Repetitive Maladaptive Behavior: Beyond Repetition Compulsion

Maladaptive behavior that repeats, typically known as repetition compulsion, is one of the primary reasons that people seek psychotherapy. However, even with psychotherapeutic advances it continues to be extremely difficult to treat. Despite wishes and efforts to the contrary repetition compulsion does not actually achieve mastery, as evidenced by the problem rarely resolving without therapeutic intervention, and the difficulty involved in producing treatment gains. A new framework is proposed, whereby such behavior is divided into behavior of non-traumatic origin and traumatic origin with some overlap occurring. Repetitive maladaptive behavior of non-traumatic origin arises from an evolutionary-based process whereby patterns of behavior frequently displayed by caregivers and compatible with a child's temperament are acquired and repeated. It has a familiarity and ego-syntonic aspect that strongly motivates the person to retain the behavior. Repetitive maladaptive behavior of traumatic origin is characterized by defensive dissociation of the cognitive and emotional components of trauma, making it very difficult for the person to integrate the experience. The strong resistance of repetitive maladaptive behavior to change is based on the influence of both types on personality, and also factors specific to each. Psychotherapy, although very challenging at the best of times, can achieve the mastery wished and strived for, with the aid of several suggestions provided.     

"Enactment" in the lives and treatment of Holocaust survivors' offspring

This paper explores an aspect of "enactment" often seen in Holocaust survivors' offspring: the compulsion to re-create their parents' experiences in their own lives through concrete acts. At the core of this compulsion is a psychic hole, a gap in the child's emotional understanding, stemming from identification with the parents on one hand, and the parents' denial or repression of the trauma on the other. The compulsion to enact can be transformed into a cognitive mode when such offspring are helped to find the meaning of the trauma in their parents' lives, as is illustrated here by clinical examples.     

Thinking Developmentally in Child and Adult Psychoanalysis

Psychoanalysis in theory and clinical practice is a developmental domain. Psychoanalysts think about their patients from a developmental point of view. The analytic relationship promotes development in both analyst and patient. Two concepts central to this author’s developmental point of view are epigenetics—as used in biology and philosophy—and that of the analyst as “developmental object.” Optimally, the analyst as developmental object facilitates what Rita Tähkä terms the “developmental illusion,” which intersubjectively transforms psychic structures, enabling alternatives to the repetition compulsion. Two vignettes with adult patients illustrate how empathic intimacy in psychoanalysis with an emphasis on latency and toddler phases as reconstructed in adult analysis presaged psychic growth. Transference as a vehicle for a developmental history taking is also considered.     

Purposive aspects of the erotic transference

This paper illustrates the erotic transference of a male patient towards his female analyst and the pressures and resistances within the transference and counter-transference to act out sexually. The patient's desire to act out sexually is seen both as a form of repetition compulsion within the transference and, in its purposive aspect, as an expression of the patient's need to find a loving breast and an empathic father. The patient's confused sexual identity is seen as a narcissistic defence against the experience of unbearable frustration in the pre-Oedipal stage. Through internalizing a new primal scene, the patient is able to separate from his past and to work through the Oedipus complex within the transference.     

Why the Capacity to Pretend Matters for Empathy

A phenomenological insight in the debate on empathy is that it is possible to directly perceive other people’s emotions in their expressive bodily behaviour. Contrary to what is suggested by many phenomenologists, namely that this perceptual skill is immediately available if one has vision, this paper argues that the perceptual skill for empathy is acquired. Such a skill requires that we have undergone certain emotional experiences ourselves and that we have had the experience of seeing the world differently, which is a form of pretence. By investigating how we retain knowledge of what is real while pretending, that is, how we anchor the experience of pretence in something that is not pretended, the paper argues that we split our experiential perspective into a double perspective, which differs from the cognitive act of understanding what a perspective is. With this notion in hand, we can return to the debate on empathy. It is argued that in order to have the capacity for direct empathic perception, one must have undergone experiences involving a double perspective.     

