Time On My Hands

Psychoanalytic Psychology Copyright 2006 by the American Psychological Association
2006, Vol. 23, No. 4, 619 643 0736-9735/06/$12.00 DOI: 10.1037/0736-9735.23.4.619
TIME ON MY HANDS
The Dilemma of the Chronically Late Patient
W. W. Meissner, S.J., MD
Training and Supervising Analyst Emeritus, Psychoanalytic Institute of
New England East
In this article the author discusses the problems and dilemmas created by
patients who are chronically late for analytic hours or frequently absent from
them. The discussion focuses on a single case study, in which this phenomenon
was a predominant feature of the analytic process. The author explores some of
the issues, dynamic and defensive, underlying such behavior as well as moti-
vational components involving unresolved oedipal issues and powerful unsat-
isfied narcissistic needs. The temporal difficulties of patients such as this one
demonstrate the role of time as a point of conjunction of aspects of the analytic
relation involving the temporal dimension of the real structure of the analytic
situation and its intersection with transferential and alliance considerations. The
analytic task is to balance the temporal requirements of the analytic process
against the array of the patients infantile and narcissistic needs on one hand and
legitimate claims for autonomy and freedom on the other.
Keywords: lateness, narcissism, transference, therapeutic alliance
Were I to try to tell experienced analytic therapists that patients come late to their analytic
hours, it would not be much of a revelation, nor would I imagine that they would not also
consider lateness to always be a problem. We all would agree that when lateness is
occasional and minor, the problem is minor, although most would entertain some interest
and an index of suspicion regarding the patients motivation for even occasional lateness.
Even minor lateness can harbor dynamic or defensive themes calling for exploration and
understanding (Meissner, in press). But there are also other cases in which the lateness can
be significantrather than the patients lateness being exceptional, the lateness and
absence become chronic such that lateness and missing hours become normative and
coming on time becomes the exception rather than the rule. When such lateness is
continual and habitual, and when the patient arrives 20 30 minutes late rather than just
510 minutes late, the problem becomes major and carries with it a challenging dilemma.
W. W. Meissner, S.J., MD, Training and Supervising Analyst Emeritus, Psychoanalytic Institute of
New England East.
Correspondence concerning this article should be addressed to W. W. Meissner, S.J., MD, St.
Marys Hall, Boston College, Chestnut Hill, MA 02467. E-mail: william.meissner@bc.edu
619
620 MEISSNER
If such acting out cannot be modified, the analyst is faced with a difficult decision: on one
hand, whether to discontinue the analysis in the face of severe and seemingly intractable
time dilution and significant avoidance, or, on the other hand, to persist in efforts to
maintain the analytic process in some limited and compromised sense, in the hope of
facilitating some therapeutic gain and advantage for the patient regardless of the obvious
temporal obstacles.
In the analytic literature, as far as I could discover, there are some valuable general
discussions of the time parameter in analysis (Bach, 2001; Boris, 1994; Boschan, 1990;
Green, 2002; Hartocollis, 1983, 2003; Namnum, 1972; Panel, 2005b). Closer to the
subject matter of this article, there are a handful of articles dealing in one way or another
with lateness, but usually with occasional or exceptional lateness of the patient (Barrows,
1999; Ferro, 2003; Kaplan, 1990; Ogden, 2002; Paniagua, 1998; Spero, 1993, Wolf,
1983). Only Hinz (2003) addresses the problem of chronic lateness. The sparseness of
discussion among analysts of this topic leads me to think that more careful attention to it
may be called for.
In this article I reflect on issues related to such lateness and missing of analytic hours
in a patient for whom time problems played a central role in the evolution of the analytic
process and for whom significant lateness and frequent missing of his analytic hours
created severe difficulties in the development of the analytic process. I emphasize that this
case, as with all analytic cases, involved a variety of complex issues that played a
significant role in the overall analysis (for example, the further ramifications of his sexual
orientation and his extensive narcissism) but that I will not consider here, because my
purpose here is to focus attention specifically on the time problem and a few salient related
issues. In addition, one compelling emphasis in this discussion concerns the extent to
which his limiting the time spent in analysis severely compromised the degree to which
many of these core issues could be explored and the underlying genetic, defensive, and
dynamic components successfully processed. Space does not allow extensive discussion
of otherwise analytically relevant and even important other issues.
Doubtless such chronic lateness and absences leave the patiently waiting analyst
sitting with time on his hands, with analysands like this a good deal of time. We may
wonder whether such lateness introduces a parameter into the analytic process that can
lead to a variety of troublesome interactions that will prove to be detrimental to analytic
work. I will discuss these within the framework of what I consider to be the tripartite
structure of the analytic relation as constituted by transference countertransference in-
teractions, the real relationship, and the therapeutic alliance (Meissner, 1996). I will first
discuss the analytic data related to problems of time orientation and time management in
this analysis and then offer some reflections on the issues raised by such cases.1
History
This patient, whom I will call Jake, was a Jewish man in his late 20s, a recent law school
graduate who was currently employed as a legal aid lawyer. He had married about 1 year
1
I am not arguing on a ab uno disce omnes (learning everything from one case) basis, but as
Freud himself observed we often can learn something from a single case that contributes to our
understanding of more than one case. I have been struck in several experiences with late and absent
patients by how similar the issues can be. I have dealt more extensively with these questions in a
monograph in process (Meissner, in press).
DILEMMA OF THE CHRONICALLY LATE PATIENT 621
before coming to analysis. In addition to his daytime job, he was pursuing a more
advanced law degree, hoping that it would gain him access to a more prestigious position
in a law firm, When he began his analysis, he was embroiled in writing the dissertation
required for this degree, and the difficulties he was encountering in this effort persuaded
him to seek analytic help.
Jake was the oldest child in his family and the only male child; he also had two
younger sisters. His father was a vice-president in a small manufacturing firm and his
mother, who had had a career as a successful business executive before marriage, ran the
house and family. Jake was obviously very bright and facile and very precocious as a
child; he was always at the top of his class in grade and high school, was very talented,
and was his mothers favorite. These advantages and his obvious talent allowed him to
surpass his less talented and more pedestrian sisters and gave him a unique status in the
family. But he was unable to relish this distinction without a considerable degree of guilt.
Although he could enjoy and take considerable advantage in his position as mothers
favorite, his relation to her was ambivalent. Whereas he basked in her approval and pride
in his accomplishments, he felt that the price for her favor was a degree of dependency and
compliance against which he rebelled in various ways, some subtle and some not so
subtle. Consequently, going to college away from home represented a form of breaking
away from her dominance and control, a move that took the additional form of plunging
into the radical, somewhat rebellious, quasi-bohemian quality of student life, experiment-
ing with drugs and sex. He identified these rebellious behaviors as acting out against all
those values and standards of behavior for which he felt his parents stood. Despite this
acting out, he continued to maintain good academic standing and finally graduated with
honors. Soon after graduation, he married the girl he had been living with during the last
year or so of college. Largely because of her family ties and dependence, he chose to
attend a local law school rather than to take advantage of better opportunities elsewhere.
If there were difficulties in his ambivalent relationship with his mother, they were
benign in comparison with his problems with his father. Jake and his father simply could
not establish a common wavelength on which to communicate. They seemed out-of-sync
at all points. Whenever Jake achieved anything or received any attention or praise, his
father, as Jake recounted it, seemed always ready to question or criticize. As Jake phrased
it, his fathers question was always Are you really as good as you think you are? or some
variant on that theme. One of Jakes oft repeated complaints about his father was that the
father had little or no real interest in him, never bothered to teach him anything or help
him learn, and never had any time to play with him. I heard frequently repeated stories
about occasions when his father would take Jake out to teach him to play baseball (usually
at his mothers insistence), but when they got outside his father would start playing with
other neighborhood kids and left Jake to himself. The father prided himself on having been
a sometime school athlete, often bragged about his exploits, and placed a high value on
sports. But, Jake, who was more intellectually and artistically inclined, had no interest in
sports, and portrayed himself as awkward and clumsy in any sport activity. I could never
determine clearly how accurate this self-appraisal was; my guess was that he probably had
average abilities and was moderately well-coordinated, but these did not measure up to the
level of his fathers supposed expectations.
This fatherson antipathy went much deeper, however. In his late oedipal and latency
years, Jake described himself as having a terror of his father. He developed nightmares
about his father and was convinced that his father hated him and wanted to kill him. This
fear was central to a memory, possibly a screen memory, of an occasion when his father
was teaching him to swim and, in Jakes retelling, held Jake underwater in an attempt to
622 MEISSNER
drown him. This basic antipathy between father and son persisted through the years and
extended even into Jakes current relations with his father. An important contributing
factor was the tension between his father and motherpart of the fathers antipathy and
