New Windows on Understanding Addictive Vulnerability: Commentary on Papers by Lisa Director and Noelle Burton

The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation—integration, helplessness—omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.     

Some observations on the psychoanalytic process

The author's aim is to delineate the psychoanalytic process and to distinguish it from the psychoanalytic situation, the transference neurosis, "insight," and psychoanalytic technique in general. Freud's 1913 views provide the basis for a concept of the psychoanalytic process centered on the recognition and interpretation of resistances and on the patient's reactions to the analyst's interventions. This clinically observable "unit" of the process is described and compared with Bernfeld's "facts of observation." The proposition is advanced that the process does not come to an end with the termination of analysis. It continues postanalytically in the form of the patient's more objective and more effective capacity for self-observation. The paper closes with a warning about the "pitfalls of perfectibilism" and with a plea for the elevation of the not-so-good analytic hour.     

Three perspectives on addiction

Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlier contributions to the understanding of addictive illness. It is suggested that these distinct yet overlapping formulations of the dynamics of addiction form a hierarchy for each patient suffering from an addiction. Assessment of a patient's ego strength, and of the relative importance of addictive behaviors in overall character structure, allows referral to various types of treatment, including psychoanalytic therapy. Case examples are presented, including material from the psychoanalysis of a woman addicted to heroin, methadone, cocaine, amphetamines, nicotine, alcohol, and shopping.     

The psychoanalytic process: the developmental and the integrative

Psychoanalysis is a treatment that focuses on intrapsychic events and activates integrative tendencies to promote-insights. Almost from the time it originated, however, it was also promoted as a therapy informed by the interpersonal, inducing change through experiences generated within the psychoanalytic situation. In recent years the interpersonal or object relations approach has come to be categorized as "developmental," a term that fosters no end of ambiguities. The resulting confusion compromises the study of the actual developmental process on the one hand and the structure-enhancing features of transactions on the other. This encumbers research on the psychoanalytic process. The author distinguishes the intrapsychic from the interpersonal, the integrative from the developmental, and the two very different realms of psychological activities currently advanced as "developmental."     

Finding the Lost Girls: Multiplicity and Dissociation in the Treatment of Addictions

Relational perspectives on the nature of self and the unconscious have transformed how we can understand addictions and substance use problems. Addictions have received little attention in the contemporary literature and therapeutic approaches outside of psychoanalysis have been skeptical of psychoanalytic approaches. It is my contention that viewing substance use problems through the lens of a relational/multiple self-state model offers new clinical possibilities resulting in greater success in treating these patients. In this model, addictive behavior is seen as embedded in dissociated self-states. Therapy focuses on helping the patient to move from dissociation to a true multiplicity and a decreased dependence on substances.     

Reply to benjamin

Action and insight form an essential dialectic within the psychoanalytic process. Yet many recent psychoanalytic formulations, while emphasizing integration, have continued to view psychoanalytic and action‐oriented techniques dichotomously. It is reasoned that certain behavioral‐cognitive techniques that promote adaptive behavior can become an active part of an in‐depth analytic experience, providing material for an exploration that results in new ways not only of relating but also of experiencing the self and others. Such an approach, while at times helpful to certain patients, can be counterproductive for others. An integrative approach is compatible with many recent psychoanalytic frameworks emphasizing a two‐person psychology, but not with a one‐person vision of the psychoanalytic situation; in the two‐person view, it is reasoned that an integrative approach is capable of maintaining the integrity of the analytic process. The outlined technique reflects a relational psychoanalytic orientation emphasizing internalized object relations, with the use of action‐oriented techniques organized by the superordinate goal of modifying psychic structure, conceptualized principally in terms of self‐ and object‐representations. Reasoning that this approach is congruent with certain theoretical contributions from Gill, Mitchell, Sandier, and especially Wachtel, among others, I state underlying assumptions of the approach, preliminary technical guidelines, and illustrative case material.     

When Interpretation Derails the Patient: The Negative Impact of Certain Misuses of the Concept of the Unconscious

Alternatives to classical psychoanalytic theory and technique have existed in the form of various "deviant" schools, all of which have found that contemporary conflict theory fails to achieve good results with the patients they treat. While the principles of interpersonal, self-psychological, intersubjective and relational schools are reasonably well known through the psychoanalytic literature, the opportunity to examine detailed analytic accounts by classical analysts has only recently become possible. The publication of full case reports has recently become a feature of the traditionally based psychoanalytic journals. This paper makes use of a recent volume of the Psychoanalytic Quarterly to examine the interpretations made during a lengthy analysis of a male patient struggling with his ambivalence about marrying his fiancée. The analyst repeatedly attributes his patient's reluctance to marry and negative feelings about his fiancée as determined by his unconscious conflation of his mother and his fiancée. The author attempts to demonstrate the derailment of the patient by these interpretations. They prevent him from solidifying his own judgment and, in so doing, prevent him from taking suitable action. An alternative approach to the material of the case is presented, including very different interpretations that would, in the author's opinion, liberate the patient rather than derail him from achieving his life goals.     

