When Theories Touch: A Historical and Theoretical Integration of Psychoanalytic Thought

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This book aims to deconstruct the different theoretical perspectives of psychoanalysis, and reconstruct these concepts in a language that is readily understood. Wherever possible this is meant not to do away with terms that are meaningful, but to attempt to clarify terms and concepts.The book comes in three sections. The first examines Freud's different theories and describes how Freud shifted his emphasis over time. The second section covers all the major post-Freudian theorists: Hartmann and Anna Freud (together in one chapter), Melanie Klein, Fairbairn, Winnicott, Sullivan, Mahler, Kohut, Kernberg, and Bion; and a chapter on the movement from classical theory to contemporary conflict theory. The last section deals with issues raised in contemporary psychoanalysis - issues as they pertain to the clinical situation, and the rationale for a theory of endogenous stimulation.

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Chapter One

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Slightly before, slightly beyond

Chapter summary

The title of the chapter is from Walter Stewart's book, Psychoanalysis: The First Ten Years (1963). In this chapter we look at the beginning of Freud's career as a therapist and an emerging psychoanalyst. He attempts to formulate a theory where psychological disturbances are caused by a combination of environmental events and physiological conditions. He is strongly influenced by the neurophysiologists of his era, and the familiar Freudian concepts such as fantasy and transference do not play a prominent role in the theory of this era. Rather, in adults there are actual causes that produce neurotic symptoms. The sexual practices of the era are thought by Freud to produce symptoms such as anxiety and neurasthenia. He calls neuroses that are produced by sexual practices, such as excessive masturbation or coitus interruptus, actual neuroses. Neuroses that are caused by conditions in childhood are called psychogenic neuroses, but these disorders are also caused by “real” events, trauma in childhood. The trauma that

 

Chapter Two

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In this chapter we go over both The Interpretation of Dreams and Three Essays on the Theory of Sexuality. I have put the summaries of both at the beginning of the chapter, although these works are discussed separately.

Summary of “the dream book”

Although Freud initially presented a complex model of dreaming, the emphasis of this model was on the wish. The wish, to paraphrase Freud, is the capital needed to fuel the dream, and Freud and those that followed him have focused heavily on the capital in the business of dreaming. Freud maintained that dreams are instigated by unconscious wishes. After making this assertion, Freud, in Chapter Seven of The Interpretation of Dreams (1900a), frequently reminds us of Socrates helping his listeners search for the meaning of the good and the beautiful. The sceptic might ask, if all dreams are instigated by a wish, what about anxiety dreams or dreams that feel horrific and typically are called nightmares? Freud answers these queries and his answers lead him to consider a realm of experience that, up to that point in time, had been largely unexplored: the earliest and deepest recesses of human experience. He defines an unconscious wish as a pleasure that has its source in early childhood. It is a pleasure that, if activated, shows the mind in conflict, since what is pleasurable at one level (unconscious) will cause anxiety on another level (pcs-conscious). This conflict is mediated by the censorship (which serves a defensive function), and these two levels of awareness are primarily governed by different modes of cognition (primary vs. secondary process).

 

Chapter Three

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Summary

T his is the period where Freud is both most prolific and writes a series of papers that are both complex and compelling. Despite this, they are not well integrated into the next period of his theorizing (Chapter Four) where he develops the more familiar structural model (ego, id, and superego). In this epoch, Freud more fully explicates his instinctual theory and uses this theory to reintroduce the concepts of primary and secondary process (see Chapter Two).

During this era, Freud also develops new psycho-sexual stages. These stages are his attempt to explain the difficulties in achieving a fulfilling mutual love relationship. His psycho-sexual stages are somewhat foreign to contemporary psychoanalysts. They are autoerotism, narcissism, object choice (or anal sadism), and object love. These stages are defined in terms of the child's relation to the object (typically, the child parents or fantasized others). Although Freud's theory does not leave his view of the child's powerful interest in her/his body and bodily functions, he puts this interest in terms of how the infant/child internalizes the object. In developing this new theory, Freud posits the concept of narcissism as a developmental stage. He also states a series of fixation points, and only one of these fixation points is in the Oedipal period.

