Symposium: On the Interface of Kleinian and Intersubjectivist Approaches to a Clinical Case

This symposium is the first of what we hope will be a series on the interface between Kleinian and intersubjective/relational approaches to psychoanalysis. There are some commonalities between these approaches that may not be entirely obvious. The Kleinian clinical approach organizes the internal world in terms of internal object relationships, and relies on attention to certain aspects of the countertransference as the central data source for analytic work. Both of these qualities provide an immediate link to the two-person model so central to the relational turn. At the same time, the Kleinians' radical insistence on the primacy of the internal world and in particular, the world of the primitive phantasies, runs counter to the relational interest in the equally important role of actual, social reality. This contrast is perhaps most acute in their approaches to the analyst's participation in the analytic dyad, which is meant to be limited to particular analytic functions in the Kleinian approach, but acknowledged and used as a part of an interpersonal relationship in the relational model. As the Kleinian perspectives gain currency in the United States and international interest in the relational approach grows, an exploration of these complex conceptual and clinical differences and similarities seems quite timely.     

On “That Is Not Psychoanalysis”: Ethics as the Main Tool for Psychoanalytic Knowledge and Discussion

“That is not (or that is) psychoanalysis” is a statement that, more often than not, can only remind us that psychoanalysis is divided into many schools and that discussion among them is difficult if not impossible. This will always be the case as long as analysts hold to their respective ontological definitions as if these were impervious to the laws and, most important, to the Ethics of translation. In psychoanalysis our Ethics and our Epistemology are two sides of the same coin, inseparable from our know-how. Our ethical stance is what allows (or impedes) central psychoanalytic facts to be brought into daylight. This principle applies both in the analytic room and in the room where analysts from different schools try to hold a productive discussion. In both instances “translation” is necessarily incomplete; it is therefore recommended to start by looking for the missing part.     

The psychoanalytic process: motives and obstacles in the search for clarification

One motive for regarding psychoanalysis as a "process," and for attempting to define its exact nature, is to enable analysts to clarify their criteria for distinguishing authentic psychoanalysis from other therapies that resemble it or are derived from it. In the present climate of theoretical pluralism, any list of defining qualities that could win wide acceptance would of necessity be cast in terms of such general quality as to limit its utility as a precise template. Another motive for holding on to the "process" concept arises from the unpredictable nature of analytic progress in even the most satisfactory cases.     

Editorial

Abstract

This paper will examine the current crisis in psychoanalysis in terms of the profession's decline, the apparent lack of patients, the ongoing debate over what constitutes psychoanalysis versus other therapies, and the lack of clinical focus in those debates. The concept of analytic contact will be introduced, and clinical material is used to showcase this concept as a bridge from the circular political debates to a more meaningful examination of what is psychoanalytic. In addition, case material will explore how patients tend to fight off the establishment of analytic contact in favor of safer, less threatening modes of relating. The author suggests that most patients fight off analytic contact and try to shift the treatment into something less analytic. It is up to the analyst to detect this, interpret it, and notice any countertransference collusion that may occur. Although the state of psychoanalysis as a profession is less than stellar in the eyes of the public, and the profession is apt to sabotage itself with endless debates about what constitutes true analytic work, the end is not necessary near. This paper proposes analytic contact to be the more useful focus of research and productive area of clinical exploration. If the decline of our field is to turn around, it will be on the clinical battlefront, not in terms of the theorizing among disagreeing groups of territorial analysts afraid of losing their political high-ground. The concept of analytic contact assumes that a deep exploration of intrapsychic phenomena, conflicts, and defenses, all within the realm of the transference, is the best clinical method of helping the mentally troubled individual. This genuine chance of change is best administered by a trained psychoanalyst. This simple idea is something the profession has contaminated with its often pointless arguments over frequency, analyzability, couch, and so forth. The clinical material will show that what happens in the room between analyst and patient is what best defines the true psychoanalytic treatment.     

Toward a Critical Global Psychoanalysis

In light of the contemporary shift away from the universalizing of the Eurocentric perspective, brought into focus with the advent of globalization, it may be useful to consider reorienting traditional psychoanalytic assumptions about human nature to those that are more appropriate to the recognition of a culturally pluralistic world. The author argues that ego psychology originated in the Western Enlightenment's emphasis on liberal individualism, which has limited its applicability across races, classes, and cultures. Relational theories, in their capacity to include the examination of the socially constructed dimensions of the analytic dyad (including race, class, gender, ethnicity, and sexual orientation), offer crucial theoretical and clinical possibilities, lacking in traditional psychoanalysis, that may help analysts to address some of the important cultural sources of psychological suffering. In the relational view expressed here, the unconscious—as made manifest in everyday life and in the transference and countertransference of the analytic situation—is reformulated to include social and cultural influences.     

