Between Subjects: Commentary on Paper by Robert P. Drozek

This commentary on Drozek's paper outlines its key points under 10 headings, looking at various aspects of the intrapsychic and intersubjective elements involved in understanding motivation. There is discussion of issues of autonomy and dignity based upon Kant's philosophy that underpin the paper's assumptions about unconditional valuing of the other as a universal element of intersubjective motivation. In the commentary attention is paid to the role of desire in motivation, as well as some of the psychoanalytical literature on motivation, including papers by Sandler, Loewald, and Winnicott, some aspects of which connect up with the paper's theses. At various points, some of the clinical relevance of the paper's proposals are brought to light, in particular how the patient may be in a position to use the analyst's interventions as a source of intersubjective motivation.     

The Politics of Relational Psychoanalysis

Given the foundational premises of relational psychoanalysis, the lack of attention to the social and political world on the part of analytic writers who identify with this orientation is curious. Perhaps relational psychoanalysis itself, particularly in its democratizing impulses (e.g., emphasis on mutuality, concern with questions of authority and self-disclosure), has become a replacement for politics, an effort to provide for patients (and analysts) in the consulting room an experience of a world that no longer seems attainable outside it. The analytic situation thus created would represent a recasting of the world as analysts wish it could be, projected into therapeutic space.

This development in the analytic field is part of a more general cultural shift away from a belief in the possibility of social transformation and a redirection of energies into ameliorative projects. This discouragement dispirits the work of those relational writers who do engage a political aspect in their thinking. The author argues that the recovery of a sense of political efficacy would vitalize analysts' endeavors inside and outside the therapy office and could help to balance the overinvestment of the clinical dimension of psychoanalysis that has accompanied the ascendance of the relational perspective.     

Our Literature as the Problem Child of Psychoanalysis Commentary on Paper by Drew Westen

This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its “trials” are all the analytic sessions that have been conducted. Our “literature” has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.     

Psychoanalysis and Groups: History and Dialectics

Abstract

Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.     

And Now For Something Completely Different: Humor in Psychoanalysis Commentary on Paper by Joseph Newirth

In this commentary, I argue that if humor is to be considered in an intersubjective context, the impact of any comment or action by analyst or patient cannot be predicted with much confidence. An interaction that is experienced by both parties as humorous depends on an unconscious confluence that is largely spontaneous. Efforts to orchestrate a particular outcome to an intervention that is meant to be humorous may well reveal more than was intended, and thus have an unpredictable unconscious resonance.     

Group Treatment in Psychotherapy by Robert G. Hinckley and Lydia Hermann

A recently completed clinical trial that investigated the effectiveness of a group-oriented, day treatment program provided an opportunity to pursue a multidimensional approach to the prediction of treatment outcome. The sample consisted of 99 psychiatric outpatients, most of whom had received diagnoses of affective and personality disorders. The predictor variables included a patient personality characteristic (psychological mindedness), a group process variable (patient work), and their interaction. Univariate analyses revealed significant direct relationships between psychological mindedness and both work and favorable outcome, and between work and favorable outcome. Multivariate analyses indicated that psychological mindedness and work had independent significant relationships (additive or interactive) with several of the outcome variables. In combination they accounted for up to a quarter of the outcome variance. The results demonstrate the benefit of using a theoretically consistent multidimensional approach. The time-efficient nature of the predictor measures used in the study make them particularly amenable for use by clinicians and researchers.     

Psychoanalysis and Nature: Commentary on Papers by Bodnar and Santostefano

This is a response to papers by Sebastiano Santostefano and Susan Bodnar. The response argues that the psychoanalytic view of constitutive conflict makes any assimilation of analysis and ecology very problematic. Patients may benefit from being in pleasant surroundings outside urban areas, but this is not psychoanalytic work. Psychoanalysis would entail them coming to understand why they are fueled by desires they do not recognize as their own. It would entail them working through how these desires have come to belong to them. Calling these desires natural or unnatural is not helpful, and it may be pernicious.     

Notes on Psychoanalysis,Psychotherapy and Methodology

Abstract

Technical innovations always carry with them clinical and scientific challenges. The aim of this paper is to provide a context for exploring the consequences of technical innovations for psychoanalysis as an interrelated method of observation, treatment, and body of knowledge about mental functioning. The problems are approached from a methodological perspective because scientific progress requires methodological clarity. The inquiry begins with a methodological investigation of the technical and theoretical consequences of first principles, that is, the consequences of the assumptions and methods we adopt for the kind of data that are obtained by their application and for the theory required to understand and unify the resulting observations. The conclusion suggests that if one organizes a doctor-patient relationship around the clinical-historical and free-association methods with the aim of removing all obstacles to communication, if the understandings that emerge include a full range of dynamic, structural, genetic and adaptive propositions, one is engaged in psychoanalytic inquiry. The circumstances under which Rothstein's technical recommendations enable such understandings to develop are an important topic for future research.     

An Independent Theory of Clinical Technique Viewed Through a Relational Lens: Commentary on Paper by Michael Parsons

This discussion of Michael Parsons's exposition of the Independent Tradition's clinical theory of technique compares and contrasts the British Independent and American Relational perspectives in regard to their approach to technique. In this discussion I will consider the question whether, given strong object relational influences on relational psychoanalytic theory, we are able to locate systematic differences in the way that Independent and Relational analysts attempt to work, to be with, and to relate to their patients in the psychoanalytic situation. Overlapping historical roots of the two traditions are considered, along with apparent differences in the ways in which the contributions of common ancestors, such as Ferenzci, are applied. I suggest that the integration of American Interpersonal School ideas with Object Relations theory in American Relational Psychoanalysis led to a different therapeutic sensibility, different ways of thinking about and participating in the analytic process from those that are reflected in the Independent Tradition as Dr. Parsons describes it. The discussion includes an imaginative reconsideration of clinical process along relational lines, in an attempt to clarify different emphases in technique between the two schools.     

