רני לוי
רני לוי
עובד סוציאלי מטפל, פסיכותרפיסט ומנחה קבוצות מוסמך

‏Hospitality and Containment: On the Ethics of the Therapeutic Encounter

A person knocks on the door. Another one, on the other side of the door, opens it for him. The person who knocked on the door is asked to come in, take a seat, lie down on the couch, to pace the room, talk, do nothing; he can choose not to come in if that's what he wants, he does not have to: now he's already there, with the one who opened the door for him.

Introduction

Try and remember the first time you knocked on the door of a therapist's clinic. There are very few moments like that in your life.  The moment holds many expectations – some unknown even to yourself –  from both the therapy and the therapist. We host the patient who in his turn hosts us, containing guests, in his inner world. Some relationship is underway before the door has even opened.  We can think about the degree of expectation and the degree of readiness to host.

In this paper I try to describe the dynamic of hospitality between therapist and patient. Receiving guests, as Levinas describes it, is an ethical act. I will refer to this as I examine what is ethical in the therapeutic act.  For me, taking in guests communicates with Bion's notion of containment.

While the notion of hospitality is part of Levinas' philosophical thinking, the notion of containment belongs in the domain of psychoanalysis where it was developed by Bion. Here, then, philosophy and psychoanalysis, as fields of knowledge, are hosting one another. In this mutual enriching and expanding, these discursive domains also include us.

When we formulate the philosophical – and not only the psychoanalytical – foundation of the therapeutic act, we apply tools from outside psychoanalysis' conceptual frame. This allows us to put the therapist's experience into words that meet that experience at a fundamental site.   We could say, in this sense, that ethics contains psychoanalysis.

Both Bion and Levinas constructed rich and extensive theoretical worlds. To bring the notions of containment and hospitality into contact, I shall here introduce some of the conceptual domains of each of these thinkers, while focusing on where they meet as well as where they clash.  From Levinas's work, I will especially refer to the following concepts: infinity, responsibility,

dis-appropriation, and hospitality. And from Bion's work, I look at O, link K, containment, and his notion that the work of the therapist should be done without memory and without desire. When these concepts and ideas are brought together they generate a new – third – type of thinking on the ethics of the therapeutic act. I look at the practical-clinical implications by addressing questions like:  How do we preserve the otherness of the other in the course of therapeutic interpretation? and by offering a description of a state of openness towards the otherness of the therapist in the course of the therapeutic encounter.

The focus of this article is on the ethical-philosophical side of the therapeutic act rather than on the ethical-professional aspect, the latter of which has already gained a great amount of most welcome attention from the therapeutic community.  The present relationship between the ethical position and the professional act as such resembles that between any moral position or idea and its concrete application or between a creative idea and its material execution.

Review of the Literature

While the work of diverse philosophers (Sandler, 2006) was an important resource for Bion who adopted a number of concepts from the philosophy of science as well as from mystical thinking, Levinas's attitude to psychoanalysis was critical; in fact he is known to have remarked "I am definitely not a Freudian"(Levinas, 2001, p.174). However, Levinas came to be a welcome and familiar guest among psychoanalysts and some of his key concepts, such as  responsibility, otherness, and the face of the other, as well as the asymmetric relationship between the therapist-self and the patient-other are intuitively lucid for the therapist community.

A number of articles have been published comparing between Levinas's and Winnicott's theories (Alford, 2000, 2007). This work emphasizes commonalities between Levinas's and Winnicott's notions of motherhood pointing out the former's central notion of interiority and how it can be related to Winnicott's transitional space. The authors also turn to Levinas to tease out the ethical aspects of Winnicott's work which does not explicitly refer to the ethical-philosophical side of psychoanalysis.

Then there is a book that is dedicated to a comparison between Lacan and Levinas  (Harasym, 1998). Bracha Ettinger introduces Levinasian terms to a reading of Lacan and uses the notion of the "matrixial space" which she construes as a common, pre-Oedipal space whose significance is not merely developmental but also ethical (Ettinger, 2006). Eigen (Eigen, 2007), too, uses Levinas in his attempt to describe the moral aspect of psychotherapy.

Ghent (2000), in an article on the implications of Levinas's philosophy for psychotherapy argues that the latter's ideas allow us to evolve a therapeutic method with utopian features that may come to replace the medical model. Ghent's article illustrates how Levinas's inspired, intensive and utopian manner of writing has affected these various authors:

The work of psychotherapy can begin a movement away from the dehumanizing dualism and mechanical reductionism of modern medical-model psychotherapy and toward satisfying the ethical obligation to suffer with the other in the here-and-now immediacy of his or her misery … the Levinasian alternative outlined her seeks to radically recast the meaning of human suffering so as to alert us to the fundamentally ethical summons embodied in that suffering, a summons that demands that we be willing to shoulder the heavy and agonizing burdens of an-other's pain. (Ghent, 2000, p.23)

Ghent poses suffering of and for the other as the ethical alternative to the medical model which, being analytical and disjunctive, de-humanizes the other. Suffering with and for the other is, according to Ghent, a therapeutic point of departure. I shall not go into how the therapist achieves this because Ghent explains it at length in his article. The therapeutic position whereby the therapist suffers with the other in the here and now by means of projective identification, a mechanism the workings of which I shall describe below, is where Ghent's approach relies on Levinas's ethics.

One article that deals directly with Levinas and Bion is by Emery (2000) By means of readings of Derrida and Freud, and more specifically, of the notion of infinity in the work of Levinas and Bion, Emery offers a poetically written case study. Both the European Journal of Psychotherapy, Counseling and Health (2005), as well as the Psychoanalytic Review (2007) moreover, have dedicated issues to the subject of Levinas and psychoanalysis, including a number of articles dealing with ethics, hermeneutics, otherness, and psychotherapy.

The Ethics of the Therapeutic Act

A psychotherapist cannot avoid asking her-or himself philosophical questions. The encounter with the other demands this.  There is an implicit, underlying – but unexamined – assumption in the therapeutic community that therapy – psychoanalysis in this case – is a good and moral thing.
‏My ethical-philosophical inquiry is aimed at this implicit assumption and also tries to lay the philosophical ground for an explanation of the ethics of a certain mode of therapy.

