Psychoanalytic Quarterly, LXXVI, 2007

A NOTE ON NOTES:
NOTE TAKING AND CONTAINMENT

BY HOWARD B. LEVINE

Psychoanalysts often record detailed process notes during sessions.

While this is a common practice, it runs counter to the traditional
advice of many, who, beginning with Freud (1912), have counseled
against making transcripts during the psychoanalytic hour. Freud
argued that a focus on remembering details is apt to produce “ex-
pectations” of what will be found and “inclinations” as to what one
should listen for, and that neither of these is helpful to the analytic
task. If the analyst follows his expectations, Freud noted, “he is in
danger of never finding anything but what he already knows; and if
he follows his inclinations he will certainly falsify what he may per-
ceive” (1912, p. 112).
In advising analysts against taking notes during sessions, Freud
made clear that he was describing what worked best for him. He
left open the possibility that the minds of other analysts might func-
tion in ways that were different from his. Also, these recommenda-
tions were made in the context of the topographic theory, based
upon Freud’s 1900 model of dream interpretation. He could not
then have known that his metapsychology would undergo signifi-
cant changes, as would our views of mental functioning. Mental
states characterized by failures of representation (e.g., Botella and
Botella 2005; Green 1975) in fragmented minds would take their
place as the agents of psychopathology, alongside repressed mental

Howard B. Levine is a faculty member at the Psychoanalytic Institute of New

England, East, and a faculty member and Supervising Analyst at Massachusetts In-
stitute of Psychoanalysis.

981
982 HOWARD B. LEVINE

contents in an intact psychic apparatus. Analysts would come to ap-

preciate the extent to which the optimal conditions for analytic
functioning may be pair specific and vary from moment to moment
for a given analytic dyad.
Bion (1967, 1970) elaborated upon Freud’s recommendations,
encouraging analysts to try to listen to their patients without mem-
ory or desire. He argued that the psychic phenomena that are the
proper objects of analytic study are ineffable and emergent and,
unlike the phenomena of ordinary experience, “have no back-
ground in sense data” (Bion 1970, p. 57). Their essence cannot be
captured in notes or transcripts. For the analyst to try to do so may
lead to difficulties: “The attempt to remember or record destroys
the capacity for, and interrupts the exercise of, observation of the
psycho-analytically significant events” (p. 71).
Central to Bion’s work, however, is a particular sensitivity to
the vicissitudes of the analyst’s ego functioning and a curiosity about
the specific moment-to-moment factors that may support or im-
pede the analyst’s capacity to think, feel, bear affect, intuit, com-
prehend, and formulate meaning. It would not be inconsistent
with the spirit of his approach—and that of many other contem-
porary analysts—to replace a categorical injunction against note
taking during sessions with an examination of the specific condi-
tions under which a particular analyst’s analytic functioning may
be facilitated or impeded by note taking with a given patient at a
given moment in time.
It is in that spirit, and in line with my own experience, that I
suggest the traditional position regarding note taking during ses-
sions holds for many analysts at many times, but it does not merit
being viewed as the uniform or universal proscription that it is of-
ten thought to be. For at least some analysts at some times in their
work with some patients, note taking during sessions may not be an
impediment or a distraction, but instead may be an aid to competent
analytic listening and good analytic technique. What I am asking the
reader to consider is not note taking for the purposes of remem-
bering, but rather note taking as a centering and self-regulating
 A NOTE ON NOTES: NOTE TAKING AND CONTAINMENT 983
device employed to help maintain one’s analytic composure and
competence in the face of certain stressful or difficult situations.
According to Bion (1962, 1970, 2005a, 2005b), the therapeutic
action of analysis—the aim of which is transformation and expan-
sion of the patient’s capacity for psychic functioning—is closely
linked to the analyst’s function as container for the patient’s un-
metabolized and projected emotional experience. In order to per-
form this function, the analyst must keep intact his or her capac-
ity to absorb, bear, and make sense of that which is inchoate, un-
bearable in, and projected by the patient. If the patient’s projec-
tions begin to overwhelm and outstrip the analyst’s capacity to
withstand, absorb, and process them, the analyst may become dys-
functional. This incapacity may be temporary or chronic, related
to specific affects or contents raised by the patient, or reflective
of a more general response to some combination of the analyst’s
own conflicts, current life situation, and/or what is stirred up in
or required of the analyst by exposure to the patient and the ana-
lytic situation.
When I reflect upon the patients I have analyzed over the past
thirty years, I have come to recognize that in certain circumstances
with specific patients, note taking during analytic hours has played
an important role in helping me to protect and maintain my thinking
and therefore my analyzing capacity. While the contents of the notes
—i.e., remembering—may play a part, it is not necessarily the cen-
tral part nor the part to which I wish to draw attention. Rather, I
wish to emphasize the role that the act of note taking during the
session has played in supporting my ability to maintain my analytic
competence and capacity to think coherently, analytically.
The common elements that I can discern among those pa-
tients for whom this proved to be the case were that each was se-
verely withdrawn, susceptible to feeling isolated and/or deeply
traumatized, and had little capacity to tolerate, acknowledge, or
make sense of areas of their own experience. These patients were
usually engaged in very lengthy analyses, the need for which I
would retrospectively say was directly related to their limited ca-
pacities for self-regulation and the challenges they presented to
984 HOWARD B. LEVINE

