Organizational Structure and the Establishment of Psychoanalytic Identification: Commentary on Paper by Randall Lehmann Sorenson

This commentary addresses two themes: parallels between religious and psychoanalytic education and the question of group survival in a world of competitive groups, whether religious (“strict” vs. “weak”) or psychoanalytic (differing psychoanalytic approaches). “Strict” religious education involves teaching both critical thinking and identification with the particular religion. This blend of critical thinking and identification with psychoanalysis is crucial in psychoanalytic education. We want to graduate students who see themselves as psychoanalysts rather than as being “interested” in psychoanalysis. This goal is accomplished when students have close, positive experience with personal analysts, supervisors, and teachers who are strongly committed to psychoanalysis but in a manner that encourages students to think critically and find their own psychoanalytic perspective. With regard to the second theme, I discuss how our narcissistic commitment to one or another psychoanalytic model interferes with open integration of new insights. Individual analysts privately integrate competing ideas in their own idiosyncratic ways. When these individuals publicly represent competing psychoanalytic groups, however, they tend to emphasize differences among these groups. They then find ways to appropriate new ideas as extensions of their own evolving tradition. In this way, a theoretical school is able to integrate new developments while preserving its own identity.     

Ghosts of paradigms past: the once and future evolution of psychoanalytic thought

An example of the psychoanalytic mode of thought is put forward concerning how psychoanalytic theories have historically been constituted and transformed. The model of world hypotheses, characterized by multiple irresolvable truth claims, captures the nature of most psychoanalytic theorizing until about 1970. Each of two world hypotheses--one grounded in intrapsychic conflict (seen when the analyst observes from outside the transference) and the other in interpersonal internalization (seen when the analyst observes from inside the bidirectional interactive processes)--is an autonomous and self-sufficient aggregate. The stance taken by the analyst-observer with respect to the analytic interaction is key to seeing how the two world hypotheses are made manifest in clinical work and in theory. By contrast, the model of competing programs captures the essential nature of most psychoanalytic theorizing since about 1970, and is characterized by the necessity of each progressively evolving through a particular kind of commerce with its neighbors. Such commerce is necessary when a program is in danger of degenerating. In this way of thinking, there is a fundamental tension between classical psychoanalysis adapting to the demands and exigencies of its particular and ever evolving historical niche and simultaneously retaining the core commitments that guarantee continuity. Honoring the forces of progression displaces the quest for truth as a paramount goal of psychoanalysis. A developmental lag in recognizing this transformation has hindered progress toward a comparative, process-centered psychoanalysis.     

精神分析客体关系革命的折衷进路:英国独立学派评述

自精神分析学诞生以来,其发展进路经历了自我革命、客体关系革命、自体革命、关系革命和神经科学革命。英国独立学派是客体关系革命的主要发起者和中间力量,它诞生于20世纪40年代英国精神分析学会内部的“论战”,并在规模以及精神分析理论和技术方面都取得重大发展。独立学派的精神分析师以开放和折衷的态度批判性地汲取各种现存的精神分析观点,形成不同于克莱因学派的客体关系思想,并表现出独立性、开放性、关系性和真实性的内涵与特征。温尼科特、费尔贝恩和巴林特是独立学派的主要代表人物,他们各自建构出独特的客体关系理论,促使精神分析范式从一元驱力模式转向二元客体关系模式,推动了客体关系理论的深入发展,奠定了后续精神分析发展的基石。     

Models of learning and psychoanalytic traditions can reform be sustained in psychoanalytic training?

This paper presents a series of training vignettes which suggest that a subtext of defensiveness regarding exposure to our patients, fear of feelings, adherence to an unwritten set of rules, and a profound need to control our way of thinking and working pervades the way psychoanalysis is taught and practiced in many settings. The paper explores the way in which the basic culture of psychoanalysis, and the manner in which psychoanalysts are socialized, may make these kinds of episodes commonplace. The paper suggests that a paradigm shift that has been taking place in psychoanalytic clinical thinking has not yet affected the training process because of the danger that the new paradigm might undermine the safety, clarity, and ways of knowing that our traditional theories and clinical practices have provided.     

Observations on some aspects of current psychoanalytic theories

The competing theories in the psychoanalytic marketplace today should be judged on their merits, not on the basis of the authority of whoever first proposed them. What is valid in each theory should be included in any formulation of a psychoanalytic theory of mental development and functioning. Since psychoanalysis, as part of psychology, is a branch of natural science, pluralism in theory is to be avoided in psychoanalysis as in every branch of science. The psychoanalytic method is a valid one of studying a particular aspect of brain functioning. The method and the theories based upon it are as "organic" as is the case with any of the other neurosciences. Any valid psychoanalytic theory of mental functioning and development should include the following conclusions: (1) Unconscious mental processes are omnipresent and of great importance in mental functioning; (2) Thoughts are as causally related to one another as are other events in the universe; (3) Mental functioning is a developmental phenomenon with describable, sequential features; and (4) A major role in mental functioning and development is played by conflicts over the sexual and aggressive wishes that characterize mental life during the period from three to six years of age, and by the compromise formations that result from those conflicts. The last of these conclusions, though disputed by many, is abundantly supported by evidence that is not dependent on the use of the psychoanalytic method, as well as by evidence furnished by the use of the psychoanalytic method. There is also much evidence to support the assertion that any psychoanalytic theory that attributes language-dependent thoughts to a child whose brain is not yet mature enough to be capable of language is to be considered invalid, as are any observations made by the psychoanalytic method (= clinical observations) that are influenced by such an invalid theory. In psychoanalysis, as in every other branch of science, an observer--no matter how astute and how experienced--who subscribes to an invalid theory will be led astray by that theory, sooner or later, in one way or another.     

