International Forum of Psychoanalysis.

2008; 17: 221231

ORIGINAL ARTICLE

‘‘Can you whistle?’’: The grammar of ‘‘living through’’ in

psychoanalytic child psychotherapy

EYSTEIN VICTOR VÅPENSTAD

Abstract
The psychotherapist’s or psychoanalyst’s subjectivity is an important topic in modern psychoanalysis. In child
psychotherapy and psychoanalysis, the therapist’s subjectivity can play a central part, first of all as a receptive and
understanding organ, but it can also take a more active role. This can be the use of self-disclosure or an active interaction
with the child in what the author calls ‘‘living through.’’ Living through consists of the constant influence, interaction, and
mutual dependence between child and therapist, and of the ability, or necessity, to bring the results of this relational
phenomenon explicitly into the therapeutic exchange. This is especially important with severely disturbed children because
these children will project heavily into the therapist, and inevitably the therapist must fail to contain all of what he or she is
exposed to from the child. Severely disturbed children often cannot endure the mental work entailed in making use of the
therapist’s interpretations, and therefore it is important that the therapist can live through the difficult situations which often
arise in therapy with these children. The child is affected by the relation to a struggling therapist and will therefore also be a
participant in living through.

Key words: Therapist’s subjectivity, self-disclosure, relational psychoanalysis, living through, therapist’s error

This paper is an attempt to describe how the
child psychotherapist’s subjectivity plays a central
part in child psychotherapy. This is illustrated by a
child psychotherapy case where a certain type of
self-disclosure was used and by introducing a new
concept called ‘‘living through.’’
The use of self-disclosure as an expression of the
therapist’s subjectivity in child and adolescent psy-
chotherapy has received little attention in the litera-
ture. Even a recently published book (Altman,
Briggs, Frankel, Gensler, and Pantone, 2002), based
on the relational psychoanalytical tradition, which is
otherwise quite positive to the use of self-disclosure in
the treatment of adults, does not specifically mention
therapists’ self-disclosure. In one of the very few
articles on this subject, Gaines (2003, p. 569) claims
that the ‘‘child/adolescent therapist makes extensive
use of him or herself in clinical interactions.’’ But
Gaines concludes that this ‘‘aspect of work with
children and adolescents has received scant attention
in the clinical literature’’ (p. 569). The main reason
for this, in Gaines’ opinion, is that child therapists of
a psychodynamic orientation are still using an old
Freudian model of technique where neutrality, ab-
stinence, and anonymity are the cornerstones, while
their colleagues, the adult psychotherapists, have
experimented extensively with a more expressive
use of their own experience (Aron, 1996; Bollas,
1983; Ehrenberg, 1992; Renik, 1999). One reason
for the scarcity of literature on this subject can be that
the child psychotherapists’ use of self-disclosure is so
common that there is no need for discussing it in the
literature. Another and maybe more plausible reason
for this lack of attention is the very complicated
nature of the phenomena of self-disclosure. In adult
psychotherapy as well as in psychoanalysis, self-
disclosure has proved to be a very provocative topic
which has generated rather heated discussions (Aron,
1996; Gediman, 2006; Greenberg, 1995; Jacobs,
1999; Mills, 2005; Våpenstad, 2003).
Self-disclosure as an expressive use of the thera-
pist’s subjectivity is a very complicated phenomenon
that has been discussed extensively in recent psycho-
analytic publications on adult psychoanalysis (Aron,
2006; Gediman, 2006; Orbach, 2007; Renik, 1999;
Zeddies, 2000). One of the main points is that it is

Correspondence: E. V. Våpenstad, Psy.D., PO Box 7217 Majorstua, 0307 Oslo, Norway. Tel:
47-95-72-52-72. E-mail: vaapenst@online.no

