Independent Psychoanalysis Today

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Independent Psychoanalysis Today is a book that shows how contemporary Independent psychoanalysts think and work. There are three themes to the book: Independent thinking including the theory of technique; exploration of clinical concepts and demonstrations of ways of working by some of the most prominent Independent clinicians practicing today; finally, the evolution and enduring impact of Independent ideas and the influence of past Independents on present ways of working.

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CHAPTER ONE. Reflections on the evolution of Independent psychoanalytic thought

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John Keene

Many psychoanalysts outside and inside the UK have been puzzled, if not frustrated, at the failure of the Middle Group, later the Independents, to function as a group or school in the way that the Kleinians have been seen to have done. In contrast, in spite of the effort of Gregorio Kohon (1986) and Eric Rayner (1991)1 to put the Independent approach together in their books, the Independent Group can appear diffuse and unco-ordinated. This quality of the “group” can really only be understood in relation to the political processes which led to its formation and which have frequently drawn attention away from the Independents’ key role in the development of the object relations approach in psychoanalysis which was pioneered by Balint, Winnicott, and Fairbairn in a prolonged dialogue with Klein’s and her followers’ technical and theoretical innovations. I suggest that the domain of Independent thinking is better defined as the elaboration of an underdeveloped assumption in Freud’s theorising which seriously overestimated the capacity of average maternal care to satisfy an infant’s needs. This line of exploration was largely pioneered in Europe by the Hungarians, led by Ferenczi, and by their counterparts in the British Psychoanalytical Society, who were eventually largely concentrated in the Independent Group. I believe it is helpful to set out the organisational political context in which the group’s theoretical thinking developed, because philosophical and organisational issues at times were as important as the theoretical stances which were taken up by most members of the group.

 

CHAPTER TWO. An Independent theory of clinical technique

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Michael Parsons

The word “Independent”, with a capital “I”, entered the psychoanalytic vocabulary around 1950. That was when, after the so-called “Controversial Discussions”, the informal “Middle Group” of analysts, who did not align themselves with either Anna Freud or Melanie Klein, agreed to become formally a third group within the British Society: the Group of Independent Psychoanalysts. Melanie Klein settled in London in the late 1920s and became an influential member of the British Society. A polarisation developed between her views and those of Anna Freud about child analysis and about early psychic development. So long as Anna Freud was at a safe distance with her father in Vienna, these debates remained at the level of theoretical and technical discussion. The flight of the Freud family to Britain in 1939, however, brought Anna Freud to settle in London as well, and from then on the arguments between Klein’s adherents and those of Anna Freud took on an acrimonious, personal quality. The essential points of theoretical disagreement were about Klein’s emphasis on early infantile phantasies, which Anna Freud did not believe in, Klein’s stress on innate destructiveness as the main factor around which development was organised, which Anna Freud thought devalued the importance of infantile sexuality, and Klein’s early dating of the Oedipus complex. The Controversial Discussions in the early 1940s clarified these differences but did not resolve them.

 

CHAPTER THREE. The intersubjective matrix: influences on the Independents’ growth from “object relations” to “subject relations”

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Joan Raphael-Leff

Mapping beliefs and empirical findings across womb, cradle, and couch, this chapter traces the transition within the British Group of Independents towards intersubjectivity in psychoanalytic theorising. Focusing on both psychoanalytical modifications and social trends in mothering, I argue that recognition of the m/other “object” as subject spearheads a paradigmatic shift both within the clinical process and the parent–infant exchange, now conceptualised as a bilateral meeting of minds. Psychoanalytic models are supplemented by models of parental orientations.

