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The Second Century of Psychoanalysis

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This book focuses on the question of the theory of therapeutic action underlying the multiple perspectives in psychoanalysis. The question of how psychoanalysis effects therapeutic change and the methods by which this change is achieved is answered from the perspectives of: ego psychology and modern conflict theory, classical theory, contemporary object relations theory and neo-Kleinian theory, attachment theory, and self psychological theory, as well as total composite theory and pluralistic perspectives. The volume concludes with an exploration of how these theories of therapeutic action diverge and converge, and ultimately what holds these diverse approaches within the boundaries of psychoanalysis.

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CHAPTER ONE: A brief history of therapeutic action: convergence, divergence, and integrative bridges

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Christopher Christian and Michael J. Diamond

Freud’s thinking about how analysis cures and the aims of therapeutic action underwent significant revisions throughout his life. The very notion of “cure” as an aim of psychoanalysis has been evolving, resting mainly on a medical model’s conception of an end-state, conveyed as both a noun and verb, which analysts have defined in various ways in accordance with the prevailing state of analytic knowledge and clinical theory. An analyst’s conception of therapeutic action depends on his or her understanding of the psychic apparatus or mind and the view of what is muta-tive in the clinical process. How these issues are approached may be conscious, yet a considerable portion often remains implicit as well as unconscious.

In tracing the history of therapeutic action and its connection to analytic cure, it is useful to consider three different, though interrelated viewpoints: first, the nature of the psychopathology or syndrome that psychoanalysis sought to address at its inception and how particular pathologies and clinical populations challenged established notions of therapeutic action, leading to the emergence of alternative perspectives over time; second, the theory of the syndrome’s pathogenesis, perhaps initially in terms of symptomaticexpression and subsequently as character; and finally, the various theories of mind or metapsychology.

 

CHAPTER TWO: The aims and method of psychoanalysis a century later

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Leo Rangell

In this compressed presentation, I will examine the core raison d’être of the science and profession of psychoanalysis as it has grown and developed over its first century of existence. Bursting upon the scientific scene like a thunderbolt at the turn of the 20th century, the new system of knowledge has been characterized during its entire life span by tumultuous upheavals. Through all of these, there has emerged a durable entity that I believe will maintain a permanent place in the intellectual armamentarium of man. Its goals and technique are intimately intertwined and directly derivative from its theory of understanding. I will focus on the growth and changes that have evolved in both, the theory, and the resultant aims and method derived from that.

Psychoanalysis, if we are to anthropomorphize a science and profession, after a steady evolutionary growth, has reached a new phase of its development. In terms of this longitudinal survey of its existence a century after it was born, we might venture to say it has reached the beginning of its adolescence. While this may seem jarring to many who feel it has more likely already passed its old age and has become moribund if still alive, I shall present what I feel isa more accurate and enduring description of its present condition and status.

 

CHAPTER THREE: Classical theory, the Enlightenment Vision, and contemporary psychoanalysis

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Morris N. Eagle

There is little doubt that in important ways traditional or classical psychoanalysis is a product of what Searle (1998) referred to as the “Enlightenment Vision”. The links between the Enlightenment Vision and the classical psychoanalytic conceptions of neurosis and its treatment, as well as of human nature and the relationship between the individual and society, are evident in a number of ways. Paralleling the Enlightenment perspective that goes as far back as Plato, according to the classical psychoanalytic view of human nature, we are beset by the ongoing conflict between the demands of peremptory, instinctually derived passions (id) and the voice of reality-testing and reason (ego). From this perspective, neurosis can be understood as a way of dealing with the inevitable conflict between passion and reason that is characterized by exclusion from awareness of unacceptable aspects of oneself (via repression), which leaves the individual at war with himself or herself. If neurosis is characterized by exclusion and not knowing, treatment consists in the transformation of not knowing into knowing (making the unconscious conscious through liftingrepression) and thereby enabling more adaptive means of dealing with inner conflict.

