Slippery when wet: the imperfect art of interpretation

When pursuing a line of psychoanalytic interpretation, there are many factors that need to be considered. Interpretation is always a provisional exercise in which the analyst's proposes something to the patient to consider and then wait to see his or reaction. Whether or not the interpretation is correct is not as important as the patient's reaction to it. Does it cultivate insight, does it spur defensive reactions, does it feel helpful, does it leave the patient hurt or misunderstood, or does it aid the patient in facing their anxieties and exploring them in a way that might facilitate change? These are just some of the possibilities when analysts voice their opinions about what might be happening at an unconscious level in a patient's immediate experience. Interpretations may be correct and address the patient's phantasies and transference state, but they can also be part of a pathological projective identification system. In other words, it can be a collusive acting out that not only helps patients to grow but also serves their defensive structure and thus helps them to retreat at the same time. The author explores clinical moments in which interpretive enactment or interpretive acting out occur. The constantly shifting emotional states produced by transference, countertransference, and the dynamics of projective identification make the interpretive process prone to instability, fallibility, and uncertainty. The unavoidable pros and cons of interpretive acting out are examined through the lens of one complex psychoanalytic treatment.