CONTEMPORARY CONTROVERSIES IN PSYCHOANALYTIC THEORY, TECHNIQUES, AND THEIR APPLICATIONS
CONTEMPORARY CONTROVERSIES IN PSYCHOANALYTIC THEORY, TECHNIQUES, AND THEIR APPLICATIONS
otto f. kernberg, m.d.
yale university press / new haven and london
Copyright © 2004 by Otto F. Kernberg. All rights reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviewers for the public press), without written permission from the publishers. Set in Minion type by The Composing Room of Michigan, Inc. Printed in the United States of America. A catalogue record for this book is available from the Library of Congress and the British Library. ISBN: 0-300-10139-2 The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources. 10
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To Paulina, with all my love
CONTENTS
PREFACE
viii
PART ONE: THEORY AND APPLICATIONS 1 CHAPTER 1 Freud’s Theories and Their Contemporary Variations
3
CHAPTER 2 Psychoanalytic Object Relations Theories
26
CHAPTER 3 The Concept of Drive in the Light of Contemporary Psychoanalytic Theorizing
48
CHAPTER 4 Unresolved Issues in the Psychoanalytic Theory of Homosexuality and Bisexuality
60
CHAPTER 5 Mourning and Melancholia Revisited
75
CHAPTER 6 Resistances to Research in Psychoanalysis
86
CHAPTER 7 Authoritarianism, Culture, and Personality in Psychoanalytic Education
94
CHAPTER 8 A Concerned Critique of Psychoanalytic Education
104
CONTENTS
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CHAPTER 9 Some Proposed Complementary Solutions to the Problems of Psychoanalytic Education
132
CHAPTER 10 Sanctioned Social Violence: A Psychoanalytic View
142
CHAPTER 11 Some Psychoanalytic Contributions to the Prevention of Socially Sanctioned Violence
170
PART TWO: TECHNIQUE
191
CHAPTER 12 Listening in Psychoanalysis: The Importance of Not Understanding
193
CHAPTER 13 The Analyst’s Authority in the Psychoanalytic Situation
206
CHAPTER 14 Validation in the Clinical Process
221
CHAPTER 15 The Interpretation of the Transference (with Particular Reference to Merton Gill’s Contribution)
232
CHAPTER 16 The Influence of the Gender of Patient and Analyst on the Psychoanalytic Relationship
246
CHAPTER 17 Convergences and Divergences in Contemporary Psychoanalytic Technique
267
CHAPTER 18 Recent Developments in the Technical Approaches of English-Language Psychoanalytic Schools
285
REFERENCES
305
INDEX
325
PREFACE
Contemporary psychoanalysis is involved in an active process of transformation and enrichment of fundamental psychoanalytic viewpoints regarding development, psychopathology, and treatment. This book presents some of these developments and the corresponding controversies that are being explored; it reassesses standard psychoanalytic technique as well as derived modalities of treatment under the impact of new understandings regarding development and psychopathology. A central formulation that has influenced psychoanalysis in the broadest sense is psychoanalytic object relations theory. Therefore I begin the book with an overview of the principal approaches to psychoanalytic object relations theory. Intimately connected with the questions raised by object relations theory is the question regarding the drives as basic motivational systems, specifically the relations between drives, affects, and object relations in the genesis and development of unconscious motivation. In contrast to the rejection of the psychoanalytic drive theory on the part of some object relations theoreticians, particularly those connected with the intersubjectivist and self-psychology approaches, I propose that contemporary object relations theory and Freud’s dual drive theory are eminently compatible, but that this compatibility implies a radical review of our concepts involving the relationships between drives and affects. I propose that affects constitute the building blocks of the drives, and, once the dual drive system is structurally consolidated, affects carry out a signal function for the drives within each concretely activated object relationship. In reviewing contemporary developments and controversies in psychoanalytic technique, I stress the importance of the analysis of affectively invested internalized object relations in the transference as the essential aspect of transference developments and the corresponding countertransference reactions as well. By contrasting the contemporary controversy between the psychoanalytic “mainstream”—derived from a gradual integration of ego psychological and object relations approaches—on the one hand, and the self-psychology-intersubjective approaches on the other, I explore the clinical implications of my view of affects for the diagnosis and manageviii
PREFACE
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ment of transference and countertransference and their implications for the analyst’s listening and authority. At the same time, I introduce a brief overview of the French psychoanalytic approach to technique, which is evolving in parallel to those others referred to earlier, an approach that is beginning to influence—as well as to be influenced by—the developments in the mainstream psychoanalytic approach. There are particular controversial areas that I attempt to highlight, regarding psychoanalytic theory and technique, such as our new views of homosexuality, bisexuality, and the influence of gender in the analytic relationship, as well as areas of application of psychoanalysis to nonclinical fields that are a focus of concern of the psychoanalytic community. The latter ones include the problem of psychoanalytic research and its clinical implications, the validation of our interventions in the clinical process, the challenges of psychoanalytic education—our recognition of significant problems in our traditional educational model that may require a radical review of our training institutions—and the application of psychoanalytic understanding to social and cultural problems. The application of psychoanalytic understanding to problems of culture and society, a major concern of Freud’s throughout his entire work, also represents, I believe, a responsibility of the psychoanalytic profession beyond our concern for individual patients. It involves the complex area of the manifestations of the unconscious in the social and political process, particularly regarding the dramatic developments of the twentieth century with its unleashing of human destructiveness on a scale that was undreamed of before the development of modern totalitarian regimes. The upsurge of fundamentalist movements at this time signals the permanent nature of the threat to social life by unrestrained aggression triggered in the context of the social process. Psychoanalysis certainly does not have all the answers, but I believe it is able to contribute to our understanding in this field and bears responsibility to do so. I am grateful to many colleagues and friends who have contributed, in our discussions of these issues, to helping me clarify my own thoughts and gain new understanding of the many subjects touched on in this book. They include, in the United States, Drs. Martin Bergmann, Harold Blum, William Grossman, Paulina Kernberg, Robert Michels, Ethel Person, Gertrude Ticho, Robert Tyson, and Robert Wallerstein. My views on psychoanalytic education have been profoundly influenced by Drs. David Sachs and Robert Tyson in the United States; André Lussier in Canada; Claudio Eizirik and Elias Mallet da Rocha Barros in Brazil; Sara Zac De Filc and Isidoro Beren-
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stein in Argentina; and Caesar Garza Guerrero in Mexico. In Germany, I am grateful to Drs. Karin Bell, Peter Buchheim, Rainer Krause, and Ernst Lürssen. In recent years I have been influenced by the developments in French psychoanalysis, particularly through the work of Drs. Alain Gibeault, André Green, Jean Laplanche, Joyce McDougall, and Daniel Widlocher. My views about psychoanalytic research have been shaped by ongoing dialogues with Drs. Peter Fonagy, André Green, Horst Kächele, Rainer Krause, and Anne Marie Sandler and the late Joseph Sandler, in addition to the exciting research atmosphere of the Personality Disorders Institute at Cornell University that I direct. I wish to warmly thank the senior members of this institute, in particular Drs. Anne Appelbaum—who for many years has patiently edited my writings—Eve Caligor, John Clarkin, Diana Diamond, Pamela Foelsch, Perry Hoffman, James Hull, Catherine Haran, Paulina Kernberg, Sonia Kulchycky, Kenneth Levy, Armond Loranger, Michael Stone, and Frank Yeomans. Finally, I wish to thank heartily the secretarial staff of the Personality Institute: Mrs. Joanne Ciallella, who patiently typed many versions of the chapters of this book; Mrs. Rosetta Davis, who organized the growing manuscript and was always willing to take on additional chores with a friendly smile, and especially the institute’s and my personal secretary, Ms. Louise Taitt, who over many years has been effectively taking care of the enormous amount of work and the responsibility for decision making in many areas that landed on her desk and who, with an unerring judgment and a tactful but strong determination, did whatever was necessary to protect my own time. She deserves my heartfelt gratitude.
part one theory and applications
1
freud’s theories and their contemporary variations
Psychoanalysis is (1) a personality theory and, more generally, a theory of psychological functioning that focuses particularly on unconscious mental processes; (2) a method for the investigation of an individual’s psychological functioning based on the exploration of his or her free associations within a special therapeutic setting; (3) a method for the treatment of a broad spectrum of psychopathological conditions, including the symptomatic neuroses (anxiety states, characterological depression, obsessive compulsive disorder, conversion hysteria, and dissociative hysterical pathology), sexual inhibitions and perversions (“paraphilias”), and the personality disorders. Psychoanalysis has also been applied, mostly in modified versions—that is, in psychoanalytic psychotherapies—to the treatment of severe personality disorders, psychosomatic conditions, and certain psychotic conditions, particularly chronic schizophrenic illness. All three aspects of psychoanalysis were originally developed by Sigmund Freud (1916 –17, 1938a; Breuer and Freud, 1895), whose theories of the dynamic unconscious, personality development, personality structure, psychopathology, the methodology of psychoanalytic investigation, and methods of treatment still influence the field heavily, both in the sense that many of his ideas continue to be the basis of psychoanalytic thinking and in the sense that subsequent divergences, controversies, and innovations can be better understood in the light of his contributions. Freud’s concepts of Published in New Oxford Textbook of Psychiatry, edited by M. G. Gelder, Nancy C. Andreasen, and Juan J. López-Ibor Jr. (New York: Oxford University Press, 2000), 1:331– 343. Reprinted by permission of Oxford University Press. 3
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dream analysis, mechanisms of defense, and transference have become central aspects of many contemporary psychotherapeutic procedures. Freud’s ideas about personality development and psychopathology, the method of psychoanalytic investigation, and the analytic approach to treatment gradually changed in the course of his dramatically creative life span. Moreover, his theory of the structure of the mind, which he assumed underlay the events he observed clinically, changed in major respects, so that an overall summary of his views can hardly be undertaken without tracing the history of his thinking. FREUD’S THEORY OF THE MENTAL APPARATUS: MOTIVATION, STRUCTURE, AND FUNCTIONING Unconscious Mental Processes: The Topographic Theory; Defense Mechanisms
Freud’s starting point was his study of hysterical patients (1905a), which led him to the discovery that their conversion symptoms, dissociative phenomena, and pathological affective dispositions all could be traced to traumatic experiences in their past that had become unconscious. That is, these traumatic experiences continued to influence the patients’ functioning despite an active defensive mechanism of “repression” which excluded them from conscious awareness. In the course of a few years Freud abandoned his early efforts to recover repressed material by means of hypnosis, instead adopting the technique of “free association,” which remains an essential aspect of psychoanalytic technique today. Freud instructed his patients to eliminate all prepared agendas and try to express whatever came to mind, with as little censorship over this material as possible. He provided them with a nonjudgmental and stable setting in which to carry out their task, inviting them to recline on a couch while he sat behind it. The sessions lasted for an hour and were conducted five to six times a week. The method of free association led to the gradual recovery of repressed memories of traumatic events. Originally, Freud thought that the recovery of such events into consciousness would permit their abreaction and elaboration and thus resolve the patients’ symptoms. Practicing this method led Freud to several lines of discovery. To begin, he conceptualized several unconscious mechanisms of defense that opposed the recovery of memories by free association—namely, repression, negation, isolation, projection, introjection, transformation into the opposite, rationalization, intellectualization, and, most important, reaction for-
FREUD’S THEORIES VARIATIONS
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mation. Reaction formation involves overt, chronic patterns of thought and behavior that serve to disguise and disavow opposite tendencies linked to unconscious traumatic events and the intrapsychic conflicts derived from them. The discovery of reaction formations led Freud to the psychoanalytic study of character pathology and normal character formation, which still constitute important aspects of the psychoanalytic understanding and treatment of personality disorders. (For practical purposes, character pathology and personality disorders are synonymous concepts.) A related line of development in Freud’s theories was the discovery of the differential characteristics of conscious and unconscious thinking. Conscious thinking, the “secondary process,” was invested by “attention cathexis” and dominated by sensory perception and ordinary logic in relating to the psychosocial environment: the “primary process” of the “dynamic unconscious” exerted constant pressure on conscious processes, against the active barrier constituted by the various defensive operations, particularly repression. The dynamic unconscious, Freud proposed, presented a general mobility of affective investments and was ruled by the “pleasure principle,” in contrast to the “reality principle” of consciousness. It was characterized by the absence of the principle of contradiction and that of ordinary logical thinking, the absence of negation and of the ordinary sense of time and space, the treatment of a part as if it were equivalent to the whole, and a general tendency toward condensation of thoughts and the displacement of affective investments from one mental content to another. Finally, Freud proposed a “preconscious,” an intermediate zone between the dynamic unconscious and consciousness, representing the storehouse of retrievable memories and knowledge and of affective investments in general. The preconscious was the seat of daydreaming, in which the reality principle that ruled consciousness was loosened and derivatives of the dynamic unconscious might emerge. Free association, in fact, primarily tapped the preconscious as well as the layer of unconscious defensive operations opposing the emergence of material from the dynamic unconscious. This model of the mind as a “place” with unconscious, preconscious, and conscious regions constituted the “topographic theory” (Freud, 1916– 17). Freud (1923) eventually replaced it with the “structural theory,” the concept of three interacting psychic structures, the ego, the superego, and the id. This tripartite model still dominates psychoanalytic thinking. A major determinant of the shift from the topographic to the structural model was Freud’s recognition that the regions of conscious, preconscious, and unconscious were fluid and that the defense mechanisms directed against
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the emergence into consciousness of the dynamic unconscious were themselves unconscious. Another consideration was Freud’s discovery (1923) of a specialized unconscious system of infantile morality, the superego. What follows is a summary of the characteristics and contents of these structures, an analysis that will lead us directly into contemporary psychoanalytic formulations. The Structural Theory, the Dual-Drive Theory, and the Oedipus Complex The Id: Infantile Sexuality and the Oedipus Complex
The id is the mental structure that contains the mental representatives of the “drives”—that is, the ultimate intrapsychic motivations that Freud (1920a) described in his final “dual-drive theory” of libido and aggression, or metaphorically, the sexual or life drive and the destruction or death drive. Behind this categorical formulation lies a complex set of discoveries. In exploring patients’ unconscious mental processes, Freud found that what at first appeared to be specific traumatic life experiences in fact reflected surprisingly consistent, repetitive intrapsychic experiences of a sexual and aggressive nature. Freud (1905b) was particularly impressed by the regularity with which his patients reported the emergence of childhood memories reflecting seductive and traumatic sexual experiences, on the one hand, and intense sexual desires and related guilt feelings, on the other. He discovered a continuity from the earliest wishes to be taken care of (the psychology, as he saw it, of the baby at the mother’s breast) during what he described as the “oral phase” of development, to the pleasure derived from exercising control and developing autonomy (the psychology of toilet training) in the “anal phase” of development, and, particularly, to the sexual desire toward the parent of the opposite gender and the ambivalent rivalry with the other parent for the desired parent’s exclusive love, a state that he described as characteristic of the “infantile genital stage,” from the third or fourth to the sixth year of life. He called its characteristic constellation of wishes and conflicts the positive Oedipus complex as differentiated from the negative Oedipus complex— that is, love for the parent of the same gender and the corresponding ambivalent rivalry with the other parent. Freud proposed that oedipal wishes came to dominate the infantile hierarchy of oral and anal wishes, becoming the fundamental unconscious realm of desire. Powerful fears motivated the repression of awareness of infantile desire: fear of loss of the object, and later of loss of the object’s love, was the ba-
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sic fear of the oral phase, directed against libidinal wishes to possess the breast; fear of destructive control and annihilation of the self or the object was the dominant fear of the anal phase, directed against libidinal wishes of anal expulsion and retentiveness; and fear of castration, “castration anxiety,” was the dominant fear of the oedipal phase of development, directed against libidinal desire for the oedipal object. Unconscious guilt was a dominant later fear, originating in the superego and generally directed against drive gratification. Unconscious guilt over sexual impulses unconsciously equated with oedipal desires constituted a major source of many types of pathology, such as sexual inhibition and related character pathology. Prototypical intrapsychic infantile experiences linked to the Oedipus complex were fantasies and perceptions around the sexual intimacy of the parents (the “primal scene”), and unconscious fantasies derived from experiences with primary caregivers (“primal seduction”). The oedipal stage, developing gradually during the second through the fourth years and culminating in the fourth and the fifth years of life, is followed by more general repressive processes under the dominance of the installation of the superego, leading to a “latency phase” roughly corresponding to the school years and finally to a transitory reactivation of all unconscious childhood conflicts under the dominance of oedipal issues during puberty and early adolescence. In all these phases of infantile development of drive motivated wishes and fears, powerful aggressive strivings accompanied the libidinal ones, such as cannibalistic impulses during the oral phase of physical dependency on the breast and psychological dependency on mother, sadistic fantasies linked to the anal phase, and parricidal wishes and fantasies in the oedipal stage of development. The Id: Drives
The drives represent for human behavior what the instincts constitute for the animal kingdom—that is, the ultimate biological motivational system. The drives are constant, highly individualized, developmentally shaped motivational systems. Under the dominance of the drives and guided by the primary process, the id exerts an ongoing pressure toward gratification, operating in accordance with the pleasure principle. Freud initially equated the drives with primitive affects. He described the libido or the sexual drive as having an “origin” in the erotogenic nature of the leading oral, anal, and genital bodily zones; an “impulse” expressing the quantitative intensity of the drive by the intensity of the corresponding
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affects; an “aim” reflected in the particular act of concrete gratification of the drive; and an “object” consisting of displacements from the dominant parental objects of desire. After discarding various other models of unconscious motivation, Freud ended up with the dual-drive theory of libido and aggression. The idea of an aggressive or “death” drive (Freud, 1920a) stemmed from his observations of the profound self-destructive urges particularly manifest in the psychopathology of major depression and suicide and of the “repetition compulsion” of impulse-driven behavior that frequently seemed to run counter to the pleasure principle that supposedly governed unconscious drives. Freud never spelled out the origins of the aggressive drive in detail, an issue taken up later by Klein (1952), Fairbairn (1954), Winnicott (1965), Jacobson (1964), and Mahler et al. (1975). Freud (1915) described drives as intermediate between the body and the mind; the only thing we know about them, he suggested, are “representations and affects.” The Structure and Functions of the Ego
The ego, Freud (1923) proposed, is the seat of consciousness as well as of unconscious defense mechanisms that, in the psychoanalytic treatment, appear as “resistances” to free association. The ego functions according to the logical and reality based principles of “secondary process,” negotiating the relations between internal and external reality. Guided by the reality principle, it exerts control over perception and motility, draws on preconscious material, controls “attention cathexes,” and permits motor delay as well as the selection of imagery and perception. The ego is also the seat of basic affects, particularly anxiety as an alarm signal against the danger of the emergence of unconscious, repressed impulses. This alarm signal may turn into a disorganized state of panic when the ego is flooded with external perceptions that activate unconscious desire and conflicts or with traumatic experiences in reality that resonate with such conflicts and overwhelm the particularly sensitized ego in the process. The fact that Freud saw the ego as the seat of affects and that he had previously described affects as discharge phenomena reflecting drives (together with their mental representations) tended to dissociate affects from drives in psychoanalytic theory, although they were equated in Freud’s early formulations. As we shall see, the centrality of affects in psychic reality and interactions has gradually reemerged as a major issue in contemporary psychoanalytic thinking. Freud originally equated the “I”—that is, the categorical self of the philosophers—with consciousness. Once he established the theory of the
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ego as an organization of both conscious and unconscious functions, he sometimes treated the ego as if it was the subjective self and at other times as an impersonal organization of functions. Out of this ambiguity evolved the contemporary concept of the self in modern ego psychology as well as in British and American object relations and cultural psychoanalytic contributions (Kernberg, 1984). An alternative theory of the self was proposed by Kohut (1971), the originator of the self psychology approach within contemporary psychoanalysis. Nowadays, an integrated concept of the self as the seat of subjectivity is considered an essential aspect of the ego, and the concept of “ego identity” refers to the integration of the concept of the self. Because of our better understanding of developmental processes in early infancy and childhood, today an integrated self-concept usually goes hand in hand with the capacity for an integrated concept of significant others. An unconscious tendency toward primitive dissociation or “splitting” of the self-concept and the concepts of significant objects runs counter to such integration. In one of his last contributions, Freud (1938b) described a process of splitting in the ego as a way of dealing with intolerable intrapsychic conflict, thus opening a path for considering splitting as an alternative, pathological defense against intolerable intrapsychic conflict (alternative, that is, to the repression of that conflict and important related ego functions). Character, from a psychoanalytic perspective, may be defined as constituting the behavioral aspects of ego identity (the self-concept) and internal relations with significant others (the internalized world of “object relations”). The sense of personal identity and of an internal world of object relations, in turn, reflects the subjective side of character. The ego psychological approach—one of the dominant contemporary psychoanalytic schools—contributed importantly to the psychoanalytic treatment of personality disorders by developing the analysis of defensive operations of the ego and the concept of pathological character formation as a stable defensive organization that needed to be explored and resolved in treatment. Personality disorders reflect typical constellations of pathological character traits derived from abnormal developmental processes under the influence of unconscious intrapsychic conflicts. The description of “reaction formation” as one of the defenses of the ego led Freud to formulate the “oral,” “anal,” and “genital” characters and particularly the obsessive-compulsive personality as a typical manifestation of reaction formations against anal drive derivatives. Abraham’s description (1920) of the hysterical personality as a consequence of multiple reaction formations against the fe-
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male castration complex followed. Over the years, psychoanalytic explorations led to the description of a wide spectrum of pathological character constellations that today are a part of the spectrum of personality disorders. Perhaps the most important psychoanalytic contribution to character pathology and the personality disorders is the clinical description of the narcissistic personality disorder. While Freud provided the basic elements that led to the eventual description, psychoanalytic understanding, and treatment of this disorder, the concepts of normal and pathological narcissism were crystallized by later theorists. Freud (1914a) conceptualized narcissism as the libidinal investment in the ego or the self in contrast to the investment in significant others (“objects”). In proposing the withdrawal of libidinal investment from others and excessive investment in the self as the basic features of narcissistic pathology, he stimulated the contributions of Abraham (1919) and later Klein (1957), Rosenfeld (1964), Grunberger (1979), Kohut (1971), Jacobson (1964), and Kernberg (1975). Kernberg, integrating the contributions of Klein, Rosenfeld, and Jacobson, developed the description of narcissistic personality disorder as derived from a pathological integration of a grandiose self as a defense against unbearable aggressive conflicts, particularly around primitive envy. The Superego in Normality and Pathology
In his analysis of unconscious intrapsychic conflicts between drive and defense, Freud regularly encountered unconscious feelings of guilt in his patients, reflecting the extremely strict, unconscious infantile morality that he called the superego. This unconscious morality could lead to severe selfblame and particularly to abnormal depressive reactions, which Freud came to regard as expressing the superego’s attacks on the ego. It was particularly in studying normal and pathological mourning that Freud (1917) arrived at the idea of excessive mourning and depression as reflecting the unconscious internalization of the representation of an ambivalently loved and hated lost object. In unconsciously identifying the self with that object introjected into the ego, the individual now attacked his own self in replacement of his previous unconscious hatred of the object. The internalization of aspects of that object into the superego reinforced the strictness of the individual’s preexisting unconscious infantile morality. Freud traced the origins of the superego to the overcoming of the Oedipus complex via unconscious identification with the parent of the same gender, the “oedipal parent.” In internalizing this parent’s prohibition against the child’s rivalry with him or her and the unconscious death wishes
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regularly connected with such a rivalry, and against the incestuous desire for the parent of the other gender, an unconscious infantile morality was born. The superego, thus based on prohibitions against incest and parricide and the demand for submission to and identification with the oedipal rival, became the guarantor of the capacity for identification with moral and ethical values in general. In simple terms, the little boy renounces mother out of fear of and love for father, takes father’s fantasized prohibition against his son’s sexuality into the superego as a fundamental prohibition, and establishes an identification with father in the consolidation of his character structure. The little boy thus enacts the unconscious fantasy that, in identifying with father, he will gradually grow into his role and will satisfy his sexual desire in the distant future by choosing another woman, who, unconsciously and symbolically, will represent mother. The superego thus introduces a new time perspective into the functioning of the psychic apparatus. Freud also described the internalization of the idealized representations of both parents into the superego in the form of the “ego ideal.” He suggested that the earliest sources of self-esteem, derived from mother’s love, gradually fixated by the baby’s and small child’s internalizations of the representations of the loving mother into the ego ideal, led to internalization of the parental demands as well. In other words, self-esteem is normally maintained both by living up to the expectations of the internalized idealized parental objects and by submitting to their internalized prohibitions. This consideration of self-esteem regulation leads to the clinical concept of narcissism as normal or pathological self-esteem regulation, in contrast to the theoretical concept of narcissism as the libidinal investment of the self. The superego, in summary, is a mental structure constituted by the internalized demands and prohibitions from the parental objects of childhood, the “heir to the oedipal complex” (Freud, 1923). This unconscious structure is of fundamental importance in determining unconscious “fixations” to infantile prohibitions against drive derivatives and the corresponding unconscious motivation for the activation of a broad spectrum of ego defenses against them, thus preventing the ego from reexamining and reintegrating unresolved pathogenic conflicts from early childhood. In health, this internal sense of unconscious morality is the underpinning of moral and ethical systems. Excessive superego severity, usually derived from excessive parental strictness, determines excessive repressive mechanisms and ego inhibitions, irrational moralistic behavior, or pathological activation of depression and loss of self-esteem.
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PSYCHOANALYTIC TREATMENT The Psychoanalytic Theory of Psychopathology
The psychoanalytic theory of psychopathology proposes that the clinical manifestations of the symptomatic neuroses, character pathology, perversions, sexual inhibitions, and selected types of psychosomatic and psychotic illness reflect unconscious intrapsychic conflicts between drive derivatives following the pleasure principle, defensive operations reflecting the reality principle, and the unconscious motivations of the superego. Unconscious conflicts between impulse and defense are expressed as structured conflicts between the agencies of the tripartite structure: there are ego defenses against impulses of the id; the superego motivates inhibitions and restrictions in the ego; and at times the repetitive, dissociated expression of id impulses (“repetition compulsion”) constitutes an effective id defense against superego pressures. The resolution of unconscious conflicts implies the analysis of all these intersystemic conflicts. All these conflicts are expressed clinically by three types of phenomena: (1) inhibitions of normal ego functions regarding sexuality, intimacy, social relations, and affect activation; (2) compromise formations between repressed impulses and the defenses directed against them; and (3) dissociative expression of impulse and defense. The last of these categories implies a dominance of the splitting mechanisms referred to earlier; these have acquired central importance in the contemporary psychoanalytic understanding of severe character pathology. The Structural Formulation of the Psychoanalytic Method
Psychoanalytic treatment consists, in essence, in facilitating the reactivation of pathogenic unconscious conflicts in the treatment situation by means of a systematic analysis of the defensive operations directed against them. This leads to the gradual emergence of repressed impulses, with the possibility of elaborating them in relation to the analyst and eventually integrating them into the adult ego. Freud (1905b) described “sublimation” as an adaptive transformation of unconscious drives: drive derivatives, converted into a consciously tolerable form, are permitted gratification in a symbolic way while their origin remains unconscious. The result of this process is an adaptive, nondefensive compromise formation between impulse and defense. In analysis, the gradual integration into the patient’s conscious ego of unconscious wishes and desires from the past and the understanding of the
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fantasized threats and dangers connected with them facilitate their gradual elaboration and sublimatory expression in the consulting room and in everyday life as well. The Psychoanalytic Treatment Process
Psychoanalytic treatment consists of the creation of an atmosphere of safety in which the patient is willing to try to express whatever comes to mind. In forty-five- to fifty-minute sessions three to five times per week, the patient usually reclines on a couch while the analyst, generally sitting behind the patient, helps him become aware of his defensive operations (“resistances”) by means of interpretations. The systematic interpretation of resistances gradually permits an ever-growing freedom of free association and awareness of unconscious desires and fears, fantasies and terrors, traumatic situations and unresolved mourning. Defensive operations are usually classified as ego defenses (in the form of the mechanisms listed earlier), superego defenses in the form of excessive guilt feelings activated during the treatment, id resistances in the form of repetition compulsion, the development of secondary gain from symptoms as a powerful resistance, and, most importantly, the transference as the dominant resistance and source of information. The transference is the unconscious repetition in the “here and now” of unconscious, conflicting pathogenic relationships from the past. The past conflict is reactivated not in the form of a memory but in the form of a repetition. This provides essential information about the past and at the same time constitutes a defense in the sense that the patient repeats instead of remembering. Therefore, the transference has important informative features that need to be facilitated and defensive features that need to be clarified and therapeutically resolved. Transference analysis is the fundamental ingredient of the psychoanalytic treatment. Merton Gill (1954), in a classical formulation that is still relevant, defined psychoanalysis as a treatment that facilitates the development of a “regressive transference neurosis” in the patient and its resolution by means of interpretation alone, carried out by the analyst from a position of technical neutrality. Let us define these concepts. “Regression” refers to the patient’s return to earlier experiences (temporal regression) and modes of functioning (structural and formal regression) under the effect of the analysis of resistances. It is an expression of the reactivation of unconscious conflicts from the past in the transference. In
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essence, the patient enacts earlier object relations in the transference. Certain past stages of development in which particular traumatic experiences occurred act as gathering points (“fixations”) that foster regression toward them. “Regressive transference neurosis” refers to the gradual gathering into the relationship with the analyst of the patient’s most important past pathogenic experiences and unconscious conflicts. The concept of a regressive transference neurosis has been largely abandoned in practice because, particularly in patients with severe character pathology, transference regression occurs so early and consistently that the gradual development of a regressive transference neurosis is no longer a useful concept. Gill’s proposal that resolution of the transference be achieved “by interpretation alone” refers to “interpretation” as a set of interventions by the analyst, starting with “clarification” of the patient’s subjective experiences communicated by means of free association, expanding into the tactful “confrontation” of patterns of behavior that are expressed in a dissociated manner split off from the patient’s subjective awareness, and finally evolving into “interpretation per se,” the formulation of hypotheses regarding the unconscious meanings of the patient’s material in the “here and now” and their relation to the “there and then” of the patient’s unconscious, past pathogenic experiences. The analysis of the transference is “systematic” in the sense that all emerging transference dispositions are interpreted, ideally, in the natural sequence of their emergence in the analytic situation. Gill’s phrase implies that the psychoanalyst’s sole aim is to help the patient fully understand the unconscious conflicts activated in the here and now; he abstains from measures other than helping to understand, such as providing guidance about life decisions or attempting to modify the patient’s behavior or state by means of praise, prohibition, or reward. “Technical neutrality” refers to the analyst’s concerned objectivity regarding both impulse and defense, which provides a helpful collaboration with the patient’s efforts to come to grips with his intrapsychic conflicts. This definition of psychoanalytic treatment needs to be complemented by the contemporary concepts of “transference,” “countertransference,” “acting out,” and “working through.” An Object Relations Theory Model of Transference and Countertransference
Whereas the psychoanalytic method, based on the structural theory, focuses on the resolution of unconscious conflicts between impulse and defense, contemporary object relations theory (presented in more detail in
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chapter 2) proposes that any particular conflict around sexual or aggressive impulses is embedded in an internalized object relation—that is, in a repressed or dissociated representation of the self (“self-representation”) linked with a particular representation of another who is a significant object of desire or hatred (“object representation”). The consolidation of such units of self-representation, object representation and the dominant sexual, dependent or aggressive affect linking them (the basic “dyadic units”) gives rise to the tripartite structure. Internalized dyadic relations dominated by sexual and aggressive impulses constitute the id; internalized dyadic relations of an idealized or prohibitive nature the superego, and those related to developing psychosocial functioning and the preconscious and conscious experience, together with their unconscious, defensive organization against unconscious impulses, the ego. These internalized object relations are activated in the transference with an alternating role distribution; that is, the patient at times enacts a self-representation while projecting the corresponding object representation onto the analyst, and at other times while projecting his self-representation onto the analyst and identifying with the corresponding object representation. The impulse or drive derivative is reflected by a dominant, usually primitive affect disposition linking a particular dyadic object relation; the associated defensive operation is also represented unconsciously by a corresponding dyadic relation between a self-representation and an object representation under the dominance of a certain affect state. For example, a conflict between unconscious aggression and unconscious guilt feelings, respectively located in id and superego, is clinically represented by manifestations of a guilt-provoking object representation relating to a guilty self (the superego defense) and an enraged selfrepresentation attempting to attack a threatening or frustrating object representation (the id impulse). The development of the transference, therefore, consists of the sequential activation of such impulsively and defensively determined internalized object relations and their systematic clarification, confrontation, and interpretation by the analyst. Countertransference, originally conceived by Freud as the unresolved, reactivated transference dispositions of the analyst, is currently defined as the total affective disposition of the analyst in response to the patient and his transference, shifting from moment to moment and providing important data to the analyst. The countertransference thus defined may be derived in part from unresolved problems of the analyst, but it stems as well from the impact of the dominant transference reactions of the patient, from reality aspects of the patient’s life, and sometimes from aspects of the ana-
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lyst’s life situation that are emotionally activated in the context of the transference developments. In general, the stronger the transference regression, the more the transference determines the countertransference; thus the countertransference becomes an important diagnostic tool. The countertransference includes both the analyst’s empathic identification with a patient’s central subjective experience (“concordant identification”) and the analyst’s identification with the reciprocal object or self-representation (“complementary identification”) unconsciously activated in the patient as part of a certain dyadic unit and projected onto the analyst (Racker, 1957). In other words, in the latter case countertransference implies the analyst’s identification with what the patient cannot tolerate in himself and must dissociate, project, or repress. Primitive defensive operations, as described by Melanie Klein (1952) and her school, are characteristic of patients with severe personality disorders and emerge in other cases during periods of regression. They include projective identification, denial, omnipotence, omnipotent control, primitive idealization, and devaluation (contempt), but all primitive defenses center around splitting—that is, the active dissociation of contradictory ego (or self) experiences as a defense against unconscious intrapsychic conflict. They represent a regression to the first two to three years of life, before repression and its related mechanisms are established. Primitive defensive operations present important behavioral components that tend to induce behaviors or emotional reactions in the analyst which, if he manages to “contain” them, permit him to diagnose in himself projected aspects of the patient’s experience. Projective identification in particular is a process in which (1) the patient unconsciously projects an intolerable aspect of self-experience onto (or “into”) the analyst, (2) the analyst unconsciously enacts the corresponding experience (“complementary identification”), (3) the patient tries to control the analyst, who now is under the effect of this projected behavior, and (4) the patient meanwhile maintains empathy with what is projected. This scenario is in contrast to the more mature mechanism of “projection,” secondary to repression, in which there is no longer any conscious emotional contact with what is projected. Such complementary identification in the countertransference permits the analyst to identify through his own experience with the aspects of the patient’s experience communicated by means of projective identification. This information complements what the analyst has discovered about the patient by means of clarification and confrontation and permits the an-
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alyst to integrate all this information in the form of a “selected fact” that constitutes the object of interpretation. Interpretation is thus a complex technique that is very much concerned with the systematic analysis of both transference and countertransference. Contemporary Trends in Psychoanalytic Methodology
Contemporary psychoanalytic technique can be seen as having evolved from a “one-person psychology” to a “two-person psychology” and then to a “three-person psychology.” In a one-person psychology, Freud’s original concept, the patient’s unconscious intrapsychic conflicts are treated by analyzing the intrapsychic defensive operations that oppose free association. The two-person psychology refers to the central focus on the analysis of transference and countertransference. In the views of the contemporary intersubjective, interpersonal, and self psychology psychoanalytic schools, the relationship between transference and countertransference is mutual in the sense that the transference is at least in part a reaction to reality aspects of the analyst, who therefore must be acutely mindful of his contribution to the activation of the transference. The so-called constructivist position assumes that it is impossible for the analyst to achieve a totally objective position outside the transference-countertransference bind. In contrast, the contemporary objectivist position, represented by the “three-person psychology” approaches of the Kleinian school, the French psychoanalytic mainstream, and significant segments of contemporary ego psychology, proposes that the analyst, influenced by transference and countertransference developments, must also, by means of self-reflection, maintain himself or herself outside this process, as an “excluded third party” who symbolically provides an early triangulation to the dyadic regression that dominates transference developments. This triangulation becomes particularly important in the treatment of severe personality disorders. The “enactment” of pathogenic object relations from the past internalized in the form of both transference and countertransference developments needs to be differentiated from “acting out,” the replacement of selfawareness by often dramatic and at times violent action. Acting out is characteristic of patients with severe character pathology and may occur in both patient and analyst under the influence of regression, both during and outside the sessions. While it reflects an intense defensive operation and resistance, it also offers the opportunity for a very fundamental exploration of a primitive conflict if dealt with by consistent interpretations in as much
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depth as possible. Acting out may also be considered an extreme behavioral manifestation of enactment as the usual experience of transference-countertransference manifestations. “Repetition compulsion” as a resistance of the id is very likely a form of acting out as a defense against emotional containment of an extremely painful or traumatic set of experiences. “Working through” refers to the repeated elaboration of an unconscious conflict in the psychoanalytic situation. It is a major task for the analyst, who has to be alert to the subtle variation in meanings and implications of what may appear to be an endless repetition of the same conflict in the transference. The patient’s elaboration of the conflict presented with these repetitive characteristics also implies the function of “holding,” originally described by Winnicott (1965). It consists of the analyst’s capacity to withstand the onslaught of primitive transferences without retaliating, abandoning the patient, or in a self-devaluating way giving up, and to maintain a working relationship (or “therapeutic alliance”) that addresses itself consistently to the healthy part of the patient, even when this is under the control of his most conflicting behaviors. Bion’s concept (1967b) of “containing”is complementary to “holding”in the sense that holding deals mostly with the analyst’s affective disposition and “containing” with his cognitive capacity to maintain a concerned objectivity and focus on the “selected fact,” permitting the integration in the analyst’s mind of what the patient can express only in violently dispersed or split-off behavior patterns. In Freud’s view (1900), dream analysis, developed in the context of the method of free association, constituted a “royal road to the unconscious.” Freud’s discovery of primary process thinking derived from his method of dream analysis. Today the psychoanalytic view is that there are many “royal roads” to the unconscious. The analysis of character defenses, for example, or of particular transference complications may be an avenue of entry into the patient’s unconscious mind, no less important than dream analysis. The technique of dream analysis consists, in essence, in asking the patient to free associate to elements of the manifest content of the dream in order to arrive at its “latent” content, the unconscious wish defended against and distorted by the unconscious defensive mechanisms that constitute the “dream work” and have transformed the latent content into the manifest dream. The latent content is revealed by means of simultaneous analysis of the way in which the dream is being communicated to the analyst, the “day residuals” that may have triggered the dream, the unconscious conflicts it reveals, and the dominant transference dispositions in the con-
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text of which the dream evolved. Dreams also provide some residual, universal symbolic meanings that may facilitate understanding of the latent content. The analysis of character may be the single most important element of the psychoanalytic method in bringing about fundamental characterological change. Character analysis is facilitated by the patient’s use of reaction formations—that is, his defensively motivated character traits—as transference resistances. Thus, the activation of defensive behaviors in the transference, reflecting the patient’s characterological patterns in all interpersonal interactions, facilitates both the analysis of the underlying unconscious conflicts and, in the process, the resolution of pathological character patterns. The result is an increase in the patient’s autonomy, flexibility, and capacity for adaptation. Character analysis was originally developed by Wilhelm Reich (1933) within an ego-psychology perspective but has reemerged in the work of Herbert Rosenfeld (1987) and John Steiner (1993) within the Kleinian school in the analysis of “pathological organizations” in the transference. Character analysis, although not always referred to as such, constitutes a major focus of contemporary psychoanalytic treatment. In essence, it addresses repetitive, egosyntonic behavior patterns in the transference, raising the patient’s curiosity about their function in the relationship with the analyst and inviting him to associate about this behavior. Gradually, the exploration of character resistances makes them egodystonic and facilitates the discovery of the underlying internalized object relations condensed in these pathological character traits, in both their defensive and impulsive meanings. The question of whether such rigid behaviors should be analyzed first, in order to free the patient’s capacity for analytic work, or later, after more fluid conflicts have been resolved, has been settled in favor of the general principle of focusing interpretations on what is affectively dominant in each hour (Fenichel, 1941). Affective dominance refers once more to the “selected fact” (Bion, 1967b) to be interpreted. Interpretations are usually carried out from surface to depth, which in practice means analyzing the object relation activated by the need for defense before the corresponding object relation activated by impulse. The overall objective of psychoanalytic treatment is not only to resolve symptoms and pathological behavior patterns or characteristics but to bring about fundamental structural change—that is, the expansion and enrichment of ego functions as a consequence of the resolution of unconscious conflict and the integration of previously repressed and dynamically
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active id and superego pressures into ego potentialities. Such change is reflected in the increasing capacity for both adaptation to and autonomy from psychosocial demands and expectations and an increased capacity for gratifying and successful functioning in love and work. DERIVED MODALITIES OF TREATMENT
One of the most important contributions of psychoanalysis to the treatment of patients with severe psychopathology who, for various reasons, cannot benefit from psychoanalytic treatment proper is the development of psychoanalytic psychotherapy (also called expressive or exploratory psychotherapy) and of supportive psychotherapy based on psychoanalytic principles. Psychoanalytic Psychotherapy
Psychoanalytic psychotherapy deploys the same basic techniques as psychoanalysis but with quantitative modifications that, in combination, result in a qualitative shift in the nature of the treatment. Any given session of psychoanalytic psychotherapy may be indistinguishable from a psychoanalytic session, but over time, the differences emerge quite clearly. Psychoanalytic psychotherapy utilizes interpretation, but with patients with severe psychopathology, a good deal of time must be devoted to clarification and confrontation before interpretation can be effective. Interpretations of unconscious meanings in the “here and now” occupy the foreground until late in the treatment, when genetic interpretations in the “there and then” become useful (Kernberg, 1984; Kernberg et al., 1989). In the treatment of patients with severe character pathology, transference analysis is the essential focus of psychoanalytic psychotherapy from the very beginning; it must be modified, however, by the active interpretive connection of transference analysis with exploration in depth of the patient’s daily life situation, an approach made necessary by the predominance of primitive defense operations in these patients. Splitting operations in particular tend to dissociate the therapeutic situation from the patient’s external life and may lead to severe, dissociated acting out either in or outside the sessions. Therefore, interpretive linkage between the patient’s external reality and transference developments in the hours becomes central. In order to enable the therapist to analyze transference developments in sufficient depth, psychoanalytic psychotherapy requires a minimum frequency of two sessions per week. It is usually carried out face to face. Technical neutrality is an essential feature of analysis in general, but in
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the treatment of patients with severe character pathology, the need to set limits may require the analyst to abandon neutrality again and again, in order to control life-threatening or treatment-threatening acting out. Whenever the analyst has to abandon technical neutrality to protect the patient or the treatment, it is essential to explore the episode immediately. The transference implications of the therapist’s structuring behavior must be laid out, followed by analysis of the transference implications of the patient’s behavior that necessitated the imposition of limits or the initiation of a new structure in the treatment; this must be followed in turn by the gradual resolution of the structure or limit setting by interpretive means, thus restoring technical neutrality. In short, technical neutrality in psychoanalytic psychotherapy is an ideal working state that is again and again preventively abandoned and interpretively reinstated (Kernberg, 1984, 1992; Clarkin et al., 1999). Supportive Psychotherapy
Supportive psychotherapy based on psychoanalytic theory may be defined in terms of the three major techniques: interpretation, transference analysis, and technical neutrality. It utilizes the preliminary steps of interpretive technique—that is, clarification and confrontation—but rarely uses interpretation per se. It seeks to strengthen the ego’s efforts to reach adaptive compromises between impulse and defense through providing cognitive support in the form of information, persuasion, and advice and emotional support in the form of suggestion, reassurance, encouragement, and praise. Supportive psychotherapy may involve direct environmental intervention by the therapist, the patient’s relatives, or other mental health personnel engaged in auxiliary therapeutic functions (Rockland, 1989). While the transference is seldom interpreted in supportive psychotherapy, it is not ignored either. Careful attention to transference developments helps the therapist to analyze any maladaptive transference developments, to call the patient’s attention to his reproduction in interactions with the therapist of pathological interactions the patient generally engages in with significant others, and to encourage the patient to reduce such pathological behaviors. Pointing out the distorted, unproductive, destructive, or confusing nature of the patient’s behavior is accompanied by clarifying the patient’s conscious reasons for the behavior, followed by the transfer of the knowledge thus achieved to the patient’s relationships outside the treatment. In short, supportive psychotherapy includes the clarification, reduction, and “export” of this understanding of the transference, thus contribut-
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ing to the re-educative functions of the therapy, together with the direct cognitive and affective support of adaptive combinations of impulse and defense and direct supportive environmental interventions. Technical neutrality is systematically abandoned in supportive psychotherapy, the therapist taking a stance on the side of the ego, the superego, the id, or external reality, according to which agency represents, at a certain point, the most adaptive potential for the patient. The main risks, of course, are that of infantilizing the patient by an excessively supportive stance and, on the other hand, of countertransference acting out as a consequence of abandoning the position of technical neutrality. The therapist carrying out supportive psychotherapy needs to be aware of these risks. Like psychoanalytic psychotherapy, supportive psychotherapy is carried out in face-to-face sessions. It has the advantage of considerable flexibility regarding frequency, from several sessions per week to one or two per month, according to the urgency of the patient’s current difficulties, the long-range objectives of the treatment, and the patient’s ability to tolerate and use the relationship with the therapist. INDICATIONS AND CONTRAINDICATIONS FOR PSYCHOANALYSIS AND DERIVED PSYCHOTHERAPIES
The indications for these three modalities of treatment remain controversial: with the recognition of the limitations of psychoanalysis in many cases with severe, chronic, life-threatening self-destructive behavior, such as chronic suicidal behavior, severe eating disorders, dependence upon drugs or alcohol, and severely antisocial behavior, psychoanalytic psychotherapy has proved to be a highly effective treatment for many but by no means all patients with these conditions. The differential diagnosis of cases of severe self-destructive and antisocial behavior who are amenable to treatment with psychoanalytic psychotherapy has been one of the important by-products of the psychoanalytic exploration of these cases (Kernberg, 1992). Supportive psychotherapy, originally the treatment of choice for patients with severe personality disorders, now may be considered the alternative treatment for patients with severe personality disorders who are unable to participate in psychoanalytic psychotherapy. The Menninger Foundation Psychotherapy Research Project showed that patients with the least severe psychopathological disturbances tend to respond very positively to all three modalities derived from psychoanalytic theory, although they respond best to standard psychoanalysis (Kernberg et al., 1972).
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Standard psychoanalysis is the treatment of choice for patients with neurotic personality organization—that is, those with good identity integration and a repertoire of defenses centering on repression—along with sufficiently severe illness to warrant such a major therapeutic intervention. Psychoanalysis has also expanded its scope to some of the severe personality disorders, particularly treating patients with narcissistic personality disorders, patients with mixed hysterical-histrionic features, and selected cases with severe paranoid, schizoid, and sado-masochistic features. We are still lacking systematic studies of the relationship between particular types of psychopathology and outcome with the various treatments derived from psychoanalytic theory. As a tentative generalization, we can say that there is a definite relationship between outcome and the severity of illness in any diagnostic category. The least severe cases will respond favorably to either brief psychoanalytic psychotherapy, supportive psychotherapy, or psychoanalysis. Psychoanalysis presents the opportunity for the greatest improvement if the severity of the case warrants psychoanalytic treatment. For moderately severe cases of neurotic personality organization, psychoanalysis is the treatment of choice; definitely less can be expected in these cases from psychoanalytic psychotherapy. A few of the most severely ill patients (those with severe identity diffusion, predominance of primitive defenses centering on splitting, and general “ego weakness”) may be able to participate in psychoanalysis and benefit from it, but for most of them psychoanalytic psychotherapy is the best approach, with supportive psychotherapy a second choice if psychoanalytic psychotherapy is contraindicated. Individualized contraindications for the respective treatment are no less important than the indications. In the case of psychoanalysis, the factors to be considered include ego strength, motivation, introspection or insight, secondary gain of illness, intelligence, and age. In the case of psychoanalytic psychotherapy, secondary gain, the impossibility of controlling life- or treatment-threatening acting out, limited intelligence, significant antisocial features, and a desperate life situation may constitute individual contraindications, particularly when they occur in combination. When psychoanalytic psychotherapy is contraindicated for such reasons, supportive psychotherapy becomes the treatment of choice. Participation in supportive psychotherapy requires at least a sufficient capacity for commitment to an ongoing treatment arrangement and the absence of severe antisocial features.
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TREATMENT RESULTS: RESEARCH ON OUTCOME
The psychoanalytic profession has been slow to develop systematic research on treatment process and results, let alone controlled randomized comparison of treatment methods evaluating efficacy and efficiency. The reasons are multiple: the complexity of psychoanalytic treatment; changes in the technique over time; the long duration of treatment, making systematic research and controlled comparison with other treatment methods difficult; the private nature of psychoanalytic exploration in the context of patients’ regression; and related concerns over disturbing the therapeutic relationship by recording or direct observation. In addition, the general methodology of psychotherapy research has only recently evolved to a degree of sophistication applicable to the evaluation of psychoanalytic treatment. Despite these reservations, significant progress has been made, and outcome studies are beginning to be available. The Menninger Psychotherapy Research Project, a naturalistic study comparing psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy, showed psychoanalysis to be the most effective approach with patients presenting relatively good ego strength; patients with severe ego weakness—what nowadays would be described as presenting severe personality disorders or borderline personality organization—improved most with psychoanalytic psychotherapy (Kernberg et al., 1972). That research also showed how important supportive elements were throughout all modalities of treatment (Wallerstein, 1986). A comprehensive review of outcome studies on psychoanalytic psychotherapy and psychoanalysis (Bachrach et al., 1985) concluded that the improvement rates are in the 60 to 90 percent range, but it also pointed to limitations and problems in the methodology utilized. Recently, studies of the treatment process and outcome of psychoanalysis and psychoanalytic psychotherapy have become more precise in defining the specific treatment variables of these approaches, and several systematic studies are currently in progress (Fonagy, 1998). A recent study by the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP) has found, on the basis of a relatively large patient population, that psychoanalytic treatment obtained a significantly higher degree of long-range symptomatic improvement than psychoanalytic psychotherapy (Sandell et al., 1997). Therapists with long experience in teaching or supervising psychotherapy had a significantly better outcome than therapists who only had been in supervision or personal therapy for long periods. It also appeared that a rigid “psychoanalytic” attitude was less effective in psy-
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chotherapy than a willingness to shift techniques, but this was not the case in analysis proper (Sandell et al., 1997). Research on a manualized psychoanalytic psychotherapy designed specifically for a borderline patient population is currently under way by the Cornell Personality Disorders Institute (Clarkin et al., 1999). So far it has provided evidence on the efficacy of the treatment with severely ill patients, although comparative studies with other treatment modalities remain to be done. In summary, process research has predated outcome research on psychoanalysis and derived psychotherapies; major efforts at outcome research are under way and should help to clarify the effects not only of psychoanalysis proper, but also of the derived psychotherapeutic approaches now being carried out in clinical practice.
2
psychoanalytic object relations theories
DEFINITIONS AND CONTROVERSIES: AN OVERVIEW
Psychoanalytic object relations theories constitute so broad a spectrum of approaches that it might be said that psychoanalysis itself, by its very nature, is an object relations theory: all psychoanalytic theorizing deals, after all, with the impact of early object relations on the genesis of unconscious conflict, the development of psychic structure, and the re-actualization or enactments of past pathogenic internalized object relations in transference developments in the current psychoanalytic situation. The narrowest definition would restrict object relations theory to the so-called British School, particularly as exemplified in the work of Melanie Klein (1935, 1940, 1946, 1957), Ronald Fairbairn (1954), and Donald Winnicott (1958, 1965, 1971). A third definition of what constitutes object relations theory—my own— would include the British School and the contributions from ego psychology by Erik Erikson (1950, 1956, 1959), Edith Jacobson (1964, 1971), Margaret Mahler (Mahler and Furer, 1968; Mahler et al., 1975), Hans Loewald (1960, 1980), Otto Kernberg (1976, 1980, 1984), and Joseph Sandler (1987), as well as the interpersonal approach of Harry Stack Sullivan (1953, 1962) and Greenberg and Mitchell (1983; Mitchell, 1988). Psychoanalytic object relations theories could then be defined as those that place the internalization, structuralization, and clinical reactivation (in the transference and countertransference) of the earliest dyadic object relations at the center of An early version of this chapter was published in Psychoanalysis: The Major Concepts, edited by Burness E. Moore and Bernard Fine (New Haven, Conn.: Yale University Press, 1995), pp. 450 – 462. Copyright 1995 by Yale University Press. 26
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their motivational (genetic and developmental), structural, and clinical formulations. Internalization of object relations refers to the concept that, in all interactions of the infant and child with the significant parental figures, what the infant internalizes is not an image or representation of the other (“the object”) but the relationship between the self and the other, in the form of a self-image or self representation interacting with an object image or object representation. This internal structure replicates in the intrapsychic world both real and fantasized relationships with significant others. This third definition constitutes the frame for what follows. The various object relations theorists differ on several major issues. The most important is the extent to which the theory is perceived as harmonious with or in opposition to Freud’s traditional drive theory (Freud, 1920a, 1923, 1933b), that is, whether object relations are seen as supplementing or supplanting drives as the motivational system for human behavior. From this perspective, Klein as well as Mahler and Jacobson occupy one pole, combining Freud’s dual-drive theory with an object relations approach. For Fairbairn and Sullivan, on the other hand, object relations replace Freud’s drives as the major motivational system. Contemporary interpersonal psychoanalysis as represented by Greenberg and Mitchell (1983; Mitchell, 1988), based on an integration of principally Fairbairnian (1954) and Sullivanian (1953, 1962) concepts, asserts the essential incompatibility of drive-based and object relations–based models of psychic motivational systems. Winnicott (1958, 1965, 1971), Loewald (1960, 1980), and Sandler (1987) maintain an intermediate posture (for different reasons); they perceive the affective frame of the infant-mother relationship as a crucial determinant in shaping the development of drives. While I adhere to Freud’s dual-drive theory, I consider drives to be supraordinate motivational systems, with affects their constituent components (see Kernberg, 1976, 1984). A related controversy has to do with the origin and role of aggression as a motivator of behavior. Those theoreticians who reject the idea of inborn drives (Sullivan) or who equate libido with the search for object relations (Fairbairn) conceptualize aggression as secondary to the frustration of libidinal needs, particularly traumatic experiences in the early mother-infant dyad. (It should be noted, however, that although Fairbairn in theory rejected the idea of an inborn aggressive drive, in clinical practice he paid considerable attention to the structuralization of aggressively invested internalized object relations and their interpretation in the transference.) Theoreticians who adhere to Freud’s dual-drive theory, in contrast, believe
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that aggression is inborn and plays an important part in shaping early interactions; this group includes Klein in particular and to some extent Winnicott and the ego psychology–object relations theoreticians. Another controversy concerns the extent to which actual experiences with significant others in infancy and early childhood are seen as transformed by the combination of unconscious fantasy and the building of psychic structure that reflects intrapsychic conflicts. For the British School— in spite of the heavy emphasis of Winnicott and Fairbairn on the reality aspects of the early interactions between infant and mother—the effects of unconscious fantasy on the development of psychic structures and the defensive reshaping of structuralized internalized object relationships result in a significant gap between actual early experience and unconsciously reactivated object relations in the transference; the Kleinians insist on the fantastic nature of the internalized world of object relations. For interpersonal psychoanalysts, particularly Sullivan (1953, 1962), Fromm-Reichmann (1950, 1959), and Guntrip (1961, 1968, 1971), early internalized object relations are maintained with relatively little structural change, so that these theorists tend to interpret transference developments as fairly close reflections of actual traumatic object relations of the past. Along with Jacobson, Mahler, and Sandler, I occupy an intermediate realm in this respect, with a particular emphasis on the characterological transformations and fixations of internalized object relations. The various theorists also differ in the extent to which they interpret transference enactments in terms of the activation of the patient’s intrapsychic conflicts or as shaped in part by countertransference and the analyst’s personality. The interpersonal or relational school views the patient-analyst dyad as a new, potentially growth-promoting experience which makes an important contribution to the resolution of the patient’s unconscious conflicts. Klein and her followers, as well as Jacobson, Mahler, and myself, are close to the classical position in emphasizing the intrapsychic-conflicts aspects of the transference and making limited utilization of countertransference elements. (I focus more sharply than the others, however, on countertransference, especially in my treatment of severe character pathology.) Interpersonal psychoanalysis, as represented by Guntrip (1961, 1968) (who was influenced by Fairbairn and Winnicott) and Greenberg and Mitchell (1983; Mitchell, 1988), places heavy emphasis on the mutual influence of transference and countertransference and the reality aspects of the therapeutic interactions derived from the analyst’s personality.
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Certain characteristics distinguish object relations theory in general from other approaches. My ego psychological object relations theory differs from traditional ego psychology in emphasizing the indissoluble integration of drives with object relations. For Jacobson, Mahler, and myself, affects are not simply discharge manifestations of drives but sustained tension states that represent the drive derivative embedded in the relationship between self and object representation. In contrast, traditional ego psychology assumes a much looser relationship between drive derivatives and their investments in objects. Ego psychology–object relations theory also focuses strongly on the early, preoedipal stages of development, while traditional ego psychology stresses oedipal conflicts. And while traditional ego psychology stresses the interplay of impulse and defense in terms of impersonal defense mechanisms directed against diffuse drive derivatives, ego psychology–object relations theory describes the impulse-defense equilibrium in terms of impulsively and defensively activated object relations in the transference (and countertransference) (Kernberg, 1987, 1988). Finally, ego psychology–object relations theory focuses on the structural characteristics of the early ego-id matrix before the consolidation of the tripartite structure, particularly in exploring severe psychopathologies; in contrast, traditional ego psychology tends to explore all psychopathology within the frame of the tripartite structure (Arlow and Brenner, 1964). Interpersonal object relations theory has significant similarities to Kohut’s self psychology (1971, 1972, 1977). In fact, Fairbairn, Winnicott, Kohut, and Sullivan all stress the reality aspects of good versus bad mothering and the influence of satisfactory early relationships of the infant and the mother in setting up the structure of the normal self. However, a basic difference between all object relations theories—including interpersonal psychoanalysis—and Kohut’s self psychology is that Kohut’s developmental model centers on the gradual consolidation of an archaic grandiose self in relationship to idealized “self-objects,” while all “bad” relationships are not conceptualized as internalized object relations; in Kohut’s view, aggression is a disintegration product and not part of structured internalized object relations. In contrast to self psychology, object relations theories, even those that deny aggression as a drive (Fairbairn and Sullivan), stress the importance of the internalization of “bad” object relations—that is, aggressively invested, dissociated representations of self and objects. These differing formulations have significant impact on technique, particularly on the conceptualization and management of negative transferences.
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Finally, object relations theory may be contrasted to French approaches, both Lacanian (Roudinesco, 1990) and mainstream psychoanalysis (Oliner, 1988). The latter has maintained close links with traditional psychoanalysis, including the British object relations theories. Insofar as Lacan (1966) conceptualized the unconscious as a natural language and focused on the cognitive aspects of unconscious development, he underemphasized affect—a dominant element of object relations theories. At the same time, however, in postulating a very early oedipal structuralization of all infant-mother interactions, Lacan emphasized archaic oedipal developments; this implicitly links his formulations with those of Klein. French mainstream psychoanalysis also focuses on archaic aspects of oedipal developments but places much more emphasis on Freud’s dual-drive theory and on the affective nature of the early ego-id (Chasseguet-Smirgel, 1986). But in that neither mainstream nor Lacanian psychoanalysis spells out specific structural consequences of dyadic internalized object relations, neither would fit the definition of object relations theory proposed in this chapter. Object relations theories have several additional characteristics in common. They all focus on the influence of the vicissitudes of early developmental stages in the formation of the psychic apparatus. They are all interested in normal and pathological development of the self and in identity formation; and all accept an internalized world of object relations as part of their conceptualization of the psychic apparatus. Insofar as they deal with the relationship of past and present intrapsychic and interpersonal object relations, they also provide links to family structure and group psychology. Their interest in the affective aspects of the relationship between self and object, between self representations and object representations, leads them to a particular concern with the origin and vicissitudes of early affect. This, in turn, provides a linkage between object relations theory, empirical research on affect development, and neurophysiology. All object relations theories focus heavily on the enactment of internalized object relations in the transference and on the analysis of countertransference in the development of interpretive strategies. They are particularly concerned with severe psychopathologies, including those psychotic patients who are still approachable with psychoanalytic techniques and those with borderline conditions, severe narcissistic character pathology, and the perversions. Object relations theories explore primitive defensive operations and object relations both in cases of severe psychopathology and at points of severe regression with all patients.
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REPRESENTATIVE OBJECT RELATIONS THEORIES Melanie Klein
Klein’s object relations theory (1935, 1940, 1946) fully incorporates Freud’s dual-drive theory, particularly emphasizing the importance of inborn aggression as a reflection of the death instinct. Both the death instinct and the life instinct operate from birth on and influence the development of earliest object relations; these will determine the structure of early ego and early superego formation. Both instincts find mental expression in the form of unconscious fantasy, the content of which represents the self and objects under the influence of primitive emotions reflecting the drives. Envy, greed, and to some extent also jealousy later on are specific emotions derived from oral aggression. The life instinct is expressed from birth on in pleasurable contacts with gratifying objects, primarily the “good breast.” Those objects are invested with libido and are introjected as internal objects infused with emotions representing libido. The projection of the good inner object onto new objects is the basis of trust, the wish to explore reality, and learning and knowledge. Gratitude is the predominant emotion linked with the expression of libido. The death instinct, expressed in primitive emotions, particularly envy, is projected outward in the form of fears of persecution and annihilation. All early experiences of tension and displeasure are expelled in an effort to preserve purified pleasure within the ego; these experiences are projected into what become persecutory objects. From the beginning of life, an ego is in operation, developing defenses against anxiety, processes of introjection and projection, and object relations and carrying out integration and synthesis. Anxiety constitutes the ego’s response to the expression of the death instinct; it is reinforced by the separation caused by birth and by the frustration of oral needs. Anxiety becomes fear of persecutory objects and later, through the introjection of aggression in the form of internalized bad objects, the fear of being persecuted from within and outside. Inner persecutors constitute the origin of primitive superego anxiety. The projection of inner tension states and of painful external stimuli constitutes the origin of paranoid fears, but the projection of pleasurable states, reflecting basically the life instinct, gives rise to basic trust. External stimuli invested with libido or aggression become primitive objects. Objects are at first split-off or part objects and only later become total
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or whole objects. The tendency to perceive objects as either ideal (all good) or persecutory (all bad) is the consequence of the defense of splitting. The predominance of part object relationships in earliest life is a consequence of the maximal operation of splitting mechanisms. Only later, when splitting mechanisms decrease, is a synthesis of good and bad aspects of objects possible; ambivalence toward whole objects can now be tolerated and acknowledged. Klein described two basic constellations of defenses and object relations that constitute, from the first year of life on, recurring polarities of human experience, reenacted at all stages of psychosexual development. She called these the paranoid-schizoid position and the depressive position. The paranoid-schizoid position is the earliest developmental stage; it culminates within the first half of the first year of life and is characterized by the predominance of splitting and other related mechanisms, by partobject relations, and by paranoid fears about the preservation or survival of the ego, stemming from oral-sadistic and anal-sadistic impulses. Excessive persecutory fears can result in pathological strengthening and fixation at this first position, which underlies the development of schizophrenia and paranoid psychosis. The principal defenses of the paranoid-schizoid position are splitting, idealization, denial of internal and external reality, stifling and artificiality of emotions, and projective identification. Projective identification, originally described by Klein, is of fundamental importance in this group of primitive defenses. The depressive position dominates during the second half of the first year of life. Splitting processes begin to diminish, as the infant becomes more aware that the good and bad external objects are really one and that mother as a whole object has both good and bad parts. The infant’s recognition of its own aggression toward the good object, which had been perceived as bad, reduces projection. In contrast to the persecutory fears of external attack characteristic of the paranoid-schizoid position, the predominant fear in the depressive position is of harming the good internal and external objects. This basic fear constitutes depressive anxiety or guilt, the primary emotion of the depressive position. The preservation of good objects now becomes more important than the preservation of the ego. Internal bad objects that are no longer projected constitute the primary superego, which attacks the ego with guilt feelings. Within the superego, bad internal objects may contaminate good internal objects that, because of
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their demanding or standard-setting nature, have also been internalized into the superego, bringing about cruel demands for perfection. Under normal conditions, the following mechanisms permit the working through of the depressive position: reparation (the origin, in Klein’s thinking, of sublimation); increased reality testing; ambivalence: the capacity to become aware of and to tolerate love and hate toward the same object, with love predominating over hate in emotional reactions to whole objects; and gratitude, which is reinforced by guilt. Normal mourning, for Klein, always implies guilt, reactivating the guilt of the depressive position and the introjection not only of the lost external object but also of the internal good object which was felt to be threatened, and the gratification at being alive, including the activation of manic triumph and secondary guilt over it. Pathological developments of the depressive position are represented by the manic defenses, which include reactivation of idealization as a way of preserving the good internal and external objects in the face of ambivalence toward them, a sense of triumph over the lost object, and contempt. Another major development of the depressive position is pathological mourning, characterized by the loss of the good external and internal objects caused by the fantasized destructive effects of the hatred directed toward them, failure of the efforts of compensation by means of idealization, and a circular reaction of guilt, self-reproach, and despair. Depressive psychosis constitutes the final outcome of pathological mourning, while hypomanic syndromes reflect the pathological predominance of the constellation of manic defenses. Such manic syndromes include, in addition to the manic defenses mentioned, identification with the superego, compulsive introjection, manic triumph, and extreme manic idealization. In Kleinian theory, both the ego and the early superego are constituted of internalized object relations. All conflict-laden situations and developmental stages reactivate paranoid-schizoid and depressive object relations and defenses; the systematic analysis of these mechanisms in the transference is a central aspect of Kleinian technique (Segal, 1967). Klein (1945) also proposed that the oedipal complex is activated toward the end of the first year of life. She believed that these early oedipal developments were secondary to the displacement from mother to father of the infant’s paranoid-schizoid and depressive positions. The transfer of oral dependency from mother to father dominates the early positive Oedipus complex in girls and the early negative Oedipus complex in boys; the transfer of aggressive fears and fantasies from mother to father produces fan-
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tasies of dangerous sexual organs and destructive parental sexual relations. The projection of oral and anal sadistic fantasies onto the genitals of both sexes colors early castration anxiety in both sexes. Oral envy of mother is the origin of penis envy in girls and oedipal jealousy and rivalry in both sexes. The transfer of good object relations to the oedipal object and to the fantasized sexual relations of the parents determines the capacity for normal oedipal identifications and development and the capacity for good sexual relations. The aggressive infiltration of the fantastic views of the primal scene and of the relations with both parents results in severe oedipal inhibitions and conflicts. Kleinian technique, in addition to focusing on the analysis of primitive object relations and defenses, strongly insists on the primacy of the analysis of the transference from very early in the treatment and on the analysis in depth of transference developments to their dominant and often primitive levels of anxiety. The early Kleinian tendency to interpret most transference reactions as reflecting developments in the first year of life, however, has gradually shifted; contemporary Kleinian technique emphasizes the analysis of unconscious meanings in the “here and now” and takes a more gradual and cautious approach to genetic reconstructions. Segal (1981), Rosenfeld (1987), and Spillius and Feldman (1989) represent the mainstream Kleinian approach. Bion (1967b, 1970) and Meltzer (1973; Meltzer et al., 1975; Meltzer and Williams, 1988) have developed what may be characterized as more radical transformations of classical psychoanalysis in the light of Kleinian developments. Ronald Fairbairn
Fairbairn’s object relations theory (1954) is closely related to Klein’s. He proposed that an ego is present from birth, that libido is a function of the ego, and that there is no death instinct, aggression being a reaction to frustration or deprivation. For Fairbairn, the ego (and therefore libido) is fundamentally object seeking, and libido is essentially reality oriented in promoting the attachment of the infant to the earliest objects—first, mother’s breast, and later, mother as a total person. The earliest and original form of anxiety, Fairbairn suggested, is separation anxiety, activated when frustrations—largely temporary separations from mother—occur. These frustrations bring about the internalization of the object and also ambivalence toward it. Fairbairn proposed that both the exciting and the frustrating aspects of the internalized object are split off from the main core of the object and re-
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pressed by the ego. There thus come to be two repressed internal objects, the exciting (or libidinal) and the rejecting (or antilibidinal). Both carry with them into repression parts of the ego by which they are cathected, leaving the central ego unrepressed but acting as the agent of repression. In consequence, the original ego is split into three egos—a central (conscious) ego attached to an ideal object (ego ideal), a repressed libidinal ego attached to the exciting (or libidinal) object, and a repressed antilibidinal ego attached to the rejecting (or antilibidinal) object. This concept differs from Freud’s tripartite structure in that there is no id and all three components are fundamentally ego structures. Fairbairn considered this splitting of the ego to be in the service of defense; the splitting of a fundamental core object that was libidinally invested and yet frustrating at the same time—a basic “schizoid” operation—leads to the repression of the frustrating aspect of the object as a bad internal object (the antilibidinal object) and of the exciting aspect of the object as an unavailable, libidinal object. In psychoanalytic treatment, the patient’s initial relationship to the analyst as an ideal object reflects the activation of the central conscious ego as a defense against the repressed libidinal and antilibidinal internalized object relationships; these, however, gradually emerge in the transference as well. Fairbairn suggested that the exaggerated development of such an impoverished central ego as a product of excessive schizoid operations is characteristic of both the schizoid and the hysterical personalities. Fairbairn believed that the infant’s original fear was that its love for mother would empty her out and destroy her, which made the infant feel futile and depleted. Fairbairn considered this fantasy an essential emotional experience of schizoid personalities, which imparted an aggressive quality to their dependent needs. Only later on, Fairbairn suggested, was the frustration from mother experienced as a consequence of the individual’s own aggressive impulses, now projected onto mother as a bad object and leading to the internalization of a bad internal object. Fairbairn saw these split-off internalized object relations not simply as fantasies but as endopsychic structures, the basic structures of the psychic apparatus. For Fairbairn, the various erotogenic zones represented not the origin of libidinal stimuli but the channels available for expression of libidinal needs directed to objects; he defined anal and phallic conflicts not in terms of libidinal stages but as particular “techniques” activated in a sequence of interactions and conflicts with parental objects. Fairbairn saw the development of masochistic tendencies in the treat-
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ment as a basic manifestation in the transference of previously split-off bad internalized object relations; he considered the interpretation of such masochistic needs as a key phase in the resolution of pathological schizoid states. He described the “masochistic defense” as a consequence of unconscious efforts to preserve the relationship with frustrating yet needed objects: the “absolution of blame” of the object on the part of the self transformed the unconditional badness of the object into a conditional one, and the experience of unconscious guilt expressed this effort to maintain a relationship with the frustrating object. He proposed that the psychoanalytic resolution of unconscious guilt feelings might bring about an intensification of the patient’s resistances and of negative therapeutic reactions because the patient then would be faced with the need to come to terms with his libidinal attachment to bad, ambivalently loved objects, a crucial aspect of internalized object relations. Fairbairn maintained a rather classical psychoanalytic technique throughout most of his professional life, only adopting minor modifications, late in his career, of the psychoanalytic setting to enable the patient to see the analyst if he so desired. His principal followers include Sutherland (1989) and Guntrip (1961, 1968, 1971). The latter introduced significant changes in Fairbairn’s approach, with an even more radical rejection of drive theory than Fairbairn’s original formulations. Donald Winnicott
Winnicott’s object relations theory (1958, 1965, 1971) is less systematized than those of Klein and Fairbairn. His writings have an evocative quality which has had a profound influence on psychoanalytic theory and practice. But, although he maintained his allegiance to many of Freud’s and Klein’s formulations, there are potential contradictions between his ideas and some of theirs. While his approach is eminently compatible with Fairbairn’s, he did not fully work out these relationships; Guntrip attempted to achieve such an integration of Fairbairn’s and Winnicott’s thinking. Winnicott’s emphasis is on the concept and origin of the self, the development of the infant’s subjective sense of reality in the context of its relationship to mother. Winnicott suggested that the infant’s primary experience is an oscillation between integrated and unintegrated affective states and that the protective environment provided by the empathic presence of the “good enough mother” permits the infant to experience a nontraumatic gratification of its needs. The repeated availability of mother’s gratifying presence in response to the activation of its internal needs gradually shapes
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a normal self experience. Mother’s capacity for appropriate physical handling of the infant’s instinctive needs and her emotional “holding” of its affective needs—a capacity derived from her “primary maternal preoccupation” during the latter stage of pregnancy and the first few months of the infant’s life—fosters the infant’s omnipotent fantasy that it is able to create the reality required for satisfaction. The infant’s subjectively experienced initiative “impinges”on the “environment-mother,”bringing about her empathic response and gratification of its needs. The sense of omnipotence— the infant “created” the needed object at the point of need—strengthens the early self experience and creates the basis for the later development of transitional objects and transitional experiences. When mother is not empathic to the infant’s needs, fails to react to them, or reacts in a faulty way, the infant’s experience is that of an external “impingement,” which is traumatic. A basic defensive operation then occurs in the form of splitting between the infant’s nascent “true self”— which now withdraws into an internal world of fantasy—and an adaptive “false self.” The true self relates to an internal world of gratifying and frustrating object representations, roughly corresponding to Klein’s internal world of object relations; the false self deals with adaptation to external reality. Under excessively traumatic circumstances, with chronic failure in the mothering function, an exaggerated false self may lead to a chronic sense of inauthenticity and even to severe psychopathology, including antisocial behavior. Cognitive functions may be recruited to rationalize the operation of the false self and to promote a defensive, intellectualized version of self and others that does not correspond to the authentic object-related needs of the true self. Under optimal mothering conditions, the infant is able to adapt to a shared reality with mother. The infant at first assumes this reality to be omnipotently created; gradually, when its tolerance for unavoidable environmental frustration and failure increases, it creates what Winnicott called a “transitional object,” a concrete object that is the infant’s “first possession”—that is, is recognized as not part of the self and yet as not part of external reality either. The transitional object fulfills the functions of a fantasized relationship that is unchallenged by mother and infant alike; it constitutes the origin of future “illusion,” creating an intermediate “space” between internal reality and external reality that will evolve first into the illusional space of play and eventually into the creative areas of art, culture, and religion. The transitional object is “created” by the infant with mother’s silent agreement during the second half of the first year of life. It gradually
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“dissolves” without a sense of loss or mourning during the second or third year of life. Winnicott posed a connection between the normal development of transitional objects and subsequent psychopathology of fetishism and fetishistic object relations. The infant’s relation with the transitional object replicates the relation with mother in reality and in its internal world. In expressing both libidinal and aggressive needs toward that transitional object and in that object’s “survival,” the infant is reassured that its aggression has not destroyed the object. Winnicott saw the origin of aggression in the child’s initial “ruthlessness” in treating the object, roughly corresponding to the time of Klein’s paranoid-schizoid position. He modified Klein’s transition from the paranoid-schizoid into the depressive position in his concept of the development of the “capacity for concern”—namely, the infant’s gradual recognition that its ruthlessness corresponds to aggression directed to a bad object that is also a good object. Mother, at that stage, exercises her “holding function” in the sense of her symbolic “survival” following the onslaught of her infant’s aggression. Winnicott described the infant’s capacity to both “use” an object ruthlessly and relate to it in dependent, lovingly gratifying ways; he described the “capacity to be alone” as derived from the infant’s capacity to be alone in the presence of mother, assured of her potential availability, a capacity corresponding to Klein’s concept of the consolidation of a good internal object and the related capacity for trust. Winnicott considered patients who had achieved consolidation of a true self and the capacity for concern—the equivalent of Klein’s consolidation of the depressive position—suitable for psychoanalysis. He considered those in whom a false self dominates and the normal trusting relationship to external objects has not become consolidated—particularly cases with severely schizoid pathology and antisocial behavior—as requiring modifications in analytic technique. For these severely ill patients, Winnicott proposed that the analytic setting itself, in its stability, reliability, and soothing quality, represents the “holding environment” that was prematurely disrupted. He contended that the psychoanalyst must provide, by his own stability, reliability, and availability, the “environment mother” that the patient lacked in the past. Optimally, this will permit the patient’s benign regression to an early state of nonintegration, which replicates the early state of the infant-mother relationship, when there was as yet no clear boundary between mother and infant. The analyst’s tolerance for and interpretation of the patient’s need to regress, to be understood in regression, and, symbolically speaking, to be “held” by the analyst may permit the reactivation of early
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traumatic circumstances, the undoing of the defensive withdrawal of the true self, and the beginning of the consolidation of object relations involving the true self and the early gratifying and frustrating maternal object. Winnicott significantly influenced mainstream French psychoanalytic thinking as well as ego psychology–object relations theories, such as Modell’s (1976), and interpersonal psychoanalysis as represented by Greenberg and Mitchell (1983). There are important potential correspondences between Winnicott’s approach and Kohut’s self psychology (1971, 1977)— such as their stress on the therapeutic importance of a good analytic relationship, but also very significant differences: Winnicott’s conceptualization of a complex internal world includes aggressively determined internalized object relations. Harry Stack Sullivan
Sullivan (1953, 1962) was the chief proponent of interpersonal psychoanalysis. The cornerstone of his approach was the belief that all psychological phenomena are interpersonal in origin and that psychic life starts out as the internalization of relations with significant others. Sullivan classified the essential human needs as “needs for satisfaction,” corresponding to instinctively anchored biological needs, and “needs for security,” implying the need for gratifying experiences with others that would consolidate a sense of an effective and safe self and a basic sense of goodness. Gratification of the needs for satisfaction would increase security, bring about a sense of euphoria, and facilitate emotional growth. But undue frustrations of the needs for satisfaction would affect the need for security as well. Undue frustration of the emotional need to relate to significant others—even given gratification of basic needs for satisfaction—determines the experience of anxiety and, if exaggerated, its extension to a sense of personal “badness.” Excessive anxiety is the fundamental cause of emotional illness, and the frustration of essential security needs is its origin. For Sullivan, the development of a healthy sense of self depended on the “reflected appraisal by others”; acceptance by others creates a sense of good self and promotes the integration of the self in satisfying security needs. Sullivan described stages in the capacity for appraisal of the interactions with others. The original or “prototaxic” experiences are characteristic of the first months of life, before the development of the capacity for differentiating self from others. “Parataxic” experience corresponds to the development of distortions in early experiences with others that are reflected in the transference developments in psychotherapeutic treatment.
