THE TEACHING
:
AND LEARNING OF PSYCHOANALYTIC
DEVELOPMENTAL
SAMUEL ABRAMS,M.D.
:
PSYCHOLOGY
HE FOLLOWING PRESENTATION
rests on a series of prem-
Tises: The developmental point of view is one of several orienting perspectives in psychoanalysis, containing certain basic a priori assumptions. Psychoanalysis is a developmental psychology as well as a genetic, dynamic, and structural one. Consequently, it sometimes utilizes explanatory hypotheses which rest on assumptions of a developmental point of view. The hypotheses of psychoanalytic developmental psychology are close to clinical data; they have evolved gradually from research , notably that research conducted within the psychoanalytic situation , and serve as a basis for accounting for behavior. There has been a relatively recent flourishing of interest in potentially innovative directions deriving from developmental considerations (Settlage, 1974). Those directions, however, should be distinguished from the established hypotheses of psychoanalytic developmental psychology, Presented in a slightly modified form at the Annual Meeting of The American Psychoanalytic Association in Baltimore, Maryland on the Panel, The Contributions of Developmental Concepts to Clinical Analysis, May, 1976. Dr. Abrams is Clinical Associate Professor. Downstate Psychoanalytic Institute.
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which are well integrated within the existing corpus of our science. It is these established hypotheses that I am considering here. Certain approaches in teaching may inadvertently create impediments to the optimal use of the hypotheses of psychoanalytic developmental psychology. These impediments derive partly from teaching methods, particularly those utilized in instructing on the clinical management of adults. I shall first list some of the accepted hypotheses that could be subsumed under the heading of psychoanalytic developmental psychology. After placing them within a brief historical context, I shall focus on three specific areas of psychoanalytic education: the teaching and learning of stance, theory, and technique. Each of these areas serves to transmit critical facts and conceptual proposals by way of certain customary pedagogic approaches. Some approaches to teaching are effective conduits for one group of ideas, but unwittingly become barriers to others. I believe that something like this happens regularly where developmental issues are concerned. I hope to demonstrate how barriers in learning about development are created and I shall offer suggestions as to how they might be overcome without interfering with the transmission of any of the other well-accepted facts and theories.
The Fundamental Hypotheses of Psychoanalytic Developmental Psychology 1..Maturational emergence: there is an expected sequence of emerging functions in the psychic apparatus leading to progressively differentiated structures of hierarchical organization; the sequences, the functions, and the structures are rooted in biological sources. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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2. Milieu: to materialize and flourish, each require environmental stimulation. The range of stimulation and the timing are important variables influencing outcome. 3. Experiential interface: the experiential products of the “outer” and “inner” interaction also codetermine what is to follow. 4. Transformations: each step in the sequence involves transformations as well as sequences. 5. Progression-regression processes: development is also effected by intrinsic regressive and progressive processes which influence intensity, duration, and cadence. A Brief Historical Survey The developmental hypotheses arrived early on the psychoanalytic scene. By 1905, in the course of outlining the psychosexual phases, Freud had found use for all of the listed five. Maturational emergence: oral, anal, and phallic drives was a sequence guaranteed by biology. Milieu: the Anlagen materialized within settings. Experiential interface: severe frustration or. excessive gratification were believed to have critical impact on what would follow. Transformations: transformations were explicit in the concept of sublimation of sexual aims and implicit in the appearance of hierarchical levels of organization. Progression-regression processes: shifts, arrests, and fixations were critical in appreciating the range and implications of the new discovery. Despite the centrality of these propositions, it was not the developmental aspects of Freud’s thesis that attracted the attention of the clinicians. Rather, what stood in the foreground was the convincing demonstration of the existence of infantile sexuality and the far-reaching theory of instinctual drives which Freud conceived to account for its existence. The clinician’s goal became access: access to the drive-derived sexual expressions of childhood which had gone awry. A Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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topographic model of the mind was created to concretize the quest for those earlier determinants of behavior. What followed was a couple of decades of depth psychology, an important period of confirmation and new challenges. In 1926, in his monograph on anxiety, Freud summed up much of what had been discovered in the preceding generation and mounted a new plateau. He re-examined anxiety and used the frame of reference of his developmental psychology to do so. Steps in the ontogeny of danger was a maturational given; each step involved a climate of interaction; the resultant product of the innate and of the milieu cast its influence on what followed; new signals of danger were correlated with the establishment of new mental structures; and, naturally, there was the inevitable ebb and p o w to it all. Anxiety wasn’t simply a result of repression; it was a biological guarantee, both a signal of danger and a stimulus for growth. However, once again, it was not the developmental features of Freud’s monograph that moved the clinician. Instead, attention to this critical ego function had the effect of accelerating the shift from “topography” to “structure.” The clinical focus was no longer the drive-derived infantile sexual components alone. Rather, the orientation turned toward access to the unconsicous conflicts which had existed between systems of the mind and had become accessible to recall in the structure of those systems thereafter. Anna Freud’s The Ego and the Mechanisms of Defense (1936) was a pivotal contribution in the thirties. The same developmental concepts were central in this work as well. However, the opportunity to sharpen defense analysis that this book provided eclipsed whatever influence it might have had on the growth of psychoanalytic developmental psychology. Even the clinical applicaton of the proposition of transformations explicitly detailed in the treatment of adolescents was relegated to a secondary position. The thirties ended and the forties began with interest in Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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the “milieu” postulate. There was an enhanced attention to life’s circumstances, either from the viewpoint of their being “average expectable” (Hartmann) or definitively directive (e.g. Erikson). Although Hartmann and Erikson’s work remained will within the classical psychoanalytic framework, an accelerated interest in “social” issues and “external” sources of conflict induced many other clinicians to shift their therapeutic perspective from the field of mental representations to the arena of interpersonal reactions. Unfortunately, once an analyst turns too far from the intrapsychic, he injures his unique investigative method. The thirties and forties consequently became a period characterized by a rise of a host of “divergent” schools. The turbulences and splits of those years left the “milieu” postulate with a somewhat tarnished reputation. The past 25 years have seen the pressure to attend to developmental propositions arising primarily from the research observations and the analyses of children. A listing of all the sources of such pressures would produce an impressive bibliography. Piaget from a position outside of psychoanalysis and Mahler from inside it would have many citings in such a reference list. And what effect has this new information had on the psychoanalytic treatment of adults? The newly acquired facts are probably used primarily to sharpen the work of reconstruction of childhood experiences or to assist in grasping the earliest periods of life. These are practical and valuable uses of the accumulated information, but they are limited. When new data are simply assimilated into existing frames of reference, the prospects for their wider application became reduced even further. Consequently, despite Freud’s pace setting and all the subsequent curiosity, research, and new information, a fairly widespread impression persists that developmental data and propositions have very little direct influence on the psychoanalytic treatment of adults, whatever its usefulness with children. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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What are the barriers against integrating such data and propositions? Obviously there must be many, and they are of different orders. For example, there is no effective lexicon that bridges psychoanalytic psychology and the field of development, so that there is the barrier of language and of autonomous disciplines working apart. Then there is the natural barrier against the fresh or the new which exists in any viable scientific system. Any organization which too readily admits innovations is likely to promote decay sooner than it will institute progress. Every enthusiastic wave sweeps deposits of disintegration along in its rush, while threatening to victimize established knowledge in its wake. These two barriers-misunderstandings and the need to assure standards -are reasonable enough. I propose to discuss three other impediments which are not so acceptable. They arise as a consequence of current modes in psychoanalytic education. They are silent, insidious barriers precisely because they also happen to be effective conduits for the teaching of certain other essential features of clinical work. This makes them difficult to dislodge, because any attempt to do so seems to threaten those essential features. The first of these three barriers is imposed by the traditional explanatory stance of the clinician. The second results from the metapsychological framework within which he frequently operates. And the third derives from the accepted perspectives and procedures through which the psychoanalytic treatment is implemented. Explanatory Stance The traditional explanatory stance of the clinician is inclined to have a reductionistic base. The analyst searches for fundamental elements, for the roots of behavior. He seeks access to the forgotten past and especially to certain critical experiences in that past. His explorations may lead him to Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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original traumata, to depressive and paranoid “positions,” to drive-derived fixated phases, to infantile unconscious wishes, to formative masturbatory fantasies, to key conflicts of childhood-and so on. What people probably think about most when they think about psychoanalysis is this explanatory orientation: “understanding” requires access to the fundamental, to the source elements that determine behavior. That is what “analysis” literally means, i.e., “the resolution of anything complex into its simplest elements.” All analysts recognize, of course, that explanations require much more than merely the discovery of source elements. Gaining access to origins is necessary, but it is rarely sufficient to allow for a complete understanding of phenomena. However, this stance has proven so therapeutically serviceable within the clinical setting as a means of achieving results that it can be confused with the over-all goals of psychoanalysis. Since reductionism is so serviceable, it is difficult to challenge it as a basis for explanations, even when the challenge implies an extension and not an excision of the concept. A reductionist stance, too rigidly entrenched, precludes the recognition of other explanatory possibilities, some of which may be useful in engaging the developmental features of the psychoanalytic situation. Something more than a reductionist stance, something more than atomistic reasoning is necessary to account for the existence of new products and for their influence. For example, Schur (1955) has proposed that a “somatization” may be understood as a transformation of an affective state, not necessarily a consequence of simply some antecedent element of impulse. Similarly, reductionism alone can never account for the presence of special idealistic trends, of object removal, or of affective intensities of the kind that first make their appearance during the phase of adolescence. They are all products of a new organization which carries old themes into complex new variations. A good deal of the behavior of teenagers can be explained on the basis of the Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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impact of these new emergences rather than earlier determinants. . An additional explanatory stance is necessary to comprehend complexities of this sort. An effort at synthesis is one of the requirements in that addition. Entailed within it is coordinating, integrating, bringing together the old and new in a way that places the same and the different on a new plane of experience. Piaget (1963) calls a stance of this kind a “constructivist” type. He defines a constructivist explanation as one . . which while giving a certain place to reductionism (since it is one of the aspects of all explanation), mainly .. emphasizes construction processes . . . .” He goes on insofar as one can give a constructive explanation of conduct or mental activity, a certain specifically psychologic explanation is attained which is no longer reducible to social, physiologic or organic properties . . .” (p. 164). Perhaps such attention to the possibility of emerging new levels of integration routinely pervades every good clinician’s mind in the course of his analytic efforts. The label, constructivist, if such is the case, simply affixes a name to that process. This explanatory stance, which involves a readiness to consider the varying synthetic processes at different levels of hierarchic organization- this “constructivist” mode of attending-should be viewed as an addition to the customary reductionist approach. The added stance offers encouragement to the clinical perspective which inquires, “Why has this element led to that product and not to some other?” rather than to the one which simply assserts, “That product is derived directly from this element.” It raises, “What is new or different in this behavior?” and not simply “What is the same or what has persisted?” It impels one’s attention to move to transformations and the organizational impact of new structures rather than to linger on past sources alone. The attempt to reach beyond mere reductionism is actually not very new in psychoanalysis. Freud cautioned Abraham that accounting for a specific phenomenon by ‘I.
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simply reducing it to sadism and anal-erotism was passing over the “real explanation,” which required attending to a broader range of perspectives and integrating them (Jones, 1955, p. 329). Hartmann and Kris (1945) specifically recommended such a broadened approach to clinical matters. They noted that the information acquired in the psychoanalytic situation is not intended to show only “how the past is contained in the present” but rather why a specific solution was once adopted, why one was retained while another was dropped and what the causal relationships were between the original solutions and later developments. Clinical papers, case summaries, experiences in supervision and seminars confirm the impression that the effectiveness of the reductionist stance is being successfully demonstrated to a new generation of clinicians. It is necessary that educators continue to transmit this essential cognitive orientation. But it is not necessary that this be the exclusive one. A description of additional possibilities and of their potential usefulness might help make our explanations to patients even more precise. Met apsy ch o logy
The second barrier arises from the realm of theory, specifically from our metapsychological formulations. Whatever the disputes about its proper place and use (see, e.g., Gill, 1976), for many clinicians metapsychology provides a framework for theory building and for clinical reflection. Since Rapaport and Gill’s 1955 paper, five specific points of view have come to achieve general acceptance: dynamic, economic, structural, genetic, and adaptive. The perspectives are not meant to be sharply delimited from each other, and the assumptions subsumed under each are recognized to have a degree of overlap. The basic hypotheses of psychoanalytic developmental psychology-maturation, milieu, experience, transformaDownloaded from apa.sagepub.com at Monash University on June 21, 2015
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tions, and progression-regression processes -are derivatives of the assumptions that are found within the existing metapsychological framework. However, those assumptions are scattered about among the five perspectives. Some are explicated in the genetic point of view, others appear as postulates in the adaptive or structural or economic. Precisely as a consequence of such scattering, the basic assumptions underlying developmental hypotheses fail to coalesce into a circumscribed conceptual entity. Consequently, they are frequently overlooked as a tool of theoretical generalization or clinical reflection. For example, the genetic point of view contains postulates both of historical antecedents and of sequential transformations. Yet definitions of the genetic point of view which appear in the literature often emphasize the significance of the former while omitting the latter, i.e., the “antecedents” are noted, the “transformational” omitted (Abrams, 1977). As a result, among those analysts who use metapsychology as a scaffolding to help create their explanatory hypotheses, the further tendency is promoted to ignore the developmental implications of their data. There are several possible remedies for this barrier. One could be a reorganization of the assumptions of metapsychology so that they might be subsumed under six points of view instead of five. The sixth might be called the developmental point of view, a perspective ranking at an equivalent level to all the others. The developmental point of view should, of course, be differentiated from psychoanalytic developmental psychology. Another remedy, suggested by Marianne Kris (personal communication), would entail a change of labeling from the “genetic” to the “genetic-developmental point of view,” thereby emphasizing the two components. And still another, requiring neither a redistribution of the assumptions nor a new labeling, would require merely the emphasizing of the difference in the course of teaching. Any of these should efffectively reduce this barrier deriving from theory. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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Clinical Technique And now the third barrier, the barrier that is created in the course of transmitting the technical precepts of clinical psychoanalysis along its usual educational conduits. The technical precepts of clinical psychoanalysis do not especially highlight developmental propositions. The analytic situation permits the past to be placed into a highly intensified focused present. To do so, it taps the regressive unconscious trends in the personality. In the best of circumstances, those silent trends become manifest in the transference neurosis. The patient finds aspects of the analyst and of the analytic situation with which to concretize his childhood. The analyst helps activate those silent trends by his neutrality and by way of specific interventions, primarily interpretations and reconstructions. However, unconscious progressive trends are also activated in the analytic situation. Another kind of intervention, perhaps it could be called a developmental one, might permit certain patients greater access to those silent progressive trends. Such access would be valuable on several accounts. For one thing, it is worthwhile to have a conscious awareness of any area of unconscious activity; for another, aiding in the distinction between the progressive and regressive may result in a further sharpening of the expressions of the transference neurosis; and lastly, by rendering a progressive potential into consciousness, one might facilitate the emergence of experiential building-blocks necessary for development. Psychoanalytic theory holds and observations confirm that experiences are essential components if any developmental movement is to occur. I am not suggesting something like the analyst being a so-called “real” object, of counseling his patient or supporting him or advising him or directing him or anything like that. Such interventions simply cloud the analytic process and generally have a calamitous effect on the transference Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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neurosis. Rather, I have in mind something which might promote the progressive trends without doing injury to the regressive resurgences. I have a clinical illustration with which to concretize this concept. It is more a reflection of my own initial attempts at applying this view than a precisely defined example. It might, however, help clarify what I’m trying to say. Anna Freud (1965, pp. 78-79) has outlined the developmental line leading from Egocentricity to Companionship. She has described four steps in that sequence. First, there exists a selfish, narcissistically oriented outlook on the world. This passes on to a second step in which other people are viewed as lifeless things which can be manipulated and discarded as the mood demands. At a third juncture, persons may be related to for the purpose of carrying out a specific task; the duration of the relationship is secondary to the task and limited by it. Finally, there is a fourth step in which individuals are seen as partners as well as persons in their own right toward whom feelings can be recognized and acknowledged and.with whom possessions can be shared on a basis of equality. It goes without saying that the negotiation of this sequence requires overcoming a variety of conflicts and acquiring higher levels of structural organization. The woman I’m about to describe suffered (among other things) from an interference in the line of development that moves from Egocentricity to Companionship. She had a poor grasp of the concept of people as “partners” or of “sharing” or of “equality”; she found it difficult to understand “cooperation” or “mutuality.” Her object relations were clustered about prephallic modes: she showed a disposition toward the dyadic, and there was little evidence that the Oedipus complex had been experientially engaged in a way that would facilitate the emergence of an oedipal-phase organization. She had quite a problem with aggressivity-but that statement does not do justice to her difficulty. Her feelings of hate had failed to undergo the expected ontogenetic binding, so that Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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when she finally got in touch with them they proved unusually threatening. Within the setting of the analytic process, I hope to outline her characteristic mode of functioning with people, its entrenchment within the structure of her personality, the effects of that entrenchment, its persistence through different periods of life, and the transference manifestations. You will hear something about the dynamic and genetic determinants of her disturbed relations to people as well as the apparent strategic achievements served by those relations. And all this arising as a result of the mobilization of the inherent regressive trends. But what 1 also hope to illustrate is the mobilization of the inherent progressive trends as well. The implicit hypothesis is that, once the psychoanalytic situation has been able to deal with the entrenched regressive organization, it may be possible for it to tap the emerging developmental potential and promote growth. The young woman found her way into analysis because of difficulties in sustaining her interests in a career and people. Reared in a rural midwestern atmosphere, she had come East in the hope of overcoming her inhibitions by settling in a big urban area. Her personal relationships were characterized in two ways. In the first of these, people were seen to exist simply as extensions, for example, as decorative accoutrements or as objects of need. The two of us came to call this her “assimilation” of people, by which we meant her processing them into previously existing perspectives. This was what human interaction was all about as far as she was concerned. People used one another for their own requirements. What might look like a genuine contact concealed the inevitable hidden selfishness of all actions: a “loving” exchange was simply a smoothly functioning joint exploitation. Naturally, she was made wary, cautious, and somewhat cynical as a result of this view. The second kind of relation she anticipated was characterized by such an all-embracing intimacy that it left her with Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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a sense of selflessness, quite literally without a feeling of being with boundaries. Images of swallowing up, of being eaten, and of dissolving were components of this state. Within her organizational scheme, a fully mature relation was not imaginable. The structure that led to joint exploitation put her at a great distance from others and left her feeling saddened and bitter; the structure that took her toward passionate intimacy brought her too close, and this left her scared to death. The best she could do was oscillate between the two possibilities. She described this graphically: “There is a dark area of loneliness and depression. It is helplessness without power; the quality of the outcast. Alone. An object of deprecation. Then the path to the other person opens up. My salvation is being part of that person. I love being loved. It takes me out of the dark state [but] . . . then I feel it closing in . . . I’m going to faint. Eventually, these perspectives materialized in the treatment setting. Analysis, she declared, was obviously merely a situation in which the analyst solves problems in exchange for a fee. She was to give information and offer payments for which she would in return receive direction and counsel. We were each to make use of one another, a barter and an exploita.tion, so to speak. This detached view of the contract made her feel alienated, and it saddened her. While entrenched within this set of distance, she reacted to any interpretation as if I were using her associations merely to confirm analytic dogma and thereby to please myself. She resented being “assimilated” into “establishment” theory, belittled all my endeavors, and threatened to quit. My silence or the evidence that I could see things differently from the way she could only seemed to confirm the existence of exploitativeness and of inevitable human distance. She decried what she viewed as threats to her autonomy. On the other hand, the analytic situation could become too intimate. A comment that touched her affectively sometimes was experienced as a.wave or a wash over her body with
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some genital resonance. While entrenched within this perspective of closeness, she perceived my comments or my silent attention as evidence that she was being encompassed within my personal fantasies. Since this was seen as a threat to her autonomy as well, she would assail me vigorously once more. Essentially, therefore, the same analytic stance threatened to either absorb her or exploit her, brought her too close or set her at too great a distance, and left her furious in any case. I pointed out (more than once) that this was what we observed about her relations to people, in general. Eventually, she became convinced that she had been trying to assimilate the actuality of the analytic setting into her own perspectives. Childhood memories following this conviction centered about a game with her pet dog. As a little girl she used to strike or scold him, thrusting him away. He recoiled at a distance in what appeared to her to be a cowering state. After a few moments she would be moved to sweep him up in a warm and sympathetic embrace. She would imagine his initial despair upon being so dispatched and then his subsequent ebullience upon being re-encompassed, after which she set the sequence into motion once more. I linked the childhood game, the character of her object-relations and her view of the analytic interaction. This ushered in experiences with her mother. Recollections from the patient’s second and third year of life mixed with adolescent memories. In her teen-age years she often felt that she was the tool of her mother’s ambition and pleasure. It did not prove too difficult to reconstruct similar impressions deriving from earlier years. Interspersed were fantasies of a violent quality in which beating and strangling predominated. To be someone’s instrument of pleasure meant you were regarded as no real person at all. This especially pernicious form of rejection evoked grief and anger. But the little girl found a way out. She learned to work her own needs into the setting. When mother fawned over her, for example, she tried Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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to see herself as a princess with a servile attendant. The illusory gratification temporarily overcame distress. Sometimes, she melted into the blissful fantasy altogether. The melt pre-empted hate, since hate is only possible across a boundary that clearly defines two separate people. Not only was hate obscured in the melt; there could be no helpless grief either. Sadness was denied in the illusory inflated joy of union. So she discovered, as a result of her analytic work, that fusion was both a defense against hate and a denial of despair. The resulting annihilation of self, however, proved too terrifying, so that the melt