Origins

For over half-a-century, the British Psychoanalytical Society was unusual in containing three different schools of thought under one roof. This diversity stems from the 1918 Budapest congress decree that personal analysis was essential for practice. Consequently, founding members of the British Society chose to have analyses with Freud in Vienna, Abraham or Hans Sachs in Berlin, or Ferenczi in Budapest. The differing theoretical approaches they imbibed laid a seedbed of plurality, awareness of which further crystallised in the wake of the 1941–1945 “Controversial Discussions” (see King & Steiner, 1991, pp. 1–36). Over the years, the (uneasy) coexistence of Anna Freudian, Kleinian, and “Middle” group schools of thought revealed a multi-faceted picture of primary experience as viewed from differing perspectives. This was hallmarked by Anna Freudian ego evolution to mediate between conflictual internal structures and accommodation to external ones, Kleinian notions of an innate ego, internally generated unconscious phantasy and narcissistic projections, and “Middle Group” focus on emergence of the subject from symbiosis to internalised self-object relations. In addition to specifically British influences, these also reflected differences between the Viennese baby’s primary narcissism and anaclitic attachment, the Berlin baby instinc-tually driven by oral eroticism, sadism, envy (an innate hatred later ascribed to outward deflection of the “inarticulate” death drive) in the formation of primitive object-relationships, and initiation of the Budapest school’s innately loving baby in a “dual unit”, with aggression seen as a secondary reaction to frustration and separation. These differences were passionately upheld. As Michael Balint quipped in 1949:

 

CHAPTER FOUR. Psychoanalytic learning, training, teaching, and supervision in relation to the ego and especially the superego

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Bernard Barnett

Initial remarks

In psychoanalytic circles, the superego has generally had a bad press. This is a pity, because the concept, together with its close ally, the traditional “conscience”, does indeed have some very important positive attributes. I have in mind the contribution that the superego and the accompanying sense of guilt make to a person’s individual wellbeing and (as Freud himself emphasised) to civilisation in general. However, in this chapter, I, too, will treat the superego as the villain of the piece, whatever the piece is.

I begin my discussion on education in relation to the superego with some remarks made by Woody Allen concerning reading, a major skill needed in learning and education. In his stand-up comedy routine in the 1960s, Allen tells us that he has just completed a course on speed reading, which was popular at that time. He then says that he has now read Tolstoy’s War and Peace and that he has done this in twenty minutes! He then adds, for the benefit of his listeners, “It is all about Russia!”

 

CHAPTER FIVE. Incorporation of an invasive object

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Paul Williams

Introduction

This chapter addresses the experience of “being invaded” that is communicated by certain severely disturbed patients. The complaint can sometimes be couched in terms of bodily suffering and the patient might state that they have the experience of a “foreign body” inside them. It is suggested that these individuals have suffered severe early failure of containment of their projections, while simultaneously incorporating primitive characteristics of the object that have been projected violently into them. An object that invades in this way, it is suggested, experiences a compulsive need to expel unbearable states of mind using others as a repository. The infant incorporates these invasive projections as part of his own mental representational system, normal identification processes being impaired or disrupted. There occurs serious breakdown of processes leading to the development of a sense of self. Clinical examples of how the invasive experience manifests itself in the analytic setting, particularly in the transference and countertransference, are presented. It is argued that this highly complex form of early subject–object interaction (prior to the differentiation of psyche–soma) is more likely to be found in extremely disturbed individuals who are narcissistic or psychotic. Some reflections on the origins of invasive phenomena are provided.

 

CHAPTER SIX. Boundary issues in the recovery from trauma and abuse

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John Keene

Introduction

This paper describes the evolution of the author’s perception that his patient’s move from passive acceptance to taking control of boundaries both of her body and its symbolic equivalents, and accepting responsibility for her states of mind were aspects of the patient’s psychological functioning which had been badly disrupted in her history of early trauma and abuse. The acting out of the determining issues in and around the analytic frame can be seen to be crucial issues in her recovery. Some patients stretch our technique and our thinking more than others. David Riley (2005), among others, has written about the variations between analysts as to the degree to which the patient is required to fit the analyst’s technique or the analyst to find a way to relate to a particular patient. Marjorie Brierley put her characteristically Independent view of this dilemma in 1943.