Ethics is the branch of philosophy that enquires into questions of right and wrong, good and bad, permissible and impermissible in relation to our actions. In this article I try to outline an answer to the question: What is ethical about the therapeutic act? In our work as therapists we reflect, interpret, reinforce, contain, constitute a self-object, among other things, and all of this we do in terms of the theoretical model we follow. What is the ethical nature of these activities? What is ethical about our very act of speaking as we address ourselves to the other who is in our treatment?

I do not suggest that one type of therapy is more ethical than any other type of therapy. Nor is it my intention to show that psychotherapy, in its many varieties, is fundamentally ethical.  I don't want to force psychoanalysis into the mold of ethics or vice versa. I would like to define the ethical aspect of the therapeutic act with reference to Bion's and Levinas's terms.

It is against the background of the crisis in values that has marked the postmodern period that I pose this problem –  a period during which the absolute values by which Freud, his contemporaries and many of his followers, lived came under question. In Ophir's (2005) terms postmodern critique:
‏mocks the pretensions of modern philosophy to trace the limits of reason and language and guide our use of them to lay the groundwork for moral and aesthetic judgment (or for the proper use of concepts, or the legitimate performance of speech acts), and to guarantee the existence of one philosophical or scientific idiom that can faithfully describe multiple dimensions of reality and translate correctly and unambiguously into 'one language and one speech' what is said and expressed in all languages and dialects spoken.(Ophir, 2005, p.21)

The postmodern critique of modern morality made a re-formulation of moral theory necessary. The question arises  how we should act in the world without the support of a set of absolute values, of a supreme authority, and in the absence of the hitherto familiar morality.

A meta-theoretical change at the very base of psychoanalysis has occurred since Freud's times (Mitchell, 1993): from a modern scientific notion of truth, linear and absolute in nature, to a postmodern one which is many-faceted, context- and viewpoint-dependent. At the present, coming after Foucault, Deleuze and Guattari, and coming after, also, the long and complex dialogue in which Derrida engaged Freud's writings – in the wake of all this, can we still in all sincerity and with any clarity define the "patient", the "physician", and the "illness"?  Is our notion of psychological health unaffected? These are some of the questions I found myself facing in the course of my daily work as a psychotherapist and this is what led me to turn to Bion and Levinas in the hope of finding a new, stable theoretical grounding for the ethical aspect of my profession.
‏Levinas

One of the most radical efforts to formulate a moral theory, in the twentieth century, was made by Emmanuel Levinas.  His theory re-introduces the concepts of truth, faith, responsibility, and God into the philosophical discourse – concepts which had come under serious question, to the point of erasure, in the philosophical discourse of the second half of the twentieth century. Levinas restores the moral aspect of man's existence after World War II.  As a first step in this project, Levinas criticizes philosophical discourse as a whole rather than more specifically modern, or postmodern philosophy, or indeed psychoanalysis. From Socrates to Heidegger, philosophy has kept away from what is beyond it, from the infinite. Even where it directed itself to the sublime and the transcendental, it did so with full confidence in its ability to identify and define them. As a result it always remained locked within itself, in the confines of ego-logic.

"Western philosophy has most often been an ontology: a reduction of the other to the same by interposition of a middle and neutral term that ensures the comprehension of being"(1969, p.43)

Levinas criticizes psychoanalysis and the other scientific disciplines for having reduced man to a collection of mechanisms and patterns. This put a limit to man's infinite otherness (Levinas, 1969).

By explaining human motivation in terms of libidinal energies, the pleasure principle and the reality principle, Freud altogether missed out, Levinas argues, on the ethical dimension of human existence.  The notion of the unconscious, too, comes under his criticism, with Levinas claiming that it is nothing but a derivative forged in the image of consciousness which fails to escape the similar into the infinite other (Levinas, 1996). Levinas resists the notion that a discourse rooted in notions of sameness and identity should serve as the point of departure for relating to the other, and hence he rejects psychoanalysis as part of such an effort.

If this is how things are, it would be possible at this very early stage to put an end to the comparison between Levinas's notion of hospitality and Bion's containment. Yet if we did so, we would miss an opportunity to re-formulate the notion of containment and the theoretical profit we may gain from this encounter.

I would like to try and extend this hosting of the un-hostable. Such a continuation bears witness to one of the paradoxes that are inherent to Levinas's theory: In order to host the other and receive him I must know him, yet by knowing him I must necessarily reduce him.  As we shall see below, containment and hospitality are never tantamount to the containment of everything and to total hospitality.  As we define the other, we reduce him and he becomes part of the same. And so we find ourselves engaging, unwittingly, in violence against the other whom we wish to host.

Levinas's Notion of Infinity and Bion's O

Both Levinas and Bion used a Kantian notion of the "thing in itself" when describing reality as such. Reality is what is beyond our senses and what we cannot perceive as it is. It is only through the intervention of our senses that we can know reality.

‏Freud described this as follows:

"Behind the attributes (qualities) of the object under examination which are presented directly to our perception, we have to discover something else which is more independent of the particular receptive capacity of our sense organs. We have no hope of being able to reach the latter itself, since it is evident that everything new that we have inferred must nevertheless be translated back into the language of our perceptions, from which it is simply impossible for us to free ourselves (…) Reality will always remain 'unknowable'" (1940, p.196)

Freud's words refer to the otherness which always resides beyond our senses and which it is up to us to interpret. Bion relates to reality as such in a similar way: he refers to it with the symbol O, which he defines as the absolute truth, absolute reality, infinity, the thing in itself, the noumena (Mondrzak, 2004), and he describes it as follows:

The fundamental reality is 'infinity', the unknown, the situation for which there is no language – not even one borrowed by the artist or the religious – which gets anywhere near to describing it. (Bion, 1994a, p.372)

For Grotstein (2007), theories like the pleasure principle, the reality principle, the death drive and Klein's psycho-paranoid and depressive positions, are nothing but a manic defense against O. Thus, O opens psychoanalysis toward what is always beyond, what is always ungrasped and unknowable and hence anxiety inducing.  One way of defending against such anxiety is by reducing O to some psychoanalytic theory (Grotstein, 2007, p.121). By means of the Alpha function, we can convert ultimate reality, that is, O, into knowledge (K) but such knowledge, as Freud already mentions in the above quote, will always already be some processed form of that reality.

