On knowing one's patient inside out: The aesthetics of unconscious communication∗1

Abstract

“Knowing one's patient inside out” is a metaphor that is intended to capture the paradoxical quality of the intersubjective field that we call the analytic relationship. The interface among trauma, dissociation, and regression is discussed in the context of unconscious communication as a transferential enactment of unsymbolized experience.The view is offered that for certain patients in particular, past experience is not so much unconscious as “frozen in time” and that a key element of the psychoanalytic relationship is bridging dissociated aspects of self through the creation of a dyadic experiential field that is both “inside” and “outside.” The writings of Michael Balint, D. W. Winnicott, and several other British object relational theorists are explored in the context of a contemporary interpersonal psychoanalytic perspective.

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