Naturally I approach every patient with a full quota of implicit rather than explicit theoretical and technical preconceptions. On the whole it seems to me that these pre-conceptions are of the nature of a chart on which the patient plots his own pattern. They don’t force any shape on the pattern itself but they certainly influence the ways in which I apprehend the pattern and the terms in which I describe it to him. But I am more inclined to alter my pre-conceived notions to fit the patient’s new pattern than to cut the pattern to fit my notions. The effort to understand in order to help is also a continuous process of learning from the patient. (King & Steiner, 1991, p. 620)

 

CHAPTER SEVEN. Endings and beginnings

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Sira Dermen

Introduction: no ending without a beginning

In the seventh year of his weekly treatment at the Portman Clinic in London,1 Mr A, a transvestite patient, ended his therapy as follows. In mid-session, he said, “I’m sorry, but I have to do this,” got off the couch, and walked out of the consulting room.

It was not wholly out of the blue. We had been talking about ending for some two years, but when he ended in this singular manner—doing this, as he called it—I was dismayed, though I knew he was telling me he could not “end” in any other way.

After some weeks, Mr A contacted the clinic again, requesting to see me. In this last meeting, I commented that he had to come back to check that I was alive: ending his therapy had not killed me. I did not hear from Mr A for the next ten years. Then, in the very month that I was retiring from the Portman Clinic, he was referred back to the clinic by the same agency that had originally referred him eighteen years earlier.

***

Ms B was a private patient in five-times-per-week psychoanalysis, an accomplished professional woman, in a stable marriage, with two children. Yet, after ten years of analysis, an ending was nowhere in sight. She would, from time to time, raise the question of ending in the form of how much longer “this” would last. By contrast, my preoccupation was not with an ending, but with a beginning. Despite diminution of her psychosomatic symptoms, despite substantial improvements in family life, especially her relationship with her children, despite positive developments in her career, I felt little had changed in her mode of engagement with herself or with me. She remained dissatisfied and demanding, controlled and controlling, and there was a cold, calculating quality in her attitude toward me, as if her eye were constantly on a narcissistic balance sheet.

 

CHAPTER EIGHT. The Oedipus complex

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Gregorio Kohon

In spite of its many contradictions, inconsistencies, paradoxes, and ambiguities, psychoanalytic theory has a certain definite structure; within it, one single aspect of the theory cannot be understood without taking into consideration the rest of the metapsychological structure. The Oedipus complex would not make sense unless put in the context of the psychoanalytic understanding of the unconscious. At the same time, the concept of the unconscious cannot make any sense without understanding the meaning given to sexuality in psychoanalysis. The psychoanalytic concepts of sexuality and the dynamics of the unconscious cannot be understood without reference to the Oedipus complex and its corollaries, the castration complex and the concept of penis envy. Yet, castration would not make much sense without its theoretical connection to the primal scene and the phantasies of seduction. The theory is intricate and comprises a multiplicity of meanings, which are all interlocked and interconnected.

 

CHAPTER NINE. Embodied language

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Kenneth Wright

The psychoanalytic relationship offers a unique kind of intimacy. Although asymmetric, it demands intense involvement from both parties, and a willingness to share thinking and feeling to a degree unparalleled in other kinds of relationship. Such unprecedented sharing is mediated principally, though not exclusively, through language, and while analytic debate considers every aspect of this curious engagement, I shall focus on talking, in particular the way the analyst talks to his patient.

Historically speaking, this is a relatively neglected topic. Clinical discussions have usually focused on the content of the patient’s communications and the way these are understood by the analyst. The emphasis has been on whether, when, and why the analyst makes an interpretation and which aspect of the material he “takes up”: for example, whether he focuses solely on the here and now of the transference or whether he also includes reconstructions of the past.

Discussions of this kind make two assumptions: first, that the analyst’s main task is to make sense of the analytic material, including the analyst’s countertransference; second, that interpretation, however defined, is the most important analytic intervention. These assumptions underpin an approach to analysis in which the primary aim is to draw the patient’s unconscious organisations of experience into the realm of conscious thought, and, within this view, interpretation is the analyst’s main tool.

