Patients' Motivations and the Analyst's Experience

Although the analyst's way of organizing what he or she hears is influenced by assumptions about human motivation, the analyst's experience in the room with a patient is quite removed from any theories about motivation he or she might hold. So compelling is the clinical interaction that it may only be retrospectively that it is possible to observe how one's theory of motivation influences one's work. Several years ago, on the day before I began working on this paper, I took verbatim notes on the last three sessions of a holiday shortened week to see whether I could discern what assumptions about motivation I was making. I would not describe my theory of motivation as it appears at the end of the essay the way I did at the time I wrote this essay. Today, I would try to integrate drive theory with object relations more explicitly.     

Motivation: Sic Transit Gloria?

Sic transit gloria—so passes away the glory once accorded to motivation as a central focus of psychoanalytic theory and practice. How and why? That is the subject of this paper. I will track the ups and downs of motivation historically and its current replacement by the attention correctly afforded to relationships across a spectrum of contemporary theories. I will then take up my proposal of five motivational systems embedded in an intersubjective context and consider critiques of the proposal from different vantage points. Despite waning interest, motivation remains an intrinsic component of psychoanalysis.     

Object Relations,Affects, and Drives: Toward a New Synthesis

This paper summarizes my efforts to develop a contemporary psychoanalytic theory of drives, integrating this theory with contemporary affect theory and with psychoanalytic object relations theory. It proposes, in essence, that affects are the primary motivations of behavior, that they include a fundamental communicative function in the infant/caregiver relationship, and that it is the integration of, respectively, positive and negative affects that will crystallize libido and aggression as supraordinate motivational systems or drives. At the same time, insofar as peak affect states organize the internalization of the relationship between self and objects in the form of affect-invested self and object representations, affects are also contributing fundamentally to the organization of an internalized world of object relations, eventually consolidated in the tripartite structure of the mind.

This proposed interrelationship of affects, self- and object representations, and drives rejects the assumption of incompatibility of drive theory and object relations theory and provides potential bridging functions with the neurobiology of affects.     

Black holes: Some notes on time,symbolization, and perversion in the psychodynamics of addiction

Abstract

The existence of man is distinguished by its split state: man stands in the middle of life yet still has an awareness of his own death. He has to compensate whatever is missing in him naturally at the societal level, created as culture, and at the individual level through creativity. Rank investigated the human ‘creative drive’, the anthropological aspiration to express oneself in creative works, and to overcome the fear of death with its help. Freud admired poets and artists, whose achievements he could not psychoanalytically access, but he considered science superior to the harmless and naïve arts. There are two anthropological radicals: premature birth and the consciousness of death. Freud's massive fear of death made it difficult for him to acknowledge the problem of death appropriately. In Rank's concept, the development of human creativity contributes towards the fear of death being alleviated so that the knowledge of death can be integrated into life; creativity belongs to the fundamental opportunities of man that may enable him to find a way through neurosis. Failure is as much a part of life as is creativity: those who do not experience and accept life in its tragic dimension are denied creativity. Only a creative person who accepts his partial failure finds the strength to continue to be creative without his imperfect work leading to the ritual repetition of the same thing again and again, that is, getting stuck in recidivism.     

Interpretation and method

Abstract

Interpretation started as the central tool of psychoanalytic theory, but it has undergone changes, just as the theory it was based on has evolved. Not only have these significant changes been determined by cultural trends, but different authors have also contributed to their evolution through their approaches to various other pathologies besides neurosis. Today, the cure process is divided between those who believe that therapeutic efficiency should be based on the different interpretation models, and those who maintain that it can be only sustained by the modifying capacity of the therapeutic relationship. Both positions are supposedly upheld by the results of tests that both models believe are sufficient proof but that, in the current author's opinion, lead back to the type of pathology they arose from, although they may at times attempt to cover the entire theoretical spectrum. The position upheld by Gedo—who considers that the psychoanalyst's intervention will depend on the degree of evolution that the pathology has achieved—is of great interest for specific practice. Hence, the more primitive levels require a treatment founded on holding, whereas more evolved pathologies require a more classic level of interpretation. This implies that the stages of a particular patient's evolution may require interventions at different levels, even though these may be founded on different theoretical models. This model, which we may brand as eclectic, is basically the one we find underpinning different theoretical models, which effectively appear to integrate others.     

Book Review

Abstract

Case vignettes are offered to illustrate five principles of self psychological treatment the author believes are generally accepted by self psychologists. A sixth principle is included, contributed by self psychologists informed by intersubjectivity. They are:

1. The centrality of the empathic vantage point for analytic observation. This requires a shift in the listening stance from observing from the outside to observing from the inside. The analyst attempts to listen from within the context of the analysand's subjective reality in order to understand his experience.

2. Alterations in the sense of self must be recognized and understood.

3. When ruptures occur between patient and analyst (selfobject bond), such ruptures are analyzed.

4. From a technical point of view, the careful exploration of both the state of the selfobject bond, and the meanings to the patient of the analytic activity needs to be carefully examined and understood by both patient and analyst.

5. Defensive activities are thought to be undertaken in the service of psychological survival.

6. A deeply entrenched defensive structure may appear as a resistance to progress in treatment. Such pathological structures of accommodation function to dismantle progress in self delineation.     

Diagnose „Gesundheit“

In the early days of psychotherapy diagnoses were seen as unnecessary and even not helpful. After psychotherapy has become a method of medical treatment diagnoses are necessary in order to justify reimbursement of treatment by health insurance. Diagnoses are also useful to guide treatment, help communication between professionals and morbidity statistics. Diagnoses can have negative effects, such as simplification of complex problems, aggravation of normal life experiences or stigmatization and labelling. Therefore, diagnoses should be made when a person is suffering from an illness in order to avoid underrecognition and undertreatment. Similarly, the diagnosis “healthy” is important when no disease is present but only a normal problem in everyday life. To say that a person is healthy is an important and difficult task in all areas in medicine. Therapists must not only know the criteria for illnesses but also those for the spectrum of healthy problems in normal life. This can be done when the psychopathological assessment is professionally precise and makes a differentiation between signs of illness and other negative feelings. Also, normal life events must not be directly translated into illness states. Furthermore, therapists must be aware of their diagnostic preferences and bias. In the training of psychotherapists recognition of healthy states should get as much attention as the diagnosis of illnesses.