LISTENING AND SPEAKING PSYCHOANALYTICALLY ‐ WITHWHAT IN MIND?*

In this paper, the proposition is developed that multi‐model thinking with respect both to theories of mind and to theories of technique has always been implicitly present in psychoanalytic practice as a response to the demands of the clinical moment. But this has gone unnoticed and untheorised, in part because it is hidden in general considerations regarding tact, timing and (less discussed) variations in voice tone and also because our psychoanalytic practices, without our awareness but as adaptations to the clinical moment, do not always match our theories. The author offers reasons from the broad culture of psychoanalysis why this is so. He also offers a conceptualisation and a strategy for raising the implicit and untheorised to heightened levels of awareness; he does this by highlighting the place of patient characteristics as the underpinning of theory variation and the place of a vast array of clinical possibilities as the backdrop of analytic listening. Clinical examples are used throughout.     

The limits of psychoanalytic insight

Psychoanalysis has the intellectual power to decipher the inner structure of subjectivity, thus distinguishing itself from neighbouring human sciences. In doing so psychoanalysis is able to show the damages a society does to its individuals. Present-day psychoanalytic practice and thinking however runs counter to these inherent possibilities. The interaction of unresolvable neurotic phenomena and ideological bias in individual psychoanalysts reflect the increasing subsumption of psychoanalysis under the dominating interests of society--a dependency, which characterizes the actual psychoanalytic practice and theories in our time as basically affirmative.     

Toward a postmodern realism for psychoanalysis.

The current status of psychoanalysis is explored in the light of the postmodern critique of forms of knowledge. Analysts have tended to respond by redefining psychoanalysis in the language of the exact sciences or by finding a language that includes both (Kuhn, Rorty), thereby falling either into a reductive "scientism" or the fallacies of the "strong program" in postmodern thought. However, psychoanalytic theories do not meet the probative requirements of science. Neither is the serious problem of competing theories and interpretations adequately addressed by hermeneutics. Philosophical realism (Putnam 1981, 1988) offers some helpful ways to look at this problem. Following Lacan, we define psychoanalysis as a clinical discipline which has as its unique object of study the human subject, an indeterminate and language dependent entity. Concepts and rules specific to our field make an internal realism of psychoanalytic inquiry possible. An extended case vignette accompanies this philosophical discussion.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Validation of psychoanalytic theories: Towards a conceptualization of references

The authors discuss criteria for the validation of psychoanalytic theories and develop a heuristic and normative model of the references needed for this. Their core question in this paper is: can psychoanalytic theories be validated exclusively from within psychoanalytic theory (internal validation), or are references to sources of knowledge other than psychoanalysis also necessary (external validation)? They discuss aspects of the classic truth criteria correspondence and coherence, both from the point of view of contemporary psychoanalysis and of contemporary philosophy of science. The authors present arguments for both external and internal validation. Internal validation has to deal with the problems of subjectivity of observations and circularity of reasoning, external validation with the problem of relevance. They recommend a critical attitude towards psychoanalytic theories, which, by carefully scrutinizing weak points and invalidating observations in the theories, reduces the risk of wishful thinking. The authors conclude by sketching a heuristic model of validation. This model combines correspondence and coherence with internal and external validation into a four‐leaf model for references for the process of validating psychoanalytic theories.     

Obsessive-Compulsive Disorder: Current Views

Obsessive-compulsive disorder has been of central interest to psychoanalysis since Freud's early papers, most particularly in the “Rat Man” case. This early literature spelled out with great clarity the presumed development, psychodynamics, and meaning of obsessional and compulsive symptoms. Unfortunately, since Anna Freud's 1969 review of the subject, virtually nothing has appeared in the psychoanalytic literature that has added to our understanding of the disorder or enhanced the very limited therapeutic influence of psychoanalysis in such cases. Meanwhile, there has been an avalanche of contributions from biological psychiatry and behavioral psychology that have propounded different theories of pathogenesis and have laid claim to significant therapeutic effectiveness. If psychoanalysis is to have credibility in this field, it will have to enlist itself in multidisciplinary research efforts directed toward enriching our knowledge about the psychodynamics and the biological substrate of this illness (more common than once believed) and the efficacy of our efforts to treat it.     

