Conservative and Radical Perspectives on Psychoanalytic Knowledge: The Fascinated and the Disenchanted 9781138856370, 9781138856387, 9781315719153

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CONSERVATIVE AND RADICAL PERSPECTIVES ON PSYCHOANALYTIC KNOWLEDGE

Psychoanalysis really should not exist today. Until a few years ago, most of the evidence suggested that its time was drawing to a close, and yet psychoanalysis demonstrated remarkable resilience in the face of criticism, alongside significant resurgence over the course of the last years. In Conservative and Radical Perspectives on Psychoanalytic Knowledge: The fascinated and the disenchanted psychoanalyst and philosopher Aner Govrin describes the mechanisms of sociology within the psychoanalytic community which have enabled it to withstand the hostility levelled at it and to flourish as an intellectual and pragmatic endeavour. He defends the most criticized aspect of psychoanalysis: the fascination of analysts with their theories. Govrin demonstrates that fascination is a common phenomenon in science and shows its role in the evolution of psychoanalysis. Govrin argues that throughout its history, psychoanalysis has successfully embraced an amalgam of what he has defined and termed “fascinated” and “troubled communities.” A “fascinated community” is a group that embraces a psychoanalytic theory (such as Bion’s, Klein’s, Winnicott’s) as one embraces truth. A “troubled community” is one that is not satisfied with the state of psychoanalytic knowledge and seeks to generate a fundamental change that does not square with existing traditions (such as new psychoanalytic schools, scientifically troubled communities and the relational approach). It is this amalgam and the continuous tension between these two groups that are responsible for psychoanalysis’ rich and varied development and for its ability to adapt to a changing world. Clinical vignettes from the work of Robert Stolorow, Betty Joseph, Antonino Ferro and Michael Eigen illustrate the dynamic by which psychoanalytic knowledge is formed. Conservative and Radical Perspectives on Psychoanalytic Knowledge will be of interest to psychoanalysts, psychotherapists and philosophers alike. Aner Govrin, PhD., is a clinical psychologist and the Director of the doctoral program Psychoanalysis and Hermeneutics, The Program For Hermeneutics and Cultural Studies, Bar Ilan University, Israel. He is in private practice as a psychotherapist and psychoanalyst in Tel Aviv. He is the author of two books and various papers on psychoanalysis.

RELATIONAL PERSPECTIVES BOOK SERIES Lewis Aron & Adrienne Harris Series Co-Editors Steven Kuchuck & Eyal Rozmarin Associate Editors

The Relational Perspectives Book Series (RPBS) publishes books that grow out of or contribute to the relational tradition in contemporary psychoanalysis. The term relational psychoanalysis was first used by Greenberg and Mitchell1 to bridge the traditions of interpersonal relations, as developed within interpersonal psychoanalysis and object relations, as developed within contemporary British theory. But, under the seminal work of the late Stephen Mitchell, the term relational psychoanalysis grew and began to accrue to itself many other influences and developments. Various tributaries—interpersonal psychoanalysis, object relations theory, self psychology, empirical infancy research, and elements of contemporary Freudian and Kleinian thought— flow into this tradition, which understands relational configurations between self and others, both real and fantasied, as the primary subject of psychoanalytic investigation. We refer to the relational tradition, rather than to a relational school, to highlight that we are identifying a trend, a tendency within contemporary psychoanalysis, not a more formally organized or coherent school or system of beliefs. Our use of the term relational signifies a dimension of theory and practice that has become salient across the wide spectrum of contemporary psychoanalysis. Now under the editorial supervision of Lewis Aron and Adrienne Harris with the assistance of Associate Editors Steven Kuchuck and Eyal Rozmarin, the Relational Perspectives Book Series originated in 1990 under the editorial eye of the late Stephen A. Mitchell. Mitchell was the most prolific and influential of the originators of the relational tradition. He was committed to dialogue among psychoanalysts and he abhorred the authoritarianism that dictated adherence to a rigid set of beliefs or technical restrictions. He championed open discussion, comparative and integrative approaches, and he promoted new voices across the generations. Included in the Relational Perspectives Book Series are authors and works that come from within the relational tradition, extend and develop the tradition, as well as works that critique relational approaches or compare and contrast it with alternative points of view. The series includes our most distinguished senior psychoanalysts, along with younger contributors who bring fresh vision. 1 Greenberg, J. & Mitchell, S. (1983). Object relations in psychoanalytic theory. Cambridge, MA: Harvard University Press.

Vol. 1 Conversing with Uncertainty: Practicing Psychotherapy in a Hospital Setting Rita Wiley McCleary

Vol. 9 Influence and Autonomy in Psychoanalysis Stephen A. Mitchell

Vol. 2 Affect in Psychoanalysis: A Clinical Synthesis Charles Spezzano

Vol. 10 Fairbairn, Then and Now Neil J. Skolnick & David E. Scharff (eds.)

Vol. 3 The Analyst in the Inner City: Race, Class, and Culture through a Psychoanalytic Lens Neil Altman

Vol. 11 Building Bridges: Negotiation of Paradox in Psychoanalysis Stuart A. Pizer

Vol. 4 A Meeting of Minds: Mutuality in Psychoanalysis Lewis Aron

Vol. 12 Relational Perspectives on the Body Lewis Aron & Frances Sommer Anderson (eds.)

Vol. 5 Holding and Psychoanalysis: A Relational Perspective Joyce A. Slochower Vol. 6 The Therapist as a Person: Life Crises, Life Choices, Life Experiences, and Their Effects on Treatment Barbara Gerson (ed.) Vol. 7 Soul on the Couch: Spirituality, Religion, and Morality in Contemporary Psychoanalysis Charles Spezzano & Gerald J. Gargiulo (eds.) Vol. 8 Unformulated Experience: From Dissociation to Imagination in Psychoanalysis Donnel B. Stern

Vol. 13 Seduction, Surrender, and Transformation: Emotional Engagement in the Analytic Process Karen Maroda Vol. 14 Relational Psychoanalysis: The Emergence of a Tradition Stephen A. Mitchell & Lewis Aron (eds.) Vol. 15 The Collapse of the Self and Its Therapeutic Restoration Rochelle G. K. Kainer Vol. 16 Psychoanalytic Participation: Action, Interaction, and Integration Kenneth A. Frank

Vol. 17 The Reproduction of Evil: A Clinical and Cultural Perspective Sue Grand Vol. 18 Objects of Hope: Exploring Possibility and Limit in Psychoanalysis Steven H. Cooper Vol. 19 Who is the Dreamer, Who Dreams the Dream? A Study of Psychic Presences James S. Grotstein Vol. 20 Relationality: From Attachment to Intersubjectivity Stephen A. Mitchell Vol. 21 Looking for Ground: Countertransference and the Problem of Value in Psychoanalysis Peter G. M. Carnochan Vol. 22 Sexuality, Intimacy, Power Muriel Dimen Vol. 23 September 11: Trauma and Human Bonds Susan W. Coates, Jane L. Rosenthal, & Daniel S. Schechter (eds.) Vol. 24 Minding Spirituality Randall Lehman Sorenson Vol. 25 Gender as Soft Assembly Adrienne Harris

Vol. 26 Impossible Training: A Relational View of Psychoanalytic Education Emanuel Berman Vol. 27 The Designed Self: Psychoanalysis and Contemporary Identities Carlo Strenger Vol. 28 Relational Psychoanalysis, Vol. II: Innovation and Expansion Lewis Aron & Adrienne Harris (eds.) Vol. 29 Child Therapy in the Great Outdoors: A Relational View Sebastiano Santostefano Vol. 30 The Healer’s Bent: Solitude and Dialogue in the Clinical Encounter James T. McLaughlin Vol. 31 Unconscious Fantasies and the Relational World Danielle Knafo & Kenneth Feiner Vol. 32 Getting from Here to There: Analytic Love, Analytic Process Sheldon Bach Vol. 33 Creating Bodies: Eating Disorders as Self-Destructive Survival Katie Gentile

Vol. 34 Relational Psychoanalysis, Vol. III: New Voices Melanie Suchet, Adrienne Harris, & Lewis Aron (eds.) Vol. 35 Comparative-Integrative Psychoanalysis: A Relational Perspective for the Discipline’s Second Century Brent Willock Vol. 36 Bodies in Treatment: The Unspoken Dimension Frances Sommer Anderson (ed.) Vol. 37 Adolescent Identities: A Collection of Readings Deborah Browning (ed.) Vol. 38 Repair of the Soul: Metaphors of Transformation in Jewish Mysticism and Psychoanalysis Karen E. Starr Vol. 39 Dare to be Human: A Contemporary Psychoanalytic Journey Michael Shoshani Rosenbaum Vol. 40 The Analyst in the Inner City, Second Edition: Race, Class, and Culture through a Psychoanalytic Lens Neil Altman

Vol. 41 The Hero in the Mirror: From Fear to Fortitude Sue Grand Vol. 42 Sabert Basescu: Selected Papers on Human Nature and Psychoanalysis George Goldstein & Helen Golden (eds.) Vol. 43 Invasive Objects: Minds under Siege Paul Williams Vol. 44 Good Enough Endings:Breaks, Interruptions, and Terminations from Contemporary Relational Perspectives Jill Salberg (ed.) Vol. 45 First Do No Harm: The Paradoxical Encounters of Psychoanalysis, Warmaking, and Resistance Adrienne Harris & Steven Botticelli (eds.) Vol. 46 A Disturbance in the Field: Essays in Transference-Countertransference Engagement Steven H. Cooper Vol. 47 Uprooted Minds: Surviving the Politics of Terror in the Americas Nancy Caro Hollander Vol. 48 Toward Mutual Recognition: Relational Psychoanalysis and the Christian Narrative Marie T. Hoffman

Vol. 49 Understanding and Treating Dissociative Identity Disorder:A Relational Approach Elizabeth F. Howell Vol. 50 With Culture in Mind: Psychoanalytic Stories Muriel Dimen (ed.)

Vol. 57 The Play Within the Play: The Enacted Dimension of Psychoanalytic Process Gil Katz Vol. 58 Traumatic Narcissism: Relational Systems of Subjugation Daniel Shaw

Vol. 51 Relational Psychoanalysis, Vol. IV: Expansion of Theory Lewis Aron & Adrienne Harris (eds.)

Vol. 59 Clinical Implications of the Psychoanalyst’s Life Experience: When the Personal Becomes Professional Steven Kuchuck (ed.)

Vol. 52 Relational Psychoanalysis, Vol. V: Evolution of Process Lewis Aron & Adrienne Harris (eds.)

Vol. 60 The Origins of Attachment: Infant Research and Adult Treatment Beatrice Beebe & Frank M. Lachmann

Vol. 53 Individualizing Gender and Sexuality: Theory and Practice Nancy Chodorow

Vol. 61 The Embodied Analyst: From Freud and Reich to Relationality Jon Sletvold

Vol. 54 The Silent Past and the Invisible Present: Memory, Trauma, and Representation in Psychotherapy Paul Renn

Vol. 62 A Relational Psychoanalytic Approach to Couples Psychotherapy Philip A. Ringstrom

Vol. 55 A Psychotherapy for the People: Toward a Progressive Psychoanalysis Lewis Aron & Karen Starr Vol. 56 Holding and Psychoanalysis: A Relational Perspective Joyce Slochower

Vol. 63 Cyclical Psychodynamics and the Contextual Self: The Inner World, the Intimate World, and the World of Culture and Society Paul L. Wachtel Vol. 64 Traumatic Ruptures: Abandonment and Betrayal in the Analytic Relationship Robin A. Deutsch (ed.)

Vol. 65 The Cut and the Building of Psychoanalysis, Volume 1: Sigmund Freud and Emma Eckstein Carlo Bonomi Vol. 66 Relational Psychoanalysis and Psychotherapy Integration: An Evolving Synergy Jill Bresler & Karen Starr (eds.) Vol. 67 The Legacy of Sandor Ferenczi: From Ghost to Ancestor Adrienne Harris & Steven Kuchuck (eds.) Vol. 68 Somatic Experience in Psychoanalysis and Psychotherapy: In the Expressive Language of the Living William F. Cornell

Vol. 69 Relational Treatment of Trauma: Stories of loss and hope Toni Heineman Vol. 70 Freud’s Legacy in the Global Era Carlo Strenger Vol. 71 The Enigma of Desire: Sex, Longing, and Belonging in Psychoanalysis Galit Atlas Vol. 72 Conservative and Radical Perspectives on Psychoanalytic Knowledge: The Fascinated and the Disenchanted Aner Govrin

“This book is an innovative study of the mechanisms that explain the vitality and robustness of psychoanalysis as an intellectual enterprise. Using a unique methodology of critical analysis and the philosophy of science, Govrin illuminates the dynamics of psychoanalytic communities, transforming schisms and latent struggles over images of knowledge, into essential dialectics of fascination and loyalty on the one hand, and troubled criticism and doubt on the other. Arguing that both are necessary, Govrin does not only describe the major ideational currents in contemporary psychoanalysis but charts a possible future which he calls a post-postmodernist phase, in which dedication to psychoanalytic dogma and pluralism can co-exist. This lucid comprehensive and ambitious book will be of great interest to scholars of psychoanalysis and the history of ideas, as well as to practitioners and members of psychoanalytic communities.” —Chana Ullman, PhD., President of The International Association for Relational Psychoanalysis and Psychotherapy (IARPP), Training Analyst, Tel Aviv Institute of Contemporary Psychoanalysis “In Conservative and Radical Perspectives on Psychoanalytic Knowledge: The fascinated and the disenchanted, Aner Govrin treats the communities of psychoanalysis the way an anthropologist treats culture. We have never imagined Govrin’s perspective, but instantly we grasp its immense potential. This book is nothing less than a new way of thinking about the field of psychoanalysis in general, and the pluralism of psychoanalytic theories in particular. Govrin is confident that psychoanalysis is not only enduring but growing, and he makes an excellent case for why that is, and how it all works. This book is so significant that anyone interested in psychoanalysis will want—and need—to read it.” —Donnel B. Stern, PhD., William Alanson White Institute, New York City “This is an important contribution to the intellectual history of psychoanalysis. Integrating philosophical, sociological and historical sensibilities with a remarkable breadth, Govrin delineates how the interplay of two types of analytic communities—‘fascinated’ and ‘troubled’—has sustained the continued vitality of the discipline. He gets underneath the usual shibboleths to describe the structures through which analysts think their theories— ‘images of knowledge,’ ‘inventors, tinkerers and implementers,’ and more. This book deepens our perspective on our own professional identities. It will change the way that you look at psychoanalysis.” —Stephen Seligman, DMH, Psychoanalytic Dialogues: International Journal of Relational Perspectives, Joint Editor-in-Chief, Clinical Professor of Psychiatry, University of California, San Francisco; Perspectives & Training and Supervising Analyst, San Francisco Center for Psychoanalysis, Psychoanalytic Institute of Northern California

CONSERVATIVE AND RADICAL PERSPECTIVES ON PSYCHOANALYTIC KNOWLEDGE The fascinated and the disenchanted

Aner Govrin

First published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 Aner Govrin The right of Aner Govrin to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Govrin, ‘Aner, 1966Conservative and radical perspectives on psychoanalytic knowledge : the fascinated and the disenchanted / Aner Govrin. pages cm. — (Relational perspectives) Includes bibliographical references and index. 1. Psychoanalysis. I. Title. BF173.G635 2016 150.19′5—dc23 2015020126 ISBN: 978-1-138-85637-0 (hbk) ISBN: 978-1-138-85638-7 (pbk) ISBN: 978-1-315-71915-3 (ebk) Typeset in Bembo by Swales & Willis Ltd, Exeter, Devon, UK

In memory of my beloved father, Shlomo Govrin.

CONTENTS

Acknowledgmentsxiv

1 2 3 4 5 6 7

8 9

Introduction1 Characteristics of fascinated and troubled communities 14 Images of knowledge of fascinated and troubled communities 38 Troubled communities and psychoanalytic controversies 57 The relational approach 91 The dialectics of the fascinated and the troubled within psychoanalytic schools: Stolorow, Joseph, Ferro and Eigan 107 Utilitarian influences in Freud’s early writings 142 The father, the son, and the spirit of change: how the psychoanalytic community incorporates the ideas of non-analytic methods 158 The dilemma of contemporary psychoanalysis: toward a “knowing” post-postmodernism 179 The vices and virtues of monolithic thought in the development of psychotherapy 200 Afterword212 References216 Author Index 240 Subject Index 245

ACKNOWLEDGMENTS

The immediate facilitator of this work was the course on psychoanalysis I gave over the last several years as part of the “Psychoanalysis and Hermeneutics” doctoral track in the Program of Hermeneutics and Cultural Studies, Bar Ilan University, Ramat Gan, Israel. I am grateful to my students and the University for this stimulus. I would also like to thank the Tel Aviv Institute for Contemporary Psychoanalysis (TAICP), my professional home, not only for support from my colleagues, but also for providing me with a sense of belonging to a wonderful group of caring analysts both fascinated and troubled. I would like to thank Lewis Aron, editor of the Relational Perspectives book series, for inviting me to contribute to his series. Lew’s generous encouragement and thoughtful reading played a special role in refining my thoughts and stimulating my understanding about the importance of dialectics within the psychoanalytic movement. Gidi Lev and Hagai Shickler devoted a great deal of time during the early phases of my writing, and both offered very useful and incisive suggestions. Prof. Avi Sagi has been a friend and a tremendous source of support throughout. Baruch Many, my friend for many years, played a special role with his consistent reassurance, support, and help. I am particularly indebted to Prof. Golan Shahar from Ben-Gurion University, who was aware of my project from the outset—his generous support throughout the years has been deeply appreciated. My devoted translator and editor, Dan Gilon, has been working with me for the last five years, and his painstaking, thoughtful, and professional editing has improved my text considerably. Many thanks to my language editor, Kristopher Spring, who worked day and night to complete the manuscript on time. At Routledge, Kate Hawes, Senior Publisher, and Susan Wickenden, Editorial Assistant, have been kind and helpful with professional assistance and practical advice. They were behind my book from the time they saw it and worked to bring it to completion.

Acknowledgments  xv

Last—but certainly not least—I owe a tremendous debt to my wife, Osnat Govrin, whose thoughtful comments and critical listening have contributed a great deal to my writing. Her special support for the often gripping nature of the writing made my work on the book achievable. I have drawn material from some of my early papers for this book and wish to acknowledge and thank my publishers. “The Vices and Virtues of Monolithic Thought in the Evolution of Psychotherapy” (2014) was published in Journal of Psychotherapy Integration, 24(2), pp. 79–90, and was followed by commentary from Paul Wachtel, Society for the Exploration of Psychotherapy Integration (SEPI); Giancarlo Dimaggio, Center for Metacognitive Interpersonal Therapy, Rome; and Paul H. Lysaker. “Utilitarian Sources in Freud’s Early Writing” (2004) was published in Psychoanalysis and History, 6(1), pp. 5–21. “The Dilemma of Contemporary Psychoanalysis: Toward a “Knowing” Post-Postmodernism” (2006) was published in Journal of the American Psychoanalytic Association, 45(2), pp. 507–536.

INTRODUCTION

There is too much that is new and unbelievable, and too few strict proofs. – Freud to Fleiss, 14 December, 1899 (Masson, 1985)

Psychoanalysis1 really should not exist today. Until a few years ago, most of the evidence suggested that its time was drawing to a close. It had suffered blow after blow—in particular, contempt and hostility from academic psychology— because very few of its underlying theories had been empirically proved in any meaningful way. As a result, psychoanalytic papers were no longer published in psychology’s flagship journals, and the number of therapists applying for psychoanalytic t­raining declined. Moreover, shorter-term and more focused methods of treatment—many with evidence-based research supporting their efficacy—were being offered as alternatives. Psychoanalysis stayed out of the cognitive revolution of the early 1950s, which radically altered the approach to psychological research. Nor was it a partner to the momentous discoveries made in the field of brain research. And yet, though psychoanalysis was frequently elegized by both critics in other related fields as well as by some of its own followers, the prophecies of doom turned out to be dramatically wrong. Though not as popular as it once was, psychoanalysis today is experiencing a significant renaissance. Later in this chapter I will elaborate this point. But it is worth noting at the outset that in a matter of only a few decades, psychoanalysis has become an enriched and multifaceted discipline, now enjoying a particularly exciting period of intellectual and clinical resurgence due to the development of various novel theories about the human mind. Around the world, numerous psychoanalytic communities maintain their belief in the discipline’s relevance and efficacy, continue to work on developing its theories and to use it as their preferred method of treatment.

2 Introduction

Fascinated and troubled communities: an introduction Psychoanalysis’s continued survival and its prolonged success inevitably raises the following questions: What strengths does this frequently elegized community possess which have enabled it to withstand the criticism and hostility leveled against it? Can the fact that it continues to flourish be attributed solely to its ability to recruit a large enough number of uncritical followers, sealed off in ghettos of psychoanalytic thinking and thus immunized against all other influences? Or could it be that psychoanalysis encompasses robust mechanisms of development and growth that, over a long period of time, have enabled it to adapt to a changing world and respond to contemporary problems? In this book, I will demonstrate that the vitality and robustness of psychoanalytic theory has been maintained by, on the one hand, loyalty to the theory and, on the other hand, by criticism and doubt, a combination reinforced by positive mutual, albeit tense, interaction. I shall argue that throughout its history, psychoanalysis has successfully embraced an amalgam of what I have defined and termed fascinated and troubled communities. A fascinated community is a group who adopts a psychoanalytic theory (such as Bion’s, Klein’s, Winnicott’s, or the like) as representing their world-view. A troubled community is one that is not satisfied with the state of psychoanalytic knowledge and seeks to generate a fundamental change that does not square with existing traditions. In this book, I present three kinds of troubled communities that are active in the psychoanalytic world: new psychoanalytic schools, scientifically troubled communities, and philosophically-culturally troubled communities. It is this amalgam which, over many years, has enabled psychoanalysis to endure the criticism it kept on sustaining from the rancor of a hostile academic world. This, more than any other factor, has been responsible for psychoanalysis’s rich and varied development and for its ability to attract therapists to its ranks at different periods of time. As I will show throughout the book, post-positivist philosophers of science, such as Larry Lauden, Thomas Kuhn, Imre Lakatos, and Yehuda Elkana, demonstrate by using countless examples that what I term here fascinated and troubled communities are very common in the scientific world. A theory’s survival depends upon a loyal community of followers who strongly believe in its truth and enthusiastically engage in its development. Once advanced, the theory will inevitably come under fire and be confronted by critics with its inadequacies, inherent contradictions, and lack of practical success. Sometimes, as a consequence of such objections, the idea is rebutted and replaced by an alternative theory; in other instances, the theory advances and broadens its scope, becoming richer and more varied. The tension between the original set of ideas and the criticism leveled at it, between the loyal followers and the skeptics, occasionally triggers a change in the theory and cajoles its adherents to develop it further and reinforce its intellectual depth. Thus, this tension is a source of dynamism and a key to survival: thanks to it, the idea is not abandoned. However, the communities grouped around it, far from resting on their laurels, engage in updating it and preventing it from becoming

Introduction  3

obsolete or irrelevant. The tension, therefore, is a source of a new creativity and innovation in the face of censure, animosity, and derision. A large segment of the book is devoted to defending fascinated communities. Why? First, fascinated communities are viewed as basing their conceptualizations on subjective, unscientific, and uncritical beliefs. Because of their loyalty to the original theory, their isolation, their introversive character, and their refusal to accept any “external” ideas that would substantively alter the original conceptualizations, members of the community are mistakenly compared to followers of a religious cult. However, the possible resemblance between fascinated communities in psychoanalysis and the traits of a religious sect does not point to them being in any way identical. The resemblance merely testifies to the tendency of the human mind to be loyal and devoted to everything that it perceives as “real” and refuse— in a way reminiscent of a community of believers—to accept any criticism of or opposition to that perceived truth. Second, though fascinated communities are commonly found in the sciences, the criticism of them in psychoanalysis is particularly harsh. The hostility aroused by psychoanalytic fascinated communities could, in and of itself, be an appropriate subject for research. The powerful, charged, emotional, hostile, and demeaning opposition toward fascinated communities says at least as much about the critics as it does about the nature of the disparaged community. In any event, the major error of the criticism leveled at psychoanalysis is that it has always equated the discipline with fascinated communities. This ignores both fascination’s contribution to science and the huge achievements of the troubled communities that work alongside their fascinated colleagues. The best-known critique of fascinated communities was that of Karl Popper (1963), who described them thus: Once your eyes were thus opened you saw confirming instances everywhere: the world was full of verifications of the theory. Whatever happened always confirmed it. Thus its truth appeared manifest; and unbelievers were clearly people who did not want to see the manifest truth; who refused to see it, either because it was against their class interest, or because of their repressions which were still “un-analyzed” and crying aloud for treatment. It was precisely this fact—that they always fitted, that they were always confirmed—which in the eyes of their admirers constituted the strongest argument in favor of these theories. It began to dawn on me that this apparent strength was in fact their weakness. (Popper, 1963, p. 219) In his article “The Impending Death of Psychoanalysis” Robert F. Bornstein (2001), another critic of these communities, described what he called the discipline’s seven deadly sins: insularity (psychoanalysts cooperate almost exclusively with one another); inaccuracy (they do not take into consideration studies that have refuted many concepts in Freud’s theory and continue to view these concepts

4 Introduction

as valid); indifference to contrary external evidence; irrelevance to contemporary psychological discourse; inefficiency of established psychoanalytic methods; imprecision (use of vague and ambiguous concepts); and arrogance (analysts interact only with each other and become increasingly convinced of the correctness of their ideas). Bornstein’s summary is a good reflection of the commonly accepted view of psychoanalysis held by many circles in the academic world. However, his description is inaccurate in that it relates to psychoanalysis as though it were a single system of homogeneous concepts. The dramatic style used by Bornstein to present his claim will undoubtedly convince the unenlightened reader. Differing and often conflicting strands have been grouped together under one heading as if they had a shared position. Psychoanalysis, because of its nebulous definition, is often regarded as a school that is of one piece, following a single line of thought. But the terms psychoanalysis and psychodynamic therapy describe a number of conflicting viewpoints. The indiscriminate use of the terms ignores the complexity of psychoanalysis’s history and the extent of the diversity of its different orientations. This is not just an academic issue. Bias against fascinated communities reflects perceptions that have taken hold in the public’s mind—a fact that must be noted so that a far broader, more complex, and more accurate picture can replace this distorted view.

A fascinated and troubled analyst: a personal view When I look back on my career, I discover that in the course of it, I have been both a fascinated as well as a troubled analyst. Every analyst certainly remembers those impressionable days when they began to view the human mind through the psychoanalytic prism. For me, that period was the early 1990s. These were the formative years during which I did my clinical training, taking a Master’s degree in Clinical Psychology at Tel Aviv University and working as an intern at a mental health clinic in one of the city’s suburbs. It was a period when the psychodynamic approach dominated psychological treatment in the public health sector. Although I had been treated in my youth by a Freudian therapist, nothing had prepared me for the eye-opening experience of those years, when I was first exposed to the major theories then being taught: Freud, Klein, Bion, Winnicott, Kohut, Kernberg, and Mahler, each of them with their own rich and varied descriptions of the human mind. Our supervisors at the mental health clinic openly displayed their admiration for those psychoanalytic theoreticians in whose conceptualizations they so deeply believed. With great enthusiasm, they disseminated new ideas and urged us to read the most current psychoanalytic literature. Many of them were identified with theories of object relations; some were undergoing analytic training. We were in awe of our teachers and developed a profound appreciation for their extensive knowledge and long years of experience. Our instructors’ enthusiasm was infectious, and we eagerly awaited their insights about our patients. Psychoanalytic texts

Introduction  5

opened our minds to treasure troves of knowledge, revealing to us, for the very first time, the compelling and at times mad functioning of the unconscious mind. They opened up to us with a way of thinking that helped in processing and understanding the most complex and enigmatic phenomena we had encountered in the clinic. Eigen’s (2012) observation that “texts can be like living organisms, at times more real than life” (p. 5) aptly fits this context. My own clinical experience demonstrates how psychoanalytic understanding has had such a great impact on me. As his therapy proceeded, one of my patients, a bachelor in his late thirties, showed significant improvement. He had experienced years of hostile relations with his surroundings, periods of extreme solitude, and an absence of social or collegial relations (his main complaint). After several months in therapy, he seemed less suspicious, his relations at work had improved, and for the first time, he had won the appreciation of his superiors. While all of this was happening, he became friendly with a woman and began going out with her. But the more he improved, the more he hated me, becoming increasingly hostile to the therapy he was receiving. During our sessions, he would criticize me for my lack of experience, my irritating interventions, and my inability to really help him. When he wasn’t trying to attack me, he would talk about the despair he felt because of his lack of belief in my ability to help him. He told me about the progress he had made in his personal life in an offhand way and without linking it to the therapy. The confusion, anxiety, and frustration that I felt as a novice therapist were hard to bear. The phenomenon was also extremely odd: A person whose life had undoubtedly changed for the better because of therapy not only failed to acknowledge it as such, but did everything he could to undermine what had been achieved. A devoted and empathetic supervisor, a Kleinian by training, came to my rescue. She explained how the Kleinian approach understands the phenomenon of the negative therapeutic reaction (N.T.R): Such a response may indicate a patient’s transference  repetition. Out of envy, which Klein maintained was the mental representation of the death instinct, the patient tries to destroy the awareness of the goodness of the therapist so as to remain omnipotent and avoid awareness of his dependency. The forces within driving him to love, show gratitude, and make amends—possibly leading to a steady improvement of his condition—are ­overpowered by envy, revenge, and hate. The Kleinian supervisor also emphasized the notion that the patient regarded “suffering” as the link between us and could maintain contact with me only as long as he believed we were both suffering. During supervision, we read additional case studies related to this phenomenon, such as Freud’s Wolf Man (1918). All of this had a big impact and affected me in a number of ways. First, the supervision itself and the clinical theories taught demonstrated the ability possessed by psychoanalytic conceptualization to turn something irrational into an understandable and explicable phenomenon:The more the therapy helps the patient, the more his envy and condemnation of the therapist increases. Second, the conceptualization helped me create a space that distanced me from the patient’s attacks. It enabled me to understand that his animosity was a form of communication that was actually intended to keep us in touch with one another. Third,

6 Introduction

I was now able to understand that my difficulty with this patient was a phenomenon that had a tradition, deeply embedded in psychoanalytic thought.The personal therapeutic dyad was just one of a long sequence of links in a chain of clinical phenomena first observed in analyses carried out in the early history of psychoanalysis. As the clinical training course progressed, I had no reason to doubt the correctness of this conceptualization as a way of understanding the patient. It seemed right and appropriate, and from this, it derived its veracity. To this day, I believe in its truth. Other than this Kleinian explanation, I haven’t found any other theory capable of accounting for these regressive phenomena, which appear to be so strange and seemingly contrary to common sense. In this training in Kleinian thinking, as well as in our Freudian or Winnicottian course studies, the supervisors training us offered their interpretations with the utmost confidence. While they were careful to say, “It is possible that she behaves in this way because of some event that occurred in her childhood,” there was no doubt that they felt they had touched a “real” area of the patient’s psyche and that they trusted their interpretations. It seemed to me that we had indeed hit upon a certain kind of truth. The new world that opened up to us—the world of psychoanalytic knowledge— was not only limited to the use we made of it in understanding patients. The entire world—our families, our friends, our own selves—appeared in a different light. We began to speak in psychoanalytic jargon in our daily lives, and often used words like defense, split, grandiose, transitional space, anal character, and projection. Psychoanalysis became part of our lives, our language, the way we understood many social and human situations. This pathway began to shape us in its own image. Our openness to these ideas can also be attributed to our desire to belong confidently to a vibrant, unified community in which we could anchor our professional identity. We wanted to be part of an international community with deep roots and a rich tradition whose members were privy to a body of learning that had a special quality about it, knowledge that set us as apart from the wider public. This knowledge we would come to possess, was based on the attentiveness and diligence of the therapists in dealing with the distress and suffering of their patients, on their ability to explain the unconscious and concealed areas of the mind and their skill in having achieved all of this within the complex and delicate framework of the therapeutic relationship. The voyage I embarked on during those formative years has, I imagine, been undertaken by thousands of analysts around the world ever since psychoanalysis first came into being. Analysts and psychodynamic therapists have been fascinated by different theories; sometimes the therapies suggested by those theories are at odds with each other. However, they all strongly believe that the psychoanalytic theory they adhere to offers the most accurate explanations for the astonishing array of complex and irrational clinical phenomena with which the therapist is confronted. It also provides the practitioner with the appropriate tools for addressing these issues as well as with a wide range of possible therapeutic interventions.

Introduction  7

However, I cannot in truth say that I was an unequivocally enthusiastic ­analyst. Many things troubled me and made me hesitate before I took the decision to undergo psychoanalytic training. On the one hand, psychoanalytic training became an ideal, an intimation of the profoundest training psychotherapy had to offer. The analysis I personally underwent, and its powerful and beneficial impact on my life, aroused hugely my curiosity and my desire to investigate psychoanalysis as a method I could use in my work as a therapist. There was, after all, no reason for me to doubt a theory that had proved to be of such benefit to me. And yet, over a prolonged period of time, I had my reservations about psychoanalytic training. At some stage in my progress towards becoming a therapist, I began to think more and more about the fact that everyone around me could be described as being “fascinated” by psychoanalysis. It seemed to me that there was an overly devout commitment to the psychoanalytic theory characterized by a lack of critical thinking about psychoanalytic conceptualizations, an absence of interest in non-­psychoanalytic bodies of knowledge, and a persistent usage of psychoanalytic jargon. I was afraid that psychoanalytic training meant becoming devoted to one thing and one thing only. Perhaps it even meant becoming fixated and losing one’s freedom of thought. I was reluctant to become identified with a single notion, with one world-view, one therapeutic method, one language that would restrict me and undermine my freedom to roam other worlds of discourse, including nonanalytic worlds. In the end, my curiosity tipped the balance in favor of going in for the training. I chose the Tel Aviv Institute of Contemporary Psychoanalysis (TAICP), which championed openness and an interdisciplinary approach. Some members had joined the institute not as would-be therapists, but rather as PhD scholars who had researched the field of psychoanalysis over many years in the Arts and Humanities Departments of various universities. Their presence was intended to enrich our clinical departments at the same time they were enlightened by what we were doing. I took steps to protect my freedom of thought and prevent myself from becoming fixated by overly focusing on clinical theory in isolation. Instead, I found myself taking a major interest in meta-theory and in the history of psychoanalytical ideas. I was interested in those cultural, philosophical, and social influences that had, sometimes consciously and at other times unconsciously, permeated and shaped psychoanalysis. Rather than falling in love with one particular theory or another, my preference was to find out what the necessary requirements for forming a psychoanalytic theory were, and what cultural and historical factors were behind the development of psychoanalysis. This direction of research protected me from being carried away, from becoming too attached to one comprehensive all-inclusive set of opinions, and broadened my analytic understanding. My focus on meta-theory and the history of psychoanalytic ideas alongside the life I was leading surrounded by groups of practicing analysts enabled me, at one and the same time, to both watch and understand the views of my fellow analysts as well as to observe them as an outsider, thus opening the door to critical thoughts.

8 Introduction

Added to the fascinated analyst within me was a troubled professional practitioner. I have been the recipient of psychoanalytic training and at the same time have researched the philosophical roots of psychoanalytic ideas. I hope my ­familiarity with both points of view will enable me to offer a different perspective of how psychoanalytic knowledge evolved. I may perhaps even be able to show what science is likely to learn from the impressive endurance of the psychoanalytic community and its ability to maintain its unique mindset in a technological, medical, and scientific world.

The achievements of psychoanalysis My entire thesis presupposes that psychoanalysis is a successful project. This might seem controversial for many readers because, as I mentioned earlier, we are too easily convinced by the anti-analytic community that psychoanalysis is passé. However, as a body of knowledge that has survived and flourished over such a long period of time, psychoanalysis can surely be counted as one of the most successful intellectual enterprises in the history of Western thought, with a number of achievements to its credit.

Psychoanalysis has altered contemporary culture’s perception of the human mind Few theories that changed our understanding of the human mind have permeated so deeply into people’s lives as has psychoanalysis. Psychoanalytic concepts are still widely recognized and have pervaded every facet of western culture. According to Alfred Tauber (2010), Freud’s professed aim was to create nothing less than a comprehensive philosophy of human history and culture. Although his work was roundly criticized, Freud did actually succeed in producing a wide-ranging methodology that encompassed and described a significant number of universal truths about human nature. In 1986, the New York Times literary critic Harold Bloom wrote that Freud had been the twentieth century’s most outstanding exponent of the human imagination, more so even than such writers as Proust, Joyce or Kafka. Freud’s views, according to Bloom, “have begun to merge with our culture, and indeed now form the only Western mythology that contemporary intellectuals have in common” (Coltart, 1992, p. 165). In a similar vein, the influential American philosopher Richard Rorty (1993) noted that in a surprisingly short time, Freud’s ideas had gained “the same kind of acceptance as those of Plato and Jesus,” and that Freud had become “one of the moral teachers of our time” (p. 25).

Psychoanalysis continues to flourish and prosper worldwide Over the last decade, the dramatic decline in the number of candidates applying for psychoanalytic training in the United States has been halted (Ascherman &

Introduction  9

Brett, 2014). Elsewhere, in such countries as Israel, France (Aisenstein, 2010), Germany, and Argentina (De Salvarezza, 2001), the discipline is enjoying a noticeable growth. The last ten years have witnessed the development of a considerable psychoanalytic culture in China and various countries in Eastern Europe (Fonda, 2011). Every year, dozens of Western analysts travel to these countries to train their colleagues in psychodynamic psychotherapy. For example, twice a year, about two hundred Chinese psychiatrists attend a Western-run course in Shanghai, which trains and certifies them as psychodynamic therapists. Although it costs about half a month’s salary and sometimes involves a journey of several thousand kilometers, the course is much in demand because the certification greatly improves the trainees’ chances of being appointed as a director of psychiatric departments (Schlösser, 2009).

Psychoanalysis has succeeded in becoming more scientifically current and relevant In recent years, various research studies have demonstrated the efficacy of psychoanalytic and psychodynamic therapy (Barber et al. 2013; De Maat et al. 2013; Levy, Ablon & Kächele, 2012; Shedler, 2010). These studies indicate that in most pathologies, psychodynamic therapy is just as effective as are evidence-based therapeutic methods. Moreover, these same studies also show that the positive therapeutic benefit among patients undergoing psychodynamic therapy lasts for a significant period of time after treatment. Shedler (2010) asserts that the claim that the psychodynamic approach is not supported by empirical evidence of its efficacy is nothing but a “big lie.”

Psychoanalytic theory continues to be used by therapists of all schools of thought Despite its estrangement from academic psychology and the evident ascendency of cognitive-behavioral methods of treatment, many therapists continue to regard psychoanalysis as a relevant therapeutic approach. One of the key findings of a 2010 survey involving more than two thousand therapists in North America (Cook et al. 2010) showed that with the vast majority or even all of their patients, a third of the therapists interviewed used psychodynamic techniques. These techniques included interventions such as linking current problems to childhood and family experiences or helping patients delve into non-conscious aspects of their lives. Another third of the therapists surveyed made partial use of these techniques. The survey found that in their treatment of patients, most therapists combined different therapeutic methods (integrative psychotherapy), with cognitive-behavioral techniques dominating the field. However, the fact that such a high percentage of therapists use psychodynamic practices demonstrates that psychoanalytic methods are still widely used and of considerable value to many therapists.

10 Introduction

Psychoanalysis has had an influence on the arts Much of today’s discourse on art, literary criticism, cinematography, and many other facets of our western culture are inspired by psychoanalytic ideas, ideas that are broadly regarded as explaining man’s creative capacities. Procci (2013), in his illuminating paper, provides numerous examples. According to Procci, the influence of psychoanalytic ideas on cinematography is so generally accepted, so deeply rooted in our culture, that it is almost taken for granted. It so happens that both film and psychoanalysis made their entry into the world in the last decade of the nineteenth century. In the very early years of cinematography, the influence of psychoanalytic ideas on directors was evident in the way in which certain scenes and images were handled. Truffaut, Cocteau, Kurosawa, Bertolucci, Bergman, Woody Allen, Kiarostami, and Hitchcock are among the many directors whose screen imagery and narratives were suffused with psychoanalytic ideas. Procci (2013) notes that in theater, a recent Broadway play revolved around the Abstract Expressionist painter Mark Rothko’s dalliance with Mammon when he accepted a commission to paint a series of murals on the walls of Manhattan’s Four Seasons restaurant. The play offers glimpses into the mind of the artist as he struggles to maintain his identity and integrity, questioning whether his paintings would survive in a place that represents everything he detests—greed, commercialism, bourgeois comfort. In short, the artist is portrayed as being very familiar with psychoanalytical theory and the significant role these analytic ideas had had on his creativity. Another play, Freud’s Last Session, the longest running theatrical drama in recent years, is yet another example of the interest taken by the general public in psychoanalysis. It ran off-Broadway for well over a year, a remarkable achievement for such a “highbrow” production. In books and popular television series, there are numerous references to psychotherapy and sometimes entirely explicit ones to psychoanalytic psychotherapy. They are more often than not the most viewed TV series and bestselling books. The global audience for such repeatedly-run shows as The Sopranos, In Treatment, or the movie Analyze This, is enormous. In these, as in many others of a similar kind, the therapy offered and received is quite evidently psychoanalytically orientated. In addition, there is the world of academic disciplines, where the contribution of psychoanalytic ideas is evident. The range of disciplines affected includes English literature, literary criticism, history, philosophy, religion, and anthropology. In the French departments of numerous universities around the world, a familiarity with psychoanalysis is very common, especially when it comes to the ideas of Lacan.

The aim and organization of the book This book offers a new perspective on the development of psychoanalysis amid the concealed components underlying the dynamics involved in the development of psychoanalytic thinking by fascinated and troubled communities. In addition, it will explain the social and psychological considerations involved in the establishment of such thinking.

Introduction  11

Rather than foreseeing psychoanalysis’s imminent death, the book describes and explains the discipline’s outstanding capacity to survive against all the odds. Instead of adopting the view that psychoanalysis’s history is one of failure, the book looks at the way in which the discipline is currently thriving, progressing, and defying the predictions of its impending demise. Ultimately, the book dismisses the claim that psychoanalysis has become “irrelevant.” On the contrary, it shows psychoanalysis to be capable of innovation and of aligning itself with the times in any given period. In its investigation of these issues, this book is first and foremost a voyage of discovery. It is a journey in search of the way in which fascinated and troubled communities go about developing and enriching psychoanalytic knowledge. The objective is to explore these communities in depth, to find a way of reaching into their minds; to fathom their motives and understand their deliberations; to penetrate their very being and to be able to describe what transpires within them; and to understand the logic of their world-views. This voyage can be likened to an anthropological study that tries to track the rituals of a tribe that, to the outsider, appear odd and inexplicable. Shweder (1991) describes the attitude that such a voyage demands: Astonishment and the assortment of feelings that it brings with it—­surprise, curiosity, excitement, enthusiasm, and sympathy—are probably the affects most distinctive of the anthropological response to the difference and strangeness of “others.” Anthropologists encounter witchcraft trials, suttee, ancestral spirit attack, fire walking, body mutilation, the dream time, and how do they react? With astonishment. While others respond with horror, outrage, condescension, or lack of interest, the anthropologists flip into their worldrevising mode. (p. 1) Using this approach, I will try to describe various organizational structures with differing constituent cores. Seen from this perspective, science, faith, and sociology stand shoulder to shoulder in their ability to create coherence and structure, none of them inherently preferable to any other. My purpose is to observe, identify, and describe, and by so doing, to understand. This book is divided into nine chapters. Chapter 1 explores in detail the two kinds of communities. I explain what prompts therapists to become fascinated by a theory, describe fascinated communities today, and differentiate between different kinds of troubled communities. Chapter 2 explains how images of knowledge (Elkana 1981) enable us to understand many of the distinct phenomena linked to fascinated and troubled communities. Some appear to be alien to scientific thought in areas such as indifference to empirical research studies, exclusive reliance on clinical situations, and intolerance displayed towards alternative theories. Chapter 3 describes two areas of disagreement within psychoanalysis, each of which defines a specific troubled community: the controversial discussions in

12 Introduction

British Society surrounding the differing views of Melanie Klein and Anna Freud (1942–1944), and the debate relating to the relevance of infant research to therapeutic processes. Chapter 4 explores the surfacing of the idea of a mutuality of influence between therapist and patient as conceptualized by the relational approach, a philosophicallyculturally troubled community. Chapter 5 discusses a dialectic movement within the communities themselves, a movement that alternates between being fascinated and troubled. By using clinical material, I will select psychoanalysts whose writings represent a change within a school of thought: Robert Stolorow and his work on self-psychology, Betty Joseph in relation to Kleinian theory, and Antonino Ferro and Michael Eigen vis-à-vis Bion’s theory. Chapters 6 and 7 challenge one of the most frequently repeated criticisms of fascinated psychoanalytic communities: that they are isolated, inward-looking, and impervious to non-psychoanalytic ideas. In these chapters I explain why what appears to be a closed orthodox community is not quite so. Communities which are in practice fascinated also integrate into their thinking ideas from outside sources. They simply don’t admit it. They are attentive to the world but the world’s influence on them is complex: They use external ideas, blur their identity and modify them so that in terms of contents they fit in with their own traditional lines of thought. Thus they present ideas that have come from outside as if they had sprung from within the boundaries of their own heritage. Chapter 6 demonstrates a paradigmatic example of this process, showing the influence of the theory of utilitarianism on Freud. Freud was influenced by non-psychoanalytic sources more than any thinker after him. However, although these influences were discernible in his work, Freud often avoided explicitly citing philosophers who influenced his work. I present an important source of Freud’s conceptualizations that hasn’t yet been fully researched: The utilitarian theories of Jeremy Bentham and John Stuart Mill, from which he borrowed the concept of the pleasure principle. Chapter 7 shows that during the 1970s, other fascinated theorists unknowingly followed Freud’s example by assimilating non-psychoanalytic ideas from different bodies of knowledge. I will focus first on the way in which Kohut’s concept of empathy was influenced by Carl Rogers, the founder of Humanistic Psychotherapy. I will then show how the cognitive-behavioral approach impacted on the development of short-term dynamic therapy. As with Freud and utilitarianism, here too the “external” sources are not explicitly cited and the “borrowed” ideas are fundamentally modified, thus adapting it to the field of psychoanalysis. Chapter 8 deals with the contribution of fascinated communities to the creation and development of new psychoanalytic theories. Chapter 9 shows that fascinated and troubled communities are not unique to psychoanalysis, but rather characterize the entire world of psychotherapy. The chapter explains how the integration movement (which tends to be critical of single-orientation schools) in fact relies on the essential and vigorous activity of

Introduction  13

fascinated communities (such as psychodynamics, cognitive, humanistic, or family therapy). The Afterword summarizes the book’s implications, explaining why psychoanalytical discourses occasionally sound like a debate between the deaf. The bitter arguments sometimes focus on contents, but mostly they center on methodology. The struggles are directed at finding a “correct” methodology that is appropriate to psychoanalytic thinking. The purpose of this book, through its preoccupation with images of knowledge as they are understood by post-positivist philosophy of science, breaks new ground that enables us to look at various streams of thought and their influence upon each other. The assumption that there is a latent and inbuilt struggle over images of knowledge opens the way to bringing this struggle to a conscious level, so turning it from factious dispute to a dialogue in the best tradition of psychoanalysis.

Note 1 I use psychoanalysis and psychodynamic psychotherapy interchangeably. Within the term psychoanalysis, I include therapeutic approaches consistent with psychoanalysis’s original theories. This definition embraces a number of different methods of treatment, including both traditional psychoanalysis as well as dynamic psychotherapy. For the logic behind this definition see Thomä and Kächele (1987).

1 CHARACTERISTICS OF FASCINATED AND TROUBLED COMMUNITIES

Fascinated communities A fascinated community consists of analysts and psychodynamic therapists allied with one or another psychoanalytic school of thought. They adopt their psychoanalytic theory (such as Bion’s, Klein’s, Winnicott’s, or the like) as representing their world-view. I will rely on the American philosopher Stephen C. Pepper’s (1942) definition of world-view as well as Freud’s (1933a), because they describe well the mindset of a fascinated community. Freud’s definition regards such a world-view as an intellectual construction that solves all kinds of human distress on the basis of a single, integrated, and unified whole. Accordingly, such an approach leaves no subject unanswered, and everything that is of significance in human behavior finds its place. Pepper (1982) thinks that world hypotheses get started like any man’s everyday hypothesis framed to solve a puzzling practical problem. The man looks back over his past experience for some analogous situation which might be applicable to his present problem. Similarly, a philosopher, puzzled about the nature of the universe, looks about for some pregnant experience that appears to be a good sample of the nature of things. This is his root metaphor. He analyzes his sample, selects its structural elements, and generalizes them as guiding concepts for a world hypothesis of unlimited scope. This set of concepts becomes the set of categories of his world hypothesis. (p. 199) Ideally, the theory of a fascinated community has unlimited scope and is so precise that it permits only interpretations of mental events that are in accordance with its world-view. It is based on an effort to explain a clinical puzzlement: slips of tongue and hysteria, envy and gratitude, art and a child’s play with a teddy

Fascinated and troubled communities  15

bear. The first patients come to be prototypes and good samples of the nature of things. In practice, all psychoanalytic schools (and all scientific theories) fall short of these ideals. Though all have an imperialistic tendency in their aspirations to explain everything with one coherent theory, none of them is able to do so. Every psychoanalytic school is autonomous and forges its own areas of activity. Psychoanalytic schools also have a political and social dimension, and most of them institutionalize their activities by setting up international organizations. Each school attracts a community of followers. These disciples form a cohesive community of therapists whose training in, and approval of, a particular theoretical tradition shapes their clinical work (Stepansky, 2009). Within any given school there are groups with differing understandings of its teachings; there are numerous versions of self-psychology, many differing perspectives on object relations theories, diverse interpretations of Bion’s work, and so on. Nonetheless, the similarities between different versions of a particular school justify their being grouped together. These similarities are often anchored in a shared conceptualization of the psyche.

What prompts therapists to become fascinated by a theory? A theory’s basic assumptions aim to expose the underlying etiology of a given mental phenomenon Diagnostic books in psychiatry such as the DSM, and other therapeutic methods like CBT can characterize the symptoms of mental disorders but are unable to explain the complex mental inner factors which cause them. Therefore, they cannot properly classify the structure of these mental disorders, and misconstrue a significant part of their phenomenology. Many aspects of mental disorders remain unexplained and are not related to or discussed. The theory’s fascination derives from its capacity to reach the root of the matter: intrapsychic causes that are perceived as being the most vital in gaining an understanding of the mental distress of a patient. Every single fascinated community is convinced that it has discovered the most appropriate and most precise description of various mental disorders. If so, the theory’s fascination does not stem from its scientific success but rather from its ability to account for a complex phenomenon that had not been previously understood. The experience of having achieved a fundamental understanding of the human mind is a powerful intellectual and emotive occurrence, which is often linked to the thinker behind it. Consider schizoid personality disorder. The World Health Organization’s ICD10 lists schizoid personality disorder as being characterized by criteria such as emotional coldness, detachment or reduced affect, limited capacity to express either positive or negative emotions towards others, or consistent preference for solitary activities and preoccupation with fantasy and introspection. Compare this list of symptoms to Harry Guntrip, one of the foremost advocates of the British Object Relations School. According to Guntrip (1968), the “shut-in”

16  Fascinated and troubled communities

individual, like the patient who said in the consulting-room, “I don’t seem to come here”, may be physically present but emotionally absent. Such people, unwilling to feel anything, are attempting “to cancel object-relationships and live in a detached and withdrawn way” (p. 19). They are thereby condemned to an inner life of struggle with the bad objects of an unfortunate infancy. The schizoid’s need is so increased by insufficiency (of initial good mothering) that he is afraid to love lest his voracity devour the good object. He both needs and fears object-relations, not having outgrown his infantile helpless dependence with its strong oral connotations. He is afraid not only of actively devouring but also of being passively devoured and so losing his identity. Thus “he must always be rushing into a relationship for security and at once breaking out again for freedom and independence” (p. 36). One patient remarked: “I want to be loved but I mustn’t be possessed” (p. 37). If the strain of these oscillations becomes too great, total withdrawal may occur; withdrawal means that identification, with its infantile over-dependence, becomes the only means of maintaining the ego. In the DSM, disorders are depicted as relatively isolated conditions that can be diagnosed by an assessment of manifest symptoms having a relatively distinct etiology and pathogenesis. Accordingly, it is assumed that one can develop and “manualize,” analogous to the development of a drug for a disease, treatments that are specifically designed for this particular “disease.” When this treatment leads to a disappearance of symptoms, the disease has been “cured” (Luyten, 2006). In contrast, Guntrip’s rich and detailed example does not limit itself to a restricted area of functioning. It is about the “why,” the inner causes of the schizoid’s withdrawal. It depicts the more intricate area of understanding the inhabitants of a patient’s inner world.

The discovery of order in complex and unusual clinical phenomena Fascinated communities are enchanted by their working model, according to which clinical phenomena that look entirely different originate from the same core pathology. Bion (1962), writing about “selected fact,” cites the mathematician Henri Poincaré’s comment on the creation of a mathematical formula: If a new result is to have any value, it must unite elements long since known, but till then scattered and seemingly foreign to each  other, and suddenly introduce order where the appearance of disorder reigned. Then it enables us to see at a glance each of these elements in the place it occupies in the whole. Not only is the new fact valuable on its own account, but it alone gives a value to the old facts it unites. Our mind is frail as our senses are; it would lose itself in the complexity of the world if that complexity were not harmonious . . . The only facts worthy of our attention are those which introduce order into this complexity and so make it accessible to us. (p. 71)

Fascinated and troubled communities  17

In my view, this is a highly influential factor in explaining why psychodynamic therapists in particular become fascinated: the capacity of a psychoanalytic theory to offer an orderly explanation for clinical phenomena and mental events that appear to be unconnected. In other words, its ability to discover their gestalt, establish the order that links them together, and bestow a new meaning upon such seemingly unrelated observed events. This is especially so when a link can be made between childhood events and current distress. For example, self-psychology (Wolf, 1994) distinguishes between two types of personalities, which appear to be almost polar opposites. The first is a contactshunning personality, which withdraws from any form of social connection. What stands behind this personality is an acute and passionate need for the attuned responsiveness of others, which leads to an unconscious sensitivity to potential rejection. To avoid such painful and possibly self-destructive rejection, social intercourse is shunned. Rather than indifference, this defensive isolation actually expresses a need for the company of others. The second type is a mirror-hungry personality, characterized by a tendency to indulge in exhibitionist behavior in order to attract admiration and so possibly lessen feelings of insignificance. Despite the fact that, from a clinical point of view, these personality patterns are very different from one another, the underlying etiology of the two disorders is identical. Both convey a desire for selfobjects whose confirming and admiring reactions will nourish the starved self; both are characterized by a fragmented and wounded self resulting from continuous parental empathic failure and from the parent’s inability to reflect itself as a genuine self to the grandiose parts of the infant.

The clinical objectives of psychoanalytical theories The search for the true self, the ability to deal with mental reality, transmuting internalization, accepting ownership of the various split parts of the self: Each one of these objectives embodies an ideal therapeutic goal representing mental growth with which therapists identify. For example, the discovery of the true self represents an ability to develop a subjective experience based on the capacity to conduct a dialectic between the internal and external reality, between fantasy and reality (Amir, 2008). The ability to fully experience depressive mourning enables the possibility of insight into oneself and a sense of internal and external reality. The ability to endure the psychic reality enhances emotional development by means of a process of thought that can contain painful experiences. The objectives of such therapeutic work have been best described by Fred Busch (2014), who termed these objectives to be “creating a psychoanalytic mind.” The therapy is based on “a shift in the patient’s relationships to his own mind . . . with the development of the psychoanalytic mind the patient acquires the capacity to shift the inevitability of action to the possibility of reflection. [This] potentially frees one from the slavery of repetition compulsion” (p. xv). Other fascinated communities (such as self-psychology or Winnicott) focus less on self-knowledge and more on the powerful therapeutic connection that is

18  Fascinated and troubled communities

created between the patient and the therapist—a connection that can restore and heal impaired or injured mental structures and enable a reconnection with the true self. The point is that therapists experience great satisfaction derived from attaining a psychotherapeutic aim that matches their psychoanalytic theory. If the patient improves after a successful analysis the improvement always described according to the core principles of the theory. The patient’s self-report that she was helped by the analysis is saturated and undifferentiated from the theory itself. I believe this fascinates many analysts. Consider the following example from Segal (1952). Her patient needed to give up her analysis. She then told Segal the following dream: “A baby has died—or grown-up—she didn’t know which; and as a result her breasts were full of milk. She was feeding a baby of another woman whose breasts were dry” (p. 202). Segal thought that the meaning of that dream was that she weaned her patient — Segal’s breast was dry—but the patient had attained a breast and could be a mother herself. The baby who “died or grew up” is herself. The baby dies and the adult woman takes its place. The loss of the therapist is an experience leading to the enrichment of her ego—she now has the breasts full of milk and therefore need no longer depend on me. Near the end of the hour, the patient said: “Words seem to have a meaning again, they are rich”, and she added that she was certain she could now write “provided I can go on being sad for a while, without being sick and hating food”— i.e. as Segal explains: “provided she could mourn me instead of feeling her as an internal persecutor” (p. 202). Another example, this time from Philip Bromberg (1996), a relational therapist: Bromberg thinks that an approach that attends the multiplicity of self is so experience-near to most patients that only rarely does someone even remark on why he is talking about them in “that way.” It leads to a greater feeling of fullness because each self-state comes to attain a clarity and personal meaning that slowly lessens the patient’s previously held sense of bewilderment about who he “really” is and how he came, in the past, to be this person.  Bromberg uses an example of a patient who began with an unusually long silence, broken by her speaking in an off-hand manner and without any evident anxiety. The patient told Bromberg that she was having three different conversations with him that day. He asked her in what way were they different. His question was followed by additional silence. “Good question!” the patient stated. “First I thought that the topics were different. But when you asked that question I started to realize that I didn’t want to answer because there are really three different moods all at the same time, and I don't know which one I want to answer you from” (p. 525). Bromberg writes: There could be no clearer evidence than this  moment  to show that dissociation is not principally a mode of self-protection (even though it serves

Fascinated and troubled communities  19

as such in the face of trauma). It can be seen here in its intrinsic form as the basis of  creativity,  playing,  illusion, and the use of  potential space  to ­further self-growth. It was shortly after this session that, following a typically unsatisfying phone conversation with her father, she described looking at herself in the mirror, hating her father, and watching her face while she was hating—playing with the facial expressions, trying them out, enjoying the hateful feelings, but, as she put it, “still feeling like ‘me’ all the way through it” (p. 525). You can see from these examples that the clinical material expressed by the patients is strongly influenced by the theoretical orientation of the author. The patients, so to speak, give a voice to the analyst’s theory and this makes the analyst more convinced, more fascinated by his or her own theory. The scientific camp may think that analysts should seek falsification rather than confirmation in case studies or use causal modeling and statistical controls (Edelson, 1984). Neither Segal nor Bromberg consider alternative and rival hypotheses seriously. This is simply not how fascinated analysts work. However, scientists themselves as reported by Kuhn, Lakatos, Lauden and Elkana rarely seek falsification. Segal and Bromberg like most analysts enable us to study rare phenomena, generates insights and hypotheses about personality dynamics that are not readily elicited in other situations, and most important: they make a point (Eagle & Wolitzky, 2011).

