Accompaniment in Jazz and Psychoanalysis

Psychoanalytic Dialogues The International Journal of Relational Perspectives ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/hpsd20 Accompaniment in Jazz and Psychoanalysis Henry Markman To cite this article: Henry Markman (2020) Accompaniment in Jazz and Psychoanalysis, Psychoanalytic Dialogues, 30:4, 432-447, DOI: 10.1080/10481885.2020.1774340 To link to this article: https://doi.org/10.1080/10481885.2020.1774340 Published online: 11 Sep 2020. Submit your article to this journal Article views: 16 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=hpsd20 Psychoanalytic Dialogues, 30:432–447, 2020 Copyright © Taylor & Francis Group, LLC ISSN: 1048-1885 print / 1940-9222 online DOI: https://doi.org/10.1080/10481885.2020.1774340 Accompaniment in Jazz and Psychoanalysis Henry Markman, M.D. Berkeley, CA The author explores a fundamental role of the analyst as improvisational accompanist. This role requires a dedicated attention to the shared rhythmic dimension of the interaction, a mode of psychoanalytic attention of embodied self-awareness and sensitivity–that is, embodied attunement to the pulse of the interaction. Directed action follows by providing various forms of accompaniment that depend on the nature of the patient’s needs and emotional state. By refining our accompaniment to meet clinical situations and challenges, we enlarge the range of analytic engagement. Using examples from jazz, the way the rhythm section finds the right form of accompaniment to support the soloist’s creativity and unique voice, the analyst similarly accompanies his or her patient, providing a temporal framework, a pulse that affirms emotionally shared states, recognition, differentiation, and creative expression. Various forms of analytic accompaniment include steady and present beat, an unobtrusive and loose presence, an interactive and conversational presence, or disruptive rhythms. From experiences of solid support and recognition, accompaniment can fuel the patient’s improvisations, allowing him to move away from the analyst and create a clearer differentiated voice. As the patient separates, he ventures out into new or difficult territory, the analyst’s presence is there following. Accompany (v.) early 15c. “to be in company with,” “take as a companion.” Musical meaning “play or sing along with.” ANALYST AS IMPROVISATIONAL ACCOMPANIST While listening to a jazz quartet, the drummer laying down a pulse for the group to share and the soloist to improvise, one feels the beauty of the drummer’s supportive role: the responsive flexibility of his accompanying work to create a collective pulse for shared emotional experience. Small jazz ensemble performance provides a musical metaphor for an important aspect of analytic engagement, to be appreciated and studied. Accompaniment is an integral role in this musical fabric, analogous to the analyst as improvisational accompanist. As the jazz rhythm section lays down vitalizing accompaniment for the soloist to “say something.” the analyst similarly accompanies her patient, providing a temporal framework, a pulse that affirms emotionally shared states, recognition, differentiation, and creative expression. Pulse is not simply “beat”, but a three- I am very grateful to Sam Klein-Markman and John Schott for their insights into jazz communication and improvisation. Correspondence should be addressed to Henry Markman, M.D., 2435 Russell St., Berkeley, CA 94707, USA. E-mail: [email protected] ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 433 dimensional affective form involving intensity, tone, rhythm, and movement. In accompanying, the analyst works to find the right pulse, the right accompaniment for the patient. The patient senses when the analyst is with them, when the accompaniment is right, and knows this in the feel of the interaction– not necessarily by what the analyst says. As Nebbiosi and Federici-Nebbiosi (2008) writes, “The experience of sharing a rhythmic-affective form with another is a significant confirmation of the meaning of the relationship” (p. 217). Accompaniment expresses our ‘presence’1: a welcoming, available, and flexible way of being that the patient feels. Presence is palpable, the heart of, “I am with you.” Where the analogy with jazz is incomplete is that the analyst-accompanist has the responsibility in an asymmetric relationship to find and provide what is needed and take responsibility when his accompaniment fails. The two components of successful analytic accompaniment are recognition and improvisational participation. Recognition requires the analyst’s embodied awareness–in himself or herself and the relationship–of what is going on and what is needed. Accompaniment entails working through emotional obstacles to receptivity while containing the impact of what is shared, so as to be present. Then the analyst can impart what feels like the right form of accompaniment. It is improvisational because the “right form” is salient at a particular moment and may shift. The aim of this paper is to bring an implicit realm of analytic work up front and in view, giving it a primary role in analytic technique. We can see in jazz that the role of accompanist requires a dedicated attention to the shared rhythmic dimension of the interaction. I want to make the same claim for a mode of psychoanalytic attention of embodied self-awareness and sensitivity–that is, embodied attunement to the pulse of the interaction. Directed action of accompaniment follows from this, depending on the nature of the patient’s needs and emotional state. By refining our accompaniment to meet clinical situations and challenges, we enlarge the range of analytic engagement. MUSIC AS METAPHOR Music is a compelling metaphor for what happens between patient and analyst at the rhythmic nonverbal register.2 When Langer (1956) writes that “music is our myth of the inner life” (p. 245), we can also say that ensemble playing is our myth of the inner life of a shared emotional relationship, an emotionally meaningful world without words. As Langer (1942) beautifully puts it, “music articulates forms which language cannot set form” (p. 233, author’s italics). Musical metaphors expand analytic attention to grasp forms of interaction, nonverbal ways of relating– not dynamic content– many consider the bedrock of what happens in relationships. The form of expression and interaction get at the way we feel into our own experience and those of others.3 Trevarthen’s studies of the infant-parent interaction give us a look at music’s communicative power and interactional importance. Trevarthen and Malloch’s (2002) term “communicative musicality” describes a shared non-verbal, rhythmic and embodied aspect of relating, story telling without words, through pulse, tone, and gesture beginning early in life, between infant 1 See Marcel’s (1933/1956) work on presence and availability and Markman (2017) for a consideration of Marcel’s concept in clinical practice. 