Breakthroughs and Phallacies: Commentary on Paper by Dianne Elise

This is the third in a series of papers comparing the work of three contemporary theorists, each of whom is associated with the intersubjective turn in psychoanalysis: Jessica Benjamin (Gerhardt, Sweetnam, and Borton, 2000), Christopher Bollas (Gerhardt and Sweetnam 2001), and Darlene Ehrenberg. This paper describes aspects of the work of Ehrenberg and attempts to show how her trailblazing ideas of the therapeutic relationship and its nuanced particularities bear on issues in intersubjectivity theory. Ehrenberg's distinctive twist lies in her painstaking exploration of the processes of mutual influence in the ongoing therapeutic interaction and their bearing on the analytic process. The manner in which Ehrenberg attempts to integrate both interpersonal and intrapsychic perspectives and uses the interpersonal as a way of locating the intrapsychic is another focus of this inquiry. Moreover, the sense conveyed through Ehrenberg's voice—a voice both sensuous and strident, tender and provocative—in her attempt to make living, breathing contact in the moment with patients otherwise deadened to their own desire is also examined as bearing on issues associated with the intersubjective turn. While our own authorial positioning is never quite declared, our object relational biases exert their influence throughout our reading of her work, not surprising for a paper on intersubjectivity.     

Conceptualizations of the psychoanalytic process

A demonstrable psychoanalytic process involves elaborate and sustained intrapsychic experiences and phenomena for both analysand and analyst. It also includes a complex and at times subtle interpersonal relationship in which each participant is actively sensitive and responsive to verbal and nonverbal input from the other. These interpersonal experiences stimulate further intrapsychic responses which in turn may have further interpersonal effects. Within the framework of the psychoanalytic situation, these combined intrapsychic and interpersonal responses lead first to facilitative and ultimately to definitive changes in the patient's psychological organization and function. A method for demonstrating a psychoanalytic process is described.     

A challenge to psychoanalysis: a review of the negative therapeutic reaction

In this paper, I have summarized the large body of literature on the N.T.R. and noted that the term has been broadened from Freud's original definition of deterioration following improvement or correct analytic work to include a negativistic, ongoing narcissistic reaction with failure to recover. Like Freud, Klein became very pessimistic about reversing this phenomenon. The N.T.R. is a multidetermined but not unitary clinical phenomenon that has generated much controversy. Its dynamics involve interpersonal and intrapsychic elements. Aggression, revenge, and oppositional reactions interfere with analytic progress and may range from temporary to a characteristic way of responding in the analysis. Aggression, the reaction to early frustration and deprivation, plays a large part in the narcissistic organization. Patients who experience N.T.Rs. are shown to have strong narcissistic features. Interpersonally, conflict between longings for fusion and the wish for separateness is central. The transference-countertransference is made difficult by projective identification. Envy and narcissism are critical in the N.T.R. patient's intrapsychic dynamics. Clinical material illustrated the difficult interpersonal and intrapsychic factors that prevailed in a severe N.T.R. patient. The N.T.R. is an insidious obstacle to analytic success and one that requires mastery of the interpersonal and intrapsychic dynamics of the patient and the treatment situation.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.     