Personal acquaintance with a school’s founder A personal acquaintance with such a thinker enhances the fascination still further. This was best described by Neville Symington’s portrayal of Bion (2002): I attended several workshops taken by Wilfred Bion, which had a huge influence. I also went twice to supervision with him. I learned more from those two than from any number of supervisions from others. He had that simplicity of soul that cut through to what was most essential. There is no one within the psychoanalytic world who understood madness better or realized the extent to which it applied in institutions and cultures in the wider world. I felt with him that same resonance of soul that I felt with George Ekbery— that sense of “Oh, thank heaven to have found the voice I have been looking for so long.” That particular quality shared by Bion and George Ekbery is something that transcends any particular discipline of thought. It is an attitude of heart and soul that comes I know not from where, but I am certain it is not the product of any particular educational system or discipline. It is as difficult to account for as genius. (p. xi) Expressions of admiration of this kind can also be found among followers of Freud, Kohut, Winnicott, Klein, and others.

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Main characteristics of fascinated communities Loyalty Fascinated communities often function within psychotherapeutic training programs or psychoanalytic institutes. Such programs and institutes continue to teach Bion’s, Klein’s, and Kohut’s theories with the same degree of enthusiasm as they were taught thirty years ago. Professional practitioners continue to be trained by them to provide long-term psychotherapy and analysis. However, this is not something that can be laid at their door, since the original texts set the basis for an understanding of the therapeutic process, foundations that are seen by many as still being relevant today. Precisely the same applies to philosophy departments that continue to be interested in the works of philosophers penned hundreds and even thousands of years ago. Theoretical change is slow and occurs over long periods of time. Most of the concepts developed by the original founders (e.g., Projective Identification, Reverie, The Mirror Stage, Transitional Object, and Transmuting Internalization) continue to be the key concepts used by the community. Fascinated communities particularly like to read and re-interpret the canonical texts of Freud, Jung, Lacan, Bion, Klein, Kohut and others, on which their schools were founded. The texts they rely on remain unaltered, but with the passage of time the meanings change and assume a new significance. Even when the texts are updated, fascinated communities think it is important to show that the theoretical development is a continuation of, and sequential to, the original theory. Consider the following paragraph from the introduction of Fred Busch’s book (2014) on new perspectives in ego psychology: “This book represents a definite step toward bridging the existing development gap between the old classical technique and modern approaches based on Freudian structural theory” (p. xiii). The leading figures in fascinated communities are the analysts who write up and interpret the discipline’s canonical texts, showing colleagues new and inventive ways of using existing conceptualizations (as did Hanna Segal and Robert Hinshelwood in relation to Klein, Antonino Ferro vis-à-vis Bion, and Paul and Anna Ornstein and Arnold Goldberg with respect to Kohut, to mention just a few).

Non-analytic influences Often, the founders of the various schools (Freud, Klein, Bion, Winnicott, Kohut, etc.) were influenced in the development of their initial formulations by other psychoanalytic theories and by non-psychoanalytic ideas (e.g. Freud was influenced by many different bodies of knowledge from biology and neurology to anthropology and philosophy; Winnicott and Klein by observational studies of children; Kohut was probably influenced by Rogers). However, as will be seen in examples throughout the book, the non-psychoanalytic sources influencing a given theory not only fail to be acknowledged, but undergo a process of conversion and change that conveniently adapts them to the theory and distances them

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from their roots. For example, as I shall show in Chapter 3, Freud, in his use of the “pleasure ­principle,” was influenced initially by Bentham and Mill’s utilitarian philosophy but never cited it as a source. He altered the original “pleasure principle” to make it fit in with Freudian conceptualizations, thus all the more blurring source of the concept. Once a theory is developed and established, the fascinated community displays little interest in other disciplines of thought or an inclination to be influenced by such schools.

A shared world-view It is commonly thought that fascinated communities are “unscientific” because their firmly-held beliefs in psychoanalytic conceptualizations are not based on the accepted methods of research in the social sciences. In practice, fascinated communities regard themselves as scientific in the sense that their world-view—an acceptance of realism and the correspondence theory of truth—puts them on a par with scientists. Like scientists, they subscribe to a world-view that regards the mental processes they describe as corresponding to the reality that, in the mind of the patient, is “out there.” Thus, it is argued, psychoanalytic knowledge is scientifically valid and reliable even if difficult to prove. According to this view, the scientific characteristic of psychoanalytic therapy lies in its search for evidence, particularly evidence gathered in the course of therapeutic situations. The purpose of such evidence is to confirm the validity of concepts and theories bequeathed to the therapist by psychoanalytic conceptualizations. The Kleinian community, for example, really believes that the infant is engaged in a fantasy in which it is actually tearing the mother’s breast. The self-psychology community regards the emergence of the grandiose self as a truth, while the Winnicottian community is convinced that an infant goes through a temporary phase in its early development when it experiences an illusion of omnipotence and discovers the objectivity of the mother and its feelings of hatred towards her. For these communities, stages of development are not metaphors or possible narratives, but concrete intra-psychic events. The matter, however, is in fact far more complicated because the “truths” they found were open to many interpretations and meanings. The creative thinkers who founded many of the major schools were not searching for clear, uniform, operational definitions for their principal concepts. Their perceptions of the human mind and the pressures it was being subjected to were more multifaceted than even the most lucid scientific writing could hope to achieve. Over the years, these thinkers had experienced mental and therapeutic processes with their patients—including dreams, free associations, and powerful transference relations—that could not be reduced to the language of science. The vivid and intricate language employed did justice to this rich variety of human experiences, which were far more intricate than any scientific operational definition could possibly convey. On the one hand, they provided an exhaustive representation of the structure of the mind using a

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wealth of detailed insights and discoveries describing their perceptions of the main processes affecting the development of the human psyche. These included thorough descriptions of the various stages of childhood development, psychopathology, and transference relations. On the other hand, as they accumulated and assembled the different components of what was effectively a vehicle of the mind, the language they wrote in was rich, paradoxical, and ambiguous, verging on the poetic and the obscure. A few of them (such as Freud, Winnicott, and Bion) loved texts for their music as much as for their ideas; they loved texts for their own sake, for their feeling and touch, their tempo and nuance, as much as for their meaning. Almost everything they wrote was open to numerous and varied interpretations. Thus, the theories they developed could be understood from a number of different perspectives. This theoretical and linguistic richness was part of the theory’s magic. However, it also undermined the possibility of scientifically defining psychoanalytic conceptualizations so that they could be corroborated in controlled laboratory conditions. How can one possibly test empirical evidence relating to such concepts as Winnicott’s “true self,” Bion’s “O,” or Kohut’s “twinship selfobject” experience? Thus, the beliefs of a fascinated community conceal a difficulty, one could even say a paradox: They believe in realism but possess no methodology to corroborate their underlying assumptions in a way consistent with accepted “scientific” methods. It is evident that members of such communities are aware of this paradox. Paula Heimann (1960[1989]), a Kleinian analyst, has written that: I have had occasion to see that my paper (Heimann, 1950) also caused some misunderstandings . . . [analysts] referring to my paper for justification, uncritically, based their interpretations on their feelings. They said in reply to any query “my counter transference,” and seemed disinclined to check their interpretations against the actual data of the analytic situation. (p. 153)

One-person psychology Most fascinated therapists do their work in line with one-person psychology, which does not recognize the inevitability of interaction and mutual influence in the analytic relationship.1 The therapist, in an object relations approach, is a receiver who understands and accepts “projective identification”; in Winnicotian therapy, the therapist may create what could potentially be a mental space within which the patients can mold the therapist they think they need. In these therapies, the underlying assumption of one-person psychology requires that the only psychology that is meaningful in the clinic is that of the patient (Aron, 1996). One-person psychology often entails that the therapist recognize the patient’s distortions of perception of the outer world.  In some schools, such as self-psychology, therapists avoid telling their patients that they have misinterpreted a life situation. In others, therapists sometime confront their patients. The following vignette of Shapiro (1974) demonstrates a confrontation of this sort: After three years of analysis with Shapiro, the patient decided to marry and

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frequently mentioned his intention to telephone his ex-girl friend to tell her of his plans since he knew, he said, how she would feel if she heard the news from someone else. What might be perceived as an empathic response was held with great certainty, but Shapiro wondered if his supposition about her reaction was accurate. Was the planned call really benevolent? Since the patient had a close intimate relationship with her for four years, it was likely that his call informing her of his forthcoming marriage to someone else might be taken as an act of aggression. She might interpret it as “rubbing-it-in,” as a narcissistic hope to know that she was still “pining” for him, or as some other interactional manipulation. Shapiro writes: Only after his delay in communicating with her and his reflection that he hoped she, too, might be planning to marry, did I confront him with his use of projection  in the guise of empathic understanding . . . Following this interpretation that he was assuming he knew what this woman would feel because under similar circumstances he would be hurt, the patient was able to consider a broader range of possible responses that he had formerly omitted. He was no longer certain of his empathic understanding. (p. 6) No doubt, therapists who endorse a two-person psychology might argue that Shapiro’s confrontation reflects the conception that the therapist is in a privileged position to observe and interpret the patient’s unconscious impulses, defenses, and resistances. However, I want to raise another point: In Shapiro’s vignette, we can witness the vantage point of the objective “outside” listener. This is also a part of what fascinates analysts: The notion of an observer using a specific therapy and having a God’s-eye perspective on truth as an unsound and obsolete positivist outlook might also contribute to the tremendous power psychoanalytic school have on therapists’ minds.

Limited interest in epistemology Generally speaking, and from the point of view of their tradition, fascinated communities are not particularly interested in epistemological questions related to knowledge and for the most part focus on clinical issues. It may be that this lack of interest stems from the fact that most psychoanalytic thinkers (with the exception of Freud and Bion) also had a limited interest in these questions. Instead, they mainly saw themselves as clinicians and therapists developing existing conceptualizations to describe and better understand complex mental states and therapeutic processes.

Pluralism of conservatism The work of many psychodynamic psychotherapists combines a number of psychoanalytic approaches. Often the blend involves schools that share concepts such as object relations (Klein, Bion, Fairbairn), theories of self (Kohut and Winnicott),

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or other combinations. Within psychoanalysis, this looks like a pluralistic group, but it too can be said to be monolithic in its perception. Those whose objective it is to achieve an integration between various psychoanalytic schools take little interest in scientific research. Many of them are preoccupied with psychoanalytic jargon, indifferent to other non-psychoanalytic disciplines, and pay little attention to psychotherapeutic research.

Contribution to the discipline There are two ways in which the passion of fascinated communities for a given psychoanalytic theory promotes the progress of psychoanalysis. First, such communities tend to form active international organizations that run training programs, arrange international and local conferences, publish journals, and set up reading groups and workshops. This intensive level of activity maintains the vitality of the theory and reinforces the professional identity of the community’s members. Second, fascinated communities are unusually knowledgeable about the theory they believe in. The study of theory is a long-term undertaking, which may span the whole of a therapist’s professional life. In the course of their rigorous and lengthy training, such therapists acquire a profound understanding of human development, psychopathology, and a variety of therapeutic processes. With the passage of time, they also develop novel understandings and meanings related to the theory, which they put into practice when dealing with a new clinical phenomena: for example, a Kleinian explanation of the development of masculine identity in New Guinea (Michele, 2003); the treatment of eating disorders based on the principles of selfpsychology (de Groot & Rodin, 1994); understanding the phenomenon of “forgiveness” in line with Winnicottian principles (Alford, 2013); and so on. Kleinian, Winnicottian, Kohutian, and Bionian theories are much richer and more complex today than they were when their founders were still alive. The fascinated communities that stood behind them applied these theories to a vast range of mental phenomena and clinical situations. They deepened and broadened the scope of the original theories, invented new concepts, and considered their use of them in a variety of contexts.

Independent analysts Alongside fascinated communities, there are also independent analysts. Among these, one can include Thomas Ogden, Michael Eigen, Adam Phillips, Jonathan Lear, Christopher Bollas, Neville Symington—all are active today—as well as Marion Millner, Nina Coltart, and Hans Loewald, who are no longer alive. The work of these analysts, each with their own unique style of writing, does not stem from loyalty to any particular psychoanalytic community. Conceivably, it is precisely this fact that arouses such interest in their ideas. Each of them is possessed of an independent, unique, and original way of thinking; each of them in their own field excels in their innovative writing, poetic style, and groundbreaking

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and creative thinking. Some are highly influenced by non-psychoanalytic worlds of thought (e.g. Lear is a professional philosopher; Bollas’s and Phillips’ field of expertise is literature; Eigen in his writings combines mystical and religious ideas; Symington was a Catholic priest). The writings of this group deviate from regular psychoanalytic works. Behind each of them is indeed a prominent thinker. One could justifiably regard each of these writers as a “fascinated analyst.” Almost all of them indicate their deep love of Winnicott and Freud, Eigen, Symington and Phillips are deeply influenced in relation to Lacan and Bion, Lear is an admirer of Loewald, and Ogden’s fascination is with object relation theories. However, in describing their case studies or applying the ideas of such a thinker to newly observed clinical phenomena, these authors are not satisfied with merely assimilating the thinking of those whose underlying principles they initially adopted. Each one of these writers took the original psychoanalytic conceptualizations in new directions, using them as a platform to introduce and develop their own innovative ideas. Unlike Klein, Bion, or Winnicott, their ideas in relation to the human mind didn’t include new thinking about stages of development in childhood. Instead, they all borrowed components of the original conceptualizations that they found fascinating in order to progress those in directions that they themselves were interested in. Carlo Strenger (2010) called these thinkers “the playful version of psychoanalysis” (Strenger 2010, p. 380), and Anthony Molino (1997), who interviewed some of these thinkers, labeled them “freely associated.” In other words, they were being lead more by their own creativity than their loyalty to a particular school.

Fascinated communities today A theory’s power to fascinate stems from three important elements: The belief that the theory is true; the scientific authority of the thinker behind it; and the acceptance of the theory as some kind of overarching narrative which explains a huge range of mental disorders. However, postmodernism, which has had an enormous influence on the Zeitgeist of our age, changed the way in which each of these elements was perceived. This cultural change weakened the authority of fascinated communities. There have been far-reaching changes in the perception of truth, which were not consistent with the world-views of many fascinated communities. The desire for objectivity has given way to an interest in, and respect for, subjectivity. In the postmodernist world, conceptualizations of the truth are attacked from every conceivable viewpoint. Scientifically objective universal truths are yielding to pluralistic truths, which are now perceived as dependent on culture and context. In the past, the classical psychoanalyst was the unchallenged source of judgment vis-à-vis the patient. The analyst was believed to “know the truth,” to represent the reality and the correct perception of the patient’s reality. The analyst’s knowledge and training were regarded as enabling him to distinguish between what was real and what was distorted by the patient’s conflicts and defense mechanisms. However, the enormous cultural changes of the past few decades compelled

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psychoanalysis to confront a new situation in which question marks were raised in relation to authority in every sphere of our lives. As a result, interpretation has come to be viewed as an unwarranted exercise of power (Aron, 1996). Turning away from objective truths was followed by a growing estrangement from the “big theory” that professes to establish a universal truth (Aron, 1996). It would appear that the era of the wholly monolithic theories has ended. The wish for a narrative which unifies a huge quantity of complex facts in one all-embracing explanation has submitted to postmodernist trends of thought, which encourage the dismantling and deconstruction of the single overarching narratives and aspire to expose them as being simplistic myths. This change in the fundamental assumptions underpinning fascination pulled the rug from under its feet and left the community without a world-view that could support it. Its perception of the truth came under attack from two fronts. On the one hand, scientists criticized it for the absence of a scientific basis in the formulation of its theories; postmodernists, on the other hand, censured the community for its reliance on concepts of authority and truth, which were perceived by them as outdated and irrelevant. It is also the case that characteristics that distinguish between differing psychoanalytic schools are not as distinct and pronounced as they were in the past. What was once central and dominant has become marginal. And yet it has to be said that this “periphery” still has a powerful presence and regularly influences the pluralistic centre ground. Looking at the psychoanalytic world as a whole, the influence of fascinated communities is extremely evident. Even today, fascinated communities have a presence in virtually every psychoanalytic institute and an influence on practically all psychodynamic training programs. Today’s fascinated communities are especially interesting. Despite all the ostensible outward support for pluralism and tolerance of different and sometimes contradictory conceptualizations, in their heart of hearts, many professionals still adhere to a particular treatment method and remain loyal to a single theory or thinker. In the wake of a change both in the mood of the times and in the concept of truth, they no longer claim—at least not openly—that the theories and interpretations held by them are either scientific or objective. However, without them being at all aware of it, they do, in practice, regard their conceptualizations as if they were “objective.” Perhaps it would be more correct to describe these communities as followers of a “pragmatic” truth; they believe that since their conceptualizations “work” they are also “true.” Moreover, they continue to regard the language and methodology of other psychoanalytic schools as “alien” to their own. And yet the communities co-exist, belong to the same organizations and institutions, and participate in the same training programs. As a consequence, there is a large international community that embraces both fascination and pluralism at one and the same time.

Troubled communities A troubled community is one that is not satisfied with the state of psychoanalytic knowledge and seeks to generate a fundamental change that does not square with

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existing traditions. Currently active in the psychoanalytic world, these ­communities can take a number of forms.

New psychoanalytic schools The most prevalent types of troubled community are those set up by new psychoanalytic schools. All the leading thinkers behind the establishment of psychoanalytic schools—Klein, Bion, Winnicott, Kohut, among others—were analysts dissatisfied with existing conceptualizations about the human mind, infant development, therapeutic goals, or psychopathology. They evolved wide-ranging and comprehensive new theories within the broad psychoanalytic community as a response to these perceived flaws. Kohut observed that patients respond better to empathetic understanding than to interpretations based on Freud’s instinct theory of motivation. Before Kohut, empathy had been at the margins of psychoanalytic writings. Klein thirsted for an understanding of the destructive aspects of the ego of younger patients and their sadistic ways of playing and interacting. She conceptualized numerous clinical phenomena, such as projective identification, manic defenses, and envy, none of which had merited investigation prior to her work. Fairbairn tried to explain why people found it so hard to sever relations with their objects, even when the objects were themselves violent and sadistic. He developed an entire theory around this phenomenon. Every troubled community of this kind starts off with a troubled analyst joined by other like-minded colleagues whose purpose is to change the existing body of knowledge. Ultimately, the community focuses on a particular set of clinical phenomena, interventions, therapeutic objectives, or a perception of transference relationships, and unites in debate around these issues. At some point, having reached a new set of assumptions regarding the early phases of development of psychopathology and therapeutic processes, such communities cease to be troubled and become fascinated. Their fascination lies in the wide-ranging comprehensive theory they have created, the clinical phenomena that this theory covers, and their ability to extract a huge variety of therapeutic understandings and interventions from their new assumptions.

Scientifically troubled communities This community is troubled by the exclusive reliance of analysts on the clinical situation and is preoccupied with the verification of existing therapeutic processes by scientific methods. It seeks to develop new theories with evidence-based recommendations to refine and improve treatment procedures. Members of these communities warn that if psychoanalysis doesn’t adopt scientific research methods, it faces a grim future. According to Kächele, “The case for psychoanalytic research is not academic, it is imperative” (Kächele et al. 2009 p. 1).2 The scientifically troubled community also seeks to corroborate and expand on psychoanalytic conceptualizations in university’s laboratories and research

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institutes. This group includes Sidney Blatt, who researched mental representations (cognitive-affective schemas) of self and significant others; Joseph Reyher, who studied repressed emotions; Jay Halpern, who investigated the phenomenon of projection; Lloyd Silverman and his work on subliminal messages; Phebe Cranmer, who developed the Defense Mechanisms Manual (DMM) to assess three defenses: denial, projection, and identification; Golan Shahar, who demonstrated the relevance of psychoanalytic theory and research to behavioral medicine; Drew Westen and his work on personality disorders through his Social Cognition and Object Relations Scale Scores (Westen, 1995; Westen et al. 1991); and many others. These communities also seek to test the efficacy of psychoanalytic therapeutic methods among a large sample of patients3 and/or aim to change psychoanalytic knowledge through other scientific disciplines. Two key groups are engaged in this latter work: researchers of infant-mother interactions (such as the Boston Change Study Group) and neuropsychoanalysis.

Philosophically-culturally troubled communities This community is inspired by contemporary Western philosophical and cultural world-views, and aims to change psychoanalysis in light of that influence. Western culture, philosophy, the mood of the times, even the perception of mental disorders—all have undergone far-reaching changes in the period since Freud and other major psychoanalytic thinkers. These changes have wide-ranging implications. In their wake, the meaning that people attach to their lives has changed, as has their perception of the appropriate way to live it; the world-views that we rely on change dramatically. In an apt metaphor, Yankelovitch (1981) compared the processes of change in the world-view to the movement of tectonic plates: When the society’s tectonic plates begin to move—which is to say, when the deepest and most vital foundations of its beliefs begin to change—this leads to colossal shifts in our lives. According to Gideon Lev (2015), psychoanalysis is the first to feel the impact of these upheavals. He argues that, contrary to the belief that psychoanalysis is estranged and detached from society, it is an especially sensitive seismograph in recording shifts in the dominant world-view and adapts itself to changes of meaning dictated by every new outlook. If psychoanalysis wishes to remain relevant, the discipline cannot avoid adapting itself to the huge social and cultural changes taking place at any given time. These improvements are the product of the work of philosophically-culturally troubled communities. Such communities ensure that psychoanalytic discourse will incorporate the most current cultural changes. However, psychoanalysis is slow in responding to changes of this kind; modern hermeneutics and postmodernism entered the psychoanalytic discourse many years after they became rooted in Western culture. In this context, one of the most significant attempts at change in the field was undertaken by philosophically-culturally troubled therapists such as Schafer

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(1996), Spence (1982), and Mitchell (1993), who wanted to establish a link between psychoanalysis and modern hermeneutics and offer it as an alternative to the scientific world-view. In its belief that dreams, associative thinking, or any other outcome of human thought processes are analogous to written texts, hermeneutics was an inspiration to psychoanalysis as a whole. Given that above all else psychoanalysis is an interpretive discipline, these thinkers argued, its world-view offered a better understanding of what the psychoanalytic process involves. The fundamental goal would be for the patient and analyst to establish an understanding. Psychoanalysis, as Schafer (1996) said, was about the retelling of lives. As Strenger (2010) wrote about hermeneutics and psychoanalysis: Psychoanalysis might as well live in a playful universe of coexisting narratives and metaphors; what mattered was that patient and analyst co-created joyfully and fruitfully. Adam Phillips . . . pushed this conclusion one step further: psychoanalysis, he argued, was about refusing to be in the position of the expert who could tell the patient anything authoritatively; it was a form of conversation, not a technique. (p. 379) However, the hermeneutic perception always remained outside the framework of clinical work. For most therapists, it had little relevancy in terms of their chosen ways of treatment. Since the 1990s, the most important active philosophically-culturally troubled community is the relational approach. This orientation called for a radical change in thinking about the relations between analyst and patient based on the principle of mutuality. Their appeal was influenced by postmodernism, constructivism, and perspectivism, as well as contemporary feminist thinking. The change in therapeutic thinking brought about by the relational approach will be described in Chapter 4.

The rivalry between fascinated and troubled communities There is a constant tension between fascinated and troubled communities. Often, the entry into the discourse of a new psychoanalytic school can trigger a degree of opposition that is powerful enough to cause an organizational split. Given that fascinated communities believe in the truth of their underlying theories, they are frequently compelled to challenge the attempt of troubled communities to radically change these conceptualizations. This rivalry strengthens the position of fascinated communities and reinforces the sense of the solidarity of their members as well as deepening their intolerance vis-à-vis alternative theories. Fascinated communities often openly express their disapproval of communities that are scientifically and philosophically-culturally troubled. The main fear of fascinated communities is that psychoanalysis will be dragged in a different and, in their view, alien direction and will be practiced in a way that doesn’t maintain the centrality of the interpretation of the unconscious. If that were

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to happen, they argue, the profession would give way to superficial, focused, and fast therapies.4 Consider, for example, the response of this hard-core oppositional group for psychodynamic psychotherapy. Notwithstanding its pragmatic advantages, it is seen as inferior and more superficial than psychoanalysis (Busch, 2010; Gill, 1954; Rangell, 1954), and there are those who have compared psychoanalysis to an oil painting and psychodynamic psychotherapy to an ink drawing (Zerbe, 2007) in order to illustrate more vividly psychoanalysis’s robustness and diversity when compared to psychodynamic therapy. In the opinion of practitioners like these, psychodynamic psychotherapy lacks the essential components required for the kind of profound treatment that reaches the deepest layers of the mind. As Fred Busch (2010) has written: I am concerned that psychoanalysis is in danger of becoming a pale echo of what inspired Freud, excited psychoanalysts for generations afterwards, and is still true in the twenty-first century. That is, we are in danger of losing contact with the deeper motives for why people seek us out, i.e. the terror with no name, the unconscious murder, mayhem, and sexual fantasies of every sort that drive our patients into “private madness” (Green) and lead to the pulsating conflicts that cause our patients to hate what they want, and reject what they have, all going on outside of awareness. (p. 23) As the years passed, the distinction between the two kinds of therapy has been blurred. Indeed, they have become so intertwined that there is now in effect one procedure with two names (Miller, 1991; Wallerstein, 1995; see also an extensive summary in Eisold, 2005). The point at issue is not whether Busch is right or wrong, whether he represents an outdated approach whose time has passed or whether he has a better understanding than others of the real substance of psychoanalytic therapy. What is important is that his voice should be heard and that it be a part of psychoanalysis’s bigger chorus of voices. By reminding us of what psychoanalysis once was, Busch and his colleagues are challenging the troubled communities to conduct a dialogue with the past and to define themselves in relation to that bygone era and as belonging to it. Contemporary psychoanalysis, even if it has deviated in significant ways from the discipline it once was—and which Busch so admires—is still nonetheless a link in a chain that has a present and a future that stem from one source. The “margins” that Busch represents draw attention to the center and highlight its uniqueness and contemporaneousness. In practice, since psychoanalysis “proper” is so infrequently used as a form of treatment, psychoanalytic conceptualizations are for the most part employed by psychodynamic psychotherapists. Had it not been for psychodynamic psychotherapy (including short-term psychodynamic treatments), it is almost certain that psychoanalysis would have become an esoteric, marginal movement. Given that the troubled and fascinated communities are in constant dialogue with each other—be it open or clandestine—the tension between them can be

Fascinated and troubled communities  31

viewed as a positive contribution to the development of psychoanalysis. As I will show in later chapters, at least initially, troubled communities have a need to be acknowledged by fascinated communities—the hard-core analysts—and therefore emphasize the traditional psychoanalytic elements of their conceptualizations. Fascinated communities energetically develop their original conceptualizations to address the different problems raised by troubled communities. Thus fascinated and troubled communities are continually reacting to and changing one another.

The dominance of the past in psychoanalytical writings The statistical data on the most viewed and most cited articles included in the digital archives of the Psychoanalytic Electronic Publishing Website (PEP) provides us with a certain picture of the most common theoretical trends in psychoanalysis in recent years. This statistical information shows that the classical conceptualizations identified with specific schools (those developed in the period between the 1920s and 1980s) are at the heart of the psychoanalytic body of knowledge. Out of the ten most viewed articles in 2013, seven were written between 1946 and 1978 by Winnicott, Bion, Klein, and Kohut.5 Both fascinated and troubled analysts certainly read these articles, and the data undoubtedly shows that the canonical writers are still the focus of interest for members of the psychoanalytic community as a whole. The three other most viewed articles are by an analyst belonging to the relational approach (Jessica Benjamin), a group of authors interested in integrating the findings of infant research in the understanding of the process of interpretation (The Boston Change Study Group), and an independent author (Thomas Ogden). This conclusion is further reinforced in light of the articles most often cited in the period 2004–2014. In the thirty most frequently cited articles during these years, there is a clear-cut numerical advantage in favor of classical canonical writings (Winnicott: five; Bion: three; Klein: two; Kohut: two; Sandler: two; Segal, Heimann, Bick, Rosenfeld, Strachey: one each). These papers were written between the years 1935 and 1983. There are two additional papers by independent writers (Ogden and Loewald), one by the Boston Change Study Group (the most quoted of all the papers), one article by Fonagy and Tagert, one on the analytic situation as a dynamic field according to object relations theory (Baranger and Baranger), and six papers identified with the relational approach (such as Benjamin and Bromberg). The fact that more than seventy percent of the papers were written by the leading thinkers themselves or those scholars responsible for developing their theories shows that the fascinated and troubled communities are united in their use of the classics as the foundation of their knowledge. The proposed model, which distinguishes between fascinated and troubled communities, is schematic and cannot hope to cover the entirety of psychoanalysis’s richly varied literature from the inception of the discipline to this day. Many analysts belong to more than one category. For example, there are those who see in the relational approach the negative features of fascinated communities, such as

32  Fascinated and troubled communities

indoctrination and a lack of open mindedness to “other” points of view (Mills, 2012). Moreover, the distinction between a fascinated and a troubled analyst is not at all simple and clear-cut: All troubled analysts, including those who sharply criticized psychoanalysis for its lack of scientific method, are, to some extent, sufficiently fascinated as to be part of that community. Furthermore, fascination is often linked to some bothersome aspect of a theory being resolved. Thus, troubled analysts also tend to be fascinated by the proposed solutions and unite around them. For example, infant researchers are often fascinated by the implications of mother-infant interaction studies, write about them with great enthusiasm, and find such examples in every area of treatment, just as do other more traditional fascinated communities. In addition, many psychoanalysts including those who established a new psychoanalytic theory have warned against the excessive use of theories. Consider the following citation from one of Bion’s (1987) seminars. The supervisee tells Bion that, in order to find a correct interpretation for the child in treatment, he would use the Kleinian point view. Bion answers: “I think I would do the same if I were tired and had no idea what was going on, and if this child wasn’t telling me anything. If, in fact, the worst came to the worst, I might fall back on Kleinian theories, Freudians theories, Abrahamiam theories, any theories” (pp. 58–59).

Fascinated and troubled communities in science Psychoanalytic theorizing is subject to the same cognitive processes and ramifications as all other areas of human reasoning. The existence of fascinated communities is not a phenomenon exclusive to psychoanalysis. In a variety of forms, such communities are also to be found in other scientific communities. For post-positivist philosophers of science, such as Kuhn, Lauden, Lakatos, Thagard, and others,6 scientific paradigms and research traditions, once adopted, are rarely if ever rejected solely because new empirical findings raise doubts as to their validity (Lakatos, 1978). In fact, post-positivist philosophers have claimed that contradictory findings affect scientific theories far less than is commonly believed. Spiritual factors, doctrinal beliefs, and other not necessarily empirically-based considerations—say the post-positivists—play an important role in the judgment of scientific theories and research traditions. In The Passionate Scientist: Emotion in Scientific Cognition, Paul Thagard (2002) discusses the vital role that emotions play in the investigation, discovery, and justification stages of scientific work. At first, Thagard posits, inquisitiveness, involvement, and fascination are essential elements in the search for scientific ideas. Once that search leads to a discovery, it triggers such emotions as elation and satisfaction. Even when it comes to the justification of a theory, emotions continue to play an essential role in helping to recognize its “rightful” acceptance. Valid theories are also judged in terms of their refinement and sophistication: again, an emotional response usually restricted to issues of subjective taste rather than scientific judgment. Thagard provides us with numerous examples of these phenomena in the scientific world. One of the interesting cases cited by him in this context is the discovery

Fascinated and troubled communities  33

by Watson and Crick’s of the structure of DNA. One reason for the scientists’ certainty that they had discovered the “true structure” was its aesthetic appeal, its fascination. Thagard cites Jacob as having written that “This structure was of such simplicity, such perfection, such harmony, such beauty even, and biological advances flowed from it with such rigor and clarity, that one could not believe it untrue” (quoted in Thagard, 2002, p. 247). Whilst fascinated communities in the scientific world continue to develop, refine and deepen their own research traditions, troubled communities breach the boundaries of conventional thinking and create new frameworks of research. Moreover, troubled communities also represent the demand for change, criticism, and the search for better alternatives to existing theories. Elkana (1981) writes: We know that scientists, if they are at work on some theory, are often so committed to it that they are incapable or unwilling to be critical of much of what they are doing. There is, however, consensus in the scientific community about the desirability of a critical awareness of alternatives, and therefore it is the community as a whole which provides the critical scrutiny of each theory or result, keeping alternatives in mind. (p. 40) From this description, it is apparent that, notwithstanding their zealous devotion to the theory, fascinated communities, no matter what their particular scientific field may be, cannot, over time, keep an entire discipline alive. Consequently, as the years roll by, their theories become increasingly irrelevant in light of the vast changes that have occurred in the sciences, in philosophy, in society, and in culture. The major paradigmatic changes that have taken place in psychoanalysis since its inception were the work of troubled analysts.

The case of Skinnerian behaviorism Until now, I have linked the theoretical richness and ability of psychoanalysis to survive over time to the co-existence of fascinated and troubled communities. If this were reasonable, the expectation would be that the growth of scientific communities in which such successful co-operation did not take place would be halted and their development stunted. The absence of successful co-existence between troubled communities and fascinated communities is likely to be a key explanation for the fall from favor of Skinnerian behaviorism. Like psychoanalysis, behaviorism also grew out of a revolution that changed the definition of psychology. Until the appearance on the scene of behaviorism, psychology had been defined as the study of the human mind. Behaviorism, established as a school of psychology by John B. Watson (1878–1958), set aside the human mind as its focus, replacing it with the study of human behavior as psychology’s number one objective. Watson’s general approach was adopted by various and occasionally conflicting research traditions (Watrin & Darwich, 2012). This formed the background to the development of B. F. Skinner’s (1904–1990)

34  Fascinated and troubled communities

behavioral analysis, or as Skinner himself termed it, “radical behaviorism.” Radical behaviorism’s world-view regarded mental events (such as thinking and feeling) as linked to behavior, thus making them legitimate objects of its research. On the other hand, it rejected the notion offered by causal mentalism that behavior is a function of mental events—the view held by psychoanalysis. This “anti-mentalism” became one of the central features of the behaviorist approach. Like psychoanalysis itself, Skinnerian behaviorism became part and parcel of socially oriented practice. Thus, child care, the treatment and rehabilitation of prisoners, educational methods, and many other aspects of dealing with social behavioral problems were deeply influenced by behaviorist ideas. In ways comparable to the path taken by psychoanalysis, the behaviorist movement led by Skinner attracted many followers who pursued and expanded on his method and who saw in Skinner himself a pre-eminent and inspirational man of science. A group of faithful followers institutionalized his method and set up organizations and journals that were responsible for its continuing success.7 From within this group sprung a large number of disciples whose work led to a series of breakthroughs, which, in and of themselves, led to the broadening and development of the method.8 Skinner remained the unchallenged exponent of his movement and continued to be its spokesman between the 1950s and 1980s. During this period, his concepts influenced the course of American psychology to an extent greater than did the ideas of any other psychologist (Watrin & Darwich, 2012). But the cognitive revolution that began to blossom in the 1950s and 1960s and its notion that the human brain’s processing of information was analogous to the workings of a computer undermined behaviorism’s fundamental tenet. On this, Pinker (1999) wrote as follows: Skinner and other behaviorists insisted that all talk about mental events was sterile speculation; only  stimulus–response  connection could be studied in the lab and the field. Exactly the opposite turned out to be true. Before computational ideas were imported in the 1950s and 1960s by Newell and Simon and the psychologists George Miller and Donald Broadbent, psychology was dull, dull, dull. (p. 84) The rapid growth of the cognitive movement cast a heavy shadow over behaviorism as many of its loyal followers chose to abandon it. In a survey carried out by Boneau (1992), senior psychologists noted that in their view the decline of behaviorism and the rise of cognitivism had been among the most surprising developments in psychology over the past twenty-five years—a development which in later years became an established fact within the psychology community. Similarly, quantitative surveys of a number of publications covering different areas of psychology also show a significant increase in articles published on cognitive psychology and a decline in the interest of researchers in Skinnerian behaviorism (Tracy, Robins & Gosling, 2004).

Fascinated and troubled communities  35

The reasons for the decline of Skinnerian behaviorism are numerous and ­complex.9 In effect, Skinnerian behaviorism consisted of a single fascinated community that was responsible for its rise and consequent pre-eminence in the middle of the last century. Yet it was this very same community that was also responsible for the school’s homogeneity and its difficulty in updating and renewing behaviorism by introducing novel ideas and additional discoveries. Though its members were loyal and devoted supporters, there was a discernible lack of troubled communities alongside them, which could conceivably have altered and adapted behaviorism such that it could have been in tune with the times while still remaining faithful to its basic tenets. As a result, as Skinner’s followers were slowly expanding his conceptualizations, cognitive psychologists were galloping ahead, making new discoveries and achieving major breakthroughs in such areas as thinking, memory, mental imagery, learning processes, problem solving, and decision-making. According to Watrin and Darwich (2012): It would seem that between 1958 and 1989 the behaviorist school isolated itself from other approaches as shown a by high level of “self-citation” in one of its major journals, The Journal of Experimental Analysis of Behavior (JEAB) . . . they were so preoccupied with erecting a defense against cognitivism that most of their time was spent debating only among themselves. (p. 277) Summing it up in 1990, Skinner wrote that: Because of its similarity to the vernacular, cognitive psychology was easy to understand and the so-called cognitive revolution was for a time successful. That may have accelerated the speed with which behavior analysts drew away from the psychological establishment, founding their own associations, holding their own meetings, publishing their own journals. They were accused of building their own ghetto, but they were simply accepting the fact that they had little to gain from the study of a creative mind. (p. 1210) Skinnerian behaviorism didn’t disappear; it simply became more contracted and its significance shrank. The conservative approach in psychological behaviorism is alive and well and to a large extent has demonstrated an immunity to change. Even the smallest sign of deviation from the spirit of Skinner’s original theory arouses opposition as if the critique poses an existential threat to the school’s professional and scientific identity. For example, among the movement’s committed loyalists, there were complaints about the increasingly prominent standing of mentalism in behavioral psychology, including the usage of cognitive terminology (see for instance Branch & Malagodi, 1980; Michael, 1980). The school was quite often accused of a lack of intellectual tolerance. In actual fact, the scientific and professional distinctiveness of behaviorism relied on its divergence from other approaches such as the cognitive movement. Though such distinguishing characteristics are

36  Fascinated and troubled communities

still significant, there are too few attempts to make the field more accommodating and receptive to new ideas (Watrin and Darwich, 2012). When compared to behaviorism, the successes of the cognitive revolution were far more enduring and wide-ranging. Apparently this was so because cognitive psychology was more diverse and pluralistic in its approach. In fact, in terms of its variety and richness, the cognitive revolution is reminiscent of psychoanalysis’s own development over the course of the last two decades. Like psychoanalysis, the cognitive movement is not homogeneous in its makeup. It is the outcome of a chain of concurrent developments in such fields as psychology, linguistics computer science, philosophy, anthropology, and neuroscience (Gardner, 1985; Miller, 2003). The idea was that each field of study would offer its own view of cognition, a well-defined level, and the target of the analysis. In so doing, the cognitive movement would, from the start, show itself to be a highly diverse group of researchers and theories. The fate of Skinnerian behaviorism carries with it an important message. It proves that even a school of thought that flourishes for decades and gains broad public popularity is not guaranteed a successful and enduring future. Quite the reverse—the real challenge to a body of knowledge is its ability to cope with a painful period of disenchantment in which the trendy and volatile “mood of the times” turns its back on a once admired-school, and its critics celebrate their victory by repeatedly focusing on the field’s flaws. At such difficult times, the extent to which troubled communities are essential becomes clear and is given expression. Its function, among other things, is to take note of changing cultural, social, and scientific trends and in one way or another reshape the body of knowledge that is under attack in line with the new mood of the times and so prevent its fossilization.

Notes 1 By contrast, two-person analysts emphasize the limits of the analyst’s  knowledge, the analyst’s inevitable subjectivity, and inescapable participation in the patient’s transference. 2 The community includes groups such as the Menninger Psychotherapy Research Project (MPRP) (see Wallerstein, 1986); the Penn Psychotherapy project (Luborsky and CritsChristoph, 1988); the Psychoanalytic Process Research Program at the University of Ulm; Enrico Jones’s Psychotherapy Process Q-Set (PPQS); Harold Sampson and Joseph Weiss’s research group at the University of California, San Francisco (UCSF) on the Process of Change in Psychotherapy, and Fonagy’s mentalization-based treatment. For a detailed survey of systematic scientific research, see Hinshelwood (2013, pp. 5–25) and Leuzinger-Bohleber et al. (2003). 3 For example, see Bateman and Fonagy (2001); Chiesa and Fonagy (2000); Chiesa et al. (2002); Hersoug, Leichsenring, Klein and Salzer (2014); Richardson et al. (2004); Roth et al. (1996); Shedler (2010); Barber et al. (2013); Zilcha-Mano and Barber (2014). 4 See, for example, the objections of Blass and Carmeli (2007) to neuropsychoanalysis and that of Green (2000) to the use of infant research in psychoanalysis. 5 Lacanian and Jungian therapists have their own journals and are therefore not included in this archive. 6 For a comprehensive summary of such approaches, see Laudan et al. (1986).

Fascinated and troubled communities  37

7 Skinnerian behaviorism was institutionalized in the 1970s with the founding of The Society for the Experimental Analysis of Behavior and the setting up a year later of the Society for the Analysis of Behavior (SEAB). In 1968, The Journal of Applied Behavior Analysis (JABA) was set up, followed by the establishment of other journals and organizations such as the Midwest Association for Behavior Analysis (MABA) in 1974, which in due course became the Association for Behavior Analysis (ABA). 8 Such as Fred Keller (1899–1996), Charles Ferster (1922–1981), William Schoenfeld (1915–1996), and Murray Sidman (1923–). 9 For a detailed analysis, see O’Donohue et al. (1998); Overskeid (2008); Roediger (2004); Watrin and Darwich (2012).

2 IMAGES OF KNOWLEDGE OF FASCINATED AND TROUBLED COMMUNITIES

How can rational people, devotees of Western culture with an education based on the scientific ethos, be fascinated by a theory—with virtually none of its assumptions proven in a laboratory—that is struggling to corroborate the efficacy of its therapy? Can the fact that they show so little interest in scientific research be logically explained? What disturbs professional practitioners in troubled communities? What characterizes the divergence of views between fascinated and troubled communities? To begin to offer answers to these questions, we need first of all to outline a theory of knowledge. This will provide us with the tools we require to compare different communities and describe various phenomena that characterize differing psychoanalytic schools. To understand the way in which scientific communities perceive science, I shall begin this chapter with a description of an epistemological account suggested by the philosopher of science Yehuda Elkana (1981). I will do so using the concept Elkana himself coined: “images of knowledge” (p. 15). I shall then compare the images of knowledge of fascinated communities, scientifically troubled communities, and philosophically-culturally troubled communities. In the subsequent part of the chapter, I shall show that the knowledge possessed by psychoanalytic communities sheds new light on and explains numerous phenomena that have been sharply disparaged by psychoanalysis’s various critics. For example, by closely observing the behavior of a psychoanalytic community’s members, doing so through the eyes of the psychoanalyst practitioner clinician himself, we can see why many analysts rely exclusively on the clinical situation and why they seem indifferent to empirical research. According to Elkana (1981), images of knowledge are socially determined views about knowledge (as opposed to views about nature or about society). These are ideas that touch on questions such as what is the objective of science (prediction

Images of knowledge  39

or understanding); what is the truth (a certainty, a probability, or something that is objectively unattainable); what are the sources of knowledge (sensory perceptions, observations, deduction). Images of knowledge are dependent upon periods of time, culture, and society. They determine what is considered important, interesting, ridiculous, absurd, harmonious, symmetrical, beautiful, or of value in a scientific theory. There are images of knowledge held by the general public and images of knowledge characteristic of a particular scientific community. Some images of knowledge remain intact for hundreds of years, some endure for decades, while the acceptance of still others lasts just a few years.

Sources of knowledge These are the sources upon which a particular field of research is based. The legitimate sources of knowledge are not decided upon by the theory itself; rather, such sources are determined by images of knowledge. Even within the same body of knowledge, there are occasionally a number of parallel sub-communities that may hold differing or contradictory images of knowledge. Some images of knowledge are apparent and conscious; others are concealed and non-conscious. The ranking of the possible areas of research in their order of importance is also decided by socially-determined criteria, thus settling what will and what will not be at the frontier of scientific research. Sources of knowledge are hierarchically organized, and they range from those that have gained the broadest levels of acceptance within a large community to sources associated with smaller and more marginal communities, even including sources linked to specific research institutes. These latter images of knowledge hold sway for much shorter periods of time. Among knowledge’s multiple sources are: experimentation, sensory experiences, clear and coherent ideas, tradition, authority, discovery, innovation, beauty, intuition, and analogy. Thus, for example, researchers occasionally forgo rich and complex explanations in favor of ideas that are clear and coherent. No branch of science can be said to have a single source of knowledge or a source that is preferred above all others, and it would be incorrect to suggest that science’s only sources of knowledge are experimentation or evidence-based research. What can be said is that clear, coherent, and incisive ideas, experimentation or evidence-based research, aesthetic considerations, and analogy are all considered to be legitimate sources of knowledge. Innovation—despite the fact that in reality its status is no more credible than tradition and authority—is, in today’s world, recognized as a legitimate source of scientific knowledge. Though intuition is not self-evidently a reliable source of scientific knowledge, it is generally accepted as a legitimate source with which to justify a new scientific discovery nonetheless. Analogy has a long history in science and is regarded as one of the most legitimate and interesting sources of scientific knowledge. In contrast, according to Elkana, revelation has become “unfashionable” (1981, p. 3) and is no longer regarded as a legitimate source of scientific knowledge. It is our

40  Images of knowledge

world-view, together with its images, that determine when we are to favor the senses over revelation and when to give preference to the senses in dealing with scientific matters while restricting our use of revelation to the sphere of religion. Those who can come to terms with this tension escape the conflict of having to rely on one source of knowledge when dealing with scientific matters and another when going to the mosque, synagogue, or church.

Images of knowledge in psychoanalysis The idea that various scientific communities have differing images of knowledge enables us to compare and contrast the perceptions of knowledge held by various psychoanalytic communities. Elkana’s (1981) model possesses a rich potential for understanding the logic behind the way in which analysts think and make clinical judgments. There are a number of reasons for this. First, Elkana describes a wide range of images of knowledge held by different scientific communities. The fact that images of knowledge are dependent on culture and society means that no single image of knowledge is pre-eminent or preferable to any other. Elkana offers an “anthropology of knowledge” instead of a defined epistemology. His theory makes it possible to distinguish between images of knowledge and the beliefs and needs that led to their formation. My aim is not to judge which images of knowledge are true or false, but to understand what embracing certain images of knowledge means, and its consequences. Second, whereas other postmodern philosophers, such as Kuhn, Lauden, and Lakatos, were mainly preoccupied with the way in which knowledge develops, Elkana was more interested in how scientists perceive knowledge. His theory is a tool that helps us to access the mindset of psychoanalytic communities and characterize them in line with their images of knowledge and their methods of verification. Elkana’s theory also helps us understand the contemporary crisis in psychoanalysis from a new perspective. This crisis is an outcome of a gap between the images of knowledge held by two widely different communities: the psychoanalytic community (or at least a substantial majority of it) and the broad scientific community, especially the discipline of academic psychology. Because these communities have such opposing views as to what constitutes a legitimate source of knowledge, they have difficulty in accepting each other and tend to ignore one another instead. Third, Elkana’s theory can help us characterize critically important turning points in psychoanalytic development in line with a community’s altered perception of its images of knowledge. In Freud’s time, the answer to the question “what is psychoanalytic knowledge” would have been entirely different from the answer to that question today. The difference is a result of fundamental social and cultural changes that have led to a reappraisal of the conceptualization of knowledge. For example, postmodernism has led to far-reaching changes in philosophy’s concept of “truth”: It regards truth as contextualized, multifaceted, fragmented, continuously changing, and dependent on the self-interests of the person voicing it. This

Images of knowledge  41

reassessed image of knowledge is not consistent with the traditional psychoanalytic notion of truth, which aimed at gaining an “objective” understanding of the patient and her unconscious, nor does it match the perception of truth held by members of fascinated communities, who believe their conceptualizations reflect reality. Nowadays, fascinated and troubled psychoanalytic communities differ in their perceptions of what constitutes knowledge. To a great extent, these divergent views determine their respective conceptualizations, their research methods, and the ways in which they are influenced by other bodies of knowledge. These communities cannot be understood without understanding their images of knowledge. Last, despite the fact that Elkana thinks that science has an irreducibly social and political character, he is not a relativist philosopher. On the contrary, he thinks that on the majority of issues, most people embrace realism and relativism simultaneously. In the main, we select a framework relativistically, fully conscious of the fact that we cannot verify the correctness of the choice and aware that other options are available to us. Yet, once the choice is made, we behave toward the selected framework in a way suggesting that our thoughts about it are realistic. These two attitudes or views are held simultaneously: In other words, we find ourselves engaged in what Elkana termed “two-tier thinking” (p. 15).

A comparison between images of knowledge of fascinated and troubled communities within psychoanalysis For any given psychoanalytic community, images of knowledge define the following: 1. The legitimization of knowledge: Every psychoanalytic community has its hierarchical ranking of sources of knowledge. These include knowledge derived from clinical situations, an acknowledged authority, intuition, scientific research studies, and a variety of world-views. No psychoanalytic community relies exclusively on one source of knowledge alone. For example, scientifically troubled communities attach far greater importance to psychoanalytic knowledge that is consistent with scientific research, while fascinated communities mainly rely on the clinical situation and, within it, the hidden meaning attached to the patient’s overt content. In psychoanalysis, what is scientifically germane is the particular patient’s inner experiences in relation to her life history, current phenomenology, and attitude toward the relationship with the analyst (Mills, 2007). 2. Sources of knowledge: Fascinated communities and culturally troubled communities (such as those following the relational approach) validate knowledge almost exclusively through the clinical situation and base themselves on single case studies. Scientifically troubled communities search for scientific ways of corroboration through methods of research such as questionnaires, interviews, experiments, and the analysis of recorded encounters between therapist and patient.

42  Images of knowledge

3. The degree of importance that is attached to non-psychoanalytic sources of knowledge: Many fascinated communities display little interest in these sources, such as infant-observation studies and brain research, whereas scientifically troubled communities tend to rely on them to a great extent. 4. The degree of importance accorded to empirical and evidence-based research: Many fascinated communities do not consider this kind of corroboration important, whereas scientifically troubled communities regard such findings as a vital means of verification. It is important to note that in their therapeutic work, therapists who embrace a variety of different approaches in general—and not just psychoanalysts—attach a low level of relevance to empirical research compared to the high relevance they attribute to articles, counseling, and personal therapy. This is because (so it is argued) empirical research does not accurately reflect the complexity of the clinical process (Safran, 2012). 5. The degree of tolerance shown to other psychoanalytic theories whose underlying assumptions differ: Fascinated communities can be hostile or indifferent to alternative theories, while scientifically troubled communities only tolerate conceptualizations that can potentially be scientifically tested. Socially or culturally troubled communities tend to be pluralistic in their approach and therefore far more tolerant in their willingness to consider alternative theories. 6. Authority: The images of knowledge of any given psychoanalytic community also determine that community’s s loyalty to, or divergence from, the ideas of Freud or the theories of some other pre-eminent thinker. Fascinated communities often develop only those conceptualizations that are consistent with the views of the thinker in whose theory they believe. Every new conceptualization is a link in a chain of ideas initiated by that original thinker. Scientifically and culturally troubled communities do not remain loyal to one thinker or theory; in their case, the abiding loyalty is to their own chosen world-view. Hinshelwood (2013) thinks that conviction arising from faith induced by teachers is not necessarily emotional and irrational. Accepting the authority of someone with extensive experience might be reasonable . . . Each person does not have to start from square one on everything . . . And clearly the development of human knowledge through this kind of social accumulation arises from the capacity of individuals to pass on their experience to each other and to later generations. (p. 39) Elkana (1981) thinks that authority is a source of knowledge in science. However, being critical is part and parcel of the scientific ethos, and its image is, to an extent, built around its unwillingness to accept evidence merely on the basis of the authority behind it. The same holds for tradition. Table 2.1 summarizes the main differences between the various communities.

Legitimate knowledge is supported by scientific research or non-analytic findings

High tolerance for conceptualization supported by research or non-analytic findings Low

Generally low tolerance

High

Tolerance and Interest in Other Theories

Loyalty to Thinker/ Conceptualization

The clinical situation; case The clinical situation and scientific/nonstudies; canonical texts; analytic research carried out in line with authority scientific research methods

Sources of Knowledge

Legitimate knowledge corresponds to psychoanalytic conceptualizations

The correspondence theory of truth; realism

The correspondence theory of truth; realism

World-view

Legitimization of Knowledge

Scientifically troubled Neuro-psychoanalysis; infant-mother research; empirical research to validate psychoanalytic conceptualizations; evidence-based research on the efficacy of psychoanalytic treatment

Fascinated

Psychoanalytic schools (Kleinian, Winnicottian, Bionian, Kohutian, et al.)

Name of Community

TABLE 2.1 

Philosophically-culturally troubled

Low

Tolerant and open to different conceptualizations, but opposed to a oneperson psychology, the drive model and therapeutic neutrality

Knowledge is dependent on culture and context, corresponding to and consistent with pluralistic, postmodern, feminist and cultural approaches

The clinical situation; case studies

Truth perceived as dependent on culture and context; subjectivity viewed as important to therapy and to the creation of new conceptualizations

Relational approach

44  Images of knowledge

Characteristics of images of knowledge in psychoanalytic communities Psychoanalytic theories are consistent with some images of knowledge and not with others. A therapist who places his belief in a particular psychoanalytic conceptual system—be it Kleinian, self-psychology, the relational approach, or any other such body of ideas—accepts the dictates of the images and sources of knowledge upon which that system is based. It is difficult to be a devotee of the Kleinian theory, for example, and at the same time accept postmodernism’s images of knowledge that posit that truth is relative and dependent on culture and context. Similarly, a Bionian therapist would not be expected to be troubled by psychoanalysis’s empirical weakness, since empirical evidence is not viewed by Bionians as being in any way relevant to their theory’s validity. And we would not expect a therapist whose knowledge is based on infant research to adopt with enthusiasm a Bionian model, given the yawning gap between that model’s assumptions and those derived from empirical observations of the infant. These examples demonstrate the extent to which the chosen theory goes hand in hand with certain images of knowledge while rejecting others. At the heart of any choice of theory lies an entire epistemology. It is enough for someone to say how enthusiastic he is about a Bionian conceptualization for us to know a great deal about his perception of knowledge.

Images of knowledge are non-negotiable The formation of images of knowledge is influenced by the individual’s personality, society, culture, and the education and training which he has had. Images of knowledge resemble moral values in that they are often fixed and non-negotiable. People who have entirely contradictory images of knowledge are simply unable to conduct a productive debate and instead engage in what is effectively a dialogue of the deaf. Their discourse will be somewhat like a conversation about the creation of the universe between a religious man and a scientist, or between supporters and opponents of abortion. There is no convincing argument that can change the minds of those who believe that case studies provide a sufficient foundation of knowledge on which to base psychoanalytical conceptualizations (e.g. see the debate between Hoffman, 2012, and Safran, 2012). Ultimately, the arguments often go like this: A: I have difficulty believing that every child between the ages of four and five goes through an Oedipal period. After all, there is no proof of this to be found in scientifically conducted empirical research studies. B: Of course every child goes through such a phase. Even now, I can point to a wealth of clinical material stemming from the analysis of just three patients in whose cases the Oedipus complex was an important element. A: That’s not enough for me to believe in it or even take it seriously. For me to do so requires a great deal more than the anecdotal evidence from

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experiences you have had with your own patients. Aren’t you troubled by the fact that no scientific experiment has been conducted to prove the truth of this phenomenon? B: Not at all. This is not the sort of clinical phenomena that can be validated in the laboratory. I have witnessed this phenomenon in my clinic and read dozens of articles about it in the profession literature. Did you not read Freud and the numerous examples showing that the Oedipus complex has had an impact on all human societies? Besides, the patients themselves recognize their oedipal desires. Why should I doubt a phenomenon I have witnessed with my very own eyes and which, in practice, helped me to better understand the lives of so many patients?