Revisiting the destiny compulsion

This paper is an attempt to deal with some questions raised by the so‐called ‘compulsion of destiny’ constellation. In presenting the standpoints of Freud and of psychoanalysts who after him were concerned with this problematic, the author takes the view that several aspects of the configuration merit further discussion. Accordingly, the dynamics of repetition compulsion, the complexity of the projective strategy, the coexistence of passive and omnipotent trends are considered. Concerning compulsive repetitions the dimension of drive intrication is underlined, thus moderating the understanding of this clinical entity as mainly related to death drive trends. Projection is understood as serving complex psychic demands. The coexistence of passive and omnipotent trends is envisaged, as manifested in phantasies of submission / participation of patients to a force that exceeds human limitations. For certain cases the consonance of somatic and psychic experiences is noted. Finally, elements from the material of two cases are presented which pertain to the problematic of the compulsion of destiny in which random events are submitted to heavy psychic necessities.     

Crossing Boundaries: Commentary on Paper by Sarah Hill

This commentary focuses on two aspects of Hill's presentation. First, it addresses the critical role of repetition compulsion in carrying into analytic enactments the patient's early, unsymbolized traumas. This discussion addresses, furthermore, Hill's reference to her early, preverbal, experience with an African nanny, as this resonated with some of the author's personal experiences. It is suggested that, particularly in American culture, the identities of white children who experience extended care by black nannies must be regarded as multiply determined, race being a critical determinant. How this aspect of white identity is negotiated in a culture bounded by established racial dichotomies is regarded as critical to analytic inquiry, regardless of the racial makeup of the analytic dyad.     

Primary shame,mortal wound and tragic circularity: Some new reflections on shame and shame conflicts

Invited to contribute some thoughts on recent developments in psychoanalytic thinking about shame, the author starts off with Aristotle's prescient analysis of shame and then focuses on accumulating experiences in the psychoanalytic treatment of patients with severe neuroses, in particular the close relationship of severe traumatization and chronic states of shame, and how this is reflected in shelfdestructive repetitions. Reminiscent of what we know from tragedy and the tragic dimension of human existence, this repetition compulsion shows a built‐in circularity. These circular dynamics have at their core struggles with deep woundedness that can variably be conceived of as primary pain, primary shame and primary anxiety. Consequently, throughout the experiences with these patients goes the absoluteness both of their conscience and of their ideal, what we know as the “archaic superego:”     

Re-enactments in their developmental context

The power of the repetition compulsion is felt in an especially keen way during re-enactments within psychodynamic psychotherapy. In this paper, the authors recommend greater attention to the developmental aspects of re-enactments as providing valuable information about the affective character of the crisis being brought to life in the treatment. Specifically, the authors suggest that the current developmental stage of the patient influences the experience and expression of the core developmental conflict that lies at the heart of the re-enactment in the treatment dyad. Re-enactments in childhood, adolescence and young adulthood, as well as at midlife and in the later years, each have different signatures. Thus, increased knowledge and awareness of both developmental stage and developmental core conflict is important for the following reasons: It provides a firmer theoretical foundation for understanding what is, by definition, a formidable moment in treatment; it adds another dimension and thus enhanced flexibility to the clinician’s clinical stance during a time of greater countertransference potential; and it adds to the theoretical perspective that the compulsion to repeat functions, at least in part, as an attempt to master an intrapsychic, affectively charged, previous experience of defeat. Clarifying the developmental nature of re-enactments for both patient and therapist can serve an orienting function during what is often a confusing and destabilizing time in the treatment relationship, and it can help differentiate developmentally appropriate behaviour from re-enacted conflict.     

The compulsion to confess and the compulsion to judge in the analytic situation

In this paper the author shows that human beings have two quasi‐instinctual primitive tendencies – namely, the compulsion to confess and the compulsion to judge (to condemn or to absolve). These compulsions are originally unconscious and become conscious during the course of the analytic process. The compulsion to judge is a natural consequence of the compulsion to confess. These two tendencies are intensified by the analytic situation. The patient has a compulsion to confess to the analyst and to himself, and likewise the analyst has a compulsion to confess to himself and to the patient. The patient therefore has a compulsion to judge himself as good or bad and to judge the analyst as good or bad while, on the other hand, the analyst has a compulsion to judge himself as good or bad and to judge the patient as good or bad. The task of analysis is to make both patient and analyst conscious of their compulsions to confess and to judge (to condemn or to absolve). The compulsion to judge in the analyst, particularly if unconscious, may give rise to mistakes in diagnosis, technique, treatment, and the assessment of analysability. The requirement of analytic neutrality in the analyst constantly conflicts with his compulsion to judge. If we are profoundly involved in our patient's dramatic conflict, we are bound to pass a judgement (condemnation or absolution); however, when we judge, we are not neutral and therefore become incapable of intellectual consciousness of the patient's conflict. Conversely, if we do not judge, we are neutral, but are then relatively uninvolved in the patient's conflict and are hence virtually unable to achieve emotional consciousness. The author attempts to show that neutrality cannot and must not be a preconstituted attitude in the analyst, but can and must be a point of arrival following a profound, intensely felt existential experience based on an attitude of non‐condemnation and non‐absolution.     