Hidden in Plain Sight: Reply to Commentary

Drawing on anecdotes that illustrate some European fantasies about the U.S.A. and its citizens, this paper suggests that what's American about American psychoanalysis has to do with differing cultural perspectives on human nature and on the relation of self to other. Via the European prejudices and stereotypes conveyed in the anecdotes, the essay delineates certain enviable things about what the U.S. stands for, such as persistent demands for equality and relatively greater possibilities for social mobility, as well as certain unenviable things, such as a superficial niceness and a tendency to deny the individual's embeddedness in social contexts. The paper puts relational analytic theory in its socio-historic context, praising its deconstruction of analytic authority while questioning the way it for the most part maintains the analytic tradition of grounding the individual in no larger social context than that of the family.     

Innen, Außen, Zwischen

The so-called “intersubjective turn” (or “relational turn”) in psychoanalysis is closely associated with the work of Winnicott. It was him who added a new dimension to the psychoanalytic theories of a separate inner world, a dimension focussing on the mediating processes between the separate spheres of psychic and external reality: a space between subject and object, drive and civilisation, Ego and reality — the “potential space” that unconsciously connects our self to the Other as well as to a shared physical and social world we live in. Winnicotts paradoxical notions of the self are traced in this paper and unwrapped from their often enigmatic, developmentally and epistemologically confusing veils: the infant who does not exist without a holding mother; who is not aware of his/her being held because of its evidence, and only has an experience when falling; who him-/herself creates that reality which is already there; who must destroy the object in order to use it; who can only be alone when another person is present. The author, starting from apparently narcissistic phenomena of the media society, rehabilitates the term of “in-between” in contemporary psychoanalytic discussion which for a long time was considered as suspect, as being part of a “non-psychoanalytic” superficial social psychology (as the intersubjective, the interpersonal or the interactive). Under the strong influence of Winnicott, and overarching the different schools, contemporary psychoanalysis is focussing on intersubjectivity and relationality. The paper is an appeal for reformulating classical intrapsychic concepts — including the theory of the unconscious—in intersubjective terms, thus unfolding a relational approach inherent in Freud’s metapsychology.     

The “death of freud”; and the rebirth of free psychoanalytic inquiry

The relevance of Grunbaum's recent critique of psychoanalytic theory is explored as it relates to relational/interpersonal theories. Griinbaum finds no scientific evidence for repression, the cornerstone of psychoanalysis. I argue that studies demonstrating the effects of motivated, unconscious processes are beginning to emerge in psychological research. This research, as well as interpersonal theory, refers to these processes as dissociated, not “repressed.”; I agree with Griinbaum that scientific validation of psychoanalytic theories of the mind, personality, and change cannot be gleaned from case studies alone. In relational theories the analytic situation is admittedly “contaminated”; with the analyst's participation by its very nature. There is beginning to be support for some relational hypotheses, but measures to validate these hypotheses are only now being developed. Grunbaum's criticisms have come at a time when the convergence between relational theories and theories in social/clinical psychology makes it more likely that relational hypotheses will be articulated in a more precise manner by researchers, if not by analysts.

The issues of the difficulty of measuring unconscious processes and the quest for knowledge seemingly beyond human limitations are addressed. Psychoanalysis is not only less than scientific, but more encompassing, in that it is also a creative activity that cannot be understood through science alone.

Science is not enough, nor art: In this work patience plays a part [Goethe].

The most beautiful and deepest experience a man can have is the sense of the mysterious.... To me it suffices to wonder at these secrets and to attempt humbly to grasp with my mind a mere image of the lofty structure of all that there is [Albert Einstein, quoted in Pagels, 1985].     

Hans Loewald: A radical conservative

Hans Loewald's work was relatively marginalized in its day and it is little known outside the United States. It is, however, assuming increasing importance in American psychoanalysis. Loewald's attractiveness as a theoretician is due, in no small part, to his rigor and synthetic reach. He is able to accomplish the difficult feat of remaining non-sectarian and systematic at the same time. Indeed, Loewald's work contains an integrative vision that is unusual in today's fragmented psychoanalytic world. This author tries to show how Loewald attempts to reconcile many of the rigid oppositions that often become reified in analytic controversies: structural theory versus relational psychoanalysis, traditionalism versus revisionism, oedipal versus pre-oedipal, modernist versus postmodernist and hermeneutical versus scientific. The article examines how Eros, understood in terms of the psyche's synthetic strivings, plays a major role in Loewald's theory. The author also situates Loewald's position within contemporary psychoanalytic discussions of epistemology. These discussions tend to criticize the objectivism of modern science-and analysis in so far as it models itself on science-and stress countertransference and the subjectivity of the analyst. Loewald's argument, however, runs in the opposite direction. Because of his concern with the autonomy and individuality of the patient, he is concerned with the clinical dangers rising from an overemphasis on the subjectivity of the analyst.     