 

CHAPTER TEN. The illusion of belief: a not so uncommon misbelief

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Leon Kleimberg

Introduction

In this presentation, I shall describe a particular psychological journey and experience that I believe is present in normal psychic development, but also in the several pathological deviations or transformations that the life cycle challenge us with, when this journey can not be done or achieved. In order to do that, I shall quote first an extract from the book of prayers for the Jewish festivity of the Day of Atonement that I believe describes very well the journey I am trying to describe.

There is a story that is told in every culture, in every Religion, in folk tales, in legends and in our Dreams. It is the story of the journey of a hero or heroine in search of a treasure. Every version of it is different, yet every version is also really the same. The hero is called out of his usual life—by seeing a burning bush, by hearing a voice saying: ‘Lech l’ cha! Go! For your own sake, go!’ Ahead lie many adventures and on the way he meets an enemy who tries to stop him and a friend who tries to help. At the end he reaches the entrance to the underworld, or the world of gods—Jonah entering the fish, Moses climbing to heaven to receive the Torah. With luck or skill or aid he crosses the threshold and enters this mysterious land, of darkness and beauty, where the treasure is to be found. It is a land where the usual rules no longer hold, where he discovers that the enemy and the friend he had met on his journey are really one and the same, and sometimes they turn out to be the guardian of the treasure that this mysterious world conceals. Whether the treasure is given, or it must be stolen, there begins the journey back to the familiar world again.

 

CHAPTER ELEVEN. The interplay of identifications: violence, hysteria, and the repudiation of femininity

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Rosine Jozef Perelberg

Introduction

In this chapter, I suggest that what lies at the basis of violence and hysteria in some patients is the repudiation of femininity. Whilst hysteria takes the person’s own body as the vehicle for the expression of the drama of the conflict between masculine and feminine identifications, in violence there is an externalisation of the drama and an attack on the body of the other. In both, the “drama” is secondary to a primary conflict in relation to the maternal imago. Green has suggested that: “Manifestations of hatred and the following process of reparation are manifestations which are secondary to this central decathexis of the maternal primary object” (1986, p. 146). Both symptomatologies point to the limits of what can be expressed through representations. “A feeling of captivity … dispossesses the ego of itself and alienates it to an unrepresentable figure” (1986, p. 152). Green suggests a crucial point of technique: “to interpret hatred in structures which take on depressive characteristics amounts to never approaching the primary core of this constellation” (ibid., p. 146).

 

CHAPTER TWELVE. The use and misuse of transference interpretations

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Susan Budd

“An analyst may relate all the material presented to him by the patient in a vague way to the transference such as ‘You feel this about me now’ or ‘You are doing this to me’ or they repeat the words of the patient parrot-like and relate them to the session. I think this stereotyped kind of interpretation, which is supposed to be an interpretation of the here-and-now situation, changes Strachey’s valuable contribution of the mutative transference into something absurd”

(Rosenfeld, 1972, p. 456)

When I began to think about what seems most characteristic of the theory and practice of the Independent Group, two factors stood out above all others. The first is a continuing willingness to consider interventions other than transference interpretations, and the second is to reflect that it might be the context in which interpretations are given which is more important than their content. No clear lines can be drawn between psychoanalytic schools; we all give both transference and other kinds of interpretation. Often, it is the followers who ossify technique; like Marx, Melanie Klein once protested that she was not a Kleinian! It is a question of emphasis, but the issue ramifies into every aspect of theory and technique, and so I begin with a brief historical resumé.