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The mature capacity for realistic assessment of one’s relations with others is expressed in the “syntaxic” mode of experience. These are alternative ways of formulating Freud’s primary and secondary processes, just as Sullivan’s classification of the needs for satisfaction and security replaced Freud’s drive theory. Sullivan also proposed early defensive operations of “selective inattention,” roughly corresponding to Freud’s preconscious, and “dissociation” as a more radical elimination of self-awareness, equivalent to Freud’s mechanism of repression. Sullivan described three levels of development derived from normal and conflictual early object relations. Gratifying internalized object relations lead to a sense of “euphoria” and inner goodness, which facilitates emotional growth and the deepening of an external and internalized world of object relations. They are the source of the “good me.” Unsatisfactory relations with others, characterized by anxiety and frustrations of the need for security, lead to setting up a sense of a “bad me.” The psychopathology of a dissociated “bad me” may lead, by projection, to paranoid developments. In intimate relations to the “good me” and the “bad me,” the individual develops “personifications” of significant others, particularly “good mother” and “bad mother”; here Sullivan described the intrapsychic structures common to all object relations theories. Extremely frustrating experiences leading to commensurate anxiety and profound personal disorganization are expressed in a sense of “not me,” a primitive distortion and destruction of intrapsychic experience characteristic of psychosis. Sullivan described extreme conditions under which, by a process of “malevolent transformation,” all object relations would be interpreted as essentially bad and dangerous, characteristic of paranoid psychoses. Sullivan’s treatment approach focused on the need to reactivate the patient’s dissociated “bad me” and “not me” experiences in the transference by providing an empathic, stable, sensitive interpersonal environment in which the patient would be able gradually to tolerate activation of dissociated parataxic relationships. For practical purposes, Sullivan focused on the understanding, ventilation, and interpretive resolution of negative transferences, on the assumption that this would permit the patient to unblock his capacity for gratifying object relations and enable the development of positive growth experiences in the psychotherapeutic relationship, the resumption of a basic sense of goodness, a consolidation of the self, and emotional growth. Sullivan profoundly influenced Frieda Fromm-Reichmann (1950, 1959), Otto Will (1959), and Harold Searles (1965, 1986), who further developed
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his approach to the psychoanalytic treatment of psychotic, particularly schizophrenic, patients. In developing a general theory of the treatment of patients with psychotic and borderline illness, Searles has integrated Kleinian concepts, particularly those of Rosenfeld and Bion (both of whom had worked with psychotic patients within a Kleinian frame of reference), with his Sullivanian background. Sullivanian thinking, together with Fairbairn’s approach, has profoundly influenced contemporary interpersonal psychoanalysis as represented by Greenberg and Mitchell (1983). Edith Jacobson
Starting out with an ego psychological approach strongly influenced by Hartmann (1950, 1953, 1964; Hartmann et al., 1946; Hartmann and Loewenstein, 1962), Jacobson (1971) focused on affect development. She proposed that affects were not simply discharge processes but the representations of drives intimately integrated with self and object representations from the earliest stages of development. Her conceptualization of affective processes explained how affects carry out fundamental intrapsychic regulatory functions by means of this investment of self and object representations and clarified the relationships between setting up affectively invested self and object representations, on the one hand, and the vicissitudes of ego and superego development, particularly their constituent constellations of self and object representations, on the other. In her treatment of patients with affective disorders and of adolescents with severe identity problems and narcissistic conflicts, Jacobson integrated her findings with Mahler’s (Mahler and Furer, 1968) regarding autistic and symbiotic psychosis in childhood and separation-individuation. Mahler, in turn, had interpreted her findings in the light of Jacobson’s earlier formulations (1964). Jacobson (1964) proposed that intrapsychic life starts out as a psychophysiological self within which ego and id are not differentiated. She suggested that the first intrapsychic structure was a fused or undifferentiated self-object representation. This evolves gradually under the impact of the relationship of mother and infant. This fused self-object representation (corresponding to Mahler’s symbiotic stage of development) ends with the gradual differentiation of the self representation from the object representation, contributing to the capacity for differentiating the self from the external world. Jacobson saw the defensive refusion of self representation and object representation under severely traumatic circumstances as the origin of sub-
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sequent psychotic identifications characteristic of symbiotic psychosis of childhood and of affective psychosis and schizophrenia in adulthood. She also described the defensive dissociation of fused or undifferentiated selfobject representations invested with aggressive drive derivatives as the counterpart to the libidinally invested ones, so that, particularly under pathological circumstances, fused self-object representations of an “all good” and an “all bad” nature coexisted while being mutually dissociated. Gradually, during the stage of separation-individuation that dominates the second part of the first and second years of life, differentiation of self and object representations in both the “good” and the “bad” segments of experience is achieved. This is followed, first, by the integration of the “good” and “bad” self representations and object representations and, later, by the development of ideal-self representations and ideal-object representations, which crystallize in order to restore a sense of an ideal relationship with mother. It is the toned-down, ambivalent relation to mother in reality that evokes the psychological need to recreate an ideal relationship in fantasy. Efforts to deny and devalue the bad aspects of self and of mother may lead to the exaggerated fixation of dissociated “bad” self and object representations that dominates the psychopathology of borderline conditions. Under optimal circumstances, in contrast, good and bad self representations become integrated into a consolidated concept of self, and good and bad representations of mother, father, and siblings evolve into integrated constellations of real and idealized objects and object relations, which become part of ego structures. Jacobson suggested that the superego also evolves out of successive layers of internalized object relations. The first layer is represented by “bad” object representations with a prohibitive, punishing quality. This is followed by a second layer of ideal-self and ideal-object representations that will enact idealized superego demands. Again, under normal circumstances, the gradual integration of these bad and ideal layers of superego precursors leads to their toning down and to the consequent internalization and integration of a third layer of the more realistic superego introjects of the oedipal period. The gradual individualization, depersonification, and abstraction of these three layers lead to the healthy integrated superego of latency, puberty, and adolescence, when a partial reorganization brings about the transformation into the adult superego. Jacobson applied this model to the treatment of neurotic, borderline, and psychotically depressed patients. It is tempting to trace parallels in the theories of Jacobson, Mahler,
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Klein, and Fairbairn. All of them focused on the vicissitudes of the internalization and gradual integration of self and object representations, on splitting or primitive dissociation and integration, and on the gradual building up of the overall psychic structures under the influence of the integration of early object relations. Margaret Mahler
As a result of her observations of children with autistic and symbiotic psychoses and of the mother-child relationships in the first few years of life, Mahler (Mahler and Furer, 1968; Mahler et al., 1975) developed a theory of the psychostructural preconditions of autistic psychosis, symbiotic psychosis, normal and pathological separation-individuation, and the culmination of early development in object constancy and a consolidated tripartite structure. Mahler hypothesized an earliest stage of development, the autistic phase, during the first month of life, predating the establishment of the symbiotic phase (which develops between the second and the sixth month of life). In the last part of her life, however, as a result of the findings of neonatal observations, she revised this idea and concluded that a normal autistic phase probably did not exist and that cases of autistic psychosis with strong psychological determinants were pathological developments. The symbiotic phase of development is characterized by cueing and matching between infant and mother in which the infant experiences blissful states of merger with mother. The infant anticipates and initiates pleasurable responses in interacting with mother and develops a sense of confidence and basic trust in mother, expressed in smiling and direct eye contact; this leads to the capacity to be alone as well as with mother. In the second half of the first year of life, the stage of separation-individuation sets in, to be completed toward the end of the third year. The first subphase of separation-individuation, between about six and ten months, is “differentiation” or “hatching,” characterized by an increase in the infant’s scanning of the environment and checking back to mother for “visual refueling.” The infant now is capable of easily being comforted by mother substitutes, but it also develops stranger anxiety, “custom inspection” in intensive visual interaction with mother’s and others’ faces, and a gradual differentiation between what is animate and inanimate, good and bad. The differentiation subphase is followed by “practicing,” from roughly eleven to sixteen months, characterized by the mastery of upright locomotion, pleasure in exploring and in asserting “free will,” and the tendency to
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take mother for granted except when prolonged separation leads to “low keyedness.” Now the toddler develops a “love affair with the world,” with a sense of omnipotence, an active, even aggressive autonomy, darting and running away from mother but also wishing to share with her, to control her by means of “shadowing.” Practicing leads into the subphase of “rapprochement,” between eighteen months and the third year, when the toddler makes intense efforts to control mother while clinging to her anxiously. This subphase culminates in what Mahler called the “rapprochement crisis,” characterized by an intensification of darting away alternating with temper tantrums. There is aggressive control of mother, insistence on autonomy in responses to her, and manifestations of sharp splitting characterized by idealizing clinging to mother and aggressive separation from her. The pathology of the rapprochement crisis is marked by excessive separation anxiety, passivity or demandingness, depressive mood, pathological coercion and possessiveness of mother, pathological envy, and temper tantrums. It is related to severely disappointing, unavailable, or overintrusive mothers, to painful and sudden dissolutions of the child’s fantasized omnipotence, and to traumatic circumstances causing excessive narcissistic frustration. Over the fourth and fifth years of life, in the process Mahler called “toward object constancy,” the child develops an integrated sense of self, a differentiated relation with other adults and peers, awareness in depth of mother, and tolerance for ambivalence. During this phase, oedipal conflicts become clearly dominant. Mahler’s understanding of the underlying nature of internalized object relations, utilizing Jacobson’s developmental model, implied dealing with mutually dissociated or split-off idealized and persecutory relationships within which self and object representations were fused, typically activated in the transference of psychotic patients. The psychoanalytic exploration of borderline conditions, in contrast—reflecting particularly the pathology of internalized object relations during the subphase of rapprochement—implied the analysis of mutually dissociated or split-off idealized and persecutory relationships within which the patient had achieved a clear capacity to differentiate between self and object representations in both segments. Harold Searles’s description (1965) of the stages in the psychoanalytic treatment of psychotic patients—that is, (1) the early, out-of-contact phase, (2) intense symbiotic involvement, (3) separation, and (4) integration—also is Mahler’s concept of symbiotic psychosis and separation-individuation development. I have drawn on both Mahler’s observations regarding patho-
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logical rapprochement crises and Jacobson’s developmental schemata to provide a theoretical background for an approach to the psychoanalytic psychotherapy of borderline conditions. Otto Kernberg
Like Jacobson and Mahler, I adhere to Freud’s dual-drive theory and consider drives indissolubly linked to object relations. I believe that libidinal and aggressive drive derivatives are invested in object relations from very early in life, namely, in temporary symbiotic states under the influence of peak affect activation. I propose that the ideational and affective representations of drives are originally undifferentiated from each other and that affect states representing the most primitive manifestations of drives are essential links of self and object representations from the very beginning (following Jacobson in this regard). I propose that affects are the primary motivational system and that, internalized or fixated as the very frame of internalized “good” and “bad” object relations, affects are gradually integrated into libidinal and aggressive drives to form hierarchically supraordinate motivational systems. In other words, primitive affects are the “building blocks” of the drives (Kernberg, 1990). I see unconscious intrapsychic conflicts as always between (1) certain units of self and object representations under the impact of a particular drive derivative (clinically, a certain affect disposition reflecting the instinctual side of the conflict) and (2) contradictory or opposing units of self and object representations and their respective affect dispositions reflecting the defensive structure. Unconscious intrapsychic conflicts are never simply between impulse and defense; rather, both impulse and defense find expression through certain internalized object relations. At levels of severe psychopathology—in patients with borderline personality organization—splitting mechanisms stabilize such dynamic structures within an ego-id matrix and permit the contradictory aspects of these conflicts to remain at least partially conscious, in the form of primitive transferences. In contrast, patients with neurotic personality organization present impulse-defense configurations that contain specific unconscious wishes reflecting sexual and aggressive drive derivatives embedded in unconscious fantasies relating to the oedipal objects. Repressed unconscious wishes, however, always come in the form of corresponding units composed of self representation and object representation and an affect linking them (Kernberg, 1987, 1988). Patients with neurotic personality organization present well-integrated
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superego, ego, and id structures. In the psychoanalytic situation, the analysis of resistances brings about the activation in the transference, first, of relatively global characteristics of these structures and, later, of the internalized object relations of which they are composed. The analysis of drive derivatives occurs in the context of the analysis of the relation of the patient’s infantile self to significant parental objects as projected onto the analyst. The borderline personality organization shows a predominance of preoedipal conflicts and psychic representations of preoedipal conflicts condensed with representations of the oedipal phase. Conflicts are not predominantly repressed and therefore unconsciously dynamic: rather, they are expressed in mutually dissociated ego states reflecting the defense of primitive dissociation or splitting. The activation of primitive object relations that predate the consolidation of ego, superego, and id is manifest in the transference as apparently chaotic affect states, which have to be analyzed in sequential steps as follows: first, clarification of a dominant primitive object relation in the transference, with its corresponding self and object representation and the dominant affect linking them; second, analysis of the alternative projection of self and object representation onto the therapist while the patient identifies with a reciprocal self or object representation of this object relationship, leading to the gradual development of awareness of this identification with self and object in that relationship; and third, the interpretive integration of mutually split-off, idealized, and persecutory part-object relations with the characteristics mentioned. Analysis may gradually bring about a transformation of part-object relations into total object relations and of primitive transferences (largely reflecting Mahler’s stages of development predating object constancy) into the advanced transferences of the oedipal phase. The analyst’s exploration of his countertransference, including concordant and complementary identifications (Racker, 1957), facilitates transference analysis, and the analysis of primitive defensive operations, particularly splitting and projective identification, in the transference also contributes to strengthening the patient’s ego. I have also described (1975, 1984) the pathological condensation of idealized internalized object relations in the pathological grandiose self of narcissistic personalities and the gradual resolution of the pathological grandiose self in the transference as its component part-object relationships are clarified and the corresponding dominant primitive defensive operations are interpreted. Insofar as I have drawn on findings regarding primitive defenses and
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object relations stemming from the Kleinian school, Fairbairn’s ideas about the essential dyadic structures involving self representation–object representation–affect, and Jacobson’s and Mahler’s theoretical frames, my approach may be considered an effort to integrate several object relations theories within an ego psychology–object relations theory model.
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the concept of drive in the light of contemporary psychoanalytic theorizing
The effort to develop a synthesis of Freud’s dual-drive theory (1920a, 1923, 1933b) and object relations theory by now has a long tradition that includes the contributions of Melanie Klein (1940, 1945, 1946, 1957), D. W. Winnicott (1958, 1965, 1971), Edith Jacobson (1964, 1971), and Margaret Mahler (Mahler and Furer, 1968; Mahler et al., 1975). As I noted in earlier chapters, some leading object relations theoreticians, such as Fairbairn (1954), Guntrip (1961, 1968, 1971), Sullivan (1953, 1962), Greenberg (Greenberg and Mitchell, 1983), and Mitchell (1988), have concluded that object relations theory and drive theory are essentially incompatible. Interpersonal psychoanalysis rejects Freud’s drive theory (Greenberg and Mitchell, 1983); and I believe that self psychology (Kohut, 1971, 1977) also may be regarded as a type of object relations theory that rejects Freud’s theory of the drives. The contemporary reevaluation of Freud’s dual-drive theory, which has taken place mostly in France, is relevant to the relationship between object relations theory and drive theory. The work of Laplanche (1970, 1987, 1992) and Green (1973, 1986, 1993) in particular has emphasized the central importance of unconscious destructive and self-destructive drive manifestations in the form of attacks on object relations and the central role unconscious erotization in the mother-infant relationship plays in libidinal development. All this, in my view, tends to link drive theory and object relations theory in intimate ways. Reprinted from Mankind’s Oedipal Destiny: Libidinal and Aggressive Aspects of Sexuality, edited by Peter Hartocollis (Madison, Conn.: International Universities Press, 2001), 95–111, by permission of International Universities Press, Inc. Copyright 2001 by International Universities Press, Inc. 48
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Another important development in psychoanalytic theory is the growing emphasis on affects as primary motivators and/or the communicative functions of affects in early development, particularly in the infant-mother relationship (Krause, 1988; Krause and Lutolf, 1988). This emphasis links affect theory and object relations theory quite closely, despite the persistent controversy between those who see affect, particularly peak affect states, as essentially representative of the drives and those who stress the psychophysiological nature of the affective response and attempt to replace drive theory with an affect theory. I would like to stress the importance of linking drive theory and object relations theory, for there are undesirable consequences of keeping these two major trends of psychoanalytic thinking apart: an object relations theory devoid of a theory of drives tends to devolve into a theory of interpersonal functioning that may stress the unconscious aspects of intersubjectivity but is usually attracted to sociological models of development in which the unconscious world of current transference developments is seen as a replica of aspects of actual past interactions. This leads to neglect of the formation of unconscious mental structures and, in my experience, tends to accentuate superficial aspects of unconscious functioning (the role of adaptation and reality) and to minimize or ignore the uncanny aspects of primitive hatred and the primitive nature of early erotic and sadomasochistic unconscious fantasy. An object relations theory without a theory of drives tends to underemphasize both aggression and eroticism while stressing pregenital, preoedipal, dyadic relations as the origin of the dynamic unconscious. On the other hand, a traditional drive theory that does not explore the implications of object relations theory and affect theory eventually tends to assign drives to a mythical structure, such as equating the unconscious with the structure of a natural language (Lacan, 1966) or assuming primary, innate developments of the drives as inherited from philogenetically determined primary fantasies. Finally, replacing drive theory by an affect theory relegates motivation to its biological sources, minimizing the importance of unconscious fantasy and the psychological nature of human desire. Now I wish to pursue the effort to synthesize a contemporary theory of drives with a developmental object relations theory model and to describe the role of affects in constructing the world of object relations and constituting the substrate of the drives (Kernberg, 1976, 1990, 1992). Freud (1920a, 1923, 1933b) conceived of instincts much as they are seen today, as biological motivational systems, innate, discontinuous,
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species-specific. They are differentiated in terms of patterns of “consummatory behaviors”—fixed, innate patterns of perception and behavior organized by their interaction with environmental triggering factors. Higher biological centers mediate broad, alerting, exploratory behaviors that then, under the influence of specific environmental conditions, trigger actual consummatory behavior patterns. Biological instincts, in their modern conception, are integrated, sequentially organized behavior patterns derived from the interaction of their component inborn dispositions with triggering environmental conditions. Drives, in contrast, are conceptualized as highly individualized, malleable, and displaceable unconscious motivational systems, continuous in their motivational function. In Freud’s terms, they occupy an intermediate realm between the physical and the psychological and are manifest only by their derivatives—namely, representations and affects. A contemporary psychoanalytic view, as put forward by Klein (1945, 1946, 1957) and Laplanche (1970, 1987), conceives of the drives as affectively charged unconscious fantasies that involve desired and feared relations between the self and internalized objects. I have described the relationship of a self representation with an object representation in the context of a dominant peak affect state as the basic unit of unconscious fantasy. Libido and the death drive must be differentiated from sexuality and aggression as biological functions. Laplanche’s discussion (1992) of Freud’s reasons for abandoning his earlier classification of drives into ego drives and sexual drives is convincing, as is his description of the drives as intrapsychic motivational structures originating in the context of the infant’s total dependency not only on the care of the mothering person but on the unconscious messages reaching the infant from mother, experienced as enigmatic stimulations from birth on. These early experiences determine the earliest unconscious fantasy by a process of accumulation, the retrospective unconscious elaboration of these experiences, and the gradual differentiation of the dynamic unconscious from a primary ego-id matrix. I find this general formulation eminently compatible with my proposal that intensely pleasurable experiences of the infant in the relationship with mother generate primary,“all good” units of self and object representations while peak experiences of pain and fear generate “all bad” ones. Within these primary units, self and object representations are not yet differentiated from each other. Early splitting operations maintain the segregation of experiences negatively and positively charged with intense affect. At a later stage, splitting between idealizing and persecutory experiences is
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complemented by the differentiation of self and object representations in each experience that contributes to the delimitation of ego boundaries and reality testing. These highly charged primitive affective experiences recede deeply into the repressed unconscious, while those conscious and preconscious interactions of infant and mother that take place under conditions of low-level affective activation serve adaptive purposes and are incorporated into the conscious and preconscious ego. In this latter realm of experience, differentiation between self and object representations evolves from very early on. In my view, the gradual integration of the “all good,” idealized, pleasurable affective experiences with mother with the unconscious erotic meanings injected via mother’s “enigmatic” messages constitutes libido as a drive in the same way that the integration of all painful, terrifying, rage-inspiring affective experiences with the unconscious meanings of mother’s hostile enigmatic responses constitutes the death drive. The expression of the death drive as a primitive layer of persecutory superego precursors along with the projective mechanisms attempting to externalize these internal persecutors gives rise to the deepest layers of potential self-destructiveness, paranoid tendencies, and a defensive effort to eliminate or destroy relationships with significant others. Those motives are part of a gradually developing dynamic between the search for erotic linkages with significant others and the attack on those linkages, with the ultimate goal of eliminating any need for others together with the experiencing self. It seems justifiable to use the term “death drive” for these antilibidinal, “anti-eros” forces (Green, 1993). Contemporary affect theory sees affects as philogenetically recent systems of regulations in mammals that assure the protection of the infant during its long stage of dependency, functioning as a mode of communication and as major motivational influences throughout life. Affects include the subjective experience of pleasure or displeasure, which motivates the infant to move toward or away from a determinate stimulus or situation. Each affect includes typical patterns of neurovegetative and psychomotor responses, with expressive movements that communicate the affective state to the caregiver. Inborn affective responses thus foster both the linkage of early self-experiences with the pleasure-giving object and the tendency to destroy those linkages under conditions of intensely experienced danger, pain, or frustration. It is at the moment of peak affect that self and object representations are linked and fixated in early memory structures and elaborated secondarily in unconscious fantasy. Thus the libidinal and aggressive drives
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are formed not simply by the accumulation and integration of affect states per se but by the ongoing development of fantasized, feared and desired, idealized and persecutory relations with significant objects. In contrast to instincts, which are discontinuous, homogeneous for the species, innate, and inalterable, drives have an essentially psychic nature: they are continuous, individualized, and subject throughout development to alteration through displacement and condensation. Practically, this means that the primitive affect states of elation, fear, rage, sadness, shame, surprise, disgust, and sexual excitement are elaborated and modified in the context of their integration with internalized object relations. These in turn are condensed and integrated in the context of the commonality of their affect states. In other words, relationships with different objects in the context of hatred or of love are integrated as fantastic primitive object representations of the self. The affects themselves are condensed, converging into two key series of emotional experiences: erotic desire, on the one hand, and murderous hatred, on the other. Freud described the origin of libido in erogenous zones, the pressure toward the achievement of pleasure, the specific aim, and the object of the drive. The basic units of self and object representations and the affects linking them bring together these characteristics of drives. As Laplanche (1987, 1992) has pointed out, the erogenous zones represent the general erogenous quality of the body. The desire for erotic fusion with mother takes the specific contours of those erogenous zones most involved in the intimate relation with her at a certain point of time. The infant’s fantasized relation to mother’s body under the impact of early erotic stimulation will profoundly influence the nature of erotic fantasy as it later incorporates these retrospectively interpreted early experiences. The intensity of the affect of erotic desire represents the intensity of the drive at any given point; the particular erogenous gratification involves the libidinal aim, and the origin of the drive lies not in the specific erogenous zone but in the entire relationship of the child’s primitive psychic apparatus with the first needed and then desired object. The erotic desire “leans” on the biological apparatus of sexual excitement (Laplanche, 1992), and integration of the experience of the primitive affect of elation with the perception of the erotic bodily response to the relationship to the breast creates the prototype of erotic desire that, later on, will “lean” on the focused sexual response of the genital organs. In this connection, it is ironic, although not surprising to a psychoanalyst, that the highly complex affect of sexual excitement has been almost totally ignored in most studies on the development of affects.
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As erotic desire “leans” on the biological apparatus of sexual excitement, so hatred “leans” on the primary affect of rage as aroused in the earliest object relations. Rage is one of the fundamental affects, an inborn biological response that acquires its function as the originator of hatred only in the context of the internalization of persecutory, “all bad” internalized object relations. The complex affect of hatred, a central aspect of the death drive, involves, in its most primitive forms, the desire to destroy not only the hated object but even awareness of the relationship with it and, in a profound sense, the self as the organ of perception of hatred. Sadistic pleasure already reflects the condensation of such primitive hatred with erotic desire, as masochistic pleasure reflects the erotization of the most primitive desire for self-elimination together with the elimination of self-awareness. The basic units of internalized object relations (self representation–object representation) thus include the constituent affective components of the drives. One might say that sexual excitement is the central affect of libido in the same way that primitive hatred is the central affect of the death drive. The id is conceptualized in this model as the sum total of repressed, desired, and feared primitive object relations. Successive layers of persecutory and idealized, prohibitive and demanding, internalized object relations become part of the primitive superego, while internalized object relations activated in the service of defense consolidate as an integrated self-structure within the ego surrounded by integrated representations of significant others. In short, the id or dynamic unconscious, the superego, and the ego are constituted by different constellations of internalized object relations so that the development of the drives and the development of the psychic apparatus—the tripartite structure—occur hand in hand. We can now see how contemporary affect theory constitutes a bridge between biological and intrapsychic structure and why affect theory cannot replace a drive theory. Primitive affects are inborn psychophysiological structures, and, regardless of which classification of affects one accepts, they reflect multiple moments of arousal in the relations to any particular object that are less important than the consistent, deeply repressed, stable unconscious relations to the parental objects, which transcend any particular affective reaction to it. Affects, shorn of the object relations in the context of which they enter the psychic apparatus, cannot reflect the nature of unconscious fantasy or motivating desire. Perhaps the erotic response illustrates most clearly how unconscious desire “leans” on the biological function of sexuality but transcends it by far in its importance in human sexual life. We know that, in addition to the
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normal development of the anatomical aspects of the sexual organs, a normal level of testosterone is a precondition for normal activation of genital excitement, and that long-term insufficiency of testosterone reduces the intensity of sexual excitement in both genders. However, it is evident that sexual excitement is determined by unconscious and preconscious fantasy much more than by fluctuations in the hormonal level. In fact, the study of severe personality disorders illustrates that, under conditions of extremely severe pathology of internalized object relations related to severe physical and psychological trauma, the erotic response may be extinguished in spite of an absolutely normal physiological apparatus. Clinically, the greater the patient’s capacity for polymorphous perverse infantile sexual experiences, the better the prognosis for the treatment of severe personality disorders. Braunschweig and Fain (1975) have illustrated how the unconscious relationship of infant and mother activates the capacity for the erotic response. Thus they have helped, in my view, to clarify the nature of core gender identity as well as object choice. Stoller (1975, 1979) has demonstrated how unconscious aggressive conflicts contribute, in confluence with the erotic response, to determine the nature of sexual excitement. Unconscious fantasy has its origins in earliest infancy. Contrary to Freud’s view of the infant as initially isolated and disconnected from his human environment, contemporary psychoanalytic infant observation has confirmed the connectedness of the human infant and the high degree of differentiation of his perceptive capacity—including cross-modal sensorial perception transferred from the very beginning (Stern, 1985). These observations make Mahler’s concept (Mahler and Furer, 1968) of an original autistic phase and a succeeding symbiotic phase of development highly questionable. There is much evidence of the infant’s ability to differentiate between self and object during alert states of low-level affect activation. It is interactions in peak affect states of euphoria and rage that dissolve differentiation into “symbiotic” fantasies of merger. In other words, I think that symbiotic and nonsymbiotic (differentiated) modes of relationship alternate from the beginning of life on and that unconscious fantasy starts when a shift into the symbiotic mode is prompted by moments of maximal distress or pleasure, with their corresponding peak affect. I see such symbiotic states of experience as the preconscious origins of what eventually will become the dynamic unconscious, the point at which the memory traces of intense affects begin to be laid down in the context of fused self and object representations. I am in-
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cluding here the infant’s ever-more-complex perception of the interactions between him and mother, in which unconscious messages from mother are stored, to be retrospectively activated by later traumatic experiences and reinterpreted in light of the ongoing development of unconscious fantasy (Laplanche, 1987, 1992). Cognitive experiences and memory traces from states of low affect activation that powerfully influence the developing ego’s adaptive functions will gradually enter into conflict with unconscious fantasy and will indirectly influence compromise formations that enable unconscious fantasy to infiltrate the developing ego. In my view, splitting mechanisms dominate and precede the development of repression as the major defensive operation of the ego in sealing off the dynamic unconscious. The mother’s unconscious fantasy, expressed in her interactions with her baby, may be “read” and unconsciously interpreted by the infant. Because of the infant’s innate capacity to read affective communication, severe distortions in mother’s affective life may distort the organization of the infant’s affective life; thus severe pathology of mother’s internalized object relations may participate crucially in setting up the unconscious life of the infant. Language as communication of subjective experience and in the creation of early intersubjectivity comes to be superimposed upon affective communication. The condensation of different internalized object relations under a similar affective sign and the displacement of affective reactions from one object to another are replicated in the linguistic categories of metaphor and metonymy. From this viewpoint, one might reverse the Lacanian assumption that the unconscious is structured like a natural language by pointing to the fact that aspects of language are structured like unconscious affects. The eruption of affect into language structure and the linguistic styles that defend against the affects of unconscious internalized object relations constitute a rich clinical area; here the analyst can explore the expression of unconscious fantasy and desire in the manifest content of the patient’s free associations, his linguistic style, and his nonverbal behavior. In this process, the role responsiveness of the psychoanalyst listening to his patient’s communications is codetermined by his capacity to read the unconscious affective messages that powerfully influence the countertransference. I believe the model I have presented so far enables us to formulate more precisely the mutual influences of psychic structure and biological developments, of unconscious fantasy and the neurophysiology of affects. The rela-
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tive intensity of sexual and aggressive drives may be considered as mediated by temperament—that is, by the inborn disposition to intensity, rhythm, and thresholds of affective responses. The influence of traumatic experiences on drive developments is mediated by the intensity of traumatically induced affects first, and later by their unconscious modification through retrospective interpretation of these traumatic experiences (Laplanche, 1992). While temperament, operating through the disposition to intensity of affect, on the one hand, and trauma, on the other, is a significant contributor to the vicissitudes of drives, the overriding influence I believe lies in unconscious elements of the relationship of mother and infant. In this relationship, the paternal figure as “excluded third person” (Kernberg, 1997a) makes its appearance not only as part of the reality of the infant’s life but also as part of the unconscious reality of mother’s image of the infant’s father and her own—and the influence of these images on her unconscious erotic relationship to her infant. And again, in this unconscious communication, mother’s affective messages may be crucial in the organization of the infant’s affective responses. When the analyst interprets the nature of the transference-countertransference relationship from an “external” perspective, he symbolically replicates the role of the oedipal father who disrupted the preoedipal, symbiotic relationship between infant and mother and thus originated the archaic oedipal triangulation. (The French psychoanalytic perspective [De Mijolla and De Mijolla, 1996] conceptualizes the analyst as functioning like the “third person.”) Patients with neurotic personality organization possess an internalized “third person,” expressed in their capacity to split the self into an acting and an observing part; this indicates the firm establishment of a triangular structure, the advanced oedipal stage of development. The analyst’s self-reflective exploration of his countertransference indicates the same triangulation. Patients with a borderline personality organization, however, strive to maintain a symbiotic link with the analyst and tend to experience the analyst’s enactment of the interpretive role as a violent disruption of that symbiosis. Their strenuous resistance to the analyst’s interpretive activity is partly in the service of avoiding the traumatizing effects of discovering the relationship of the parental couple and their own envy of it, the differences between the sexes and generations, the shock of the primal scene, and the most primitive level of frustration and anxiety in the form of fear of annihilation, related to the establishment of triangulation.
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The clinical and metapsychological concept of normal and pathological narcissism, which I have discussed elsewhere (Kernberg, 1984, 1992), is a major implication of the theory outlined here. At a metapsychological level, narcissism refers to the libidinal investment of the self and to the vicissitudes of normal and pathological investment of the self with both libidinal and aggressive drive derivatives. At the clinical level, narcissism refers simply to the normal or abnormal regulation of self-esteem and, more specifically, to the particularly frequent and severe pathology of self-esteem regulation that we describe as the narcissistic personality disorder. Normal narcissism implies the investment with libido of normally integrated self representations as these are integrated into total object relations in the development of object constancy. The normal integration of mutually split-off internalized object relations requires that self representations invested with libido predominate over those invested with aggression; their integration implies a recruitment, one might say, of aggression at the service of libido. Normal self-esteem regulation is guaranteed by the integration of the tripartite psychic structure, which, in turn, is based on such integrative processes within ego and superego. In contrast, in pathological narcissism, the pathological grandiose self, as described originally by Herbert Rosenfeld (1964), reflects a condensation of the libidinal sector of self representations, while the bad, devalued, and persecutory aspects of internalized object relations are repressed, dissociated, and projected. Here, narcissistic grandiosity largely replaces object love, with its genuine investment in others, its desire for their approval, and its capacity for gratitude. Nevertheless, in most cases of pathological narcissism there is still a search for relations with others that have a libidinal, if selfish, character. In more severely pathological cases, the pathological grandiose self is infiltrated with aggression, and this is reflected clinically in a search for autonomy and power at the expense of investment in relations with others: powerful destructive tendencies incorporated in the patient’s psychic equilibrium gravely endanger relations with others as well as the patient’s own survival. This constellation, which corresponds, I believe, to what Green (1993) has described as negative narcissism or the narcissism of death, has led me to describe the syndrome of malignant narcissism and its relationship to the antisocial personality structure (Kernberg 1992). The point here is that normal and abnormal types of personality structure are intimately linked to the vicissitudes of internalized object relations and to the quantitative equilibrium between libidinal and destructive drives.
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I have described in earlier work (1992) how the primary affect of rage may become transformed by repetitive activation into hatred, and how hatred may, in turn, affect cognitive and perceptive functions, leading to internalization of primitive or persecutory objects. Respective experiences of violence and mistreatment may become part of psychic structure by the dual nature of identification—that is, the fact that identification is always with an object and with the self in affective interaction with that object. In fact, perhaps the most important practical implication of object relations theory is the conception of identification as a series of internalization processes ranging from earliest introjection to identification per se, to the development of complex identity formation. Each step includes the internalizing of both self and object representations and their affective interactions under conditions of different developmental levels. In the transference of healthier patients with a well-consolidated ego identity, the diverse self representations are relatively stable in their mutual coherent linkage. This fosters the relatively consistent projection onto the analyst of the object-representation aspect of the enacted object relationship. In contrast, patients with severe identity diffusion lack such linkage of self representations into an integrated self. They tend to alternate rapidly between the projection of self and object representation in the transference, so that the analytic situation seems chaotic. Systematic interpretation of how the same internalized object relation is enacted again and again with rapid role reversals makes it possible to clarify the nature of the unconscious object relation and the double splitting of self representation from object representation and idealized from persecutory object relations. This process promotes integration of the split representations that characterize the object relations of severe psychopathology. I have tried to show that the proposed theory linking drives, affects, and object relations has direct relevance for psychoanalytic practice in addition to providing an instrument for the classification of personality disorders on a psychoanalytic basis (Kernberg, 1996b). The central task of psychoanalytic treatment is the systematic elaboration of the transference—that is, of unconscious pathogenic internalized object relations from the past that are activated in the “here and now.” The psychoanalyst listens simultaneously to what the patient says, how he says it, and his own affective response to the patient; these constitute the raw material that will enable the analyst to clarify the nature of the dominant object relation in the transference. But transference analysis, as Laplanche (1992) suggested, always includes an additional element: the unconscious communication from the analyst. This is
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not to be confused with countertransference in the ordinary sense but is, instead, a reproduction of the situation in which the infant experienced the enigmatic messages of the mother. This archaic relationship, repeated in the here and now and acknowledged as such, leads to the analysis of the deepest levels of unconscious fantasy. The transference is never fully resolved (Laplanche, 1992) but ends up reinvested elsewhere when the patient has acquired sufficient freedom from his pathogenic conflicts.
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unresolved issues in the psychoanalytic theory of homosexuality and bisexuality
The scientific study of homosexuality is undoubtedly one of the most fraught examples of the harmful impact of ideology on scholarly inquiry. Indeed, given our still limited knowledge of the relative importance of biological disposition, psychodynamic features, and social and cultural influences in determining homosexuality in humans, it should not surprise us that powerful ideological currents, masked as scientific approaches, complicate our exploration of this field. And, as the cynic might say: “My belief is science, yours is ideology.” The psychoanalytic exploration of homosexuality cannot escape the powerful social biases affecting this field. In fact, no area of psychoanalysis has escaped such ideological conflict or contamination. How could it be otherwise, given Freud’s revolutionary discoveries of profound human realities that run counter to cherished conventional beliefs—the importance of infantile sexuality, the influence of unconscious conflicts on conscious functioning, the fundamental influence of destructive and self-destructive tendencies in the life of the individual and of society? Throughout its history, psychoanalysis has had to struggle again and again to regain its revolutionary nature in the face of the temptation to water down its discoveries to conform to conventional social pressures. Obviously, in the expanding field of clinical and empirical research inspired by Copyright 2002, The Haworth Press, Inc., Binghamton, N.Y. “Unresolved Issues in the Psychoanalytic Theory of Homosexuality and Bisexuality,” Journal of Gay and Lesbian Psychotherapy 6 (1) (2002): 9 –27. Article copies available from The Haworth Document Delivery Service: 1-800-. E-mail address: docdelivery@haworthpress inc.com. 60
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psychoanalysis, new findings challenge old theories, and such findings, in turn, may be interpreted in the light of new theoretical developments, always under the shadow of ideological challenges. Regarding the psychoanalytic theory of homosexuality, a number of statements may be formulated at this point, reflecting changes in the traditional assumptions of psychoanalytic theory for which there exists generally accepted evidence and other proposals that are still open to question and even highly controversial. I believe that it is generally accepted by now that homosexuality cannot be considered one of the “paraphilias.” In contrast to the perversions, with their rigid and restricted sexual behavior that becomes an obligatory precondition for sexual excitement and orgasm, homosexuality implies a sexual disposition and set of sexual activities that can be as broad, flexible, and rich as heterosexual commitment can (Friedman, 1988; Friedman and Downey, 1993, 1994). We no longer believe that there exists only one homosexuality; rather, there is a spectrum of homosexual orientations reflecting different psychodynamics, possibly different etiological factors, and these range clinically from severe psychopathology to health. Whether the polarity of health or “normality” exists is still controversial: more about this later. The same spectrum, however, may be described for heterosexuality, although idealized, normative formulations regarding heterosexuality are more readily available (Kernberg, 1995a). Another assertion that is probably noncontroversial is that the evidence points to a combination of biological and psychodynamic dispositions to homosexuality, probably with a dominant influence of psychodynamic features in most cases; again, the same can safely be said about heterosexuality (Friedman, 1988; Kernberg, 1992, 1995a). Finally, there are abundant clinical observations indicating that male homosexuality and female homosexuality show significant differences—as do, once more, male and female heterosexuality. So far some basic agreements: now to the controversies. The first contemporary controversy has to do with whether gender is biologically determined or socially constructed. I think there is abundant evidence to indicate that gender is biologically determined in the sense of the anatomical, neurohormonal, and behavioral aspects that derive from the genetic determination of gender. At the same time, gender is also culturally determined in the sense that the dominant features differentiating masculine and feminine gender role identity are culturally constructed. As for sexual behavior, our current knowledge indicates that it has at least four key components, which complicates the study of homosexuality
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and bisexuality (Maccoby, 1998; Maccoby and Jacklin, 1974; Kernberg, 1995a). First is the intensity of sexual desire, which is controlled, basically, by the level of testosterone in both genders; but complex psychodynamic dispositions may radically inhibit sexual desire even in the presence of absolutely normal biological functioning. Second is core gender identity, reflecting both the subjective sense of being either male or female and the experience of being identified by society as belonging to one or the other gender. Core gender identity begins with sex assignment, although some limited research points to the possibility that biological factors may influence core gender identity as well. Third, gender role identity (the enactment of masculine or feminine roles) is mostly the product of social and cultural factors, although also to some extent of biological factors, particularly the presence or absence of testosterone. Rough-and-tumble play in boys and (to a lesser degree) maternal doll play in girls are influenced by hormonal factors (Friedman and Downey, 1993, 1994). In lower mammals, with the exception of primates, gender coding of differential behaviors of males and females is genetically and hormonally determined and prenatally fixed. In primates, by contrast, early infant-mother interaction powerfully influences sexual behavior (Money and Erhardt, 1972; Bancroft, 1989). The fact that in humans psychodynamic and psychosocial factors are by far dominant in establishing gender role identity fits with this evolutionary perspective. Although dominant features differentiating masculine and feminine gender role identity are culturally constructed (Maccoby and Jacklin, 1974; Chodorow, 1978, 1994), from a psychodynamic viewpoint, the crucial aspects of gender role identity, which derive from unconscious identification with both parents, do not say anything about masculinity and femininity except that they represent identification with paternal and maternal images, respectively. In other words, insofar as the characterological constellation contains identifications with both parental images, what may be called masculine or feminine depends on whether it stems from father or mother; and they, in turn, present characteristics that they have taken over through identification from their own parental images and that may be mixed. Masculinity and femininity, therefore, contain relatively stable biological and sociocultural elements and highly variable psychodynamically determined identification aspects. The fourth component is object choice, the most crucial aspect of all the controversies regarding homosexuality and also the area of behavior
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about which our ignorance is greatest. The persistent taboo regarding research on child sexuality has kept this field unexplored, with the exception of retrospective insights into early childhood derived from adult analysis and the direct clinical experience of child analysis. Psychoanalysis, in this regard, has a well-deserved central role in the elucidation of this major area of our exploration of homosexuality. It is the perceived gender (based on the enactment of gender role) of the object of sexual (erotic) desire that defines one’s heterosexuality, homosexuality, or bisexuality. From the viewpoint of object relations theory, it seems reasonable to assume that object choice is determined in parallel with the establishment of core gender identity (Kernberg, 1995a). In other words, fixation on an object of erotic desire carries with it, psychologically, a definition of the sexual self in relating to that particular object: here we come to a central, and controversial, area of contemporary psychoanalytic theory. Freud (1905b, 1923) postulated a psychological bisexuality derived from unconscious identification with both parental images in the positive and negative oedipal constellation. This proposal has survived to this day, supported by clinical experience with both heterosexual and homosexual patients in terms of their unconscious identification with aspects of both parents. Usually there is a clear dominance of the unconscious identification with the parent with whom more severe conflicts existed in the past, regardless of the gender of that parent. In this connection, an unconscious bisexuality—that is, unconscious identification with both parental figures— emerges as a crucial determinant of core gender identity as well as gender role identity. In my experience, unconscious identifications with both parental images and aspects of their sexual identity is a universal finding in clinical psychoanalysis. I am fully aware that the experimental studies of Friedman and Downey (1993, 1994) have not been able to confirm this, but there are important methodological questions unresolved in this area, and the corresponding empirical research is only in its beginnings. Phyllis Tyson (1994) has described the combination of a primary vaginal genitality in the little girl and her unconscious identification with paternal and maternal features as the “bedrock,” respectively, of core gender identity and gender role identity. Laplanche (1992), in describing the unconscious selective erotization of the little boy and the little girl in the mother-infant relationship, has provided a contemporary theoretical frame for these developments. If we assume that an unconscious primitive bisexuality is universal, we
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may also assume the universality of homosexual as well as heterosexual tendencies. A derivative hypothesis would be that, on the basis of such bisexuality, psychodynamic as well as biological features might shift object choice in a homosexual or heterosexual direction or, lacking a fixed object choice, a bisexual orientation. In practice, we would expect a spectrum regarding object choice within each gender, from exclusive homosexuality to exclusive heterosexuality, with an intermediate bisexual area (Kernberg, 1992). The predisposition toward one orientation and its reinforcement by social and cultural pressures might determine the relative strength of the fixation in one or another segment of this spectrum. For example, a socially fostered male bisexuality within strict conventional regulations was prominent in ancient Greece, and anthropological observations have suggested a direct relation between a culture presenting exclusive male homosexuality, on the one hand, and conventionally suppressed homosexuality within such a culture, on the other (Bancroft, 1989). Before we explore the clinical aspects of bisexuality, it may be helpful to clarify the controversy around the definition of the term. Now almost fashionably used in discussions of alternate sexual lifestyles, the term has become controversial because of the confusing uses to which it has been put. The various conditions described as bisexuality reveal a lack of clarity in relating this concept to the four basic components of sexual behavior (core gender identity, gender role identity, object choice, and intensity of erotic desire). Freud’s original use of the term (1905b) referred to bisexuality as a basic, original psychic disposition derived from unconscious identification with aspects of the parental images of both genders. His hypothesis points to the impossibility of differentiating masculinity from femininity on a purely psychodynamic basis, in contrast to both the biological definition of gender and the cultural construct of conventionally assumed—and promoted—characteristics of masculinity and femininity. More recently, the term bisexuality has been used to refer to habitual or extended object choice of both genders—that is, the coexistence of homosexual and heterosexual object choice (Friedman, 1988). In this definition, bisexuality, in effect, is a behavior that can be observed in typical constellations and that appears in different contexts in men and women. In a brief summary of these differences, I have proposed (1992, 1995a) that bisexual object choice is characteristic of late-onset homosexuality in women, usually in the context of neurotic or normal personality organization. In contrast, most of the bisexual men I have diagnostically evaluated
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and/or treated have presented the syndrome of identity diffusion and severe character pathology. This may not be the case in situations such as prisons, where previously exclusively heterosexual men may show transitory homosexual behavior. The confusion regarding the term bisexuality derives from the fact that in the psychoanalytic literature it is often used to refer interchangeably to the original psychological bisexuality in a Freudian sense, to bisexual object choice, and even to an assumed characteristic of core gender identity. This last usage appears particularly in feminist literature (Layton, 2000). It needs to be clarified that, from a clinical viewpoint, bisexual behavior in adults is never seen in the absence of a clear core gender identity. In other words, there is no such condition as bisexual core gender identity. Children with gender identity disorder show bisexual characteristics in their gender role behavior, but they do have a clear core gender identity, as do the adults with bisexual behavior seen in the clinic. Unconscious psychological bisexuality, we might say, is the common matrix out of which, presumably by dominant assignment (although we may not yet discard biological features), core gender identity emerges in the first three years of life (Stoller, 1968). From a clinical viewpoint, then, bisexuality should refer only to object choice and should be clearly differentiated from the psychoanalytic hypothesis of a basic psychological bisexuality derived from identification with features of both parents. In the consulting room bisexuality looks different in men and women. In the case of women, we find an elective bisexuality, a late-onset homosexuality that is usually preceded by and may revert to a heterosexual lifestyle. This group includes women who present a normal or neurotic personality organization, are well adjusted in all or most areas of their lives, and usually would not need to come for treatment. This observation dovetails with the greater tolerance women have of their homosexual impulses, as illustrated by the flexibility in engaging in homosexual encounters in the context of group sex, in contrast to the panic of heterosexual men when approached homosexually in such group-sex situations (Kernberg, 1995a). Such a transitional zone of bisexuality is not present in men who seek treatment. Their bisexuality usually presents in the context of severe character pathology, with identity diffusion, and most frequently in a narcissistic personality structure. Men with this type of sexuality need to be differentiated, of course, from men with a clear homosexual identity who have attempted, over many years, to fit into a heterosexual pattern in response to
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socially and/or psychodynamically determined pressures. In healthier men there may be suppression of that potentially flexible area of bisexuality that can be observed in women. The explanation for the difference between the sexes in tolerance of homosexual impulses in the context of a heterosexual identity (relevant for the difference in bisexual behavior) has both psychodynamic and cultural features. From a psychodynamic viewpoint, it has been proposed that, because men have to abandon a primary identification with mother, their core gender identity is less secure than that of women, who are maintaining their primary identification with mother (Stoller, 1968, 1985). This hypothesis, however, has been challenged by several psychoanalytic authors, who propose that mother unconsciously treats her male and female infants in differentiated ways from the beginning of life (Braunschweig and Fain, 1971). From the viewpoint of cultural influences, traditional patriarchic societies have designated male homosexuality and female infidelity the major taboos of the social order, in contrast to matriarchal societies, where father-daughter incest and male infidelity are the major taboos. The implication, then, would be that it is the social bias against and suppression of male homosexuality that lead to the suppression of bisexual features in men who are not exclusively heterosexual, while a bisexual spectrum in the case of women is socially tolerated. In any case, it seems reasonable to propose that, among chronically bisexual men and women, the majority probably have significant character pathology, as indicated by their restricted capacity to commit themselves to one type of object choice; but the “normal” intermediate zone of the total spectrum from homosexuality to heterosexuality is still a theoretical possibility to be explored. The proposed combination of biological and psychodynamic determinants of the homosexualities and the influence of early developmental features and cultural pressures on the differential characteristics of male and female bisexuality are challenged by the ideologies of both traditional psychoanalysis and homosexual organizations. For the latter, there is great attractiveness in the notion of a biologically determined homosexuality as a normal alternative to heterosexual identity, a view that corresponds to some culturalist psychoanalytic approaches, such as Morgenthaler’s assumption of normal alternative pathways for sexual identity and object choice (Isay, 1989; Morgenthaler, 1980). On the other side, a traditional psychoanalytic viewpoint strongly maintained by the French psychoanalytic mainstream postulates that, insofar as the normal resolution of the Oedipus complex implies identification
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with a parent of the same gender in his or her heterosexual orientation as well as in the disposition to motherhood or fatherhood, a homosexual identity always implies the incapacity to identify fully with that oedipal figure and indicates a failure to resolve the Oedipus complex (ChasseguetSmirgel, 1970, 1986). A corollary of that position is that homosexual object choice always implies a dominance of narcissistic defenses against unresolved oedipal conflicts. Meanwhile, the older psychoanalytic view, which included homosexuality with the perversions, has mostly been abandoned in the recent literature (although a few adherents remain in the field, such as Socarides [1978]). How is such a clash of opposing theoretical commitments to be resolved? In my view, advances in our knowledge of the biological and psychodynamic contributions to core gender identity, gender role identity, and object choice should gradually clarify the relative importance of biological and psychodynamic features and facilitate the differentiation of psychodynamic features from sociocultural ones as well. In this connection, research on children with gender identity disorder has provided evidence of a high correlation of such disorders with severely traumatic experiences, probably present in approximately 68 percent of these cases. A large proportion of male children with gender identity disorder develop a homosexual identity later on: about 70 percent do so without treatment (Coates et al., 1991; Coates, 1992). The majority of male homosexuals who come for treatment, however, do not present a history of gender identity disorder, and there is no evidence of a genetic component of gender identity disorder (Green, 1985). At the same time, research points to a definite genetic component in at least a subgroup of male homosexuals; this entire line of research, however, is far from being concluded (Friedman and Downey, 1993, 1994). From a psychoanalytic perspective, the hypothesis that “normal homosexuality” underlies a spectrum of sexual orientation ranging from the homosexual to the heterosexual with a bisexual intermediate zone may be indirectly evaluated by the study of the psychoanalytic treatment of homosexual patients who do not present significant psychopathology to begin with. These might be analysands who seek treatment for training purposes or out of a belief that their homosexuality per se requires treatment or in the aftermath of a failed love relationship. If, at the end of such treatment, their homosexuality is unaffected while they are able to function in a full and satisfactory way in all areas of their life experience, with a rich love life that integrates erotic and tender components, an object relation in depth with their sexual partner, without manifestations of severe repression or denial
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of heterosexual impulses, and with the capacity for a broad range of meaningful relationships with both genders, the notion of homosexuality as an illness by definition would become highly questionable. In fact, with the acceptance of homosexual candidates in psychoanalytic training in this country and abroad, we do have a way to test this hypothesis. Beyond the criterion mentioned above, we may evaluate the capacity of such candidates to identify with the unconscious conflicts of patients of both genders in a sufficiently sublimatory way to be able to become psychoanalysts with as few (or as many) blind spots as the traditional “well-analyzed” heterosexual candidate. This viewpoint implies a critique of those homosexual psychoanalysts who imply that only a male homosexual analyst can optimally analyze a male homosexual patient (Isay, 1989), a position that reminds one of the equally problematic assumption that women analysts should analyze women patients, or that women should analyze patients with predominantly preoedipal issues, and so forth. Let us now review briefly some dominant psychodynamics that emerge in the psychoanalysis of homosexual patients in comparison with the corresponding psychodynamics of heterosexual patients. I have proposed in earlier work (Kernberg, 1992) that the prognosis of male homosexual patients in psychoanalytic treatment depends on the severity of their character pathology, an opinion I still hold. From this perspective, homosexual patients with a neurotic personality organization have an excellent prognosis for psychoanalytic treatment. In these cases the psychodynamics originally described by Freud are usually dominant: a predominance of oedipal conflicts, a reinforcement of the negative oedipal complex as a defense against castration anxiety, with a typical split of the paternal image into an idealized one—to which an erotic submission or allegiance protects the patient against the terror of a split-off, sadistic, and castrating paternal image— and a profound prohibition against sexual impulses toward the oedipal maternal image. A defensive idealization of anal sexuality as a regression from a predominant genital sexuality complements this constellation. This dynamic usually overlaps with an unconscious identification with a maternal figure in an unconscious bid for father’s love, an identification powerfully reinforced in cases where a severely rejecting maternal image determines a primitive split of that image. This split involves a persecutory and castrating female image, determining horror of and disgust with the female genitals, and an idealized one, with the erotic disposition to mother displaced toward or condensed with the idealized father image. Many of these cases reveal a relatively weak identification with the parental power of
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the oedipal paternal image and a tendency to adopt female gender role characteristics as the counterpart to rejecting male gender role features. The question can be raised, to what extent do all these conflicts obscure a primary dominance of the negative Oedipus complex—that is, a primary love for father that transfers the earliest loving relationship from mother to a nonconflictual homosexual object choice (Isay, 1989; Morgenthaler, 1980)? I believe it is fair to say that ideological biases and theoretical preconceptions may tilt the balance of the analytic conviction regarding how much is primary homoeroticism and how much is conflictual, defensive reactivation of the negative oedipal conflict under the impact of castration anxiety. Male homosexual patients with a borderline personality organization show the condensation of oedipal and preoedipal conflicts typical of the entire borderline field. It could be argued that gender identity disturbance is a natural consequence of the syndrome of identity diffusion. Most children with gender identity disorders, however, do not present borderline personality organization in spite of the fact that severe trauma is a crucial etiological factor in those cases. Therefore, the dominant homosexual orientation in patients with gender identity disorder should not be ascribed to the general psychodynamics of borderline personality organization alone. In contrast, homosexual patients who present a predominantly oral orientation toward the idealized father, with severe and pervasive conflicts of hostility toward the preoedipal mother, constitute a specific syndrome of male homosexuality linked to borderline personality organization. Here the childlike, dependent, clinging relationship to the male partner, in the context of general emotional immaturity and lability, replicates the clinging nature of chaotic love relations of heterosexual borderline patients. A third and quite characteristic constellation is that of male homosexuality in a narcissistic personality structure, with a defensive idealization of the homosexual relationship as the counterpart to an aggressive devaluation of women and an alternation between exploitive tendencies toward a “mirror image” erotic partner and the incapacity for any stable erotic engagement as part of a general incapacity for any object relation in depth. Paradoxically, the relationship of such narcissistic homosexual men with women may appear on the surface to be more stable and adaptive than that of the borderline homosexual patient with an unconscious identification with a dependent, clinging infant relating to a maternalized father image. In this latter case, a chaotic relationship to women, with frail desexualized idealization, on the one hand, and aggressive devaluation of women, on the
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other, may go hand in hand with a caricaturized identification with female gender role features that hides a profound aggression toward women. This overall chaos in the object relations of male homosexual borderline patients contrasts with the apparent stability of the narcissistic type. The prognosis for the treatment of this spectrum of characterological constellations is quite similar to that for the corresponding heterosexual patients, and the dynamics overlap to a large extent. The most severe category of male homosexuality manifests malignant narcissism, a syndrome that presents virtually the same dynamic characteristics as heterosexual malignant narcissism. Male antisocial personality disorders of the aggressive type—the homosexual serial killers—share the clinical characteristics and “null” prognosis for treatment of heterosexual antisocial personalities who are serial killers. In short, it is the severity of the personality pathology that determines the prognosis. From a theoretical viewpoint, the main issue involved in all these psychodynamic features of male homosexuality, as underlined by Isay, is the question of the existence of a primary love for father. Is there an original, “negative” Oedipus complex that only secondarily is complicated by castration anxiety and that leads to pathological distortions because of a superimposed, culturally determined homophobia? Or, to the contrary, should we accept the theoretical assumption of a primary positive Oedipus complex evoked in the unconscious seduction of the male baby by mother as part of the universal process of maternal “general seduction,” as proposed by Laplanche (1992)? Turning to female homosexuality, the most important question raised by those who postulate a primary homosexual orientation in the little girl is the same “general seduction” theory that is involved in the mother-infant relationship and the eroticization of the infant’s body in both genders. According to Braunschweig and Fain (1971), such unconscious eroticization by mother operates fully in the case of the relationship of the mother and the infant boy and is restricted in the case of the relationship of the mother and her infant daughter. Mother unconsciously avoids stimulation of the little girl’s genitals and treats her as a narcissistic replica of herself; in contrast, she treats her little boy as an alternative sexual object unconsciously representing her own father. Eva Poluda, in a recent comprehensive review of the psychodynamics of female homosexuality (2000), stresses the primary, unconscious, homophobic attitude of mother as a determinant of the little girl’s turning from mother to father. Poluda, reviewing the contributions of Freud (1905b,
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1920b), Chasseguet-Smirgel (1970), McDougall (1964, 1986), Halenta (1993), Siegel (1988), and Kestenberg (1986, 1993), concludes that a primary, “negative” Oedipus complex is a universal disposition in women, inhibited by mother’s unconscious homophobic defense and leading secondarily to the various psychodynamic constellations described by the authors she quotes. Freud (1920b) described a case of female homosexuality as reflecting the predominance of the negative oedipal complex as a defense against the repressed positive one. Abraham (1920) suggested that, in a reaction to the development of penis envy, which normally would determine the disappointed turning away of the little girl from mother to father, the positive oedipal relationship might be disrupted by the transfer of that disappointment to father, in a situation where the pathological intensity of penis envy would determine an unconscious identification with father’s penis, the devaluation of masculinity, and the development of a masculine, “revenge” type of female homosexuality. In other cases, Abraham proposed that in a disappointed turning away from a rejecting father or in an effort to deny penis envy, the girl’s regressive, submissive erotic idealization of mother might serve both to eliminate oedipal guilt and to avoid competition with the envied father. The implication of these views is that penis envy plays a fundamental etiological role both in the shift of the little girl’s love from mother to father and in the failure of this shift, determined by either excessive preoedipal conflicts reinforcing penis envy or excessive unconscious guilt regarding the positive oedipal complex. Melanie Klein (1945), in her fundamental critique of the primary nature of penis envy, pointed to unconscious envy of the other gender as a universal characteristic of both boys and girls. She also stressed the tendency to escape from severe preoedipal conflicts dominated by aggression into a premature oedipalization that, because of the transfer of preoedipal aggression onto the oedipal object, might fail in turn, leading to a regressive split of the preoedipal object into an idealized and a persecutory image. Klein proposed that the primary, preoedipal conflicts of the little girl with mother may determine the transfer of such conflicts, particularly aggression, to the relationship with father, bringing about excessive penis envy and rejection of the feminine position, a defensive splitting of a maternal image into a persecutory and an idealized one, and a sexual orientation toward such an idealized maternal image. Joyce McDougall (1964, 1986), like Chasseguet-Smirgel and Braunschweig and Fain, focuses on the primary vaginal genitality of the little girl
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and its inhibition under the influence of the selective rejection by the preoedipal mother of the erotic relationship with her little daughter. While implicitly acknowledging a primary homoerotic tendency of the little girl, McDougall stresses the normal shift of the girl’s erotic interest to father in an unconscious identification with mother, the identification with mother’s desire. When this process is disrupted by excessively severe aggressive interactions with mother, it leads to splitting of the maternal image into an idealized and a persecutory one, a defensive erotic submission to the idealized mother representation, and a rejection of the erotically frustrating and unavailable father. Obviously there are many individually differentiated psychodynamics that can be only roughly encompassed by such general statements. However, as Poluda (2000) emphasizes, all the described dynamic constellations of female sexuality share the assumption that the little girl has a primary homoerotic relation to mother that appears to be clearer than the corresponding assertion of the little boy’s primary homoerotic relation to father and may provide part of the explanation of the differential characteristics of female and male homosexuality and bisexuality. In any case, from a clinical viewpoint, we find both some parallel developments and some differences of female and male homosexuality. Female homosexual couples tend to be more stable and less tolerant of promiscuous sexual behavior than male homosexual couples, probably replicating important differences in male and female sexuality that override the differences between homosexual and heterosexual orientations (Kirkpatrick et al., 1981; Bell and Weinberg, 1978; Bell and Hammersmith, 1981). Female homosexuality may present within the context of a neurotic personality organization where relatively clear oedipal dynamics predominate together with a relatively clear differentiation of maternal and paternal images, unconscious guilt over positive oedipal longings, a regressive idealization of the oedipal mother condensed with preoedipal longings toward her, and a predominant female gender role identity. This constellation differs from the unconscious identification with male gender roles characteristic of the “revenge” type described by Abraham, where intense penis envy and resentment against men reflect a condensation of severe aggressive conflicts with both the oedipal father and the preoedipal mother. Female homosexuality in the context of borderline personality organization has similar or parallel features to male homosexuality with a borderline personality organization. Here we find intense ambivalence toward the love object, with rather chaotic splitting of both male and female images
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into idealized and persecutory ones complementing the homosexual object choice. Homosexual women with a narcissistic personality also present characteristics parallel to those of homosexual narcissistic males, with a surface idealization of female bonding, devaluation of men, and problems in developing a relationship in depth similar to problems of narcissistic personalities with heterosexual orientation. As mentioned before, in contrast to these relatively fixed or permanent types of female homosexuality, late-onset female homosexuality occurs in women who have had a dominant, basically nonconflictual heterosexual orientation during significant parts of their life and who, usually after the loss of a spouse through death or divorce or the moving away of the children from home, establish a homosexual relationship, often in the context of a supportive homosexually oriented community. These cases constitute what corresponds to the theoretically normal bisexual spectrum outlined before. The final controversy in this field concerns what is to be expected from the treatment of homosexual and bisexual patients. It is probably not controversial to state that concepts implying that the psychoanalytic treatment of homosexual patients should optimally transform them into heterosexual persons have been abandoned. To the contrary, there seems to be general agreement that the analyst needs to be honestly technically neutral in the sense of helping the patient to consolidate his or her own sexual identity, totally accepting that potential freedom of the patient, and maintaining a selfreflective awareness of the high risk of ideological contamination of the clinical approach in this area. This is a task for both heterosexual and homosexual analysts who analyze homosexual patients, analysts whose particular biases might reduce their technical neutrality by either subtly demeaning or subtly idealizing homosexual solutions. From a clinical viewpoint, the criteria of normality previously referred to should be more than sufficient to consider that analysis of a homosexual patient has been completed, not different from the expectations we have of the analysis of a heterosexual patient. The countertransference complications in treating homosexual patients constitute particular challenges that need to be carefully explored in the analyst’s self-analysis. I have referred to the relationship of the gender of the psychoanalyst with that of the patient in earlier work (Kernberg, 2000b), and see chapter 16 below. Here I want to limit myself to simply stating that what is required is a comfortable relationship of the heterosexual analyst with his or her homosexual tendencies and a comfortable relationship of the homosexual analyst with his or her
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heterosexual tendencies: easier said than done, but an indispensable part of analytic work. After all, the heterosexual analyst analyzing a heterosexual patient of the other gender must be able, at certain points, to identify with the erotic aspirations and fears, the excitement and terror, of that patient: there is no reason that this task, ordinarily demanded of the psychoanalyst, should not be demanded also of the psychoanalyst whose patient’s object choice is homosexual.
5
mourning and melancholia revisited
Mourning and Melancholia (1917) is Freud’s first and fundamental contribution to the psychoanalytic understanding of normal and pathological mourning, the psychopathology of major affective disorders, and the psychodynamic determinants of depression. It also marks major developments in psychoanalytic theory at large, particularly the early formulations of the concept of the superego, the fundamental nature of identification processes, and the role of aggression in psychopathology. It puts forth several strikingly original and fundamental propositions in the theory of the psychopathology of depression, including the central importance of aggression turned against the self when the lost object is invested with intensely ambivalent feelings, the role of the superego in this self-directed aggression, the split in the self revealed in the superego’s attack on the ego, and the fusion of a part of the self with an internalized object as the victim of that attack. Since Freud’s original statement, the contributions of Karl Abraham (1924), Melanie Klein (1940), Edward Bibring (1953), and Edith Jacobson (1971) have helped us to formulate a contemporary psychoanalytic theory of depression. Freud described fundamental differences between normal and pathological mourning processes. In normal mourning, he proposed, there are no guilt feelings regarding the lost object. The work of mourning culminates in This paper, in an earlier version, originally appeared in Changing Ideas in a Changing World: The Revolution in Psychoanalysis: Essays in Honour of Arnold Cooper, edited by Joseph Sandler, Robert Michels, and Peter Fonagy (London: Karnac, 2000), pp. 95– 102. 75
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the introjection of the lost—external—object; the narcissistic gratification of being alive contributes to the successful working through of the mourning process. In melancholia, in contrast, the ambivalent relation to the lost object arouses intense guilt feelings and the turning of the unconscious aggressive attack on the external object into an internal attack on a part of the ego identified with the lost object. This attack on the self prevents the narcissistic gratification of being alive and thus intensifies and prolongs the pathological mourning process. Melanie Klein postulated the splitting, in the mind of the infant, of idealized and persecutory relations with mother and the generation of guilt and depression when integration of these split segments of the ego or self and of the corresponding internal objects would bring about the infant’s awareness that his own aggression was directed against the ideal mother: this is the depressive position. Klein pointed to the normal consolidation of the good internal object and the ego when aggression is not excessive and described how conditions promoting marked dominance of aggressive over libidinal investments prevent such a normal integration. The result is intolerance of ambivalence and lack of assurance of one’s own goodness, creating the predisposition to pathological mourning and melancholia. In contrast to Freud, Klein felt that in normal mourning there was an unconscious process of reinstating the early good internal object and that ambivalence characterized normality as well as pathology. Normal mourning, she proposed, includes unconscious guilt feelings related to the reactivation of the depressive position, together with the activation of reparative urges, gratitude, and longing for the lost good object. It is completed, she suggested, not only by the introjection of the good external object but also by the reinstatement of the good internal one. Pathological mourning is characterized by the failure to work through the depressive position due to the sadism and cruelty of the superego, its demands for perfection, and its hatred of instincts. In melancholia, Klein stated, this hatred has destructive consequences for both the internal and the external good objects, leading to a sense of internal emptiness and loss. Because of the attack on and destruction of the idealized object, a vicious circle of guilt evolves, with an attack on the bad self, not on the internalized object. Suicide would be an unconscious effort to destroy the bad self and rescue the good object. Edward Bibring (1953) described depression as the result of acknowledgment of the loss of an ideal state of self in the context of a severe discrepancy between the ideal self and the real self. This pointed to the affect of
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depression as an ego potential predating the differentiation of the superego from the ego. In contrast to the Kleinian view that depression necessarily involves superego mechanisms, Bibring stressed the early emergence of the loss of an ideal state of self under conditions of severe failure of the protective environment, thus foreshadowing, I suggest, the catastrophic reaction to prolonged early separation described by Bowlby (1969) in the pathology of attachment. A potential for depressive affect, triggered by the loss of an ideal state of self, may be caused by early maternal failure as well as by a later internal, superego determined attack on the self. The basic mechanism is a loss of an ideal state of self related to the loss of an ideal object. In my view, the potential for the affective reaction of depression to loss of an ideal ego or self state is compatible with Melanie Klein’s description (1946) of the depressive position when the aggression stemming from the self can be acknowledged, when ambivalence can be tolerated, and when the implicit comparison between a past illusory, split-off, idealized self and the realistic, integrated, present one signals the loss of that ideal self state. Edith Jacobson’s analysis (1971) of normal, neurotic, borderline, and psychotic depression mapped out a comprehensive psychoanalytic theory of the psychopathology of depression. In describing the dyadic, internalized object relations reflected in the affective connection between libidinally invested self and object representations and the corresponding aggressively invested self and object representations, she originated what I consider the contemporary object relations theory model in psychoanalysis. I believe that she accomplished this independently from, although at the same time as, Ronald Fairbairn in Scotland. Jacobson described the originally fused or undifferentiated units of self and object representations in both the libidinal and the aggressive domains of experience and the defensive refusion of libidinal self and object representations under conditions of psychotic regression. In psychotic depression, this regressive refusion would also affect the aggressively invested self and object representations in the ego and would also involve a refusion of the earliest aggressive superego precursors with the later idealized ones. It is the regressive fusion of persecutory and idealized object representations in the superego, she proposed, that brings about the sadistic demand for perfection and the typical cruelty of the superego in melancholia. The attacks of this sadistic superego are directed toward the units of fused aggressive self and object representations in the ego. In the process, the frail remnant of the idealized segment of the self that was overwhelmed in the total refusion process occurring in the ego
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succumbs to the generalized activation of guilt, despair, and self-accusation. As a consequence, the nihilistic, hypochondriacal, and self-devaluing delusions of psychotic depression evolve. Jacobson proposed that in borderline conditions the boundaries between self and object representations in both libidinal and aggressive domains of internalized object relations persist, facilitating the defensive processes of dissociation, depersonalization, and projection that help these patients avoid the sadistic superego attacks characteristic of depression. In neurotic depression, a sufficiently well integrated self relating to integrated representations of significant others still experiences the attacks of the superego in the form of exaggerated, pathological guilt and self-devaluation, but such a self suffers neither the fusion processes that, in melancholia, transform guilt into a total delusional devaluation of the self identified with the object nor the primitive defenses characteristic of borderline conditions. In all these psychoanalytic theories of depression except Bibring’s, depressive affect emerges as the connection between the basic experience of loss of an ideal state of self as the result of the loss of an object and the assumption that the loss of the object itself was caused by one’s own aggression. The empirical research of John Bowlby (1969) and his followers on normal attachment and its pathology and their description of the stages of protest, despair, and detachment as a result of catastrophically prolonged separation of the infant from mother provided a fundamental link between the psychoanalytic theory of depression, on the one hand, and the reaction to early separation, on the other. Depressive affect as a basic psychophysiological reaction is triggered by early separation from mother, if excessive or traumatic, and similarly by an internal sense of loss of the relation between the self and the good internal object derived from the superego’s attack on the self. Early separations provoke depressive affects, a chain reaction of rage, despair, and despondency, and their neurohormonal correlates, in humans as well as other primates (Suomi, 1995). This link between felt emotion and neurochemical response begins to connect the psychoanalytic theory of internalized object relations with biological research into the genetic and neurobiological determinants of aggressive and depressive affect. Freud (1917) had speculated on the organic determinants of the circadian nature of melancholic illness. Contemporary research on the genetic disposition to major affective illness, its potential relation to abnormality in the noradrenergic and serotinergic systems regulating depressive affect, and the hyperactivity of the hypothalamic-pituitary-adrenal systems in depres-
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sion and under conditions of stress has opened the field for study of the biological determinants of affect and of depressive affect as the bridge between biological and psychodynamic determinants of depression as a clinical phenomenon (Nemeroff et al., 1997). Prolonged separation of the infant from mother powerfully activates the affects of rage first, despair later, and, under extreme circumstances, despondency and reduction of the capacity for object relatedness. Neurobiological studies in both humans and other mammals have confirmed the corresponding activation of the hypothalamus-pituitary-adrenal (HPA) axis, the resulting hypercortisolemia, and, more recently, the resulting longrange consequences in terms of lowered blood cortisol, excessive stress response to later traumatic stimuli, and reduction in the hippocampal volume, the brain structure most directly involved in explicit affective memory (Panksepp, 1998). The mechanism by which the HPA stress response activates the basic affective responses of rage, panic, and depression are still insufficiently elucidated, although the brain structures mediating rage and pain have been circumscribed more clearly. As Jaak Panksepp (1998) points out, the complexity of affect activation demands the simultaneous analysis of the brain structures involved—the generally activating biogenic amines (particularly, in the case of depression, the serotonergic and noradrenergic systems), but also particular neuropeptides related to specific affect systems that are as yet only partially known—in the context of the analysis of behavioral manifestations and subjective experience. Basic autonomous vegetative functions of affects involve the hypothalamus, the amygdala, and the periaqueductal gray; early emotional experience involves the amygdala, the hippocampus, and the ventral striatum; but mature emotionality, with the development of complex later emotions, involves the prefrontal cortex along with cognitive control of emotions mediated particularly by the orbital, frontal, and cingulate cortex. At this time psychoanalysis and neurobiology are still too far apart in their focus and methodology to permit any satisfactory integration. I believe, however, that it is now reasonable to assume that the psychopathology of depression is determined by a complementary set of etiological factors. These include, on the biological side, an abnormal, genetically determined, and neurochemically controlled activation of the affect of depression under conditions of early separation and object loss, most probably mediated by abnormal biogenic amine systems. Early, severely traumatic circumstances, particularly failed or insecure attachment, further contribute, triggering
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not only exaggerated stress response but a disposition to later excessive activation of negative, particularly depressive affect, mediated by the corresponding hypercortisolemia and, presumably, by the loss of the modulating influence of the hippocampus—affective memory—on deeper affect-activating centers. On the psychological side, depressive affect is activated by loss of the ideal state of self when anxiety is aroused by need and seeking gratification fails to produce the expected maternal response; and later, when active rejection by an ideal object is no longer perceived as an external attack but resonates with the internal buildup of archaic superego structures. Here what is relevant is the buildup of complex affective memory structures that are symbolically manipulated unconsciously and integrated, leading to the concepts of self and the world of internalized object representations. The extraordinary richness of the human neocortical brain structures constitutes the basis for this evolution of psychological structures. In short, on the psychological side, the development of pathological ego and superego structures in response to the aggressive affects activated by a hostile, depriving, abusive environment, with the consequent threat to the normal dominance of libidinally invested internalized object relations in ego and superego over those invested with aggression, determines the potential for pathological depression. The work of Melanie Klein and Edith Jacobson has enriched the analysis of normal and pathological depressive reactions by delineating the role of the primitive defensive operations of splitting, idealization, projection and introjection, projective identification, denial, omnipotence, and devaluation. Both authors described a vicious cycle of early aggressive response to frustration, the infant’s tendency to project his own aggression onto the frustrating object, and the re-internalization of that aggressively perceived object into the basic layer of the early superego in the form of persecutory internalized object representations. A constitutional disposition to excessive depressive affect may contribute significantly to the intensity of depressive response to superego-mediated attacks on the self. These vicissitudes of early aggression complement the vicissitudes of normal and pathological withdrawal of libidinal investment from the lost objects spelled out by Freud in Mourning and Melancholia. While Freud pointed to the crucial function of aggression toward the object in melancholia, his dual-drive theory had not yet been formulated, and the theory of the superego had only very recently emerged. Both the structural development of the superego, so brilliantly described by Edith Jacobson, and the vi-
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cissitudes of the aggressive drive, spelled out by Melanie Klein and Freud himself, were important components of the evolving theory of depression. IDENTIFICATION
Perhaps the major theoretical formulation initiated in Mourning and Melancholia, transcending the subject of depression, is the concept of identification. Here, I believe, the work of Fairbairn (1954) and Jacobson (1964), who arrived independently at remarkably similar conclusions regarding this essential mechanism, provides major contributions to Freud’s original observations in Mourning and Melancholia (1917), Group Psychology and the Analysis of the Ego (1921b), and The Ego and the Id (1923). Briefly summarizing how I conceptualize the contemporary view of identification, I would stress as a central concept the definition of identification as the internalization of a representation of the object interacting with a representation of the self under the impact of an intense affect. The more intense the affect, the more significant the object relation, and the more significant the object relation, the more intense the affect state. This theory of identification overlaps with the theory of the centrality of depressive affect in normal and pathological mourning: the more intense the predisposition to react with depressive affect to separation or loss, the more powerful the identification with an abandoning object and with an abandoned self. The more profound the experience of rejection or loss of a good external or internal object, the greater the potential for depression. Whether one accepts Jacobson’s proposal that libido and aggression always enter psychic structures as libidinal or aggressive affects linking self with object representations, or Fairbairn’s proposal that libidinal investments of internalized object relations (in the form of libidinal self and object representations) constitute the basic human response, with aggressive investments of internalized object relations developing only in response to a frustration of basic libidinal needs, or my conception (Kernberg, 1992) of libidinal and aggressive drives as the hierarchically supraordinate integration of corresponding basic libidinal and aggressive affects, the concept of identification as the internalization of a significant object relationship (the identification being with the interaction of self and object and not only with the object or the self in that interaction) constitutes a common ground. This concept permits us to conceive of the development of ego and superego structures as resulting from a progressive integration of dyadic units of self representation–object representation–affect state. Ego structures would thus include an integrated concept of the self and integrated
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concepts of significant others with whom the self is in internalized interaction. Superego structures would include integrated layers of persecutory, idealized, and realistic internalized object relations. There would be a buildup of idealized object representations in both ego and superego, with the idealized representations of self and objects in the superego jointly constituting the ego ideal and such representations in the ego representing desired or aspired to aspects of self and of relations with significant others. The most intense, intolerable aggressive and sexualized dyadic units would be repressed, becoming part of the id. In short, the dyadic units of internalized object relations constitute the building blocks of ego, superego, and id. This concept explains the typical enactment by borderline patients, at different times, of an identification with the self representation while projecting the corresponding object representation onto the therapist, or with the object representation while projecting the self representation onto him. It also accounts for the corresponding mechanisms of identification with the aggressor, the transformation of passive into active, and the dynamics of omnipotent control and projective identification in the transference. Identification with the relationship between self and object also explains the consistent loss of a state of ideal self with the loss of an ideal, good object. Returning once more to the determinants of normal and pathological depression, we can now conceive of a genetic disposition to pathological activation of aggressive affects that will be integrated into the aggressive drive in the form of a structured sense of self or object as victim or persecutor, self and object bound by affects of fear, rage, and despair. The result is proneness to the excessive activation of rage, anxiety, and despair under conditions of frustration and object loss. It is important to keep in mind that the stress response mediated by the activation of the HPA axis includes intensive rage and panic as well as the disposition to depression. In fact, the combination of an intense rage response and panic may be the origin of the later structured internalized relation between a rageful self and a frustrating, sadistic object. The projection of rage onto the object intensifies the fear and wish to destroy the persecutory object, thus transforming rage into hatred, a complex affect that will later constitute the core affect of the aggressive drive. Here I refer to my theory, spelled out in earlier work (1992), that the libidinal and aggressive drives are hierarchically superordinate integrations of the libidinal and aggressive affects, respectively, and that affects constitute the primary motivational systems first and, later, the signals of the drives in terms of the affective quality of reactivated internalized object relations. I believe that this theory does justice to the convincing clinical im-
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plication of Freud’s dual-drive theory and to the emerging knowledge of the fundamental motivational functions of affects in neurobiology. Temperament as a genetically determined, constitutionally given disposition to a certain intensity, rhythm, and threshold of affect activation links the innate disposition to aggression with the traumatic impact of early separation, trauma, and frustration on the internalization of object relations. By far the most important determinant of the internalized object relations expressed in the tripartite psychic structure is the earliest mother-infant interaction. This early interaction, however, is not necessarily “pregenital” and may include early development of eroticism and sadomasochism in the context of an archaic Oedipus complex (ChasseguetSmirgel, 1986). Severe frustration and trauma in this early interaction, with consequent excessive activation of aggressive and depressive affect, would then give rise to the structural consolidation of a psychic apparatus with a “hypertrophic” superego and the predisposition to react with depression to relatively minor triggering factors from the environment. An extremely severe inborn disposition to depressive affect would exacerbate the development of such pathological structures. At the other extreme, even without any genetic disposition, the structural consequences of severe frustration and trauma, with a consequent activation of excessive aggression, would contribute to the buildup of a severely pathological, though well integrated, superego structure predisposing to depression in later life. A depressive-masochistic personality structure predisposes to characterological depression and to a loss of normal self-esteem, determined by the superego, under conditions of multiple sources of unconscious guilt. This is the counterpart to the activation of anxiety as a nonspecific manifestation of danger derived from unconscious intrapsychic conflict (Kernberg, 1992). Anxiety, in fact, also may function as a warning of the impending danger of unconscious guilt and object loss leading to depression. Mourning and Melancholia points to the central importance of pathologically intense ambivalence, self-directed aggression, severe pathology of internalized object relations, and a constitutional disposition to the activation of depressive affect. It is remarkable how these basic components of Freud’s contribution continue to occupy the very center of our psychoanalytic theory of depressive pathology. Edith Jacobson’s definition (1971) of moods as generalized affects that, for a period of time, impact the entire world of internalized object relations points to the mutual reinforcement of the two major etiological factors in depression: the intensity of depressive affect and the pathology of internalized object relations.