 

Chapter Four

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Summary

I n this chapter, we go over the most familiar Freudian concepts. Freud's structural model is described, and we look at the meaning of the ego, superego, and id. Freud, at this point, reinforces the centrality of the Oedipus complex and the fixation points that were described in Chapter Three are discarded or, at least, no longer mentioned. His new drive theory is discussed, and he now has a theory where the two drives are Eros and Thanatos. Thanatos is often taken to be equivalent to aggression, but this was not Freud's meaning, and this point is discussed in the chapter. The chapter also allows for a review of previous concepts, since, in each of the major works in this era, there is a review of past papers. The main papers that are discussed are Beyond the Pleasure Principle (1920g), The Ego and the Id (1923b) and Inhibitions, Symptoms and Anxiety (1926d). In addition, we will briefly discuss some of Freud's later papers.

Introduction

 

Chapter Five

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Summary

T his chapter brings together two analysts (Anna Freud and Heinz Hartmann) who were perhaps the two most influential Freudian theorists from 1940-1960 and beyond. Their theoretical efforts were frequently labelled as ego psychology, since the Freudian theory that they promulgated began from Freud's structural theory (Chapter Four). Hartmann and Anna Freud were initially the main explicators of Freud's move to , and their clarification and development of help to make it the dominant theoretical influence in the USA. It is hard to understand the import of both Hartmann and Anna Freud without making some attempt to recreate the atmosphere that faced both these theorists in the mid 1930s.

Freud, at this point in time, was quite ill, and was to die in 1939. Melanie Klein was in England and having a substantial impact on the members of the British Psychoanalytic Society. European psychoanalysis was dominated by Freudian theory, but there was unease about considering Thanatos, or the death instinct (see Chapter Four), a central psychoanalytic concept. The idea of a death instinct, while embraced by Klein, was certainly not finding strong acceptance in the Freudian community. Moreover, while Freud had proposed during the 1920s, few writers (including Freud) had shown the clinical relevance of Freud's newest theory. (Nunberg [1931] extended the idea of ego functions to include the synthetic function. Glover's paper on inexact interpretation in his book on technique [1955] to some extent utilized the new concepts embedded in the structural theory.) It remained for Hartmann and Anna Freud to begin to plumb the implications of . In 1958, Hartmann published Ego Psychology and the Problem of Adaptation, and Anna Freud, in 1936, The Ego and the Mechanisms of Defence (the English translation of which was published in 1946). These two works signalled a much fuller acceptance of the structural theory, particularly in the USA. Both of these volumes paid considerably greater attention to the conscious experiences of the patient. While the main focus of Freudian theory was the unconscious, both Anna Freud and Hartmann made the elementary but necessary point that one can only theorize about unconscious tendencies based on certain conscious experiences or actions. In the language of the structural theory, the unconscious is mediated through the ego and known through the preconscious and conscious aspects of the ego. Both Anna Freud and Hartmann also subtly but decisively rejected the idea of Thanatos, much to the disappointment of Freud. Freud, in “Analysis terminable and interminable” (1937c), noted that a number of analysts did not accept his instinct theory and he seemed clearly upset, particularly since some of the revisionists were his closest supporters.