A Practical Guide to the MMPI (Book)

The projective imagery, artwork, and behavior of an artistically trained psychiatric patient are presented 10 years after having committed a murder. The case is examined to see whether the Rorschach responses and the artist's choice of subject matter demonstrate the repetition compulsion familiarly associated with trauma. Additionally, does psychotherapy in which the crime is remembered serve as a stimulus to these other forms of repetition? Our case shows evidence of a continuing psychological struggle to express or deny his involvement in the murder, with phases of limited resolution.     

So viel? So oft?

Psychoanalysis is usually only considered as a treatment option when other therapeutic procedures have not resulted in any lasting improvement or in particularly burdensome situations. In psychoanalysis, it is assumed that the unconscious is reflected in a structural pathology of the personality and, based on repetition compulsion, presents itself again and again in the person’s life and relationships with varying psychiatric symptoms. Within the framework of more frequent psychoanalytic treatment in an outpatient clinic, these established structures can be identified and altered as transference and countertransference in the therapeutic relationship. This requires elaborate and systematic reflection on the basis of modern theoretical and clinical developments.     

THE RELATION BETWEEN PSYCHOANALYSIS AND ITS METASCIENCE

This paper deals, first theoretically with the concepts of trauma, narcissism, and conflict causality, then clinically with the recurrent sequences of compromise formations which form characteristic vicious circles of a narcissistic, masochistic, and addictive kind, and ends with some technical conclusions and a psychological and philosophical reconsideration of the concept of repetition compulsion. The repetition compulsion, reflected in those “vicious cycles”, is viewed as an attempt to attain in symbolic ways affect regulation and conflict resolution which proves blocked because the affects and the drive needs evoked by them and closely connected with them, the forms of defense, and the superego demands, are all of a global quality and therefore irreconcilable with each other. Therefore, the consistent endeavors to express them in symbols also have to be defeated. Narcissistic crises, loyality conflicts, and shame-guilt dilemmas have a commanding position in the triggering of those sequences, of the ensuing impulsive actions, and of the splitting of consciousness and identity.     

催产素对共情反应的影响及其作用机制

催产素是一种亲社会激素, 对人类的共情反应有重要的影响作用, 主要表现为可以促进情绪识别率, 增强对他人不幸的共情关注, 并弱化自身的个体忧伤水平等。从作用机制上来看, 催产素可能是通过促进具身模仿能力, 弱化自我中心主义倾向及调节情感表征过程来影响人类的共情反应的。未来研究可以进一步关注催产素对不同类型共情反应的影响及其催产素影响共情反应的性别差异问题, 并积极将催产素应用于共情缺陷的临床干预中。     

A Structural Analysis of the Obsessional Character: A Fairbairnian Perspective

This paper reviews the object relations model of W.R.D. Fairbairn and applies it to the understanding of the obsessional personality. Fairbairn's model sees attachment to good objects as the immutable component of normal development. Parental failures are seen as intolerable to the child and trigger the splitting defense that isolates (via repression) the frustrating aspects of the object along with the part of the child's ego that relates only to that part-object. This fundamental defense protects the child from the knowledge that he is dependent on indifferent objects and preserves his attachment. The split-off part-self and part-object structures are too disruptive to remain conscious, yet despite being repressed make themselves known through repetition compulsions and transference. The specific characteristics of families that produce obsessional children impact the child's developing ego structures in similar ways. This style of developmental history creates predictable self and object configurations in the inner world, which then translate via repetition compulsion into obsessional behavior in adulthood.     

Can empathic concern be generalized from one person to others? Another positive side of the ‘one‐among‐others’ effect

Previous research on the one‐among‐others effect has shown that inducing empathic concern towards a victim presented among other individuals in need enhances: (1) awareness of these others and (2) the willingness to help them individually. In this work, we test that these outcomes are linked by an additional process: the generalization of empathic concern felt for the victim towards the others in need. Study 1 revealed that inducing empathic concern for a victim presented as one‐among‐others led to see the others as separate and different individuals, not as a unitary group. Study 2 showed that the one‐among‐others presentation (vs. only‐one‐victim) increased empathic concern towards those presented along with the main victim. Study 3 showed that the one‐among‐others presentation (vs. a single‐victim or a statistical presentation) increased the empathic concern felt for other individuals in need. Therefore, the one‐among‐others presentation does not weaken empathic concern but, instead, it leads to its generalization from one to others.     