my capacities for containment. They had weakened affect toler-

ance, disruptions and discontinuities in ego functioning, and were
prone to feeling—or to massively defending against—overwhelm-
ing states of emotion; they were subject to being driven by signi-
ficant areas of unrepresented mental states (Botella and Botella
2005).
These patients had borderline or narcissistic characters or a
schizoid core; they had histories of early massive trauma or sexual
abuse; and they relied heavily upon narcissistic withdrawal, disso-
ciation, splitting of the self, and/or the massive use of projective
identifications.1 Unlike other patients with similar histories and di-
agnoses, I found that with these patients, my analyzing capacities
were at times overwhelmed and disabled in specific ways. My ex-
perience ranged from intense fatigue and even somnolence, on
the one hand, to confusion and inability to make sense of the situa-
tion or the common-sense meaning of the patient’s associations,
on the other. This confusion did not seem to be, at least on the
surface, the product of my overt anxiety, emotional distress, or in-
ability to deal with the conflicts stirred up by a particular set of
contents or issues. It felt more like a profound, general disabling
of my mind.
While aspects of my susceptibility to these responses may be con-
jectured to lie along the fault lines of my own traumatic past and
areas of potential residual conflict (my countertransference), the
kind of analytic disabling that I am trying to describe is not sim-
ply remediable by “more analysis.” I remained capable of “good
enough” analytic functioning with other patients and in other cir-
cumstances with the same patients. I am trying to describe some-
thing that goes beyond the more usual experience of finding that

1
It remains an open question—one deserving of further investigation—wheth-
er other analysts have experienced the kind of reactions that I am describing with
less severely disturbed patients. My speculation is that these phenomena are linked
to the presence of severe psychopathology, such as significant traumatic residues,
failure of representation, and other forms of disorganized psychic functioning. I
believe that it is these factors that shift the patient’s discourse away from a means
of conveying unconscious symbolic content and more toward a kind of discharge
phenomenon that is “dead,” meaningless, or evacuative in function.
 A NOTE ON NOTES: NOTE TAKING AND CONTAINMENT 985
one’s associative capacities have temporarily dried up in reaction to
a patient’s resistances or affective withdrawal.
I suspect that a development of this type between analyst and
patient is one to which each of us may at some point succumb.
Given the massive traumatic past to which many of these patients
have been subjected, it may even be that a period of analytic dis-
ablement is a necessary stage for the analyst to go through, as a
form of enactment in which the analyst’s mind is disabled in tran-
sient identification with a once-traumatized part of the patient.
Whatever the form of the problem and its underlying dynam-
ics, the common challenge these patients have presented is that of
analytic survival (Winnicott 1962): how to maintain an adequate
degree of functioning as a containing, thinking, and analyzing ana-
lyst. What I have discovered is that the “technique” of taking pro-
cess notes during sessions offered me a temporary solution to that
problem. It was as if the patient’s words and/or my ability to hold
them in mind were fleeting and evanescent. The act of writing
them on the page as the hour unfolded helped me to better hold
them in mind—and to feel like I had a mind in which to hold
them!
Perhaps the act of writing itself, writing as action in the face of
the stasis-inducing withdrawal of these patients, was an important
gesture of vitality that had a salutary effect. Whatever the mecha-
nism, the act of writing and gazing at the words during the session
as I was listening to the patient—perhaps, one might say, relating
to the words in the emotional absence of a patient with whom I
could relate—helped me maintain a competent mind.
With several of these patients, I decided to take notes in the
hope of studying the sessions afterward and trying to figure out
why I was having so much trouble, or with the idea of presenting
the case to colleagues in a study group or to a consultant. What I
found, much to my surprise and relief, was that in the session,
the very act of taking and having the notes enabled me to focus,
to retain my comprehension and keep my mind intact, and to re-
gain a better level of analytic functioning. I almost never reread
the notes outside the hours, and I found that once my analytic ca-
986 HOWARD B. LEVINE

pacity was restored, presenting the situation to others became less

imperative. The act of taking notes stabilized my capacities within
the session and was enough to help me resume my more usual lev-
el and manner of analytic functioning.