Contradictory images of knowledge can lead to leaving a profession Occasionally, a community or an individual may find itself embracing contradictory images of knowledge. In some cases, the contradiction may be resolved, while in others, no such resolution can be found. This leads to a kind of tension within the community or the individual. Eric Kandel, the American neuro-psychiatrist and recipient of the 2000 Nobel Prize for his research on the physiological basis of memory storage in neurons, is an interesting example of a scholar who was confronted by precisely such a dilemma. Initially, Kandel was fascinated by psychoanalysis but eventually was so disturbed by its scientific shortcomings that he abandoned it as his profession in favor of brain research. Recently, Kandel was asked by journalist Claudia Dreifus (2012) why he had wanted to become an analyst at the beginning of his career: “In part I was drawn to psychoanalysis because it promised much,” Kandel answered. In the 1950s and early 1960s, psychoanalysis swept through the intellectual community, and it was the dominant mode of thinking about the mind. People felt that this was a completely new set of insights into human motivation and that its therapeutic potential was significant. It was seen as the treatment that solved everything in the world, from schizophrenia to ingrown toenails. It’s amazing how it was oversold. When this turned out to be more hope than reality, things flipped in the other direction. In my case, I didn’t pursue it because I fell in love with research. (Dreifus, 2012, p. D2) Addressing Dreifus’s question as to whether it was the lack of supportive scientific evidence which had discredited psychoanalysis, Kandel responded: I think so. And it’s a shame. There are many fantastically interesting components to it that are worthwhile. The problem of psychoanalysis is not the body of theory that Freud left behind, but the fact that it never became a

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medical science. It never tried to test its ideas. When you asked, “How come there are not outcome studies?” you were told, “You can’t study this. How are you going to measure it?” In fact, there were questions it was possible to ask. For instance, under what circumstances does psychoanalysis work better than a placebo? Does it work better than other kinds of therapy? Who are the best therapists for what kinds of patients? (Dreifus, 2012, p. D2) Fortunately for psychoanalysis, there are many therapists who, while troubled by the absence of a scientific basis for the discipline’s theories, did not bow out and instead became attached to scientifically troubled communities. Some of them endeavored to advance psychoanalytic conceptualizations in their laboratories, while others tried to find a way of demonstrating the efficacy of the discipline’s therapeutic methods on the basis of their effect on a sample number of patients. There were also those who attempted to find a methodological way of reconciling psychoanalytic practices with scientific principles.1 The fact that scientifically troubled communities also chose not to give up on psychoanalysis shows that even the most enthusiastic supporters of empirical research in psychoanalysis continue to be fascinated by its conceptualizations. There are numerous examples of experiments conducted in laboratory conditions to develop new psychoanalytic conceptualizations by methods that do not exclusively rely on the subjective reports of clinicians.2 Often, laboratory research of psychoanalytic theories is not undertaken to test propositions about which they have doubts. Rather, the intention is to try to prove the validity of these conceptualizations to the non-psychoanalytic world and meet its demand that theories be empirically verified. However, in doing so, they are no different than other scientific communities. Supporters of empirical research within psychoanalytical scientifically troubled communities usually occupy positions at university research centers, and their origins are in the non-psychoanalytic world of research.3 Membership at a university institute is of great significance in relation to the images of knowledge held by community members. A member of a scientifically orientated research department accepts the images of knowledge held by their colleagues, for whom external testing is of the highest importance in the validation of a theory. According to their world-view, the subjective reports of therapists provide insufficient proof of the veracity of a theoretical idea. In fact, those who belong to a university or medical institution as well as to a psychoanalytic institute are the ones who face the most difficult dilemma in bridging the gap between the images of knowledge of the two communities. Scientists can question psychoanalytic conceptualizations, and analysts can be indifferent to evidence-based research. However, an analyst working alongside scientists seeking empirical evidence and accepting the images of knowledge of their university while simultaneously believing in the correctness of psychodynamic ideas is inevitably going to be constantly conflicted. For the most part, such analysts will attempt to resolve this clash of images through psychoanalytic empirical research.

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The clinical situation: psychoanalysis’s primary source of knowledge The vast majority of psychoanalytic conceptualization did not emerge from either the laboratory or any other form of controlled experimentation. Most psychoanalytic theories were the product of just one source of knowledge: the clinical situation, the most common and accepted source of knowledge for fascinated and troubled communities alike. The knowledge gained in the clinic was passed on to members of the community through written case histories. Every one of Freud’s major conceptualizations—which for many years after his death constituted the infrastructure of psychoanalytic knowledge—were derived from the clinical situation. The Oedipus complex, castration anxiety, his theory of the unconscious as well as the topographic structure of the mind—all were founded on knowledge deduced from clinical material.4 Freud did, it is true, respect some empirical verifications of his theories and even cited them, in, for example, his comments in the 1919 edition of The Interpretation of Dreams about Otto Petzl’s articles concerning the formation of dreams (p. 638). However, it was Freud’s general belief that the thousands of hours of analysis with his patients—added to the equal length of time his students spent—provided sufficient evidence to prove how right his ideas were. For example, in 1934, the American psychologist Saul Rosenzweig sent Freud an empirically researched study designed to test the truth of a number of psychoanalytic propositions. Freud’s response was courteous but brief: My dear Sir. I have examined your experimental studies for the verification of the psychoanalytic assertions with interest. I cannot put much value on these confirmations because the wealth of reliable observations on which these assertions rest make them independent of experimental verification. Still, it can do no harm. Sincerely yours, Freud. (Shakow & Rapapport, 1964, p. 129) There are those who think that Freud’s approach to empiricism was, at the very least, a tactical error (Gay, 1988). Because the status of psychodynamic therapy had declined both among academic researchers and within the mental health system, the call for this method of treatment to be backed up by evidence-based research struck a chord within the psychoanalytic community (Curtis, 2014; McWilliams, 2013; Shahar, 2010). And yet the study of psychoanalytic therapy using scientific research methods did not become a broadly based movement, nor were such methods ever regarded as mandatory. The need for such methods continues to be advocated, especially by a handful of American therapists who pioneered the idea (see note 1). However, their belief in its importance has not attracted a significant following within the discipline. In as much as psychoanalysis continues to exist and even thrive in some countries in the world, it can be inferred that many therapists, fascinated and troubled alike, have come to terms with the fact that psychoanalysis has found it difficult to

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prove its assumptions empirically.5 They attribute this to the complex and elusive nature of a field of research that includes vague and inconsistent definitions of psychic phenomena. Thus, the researcher is faced with the difficulty of quantifying mental variables and checking inner and non-conscious structures, such as fantasies and identifications. In addition, the research must translate such concepts as “projective identification,” the “true self,” the “analytic third,” and so on into operational definitions, into a language that can be empirically tested. To date, no scientific method has ever met this challenge. Ernest Jones (1957) quotes Freud as having told him and Marie Bonaparte that Mediocre spirits demand of science a kind of certainty which it cannot give, a sort of religious satisfaction. Only the real, rare, true scientific minds can endure doubts which are attached to all our knowledge. I always envy the physicists and mathematicians who can stand on firm grounds. I hover, so to speak, in thin air. Mental events seem to be immeasurable and probably always be so. (p. 418)

Knowledge and the unconscious Most psychoanalytic knowledge is deduced from exposure to the unconscious content of the mind of a small number of patients. The discovery of the unconscious, with all its derivatives and complexity, was perceived thereafter as constituting the most important source for new psychoanalytic conceptualizations and the bolstering of already formulated theories. But why is unconscious material derived from dreams, free associations, and transference processes so vital to psychoanalytic knowledge? Descartes’s dream argument might be of help in understanding this point. The dream argument is the assumption that the act of dreaming provides primary evidence that the senses we trust to differentiate reality from illusion should not be thought of as fully reliable. Therefore, any state that is dependent on our senses should, at the very least, be cautiously examined and rigorously tested to determine whether it is in fact reality. Conversely, psychoanalysis adopted the view that the unconscious manifestations of dreams were the clearest proof of the existence of mental reality. Psychoanalysis regarded the conscious mind as capable of tricking the mind; it is a structure that is hidden, censored, disguised, and possesses the ability to deceive us. The dream draws us nearer to a more correct understanding of things precisely because its interpretation is not accessible to the conscious mind. In The Interpretation of Dreams (1900), Freud notes that “the unconscious is the true psychical reality; in its innermost nature, it is as much unknown to us as the reality of the external world, and it is as incompletely presented by the data of consciousness as is the external world by the communications of our sense organs” (p. 613). Many analysts believe that the clinical setting is the only real place from which psychoanalysis can really derive its knowledge about the psychic reality that is in all of us but which is accessible only through the free associations and interpretation of the patient and the analyst (Steiner, 2000). Psychoanalysis paid a heavy price

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for placing the clinical situation so high in its hierarchy of sources of knowledge: The deduced knowledge gained from these situations lacked any kind of e­ mpirical, quantitative, or experimental foundation. Furthermore, the clinical material is subjected to subjective distortions, and each analyst perceives clinical phenomena differently. Psychoanalytic knowledge therefore had little chance of being accepted by those who have no part to play in the therapeutic world and whose images of knowledge vary. The clinical situation’s primacy over every other source of knowledge is among those features of the discipline of psychoanalysis that most commonly trouble analysts (Wallerstein, 1989; Wallerstein & Sampson, 1971). Eagle and Wolitzky think that “the long-reigning hegemony of the case study has made us vulnerable to some rather harsh reactions by scientifically minded colleagues, despite the fact that we are beginning to offer good answers to our critics” (p. 811). Mischel states that “the disconnect between much of clinical practice and the advances in psychological science is an unconscionable embarrassment for many reasons, and a case of professional cognitive dissonance with heavy costs” (Mischel, 2009, p. i). And strikingly Paul Meehl noted that most clinicians choose their methods “like kids make choices in a candy store: They look around, maybe sample a bit, and choose what they like, whatever feels good to them” (cited in Mischel, 2009, p. i). It is these aspects that, to a great extent, led to the emergence of scientifically troubled communities. Donald Spence (1993), who wrote frequently about this subject, called on analysts not to rely solely on the clinical situation: [W]e have no fundamental knowledge of underlying patterns and structures. We are at the same point as the medical establishment found itself at the turn of the century: We need to develop a basic science of psychoanalysis that can be used as a foundation for our clinical wisdom. When wisdom is turned into knowledge in this manner, it stands apart from the clinical moment and carries a truth that is not conditioned by the specific needs of the patient and analyst in the midst of a particular clinical encounter. Just as medicine now rests on hundreds of chemical and biological facts that apply equally to all forms of life, so we need to ground psychoanalysis on a set of principles that go beyond the specific clinical happening. (p. 131) The comparison between psychoanalysis and modern medicine is an analogy frequently used by scientifically troubled analysts; Spence, like other scientifically troubled analysts, spent much of his professional life building bridges between the images of knowledge of these two disciplines.

Why do fascinated communities take such little interest? The reliance on the clinical situation as the most important source of knowledge also explains why non-psychoanalytic knowledge is perceived by many fascinated communities as irrelevant to the therapeutic process. This is the attitude of a large

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number of analysts toward empirical research, brain studies, infant research, and evidence-based research in psychotherapy and psychopathology. Many analysts no doubt feel a sense of satisfaction when empirical research supporting psychoanalytic conceptualizations is published. However, in light of the most deeply-held beliefs of such analysts, research of this kind doesn’t in any way alter their view or assessment of the theory that they consider to be true; they continue to believe in the conceptualization with the same degree of devotion as they did before knowing that it had been scientifically confirmed. The reason for what in the eyes of many would appear to be a puzzling finding can be found in the images of knowledge of the analysts in question. As Freud said, an empirical finding, though unharmful, is certainly not an absolute requirement. The clinical situation becomes both a source of knowledge and the standard by which the knowledge obtained is measured. For fascinated communities, this is certainly an embarrassment, because their strongly held beliefs are liable to undermine their sense of self-criticism in instances where there is an inconsistency between a theory and the evidence derived from a clinical situation. The philosopher Charles Peirce, regarded as the founder of pragmatism and one of the pioneers of modern semiotics, claimed in his article The Fixation of Belief (1877) that The irritation of doubt is the only immediate motive for the struggle to attain belief. It is certainly best for us that our beliefs should be such as may truly guide our actions so as to satisfy our desires; and this reflection will make us reject any belief which does not seem to have been so formed as to insure this result. But it will only do so by creating a doubt in the place of that belief. With the doubt, therefore, the struggle begins, and with the cessation of doubt it ends. Hence, the sole object of inquiry is the settlement of opinion. We may fancy that this is not enough for us, and that we seek, not merely an opinion, but a true opinion. But put this fancy to the test, and it proves groundless; for as soon as a firm belief is reached we are entirely satisfied, whether the belief be true or false. And it is clear that nothing out of the sphere of our knowledge can be our object, for nothing which does not affect the mind can be the motive for mental effort. The most that can be maintained is, that we seek for a belief that we shall think to be true. But we think each one of our beliefs to be true, and, indeed, it is mere tautology to say so. (p. 4)

The power of psychoanalytic narratives Peirce’s argument leads us directly to one of the main reasons for the isolation of fascinated analysts and their lack of interest in the non-psychoanalytic world. Spence (1983) spoke a great deal about the enormous rhetorical influence that the psychoanalytic narrative exerted over the patient—but it is also important to note the power that this narrative exerts over the therapist. Psychoanalytic

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­ arratives are astonishingly productive. They are capable of creating meaning for n an almost infinite number of clinical phenomena, and they are especially skilled in finding a hidden thematic link between the adult patient and his early experiences. By detecting similarities of themes from the past in the present, the analyst finds a cause for much of the patient’s suffering. A strong and convincing narrative is now a dominant theme that guides the analyst attention and selection of interventions. Over the past thirty years, the enormous influence of narratives in the organization of our psychic lives has become more fully understood. Narratives organize human experience and events; they are an agreed-upon construct that is passed on culturally in a sequence of written or spoken words. Acceptance of a narrative, according to Bruner (1991), is reliant on cultural agreement and “recitative necessity” (p. 9) rather than on empirical validation or a logical imperative. However, the strange nature of narratives ensures that we have no difficulty describing them as either “true” or, alternatively, as unfounded. A rich and complex narrative that can be termed “overarching” is available to the fascinated analyst. This overarching narrative offers a coherent scenario in the form of a story that unfolds over time. The overarching narrative’s central hero is the human infant and his complex storyline. It is a narrative that makes sense of experiences the infant has had with his own self and his immediate environment as he matured—in other words, as he turned into the adult patient. In the course of doing so, the infant passes through different and significant developmental turning points: the Oedipus complex, the good breast and the bad breast, the transitional object or the empathetic failure are phases central to the plot. The overarching narrative of each school endows the therapist with endless game-like options through which to gain an understanding of the patient. This narrative directs the therapist’s listening, determines what is central and what is marginal to the conversation, helps him to decide between different interventions, and even determines the objectives of the ultimately chosen treatment. At the same time, a psychoanalytic narrative also limits the range of possible interpretations because it confines them to the framework of a single coherent plot. The overarching narrative (conceivably more than one) that the analyst follows is thus rich, very complex, highly detailed, and offers many options for giving meaning to clinical material—all of which make it a very satisfactory text for the analyst to use. The richness of the narrative, and the fact that its contents are an appropriate means of gaining a profound understanding of every clinical situation, leads to the following conclusion: In the face of this richness, it is impossible to desire a non-psychoanalytical conceptualization that the therapist will come to rely on regularly. The overarching narrative creates in the analyst a sense of coherent wholeness. The analyst had become used to thinking—an idea supported by experience—that all the spaces and gaps, the contradictions and complexities, in the patient’s life could be dealt with by one theory or by several closely related theories. A fascinated analyst can live through an entire professional lifetime without feeling, even

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once, that he is in need of anything other than the psychoanalytic formulations with which he is so familiar. He derives pleasure from the game of psychoanalytic possibilities, interpretations, language games and the abundance of options it offers. One can regard psychoanalytic narratives as a genre with its own rules and one which doesn’t readily integrate many additions that are not consistent with the narrative’s essential storyline. However, the different psychoanalytic plots and their rules impose a limitation on the understanding of clinical material. Understanding a patient in line with one overarching narrative (or a combination of several such narratives) reduces the possibility of the analyst being influenced by non-psychoanalytical bodies of knowledge. This is somewhat like writing a screenplay for a James Bond film. The Bond novels and movies are an admixture of realism and science fiction and are frequently shot in spectacular locations all over the globe, which allows for an infinite number of possible plots. At the same time, the Bond movies represent a certain genre, which imposes a limitation on the screenwriters so that it is hard to imagine that they could incorporate a text from, say, Shakespeare, Byron, or a children’s cartoon into the screenplay. The psychoanalytic narrative can also be compared to a game with any number of different ways of playing it, but which also has rules that impose limitations. It is unlikely that anyone who has played the psychoanalytical game, keeping tightly to the rules, would be interested in introducing into the game some external “moves” that are not part of its original format. Thus, for example, during therapy, a classical therapist will not reveal personal details about himself, nor will a relational therapist spend time on numerous interpretations of the unconscious. Most analysts will not give their patients behavioral tasks to perform at home, simply because such tasks are not included in the rules of the psychoanalytic game, in much the same way as the rules of soccer do not permit a player to score a goal with his hands. However, we must be cautious when we compare therapy to a game; we cannot ignore the fact that writing a new Bond screenplay or playing a game of soccer does not lead to an epistemological debate. The epistemology of psychoanalysis contains an unresolved contradiction: The “players” taking part in the psychoanalytic game do not generally see themselves as players or as spinners of narratives or storylines. They believe in the reality of their conceptualization and often become quite critical when they hear about other overarching narratives that challenge those acceptable to them. They can of course be “playful people” in the sense suggested by Winnicott, but they cease to play when they are engaged in serious consideration of the therapeutic decisions they have to make. There is, therefore, a yawning gap between what I have termed “narrative” or “game” and the way that fascinated analysts perceive their work. From the outside, it may look like a game; from the inside, it seems like a truth or an approximation of a truth. This gap is important, and there is no need to bridge it. By this, I mean that in the context of his therapeutic work, a therapist must not (in my view) think that he is offering the patient a metaphor or narrative that has no link to experiential truth. Were he to do so, it would result in his therapeutic

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presence being greatly weakened—patients don’t enter therapy to hear “stories” or “narratives” (Govrin, 2006). This long and difficult voyage into the psyche is embarked on so as to understand something profound and true about themselves. From the outside, we are entitled to think of the process between therapist and patient as a narrative—but we must not make any such demand of the therapist during his work, nor is this a contradiction for us to resolve. None of this means that the therapist has to be rigid and is unable to play with his patients, in the Winnicottian sense of that word, and nor does it mean that the therapist is committed to a single truth or that he is unwilling to consider various alternative therapeutic approaches. All it means is that the therapist has to believe that what he is doing is right for his patient! Analysts do not take an interest in empirical research because such research is not an integral part of the main narrative they use; rather, it is an alien component to the understanding of the patient in exactly the same way that a Greek tragedy is alien to a James Bond plot. Besides their need to find coherent narratives, there is yet another reason why analysts do not take an interest in empirical research. This reason has to with their images of knowledge of the unique therapeutic interaction that rejects “objective” measures based on hundreds of other dyads. Many therapists, not just psychoanalysts, believe that systematic empirical research “simply [does] not control the consequential uniqueness of the analyst, of the patient, of their relationship, and of the moment” (Hoffman 2009: 1049). Toward the end of a distinguished career devoted to psychotherapy research, Hans Strupp (2001) wrote that “given the uniqueness of every therapeutic dyad and the multitude of relevant interacting variables influencing the course of treatment, the “empirical validation” of any therapy is utterly illusory” (p. 613). But how are we to explain the belief that psychodynamic therapists have in the truth of their “stories”—the Oedipus complex, the good and bad breast, primary mental states or penis envy—which to so many seem to lack a scientific foundation? Perhaps it is because they are exposed more than others to the irrational and fantastical aspects of humankind’s nature, features that are very difficult to verify in the course of scientifically conducted research. In this sense, their acknowledgement is sensitive and attentive to narratives that provide them with satisfactory explanations of irrational patterns of thought and behavior, narratives that to others will appear to be absurd. This phenomenon was well described by Jonathan Lear (1998): There is one way to refute psychoanalysis entirely: if from now on, every person would act rationally and clearly, it would be easy to dismiss psychoanalysis as idle chatter. However, since people often act in strange ways, causing pain to themselves and others, raising questions even among the players themselves, psychoanalysis will draw us to it. (p. 25) But why do psychodynamic therapists believe that their treatments are for the most part successful and help their patients, without testing these assumptions with

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a significant sample of interviewees under controlled research conditions? What would stop these therapists leaving psychoanalysis in droves and going over to treatment methods well-supported by scientific research? There are several reasons for this deep belief in the success of psychodynamic therapy. First, more often than not, a therapist will use the method that he himself experienced as a patient. The personal therapy he received has an enormous influence on a therapist’s professional life. A very large proportion of candidates that undergo psychoanalytic training note that their own experience of therapy (or supervision) based on the psychoanalytic approach was one of the main reasons they decided to go in for analytic training (Katz, Kaplan, & Stromberg, 2012). When something works for us, we don’t tend to look for other unknown and distant cures. Second, we have to accept the fact that in the course of their long years of experience, psychodynamic therapists do, in fact, succeed in helping a large number of patients, easing their suffering and solitude, and encouraging processes of development and growth; as I mentioned earlier, this has been verified by outcome studies. In particular, such therapists believe that they manage to establish significant and profound relationships with their patients. All of this sustains the therapist’s belief in the ways in which he has chosen to work. The therapist becomes a kind of oneperson laboratory through which dozens of patients (including difficult patients) have passed over a period of many years. Almost every patient validated the therapist’s theory and his method of working. The therapist also reads about and hears from colleagues using similar methods of treatment that they are highly satisfied, and that the therapy is successful. Third, therapeutic failures, errors, and the therapy getting somehow stuck are all included in the overarching narrative, and participate in the game. Failures do not cause the therapist to feel dissatisfied with the conceptualization he is using. When a therapist is overcome by confusion and uncertainty in those many cases in which he doesn’t understand some facet of his patient, he will tend to look for answers in the overarching narrative in which he believes. If he is still dissatisfied by the ongoing process, he is likely to turn to a supervisor who works with a similar narrative. It is conceivable that therapeutic failures will lead the therapist to the conclusion that a minority of patients do not respond well to his method, or that, for various reasons, he erred in implementing the method’s principles. Chused (Rosenblum, 1994) is a rare voice who points out that there are some resistances that poorly respond to interpretations: As a result, we change our technique with different patients. Whatever the deviation each of us adopts, to the extent it deviates from what we consider our standard analytic technique, it reflects an internal decision that the patient needed something different in order to do the work of analysis. (p. 1259) But according to Chessick (1996) this leads to an unsolved issue in the understanding of impasse because many more conservative psychoanalysts think that departures in technique are often the cause of impasses in psychoanalysis.

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Experienced therapists do not expect to be able to help all their patients, and they also know that no therapeutic system can point to a one hundred percent record of success. Only in rare cases will therapists abandon one therapeutic method in favor of some other method as a result of therapeutic failures. I am not claiming that there is no development or change in the lives of therapists; it is by no means rare to find therapists who have gone from one treatment method to another. But such a development usually did not come about because of therapeutic failures, but rather as a consequence of a fascination with a new theory, frequently as a result of an encounter with a new therapist, supervisor, or colleague.6

A gap in images of knowledge: the main reason for psychoanalysis’s isolation from academic psychology Just as fascinated communities do not take an interest in non-psychoanalytical sources, so non-analytic communities do not have regard for psychoanalytic knowledge. Scientists outside of the psychoanalytical world hearing about the Oedipus complex, the good and bad breast, or the grandiose self, feel that they have been caught up in a delusional fictional tale. One can only imagine the experience of reading a description of a psychoanalytic case by someone who does not belong to that world. He is undoubtedly unable to find any guidance to the concept, meaning in the sentence, or significance in the story. From this point of view, the scientifically troubled communities are right. On what basis can we demand of a non-analytic researcher that they accept these conceptualizations, when the only evidence for their existence comes from a closed clinical situation in which he was not present or a participant? Scientifically troubled communities are engaged in trying to cover precisely this problem and bridge the gap between the two perceptions of knowledge. However, it appears that analysts’ expectations that their narratives would be accepted by the general public and scientific communities were in fact unrealistic. Such a window of opportunity existed in Freud’s time and after World War II, when a sympathetic public in Europe and the United States accepted with enthusiasm psychoanalytic conceptualizations and made such concepts as the unconscious, the Oedipus complex, the importance of dreams and others part of everyday language.7 It would seem that this window was closed many years ago. Other analysts such as Winnicott, Kohut, and Mahler, among others, were recognized by the general public and were instrumental in shaping the culture of their time, primarily in the areas of educational practices and raising children. Yet it appears that the public at large is no longer as enthusiastic as it once was about the idea of assimilating new psychoanalytic conceptualizations into its culture. There are profound reasons for this phenomenon. It may be linked to the sequestration of entire communities within psychoanalysis that chose to limit their contact with the “real” world because of their investment in establishing contact with the inner world, a world often described in a jargon that seems incomprehensible and even idiosyncratic to everyone else. It is also possible that in the era of social networks

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and globalization, the world has become interested in other, completely different mental phenomena that psychoanalysis does not deal with. Having described the internal logic behind the phenomena characterizing fascinated communities, we will now look into what it is that troubles psychoanalytical communities.

Notes 1 For an especially interesting attempt at such a reconciliation—all the more so because it was undertaken by a representative member of a fascinated community—see Hinshelwood (2013). 2 For a review of this kind of research, see Shulman (1990); see also Bornstein and Masling (1984); Burns and Reyher (1976); Perkins and Reyher (1971); Reyher (1962, 1963); Reyher and Basch (1970); Reyher and Smyth (1971); Shulman and Ferguson (1988); Silverman (1975, 1983); Smyth (1982); Sommerschield and Reyher (1973). 3 The centers at which they work include: the Personality Disorders Institute at Cornell University’s Weill Medical College; the Derner Institute of Advanced Psychological Studies at University of Adelphi; the Psychiatry Department at Yale School of Medicine; the Research Center for Mental Health at New York University; and Columbia University’s Center for Psychoanalytic Training and Research. 4 For details of Freud’s investigative methods see Hinshelwood (2013, 73–77). 5 Drew Westen (1998) identifies five central assumptions common to all psychoanalytic theories and cites ample evidence to show that they are based on research. However, since these assumptions are shared by so many theories, they remain quite general (e.g. the centrality of the unconscious in mental life or the theory that early childhood strongly influences the shaping of personality). In my view, Westen’s article is further proof that empirical research has, at best, succeeded in proving that some aspects of psychoanalysis are right—but not much more than that. 6 For the different ways in which psychodynamic therapists became fascinated with a theory, see Katz et al. (2012). 7 For the reasons for this, see Hale (1995).

3 TROUBLED COMMUNITIES AND PSYCHOANALYTIC CONTROVERSIES

Controversies of one kind or another have been with us since psychoanalysis’s inception. From the discipline’s earliest days, there were memorable disagreements between Freud and Joseph Breuer, as well as a range of disputes between Freud and Carl Jung, Alfred Adler, Otto Rank, and Sándor Ferenczi. After Freud’s death, there developed the historically famous disagreements between Melanie Klein and Anna Freud, between Karen Horney and the New York Psychoanalytic Institute, and between Jacques Lacan and the International Association of Psychoanalysis. Thereafter, during the 1970s and 80s, disputes arose in the United States between Heinz Kohut and the supporters of ego psychology as well as between ego psychology and the followers of Melanie Klein. Today’s most marked controversies are between those who believe that psychoanalysis will benefit in a significant way from empirical and brain research, as well as mother-infant observational studies, and those who claim that these kinds of research are irrelevant to the progress of psychoanalysis (Blass & Carmeli, 2007; Sandler, Sandler, & Davi, 2000; Spezzano, 1993). There is an additional controversy between those who believe in the need for therapists to remain loyal to the original conceptualizations of a particular school (Blass, 2010; Chessick, 2007) and others who yearn to update the discipline and bring it into harmony with contemporary cultural and philosophical changes (Aron, 1996; Mitchell, 1988). For example, the new conceptualizations of the relational approach stirred a great deal of controversy by undermining a number of psychoanalysis’s most firmly held beliefs, such as that a patient’s transference reflects a warping of their perception of reality, as well as the idea that the object of psychoanalytic research is the individual mind. Psychoanalytic controversies, particularly up until the 1980s, were highly charged, emotional, and characterized by hostility, tension, and an air of competitiveness. How are we to explain the contempt and lack of esteem that characterizes

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the attitude of some fascinated communities toward other communities similarly fascinated by a theory? Why is the appearance of competing camps and the demand for loyalty so widespread in the psychoanalytic world? If the analyst can justify his fascination—such as the fact that it is helpful to his patients—why is he troubled that other members of the community are fascinated by other theories with different assumptions about human mind and the objectives of the therapy? One of the main reasons for this, which will be elaborated throughout this chapter, is that in the absence of an empirical foundation for psychoanalytical assumptions, the discipline is reliant on a social consensus. The phenomena of opposing camps, splits, and hostility to various traditions of research can also be found in other scientific communities. However, the fact that scientists use objective external tests that are agreed to by all, places the tests themselves at the forefront of any discussion, thus allowing less dependence on socially arrived-at agreements. In psychoanalysis, the situation is different: In the absence of agreed-upon criteria for testing assumptions, the knowledge base is shakier. As a result, confidence is eroded and, paradoxically, the tendency to cling to knowledge becomes stronger. This does not mean that psychoanalytical assumptions are not valid; a theory can be true even if only one person in the world believes in it. But such a truth will not gain the recognition of society. Therefore, the endorsing of such a theory by a community which relies on consensus is characterized by extreme sensitivity to social acceptance or rejection. The impatience of fascinated communities toward other communities exposes their vulnerability, their weakest link—a point that their sharpest critics tend to bring up time and again (Bornstein, 2001; Popper, 1963). This is precisely the issue over which critics tend to compare members of fascinated communities to members of a zealous religious sect. How is one to understand such a phenomenon? First, I suggest that the highly charged nature of these controversies can be explained not merely in terms of the dispute about mental processes and psychotherapeutic aims, but also by the way in which the theory’s assumptions are anchored in certain images of knowledge. We live in a world that we are constantly trying to explain and anchor. In that sense, the epistemological voyage we embark on is not purely theoretical or academic. On the contrary: all of us are crucially dependent on our knowledgeability. Consequently, when what we know or think we know is dismissed by someone on the grounds that, in his view at least, the sources we are using are invalid, it negates not only our knowledge, but also the tool we use to accumulate knowledge, our methodology, our way of being in the world. This is not simply a matter of theory; it is a question of existential security (Gadot, 2013). Second, fascination is a social phenomenon, and it emerges within a community of enthusiastic supporters. The fascination doesn’t merely stem from a lone therapist being fascinated by Klein’s or Bion’s complex mental theories, or his success in understanding and helping a small group of patients with the aid of these theories. The origin of the lone therapist’s fascination is usually to be found in a meaningful interpersonal experience in therapy or supervision that had a strong and lingering impact on the analyst in the course of his therapeutic work (Katz et al. 2012).

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In one way or another, the supervisor or therapist “infects” the patient or supervisee with his own fascination. From the moment that fascination takes hold of him, the therapist is eager to find an echo of it in the world, and he yearns for the recognition of others in the theory’s beauty and explanatory power. The therapist’s glimmering eyes, celebrating the revealed truth, look for partners within a community of professionals to share this experience by recognizing the profundity of the theory and the greatness of the thinker behind the school of thought. This validates both the experience of greatness and the perception of the truth. In this sense, the experience of becoming fascinated has much in common with the experience of falling in love: idealization, an exaggerated sense of merit, defensiveness and blindness in relation to shortcomings. However, whereas in a romantic dyad both parties relate nonchalantly to everything around them, as if the external world does not exist, the experience of being fascinated by a body of knowledge is fraught with many dangers in the form of other hostile communities. These communities reject the fascination and often ridicule the theory, pointing to its weaknesses and failings while emphasizing the advantages of the different approach with which they are fascinated. An onlooker seeing all of this from the outside is liable to be very critical of the phenomenon. Given that the fascinated lacks all critical sense, his tendency to readily reject other methods of treatment and his absolute trust in his own views does not put him in a particularly good light. Such an outlook brings to mind a fanatically religious person rather than a rational therapist for whom the interests of his patient come first. Fascinated communities have been at the receiving end of a great deal of criticism because of these kinds of tendencies. However, in my view, the axis of fascination-captivation-enchantment is, in many ways, essentially important. Therefore, the negative features of this axis have to be treated leniently, and the axis itself must be seen as a vital component in the initial stages of any new theory’s development. Indeed, it remains so when, in a later phase, the theory begins to expand, becomes more profound, and succeeds in tracking the many problems it is capable of resolving. But without this axis of fascination-captivationenchantment, it is hard to believe that professionals would bother at all to develop the theory and become utterly devoted to it. The enfeeblement of fascinated communities over the past few decades lessens the danger of fascination. As long as there are active troubled communities alongside the fascinated communities to balance the picture, persistently expressing their unease with the existing theories as they continue trying to breach conventional thinking, we must have compassion for the difficulties experienced by fascinated societies. Being lenient about their shortcomings does not of course prevent us from being critical of fascinated communities and exposing their limitations.

Psychoanalytical theories, their promoters, and the zeitgeist There is yet another aspect to the phenomenon of devotion to a psychoanalytic theory. The powerful bonding is not only felt toward the brilliant and new psychoanalytic theories of Freud, Klein, Winnicott, Bion, Kohut, and others—it is

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also directed at the thinkers themselves who were admired and idealized by their followers. The biographies of these thinkers are of much interest to the fascinated. Indeed, every new psychoanalytic school of thought was identified with a dominant, charismatic, leading persona. This further supports the idea that the vaguer the knowledge base, the more dependent it becomes on the personality of the thinker behind it and the extent to which that thinker’s authority is valued. Moreover, a new theory’s ability to express a vital element of the mood of the times also plays an important role in its acceptance, or otherwise. Thus, for example, Kohut’s theory can be seen as a reflection of the dramatic social changes that took place in the United States during the 1960s, which, among other things, led to a growing preoccupation with the “self” (see Chapter 7). In general, a theory’s acceptance within the community was far more dependent on a combination of political and cultural factors than on its scientific success. In this context, a number of interesting questions arise. For example, the question as to why, in the post-Freudian period, it was Klein’s theory that so massively influenced the psychoanalytic movement. Ferenczi, after all, also offered an alternative to Freud that was no less interesting and challenging than was Klein’s. So why was it that Klein’s and not Ferenczi’s theory became central to psychoanalytic thinking after Freud’s death? The answer is complex and connected to issues of geography, personality, and the mood of the times. Ferenczi didn’t bother to cultivate a coterie of followers and admirers. He died in 1933, leaving behind him a set of ideas that were not supported by any of the period’s prominent thinkers. He therefore didn’t have a close confidant who might have represented him in London, which, after the outbreak of World War II, became the most important psychoanalytic centre in Europe. Ferenczi’s reputation was tarnished by Anna Freud and Ernest Jones, who were shocked by what they regarded as the “softer” and more subjective direction in which Ferenczi was leading psychoanalysis, and by his bold experiments in mutual analysis. Klein, on the other hand, worked in London and assembled around her a group of enthusiastic admirers who defended her ideas zealously. Moreover, Klein’s thinking was echoed in the writings of Jones, who held a key position in London’s psychoanalytic community and was President of the International Psychoanalytical Association. Jones embraced and encouraged Klein, took her under his wing within the London community, and even sent his two daughters to her for analysis. Obviously, Klein had many more available and powerful friends than did Ferenczi. Moreover, Klein’s ideas fitted in with the mood of the times far more than Ferenczi’s. As Steiner (1985) notes: Her descriptions of adult analysis and of the use of toys in infant analysis shed light on sufferings and illnesses which seemed to express the pathological anxieties of advanced industrial societies, where the traditional role and relationships between mothers, fathers and children were undergoing profound changes due also to deep social pressures. Indeed, I do not think it

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was purely a matter of chance that Klein stressed the importance of the early relationship of the child with the mother and not only with father during the late twenties, if one takes also into account the deep transformations of the family and of the process of mothering under the impact of the second industrial revolution. (p. 37) Other researchers of the subject think that the centrality which Klein attributed to the mother figure in the life of an infant is linked to the fact that many of Klein’s patients during the World War I were raised solely by their mothers, the fathers either fighting or having been killed on the frontline (Aguayo, 1997). Klein’s powerful influence on the discipline compared to Ferenczi’s relatively minor role was also connected to their respective loyalty to the Freudian method. Klein’s theory included stages of development that Freud had not addressed which altered the developmental approach, the contents of therapeutic interventions, and the overall process of psychoanalytic treatment. However, she left one significant Freudian component in place: the therapist’s position in relation to the patient. In other words, she kept to the position that the patient is a relatively closed system, determined by internally generated drives, defenses, and unconscious fantasies. The rational part of the patient’s ego is expected to collaborate with the analyst and assimilate his interpretations, while it is anticipated that the patient will resist in various ways dictated by his conflicts and unwittingly play out an internally driven scenario in the form of a transference whose form and content are projected onto the analyst (Kirman, 1998). The therapist’s personal non-involvement was of the utmost importance to a hierarchical therapeutic process in which the therapist had objective knowledge of the patient’s unconscious. It has to be remembered that psychoanalysis was, at the time, a revolutionary idea: It involved the creation of an all-knowing therapist who sat outside the patient’s field of vision, an arrangement that also anchored the therapist’s knowledge. Having knowledge of the patient’s unconscious was the source of the therapist’s authority. Thus, Klein maintained images of knowledge and a methodology that were consistent with Freud’s, within which interpretation remained the central therapeutic instrument. In contrast, Ferenczi was confronted by a body of knowledge that wasn’t ready for the changes he suggested; conceivably, the therapists of the time who joined the ranks of this young science may have been unable to come to terms with Ferenczi’s notion that their knowledge was incomplete, given to error, and subjective. Such acceptance comes with maturity. It was only in the New York of the late 1990s that Ferenczi was finally discovered by the proponents of the relational approach. The relational approach has been rediscovering Ferenczi, and inasmuch as he was previously dismissed by mainstream psychoanalysts as bizarre or acting out an unsettled negative transference to Freud, he is currently being “transformed” and “rehabilitated.” Many of the notions that were exceedingly debatable in the early 1930s do not seem so shocking to us today: Ferenczi stressed the significance of trauma, childhood sexual abuse, the importance of the affective experience in analysis, the appreciation of

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the therapist’s empathy, the recognition of the real relationship between therapist and patient and between parent and child, the etiology of psychopathology as a consequence of character pathology in the family, and the significance of avoiding hypocrisy and showing honesty and sincerity on the part of the analyst, as well as the use of the analyst’s countertransferential experience—only a few of his numerous ideas that are being used by relational psychoanalysts (Aron, 1992, 1998). The relational approach, searching for its deep roots in psychoanalysis, discovered Ferenczi, who was in effect the school’s lost father, resurrecting his name and ideas. Thus, many years after his death, Ferenczi enjoyed his finest hour. The success or failure of a psychoanalytic theory, therefore, has nothing to do with scientific success as it is commonly understood. At no stage is there a requirement that its clinical evidence be empirically tested. The spirit of the times, the reigning cultural mood, the connections enjoyed by a discipline’s most prominent representative, the efficacy of its public relations, a critical mass of followers—all play a significant role in whether or not the new ideas of a given school develop. A professional literature has emerged which, in a focused way, has mapped out the areas of controversy between the various psychoanalytical streams of thought (Eisold, 2003, 2005; Robles, 2013; Summers 2006, 2008). These disagreements are dealt with in the literature with integrity and carefully thought-out arguments. The various accounts of the discipline’s disagreements has at all times been rightly explained by personal rivalries, the need to protect the analyst’s sense of identity, and a defense of psychoanalysis as it confronted a hostile outside world. Moreover, the discourse has consistently reflected the organizational structure of psychoanalytic training that encourages loyalty and mimicry as well as the threat of change, a threat that has accompanied psychoanalysis since its inception (Eisold, 2003; Richards, 2003; Robles, 2013; Summers, 2008). To these explanations of the characteristics of the psychoanalytical discourse, I suggest an additional complementary explanation: namely, that psychoanalytical disagreements and their centrality to the discipline are the result of two things: first, tension between troubled communities working towards change and adapting themselves to the mood of the times and fascinated communities straining to protect and expand existing formulations; and second, that these controversies revolve around questions linked to facts, images of knowledge, and sources of knowledge. It is not just the dispute about facts that is important—so too is the meta-theory standing behind it. The exposure of these two elements can, as I will show, shed new light on the controversies themselves. Below, I shall analyze two controversies about psychoanalytic theory that are representative of the types of disputes that have taken place in different periods. The first is the debate around the disagreement between Klein’s supporters and those supporting the Freudian viewpoint. This controversy is an example of the tension between a fascinated community (Anna Freud) and a troubled community (Melanie Klein) who offered a new conceptualization of the human psyche as an alternative to the Freudian theory. As I will show, the hardest and most charged controversies belong to this category. One of the most prominent characteristics of

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this type of controversy is that, in the discussion between the two approaches, there is agreement between them about images and sources of knowledge but not about the facts. The second is the controversy between communities claiming that infant research has significant contribution towards understanding psychodynamic therapy and the community which any source of knowledge that doesn’t stem from the clinical situation. In this controversy, there is agreement about images of knowledge but not about sources of knowledge. In other words, there is an attempt by both communities to sketch the main mental characteristics of an actual infant. However, they are unable to agree on the relevant data that has to be taken into account when describing that actual infant.

The controversy between Anna Freud and Melanie Klein: agreement about images and sources of knowledge, disagreement about facts The most highly charged controversies in psychoanalysis occur between an existing fascinated community with a canonical tradition and a troubled community that offers a new theory of the human psyche and that ultimately becomes a fascinated community itself. As we will see, the two communities share a similar perception of images of knowledge and agree on a hierarchy of legitimate sources of knowledge. The charged discussions in these cases are about “the facts.” This is what happened in the disputes between Freud and Breuer, Jung, Adler, Ferenczi, and Rank, between the supporters of Anna Freud and the followers of Melanie Klein, and between those analysts who embraced ego psychology and selfpsychology. For the most part, despite the lack of empirical evidence, these communities perceived psychoanalytic knowledge as an objective and universal truth to be found “out there” and as including causal scientific explanations. Therefore, the theory could not exist alongside alternative psychoanalytic truths. The reasons why analysts chose to perceive themselves as scientists was not connected to their profound understanding of philosophy of science. Rather, it came out of a deep emotional link to psychoanalysis as a scientific discipline. An essential part of the legacy left by Freud to his followers was the idea that psychoanalysis shared a world-view with the sciences (Freud, 1933a) and that analysts were scientists engaged in studying the non-conscious and irrational foundation of human existence. Freud himself was trained as a neurologist and was utterly committed to the scientific approach. He invested his energy and resources in showing why psychoanalysis had to be viewed as a branch of science. His success, at least among analysts, was huge; his was the accepted world-view for decades (though admittedly there were some exceptions). All the various alternative philosophies, such as hermeneutics and postmodernism, permeated psychoanalysis only many years later. Even Ferenczi (1932/1998), writing in his clinical diary, noted that “I am first and foremost an empiricist. Ideas are always closely connected to the therapeutic fate of patients; that is what allows us to reject ideas or discover their validity” (p. 11).

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In light of the above, let us look at one of the most difficult and fascinating controversies between two fascinated communities: namely, the dispute in 1940s London between Klein’s supporters and the followers of Anna Freud. The discussions between the two communities on the issues arising from the controversy have been published in full in King and Steiner’s excellent book, The FreudKlein Controversies 1941–1945 (1991). They are a first-rate source for research into the sociology of knowledge in psychoanalysis during the early years of the discipline’s existence. Not only are we presented with an engrossing polemic in which each side passionately presents the entire array of arguments at its disposal so as to undermine the legitimacy of the other party to the dispute, it is also an excellent source because of the broad and comprehensive documentation of the controversy itself, which this account contains. Within it all, the widespread assumptions of that period are exposed: what was considered psychoanalytical knowledge; what knowledge was thought to be legitimate; the hierarchy of sources of information; what the widely accepted images of knowledge of that era were. A brief background of the controversies is required. Immediately following Freud’s death, there was a split within the British Institute of Psychoanalysis between Anna Freud’s disciples and supporters of Melanie Klein. What ensued is regarded as having been one of the most turbulent periods in the history of the London Institute. The tense and cantankerous atmosphere inside the institute’s debating chamber led to a series of decisions designed to bridge the differences between the camps. One of the decisions taken was to present the Kleinian viewpoint to the Institute’s scientific committee in a series of four papers that would be circulated to the committee’s members and discussed in scientific meetings (King, 1994; King & Steiner, 1991). Between 1940 and 1946, members of the British Psychoanalytical Society met to debate Melanie Klein’s theory, a controversy that spanned the entire period of World War II. The papers presented to members were Susan Isaacs’s “The Nature and Function of Phantasy” (see Isaacs, 1991), “Some Aspects of the Role of Introjection and Projection in Early Development” by Paula Heimann (see Heimann, 1991), a paper by Paula Heimann and Susan Isaacs on “Regression,” and Klein’s article on “The Emotional Life and Ego Development of the Infant with Special Reference to the Depressive Position” (see Klein, 1991). The Committee nominated three of its members—Edward Glover, Marjorie Brierley, and James Strachey—to organize the scientific discussions. The central question facing those present were: Is a theory of mental development expressed mainly in terms of the vicissitudes of infantile object-relationship compatible or incompatible, in principle or in detail, with theory in terms of instinct vicissitude? Are such theories antithetic or complimentary? How far do current differences in theory imply radical alterations in technique? (King & Steiner, 1991). Interestingly enough, the key question asked did not touch upon the issue of the validity or plausibility of Klein’s theory. Rather, the question at hand was whether the differences between Klein and Freud’s theory could be bridged. It seems that the two questions were thought to be two sides of the same coin, and Freud’s theory was perceived by both factions as the point of departure for any new theory.

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Thus, in essence, proving the validity of Klein’s theory meant establishing the continuity between it and Freud’s writings. Refuting Klein’s assumptions involved demonstrating that the differences between her theory and Freud’s were unbridgeable. The way the question was posed already showed how problematic it was. Klein’s theory was not to be discussed independently as a theory in its own right, but only in relation to a previous theory that was regarded as “true” and valid. In actual fact, both questions—the extent to which Klein’s theory corresponded to Freud’s original conceptualization, and the scientific quality of Klein’s theory in and of itself—were extensively and separately discussed. Though the debates between the warring factions were stormy and emotional, they were conducted at the very highest intellectual level. The participants employed the most sophisticated armoury of argumentation and reasoning. From today’s perspective, some of the community’s sources of knowledge at the time seem absurd (such as using Freud’s authority as a criterion to establish a theory’s “truth”). At the same time, other sources of knowledge seem as valid today as they did then (for example, using the clinical situation as a reliable source of new conceptualizations). As for images of knowledge, the two sides were in broad agreement. Both factions perceived psychoanalysis as a scientific body of knowledge whose practitioners possessed the tools to corroborate or refute theories, and both believed that their conceptualizations were based on objective findings and observations. None of the participants in the controversy doubted that in the course of analysis it was possible to obtain valid psychoanalytic conceptualization through clinical observations. The main areas of division revolved around the question of whether Klein’s theory met the accepted criteria for validation. The criteria themselves, however, were not questioned by any of the participants. Words such as science, scientific criteria, observation, fact, proof, refutation, and lack of clarity were frequently used by both camps. A central question was whether the new “facts” that Klein presented were indeed based on and supported by observations. Each camp accused the other of laxity in their scientific methods. On both sides of the divide, there was a belief that there was only one psychoanalytic truth. It thus followed that if psychic events developed as anticipated by Klein, it could not be that an opposing thesis of Anna Freud’s would also materialize as she expected it to. Klein’s supporters believed (as supporters of other schools believe to this day) that they were dealing with real psychic events and not with assigning meaning or metaphors. Many of Anna Freud’s supporters felt that there was an unbridgeable gap between “Freudian psychoanalysis,” as they understood it, and Melanie Klein’s conceptualizations. The fear was that members of the Institute (and the general public too) would be exposed to a “foreign” theory that did not reflect the psychoanalysis with which they had become familiar. Of course, the argument was not only theoretical, but also, and perhaps primarily, political. First and foremost, it was a struggle over the image of psychoanalysis. In the introduction to his book, King (King & Steiner, 1991) asks:

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Unless psychoanalysis is regarded as a closed system, incapable of extension, correction or development, its practitioners are bound to be confronted with new observations, which cannot always be satisfactorily accounted for with the help of existing psychoanalytic theories, and new hypotheses will be put forward to account for them. This poses the question, How are they to be assessed and when should they be added to the general body of psychoanalytic knowledge and passed on to students? (p. xxviii) The main differences of view concerned technical and theoretical issues. According to King, there were two “anomalies” in the way in which Klein proposed children be treated. The first was that she had decided to relate to children’s playtime as if it were the equivalent of an adult patient’s free associations. The second was that she was not afraid of interpreting the negative material and aggressive drives of adult patients as and when they appeared without, as was generally done, nurturing the positive feelings of the patient. Klein’s work with children had enabled her to observe the intense anxiety aroused in patients by aggressive thoughts and actions. In Klein’s view, for the therapy to be successfully continued, such thoughts and actions had to be verbalized. Anna Freud, on the other hand, took the view that nurturing a child’s positive responses was an important element in helping it to trust, and depend on, the analyst. She did not believe that the transference that occurred with adult patients could take place with children, because a child’s feelings were still linked to those of its parents and the child’s genuine relationships would interfere with the development of a transference neurosis—an essential therapeutic tool in the treatment of neurosis in adults. Because Anna Freud didn’t accept the Kleinian proposition that children’s playtime could be equated with the free association of adults, her approach was more explanatory and educative than interpretative. Anna Freud also objected to the idea that children should be “prophylactically” analyzed, a central pillar of the Kleinian approach. Today’s readers undoubtedly find it strange that this controversy provoked such strong reactions. Why was it not possible to let the contrary assertions of these two writers coexist rather than demand that a choice be made between them? Moreover, it will be asked, why were Freud’s supporters not appeased when Klein and her followers swore their abiding loyalty to Freud the father and chose not to leave the institute? This puzzle raises broader questions about the impenetrable nature of psychoanalytic communities: When does a psychoanalytic community feel that the novel conceptualization has taken the movement a step too far and become a “deviation”? What is the dividing line between a new conceptualization being regarded as an expansion of an existing theory as opposed to a conceptualization being viewed as different and “alien”? In fact, it would appear that a split and a formal separation between these two warring factions is precisely what might, in this particular instance, have led to an abatement of the controversy and led to peace between the sides. Had the parties decided to split and simply agreed not to live under the same “theoretical roof,” it would have freed each of them to go

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their own independent way. However, the picture becomes complicated when the “digresser” and her followers go out of their way to prove that they are loyal to the original theory. It seems that such declarations of fidelity only increased the threat felt by the old established order and stoked the fear of a hostile takeover and the annulment of the existing theory. Indeed, Anna Freud’s supporters, who saw her as the true representative of her father’s ideas, feared that the Kleinians would “steal” psychoanalysis from them and control it. The struggle for political power was conducted under the guise of a fight over the truth. The controversy touched upon the very heart of the therapeutic process: understanding the objective of the treatment, the nature of the interventions, the nature of transference relationships. Sylvia Payne (1991) was the only one to raise the possibility that Freud and Klein represented different and yet true aspects of mental reality, and that they could therefore coexist without a choice having to be made between them. Payne tried to reassure those who feared a Kleinian takeover of psychoanalysis: I cannot see why people with a true scientific outlook should not work in the same society on different aspects of mental functioning, some relating to the most primitive phases of mental development, and others on more differentiated parts of the mind, conscious and unconscious. We know so little at present about the nature of cure. We are not able to sort out cases properly, and send the right case to the right person. We ought to be able to do so as everyone does not require the same approach to regain mental health . . . When new work is added to old, especially when it includes therapy, there is often a tendency to think that past knowledge has been superseded, and it takes time for new knowledge to be put into relation to old. (p. 53) Let us take a close look at some of the major issues raised in the debates on the controversy between Melanie Klein and Anna Freud so as to better understand the perception of knowledge adopted by fascinated communities of that period.

Was Klein loyal to Freud? As noted, the central question preoccupying the participants in the debate was the extent to which the new theory matched Freud’s original ideas. This question was not exclusively linked to the controversy between Klein and Anna Freud; it rearose every time as a response to the emergence of a new psychoanalytical school.1 The two sides went out of their way to prove the fidelity or lack of fidelity of Klein’s ideas to those of Freud. Glover (1991) has argued that the quotes cited by Klein’s supporters (in this case, Susan Isaacs) in Freud’s name are fictitious: Mrs. Isaacs’ method of quotation from Freud and other writers does not conform to scientific requirements, in particular that the quotations are given

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without the necessary context which in many cases would show that they do not support Mrs. Isaacs’ contentions. In my opinion Mrs. Isaacs has failed in her attempt to build a new metapsychology. She has failed because she disregards, neglects or misunderstands precisely those parts of Freud’s metapsychology which eliminate the very confusions into which she persistently falls. (p. 326) Conversely, Isaacs (1991) notes that: Again, I do most definitely claim that Melanie Klein’s views are derived from Freud’s own theories and observations. They are in large part identical with his. Where they differ, they are a necessary development of his work, arrived at by making use, with very young children, of Freud’s own instrument of discovery, the study of the transference situation. (p. 330) Elsewhere, Isaacs writes: Listening to the selective accounts of Freud’s theories offered by some of the contributors to this discussion, and noting their dogmatic temper, I cannot help wondering what would have happened to the development of psychoanalytic thought if for any reason Freud’s work had not been continued after 1913, before his work on Narcissism and Mourning and Melancholia; or after 1919, before Beyond the Pleasure Principle and The Ego and the Id. Suppose some other adventurous thinker had arrived at these profound truths and had dared to assert them! I fear that such a one would have been treated as a backslider from the strict path of psychoanalytic doctrine, a heretic whose views were incompatible with those of Freud, and subversive of psychoanalysis. (p. 453) However, Freud’s authority was not limited to the issue of theory but included questions of methodology. With considerable justification, Klein’s supporters argued that her research methods were the same as those advanced by Freud. Both drew their conclusions about the early stages of childhood development from analyses of adult patients (Klein also relied on analyses of young children). Freud’s supporters could not, of course, accept this claim. In this context, the views of Klein’s daughter—Melitta Schmideberg, one of her mother’s most determined opponents—are interesting: I have heard Mrs Klein claim that as Freud drew conclusions from adults to children, so she is entitled to draw conclusions from the analysis of children to infants. There are important differences, however: (a) Freud based his conclusions largely on actual recollections of patients; (b) the conclusions (e.g. concerning manifestations of infantile sexuality) could be checked by

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direct observations on children; (c) they were to quite a degree borne out by observations of a different type, e.g. on psychotics, perverts, etc. (King & Steiner, 1991, p. 394) Needless to say, Schmideberg’s arguments are problematic. The memories that led Freud to his theories were not actual memories but rather reconstructions of events. His conclusions were not corroborated by direct observations of children. Their validation by other means—such as the analysis of psychotics and sexual deviants—were methods also used by Klein and her supporters. Neither camp had any doubts about the need to refer to Freud as the ultimate source of authority. Images of knowledge are what dictated that Freud was to be regarded as the main source on which psychoanalytical conceptualizations had to be based.2 Nonetheless, some reference to this question is to be found in the following comment by Sylvia Payne (1991): It might be said, why should we limit our basic principles to those laid down by Freud? My answer to this is that we have in the past done so publicly and voluntarily, both by adherence to the International Psychoanalytical Association and by acclaiming our intention to the Committee set up by the British Medical Association, who passed the resolution that only those analysts adhering to the conceptions of Freud had the right to call themselves psychoanalysts. (p. 53) Payne’s arguments deal only with formalities and do not provide a real answer to the question as to why fidelity to Freud is regarded as an important scientific criterion in the evaluation of a theory.

Klein and non-psychoanalytic knowledge Non-psychoanalytical sources from other disciplines were also key elements in the debates related to the Klein-Freud controversy. The absence of these in the validation of Klein’s theory served the interests of Anna Freud’s supporters. Kate Friedlander, another representative of Anna Freud, notes that Mrs. Klein’s theories of phantasies . . . are in complete contradiction to the anatomical and physiological knowledge of the development of the brain during the first year of life . . . if we would translate these ascribed mental functions of the baby into motor functions it would mean that the child starts to walk within the first weeks of life, before it has been sitting up and crawling. (King & Steiner, 1991, p. 406) Whereas in the course of the debates, supporters of Klein were required to provide empirical proofs to substantiate their theoretical assumptions, no such demand was

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made in relation to the writings of Freud himself. Apparently, his status as the discipline’s founding father shielded Freud and his theories from any doubt as to their veracity. This is even more surprising when we recall Freud’s own efforts to be identified with the scientific method; neither he nor his followers ever demanded a scientific proof during that period. Yet even when one turns to non-psychoanalytical proof, there still remains the question of how such findings are to be interpreted. It would appear that the issue of interpreting observation almost takes us back to the question of the tenuous validity of clinical observation, as exemplified by the following exchange between Payne and Anna Freud that touches on the behavioral observations of children: Dr Payne: I should like to ask Miss Freud a question. She said she did not think that the mother was regarded by the child as an object in the first year of life. (Miss Freud: “First half year.”) There are behavioristic facts, for instance, that the child may be given the bottle by a stranger and refuse it, just as it may be given a wet nurse and would not take the breast from her. Such facts suggest that the child differentiates between objects. Dr Glover: Would Miss Freud like to answer this question now? Miss Freud: . . . There is no doubt that the child notices differences and even the slightest differences in atmosphere, position, behavior, mood of the person who gives the bottle. But, as I said before, these differences reach the child because there is a change of the form in which the satisfaction is presented. It is not the same as the beginning object relationship we find in the second half year where the child will refuse just because it is a different person. What we call change of atmosphere, change of mood, it is not the tie to the person. If one could imitate the form in which the satisfaction is given completely, the child would accept it. Experience shows that it is surprisingly easy to interchange objects at that time, just as it is surprising how difficult it is later. Dr Payne: It seems to me the difference is one of degree. Miss Freud: It seems so absolutely different in kind when one watches it closely. Dr Payne: But I have watched it too. (King & Steiner, 1991, p. 435) This exchange is a good example of the limitations of infant research in validating conceptualizations. As the above shows, the very same observation confirms contradictory conceptualizations about early mother-infant attachment. It would appear that until the Klein-Freud controversy got underway, the psychoanalytic movement had never shown that degree of interest in knowledge beyond its own field. All at once, conceptualizations related to infant observations

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and brain research assumed an importance, and the discipline’s previous reliance on the clinical situation was now deemed to be insufficient. Moreover, as soon as non-psychoanalytical findings began to be used within the discipline, they proved to be problematic and their results disappointing. No such finding either refuted or corroborated Klein’s theory. Once the debates ended, psychoanalysis was to forget the non-analytical world for many years to come.

