The International Journal of

Int J Psychoanal (2013) 94:1–5 doi: 10.1111/j.1745-8315.2012.00558.x

Here and now: My perspective1

Betty Joseph
36 Clifton Hill, London, NW8 0QG, UK – [email protected]

In this paper the author describes her particular perspective in doing analytic
work. She stresses working in the here and now. For example, making interpreta-
tions that grow out of what the patient says or does in the sessions, keeping the
patient’s history in mind, but not letting it lead interpretations. The analysis tries
to understand why something is being said now, in this way, and what impact it
may have or be designed to have in the analytic relationship. The term ‘here’
refers to what is going on between patient and analyst in the room while not leav-
ing out the patient’s immediate reality in the outside world, his everyday life. The
word ‘now’ implies awareness of time that is not just of the past and future but of
the patient’s situation at the moment in analysis, which is constantly shifting.
The author believes that by working primarily in the present the patient will feel
more anchored, both patient and analyst can observe what is going on, for example
how anxiety arises or decreases, how defences are mobilised or lessen. Both analyst
and patient experience movement and change rather than relying on more theoreti-
cal explanations.

If I look back over my analytic career I realize that my work has increas-
ingly focused on, or perhaps rather started from, what is going on in the
room between patient and analyst. Today I want to think briefly why this is
so. What is clear is that this focus allows the patient and analyst to feel
more anchored.
By working in the here and now I mean this in a broad, global way but
also in a minute way, and it is related to my understanding of psychic reality
in the patient and the analyst. I like primarily to make interpretations that
grow out of what the patient is saying or doing in the session, with his back-
ground and our previous work somewhere in the back of my mind and thus
to eschew general explanations. The patient may tell me that her mother
was so fragile that even when she was very young she felt that she had to be
very protective towards her mother. It may seem from previous experience
that this refers to myself, but I suspect this is not of real use to her, nor con-
vincing to me, unless it is being manifested in some way in the session. But
it would alert me to examine, for example, whether I was talking a bit care-
fully, was my tone a bit delicate, etc. and if so as a consequence she might
have experienced me, whether consciously or not, as pussyfooting round her
rather than interpreting straight. This can then give me a more global view-
point – I may come to realize that over a series of sessions the patient and I
have been talking to each other ‘carefully’ as if each was more comfortable

1
Editor’s note: These two papers, Edna O’Shaughnessy, ‘‘Where is here? When is now?’’, and Betty
Joseph, ‘‘Here and now: My perspective’’, were invited papers for the UCL Psychoanalysis Unit Annual
December Conference (12th December 2008–14th December 2008). The papers are part of a series
entitled ‘‘Here and Now’’ (Aguayo 2011; Blass, 2011; Busch, 2011).

Copyright ª 2013 Institute of Psychoanalysis

Published by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and
350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis
2 B. Joseph