2 For example, Elise (2017) and Rose (2004). 3 In Forms of Vitality (2010) Stern considers vitality forms the substrate of all experience. 434 MARKMAN and care-taker. Through rhythmic sharing, a synchronizing in the medium of musicality, felt emotional states are passed back and forth, recognized and elaborated. Knoblauch (2000), in The Musical Edge of Therapeutic Dialogue, uses a jazz metaphor to explore, among many aspects of listening, accompaniment as an improvisational part of clinical technique. His focus on the idea of the analyst following and leading, and the importance of surprise, is very prescient and relevant here. I have incorporated many of his ideas explicitly and implicitly in this paper. I am extending Knoblauch’s work. First, I am allocating accompaniment a primary mode of clinical engagement, while exploring the emotional work and enhanced bodily awareness accompaniment requires. Second, I am offering a provisional repertoire of accompanying forms based on jazz accompaniment. Further, important aspects of asymmetry and responsibility, the specific mode of attention called “embodied attunement” will be developed. Knoblauch opened up the metaphor of accompaniment that merits deeper investigation into its qualities and clinical implications. FORMS AND THERAPEUTIC ACTION OF IMPROVISATIONAL ACCOMPANIMENT Jazz offers vivid models of forms of accompaniment, represented by iconic drummers that range from Elvin Jones’ steady textured beat, to Tony Williams and Eric Harland’s spacious, responsive, interplay, to Paul Motian’s unobtrusive loose weave, to Sunny Murray’s disruptive independent rhythm. Likewise, the analyst can be like a steady drummer, providing a strong pulse and attuned presence in tone, rhythm, intensity, and words, pushing things along, or holding things up; or a more diffuse, less hard-edged rhythmic accompaniment, what Balint (1968) calls the “unobtrusive analyst”; or opening space for interactive play; or a more disruptive rhythmic accompaniment meant to enliven and provoke. These forms are determined by the particular momentary needs of the patient, as sensed by the analyst at the embodied level of communication. How the analyst senses which form of rhythmic engagement will be taken up in a section below. As the point of jazz accompaniment is to share, contain, and enhance emotional experience, ultimately to promote the soloist’s greater improvisational freedom, there is a similar aim of accompaniment in analysis. Accompaniment offers the person a shared world of emotional experience, active engagement, recognition, and witnessing–whatever personal rhythms and emotions are given to the analyst-accompanist. The patient is offered the radical, often unprecedented experience of acceptance, welcoming, being-with-ness, and attunement. This gives the patient a way out of isolation, non-relating, and hopelessness, a way out of a being entrapped in protective defenses. I would argue that whether a person comes from a traumatic background or not, the experience of sharing rhythmic-affective forms is significant in “confirming of the meaning of the relationship”–an important element in emotional growth. The patient feels recognized by the analyst’s verbal and non-verbal attunement in a way that strengthens his sense of self and her the capacity for self-presencing. Many patients need this sort of accompaniment prior to elaborating their own voice. From experiences of solid support and recognition, accompaniment then can fuel the patient’s improvisations, allowing him to move away from the analyst and create a clearer differentiated voice. As the patient separates, he ventures out into new or difficult territory, the ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 435 analyst’s presence is there following. Over time the person develops greater confidence in selfexpression, taking chances while still relying on supportive accompaniment. Part of the work of accompaniment, and a crucial aspect of therapeutic action, involves failures of accompaniment. The analyst is in the wrong key or time signature, and as when this happens in jazz ensembles, an intensified listening and greater mutual understanding than previously experienced ensues. Through heightened episodes that result from disruption of accompaniment, and subsequent re-attunement by the analyst as she struggles to regain attunement in an open, non enigmatic way, the patient gains trust in her analyst and her object world, her perceptions, and her ability to act and impact her object. She gains a greater sense of what is real. These moments of re-alignment and mutual understanding are intensely meaningful. The therapeutic effect is contingent upon the analyst’s recognition of failure and its effect on the patient, and the responsibility the analyst takes for these mis-attuned episodes. THE EMOTIONAL WORK OF ACCOMPANIMENT The shared emotional experience is not always–or often–pleasant and easy. The work of accompaniment involves the analyst’s increasing capacity to bear uncertainty, confusion and suffering, allowing her to be with the patient in various forms of accompaniment. The analyst’s instrument for finding the right form of accompaniment is embodied attunement, meaning the analyst’s kinesthetic sensing of herself and her patient, knowing their rhythm, affect, and experience as communicated through the body. Embodied awareness can be expanded with time and dedicated attention. It shifts the direction of the analyst’s attention, from primarily on the patient’s words and associations, or the analyst’s “reveries,” to the immediacy of bodily and perceptual experience in oneself and in the dyad. This way of attending has a concrete “now-ness” and “here-ness.” The consistency of time and space that frames the analytic experience allows for increased attention to our sensorial-perceptual experience. The sense of my body in space, in relation to the patient, my sense of movement, the sound and colors and atmosphere, all move in response to the interaction, where emotions are first recognized through the body, then put into words as feelings. “Presence”–the ways I sense my openness and welcoming —is also felt in the body. This is my subjective embodied “home base,” the best set point to listen and accompany. In my experience, when I am a present, embodied accompanist, I notice the quality of light in the consultation room and the richness of color, the way my body moves in fluid ways, the rounder tone and timbre and rhythm of my voice. These somatic-perceptual qualities are constantly changing and signal shifts in my emotional states that often mean a disruption in the “home base” of receptive accompaniment. I feel relaxed and open to sensations and feelings I know through bodily response. To