devaluing of Jake was related to the fact that Jake was his mothers favorite. There was
an undercurrent of resentment between his parents that he attributed to the fact that when
they married, her father had forced her to give up her successful job and career to marry
his father. The grandfather was convinced that the place of women was in the home and
not in business. In deciding to marry, she felt forced to give up her career and submit to
the demands of her father and future husband, The resentful reverberations echoed through
the subsequent years of their marriage and set up a kind of competitive antagonism
marked by her continual criticism and undermining of the fathers position and influence
in the family and in turn by his undermining and criticism of her efforts to dominate and
control matters in the family. Her constant complaint against him was that he was not
successful enough in business and never made enough money. Most of her socially
prominent friends were financially well-off, and she felt diminished in not having
comparable wealth and resources. Jake seemingly became a pawn in this covert struggle.
One consequence for him was an abiding sense of guilt over his masculinity and the
seeming advantages that provided him. One of the persistent themes in his analysis was
his preoccupation with womens rights and privileges and his deference to the women he
worked with, even at times to his own disadvantage. At times he explicitly referred to his
guilt about preferment over his sisters and to the injustice of his mother having to
surrender her career at his grandfathers insistence.
This struggle continued unabated during Jakes analysis. His parents had married late,
and at the time of the analysis his father was approaching retirement. His negotiations
around retiring turned out to be foolhardy and courted financial disaster for the family.
Among the problems that came to light was the fathers failure to pay income taxes for a
significant period of years, apparently, as Jake saw it, in an abortive attempt to keep up
with his wifes monetary demands. The threat of severe penalties or even conviction and
the possibility of jail time were imminent. In her anxiety and rage, the mother turned to
her lawyer son as her rescuer, casting him once again in a role of opposition and antipathy
to his father.
The Analysis
Jake arrived late for his first analytic hour. Little did I suspect that the pattern which would
characterize the entire course of the analysis was set from the very beginning. As a device
to help the reader appreciate the extent that the lateness problem posed for Jakes analysis,
I have organized a chart (see Figure 1). Each column of the chart represents the percentage
of the available analytic time actually utilized for a given 1-month period during which
any analytic hours were scheduled.2 Casual observation shows that in no month was
attendance complete; in only 2 months did the level of attendance reach the 90% level, in
several months the level of attendance fell below the 50% level, and the overall level of
attendance was in roughly the 60% range plus-or-minus. Of the 1,000 hours of the
2
Some months (as during vacations, e.g., usually August) had no scheduled hours and were
omitted from the chart; some months (as when shortened by vacation or holiday time off or other
longer interruptions) might have as few as 5 or 6 hours, and other months, when a full schedule was
in effect, might have as many as 20 hours scheduled.
Percentage of Time Utilized
100
90
80
70
60
% Utilized
50 Series1
40
30
20
10
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88
Time (months)
Figure 1. Percentage of scheduled analytic time utilized in monthly intervals.
analysis, Jake arrived on time for his session 141 times, that is 14.1% of the time. He
missed his hour completely a total of 111 times, that is, 11.1% of scheduled hours.
Homosexuality
An added dimension to his analytic picture was Jakes homosexuality.3 Within about 1
month from beginning his analysis, he began acting out homosexually, usually cruising for
pickups and one-night stands. He concealed this activity from his wife, usually making
excuses for his absences, saying that he was spending the time working on his dissertation
or in work-related activity. He felt that he had experienced homosexual attraction and
impulses as far back as his latency years but had always repressed or suppressed them,
usually with a good deal of guilt. This activity persisted for the better part of the analysis,
seemingly relatively unaffected by the insights we developed into the oedipal dynamics
being expressed by it. From one perspective, it seemed to be related to his abundant guilt
over his success and the ease of his accomplishments and the guilt related to his masculine
status, such that running the risk of discovery and exposure would satisfy his guilt and
would bring about professional disgrace and ruin. In addition, it would have the twofold
effect of dispelling the idealized image of the wunderkind in his mothers expectations
and, by the same token, would make real his fathers estimate of him as not a real man and
3
I am including some of the material dealing with Jakes homosexuality for two reasons: (a)
Jake himself drew a parallel to the manner in which he regarded the temporal aspect in his
homosexual episodes with the way he regarded the matter of time in the analysis; and (2) there is
a significant overlap in the motivational backdrop behind both his homosexual acting out and his
acting out around the temporal aspects of the analysis.
624 MEISSNER
not capable of manly pursuits and attainments. The difficulties this behavior posed for him
grew more complex and conflictual as he became more established professionally and as
he began to have a family of his own (during the course of the analysis his wife bore two
children, the first a girl and a boy 1 year later). Only toward the end of the analysis was
there any suggestion that this pattern of homosexual involvement might have begun to
abate and become less frequent. It increasingly seemed to become more ego-alien and
conflictual, and gradually receded into the background.
I was struck by his description of his time experience in these episodes. He seemed to
regard these escapades as taking place in some dissociated frame of reference, as if out of
time and space and remote from the current of his real life. As he once phrased it: I did
some homosexual acting out. It felt like it was out of time and space, totally irresponsible.
As if it wasnt related to anything else. I separate off homosexuality: I feel like a different
person, acting out. [How do you see it?]4 Im like a person without past or future, who
exists only in the moment and has no identity, totally compartmentalized. Everything is
present tense. I feel irresponsible and guilty in retrospect, but not at the time. I get some
sort of satisfaction from being unrelated to the other person or to the rest of my life. I get
out of life for a minute, as if slipping into something that doesnt exist. And I have a sense
of freedom. I feel anger at having to live up to others definitions of me. I resent having
to obey any laws or restrictions. I struggle over defining myself about my jobwhat I
want versus others expectations. How important is a career versus the rest of life? I feel
pressure to build a career as opposed to just doing legal aid work and living comfortably.
Acting out homosexually is an escape from all that. I have fears of consequences, but its
as if they dont exist when Im doing it.
The homosexual motif was interwoven with themes of dominancesubmission that
resonated with the transference, particularly in relation to his frustrated desire for close-
ness and approval from his father. It also became clear that the temporal disengagement
in these episodes was a form of rebellious and defiant rejection not only of the demands
of time but also of all demands for performance and responsibility. He expressed these
thoughts variously: In homosexuality I feel wanted and desired by a male who wants a
male. I can dominate, in all my relations with men I want to be accepted and approved.
[You want that from your father too, but do you find ways not to get it?] I want approval
and acceptance of me as a male. . . . When Im cruising Im not doing what Im supposed
to do, so Im breaking the rules. Theres dominance and submission in homosexuality:
another male wanting and submitting to me, and the other way around too. His wanting
affirms my masculinity, but they want my penis more than me. I need approval from men;
I assume that comes from my father. . . . I play hooky from time with the homosexual
stuff. Homosexual cruising is time out of time, just mine; no one knows about it. . . . But
I steal time from my thesis for homosexual acting out. Theres not enough of me, so Im
constantly borrowing. [Are you aware of the interest rate?] It feels anal, like withholding
and controlling. It certainly does here, but then I squander time in cruising. I want that sort
of escape.
These themes were condensed into the transference. As he commented: I attribute
magical power to you. I judge myself, but when I say that out loud I get confused as to
whose judgment it is. [You mean like when you apologize for being late?] Thats
superficial politeness. I say that to both of us, but judging comes more from me. But I want
you to be judging and have external controls; I want you to assume my superego functions.
4
The analysts interventions are set in brackets ([ ]) throughout.
I want something but I dont know what. I deny feeling that I want to be held. You can
be my parent. I was picked up Monday night, a nice and pleasant experience. There was
a lot of holding and not just sex. I split things off. I look for holding and acceptance in
homosexuality. But Im looking for judgment and a parental role from you, telling me
what do. My father never told me what to do. [Who did?] My mother did in some ways
and some areas, but not a lot. I had a feeling of closing off when I thought of Mom, like
a little kid. Thats the wrong question and I dont want to play, but it probably is the right
question. [We can wonder why you want be to be held by a man?] Being held by a woman
is threatening. Im afraid of women.
Time and Transference
As the pattern of lateness persisted, I made occasional sallies into trying to find out more
about it. He was at times apologetic about being late and frequently offered excuses; they
varied, ranging from the alarm clock failing to go off, to traffic delays, parking difficulties,
and other demands on his time, and, when children came on the scene, their demands for
time and attention became prominent. A major theme in this regard was his capacity for
wasting time and procrastinating. Something always seemed to slow him downthings
took more time than they should or he would attempt to squeeze something else in with