 

Chapter Six

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Summary

T his chapter covers Klein's contributions from 1921-1945. From the beginning of her career, fantasy (spelled phantasy by Kleinians) was of extraordinary importance. Tolerating and utilizing phantasy is considered to be a crucial aspect of childhood. It was Klein's view that our educational systems and parental patterns caused children to defend against their phantasy life, which, if appropriately sublimated, would be a main source of creativity. Klein initially felt that she derived this view from Freud. During the period of the present chapter, she begins as an enthusiastic Freudian writer and ends this period as a devoted Kleinian. By 1928, although Klein introduces her new concepts as deriving from Freud, she has already introduced a variety of new thoughts and the beginnings of various extensions, modifications, and new pathways for psychoanalytic theory. She places (Klein, 1928) both Oedi-pal dynamics and superego development as occurrences within the oral stage. This shift in perspective was in part a result of her analysis of young children. Her new view of development led her to first posit Oedipal dynamics and a superego structure as beginning to appear by the end of the first year of life. In this paper, Klein introduces splitting and projective-introjective sequences as central to her new concepts.

 

Chapter Seven

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I wish to point out, therefore, that from the beginning of life, on Freud's own hypothesis, the psyche responds to the reality of its experience by interpreting them—or, rather, by misinterpreting them—in a subjective manner that increases it pleasure and preserves it from pain. This act of a subjective interpretation of experience, which it carries out by means of the processes of introjection and projection, is called by Freud hallucination; and it forms the basis of what we mean by phantasy-life

(Riviere, 1936)

I have always insisted on the necessity of postulating the primary reality function of the primitive ego. Indeed, without such a postulate, there is nothing to prevent us falling into a primitive variety of mysticism

(Glover, quoted in King & Steiner, 1991, p. 399)

Summary

In this chapter, Dr Vorus gives a moving account of the Freud-Klein controversies and some of the historical and political tensions that led up to these fateful discussions. Ellman provides a brief commentary at the end of the chapter. The controversial discussions, in many ways, presaged debates that continued over the next several decades. The divisions that are depicted in this chapter did not allow for meaningful discussions across theoretical lines until the recent past (however one defines recent past).

 

Chapter Eight

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Summary

This period begins with Klein's paper on schizoid dynamics (1946), which she publishes at the same time that Fairbairn is publishing his paper on schizoid dynamics. She now has two named positions, the paranoid-schizoid and the depressive position. The depressive position is thought to occur a good earlier than had been the case in previous publications. Klein, in this era, spells out many of her concepts: projective identification is conceptualized as both an important defence and a mode of communication with both developmental and clinical importance. During this period, Klein writes an important paper on transference, expanding the Freudian concept and using the concept of projective identification to account for transference manifestations. A great deal of the chapter is devoted to her last major work “Envy and gratitude” (1957), where she details the centrality of envy and greed. Dynamics concerning envy and greed account for the most venal of “sins” (or human difficulties), and dynamics concerning envy are an inevitable aspect of early development. Despite her new emphasis on envy, Klein finds some renewed accommodation with Winnicott. Her new emphasis is a movement to accommodate environmental influences in her theoretical matrix.

 

Chapter Nine

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Summary

WR. D. Fairbairn was a Scottish psychoanalyst whom in the early 1940s, wrote several vital papers at the same time that were under way (see Chapter Seven). between Freudian and Kleinian analysts of the British Psychoanalytic Institute were designed to determine whether Kleinian theory was “truly” psychoanalytic. During this period, Fairbairn developed a theory that was a clear alternative to Freudian psychoanalysis. His focus on early object relationships, while bearing some similarity to Klein's emphasis, came at these issues from a very different perspective. Fairbairn reinterpreted many of Freud's and Abraham's conclusions and, in his interpretation, developed a theory that included a pentagon of structures while eliminating Freud's drive theory. He also rejected a number of aspects of Freud's theorizing that Fairbairn concluded were based on nineteenth century science. In both his developmental theory and his ideas about the psychoanalytic situation, he emphasized schizoid dynamics and proposed that all psychopathology was a response to schizoid dynamics or what he termed “love made hungry”. In 1946, he and Klein simultaneously published papers on schizoid dynamics. The publication of Fairbairn's paper, in effect, introduced his ideas to the larger psychoanalytic community. Since that time, the years have been kind to Fairbairn's theorizing; his influence in contemporary psychoanalysis might be greater now than at any point during his lifetime.