An Illustrative Vignette from My Own Practice

After several years of more ordinary functioning in his four-
times-per-week analysis, Mr. L, a man in his early fifties with prob-
lems related to early object loss and narcissistic parenting, began
to fall silent and to emotionally withdraw during sessions. This
occurred to such an extent that I came to feel devoid of all affec-
tive contact and sustenance. As he would fade out without much
discernible stimulus for doing so, I would also begin to fade, ex-
periencing terrible fatigue states that would occlude my mind, in-
terrupt my attention, and interfere with my ability to comprehend.
These states seemed quite specific to my exposure to Mr. L, as they
would lift as soon as the hour was over and he left the room.
I began to take notes during these sessions in an attempt to
stabilize my functioning. As I did so, I recognized that, despite the
dissociated and/or intellectualized quality of Mr. L’s sparse asso-
ciations—the latter appeared as disconnected pictographic images
that would punctuate long, often uncomfortable silences—there
were hints of catastrophic and destructive fantasies and intense,
overwhelming needs, which the patient could not bear to experi-
ence and from which he was defensively withdrawing. That is, rath-
er than “nothing much” going on in the sessions, there were hints
of a great deal that was potentially catastrophic and disturbing.
For example, a long silence would be punctuated by the pa-
tient’s reference to an image of a claw tearing at the earth, a dog
attacking a squirrel, or a toddler alone and crying in a parking lot.
No sooner were these images spoken than Mr. L would “forget”
them, and my attempts to ask for associations or offer conjectures
about their meaning were met with questions such as “What did
I just say?” Prior to the stabilizing activity of the note taking, I, too,
would miss the potential power and significance of these occasion-
al images. However, once they were more clearly formed in my
 A NOTE ON NOTES: NOTE TAKING AND CONTAINMENT 987
mind, I was able to better track the comings and goings of Mr.
L’s emotional withdrawal, and to slowly help him see and face
what he was so massively turning away from.
Over time, my restored analytic functioning helped me assist
the patient in reengaging emotionally with his own feelings and
with me at a deeper and more meaningful—albeit more con-
sciously painful—level. As Mr. L became more engaged, I found
that my need to take notes during the sessions diminished.
While much might be said about my own dynamics and sus-
ceptibility to the pressures that I was being put under by this pa-
tient, what I wish to underscore is the type and degree of dis-
abling force that I experienced. Prior to my taking notes, when I
imagined what I might say to a consultant to illustrate what went
on in these sessions, I felt that I would have little to report about
the content of the hours. Once I began writing notes, however, I
felt more alert and alive, and more affectively engaged with the
deadness in Mr. L and its effects upon me. I also saw that there
was more “content” to the sessions than I had recognized, and, ul-
timately, that the patient’s withdrawal had powerful self-protective
and aggressive meanings as enactments, which were eventually an-
alyzed.
Britton (1998, 2004) has noted that the capacity to effectively
function analytically requires the presence in the analyst’s mind
of a triangular space that is constituted through an internal rela-
tionship to a generative object or third.2 Had I, due to some com-
bination of my own conflicts and exposure to Mr. L’s projections,
become temporarily enmeshed in an internal situation, which in-
terfered with or removed me from my usual productive relation-
ship to a generative third? Did my internal analytic space become
constricted or collapsed, or did my third become a deadening
2
For an elaboration of the dynamic functioning of triangular space in the
minds of both patient and analyst, see Caper (1997), who suggested that the ana-
lyst’s internal third is psychoanalysis itself in any of a number of manifestations:
psychoanalysis as an investigative enterprise or profession; identifications with
past teachers, analysts, or supervisors; etc. This concept has also been taken up
extensively in the French literature; see, for example, Lacan (1953) and Green
(1975).
988 HOWARD B. LEVINE

or destructive object evoking a situation from my own traumatic

past?
The act of taking notes, with the thought of perhaps presenting
the case to colleagues or to a consultant, may have reinforced or
restored my internal relationship with a generative and stabilizing
other, reactivated a triangular analytic space within my mind, and
restored my potential for analytic functioning. Whatever the dy-
namics involved, I found that if I took notes during the session, I
could begin to think and function more effectively and could better
track the material during the hours.