 

CHAPTER FOUR: The therapeutic action of resistance analysis: interpersonalizing and socializing Paul Gray's close process attention technique

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Stephen Howard Portuges and Nancy Caro Hollander

When we began to do the research for this paper on the therapeutic action of resistance analysis, we had to take into account how our theoretical differences would influence our respective reading and understanding of the material. Portuges, whose psychoanalytic research has focused on Freudian conflict theory, wanted to evaluate Paul Gray’s unique ideas about the analysis of resistance as an important strategy for therapeutic change. Hollander, whose research and clinical orientation integrates object relations, relational psychoanalysis, and trauma theory, was intrigued about how Gray’s treatment model could be applied to psychoanalytic orientations beyond contemporary ego psychology. We struggled to integrate what were often conflicting ideas about Gray’s “close process attention” technique, which arrives at the investigation of transference by emphasizing the analysis of resistance in order to promote therapeutic change. Ultimately, we found a way to incorporate relational and intersubjective ideas in a framework that seeks to understand how social reality is mentally registered and manifested during treatment. We believe that in so doing, we have developed a way of making Gray’s analysis of transference,defence, and resistance consonant with our shared psychoanalytic perspective.

 

CHAPTER FIVE: From ego psychology to modern conflict theory

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Christopher Christian

The ways and means by which psychoanalysis achieves meaningful change remain as poorly understood today as they did two decades ago, when Fonagy (1982) made a similar observation. Although we have been able to systematically show that psychodynamic psychotherapy is effective, despite difficulties in disseminating those facts (Shedler, 2010), we have had more difficulties in understanding the therapeutic action by which either psy-chodynamic psychotherapy or psychoanalysis achieves its effects. In an issue of The Psychoanalytic Quarterly, devoted in its entirety to the question of therapeutic action, Smith (2007) drew attention to the fact that therapeutic action is often discussed at different levels of abstraction making comparisons between different schools difficult. On one level are our theories of pathogenesis; on another are our theories of how the mind works; then there are a number of ideas about what the analyst does; and at another level still is the role of the analyst as a person effecting change.

 

CHAPTER SIX: The interpretive act: returning freedom and agency to a beleaguered ego

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Alan P. Spivak

A layman will no doubt find it hard to understand how pathological disorders of the body and mind can be eliminated by “mere” words.

—Freud (1905c, p. 283)

What the patient needs is not a rational reworking of unconscious infantile fantasies; what the patient needs is a revitalization and expansion of his own capacity to generate experiences that feel real, meaningful, and valuable.

—Mitchell (1993, p. 24)

Freud introduced interpretation into psychoanalysis as the central agent for deciphering and communicating the meaning of dreams (1900). Once he realized that the dynamic structure of neurosis is similar to that of dreams, Freud extended its purview, making it the primary vehicle to unlock the unconscious meaning of any and all analytical material. By this move, interpretation was elevatedto the status of primus inter pares for effecting psychic growth by psychoanalytic means. The phrase “to analyse” now was synonymous with “to interpret”. For most analysts today, interpretive activity remains primary, elemental, and indispensable. But in some current writings, interpretation has lost pride of place to factors in the analytic process that once were considered ancillary or preparatory. This alternative view holds that various emotional experiences mediated through relationship are the primary facilitators of change, and that insight derived via interpretation is either unnecessary or, at best, icing on the cake. At the extreme of this position resides scepticism about the power of “mere” words, at least those of the analyst, to influence psychopathology. The scepticism echoes that of the lay persons to whom Freud alluded in the above quotation.

 

CHAPTER SEVEN: Back to the future: the curative fantasy in psychoanalysis

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Linda Sobelman

Back to the Future, a popular 1985 movie directed by Robert Zameckis, tells the story of an adolescent boy struggling to come to terms with his feelings about his family, with his anxieties about his own worth and abilities, and with what these portend for his future.

Marty McFly, the lead character, views his father as an ineffectual, passive loser and his mother as dowdy and prudish. Marty fears that he will follow in his parents’ footsteps and be unsuccessful in his own life. Indeed, in the early scenes of the movie, Marty is shown suffering a series of humiliating defeats that seem to justify his fears.