ISSN 0803-706X print/ISSN 1651-2324 online # 2008 Taylor & Francis

DOI: 10.1080/08037060802031694
222 E. V. Våpenstad
impossible to avoid revealing something. The myth
of the analyst as a completely neutral observer is left.
But this does not mean that the analyst or therapist
always should deliberately disclose something. The
new view of the analyst/therapist as a participant in
an intersubjective relationship to the patient demon-
strates that his role and interventions are mainly
context dependent and ambiguous. For instance, if
the therapist chooses to disclose something to the
patient, he will at the same time conceal something
else. Furthermore, are we as therapists completely
free from unconscious motives, or can we know
them in advance? Self-disclosures can turn the
therapy around and place the therapist into the
role of the patient, thus making a mess of the
transference. But it may be the one and only factor
that can cause a stalemated therapy to get going
again, and it can also become a powerful incentive
for some patients to learn more about themselves
and the impact they can have on others. In the
modern view, transference is always within a context
created jointly by patient and therapist, and the
analysis of this transference is closely related to the
analysis of the countertransference, which some-
times involves the expressive use of the therapist’s
involvement and experience (Aron, 1996; Bollas,
1983; Hoffman, 2006).
In this paper, I want to describe the use of one
particular type of self-disclosure which I think can be
therapeutic, especially in the treatment of severely
disturbed children often described as borderline or
borderline psychotic (Alvarez, 2000; Lubbe, 2000).
This kind of self-disclosure is characterized by its
close relationship to the therapist’s ongoing struggle
in the countertransference and can therefore also be
termed countertransference disclosure or expressive
use of the countertransference (Bollas, 1983). It
is an expression of the therapist’s struggle in his
relationship to the patient and to himself, and it is
one particular way in which the therapist’s subjec-
tivity becomes a focal point in the therapy. With
borderline children, the therapeutic relationship can
be very demanding and a challenge to the therapist’s
psychoanalytic attitude and neutrality. I will try to
illustrate my point by giving an extract from a
psychoanalytically oriented child psychotherapy.
Living through
In severely disturbed children functioning on a
borderline level, the projections used by them can
be quite difficult for the therapist to handle. These
children often need the therapist to carry their
projections for a long time and not to interpret too
early or too deeply. The therapist’s main task during
most of the therapy is to be able to stand in the line
of fire and try to think about what is going on in
the child, in himself, and in the relationship. The
borderline child is in urgent need of communicating
its desperate inner state to someone and that
this someone can contain and transform these
primitive yet powerful communications. This was
first described by Bion (1962, 1965) and was later
further elaborated upon by many writers in the
Kleinian tradition (cf. Alvarez, 1997; Joseph, 1987;
Money-Kyrle, 1977). Bion’s main contribution was
that he made us understand that these projections
and projective identifications not only were the
patient’s way of getting rid of certain feelings, but
also represented the patient’s need for the therapist
to feel their feelings and to try to understand and
transform them. Bion (1962) pointed out that it is a
normal need of the human infant to be in close
contact with a mindful mind which is able to contain
its communications. One revision of Bion’s descrip-
tion of the container and the contained is made by
Alvarez (1997) in her description of how these
emotions, communicated by the patient in this
way, are emotions that the patient needs the thera-
pist to have on behalf of the patient. The patient
needs to explore these emotions in the therapist
(Joseph, 1987), maybe for a long time, before he or
she can take them back and make them his or her
own. Pick (1992), referring to Bion, describes how
patients who have had a bad object will, when
coming to a good object, tell the good object how
the bad object was experienced.
The containing process can make great demands
on the therapist. The challenge is, on the one hand,
the balance between neutrality and nonintrusive-
ness, and on the other, the opening for the patients
to explore the experience of their own feelings as
they take place in the therapist. To help the
therapist deal with this, Alvarez (1997, pp. 755
756) suggests a ‘‘move from a grammar of explana-
tion to a grammar of description.’’ By this, she
means that borderline children often cannot endure
the mental work entailed in making use of the
therapist’s interpretations about what lies behind
their behaviour or their feeling state. The border-
line child is in an urgent, single-minded state where
its experiences are concrete and the room for
thought and reflection is minimal. For a borderline
child in such a state, the experience is not about
something else (i.e. a desire for omnipotence), but
is a need for (maybe never experienced) potency
(Alvarez, 1992). In the grammar of description, the
therapist is more interested in what the patient is
bringing and needing at the moment than in telling
the patient what this is ‘‘really’’ about. This point
has also been described by the Italian analyst
Antonino Ferro (1999, 2002).