the result that he would be inevitably late for his appointment. As he put it: Theres so
little time yet I waste so much. I want to stretch it out and get more into it than I know
is possible. [Does that explain how you get to be so late?] Its a combination of my
wasting time and trying to squeeze more in, but theres never enough time.
The time element quickly became the focus for issues of dominance and submission
and control in the analysis. The scheduling requirements, despite the negotiating process
by which we decided them, were viewed as an exercise of my power and control. In regard
to the actual hours, he declared that if I had power to decide the end of the hour, he could
have power of deciding when the hour was to begin. At one point I broached the subject:
[We should talk about your lateness; you eliminate the equivalent of a whole hour per
week.] I assume thats resistance. Im looking to be told to cut the shit and be on time;
same way about my dissertation. I put off doing it and procrastinate. Just thinking about
it makes me anxious. Im afraid of somethingthe thought of sitting down and writing is
scary; I find any kind of distraction, I just want to scream No Im not going to do it, and
I feel frustrated and angry at myself. But I feel anger at anyone who ever expected
anything of me, anger at being a good boy and always doing whats expected. [Is any of
that related to your feeling about how much you can get away with?] I like having the
sense that people are waiting for me; it gives me a sense of power. I never remember you
being late, and that annoys me. Youre very exact about time; but Im the opposite.
Sometimes I feel angry about the exactness of your ending the hournever a minute more
or less.5 Thats so confining. You can set the end but I can set the beginning. [Do you
make it into a power struggle?] Im not sure: I dont like your lack of flexibility. I
understand why you do it, but it doesnt filter down emotionally. Maybe it is a control
issue between us. [Do you see analysis as somehow submitting?] In part, I have difficulty
5
Similar cases of patients encountering difficulties with the ending of the analytic hour were
reported by Ferraro (2001); Hartocollis (2003); Langs (1982); Lichtenberg (1999); Lombardi
(2003), and Spero (1993),. See also my discussion of similar cases in which this was a problem in
(Meissner (in press).
626 MEISSNER
with passivity. I get angry when youre not here every time. It feels like feminine passivity
that I have to accept your schedule. [So you see coming on time as a sort of feminine
passivity?] Its the issue of control: I have anger that I feel controlled.
His complaints about the control aspect of my ending the hour and canceling hours for
my own reasons also proved to be related to issues of dependence and seeking the
closeness and approval he never felt with his father. Yesterday you questioned your
control over ending the hour and my anger about it. I thought that was a lousy curtain line,
and it confirms my anger. At times it seems so arbitraryyou stop in the middle of
something. So I use it as a resistance: I know Ill be cut off, so I can be angry at you but
also use it. Saying goodbye here is like ending a homosexual contact; the social formality
has nothing to do with what went on before. I wonder if youve been listening to me, if
a minute later you can be pleasant and social. Where have you been for the last hour? [In
terms of what you feel how would you expect me to be?] It feels good when I leave. [Is
it that you expect something different?] I dont know if I expect anything different, but the
discrepancy of time is jarring. It makes me question your listening and hearing me. [You
seem angry that I dont respond in terms of the image you project of yourself?] I know I
intellectualize here, but I wonder if you can hear the pain underneath. I wish to be seen
as fragile, vulnerable, and needy. Also I wish that you wouldnt see me like that. I have
a magical wish that you could read my mind. [Youre disappointed that I dont respond
to the image of you as fragile and so on?] I guess I just want to be held. I want you to hold
me, but I also fear that. I dont know what I want you to actually say or do. I want to see
you as strong and nurturing, and I also want you to be challenging and not see me as
vulnerable. I see you as having strengths my father didnt have, but being fragile is my
way of getting taken care of. When I leave here its like ending a homosexual encounter
back to the real world. This is another out-of-time experience, away from the rest of life.
Occasionally I would make an effort to address the time problem directly. For
example: [Have you noticed that you seem to be keeping to a pretty regular schedule?]
Yeah! [Youre often 1520 minutes late plus-or-minus.] I feel I need to please you, but I
also have a fear of rejection, I feel like its a battle over control. I feel rage at having to
be the little boy who comes on time. [Your anger is that you have to be good all the time?]
Yeah, like my fathers obsession about being on time. That drove us crazy. Consciously
I try to get here, but I must not want to. I was always upset by my fathers obsessing with
time; hed panic if we were late for anything. I always have the sense of running late.
Thats probably a reaction to my father: He was always anxious about being on time; hed
go berserk about being on time. Hed bug us hours before it was time to go; he had to be
early for everything, as if no one would wait for him. Also it gave him a sense of
importance: He had to be the first one there. Mom said it was his insecurity and also
narcissism. He had to be first one at Temple because he was so importantit had a driven
quality, so I react against that. [So in an effort not to be like him, you resolved not to be
on time?] That could be: I get set off by rigidity, I still have trouble with the inflexibility
of your ending the time: It feels like Im in mid-sentence. I use it defensively, so I dont
get into things at the end. . . . I feel conflicted over time. That plays into my coming late:
This is my time, and I react against your rigidity about time. I rebel against time by
coming late, but thats self-destructive. I have to find time for everyone elses needs and
thats a hassle. But this is my time; I can afford to be late, like taking time out. Every
second of the day is accounted for, but I act out against the rigidity of time. Also its like
something taken away from me. I want to be in control; if I dawdle and leave late thats
OK, but if get stuck on Route 6 I get angry. Then I have no control, and it feels like
something is taken away from me, I feel anger about time demands, that I have to be
anywhere at certain time. I arrive late for a lot of things. [Do you try to shave it even closer
here?] I dont allow any leeway: if I left 50 minutes to get here Id sometimes be here 15
minutes early. The patient after me is always early. That bothers me: shes a good little
girl and on time. Even on Saturday when Im early, Ill stop someplace so I get here just
on time or a few minutes late. I rebel against being a good little boy: It has a too good
quality, too much eagerness to please. I feel egocentric and that people can wait for me.
I rebel probably because I do want to please: I want you to like and approve of me, but
I fight against that. [So coming late acts out your conflict?]. . . . Im always trying to catch
up. I have a wish for time outside of time to catch up. I feel that with my dissertation: I
shouldve been done 3 years ago, but theres always something else to be done. My
homosexuality is out of time too. Im compulsively messy in terms of time: If I plan for
an hour, it takes an hour and a-half. Im always 5 minutes late. [Is it that you make sure
of being late?] Not consciously, but I must. I always underestimate the time something
takes; that creates a sense of pressure and running behind. [Does anything come to mind
about underestimating?] I overestimate my ability to do things quickly. I seem to need the
pressure of being behind. . . . Its the frustration of timenever enough. Its a constant
squeeze, running back and forth trying to meet everyones needs. Ill never catch up. I
dont allow time for things like parking. [What is the problem allowing more time?] I
always underestimate: I try to leave just enough time, but something always happens. I
end up late and tense and have things hanging over my head like my dissertation.
On another occasion he arrived with just a few minutes of his hour left. Sorry Im
late. The gas gauge wasnt working. I knew it was close to empty, and I shouldve had it
filled last night. [You seem to be playing it close to the vest, no leeway?] Yeah, I always
let the gauge go down to zero; I have the image of running close to edge of a cliff. Im
afraid of heights and cliffs. [What does that suggest?] Im counterphobic. [Is there
something counterphobic about letting the gas run out?] More how much can I get away
with. [I guess you play that role in other areas?] Sure, part of homosexuality is the
excitement of playing it close to the edge. It scares me that Im so like my father,
especially his tax stuff. [Does that influence how you deal with getting here on time?]
Partly, I allow minimal time. That doesnt allow for anything else; if nothing else gets in
the way Id be on time. [But it seems that something always does?] I never get done what
I plan in a day. I dont allow for contingencies. Its my entitlement and wanting to have
people wait for me.
His running out of gas proved to be a not infrequent occurrence. One day he explained
his lateness: I wanted to be on time but ran out of gas on the way home. [Any thoughts
about running out of gas?] I kept thinking about it but when got near a station I forgot.
Thats not the first time Ive run out: I play around with it and try to see how far I can go.
That sounds familiar (laughs). Theres other stuff like thatpart of my being late. I try to
see how late I can be. I used to be late all the time, but mostly its just here now. Its a
little kid thing: How bad can I be and youll still like me how much can I get away with?
Testing the limits. I feel anger that you dont set limits, but thats adolescentId be angry
if you did too. I want to be caught and have people think Im bad. If I get away with
something its magical. I can get away with things other people cant; people make
allowances for me because Im an exception. I felt that in elementary school: I could do
what other kids couldnt. I didnt have to work and I felt magical. I got away with that,
but I also felt eventually Id be caught and exposed as a fraud. I was special in the family
too, special compared to my sisters without doing anything. I didnt do any adolescence
acting out and little rebellion. Homosexuality is my most serious rebellion, and I have a
fear of getting caught. I want you set some limits, but if you did Id probably be angry.
628 MEISSNER
On occasion I took the opportunity to address the transference reverberation: [You