The soul of psychoanalysis in the modern world reflections on the work of Christopher Bollas

The paper begins with the claim that psychoanalysis faces a dilemma in locating itself in a contemporary world that devalues experiences of interiority, depth, and embeddedness in personal history. Psychoanalysis's coming to terms with this modern world—reflected in contemporary relational paradigms and emphases on interaction, authority, and epistemology—is essential yet tends to replace an outdated conformity with an updated one, in which what is offered to analysands may become limited and the soul of psychoanalysis lost.

Bollas's work attempts to reinspire psychoanalysis. This paper explores his contributions and the tensions within them and develops several points about how psychoanalysis can maintain a worthwhile self—for itself and for its analysands—in the modern world. Among the issues discussed are the sense in which an endogenous motivational core associated with an emphasis on interiority may be compatible with a relational paradigm and how the notion of personal idiom is a rich and fruitful one, but that the cultural field deserves a more fundamental place than it is given by Bollas. The problem of authority and exploitation, within and outside the consulting room, is also taken up, and it is argued that psychoanalysis should be conceived as a moral discourse in which the analyst's self‐subverting (but not diminished) authority is essential.     

Psychoanalysis and the United States research university: current trends

In this essay the author describes the status of the humanities within United States research universities, and notes that there is a place in the research university for clinical analysts with non-quantitative research interests, who are seen as humanities scholars by other humanities specialists. He discusses the current trend in psychoanalytic research in the United States, which perpetuates an historically well-known divide between quantitative and non-quantitative investigators, and causes non-quantitative clinician-researcher analysts to seek a workplace outside organized analysis, as it exists within the American Psychoanalytic Association. He goes on to describe the way a clinical analyst with a strong non-quantitative research commitment has found a supportive home for his investigations in a humanities institute in a research university. That analyst has been welcomed as a colleague by university-based humanities scholars, and has found that those collegial relationships offer creative freedom and interdisciplinary stimulation. The author notes that a cadre of analysts, enriched by such experiences, will be better equipped to bridge the divide which exists between non-quantitative and quantitative analytic researchers, for the benefit of psychoanalytic research in the future. The author also illustrates the benefits experienced by university-based humanities scholars when they collaborate with clinical analysts, and suggests this makes stronger ties between psychoanalysis and research universities more likely in the future.     

Seeking an Analytic Identity

Abstract

Rothstein has stimulated all analysts to rethink how we can better commit ourselves to our analytic work. In this paper I focus on factors in analysts' personalities and experiences in their training and practice that contribute to or distract from establishing an analytic identity.

First, I explore analysts' background and motivation. In admissions to psychoanalytic institutes we look for candidates who can see psychoanalysis as an intellectual puzzle to be solved and an emotional involvement to be experienced. We look for earlv conflicts that the candidate can sublimate in the service of analytic functioning. We assume that the capacity to sublimate is only partial and that analysts in their development continue to recognize conflicts in transference—countertransference reactions.

Second, I give some examples of experiences from analysts' training that stimulate the formation of their analytic identities. These include transient identifications and counter-identifications with the training analyst, supervisor, seminar leader, and favorite analytic authors.

Third, I discuss more external factors that influence the development of analytic identity. These include the climate in training and continuing education at the institute. How much does the institute support its members in immersion in psychoanalysis? Economic factors continue to he an important factor in determining individual choice in this immersion.

Finally, I review studies on the effectiveness of psychoanalysis. Dedicated analysts with considerable experience believe that analysis works despite some limitations. Part of high motivation to continue analytic work includes understanding how analytic results differ from the simpler solutions achieved by nonanalytic therapies.     

History Repeats Itself in Transference—Countertransference

The dynamics of the larger society inevitably are manifest in intrapsychic dynamics, as well as interpersonal interactions, in and out of the psychoanalytic consulting room. Traditional psychoanalytic inattention to the social world predisposes analysts to enact unreflectively some of the racist and classist patterns in the social world around us in our clinical work. This author argues first that U.S. psychoanalysis, as a field, has sought to define itself as white, thereby demonstrating the influence of racism in this country. Second, in a clinical example, the author demonstrates the subtle imprint of racism and classism in a dyad in which both participants are conventionally classified as white. He concludes that open discussion of U.S. history and of the past and current social location of psychoanalysis as a field goes hand in hand with increased awareness of the ways in which social forces organize psychoanalytic interactions.     

