Mutually Mutative Moments in the Psychoanalytic Experience
Ernest S. Wolf, M.D.
Chicago
[ Self Psychology Bulletin Board ]
This paper originally was delivered at the International
Self-Psychology Symposium in Dreieich, Germany, June, 1999. It is
presented here for the first time.
I
Throughout its first century psychoanalysis has
retained the core outlook and concepts that emerged from its creation by its
founding genius Sigmund Freud. To be sure, psychoanalysis has become the
fountainhead for a long list of psychological theories and methods that were
derived from the basic Freudian thought. These then developed further into
numerous directions. No doubt, there were many factors that influenced Freud
to move into that particular way of thinking which we can still identify as
early psychoanalysis. It is beyond my present scope here to try to analyze in
any detail how and why Freud arrived at his conclusions. It appears, however,
quite worthwhile to pickup some threads that went into the web of his
thinking, especially some of those formative influences that were determined
by the place and time of the history of the period in which he lived. A better
understanding of the then contemporaneous forces will bring into focus
comparisons with related current contemporary influences. Such comparisons may
well highlight and illuminate important differences between the original
Freudian outlook and some modern views of analogous issues. It may well turn
out that in certain instances where our current views appear to clash sharply
with those of Freud we are likely dealing with genuine Freudian ideas and
derivatives in continuing development. Seen through the eyes of the changed
circumstances as well as the changed philosophical approaches to modern life
and thought we might perhaps conclude that Freud, if he were living today,
would see things much the way we do.
Of course, we cannot be certain of that. Indeed, our very uncertainty is a
symptom of the changed philosophical ambience in which we think and act. Most
of our leading thinkers have surrendered claims of infallibility and stress
the relativity of the truth values of all of our knowledge. This is still a
very controversial stand in current philosophical discussions and I am not
nearly well informed enough in philosophical thinking to argue persuasively
one way or the other. Yet intuitively I feel much more comfortable with
today's "I'm not sure" than with the professed certainties of the
great authorities of former decades, whether they were philosophers or
psychoanalysts. Could it be that in my 7th decade I am more modern than I
suspected?
But let's get back to Freud. His choice of a medical career was influenced
by his hearing a lecture by the zoologist Carl Brühl who read an essay on
Nature ascribed to Goethe. In medical school Freud adopted Ernst Brücke, the
noted physiologist, as his admired idol. Brücke as a student of Helmholtz was
the symbol for the revolutionary advances in physiological science. A true
pioneering scientist, he aimed to reduce physiological processes to physical
and chemical laws. Freud was inspired to do for psychology what had just been
accomplished for physiology by his teachers. Thus Freud's aim was to reduce
the chaos of psychological observations to scientifically observed
psychological processes and then further to psychological laws in analogy to
the laws of physiology, chemistry and physics. A most ambitious undertaking of
which one may well say that he largely succeeded. Along with the other
scientists of his day Freud conceptualized within the positivistic framework
of Cartesianism, the reigning philosophy of René Descartes. In Freud's view,
therefore, the mind became an isolated mechanistically constructed machine
like many other objects in the world. Dichotomous conceptualizations such as
object vs. subject, inner vs. outer, psychical reality vs. external reality,
became the metapsychological pillars upon which the whole house of theory was
being built. We all grew up in this Cartesian thinking and to free ourselves
is extremely difficult.
Our topic here today is the therapeutic process. What happens in a
psychoanalysis that is experienced as psychological change? My aim in the
following is to help open the door of the Cartesian box and let me and all of
us follow the psychoanalytic process from the point of view of experiencing it
rather than looking at it objectively as something out there. And immediately
as I write this I am experiencing some apprehension that I am attempting the
impossible, that I will not be able to understandably talk about conscious and
unconscious experiences. But I will try and hope for the best, just like when
beginning an analysis.
II
What is the future analysand likely experiencing
while he or she attempts to get into a treatment relationship with an analyst?
I think we can assume that the potential patient who voluntarily is
approaching a therapist has a number of scary questions on his/her mind.
Perhaps the most universal and pressing of these questions is "I feel
bad. Can I be helped and will this professional person be willing and able to
help me with my feeling so bad?"