The psychoanalytical community, considering it a religious deviation from psychoanalysis in its scientific guise, received Bion's notion of O with considerable criticism and skepticism. Some of these critics even claimed that at this point Bion stopped thinking as a psychoanalyst and crossed over to mysticism (Symington & Symington, 1996).

As scientists, both Freud and Bion approached psychic reality with questions and attempted to examine it by creating theoretical models. Based on empirical data, these theories strive towards objective, scientific universalizations concerning human psychic reality.

Levinas, by contrast, referred to this same ungraspable, infinite and by definition unknowable reality but with the aim to evolve an ethical, rather than a scientific theory. His description of the idea of infinity resembles Bion's notion of O – in fact, it is deceptively easy to confuse and conflate them: both describe the unspeakable, the absolute, the transcendent, the divine, and in both the encounter between two subjects is an encounter with the infinite.

The idea of goodness, like the idea of the infinite, is beyond human grasp. The source of man's movement toward the other Levinas finds in Plato whose Form of the Good is man's metaphysical desire. This desire for the idea of goodness, or for infinity is a desire that must remain unsatisfied: indeed, it grows the more man yearns for it. It is by means of the notion of infinity that Levinas

extracts man from totality, as the latter is punctured by the former. We are surprised by the idea of the infinite because it is radically unlike any other concept, posing a challenge beyond our ability to think. While being, on the one hand, beyond the reach of our thinking, it exists on the other as a concept in thought.

This is how Maurice Blanchot, Levinas's colleague and friend, described it:

“When I think the infinite I think what I am not abele to think  (for if I had an adequate representation of it, if I comprehend it, assimilating it and make it equal to myself, it would be a question only of finite). I therefore have a thought that goes beyond my power; a thought that, to the very extant that it is a thought of mine, is the absolute exceeding of the self that think it  – in other words: a relation with what is absolutely outside myself: the other. (1993, p. 53)

Man's consciousness opens out onto infinity, that which "is not the "object" of cognition (which would be to reduce it to the measure of the gaze that contemplates), but is the desirable, that which arouses Desire, that is, that which is approachable by a thought that at each instant thinks more than it thinks." (levinas, 1969, p. 62) Man's consciousness thinks more than it thinks because it cannot "think from within itself" alone and this is because the concept of infinity is embedded within it.

Because thinking includes the infinite it thinks beyond what it is able to think. If it could think the infinite, the latter would no longer be the infinite. In much the same way, containment contains what is beyond it, namely the other, for if it were to contain what is not beyond it, it would in fact contain what is like it, namely itself. Containing means to contain the different, the other. Neither thought nor containment can be locked within themselves: infinity is part of them.

At the beginning of Totality and Infinity, Levinas writes this:

"…The I, nonetheless contains in itself what it can neither contain nor receive solely by virtue of its own identity. Subjectivity realizes these impossible exigencies – the estonishing feat of containing more then it is possible to contin…subjectivity as welcoming the other, as hospitality"(1969, p.27)

This is how the subject can achieve its subjectivity, which is related to infinity. The ability to contain and to think more than what can be contained or thought is what allows for and constitutes human subjectivity.

Responsibility

It is the manner in which one responds to the other that creates subjectivity. I would like to argue that the patient constitutes the therapist in the same way as the other constitutes the subject.  The patient who faces me, whose face commands me, makes me responsible for him. I can elect neither to see nor to shoulder this burden but once I stay there facing him I become his "hostage" and responsible for him.

Responsibility is the mode of relating between self and other, and it constitutes the self's subjectivity. For Levinas the face is a transitional space between the metaphysical and the ethical, a space between the ideal and the concrete face of the other who is in front of me. Through the face of the other, infinity appeals to me and commands me. The idea of goodness renders me responsible for the other who is facing me. Infinity charges me with responsibility for the other and subjects me to him:

"I must encounter the indiscreet face of the other that calls me into question. The Other, the absolutely other paralyzes possession, which he contests by his epiphany in the face. He can contest my possession only because he approaches me not from the outside but from above." (Levinas, 1969, p.171)

We will always feel guilty, adds Levinas, about this responsibility. He quotes a sentence from Dostoevsky's Karamazov Brothers, according to which “… everyone of us has sinned against all men, and I more than any” (Dostoevsky‏, 2000, p. 266). for Levinas, as this quotation bears out, subjectivity itself is responsibility for the other and hospitality toward him, and this is why the other is what constitutes human subjectivity. We can say, in parallel, that it is the patient who constitutes the therapeutic position of the therapist and thereby turns him into a therapist.

The Precedence of the Other

This precedence of the other in constituting the subject can be found back in Laplanche's commentary on the revolution Freud brought about by situating the unconscious within the human subject, thus taking away the latter's mastery over his own house. Then, by looking at Freud's seduction theory, Laplanche goes on to show how Freud positions the other at the very foundation of the individual's psychic structure:

"We have reached the point that I consider is the essence of the revolution begun by Freud. In reality, its de-centering is double: the radical alterity of the other-thing (das Andere), the unconscious, is only guaranteed by the other person (der Andere): briefly, by seduction" (1997, p. 659).