get there involves a struggle between urges to erase or anesthetize my experience, or stay with and contain the patient’s distress and my uncertainty about what is going on. When I am preoccupied and off, or when I match the difficult states in my patient in ways that overwhelm me and I dissociate, that can be known to me (and the patient as well) by the way my body signals me that I am not settled, cannot focus, am agitated, or at times familiar to me, when I start to make intellectual disembodied connections. The following is an example. John was an unusually sensitive and perceptive patient. He was exquisitely reactive to intrusion and abandonment and needed just the right rhythm from me in order to stay with his own mind and experience. In contrast to many patients who make silent accommodations to 436 MARKMAN our frame and way of working, John “knew” what he needed from me to get on. It could not be otherwise. What he needed was a felt sense of my struggles to get the accompaniment right, while surviving my multiple failures. If I could stay with him and endure his stinging accusations of my lapses, he went on with what he wanted to explore. I understood from this that he did not want any intrusions that he discerned—often accurately—came from my own needs. This exposure was uncomfortable; he picked up on real aspects of my personality I was not especially proud of that did indeed interfere. When I hung in there and tried to relax physically into the immediacy of what was going on between us, I could find the right rhythm and he would go on and be with him. I needed to be present, not too laid back: he could not tolerate silence on one hand, or liveliness on the other. After many attempts I “found” the right rhythm and tone, guided by his constant feedback. I discovered this by trial and error and through a heightened awareness of my bodily state that often involved physical manifestations of shame and stress. When I surrendered to these feelings and could accept them, I was able to respond in spontaneous ways in the give and take in the moment. My aim was to find a relaxed groove in myself that I could then offer him. With each patient, unless there is an immediately intuitive sense of how to be, which is rare for me, there is work in finding the right accompaniment. The challenge is that “rightness” can shift frequently. The work initially involves accepting failure and being in the dark, tolerating difficult bodily states and feelings. Because failures come from necessary experimentation, we are constantly at risk of missing the mark. But being too cautious is itself a kind of weak accompaniment that is difficult for many patients. With John I found a form of accompaniment that was a soft and steady rhythm, closely following his lead, using bodily clues to his state of mind and need for quiet or more active support. I was almost always active, rarely silent, giving him a sense that I enjoyed listening and being there with him. This took time. I needed to tolerate his intense scrutiny and exposure and the negative feelings it evoked in me in order to find a relaxed set point. John made the state of my body and mind a prerequisite for being in his own mind. He sensed immediately my bodily state and thus my state of being with him. When I relaxed in my chair, tilting it fully back, he would comment, “I like that you’re at ease with me. It makes me feel you want to be here.” My tone of voice, its depth and timbre, registered immediately as well. If I spoke out of pressure, coming from my need for contact or meaning, he would unfailingly decry my “thin voice” or “fast tempo.” If I asked a question that related more to my need to know than what he was developing, he would tell me to stop interrupting him, “Is it OK for me to go on with what’s on my mind?” I thought of him as a real connoisseur of the quality of accompaniment, and he taught me, how to handle failures of accompaniment that allowed for his continued emotional growth. I am not presenting John in the usual form of a verbal dialogue. This is intentional and necessary. What happened between us, the real juice of the interaction, was in the emotional rhythmic exchanges and my internal work to recognize and contain my emotional states so as to be with him in a relaxed way, so that “the dance and music of the relationship”4 was like an easy and slow blues ballad. Many questions must arise from this account regarding enactments, countertransference pressures, and projective identification.5 Yet I believe there is value in 4 See Harrison (2014). These questions involve the content of our relating but not its embodied form. It was not my first priority to communicate content: action and interpretation derived from metabolizing and symbolizing non-represented states in the patient or living out unconscious object relations. 5 ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 437 waiting until I have provided a basic and necessary presence as accompanist. Accompaniment that involves the analyst’s containing-metabolizing function as an emotional form of engagement has therapeutic value, I believe. My main job though was to get back to John and his world, to get back to accompanying him and not continue to work through my world of memories, or “make sense” of what happened between us. If I could detect that John was disturbed in a way that led to a kind of manic flight, not wanting to confront me with my absence, then I might slow down the interaction, to see what more emotionally lies there, and to take responsibility for my absence. My solid and reliable accompaniment eventually allowed John to take my attention and care more and more for granted. This was freeing: he could feel himself, his needs and desires, in my presence. He eventually “knew” when my embodied state communicated relaxed openness and non-acquisitiveness, when not preoccupied with my needs or disturbed by his freedom and spontaneity. He summed it up quite beautifully: “if you’re calm and relaxed I feel you want to be here for me, with me, and I can go on.” Perhaps even more telling, he said at one emotional moment. “I think you care more about me than your own theories.” FORMS OF ACCOMPANIMENT The following clinical examples show a range of accompaniment, from active constant pulse, to more spacious accompaniment, from active-interactive engagement, to disruption. I am not suggesting that forms are constant with each patient, or even within a session. There is often modulation as the situation call for. The musical examples are referenced at the end of the paper and might provide an enjoyable and illustrative accompaniment to your reading. Illustration #1: The Steady Support of Accompaniment One form of accompaniment gives the patient a steady rhythmic support. On John Coltrane’s Impressions, the drummer Elvin Jones is palpably and energetically there in a way