seem to cast it in terms of my wish and expectation?] Its for you that I come on time, but
Im courting rejection. How naughty can I be before I get rejected? [That way I guess you
can dilute and draw out this analysis ad infinitum.] Thats my way of keeping you. . . .
[Part of you wants to keep the analysis unchanging?] Unending. I have a fantasy of safety
in your permanence; I need a safe base; I need to know that youre there and unchanging.
And later he reflected: I thought about my fear of losing you. It reminds me of the story
of a friends analyst canceling therapy because of terminal cancer. [What thoughts about
losing me?] Its coupled with my fear of rejection: part of my lateness is testing of that.
From time to time I tried to approach the issue of his taking some responsibility for
his part in the analysis: [I guess the basic question is: Whose analysis is this? mine or
yours?] Do I ever differentiate what I do from performing? What would happen if I
stopped performing? I feel scared of that; Id be alone. [Maybe this goes deeper, as if you
feel you can do analysis with the left hand. That might be the problem with lateness: You
expect that you can get out of analysis what you want with reduced time. I doubt you
would feel that way with your own clients?] Im being protective: the full 50 minutes
seems frightening. Im afraid I cant handle it. In the hour, I wander around then get to
something important toward the end. Coming late may cut that short and prevent getting
further into it. I dont feel defensive; its as if I just find myself late, each time for different
reasons, I have a wish to be given to without having to work for it. . . . My entire life
runs 15 minutes late and I get angry at myself. Im constantly rushing. [What comes into
it that makes you late?] Usually dawdling, trying to squeeze things in; it never works. Its
like Im pushing the limits: how long can I get away with bad behavior? [It seems odd that
you keep trying to do that even though its clear that it isnt working?] I feel anger at
having to be places on time: dawdling is almost a denial of demandsmake-believe
freedom.
It happened that, during a summer vacation break, I had moved my office and had
informed the patient of the move just before the break. But over the vacation he had
forgotten about my moving and missed the first hour back; he subsequently accused me
of forgetting to tell him about the move. It was a relief to see you here today. This is my
hour and you should be here. [Do you expect me to sit and wait for you?] I guess so. I had
some feeling of abandonment. My anger was spurred by your moving when you didnt tell
me. That plays into my fears that youre angry, that you dont like me. I feel abandoned,
but I do expect you to sit and wait. [Does anything come to mind about that?] You referred
to my brinksmanship, driving with gas on empty how far can I go and still be accepted?
[Do you make that an issue here?] Its always an issue for me. I have the sense that Im
successful in getting you angry; Id be disappointed that I can get you down to my level.
[So if I violate your expectations I must be angry?] Yeah! [That might suggest a more
general problem, that you feel people should wait for you and make allowances?]
On another occasion, after arriving more than 12 hour late for a Friday appointment,
he commented: I thought about Thursday: You commented that it wasnt an analytic
session. That bothered me; I felt like I was being criticized. It seemed like rigidity on your
part, your definition of what analysis is or isnt. I was disappointed. [How so?] Freuds
analyses werent so rigid. [This could be related to a larger issue of how you approach the
analysis, cutting down on time. It seems hard to know whether youre doing it or not doing
it?] I fight it from within: If I resolve that a major part of the analysis will be done. [Im
concerned that that doesnt get worked on here but gets acted out?] I dont know whether
its just resistance. [Resistance to what? You seem to have an idea that you dont have to
sacrifice anything?]
Reality also came to play its part in reinforcing the sense of time passing. As the date
for the expected birth of his first child drew near, he commented: I feel the pressure of
time; I have a lot to do with the birth getting closer. It could be born anytime now.
Sometimes Im excited but I also want more time and dont feel ready. I still want to be
a kid myself, but once the baby is born theres no turning back. Its a commitment forever.
Thats frightening. I have a fantasy of being able to go back and do things over again, but
time isnt going to stand still. You have no options with a baby; you cant stop and turn
back. Theres finality, no undoinga baby is nonreturnable. The responsibility is scary.
I see procrastination as a way of trying to stop time. [As though you had unlimited time?]
I have a wish to be out of time and be able to move back and forth. But I have a feeling
of guilt and failureIm going to be 30 and I havent finished graduate school. I waste
time, but Im not a kid any more, and I never can be a kid again. I feel a loss: What
happened to the part of me that wants to be a kid and be taken care of? I dont have that
freedom any more. . . . I do things at the last possible minute. [What do you make of that?]
I have a sense of risk-taking, squeaking throughI can do it despite the odds. I got
satisfaction in college from ripping something off at the last minute and still getting an
Amy show-off style.
The issue of his attachment and dependence and his rebellion against it came up
around interruptions in the analysis. As he put it on one such occasion: I feel your leaving
for 2 weeks is arousing more than Im aware, and its related to my being late. Its got to
be a control issue: You said I lost an hour and here you are leaving for 2 weeks. It comes
back to control. I do petty things like coming late, but I see your leaving as your control
of the situation. [So then you would have to balk?] Yeah, it gives me 2 weeks of vacation
too, and part of me likes that. I dont have to deal with my ambivalence. I can be angry
that you leave me, but at the same time want it to avoid having to deal with my
ambivalence. I dont want to take responsibility. I get angry at others when they try to
control me, but I also get people to control me. Later he returned to the subject: I have
feelings about your leaving. Im angry at your absences. What could take precedence over
this? Thats egocentric. But you never say why you go: Im jealous of your activity outside
of here. I just want you all to myself. [Do you make my going away equivalent to a
judgment?] Something else took precedence over me, something more important than me.
[Do you feel that in other contexts?] With my father work was always more important;
that still continues he canceled a visit to my sisters because he had too much work.
Growing up, his work was more important than the family and his relation with me. He
rationalizes that his work is for us, like in some way his not paying taxes was for us. Who
asked him to pay for us that way? I feel angerI couldve taken out loans or worked part
time for college.
And again: I have negative feelings about this vacation: its like starting over. Each
session is like that: It has little connection with the previous session. For some of my
friends, analysis is the main focus of their lives, but not for me. Is that lack of commitment
or just too many other things going on? Im afraid of my emotions spilling over into the
rest of life. I create a balancing act to avoid that. I had to encapsulate: so much of my
thoughts are tied up in death and dying and grieving. I thought of wishing my father dead.
I had a fantasy that if I grew up it would kill him. I also had a fantasy that he tried to kill
me. I have no guilt about wanting my father dead. How is that possible? Im afraid that
Ill open that up and then cant close down. [So you have some negative feelings about
my leaving?] I want to put the lid on. [Do you mean that at the end of the path of change
looms death?]
He returned to the same subject again: I think my depression is related to your leaving
630 MEISSNER
and not giving me time. I associate to a blank without number, infinite. [Does that mean
you want time to be infinite?] Theres so little time, yet I waste so much. I want to stretch
it out and get more into it than I know is possible. [Does that help us explain how you get
to be late?] Its a combination of wasting time and trying to squeeze everything in. Theres
never enough timethats partly magic, my belief that I can catch up and fit it all in. Its
like letting things go and then cramming all night before an exam; theres enough payoff
so that it persists. It sustains an image of myself as special and magical: I can get away
with it and control time. But my depression is related to coming to terms with not being
specialnot that there was no magic, but that the magic is over and lost. But I still retain
the belief that Im Gods favorite and able to do anything. Im convinced that something
will always turn up magically, but it hasnt, and thats a loss. [We can translate that into
your analysis: Its as if you can waste that time and somehow still catch up?] I feel I dont
have to do anything, that somehow it will happen. [You seem to want to be able to control
timeany thoughts?] I make coming here a demand. When you cancel I have a combined
sense of loss and freedom; its not my choice but yours, and that takes away my
responsibility and guilt. Does that make sense? I need confirmation from you and Im not
getting it. [What thoughts about wanting confirmation?] I look for cues that Im not
isolated here. [You speak of wanting to control time, but no one controls time.] Thats
frustrating: Time is irreversible. I was enormously aware of that when I was little; I was
afraid of that and frustrated by it. Actions are irreversible: If I say something I cant take
it back. I feel that about anything written. I can take back what I say in conversationIm
skillful at that. Its frustrating that I cant do that here. [I guess that makes you wary of
what you say?] Sure, Im not just intellectualizing. I was fearful as a child, and thoughts
of suicide were tied in. [Suicide is irreversible too.] I think of the fragility of life and time:
a split second decision could end it all.
Termination
Despite these concerns and pressures, Jake came to the idea of finishing the analysis
reluctantly, ambivalently, and with a considerable degree of anxiety and apprehension.
Even early in the analysis he was concerned about how long the analysis would take,
feeling impatient with the slow pace of analysis and wanting a sense of closure. He was
impatient with himself because of his temporizing and delaying tactics that only prolonged
the analysis. As he commented: Im angry at myself because of the games I play my
way of holding on, keeping secrets, makes this longer. Im holding on to you, but all the
bad stuff is stirring around, like a pot and Im holding the lid on. I want to cut the shit,
spill all my secrets, have it over with. But Id feel exposed. [And judged?] Absolutely!
Theres no point in being ashamed if I cant be judged. I almost want that, I want to be
ashamed; the dissertation is the same, Im ashamed that Im not finishing it. [Are you
afraid of judgment there too?] Also judged that Im not done. In addition to his concerns
about wasting time in the analysis, these comments point to another salient dynamic in his
overall picture, namely the problem of shame. There was plenty to suggest that the shame
dynamic played an important part in Jakes approach to the analysis and to much of his
behavior outside the analysis. It may also have had a lot to do with his lateness.
Separations also precipitated feelings of loss and abandonment that seemed intolera-
ble. On the verge of one summer vacation, he volunteered: This is our last session. I
should have feelings about that, but Im not aware of any. My detachment scares me; I
assume theyre there. How crazy is my isolation? [Is it that you need to keep them out of
sight?] It has to do with this being the last session. I want to seal over, just have the break
and then come back. I think of being in analysis forever. I have associations to rejection;
termination is like rejection. I infer feelings of rejection around this break. I want to have
a sense that youll always be here. Another 4 years were to pass before we heard anything
more about termination. But then about 1 year before he actually terminated, after
returning from another summer vacation, the subject resurfaced: I was thinking about
termination, and I felt a sense of loss and a fear of being on my own. Those are
connotations of growing upI sealed over as soon as I felt it. I mustve split off other
feelings, like loving and yearning for attention and protection. Talking about termination
raises a lot of issues, especially wanting to hold on and have control, but I have to shit or
get off the pot. Im so compartmentalized and fragmented that I cant integrate; I need
walls or Ill fall apart. . . . I have to control my feelings: rage and sadness and frustration.
Its as if Im selfish and want everything. But I want to protest, I am what I am. I feel
rage that I have to make choices; its not fair that life is so difficult.
Despite the continuing lateness and missing of analytic hours, Jake seemed to make
halting and tentative progress. Eventually he brought up the subject of termination as a
distinct possibility: I feel anxious and guilty over lost time. Ive been thinking about
termination. Im 37; that sounds old. [Any thoughts about lost time?] I feel anger at
myself. I have associations between ending and death: that somehow my finishing and
growing up would kill my father. That has to do with wasting time and lost opportunities,
but also keeping off a sense of loss. [What would you lose by finishing?] Id lose my
anxiety, but it also means the death of something else, like my fantasy that I could produce
something really good and more than adequate. [So finishing would mean losing that
illusion?] Yeah! I think of infinity, timeIm at an age at which my own time no longer
seems infinite. I could settle into a legal aid job, then thats it until I die. I dread the feeling
of ordinarinessI do what I do but no impact, and then I die.
In the last week of analysis, he mused: When is the last session? I feel like Im being
pushed out of the nest; its the end of my fantasy of you as a good father who will take
control over me and take responsibility for me so I dont have to be responsible. Im not
unambivalent, like a bird pushed from the nest for its own good. I deny my own volition.
I have felt nurtured and held here, but Im feeling the loss. . . . Im thinking about
termination. Analysis has been part of my everyday life; its hard to imagine what it will
be like without it. [What thoughts?] I dont know. [Maybe you wonder, is there life
beyond analysis?] It will take a while to integrate; the energy I put into this will be more