And further on in the same article:

"Internal alien-ness 'held in place' by external alien-ness; external alien-ness, in turn, held in place by the enigmatic relation of the other to his own internal alien – such would be my conclusion concerning the de-centering revolution I have proposed here in continuation of the Freudian discovery." (1997, p. 661)

What is important in Laplanche's theory regarding external otherness being an organizing principle of the self and situating the unconscious within itself is its similarity to Levinas's theory and the formative role it allots to the other in constituting the subject qua responsible subject.
‏Containment

The link with O, for Bion, is a link of containment, of recognition (K-link) and faith (f in O), as well as a link of the intuition.  Through an internal epistemic drive, O becomes an object of enquiry (Bion, 1962). Where Levinas places responsibility for the other, I would like to situate this epistemic drive,K, as an emotional act(Bion, 1962). This drive is curiosity, the wish to know (Fisher 2006; Schneider 2005), the inborn drive to truth (Grotstein, 2004).  Together with the sense of responsibility for the other, this emotional link, the K-link, operates in the face of infinity. While one originates in an internal drive and expresses itself in an emotional connection, the other's origin is external in the form of a responsibility for the other with which I am charged by his face that commands me: "You shall not kill". Responsibility for the other is not an emotion – it is an ethical obligation whose emotional outcome is the guilt we feel towards the other.

The K-link, which drives one to know the other is how responsibility for the other arises. Our mode of knowing the other includes our taking him in, hosting, containing him.  Fisher offers a description of the work of containing:

"The container-in-K introjects the bad feelings projected into it, it functions to 'modify' or 'remove the fear from' or 'detoxicate' those projections. What Bion implies, but never quite says sufficiently clearly, is that the container does so by remaining a container-in-K, wanting to know and understand, not from an emotional distance, but by experiencing those emotions and yet retaining a K-state-of-mind." (Fisher, 2006, p.1231)

When the therapist asks the other who comes for therapy questions, he is, thereby, evolving toward and on behalf of that other a curious, inquisitive attitude, looking for the truth. The therapist makes himself present as an external container who wants to find out about the other in his treatment and he does so by processing feelings arising in the encounter that are indigestible for the patient. The link through knowledge does not involve knowledge as facts but knowledge as emotional facts.  The therapist's question to the other in treatment is not, What happened? But, How did it feel, how does it feel? This curiosity with its attendant containment is what hospitality is about, the therapist's ethical act.

Containing the Uncontainable

Levinas states: "The same and the other can not enter into a cognition that would encompass them." (1969, p. 80). For Levinas it is not possible to contain the other because he (or it) is infinite. The face of the other is turned toward me and demands an ethical relationship from me, but I cannot contain this face. In its infinity, it is always beyond thematization.  This very same infinity of the other, that which one cannot contain, however, is what institutes one's relation to him and the attempt to contain him.

It is the function of infinity to spark the desire to go on thinking and containing what cannot be contained and thought. Exactly because we cannot fully contain the other, we open up to him in an attempt to contain. Truth and transcendence are not accessible as such: what we receive and decipher are the signs they emit. Containment therefore must always be partial.  Yet at the same time, containment always already contains more than it is able to contain because, as we have seen, it is open to infinity which is an integral part of it.

For Bion, too, containment is never of everything. It is containment of the patient's O – the Op – which already is a reduction of O. We contain Beta elements which are already the thing itself as the senses can perceive it.(Bion, 1962)  That this is so actually spurs us on, rather than preventing us to do our utmost in our attempt to contain the other.
‏Hospitality

Containment is a psychic act which occurs outside in any specific spatial domain. For Bion, the container and contained are parts of a theoretical construct that explains the relationship between mother and infant. This aspect, according to Bion, is crucial in the infant's mental development. The concept of containment matches Levinas's concept of hospitality, one of whose concrete modes is described in Genesis 18:1-2:

"And the LORD appeared unto him in the plains of Mamre: and he sat in the tent door in the heat of the day; 
And he lifted up his eyes and looked, and, lo, three men stood by him: and when he saw them, he ran to meet them from the tent door, and bowed himself toward the ground"

Abraham hurries out towards his guests, prostrates himself before them and takes them into his home.  The fact that Abraham interrupts his communion with God in order to host his guests, led the Sages to formulate the following sentence: "receiving gusts is greater than greetiong the divine presence".  This dictum illustrates how important hospitality is in Judaism – more important, indeed, than prayer.

Hospitality, for Levinas, is one's laying one's self open to the face of the other as such. Abraham does not check who the three men are and invites them .

Levinas describes two types of law: political law and ethical law (Kantor, 1999)  These notions will assist me to explain the concept of hospitality. The political law of hospitality is conditional and dependent, a law of rights and obligations determined in terms of one's belonging to a certain group (a nation's citizens, women, men, below or beyond a certain age). This law affords certain people, the citizens of a certain country, entry to that country while disallowing others – refugees for instance – to come into the same country. This is the law that takes into account a certain "reality" with its limited resources in which we have to choose some priorities if we want to have a society that cares for its citizens. The ethical law, in contrast, is an unconditional law of unlimited hospitality: it offers those who come by the entire home, it recognizes their entire being and singularity without asking for anything in return – neither their names, nor some material good, nor indeed the fulfillment of some condition.

Below I offer an example of how therapeutic containment combines with hospitality in the therapeutic encounter.

The patient experiences O, infinity, within himself like Beta-elements, like traces of infinity. He has trouble containing these. His psyche is unable to host these sensations and feelings because they threaten and hurt it insufferably. Through projective identification, the patient projects these feelings onto the therapist. The latter uses his Alpha-function to contain these sensations and feelings and in so doing he transforms Beta-elements into Alpha-elements. Once this is done, he can, in due time, return the processed feelings and thoughts to the patient. As the patient receives the processed psychic knowledge from the therapist he transforms it into personal knowledge concerning himself.  Hospitality, here, is containing the difficult contents that the patient, through projective identification, deposits with the therapist. This act comes under the law of ethics as Levinas defined it for the therapist takes in the projected contents without first ascertaining what they are.

At one level or another this containing goes on all the time.  It is a means of coping with reality by processing and transforming sensations and feelings into thought. In this sense, the objective of psychoanalysis is to help the patient to contain the uncontainable and thus to allow him to think the hitherto unthinkable. The evolving ability to think is the ability for personal development and growth.(Ogden, 2005)  As he takes in what is projected onto him, the therapist, if he does not know how to contain them, risks being hurt by the projected feelings. Facing the painful and frightening reality of the patient means choosing an ethical position of exposure to the other's suffering for the latter's sake.