In a later scene, Marty meets up with Doc, his adult mentor-friend, an eccentric inventor who has developed a time machine. Through the accidental use of this machine, Marty is transported back in time to the year his parents met, when they were Marty’s current age. By means of a series of ingenious interventions, Marty transforms his timid father into a brave hero, enabling his father to triumph over the town bully, win his mother’s love, and achieve status and respect in the eyes of the community. When Marty returns to present time, he now views his parents as successful, sexually vital,and happy. Marty’s father has become the ideal parental figure with whom Marty can identify.

 

CHAPTER EIGHT: The seminal therapeutic influence of analytic love: a pluralistic perspective

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Peter Wolson

On December 6, 1906, in a letter to Carl Jung, Freud wrote,

It would not have escaped you that our cures come about through attaching the libido reigning in the subconscious (transference) … . Where this fails, the patient will not make the effort or else does not listen when we translate his material to him. It is in essence a cure through love. Moreover, it is transference that provides the strongest proof, the only unassailable one, for the relationship of neurosis to love [McGuire, 1974, p. 185].

In addition, Bach (2006, p. 125) noted that Freud told the Vienna Psychoanalytic Society shortly after writing the Jung letter, “Our cures are cures of love,” and he mentioned to a colleague, Max Eitington, that “the secret of therapy is to cure through love” (Grotjahn, 1967, p. 445). As indicated in the letter to Jung cited above, Freud believed it was necessary for the patient to love the analyst through the attachment of libido in the transference, but did he also mean that the analyst needed to love the patient, and for the patient to experience the analyst’s love, in order to be cured? A number ofwriters (Loewald, 1960; Lear, 1990; Bach, 2006) believe that Freud intended the latter, and have cited the 1906 letter as evidence.

 

CHAPTER NINE: The analyst's subjective experience: holding environment and container of projections

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Peggy Porter

Iwill begin with the wisp of a memory: a beautiful young woman from another culture—a first session, a beginning rapport, a painful topic. Her rapid blinking of eyes and almost imperceptible turning away from me, her quick fanning of the air in front of her face. I knew she was fighting tears.

But here is my point: I also knew with some certainty that I must not appear to notice. (I knew this before I consciously realized she did not want me to notice.) I remember glancing involuntarily at the tissue box on the table, quickly glancing away, making the unaccustomed effort to sit completely still and silent until she could regain her composure. I felt we were both working to “contain” the moment, to move beyond it. I remember wondering if I should “do something” after all. This all occurred within the space of seconds, and it was an atypical reaction for me to a patient’s being close to tears. Weeks later, when this woman finally allowed herself to cry openly, she told me how devastating it would have been for her on that first day if she had, in her words, “lost face in front of a stranger”.

 

CHAPTER TEN: The impact of the mind of the analyst: from unconscious processes to intrapsychic change

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Michael J. Diamond

“I just dropped in to see what condition my condition was in.”

—Pop song lyric (Newbury, 1967)

Since beginning to train as a psychoanalytic clinician more than 30 years ago, I have tried to understand how the various psychoanalytic theories of mind and clinical technique create the conditions for therapeutic change. During my formative years of psychoanalytic practice, particularly when working with more regressed and disturbed patients, I experienced in an immediate way the patient’s stubborn resistances, challenges, and character-based defensive operations, each contributing to my countertransference and accompanying subjective experiences. As a novice psychoanalyst, these experiences seemed like obstacles preventing me from getting through to my patients.

I sought ways to generate meaningful change through these “stalemates” (see Diamond, 1989). Simultaneously, I was beginning to recognize my fluctuating internal experience with each unique patient. As a result, I realized how the tripartite model of training, particularly the significance of a deeply engaged, personal psychoanalysis,is essential for conducting psychoanalytic treatment. In learning how to be more open to my emotional and mental life, I was progressing from a psychotherapist to becoming a psychoanalyst. Now, decades later, I am still learning my way along this path.