could only be a temporary refuge. A surer solution evolved. It entailed her oscillating between the exploitativeness and the fusion, the distance and the intimacy, with each affording protection against the other, while both served to relieve her from feelings and impulses judged as unmanageable. And in repeating the game with people in the same way she had done with her dog, there was the additional advantage of actively controlling that set of experiences against which she had felt so helpless. All in all, it was a pathway of development of human interacton that seemed to work fairly well as far as she was concerned; however, it was a divergent path with evident disadvantages. Fixated within that route, she was inevitably stalled in the growth toward definition, true mutuality, and companionship. The characteristic qualities of her relatedness were seen in the past, and they were replayed in the transference. I had been experienced as the mother who engulfed and the mother who ignored. She had made me the dog who could be both actively rejected and reeled back. In this parade of early object-ties, I also came to represent a specific latency-age figure: her “spelling-homework” sister. She tried to discover this “spelling-homework” sister in me. As a little girl her first sojourns into spelling had proved trying. Her older sister, on the other hand, enjoyed something Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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of a reputation for being gifted in this area. Using wile or sometimes barter, she would entreat her sister to do her homework. She received good home reports as a consequence, although she grew up to be relatively poor speller. This latency-age representative of her earlier object-ties transmitted the antecedent interactions and solutions into later life. The “spelling-homework” mode was promoted by a subsequent series of experiences which added further accretions of this style of relating onto her character. People were there to be “used”- to do for her; they were to oversee her finances, provide love, arrange for her to get into the proper schools or areas of employment, be attendant to her interests, etc. She particularly hoped to rediscover a new edition of the “spelling-homework” sister in the transference. Without the control over things which it could afford her, there would be danger, e.g., threats of differentiation and the invariable rage and despair which would erupt once two people became clearly differentiated and well defined to one another. She wondered openly (and I privately) whether it was possible for her to face such primal affects, so that she might settle the real conflicts and implement a different quality in her contacts. Then, one day, within the treatment, a new kind of recollection appeared. Again it reflected an object tie with her sister. In this memory, the sister was lacing her shoes; this time, however, the patient was observing her and learning to do it for herself. This was a quality of interaction that was closer to differentiation and mutuality. Apparently, a more advanced step had emerged at some point in the past, but it had been only a fragile emergence, a relatively impoverished pathway. Without evident strategic value, it had remained underutilized, providing little opportunity for experiential additions. The reappearance of this preferred direction gave rise to the following questions: What had brought it forward? How was it realized in the current setting? Could any intervention be offered to give it additional impetus? Her attempts to really resurrect a “spelling-homework” Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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relationship in the analysis had failed. The abstinence had reactivated the earlier conflicts and challenged her strategy of solving them. At the same time, the uctual mutuality of the analytic situation provided a platform upon which the latent “shoelace” image could surface. The surfacing was facilitated by a treatment relation which really offered an alliance and a cooperativeness in spite of the distortions to which these offerings were continuously subjected (see Loewald, 1960). This might be stated as a more generalized hypothesis: Where a residual tendency to complete a developmental line exists, the focused setting of a psychoanalysis provides the intensity and the components for the experiences needed for growth. Consequently, for certain kinds of patients, the analytic situation not only provides the opportunity to understand how the pathways went awry, but makes available those ingredients by which new routes may be engaged. What can the analyst do to give the new path additional impetus for such patients? With this one I offered the following explanation for the memory of the “shoelace” sister. I said that she was recalling a different kind of relationship, one through which she could learn and not simply exploit or use as a melt. I added that she had become reminded of this different kind of interaction partly because she was experiencing it in operation between us. It was my intention to further raise this mode into her awareness and thereby facilitate its surfacing. I reasoned to myself that the new memory of her sister lacing her shoes was evidence that this alternate underdeveloped route was now potentially serviceable. To have attempted to use the real quality of the analytic interaction by imposing it upon her precociously, hwoever, might have only resulted in the blanketing of some pathologic regressive elements before they could receive analytic work. The comment I made may very well be of a kind many analysts would offer at this juncture. Perhaps experienced clinicians intuit this potential new emergence and give expression to their preconscious awareness through such interDownloaded from apa.sagepub.com at Monash University on June 21, 2015
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ventions. The use of the term “developmental intervention” is not to suggest that an entirely new procedure is being recommended, but rather to permit a greater focus on what might very well be a common sort of response, one especially useful with a certain group of fixated persons. For the patient, the focusing proved to have a positive effect. Curiously enough, it intensified her awareness of the unconsious conflictual trends and permitted them to surface even more sharply. With the achievement of additional self-definition, her feelings of hate became more manifest. It was one of those feelings she had never appropriately experienced or worked into her growing mental organization. She was devoid of a normal ontogeny of hate and of a proper balance between it and her libidinal distribution. From a structural and economic point of view, these features appeared to be at the core of her pathological disposition. With such features gripping at her core, psychological sex differentiation, envy, rivalry and the other crucial issues of the oedipal phase had not been able to evolve during childhood in the manner customarily observed in the psychoneurosis. The analytic situation was making some of those evolvements possible. It would be inaccurate to assert or imply that developmental concepts alone -be they “point of view,” “hypotheses,” or “interventions”- could account for the progress noted. Rather, what is being stressed ‘is the possible usefulness in integrating such ideas into customary analytic procedures. Teaching and learning are facilitated whenever what is silent is articulated.
Summary I have described three areas in psychoanalytic education where I believe greater attention to existing methods is necessary so as to facilitate the learning of certain principles of development. Explanations might be enhanced by including Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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constructivist with reductionist elements; metapsychology might be clarified in a way that would make the “developmental” more available to analytic scaffolding; and finally, the technical precepts that help focus on the emergence of regressive trends should be broadened to permit enhanced awareness of the progressive trends as well. REFERENCES Abrams, S. (1978), The genetic point of view: historical antecedents and developmental transformations. This Joumul, 25:417-426. Freud, A. (1936), TheEgo and the Mechanisms of Defense. The Writings of Anna Freud, 2. New York: International Universities Press, 1966. -(1965), Normulity and Pathology in Childhood: Assessments of Deuelopment. The Writings of Anna Freud, 6. New York: International Universities Press. Freud, S. (1905). Three ways on the theory of sexuality. Standard Edition, 7:125243. London: Hoganh Press, 1953. -(1926), Inhibitions, symptoms and anxiety. Standard Edition, 20:77-174. London: Hogarth Press, 1959. Gill, M. M. (1976), Metapsychologyis not psychology. In: Psychology VernrJ Metapsychology: Psychoanalytic &says in Memory of George S. Kkin, ed. M. M. Gill & P. Holzman [Psycholog. Issues, Monogr. 361. New York: International Universities Press. Hartmann, H. & Kris. E. (1945), The genetic approach in psychoanalysis. The Psychoanalytic Study of the Child, 1:ll-29. New York: International Universities Press. Jones, E. (1955), The Life and Work of Sigmund Freud, 2. New York: Basic Books. Locwald, H. (1960), On the therapeutic action of psychoanalysis. I n t e m t . J. P s y c h o - A d . , 41:16-33. Piaget, J. (1963), Explanation in psychology and psychophysiological parallelism. In: Experimental Psychology: Its Scope and Method, Vol. I, ed. P. Fraisse & J. Piaget. New York: Basic Books, pp. 153-191. Rapaport, D. & Gill, M. M. (1959), The points of view and assumptions of metapsychology. Internut.J. Psycho-Anal., 40:153-162. Schur, M. (1955), Comments on the metapsychology of somatization. The PsychoanulyticStudy of the Child, 10:119-164. New York: International Universities Press. Settlage, C. (1974), Response to discussant on child analysis. In: Psychoanufytic Education and Research, ed. S . Goodman. New York: International Universities Press, 1977, pp. 94-100. 25 East 83 Street
New York, New York 10028
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:
AND LEARNING OF PSYCHOANALYTIC
DEVELOPMENTAL
SAMUEL ABRAMS,M.D.