Controlling the uncontrollable. Self-regulation and the dynamics of addiction

The multidisciplinary research on addictions generally promotes the assumption that addictive behavior is caused and maintained by the external psychoactive substance, which accordingly is considered to be ‘addictive in itself’. The present article challenges this widespread assumption by engaging in a detailed examination of the psychodynamic structures of addiction. Tracing addictive behavior back to problems in affect regulation, the article discusses the object, motivation, dynamics, and developmental origins of addiction. Linking the problem with the topic of transitional object relations, the article eventually argues that addictive behavior amounts to a desperate pursuit for self-control. The tragedy of the addict is that he or she only manages to replace one sense of uncontrollability with another.     

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。     

The Role of Consultations in the Prevention of Boundary Violations: Introduction to Panel

Lachmann's paper is reviewed as an essential statement of the implications of empirical infant research for psychoanalytic theory and technique, oriented by his intersubjectivist self-psychological perspective. His essay reflects the extent to which this application has come to maturity. This commentary elaborates several of his points: that infancy, basic psychopathology, and primitivity are not analogous; the emphasis on continuity in development; and the importance of social reciprocity and adaptation in early relationship and development. I note theoretical resonances to other psychoanalytic orientations, including developmental ego psychology, British object relations theory, contemporary Kleinian thinking, and, especially, the contemporary American relational movement.

Lachmann's clinical approach is then discussed as fitting into the overall relational emphasis on reciprocity and direct engagement in psychoanalysis. Within a framework of broad agreement, I wonder if Lachmann overemphasizes affirmative and idealizing selfobject relations at the expense of other transferences and mutual influence patterns. Finally, the theory of motivational systems is reviewed as an important innovation that does not go far enough in integrating dynamic systems theory.     

Intergenerational Transmission of Violence: Shattered Subjectivity and Relational Freedom

This article considers a relational perspective regarding the intergenerational transmission of the trauma of violence. The psychoanalytic literature suggests that parents often transmit the trauma of violence to their children in the form of projected nameless dread and unmentalized states that interfere with the children's emotional needs and support. The offspring absorbs the trauma, which manifests itself in the form of disorganized attachment and in turn leads to the development of a predisposition toward cocoon-like dissociative states. This study considers two clinical cases that examine the interpersonal dynamics of dissociative processes. The therapist's reverie about his ancestors' survival of depersonalizing violence and Winnicott's concept of the survival and the use of the object help the therapist find his or her identity and gain the relational freedom needed to overcome the dissociative state, thereby becoming an alive subject who is able to help the child patient.     

MMPI validity scales and behavioral disturbance in psychiatric inpatients.

Sixty psychiatric inpatients were assigned to one of three groups on the basis of F and K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for help" validity profiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help" profiles were perceived as "acting-out" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% of the seclusions in the patients sampled. Although the "plea for help" profile is considered invalid in some scoring systems, results suggest that this validity profile may be useful in treatment planning.     

Relational Psychoanalysis and the Inner Life: Commentary on Cooper,Corbett, and Seligman

Relational analysts know that their experience feels private and contemplative during a significant portion of their working hours. A consideration of the inner life, both the analyst’s and the patient’s, is part of relational praxis. Yet relational analysts also recognize that they are continuously involved with their patients, even at those very same quiet moments. Cooper, Corbett, and Seligman recognize both these parts of relational clinical work and argue that both are necessary. Making this argument explicit is important for its own sake, but also because analysts from other schools sometimes write as if there is no place in relational clinical practice for a quiet consideration of the inner life. Two examples of such criticism are offered, in both of which relational analysts are described as being too focused on social interaction and too little on the inner life. I offer my own version of the kinds of arguments about privacy and contemplation offered by Cooper, Corbett, and Seligman. I then make the case that all psychoanalytic theories come with risks of excess. Relational and interpersonal theories come with the risk of an overenthusiastic embrace of clinical interaction, whereas more intrapsychic theories carry the risk of attending too little to the impact on their patients of present-day relatedness—which is just as likely to have unconscious roots as the inner life.     

The Products of the Imagination: Psychoanalytic Theory and Postmodern Literary Criticism

This article considers some of the affinities between postmodern literary theory and the psychoanalytic theories concerned with intersubjective phenomena. Postmodern literary theory is described briefly, and it is argued that one of its major concerns is the nature of, and the political and cultural influences on, subjectivity and identity. Despite that, postmodernism generally, and literary postmodernism in particular, can be said to lack a theory of the psychological and interpersonal dimensions of the experience of self. This article contends that the more relational schools of psychoanalytic theory can provide an example of the construction of selfhood that is of importance to contemporary and postmodern literary criticism. The academy has, to a considerable extent identified psychoanalysis with the work of Jacques Lacan, but since the 1980s the work of such theorists as Jane Flax and Jessica Benjamin, building on the work of Nancy Chodorow, have increasingly opened up the possibilities of relational and object relations theory for literary studies. The relational psychoanalytic theories operate in the same epistemological universe as postmodern literary criticism, congruent with the postmodern idea of truth as constructed and relational, and selfhood as shifting, contingent, and always-in-process. Particular attention is paid to the work of Wilfred Bion, whose understanding of self provides an account both of the failure of meaning, and of the development of mind. Some examples of a relational approach to literary analysis are provided.     