Klein’s findings: observations or mistaken assumptions? Claims of erroneous interpretations of clinical findings were also a major topic of debate in the Klein-Freud controversy. Thus, for example, in his response to Isaacs’ article, Glover (1991) noted that “To discuss it effectively we must decide how much of Mrs Isaacs’ argument is based on facts and how much on her own (that is to say Mrs Klein’s) favored interpretations of unconscious content” (p. 324). Melitta Schmideberg, for one, agreed that infants under the age of one have fantasies. However, Schmideberg was not prepared to accept that these were the same fantasies that Klein had described on the basis of her experience in the treatment of children aged two and a half years and up: To convince us of the existence and importance of the specific phantasies she attributes to babies, she must give us the analytical material from which she draws her conclusions, and the method step by step by means of which she has arrived at the conclusion. We must discuss the criteria that justify “reconstruction,” and the varying degrees of plausibility achieved in each individual attempt. To be told, as we had been more than once, “we found in analysis” or “the material proved” is no argument. We must be careful to avoid false analogies. (King & Steiner, 1991, p. 394) A dispute also developed over the issue of “inferred knowledge.” Anna Freud’s supporters claimed that it was not possible to make deductions from the treatment of adults and young children about the mental world of infants. Schmideberg argued that: Children have no direct memories of infancy, and the “constructions” made by analysts must be very carefully checked . . . In those recent discussions and on other occasions various speculations about infants have been put forward . . . some of which are quite interesting. But it is important to stress that these are only speculations which are difficult both to prove and to disprove. Needless to say it is not possible to observe the unconscious phantasies of babies directly. It is possible to observe their expression of emotion, their actions, etc., but again we must distinguish strictly between such observations and the speculations derived from them. (King & Steiner, 1991, p. 395)

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Friedlander said that: [T]he analysis of children over two can only give us inferred knowledge about the first year of life and is as such not much more valuable as evidence than data gained by other analysts with older children and grown-ups . . . we know that phantasies of this kind occur in grown-ups, especially in psychotics and borderline cases, is known, but does in itself not prove their development in the first year of life. (King & Steiner, 1991, p. 409) Isaacs responded to these various accusations noting, with considerable justification, that the opposing camp’s methods of investigation were no better than those used by Kleinians: Dr Friedlander, like some other speakers, questioned the validity of inferred conclusions. Actually, the technique of psychoanalysis itself is based almost entirely upon inferred knowledge. Freud’s writings contain more than one well-known passage where he deals faithfully with those who decry its value, and points out that the capacity to accept and rely upon inferred knowledge was one of the major advances made by man in his intellectual development. Our phantasies are always inferred, never observed as such . . . Anyone who traces the course of Melanie Klein’s work, from her earliest contributions to the present day . . . will see that her conclusions were formed step by step, in close accordance with the facts available at the time. She had tentative theories in her mind, based on former work, as Freud did and we all must do; but she held them in suspension. She did not regard them as touchstones of fact, but as explanations of the facts when these were brought together, and modifiable by new facts. (King & Steiner, 1991, pp. 444–446) Occasionally, a clinical experience was cited in an attempt to refute one or other of Klein’s conceptualizations. Schmideberg, for example, refers to a number of case studies of children she treated together with their mothers. She concluded that none of these cases prove with “absolute certainty” what goes on in an infant’s mind or its unconscious. Klein’s followers claimed, however, that her methods of investigation were identical to those of Sigmund Freud. In this sense, one could say that, insofar as images of knowledge are concerned, Freud paved the way for Klein’s acceptance. Although the two differed about the facts and inferred contents, in practice, it was Freud’s methodology that “legitimized” Klein’s findings. Isaacs was right: In terms of sources and images of knowledge, Klein didn’t change a thing in the postFreudian era. Most of the arguments raised by Klein’s opponents could therefore just as well be employed by Freud’s detractors. In fact, most of the criticisms leveled at psychoanalysis today were raised by Klein’s opponents in the course of the debates. These included the claim that clinical findings are not consistent with

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non-psychoanalytical empirical observations; that what is presented as “factual” is open to differing interpretations; that psychoanalytical theories are not based on direct empirical observations; that its assumptions are counterintuitive; that many of its propositions are obscure; that it does not differentiate between a proven fact and an hypothesis; and so on and so forth. From the Klein-Freud controversy, we also learn how difficult it is to prove psychoanalytic “facts” through the clinical situation. As has been noted with respect to both clinical findings, the very same set of facts can be explained in various ways, depending on the interpretation of the observer. Again, the power of the narrative comes to the fore; the same clinical material can be used to form a number of differing meanings and storylines. The use of clinical material derived from the analysis of an adult in a developmental narrative is not as self-evident or as clear-cut a truth as the analysts of that period believed. Therefore, we need to search elsewhere for the parameters that will determine our beliefs and decide which schools we join.

The controversy surrounding infant research: disagreement about sources of knowledge, agreement about images of knowledge Important psychoanalytic controversy is not always about “facts”; sometimes the disputes are about the sources of knowledge themselves. A subject that persistently arouses controversy is the relevance to psychoanalytical conceptualizations of sources of knowledge other than the clinical situation. Most fascinated analysts rely almost exclusively on the clinical situation. However, over the past twenty years, an approach has developed calling for the assimilation of infant research within psychoanalytical conceptualizations. The opponents of this approach maintain that the sole relevant source for psychoanalytical conceptualizations is the clinical situation. Before elaborating on the controversy, it is important to describe the place of infant research within psychoanalytic theorizing.

Theories of infancy without real infants It is an accepted psychoanalytical assumption that one cannot understand a patient and the concepts with which he is preoccupied without taking his first years of life into account. And yet, Freud, Bion, and Kohut advanced detailed developmental theories without ever seeing children in their clinics. Klein saw young children (aged two and a half and up), and from them and adult patients came to conclusions about stages of development in infancy without observing infants. How is it possible to come up with a detailed theory about the psychic world of infants without ever observing or treating a single infant? Moreover, developmental theories based on direct observation of children, such as those of Margaret Mahler or Daniel Stern, have failed to attract a broader following within psychoanalytical communities than theories not based on direct

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observation. How come direct observation has such little value in the eyes of ­psychoanalytical communities whereas inferred knowledge from clinical situations is so highly thought of? The answer is linked to psychoanalysis’s images of knowledge. It is those images that determine the hierarchical standing of various sources of knowledge. In this hierarchy, the knowledge a therapist deduces from a clinical situation by gaining access to the patient’s unconscious ranks first in the order of validity. On the other hand, that which is observable outside of the special conditions of a clinical situation is considered as belonging to the conscious mind. Not only that conscious content is less informative, it is also perceived as obscuring another reality, unconscious and more profound. At the same time, Riccardo Steiner (2000) notes that “there is no doubt that extra-analytical observations played a certain role in confirming and refining, at times, Freud’s and the first child analysts’ observations and hypotheses concerning the chronology of development of the internal life of the baby and the child” (p. 10). Steiner assumes that psychoanalytic conceptualizations of primary narcissism, infant sexuality, and an infant’s evolving awareness of objects were shaped in the context of infant research, in those places in Vienna, Budapest, Berlin, and London where Freud and his colleagues worked. Steiner finds it hard to believe that theories were developed without taking into account infant observations carried out by William Preyer, James Baldwin, and, most especially, Charles Darwin, whose observation of his infant son greatly influenced observational infant research within psychoanalysis and beyond it. Freud was also influenced by research carried out by the neurologist Paul Flechsig on the myelination of an infant’s nervous system. Steiner notes that, in Klein’s conceptualizations of early object relations, the weaning phase, and the chronology of the depressive position, she was influenced by infant observations carried out by such researchers as Hug-Hellmuth (1913) and Siegfried Bernfeld (1929). Also worth mentioning in this context is the influence on Susan Isaacs of Jean Piaget, as well as the impact Charlotte Bühler’s research in Vienna during the 1930s had on her. Bühler’s work also had an impact on a number of Anna Freud’s younger colleagues, such as Hartman, Spitz, Hellman, and others. As Lacan himself was to testify, his own mirror stage was influenced by the research studies undertaken by Baldwin (1895), Bühler (1928), and Henri Wallon (1949). Winnicott acknowledged that his idea that there is no such thing as a mother separated from her infant was influenced by Merrell Middlemore’s observations of what she termed the nursing “couple” (King & Steiner, 1991). Thus, it is apparent that, in the early days of psychoanalysis, quite a few of those who established schools of thought not only took an interest in infant observation, but in a limited way went so far as to integrate such studies within their conceptualizations. In his Three Essays on the Theory of Sexuality, Freud (1905b) wrote that: Psychoanalytic investigation reaching back into childhood from a later time and contemporary observation of children, combine to indicate to us still

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other regularly active sources of sexual excitation. The direct observation of children has the disadvantage of working upon data which are easily misunderstandable. Psychoanalysis is made difficult by the fact that it can only reach its data as well as its conclusions after long detours. But by cooperation the two methods can attain a satisfactory degree of certainty in their finding. (p. 67) As Steiner notes, Freud admitted that for many years he had been urging his pupils and friends to chronicle their observations of the sexual lives of infants (Freud, 1909). These observations had been a regular topic of discussion at meetings of the Vienna Psychoanalytic Society3 (Nunberg & Federn, 1974). Freud’s observations of children served mainly to confirm his findings from the analyses of adults.The child was an object used to demonstrate the correctness of the psychoanalytic etiology about infantile sexuality and fixations, inferred from adult analyses (Frank, 1999). In the final analysis, infant research was on the whole intended to validate existing conceptualizations, even if such research played some role in the formation of these conceptualizations. However, latter day disciples of these thinkers lost all interest in the matter and focused instead on the clinical situation as the only tool for developing their theories about infants. How can this be explained? First of all, for those who established schools of thought and their followers, the clinical situation had always been the main staging ground giving rise to conceptualizations about the inner life of infants. For example, Winnicott, a pediatrician who had certainly observed many infants, wrote in his article “Ego Distortion in Terms of True and False Self” that “my experiences have led me to recognize that dependent and deeply regressed patients can teach the analyst more about early infancy than can be learned from direct observation of infants, and more that can be learned contact with mothers” (p. 141). Second, the reliance on infant observation was much more important during the first stage of the theory’s development than it was once the theory was firmly established and finalized. One can imagine how Klein or Winnicott pictured the infant and gradually began, over a period of many years, to sketch out its features and the way in which it was developing and assuming a certain psychic shape. These were very early, slowly developing conceptualizations, which at that initial stage needed every possible assistance as they expanded and developed. There is no doubt that certain conceptualizations were formed during analysis (especially of adults). However, at that stage of the discipline’s development, infant observations that supported new conceptualizations reinforced, at least to a certain extent, the image of the infant that was evolving in the analyst’s mind. In these later phases of a theory’s development, the expanders of a school’s thinking have clearer images of the features of the Kleinian, Winnicottian, or Kohutian infant. They are brought to life in the clinic during the therapist’s encounter with his patients, thus still further reducing the relevance of the observed infant. From this point on, the Kleinian, Bionian, Winnicottian infant, and that of others, lends a new and rich meaning to various clinical phenomena. It is this meaning that validates “actual”

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existence of this infant in the eyes of psychodynamic therapists. These psychoanalytic theorists and their supporters did not account for their altered thinking; it is more than likely that they were unaware of their loss of interest in actual infants. To paraphrase Winnicott, the question to be asked about the clinical infant is: Did the theorist discover the infant, or did he invent it? This question must not be asked at all. But there was no unanimity over this issue. Over the past twenty years, a number of psychoanalytical thinkers have claimed that the findings from infant research can contribute in a significant way to the formulation of psychoanalytic conceptualizations and provide new insights into the relations between therapist and patient.

Infant-mother observations aimed at confirming existing psychoanalytical conceptualizations: Bowlby, Bick, and Mahler During World War II, and after, the British psychoanalyst John Bowlby was the first to develop the idea that patterns of attachment in infancy had a major influence on relational patterns in adult life (see Bowlby, 1973). Bowlby was the first analyst to base his conceptualizations on observations of infants and their mothers rather than on the clinical situation. Bowlby thought that the infant’s experiences in attachment to its mother led to the creation of “internal working models,” unconscious rules that determine how the infant organizes its cognition, and behavior linked to attachment relations. Yet to this day, Bowlby is regarded as an outsider to psychoanalysis precisely because of the fact that his theory didn’t develop through the respected and accepted psychoanalytical sources of knowledge—the unconscious of adult patients in a clinical situation.4 But even in mainstream psychoanalysis, there were analysts who wanted to meet real infants rather than making do with infants molded in a clinical situation. Certain analysts, particularly in the Tavistock Clinic, were not prepared to accept the clinical situation as the exclusive source of knowledge in the formulation of psychoanalytical conceptualizations. The aim of these observations was to enable analysts working with small children to learn a great deal more about object relations theories. The observations were conducted under the supervision of analysts who had embraced this approach, and their purpose was to enrich existing insights and validate them. Esther Bick, the pioneering researcher in this field, thought that therapists receiving psychoanalytical training in the treatment of children had to “feel” the infant, observe its nonverbal behavior, its way of playing and its relations with the mother, so as to actually observe the development of early object relations. The weekly course of observing infants at Tavistock also made it possible to make comparisons between various infants, adding further knowledge about the possible pathways of infant development (Bick, 1964). These observations did not include any experimental manipulation of the infants. Instead, the trainee analyst would visit the family once a week and observe the infant and its interactions with the

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mother. Bick permitted trainees to be friendly and sociable observers and even to pick the infant up and help with various tasks connected to caring for it if such a request were to come from the parents. Since the observation is regarded as being an instrument of scientific research, a great deal of thought was devoted to ensuring that the observer’s presence didn’t in any way affect the family’s usual patterns of behavior. Bick thought a great deal about the observers’ projections and identifications because she had taken note of the fact that observing a mother-infant interaction could be a highly charged experience for the observer, especially in cases where there was neglect and poor maternal care. She assumed that the personal analysis that trainees received would help them cope with such emotionally charged situations. Bick taught her students to be vigilant and patient in their observations of infant and mother before jumping to conclusions or offering an interpretation. Her hope was that her students would learn to value the maternal care they were witnessing and become acquainted with the different ways in which mothers found solutions to emotionally charged situations. She expected her students to be flexible in their evaluations of the mother, relinquishing dogmatic views. She taught students to appreciate what was special in each infant-mother dyad and to watch the way every infant progressed at its own pace and developed unique methods of communication with its mother. One of the difficulties pointed out by Bick was the use of language. The choice of particular words was liable to determine their psychological meaning. Should the student say that the mother’s nipple “slipped,” “dropped,” was “released,” “broke loose,” or was “pushed” out of the infant’s mouth? Bick thought that observers had to be very cautious before choosing the appropriate word and avoid a decision until they watched a phenomenon many times. Such observations seem to be designed for two purposes: training child analysts, and validating existing psychoanalytic conceptualizations by using observed mother-infant interactions. The idea was to encourage observers/clinicians to develop a “special sensitivity,” to use their senses while observing the same phenomena that they encountered in the clinical situation when treating both children and adults. The conceptualizations themselves (such as the good breast and the bad breast, reverie, fantasy, and projective identification) and their correspondence to reality were not doubted by Bick. What occurred in the clinic had already been conceptualized. Now the time had come to observe them in real infants and mothers. Let us look at one of the examples. Bick (1964, p. 565) reports on her observation of Charles, a 10-week-old infant. Observing him, Bick discovered that the infant related to each of his mother’s breasts differently. When he was at the right (second) breast, he would stroke and caress the breast in a variety of gentle movements, but when he was at the left breast, his hand was either on the mother’s chest, his fingers sometimes clenching, or both hands were on either side of the breast, motionless. As a consequence, Bick wanted to know:

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Is this evidence that the relationship to the breast as part-object is the basic unit of relationship from which more complex relationships are built? Is the poking through and the poking in of fingers evidence of a projective mode of achieving identification? Are the hands held away and the clenching alternating with powerful sucking to be seen as a primitive attempt to spare the breast? Innumerable exciting questions arise, showing the students the vast area of the unconscious still to be explored by psychoanalysis. (p. 565) The employment of rhetorical questions shows that when it comes to the infant’s fantasies, observation does not in and of itself increase the theory’s level of probability, so that it continues to be as speculative as it was prior to the observation. Margaret Rustin (2006) believes that although Bion based his theories on adult analyses so as to develop his conceptualizations about children, it is conceivable that he was also influenced by infant observations. However, Rustin does not offer any proof of this. A safer assumption would be that analysts who observed infants, as Bick did, felt a need to anchor the clinical phenomena they had observed in an actual infant. In contrast, analysts such as Bion, whose conceptualizations were based solely on analyses of adults, apparently showed little interest in real infants. As we saw in Chapter 2, images of knowledge as such can be justified, but the choice of which images of knowledge one adopts is not a rational one. It is difficult to explain why one particular analyst is willing to be satisfied with the evidence from a clinical situation while another analyst demands “proof” in the form of observations. It is important to note that the observations of infants and their mothers at Tavistock not only confirmed existing conceptualizations, but also led to the development of new and important conceptualizations in object relations theories. For example, there is Bick’s (1968) idea about experiences involving the skin in early object relations.5,6 In the United States, Margaret Mahler and Rene Spitz conducted infant observations. In the 1950s, Mahler (1986; Mahler, Pine & Bergman, 1975) conducted in-depth observations of infants and children with severe psychotic disturbances. Comparing her observations of the developmental pathology of these children’s with that of normally developing children, Mahler formulated a theory of the phases of human development in the first years of life termed separation-individuation, which related to one of the main phases of development in her observations. Mahler’s theory found new phases of infant development, her conceptualizations being clearly influenced by Freud and object relations theory. It was in her clinic that Mahler first encountered mental disturbances—autism or severe psychosis in children—that up to then had been considered untreatable by psychoanalysis. The separation-individuation theory that she formulated posited that such disturbances stemmed from a child being “stuck” as it faced a whole range of infantile challenges at an age at which it was supposed to be developing independent skills. The child is unable to cope with the changing object relational developments and therefore

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cannot fulfill the need for renunciation of the Oedipal objects that is crucial for healthy development. The difference between Mahler and Bick was that Mahler was not satisfied with just confirming existing theories. Based on her observations, she developed a novel psychological theory of infant development that also laid a new foundation for psychoanalytic treatment. Greenberg and Mitchell (1983) think that through her emphasis on the experiential residues of early dyadic exchanges, Mahler paved the way for a diverse group of contemporary theorists (such as Kernberg and Kohut) to shift the delicate balance of the drive model to early and real object relations. Bick’s observations, in contrast, are much more conservative and stay loyal to the tradition of British object relations theories. One of Mahler’s discoveries was that the infant begins life in an “autistic phase” in which it is oblivious to its surroundings and the world. The autistic phase is possibly the only psychoanalytic conceptualization to have been refuted by infant research. In his research, Daniel Stern (2000) discovered that at no stage is the infant autistic, since from the moment of its birth it is in touch with its surroundings and has an image of both the self and of the “other.” As Stern notes, “the existence of a normal autistic phase is simply not plausible in light of the findings of infant observation. This research does not disprove the existence of such a phase. However, it does act to isolate this particular psychoanalytic tenet from mainstream of general knowledge and thus makes its acceptability precarious” (p. 75). All the other psychoanalytic conceptualizations connected to the phases of childhood development were rarely if ever researched via mother-infant interactions because they lack observable components. For example, infant research studies have had little to say about conceptualizations such as the good breast and the bad breast, projective identification, reverie, persecution fantasies, or the grandiose self. Most psychoanalytic conceptualizations describe an unconscious mental reality that relates to the infant’s intrapsychic life, and such characteristics are hard to find in the observed infant. The autistic phase is one isolated example of a situation in which the observed infant and the clinical infant cross paths. On the one hand, the autistic phase describes an intrapsychic, unconscious mental reality with numerous links to the psychopathology of adults; on the other hand, there are also observedbehavioral characteristics, such as detachment from the immediate surroundings, prolonged sleep, and lack of perception of the outside world. The autistic phase is particularly interesting because Mahler based her conceptualizations on observations of children and infants in exactly the same way as Stern. Nonetheless, each of them reached entirely different conclusions. Almost certainly, the differences between them do not stem from the fact that they observed different children, but rather that Mahler wanted to remain loyal to the Freudian theory and therefore looked at infants through the eyes of Freud. Mahler saw herself as belonging to psychoanalysis’s mainstream and worked within the framework of object relations theories (Pine, 1986). Stern, on the other hand, wanted to remain faithful to the scientific research method. This approach influenced the interpretation of his observations. Mahler saw “autistic” and detached infants, whereas

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Stern saw infants who were in constant communication with their surroundings and were engaged with their mothers in various reciprocal/mutual activities. It is important to note that, in her later writings, Mahler dropped the idea of the autistic phase and did not include it among her conceptualizations, though many continue to link her to it. Mahler’s success (her theory was very popular in the 1970s and ’80s) is very reminiscent of Stern’s. Both were able to link the real, observed infant to psychoanalytic conceptualizations. Mahler ran a clinic for mothers and infants and was principally engaged in working with infants suffering from developmental problems. The separation-individuation phase so closely identified with Mahler grew out of these observations. It seems that her success is also connected to her achievement in linking observed and clear phases in the development of infants (such as the separation-individuation phase) with character disturbances in adulthood (mainly borderline personality disorders). All of this was done by Mahler in an elegant and convincing fashion. She and Stern, with all their differences, added an important component missing in Klein and Bion’s work: the link between psychoanalytic conceptualizations and our knowledge of real infants.

Contemporary infant research A new generation of infant researchers with a psychoanalytic orientation began to work in the United States in the 1990s.7 Their approach was entirely different than that of their predecessors. They were not interested in finding corroborating evidence for existing conceptualizations within a particular tradition of thought. In contrast to Bowlby, this group of researchers did not limit itself solely to patterns of attachment between infant and mother and to the extent of security an infant feels in the presence of its mother. Many infant researchers in this tradition were influenced by groundbreaking infant studies undertaken by Louis Sander, whose writings were less wellknown to the general public (Sander, 1975, 1985, 1991, 1997). Sander was the very opposite of the fascinated analyst. Everything connected to the scientific world interested him and was regarded by him as relevant to psychotherapy. Sander began observing infants in the 1950s when no one else was doing it (other than Bick’s group at Tavistock, which was, as we have seen, committed to object relations theory). Sander was far more ambitious than were the researchers at Tavistock. He was not content with just asking how existing psychoanalytic conceptualizations are expressed in infant research; he wanted to develop new conceptualizations based on non-psychoanalytic analytic areas of study. His conceptualizations combined infant observation research, theories of nonlinear dynamic systems, contemporary biology, physics, and other “hard” sciences. His psychoanalytic conceptualizations touched on mental structures, motivation, and therapeutic intervention. Sander stressed the dynamic relationship between components in systems. His method was to draw analogies between various functioning natural systems, beginning at the biological level of cells and organs and up

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to the mental and interpersonal phenomena with which psychoanalysis is directly engaged (Seligman, 2002). All of the infant researchers who followed in Sander’s footsteps—such as Beebe, Trevarthen, Tronick, Fonagy, Mayes, Cohn, Stern, and others—adopted his approach. They all wanted to be open to knowledge from other disciplines, believing that psychoanalytic knowledge must be updated and compatible with contemporary science. They were also influenced by systems theory, in which Sander believed. According to this theory, the mother-infant interaction is a dyadic system through which the self is created. This is what determined patterns of relations in later life. While the observations at Tavistock were remote and non-interventional in the best tradition of British object relations theory, researchers using the new approach did the very opposite: they employed an array of research methods and sophisticated manipulations to influence the situation. Thus, for example, in one of his first studies in the 1950s, Sander asked mothers of one-week-old infants to wear ski masks during feeding and documented the infant’s distress in this situation. This was one of the first findings to show that at the very beginning of their lives, infants already develop expectations from the “significant other.” Another classic work of research on infants and their mothers was carried out by Stern (1985) and Beebe and Stern (1977). The researcher used a 16mm camera to film interactions between mother and child. In every dyad, the camera took simultaneous shots of the mother’s and the infant’s faces (twenty-four frames per second), and each frame was numbered. The researchers moved forward and backward in the course of every few seconds and were thus able to see how the behavior of each of the parties changed over time and the way in which each of them either adjusted or didn’t adjust their behavior towards the other. This microanalysis enables one to notice fast and precise patterns of interaction between the mother and the child that are not visible to the naked eye. This protocol and many variations of it (Beebe et al. 2005) show quite convincingly that the interactions between mother and infant are by their very nature synchronized, regulated, mutual, and two-way. Though the interaction is asymmetrical and unequal in the sense that the mother introduces into the situation a richer repertoire of responses, the inborn ability of the infant to respond to the mother enables it to actively participate in the situation and influence the interaction with the mother. The researchers further discovered that interaction patterns between mother and infant are organized by violations of expectancy and followed by efforts to resolve these breaches. Beebe and Lachmann (2014) termed this “disruption and repair”. Whenever there is a degree of violation of expectancy, both parties aspire to “repair” it and return non-matches to matches. Infant research studies also base their conceptualizations on ideas developed outside the realms of psychoanalysis, such as implicit knowledge, motivations and intentions, mirror neurons, nonlinear dynamic systems theory (NDST), metaphors and their origins in embodied mind theory, and nonverbal communication. One of the major representatives of this approach is the Boston Change Process Study Group (BCPSG), which has given a clear explanation of the link between the

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findings of developmental studies and change processes in adult psychotherapy and psychoanalysis (Nahum, 2002). Various research plans were developed to examine situations in the motherinfant interaction. In a study of “frozen faces” (Trevarthen, 1987; Tronick et al. 1978), mothers, after playing a few minutes with their infants, were asked to look at them with a still face without making a sound or changing their expression. At first, the infants smiled and made sounds, trying to produce a reaction in their mothers; then, surprised when the mother did not react to their attempts, they moved between disassociation and repeated attempts to elicit a response from their mothers. Tronick (1989) showed that the effect of the frozen face experiment continued several moments after the mother resumed reacting and playing with her infant: the infant avoided looking at the mother’s face. But how are these observations related to psychoanalytic treatment? The idea behind the relevance of infant research to psychotherapy is simple: if the mutual interaction between therapist and patient is very reminiscent of, and in many cases even recreates, the parent-infant/child relationship, why not learn from what occurs between mothers and their infants for the therapeutic situation? Since the preverbal period is so important to most psychoanalytic conceptualizations, interpretation may not be the central tool through which change will occur, just as the parent’s verbal content is not dominant in the interaction with the infant. The idea was that observations of mother-infant interactions could be a rich source of information for the preverbal processes in therapy considered so therapeutically important. Researchers from the Boston group reached a number of important conclusions that touch on psychoanalytical therapy. They made use of the concept of “implicit relational knowledge”—borrowed from cognitive psychology—and procedural memory. Implicit knowledge is knowledge that is unformulated and not expressed in words. This kind of knowledge comes to be expressed by the way in which we carry out or understand certain tasks. It is the domain of knowing how to do things with others, how to be with them (“ways of being with”; D. N. Stern, 1985). Implicit relational knowing typically operates outside focal attention and conscious experience, without translation into language (Nahum, 2008). Overt knowledge, on the other hand, is knowledge we are conscious of—knowledge that can be formulated verbally. Evidence for the existence of such knowledge can already be seen in a two-month-old infant: at that age, infants have expectations of their mother’s behavior and are surprised or despondent when these expectations are violated (Tronick et al. 1978). Infants have a procedural representation of their anticipated interaction with the mother, and this expectation, stored in procedural memory, can change and be updated. The infant knows and remembers how to organize itself physically and motorically in spaces. Moreover, it also knows and remembers how to be with the “other” in a nonverbal reality. This describes not only behavioral interaction at the kinesthetic level, but also the infant’s ability to understand and encode the mother’s intentions, as well as to convey its own. The infant regularly coordinates its intentions

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with those of its mother, whom it apparently perceives as an intentional agent. From the beginning of its life, the infant functions within the intersubjective relationship and builds an impressive body of knowledge about being with the “other.” The researchers attribute changes that occur during therapy to this knowledge. According to the Boston group’s model, when two people meet, whether it is infant and mother or therapist and patient, both sides hope to improve the fittedness of their behavior and intentions (Nahum, 2008). In adults, these adjustments are mediated by developed verbal abilities and symbolic skills. Both sides of the dyad are engaged in a process of mutual regulation between their situation and that of the other. This process of trial and error is based on micro-interaction always expressed in the “present moment.” The process of adjustment occurs at the local level and, at any given moment, is intentional. The search for matching is necessarily a “sloppy” business—as suits a process that is dominated by general systems theory and cannot be controlled or predicted ahead of time (Levenkron, 2009). Indeed, in its very sloppiness lies the system’s prospect for new developments and thus for surprise and transformation. As the similarly sloppy process of therapy or analysis moves along, small changes in the implicit relational knowledge of each party grow; this paves the way to growth and change. The openness of the analyst to the sloppiness of the adjustment and the need to achieve a more complete adjustment through a process of dialogue and negotiation is essential to the growth of common intention and successful analysis. Changes can also be carried out in a more dramatic way. These are present moments, occurring in the here and now. The change that occurs goes beyond the interpretation of the here and now and is made known by implicit knowledge at the moment of meeting. For example, a moment of meeting occurs when the therapist says to a patient that he has been late for the past three sessions. There is another such moment when the patient responds and tells the analyst that he thinks he has been coming late because he is angry with him, or when the patient declares that something the analyst said a week ago was bothering him (Levenkron, 2009). There can appear in the clinical encounter what have been termed in motherinfant interactions “heightened affective moments” (Beebe & Lachmann, 2002), when, for example, the patient asks the therapist if he likes him. Such moments are called “now moments,” and they draw both participants deeply into the interaction. They take the familiar and predictable framework of relations and change by a process based on implicit knowledge. According to Beebe and Lachmann (2002), the dyadic model has a number of implications for the interaction between therapist and patient: The distinction between implicit and explicit processing provides a new frame of reference incorporating verbal and nonverbal communication in psychoanalysis. Patterns of expectation can provide one definition of procedural implicit knowledge, which is a potent pattern of action in treatment. Third, a therapeutic action can occur implicitly without necessarily having to be translated verbally and openly. (p. 217)

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Linda Mayes (2005), a researcher from the Center for Child Research at Yale University, adds that the early interactions between the infant and mother are relevant to the therapeutic relationship on three levels. First, a complex system constantly moves between states of organization and disorganization, stability and instability. Instability is not a manifestation of regression or error, but expresses the need to adapt and reorganize. At moments of instability, the boundaries inside the system are vague. Second, change at the organizational level is not linear. The early level of organization is not predictive of the shape and stability of the system at later stages. Third, small changes in the behavior of the therapist and the patient are significant to the system’s organization and stability. In Mayes’s view, the metaphor of a complex system conceptualizes the therapist and patient not as two individuals in contact with each other, but as a single system with changing levels of organization that reflects the efforts of each side to understand the intentions of the other. It is impossible to disconnect either side’s understanding of the system they created together. The system is, indeed, composed of individuals, but the characteristics of the individuals are subordinate to and vary according to the system as a whole. In Mayes’s opinion, the metaphor also calls for understanding the process as consisting of small changes to larger ones, and from there to significant junctions, such as when an infant begins to walk or a patient begins to see past events in a different light.

Psychoanalytic implications of infant research I have described in a nutshell a few of the new conceptualizations of infant research and the way in which they can be applied to psychoanalytic therapy. Beebe and Lachmann (2002) claim that models of infant development deriving from infant research cannot be directly applied to the psychoanalytic situation with adult patients. They think that in adults the ability to symbolize, and the unconscious emotional processing of experiences in the form of fantasies, wishes, and defenses, change the organization of interactive patterns. However, infant researchers note that the advantage of their findings is that they do not assume anything about the dynamic contents of their patients’ experiences; instead, they focus only on the process of mutual or interactive regulation of behavior in the therapeutic situation. These researchers argue that conceptualizations emerging from infant studies, such as ongoing regulation, disruption and repair of expectations, and heightened affective moments, can help us gain an understanding of the therapeutic process. Rather than focusing on the contents of the experience looks instead at the patterns of interaction. Judith Rustin (2013) cites an instructive example of how infant observations are helpful to the therapeutic process. I will relate only a small segment of the clinical material. She describes Jack, a patient who was a university professor and whose ability to communicate was too limited. He sat on the analyst’s couch, fearful, gloomy, silent, and rigid. His face was turned away from the therapist and beyond her, looking down, his head nestled between his shoulders. The therapist’s

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attempts to make contact with him were rarely met with a response. For him, the use of words was not an efficient means of communication. Apparently, the therapist’s questions were seen by him as an assault. Rather than using words, he told the therapist about his experiences through the rejection reflected by the movement of his head and his eyes, the positioning of his body, and his prolonged silences. In the end, the therapist dropped her insistence on a verbal response and the creation of a narrative. She moderated her emotions and tried to turn herself into a less invasive and less poisonous presence in order to adjust herself to the patient and to match and mirror him. She breathed with him and tried to shrink her own presence and join him. The therapist had learned the relevance of mother-infant interaction studies and reached the conclusion that nonverbal techniques were the best way of communicating with Jack. This is an excellent example of both the power and limitation of mother-infant interaction studies. On the one hand, the studies help in understanding the patterns of interaction that occur in the course of therapy—in particular, those that cannot be verbalized. They are also helpful in situations in which there is a need to mobilize the patient to be more present and more involved in the therapeutic dyad in the light of disruptions in early interactions with the mother. On the other hand, since they are focused in modes of interactions, they lack the formative narrative that could attach a meaning to the distress. An additional point highlighted by infant researchers, and the Boston group in particular (Nahum, 2008), relates to the question of what is to be found below and above the surface. In their view, traditional psychoanalysis posited that transactions between analyst and patient were “surface.” Below was a more profound level of psychodynamic meaning waiting to become conscious by interpretations. In contrast, infant researchers believe that the “deep” level, as depicted in interpretations, is in fact derived from the “surface” level of moment-to-moment exchange: “In this framework they assert that the local level, where implicit relational knowing is enacted, is the foundational level of psychic life. It is where psychodynamic happenings, including affect, conflict and defense originate” (p. 845). What is relevant here is that the unconscious is available through communication within the interaction. The researchers claim that this deeper meaning is actually a derivative of direct interactions within the moment-to-moment interactions during which implicit knowledge is transferred. This, of course, completely contradicts methods of classical psychoanalysis that see the transformation of the unconscious to the conscious as being the focal point of change. In this, infant researchers are very close to the relational and interpersonal approaches that emphasize the “here and now” (Levenkron, 2009). But, above all else, it would seem that mother-infant research studies have made a significant contribution in grounding one of psychoanalysis’s central claims and one of the most difficult to prove: namely, the profound effect the infant’s experience with the primary caregiver has on the development of self and adult relationships. In fact, the aspiration of infant researchers corresponds to that of psychoanalysis: to demonstrate how patterns of behavior formed in

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infancy and early childhood are of great significance in adult life, and that the significant events during this early period will find expression in the course of therapy. Thus, the importance of therapists being aware of these findings. This was best described by Seligman (2014): “working clinicians now have greater empirical legitimacy behind the clinical imagination, one that both finds and creates workable coherences across a wide range of observations and speculations” (p. 189). For example, Beebe and Lachmann (2014) succeeded in characterizing secure, avoidant, and ambivalent attachment patterns at a much earlier age (four months) than the literature on attachment patterns suggested. They showed how “unorganized” attachment patterns, in which a mother shows signs of being ambivalent and doesn’t properly read the infant’s distress, lead an infant to experience its mother figure as someone who doesn’t “feel” or acknowledge them. An infant’s harshest experience in relating to such a mother is that the mother finds it difficult to respond to suffering, to mirror its distress and be there for him in this experience. As a result, the infant doesn’t recognize himself and feels very confused about his identity and emotional needs, particularly when distressed. The studies of mother-infant researchers differ in many ways from traditional psychoanalytical writing. Ideas are formulated clearly and incisively, which is not in the nature of psychoanalytical writing; infant researchers make little use of psychoanalytical jargon, and there is a noticeable absence in their writing of any kind of poetic description that lends itself to differing interpretations. Moreover, psychoanalysis’s prominent thinkers (Freud, Klein, Bion) are barely mentioned in their books. In fact, the canonical psychoanalytical literature is not at all regarded by them as a source of knowledge.8 Their main source of knowledge relies on mother-infant research studies carried out in the laboratory, as well as case descriptions in which patients were understood in line with principles formulated in those laboratories. At the same time, this group’s work is undoubtedly aimed at psychodynamic therapists. In the last part of Beebe and Lachmann’s (2014) book, the authors ask psychodynamic therapists who are not infant researchers to describe how the conceptualizations derived from these studies helped them to understand therapeutic processes.

Andre Green’s opposition to contemporary infant research Since infant research (such as the studies carried out by Daniel Stern) began to demonstrate the relevance of their findings to the understanding of psychoanalytical therapeutic processes, they have encountered considerable opposition. Such studies, it is claimed by their opponents, are possibly interesting, but they cannot contribute to any new understanding of relations between therapist and patient. In their view, new therapeutic understandings can only develop out of a close exploration of a patient’s unconscious in a clinical situation.

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Andre Green, among the most prominent and most vocal opponents of infant studies as a source of psychoanalytic knowledge, is an excellent example of this view. In the midst of the incisive debate between Stern and Green, to which an entire conference and subsequently a book (Sander, Sander & Davies, 2000) was dedicated, one important fact seems to have been forgotten: for all their differences, there is agreement between them on many of their of assumptions about describing an infant that corresponds to reality. Common to both supporters and opponents of the integration of infant research are their images of knowledge. Both groups believe it is important to explore characteristics of the “real infant.” The only thing they differ about is how to do it. Green’s position is complex. On the one hand, he argues that “the clinical situation does not pretend to be a scientific setting” (Sander et al. 2000, p. 58). At the same time, Green provides us with ample evidence of his own images of knowledge, and reading him makes one realize that his and Stern’s images of knowledge were, in fact, identical. Many psychoanalysts, mainly in the United States, strongly adhere to the idea that psychoanalysis is a science. But we know that others prefer the idea that psychoanalysis belongs to hermeneutics . . . I have defended previously the idea that the ideal of psychoanalysis was to be part of science, but that the specificities of its practice and of its mode of thinking were not compatible with the ordinary requirements of scientific evidence. (p. 22) Green further argues that the more the aim of scientific enquiry is restricted to inanimate objects, the more accurate it is. When it comes to animate objects, the questions become less apparent and the riddles harder to resolve. Finally, when one reaches the stage of investigating mental activity, the problems encountered are complex, and one’s ability to draw firm conclusions is more limited. Green expresses a very similar view to that of certain analysts (mainly in the United States) that psychoanalysis is a science like any other, but that the particular issues of its research—the human unconscious—made it very difficult to adapt its methodology to the scientific method (Hendrick, 1955; Kubie, 1960). Ironically, this is the epistemological position of classic American ego psychology to which Green was so hostile. Within the field of psychoanalysis, Green was an advocate of pluralism and tolerance and a critic of the scientific approach. He adopts a pluralistic view by stating that “we have so many conceptions of infancy, none of which is considered as being universally true, nor having the right to falsify the other. Who is right— Freud, Melanie Klien, Bion, Winnicott, Anna Freud, Hartmann, the Sandlers, Lebovichi?” (p. 58). And yet he was clearly unable to live at peace with views that differed from his own—and which regarded the infant in a different light than did the established psychoanalytic schools. The fact that his main attacks were aimed at refuting the conclusions reached by infant researchers is a further indication of his fidelity to a single truth.

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One of Green’s central criticisms of infant studies is that they are entirely speculative and inconsistent with the “real infant.” Green maintains that the “clinical infant” can only be studied within a psychoanalytic situation and by reading the writings of Freud, Klein, Winnicott, and Bion. He claimed not to have any interest in a concrete infant; what interested him was the infant within the adult. In Green’s view, observations of real infants tell us very little about the adult. Regarding Daniel Stern’s research, Green writes: “I find these ideas highly speculative, in no way less so than Freud’s or Melanie Klein’s most unproved hypothesis; but at least the latter were born, albeit partially, ‘from the couch’” (Green, 2000, p. 54). A way of thinking based on facts that correspond to reality rather than speculation is as important to Green as it is to Stern. The criticism once voiced by Klein’s opponents within the psychoanalytic camp is now being hurled at Stern. Green is also critical of Stern for what he regards as the latter’s non-scientific approach, thus re-exposing his own commitment to a scientific model: On the one side we have [in Stern’s argument—A.G.] the facts, on the other the ideas, but there are no visible links. I also find that Stern’s contradictory attitudes towards the mental disposition of the researcher. At one point, Stern advises the researcher to wipe any preconceptions out of his mind; at another point he recommends that the researcher put himself “in the place of the baby.” He advocates achieving this identification along the lines of his hypothetical ideas, rather than on a factual basis . . . As Wolff says, hypothesis have to be verified. Finally, the results look more like science fiction than science, except that they are less imaginative . . . (p. 56) For Green, the danger of infant research lies in the possibility that the clinical situation—the most important source of knowledge, in Green’s view—will be replaced by mother-infant observations, a source external to the discipline and one he thinks is liable to bring about psychoanalysis’s destruction: In the end, what is the aim of infant researchers? It is clear that, after one has read the best of their papers, what they are trying to do is to destroy psychoanalytic theory . . . and to replace them by a non-psychoanalytic, so-called scientific psychology, with which they are most at ease, because it is more simple, more amenable to experimental studies, and easier to teach. (p. 59) The reason Green singles out infant researchers as the “enemies of psychoanalysis” stems from the fact that their studies are a serious and particularly rich source of knowledge. Today, such studies are also the only available source of research knowledge—other than the clinical situation—on which a psychoanalytic conceptualization can be based. Green’s concern is that because infant researchers are regarded as “scientific,” the psychoanalytical community is liable to become increasingly reliant on their work. This could mean the displacement of Freud,

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Klein, Bion, and Winnicott and their replacement by conceptualizations based on infant observation studies. Green’s angry tirades against psychoanalytically orientated infant researchers left little room for doubt as to Green’s fundamental world-view: namely, that he was a firm believer in the correspondence theory of truth, that he totally accepted the existence of a single truth and was a sworn realist. Apparently, Green’s fears were exaggerated. Fifteen years after the conference, none of Green’s nightmares have materialized. The anticipated abandonment by a mass of analysts of psychoanalytic conceptualizations and adoption instead of the theories of Stern, Fonagy, Beebe, Emde, Sander, Mayes, and others has not happened. Instead, infant research studies and the interesting conceptualizations they spawn co-exist with the regular array of psychoanalytic activities. Apparently, infant researchers were primarily interested in being in touch with the theoretical work emerging from the clinical situation, more than offering themselves as an alternative to those conceptualizations. It is not unreasonable to think that most psychodynamic therapists would prefer to maintain existing psychoanalytical conceptualizations. Even those who take an interest in infant research will only use such studies in a limited way. There are two reasons for thinking this. First, according to Daniel Stern (2000), the two fields employ such different epistemologies that mother-infant dyadic research cannot directly affect psychoanalysis. Second, infant researchers emphasize processes and not contents: the way in which the mother-infant/therapist-patient dyads are structured and organized in situations such as the presence/absence of the mother/therapist, response and lack of response, the fulfillment/breach of expectations. Thus, the great advantage of infant research studies—the fact that they deal with processes and not contents—is also their weakness. The information derived from mother-infant dyadic research provides us with many insights as to how to listen but not to what we should listen. The studies emphasize the need to pay attention to nonverbal communication, to adjustments and lack of adjustment, correction and discord, present moments, interaction that changes from moment to moment, nonlinear processes, and more. But the human brain, as we have seen in the previous chapter, prefers to organize complex human material in narratives, dramatic happenings that are integrated in a complex and wide-ranging plot with a coherent and complete structure. Every one of the psychoanalytic schools offers this kind of drama. As such, it comes readily into the mind of the analyst as he sits facing his patient. Again and again, clinical material is organized around one of the major dramas suggested by the various psychoanalytic schools. In fact, it is almost impossible to administer therapy in line with the psychodynamic method without using one of the great old psychoanalytical narratives, at least in a partial form. This is exactly why infant observation studies have always had to combine with existing psychoanalytic theories and why it is difficult to construct an independent therapeutic method exclusively based on such research.

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Notes 1 See, for example, the response of Freudian psychoanalysis to Karen Horney (Jekels, 1941). 2 Carlo Strenger (2000) tells of how he once heard Joseph Sandler, then editor of the International Journal of Psychoanalysis, instruct would-be contributors how to prepare an article for the journal: “start the article with a citation from Freud.Write that Freud didn’t deal with the question because he lived in too early a period. Then write what it was that you wanted to write and end by explaining why Freud would have agreed with the idea had he been alive today” (Strenger, 2000, pp. 381). 3 Known at the time as the Wednesday Psychological Society. 4 Mitchell (2000) also attributed Bowlby’s rejection by mainstream psychoanalysis to his clear linguistic style, which was not characteristic of psychoanalytic writing. On the psychoanalytical community’s treatment of Bowlby, see also Fonagy and Target (2007). 5 Bick (1968) thought that the skin, supported by maternal containment, is the infant’s primary container, given that it binds the separate parts of the self. When the mother’s containment abilities are impaired, the infant uses “second skin” type defences, which are omnipotent, pseudo-independent forms of protection that use muscular tension to hold the self together and prevent it from falling apart. 6 Infant-mother observations are to this day widely used in psychoanalytic training institutes around the world that have a track for child analysis. Findings from observations identified with object relations theory can be read in Infant Observation: International Journal of Infant Observation and Its Applications where there such articles as “To Look into the Eyes of an Infant: Bion’s Baby’s Fear of Dying” (Proner, 2013) and other articles stressing the link between the Tavistock tradition of infant observation and early object relations. 7 The prominent among them included Daniel Stern, Beatrice Beebe, Joseph Lichtenberg, Linda Mayes, Donald, J. Cohen, Robert Emde, Colwyn Trevarthen, Edward Tronick, and Louis Sander. 8 Winnicott is the exception, but he too uses this literature as a source of inspiration rather than as a source of knowledge.

4 THE RELATIONAL APPROACH

The ideological revolution that erupted as a result of the appearance of the relational approach differed radically from previous such conceptual transitions. The most significant differences were that the relational approach did not offer a systematic and uniform psychoanalytic theory, did not pretend to be an alternative to existing psychoanalytic schools, and was not supported by one particular charismatic thinker, as were the earlier shifts in psychoanalytical thought. Moreover, the relational approach did not present a blueprint for an ordered narrative covering such issues as stages of development, psychopathology, and well-defined therapeutic aims. In short, the relational approach did not offer new “facts” about the human mind in the form of a narrative, as other schools of thought had done. Instead, what essentially characterized the relational approach was the change it offered in its images of knowledge—what the therapist knows about the patient. It posited that there are no absolute truths out there waiting to be discovered by clever human minds, but only meanings to be constructed by two persons functioning together in a cultural context. Mind is itself a social derivative, and the idea of an isolated mind is an old-fashioned Cartesian myth (Kirman, 1998; Stolorow & Atwood, 1992). This view regards the idea of any observer having a God’s-eye truth as an erroneous and passé positivist outlook. Relational therapists claim that all knowledge is relative and perspectival—dependent on the particular character and situation of the knower. Knowledge is therefore unavoidably constructed from a specific perspective, and it is constructed within a social matrix in a social context (Kirman, 1998). The new approach changed the way in which analysts related to their theory; it undermined fascinated communities’ perception of truth and made the psychoanalytic community examine their theories more soberly. As a consequence,

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the psychoanalytic community went through a painful process of disenchantment as it recognized the limitations of the psychoanalytic method. The idealization of psychoanalytic discoveries was weakened and, with it, so was the fascination. However, as we will see, new possibilities have opened up. Since the therapist cannot help revealing his subjectivity (Gill, 1982; Renik, 1993a), he might as well loosen up and allow himself greater spontaneity and authenticity (Kirman, 1998).

Stephen Mitchell and fascinated communities When the relational approach first surfaced during the 1990s and early 2000s, its leading spokesperson, Stephen Mitchell, aimed his fire at fascinated psychoanalytic communities. It wasn’t so much the conceptualizations of these communities that were the target; on the contrary, the theories themselves were highly valued by Mitchell. In his sights, rather, were two phenomena linked to fascination: the therapeutic ideals of fascinated communities, and the world-view of those who supported Kleinian, Kohutian, or Bionian theories, according to which their conceptualizations were objective and corresponded to the truth. As a result, these communities regarded their theory as superior to all its competitors. Mitchell argued that “single orientation” therapists of a particular school tend to formulate ideal and unattainable therapeutic aims. Thus, the traditional therapist cannot really remain neutral: the Bionian therapist is not in reality a therapist without memory or desire; the therapist embracing the self-psychology approach cannot simply be empathic; the therapist who sees himself in the role of a parental figure cannot, even if he tries very hard, really be the patient’s parent: “there is in psychoanalysis, unlike in navigating the earth, no objective, singular electromagnetic field and generic compass. Each analyst’s clinical judgment is shaped by his or her personal integration of psychoanalytic models and concepts, seasoned by with his or her personal dynamics, character, and life experience” (Mitchell, 1997, p. 195). Unlike therapists identified with a specific school, the relational therapist doesn’t aspire to reach impossible ideals and particular states of mind. Rather, his aim is to induce involvement, “engagement in a process” (Mitchell, 1997, p. 193), during the therapeutic interaction. The tools at his disposal are not, in fact, psychoanalytic conceptualizations, but rather his commitment to self-reflective responsiveness. According to Mitchell, the relational therapist maintains that the ambition to reach such limitative states of mind—such as Freud’s free-floating attention, Schafer’s analytic attitude, or Bion’s reverie—closed off other therapeutic options and interventions. Instead of employing just one of these therapeutic ideals, the therapist can use them all in differing situations and in line with the circumstances of the case and its context. At times, the therapist may feel that he has to be very focused and avoid anything resembling free-floating attention; in other situations, the therapist may feel that his patient needs a concrete, rational, explanatory response, and therefore he should avoid a reaction that stems from a situation of reverie. In Mitchell’s view, the most significant moments in therapy, in fact, occur when the therapist is prepared to let go of his professional “self,” which is so well-anchored

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in confidence-inspiring theory, and allow himself to be carried away to a less familiar place where emotion, yearning, fear, and insecurity are the dominant forces. In such moments, the therapist is released from the drive to know. The therapist should not aim to relinquish his own desires and intentions (as Bion had suggested), but rather remain as open as possible to the rich flow of varying intentions, all of which are prone to self-reflection. The relational therapist learns from the writings of various thinkers who have an influence on him. However, at all times, he maintains his inner sense of freedom, which enables him to react in different ways at differing times and in various contexts, employing a rich repertoire of responses. Every therapist chooses his own unique guiding compass, which he uses in line with his personal blend of varying theories, his own individual dynamic, his character, and the circumstances of his life. Theoretical concepts remain an essential part of every therapist’s guidance system; analysts devote a great deal of time to assimilating psychoanalytic ideas, embracing some, discarding others, altering many of them, and finally reaching a synthesis that suits them. Mitchell (1997) thought Freud’s view that psychoanalysis (unlike religion) was backed up by a scientific world-view no longer fitted in with contemporary culture, where the search for meaning and value had taken the place of the scientific ideal. He contended that if psychoanalysis wanted to remain relevant and accepted as a method of therapy, it had to be sensitive to the new cultural and historical context defining the lives of both therapists and patients today. Indeed, most of the criticism leveled at psychoanalysis by the general public are responses to this scientific world-view, which was endorsed by early generations of analysts: “Clay feet are being rapidly exposed beneath the robes of virtually every traditional institution and authority, and psychoanalysis is no exception” (Mitchell, 1997, p. 206). In Mitchell’s view, the monastic isolation of the psychoanalytic community from the rest of humanity will not allow it to survive for long.

Mitchell’s criticism of the fascinated analyst’s perception of knowledge Mitchell understood that an analyst’s fascination was linked to his perception of knowledge. He, together with the relational approach as a whole, dismissed the fascinated community’s perception that a therapist had “knowledge of what was going on in the patient’s head” and that this knowledge could be discovered and exposed in the course of therapy. For Mitchell, there was no single distinct process occurring in the patient’s inner world which the therapist could either perceive or overlook. Both conscious and unconscious mental processes that analysts took an interest in, he argued, were highly complex and could be understood in a number of different ways. Both therapist and patient organize and “compose” the therapeutic material in an active way so as to give it meaning. This is not to say that all versions are equally true, since ways of organizing the material are closely linked to the details of the situation. Despite the actual experience being hazy and

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understandable in a number of different ways, one’s ability to interpret it is limited in much the same way as a Rorschach inkblot limits the perception of the person looking at it. The difference between relational therapists and those working along more traditional lines is that contemporary therapists do not employ psychoanalytic conceptualizations to discover what is inside the patient’s mind, but rather “use language in a fashion that actually discovers and creates new experience, something that was not there before” (Mitchell, 1997, p. 219). There is no search here for a hidden truth about the patient’s life. Instead, issues are raised by an inquisitive method and an acceptance of the uncertainty that, were it not for this curiosity and dubiety, would never have been raised. The theoretical model used by the relational therapist is not evidence-based and objective. However, it may be influenced by empirical data and is likely to change in the light of new and contradictory empirical evidence. Change also occurs when a large number of therapists show a preference for a different way of thinking. More than any other thinker, Mitchell exposed the link between fascination and the world-view that goes along with it. Fascinated therapists adopted Freud’s (1933a) view of truth, according to which “It is simply a fact that the truth cannot be tolerant, that it admits of no compromises or limitations, that research regards every sphere of human activity as belonging to it and that it must be relentlessly critical if any other power tries to take over any part of it” (p. 159). Fascinated therapists may neglect the arguments for an objective truth in favor of pragmatic truth. There is no reason why a fascinated analyst cannot abandon the contention that his theory has the status of objective truth in favor of the claim that it simply works better than any other theory does. The more powerful the love for a theory is, the more the follower is able to overcome the biggest epistemological difficulties. Indeed, a major part of a theory’s fascination lies in its exclusivity: it is only my theory and not some other conceptualization that reveals the right way of going about doing therapeutic work, and of arriving at the correct therapeutic aims and therapeutic truths. Mitchell was not alone in his critique. He was joined by many other critics from the relational and hermeneutical streams, such as Paul Ricouer, Roy Schafer, Donald Spence, Merton Gill, Charles Spezzano, Irwin Hoffman, and Lew Aron. They sharply critiqued the view according to which psychoanalytic knowledge is objective and real. This criticism undermined the fascination but didn’t entirely eliminate it.

A new therapeutic perception The new images of knowledge led to a novel perception of therapeutic relations. At the centre of this perception is the idea of different dimensions of mutuality in the psychoanalytic relationship (Aron, 1996). Jody Davies (1994), a prominent figure in the relational movement, thinks that “therapy is a genuine relationship between two persons and not merely some one-way internal relations that belongs

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exclusively to the intrapsychic life of the patient’s mind,” but rather a “mutually constructed intersubjective background and perpetual interaction between two actively engaged participants” (p. 168). What led to this change in world-view? In the past, changes in the ways that analysts perceived patient-therapist relations were based on pragmatic reasoning; these changes were part of an attempt to refine technique. Consider how Freud changed his mind about transference. Initially, Freud saw transference as a disruptive feature of the therapeutic relationship. He expected his patients to show the gratitude that patients ordinarily feel towards their doctors. He was very quickly astonished to discover that instead of gratitude, his patients were “falling in love” with their therapist, being sexually attracted, and displaying high degrees of emotion. At first, Freud understood transference as being nothing more than a psychological resistance that seemed designed to become the biggest obstacle in psychoanalysis’s way forward. However, he later changed his mind and saw it as the discipline’s most powerful and helpful therapeutic tool, and that it could be of great benefit to therapeutic change. There was a similar process after Freud’s death in relation to the concept of countertransference. Freud saw countertransference as an emotional response by the analyst to the influence the patient had had on his unconscious feelings. In Freud’s time, countertransference was seen as an obstacle that had to be overcome through personal analysis. It was thought that countertransference could distort the analyst’s observations and that this warping could be reduced or eliminated by psychoanalytic analysis. In practice, what was at issue here was the need for dispensing with the therapist’s subjectivity so as to make it possible for him to analyze the patient’s mind neutrally and objectively. Just as Freud had finally discovered the importance of transference, so analysts belonging to the object relations approach found that countertransference contributed to a more profound understanding of the patient as well as of the therapeutic process. What was at first regarded as an obstacle that had to be removed turned out to be a very potent tool for deciphering the patient’s inner world. The term that best expresses the importance of countertransference to the understanding of the patient is “projective identification.” This term emerged from object relations theories but was accepted by all the approaches. Projective identification refers to a form of one-directional communication by the patient as he tries to behave in ways that would force the therapist to identify with feelings he himself is unable to contain. In fact, the most painful parts of the patient’s memories and those that cannot be verbalized are brought to light in this way. It would seem that with this approach the first barrier is removed, thus paving the way for the expression of the therapist’s subjectivity—even though this wasn’t the intention of the approach’s conceptualizers. Compared to therapists of an earlier period, who perceived their subjectivity as disruptive to the therapy, projective identification was a ground-breaking clinical phenomena. For the first time, the patient’s feelings—not just the analyst’s theoretical abilities—were recognized as being relevant to the therapy.