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Once depressive affect is structured into an internalized object relations frame that reflects the relationship between a guilty, internally abandoned self and an idealized abandoning or critical object, it would seem reasonable to hypothesize that any critique, disqualification, or abandonment in everyday life would immediately activate depressive affect as part of such an object relation. And vice versa: when, given such a structured internalized object relation, depressive affect is triggered or accentuated by a constitutional disposition to pathological affect activation, the entire constellation of intensive guilt feelings, self-devaluations, and the experience of abandonment will be activated as well. Insofar as the pathology of internalized object relations and of depressive affect both relate to the psychopathology of aggression, a major and controversial issue in contemporary psychoanalytic thinking is the relationship of aggressive drive, affects, and object relations. The sharp division between psychoanalytic object relations theories that reject the concept of drives and those that affirm their central motivational nature constitutes a major focus of contemporary psychoanalytic theory development. Throughout my work in this area, I have stressed my conviction of the compatibility and complementarity of the dual-drive theory and the theory of structure formation by internalized object relations. The concept of the relationship between affects as instinctive components and drives as hierarchically supraordinate motivational systems, I believe, does justice to the unconscious motivational forces described by Freud while beginning to integrate psychoanalysis and neurobiology through the analysis of the determinants and vicissitudes of affects. Such an integration is relevant for the contemporary approach to the treatment of depressive psychopathology. It points to the possibility of integrating psychoanalytic psychotherapy with psychopharmacological approaches to major affective illness while limiting the psychopharmacological treatment of atypical depression, characterological depression, and pathological mourning reactions to cases of severe depression that seem unapproachable with standard psychoanalytic treatment or psychoanalytic psychotherapy. In practice, the approach to most cases with neurotic depression—that is, the vast majority of patients with characterologically determined depressive reaction—should be psychoanalytic, focusing on their superego pathology and the vicissitudes of the unconscious conflicts, structured into internalized object relations, that are reactivated in the transference. The major emphasis in this presentation has been on the attempt to in-
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tegrate the psychoanalytic approach to depression with evolving knowledge regarding the neurobiology of depression. For neurobiology, contemporary psychoanalytic theory offers an instrumental approach to higher symbolic functions that cannot be reduced to neocortical circuitry. For psychoanalysis, neurobiological progress offers the challenge of reexamining older theories of drives, the impact of neurobiological structures on stress and trauma, and the mutual relations of unconscious interpsychic conflict and the genetic and temperamental disposition to depressive affect as causes of depression. Freud was acutely aware of developments in the neurosciences of his time, as his impressive work on aphasia and his later shift to theorizing about drives and affects attest. What would his theories of drives be if his monumental discoveries were made today? Would he still, and very reasonably, insist on his dual-drive theory as essential to unravel the mystery of unconscious intrapsychic conflicts, while considering the psychophysiological structures of affect as the intermediate link between biological and intrapsychic structures, the building blocks of the drives? And what is our responsibility for the elaboration of Freud’s scientific discoveries in the context of ongoing developments in the sciences at the boundary of psychoanalysis? Many years after Freud published Mourning and Melancholia, the fundamental truth of his findings remains evident, illuminating our basic understanding of depression as aggression turned against the self. Unconscious aggression against the self, mediated by the superego, is a common thread throughout the entire spectrum of depressive illness, permitting us to understand the psychodynamics of individual cases as well as to employ psychoanalytic and psychotherapeutic strategies to deal with this major area of human suffering.
6
resistances to research in psychoanalysis
The classical definition of psychoanalysis describes it as a theory of mental functioning, a means of investigating the human mind, and a method of treatment. Significant questions have been raised that signify an urgent need for more intense, consistent, and comprehensive research in all three of these domains. In the area of theory, the classical psychoanalytic metapsychology has been challenged by the explosion of knowledge in the biological sciences. The theory of drives as fundamental motivators of human behavior and psychoanalytic theories of the origins and structure of psychic functioning, psychopathology, and psychic change need to be integrated with the implications of current research in neuroscience as well as in psychiatry, psychology, and sociology. New findings about the relationship between exploration of the dynamic unconscious, the lifting of repressions as contrasted to the effects of suggestion, and the effects of the interactive therapeutic process on exploration of the unconscious have raised important scientific challenges to psychoanalysis as an instrument of investigating human functioning. The efficacy of treatment by psychotherapeutic methods derived from psychoanalysis, as well as such nonanalytic treatments as cognitive, behavioral, and nonverbal therapies, has yet to be systematically compared with that of psychoanalysis. Recognition of the nonspecific effects of various psychological treatments and of the complex relation between treatment process and treatment outcome poses challenging research questions Originally published in Psychoanalysen im Rückblick: Methoden, Ergebnisse und Perspektiven der neueren Katamneseforschung (Giessen: Psychosozial-Verlag, 1997), pp. 39 –45. 86
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regarding psychoanalysis as an agent of structural psychic change and the indications and limitations of psychoanalysis as a treatment method. Given these challenges, the advances in scientific knowledge in boundary fields, and new developments in the practice of psychoanalytic treatment itself, it is puzzling that significant resistance to psychoanalytic research persists within the psychoanalytic community itself. What follows is an attempt to examine and understand common reservations about psychoanalytic research in the international psychoanalytic community. Perhaps the main reservation stems from appreciation of the complexity of the psychoanalytic theory of mental functioning, the theory of psychoanalytic technique, and the rationale of actual clinical interventions. In fact, it has been questioned whether psychoanalytic procedures may accurately be subsumed under theories of “technique” rather than considered to be aspects of a method that cannot be described with any precision, given the complexity of the interactional field involving patient and analyst. This leads, in turn, to consideration of the complexity of the interactional psychoanalytic process, of “intersubjectivity” as a challenge to “objectification,” and of the actual or potential disruption of the psychoanalytic situation created by the use of external observational instruments. At a simple, guts level, psychoanalysts are concerned that anything beyond the retrospective description of a clinical situation by the analyst—that is, any recording or direct observation—would disrupt the psychoanalytic process to the point of falsification. A leading psychoanalytic clinician, after listening to audiotaped psychoanalytic sessions, exclaimed: “One thing I can tell you for sure; whatever this is, it is not analysis.” At a seminar on psychoanalytic research in a major psychoanalytic institution overseas, 50 percent of a full-day workshop had to be dedicated to discussing the anxieties expressed regarding the recording of psychoanalytic sessions. There is abundant evidence that psychoanalysts are more concerned than their patients are about audiotaping psychoanalytic sessions and that their apprehensions about the reaction of colleagues and their insecurity about their interpretive interventions are important aspects of this reluctance. Another major source of resistance to psychoanalytic research derives from the widespread perception within the psychoanalytic community that empirical methods of evaluating the psychoanalytic situation are relatively simplistic and thus do not do justice to the complexity and subtlety of the encounter. Such sophisticated research approaches as Luborsky’s “Core Conflictual Relationship Theme” methodology for studying the transfer-
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ence (Luborsky and Crits-Christoph, 1998), Gill and Hoffman’s research on transference resistance (Gill and Hoffman, 1982a), Kächele’s computerbased analysis of themes shifting over time within the psychoanalytic process (Kächele et al., 1988), and Sampson and Weiss’s analysis of the relationship between superego functions, repression, and anxiety (Sampson and Weiss, 1986) have all been attacked as partial and oversimplified, not directly relevant or helpful in answering the concrete challenges in the clinical situation. These approaches, further, have been said to restrict and potentially distort core psychoanalytic concepts by their efforts to operationalize them. The conclusions of these research methodologies have been seen as too general, too limited, or too methodologically flawed to be immediately relevant for clinical practice. When these conclusions support psychoanalytic theory, they sometimes provoke the cynical remark that all this complicated research leads to findings that are self-evident to the experienced clinician. The analytic community at large tends to regard psychoanalytic research as a lengthy and expensive horse race with outcomes that are not dramatically different from those achieved by other treatment methods; such research, it is charged, has great limitations in providing evidence of the more specific and subtle effects of psychoanalytic treatment. A third major type of resistance to psychoanalytic research focuses on the application to psychoanalytic practice of new theoretical models, such as those derived from Kleinian analysis, self psychology, object relations theories, the French psychoanalytic mainstream, the intersubjectivity approach, and the like (Kernberg, 2001). Insofar as adherents of these alternative psychoanalytic models have a sense that exciting developments are taking place in their theory and technique and that there are mutual influences among theory, technique, and clinical interventions—particularly with the more difficult and marginal cases—there is pressure on clinical researchers to develop a particular model of psychoanalysis, increased competition and rivalry with other models, and the conviction that only sophisticated, “nondisrupted” clinical work will permit such creative competitiveness. Formalized research protocols, it is felt, could not possibly do justice to the differences between, say, a contemporary ego psychological and a contemporary Kleinian approach. The work of Bion, Green, Laplanche, Liberman, Loewald, Schafer, or Winnicott is experienced as more exciting than the research findings by empirical researchers in psychoanalysis. A fourth factor is the concern of psychoanalytic clinicians, educators, and theoreticians that the theoretical conclusions derived from empirical
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research such as, for example, infant observation may be “overstretched,” yielding to the temptation to link observable behavior patterns directly with assumed underlying neurological structure, and thus presenting an impoverished or superficial presentation of psychic reality and mental structures. For example, to many analysts, psychoanalytic infant researchers who demonstrate behavior patterns in infants that are clearly responsive to maternal behaviors underestimate the role of unconscious determinants of behavior, particularly unconscious aggressive and sexual drives. Because of the unconscious nature of these drives and the defensive operations directed against them, descriptive observation may provide only a partial view of infant development (Green and Stern, 2000). A fifth factor derives from the nature of psychoanalytic education. As I have pointed out in earlier work (Kernberg, 2000a), psychoanalytic institutes, for a variety of historical and institutional reasons, are mostly geared to educating psychoanalytic practitioners and tend to emphasize the transmission of psychoanalytic theory and technique as practiced in the particular psychoanalytic center, to the relative neglect of the development of new knowledge. This emphasis on a particular approach as opposed to the alternatives favored in other centers or countries fosters an atmosphere of conformity rather than the questioning attitude research demands. The institutional status of training analysts, their idealization as part of transference regression, and the institutional reinforcement of that idealization by the collective “anonymity” of the training analysts tend to restrict the examination of the analytic process to the candidates’ treatment of patients. That juniors present to seniors but not vice versa leads to the tendency among candidates to idealize the (unknown) work of the senior analysts, perpetuates their insecurity about their work, and reinforces everybody’s fear of external observations of the actual psychoanalytic process. At the same time, the questioning attitude required by a concerted effort to develop further theory and technique runs counter to the culture of idealizing transmitted knowledge and is all too readily identified as rebellious subversion. The perception of psychoanalytic research as a subversive activity, in turn, runs counter to candidates’ wishes to avoid unnecessary conflicts during their training. A related factor is the relative isolation of psychoanalytic institutes from university settings where ordinary research in scientific fields at the boundary of psychoanalysis is carried out. This contributes to an implicit, practical competition for time and dedication, with “outside” interests per-
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ceived as being in competition with psychoanalysis. Thus, for example, commitment to and research on psychoanalytic psychotherapy, group therapy, couples therapy, and sex therapy appears to be in potential competition with the study of psychoanalysis proper. In order to protect the focus on traditional psychoanalysis, the analytic institute may unwittingly inhibit an interest in research in fields of applied psychoanalysis. By the same token, alternative formulations regarding mental functioning, related to research in adjacent fields of knowledge, may be perceived as a challenge to traditional psychoanalytic theory, with the result that interdisciplinary research is discouraged. A final and increasingly important factor is the social, political, and financial challenge to psychoanalysis that comes from psychiatry, clinical psychology, and commercial health systems. The socially sanctioned, cynical approach to the reduction of resources for mental health in the interest of cost-effectiveness threatens psychoanalysis as a long-term treatment method, puts pressures on psychoanalytic institutions and the psychoanalytic community at large to demonstrate the cost-effectiveness of analysis as compared to various other treatments, and creates resentment against research as an agent of the social rejection of psychoanalysis even among those analysts who realize that there is no shortcut to sophisticated outcome research. This drives a further wedge between psychoanalytic practice and the research endeavor. What is to be done? To begin with, it is important to strengthen the dialogue between the small group of psychoanalytic researchers and the psychoanalytic community at large in an effort to moderate the intensity of the conflict between those who hold that only empirical research is of any value and that ordinary clinical research is old-fashioned and irrelevant, and those who perceive naïveté, scientism, and unconscious resistance to psychoanalytic theory and methodology in any empirical research. Both viewpoints might come to be regarded as equally biased and unjustified. The empirical research conferences of the IPA (International Psychoanalytic Association) held annually in London demonstrate what can be achieved in focused dialogues to overcome the gap between researchers and clinicians. I believe it is an important task of the IPA to foster such smallscale conferences on particular areas in research that bring together specialists from worldwide psychoanalytic centers. This dialogue should be fostered in our professional publications as well as in the concerted efforts of psychoanalytic institutes to strengthen their relationship with the univer-
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sity in their geographic area. The recent IPA volume on research in psychoanalysis (Fonagy, 1998) provides an encouraging example. The understanding that psychoanalytic research needs to proceed simultaneously within the ordinary clinical setting, in applied analysis, in interdisciplinary research, and in empirical research should help to eliminate sterile and at times self-destructive discussions about what psychoanalytic research is and whether psychoanalysis is a natural or a social science. So far, the most significant progress in our field has been achieved through understandings derived from the psychoanalytic situation itself, while naturalistic and empirical research is only beginning to deal with the growing complexity of theoretical formulations, clinical observations, and methodological challenges. We have to accept the fact that for quite some time to come, empirical research in psychoanalysis, in contrast to other, more mature sciences, will probably not contribute much to advancing our clinical methodology, and that the short-term achievement of research in terms of strengthening the relationship between psychoanalysis and related fields will precede a time when breakthroughs in research outside the clinical situation will influence that situation. The political divide between empirical researchers and psychoanalytic theoreticians is damaging to our field and urgently needs to be overcome. It is important to provide opportunities and encouragement to theoreticians and clinicians interested in conceptual and “qualitative” research that follows the methodology derived from the use of psychoanalytic inquiry into the psychoanalytic situation as well as to empirical or “quantitative” researchers whose experience in systematic research is more advanced. Meanwhile, a consistent educational process is required to acquaint psychoanalysts with research developments in related fields and with important implications, if not for psychoanalytic technique, at least for (or against) the validity of psychoanalytic findings and psychoanalytic theory. For example, the demonstration of the mechanism of projective identification in a nonclinical setting, drawing on the research on affect expression by Rainer Krause (1988), constitutes, I believe, an important illustration of the possibility that methodologies derived from other scientific fields can contribute to research on psychoanalysis. Specialized programs in psychoanalytic institutes to train experts in other sciences to apply psychoanalytic theory to their own fields of knowledge should contribute significantly to research in applied psychoanalysis. For example, the contributions of Marcia Cavell (1993) in philosophy and of Ellen Handler Spitz (1985) in art the-
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ory—both of them graduates of the Columbia University Center for Psychoanalytic Training and Research—illustrate the effectiveness of this effort as part of psychoanalytic education. Psychoanalytic institutes need to invite leading scientists from related fields to participate in teaching the theory of mind. It is perhaps particularly in the fields of neurosciences, infant development, and social psychology that important contributions may fertilize psychoanalytic thinking. Beyond these practical arrangements lies the need for a fundamental rethinking of psychoanalytic education. I believe that psychoanalytic institutes should conceive their mission as not simply the transmission of psychoanalytic knowledge but the development of new psychoanalytic knowledge, thus acquiring a university function regardless of their direct relationship to any particular university setting. Such a conception is a far cry from setting up isolated courses on methodology of research. All clinical and theoretical seminars, as well as individual supervision, need to stimulate candidates to raise questions and, whenever possible, to pursue researchable questions with a personal contribution. Such a focus moves the perennial discussion of whether Freud should be taught, for example—whether in historical sequence or in segments relating to particular areas of development, psychopathology, or technique—toward the idea of teaching Freud’s method of thinking as well as his conclusions, and how this method might apply to further developments of his own ideas. It would also challenge the student to consider alternative methods of exploring Freud’s conclusions in light of other areas of contemporary scientific knowledge. A course on research methodology that both familiarizes psychoanalytic candidates with major ongoing research efforts in clinical, theoretical, and applied psychoanalysis and provides them with consultation regarding projects stemming from their own questions and interests might become an important rallying point for such an approach. This approach, I believe, has clear advantages over the traditional practice in some institutes of asking or requiring candidates to write a graduation paper, often in a context that discourages any serious challenge to traditional belief systems. And this graduation paper, paradoxically, may be evaluated by senior analysts who have not contributed to the field for many years. Attempts to “justify” psychoanalysis to the outside world as an effective treatment or as a major stimulus to research are problematic. In the short run, intelligent and consistent political efforts will be required to protect psychoanalysis within the present climate of reduced resources for psy-
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chotherapeutic treatment. In the long run, the recognition of psychoanalysis as a basic science of mental functioning and respect for psychoanalytic treatment as a major, specialized treatment approach will depend largely upon the creation of an accepting environment in the university and in the culture. Ongoing psychoanalytic research and respect for research in boundary fields may provide a bridge to that environment.
7
authoritarianism, culture, and personality in psychoanalytic education
For an article titled “Institutional Problems of Psychoanalytic Education” (1986), I researched the claims that many psychoanalytic institutions are characterized by an atmosphere of indoctrination rather than free scientific exploration, with a rigid presentation and uncritical discussion of traditional theories; that candidates are systematically prevented from knowing the details of their faculty’s analytic work and therefore develop an unrealistic idealization of psychoanalytic technique as carried out by senior faculty; and that the excessive investment of authority in the training analyst has resulted in a fragmentation of the supervisory and monitoring process throughout candidates’ training and leads to self-demeaning attitudes in the supervisory and instructional nontraining analyst faculty; in short, that the failure to share information and authority was a major problem in psychoanalytic institutes. The paranoid atmosphere that often pervades psychoanalytic institutes has a devastating effect on the quality of life in those institutes. This is the counterpart of the extreme idealization of particular training analysts, subgroups, or the entire local institute, or the theoretical school and the founders closest to it. The apparent or real arbitrariness in the appointment of junior faculty and training analysts is often politically motivated, forcing a regressive “family life” structure on the institution and leading directly to deterioration of the institution’s social life and functions. This paranoiagenesis—a term coined by Eliot Jaques (1976)—is fostered by the absence of Published in the Journal of the International Association for the History of Psychoanalysis 5 (1992): 341– 354. 94
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explicit public policies and criteria for the selection of training analysts and the lack of communication of the general locus of and accountability for decision making. A major symptom of dysfunctional psychoanalytic institutes is diminished creative thinking and scientific productivity on the part of faculty, students, and graduates, a narrow intellectual frame determined by the locally prevalent views within the broad theoretical spectrum of psychoanalysis, petty “cross-sterilization,” and discouragement of original thinking. In that 1986 paper, I noted that the immediate cause of all these symptoms is in the serious discrepancy between the primary task of psychoanalytic education and its organizational structure. I described four models, corresponding to explicit aims that have been formulated for psychoanalytic institutes, and the recommended organizational structure for each of these models: (1) an art academy, (2) a technical trade school, (3) a monastery or religious retreat, and (4) a university college. I concluded that psychoanalytic educators often think they are transmitting what is both an art and a science but in fact have structured their institutes to resemble a combination of a technical school and a monastery. I proposed that if, instead, educators adopted a model combining the features of an art school and a university college, they would be more likely to achieve their explicit aims and to reduce significantly the negative symptoms listed earlier. The underlying cause of this discrepancy between explicit aims of psychoanalytic education and the actual models of administrative structure in place is the nature of the product elaborated in psychoanalytic institutes: namely, uncovering the unconscious in the context of the institutional boundaries of the psychoanalytic institute. In ordinary psychoanalytic treatment, much of the transference and countertransference activated is dispersed in the form of displacement, working through, and the dilution of the emotional impact of the psychoanalytic session as patient and analyst move in totally separate social environments between the sessions. In contrast, the training analysts’ treatment of candidates occurs within a shared social setting and organizational structure. This creates ample opportunities and temptations for acting out transference and countertransference and for amplifying these powerful emotional forces. The mutual exposure of training analyst and candidate analysand, their vulnerability to directly exerted and indirectly expressed mutual influences, the facilitation of the displacement of the transference, and its dispersal onto other members of the faculty, acting out the negative and positive transference at seminars and in supervision, all contribute to making the training analyst more
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vulnerable to his candidates’ acting out. The training analyst actually exerts power not only in institutes that encourage or mandate “reporting,” but in nonreporting institutes as well, for he is part of the administrative structure of the institute, a senior and influential member of the faculty. When individuals function in groups, and especially when these groups exist in an organization structurally out of tune with its explicit aims, regressive group processes tend to become operative. In the relationship between training analysts as a group and candidate analysands as a group, the effect of multiple transferences and countertransferences operating simultaneously on all participants is to increase the need for protective, defensive operations on the part of both groups that transform them into non-taskrelated or “sentience” groups (Miller and Rice, 1967). (“Sentience” here refers to the emotional bonds that influence group formation and cohesiveness.) Insofar as group cohesiveness is not directly related to the task—in this case, psychoanalytic education—these nontask groups develop defensive processes that are in potential conflict with the educational functions of the organization. Idealization processes and an ambience of persecution are the most immediate, practically universal consequences of group regression in psychoanalytic institutes. Jointly, these mechanisms also point to the prevalence of splitting operations, the division of the institutional world into idealized and persecutory objects. These regressive features might be reduced, if not eliminated, by an organizational structure optimally adapted to the organizational tasks, but, because of the administrative distortions outlined, the opposite developments take place. At the very center of these prevalent defensive operations is the idealization of the training analysis and the training analyst. This is fostered by the training analysts’ insecurity, derived from the confusion of the technically neutral analyst with the “anonymous” analyst, the effects of the training analyst’s “going into hiding” on the professional level, and the limitations to the analysis of this idealization of the training analyst derived from the analysand-candidate’s nonanalyzed identification with his training analyst as a professional model (a problem that Arlow [1972] and Roustang [1982] have explored in great detail.) I have been able to observe at least three psychoanalytic institutions in depth over a period of time: the Chilean Psychoanalytic Institute, the Topeka Psychoanalytic Institute, and the Columbia University Center for Psychoanalytic Training and Research. In addition, I have had brief experiences as guest student and faculty member of several other institutes. These
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experiences have strongly influenced my basic thesis that the principal cause of authoritarianism in psychoanalytic institutes is the motivated discrepancy between explicit educational goals and actual administrative structure. Unacknowledged influences from the surrounding culture, from prevalent political crosscurrents—particularly totalitarian ideologies— from the educational system generally, and from the personality of the psychoanalytic leader all have the potential to contribute to authoritarianism in subtle or not so subtle ways. Sometimes even ordinary social conventionality may be transformed into a focused oppression. POWER, AUTHORITY, AUTHORITARIANISM
The most immediate effect of a nonfunctional administrative structure is the growth of authoritarian tendencies in the organization. The development of chaos is another consequence, usually complemented or followed by authoritarianism. The immediate symptoms of authoritarianism include fearfulness, submissiveness, rebelliousness, and passivity throughout the organization. In psychoanalytic institutes, for the reasons mentioned, idealization and paranoiagenesis become dominant under such circumstances. Authoritarianism depends on the extent to which the power invested in and the authority exercised by faculty, particularly training analysts as a group, are appropriate to their functions—that is, “functional.” Faculty may be either “powerless,” that is, lacking power commensurate with the authority required to carry out their tasks, or “authoritarian,” with power greatly exceeding what would be functionally required by the task. One institute, controlled by an extremely powerful training analyst who was, at the same time, the head of the psychiatric institution within which that institute functioned, illustrates the arbitrariness of decision making that is typical for authoritarian structures. A senior candidate at the institute was assigned a patient who had murdered her infant son. The candidate considered the case unanalyzable, but his supervisor (the powerful leader) insisted that this was an acceptable analytic case. All senior psychoanalytic consultants involved agreed that psychoanalysis was contraindicated, and the candidate refused to continue the analysis, referring the patient instead for psychotherapeutic treatment. His supervisor later opposed the candidate’s graduation for an extended period of time, although the other members of the senior faculty agreed that the candidate had fulfilled all the requirements. Many unofficial meetings took place among the senior members of the faculty to try to find ways of helping the candidate to grad-
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uate, bypassing the leader’s veto. The postponement of this candidate’s graduation eventually became an open secret throughout the institute, increasing the existing atmosphere of fearfulness and cynicism about psychoanalytic training. THE SURROUNDING CULTURE AND INSTITUTIONAL BLIND SPOTS
On moving from one culture to another, differences in the concepts of technical neutrality and of acting out may become apparent, thus influencing the definition of acting out behavior. In Santiago, Chile, in the 1950s, it was culturally acceptable to go to great lengths to avoid paying taxes; a rather liberal, European-style attitude regarding sexual morality also existed, as did a prevalent “double morality” that combined the influence of a paternalistic tradition with that of the Catholic church. Divorce was frowned upon, while extramarital affairs, particularly on the part of men, were tolerated rather freely. These attitudes were reflected, I realized later, in our attitude toward patients’ and candidates’ sexual behavior as well. Topeka, Kansas, in the heart of the American Bible Belt, was characterized by a very strict adherence to the responsibility for paying taxes—in fact, a strong moral attitude invested in that social responsibility (which, of course, is part of the American culture and has also permeated Chilean culture in recent years). The Topeka institute accepted divorce and very often considered it a reasonably mature solution to marital conflicts, but extramarital affairs were severely frowned upon. The reflection of these cultural differences in analysts’ attitudes toward their patients’ clinical material was startling, to say the least. In fact, a joke circulating among psychoanalytic candidates who had immigrated to Topeka from various Latin American countries had it that in the United States a man had all the women of his life in sequence, while in Latin America they were available simultaneously. A training analyst in Topeka, trying to be helpful, once warned me that she had observed me the day before in a movie theater kissing my wife. She was concerned that such public display might endanger my future appointment as a training analyst. POLITICAL IDEOLOGY
In Chile, during the presidency of Salvador Allende, a sharp split took place between the leftist supporters of the Allende government and the center and rightist opposition to it (including center-left Social Christians). This division extended to Marxist-oriented training analysts identified with the
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Allende regime and non-Marxist training analysts identified with the opposition. A Social Christian candidate happened to be in analysis with a Marxist training analyst. The analyst interpreted the candidate’s participation in a physicians’ strike against the Allende government as submission to the capitalist ideology representing his oedipal father. The candidate protested, stating that he did not want to discuss politics with his training analyst. The training analyst then suggested immediate termination of the analysis. He was willing to retract this proposal only after a lengthy and painful discussion with the institute’s education committee a few days later. Upon discovering that he would be resuming his analysis with the same analyst, the candidate, panic-stricken, left the country to continue his psychoanalytic training elsewhere. We tend to forget that technical neutrality is based on the implicit assumption that analyst and patient share a common cultural and ideological ground. The reproduction in the analytic situation of ideological conflicts in the political culture that destroy this underlying consensus may lead to a breakdown of functional preconditions for analytic work and consequent authoritarianism. The transformation of psychoanalysis itself into a Weltanschauung may become a risk for the position of technical neutrality. EDUCATIONAL SYSTEMS
The situation of psychoanalytic institutes in the United States within a university setting, particularly a department of psychiatry, may significantly influence educational procedures. When the psychoanalytic faculty members conduct a large private practice and isolation of the psychoanalytic institute develops, the risk of a narrow, insulated educational program increases. In some places, biologically oriented departments of psychiatry have almost no faculty with a psychoanalytic orientation, while the local psychoanalytic institute lacks the challenge from biological sciences at the boundaries of psychoanalysis. This separation tends to restrict scientific inquiry and debate and to flatten psychoanalytic education. At the other extreme, psychoanalytic institutes within departments of psychiatry may be at risk of undue influence from the attitudes of departmental chairmen toward psychoanalysis. However, when the chairman of a department appreciates the contributions of psychoanalysis, psychoanalytic institutes exposed to the challenge and stimulation of an academic ambience may develop exciting enrichments of their curriculum, stimulating a scholarly atmosphere and developing innovations in the educational program.
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One of the reasons for the increasing attraction of the Columbia University Psychoanalytic Center in recent years has been its encouragement of scientific dialogue between the department of psychiatry and the university and its development of interdisciplinary symposia and conferences. THE PERSONALITY OF THE LEADER
Roustang (1982) points to the paradox that Freud, who critically described the irrational relations between leaders and followers in organized institutions, was also the author of “On the History of the Psychoanalytic Movement,” written in 1914, a paper that clearly indicates his conviction that a truly scientific commitment to psychoanalysis required loyalty to his (Freud’s) ideas and that any questioning of key psychoanalytic concepts represented unconsciously determined resistances to truth. We might dismiss Freud’s relationships with his immediate followers as an irrelevant historical curiosity were they not so intimately linked to subsequent psychoanalytic history. Roustang calls attention to a contradiction inherent in psychoanalytic movements: the goal of psychoanalysis is to resolve the transference, but the goals of psychoanalytic education include the candidate’s identification with his analyst, which runs counter to the general goal of psychoanalysis. If fidelity to Freud, the charismatic founder of psychoanalysis, were a requirement, the members of the societies could not be scientifically independent. This tradition has persisted, as Roustang makes clear in his discussion of Lacan. It could easily be argued that the structural characteristics of the psychoanalytic movement initiated by Freud and consolidated in the prevalent arrangements of psychoanalytic institutes are primarily responsible for the authoritarian developments summarized earlier in this chapter. While respecting the historical origins of authoritarian features of psychoanalytic education, I have argued that the very nature of the task, by activating organizational defenses particularly along the lines of training analysts’ and candidates’ group regression, tends to perpetuate the disparity between task and structure. The personality of the leaders in each psychoanalytic institution does have a significant influence, for better or worse, on institutional functioning. The chairman of the Department of Psychiatry of the University of Chile, from the late 1940s to the early 1960s, was also the founder of the Chilean Psychoanalytic Association and its institute. A strong leader, he was mostly concerned with the development of new ideas and was remarkably
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free of the need to impose these ideas (and his will) on those who worked with him. In fact, the dynamics of the institute centered around the faculty’s effort to systematize and normalize psychoanalytic education, while the leader’s chief emphasis was on the revolutionary content of psychoanalytic thinking and the need for ongoing exploration of new territories. Thus, a strong personal leadership coincided with a remarkably informal structure of psychoanalytic education. While it is true that the enthusiasm and commitment of an early generation of psychoanalysts in that country contributed to the high morale of the institute, the informality of the leader’s relation to both faculty and candidates counteracted the natural division of training analysts and candidates. During his tenure, idealization and paranoiagenesis were remarkably low. The Topeka Psychoanalytic Institute in the early 1950s and the 1960s was led by a senior training analyst who at the same time was chief of staff of the Menninger Foundation, within which the psychoanalytic institute functioned: thus he was everybody’s ultimate boss. He was also a powerful personality both admired and feared. The atmosphere in seminars and in the supervision of candidates was extremely tense in comparison to my experiences in Santiago, Chile. In fact, I was struck by the cautious, at times frankly fearful, attitudes of candidates as individuals and as a group. The leader was less concerned about the particular orientation of psychoanalytic education—Topeka was firmly identified with American ego psychology—than with loyalty to himself and to the Menninger Foundation. The emphasis was on the hierarchical structure of the psychoanalytic institute; this resulted in the usual hierarchical organization of teaching and the latent division between faculty and candidates and between training and nontraining analysts. The founder and leader of the Columbia University Center for Psychoanalytic Training and Research had left the New York Psychoanalytic Institute to set up a new psychoanalytic institute within a department of psychiatry at a prestigious medical school. He had expressed a strong commitment to psychoanalysis as a science and believed in a strong, centralized leadership. The degree of authoritarian pressure he had generated was revealed to me very concretely when I moved from Topeka to New York, years after this leader’s retirement. By then, a new generation of Columbiatrained analysts was dedicated to transforming an authoritarian into a functional administrative structure. They explained to me at a private dinner that they welcomed my joining them but wanted to be sure that I un-
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derstood and would subscribe to their commitment to a nonauthoritarian administrative structure and an open scientific attitude toward theory and practice. More recently, under the leadership of a woman director, the Columbia institute developed an administrative structure that corresponds remarkably well to the requirements of the combined university-college and artacademy model that I have recommended. In my view, this leader’s commitment to a model of psychoanalytic education that fostered a spirit of inquiry and an open discussion of the broadest range of psychoanalytic thinking, encouraged research and, above all, carefully limited the authority vested in training analysts and faculty to what is functionally required placed the Columbia institute at the center of the intellectual life of the American psychoanalytic community. The level of idealization and paranoiagenesis at the Columbia institute has been remarkably low in recent years, as it was during the 1950s and early 1960s in Santiago, and in contrast to what I observed in the early 1960s at Topeka. I should stress, however, that similar variations in the amount of idealization and paranoiagenesis and of authoritarian structure may be observed in institutes where strong personalized leadership is not present or is defended against by bureaucratic or political arrangements. In the 1960s and 1970s a struggle was in progress at the New York Psychoanalytic Institute between an in-group of senior psychoanalysts, who maintained a firm control of the institution, and an out-group, including both a minority of training analysts and a large number of nontraining analyst faculty, who were challenging what they saw as the rigid control of their institute, particularly the process of appointing training analysts, which had become highly politicized. When I first arrived in New York, I simultaneously joined the faculties of Columbia and New York, and during the three years of my participation in the New York institute, I was able to compare the two. The contrast between the relaxed, open, inquisitive spirit at Columbia seminars, panels, and conferences and the high tension and anxiety of candidates as well as nontraining analyst faculty at the New York institute was impressive. Yet both institutions were directed by groups of faculty rather than by any particular leader. In fact, some of the most prestigious training analysts at the New York institute at that time were part of the out-group. In all fairness, it needs to be said that, in recent years, the New York institute has changed significantly in a positive way. An authoritarian structure may evolve in a system characterized by a collective leadership, and a functional institution may evolve in a system
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with strongly individualized leadership. In this connection, it needs to be stressed that the effort to correct for authoritarian institutional structure by the development of democratic processes may backfire, because, as I have pointed out elsewhere (1979), when political decision making replaces task-oriented decision making, functional authority also may suffer. For example, the appointment of faculty members by secret vote on the part of all members of a psychoanalytic society may be a democratic process, but it may not be the optimal way of selecting faculty: on the contrary, it may foster politicization of the membership around an ideology tangential to the functional needs of psychoanalytic education. In my previous discussion of this subject (1986), I focused on some major corrective measures available to reduce the negative effects of the development of paranoiagenesis and idealization in psychoanalytic education. These include the elimination of all reporting functions of the training analyst; a public, functional method of training, selection, and monitoring of faculty; an insistence on the training analysts’ communicating their own clinical work; the organization of faculty and of candidates to facilitate open communication, redress of grievances, and correction of distortions in the educational process; the demystification of all aspects of the selection, progression, and graduation of candidates; and the participation of candidates individually and as a group in generating new developments in psychoanalytic knowledge. Perhaps the most pernicious effect of authoritarianism on psychoanalytic education and psychoanalysis generally is the restriction and flatness of the teaching and learning about psychoanalysis. The willing confrontation of alternative theories and practice is essential for scientific development and education.
8
a concerned critique of psychoanalytic education
Psychoanalysis is currently under powerful attack from within our culture and within the university—particularly from the viewpoints of a strong biologically oriented psychiatry and a cognitive-behaviorally oriented clinical psychology. Governmental and health delivery systems are questioning the efficacy and cost-effectiveness of psychoanalytic treatment. Controversies about the applicability of psychoanalytic concepts and techniques to psychotherapy and the competition of other psychotherapeutic approaches have raised basic conceptual, clinical, educational, and political questions. In this context, I believe that psychoanalytic institutes have the responsibility to go beyond transmitting psychoanalytic knowledge and methodology to new generations of candidates and must take a major initiative in fostering the development of new knowledge about psychoanalysis while strengthening its relationship to the academic, intellectual, and cultural environment. The challenge is to maintain an exciting ambience of scientific discourse, encourage ongoing systematic development of knowledge, and foster the collegial collaboration of faculty with creative candidates so as to invigorate the scientific and professional presence of the psychoanalytic endeavor. Analysts tend to become passionate defenders of the system in which they were trained and sometimes passionate detractors of other systems. Perhaps this chapter can facilitate a more dispassionate scrutiny of the assets and liabilities of different systems of analytic training and thus encourage modifications in the direction of improving analytic training everywhere, whatever the dominant system may be. An earlier version of this chapter was published in the International Journal of Psychoanalysis 81 (2000): 97–120. Copyright © Institute of Psychoanalysis. 104
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THE TRADITIONAL EITINGON MODEL
While fundamental shifts in educational methodology have taken place in the academic world surrounding us, a cautious conservatism has dominated psychoanalytic education. Our educational methodology has actually changed very little since the inauguration of the Eitingon model in 1920 –26 at the Berlin Psychoanalytic Institute. This model still prevails in most institutes worldwide. Over the years, concerned psychoanalysts (e.g., Bernfeld, 1962) have pointed out the destructive nature of this system as it has evolved, but they have been isolated voices within a generally self-congratulatory chorus at conferences and congresses dealing with psychoanalytic education. More recently, critics of the Eitingon model (Bruzzone et al., 1985; Giovannetti, 1991; Green, 1991; Infante, 1991; Lussier, 1991; Wallerstein, 1993) have become more vocal. This has led to important efforts to correct some of the model’s most negative features while maintaining the basic model. Yet in my experience many of these problematic features are still present in many institutes. While Eitingon’s model has ensured the thoroughness of psychoanalytic education and provided a proven method for maintaining minimal common standards, its shortcomings deserve further attention, particularly in view of the urgency of the challenges from our external social and intellectual milieu. Major Shortcomings of the Eitingon Model
The classical Eitingon model established a tripartite model of education, requiring all candidates to participate in a training analysis, supervision of control cases, and theoretical and clinical seminars. The training analysts, those to whom the analysis of candidates was to be entrusted, were meant to be the elite of psychoanalytic practitioners. But the role of training analyst was gradually incorporated into an organizational status system as part of an oligarchic administrative structure that controlled psychoanalytic institutes and contributed to their authoritarian atmosphere (Kernberg, 1986). That atmosphere was often actualized in a monolithic theoretical orientation determined by the leading training analysts of the respective institutes. Controlling political groups have had inordinate influence in determining who would have the right to teach, and an institutional arrogance developed that antagonized many professionals in the boundary disciplines from which candidates potentially emerge. The result has been the isolation of psychoanalytic institutes throughout the world from their academic and cultural environments. The selection of training analysts as part of the ruling elite was often a secretive, political process, geared to protect and
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strengthen a group in power as much as to assure a high-quality personal analysis for candidates. In some cases oligarchy became a gerontocracy of training analysts, which helped to politicize the educational process as competing groups of training analysts tried to reinforce their respective lines by selective appointments to institute faculty. A major problem of the training analysis, of course, has been the “reporting” training analyst, a radical deviation from the clinical requirements of technical neutrality. The system of reporting candidates’ analytic progress to the institute inevitably stimulates nonanalyzable submissive behavior in the candidates, as well as some degree of dishonesty (acknowledged by some former candidates who sought a second analysis “for themselves”). The teaching of seminars was typically reserved for training analysts, ensuring their monopoly of theory that influences analytic technique and implicitly discouraging a questioning attitude and creativity in the candidates. Case presentations and ongoing process groups were carried out by candidates and junior members under the consistent supervision of training analysts and senior members of the psychoanalytic community, who never presented their own analytic work. Thus the candidates never had the opportunity to familiarize themselves with the actual clinical work of the training analysts, with its inevitable difficulties and shortcomings. As a result, their idealization of the training analyst was reinforced and the principle of technical neutrality became confused with the concept of “anonymity.” Anonymity rationalizes the veil cast over the personal idiosyncrasies of the training analyst as a means of permitting the full deployment of the transference by the candidate-analysands. On a deeper level, however, the emphasis on anonymity implicitly protects idealizations that can never be analyzed and reinforces the essential paradox intrinsic to the training analysis: the explicit purpose of analysis is the resolution of the transference, but an implicit goal of the training analysis is the candidate’s identification with his analyst (Arlow, 1969, 1970, 1972; Roustang, 1982). It is no coincidence, I believe, that insistence on the anonymity of the training analyst within both ego psychology and the Kleinian school reached its height during the late 1950s through the early 1970s, the time of the maximal power, prestige, institutional autonomy, and isolation of psychoanalytic institutes, particularly in the United States and Great Britain. The intrinsic problem of idealizing teachers whose concrete clinical work is unknown was complicated by the tendency of supervisors to as-
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sume an elusive attitude that forced psychoanalytic candidates to learn and adjust to the technical views of their supervisors without a full and explicit communication of those ideas. Meanwhile, the supervising analysts failed to appreciate their responsibility to link individual case supervision with the approach to psychoanalytic technique being taught in the seminars. The candidate was supposed to develop such an integration by himself; it was implied that the optimal methodology exists, although it is not fully and explicitly taught or otherwise communicated. Clinical seminars typically began with the works of Freud, presented not as history but, rather, categorically and reverentially. Sometimes such teaching was carried out by senior training analysts accompanied by junior faculty who aspired to traininganalyst status; the implications of their subservient behavior toward the seminar leader was easily grasped by the candidates. The psychology of the “silent”psychoanalyst, which influences supervision, pervaded the relationship between the institute and the candidates as a student body as well: The institute, too, was “silent,”failing to provide clear information about requirements for acceptance and the criteria for admittance to seminars, the assignment of control cases, and graduation. This stance contributed to the mystification of the entire educational structure of the institute. Not knowing how and where decisions were made and by whom affected graduates as well as candidates. The selection of training analysts often occurred by “delicate tapping on the shoulder” of the chosen, while those who were “untapped” searched in vain for an explanation of their exclusion. The development of a three-tiered class system in psychoanalytic institutes and societies throughout the world was an inevitable consequence of this educational system. The “ruling class” of training analysts enjoyed a sense of security but had to be concerned with protecting their power base against potentially challenging groups of other training analysts. Many splits of psychoanalytic societies derived from the power struggles among competing groups of training analysts. Others arose from the final rebellion of the “second class,” the graduates without training-analyst status, who were excluded from educational functions and deprived of a major source of prestige within the psychoanalytic institution. The “third class” was the candidates. Some were well protected by their submissive allegiance to their training analysts within what Greenacre (1959) described as the “convoy system.” Others had to struggle against the fear that their development was threatened, that ominous failures or shortcomings had been or might be discovered that would threaten their even-
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tual graduation. The candidates were isolated from one another by the system of “unhooked telephones”—that is, the danger that if they were to reveal to their training analysts the critical comments expressed about them by other candidates, there would be punishing consequences for the latter indiscreet souls. The resulting climate of protective distancing among the candidates reinforced a paranoid atmosphere among them, or at least led to paralysis regarding any joint action to address their concerns about the educational process (Dulchin and Segal, 1982a, 1982b; Lifschutz, 1976). I believe it is no coincidence that one of the most creative psychoanalytic institutions in the 1940s and 1950s was the British Psychoanalytic Society, where the open controversy and competition among Kleinian, Anna Freudian, and middle-group analysts engendered enormous scientific curiosity, creativity, and productivity in spite of the negative aspects created by the Eitingon model. This atmosphere of uncensored scientific exploration of alternative theoretical and technical models counteracted the stifling effects of intellectual monopolies. Elsewhere in the world, however, the educational process became increasingly sterile. For example, in many societies candidates were implicitly or explicitly excluded from scientific meetings so as not to contaminate the transference by premature and inappropriate exposure to the personalities of their training analysts. In society meetings, the subservient repetition of the ideas of the local leading lights, with or without minor variations, was warmly applauded while any “deviant” viewpoint was sharply criticized, often in a formally gentle and intellectually savaging way. Psychoanalytic parochialism was painfully apparent in international psychoanalytic congresses, where opposing viewpoints were aired without leading to authentic dialogues, so that scientific progress was hardly possible. In short, the educational structure of psychoanalytic institutes cast a wide shadow over psychoanalytic societies and the entire scientific life of the psychoanalytic community (Keiser, 1969). Corrective Modifications of the Eitingon Model
The first important modification of the Eitingon model was the widespread elimination of the “reporting” training analyst. Some psychoanalytic institutions have made it explicitly unethical for the training analyst to provide any information about his candidate (other than when the training analysis started, the frequency of sessions, and when the analysis would be concluded or interrupted). The few institutes that still tolerate the reporting training analyst are no longer proud of this practice, and it may be expected that it will totally disappear in the near future.
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A second significant change has been recognition of the divisive and corrupting features of the traditional selection of training analysts and the need to depoliticize that process as much as possible. Unfortunately, the lack of understanding of administrative theory by authorities in many psychoanalytic institutes has led to new complications. Nevertheless, the development of functional criteria and processes for the appointment of training analysts should go a long way toward eliminating the problem. In one institute within the American Psychoanalytic Association, for example, all graduates who have completed five years of practice beyond their graduation are routinely asked whether they would be interested in becoming training analysts. If they respond positively, the education committee (I am using this term although in many institutes it is the executive committee that performs this task) then appoints an ad hoc committee of two or three training analysts to meet with the applicant to explore his professional activities since graduation, participation in psychoanalytic seminars, supervision, scientific publications, and interest in and plans for a future psychoanalytic career and to hear the applicant present one or two cases in detail. On this basis, the ad hoc committee then makes a recommendation to the education committee. If, after a full discussion, the education committee decides against appointment of the applicant at this time, the director of the institute is charged with communicating this decision to the applicant, together with the reasons for it and what if anything the applicant can do to change the decision. If there are conflicts or controversies of any kind, the director appoints another member of the education committee for a second review. In some other institutes, the ad hoc examining committee for the appointment of training analysts is constituted by members of other institutes, not their own. The obvious advantage of this system is that it is potentially fair and functionally reasonable and provides candidates for training analyst status with information regarding how the decision was made, why, and by whom. It can eliminate the politicization of the process of selecting training analysts along with the conflicts and emotional regression that formerly characterized it. By contrast, many societies in Europe and Latin America have tried to eliminate the authoritarian way of selecting training analysts by instituting a process of progression whereby members are advanced from recent graduates to associate members, from associate members to full members, and from full members to training analysts by means of universal secret votes. These societies have confused political with functional decision making. The latter involves a mechanism that corresponds to the task; is transpar-
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ent, logical, and fair; and is not subject to the vagaries of a political process (Kernberg, 1998a, chap. 8). The secret vote shifts the locus of control from the psychoanalytic institute proper to the political currents of the psychoanalytic society. These, in turn, are linked to the political currents within psychoanalytic institutes, so that sometimes the treatment is as bad as the illness. Another significant change in the Eitingon system has been to permit candidates to attend elective seminars if they wish to do so and to give institute faculty or even members of the society the opportunity to offer such seminars as part of the institute structure. This is significant progress toward broadening the content of the psychoanalytic curriculum, with the potential for bringing in controversial subjects or orientations. In addition, the development of candidates’ organizations that provide feedback regarding their educational experience, evaluate their teachers, participate in the curriculum committee, and maintain a direct, ongoing channel of communication with the institute director or executive committee may change the atmosphere of psychoanalytic education, particularly when it is matched with a concerted effort on the part of the faculty to provide ongoing, clear, and complete information regarding all educational issues. Continuous case seminars in which senior analysts, particularly training analysts, present cases they are currently treating, seminars for supervisors that help them to link their supervisory function with the overall teaching of technique at the institute, and mutual sharing of the cognitive, academic functions that should be included in supervision contribute to demystifying the supervisory process. The Argentinean Psychoanalytic Association has developed a system by which candidates as well as members of the society may accumulate points for progression, promotion, and advancement in institutional tasks. While one might criticize the mechanical nature of these procedures, in this very large institution, the advantages of a method that decreases potential bureaucratic complications are significant. The Argentinean association also combines the principle of “freedom of teaching” with “freedom of curriculum,” meaning that any member of the psychoanalytic society may teach any type of seminar as long as a sufficient number of students elect it to make it worthwhile. All students have the freedom to select their own curriculum as long as they attend an established number of both obligatory and elective seminars. The advantages of this model include a remarkable absence of ideological struggles between groups with different theoretical orientations, the
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opportunity to learn from a broad variety of faculty members with very different viewpoints, and a refreshingly tolerant atmosphere at seminars and supervisions. A potential disadvantage is the loss of quality control; seminar teachers are sometimes reluctant to criticize students for fear that attendance at their seminars might decline. Also, some charismatic teachers are able to attract students regardless of the quality of their teaching. Furthermore, some candidates, left to exercise their own choices, may experience the many approaches offered to them as fostering an uncritical eclecticism. In general, all educational enterprises face the problem of constructing a functional system that maintains quality control while maximizing creativity; psychoanalytic education is not exempt from this dilemma. Another psychoanalytic society, RIO II, based in Rio de Janeiro, devised a system in which a limited number of training analysts and candidates work together over a period of two years in both seminars and individual supervision. The group spirit that develops during this experience permits the free interchange of information, shared knowledge of the development of each candidate, and open communication among all those involved. I believe, however, that the problem of quality control may also affect this structure, because the attachments between members of these groups make it more difficult for the faculty to criticize candidates who are part of their own collegial group. In short, significant attempts are being made to correct the most striking shortcomings of the Eitingon system. Increased communication within the international psychoanalytic community has also contributed indirectly to improving the atmosphere of psychoanalytic education. As contrasted to the rigid intellectual barriers that separated, for example, ego psychology from Kleinian analysis, French psychoanalysis from Anglo-Saxon and German approaches, and so forth, growing awareness of the problems of monolithic institutions has led to active efforts to establish contacts with analysts from different orientations. The tradition of teaching about “deviant schools” in order to subject them to preventive downgrading, prevalent in U.S. psychoanalytic institutes until about fifteen years ago, has shifted into a growing effort to learn about alternative approaches with an open mind (Cooper, 1990). THE FRENCH MODEL OF PSYCHOANALYTIC EDUCATION
The so-called French educational model emerged in the 1960s and has become dominant in the French Psychoanalytic Association (APF), the Psychoanalytic Society of Paris (SPP), and the Belgium Psychoanalytic Society.
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It has also had a strong influence on the organizational functioning of the Francophone Branch of the Canadian Psychoanalytic Society and the Swiss Psychoanalytic Society. The basic common features and underlying rationale of this model (which has undergone significant changes since its introduction and is still being modified in several societies) as they have been spelled out by Green (1991), Lussier (1991), and Wallerstein (1993) are its attempts to eliminate those authoritarian and regressive aspects of the Eitingon model that led to distortion of the psychoanalytic process and infantilization of psychoanalytic candidates. The French model rejects the concept of the training analyst and attempts to keep the candidate’s analytic experience totally uncontaminated by institutional complications. In its ideal form, this model proposes that the personal psychoanalysis should predate the aspiring candidate’s formal entrance into psychoanalytic training and that the candidate should feel free to select any psychoanalyst he feels deserves his trust. Admission into the psychoanalytic institute takes place only after a sufficient number of years of analysis to enable the future candidate to experience the influence of the unconscious mind and to acquire an analytic attitude. Thus the selection of candidates takes place not at the start of their training but after an analytic experience that can provide the faculty members who examine prospective candidates with more realistic and tangible evidence of their capacity for analytic work, their analytic attitude, their capacity for insight and introspection, their intuitive grasp of unconscious material, and the extent to which potential blind spots have been resolved. In the original model, the future candidate could enter into analysis with anyone he chose, including an analyst who did not belong to the society to which he was applying. In practice, over the years, the tendency has been to restrict future candidates’ choice of analysts to members of the society to which they seek admission and, even further, to full members of that society. There are differences in this regard among the societies that follow the French model. It almost goes without saying that the French model has been strictly “nonreporting” from its very inception and that it has repudiated the analyst’s judgment of an analysand as an influence upon the latter’s progress in the psychoanalytic institute. The French model also criticizes the implicitly authoritarian nature of the Eitingon model’s seminar structure. In the typical arrangement, seminars are presented by years, in a hierarchically organized curriculum like that of an elementary or high school. In its ideal form, the French model proposes complete freedom for candidates to participate in seminars that
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interest them. Such seminars, therefore, include faculty, candidates, and members of the society. The seminars are conceived as gatherings in which knowledge is not simply transmitted but generated in the context of the study of psychoanalytic literature. The interest and excitement they generate make the seminars attractive to candidates as well as fostering a learning process without the submissiveness and indoctrination that are potential by-products of the Eitingon model. In practice this aspect also has been modified to the extent that, while candidates are encouraged to participate in postgraduate seminars of the society, they are also expected to attend seminars specifically geared to them. But each candidate is free to choose the number and sequence of the required seminars, thus determining his progression through the seminar structure rather than being subjected to a rigid, year-by-year regimen. Candidates’ performance in the seminars is not evaluated, reflecting the overall stance toward the candidates as mature individuals whose learning is determined by their motivation and responsibility. The responsibility for quality control of the institute falls mainly on the supervisors. In the French model individual supervision is highly specialized, intended to transmit a methodology for observing and understanding unconscious processes. This emphasis on learning the unconscious process activated in the transference-countertransference bind is reinforced by exploration of the unconscious processes activated in the supervisory experience itself. This model therefore maximizes the utilization of “parallel process,” in which the situation of the candidate vis-à-vis the control case is seen as reflecting and being reflected by unconscious processes generated in the supervisory relationship. Supervision thus becomes a very intense, private, and emotionally charged experience in which the experiential function strongly dominates the academic one. In the French model, psychoanalytic supervision ideally acquires characteristics similar to those of the psychoanalytic process being explored. The model, as proposed by Lussier (1991), anticipates the supervision of four to five cases for at least four to five years each, but in practice the number of cases and the duration of the supervisory experience have declined to approximate the usual frequency and duration of supervision prescribed by the Eitingon model (four or five sessions a week for both training analyses and the supervised control cases). The original French model accepts a minimal frequency of three sessions per week for both training and supervised control cases. The differences between supervision in the Eitingon and the French models were demonstrated unintentionally at the 1997 pre-
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Congress on Training at the Barcelona International Psychoanalytic Congress. A proposal offered by institutes based on the Eitingon model to study the supervisory process by exploring actual supervisions raised strong protest from European psychoanalysts working within the French model, who were sharply critical of what they considered the inappropriateness of a public examination of highly private individual supervisions. A Critical Review of the French Model
In practice, some of the problems of the Eitingon model have tended to emerge within the French model as well. The tendency to restrict the selection of analysts for precandidates to full members of the psychoanalytic society to which the candidates plan to apply has encouraged politicization of the progression from associate to full member. A two-class system has emerged involving full members invested in maintaining some obstacles for associate members who aspire to become full members and the class of associate members struggling to eliminate these barriers. Here the bureaucratization and democratization of the system of deciding who has the right to analyze future candidates once again politicize what should be an educational process and tend to activate authoritarian pressures. In addition, the freedom of the candidates to select the seminars they will attend produces a relative isolation of the candidates from one another, as the group processes involving each candidate’s class, typical in the Eitingon model, do not develop. In small psychoanalytic societies, where everybody knows everybody else, this might not be a problem, and collegial processes evolve between candidates and society members. In large societies, however, or those that control psychoanalytic education over several cities, it tends to lead to a sense in candidates that they are being neglected or that nobody is watching over their interests; and this fosters dissatisfaction, disorientation, and a sense of drifting. However, because the candidates in the French model institutes are usually older than those in the Eitingon-model institutes, their relative isolation may be less of a problem: the candidates may be autonomous professionals in other fields, accustomed to independent functioning. Because there is very little centralized control of the candidates’ progress, evaluation of their readiness to graduate tends to be pushed toward the end of their training. At this point they are usually expected to present a graduation paper, to be evaluated by the entire group of full members of the society. Here, instead of the process by which candidates are selected before they start their training analysis, typical of the Eitingon model, the French
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model in some societies has evolved into one in which critical judgment is applied only at the very end of the training. This “final judgment,” rendered in a secret vote, inevitably provokes anxiety and stimulates regressive trends in the candidates, not to mention the possibility of arbitrary decision making by society members who may not know the candidates well, if at all. If the society is constituted by groups with very different ideological commitments, the termination paper may have to be a truly political document in which the candidate has to avoid offending one or another group of judges. This may lead to a significant distortion of what should be an exercise in scientific and professional thinking. It fosters passive resistance, paranoid fears, and dishonest formulations and casts an authoritarian shadow over the entire educational process. In small psychoanalytic societies such a problem does not evolve, but there, given the intimate professional contacts between candidates and members as part of the effort to avoid infantilizing the academic work of candidates, joint professional endeavors of candidates and members may lead to the selection of candidates who espouse the institution’s particular idiosyncrasy or ideology. An elitism is thus fostered that may acquire provincial qualities as well: “we select only those we feel we can get along with.” While the French model is quite efficient in selecting supervisors from among those society members who have given observable evidence in group supervisions of their educational capacity (and thus is potentially much more reliable than the Eitingon model), it has the disadvantage of a regressive idealization of the supervisory process. For example, it is an open secret (or myth?) in Paris that, in order to be accepted as a candidate by the relatively small and relatively “elitist” French Psychoanalytic Association, it is a definite advantage to have a personal analysis with one of the supervisors of that society. Finally, a major problem with the French model is that training is lengthened by the time required for the personal psychoanalysis that precedes it. This exacerbates a problem common to all psychoanalytic training—namely, that people in the most productive years of their lives remain students, not fully authorized to contribute originally to their own science and profession, with an implicit reduction of creativity and contributions to the field. It may be argued that this older age range is an advantage in terms of the candidates’ life experience and maturity. I believe, however, that the extended duration of the training itself may foster an unhealthy regression.