The Whole and the Parts: Working in the Analytic Field

Field concepts have been imported from physics into psychology and philosophy, in the work of writers such as Kurt Lewin and Maurice Merleu-Ponty. In psychoanalysis, they are found in the work of Harry Stack Sullivan, Enrique Pichon-Rivière, and Willy and Madeleine Baranger. They are essential for relational analysis, where everything than happens in the analytic situation is considered to depend on both parties of the analytic relationship. The analytic situation is understood as a two-person setup, in which neither party can be conceived without the other, because they are inescapably bound and complementary. This is called a “dynamic field,” and it corresponds to an experiential configuration that changes and evolves in time. Insight is better understood as a restructuring of the field, a gradual development of both parties' understanding of their shared unconscious situation. In this paper I discuss the main ideas posed by the Barangers, as well as my own, and present a clinical vignette to illustrate the phenomenology of the field.     

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.     

The Dignity in Multiplicity: Human Value as a Foundational Concept in Relational Thought

This paper explores the foundational status of the concept of human dignity in relational thought. The author highlights the importance of dignity in everyday clinical work, as well as the role this notion has played in inspiring what has been called the “relational turn” in psychoanalysis. Utilizing concepts from ethical theory and current analytic ideas regarding the multiplicity of self-states, the author sketches a model of psychic experience in which dignity plays a defining role. This model emphasizes the ongoing dialectic between dignity-based processes (in which Self and Other are experienced as unconditionally valuable) and processes in which we experience Self and Other as only conditionally valuable, or in many cases of pathology, unconditionally bad. A dignity-based vision of analytic process is proposed, wherein analyst and patient are engaged in the co-construction of an intersubjective space that is progressively more consistent with their intrinsic worth as human beings. It is suggested that, by explicitly affirming human dignity as an overarching value of relational thought, we would be encouraging continuous revision of our theories in order to further reflect the worth of the human subject, a process that could lead to more humane theories of analytic work.     

Field of Vision: Radical Uncertainty and the Analyst's Conduct: Commentary on Paper by Donnel B. Stern

There is a relationship between biography and theory. The analyst's ideas or formulations about his patients—theories really—must be determined, to some degree, by the certain and uncertain impact of his own history. Harry Stack Sullivan brought psychoanalysis squarely into the ambit of the relational/historical world by insisting that the mind is thoroughly and inherently social. In doing so, he staked a claim for the link between history, that is, social experience, and personhood. Our personalities and our theories are social-historical constructions. In relation to this, some differences between the interpersonal/relational and Bionian concepts of field theory are provided. One important difference pertains to the role of the analyst's conduct. Two meanings of conduct—to behave or to organize behavior—are at the center of what distinguishes the interpersonal/relational view of the analyst's position in the field from the Bionian view. For the relational analyst, action in the analytic field, including enactment, is conduct, and conduct is always bidirectional. The analyst, then, is a medium to alter, to reconstruct the self. He does not provide experience, he is experience. The form of an analytic exchange gives shape to the field and its content.     

The Relational Model: International Relations and Dissemination in Italy: A Historical Account

In this paper we attempt to describe how the relational model spread in Italy primarily from the microcosm of the Institute that we founded—ISIPSÉ—and in which we tried to create a community within which we could study the contemporary theories and meet the psychoanalysts who gave life to the relational movement. We describe a process of creating a cultural space that allows us to dialogue directly with those who contributed to the evolution of contemporary psychoanalysis. Today in psychoanalytic literature the growing importance of the implicit refers primarily to the importance of the body in the analytic relationship. Therefore we believe that in the training of therapists attention for an embodied, physical transmission of psychoanalysis makes the transition from theory to clinical situation more consistent and smoother.     

Hope and Dread in Mutuality and Asymmetry Regarding the Analytic Setting: Reply to Commentaries

The challenging commentaries to the discussion on the analytic setting help to clarify the various meanings this concept have to us as analysts, supervisors, theoreticians, and members of the analytic community. This sharing of our thoughts, experiences, and feelings helps refine the dilemmas we share as relational analysts regarding the setting as structure or as process. As I see it, the challenge of being a relational analyst lies in the tension between affording mutuality while retaining the asymmetry that enables a deepening of the mutuality regarding the analytic setting.