that is both strong and relaxed. Elvin Jones’ pulse says, “There is no getting off this train,” as he pulls the group along while giving the soloist a solid and reliable floor of support. “I am here with you; I won’t let you go,” he speaks, “no matter where you go.” Coltrane depends on Jones to carry him and push the beat, allowing Coltrane to extend his narrative in fresh, surprising, and passionate ways. In this clinical example with Phillip, the analytic pair starts in rhythmic disarray and it remains jagged for a time. Recognizing this, I try to generate a strong pulse to engage and support the patient. Once the pulse is established the patient begins to stretch out. The pulse between Philip and me was fragile and would drop off when he felt I was not with him. The disruptions for Philip often involved his suspiciousness, expecting my criticism, boredom, or disinterest. If I could supply a calm and steady rhythm, a steady ease of tempo—communicating in the musicality of my response acceptance and interest—he would be very receptive and join me. This experience often required a pass through disruption. In this session, as Philip greets me with a smile he abruptly shifts his gaze in doubt. The tempo has stopped; there is a sensation of dropping or falling. “You’re less friendly today, you’re not on my side,” said Philip by facial expression, slight movement in his hands, and 438 MARKMAN overall stiffness in his posture—as if he had taken a step backward. A moment of promise collapses into punctuated rhythm, tension, and heavy silence, as he then slowly makes his way to the couch, carefully lowering himself down, bracing himself. This says to me, “What am I in for?” I am immediately disappointed and let down: “Oh no, we’re in this world again.” Despite being here many times I feel a slight panic. I have to fight the urge to change his reaction or somehow “understand” by using what I already know. Should I point out his suspicion and anticipated rejection, aiming to get at the unconscious phantasy guiding the patient? (And also perhaps to deny the accuracy of his perception?). When I am tense and feel on the spot I have a tendency to get “thoughtful” and a bit heady, to figure something out and put it quickly into words. When I resist this urge we can continue the conversation without words by making myself open to John through observation of my bodily state. Just this shift in my attention to my bodily state shifts my presence with him. I must take into account the way I am and find a way to accept what is going on by making space for it. What had I communicated that he responded to? Perhaps it was I who disrupted the rhythm? I recall some physical tension in me upon greeting him: a physical reserve and a more quiet “hi.” Yes, I was guarded. I was the one suspicious and slightly closed off in our initial encounter, so not responding fully to the invitation of his smile. This was the disrupted nonaccompanying state I offered that led him to withdraw in a self-protective silent retreat. As I filter through these feelings and associated sensations my body relaxes a bit and feels more supple and open, as does my mind. I am aware that my breathing is deepening, slowing down. Simultaneously I sense that he seems more relaxed as well: there is a lighter feeling to the silence and a sense of possibility. These moments are hard to put into words. I sensed we were sharing a physical space in subtle rhythm of movement that was now warm and encouraging, that the quality of our silence shifted to a peaceful register. Something important was communicated without words at the level of bodily resonance and I felt the two of us settling in. This is the beginning of my accompaniment, a grounding rhythm he can sense, share, and build on. In the somatic register I am saying, “OK, go on, tell me, I’m listening.” In this shared peaceful state I noticed that the light in the office is softer and the sounds from outside less intrusive. “I am glad to be here, I like doing this” comes to mind. I sink more deeply into my chair. I then started a steady accompaniment. I offered in a relaxed way, “That was a tense start but we’ve found a good way through it to be together now.” “Yea I felt you really don’t like me … I know I’m difficult at times and I’m very wary. You get that for sure and it must make you tense.” “Well,” I responded, “maybe, but I bring my own tensions into the picture too.” He gives a laugh, “I don’t know why but that’s relieving. You were tense at the beginning then? I’m never sure what I see.” “Yes, and it messed you up, stopped us in our tracks.” “It stopped me for sure, I didn’t feel like talking to you.” (I was concerned he could be going along with me, being compliant, rather than using my steady leading accompaniment to get deeper into his own experience. So I remained actively present and less directive). “That’s rough,” I say. (Meaning, “I’m here, let’s go on”). “It’s hard when we don’t connect. I am so affected when I pick up something negative in you. I always feel I’ve done something wrong.” (This is emotionally poignant, taking responsibility for what goes wrong in relationships, and this goes way back). “Now you see I have a part in it. You didn’t cause it.” “I’m grateful you say that,” he says. ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 439 I am providing a steady rhythmic accompaniment, taking the tone, length of expression, and intensity, and matching his, not in mannered way, but loose. The content is important of course, but at another level he senses that I am with him and will receive him, adding a bit for him to tell me more. Adding something of my experience in an emotionally present way gives Philip a stronger sense of himself and his experience. This interaction feels warm and important, and I sense we both feel that. He feels my comfort and openness, in marked contrast to our meeting at the beginning of the session. I believe the patient recognized a shift in me without my putting it into words, that I was no longer on guard. Then I could initiate a rhythm of welcoming and openness. The pulse was there, strongly. But I have to initiate it. The accompaniment that initially was absent, confused, and conflicted; with internal work and my accompaniment, the patient could go on. The patient’s thoughts began to roam more freely soloing. For some patients it can take a long time to tolerate the sense of separateness that soloing requires. Philip’s jagged staccato rhythm of self-interruption was met by my steady stream of supportive responses; this allowed him to go a bit further. Philip made use of a constant strong rhythm that did not vary. Any break in my pulse felt to him like tentativeness, withdrawal, or a negative reaction. I had to learn this through patiently through experience. This is an example of the importance of accompaniment in the concrete immediate