Empathy, Embodiment, and Care: How the Radical Complexity of Transference Secures the Embodied Psychoanalytic Frame

In "Let Us Not Forget the Clinic," I critique the tendency of academic psychoanalysis to drift into abstraction, prioritizing intellectual theory over the lived, embodied realities of therapeutic care. The clinic is not just a conceptual space; it is an embodied relational environment where the complexities of human experience unfold, guided by the psychoanalytic frame.

The disruptions of the pandemic and the necessary rise of online therapy it engendered forced me to confront again what it means to offer care within the radical complexity of transference, particularly as theorized by Jean Laplanche, and how Laplanche's theory of transference is best treated through the embodied care of in-person psychoanalytic psychotherapy.

Laplanche’s revised seduction theory emphasizes the unconscious messages conveyed by caregivers to the child. These messages are enigmatic and laden with meaning beyond the adult’s awareness and way beyond the child's limited understanding. These messages form the bedrock of the child's unconscious, creating a dynamic that necessitates embodied presence within a stable psychoanalytic frame to process and transform them as adults.

Jean Laplanche

Laplanche’s Radical Complexity and the Nature of Transference

At the heart of Laplanche’s theory is the idea that the unconscious emerges through seduction—not in the colloquial sense, but as a process by which the adult’s unconscious “seduces” the child into grappling with enigmatic messages coming from the caregivers' unconscious processes. These messages carry meanings the child cannot fully decode, creating a foundational tension that fuels the creation of the unconscious.

In the therapeutic setting, transference replicates this dynamic. The patient unconsciously re-enacts the unresolved tensions of their early relational experiences, projecting these onto the therapist. Transference, potentially Freud's greatest discovery, is not simply a distortion of the present but a radical, multi-layered reactivation of distorted and distorting dynamics of the past that are both deeply personal, fundamentally enigmatic, and deeply embedded in the unconscious.

Laplanche’s view of transference as a process of radical complexity requires the therapist to hold the ambiguity and intensity of these projections, creating a space where unconscious material can be worked through.

The Role of the Psychoanalytic Frame for Working with Radical Complexity

The psychoanalytic frame provides the structure needed to engage with the radical complexity of transference as theorized by Laplanche. The frame—defined by the stability of time, space, and therapeutic boundaries—functions as a container for the intense, chaotic, and radically complex dynamics of unconscious communication. It establishes the conditions for care by creating a predictable and secure environment in which the patient can explore their inner world with the analyst. An effective frame requires the analyst to be a container, a holder of the patient's emotions, suffering, and unconscious complexities.

The consistent space (the analyst's consulting room) and the embodied presence within this frame are essential. The therapist’s physical and relational attunement within a shared space determined by the therapist and consistent throughout the work provides a safety container for the patient’s experience, allowing them to engage with the unresolved tensions of transference without becoming overwhelmed. This embodied presence is not passive; it is an active, relational process that involves the therapist’s own unconscious responsiveness to the patient’s projections.

Heinz Kohut

Embodied Presence and the Process of Care

Embodied presence in psychoanalytic care involves more than simply being physically present. It is a form of attunement that engages the therapist’s entire being—body, psychology, and emotions—in the relational process. Empathy, as Heinz Kohut theorized, is central to this embodied presence, enabling the therapist to respond to the patient’s needs in a way that fosters growth and repair.

Thomas Ogden’s concept of unconscious-to-unconscious communication further enriches this understanding of embodied presence. Ogden posits that the analytic setting is not merely a space for verbal exchange but a dynamic field where the unconscious of both analyst and patient engage in a nonverbal, mutual dialogue. This communication manifests through subtle shifts in tone, pauses, silences, and the bodily sensations that arise in the therapist as they attune to the patient. These exchanges, while often outside conscious awareness, are critical to the therapeutic process, enabling a deeper engagement with the patient’s unconscious material.

Other psychoanalytic theorists, such as Wilfred Bion, have also emphasized the complexity of these nonverbal interactions. Bion’s concept of “container and contained” underscores the therapist’s role in holding and metabolizing the patient’s unconscious projections, transforming raw emotional experiences into something tolerable and thinkable. Similarly, Marion Milner explored the importance of nonverbal communication and the therapist’s embodied presence in creating a safe space for the emergence of the patient’s deepest vulnerabilities.

In the context of Laplanche’s radical complexity, embodied presence becomes even more crucial. The patient’s unconscious messages, laden with ambiguity, are never fully accessible through verbal communication alone. They are invariably communicated through subtle, nonverbal channels: shifts in posture, tone of voice, micro-expressions, the felt sense of relational tension, etc. The therapist’s capacity to attune to these cues and hold them within the structure of the frame is what allows for meaningful engagement with the unconscious.

The analytic setting intensifies this complexity because it requires the therapist to navigate not only the patient’s transference but also the countertransference that arises in response. Ogden’s idea of “the analytic third” encapsulates this shared, co-created unconscious space where patient and therapist unconsciously shape and influence each other. This dynamic interplay, while profoundly generative, also heightens the complexity of the analytic work, demanding a high degree of self-awareness and reflective capacity from the anlayst.

The embodied presence of the therapist serves as a counterpoint to the radical complexity of the patient’s transference and the analyst's countertransference, or Ogden's analytic third. By maintaining a grounded, empathic connection, the analyst provides a sense of stability that enables the patient to confront the ambiguity and intensity of their unconscious material.

Without this embodied anchor, the complexity of transference risks becoming overwhelming, potentially leading to therapeutic impasse. Bion, Ogden, and Laplanche's collective work underscores the importance of this attuned, embodied presence in navigating the layered intricacies and the radical complexity of the psychoanalytic relationship.

The Disruption of Online Therapy

The pandemic’s abrupt shift to online therapy disrupted the physical dimension of the psychoanalytic frame, stripping away many of the cues that support embodied presence. The shared physical space of my consulting office, where the relational dynamics of transference could unfold within a familiar and grounded environment, was replaced by a flat, pixelated medium and the patient deciding what room in their house they would use to do the work. The absence of shared physical presence and a varying "shared space" made it much harder to navigate the radical complexity of transference and to provide the kind of embodied care that Laplanche’s theory demands.

For me, this disruption of online work was disorienting and deeply unsettling. I recognized that the screen became a barrier to the subtle, nonverbal communication that underpins the therapeutic relationship long before the pandemic hit since I had done online work many years before that. Without the grounding provided by a consistent embodied frame, I invariably struggled to hold the complexity of my patients’ transference dynamics. This difficulty underscored the importance of the embodied aspects of the psychoanalytic frame in creating a space where care can occur.

Early in my career, I supported the idea of online psychoanalytic training--at least in theory--as a way to democratize access to psychoanalytic education. I had hoped that technology could bridge geographical and financial barriers, making psychoanalytic training and psychotherapy more accessible to a broader range of patients and clinicians. However, my enthusiasm for online work changed after I tried providing therapy online. Despite my initial optimism, I found the experience deeply unsettling.

When the pandemic hit, I made the difficult decision not to transition to online work. I stopped my clinical practice entirely because I could not provide the level of care I felt my patients deserved online. This decision was not made lightly. It reflected my deeply held belief that the psychoanalytic frame requires embodied presence and physical co-location to effectively contain the intense dynamics of transference. When I tried to restart my practice after the pandemic had waned enough to return to in-person work, I found that patients often chose cheaper and more convenient forms of therapy rather than expensive psychoanalysis in a downtown office.

Laplanche’s radical complexity reminds us that care requires more than theoretical understanding; it demands embodied presence within a stable, structured frame.