that way, so that the patient was feeling that interpretations were only ‘inter-
pretations’ and not to be taken too seriously and I was colluding with this.
But the statement that the mother was so fragile may of course be stated
for some quite other reason, for example, to express understanding she had
gained from previous work, to control the analyst and prevent her from being
straight and clear. The possibilities are legion and our attempt to understand
what is going on in the here and now means trying to understand not
only what is actually being said, but why it is being said now and said in this
way, what impact it may be designed to have and what impact does it have.
When we are using the expression here and now, ‘here’ refers primarily to
what is going on between the two participants in the room, but in addition
it conveys the immediate, often concrete, reality of the individual’s experi-
ence, which may, for example, be focused on his body, the analyst’s room ⁄ -
body. This aspect is particularly vivid in patients with strong psychotic
anxieties. To give an example, a child patient at a certain point in his analy-
sis, was almost unable to enter the playroom where the shadowy remains of
another child’s scribbling remained indelibly crayoned on the wall. To him
the shape of the scribbling became volcanoes, ‘here’, my room became an
object of terror, and when he managed to come in he was extremely anxious
and would stand flat against the opposite wall as far away as possible.
The notion of ‘here’ also implies that there is a world outside, and I like
to keep this connection somewhere in the back of my mind so that links will
occur, or will need to be made, between what is being understood in the
consulting room and its implications in the patient’s everyday life. Some
patients will resist this linking firmly and try, probably unconsciously, to
hold the analyst’s mind fixing it into a kind of emotional pas de deux. This
in itself will need understanding and interpreting.
The now, when we speak of here and now, implies a sense of time, not just
past and future, but an awareness of the patient’s situation at the moment,
one that is dynamic, never static, and that changes from moment to
moment. The analyst is in a position to witness the movement and thus to
gauge the forces operating in the patient, forces however that will find
responses in the analyst, which should help in his understanding. Seen from
this angle the analyst’s interest will lie in trying to understand the dynamics
of change, without using the notions of progress or regression – rather
observing that this is the way that this patient operates at this time – a kind
of respect for his defences and his need for them.
I am very much concerned to try to follow the movement in the session,
in the patient’s associations and in his response to interpretations, recogniz-
ing the brevity of ‘now’. As the analyst interprets the situation changes, the
patient responds, or does not respond, anxiety increases and new defences
are quickly mobilized, or there is a moment of relief, tension lessens and
one can sense that the patient feels warmth towards the analyst. The nature
of the response can help us to see something of the anxiety, for example,
that lies behind it. The kind of movement going on in the session means
constant change, change in the nature of defences or need for them, change
in the perception of the object and change in the feelings towards the object.
In this way we have a chance to see in a mini form the stuff that may lead

Int J Psychoanal (2013) 94 Copyright ª 2013 Institute of Psychoanalysis

 Here and now: My perspective 3

to real stable psychic change. A further advantage of trying to follow in

detail and in the present the movement of the patient and his material in
the session is that it enables us to contact and begin to understand small
quantities of anxiety or excitement as it arises and shifts rather than its
accumulating or being evaded and the patient then being confronted with
more massive anxiety or panic states later on.
I am stressing here the importance to me of trying to follow the moment
to moment shifts in the session; there is of course always the risk of this
leading to the patient feeling too closely followed or even harassed and
trapped. Certainly the analyst needs to try to be aware of the possibility of
this and be sensitive to the patient’s state of mind and his need for space to
elaborate and stretch mentally.
Working in the here and now, I have indicated, of course involves an
awareness not only what is going on immediately in the patient but is neces-
sarily dependent on the analyst’s sensitivity, so far as is possible, to what is
being evoked in himself. I gave an example of this where the analyst came
to recognize that she was pussyfooting round the patient. To me this means
that whatever our technical and theoretical knowledge our basic tool is our
ability to try to recognize what we actually feel, experience or suspect is
going on in ourselves – our psychic reality. In the absence of this capacity
something quite fundamental will be lacking, I believe, in relation to our
patients and our understanding of them.
Freud saw transference as being aspects of the patient’s early history
being repeated, transferred in his relationship with the analyst. Melanie
Klein took this further showing how aspects of the very early relationship
of the child with his parents were internalized and built up his inner world
of objects, and that aspects of these inner objects were projected into the
relationship with the analyst forming the transference. I am suggesting that
as we follow the moment to moment shifts in the session we can begin to
get an idea of how his past was built up because we can see elements of it
being reconstructed in the session. To give a very over-simplified kind of
example – the analyst gives what seems to her a straightforward interpreta-
tion, the patient responds with anxiety and anger suggesting that he felt that
the analyst was rebuking and mocking him, but his angry response evokes
in the analyst a sense not only of being grossly misunderstood but of want-
ing to pressurize or bully the patient into understanding. If this type of situ-
ation seems in varying ways to be repeated as the analysis goes on and the
analyst is aware of the pull towards this kind of enactment it can give us
some idea of the kind of pressures the patient very possibly experienced in
his past with, say, a father who actually did or was felt to bully or pressurize
the child. And we see how the child probably responded with fear and anger
or hostility. This would make the father more upset and hostile and the two
would get caught up in a vicious cycle. A cycle that is repeated in the trans-
ference but there we may begin to be able to unwind it. (This I shall discuss
further in a moment.) Thus fragments of history come alive under our eyes.
I like therefore to try to understand what is being lived out by the patient
and the role that I am being asked to play. If what I have learnt about his
past comes into my mind and seems relevant at that moment then I like to