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PROBLEMS COMMON TO BOTH EDUCATIONAL SYSTEMS Infantilization of the Candidate
The regressive effects of the personal psychoanalysis, potentially reinforced by those of personal supervision, are, obviously, an unavoidable feature of psychoanalytic education and influence the entire educational process. In theory, this regressive pressure may be counteracted and reduced by stressing the academic aspects of psychoanalytic education, including, first of all, the theoretical and clinical seminars and, second, the academic and collegial functions of personal supervision. However, as I shall point out, there are regressive features in both models that reinforce this regression and weaken the academic aspects of the training (Kernberg, 1996c). One of the more painful and striking problems of psychoanalytic education is that, instead of utilizing the knowledge and experience some candidates bring from other fields, we treat their extra-analytic contributions with indifference, depreciation, and even suspicious rejection. It is as if learning about the unconscious requires that the mind be cleansed of all interest in “conscious” knowledge and experience. Candidates’ tendency to idealize their training analysts and the group or ideology to which they belong activates splitting mechanisms and paranoid attitudes toward alternative psychoanalytic groups or ideologies. Such tendencies are reinforced by psychoanalytic institutes’ critical rejection of alternative psychoanalytic models and their tendency to foster toward certain basic psychoanalytic texts or masters a quasi-religious attitude that a candidate can question only at his peril. Here we must talk about the idealization of Freud’s work, which takes on different characteristics in the Eitingon and French schools. In the Eitingon model, Freud’s work tends to be presented for study without being connected to contemporary thinking or to developments in other fields. In the French model, on the contrary, there is a tendency to study Freud’s way of thinking while not necessarily accepting his conclusions, so that independent and critical review of Freud’s contributions is encouraged. At the same time, however, insistent reference to Freud’s thinking as the basis for all new contributions conveys a dependency on his work that lends itself to idealizations and their split-off counterpart. In both models there is an implicit tendency to discourage candidates from participating creatively in the development of psychoanalytic science. For example, at the precongresses held during the International Psychoan-
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alytic Congresses, candidates present papers to one another relating to their common educational experience as well as to general areas of psychoanalytic endeavor. This seems a strange split in the activities of our profession: what would we think if cardiologists in training presented scientific papers on cardiology to their fellow residents and not to the cardiologists at large? That both candidates as a group and analysts as a group seem to feel comfortable with this strange arrangement, I believe, illustrates this issue. The presentation of a “scientific” paper at the end of training to members who then decide by majority vote whether or not the author should be allowed to graduate and be accepted into the society is another illustration of the regressive distortion of scientific work by hierarchical and political pressures. It is of course important that psychoanalysts learn how to carry out scientific work and write scientific papers. However, the production of such a paper is often an isolated activity within an educational process that does very little to foster a scientific attitude or kindle interest in the acquisition of research methodology appropriate to the psychoanalytic process. The association of the “graduation” paper with the implicit disappointment, disillusionment, and loss of motivation connected with the paranoid fears around graduation leads many candidates to abandon scientific work entirely once accepted into the society. In some societies, candidates’ graduation papers are judged by a group of senior psychoanalysts who have written very little in their professional life; this conveys the message that scientific work is for students, not for those who are safely established in the power structure of the psychoanalytic organization. The fact that such graduation papers often have to be written with careful attention to quoting the right authors from the same society (and avoiding quoting authors who belong to other or “deviant” schools) contributes to making a mockery of what ideally could be part of scientific education. Scientific Isolation and Ignorance
A number of psychoanalytic institutes throughout the world implicitly ignore psychoanalytic contributions from other approaches or schools. Here the cultural and linguistic barriers that affect psychoanalysis at large have a particularly powerful impact. French candidates often ignore significant contributions from Anglo-Saxon psychoanalysis; English-speaking candidates systematically ignore key contributions from French psychoanalysis; both groups ignore significant Spanish-, Italian-, or Portuguese-language contributions. The mutual ignorance of French- and German-speaking
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psychoanalytic institutions is proverbial, although the general ignorance of German contributions in other psychoanalytic communities is even more impressive. This problem transcends psychoanalytic education, of course, but it seems to reflect a passive renunciation of the task of expanding psychoanalytic knowledge and providing a broad scientific perspective, which properly belongs to our institutions of learning. Psychoanalytic institutes remain highly reluctant to introduce relevant information from sciences bordering on our field into their seminars and discussion groups. For example, in studying the psychoanalytic theory and treatment of depression, important contributions from neurobiology are largely ignored; discussions of drive theory neglect important shifts in the conceptualization of instinct theory in biology; and important contributions of the neuropsychology of affects to the study of the relationship of affects and drives are similarly ignored. While there are controversies about the extent to which infant observation has relevance for psychoanalytic theory, the very discussion of these controversies is avoided in many institutes’ seminars. Perhaps the most striking example of avoidance of developments in related sciences by psychoanalytic institutes concerns the possibility of expanding and updating Freud’s analysis of mass psychology with the evidence gathered in sociological and historical studies of small and large groups. In many psychoanalytic institutes throughout the world, there is a distrust of the university and of clinical psychiatry and psychology; psychiatrists and psychologists who spend significant time in academic endeavors are suspected of not being “true” psychoanalysts. Paradoxically, “psychiatrist” is a denomination that has particularly pejorative connotations in the French and some Latin American psychoanalytic approaches. The systematic neglect of research training and of developing a research attitude, explored in chapter 6, is a major problem of contemporary psychoanalytic education, reflecting a dangerous lack of concern for the scientific standing of psychoanalysis in the world that surrounds us. It needs to be stressed that psychoanalytic research includes a broad spectrum of investigation, ranging from clinical research in the psychoanalytic situation to scholarly critique of psychoanalytic concepts; from hermeneutic research regarding the clinical application of conceptual models to empirical research within and outside the psychoanalytic situation. Isolated courses on scientific methodology or isolated discussions of the controversy regarding psychoanalytic research are a far cry from systematically building into psychoanalytic education concern for and commitment to the devel-
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opment of new psychoanalytic knowledge and its acceptance in the intellectual world. Irresponsibility Regarding Candidates’ Educational Experience
Here I refer to the attitude of the psychoanalytic institute toward the candidates as a body and the responsibility it takes on in accepting candidates for psychoanalytic education. Perhaps the best-known aspect of this problem is the reluctance of individual supervisors and seminar leaders to confront candidates with serious problems in their functioning or to face in timely fashion a candidate’s inability to deal with psychoanalytic material. Supervisors as well as seminar leaders tend to be reluctant to express criticism to candidates and often do so only indirectly, in communication with other members of the faculty, so that a less than totally honest atmosphere develops around candidates who have problems in the course of their education. It takes courage to confront a candidate or to be critical in a seminar within a social structure where candidates’ freedom of choice may mean that teachers who are demanding will be shunned in favor of others who are not. There are differences in this regard between the French and the Eitingon models. One of the advantages of the Eitingon model is the potential availability of the entire group of seminar leaders and supervisors, who jointly may provide clear feedback regarding the candidate’s functioning. In the French model, the supervisor’s exclusive responsibility for this task makes the supervisory process much more difficult and fosters a regressive ambiguity of the evaluation process. In addition, the concerted effort to protect the autonomy of the candidate in learning psychoanalytic theory, methodology, and applications may reinforce a relative neglect of his progress, abandonment being the price paid for avoiding the risk of infantilization. Therefore, the tendency toward “postselection” in the French model, in contrast to the dominance of “preselection” in the Eitingon model, presents particular problems, different from those of the Eitingon model. The problem with selecting candidates before they have started their training analysis or after only a very brief period of analysis is that it limits our ability to predict which candidates will actually become good psychoanalysts. The preselection model may be quite adequate in most cases, but I believe it fails with those who have severe personal psychopathology that is unmasked only in the course of psychoanalysis. It is noteworthy, though, that the unusual and eccentric but highly creative candidate and, even more, the distinguished, professionally productive professional from an-
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other field who wants psychoanalytic training are often regarded with suspicion or even rejected in what sometimes amounts to true institutional masochism: not infrequently, the understandable resentment of these rejected candidates extends from the rejecting institute to psychoanalysis in general. Their loss to our field may be greatly detrimental to analysis. On the other hand, the postselection model, when combined with an institute’s laissez-faire attitude toward candidates’ progress, may result in candidates drifting for ten to fifteen years without being clearly aware of what is preventing them from graduating. Meanwhile, their institutes are faced with eternal students who may express a collective unconscious protest against an educational process in which they have been abandoned to waste what are potentially the most productive years of their lives. Not graduating is their revenge. Some institutes of the Eitingon model have attempted to correct the regressive effects of psychoanalytic education by appointing special mentors or ombudsmen to provide feedback and further the candidate’s professional development. A fundamental paradox exists between a tight educational structure that tends to foster regression in the candidates and an excessively loose one that may produce regressive features through its very lack of structure and support, increasing candidates’ anxiety. From the viewpoint of a functional educational experience, I believe that the ideal quality control should not take place in the form of pre- or postselection but should be ongoing, by means of appropriate feedback within a respectful and collegial atmosphere that makes conscious efforts to reduce the regressive effects of psychoanalytic education. Authoritarianism and Arbitrariness
Because of the largely unavoidable regressive features in both models, the potential exists for arbitrary assaults on candidates’ professional development, self-esteem, and survival in the training program. There are candidates who, for various reasons, become favorites in the training institution while others are held back or punished for minor infractions; this sends implicit messages to the entire body of candidates as to what behavior patterns lead to advancement and which are risky (Kernberg, 1998a, chap. 13). The more authoritarian the institute, the more such “black sheep” experiences become part of the legends of psychoanalytic education. In one Latin American psychoanalytic institute, for example, a small number of training analysts prevented the appointment of new training analysts for many
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years, accumulating a large list of “precandidates” in a waiting list while their charges for personal psychoanalysis reached astronomical proportions. Several institutes in Europe and Latin America tolerated the inappropriate sexual involvement of training analysts with candidates for an extended period of time, a reflection of the hierarchical power exerted by those particular analysts. Corrective interventions by the local society or the International Psychoanalytic Association were belated and painful. Influential training analysts have been able to postpone the graduation of “rebellious” candidates for many years, in an action correctly perceived by the entire psychoanalytic community as a demonstrative punishment. “Rebellious” behavior might include a candidate’s refusal to take on a particular patient recommended by a powerful training analyst; an allergic candidate’s insistence that his training analyst not smoke during their sessions; a training analyst’s rejection of a candidate who differed with him politically (a rejection, in a Latin American institute, that placed the candidate’s professional future at risk during a profound political division of their country). That psychoanalysis cannot survive in totalitarian political systems has been amply confirmed by the painful experience of the twentieth century. One might say, of course, that in all academic institutions—in fact, in all social organizations with hierarchical power structures—arbitrariness and mistreatment are unavoidable. I believe, however, that these cases are too common within the psychoanalytic educational system to be dismissed as part of ordinary institutional functioning and instead point to the powerful authoritarian pressures generated in the course of psychoanalytic education. Denial of External Social Reality
In many countries, psychoanalysis is faced with powerful challenges and social and financial restrictions that affect the life of candidates as well as the faculty of psychoanalytic institutes. These realities and their implications are rarely discussed and integrated into the institute’s educational policies. A major case in point is the scarcity of control cases around the world in the current climate of rejection and distrust of psychoanalysis proper along with the proliferation of competing psychotherapies and of professionals offering therapy at low intensity and low cost. This obviously affects the psychoanalytic community at large but is of particular relevance to the psychoanalytic institute, where candidates have difficulty getting control cases in time and have to reduce their fees in order to maintain the desired four-
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times-a-week frequency. The severe reduction in their income caused by this exigency is difficult or impossible for many candidates to bear, especially since they must pay for their own analysis, their supervisory experience, and attendance at seminars. This is an objective constraint that I believe demands that psychoanalytic institutes undertake active consideration of ways to help candidates obtain patients. There are institutes that do not perceive this problem as their responsibility. Training analysts are relatively protected from this social reality by the very fact that they have a number of candidates in analysis. This constitutes an often subtle pressure toward restricting the appointment of additional training analysts and may encourage a lack of concern among training analysts for their juniors’ difficulties in obtaining patients. These difficulties are related to the disconnection of the institute from the university, from clinical psychiatry and psychology, and from medicine. Intellectual isolation contributes to reducing the prestige of psychoanalysis in the scientific community, adding significant weight to the criticism in the culture at large that psychoanalysis is an elitist, subjectivist, impractical, expensive procedure. Many institutes fail to explore the relationship between psychoanalysis and psychotherapy or to recognize the indications, contraindications, and limitations of psychoanalysis and of modified techniques. Candidates learn only a standard psychoanalytic technique, although in practice most of their work consists of ad hoc psychotherapy, for which most of them have had little or no systematic preparation. In fact, in some places in Europe and Latin America, institute leadership is quite happy to see societies of psychoanalytic psychotherapy develop independently in their city or region, seeing it as their mission to preserve the “purity” of psychoanalytic education. They thus ignore the complications and challenges to psychoanalysis that may derive from competition between well-trained psychotherapists, on the one hand, and analysts unfit to practice anything but standard psychoanalysis, on the other. Psychoanalytic institutes are in a position to provide psychoanalytic candidates with training in the most sophisticated and specific psychoanalytic psychotherapy. By failing to do so, they are missing an opportunity for effective competition with alternative schools and for strengthening the psychoanalytic identity by defining an integrated theoretical frame for analysis and psychotherapy. In many places around the world, the brightest and most motivated psychiatrists and psychologists in training in their respective specialties are not interested in psychoanalytic education. This fact, I believe, is a reflection not only of popular attacks on analysis, particularly the hostility in many departments of psychiatry and
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psychology, but also of the lack of excitement with which many psychoanalytic institutes convey what they have to offer. PROPOSED SOLUTIONS
It should be clear from what I have said so far that I think neither of the major models of psychoanalytic education or their modifications offers an ideal solution to the problems I have outlined. We can, however, hope to reduce the regressive, authoritarian, and infantilizing features of psychoanalytic education by an ongoing effort to maintain and develop the best of our experience while modifying or discarding what has proved to be ineffective or even damaging to the mission of psychoanalytic institutes. Clearly, we need to investigate the effects, strengths, and shortcomings of alternative educational methods. And psychoanalytic education can no longer assume that it is immune to changes in the social, professional, scientific, and educational culture that surrounds us. A key aspect of my proposals is functional organizational structure— in contrast to authoritarian models or the defensive democratization and bureaucratization of psychoanalytic education as reaction formations against authoritarianism. I believe it is important to provide intense experiential as well as academic learning, with interactive feedback that gives candidates appropriate knowledge of their strengths and weaknesses and quality control together with stimulation for improvement. As mentioned before, I believe that ongoing, step-by-step evaluation of candidates’ performance is the optimal educational approach rather than pre- or postselection. This implies a flexible and open admissions policy that permits the selection of candidates who are really able to become analysts and facilitates their development at a reasonable speed in order to enable them to become full-fledged members of the profession while they are still young adults. We need to select supervisors who are knowledgeable, clear and direct in their interactions with candidates, able to be critical without becoming sadistic, respectful and open to different views, honest in their criticism, and able to say no. Obviously, seminar leaders need to show similar qualities; in all cases, we need to avoid contradictions between what is communicated to the candidate and what is said about him behind his back. Candidates need individualized attention, particularly during the early phases of their analytic education: an ombudsman or mentor assigned by the institute to provide candidates with feedback and advice regarding all academic matters and knowledgeable about the candidates’ specific professional background and expertise can make an enormous impact and can
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limit the regressive effects of the personal analysis on the total educational experience. Obviously, like all other educational experiences, this one can be perverted—for example, if the ombudsman is obtaining confidential information from a candidate and communicating it, without authorization, to institute authorities. The function of the ombudsman as the candidate’s “lawyer” needs to be differentiated from his role as mentor. If the ombudsman function leads to an increase in paranoiagenetic effects on the candidate, its purpose has clearly failed or been perverted. The discussion of “standards” of training is often reduced to considering whether three or four or five sessions a week are required for adequate training or control analyses. This is an important theoretical and clinical (and also political) question that concerns the psychoanalytic community and demands appropriate research. Unfortunately, this issue tends to decrease the attention paid to the problems I have outlined regarding training analysis, supervision, and seminars. We probably have an excellent opportunity to experiment with new educational models when expanding psychoanalysis into new regions such as eastern Europe, the Far East, the Middle East, and the African subcontinent. The IPA’s approval of “concentrated analysis”—that is, the possibility that candidates who have to travel enormous distances to get to their analyst may have two sessions on the same day, within a total of two or three days of the week—may make psychoanalysis available to distant and isolated communities, while avoiding the negative consequences (and masochistic temptations) for candidates who might otherwise obtain psychoanalytic training only at the cost of severe disruption of their personal, family, and professional life. Preliminary clinical evidence, provided particularly by Brazilian institutes, suggests that the concentrated analysis model is feasible. Above all, the regressive idealization and split-off paranoiagenesis that haunt psychoanalytic institutes need to be reduced by a functional administrative structure and functional approaches to the major tasks of psychoanalytic education. With regard to training analysis as a function, a professional status, and an essential aspect of the Eitingon model, I believe that there are two major alternatives to be followed. On the one hand, if the psychoanalytic education offered by an institute is of such high quality that it can assure excellent graduates, and if they become full members of the psychoanalytic society upon graduation, there would be no need for the title and status of “training analyst” in such an institute. Any members of such a society who expressed an interest in analyzing candidates after, say, five years of experience
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would be authorized to carry out this function. If, on the other hand, the institute cannot ensure the excellence of its graduates to the general satisfaction of the entire society, the selection of training analysts as the members most capable or best prepared to provide a good analytic experience to candidates may be the optimal method, as long as that selection is a truly functional one. Again, a minimum of five years’ experience as a graduate analyst may be a reasonable requirement, in addition to the specific criteria of professional maturity, emotional and intuitive subtlety, knowledge in depth of theory and method, openness to one’s unconscious, and intellectual clarity and openness. In this connection, I strongly believe that all “military” ranking of analysts should be eliminated, particularly the problematic classification into “associate” and “full” members. All graduates of an institute should be eligible for immediate full membership. The presentation of a scientific paper should come after acceptance, as a joyful welcome, not as one more initiation ritual. The pleasures of scientific contributions should not be spoiled by making it a precondition for hierarchical ascendance in the society’s power structure. I believe that it is essential to separate the personal analysis from the rest of the candidate’s educational experience and that reporting should be considered unethical behavior and eliminated. The training analyst should maintain complete distance from any decision making involving a candidate who is in analysis with him or her. I also believe that the personal analysis should come to a natural end, disconnected from all other educational experiences of the candidate, whether before or after graduation. The expectation in some institutes that the candidate must continue in a personal analysis until the day of graduation runs against the very spirit of the psychoanalytic encounter. Kächele and Thomä (1998) have recommended that the triad of training analysis, supervision, and seminars be replaced by the triad of “teaching, treatment and research.” Psychoanalytic institutes, they suggest, should request a strictly limited number of sessions—say, two hundred hours—of training analysis with a training analyst. Then the candidates should be free to decide whether and with whom they want to continue in a therapeutic analysis. Kächele and Thomä believe that senior analysts should present their case material in continuous case seminars, and they point to the importance of research training as an essential aspect of psychoanalytic education. I fully agree with both proposals, but I wonder whether a regimented restriction of the number of hours of training analysis (or personal analysis with an analyst authorized by the institute) can do justice to the
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complexity of personal psychoanalytic experience. Candidates with significant narcissistic character pathology, for example, may require more than two or three years of personal analysis to overcome their narcissistic defenses, and the artificial separation of the training and therapeutic functions of the personal analysis seems problematic. I agree with Kächele and Thomä and with Sandler (1998), however, in questioning the very long duration of many training analyses. I believe that both bureaucratic restriction and bureaucratic extension of the personal analysis are problematic approaches. The combination of obligatory and elective seminars and the flexible opening up of society seminars in which candidates may participate, in the same way that society members are invited to participate in institute seminars if they so desire, are positive contributions of the French psychoanalytic model that deserve further exploration. The educational culture surrounding the psychoanalytic institute, particularly how university education is organized, probably influences local psychoanalytic education more than we are aware of, and it would seem perfectly appropriate that such culturally dominant educational models be replicated in psychoanalytic institutes. The main point here is to provide an atmosphere of excitement and freedom, to avoid indoctrination, and to encourage questioning and original work within the institute seminar structure. At the same time, the provision of a basic frame of reference may protect the candidate from what, at an extreme, may become a chaotic eclecticism. It may be helpful for institute faculty to familiarize themselves with the theories and contributions of outside academics invited to teach in interdisciplinary seminars and to consider the developments in boundary fields that need to be integrated as part of a sophisticated scientific education. I am proposing what may appear to be a paradox: an enriched, intensive, challenging curriculum combined with a flexible approach that gives candidates responsibility and autonomy for structuring their learning; an integrated, basic frame of theory, technique, and applications, with a questioning and challenging attitude toward all dogmatic assertions; and ongoing vigilance against the risks of indoctrination and passive receptiveness. It seems important to enrich psychoanalytic seminars with a multiplicity of academic methods geared to stimulate excitement and creativity, ranging from informal discussion groups to formal lecture series, from inviting leading theoreticians from alternative schools to meet with the candidates to developing seminars with experts in other scientific disciplines related to psychoanalytic exploration, thus providing a broad scientific ed-
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ucation in areas where interdisciplinary study is most crucial. The seminar structure of psychoanalytic institutes should provide opportunities to observe the pedagogic talents and attitudes of teachers, thus facilitating a functional selection process for supervisory status and for mutual feedback of teachers and students, while preserving the possibility of quality control regarding specific learning. There are pros and cons as to whether seminar performance should be part of candidates’ evaluation process; we need to study the extent to which a purified French model of quality control carried out exclusively through supervision may be preferable to one in which seminar participation is also evaluated. I believe that, in a functional academic atmosphere, evaluation of candidates’ academic learning in the seminar structure is appropriate and feasible without generating a dogmatic and infantilizing atmosphere. Obviously, if such evaluation is combined with indoctrination of theory and suppression of critical thinking, quality control may simply become a method of thought control. I believe that the emphasis on the personal evaluation of a candidate’s work by means, predominantly, of the supervisory process and the emphasis on the seminar work and scientific development by means of the intensive yet flexible curriculum are complementary. All candidates need to be well grounded clinically; those who are interested and effective in their scientific development will be particularly rewarded by the institute’s intellectual climate and their personal recognition and stimulation. I believe that the effort to develop an explicit, detailed, specific, basic methodology or theory of psychoanalytic technique is worthwhile in that a common frame of reference permits the evaluation of alternative technical approaches; the fear that learning a theory of “technique” will reduce the freedom to intuitively grasp the unconscious expressed in the psychoanalytic situation is unfounded. An explicit theory of technique can support the analyst’s efforts to understand and manage chaotic countertransference responses to the patient’s material; a theory of interpretation may provide a background that is general enough to allow for a wide variety of intuitive approaches to the patient’s material. The same is true for psychotherapy: having incorporated a psychoanalytic theory of technique facilitates the learning of psychoanalytic psychotherapy, enormously enriching one’s technical capabilities and helping psychoanalysis scientifically and professionally in a social environment often characterized by undisciplined “wild psychotherapy.” I believe that the content of the psychoanalytic curriculum should vary
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over time. The teaching of Freud’s work—whether from a historical viewpoint or a theme-oriented viewpoint, whether the emphasis is on the content of his conclusions or his methodology of thinking—needs to be integrated with an analysis of contemporary developments within psychoanalysis as well as in the surrounding scientific world. In other words, we have to avoid teaching Freud’s work as bible reading and to prevent unanalyzed idealization processes from infiltrating psychoanalytic education. Candidates should be stimulated to carry out research as part of their analytic training experience. I agree with Cooper (1999) that “the development of a cadre of dedicated researchers and scholars . . . [is] our most pressing task.” This implies that research departments should be set up within psychoanalytic institutes and that experts in appropriate research methodologies should be developed and made available on an ongoing basis as consultants to psychoanalytic seminars, to study groups, and particularly to individual candidates and faculty members. In my experience, encouraging candidates to undertake scientific contributions, to present this work at society meetings, and to publish it has a powerfully positive effect on the commitment, excitement, and creativity of all candidates. The inhibition of the creativity of psychoanalytic candidates, in my view, is one of the major problems of present-day psychoanalytic education and one of the most damaging for the development of psychoanalysis as a science (Kernberg, 1996c). Giving additional support to research by selected candidates may indirectly stimulate a questioning attitude and creativity in the entire candidate group. The curriculum should be a curriculum in evolution, with ongoing testing of the effectiveness of the seminar program as a whole and of each particular seminar. It is important that certain senior members of the faculty not become chronic monopolizers of key seminars; appropriate rotation of teachers can provide candidates with a broad spectrum of educational experiences. Supervision emerges as the essential quality-control measure, a learning experience that optimally combines academic and experiential features. In the Eitingon model, training analysts and supervising analysts are usually selected as if the same person could perform both training and supervision; this illustrates, I believe, a failure to appreciate the importance of the pedagogical qualities of the supervisor. The selection of supervisors and the assurance of the quality of their work constitute perhaps the most essential responsibility of the psychoanalytic institute. Appropriate selection criteria
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for supervisors are usually missing or underemphasized in the Eitingon model. The French model of supervision, however, creates its own problems, stemming from its regressive features and its often excessive focus on the experiential aspects of the process, to the neglect of the responsibility to teach directly. For different reasons, the same problem may affect supervision in the Eitingon model if the supervisor imitates psychoanalytic “neutrality” and “anonymity.” Supervisors should have a thorough knowledge of the general theory of technique presented in the seminars and should be able and willing to refer to that theory in relation to the practical interventions warranted in the control case under supervision. They should feel free to explore the consequences of countertransference dispositions in the candidate for the treatment of the patient, while respecting the candidate’s privacy and avoiding the temptation to transform supervision into a psychoanalytic treatment situation. Supervisors should be able to identify with the overall educational objectives of the institute and yet preserve sufficient autonomy to be able to share candidly with the candidate whatever philosophical differences they may have with the way in which various issues are taught. In other words, exploration of “parallel process” applies not only to the explicit analysis of the transfer of the candidate’s experience in the treatment of a patient into the supervisory situation but also to the supervisor’s selfreflection on the transfer of his or her relationship with the institute into the concrete supervisory relationship with the candidate. In short, much should be expected from the supervisor. The observation of group supervision may provide important information about the supervisor’s talent, knowledge, and emotional capabilities for supervisory work. Supervisors should communicate with one another, jointly evaluating how their candidates are functioning with their various control cases. And this information should reach the candidates, ideally through the supervisors themselves or via an ombudsman designated to help them work through such feedback. The supervisory experience should be a collegial one with periodic mutual evaluation of candidates and supervisors. The extent to which candidates should be able to select their supervisors is an open question. This is an area for experimentation and for potential cultural variation among institutes. Regarding the overall structure of the psychoanalytic institute, the methods and criteria for selecting faculty members, training analysts, and candidates and for the progression of candidates, graduation, and the like, should be transparent, public information. The organization of psychoana-
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lytic candidates into an administrative structure in ongoing contact with the institute director or executive committee can enable the candidates to participate responsibly in the educational process and provide them with a channel for redress of grievances. Obviously it is possible to develop such formal structures without delegating any real authority to them, and it is one of the tasks of the institute to analyze honestly the extent to which its structures correspond to their functional purposes. Many of these measures are currently being developed at institutes throughout the three regions of the International Psychoanalytic Association. Many changes, however, are made in response to particular problems in a particular institute rather than arising from an overall evaluation of the basic tasks of the institute, the basic constraints to these tasks, and the optimal administrative structure that would do justice to those tasks and constraints. A well-devised organizational structure can probably protect an institute against excessively regressive organizational features, but it cannot assure its optimal development without creative and inspired leadership (Kernberg, 1998a, chap.13). It is important that a mechanism for selecting inspired educational leadership be built into the structure of psychoanalytic institutes and that institute directors be given sufficient authority over a sufficient time span to be effective (it takes at least several years to provide an innovative organizational leadership). An institute whose directors routinely change every year or two may be indicating by this system that it is not interested in change or progress. Periodic meetings of the entire faculty and faculty retreats with combined meetings of faculty and candidates or their representatives may permit the ventilation of problems obscured in the daily management of the educational enterprise. One indication of a functionally adequate institute may be that the scientific contributions of faculty and students and the ability of its teachers to inspire the candidates are its most important sources of pride, while professional prestige is no longer dependent upon attaining training-analyst status on the hierarchical ladder. To conclude, responses to the following questions may quickly indicate how far a psychoanalytic institute has progressed with the work of educational innovation: 1 2
Are research methodology and concern built into the program? Are multiple psychoanalytic theories and clinical approaches taught respectfully?
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Is there a functional candidates’ organization in place? Are candidates participating in making scientific contributions to the field? Are scientific developments at the boundaries of psychoanalysis being taught? Is there a functional, nonpolitical method for appointing training analysts or for assigning the authority to analyze candidates? Are candidates helped to accelerate their training? Is there a functionally changing curriculum in place? Is there integration of pre- and postgraduate seminars? Are candidates evaluated in an ongoing, step-by-step process, with appropriate feedback? Do supervisors communicate with one another and with seminar leaders? Is the institute actively engaged in collaborating with the local university settings and participating in training mental health professionals? Are junior faculty invited, developed, and functionally integrated into the institute? Is the personal analysis of candidates totally separate from the rest of their educational experience? Is there a functioning mechanism in place to deal with candidate or faculty breakdown or incompetence in a humane yet responsible way?
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some proposed complementary solutions to the problems of psychoanalytic education
The proposals listed below have been formulated in various quarters with the intention to energize, innovate, and optimize psychoanalytic education. I have included some proposals that may be controversial and some that are self-evident, in an effort to bring all issues to the table rather than taking any particular stance regarding them. And the list, of course, is not exhaustive. The background is our shared concern over the relative stagnation of our educational methods over many years, over the authoritarianism and bureaucratization within many psychoanalytic institutes, and over the need for our educational institutions to develop an active response to the changing social and cultural environment. The proposals are not listed in order of importance, nor is my purpose to impose or even propose a uniform set of educational methods and administrative arrangements to be adopted by all institutes and societies. Rather, my aim is to stimulate further discussions and creative innovations and to work toward a reformulation of basic standards of training that support and foster such innovations. THE TRAINING ANALYST
Has the institutional status of the training analyst outlived its usefulness? Combining the functions of supervisor and seminar leader with that of training analyst implies that the talents and capabilities required by these roles usually coexist in the same person: obviously this is seldom the case. In some institutes training analysts as a group have tended to constitute power hierarchies, distorting the educational process and leading to negative and regressive features of such institutions. 132
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In some societies the status of full member confers the right to conduct training analyses. Unfortunately, the criteria for change of status from associate to full member in such societies have become politicized, replicating the problematic politicization of the appointment of training analysts in other societies. It has been proposed that the status of associate membership should be abolished, so that bona fide graduates of our psychoanalytic institutes immediately become full members, who may obtain the authority to carry out training analyses after, say, five years of clinical experience. It could be argued that there are good reasons for exercising some kind of quality control before authorizing training analysis functions and that members who have reached the five-year experience point might apply for a specific examination that would assess their capacity to carry out those functions. If careful guarantees were built into the process, a plan of that sort might significantly reduce the politicization of training-analyst status. In any case, opening such a procedure to all institute graduates would avoid the tendency to restrict the number of training analysts in order to assure a sufficient number of candidates to those elected. It would go a long way toward reducing the authoritarian temptations and pressures in psychoanalytic institutes, as would the formation of training-analyst selection committees made up of faculty from several institutes within the same region rather than from only the society of the prospective training analyst. There now seems to be general agreement that the reporting functions of the training analyst should be restricted to routine confirmation to the institute that the personal analysis of a candidate has begun, is proceeding at a certain frequency, or has ended. The French and Eitingon models differ with regard to the frequency and total number of sessions required. We may not have enough experience with the French model to assert that a frequency of three sessions per week suffices for a standard psychoanalysis, but so far there is no indication that graduates of French institutes are less competent than those trained with the Eitingon model. The view that authorizing three sessions would lead to two sessions of analyses per week or even less seems cynical. Of course, there are analysts who state that any treatment by a psychoanalyst carried out from a psychoanalytic perspective is analysis, regardless of frequency; but this position is highly problematic, often geared to avoiding the complex issue of the relationship between psychoanalysis and psychoanalytic psychotherapies. Some societies that train candidates on a three-times-a-week basis extend their analyses over significantly more years than some other societies that require four or five sessions per week. It might be reasonable to expect
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a certain minimum number of sessions of personal analysis—say, six hundred—regardless of the frequency of sessions. It seems reasonable to think about frequency in terms of the goals of the analysis. A higher frequency promotes greater intensity and more useful transference states, especially desirable as part of candidates’ training, just as more than three sessions per week may be desirable during certain periods of personal analysis. Clinical experience indicates that the analysis of persons with certain types of pathology, such as narcissistic personality structures, often goes better with more frequent sessions; this might determine the frequency of a candidate’s personal analysis and his supervised analyses as well. THE SUPERVISORY EXPERIENCE
Obviously, the supervisor is the one who knows the most about what the candidate is learning and his or her capacity to conduct an analysis. How the candidate thinks about and carries out the supervised analyses is likely the strongest test of his learning to understand his own unconscious, as well as his mastery of the psychoanalytic theory of psychopathology and technique. It is therefore surprising how little emphasis some societies place on the supervisory experience, while strongly stressing the importance of a high frequency in the personal analysis. It might be reasonable to establish a certain minimum number of supervisory sessions—perhaps two hundred—as a prerequisite for graduation. The quality of the supervisory process is easier to assess than that of the training analysis, given that the former is reportable and the latter is not. Furthermore, the competence of the supervisor can be assessed by direct observation of supervision of clinical cases by a society member over a long period of time. Junior faculty can observe a supervisor in a group, and this may be the optimal basis for a functional selection of supervisors, providing important information about the supervisor’s talent, knowledge, and emotional capabilities for supervisory work. An important element in the assessment of supervisors, along with their ability to teach, is their capacity and willingness to share their assessment of a supervisee’s work. So, too, is their ability to relate recommendations for specific interventions to a general theory of technique. Supervisors obviously need to evaluate their candidates, and they should be expected to have the courage to discuss candidates’ difficulties directly rather than holding back and conveying their criticisms only to third parties. The selection of a body of proven effective supervisors and the es-
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tablishment of an institutional structure that permits an open sharing of supervisory experiences as part of the evaluation of candidates’ progression, in addition to an honest and ongoing reflection back to the candidates of their evaluation, are essential aspects of a good psychoanalytic institute. Patients treated under supervision should have three- or four-sessionper-week analyses: the relationship between frequency and type of pathology is relevant here. One may also question whether cases of psychoanalytic psychotherapy should be part of the panel of control cases. It seems reasonable to try to reduce the present discrepancy between the frequency of sessions of control cases and ordinary local clinical practice. Supervision emerges as the essential quality-control measure, a learning experience that optimally combines academic and experiential features. The selection of supervisors and the assurance of the quality of their work constitute perhaps the most essential responsibility of the psychoanalytic institute. CLINICAL AND THEORETICAL SEMINARS
Good supervisors and good training analysts may or may not be good seminar teachers. Seminar leaders should therefore be selected on their own merits, which will be apparent to junior faculty members who observe their teaching. Seminar leaders should have demonstrated pedagogical capacities as well as knowledge, enthusiasm for teaching, and a demonstrated capacity for stimulating students to take initiative in the learning process. They should be free from the tendency to dogmatically impose their viewpoints, instead stimulating independent thinking in the candidates. If psychoanalytic institutes want to attract the brightest and most creative candidates, they have to generate a climate of intellectual excitement and challenge. Institutes need to avoid the monopolization of teaching certain seminars. Highly qualified teachers from other fields at the boundary of psychoanalysis—neurobiologists, sociologists, anthropologists, philosophers—should be part of the seminar structure of the psychoanalytic institute, regardless of whether they are in agreement with basic psychoanalytic theories. Should a minimum of “obligatory” seminars or areas be defined in combination with “elective” areas of teaching and learning? The traditional “monolithic” teaching of seminars in accordance with a local approach to psychoanalytic theory and technique—as opposed to a broad spectrum of seminars that include the open and honest communication of alternative psychoanalytic approaches—is no longer a problem in most contemporary psychoanalytic institutes. It would seem reasonable that the “obligatory”
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seminars include not only the basic areas of Freudian theory (regarding unconscious functioning, development, structure formation, psychopathology, and treatment) but also the cutting-edge developments within contemporary psychoanalysis. It may no longer be controversial to invite candidates to join curriculum committees and to assure them of “safe” ways of evaluating their teachers, in parallel with the teachers’ evaluating them. Candidates and seminar leaders should be apprised of their evaluations. Meanwhile, the institute needs to ensure an ongoing critical review of the content and the effectiveness of the curriculum. RESEARCH
The time has come to pay more than lip service to research in psychoanalysis and to cast aside the pseudocontroversy of “empirical” research versus “clinical and hermeneutic” research. Research refers to systematic observations geared to examining psychoanalytic concepts. It is a responsibility of every science to take cognizance of and participate in general scientific advances at the periphery of its field. The uniqueness of the psychoanalytic instrument and the nature of its subject, the dynamic unconscious, do not eliminate the need for the scientific development and new applications of this instrument, as well as efforts to link our findings with those of related sciences. The role of psychoanalytic institutes to transmit knowledge cannot but lead to dogmatic “imprinting” if it is not matched by an ongoing, thoughtful exploration of the limits of this knowledge and the means to advance it. Research methodology should be a required part of the psychoanalytic curriculum. Expertise in research methodology is acquired through formal courses and through the presence of an active research questioning in all areas of teaching. Research projects and scholarly studies by candidates and faculty can serve as the nucleus around which research methodology can be taught and creative initiatives of candidates and faculty fostered. Stimulating scientific contributions—from case presentations to systematic review of a controversial area—by candidates with particular research capacity and interests may be a central responsibility of all seminar leaders. The excitement of interdisciplinary research needs to be built into the core curriculum rather than displaced into the old-fashioned “extension divisions” of psychoanalytic institutes, to be taught as a kind of consolation prize by analysts who have not been given the status of training analyst (and hence are neither supervisors nor seminar leaders within the institute).
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Clinical and theoretical seminars of the regular teaching program need to be the focus for raising controversial questions and investigating them, possibly with collaboration of experts in disciplines at the boundary of psychoanalysis. All these functions require the establishment of a department of research within psychoanalytic institutes and a clear participation of that department in the institute’s administrative leadership. THE SELECTION AND EVALUATION OF CANDIDATES
While it is desirable in general to create a candidate body representing a broad spectrum of professional backgrounds, institutes should maintain a significant proportion of candidates from medicine, psychiatry, and postdoctoral clinical psychology in order to keep a strong relationship with medicine and psychology as important boundaries of psychoanalytic and psychotherapeutic practice and as closely related scientific fields. In the French method of selection, candidates are not accepted until they have had several years of personal analysis, in order to ascertain whether they have been able to learn about their own unconscious functioning. The disadvantage of this system is the extension of candidate status as such over many years. This of course denies the candidate full authorization to participate in the scientific endeavor of psychoanalysis, and it may foster a regressive infantilization. Insofar as the French system remains very flexible throughout the seminar years, it counteracts that regressive potential, but it puts an enormous emphasis on the conclusion of training with a graduation paper. In this “postselection” method, after initial acceptance, candidates progress at their own pace, with relatively little ongoing evaluation until the point of graduation, when they are judged at least in part on the basis of a graduation paper. The Eitingon method has the advantage of an accelerated training in that candidates are accepted before the initiation of their training analysis. This “preselection” mode results in much more uncertainty about candidates’ analyzability and their capacity to learn about their own unconscious. And it may preclude the acceptance of potentially creative candidates who don’t fit the particular local idiosyncrasy of a psychoanalytic institute. Most Eitingon model institutes require only one year of personal analysis before the candidate is authorized to attend seminars. To avoid premature closure of potentially good candidates and the passivity that the long duration of training encourages in candidates, I suggest that Eitingon institutes establish open criteria for admission. A selective process should assure a high level of intelligence and honesty and the ab-
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sence of severe psychopathology of a kind not usually treatable by psychoanalysis. The optimal solution to the shortcomings of both models is neither a preselection nor a postselection system, but the ongoing step-by-step evaluation of candidates’ work, particularly in the context of their supervisory experience. As has been mentioned, supervisors have to honestly reflect their views to candidates, including the advice to discontinue the training when indicated. It would be profoundly unfair to hide behind the anonymous voting system for accepting candidates’ graduation or membership. While ongoing evaluation of candidates is surely preferable to the preand postselection systems, there is a risk that evaluating candidates in the context of the seminar structure may establish a “high school” atmosphere of grading, with implicit fostering of submission to teachers and reduction of creativity. This is a danger of the Eitingon model. The supervisory experience should be given more weight than candidates’ seminar performance. GRADUATION REQUIREMENTS AND SOCIETY MEMBERSHIP
It seems reasonable to require that candidates be able to describe intelligently in writing a case they have been treating, but requiring a scientific paper from candidates whose educational process has not been geared to developing a research attitude and a scientific posture is an institutional hypocrisy that should be confronted. Graduating candidates should have satisfied the requirements of a personal analysis, successful completion of a minimum number of supervisory hours with at least two supervisors, and active participation and potential creative investment in the seminar structure. Creative candidates should be invited to teach seminars or participate in the research activities of the institute if they have particular interests and talents in this area. The graduation requirements should, of course, be consistent with the educational emphasis of the institute. Graduates should be accepted automatically as members of the society. To require a scientific paper as a precondition for acceptance seems a bureaucratic and essentially questionable old custom, reflecting, at base, the hierarchical rivalry between psychoanalytic institutes and societies. The psychoanalytic society should be represented in the executive body of the psychoanalytic institute, helping to ensure the fair, effective, legitimate functions of the institute; and the society should be able to trust the educational functions of its own institute to graduate potentially valuable members. Inviting new members to give scientific papers, to recognize and honor their achievement, would convey a
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completely different message than requiring such papers and having them judged in a secret vote by older members. Often the discussion of innovation in psychoanalytic education takes the form of “flexibility” versus maintenance of “minimal standards,” as if these concepts were in conflict. The problem is one of semantics: our minimal standards for psychoanalytic training really refer to minimal requirements for the graduation of candidates. What constitutes a high-functioning clinician has not been specified, while the insistence on determinate minimal requirements, particularly the number of hours of personal analysis, supervision, and control cases has been used as an equivalent of such optimal functioning. We should work toward establishing criteria for an optimal level of professional functioning and acknowledge that alternative requirements may lead to that same professional quality. Obviously, the understanding of the unconscious in oneself and in patients, the capacity to promote this understanding in patients and facilitate psychoanalytical changes through it, and a continuous growth and development of these capacities in the analyst are essential aspects of optimal professional functioning of the psychoanalyst. There is no evidence, however, that there is only one way of achieving this desired goal. The term “standards”should be rescued from its code meaning of requirements and become a synonym for quality of performance. THE CURRICULUM: TEACHING A THEORY OF PSYCHOANALYTIC TECHNIQUE
I believe that the effort to develop an explicit, detailed, specific, basic methodology or theory of psychoanalytic technique is an advantage, insofar as a common frame of reference then permits the evaluation of alternative technical approaches. The fear that learning a theory of technique will reduce the freedom to intuit the unconscious as expressed in the psychoanalytic situation is unfounded. An explicit theory of technique can support an analyst’s efforts to understand and manage chaotic countertransference responses to the patient’s material, while a theory of interpretation may provide a background that is general enough to allow for a wide variety of intuitive approaches to the patient’s material. Similarly, having incorporated a psychoanalytic theory of technique facilitates the learning of psychoanalytic psychotherapy, enormously enriching the technical capabilities of candidates and helping psychoanalysis scientifically and professionally in a social environment often characterized by undisciplined “wild psychotherapy.”
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I believe it is time to explore and teach systematically the application of the psychoanalytic method to derivative psychotherapeutic treatments, including the psychoanalytic psychotherapy of nonanalyzable, severe psychopathologies and group, family, and couple therapies based on the psychoanalytic method. The common institutional hypocrisy of officially ignoring psychotherapy while individual senior faculty members train psychoanalytic psychotherapists outside the institute should be confronted. There is no reason the psychoanalytic institute could not offer training in psychoanalytic psychotherapy to advanced psychoanalytic candidates whose core identity as psychoanalytic clinicians has been sufficiently established to be able to absorb and carry out modified types of treatment. Such training may significantly impact the social surround of psychoanalytic institutes, strengthen the position of psychoanalysis within the community and the mental health sciences, and provide an important area of challenging research. It is a common practice in institutes of the American Psychoanalytic Association to offer psychotherapy training to clinicians who have not had psychoanalytic training. Energetic implementation of psychotherapy training within the institute may prevent the self-inflicted wound of creating psychoanalytically oriented training centers in which our own faculty competes with the psychoanalytic institute. THE STRUCTURE AND ADMINISTRATION OF THE INSTITUTE
The time has come to acknowledge the important contributions to psychoanalytic education of supervisors, seminar leaders, researchers, and experts in applied psychoanalysis. Once such differentiated groups come to exist within a faculty, their role in the leadership of the institute must be defined. Representatives of these faculty groups and of the membership of the society at large would most appropriately constitute the executive body of the institute. If a large number of the society members were to have training analytic functions, the selection of an executive committee representing seminar leaders, supervisors, researchers, and applied science experts might include enough analysts with training analytic functions to preclude concern about a specific representation of training analysts. Such an organizational structure would, de facto, eliminate the training-analyst career as the only professional progression within psychoanalytic institutes and societies and assure realistically parallel careers of psychoanalytic development. Above all, the institute leadership would include faculty with the specific function of monitoring and developing areas of psychoanalytic education, particu-
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larly supervisory excellence, intellectual excitement and stimulation in the seminars, and an ongoing research atmosphere. I have already argued that it would be reasonable to confer full membership on new graduates. By the same token, I think it would be reasonable to confer associate membership status on psychoanalytic candidates, thus signaling to them that they are already considered to be members of the psychoanalytic community and are invited to participate in scientific meetings and postgraduate seminars as well, if they so choose. If seminars for candidates are geared not only to transmitting knowledge but to generating new knowledge, graduate members of the society may wish to participate. It often appears that associate and full memberships are hierarchical steps along the road to becoming training analysts; this pathway to power should be eliminated. Above all, the regressive idealization and split-off paranoiagenesis that haunt psychoanalytic institutes need to be reduced by a functional administration structure and by functional approaches to the major tasks of psychoanalytic education.
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sanctioned social violence: a psychoanalytic view
Social violence refers to sustained sadistic, intentionally destructive behavior—against unarmed, defenseless, noncombatant civilians that is typically in dramatically sharp contrast to the ordinary actions of the perpetrators in their lives outside the specific area of interactions with selected human groups. I am explicitly excluding here belligerent behaviors as an expression of warfare, in which the combination of nationally mandated participation in the armed forces, the actual presence of armed, belligerent opponents, and the corresponding nationalistic ideological superstructure tolerates and encourages violence on a large scale. Nor am I here considering the voluminous psychoanalytic literature on the origins of warfare, or the contributions of psychodynamic factors to war as an immanent aspect of human history, destructiveness that has not yet erupted into visible violent acts directed against a defined minority (Segal, 1997). It could be argued that the most extreme manifestations of social violence and the best-studied cases are the ideologically totalitarian regimes of Nazi Germany and the Communist Soviet Union. The recent opening of historical archives and intense historical and sociological research have provided information that lends itself to exploration from a psychoanalytic viewpoint (Bullock, 1991; Furet, 1995; Gilbert, 1997, 1998; Malia, 1994; Sinyavsky, 1988; Sofsky, 1997; Werth and Moullec, 1994). I am suggesting that the massive killing of civilians, the open and socially sanctioned torture and persecution of minorities, and the mass abanThis chapter is based on a modified version of O. F. Kernberg, “Sanctioned Social Violence: A Psychoanalytic View, Part I,” International Journal of Psycho-Analysis 84 (2003): 683 – 98. © Institute of Psychoanalysis, London, UK. 142
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donment of the usual standards of human decency, empathy, and pity reflect the operation of the extreme degree of psychopathology of the aggressive drive that justifies the concept of the death drive; the death drive affects individuals, but also, and very importantly, groups and institutions. I believe that, without ignoring the specific historical, political, economic, social, and cultural origins of intergroup violence, psychoanalysis can help to explain the sudden shift of human behavior from ordinary civilized interactions and respect for human life to massively expressed and sanctioned social violence. The ultimate purpose of the effort to increase our understanding of social violence and of the conditions under which it may become prevalent and uncontrollable is, of course, to contribute, however modestly, to the prevention and control of this scourge of humanity. My premises and conclusions may be summarized as follows: The biological basis of aggression and destructiveness gives rise to a universal human potential to experience and express aggressive affects. These affects are fixated in unconscious internalized object relations. 2 Under the impact of peak affect states, a primitive, split organization of internalized object relations takes place, with “idealized” and “persecutory” unconscious experiences, which normally become integrated in the course of development, kept separate from each other. They may remain separated as a consequence of excessively intense aggressive affects and/or early traumatic experiences of aggression, pain, or victimization. 3 Severe personality disorders, in the syndrome of identity diffusion, reflect the pathological persistence of primitive splitting, expressed in two prototypical personality types: the narcissistic and the paranoid. Narcissism reflects an organization of purified “idealized” self and object relationships: it defends against aggression by idealizing the self and devaluing others. Paranoia expresses the “persecutory” organization of painful, hate-infused unconscious relationships by defensive suspiciousness and the projection of aggression onto others. The condensation of narcissistic and paranoid organizations characterizes the syndrome I have called malignant narcissism. 4 Psychoanalytic studies of regression in small and large groups, mass movements, and social organizations in crisis indicate striking similarities to the defensive organizations of narcissistic and paranoid personality disorders in individuals. In fact, narcissistic regression in groups appears as a first level of regressive defense against the potential for a more primitive, paranoid regression. This parallelism between group 1
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regression and individual psychopathology can be explained by the reactivation in unstructured group situations of the universal primitive potential for peak affect states to disintegrate into an idealized and a persecutory experience, with the concomitant activation of corresponding primitive defenses (i.e., splitting, denial, projection, and idealization) and, finally, the direct expression of primitive aggressive affect dispositions in socially fostered and sanctioned violence. The analysis of political ideologies reveals a striking similarity to the narcissistic-paranoid polarity in that ideological systems usually reveal a central humanistic core and a tendency to shift toward a narcissistic or paranoid extreme under historically determined circumstances. The media contribute to massive group regression by activating mass psychology, thus reinforcing the narcissistic and paranoid polarities of the culturally dominant ideological systems. Regressive groups attract and promote leaders with a corresponding narcissistic or paranoid personality and, under conditions of the most severe regression, leaders with the syndrome of malignant narcissism. Socially sanctioned violence then becomes a dominant expression of this severe regression, promoting violent and antisocial behavior on a large scale and involving masses of individuals who would maintain civilized behavior under ordinary conditions. Historical traumas may be transmitted into transgenerational reactivations, illustrating the internalization of ideological value systems of a particular culture into early object relations, particularly the notions of gratifying “belonging” and threatening “otherness.” Present-day social crises may reactivate historical traumas, particularly under the influence of a regressive, paranoid ideology promoted by the corresponding paranoid or malignant narcissistic leadership. Finally, the condensation of the narcissistic and paranoid extremes of a regressive ideology, expressed in a mass movement directed by a leader presenting malignant narcissism, in a historically traumatized society subject to a current social crisis, and with a clearly designated or defined minority, may lead to massive dehumanization of that minority and to socially expressed, sanctioned, and promoted genocide. THE PSYCHODYNAMICS OF GROUP PSYCHOLOGY AND MASS PSYCHOLOGY
The psychoanalytic study of regressive group processes shows that the same basic defensive operations employed by the severe personality disorders to
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deal with primitive aggression are activated in an impressively regular way under certain conditions of regression in groups. The original contributions of Wilfred Bion (1961), Kenneth Rice (1965, 1969), Pierre Turquet (1975), and Didier Anzieu (1981) on the behavior of unstructured small and large groups have been substantiated by subsequent clinical observations. When small groups (seven to fifteen members) are formed to carry out a task, a functional organization for task performance sustains the group’s adherence to reality, permits the desire for mutual affiliation to prevail in the coordination of work, and facilitates the emergence of task-oriented leadership. The authority of that leadership derives from its institutional authorization as well as from the group’s acknowledgment of the leader’s technical, conceptual, and human qualities. The group operates on the basis of these factors in a rational mode, adapted to reality. But when such a “work group” is rendered ineffective by the lack of a realistic task, by overwhelming demands for performance, or by threats to its security, two sets of primitive reactions rapidly emerge. Bion (1961) called them the “dependent basic assumption group” and the “fight-flight basic assumption group,” but they might equally well be called, respectively, a narcissistic regression and a paranoid regression. These two reactions can be observed systematically by giving the group the task of observing its own behavior without any other work commitment that relates it to its environment. A narcissistic regression of the group (corresponding to Bion’s “dependent group”) stimulates the emergence of a narcissistic, self-congratulatory, self-assured leader who thrives on the admiration of others and assumes the role of an all-giving parental authority, on whom everybody else can depend for sustenance and security. In the throes of the group’s regression, the members become passive and dependent on the leader and assume that it is their right to be fed and taken care of. They begin to feel insecure and confused, unable to take an active stance toward their assigned task and, instead, competing in a greedy, envious way for the attention of the leader. This constellation of behavior describes the “dependent basic assumption group.” A group involved in a paranoid regression becomes hyperalert and tense, as if there were some threat against which it has to establish an aggressive defense. The group selects as its leader a hypersensitive, suspicious, aggressive, and dominant person who is ready to experience and define some slight or danger requiring that he and his followers protect themselves and fight back. The members of the group, in turn, tend to divide between an “in-group” rallying around the leader and an “outgroup” that is suspect
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and needs to be fought off. The mutual recriminations and fights between the in-group and the out-group give a frankly hostile and paranoid quality to the entire group and may lead either to its division into paranoid splinter groups or to the discovery of an external enemy against whom the entire group can consolidate around the leader. The narcissistic regression of the dependent group is characterized by the prevalence of primitive idealization, projected omnipotence, and acting out of a regressive parasitic dependency. By contrast, the paranoid regression of the fight-flight group is dominated by projective identification, splitting, and acting out of rationalized aggression. If the leader of the group fails to conform to the respective expectations of the narcissistic or paranoid regressive group, the group will find other leaders who meet its expectations. Such groups tend to select the most narcissistic or the most paranoid member of the group with unerring certainty. Unstructured small groups, such as those assigned no task other than to observe their own behavior, may oscillate relatively quickly between the paranoid and narcissistic forms of regression or they may adopt a third alternative, forming what Bion (1961) called a “pairing basic assumption group.” In this type of regression, the entire group develops a focused interest in the fantasized relationship of a particular couple to give the group a sense of meaning and purpose and create a messianic hope for the future of the group. This promotes cohesiveness and mutual gratification among the members and offers protection against the dangerous (pregenital) narcissistic and paranoid developments of the dependent and fight-flight groups, respectively. The messianic hope for a better future conveyed by the pairing group wards off the sense of helplessness and overdependency on an idealized leader in other members of the group, counters the easily triggered frustration of the dependent group, and protects the paranoid group from its potential destruction by the mutual aggression of all involved: it may be considered a flight into a primitive oedipal structuring of the regressive group. The observations of Pierre Turquet (1975) and Kenneth Rice (1965, 1969) regarding large-group processes document these phenomena in an astounding way. The members of large groups (30 –150 people), if they meet regularly in a stable place for an established time, can hear, observe, and communicate with one another regarding actions that the group or components of it have to perform in relation to external reality. Such a work orientation and the corresponding work-oriented structure bring about perfectly “normal,” rational, reality-oriented functioning. When the ratio-
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nal task that brings such a large group together is lacking or fails, or if the group is unstructured by design, intense anxiety tends to develop, and the group soon regresses to a shared sense of danger and chaos. Systematic observations of such large groups, when they are unstructured or at points of failure at the task that related them to their environment, consistently reveal fear, irritation, apprehension, and a sense of impotence in most members. Some individuals may make efforts to consolidate subgroups to provide some protection against the large-group psychology, but these efforts usually fail. The lack of stable individualized relationships in the large group prevents effective mutual control and promotes unsuccessful reliance on the mechanisms of projective identification, omnipotent control, denial of aggression, and gratifying passivity to protect the participants against the common anxiety, which may very quickly reach great heights, even panic. The outbreak of random individual aggression in the midst of the general fearfulness intensifies the chaos and the shared sense of danger. Some members may succeed in isolating themselves from the group’s mood, but at the cost of increasing their sense of impotence or paralysis. Efforts by level-headed individuals to control this situation by rational analysis of the shared group experience usually fail because other members tend to develop intense resentment against them. Inordinate envy and even hatred of such individuals rapidly evolve. The unstructured large group does not tolerate rationality, regardless of the maturity and knowledge of the group members. There are two major roads to organizing this regressive group and relieving the panicky atmosphere, corresponding respectively to the narcissistic and paranoid developments in the unstructured small group (Kernberg, 1998a). In a narcissistic reorganization, the group intuitively selects a leader with strong narcissistic features—that is, a person who is self-assured, enjoys being the center of attention, and spews reassuring banalities and clichés that have a tranquilizing effect. The group accepts the leader’s proffered “wisdom” with a subtle ironic disqualification of it. A shared passive dependency on a mild grandfatherly or grandmotherly patron prevents the emergence of mutual suspicion and of destructive envy and resentment of members who possess authentic autonomy and depth. The narcissistic large group, under these conditions, tends to acquire the characteristics of what Canetti (1960) has called the “feast crowd”: a shared enjoyment of being safe and taken care of. The content of the group interaction now takes on features of marked conventionalism and superficiality of cognitive elaboration.
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If the group regresses to a paranoid mode of functioning, it may select a leader with unmistakably paranoid features, who rallies the group in preparation for a fight against the enemies he defines. He transforms the disorganized large group into a mob and transforms the intragroup aggression into loyalty to the group derived from the shared identification of all members with the leader. The group thus acquires the embryonic structure of what, on a larger scale with a more permanent organization and the development of an ad hoc paranoid ideology, might become a political mass movement. Whether the unorganized large group will take a paranoid or a narcissistic direction will depend on a number of influences: the composition of the group, the sociocultural environment within which it operates, the characteristics of the leadership that emerges, and the realistic external pressures or constraints affecting the members’ economic, social, or political well-being. Whether the preexisting ideology of the group reflects a static, self-assured, conventional political environment with a low level of conflict or one of social unrest or rapid social change will also affect the direction the group takes. There are no direct psychoanalytically oriented observations or empirical studies of regression in unstructured crowds, but there is ample informal evidence of rapid changes in unorganized crowds during festive occasions, such as big sporting events or theatrical performances: these can crystallize a spectator mass. And there are many examples of the sudden disintegration of a crowd into a panic-ridden multitude in response to a sudden natural disaster that cannot be confronted in an organized and rational way. In fact, in that a crowd is in effect a conglomeration of hundreds or thousands of people without any common purpose or activity, it does not yet constitute an unstructured group; only a common activity or destiny transforms it into organized spectatorship, a panic-ridden multitude, or a temporary mass movement. It is interesting that, once a crowd is transformed into a paranoid mass or a spectator mass, it immediately tends to select a leader who corresponds to its psychology: only a “merchant of illusions” (Chasseguet-Smirgel, 1975) who provides reassuring banalities will gratify the feast crowd, and only a paranoid and possibly demagogic warrior who appeals to the fear, anger, and thirst for aggressive action of the multitude will be listened to by the paranoid mass. This outline brings us to the psychoanalytic theory of mass psychology first spelled out by Freud (1921b) in Group Psychology and the Analysis of the Ego, in which he described the common identification of all the members of the mass movement with the leader, onto whom they collectively project
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their superego and whom they pledge to follow wherever he directs them. This mutual identification provides the members with a sense of belonging and strength; the projection of their ego ideal onto the leader gives them a sense of exhilaration and frees them to express their instinctual urges, particularly the aggressive ones. The mass becomes willing to attack, destroy, and murder at the leader’s behest. Psychoanalytic explorations of the psychology of large and small groups, which reveal the regular emergence of aggression in groups of all kinds when the groups are unstructured and particularly when their task structure fails, suggest important additional implications of Freud’s analysis. Fear of the consequences of such aggression mobilizes defenses of a narcissistic or paranoid kind. Although Freud explicitly stressed the importance of the libidinal linkages among the members of the mass and the libidinal implications of the idealization and potentially blind following of the leader, the importance of the underlying aggression was evident to him as well, although he had not yet formulated the theory of the death drive. In fact, it is striking how intensely aggression is activated in small and large groups and in mass movements (however short- or long-lived they may be), enabling individuals to behave in ways that would be unthinkable for them under ordinary circumstances structured by ordinary status-role relationships. The normal processes of socialization in the family; the elaboration, sublimation, repression, and reaction formations dealing with primitive aggression; the normal tolerance of ambivalence with a corresponding dominance of love over hatred; the normal acknowledgment of aggression with efforts toward its rational and conscious control—all seem to vanish under certain conditions of group functioning, replaced by the primitive defensive operations typical of the paranoid-schizoid mechanisms originally described by Melanie Klein as predating the stage of total object relations (object constancy, in ego psychology terms). I have proposed in earlier work (Kernberg, 1994c) that the situation in the unstructured large group prevents the enactment of ordinary statusrole relationships, so that the relations to parental objects and siblings, neighbors, employers, and friends, slowly developed throughout life, become inoperant. At the same time, relations evolve among the members of the group that cannot be managed by ordinary defensive operations, particularly because of the ineffectiveness in such groups of primitive defenses (e.g., projective identification, omnipotent control, denial, and splitting operations). The usual confirmation of the perception of self by significant others disappears. And all this uncannily reproduces the psychological con-
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ditions that predate identity integration and object constancy in the individual when there are nonintegrated representations of partial aspects of others without an integrated concept of self. Therefore the characterologically anchored behavior patterns that normally reflect and confirm ego identity are not operant in the large-group situation. The consequent experience of helplessness permits the emergence of primitive aggression and fears and promotes regression to the structural conditions of very early (paranoid-schizoid) development. From a different perspective, the rapidity of onset, the intensity, and the surprisingly universal nature of group regression under unstructured conditions point to a persistent, unmetabolized core of primitive aggression, primitive object relations, and primitive defensive operations as an important, perhaps even essential part of the psychological makeup of the individual and to a surprising frailty of the mature defensive operations centering around repression. This powerful, uncontrolled regressive potential for primitive defensive operations may be important evidence for the basic motivational system that Freud called the death drive. Freud’s (1921b) description of the projection of the ego ideal (his early term for the integration of conscious and unconscious internalized demands and prohibitions, value judgments and ethical principles later called the superego) onto the leader acquires new meaning in unstructured small and large groups. This projection is obviously facilitated if the leader enunciates a system of morality corresponding to his perception of his leadership role. But the massive projection of superego features in fact occurs spontaneously and consistently even without the crystallizing presence of an individualized leader. Freud defined mass psychology as including both the behavior of masses and the attitudes of individuals when they experience themselves as part of a mass. In his seminal book The Age of the Crowds (1981), Serge Moscovici expanded Freud’s analysis to encompass the influence of mass communication on individual regression. Moscovici proposed that mass media create mass psychology and that mass psychology both stimulates the elaboration of mass culture and brings about its immediate acceptance. Mass culture may include objects of economic and commercial but also political interest and ideas. Moscovici pointed out how modern communication creates temporary masses as large numbers of individuals simultaneously receive communication from mass media and thus experience themselves as part of a mass. In medieval times the villagers were gathered together by a drummer
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who would loudly announce the latest developments of importance to all of them, thus instantaneously transforming the crowd of villagers into a large group. The invention of the printing press made it possible to communicate edicts and proclamations to even larger groups of people. Newspapers then became the most efficient medium of simultaneous communication of information to the masses. (The reader of a newspaper unwittingly perceives the communication as if he were part of a large group of readers; the reader of a book, by contrast, has the opportunity to make an individual choice, and the act of selecting and reading a book may even be said to imply separation from what is commonly absorbed and reacted to in daily life.) The functions of the radio as a powerful instrument for creating a mass susceptible to indoctrination with the dominant state ideology was effectively exploited by the Soviet Union and Nazi Germany. Television communication is both powerfully immediate and clearly perceived as being directed to the entire population. In recent political campaigns, at least, television has continued to play a central role in influencing mass behavior. We do not yet have a comprehensive analysis of the corresponding functions of the Internet. However, insofar as the Internet includes a bewildering simultaneity of contradictory and confusing appeals to ideological and cultural orientations and biases, it may serve to consolidate the members of regressive groups rather than to organize public opinion in the direction of one prevailing ideology. I have proposed in earlier work (Kernberg, 1998a) that the nature of conventionality (that is, of value systems and ethical judgments arrived at, confirmed, or condoned under the influence of mass psychology in the absence of a specifically focused leader) reflects the individual’s projection onto the social group, not of the total infantile superego structure, but rather the projection of the infantile superego layer of the “latency” years (Jacobson, 1964). In this period, which follows the advanced oedipal stage (four to six years of age) and extends to the reorganization of the superego beginning with puberty, the superego maintains many features of primitive psychic functioning: a tendency to sharply differentiate what is good and what is bad; intolerance for ambivalence and ambiguity; a tendency to split the object world into idealized and persecutory figures; a primitive morality in which the bad are punished and the good always triumph; an acknowledgment of sexuality, but with profound repression of the link between eroticism and tenderness (unconsciously reserved to the oedipal couple); regressive analization of acknowledged and permitted sexuality, which links sex with excretory functions; an intolerance for emotional depth (re-
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served for the libidinal ties linking the adult couple), with a tendency to replace sentiment with sentimentality; and, finally, an outstanding urge to adapt to the group mores and to values that reflect social life outside the home, in an effort to separate emotionally from total dependency on the parental couple. At the same time, cultural objects that evoke infantile omnipotence help the individual to overcome the sense of frailty and inferiority and free him from painful reality, and ordinary social constraints also become an avidly appreciated source of fantasy. The mass media activate this “latency” aspect of mass psychology, which is perhaps most typically reflected by soap operas, detective fiction, appeals to cliché-ridden sentimentality, and advertising geared to the gratification of narcissistic needs. Insofar as the mass media provide powerful gratification of affiliative needs; recreation; a gratifying, socially sanctioned fantasy life; and a means of experiencing oneself as linked to and accepted by the group, they foster the narcissistic group regression characteristic of the large-group experience and the dependent small group. Mass media, however, may also exploit and intensify the paranoid regression of the paranoid large group and the fight-flight small group by developing information that conforms to a sharp division between good and bad, between loyal friends and dangerous enemies. The media achieve this regression by presenting a world picture in which the individuals addressed are described and confirmed as part of a good, valuable, progressive, superior, rightfully dominant group, in contrast to a outsider group portrayed as aggressive, malignant, sadistic, revengeful, and, above all, dangerous and threatening. Here the mass psychology originally described by Freud comes into full development, even in the absence of a specific, defined paranoid leader. In fact, the development of a particular ideology, as explained below, may contribute to the severe paranoid regression of an entire community or nation. Mass psychology, in this respect, is a most powerful amplifier of both paranoid ideologies and the leadership provided by the narcissistic merchants of illusions or by the paranoid revolutionary. THE REGRESSIVE PULL OF IDEOLOGIES
An ideology is an integrated system of beliefs that provides an explanation and a rationale for the existence of a social group, a sense of common purpose, an ideal condition to which the group aspires, and potential or assumed means of achieving that condition (Althusser and Althusser, 1976;
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Green, 1969). It may include national, social, racial, religious, and/or political belief systems. Because of its reference to a preexisting or transcendent deity, religion occupies a particular place within ideologies. It ranges from primitive assumptions of ad hoc deities related only to a particular social group to mature religions with a universal deity and a moral value system that transcends any particular social group (Canetti, 1960). What interests me here is the possibility of detecting narcissistic and paranoid dimensions as extreme potential features of all ideologies, with an intermediate realm characterized by a focus on individual rights and obligations and, particularly, on the value of the individual within that particular ideological system. This intermediate realm of ideologies has a humanistic core and is thus a bastion against the perilous loss of identity that both promotes and results from the regression of the large group. I am proposing that our “normal,”civilized stance is poised perilously between the potential threats of the narcissistic and paranoid dimensions. For example, the paranoid extreme of the Marxist political ideology was illustrated by the doctrine of total warfare against the remnants of bourgeois culture as part of the cultural revolution sponsored by Mao Tse Tung in Communist China (Kolakowski, 1978a, 1978b). The ideologies of the Pol Pot regime in Cambodia and the Shining Path in Peru are other examples. In contrast, the cultural Marxist ideology dominant in the Soviet Union during the Brezhnev years manifested the typical characteristics of the narcissistic polarity; official Marxism, at that point, constituted a type of state religion, universally accepted and repetitively proclaimed, but without any implication of its particular relevance to the nature of daily life or any shared ideological impetus toward change. Formal adherence to this doctrine conferred social legitimacy and secure expectations for advancement in work and profession upon individual citizens. At the intermediate zone of Marxist ideology we might place the humanist Marxism of western Europe, with its emphasis on social equality and responsibility, a progressively egalitarian distribution of wealth, and respect for the authentic autonomy of the individual (Anderson, 1976; Haberman, 1987; Marcuse, 1964). A similar spectrum, from paranoid fundamentalism to narcissistic banality, with a humanistic center, can probably be illustrated by many other political and religious ideologies. It may be argued that some systems have existed within only one modality—for example, the extremely paranoid National Socialist ideology of Germany during the Hitler regime, which led to the intentional physical elimination of millions of men, women, and
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children. Canetti (1960) has pointed out that religious ideologies may also evolve from fundamentalist to humanistic tenets over the course of their historical development. It is, of course, the paranoid extreme of ideologies that is particularly relevant to the analysis of social violence. In fact, paranoid ideologies powerfully facilitate social violence by directly neutralizing individual moral constraints against the personal perpetration of suffering, torture, and murder. It is characteristic of such systems that they divide the world between the ideal carriers of the ideology and its dangerous, threatening enemies, who must be destroyed to prevent them from destroying the true believers. Typically, paranoid ideologies stress mass action, seeking to arouse a group spirit that tolerates or even encourages the sacrifice of individual autonomy, reasoning, interests, and rights in the service of the community. As Freud (1921b) pointed out, mass psychology significantly restricts the autonomy of the sexual couple, curbs the freedom of love relations from social regulation, and recruits the establishment of intimate pairs to the service of the community. In paranoid ideologies, strikingly, we find once more the characteristics of the latency superego and the mass psychology of conventionality, now intimately linked with a rationalized expression of primitive aggression in the form of morally sanctioned and stimulated destruction of out-groups. Fundamentalist ideologies—that is, religious systems of ideas that take the paranoid form—may express all these characteristics in essential ways. The division of the world into the faithful and the infidel, the need to crush the unbelievers, the promise of an utopian future once the world is freed of all the “bad,” the strict submission of the chosen to a sexually restrictive morality, and the rigid boundaries separating “bad” social groups from the faithful are typical of fundamentalist ideologies. The leader, who may represent the deity, demands and receives total, uncritical submission. Individuals born into a totalitarian system and educated by it from early childhood have very little opportunity to avoid total identification with that system unless hidden resistances against it still operate in the intimacy of the family or in a restricted social circle. Totalitarian educational systems permit the systematic indoctrination of children and youth into the dominant ideology, including adoration of the omnipotent and omniscient leader. Those exceptional individuals whose personal growth and maturity enable them to stand up to such a system deserve attention and admiration, but historically they have been few. Even in large countries under a totalitarian regime, the total control of the armed forces, the economy, and the mass media, combined with a social, political, or economic trauma that af-
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fects the society at large, will swiftly produce submission to and enactment of the tenets of the most bloodthirsty totalitarian doctrine (Bracher, 1982). Thus, for example, the savagery of Mao’s cultural revolution rapidly spread throughout China, bringing about within a few years the socially sanctioned mass murder of millions and the destruction of much of the country’s historical and cultural patrimony. It took Nazi Germany fewer than eight years to engender widespread tolerance and acceptance of the mass murder of civilians, including almost the entire Jewish population. Clearly, we can no longer assume that only characterologically severely disturbed individuals are prone to violent behavior under regressive group circumstances. As André Green (personal communication, 1987) put it, the death drive operates within individuals as well as in groups and institutions in society at large, a frightening reality of social life. Under less dramatic circumstances, within a democratic political regime and a humanistic cultural tradition such as prevails today in western Europe and the United States, the adherence of individuals to one or the other extreme of a given ideology is codetermined by social factors and individual psychopathology. Adorno’s classic study (Adorno et al., 1950) provides a basic paradigm that relates the authoritarian personality to identification with authoritarian ideologies that are roughly equivalent to what has been described here as narcissistic and paranoid systems. While the concept of the authoritarian personality as a unitary syndrome is questionable in light of our contemporary understanding of personality disorders (it may be a consequence of many different personality styles), immaturity and rigidity of superego functioning foster the espousal of regressive narcissistic or paranoid ideologies as opposed to their humanistic center (Green, 1969). Studies of contemporary adolescents and young adults in Germany who adhere to the extreme right reconfirm the relationship between totalitarian ideologies and personality structure. It is likely that many of the sadistic guards working in extermination camps had the character structure of malignant narcissism or antisocial personality (Dicks, 1972). PERSONALITY FEATURES OF SOCIAL AND POLITICAL LEADERSHIP
An additional dimension of group and mass regression is the nature of leadership itself. As Freud pointed out, the universality of oedipal strivings and the search for and fear of a powerful, protective, dominating, and threatening father image overshadow the real authority of the leader and foster the regression into mass psychology. However, the more the personality characteristics of the leader reinforce these regressive tendencies, the
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stronger the tendency for the group or the mass to regress along narcissistic or paranoid lines. In earlier work (Kernberg, 1998a) I proposed that functional leadership ideally combines the following characteristics: (1) high intelligence, enabling the leader to apply long-range strategic thinking to diagnosing, formulating, communicating, and implementing the requirements of the task; (2) sufficient emotional maturity and human depth to be able to assess the personalities of others in selecting subordinate leaders and delegating appropriate authority to them; (3) a solid and deep moral integrity, which protects the leader from the unavoidable temptations intimately linked to the exercise of power and from the corrupting pressures of his entourage; (4) sufficiently strong narcissistic tendencies to be able to maintain self-esteem in the face of the unavoidable criticism and attacks without depending on the followers for fulfillment of excessive narcissistic needs; and (5) sufficient paranoid features—in contrast to naïveté—to diagnose early the unavoidable ambivalent and hostile undercurrents in the organization, which express the resentful, rebellious, and envious aspects of the aggression directed toward leadership. I believe that the fundamental paradox of leadership is that the same narcissistic and paranoid features that, in moderate proportions, are indispensable to good leadership will contribute, at a pathological and exaggerated intensity, to narcissistic and paranoid mass regression. The excessively narcissistic leader needs to be loved and admired and tends to surround himself with “yes men” whose submissiveness and adulation protect him from the resentment of the rejected out-group and help him maintain his narcissistic equilibrium at the price of depriving him of realistic criticism and feedback. Favoritism toward the in-group creates massive corruption throughout the entire leadership structure. The overall system promoted under such circumstances is static, conventionally supportive of the status quo, and extremely suspicious of any opposition. Corruption is an unavoidable consequence of the suppression of the out-group at the periphery of the system. The paranoid leader, in contrast, does not want to be loved; in fact he is very suspicious of those who seem to love him and feels secure only when those he controls submit to him out of fear. Under extreme circumstances, the authoritarian atmosphere created by the paranoid leader may produce a sense of terror. But even under less extreme conditions, the need to submit to leadership, the fear of the leader’s suppression of criticism and protest, and the sense that nobody can be trusted contrast with the apparently easygoing identification of an organization with a narcissistic leader. The para-
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noid organization or movement is essentially dynamic; a constant atmosphere of warfare protects the mass movement against real or imagined enemies; the massive projection of aggression outside protects the cohesiveness of the group. When large social, political, or national parties are dominated by a paranoid leader, the natural enemies represented by other social groups, religions, or nations will eventually provide confirmatory evidence of a threatened and therefore threatening enemy. The worst-case scenario of pathological leadership is represented by a condensation of narcissistic and paranoid features in the syndrome of malignant narcissism. As we have seen, this reflects a particularly severe type of personality disorder and, we may now add, is a rather common manifestation in dictatorial and particularly totalitarian leadership. The leader characterized by malignant narcissism experiences and expresses inordinate grandiosity; needs to be loved, admired, feared, and submitted to at the same time; cannot accept submission from others except when it is accompanied by an intense, idealizing loyalty and abandonment of all independent judgment; and experiences any manifestation contrary to his wishes as a sadistic, willful, grave attack against himself. Such a leader cannot help but bring about a regime of terror and requires an entourage that combines totally subservient, idolizing subjects with totally corrupt and ruthless antisocial characters who pretend to love and submit to the leader so as to ensure their parasitic enjoyment of his power. When the personality style of such a leader is combined with a paranoid ideology, the world is split between friends and enemies; the extreme hatred of the enemies and the fantasized danger they represent, derived from the projective processes of the leader, brings him to justify their total destruction. Hannah Arendt’s differentiation of ordinary dictatorships from totalitarian systems (Furet, 1995) here acquires its full importance, linking social pathology with the individual pathology of the leader. The personalities of Hitler and Stalin have acquired a paradigmatic quality as typical of leaders suffering from malignant narcissism. There is, further, a complex relationship among the nature of the leadership, the dominant ideological system, and the efficiency of the bureaucratic organization of society at large. A humanitarian ideology may mitigate the regressive effects of mass psychology and of an authoritarian, paranoid leadership; an efficient bureaucracy may prevent or reduce the regressive effects of mass psychology and unstructured group processes, by establishing or maintaining a stable social task system. However, ideology and bureaucracy may also worsen the effects of pathological leadership. A
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leader with malignant narcissism may increase the level of terror and submissiveness around him by causing the official adoption of a paranoid ideology. And an efficient bureaucracy may dramatically augment the speed and power of a totalitarian ideology and leadership. The efficient German bureaucracy combined with the paranoid features of Nazi ideology greatly enhanced the power of Hitler’s malignant narcissism. The rapidity with which the ordinary rules of law and basic human decency were eliminated in Nazi Germany illustrates the combined effect of leadership, ideology, bureaucracy, and state control of the armed forces, the economy, and the media. HISTORICAL TRAUMAS AND SOCIAL CRISES
Another factor predisposing to social violence is of obvious importance but still requires examination from a psychoanalytic viewpoint. I am referring to the historical traumas that bind together the members of a social group, a race, a religion, or a nation and predispose them to rapid regression into a paranoid ideology, a paranoid mass movement, and a violent attack upon another social, political, national, or racial subgroup. Vamik Volkan (1988, 1999) has made fundamental contributions to our understanding of the interrelationships of historical traumas, identity formation, and intergroup conflict. What interests me here is how, from very early on, the linguistic and cultural characteristics of the particular social subgroup to which the individual belongs become integrated with self representations to consolidate ego identity. I have referred earlier (Kernberg, 1998a) to the “groupishness” of the child entering the school years as his first effort to distance himself from threatening oedipal conflicts. Identification with a culture and a language, of course, occurs even earlier, from the moment of the acquisition of language; and identification with oedipal figures includes identification with their relationships with the surrounding culture and religion. A major political upheaval, a lost war, and a historically long-lasting, ongoing rivalry with another social group are included in the culturally shared myths about the origin and history of one’s family and intimate social group that are learned in early childhood. “Other” groups become objects of early splitting mechanisms, narcissistic and paranoid regressions, and defenses against them (Volkan, 1999). As part of normal narcissism, a sense of personal value becomes attached to membership in a certain language, culture, or religious group. The powerful effect of the social commonality of language, rituals, art, and myths reflects the integration of self representations into a cohesive self and of partial object representations
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into total object representations as part of the consolidation of ego identity: the mutual similarity of others assures the integration of their images, as well as that of the multiple self representations that reflect interactions with “similar” others. At the same time, the demands and prohibitions that are part of the cultural heritage or of the particular religious beliefs of the family are integrated into early superego structures together with the more idiosyncratic parental value systems and the culturally shared aspirations, biases, and frustrations that link the individual and his family to a particular social group (Volkan, 1999). Such a shared historical heritage, particularly when it involves significant social traumas, becomes part of the individual’s narcissistic equilibrium (Volkan, 1988). Social trauma, personal trauma, and narcissistic frustrations coalesce and reinforce each other. The violent redress of a social injustice becomes the violent redress of a narcissistic trauma, and vice versa. Violent behavior against another social subgroup may become the preferred channel for the expression of individual psychopathology. Acceptance into a violent subgroup is often contingent upon the individual’s willingness to commit acts of violence. When historical traumas facilitate the physical separation of social subgroups (as in the “racial cleansing” that separated Christian Serbs from Moslem Albanians) or highlight such differentiating characteristics of subgroups as language or skin color, and when a paranoid ideology promotes dehumanization of one group by the other, a leadership characterized by malignant narcissism or paranoia can readily create the circumstances that trigger social violence. Once massive propaganda has succeeded in separating and dehumanizing a subgroup, its physical extermination may be widely tolerated and supported, as was the case of the Jews in Nazi Germany (Dawidowicz, 1975; Goldhagen, 1996; Klemperer, 1995a, 1995b). It is important to stress here the psychological effects of a severe, shared psychic trauma inflicted by intentional human action as distinct from the effects of natural calamities. Impersonal events do not lend themselves to the development of new identifications. But defeat in a war, the persecution of a religious minority, and its brutal suppression by a rival racial group are experienced as traumas whose central aspect is sadistic human intervention. Historical traumas, unlike natural disasters, tend to have lasting effects on the survivors, such as permanent displacement, extensive separation of family members, and permanent loss of social status. These effects produce in the victims the tendency to identify themselves unconsciously with the total traumatic situation: that is, all such identifications are with both self as
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victim and the other as perpetrator, with the potential for later enactment of that identification with the roles reversed. Such an enactment with role reversal typically takes the form of identification of the self with the perpetrator of the trauma, while the role of victim is projected onto the outgroup, now seen as deserving to be persecuted (Kernberg, 1994a). Both traumatized individuals and traumatized nations unconsciously identify with self and other by massive activation of the corresponding traumatic memory in an effort to reverse the trauma. The result is ongoing retraumatization over years—or centuries. The barbaric warfare that recently erupted in the former Yugoslavia is a dramatic illustration of the rationalization of massive social violence, powerfully stimulated by a pathological leadership and reinforced by nationalistic and fundamentalist religious ideologies, historically triggered by the breakdown of the Communist regime in Yugoslavia. From individual psychopathology we have learned that the only way to escape from this traumatic vicious circle is via recognition of the identification with self and other, with victim and aggressor, and a process of mourning that, by overcoming the split between these representations, leads to efforts to resolve the damage caused by the trauma and, potentially, even reconciliation with an erstwhile enemy. Mitscherlich (1963), Segal (1997), and Volkan (1999) have pointed to the danger that a historic past traumatic experience may be repeated on a social level when such socially anchored mourning does not occur. A humanistic ideology is a precondition for the resolution of social trauma and an alternative to the exacerbation of social and historical traumas by new social crises. Social violence is also fostered by the disorganization of a traditional, powerfully structured, and socially stable system of government, whether as part of the collapse of a totalitarian system or during a period of rapid economic and cultural transformation. The consequences—a breakdown of traditional cultural linkages and the emergence of severe economic hardship for large social groups involving unemployment, family disorganization, and lawlessness—may lead to the emergence of the paranoid characteristics of large-group processes and the ad hoc development of paranoid ideologies and of subgroups with antisocial behavior. Social chaos and disorganization may promote immediate regression into large-group processes, with the rapid onset of diffuse, random social violence which is finally channeled into a particular paranoid ideology and socially sanctioned and organized violence. A sadistic tyrant who controls the economy, the army, an effective bu-
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reaucracy, and the mass media, with its capacity to propagate a totalitarian ideology supported by historical traumas, may turn the population of a country against an oppressed minority by creating a paranoid mass movement that generates a powerful enjoyment of its rationalized hatred and destructiveness. DEHUMANIZATION
There are important differences between such highly organized death machinery as that of the German extermination camps and the Gulag and the violence and mass murder committed in the course of coordinated mob actions ideologically inspired and state supported, like those carried out by the Red Guards in China or during Kristallnacht in Germany. Betty BaoLord (1990) has described the confession of a former Red Guard, now a distinguished academic, who participated in the public humiliation and collective beating of his own beloved professor as part of a massive public condemnation organized and carried out by Red Guard students. His regression becomes understandable in light of the powerful group pressure of the enraged, excited students surrounding the professor and the hostile questioning and distrustful looks they directed toward this professor’s student for his initial reluctance to join them. Some years ago, during a mass demonstration in support of the Argentinean dictator Juan Peron, I had to flee the public square where the demonstration took place when my lessthan-enthusiastic response to the dictator’s speech aroused the hostility of the crowd. When an enemy once considered dangerous is taken prisoner, the primitive hatred of the victors may be expressed in murderous wishes and actions, or at least in the desire to humiliate him and make him suffer, or simply to exercise total control over him. Such hatred, after all, still has a “human” characteristic that renders it understandable. But chronic, mindless, affectless cruelty, such as has been amply documented in studies of the Nazi concentration and extermination camps, exhibits a degree of destructiveness that exceeds ordinary hatred. Here human beings are treated like inanimate objects, with a thoughtless, even bored dispensation of death and torture for any arbitrary cause, or for no reason at all. At this point we approach the psychology of the torturer and the executioner, the dynamics of the total “deobjectalization” described by André Green (1993), the total identification with a violent fundamentalist ideology described by Henry Dicks (1972), and the absolute social power described by W. Sofsky (1997). The great Yugoslav writer Aleksandar Tisma
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(1993, 1997) has given us a dramatic picture of the subjective experience of the torturer. Janine Chasseguet-Smirgel (1984) has described the perverse “anal universe” of patients with severe narcissistic pathology, which I have referred to as the syndrome of malignant narcissism. She described the unconscious needs of these patients to deny any differentiation between genders and generations—in fact, any differentiation that would imply boundaries. Unconsciously, they desire a world devoid of all restrictions, particularly moral restrictions, in an assertion of personal power that destroys all value systems and any threats to them and thus defends against their deepest fears of failure and annihilation. The denial of the oedipal structuring of reality, of the prohibitions against murder and incest frees these from superego constraints while permitting the condensation of power, aggression, and self-esteem. The dominance of anal fantasies that imply the transformation of external reality into undifferentiated feces is the counterpart to the dominance of primitive, unbridled aggression. Ordinary social conventions and adaptations to external reality may be maintained in a completely split-off part of the mind of such individuals while unrestricted primitive aggression, in which the real or imagined world of enemies is transformed into excrement, is enacted in submission to an authority that requires the murder of victims. Such individuals, released from conventional social inhibitions by means of totalitarian ideology and a social structure that facilitates the enactment of total power, readily become participants in the world of extermination camps. Their sexual behavior integrates sexual assault and murder, incest and the murderous invasion of the bodies of other human beings with excitement and triumph.Yet their sadistic pleasure in inflicting torture and total control nonetheless reflects some degree of primitive erotic capability. The worst cases may lack even those remnants of erotic excitement or libidinal investment in a sadistically controlled object. At this point, the aggression becomes mechanized, devoid of any relationship to an object. Eventually the power exerted may compensate for the meaninglessness of murder with the intoxicating conviction of total dominance over the world and freedom from essential fears of pain or death. Henry Dicks (1972), in his study of German concentration camp guards imprisoned in England, observed that they found a sense of personal value and meaning in submission to the authorities of the SS. Their cruel and murderous control of the inmates was carried out with a clear conscience, derived from their conviction that they were operating according to the just and unquestionable Nazi ideology, which was condensed with their
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total belief in Hitler and his SS representatives. They experienced the internal corruption and obvious dishonesty that infiltrated the SS hierarchy as well as the entire management of the concentration camps as an expression of humane flexibility and the camaraderie of the SS troops. In many cases, their perception of the inmates was so dehumanized that they were incapable of feeling disgust, revulsion, or fear in the face of the immensity of their criminal behavior. All these individuals, Dicks found, presented severe personality disorders, with a dominance of what I have called malignant narcissism. However, once outside the social system that had fostered their criminal activities, they no longer seemed violent or dangerous. The background of these Nazi prison guards included severely traumatic circumstances in early life. Typically they described their fathers as extremely sadistic and controlling, their mothers as unloving or unavailable. Their identification with cruel and merciless parental figures was a significant aspect of their pride in being part of the “master race.” The complete splittingoff of conventional social relations throughout the years of their criminal activities was a common feature of the life of these individuals. Sofsky (1997) has applied a sociological analysis to the nature of “absolute power” that complements the analyses by Chasseguet-Smirgel and Dicks. He differentiated absolute power from ordinary despotism. In ordinary despotism or tyranny, terror is meant to intimidate, to crush resistance, to spread fear; violence is an instrument of suppression, a means to an end. Ordinary despotism implies social rules characterized by the willingness to obey; punishment supports this submission and guides the social future. In contrast, absolute power as exercised in the concentration camps is power over those who are already totally crushed. Its aim is not to achieve blind obedience or discipline but to generate total uncertainty. It transforms its victims into an aggregate mass. Terror is used as an instrument of daily cruelty, not for assuring submission: it requires neither occasions nor reasons and reserves total freedom for itself while destroying that of its subjects. Absolute power, Sofsky said, depends on a monopoly of military means of violence and creates a stable framework of social structure with a strict hierarchy, which itself is used as the motor for expansion of terror. Along the Nazi concentration camp hierarchy, arbitrary initiatives in the exercise of absolute power were welcomed, increasing the victims’ uncertainty and defenselessness. The distribution of power among the victims themselves by means of the “Kapos” generalized sadism, arbitrary control, and submission among them. Absolute power, Sofsky has suggested, legitimates itself by its own exer-
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cise of power; in the concentration camp, it was able to shred the very ideological basis that constituted the schooling of the SS guards. Absolute power destroys the meaning of all ordinary human values: work was meant not to fulfill economic goals but to sap the life of the prisoners. Absolute power uses violence not to threaten but to demonstrate its overwhelming might. The deliberate nature of cruelty, the elimination of all inhibitions in violence, gives the torturer a sense of absolute freedom. The very line of demarcation between life and death is obliterated because the victims are destroyed gradually, step by step. Sofsky proposes that absolute power perpetuates itself by the endless expansion of the killings of the victims. Here his analysis touches Canetti’s analysis (1960) of the tyrant as “survivor.” It is striking how Sofsky’s sociological analysis, based on a most detailed study of the social structure of the Nazi concentration camps, dovetails with the intrapsychic world of perverse narcissism described by ChasseguetSmirgel. Conversely, the intrapsychic structure of individuals with malignant narcissism is replicated in the social structure of the concentration camp. But here, in my view, the exercise of absolute power has several consequences that reinforce each other. First, the savagery of primitive aggression, the sadistic onslaught on helpless victims, erases all remnants of humanity in the perpetrators and even the remnants of erotization of sadism. Now the permanent expansion of power itself becomes the only remaining source of gratification. Second, splitting mechanisms no longer permit “ordinary” functioning on the part of the perpetrators; their brutality encompasses their whole life. This promotes the dominance of the aggressive psychopaths, those whose malignant narcissism is matched by the elimination of all superego functions. The contamination of the power structure by the dominance of these individuals further brutalizes the perpetrators. Finally, only the unbridled expansion of the savagery and willful arbitrariness of the exercise of absolute power, with its denial of civilization and humanity, permits the survival of the perpetrators faced with the meaninglessness of the sheer magnitude of death. FUNDAMENTALIST IDEOLOGIES AND TERRORISM
The terrorist attack on the United States on 11 September 2001 has naturally focused attention and concern on the nature, causes, and implications of this dramatic expression of social violence. Because the event is so recent and its immediate psychological, political, ideological, and military consequences are so serious, it is difficult to compare its psychological characteristics with those of other forms of social violence from a “technically neu-
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tral” viewpoint. Sociological and historical analyses of terrorist movements, clinical studies of actual and potential suicidal bombers, and the ongoing consequences of terrorist attacks elsewhere serve as elements for exploring the relationships of terrorism to the general area of socially sanctioned violence (Armstrong, 2001; Bergen, 2001; Gallanter, 1989; Guzman, 2000; Haynal, 1983; Hoge and Rose, 2001; Kakar, 1996; Kepel, 2000; Laqueur, 1998; Post, 2001; Reinares, 1998; Volkan, 2001a, 2001b). Terrorism as a social phenomenon must be differentiated from fundamentalist ideologies, although these beliefs constitute the most common basis for terrorist motivation and action. Terrorism must also be differentiated from the severely regressive group processes described earlier as developing into socially sanctioned and organized manifestations of brutal, sadistic behavior against a persecuted minority, justified in terms of the ideology of the dominant group. Fundamentalist ideologies divide the world into ideal and evil realms; their proponents, of course, belong to the ideal realm and are thus guaranteed survival and redemption, happiness, and moral triumph. The ideas, beliefs, and behaviors of the realm of evil are immoral, dangerous, destructive, and threatening to everything the good stands for. The triumph of the good and the destruction of evil will bring about universal peace and harmony and an end to all conflicts and grievances. Typically, such an ideology projects all aggression onto the evil social group while justifying acts of aggression against the nonbeliever as a necessary defense and retribution if not a moral imperative. The fundamentalist ideology requires strict adherence to its basic theories and assertions; the mutual confidence and trust of believers are based on the assurance of such adherence. Characteristically, in the belief system of a fundamentalist ideology, the individual is less important than the community, and submission to the values of the community overrides any conflicting needs or desires of the individual. Fundamentalist ideologies frequently have a puritanical character, are suspicious of individual sexual behavior and the private life of the couple, and tend to regulate and restrict sexuality. They usually require submission to an absolute leader who incorporates all the values of the ideology. According to Volkan (2001a, 2001b), religious fundamentalists typically share the wish to return to an original and idealized past, a pessimistic outlook regarding the present, and the conviction that the specialness of their faith is justified by a divine text that only the absolute leader is authorized to interpret. Fundamentalist groups are often dominated by a feeling of victimization, a belief in magical signs, a sense of danger from evil forces, and a sense of omnipo-
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tence in belonging to the elected group. Religious fundamentalism sharply distinguishes the believers from dangerous or at least negative outside groups or forces, a differentiation often expressed literally or symbolically by dress codes or other modes of presentation in public. A religious commitment to an absolute belief system and trust in the deity give the manifestations of mass psychology described by Freud their greatest intensity. As S. Kakar (1996) has pointed out, total commitment to the deity is condensed with an emotional religious experience derived from the earliest longings for fusion with an idealized protective parental figure. That experience confers on the individual a sense of emotional integrity, calmness, and security which is enhanced by participating in a benign and supportive matrix of social goodness. A systematic and massive indoctrination with a fundamentalist religious ideology in the context of isolation from the believer’s family of origin and total submersion within a group setting may facilitate the shift from a personal religious feeling to the socially resonating sense of oneness with a community that shares absolute ideological convictions. Terrorism is a type of socially directed violence committed by individuals and groups who live in relative isolation, secrecy, and defiance, united by a fundamentalist ideology. Their fervor is reinforced by a personal disposition to primitive hatred, ruthlessness, sadism, and cruelty, rationalized in terms of the corresponding fundamentalist ideology. Their hatred is expressed in a commitment to destroy the forces that stand between the fundamentalist ideology and the eventual utopia, the reign of human brotherhood or the Kingdom of Heaven. Typically, individual terrorists have undergone a strict and consistent training that intensifies both their hatred of the representatives of evil and their commitment to suppress any concern for the victims of the terrorist act. This permits the terrorists to kill women and children, innocent bystanders, in the assurance that they are fulfilling the moral demands of the ideology. The literature on the personality features of individual terrorists frequently describes a history of severe trauma, a sense of inferiority or abandonment in infancy and childhood, and the later transformation of this sense of victimization into aggressive self-affirmation and an ideologically rationalized passion for sadistic revenge as the redress of earlier grievances (Haynal, 1983; Post, 2001; Volkan, 2001a, 2001b). Volkan has explored how behind the terrorist’s surface calmness and pseudorationality, one typically finds an ideology that permits no questioning. Examination of its internal
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logic reveals both underlying confusion and the inability to negotiate that confusion rationally. The regressive mass psychology that constitutes the social and cultural background of future members of terrorist groups does not have a uniform quality. It may derive from a historical religious fundamentalism that is reactivated by a contemporary traumatic situation or in response to massive social trauma that may promote followership in frustrated, impoverished, disappointed, and isolated individuals. But immersion in such mass psychology may also lead to the emergence from a highly individualized background of ideological indoctrination of an individual with strong paranoid, narcissistic, and/or antisocial features. Often fundamentalist and terrorist groups are led by an individual who comes from an elitist class which he felt rejected or traumatized him and who subsequently identifies with the oppressed and humiliated as justification for his revengeful attack on his class of origin (H. Neira, personal communication, 1999). His followers are gathered from members of the disadvantaged or traumatized social group that is experiencing an acute or chronic regression into mass psychology. In short, the typical combination of circumstances that facilitates the outbreak of sanctioned social violence can be transformed, under the influence of specially predisposed individuals, into an exhilarating sense of mission and total commitment to the destruction of the enemy. That mission confers a sense of control, omnipotence, and triumphant sadism, a sadism entirely split off from the idealized ideology that provides the terrorists with a sense of community with their own group. This radical split contributes to an overall dynamic stability throughout the period of patient preparation and execution of the terrorist acts. The commitment to terrorist action implies a particular orientation toward both the terrorist in-group and external reality. The terrorist presents absolute submission to the leader and his delegates, acceptance of whatever limitations of private life they decree, and vigilance in maintaining the purity of the in-group, by selecting for immediate elimination any comrade whose commitment to the group and its ideology seems to weaken. Absolute obedience, cruelty, and fearlessness are the guiding principles of this moral system, and the brotherhood of the conspirators provides the compensating sense of warmth and humanity. The terrorist’s sole objective is the destruction of the enemy world by whatever cruel and dehumanized means, disregarding the nature of the victims and obeying orders slavishly.