As you can see, for the time being I am restricting myself to talking about
the person with feeling states of discomfort about the self. Such feeling
states commonly include degrees of anxiety and depression and probably have
been experienced more or less for some time. Other feeling states, such as,
for example, mania, are less likely to be experienced with the immediate
discomfort that calls for a remedy. However, even the patient, who comes in
apparently feeling good and cheerful, is in all probability hiding the anxiety
and depression that could be experienced. Fear of experiencing shameful
judgments regarding the self may serve the attempt to push everything less
than perfection out of mind. However, in the absence of a critical posture on
part of the therapist, the patient is likely to gain some confidence that the
therapist may actually try to be helpful without intentionally introducing
negative consequences, such as a put-down of the patient.
The therapist may say all kinds of things that the patient agrees or
disagrees with. Information passed from therapist to patient via verbal
interpretation may be very illuminating and may even succeed in making
something conscious that was unconscious. Yet, in order for the therapeutic
work to achieve some success in the judgment of both participants something
more is required than mere agreement or disagreement as expressed verbally
regardless of whether the verbal exchange has increased the scope of conscious
awareness or not.
That something more is an aspect of the relationship between the two
participants, namely how the relationship of patient and therapist with each
other is experienced. We may call it an intersubjective relationship. What the
patient hopes for is the experience of being understood and accepted by the
therapist. Understanding and acceptance mean more than a mere intellectual
cognition and a tolerant acknowledgment of the patient's behavior, wishes,
feelings, and goals. It means also that the therapist's response to
understanding the patient includes a set of the therapist's own feelings which
the patient can experience and sense, and which indicate that the therapist's
essentially friendly and benign posture vis-à-vis the patient is genuinely
representative of the therapist's self. No play-acting or following some
prescribed technique of analytic responsiveness but with a personal honestly
respectful spontaneity expressing good-will.
It is only when such a relationship has been established or is about to be
established that experiencing a verbal interpretation or any other kind of
cognitive intellectual insight can have a therapeutic impact. A verbal
interpretation or some other behavior on part of the therapist can be
experienced as a mutually mutative moment that advances the treatment toward a
mutually agreed goal only within the context of such a reciprocally accepting
and understanding relationship of both participants.
III
At this point, I would guess, most psychoanalysts
would think of transference and the appropriate interpretation of the
transference phenomena as they manifest in the relationship between analyst
and analysand. However, it is important to recognize that the intersubjective
relationship between the two participants that I have been discussing is
qualitatively and dynamically separate and different from the transference
relationship. To put it most succinctly, transference is the manifestation in
the present of mostly unconscious aspects of childhood experiences and the
defenses developed in reaction to these early experiences. Wishes, thoughts,
feelings, behaviors, and the reactions and defenses that were constructed to
protect against unpleasant and destructive effects have become or remained an
unconscious part of memory and are displaced in the here-and-now onto persons
with which the individual is currently engaged in some interpersonal
relationship. The therapist is, of course, a prime target for such
displacements. While it is possible that some actual behaviors of the
therapist may encourage or facilitate the transference displacements onto
him/her it should be remembered that these transference displacements
originate from and represent past experiences and are not at all indicative of
the qualities and behavior of the person onto whom the transferences are
targeted. There is a discrepancy between the actual reality of the person onto
whom the transference is displaced and how this person is perceived as a
result of the transference which alters aspects of how this person is
experienced. Interpretation of the discrepancy may often allow a more accurate
perception of the actual reality with a reduction in the power of the
displaced past to influence current experience. However, as already stressed
above, the power to alter the experience of the relationship in a positive
therapeutic direction depends more on the reality of the therapist's posture
and being than on the transference induced distortions. The experienced
reality is more powerful than the verbal explanation of the transference.
An additional complicating factor is the therapist's mostly unconscious
transference onto the patient. Usually this is designated as
countertransference. The therapist may be partially aware of these
countertransference displacements onto the patient originating in the
therapist's childhood experiences. Furthermore, there may be direct reactions
of the therapist to the patient's transferences that have often been labeled
rather imprecisely as countertransferences and would better be designated as
counterreactions. It is clear that any counterreaction is part of the actual
reality of the patient's experience of the therapist and, therefore, likely to
influence the therapeutic process in either a positive or negative direction.