Don't Drag Me Around: The Phenomenology of Complexity in Group Psychotherapy: Commentary on Paper by Robert Grossmark

Robert Grossmark expands our current understanding of the relationship between hermeneutic psychoanalysis, relational psychoanalysis, and complexity theory, illustrating this relationship in the context of presenting his work and discussion of his group psychotherapy experiences. Complexity theory continues to be increasingly elaborated in psychoanalysis and integrated into psychoanalytic theories centered on multiplicity, dissociation, and enactment. The utility, vicissitudes, and potential problems with this integration necessitate an emphasis on the distinction between thinking phenomenologically and thinking explanatorily. Recommendations are offered for a more seamless integration and application of these theories.     

What's Possible? What Matters? Reply to Commentaries

The three discussants agree that a definition of psychoanalysis tied to session frequency is problematic and needs to change. Yet none supports my recommendation to redefine the practice of psychoanalysis in terms of the practitioner's training. This prompted me to look more closely at my proposal and push my thinking further. I argue that psychoanalysis, like many other professions, needs to define its practice as the application of its complex and evolving knowledge and skill base, grounded in its unique field of inquiry. Although there are individual exceptions, the inculcation of this knowledge and skill base is generally best accomplished through psychoanalytic training. This assertion, however, rests on the premise that our training curricula keep pace with our rapidly evolving field of inquiry and knowledge. To further clarify my vision I examine the nature of psychoanalytic expertise. I suggest that such expertise amounts to the inculcation and integration of a large number of psychoanalytic frames of reference. I contend further that the nature of contemporary psychoanalytic theories is such that important psychoanalytic frames of reference are proliferating more rapidly than in the past, that the relationships among them are becoming more complex, and that consequently the application of psychoanalytic theory to practice is also becoming more complex. Psychoanalytic training programs need to recognize this expanding complexity and revise curricula and pedagogic methods on an ongoing basis to reflect this evolution within our field.     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

'This is not psychoanalysis': On the stony way of the Danish Psychoanalytical Society

When Freud founded the International Psychoanalytical Association (IPA), he wanted a network of local groups responsible for psychoanalytic training. The groups would function as ‘headquarters whose business it would be to declare: All this nonsense is nothing to do with analysis; this is not psychoanalysis. Today, with psychoanalytic pluralism, Tuckett (in press) has asked ‘Does anything go? He has pointed out that the psychoanalytic community has been increasingly willing to accept within its ranks apparently very varied approaches to theory and practice, and that this increasing diversity has many negative consequences for psychoanalytic institutions and especially for training schemas. The aim of this paper is to give an example of psychoanalysis that ‘did not go’, and how that led to a shaky start for the new Danish Psychoanalytical Society, with confusing boundary relations between psychoanalysis and psychotherapy and no training institute. Beginning with the written psychoanalytical contribution of the three founders of the Danish Society, the paper will try to identify factors that contributed to the ‘shaky start’. The paper will also examine how stones were removed from the path, thus paving the way for the members of the Society to discover ‘competent psychoanalysis’.     

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.     

The multiple meanings of neutrality

Throughout the evolution of psychoanalysis, its theories and methods have been deeply influenced by ideas about psychoanalytic neutrality. However, considerable dissension has surrounded the concept of neutrality. This paper defines five distinct categories of neutrality the author considers relevant to all theoretical perspectives on psychoanalysis: behavioral, attitudinal, interpersonal, interactional, and essential.     

Psychoanalysis: The Sacred and the Profane

Colleagues from a variety of perspectives have written about the propensity to enshrine psychoanalytic theory. The meaning of the word “enshrine” is to cherish as sacred an idea or philosophy and protect it from change. In other words, the way we view psychoanalysis, our theories of mind and technique, become holy writ and we have divided the world of theory into the sacred and the profane. This is the kiss of death for theory, which must constantly evolve and change, but comforting for the analyst who believes he is on the side of the right, the sacred. In this paper I will discuss how our propensity to enshrine theory has had a debilitating effect on the development of psychoanalysis and, in particular, as a treatment for the most vulnerable people who seek our help. I also address the idea that movement away from enshrined positions allows us to construct different versions of reality. In this context, the notion of “action at a distance” is presented along with the attendant idea of psychoanalytic entanglement.     

Kernberg and Kohut: a test of competing psychoanalytic models of narcissism

Over the past ten years the problem of validating psychoanalytic theory has received increasing attention from psychoanalysts and nonpsychoanalysts alike. Yet, very little research responsive to this question of validation has been produced. During this same period one of the most fertile controversies in contemporary psychoanalysis reached its peak--the Kernberg-Kohut debate concerning the nature of narcissism. However, for the lack of a validation strategy, this debate has become increasingly sterile, degenerating to a theoretical stalemate at this point. This paper addresses the problem of validation by using causal modeling as a mechanism for empirically testing many of the claims of these competing models of narcissism. Although the data provide empirical support for both theories, strategic comparisons tentatively suggest that Kohut's self psychology is more parsimoniously explained as a special case of Kernberg's ego psychology-object relations theory.