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The primary objective of terrorism is the production of terror, a paralyzing, disorganizing sense of dread that destabilizes and eventually delegitimates the enemy’s social structure, way of living, and leadership. Terrorist groups may enter into negotiations with the enemy, but those negotiations by definition must be dishonest, because the ultimate objective is not the resolution of differences but the destruction of the enemy. Any compromise would weaken the boundary between the ideal and the persecutory world, threaten the purity of the terrorist’s utopia, and thus endanger the very survival of the fundamentalist ideology. Death becomes an essential aspect of the terrorist’s mental world. To the terrorist, death inflicted on the enemy signals triumph, and his own death in the course of inflicting terror and destruction on the enemy is an additional source of moral triumph and, in the case of religious fundamentalism, a guarantor of happy survival in the Kingdom of Heaven. Islamic suicide bombers often indignantly reject the implication that they are suicidal: death in the fulfillment of the terrorist act is only a moment of transition to their entrance into heaven, to martyrdom and immortality (Post, 2001). Laqueur (1998) has pointed out that while self-sacrifice has been a characteristic of terrorist movements for centuries—as, for example, the eleventh-century Islamic sect of the “Assassins”—different historical periods and social circumstances have modeled the relationship of terrorists to punishment and death. Thus, nineteenth-century anarchic terrorists directed their aggressive actions only against perceived leaders of the social or political establishment, tried to avoid harming innocent bystanders in the process, and expected to be punished with long prison sentences. Self-sacrifice may be induced by a commitment to nationalist fundamentalism, such as the ideological commitments of the Japanese kamikaze pilots during the Second World War. The profoundly masochistic implications of self-sacrifice may emerge in pure form in ideologically motivated self-immolation as a social protest. In this case, the split between the ideological ideal and the dissociated aggression is achieved by an exclusively self-directed aggression as an assumed expression of altruistic love. Obviously, the outline presented above necessarily simplifies the complex individual variations of entrance into the terrorist system and the motivations of individual terrorists. From the rather simple-minded follower who derives a sense of personal significance from belonging to a terrorist group, to the narcissistically isolated, omnipotent fanatic, to the individual with antisocial tendencies who expects financial gains for himself or his
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family, to the severely traumatized, paranoid individual searching for personal revenge, a broad spectrum of individuals engage in terrorist acts; their diversity is similar to that of the leaders who induce such individuals to the terrorist commitment and remain distant from the terrorist act itself. From a social and political perspective, the terrorism of religious fundamentalism is distinct from terrorism linked to a particular idiosyncratic aim, usually within a particular culture or country, for example, the Tamil Tigers, motivated by essentially nationalistic ideology; the Maoist terrorists of the Shining Path in Peru; the Lord’s Resistance Army in Uganda (Laqueur, 1998). State-sponsored terrorisms differ from autonomous terrorist movements in that they correspond to the limited political aim of certain states, as in the terrorist groups sponsored by various Middle Eastern states and the support by the former East German Republic of the extreme left terrorists in West Germany, the Red Army Fraction. The growing wave of terrorist organizations and movements in other parts of the world over the past twenty years was perceived as a relatively distant social phenomenon from a North American perspective, a situation that changed dramatically with the expression of Islamic terrorism on the U.S. mainland on 11 September 2001.
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some psychoanalytic contributions to the prevention of socially sanctioned violence
In the previous chapter I explored the phenomenon of socially sanctioned violent behavior against defenseless civilians, behavior that is typically in dramatically sharp contrast to the ordinary standards and social behavior of the aggressors in their lives outside the specific area of violent assaults upon members of the groups selected as victims. I offered several postulates from a psychoanalytic viewpoint that may be helpful in preventing or mitigating this behavior. To summarize briefly, a fundamental source of social violence is the unresolved primitive aggression that is always potentially available in every individual but is usually controlled and integrated into normal ambivalence in ordinary family and status-role interactions. The internal world of primitive object relations, with its corresponding defensive operations, is activated in unstructured group processes that may evolve as a consequence of social disorganization. Mass psychology as a constant individual disposition can be stimulated by mass media and intensified by paranoid ideology; it can rapidly escalate into social violence against the members of a social subgroup onto whom primitive aggression has been projected. Pathological leadership may aggravate the combination of paranoid mass regression and paranoid ideology formation in the social body, particularly when this is reinforced by historical traumas that widen the existing splits in the society. Individuals with severe psychopathology and antisocial tendencies will form the spearhead of murderous masses. And even those This chapter is based on a modified version of O. F. Kernberg, “Sanctioned Social Violence: A Psychoanalytic View, Part II,” International Journal of Psycho-Analysis 84 (2003): 953 –68. © Institute of Psychoanalysis, London, UK. 170
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individuals who ordinarily regulate their social interactions by an individualized superego system and commitment to moral values may be drawn into the paranoid reorganization of the social process and eventually into the dehumanization and sadistic onslaught on defenseless minorities. A sadistic tyrant who controls the economy, the army, an effective bureaucracy, and the mass media, with its capacity to propagate a totalitarian ideology supported by historical traumas, may turn the population of a country against an oppressed minority by creating a paranoid mass movement that generates a powerful enjoyment of its rationalized hatred and destructiveness. Psychoanalytic studies of group processes, particularly of regressive behavior in unstructured small and large groups, in mass movements, and in organizations (Kernberg, 1998a), all point to the rapid ascendance of primitive splitting mechanisms under conditions that promote the division of the world into “good” and “bad” segments. Groups of people along with their ideologies and political and social leaders will then be either idealized or seen as persecutory. Melanie Klein’s studies (1946, 1957) of the paranoid-schizoid and depressive positions and their application to group, social, and ideological phenomena by Bion (1961), Turquet (1975), Anzieu (1981), and Moscovici (1981), as well as my own earlier contributions, linked these phenomena with the earliest internalization of object relations. Volkan (1988, 1999) has pointed to the influence of historical traumas on ideology formation and intergroup conflicts, illustrating how the transgenerational transmission of such traumas may affect an entire nation or social group, coloring the ideological divisions that emerge under circumstances favoring regression to pave the way for socially sanctioned violence. I propose that the original tendency to split idealized and persecutory early experiences, derived from the earliest dissociation of contradictory peak affect states and the object relations that take place under their influence, also includes the assignment of such idealized and persecutory roles to the cultural manifestations and values that are part of all introjections and identifications. Such assignment also occurs to the many others who gradually come to people the child’s internal world with challenging, threatening, and idealized representations. Starting with parents, siblings, and other relatives, that inner world expands to include friends and neighbors, along with their customs and particular characteristics. The natural love, trust, and dependent longing for the good mother and the good grandparents or older siblings go hand in hand with threats
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from rival siblings and the disappointing behavior of some friends in contrast to the assuring friendliness of others. From early “stranger anxiety” to later parental warnings against risky behaviors or interactions with others, fear and suspicion of those who are “not like us” become a typical experience of early life. The profound need for affiliation, for “belonging,” for being positively responded to by those who share our language, accent, skin color, clothing, behavior patterns, and preferences contrasts with this potential fear and suspicion of those who are different. From a psychoanalytic perspective, “maternal” and “paternal” principles are involved here, not to be confused with father’s and mother’s actual attitudes. The maternal principle refers to the search for an idealized, symbiotic relation with a mothering image, the ecstatic fusion in an “all good” relationship that provides total pleasure, security, and closeness and gradually acquires erotic qualities that culminate in oedipal strivings. The expression and displacement of such longing toward both parents have their counterpart in the expression and displacement toward both parents of the contrasting, paternal principle of “do’s and don’ts,” demands for behavior that is accepted and prohibitions against behavior that is rejected. These rules, at bottom, control aggression and, later, the specific aspects of oedipal rivalry. At first the rules are strongly dominated by the primitive superego, which both controls the expression of aggression and intensifies regressive stirrings, so that escape from its strictures is an ever-present possibility. In contrast to these essentially rigid primitive internalized rules is the mature conscience, based on identification with generous and beloved, yet strict, clear, and consistent paternal figures. This determines stable ethical behavior. In the establishment of idealized and persecutory segments of experience, the maternal principle contributes to the longing for fusion, intimacy, and security within a group that shares our language, behavior, and appreciation for aesthetics and ethical values, that behaves commensurately with our own patterns and acknowledges our acquired knowledge. Commonality of food and music and the home, celebrations, and rituals that bring everybody together in a “feast mass” (Canetti, 1960) provides narcissistic gratification as well as the safety of belonging to a loving and beloved ingroup. Meanwhile, aggressive strivings toward members of that same beloved group arouse intolerable guilt feelings. These are dealt with by projection onto those who are different, “not like us,” those who express an alien culture with alien systems of ethics, values, aesthetics, culturally sanc-
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tioned interactional behavior patterns, and areas of accepted knowledge or truth. Even under optimal circumstances, the growing awareness throughout childhood of the limited control exerted by the cultural domain of the home and the infractions of the rules of this domain accepted in the world outside, the external realities that fail to match the real and fantasized parental version of how things ought to be, fosters suspicion of segments of that outside world and ultimately leads to the development of a paranoid stance toward experience. My point is that during the stage of the early paranoid-schizoid position or preobject constancy, the division of the surrounding world of objects into an idealized and a persecutory segment is virtually unavoidable and persists as a regressive potential after the integration of the idealized and persecutory levels of experience in the context of the depressive position (Klein, 1946). Thus, beneath the recognition of and tolerance for aggression in self and others, under the reduction of projective tendencies and the increasing reality testing and deepening of emotional experience characteristic of the depressive position or the stage of object constancy, there remains a readiness to split the world into cultural stereotypes. Insofar as historical traumas provide any culture with a world of potentially threatening “others,” alienating forces are active even under the most favorable circumstances, in relatively stable, culturally integrated small communities. Historical traumas and the actual alienating presence of cultural diversity are hallmarks of modern life. Parental religious, nationalistic, racist, and sexual biases and prejudices are transmitted both explicitly and experientially in the interaction with the child, and these biases are eagerly absorbed by the ground prepared by the early splitting operations. Severe psychopathology, of course, amplifies the impact of such cultural biases. FOCUSED ATTENTION ON CHILDHOOD VIOLENCE
Psychoanalytic knowledge probably has the potential to make strong contributions for individualized action to prevent childhood violence, although we have to recognize that the social forces encouraging regression into large-group and mass psychology, with their aggressive consequences, cannot be influenced by individually focused measures. We analysts may offer certain principles of prevention, but we lack concrete, potentially helpful interventions aimed at preventing or minimizing massive violence in society as a whole. Given these limitations, the first principle is to focus on the early diagnosis of children who are at risk of pathologic development be-
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cause they have been traumatized by early abandonment, by experiencing or chronic witnessing of physical and sexual abuse, or by open violence in chaotic family circumstances. The protection of pregnant women, the early recognition of and protection against physical abuse of women, the diagnosis of excessive aggression and lack of normal socialization in infants and children from the nursery through the school years, all are channels of diagnostic recognition and potential intervention by psychoanalytically oriented mental health professionals. The psychoanalytically inspired treatment of early disturbances in mother-child relationships represents a concrete preventive intervention. Of particular relevance here is the clarification, confrontation, and interpretation of mother’s projected aggression (derived, in part, from her own frustrations in interaction with her child) onto the infant or child, leading to a vicious cycle of her reduced tolerance of his aggression, which in turn increases the infant’s fear and intensifies his own aggressive reaction, weakening the idealized segment of experience and fixating splitting mechanisms. Reversing this cycle can prevent the increase of aggressive affects and their characterological fixation in the child (Atkinson and Zucker, 1997). The role of the school in providing an educational experience in the exercise of responsibility, authority, and collaboration as well as the establishment of friendship and tolerance of others may also facilitate diagnosis and preventive intervention with children at high risk, who usually present with a high level of aggressive affects and are generally not diagnosed before the school years. Inordinate expression of aggression, sadistic control over others, and acts of cruelty or destructiveness may be alarm signals for specialized teachers, school psychologists, and social workers to intervene in individual cases. It is equally important to give attention to children who are withdrawn, scapegoated, rejected, and bullied by other children. A history of being an outcast seems to be common to a number of mass killers among school children. Possible interventions to protect against social violence of children of high school age include the early diagnosis of gang formation, methods to prevent adolescents from acquiring weapons, discouraging participation in gangs, and intelligent sex education (Flannery and Huff, 1999). Sex education should be designed above all to prevent undesired pregnancies and to stress the normal integration of love and sexuality as the counterpart to strict control of aggressive behavior in the school and on the street. When adolescent gangs are approached therapeutically by psycholo-
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gists and social workers rather than through the police, the resulting analysis of the psychological structure of the gang may lead to its dissolution. Here the tasks include the diagnosis of those with antisocial personality disorders proper, who usually take control of antisocial gangs. A psychotherapeutic approach to most gang followers includes evaluating their individual motivational systems; their conflicts at home have to be taken into consideration in specific therapeutic actions. Above all, it is essential, particularly in disadvantaged neighborhoods, to protect ordinary social structures at the school against attempts by organized adolescent gangs to take control of the school environment. The second principle, then, is to maintain social structures and control social violence while offering a therapeutic space for empathic, tolerant exploration of individual regression and psychopathology. The aim is to prevent or resolve regressive group phenomena at all levels of social violence. Both school and parents have to be helped to withstand adolescents who are threatening them; psychotherapeutic endeavors are feasible only if ordinary social controls are maintained. The importance of maintaining firm boundaries that protect the individual, the group, the school, and the home from violence, while offering a psychotherapeutic space, also applies to the treatment of older adolescents whose frankly criminal aggressive behavior brings them into the judiciary system and who come in contact with a psychoeducational system only secondarily. The first requirement is a careful, sophisticated diagnostic evaluation of the individual, particularly the differential diagnosis of antisocial behavior, to distinguish the essentially untreatable antisocial personality proper from other types of personality disorders and from delinquent behavior in individuals without significant personality disorders, who are eminently treatable (Kernberg, 1992). Psychotherapeutic treatment should not be a device to avoid the criminal justice system, and indiscriminate prison sentences should not be an excuse not to provide careful differential diagnosis and the establishment of an individualized prognosis for each case. Advances in the psychoanalytic evaluation of personality disorders have an important function in designating the optimal boundaries of intervention for each case. A special problem may be posed by religious cults, which are often particularly attractive to adolescents with serious psychological problems as well as to alienated minorities. Regressive features of fundamentalist religious cults include the tendency to restrict the autonomy of participants and the combination of financial and even sexual exploitation with a de-
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mand for total submission to the authority of the cult. I believe that preventive social interventions to protect individuals from potentially dangerous immersion in such a restrictive atmosphere should be considered, together with psychotherapeutic intervention with individuals already traumatized by that experience. The delicate balance between religious freedom, on the one hand, and the mutual responsibility of the dominant culture and particular religious subcultures, on the other, should determine the degree and nature of the intervention. PREVENTION OF CULTURAL PREJUDICE
One preventive intervention that has the potential to reduce regression toward large-group and mass psychology is to give focused attention to culturally prevalent biases. The school system can play a role in fostering a spirit of curiosity and tolerance toward different cultural groups and expanding children’s knowledge about alternative cultures and traditions. Implicitly, this approach provides a first chance to examine the antihumanist, fundamentalist features of socially prominent ideologies, a process possible only within a democratic system of government. Under conditions of military dictatorship and, even more so, in totalitarian regimes, the educational system itself fosters fundamentalist divisions of humanity into good and evil and may be transformed into a most effective reinforcer of fundamentalist ideologies. The interventions of the school designed to foster a curious, openminded, tolerant attitude toward out-groups and other cultures obviously need to be integrated with comparable interventions at home. Parents’ involvement with the school system and the school’s educational relationships with parents regarding alienating and fundamentalist risks in a particular culture in turn require a politically democratic system. Otherwise, a state-controlled educational system with authoritarian relationships between the school system and parents who have to avoid challenging “official” ideologies paralyzes this potentially corrective function. Simon and Faktor (2000) have pointed to the conflict between the suppressed Nazi ideology of parents from a certain social and economic background in the German Democratic Republic and the official Communist doctrine suppressing any awareness of and confrontation with the Nazi past. This contradiction was eventually expressed at the point of German reunification in the latent Nazi identification of a generation of youngsters who were disappointed in the Communist regime but were also mirroring the frustration and resentment of their socially and economically failing
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parents. The latent conflict between home and school and, in a deeper sense, the endangered situation of private life in the context of a mendacious public culture may have helped to determine the neo-Nazi coloring of a significant subgroup of East German youth after reunification. In America, socially engineered school busing in an attempt to bring black children into a normal relationship with white children in the school system failed, wherever the need to involve the home and the black and white communities at large was ignored. The involvement of the home—by invitation and patient consensus building—is an essential aspect of successful programs to increase tolerance and reduce prejudices in the school. THE INTEGRATION OF SUBGROUPS IN A DOMINANT CULTURE
The problem of alien cultures has become urgent as major migrations of populations from one country to another and, particularly, the movement of people from different ethnic, religious, linguistic, racial, and cultural groups have been taking place all over the world. Racism has different characteristics in the United States and western Europe, and it differs in these areas from the simmering animosity of conflicting religious communities in Ireland and India. The radical transformations in South Africa and the Balkans have different characteristics from the nationalist struggle between Israelis and Palestinians. The murderous tribal wars in Africa have perhaps been the deadliest expression of socially sanctioned violence in the last two decades of the twentieth century, although the genocide of the European Jewish population by Nazi Germany remains its single most extreme expression in the modern era. I have already referred to the crucial function of the school in reducing mutual intolerance. Preventive measures also require general policies regarding relationships among social subgroups to regulate conflicts at the boundaries between groups. Here the basic principle from a psychoanalytic perspective is to develop awareness of and respect for the social and cultural requirements of alternative communities and tolerance for cultural subgroups, as well as a sense of responsibility on the part of such subgroups to integrate into the culture of the country in which they have decided to live. It is important to understand analytically the psychological needs of both the dominant, traditionally present culture and the threatened or discriminated-against minority. It is important to raise the consciousness of the majority and to explore its projection onto the minority of a “persecutory” set of social and political biases in the form of threatening myths about the “alien” culture. But the responsibility of the dominant culture to
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offer tolerance, curiosity, integration, and equal rights to minorities needs to be reciprocated by the minorities’ sensitivity to the cultural values of that dominant culture. A cultural minority struggling against its own sense of inferiority by “identifying with the aggressor”—and potentially also defending against its unconscious guilt over betraying its own tradition in adapting to the new or dominant culture—may adopt a provocative stance. For example, to eliminate odious restrictions and discrimination against blacks in the United States and to outlaw the long-sanctioned violence of lynching were essential and eminently reasonable aspirations and mostly successful efforts of the civil rights movement in the 1960s and 1970s. But fundamentalist political movements stressing “black power” reflected a lack of sensitivity to a dominant culture formally committed to political equality. As another example, the wearing of shadors by Algerian girls attending schools in France represents an ideological attack on the predominant French culture, which stresses the equality of women; it has a very different implication from the wearing of saris by Indian schoolgirls, which does not have ideological connotations. In general, demonstrative alternatives in the manner of presenting oneself in public that have ideological implications should be discouraged. From this viewpoint, “multiculturalism” at times reflects a hidden request for special privileges for cultural subgroups; this needs to be questioned in the context of the general principle of the mutual responsibilities of dominant culture and minority. THE PROTECTION OF DEMOCRATIC POLITICAL SYSTEMS FROM FUNDAMENTALIST CHALLENGE
A fundamentalist ideology guiding the program of a particular political party usually represents threats from the extreme right—in the tradition of nationalist, fascist ideologies from the twentieth century or, more recently, Islamic fundamentalist states—or, from the other extreme, a remnant of Marxist-Communist ideologies. It needs to be stressed, as I have attempted to do in earlier work (Kernberg, 1998a), that most ideological systems evolve along a broad spectrum of ideas that present either a “narcissistic” polarity of trivial social conformity or a “paranoid”polarity of militant fundamentalism, with a typical division of the world into friends and enemies, a promised utopia, and a project for the destruction of those who stand in the way. As André Green (1969) and I (1998a) have proposed, from a psychoanalytic viewpoint, fundamentalist systems usually emphasize the responsi-
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bility of the individual toward the collective, limit individual privacy and autonomy, and attempt to regulate the life of the sexual couple. Such systems are consonant with a strict, primitive superego or ego ideal that accepts the oedipal prohibitions but has not incorporated the sublimational identification with the “generous” and procreative oedipal father. The humanistic center of ideologies, in contrast, stresses the value of privacy and autonomy, the freedom of the couple to construct a private sexual life, and the rights, privileges, and responsibilities of the individual. As we have seen, it is the paranoid polarity of ideologies that constitutes a concrete and grave threat to social life and that may push a society into regressive group and mass phenomena that can lead to social violence. The question is, to what extent should a society or a nation tolerate, in the name of its democratic principles, extremist political movements that threaten its very essence? I believe that, in light of the experience of the twentieth century, democratic regimes have the responsibility to defend themselves against the threat of being undermined by fundamentalist political movements. The legal suppression of political movements that attempt to destroy the democratic structure of the state and oppose the principles of fundamental individual rights and tolerance toward social subgroups, religions, and foreigners needs to be considered. Obviously, this is a delicate and worrisome task, particularly for countries that themselves have emerged from dictatorial or totalitarian systems, which tend to be highly sensitive to providing the state with the right to restrict ordinary civil rights. A general statement such as the one formulated here cannot do justice to the complexities that differentiate, for example, the political struggle with terrorist nationalist movements in Spain, the Shining Path challenge in Peru (successfully overcome by a government that itself slid into a corrupt and violent dictatorship later on), and the neo-Nazi groups in Germany. The struggle against terrorist movements is a particular challenge for a democratic society that, while protecting its citizens from the socially disorganizing consequences of terror, needs to avoid the temptation to deal with the terrorist challenge by transforming itself into an authoritarian state. In this connection, the frequent confusion of authority and authoritarianism needs to be avoided. Authority is the rational, socially sanctioned, functionally necessary exercise of power in the pursuit of realistic, socially acknowledged goals (Kernberg, 1998a). Authoritarianism is the exercise of power that exceeds that functionally required by the task; it leads to distortions of organizational and political structures that eventually destroy the task-ori-
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ented functionality of social and political systems. The degree of authority required to protect an open society from potential enemies varies from country to country, from one social situation to another; the functional authority required to deal with a social emergency needs to be clarified and negotiated in each concrete instance. For democratic countries, the danger that criminal elements such as the Mafia in Italy and the narco-traffic in some South American countries may corrupt and undermine the political structure is distinctly different from the threat posed by fundamentalist political movements. Criminal corruption generates unorganized social violence, particularly in the lower socioeconomic strata of society, where drug-related struggles become an essential aspect of economic survival, or focused areas of political influence assure financial control to criminal elements. Again, the political response of democratic systems has to include an organized fight against criminal organizations. In addition, in the case of the narcotics-traffic challenge, a major question is the advisability of decriminalizing narcotic drugs or of making their cost sufficiently high to restrict their sale and use, and investing the resultant financial resources, derived from taxation, in treatment and reeducation. Here the culturally dominant ideology opposing decriminalization is reinforced by the concern that uncontrolled drug use may have disorganizing effects at a broad social level. The preservation of ordinary social structures—that is, the protection of civil society against criminal behavior at all levels—should make it possible to avoid such consequences. I believe that the potential for delivering a mortal blow to the powerful criminal elements involved in the drug trade, together with strong social controls over potentially violent or antisocial behavior of individuals under the effects of drugs, justifies the decriminalization of drugs. And drug-derived taxation should significantly increase the potential for preventive, therapeutic, and reeducative intervention. The psychodynamics causing or contributing to drug abuse and dependency include the addictive predisposition of severely traumatized and characterologically disturbed individuals, particularly prevalent in disadvantaged and discriminated-against social groups; the unconscious protest against a social and cultural system perceived as oppressive and restrictive, combining impotent frustration by a traumatic past and a severely restrictive social present; and the superego pathology that inhibits the development of long-range sublimatory value systems, restricting the individual to the search for short-term pleasure and oblivion. Support by therapeutic institutions and available mental health profes-
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sionals—made financially possible by the taxation of drug consumption— should be matched by the protection of individuals and the social system from drug-related violence and criminality. Finally, the rights of individuals to indulge in self-destructive behavior, when they categorically reject or are unable to accept therapeutic help, also need to be respected, as long as others are protected from damaging effects of such rights. THE PROTECTION OF SOCIAL STRUCTURES FROM UNORGANIZED SOCIAL VIOLENCE
In contrast to the prevention of organized, planned social violence by ideologically motivated political groups, I am referring here to the need to protect the ordinary freedom, autonomy, and safety of citizens; the legality of social processes; and individuals’ interactions with bureaucratic systems from unorganized social violence as a consequence of the illegal drug trade, urban gangs, and (particularly in the United States) the inordinate freedom to acquire and use guns. It is a paradox that, on the one hand, ethical concerns over the prospect of indiscriminate drug use by individuals should bias American culture against the decriminalization of drugs while, on the other hand, ideological concerns to preserve the historic freedom to bear arms, cynically exploited by the munitions industry, provide a powerful counterpart to the concern over unorganized social violence, particularly in large cities, with their inordinately high rates of murder. From a very abstract psychoanalytic point of view, one might argue that the cultural manifestations of unintegrated aggression are relatively constant, regardless of the degree of civilized cultural development, and take different forms only in underdeveloped countries. It would seem more reasonable, however, to consider the negative impact of the ideological bias that protects both the free trade in small weapons and the criminalization of drugs. It is a sad illustration of the power of ideological commitments and financial pressures in the United States that gun control has not yet been achieved, while statistics on violent death place large American cities in the range of underdeveloped nations. It is an ongoing responsibility of the mental health profession to explore and confront the destructive effects of ideologically rooted social policies that affect mental health and tolerate and foster aggression among individuals and social groups. VIOLENCE AND POVERTY
It is well established that the relationship between violence and poverty is an indirect one, in the sense that traditional cultures with enormous socio-
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economic differences but stable social and particularly family structures keep violence at a low level. The example of such traditional cultures gives democratic systems a chance to improve both productivity and a socially fostered distribution of property that can mitigate poverty and its consequences and reduce the sharp differences between socioeconomic strata. The political extremes of total economic anarchy and widespread social injustice, on the one hand, and a state-controlled economy with centralized distributive policies, restriction of individual liberties, and socially controlled systems of distribution need to be reconciled in social policies protecting a reasonable degree of freedom while assuring a fair distribution of social resources. The point is to preserve social structures in the sense of ordinary, safe, legal procedures for social, political, and economic interchange that protect societies against regression into unstructured large groups and mass movements, as part of an attempt to regulate social conflict. A democratic political process with the ordinary social structures preserved would seem best equipped to protect the interests of minorities and the entire society against the risk of socially sanctioned violence. In contrast, socially centralized controls of the production and distribution of resources support the development of authoritarian political systems that eventually reintroduce gross injustices and foster regression through the destruction of functional systems of political and economic interchange. A major financial crisis, an acute economic depression, or the aftermath of a war or social revolution can have an immediate traumatic effect on large segments of the population that may lead to the regressive group processes expressed in mass movements and reactivate the transgenerational historical traumas and social biases against out-groups that trigger massive violence. THE ROLE OF THE MEDIA AND THE INTERNET
As Moscovici (1981) first pointed out, updating Freud’s study (1921b) on mass psychology, television represents the most effective mass medium for tapping the disposition to mass psychology in all individuals and thus contributing to regressive mental functioning. We can differentiate two levels of psychological regression fostered by the media, particularly television: a more surface, “narcissistic” one, bringing about enjoyable relaxation together with a certain trivialization and reduction in the level of cognitive differentiation. This is television as entertainment, in contrast to television as a medium for disseminating cognitive information or education, which requires an effort on the part of the individual viewer and does not provide
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the emotionally gratifying sense of being part of a “virtual multitude” participating in the event presented on television. A still more regressive television-induced psychological reaction represents a “paranoid” atmosphere, which encourages alertness regarding potentially dangerous out-groups and activates the potential for paranoid regression and a relationship with a persecutory segment of experience. Under socially benign circumstances, ordinary thrillers or situation comedies in which the “good” are threatened and overcome by “dangerous bad” ones constitute “recreational” tapping of this paranoid disposition. However, under conditions of severe social conflict and the ascendance of fundamentalist ideologies, even recreational TV may powerfully induce a commitment to regressive, fundamentalist, paranoid-style ideologies in masses of the population. One implication here is that the educational potential of television, insofar as it realistically provides new knowledge and fosters individual elaboration of it by the viewer, requires an individual work effort that runs counter to the mass psychology–inducing influence of mass media entertainment. The dilemma, from the viewpoint of the prevention of social violence, is how to preserve the essential freedom of television as a medium for entertainment and education while maintaining adequate social controls to prevent its regressive use, which can encourage viewers to slide into paranoid fundamentalist ideologies. The fact that television, in general, is prone to express violence more freely than mature sexuality already indicates its regressive potential; it maintains an approach to human matters that follows the general psychology of conventionality (Kernberg, 1998a). This psychology is closer to that of the latency age superego than to the mature individual judgment of adults. The extent to which the exploitation of expressions of primitive violence on television may lead to actual violence is still a controversial issue. It probably stimulates violent behavior in individuals already disposed in this direction by personal psychopathology. If further research indicates television’s definite influence in fostering individual or social violence, it would seem warranted to exercise social controls. The situation appears to be quite different with regard to the Internet. The almost chaotic multiplicity of contrary messages and ideological orientations clearly has the initial potential of fostering freedom of communication but eventually of permitting extremist and fundamentalist groups to contact each other and coordinate their efforts. However, the Internet lacks television’s overall influence on predominant ideological dispositions. Perhaps the control of hate-filled fundamentalist propaganda on the Internet,
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if it were feasible, might help to reduce the influence of fundamentalist ideology in society. THE SELECTION OF LEADERSHIP
In earlier work (Kernberg, 1998a), I suggested that, from the viewpoint of effective organizational leadership, a prospective leader should be evaluated in terms of his overall intelligence, moral integrity, capacity to evaluate others in depth, and a discrete degree of both narcissistic and paranoid tendencies. Conversely, a lack of high-level intelligence and moral integrity, the inability to evaluate others in depth, and, particularly, an excess of narcissistic or paranoid features describe not only incompetent but dangerous leaders. Pathologically narcissistic features lead to an authoritarian leadership style that fosters submissiveness, adulation, and corruption in those around the leader and thus limits the potential for functional leadership. In the case of the excessively paranoid leader, his influence may bring about, in addition to fearful submissiveness, regressive deterioration in the ideological stance of his supportive group, a reinforcement of fundamentalist tendencies, and the liberation of aggression against out-groups. It is the combination of extreme narcissistic and paranoid tendencies in the syndrome of malignant narcissism that is especially dangerous and is characteristically linked to leadership in dictatorship and, particularly, totalitarian systems. These are leaders with a narcissistic personality structure, severe paranoid tendencies, egosyntonic aggression potentially expressed in cruelty, and antisocial behavior expressed in chronic deceptiveness. In a culture of violence, these characteristics and their projection onto other people foster aggressively violent mass movements. We have evidence, for example, that the syndrome corresponds to the personalities of both Hitler and Stalin and contributed significantly to the murderous nature of their regimes (Bullock, 1992; Kershaw, 1999, 2000). It is, of course, inevitable that such individuals will ascend to leadership positions in marginal, extremist, fundamentalist social groups and movements. It is important for democratic systems not only to prevent such individuals from acquiring political control but also to be aware of how to manage conflicts with such leaders in non-naive ways. CONCILIATION OF NATIONAL, ETHNIC, OR RELIGIOUS GROUPS AND INTERNATIONAL CONFLICTS
Volkan (1988, 1999) stresses the need to obtain the honest collaboration of the leadership of both sides in ethnic or national conflicts. The implication
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is that such conflicts cannot be considered symmetrical; one side, or one country, may be so poised for control or conquest that apparently conciliatory behavior is only a tactical maneuver while preparing for violence. This implies that conciliators cannot afford to naively espouse a radical form of pacifism; there are rogue military threats and actions that need to be defended against by democratic societies. If a truly symmetrical relationship can be established—that is, awareness of a common need to resolve a major conflict between two feuding nationalities, social groups, or nations—Volkan recommends, first, dealing with the objective reality of mutually incompatible aspirations and demands, achieving a compromise that requires both sides to make sacrifices. But they must be worthwhile ones in terms of the goal of peaceful conflict resolution. Second, in the attempt to resolve a conflict, it is important to evaluate the historical traumas reflected in the ideological structure of both sides and to include measures that take notice of them and of the revengeful aspirations related to them, trying to build real or symbolic compensation into the conciliatory effort. Third, Volkan insists on the importance of considering the individual psychodynamics of the leaders of both sides, their personal history and traumas related to their assumption of leadership, in the enactment and potential resolution of the conflict. An honest encounter between the leaders of feuding nationalities is considered essential but may not be sufficient to resolve the conflict if the other conditions are not met. TERRORISM
Over the centuries, terrorism has appeared in many guises. It is not an ideology or a political doctrine but rather a method of sowing panic, intended to bring about political change through applications of violence or the threat of violence (Laqueur, 2001). While the psychology of individuals engaged in terrorism and the psychological preconditions for their behavior, as well as the psychology of the victims—the individual, group, and mass regressions caused by terrorist acts within the victim population—are relatively open to psychoanalytic exploration, the causes of terrorism and its prevention and treatment demand complex social, political, cultural, economic, and historical approaches. Psychoanalytic contributions necessarily occupy a limited space in this analysis. Some general considerations, however, might be useful. Most authors seem to agree that terrorism cannot be reduced to any
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single cause such as poverty, population pressures, religious conflicts, massive migrations, ethnic divisions, nationalist aspirations, or the uncontrolled growth of megacities (Hoge and Rose, 2001; Huntington, 1996; Kakar, 1996; Kepel, 2000; Laqueur, 1998). Religious and nationalistic aims may coalesce, as in the Islamic terrorist groups in the Middle East and Central Asia, the IRA in Ireland, and terrorist groups in Kashmir. However, in searching for causes of terrorism and therefore for methods of prevention and treatment, one has to keep in mind that typically, the professed statement of the “cause” that justifies a terrorist group’s actions is itself part of the terrorists’ strategy and follows political objectives rather than corresponding to authentic grievances. As Hugo Neira (personal communication, 1997), referring to the Shining Path movement in Peru, put it:“Terrorists often wrap themselves in the flag of grievances for the oppressed, whom they themselves attack ruthlessly.” Laqueur (1998), in agreement with other authors, points out that terrorists tend to escalate terrorist actions until they obtain a significant reaction from the enemy. Lack of response to terrorist provocation usually increases terrorist action until it becomes so outrageous that the threatened society reacts strongly and usually manages to defeat terrorism. Efforts to compromise with terrorist organizations usually fail: compromise and conciliation are anathema to the terrorists because they challenge the very basis of their ideological commitment. The only effective way to deal with terrorism is to control and defeat it while seeking to understand the long-range factors that fostered its development. Both processes must go on simultaneously, and that requires a complex combination of social, economic, political, diplomatic, and military means. Terrorist movements thrive in open societies in which they can set up their operations relatively undisturbed. The fight against terrorism, therefore, necessarily means some restriction of civil liberties, with the danger that excessive restriction may play into the terrorists’ hands. All states affected by terrorist onslaughts have to maintain a delicate balance between sufficient control of the social structure to stop terrorist activities and the protection of civil liberties against excessive control. The struggle to do so is exacerbated by the particularly dangerous nature of contemporary terrorism with its access to biological, chemical, and nuclear weapons. Protection against these dangers implies expensive, long-term, global measures of prevention and control to disconnect terrorists from their sources of financial and political support. The gradual, effective cutting off of funding and logistic support of the IRA in Northern Ireland, the ETA (the Basque ultrana-
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tionalist liberation movement) in the Basque country, and the RAF (Red Army Faction) in Germany was achieved by concerted efforts of the political, social, and cultural communities of those countries, together with police and military action. Once terrorists lose the support of silent sympathizers, they have difficulty surviving. From the viewpoint of the psychoanalytic understanding of smallgroup and large-group processes, a number of interesting questions arise that may be relevant for the prevention and treatment of the traumatic consequences of terrorist assault. The victimized social group may ask: “Why do they hate us so much?” This question reflects the natural shock of a nonregressed population living in an ordinary psychosocial environment when suddenly confronted with the most primitive and violent manifestations of human aggression. The victims are accustomed to newspaper or television accounts of crimes committed by individual psychopaths or of violence in the course of military conflict. But random violence that involves them for no apparent reason tempts the traumatized group to take seriously the terrorist’s propaganda statements justifying their actions as caused by the behavior of the victims’ society. The real answer lies in the typical characteristics of regressive paranoid developments in large-group processes, reinforced by the fundamentalist ideological convictions of the terrorists, the concrete educational (or brainwashing) pressures to which the terrorist group was subjected in preparation for its task, and the personal psychopathology of the individual terrorists. A second question in the mind of the victims, naturally, is “What have we done wrong?” This is a masochistic response to a sudden experience of sadistic violence, reflecting the unconscious tendency to identify with the aggressor in order to make sense of an incomprehensible, traumatic experience by relying on ordinary means of reasoning. The danger is that the victims may submit internally to the terrorist aggression by developing intense guilt feelings. Insofar as this tendency to self-blame—the so-called Stockholm syndrome—leads to self-doubt and paralysis, it may actually feed into the terrorist group’s objectives. The manifest statement of the “cause” of terrorist action is intended to resonate with the particular victims’ predisposition to guilt feelings. A third question derives from the first two: “Can anything be done to change such a profound and pervasive sense of hatred?”Here it is important to differentiate the fundamentalist ideology within which the terrorist movement has evolved from the terrorists’ unshakable commitment to violence. As mentioned before, this commitment cannot be influenced; it must
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be controlled and defeated. But the masses of passive sympathizers who constitute the social and political world within which terrorism develops can and must be influenced in order to isolate the terrorist group. An understanding of the immediate consequences of group regression and mass psychology can be helpful. Historically determined biases and hatred may be transmitted transgenerationally but do not necessarily interfere with the peaceful coexistence of different social groups under ordinary social and political circumstances. Just as immediate regression to violent mass psychology may emerge under the influence of acute socially traumatic circumstances or crises, so such violence may be decreased rapidly by the reduction of such regressive phenomena in the context of social reorganization, political action, or conciliatory efforts with political and social forces related to but not identical with the terrorist group (Huntington, 1996; Volkan, 1998). Thus, for example, Christian Serbs and Bosnian Muslims have been able to live together peacefully over many decades; outbreaks of intercommunity violence have been closely related to concrete political developments, war, and particularly the breakdown of the Soviet system. The rapid disappearance of the remnants of Nazi ideology and mass psychology with the defeat of Nazi Germany and Hitler’s death illustrates the same phenomenon: the fundamentalist ideology died with the leader. This brings us to the role of the media in triggering mass psychology and influencing its demise. In their commercially driven thirst for sensationalist news, the media may unwittingly reinforce the impact of terrorist action and thus become the tools of terrorist strategies. But just as the violence can be stirred up by mass media in the service of a fundamentalist ideology, so it may be influenced rapidly by mass media that dare to challenge that ideology. The social responsibility of the media in the war against terrorism is the counterpoint of a naive defense of their total freedom and irresponsibility to publish what may sell. This lesson has been absorbed by the press in European and Latin American countries that have been subjected to long-term terrorist threats and antiterrorist efforts. From a psychoanalytic perspective, finally, the question may be raised: “What are the chances that an individual terrorist may escape the terrorist system and return to a condition of normality that resolves his personal regression, split-off aggression, and submersion in a fundamentalist ideology?” Obviously, this depends on the psychopathology of the individual terrorist and whether paranoid personality dispositions that foster entrance into a paranoid group psychology are part of the more severe syndrome of malignant narcissism and are accompanied by significant antiso-
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cial features. An ordinary capacity for human empathy and identification with ethical values may permit some terrorists to leave their system once its basic sadism, cruelty, irrationality, and inhumanity become obvious to them. We certainly have examples of this in political leaders who emerged from an early identification with a terrorist group—for instance, Menachem Begin, eventually prime minister of Israel, and Joska Fischer, who became foreign secretary of the German Federal Republic, despite their earlier immersion in terrorist groups. It would certainly be naive to imagine that the principles outlined in this chapter are sufficient for all situations of socially sanctioned violence. They reflect general approaches from a psychoanalytic viewpoint that should be integrated with other approaches derived from social-psychological, political, historical, and socioeconomic expertise. But insofar as psychological factors influence conflicts and violence at individual, group, and national levels and provide some understanding of ideological systems as well as leadership, they should become part of our social armamentarium to reduce, if not eliminate, the terrible problem of violence in our human reality. It is an ironic paradox that humanistic ideological systems, such as religions that proclaim a universal system of morality for all mankind, have much less appeal and dynamic tension than the polarities of narcissistic and paranoid regression characteristic of mass psychology, with its predilection toward social violence. Democracy as an ideology cannot aspire to the emotional appeal of totalitarian fundamentalism. The education of the individual in a tolerant social system may provide for the development of normal ego identity and an integrated, autonomous system of morality. But humanity has to deal with utopian aspirations for perfection that implicitly carry with them the need to deny the aggressive and self-destructive components of human life, for individuals and for society at large. Once a utopian ideology splits off and projects aggression, the preconditions for a threatening and threatened out-group, the enemies of utopia, are established. The mourning process that acknowledges unavoidable human aggression provides a counterbalance to historical traumas and may have healing effects on the divisions between social groups, but rational humanistic systems will always remain exposed to the dynamics of paranoid, fundamentalist, and totalitarian ideologies (Segal, 1997).
part two technique
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listening in psychoanalysis: the importance of not understanding
Listening in the context of a psychoanalytic exploration seeks, first of all, to understand a patient’s conscious experience and follow him to the boundaries of his self-awareness, while yet being aware that the relationship with the analyst may significantly limit his willingness or ability to share his conscious and preconscious experience, to open up the dark corners into which he himself is reluctant to look. Second, psychoanalytic listening implies searching for input from the patient that transcends his conscious and preconscious experience and that becomes evident by considering what is missing from his conscious experience as well as what he is unwittingly communicating: that is, the derivatives of his unconscious life, the dynamic unconscious pressing to invade the space we have opened within the analytic setting. Third, psychoanalytic listening involves listening to our own emotional response to the patient’s communication while remaining aware of our way of reasoning in response to his information and alert to stirrings in ourselves of our unconscious role responsiveness to the transference. Fourth, the psychoanalytic approach to listening must acknowledge the multiplicity of channels of communication, the temptation to focus arbitrarily on some of them rather than others, and the need to encompass the broadest possible number of channels in order to allow oneself to become aware of the almost spontaneous organization of the material into a dominant theme. I am referring here to such sources of information as the paAn earlier version of this chapter was published in The Perverse Transference and Other Matters: Essays in Honor of Dr. Horacio Etchegoyen, edited by J. L. Ahumada, A. K. Olagaray, A. K. Richards, and A. D. Richards (Northvale, N.J.: Jason Aronson, Inc., 1997). 193
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tient’s cognitive style and linguistic particularities, the affective coloring of his communications, his nonverbal behavior, the extent to which he is consciously guiding his communication as opposed to freely associating, our countertransference reactions in the broadest sense of the term, the aspects of our theoretical formulations stimulated by the material, and the extent to which we experience ourselves as blocked by enigmatic messages that seem to emanate from within ourselves while listening (Laplanche, 1987). Finally, psychoanalytic listening involves, of course, an effort to clarify to ourselves the information about the dynamic unconscious as we are digesting all that material and a concerted effort to communicate our understanding to the patient without imposing it on him and, more crucially, without attempting to influence his behavior. On the contrary, our efforts to increase his self-knowledge are intended to increase his internal freedom. Psychoanalytic listening is inherently paradoxical in that we want to listen freely, objectively, and desirelessly, yet we cannot listen for unconscious meanings without some theory regarding unconscious mental functioning. Thus the first task in psychoanalytic listening is to accept the fact that our listening is unavoidably influenced both by our theoretical frame and by our own unconscious, despite the effort to minimize the effects of these influences on our communications with the patient. I believe that analysts who insist that their listening is intuitive, atheoretical, or simply empathic are operating within schemes of references that may (because they are unacknowledged consciously) affect the listening process even more than is the case when the analyst is clear in his mind as to his theoretical frame and the risk that it may restrict or distort the exchange between patient and analyst. This is precisely the dilemma: the clearer our frame and our awareness of it, the greater the likelihood that we will avoid imposing this frame on the patient’s thinking. A second, major issue involving psychoanalytic listening is the relation between the radical, asocial, erotic, and sadomasochistic nature of the dynamic unconscious, on the one hand, and the reasonable, seductive, conventional nature of conscious experience. The very history of psychoanalysis is marked by this dialectic. From the enthusiastic early “id analysis,” focused on unconscious sexual and murderous impulses, the pendulum swung toward the adaptive functions of the ego and defense analysis, and then back to the Kleinian stress on earliest unconscious reality, part object relations, and primitive condensation of aggression and oedipal strivings. The next direction was back again to a focus on unconscious interactions in the “here and now,” which are highlighted in more recent British and inter-
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personal approaches to analysis (Etchegoyen, 1991; Greenberg, 1991; Kernberg 1993a). Similarly, the focus of self psychology on the adaptive aspects of preoedipal conflicts and the relation of the self to its self-objects was followed by renewed attention to the unconscious erotic layers of the mind and the emphasis of French psychoanalysis on the deeply unconscious primitive fantasies of the primal scene, oedipal seduction, and castration (Laplanche, 1992; Schwaber, 1983). While this kaleidoscopic view of contemporary controversies about psychoanalytic theory obviously cannot do justice to the complexities involved, I believe it reflects an important dilemma for the clinician, unavoidable by the very nature of psychoanalytic listening: the effort to help the patient become aware of the deepest levels of his psychic experience may force the listening psychoanalyst to deliver what may appear to be shocking disclosures or else may be seen as indoctrination of the patient. At the same time, the effort to stay close to the immediate emotional reality of human experience may reduce the sharp edge of the discrepancy between the patient’s conscious experience and the psychoanalyst’s awareness of the deep nature of the repressed. Flexible, noninvasive listening may purchase empathy at the cost of remaining at the surface, being seduced by conventionality, and ultimately reducing the patient’s opportunity to learn about himself in depth. A third problem of psychoanalytic listening relates to the central importance of non-understanding as a precondition for understanding. The intolerance of non-understanding derives not only from an analyst’s guiltridden or narcissistic need to help the patient by understanding but also from the patient’s unconscious emotional investment in maintaining “nonunderstanding” on the part of the analyst as well as himself because of the danger he fantasizes is associated with the unconscious reality being defended against. And insofar as the analyst’s unconscious is activated in his role responsiveness to the patient, there may be powerful forces fostering non-understanding in the analyst as well. Bypassing such moments of confusion or bewilderment by relying on theoretical clichés is tempting; colluding with the patient to remain on a conventional level or to continue conventional pseudounderstanding is perhaps a more common way of dealing with non-understanding (Bion, 1967b). Disruption in the flow of associations signals the operation of a defense. The emergence of an unconscious conflict into consciousness is often signaled by a subtle—or not-so-subtle—breakdown of communication between patient and analyst, leaving the analyst feeling at a loss. Non-
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understanding may thus be respected as an indicator of emerging conflict, and psychoanalytic listening includes listening to being at a loss as an important aspect of the therapeutic interaction. Being at a loss indicates no specific intervention but rather a generalized attention to what might be missing in the analytic situation. I am fully aware that I have not yet spelled out the theoretical frame that organizes my own listening, but I trust that it will emerge through the examples that follow and from my final comments. TWO ILLUSTRATIVE CASES
Mr. A, a man in his late thirties, consulted me because of a compulsive neurosis, expressed in a tendency to excessive and time-consuming hand-washing and the need to recheck where he had put small objects in his house. The patient was a financial expert in a complex organization. His rigid and perfectionistic behavior had created problems with colleagues and superiors, and he had also been sharply criticized for passivity and slowness, surprising in this otherwise apparently perfectionistic individual. Eventually he followed the advice of the rabbi of his Orthodox Jewish community and consulted a psychiatrist, who felt he was too strict in pursuing the community’s elaborate rules and prescriptions for daily living. His wife shared his Jewish identity, but the patient felt that she accepted their religious life more for conventional reasons than out of deep personal conviction. His resentment of what he regarded as her superficiality had led to conflicts between them. His father was a Conservative Jew who gave the patient a Jewish education but then, in Mr. A’s adolescence, disappointed his son bitterly by what the patient considered his “wishy-washiness,” uncertainty, and the lack of depth in his religious beliefs. Mr. A went through an atheistic phase in early adolescence, in rebellion against his father, and then became an Orthodox Jew, repudiating what he considered his father’s hypocritical, superficial observance of the demands and expectations of their religion. The patient described his mother as a strong person who ran the household and was much more available than his somewhat aloof and withdrawn father. But in spite of her closeness and apparent warmth toward Mr. A, she was willing to drop her support of him when that would have meant facing criticism from her husband. Mr. A was by far the youngest of his several brothers, and he conveyed the impression that he had had very little contact with them. The sparseness of his memories from early childhood suggested a severe and diffuse repression. His concern about the lack of religious sincerity
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in all the members of his family seemed to replace reflections about other aspects of his emotional life. His wife, he said, had become increasingly resentful of the time he devoted to religious commitments, spending many evenings and weekends totally involved in studies and work in his Orthodox community. Mr. A seemed to have a very good relationship with his two sons, although they too were beginning to chafe at his strict and perfectionistic ways. In the course of his treatment, he complained that his wife was now resentful of the time he was spending in his analysis. At the time of the session summarized here, approximately three years into his treatment, we had already explored how he unconsciously projected his own doubts and questions about treatment onto his wife and how her complaints reflected feelings about the treatment that he shared but did not dare to express directly. We had also explored his particular relationship to God, whose laws he considered reasonable, just, and firm, while human authorities were weak and treacherous, dictatorial and despicable. He had a history of having lost jobs because of his challenging behavior and severe conflicts with authority figures whom he experienced as dishonest and sadistic, and his attitude toward his current bosses was similar. Mr. A’s initial view of me had been very positive because his rabbi, in recommending me, had stated that, unlike other analysts, I was accepting and respectful of religious commitments. This positive view rapidly dispersed as the patient experienced my efforts to explore his emotional reality as an indication of sentimentality and histrionics on my part, along with what he considered my rigid and doctrinaire attempts to push psychoanalytic theory. At the same time, he attempted to maintain the positive aspect of his ambivalence by reassuring himself that I had not given any evidence of attempting to dissuade him from his religious convictions. This picture of me had recently become threatened by the emergence of frequent sexual dreams involving women other than his wife. My attempts to elicit associations to these repetitive dreams evoked dismissing statements that “everybody has sexual impulses about the other sex in his unconscious” and that there was no reason to relate such dreams to any conflict in his present or past sexual life. My exploration of this subject matter, as he saw it, indicated that I might be trying to tempt him to get involved with other women and conjured up the image of me as sex-preoccupied, given to “Freudianism as pansexualism.” In this context, Mr. A began a session by expressing intense anger toward his boss, whom he accused of having mendaciously distorted a busi-
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ness transaction in order to hide his own incompetence. The patient had told his boss that he disagreed with a decision involving a co-worker, a protégé of his boss and a rival of Mr. A; he had made it clear, he said, that the matter would have developed very differently if his boss had listened to Mr. A instead of trusting excessively in this other man’s judgment. Following a lengthy description of this altercation, Mr. A dismissed the whole issue by saying, “What else can be expected of F [his boss] and D [his colleague and rival]?” At first, I listened with great interest to his account of this conflict; in fact, I felt a little shocked—not so much by the vehemence of the patient’s rage against his boss as by what seemed to me his heightened sensitivity to minor slights. The paranoid attitude revealed in this relationship, which had already caught my attention on several occasions, now struck me as also fitting with his strange way of looking at me upon entering my office that day, as though he were suspiciously and almost fearfully “casing the joint”; this was followed at once by a slightly self-deprecating smile, an expression that disappeared as quickly as it had emerged. In fact, all this happened so quickly that I could only gradually reconstruct it in my mind, recalling similar experiences from other sessions. Eventually, the patient’s delivery became more monotonous. His account ended in what seemed an almost bland list of experienced injustices and finally with a sudden brief laugh of dismissal of his boss and his colleague. Mr. A suddenly seemed completely relaxed, as if he had expelled this disagreeable experience. The idea emerged in my mind that I had witnessed an expanded version of the quickly developing shifts of expression toward me at the beginning of the hour. I raised the question whether, in dismissing the behavior of his boss and his rival with a derisive comment, he was trying to control the rage that he had initially expressed. I wondered whether the intensity of that rage might have caused equally intense fears that the boss would retaliate. Perhaps he was trying to avoid such fears by his derision. Without hesitation the patient responded that what I had said was “bullshit.” I asked him why, and he replied that it sounded like a theoretical statement I had gotten out of a book; it only showed how I dramatized all emotional situations, exaggerating them in the process. His dismissal came so quickly, calmly, and rationally that it had a disorienting effect on me. He then went on to talk about his plans for the weekend and about his irritation with his wife for not understanding the importance of the religious functions in which he intended to be involved.
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As I reflected on what had just gone on, I thought that my comment had certainly come not from a theoretical understanding but from an emotional experience with this patient and that his calm expression of this view of me as bookish and hysterical suggested that he rather enjoyed seeing me in that way. I said that he did not look unhappy because of what he considered my inappropriate, intellectual comment; he answered ironically that he was not surprised by my attitude. I then commented that if indeed I was bookish and off the mark, it was strange that he took this so calmly, almost with an expression of satisfaction. I wondered whether this attitude protected him from troubling worries about whether he could rely on me for authentic understanding. Mr. A replied that everyone had weak spots, but he looked a little more anxious. I then said that he had previously made similar comments to the effect that I was rigidly trying to impose my thinking on him, giving him standard, superficial answers without any real conviction. If this were true, he would have good reason to be troubled by my incompetence or my dishonesty, and his dismissal of the whole issue as a matter of human frailty was an attempt to protect himself and me from that. The patient now said that he really did not want to see me in the same light as his boss. I added, “and the previous two bosses that we have talked about in your analysis, and your father with such similar behaviors as well.” Mr. A became thoughtful and for the first time seemed to reflect from a new perspective on what had been going on in the fight with his boss. I, however, now felt that my comment was too much at the surface of the material and failed to capture the intensity of his dismissal of his boss and of my comment and his supercondensed enactment of that same behavior in the first moments of the sessions. I felt as if I had been seduced into making everything very rational, bypassing the explosive violence I sensed in the patient. I said,“On second thought, I believe there is another level of experience here, related to your view of dishonest authorities who try to impose their will on you—namely, the intense violence with which you not only attempt to respond to them at certain moments but try to eliminate the situation itself by derogatory laughter or a derisory thought such as you expressed toward your boss and then later toward my comment. I also experienced this at the beginning of the session, when you came in, looked around the room somewhat suspiciously, and then had what impressed me as a slightly derogatory smile. It is as if symbolically, you were defecating on all these horrible authorities and then flushing the toilet, freeing your mind of the
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whole problem.” “And,” I added, “I wouldn’t be surprised if you were tempted to dismiss what I’m now saying as another bookish comment.” The patient said, “No, what you said about my reaction on coming in is true: I had a sense of a little world terribly orderly and routine, somewhat ridiculous, but now that I think of it, it reminds me of my own way of having everything in a terribly neat order, which takes up all my time.” This comment came as a surprise to me and opened up an angle of the situation that I had not perceived before: the patient’s projecting onto me the defensive nature of the organized good little boy pseudosubmitting to a violent father. But I shall leave this example here to proceed to the second case. Mr. B, a man in his midforties, had been in psychoanalytic treatment for years because of severe difficulties in his relationships with women. He had had very little sexual interest in the two women to whom he had previously been married, and his relationships with other women were frantically promiscuous, lasting from a few days to several months. They were fully satisfactory as far as his sexual impulses were concerned but were also characterized by transient idealizations that evaporated rapidly, carrying him from one woman to the next. His personality structure was that of a narcissistic personality disorder, and during the early years of his analysis he had invested a significant amount of time in analyzing his character defenses against a dependent relationship in the transference. His third marriage, which occurred in the course of the treatment, reflected his developing ability to fall in love and remain in love. For some time he had experienced the warmth and commitment of his new wife quite clearly, as well as her responsiveness to his sexual interest. In fact, as a consequence of treatment, his capacity to understand himself and his wife had significantly increased, and he had also gained important understandings regarding the underlying dynamics that I shall not explore here in detail, although some of them will become apparent. In the first of the three sessions summarized here, the patient, having returned from an extended vacation with his wife, complained that he had again experienced his old symptom of loss of sexual interest. He said that he continued to feel very much in love and that their emotional relationship was very satisfactory, but he found himself without an erotic response to her, so that sex had become mechanical. He could enjoy sex with her only if he had fantasies involving other women, particularly older women from his past, women from a lower socioeconomic environment, who had seemed extremely interested in him sexually and who had reassured him against his
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deep fears of being exploited by ruthless, controlling, frustrating, and dishonest women. His mother was a near-psychotic person who had managed to control her three sons by playing one against the others through a combination of teasing seductiveness and the imposition of irrational behavioral rules. During the patient’s early childhood, these rules appeared sacred to him, but later on he saw them as completely arbitrary and absurd. The patient’s father, who was subject to angry outbursts and rapidly shifting moods, basically submitted to his wife and endured her chronic complaints about his ineffectiveness at work. We had explored Mr. B’s unconscious fears and hatred of women in the past, his fantasy that sexual gratification was something he had to extract from women who, in turn, would use it as a trap to control and exploit him, and the importance of aspects of his unconscious identification with a sadistic mother in his hostile and erratic womanizing. But what impressed me in this session was the patient’s somewhat restless impatience with himself: the absence of sexual excitement with a women he loved was, he felt, a problem he should have overcome long ago; he acted as if this recurring symptom was a meaningless reflex to be treated by repeating to himself what he had learned in his analytic experience. In the midst of his associations about the older women in his past, who were now serving to sustain his erection and help him reach orgasm in intercourse with his wife, he suddenly had an intrusive thought about my genitals. Such thoughts had emerged in the past in connection with fantasies that an emotional closeness to me would acquaint him with all the secrets of how to deal with women. Behind this theme were fantasies of sexual seduction by me that in turn related to a deeper level of his identification with a teasing and frustrating mother, by whom I would be sexually aroused. Thus complex roots and problems behind this apparently simple fantasy now intruded into the session, together with his attitude of impatience and wish to resolve his difficulty with his wife by means of “willpower.” Meanwhile, as the session went on, I experienced a sense of frustration and disillusionment, as if resolution of my patient’s sexual inhibition with his wife was linked to a narcissistic gratification of me. In fact, I shared or was seduced by the patient’s sense of impatience and wish to resolve this recurring symptom rapidly. And I experienced a sense of insecurity, in response to the patient’s description of his sexual experiences with his wife during the vacation, linked to a strange feeling that she really was sexually
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uninteresting or unappetizing. In other words, I found myself emotionally identifying with my patient’s sense of failure, impatience, and disappointment. I also thought that behind his intrusive thoughts about my genitals there might be an unconscious wish to seduce me into a sexual attraction to him—one more narcissistic regression as a defense against the oedipal fears that had emerged during the vacation. But my thought seemed to me speculative, as it failed to reflect the uncertainty, impatience, and deadening of erotic feelings that pervaded the session. I suggested that he associate further about the imagery of my genitals, and he said, sounding quite convincing, that no other ideas were coming to his mind except various interactions with his wife during the vacation. He continued to talk quite unemotionally about all the things they had been doing and enjoying together. I experienced this session as a frustrating hour and, retrospectively, as a clear indication of non-understanding on my part or, rather, of the possibility that my listening to the patient was disturbed by my concern over non-understanding. Several sessions later I became aware of that same sense of insecurity, again in connection with Mr. B’s account of difficulties in his sexual relations with his wife. This time I noticed a curious sense of paralysis in my listening, which I eventually translated as a momentary but total sense of insecurity in my analytic work with him. And precisely as this experience repeated itself with growing clarity in my mind, I realized that what had been strikingly missing from the patient’s description of his difficulties on the vacation was any reflection of his internal feelings and thoughts about his wife. As I pointed out that he was telling me about his behavior toward his wife but not about his feelings, it suddenly became evident to him that he had been experiencing enormous insecurity linked with the fantasy that he really was a small child and that it was incredible that this adult, responsive, intelligent, attractive woman really loved him and had decided to dedicate her life to him. He had had the fleeting thought that such a harmonious marital understanding had been completely absent from his parents, and he anxiously dreaded the inevitable end of his own happiness. Then fantasies came to his mind about his wife’s attempting to have sex with him while he did not have an erection; she would treat him ironically, like a little boy with a small penis. He wondered whether the idea of my penis and testicles had come to mind as particularly big genitals that he imagined in contrast to what he experienced as his own small genitals. This led him to the recovery of an expe-
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rience in his early childhood in which his mother had taken him to a doctor because she was concerned about the lack of descent of his testicles. Gradually his sense of impatience and the wish for a rapid solution of his problem reminded him of his father, who believed only in practical instructions and to whom any psychological understanding and selfreflection seemed absurd. I had the sense now that in my feelings of insecurity and disorientation I was empathizing with a part of him that he could not tolerate—namely, the small castrated child unable to satisfy big mother. Mr. B had been projecting that rejected, infantile, castrated self onto me while imitating his father’s impatience and lack of psychological-mindedness. So he was caught between fear of asserting himself as an adult man with his wife, which was fraught with unconscious prohibition and castration anxiety, and fear of a dependent relationship with me, which implied sexual submission. To submit to me meant to incorporate my strength in acting in an adult way with women but also to renounce his independence and manliness. The fear of depending on me because of his fear of homosexual feelings had been a subject elaborated earlier in his analysis: now it reemerged fleetingly as an expression of the increase of oedipal fears, an early moment of which I believe I had captured without full awareness in my sense of insecurity during that first confusing session. I hope I have illustrated with Mr. A the many sources of information entering into psychoanalytic listening and the dynamic issues regarding surface versus depth interpretation. Mr. B again illustrates the complexity of sources of information, including the cumulative data in advanced stages of an analysis, and the confusing yet eventually illuminating moments of not understanding under conditions of the emergence of a new aspect of the repressed unconscious. A THEORETICAL APPROACH TO LISTENING
I believe that the sources of information requiring the psychoanalyst’s attention can be grouped into, first, the patient’s verbal communication—its content, the sequence of his free associations, their allusions and references, and the affective implications of his subjective experience in the hour; these constitute what I have called “channel one” (Kernberg, 1984). Second, or “channel two,” are the nonverbal aspects of the patient’s communication— his behavior as it conveys affect and motive, as well as the style and structure of his language. Free association thus has a central role, not only indicating
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the patient’s conscious freedom to communicate but also conveying a defensive style in its very structure. A third “channel” is the countertransference, conceptualized in a contemporary sense as the total emotional reaction of the analyst toward the patient, with a particular emphasis on concordant and complementary identification as part of it. These various channels of communication operate with different intensity at different times with the same patient, and according to the severity of the patient’s psychopathology: the more severe the character pathology, the more channels two and three tend to dominate over channel one. I pay particular attention to the dominant affect of the patient’s experience, considering that paying attention to this material usually leads to a natural ordering of the analytic process. Affective dominance does not necessarily mean affect as consciously experienced, described, or expressed. The dominant affect emerges in the conjoint analysis of all the sources of information to which psychoanalytic listening is open; hence it is an inference of the analyst. Frequently but not exclusively, affective dominance coincides with transference developments; and it is important for the analyst to be open to explore unconscious conflicts not only in the transference, although such exploration leads, directly or indirectly, into the transference. I expect that psychoanalytic listening will facilitate the emergence of ever-clearer representatives of the dynamic unconscious, be that in the form of derivatives of repressed unconscious conflicts or, in cases of severe psychopathology, in the form of dissociated and split-off aspects of the unconscious. I assume that unconscious conflict always involves the conflict between opposing internalized object relations under the impact of peak affect states, so that the sexual and aggressive drives are represented, respectively, by a series of idealized and erotized relations and of aggressive and persecutory ones. I assume that such internalized object relations, colored by primitive, peak affect states, always involve at least a self representation, an object representation, and the affect linking them, and that defensive structures as well as the impulses against which they defend are represented by such defensive or impulsive internalized object relations. The psychoanalytic setting established by the initial treatment contract constitutes the frame for a potentially “normal” object relation derived from the conscious purposes and working arrangements of patient and analyst. This conscious and preconscious “normal” object relationship will rapidly be submerged by the emerging primitive, repressed or dissociated, projected or split-off, aspects of primitive object relations reenacted in the transference. Transference analysis is by far the dominant scenario of psy-
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choanalytic understanding, interpretation, and working through, and as mentioned before, the analysis of countertransference occupies an important place in it. This may be a good place to point out my questioning of the contemporary trend that confers as much importance on countertransference as on transference analysis in the sense of considering them as almost symmetrical. I believe that it is crucial to analyze the patient-analyst interaction and the total interpersonal field it represents, but with a clear focus on the analysis of the patient’s unconscious conflicts in a setting in which the relationship, by definition, is asymmetrical. The analyst’s unconscious participates in influencing the countertransference and the transference as well, but acknowledgment of the influence of such unconscious elements in the analyst on analytic work has to be tempered by the awareness that the analyst’s unconscious may be stimulating the transference in “enigmatic” ways (Laplanche, 1992) and thus constitute an ultimate residual and unexplorable residue after the patient’s contributions, both in the transference and in his evocation of specific countertransference reactions in the analyst, have been explored in the context of the interpretation of the transference. Otherwise, there is a risk of an analysis of the interaction in terms of a mutual exposure at a preconscious level that may tend to draw the interpretation toward a conventional surface, rather than dealing with the explosive and uncanny aspects of the dynamic unconscious.