One could argue that some counterreactions are practically inescapable and
that the posture of understanding and acceptance described above as needed is
just a particular type of counterreaction which happens to be therapeutically
desirable.
IV
When we last met here in Dreieich in the summer of
1997 we focused our discussions on the role of interpretation in
psychoanalytic treatment. At that time I briefly described how the total
experience of the two participants in the analytic situation inevitably
developed into something more than could be based on mere verbal
interpretations. Please allow me to quote myself:
"Patients noticed much more about their analysts than the words that
had been spoken. They noted the analyst's office, dress, mood, tone of
voice, posture, attitudes in general and specifically the analyst's
intentional or unintentional revelations about attitudes towards the
patient. For their part, analysts, when honestly introspective, became aware
that they were not neutral but had sometimes intense inner reactions and
affects evoked by the patients. As it turns out, analysis is not a process
that develops strictly within a patient nor even a process that can be
described by an outside observer to be going on between a patient and an
analyst, i.e., an interpersonal process. Rather, analysis consists of
experiences created by both the analysand as well as by the analyst. It can
fairly be said that each of the two participants' experience consists of an
awareness, limited in degree of consciousness, intensity and depth, 1) of
one's own inner thoughts and affects accessed by introspection, 2) to a
lesser extent, of the other's inner thought and affects accessed by
vicarious introspection (i.e., empathy), and, 3) most importantly yet also
most speculatively, of the what the other's thoughts and affects are about
oneself who to them is an other, accessed by a processing of one's
introspection and vicarious introspection with whatever else one knows about
the self and the other. In other words, the experience of both participants
revolves almost exclusively around their relationship with each other. As a
profession we are still struggling to describe accurately this experience of
mutual reciprocal awareness of self with other and how we are affected by it
in our thoughts, feelings and actions."
V
Having described how the mutually mutative moments in
psychoanalysis are experienced, it remains to discuss how such experiences
come into existence and how they change the dynamic constellation that we have
learned to label the self or, in other words, what makes them mutative moments
for the self.
The above described and experienced relationship of mutual understanding
and acceptance of both participants of each other in the analytic situation
characterized by cooperation and collaboration in an ambience of mutually
benign friendliness that is necessary for interpretations to be effective has
been labeled "Therapeutic Alliance" or "Working Alliance"
by some theorists. I must stress here, however, that this important and needed
relationship by itself alone is also no more sufficient for therapeutic
progress to occur than is interpretation alone. To put it bluntly but simply,
neither love nor rationality are enough. For change to occur, whether it is a
desired therapeutic change or a not so desirable anti-therapeutic change,
requires first a regressive disorganization of the cohesive self experience
commonly referred to as a fragmentation (or, at least, a mini-fragmentation)
followed by a rearrangement of the constituent aspects of the experience into
a new more cohesive and more stable configuration.
I will again repeat from my discussion here two years ago when Kohut
described optimal frustrations as a precondition [of] change when Kohut had
not yet dismissed the drive-defense model:
This concept of optimal frustration became Kohut's fundamental approach
to a metapsychological theory of structure formation both in childhood as
well as during the psychoanalysis. Transmuting Internalization was the term
that Kohut used to designate this structure building process while he was
still struggling with an integration of both drive psychology and self
psychology:
"Preceding the withdrawal of the cathexis from the object there is a
breaking up of those aspects of the object imago that are being
internalized. This breaking up is of great psychoeconomic importance; it
constitutes the metapsychological substance of what, in a term closer to
empathically or introspectively observable experience, is referred to an
optimal frustration. The essentials of the process of fractionized
withdrawal of cathexes from objects were, of course, first established by
Freud (1917a) in the metapsychological description of the work of
mourning." (Kohut, 1971, p.49-50)
and
"…the most important aspect of the earliest mother-infant
relationship is the principle of optimal frustration. Tolerable
disappointments in the pre-existing (and externally sustained) primary
narcissistic equilibrium lead to the establishment of internal structures…"(Kohut,
1971, p.64)
Arlow and Brenner also see the creation of destabilization as desirable
when they state
"What analysts communicate to analysands serves to destabilize the
equilibrium of forces within the mind, leading to the analysands' growing
understanding of the nature of their conflict…"(Arlow & Brenner,
1990, p.678)
More recently the same idea was also stated by Schlesinger:
"An invariable consequence of a well-timed and accurate
interpretation is a disturbance of the patient's neurosis and the analytic
field. In the short run, the analyst's purpose is to accomplish just that.