available elsewhere. I had expectations that life would be different and wonderful after
analysis. [And analysis hasnt done that?] Reality is still there. I have the wish hold on to
my fantasy; there are still remnants of that. But I have to realize that reality and bad things
are always there, and I have to deal with them. [Youll have to stand on your own feet?]
I know I can, but I dont want to have toI want someone to make things better and Im
angry that I cant make things better and change; its against my omnipotence fantasies.
But I guess the choice is mine.
The last hour had a poignant quality, reflecting his unresolved ambivalence and his
conflictual struggle between attachment and loss. The effect on me was both puzzling and
confusing. I could not escape the feeling that the analysis and his relation to me had meant
a great deal to Jake. The mystery was that in the course of his struggles with ambivalence
and the disruptive and interfering effects of his constant lateness and frequent missing of
analytic hours, something important had happened in the analysis. As he left my office for
the final time, it was clear that there was a great deal of uncertainty and much in his life
that remained unresolved. But I felt something had changed. Something, I thought or
632 MEISSNER
maybe hoped, had changed in Jake. I thought I heard the music of some greater maturity,
more of a sense of responsibility, and more realistic acceptance of what life and the world
had to offer him than had previously been the case. At the same time, I was rather skeptical
that among the possible resolutions that might lie ahead of him he would ever come to
terms with the demands of the clock. I could not see Jake becoming a model of punctuality
and efficiency. But perhaps there was a little more acceptance that time and the clock were
realities that he could deal with in some more effective and productive way. And that in
the end he might even have a better leg up on dealing with life itself, and even its ending
on better, if not ideal, terms. At least, I had some reason to hope so.
Discussion
Throughout the analysis, Jake struggled with the conflicting elements of the reality
demands on his time, the temporal aspects of his commitment to the analysis, and his own
motivational conflicts and attitudes in dealing with time. His unwillingness to come to
terms with these tensions and his refusal to compromise these demands was striking and
unrelenting. I concluded that in large part oedipal issues and motives were important
contributing factors. In relation to his father, his hostility and rejection of his father were
reflected in his refusal to submit to the demands of time and his rejection of any attempts
to impose time demands on him out of a reaction against and rejection of his fathers
obsessional and anxiety-filled concerns about being on time and undoubtedly, I would
venture, out of a latent identification between the inexorable demands of the ticking clock
with the threatening imagery of Father Time who constantly beckons and draws one down
the path leading to the end of time and death. In relation to his mother, coming on time
took on the implications of being the good boy and conforming to her expectations and
controlling demands. Thus, coming to the analytic hour on time carried with it the
innuendoes of submission to maternal control, and the corresponding lateness reflected his
rebellion against it. These elements came into focus in the transference insofar as my
persistence in keeping to the analytic schedule resonated both with his fathers time
obsession and with his mothers controlling demands. In this context, the issues of
dominance and submission, of control versus freedom, of autonomy versus dependence,
and of conformity and defiance came to life and played themselves out.
For Jake, the problem was often that he had so procrastinated and underestimated the
time required to do something or had tried to work in too many things in the time available
that when the clock told him he had to get on his way to my office, part of him rebelled
and refused to be so coerced. Although this perception was conscious many times, there
were many other occasions when he consciously felt he had honestly made an effort to
come on time, but somehow other things that he had not taken into account got in the way.
Some of these, such as the car not starting or traffic jams, he had no control over but over
others, such as running out of gas, he had plenty of control. But in his narcissistically
embedded entitlement and omnipotence, he refused to come to terms with the reality either
of traffic jams or the necessity to take time to put gas in his tank. It was as though things
in this world should not create any problems for him, and everything should work as he
wished them to. The result was that he often found himself stranded on the highway
without gas. He refused to allow the extra time for getting to my office at times when he
knew traffic would be heavy or that construction along his route might cause delays. None
of those things, he protested, should happen and get in his way since they violated his
sense of himself as an exception to the laws of time and space to which ordinary mortals
had to submit. At the same time he resisted and rejected any suggestion that there was
anything he could do about such circumstances or that he might have to compromise with
reality and adaptively adjust his scheduling. This attitude was compounded, of course, by
his transferentially derived conception that I was the master of time and that requiring him
to come to the analytic hours was my authoritarian demand being imposed on him
unilaterally and coercively. This dynamic took on powerful and convincing form for him,
so that the issues of complying and defying and of submission and rebellion were alive at
every step. But although the power game was never actually realized as such, simply
because I was not playing my part, nonetheless in the realm of his psychic reality the
power struggle had taken on real proportions. For him, coming on time did involve a
power struggle, but one that took place entirely within his own mind.
On another level, more profound and far-reaching issues had to do with his sense of
infantile narcissistic omnipotence and his corresponding refusal to submit to or compro-
mise with the forces of reality and the inexorable advance of time. The clock was his
enemy. The pressures of the clock as it registered the unstoppable movement of time were
to be resisted, ignored, circumvented, and escaped from in whatever way possible. His
escape from these inexorable demands took the form of a dissociation involving both his
homosexual acting out and his engagement in the analysis. In his homosexual adventures,
it was as though he were stealing time out of the inexorable flow of real time, exercising
a kind of illusory control over time outside of real time, making it somehow his own and
giving him the space to play out his fantasies and satisfy libidinal wishes and desires that
were forbidden him in his real life. The pleasure principle thus took the play away from
the reality principle, at least within the limited confines of this period of dissociated and
disconnected time. The analysis also took on some of the same quality: It became time that
he could claim as his own, outside the inexorable and demanding flow of real time, and
thus was transformed into a framework within which the claims and demands of ordinary
time could be ignored or dismissed. In this respect, if the analytic time were his, he could
control it as he wished, do with it as he wished, use it or not, come on time or not, come
when he wanted to and not when he had to, or not come at all if he chose. These desires
and choices remained largely unconscious; rarely could he admit choosing to be late, but
rather would constantly complain that his lateness was beyond his control or blame
impeding circumstances or demands on his time by others. Missing hours and coming late
to his hours were never accepted as his responsibility. Only by dint of continual confron-
tation and interpretation did it gradually dawn on him that he had something to do with
it, that it was in some respect a matter of his choosing and deciding, and that there were
identifiable motives that accounted for his behavior.
Beyond the motives derived from unresolved oedipal conflicts, the heavy narcissistic
coloration of his basic motivation was central. Around this stratum of narcissistic moti-
vation, his resistance proved most stubborn and unyielding. Gradually, as the analysis
progressed, his acting out around these narcissistic issues in other venues diminished, until
clearly the analysis remained the main, if not the only, arena in which these narcissistic
wishes and fantasies played themselves out. His retrenchment from his entitlement and the
need to compromise with time was at best begrudging and resentful, but finally came to
a point of seeming resignationlike it or not, he had to compromise with the reality of
time. Underlying much of this behavior, the negative side of his narcissism played a
crucial role. If his sense of himself as an exception and his narcissistic omnipotence and
entitlement displayed the superior dimension of his narcissism, the inferior side was
reflected in a sense of inferiority, inadequacy, and shame that remained largely uncon-
634 MEISSNER
scious.6 Lansky (2005) has recently called attention to the phenomenon of hidden
shame, which seems to have played a significant role in Jakes unconscious. It undoubt-
edly played its part in relation to his homosexuality and may also have contributed to his
often self-deferential attitudes to women and to his more consciously available feelings of
guilt. I would surmise that the guilt was in a sense defending against and covering the
sense of hidden shame regarding not only his homosexuality but also his guilt-ridden
sense of entitlement and omnipotence. The guilt and shame were, in turn, countered by his
more aggressively reinforced and defiant sense of entitlement and his position as an
exception. This played itself out further in his somewhat rebellious disregard for the time
commitments in the analysis and his general refusal to submit to the demands of time.
These dynamics were joined in the transference in which I became the accusing and
shaming judge whose demands and standards had to be resisted and rejected.
Related to these concerns and central to his concerns over the passing of time was the
inevitable connection of time and death. His wish to control time and his struggles to resist
the inexorable passage of time covered an underlying fear of the ultimate ending of the
flow of time in death. This narcissistically overburdened dread dogged his heels at every
turn and remained a persistent and largely unconscious factor in his obsessive preoccu-
pations with time and its passage. As this and the related narcissistic components came
into gradual perspective in the analysis, there did not seem to be any resolution or
abatement of these issues, but rather a gradual sense of resignation and a somewhat
depressive sense of loss. By the time termination arrived, it was not that these desires and
fears had abated or disappeared, although they did seem to play less of a determining role
in his life, but rather that how he encountered and dealt with them was, in the last analysis,
his responsibility, and that, in fact, was a matter of his choice. When we ended, it was with
some hope that what he had learned about himself in the analysis and his newfound sense
of responsibility and capacity to adapt to the demands, not just of time but of reality as a
whole, might stand him in good stead.
From a temporal perspective, I feel it is important to keep in mind the fact that the
denial of temporality, particularly the nature of time as passing, can be a fundamental
aspect of the time sense of many of these patients. The operative, if unconscious, wish is
to deny time, to deny the passage of time, to treat time in effect as if there were no past,
present, and future and no inexorable flow of time from one to the other, and to regard
time as though it consisted of a timeless Now. Jake made this aspect of the time dynamic
dramatically explicit in portraying both his homosexual episodes and his analysis as
somehow taking place beyond the reach of time, outside of time, and therefore not subject
to the otherwise intolerable and frustrating demands of the passage of time. In this sense,
the analysis became a safe haven, an escape from the relentless demands and pressures of
the clock.
The same dynamic becomes operative, as we have seen in relation to the dynamics of
termination. For Jake and for other similar patients, confronting and accepting the
inevitability of the ending of the analysis meant accepting the flow of time from past to
present and on into an unknown and perilous future, leading inexorably to the final end of
life in death. The omnipotent wish and the narcissistic illusion of control over the harsh
reality of passing time had to give way to an acceptance of reality, especially the reality
6
This formulation of narcissistic configurations reflects the analysis of narcissistic introjective
configurations in terms of superior and inferior narcissistic introjects as described in Meissner (1978,
1981).
of time, aging, and death. In the context of termination, therefore, not only does the
integration of past and present become all the more telling, but also the prospect of the
future looms even more persistently with its expectations and anticipations of what life
will be like when the patient is forced to deal with the demands of time and reality on his
own terms.
Consequently, although I agree that the confluence of past, present, and future are
familiar and fundamental to analytic understanding throughout the analytic process, I also
feel that in the face of termination the future tends to assume even greater salience. But,
as we have seen, difficulties can arise within any of these dimensions of temporal
experience. Schou (2000) elaborates this perspective further: Psychoanalytic understand-
ing of past and present always implies the dimension of the future as the realization of the
potentiality of the psychoanalytic situation. In the psychoanalytic telling of past and
present, the idea of the future is represented by its own narratives of change and growth
(p. 759). And further:
The dimension of the future is meant to connote the sense of future associated with the
analysts therapeutic intent. The idea that treatment can bring about desirable change implies
a perspective on the future, even if the future as such is only rarely the object of deliberate
consideration or prediction in the treatment situation. In my view, the analyst is always
oriented toward the future, insofar as the aim of his or her interventions is to bring about
change and growth. (pp. 761762)
The importance of a future orientation in relation to termination is also emphasized by