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And yet, all the changes I have described, despite their clinically innovative features, were still introduced within a conservative epistemology. Projective identification, like transference, is a phenomenon belonging to an era in which there was a clear distinction between object and subject. The transference is understood to be a projection, a distortion of who the analyst really is. The analyst has a privileged authority in knowing what is real and unreal, whereas the patient has no access to his unconscious. The analyst’s task is to interpret this transference to the patient and trace it back to its conflicts and traumatic experiences. Freud (1940) clearly expresses this view when he writes: “the analyst must tear the patient out of his menacing illusion and to show him again and again that what he takes to be new real life is a reflection of the past” (p. 177). The new perception of knowledge introduced by the relational approach led to a radical change in the understanding of therapeutic relations. The change suggested is far wider than a pragmatic clinical change. According to Lew Aron (1996), the relational approach to the psychoanalytic situation abandons the idea that analysts have preferred knowledge about the patient’s mind or his mental dynamics. As an alternative to this idea, there is a strong commitment to seeing the psychoanalytic situation as a space that enables a shared, mutual, creative process of building meaning. In the analytic state, meaning is not a product of the analyst’s logical processing (secondary process) of the associations expressed by the patient; meaning is perceived as relative, multifaceted, and invincible, with each interpretation subject to ongoing interpretation that has no end point for either the analyst or the patient. Meaning is derived from the relationship and dialogue, or created through negotiations and mutual construction. In Aron’s view meaning is the product of a meeting of minds (1996). It can easily be seen that this concept unveils a radically different image of knowledge than that embraced by traditional psychoanalysis. The relational approach’s revolutionary thinking was an attempt to alter what therapists thought they knew about their patients and, in doing so, to change the therapeutic process altogether. One can say, as did the relationists themselves, that their ideas were not new. Such concepts can be found in the writings of Ferenczi, Rank, Racker Loewald, and others. Many relational ideas also find expression in interpersonal theory, though that theory remained for many years outside the psychoanalytic mainstream in the United States. The notion of observing the inner mind as interpersonal was, after all, conceived by Harry Stack Sullivan, a brilliant theoretician, and it was Erich Fromm who in the 1960s said that the analyst not only cures the patient but is also cured by him (Aron, 1996). If so, what precisely was the innovation introduced by the relationists? Why did the ideas of their predecessors not enjoy the same success and popularity in North America as did those of the relational approach? One of the answers has to do with images of knowledge. The relational approach’s radical conceptualizations were greatly encouraged by a new image of knowledge nurtured by philosophical changes in western culture. These epistemological changes included the erosion of positivism’s dominance and the rise

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of a range of new epistemologies, such as modern hermeneutics, postmodernism, post-structuralism, and feminist theories. As Jon Mills (2012) notes: By closely examining the dialogic interactions and meaning constructions that emerge within the consulting room, relational psychoanalysis has largely embraced the hermeneutic postmodern tradition of questioning the validity of absolute truth claims to knowledge, objective certainty, and positivist science. Meaning, insight, and conventions of interpretation are largely seen as materializing from within the unique contexts and contingencies of interpersonal participation in social events, dialogical discourse, dialectical interaction, mutual negotiation, dyadic creativity, and reciprocally generated co-constructions anchored in an intersubjective process. This redirective shift from uncritically accepting metaphysical realism and independent, objective truth claims to reclaiming the centrality of subjectivity within the parameters of relational exchange has allowed for a reconceptualization of psychoanalytic doctrine and the therapeutic encounter. (p. 3) It is very difficult to assimilate a new and ground-breaking idea that is not backed by a novel image of knowledge accepted by the entire community. This is wellexemplified by a the quote from the late 1950s by Heinrich Racker (1957). It is often cited by relationists and has been tagged by Lew Aron (1996) as psychoanalysis’s “anthem”: The first distortion of truth in “the myth of the analytic situation” is that analysis is an interaction between a sick person and a healthy one. The truth is that it is an interaction between two personalities, in both of which the ego is under pressure from the id, the superego, and the external world; each personality has its internal and external dependences, anxieties, and pathological defenses; each is also a child with its internal parents; and each of these whole personalities—that of the analysand and that of the analyst—responds to every event of the analytic situation. (Racker, 1957, p. 308) Here, Racker is ostensibly writing about a new theory of clinical relations. But beneath the surface there are a set of new epistemological assumptions relating to the perception of truth and suggesting that the therapist has no monopoly over the truth and is subject to the same processes as the patient. However, in Racker’s time, the psychoanalytic community was not yet ready to accept these new conceptualizations, since it still embraced the then generally agreed-upon images of knowledge posited by the scientific world-view. At the time, the community still had faith in the notion of an objective, neutral analyst trying to neutralize his subjectivity. This idea was to alter in Western culture due to social, political, and economic change. At first, these cultural changes permeated into psychoanalysis through modern hermeneutics (Paul Richer, George Klein, Donald Spence, and Roy Schafer).

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Later on, the discipline was even more radically affected by postmodernism and the relational approach. Racker and Ferenczi’s theories were only acknowledged after a profound change had occurred in psychoanalysis’s images of knowledge. It was only after influential streams in Western cultural thought suggested that truth be perceived as essentially unstable, open to interpretation, and dependent on a social, political, and historical context that large numbers of analysts abandoned the classic conceptualization of therapeutic relations and opted for the relational approach. This necessitated the adoption of the view expressed by Aron (1996), according to which meanings that are seen as a product of universal laws lose their value when doubt is cast on the very ideas of objectivity, reality, and truth. Thus, the change in images of knowledge had its origins in the influence of non-analytical ideas on psychoanalytic theory, an influence that came mostly from the world of philosophy and its concept of truth. But how was the new image of knowledge accepted and internalized? Did thousands of therapists begin to take an interest in philosophy and delve deeply into the ideas of key postmodern thinkers and their perceptions of the truth in order to form a new psychoanalytic approach? Of course not. One of the important things that has to be understood about images of knowledge is that they are not acquired consciously and intentionally; they are the outcome of a cultural and social environment that is indirectly internalized. There is no need for one to have any knowledge of philosophy in order to change an image of knowledge. In this instance, what happened was that analysts began to feel uneasy about the psychoanalytic models they had worked with for years, which were perceived as closed, rigid, limited, and monolithic. That was a sufficient reason for a new and more youthful approach to emerge, which brought with it a wind of change offering pluralism and democracy and attracting a mass following. The roots of the new image of knowledge were philosophical and cultural. However, the outcome was far more important than its origins. The process looks like this: in the wake of profound philosophical changes, there are consequential changes in the non-psychoanalytic world’s concepts of truth and its perception of knowledge. A small group of analysts, open to such new ideas and familiar with them, is quick to assimilate the change and develop innovative psychoanalytic conceptualizations (within the relational approach, this small group included Stephen Mitchell, Lew Aron, Irwin Hoffman, Jessica Benjamin, Emmanuel Ghent, and Philip Bromberg). The group quickly understands that this is a real revolution in therapeutic relations and that it will have massive implications. The mass of therapists who follow in their footsteps do not know much about the philosophical sources of these ideas but are quick to agree with the new implications that are more compatible with the spirit of the times. The pragmatic clinical implications were far more important than philosophical abstract ideas. These profound implications signaled an end to the era of the knowing, authoritative therapists who were regarded as holding the key to the patient’s unconscious, an end to a period in which therapists struggled to hide their personalities and blur their subjectivity in order to ensure that the patient’s emotional

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issues were not subjected to the effects of therapists” countertransference. A new era had begun. John Mills (2012) describes it best: One gets the impression that within the consulting room there is generally more dialogue rather than monologue, less interpretation and more active attunement to the process within the dyad, more emphasis on affective experience over conceptual insight, and more interpersonal warmth conveyed by the analyst, thus creating a more emotionally satisfying climate for both involved. No longer do we get an image of the sober, cerebral, emotionally sealed-off analyst who greets the analysand with a curt social acknowledgment, then walks back to his chair saying nothing, standing in thick uncomfortable silence with an expressionless face waiting for the patient to lie on the couch or sit down. Rather we imagine the analytic encounter aspiring toward an interpersonal ideal of relational fulfillment and mutual recognition that serves a nurturing and validating function for both the patient and the therapist, similar to the consummate holding environment envisioned by Winnicott or a milieu of optimal empathic attunement identified by Kohut, with the supplementary exception that the analyst is also recognized, or at least acknowledged, as being a human subject with a distinct personality and needs. (p. 98) The change, then, is not only in abstract philosophy about the nature of analytic knowledge; it is much broader. Psychoanalysis has become less “heavy-handed,” takes itself less seriously, seems less satisfied, freed from being honourable and oldfashioned. Analysts have “thrown away their books” (Hoffman, 1998), which is to say they have become less devoted to teachers and belief systems—the hiding places offered by rules and rituals. They maintain a tension between ritual and spontaneity (Hoffman, 1994). They now talk to their patients and do so as equals, creating a more genuine relationship with them instead of working in line with a system of fixed and rigid principles of interpretation. The relational approach also wrought changes in the dogmatic messages coming from classical American training and encouraged independent thought, experimentation, innovation, spontaneity, creativity, genuine self-expression, humor, and playfulness. It gave therapists the freedom to choose the most appropriate intervention given the unique needs and characteristics of every patient (Mills, 2012).

Irwin Hoffman’s theory The relational approach’s change of the image of knowledge has been described many times in the literature by different writers (Mitchell, Aron, Hoffmann, and Stern). I will describe it here briefly by referring to a number of the central ideas in Irwin Hoffmann’s theory, which is labeled “dialectical constructivism” (1998) and which, more than anything else, is identified with the change that has occurred in the perception of knowledge. Hoffmann termed his method “constructivism”

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because the therapeutic situation constructs a therapeutic reality rather than uncovering a predetermined one. In employing this concept, Hoffmann is also emphasizing the element of choice: the therapist chooses a particular interpretation from a number of options. This choice is influenced by theoretical considerations, but no less by the therapist’s personality, interests, needs, and personal history. Hoffmann believes that there is no way of knowing in advance what the therapist’s reactions will be. There is also no way of knowing if other interventions, not chosen, would have been as good as, or better than, the one selected. In the interaction that develops between two people, nothing is known in advance. The patient’s life story is not hidden and exposed in the course of treatment; it is constructed in the here and now of the immediate therapeutic interactions. Hoffman writes: When we interpret the transference, we like to think that we are merely bringing to the surface what is already “there,” rather than that we are cultivating something in the patient and in the relationship that might not have developed in the same way otherwise . . . If we believe that the analyst is involved in the construction rather than merely the discovery of the patient’s psychic reality, we are confronted with the fact that there is no way to reduce one’s involvement to merely being that of a facilitator of self-awareness or even integration. There is no objective interpretation and there is no affective attunement that is merely responsive to and reflective of what the patient brings to the situation. There is always something personal and theoretical (the theoretical being an aspect of the personal) that is coming from the side of the analyst. (pp. 109-110) It is not simply that a therapist is unable to maintain an objective scientific approach toward his patient; it is that, together with the patient, the therapist is a participant in the therapeutic process. This personal participation significantly influences his understanding of the patient. A therapist’s understanding always depends on his perspective at any given moment. It is an understanding that is vulnerable and influenced by the therapist’s stance. Hence, there cannot be a definitive understanding of the therapeutic relations between the two, because such an understanding will always depend on both therapist and patient and the interaction between them at any given moment. In the therapeutic situation, the therapist’s personal life is no less important to the therapy than is the patient’s personal life. However, instead of trying to neutralize this influence, both sides should unite in the course of their therapeutic exchange, while the analyst maintains his separateness and independence. Hoffman suggests that in the course of treatment therapists should reveal their subjectivity in a genuine way. He encourages them to pass on to their patients insights linked to their experiences in life and their mental realities whenever it seems right. In doing so, Hoffman argues, their presence during the therapy will be felt, and they will be taking responsibility for what has been jointly created between them and the patient in the course of the treatment.

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According to Hoffmann, every interpretation reflects aspects of the therapist’s subjectivity, and no therapeutic intervention can be seen as expressing an objective position. Moreover, in therapy, this facet is perceived as the most positive of all. As Hoffmann (1996) notes: “the personal foundations contained in intervention are exactly those that are most responsible for therapeutic impact” (p. 127). Even for analysts who interpret without expressing anything personal, something of their subjectivity emerges in their interpretations. The idea is that the combination of the personal subjective base and the theoretical technical base produces effective analytic intervention that underlies the forces of change in therapy. When the patient senses that the analyst, in becoming more personally expressive and involved, is departing from an internalized convention of some kind, the patient has reason to feel recognized in a special way. The deviation, whatever its content and whatever the nature of the pressure from the patient, may reflect an emotional engagement on the analyst’s part that is responsive in a unique way to this particular patient. According to Hoffman’s approach, there is no way to tell which element of countertransference belongs to the patient and which to the therapist. In fact, every interpretation is part of countertransference, or at least articulates something of it! After all, we are not speaking of relations between subject and object (Freud’s version) or the relationship between two subjects, where one (the therapist) tries to lessen subjectivity (the object relations approach), but rather of relations between two subjects in ongoing and mutual interaction, of which it cannot be said who started and who is responsible for what (Aron, 1996). As a result of such views, some have even objected to using the word interpretation in the relational context, because this word embodies an asymmetry between someone who knows a great deal and someone who knows less (Bromberg, 1985; Maroda, 1998; Renik, 1993b).

Therapists’ lives are exposed in the presence of patients One can confidently say that the relational approach led to changes in the therapeutic perception of large sections of the psychoanalytic community. The floodgates had opened; everything once considered “sacred” was now questioned. There began an intense, almost obsessive preoccupation with the issue of the therapist’s subjectivity while conducting a therapeutic session—a matter that analysts had been secretive about since Freud and continued to be so until relatively recently (Aron, 1996). Many case studies described the way in which analysts disclosed personal aspects during therapy and presented the rationale for doing so. Therapists began to openly address a wide range of matters such as: the therapist sharing with his patient an association arising in his own mind in the course of the session; an analyst’s immediate emotional reaction to something the patient had said or done; sharing with the patient the emotional responses of the analyst, including issues outside the current analytic interaction (Aron, 1996). Since in each session and intervention

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a different facet of the therapist’s personality was revealed, this significantly influenced the therapeutic relationship. Even disclosure of the therapist’s sexual fantasies about a patient was no longer considered taboo as long as an appropriate rationale was presented (Davies, 1994). An old-new concept made a comeback in the field: enactment. In traditional psychoanalysis (according to an APA panel’s definition), enactment “is the patient’s unconscious efforts to persuade or force the analyst into reciprocal action: a twoparty playing out of the patient’s most fundamental internalized configurations” (Hirsch, 1998: 78). This definition of enactment is closely allied to current conceptualizations of projective identification, where the analyst is pressured to feel and behave in a manner consistent with what the patient has in fantasy projected to him (Feldman, 1997; Ivey, 2008; Spillius, 1992). In contrast, the contemporary approach defines enactment as a continuous, mutual living out of important, mostly unconscious, conflicts and fantasies of both parties in the analytic relationship . . . the ways in which the analytic encounter may be viewed as a complex, overlapping, embedded series of often subtle, unconscious, interactive, mutually constructed dramas that are jointly lived out rather than only spoken of. (Levine and Friedman, 2000, p. 73) This definition stresses mutual responsibility and unconscious participation of analyst and patient in the spontaneity of enactments. The analyst is not merely a passive, unwitting respondent to the patient’s unconscious forces, but an equal participant actively molding the enactment in a way that is dependent on his own unconscious needs and fantasies in an enduring way (Ivey, 2008). Whereas more traditional psychoanalysts perceived enactments as an expression of the harmful consequences of patients falling short of boundary violations, relational therapists appreciate their therapeutic usefulness. On this last point, various relation analysts hold quite differing perspectives. Some posit that enactments can be understood and that the dyadic unconscious can be made conscious. Others think that one enactment simply leads to another, with change occurring even when there is a lack of any significant insight into what was intended or even into what actually happened (Greenberg, 2001). From this perspective, healing through talking became healing through action; what was discussed was also implemented during the process, and what was implemented also required discussion (Aron, 1996, 2003, 2006). From here, it took only a small step to become constantly and repeatedly preoccupied with analyzing the impact of the therapist’s intentional and unintentional self-disclosures on the patient. Some therapists even wrote case studies of situations in which patients helped them get over personal crises they experienced (DiAmbrosio, 2014; Sirote, 2015). All of these cases demonstrated how therapeutically valuable the patient’s impact on the therapist’s personal life was.

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Here is a case study written by Alan Sirote (2015).1 Sirote is a relational therapist, and his vignette nicely illustrates how therapists talk with their patients and think about them. Raphael [the patient] asked, “You know I get the feeling that you just don’t like me. Am I right?” I was . . . stupefied! This question is the therapist’s worst bogeyman. The patient you don’t like asking you if you hate him. Well . . . I’m not supposed to dislike you. How can I? I’m a helping professional; a “good guy,” a mandated healer, a coach, a friend, a confidante, at the very least, a provider. Am I allowed to provide hatred? Confounded and speechless, I sucked in my breath. He sensed my hesitation, smelled blood; a piranha circling its kill. Should I sidestep this? After all, there must be something I like about him that I can share. Or, maybe suggest it isn’t him I dislike, just some of the things he says or does. None of these thoughts felt authentic. Finally, after a long apprehensive pause: “To be honest Raphael, I really don’t!” Thunderstruck. His face now bleached white, he stammered: “This . . . uh  . . . this . . . uh . . . this . . . is the first time in 18 years I’ve ever heard that from any therapist.” (n. p.) In this dramatic example, we see the change that psychoanalysis has undergone as a consequence of the relational approach. The minimal use of psychoanalytic jargon is also evident in this intervention. The focus becomes transference relations, the here and now, the real feelings that the therapist has for the patient. When the therapist speaks, he influences the person he is talking to. The therapist’s interpretation is an interpersonal communicative act and the only way in which the relational analyst can participate in the therapeutic interaction (Aron, 1996). The therapist’s task of revealing the unconscious to make the patient aware of his needs and conflicts is replaced by a unique personal expressiveness within the therapeutic relationship. We can see from this vignette why enactment became so significant and is perceived as virtually equal to the psychoanalytic process. Enactments are interactions of therapist and patient with communicative implications that lead to important insight and can constitute corrective emotional experiences. Enactments that are acknowledged and defined become valuable heightened moments that have condensing, clarifying, and intensifying results upon consciousness (Friedman & Natterson, 1999). Despite the impression created by this example, it is important to note that the therapist himself fully understands the implications of the intervention and shares them with the patient. According to Aron (1996, 2000), relational therapists do not make an effort to initiate enactments. Rather, they try to maintain a balance between participation in the observation and recognition of the fact that the act of observation is in itself a form of participation and that the influences of the enactments must be constantly tested.

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Clinical material When my father died a couple of years ago, I thought about the impact this might have on my patients. I also wondered how I could justify my absence from work during the “Shiva,” the week-long mourning period in Judaism for first-degree relatives. There were two options: I could either waste a great deal of effort trying to hide my feelings and pretend that nothing happened, or I could share the news with my patients. I consulted a therapist—in fact a Kleinian—who answered in an unexpected way: “it would be good for you to share this news with your patients. They will in any case feel it.” I thought that the fact that a Kleinian therapist was suggesting the latter option demonstrated the evident influence of the relational approach on all the psychoanalytic schools. Her approach seemed to me very reasonable. In the end, I did not tell all of my patients about my father’s death. There were some who I feared would be overwhelmed by such information and would gain nothing from being told. In contrast, there were those who very much appreciated my sharing with them such private details. For some among those to whom I reported the news, this was an opportunity to discuss issues linked to their relationship with their fathers that had not been discussed during the therapy. However, there were negative as well as positive consequences resulting from my exposure. One of my patients found it difficult, over a long period of time, to talk about herself while I was mourning the death of my father. For months, at almost every meeting, she would ask me how I was coping with my grieving. I tried to link her difficulty talking about herself to an issue that frequently came up in her therapy: the difficulty she had feeling that she was entitled and had the inner freedom to express her own needs. She always felt that her own needs were secondary to those of others (mainly her mother’s). But these interventions of mine were not well-accepted, and the patient didn’t manage either to forget my grieving or continue to deal with her own issues. This example shows how difficult the work of a relational therapist really is. In the past—when no such disclosure by the therapist was permitted—the rules were clearer, and therapists didn’t have to cope with such dilemmas. Whereas in the past there were “objective” rules that determined which interventions were acceptable and which were not, the boundaries now are far less clear. Therefore, what tips the balance as to what is acceptable is no longer a set of external objective rules, but rather the conscience of the individual therapist. The difference between relational and classical therapists reminds one of the difference between today’s generation of parents and the parents of earlier generations. In the past, the boundaries set by parents were rigid, unambiguous, clear-cut. But the parents were less empathic, open, and attentive to their children’s needs. Today’s therapists are more spontaneous, warm, and less fearful of being open with the patient. The analyst is more fundamentally attentive when his or her subjectivity is recognized as a valid aspect of the therapeutic process. As a result, however, the field of therapeutic interventions is less clear and defined, there is more confusion, “messiness,” less guidance, and the ethical responsibility of the therapist has become far greater.

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It is also important to note that, generally speaking, those who write about the relational approach do not encourage ill-considered analyses or unbridled personal revelations by the therapist. Aron writes that “just as anonymity is not an option for the analyst, nor is full self-exposure . . . what I see as especially problematic are those self-disclosures in which the analyst declares what he feels about the patient in a way that blocks further discussion” (p. 131). An additional contribution to the success of the relational approach was its openness to political, social, and gender-related topics, subjects that had been excluded from psychoanalysis in the past. The relationalists, influenced by the interpersonal approach, conceptualized the inner world as affected not only by early experiences and family dynamics, but also by social factors such as sex, race, and social standing (see Altman, 1995). All of these were seen as also contributing to conscious and unconscious mental states. Some say that even the relationship to nature influences the human mind and that the changing relationships between people and ecosystems affect the intra psychic (see Bodnar, 2008). As strange as it may sound, the relationalists are successors of Freud in one very important way: like him, they too are the product of their era. In much the same way as he had done, they too brought the cultural, philosophical, and social world of their time into psychoanalytic theory. Like the discipline’s founding father, they too were willing to absorb and be influenced by the ambiance of their culture and their epoch. Finally, the relationists followed Freud in taking a keen interest in a huge range of non-psychoanalytical areas of study. It began with their enquiry into infant studies and progressed to include postmodern philosophy and hermeneutics, the philosophy of science, feminist theories, theories of gender and race, and ecological theories. Like Freud, whose curiosity was insatiable, the relationalists also tried to find their way through the maze of varied sources and bodies of knowledge. Though they discovered no new “facts” about infant development or the differing types of psychopathology (facts, we have seen, require the adoption of realism and the correspondence theory of truth, both of which were rejected by the relationists), they most definitely recognized psychoanalysis’s cultural climate and re-conceptualized the therapeutic relationship. In being eclectic and contemporary, the relational approach presented psychoanalysis with two precious gifts. In line with the spirit of the times, it freed analysts from having to commit to a single, consolidated, uniform world-view. It offered them a huge range of perspectives with which they could identify, without requiring them to commit to any particular one. It also provided a sense of belonging to a large population of therapists who had no place they could call “home,” or who held pluralistic views, or who wanted to conduct a dialogue with other streams of thought while at the same time remaining loyal to a specific therapeutic approach. In addition, the relationalists succeeded in updating psychoanalysis, which had stagnated and become stuck in its ways, thus linking it to the conservative modern world of today. Relationality’s interest in social and political development in all areas rejuvenated psychoanalysis and made it relevant to the contemporary world. It replaced an isolated discipline, preoccupied with its purity, with a discipline that

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was vibrant, lively, and capable of self-deprecating humor, involved in the issues of the here and now, such as gender, culture, and politics, and employing images from the world of jazz, literature, and the cinema. Despite the relational approach’s considerable contributions, in Chapter 5 I will comment on the price that psychoanalysis has paid in letting go of realism and the correspondence theory of truth.

Note 1 I thank Alan Sirote for his permission to cite from his case study.

5 THE DIALECTICS OF THE FASCINATED AND THE TROUBLED WITHIN PSYCHOANALYTIC SCHOOLS Stolorow, Joseph, Ferro and Eigan

Up until now, I have drawn a clear dividing line between fascinated and troubled communities. I suggested that fascinated communities progress their knowledge over the course of many years and that the theory and technique of fascinated communities undergo slow processes of change and growth spanning many years. The theoretical changes within a school are the outcome of the endeavors of fascinated analysts who remain loyal to the school’s theoretical framework, but are nonetheless also troubled by a particular aspect of the theory or the therapeutic technique. Moreover, I pointed out, in the introduction, that analysts identified with troubled communities may also be fascinated by their suggested solutions and become dogmatically attached to their proposed explanations. Instead of talking about a binary division of the psychoanalytic world into fascinated and troubled communities, we need to refocus and discuss a dialectic movement within the communities themselves, a movement that alternates between being fascinated and troubled. In this chapter, I shall try to describe what influences the delicate balance of reciprocity between the fascinated and the troubled within various communities. Over time, all psychoanalytic communities undergo change. But what is it within each community that dictates the pace of change and the extent of loyalty to the school’s original conceptualizations? When is the change linked to the theory’s assumptions and world-view, and when is it simply limited to the therapeutic technique being used? Which are the therapeutic and theoretical constituent parts in any given school that can be said to be “firm” and immune to change, and which are the “soft” and bendable components that members of the community seek to vary? After a brief description of the dialectic between fascinated and troubled communities, I describe in more detail about four factors that are to an extent interrelated,

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and that I believe play a significant role in shaping the dialectic between f­ ascination and change. I will then attempt to characterize the dialectics of several of the key communities that are currently dominant: Kohutian, Kleinian, and Bionian. In each community, I will select one or two psychoanalysts whose writings represent a change within a school of thought: Robert Stolorow and his work on selfpsychology; Betty Joseph in relation to Kleinian theory; and Antonino Ferro and Michael Eigen vis-à-vis Bion’s theory. The description of the changes introduced by these analysts will be illustrated with clinical material.

The dialectic between fascinated and troubled communities Dialectic refers to a ubiquitous tension within a process, a pull by contrasting tendencies in opposing directions. A stable equilibrium between fascination and disenchantment is crucial. Too great a shift toward fascination may lead to the stagnation of the original theory, while too great a tendency toward disenchantment might undermine the core defining ideas which the community is centered on. Just as the lack of new discoveries may render psychoanalytic communities irrelevant, so the dismissal of their traditions and their basic body of acquired knowledge leaves them without either a cohesive core or an identity. Every psychoanalytic community has its own checks and balances in relation to dialectics, and each deals differently with the question of how its original theory is to be modified while at the same time remaining loyal to its basic assumptions. The pace of change, the profundity of the variance, and the extent of tolerance with which the changes are accepted differs from one community to another. The Kleinian community, for example, is relatively cohesive; deviations among its members are comparatively rare, so that they are almost always united in their views. On the other hand, there are other communities within which disagreements over the right methods of therapy often erupt. As a result, different psychologies and ways of treatment come into being in the same school. This often leads to a great deal of tension, but the school generally succeeds in containing this plurality and remains united. This is what happened to self-psychology, which, as we shall see, was integrated and of one piece during Kohut’s lifetime. After his death, however, his successors developed his model in various very different directions (Shane & Shane, 1993). Communities I have termed “troubled” are also characterized by a dialectic between the fascinated and the troubled. Followers of the relational approach, for example, began as a community troubled by the one-person psychology of classical psychoanalysis and fiercely advocated a two-person psychology to replace it. It also set itself apart from other dogmatic schools of thought by declaring itself as pluralistic and more open to change. This community is less sensitive to “deviations” because, among other reasons, from the outset it didn’t base itself on a particular set of methodologically defined and uniform assumptions related to development and therapy.

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As Jay Greenberg (2001) aptly noted, “Freudians, Kleinians, and Kohutians do not, to my knowledge, have a theory that builds technical flexibility into the core of its canon, while relational psychoanalysis—much to its credit—does” (p. 425). However, Dimen (2014) notes that even within the relational discipline exists tension. Despite the lack of stiff, unified system of thought and technique, unofficial conceptions of what make up relationality have cohered within the relational approach. Dimen tells of one anecdote: “A patient, herself a relational analyst, asked with a conspirational smile, “Are we allowed to say “I” in relational psychoanalysis? The “analytic police” is everywhere,” we giggled, almost as though, having momentarily escaped the panopticon, we felt it wicked to imagine our canon’s limits” (p. 508). Dimen thinks that: Even where hegemony is overtly disavowed – as in relational psychoanalysis’s openness to a multiple perspectives – a central tendency toward a correct and reductive line of theory emerges. Hence, even though my patient and I “know” better, we experienced a pull, at once syntonic and dystonic, to believe that intersubjectivity is all, which inclines us to feel-not think, but feel – that we can never say “I”, only “we”. We felt governed by an unspoken rule, which somehow seems to be the whole story even if it is itself only half. Regulation may come from a single authority – for example, Freud – or it may come from the tendency of discourses to fold on themselves, of groups to close ranks in self-creation.” (p. 508) What is unique about the relational approach is that relational analysts write papers about their own indoctrination and giggle when caught in an “act of disloyalty” whereas other schools lacks humor and self-critical thought. Critics of the approach (Greenberg, 2001; Mills, 2012) think that some members of the community took the idea of mutuality too far and exaggerated its importance. Greenberg (2001) calls this “psychoanalytic excess,” an uncontrolled use of selfdisclosure, and argues that insistence on openness to such an extent may say more about the needs of the therapist than of the patient. There are also therapists troubled by the assumptions of the approach. For example, there are huge differences and disagreements among relational analysts on core issues like trauma, multiplicity of the self, and whether to adopt an extreme or moderate version of relationality. What factors play a role in the theoretical change of a school of thought over a period of years? What influences the delicately balanced dialectic between the fascinated and the troubled? I wish to point to four such factors.

The images of knowledge of the community Fascinated communities (such as Kleinians and ego psychology) which adhere to a one-person psychology and which believe in realism and the correspondence

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theory of truth tend to be more conservative in their approach and less open to change. Most of these communities believe that there is an operative unconscious with a definite nature of its own. They maintain a degree of epistemic autonomy of subject and object and posit that what goes on inside a single person should be perceived as a more or less closed system.  For many years, such communities tended to protect and maintain the theoretical assumptions linked to psychic structures, developmental stages, and their perception of psychopathology. Why does the perception of the truth influence the extent to which members of a community are inclined to demonstrate their devotion to the original assumptions? The meaning of the correspondence theory of truth is that a verity is discovered rather than construed. Whenever a truth becomes evident, it also becomes firmer, and there is a tendency to stick to it. The truth value of the psychoanalytic concept is strengthened by considerable pragmatic clinical understanding. Thus, for example, the clinical truths related to the schizoparanoid and the depressive positions led to a profound understanding of a vast range of clinical phenomena among regressive and psychotic patients, such as new insights in the understanding of severe regression, envy, manic defenses, and negative therapeutic reaction. It is not only true; it also works—or, one may say, it is true because it works! In contrast to the correspondence theory of truth, truths discovered within the relational approach are more contextual, more specific, and lend themselves to adaptation, abstractions, and changes. Interpretations are always personally expressive of the analyst’s own subjectivity (Aron, 1996). They are never the application of some psychoanalytic truth from a psychoanalytic school, but are always an action by a particular sort of new object, different from early parental figures. Interpretations are never simply informational occurrences; they are always relational happenings, and they change relationships (Mitchell, 1997). Correspondence theory of truth is perceived as naïve (Orange, 1992). This approach endorses other forms of realism, especially those that see truth as progressively growing in a community of inquirers (Peirce, 1877) or in a dialogic community. One version of this communitarian or intersubjective (Bernstein, 1988) realism might be a perspectivalism that would conceive of reality as a socially understood or socially articulated process in which each participant has a perspective that gives entrée to an aspect of reality. There could be an indefinite number of such perspectives. Since we cannot entirely escape the limitations of our own perspective, our view of truth is partial, but dialogue can enhance our access to it (Orange, 1992). In any event, there isn’t an independent authority on the basis of which it is possible to decide that one such system is more valid than another. Clearly, when this is the prevailing outlook, as it is in the case of the relational approach, the approach is much more open to change. It also ensures that the diversity of the people behind the relational approach can hold differing views and respect this difference. However, the phenomenon of fascination exists within this approach too, though this is more a psychological fascination that lacks an epistemological backing.

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“Firm” and “soft” components of a theory Every theory has firm components, which are its pillars. At the same time, there are other elements that are “softer” and less rigid, which can be varied and understood from a number of different perspectives. The firm components are resistant to change and to the capriciousness of the mood of the times, whereas the more malleable parts of the theory constantly change. Sometimes, the firm element is the structure and the soft, alterable component is the narrative. So, for example, the centrality of the life and death instincts is a firm element in Freud’s theory. Everyone who believes in it is a Freudian, even if he doesn’t accept the Oedipal complex. The difference here is that the Drive is the structure, whereas the Oedipal complex is a narrative. In the Freudian case, it is easy to give up or substitute narratives, but much harder to forgo structures. In Klein’s and Bion’s theories, there are different firm assumptions. Both theorists are concerned with unconscious truth and the understanding of it emotionally, verbally, and intellectually, as it comes alive within the analytic situation. However, as we shall see, the therapeutic interventions required to unmask the unconscious truth are in dispute, and the emphases differ from one approach to another. In the relational approach, the firm element is the two-person psychology and the emphasis on different kinds of mutuality in the psychoanalytic relationship. In addition, there is the rejection of the centrality of “drives” when it comes to human motivation. The concept of the “self” is a soft element. Some relationalists champion multiplicity, while others are more committed to the view of an integrated self. It is important to carefully consider the differences between the firm elements of the relational approach and those of the other schools of thought. Many of the firm elements in the traditional schools are connected to “facts,” which relate to psychic structures, stages of childhood development, or reaching an “ideal” therapeutic aim of one kind or another. The firm and unalterable elements of the relational approach, on the other hand, are linked more to loyalty to a certain description of a therapeutic relationship than to a portrayal of psychic structures or developmental stages. A relational therapist will not disqualify a Kleinian interpretation but will always remain faithful to the idea of dyadic reciprocal involvement. In the course of a therapeutic situation, the therapist can enter a state of Bionian Reverie, but at the same time, he will know that even Reverie is an expression of the therapist’s subjectivity. Relational analysts are hardly homogenous with respect to their theoretical perspective. Some of them were trained classically and still adhere to certain characteristics of the classical sensibility; others were trained in a more interpersonal tradition and have moved to integrate it with British  object relations theory as well as Winnicottian and Kleinian theories. Still others who feel an affinity with relational psychoanalysis were trained in the tradition of self-psychology and have moved in the direction of theories that are more intersubjective (see Altman & Davies, 2003).

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Well-defined ideas Theories or parts of theories that are well-defined tend to be more resistant to change than vague and unclear notions. In contrast, vague notions are a source of creativity, since they can be interpreted in many ways depending on the writer’s theoretical aspirations. The more unequivocally a theory is structured, the more the ideas of its founders are well-defined and distinguishable from the ideas of others, so its development is slower. Areas of thinking in which the figure behind a theory is unclear and ambiguous will end up being the areas in which the most significant change occurs. Distinct and clear ideas become firmly rooted and are more resistant to change. Much of this is connected to the style of the thinker’s writing and the nature of his ideas. For example, Klein’s ideas on two developmental states of minds and the dynamic between them—as well as a detailed and well-defined list of defense mechanisms associated with each one of these positions—are clear and defined in an almost scientific style. Much of Klein’s clarity of ideas is the outcome of her representative Hannah Segal, who writes to explain Klein’s ideas with clarity and concision. Most Kleinians begin their knowledge of Klein through what Hinshelwood (2009) termed “Segal’s transparent gaze” (p. 280). This places constraints on the future development of these conceptualizations. It is unlikely that the psychic states of mind presented by Klein will change anytime soon. Ogden (1986) proposed an autistic-contiguous (AC) position as a way to conceptualize a psychological organization more primitive than either the paranoid-schizoid or the depressive position, but as far as I know it was never accepted by the Kleinians. By contrast, many of Winnicott’s contributions are linked to his unique talent of understanding and tolerating contradictory and paradoxical tensions without having to arrive at an absolute conclusion. Perhaps this is the reason why Winnicott can be a source of inspiration for various kinds of therapeutic work both relational and classical, and why it is hard to link him to just one therapeutic position. Many of Bion’s ideas are written in a poetic style and are open to various interpretations and many perspectives. The mystical aspects that appear in his later writings add to his mysteriousness and the possibility of interpreting him in many and different ways. “O” is perhaps Bion’s most influential conception and one of the most elusive ideas in psychoanalytic literature. It has captured the minds of many writers of different orientations. Bion himself refers to it by different terms: “Absolute Truth,” “Ultimate Reality,” or “reverence and awe”; when supernaturally personified, it is called “God.” The “Keter-Ayn-Sof” of the Zohar Kabbalah translated it as “Nothing” (Scholem, 1960). Kohut, like Klein, cited clear and distinct stages of childhood development and clearly articulated the various functions of the self-object, which most of his successors tend to accept. However, many of them further develop his ideas in many different directions. In Kohut’s case, the vague area, and the one open to change, is connected to his epistemology. Though Kohut offered a positivist philosophy to which he remained loyal until the end of his life, he also had a huge commitment to the validation of the patient’s subjectivity through empathy, which is

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to say, through the subjectivity of the therapist. Therefore, his epistemology was not clear-cut, and seemingly formed a bridge between conservative positivist epistemology and contemporary postmodern epistemology (Govrin, 2004; Teicholz, 1999). This led Kohut’s different disciples to develop his theory in these three directions: the traditional, the intersubjective, and the relational (Goldberg, 1998). Alongside those who supported empirical research and a scientific view of the psyche (such as Basch), there was also the intersubjective group (such as Stolorow, Atwood, and Orange) who adopted a postmodernist epistemology.

The character of a community The circumstances in which a school of thought was founded also determine the extent of loyalty to its original conceptualizations and their development in new directions. Communities whose emergence was accompanied by opposition and a significant degree of hostility on the part of the broader psychoanalytic community developed a siege mentality and became tightly knit and cohesive. This applied to the Kleinian group, which triggered great animosity within the British Institute over a period of many years, and which was hounded in the United States by the psychoanalytic mainstream establishment (Kirsner, 2000). Self psychology also encountered belligerent opposition from a conservative establishment (see Chapter 7), which led to a high level of cohesion among the members of the community during Kohut’s lifetime. Victoria Hamilton (1996) conducted a survey among a broad range of theoretical orientations. These included classical and contemporary Freudians, ego psychologists, British Independents and Kleinians, American interpersonalists, self psychologists, and intersubjectivists. She found that the Kleinians and Kohutians, despite the theoretical antagonism between them, were substantively quite similar in the way in which their respective groups were functionally structured. They “appeared to be the most cohesive groups, acknowledging much less influence by any other sources of influence” (Hamilton, 1996, p. 15). Sorenson (2000) notes that In a sense, the two groups with growing numbers in Great Britain and the United States were the fundamentalists: they interpreted everything from one cohesive theory, cited those from within their own camps often, and generally ignored those outside except as these could serve as object lessons to demonstrate the folly of alternative views. (p. 858) In my view, the self-psychology community has succeeded in emerging from its solitude. This becomes evident from its numerous internal disputes and the different outlooks it holds that relate to motivation, the origin of aggression, the group’s reliance on infant research, its perception of self, and so on. In contrast, the Kleinian group is more zealously protective of its original conceptualizations, and within this group, there are changes of emphases but no real differences of opinion. This group eulogizes its attachment to the truths it has discovered.

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Troubled therapists within psychoanalytic schools: Robert Stolorow, Betty Joseph, Antonino Ferro, and Michael Eigen Let us now look at the dialectics within the various schools in more detail so as to examine up close the subtle game of reciprocity between the fascinated and the troubled. Through clinical examples, we will investigate changes brought about in three quite separate schools by a number of different analysts: Robert Stolorow in the self-psychology community; Betty Joseph in the Kleinian community; and Antonino Ferro and Michael Eigen in the Bionian community.

The self-psychology community: Robert Stolorow Immediately after Kohut’s death, self-psychology’s supporters began to develop his thinking along various new lines that were not necessarily faithful to the ideas of the founding father. As a result, self-psychology today is not a unified theory. Although Kohut’s work has been a source of motivation and vision, self-psychology  is constantly being revised and expanded (Beebe & Lachmann, 1995). That is not to say that the innovators were unopposed. Robert Stolorow (1995) divided the supporters of self-psychology into two main camps: loyalists and the expansionists. The loyalists tended to belong to a circle of students and patients who had close and personal relations with Kohut. Most of the expansionists, on the other hand, only knew Kohut from a distance, mainly from his writings. As a matter of fact, loyalists from the first generation lived in the geographical areas closest to where Kohut lived, whereas the expansionists hailed from far more distant places. According to Stolorow, for the loyalists, Kohut is the dominant authority, and they tend to be scornful of the contributions made by the expansionists. Their claim is that the expansions are unoriginal and can all be found in Kohut’s own writings. Stolorow (1995) describes one of Kohut’s most prominent loyalists thus: Paul Ornstein (1994, personal communication) has even gone so far as to declare that people are interested in the theory of intersubjectivity mostly because they  “do not know and do not read and do not fully understand Kohut’s writings.”  Kohutian loyalists seem unaware or unconcerned that they respond to expansionists in much the same manner that the Freudian loyalists responded to Kohut. (p. xii) My impression is that the influence of the expansionists is currently growing and that the theory’s followers have become proud of its pluralism and the range of ideas and directions that characterize it. Thus, for example, in the first issue of the International Journal of Psychoanalytic Self Psychology, its editor, William Coburn, announced the journal’s readiness to be accessible to a variety of self psychologies and that openness and pluralism represented the self-psychology community’s consensual views.

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Commenting on self psychologists,1 Shane and Shane (1993) aptly note that they are “less interested in sounding like one another, or Kohut, than in clearly defining and putting forth their own views” (p. 795). They posit that “there are many self psychologies, not just one, reflecting not only the state of psychoanalysis in general, but also the vigor and ferment that constitute health in any growing and changing science” (p. 795). It would seem that the self-psychology community extols the virtues of the plurality of theories within the school. As Arnold Goldberg (1998), one of the leading representatives of the approach, has written, “efforts to diminish differences or to integrate disparate ideas into some sort of uniformity could turn out not to be in the best interests of the field” (p. 254). There are various reasons why, far more than any other community, selfpsychology has become so diversely pluralistic and characterized by such a multiplicity of voices. It would seem that the central figures in the community, such as Arnold Goldberg, Morton and Estelle Shane, and Beebe and Lachmann, very much valued this multiplicity and were proud of the pluralistic tendency. Selfpsychology’s internal pluralism is also an outcome of the position taken up by Kohut himself. It would seem that Kohut encouraged his supporters to develop and expand his theories: What a new system of thought in psychology needs in order to establish the relevance and accuracy of its explanatory approach is not only the concreteness and realism of the innovator and of his close co-workers and friends, but the confirmatory response of workers at a distance from the innovator, of individuals who are not exposed to frequent contact with the teacher figure, and whose views are not influenced by the feelings of loyalty and devotion toward the leader which inevitably arise under these circumstances. (1979, pp. 472-473) Thus, for example, Kohut revealed an affinity toward Stolorow’s ideas despite the differences of views between them. Stolorow (2010) tells of one such encounter: At one point, I was disagreeing with him about some theoretical issue, and he slapped me on the leg and, with what seemed to me to be mock exasperation, exclaimed, “Bob, you’re a reluctant self psychologist!” Then he corrected himself, voicing encouragement in the way that I had come to know to be characteristic of him, saying, “No, it’s very important that you have your own ideas.” (p. 181) Similarly, in a note dated November 12, 1981, composed after Kohut’s memorial service, his widow, Betty, wrote to Stolorow: “I’m sure Heinz told you, either directly or indirectly, how much you meant to him and how he admired you because, while understanding his work, you went about your own” (p. 182). In fact, the founding father himself encouraged his disciples to develop their own lines of enquiry and expand the theory. He chose not to appoint analysts preferred

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by him to be on guard and oppose any change that deviated from the authorized theory. That, in and of itself, played a major role in fostering the multiplicity of voices within the movement that is so evident today. In psychoanalysis, Stolorow is undoubtedly the most interesting and unique example of an expansionist. His contribution to self-psychology in particular, and to psychoanalytic community in general, is remarkable. Indeed, the majority of expansionists tend to seek clinical rather than epistemological expansion. The contribution made by Ernst Wolf and other like-minded self-psychology expansionists is undoubtedly important. However, it is strictly limited to clinical issues and does not touch upon the broader question of a school’s world-view. For example, to Kohut’s list of three transferences (the mirror transference, the idealizing transference, and the alter-ego transient transference), Ernst Wolf (Hunter, 1992) added the ally-antagonist transference and the adversarial transference, an essential aspect of any important self-object experience. He also added the efficacy experience, the experience of being able to make an impression. When it came to epistemological issues, those involved in the expansion of Kohut’s theories remained loyal to the conservative epistemology. For example, Wolf (1983) suggested that “we oscillate between extrospective and introspective modes of gathering data” (p. 685), observing sometimes from outside and sometimes from within the patient’s own subjective world. Shane and Shane  (1986) proposed that psychoanalytic work derives not only from the subjective world of the patient and the intersubjective experiences that take place during the therapeutic process, but also from “the objective knowledge possessed by the analyst of the patient’s life and of human development and human psychological functioning” (p. 148). And Basch (1988) maintained that psychoanalytic explanations must be grounded in experimentally validated and objectively obtained knowledge of the functioning of the brain. Stolorow, along with his colleagues George Atwood, Bernard Brandchaft, and Donna Orange, are interested in a much broader expansion then clinical additions. As we shall see, Stolorow and his colleagues showed an enormous interest in the world-views behind any psychoanalytic theory in their first published books and papers. This too is uncharacteristic of those who seek to expand psychoanalytic theories. Unlike other expansionists, Stolorow, over a period of many years, constantly emphasized the differences between his and Kohut’s ideas. This was an unheard-of approach within fascinated communities. The fact that Stolorow calls his approach by a different name—the intersubjective approach—is also a highly unusual step. Therefore, there is a question mark hanging over whether the intersubjective approach is a version of self-psychology or whether it is an independent theory. In the 1990s, Stolorow and his colleagues wanted to separate themselves from self-psychology and be recognized as new players on the map, developing an independent psychoanalytic approach. Orange (1999) defined the connection between the intersubjective approach and self-psychology as a “family resemblance.”2 The conceptualizations of Stolorow and his colleagues developed in

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parallel with, but without any connection to, Kohut’s self-psychology. In their early ­psycho-­biographical research at the end of the 1970s, Stolorow and Atwood (1979)—long before they got to know Kohut—indicated that the meta-psychology of such thinkers as Freud, Jung, Reich, and Rank stemmed directly from the subjective worlds of their authors. From this, they concluded that what psychoanalysis needed was a theory of subjectivity—a unifying framework that could deal with a variety of clinical phenomena as well as the theories themselves. Kohut’s approach had been revolutionary in that it emphasized the empathicintrospective stance as the hallmark of psychoanalytic  inquiry and the dominant role of self-experience as a motivational force. Yet when compared to the revolutionary clinical theory suggested by Kohut, his epistemological views were fairly conservative. In his latter writings, Kohut admits the impossibility of ever reaching an absolutely objective truth and is even willing to concede the influence the observer may have on the observed. Nonetheless, he still considered the analyst’s potential ability to reach the truth as an ideal and continued to think that the obstacle that stood in the way of reaching the truth was the subjectivity of the analyst. Kohut never withdrew from his initial view that an objective truth existed and that, for the therapist, its discovery was a desirable ideal. In addition, Kohut described the self as a stable universal and determining structure that includes a kind of innate nuclear program that can be realized by an empathic environment. This description of the self indicates a loyalty to what Stolorow and Atwood (1994) termed the “isolated mind” world-view, which makes a clear distinction between the intrapsychic and the interpersonal and between subject and object. It was precisely this isolated mind that Stolorow and his colleagues’ theory of intersubjectivity was intended to alter. In 1995, he published a paper called “An Intersubjective View of Self Psychology”, a title that is the best depiction of the similarities and differences between the intersubjective approach and self-­ psychology. The intersubjective field is defined as system of reciprocal mutual influence: “Not only does the patient turn to the analyst for selfobject experiences, but the analyst also turns to the patient for such experiences and a parallel statement can be made about the child-caregiver system as well” (Stolorow & Atwood, 1995, p. 395). Stolorow and Atwood (1992) believed that one can only understand psychological phenomena within their intersubjective context. They defined psychoanalysis as the science of intersubjectivity, which focuses on the reciprocal game between the two worlds of observer and observed that are separately organized. In his view, the stand of the observer is always from within the intersubjective field and not outside it. This fact ensures the centrality of empathy and introspection as the exclusive methods of research. Stolorow positioned himself as an opponent of the isolated mind tradition, a tradition that in his view is common to Freud, Hartman, Schafer, Kernberg, Sullivan, and Kohut. He believed that remnants of this tradition could even be found in the postmodernist writings of Steven Mitchell. Stolorow (1995) and Stolorow and Atwood (1992) criticized Kohut for seeing the self as an independent existential entity containing an innate nuclear program, waiting for an empathic environment

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in order to realize its unfulfilled potential, suggesting that the intersubjective approach paved the way for a new epistemology: The pervasive reifications of the concepts of the self, the selfobject, and the self-selfobject relationship threatens to transform self-psychology into just the sort of crude interpersonalism or social interactionism that Kohut wished to eschew. A solution of this quandary can be found in the perspective of intersubjectivity. The concept of an intersubjective system brings to focus both the individual’s world of inner experience and its embeddedness with other such worlds in a continual flow of reciprocal mutual influence. In this vision the gap between the intrapsychic and interpersonal realm is closed, and, indeed, the old dichotomy between them is rendered obsolete. (Stolorow, 1995, p. 394) Like the relational approach, the intersubjective view diverges from  other  psychoanalytic theories in that it does not posit a specific theory of developmental stages. Instead, it is a sensitivity, offering broad methodological and epistemological principles for investigating and comprehending the intersubjective contexts in which psychological phenomena arise (Stolorow & Atwood, 1996). With regard to psychological development, for example, Stolorow and Atwood (1992) have suggested that the “organization of the child’s experience must be seen as a property of the child-caregiver system of mutual regulation” ( p. 23) and that it is the “recurring patterns of intersubjective transaction within the developmental system [that] result in the establishment of invariant principles that unconsciously organize the child’s subsequent experiences” (p. 24). The dialectic between a one-person and a two-person psychology is expressed in the intersubjective approach’s perception of the unconscious. In my opinion, the unconscious is a product of a “one-person psychology,” which emphasizes a private, hidden, intrapsychic aspect of a person. This concept, which is common to all psychoanalytic schools, is a problem for the intersubjective approach because a person’s unconscious is inaccessible to others and doesn’t directly express itself in a social context or interpersonal encounter. And yet, for Stolorow—though not for the majority of relational writers—the unconscious was a central concept, despite the contradictory implications it had for their approach’s key assumptions. Conceivably, this centrality is also a response to the criticism leveled at Kohut for attaching so little importance to the unconscious (Kernberg, 1982). The intersubjective approach (Stolorow & Atwood, 1992) distinguishes between three kinds of unconscious: the prereflective unconscious, which develops in the wake of reciprocal activity between the infant and its parents; the dynamic unconscious, which includes experiences that threatened the needs of the self and put them at risk; and the unvalidated unconscious, which includes experiences that could not be voiced because they never evoked the requisite validating responsiveness from the surround. The  dynamic  unconscious  is seen as consisting “not of repressed instinctual drive derivatives, but of affect states that have been defensively walled off because

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they failed to evoke attuned responsiveness from the early surround” (Stolorow, Atwood & Brandchaft, 1992, p. 26). This defensive sequestering of central affective states, which attempts to protect against retraumatization, is the principal source of resistance in psychoanalytic treatment. The emphasis on the unconscious in this approach is evidence to the fact that the intersubjective also includes components of the isolated mind. In the final analysis, however, this approach is forced to admit that there is a private, inaccessible part of a person that is beyond the reach of intersubjective contexts. Of course, this begs the question: How can the therapist, who is supposed to learn about the patient solely by means of empathy and introspection, learn about the patient’s unconscious which, by its very nature, is not accessible to experience? According to the intersubjective approach (Stolorow, Atwood, & Brandchaft, 1992), therapeutic  action  varies for each of the three states of  unconsciousness.  Psychoanalysis is first and foremost a method for revealing the prereflective  unconscious, and it achieves this aim by exploring the ways in which the patient’s experience of the analyst and his or her activities is unconsciously and persistently patterned by the patient “according to developmentally preformed meanings and invariant themes” (Stolorow et al. 1992, p. 28). The dynamic unconscious  is treaded mainly through  analysis  of  resistance, the investigation of the patient’s anxieties in the transference: if his or her central affective states and developmental longings are exposed to the analyst, they will encounter the same disappointment and frustration that they received from the original caregivers. Analysis of the realm of the unvalidated unconscious is particularly significant in the therapy of patients who have undergone severe developmental deficits in the expression of perceptual and affective experience: These are patients, often prone to fragmented, disorganized, or psychosomatic states, for whom broad areas of early experience failed to evoke validating attunement from caregivers and, consequently, whose perceptions remain ill-defined and precariously held, easily usurped by the judgments of others, and whose  affects  tend to be felt as diffuse bodily states rather than as cognitively elaborated feelings. In such cases, the analyst’s investigation of and attunement to the patient’s inner experiences, always from within the patient’s perspective, serves to articulate and consolidate the patient’s subjective reality, crystallizing the patient’s experience, lifting it to higher levels of organization, and strengthening the patient’s confidence in its validity. This, we contend, is a foundation stone of the sense of self, a selfobject function so vital and basic that we designate its appearance in  analysis  by a specific term—the  self-delineating selfobject transference. (Stolorow et al. 1992, pp. 28-29) As noted above, insofar as the intersubjective approach is concerned, psychoanalytic therapy crucially depends on reformulating the principles that organize our experiences. These alternative principles, it is argued, would expand the patient’s

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experiential horizons, as well as make those experiences richer, more manageable, and more varied (Stolorow, 1994). In this emphasis on the unconscious, one can see a very interesting combination of conservatism and innovation. On the one hand, the analyst’s main work remains the exposure of the unconscious and overcoming resistance, exactly as in Freud’s classic technique. On the other hand, the contents of the unconscious in this approach differ greatly from those of the Freudian unconscious. They include experiences that were repressed not because of forbidden sexual drives but because they were not empathically validated by the person’s immediate surroundings. The raising into awareness of repressed material remains central to the therapy. However, it takes place in an intersubjective-experiential-emotional context as a result of an empathic and attentive environment and not through interpretation. The innovative component also lies in the intersubjective view that the patient’s psychological structure is neither a sufficient basis for assessing any given analysis, nor is it sufficient to understand the patient’s suffering. That had to be viewed as being a property belonging jointly to the patient-analyst system—in other words, the extent to which the match between what a particular patient most needs the analyst to have understood and what a particular analyst is capable of understanding. The theoretical place where Stolorow is most troubled by existing psychoanalytic theory is nowhere more evident than in his approach to emotional trauma (Stolorow, 2008). From an intersubjective view, trauma is perceived not as an instinctual flooding of a damaged Cartesian container but as an horrendous experience. Furthermore, the intolerability of affect states can be grasped only in terms of the relational systems in which they are sensed: Developmental trauma originates within a formative intersubjective context whose central feature is malattunement to painful affect—a breakdown of the  child-caregiver system of mutual regulation. This leads to the child’s loss of affectintegrating capacity and thereby to an unbearable, overwhelmed, disorganized state. Painful or frightening  affect  becomes enduringly traumatic when the attunement that the child needs to assist in its tolerance, and integration is profoundly absent. (Stolorow, 2008, p. 114) Like Freud, intersubjectivists think that the essence of trauma is embedded in an unbearable affect. However, the inability to cope with the affect is not just (or in any major way) connected to the intensity of the painful feelings caused by the hurtful event. Instead, the child’s emotional experiences are regulated by a parentchild system. A trauma that occurs at an early age has it origin in a formative intersubjective context, the main component of which is a failure in affect attunement. The trauma is not the event itself, but rather a crisis in the parent-child system, which was supposed to reciprocally regulate the painful feelings. This failure leads the child into a catastrophic emotional state. The painful or frightening feeling becomes traumatic only when the emotional responsiveness that the child needs in order to overcome, contain, and control the painful feelings is not forthcoming.

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In other words, it is not the event itself that is traumatic, but the failure of the environment to respond to it. As a consequence of this failure, the child is likely to doubt the reality of the events that befell him. Stolorow (2008) recounts the story of a therapist who brought to supervision an analysis of a young patient who in her childhood had been subjected to a prolonged period of sexual abuse by her father. At the beginning of the analysis, every time the patient began to remember and describe the sexual abuse, her arms and upper body would tremble; at times, she would be gripped by an intensive shaking of her entire body. In addition, the patient would blush, her face flushed. The patient’s trembling greatly agitated Stolorow’s supervisee, who looked for ways to calm her down. Stolorow thought that the trembling was a physical response to a traumatic situation and that the blushing was linked to a feeling of shame that gripped the patient whenever her physical responses became visible during therapy. He suggested that the supervisee focus on the flushing rather than the trembling. As a result of this altered focus, the patient began to talk about how she perceived her therapist while she was trembling: she was sure that the therapist was contemptuous of her and regarded her as nothing more than a damaged human wreck. Under Stolorow’s supervision, the therapist calmed her patient down by responding to her with empathy and understanding rather than contempt. As a result, both the blushing and trembling considerably lessened. The trembling was replaced by words, and the patient began to talk about her terror of the annihilating intrusion she was suffering. In this case, we can see that what led to the change was a typical Kohutian empathic response, with which most members of the self-psychology community would be able to identify. There is no sign here of some unusual intersubjective therapeutic intervention. This example shows it is not inevitable that every new meta-psychological line of thought also has far-reaching clinical implications. Had we not known that the supervisor was an intersubjectivist, we could easily have erred and thought that he was a classic self psychologist. The differences are to be found at the explanatory level, the broader cultural thought and the more abstract metatheoretical level. Self-psychology would have set about explaining the change in the supervisee’s patient as being the result of the therapeutic healing effect of an empathic response in its broadest sense—empathy as therapeutic action. In contrast, the intersubjective approach understands the origin of the trauma as having been the shameful response of the mother and her refusal to relate empathically to the father’s abuse of his daughter. The failure was not in the lack of empathy per se, but rather in the intersubjective context in which the traumatic experiences become dissociative and frozen into nameless bodily symptoms. It was only when her analyst became established as an attuned, understanding  presence that the patient was able transform her feelings into a nameable terror. In this, we see not only the Kohutian roots of the intersubjective approach, but also the fact that, at times, the same clinical interventions are set in motion by differing factors. From the perspective of the intersubjective approach, the intervention didn’t occur between two separate people but rather within the dyad as an emotional unit,

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a dyad constituting a single entity. In self-psychology, the empathy is realized in the context of object relations between two separate people. We recognize the separateness of the two when one of them understands the other. In contrast to this, in the intersubjective approach, the two function as one unit. The difference between the two is the difference between the perception of the mother and infant as a couple composed of two people and viewing them as a unit in and of itself.