My suggestion, based on the move from the
grammar of explanation to the grammar of de-
scription, is that we can move even further and try
to describe the concrete interaction between the
child and the therapist as the grammar of ‘‘living
through’’ or the grammar of ‘‘doing live.’’ By this,
I mean that the therapeutic work with borderline
children (and maybe with other children and
adults to) must be done jointly by the therapist
and the patient. They must both carry out the
work of development and change. It is not always
possible to find out who the actual feeling belongs
to or where it originally came from, and it is not
always possible to distinguish between, or find out,
when the feeling left the therapist (in a trans-
formed way) and when it entered the child. This
process goes back and forth, and I think it can be
helpful to think about this as a joint venture where
the therapeutic development lies in the experience
of doing it live or together living it through. The
child and therapist are doing it, rather than talking
about it, and this means that the therapist also
must be willing to change in some way. I think it is
possible to find support for this line of thought in
the book Live Company by Alvarez (1992). In this
book, Alvarez emphasizes that containing certain
developmentally necessary projections is ‘‘living
through’’ with the patient and bringing life to
areas in the patient where psychic deadness pre-
vails. In the 1997 paper, Alvarez calls this ‘‘over-
coming.’’
I think that when we speak about the therapist
experiencing the patient’s feelings, we are (at least
sometimes) talking about this way of living
through. In this way, it resembles what Pick
(1985) describes as working through in the coun-
tertransference. It will often start with the therapist
feeling something inside himself, but living through
means that sooner or later it will enter the
relationship. And we know that the therapist often
becomes aware of his countertransference while it
is being enacted (Money-Kyrle, 1956). If a projec-
tion is really felt, the patient will be able to register
its impact on the therapist (Carpy, 1989; Pick,
1985). Most of the transformative work is done
inside the therapist, but its therapeutic value often
depends on the way the child and the therapist are
able to live through the projective and introjective
struggle together.
An important part of the grammar of living
through can be to self-disclose the therapist’s
countertransference. If this is done in a careful
and honest way, it may for many of these children
be the first time they experience a genuine human
relationship. What many of these children remem-
ber from their therapies is how they came in
The ‘‘living through’’ of child psychotherapy 223
contact with an authentic and personal side of the
therapist. A borderline child will not only feel
triumph if the therapist, for instance, reveals his
shortcomings and doubts, but for these children
such a revelation can also be a developmentally
needed contribution of something authentic and
real. Many of these children know too well how
adults deny and externalize what is obvious in
themselves and in the relationship to the child.
Such a self-disclosure can show the child that the
therapist is both moved by the relationship and has
struggled with the patient’s projections, that the
therapist has come through the struggle with some
scratches, but has survived and is now able to talk
with the child about it.
The therapist’s subjectivity
The child psychotherapist needs to find his own
personal style grounded in his experience and
recognition of the difficult, ambiguous, and demand-
ing nature of child psychotherapy. The therapist
should let his work be less governed by technical
restrictions. The therapist’s interventions should be
guided by his ability to contain and understand. The
question of right or wrong is a relative one and
cannot be answered without taking into account the
actual therapeutic relationship here-and-now. The
one thing that is certainly wrong is to refuse to reflect
or to stop reflecting on what the therapist is doing
and why he is doing it. There may be many and
complex reasons for this which we may only find out
after the intervention has taken place. This does not
mean that everything goes and that the therapist
can do whatever he wants or considers possible.
Obviously, maltreatment and abuse are strictly
prohibited. My point is that we should also be
open to the possibility that ‘‘standard technique’’
may be harmful, and that sometimes deviations from
the standard, for instance a self-disclosure, can be
the very factor that may save a child psychotherapy
and bring it back on track.
It is not a novel idea that a psychotherapist needs
to find his own personal style, but I think we need
to say something more about what this is and how it
can be done. What the therapist actually can do is
to prepare himself for the task. This is done through
reflection and the ever-present and ongoing struggle
with the hermeneutic interpretation of himself, his
profession, theory, technique, and relationship to
patients, both in general and in particular (Binder,
2000; Reeder, 2002). This preparation is carried
out not only in advance, but also in the course of
the therapist’s ongoing effort to become an under-
standing and developmentally good object to his
patients.
224 E. V. Våpenstad
The relational view
The relational movement emphasizes that the psy-
chotherapist should not be superhuman, but suffi-
ciently good to contain and handle the patient’s
projections and communications, both normal and
pathological (Jørgensen, 2006). This means that
the therapist will be able to work with his inevitable
mistakes and their relational meaning, and some-
times feel free to communicate about this to the
patient (Benjamin, 2004).
The therapist’s participation as a subject is in-
evitable. The therapist’s subjectivity should not be
cleared away but used as an important therapeutic
tool (Aron, 1991; Mitchell, 1993; Renik, 1993). The
therapist’s subjective experience is influenced in
many ways by the patient’s nonverbal communica-
tion and transference. This can be used to under-
stand the patient more deeply. The therapist’s
personal involvement is not an obstacle, but is of
vital importance to the true understanding of the
patient. Aron (1996) says that the therapist’s per-
sonality, his subjectivity, human qualities, and ways
of relating to the patient are decisive in the treatment
of severely disturbed patients.
The relationalists are also concerned with the
problems raised by this view, which can easily be
misused or misunderstood to mean that anything
goes as long as it comes from the therapist’s
subjective experience. Hoffman (1983) issues a
warning against such a simplification of the ther-
apeutic relationship and the therapist’s contribution,
because it may draw the therapist’s total personality
into the therapy in the same way as in other intimate
and personal relationships. This would require the
therapist to be superhuman, in terms of having to
avoid an acting out or re-enactment of his own
neurotic parts, and transferring the dynamic focus of
the therapy to himself. Hoffman warns that when the
therapist reveals his countertransference, it may put
too much emphasis on his conscious experience and
neglect the therapist’s resistance to what is uncon-
scious. Such disclosures can create an illusion that
the ambiguity in the therapist’s attitude has been
cleared away and can restrict the patient’s possibility
to interpret the therapist’s state of mind in several
different ways. But Hoffman (1998, p. 129), in an
evaluation of his paper from 1983, states that:
I now believe that it is often useful to be open with
patients regarding one’s personal reactions in the pro-
cess. Such openness can facilitate identification and
exploration of enactments as they occur; it can help the
patient identify and take account of the analyst’s biases as
they affect his or her participation; and it offers the
possibility for a level of spontaneous personal engage-
ment which, in a dialectical relationship with psycho-
analytic discipline, has great therapeutic potential.
In child psychotherapy, the therapist’s personality
and subjectivity is at least as important as in adult
psychotherapy, but the dangers of a more active use
of the therapist’s subjectivity may also be greater. On
the one hand, a child will challenge and provoke in
the therapist many of his or her more private aspects,
and on the other hand, a child is also more in need of
protection from a therapeutic relationship where the
child could become responsible for making sense of
the therapist’s experience. Gaines (2003) argues that
children have difficulties understanding that the
therapist is professional and will therefore act
as though the relationship were real. Gaines there-
fore thinks that the child psychotherapist must be
prepared for a more self-exposing way of relating to
his patients. This does not mean concrete verbal
disclosure of personal information but a more open
way of participating. The child psychotherapist often
takes actively part in play, revealing parts of himself
through his actions.
A child psychotherapist must evaluate how his
subjectivity impacts the child and their relationship.
He must know that the child’s resistance can also
be against the therapist’s unconscious psychology
(Wolstein, 1983). But just as children will try to
know more about their parents’ unconscious, so will
the patient try to explore the therapist’s moods and
motivations, and if the parents or the therapist can
permit this, it will also increase their own self
awareness (Loewald, 1986).
Renik (1993, p. 564; original italics) says that
psychoanalysis should be ‘‘a theory of technique that
accepts the analyst’s constant subjectivity, namely,
that unconscious personal motivations expressed in
action by the analyst are not only unavoidable, but
necessary to the analytic process.’’ And Renik continues
by referring to Boesky (1990), who states that: ‘‘If
the analyst does not get emotionally involved sooner
or later in a manner that he had not intended, the
analysis will not proceed to a successful conclusion’’
(p. 573).
The Kleinian and independent view
Both Kleinian and independent psychoanalytic wri-
ters support the view that enactments are unavoid-
able, and that the therapist’s subjective involvement
can be useful in the therapeutic process. Casement
(2002) is explicit about how the therapist can use his
mistakes to the benefit of the treatment. Hinshel-
wood (1999, p. 814), in Kleinian terms, says that:

The role he [the analyst] experiences in the counter-
transference is not just a matter of professional compe-
tence, it is also one of personal identity: what conscious
and unconscious role is he entering into with his patient?
He strives to be an analyst; yet he plays a part in his
patient’s phantasies; and, in addition, he has his own
conscious and unconscious phantasy life that he plays
out with his objects.
Feldman (1997) goes on to say that the analyst
cannot avoid a certain degree of enactment, but in
order to understand what is happening, he can
hopefully and, at least temporarily, extricate himself
from it. Carpy (1989) maintains that it is important
that the impact of the patient’s transference on the
analyst is visible. Pick (1985) says that the counter-
transference will be acted out in one way or another
if the patient’s projections are thoroughly experi-
enced by the analyst. The Kleinians encourage the
analyst to keep an eye on how his or her own anxiety
and defense mechanisms contribute to the interplay
between patient and analyst.
Likierman (2006) makes a good point when
stating that what is projected in projective identifica-
tion is not an objective entity, something taken from
the patient and placed into the therapist. Likierman
describes projective identification as a very evocative
way of communication which will touch the therapist
on a deep and unconscious level. The feelings stirred
up in the therapist are not placed there, but are the
therapist’s own feelings evoked by the relationship to
the patient. The therapist cannot feel the patient’s
anger or grief directly, but can understand more
about the patient’s feelings by coming into closer
contact with his own anger or grief.
Alvarez (1996) does not underestimate the pro-
blem of the therapist’s overreaction to the patients’
projections, but she points out that underreac-
tion too may become a technical problem. This
problem has also been addressed by both Coltart
(1986) and Symington (1986) from the independent
tradition. Alvarez (1992) introduces the
term ‘‘reclamation’’ to describe how she thinks the
therapist must conduct the treatment of severely
disturbed children. Reclaiming the child also means
being a real object in the external world and actively
engaging the child in the relation to the therapist. It
also means standing up against obvious destructivity
and being explicit about the moral rights of the child,
as well as actively showing an interest in the child.
Alvarez calls this being an auxiliary id for the child,
carrying the child’s sense of being alive.
Living through depends on the therapist’s subjectivity
As mentioned earlier in this paper, I think it is
important that patient and therapist should ‘‘live
The ‘‘living through’’ of child psychotherapy 225
through’’ the therapeutic struggle, and that thera-
peutic change comes from the immediate relational
exchange of projections, transformations, introjec-
tions, feelings, and experiences. For instance, the
therapist must carry the confusion provoked in him
by the patient, but the therapist cannot do this only
at home or alone; it must be done in the consulting
room in the presence of the patient and, in some
way, in cooperation with the patient. Not in the sort
of cooperation which we call symmetrical, but in
mutuality. My point is that the patient needs to take
part, and will inevitably take part as the originator of
the projections, in the therapist’s struggle. When the
patient observes the projection having its impact on
the therapist, the patient is not only an observer, but
also a participant*in the same way as modern
psychoanalysis has moved the analyst from an
exclusive observer position to a role of participation.
The patient cannot be completely unaffected by the
relationship to a therapist who is struggling to
contain what has arisen in the therapist as a result
of the transference.
This living through together depends on the use
of the therapist’s subjectivity and the therapist’s
ability to create an arena for intersubjective explora-
tion of the therapist’s contribution, the patient’s
contribution and what is co-created in the thera-
peutic relationship.
Case illustration
I would now like to present an extract from a
psychoanalytically oriented child psychotherapy
with a 7-year-old girl whom I will call S. The therapy
lasted for more than 4 years with sessions three times
weekly. S. could be quite demanding and in the
transference act out many of her early experiences of
having been a traumatized child left on her own
while her criminal father was tormenting her mother.
She would sometimes treat me as though I were
some sort of chopping block which she could use for
her own pleasure, by stuffing amounts of plasticine
into my ears or throwing a ball repeatedly in the
direction of my head for the whole session, missing
only by some strands of hair. But she could also
search for closeness and become infantile and a very
needy little girl. Sometimes she would just lie down
on my couch, ask me to put the rug over her and
then immediately fall asleep. In many ways, she
resembled the children Lubbe (2000) and others
have described as borderline.
The patient’s most striking and perhaps most
challenging aspect was her constant demand that
I should tell her more about my private life. This
demand was put forward very intensely, and she
became difficult to handle when I did not answer
226 E. V. Våpenstad
her. She would scream or run out of the office, or