Copyright ª 2013 Institute of Psychoanalysis Int J Psychoanal (2013) 94

4 B. Joseph

connect it in my interpretations. It means that the patient’s history so far as

it is known, or assumed to be known, is at the back of my mind rather than
leading my expectations. Premature linking with history can easily be a
defensive move both for patient and analyst. But in the long term I do feel
that an understanding of what has gone on in the past, its meaning to the
patient and his involvement in it, is not only of great interest to me as his
analyst. It is also important to the patient that he can feel that his analyst
has a sense of continuity and has his history in his mind. I believe this gives
the patient a sense that there can be some flexibility in the understanding
and interpretation of his history, and a greater sense of integration of himself.
This I think has an important bearing, as I indicated earlier, on the whole
issue of psychic change. To my mind real psychic change does not come
about through the patient’s recognition of the way he repeats old patterns
of behaviour and relating, important as this awareness may be. Psychic
change I think must depend on the patient’s ability to feel how and why he
experienced or was caught up in certain manoeuvres, anxieties, defences,
and this will only come about as he not only repeats his past, but moment
by moment reconstructs it in the transference. The process of reconstructing
will have an impact on the analyst as he is drawn into the various roles he
is required to enact – or rather, since he is the analyst, he needs to become
aware of this, to verbalize what is going on rather than enact. I attempted
to illustrate this with the example of the child with the bullying father. As
the patient experiences an object, the analyst, who does not get drawn into
bullying he may begin to feel less angry, more trusting, and thus the analyst
will be experienced as more benign and internalized as a more benign object
evoking less anxiety and rage in the patient. In this way the vicious cycle
can begin to loosen. I believe that this is an import aspect of achieving psy-
chic change – by minute but ascertainable changes that take place within
the transference and hence in the patient’s internal world.
I want to return to the issue of analytic explanations. They, like the
patient’s told history, have a place at the back of my mind. I do not like to
try to explain to a patient in general, for example, why he is using a particu-
lar defence unless I can see what is happening in the transference, how, for
example, he has gone silent or become withdrawn and what seems to have
resulted from this, what has been achieved by it. My aim is to help both of
us to observe and understand the movement rather than my giving my
patient what is essentially a more theoretical explanation, however correct
this may be. If we give our patients general explanations or show them sim-
ply the way they are repeating their past, I suspect we become, in their
minds, someone who wants them to change, a needy or a superego figure,
rather than an analyst who will really try to enter into their state of mind at
that moment. I do not, as I said previously, think that our interpretations
are only concerned about what is going on in the room; I like to start from
there and be able then, or maybe much later, to understand and to help the
patient to understand its relevance to what is going on in his outside life
and to his general difficulties and hopes.
In this brief contribution I have been stressing the importance of move-
ment; here I am adding the importance of the analyst’s mind being able to

Int J Psychoanal (2013) 94 Copyright ª 2013 Institute of Psychoanalysis

 Here and now: My perspective 5

move from what is going on in the room to the outside world and the past,
but understanding, I am suggesting, needs to start from what is going on
here and now.

References
Aguayo J (2011). The role of the patient’s remembered history and unconscious past in the evolution
of Betty Joseph’s ‘here and now’ clinical technique (1959–1989). Int J Psychoanal, 92:1117–1136.
Blass RB (2011). On the immediacy of unconscious truth: Understanding Betty Joseph’s ‘here and
now’ through comparison with alternative views of it outside of and within Kleinian thinking. Int J
Psychoanal, 92:1137–1157.
Busch F (2011). The workable here and now and the why of there and then. Int J Psychoanal,
92:1159–1181.

Copyright ª 2013 Institute of Psychoanalysis Int J Psychoanal (2013) 94