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the analyst’s authority in the psychoanalytic situation
QUESTIONING TRADITIONAL AUTHORITY
A significant development in the theory of psychoanalytic technique during the past two decades, particularly in the United States, has been the tendency to question the authority of the psychoanalyst’s interpretations based on “facts” in the psychoanalytic situation. From different psychoanalytic viewpoints, with different theoretical underpinnings, the question has been raised, To what extent is the analyst’s stand toward the patient at risk of becoming an authoritarian imposition of the analyst’s view? Or to what extent are a respectful empathy with and understanding of the patient’s experiences in the psychoanalytic situation brushed aside by the analyst’s tendency to treat divergences from or incompatibilities with his views as “resistances”? The analyst’s assumed professional authority, in short, may contain authoritarian elements that run counter to the spirit of analytic work and may even strengthen or perpetuate the patient’s emotional difficulties and pathology. A related critique has been the observation that the analytic emphasis on keeping the patient from acquiring any realistic knowledge of the psychoanalyst’s life and personality, and thus maintaining the “anonymity” of the psychoanalyst, may in fact perpetuate unchallenged idealizations in the psychoanalytic relationship, transforming the analyst as a “person without personality” into an image of perfection that reinforces idealizations and the splitting off of the negative transference toward other authority figures. An earlier version of this chapter was published in the Psychoanalytic Quarterly 65 (1) (1996): 137–157. 206
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Within the Lacanian school, the image of the analyst as the “subject of supposed knowledge” has been questioned as a form of acting out of the oedipal situation that potentially remains unchallenged by the analyst’s authoritative interpretations (Etchegoyen, 1991, pp. 127–146). Bion’s critique (1967a) of the categorical formulation of interpretations within the Kleinian school, expressed in his recommendation that the analyst interpret “without memory or desire,” reflects his major concern about the risk that the analyst may impose preset theories on the developments in each session. Within ego psychology, research by Gill and Hoffman (Gill, 1982; Gill and Hoffman, 1982a) led to the concept of the transference as a compromise formation between the patient’s transference dispositions and the analyst’s contributions to transference enactment. Thomä and Kächele (1987) have elaborated this viewpoint further, pointing to the intimate connection between transference and countertransference developments and to the unique nature of each psychoanalytic process, derived from the personalities of both participants. The interpersonal psychoanalytic school has also stressed the intimate interaction between transference and countertransference, emphasizing the centrality of countertransference reactions in the analyst’s understanding of the unconscious meanings enacted in the psychoanalytic situation; understanding of the patient’s unconscious conflicts may proceed via understanding of the unconscious conflicts enacted in the current dyadic psychoanalytic relationship (Epstein and Feiner, 1979; Greenberg, 1991; Mitchell, 1988). Self psychology has affirmed the need to tolerate the patient’s idealizing transferences, particularly in the treatment of narcissistic personalities; its focus on traumatic experiences that may disrupt the optimal self–self-object relationship in the transference also implies attention to the analyst’s contribution to the creation of such disruptions (Kohut, 1977). Without adopting the theoretical framework of self psychology, Schwaber (1983, 1990), in carefully documented work, illustrates how behind what at first appear to be transference reactions derived from the patient’s past there emerge realistic reactions to the analyst’s behaviors, behaviors of which he was originally unaware and that need to be explored systematically in the psychoanalytic situation. From a different vantage point, Laplanche (1992) has suggested that unconscious messages stemming from the analyst’s own unconscious are an unavoidable aspect of the psychoanalytic interaction and, by this very fact, constitute a repetition of the patient’s earliest experience in the mother-infant relationship: mother’s unconscious fantasies are expressed
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in the interaction with her infant and are experienced by him as “enigmatic” messages that profoundly influence the development of the original unconscious fantasies in the infant’s mind. One of the most interesting recent developments in psychoanalytic theory and the theory of psychoanalytic technique has been the gradual increase in communication among psychoanalysts from different theoretical approaches, leading, at times, not only to what might seem a somewhat loose eclecticism but also often to the creative stimulation of new formulations and research (Kernberg, 1993b). A major consequence has been the growing awareness that the same psychoanalytic material, subjected to very different viewpoints, may produce very different interpretations and that even within a particular psychoanalytic orientation, analysts perceive and interpret quite differently from one another. As a result, there has been a major philosophical shift in the field, a questioning of the traditional assurance with which analysts describe “facts” in the patient’s material, an emphasis on the conceptual frame and perceptive sensitivities of the analyst, and acknowledgment of the unavoidable importance of the analyst’s theoretical model in perceiving and organizing his observations. Carried to an extreme, such a questioning attitude may lead to nihilistic denial of the possibility that any “objective” information and knowledge are available regarding the patient’s unconscious motivation and psychic past other than the unconscious meanings derived from the present interpersonal psychoanalytic situation per se. A radical questioning of the professional “authority” of the psychoanalyst is a natural consequence of these developments. Powerful cultural influences have contributed to this trend toward selfquestioning. The feminist critique of the enactment of patriarchal power relations in the treatment of female patients by male analysts; the Marxist critique of the reproduction of the analyst’s ideological commitments under the guise of technical neutrality; the questioning of traditional assumptions about sexual orientation; the prevalence of physical and sexual abuse (in contrast to infantile sexual fantasies); and research in psychiatry pointing to the actual past victimization of patients, particularly women, who enter psychotherapeutic treatment—all these developments have raised questions about the psychoanalytic assumption of unconscious intrapsychic conflicts in contrast to reality-determined deficits and have drawn attention to the need to validate patients’ experiences rather than merely analyze their resistances to the awareness of unconscious conflict. They have challenged the traditional authority of the psychoanalyst and his role as a participant observer of the patient’s psychopathology. The traditional view,
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from this perspective, reflects an outdated “one-person” psychology that does not correspond to the “two-person” reality of the analytic situation. The tribulations of psychoanalysis in countries suffering under dictatorships and totalitarian regimes have highlighted the danger that an apparent position of technical neutrality may correspond to a correspondence of cultural and political orientations of patient and analyst, thus strengthening the question regarding the authority and related cultural and ideological “blind spots” of the analyst. Extreme manifestations of these recent trends in clinical practice include the tendency to treat the transference and countertransference practically as if they were symmetrical; the assumption that the analyst has no specific knowledge other than what evolves jointly in his exploration with the patient; the neglect of unconscious intrapsychic conflict in favor of a focus on deficits, distortions, and fixation derived from past trauma; and a stress on the curative aspects of the present interpersonal psychoanalytic relationship in contrast to the interpretation of past unconscious conflicts. At the theoretical level, such trends are usually matched by a type of object relations theory that underemphasizes or denies drives, questions technical neutrality together with the anonymity of the analyst, and accepts or proposes the relatively free communication of the analyst’s emotional reactions and viewpoints to the patient in an atmosphere that stresses an egalitarian, nonhierarchical interchange. THE EMERGENCE OF A NEW SYNTHESIS
Obviously, in describing the confluence of multiple theoretical, clinical, and cultural developments in the questioning of the analyst’s authority, I have not been able to do justice to the complexity of all the arguments involved. In what follows, I shall attempt to clarify some of the strengths and weaknesses of these arguments and the psychoanalyst’s responsibilities and functions in the psychoanalytic situation. To begin, the concept of authority itself needs to be clarified further: authority and authoritarianism are often confused, and so are the concepts of authority and the exercise of power. Insofar as authority refers to the exercise of power in a social situation, the confusion is understandable. Power refers to the capacity to carry out a task and, in the social realm, the capacity to influence or control others; authority refers to the adequacy of the exercise of power to the task and, in the social realm, to the adequate and legitimate exercise of power in order to carry out a socially desirable task (Kernberg, 1978, 1979, 1991, 1993c). Authority, in short, refers to the “functional”
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aspects of the exercise of power and the legitimate authority vested in leadership, to the functional requirements for carrying out leadership functions. Authoritarianism, in contrast, refers to the exercise of power beyond what is required to carry out the task and, in the social realm, the illegitimate use of power beyond or divergent from that justified by the socially acknowledged and sanctioned task. All task performance implies the exercise of power and authority. In the social realm, the exercise of authority without adequate power leads to impotence, paralysis, breakdown, or failure of leadership and results in chaos. In fact, while authoritarianism usually results in petrification in the social realm, the consequent disauthorization of others whose function would be central in the decision-making process and/or task performance also may induce chaos at some steps removed from the authoritarian leadership: chaos and petrification may coexist rather than simply alternate when authoritarianism is followed by total breakdown in the leadership function (Kernberg, 1994b). Insofar as the psychoanalyst carries out a professional function based on his specific training and knowledge, his authority is thereby legitimated. It is, in fact, an indispensable and central aspect of his work. In setting up the frame of the psychoanalytic treatment, explaining to the patient the rule of free association and the analyst’s function to provide knowledge about the unconscious by means of interpretation, I believe the analyst carries out legitimate authority—that is, adequate power required by his professional functions. Thus, the analyst enacts a leadership function in a collaborative process in which part of his authority is delegated to the patient, while the patient, in turn, delegates aspects of his authority to the analyst for work during the treatment. This description may sound trivial or obvious, but in practice, as we know, the analyst’s realistic authority as defined by the treatment contract may be rapidly transformed by transference developments into a perception on the part of the patient of an idealized, omniscient, and omnipotent authority to whom the patient can delegate total responsibility for his life or else into an arbitrary, oppressive, authoritarian authority who demands submission and attempts to exercise total control over the patient (Kernberg, 1995b). If the patient were not to assume that the analyst has some legitimate authority and that in entering psychoanalysis with someone who has been trained to carry out such a treatment, he has to accept that leadership authority from the analyst, the psychoanalytic relationship would become absurd. There is no reason the patient should pay any credence, re-
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spect, or money to a psychoanalyst without a specific professional authority. In my view, the concept of technical neutrality assures the functional authority of the psychoanalyst and protects the patient from an authoritarian imposition of the analyst’s views or desires. Technical neutrality, as defined by Anna Freud (1936) and originally clarified by Sigmund Freud (1909 – 39) in a letter to Pfister is not “disgruntled indifference” but an objective, concerned stand regarding the patient’s problems and an unwavering effort to help the patient clarify the nature of these problems. Technical neutrality implies equidistance from the patient’s id, superego, acting ego, and external reality and a position of closeness to, or an alliance with, the observing part of the patient’s ego. Undoubtedly, technical neutrality may be considered an ideal position from which the analyst tends to be torn away again and again by countertransference developments but that he needs to reinstate again and again by his self-analytic working through of the countertransference. The analyst’s willingness to utilize his understanding of his countertransference as part of the material entering into his interpretive work needs to be matched by a willingness to acknowledge any acting out of his countertransference disposition that may occur in the heat of the sessions, thus acknowledging his humanity to the patient without undue self-revelation, atonement of guilt, or defensive rationalization (Kernberg, 1992). Technical neutrality, however, needs to be clearly differentiated from the analyst’s “anonymity,” the concerted effort to avoid giving the patient any information about the analyst as an individual other than his interpretive function. At an extreme, the aspiration to anonymity may have led to the analyst’s artificial, nonnatural behavior and phobic avoidance of even ordinary social role performance within the professional relationship, let alone any contacts with patients outside the analytic situation. The concept of analytic anonymity strongly influenced psychoanalysis from the 1940s through the 1960s, perhaps especially within the Kleinian and ego psychological schools. In practice it contributed to exaggerating the idealization processes in the transference to an extent that interfered with the full analysis of the transference and fostered splitting and displacement of the negative transference and a nonanalyzed submission to the idealized psychoanalyst. The problem was particularly marked in psychoanalytic education, an issue I have explored elsewhere (Kernberg, 1986; see chapters 7, 8, and 9 above). Such unanalyzed idealizations in training analyses I believe lead candidates to an unconscious identification with their own idealized
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training analyst, the adoption of an “anonymous” role, and a contamination of technical neutrality by an authoritative and categorical stance in the interpretive process. From this viewpoint, anonymity, I believe, has distorted technical neutrality and encouraged a categorical style of interpretation as well as a lack of full examination of subtle countertransference acting out in the psychoanalytic situation. Leo Stone’s concern (1961) over this development was an early reaction to this trend. In the course of every psychoanalytic treatment, the analyst’s way of formulating interpretations and exploring open questions with the patient, his office, and his demeanors provide powerful clues to the reality of his personality. Active efforts to deny the reality of the patient’s observations or to ignore them would sharply contrast with the technical requirement that the analyst pay careful attention to the patient’s perception of him in order to explore in great detail the reality of the stimuli that motivate transference developments. A position of technical neutrality is eminently compatible with a nonphobic, full exploration of the patient’s realistic and unrealistic perceptions of the analyst. The analyst’s curiosity about his patient and the analytic material is naturally selective, dependent upon the analyst’s theoretical approach, technical preferences, and countertransference reactions, plus, of course, the patient’s conscious and unconscious stimulation of the analyst’s curiosity. As long as such curiosity leads to questions formulated from a position of technical neutrality, it can only help the psychoanalytic work, and interdictions against the analyst’s raising questions, against indicating his particular interest, or against all comments that are not interpretations may contribute to an artificial picture of the psychoanalyst as the perfect interpreting machine. This fits with the concept of anonymity (and unchallenged idealization) and, I believe, reflects a remnant of the tradition of the 1940s to 1960s. I believe that the psychoanalyst should behave as naturally as possible, without any self-revelation and without gratifying the patient’s curiosity and transference demands but acting, outside his specific technical function, within ordinary norms of social interaction. Being his natural self, however, must be matched by a position of technical neutrality that, by definition, implies not revealing his preferences, commitments, desires, and fears, in order to provide maximal freedom for the patient to develop his transference dispositions and his own solutions to his intrapsychic conflicts (Kennedy, 1993). From that viewpoint, technical neutrality does not imply
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an invisible personality but naturalness and authentic respect for the patient’s freedom to arrive at his own decisions. Technical neutrality, in short, is not anonymity, and natural behavior does not imply that the analyst is not in a consistent, stable professional role relationship with the patient. Nor does technical neutrality imply that the psychoanalyst’s personality will not be influencing the patient, in the same way that the patient necessarily will influence the psychoanalyst by means of the development of countertransference reactions. The reality of the analyst as a professional person concerned with understanding the patient, empathic with the patient’s suffering, alert to the patient’s destructive and self-destructive temptations, cannot but provide, in the long run, a uniquely helpful human experience. Some patients may not have had any human experience of such a positive nature before in their lives. The positive influence of the analyst’s personality, however, will necessarily be undermined by the patient’s distortions of the analyst as part of transference developments: under ideal circumstances, the systematic analysis and resolution of the transference will permit a sublimatory internalization of realistic aspects of the analyst’s personality as part of the reorganization of the patient’s personality throughout the treatment. In contrast, bypassing, deterring, or overriding transference developments by actively utilizing his own personality clearly implies that the analyst has abandoned technical neutrality, to the detriment of the patient’s autonomous growth. By the same token, the analyst’s openness to and full self-exploration of his countertransference reactions and the psychoanalytic use of his countertransference understanding in the formulation of his interpretations strongly increase the focus on the interpersonal nature of the psychoanalytic situation and clearly reflect the concept of a “two-person psychology” as an essential frame for understanding the patient’s unconscious conflicts, and understanding the countertransference as a major channel of communication (together with the content of the patient’s free associations and his verbal style and nonverbal behavior in the hours). It may sound trivial, but I believe that, given the concern about the authoritarian behavior of analysts expressed in recent psychoanalytic literature, it needs to be restated that every analysis that penetrates to the depth of unconscious conflicts will face the patient with unavoidable anxiety, guilt, and pain. If the function of defense mechanisms and defensive structures is to avoid anxiety over unconscious conflict, interpretation of such defensive structures cannot avoid bringing about anxiety and pain and, in their wake,
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strong efforts to defeat this exploration via defensive operations and structures that oppose the analyst’s efforts toward uncovering unconscious conflict. And beyond such unavoidable conflicts in the transference, derived from the very nature of impulse-defense configurations, the destructive and self-destructive unconscious forces at work, particularly in patients with severe psychopathology, will unavoidably activate an adversary stance toward the concerned and helping analyst. Under such conditions, sharp discrepancies between the views of patient and analyst may evolve, and the analyst may be tempted to avoid such clashes by reducing or postponing his efforts to face the patient with painful aspects of his intrapsychic conflicts. The assumption that any painful experience of the patient in response to an intervention from the analyst requires recognition of the analyst’s potentially authoritarian assertion of his views risks slowing down or paralyzing the interpretive work. To put it differently, an analyst’s excessive concern with the effects of his authority on the patient or with the patient’s particular “vulnerability” to any viewpoint different from his own may bring about the analyst’s masochistic submission to the patient’s pathology and a loss of the psychoanalytic perspective. By the same token, the patient’s conscious and unconscious efforts to “reward” the psychoanalyst by seducing him to accept the patient’s conscious views about himself may bring about temporary improvements in the patient’s condition as part of the supportive effects of such a collusion but will inhibit the psychoanalytic work in the long run. A related danger is that the psychoanalyst may analyze an unconscious conflict at the more superficial levels the patient can tolerate while bypassing the deeper, more primitive levels of the same conflict, which might trigger the patient’s primitive anxieties and guilt. Thus, for example, direct manifestations of primitive destructive wishes and fantasies, of conflicts around sadomasochism and threatening erotic longings, may not be explored fully. One of the immediate effects of an effort to maintain a “positive emotional relationship” in the transference at all costs is the fostering of repression, splitting, dissociation, and/or projection of the aggressive aspects of ambivalent transference relationships toward third parties. A related issue concerning authority and authoritarianism arises in psychoanalytic work with patients who have been severely traumatized in the past and who enact the unconscious identification with both victim and victimizer in the transference, with both participants showing particular anxiety over the enactment of the patient’s unconscious identification with the traumatizing agent. Under these circumstances, the psychoanalyst may
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be seduced by the patient to focus on the aggressive conflict between the patient and the original traumatizing object: the enactment of the patient as victimizer in the transference, in contrast, would lead to immediate activation of a hostile interaction and violent accusations against the psychoanalyst as part of a rationalization of the patient’s effort to exercise omnipotent control. If the analyst fears that any assertion of his authority means an authoritarian attitude, he may be quite relieved by the displacement or split-off activation of the patient’s sadomasochistic relationship outside the transference. In practice, interpretations under conditions of positive or strong negative transference may require different styles and emphases. The maintenance of an unwaveringly calm and friendly style of communication on the part of the analyst may become an unconscious provocation under conditions of intense negative transference, and the analyst’s occasional firm statement of his view may be an appropriate communication of his “indestructibility” in the face of the patient’s onslaught, reassuring the patient that his aggression is not as dangerous as the patient feared. More generally, wording interpretations along a broad spectrum of certainty, from tentative questions and casual comments to emphatic statements, may reflect both the stages of interpretive elaboration and the emotional atmosphere of the hours. This brings me to the major issues of what are psychoanalytic facts, the unavoidable influence of the analyst’s theoretical assumptions on his perceptions and interpretive work, and the questioning of the “objective” nature of interpretations. Obviously, all interpretations are “subjective” in the sense that they reflect the analyst’s conclusions about what his understanding of the “selected fact” is. There is no doubt that the patient expresses himself by multiple channels of communication—free associations, slips of the tongue, dreams, nonverbal behavior, affect displays, and condensations, contiguities, and metaphors in his discourse—and that the psychoanalyst necessarily has to select the data that he believes are most relevant at the moment (Levy and Inderbitzin, 1990). Such selection, however, if carried out within a broad spectrum of observations and with the analyst’s tolerance of necessary periods of non-understanding, should eventually reflect what is actually dominant in the patient’s experience. A position of technical neutrality, an openness to what the patient brings to every hour, and, particularly, an openness to what appears to be affectively dominant throughout all these channels should help the psychoanalyst integrate his observations into a “selected fact” and minimize the
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danger of artificially distorting or straitjacketing the analytic material. The legitimate authority of the psychoanalyst does not imply that he always understands what is going on or that in his understanding and interventions he always is doing “the right thing.” Just as there are multiple surfaces of the psychoanalytic material leading to a common issue beneath all these surfaces, so there are multiple ways of formulating the material that, by means of the patient’s reactions to them, may gradually help to direct the psychoanalyst to the center of presently activated unconscious conflicts. In other words, the conception of the interpretive process as a process of trial and error, of gradual approximation to the material, including periods of non-understanding as well as tentative explorations of the material, should counteract the analyst’s temptation to present categorical, authoritarian interpretations that force the patient’s material into the analyst’s theoretical frame of reference. The formulation of interpretations in an “unsaturated” way, avoiding technical language and the theoretical concepts that are part of the psychoanalyst’s frame of reference, a formulation that lends itself to an open-ended spectrum of responses, should counteract the risk of authoritarian interpretations. There are unavoidable moments, particularly with patients who present severe psychopathology, in which what the analyst interprets as a transference regression will appear to the patient a reasonable reaction to the analyst’s behavior. Under these conditions, the first step is to examine the extent to which the patient may be observing realistically aspects of the analyst’s behavior that the analyst has been blind to; Schwaber’s critique (1983) in this regard is pertinent. However, after the limits of the patient’s realistic perceptions have been established in the analytic exploration and the analyst clearly perceives the repetition of unconscious patterns from the past in the present relationship, it is important to analyze these patterns and to do so to the point where the patient is able not only to acknowledge his distortion of the reality of the analyst’s behavior in the light of his own unconscious conflicts in the “here and now” but to continue this exploratory process to the deeper levels of the past. In my experience, one of the problems in resolving intense negative transferences by analyzing the unconscious meanings only in the “here and now” is that such a resolution has so seductive an effect on both participants that the analyst may neglect to pursue the problem further into the patient’s past. There is no doubt that psychoanalytic work is influenced by the personality as well as the communicative style of the psychoanalyst. The analyst’s ongoing exploration of his own contribution to the particular rela-
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tionship established in the transference, from patient to patient, should convey to him, over time, what his strengths and potentially weak spots are. Ongoing peer supervision is probably the most important, potentially corrective experience for problems in the analyst’s functioning, and it makes an important contribution to continuous growth and self-knowledge in his work. At the same time, it is important that in any particular analytic situation, the analyst be aware of the risks of his imposing a “conventional” frame on the patient’s experience. To be “unconventional,” not in the sense of a countertransference acting out by identifying with a patient’s antisocial conflicts, but by maintaining an openness to alternative solutions to challenges in life, is an important corrective to the observation that technical neutrality is based on a collusion of cultural viewpoints between patient and analyst. A CLINICAL ILLUSTRATION
The problems and conflicts around authority are illustrated, I believe, in the treatment of a patient with an obsessive personality disorder who reproduced in the transference his submissive and rebellious relationship to his extremely dominant father. The patient had developed obsessive doubts, depression, and inhibition in work as well as sexual-potency difficulties after the death of his father and, shortly thereafter, that of an older sister. The sister’s controlling behavior had replicated the father’s, and her envy of a competition with her successful younger brother had been a source of fear and resentment on my patient’s part. His conflicts with subordinates whose rebellious behavior, as he saw it, was a challenge to his authority were matched by his authoritarian attitude toward his wife and daughters. He had intense relationships with a few male friends who represented wise and supportive father figures to him and whose advice he would insistently and repeatedly seek when his own obsessive doubts paralyzed his actions. In the transference, he attempted to seduce me into “telling him what to do,” and much time was spent analyzing how he was trying to read into my comments what my preferred solutions to his conflicts in reality might be, thus escaping from his sadistic superego’s attack on whatever decision he might make. This patient had rebelled against his father in his early childhood by repeated school failures in spite of his high intelligence, and the father’s unsuccessful efforts to improve the patient’s school performance represented a major problem throughout his childhood. Father, a creative, “self-made” man, seemed to be successful in all aspects of his life except in
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dealing with the patient’s difficulties. Mother always remained somewhat in the background and eventually turned out to have supported the patient only when his father was away, using her son as a companion but dropping her support for him as soon as father initiated punishments because of the boy’s failure at school. After he had spent many months in elaborating his unconscious submission, rebellion, and identification with his father and his struggle against homosexual feelings related to both an oedipal submission to father and a search for early dependency needs frustrated in the relationship with his mother, whom he experienced as teasing and rejecting, the patient’s symptoms worsened again. He could not decide how to reorganize the administrative structure of his institution, creating a serious danger to his own position; he was unable to decide what actions he would take with regard to one of his daughters, whose difficulties in school seemed to replicate his own childhood experience; he was afraid to confront his wife with what he felt was her unresponsiveness to his particular sexual needs; and he could not tolerate the prospect of enjoying himself on a forthcoming vacation. In the midst of this symptomatic worsening, the patient complained that I was not helping him, that all the understanding he had attained had a purely intellectual quality, that nothing had changed; he appealed to me to tell him what I thought about this situation and whether some other treatment might be indicated at this point. He was convinced that ending his psychoanalysis now would restore the independence he had achieved earlier, which was now threatened by his continuing in this hopeless and restrictive treatment situation. He made enormous efforts to seduce me into what I could only interpret as advice giving, while protesting strongly against my “rigidly” maintaining an analytic relationship rather than providing him with the advice he needed. At the same time, he was sure that he would be able to resolve his difficulties if he freed himself from me. In summarizing developments over many weeks of treatment, I cannot do justice to the intensity of this patient’s plea for me to help him actively to decide how to deal with the various conflicts in his life. It seemed very clear to me that in response to major triumphs in his professional life and the improvement of his relationship with his wife and children, his unconscious guilt over assuming the role of a strong and loving father had determined the regression in both his behavior and the transference. This patient had ended a previous psychoanalytic experience prematurely by persuading his analyst of his capacity to function much better by
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himself. It was only two or three years after this experience that the return of his major symptomatology brought the patient back into treatment. I pointed out to him that he was now tempted to carry out the same rebellious “disruption” of his analysis with me, simultaneously expecting advice and counsel from me and disregarding all self-exploration of the issues we had examined in the analysis. The patient then accused me of imposing “self-reflection” on him as an arbitrary exercise of my authority; I pointed out that this reminded me of the experience he had had with his father, whose attempts to “force” him to go to school seemed a brutal restriction of his freedom. He was enacting the fantasy that his only alternatives were to submit to an irrational authority, such as I represented at this point, or to rebel against it by rejecting everything that came from me, with the selfdestructive effect of renouncing either his autonomy or what he had learned in the psychoanalytic process. His categorical demands that I provide him with guidelines for “better behavior” or risk his ending our relationship also reflected an identification with what he had perceived as the arbitrary authority of his father: he was attempting now to force me to submit to his view of treatment. In this identification with pathological aspects of his father, he denied himself, out of guilt, identification with his father’s creative attributes, which would have permitted him both to use what he was learning in the analytic situation and to become more independent and assertive in his life. Eventually, working through this level of unconscious conflict in the transference led to a deeper level of the same conflict: his rage and resentment about being “force fed” by an indifferent yet controlling mother. While I analyzed various transferential implications of the patient’s complaints that I was refusing to help him and was abandoning him to his own paltry devices—such as the angry demand for love from a cold and ungiving mother (and the enraged refusal to be force-fed) and the protective authorization from a dominant and otherwise guilt-inducing father—I felt that firmly maintaining my nondirective stance represented a position of technical neutrality in spite of the patient’s assumption that I was insisting in an authoritarian way on my manner of treating him. In the process, I analyzed his conflicts with oedipal authority without submitting to or being seduced into a supportive stance or agreeing to what I interpreted as a premature, rebellious acting out by the threat of disrupting of his treatment. I believe the interventions he begged for would have meant my taking a stance regarding the educational problems of his daughter, his sexual difficulties with his wife, the reorganization of his institution, and his manage-
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ment of vacations. Throughout this entire period of his analysis, he experienced my resistance to his efforts as authoritarian control, a condensation of father’s authoritarian control and mother’s force-feeding him, which I attempted to work through interpretively. In conclusion, I believe that the exercise of functional authority in the psychoanalytic situation is a necessary aspect of the psychoanalyst’s work, that such functional authority is facilitated by a position of technical neutrality, that technical neutrality implies a combination of naturalness and remaining in role but not anonymity, and that the appropriately growing importance of the analysis of countertransference does not imply a symmetry of transference and countertransference. The analyst’s personality unavoidably influences the psychoanalytic treatment, but this influence should be significantly and adequately reduced by the very position of technical neutrality, with the understanding that the gradual working through and resolution of the transference will permit the patient eventually to identify in a sublimatory way with aspects of the personality of his analyst with which he will unavoidably become acquainted. I think that a “nonconventional” attitude in the sessions may protect the analyst to some extent against the limitations of technical neutrality derived from the common cultural background of patient and analyst and, above all, that the maintenance of technical neutrality and noncommunication of the analyst’s value systems and life experience best protects the patient’s freedom to arrive at his own conclusions through the understanding and resolution of his unconscious conflicts.
14
validation in the clinical process
In theory, every interpretation is a hypothesis to be confirmed or invalidated by the patient’s response. Often, both the patient’s immediate response and developments over several sessions have to be considered. The nature of the interpretation itself may be quite complex: often, an interpretation is not a simple statement but a set of progressive interventions that may start with the analyst’s clarification of the patient’s subjective experience, may then confront the patient with the implications of nonverbal aspects of his communication, and may even include observations derived from the analyst’s countertransference. What we hope for, the ultimate validation of our interpretation, is an increase of the patient’s insight or emotional introspection, the emergence of new associative material leading to deeper layers of the patient’s mind, and changes in the patient’s symptoms and behavior. If, as part of formal research procedures, an ordinary supervisory session, or a clinical seminar in which a group of colleagues discuss a case, validation is “objectified” in terms of a shared agreement or disagreement with the analyst’s interpretation in light of the patient’s response, the problem may be complicated further because of differences in underlying theories. And yet, regardless of his or her theory, something in the psychoanalytic situation stimulates the analyst to pursue a particular line of investigation or shift to a different approach when a previous one does not appear to be productive in deepening the understanding of the patient as well as the analyst. An earlier version of this chapter was published in the International Journal of PsychoAnalysis 75 (1994): 1193 –1200. Copyright © Institute of Psychoanalysis. 221
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As Wallerstein (1992) has pointed out, our clinical theories are closer to consensus than our metapsychological formulations. I have earlier (Kernberg, 1993a) suggested that our technical approaches are even more convergent than our clinical theories. In what follows, I attempt to spell out a general theory that contains a theoretical frame for validating interpretive interventions in light of subsequent changes in the patient. The more one can observe validating aspects in the clinical situation predicted in this theoretical frame, the stronger is the case for considering the interpretation a valid one. Conversely, the more the patient’s responses move in a direction opposite to that predicted by the theory, the less valid is the corresponding interpretation. I assume that in each analytic hour, affectively dominant unconscious conflicts are revealed by the patient’s free associations, the language and style in which he expresses them, his nonverbal behavior, and the analyst’s dominant emotional responses (countertransference in the broadest sense) to the patient during that session. Although several unconscious conflicts may be evident in any particular session, and it may be difficult to judge which is dominant, I assume that an interpretation focused on one of these conflicts or on the potential combination of several will activate or intensify the patient’s awareness of his emotional reaction and permit clarification of the corresponding unconscious object relation. This assumption is based on the theory that all affects or emotions are embedded in a relationship between self and object representation and that clarification of an affective state therefore implies clarification of an internalized object relation as well. As I have pointed out in earlier work (Kernberg, 1993b), I consider both the defensive side of an unconscious conflict and the corresponding impulsive side as constituted, respectively, by a defensively activated internalized object relation and an impulsively activated internalized object relation. Therefore, the dominant object relationship in the transference is usually double-layered. The affectively dominant object relation (or rather, the dominant couple of defensive-impulsive object relations) may be active in the transference at any time and, in fact, more often than not reflects the dominant transference within any particular session. When the dominant affective investment and the corresponding unconscious object relations are expressed in an extratransferential relationship, the interpretation would naturally focus on that. I have found that in relatively healthy or nonregressed patients, the activation of a dominant unconscious object relation in the context of a par-
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ticular affect state will emerge mostly (if not exclusively) in free associations; this is not the case in extremely well-defended character pathologies, in which resistances are typically activated in the transference and trigger particular nonverbal behaviors or a certain linguistic style. In these cases, a correct interpretation of the character defense that has become a transference resistance should lead to deeper levels of the unconscious conflict reflected in the patient’s free associations, together with intensification of the corresponding affect followed by a significant shift in this affective state. If the expression of a dominant object relationship is predominantly nonverbal, shifts in the patient’s nonverbal behavior as a consequence of an interpretation are part of shifts in the dominant object relations. If the unconscious conflict is manifest in the transference disposition, interpretation of the transference at that point should activate, clarify, and eventually modify the dominant affective relation of the patient to the analyst, in the context of a verbal communication reflecting the shift in the patient’s subjective experience, including his awareness of this change. In patients with severe psychopathology or marked regression in the transference, the affectively dominant unconscious conflicts almost always coincide with an activated defensive transference relationship and its corresponding, defended-against, repressed, dissociated, or projected transference disposition, reflecting the impulsive side of the unconscious conflict. Therefore, interpretation of the dominant transference relationship should impact the dominant affect, the nature of the momentary transference relation, and the patient’s subjective awareness of the corresponding change. The most general formulation of change derived from transference interpretation is that an enactment in the transference is transformed into a subjective experience that reflects the patient’s growing understanding of that enactment. A change in the patient’s affect state does not always indicate intensification of his affective response. Whereas in a typical obsessive patient, who has been communicating in an intellectualized, even pedantic fashion, the emergence of an intense affect in response to an interpretation may reflect an affective response to it, a hysterical patient’s previously intense affective display may shift, as a consequence of an interpretation, to a more selfreflective, emotionally toned down, cognitively focused communication. But a shift in the affective response or behavioral aspects of the dominant object relation and a corresponding deepening of the patient’s communication of subjective experience may be considered validating criteria for an interpretive intervention.
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Obviously, a crucial precondition for the validation of change in response to an interpretation, whether such change is in the patient’s verbal communication of subjective experience, in his verbal and nonverbal communication of affective experience, in the activation of a particular transference disposition, or in the therapist’s countertransference response, is the availability of a baseline of observations predating the interpretation. The baseline for the communication of subjective experience is defined by the analyst’s awareness of the patient’s usual communicative style and the boundaries of his self-awareness. If a patient’s typically intellectualized speculations about the past continue in response to a particular interpretation, one can conclude that the interpretation has not managed to shift his previous defensive equilibrium or to make deeper layers in his subjective experience available. The analyst’s awareness of the patient’s usual range of expressiveness will permit him to observe specific affective responses to the interpretation. By the same token, evaluation of the dominant, currently activated transference disposition requires that the analyst have a clear view of the “normal” relationship between him and the patient—including both the theoretical normality of the relationship undistorted by acute or chronic transference dispositions and the dominant, chronic transference dispositions that permeate the analysis over an extended period of time and that may or may not reflect the acutely dominant aspect of the transference in any particular session. To interpret an acute conflict while ignoring a chronic transference disposition may or may not be the correct procedure. The patient’s response as reflected in his affect, communicative style and behavior, free associations, and the countertransference will show whether the interpretation touched him and deepened the expression of his unconscious conflicts. Countertransference, understood as the analyst’s total emotional reaction to the patient, implies an active alertness to countertransference shifts. Such shifts usually reflect shifts in dominant transference dispositions, although sometimes they reflect some unconscious conflict of the analyst activated by but not necessarily related to the dominant problem of the patient at this time. Validation of an interpretation, within the theoretical frame outlined, requires the emergence of new information in the patient’s free associations, thus broadening and deepening his understanding of a certain conflict; the emergence of deeper understanding of a dominant, defensive object relation and its underlying, dynamically opposite object relation, with a
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corresponding shift in affective expression; a change in the patient’s transference relationship or in his internal relationship to an extra-analytic object; and a rapprochement between the patient’s experience and the analyst’s understanding of it. The new information available to the patient and the analyst should somehow impact the patient’s symptoms, character, and fantasies and broaden his capacity for psychic experience as contrasted with expressing unconscious conflicts in somatization or acting out. Let us see these ideas in practice in a session from the psychoanalysis of a neurotic patient suffering from obsessive doubts and indecisiveness, chronic anxiety, characterological depression, interpersonal difficulties with business associates, and sexual inhibition with his wife. The patient, in his early thirties, had established a business in a field in which his father had already succeeded. As a result of his obsessive doubts and procrastination regarding the acquisition and pricing of products necessary for his business, he had experienced the loss of important business opportunities and had antagonized clients and suppliers. By the time of the session summarized below, which occurred in the third year of his analysis, we had already explored his profound guilt feelings over competing with his father and his masochistic rebellion against father. The patient started by talking about an outing with his wife the previous evening. She was dressed very elegantly, and he felt sexually aroused at the time. On returning home, he wanted to maintain the erotic atmosphere that he felt had been generated in the evening, but, he went on, it all fell apart because she just undressed in a routine fashion and did not go along with his wish for her to carry out a striptease. He said he had dared to tell her that he would like her to look like an elegant prostitute and to tease him by exciting and frustrating him, finally giving in to his desire to have sex. But she seemed irritated by the request. Although she was willing to have sex, it ended up as a mechanical encounter in which he felt he had difficulty maintaining an erection and ejaculated prematurely. He then offered to help her achieve orgasm by masturbating her, but she refused, and both went to sleep with a sense of frustration: at least he felt that way. The patient then remained silent while I wondered to myself whether in telling me that he had been “daring” enough to share his sexual fantasies with his wife while she remained unresponsive, he was saying that she, rather than he, was to blame for their sexual problems. In the past, while acknowledging his own sexual inhibition, he had tended to attribute it to his wife’s lack of interest. He had often complained about her difficulties in enjoying sex beyond manual stimulation of her clitoris; he could bring her to
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orgasm by this means, but without any mutuality in their sexual pleasure. In exploring his sexual difficulties with him, he felt, I was really imposing on him an unrealistic standard of “good sex.” After several minutes of silence, the patient said that he had been thinking of an experience in which two business friends in another city had invited him to a private club where striptease dancers had been quite available. He had spent a wonderful night with one of these dancers, a woman who was probably a prostitute but who had responded to him positively. Sex with her had a wonderfully wild, animal quality that he greatly enjoyed. He said that this was how he would love to experience his sex life with his wife, without guilt or recrimination. He then wondered whether this was possible within the reality of marriage. With a woman with whom one has an emotional relationship, so much self-consciousness and so many psychological complications enter the picture that they must transform sex into something mechanical. At this point, I commented that he seemed to be communicating both his active effort to improve his sex life with his wife and his feeling that it was doomed to fail because of his sense that a sexually exciting experience with a woman required the absence of an emotional relationship. The patient replied, with some irritation in his voice, that this might be, in part, his problem, but it was also objective; the best sex he had experienced in his life was before his marriage, with women with whom he had very little emotional involvement. I said that he sounded irritated, and he agreed, saying that he felt I was blaming him once again for not functioning well sexually with his wife under conditions when she and not he had ruined the evening. I said it was as if I was trying to force him to have good sex with his wife and was ready to blame him if he did not achieve this. The patient said “exactly!” and went on to mention how annoyed he was with Mr. F, the owner of a house the patient wanted to buy. The patient had found this house some time ago and had vacillated about buying it. He had started out making an offer far below the asking price and then became engaged in a tug-of-war with Mr. F around the price and many details of the house that needed repair, while becoming very anxious over the possibility that he might acquire it after all. In previous sessions we had learned that, while he was very suspicious of Mr. F’s exploiting him, he thought, in fact, that the house was worth much more than anything else he had found in this price range, and both he and his wife really wanted to buy it. But then he was afraid of being outmaneuvered and
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taken advantage of by Mr. F. The patient’s obsessive doubts about what was a realistic price had persisted for several weeks. The patient now said that he did not know what to do. The situation was making him very anxious, and he was afraid that Mr. F would become enraged with him and reject his latest offer. He described how beautiful the house was and went into some detail describing how he would furnish it if he bought it. Throughout this recital, I had a growing sense of frustration. I felt that my comment about his dividing women into emotionally involved but unresponsive ones and sexually exciting but uninvolved ones was too superficial and had played into the underlying transference: his perception of me as a dictatorial, paternal authority “forcing” him to have poor sex. In revenge, I felt, he was now unconsciously trying to bore me to tears. I thought the rapid shift of theme, the obsessive references to Mr. F and the house, replayed the same transference theme—that is, a self-defeating rebelliousness against a threatening father image. At this point, I said that I wondered whether, in his description of how attractive the house was, there might not be a wish that I help him to make a decision, presumably in the direction of buying the house, but with the simultaneous fear that he would experience such “help” once more as an irritating imposition from me as an authoritarian father figure. And that would unavoidably interfere with his wish to buy the house. In reaction to this comment, he remembered that his father was never able to buy any of the houses they lived in during his childhood. He spoke with sudden animation, in sharp contrast to his customary deliberate, carefully constructed, droning sentences, and reported a flash of associations. The houses in his childhood were all attractive but always rented, as if his father was always ready to leave. In the past, the patient had described his father as extremely dominant and unhappy with his son because of his relatively poor performance in school. Father’s unwillingness or fear to live in a house that he owned had seemed a contradictory trait to his dominating behavior toward his son. The patient had wondered whether his father’s restlessness was a consequence of father’s traumatic experiences during the Second World War. The patient remained silent for a bit and then said that he realized he was irritated with me because he wanted my help, but at the same time he realized that he would resent it if he made a decision thinking that it had come from me. His emotional tone changed. He seemed relaxed now, more thoughtful than resentful. I said I wondered if he felt guilty for buying a
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house in contrast to his father’s not daring to do so, and a house that, as he described it, was superior to the houses of his childhood. To get my “authorization” to buy the house would alleviate his guilt, but at the cost of a sense that he had to submit to me now in the same way that he had had to submit to his father’s decisions regarding “what was best for him” until his early adulthood. The patient said that he was now less afraid of Mr. F and realized that he reminded him in some ways of his father. He said he felt that he would buy the house and accept the conditions from Mr. F: they really were quite reasonable. But then, he went on, he would miss his previous house, which had a modest aspect from the outside but was actually very comfortable without being ostentatious. There was something ostentatious about the new house, and he wondered whether his friends might feel that he was showing off. He then talked about an assistant at his business, a woman he found very attractive but whom he suspected not carrying out all his instructions and possibly of cheating at work. He then went on to talk about another woman, whom he had dated briefly before his marriage. She had approached him asking for work, and he had promised to try to help her obtain a place in a friend’s business. He said he had the fantasy that she would have been willing to have an affair with him. He had known her for quite some time, but their relationship had never reached sexual intimacy. If he were now to get involved with her sexually, he felt that would commit him to help her find a job, and he would feel exploited emotionally. I said it now sounded as if, in contrast to his earlier statement about women with whom he could be emotionally involved versus women who could enjoy sex without emotional involvement, women who were sexually available could not be trusted either regarding their sexual enjoyment. He said that was true; one had to evaluate very carefully whether a woman really enjoyed sex or whether it was a way of getting a man to commit himself to her interests. I again felt that he was rejecting my intervention, in the sense of an agreement with my statement that did not lead to a deeper exploration of his relationship to women. He then went on to talk about his sudden sense of relief because he was going to accept Mr. F’s last counteroffer. He had the sense of a genuine change in his internal disposition at this point. I said I realized that he seemed more relieved when talking about Mr. F, and I wondered whether the change had to do with his fantasy that I agreed with his buying the house and that he therefore did not need to feel guilty, because it was like a “good” father approving his growth in contrast to his sense that his “bad” father
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would be jealous. The patient said he did think that I would approve although I had not said so, and he smiled. But then, he added, he was worried about whether M, a close friend who had given him “fatherly” advice in the past, might be envious because he was acquiring such an attractive house. I wondered whether he was displacing his guilt feelings over buying the house from father and from me onto M; the patient said that he had observed some signs of envy in M in the past, but he did not feel that I would be envious. He added, even if M did feel envy, why should that inhibit him? He then remained silent for a time. Eventually he said that he thought his wife would be happy with the new house but that she had been unable to help him make the decision. He went on complaining with increasing bitterness about her passivity. At this moment, I felt that, with all his ambivalence toward father figures, he had much more distrust of women (he always described his mother as treacherous); I wondered whether he might be defending himself against a displacement of sexual wishes from mother to father and against corresponding homosexual fears in the transference. I asked whether his feeling that I approved of his buying the house had helped him to overcome his fantasy that I might be resentful about it, like his father and M, and whether his irritation about what he assumed were my efforts to help him have better sex with his wife might reflect his experience of me as rejecting him, sending him away to her, so to speak. The patient reacted with an immediate increase in tension and asked me to clarify what I had said. I asked what it was that he did not understand. I said it seemed to me that something I had said made him uncomfortable. The patient said yes, the idea was strange that he might experience being sent off to have good sex with his wife as a rejection by me. I said that it sounded as if he understood perfectly what I had said; what was the nature of his uneasiness about it? The patient said that he believed there was no relationship between his wanting to be helped by me or by M and his sexual difficulties with his wife. He then remained silent for quite some time. I wondered whether I had prematurely touched his homosexual conflicts. My hypothesis regarding his unconscious wishes to submit sexually to father as an escape from women who were both forbidden by father and untrustworthy was based on increasing evidence in this regard in recent sessions. A major dynamic of this patient was a deep sense of resentment toward his mother, whom he perceived as manipulative and “treacherous” in the sense that she immediately lined up with father when father wanted to punish him. The patient looked at his watch, said, “I believe the time is over,” and left.
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I believe that this session illustrates both the preconditions for validating an interpretation and the contrast between an interpretation that obtained confirmation in the session and several that did not. The patient’s unconscious guilt over buying the new house, reflected in his obsessive doubts and behavior, was interpreted as derived from unconscious guilt over competing with his father; this interpretation brought about new information in his subjective communication, a shift in his affect disposition (a decrease in his anxiety), and a shift in the transference from a subtly oppositional to a dependent relationship with me. The decrease of his unconscious guilt over competing with his father permitted him to make a decision, thus overcoming his obsessive doubts as well as fostering a deeper, dependent relationship with me as a good father. At the same time, however, the deeper meaning of his resentment of my attempts to help him clarify the difficulties in his sexual relationship with his wife remained problematic. I did not follow up his early irritation with me because of his feeling that I blamed him unfairly for these sexual difficulties (for example, by interpreting how, in this instance, he perceived me as an authoritarian father). Thus I remained at the surface of that irritation, and the patient shifted to his concern with the new house: perhaps a too superficial comment on my part just led to his confirming his irritation with me without further change in him. Later on, the suspiciousness he expressed about his woman assistant and the woman who approached him for a job prompted my interpretation that my “sending him to have good sex” with a woman constituted a rejection of him, an interpretation that led to increased anxiety and his rejection of the interpretation. It evidently touched him, but whether this reflected validation of my underlying hypothesis or an increased defensive reaction because of my premature intervention in another area of conflict was unclear. I believe that the central issue in this session was the patient’s struggle against the wish to be dependent on a giving, protecting paternal figure because of his fears over the sexual wishes involved in submission to father. His guilt-ridden masochistic rebellion against father—his self-defeating, obsessive passive response— was being worked through, but it served now as a defense against that homosexual conflict. Later sessions provided further evidence of a significant repressed homosexuality, as well as a still deeper dissociation between sexual and tender feelings toward women because of unconscious oedipal prohibitions against sexual excitement with a maternal image. The reality of his wife’s sexual inhibition also contributed to obscuring, for the time being, his con-
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tributions to their sexual difficulties and his deep resentment of untrustworthy women, the dangerous preoedipal mother. In summary, the combined analysis of the predominant themes in the patient’s communication of his subjective experience, his nonverbal behavior and linguistic style, and the countertransference provided indications for the main focus of the interpretive work as well as potential evidence, in the corresponding changes in those three areas, of the patient’s confirmatory or disconfirmatory reaction to the interpretation. Exploring the patient’s responses to interpretive interventions in the light of these criteria permitted me to validate one interpretation at a “right level in the right moment,” to discard other interventions as too superficial, and to characterize one interpretation as probably premature.
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the interpretation of the transference (with particular reference to merton gill’s contribution)
Contemporary controversies regarding transference analysis in the American psychoanalytic community present a panorama quite different from that offered by French psychoanalysis. I hope that my critical attitude toward recent trends in American psychoanalysis—particularly under the influence of Merton Gill’s critique of classical ego psychological approaches to transference analysis—will help to clarify the connections between the French psychoanalytic mainstream and some recent developments in the United States. At the same time, the influence of French psychoanalysis on my views should emerge throughout this chapter. Gill’s contribution (Gill, 1982; Gill and Hoffman, 1982a, 1982b) to psychoanalytic technique, summarized in the two-volume Analysis of Transference (the second volume written jointly with Irwin Hoffman), was a significant step toward the convergence of ego psychology with other major psychoanalytic currents, particularly the American and British object relations approaches (Kernberg, 1993a). In addition, Gill’s assertion that the transference is a product of both the reactivation of the patient’s past unconscious conflicts and the reality of the present interpersonal relation with the psychoanalyst is a major bridge to the contemporary interpersonal– intersubjectivist–self psychological approach (Kernberg, 1997a), one that has been fundamentally influential in this country and abroad (for example, in Thomä and Kächele’s approach to psychoanalytic technique). An earlier version of this chapter was published in Changing Conceptions of Psychoanalysis: The Legacy of Merton M. Gill, edited by Doris K. Silverman and David L. Wolitzky (Hillsdale, N.J.: Analytic Press, 2000), pp. 251–264. Copyright © 2000 by the Analytic Press. 232
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THE PREVALENCE OF THE TRANSFERENCE
Gill demonstrated convincingly that transference phenomena are ubiquitous from the beginning of the treatment. He differentiated the patient’s initial resistance to awareness of the presence of transference from a general resistance to transference development, as well as from resistance to its resolution. Thus he described three distinct ways in which transference manifestations are deployed in the psychoanalytic situation. He pointed to the transference as the major vehicle by which the “infantile neurosis” is expressed in psychoanalytic treatment. Gill’s insistence on the importance of analyzing transference manifestations from the beginning of the treatment represented a radical change from traditional ego-psychological technique, which at the time was still influenced by Glover (1955), who divided the psychoanalytic process into an early phase of “gathering the transference,” a middle phase of the “transference neurosis,” and the final phase of resolution of the transference. Gill rightly criticized and dismantled that traditional position. He might have added the evidence from the psychoanalysis of patients with severe personality disorders, in which blatantly manifest transference always dominates the treatment situation from its very inception; the more severe the pathology, the more intense the early dominance of the transference. Gill emphasized the difference (pointed out earlier by Fenichel [1941]), between defenses as intrapsychic phenomena and resistances as interpersonal expressions of defenses in the psychoanalytic situation. In other words, all defenses in the clinical situation are manifest as resistances that, in a practical sense, become part of transference expression. He examined the concept of the therapeutic alliance as an expression of the “unobjectionable positive transference” separating the affective aspect of that positive transference from the reality-oriented, cognitive aspects of the rational collaboration between patient and analyst. Here, I believe, Gill failed to do full justice to the concept of the therapeutic alliance. Deserno (1990) did so. The therapeutic alliance, I believe, is now more accurately conceptualized as the alliance between the observing part of the patient’s ego and the analyst in his professional role. The observing part of the patient’s ego is, indeed, influenced by basic positive transference dispositions related to the capacity for basic trust; in this sense, the very capacity for a realistic collaboration with the analyst has a transference basis. That transference basis, however, is transformed into the capacity for realistic object investment and commitment and therefore deserves to be considered a specific transformational product corresponding to the realistic relation-
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ship between patient and analyst set up as part of the psychoanalytic frame by the initial instructions of the psychoanalyst. Loewald’s definition (1960) of that frame, it seems to me, spells out the conscious and rational contribution of analyst and patient to the relationship, in contrast to the other transference developments, which evolve, as Gill proposed, from the beginning of the treatment. By the same token, the analyst’s capacity for a concerned yet technically neutral investment in the patient’s well-being is also based on the sublimatory transformation of his own transferential potential, linked to the earliest establishment of the capacity for basic trust. Gill was aware that in his radical stress on the importance of focusing on transference analysis from the beginning of the treatment, he was coming close to what the British schools, particularly the Kleinians (Segal, 1964), had been affirming and practicing for many years. He argued for the correctness of that approach but criticized its essential neglect of the reality of the patient-analyst interaction and its tendency to interpret the transference prematurely as related to the earliest and deepest levels of the presumed origin of intrapsychic conflicts rather than focusing on the interplay between the transference and the reality of the patient’s experiences in the psychoanalytic situation. Gill’s critique of the Kleinian position is warranted, I believe, if applied to Kleinian technique of thirty years ago, but it does not take account of more recent developments (Spillius, 1988) that clarify the similarities between his proposals and the practice of contemporary Kleinians. Betty Joseph (Spillius and Feldman, 1989) and Hanna Segal (Segal, 1986), for example, stress the need to analyze unconscious meanings in the “here and now,” avoiding early “deep” interpretations and maintaining a consistent focus on the total transference. In fact, this is one of the major areas of convergence between contemporary Kleinian and ego psychological techniques. THE NATURE OF THE TRANSFERENCE
Gill’s observations regarding patients who unconsciously defend against awareness of the transference as well as against its development and resolution point to significant aspects of transference analysis previously underemphasized in the ego psychology literature on technique. We now know that unconscious resistance to the development of authentic dependency on the analyst and, with it, to all transference developments characterizes the narcissistic personality disorder and constitutes the narcissistic transference in a specific sense (Kernberg, 1984). It needs to be pointed out, however, that this very resistance is also a form of transference. Gill’s emphasis
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on resistances to awareness of the transference leads to his stress on the importance of analyzing this type of resistance from the beginning of the treatment, and his research cases convincingly demonstrate this technical approach. The emphasis on resistance to the resolution of the transference has been a major subject of our technical literature since Freud (1912a, 1914a, 1937), and Freud’s analysis of the vicissitudes of erotic transferences and of the repetition compulsion in the transference are related subjects. What Gill, surprisingly, underemphasized are the long stretches of productive analysis of major transference developments, those stages of the treatment in which transference developments may be explored in both their informative and their resistive aspects, with gradual deepening of the analysis of unconscious meanings in the here and now followed by tracing them back toward their genetic origins. Gill illustrated two types of developments in the transference: displacement from the original parental object onto the analyst, and the patient’s unconscious identification with his parental object. What Gill missed is the intimate—in fact, indissoluble—link between transference by displacement and transference by identification: what is activated in the transference is not simply the representation of a past, internalized object representation, but a relationship between self representation and object representation. What Gill called displacement refers to the patient’s identifying with the self representation while projecting the object representation onto the analyst. What he called identification refers to the situation in which the patient unconsciously identifies himself with his object representation while projecting the corresponding self representation onto the analyst. This basic concept of object relations theory—namely, that all internalizations are internalizations of a relationship and not of the representation of an object—would flow naturally from Gill’s observations, but he probably was unable to take this step because of his view of defenses and drive representatives as relatively independent entities, a view of impulsedefense configuration predating the revolutionary clarification of this issue by Edith Jacobson (1964) from the ego psychology perspective and by Ronald Fairbairn (1954) from the British school. The name of neither Jacobson nor Fairbairn appears in Gill’s 1982 and 1994 reference list. A consequence of this neglect is Gill’s underemphasis on the extent to which the patient’s transference determines specific countertransference reactions in the analyst—in other words, the unconscious induction of complementary identification in the countertransference, which may bring about an enact-
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ment of the dominant object relation activated in the transference. Gill did mention Racker’s fundamental contribution (1968), the clarification of concordant and complementary identification in the countertransference; but he did not link it naturally to a concept of the transference as the activation of an unconscious internalized object relation of the patient. He also therefore missed the analysis of resistances as particular defensively activated object relations in the transference, directed against opposite, repressed, dissociated, or projected impulse-dominated object relations. THE ANALYST’S CONTRIBUTIONS
Gill (1982, p. 177) came to another major conclusion regarding the transference: Rather than regard transference as primarily a distortion of the present by the past, I see transference as always an amalgam of past and present. In so far as the present is represented in the transference, it is based on as plausible a response to the immediate analytic situation as the patient can muster. This view implies a shift to the position that the analyst is perforce a participant/observer (Sullivan’s term) rather than merely an observer. It also implies a shift from the view of the reality of the analytic situation as objectively definable by the analyst to a view of the reality of the analytic situation as defined by the progressive elucidation of the manner in which that situation is experienced by the patient. From this view that the transference is a result of the interaction between the patient and the analyst it follows that the transference is ubiquitously present from the beginning of and throughout the analysis. I believe that this statement contains both valid observations and problematic conclusions. It is true, of course, that the patient reacts to his realistic observations regarding the analyst’s attitude, behavior, and personality and that the expression of the transference crystallizes around these observations. This does not mean, however, that the patient’s entire reaction to the analyst should be attributed to the transference. His realistic reaction to aspects of the analyst’s behavior is just that, appropriate behavior that has to be differentiated from those inappropriate, exaggerated, or idiosyncratic responses that represent the activation of past internalized object relations in the here and now. The overextension of the concept of transference to the patient’s total behavior blurs and dilutes precisely what needs to be high-
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lighted and clarified. It happens quite frequently, of course, that unacknowledged or defended-against behavior of the analyst may move him to attribute a patient’s reactive behavior inappropriately to the transference; this constitutes an authoritarian denial of realistic aspects of the interaction that the analyst has created or contributed to in the psychoanalytic situation. Gill’s stress on the importance of honest self-scrutiny on the analyst’s part, the need to recognize and acknowledge his own contributions to the patient’s behavior, is very well taken. It is also true, I believe, that there are residual aspects of the analyst’s countertransference—namely, very early transference dispositions that constitute the counterpart to the patient’s transference dispositions linked to basic trust—that can never be fully acknowledged and understood by the analyst himself; but this observation does not relieve the analyst of the obligation to listen attentively for clues to how the patient experiences him, to scrutinize these clues for whatever realistic aspects they may contain, and to differentiate in the patient’s response that which is truly transferential and that which is not. Just as not all behavior of the patient corresponds to the transference, so not all behavior of the psychoanalyst can be subsumed under the current concept of countertransference as the analyst’s total affective reaction to the patient. The observing part of the analyst’s ego, his capacity for self-reflection, enriched and reinforced by his training, knowledge, and experience, is not part of the countertransference. Gill’s statement implies that the analyst cannot study the analytic situation objectively and that his view of reality must be defined by “the progressive elucidation of the manner in which that situation is experienced by the patient.” Here Gill can be read as privileging the patient’s subjective experience as the basic data for evaluating the reality of the psychoanalytic situation, a major shift in the analysis of the transference-countertransference bind. This position has been enthusiastically adopted by the contemporary interpersonal–intersubjectivist–self psychological approach, but I challenge it, from the following viewpoints. The contemporary view of countertransference as the total emotional reaction of the analyst to the patient captures both the patient’s contributions (particularly but not exclusively by means of projective identification and omnipotent control) and the potential participation of the analyst’s transference dispositions in the countertransference, particularly under conditions of intense and regressive transference enactments. I consider the analysis of countertransference in terms of concordant and complementary
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identifications a key instrument for the analysis of the unconscious conflicts enacted in the transference in the form of affectively invested internalized object relations. (It may be appropriate to point out here that the original meaning of agieren in Freud’s work was not “acting out” but “enactment” or, as rightly translated in French, passage à l’acte. The effective analysis of transference and countertransference can occur only in the context of the enactment of the corresponding relationship in the analytic setting.) So far, my approach reflects a focus on the activation of dyadic object relations in the intersubjective experience of patient and analyst. But I see it as essential to go beyond clarifying the patient’s subjective experience to interpret what the patient may not yet be aware of, or is avoiding becoming aware of. In fact, the more severe the patient’s psychopathology, the more significant is the information conveyed by his nonverbal behavior. Tactfully confronting and clarifying that behavior and integrating it interpretively with the content of free association and the patient’s subjective experience are important aspects of the clarification of the total nature of the transference. In so doing, the analyst is also clarifying his own experiences and observations as a different, external object. The combination of the evaluation of the information derived from the patient’s subjective experience, his nonverbal behavior, and the countertransference provides a global view of the analytic field. The analyst’s subjective experience is not “privileged,” but neither is the patient’s: the analyst’s willingness to correct his interpretations as tentative hypotheses is the counterpart of the patient’s willingness to correct his own hypotheses about his experience. The analyst both clarifies the intersubjective field and adds a new dimension: an “outsider’s” view, a reflection on what is experienced by patient and analyst, in addition to conveying his understanding of the patient’s subjective experience. Here the analyst’s observing ego, his self-reflection on the nature of his countertransference as well as on the patient’s subjective experience of their interaction and nonverbal behavior, provides a new dimension to the analytic process. The analyst’s interpretive activity validates the patient’s subjective experience, broadens the patient’s awareness of the object relation activated in the interpersonal field, and encourages internalization of the observing function of an external object (the analyst) that includes the object’s own subjective experience. I believe that the psychoanalytic situation includes three “frames”: first, the treatment frame or psychoanalytic setting created by the arrangements
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of the treatment, including agreement about when, where, and for how long to meet, the respective tasks of patient and analyst, and so forth. This frame establishes a realistic interpersonal relationship, one that Hans Loewald (1960) defined as the meeting of a person who needs help and another person whom he trusts to have the knowledge and experience as well as the wish to be helpful without being omniscient or omnipotent. A second frame is created by the analyst’s position of technical neutrality and his analysis of the defensive operations that militate against free association and the activation of transference regression. This frame permits the reactivation and enactment of the patient’s world of internalized object relations, with their corresponding impulse-defense configurations, and the elaboration of the intersubjective field that will become the object of analytic inquiry. Within the facilitating environment of the psychoanalytic frame, enactments of transference and countertransference dispositions immediately begin to distort the realistic relationship of the treatment frame. A third frame is created by the analyst’s dissociating himself internally into an experiencing part that participates in the transference-countertransference bind and an observing part that includes his specific knowledge, technical tools, and sublimatory affective investment in the patient. It is this third frame that is essential in the interpretive process. Within it, the analyst immerses himself in the transference and countertransference relationship and yet remains outside of it as he interprets the meaning of the distortion of the treatment frame by the transference-countertransference regression. I believe that this “third position,” to use a term from French psychoanalysis, is an essential precondition for psychoanalytic work. It implies that the analyst transcends the transference-countertransference situation and brings in a new perspective that will clarify the unconscious conflict activated in the transference. As a consequence, by the mechanism of introjective identification, the patient is helped to develop a self-reflective function as part of the increase in his ego’s capacity to deal with intrapsychic conflicts. The split of the ego into an observing and an acting part, as originally described by Richard Sterba (1934), represents the activation of the selfreflective function derived from internalization of the reflective function of the caregiver, not simply from mother’s empathy with the infant’s experience. By the same token, patients develop enhanced capacity for selfreflection not just through experiencing the analyst’s empathic response but also, and essentially, through identifying with the reflective function of
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the analyst’s “third position.” I propose, in short, that we need a “three-person psychology,” the third “person” being the analyst in his specific role. For example, a patient was impotent with his wife but fully potent in sexual engagements with other women, who had to submit to him in a masochistic scenario in which he would tie them up and have them carry out self-demeaning acts that symbolically represented their humiliation and his total control over them. In contrast, he behaved like a shy little boy with his wife. With me, he displayed almost a caricature of submissiveness: he became interested in psychoanalytic ideas, sought out my published papers, and in an overblown identification with me, used the ideas he found there to argue with his friends and colleagues about alternative psychological theories. In the course of the treatment, as the image of a father who was sexually promiscuous and a tyrant at home came into focus, the patient gradually became aware of his inhibited behavior as a fear of rebelling against this father and of his fantasy that the only way to rebel against him would be a violent, bloody overthrow. An underlying fantasy slowly emerged in which he would sexually submit to powerful father representatives and thus solve the conflict with father by becoming his sexual loveobject. What made the analysis of the transference particularly difficult was the surface, “as if ” submission of the patient, which protected him against the underlying wish for a dependent sexual relation with me: the analysis of that underlying wish was stymied by the patient’s “guessing” my thoughts and immediately accepting what he believed were my theories, fully endorsing them in intellectual speculations that not only raised serious doubts in my mind about whether all this had any emotional meaning but also produced a kind of disorganization in my thinking. It dawned on me after a period of time that I had become the bound-up victim of the patient’s sadistic control in the transference; his ready acceptance of what he thought was my train of thought, his way of disorganizing my thinking, had led to a paralysis of all work in the sessions. The analysis of that “as if ” quality in his relationship with me eventually induced in the patient a sense of confusion and intense anxiety and the emergence of fear of me as a threatening father who wanted to keep him in the role of a little child and stood ready to castrate him if he were to penetrate his wife, who unconsciously represented his oedipal mother. It thus became possible to analyze the confusion and paralysis the patient had projected onto me rather than continuing to enact the “as if,” pseudosubmissive father-son relationship. In this case, my early countertransference was one of a somewhat
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amused curiosity regarding this patient’s battles in the defense of psychoanalysis, gradually shifting in the direction of a skeptical concern over his idealization of my viewpoints in psychoanalytic controversies. I had moved from being seduced toward becoming a little paranoid and, eventually confused. It took me some time to sort out the patient’s actual, deep wishes for a submissive, homosexual surrender from his subtly mocking submissiveness. The intersubjective quality of the interplay of his attitude of “Trust me, I am a totally convinced follower of yours” and my implicit “I can’t tell any more what, if anything, I can trust” could be resolved by my growing awareness that my paralysis and his joyful tranquility in the hours represented the sadomasochistic scenario of this patient’s perversion. My “third position” facilitated the analysis of the sadistic nature of this transference development and my masochistic submission and led to the activation of his underlying fears of the violent, castrating oedipal father and the deeperlevel, authentic wish for a homosexual submission to him. There is, of course, the danger that the analyst may misuse or abuse his specific function of remaining outside the transference-countertransference bind by assuming an attitude of arbitrariness, authoritarianism, or indoctrination of the patient. The risk of abusing functional authority by the exercise of nonfunctional power is intrinsic in any work carried out with authority. It is naive, I believe, to attempt to protect the patient against this danger by eliminating the realistic, functional authority of the analyst in the treatment situation. An egalitarian ideology that considers the analyst’s perspective as coequal with the patient’s, the countertransference as neither more nor less pathological than the transference, represents a distortion of the psychoanalytic situation (Kernberg, 1996a). In all fairness, Gill did not propose such an ideology, but privileging the patient’s subjectivity may lead to it. Optimally, interpretations should be offered as hypotheses, to be confirmed or disconfirmed by what evolves as a consequence of their formulation. They are enhanced by the use of metaphor and have at best an “unsaturated” quality not linked to any particular, theoretically assumed historical moment in the patient’s past. They are focused, in short, on the “unconscious in the here and now,” with the expectation that the interpretive process will gradually deepen and find its genetic direction as patient and analyst follow the associations and observe developments in the transference-countertransference analysis. This view is in contrast to the current questioning of the “objectivity” of interpretations, the denial of the scientific, objective nature of the criteria for formulating of interpretations, and
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the potential slippage of a constructivist perspective into a solipsistic relativism. Merton Gill cannot be blamed for this latter-day development of privileging the patient’s subjectivity. Gill criticized—appropriately, I believe—the analyst’s defensive denial of his contribution to the patient’s transference regression. The view of the stereotypical silent, passive, anonymous “mirror” psychoanalyst as a kind of a robot has probably been an unrealistic cliché all along. It was supported, however, by the idealization of the notion of the analyst’s “anonymity,” prevalent in both ego psychological and British psychoanalytic traditions in the 1950s and 1960s, which led to an unrecognized and unacknowledged idealization of the psychoanalyst and a defensive protection of that idealization by neglecting to explore countertransference enactments and acting out and their implications for transference analysis. As I have pointed out earlier, anonymity should not be confused with technical neutrality, a crucial concept often misunderstood and exaggerated in clinical practice. According to Gill (1982, p. 63),“neutrality does not mean an avoidance of doing anything, but rather giving equal attention to all the patient’s productions, without prior weighing of one kind of material over another, and confining oneself to the analytic task—that is, abstaining from deliberate suggestion. I have elsewhere described neutrality as including persistent attention to the inadvertent effects of the therapeutic setting and the therapist’s interventions on the patient’s experience of the relationship.” Technical neutrality, as first described by Anna Freud (1936), refers to the analyst’s equidistance from the polarities involved in the patient’s intrapsychic conflicts, an equidistance that becomes particularly crucial when such conflicts are activated in the transference. Thus conceived, technical neutrality, I believe, implies not anonymity but the expectation that the analyst will behave in role while accepting the manifestations of those aspects of his personality that are commensurate with an ordinary professional relationship. Technical neutrality permits careful differentiation of the patient’s transference from his realistic reactions determined by the treatment frame, the analyst’s behavior, and the manifest expressions of his personality. The analyst’s conclusions, of course, are always “subjective” in the sense that he operates as a subject utilizing his subjective responses to the patient. However, his specific knowledge, his experience, and particularly his specific attitude regarding countertransference analysis and the introduction of the third position referred to before facilitate his objectivity, not in the sense that they ensure absolute certainty about the truth at any particular
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moment, but in the sense that they enable the analyst to gradually sort out transference from reality and to help the patient identify with the analytic function, which eventually will translate into the patient’s self-reflective function. I believe that the French conceptualization of the analyst’s functioning as the “third person” is an important contribution to this discussion (De Mijolla and De Mijolla, 1996). Interpreting the nature of the transferencecountertransference relationship from an “external” perspective symbolically replicates the role of the oedipal father in disrupting the preoedipal, symbiotic relationship between infant and mother, thus giving rise to the archaic oedipal triangulation. In the case of patients with neurotic personality organizations, such a function is already available to the patient, whose capacity to split himself into an acting and an observing part indicates the firm establishment of a triangular structure, the advanced oedipal stage of development. Obviously, the analyst’s self-reflective exploration of his countertransference also reflects this triangulation. Patients who present borderline personality organization, however, may experience the analyst’s interpretive behavior as a violent disruption of the symbiotic link between patient and analyst. They strenuously resist the analyst’s interpretive role precisely, among other reasons, to avoid the traumatizing effects of discovering the relationship of the parental couple, the differences between the sexes and the generations, their envy of the parental couple, the shock of the primal scene, and the most primitive level of frustration and anxiety in the form of fear and annihilation related to the establishment of triangulation. By the same token, the transference-countertransference developments in the early stages of the psychoanalysis of a borderline patient, a reflection of the activation in the patient of explosive affect states that typically threaten the very frame of the treatment, determine a primitive type of “intersubjectivity.” This reflects the activation and transformation in the transference of early characterological structures that condense affective experiences the patient cannot symbolize. In my experience, the analysis of these explosive affect states in borderline patients regularly permits the discovery of dyadic structures in the transference with rapid interchange between self and object representations enacted by the patient or projected onto the analyst. It is true that these object relations have to be constructed or reconstructed by interpretations from the moment-to-moment exploration of transference-countertransference binds. This kind of “intersubjectivity,” in which what may be considered a psy-
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chotic nucleus in the patient translates into a semipsychotic emotional interaction with the analyst, should not be confused with the surface intersubjectivity as a “here and now” experience determined by the more conscious and tolerable affective exchange as part of the communication between patient and analyst. Primitive intersubjectivity of the kind I am describing is typically expressed in the development of “incompatible realities” of the patient’s and analyst’s experiences. It is a truly psychotic relationship within which the patient’s reality testing is totally absent; it can be modified only by the analyst’s firmly maintaining that incompatibility of realities while analyzing its meanings for the patient. In other words, a transference relationship within which the analyst must appear to the patient as either dishonest (pretending to have completely different views while knowing that the patient is right) or psychotic (stubbornly insisting on a view of the relationship and of reality that the patient is convinced reflects a crazy, dangerous affirmation of aggression and sexuality) is the intersubjective fabric from which time and meaning can be rescued. The analyst’s function as a third person is an important source of reflection and eventually self-reflection by the patient and a powerful stimulus for the development of introspection, insight, and autonomy, including autonomy in the search for further understanding of the deeper layers of the dynamic unconscious. I believe that, under optimal circumstances, in advanced stages of the treatment, the dominance of intersubjective activation of transference-countertransference developments may gradually give way to dominance of the patient’s communication of his subjective experience, with internalization of the analyst’s reflective function. This is manifest in the patient’s capacity to reflect about his own subjective experience, so that deeper layers of the unconscious emerge as self-discovery goes beyond the examination of current intersubjective experience. In contrast, when the entire analytic experience is bound to the analysis of current intersubjectivity, there is a risk that unconscious conflicts will be translated into a more reality-based here-and-now experience that may end up serving defensive purposes against the deep understanding of the unconscious. Such a defensive fixation at the relative surface level of intersubjective communication may also serve as a defense against deep levels of polymorphous perverse infantile conflicts, primitive sadomasochism, and conflicts around erotization in general. The analyst’s unconscious will always be present and influencing the patient, but this is no license for discounting the analyst’s preconscious elaboration and conscious formulation of interpretive hypotheses. These
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interventions foster the patient’s development of tolerance of separateness between patient and analyst, his acceptance that it is impossible for him to totally know the personality of the analyst, and his recognition of how the analytic relationship replicates the separation of the generations. The unavoidability of the patient’s being an excluded third person from the oedipal relation of the parents becomes an affirmation of loss, separateness, and autonomy that includes separateness and autonomy in the erotic realm. I believe that the development of a “real relationship” between patient and analyst as a consequence of consistent transference analysis and working through is a nonspecific, growth-promoting aspect of the advanced stages of the treatment that leads to partial sublimatory identifications instrumental in working through the depressive transferences and mourning reactions in the termination phase. This process culminates in the capacity for both separateness and closeness, for difference and loss as well as gratitude.
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the influence of the gender of patient and analyst on the psychoanalytic relationship
The influence of gender on the psychoanalytic situation is a complex topic and does not lend itself to simple generalizations; current views reflect the accumulated experience of several generations of psychoanalysts, developments in psychoanalytic technique, changing ideological crosscurrents in psychoanalytic theory, and new knowledge regarding similarities and differences in the development of the genders. Major open issues are the relationship between gender and sexuality and that between erotic desire and love; the psychoanalytic relationship as a facilitating and containing frame for the exploration of oedipal conflicts; and the related temptations, prohibitions, and derivatives of the erotic tension in the transference and countertransference. An overview that attempts to bring these various subjects together will necessarily be highly condensed and cannot take many subtleties into account or do justice to the enormous bibliography dealing with these problems. CHANGING VIEWS OF THE DETERMINANTS OF TRANSFERENCE
The contemporary focus on the psychoanalytic relationship as an interaction between transference and countertransference has moved away from the classical, “objectivist” definition of the transference as the unconscious repetition in the here and now of pathogenic conflicts from the past toward a “constructivist” consideration of the transference as derived from the reactivation of unconscious conflicts from the past and the patient’s realistic An earlier version of this chapter was published in the Journal of the American Psychoanalytic Association 48 (3) (2000): 859 – 883. 246
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reaction to the personality, interventions, and countertransference of the analyst (Gill, 1982). The controversy between the classical or objectivist position and the modern, constructivist position, brought into the mainstream by Merton Gill’s research on the transference, affects the discussion of the influence of the gender of both participants in the psychoanalytic relationship. Freud’s recommendation (1912b) that the analyst maintain the function of a “mirror,” implying that the intrapsychic conflicts of patients should be highlighted while countertransference should be overcome, has shifted into the contemporary view, according to which the psychoanalyst carefully observes both transference and countertransference in the construction of the unconscious object relation that is emerging at any particular point in the treatment (Kernberg, 1993a). Heinrich Racker’s revolutionary analysis (1957) of the countertransference in terms of concordant and complementary identifications has provided an instrument for the analysis of the psychoanalyst’s identification with the patient’s projected representation of self or a corresponding object, while in the transference, the patient identifies with a reciprocal object or self representation. This conceptualization enables the analyst to focus consistently upon countertransference as an ongoing source of important information. As I have noted in earlier chapters, the impact of the reality of the analyst on the psychoanalytic situation is generally recognized in contemporary psychoanalytic technique, and this has moved the gender of the analyst into the foreground as an obvious reality element potentially influencing the psychoanalytic situation. The objective manifestations of gender on the part of both patient and analyst have also acquired new significance in light of the contemporary understanding of the composite nature of gender identity and sexual orientation. Sexual identity depends on how four relatively independent factors become specifically integrated in each individual (Kernberg, 1995a): (1) core gender identity, determined mostly by gender assignment in the first few years of life and expressed in the basic subjective experience of being male or female; (2) gender role identity, the constellation of behavior manifestations practically assigned to one gender or the other, mostly dependent on cultural factors but also to some extent on hormonal dispositions—that is, on genetic and constitutional factors (such as, for example, the dependence of aggressive play and “tomboy” activities on the presence and the level of testosterone [Maccoby and Jacklin, 1974]); (3) the intensity of sexual desire, dependent on the integrity of the biology of the sexual apparatus but, given a normal level of biological parameters, much more de-
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pendent on psychological features—that is, the development of unconscious and conscious erotic relationships from early infancy on; and (4) object choice—that is, whether a homosexual or a heterosexual object is fixated upon as a major target of erotic desire. The determination of object choice is still to a large extent shrouded in mystery because of the taboo against infant and child sexual research and because of the strong influence of ideological currents regarding the etiology and the normality or pathology of homosexuality. From a psychoanalytic viewpoint, object choice would seem to be intimately related to core gender identity, in the sense that, given the dyadic nature of basic internalized object relations, object choice and core gender identity, in their dyadic link, would also include the gender aspects of definition of self and the related object (Kernberg, 1976). From the first moment of their first encounter, the demeanor of patient and analyst in their mutual interaction sends powerful signals of the core gender identity and gender role identity of each. The immediate nonverbal behavior of the patient and the erotic developments in the transference and countertransference make it possible to diagnose disturbances of gender identity as an essential aspect of early pathology. When gender-identity discrepancies between patient and analyst are extreme—for example, in the psychoanalysis of transsexual patients—their impact on the patient-analyst relationship may become dominant (Danielle Quinodoz, personal communication, 1997). But gender effects may also emerge in less extreme ways in patients with borderline personality organization with marked predominance of preoedipal pathology. The pathological condensation of features of both parental images may be accompanied by gender-identity conflicts and the rapid unconscious transfer of the relationship with one gender to the other, resulting in chronic turbulence in the transferencecountertransference relationship. The question has been raised whether there are particular differences between male and female psychoanalysts in their sensitivity to patients’ sexual conflicts and erotic disposition. It has been widely assumed that women have a greater capacity for object-related dependency and that men have a greater disposition to autonomy and value system differentiation. I suspect that many of these assumed differences between men and women are culturally determined and ideologically exaggerated and that Freud’s concept of a basic bisexuality derived from the unconscious identification with both parents is practically reflected in a broad spectrum of identificatory processes that provide “masculine” and “feminine” sensitivities and attributes to psychoanalysts—and patients—of both genders.