Without memory and desire; De-possession

To make contact with the patient's otherness we, as therapists, must be without memory and without desire. Emery writes:

"The responsibility of the analyst, then, is the capacity to respond to the infinite – to the exorbitant of the Other before figurations of the Same. Interest, by contrast, can never pay its debt as it never makes contact with the otherness of the Other". (Emery, 2000, p.385)

I must be in a mentally free state in order to offer an interpretation to the other whom I treat. Emery argues that interest gets between the therapist and the otherness of the other. Bion calls the state of mind that is free of memory and desire (ie., interest) reverie. This is a condition of full openness to the other, which is also a condition of full responsibility: the therapist's responsibility for the other in his care. This is also the responsibility reflected in the wish to know, to contain and to recognize the other who is in therapy – as we have already seen when dealing with the K-link.

To attain this state of reverie we are required to adopt a stance of "de-possession" (Levinas, 1969, p. 173) or expropriation of self. These are Levinas's terms for a condition of non-adherence to a conatus essendi aimed to create a void into which the other can be received.

This state, too, is marked by being without memory or desire: Here I am not occupied by my narcissistic needs but only by being for the other. I am called to bear the suffering of the other in his place and on his behalf.  To do so, I must expropriate myself from myself and to offer place within me to the other. This resembles what Bion describes as being without memory and without desire or understanding. In order to be open to absorb the other whom he is treating, the therapist remains without the key components of his personality.

The Therapeutic Position: "We Will Do And We Will Hear" –Primary Unconscious Containment
‏For Levinas it is the patient who actually places the therapist in his therapeutic position, turning the latter, in fact, into his therapist by virtue of his – the patient's – presence. We may use the Biblical dictum "We will do and we will hear" (Exodus, 24:7) to denote the therapeutic position where the therapist is designated by the patient:  "And he took the book of the covenant, and read in the audience of the people: and they said, All that the LORD hath said will we do, and we will obey [hear]." These are the words of the people of Israel when they receive the covenant at Mount Sinai. They receive the ten commandments before they understand them, and Levinas interprets this as follows: "Through trust in him who speaks, we promise to obey and now we will listen to what he tells us" (Levinas, 1990, p. 42), and further on: "The adherence to the good of those who said "we will do and we will hear" is not the result of a choice between good and evil. It comes before it." (Levinas, 1990, p. 43). This is an attitude of absolute faith in God and of acceptance of the contents of that faith even before it is known or indeed has risen to consciousness. In Levinas the infinite God commands me through the face of the other and I respond before I know the nature of the command, just like the people of Israel responded to Him on Mount Sinai before they knew of what the ten commandments consisted.

Following Levinas, then, I would like to propose this position as the primary therapeutic position. In this position, openness comes before subject matter, thought, acceptance and decision, and all content is received as a command issuing from the other and demanding containment. "We will do and we will hear" means acceptance and containment prior to understanding – a position of unconscious primary containment. It is unconscious not because it has first been conscious and then repressed but rather because this position is taken without conscious relating or consideration of its subject matter.

The sense which allows one to know the other before knowledge emerges is intuition. Bion poses the question whether the psyche's mode of knowing resembles the way illness or some physical symptom is known. Anxiety, psychic pain, and the other objects that populate the mental world, he claims, are not given to sensory knowledge but only to intuition (Bion, 1970). While containment denotes the act by means of which we psychologically know the other, intuition is the sense that makes such knowledge possible.  The other senses, claims Bion, occlude intuition.  Hence the advice to steer clear of memory, desire and understanding: they interfere with intuition (Bion, 1970). Intuition allows us to know without knowledge and without reduction. It antecedes conceptualization.

Through it we know even before we know and contain even before we contain.
‏The position of primary containment, much like intuition, exists before consciousness and is automatic and spontaneous in the primary and good sense of these words. It is like the head that moves in the direction of the sound of crying, or like picking up something someone dropped in the street, or doing something heroic and very risky which, with hindsight, seems unreasonable, and about which the subject himself will say: "I just didn't think of what I was doing."
‏(F in O)

The openness of this "We will do and we will hear" attitude parallels what Bion suggests we should maintain in the clinic. The therapist must be in a condition of faith in O (F in O). Grotstein too drew this connection between what happened at Mount Sinai when the people of Israel expressed their faith in God, saying: "We will do and we will hear" and Bion's O. Grotstein writes that the people of Israel followed the Golden Calf (K) while Moses brought them the covenant (O), and he remarks:
‏For Moses, as for Bion, faith lay in the belief in the existence or presence ("holy ghost") of an ultra sensual object" (2007, p.315).

Like for Moses, for Levinas and Bion faith is the mode by which we relate to what is outside us, something that forms the very foundation of the religious position but also that of science and of psychoanalysis. The two things that Levinas and Bion share are openness toward the other and faith in something that is beyond understanding and perception. Taking this position of outwardly directed openness each looks on from their different view point. While for Levinas, this is an ethical-religious vantage point of responsibility for the other, for Bion it is a scientific one. Bion writes:

"(…) for me "faith" is a scientific state of mind and should be recognized as such. But it must be "faith" unstained by any element of memory and desire" (Bion, 1970, p.32).

The analyst's faith is in the fact that the patient's emotional truth is out there and will emerge from his associative material in a manner that will be absorbed by the former's intuition. This state of belief is pre-conscious rather than conscious. Bion writes that this implies the relationship between apriori knowledge and knowledge:

"it [faith] has a relationship to thought analogous to the relationship of a priori knowledge to knowledge" (Bion, 1970, p.35).

These two approaches, the ethical and the scientific, do not clash; they are, rather, complementary and together they form the very umbilicus of the primal, unconscious therapeutic position which I have been attempting to outline, a position of primary openness and containment of the other whom I treat in therapy.

