‘Can you push a camel through the eye of a needle?’ Reflections on how the unconscious speaks to us and its clinical implications.

There has been a recent surge of interest in a type of thinking seen in some patients most of the time, and all patients some of the time. In the past it was simply called regressive thinking, but attempts to be more specific have led it to be called by various names, like ‘pre-symbolic’, ‘pre-conceptual’ and ‘pre-operational’. What these labels attempt to capture is that the patient’s thinking, at these times, is without representations and closer to actions. As a clinical phenomena I prefer to use Loewald’s term, ‘action–language’, that is, where words become attempts to bore, seduce, anger, etc. It is different from when words are used to communicate internal states via free association. A case is made for action–language being the primary method by which the unconscious speaks to us in psychoanalytic treatment. This paper explores some of the reasons for this type of thinking, along with the clinical methods to find the thinker where there appears to be none. Distinctions will be made as to the use of the process versus the content, on the goal of interventions as bringing insight versus the capacity for insightfulness, and the model of treatment as leading to transformations in thinking, rather than lifting of repressions. A clinical example is presented to demonstrate these perspectives. [ABSTRACT FROM AUTHOR]