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The pregnancy of women analysts is commonly regarded as an objective influence on the psychoanalytic situation. It has traditionally been treated with a phobic attitude in the psychoanalytic literature, associated perhaps with unease on the part of both male and female analysts about dealing openly with the assumption that increased narcissistic involvement must decrease the capacity of the pregnant psychoanalyst for empathic commitment to the patient. This attitude has been replaced by a new openness to the significance of pregnancy in the countertransference and a willingness to explore with the patient the meanings of the psychoanalyst’s pregnancy in a nondefensive manner. For the patient, of course, the psychoanalyst’s pregnancy may occupy the center of the transference, constituting a painful narcissistic lesion, activating intense oedipal and sibling rivalry, and arousing fears of abandonment. I believe that by far the most important consequence of a gender difference between patient and analyst lies in the timing and intensity of the development of erotic transferences and defenses against them, an issue to which I shall return. The importance of primitive sexuality and erotic desire and of the archaic precursors of the later stages of the Oedipus complex has been a major recent focus of French psychoanalytic theoreticians. André Green (2002) has pointed to the neglect of archaic oedipal conflicts, eroticism, and sadomasochism in the American and British ego psychological and object relations theory approaches. Jean Laplanche (1987) has proposed a “general theory of seduction,” referring to the primary erotization unconsciously induced in the infant by the mother. This erotization “leans on” the erotic responsiveness of the infant’s body surface and mucous openings, represents the mother’s unconscious erotic strivings in regard to the infant, and is experienced by him as “enigmatic messages” that at first cannot be deciphered but that are retrospectively (“nachträglich”) interpreted as erotic stimuli, promoting primary unconscious sexual fantasies. This theory is Laplanche’s clinical application of Freud’s proposal (1905b) that libido, the psychic drive, “leans on” biological, instinctive sexuality. These early erotic interactions, anchored in the unconscious fantasies of mother and child, are reproduced at the deepest levels of transference dispositions. They are also the wellspring of the most profound aspect of the countertransference, the deepest transference dispositions of the analyst, which can never be completely resolved by the analyst’s analytic experience. The infant, erotically stimulated by mother and then frustrated by her repetitive unconscious withdrawal from him to return to her adult sex-
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ual partner, develops a double identification, with the frustrating mother and the archaic oedipal father—the object of mother’s erotic desire—thus giving rise to primary unconscious psychic bisexuality (Braunschweig and Fain, 1971). Clinical observations in the analysis of women during pregnancy and the early stages of their relationship with their infant document the powerful erotic currents between mothers and their infants of both genders, even if differential unconscious behaviors toward their male and female infants induce differential elaborations of their early sexual organization (Laplanche, 1992). Under the impact of psychoanalytically oriented infant observation, the concept of a primary autistic phase has been rejected, and the symbiotic phase described by Mahler and Furer (1968) is now better considered as transitional symbiotic states that occur during peak affect interactions between mother and infant. It is reasonable to assume that, precisely at such moments of maximal affective interaction between mother and infant, representations of internalized object relations are established, some intensely gratifying and some terrifying (Kernberg, 1992). French psychoanalytic theory (De Mijolla and De Mijolla, 1996) proposes that the symbiotically gratifying mother’s repetitive withdrawal from the infant to reestablish the erotic relationship with father generates the experience of father’s disrupting the symbiotic fusion, thus originating the threat of annihilation as the prototype and precursor of castration anxiety and giving rise to the infant’s fantasies of the primal scene and oedipal seduction. This early triangulation is replicated in the analyst’s function as the “excluded third party”—his interpretive function. The function of the oedipal father in dissolving the primitive symbiosis is replicated in regressive transference-countertransference entanglements and strengthens a dimension of objectivity linked to the analyst’s interpretive formulations that disrupt the transference-countertransference regression. Primitive erotic as well as sadomasochistic transferences constitute a fundamental aspect of the psychoanalytic situation, reflecting the activation of primary erotic transferences on the patient’s part but also an unanalyzable residual following transference interpretations (Laplanche, 1992). The analyst’s interpretive behavior reconfirms the sublimatory working through of the oedipal situation and determines the symbolic transformation of the analytic dyad into a creative couple, which fosters the patient’s growth and individuation and his capacity for separateness as well as for mature dependency. Erotic seduction and erotic disillusionment, in short, are essential aspects of transference-countertransference processes, high-
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lighting the effects of actual gender differences as well as the fantasies related to the unconscious bisexual dispositions of both participants. CULTURAL CRITIQUE AND IDEOLOGICAL INFLUENCES
Recent psychoanalytic theorizing, particularly under the influence of feminist critiques (Alpert, 1986; Chodorow, 1994; Irigaray, 1993; ChasseguetSmirgel, 1986; Boothe and Heigl-Evers, 1996), has criticized Freud’s “phallocentric attitude.” The assumption that penis envy is universal and a fundamental matrix of female psychology had been challenged earlier by culturalist psychoanalysts such as Karen Horney (1967), by Melanie Klein (1945) in the British school, by Janine Chasseguet-Smirgel (1986) and other French psychoanalysts, and by Edith Jacobson (1964) within American ego psychology. These authors question Freud’s proposals (1905b, 1933a) that the little girl experiences an early masculine identification, as reflected in her investment of the clitoris, that this identification is shattered by her discovery of the differences between the sexes, and that her wish for a penis is replaced by the wish for a baby from father. They have suggested a primary female identity, with the displacement onto the penis of primary envy of the breast by both genders (Klein, 1945); cultural biases against women are seen as internalized in the patriarchal family (Horney, 1967). Braunschweig and Fain (1971) have proposed a primary vaginal genitality of the little girl that is unconsciously inhibited by the lack of direct unconscious stimulation from mother—in contrast to mother’s unconscious erotic stimulation of the little boy’s genitals. The little girl would thus suffer an inhibition of her primary vaginal genitality, only later resolved in the context of the resolution of the unconscious infantile prohibitions against genital sexuality as the normal outcome of her Oedipus complex. In contrast to Freud’s tendency to ascribe a primary masculine genital identity to the little girl, Robert Stoller (1985) and Ethel Person and Lionell Ovesey (1983) have proposed, on the basis of their studies of perversion and transsexuality, that mother is the primary identificatory object for both genders and that the little boy has to free himself from this primary feminine identification, misidentifying himself with mother as part of early individuation and the negative Oedipus complex. As a consequence, core gender identity may be more stable and secure in women than in men and homosexual leanings more threatening to men than to women. The critique of Freud’s phallocentric theory also extends to his belief that the superego is less developed in women than in men. His assumption that in the relationship with the love object there are more narcissistic lean-
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ings in women’s love disposition than the anaclitic love dispositions of men implied that women experience a developmental sequence less conducive to setting up a strict superego. On the basis of much clinical experience with narcissistic pathology in men and masochistic pathology in women, this theory has been discredited (Rosenfeld, 1987; Chasseguet-Smirgel, 1985; Jacobson, 1937). It is probably reasonable to state that most psychoanalytic theoreticians today are strongly critical of the early psychoanalytic attitude toward women, which seemed to reflect the ideology of a traditional patriarchal society. Klein, Jacobson, Horney, and many others have criticized the unconscious tendency to perpetuate the subordinate position of women in the analysis of the transference. Not too long ago one could still find an implicit tendency on the part of many male psychoanalysts to reduce the social role of women to the classical “Kinder, Kirche, Küche.” Lest one fall into the trap of an opposite, also ideologically motivated, position of disparaging Freud’s contributions, it needs to be kept in mind that, although Freud himself was a product of traditional patriarchal culture, he challenged basic assumptions of his time in affirming the fundamental bisexuality of both genders, the normality of polymorphous perverse infantile sexuality, and the differentiated sexuality of women. Moreover, from the very inception of the psychoanalytic movement, he fostered a trend toward allowing or encouraging women to leadership positions. THE DIFFERENTIAL DEVELOPMENT OF MEN AND WOMEN
On the basis of direct observation of infant-mother relationships, the psychoanalytic study of women and their infants, and clinical observations in the psychoanalytic treatment of children and adults, a series of mutually complementary psychoanalytic formulations has emerged that, I believe, permits us to construct a tentative view of the early development of the sexual relationship between the genders and of the complex interaction between libidinal and aggressive strivings of the infant and child in relation to the parental couple. I am drawing here particularly on contributions from French and British authors relatively underrepresented in North American literature. I am very much aware of the risk of oversimplifying the complex relationship between gender issues and sexuality and of the fact that they are reconfigured over the course of development. The following outline, however, may constitute an organizing frame that permits us to enter such modifying factors at various points of development, integrating new findings and formulations from Europe as well as North America.
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As noted earlier, Braunschweig and Fain (1971) have suggested that the alternation between mother’s erotic involvement with her infant and her periodic withdrawal to return to her sexual partner constitute an early form of teasing that gives rise to the infant’s erotic desire. Sexual excitement condenses the wish for erotic fusion with an aggressive wish to control the object in response to her unconsciously teasing behavior. Here Laplanche’s theory (1992) of primary erotization and the function of disillusionment in activating early sadomasochistic tendencies—the infant’s aggressive reaction to early frustration of his erotic desire—come together. Donald Meltzer (Meltzer and Williams, 1988), from a Kleinian approach, has suggested that the infant’s early idealization of the surface of the body of mother is the origin of both the sense of aesthetics and the later idealization of sexual activities and objects. The counterpart of that idealization is the projection of the infant’s aggression into the interior of mother’s body, leading to fear of aggressive, dangerous contents in mother’s body and constituting a primary aspect of castration anxiety. In boys, castration anxiety concentrates around the genital area, while in girls the projection of primitive aggression leads to a diffuse fear of bodily damage (Joyce McDougall, personal communication, 1993). The greater aggressiveness of boys, related to testosterone levels, may provide an additional clue to the linkage of biologically and psychologically determined differences between the genders. In both genders, the existence of mother as the primary love object coincides with the tendency to identify unconsciously with mother and search for father as the object of love. That is, the desire for mother is transformed into the desire for mother’s object, and this combination of identification and complementation gives rise to the unconscious bisexuality that will permit the final selection of one gender or the other as the object of erotic desire. Melanie Klein (1945) pointed to the transfer of both libidinal and aggressive strivings from the preoedipal mother to the oedipal father and described the experience of combined father-mother images, split into idealized and persecutory ones, as an alternative to splitting operations along gender lines, with one gender considered “all good” and the other “all bad.” Under normal circumstances, the interplay of aggression and erotic desire and their mutual integration under the dominance of love prevent such absolute splits or pathological condensations of both genders. By stimulating the little girl’s body while avoiding direct erotization of her genitals, the mother unconsciously fosters the inhibition of primary vaginal genitality in her daughter. Father’s unconscious erotic attraction to his little daughter stimulates the displacement of the child’s erotic longings from mother to-
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ward him and brings about a fundamental shift in the choice of love object that will characterize the woman’s sexuality. This shift signals an early capacity for loving an object “at a distance,” thus establishing what Braunschweig and Fain call the little girl’s “courageous” expression of trust in an object relationship that is exciting yet distant. This leads to a deepened capacity for love relations and for object relations in general, promoting an accelerated psychological maturation in this area for girls as compared to the experience of boys. The little boy, unconsciously stimulated erotically by mother with the particular accentuation of his genital responsiveness, will maintain his infantile genital masturbation if it is not interfered with, practically throughout his childhood. Nursery observations of little girls, on the other hand, indicate their abandoning masturbation in the second or third year of life. Men’s greater capacity for direct genital stimulation, excitement, and orgasm may derive from this uninterrupted early stimulation. However, it is only after a conflictual struggle in working through his oedipal conflicts that the adolescent boy is able to abandon the unconscious selection of mother as his primary love object, with all its ambivalence and unconscious oedipal prohibitions, and invest in an in-depth relationship with a woman. The adolescent girl, in contrast, with her earlier capacity for an in-depth relation with the love object, will have to rediscover her freedom of genital excitement and orgasm in the context of a gratifying love relationship. Therefore, the separation between idealized, romantic love and sexual desire is a prevalent problem of adolescent boys and emerges as a central problem in pathological narcissism in men. The predominant problem for women, in contrast, is some degree of sexual inhibition in the context of the capacity for a romantic love relation, an expression of unconscious guilt over the oedipal implications of sexual intimacy, which promotes a tendency toward masochistic love relations. In men, unconscious guilt over the oedipal implications of masculine triumph is expressed predominantly in masochistic and sadomasochistic relations in the context of work. The sexual development of both genders may be affected by the existence of excessive aggression, whether this is determined biologically or results from early frustration, chronic exposure to physical and sexual abuse, or a severely sadomasochistic family structure. In extreme cases aggression may override the early capacity for sensual stimulation of skin and mucous openings; interfere with the development of the affect of elation in the context of gratifying, symbiotic fusion with mother; and thus destroy the primary capacity for sexual excitement and erotic desire. Under less severe cir-
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cumstances, the normal aggressive components of polymorphous perverse infantile sexuality—that is, the aggressive components of exhibitionistic, voyeuristic, fetishistic, sadistic, and masochistic features—dominate sexual behavior or infiltrate love relations. Conflicts around aggression often constitute a significant psychological component in the shift of primary unconscious bisexuality to a homosexual fixation, whether this is determined by biological predispositions or by an early unconscious identity disturbance with a complementary erotic fixation on a homosexual object choice. Displacement of the surge for love and dependency from mother to father in the case of a little boy suffering from severe preoedipal frustration and intense envy and resentment toward mother determines a form of homosexual orientation that may be contrasted with homosexuality as an unconscious oedipal submission to father. In the case of the little girl, the dominance of intense preoedipal aggression and hatred of mother may bring about both a displacement of that hatred to father and the splitting of maternal figures into idealized and persecutory ones; homosexuality may then result as an effort to protect the idealized segment of the love relation with mother from contamination by aggression. Again, the development of homosexuality in the girl out of submission to the oedipal mother parallels the development of oedipal homosexuality in the boy. The dominance of aggression may also affect heterosexual relationships by accentuating a “reverse triangulation” (Kernberg, 1995a)—that is, the unconscious wish to invert the competition with the parent of the same gender for the love of the other parent by unconsciously fostering relationships in which two members of the other gender fight for the love of the subject (unconsciously the oedipal child): this is the most common manifestation of unconscious aggression that cannot be tolerated directly in the love relationship, leading to the breakup of long-standing relationships by the introduction of an “excluded third other.” Similar dynamics involving preoedipal aggression play a central role in the development of perversions. A “higher level” of perverse fixation reflects defensive structures against unconscious castration anxiety and oedipal guilt; at a “lower level” of pathology, perversions reflect the replacement of early object relations, feared because of their infiltration by aggression, with a defensive restriction of sexual excitement to body parts or personified sexual-substitute objects. All these new psychoanalytic perspectives imply an increasingly complex conception of both normal and abnormal sexual developments and a
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heightened awareness of the vicissitudes of early unconscious bisexuality, the interplay between libidinal and aggressive strivings, and the mutual influence of unconscious interactions between parental objects and the infant or child. They also are more sensitive to how cultural traditions and ideological biases may influence both the observation of clinical phenomena and theoretical formulations and the way cultural crosscurrents and scientific progress in the realm of sexuality are intertwined. What further complicates these issues is the influence of cultural norms and conflicts in molding particular character pathology. Thus, as mentioned earlier, masochistic pathology in women shows itself more in love relations than in work, while in men work is more affected by such pathology. This differentiation is most likely related to the traditional distribution of work functions in a patriarchal society and the culturally constructed dependency of women on men for their financial and social support. Traditionally, narcissistic pathology in women showed itself in passively controlling, self-centered, and potentially exploitive relations to marriage and children, while narcissistic pathology in men was expressed in a sexual promiscuity that expressed an unconscious envy of women. Men’s relatively limited capacity for object relationships in depth was fostered by the traditional double moral standard of a patriarchal society. Nowadays, with the ascent of women’s liberation and their increasing financial independence, we begin to observe a pattern of sexual promiscuity in women with narcissistic pathology, which was traditionally ascribed only to men. The so-called new impotence in men may reflect the breakdown of the defensive system previously provided by their privileged status in patriarchal society; in other words, a new reality exposes them increasingly to the insecurity and unconscious conflicts around oedipal issues for which social dominance previously compensated. CLINICAL OBSERVATIONS: GENDER, TRANSFERENCE, AND COUNTERTRANSFERENCE
“Technical neutrality,” as I have previously established, may be defined as the psychoanalyst’s effort to maintain himself equidistant from the patient’s superego, external reality, the id, and the acting (as contrasted to the observing) ego. In alliance with the observing part of the patient’s ego, technical neutrality establishes the therapeutic alliance. We have also come to understand, however, that in the case of joined patient-analyst cultural biases, technical neutrality may bring about what Baranger and Baranger (1969) called a “bastion”—that is, an area of blindness in which both patient and
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analyst ignore an aspect of pathology, including the inhibiting or repressive effects of social and cultural conditions on the patient’s psychic equilibrium. The most typical example, in my experience, was the traditional underestimation by analysts of women’s capacity and right to fight for their positions of authority in the workplace. This constituted an unintentional collusion with the cultural reinforcement of what may still be a practical problem but was considered an almost moral one—namely, the conflict between a woman’s tasks and role as mother and housekeeper and her selffulfillment in work or a profession. Gender issues may also affect the development of the transference in important ways (Appelbaum and Diamond, 1993), depending on the pathology and character style of both participants in the analytic process. When the analyst is male and the patient is a female with a neurotic personality organization, the typical manifestations of a positive erotic transference will emerge strongly, presenting the analyst with the potential activation of an intensely erotic countertransference, with the risk of boundary violation. Technical neutrality can be endangered, with the analyst feeling that his attractive patient is not appreciated by her partner as he appreciates her. When Freud and his disciples encountered such cases, the disturbing discovery of the intensity of transference love led Freud to his originally phobic attitude toward countertransference, on one hand, and to awareness of the risk of boundary violations, on the other (Krutzenbichler and Essers, 1991). Today we know that male psychoanalysts with severe narcissistic pathology and some of those with masochistic pathology (Gabbard and Lester, 1995) are particularly prone to boundary violations. This vulnerability is fueled by the intense positive erotic transference of the neurotic female patient to the male analyst, which reflects not only the oedipal love relation but also the culturally dominant power gradient of patriarchal society—that is, the erotic love of a dependent woman for an idealized powerful man. When the female patient of a male analyst presents a narcissistic personality disorder, there is usually very little overt erotic transference (Kernberg, 1995a). On the contrary, erotic love for the analyst tends to activate the dependency wishes that narcissistic personalities dread and cannot tolerate, so that the defensive avoidance of erotic dependency is very powerful. Erotic longings generate extraordinary unconscious envy and a sense of humiliation, so that it is only in the advanced stages of treatment that erotic transferences emerge, and these tend to be relatively mild. The narcissistic female patient’s lack of apparent emotional investment in the analyst, her
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unconscious efforts to control him, and her devaluation of him as a defense against envy typically bring about intense insecurity as a dominant issue in the countertransference. Narcissistic women with antisocial personality features may use erotic seduction to bring the male analyst down from what they perceive (and envy) as his powerful, dominant, protected position. They may evince a “pseudoerotic” transference; in such cases the countertransference may be strongly erotic, but the transference is not. In the case of a woman analyst and a male patient with neurotic personality organization, the erotic transference is initially relatively weak and tends to be displaced onto other love objects. The patient’s erotic desire for an idealized, powerful female analyst is counterbalanced by the cultural assumption of male dominance in love relationships and thus produces enormous insecurity in the patient. This situation, in fact, unconsciously replicates the insecurity of the little boy who experiences his little penis as insufficient for the sexual needs of the idealized big mother (ChasseguetSmirgel, 1985). A typical countertransference reaction of the female analyst with a male neurotic patient is a defensive maternal response that may lead her to neglect analysis of the patient’s fear of a more intense erotic transference development. By contrast, a narcissistic male patient may develop an intense erotization of the relationship with a female analyst in the effort to reverse the experience of dependency and destroy the analyst’s authority by seducing her, thus replicating the conventional relationship between the dominant male and the subservient female. The female analyst’s countertransference to this narcissistic seductiveness is often intense anxiety, an expression of unconscious or preconscious awareness of its aggressive implications. When patient and analyst are of the same gender but differ in their gender role identity, somewhat different problems arise. Male homosexual patients with neurotic personality structure tend to develop an orally tinged, dependent transference to male analysts as a reflection of preoedipal homosexuality and/or an idealizing reaction formation against profound and threatening oedipal rivalry and projected competitive aggressive impulses. The analyst’s countertransference involves the activation of his feminine identifications and requires him to face his own homosexual tendencies so as to maintain empathy with the patient’s transference feelings. This can be a complex challenge. The degree to which the male analyst is comfortable with his homosexual leanings will determine his capacity to creatively analyze the patient’s transferences.
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A male homosexual patient with narcissistic personality structure may develop an intense erotic transference toward a male analyst that has an aggressively controlling quality, reflecting both a defense against dependency and unconscious efforts to destroy the oedipal father. The analyst’s response may be an intense paranoid countertransference that can constitute a significant complication. Its management will often require a delicate balance between helping the patient explore the aggressive implications of his efforts at sexual control and maintaining the boundaries and structure of the psychoanalytic situation. A male homosexual patient with narcissistic personality may evince a surface submissiveness toward a female analyst as a defense against very powerful devaluating responses to a woman perceived as both an object for possible dependent longings and a challenge to the narcissistic dismissal of the other gender. The few cases I have supervised or followed for some time showed extremely difficult and complex transference developments. In contrast, a male homosexual with a neurotic personality structure may develop split transference toward his female analyst, as a “desexualized” maternal figure on whom he can depend and a threatening phallic mother who activates severe castration anxiety. Similarly, narcissistic homosexual women show great resistance to dependent developments in the transference with a male analyst, with the double threat of a humiliating dependency aggravated by the resented alterity of the other gender. From my limited experience with such patients with neurotic personality organization I would tentatively suggest that with a male analyst these patients appear much more open to a rich and relatively early development of regressive transferences that do not appear to be systematically different from those of heterosexual female patients with male analysts. A homosexual female patient with a neurotic personality organization may experience an intense desire for a preoedipal dependent and symbiotic-like relationship with a female analyst. This may present itself as an intense transference regression, with idealization of the analyst usually split off from strong aggressive transferences toward other women. The countertransference may vary from time to time, from activation of a motherly relationship to the patient to paranoid responses to the patient’s split-off aggression. Finally, in the case of a narcissistic homosexual woman patient with a female analyst, the transference may be dominated for extended periods by the patient’s denial of her dependency and intense aggressive efforts at omnipotent control. By projective identification these defensive maneuvers
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may induce in the analyst an internal rejection of the patient that may become an important countertransference problem. While these cases hardly constitute an exhaustive list of the possible combinations of genders and gender identities that create special problems for analytic couples, they do illustrate the relationship among the gender and the dominant psychopathology of each participant and the prevailing culturally determined relationships of power and authority between men and women. Successful work with these issues requires, first of all, the analyst’s ability to tolerate his or her own bisexuality, oedipal sibling rivalry, and homosexual longings activated in the countertransference, which may reflect an unconscious identification with the erotic desire of the patient. There are extreme cases of countertransference difficulties linked to gender issues that, in fact, maximize potential disturbances in the analyst’s work and yet provide absolutely fundamental information regarding the deepest levels of the transference. Such cases include the countertransference to transsexual patients who have undergone sex change operations, in which the analyst’s efforts to identify with the patient may be significantly affected during some stages of the treatment, replicating the basic confusion in the patient’s core sexual identity. Major countertransference complication may also derive from the analyst’s difficulty in empathizing with the internal world of a patient with sexual perversions (Kernberg, 1997b). It can be a major challenge for the analyst to identify with such a patient’s erotic desire as it is expressed in his specific perversion, requiring tolerance of polymorphous perverse infantile impulses and fantasies seldom activated in other countertransference reactions. Finally, cases in which the patient experiences either himself or his partner as profoundly unattractive may create, by a process of introjective identification, a specific sense of hopelessness or inhibition in the countertransference, which replicates the patient’s basic fears. The analyst can be brainwashed by the patient’s conviction that either he or his partner is sexually unattractive and that the patient’s pervasive self-loathing or sexual inhibition with his partner is therefore fully justified; as a result, the analysis of the unconscious meanings of this conviction is neglected. ARE THERE REAL DIFFERENCES BETWEEN MALE AND FEMALE ANALYSTS IN THEIR TREATMENT OF MALE AND FEMALE PATIENTS?
Obviously, men and women differ in three of the four aspects of sexual identity, mentioned—that is, core gender identity, gender role identity, and object choice. However, ideological tendencies to declare either that there
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are no meaningful differences between men and women or that if differences exist, one gender is superior to the other, tend to color the scientific attitude to this question. As I have said, I believe the notion that women have a greater capacity for contact, fusion, dependency, and intimate relationships, while men are supposedly more focused on differentiation, autonomy, and aggression is a cliché; there have been periods in history in which the typical attitudes of men and women were conceived quite differently. The pregnancy of the woman analyst is an obvious manifestation of gender that influences transference developments, but again, one may ask whether these transferences in the patient would emerge at other points, with other characteristics, at times of regression with analysts of both genders, and would then be subject to equally fruitful analysis. Ideological dispositions regarding the social roles of men and women may influence technical neutrality and countertransference. Here what matters is the relative freedom of psychoanalysts of both genders from cultural clichés and conventionality. The analyst’s attitudes toward homosexuality, divorce, abortion, the professional commitments of women, homemaking choices by men, and parenthood by homosexual couples all challenge his or her ability to maintain the internal freedom required for transference-countertransference analysis and for helping patients acquire authentic autonomy in decision making. THE ANALYTIC COUPLE AND THE LOVING COUPLE
The basic love relationship of a sexual couple may be considered in the combined contexts of their erotic relationship, the dominant object relation activated in their interaction, and the prevailing ego ideal mutually created by the couple. The dimension of the erotic includes the relationship between sexual excitement and erotic desire, on one hand, and hatred and envy on the other, at preoedipal and oedipal levels. The wish for fusion as well as for differentiation; the ecstasy of the erotic encounter as well as the frustration, disillusionment, and depression over loss of the object; and the longing for impossible gratifications infuse not only the eroticism but also aspects of the object relation and the ego ideal of the couple. In the psychoanalytic couple, both members fear the activation of eroticism, and this makes the erotic dimensions of transference and countertransference a fundamental problem of psychoanalytic treatment. Moreover, the effective exploration of sexual behavior, fantasies, and dreams is often hindered by conventional taboos and restrictions affecting both patient and analyst.
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In the object relationship of the couple, direct and inverse triangulation signals the dominance of the oedipal situation. Here considering the oedipal situation as a universal structure rather than simply as a phase of development seems to me a major contribution of French psychoanalysis and of immediate and fundamental relevance for the analysis of the psychoanalytic situation. The ego ideal of the analytic couple is reflected in the maintenance of firm boundaries that prevent them from acting out the oedipal conflict in boundary violations that are profoundly destructive to the analytic situation. The ego-ideal function is further reflected in the joint commitment to freedom in exploring the patient’s sexual life in all its aspects and consequences, in its darkest corners. This combination of a firm structure and total permissiveness is a unique contribution of psychoanalysis to the analysis of superego pathology and the achievement of normal ego-ideal functioning. From a practical viewpoint, it is important to keep in mind that erotic desire is universal, that it always includes aggressive elements, and that its absence reflects either a devastating primary deadening of the erotic by the predominance of primitive aggression or, in a majority of cases, profound repression of infantile sexuality that needs to be vigorously explored in the treatment. The patient’s search for preoedipal fusion and dependency may be a most powerful defense against full activation of the erotic by facilitating the split between sexuality and aggression and between dependency and aggression and both dependency and aggression from denied sexual feelings. Linear models of development have of course been challenged by psychoanalytic exploration and have been replaced by the concept of the synchronic presentation of multiple periods of development in the light of one particular conflict and the diachronic developments of a particular theme in advanced stages of the treatment (De Mijolla and De Mijolla, 1996; Kernberg, 1993a). Practically, this means that the oedipal dimension and sexuality are always present, although other issues may temporarily appear to be dominant. Oedipal temptations are activated in the analyst as well as in the patient, and it is important to gauge their activation in the countertransference. While the patient profoundly defends against awareness of his feelings, the repression of such sexual feelings or their projection onto the analyst usually does not bring about any particular countertransference. The patient may be talking about sexual memories and desires, but they are not yet
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active in the analytic encounter. Once sexual feelings are directly expressed in the transference, they may be either suppressed or readily expressed; they then tend to activate powerful erotic countertransference. The frustration of the patient’s sexual desires, his disappointment in the analyst’s lack of erotic response, and his sense of narcissistic humiliation or oedipal guilt may evoke, by projective identification, complementary experiences of guilt and deskilling in the analyst. If the patient can tolerate his or her sexual feelings while deeply accepting that they will not be gratified in the psychoanalytic situation, then mourning, working through, displacement, and sublimation of sexual feelings may consolidate an intense relationship in the transference while helping both patient and analyst to begin their process of separation. As mentioned before, patients with neurotic personality organization, in whom unconscious guilt over oedipal conflicts may determine masochistic transferences, can arouse strong sexual countertransference dispositions and defensive maneuvers against them. It is very important to explore whether and how such masochistic tendencies are enacted outside the treatment situation, as a way of protecting the positive oedipal relationship with the analyst by deflecting guilt or hatred outside the treatment situation. The provocative sexual behavior of patients with borderline personality organization, whose sexual needs are intensely infiltrated with aggression, is easier to deal with than the ambivalent, nuanced, and evocative erotic transferences of neurotic patients. The absence of erotic feelings toward the analyst in narcissistic patients or their aggressive efforts to control the analyst by erotic provocation may bring about fearfulness and withdrawal in the analyst, but by the same token, they may alert him to the importance of analyzing the aggressive implications of the patient’s sexual life. A special problem—highly distorted in the literature because of ideological crosscurrents—is the psychoanalytic treatment of patients who have been sexually traumatized. Here the most important psychoanalytic finding, I believe, is that whenever such traumatization has affected personality structure and sexual behavior, the patient must deal with an unconscious identification with both victim and perpetrator. This means that the patient will be tempted again and again to reactivate the past traumatic object relation in an unconscious effort to come to terms with it by enacting both the role of victim and that of perpetrator, with reciprocal projections of each role or its complementary one onto the analyst. This basic relationship is often obscured by defensive idealization of the analyst while the role of perpetrator is projected onto a third person; or else the analyst himself is
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treated as if he were a perpetrator and, by a combination of projective identification and omnipotent control, is in effect induced to enact aspects of that role. It is crucial that the patient be helped to come to terms with this double identification as victim and perpetrator and with the defensive projections and splitting off from protective idealized relationships. The systematic analysis of transferences controlled by these object relations may bring about not only resolution of sexual pathology but profound personality changes; the prevalent trend to treat the patient only as a victim, to the contrary, drives the unconscious identification with the perpetrator into deeper unconscious structures and maintains both the pathological personality structure and, usually, the sexual inhibition as well. In all the situations considered in this chapter, the analyst’s interpretive function will be compromised to the extent that he is unable to tolerate polymorphous perverse infantile sexuality and its expression in adult perversion, homosexual tendencies in heterosexual patients, and the desire of many if not most homosexual patients to resolve their psychopathology without giving up their homoerotic object choice. The analyst must possess a high degree of freedom in experiencing the activation of countertransference without either communicating it or acting it out. In-depth analysis of the transference within the frame of the analyst’s common sense and life experience provides both members of the analytic couple with the freedom to explore the deepest aspects of eroticism and sadomasochism. The analyst’s position as a “third excluded person” permits him to tolerate the activation of regressive erotic desires in the transference and countertransference, the confusion of condensations of both parental images, and the universality of erotic strivings as well as of preoedipal destructive impulses. The ages of patient and analyst may also affect the analysis of erotic transference and countertransference (Kernberg, 1998a). A significant age difference may strengthen particular aspects of the oedipal situation in the transference and countertransference, at least initially. An older analyst may evoke oedipal prohibitions and fears; an analyst of the same age as the patient, an early activation of anxieties over erotic feelings or sibling rivalry. When the analyst is much younger than the patient, unconscious oedipal prohibitions may interfere with the full exploration of the patient’s sexual life. Among the most controversial aspects of psychoanalytic work today is the question of the analysis of homosexual patients. Can a heterosexual analyst identify fully with homosexual patients? I believe this is possible. A re-
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lated question is whether an analyst of a determined gender is indicated for the treatment of any particular patient. Ideology here overshadows by far the lessons of abundant psychoanalytic experience, which demonstrates that for patients with neurotic personality organization, the gender of the psychoanalyst makes no difference in the long run. In patients with severe regressive psychopathology, narcissistic personality disorders, and borderline personality organization, where unconscious identification with the parental images of both genders is complicated by identification with combined father-mother images and defensive splits of genders along an idealizing and persecutory line, primitive transferences will express both maternal and paternal object relations in the analytic situation, whatever the gender of the analyst. The common assumptions that patients with severe preoedipal pathology and deficient maternal care require a female analyst or a male analyst with a maternal attitude and, conversely, that patients with an absent father may require identification with a male analyst, confuse the narrative of the patient’s “objective” past history with the unconscious activation of a primitive world of internalized object relations in the transference. Behind the wish for maternal nurturing is the split of primitive aggression against the maternal figure; behind the “absence” of a significant parental figure are the unconscious images of the idealized and persecutory internal correspondences of absent as well as present parental images. André Green (1993b) has beautifully illustrated this issue in his analysis of the transference of the dead mother. Finally, should the psychoanalyst remain technically neutral regarding the homosexuality of his patient, or should he assume that homosexuality always constitutes pathology that should be resolved in psychoanalysis? Whether a normal dimension of homosexuality exists, derived from a genetic or constitutional disposition and present in a relatively harmonious personality structure, is still an open issue. We are only at the beginning of scientific research in this regard. What seems clear from the clinical viewpoint is that it is absolutely essential for the analyst to tolerate whichever way the core gender and object choice of his patient crystallize and that he adhere strictly to technical neutrality, in the sense of not imposing particular solutions on the patient. In conclusion, gender makes for not only one but many differences, but these differences do not conform to the conventional commonsense view of the influence of the actual gender of both participants on the treatment. Rather, they reflect the unconscious activation of primitive transferences that in the long run override the actual gender of the analyst, although the
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sequence of transference activations present particular challenges to patient and analyst. The shape of transference developments may vary from case to case; the potentially full deployment of the transference with psychoanalysts of both genders depends on the analyst’s skilled experience and relative freedom from conventional assumptions regarding the relationships of the sexes. The main problems for the analyst are awareness of the profound layers of the oedipal structure as a permanent frame of eroticism and of the challenge to the analytic instrument of conventional assumptions and compromises regarding sexuality derived from the dominant culture and ideologies.
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convergences and divergences in contemporary psychoanalytic technique
One of the most interesting consequences of the discussion of “the common ground” of psychoanalysis (see Wallerstein, 1992) has been the increasing attention given to the actual principles of technique that flow from alternative psychoanalytic theories, in contrast to the “clinical theories” derived from these various formulations. In other words, general theory or metapsychology needs to be differentiated not only from clinical theory or patient-specific dynamic hypotheses in concrete clinical situations, but also from the technical strategies of case intervention. Although Wallerstein’s concept of the common ground of clinical theory—as against the marked discrepancies in metapsychological or theoretical formulations—is still being debated in the literature, surprising confirmations as well as disconfirmations of shared technical approaches may be discovered in comparing the actual work of clinicians from different backgrounds. I think it is possible to detect certain areas of major convergence of technique affecting Kleinian, ego psychology, British Independent (what used to be called the “middle group”), French mainstream (non-Lacanian), interpersonal (earlier called “culturalists”), and self psychology approaches. The opportunity to discuss clinical material with colleagues from different psychoanalytic societies and orientations in various countries has strengthened this impression, and the recent publication of major texts on technique further reconfirms it. Etchegoyen’s comprehensive treatise on psychoanalytic technique published in 1991 highlights the development of a An earlier version of this chapter was published in the International Journal of PsychoAnalysis 74 (1993): 659 – 673. Copyright © Institute of Psychoanalysis. 267
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major trend toward explications of similarities and differences among alternative psychoanalytic approaches. In the past few years, in addition to Etchegoyen’s Kleinian text, we have had Blum’s contributions (1980, 1985) from an ego psychological perspective; Thomä and Kächele’s German textbook (Thomä and Kächele, 1987; Thomä, 1991), with an emphasis on the analyst’s contribution; Le Guen’s French mainstream viewpoint (1982, 1989); the contributions of Greenberg (1991) and Mitchell (1988) from interpersonal psychoanalysis; two volumes on developments in Kleinian theory and practice edited by Spillius (1988); Mertens’s introduction to psychoanalytic therapy (1990), combining ego psychological and interpersonal perspectives; a special issue of the Psychoanalytic Quarterly (vol. 59, no. 4, 1990) dedicated to the psychoanalytic process; overviews by Kohon (1986) and Rayner (1991) of the Independents’ approach; and last but not least, the second edition of Sandler, Dare, and Holder’s brief and crisp text (1992). To compare these works is to find remarkable agreements as well as certain disagreements. Equally interesting is that, even in texts that clearly announce their author’s own bias, viewpoints of alternative schools are included, and one finds a generally more flexible attitude toward other viewpoints, an indication, in short, that older antagonisms have given way to a concern for communicating differences. In the following I attempt to summarize briefly some major areas of both convergences and divergences. In attributing certain approaches to a certain school, I have had to simplify and generalize, sometimes not doing justice to fine distinctions between viewpoints within each approach. Fairbairn (1954), for example, an Independent, favored a rather classical psychoanalytic technique, probably more than most of his colleagues. Among the Kleinians, Bion (1974, 1975, 1980), Meltzer (Meltzer and Williams, 1988), and Rosenfeld (1987) significantly departed from what I describe as the contemporary Kleinian mainstream, as reflected in Spillius’s Melanie Klein Today (1988) and the selected papers of Joseph (1989). Within American ego psychology, significant differences are occurring between those who, following Brenner (1998), tend to deemphasize such concepts as defense mechanisms and conceptualize all unconscious conflicts and their consequences in terms of compromise formations, on the one hand, and developmental psychologists influenced by Mahler (Akhtar and Parens, 1991), who have introduced object relations concepts into an ego psychology model. Similarly, other American ego psychologists have attempted to
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integrate their views with those of Winnicott and the Independent school (Modell, 1990). CONVERGENCES Transference
In all psychoanalytic approaches except, probably, the Lacanian, there seems to be less overall emphasis on the uniqueness of dreams, the recovery of concrete memories, and external reality, and more on both early and systematic analysis of the unconscious meanings of transference developments. The heightened stress and early focus on the transference are moving the technique of ego psychology, for example, closer to that of object relations theories. Gill and Hoffman’s empirical research (Gill, 1982; Gill and Hoffman, 1982a, 1982b) on transference initially received a mixed reception, but it left an important imprint not only on American ego psychology but on interpersonal psychoanalysis and on Thomä and Kächele. Early criticism of Gill and Hoffman was mainly directed at their strong focus on the analyst’s contribution to the transference and on the interactional matrix within which transference develops, but their emphasis on the importance of defenses against the transference (rather than to the defensive functions of the transference itself ) influenced ego psychology thinking and led to increased attention to the subtle, particularly nonverbal manifestations of the transference from early in the treatment. Indeed, a complementary move among the British, particularly the mainstream Kleinians as represented by Spillius’s edited volumes, indicates that Kleinian authors, too, are giving more systematic attention to the analysis of character resistances and their relation to the transference, a more gradual analysis of the patient’s associative and attitudinal material from surface to depth, and the omission of direct references to genetic material in early stages of transference interpretation. In this regard, they are moving in the direction of both the Independents and ego psychologists. Significant differences nonetheless persist in the interpretive approaches to the transference among the different schools. Character Analysis
There is a general tendency to focus on the analysis of the patient’s habitual—often unobtrusive, yet rigid—behavior patterns in the psychoanalytic situation: on character defenses instead of the unconscious meanings of
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particular symptoms, experiences, or memories. This approach, however, does not have the qualities of a confrontational (and at times authoritarian) “overcoming” of character resistances, as did Wilhelm Reich’s (1933). In this respect, Kleinian technique was moving into the direction of ego psychology. This trend was spearheaded by Rosenfeld’s descriptions (1964) of the transference resistances of patients with narcissistic personality; the emphasis in his later contributions (1987) on clarification of the patient’s experiences as well as nonverbal manifestations reflecting persistent, repetitive characterological features; and again, in the emphasis of Joseph (1989) and Segal (Spillius, 1988; Levine, 1992) on chronic, repetitive, subtle, yet significant aspects of the patient-analyst interaction. Although what ego psychology regards as the rigidity of traditional “Reichian” character analysis has long since been abandoned, under the impact of treating more seriously ill patients, a renewed focus on character analysis has been evident in practice if not formulated systematically. The fact that character pathology and severe personality disorders are becoming increasingly prevalent indications for psychoanalytic treatment may be contributing to this trend, but so is the growing awareness that the analysis of verbal contents that bypass character structure often leads to intellectualization and pseudoinsight (Kernberg, 1983, 1987, 1992). The Here and Now
The focus on unconscious meanings in the “here and now,” what Sandler and Sandler (1984) described as the “present unconscious” in contrast to the “past unconscious,” is increasing a general reaction against the risk of premature genetic reconstructions, particularly on the basis of conscious memories of the patient that bypass unconscious fantasies and meanings in the transference; there is a general trend to explore such unconscious meanings in the here and now before attempting reconstructions. This trend is linked to the increasing emphasis on analyzing the transference. Analysis of the here and now does not imply a neglect of the unconscious past, although certain tendencies to overemphasize the interactional aspects of the psychoanalytic situation (sometimes linked to an existential approach) may neglect dealing with the infantile determinants of the transference. The ego psychology formulations on the metapsychology of interpretation—in particular, the economic, dynamic, and structural criteria of interpretation most cogently formulated by Fenichel (1941)—always stressed the importance of proceeding “from surface to depth,” that is, from the
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analysis of defense or resistance to the analysis of impulse or content. Kleinian technique, in contrast, used to focus on interpretation at the deepest level of anxiety (Segal, 1973) and tended to move quickly into genetic interpretations (often conveyed in a language referring to body parts and assumed fantasies of the infant in the first year of life); it thus risked encouraging the patient to intellectualize if not to translate his experiences restrictively. Contemporary mainstream Kleinians, in reaction to this trend, avoid premature genetic reconstructions and attempt to analyze unconscious meanings in the here and now at a level more consonant with the patient’s current way of formulating his experiences. In the process, they increasingly focus on the manifestations of character pathology in the transference. Hanna Segal (personal communication, 1986) now stresses interpretation at the most active—not the deepest—level of anxiety and with the patient’s current level of mental functioning. Etchegoyen’s text (1991) illustrates a parallel development among the Argentinean Kleinians. The Increasing Focus on the Translation of Unconscious Conflicts into Object Relations Terminology
It is important to differentiate the technical approach to clinical material from the ongoing controversy that neatly divides those object relations theoreticians who still adhere to drive theory ( Jacobson, Mahler, Klein, Kernberg) from those who consider it incompatible with object relations theory (Sullivan, Fairbairn, Mitchell, Greenberg). Technically, there is a general tendency to express impulse-defense configurations in terms of corresponding unconscious, internalized identification with self and object representations that carry the corresponding drive derivative or its affective expression. The British and interpersonal schools have, of course, always formulated their interpretations in object relations language, as has self psychology, with the significant difference that self psychology disregards the existence of aggressively invested internalized object relations. But the ego psychology literature on technique has also been increasingly formulated in object relations terms, as, for example, in the developmental approach derived from Mahler (Akhtar and Parens, 1991) and in the work of Arlow (1991), Gill (Gill and Hoffman, 1982a), and Sandler (Sandler et al., 1992). It may be argued that psychoanalytic theory has implied an object relations theory from its very beginning, but it seems to me that the linkage of affect
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dispositions and drive derivatives with the self and object representations that are part of ego and superego structures has only recently become dominant in the non–object relations theory approaches. Countertransference
Parallel developments regarding countertransference have taken place in ego psychology, Kleinian, and Independent approaches, typically illustrated by the contributions of Heimann (1950), Little (1951), Racker (1957, 1968), Annie Reich (1951), and Winnicott (1949, 1960). The net effect of these contributions has been to broaden the concept of countertransference from the analyst’s unconscious reaction to the patient or to the transference to his total emotional reaction to the patient. These contributions also signaled a shift in attitude toward the countertransference from the negative view that it is a reflection of the analyst’s unresolved neurotic conflicts to the view that it is an important instrument for investigating the transference and the total patient-analyst interaction. Interpersonal psychoanalysis, as we know, started out with such a global definition and technical approach to the countertransference (Fromm-Reichmann, 1950; Searles, 1979). Racker’s pathbreaking clarification (1957) of concordant and complementary identifications provided a theoretical frame for countertransference analysis that has been utilized widely in all object relations theory approaches and is a centerpiece of Etchegoyen’s Kleinian treatise (1991). Jacobs’s text (1991) illustrates how these concepts have become part of the mainstream of ego psychology thinking in the United States as well, and Epstein and Feiner’s (1979) selection of papers on countertransference points to parallel developments in a broad spectrum of psychoanalytic approaches, including the French mainstream (McDougall, 1979). Major differences remain, however, regarding the extent to which transference and countertransference analysis are linked: interpersonal psychoanalysis gives them almost equal attention, the Independents somewhat less, and ego psychologists and Kleinians even less. I think it is fair to say that all analysts today utilize the exploration of their own affective responses to their patients more consistently and more freely than earlier clinicians did. By the same token, however, there is a general tendency to utilize the analysis of countertransference only in the formulating of interpretations, while carefully avoiding communicating it directly to the patient.
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From a theoretical viewpoint, the expansion of the concept of countertransference and its utilization in the formulation of transference interpretations imply a gradual acceptance—in varying degrees and with varying limitations—of the concept of projective identification as an important means of defense and unconscious communication in the transference. The patient’s actualization or enactment of past conflicts in the transference, particularly with “role reversal” (Kernberg, 1984) of the original pathogenic object relation, is met by the analyst’s “role responsiveness” (Sandler, 1976). The analyst’s trial identification with the patient includes the activation of reciprocal roles in the countertransference. The Increasing Focus on the Patient’s Affective Experience
Psychoanalysts have always focused on the patient’s affective experiences. Fenichel (1941) eloquently summarized the risks of two polarities of resistance: an intensity of affect as a defense against cognitive awareness of an unconscious conflict, and a reliance on intellectualization and rationalization as a defense against affective awareness of such a conflict. Here, however, I am referring to the gradual transformation of the traditional ego psychological focus on the intensity of instinctual conflicts per se as determining the “economic” criterion of interpretation (Fenichel, 1941) (or, throughout the Kleinian school as well as in ego psychology, the focus on libidinal and/or aggressive investments) into a detailed study of the affects that represent or reflect the dual drives in the clinical situation. Regardless of one’s position regarding whether drive theory should be replaced or complemented by other motivational theories, in the clinical situation the dominance of affective investment has come to be accepted almost universally as the most appropriate point for analytic intervention. Lacanians may be an exception. This point is stressed most strongly in recent contributions from the Independent group (Bollas, 1987, 1992; Casement, 1991; Ogden, 1989; Stewart, 1992). Interpreting where the dominant affective investment is, however, does not mean simply addressing the material that produces more conscious affective display. The ongoing exploration of the relationship among dominant themes in the transference, affective dominance in the total material presented by the patient, and affective dominance in the countertransference represents, at an operational level, the concrete analysis of transference and countertransference developments in each session. Determining the relative contributions of external reality, developments in the transference,
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and the emergence of repressed infantile material to the concrete affective climate of each session is perceived as a major task by most contemporary psychoanalytic approaches. The Multiplicity of “Royal Roads” to the Unconscious
The emphasis on dream analysis as the “royal road” to the unconscious has diminished as our understanding of the multiple channels the unconscious uses to communicate in the analytic situation has increased. Brenner (1976) observed that “the traditional emphasis on the importance of dreams in psychoanalytic therapy has been at the expense of attention to the place in analysis of such other mental phenomena as daydreams, slips, metaphors, jokes, reactions to works of art and even neurotic symptoms” (p. 165). Gray (1986), in the context of interpretive interventions, points to the multiple “surfaces” of the psychoanalytic material, thereby illustrating the potential flexibility of an ego psychological approach that directs the patient’s attention to a broad variety of defensive operations. Other developments in ego psychology include Kris’s renewed focus (1982) on the technical utilization of the patient’s free association and Schwaber’s emphasis (1983) on exploring the patient’s subjective experience of the analyst’s interventions, particularly when there are disruptions in the communicative process. It is here, I believe, that a new flexibility in dealing with the patient’s material has become evident throughout different approaches. In earlier work (Kernberg, 1992), I attempted to synthesize this flexibility as simultaneous attention to “three channels” of communication: the communication of verbal content through free association, communication by means of nonverbal behavior and the formal aspect of language, and communication by the total, constant, implicit object relation developed in each analyst-patient pair as contrasted to the moment-by-moment shift in dominant transference-countertransference equilibrium. Liberman’s pioneering work (1983) in Argentina on the relationship between psycholinguistic styles and dominant character patterns, crisply highlighted by Etchegoyen (1991), provided a new frame for understanding the formal aspects of verbal communication in the psychoanalytic process. Rosenfeld (1987), in describing the relationship between narcissistic character pathology and its transference manifestations, updated the importance of the transformation of narcissistic character defenses into transference resistances within a Kleinian frame, a transformational process independently explored by Grunberger (1971) from the French psychoanalytic mainstream and by Kohut (1971, 1977) in self psychology.
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Within ego psychology, Levy and Inderbitzin (1990), in their succinct summary of four different conceptualizations of “analytic surface,”describe how “Gray’s focus on opportunities for illustrating defensive ego operations, Gill’s careful attention to here-and-now transference manifestations, [Anton] Kris’s search for discontinuities in the patient’s free associative process, and Schwaber’s consistent efforts to clarify deficiencies in the analyst’s understanding of the patient’s subjective experiences all take off from various suggestions inherent in Freud’s ideas about technique. They organize the analyst’s listening and responding” (p. 386). Levy and Inderbitzin also note the danger that the analyst may get lost in a particular “microscopic focus” and lose his awareness of other issues. They stress the importance of flexibility and the many choices of material in each analytic hour. Bion’s caution (1967a) that the analyst should interpret “without memory or desire” points to a related concern about exploring the material in each session without restricting preconceptions. I believe that the dynamic and economic criteria of interpretation can be summarized from a contemporary perspective by stating that interpretation should be guided by the analyst’s assessment of the dominant affective investment at any particular time, predominantly but not exclusively through the analysis of the transference and proceeding from surface to depth, with awareness of the existence of multiple surfaces and the possibility that the same impulse-defense organization can be approached from alternative surfaces into a common depth. Increasing Concern with the “Indoctrination” of Patients
Widespread concern has been expressed over the risk of involuntarily seducing the patient to adapt the theory or at least the language of the analyst, thus producing “transference cure” rather than transference resolution and appearing falsely to confirm the analyst’s theories as they are reflected in the patient’s reorganization of his subjective experience. This preoccupation has taken different forms in the different approaches: ego psychology has criticized the concept of “resistance” as potentially fostering an adversary relation between patient and analyst and imposing the analyst’s views on the patient (Schafer, 1992); Kleinians address the problem in Bion’s Notes on Memory and Desire (1967a), warning against analysts’ preconceptions before each session; Lacanians write of the notion of the analyst as the “subject of supposed knowledge” (see Etchegoyen, 1991, chap. 11). The consistent emphasis in self psychology on empathy with the patient’s subjective experience also implicitly contains a criticism of authoritative interpreta-
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tions (Schwaber, 1990). Interpersonal psychoanalysis and the Independents, in stressing the fundamental importance of clarifying disruptions in patient-analyst communication, have always focused implicitly on the possibility that the analyst may impose his views on the patient. The problem is that the analyst’s theoretical orientation will inevitably influence his style of communication, and the patient, given his alertness to the analyst’s communications, will necessarily extract a view of the analyst’s approach. It is usually not difficult to recognize the analyst’s theoretical background from any of his particular interventions. An analyst’s cautious avoidance of any interpretation that might be challenged as an “imposition” on the patient may lead to the acting out of sadomasochistic transferences as much as if the analyst in fact imposed his formulations on the patient. Awareness of this dialectic increasingly influences psychoanalytic technique, and there is a general tendency to avoid formulations that might lend themselves to intellectualized reorganization of the patient’s experience, bringing about closure rather than opening a potential space for the unexpected. Increased Questioning of Linear Concepts of Development
There is an increasing tendency to question the linear sequence from oral to anal to genital and oedipal conflicts, in contrast to the elaboration, in the psychoanalytic process, of highly individualized sequences of condensed oedipal and preoedipal structures. The current trend is for the analysis of transference paradigms to oscillate between the analysis of highly condensed, synchronic structures that incorporate disparate aspects of the past and the analysis of any particular diachronic line of development that emerges temporarily within those condensed structures. This development, perhaps most strongly accentuated among Lacanians but characteristic as well of non-Lacanian French psychoanalysis, also focuses on the structural aspects and developmental consequences of early oedipalization, the archaic Oedipus. This emerging consensus, in my view, is still being obscured by the older controversy regarding the dominance of oedipal and/or preoedipal issues in psychopathology, which separates self psychology and some radical interpersonal psychoanalysts from ego psychology, the British schools, French mainstream, and Lacanian psychoanalysis. Careful exploration of the developmental schemata of all these approaches, however, indicates that the intimate interrelationship between preoedipal and oedipal conflicts and structures decreases the importance of the more traditional linear models
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of development. For example, the original oedipal structuring of reality, the archaic Oedipus situation, proposed by both Lacanian theory and the French mainstream (Lacan, 1966; Le Guen, 1974; Benvenuto and Kennedy, 1986; Chasseguet-Smirgel, 1986), points to the original function of the father as the third party interfering with the symbiotic relationship of mother and infant, so that the progression from archaic oedipal conflicts to the advanced oedipal conflicts occurs simultaneously with the development of oral and anal conflicts. At the same time, psychoanalytic literature dealing with severe character pathology and borderline conditions generally points to the intimate condensation of oedipal and preoedipal conflicts in these patients (Akhtar, 1992; Kernberg, 1984, 1992; Rosenfeld, 1987). My view is that the more severe the patient’s psychopathology, the more we find condensed manifestations of early and later conflicts, so that only in advanced stages of the treatment do we find transferences that conform to the classical models of predominantly oral or anal unconscious conflict material. From a theoretical viewpoint, the importance of retrospective modification of past experience in the light of later ones (Freud’s Nachträglichkeit) has changed the nature of our discussion of the emergence of very early, particularly preverbal material in the psychoanalytic situation. DIVERGENCES The “Real” Relationship and Transference-Countertransference Issues
Significant differences in the conceptualization of the psychoanalytic process cut across the major schools. At one extreme is the assumption that everything in the patient-analyst relationship is transference and that even the “unobjectable” aspects of the transference, related to what Zetzel (1956, 1965) called the therapeutic alliance and Greenson (1965) the working alliance or working relationship, reflect transference dispositions stemming from a normally achieved trusting relationship between the infant and mother. In self psychology, for example, the assumption that throughout the treatment, the analyst fulfills self-object functions that continue as a normal aspect of human life for all individuals implies such a view. This position, which considers all aspects of the analyst-patient relationship as reflecting transference dispositions, makes it difficult to conceptualize how the transference can be analyzed and resolved (Thomä and Kächele, 1987). Those who, like most ego psychologists, assume that a “real” relationship exists independently of the transference and that the therapeutic al-
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liance reflects the working relationship between the healthy part of the patient’s ego and the analyst in his professional role may unwittingly foster a distortion of the psychoanalytic situation in the direction of conventionality, in which unacknowledged, culturally and socially determined joint biases of patient and analyst help to restrict the full investigation of the transference: this is, in effect, a critique that Deserno (1990) in Germany makes of the concept of the therapeutic alliance. The role of the analyst is also related to whether one believes that the therapeutic effect of psychoanalysis derives from interpretation alone or from a new experience that will permit compensation for the patient’s developmental deficits and arrest and facilitate the resumption of growth by means of a new (we might even say corrective) emotional experience. This position often emphasizes the particular personality of the analyst as contributing to this new experience. In all fairness, this is a matter not of the analyst’s artificially providing the patient with a “corrective emotional experience”—that is, of manipulating the transference—but of providing an authentic relationship in which the personality of both participants participate, along with, certainly, transference and countertransference analysis. A third factor, which intersects with these two, is represented at one extreme by the position that the transference is an exclusive creation of the patient, the unconscious reproduction in the here and now of pathogenic conflicts and object relations from the past, with the analyst remaining outside these conflicts except to facilitate their clarification by the successive analysis of transference paradigms. This position is often linked with the traditional concept of the transference neurosis as the sequential deployment in the transference of the patient’s unconscious conflicts, with a gradual concentration of these conflicts as opposed to other areas of the patient’s life and with the possibility of their gradual resolution by systematic transference interpretation. This position, rather strongly maintained by both ego psychologists and Kleinians, was challenged by Gill (Gill and Hoffman, 1982a, 1982b) from within ego psychology and developed further by Thomä and Kächele (1987). These writers emphasized the analyst’s contributions to the transference, as did both the Independents and the interpersonalists somewhat earlier. Thus, paradoxically, traditional ego psychology contrasts the real relationship and the transference relationship but downplays the importance of the analyst’s personality. The interpersonal approach (Greenberg, 1991; Mitchell, 1988), by contrast, proposes that the analyst’s personality unavoidably influences the transference and that, in order for the patient to experience him as a “safe” object, the analyst must
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modify his behavior to maintain equidistance from the danger of being “unsafe” and from colluding with the transference. This approach thus stresses the unavoidability of mutuality in transference-countertransference activation and, implicitly, what may be considered a manipulative adaptation by the analyst to the patient’s transference. My view is that the reality of the analyst’s personality becomes important only insofar as it serves as an anchoring point for the transference, where the analyst’s ongoing self-scrutiny of his own behavior and countertransference reactions is required. I also view the patient’s capacity to use the “real” aspects of the therapeutic relationship in the case of very ill patients, that is, to perceive the analyst realistically in his therapeutic role, as a consequence of the analysis of regressive transferences. In contrast, the analyst’s regression to his own defensive character patterns in response to severely pathological transference-countertransference developments with chronically regressed patients requires the protection of the treatment frame and the analytic working through of the transference simultaneously with attempts to utilize the understanding derived from his own countertransference. In short, I agree with Etchegoyen’s criticism (1991) of the interpersonal approach for its overemphasis on the importance of the analyst’s personality. Therapeutic versus Resistance Aspects of Regression
The controversy in this area, related to the preceding one, refers specifically to the transference regression of patients with severe psychopathology. The Independents, following Balint (1968) and particularly Winnicott (1965), argue for the therapeutic value of regression in the transference in patients with severe personality disorders, particularly the severely schizoid, the antisocial, and those with generally “false self ” characteristics. The assumption is that the analyst’s capacity to tolerate and to “hold” the patient during this regression permits “a new encounter,” a resumption of normal growth at certain points even without full verbalization of this experience by the analyst. Interpersonal psychoanalysts Sullivan (1953), Fromm-Reichmann (1950), and Searles (1979) also considered the possibility that severe regression may have therapeutic effects as long as the therapist analyzes the negative, terrorizing misinterpretations of the treatment situation that interfere with the regressed patient’s capacity to resume emotional growth. The Kleinians, in contrast, particularly Rosenfeld (1987), stressed the importance of systematic analysis of the positive and negative transference of severely regressed patients, with the analyst remaining in a technically
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neutral position. The object relations approach that has evolved within ego psychology ( Jacobson, 1971; Kernberg, 1975, 1984; Kernberg et al., 1989) has proposed a technique that provides structuring of the treatment frame in order to protect the severely regressed patient and the treatment situation; at the same time it stresses the importance of an essentially interpretive approach. Etchegoyen (1991) spells out recent Kleinian contributions to the analysis of severe regressions in the transference that permit the maintenance of a consistent psychoanalytic frame and of the analyst’s technical neutrality. My view is that, particularly with those severely regressed patients with whom a psychoanalytic approach is still warranted, providing sufficient structure to permit the maintenance of an analytic setting and interpretation of the patient’s primitive defensive operations and object relations in the transference makes it possible to gradually transform regressive transferences into more advanced ones, strengthens the patient’s ego, and allows him to collaborate in the analytic exploration. Under these circumstances, analysis of the reasons for whatever deviations from technical neutrality have occurred protects and permits reinstating of the psychoanalytic frame. Increasing attention to severe cases of borderline, narcissistic, and perverse psychopathology in recent years has highlighted the importance of some patients’ efforts to protect themselves from the painful awareness of their primitive hatred by destroying the communicative process in the analytic situation and thus the very viability of the analytic situation itself. Severe, often life-threatening forms of acting out, destructive violence in the sessions, and constant challenges to the boundaries of the psychoanalytic situation might be said to reflect symbolically the struggle between love and aggression at the deepest levels of regression: now the psychoanalytic frame stands for the survival of the analytic process geared to resolving this calamity. I believe that when the interpretation of the patient’s consistent attacks on the analytic frame does not manage to protect the frame, to “contain” or “hold” the analytic relationship, limit-setting or structuring of the analytic situation becomes essential. This in itself represents a modified frame that permits the interpretive work to continue and to be followed eventually by the interpretive resolution of that limiting structuralization itself. Psychoanalysis and Psychoanalytic Psychotherapy
In the long-standing controversy between these modalities, two problems are involved: the boundaries of what may be considered standard analysis in contrast to its modification or extension for patients who are not able to un-
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dergo such treatment, and the question of the “dilution” of standard technique when a clear distinction between psychoanalysis and psychoanalytic psychotherapy is not maintained, as opposed to those who wish to experiment freely with the elements of the psychoanalytic technique and apply it to new fields. In general, both ego psychology and Kleinians favor a firm distinction between psychoanalysis and other psychotherapies, while the Independents and the interpersonalists maintain more flexible boundaries. Greater flexibility probably also characterizes child psychoanalysis within the French mainstream. My view is that, because it is helpful to evaluate the specific effects of the technical approach utilized, it is advisable to differentiate standard psychoanalysis rather sharply from psychoanalytic psychotherapy, but without regarding psychoanalytic psychotherapy as a “second best” treatment. I have proposed that this differentiation be done on the basis of three tools derived from standard psychoanalytic technique which are used in modified form in psychoanalytic psychotherapy. First, interpretation is restricted to the clarification, confrontation, and interpretation of the unconscious meanings in the here and now; genetic reconstructions are reserved for the advanced stages of treatment. Second, in each session, transference analysis incorporates attention to the long-range treatment goals and the dominant current conflicts in the patient’s life outside the sessions. Third, technical neutrality in psychoanalytic psychotherapy must be modified by the need to structure or set limits in the treatment situation but must eventually be reinstated by the therapist’s clarifying to the patient by means of interpretation the reasons for departing from the neutral position in the first place (Kernberg, 1975, 1984; Kernberg et al., 1989). The Role of Empathy
Here the controversy is particularly between self psychology and all other psychoanalytic orientations. Whereas self psychology stresses the primacy of the analyst’s empathy with the patient’s subjective experiences and the need to focus on such experiences, particularly at moments of disruption of the affective relationship between patient and analyst, all other approaches consider the capacity for empathy a general precondition for all psychoanalytic work and broaden the concept to include the analyst’s empathy not only with the patient’s central emotional experience but also with that which the patient cannot tolerate in himself and thus projects or dissociates.
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In this regard, the concept of projective identification, originally formulated by Klein (1946) but gradually adopted by the Independents, the interpersonalists, the French mainstream, and significant sectors of the object relations ego psychology approaches, implies the need to empathize not only with the patient’s current self experience but also with what the patient projects, dissociates, or represses. All psychoanalytic approaches point to empathy as a precondition for the capacity for analyzing transference and countertransference, and utilizing empathy with the patient’s subjective experience in transference interpretation. In contrast to self psychology, the other approaches focus on the multiplicity of observational data in the psychoanalytic situation. A related issue is whether negative transference simply reflects the traumatic disruption of a “self self-object relationship” (that is, of a positive transference), as self psychology asserts, or the activation of “negative introjects” (of persecutory in contrast to idealized self and object representations), as all non–self psychology approaches affirm. With severely ill patients, where verbal communication itself may be distorted at times in the service of defense in an effort to remain empathically in touch with the patient, the analyst may adapt himself to the patient’s style, thus unwittingly reinforcing the resistance. At other times, the analyst’s complete absorption in an effort to understand the patient’s confusing communication at the cost of a loss of the analyst’s internal freedom to interpret this very process may also paralyze his analytic function: here, one might say, efforts at empathy may become dangerous. An opposite danger under such circumstances is that the analyst may defensively fall back on his general theoretical formulation, thus, in effect, disconnecting himself from the disorganizing process in the transference that requires his understanding. “Historical Truth” versus “Narrative Truth”
The contributions of Schafer (1976, 1992) and Spence (1982) represent a radical proposal that the attempt to reconstruct historical truth and causality be replaced by the construction of new narrative “myths.” They even question the possibility of reconstructing the historical past, despite the traditional assumption that this facilitates and signals the resolution of the transference. It may be that this controversy represents a temporary turbulence in psychoanalytic thinking, in the sense that it points to the problematic nature of many “historical” reconstructions and to the facts that most of them are based on unconscious meanings in the here and now, that the
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“logical fit” of the present into the past is often problematic, and that the correspondence between past and present is open to vastly different views. I agree with Klein’s widely accepted position (1952) that the transference represents real experiences from the past, fantasized experiences from the past, and defenses against both. Recent knowledge regarding actual physical, mental, or sexual trauma in the early infancy and childhood of patients with regressive psychopathology has not solved this problem. Between historically documented, severely traumatizing situations in the past and the current, unconscious mental structures of our patients lie significant transformational processes. To interpret current transference regressions directly on the assumption that they are repetitions of such past trauma may bypass the unconscious meanings of the trauma and its developmental structuralizations. A typical example is the failure to interpret, in victims of physical or sexual abuse, their unconscious identification with the aggressor and the elaboration of that identification activated in the transference. Technical Neutrality and Cultural Bias
Cremerius (1984) raises the question whether there is unconscious collusion of analysts and patients regarding social, cultural, and political issues, ideologies, and power struggles. Here the approaches of some feminist and Marxist psychoanalytic groups converge. In contrast to this viewpoint, the question has been raised whether excessive concern over “hidden” ideologies may transform the analytic encounter into a political project. At the same time, in support of the concern over ideological distortions, the avoidance of covert—and overt—political issues, including psychoanalytic politics, may reflect an unconscious collusion between patient and analyst. Efforts to recognize how these hidden ideologies affect the psychoanalytic process may, I believe, enrich it. The Reconstruction and Recovery of Preverbal Experiences
The traditional criticism of Kleinian analysis by ego psychologists centered on the Kleinian interpretation of assumed developments in the first year of life and the related assumption that the infant possesses a degree of sophistication and complexity of unconscious fantasy that does not seem likely. Paradoxically, recent infant research has demonstrated much greater complexity of mother-infant interaction in the first year of life than ego psychology traditionally assumed. Further, on the basis of their own experience over the past thirty years, Kleinian analysts have become much more
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cautious and reluctant in carrying out early genetic reconstructions of the preverbal period. Simultaneously, the impact of Mahler’s investigation of children with symbiotic psychosis and of the separation-individuation process has given new impetus to the exploration of preverbal material in patients’ nonverbal manifestations and relationship to the analytic setting (Akhtar and Parens, 1991). Child observation, Mahler’s developmental approach, and the analytic exploration of regressive transferences from many viewpoints all point to the importance of continuing investigation of the preverbal in the analytic setting. The increased emphasis on “retrospective modification” by the Lacanian school as well as the French mainstream has provided an additional impetus to the exploration of the condensation of the preverbal with material from later levels of development, a position not far from the ego psychology view that all aspects of early development can be seen only in the context of their developmental transformation under the impact of advanced oedipal relationships (Arlow, 1991). In short, it may be that this controversy is being laid to rest.
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recent developments in the technical approaches of english-language psychoanalytic schools
The “controversial discussions” at the British Psychoanalytic Society between 1941 and 1945 (King and Steiner, 1991), ending with the “gentlemen’s agreement” among Melanie Klein, Anna Freud, and Sylvia Payne, constitute, in my view, the starting point of the contemporary developments of approaches to technique within the English-speaking, particularly the North American and the British Psychoanalytic, communities. Those controversial discussions led to a clearer definition of the respective approaches of the ego psychological group led by Anna Freud, now called the “contemporary Freudians”; the Kleinian approach led by Melanie Klein; and the “middle group” approach, now called the “British Independents,” inspired by the theoretical approaches of Balint (1968), Fairbairn (1954), and Winnicott (1958, 1965). At first, these controversial discussions initiated a sharp differentiation of psychoanalytic approaches, perhaps most clearly reflected in the traditional Kleinian approach in Great Britain, on the one hand, and the ego psychological approach, under the influence of Hartmann and his group in the United States, on the other. The traditional Kleinian approach, intimately linked to the revolutionary exploration of primitive object relations and primitive defensive operations described by Melanie Klein (1945, 1946, 1952, 1957), her stress on the earliest, preoedipal levels of development, and the clinical application of Freud’s theory of the death drive, was characterized by the following features: an approach to the clinical material from the viewpoint of a focus on the maximum anxiety expressed by the patient at any particular point, the Published in the Psychoanalytic Quarterly 70 (3) (2001): 519–547. 285
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effort to interpret his unconscious fantasies at the deepest level, and an ongoing exploration of primitive object relations within the frame of the paranoid-schizoid and depressive positions (Segal, 1973, 1981, 1986). Kleinians insisted on the early, consistent, and comprehensive analysis of transference developments, the exploration of the deployment of an unconscious world of internalized object relations in the transference, and the linkages of such transferences with primitive fantasies involving bodily aspects and the interior of mother’s body. Kleinian authors proposed that unconscious fantasy, involving instinctually dominated, primitive object relations, represented at the same time primitive impulses and the defenses against them, so that unconscious fantasies were considered as the mental correlates of the drives. They have made fundamental contributions to countertransference analysis (Racker, 1968). In contrast, the ego psychology approach focused on later levels of development centered on interstructural conflicts and the centrality of the oedipal situation, the analysis of unconscious conflicts as represented by impulse-defense configurations with a particular focus on the defensive structures of the ego—including character defenses—and the analysis of such defenses as they become resistances in the psychoanalytic treatment situation. The dominance of the consideration of the structural theory (“second topic” within French psychoanalysis) as the basis for interpretation also implied the importance of superego defenses, the role of unconscious guilt. Fenichel’s text Problems of Psychoanalytic Technique of 1941 was the fundamental statement of the technical approach of ego psychology, later expanded in Greenson’s classical text (1967), and Rangell’s contributions (1963a, 1963b). Fenichel spelled out the economic, dynamic, and structural criteria for interpretation, stressed the importance of interpreting always from the side of the ego, from surface to depth, and considered the interstructural relations of the conflict between defense and impulse. Fenichel’s work remained the definitive summary of ego psychology technique well into the era of the “contemporary Freudian” approach in the United States. The British Independents, the original “middle group,” acknowledged their roots in both ego psychology, as represented by Anna Freud, and the Kleinian approach, particularly the latter’s emphasis on internalized object relations as a guiding principle for psychic development, structure formation, and psychoanalytic technique (Kohon, 1986; Little, 1951; Rayner, 1991; Stewart, 1992). Their technical stress was on the exploration of affective developments in the psychoanalytic situation, the importance of pre-
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oedipal stages, the centrality of countertransference analysis, and the consideration of early traumatic situations as bringing about a “basic fault” (Balint, 1968) that might require modifications in technique with regard to tolerance and interpretive management of severe regression. The analysis of transitional phenomena and of the true and false self, expressing Winnicott’s contributions (1958, 1965), as well as the systematic analysis of the relationships with “bad internal objects” stressed by Fairbairn (1954), converged in the stress on the analysis of the transference, although transference analysis was not the exclusive focus. The Independents also made use of the Kleinian contributions to the understanding of primitive object relations and primitive defenses, particularly projective identification, but they also recognized the implications for psychopathology of more advanced levels of development and the impact of later developmental stages on intrapsychic structure and the psychoanalytic situation. Because the Independents occupied an intermediate position between the approaches of ego psychology and the Kleinians, their boundaries are more difficult to define; by the same token, they contributed fundamentally to the gradual rapprochement of the ego psychology and the Kleinian approaches in the last twenty years. In fact, the most impressive development of psychoanalytic technique within the English-language psychoanalytic community, in my view, is the gradual rapprochement of these three viewpoints, as members of the separate groups learned about each other’s ideas in their confrontations at international meetings, and as practicing clinicians gradually recognized the therapeutic limitations of whichever theory they were attempting to apply. Thus new generations of psychoanalysts reshaped the respective technical formulations. Within the Kleinian school, Rosenfeld’s analysis (1964, 1987) of the narcissistic personality, applying Klein’s contributions in Envy and Gratitude (1957) to a particular character pathology that had proven to be remarkably resistant to classical psychoanalytic technique, implicitly introduced the concept of character analysis—so central to ego psychology— into Kleinian technique. The development of this approach in Steiner’s analysis (1993) of “psychic retreats” expanded the Kleinian analysis to pathological personality organization and an explicit focus on the “here and now” analysis of characterological resistances. While Bion’s work (1967b) focused mostly on primitive transferences of severely regressed patients, his questioning of the authoritarian stance of the psychoanalyst, distilled in his famous recommendation to analyze “without memory nor de-
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sire,” also raised implicit questions about the categorical style of interpretation of traditional Kleinian analysis (Bion, 1967a, 1970). The Kleinian mainstream, represented particularly by the group led by Hanna Segal (1973, 1979, 1981), Betty Joseph (1989), and Elizabeth Spillius and reflected in the fundamental Melanie Klein Today volumes (Spillius, 1988), proposed fundamental changes in Kleinian technique: the focus on unconscious fantasy was maintained, but shifted from its concern with anatomical organs to stress on the functions of primitive fantasy. The interpretive style became less categorical; less focused on aggression, destructiveness, and envy; and more focused on the dominant level of anxiety in the “here and now” rather than on the assumed deepest level of anxiety. Increasing attention was paid to projective identification as it affects transference and countertransference, to the patient’s implicit expectations reflected in the analyst’s being tempted to move into certain interventions, with an increased focus on nonverbal behavior and on the interactions in the here and now. All of these developments moved Kleinian analysis in the direction of ego psychology without explicit acknowledgment of this shift. Nevertheless, Kleinian interpretations were no longer dealing so much with bodily fantasy as with the present level of mental functioning of the patient and his level of symbolization (Spillius and Feldman, 1989; Segal, 1981, 1986). In the United States, Ogden (1982, 1986, 1989) introduced a Kleinian approach—with some Winnicottian aspects to the psychoanalytic approach to psychotic patients. Simultaneously, within the contemporary Freudian approach, Sandler and Sandler (Sandler, 1976, 1987; Sandler et al., 1992; Sandler and Sandler, 1984), in Great Britain, and a variety of American psychoanalysts within the ego psychology tradition began to include an object relations perspective in their theoretical formulations and technical interventions. Modell (1990), influenced by Winnicott, introduced an object relations approach. Authors dealing with borderline psychopathology and severely regressed patients in general, such as Jacobson (1971), Searles (1979), Volkan (1976), and myself (1976, 1984, 1992), introduced an object relations approach focusing on the consequences of earliest internalizations for primitive defenses and object relations, and particularly on the clinical implications of splitting mechanisms and projective identification, including concepts and technical approaches from the Kleinian and Independent British schools. Sandler and Sandler (1998), in an implicit critique of the ego psychology tradition of interpreting “pure” drive derivatives in the context of the analysis of the defenses against them, stressed that unconscious fantasy in-
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cludes not simply derivatives of libidinal and aggressive drives but specific wishes for gratifying relationships between the self and significant objects. They proposed that unconscious fantasy thus takes the form of wishes for specific relationships of the self with objects represented by fantasized, desirable relations between self representations and object representations. In this view, the expression of impulses and their derivatives is transformed into a desired interaction with an object, and a wishful fantasy includes the reaction of the object to the wishful action of the individual. In the transference, the patient expresses behavior dedicated to the induction of complementary actions on the part of significant objects, at the same time being unconsciously attuned to the “role responsiveness” of the analyst. The analyst’s countertransference, codetermined by the patient’s transference developments and by the unconscious role responsiveness of the analyst, facilitates the actualization of unconsciously fantasized object relations in the transference. This provides the analyst with a powerful tool for the interpretation of unconscious fantasy in the “here and now.” Sandler and Sandler described the continuities and discontinuities between the most primitive realizations of unconscious fantasy in hallucinatory wish fulfillment and delusion formation, the complex layers of unconscious and conscious daydreaming, and the unconscious and conscious illusory transformation of the perception of present reality. They clarified, in a contemporary ego psychology theoretical frame, the differences between the ego as an “impersonal” set of structures and the “representational world” constituted by representations of self and object and of ideal self and ideal object. Affectively invested internalized object relations are actualized in the transference not only in specific, fantasized desires and fears emerging in free association, but also—and significantly so—in the patient’s character traits that emerge as transference resistances, very often in the early stages of the analysis. Sandler and Sandler stressed the central importance of affects as the link between self and object representations in any particular fantasized interaction between them, thus expanding the theoretical formulations originally laid down by Jacobson. The clinical rapprochement of ego psychology with the Kleinian approach is signaled most impressively by Roy Schafer in his recent book, The Contemporary Kleinians of London (1997), an extremely careful, critical, yet obviously sympathetic exploration of key contributions from the contemporary British Kleinians addressed to a North American audience. A new mainstream of psychoanalytic technique within the English-language psychoanalytic community seems to be evolving.
