What interests me more and more is why people come to see us, what they get out of it, and what we can do to be the most helpful.   These questions seem to me very  fundamental.  Often, when I read in the psychoanalytic literature, I find the theoretical peregrinations of the authors of interest only when these sorts of issues are addressed.  I become wary, doubtful, and sometimes sleepy, when our colleagues engage in flights of theorizing and in efforts to systematize an approach to clinical work. 

I find that I keep returning to what my patients say, their actual discourse.  I am interested in what they are trying to tell me about, their story.  What makes this clinically psychoanalytic is that I am listening for the variety of latent, unconscious stories that create conflict and distress or dysfunction and articulate the complexity of the patient's character.  A major tool in doing this, is our listening for who the patient is talking to.  In other words, we want to try to figure out how the patient is unconsciously constructing us each step of the way in order to make the telling of the story a meaningful enterprise--or, how the patient is constructing us to interfere with the narration of crucial aspects of the story that, at still another layer of unconscious motivation, demands to be told.  This is the transference and resistance to the transference, respectively, although I am taking liberties with an old coinage. We will return to this later. 

Not long ago, a woman phoned for an appointment.  Speaking tiredly, she said she  had forgotten my name from a former patient and "wanted to talk to someone."  We arranged to meet in consultation.   Over the past few years, I had become interested in how to better
appreciate what people say in the clinical setting.  I had begun reading in so-called narrative theory, or narratology, to see how a narrativist point of view might help.  I also began to add some of my own ideas to the small literature that had germinated at the intersection of analytic therapy and narrative theory.  The acts of saying and listening were illuminated by this investigation.  Whatever other clinical issues might emerge in my upcoming consultation, for example, wanting to talk to someone, which I had heard countless times before and disregarded as clinically meaningful, now seemed to constitute a legitimate chief complaint.  Who this someone would be was for me to decipher. 

Another motivation for me in pursuing how narrative theory might apply to clinical work was the increasing realization that more traditional models of analytic therapy have encountered difficulty in integrating psychopharmacological advances into theories of clinical dynamic therapy.  In the past, the patient's wish for medication, or the analyst's wish to provide it, was to be analyzed for transference or countertransference issues.  Medication, itself, was devalued for the biological assistance it might provide.  With the advent of obviously beneficial, low-risk medications, this entire point of view has needed to be addessed.  Efforts to integrate psychopharmacology and psychoanalytic theories of practice is, in my judgement, an inadequate, jury-rigged effort.  In the end, integration requires that we retain the separateness of the original perspectives, trying merely to bring them together.  At best, it is a conservative, intermediate position that possesses a seed for a new synthesis.  One new synthesis may be embodied in a narrativist point of view.  That is, the therapist can more easily include effective medication, making it a part of the therapy story. 

Historical Background

There is no clear starting point for when narrativity entered psychoanalysis though we might consider Freud's excellence as a literary stylist to be a necessary precursor.  Freud had noted that his case histories sounded like "short stories."  More recently, Donald Spence challenged the psychoanalytic world with Narrative Truth and Historical Truth.  In a similar vein, Roy Schafer has been persistently migrating literary theory into psychoanalysis, leading to his argument that therapists help patients by renarrating who they are.  Also, contributors such as Michael White, who have signaled the value of narrativity for family therapy, have also influenced the psychoanalytic community. 

Sometimes it seems that  "narrative" is one of the generative metaphors of our epoch which, like "computer," has transformed how we conceive our world.  Much of academia has felt the impact of the narrativist perspective since the 1970s when  literary theory overflowed its
traditional boundaries.  Theories of the novel were replaced by theories of narrative and text.  More and more, thinkers across many disciplines began to wonder how the words we use unthinkingly influence our sense of things or suggest meanings we didn't know our words possessed. 

In some measure, the increasing attention accorded the place of conversation and dialogue in knowledge development has accounted for the shift to a narrative position.  Consider some of the contributions of Lacan:

Lacan stressed how much language plays a part in the expression of character.  For Lacan, the rhetorical devices, or tropes, of language may be regarded as the true defense mechanisms.  Although he points most specifically and importantly to metaphor and metonymy, all the tropes can play a role.  As Holland points out, Lacan gave no attention
to Ella Freeman Sharpe who contributed to the classical theory of word-usage.  Overlapping meanings of which the patient is unaware but of which we might gain awareness is one of the hallmarks of the narrativist approach. Our own private language, the unconscious syntactic strategies that constitute our discourse form, for each of us, an idolect.  And two of us, together, like patient and analyst, organize a private microdialect. (A dyadolect, if I may offer a coinage.)  The elements of this microdialect can be regarded as aspects of the signature of the analytic relationship.  As previously noted (Ingram, 1994),  these signature elements refer to the unique aspects of the relationship--unique to this analyst and this patient, together.  The elaboration of signature elements in the dialogue, those tropes and stylistic manifestations that speak for this and only this relationship, are noted and used for the purpose of underscoring the particularization of the clinical encounter.  They become the defining elements of the microdialect.  Each dialogue emerging as a microdialect stands out as having its own character, rhythm, and universe of possibility.  The interiorization of the therapeutic dialogue is enhanced through the cocreation of a microdialect.  The interiorizationa concept borrowed here from Bakhtin--by the patient of this dialect and its narrative substance becomes the means whereby the story the patient tells about h/himself may be altered.  For Bakhtin, each word is an ideologeme because it is sataurated with hidden and overt meaning.  Much of the task of analysis is the exploration of our patient's words and the interiorization of the resulting dialogue by the patient. Spero has emphasized that interiorization "presumes a psychic interiority, and the capacity to share psychic space."  When this is not the case, or when psyhic interiority and space exists only in brittle or fragmented form, interioirzation, such as may occur, will be experienced as frighteing, suffocating, and as an "internal catastrophe."  A significant question, emphasized by Spero, and to be developed is, How does the capacity for interiorization of the analytic dialogue occur.  It may arise out of the progressive and reflexive experience of the patient by the analyst.  The patient thinks, "If I am worth being listened to, then I am worthwhile."  In other words, the patient begins to construct herself out of the experience imagined of him in the analyst. 

Stories and Meta-stories

Within psychoanalytic psychotherapy, the narrativist perspective has arrived without fanfare or some single spokesperson articulating just what it is.  Somewhat relativist and  empiricist, the narrativist perspective struck some of us as worth exploring.  We began to think that it may help us to accomplish more with our patients.  This was not easy to do, particularly if one's ideas were traditional.  From this new narrative perspective, traditional psychoanalytic theories seemI still find myself hesitant to say itrather like stories. 

From the narrativist point of view, psychoanalytic theories are meta-stories, stories about stories.  They are stories about how to interpret the stories that people tell us in our consultation rooms.  As such, the array of psychoanalytic meta-stories becomes valuable in a way different from what we used to think.  That is, if psychoanalysis is largely an interpretive (or hermeneutic) discipline, then our theories can work very well as a means to make sense of the stories that our patients tell us.  We want to replace the large meta-stories of psychoanalysis with ôlittle storiesö that, as much as possible, provide the possilibity of articulating in small, immediate ways a meaningful story of the patient.  This is what is called paralogy.

Paralogy

The work of Lyotard, as applied by Lois Shawver, extends the narrative position.  Parology refers to a quality of conversation in which the imaginative rearrangement of ideas leads to improved understanding.  Existing sources and authorities are regarded as stimuli for
conversation, not as holding answers.  This lead to the formation of the "little stories," which are always provisional and always local.  Paraological conversation is immediate.  Words are defined by the interlocutors, not by the dictionary.  The terms of the conversation are based on bricolage, Levi-Strauss's term for using objects close at hand for nonstandard purposes.  For example (from Shawver), a patient uses the term "irritation" to mean "passing anger."  There is no single word in our common lexicon to emphasize the fleeting quality of anger, but in a specific context, the patient uses the word, "irritation," to express just this usage. 

We also want to recognize that for co-created narratives to develop, there needs to be alterity.  Following Shawver, alterity refers to little narratives that present alternate points of view.  Alterity ensures that the voices in dialogue are not merely echoing each others
stories.  In the psychodynamic context, alterity is often present because the analyst, in the transference, who is serving as an apostrophe for the projected self- or  object-representation, occupies a dissociated position.  So, for example, a patient imagines that her therapist hears what she says as accusatory when, from her position, she doesn't intend accusation.  Sensing this even before she utters her comment, she may insert a denial of the accusation to ward of counteraccusation:  "Now, don't take this the wrong way, but your ties are on the drab side!"

Paralogical development in conversation requires alterity, but alterity always runs the risk of misinterpreting how words are intended or where there is something that needs to be put into language, but cannot be.  This is called a differend.  A differend occurs commonly, for example, when pro-lifers and pro-choice advocates in the abortion debate find that conversation cannot progress because of the ambiguity inherent in language and the subtle ways in which the different word usages cause a sense of frustrating blockage. 