 

Chapter Ten

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Summary

We trace Winnicott's writings from his earliest papers to some of his posthumous publications. In his hands, psychoanalytic theory describes human experience in terms of the trials of becoming real or authentic. Each concept of Freud's or Klein's is transformed into his personalized way of understanding the internal life of the baby and the baby and child present in the adult. In Winnicott, we see the firm beginning (or in parallel with Fairbairn) of the importance of the two person field. Although Winnicott accepts the idea of the infant's instinctual excitement, it is the relationship with the mother that is crucial in the fate of this excitement. In ideal development, the instinctual component is not the important factor, but, rather, it is the overlapping experiences of the two participants that is crucial in terms of what will be internalized in the infant's developing representational world. Winnicott presents a number of concepts that help the infant's/developing child's transition into the world of others, while developing an indwelling sense of self. Perhaps his most familiar concept is that of the transitional object and transitional space. In this space, the child is able to construct the tools to create reality; for Winnicott, the authentic self does not passively receive, but actively creates reality.

 

Chapter Eleven

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Summary

Harry Stack Sullivan is truly an American original and, although this chapter does not do justice to his enormous influence, I hope the reader can glimpse some of his originality and authenticity. His career is traced from his beginnings in Chicago as a medical resident to his mature years, where he pioneered both a theoretical perspective and treatment modalities for psychotic patients. He, along with Fairbairn and Ferenczi, was perhaps the strongest historical influence in forging relational theory.

Brief personal note

I first encountered Harry Stack Sullivan (1892-1949) in graduate school, since he was a featured author for a segment of the faculty in our clinical psychology programme (NYU Clinical). Sullivan was a major influence for the Director of our programme, Bernie Kalin-kowitz. Bernie's version of a Sullivan quote was that schizophrenic patients (people) were more human than otherwise. It was a quote that was oft repeated. Although I read a bit of Sullivan in graduate school, it was not until I began to treat schizophrenic patients that I became interested in Sullivan, partly through the influence of Harold Searles (1965). My interest in schizophrenia has continued to this day. Early in my career, the first course I taught when I was a faculty member at the clinical programme at City University was “Theories of schizophrenia”. Sullivan was an author that I featured. This course contained Sullivan, Searles, and Fromm-Reichmann, as well as Freud, Hartmann, and Anna Freud. Winnicott, Kohut, and Guntrip were also authors who were part of this course syllabus. When I started psychoanalytic training at a Freudian institute, Sullivan's presence in my courses became greatly attenuated and eventually disappeared entirely. I have finally returned to a state of naïveté, where I believe that each position has a great deal to offer and can provide complimentary viewpoints and, at times, integrat-able perspectives.

 

Chapter Twelve

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Freud in relation to Mahler's concerns

Freud was frequently concerned with how the infant began to learn about the external world. In The Interpretation of Dreams (1900a), he presents his well-known views of the infant, at first primarily or only concerned with pleasure and, later, through deprivation, coming to know about the external world. This conception of how the infant turns from its primary concern (pleasure or tension reduction) to secondary concerns (the outside world) is based heavily on a tension-regulation model. Freud's later views, which are contained in large part in his papers on narcissism and his metapsychological papers (1914c, 1915c), are less centred on a tension-regulation or reduction model. In these and other papers, Freud put forth the guidelines of an interesting theory of early development, but, in this chapter, we can only sketch out some of his ideas (see Chapters Two and Three). Freud sees the early mental development of the infant and child as taking place along three polarities: pleasure-pain, subject-object, and active-passive, an idea that has a developmental unfolding. In early life, pleasure and pain predominate, and Freud maintains that for the infant or child

 

Chapter Thirteen

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Summary

In this chapter, we follow Kohut's work from 1959 to 1984 (his last published volume). Kohut starts by expanding Freudian concepts of narcissism in terms of both a developmental and clinical perspective. By 1972 (at least in retrospect), Kohut's paper on narcissistic rage was a pivotal point in his moving away from Freudian theory and towards a new self-psychological perspective. By 1977, Kohut has moved towards defining a self-psychological perspective where he distinguishes his theory from Freudian, or at least classical, psychoanalytic concepts. His emphasis on the empa-thic analyst in the analytic situation, has proved a strong influence with analytic clinicians across a number of theoretical orientations.