just not talk to me for the rest of the session.
She wondered if I had children of my own, where
I lived, if I had been to the same shopping centre as
she had the previous night, if I was in love with my
wife, what I thought about some television show or a
pop artist. Of course, I tried to analyse this by
suggesting what sort of fantasies she might have
about me, or by interpreting what I thought her
questions really meant. But her questions did not
stop, and their demanding quality made me think
that they might represent something more. My
attitude was not to answer her questions except
when it was obvious that she already had some
knowledge*for instance, she once saw me arrive in
my car, and in the car she could see a children’s
safety seat. After that, I thought it was right to
confirm that I had a blue car and that I had children.
But I did not answer her question about how many
children I had, their names or ages, or any other
detail. I usually said to her that I did not want to talk
about that with her and that discussing my private
life was not part of my job. She could become very
disappointed with me and protest against my reluc-
tance to provide answers. She told me very clearly
what she thought about me when I did not answer,
using quite harsh words.
Not surprisingly, S. could sometimes be very
unhappy about coming to her sessions and fight
with her foster parents when they tried to motivate
her to go to the sessions. Even so, she came to almost
every session using her own special taxi transport.
But the parents were very upset by her complaints,
which almost exclusively dealt with her dissatisfac-
tion with my reluctance to answer her questions
regarding my private person. Once the parents took
this out on the parent-worker, demanding that this
experienced colleague should call me and make me
understand how important it was for S. to know more
about my private life. The pressure was so strong that
the parent-worker called me immediately after the
meeting with the parents, suggesting that I should tell
S. only a little bit*just to make them all happy.
The episode I want to describe in detail occurred
almost 2 years into the treatment. One day, S.
arrived at her session and immediately asked me if
I could whistle. Her question was frank and direct
and she seemed genuinely interested, but I got
confused and did not know if I should answer the
question, or if I should try to understand what
she really meant by it. What should I say? The true
answer would have been: yes, I can whistle. How-
ever, I feared this would put me into a position where
she would command me to whistle increasingly
difficult tunes until I could not do it any more, and
then she would triumph and make me feel bad and
exploited. Or would this self-disclosure be too
private, which she could then use to make me tell
her more? So I was confused about what to do, and
when she asked me once more, ‘‘Can you whistle?!,’’
I answered that I could not, which I immediately
regretted, also because she then urged me to make a
try. ‘‘But try then,’’ she said, ‘‘it’s not so difficult.’’
I was lost, and my feeble attempts at pretending
that I could not whistle must have looked ridiculous.
She soon gave up and turned to something else*
probably very disappointed with me. I tried to
comment on her disappointment, but she did not
seem to listen or want to discuss it further.
I can remember my regret and thinking that this
had been a very stupid thing to do; I wanted to do it
right again, but I did not know how. Afterwards,
I thought that I had been afraid of doing something
wrong and that it would have been wrong to disclose
my ability to whistle, which I at the time probably
perceived as too private. I believe that somehow
I must have been influenced by her strong interest in
my private person, and that my terrible answer to her
about such a trivial matter as being able to whistle
came as an unconscious reaction to her previous
demands to know ‘‘all’’ about me.
The psychotherapy continued and was quite
productive in the following months. I looked for an
opportunity to talk to her about the whistling
question and to find out more about how she had
experienced that situation. But the opportunity
did not arise, and maybe both of us were somehow
afraid of taking another look at it. I was probably
afraid of admitting that my answer had been false.
But even so, the psychotherapy was productive in
this intermediate period. S. produced new and more
comprehensive drawings of families, and this gave us
the opportunity to explore and think about her own
background and her current situation. In this period,
she was more open and could stay longer with
difficult and problematic emotions and realities.
Although this period was productive, it was
not easy. After the whistling episode, I became
more aware of my hate in the countertransference
(Winnicott, 1949). And just as Winnicott said,
I looked forward to ending the sessions, and could
sometimes be very devoted to and absorbed by the
clock and ending the session on the exact time.
I think this hate also came from my own rigid
analytical super-ego and was just as much pointed
at myself for being so stupid with the whistling
episode.
In the period between the whistling incident and
the episode which I will soon describe in some detail,
S. and I avoided anything that could bring us in
contact with whistling. It was as if we had a silent
agreement not to touch this subject again before we