Differends are avoided when we say, "I wonder if . . .," or "I was thinking that . . ."  That is, qualifiers of uncertainty disrupt the crystallization of meaning.  Another means to avoid differends is through the use of transvaluation,  which is a means for replacing the
patient's potentially self-devaluing term with another.  A patient referred to himself as a trouble-maker who came us with bold ideas that causes people to criticize him.  I said, "Sounds like you're something of a maverick."  Incorporating this into his personal narrative, the transvalued sense of the patient from troublemaker to maverick with its associations for this patient to the Wild West and heroism provided an immediate and somewhat durable therapeutic benefit.  Is this a move away from scientific theory?   No, it is simply another track within psychoanalysis, supplementing the scientific track. It speaks more to the art than to the science of clinical therapy. 

From within a narrativist frame, we can happily embrace all the analytic meta-stories, appreciate how helpful they can be, and seek to learn them.  Even while we might sometimes dispute the truth claims of these meta-stories, we immensely value and affirm the benefit of analytic therapy.  Psychoanalytic therapy is regarded as an opportunity for a patient to language his or her life.  We privilege the poetical aspects of the clinical enterprise.

The narrativist analytic therapist brings particular attention to wordswhole words, broken or stammered words, rare or archaic words, pronouns with uncertain antecedents, oddly used prepositions, passive, active, subjunctive, and imperative voicesas a means to illuminate the
patient's narrative.  The patient's lexicon, and the lexicon of the analyst, provides the elements of the stories that are unfolded.  Each word is a cosmos of possibility, a space in which the patient comes alive, or, relying upon a very different metaphor, each word is
regarded as a tool for constructing meaning. 

Returning to my consultation with the woman, a 35-year-old, who "wanted to talk to someone," I found her laconic, languid, and withholding.  She palpably experienced a hesitation about  the very thing she wantedto talk to someone.  I said so.  She agreed and the tension of the consultative session relaxed. 

She was unhappy on many fronts.  In more fashionable clinical language, my patient suffered with a subsyndromal depressive disorder.  We began working together twice weekly in a narrativist analytic therapy.  She responded favorably to buproprion.  In our tenth session. and I mention this only be way of example, she  described herself as generally more willing to "get into the brawl of it," referring to the challenging world of career and courtship.  What a marvelous capture of her experience: "brawl"!  I explored the personal provenance of this word, namely,  the way she came about the word and how she might have used it in the past.  We considered past and present brawls, and we briefly touched upon her brawl in the transference.  Brawl, precisely because of its rarity in this patient's lexicon, could be italicized in the therapy itself.  I wanted to appreciate how my patient configured through this particular word a unique set of ideation, affect, associations and impulses.  This word, brawl (along with everything else she says, of course), entered our the dialogue.  The word became dialogized and defamiliarized.   That is, the word became refreshed and renewed because my voice, and all that my voice carries, became insinuated into how she experienced the word and all that she already associated with it.   I asked her, Do you have any sense of  this medication changing the way you enter into the brawl of life?"  She answered that now she stands a chance of surviving, even of prevailing.  Not incidentally, she changed her story and I silently noted that.  The interiorization of this kind of dialogue sustains for this patient an enriched inner world, and I believe, provided an essential contribution to what would enable a next stage in the analytic work to unfold. 

Thankfully, words are multiply interpretable.  Meanings are subject to change depending on context, mood, and the person addressed.  In some measure following Lacan, we celebrate the ambiguity of language and the opportunity for humility and healthy skepticism this ambiguity provides.  Much of the language we use can be usefully deconstructed.  IÆll explain.

Deconstruction in Dynamic Therapy

Killing two birds (one practical, one theoretical) with one stone, I'll use narrative, itself, as an illustration.  As we are using it here, narrative is metaphoric: Life is the telling and performing of stories.  In deconstructing narrative, we examine how it functions as a metaphor to organize knowledge.  Metaphors organize knowledge by taking what we know very well, often something simple and direct, like telling a story, and applying it to something we know less well, perhaps something elusive and difficult, like living a life.   Metaphors, including this one, highlight certain matters, eclipse others, create invisible entailments, and subtly intercept our finding ready access to other means for gaining knowledge.  Hence, the narrative metaphor highlights the storying rather than the sensual experiencing of  life, the poetics of description rather than the listing of symptoms, the multiplicity of voices that live within a person rather than a single invariant self, and the emphasis on language rather than action or feeling. These are the drawbacks, all major, of the narrativist point of view.  There are compensating factors, however. 