A Relational Psychodynamic Perspective on Assimilative Integration

In this paper we discuss recent advances in relational psychoanalytic thinking, and demonstrate how an assimilative approach to integration can be based on this theoretical and clinical model. We describe 3 instances in which active interventions may be used to enhance relationally oriented, psychoanalytic work: by impacting on relationships outside of therapy that maintain pathological patterns, by filling in intrapsychic deficits, and by supporting the patient's active efforts at change. We provide clinical examples to illustrate each of these points.     

An approach to families of acting-out adolescents--a case study.

Certain types of acting-out in the adolescent express the feelings of deprivation of the parental pair in a maladaptive aggressive way. Family therapists have attempted to convert the acting-out behavioral disorders into an effective state, i.e., make the family aware of their feelings of deprivation by focusing on the aggressive component. In many instances, the family becomes depressed and then interrupts or terminates treatment. The authors feel that this is due to the therapist's interpretations which bring about the depressive state via guilt provocation. The family understands the interpretations as meaning "You are bad to have your adolescent offspring behave in such a way". The therapist is thus seen as the family's collective super-ego. In order to prevent premature termination, the therapist should instead help the members of the family to become more conscious of their loving, "welfare" feelings for one another. In this way the self-esteem of the family is increased, which then permits more verbal action of aggressive feelings--thus a decrease in the acting-out, and ultimately an increase in the capacity to mourn. It should be pointed out, however, that in certain families, the technique described is not applicable. In these cases, although there is acting-out, the families are unable to draw on sufficient good experiences together which are necessary to elicit positive feeling for one another. The absence of readily available "welfare" feelings is of diagnostic and prognostic significance and differentiates the disorganized, sociopathic or schizophrenic family from the acting-out of parental deprivation as illustrated in this paper.     

The indivisibility of Freudian object relations and drive theories

The term "object relations theory" has little meaning unless placed in a context. Left unmodified, it applies to a variety of contradictory theories, many of which leave out or diminish other metapsychological points of view. This paper utilizes an account of an "ordinary" analysand's life and treatment as a context for the close examination of one session, also "ordinary," and undramatic, in order to demonstrate by example the usefulness of the psychoanalytic theory of drives in indivisible relationship with the psychoanalytic theory of object relations which, in turn, are related to all of the other metapsychological points of view.     

The Unobtrusive Relational Analyst

I describe an unobtrusive relational approach to the psychoanalytic treatment of nonalive and nonspeakable states and ways of being. I build upon a contemporary relational sensibility that values the intersubjective engagement of analyst and patient and the enactment of dissociated and unformulated states, together with the concepts of regression and the unobtrusive analyst central to the work of the British independent analysts, with a special focus on Michael and Enid Balint. I stress that in being unobtrusive, the analyst is not neutral or abstinent, but deeply engaged and becomes the analyst the patient needs. A case is offered as an account of analytic work that was enhanced and made possible by my engaged but unobtrusive presence, and the privileging of the patient's own idiom, object relating and early developmental needs. I offer a contemporary rendition of regression that encompasses mutuality, regulation and accompaniment. I suggest a concept of “benign regressive mutual regulation” and outline and differentiate some of the influences from the contemporary psychoanalytic field.     

After pluralism: Towards a new,integrated psychoanalytic paradigm1

After a restatement of the isolationism of psychoanalysis from allied disciplines, and an examination of some of the reasons for the diversity of schools of thought and the fragmentation of psychoanalytic knowledge, the author suggests the need to adopt principles of correspondence or external coherence along with those of hermeneutic coherence to validate psychoanalytic hypotheses. Recent developments in neurocognitive science have come to the aid of psychoanalysis in this period of crisis, resulting in the proposition of integrating both areas to form a new paradigm for the construction of the theory of the mind. This emerging paradigm tries to integrate clinical knowledge with neurocognitive science, fi ndings from studies on the process and outcome of psychotherapy, research into the early mother‐infant relationship, and developmental psychopathology. The author examines theoretical‐ technical models based on the concept of drives and of relationships in the light of interdisciplinary fi ndings. He concludes that the relational model has a broad empirical base, except when the concept of drives is discredited. Interdisciplinary fi ndings have led to the positing of the replacement of the Freudian model of drives with a model of motivational systems centred on affective processes. He draws certain conclusions which have a bearing on the technique of psychoanalytic treatment. These arise from the adoption of the new integrated paradigm.