way in which the patient needs our unquestioned constant presence. Illustration #2: Unobtrusive Accompaniment This rhythmic accompaniment is not immediate and pulsing, more a sound “medium” of support, finding the patient where she is, not urging her on or directing her, carefully and lightly following. The pulse is fluid and expansive in a quiet way, drawing less attention to the drummer as a differentiated voice. Musically, this can be heard in Paul Motian’s work on River’s Run. The drummer’s support here is palpably there, but less conspicuous. He creates a fine yet firm tissue that surrounds the soloist. His touch is light, non-repetitive, not driving the beat but suggesting it, creating spaces with silence or minimal fills. You can almost take his voice for granted—almost, yet the pulse is there, his presence a vital atmosphere of support. Here is how that same form of accompaniment worked with Betty, a successful doctor who came to therapy to discuss problems with her “fussy child”. From the initial session she could not get physically confortable. The couch, which she first tried, lacked proper support, “was weak and uneven.” She lay on the “too hard” floor, tried all the chairs in my office, paced, sat on pillows. Nowhere felt right. She chose one chair as the lessor of evils. Understandably, she often talked about somatic discomforts of one sort or another that moved throughout her entire body and affected her mind. There was a kind of insistently repetitive rhythm, unvarying in intensity and form. For example, the beginning of sessions often sounded like this: P: I can’t think … I’m not doing well at work … I’m not doing well at all … I’m stuck … my back hurts and I’m tired … I can’t get comfortable here; maybe I’ll walk around. (She stands up and paces for a moment. Then sits down.) The bureaucracy at work is killing me, causing me so much work … Incompetent … I never should have left X. (This is said in jagged broken rhythm matched by her movements, which are broken and abrupt.) 440 MARKMAN At first I interrupted her rhythm by suggesting the symbolic meaning of her bodily experience. My long comments concerned the concrete aspects of the uncomfortable office as representations of her emotional experience with me, and in herself. I often thought about and at times interpreted the sort of transference-countertransference we were in. For example, the inadequate mother unable to soothe her baby. In response she would insist on the real difficulty of this chair or that couch, or this situation or that somatic pain. As we went through these exchanges a deadening shared rhythm began to have a life of its own, the back and forth of two agitated and frustrated bodies matching each other. My feeling of failure to bring her bodily experience into a symbolic realm frustrated me and make me tense. My voice sounded sharp and clipped as I began to have feelings of suffocation and pressure. Over time I recognized that I was dominating her with stabbing comments, giving her little room to get comfortable, relax, and breathe. I was not accompanying her in the world in which she actually lived, but rather matched her state. There is an important distinction between matching (especially negative matching and merger) and accompaniment by a separate and attuned presence. Matching is the absence of accompaniment. Instead my accompaniment needed to welcome her and provide space for her, to share this uncomfortable repetitive experience in a containing way rather than simply vibrate at her rhythmic frequency. That is, to pick up the rhythm where she moved and suffered, and tune into it from a calm place in me. Though I approximated her rhythms, the vitality form was different in me, calmer and relaxed. I found a way of way of being together that accepted wherever she happened to be without intruding my desires or ideas about how things should go. All the while I related to her physical states as physical states, not symbols or metaphors or unconscious. I could then empathize with where she lived. I accompanied her as someone in pain, perhaps pain that will never end. I would ask simple questions, taking interest in whatever held her attention, allowing her to expand her somatic story. Her pains had an impact on me. For example, P –God I’m sick today … my neck … everything is falling apart A –I see that. You’re body’s really tense. P –It’s especially tense in my shoulders and neck … to much time at the computer … like this (She shows me.) A –That looks like it hurts, that way. P –Yea. (I immediately notice her shoulders relaxing and there is a long silent pause.) I’ll try to be aware of that. Although the painful somatic narrative continued, it was given in a more related, relaxed, and emotional way, with more detail and nuance. I could tell she wanted me to hear it all and she sensed I wanted to hear it all. I think she felt a shift in me: I was with her, wanting to be with her, communicated in the spreading arc of my tone, cadence, and relaxed presence. The first change I noted was that she seemed more comfortable in the chair and moved around less. She was not scouting her next move. Her body relaxed and she gestured more freely. At one point she told me she loved to dance as a child and wondered if she should try a dance class now. She requested more time with me without needing (or able?) to explain why. And things changed in her life, trying new relationships and activities. I would describe this kind of treatment as support at the most fundamental level of being, though a pain at her core, she could share that with me; it was the beginning of going on being with her pain. Betty found more comfort in herself that opened up possibilities not there before. I would analogize my ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 441 work here to the way Paul Motion creates a broad and flexible rhythmic container of warm space that does not push the pulse or announce a more differentiated presence on my part. Soothing and patient. Illustration #3 Interactive, Playful Accompaniment In ensemble playing with less firm, differentiated roles (while still maintaining asymmetry in responsibility), both patient and analyst play together, at times in a mutually interactive way, elaborating each other’s contributions. There is more anxiety and uncertainty for the analyst here requiring spontaneity, improvisation, and risk-taking. Miles Davis created an interactive group conversation on My Funny Valentine—Live at the Plugged Nickel. Here, an attentive sharing of the creative movement requires the drummer Tony Williams moment-to-moment responsiveness all the while maintaining the rhythmic framework. Williams sometimes solos and the group accompanies him, a beautiful trade off of roles, though William’s beat, his responsibility for the beat, is never lost. He offers the possibility of mutual play and interactive