The Kleinian community: Betty Joseph While the vast majority of the self-psychology community celebrates its pluralism, the Kleinian community extols its fidelity to Klein’s original conceptualizations. It would seem that members of the community believe that the fact that the original conceptualizations have survived over such a long period of time is evidence of their veracity. In 2010, an international forum of leading spokespeople from this community convened to discuss what had happened to Klein’s ideas and the Kleinian community in recent years. The forum’s conclusion was that: The concepts originated by Klein have been expanded in certain respects but not replaced. The basic tenets of (a) the origins and initial harshness of the super-ego, (b) object relations from birth or before, and (c) projection, introjection and identification as the fundamental processes of development, all remain. (Hinshelwood, 2012, p. 741) Albert Mason (in Hinshelwood, 2012) listed the distinctive features of Kleinian thinking and practice as they appear today. Among others these features included: the emphasis on the here-and-now; a stress in interpretations on functions rather than parts (particularly bodily ones); the relationship between the paranoid-schizoid and depressive position states of mind; Rosenfeld’s understanding of the psychotic’s “living inside the object”; Bion’s distinction between thinking to understand thoughts and thinking to produce thoughts; Donald Meltzer’s emphasis on the baby in the room during analysis; Esther Bick’s introduction of infant observation and the conceptualization of the skin as representing a foundational psychological structure; Elizabeth Spillius’s work on envy (and her studies on Melanie Klein’s archives); and Betty Joseph’s widely acknowledged development of technique. The innovations can be subdivided into a number of groups: innovations connected to therapeutic technique and the work of the therapist; innovations linked to the expansion of Klein’s conceptualizations; and, innovations connected to the conceptualization of new clinical phenomena. This listing of innovations has a number of remarkable features. First, the majority of them were introduced many decades ago. This fact is liable to foster the mistaken impression that nothing has happened in the intervening years. The truth, however, is different. Changes are assimilated by this community only very slowly. In all likelihood, new conceptualizations currently being suggested in articles and conferences will only be properly assimilated many years from now.

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Second, the suggested changes do not touch upon either epistemological issues or world-views. Kleinian theory is intimately linked to and inseparable from realism, the search for the truth, and the correspondence theory of truth. If you accept that Klein discovered truth and that the mental image corresponds to the actual image of the mind, then it becomes very difficult to replace it with new conceptualizations. Moreover, the search for truth is also the aim of Kleinian psychoanalytic therapy. These points of view are often expressed by Kleinians (Bell, 2009; Hinshelwood, 2013). For example, Segal (2006) argues that the analyst has just one main function: to uncover the truth of the intrapsychic world and make it accessible to the patient. The central aim of the therapy, claims Segal, is: To bring about change through gradually coming to know and withstand truth. Rather than speak of truth in terms of “illumination,” I prefer to use as guidance something Bion, Rosenfeld, and I formulated: that psychoanalysis shares the world-view of science, which has as its aim to see life “as it is,” and that what is peculiar to psychoanalysis is that in its scientific endeavor, in its steady pursuit of truth, it is in itself restorative. (p. 290) What Segal’s view demonstrates is the way in which images of knowledge permeate the very essence of psychoanalytic therapy. If a theory is capable of nearing the truth in its description of the mental world, then the patient must also aspire to reach that objective. Third, as a consequence of this perception of truth, changes in Kleinian theory are restricted to the narrow filed of the theory itself—discovering new facts with the existing theory, expanding the current Kleinian understanding to new clinical phenomena. It does not pre-occupy itself with questions about knowledge. The community is very satisfied with its “discovery of the truth.” It gets pleasure from its real discoveries and does not feel a need to search for any additional truths and certainly not truths from other fields of knowledge. Analysts such Ogden, Grotstein, and Bion, who “breached” the Kleinian conceptualizations for other views, are not mentioned among the community’s innovators apart from in those places where their conceptualizations correspond to Klein’s original theses. Kleinian theory sometimes appears to be so antiquated because it doesn’t incorporate a single new idea from any other bodies of knowledge, from philosophy, or from new scientific discoveries thus excluding the living, developing and everchanging world beyond its own boundaries. Fourth, it is a tradition within the Kleinian movement to demand the fidelity of its members. It is conceivable that this is in some way linked to Klein’s own authoritative character or to the strong opposition that Kleinian theory aroused within the British Psychoanalytic Society during the 1940s. This forced Klein to assemble a group of supporters who shared the basic assumptions of the theory. As Joseph (2006) described in an interview published by the Melanie Klein Trust internet site, while there were indeed members developing their own ideas,

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Klein had assembled a group of loyal followers around her and did so with a firm hand. Despite her age, she ensured that nothing of importance happening at the Institute—be it political, analytic, or any other matter—passed her by. Whatever had to be done to uphold her theory, she was there to do it. In so doing, said Joseph, Klein was firm, yet that clearly didn’t prevent others from developing their own ideas. But the ambition to unite around one common substantive fundament and the sense of struggle was not just a characteristic of the first period of the Kleinian theory. As Blass (2010) writes: The different Kleinian perspectives are not readily integrated or blended within a comprehensive formulation whereby they are both applied at different times or in degrees. However, I think that the understanding of the differences together with the recognition of a commitment to a shared foundation, to a common struggle, allows for their actual or lived coexistence in our analytic thinking and work. It allows us to live with the divergent views and contend with them in a way which, in my experience, is enriching. (p. 1154) In light of this, we couldn’t expect the most important innovator of Klein’s therapeutic technique, Betty Joseph, to challenge Klein’s original assumptions. Joseph was a modest thinker who tended to discount the importance of the change for which she was responsible. In interviews, she often emphasized that one shouldn’t view her suggested therapeutic technique as a revolutionary breakthrough. Instead, she asked that it be regarded as a natural evolution of Klein’s therapeutic technique. Troubled analysts in well-integrated communities tend to minimize the importance of the differences of view between members of the community. In a 2006 interview with Daniel Pick and Jane Milton,3 Joseph was asked about differences of technique between her and Hanna Segal. She conceded that though there were some differences, they were small, and that there was a tendency among commentators to exaggerate the disparity between them. The impression given at times in the course of this interview is that Joseph is claiming that she had emphasized various aspects of the therapeutic technique only because of her limitations as a therapist and that she lacked the therapeutic skills possessed by Klein and Segal. She told her interviewers that theoretically and even clinically, Segal had a more immediate grasp of unconscious fantasy than she did. This understanding was, in Joseph’s view, highly spontaneous and displayed a real gift that Segal had. She thought that this enabled Segal to reach the deeper layers more quickly and easily, whereas her own inclination was to work from the top and go very slowly down. In the interview, Joseph explains what it was that led her to want to change Klein and Segal’s therapeutic technique. Later in the same interview, she was asked what she thought would most surprise people about meeting Klein face to face rather than through her writings or her historical reputation. Joseph thought that

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Klein’s writings didn’t altogether revealed her liveliness, and that sometimes they appeared to be repetitive or dry. Moreover, when one read, for example, Narrative of a Child Analysis, one got the feeling that the interpretations are often so immediately deep that you couldn’t entirely see how it would work for the patient. However, Joseph added, anyone who knew Klein was able to see that her technique would work. From this, we can gather that Joseph thought something in the therapeutic technique Klein had described in her writings “wasn’t quite working.” However, Joseph was always scrupulous about giving Klein the credit. Jane Milton put it to her that Klein must have been using her countertransference very sensitively, but that she simply hadn’t gone as far as conceptualizing it. Though that was true, Joseph replied: I do think that the way we are using it now is a bit different. For example the kind of stress that we tend to put on the analyst’s observing carefully what is being aroused in himself and how he may be being influenced by what is going on and pushed unconsciously into some kind of enactment, the weight we give to this is I think an important development. Klein must have used it – and you can see examples in her work – she could sense what was going on and clearly used this sensitivity enormously – but I wonder how she would have felt about the current developments. . . . . I think the main difference being that most of us today would make less immediate interpretations to deeply unconscious phantasies, especially connected with bodily parts. (Milton & Pick, 2006, n.p.) So Joseph discovered that something in the Kleinian treatment didn’t work. What had failed, as Joseph saw it, was the attempt to raise into consciousness the deep fantasies of the unconscious. In traditional Kleinian therapy, the patient would bring clinical material about his life, whereas the therapist would interpret the material in line with the unconscious fantasies he had uncovered in the manifest material. What didn’t work therefore was past-to-present transference interpretations in order to effect  psychic change. Joseph discovered this method’s lack of efficiency, especially amongst patients who were difficult to reach. Such patients tended to accept Kleinian interpretations and use them in a defensive way. But how did Joseph resolve the problem she’d pinpointed? Joseph made interpretations that grew out of what the patient said or did in the sessions, keeping the patient’s history in mind but not letting it lead interpretations. She tried to understand why something is being said now, in this way, and what impact it may have or be designed to have in the analytic relationship. Joseph posited that by working mostly in the present, there is more direct contact with the inner world, and both patient and analyst can be aware to such psychic processes as how anxiety arises or decreases, how defenses are mobilized or lessen. In this technique, the analyst attempts to effect psychic change by widening the ego’s perceiving functions through emphasis on the here and now rather than count

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on more theoretical explanations (Joseph, 2013). As Aguayo (2011) has indicated, “The analytic language was now cast more in the form of “you and I” rather than “breast and mouth’” (p. 1126). The bold step taken by Joseph of abandoning direct remembrance of the past through transference relations is reminiscent of Freud’s move. Freud and Klein were certain of the validity of the theory of development. They were so enthusiastic at having discovered the “truth” of early childhood that they were certain that their theory of developmental stages would be fully and directly exposed during therapy through the patient’s memories. Freud, as revealed in his letters from 1897 to Wilhelm Fleiss, tried to convince some of his patients, almost by force, to accept the etiological explanation that he thought was linked to the development of neurosis. Finally, when he understood that there would be no direct remembrance, he replaced it with another technique, —transference neurosis. In the end, Freud sobered up from his fascination with this approach and understood that present-past interpretations are not well-accepted because the patient is very distanced from them, doesn’t remember the event the therapist presents to him, and the talk about the past becomes far too intellectual. After that, Freud refined the method, exploring the “past” through the “here and now” repetition revealed in transference relations. Freud (1914) discussed the process he had gone through in his article “Remembering, Repeating and Working-Through,” where he described how he had abandoned cathartic hypnosis and the method of direct remembrance in favor of remembering through action. Instead of the patient remembering or being made to remember his early trauma, he acts it out through transference relations: We have learnt that the patient repeats instead of remembering, and repeats under the conditions of resistance. We may now ask what it is that he in fact repeats or acts out. The answer is that he repeats everything that has already made its way from the sources of the repressed into his manifest personality—his inhibitions and unserviceable attitudes and his pathological character-traits. He also repeats all his symptoms in the course of the treatment. And now we can see that in drawing attention to the compulsion to repeat we have acquired no new fact but only a more comprehensive view. We have only made it clear to ourselves that the patient’s state of being ill cannot cease with the beginning of his analysis, and that we must treat his illness, not as an event of the past, but as a present-day force (p. 150). The first generation of Kleinian therapists didn’t internalize what Freud had learned from his failures. Once again, the truth about the early stages of development was revealed; again, a similar set of expectations arose: that the patients would remember their early childhood sometimes through transference interpretations and sometimes independently of such interpretations. Once again, it was expected that the original drama would be revealed and directly reconstructed in the course of therapy.

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The use of part-object  interpretative  language,  as reflected in Klein’s use of the unconscious past, shows that the therapy, like in Freud’s early thinking, was intended as a kind of laboratory on the couch to validate the theory. As is evident in her clinical work, Klein was wholly convinced of the direct link between the patient’s current state and his early life. She pressed on analysts to make an explicit link between a person’s past and present through transference and other clinical material (Spillius, 2007). Together with other Kleinians, Hanna Segal carried out her clinical work along these lines. Her candidates and post-graduate analysts were trained to use the same method. These corroborating experiments led Joseph—with her sharp clinical instincts and in a manner not unlike that of Freud—to become realistic about the method’s limitations. Her work, as she mentioned in the interview cited above, developed out of a deep sense of disaffection with having found that she was interpreting to patients things that seemed to her to be completely accurate, except that they didn’t get through to the patient—a rather significant failure. Finding the patient (or that part of the patient that could be talked to) was, in a sense, the focus of her work. What is common to Freud and Joseph is that they both gave up on reconstructing the “actual” truth as perceived by their theories. They both despaired of discovering the past through simple remembrance, and their initial expectation that their theory of development would be directly validated in the clinical situation through remembrance and interpretation did not materialize. Consequently, the validation became more indirect, and in that sense, it was also more realistic and had the capacity to be a more communicative therapeutic tool: “Not what patients recall about their early past, but the patient’s direct lived experience in the consulting room, a development that led to its more immediate analysis in the transference” (Joseph, 1971, p. 441). Joseph reached a conclusion similar to Freud’s, but Joseph went further. She decided, perhaps unconsciously, that the patient’s acceptance of the therapist’s theory would not only fail to produce good therapeutic results, but was also partly responsible for the patient’s resistance to treatment. In Joseph’s (2000) view, the patient’s consent is part of his pathology, part of his defense system. She called this phenomena “excessive agreeableness” or “agreeableness as obstacle.” In the analytic situation, excessive agreeableness suggests that the patient agrees with all the interpretations, accepts everything suggested to him by the analyst in such a way as to ostensibly allow for the treatment to continue in a peaceful but in fact semiparalyzed manner. The therapist, in some way, gets pulled into this as if there was real mutual insight, and a whole agreeable situation is established between the two. So the cycle comes to a close. Early Freud and Klein were dependent on the patient’s consent and persistently pursued him to obtain his confirmation of their theory. In one fell swoop, Joseph ended this chase. There was to be no expectation of the patient’s consent. That consent, Joseph argued, was mendacious and intended to prevent awareness of the mental pain that comes with the discovery of the truth. Conceivably, a Kleinian therapist may have seen in this a kind of manic defense on the side of the therapist: the desire for something that was beyond

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reach and that the patient refuses to offer turns out to be a lie—an expression of a profound pathology. And, in any case, therapists must not rely on the patient’s verification of their theory. This is how Joseph (2000) describes the treatment of Jenny a young girl, aged sixteen: In the analysis her response to the work was striking. She was always pleasant and friendly, apparently expecting me to feel as comfortable and satisfied as she did. She accepted interpretations quite uncritically and brought further associations that seemed to confirm what I had just said. When I showed her this she would agree and bring further associations to confirm the agreement—and this would continue, agreement piled on agreement, like a kind of verbal clinging. As I showed her this, thus shifting ground, her agreement shifted with it as if she was literally gummed to me, which produced an atmosphere of stalemate, almost paralysis. (p. 642) Some further examples: N. denied my interpretation about his despair about the progress of the analysis, but in such a way, it seemed to me, as to be encouraging me to make false interpretations and to pick up his pseudo-interpretations as if I believed in this, while knowing that they and we were going nowhere. (Joseph, 1987, p. 175) [H] came regularly, he brought his problems and  dreams, he listened to interpretations; he responded by saying, “Yes” and “How interesting,” and they and I appeared to be completely unimportant to him. He would talk round interpretations academically, or become extremely wordy, until the feeling and significance of what I had said were lost. (Joseph, 1971, p. 442) Clearly, a therapist who perceives the patient’s agreement in this way will never see in it a means of validating anything—not the patients inner world and certainly not that of the theory. Instead of the therapist straining to prove the truthfulness of his conceptualizations to the patient, it is the patient that now tries hard to prove that his love of the therapist and acceptance of the suggested therapy is genuine and not defensive.

The Bionian community: Antonino Ferro and Michael Eigen Bion’s community is far more heterogeneous than Klein’s or the self-psychology community. This community was neither formally established, nor has it founded an international organization of any kind. Bion may have lacked the kind of developed political and organizational skills required—he invested all his energy in progressing his clinical thinking. Nonetheless, he was a leading analyst, the founder of an independent approach, an approach that is taught in many psychoanalytic institutes all over the world. Indeed, Bion’s ideas have developed in broadly distinct

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theoretical and geographical cultures; there are Bionians in Britain, Europe, the US, and North America (see Greenberg, 2013). Lawrence J. Brown (2013) refers to Bion as “a kind of “stem-cell” comment from which many different contemporary ideas have evolved” (p. 420). Bion more resembled Freud than Melanie Klein. Klein’s theory has a root that is connected to an indivisible trunk. With Bion, in addition to the root and the trunk, there are also many branches that can lead one in different directions. One can choose some of these and forgo others. For example, Bion’s Theory of Groups was his first theory of thinking for clinical use (Bion, 1962, 1963), in which he saw thinking, or unconscious processing of emotions, in line with Klein’s ideas of unconscious phantasy. Then there was the Ps-D, container-contained, and “selected fact,” the study of the transitions between the elements or different categories of the Grid by using the geometric “theory of Transformations” (Bion, 1965). In his last years, Bion posited an unrepresented, undifferentiated psychic zone, O, which by definition cannot be known but can be experienced. Bion’s ideas were difficult to understand. The obscurity of his writing, with phraseology that sometimes resembled a series of riddles, also explains the multiplicity of interpretations. Antonio Ferro and Michael Eigen are two of the most prominent interpreters of Bion. Comparing the two will also help us to distinguish between two types of psychoanalytic innovators: Ferro developed a therapeutic technique, a model for working with patients based on Bion’s ideas and those of William and Madeleine Baranger (2009). In contrast, Eigen belongs to a group of independent writers who use basic psychoanalytical ideas in order to develop original ways of thinking and treatment without identifying themselves as belonging to any particular stream of thought (see Chapter 1). Ferro’s technique is based on a number of relatively simple principles and can be understood, learned, and worked with. In this sense, Ferro resembles Betty Joseph, who, as we saw, also developed a unique way of working with patients. Eigen’s aspirations, on the other hand, are rather different. He does not offer his readers a systematic ordered technique. Instead, he writes about a huge range of subjects, and though the connection between them is not always clear, common to them all is an “openness to experience.” Eigen is influenced by numerous and diverse sources. Over the past few years, he has been inspired by Bion, who showed a profound interest in the links between psychoanalysis and the Kabbalah.

Antonino Ferro The problem that troubled Ferro was very similar to that bothering Joseph. Each was trained in the Kleinian tradition, influenced by Bion,4 and troubled by the fact that patients didn’t respond well to the interpretations/truths that the therapist presented to them. In an interview in Fort Da, Ferro (Ferro & Donna, 2005) explains what led him to develop a new therapeutic technique. After many years of clinical work with disturbed patients, Ferro realized that complete interpretations or saturated interpretations are not useful to patients. His work was especially shaped by

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working with psychotic and borderline states. He found that interpretations that are direct or frontal are not effective and realized that the patient is more receptive when interpretations go around—when they are done in a circular manner. Throughout his professional life, Ferro developed ways of overcoming this problem. Here too there is a great similarity between him and Joseph, as they both abandoned their conservative ways by completely putting aside the technique of directly linking  the patient’s early  history  with current clinical material. Joseph and Ferro have many other common lines of enquiry; they were both engaged in attempts to enter into the clinical material, to create more affective links within the psychoanalytic encounter, and they both embraced an inherent theory of psychic change. This valued the moment-to-moment psychic oscillations within the analytic hour over reconstructing past to present interpretations. But Joseph’s fidelity to Klein also shackled her within a particular theoretical framework, and it would seem that it was not her intention to propose a new therapeutic technique. Ferro, on the other hand, introduced a new spirit into therapy—a spirit that was playful, creative, free, open, and full of humor. One could describe his approach as a Middle Eastern version of the object relations approach. Before I briefly describe Ferro’s technique, it is important to look into this new spirit, something which is very rare in the Kleinian-Bionian tradition. In the same interview mentioned above (Ferro & Donna, 2005), Ferro says that for him there was no such thing as “correct.” Instead, there was a way to enter into the material to create more affective links. The aim was to enlarge the field, to broaden one’s own mind in the work, and the analyst should digest the interpretations before delivering them. This, Ferro admitted, was a somewhat simplistic way of describing the complex process of interpretation. It had to be understood, Ferro told the interviewer, that there were now two minds at work. Analysts weren’t as rigid as they had been in the past. Contemporary work, Ferro claimed, was more creative and more flexible. Psychoanalysts now resembled artisans or Renaissance workers; during the session, they were artists primarily and scientists secondarily. It was brighter and contained more reveries, more affective emotions, more flavor, “like the isles of Capri or Sicily” (1993). Additionally, psychoanalysis, Ferro argued, should bring some joy and not be a masochistic profession. Analysis was not easy—but, despite the difficulties, analysts should enjoy the work with their patients. There had to be something playful in the interaction with their patients, something that would make analysis livelier and a more transformative experience. Many patients were suffering, and analysts could help them if they were to approach psychoanalysis in a more plastic manner with less rigidity and fewer preconceptions. From this characterization, one can understand what it was that troubled Ferro and why he bothered to develop a new therapeutic technique. What characterizes Ferro’s therapeutic technique? Ferro calls his method Bionian Field Theory (BFT), and he describes his theoretical position as a combination of many concepts developed by Wilfred Bion and William and Madeleine Baranger (2009). The Barangers are two French analysts who have been working in South

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America since the 1960s. They described the analytic situation as a “field.” Ferro first introduced the concept of bi-personal field in a series of articles he wrote during the 1990s and in his book The Bi-Personal Field (1999). The Barangers had emphasized that the analytic field was a shared unconscious fantasy. Ferro doesn’t often use the concept of “fantasy,” but like other Kleinians and Bionians, he affords a central place to the inner world of the patient. According to Ferro, the patient and therapist together create a relational and emotional field. In Ferro’s writing, we can see an interesting mixture of conservative and radical elements. It is his belief— again like that of many Kleinians and Bionians—that every communication by the patient is linked to this field. Like Joseph, he too thinks that a patient’s communication is a response to something that the therapist said or did. For BFT, the field serves to elucidate psychic reality and the unconscious performance of the couple; like conservative object relations theories, BFT strives to capture external reality in terms of how they are represented in psychic reality. Ferro, like object relations theory, also seems to think that reality is indeed “there” and that reality limits what we can think, feel, and perceive while remaining truthful (see Stern, 2013). There can be also no doubt that Ferro is fascinated by Bion: “Bion provided a revolution comparable to the French Revolution: Nothing can ever be the same again” (Ferro & Donna, 2005, p. 257). Ferro (2012) bases his therapeutic technique on Bion’s theories of thinking and dreaming. For Ferro, Bion’s key idea is that the work of dreaming is a prolonged activity of the mind both in wakefulness and sleep and that the primary and secondary processes (Westen, 1999) cannot be separated. Therefore we dream both at night and during the day. Ferro uses a technique by which transformation into a dream precedes the analytic dialogue with the phrase “I dreamed that” (Ferro, 2006, 2008, 2007/2011, 2009). This technical device is adopted consciously by the therapist in order to relive an internal setting, whereby he can see the session as a dream, adjust himself to the unconscious communication in the session, and hence center on psychic reality. Every encounter with reality triggers a quanta of sensoriality ( β elements), which then have to be metabolized and transformed through the hard to define psychic mechanism that Bion named the alpha function. They are transformed into elements that are like elementary building blocks in the production of emotions and thoughts—what Ferro terms “visual pictograms.” These pictograms (made up of α elements) go to constitute a series of α elements or “dream thought in a waking state.” In itself, this is not comprehensible, yet it is knowable by means of its narrative products, which belong to different literary genres: childhood memories, an account of something happening the previous day, a report of a film, and so on. It is by carefully attending to these narrative products that Ferro moves toward the emotional truth of the patient. In his thinking, Ferro incorporated Bion’s basic idea that the unconscious is in constant movement and processes of change and that it is subordinate and influenced by the relationship with the other. Alpha elements are continually repressed; they form the ability to remember (and thus to forget) and to build the contact barrier that separates the conscious from the unconscious. Ferro’s unique contribution

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is pointing out the fact that some beta elements penetrate and “get away” with the process of alphabetization. Ferro (2012) thinks that these are where the center of interest for analysis lies, namely those quanta of never-transformed protoemotions of sensoriality (which, at times, if zipped or freeze-dried, can form autistic scars). These quanta produce the tsunami, whirlwinds, and windstorms of beta elements, which—if not sufficiently transformed—give rise to more serious pathologies. (p. 258) According to Ferro, the aim of the analyst is in increasing the ability of the patient to think. It is the analyst’s first aim to suggest to the patient an interpretation that has an experiential meaning that can be grasped and digested; this will then create a “micro-transformation,” a growth of the container, and a buildup of the capacity to be able to think, resulting gradually in a macro-transformation. Ferro (2012) presents a patient, Simone, in his third year of analysis, with a problem Ferro calls complaisant mutism: he can only express positive and submissive emotions. Simone was not able to have a child with his young partner. A series of tests had shown that his wife has closed tubes and that he had testicular calcifications. Analysis of the seminal liquid had also shown that ten percent of his spermatozoa were good and the rest had “monstrosities in the head.” Here is an excerpt from this analysis: P: This morning I went to the hospital to do the artificial insemination. The women go one way, the men the other. Me with my little jar [barottilino] in my hand. I asked where I was supposed to go and they showed me a toilet: It was really sordid. And now we’ve got to wait about three weeks. A: [I decide to stick to the patient’s manifest text] It’s really disgraceful, such a total lack of privacy and with barely a minimum of comfort or even decency, and then there’s the patience you need to wait . . .  P: [after a short silence] Then I heard that the guy in the community who was tattooed all over, like in the Larsson book, has been thrown out because it wasn’t the right place to keep him. A: [I didn’t think I had fully grasped Simone’s compressed feelings. He seems to be afraid that I am not the right place to contain his feelings. I limit myself to trying to develop his point] I don’t think you’ve ever mentioned him before. P: He’s called Mr. Barattoli [Mr. Jar]. A: [I withhold the obvious possible interpretation, as it would be too premature, and ask] What happened to Mr. Barattoli? P: He beat someone up. He broke this guy’s arm and cheekbone and so they threw him out.

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A: Perhaps we should see how he could be held. He’ll have his own reasons. He’s like a kind of bison with enormous energy that could be put to use for something. After all, we could say, he who is without Mr. Barattoli should cast the first stone. P: [He seems to have sensed my thoughts about Mr. Barattoli as a violent functioning of himself and, at the same time, about the functioning that fails to contain the potential monsters of his not yet evolved spermatozoathoughts] But you can assure me that I still have it, can’t you? There’s still a bit left, isn’t there; I haven’t eliminated it completely? A: If we are talking about it, it’s because it’s there. P: I need to produce something, something living. I was reading a book by . . . in which someone in an ultraorthodox community started to blaspheme and to shout, “You’re a bastard!” A: At least you’ve said it to me! P: (laughs) But why should I say something like that? A: Who knows? It’s like the light from the stars; we see light coming from stars that are possibly not even there anymore, and yet it arrives. P: Do you mean that perhaps it’s something that stems from an event that happened three years ago or thirty years ago? A: [thinking that the spermatozoa-monsters have not yet developed with their feared uncontainable explosivity] Or it could be an event three years hence. Let us arm ourselves with patience and a telescope. The important thing is to use Mr. Barattoli’s energies and to put them to constructive use. (Ferro, 2012, pp. 261–266) This is a wonderful example not only of Ferro’s work, but also of the way in which disenchantment, criticism, and dissatisfaction led to psychoanalytic development without giving up the basic core and therapeutic aims of the theory. What is special about Ferro’s approach is that a tradition considered rigid and authoritative becomes—with his method—playful, creative, and filled with humor and yet remains loyal to the believe in psychic truth and the importance of the intrapsychic world. Ferro’s interventions, together with his thoughts during therapy, display great sensitivity, tenderness, and compassion vis-à-vis the patient, an empathy and understanding of his needs. These are feelings that are not usually emphasized in traditional object relations theory. My impression is that Ferro has a profound love for Simone. At the same time, tenderness and empathy are not an aim in and of themselves. It is not empathy that is supposed to be the healer; it is merely the means of reaching the psychic truth, to movement and transformation through turning beta elements into alpha elements. Ferro doesn’t for a moment abandon the aims of object relations: the search for unconscious contents and painful psychic truth that

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the patient can contain and which is phrased in language he is capable of understanding. Simone’s personal problem has become the therapeutic field’s problem. Once again, the problem is always painful feelings that cannot be digested. Within the session, Ferro choreographed a dance for two with passionate parts in each of their respective stanzas. There are two in the room, two minds at work: a play, a choreography with unlimited movements. Ferro’s reader is often surprised at what he sees in the material and the depth and subtlety of his response. Ferro believes that creativity stems from letting yourself be just what you are and being able to accept whatever comes into your mind as a consequence of the narrative that the session has led to. Ferro offers a number of highly interesting examples of a thought entering his mind and, having been verbalized, leading to a change in the mind of a patient under supervision. In Ferro’s view, the enemy of creativity and productive thinking is a tendency to apathetically follow the rules and the over-employment in analysis of transference interpretation. Ferro’s advice (2005) is that one should focus for as long as possible on the apparent contents and see where that leads you.

Michael Eigen Michael Eigen went to Bion at the end of the 1970s for a number of supervisions. The encounter left a powerful impression on Eigen. Bion told Eigen, then in his forties, to get married. Bion reassured him that marriage was not what he thought it was, not something to be so afraid of. Bion said: “It’s just two people speaking truth to one another; a relationship to help mitigate the severity to yourself” (Eigen & Govrin, 2007, p. 32). He also told Eigen to stop analysis. In less than a year, Eigen terminated his analysis and got married. Bion’s influence on Eigen was huge and is mentioned in almost all of his writings. However, Eigen is a Bionian in a very different sense than Ferro is. Eigen was not educated in the Kleinian-Bionian tradition. The widely-known perception of this tradition—mainly based on the understanding of identity projection as a way of arriving at profound insights about the patient—is rarely mentioned by Eigen. In fact, Eigen hardly uses psychoanalytic jargon, and his treatments are characterized by direct communication, openness, an animated atmosphere, and unexpected interventions. Bion is Eigen’s main source of inspiration. Eigen explores Bion’s ideas in depth and systematically. For example, Eigen explores Bionian ideas such as nameless dread, lying, transformations in hallucinations, and transformations in analysis (Eigen, 1999), Bion’s No-thing, Minus signs (Eigen, 1998), and Bion’s O (Eigen, 2012), and showed how they helped him to understand his patients. However, Eigen is also influenced by Winnicott, Lacan, Freud, and many other writers. Just as it is not possible to identify Eigen with one particular therapeutic idea, so one cannot say that he is a “Bionian” therapist. A fairly early article by Eigen, “Working with Unwanted Patients” (1977), is in my view the only place where Eigen uses Kleinian-Bionian psychoanalytic jargon,

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which he later dropped. The subject of the article is also very close to the subjects that the British object relations tradition dealt with: difficult to reach patients. The understanding is typically Kleinian, according to which what leads to change is “introjecting the therapist in a way which builds up the patient’s good object representations” (Eigen, 1977, p. 108). And yet Eigen’s way of working is so different to that of the early Bion or Betty Joseph, or even Ferro. Eigen (1977) writes that Therapy provides a healing rather than a toxic frustration in that the patient is enabled to live out his pathology in the transference within the framework of a broader, corrective relationship. In order to accomplish this the therapist allows himself to be led by imagining or observing what spontaneous forms patient-therapist interactions would tend to take if inhibitions were lifted. (p. 115) For example, patient and therapist may vary exciting and rejecting roles, tantalizing and frustrating each other: P: I want something from you A: I don’t see why I should give you anything. When I don’t, you want me more. P: Give it to me. This time will be different. A: If I want you to want me, I should play it cool, you’ll think I don’t want you to like me if I do what you say. P: Damn that stuff. Just give it to me. Let me worry about it. A: Why should you get me? When you have me, you can’t stand me. P: Why do you always bring up past sins? What’s past is past. Maybe this time will do it. A: Well, maybe . . .  P: Got you (laughing foxily, smugly). (p. 35) These playful, spontaneous, free-flowing exchanges demonstrate that even when Eigen occasionally interprets a clinical phenomenon according to British object relations tradition, he almost always produces surprising and unprecedented interventions. He refuses to be an essentialist, tends to use unusually vocabulary, and, contrary to early Bion and Klein, his psychoanalysis has more to do with the language of Romanticism than the ideas of scientism (Phillips, 1993). Bion (1992) has said that, for primary processes, we need “a language of infrasensuous and ultra-sensuous, something that lies outside the spectrum of sensuous experience and articulate language” (Bion, 1992, p. 372). Eigen’s (1998) prose is a

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radical experiment that tests whether it is possible to do what Bion suggests—create a language that has an indescribable, incomprehensible, yet deeply and strongly felt impact, not immediately registered by the reader’s conscious processes. A language that attempts to convey experiences “not yet formalized or formulated” (Eigen, 1998, p. 83). As Eigen’s thinking continued to develop, he became increasingly aware of his desire to say something that goes beyond theory, cognition, and knowledge. He wanted to say more about O, to be an O writer. Eigen’s portrayals of O are different than Bion’s O, although there is some overlap in its significance and basic meaning. Bion’s descriptions of O tend to come from the realm of terror and dread, while Eigen’s tone contains more trust and faith. Eigen’s O is more orgasmic, sensuous, and poetic and contains a love of beauty, truth, and goodness. It is also far more mystical. It celebrates the ability of the human spirit to awaken from emotional death. Eigen is also more personal in describing O, whereas Bion sometimes seems detached and distant. Eigen’s profound interest in O made him search for other non-conventional ways to express his thoughts about human life. His later works are increasingly more imaginative, obscure, and poetic. With them, reading which leans heavily on previous conceptions might turn out to be a burden, an obstacle for dealing playfully with the text. Over the past few years, Eigen has researched the congruence between psychoanalysis and Kabbalistic and mystical foundations. This research was directly influenced by Bion. As Eigen (2012) relates: We were speaking and out of the blue he asked, “Do you know the Kabbalah, the Zohar?” As far as I was aware there was no preparation for this remark. He just said it. I was a bit taken aback and said, “Well, I know it, but I don’t really know it.” I read bits of Kabbalah since my early twenties and without conscious awareness it was part of my lived background from early childhood. I was in my early forties when I met Bion. He quickly said, “I don’t either, really know it,” modestly reassuring me. It was established that neither of us were scholars, experts, “knowers,” but had awareness acquaintance. There was a pause. Then he looked at me and said, “I use the Kabbalah as a framework for psychoanalysis. I said nothing for a while, letting the remark sink in . . . I wondered for years why he said that to me. As far as I have been able to learn so far. I did not hear of him saying that to anyone else. Why me?” (p. 65) Eigen’s voice in psychoanalysis is unique. He is a romantic writer-poet and analyst whose profound interest in spiritualism and God deters readers as much as it attracts them. Since Jung, no author has allied psychoanalysis with God and the mystic as much as Eigen does. No psychoanalytic writer has dared to say that “psychoanalysis is a form of prayer” (Eigen & Govrin, 2007, p. i) or urged his readers “to love God with all your heart, soul, might and to feel the heartbreak at the center of existence,

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and the deeper joy, working within the storm, in the feel of feelings, the feel of life, the feel of one’s life” (p. x). Reading his most mystical books, Rage (2001), Ecstasy (2002), The Sensitive Self (2004), Emotional Storm (2005), and Contact With the Depth (2011), one seems to enter not only a pre-scientific, magical era but a new psychoanalytic form—one in which rage, ecstasy, sensitivity, and emotional storm play a much larger role than they do in the often systematic and analytic case studies of mainstream psychoanalysis. Many psychoanalytic writers are hard to understand, but the difficulty of Eigen seems of another level. The sounds of Eigen’s ideas are not always pleasant to the ear. His obsession with mystical experiences might be an embarrassment to analysts who are used to perceiving psychoanalysis as a scientific body of knowledge. His autobiographical revelations mock the well-accepted barrier between reader and writer, patient and therapist, normal and pathological. His distinctive prose and particular pleasure in borrowing themes from biblical stories, Buddhism, Judaism, and Kabala make some of his texts seem bizarre. Eigen’s reader is often provoked, disturbed, and puzzled. Eigen (2001) once wrote that “psychoanalysis is the voice for the excluded. It investigates what’s left out of the official ‘self’” (p. 12). Perhaps Eigen is the voice of what has been excluded from psychoanalysis: God, Satan, the Bible, light, mysticism, ecstatic orgasm—everything that is too much for mainstream psychoanalysis. A fundamentally spiritual sense of life is central and unchanging in all of Eigen’s writing. Whether describing clinical phenomena or specific patients, Eigen’s work is always affected by deep spiritual feelings. Eigen (1998) writes: Throughout my career I have heard that therapy is not a religion, and must stop short of religious dimension. Perhaps this is true for many practitioners but it has never been so for me. Therapy is a holy business for me and was so from my first session, as patient and as therapist. (p. 42) This is the core of Eigen’s writing. Although he accepts that internalization processes are “necessary for a fully developed human self” (Eigen, 1998, p. 34), he also believes in an original naked self as the true subject of experience. In Bion, he finds the same conviction. Eigen admires Bion because Bion shows how fresh possibilities of experience uplift the self. It is important to note that Eigen’s self is very much in this world, very much in everyday life. In his work, he tries to be attentive to psychic micro-life, to draw the ins and outs of psychic reality, and to build a dense texture of the reality of psychic life. Eigen’s deep sense of mysticism challenges many conventionally accepted ideas in the mental health field regarding mental growth, human development, and the psychoanalytic encounter. I believe he sees psychoanalysis in a way that is different from most widespread notions. Bion and Winnicott have said that a successful analysis helps the person to feel real, to become. Eigen is willing to go to extremes in order to find out exactly what this “real” means. Following Bion, Eigen thinks

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that therapy is not merely helping someone get better. A good half of therapy—the better half—is not relieving pain but experiencing the real, experiencing being: “The center of the drama is a feeling self—whether in the midst of joy, suffering, emptiness, unreality or bleakness” (Eigen, 1998, p. 59). This is one way to understand passages like the following: Give helplessness a chance. Don’t leave helplessness behind . . . There’s a moment of helplessness that stops our breath, a quick shock, before we jump into action. I propose we do more tasting of that moment, sifting it, letting our faith muscle grow, as building tolerance for the fleeting shock begins to transform us. (Eigen, 2005, p. 77) Eigen seems to be saying that therapy is not aimed at making patients happy or relieving their suffering. It is not exactly helping patients accept their suffering, either. Rather, it is the realm of experience that is important, “the openness to the impact of psychic reality” (Eigen, 1993, p. 251). We must be attentive to this realm even if it is contrary to our conventional beliefs about a happy life or the relief of pain. Conventional beliefs are blocked meanings, whereas people should try to listen with the help of their therapist to their inner music, their psychic movement, the song that their soul and body sing. In Emotional Storm (2005), Eigen writes, [S]uffering opens worlds. Not always, not with all people. But frequently enough to warrant appreciative regard . . . what a moment earlier had been acute emotional pain turned into: (1) beatific, radiant light; (2) more variegated emotional fields with bright and light spots of shifting densitydiffusion; (3) appreciative apprehension of the miracle of feelings and the magical transformations they undergo; (4) an ethical commitment to bettering life, living better, or, at least, sharing appreciation for our amazing experiential reality. (p. 194) This may seem odd; indeed, it is a totally new vision of psychoanalysis and one that will no doubt stimulate considerable controversy. It deeply echoes some of Bion’s ideas, but more bluntly and directly. Many analysts will find it hard to accept that to help sometimes means to taste moments of trauma, suffering, and helplessness, not merely as a necessary means for moving on to more secure and happy moments but as a therapeutic aim in itself. It is not that Eigen thinks this is the only business of therapy or that therapy is not also about pain relief or helping patients feel happier. Rather, it is his almost perfect attunement to the truth, the living center, the realm of experience, the opening of the feeling self, and his insistence on putting aside and silencing as much as possible (but not completely) the normative meaning, that accounts for his sometimes strident voice and unconventional ideas. Eigen seems to be saying: suppose we fully register the music of the unconscious, the inner rhythm of the disorganized self; suppose we give them a voice, uncensored

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by conventional norms. What will that voice sound, taste, smell, look, feel like? Eigen is trying to write that voice. The dialectic between fascination and disenchantment that is such a feature of the writings and thinking of Stolorow, Joseph, and Ferro is lacking in Eigen’s work. There isn’t that tension that one usually finds among innovators who straddle the line between the new underlying concepts and the original theory. Eigen interprets Bion in a way that is unique to him. Yet he sees Bion as an inspiration enabling him to follow a deviatory and Kabalistic orientation rather than a guiding light to a certain therapeutic technique. For now, at least, Eigen’s theory remains what can be termed “fringe psychoanalysis.” It is difficult to imagine it being in any way institutionalized and fashioned into a “method.” At the same time, one can say that Eigen, together with a small group of therapists who are inspired by his ideas, represent what Gideon Lev (2012) has termed “spiritually-sensitive psychoanalysis.” According to Lev (2012), in spiritually-sensitive psychoanalysis, faith gains renewed legitimacy as a potentially positive and necessary element in human life and not an illusory mental product. Spiritually-sensitive psychoanalysis sets ideals of life, which include encouraging a compassionate moral stance and social responsibility, reducing excessive preoccupation with the self, and even aspiring to mystical experiences of no-self, unity, ecstasy, or contact with the numinous. Lev writes: To the existing models of “tragic man” and “guilty man” spiritually-sensitive psychoanalysis offers to add “sacrificing man.” In addition to the paranoidschizoid and depressive positions it offers “transcendent position.” And to the common understandings of the self it contributes a new perspective, from which a stable, isolated and inherent self is seen as an illusion. (p. 48) This community, like the relational approach, can be defined as a philosophicallyculturally troubled community. It would seem that Eigen’s spiritually-sensitive psychoanalysis offers an alternative to the relationists’ postmodernism. After some three decades during which postmodernism dominated the field and had a broad and profound influence on every aspect of western life, its ascendency has begun to wane. Naturally, something of such significance as a world view doesn’t simply “vanish” in the space of a few years even in an era of accelerated change such as we live in today. Linda Hutcheon (2001) didn’t hesitate to write “let us simply say it: it’s over . . . the post-modern moment has passed” (p. 3). Kirby (2006) is more cautious, noting that: [A]lthough “the death of postmodernism” makes a great headline, it isn’t strictly true . . . But postmodernism’s heyday is over; its reign has ended. Muted and mutating, its traces and echoes linger on in the culture. Its shadow falls over us from behind. But it is no longer the best place to go to get a handle on the world that we live in. (p. 34)

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The reappearance of values, faith, and spirituality would appear to return the religious world-view to center stage (Lev, 2013). However, as is always the case with history, what returns never does so in the same form that it appeared in the past. Thus, the religiosity—be it ultra-, pseudo- , meta-modern, or any other kind—is not the piousness that postmodernism and the enlightenment opposed. Rather, it is a spirituality that responds to the unique needs of people in the present era and that has also exerted a powerful influence over psychoanalysis. There is a great deal of evidence for the spread of spirituality in western society. In 1996, Heelas reached the conclusion that at least 10 million Americans either indulge in or take an interest in some form of spiritual activity. Nearly a decade later, Forman (2004) estimated that “between 50 and 80 million people in the United States embrace a more spiritual view . . . of the absolute reality and or a new age sympathy” (p. 10). Forman thought that this phenomenon was evident on the same scale in the other industrialized counties of the world. For decades, the anti-religious viewpoint was the common and accepted analytical position in psychoanalysis, not least because of Freud’s own hostile attitude to religion. However, as Lev (2012) points out, over the past few years, psychoanalysis has undergone a profound change, with dozens if not hundreds of articles being written on religious and mystical subjects. Thus, for example, a preoccupation with Buddhism has become fashionable, and analysts take a pride in the number of years they have spent doing exercises in meditation. There can be no doubt that psychoanalysis will have to supply a theoretic and therapeutic response to a world that has become more and more spiritual. There is of course also an economic aspect to this. As this drift towards spirituality takes greater hold, more and more potential patients are people who can be said to be trapped in some form of spiritual unease. These patients want the spiritual uncertainty plaguing them be deal with respectfully and seriously rather than reductively, as if pointing merely to unresolved conflicts in their past. A large proportion of patients preoccupied by spiritual questions will certainly look for a relevant form of therapy interested in their problems. Psychoanalysis would do well to open its doors to this interesting and unique population. Eigen and other therapists, such as Mark Epstein, have succeeded in shifting the focus to the spirituality that is already to be found within psychoanalysis, thus enabling the discipline to undergo a change that parallels the change experienced by society as a whole. From the moment that the spiritual experience is seen as being internal and ceases to be dependent on society/church/formal religion, it becomes far more open to therapy. As Stone (2005) has indicated, “both psychoanalysis and spirituality aspire to support personal development beyond completeness and authenticity” (p. 428). In my view, we are not talking here of a new psychoanalytic school with a systematic and defined ideological orientation, but rather the coming together of a group of thinkers and writers developing a new branch of the discipline that enables psychoanalysis yet one more significant expansion and thus contributes to its strengthening.

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Notes 1 These included Bacal and Newman, Basch, Gedo, Goldberg, Lichtenberg, Stolorow, Brandchaft and Atwood, and Wolf. 2 Aron (1996) compares the connection between the intersubjective approach and self psychology to the link between the relational approach and the interpersonal theory. Both were highly influenced by the original core theory. However, rather than developing as a branch of that original theory, they progressed in tandem with it. 3 I thank the Melanie Klein Trust (http://www.melanie-klein-trust.org.uk) (for permission to use material from this interview. 4 On the influence Bion had on Joseph, see Aguayo (2011).

6 UTILITARIAN INFLUENCES IN FREUD’S EARLY WRITINGS

The next two chapters challenge one of the most widely repeated criticisms of fascinated psychoanalytic communities: that they are isolated, inward looking, and impervious to non-psychoanalytic ideas. In contrast to this view, I will present a more multifaceted vision showing the complex strategies by which fascinated analysts assimilate non-psychoanalytic ideas, especially at the initial stage of a theory’s development. This chapter deals with Freud and the theory of utilitarianism. Freud was influenced by non-psychoanalytic sources more than any thinker after him. However, although these influences were discernible in his work, Freud often avoided explicitly citing them. Here, I present an important source of Freud’s conceptualizations which hasn’t yet been fully researched: the utilitarian theories of Jeremy Bentham and John Stuart Mill, from which he “borrowed” the concept of the “pleasure principle.” In “A Short Account of Psychoanalysis,” Freud (1924a) writes: Psychoanalysis may be said to have been born with the twentieth century . . . But, as may well be supposed, it did not drop from the skies readymade. It had its starting-point in older ideas, which it developed further; it sprang from earlier suggestions, which it elaborated. Any history of it must therefore begin with an account of the influences which determined its origin and should not overlook the times and circumstances that preceded its creation. (p. 191) In this chapter, I center on these “older ideas” that were elaborated further by Freud—the utilitarian vision of mankind supported by authors like Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873). I believe this is a rather

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overlooked source of influence on Freud’s metapsychology; it is usually thought that positivistic thought, German idealism, and contemporary neo-Kantian scientific theory were the major philosophical sources for Freud’s understanding of the human mind (e.g., Gay, 1988; Ricoeur, 1970; Sulloway, 1979). Although British utilitarianism entered Freud’s writings in his regulatory principles of mental functioning, especially in relation to the pleasure principle, it was never acknowledged by Freud nor by his interpreters as an important source. Only very recently, the ideas of John Stuart Mill (Bentham’s pupil and editor) are mentioned as a possible source for Freud’s work (Molnar, 1999; Ricaud, 1999). Moreover, there is apparently only one source that connects Freud to utilitarianism (Watson, 1958). As I shall show, Freud was familiar with Bentham’s and Mill’s idea that avoiding pain and seeking pleasure are the two most dominant motivational forces in human life. Interestingly, while Freud did not mention these utilitarian influences, he eagerly acknowledged another source of the pleasure principle: It was Gustav Theodor Fechner (1801–1887), a pioneer in experimental psychology and the founder of psychophysics, who took all the credit (see Schur, 1966; Sulloway, 1979). Freud’s predilection can be seen as related to his well-known disinclination to acknowledge philosophical sources: Even when I have moved away from observation, I have carefully avoided any contact with philosophy proper. This avoidance has been greatly facilitated by constitutional incapacity. I was always open to the ideas of G.T. Fechner and have followed that thinker upon many important points. (Freud, 1925, p. 59) When once asked how much philosophy he had read, Freud replied: “Very little. As a young man I felt a strong attraction towards speculation and ruthlessly checked it” (Jones, 1953, p. 29). Perhaps the antagonism Freud expressed towards philosophy and his admiration for Fechner’s psychophysics were part of Freud’s reluctance to allow psychoanalysis to slip into vitalism, mentalism, or even occultism—philosophies that view the mind as a non-material entity (see a conversation between Freud and Jung; Jung, 1963). But the influence of utilitarian philosophy on Freud’s writings—together with the other philosophical influences that have been proposed, such as Nietzsche, Brentano, Schopenhauer (Domenjó, 2001; Robertson, 2001; Sulloway, 1979)—shows that philosophy remained a dominant tradition behind his many fundamental insights. But the puzzling thing about Freud and utilitarianism is not merely their unacknowledged resemblance, but also their sharp differences. How could it be that two theories based on the same principle—namely, that seeking pleasure and avoiding pain should be regarded as the primary motivation of mankind—are profoundly different from each other? And why is Freud not utilitarian after all despite his emphasis on the pleasure principle?

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The present chapter progresses through four main points. First, I describe facts that prove Freud was familiar with the British utilitarian-empirical school. Second, by stripping Freud’s language from its biological connotations, I will demonstrate how utilitarianism is ubiquitous in Freud’s early thinking, especially in Freud’s pleasure principle. I shall argue that Bentham’s and Mill’s ideas found their way into Freud’s metapsychology and idiom and indirectly caused Freud’s regulatory principles. Third, I will define three aspects that sharply distinguish Freud from utilitarianism: the quality of pleasure, conflict, and irrationality. Last, these aspects will be demonstrated through different central concepts in Freudian thought: quality-quantity, the constancy principle, repression, and hallucination. The chapter then uses two main methodologies: a historical approach and an archaeological one, in the sense debated by Foucault and Hacking (1986). In its historical perspective, it describes chains of factual associations that connect Freud with utilitarianism. But it also tries, in Hacking’s words, “to understand the conditions of possibility for ideas” (Foucault & Hacking, 1986, p. 30) and to tell a story about “the web of specific sentences that were uttered, and a theory of what made it possible for those sentences to be uttered” (p. 31).

An important source of influence Let us begin by stating a few facts that might connect Freud to Bentham and Mill. In 1879, when Freud was called up for his year’s military service, he translated four essays by John Stuart Mill (Jones, 1953). These essays were translated for Theodor Gomperz, the editor of Mill’s collected writings in German. (Jones tells us that it was Brentano who gave Gomperz Freud’s name; Gomperz needed a new translator because of the unexpected death of his former translator, Eduard Wessel.) One of the essays Freud translated, according to Jones, was Mill on John Grote’s elaborate four-volume study of Plato. In this essay, Mill extensively refers to Bentham’s utilitarianism, so Freud must have known about Bentham’s philosophy. But this was not the first time Freud had read about these British philosophers; in 1874, when he was 18, he wrote to his friend Eduard Silberstein that on Friday he regularly attended Brentano’s lectures on the utilitarian principle. Freud referred to Brentano’s course on Mill’s Utilitarianism published in 1863; this text described Bentham’s and Mill’s utilitarian philosophy. Freud’s decision to translate the word pleasure in Mill’s (1886) essay on Plato as the German word Lust is also a hint to his future association between pleasure and the sexual drives, an association that was perhaps evolved at that time. Actually, Freud’s Lustprinzip should be translated more accurately as “the principle of desire and delight” and not (as in Strachey’s translation) “pleasure principle” (Ornston, 1986). While the utilitarians meant by “pleasure” any positive affect, Freud’s Lust was much more active and sexual. Perhaps, then, Lustprinzip was an interpretation based on the centrality Freud gave to the sexual instincts and not a mere translation of a well-known concept.

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However, apparently contrary to this, Jones (1953) dismisses the possibility that Mill’s essay had any influence on Freud’s writings: This was the only work, original or translation, he ever published that had no connection with his scientific interests, and, although the content of the book probably appealed to him, his main motive was undoubtedly to kill time and, incidentally, earn a little money. (p. 55) It is hard to know if Jones is relying on Freud himself or just repeating his own lack of appreciation of philosophy, which he expressed many times; see, for example, his discussion on the “Project” (Jones, 1953, p. 384).

Bentham, Mill, and Freud In his best-known work in English, An Introduction to the Principles of Morals and Legislation (1789), Bentham begins with his basic utilitarian claim: “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do” (p. 125). The Fragment starts with the famous formula, declared as an “axiom,” that “it is the greatest happiness of the greatest number that is the measure of right and wrong” (p. 1). According to Bentham, the way to judge between alternative courses of action is to consider the consequences of each, in terms of the pleasure and pain of all the people affected. Utilitarianism is a general theory about which actions and institutions are instrumentally desirable; the idea is that they are so in view of their promotion of actual expectable happiness, or utility. Utility is therefore to be understood in terms of happiness. Among his catalogue of pleasures, Bentham listed the “pleasure of sense,” and part of this is “the pleasure of sexual sense” (p. 156). Bentham’s chief study was planning how there could be a good system of government and law—that is, how laws could be created so that people being as they actually are (seeking their own pleasure) might nevertheless do what they ought (seek the greatest happiness of the members of the community). The essential aim of Bentham’s attempt to produce an exhaustive analysis of pains and pleasures was to lay out before the legislator the factors that determined the conduct of human beings and the possible means of influencing it (Dinwiddy, 1989). Bentham devoted great efforts to refining the calculus of pain and pleasure and working out their implication for legal reforms. Bentham believed the values of pain and pleasure could be measured according to their intensity, duration, certainty or uncertainty, propinquity or remoteness, fecundity, and purity. He also believed that gratification as such is always good, and that, while it may often be necessary to withhold some desires, this is only to ensure that other desires may be gratified. Mill adopted Bentham’s conception of utilitarianism with some variations. He thought that Bentham’s conception of the good was too narrow and perceived pleasure as complex mental experiences rather

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than sensations. Contrary to Bentham, Mill takes the quality of happiness as well as its quantity to be productive of its value (Donner, 1998). Note the similarity between Bentham and Mill’s utilitarian principles and the following Freudian characterization of the reality principle: “Just as the pleasureego can do nothing but wish, work for a yield of pleasure, and avoid unpleasure, so the reality-ego need do nothing but strive for what is useful and guard itself against damage” (Freud, 1911, p. 223). Freud perceived the reality principle not as a new and different phase in life but merely as a better way to achieve pleasurable goals. Contrary to the ego psychologist’s claim that the reality principle contains “free” and neutralized aspects (Hartmann, 1939/1958), Freud thought that the pleasure principle remained superior through the entire lifespan. The correspondence between Freud and Jones (Paskauskas, 1993) demonstrates this point. In 1911, after the publication of “Formulations on the Two Principles of Mental Functioning,” Jones (26/11/1911) writes to Freud: I was puzzled by the sharp opposition of the two (the pleasure and reality principles). I had conceived of the desire for reality as being essentially merely a more effective method of obtaining gratification than the hallucinatory method. Do I understand you to mean that it was so originally, having come into existence for this purpose, but that later on it acquires a meaning of its own—the search for reality being an aim or principle in itself, quite apart from the greater power thus won procuring gratification? Or does it continue to serve the latter in a more roundabout way? In other words isn’t the reality principle constantly a form of sublimation, or do the two principles become secondarily entirely divorced from each other? (Jones, 1953, p. 121) And Freud answers (14/1/1912): Your question about the relation of the R. Prinzip to the L. Prinzip is answered in the paper itself in agreement to what you yourself suppose. The Reality Pr. is only continuing the work of the L.P. in a more effectual way, gratification being the aim of both and their opposition only a secondary fact. (Jones, 1953, p. 125)

Sir William Hamilton’s pleasure principle Freud not only translated some of Mill’s essays, but also kept in his library An Examination of Sir William Hamilton’s Philosophy (Mill, 1865). Sir William Hamilton was an exponent of the Scottish philosophy of “common sense.” Unlike the empiricists, he thought that there are certain powers and beliefs natural to the mind that can neither be doubted nor justified. Mill took Hamilton to be the leading opponent to his own empiricism and therefore subjected his views

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to a severe criticism. What may interest us here is that, in this book, Hamilton’s views about pleasure and pain are very similar in their content and idiom to Freud’s pleasure-unpleasure principle. We know that Freud read Hamilton’s book because he cites it in On Aphasia (1891, p. 78). According to Hamilton, “pleasure is a reflex of the spontaneous and unimpeded exertion of a power of whose energy we are conscious. Pain, a reflex of the overstrained or repressed exertion of such a power” (Mill, 1865, p. 480). In another paragraph, Hamilton’s principle seems very close to Freud’s terminology about the constancy principle. According to Hamilton: A feeling of pleasure is experienced, when any power is consciously exercised in a suitable manner. That is, when we are neither, on the one hand, conscious of any restraint upon the energy which it is disposed spontaneously to put forth, nor, on the other, conscious of any effort in it to put forth an amount of energy greater either in degree or in continuance, than what it is disposed freely to exert. In other words, we feel positive pleasure, in proportion as our powers are exercised, but not over-exercised; we feel positive pain, in proportion as they are compelled either not to operate, or to operate too much. (Mill, 1865, p. 482) Hamilton is actually postulating a kind of equilibrium that can be upset. The free energy of the power tends to put forth maximally; it can either put forth in a less amount or in a greater amount. Pleasure is experienced when the power is put forth in the exact proper limit, a “suitable manner.” Freud’s concepts of pain and pleasure have more resemblance to Hamilton’s than to Bentham’s and Mill’s ideas. Hamilton postulates an intrinsic factor, inside the personality, which has to be balanced, a formulation that is missing in the philosophy of Bentham and Mill. Freud might then have been influenced by Mill’s polemic with Hamilton somewhere before 1891 in his choice of most of the terminology concerning the pleasure principle, including concepts like stability, pleasure, pain, energy, reflex, power, stimulation, amount, quantity, proportion, and intensity. Note that Hamilton’s principles (as they are depicted by Mill) are almost similar to Fechner’s constancy principle, which Freud cites in Beyond the Pleasure Principle (1920): Every psycho-physical motion rising above the threshold of consciousness is attended by pleasure in proportion as, beyond a certain limit, it approximates to complete stability, and is attended by unpleasure in proportion as, beyond a certain limit, it deviates from complete stability. (pp. 8-9) It seems then that Freud’s assumption that the “pleasure principle is directed towards keeping the quantity of excitation low” (p. 9) is congruent with these two plausible sources. A paragraph in Civilization and Its Discontents (1930) offers another important clue about the development of the conceptualization of the pleasure principle:

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One can hardly be wrong in concluding that the idea of life having a purpose stands and falls with the religious system. We will therefore turn to the less ambitious question of what men themselves show by their behavior to be the purpose and intention of their lives. What do they demand of life and wish to achieve in it? The answer to this can hardly be in doubt. They strive after happiness; they want to become happy and to remain so. This endeavor has two sides, a positive and a negative aim. It aims, on the one hand, at an absence of pain and unpleasure, and, on the other, of the experiencing of strong feelings of pleasure. (p. 76) Freud wrote a great deal about pleasure, satisfaction of instincts, and stimulus discharge, but it is hard to find even a handful of pointers about happiness in his writings. And this is the only text where Freud places the two concepts—pleasure and happiness—together. “Happiness” is a much more abstract and philosophical term, quite estranged from Freud’s physical and economic metaphors. This conjunction between the two concepts—pleasure principle and happiness—suggests a vision of the pleasure-unpleasure principle as functioning beyond tension reduction and closer to Mill’s and Bentham’s utilitarian ideas. Perhaps the two theses of Freud’s formulations on the pleasure principle—pleasure as a reduction of tension and the unelaborated idea that pleasure is happiness—correspond to two different sources that influenced Freud. Could it be that Freud’s pleasure principle in its broader sense, that of happiness, expresses Mill’s and Bentham’s unrecognized influence on Freud? We can find a clue to this idea in Beyond the Pleasure Principle (1920), in which Freud mentioned that philosophy and psychology were both major sources of influence on his pleasure principle. Although Fechner was the only source he mentioned, perhaps he was not the only one Freud had on his mind. Freud writes: It is of no concern to us in this connection to enquire how far, with this hypothesis of the pleasure principle, we have approached or adopted any particular, historically established, philosophical system . . . Priority and originality are not among the aims that psycho-analytic work sets itself. (p. 7)

Freud’s break with utilitarianism The study of the utilitarian sources in Freud’s thought also highlights how far Freud departed from Bentham and Mill’s ideas. Even though some authors emphasized that the terms pleasure and pain were used by Freud differently at different times (e.g. Schur, 1966; Smith, 1977), and hence have an ambiguity of meanings, Freudian thought involves two radical modifications of pleasure and pain: first, while utilitarianism centers only on conscious behavior, for Freud, pleasure and pain are not always conscious; second, while in utilitarian thinking pain and pleasure oppose and cancel each other, Freud (1905b) argued that “every pain contains in itself the possibility of a feeling of pleasure” (p. 159, fn).