Transgenerational Stories

I am working with a woman who illustrates something we are familiar with, but which deserves emphasis in the narrative apporach I am trying to describe.  This is the transgenerational story.  Briefly, the woman, now middle-aged and widowed, had experienced considerable distress in her early twenty's because she was unmarried.  She sufferred anxiety and depression, a great sense of herself as a diappointment to her parents because no one proposed marriage.  After several years of anguish, she did marry and had a family with several children.  Her children, now adults, are all married  with one exception.  This daughter, who is desperate to marry, enacts her mother's story.  The pain experienced by her mother, my patient, in dealing with this daughter is overwhelming.  But recently, the mother, who for many years after the death of her husband had felt quite desperate that she would need a man in her life, has come to recognize that she can manage quite well on her own.  She has developed a circle of friends and returned successsfully to a career.  As affective component  is much less.  Actually, her story is changed.  As a consequence, it has become possible for her daughter to change her story, too. 

The Familiar Story as Negative Therapeutic Reaction

It is the familiarity of the stories we live by that makes them stick, that gives a foundation to our lives.  A gay man in intensive analysis for a number of years is experiencing considerable distress arising from the awareness of how much things are not as he expects them to be.

Although it is in no way the purpose of the analytic work, there is a remarkable upswing in heterosexual desire that this man is experiencing.   Along with a new sense of the ability to care for financial matters and a growing respect he is experiencing in his community, he is inwardly fighting to keep the old story, a story in which he is a loser and a quitter,  impecunious, and flamboyantly gay.  Through projective and rationalistic defenses he struggles against the expectations that he will be seen in the same old way, that he will have the same experiences only to then discover it is not the case.  That is, he projects the wish to remain the same even as he is changing. 

Transference and Countertransference

Also, where is transference, countertransference, unconscious process, conflict, and the host of elements that we associate with psychoanalysis?   Here is part of the answer to this question:  The patient is never telling just a manifest story.  There is always at least one implicit story, hinted, disguised, or suggested.  This necessary implicit story is the transference. It is the transference which partially determines from behind the scenes just what gets explicitly told.  Whenever anything is said or even thought, an interlocutor or addressee, real or imagined, is required  Transference, as used here, refers to how the patient constructs the interlocutor so that a story can be told, determining how it is told.  The analyst is voluntarily recruited (or sometimes, alas, involuntarily conscripted),  becoming the main character in this transference story that the patient is unwittingly narrating.  It is this implicit story that, in analysis, we want to unpack and render palpably explicit.  This is the distinguishing feature of analytic from non-analytic therapies. 

The person of the therapist is, to use the name of the rhetorical figure, an apostrophe.  That is, the therapist is constructed to provide meaning to the telling of the patient's story.  The patient makes the story worth telling by constructing the therapist to make it so.  The therapist is an old object (after Loewald) and the telling of the storywhether through free association or chronological reportingis a means for making sense of events, feelings, and imaginings.  The  In narrative analytic therapy, we seek the reconstruction of meaning, the vitalization of codes of interpretation, and the patient and therapist's co-authoring of new stories that more ambiguously articulate what our patients' lives are about.  Always,  there is more to a person's life than what has been storied, indeed, more than can be storied.  We want to be sure to know that.  The stories become more unclear and more varied.  There is freedom in moving freely from one story to another, from "What an unhappy person I am," to "In this brawling life of mine, I may succeed."  It is in the movement among different, often newly authored stories, that a person finds a revitalized repertoire of feelings, behaviors, and points of view. 

Naming as Knowledge Construction

We want to consider, for example, how in naming and particularizing the experience of the patient, the therapist organizes that experience and legitimizes it.  In so doing, in naming and particularizing an experience, it is certainly true that the analyst may free the patient
from chaotic inner turbulence.  Even prior to naming and particularizing, an active dialogue establishes continuity in time and space, a continuity that  intercepts the annihilating anxiety to which Winnicott refers.  Still, it is within the analytic dialogue that the patient's experience is refigured by the naming process.  It is the analytic dialogue that enables the interiorization of the analyst's voice as the naming agent.  True, the patient receives a modicum of mastery over this previously unnamed, unformed anguish, the immediacy of which had seemed inescapable and overwhelming a moment earlier.  I remember a consultation several years ago in which a young man complained bitterly and tearfully.  He never said he was depressed.  At the close of the consultation I made this single comment, deliberate in its brevity:  "I think you are depressed."  The word depressed organized, legitimized, and demystified his experience.  He lightened with relief and we scheduled a next meeting which went on to become a successful analysis. 