Vinar (2005) who writes:
When the therapeutic work is favorable and productive, one can perceive the two sides of the
scale: on the one side, psyche time is anchored in the past or weighed down by it and, on the
other, there is a possible future, where the dimension of here and now and a future-oriented
perspective is possible. In the latter dimension palpitates something of the uncertainty of the
future rather than the oppressive burden of the permanent threat of a catastrophe which will
repeat itself internally and interminably. (pp. 320 321)
Yet in patients like Jake, for whom time in all its dimensions is overloaded with
conflictual perplexities, turning ones face to the future, as must be done in facing
termination, brings into the foreground a host of anxieties and uncertainties that may
otherwise have lingered in the background of the patients consciousness.
During the course of the analysis, conflicts can arise in the present between commit-
ment to the analytic process and the demands of external reality. In transferential terms,
patients can be caught in a form of time warp, responding to present time commitments
and pressures out of an infantile frame of reference that is no longer adaptive or functional.
Clinging to infantile omnipotence and entitlement, for example, so frequently seen in
these patients, is essentially maladaptive and creates conflictual reverberations in the
present, and these are frequently enacted within the analytic frame. Even the future
orientation carries its burden of being caught up in the unstoppable flow of time that draws
one inexorably to a final termination. In this perspective, the future prospects that loom so
large in the context of analytic termination are infused with a combination of hopefulness
and dread hope in the potential and prospects for a more adaptive and mature life
experience and dread of the inexorable progression of time leading to the final termination
of death. For patients such as Jake, for whom undercurrents of narcissistic omnipotence
and refusal to accept the limitations of time can play such a determinative role, dread can
636 MEISSNER
supersede hope as the patient draws near to termination. Termination for such patients
becomes even more problematic and difficult.
Technical Considerations
From the point of view of technique, disruptive temporal enactments are complex
phenomena whose reverberations echo in all three chambers of the analytic relation:
reality, transference, and alliance. The behavior that from one perspective expresses
transference dynamics may from another perspective also seem realistic or may be seen
as adapting to or deviating from alliance requirements. Lateness, as suggested above, may
in some degree reflect transference derived needs to rebel against any submission to the
analysts control or demands for conformity but from still another perspective may
exemplify the patients effort to gain some degree of relative autonomy and self-assertion.
As Chodorow (in Panel, 2005a) noted in discussing anger and revenge in analysis:
Revenge can also be enacted in the consulting room, as a way to slow down or sabotage
treatment (p. 518). When revenge takes the form of acting out around time issues, the
analyst is confronted with a perplexing problem. In this case, the revenge motif focused
around issues of compliance and defiance, such that Jakes lateness and missing of
analytic hours were from one aspect forms of rebellious resistance, but also possibly they
were in some degree forms of declarations of independence.
For Jake, the motivational substructure reflected important developmental vicissi-
tudes unresolved oedipal conflicts and narcissistic fixations on the level of infantile
omnipotence that came into mutually reinforcing conjunction around issues of time and
time management.7 These provided fertile ground for transference variants that brought
his internalized struggle into play in the analytic relation. Unquestionably, the structure of
the analytic situation provided the opportune context for these issues to be joined. The
time demands of the analytic structure are developed within the context of the therapeutic
alliance and are determined by way of a process of negation and decision between analyst
and patient (Meissner, 1996). The face value of this process reflects the result of a mutual
decision agreeable to both analyst and patient for which they are equally responsible and
to which both agree to accommodate. Thus, analyst and patient both commit themselves
to coming to the analytic hours and to coming on time.
But transference dynamics alter this configuration: The alliance-based agreement is
transformed into an authoritarian demand on the part of the analyst who is seen as
dominating and controlling and who must be submitted to by the conforming or comply-
ing patient. On these terms, the struggle between compliance and defiance is joined and
becomes enacted around the temporal dimensions of the analytic situation. Insofar as the
temporal boundaries of the analytic hour are stipulated as a necessary aspect of the real
structure of the analytic situation, that exigency creates an oppositional challenge to the
patients subjective sense of time. Failure on the part of either analyst or patient to observe
these time arrangements reflects operation of a therapeutic misalliance, in addition to
whatever transference dynamics it may be expressing.
It seems obvious that the analytic process cannot take effect unless analyst and patient
spend a certain amount of time together, and the alliance-based temporal parameters,
specifying when the analytic hour begins and when it ends, are intended to establish the
7
Colarusso (1987) discusses several cases of time disturbance in young children.
temporal boundaries of the analytic situation. But these parameters are not absolute. The
analytic hour does not have to be 4550 minutes to develop a meaningful analytic
process.8 But there is also a basic amount of time, perhaps varying from patient to patient,
less than which will prevent the process from developing. But no one can say for a given
patient what that amount of time is or ought to be, certainly not the analyst.
When the patient deviates from these parameters, it creates a dilemma for the analyst,
reflecting a tension within the alliance itself. On one hand, there is the necessity for analyst
and patient to spend time together for an analytic process to develop; but, on the other
hand, there are basic considerations that serve as important components of the therapeutic
alliance having to do with the patients autonomy and freedom (Meissner, 1992, 1996).
Faced with the pattern of lateness and missing hours, the analyst has to balance the
demands of the process against the claims of the patient to a degree of freedom and the
capacity to exercise his or her autonomy in choosing to come late or cancel an analytic
hour. On these terms, the patients coming late or missing the analytic hour are legitimate
and acceptable when they are the result of deliberate, reasonable and conscious choices,
but not so when they serve as expressions of narcissistic or other transference-based
enactments.
It is not unreasonable, on these terms, for the patient to choose not to come to his hour
for reasons that he regards as important and that would supersede the importance of
coming to analysis. In this respect, the analyst, on his part, must be accepting of this aspect
of the alliance as part of the patients alliance-based prerogative, but, in contrast, when
lateness and missing hours seem to reflect unconscious, defensive, or resistive determi-
nants, such lateness or missing should be addressed as enactments reflecting a therapeutic
misalliance and calling for exploration and clarification. When I decided to approach the
issue of lateness with Jake, my self-conscious intention was to approach the question from
the perspective of the alliance, keeping a respectful eye on the balance of alliance
parameters that were brought into play. The analysts interest is thus directed to the
deviation from the terms of the alliance and to trying to understand the motivations,
conscious and/or unconscious, contributing to the behavior. The analyst in these circum-
stances is obviously alert to the role of transference reactions and to their elucidation and
origins, but as a rule the first order of inquiry is directed to the alliance aspect, focusing
on the patients more-or-less conscious reasons and motives for choosing to be late or miss
and allowing the transference-related material to emerge and develop as it will.
In dealing with this dilemma, the analyst has little recourse but to try to weave an
uncertain and cautious course between the Scylla of premature confrontation and the
Charybdis of neglectful collusion and tolerance of the patients temporal enactments.
Rarely have I ever found the motivations behind any patients temporal deviations to be
transparently clear. There is usually a complex layering and interweaving of motives, both
conscious and unconscious, that can make the interpretive ground unclear and uncertain.
Consequently, the available options for confronting or not confronting, for interpreting or
not interpreting, and for understanding the behavior in alliance terms as a movement
toward greater autonomy or more negatively as a form of misalliance or in transference-
related terms of the patients resistance or defensive retreat, can leave the analyst in a
quandary of ambiguity and uncertainty.
8
This is a complex issue, one that underlay the Lacanian practice of abbreviating the analytic
hour arbitrarily or at the discretion of the analyst (Spero, 1993). See my further discussion of this
issue in Meissner (in press).
638 MEISSNER
One reason in my understanding for preferring the alliance option is that the alliance
parameters are matters of relatively conscious and explicit agreement between analyst and
analysand and are thus immediately addressable as part of the present analytic interaction.
Addressing the problem in these terms usually allows for an open exploration and
discussion of the relevant factors, both positive and negative, and often, I should say most
often, leads to an unveiling of transference difficulties that may have remained unad-
dressed previously. I find this approach preferable to an initial focus on transference-
related issues, which at any point in the analysis, especially in the early phases of the
process, may be less available and more uncertain, or the patient may not at that point be
suitably receptive of transference-related questions or interpretations.
In these terms, then, there would seem to be a split within the alliance to the extent that
from one dimension of the alliance the analyst would seek to engage the patients
observation of the agreed-upon schedule in the interest of maintaining the analytic frame,
whereas from another perspective the analyst would try to support and reinforce the
patients freedom and initiative in seeking to establish a degree of autonomy. The conflict
generated by the intersection of the objective time frame of the analytic hour and the
patients inner sense of subjective time demand sets the stage for the collision of these
aspects, both transferential versus alliance on one level and within the alliance on another,
which leads to efforts on the part of the patient to attack the analytic structure and
reestablish temporal parameters more in accord with his or her own internal and implicit
psychic demand. As Rose (1997) cautioned:
Premature (therefore experienced by the patient as critical) interpretation of the patients