It is essential that the analyst pay close attention to how the disturbance
develops, to diagnose the ways in which the patient attempts to restore
stability and to follow up with interpretation to illuminate them." (Schlesinger,
1995, p.663)
Kohut (1975?) in talking to students, however, did not think that the
disturbance caused by optimal frustration should be deliberately created by
the analyst:
"There is never any need--and by never, I mean never--there is never
any need to be artificially traumatic. Simply to give the best you can give
is traumatic enough, because you cannot fulfill the real needs…..you
always limp behind the patient's needs….you realize his hurt or
disappointment after the patient is already hurt." (Elson, 1987,.p.91)
Finally, Kohut (1985) in his posthumously published work talks about the
disturbance of the analytic relationship when the patient experiences the
analyst's failures:
"…[he] must ..demonstrate how, after the original resistance
motivated by the fear of retraumatization by the current selfobject's
empathic failure-in the selfobject transference: the analyst's failures as
manifested by his erroneous, inaccurate, ill-timed, or unfeelingly blunt
interpretations-had been overcome, … He must show, in brief, that the
quietly sustaining matrix provided by the spontaneously established
selfobject transference to the analyst that establishes itself in the early
phases of analysis is disrupted time and again by the analyst's unavoidable,
yet only temporary and thus nontraumatic , empathy failures-that is his
"optimal failures" (Kohut, 1985, p.66).
and how optimal failures lead to new structures:
"Each optimal failure will be followed by an increase in the
patient's resilience vis-à-vis empathy failures both inside and outside the
analytic situation; that is, after each, optimal new self structures will be
acquired and existing ones will be firmed." (Kohut, 1985, p.69)
In summary, we have seen how Kohut based himself on Freud's concept of
structure formation through mourning and developed from this the principle of
optimal frustration as a precondition for structure formation. As he gradually
relinquished the traditional drive-and-defense theory with a shift to a self
theory based on selfobject relations, Kohut shifted from an emphasis of
optimal frustration to a focus on optimal failures of the selfobject
relationship with its associated rupture in the relationship. Repair of this
rupture then becomes the path for rehabilitation by rearranging the fragmented
self into a new and stronger configuration.
VI
Classically the dynamics of an interpretation on the
unconscious has been described as an internalization. I try to avoid words
like internalize because the term is ill defined and I do not understand
clearly what it goes on both consciously and unconsciously. Of course, I do
understand that internalization describes results such as that an
interpretation which is given from outside, is consciously perceived, and
winds up having an effect on the unconscious where there is supposed to occur
a change in consequence of the interpretation having been made and
internalized. But to me that just labels the end result, it does not describe
how and why this internalization happens. Perhaps, Freud does describe the
dynamics of change that is labeled internalization. If so, I have forgotten it
and I am not going to try to look it up. Kohut talked about optimal
frustration and transmuting internalization. But he did not clarify either why
there is an internalization and why it is transmuting. Is the unconscious not
a domain, an area, with boundaries, that are not just easily penetrable? How
does one get into it? How does something that I say to the patient,
consciously, and is heard by the patient, consciously, get into his/her
unconscious?
In the absence of a clear understanding of how one can influence someone
else's unconscious I have concocted my own understanding. Let me put it in
self psychological language but I am sure one could easily translate this into
ego psychology, or into classical Freudian language.