Arguably, the introduction of this word "depressed" to signify, capture and contain his experience also mutilated and foreclosed useful exploration that might have been more productive.   My comment was a risk, not that I can say that I carefully calculated how it would turn out.  It was more spontaneous than that.  It was a risk that he would say, "Depressed--OK, Sherlock, see ya around!"  It was also a risk that this orotund "depressed," so current in both everyday and professional discourse, would overwhelm the nuanced aspects of his feelings.  For me, imbued by my patient with the full weight of professional authority, to call him depressed might give short shrift, for example, to his agitated feelings or to his confusion.  Depressed spins his experience in a direction that then nails it in a word, a term.  His experience is separated from its status of ineffability.  In that sense,  my use of the term "depressed" can be seen as mutilating his experience or, stronger still, killing it and preserving it in semantic formaldehyde.  Conceivably, my mildly disingenuous understatement, "I think you are . . .," paradoxically amplifies the authority of my utterance beyond the absolute pronouncement, "You are . . ."   Finally, my announcing to my patient that he is depressed was also a risk because it could foreclose or discourage his making certain expansive or self-sufficient  moves in the future. He might quickly come to expect me to drop these magical, immensely gratifying comments, and even develop a morbid dependency on my saying helpful things. (Horney, 1945).  The clinical question, whether to move into a position of authoritative discourse in the unfolding dialogue with a patient, is nearly always up for discussion. 

I think it is true that almost every patient in almost every session--I want to cover myself with these almost's--utilizes some word or word cluster that we can explore, or consider exploring.   On the morning that I drafted this part of the paper you are reading, by way of
further example, my first patient of the day used the  word cluster, "managing my. . ."  on two occasions.  He used this expression to signify thinking through the consequences of his actions.  Managing my . . . was construed by my patient as highly beneficial and as an
advance over his previous impetuosity.  I asked him about it.  He said he got it from me.  For my part, I have no recollection of ever saying anything like it; besides, the concept seems a bit alien to my usual way of thinking.  My second patient of the day wanted a description of herself, seeking some formula for how to know herself.   My third patient repetitively used the expression want to get away to organize a narrative about her wish to flee certain anxious issues she currently faces.  My fourth patient spoke about his dyslexia and the impact it has had on his life.  He preferred to think of this as being different rather than as a disorder or disability.  As we spoke about it, he spontaneously allowed that we could refer to it as a disability thereby, I thought, beginning to show either some mastery over its adverse impact on his confidence or greater trust in the quality of our dialogue.  My fifth patient spoke about my robe, using this signifier to refer to a transitional object continuing from early childhood that still helps her feel comfort. 

Entering into the lexicon of signifiers of our patients and inevitably bringing our own lexicon to them creates a dialogue of assured intimacy and specialness which, in my experience, is therapeutic.  Elsewhere, I have referred to the shared, growing and protean lexicon of words--with their shifting of nuances of unique contextualized meanings--as the
microdialect that evolves between us and each of our patients (Ingram,  1994).

Returning again to my patientshe met a man, finally, who returned her admiration.  She was delighted and amazed.  She said to me, ôIt is like it is happening to another person!ö  I saw this as a wonderful opportunity to develop another story, the story of narcissistic
gratification following a lifetime of narcissistic depletion, and one vital to her fulfillment.  I asked:  "Tell me about this other person, the one to whom this is happening."  I wanted her to language this "other person" and get to know her.

When we explore with our patients how words are ascribed meaning, how we and our patients construct meaning,  meaning that may change in the moment-by-moment context of our asymmetric dialogue that we call psychoanalysis, we discover a way to assist our patients to break free from the straitjacket of discrete simple narratives or the quest for them.  Psychoanalytic treatment through its ongoing dialogue and discourse, its talking and more talking, takes us toward that goal:  The patient comes to appreciate that each of us is beyond definition, identification, description--that we, finally, live in a domain that cannot be entered through language, however much language helps us to think about and talk about our lives.  If there is merit to the narrative metaphor.  Life is the telling and performing of stories and if we also recognize the drawbacks of the metaphor, we can affirm that the suffering of psychiatric disorders is alleviated by talking about it. 