An Ethical Space

The above described position arouses what Laplanche calls the "primal seduction" in the patient (Laplanche, 1997). Laplanche's description of this seduction is in terms of what occurs between mother and infant. The mother poses the infant with the enigma of signs and of sexuality, tempting it to know and to understand.  This position, he argues, engenders two types of transference, namely "hollowed-out transference" and "filled-in transference" – which Viviane Chetrit Vatine describes as follows:

"The filled-in transference: This is transference in the classical acceptance of the term, the repetition of pain, of past wounds, of the internalized parental imagos, of the internalized self-objects relations, etc.".

The hollowed-out transference: This is the transference of the primal seduction, impossible to represent, the result of the 'enigmatic message' that comes from the mother. This message leaves its impression, a sort of inscription under the skin that cannot be elaborated, and it leaps into existence from the first encounter with the mother.(2004, p.847)

To these two types of transference proposed by Laplanche, she adds a third kind: matricial space transference, which is associated with a matricial position of the therapist – a notion Chetrit Vatine elaborates on the basis of her reading of Levinas's notion of femininity and his notion of the womb which, for him, constitutes an ethical space. This position, then, generates a matricial ethical space:

"By proposing the term matricial space, I wished to point toward this space, originated by the parent and/or experiences by the newborn to be there, at the very beginning of  any human life. In my view, this matricial space transference is evocated or created from the beginning of any analysis, and up to its end, by the very existence of the person of the analyst, defined as the one able to be responsible for the other, the one who is/has in him/her, a matricial space for the other, the ethical subject." (2004, p.847).

This is the space that the therapist offers the patient – a space into which it is possible to project primal anxieties as well as other feelings and sensations which the patient is unable to tolerate and digest himself.  The person comes to the therapist with a primary pre-disposition, with a wish to project intolerable contents onto the therapist. The first thing that will thus be projected to this place in the therapist that is already prepared for containment, the site of this primal containment, will be associated with the patient's death fears. Bion describes this in terms of the mother-infant relationship:

"Normal development follows if the relationship [between] infant and breast permits the infant to project a feeling, say, that it is dying into the mother and to reintroject it after its sojourn in the breast has made it tolerable to the infant's psyche." (Bion, 1967, p.116)

The infant is born with a pre-conception of the breast that can contain it and the feelings it is unable to contain itself. The primary therapeutic position enables an unconscious agreement to undertake the realization of this primary pre-conception as it is expressed by the patient. Offering this space for the patient's projections, the ethics of this act is attended by risk and self-sacrifice on the part of the therapist. The emotionally intense materials that are projected onto him threaten to hurt him. Indeed, feelings and sensations can act like a Trojan horse (Pazuelo 2007) which may injure him if he does not know how to digest them by means of his Alpha function.

Practical Implications of the Theory: Interpretation That Safeguards the Otherness of the Other
‏Having considered the ethics of the therapeutic encounter, and given the ethical key role that Levinas attributes to safeguarding the otherness of the other, we must ask ourselves how we may preserve this otherness in the clinic. Two processes occur side by side in the course of clinical work: containment and interpretation. The ethical choice in the process of containment consists of the therapist taking the unconscious primary containing position which I discussed above.  But taking it, alone, does not suffice however. How can the patient's otherness be safeguarded at the stage of interpretation? As speech is always subject to the discourse of the same, this cannot be fully achieved. Interpretation itself, in addition, relies on a theory that subjects individuals to a sameness that threatens to obliterate them as such. I would therefore like to make some suggestions that are aimed to preserve otherness as much as possible:

  • Avoid giving an overly fixed, absolute, closed and hermetic name to the patient's contents: The attempt to translate everything that is unknown into the fully known is an erasure of otherness in the name of the already known and familiar. In Badiou's words: "Every absolutization of the power of troth orgenazes an evil (2001, p.84).  A new patient told me, during our first meeting, that I must not tell her what she feels. Other therapists before me tried and it was insufferable to her. Even when what they say about her is right, her sense of erasure is intolerable: "If you know too much and you are sure – I will be erased," she said.
  • Leave the question open: We must leave the question open to the otherness of  the patient, for his O. (Bion 1962)notion of consistency may be helpful in this context. He defines it as follows:

"consistency is the engagement of one's singularity (the animal 'some-one) in the continuation of the subject of true . Or again: it is to submit the perseverance of what is known to a duration peculiar to the not-known" (Badiou, 2001, p.47).

In regard to Lacan's ethical command: "do not give up on yur desire", which is a component of the unconscious, Badiou says that you must "not give up on that part of yourself that you do not know" (p. 84). We must firmly hold on to the special way in which the search for truth captures us. My understanding of the notion of consistency is the therapist's effort to keep the patient curious, vital, interested in everything that concerns his own life and the way he explains himself to himself and to the therapist. Here Bion's reference to Blanchot is appropriate: ‘La réponse est le malheur de la question’ ("The answer is the misfortune of the question") (Bion 1994b, p.307). What we are talking about, therefore, is a containment that does not contain all, and an interpretation that does not undo the otherness of the other and leaves it open to a question, to his otherness, to what is not known to himself.