I think of the self not as a structure, not as particular area of the mind
but as an organization of the memory traces of a certain type and kind of
experiences. (I realize that all these are only metaphors, but metaphors are
the only ways that we can talk about the mind, I believe). A newborn or before
birth even an intra-uterine infant has sensory experiences. These experiences
are recorded somehow (I don't know how but I don't think we need to know that
at this point) in the nervous system, most probably largely in the brain. One
of the most important of the functions of the brain seems to be to order the
incoming sensations, stimuli, perceptions, etc. Repeated identical inputs are
recognized and classified accordingly. Repeated inputs that are similar to
each other are classified as similar. Inputs from outside (extrospections) are
classified as such, inputs from inside (introspections) are classified as
such, some are classified as painful, some as pleasant, etc. pp. Another way
to describe this is to say that the brain attaches or assigns or reads meaning
into these experienced perceptions. A certain set of these experiences emerge
as pertaining to self, others pertain to not-self. The various experiences
pertaining to self are organized into an overall integration of
self-experiences that as a whole is experienced as a coherent self-experience,
and can be conceptualized as a self. But it is important to me not to think of
this as a structure but as an organization of experiences. Since many, and
probably most of the experiences that are organized into a sense of self come
from outside the individual, the resulting sense of self depends on the
environmental context as much as on the individuals' givens with which he/she
was born. The impact of the experiences from the outside on the inherent
givens strongly influence and even direct development. The latter, therefore,
is as dependent on the environment as on the inherent givens and the
developing sense of the self experience, therefore, depends to an appreciable
extent on the input of experiences emanating from outside. In other words, the
emerging self emerges adapted to the particular environment in which it
emerges. Since the self consists of the experiences that constitute it and
which were organized into a cohesively integrated sense of self, the infant's
sense of self is adapted to the milieu, that is, to the ambience created by
the parents and other caregivers. This results in certain potentials for
development being encouraged and stimulated while other potentials remain
unattended and without stimulation they tend to atrophy (=disappear). Each
developing self, consisting of the inherent givens, modified by the added
outside experiences, and by the development and non-development (=atrophy) of
potentials is a unique self.
In self psychology we are most interested in those experiences that lead to
the emergence, maintenance and modification of the sense of self. In the past
we have labeled these selfobjects because we used to think of them as objects
that thus shaped the self. However, not all are objects. Some are symbolic
experiences that stand for objects, e.g., musical experiences and other
artistic experiences. Kohut described four types of selfobject experiences
(mirroring, idealizing, alter-ego, merger), three more types (adversarial,
efficacy, vitalizing selfobject experiences) have been described since Kohut's
initial definitions. But more about that some other time.
In psychoanalysis a relationship develops between the analyst and the
analysand. Because of the particular structure, that is, experience, of the
analytic situation (regular sessions, frequency, relative quiet, calmness,
attuned responsiveness, protected confidentiality, etc. predisposing to a
certain kind of relaxation) the two participants both regress somewhat with
some disorganization of their self experience. Hopefully the analysand will
regress much more than the analyst. With the regression of the self experience
there is a degree of disintegration of the constituent experiences making up
the self experience. This allows for a closer attunement of the two
participants to each other, a more perceptive awareness of the other's
experience that can even be enhanced by a conscious effort to be aware via
empathy (as defined as vicarious introspection). It seems to be in the normal
nature of individuals to want, or even to need, to feel understood and
accepted. Such an experience of being understood and accepted strengthens the
integration of the self experience; the absence of the needed experience of
being understood an d accepted weakens the self experience and facilitates
further regression and disorganization, disintegration, fragmentation (choose
whatever term seems most descriptive to you) of the self experience into its
constituent parts that initially were integrated into the organization of the
self experience. Such a disorganization is painful and mobilizes motivation to
reintegrate and to again experience being understood and accepted.
Re-integration takes place as the constituent parts are rearranged in
adaptation to the currently prevailing ambience created by the analyst and
analysis: the rearranged organization of self experience is better adapted to
the current situation than the old organization that was first created and
then further developed from childhood on.
In other words, the old self had to encounter a disruptive experience that
caused a regression which could then be reversed by adaptation to the current
analytic experience, thus yielding a new, better adapted organization of the
self experience. One could describe a series of conditions that are needed for
such a therapeutic change to occur. But let that wait also for another time.
© 1999 Ernest S. Wolf and 3b.
All rights reserved.
[ Self Psychology Bulletin Board ]
©
1999-2000
All Rights Reserved
Published by 3b
