Patient's Surface, Clinical Surface, and Workable Surface

Abstract

Surface is a term often used in clinical theory, which seems to have eluded a reliable definition. Freud used the term mostly to denote the analysand's consciousness. This patient's surface does not always coincide with the data the analyst can observe, i.e., the clinical surface. It is proposed that clinical surface be understood, in contrast to other psychoanalytic concepts, as the clinical evidence that does not need conjecture to be grasped cognitively. The concept of "average expectable apperception" is introduced. Workable surface is defined as those aspects of the clinical surface that lend themselves well to the exploration of unconscious dynamics or genesis. Ideas about which surfaces are optimally workable vary according to different schools of technique. The advantages of considering clinical surface the objective anchorage of psychoanalysis as a positive science and of differentiating it from patient's surface and workable surface are discussed.

A Terminating Case

“…[I saw this ' unwarranted assumption of unfamiliarity with the material' (Paniagua, 1985, p. 319) as one nodal point where the clinical surface could become especially workable (cf. Paniagua, 1991). I thought that, perhaps, directing his attention to this issue could permit us to deepen our understanding of a transference fantasy concerning the impression that he supposedly made on me.…”

“…[I tried to call his attention to both the hypochondriacal nature of his perception and his identi cation with his girl, as expressed through his nonverbal communication (' acting in' , cf. Paniagua, 1998). ] P: Yes, I just noticed.…”

“…With a dream material like this, one may nd it more attractive to interpret putative symbolic meanings and assumed transference allusions or genetic displacements (cf. Paniagua, 2001). I prefer to address that which can be observed by the analysand by simply directing his preconscious attention to it.…”

Monitoring The Analytic Surface

“…This version can be seen to make particular sense in the context of the then-dominant topographic theory. In subsequent applications, the term has been expanded to mean "the level of observables" (Paniagua, 1985) or the data that can be observed without ambiguity (Paniagua, 1991). Levy and Inderbitzin (1990) have extended the concept by making a distinction between the manifest surface, which is the direct observation of the patient's mind, and the latent surface, the level at which the clinician intervenes.…”

“…Poland's reasoning helps to explain a clinical example provided by Paniagua (1991). As she entered her office one day, the author accidentally bumped into a lamp and the (maIe) patient laughed and said, "I do things like that all the time" (p. 679).…”