Understanding and using enactments to further clinical work: a case study of a man unable to experience intimacy.

This article examines the value of working within enactments-affectively charged, unconscious remnants of painful, past experiences played out in the novel context of the therapeutic relationship-to further the work of psychodynamically oriented therapy in the treatment of a HIV-positive Hispanic gay male in his early 30s with a history of relational trauma. Through clinical vignettes, I highlight how relational uncertainty and its vicissitudes-vulnerability, doubt, safety, and trust-have triggered mutual dissociation in the context of enactment. At times, this has disrupted our ability to communicate honestly and relate intersubjectively. By working within affectively charged enactments, we have expanded our capacities to accommodate to relational uncertainty and used the tension of ambiguity within our relationship to permit the emergence of a shared space for recognition and self-discovery.