Medication and Reassurance

On the face of it, the array of medications now available to us should enable our providing considerably greater reassurance than was available previously.  In practice, that is the case only sometimes.  Most of our patients perhaps curiously, perversely, or defensively,
cherish their dysphorias and we find that their suspicion of medication is often an effort to maintain their symptoms for the unconscious value their symptoms possess. On the other hand, there are those patients who come into our offices with depressive complaints ask for fluoxetine.  They are reassured to know that we concur or that we think another
medication is better for them given their circumstances, or that we think a referral for medication is advisable.   They have no interest in the unconscious deteminants of their symptoms.  It is my clinical experience that patients whose symptoms are relieved
by medication remain interested in continuing psychotherapy.  As I stated earlier, the symptom is often a ticket into therapy and to the remarkable conversation it provides.  Once in, the symptom may lose much of its value.  Whether the symptom is relieved by medication or by the therapeutic dialogue, or both in concert, we are learning that the value of "talk therapy" is not lessened.  As Phillips says, therapy is "that most unlikely thing: an interesting hedonism."  Frequently, patients are insulted by the proposition that medication will help them feel better.  Rather than being reassured, they feel dismissed.  Often, it is only when they fully recognize that they will be appreciated, understood, and given the time and attention they want, will they consent to medication. A 26-year-old man presented with a history of recurrent depression that was severe and sustained.  Suspicious of mental health treatments of any kind, he had had no prior therapy or medication. The current episode warranted treatment with buproprion, I judged.  I told him that I recommended that he take this medication, but beyond that, I wanted to learn more about him, that I would like to see him next week to begin to get to know him.  He consented to the medication because he experienced my attention to him as a person, not as a disordered entity that needed fixing.

Not uncommonly, patients taking psychotropic medication sometimes feel themselves as different from their usual selves.  Though they feel relieved of psychic pain, they do not feel quite like themselves.  For certain patients, the loss of anguish, oddly, is a loss of a certain
kind.  The anguish, idiosyncratically textured, may serve as a bridge to a significant aspect of themselves perhaps connecting them with an important quality of relationship with a person from their early life.  Their suffering, despite its pain, may prove necessary to their sense of being richly endowed internally.  They choose to discontinue medication that helps in one important way, but impairs self-recognition.  Not infrequently, these patients are reassured to know that we are willing to support their wish to start and stop medication.  For this group of patients, the exploration of the symbolic meaning of medication is often revealing and contributes to the re-narration of their lives.

References

Boyd, R. (1993), Metaphor and theory change: what is 'metaphor' a metaphor for? in Ortony, A., ed., Metaphor and Thought,  second edition, Press Syndicate of the University of Cambridge, New York, 1993.

Holland, N. N. (unpublished MS). The Barge She Sat In Psychoanalysis and Syntacti Choices.

Horney, K. (1952). Neurosis and Human Growth, WWNorton, NY.

Ingram, D. (1994)  Poststructuralist interpretation of the psychoanalytic relationship, J. of the Amer Acad of Psychoanal 22(2), 175-193. 

Ingram, D. (1996).  The vigor of metaphor in clinical practice, American Journal. of Psychoanal.56: 17-34.

Ingram, D. (1996).  How words mean in analytic psychotherapy: a neo-Horneyan contribution, J. of the Amer Acad of Psychoanal 24(3), 541-557.

Lacan, J. (1977). Ecrits. Trans: Sheridan, A., W W Norton, New York.

Lakoff, G. (1992) The contemporary theory of metaphor, in Ortony, A., ed., Metaphor and Thought,  (see above).

Levenson, E. (1983), The Ambiguity of Change: An Inquiry into the Nature of Psychoanalytic Reality, Basic Books, New York.

Schafer, R. (1992). Retelling a Life: Narration and Dialogue in Psychoanalysis. Basic Books, New York.

Shawver, L. (unpublished MS, 1997). On the clinical relevance of selected posmodern ideas with a focus on Lyotard's Concept of a Differend. Published in the Journal of the American Academy of Psychoanalysis, 26(4), 599-618, 1998.

Spence, D. P. (1982). Narrative Truth and Historical Truth:  Meaning and Interpretation in Psychoanalysis, New York: WW Norton & Co. 

Spero, M. H. (in press Am J Psa). A brief note on Ingram's (1997) concept of interiorization.

White, M., Epstein, D. (1990). Narrative Means to Therapeutic Ends. WW Norton, NY.

-- 
Douglas H. Ingram, M.D.
DHIngramMD@aol.com