:
PSYCHOLOGY
HE FOLLOWING PRESENTATION
rests on a series of prem-
Tises: The developmental point of view is one of several orienting perspectives in psychoanalysis, containing certain basic a priori assumptions. Psychoanalysis is a developmental psychology as well as a genetic, dynamic, and structural one. Consequently, it sometimes utilizes explanatory hypotheses which rest on assumptions of a developmental point of view. The hypotheses of psychoanalytic developmental psychology are close to clinical data; they have evolved gradually from research , notably that research conducted within the psychoanalytic situation , and serve as a basis for accounting for behavior. There has been a relatively recent flourishing of interest in potentially innovative directions deriving from developmental considerations (Settlage, 1974). Those directions, however, should be distinguished from the established hypotheses of psychoanalytic developmental psychology, Presented in a slightly modified form at the Annual Meeting of The American Psychoanalytic Association in Baltimore, Maryland on the Panel, The Contributions of Developmental Concepts to Clinical Analysis, May, 1976. Dr. Abrams is Clinical Associate Professor. Downstate Psychoanalytic Institute.
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which are well integrated within the existing corpus of our science. It is these established hypotheses that I am considering here. Certain approaches in teaching may inadvertently create impediments to the optimal use of the hypotheses of psychoanalytic developmental psychology. These impediments derive partly from teaching methods, particularly those utilized in instructing on the clinical management of adults. I shall first list some of the accepted hypotheses that could be subsumed under the heading of psychoanalytic developmental psychology. After placing them within a brief historical context, I shall focus on three specific areas of psychoanalytic education: the teaching and learning of stance, theory, and technique. Each of these areas serves to transmit critical facts and conceptual proposals by way of certain customary pedagogic approaches. Some approaches to teaching are effective conduits for one group of ideas, but unwittingly become barriers to others. I believe that something like this happens regularly where developmental issues are concerned. I hope to demonstrate how barriers in learning about development are created and I shall offer suggestions as to how they might be overcome without interfering with the transmission of any of the other well-accepted facts and theories.
The Fundamental Hypotheses of Psychoanalytic Developmental Psychology 1..Maturational emergence: there is an expected sequence of emerging functions in the psychic apparatus leading to progressively differentiated structures of hierarchical organization; the sequences, the functions, and the structures are rooted in biological sources. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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2. Milieu: to materialize and flourish, each require environmental stimulation. The range of stimulation and the timing are important variables influencing outcome. 3. Experiential interface: the experiential products of the “outer” and “inner” interaction also codetermine what is to follow. 4. Transformations: each step in the sequence involves transformations as well as sequences. 5. Progression-regression processes: development is also effected by intrinsic regressive and progressive processes which influence intensity, duration, and cadence. A Brief Historical Survey The developmental hypotheses arrived early on the psychoanalytic scene. By 1905, in the course of outlining the psychosexual phases, Freud had found use for all of the listed five. Maturational emergence: oral, anal, and phallic drives was a sequence guaranteed by biology. Milieu: the Anlagen materialized within settings. Experiential interface: severe frustration or. excessive gratification were believed to have critical impact on what would follow. Transformations: transformations were explicit in the concept of sublimation of sexual aims and implicit in the appearance of hierarchical levels of organization. Progression-regression processes: shifts, arrests, and fixations were critical in appreciating the range and implications of the new discovery. Despite the centrality of these propositions, it was not the developmental aspects of Freud’s thesis that attracted the attention of the clinicians. Rather, what stood in the foreground was the convincing demonstration of the existence of infantile sexuality and the far-reaching theory of instinctual drives which Freud conceived to account for its existence. The clinician’s goal became access: access to the drive-derived sexual expressions of childhood which had gone awry. A Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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topographic model of the mind was created to concretize the quest for those earlier determinants of behavior. What followed was a couple of decades of depth psychology, an important period of confirmation and new challenges. In 1926, in his monograph on anxiety, Freud summed up much of what had been discovered in the preceding generation and mounted a new plateau. He re-examined anxiety and used the frame of reference of his developmental psychology to do so. Steps in the ontogeny of danger was a maturational given; each step involved a climate of interaction; the resultant product of the innate and of the milieu cast its influence on what followed; new signals of danger were correlated with the establishment of new mental structures; and, naturally, there was the inevitable ebb and p o w to it all. Anxiety wasn’t simply a result of repression; it was a biological guarantee, both a signal of danger and a stimulus for growth. However, once again, it was not the developmental features of Freud’s monograph that moved the clinician. Instead, attention to this critical ego function had the effect of accelerating the shift from “topography” to “structure.” The clinical focus was no longer the drive-derived infantile sexual components alone. Rather, the orientation turned toward access to the unconsicous conflicts which had existed between systems of the mind and had become accessible to recall in the structure of those systems thereafter. Anna Freud’s The Ego and the Mechanisms of Defense (1936) was a pivotal contribution in the thirties. The same developmental concepts were central in this work as well. However, the opportunity to sharpen defense analysis that this book provided eclipsed whatever influence it might have had on the growth of psychoanalytic developmental psychology. Even the clinical applicaton of the proposition of transformations explicitly detailed in the treatment of adolescents was relegated to a secondary position. The thirties ended and the forties began with interest in Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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the “milieu” postulate. There was an enhanced attention to life’s circumstances, either from the viewpoint of their being “average expectable” (Hartmann) or definitively directive (e.g. Erikson). Although Hartmann and Erikson’s work remained will within the classical psychoanalytic framework, an accelerated interest in “social” issues and “external” sources of conflict induced many other clinicians to shift their therapeutic perspective from the field of mental representations to the arena of interpersonal reactions. Unfortunately, once an analyst turns too far from the intrapsychic, he injures his unique investigative method. The thirties and forties consequently became a period characterized by a rise of a host of “divergent” schools. The turbulences and splits of those years left the “milieu” postulate with a somewhat tarnished reputation. The past 25 years have seen the pressure to attend to developmental propositions arising primarily from the research observations and the analyses of children. A listing of all the sources of such pressures would produce an impressive bibliography. Piaget from a position outside of psychoanalysis and Mahler from inside it would have many citings in such a reference list. And what effect has this new information had on the psychoanalytic treatment of adults? The newly acquired facts are probably used primarily to sharpen the work of reconstruction of childhood experiences or to assist in grasping the earliest periods of life. These are practical and valuable uses of the accumulated information, but they are limited. When new data are simply assimilated into existing frames of reference, the prospects for their wider application became reduced even further. Consequently, despite Freud’s pace setting and all the subsequent curiosity, research, and new information, a fairly widespread impression persists that developmental data and propositions have very little direct influence on the psychoanalytic treatment of adults, whatever its usefulness with children. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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What are the barriers against integrating such data and propositions? Obviously there must be many, and they are of different orders. For example, there is no effective lexicon that bridges psychoanalytic psychology and the field of development, so that there is the barrier of language and of autonomous disciplines working apart. Then there is the natural barrier against the fresh or the new which exists in any viable scientific system. Any organization which too readily admits innovations is likely to promote decay sooner than it will institute progress. Every enthusiastic wave sweeps deposits of disintegration along in its rush, while threatening to victimize established knowledge in its wake. These two barriers-misunderstandings and the need to assure standards -are reasonable enough. I propose to discuss three other impediments which are not so acceptable. They arise as a consequence of current modes in psychoanalytic education. They are silent, insidious barriers precisely because they also happen to be effective conduits for the teaching of certain other essential features of clinical work. This makes them difficult to dislodge, because any attempt to do so seems to threaten those essential features. The first of these three barriers is imposed by the traditional explanatory stance of the clinician. The second results from the metapsychological framework within which he frequently operates. And the third derives from the accepted perspectives and procedures through which the psychoanalytic treatment is implemented. Explanatory Stance The traditional explanatory stance of the clinician is inclined to have a reductionistic base. The analyst searches for fundamental elements, for the roots of behavior. He seeks access to the forgotten past and especially to certain critical experiences in that past. His explorations may lead him to Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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original traumata, to depressive and paranoid “positions,” to drive-derived fixated phases, to infantile unconscious wishes, to formative masturbatory fantasies, to key conflicts of childhood-and so on. What people probably think about most when they think about psychoanalysis is this explanatory orientation: “understanding” requires access to the fundamental, to the source elements that determine behavior. That is what “analysis” literally means, i.e., “the resolution of anything complex into its simplest elements.” All analysts recognize, of course, that explanations require much more than merely the discovery of source elements. Gaining access to origins is necessary, but it is rarely sufficient to allow for a complete understanding of phenomena. However, this stance has proven so therapeutically serviceable within the clinical setting as a means of achieving results that it can be confused with the over-all goals of psychoanalysis. Since reductionism is so serviceable, it is difficult to challenge it as a basis for explanations, even when the challenge implies an extension and not an excision of the concept. A reductionist stance, too rigidly entrenched, precludes the recognition of other explanatory possibilities, some of which may be useful in engaging the developmental features of the psychoanalytic situation. Something more than a reductionist stance, something more than atomistic reasoning is necessary to account for the existence of new products and for their influence. For example, Schur (1955) has proposed that a “somatization” may be understood as a transformation of an affective state, not necessarily a consequence of simply some antecedent element of impulse. Similarly, reductionism alone can never account for the presence of special idealistic trends, of object removal, or of affective intensities of the kind that first make their appearance during the phase of adolescence. They are all products of a new organization which carries old themes into complex new variations. A good deal of the behavior of teenagers can be explained on the basis of the Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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impact of these new emergences rather than earlier determinants. . An additional explanatory stance is necessary to comprehend complexities of this sort. An effort at synthesis is one of the requirements in that addition. Entailed within it is coordinating, integrating, bringing together the old and new in a way that places the same and the different on a new plane of experience. Piaget (1963) calls a stance of this kind a “constructivist” type. He defines a constructivist explanation as one . . which while giving a certain place to reductionism (since it is one of the aspects of all explanation), mainly .. emphasizes construction processes . . . .” He goes on insofar as one can give a constructive explanation of conduct or mental activity, a certain specifically psychologic explanation is attained which is no longer reducible to social, physiologic or organic properties . . .” (p. 164). Perhaps such attention to the possibility of emerging new levels of integration routinely pervades every good clinician’s mind in the course of his analytic efforts. The label, constructivist, if such is the case, simply affixes a name to that process. This explanatory stance, which involves a readiness to consider the varying synthetic processes at different levels of hierarchic organization- this “constructivist” mode of attending-should be viewed as an addition to the customary reductionist approach. The added stance offers encouragement to the clinical perspective which inquires, “Why has this element led to that product and not to some other?” rather than to the one which simply assserts, “That product is derived directly from this element.” It raises, “What is new or different in this behavior?” and not simply “What is the same or what has persisted?” It impels one’s attention to move to transformations and the organizational impact of new structures rather than to linger on past sources alone. The attempt to reach beyond mere reductionism is actually not very new in psychoanalysis. Freud cautioned Abraham that accounting for a specific phenomenon by ‘I.
‘I.
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simply reducing it to sadism and anal-erotism was passing over the “real explanation,” which required attending to a broader range of perspectives and integrating them (Jones, 1955, p. 329). Hartmann and Kris (1945) specifically recommended such a broadened approach to clinical matters. They noted that the information acquired in the psychoanalytic situation is not intended to show only “how the past is contained in the present” but rather why a specific solution was once adopted, why one was retained while another was dropped and what the causal relationships were between the original solutions and later developments. Clinical papers, case summaries, experiences in supervision and seminars confirm the impression that the effectiveness of the reductionist stance is being successfully demonstrated to a new generation of clinicians. It is necessary that educators continue to transmit this essential cognitive orientation. But it is not necessary that this be the exclusive one. A description of additional possibilities and of their potential usefulness might help make our explanations to patients even more precise. Met apsy ch o logy
The second barrier arises from the realm of theory, specifically from our metapsychological formulations. Whatever the disputes about its proper place and use (see, e.g., Gill, 1976), for many clinicians metapsychology provides a framework for theory building and for clinical reflection. Since Rapaport and Gill’s 1955 paper, five specific points of view have come to achieve general acceptance: dynamic, economic, structural, genetic, and adaptive. The perspectives are not meant to be sharply delimited from each other, and the assumptions subsumed under each are recognized to have a degree of overlap. The basic hypotheses of psychoanalytic developmental psychology-maturation, milieu, experience, transformaDownloaded from apa.sagepub.com at Monash University on June 21, 2015
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tions, and progression-regression processes -are derivatives of the assumptions that are found within the existing metapsychological framework. However, those assumptions are scattered about among the five perspectives. Some are explicated in the genetic point of view, others appear as postulates in the adaptive or structural or economic. Precisely as a consequence of such scattering, the basic assumptions underlying developmental hypotheses fail to coalesce into a circumscribed conceptual entity. Consequently, they are frequently overlooked as a tool of theoretical generalization or clinical reflection. For example, the genetic point of view contains postulates both of historical antecedents and of sequential transformations. Yet definitions of the genetic point of view which appear in the literature often emphasize the significance of the former while omitting the latter, i.e., the “antecedents” are noted, the “transformational” omitted (Abrams, 1977). As a result, among those analysts who use metapsychology as a scaffolding to help create their explanatory hypotheses, the further tendency is promoted to ignore the developmental implications of their data. There are several possible remedies for this barrier. One could be a reorganization of the assumptions of metapsychology so that they might be subsumed under six points of view instead of five. The sixth might be called the developmental point of view, a perspective ranking at an equivalent level to all the others. The developmental point of view should, of course, be differentiated from psychoanalytic developmental psychology. Another remedy, suggested by Marianne Kris (personal communication), would entail a change of labeling from the “genetic” to the “genetic-developmental point of view,” thereby emphasizing the two components. And still another, requiring neither a redistribution of the assumptions nor a new labeling, would require merely the emphasizing of the difference in the course of teaching. Any of these should efffectively reduce this barrier deriving from theory. Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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Clinical Technique And now the third barrier, the barrier that is created in the course of transmitting the technical precepts of clinical psychoanalysis along its usual educational conduits. The technical precepts of clinical psychoanalysis do not especially highlight developmental propositions. The analytic situation permits the past to be placed into a highly intensified focused present. To do so, it taps the regressive unconscious trends in the personality. In the best of circumstances, those silent trends become manifest in the transference neurosis. The patient finds aspects of the analyst and of the analytic situation with which to concretize his childhood. The analyst helps activate those silent trends by his neutrality and by way of specific interventions, primarily interpretations and reconstructions. However, unconscious progressive trends are also activated in the analytic situation. Another kind of intervention, perhaps it could be called a developmental one, might permit certain patients greater access to those silent progressive trends. Such access would be valuable on several accounts. For one thing, it is worthwhile to have a conscious awareness of any area of unconscious activity; for another, aiding in the distinction between the progressive and regressive may result in a further sharpening of the expressions of the transference neurosis; and lastly, by rendering a progressive potential into consciousness, one might facilitate the emergence of experiential building-blocks necessary for development. Psychoanalytic theory holds and observations confirm that experiences are essential components if any developmental movement is to occur. I am not suggesting something like the analyst being a so-called “real” object, of counseling his patient or supporting him or advising him or directing him or anything like that. Such interventions simply cloud the analytic process and generally have a calamitous effect on the transference Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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neurosis. Rather, I have in mind something which might promote the progressive trends without doing injury to the regressive resurgences. I have a clinical illustration with which to concretize this concept. It is more a reflection of my own initial attempts at applying this view than a precisely defined example. It might, however, help clarify what I’m trying to say. Anna Freud (1965, pp. 78-79) has outlined the developmental line leading from Egocentricity to Companionship. She has described four steps in that sequence. First, there exists a selfish, narcissistically oriented outlook on the world. This passes on to a second step in which other people are viewed as lifeless things which can be manipulated and discarded as the mood demands. At a third juncture, persons may be related to for the purpose of carrying out a specific task; the duration of the relationship is secondary to the task and limited by it. Finally, there is a fourth step in which individuals are seen as partners as well as persons in their own right toward whom feelings can be recognized and acknowledged and.with whom possessions can be shared on a basis of equality. It goes without saying that the negotiation of this sequence requires overcoming a variety of conflicts and acquiring higher levels of structural organization. The woman I’m about to describe suffered (among other things) from an interference in the line of development that moves from Egocentricity to Companionship. She had a poor grasp of the concept of people as “partners” or of “sharing” or of “equality”; she found it difficult to understand “cooperation” or “mutuality.” Her object relations were clustered about prephallic modes: she showed a disposition toward the dyadic, and there was little evidence that the Oedipus complex had been experientially engaged in a way that would facilitate the emergence of an oedipal-phase organization. She had quite a problem with aggressivity-but that statement does not do justice to her difficulty. Her feelings of hate had failed to undergo the expected ontogenetic binding, so that Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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when she finally got in touch with them they proved unusually threatening. Within the setting of the analytic process, I hope to outline her characteristic mode of functioning with people, its entrenchment within the structure of her personality, the effects of that entrenchment, its persistence through different periods of life, and the transference manifestations. You will hear something about the dynamic and genetic determinants of her disturbed relations to people as well as the apparent strategic achievements served by those relations. And all this arising as a result of the mobilization of the inherent regressive trends. But what 1 also hope to illustrate is the mobilization of the inherent progressive trends as well. The implicit hypothesis is that, once the psychoanalytic situation has been able to deal with the entrenched regressive organization, it may be possible for it to tap the emerging developmental potential and promote growth. The young woman found her way into analysis because of difficulties in sustaining her interests in a career and people. Reared in a rural midwestern atmosphere, she had come East in the hope of overcoming her inhibitions by settling in a big urban area. Her personal relationships were characterized in two ways. In the first of these, people were seen to exist simply as extensions, for example, as decorative accoutrements or as objects of need. The two of us came to call this her “assimilation” of people, by which we meant her processing them into previously existing perspectives. This was what human interaction was all about as far as she was concerned. People used one another for their own requirements. What might look like a genuine contact concealed the inevitable hidden selfishness of all actions: a “loving” exchange was simply a smoothly functioning joint exploitation. Naturally, she was made wary, cautious, and somewhat cynical as a result of this view. The second kind of relation she anticipated was characterized by such an all-embracing intimacy that it left her with Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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a sense of selflessness, quite literally without a feeling of being with boundaries. Images of swallowing up, of being eaten, and of dissolving were components of this state. Within her organizational scheme, a fully mature relation was not imaginable. The structure that led to joint exploitation put her at a great distance from others and left her feeling saddened and bitter; the structure that took her toward passionate intimacy brought her too close, and this left her scared to death. The best she could do was oscillate between the two possibilities. She described this graphically: “There is a dark area of loneliness and depression. It is helplessness without power; the quality of the outcast. Alone. An object of deprecation. Then the path to the other person opens up. My salvation is being part of that person. I love being loved. It takes me out of the dark state [but] . . . then I feel it closing in . . . I’m going to faint. Eventually, these perspectives materialized in the treatment setting. Analysis, she declared, was obviously merely a situation in which the analyst solves problems in exchange for a fee. She was to give information and offer payments for which she would in return receive direction and counsel. We were each to make use of one another, a barter and an exploita.tion, so to speak. This detached view of the contract made her feel alienated, and it saddened her. While entrenched within this set of distance, she reacted to any interpretation as if I were using her associations merely to confirm analytic dogma and thereby to please myself. She resented being “assimilated” into “establishment” theory, belittled all my endeavors, and threatened to quit. My silence or the evidence that I could see things differently from the way she could only seemed to confirm the existence of exploitativeness and of inevitable human distance. She decried what she viewed as threats to her autonomy. On the other hand, the analytic situation could become too intimate. A comment that touched her affectively sometimes was experienced as a.wave or a wash over her body with
. . .”
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some genital resonance. While entrenched within this perspective of closeness, she perceived my comments or my silent attention as evidence that she was being encompassed within my personal fantasies. Since this was seen as a threat to her autonomy as well, she would assail me vigorously once more. Essentially, therefore, the same analytic stance threatened to either absorb her or exploit her, brought her too close or set her at too great a distance, and left her furious in any case. I pointed out (more than once) that this was what we observed about her relations to people, in general. Eventually, she became convinced that she had been trying to assimilate the actuality of the analytic setting into her own perspectives. Childhood memories following this conviction centered about a game with her pet dog. As a little girl she used to strike or scold him, thrusting him away. He recoiled at a distance in what appeared to her to be a cowering state. After a few moments she would be moved to sweep him up in a warm and sympathetic embrace. She would imagine his initial despair upon being so dispatched and then his subsequent ebullience upon being re-encompassed, after which she set the sequence into motion once more. I linked the childhood game, the character of her object-relations and her view of the analytic interaction. This ushered in experiences with her mother. Recollections from the patient’s second and third year of life mixed with adolescent memories. In her teen-age years she often felt that she was the tool of her mother’s ambition and pleasure. It did not prove too difficult to reconstruct similar impressions deriving from earlier years. Interspersed were fantasies of a violent quality in which beating and strangling predominated. To be someone’s instrument of pleasure meant you were regarded as no real person at all. This especially pernicious form of rejection evoked grief and anger. But the little girl found a way out. She learned to work her own needs into the setting. When mother fawned over her, for example, she tried Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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to see herself as a princess with a servile attendant. The illusory gratification temporarily overcame distress. Sometimes, she melted into the blissful fantasy altogether. The melt pre-empted hate, since hate is only possible across a boundary that clearly defines two separate people. Not only was hate obscured in the melt; there could be no helpless grief either. Sadness was denied in the illusory inflated joy of union. So she discovered, as a result of her analytic work, that fusion was both a defense against hate and a denial of despair. The resulting annihilation of self, however, proved