events taking place in the analysis, as described by Ferro, where the real time events are gleaned only from the ongoing narrative of the evolving session. .

However I quote it here for three reasons. The first is a historical one, as an acknowledgment of it being one of the first full descriptions of real-time psychoanalysis by the pioneer of this way of thinking. Bion was not in the habit of giving detailed clinical vignettes especially later in life, and this vignette must surely rank amongst one of his, and perhaps one of psychoanalysis, richest clinical vignettes. The second reason for giving this illustration is that it is an excellent description of extremely primitive phenomena as they are actually happening in real time in the consulting room. In passing a couple of things might be noted. First, though this is a description of beta elements, they are mixed in with alpha elements and alpha function e.g. the gramophone and faeces both of which are tightly knitted into the background narrative against which the real time hallucination takes place. Secondly, there is also a very significant statement which is made by the analysand when he says Then everything around me is made by you. This can be seen as an absolute statement in its own right, and as such explored creatively in terms of its phenomenological or philosophical significance. But we can see from the underlying patho-physiology teased out by Bion, that it is also but a way station in the evolving and complex emotional transformation taking place at that very moment in real time between analysand and analyst.

The third reason I use this example is to illustrate transformation between visual and auditory sense modalities that we attempted to explore earlier. It is true that the transformation in this example would be considered abnormal. But we now know that that many events that are considered abnormal are abnormal only in degree forming as they do, just a part of the possible human emotional continuum. Besides which, for our purposes, we need to understand that what is even categorically pathological, can only take place in what is physiologically possible. This example shows the how the auditory and visual sense modalities can interrelate and trans-mutate with each other. Here is an extremely rare instance of transformation from the auditory to the visual, while we have been talking throughout this presentation about the transformation from the emotional, to the visual to the auditory and thinking modalities.

References

[i] Ferro A. 2002 In the Analysts Consulting Room Brunner-Routledge, East Sussex p. 32-33.

[ii] Bion W.R. 1962 Learning from Experience in Seven Servants Jason Aronson New York, N.Y. p. 6-7.

[iii] Ferro A. 2005 Seeds of Illness, Seeds of Recovery. Brunner-Routledge Hove and New York p. 54.

[iv] Ferro A. 2006 Psychoanalysis as Therapy and Storytelling Routledge London and New York p.28.

[v] Bion W.R. 1967 Second Thoughts: Selected Papers on Psychoa-analysis. Jason Aronson New York, p. 75-6.