Toward a definition of psychoanalytic neutrality

The word and concept of neutrality play an important but confusing role in the history of psychoanalysis. Does neutrality imply indifference? The origin of this ambiguity is traced to the fact that Freud himself never used the word "neutrality" (Neutralitaet) in his own writings. (His term Indifferenz was translated as "neutrality" by Strachey.) The essence of the controversy that has simmered in the psychoanalytic literature ever since is contained in the question: "Is remaining true to the concept of neutrality somehow antithetical to the analyst's genuine involvement with the patient?" In this paper, I examine the feeling and power aspects of the word and suggest that the concept of neutrality becomes clinically useful when the analyst asks himself the question, "Neutral to what?" The analyst's awareness of his motives for recognizing and addressing certain conflicts and for overlooking others is heightened. With three clinical vignettes as illustrations, I explore the role of the concept of neutrality in deepening our understanding of (1) the analytic relationship; (2) The influence, on the conduct of the treatment, of the analyst's goals and theoretical persuasion regarding how the goals are to be achieved. As examples, I use the current debates over the relative value of the analyst's focusing his attention on: (a) the patient's mind in the hour rather than his life outside the hour and, (b) transference over nontransference interpretation. Finally, I emphasize the far-reaching implications of adding an explicit concept of "external reality" to A. Freud's exclusively intrapsychic definition of the "objective" analyst's position of neutrality as equidistant from id, ego, and superego. The addition of this fourth point to the analyst's "compass" widens the analytic field toward which the analyst is neutral. The concept of neutrality with respect to specifiable conflicts is thereby also broadened to include (a) interpersonal conflict within the psychoanalytic relationship and (b) conflict within the analyst. With these explicit additions, the concept of neutrality with respect to conflict becomes congruent with the current emphasis on the nonauthoritarian two-persons aspects of the psychoanalytic relationship, without detracting from the primary analytic goal of deeper understanding of intrapsychic conflict.     

Knowing another from a dynamic systems point of view: the need for a multimodal concept of empathy.

This paper explores the concept of empathy within the context of current debate regarding the advantages of an intersubjective versus an intrapsychic focus on the treatment process. The author explores the way in which dynamic systems theory, the parent of intersubjectivity, can potentially embrace the wisdom of both relational psychoanalysis and ego psychology. The ongoing analytic discourse is represented in two modes, by schematic and symbolic representations, which roughly correspond to the intersubjective and the intrapsychic record. Empathy is redefined as the enactive, imaginal, and interpretive efforts an analyst makes toward understanding both the schematic and symbolic discourse with her patient.     

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.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

The role of the preconscious in psychoanalysis.

The analytic process inevitably involves the interdigitation of the intrapsychic structures of both patient and analyst. This interplay is expressed in transference-countertransference interactions. Drawing a dichotomy between intrapsychic and interpersonal factors as central agents of psychic change is a faulty construction. Affective, behavioral interchanges between patient and analyst reflect their individual intrapsychic organizations and their interplay, which influence the form and nature of psychological change. The safer both patient and analyst feel in relation to each other, the more freely will they relax their customary cognitive controls and permit the emergence of preconscious responses. Preconscious resonance between patient and analyst is likely to facilitate the lifting of repressive barriers and the emergence of unconscious material in both participants. The integration and reworking of old conflicts then becomes possible. The role of the preconscious in facilitating the analytic process is illustrated. Creative use of preconscious processes requires the analyst's self-discipline to preserve the analytic role and keep the treatment safe for both participants.     

Ethics and the Psychoanalytic Hard Problem

The ethical aspect of self and other engagement is recognized as essential to analytic inquiry, practice, and theory, indeed as central to understanding the life of humanity in general. This valid and important viewpoint apt for relational views lives alongside the intrapsychic aspects of mental functioning that are autonomous and nonethical in their essential processes. Integrating the simultaneous truths of two-person and one-person points of view is the hard problem of psychoanalysis.     

Discussion of “Culturally Imposed Trauma: The Sleeping Dog Has Awakened. Will Psychoanalysis Take Heed?”: Commentary on the Paper by Dorothy Evans Holmes

This commentary expands on the problem of culturally imposed trauma described by Dorothy Evans Holmes. The focus on cultural trauma is both timely and necessary. I applaud Holmes’s attention to this important issue, and her clear articulation of its effects on intrapsychic and interpersonal life and the reluctance of psychoanalysis to engage with cultural trauma. My commentary explores two primary areas in an effort to further elaborate this issue: (a) The problem of defining cultural trauma as a legitimate type of trauma, and recognizing resistance to cultural trauma in psychology and psychoanalysis, and (b) the role of cultural context and narrative in addressing cultural trauma within psychoanalytic work. I aim to extend the range of questions concerning race, culture, and social class that remains to be examined in psychoanalysis.     