    •    Point out what is unknown but is considered known: So much of what the patient says is unknown even though he speaks it as though it were known: things that other people did in the therapist's absence, what will happen to him if he gets the new job or – alternatively – if he doesn't, what is finite in his life and what is infinite, what does he perceive as possible and what as impossible. The patient, on the other hand, due to the mechanism of massive projective identification, feels he knows what the therapist feels about him and experiences it as true reality. I found myself interpreting these sites as forms of inverted interpretation whose role it is not to add knowledge but rather to show the existence of a presumed knowledge which in fact does not exist. By pointing out the unknown I try to help the patient distinguish between his illusions, fears about the future, and projections onto other people , and a reality which always includes an element of unknowing. When I become aware of this type of knowledge, which has no foundation in reality but originates in projections from the patient's internal world I try to unsettle this knowledge and to explain its role. Bion, discussing the expression "a terminal cancer patient"  has a beautiful illustration of this:

"(…) terminal cancer: you only have to think about it to realize what a ridiculous phrase it is. How do they know it is terminal? Terminal of what? What is the end point of? (…) what we are concerned with is living people and if there is a job to be done for making the lives of people in a particular ward bearable for such time as they have to live, then there is something to be done. That has nothing to do with "terminal cancer"; it has to do with making such life still to come, still left over, still "in the bank" so to speak, tolerable and available, and finding a method by which patients can be given a chance of getting onto that wavelength where you bother with what can be done and don't bother overmuch with what you can't do." (Bion, 2005, p.15)

The expression "terminal cancer patient" refers to an unknown future. Knowledge of the end, "the terminalness of the cancer patient", is not a fact in reality because it relates to the future.  Thinking of the patient as terminally ill and hence untreatable is a despairing way of thinking that does not allow us to treat what can be treated. Such thinking is a defense against O which embraces the unknown future.

Relate to the patient's interpretations of the therapist: Rather than being a way of imposing a mode of living on the patient, therapy is a verbalization of an emotional experience occurring in the clinic, a verbalization which the patient will use as best he can. "He [the patient] is faced with the choice of whether to use the interpretation to further his own development or to waste it by ignoring it, or using it in an external situation" (Symington, 1996, p.37) If the therapist expresses the truth as he understands it without imposing a course of action or to subject it to anything that resembles it, this leaves space for the patient to use it as best he can:

"Verbal expression must be limited so that it expresses truth without any implication other than the implication that it is true in the analyst's opinion." (Bion 1965, p.37).

Further, we read Grotstein's testimony of his own therapy with Bion and find how emphatically Bion made sure that the patient should be aware of his own emotional response to the therapist's interpretation:

"Yes, a beautiful interpretation, you say. The snag is that my 'beautiful interpretation' was made possible only by virtue of your 'beautiful associations'. You were so keen on listening to me that you neglected listening to yourself speaking to me." (Grotstein 2007, p.30).

Bion's intervention, here, lays bare his special way of relating to idealization as well as his insistence that the patient listen to himself, experience himself as both listening and speaking in the course of the therapeutic experience.  The patient is supposed to live the interpretation and to contain it as best he can.  Thus he lives the truth that resides in him, and thus, in fact, he lives.

Interpretation from K to O as Safeguard of the Patient's Otherness

For Bion, interpretation is a type of transformation, and transformation, according to him, is transformation of K, of knowledge.  Still, near the end of his book Transformations he writes:

"If I am right in suggesting that phenomena are known but reality is 'become', the interpretation must do more than increase knowledge" (Bion, 1965, p.148).

If reality is becoming, it is our task as therapists to help our patients to become, to be more in the reality of their life.  For Bion, there is a type of interpretation that is not merely additional knowledge but that transforms. The transformation is from a state of knowing to a state of being. More than adding knowledge, this interpretation conveys a shift from a state of accumulating knowledge to one of "being becoming".

Example: A patient recounts a dream in which he is at home when he hears – how, it isn't clear – that his father has been in a public lavatory in the park for some hours unable to come out. It turns out that the father has grown senile and cannot find the exit. The patient awakes with huge anxiety which he describes as fear for his father's life.

From his associations it emerges that he has felt worried about his father and frustrated by being unable to help him. "In the dream," he says, "Each of us separately felt frustrated". Because his anxiety could not be contained in his sleep, the patient awoke.  After he awoke, he did some work-related things on his computer. His partner woke up two hours later and got up for a drink of water. She was surprised to see him awake and he told her he had woken up and felt a need to work. He did not mention the dream. "Now you will say that I went to work because that's where I feel less helpless," he told me.  "That's true," I said, "and the question is whether you can feel helpless facing your partner and whether you can feel it when you're facing me or whether, alternatively, you're doomed to remain alone with your helplessness and to assume that the other, too, will be helpless with regard to his ability to help you, just as you were with regard to your father in the dream."

The containing of the anxiety arising from the helplessness associated with the dream and making the hard-to-digest dream content more accessible through interpretation, both illustrate how interpretation can help a person to encounter his otherness.  This interpretation, raising the patient's awareness of his anxiety about being unable to help and be helped by his loved ones, once available may help the patient to grow, to take responsibility and to be more aware of this difficulty.  Bion argues that an interpretation that causes transformation from adding knowledge regarding one's reality to having more presence in one's reality, has the potential of making the patient a more mature person:

"Change from K to O is a special case of transformation: it is of particular concern to the analyst in its function of aiding maturation of the personalities of his patients." (Bion, 1965, p.158)

Awareness of difficult psychic problems, of the emotional expressions of O, makes the patient not only more mature but also more responsible. Bion discusses responsibility when he address the difference between becoming O and knowing about O. While the first is a link of knowing (K) about O (K O), the other is associated with psychic change resulting from an encounter with O:

transformation in O.

Transformation in the wake of an encounter with O, Bion argues, brings responsibility and maturity:
‏Psycho-analysts may find what I have said about theories of causation in the context of transformation, as it exists in knowing about and becoming O, more familiar if they remember how big a part is played in analysis by maturation because maturation involves being responsible. (Bion 1965, p.155)

By not aiming to add knowledge this interpretation from K to O safeguards the patient's otherness.  Though it does, obviously, add knowledge, this is not its objective.  Through such interpretation the therapist exposes the patient to his own O as he understands it at any given moment. He opens himself to his own otherness, to the emotional fact which is, as yet, unknown to him. Rather than erasing otherness, such a process opens up to it. It will always be there as part of the other's psychic reality. It is there much like the unconscious is present as internal otherness within each and every one of us. When the unknown becomes known the patient takes – or, at least, can choose to take – responsibility for this part. And taking responsibility is the maturity which Bion mentions.