both were ready. For instance, she did not ask me
any questions about the pop charts, questions with
which she had bombarded me many times before.
This intermediate period of about 4 months was
also characterized by a therapist who could partici-
pate more spontaneously during play. I contributed
more to the family drawings, and when S. invited me
to have an idea about a family member whom she
had just started drawing, I felt free to create names,
characteristics, and relationships for the new family
member. S. liked this, and I think it contributed to
the creation of a new third area, or intersubjectivity,
between us.
Almost 4 months after the whistling incident, S.
arrived a little early at her session. My consulting
room is situated behind two doors. The first one,
which is always locked, leads to a small corridor just
outside the consulting room. Patients are not
allowed into the corridor unless they are accompa-
nied from the waiting room by a therapist. But on
this day the door into the corridor was open, and S.
had entered the corridor just outside the door to my
consulting room. There were a few minutes left
before the session was due to start, and I was
preparing the room. And while doing that, I whistled
a tune, unaware that she was standing just outside
the door. When the session was about to start, I
opened the door and went to get her from the
waiting room. Meanwhile, S. had just slipped out
into the hall, but I noticed that the door was not
locked. She was eager to start the session, jumping in
front of me through the two doors and into the
consulting room.
The atmosphere in the room was tense, and after
just a few seconds she said: ‘‘You lied!’’ I was a bit
surprised and could not figure out what she meant,
the session just having started. After a while I asked
her, ‘‘About what?’’ Looking at me triumphantly, she
said: ‘‘The door was open.’’ At last, I understood and
said, ‘‘So you heard me whistle.’’ ‘‘Mmhmm,’’ she
said. I then said that she remembered the session
where she had asked me if I could whistle and she
also remembered my answer, which she must have
experienced as confusing and foolish, so that when
she today heard that I was able to whistle, she was
even more confused and probably also a bit dis-
appointed with me. She agreed to that and started to
draw a family. However, after a while, she asked me
why I had not told her that I could whistle. I tried to
recall that situation and decided that I should answer
her as honestly as possible, even if it meant that I had
to reveal something that I would not usually tell a
patient. What I said to her was something like this:
‘‘You know, I think that at the time when you asked
me if I could whistle, I must have been quite
confused and didn’t know if it was right to tell you
The ‘‘living through’’ of child psychotherapy 227
that I could whistle. I think I was afraid that it would
mean telling you too much about myself, but after-
wards I realized that it had been wrong not to tell
you the truth.’’ She listened to my words and then
started to draw again; she wanted the family to have
another baby. I said that I thought she had also been
very confused about my bad answer in that session 4
months ago, and that she probably had lost a lot of
confidence in me. She said she wanted me too to
draw a family. In the next session, she asked me if I
was the kind of person who could read other people’s
minds. I asked her if she thought that this was what I
was doing to her. She nodded and went back to
drawing more families, only looking up to say, ‘‘You
too, you can also read your own.’’
Discussion
I think that this case history illustrates how a
therapist can put himself into a terrible position by
not being able to maintain an analytic attitude under
heavy pressure from the patient’s projective identifi-
cation. Hindsight tells us that it would of course have
been much better to just admit that I could whistle,
and from there continue with my attempts to
understand the patient’s interest in me and what
was currently going on in the relationship.
But why was I not able to tell the truth? I believe it
was a result of the patient’s massive projective
identification and pressure to put me into a stupid
position, my own lacking ability to contain her
projections, as well as my rigid super-ego which
could not accept, at that moment, giving her some-
thing personal.
As Money-Kyrle (1956) has described, two factors
may contribute to the analyst’s failure to understand
the patient in difficult situations. First, the patient’s
projections of unwanted aspects of him- or herself, a
process which can be quite intense. Second, the
patient’s projections correspond to aspects of the
analyst that are unresolved and not understood.
Money-Kyrle describes how the patient’s projections
can be a too heavy burden for the analyst, and that
his disability to understand can be experienced as an
acute failure in his function and identity as analyst.
Money-Kyrle suggests that the extent to which an
analyst is emotionally disturbed by the patient’s
projections and his occasional failure to understand
the patient is greatly dependent on the severity of
the analyst’s super-ego. A friendly and supporting
super-ego can help the analyst to tolerate his own
limitations and unavoidable mistakes, and enable
him to regain contact with the patient even under
great stress. But if the analyst’s super-ego is critical
and devaluating, it can give the analyst a sense of
failure and unconscious guilt feelings, which can be