Heinz Kohut: brief biographical sketch

Heinz Kohut is the founder of the self-psychological movement in the USA. He was born in Vienna (1913-1981) and fled to the USA after the Nazis took power in Austria. Kohut's psychoanalytic career was in Chicago, and during his life he became the central figure at the Chicago Psychoanalytic Institute. (In this context we must remember that before Kohut, Chicago was the home of Franz Alexander, an analyst who attempted to provide “real” gratifications in the psychoanalytic situation. Given recent analyses of psychoanalytic treatment, there are always real gratifications; perhaps Alexander should be described as providing palpable gratifications. Whether one wants to talk about real issues in terms of gratifications depends on your theoretical perspective.) Kohut's early papers were largely involved with music and literature, and demonstrated a sensitivity to artistic and creative efforts. One of his biographers describes Kohut as a Jewish émigré who obscured his Judaism. This same biographer (Strozier, 2001) maintained that in his psychoanalytic approach he became distinctly American, and was strangely secretive about his health and other matters. Whether Kohut was secretive will not be an issue that I will discuss, but, clearly, as an analyst (for his era), he was open to discussing issues that silenced much of the analytic community. One would have to say that Kohut was a complex personality who, at the very least, opened discussions about the treatment of patients who were, to some extent, overlooked by the analytic community.

 

Chapter Fourteen

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Summary

This chapter follows Kernberg's theoretical integrations as well as his clinical observations. There is a long section on the borderline syndrome and Kernberg's use of Kleinian concepts. In addition, we look at some of the criticisms that have been levelled at Kernberg over the decades. We present the view that at least some of the criticisms are based on Kernberg's object relations perspective.

The beginnings of an integrative approach

It is a difficult task to attempt to summarize and critique Otto Kernberg's psychoanalytic contributions, for he has presented

1. A version of this chapter has been published previously: Carsky, M., & Ellman, S. (1985). Otto Kernberg: psychoanalysis and object relations theory: the beginnings of an integrative approach. In: J. Reppen (Ed.), Beyond Freud (pp. 257-296). Hillsdale, NJ: Analytic Press.

systematic and wide-sweeping clinical and theoretical statements. His work touches on many, if not most, of the topics that have been of interest to contemporary analysts. Even reviewers who have been sharply critical of Kernberg, such as Calef and Weinshel (1979), have stated that “no other single colleague has been so instrumental in confronting American psychoanalysts with Klein-ian concepts and theories” (1979, p. 470-471). Although there is no question that Kernberg has been strongly influenced by Kleinian concepts, there is also no question that he is attempting to integrate many different parts of what is called the British object relations school, as well as aspects of Freudian thought, ego psychology, and different strands of research in neurophysiology and physiological psychology. This list is by no means complete. Kernberg is strongly interested in affect research as well as research in psychotherapy.

 

Chapter Fifteen

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“… several things dovetailed in my mind, and at once it struck me, what quality went to form a Man of Achievement … I mean Negative Capability, that is when man is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact and reason”

(Keats, 1817)

“To put it in a formula: he must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient”

(Freud, 1912e)

Introduction and summary

A key concept in the work of Wilfred Bion is that of “linking”: it is fundamental in his understanding of the development of thinking and the development of the mind; the mechanism for thinking thoughts in the analysand, as well as a crucial element in a mutative interpretation on the part of the analyst. Linking can also be seen as inherent in the development of his own thinking about the work of psychoanalysis, in that he brings important elements from the work of Freud forward and links them to concepts from Melanie Klein, as well as the contemporary Kleinian Hannah Segal, and links all of them to his experience working with groups and psychotic patients.