This maturity is reminiscent of Levinas's approach to the moral demand that Jewish faith poses to its believers.  Indeed, Levinas calls the Jewish faith a "religion for adults" exactly because of the type of maturity and responsibility for others which it commands (Levinas, 1989). And thus we see how both for Bion and for Levinas the movement away from the familiarity of the same to infinite otherness, to O – in Bion's language – is associated with responsibility for psychic truth and for the other. Should we then conclude, as Marcus (2007) argues, that it is the aim of psychoanalysis to help the patient advance to a state in which he is both more moral and more mature and able to take responsibility for himself and the other? Though I have much sympathy for this line of thinking, the danger is that it may turn psychoanalysis into moral doctrine, and this is bound to reduce both the therapist's and the patient's freedom in the clinic.  Another problem of this approach would be the guilt which is integral to it. The patient, so long as he has not completed his therapy, is always guilty for not being moral enough. Most patients start therapy with more than enough guilt as it is and are actually hoping to be released from at least part of it. It is hard to see how a therapy that regards them as guilty by definition could help them.

Openness to Otherness as Reflected in the Therapist's Mode of Mental Conduct

We have seen that interpretation aims to help the patient encounter his otherness, the emotional truth which he obeys but which he is unable to face because it is too frightening or too shocking. To achieve this interpretation, the therapist must connect with the patient's O, and this he does by means of being in a state of reverie. Subsequently, he will try to subject the sensations and feelings arising from the encounter with the patient to interpretation.  Here I would like to present a distinct mode of reverie which I experienced during certain sessions when I sensed a particularly massive projection of emotional contents from the patient. Initially I made use of note-taking in the course of the session. This writing answered questions like: What does the patient say? What are my sensations regarding his words? What thoughts are passing through my mind about the feelings I just had? Is there any other thought or feeling related to this latter feeling? And: Can I formulate – as a result of what I just underwent – a hypothetical interpretation for the patient? I tried to keep track of my thought in so far as it yielded uninterrupted stretches. The patient's talking often caused me to drop one line of thought and resume somewhere else. To begin with, this type of work is very strenuous, but with time a degree of routine develops.

Example:

Here I shall present this mode of working. What follows is the result of some processing for the sake of this presentation but things were neither experienced nor originally written down in such an orderly fashion. Parentheses refer to my explanations of the thoughts I noted down.

The patient describes a professionally successful event (This is what the patient is saying). He tells me things that cause me to admire him (These are my feelings about what he said). I do admire him and he does need my admiration (My feelings and thoughts at my initial sense of admiration.)  I admire but feel protected and guarded. Both of us are safe and guarded: He causes me to admire him and I admire (More thoughts and feelings I have about admiring). He is protecting us from a certain feeling, a sense that he is unloved (I assume on the basis of earlier knowledge). He is making such an effort, he is so unloved, I feel sad. How to tell him? (Now I am already flooded with a sadness which I want to return to him; I am unsure that it's the right time.) He goes on to describe how he went and got drunk on his own after the event. I say, because he suddenly felt alone and unloved. He accepts my comment. (Could I have gone on to ask whether that's what he feels like here and now, too? It may have been the better thing to do yet the sadness and loneliness he felt before he went out to get drunk was so inaccessible to him that it seems right to direct his attention there.)

What I went through with regard to the things this patient said is a process of observation and opening up to the otherness within me in order to find my patient's O, his emotional truth. It is a reverie process which, though not absolutely open, moves firmly and as directly as possible towards an openness whose content is unknown. This movement includes: linear progress from a certain moment in the therapeutic hour where my attention was split between what the patient was saying, sensations and associations arising in me in response, a question regarding these feelings, and the same all over again.  The fact of the patient's presence, his talking or not talking, directs my sensations as well as my examination of these feelings until I find something associated with the patient and the therapeutic session which explains to me what's happening in the clinic or in the patient's psyche, and this then leads to an encounter with the patient's emotional truth.

Conclusion

I have tried, in this article, to formulate the ethical component of the therapeutic act with reference to Bion and Levinas.  Three key notions open the door of psychoanalysis and bid Levinasian ethics to enter:

The first of these is the notion of the unconscious, which by definition always remains open to examination, thereby revealing the infinite within the individual. I made an effort not to situate the unconscious with either patient or therapist: I believe it is experienced as present by the one and the other. I compared Bion's notion of infinity, which he refers to as O, to Levinas's. While each defines the concept in accordance with his theoretical enterprise, the most apparent difference between them is in the fact that Levinas uses it to formulate an ethical theory while Bion constructs a scientific theory.

The second notion is that of containment and its connection to Levinas's notion of hospitality. Here I tried to present a complex dialectic in which the patient commands the therapist to take responsibility for him, yet as soon as the therapist takes the role of hosting, the patient operates a type of transference that makes the therapy possible. I also showed that while containment is not of infinity, this does not make it redundant: rather it spurs on the therapist to contain as best he can what cannot be contained. While containment is not of infinity, infinity is part of containment nevertheless for if this were not so, what we would have here would be a case of containment of the same and not of the other.

The third key notion is floating attention, which demands full exposure to the other for the sake of containing him.  This is reminiscent of Levinas's notion of disappropriation for the sake of receiving the other.

I showed, by means of a clinical vignette, the manner in which the therapist's thinking – by always being as open as possible to its own otherness – allows him to think about the patient's otherness and helps to show this otherness to the patient by means of interpretation.
‏The danger of the encounter between Levinas's ethics and psychoanalytic theory is that psychoanalysis may, as a result, become a praxis with a moralistic ethical doctrine thus reducing its unique freedom of thought and association. Another tendency of ethical praxis is to become persecutory –which we should also avoid.

It would be very appropriate to juxtapose Levinas's work to that of other psychoanalytical thinkers, and the first that comes to mind is Laplanche. In this article I mentioned some aspects of Laplanche's work that touch upon Levinas's thinking but there is room for further exploration in this context.
‏With Bion I believe that a good theory is an efficient theory that helps us to continue thinking. Introducing Levinas's philosophy to the domain of psychoanalysis, it seems to me, is indeed thought provoking where it comes to issues like ethics and otherness in psychotherapy.

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