Space and time in psychoanalytic listening1

The analytic situation is by definition traumatic because it evokes hilflosigkeit, the state of helplessness of the newborn infant, which is the prototype of the traumatic situation, and at the origin of the experience of anxiety. The author addresses the chain of associations between the state of helplessness, repetition compulsion, trauma, infantile sexuality, pleasure and displeasure, which lie at the core of the transference experience, and which find their ultimate expression in the analyst's listening. The discovery of the compulsion to repeat instituted a paradigmatic shift in Freud's formulations, emphasizing the process of repetition of trauma, and instituting a link between the network of concepts indicated above. In the clinical example discussed, the author defines the psychoanalytic process by the primacy of sexuality, the erotic passivation in the transference that evokes the traumatic childhood sexual scene. Sexuality and sexual phantasies are at the centre of the elaboration of meaning. Furthermore, the author distinguishes between two types of interpretations, namely ‘open’ and ‘closed’.     

„Fort-da — die Vertreibung aus dem Paradies — ins Leben“

The paper attempts to explore the choreography of this text which is central to psychoanalytic thinking and clinical practice. Especially the “Fort-da”-game of his grandson Ernst, in addition to the observation of traumatized people, lead Freud to question the assumptions of drive theory. How can the intrapsychic repetition of trauma and the pain of separation, in essence the repetition compulsion, be compatible with the pleasure principle? Freud’s considerations lead him to the assumption that there is a form of psychic functioning which pre-dates the pleasure principle, is independent from it and seems to have developed even prior to the intention of gaining pleasure and avoiding unpleasure — a state of “beyond the pleasure principle”. Thus the question arises how this can be compatible with drive theory which is centered around the pleasure principle. What is the meaning of Freud’s words when he speaks about a time which pre-dates the pleasure principle and where the difference between wish and wish fulfilment and (drive)conflicts, which characterize our life, do not yet exist? Freud’s reconsideration and correction of drive theory and the introduction of the death drive seem to us an epistemological circle in his reasoning and the assumption of the death drive to be unnecessary. The introduction of the death drive seems rather to have arisen from an inner conflict between drive theory and a narcissism which is not drive-determined and which is reflected in the repetition compulsion. It seems that Freud is not aware of or does not explicitly mention the perspective of a non-drive-determinated narcissism, although we find such a point of view in other Freudian texts. Bela Grunberger’s theory of narcissism enables one to reread this text with a new perspective which has important consequences for psychoanalytic practice. For example, the question as to what it is that enables the patient to get through the painful process of psychoanalysis appears in a new light. In addition we gain new insight and a re-evaluation concerning the meaning and use of a transference interpretation. A clinical case attempts to illustrate this perspective.     

On Terrorism and the Politics of Compulsion

The concept of “terrorism” is problematized and argued to be at one end of a continuum of behavior that can be characterized as “compulsion.” This approach to conflict is explained in terms of Transactional Analysis and the inadequacy of compulsion as a means of managing human affairs (politics) is explored in relation to the use of power that it requires, and to the responses it generates. An alternative behavior, based on “turning the other cheek” and Satyagraha (confronting), is advocated in the expectation that it will prove more fruitful in managing conflict and reducing terrorist outrages.     

On Becoming Meta

This presentation will develop the concept of metapsychological capacity and describe the convergence of Systemic, Self, Intersubjective and Horneyan theory that integrates into the metapsychological construct. The traditional concepts of repetition compulsion and projective identification are expanded from their mechanistic roots towards a more real, existential, iterative force that influences the therapeutic process. Metapsychological capacity creates a therapeutic presence enabling greater emotional awareness and psychological growth for both the therapist and the patient. The foundations of repetition compulsion, Horneyan character splits and projective identification serve to frame the intersubjective space from which real self emerges. Focused on subjective/relationship-near immersion, real self emergence and resonating character splits, Horney clearly understood the metapsychological capacity required for emotional growth. Deconstruction of other more classic historical and mechanistic theoretical legacies is required to comprehend and experience this therapeutic presence.