Basic Theory of Psychoanalysis by Robert Waelder

Abstract

This study was designed to explore selected personality features of patients that are associated with clinicians’ judgments about whom to refer to dynamic group psychotherapy versus individual therapy. Results suggested that an aspect of patients’ adult attachment style, namely level of confidence and level of hostility, may have influenced the clinicians’ judgments and decision making about treatment referrals.     

The Treatment of Choice: Commentary on Paper by Susan Fairfield

Dr. Fairfield's paper brings a radically deconstructivist, postmodern perspective, with great thoughtfulness and wit, to current concepts of “multiplicity.” I consider here the importance of the points she raises yet express some discomfort with deconstructionism as a conceptual methodology. I also show why I believe that some concepts Fairfield considers irreversibly modernist, like “authenticity,” can be retooled within a postmodern perspective.     

The Strangeness of Passing: Commentary on Paper by Christopher Bonovitz

Christopher Bonovitz gives us a rich landscape of the theoretical, historical, and relational aspects of his work with his mixed-race patient. In my response I explore what seems missing: a stronger sense of the patient as a person, more of her own history in her family, more of the clinical back and forth with her therapist, a sense of what is being played out in the transference, and particularly what “passing” is for her. I show how his choices about how to think about her story and how to tell it are oversaturated with awareness of identity and race at the expense of the basic human relationship. In the face of such racial anxiety, there is a pull to rely too strongly on countertransference as a way to gain privileged access to knowledge about the other. I attribute many of these problems to the inescapable power of race in our culture. Furthermore, I address the themes of hatred, silence, secrecy and transgression as they relate to the history of transgenerational trauma for this patient and invite our broadening our awareness about how they play out in the therapeutic process. We are faced with the difficult, yet the essential task of holding and living out the patient's anger and outrage at the racial hatred that has been endured.     

The Relational Revolution in Psychoanalysis and Psychotherapy,by Steven Kuchuck,Confer Books,London, 2021, 207 pp.

The American Journal of Psychoanalysis -     

How a Kleinian Analysis Also Tells a Relational and Intersubjective Story Commentary on Paper by Meira Likierman

Dr. Likierman narrates her case in ways that differ dramatically from the usual discourse of relational analysts, and she frames her work with constructs that derive primarily from contemporary Kleinian theory. Yet I believe that if we listen closely to her clinical material, we can see how she and her patient live out a deeply relational/intersubjective process—intersubjective in both Stolorow, Brandchaft, and Atwood's (1987) broad sense and Benjamin's (1995) more developmental point of view.

I suggest is that there is real mutuality in their relationship, a reciprocal, unconscious, taking in of the mind and role of the other—a mutual change in which, paradoxically, both parties seem more real and, more deeply than ever, to express themselves. Ultimately, I think we can see that analyst and patient have “enacted” a slightly subversive, yet vital, mutual dance into and through precisely the paradoxes that Likierman recognizes as “forbidden” territory in the therapeutic relationship.     

The Coparticipant Field: Commentary on a Paper by Juan Tubert-Oklander

Psychoanalytic field theory is integral to relational praxis. In his study of the analytic field and its interpersonal complexities and relational intricacies, Tubert-Oklander emphasizes its clinical promise. Tubert-Oklander's field orientation, however, is a conservative and limited one. This commentary proposes a new, more radical coparticipant theory of analytic praxis.

As a unique form of clinical participation, coparticipant inquiry is marked by an emphasis on patients' and analysts' relational mutuality, coequal analytic authority, and dyadic uniqueness. Coparticipant inquiry represents both a one-person and two-person psychology—an integral of classical individualism and the social emphasis of the interpersonal/relational viewpoint. Coparticipant analysis calls for a new, multidimensional concept of the self that reconciles the seeming paradox that we are simultaneously communal and individual beings—from birth embedded in a series of social field, yet always uniquely individual. This psychoanalytic dialectic between personal, nonrelational selfic “I” processes and an interpersonal “me” pattern brings into relational play such concepts as will, self-determination, and agency. Coparticipation promotesatechnically freer, more self-expressive, and spontaneous inquiryandemphasizesthecurativeimmediacyofnewrelationalexperience.

I have believed for a long time that human

nature is a reciprocity of what is inside the skin

and what is outside; that it is definitely not

“rolled up inside us” but our way of being one

with our fellows and our world. I call this field

theory.

—Gardner Murphy     

Commentary on Paper by Steven Cooper

In this discussion of Steven Cooper's paper, it is argued that, although Cooper's desire to hold himself “accountable” in his work with patients is laudable, the “pluralistic third” approach that he employs gives rise in his doing so to several difficulties in the way that it is described in the paper. The vivid clinical material that Cooper provides to illustrate his approach is used as a starting point to offer an understanding of what transpired between analyst and patient, which although convergent with Cooper's formulations in some respects nevertheless follows a very different line of thinking in other areas. Broadly speaking, it is suggested that although these divergences arise from many sources—a discussion of which is beyond the scope of this contribution—one particular issue involved is a rather different understanding of the role of early internalized object relations in the patient's psychic life and the way these get lived out at many levels in the treatment situation. It is further argued that Cooper's conceptualization of the approaches of schools different from his own appears somewhat circumscribed and this detracts from his desire to make an authentic comparison between his way of working and those of other schools, something that is called for by his proposed pluralistic third method of keeping himself accountable. This is not considered surprising given the difficulties inherent in our becoming adequately familiar, in more than just an intellectual way, with the approaches of schools different from our own, especially when wide divergences are involved between schools.