228 E. V. Våpenstad
quite devastating for his ability to come forward as
an authentic and reliable analyst. The analyst may
also be very anxious of making mistakes, for in-
stance, by answering a patient’s question. The
analyst’s super-ego function can vary a great deal
depending on many factors both inside and outside
the therapy, and can usually not be regarded as
completely free from the analyst’s relationship to the
patient.
I think that in the treatment of S., I was
confronted by a severe super-ego which gave me an
unpleasant sense of failure and feelings of guilt,
shame, and confusion. But only by making this
mistake of not admitting that I could whistle, and
thereby putting myself and S. into this odd state of
confusion and ambiguity, could we move towards a
grammar of description (Alvarez, 1997) and even
further to a grammar of living through.
In the first episode, when I made the mistake of
trying to hide that I could whistle, I believe that S.
could sense my struggle and my weakness, and that
she could observe the impact she had on me. Carpy
(1989) suggests that the patient is helped by witnes-
sing the therapist’s struggles. At that point, and even
more in the 4-month period between the first
episode and the last one, where I disclosed my
confusion, she was not only witnessing, but also
participating in our living through of her projections
and their release in me of a critical and unfriendly
super-ego. This living through led to the discovery of
a more tolerant and generous self-care in the
therapist, and the patient started to develop a new
way of being with the therapist. She could also
understand a little more about herself and the
workings of her confusion and despair.
Frankel (2003) discusses how there must be room
for the analyst’s subjectivity in every treatment. But
this subjectivity is coloured by our analytic ideals,
what we have inherited from our education, analytic
society, and so on. Frankel calls this a pre-existing
analytic third. In some treatments, this pre-existing
third ‘‘require that we expunge our subjectivity from
view’’ (Frankel, 2003, p. 513). And Frankel goes on,
‘‘A submissive attitude toward the preexisting third
may result in our committing misdemeanors in an
attempt to salvage some feeling of psychic existence
in a treatment where we feel negated’’ (p. 513). I
think that my whistling mistake must be a classical
example of this type of error.
Frankel describes the development of an emergent
third which is mutually created by patient and
analyst. The emergent third should be a stance
from where an active and independent criticism of
the pre-existing third can develop. I think that the
emergent third depends on the ability to play
between patient and analyst, as Frankel says too.
But I also think that my concept of ‘‘living through’’
can cover, at least parts of, the emergent third.
I think we can see the emergent third in my ability
to participate in the playing and drawing of the
intermediate period. And I think it can also be a part
of the emergent third when I became more con-
sciously aware of my hate in the countertransference,
and that this hate had some co-created parts.
Because of her traumatic background, this was the
only way for S. to seek knowledge of the emotional
truth of certain emotional and relational areas.
My analytic super-ego, my pre-existing third, had
gone through some important change in this therapy.
My analytic ideals moved from a position of ortho-
dox theory, from a rigid view of right and wrong, and
to a more benign, tolerant, and personal style. I
became more open to what Aron (1996), Boesky
(1990), Pick (1985), and Money-Kyrle (1956) have
said about how the analytic treatment depends upon
the analyst getting emotionally involved in a manner
that he had not intended. This is not possible, and
maybe not even desirable, to prevent by trying to
influence the pre-existing third. It can only be done
by an emergent third, a living through of patient and
analyst together.
As Slavin and Kriegman (1998) put it, the analyst
has to change. This change means that the analyst
can find a different way to regulate himself, ‘‘one in
which we accept loss, failure, mistakes, our own
vulnerability’’ (Benjamin, 2004, p. 32). And Benja-
min points out that it can be therapeutic if the
analyst can communicate to the patient about this
change.
We may look at my mistake as merely an example
of terrible acting-out which should have been
avoided, but we may also see it as a way of being
human (Alvarez, 1996). It is human to be confused
and to make mistakes. Admitting a mistake can
sometimes increase the patient’s wish to be human
too, and not only increase the patient’s contempt. As
Hinshelwood (1999, p. 814) said about the analyst,
‘‘The role he experiences in the countertransference
is not just a matter of professional competence, it is
also one of personal identity.’’ It is this personal
identity which makes us human, and this is our
subjectivity, and it belongs in the treatment relation-
ship.
I think it is very important for the therapist to
hold, contain, and explore the impact of projective
identifications within himself rather than prema-
turely giving them back to the patient. But it is not
always easy to know when they have matured or
when the patient is ready to have his or her
projections returned. This is partly so because the
therapist is also a variable in the process of matura-
tion. The therapist’s evaluation of when he can try to