soloing. In my experience it takes a while for most patients to make use of this kind of accompaniment, only after the establishment of trust and tolerance of separateness and dissonance. Roger, a middle-aged male architect, brought in endless obsessional accounts of his work. He could not produce the necessary drawings for his projects. A mechanical, machine-like beat he set marked our time together. I had the sense that either creating a strong counter pulse or being more quiet and receptive would not alter his driving rhythmic obsessions. He would either graft his rhythm onto mine or power through a more nuanced background. Instead I wanted to find a way to catch his interest in another, different rhythm that we could share. I really did not know how to do this initially, nor where that sharing might lead, but I had faith, not certainty, but a sense that Roger could tolerate the space of interaction, if I could do this. However, I had to live within this mechanical rhythm until a genuine source of accompaniment organically emerged in me and with us. I let go of attending to his rhythm in order to find an embodied place for both of us to begin. This letting go expanded my sensorial consciousness, becoming more alert to sensory aspects of our meetings: the light of a particular time of day that brought out different colors and moving shadows on the walls, the way the sound of our voices echoed in the room, smell of coffee and fragrances from outside, and so on. My attention had widened and I found life in the surrounding world we shared. Then a slow accompanying rhythm started, a way I wanted to speak, that had fluidity and depth. I pointed out sensory aspects of the office; he would then comment on what I said. In the give and take about the sensory surround something was building in our interactional rhythms. Unlike a mechanical beat these rhythms varied in cadence, tone, and intensity, interweaving in something like a fugue: two rhythmic figures, two motives, that are in conversation while developing independently. In one session while listening to the nice sound and pattern the rain made one late afternoon, I said: “Listen to that rain.” “Yea,” Roger said, “It reminds me of the sound of sailing” with vitality and feeling—far from mechanical. Roger went on in an enlivened way to vividly describe the sensory qualities of sailing and sense of movement. In one moment a few sessions later, after a period of relaxed silence between us, he casually got up from the couch, sat next to me, and showed me pictures he had taken with his phone. The pictures were street scenes, 442 MARKMAN glimpses of people in motion. In contrast to many of his dreams early in the analysis, which were devoid of people and involved desert-like landscape, these pictures had life. I did not know of his interest in photography. As he described the pictures, and I responded with lively associations, he noted how important this activity was to him: “It brings me into the world of people.” Over time we were able to build on these experiences. At times he would be the one to offer some meaningful observation, to which I associated in response to what I saw, adding something of my own sensibility to the conversation. I definitely felt the risk involved in this playing, the real risk of mis-attunement, or a feeling I had taken over something of his, or used it for my own purpose. At times I could see when I went too far and backed off. But more often he was energized by the interaction and continued to bring in new aspects of his life and interests. His greater sense of creativity—in himself and interpersonally– also enlarged the space for me to respond from my own experience. A shared conversation ensued, our mutual interest in music and art as the vehicle for enjoying the vitality in each other. I did not lose track of who was responsible for the beat and accompaniment, and who was meant to develop and grow, though there was no obvious demarcation of soloist and rhythm section as in the previous examples. The accompaniment shifted back and forth, finding myself in a clearly supportive accompanying role as either the steady pulse or providing the unobtrusive rhythmic fabric of support. I found that what Roger needed was a partner in improvisation rather than a participant supporting his emotional elaborations. To do this I had to interest him enough in a world outside himself to join me in creative dialogue. Illustration #4 Enlivening Accompaniment Sometimes the analyst needs to break out of deadening rhythms and take the lead, though a lead that should eventually engage the patient in her own experience. This might be like an extended drum or piano solo that invites the soloist to engage and begin to take to the lead. Joan was a woman in her forties who sought treatment for marital difficulties. She was highly intelligent and had an elegant and erudite way of speaking, though the stories she told were intensely disturbing. Often the scenes she relayed involved sado-masochistic sexual experiences with her partner. She could not organize a thought that would have disapproved of her partner’s behavior because she did not experience it. She was not there. Initially I was so caught up in my own emotional reactions that I could not appreciate Joan’s empty state of mind. I tried to control and understand my sense of outrage on her behalf, caught up in her stories that left me silently cut off from her. I became a silent witness to a disturbing primal scene. Gradually I returned to her and the way she related to me, encountering something strange and disorienting. I had the uncanny feeling that Joan and I might as well be skyping: there was a glass wall or screen between us; we were not sharing an embodied space. I started to have overt de-realization experiences. Her mouth would move but there was no intelligible sound. At times I felt as if I was watching a movie without sound or in a foreign language. Her movements lacked meaning. There was no way to join her without entering this deadened pantomime. This shared disembodied world was important for me to know about but I had to do something with it, disrupt it by changing this rhythm by offering something that brought us back to two bodies together. ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 443 I would have to try to provide a pulse by improvising, becoming the soloist-accompanist, providing the pulse, tone, and narrative to see she could join me. To do this, it is was crucial that it not come from my anxious need to connect and her to comply, which would duplicate the exploitation she knew well. In one session, after she spoke in her usual way, I started to narrate how she came in the room that day, how she moved and looked, her facial expression and tone of voice. I tried to do this not as a distant observer, but someone close up, as someone might lively narrate in their own mind what they are doing, he basic fact of having a body, relaying on my embodied experience of her. A –I heard your light footsteps coming up the stairs and saw you smile when you came in to see me. Maybe happy and a little nervous. P –You noticed that? A –Yes, and how your voice started strong but then got quiet. Now its sounds quiet but I can still hear you. (I think at this point I’m injecting more feeling. I’m telling a story about the two of us. I am not sure if she will join me). P –I’ll speak louder A –Do you want to? P–Hmm. I don’t know. I didn’t notice my voice. Now I do. It sounds scared maybe … I remember going to a lake for summer with my family. My younger brother was fearless and would take a canoe way out there. I would be on the shore looking at him and not being able to say anything, but I was scared. (I sensed real feeling as the story unfolded. There were many ways to interpret the memory she described. Had I left her behind by initiating a story between us, as she watched me like she watched her partner, doing his own thing? She was experiencing something, not detached, relating to me in a way I felt. I thought it best to stay with her fear of separation and abandonment. The connection was delicate, I hoped to maintain it and not go too far beyond her. So I chose to emphasize my continued presence.) A –We don’t have to be that far apart. I won’t drift away. P –I want you to stay with me … tell me more what you see. (This request that I tell a story about her or about our relationship was surprising, and became more frequent going forward. The stories were actual descriptions of what I experienced, staying in an embodied register. I rarely suggested motivation and or wondered about complicated feelings. The form of request, the wish for a particular sort of accompaniment was important: “Tell me what you see,” a request for recognition, a description she can also observe, finding her way back to her body and her experience.) A –I hear a soft voice but with more feeling. P –yes, I do too … hear my voice, and feel more. This exchange went from dissociation to the emergence of her voice in response to my soloist- accompaniment. These exchanges were very important: I would commence with “what I see,” then Joan would recognize something about her own experience, become a subject in her story. Eventually Joan began to take the lead in the conversation, as when she requested that I stay close to her. 444 MARKMAN Illustration #5 the Disrupting and Disrupted Accompanist This case will illustrate the fluidity of varying forms of accompaniment, from disruptive, to unobtrusive, to echoing-reaffirming in shared emotional time the patient’s solo expression. This last form of accompaniment is not “I am with you” but “We are in this together.” There are occasions when the analyst disrupts the patient’s rhythm, creating a freer, unstructured form that may lead to stronger self-experience in the patient. Sonny Murray’s rhythm with Cecil Taylor were disruptive and rhythmically dissonant, with the aim of finding a new interaction. Overtime a heightened ensemble experience is reached. An example of this is his work in Lena. In our first meeting Deborah announced, “I don’t really know who I am.” She was a highpowered executive who ran at 78 rpm. She spoke so rapidly I often asked her to repeat herself. One aspect of her history stood out: when she was eleven she underwent surgery following a traumatic injury. This history came out casually despite the fact she had what must have been a frightening several months in hospital. She was facing the loss of important capacities for the rest of her life. She did fully recover physically. I interrupted her with questions and clarifications meant to disrupt her rhythm. I chose this path from experience. When I observed her relentless pace, my comments hardly altered her breakneck cadence. By disrupting her she eventually was at a loss of what to say: “I realize I’m just filling space … what I’m saying has no real meaning to me.” My interruptions were an attempt to empty space of “filler,” to see if, in an open space, she could find real emotional experience. Lengthy silences ensued that I did not interrupt. I thought this was uncomfortable progress for both of us. In the disquieting silence Deborah worried about her impact she was having on me: “You must be so bored.” I had faith that this could evolve productively if we both had the stamina. She eventually settled down and verbalized feelings of emptiness and hopelessness that occasionally broke long silences. I provided an unobtrusive accompaniment, careful not to take the lead, wanting to communicated patience and acceptance of what she experienced. We both expressed hope that something will come of this new and painful experience. But what happens when the analyst is disrupted and drops out as accompanist or is inadvertently disruptive? How does the analyst reemerge as accompanist in that situation? An unexpected event occurred in the analysis. We had a flood in the office building. Big dryers were placed in the common areas and the place was in shambles, with the rugs torn out exposing unfinished flooring. I was discombobulated, anxious, distracted. Should I even be seeing people in this space? The noise of the heaters was distracting. Aside from having no carpet and hardwood floors exposed, my office was much the same–enough that I did not feel completely at sea. At least I was making that case for myself, that I had enough in me to attend to my patients. But I certainly was not the calm unobtrusive analyst now! Nor the deliberately disruptive accompanist. I was in fact taken out of any obvious accompaniment mode. When Deborah arrived I expected she would have a big reaction, as did most of my patients. Instead, she casually moved to the couch and continued her silent vigil as if nothing was altered. But after several minutes she started to speak about my state. “I can really sense something is wrong in you. You seem agitated, anxious, off, not yourself … Are you OK? … This is starting to really distress me. (She starts to cry, an unusual emotional expression.) You are definitely not yourself.” ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 445 This was a crucial moment. She sensed and was affected by my agitated rhythms, which I internally, unsuccessfully, attempted to dampen down. I had the temptation interpret her attributing to me her own distress. There was some truth there, and hostility too because her safe environment had now been shattered. I did not make that interpretation because it would have been defensive, and she was having an experience of me that was accurate. This was the main thing. So I listened and encouraged her to go on. In listening I found a way to be present and tolerate my sense of exposure and guilt, until I could find the right way to accompany her and what I wanted to say. I wanted to do this in a sincere way, not denying her observations and not providing false security or false calmness, but an honest, vulnerability account. The accompanist was having trouble and that truth needed be acknowledged for an authentic rhythmic connection to begin. I found this by verifying her perceptions of my inner states in an affirming way.6 A –You’re right. I’m unsettled and distracted by my office, because of the flood. P –I assumed that. I wanted to ignore what is going on here because I assumed you would have it all in hand and it was not a big deal … that sound is actually annoying and distracting. (She starts talking about the environment in stronger, much more intense ways.) I hate this! I should just ignore it!. A –It’s pretty hard to ignore it. I’m having a hard time ignoring it. P –It’s strange how I never had a sense of you in this way—you’re not your usual calm voice—now it’s your whole anxious self! You’re moving a lot back there. Your voice isn’t normal. A –I’m not in my normal state of mind because of all this and I’m worried about how this affects you. Now I see it is my state of mind, my nervousness, that’s affecting you more than the office. … You sound different too. You’re voice is really strong, certain, distressed. Present. P –(After a very long silence). We are really together in a different way. You’re not just a talking head and I’m not either … this place is a drag really. But I feel a bit freer. In the following sessions we discussed the office scene and how we both felt about the dryers, the floors, the smell, and future construction. As she took in more and more of the external reality, asking me detailed questions about the office and my state as well, which I responded to in a open way, she made contact with herself and me in an embodied way. There was a true pulse in regular time, not double time. Due to her traumatic experience in hospital, this aspect of her inner world and relation to her body had been severely attenuated. Out of the despairing, empty silences in which I accompanied her unobtrusively, I sensed a new beginning. This period lasted a few months. With the office flood she had direct access to my embodied state in a realistic way. The way to her body then was through mine: she would first find in me a preliminary container for her own physically distressed state. My role as accompanist was to reaffirm her experience of me and its impact on her, the way the rhythm section reinforces the soloists statements. Eventually, associatively, the time in hospital entered our conversation. She went over the physical aspect of her hospital room in great detail, and the terrified expression on her parent’s face, before touching on her fears of her own body and what was happening to it. In this phase I was in again in the position of unobtrusive witnessing accompanist. But there were moments 6 For reasons of space this passage is a condensed version of the interaction. 446 MARKMAN when she sensed my anxious or disturbed reactions to her narrative that was correct and shared. This was a kind of booster that allowed her to continue in an emotionally present way because the sharing of emotional-physical states was essential to her find a way to experience her trauma. The establishment of this connection eventually opened up the “residue” of the associations to the flood: her traumatic stay in the hospital she had not experienced until then: the panic in her parents and her own fears of bodily integrity. CONCLUSION This paper extends Knoblauch’s (2000) work by arguing that improvisational accompaniment is a primary mode of analytic attention and action. Accompaniment is not blending, merging, or doubling the patient’s voice, or an easy way of “mirroring” the patient, nor is it symmetric mutuality. Rather it is offering varying modes of embodied attuned presence that is emotionally hard won; internal work is required to find the right form of accompaniment by tolerating discomfort, uncertainty and unpredictability. It involves the analyst’s internal struggles to remain receptive both to his and the patient’s disturbing, disruptive bodily experiences that often come from suffering and trauma. Accompaniment marks one important area of clinical technique. Currently, embodied awareness is usually not taught or considered in supervision, case conferences, or written case histories. Yet the training of embodied attention and internal perception allows one to grasp essential information about the pulse and affective form of the relationship, increasing awareness of two bodies together in the language of movement, tone, and rhythm. This awareness opens up a novel, potentially transformative realm of analytic accompaniment. REFERENCES Balint, M. (1968). The basic fault. Northwestern University Press. Elise, D. (2017). Moving from within the maternal: The choreography of analytic eroticism. Journal of the American Psychoanalytic Association, 65(1), 33–60. https://doi.org/10.1177/0003065116688460 Harrison, A. M. (2014). The sandwich model: The ‘music and dance’ of therapeutic action. The International Journal of Psychoanalysis, 95(2), 313–340. https://doi.org/10.1111/1745-8315.12113 Knoblauch, S. (2000). The musical edge of therapeutic dialogue. The Analytic Press, Inc. Langer, S. (1942). Philosophy in a new key. Harvard University Press. Langer, S. (1956). Feeling and form. Charles Scribners and Son. Marcel, G. (1956). The ontological mystery. In The philosophy of existentialism. Citadel Press. (Original work published 1933) Markman, H. (2017). Presence, mourning, and beauty: Elements of analytic process. Journal of the American Psychoanalytic Association, 65(6), 979–1004. https://doi.org/10.1177/0003065117747877 Nebbiosi, G., & Federici-Nebbiosi, S. (2008). “We” got rhythm: Miming and the polyphony of identity in psychoanalysis. In F. Anderson (Ed.), Bodies in treatment (pp. 213–236). Analytic Press. Rose, G. (2004). Between couch and piano: Psychoanalysis, music, art and neuroscience. Bruner Routlage. Stern, D. (2010). Forms of vitality. Oxford Press. Trevarthen, C., & Malloch, S. (2002). Musicality and music before three: Human vitality and invention shared with pride. Zero to Three, 23(1), 10–18. ACCOMPANIMENT IN JAZZ AND PSYCHOANALYSIS 447 CONTRIBUTOR Henry Markman, M.D., is a Training and Supervising Analyst, and Program Co-Chair of Dialogues in Contemporary Psychoanalysis, at San Francisco Center for Psychoanalysis. He is in private practice, Berkeley, California. MUSICAL REFERENCES 1. John Coltrane, Impressions, The 1961 Complete Village Vanguard, Impulse, 1997. 2. Paul Motian, River’s Run, Mark Copland New York Trio Recordings, Vol. 2: Voices, Pirouet, 2007. 3. Miles Davis, My Funny Valentine, Live at the Plugged Nickel, 1965. 4. Cecil Taylor, Lena, Nefertiti, the Beautiful One Has Come, Revenant, 1962.