too terrifying, so that the melt could only be a temporary refuge. A surer solution evolved. It entailed her oscillating between the exploitativeness and the fusion, the distance and the intimacy, with each affording protection against the other, while both served to relieve her from feelings and impulses judged as unmanageable. And in repeating the game with people in the same way she had done with her dog, there was the additional advantage of actively controlling that set of experiences against which she had felt so helpless. All in all, it was a pathway of development of human interacton that seemed to work fairly well as far as she was concerned; however, it was a divergent path with evident disadvantages. Fixated within that route, she was inevitably stalled in the growth toward definition, true mutuality, and companionship. The characteristic qualities of her relatedness were seen in the past, and they were replayed in the transference. I had been experienced as the mother who engulfed and the mother who ignored. She had made me the dog who could be both actively rejected and reeled back. In this parade of early object-ties, I also came to represent a specific latency-age figure: her “spelling-homework” sister. She tried to discover this “spelling-homework” sister in me. As a little girl her first sojourns into spelling had proved trying. Her older sister, on the other hand, enjoyed something Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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of a reputation for being gifted in this area. Using wile or sometimes barter, she would entreat her sister to do her homework. She received good home reports as a consequence, although she grew up to be relatively poor speller. This latency-age representative of her earlier object-ties transmitted the antecedent interactions and solutions into later life. The “spelling-homework” mode was promoted by a subsequent series of experiences which added further accretions of this style of relating onto her character. People were there to be “used”- to do for her; they were to oversee her finances, provide love, arrange for her to get into the proper schools or areas of employment, be attendant to her interests, etc. She particularly hoped to rediscover a new edition of the “spelling-homework” sister in the transference. Without the control over things which it could afford her, there would be danger, e.g., threats of differentiation and the invariable rage and despair which would erupt once two people became clearly differentiated and well defined to one another. She wondered openly (and I privately) whether it was possible for her to face such primal affects, so that she might settle the real conflicts and implement a different quality in her contacts. Then, one day, within the treatment, a new kind of recollection appeared. Again it reflected an object tie with her sister. In this memory, the sister was lacing her shoes; this time, however, the patient was observing her and learning to do it for herself. This was a quality of interaction that was closer to differentiation and mutuality. Apparently, a more advanced step had emerged at some point in the past, but it had been only a fragile emergence, a relatively impoverished pathway. Without evident strategic value, it had remained underutilized, providing little opportunity for experiential additions. The reappearance of this preferred direction gave rise to the following questions: What had brought it forward? How was it realized in the current setting? Could any intervention be offered to give it additional impetus? Her attempts to really resurrect a “spelling-homework” Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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relationship in the analysis had failed. The abstinence had reactivated the earlier conflicts and challenged her strategy of solving them. At the same time, the uctual mutuality of the analytic situation provided a platform upon which the latent “shoelace” image could surface. The surfacing was facilitated by a treatment relation which really offered an alliance and a cooperativeness in spite of the distortions to which these offerings were continuously subjected (see Loewald, 1960). This might be stated as a more generalized hypothesis: Where a residual tendency to complete a developmental line exists, the focused setting of a psychoanalysis provides the intensity and the components for the experiences needed for growth. Consequently, for certain kinds of patients, the analytic situation not only provides the opportunity to understand how the pathways went awry, but makes available those ingredients by which new routes may be engaged. What can the analyst do to give the new path additional impetus for such patients? With this one I offered the following explanation for the memory of the “shoelace” sister. I said that she was recalling a different kind of relationship, one through which she could learn and not simply exploit or use as a melt. I added that she had become reminded of this different kind of interaction partly because she was experiencing it in operation between us. It was my intention to further raise this mode into her awareness and thereby facilitate its surfacing. I reasoned to myself that the new memory of her sister lacing her shoes was evidence that this alternate underdeveloped route was now potentially serviceable. To have attempted to use the real quality of the analytic interaction by imposing it upon her precociously, hwoever, might have only resulted in the blanketing of some pathologic regressive elements before they could receive analytic work. The comment I made may very well be of a kind many analysts would offer at this juncture. Perhaps experienced clinicians intuit this potential new emergence and give expression to their preconscious awareness through such interDownloaded from apa.sagepub.com at Monash University on June 21, 2015
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ventions. The use of the term “developmental intervention” is not to suggest that an entirely new procedure is being recommended, but rather to permit a greater focus on what might very well be a common sort of response, one especially useful with a certain group of fixated persons. For the patient, the focusing proved to have a positive effect. Curiously enough, it intensified her awareness of the unconsious conflictual trends and permitted them to surface even more sharply. With the achievement of additional self-definition, her feelings of hate became more manifest. It was one of those feelings she had never appropriately experienced or worked into her growing mental organization. She was devoid of a normal ontogeny of hate and of a proper balance between it and her libidinal distribution. From a structural and economic point of view, these features appeared to be at the core of her pathological disposition. With such features gripping at her core, psychological sex differentiation, envy, rivalry and the other crucial issues of the oedipal phase had not been able to evolve during childhood in the manner customarily observed in the psychoneurosis. The analytic situation was making some of those evolvements possible. It would be inaccurate to assert or imply that developmental concepts alone -be they “point of view,” “hypotheses,” or “interventions”- could account for the progress noted. Rather, what is being stressed ‘is the possible usefulness in integrating such ideas into customary analytic procedures. Teaching and learning are facilitated whenever what is silent is articulated.
Summary I have described three areas in psychoanalytic education where I believe greater attention to existing methods is necessary so as to facilitate the learning of certain principles of development. Explanations might be enhanced by including Downloaded from apa.sagepub.com at Monash University on June 21, 2015
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constructivist with reductionist elements; metapsychology might be clarified in a way that would make the “developmental” more available to analytic scaffolding; and finally, the technical precepts that help focus on the emergence of regressive trends should be broadened to permit enhanced awareness of the progressive trends as well. REFERENCES Abrams, S. (1978), The genetic point of view: historical antecedents and developmental transformations. This Joumul, 25:417-426. Freud, A. (1936), TheEgo and the Mechanisms of Defense. The Writings of Anna Freud, 2. New York: International Universities Press, 1966. -(1965), Normulity and Pathology in Childhood: Assessments of Deuelopment. The Writings of Anna Freud, 6. New York: International Universities Press. Freud, S. (1905). Three ways on the theory of sexuality. Standard Edition, 7:125243. London: Hoganh Press, 1953. -(1926), Inhibitions, symptoms and anxiety. Standard Edition, 20:77-174. London: Hogarth Press, 1959. Gill, M. M. (1976), Metapsychologyis not psychology. In: Psychology VernrJ Metapsychology: Psychoanalytic &says in Memory of George S. Kkin, ed. M. M. Gill & P. Holzman [Psycholog. Issues, Monogr. 361. New York: International Universities Press. Hartmann, H. & Kris. E. (1945), The genetic approach in psychoanalysis. The Psychoanalytic Study of the Child, 1:ll-29. New York: International Universities Press. Jones, E. (1955), The Life and Work of Sigmund Freud, 2. New York: Basic Books. Locwald, H. (1960), On the therapeutic action of psychoanalysis. I n t e m t . J. P s y c h o - A d . , 41:16-33. Piaget, J. (1963), Explanation in psychology and psychophysiological parallelism. In: Experimental Psychology: Its Scope and Method, Vol. I, ed. P. Fraisse & J. Piaget. New York: Basic Books, pp. 153-191. Rapaport, D. & Gill, M. M. (1959), The points of view and assumptions of metapsychology. Internut.J. Psycho-Anal., 40:153-162. Schur, M. (1955), Comments on the metapsychology of somatization. The PsychoanulyticStudy of the Child, 10:119-164. New York: International Universities Press. Settlage, C. (1974), Response to discussant on child analysis. In: Psychoanufytic Education and Research, ed. S . Goodman. New York: International Universities Press, 1977, pp. 94-100. 25 East 83 Street
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