 

Chapter Sixteen

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Arnold D. Richards and Arthur A. Lynch

Summary

This chapter is primarily a review of the movement from Freud's structural theory to modern conflict theory. It covers authors such as Arlow and Brenner in more detail than in any other chapter of the present volume. The chapter also details the controversies that led to some of the formulations that present day conflict theorists have presented. Some of the material overlaps Chapters Four, Five, and Seventeen, but the viewpoint is quite different. In the present chapter, the main perspective is showing how various influences led to contemporary conflict theory. In Chapter Seventeen, the self and object Freudians are featured, and in Chapters Four and Five theorists are discussed without reference to contemporary conceptualizations.

Introduction: brief history

Ego psychology is rooted in the third and final phase of Freud's theorizing (Rapaport's [1959] classification), and takes The Ego and the Id (1923b) and Inhibitions, Symptoms and Anxiety (1926d) as its foundational works. More specifically, it grows out of Freud's final model of the mind, the structural hypothesis of id, ego, and superego. Levy and Inderbitzen (1996) aptly define ego psychology in terms of the underlying assumptions of Freud's structural hypothesis:

 

Chapter Seventeen

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Prefatory statement

A lthough the chapter begins with a historical note, part of the thrust of the present chapter is viewing clinical theories in terms of a far-reaching critique provided by relational psychoanalysts. Relational analysts have offered clinical, theoretical, and philosophic critiques of the psychoanalytic situation with a main focus of their critiques aimed at , conflict theory, or classical psychoanalysis (I will frequently use these terms interchangeably). After delineating the relational critique, there will be an effort to provide integrative answers that both incorporate elements of the critique and provide integrations that originate from various theoretical perspectives. A central current in this chapter (and volume) is how each position has dichotomized clinical and theoretical issues. When this has been done, the positive aspects of alternative theories have been overlooked, not been recognized, or have been only narrowly understood.

Summary of chapter

 

Chapter Eighteen

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Summary

This is one of the few chapters where there is a mention of research. The research is presented to illustrate a developmental model that combines physiological factors with relational factors. The research includes some mention of rapid eye movement (REM) sleep research as well as research in motivational pathways of the brain. The chapter includes a model of mother-infant interactions. It ends with a clinical case to illustrate the model in terms of the clinical situation.

Introduction

In 1995, Freudian and relational psychoanalysts published an article comparing and contrasting the two theoretical positions. Merton Gill, who by that time was clearly a relational analyst, summarized the positions and maintained that both types of theory, to some extent, account for both innate and experiential factors but differ in at least four ways.

First, it is uncontestable that the classical point of view emphasizes the innate over the experiential, whereas the relational emphasizes the experiential over the innate. Second—and really a correlate of the first—in the classical view, the innate is explanatorily superor-dinate to the experiential (sometimes reductively so), whereas in the relational, the experiential is explanatorily superordinate to the innate (sometimes reductively so). The issue is a hierarchical one. Mitchell saw the bodily urges—part of intrapsychic structure—as expressed by way of interpersonal relations. Hoffman (personal communication, August 1992) criticized Mitchell's description in that “what seems to be underestimated in this kind of formulation is the importance of sexual interest and desire in itself rather than as a channel for something else which is not intrinsically sexual.” Third, the classical point of view emphasizes how the past determines the present, whereas the relational point of view emphasized how the present can be illuminated by the past. On the whole, the classical point of view sees the present as a repetition of the past, whereas the relational point of view sees the present as more independent of the past. Fourth, the relational view stresses new interpersonal experience over insight as mutative, whereas the reverse is true in the classical view. [Gill, 1995, pp. 91-92]

 

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