distortion of time, otherwise known as attacks on the setting, which of course they undoubt-
edly are, may lead to a zealous compliance by the patient with the psychoanalysts perceived
demands and the essential data yielded then vanishes into this form of enactment. However,
if these processes are allowed to develop, the temporal structure of the setting allows the
different temporalities of the patients internal world to become conscious and apparent to the
patient and the psychoanalyst alike and therefore capable of articulation. (p. 464)
I would note that this territory is fertile ground for countertransference deviations.9 I
could not deny that, sitting and waiting for my patient to arrive, with extra time on my
hands, I did not experience a sense of frustration and irritation, compounded with concerns
as to what effect the continued lateness and missing hours was having on the analysis. I
made efforts consciously to counter these feelings by making sure that instead of sitting
and feeling irritated, I made good use of the extra time by conducting some business with
my secretary, making a telephone call, reading an article, or even grabbing a cup of coffee.
I imagined that such productive use of the time helped to undercut my negative reactions
and, in addition, sent a message to the patient that, whenever he arrived, he would find me
occupied and using the time to good purpose, not sitting and fuming and being enraged
at his acting out, as he seemed to imagine. I am not certain that my tactic was always
successful or that it successfully tempered the countertransference component. In addition,
as I have already noted, approaching these difficulties self-consciously and deliberately
from the side of the alliance, I hoped would add another safeguard against possible
countertransference enactment.
However, as we all know, more subtle factors may be at work in determining the
9
Busch and Schmidt-Hellerau (2004) have catalogued the variety of countertransference
reactions usually elicited in analysts by their patients lateness.
reluctance of a patient such as Jake to accept and adapt to the temporal parameters within
the analysis. Clearly, there was little room for doubt that his difficulties in dealing with
and managing time were pervasive in his daily life experience and did not arise solely
within the analysis. Even so, we can ask whether there was anything going on in the
analysis that might have contributed to the patterns of enactment we have described.
Along this line of thinking, Schafers (2005) recent thoughts about patterns of subtle
coercion in the analytic process are relevant. He points to certain aspects of the analytic
interaction that may be experienced by the patient as being simultaneously or sequentially
both caring and coercing. His discussion focuses on interpretation, working responsibly,
free association, collaborating with the analyst, and finally reassurance as potentially
tainted in this manner. His comments, for example, on collaboration with the analyst are
suggestive:
The analysands desire to collaborate in the work of analysis is often associated with a fantasy
of submitting to coercion. The fantasy centers on surrendering to the analysts will. Following
instructions and abiding by limitations is, of course, adaptive on one level, but on another it
can be experienced as subjugation. Consequently, collaboration can foster mixed or alternat-
ing feelings of self-satisfaction, fright, humiliation, excitement, relief, and the bliss of utter
passivity. (p. 780)
This description would certainly apply to Jake.