 

CHAPTER THIRTEEN. The basic fault and the borderline psychotic transference

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Caroline Polmear

There is a long tradition of independently minded psychoanalysts interested in work with early infantile trauma in their patients. The work often implies a conundrum of how to work in analysis in an essentially pre-verbal and “acting out” area when the traditional language of analysis is the symbolic, three-person language of the Oedipus complex. Many have explored those conditions in which therapeutic regression takes place and have examined the stresses and strains that regressed patients place on “ordinary” psychoanalytic technique. Ferenczi’s largely unsuccessful Grand Experiment, in which he attempted to gratify the patient’s requirement for complete adjustment to his needs in the analytic situation, is well documented (1932). Winnicott’s many writings on the earliest relationship between infant and “object” and “environment” mother explore this area, including the ways in which traumatic impingement in the earliest relationship re-emerges in analysis (1949, 1955, 1960a,b, 1962, 1968). Little’s contributions from her own understanding of herself and her analysis (1981, 1985) is illuminating, and Kahn’s work on cumulative trauma (1963) also focuses on this area of early infantile trauma.

 

CHAPTER FOURTEEN. Entertaining the body in mind: thoughts on incest, the body, sexuality, and the self

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Ann Horne

“There are no brakes on fantasy”

(Winnicott, 1945, p. 153)

To begin at the beginning …

There had been several years of concern about the Long family. Mrs Long, whose first marriage had been to an older, cruel, violent, and sexually abusive man, had a son (Robert) from that marriage. It was suspected—indeed, disclosed by Robert then retracted—that Mrs Long had sexually abused him and it also seemed to be a matter of local knowledge that, following the death of her husband, she had frequently entertained a group of young adolescent boys in her house. The first contact the clinic had with the family was a consultation about Robert, whose compulsive, sexualised actions had become extremely hard for his care staff and social worker to manage and understand.

Married again, to a man of her own age who, like her, had learning difficulties, Mrs Long had two further children and was pregnant with a third when she was referred. The assessment led the diagnostician to conclude that psychotherapy for Mrs Long was not at that point a treatment of choice; however, the first child of this second marriage, Katiebell, had begun to act in a sexually inappropriate way with her younger brother, being compelled to intrude repeatedly into his bedroom in the middle of the night for this sexual engagement, and a referral was made in relation to this. She had learning difficulties (global developmental delay, functioning on the first centile), was encopretic, still in nappies at night, neglected, and waif-like.

 

CHAPTER FIFTEEN. A severe form of breakdown in communication in the psychoanalysis of an ill adolescent

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Roger Kennedy

Introduction

Five-times-weekly psychoanalysis of the severely suicidal or psychotic adolescent is difficult and demanding for the patient and the analyst, both of whom require a fair amount of motivation in order to keep going through the many difficult patches. There are bound to be periods in which the patient will feel acutely suicidal, will feel strongly like opting out of the analysis, will make attacks on the setting, or will bring profound difficulties in communicating and relating for understanding. The analyst, in turn, might, not infrequently, feel tempted to relinquish his or her role, to attempt to do something rather than continue to analyse, or might feel hopeless and alone with an unbearable responsibility.

Part of the strain for the analyst might be that there often seems to be an expectation in psychoanalytic treatment that the analyst should always be “in touch” with the analysand in a number of different ways. Put simply, one could say that the analyst’s “in touchness” consists of three interlocking elements: an appropriate physical setting, adequate intellectual understanding, and selective emotional responsiveness. While I am not denying the central importance of being in touch with the patient as far as possible, I think that one can say that there are often moments, particularly in the psychoanalysis of psychotic and borderline psychotic subjects, when there are fairly major breakdowns in communication between analyst and analysand. Such moments are perhaps more sustained and serious in those subjects with whom I am particularly concerned in this paper, who have experienced a major interference in functioning, such as a suicide attempt or a serious psychotic breakdown. In this latter group, the three elements of the analyst’s in-touchness might be interfered with, so that the setting might no longer be safe, the analyst’s intellectual grasp of the analysis might be severely compromised, and/or his emotional awareness blunted. I wish to suggest that there are times when such breakdowns in communication, which threaten the analyst’s in-touchness, are useful, even though, at the time of their occurrence, they may be distressing, bewildering, and frustrating for both analyst and analysand.

 

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