“Living Memory”: Discussion of Avishai Margalit's “Nostalgia”

Avishai Margalit raises questions about how memory can be a moral and an ethical concern, and in this commentary on “Nostalgia,” Aron expands on these themes and examines the place of memory in psychoanalysis and in Judaism. The study of memory and of mind are inseparable. At its best, psychoanalysis does not contrast thoughts and actions, inner and outer, memory and motor action, intrapsychic mental life and interpersonal external behavior as simple dichotomous terms but rather views these as mutually defining transformations, different views of a single complex reality. Conceived in this way, memory is not a static internal picture, but rather is continually constructed, embedded in our interpersonal context. It is living memory.     

The dynamics of owning and disowning: psychoanalytic and family perspectives.

The dynamics of owning and disowning one's inner life have both intrapsychic and transactional or interpersonal dimensions. Freud opened new vistas on our inner world using psycoanalysis as a tool. Although not unaware of the effects of family members upon each other, Freud's rejection of the seduction theory of neurosis in 1897 fatefully influenced the future course of psychoanalysis, placing the primary focus on intrapsychic relations. Until today, it has remained the task-perhaps the principal one--of psychoanalytic theorists to do justice to the interpersonal and family realm that Freud neglected, without sacrificing the enormous insights we owe to Freud. Three conditions for successful inner ownership are described: a capacity for self-object differentiation; tolerance of ambivalence; and a sense of physical integrity, of having a cohesive, nuclear ego. The pathology of inner ownership is related to a pathology of interpersonal ownership as transacted on the family level. One form of such relational pathology--parental overowning, as revealed primarily in families with schizophrenic members--is discussed, with a case example.     

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.     

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.     

Working with the relational unconscious: an integration of intrapsychic and relational analysis

From its inception, psychoanalysis has tended to idealize the curative value of insight while devaluing the mutative significance of the analytic relationship. This paper argues that applying the construct of the "relational unconscious" in clinical practice offers a possible resolution of this "mind-relationship" rift. From this perspective, transference and countertransference provoke a continual intersubjective/interpersonal enactment of a co-created infantile drama emanating from the internal worlds of analyst and analysand in which a vital form of parental and/or self loving is at stake. Case vignettes demonstrate how to apply the relational unconscious in clinical practice.     

Combined group and individual treatment for the borderline patient

This article discusses the attenuating mechanisms of group psychotherapy that support and enhance analytic work with borderline patients in combined group and individual psychotherapy. A group case study is presented which addresses the manifestations and management of transference and countertransference in a combined treatment approach. Combined treatment was observed to respond effectively to both the intrapsychic and interpersonal difficulties of borderline patients. A multidimensional model for treating these patients in a community mental health setting is proposed.     

PSYKOANALYTISKT ORIENTERAD PSYKOTERAPI

The increasing discourse of the concept of intersubjectivity in modern psychoanalysis has pushed the interest in the intrapsychic and its emphasis on drive and object into the background. Authors who wish to avoid a one-sided focus on intersubjectivity usually subscribe to a dual dimensional approach, taking both perspectives into account. In this article, the analytic situation is described not in two, but in three dimensions, the analytic function constituting a third dimension necessary for the interplay between the other two dimensions. Focusing on the analyst's position, the author presents a model that consists of (1) the-analyst-as-subject, (2) the-analyst-as-function, and (3) the-analyst-as-object. The analytic function is understood to be invested with a particular form of desire and it is argued that the asymmetry between this desire of the analyst and the desire of the analysand is a central characteristic of the analytic situation.     

Countertransference: Our new royal road to the unconscious?

In this paper I am tracing the history of countertransference and how it has informed the current debate about self‐disclosure as a pivotal instrument of analytic work. Now that the analyst's “subjective factor”; has been understood as a central influence on the analysand and as a vital source of information about the analysand's intrapsychic life, I argue that certain currents in the relational school of psychoanalysis confuse the analyst's subjectivity with his personality. While becoming more “real”; with a patient may enliven a stale analytic dialogue, it ought not be confused with, or take the place of, an analysis of unconscious desires and phantasies. I claim that a two‐person psychology can exist only within a tripartite structure in which the analyst does not lose sight of his complex function of being the carrier, observer, and conveyor of the unconscious currents holding both participants in check.