The question in my view is whether and to what extent such factors can be attributed
to countertransference, as Schafer seems to assume. I agree fully with the theory that there
might have been something subtly coercive in my interaction with Jake. But first of all I
would note that all the aspects of the analytic interaction designated by Schafer as
potentially coercive can be also counted as aspects of the therapeutic alliance. As such
they are, in my view, both commendable and even essential to the optimal effectiveness
of the analytic process. Accordingly, from this perspective, I regard the coercive elements
in these aspects of the alliance as transference-derived contaminants of the alliance,
introduced into the analytic relation as an aspect of the patients transference. The
dynamic pull of the transference may draw the analyst into a corresponding countertrans-
ference reaction, the sort of thing Sandler (1976) designated role responsiveness.
From the side of the alliance, there may be no coercive intent on the part of the analyst.
But, regardless of the analysts intent, there may be something about the structure of the
analytic situation and interaction that can feed into the patients interpretation of the
interaction as being potentially coercive. In my view this would not necessarily be a form
of countertransference, because it would not derive from the unconscious of the analyst
but rather represents an aspect of the real organization of the analytic situation. In setting
up and agreeing on the temporal structure of the analysis, both analyst and patient are
unwittingly providing a basis for eliciting the transference reactions from the patient that
engage with these time constraints in terms that reflect the typical way in which the patient
deals with time restrictions and demands in the whole of his life experience. Analysis in
this regard is no exception. I say not necessarily countertransference because it is
entirely possible that the analysts efforts to maintain or reinforce the temporal boundaries
of the analysis may simply reflect his theoretical understanding of what is required for an
analysis to take place, but this may also call into play some aspect of his own psychic
reality and unconscious motivation that could legitimately be regarded as countertrans-
ference and would thereby fit Schafers paradigm. But other motivations and intentions
may be involved.
Does this mean that analyst and patient can somehow circumvent this dilemma or do
640 MEISSNER
without time constraints? I think not. I would regard the temporal parameters of the
analytic process as essential in setting the boundaries of the analytic engagement and as
essential aspects of the structure of the analytic situation. On one hand, they are real
factors basic to the structure of analysis, and on another they are negotiated aspects of the
analytic contract as integral to the therapeutic alliance. In what sense, then, can the
coercive dimension be countertransferential? I assume, along with Schafer, that this would
be the case when the coercive component is abetted by some countertransference dispo-
sition on the part of the analyst. Although this may not always be the case, there remains
plenty of room for the possibility that a given analyst may bring to the analytic interaction
authoritarian attitudes that can find expression in setting up and reinforcing temporal
parameters. I regard these to be effectively countertransferential contaminants of the
alliance.
But it is also possible, within the framework of the alliance, that observance of the
time dimension may be regarded by the analyst as essential to the effectiveness of the
analytic process and that his or her efforts to deal with deviations are an aspect of his or
her so-called analytic work ego. Nonetheless, as I think Schafer would agree, coercive
elements can permeate the analytic relation both from the side of the patients transference
and from the side of the analysts adherence to the terms of the alliance agreement insofar
as his or her attempts to deal with it might reflect or draw into the interaction some
countertransferential attitudes or unconscious motives of his or her own. The same
considerations would apply to all of the dimensions of the analytic interaction that Schafer
regards as potentially coercive.
To return to Jake, setting up the time parameters for the analysis dealing with
frequency, length of sessions, specific time periods during the day or week, and arrange-
ments for holidays and vacations and other interruptions all provided a ready-made
framework for potential acting out. The implicit assumption on my part was that we had
made an agreement and we were both responsible for fulfilling the obligation we had
willingly undertaken. Although a part of Jake could entertain the same view of these
arrangements, there was another part that responded to them as authoritarian demands and
constraints, the imposition of my scheduling demands and needs that, as he saw it, took
precedence over his needs and wishes, and against which he felt compelled to rebel and
defy. Consequently, partly as a function of my personal sense of fidelity and responsi-
bility, when I persisted in trying to adhere to the time parameters, he experienced my
faithfulness to the schedule as an affront that was humiliating and accusatory, thus feeding
into his underlying propensity for shame. By implication my being habitually on time for
the appointments was equivalent to an accusation and retributive demonstration of his
failure, inadequacy, and deviance. His reaction was understandably shame-ladened and
both frustrated and furious. Even worse, what I thought were gentle attempts to inquire
about his enactments, with the intention of inquiring into the underlying motivations and
meanings rather than anything that smacked of accusation or reprimand, he experienced
as accusatory indictments labeling him as deviant, bad, and rebellious.
Could these interventions on my part be regarded as part of my countertransference?
What was conscious to me was my intention of trying to modify what I saw as a severe
misalliance and transferential acting-out that was putting the analysis at risk and which I
felt it was necessary to address in some way that would advance rather than impede the
analytic effort. I was also aware of my concern and even anxiety regarding the prospects
for this analysis and my doubts and uncertainties as to what course of action to follow. I
was concerned and worried for the fate of the analysis, which seemed to me, at times, to
be in danger of either falling apart or stalemating in a kind of time warp of interminability
were I to do nothing. In retrospect, I also have to admit that I felt a degree of irritation at
Jakes deviant behavior and flaunting of the analytic contract that I could find no way to
moderate and further a sense of frustration in my inability to bring about any change and
a sense of inadequacy that challenged my sense of professional competence and narcis-
sistic balance. Could these dispositions have found their way in my interactions with Jake
in some subtle manner that escaped my conscious awareness? Indeed, it may be that
something about my demeanor, my tone of voice, or my choice of words, conveyed some
aspect of my unconscious motivation that would have contributed to the patients re-
sponse. After all, it would seem fair to say that his enactments were equivalently an assault
on my sense of professional competence and my abilities to conduct a meaningful and
productive analysis.
Concluding Reflections
In conclusion, I call attention to the fact that the temporal perspective of the analytic
interaction serves as an important focus for the conjunction and interaction of the
respective aspects of the analytic relation. Objective time, the inexorable and unstoppable
movement of time as registered on the clock, is an unavoidable reality in our lives,
whether we be analysts or patients. As such, real time is a vital component of the analytic
situation that plays itself out in temporal terms involving scheduled hours and within the
session is measured by the ticking of the clock: The hour begins at a point in time and ends
at another point in time. What these specific time points are to be is determined in relation
to the alliance, established by mutual negotiation and decision between analyst and patient
as part of the structure of the analysis, that is, as one of the components of the analytic
situation that contributes to making the analytic work of the process possible. But these
external conditions, if we can call them such, are reframed and reprocessed in the patients
and analysts respective subjectivities. How these elements get worked out in the actuality
of the analytic interaction is a matter of how they are processed through the filters of the
participants subjective psychic realities. We are forced to not only deal with unconscious
dynamic motives that come into play in dealing with the demands of objective time and
the limits and constraints imposed from the side of the alliance but also to come to terms
with the subjective meaning of time to the patient and his or her devices for resisting,
compromising with, or accommodating to these demands and constraints and to the
analyst and his or her attitudes, convictions, standards, and values as they relate to time
and time management in the analysis .
In the final analysis, the moral or lesson that I took away from my experience with this
patient and with others was that these aspects of their temporal experience, so profoundly
invested with narcissistic entitlements and so pervasively embedded in their need to
preserve a sense of self-integrity and esteem, were among the more resistant and immu-
table aspects of their neurotic adjustments and seemingly remained relatively impervious
to analytic modification. At the same time, the analytic outcome was by no means a
disaster; I feel that Jake gained a great deal from his analytic experience, not as much as
his analyst would have hoped for but perhaps enough. Whether a more effective or
successful modification of his temporal difficulties would have brought about a more
productive analytic result will have to remain a matter of conjecturemaybe or maybe
not.
642 MEISSNER
References
Bach, S. (2001). On being forgotten and forgetting ones self. Psychoanalytic Quarterly, 70,
739 756.
Barrows, K. (1999). Ghosts in the swamp: Some aspects of splitting and their relationship to parental
losses. International Journal of Psychoanalysis, 80, 549 562.
Boris, H. N. (1994). About time. Contemporary Psychoanalysis, 30, 301322.
Boschan, P. J. (1990). Temporality and narcissism. International Review of Psychoanalysis, 17,
337349.
Busch, F., & Schmidt-Hellerau, C. (2004). How can we know what we need to know: Reflections
on clinical judgment. Journal of the American Psychoanalytic Association, 52, 689 707.
Colarusso, C. A. (1987). The development of time sense: From object constancy to adolescence.
Journal of the American Psychoanalytic Association, 35, 119 144.
Ferraro, F. (2001). Vicissitudes of bisexuality: Crucial points and clinical applications. International
Journal of Psychoanalysis, 82, 485 499.
Ferro, A. (2003). Marcella: The transition from explosive sensoriality to the ability to think.
Psychoanalytic Quarterly, 72, 183200.
Green, A., (2002). Time in psychoanalysis: Some contradictory aspects. London: Free Association
Books.
Hartocollis, P. (1983). Time and timelessness. New York: International Universities Press.
Hartocollis, P. (2003). Time and the psychoanalytic situation. Psychoanalytic Quarterly, 72,
939 957.
Hinz, H. (2003). The analyst at work: Anaesthesia or psychotherapy: Eradicating thoughts or
working them through. International Journal of Psychoanalysis, 84, 203220.
Kaplan, D. M. (1990). Some theoretical and technical aspects of gender and social reality in clinical
psychoanalysis. Psychoanalytic Study of the Child, 45, 324.
Langs, R. (1982). The psychotherapeutic conspiracy. New York: Aronson.
Lansky, M. R. (2005). Hidden shame. Journal of the American Psychoanalytic Association, 53,
865 890.
Lichtenberg, J. D. (1999). Compliance as cooperation, compliance as defensive: One example of
dialectic tension in the clinical exchange. Psychoanalytic Inquiry, 19, 61 81.
Lombardi, R. (2003). Mental models and language registers in the psychoanalysis of psychosis: An
overview of a thirteen-year analysis. International Journal of Psychoanalysis, 84, 843 863.
Meissner, W. W. (1978). The paranoid process. New York: Aronson.
Meissner, W. W. (1981). Internalization in psychoanalysis [Psychological Issues, Monograph 50].
New York: International Universities Press.
Meissner, W. W. (1992). The concept of the therapeutic alliance. Journal of the American
Psychoanalytic Association, 40, 1059 1087.
Meissner, W. W. (1996). The therapeutic alliance. New Haven, CT: Yale University Press.
Meissner, W. W. (in press) Time, self, and psychoanalysis. Lanham, MD: Aronson.
Namnum, A. (1972). Time in psychoanalytic technique. Journal of the American Psychoanalytic
Association, 20, 736 750.
Ogden, T. H. (2002). Commentary on Dr. Bohms Sara in her fourth analytic year. International
Journal of Psychoanalysis, 83, 1008 1012.
Panel (2005a) Revenge. Reported by H. J. Beattie. Journal of the American Psychoanalytic
Association, 53, 513524.
Panel (2005b) A update on time. Reported by K. Arvanitakis. International Journal of Psychoanal-
ysis, 86, 531534.
Paniagua, C. (1998). Acting in revisited. International Journal of Psychoanalysis, 79, 499 512.
Rose, J. (1997). Distortions of time in the transference: Some clinical and theoretical implications.
International Journal of Psychoanalysis, 78, 453 468.
Sandler, J. (1976). Countertransference and role-responsiveness. International Review of Psycho-
analysis, 3, 43 47.
Schafer, R. (2005). Caring and coercive aspects of the psychoanalytic situation. Journal of the
American Psychoanalytic Association, 53, 771787.
Schou, P. (2000). Future and potentiality in the psychoanalytic process. Journal of the American
Psychoanalytic Association, 48, 759 783.
Spero, M. H. (1993). The temporal framework and Lacans concept of the unfixed psychoanalytic
hour. Psychoanalytic Study of the Child, 48, 115142.
Vinar, M. N. (2005). The specificity of torture as trauma: The human wilderness when words fail.
International Journal of Psychoanalysis, 86, 311333.
Wolf, E. S. (1983). Concluding statement. In A. Goldberg (Ed.), The future of psychoanalysis:
Essays in honor of Heinz Kohut (pp. 495505). New York: International Universities Press.

Time On My Hands

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Psychoanalytic Psychology Copyright 2006 by the American Psychological Association

2006, Vol. 23, No. 4, 619 643 0736-9735/06/$12.00 DOI: 10.1037/0736-9735.23.4.619

Keywords: lateness, narcissism, transference, therapeutic alliance

Percentage of Time Utilized

Figure 1. Percentage of scheduled analytic time utilized in monthly intervals.

Time and Transference

On occasion I took the opportunity to address the transference reverberation: [You

The importance of a future orientation in relation to termination is also emphasized by

Premature (therefore experienced by the patient as critical) interpretation of the patients

This description would certainly apply to Jake.

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