 

CHAPTER ELEVEN: From under long shadows: identification and disidentification in analysis

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Thomas P. Helscher

An object-choice, an attachment of the libido to a particular person, had at one time existed; then, owing to a real slight or disappointment coming from this loved person, the object-relationship was shattered. The result was not the normal one of a withdrawal of the libido from this object and a displacement of it on to a new one, but something different, for whose coming-about various conditions seem to be necessary. The object cathexis proved to have little power of resistance and was brought to an end. But the free libido was not displaced on to another object; it was withdrawn into the ego. There, however, it was not employed in any unspecified way, but served to establish an identification of the ego with the abandoned object. Thus the shadow of the object fell upon the ego, and the latter could henceforth be judged by a special agency, as if it were an object, the forsaken object.

—Freud (1917, p. 249, italics added)

What was really wrong with his heart was, however, eloquently revealed in another dream—a dream in which he saw his heartlying on a plate and his mother lifting it with a spoon (i.e., in the act of eating it). Thus it was because he had internalized his mother as a bad object that he felt his heart to be affected by a fatal disease; and he had internalized her, bad object that she was for him, because as a child he needed her.

 

CHAPTER TWELVE: Movement thinking and therapeutic action in psychoanalysis

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Beth I. Kalish

In my analytic practice I work with a variety of patients, mostly adults (on the couch), some couples, and a few children. Thinking in movement terms has become second nature due to an extensive background in movement observation and assessment (Kalish, 1976); such thinking precedes and/or occurs simultaneously with listening. It has become my practice to utilize what I refer to as “muscle memory” in my own body as I observe and/or pick up aspects of my patients’ body movement patterns as they talk. This method gives me an additional instrument for understanding what is occurring with the patient non-verbally. Repeatedly, it validates hypotheses for formulating interpretations. Later, I will illustrate the method with specific clinical examples. First, it is important to define and to elaborate what is meant by “movement thinking” and how I have come to make use of this concept as a psychoanalyst.

The term “movement thinking” originated with Rudolf Laban (1960), who began studying movement in Germany prior to World War II. He was involved with all dance forms as well as choreography. His first system of notation was developed in order to preserve dance for future performance. He named it “Labanotation”. It continues, to this day, to be used by professional dancers for that purpose. In thelate 1930s, Laban immigrated to England as a result of mounting dangers to artists in Germany. Already famous, he was hired by the British government to study factory workers’ movements and to aid them in becoming more efficient while working. Thus, he developed a second method of notating movements. He and his English colleague, F. C. Lawrence, wrote a book about this investigation called Effort (Laban &Lawrence, 1947). The word “effort” was translated from the German word “Antrieb”, which described the quality of the workers’ exertion when moving in their tasks. It was the moving body in action that interested him. After the war, Laban became interested in the development of a system of notation representing all movement qualities observable in the body. To that end, he studied movements in various cultures: American Indians, African, Chinese as well as European individuals. Ritual and work movements were his focus. Finally, his extensive study of dance, of ritual, fighting, and work movements in varying societies, culminated in an enlarged comprehensive method of notation, developed with co-workers Warren Lamb and Irmgard Bartenieff, called “Effort-Shape Analysis” (Bartenieff &Davis, 1965; Lamb, 1965).

 

CHAPTER THIRTEEN: A centenarian's retrospective on psychoanalysis: an interview with Hedda Bolgar

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Interviewed by Michael J. Diamond

Hedda Bolgar was born in Switzerland on August 19, 1909. She was the only child of two influential parents; her father was a social activist, history scholar, and diplomat representing Hungary, and her mother was the first female journalist on the staff of a German language newspaper in Budapest. Her family’s political position was considered controversial, as her mother was a feminist and socialist, and her father was involved in aiding the start of the Hungarian Revolution in 1918.

Bolgar completed her PhD at the University of Vienna in 1934, taking psychology courses with Karl and Charlotte Bühler, studying infant observation and life cycle development, and gaining exposure to the group of Vienna psychoanalysts involved with Freud including Heinz Hartmann and Rene Spitz.

In the mid-1930s, Bolgar and Liselotte Fischer, who were close friends as well as psychoanalytically-oriented clinicians, collaborated to develop the “Little World Test” (also known as the “Bolgar-Fischer World Test”, see Bolgar &Fischer, 1940). The test was developed as a nonverbal projective instrument throughwhich a clinician could observe symbolic representations of human motivation, selection, and creative behaviour.

 

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