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At this point we must introduce an additional perspective that complicates everything said so far. Heinz Kohut’s 1971 book The Analysis of the Self and Merton Gill’s Analysis of Transference (Gill, 1982; Gill and Hoffman, 1982a), starting from completely different theoretical perspectives and reaching very different conclusions, represented, nevertheless, a significant new current in North American psychoanalytic thinking. This current gradually established a relationship with the culturalist psychoanalytic approach in the United States that, beginning with Harry Stack Sullivan (1953), had persisted as a tradition parallel to the psychoanalytic community of the International Psychoanalytic Association and that now surfaced as the contemporary interpersonal, or relational approach in psychoanalysis. Self psychology, the intersubjective approach, and the relational and interpersonal psychoanalytic orientations together constitute a major alternative to the psychoanalytic mainstream within the English-language psychoanalytic community (Greenberg and Mitchell, 1983; Greenberg, 1991; Mitchell, 1988, 1997; Stolorow et al., 1983, 1987). Heinz Kohut’s self psychology (1971, 1977, 1984) had significant implications for psychoanalytic technique. In contrast to the recommendations of Herbert Rosenfeld (1964) and myself (1984) regarding the technical approaches with narcissistic personalities, Kohut proposed that the narcissistic pathology constituted a specific pathology intermediate between psychosis and borderline conditions, on the one hand, and neurosis, on the other, differentiated by the specific idealizing and mirroring transferences of these patients. These transferences reflected the activation of an archaic, rudimentary self, whose narcissistic equilibrium could be safeguarded only by the interest and approval of current replicas of traumatically missing self-objects of the past. The analyst’s task is to facilitate the consolidation of the grandiose self. Later, more mature forms of the self, reflected in selfesteem and self-confidence, can develop upon that initial groundwork. The analyst, instead of operating from a position of technical neutrality, must operate within a self self-object relationship, within which tolerance of the patient’s idealization and the facilitation of adequate mirroring permit the healing process to occur. The idealization of the analyst replicates the normal process of the transmuting internalization of the idealized self-object into the ego ideal, thus facilitating the consolidation of the tripartite structure. Narcissistic psychopathology, in the self psychology view, is due to the traumatic failure of empathic mothering functions and the corresponding failure of the idealization of the self-object to flourish. It constitutes a devel-
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opmental arrest, with a fixation at the level of the archaic infantile grandiose self and an endless search for idealized self-objects needed to complete structure formation. As a consequence, these patients experience repeated, severe traumatizations as their needs and expectations are not met, traumatizations that are activated in the transference and thus are subject to interpretive resolution. The corresponding psychoanalytic technique implies that narcissistic idealization of the analyst must be permitted in the unfolding of the idealizing and mirror transferences. The patient’s reliving of early traumas by experiencing himself as misunderstood by the analyst must be explored by means of the analyst’s empathic recognition of this disappointment and the analysis of the patient’s experience of the analyst’s failure to meet his needs. The analyst’s inevitable failure to avoid narcissistic traumatizations of the patient brings about temporary traumatic fragmentation of the grandiose self, narcissistic rage, severe anxiety, and hypochondriasis; traumatization that is severe and unrepaired may lead to the evolution of delusion formation of the grandiose self, with a paranoid form of grandiosity. It is essential, therefore, that the analyst explore how he failed the patient due to a lack of appropriate empathy. For Kohut, self self-object relations are never fully resolved, because they constitute a normal need throughout the lifetime. The technical approach derived from Kohut’s theory focused sharply on the “here and now” relationship in the context of an exploration of potentially traumatic effects of breakdown in the analyst’s empathy. With its de-emphasis of such classical psychoanalytic concepts as the importance of unconscious aggression and the centrality of the oedipal conflict and of infantile sexuality and its rejection of technical neutrality, self psychology constituted a major challenge to the dominant ego psychology approach within American psychoanalysis. The fact that it was possible to “contain” self psychology within the overall scientific, professional, and administrative structure of the American Psychoanalytic Association (in contrast to the earlier rejection of the culturalist school) had fundamental consequences in bringing to an end the dominance of ego psychology within the educational structure of North American psychoanalysis. Paradoxically, this development opened the field to the modifications of ego psychology inspired by the object relations theory that had evolved as a consequence of the exploration of severe psychopathologies and the related focus on preoedipal pathology, primitive object relations, and defensive operations.
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As part of this opening during the last thirty years, and in parallel with the incorporation of self psychology and neo-Kohutian contributions within the American Psychoanalytic Association, the fundamental contributions of Mahler (Mahler and Furer, 1968; Mahler et al., 1975) to the developmental analysis of normal and pathological separation-individuation and its implication for the treatment of borderline conditions became generally accepted, and my own efforts to integrate ego psychology and object relations theory became less controversial. Independently, Loewald (1960, 1980) introduced an object relations perspective into his exploration of the analytic process. At the same time, insofar as self psychology stressed the importance of early deficits—in contrast to the universal etiologic importance of unconscious conflicts—a broad spectrum of authors explored the implication of early deficits in severe psychopathologies for psychoanalytic technique and its modifications. Simultaneously, Ogden (1982, 1986, 1989) applied British Independent and Kleinian approaches to the treatment of patients with severe psychopathology, and the focus on “projective identification” was no longer a sign of “anti-American” activity. Gill and Hoffman (Gill, 1982, 1994; Gill and Hoffman, 1982a, 1982b), starting from a basis in traditional ego psychology, modified it in the light of their empirical research on the psychoanalytic situation, creating further theoretical and technical shifts in the thinking of North American psychoanalysts. Gill demonstrated convincingly that transference phenomena are ubiquitous from the beginning of the treatment and stressed the importance of transference analysis from the very start, in contrast to the cautious approach to transference analysis in traditional ego psychology. Furthermore, in radically questioning the traditional ego psychology concept of transference “as primarily a distortion of the present by the patient’s past,” he proposed that “transference is always an amalgam of past and present, and is based on as plausible a response to the immediate analytic situation as the patient can muster.”“This view implies a shift to the position that the analyst is per force a participant-observer (Sullivan’s term) rather than merely an observer. It also implies a shift from the view of the reality of the analytic situation as objectively definable by the analyst to a view of the reality of the analytic situation as defined by the progressive elucidation of the manner in which that situation is experienced by the patient” (Gill, 1982, p. 177). The transference, in short, is a result of the interaction between the patient and the analyst, and Gill therefore stressed the importance of honest self-scrutiny on the analyst’s part. This represented an important, implicit
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critique of the authoritarian imposition of the analyst’s view as part of his interpretive function. Gill’s proposal also implied that the analyst cannot study the analytic situation objectively and that the analyst’s view of reality must be defined, as mentioned before, by “the progressive elucidation of the manner in which that situation is experienced by the patient.” This “constructivist” view of the transference stands in contrast to the “objectivist” view of it on the part of most American ego psychological and all British approaches; it sharply focuses the analyst’s attention on the “here and now” interaction with the patient in terms of the reality aspects of this interaction, and not only the reproduction of the patient’s unconscious fantasies. It represents a definite shift from a “one-person psychology” to a “two-person psychology” approach, and to the focus on the actual, conscious and unconscious interactions between patient and analyst as the major focus of the psychoanalytic endeavor, with an emphasis on transference and countertransference analysis that implicitly privileges the patient’s subjective experience. This constructivist orientation was developed further in the intersubjective approach of Atwood and Stolorow (Atwood and Stolorow, 1984; Stolorow, 1984, 1992; Stolorow and Atwood, 1979; Stolorow and Lachmann, 1980; Stolorow et al., 1983, 1987) and established theoretical as well as technical relations with the interpersonal or relational approach of Greenberg and Mitchell (1983). A broad spectrum of psychoanalytic approaches within what might be called an overall self psychology–intersubjectivity–interpersonal framework evolved in recent years in the United States (Bacal, 1990; Levenson, 1972, 1983, 1991; Mitchell, 1988, 1993; Mitchell and Black, 1995; Mitchell and Aron, 1999). At a clinical level, the focus of self psychology on self self-object transferences as a major matrix of psychoanalytic treatment has implied a movement away from the technical neutrality that characterizes the traditional ego psychology, Kleinian, Independent, and contemporary mainstream psychoanalytic approaches I referred to before. Post-Kohutian self psychology, analyzing within a frame of providing self-object functions, has evolved into an emphasis on emotional attunement as a basic attitude to help the patient clarify his own subjectivity in the light of the analyst’s empathic, subjective immersion in the patient’s experience, and with acknowledgment of the intersubjective reality established in the interplay between the patient’s and the analyst’s subjectivity (Schwaber, 1983). The self-object function of the analyst is translated into his interpretive function in clarifying the patient’s affective experience. Both deficit
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models and conflict models of psychopathology may be combined in this emphasis on a sustained empathic immersion of the analyst in the patient’s evolving subjective experience. This approach accentuates an “anti-authoritarian” attitude of the analyst, questions the privileged nature of the analyst’s subjectivity, and questions the function of technical neutrality and anonymity of the analyst. The focus on the analyst’s role in compensating for past deficits, for overstimulation or understimulation of the patient’s archaic self, and for the absence or lack of soothing by the parental figures—with a consequent frailty of the development of the self—may derive from a self psychological perspective, but also from the application of a model of infant-mother relationship that focuses on deficits and conflicts derived from separation-individuation. The interpersonal perspective derived from culturalist psychoanalysis, originating in Harry Stack Sullivan’s contributions (1953), focuses on the development of the self as intimately linked with interpersonal experiences. Personality development, in this view, is intrinsically linked with the interpersonal field, as psychic life is continuously remodeled by past as well as new relationships, rather than being determined by fixed structures derived from past unconscious conflicts. This concept of the personality as developing in a relational matrix (rather than expressing conflicts between drives and defenses against them) requires a focus on the intersubjective field in the relationship between patient and analyst. This new relational matrix, fully explored and interpretively modified, would bring about emotional growth by the patient’s integration of these new affective interpersonal experiences. A major consequence of this overall shift of psychoanalytic perspective is the questioning of the traditional, objectivist view of the analyst’s subjectivity in facing the patient with his transference distortions and their origins. In the constructivist model, exploration of the new affective relational developments in the psychoanalytic situation is the basic source of mutual understanding of patient and analyst, and the patient’s incorporation of this affective experience is seen as a major therapeutic factor. A further consequence of the emphasis on the privileged subjectivity of the patient is the movement away from the interpretation of the aggressive aspects of the transference. If aggression is due to the breakdown of the positive relationship in the patient-analyst interaction and the loss of empathic attunement, it may be traced to that loss rather than to intrapsychic conflicts in the patient.
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Some authors would consider self psychology as a partial object relations theory focused on the positive, growth-promoting aspects of the relational matrix, not necessarily in conflict with the consideration of the introjection of negative object relations as well. One final and quite characteristic aspect of all these object relational and intersubjective approaches is a relative de-emphasis of sexuality and the Oedipus complex, with major importance accorded to the early mother-infant relationship and the traumas of separation-individuation. The general consolidation of what I have described as the psychoanalytic mainstream has gradually brought the three traditional currents of the British Psychoanalytic Society closer, to the extent that, in my experience, when one hears clinical presentations by British psychoanalysts, it is no longer easy to differentiate those with a contemporary Kleinian background, an Independent background, or a contemporary Freudian background. In the United States, the traditional ego psychology approach has maintained its relative distinctiveness in the work of important contributors to the contemporary Freudian approach, such as Blum (1980, 1985), Jacobs (1991), Levy and Inderbitzin (1990), and Pine (1990), and particularly Gray and Busch. In fact, Gray (1986, 1994) and Busch (1995) may be considered the outstanding exponents of the development of the contemporary Freudian approach in the United States, maintaining a relatively classical ego psychology technical approach with a significant shift in their analysis of resistance. The traditional ego psychology approach, that is, the analysis of the patient’s material from the viewpoint of the ego and from surface to depth, uncovering, at each step, the layers of defenses protecting against unconscious drive derivatives—that, in turn, might eventually be integrated into defensive operations against still deeper aspects of unconscious drive derivatives—gradually had led to an increased focus on the conscious and preconscious aspects of the patient’s functioning in the psychoanalytic situation and/or the external reality in which this mode of functioning was also manifest. The focus on the manifestations of defensive structures as clinical resistances often led to an analysis of resistances as unconsciously motivated opposition to the analyst’s effort to uncover unconscious fantasy and motivation. “Resistance analysis” implied, under these circumstances, a quasi-authoritarian stance of the analyst, who pointed out to the patient that he was “resisting” the interpretive efforts. In all fairness, this viewpoint did not do justice to the subtle implications of Fenichel’s and Greenson’s contributions (Fenichel, 1941; Greenson, 1967), in the sense of analyzing
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the unconscious motivation of the resistances. In practice, however, “overcoming of resistances” had led ego psychological technique often to a potentially adversarial stance in the treatment situation. Against this tradition, Gray (1994) and Busch (1995), in following Gray’s footsteps, stressed the importance of analyzing the motivation of the patient’s resistances, focusing on the patient’s preconscious reasons for the mode of functioning that the analyst considered to have an unconsciously defensive purpose. Implicitly, the exploration of the reasons for the patient’s defensive operations led to the underlying object relations activated in the transference and permitted the resolution of defensive operations without “overcoming” of the resistances. Busch proposes that this approach may also be utilized in the analytic work with severe personality disorders, where severe ego distortions interfere with standard psychoanalytic technique, and the patient’s expression in action rather than in free association then may be explored in terms of the purposes and defensive functions of such actions, gradually helping the patient’s ego to reflect on the underlying fears and fantasies. Perhaps the most radical expression of a “purified” ego psychology approach in the United States—as contrasted with the gradual integrating move of the psychoanalytic mainstream—is represented by Charles Brenner’s recent proposal (1998) to drop all considerations of interstructural aspects of the patient’s intrapsychic life, to disregard the tripartite structure (or “second topic” in French analysis), and to focus exclusively on drives, unconscious conflicts, and compromise formations between drive derivatives and defensive functions. One might illustrate the wide divergences of recent developments in technical psychoanalytic approaches in the United States by contrasting this minimalist development within ego psychology with what might be considered the most radical expression of the intersubjective approach in the work of Owen Renik. Renik (1993, 1995, 1996, 1998a, 1998b, 1999) proposes a selective communication to the patient of aspects of the analyst’s countertransference in order to make the patient aware of how he is perceived by the analyst and of the impact of his personality upon their interaction, thus facilitating the analysis of the intersubjective aspects of transference and countertransference. His technique also accentuates the desirability of an anti-authoritarian approach to interpretation. Before I proceed to summarize the two major currents of English-language psychoanalytic approaches to technique as reflected in what I have called the “mainstream” approach and the intersubjective one, it needs to be
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stressed that, naturally, each individual psychoanalytic contributor would be justified in stressing that his or her particular approach cannot be completely subsumed in one or the other of these currents; major differences remain between authors who, from a very broad perspective, might be ordered along the lines I am suggesting. I do hope, however, that while such a summary necessarily has to do injustice to specific differentiations, it will provide an overview of how psychoanalysis is evolving at this point within the English-language communities. What follows are the characteristics of the contemporary psychoanalytic mainstream. 1
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Early and systematic interpretation of the transference. This includes the “total transference” of the Kleinians and the “present unconscious” of Sandler and Sandler, as well as Merton Gill’s analysis of resistances against the development, recognition, and elaboration of the transference within an ego psychological perspective. A central focus on countertransference analysis, and its utilization in the interpretation of transference, as a consistent aspect of psychoanalytic work, with a utilization of the contemporary “totalistic” concept of countertransference as consisting of all of the analyst’s emotional reactions to the patient. Systematic character analysis, without necessarily mentioning it by name. The analysis of transference resistances as characterologically based defensive operations that reflect an implicit unconscious object relationship emerges in the ego psychological approach (for example, as reflected in Gray’s and Busch’s work), in the Kleinian approach as the analysis of “pathological organizations,” and as pathological patterns of relationships in the Independent school. Anton Kris’s ego psychological contributions (1996) to the analysis of free association also imply such a focus on characterologically determined distortions of free association. A sharp focus on unconscious “enactments” in transference and countertransference developments, with a focus on unconscious meanings in the “here and now,” as part of the analysis of the transference from surface to depth in ego psychology. Resistances are conceived as object relationships and not simply as impersonal mechanisms. This corresponds to the Kleinians’ focus on functions in contrast to anatomy in the patient’s fantasies, and to their analysis of “total transference.” Focus on affective dominance: first stressed by the Independents, but
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now considered essential both in contemporary Freudian and in contemporary Kleinian approaches. A predominance of models of internalized object relations. Even Brenner, a bastion of ego psychology, abandons the focus on the tripartite structural model in his recent technical approach. Technical neutrality: in contrast to self psychology’s explicit abandonment of the stress on the analyst’s concerned objectivity, and in opposition to the “two-person”model of the intersubjective school, the contemporary psychoanalytic mainstream keeps a sharp focus precisely on that objectivity, by implicitly stressing a “three-person” model. This three-person model stresses the double function of the analyst as being immersed, on the one hand, in a transference-countertransference relationship and, on the other, as maintaining an objective distance from which observing and interpreting the patient’s enactments of internal object relationships can be carried out. A related concept, stressed by ego psychology but implicitly present in other approaches as well, is that of the therapeutic alliance, or conflict-free aspects of the relationship between patient and analyst. As Deserno (1990) has pointed out, this therapeutic alliance or relationship is a relative concept limited, on the one extreme, by the danger of conventionalized agreements between patient and analyst that imply a joint “blind spot” regarding cultural bias, as opposed to another extreme in which the transference is considered as an “infinite regress,” and the very possibility of an objective approach to it from a position of technical neutrality is denied. Stress on the multiplicity of “royal roads” to the unconscious, in the sense of the assumption of multiple surfaces of defensive formations that lead into the dynamic unconscious, and the fact that affective dominance may point to very different aspects of the material (memories, dreams, acting out, fantasies, etc.), all of which, under concrete circumstances, constitute “a royal road” to unconscious fantasy. A concerned avoidance of “indoctrination” by categorical styles of interpretation, and a stress on the patient’s active work in exploring unconscious meanings with the help of tentative interpretations by the analyst. An increasing questioning of linear models of development, as the condensation of experiences from multiple developmental levels present themselves as condensed matrixes of experience or behavior that only gradually can be disentangled into different historical events. It
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may well be that this technical development reflects an indirect influence from French psychoanalysis. What follows next is an overall summary of the technical approaches of the intersubjectivist–interpersonal–self psychological schools. A constructivist approach to the transference is taken, as opposed to the traditional objectivist one. The transference is a compromise formation, and the unavoidable subjectivity of the analyst justifies questioning the possibility of an objective view of it. In this regard, transference develops in parallel with countertransference, which also is a composite of analyst-determined and patient-determined influences. The analysis of the transference is the construction of a joint understanding of the intersubjective structure of the patient-analyst relationship, and both patient and analyst have to accept the influence of unconscious factors in their understanding and interpretation of this relationship. 2 Technical neutrality is rejected as an illusion and as an expression of an authoritarian position of the analyst. The analyst is being conceived by the patient as having all the answers and may easily be seduced into such a position. The analysis within a self self-object position of the analyst clearly precludes technical neutrality as a potentially traumatizing and destructive effect on the consolidation of a normal self. An empathic orientation is central in the analyst’s attitude. The analyst’s “anonymity” represents a disguised position of authority and maintains an idealization that cannot be analyzed. 3 A deficit model of early development is recognized explicitly or implicitly, in the sense of failure in early attachment or of a loving dedication on the part of the parenting object, a failure of caretakers to meet the patient’s dependency needs in early infancy or childhood, leading to insecure attachment and traumatophylic transferential dispositions.“Resistances” really are mini–traumatic experiences, and the analyst has to consider the possibility of excessive or insufficient stimulation in the treatment situation as a traumatic experience for the patient. The self develops within a relationship matrix that is constantly revised and newly traumatized, and the transference repeats such experiences, which leads to the focus on the patient’s subjectivity and its privileged position. 4 Aggression is not seen as a drive, or it is de-emphasized as such. Many 1
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authors within this approach perceive aggression as a consequence of the failure in the early infant-mother relationship. Self psychologists usually interpret the emergence of aggression in the transference as a consequence of a failure in the analyst’s empathy. Neither is primitive sexuality emphasized as a drive: sadomasochism is at times considered as a consequence of insecure attachment. Here, object relations theories are perceived as in opposition to drive theories. 5 The treatment is conceived as a new object relationship, within which the real personality of the analyst is as important as his interpretive work. Communication of the countertransference, under certain conditions, may contribute to facilitating a new experience of important or fundamental therapeutic value for the patient. I referred earlier to the French psychoanalytic approach as the third major current of contemporary psychoanalytic formulations, with its corresponding differentiated technical approach. At this point, it may be helpful to summarize briefly the French psychoanalytic approach, in my view a definitely alternative approach to psychoanalytic technique, providing an external perspective that may enrich the English psychoanalytic community. I am reserving here the term “French approach” for what, from an outsider’s perspective, appear as common characteristics of the Frenchlanguage societies and institutes that are included in the International Psychoanalytic Association, in contrast to the Lacanian approach, which has nevertheless left deep traces in what I am considering to be the French mainstream (Le Guen, 1974, 1982, 1989; De Mijolla and De Mijolla, 1996; Laplanche, 1987; Laplanche, 1992; Green, 1986, 1993; Oliner, 1988). With these reservations, I would summarize the main technical characteristics of the French mainstream, in contrast to both the English-language mainstream and intersubjective approaches, as follows. A general opposition to the concept of “technique” as contrasted to psychoanalytic “method,” in order to stress the highly individualized, subjective, even artistic aspects of psychoanalytic practice. 2 A sharp focus on the linguistic aspects of psychoanalytic communication, including the search for “nodal” points where unconscious meanings may be expressed as metaphor or metonymy, in other words, symbolic condensations or displacement. The assumption is that unconscious influences determine the symbolic significance of linguistic distortions and constitute a privileged road into the assessment of un1
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conscious conflicts. More recently, the stress has been on the affective implications of symbolic meanings expressed in language. Consistent, subtle observation of the transference, but not a systematic interpretation of it; rather, a punctuated, sparing one in the interest of avoiding an authoritarian distortion of the transference by too frequent interpretive interventions. Leaving aside, rather than paying special attention to, the resistances of the ego, which represent seductive ego functions attempting to shield unconscious fantasy. In this context, careful avoidance of intellectual explanations. Direct interpretation of deep, symbolized, unconscious conflicts, while addressing the patient’s preconscious by evocative, nonsaturated interpretations. Such evocative interpretations are seen as indirectly addressing the patient’s unconscious: effective interpretations of preconscious material induce unconscious resonances. Simultaneous consideration of somatizations and nonverbal behavior (enactments) in one integrative statement, on the basis of the analyst’s combined consideration of the patient’s preconscious fantasy and the countertransference. If the patient’s behavior cannot be linked with his discourse, it is not interpreted. Efforts to avoid being “seduced” by the patient’s conscious constructions regarding the realities of daily life. Excessive consideration of external reality risks transforming psychoanalysis into psychotherapy. Direct interpretation of presymbolic psychosomatic expression of unconscious conflicts. This is a specific approach of the school of Pierre Marty. Analysis of the patient’s expectation that the analyst is the subject of presumed knowledge: in other words, the analysis of the symbolic function of the idealized oedipal father, supposed to protect the patient from the deepest aspects of castration anxiety. Focus on archaic sexuality, particularly the archaic aspects of the oedipal complex that develop in the preoedipal symbiotic mother-infant relation. Insofar as father is always present in the mind of the mother, preoedipal relations are always perceived as resistances against oedipal conflicts. This approach also implies a pervasive consideration of the role of castration anxiety. Opposition to linear conceptions of the origin of development; a sharp focus on the “après coup,” that is, the retrospective modifica-
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tion of earlier experiences, including a “two-stage” model of psychic trauma that implies that later experiences may modify earlier ones into a traumatic direction and/or that only after the secondary incorporation of an experience that could not be metabolized, it acquires the meaning of a psychic trauma. Analysis of the condensation of psychic experiences from different times into synchronic expressions, as well as focus on diachronic, narrative developments, repeating the oscillation between synchronic and diachronic expressions in the transference. 12 A “progressive” vector of the interpretation, implying a future directed elaboration of the Oedipus complex as one aspect of interpretive interventions. Interpretations are to open the way, rather than to establish the truth. 13 Acceptance of the irreducible basis of earliest transferences, derived from mother’s “enigmatic messages.” These messages reflect the unconscious erotic investment by mother of the infant, which only retrospectively will be interpreted as such in the infant’s development of primary unconscious fantasies representing the archaic oedipal complex. These transferences may be interpreted, but the final, unconscious repetition of the experience of enigmatic messages from the analyst, the transmission of “unconscious” to “unconscious,” has to be respected. This is a major emphasis in Laplanche’s work. 14 Finally, and very fundamentally, the emphasis on the analysis of preconscious fantasy and on analyzability as based on the development of the capacity for such preconscious fantasy—in contrast to the incapacity to tolerate psychic experience in this psychic realm and its expression in somatization or acting out. Therefore, the retransformation of acting out and psychosomatic expression into preconscious fantasy constitutes a major technical goal in cases where the patient’s tolerance of intrapsychic experience (of a traumatic kind) is limited. This is a major point raised by Pierre Marty and André Green. Implicitly, this French psychoanalytic approach is critical of both the English-language analytic “mainstream” and of the intersubjective approaches. The French approach would be critical of the risk of superficiality derived from the focus on conscious material and clarification of reality life circumstances within ego psychology. French authors also would be concerned over the cognitive indoctrination of patients by means of systematic transference analysis and the acting out of countertransference as a conse-
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quence of such systematic transference analysis. The French approach is critical of what its adherents consider the neglect of early sexuality and the archaic Oedipus complex in the English-language schools, and they are particularly critical of intersubjectivity as a seduction into a superficial interpersonal relationship, the denial of Freud’s theory of drives, and the implicit supportive psychotherapeutic intervention when the analyst presents himself as an ideal model, with unconscious acting out of countertransference as a major consequence. I have attempted to describe the development of the three major approaches to psychoanalytic technique among English-speaking analysts and to show how their cross-fertilization during the past thirty years has affected them. By contrasting them with the French mainstream, I have suggested how each of them may be flawed or incomplete. If the trend toward mutual modification of previously hotly defended differences continues, one might expect convergence between the French and English schools to take place over the years to come.
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INDEX
Abraham, K., 9 –10, 71, 72, 75 Absolute power, 163–64 Acting out, 17–18, 21, 95 – 96, 207, 238, 280, 298 Adorno, T., 155 Affects and affect theory, 41, 49, 51– 59, 83, 84, 273 –74, 289, 297–98, 301 Africa, 177 Aggression: S. Freud on, 6–8; Klein on, 8, 28, 31, 32, 81; and object relations, 15, 27–28, 29; Fairbairn on, 35; Winnicott on, 38; development of, 51–52; and sexuality, 54, 254– 55, 262; and homosexuality, 69–72; and depression, 80 – 84; biological basis of, 143, 253; and social violence, 143, 170; and fundamentalist ideologies, 165; and mother-child relationship, 174, 253; and transference, 294, 300; in intersubjectivistinterpersonal-self psychological schools, 299– 300. See also Sanctioned social violence Akhtar, S., 268, 271, 277, 284 Albanians, 159 Algerians, 178 Allende, S., 98 – 99 Alpert, J., 251 Althusser, E., 152 Althusser, L., 152 American Psychoanalytic Association, 291– 92 Anal fantasies, 162 Anal phase of development, 6, 7
Anderson, P., 153 Anger. See Rage and anger Animal behavior, 62, 79 Anonymity: in training analyses, 89, 106 –7, 211–12; analytic anonymity, 106, 206, 209, 211–12, 242, 294, 299 Antisocial behavior, 38, 70, 175 Antisocial personality disorder, 79, 258 Anxiety, 31, 32, 34, 39, 56, 82, 83, 88, 172, 225, 258, 285, 288. See also Castration anxiety Anzieu, D., 145, 171 APF (French Psychoanalytic Association), 111, 115 Aphasia, 85 Appelbaum, A., 257 Arendt, H., 157 Argentina, 161, 271, 274 Argentinean Psychoanalytic Association, 110–11 Arlow, J. A., 29, 96, 106, 271, 284 Armstrong, K., 165 Aron, L., 293 Atkinson, L., 165 Attachment, 77, 78, 79 Atwood, G., 293 Authoritarian personality, 155 Authoritarianism: in psychoanalytic education, 97–98, 102–3, 120–21, 123; definition of, 179–80; of analysts, 213–15, 287–88, 293 Authority: in psychoanalytic education, 97; compared with authoritar325
INDEX
Authority (continued) ianism, 179 – 80; definition of, 179, 209–10; of analyst in psychoanalytic situation, 206–20, 241; and power, 209 –10; clinical illustration of, 217–20 Autistic phase of development, 43, 54, 250 Bacal, H., 293 Bachrach, H. M., 24 Balint, M., 279, 285, 287 Balkans, 177 Bancroft, J., 62, 64 Bao-Lord, B., 161 Baranger, M., 256–57 Baranger, W., 256–57 Begin, M., 189 Belgium Psychoanalytic Society, 111 Bell, A. P., 72 Benvenuto, B., 277 Bergen, P. L., 165 Bernfeld, S., 105 Bibring, E., 75, 76 –77, 78 Bion, W. R., 18, 19, 34, 41, 88, 145, 146, 171, 195, 207, 268, 275, 287–88 Bisexuality, 63 – 66, 73 –74, 248, 251, 252, 253, 256. See also Homosexuality; Sexuality Black, M., 293 Black power, 178 Blum, H. P., 268, 295 Bollas, C., 273 Boothe, B., 251 Borderline personality organization: treatment of patients with, 24, 25, 41, 56, 82, 243 –44, 248, 265, 280, 292; and object relations theories, 30, 41, 42, 45, 46, 288; and splitting, 45; and preoedipal conflicts, 46, 248, 265; and homosexuality, 69, 70, 72–73; and depression, 78; and
326
transference-countertransference, 243–44, 248; and gender effects in psychoanalysis, 248, 265 Bosnia, 188 Bowlby, J., 77, 78 Bracher, K. D., 155 Braunschweig, D., 54, 66, 70, 71, 250, 251, 253, 254 Brenner, C., 29, 268, 274, 296, 298 Breuer, J., 3 Brezhnev, L., 153 British Independents, 267– 69, 272, 276, 278, 279, 281, 282, 285–88, 292, 293, 295, 297 British Psychoanalytic Society, 108, 285, 295 British School, 26, 28, 251, 271, 276 Bruzzone, M., 105 Bullock, A., 142, 184 Busch, F., 295, 296, 297 Cambodia, 153 Canadian Psychoanalytic Society, 112 Canetti, E., 147, 153, 154, 164, 172 Casement, P. J., 273 Castration anxiety, 7, 68, 70, 195, 250, 253, 301 Cavell, M., 91 Character, definition of, 9 Character analysis, 19, 269 –70, 287, 297 Character pathology, 9–10, 12, 21, 256, 287 Chasseguet-Smirgel, J., 30, 67, 71, 83, 148, 162, 163, 164, 251, 252, 258, 277 Childhood violence, 173 –76 Child-parent relationship. See Fatherchild relationship; Mother-child relationship Chile, 98–99 Chilean Psychoanalytic Institute, 96, 98–101
INDEX
China, 153, 155, 161 Chodorow, N., 62, 251 Civil rights movement (U.S.), 178 Clarkin, J. F., 21, 25 Coates, S., 67 Columbia University Center for Psychoanalytic Training and Research, 92, 96, 100 –102 Common ground of clinical theory, 267 Communism. See China; Soviet Union Complementary identification, 16 Compromise formations, 12, 207, 299 Compulsive neurosis, 196–200 Concordant identification, 16 Conflict resolution, 184–85 Consciousness, 5, 8 – 9, 194 – 95. See also Ego Constructivist position, 17, 246–47, 293, 294, 299 Containing, 18, 280 Conventionality, 151 Cooper, A. M., 111, 128 “Core Conflictual Relationship Theme” methodology, 87–88 Cornell Personality Disorders Institute, 25 Cost-effectiveness issues, 90, 92–93, 104, 121–23 Countertransference: and object relations theories, 14–17, 28, 30; definition of, 15, 224, 237–38; S. Freud on, 15–16; and three-person psychology, 17, 239 –41, 243, 244, 264; and two-person psychology, 17, 213; Kernberg on, 46; and affects, 55; and triangulation, 56, 243; in Mr. B case, 201–2; as communication channel, 204, 205; relationship between transference and, 204–5, 207, 209, 235 – 36, 272–73; and in-
327
terpersonal psychoanalysis, 207; Laplanche on, 207; and analytic anonymity, 212; shifts in, 224; Gill on, 235–36; analysis of, in terms of concordant and complementary identifications, 237–38; Racker on, 247, 272; gender issues in, 249, 256–60, 261; erotic countertransference, 257–58, 261–64; different view of, 272–73, 277–79; French psychoanalytic approach to, 272, 301, 302– 3; and patient’s affective experience, 273–74; and British Independents, 287; Sandler and Sandler on, 289; Renick on, 296; contemporary mainstream approach to, 297; in intersubjectivist-interpersonal-self psychological schools, 300. See also Transference Cremerius, J., 283 Crime, 180–81 Crits-Christoph, P., 88 Crowds, 148. See also Mass psychology Cultural biases, 176 –77, 256 – 57, 261, 283 Culturalist psychoanalysis, 9, 290, 294 Dare, C., 268 Dawidowicz, L. S., 159 De Mijolla, A., 56, 243, 250, 262, 300 De Mijolla, M. S., 56, 243, 250, 262, 300 Death drive/instinct, 6, 8, 10, 31, 50, 51, 155, 285 Defense mechanisms, 4–6, 8, 9, 12, 13, 29, 32–33, 213–14, 233, 286. See also Primitive defensive operations Dehumanization, 161–64 Democracy, 155, 178–81, 182 Depression, 8, 10, 11, 75–85, 217, 225 Depressive position, 32– 33, 38, 171, 173
INDEX
Depressive-masochistic personality structure, 83 Deserno, H., 233, 278, 298 Development. See Psychosexual development Diamond, D., 257 Dicks, H. V., 155, 161, 162– 63 Displacement, 211, 235 Dissociation, 40 Downey, J., 61, 62, 63, 67 Dreams and dream analysis, 18 –19, 197, 269, 274, 298 Drives, 6 – 8, 27– 31, 40, 45, 48 – 59, 83 – 86, 271, 285, 296, 299–300, 303 Drug abuse, 180 – 81 Dual-drive theory, 6, 8, 27, 30, 31, 48, 83, 84. See also Drives Dulchin, J., 108 East Germany, 169, 177 Education of children. See Schools Education of psychoanalysts. See Psychoanalytic education Ego, 5, 8 –10, 12, 31–35, 81–82 Ego and the Id (S. Freud), 81 Ego ideal, 11, 35, 82, 149, 150, 179, 261, 262, 290 Ego identity, 9, 150, 159 Ego psychology: concept of self in, 9; the three-person psychology, 17; and character analysis, 19, 270, 287; and object relations theories, 26, 29, 39, 268, 269, 271, 280, 288, 292; and drives, 29, 235; and oedipal conflicts, 29; Jacobson’s theory of, 41– 43, 235; and analytic anonymity, 106, 211; and transference and countertransference, 207, 269, 272, 275, 277–78, 295–96, 297; and Kleinian analysis, 234, 283, 287–89; and therapeutic alliance, 234, 277–
328
78, 298; compared with other psychoanalytic approaches, 267–78, 280, 281, 283; and interpretation, 270–71; and affective experience of patient, 273; and “royal roads” to the unconscious, 274 –75; and resistances, 275, 295–96, 297; and regression, 280; and distinction between psychoanalysis and psychoanalytic psychotherapy, 281; recent developments in technical approach of, 285, 286, 295 – 98 Ego-id, 29, 30, 45, 50 Eitingon model of psychoanalytic education, 105–11, 116–23, 124, 129, 137 Empathy, 16, 275–76, 281–82, 291, 293, 294, 299, 300 Envy, 71, 229, 255, 256, 258 Epstein, L., 207, 272 Erhardt, A., 62 Erikson, E. H., 26 Erogenous zones, 52. See also Sexuality Erotic desire. See Sexuality Essers, H., 257 Etchegoyen, R. H., 195, 207, 267– 68, 271, 272, 274, 275, 279, 280 “Excluded third other,” 17, 56, 243, 255, 264, 277. See also Three-person psychology; Triangulation and reverse triangulation Fain, M., 54, 66, 70, 71, 250, 251, 253, 254 Fairbairn, R., 8, 26–29, 34–36, 41, 43, 47, 48, 77, 81, 235, 268, 271, 285, 287 Faktor, J., Jr., 176 Fantasies: and Oedipus complex, 7, 11, 33 – 34; and mother-child relationship, 54–55, 207–8; anal fantasies, 162; sexual fantasies in Mr. B
INDEX
case, 200 –201, 202; and Kleinian psychoanalysis, 286, 288; Sandler and Sandler on, 288 – 89; as “royal road” to unconscious, 298; French psychoanalytic approach to, 302 Father-child relationship: father as “excluded third person,” 56, 243, 277; and male homosexuality, 68– 70; and paternal principle, 172; clinical illustrations of, 196, 200, 201, 203, 217–18, 219, 227–30; and daughter’s erotic longings, 253–54. See also Oedipus complex and oedipal conflicts Feiner, A. H., 207, 272 Feldman, M., 34, 234, 288 Females. See Gender; Mother-child relationship Feminist critique of psychoanalysis, 208, 251– 52, 283 Fenichel, O., 19, 233, 270–71, 273, 286, 295 Fetishism, 38 Fischer, J., 189 Fixations, 14 Flannery, D. J., 174 Fonagy, P., 24, 91 France, 178 Free association, 4, 5, 8, 13, 14, 17, 55, 203 – 4, 222–24, 238, 274, 275, 297 French model of psychoanalytic education, 111–23, 126, 127, 137 French psychoanalytic approach: and three-person psychology, 17, 56, 239–40, 243; and dual-drive theory, 30, 48, 303; object relations theory compared with, 30; Winnicott’s influence on, 39; and homosexuality, 66 – 67; and research, 88; technical characteristics of, 99, 296, 300–303; and unconscious, 195, 300–301; and transference, 232,
329
274, 301; and mother-child relationship, 249, 250; and oedipal situation, 249, 262, 276–77, 301, 302, 303; and penis envy, 251; compared with other psychoanalytic approaches, 267, 268, 274, 276, 277, 284; and countertransference, 272, 301; and child analysis, 281; and projective identification, 282; and reconstruction and recovery of preverbal experiences, 284 French Psychoanalytic Association (APF), 111, 115 Freud, A., 108, 211, 242, 285, 286 Freud, S.: on culture and society, x; significance of generally, 3–4, 60, 252; on repression, 4, 40; theory of mental apparatus by, 4–11; on unconscious, 4 – 6, 18, 84; on ego, 5, 8 – 10; on id, 5, 6 – 8; structural theory of, 5–11, 35; on superego, 5, 6, 7, 10–11, 75, 251– 52; on drives, 6 – 8, 27–28, 30, 31, 40, 45, 48, 50, 52, 83, 85, 285, 303; on infantile sexuality and Oedipus complex, 6, 7, 10–11, 71, 155, 252; on mourning, 10, 75 – 76; psychoanalytic treatment by, 12–20; on countertransference, 15– 16, 247; on psychoanalytic technique, 17, 275; on dream analysis, 18–19; on preconsious, 40; on instincts, 49 – 50; on libido, 52, 249; on infants as isolated and disconnected, 54; on bisexuality, 63, 64, 65, 248, 252; on neurotic personality organization, 68; on female homosexuality, 70 –71; on melancholic illness, 78, 80, 81, 83; on identification, 81; and neurosciences, 85; teaching of theories of, 92, 116, 128; relationships between immediate followers and, 100; on
INDEX
Freud, S. (continued) mass psychology, 148–50, 152, 154, 155, 166, 182; on ego ideal, 150; on technical neutrality, 211; on transference, 235, 238, 247, 257; feminist critiques of, 251–52; on penis envy, 251; on Nachträglichkeit, 277 Friedman, R. C., 61, 62, 63, 64, 67 Fromm-Reichmann, F., 28, 40, 272, 279 Fundamentalism, 164–69, 175–76, 178 – 81, 187–88 Furer, M., 26, 41, 43, 48, 54, 250, 292 Furet, F., 142, 157 Gabbard, G., 257 Gallanter, M., 165 Gangs, 174 –75, 181 Gender: as biologically determined versus socially constructed, 61– 63, 67; of patient and analyst in psychoanalytic relationship, 208, 246– 66; transference and gender issues, 246–51, 256–60; pregnancy of women analysts, 249, 261; and differential development of males and females, 252– 56; countertransference and gender issues, 256 – 60; differences between male and female analysts in treatment of male and female patients, 260 – 61; analytic couple and loving couple, 261– 66 Gender identity, 62–63, 65, 67, 247– 48, 260 Gender identity disorder, 67, 69 Gender role identity, 61, 62, 67, 247, 248, 258, 260 Germany, 169, 177, 179, 187, 189. See also Nazi Germany Gilbert, M., 142 Gill, M., 13, 14, 88, 207, 232–37, 241–
330
42, 247, 269, 271, 275, 278, 290, 292–93, 297 Giovannetti, M. de F., 105 Glover, E., 233 Goldhagen, D., 159 Grandiose self, 29, 57, 290 Gray, P., 274, 275, 295, 296, 297 Green, A., 48, 51, 57, 88, 89, 105, 112, 153, 155, 161, 178–79, 249, 265, 300, 302 Green, R., 67 Greenacre, P., 107 Greenberg, J., 26–28, 39, 41, 48, 195, 207, 268, 271, 278, 290, 293 Greenson, R., 277, 286, 295 Group psychology, 143–52, 171 Group Psychology and the Analysis of the Ego (S. Freud), 81, 148–49 Grunberger, D. B., 10, 274 Guilt, 7, 10–11, 15, 32–33, 36, 76, 83, 227–28, 230, 286. See also Superego Gun control, 174, 181 Guntrip, H., 28, 36, 48 Guzman, N., 165 Haberman, J., 153 Halenta, B., 71 Hammersmith, S. K., 72 Hartmann, H., 41, 285 Hatred, 53, 161, 187 Haynal, A., 165, 166 Heigl-Evers, A., 251 Heimann, P., 272 “Historical truth” versus “narrative truth,” 282–83 Hitler, A., 153–54, 157, 158, 163, 184, 188 Hoffman, I. Z., 88, 207, 232, 269, 271, 278, 290, 292 Hoge, J. F., Jr., 165, 186 Holder, A., 268 Holding, 18, 37, 38–39, 280
INDEX
Homosexuality: scientific study of, 60; and gender as biologically determined versus socially constructed, 61– 63, 67; psychoanalytic theory of, 61, 66–67; and object choice, 62– 64, 66, 67, 248; universality of homosexual tendencies, 64; French psychoanalytic view of, 66 – 67; of analysts, 67– 68; and gender identity disorder, 67, 69; genetic component of, 67; male homosexuality, 67–70, 255, 258 –59; and Oedipus complex, 67–72; psychoanalytic treatment of homosexual patients, 67– 68, 73 –74, 258 – 59, 264 – 65; female homosexuality, 70–73, 255, 259 – 60; and patient with obsessive personality disorder, 218; and neurotic patient with marital difficulties, 229, 230. See also Bisexuality Horney, K., 251, 252 HPA stress response, 79, 82 Huff, C. R., 174 Humanistic ideologies, 189 Huntington, S. P., 186, 188 Hysterical personality, 4, 9–10, 223 Id, 5, 6 –7, 12, 15 Id analysis, 194 Idealization: in psychoanalytic education, 89, 94, 96, 102, 103, 106–7, 116, 124, 128, 211–12; in psychoanalytic situation, 206, 207, 212, 242, 263, 290, 291; in mother-child relationship, 253 Ideal-object representations, 42 Ideal-self representations, 42 Identification, 23, 58, 81–82, 235, 253, 265. See also Projective identification Identification with victim and victimizer, 178, 214 –15, 264
331
Identity diffusion, 143 Ideologies: political ideology of psychoanalytic education, 98–99; regressive pull of ideologies and social violence, 144, 152–55; fundamentalism, 164 – 69, 178 – 81, 187– 88; and terrorism, 164–69, 179; and state-controlled educational system, 176; humanistic ideologies, 189; utopian ideology, 189; and psychoanalytic process, 283 Incest, 66, 162 Independents. See British Independents Inderbitzin, L. B., 215, 275, 295 India, 177, 178 “Indoctrination” of patients, 275–76, 298, 302–3 Infant observation, 89, 250, 283 Infante, J. A., 105 Infantile sexuality, 6–7 Infant-mother relationship. See Mother-child relationship Instincts, 49–50, 52 Integration of subgroups in dominant culture, 177–78 International Psychoanalytic Association (IPA), 90–91, 124, 130, 290, 300 International Psychoanalytic Congresses, 114, 116–17 Internet, 151, 183 – 84 Interpersonal psychoanalysis: and transference-countertransference, 17, 207, 237, 272, 278–79, 299–300; and patient-analyst dyad as growth-promoting experience, 28; compared with other psychoanalytic approaches, 29, 267, 268, 271, 272, 276, 278–79, 282; Sullivan’s theory of, 39–41, 294; Winnicott’s influence on, 39; and unconscious,
INDEX
Interpersonal psychoanalysis (continued) 194 – 95; and object relations theories, 271; and “indoctrination” of patients, 276; and analyst’s personality, 278–79; and empathy, 282, 299, 300; recent developments in technical approach of, 290, 293, 294, 299 – 300 Interpretation: Gill on interpretation of, 13–14, 207, 232–37, 241–42, 247, 269, 275, 278, 292–93, 297; definition of, 14; complexity of, 16–17; in psychoanalytic psychotherapy, 20, 281; in supportive psychotherapy, 21; and Kleinian psychoanalysis, 207, 288; and analyst’s authority, 215 –16; validation of, 221–31; and prevalence of transference, 233 – 34; and nature of transference, 234 – 36; analyst’s contributions to interpretation of transference, 236 – 45; metaphor used in, 241; “objectivity” of, 241; and ego psychology, 270–71; in “here and now,” 270 –71; and focus on patient’s affective experience, 273 –74; and “royal roads” to the unconscious, 274 –75; and therapeutic effect of psychoanalysis, 278; French psychoanalytic approach to, 302. See also Anonymity; Countertransference; Empathy; Technical neutrality; Transference Intersubjectivity, 17, 49, 87, 88, 237, 238, 241, 243 –44, 293, 296, 299– 300, 303 Introjective identification, 239 IPA (International Psychoanalytic Association), 90 –91, 124, 130, 290, 300 Ireland, 177, 186
332
Irigaray, L., 251 Isay, R. A., 66, 68, 69–70 Islamic terrorism, 164, 169, 186. See also Terrorism Israel, 177, 189 Italy, 180 Jacklin, C. M., 62, 247 Jacobs, T. J., 272, 295 Jacobson, E., 8, 10, 26–29, 41–45, 47, 48, 75, 77–78, 80, 81, 83, 151, 235, 251, 252, 271, 280, 288, 289 Japan, 168 Jaques, E., 94 Jews, 153–54, 155, 159, 196–200. See also Nazi Germany Joseph, B., 234, 268, 270, 288 Kächele, H., 88, 125–26, 207, 232, 268, 269, 277, 278 Kakar, S., 165, 166, 186 Kashmir, 186 Kennedy, R., 212, 277 Kepel, G., 165, 186 Kernberg, O. F., 9, 10, 20–22, 24, 26, 27, 29, 45–47, 49, 56–58, 61–65, 68, 73–74, 81–83, 88, 89, 94, 103, 105, 110, 116, 120, 128, 130, 147, 149, 151, 156, 158, 160, 171, 175, 178–80, 183, 184, 195, 203, 208–11, 222, 232, 234, 241, 247, 248, 250, 255, 257, 260, 262, 264, 270, 271, 273, 274, 277, 280, 281, 288, 290 Kershaw, I., 184 Kestenberg, J., 71 King, P., 285 Kirkpatrick, M., 72 Klein, M.: on aggression, 8, 28, 31, 32, 81, 253; on narcissism, 10, 287; on primitive defensive operations, 16, 80, 285; on transference, 19, 28, 34, 252, 283; object relations theory of,
INDEX
26, 27, 28, 30, 31–34, 37, 38, 43, 48, 285 – 87; on drives, 27, 50, 271; on paranoid-schizoid and depressive positions, 32– 33, 38, 149, 171, 173; on preoedipal and oedipal conflicts, 33 – 34, 71; on depression and mourning, 75, 76, 77, 80; on penis envy, 251; on libidinal strivings, 253; on projective identification, 282. See also Kleinian psychoanalysis Kleinian psychoanalysis: and threeperson psychology, 17; and pathological organizations in transference, 19; and object relations, 28, 47; and psychotic patients, 41; and depression, 77; and research, 88; and psychoanalytic education, 106, 111; and British Psychoanalytic Society, 108; and unconscious, 194, 271; and interpretation, 207, 288; and analytic anonymity, 211; and ego psychology, 234, 283, 287–89; and transference, 234, 269, 271, 274, 278, 297; and mother-child relationship, 253; compared with other psychoanalytic approaches, 267–75, 278 – 81, 283–84; and character analysis, 270; and countertransference, 272; and affective experience of patients, 273; and “indoctrination” of patients, 275; pschoanalytic psychotherapy versus, 281; and reconstruction and recovery of preverbal experiences, 283 – 84; recent developments in technical approaches of, 285 – 89, 292, 293, 295, 297–98. See also Klein, M. Klemperer, V., 159 Kohon, G., 268, 286 Kohut, H., 9, 10, 29, 39, 48, 207, 274, 290, 291
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Kolakowski, L., 153 Krause, R., 49, 91 Kris, A., 274, 275, 297 Krutzenbichler, H. S., 257 Lacan, J., 30, 49, 100, 277 Lacanian psychoanalytic approach, 207, 269, 273, 275, 276, 277, 284, 300 Lachmann, F., 293 Language, 30, 55, 274, 300–301 Laplanche, J., 48, 50, 52, 55, 56, 58–59, 63, 70, 88, 194, 205, 207–8, 249, 250, 253, 300, 302 Laqueur, W., 165, 168, 169, 185, 186 Latency phase, 7, 151–52 Layton, L., 65 Le Guen, C., 268, 277, 300 Leadership: in psychoanalytic education, 100–103, 130; personality of social and political leadership, 144, 155– 58, 170 –71, 184; characteristics of functional leadership, 156; narcissistic leaders, 156, 184; paranoid leaders, 156–57, 184; and malignant narcissism syndrome, 157– 58, 184; relationship among ideology, bureaucracy, and, 157– 58; and authority, 210 Lester, E., 257 Levenson, E., 293 Levine, H. B., 270 Levy, S. T., 215, 275, 295 Liberman, D., 88, 274 Libido, 6 – 8, 27, 34 – 35, 45, 48, 50 – 53, 57, 80–82, 249 Life instinct, 6, 31. See also Libido Lifschutz, J. E., 108 Limit setting, 21 Listening in psychoanalysis, 193–205 Little, M., 272, 286 Loewald, H., 26, 27, 88, 234, 239, 292
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Loewenstein, R. M., 41 Luborsky, L., 87–88 Lussier, A., 105, 112, 113 Lutolf, P., 49 Lynching of blacks, 178 Maccoby, E., 62, 247 Mafia, 180 Mahler, M., 8, 26 –29, 41– 45, 47, 48, 54, 250, 268, 271, 284, 292 Males. See Father-child relationship; Gender Malia, M., 142 Malignant narcissism syndrome, 57, 70, 143, 144, 157–58, 162–64, 184 Mao Tse Tung, 153, 155, 169 Marcuse, H., 153 Marty, P., 301, 302 Marxism, 153, 178 Marxist critique of psychoanalysis, 208, 283 Masochism, 240 –41, 256, 257, 263 Masochistic defense, 35 – 36 Mass media, 150–52, 161, 182–84, 188 Mass psychology, 143, 144–52, 154, 166, 167, 182, 189 Masturbation, 254 Maternal principle, 172. See also Mother-child relationship McDougall, J., 71–72, 253, 272 Media. See Mass media Meltzer, D., 34, 253, 268 Men. See Father-child relationship; Gender Menninger Foundation, 22, 24, 101 Mertens, W., 268 Middle East, 169, 177, 186 Miller, E. J., 96 Minority groups. See “Other” Mitchell, S., 26, 27, 28, 39, 41, 48, 207, 268, 271, 278, 290, 293
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Mitscherlich, A., 160 Modell, A., 39, 269, 288 Money, J., 62 Moods, 83 Morgenthaler, F., 66, 69 Moscovici, S., 150–51, 171, 182 Mother-child relationship: Klein on, 31, 32; Fairbairn on, 35; and “good enough mother,” 36–37; Winnicott on, 36–38; Mahler on, 43–44; and libidinal development, 48; and affects, 49, 52–53; and drives, 50–51; and eroticism and erotization, 52, 54, 63, 70, 72, 83, 249–50, 253, 254, 302; and fantasy, 54–55, 207–8; and father as “excluded third person,” 56, 243, 277; and sex of child, 66, 252– 56; and “general seduction” theory, 70; and splitting, 72, 76; and attachment, 77, 78, 79; and HPA stress response, 79, 82; and depression, 80; and maternal principle, 172; and aggression, 174; clinical illustrations of, 196, 201, 203, 218, 219, 229. See also Oedipus complex and oedipal conflicts Moullec, G., 142 Mourning, 10, 33, 75–85, 189 Mourning and Melancholia (S. Freud), 75–76, 80, 81, 83, 85 Multiculturalism, 178 Murder, 161, 162, 164–69, 174 Narcissism, 10, 57, 143–44, 156, 178, 182–84, 251–52, 256, 258, 263. See also Malignant narcissism syndrome; Narcissistic personality disorder Narcissistic personality disorder, 10, 30, 57, 69–70, 73, 257–59, 265, 274, 280, 287, 290–91. See also Malignant narcissism syndrome
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Narcissistic regression, 143 – 48, 158, 202 “Narrative truth” versus “historical truth,” 282– 83 National Socialism. See Nazi Germany Nazi Germany, 142, 151, 153–55, 158, 159, 161– 64, 176–77, 188 Neira, H., 167, 186 Nemeroff, C. B., 79 Neurobiology, 79–80, 83, 84, 85, 86 Neurotic personality organization, 45 – 46, 56, 68, 72, 225–31, 257–59, 263 Neutrality. See Technical neutrality New York Psychoanalytic Institute, 101, 102 Non-understanding, 195–96, 201–2 Object constancy, 44, 150, 173 Object relations theories: self in, 9; and transference and countertransference, 14–17, 28, 30, 35; and aggression, 15, 27–28, 29; definitions and controversies in, 26–30; and ego psychology, 26, 29, 39, 268, 269, 271, 280, 288, 292; Klein’s theory, 26, 27, 28, 30, 31–34, 37, 38, 43, 48, 285 – 86; and drives, 27, 29, 45, 48– 59, 84, 271; Fairbairn’s theory, 27, 28, 34 – 36; Jacobson’s theory, 27, 28, 41–43, 44, 45; Mahler’s theory, 27, 28, 43 – 45; Sullivan’s theory, 27, 28, 39–41; Winnicott’s theory, 27, 28, 36 – 39; and early internalized object relations, 28; characteristics of, 29 – 30; and self psychology, 29; Kernberg’s theory, 45–47; and identification, 58; translation of unconscious conflicts into object relations terminology, 271–72; and contemporary Freudian approach, 288
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Object representation, 15, 27, 30, 42, 45, 50–51, 81, 89 Objectivist position, 17, 246, 293, 294 Obsessive personality disorder, 217– 20, 223, 225 Obsessive-compulsive personality, 9 Oedipus complex and oedipal conflicts: S. Freud on, 6, 7, 10 –11, 71, 155, 252; and fantasies, 7, 11, 33– 34; and ego psychology, 29; Klein on, 33–34, 71; Mahler on, 44; and homosexuality, 66–72; and depression, 83; and “groupishness” of child, 158; French psychoanalytic views of, 249, 262, 276 –77, 301, 302, 303; and gender, 251, 254 Ogden, T., 273, 288, 292 Oliner, M. M., 30, 300 “On the History of the Psychoanalytic Movement” (Freud), 100 One-person psychology, 17, 209, 293 Oral phase of development, 6 –7 “Other,” 145–46, 152, 154, 158–68, 171–73, 177–78, 189. See also Sanctioned social violence Outgroup/outsiders. See “Other” Ovesey, L., 251 Palestinians, 177 Panksepp, J., 79 Paranoia, 143 – 44, 154 – 57, 173, 178 – 79, 183, 184 Paranoiagenesis, 94–95, 96, 102, 103, 124 Paranoid regression, 145, 147–48, 152, 154–55, 158, 170–71 Paranoid-schizoid position, 32, 33, 38, 149, 171, 173 Paraphilias, 61 Parataxic experiences, 39 Parens, H., 268, 271, 284
INDEX
Parents. See Father-child relationship; Mother-child relationship Paternal principle, 172. See also Father-child relationship Payne, S., 285 Penis envy, 71, 72, 251 Peron, J., 161 Person, E., 251 Personality disorders, 9 –10, 16, 21– 25, 54, 143, 233, 279. See also Antisocial personality disorder; Borderline personality organization; Narcissistic personality disorder Peru, 153, 169, 179, 186 Perversions, 251, 255, 260, 280 Pharmacological approaches. See Psychopharmacological approaches Pine, F., 295 Pleasure principle, 5, 12 Pol Pot, 153 Political ideologies, 98–99, 144, 152– 55 Poluda, E., 70 –71, 72 Post, G., 165, 166, 168 Poverty, 181– 82 Power, 209 –10. See also Absolute power Preconscious, 5, 40, 204, 205, 301, 302 Pregnancy of women analysts, 249, 261 Prejudice, 176 –77 Present unconscious, 241, 270 –71 Prevention: of sanctioned social violence, 170–89; of childhood violence, 173–76; of cultural prejudice, 176–77; of terrorism, 185–89 Preverbal experiences, reconstruction and recovery of, 283–84 Primal scene, 7, 195, 250 Primitive defensive operations, 16, 30, 46, 80, 144, 149, 280, 285, 287, 288 Primitive superego, 172, 179
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Projection, 16, 151, 172–73 Projective identification, 16, 32, 46, 91, 237, 259–60, 273, 282, 288, 292 Prototaxic experiences, 39 Psychiatry, 86, 90, 104, 118, 122–23, 208 Psychoanalysis: definitions of, 3, 13, 86; structural formulation of, 12–13; process of, 13–14; and safety for patient, 13; empathy in, 16, 275–76, 281–82, 291, 293, 294, 299, 300; characteristics of contemporary psychoanalytic mainstream, 17–20, 297–99; recent developments in technical approaches to, 17–20, 285–303; objective of, 19–20; pschoanalytic psychotherapy versus, 20–21, 280–81; indications and contraindications for, 22, 23; research on treatment outcome with, 24–25, 86–87; of psychotic patients, 44; of homosexual patients, 67–68, 73–74, 258–59, 264–65; anxieties about recording analytic sessions, 87; and cost-effectiveness issues, 90, 92–93, 104, 121–23; anonymity of analyst in, 106, 206, 209, 211–12, 242, 294, 299; theory of technique of, 127–28; listening in, 193–205; and non-understanding, 195–96, 201–2; authority of analyst in, 206–20, 241; gender of patient and analyst in, 208, 246–66; validation in, 221–31; frames of, 238–39; comparisons of contemporary psychoanalytic techniques, 267–84;“indoctrination” of patients in, 275–76, 298, 302–3; “real” relationship in, 277–79;“historical truth” versus “narrative truth” in, 282–83. See also Countertransference; Interpretation; Research; Supportive psychotherapy; Techni-
INDEX
cal neutrality; Transference; and specific approaches, such as British Independents Psychoanalytic education: and anonymity, 89, 106 –7; idealization in, 89, 94, 96, 102, 103, 106–7, 116, 124, 128, 211–12; isolation of psychoanalytic institutes from university settings, 89 – 90; and research, 89 – 90, 92, 117–19, 128, 136–37; and experts from other scientific disciplines, 91– 92; mission of, 92; institutional problems of, 94 –103; paranoid atmosphere of, 94 – 95, 96, 102, 103, 124; organizational structure and administration of, 95, 123, 129 – 30, 140 – 41; training analysts’ treatment of candidates and reporting requirements in, 95–96, 125– 26, 132– 34; power, authority, and authoritarianism in, 97– 98, 102– 3, 120 –21, 123; and political ideology, 98 – 99; surrounding culture and institutional blind spots of, 98; in university settings, 99–100; and leadership, 100 –103, 130; recommendations on, 103, 123 – 41; critique of, 104 – 41; Eitingon model of, 105 –11, 116 –23, 124, 129, 137; selection of training analysts for, 105 – 6, 109 –10, 114, 124–25, 133; seminars in, 106, 110, 111, 112–13, 114, 125, 126–27, 135–37; class system in, 107– 8, 114; supervision in, 107, 113 –14, 125, 127, 128–29, 134–35; French model of, 111–23, 126, 127, 137; evaluation of candidates’ performance in, 114–15, 123, 127, 134 – 35, 137– 38; graduation requirements for and society membership, 114 –15, 117, 121, 138 – 39; length of training, 115; infantaliza-
337
tion of candidates in, 116–17; scientific isolation and ignorance in, 117–19; irresponsibility regarding candidates’ educational experience in, 119–20; denial of external social reality in, 121–23; admissions policy for, 123, 137–38; ombudsman or mentor for candidates in, 123– 24; concentrated analysis model for, 124; standards for, 124, 139; curriculum for, 127–28, 139–40; and theory of psychoanalytic technique, 127–28; questions for evaluation of, 130–31 Psychoanalytic psychotherapy, 20–21, 23–25, 122, 140, 280–81 Psychoanalytic Quarterly, 268 Psychoanalytic research. See Research Psychoanalytic Society of Paris (SPP), 111 Psychopharmacological approaches, 84 Psychosexual development, 6–7, 10– 11, 32–33, 276–77, 298–99, 301–2 Psychosis, 30, 40–44, 288 Psychotherapy. See Psychoanalytic psychotherapy; Supportive psychotherapy Quinodoz, D., 248 Racism, 177–78 Racker, H., 16, 46, 236, 247, 272, 286 Rage and anger, 53, 58, 82, 197–99 Rangell, L., 286 Rapprochement crisis, 44, 45 Rayner, E., 268, 286 Reaction formation, 4–5, 9–10, 19 Reality principle, 5, 12 Regression, 13, 16, 120, 143–48, 152, 154–55, 158, 170–71, 175, 202, 279–80, 287
INDEX
Regressive transference neurosis, 14 Reich, A., 272 Reich, W., 19, 270 Reinares, F., 165 Relational psychoanalysis. See Interpersonal psychoanalysis Religious cults, 175 –76 Religious fundamentalism, 164–69, 186 Renick, O., 296 Repetition compulsion, 12, 18 Repression, 4, 40, 45, 86, 88 Research: by Menninger Foundation Psychotherapy Research Project, 22, 24; Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP), 24; on treatment outcome, 24 –25, 86 – 87; resistances to research in psychoanalysis, 86 – 93; Luborsky’s “Core Conflictual Relationship Theme” methodology, 87– 88; and recording analytic sessions, 87; on transference, 87– 88; weaknesses of empirical methods in, 87– 88; and new theoretical models of psychoanalytic practice, 88; infant observation, 89, 250, 283; and psychoanalytic education, 89 – 90, 92, 117–19, 128, 136 – 37; and costeffectiveness issues, 90, 92– 93, 104; and IPA (International Psychoanalytic Association), 90 – 91; recommendations on, 90 – 93. See also Neurobiology Resistances, 13, 19, 36, 46, 233–35, 273, 275, 279 –80, 282, 295–97, 299, 301 Rice, A. K., 96, 145, 146 RIO II, 111 Rockland, L. H., 21 Rose, G., 165, 186
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Rosenfeld, H., 10, 19, 34, 41, 57, 252, 268, 270, 274, 277, 279–80, 287, 290 Roudinesco, E., 30 Roustang, F., 96, 100, 106 Russia. See Soviet Union Sadomasochism, 83, 252, 254, 264, 276, 300 Sampson, H., 88 Sanctioned social violence: definition of, 142; psychoanalytic view of, 142–73; and historical traumas and social crises, 143, 144, 158–61, 171, 182, 189; premises and conclusions on, 143–44; and personality features of social and political leadership, 144, 155–58, 170–71, 184; and psychodynamics of group psychology and mass psychology, 144– 52, 154, 166, 167, 171, 189; and mass media, 150–52, 161, 182–84, 188; and regressive pull of ideologies, 152–55; and dehumanization, 161– 64; and fundamentalism, 164–69, 178–81, 187–88; and terrorism, 164–69, 179, 185–89; prevention of, 170–89; and childhood violence, 173–76; and cultural prejudice, 176–77; and integration of subgroups in dominant culture, 177–78; and poverty, 181–82; protection of social structures from unorganized social violence, 181; and conciliation of national, ethic, or religious groups and international conflicts, 184–85 Sandell, R., 24–25 Sandler, A., 126, 270, 288–89 Sandler, J., 26, 27, 28, 268, 270, 271, 273, 288–89 Schafer, R., 88, 275, 282, 289 Schizoid pathology, 38, 279
INDEX
Schizophrenia, 41, 42 School busing, 177 Schools, 174, 176 –78 Schools for psychoanalysts. See Psychoanalytic education Schwaber, E., 195, 207, 216, 274, 275, 276, 293 Searles, H., 40– 41, 44, 272, 279, 288 Segal, A. J., 108 Segal, H., 33, 34, 142, 160, 189, 234, 270, 271, 286, 288 Self psychology: concept of self in, 9; and transference-countertransference, 17, 207, 237, 274, 293, 299–300; compared with other psychoanalytic approaches, 29, 267, 274–77, 291; Winnicott’s influence on, 39; and resistance to psychoanaytic research, 88; and unconscious, 195; and empathy, 275–76, 281–82, 291, 293, 294, 299, 300; and narcissistic psychopathology, 290 – 91; recent developments in technical approach of, 290–94, 299–300 Self-blame, 187 Self-concept, 9 Self-esteem, 11, 57, 83 Self-objects, 29, 41–42, 77, 195, 207, 291 Self-reflection, 239–40, 244 Self-representation, 15, 27, 30, 42, 45, 50 – 51, 81, 289 Self-sacrifice, 168 Separation anxiety, 34 Separation-individuation, 42, 43–44, 284, 294 September 11 terrorist attack, 164– 65, 169 Serbs, 159, 188 Sex education, 174 Sex of analyst and patient. See Gender Sexual identity. See Gender identity
339
Sexual trauma, 66, 162, 263–64, 283 Sexuality: S. Freud on infantile sexuality, 6 –7, 252; and erotic desire, 52– 54, 62, 247–48, 261, 262; and mother-child relationship, 52, 54, 63, 70, 72, 83, 249–50, 253, 254, 302; and aggression, 54, 254–55, 262; components of sexual behavior, 61– 63; and gender identity, 62; and gender role, 62; and object choice, 62– 64, 66, 67, 248; child sexuality, 63; clinical illustrations of, 200– 203, 225–26, 228, 229–31; and masochism, 240–41; differential development of, in men and women, 252– 56; and father-daughter relationship, 253–54; of adolescents, 254; and masturbation, 254; and impotence, 256; and promiscuity, 256; erotic dimensions of transference and countertransference, 257– 59, 261–64; and love relationship, 261– 62; French psychoanalytic approach to, 301, 303. See also Bisexuality; Homosexuality; Oedipus complex and oedipal conflicts Shining Path (Peru), 153, 169, 179, 186 Siegel, E., 71 Simon, A., 176 Sinyavsky, A., 142 Socarides, C. W., 67 Social violence. See Sanctioned social violence Sofsky, W., 142, 161, 163 – 64 Somatizations, 301 South Africa, 177 South America, 180. See also Argentina; Chile; Peru Soviet Union, 142, 151, 153, 161, 188 Spain, 179, 186–87 Spence, D. P., 282
INDEX
Spillius, E., 34, 234, 268, 269, 270, 288 Spitz, E. H., 91– 92 Splitting, 9, 12, 16, 31–32, 35–37, 45, 50 – 51, 72, 76, 143, 158, 164, 171– 72, 253, 255, 265, 288 SPP (Psychoanalytic Society of Paris), 111 Stalin, J., 157, 184 Steiner, J., 19, 287 Steiner, R., 285 Sterba, R., 239 Stern, D., 54, 89 Stewart, H., 273, 286 Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP), 24 Stockholm syndrome, 187 Stoller, R. J., 54, 65, 66, 251 Stolorow, R., 290, 293 Stone, L., 212 STOPP (Stockholm Outcome of Psychoanalysis and Psychotherapy Project), 24 Stranger anxiety, 172 Stress response, 79 – 80 Structural theory, 5 –11, 35, 286 Sublimation, 12 Suicide, 8, 76 Sullivan, H. S., 26 –29, 39–41, 48, 271, 279, 290, 292, 294 Suomi, S. J., 78 Superego: S. Freud on, 5, 6, 7, 10–11, 75, 251–52; and psychoanalytic theory of psychopathology, 12; and object relations, 15; Klein on, 32– 33; Jacobson on, 42, 80; and depression, 77–78, 80; structures of, 82; hypertrophic superego, 83; research on, 88; primitive superego, 172, 179 Supervision in psychoanalytic education, 107, 113 –14, 125, 127, 128– 29, 134 – 35
340
Supportive psychotherapy, 21–22, 23 Sutherland, J. D., 36 Swiss Psychoanalytic Society, 112 Symbiotic phase of development, 43, 250 Symbiotic psychosis, 284 Syntaxid experiences, 40 Tamil Tigers, 169 Technical neutrality: definition of, 14, 256; in psychoanalytic psychotherapy, 20 –21, 281; in supportive psychotherapy, 22; analytic anonymity confused with, 106, 211–12, 242; and analyst’s authority, 209, 211– 13; S. Freud on, 211; and transference, 234, 239, 242– 43; and cultural biases, 256 – 57, 261, 283; and homosexuality, 265; movement away from, 290, 293, 294, 298, 299; and narcissistic personalities, 290; in contemporary psychoanalytic mainstream, 298; and three-person model, 298 Television, 151, 182– 84. See also Mass media Temperament, 56, 83 Terrorism, 164–69, 179, 185–89 Therapeutic alliance, 18, 233–34, 256, 277–78, 298. See also Psychoanalysis Thomä, H., 125–26, 207, 232, 268, 269, 277, 278 Three-person psychology, 17, 56, 239–41, 243, 244, 264, 298 Tisma, A., 161–62 Topeka Psychoanalytic Institute, 96, 98, 101, 102 Topographic theory, 5 Totalitarianism, 154–55, 160–64, 176, 189. See also China; Nazi Germany; Soviet Union
INDEX
Training of psychoanalysts. See Psychoanalytic education Transference: definition of, 13; Gill on, 13–14, 207, 232–37, 241–42, 247, 269, 275, 278, 292–93, 297; and object relations theories, 14– 17, 28, 30, 35; objectivist versus constructivist positions on, 17, 246 – 47, 293, 294, 299; and threeperson psychology, 17, 243, 244, 264; and two-person psychology, 17; and character analysis, 19; Klein on, 19, 28, 34, 252, 283; in psychoanalytic psychotherapy, 20 –21, 281; in supportive psychotherapy, 21– 22; Sullivan on, 40; Kernberg on, 46, 58; Laplanche on, 58–59, 205; research on, 87–88; resistances in, 88, 233, 234 – 35, 274, 275, 279–80, 282, 295 – 97, 299; relationship between countertransference and, 204 – 5, 207, 209, 235–36, 272–73; and interpersonal psychoanalysis, 207; and self psychology, 207; maintenance of positive emotional relationship in, 214–15; negative transference, 215, 216, 279–80, 282; positive transference, 215, 216, 233; and personality disorders, 217–20, 233; dominant transference within any particular session, 222, 224; French psychoanalytic approach to, 232, 274, 301; prevalence of, 233– 34; nature of, 234 – 36; and technical neutrality, 234, 239, 242–43; by displacement, 235; by identification, 235; analyst’s contributions to, 236–45; determinants of, 246–51; gender issues in, 246 – 51, 256 – 60; erotic transference, 257– 59, 261– 64; of dead mother, 265; different views of, 269, 277–79; and patient’s
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affective experience, 273–74; and analyst’s personality, 278–79; regression in, 279–80; and British Independents, 287; Sandler and Sandler on, 289, 297; aggressive aspects of, 294, 300; contemporary mainstream approach to, 297; total transference, 297; in intersubjectivist-interpersonal-self psychological schools, 299–300. See also Countertransference Transference neurosis, 13–14, 233, 278 Transitional object, 37–38 Transsexuality, 251, 260 Trauma: personal traumas, 56, 67, 83, 160; historical traumas and social crises, 143, 144, 158–61, 171, 182, 189; sexual trauma, 162, 263–64, 283; and terrorism, 166; childhood violence, 173–76; and drug abuse, 180; and transference, 214–15. See also Sanctioned social violence Triangulation and reverse triangulation, 17, 56, 243, 250, 255, 262 Turquet, P., 145, 146, 171 Two-person psychology, 17, 209, 213, 293, 298 Tyson, P., 63 Unconscious: S. Freud on, 4–6, 18, 84; Lacan on, 30; and object relations theory, 49; and neuroscientific research, 86; and interpersonal psychoanalysis, 194–95; and Kleinian psychoanalysis, 194, 271; French psychoanalytic approach to, 195, 300–301; and self psychology, 195; and listening in psychoanalysis, 204, 205; present unconscious, 241, 270–71; “royal roads” to, 274–75, 298. See also Dreams and dream analysis; Fantasies; Free association
INDEX
United States, 177, 178, 181 Utopian ideology, 189 Validation of interpretations, 221– 31 Violence. See Childhood violence; Sanctioned social violence Volkan, V. D., 158–59, 160, 165, 166, 171, 184 – 85, 188, 288 Wallerstein, R., 24, 105, 112, 222, 267 Weinberg, M. S., 72 Weiss, J., 88 Werth, N., 142 West Germany, 169
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“Wild psychotherapy,” 127, 139 Will, O. A., 40 Williams, M. H., 34, 253, 268 Winnicott, D. W., 8, 18, 26–29, 36–39, 48, 88, 269, 272, 279, 285, 287, 288 Women. See Gender; Mother-child relationship Working through, 18 World War II, 168, 227 Yugoslavia, 160 Zetzel, E. R., 277 Zucker, K., 174