give back some of the patient’s projections or share
some of the effects from the projective identification
depends on the therapist’s subjectivity. And some-
times this maturation, or part of it, will take place in
the outside. Alvarez (1997) describes how difficult
feelings need to stay out there, especially with
patients who may have been very heavily projected
into. I think this may mean that when the therapist is
unable to contain the projections completely and
they are in the open, visible to both patient and
therapist, it is not only a failure of containing, but
can also be a reaction on the part of the therapist,
showing that maturation is actually taking place.
This is what I call living through.
Living through cannot come about if the therapist,
in failing to contain, projects back into the patient
too much of his own pathology, or a mixture of his
own pathology and what the patient has projected
into the therapist. But sometimes containing must
mean showing how the containing process pro-
gresses. With S., I was able to do that after I had
been working with shame and guilt for about
4 months. Most of this work was done in silence
and consisted for long periods in only being able to
recognize these feelings (including hate) and trying
to be mindful of them.
And after 4 months, and with the help of S., I was
able to think and reflect more deeply about my own
limitations and mistakes, and how they had con-
tributed to the state that our therapeutic relationship
had developed into. And hopefully, I was able to take
responsibility for bearing the pain and shame which I
had put us into. Benjamin (2004) describes this as
the development of a moral third between patient
and analyst.
Betty Joseph (1998, p. 364) said, in her famous
article on child psychotherapy, that there is a
‘‘constant interaction between psychotherapist and
child’’ and that this ‘‘couple constantly uncon-
sciously influence each other.’’ Ogden (2004) puts
this forward even stronger in his description of the
container and the contained when he says that
‘‘Container and contained are fiercely, muscularly
in tension with one another, coexisting in an uneasy
state of mutual dependence’’ (p. 1362). This state of
constant interaction and influence, of uneasy mutual
dependence, sometimes requires to be disclosed and
brought to the surface if patient and therapist are to
be able to work through and gain understanding of
the patient’s problems. Living through consists, on
the one hand, of this constant influence, interaction,
and mutual dependence, and on the other hand, of
the ability, or necessity, to bring the results of this
relational phenomenon explicitly into the therapeu-
tic exchange.
The ‘‘living through’’ of child psychotherapy 229
I think that this was what I was doing in the
second episode when I disclosed to S. my experience
from the first episode. By that time, the disclosure
was of course very much coloured by the work that
had taken place in me and between us during the 4
months that had passed from the first to the second
episode. And it was also coloured by the situation in
the second episode when she heard me whistle and
was able to bring up the subject in a way that helped
me reveal my confusion, problems, and regret. This
colouring was our living through of the situation
which arose when she asked me if I could whistle,
and probably also of our struggle with some of her
inner objects that had entered the transferential
scene.
My way of handling this was to disclose some of
my countertransference reactions and to try to
understand and share with S. some of what I
believed to be the reasons for my stupid acting out
when I tried to make her believe that I could not
whistle. I think we can find some support for this
intervention with Jacobs (2001). He puts forward
that it sometimes can be beneficial if the therapist
can admit his errors. Jacobs also describes how an
apparently correct technique can disguise a more
subtle form of error which the patient and therapist
together may selectively screen out. Often this is
about aspects of the therapist’s person, attitudes,
and behaviour, in other words his subjectivity.
Feldman (1997) describes how an analyst with a
comfortable, benign, and dispassionate involvement
can join the patient in an unconscious convergence
to defend against what can be difficult in their
relation, and thereby impede real progress. It is
important that we as therapists constantly try to
reveal to ourselves what is going on. But sometimes
this is not possible without some help from the
patient to make us experience our subjectivity
(Aron, 1991) and to live through the difficulties
and possibilities created by it.
To change is hard for the patient, but also for the
therapist. This change in the therapist, as Slavin and
Kriegman (1998, p. 281, original italics) say:
is far more likely to occur when our patients see what
happens when  tapping into the fault lines in our
identity, our conflicts  they take us someplace that is
obviously hard for us to go. But we go there and often
change in the process, because having a relationship with
them requires it . . . All the time, our patients provoke in
us (and read) the quality of our inner dialectic, our ways
of experiencing and resolving internal and interpersonal
conflict. And they assess its implications for renegotiat-
ing their selves in the context of indulging us to adapt to
them  and them to us.
230 E. V. Våpenstad
I would like to end this article with another
quotation. This one is from an article by Anthony
W. Bateman (1998, p. 23):
It is likely that, during analytic treatment, narcissistic and
borderline patients need to experience an analyst who
becomes entangled with their terror, who becomes
embroiled in subjectivity and objectivity, and yet is able
to survive. Only then can they be liberated from their
destructiveness, can their relationships prosper, and their
lives become worth living.
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Author
Eystein Victor Våpenstad, Psy.D., is in private
practice in child and adult psychotherapy in Oslo,
Norway, as well as being a teacher at the Centre for
Child and Adolescent Mental Health, University of
Bergen, Norway. He is an advanced candidate at the
Norwegian Psychoanalytic Association in adult and
child psychoanalysis, and a member of the Institute
of Psychotherapy, Oslo.