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Three lines of breakthroughs can depict the radical difference between Freud and utilitarianism: the quality of pleasure, conflict, and rationality. This can be seen mainly in the analyses of the quantity-quality problem and the concepts of conflict, repression, and hallucination.

The quality of pleasure Do Freud and Bentham mean the same thing in their discussion about pleasure? Should pleasure be described in quantity terms or in quality terms? Is pleasure a sensation? Is it cumulative? Does it depend on internal factors or external factors? Is it inside or outside? Some of the answers to these questions can be found in the quantity-quality dilemma and the constancy principle.

The quantity-quality problem It is remarkable how economic formulations were central in Freud’s day. The quantityquality question, for example, bothered almost everyone from the Empiricist tradition including Freud, the Helmholtz school of medicine, Fechner, Herbart, and Exner (Sulloway, 1979). This question evoked so much interest because it reflects the intermediate zone between psychology and materialism. Many scholars, including Freud, thought that if only psychological processes (which can be described only in quality terms) could be described by mechanistic and molecular explanation (quantity terms), then psychology would have a firm ground in physiology. It is interesting to see the solutions Bentham, Mill, and Freud proposed to the quantity-quality question. Bentham and Mill, like Freud, perceived pain and pleasure in quantity and economical terms. If different actions can be measured quantitatively, then it is possible to decide which brings the maximum utility. They saw pain and pleasure as a linear, homogeneous, one-dimensional factor. Bentham, for example, in his hedonic calculus, tried to weigh pleasures against each other. For Bentham, a unit of pleasure is the minimum state of sensibility that can be distinguished from indifference. Bentham’s hedonic calculus ignores the quality, as distinct from the quantity, of pleasure. Unlike Mill, Bentham did not acknowledge that there are higher and lower pleasures. If this is acknowledged, the utilitarian premise that pleasure is the only good would be contradicted since, in this case, the higher pleasures have an element of value other than the mere quantity of pleasure that the lower pleasures lacks. This contradicts Bentham’s aim to put utilitarian philosophy under one principle. Mill broadens Bentham’s calculus by insisting on qualitative differences in pleasures, so that an intellectual or spiritual pleasure is not just quantitatively equivalent to a large number of physical pleasures. But how can one judge the difference of quality of two pleasures? Mill (1979) answers: On a question which is the best worth having of two pleasures, or which of two modes of existence is the most grateful to the feelings, apart from its

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moral attributes and from its consequences, the judgment of those who are qualified by knowledge of both, or, if they differ, that of the majority among them, must be admitted as final. (p. 213) By quality, Mill means a kind of normative property (Donner, 1998). Therefore, he retains, in fact, a monistic view of utilitarianism. One way to describe Mill and Bentham’s concepts of pleasure and pain is to compare them with two different attitudes towards money. For Bentham, pleasure adds coins to the person’s pocket, while pain subtracts them. The most pleasurable act or experience is that which gives the person the largest amount of coins. Mill adds to this calculus the fact that there are also different kinds of coins: gold, silver, and metal. It is the majority of the people that decide which experience or act is gold, silver, or metal and what the price in coins of each experience is (normative property). These claims were revolutionary at their time because not only do they describe a new psychology of people, but they also made it a theory of ethics. In “Project for a Scientific Psychology” (1895), Freud struggles with a similar quantity-quality dilemma expressed through neurology idioms. For him, the problem of acknowledging qualities is that quality is not exactly a unit that can be measured by science because “science recognizes only quantities” (p. 309). In the “Project,” Freud overcomes the quality-quantity problem by concluding that it is the system of perceptual neurons that gives rise to the various qualities. The qualities are basically conscious sensations that come about only where quantities are so far as possible excluded (p. 309). However, later on, in “The Economic Problem of Masochism” (1924b), Freud came to the conclusion that the economic point of view was pressed into carrying much more than its fair share of explanatory weight: Pleasure and unpleasure, therefore, cannot be referred to an increase or decrease of a quantity . . . although they obviously have a great deal to do with that factor. It appears that they depend, not on this quantitative factor, but on some characteristic of it which we can only describe as a qualitative one. If we were able to say what this qualitative characteristic is, we should be much further advanced in psychology. (p. 160)

The constancy principle The constancy principle is mentioned in the “Project,” which was written six years after Freud had translated Mill’s essays. Although the “Project” owes much to the tradition of Herbart and Fechner, we can see in it one of the basic tenets of Freud’s early thought regarding happiness, pleasure, and pain. Behind the neurological terminology of the “Project”, we hear Freud’s specifications of what happiness is, or what brings utility to people. We can put his main thesis in a quasi-utilitarian equation: the main factor that counts in deciding what act (or state of mind) maximizes utility and happiness is the stability and peacefulness of the psychological system. Therefore, the psychical apparatus will endeavor to strive for minimum excitation.

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In the “Project,” Freud calls this principle the “principle of inertia,” which is the “First Principle Theorem.” According to this principle, if the psychical apparatus is charged with a quantity of excitation from an external or endogenous stimulus, it will immediately strive to get rid of it by “discharging” itself. The discharge, according to this principle, is proportional to the charge. Freud also called this principle the “Zero Principle,” since zero represents the baseline initial position of the system. This is of course identical to what we know as the principle of homeostasis. Both the pleasure principle and the unpleasure principle aimed at gaining homeostasis. The unpleasure principle, the first that Freud (1900) introduced, regulates the elimination of a disturbance of the equilibrium that is equated with unpleasure. The psychical system is directed towards “keeping itself so far as possible free from stimuli” (p. 565). The pleasure principle regulates the need to recreate by action or by fantasy any situation that has created the experience of satisfaction through the elimination of drive tension. For Freud, then, one of the main things that brings pleasure is satiation, a state of mind that appears after a drive has been satisfied. It is not clear, however, if by “pleasure” Freud meant an experiential affective component, a subjective experience, or if he used “pleasure” only as an economic formulation.1 Although the neuron hypothesis was not alien to Mill (Mill claimed that it is “chemical combination” that stands behind the process in which association is created in the mind), Freud’s conception of the regulatory principle is different from British utilitarianism. First, Freud’s description of the human subject is different from the utilitarian one. Contrary to Bentham’s and Mill’s rational and conscious subject, Freud’s metapsychology in his “Project” contains no subject. There is no actual person who can be happy or who can feel pain, who can choose between alternatives (even if they are unconscious), or who can even have different “states of minds.” All we have here are “complexities of the neuronal events” (Freud, 1895, p. 292) and the principles that govern them. As Jones indicates in his editor’s introduction, the “Project” is ostensibly a neurological document, where the emphasis is on the environmental impact upon the organism and the organism’s reaction to it. The “instincts” are only shadowy entities, with scarcely even a name. What was later regarded as the “pleasure principle” is here regarded solely as an inhibiting mechanism. Another difference between Freud and utilitarianism lies in the specific content that brings pleasure. For Mill and Bentham, every person craves for more happiness and pleasure. In contrast, according to Freud’s regulatory principle, every person seeks to find constancy and avoid unsatisfied needs. For Freud, people are not seeking to gain more and more sex, money, love, or anything that might satisfy them. Rather, they want to reduce the tension stemming from their instinctual needs. Hedonistic behavior is therefore not an aim by itself but a way to satisfy demanding needs. Another radical difference lies in the types of pleasure and their intensity. For Bentham and Mill, pleasures are ordinary things in daily life: eating a good meal, reading a book, walking in beautiful countryside. The quantity of pleasures of

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a complex action, like walking in beautiful countryside, can be aggregated (the beautiful view plus the pleasant weather), while those involving pain (minus the tiredness from the walk) should be subtracted. A decision of whether to perform one action or an alternative one is the result of this calculus. Freud’s pleasures are very different; they are dramatic, intense, wild, sexual, and can sometimes be very tormenting. They can govern the person’s entire life. They usually have a subjective meaning, which others do not share. Moreover, behind daily occurrences in ordinary life hide unconscious and intense instinctual drives. Daily pleasures almost always represent instinctual and unconscious pleasures from conflicting sources.

Conflict For Bentham and Mill, a sole agent that strives to gain pleasure and avoid pain represents the person. Thus, there should be no internal conflict in human life, just a relatively simple decision of which of two or more actions brings more pleasure and avoids more pain. In contrast, Freud’s mind is a complex network of structures that includes wishes and drives with contradictory needs and conflicting mental agents. This means that the psyche as a system has different parts or structures (i.e. id, ego, and superego, Cs/Ucs) and that each of these structures has its own “interest.” Freud emphasized both in the Introductory Lectures on Psychoanalysis (1917b) and in a 1919 footnote appended to The Interpretation of Dreams (1900) via the fairy tale and the three wishes: if we want to understand a wish fulfillment, we must always ask “who is experiencing pleasure?” In many cases, as in the case of a joke, a dream, or a neurotic symptom, the utility of one part of the personality contradicts the utility of other parts of the personality. The stability that the psychical apparatus aims for is not only in reducing tension from inner or external stimulus, but also in solving the conflicts of the different interests. Therefore, in order to understand what mental states, feelings, and actions are instrumentally desirable for people—what promotes their actual happiness, or utility—we must first answer some important questions. What will be the benefit of the action that brings utility to one structure of the personality? Which structure of the personality will pay the price for fulfilling the utility of the other structure? And what conditions are necessary for the psyche, as a whole system, to be capable of deciding which of its structures will gain utility? In particular, there is an inherent antagonism between the utility of the sexual drives and the utility of the ego drives: We have discovered that every instinct tries to make itself effective by activating ideas that are in keeping with its aims. These instincts are not always compatible with one another; their interest often comes into conflict. Opposition between ideas is only an expression of struggles between the various instincts. From the point of view of our attempted explanation, an especially important part is played by the undeniable opposition between

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the instincts which subserve sexuality, the attainment of sexual pleasure, and those other instincts, which have as their aim the self-preservation of the individual—the ego instincts. (Freud, 1910a, pp. 213-14) The conflict between the two parts stems from the fact that both have the same organs at their disposal. For example: The mouth serves for kissing as well as for eating and communication by speech; the eyes perceive not only alterations in the external world which are important for the preservation of life, but also characteristics of objects which lead to their being chosen as objects of love—their charm. (p. 216) So a satisfaction of one interest or pleasure might “cause pleasure in one place and unpleasure in another” (Freud, 1915, p. 147). The result of the conflict is that one group of interests (or ideas, or instincts) “pushes” the other group to “the unconscious”: Psychoanalysis . . . traces mental life back to an interplay between forces that favor or inhibit one another. If in any instance one group of ideas remains in the unconscious, psychoanalysis . . . maintains that the isolation and state of unconsciousness of this group of ideas have been caused by an active opposition on the part of the other groups. The process owing to which it has met with this fate is known as “repression.” (Freud, 1910a, p. 213) Repression has an important role in bringing a relief from intrapsychic conflict and pain. It helps the person to direct his state of mind toward a specific “interest” so that its fulfillment might bring satisfaction and diminish the pressure from the antagonistic side. Repression is a constitutive mechanism that helps to “decide” and to follow that “decision” in a less painful way. The repressed content is not just a particular instance of some wishful but forbidden impulse, but rather a whole modality of desire. The rational decision that Bentham and Mill prescribe between two modes of action, in accordance with the ability of that action to bring more pleasure or to avoid pain, was turned by Freud into an unconscious one. Thus, if Bentham and Mill were mostly interested in working out in detail the means by which utilitarianism could be achieved in society, Freud was interested in finding out the complicated mechanisms inside each person that lie behind the psychology of utilitarianism.

Irrationality and hallucination For Bentham and Mill, people are basically rational beings and do what they think is good for them. It is the rationality of the behavior of seeking pleasure and avoiding pain that justifies turning this behavior into a philosophy of ethics. In contrast,

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Freud demonstrated again and again that the yearning to gain pleasure and to avoid pain often leads to a breaking with reality, causing irrational and pathological behavior. The concept of hallucination in Freud’s “Formulations on the Two Principles of Mental Functioning” (1911) demonstrates this point. In hallucination, the paradigm is once again that of drive satisfaction. After the baby has felt an experience of satiety from drinking his mother’s milk, he will tend to hallucinate this experience. Here, we can see that the need-satisfaction paradigm is so strong that the person does not always need real objects. Momentary pleasure can be gained through mere hallucination. In Freud’s thinking, but not in utilitarianism, one can achieve pleasure through fantasy and not just through an action. Of course, in such a situation, real satisfaction did not occur, and the infant learns how to distinguish such hallucinatory perceptions from a real fulfillment and to avoid them in the future. But, in some pathological cases, hallucination remains the main aim to achieve satisfaction or to avoid pain. Indeed, pathological behavior is a special case in which the need for satisfaction and avoidance of pain is superior to any other motivation and brings to a distortion of reality: [In the case of amentia psychosis] the ego breaks off its relation to reality; it withdraws the cathexis from the systems of perception . . . With this turning away from reality, reality-testing is got rid of, the wishful phantasies are able to press forward into the system, and they are there regarded as a better reality. (Freud, 1917b, p. 233) Here lies another important break between Freud and British utilitarianism. Freud, unlike Bentham and Mill, postulates a difference between happiness and utility on the one hand, and seeking pleasure and avoiding pain on the other. In hallucination, for example, the need to gain a momentary pleasure brings the patient to a detachment from reality that might make him miserable. In neurosis, the need to avoid pain is so strong that the patient prefers to “have symptoms” and be unhappy rather than confront the pain that arises from awareness of his sexual or aggressive wishes. As Freud (1910a) writes: We see that human beings fall ill when, as a result of external obstacles or of an internal lack of adaptation, the satisfaction of their erotic needs in reality is frustrated. We see that they then take flight into illness in order that by its help they may find satisfaction to take the place of what has been frustrated . . . we find that the withdrawal from reality is the main purpose of the illness but also the main damage caused by it. (Freud, 1910a, p. 49) From a utilitarian point of view, the psychotic and the neurotic made rational choices because more pain would be experienced without their symptoms. Had they not distorted reality, perhaps they would have been exposed to tremendous painful experiences. Nevertheless, the pathological choice of the patient involves a gross distortion of reality, and therefore it is against his utility. In the case of the

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psychotic, it includes a withdrawal of the cathexis from perception; as for neurosis, it serves no useful purpose whatever, since it uses up forces which would have been more profitably employed in dealing rationally with the dangerous situation (Freud, 1923a). Freud shows, then, the irrationality of the hedonic calculus in the psychical apparatus. The pressures of gaining pleasure and avoiding pain in the short run are so great that long-term utility is being neglected and must be put aside. But why would a person be so irrational and turn against himself? One of Freud’s explanations is that it happens in cases where the hedonistic side of the person is blocked by the moral demand put by society. It is the civilized standards internalized in each person that block the way to sexual pleasure. Freud (1910b) noted that not all the energy from the instincts could be sublimated, exchanging the sexual aim for another socially accepted one. He blames society for blocking the satisfaction of sexual needs and by that creating neurosis: A certain portion of the repressed libidinal impulses has a claim to direct satisfaction and ought to find it in life. Our civilized standards make life too difficult for the majority of human organizations. Those standards consequently encourage the retreat from reality and the generating of neuroses, without achieving any surplus of cultural gain by this excess of sexual repression. [We should not] forget that the satisfaction of the individual happiness cannot be erased from among the aims of our civilization. (Freud, 1910b, p. 54)

Utilitarianism and Freudian thought I hope I have proved by now that it is wrong to put Freudian thought and utilitarianism on the same level. Utilitarianism is a value theory: it concerns the assessment of human life because it wants to bring change in the quality of life. Schacht (1991) argued that in the nineteenth century philosophy ceased to be fundamentally metaphysical and took an “anthropological” turn—a turn that was political, social, and cultural. For nineteenth-century philosophers, issues pertaining to the quality of human life became central—issues not so much matters of “what we can know” as of “what we can (and can best) become.” And, for nineteenth-century philosophers, issues could not be considered in abstraction from considerations of historical nature, taking into account what human beings collectively have become. That is exactly the point where Freud and utilitarianism meet. They both have a theory of the psychology of human nature, and they both emphasize the centrality of the pleasure principle. But they theorize from very different perspectives. While for Bentham and Mill the pleasure principle is an important resource for ethics, Freudian psychology is much richer in its psychological scope. Liberated from the need to find ethical solutions to human problems, Freud does not hesitate to explore psychological dimensions that Bentham and Mill would not have dreamed of treading. Whereas Freud is much more interested in exploring the actual human being with all its richness and contradictions, Bentham and Mill support their value

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theory on a psychology of an abstract man, which is supposed to apply to all cases. In this sense, the relations between the two can be compared to Marx’s critique of the Feuerbach theses. Feuerbach’s sensualism and communalism were an important source for Karl Marx’s development of an anthropological humanism. But Feuerbach, as Marx claimed in “Theses on Feuerbach” (Engels & Marx, 1998), mystifies the realm of pure ideas. He never arrives at really existing, active men, but stops at the abstraction man. Just like Freud and utilitarianism, Marx’s writings are not only “different” from Feuerbach, they are the landmarks of breakthrough and novelty that define new streams of thought. Of course, we must remember that utilitarianism is not less popular and familiar than Freud and that it was once considered to be a very challenging and revolutionary ethic. Freud departs from utilitarianism also in his rhetoric and the manner in which he deals with issues. This difference resembles a gap between Nietzsche and other philosophers (Schacht, 1983). This is why Freud’s theory is much more Nietzschean then it is Benthamian. Bentham and Mill approach human nature a priori, attempting to ascertain self-evident first principles from which conclusions with respect to them may be deduced or inferred. Such a procedure may issue in a logically rigorous system, but as Schacht (1983) pointed out, in nonNietzschean philosophies, “neither the appearance of self-evidence of the first principles selected nor the logical rigor with which consequences are inferred from them establishes that the system is anything more than a description of a possible world” (p. 12). Freud, on the other hand, like Nietzsche, is interested in a broad range of forms of human activity and experience, from the social and the religious to the artistic and the scientific. His interest and curiosity are heightened when he finds that the rules he himself discovered do not hold at any time and in any case. Following Schacht’s (1983) description of Nietzsche, it is interesting to compare Freud with a lawyer who takes on difficult cases with no quick or easy resolution. Just as a courtroom verdict can be appealed, a case made by a philosopher can always be reconsidered. That is why Freud (1920) is free to write in Beyond the Pleasure Principle: It is incorrect to talk of the dominance of the pleasure principle over the course of mental processes. If such dominance existed, the immense majority of our mental processes would have to be accompanied by pleasure or lead to pleasure, whereas universal experience completely contradicts any such conclusion. The most that can be said, therefore, is that there exists in the mind a strong tendency towards the pleasure principle, but that that tendency is opposed by certain other forces or circumstances, so that the final outcome cannot always be in harmony with the tendency towards pleasure. (pp. 9-10) While Freud wanted to create a discipline that aims at understanding people with all their contradictory aspects, Bentham and Mill wanted to create a rational ethical philosophy that by its nature cannot tolerate contradictions, irrationality, and incongruity. Freud (1923b) made it clear which of the two systems he prefers:

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Psycho-analysis is not, like philosophies, a system starting out from a few sharply defined basic concepts, seeking to grasp the whole universe with the help of these and, once it is completed, having no room for fresh discoveries or better understanding. On the contrary, it keeps close to the facts in its field of study, seeks to solve the immediate problems of observation, gropes its way forward by the help of experience, is always incomplete and always ready to correct or modify its theories. (pp. 253-254)

Note 1 For different opinions, see Loewald (1971, p. 114); Smith (1977).

7 THE FATHER, THE SON, AND THE SPIRIT OF CHANGE How the psychoanalytic community incorporates the ideas of nonanalytic methods

During the 1970s, other fascinated theorists followed unknowingly Freud’s e­ xample by assimilating non-psychoanalytic ideas from different bodies of knowledge. In this chapter, I will focus on the way in which Heinz Kohut’s concept of empathy was influenced by Carl Rogers, the founder of Humanistic Psychotherapy. I will also show how the cognitive-behavioral approach impacted on the development of short-term dynamic therapy. As with Freud and utilitarianism, here too the “external” sources are not explicitly cited, and the “borrowed” idea is fundamentally modified, thus adapting it to the field of psychoanalysis. Fascinated communities often tend to ignore other forms of psychotherapy (e.g. CBT, Gestalt, person-centered therapy, etc.). And yet, this chapter argues, some of the central and newly introduced concepts in the history of psychoanalysis have in fact been influenced by these new therapies. The seemingly rival therapies/therapists all function in the same world, have to deal with many of the same clinical issues, and have a good sense of the theories being developed by their competitors; thus, there is quite a significant cross-fertilization and mutual influence. However, while psychoanalysis has been proud of its vast influence on other therapeutic methods, it has tended not to acknowledge being influenced by them in turn. This lack of acknowledgement can be easily understood when one closely looks at the psychoanalytic world. Fascinated communities of psychoanalysis insist on a strict set of guiding principles and refuse, in any way, to alter or modify their long established procedures (Goldberg, 1990). They oppose change because of a belief that it will undermine the identity of the movement and the boundaries by which it has been defined (see, for example, Blass, 2010, and the response by Berman, 2010). It is no wonder, therefore, that Summers (2006) did not hesitate to claim that the history of psychoanalysis “is frighteningly similar to fundamentalist movements” (p. 351).

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So it is clear why change is often seen by analysts as dangerous, arousing the fear of that which is new: the introduction of an alien component into the theory and the therapeutic method arouses in many analysts the concern that this will lead to a betrayal of the guiding principles of the theory, to the blurring of the distinction between “us” and “them” or to a diminution of the value of the brand name of a psychoanalytic school. Thus, every introduction of a new component involves a struggle within the community, which now has to alter basic, agreedupon conventions that were the source of its pride for years and which bestowed upon its members connectedness and identity. Every new idea introduced is felt to be brought up by a rebellious son (or daughter), which is seen as turning against the fathers (and mothers) who devised the old, classic theory and technique (e.g. Rangell, 1982). Furthermore, considering Kuhn’s (1962) widely accepted notion that “anomalies that subvert the existing tradition of scientific practice” (p. 5) will almost inevitably lead to a paradigm shift, it is no wonder that psychoanalysts have struggled to maintain the mythic accuracy of the theory, protecting it from anything that is liable to render it erroneous. However, change cannot only be dangerous or sacrilegious; without change, psychoanalysis will not survive the passage of time, will become archaic, irrelevant, and as a result obsolete, due to the difficulty of offering responses to a rapidly changing culture and the changing needs of the patient population. Change helps a theory to be updated and create new meanings in order to continue to exist. This change is often allowed not thanks to inner development, but, I will argue, thanks to introduction of exiting concepts from outside psychoanalysis. In this chapter, I will discuss the relations between a new component and the existing theory of the psychoanalytic school that incorporates it. I will point out two central fears that accompany processes of change in therapeutic theory and technique: the anxiety of influence and the fear of obsolescence. The anxiety of influence (Bloom, 1973) is a response to a change that is about to revolutionize the basic concepts of the theory. In order to illustrate this anxiety, I shall use Heinz Kohut’s introduction of the concept of empathy into psychoanalysis. While the anxiety of influence is a response triggered by the introduction of a new component, the fear of obsolescence stems from absence of change. The fear, in this case, is that leaving the theory unaltered is liable to lead to it becoming irrelevant and outdated, ostracized from the wider psychotherapeutic community and the scientific world. I will illustrate this fear with the introduction of the methods of short-term dynamic treatments in the1970s and 1980s. These two fears are in conflict, and while this conflict remains mostly dormant, it awakens at times when the theory is in need, either a theoretical or a pragmatic one. And so, I argue, empathy was introduced to psychoanalysis in the wake of a theoretical need, while short-term dynamic therapy as the result of a pragmatic need. Both ideas, as I will show, were at first new to the psychoanalytic community and incorporated from the outside, a process that involved dealing with questions of identity and the boundaries of theory.

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Common to both processes was the importation of a new component or the influence of other theories, which was done surreptitiously while at least part of the processes of internalization and incorporation was unconscious, or at least did not gain recognition. And thus, psychoanalytic theories that appear to be immune to outside influence in fact develop, at least partially, by the incorporation of new ideas taken from other theories. These ideas are both dreaded (anxiety of influence) and yet necessary due to fear of obsolescence. While addressing both dread and need, even the most seemingly inflexible psychoanalytic schools maintain a dialogue with the “other,” which is done in a very interesting way: they appropriate the new element, change it so that it fits their needs, and bestow upon it a new meaning that alters both the new component and the theory itself. These changes can be characterized not as dramatic paradigm shifts, but rather as subtle yet major differences that enable the theory’s continuity. So, the response provoked by the arrival of the new is subtle and multifaceted. Initially, the impression given is that the new component stands little chance of being accepted by traditional psychoanalysis and will forever be considered as an interloper. And yet, this turns out to be so only for a limited period, since warding off an invader also has the effect of altering the position taken up by those whose territory has been invaded. This process describes the resolution of the conflict: disguising the newness of the alien component soothes the anxiety of influence, while the process of incorporation generates change, thus soothing the fear of obsolescence. Therefore, important theoretic incorporation often occurs outside the umbrella of psychoanalysis. And yet, I argue, this kind of incorporation is sometimes the most successful form of integration done in psychoanalysis. It seems that psychoanalysis within the US was more readily influenced by non-analytic therapies than psychoanalysis within other parts of the world because America remains the country of the earliest, widest, and most thoroughgoing applications of psychoanalysis. It has seen the most extensive attempts to codify and test psychoanalytic theories and techniques against actual, recorded clinical experience (Hale, 1995, p. 390).

The anxiety of influence The term “anxiety of influence” was introduced by Harold Bloom (1973). It describes a range of experiences that are a reflection of the ongoing struggle between obligation and the creative process: the more we develop in terms of theory and practice, the more we find that we must submit to the influence of others while at the same time ensuring that we continue to expand our own individual identity and our own unique voice (Mendelsohn, 2005). Bloom’s work relates to the link that is created between poets and those who preceded them. Bloom thinks that those whom he calls ‘strong” poets—those whose works are inventive, original, and have a powerful impact—conduct an animated, though largely non-conscious dialogue with their literary ancestors. In the process of attaining a position of strength in their field, such poets are heavily

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influenced by poetry they have read; as a result, they undergo a change. However, this change does not involve merely mimicking their predecessors and sacrificing their individuality. Even though superficially the impact on them by earlier writers seems to be discounted, their very inventiveness affirms such influences. According to Bloom, poetic influence—when it involves two strong, creative poets—always proceeds by a misreading of the prior poet, an act of creative correction that is actually and necessarily a misinterpretation. Bloom terms this “misreading” or “poetic misprision.” Thus, in the act of “misreading,” we turn the writings of our forebears into our own work. What we end up writing is a reflection both of ourselves and of them. In what we write, we may discover ideas that earlier writers may or may not have intended or been able to comprehend. It is this process that opens the door to change. The earlier writings also undergo change by the way in which we use them. The way in which we interpret earlier writings will establish a reading context for those writers who follow us: “The mighty dead return,” writes Bloom (1973), “but they return in our colors and speaking in our voices, at least in parts, at least in moments, moments that testify to our persistence, and not to their own” (p. 141). What this view implies is that it is only when we first try to write for ourselves that we truly come to know and understand what we have read in the past. Each work turns into our own innovative reading of and dialogue with those who wrote before us. Comparing such a process to anxiety of influence is intended only to highlight various aspects of theory development within psychoanalysis (see also Mendelsohn, 2005; Priel, 2003, 2011). It in no way ignores the existence of fundamental differences between psychoanalytic theory and the art of poetry or literary writing. For example, the anxieties of influence that characterize Bloom’s poets are from their predecessors, whereas, in psychoanalytic theory, it is from the outer world. Also, in Bloom’s account, the poet alone is struggling with his own anxiety, whereas, in the process I describe, the entire community bears the anxiety. Analogies, it has to be said, even in those instances in which they are productive, are never more than an aspect of the whole picture. However, as pointed out by Amati-Mehler et al. (1993), “even though the fields of psychoanalytic theory and textual analysis have precise and different outlines, both can be enriched by intersections and loans” (p. 237). I believe anxiety of influence also takes place in the history of development of psychoanalytic theory—only here, the dread is of being influenced not only by previous analysts (Rangell, 1982), but also of being influenced by non-analytical therapists. Creators of new psychoanalytic schools, like magicians, learn their craft from other thinkers. And just as magicians will turn attention from what their hands are doing, the most creative thinkers in psychoanalysis also tend to camouflage their sources, perhaps for a similar purpose.’

Kohut’s empathy It is hard to imagine, but not so long ago the psychoanalytic community showed considerable worry about the notion of empathy. Only on the background of that concern can we understand Kohut’s (1984) comment, which seems today quite

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obvious: that he felt freer, guiltless, and had no sense of misgiving in showing the analysand his active participation and solicitude through the warm tone of his voice. Of course, Kohut had to stress he felt no guilt, because such guilt was expected in some psychoanalytic circles whenever an analyst did just that. Kohut’s self-psychology emphasized the central importance of empathy. For Kohut, any attempt to understand a patient’s psychopathology had to be based on empathy, a conclusion that led him to call for a change in existing psychoanalytic techniques. In his first important publication dealing with empathy, Kohut (1959) threw down the gauntlet to the practitioners of classical psychoanalysis by declaring that it was the task of analysts to do more than merely observe free association and engage in the analysis of resistance. Kohut (1959) believed that only when we “think ourselves into [the patient’s] place” (p. 461), by way of transferred introspection, can we bring to life inner experiences not previously known. Kohut, in contrast to conventional psychoanalysis (which concentrated on transference, the unconscious, and the resurrection of memory), suggested empathic validation whereby the therapist confirms the patient’s account. In his last important statement on the therapeutic dimension of empathy, Kohut (1984) insisted on deferring interpretation in favor of an extended period of empathic therapy, during which the patient’s view of reality would be confirmed. The task of the analyst was to let the patient know that he empathizes with what the patient is feeling and to show that he understands him. According to Kohut, any other therapeutic method risks delivering a blow to the patient’s narcissism by making him feel misunderstood. The interpreting analyst is criticized by Kohut as hammering “away at the analyst’s transference distortion” (p. 182). However obvious these ideas seem today to many analysts, forty years ago they were fairly new to psychoanalysis. The idea of understanding the patient through empathy somewhat contradicted the traditional world-view upon which psychoanalysis had rested since Freud. Insight achieved through interpretation was, in earlier times, considered the most important process to be developed. Though it is true that Freud referred to empathy a number of times in his treatises on jokes (Freud, 1905a) and group psychology (Freud, 1921),1 it was never thought by him to be a key tool of analysis. Instead, he championed the analyst who gave free reign to his associations and intuitions together with a rational review of the seemingly random information resulting from analysis (Shapiro, 1981). According to Pigman (1995), Freud mostly adopts an intellectual attitude toward empathy because he was ambivalent about emotions and suspicious of their place within the analyst. Despite (or perhaps because of) his insight into resistance and unconscious conflict, he remained resolutely committed to rationality, a worshipper of “our god Logos” (Freud, 1927b, p. 54). Freud (1917b) stated that “by means of the work of interpretation, which transforms what is unconscious into what is conscious, the ego is enlarged” (p. 455). His emphasis on interpretation and the achievement of insight remained the centerpiece of psychoanalytic treatment, notwithstanding the evolution of his metapsychological theories (Glucksman, 1993). A quick review of the contents of the

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Psychoanalytic Quarterly from its foundation in 1932 and up to 1955 reveals that, during this period, North America’s oldest psychoanalytic journal listed only one reference to empathy against forty-two references to insight (Shapiro, 1981). Thus, looking back we can see that, for a very long time, insight was viewed as the major component of change. Therefore, the idea of understanding the patient’s inner world through empathy (i.e. in a way that involves the therapist’s subjectivity) embodied a contradiction of an entire world-view, one which persisted long after Freud’s death, mainly through the very successful ego psychology, which also embraced these ideas (e.g. Brenner, 1956; Hartmann, 1939; Kubie, 1960). This does not mean that analysts were not empathic to their patients before Kohut; psychoanalytic literature abounds with references to empathy (Gabe, 1947; Lander, 1957; Olden, 1954; Schafer, 1959; Stewart, 1955). Robert Knight, for example, as early as 1946, recommended empathy to understand a catatonic boy when all other techniques failed. Indeed, many self-psychologists would never agree that empathy introduced a “new” idea to analysis, but rather that it clarified what analysts really did. Kohut believed that all psychoanalysis involves empathy. In How Does Analysis Cure? (1984), Kohut suggests that even though he thinks Kleinian analysis to be a “wild analysis,” it nevertheless works when patients are being understood in empathic ways. Rather than being new to the practice of psychoanalysis, empathy was “new” to its theory. Before Kohut, empathy lacked a theory of its own. It was understood as a mental phenomenon that required “an ongoing split in the ego, as well as rapid shifts of projection and introjection across momentarily relinquished boundaries” (Post, 1980, p. 277) in order for the empathizer to both maintain his boundary and surrender it. French (1970), Greenson (1960), and other authors emphasize the necessity of an ego split in such processes. Hence, the opposition that Kohut aroused was not in fact related to the use of the concept of empathy, but rather to the meaning that Kohut attached to this concept and the new theory that surrounded it. Kohut’s ideas met with fierce opposition because they were perceived as contradicting the basic assumptions of psychoanalysis. The main and strongest stream in psychoanalysis in Kohut’s time was ego psychology (Hale, 1995; Wallerstein, 2002). Some ego psychologists perceived psychoanalysis, including all its research objectives and investigation methods, as being essentially identical to the natural sciences (Eisler, 1965; Hartmann, 1951; Kubie, 1960). Ego psychology was quite medical in nature, and it identified a connection between mental health and a person’s ability to adapt to his environment. The connection between psychoanalysis and science lent legitimacy to the former, which, at that time, was extremely important for its acceptance in the United States (Cushman, 1996). In such an atmosphere, ideas such as “the essence of psychoanalysis lies in the scientific observer’s protracted empathic immersion into the observed, for the purpose of data-gathering and explanation” (Kohut, 1977, p. 302) and that “the presence of an empathic or introspective observer defines, in principle, the psychological field” (p. 32) were alien to the field and, as we will see, aroused tremendous criticism. To do justice to the complex situation at that time, it is important to

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note that ego psychology is not of one piece but, rather, diverse. Hans Loewald, Edith Jacobson, and Harold Searles were a few of the many who attempted to consider radical changes in the meaning of classical terms within the ego psychological framework. These authors, and others, had more humanistic aims and cultural preparation that reflected the Sturm und Drang of German Romanticism. These two tendencies of apprehension for two types of science (Naturwissenschaft, Geisteswissenschaft) echo the struggle to be found in Freud himself: wanting to be grounded in biological theory while at the same time recognizing the difficulties and limitations of doing so. Nevertheless, when Kohut exhibited his new ideas, he was accused of belittling Freud, of recycling concepts, populism, superficiality, subjectivity, ignoring the non-conscious, rejecting the scientific approach, and making psychoanalysis onedimensional (e.g. Brenner, 1968; Moses, 1988; Stein, 1979). Shapiro (1981), for example, wrote that he would regret it if psychoanalysis were to accept empathy as its tool because we would then relinquish our place among the sciences . . . Even the suggestion that it is a science as astronomy and archaeology are sciences does not comfort all, and certainly its inclusion within hermeneutics places it closer to religious exegesis than I, and many like me, would like to accept . . . I would submit that those who tell you about the success of their empathy are like those who invest in the stock market—they only tell you when they win! (pp. 428-444) Prominent psychoanalyst Charles Brenner (1968) stated that using empathy was a stance to be adopted by philosophers and by introspective psychologists, not psychoanalysts. Stein (1979) thought that Kohut’s work appears to be the product, not so much of painstaking exploration, of trial and error, and of attempts to test the truth, as of a more purely subjective and inspirational process, largely confined to the empathicintrospective method and relatively independent of other sources of knowledge . . . Whatever its contribution, it is difficult to accept as a genuine addition to psychoanalytic theory and practice. (p. 679) “In my mind,” wrote Giovacchini (1978), “Kohut’s work has been much too readily accepted without having been critically examined” (p. 617). And Moses (1988) asked: How can the therapist validate experiences that are unknown and poorly conceptualized by the patient? When the therapist in this case chooses to validate the patient’s pain, questions arise as to whether or not one can be sure of what feelings are real especially in view of the early history of isolation, traumatic losses, and abandonment. (p. 587)

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In his biography of Kohut, Charles Strozier (2001) describes the way in which Kohut’s continually rising popularity resulted in him being deserted by most of his contemporaries. It was some time before Kohut’s The Analysis of the Self (1971) made a real impression, and even though the book was never particularly widely read. Even so, everyone involved in the field discussed it; the debate itself produced a level of excitement not experienced since the days of Freud. Particularly dangerous to Kohut’s position was the opposition of leading psychoanalysts. He was often in conflict with such leading figures as Anna Freud and Kurt Eissler—once they had understood the real import of The Analysis of the Self and where Kohut was heading. Anna Freud never mentioned his writings after 1971, and Kohut stopped corresponding with her about his work. With Eissler, there was also an erosion of the relationship between them. Eissler wrote to Kohut that he was “shackled with self psychological theory” and that he had “doubts that an analysis of the self will initiate a new phase in the relation of psychoanalysis to other fields of research” (Strozier, 2001, p. 270). In one of his letters, written on the very day Eissler had written to him, Kohut noted that Eissler was “really just one of the great number of my colleagues who attack me and my work in the most violent way” (p. 271). In the main, all that Kohut could really do about the situation was to come to terms with the fact that his traditionalist friends would be shunning him and refusing to engage with him. Once it became clear that he was being abandoned by senior figures in the field, especially those on the east coast, who felt he had gone too far, others rapidly followed suit. There were some who had been close to Kohut for decades but who now chose to cut him out of their lives altogether. Outside of Chicago itself, Kohut was never invited to socialize after meetings. Colleagues encountered him in various places and chose to ignore him. More dramatically, at a workshop in Paris in 1973, a number of senior analysts showed their disfavor by walking out at the break. Very surprisingly, even in Chicago he was marginalized. In 1977, he was voted off the Chicago Institute’s council by the old guard. On the surface, it looked as if he had been voted out as a result of a comment he made at an Institute seminar suggesting that Josef Breuer, rather than Sigmund Freud, was the analyst who, in his work with Anna O, was the real inventor of psychoanalysis. This, in the view of the majority of the Council, meant that Kohut could no longer be said to be an analyst (Strozier, 2001). It should be noted however, that Kohut’s ideas received a warm welcome from other analysts in the community (Menaker, 1978; Schwartz, 1978). For example, when told about a presentation by Kohut, Rene Spitz responded by saying that he had been waiting all his life for such a theory to emerge, and, closer to home, almost in Kohut’s own backyard, his work was praised by Jerome Kavka of the Chicago Institute. In 1978, the Psychoanalytic Review held a symposium devoted to a discussion of The Restoration of the Self: “[It] is a stimulating, provocative, and somewhat inspiring book. Despite his firm foundation in the classical psychoanalytic tradition, Kohut advances a revolutionary position: Down with drive theory! Less emphasis on the neutral-interpretive stance!” (Tuttman, 1978, p. 628)

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In the late 1970s, admiration for, and interest in, Kohut’s work propelled the movement forward. Several important figures joined the self-psychology Chicago group, including Bernard Brandchaft, Morton and Estelle Shane, Evelyn Schwaber, Robert Stolorow, and Arthur Malin. That process, in turn, kept cloning itself after Kohut’s death. A National Council of Self-Psychology was formed; it later became international in scope and name. Several self-psychology training institutes were established in New York City and elsewhere, and even most traditional institutes came to include a self track in their curriculums. Despite all of this, there can be no doubt that Kohult felt as if he had been thrown out of his family home (Strozier, 2001). But the existing mainstream psychoanalytic perception of empathy was not the only obstacle Kohut had to overcome. Perhaps a more serious problem was that Carl Rogers had already treated patients through empathy back in the 1940s with his humanistic, client-centered therapy. The resemblance between the two theories seemed so salient to Robert Stolorow (1976) that it lead him to note that “there appear to be striking parallels between the techniques, therapeutic processes and ideal outcome formulated in the analytic treatment of narcissistic disorders and the techniques, therapeutic processes and ideal outcome of client-centered therapy as conceptualized by Rogers” (Stolorow, 1976, p. 28). The problem was that Rogers had developed his treatment method as an alternative to the psychoanalytic method. The problem facing self-psychology was thus twofold: how does one convince others that the concept of empathy fits in with the fundamental principles of psychoanalysis, and how does one do so without being identified with Rogers’s nonanalytic treatment? Before answering these questions, it is important to point out that Kohut drew as much, if not more so, from strands within the analytic tradition as he did from Rogers. Many within the psychoanalytic world traced in Kohut’s work the legacy of Ferenczi, Balint, Guntrip, Winnicott, and Sullivan (Hazan, 1999; Rachman, 1988; Strozier, 2001). It was on this contrast between his approach to these writers and his stance on Rogers that Kohut wanted to sharpen, sometimes artificially, the differences between his emerging ideas and those of others within the psychoanalytic community. According to Strozier (2001), he “was so oblivious to Carl Rogers that he have never once mentioned his name in anything written that has survived” (p. 227). Given that the main theme of Rogers’s theory was empathy, it is difficult not to notice that there is no reference to Rogers’s work in Kohut’s bibliographies. In contrast, Kohut “never questioned that there were many in psychoanalysis who were interested in some of the same problems he was” (p. 225). Kohut’s interest in Ferenczi, for example, can be traced back to the 1940s. In Kohut’s opinion, even though Ferenczi had carried through a number of cardinal therapeutic experiments using empathy, he had not articulated a theory based on them. Kohut was dismissive of Ferenczi’s later therapeutic experiments and scornful of his “simplistic view” that one could retrospectively compensate for early deprivations. Kohut referred to Winnicott in the The Analysis of the Self

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as well as in lectures at the University of Chicago addressed to the Mental Health Clinic; his sense was that, like Ferenczi, Winnicott was to be praised for his use of empathy clinically but that he had not found a way of turning the practice into a viable theory. I believe that Kohut managed to solve this twofold problem concerning Rogers. If you would present to any psychoanalyst today a list containing the following names—Melanie Klein, Carl Rogers, Wilfred Bion, Heinz Kohut, and Steven Mitchell—most would very probably point to Carl Rogers as the one who does not belong. This is so even though, in terms of ideology and content, Kohut’s theory and therapeutic technique bear much more of a resemblance to those of Rogers than to those of Klein or Bion. As Kohut developed his theory and became more independent and less concerned about his critics, his use of empathy became more similar to Rogers’s (Kahn & Rachman, 2000). Apparently, that was one of the major successes of self-psychology: it managed to get identified with psychoanalysis rather than with the method that is much closer to it from a conceptual and ideological point of view. Kohut achieved this by modifying from within an idea that was “new” to psychoanalysis, while denying its source in a way that enabled psychoanalysts to accept it. We have no well-grounded information that Kohut was directly influenced by Rogers, but the similarity between the two theories has been the subject of several studies (Bohart, 1991; Kahn, 1985, 1989a, 1989b, 1996; Stolorow, 1976; Tobin, 1990, 1991). However, as I will show, it was, in fact, Kohut’s attempt to distinguish between his and Rogers’s theory which lay behind the successful integration of Rogers’s ideas into self-psychology—and hence into psychoanalysis. An important research comparing the two theories was undertaken by Kahn and Rachman (2000). They wrote that the assumption underlying Rogers’s thinking was that within each and every individual, as well as within nature itself, there exists a positive motivation to ascend to his or her utmost potential, an aspiration that Rogers termed “actualizing tendency.” According to Rogers, the nonjudgmental acceptance of a person and the demonstration toward him or her of empathic understanding on the part of a significant other—who is also experienced as genuine and humane—fosters the self-esteem of the recipient, thus advancing the process of actualization.2 They note how early Rogers was appreciating the validity of the subjectivity of the client. Stolorow (1976) also highlighted the remarkable similarity of the therapeutic relationship for Rogers and Kohut: The therapist who follows Rogers’s recommendations thus divests himself of his own selfhood and embraces the role of a part, extension or duplicate of the client, a “pure mirror image” of the client, a depersonified medium in which the client’s sense of self may germinate and consolidate. As in the handling of the mirror transference, the client-centered therapist accepts (and even promotes) his role as an impersonal function substituting for missing or defective segments in the client’s own self-structure. (p. 28)

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Whereas Rogers, from the 1940s onward (see Rogers, 1951), advocated the ­consistent acceptance or prizing of a client, Kohut and other self psychologists, at least through the 1970s and 1980s, were more hesitant to “prize” or “mirror” a patient in analytic therapy. Kohut (1984) also denied the criticism “that we gratify our patients by ‘mirroring’ them” (p. 402), and Basch (1981) stated that “a patient’s need to be mirrored . . . can be met with an analytic response . . . no . . . indulgence of the patient is called for” (p. 343). One does find, however, examples in Kohut’s writings in which he advocated providing positive experiences for patients. For instance, in his seminal paper on introspection, empathy, and psychoanalysis, Kohut (1959) wrote, when describing addicts: Their addiction must not, however, be confused with transference: the therapist is not a screen for the projection of existing psychological structure; he is a substitute for it . . . The patient now really needs the support, the soothing of the therapist. His dependence cannot be analyzed or reduced by insight; it must be recognized and acknowledged. (p. 225) It was Kohut’s shift towards ensuring that he made a persistent effort to listen to the patient’s perspective that was, in Schwaber’s (1983) view, Kohut’s most significant contribution to the evolution of a new practice. Kohut (1984), in summing up his altered position, explained that, in listening to patients in the past, he had often believed his interpretation of what they were telling him was right and that their version was wrong. But he had learned that, in fact, what a patient chose to tell him was likely to turn out to be true, and that, after a prolonged search, his rightness had been revealed to be “superficial,” whereas the patient’s rightness was shown to be “profound.” An attitude of attempting to just listen to what the client is experiencing, without interpretation, is the attitude that Rogers was advocating as early as 1942. In a lovely passage, Rogers and Sanford (1984) noted that, in person-centered psychotherapy, the therapist’s aim is to achieve a form of care in which there is a show of open belief. Such openness would mean that clients’ descriptions of themselves could be taken at face value instead of the therapist continuing to suspect that what he is being told could well be otherwise. As is apparent from these basic principles of Rogers’s humanistic psychotherapy, there is much in his thinking that is similar to, and compatible with, Kohut’s point of view. For example, Both Rogers and Kohut emphasized the value of empathy— that is, listening to and truthfully understanding the subjective experience of the client or patient. As it happens, between 1945 and 1957, Rogers and Kohut worked at the University of Chicago: Kohut was in the Department of Neurology and Psychiatry while Rogers was a professor of Psychology. As revealed in a personal communication dated August 27th 1986 (Kahn & Rachman, 2000), Rogers was himself curious about the close similarities between his and Kohut’s work and acknowledged the large and important overlap between Kohut’s views and his. Hoping that his correspondence would be able to shed new light, Rogers wanted

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to know the extent to which Kohut’s thinking and his “new discoveries” had been founded on a knowledge of his [Rogers’s] somewhat strident work. In Rogers’s view, the fact that the aspects of empathy and self which he had been writing about for years were the very issues in which Kohut had developed an interest while he was in Chicago, could not be seen as a mere coincidence. He expressed his deep regret that he and Kohut had had no personal contact while they were both in Chicago. Kohut’s and Rogers’s writings both appeared during a period that Tom Wolfe (1976) labeled the “me decade.” It was a period notable for the works of various influential cultural critic work on narcissism, such as Christopher Lasch’s The Culture of Narcissism (1979) in the America of the 1950s and 1960s, which was remarkably similar to the self hallowed by humanistic psychology and self-psychology. Not surprisingly, theories in psychotherapy during the 1960s, 70s, and 80s portrayed a self very much like the one depicted in television commercials, magazine ads, and the ever popular musical of that era, Hair. The self in the course of those decades was keen to show off and be self-centered; for this self, the expression of emotion, the lifting of political and personal restrictions, and immediate gratification were all of the utmost importance. All in all, the period signaled a highly contrary way of being: disorganized, ambiguous, and yet sometimes inspiring—in other words “narcissistic” (Cushman, 1991, p. 213). Kahn and Rachman (2000) believe that, although Kohut was seemingly aware of Rogers’s research, he was apparently not particularly impressed by it at the time. Kohut was critical of non-analytic and non-interpretive psychotherapeutic counseling, such as the humanistic one. He made a comparison between such methods of psychotherapy and the work of a repairman who successfully manages to get his old alarm clock to work. This repairman knew nothing about clocks; to make the clock work again, all he did was to clean it up and oil the internal mechanism. There is no need to spell out the analogy between the so-called watchmaker and the practitioners of certain kinds of psychotherapy—except, I think, that my so-called watchmaker had a higher percentage of successes and knew more about what he was doing than most of the psychotherapists who borrow one or the other insight or technical rule from psychoanalysis and apply it without understanding. (Kohut, 1978, p. 525) These remarks of Kohut’s certainly do not demonstrate much in the way of appreciation for Rogers’s stance of empathic listening, in which he was attempting to view things as much as possible from the patient’s perspective. The main reason given by researchers for Kohut’s disregard for Rogers’s work was his desire to take all the credit for himself (Kahn & Rachman, 2000). I am of the opinion that the reasons for this “oversight” are more profound. Writing about Kohut’s success, Otto Kernberg has noted that Kohut and his disciples courageously stood up to a large and highly critical majority and were able to maintain themselves within the American Psychoanalytic Association and the International Psychoanalytic Association without suffering the destiny

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of “dissidents” of earlier generations whose separation from the mainstream of ­psychoanalysis impoverished psychoanalytic dialogue (Kernberg, in Bergmann, 2000, pp. 153-154). Indeed, Kohut saw himself as part of mainstream psychoanalysis most of his career. Three years before he died, he wrote: I am very eager not to encourage a break in the development of psychoanalysis and am therefore proceeding with theory change in a gradual way. By basing myself on the investigation of transferences and by retaining a psychology of the self in the narrower sense, i.e. a psychology of a self within a mental apparatus (see The Restoration of the Self ), I am retaining the concept of dynamic unconscious . . . and remain therefore in the mainstream of analysis, i.e., I do not encourage the development of a dissident school. (Cocks, 1994, p. 362) Perhaps this throws more light on the reasons Kohut had for not citing Rogers as a source for his ideas and for even treating him with disdain. As Kernberg hinted, it is precisely the fact that Kohut did not give credit to Rogers that enabled him to integrate Rogers’s ideas into psychoanalytic theory. As a result the “us/them” distinction that is so important in the psychotherapeutic culture could be maintained. Thus, Kohut’s task was particularly challenging. He had to argue convincingly that his ideas did not involve a foundation of “otherness” that would prevent them from being acceptable to psychoanalysis, but rather that they were a natural and organic development of psychoanalytic theory. He had to answer allegations such as those made by Giovacchini (1978): “Kohut’s technical orientation causes me to wonder what relevance any of his ideas have to analysis and how they differ from any supportive manipulation that is designed to respond to a patient’s infantile needs” (p. 618). Moreover, he had to be able to show that not only were his ideas not new, but that they in fact reinforced the scientific element in psychoanalysis. Thus, Kohut (1975) used metaphors from the fields of medicine and anatomy in order to describe the importance of empathy: In some individuals, at any rate, the access to the empathic capacity seems to have been blocked by the development of the non-empathic mode of cognition—perhaps analogous to the relation between the phylogenetic stunting of man’s olfactory sense and the evolutionary ascendancy of his vision . . . the decisive step analysis has taken in the development of scientific thought is that it has combined empathy and traditional scientific method, that it has introduced scientific truth-finding with regard to processes that can become accessible only through the scrutiny of the inner experiences of man. (pp. 351-352) The interesting element in this masked integration of empathy into the psychoanalytic method is that the new component is not simply copied as is to the new

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framework while retaining its original meaning. Instead, it is converted and transformed, and gains a new meaning. A number of works of research have pointed to the differences between Kohut’s self-psychology and Rogers’s humanistic psychology (Bohart, 1991; Tobin, 1990). Obviously, the conceptualization of empathy as an instrument of scientific research differs greatly from Rogers’s humanistic view. At first, Kohut took the view that empathy amounted to no more than gathering data. It was only much later on that he conceded its therapeutic value. Moreover, empathy for Kohut never included “caring,” though it has to be said that he was often ambiguous about this point. The primary objective of person-centered psychotherapy is the establishment of a certain kind of experience that the patient lives through and that enables him to look at himself from a different perspective. In particular, the patient gets help in learning how to develop the skill of using experience-based points of reference when making everyday decisions affecting their lives. For the psychoanalyst, on the other hand, empathy is primarily a way for him to gain a better understanding of the dynamics at play in the patient’s unconscious. Thus, the role of empathy in self-psychology is to reinforce the analysis of the patient’s self (Bohart, 1991).