A Colleague’s Experience
At the time of the note taking in the case I have just described,
my action did not appear to have a specific, organized, recogniza-
ble unconscious symbolic meaning as enactment and actualization
of some aspect of the patient’s internal world or my own.3 This has
not always proven to be the case.
For example, a colleague, Dr. M, described a patient in her
late forties whom he was having difficulty understanding and with
whom he began taking process notes in anticipation of seeking a
consultation. Once he began, he found that he was following the
patient’s discourse better, but that he was emotionally “a half step
behind her” in the sessions. At first glance, this situation seemed
consistent with Freud’s (1912) cautionary words, and he stopped
taking notes. However, doing so produced a dilemma for Dr. M:
while he felt that he needed to eschew taking notes in order to
be more present and therefore affectively available to his patient,
he discovered that he could not follow her without doing so!
Upon further reflection, Dr. M realized that this paradoxical
state of affairs indicated that he was caught between maintaining

3
Whether this was literally true, or simply the result of no such meaning be-
ing discernible, is impossible to know with any degree of certainty. To the extent
to which it helps stabilize and support one’s analytic functioning, however, note
taking used in this way may facilitate the analyst’s attempts to discover such mean-
ings.
 A NOTE ON NOTES: NOTE TAKING AND CONTAINMENT 989
his equilibrium at the expense of his affective availability to the pa-
tient, and being affectively available to her at the expense of his
own equilibrium. In viewing the situation from this perspective,
Dr. M realized that an early dilemma that had existed between the
patient and her narcissistically disturbed mother was being actual-
ized: the mother had repeatedly withdrawn emotionally from her
children in order to try to regain her own easily shattered compo-
sure. The situation also repeated the patient’s current internal
condition and transference, both of which were marked by her
need to defensively turn away from parts of herself and her ana-
lyst in order to maintain a tenuous emotional equilibrium.4

Summary
In extreme situations of massive projective identification, both
the analyst and the patient may come to share a fantasy or belief
that his or her own psychic reality will be annihilated if the psychic
reality of the other is accepted or adopted (Britton 1998). In the
example of Dr. M and his patient, the paradoxical dilemma around
note taking had highly specific transference meanings; it was not
simply an instance of the generalized human response of distrac-
ted attention that Freud (1912) had spoken of, nor was it the de-
stabilization of analytic functioning that I tried to describe in my
work with Mr. L. Whether such meanings will always exist in these
situations remains a matter to be determined by further clinical
experience.
In reopening a dialogue about note taking during sessions, I
have attempted to move the discussion away from categorical in-
junctions about what analysts should or should not do, and in-
stead to foster a more nuanced, dynamic, and pair-specific consid-
eration of the analyst’s functioning in the immediate context of
the analytic relationship. There is, of course, a wide variety of lis-
tening styles among analysts, and each analyst’s mental functioning

4
Presumably, the situation also resonated with meanings from Dr. M’s past
and/or internal world, the description or exploration of which are beyond the
scope of this paper. (See Levine 1994.)
990 HOWARD B. LEVINE

may be affected differently by each patient whom the analyst sees.

I have raised many questions in the hopes of stimulating an ex-
panded discussion that will allow us to share our experiences and
perhaps reach additional conclusions. Further consideration
may lead us to decide whether note taking may have very different
meanings for other analysts and analyst–patient pairs, and whether
it may serve useful functions in addition to the one that I have de-
scribed.

REFERENCES

Bion, W. (1962). Learning From Experience. London: Heinemann.

———- (1967). Notes on memory and desire. In Melanie Klein Today: Devel-
opments in Theory and Practice—Vol. 2, Mainly Practice, ed. E. Spillius.
London/New York: Routledge, 1988, pp. 17-21.
———- (1970). Attention and Interpretation. New York: Basic Books.
———- (2005a). The Italian Seminars. London: Karnac.
———- (2005b). The Tavistock Seminars. London: Karnac.
Botella, C. & Botella, S. (2005). The Work of Psychic Figurability. Hove,
England/New York: Brunner-Routledge.
Britton, R. (1998). Belief and Imagination. London/New York: Routledge.
———- (2004). Subjectivity, objectivity and triangular space. Psychoanal. Q.,
73:47-62.
Caper, R. (1997). A mind of one’s own. Int. J. Psychoanal., 78:227-242.
Freud, S. (1900). The Interpretation of Dreams. S. E., 4/5.
———- (1912). Recommendations to physicians practising psycho-analysis.
S. E., 12.
Green, A. (1975). The analyst, symbolization and absence in the analytic
setting. Int. J. Psychoanal., 56:1-22.
Lacan, J. (1953). Fonction et champ de la parole et du langage: discours de
Rome. In Les Ecrits. Paris: Le Seuil, 1966.
Levine, H. (1994). The analyst’s participation in the analytic process. Int. J.
Psychoanal., 75:665-676.
Winnicott, D. W. (1962). The aims of psycho-analytical treatment. In The
Maturational Processes and the Facilitating Environment. New York: Int.
Univ. Press, 1965, pp. 166-170.

124 Dean Road

Brookline, MA 02445

e-mail: hblevine@aol.com