The fear of obsolescence and short-term dynamic therapy Alongside the “anxiety of influence” felt by the psychoanalytic community, and which Kohut had to deal with, there exists in the same community what I term “fear of obsolescence.” In an ever-changing world, where new sets of theories and techniques frequently appear and present themselves as more veridical, informative, and efficient, the old agendas may appear by comparison outdated, tired, and irrelevant. If this situation continues, the future of these old agendas appears bleak. In psychoanalysis, the problem is particularly severe because of the continuing demands made for briefer and more economical psychotherapy sessions, and the growing interest all over the world in brief, empirically supported methods. Psychoanalysis has always been preoccupied with the tension between, on the one hand, orthodoxy and the conservation of knowledge gained thus far, and on the other, the need to innovate, to create, and to be perceived an up-to-date and relevant discipline. As early as 1933, Stekel and London wrote: “It is certain that analysis cannot remain in the form in which it is being practiced at present. It will develop, change, and be transformed, as it will have to adapt itself to a more developed, changed and transformed generation” (Stekel & London, 1933, p. 332). There are almost eighty papers written bearing the title “On the Future of Psychoanalysis.” In many of them, analysts acknowledge the fact that the psychoanalytic community has often been accused of failing to keep up with the demand for progress, to move with the times, to remain “relevant.” Their response was mostly ambivalent: “Putting aside the regrettable fact that moving with the times may not always constitute progress (all too often the reverse), there is some basis

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to those charges, at least sufficient to yield us no ground for complacency (Stein, 1979, p. 667; see also Rangell, 2002). This fear can help us understand another dramatic shift in the history of development of psychoanalytic theory and technique. As Kohut was attempting to change the face of psychoanalysis by introducing the concept of empathy, another no less daring attempt to change the psychoanalytic landscape was being made: that of introducing into psychoanalysis short-term dynamic psychotherapy (STDP). Seemingly, all important psychoanalytic assumptions had been breached all at once: free associations had been replaced by focused therapy; neutrality and evenlysuspended attention—two attitudes recommended by Freud (1912, 1915c)—were replaced by active and directed interventions by the therapist; structural change was replaced by resolving a central conflict. In the main, short term therapy developed during the 1980s and 1990s by a number of key innovators: Mann in Boston (1973; Mann & Goldman, 1982), Malan in London (1963, 1976), Sifneos in Boston (1972, 1979), and Davanloo in Montreal (1978, 1980). Additional founders include Donovon (1987), Gustafson (1984), Strupp and Binder (1984), and Luborsky (1984). There were a number of significant differences between the change Kohut introduced into psychoanalysis and the one introduced by the proponents of dynamic short-term treatment. Kohut had wanted to reconceptualize the psychoanalytic theory. The developers of short-term dynamic treatment had a different, pragmatic interest in mind; they sought to keep psychoanalysis alive and kicking in a world in which the overriding trend would be effective, evidence-based, short-term treatments. The spread in the course of the 1970s and 1980s of different and competing forms of short interventions, such as Beck’s (1976; Beck et al. 1979) cognitive therapy, which offered a formulated written and highly technical approach specifically designed for brief treatments, was quite remarkable. Many of the new methods, such as cognitive psychotherapy and behavioral treatments, registered another seeming achievement that gave them a distinct advantage over psychoanalysis; not only were they quicker and cheaper, they were supported by research that proved their efficacy (Lemma et al. 2010). Moreover, the huge increase in pharmacologically based treatments and the fact that third ­parties—particularly in the form of health insurance companies—had become increasingly involved both in payment and oversight of such treatments, greatly reduced the demand for committed and timeless psychoanalysis and its foggy outcome (Mitchell, 1991a). In this background developed short-term dynamic treatment. Its originators looked beyond the psychoanalytic world and were prepared to respond to the challenge that this world presented them with. During the 1970s and 1980s, a growing number of analysts felt that it was impossible to ignore some of the outstanding reported results of short-term psychotherapy shown by other psychotherapeutic orientations. The Iron Curtain gradually began to rise, and psychoanalysts who had taken pride in their distinctness and separateness were slowly forced to acknowledge that there were lessons

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to be learned from outside of psychoanalysis as well. Each of them reacted to the outside world in his own way. At his first theoretical departure from mainstream psychoanalysis, Kohut acted like the son who had betrayed his community, murdered his father, and then tried to cover up the murder and present himself as the one who was carrying on the tradition. His scorn was reserved for Rogers. Only in later stages of his work, in works like The Two Analyses of Mr. Z (1979) and How Does Analysis Cure? (1984), did Kohut fully acknowledged his theoretical departure from Freud and classical psychoanalysis. The psychoanalysts who developed STDP allowed themselves to go even farther. They were a lot more troubled by fear regarding the survival of their profession than by their desire to please the conservative psychoanalytic community. The developers of short-term dynamic approaches acted like a healthy, complex-free son who had left his parents’ home for communities that were refreshing, interesting, and enriching. While Kohut looked like someone furtively peering beyond the Iron Curtain, trying to turn his ideas into a behind-the-curtain conservative ideology, the developers of STDP were more reminiscent of youthful East Germans driven westward by hope. The STDP developers tried to have their legitimacy acknowledged by the psychiatric establishment, the insurance companies, the scientific world, and the masses of patients who were hungry for rapid relief from their suffering. Being embraced by the psychoanalytic establishment was less important to them than losing their relevance in the world outside. Those responsible for the development of STDP back in the 70s were practical therapists who had, as it happens, also been trained as psychoanalysts. Because of that, their theories gained particular attention outside the discipline and carried additional authority inside it. But their pragmatism also placed them in a difficult position. The three central components of STDP—a brief time line, therapeutic focus, and active interventions by the therapist—were seen as contradicting the basic assumptions of psychoanalysis, whose major task was continuous, long-term investigation of unconscious matters, in which the therapist makes do with listening and interpreting. This challenge compelled them to invest a great deal of effort in protecting the family name and the psychoanalytic reputation and to also gain credit within the community. In this matter, they also had to resolve the anxiety of influence. How did they do this? First, supporters of the new method were able to find the roots of the method within the psychoanalytical tradition and, in particular, in the works of its founder. Freud’s early treatments were very short, not only compared to the psychoanalysis of today but even compared to today’s dynamic short-term analysis. Freud met with Katarina (Freud & Breuer, 1895) only once and yet regarded it as a successful session in psychoanalysis. The composer Gustav Mahler’s consultation with Freud was also limited to one session. Freud referred to it as analysis and Mahler regarded it as a great success (Jones, 1955; Reik, 1960). The fact that Freud gave short-term treatments, and did not regard the word “psychoanalysis” as a synonym with treatment that must continue for a long time, greatly facilitated the integration of the new

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component. This was helped by the fact that Freud was not alone in this matter; additional classical analysts, such as Sándor Ferenczi, Otto Rank, Rezso˝ Bálint, and Franz Alexander recommended and offered short-term treatments. This factor is vitally important because it lent the component of identity to the seemingly new idea and thus soothed the anxiety of influence from the outside world, allowing for the fear of obsolescence to take central stage. Supporters of the new approach were, in fact, saying “we are the source, only better.” Thus, for example, when speaking about the technique of STDP developed by Davanloo (1978, 1979, 1980), Malan (1980a), one of STDP’s advocates, stated that “it is the most important development in psychotherapy since the discovery of the unconscious . . . Freud discovered the unconscious, Davanloo has discovered how to use it therapeutically” (p. 23). Supporters of the approach emphasize that it is more effective in achieving the analytic objectives than long-term treatment. That is to say, using STDP is not merely a compromise reached as a result of necessity, but rather a better implementation of classical treatment. Moreover, proponents of STDP kept a strict observance of the usage of psychoanalytic jargon. For example, Davanloo’s short-term dynamic therapy was described as strictly based on psychoanalytic principles, which are here simplified in a synthetic frame of reference, “ready to be used,” so to speak. It consists of two triangles: the “Triangle of Conflict” (DAI/F—Defence, Anxiety, Impulse/Feeling) and the “Triangle of Person” (TCP—Transference, significant people in the patient’s Current life, significant people in the Past). The first triangle refers to the classical Freudian schema of symptom formation (Freud, 1894); the second is a reformulation of Menninger’s “triangle of insight” (Menninger, 1958). Sifneos’s and Malan’s models also emphasize a great indebtedness to the classical model. They both give great importance to the expression of emotions, concealed thoughts, and fantasies by the patient, allowed through linking transference, the present situation, and the past. They describe the focus of treatment as a dynamic topic that is likely to be linked to suppressed oedipal and pre-oedipal issues. James Mann (1973) presented an approach to STDP famous for the limited amount of time at the disposal of both therapist and patient. Mann limited the treatment to 12 sessions following an initial assessment. Even in such restricted settings, psychoanalytic concepts and understanding were kept. According to Mann’s method, the therapist chooses and then focuses on a “main issue,” which is a problem that began during an earlier time in the patient’s life and has persisted until now. This, of course, is a classic psychoanalytic element. Another classic element appearing in Mann’s approach is his understanding that the patient’s childlike perception of time as being unlimited reflects his fantasy of reuniting with his mother. Here we have a psychoanalytic concept that was influenced by Margaret Mahler’s theory, one of the main theories in Mann’s time, according to which the separation from parents requires acceptance of the reality principle and an acknowledgment of time as being final and limited. Thus, as a method of treatment, the basic ideas of STDP and the psychoanalytic community were supposedly the same, and therefore there was no question

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of disclaiming them, as in the case of Kohut. The interesting point is that the ­community allowed this “similarity” to pass despite the fundamental underlying differences. What had happened was that STDP had used similar words to describe different processes. There is no doubt that the fundamental meaning of insight and transference are not the same in short- and long-term therapies. But the community was not highly motivated to sharpen differences. Somehow, despite their techniques remaining their own and not being adopted or even adapted to by the wider psychoanalytic community, STDP was allowed room under the umbrella. This is all the more intriguing if we consider that self-psychology always regarded itself as psychoanalytic, whereas STDP feels itself to be in some way apart from the discipline of psychoanalysis. In mental health clinics which adopt only evidence-based psychotherapies, the practice of brief dynamic therapy is the only “representative” of psychoanalytic concepts and theories in their armory of treatments. Moreover, due to its empirically supported effectiveness, research works on short-term dynamic psychotherapy are frequently published in professional psychotherapy and psychology journals (Abbass et al. 2008; Bilski-Piotrowski, 2011; Collins, 2012; Johansen et al., 2011; Kallestadet al. 2010; Valen et al. 2011) in which psychoanalysis barely gets a mention (Robins et al. 1999). That is to say that, in the broad world of mental health that is beyond the psychoanalytic community, the approach is the opposite: empirically based shortterm dynamic therapy is recognized and well-regarded, whereas psychoanalysis is ignored and its findings are disparaged (for a review, see Bornstein, 2001). For example, the manualized, brief (sixteen-session) psychodynamic intervention— Dynamic Interpersonal Therapy (DIT)—for the treatment of depression (Lemma et al. 2010) is based on a distillation of the evidence-based brief psychoanalytic/ psychodynamic treatments. DIT has now been selected as the brief psychodynamic protocol that will be provided nationally in the UK as part of the IAPT (Improving Access to Psychological Therapies) national program. In contrast to the stormy responses that Kohut aroused, the psychoanalytic community was relatively indifferent in its reaction to short-term dynamic treatment. Davanloo, Malan, and Sifneos are far better known in the world of psychotherapy, which is based on empirical research, than they are within the psychoanalytic world. A few expressed enthusiasm, but at the same time pointed to its inadequacies. Winokur and his colleagues (1981), for example, pointed out that if one uses a definition of interpretation which goes back to Glover, then brief psychotherapy would be more akin to suggestion or wild analysis: “From the point of view of the traditional long-term therapy, it is unlikely that the true sources of anxiety and the deeper impulses can be correctly identified in the time available” (p. 137). Winokur and his colleagues suggest, however, based on the evidence presented in many cases, that short-term dynamic psychotherapy does not rely heavily on suggestion, nor does it merely build up substitute defensive structures. In fact, it often elicits deep and meaningful memories and fantasies. Yet, they think that if

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these therapies result in dynamic personality change, as has been demonstrated unequivocally, then such changes cannot be termed mere defensive realignments, and the question of the focus as well as the accuracy and efficacy of interpretation must be reassessed. Others within the psychoanalytic establishment were proud that the shortterm methods were succeeding in preventing the obsolescence and irrelevance of psychoanalysis among the wider community of therapists (Hildebrand, 1986). In one of the lectures on short-term treatment, given at the Society of Medical Psychoanalysts, New York, the speaker stated: Today, when psychoanalysis is going through a period of crisis, the problem of the efficacy of new forms of psychotherapy is becoming more topical than ever. Particularly interesting among such new forms is the Short-Term Dynamic Psychotherapy (STDP), which is essentially a therapeutic technique based strictly on classic psychoanalytic theory, with some technical variants, such as the setting of a limit to the number of sessions. (Migone, 1985, p. 615) My guess is that many within the community did not believe that it is possible to resolve the Oedipus complex in forty sessions, let alone twelve, but that STDP fulfilled an important need and thus silenced the opposition. It provided the most powerful advocacy that psychoanalysis could suggest in terms of community mental health and the best solution it could offer to anyone seeking effective short-term treatment, and thus made an important contribution to the discipline’s perseverance— or at least to the allaying of analysts’ fear of obsolescence. This was best expressed by Heinz Kohut (1973): It would be tempting for the psychoanalyst who is confronted by the accusation that analysis belongs only to a socio-cultural elite to reply that the principles of analysis are indeed successfully employed in the service of briefer and less deep-going forms of psychotherapy which can be made available to larger numbers of those who suffer from emotional disturbances. (p. 12)

Conclusion According to Safran and Messer (1997), the various therapeutic traditions have been accustomed to conduct a discourse in which each school of thought has tended to define itself by the way in which it can be distinguished from its competitors, meaning as a response to the confrontation with the “other.” Thus, psychoanalysis comes to be defined in terms of how it differs from behavior therapy (e.g. by its emphasis on the unconscious), while behavior therapy defines itself by the ways in which it differs from psychoanalytic therapy (e.g. in its emphasis on learning mechanisms). This way, the “other” becomes the basis of defining and preserving the values of the self (Sampson, 1993).

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In this chapter, I have offered a complementary, reconciling perspective, according to which the different, competing theories not only reject the “other” and define themselves in opposition to it, but also envy it, draw influence from it, and tend to bring it in by the back door. Because of fascinated communities’ need to maintain separateness from the new elements they bring in, they also tend to change them and give them a new meaning. Thus, the theory changes together with the component that alters its original shape. Somehow, counterintuitively, the end result of this change enhances a dialogic rather than a monologic approach. From the encounter between competing psychotherapeutic cultures, an evolutionary process emerges in which the contact with difference leads to an actual, even if unacknowledged, dialogue. This type of incorporation brings entirely new elements into the dialogue; this is how a number of different schools of psychotherapy, differing conceptualizations, a variety of systems supplying dissimilar “languages,” and conflicting ways of comprehending therapeutic change are able to interact with each other. As I have shown, this form of integration gives the process of incorporation of ideas a number of characteristics. First, the incorporation is the outcome of a theoretical or pragmatic need that requires the theory to be updated or otherwise become obsolete. The need for a change in theory occurs when the existing conceptualization is no longer adequate, is perceived as ineffective or deficient, and needs to be replaced or augmented. The need for a pragmatic change occurs when the method of therapy is not sufficiently efficacious, or it is thought that its efficacy is limited to certain conditions or specific populations. It is not always easy to differentiate between a practical and a theoretical cause, since a conceptual change arises as a result of practical reasons—when the existing conceptualizations do not lead to satisfactory results. Opposite to that stands the second characteristic: incorporating a new idea poses a serious threat to the entire community. The possibility of incorporating a new idea creates a link between two parties—the existing theory and a new component unknown to it. This connection leads to opposition and the suspicion of betrayal. The dread is of a breach in the distinction between “us” and “them” and the fear that the pure theory will be contaminated by the new element and lose its uniqueness. From here, it is also clear why the new idea cannot relocate as is, since it is an idea that exists along the seam of therapeutic fields that do not entirely overlap. As mentioned earlier, these two opposing characteristics form a conflict. Its resolution resides in the third characteristic: many attempts are made to blur the threat, the “otherness” and newness of the new idea. The new idea undergoes a process of conversion by the “discovery” of its roots in the incorporating theory, so that it can be presented as a natural part of the theory. When these efforts work out well, the new idea is successfully and subtly integrated into the community, creating a tolerable crisis. The fourth characteristic is the outcome of this process and is linked to the successful merger between the new component and the incorporating theory. It is this fusion which gives this form of integration beauty and richness. This goes

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well beyond the attachment of a new component to an existing theory. The new ­component as well as the incorporating theory changes and assumes a new meaning. It does not necessarily change existing theories, but eventually another member finds himself a place within the community. It thus liberates the community from the dominance of their own restricted terminology and fiercely held (yet mythical) purity. The motion changes from defensive repelling to hospitable acceptance, which transforms the community in the direction of more tolerance and diversity.

Notes 1 Most English-speaking analysts do not realize that empathy was an important concept for Freud because the Standard Edition translates only three of the twelve other occurrences as “empathy” and never translates einfühlen (which occurs eight times) as “empathize” (Pigman, 1995; Shaughnessy, 1995). 2 Interestingly, it was a psychoanalyst, Otto Rank, who, in 1935, introduced Rogers to what at that time seemed a revolutionary approach to the therapeutic relationships. Until then, Rogers had worked within the confines of a traditional psychoanalytic model (Kramer, 1995).

8 THE DILEMMA OF CONTEMPORARY PSYCHOANALYSIS Toward a “knowing” post-postmodernism

The next two chapters extol the contribution of fascinated communities to ­psychoanalysis and show what these communities are capable of doing in ways that troubled communities cannot. The present chapter deals with the contribution of fascinated communities to the creation and development of psychoanalytic theories. As noted earlier, the relational approach was heavily influenced by postmod­ ernism. With the decline of positivism in psychoanalysis in the past decades, a new postmodern paradigm has evolved within the field. One of the most important implications of this paradigm—variously called intersubjectivity, dialectical con­ structivism, or two-person psychology—is that it casts doubt on values such as objective knowledge, truth, and correspondence to reality. It encourages analysts to be more authentic, uncertain, and subjective in their thinking and clinical stance (Aron, 1996; Hoffman, 1998; Mitchell, 1991a, 1991b, 1993, 1997; Spezzano, 1997). As noted in Chapter 4, This postmodern turn in psychoanalysis reflects the more general and broad shifting of views in Western culture toward a rejection of general laws and truths in favor of local, unique, personal, and contextualized truths. The new postmodern paradigm is focused primarily on the subjectivity of the psychoanalytic encounter, and does not attempt to generate another “true” theory of mind claiming to fit reality, nor does it claim to be a school of thought (like the classical, Kleinian, or self-psychological perspectives). This chapter examines the heavy price psychoanalysis might pay if the majority of analysts adopt postmodernism as their preferred epistemology. The contention is that only fascinated analysts who thought they “knew the truth” created the classical, interpersonal, self-psychological, ego-psychological, Kleinian, Bionian, Fairbairnian, Winnicottian, and other schools of thought. These positivist perspec­ tives gave rise to compelling and complex theories of the mind. Their creators believed that their formulations corresponded to reality.

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The arguments I will present here proceed through four main stages of devel­ opment. First, I compare the positivist image of knowledge in the era of psy­ choanalytic schools with the image of knowledge endorsed by contemporary psychoanalysis. Second, I explain why the era in which the older schools of thought were created was enormously rich, fertile, and creative; I propose two conditions that, in my view, are necessary for the creation of new schools. Third, I examine three contemporary writers who criticize the most basic tenet of all psy­ choanalytic schools of thought—the existence of causal relations between child­ hood events and transference. I conclude by suggesting that psychoanalysis move to a third phase, beyond modernism and postmodernism, one that can promote the construction of new theories and yet be sensitive to questions of knowledge. I propose here that the problem with psychoanalytic schools was that they had disciples and followers, rather than a group of investigators trying to validate find­ ings or elaborate them. Only a fundamental change in psychoanalytic organiza­ tions and institutions can help psychoanalysis become a science and an academic clinical discipline. The terms positivism and postmodernism are used throughout this chapter, though I am aware that their usage is vague and highly ambiguous. I have chosen these philosophical terms because of their direct association with images of knowledge, and their association, respectively, with the possibility and impossibility of “knowing the truth.” According to positivism, for example, a statement is mean­ ingful if and only if it can be proven true or false, at least in principle, by means of experience. A scientific theory is an axiomatic system that obtains an empiri­ cal interpretation through appropriate statements called rules of correspondence, which establish a correlation between real objects and the abstract concepts of the theory (Kolakowski, 1972). Postmodernism is associated with the impossibility of knowing a singular truth; it rejects general laws and truths, including the idea of progress itself, in favor of local, unique, personal, and contextualized “truths” (e.g. Chaikilin, 1992; Polkinghorne, 1992). It also claims that there is indeterminacy, or a plu­ rality of meaning, in events. As Elliott and Spezzano (1996) demonstrate, the theorists who come under the broad banner of postmodernism are a rather heterogeneous group. They vary considerably in the extent to which they leave room for relatively objective knowledge or universal truths. Similarly, not all psychoanalysts who adopt a relational tradition share the same epistemology. The relational tradition, though not synonymous with postmodernism, nonetheless tends to reflect postmodern ideologies. Aron (1996), an influential contributor to the relational tradition, notes that postmodernism has had a powerful impact on most relational analysts. Before elaborating any further, let me state that I am not interested in the philosophical debate between positivism and postmodernism, so much as in the sociology of building viable theories. My aim is to examine the harmful effects that postmodernism might have on the renewal and creativity of psychoanalysis, in the event that postmodernism becomes the leading force in this discipline. The crucial

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point is that theory building is impoverished when theoreticians do not strive for correspondence with reality, or for truth, however scientifically or philosophically thorny these issues may be. I argue that one of the main differences between the era of the schools and contemporary psychoanalysis is that the images of knowledge have changed. In the former, which was influenced by a positivist epistemology, the quest for truth was perceived as an ideal, and empirical knowledge had a positive image. The creators of the schools believed that it is possible to find psychoanalytic truths that explain human phenomena. They also felt a strong sense of confidence in the truth of their findings. This sense of certainty was the source of their commitment to building new theories of the mind. Images of knowledge have changed profoundly in postmodern psychoanaly­ sis; truth is no longer perceived as an ideal toward which to strive. Postmodern psychoanalysis replaces the ideal of the “analyst who knows” with an analyst who acknowledges uncertainty and embraces the impossibility of recognizing only one truth, or the inability to generate objective truths independent of historical context and culture (Hoffman, 1987). There are numerous examples illustrating the deconstruction of truth in the relational tradition (Aron, 1996; Hoffman, 1987, 1998; Mitchell, 1988, 1993). A good example can be found in the works of Spezzano (1999), a relational analyst who is influenced by Richard Rorty’s postmodern philosophy: Whether we search for the truth about philosophy in Grunbaum or in her­ meneutics or whether a scholar from outside our field comes looking to us for truth, the end never comes, and no knowledge turns out to be the final truth. That is what is appealing about Rorty’s way of talking about philoso­ phy and all other disciplines as languages and about languages as tools. When you talk about truth, you ask who is right and who is wrong. When you talk about tools, the discussion gets reframed, and you ask how the tool works and what you can and cannot do with it. (Spezzano, 1999, p. 442) Spezzano goes on to claim that the relational model redefines truth as “a rela­ tional consensus, achieved by a “dialogical community” through active critical argument.” For Spezzano, “it is time to give up certainty about truth” (p. 450). I am not claiming that the relational definition of truth is philosophically wrong; rather, I am highlighting a psychological problem as it relates to the mind of the creative analyst. One cannot create a new theory of mind, a new school of thought, and at the same time contend that one cannot be certain about anything. Whereas Spezzano (1999) holds “that by giving up certainty we accept endlessness as the most certain thing about our discussion” (p. 450), I argue that the sense of eternity and certainty is an important trait of the creative person. Hence, of the two philosophies, only positivism embraces an image of knowledge that enables the creation of new theories (for a third alternative that combines these stances, see Ricoeur, 1977).

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We can use Rorty’s own words to demonstrate this point. Rorty (1989) believes that language, which makes it possible to formulate new descriptions of the world, is the most valuable realization of our culture: “Human life is triumphant just insofar as it escapes from inherited descriptions of the contingencies of its existence and finds new descriptions” (p. 29). For Rorty, the strong maker, the person who uses words as they have never before been used, is best able to appreciate her own contingency. For she can see, more clearly than the continuity-seeking historian, critic, or philosopher, that her language is as contingent as her parents or her historical epoch. She can appreciate the force of the claim that “truth is a mobile army of metaphors” because, by her own sheer strength, she has broken out of one perspective, one metaphoric, into another. (p. 28) Praising Freud’s pragmatism, Rorty tells us something that is relevant to all schools of psychoanalytic thought: Freud “just wants to give us one more rede­ scription of things to be filed alongside all the others, one more vocabulary, one more set of metaphors which he thinks have a chance of being used and thereby literalized” (p. 28). Rorty believes that words-describing-the-world-innew-ways (rather than language as a medium to reality) are the most practical and useful projects, facilitating the realization and influence of new and distinctive ideas and theories. But Rorty is idealizing or misrepresenting Freud (or anyone else) “who uses words as they have never been used before,” by attributing to him a perspectival view (p. 28). Although Freud was sensitive to the problem­ atic issue of psychoanalytic knowledge, he did not think of his own theory as a metaphor. Even as late as 1937, he believed that the analyst’s work “resembles to a great extent an archaeologist’s excavation of some dwelling-place that has been destroyed or buried” and that “the two processes are in fact identical” (Freud, 1937, p. 259). Freud is obviously seeking an historical truth, not a narra­ tive one. And in “The Question of a Weltanschauung,” Freud (1933b) leaves no doubt as to which path psychoanalysis should follow: the “endeavor” of scientific thinking “is to arrive at correspondence with reality—that is to say, with what exists outside us and independently of us . . . This correspondence with the real external world we call ‘truth’” (p. 170). In this lecture, he also repudiated “the anarchist theory,” which, according to him, “argues that since the criterion of truth—correspondence with the external world— is absent, it is entirely a matter of indifference what opinions we adopt. All of them are equally true and equally false. And no one has a right to accuse anyone else of error?” (p. 176) Freud criticized such a view on the ground that “it breaks down with its first step into practical life” (p. 176). Freud’s fascination with the correspondence theory of truth is probably found in all “word-makers” in human culture. Inevitably, the ironist, who Rorty (1989) claims “does not think that her vocabulary is closer to reality than others, that it is in touch with a power not herself” (p. 73), is also incapable of creating a new

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vocabulary to describe the world. By contrast, the “metaphysician,” who believes that a single, permanent reality can be found behind many temporary appearances (p. 73), can be very creative. It is the tendency to choose a definitive vocabulary that enables the metaphysician to create one. These are not just two philosophical stances, but two psychological states of mind. Indeed, since the recent transformation in our images of knowledge, it seems that such productivity and creativity are no longer possible. In the last twenty years, changes in Western culture and in psychoanalysis itself have given rise to analysts who are less willing to “know the truth” or to seek it out. As a result, psy­ choanalysis has not generated a new school of thought since Kohut, the last analyst to have done so. It has therefore not provided any new and interesting descriptions of the human mind. Even the contemporary relational perspective, which has been strongly influenced by the new paradigm, is not quite a distinctive new school of thought; rather, it is an eclectic theory with many different perspectives sharing the premise that attachment and relationships are the core of human experience (Aron, 1996). In a way, especially in terms of psychoanalytic vocabulary, our era appears to be the most impoverished period in the history of psychoanalysis. The era in which the richest and most complex psychoanalytic theories of mind were created has passed. One may simply consider how little the psychoanalytic encyclopedia has developed over the past twenty years. It is quite clear that in this postmodern period only a handful of new concepts have enriched our vocabulary. In com­ parison to works like A Dictionary of Kleinian Thought (Hinshelwood, 1989) and The Language of Psycho-Analysis (Laplanche & Pontalis, 1967), a “Dictionary of Postmodern Thought in Psychoanalysis” would be a slim volume indeed. Because the adherents of the schools are still thinking in a positivist way (they cannot do otherwise), most of the innovative developments of new concepts have taken place within the framework of existing languages and schools. The excitement of the earlier days produced many new concepts, and the cur­ rent situation comes nowhere near it. Yet the downside of the old positivist era was its lack of insight into the dogmatism of the schools or into the institutional structures that discouraged or even prevented the testing of hypotheses. So, while the schools generated rich and compelling theories, almost no effort was made to test these concepts empirically to determine if they correspond to reality.

Postmodernism and new theories The limited ability of postmodernists to build new theories is not a logical neces­ sity, but a psychological situation, conditioned by the uncertain image of knowl­ edge. It is not postmodernism as a philosophy, but its image of knowledge, that makes it difficult to create new theories. If our theories are merely limited in terms of their truth-value, are influenced by cultural factors, or have a metaphorical quality, the situation would not be incompatible with the notion that they are true or valid in some qualified sense of

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the term. Furthermore, even postmodern analysts’ theories, though not regarded as incontrovertibly true, retain their functional utility and serve to guide clinical work. In short, there are ostensibly no obstacles to building new theories, even in postmodernism. It is only in radical postmodernism, endorsing a purely relativist approach, that theory building is in danger. It is to the credit of the postmodern thinkers in relational psychoanalysis, however, that they have insisted on reject­ ing radical postmodernism as an appropriate epistemology for psychoanalysis (e.g. Hoffman, 1998, p. xxiii). In a manner often seen in dialectical development, the relational tradition has in fact had a positive impact on certain aspects of psychoanalysis. In a thorough critique of institutionalized psychoanalysis in North America, Kirsner (2000) noted how mainstream psychoanalysis was often unwilling to accept new ideas and operated much as religious groups sometimes do—with a rigid authoritarian attitude and emotionally driven claims of “ultimate” truth. According to Kirsner, “most psychoanalytic disputes involve mythological ‘standards’ based more on passed down versions of the truth than on the examination of evidence” (p. 237). Kernberg (1986) too argued that psychoanalytic education is suffering serious tur­ bulence, which by analogy may be viewed as an illness affecting the educational structures of psychoanalytic institutes and societies in America. Elsewhere, Kernberg (1996) has described thirty methods by which psychoanalytic institutes destroy the creativity of candidates. As we saw in Chapter 4, the relational movement played an important role in altering this trend. One can sympathize with the pluralist, eclectic, open-minded, anti-authoritarian approach of relational analysts, which has nurtured a positive and radical shift in psychoanalysis. Analysts with a postmodern orientation have helped psychoanalysis adapt itself to the twenty-first century, being the bearers and imple­ menters of non-positivistic philosophies in theory and technique. Furthermore, as Bass (2000) has noted, the relational perspective synthesizes and integrates diverse clinical and theoretical contributions in ways that make them accessible and useful to working analysts of many schools. While the relational tradition has made extraordinarily positive contributions to psychoanalysis, and its postmodern epistemology is indeed moderate, as a political movement, the American relational tradition has had unwanted psychological and sociological effects on psychoanalysis. One such effect has been a severe decline in the positive image of knowledge that is so crucial for the building of new theories. Led by the relational movement, but influenced by a much broader movement in Western philosophy and culture, this trend has greatly altered international psy­ choanalysis. It has led not only to disparagement of the school era, but also to the devaluation of any attempt to know the truth. From this inherent tension, the question arises: how can psychoanalysis continue to be pluralistic and still change, grow, and reinvent itself? How can we salvage the achievements of the relational movement without sacrificing the sense of knowing the truth that is needed to formulate new theories of the mind?

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The importance of schools of thought in psychoanalysis One of the most important achievements of the schools was their ability to build “thick descriptions.” This concept, which is related to ethnography, was intro­ duced by Ryle (1971) and used by Elkana (1981) to evaluate the history and philosophy of science. For Ryle, thick description is a way of describing the com­ plexity of thinking. He begins with the most elementary, single-layer activity, such as counting the number of cars on the street. Describing this activity involves a very “thin” description. Then, layer by layer, the activity becomes more complex and its description thicker. Consequently, the description given when recounting the activities of a person lies somewhere on a continuum between the very thin and the very thick, and the thickness depends on the activity we are describing. The brilliance of psychoanalytic schools is that they offer thick descriptions of the human psyche. The phenomena described are explained by theoreticians as pieces of a greater theory of the human mind, rather than as isolated and local. The thickness of each psychoanalytic theory stems from the fact that, in each of them, different explanations are embedded in a unified theory that is coherent with multiple implications for all domains of human life: from development to psychopathology, from mothering to therapeutic relations, from sexual behavior to depression. Each school presents a psychoanalytic grand theory, a general theory of the human psyche that includes premises on stages of development, therapeu­ tic goals, the transference relationship, psychopathology, and healthy personality. In fact, these theories touch on every aspect of human conduct. For Winnicott, for example, the reason children play with teddy bears is to a large extent related to good enough mothering, a true self, therapeutic relations, psychopathology, and so on. In just over a hundred years, psychoanalysis has managed to produce a rich mosaic of terms, concepts, and theories that covers a wide range of human behaviors and clinical phenomena. Psychoanalysis has been influential in the devel­ opment of a new “language,” and has resulted in our attaining a new perspec­ tive for understanding our world. Its major achievement, and most remarkable creation, is a complex net of theories and concepts used to describe the human mind. Psychoanalysis, like every body of knowledge, is indeed a language, one that comprises different dialects (i.e. the theories of the schools). Every new psychoanalytic theory describes new phenomena or re-describes known phenomena in new ways. Since Freud, psychoanalysis has managed to pro­ duce hundreds of concepts and terms. Some of these have become so popular in our culture and in everyday speech that we cannot imagine our lives without them. Concepts such as the unconscious, the Oedipus complex, narcissism, hold­ ing, projection, the id, and the superego have become common parlance through novels, plays, poems, and movies, and have become embedded in Western cul­ ture. But psychoanalytically oriented psychotherapists are familiar with still other concepts, such as projective identification, countertransference, and self-object or

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mutative interpretation. These concepts influence how therapists think about their patients and understand them. Psychoanalytic terms have become our categories of thought. Without them, we cannot come to grips with our patients or understand human conduct. Our wide-ranging psychoanalytic vocabulary comprises sub-vocabularies stemming from the different schools. There is a Freudian vocabulary, a Kleinian vocabulary, a Winnicottian vocabulary, and so on. The core of psychoanalytic knowledge is made up of these concepts and languages, and the importance of this knowledge should be recognized by anyone committed to psychoanalysis, regard­ less of epistemological premises. Positivists and postmodernists alike need the schools for their thinking, though why a positivist needs them is more obvious. For the positivist, the psychoanalytic school is a body of theory to be tested to see if claims of truth can be assigned to it, and to determine whether it corresponds to reality. The knowledge derived from the theory can be tested, verified, or perhaps found wanting and replaced. But, without the schools, there are no theories to be tested. Psychoanalytic schools explain a great variety of things in a concise manner. They minimize the number of apparently independent phenomena by reusing the same arguments to explain changes of many different sorts. In other words, the schools represent explanatory unification, a virtue to be pursued in scientific theorizing (Maki, 2001). The post­ modernist view is more interesting. The postmodernist will postulate that while the old schools may have erred in thinking that their theories correspond to reality, nevertheless each has added to psychoanalytic discourse one more re-description of the human mind, one more vocabulary, one more set of metaphors. So, why and how were the schools so productive, creative, and fertile? How did each of them manage to add so many new terms, theories, and concepts to the psychoanalytic dictionary? I can think of two necessary conditions for the creation of a school: the desire to solve new empirical problems, and a relative indifference to philosophical questions.

Solving new empirical problems A psychoanalytic school of thought evolves out of a desire to create a broad theory that captures reality. The success of each school in psychoanalysis stems from the fact that each provides satisfactory solutions to important problems. Philosopher of science Larry Laudan (1977) argues that science aims fundamentally to arrive at solutions to problems. Theories should therefore be evaluated on the basis of whether they provide adequate solutions to significant empirical problems. It is less relevant to ask whether theories are “true,” “corroborated,” or “well-confirmed.” An empirical problem, Laudan argues, is “anything about the natural world which strikes us as odd, or otherwise in need of explanation” (p. 15). Examples of empiri­ cal problems in psychoanalysis include questions like: why do babies attach them­ selves to a particular object, such as a teddy bear, at a particular age? Why are some people so envious? Why are some people afraid of enclosed places?

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One of the fascinating things about the schools is that many of the phenom­ ena they describe had not been recognized as empirical problems requiring an explanation prior to these descriptions. Slips of the tongue were a well-known phenomenon before Freud noted them, but they were not considered a scien­ tific or empirical problem. The “fact” of their existence became an “empirical problem” only when Freud decided it was sufficiently interesting and important to deserve explanation. Another example is Winnicott’s theory of the transitional object: the fact that a toddler clings to a teddy bear was well-known long before Winnicott gave it an explanation. Here again is a “new” phenomenon, which no one before Winnicott had seriously thought to describe in psychoanalytic (or any other) terms. Such phenomena are real and concrete behaviors that occur in our world, but were unexplained before a theoretician decided to describe them in psycho­ analytic terms. Each psychoanalytic theory had its own domain of phenomena, or empirical problems, that it proposed to explain: Kohut noticed that patients react more positively to empathic understanding than to interpretations based on a drive model; Klein wanted to understand the destructive side of her child patients and their sadistic mode of playing. New terms, concepts, and theories were required in order to translate these phenomena into psychoanalytic lan­ guage. There are more than a dozen Winnicottian concepts related to a child’s playing with a teddy bear; Kleinian vocabulary contains dozens of concepts that describe human destructiveness; Kohut developed a rich system of thought in order to explain why empathy has such an enormous effect on patients and chil­ dren; and so on.

A relative indifference to philosophical questions Unlike the contemporary postmodern analysts, the theory builders—Winnicott, Klein, Fairbairn, Kohut, Kernberg, and most others (Bion being an exception)— were more drawn to describing phenomena that happen in the concrete reality of human life than to philosophical issues. Even when a theory builder expressed interest in epistemological questions (e.g. Kohut, 1984), these questions remained marginal to the desire to understand clinical phenomena in psychoanalytic terms. This relative indifference to questions about truth and knowledge may have nar­ rowed their points of view, but it also allowed their free-flowing curiosity to be directed toward things that happen in human life, such as envy, empathy, child’s play, ambivalence, hatred, and love. The founders of the psychoanalytic schools shared a moderate epistemological view, which is probably a necessary condition for the creation of a new psycho­ analytic theory. It was precisely their belief in realism and the correspondence theory of truth—but not in gathering statistical data—that enabled Freud, Klein, Winnicott, Kohut, and others to provide a universal map of the underlying struc­ ture of the mind. They were, fortunately or not, probably unaware of their stance and did not seriously consider all of its philosophical implications, either because

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they were relatively uninterested, or because they were not exposed to questions about knowledge. Perhaps—and there is no way we can know this—if Klein or Mahler, to name just two examples, had been exposed to the ongoing contem­ porary debate about the nature of knowledge, they would have come to the con­ clusion that to claim to “know” things about the world is a difficult and complex matter. In consequence, they might not have wanted to claim with such meticu­ lousness and determination that they “know,” for example, what goes on between mothers and infants, or inside an infant’s mind.

Can postmodern analysts solve new empirical problems? At first glance, it seems that empirical problems are not the main target of post­ modern analysts, for they are more interested in metatheory than in theory itself. Their primary motivation is not in explaining facts, empirical problems, or things that happen in the world. Mitchell (1993) states this very clearly: The shift in thinking has taken place not on the level of theory but on the level of metatheory: theory about theory. It does not concern questions about what motivates the analyst and the structure of mind, the development of emotional life. Rather, it concerns the question of what the analyst can know about any of these things. (p. 42) But it is important to remember that most postmodern writers have a keen inter­ est in “facts” and “empirical problems.” It is not exactly that there are two dis­ tinct groups: postmodernists interested in philosophy and positivists interested in facts. It seems to me that the tension between certainty and uncertainty exists not only between the two groups, but also within each analyst. See, for example, Ghent (1990), who explores what people wish and what they need, and Davies and Frawley (1991), whose work is with adult survivors of childhood sexual abuse. There are many other examples. In fact, I believe that it is difficult to draw a sharp line between “facts” and philosophy. In Stern’s (1983) “unformulated experience,” to cite one example, is something a fact, or is it an articulation of a philosophical constructivist idea? Despite this, there are two primary differences between postmodern formu­ lations and those of the psychoanalytic schools. The first difference is novelty. Postmodernists, especially the American relational group, retrieve what they see as valuable in existing theories, extricate it from its positivist moorings, and repo­ sition it in an intersubjective and constructivist model. They do this more often than they try to generate new theoretical formulations of analytic process or structures of mental life and development. Consider, for example, classic rela­ tional books such as Aron’s A Meeting of Minds: Mutuality in Psychoanalysis (1996), or Mitchell’s Influence and Autonomy in Psychoanalysis (1997). These books offer a sophisticated new framework that uses intersubjective and relational ideas as

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an organizing concept for existing psychoanalytic theories and concepts. The authors do not aim to generate novel ways of describing clinical phenomena or even new techniques. The other important difference is this: even when these analysts are trying to solve new empirical problems, they employ thin descriptions rather than thick ones. Their “truths,” as they themselves admit, are local, contextualized, and cul­ turally dependent. They cannot be placed in a grand theory of mind that has implications for all of human conduct. Irwin Hoffman, for example, one of the most prolific writers of the relational group, has enriched us with a new theory of transference based on what he calls “dialectical constructivism.” But his insights are not based on a new developmental theory, and they are not directly connected to mother-infant interactions. He bases his transference theory on existential phi­ losophy rather than on development. For Hoffman, as for other relational analysts, philosophy has become a major source of knowledge, overriding the importance of development. Perhaps Benjamin’s (1988) theory is the only one that comes close to a thick description, as she has managed to produce a developmental theory that has therapeutic implications and that could, with further expansion, become a new psychoanalytic school.

Dismissing the causal relations between past and present The most striking example of the harmful effects that postmodernism might have on the renewal and creativity of psychoanalysis is the attempt to devalue the role of development in therapy. The controversy about establishing causal relations between past and present is part of a larger debate about the validity and usefulness of etiological hypotheses. In the era of the schools, finding causal relations between past and present was a cornerstone of psychoanalytic thought and one of the main characteristics of its image of knowledge. Postmodern critique is not about devel­ opmental theories as such; rather, it arrays itself against the traditional tendency of theory-orientated analysts to favor infancy and early childhood in their considera­ tion of transference issues. This criticism is directed precisely at the major premise underlying the creativity of the schools: the causal relation between transference issues and childhood events. In a period when developmental theory is considered a metaphor or a narrative, and when analysts are cautioned not to relate to the theory too seriously, the motivation to develop a new theory of development is diminished. By examining three different views that oppose the causal relation between devel­ opment and transference, I intend to show how they contribute to a postmodern anti-theoretical atmosphere in psychoanalysis. The problem is not that these criti­ cisms are wrong or unjustified; rather, it is that with no room in psychoanalysis for those who “know the truth” (i.e. no room for the epistemological stance necessary to create a new school), the capacity of psychoanalysis for renewal and creativity is at risk.

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Spence’s views The first instance is Donald Spence’s Narrative Truth and Historical Truth (1982). A prolific writer and a representative of the hermeneutic tradition in therapy, Spence was one of the first writers in mainstream psychoanalysis in the 1980s to cast doubt on the validity of the positivist epistemology to which psychoanalysis still clung. My aim here is not to argue against the epistemological basis of Spence’s notions, but rather to show the pragmatic implications of his view, especially his hermeneu­ tic take on psychoanalysis. I consider the views of Spence to be a moderate objection to developmental theories, given his complex approach to such theories in general. In his writ­ ings, Spence managed to retain the tension between positivism and postmodernism without reaching a conclusive position concerning them one way or the other. He questioned the tendency of analysts to celebrate the establishing of historical truth after a successful interpretation; their achievement, he thought, stems from their finding a coherent narrative, not from an actual event. He demonstrated convinc­ ingly that appealing narratives can confuse analysts, who then tend to misinterpret them as historical truth: “Narrative truth has a special significance in its own right and making contact with the actual past may be far less significant than creating a coherent and consistent account of a particular set of events” (Spence, 1982, pp. 27–28). He claimed that “interpretations are persuasive not because of their evidential value but because of their rhetorical appeal; conviction emerges because the fit is good, not because we have necessarily made contact with the past” (p. 32). Spence is no radical postmodernist; the path to historical truth is blocked not because he doubts the existence of an objective external reality, or because he thinks developmental theories are just useful narratives and have no bear­ ing on concrete reality. What he finds troubling, rather, is the distorting nature of language. Memories and past experiences are by nature visual, formless, and nonverbal. When they are translated from the private language to the common language of speech, they are inevitably filtered and distorted, distancing the ver­ bal articulation from the real experience. If the interpretation is not necessarily related to the actual past, what should be used to guide the analyst’s interven­ tions? What would be considered a good interpretation? One of Spence’s criteria for an adequate interpretation is aesthetic; he thinks that aesthetic appeal should replace historical accuracy. The implications of this position for developmental theories are evident; even if we do believe in the validity of such a theory (i.e. believe this is really how things transpire for babies), we can no longer believe in the chance of finding a particular patient’s actual route of development. The role Spence attributes to developmental theories is therefore minimized: the theory may serve as a good metaphor, but we cannot expect to reconstruct actual events according to the theory. At most, we can use the theory as material for composing rich and highly convincing narratives. The first objection to Spence is that there is a conspicuous gap between his ideas and how most analysts (even postmodern ones) think and operate in their

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day-to-day work. It seems highly unlikely that analysts think of themselves merely as good storytellers, or that they will strive to become brilliant authors whose main goal is to tailor narratives according to their patient’s reports. Should analysts, along with their regular psychoanalytic training, take courses in prose, rhetoric, and speech? Should they prefer style to substance? Can they really give up the unten­ able search for historical reality? A second objection concerns the contract analysts have with their patients. Spence’s theorizing is a good example of the inherent contradictions between how we talk with patients and how we explain the cultural context in which we find ourselves. It reflects how difficult it is to fuse postmodern theory and therapeutics (Stein, 1995). Surely it is unthinkable to tell a patient: “You should know that it will be almost impossible to know anything about your actual past; we can only try to make a good story out of it. But don’t worry—a narrative truth is just as good as an historical one.” This objection is of course parallel to my main argument, which is not only that “analysts who know” are required if we are to generate new schools of thought, but also that they are needed for the simple act of helping people. Patients in distress are more likely to expect their analysts to “know” some­ thing than to be uncertain and intersubjective (for a discussion, see Freud, 1927a, p. 268; for a dialectical-constructivist view, see Hoffman, 1998, pp. 175–178). The third objection has to do with the main damage done to the renewal of psychoanalysis entailed in Spence’s hermeneutic view. If the psychoanalytic inter­ pretation is only narrative, only a story, why should theoreticians bother even to contemplate developing new grand theories based on clinical data from adult patients? If a general line of development cannot be deduced from patients’ stories, what chance does psychoanalysis have of renewing itself? We will recall that the causal relation between adult experience and childhood events is a necessary condi­ tion for creating a grand theory. Perhaps the answers to some of these questions are to be found in Spence’s other writings. Spence is no simple hermeneutician; he has an empiricist side as well. Unlike some contemporary relational analysts, Spence does not dismiss the relevance of the developmental metaphor in therapy. On the contrary, he is a great admirer of empirically well-based development theories. He thinks that the parentchild analogy can be used as a basic metaphor for the psychoanalytic therapeutic process—as long as it is based on careful research (Mayes & Spence, 1994)—and believes that validated clinical data gathered in recent years from developmental processes justifies the use of developmental metaphors in the clinical setting. He claims that, in order to be a true science, psychoanalysis must develop a pub­ lic database and a tradition of empirical investigation. Sass and Woolfolk (1988) suggest, contrary to the general assumption, that Spence did not try to ground psychoanalysis in hermeneutics. Rather, to the contrary, he is a closet empiricist who suggested that psychoanalysis ground itself in extra-clinical, natural science observation. I believe that this is only one side of the story, and that Spence wears two hats. He wears an empiricist hat when he admires empirically based developmental

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theories, and when he condemns theories that are based on powerful rhetoric but not on scientific evidence. He wears a hermeneutic hat when he doubts that analysts can know the actual past, and when he states that “once a given construc­ tion has acquired narrative truth, it becomes just as real as any other kind of truth” (Spence, 1982, p. 31). While he adopts the hermeneutic tradition in therapy and likens the therapist to an artist or a good storyteller, he does not think the same about developmental theories. In this case, the rhetorical appeal, the beauty of the theory and its aesthetic value, is a disadvantage. It is a myth that should be discred­ ited because of its lack of scientific evidence. I agree with Spence’s stress on the importance of continued investigation of actual psychoanalytic processes through more detailed and exacting research. This investigation may give rise to uncertainty concerning our strongly held beliefs, but may also give rise to more clinical certainty. To revive a new developmental theory of mind, therapists must support research that emphasizes the importance of early environmental influences on the development of personality.

A relational perspective: there is more than just the past Another objection against the use of developmental theories in therapy comes from the relational perspective. Stephen Mitchell (1988) and Nancy Chodorow (1999) both argue against the extreme use of developmental theory in therapy. Both stress the importance of the here-and-now interaction between therapist and patient, not as a direct and simplistic one-to-one connection of past experiences, but as a lively, ongoing, intersubjective interaction in its own right. While Spence doubts the possibility of ever really knowing about past events from the analytic interaction, he never denies the tremendous impact of the past on every therapeutic exchange. Mitchell and Chodorow, on the other hand, think that the past should not be taken so seriously. Mitchell’s (1988) condemnation of relying heavily on the past is, of course, part of his postmodern philosophical agenda: The use of the baby as a metaphor has been so characteristic of psycho­ analytic thought from its inception that we tend to assume that explain­ ing adult phenomena in terms of infantile prototypes is actually providing causal accounts, facts, rather than highlighting experiential similarities, which themselves call for further inquiry. (p. 169) He argues that his discussion concerning the metaphor of the baby “behooves us not to take our theories about babies too seriously” (p. 133). One of the problems with the postmodern suggestion that the past be taken lightly is that postmodernists never provide an alternative. This is understandable, as postmodern writers don’t want to add another theory, description, or technique as an alternative to traditional theories. They prefer to propose a new “sensibility”

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or meta-theory. Sometimes postmodernists rephrase existing concepts, but after­ ward one is left with ambiguous feelings, unsure of how to assimilate their writings in clinical work. Consider Mitchell’s (1988) following statement: The earliest experiences are meaningful not because they lay down struc­ tural residues which remain fixed, but because they are the earliest rep­ resentation of patterns of family structure and interactions which will be repeated over and over in different forms at different developmental stages. Understanding the past is crucial, not because the past lies concealed within or beneath the present, but because understanding the past provides clues to deciphering how and why the present is being approached and shaped the way it is. (p. 149) Mitchell calls this attitude toward the past the “interactional option” (p. 149), but, from reading him closely, it is hard to determine if there really are such meaningful differences between his option and the developmental-arrest model. In fairness to Mitchell, it should be noted that he did take the schools of thought very seriously, and in fact devoted almost all his psychoanalytic writings to promot­ ing a dialogue among different traditions and to adopting a respectful yet playful approach to psychoanalytic theories (Mitchell, 1991, 1993, 1997). But Mitchell’s justified criticism of the traditional analyst’s authoritative approach has uninten­ tionally undermined the necessary conditions for generating a new theory or description of the human mind. The same question—what should the analyst rely on principally, if not the past—is also relevant to another postmodern relational analyst, Nancy Chodorow. Chodorow (1999) argues that heavy reliance on the past in the psychoanalytic encounter obscures a much more significant aim: the creation of personal subjective meaning in relation to self and others, and the importance of the subjective here and now: We should be wary of clinical explanations positing objectivized universal childhood stages or psychobiological drives that determine or predict later psychological experience and universalist claims about the panhuman con­ tent of unconscious fantasies . . . We can observe, be surprised by, and help ourselves and our patients to create these new meanings more easily if our listening is not filtered and shaped by assumptions that an Oedipus complex, castration fears, fantasies about “the” primal scene, or envy of “the” breast or “the” mother’s inside are universally given. (Chodorow, 1999, pp. 63–64) Chodorow argues that psychoanalytic theories of mind should not be restricted to the question of how childhood events dictate transference, but should be seen as more holistic theories that cover the entire life cycle and its myriad modes of interaction. As with Mitchell, as useful as it may be to consider these aspects

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of developmental theories, it is hard (for me at least) to formulate their practi­ cal meaning. What, for instance, does Chodorow mean by “particular subjective childhood” and “unique evidence of individual transferences” (p. 64)? How can we translate these notions to our work with patients? From reading Chodorow’s clinical material, it is hard to tell the difference between her methods and those of the analysts she criticizes for conceptualizing the transference as a developmental process. Consider, for example, her analysis of a female patient, B. (pp. 81–84). B. usually arrives late to sessions. Perhaps uncon­ scious of her motives, she deliberately arranges her sessions to take place just after her work with her male employer. B. feels it hard to pull herself away from the exciting employer to the meeting with her analyst, and relates to the therapy as an obligation. During sessions, writes Chodorow, She is preoccupied with concerns about her employer. By contrast she pays little notice to me. I feel like—and she confirms that I am—taken-forgranted background, a maternal nag who can be kept waiting, who wants only to talk about boring, petty issues like lateness, schedules, and phone numbers. (Chodorow, 1999, p. 82) Chodorow’s deep understanding of the transference, unlike her opinions I have quoted, relies heavily on the past and on object relations developmental theories. The employer is “a powerful man, a perfect, ideal man who will rescue her and make her feel wonderful, rather than rejecting her as she feels her father did” (p. 82). Chodorow herself is the mother “who was weak, unable to care for herself or for her children, unable to find a good loving relationship, unable to keep a nice house” (p. 82). The experience of the therapy as an obligation that is pulling her apart from her employer is the reminiscence of a past experience: “she found the weekly good-byes to her father, who was divorced from her mother, painful and difficult” (p. 82). Here we can see that if one wants to be called psychoanalytic, it is very hard to avoid the causality that exists between childhood and transference. The gap between Chodorow’s metatheory and her case studies is a good example of the contradictions between contemporary cultural criticism and psychoanalysis proper; despite an author’s wishes, metatheory does not always have clinical implications. Chodorow is not the only example. When we compare case studies by postmodern writers with those by analysts oriented to a school, the differences are not always so clear.

Conclusion: after modernism and postmodernism To sum up, the continued generation of psychoanalytic schools is necessary for the following reasons: (1) new schools generate new theories that can be tested and verified; (2) they enrich psychoanalytic knowledge with new metaphors, vocabu­ laries, and descriptions; (3) they generate thick descriptions; (4) they identify and

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solve clinical problems, many never before acknowledged as problems; (5) they represent a healthy crisis in psychoanalysis that leads to a change of paradigm (Kuhn, 1962); (6) adherents to a new school engage in creative activity and generate train­ ing programs, journals, books, and conferences, which keeps psychoanalysis lively; (7) the new schools mirror cultural changes unrecognized by the old schools, thus transforming psychoanalysis into an updated and relevant body of knowledge. The creators of a school of thought cannot be postmodernists. They cannot think of their theory simply as a narrative or a metaphor. The creator of a school can generate a grand theory only if he or she implicitly acknowledges the existence of an independent ontological reality, a real “thing in itself” that can be known. If ­analysts forcefully and habitually remind one another that it is impossible to know the truth, they will feel performance anxiety whenever they think of something new, interesting, and positive to say about the world. The substitution of the ana­ lyst who “imagines” with the analyst who “knows” (Spezzano, 1997) may erode the potential of psychoanalysis to generate new theories that “know” new things about the human mind. “Not knowing,” to paraphrase Hoffman (1998), is not always a good thing. Winnicott (1971) perceived science under the rubric of transitional phenomena. What he writes about the baby and the transitional object rings true for the creative analyst: Of the transitional object it can be said that it is a matter of agreement between us and the baby that we will never ask the question: “Did you conceive of this or was it presented to you from without?” The important point is that no decision on this point is expected. The question is not to be formulated. (p. 96) The philosopher Mary Douglas (1978) conceived a similar idea: “Delusion is nec­ essary . . . A good part of the human predicament is always to be unaware of the mind’s own generative powers and to be limited by concepts of the mind’s own fashioning” (p. 14). Postmodernists need positivists if they want psychoanalysis to generate new theories. Using postmodernism alone risks the impoverishment of psychoanalysis, yet postmodernism still has a vital role to play in the discipline. While it does not aim to generate a new theory of the mind, it provides a metatheory that examines what the analyst can know about facts and theories of mind. Postmodernism should be viewed as a watchdog that warns against the dictatorship of any theory claiming to fit reality and to be true, rather than being the vanguard of psychoanalysis. This will enable psychoanalysis to create, imagine, and renew itself without becoming a fixed doctrine. But can that happen? Can we seriously believe that analysts can return to an innocent phase, to the naive realism that enabled their predecessors to create rich narratives of the mind that they considered incontrovertibly true? May we expect that in the future the educated analyst will put uncertainty about knowledge aside

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and ignore contemporary philosophy? That the analyst will explain things that hap­ pen in the world, such as developmental stages, parenting, and psycho-pathology, with the same conviction and self-assurance that characterized the theory builders of the modern era? I think it would be a mistake to believe this could happen. Reading a classical psychoanalytic text today is very different from the way analysts read that same text in the past. I miss my student days, during which a new psychoanalytic theory was introduced every semester in psychoanalytic courses, before we were exposed to critical questions about knowledge. We took it for granted that every healthy baby has a transitional object, wants to tear up its mother’s breast, or goes through a symbiotic phase. Every lesson broadened our horizons and opened our eyes to new meanings and new ways of understanding our first patients. We were amazed to see how these concepts corresponded to reality, and we did not think of them as metaphors. We were excited because we felt we were touching upon an astound­ ing truth about people that was about to transform our perception, not only about babies and patients, but about ourselves as well. Indeed, after reading Freud, Klein, Bion, Winnicott, Fairbairn, and Kohut, we were not the same. But after reading philosophers such as Rorty, Derrida, and Lyotard, and analysts such as Hoffman, Mitchell, Aron, and Stolorow, to name just a few, our readings (and we) have been transformed once again. How painful this disillusionment has been! It is as though a whole generation of analysts educated on psychoanalytic truths woke up one morning to find out that the world was not what they thought. Even if this generation of psychoanalysts finds a new epistemological theory, more moderate in its assumptions, that will enable us to produce knowledge (see Cavell, 1999), things will never be the same again. Our metatheory has changed. We can never read a psychoanalytic text again with the same enthusiasm of touching the “real truth” that characterized our first reading. So, if we can’t go back to a naive phase, and to stay in the postmodern phase might harm the creativity of our field, perhaps the best thing analysts can do is to move on to a third phase. The most important thing that needs to happen in order for a third phase to begin is for the psychoanalytic community to recognize the contradiction between its own interest in creating new theories of mind and the insights of postmodernism regarding knowledge. I believe that this recognition can emerge only when analysts realize that their body of knowledge is currently in a vacuum: that analysts have sharpened their sensitivity to questions about knowl­ edge, with the cost being dwindling new theories of the mind. Only a longing for revitalization can lead analysts to this third creative phase. When this longing is felt, there will be a strong movement toward a new theory of knowledge that will be sensitive to postmodernist claims about knowledge, but also enable the creation of new theories and new knowledge. It is important to note that there is no need to resolve the problem on a philo­ sophical level. As Hanly (1995) aptly states, “since these epistemologies are no less controversial in philosophy than they are in psychoanalysis, psychoanalysts cannot rely on philosophy for a resolution of the controversy” (p. 901). Moreover, there

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is a wealth of literature within psychoanalysis that from a philosophical point of view enables analysts to know, while simultaneously being sensitive to postmodern insights. Theory is not only what we know; it is also what we don’t know and yet (or so) theorize about. It may be that theories address the uncertainty issues raised by postmodernists, as the facts or truths studied by the positivists do not. Indeed, many analysts are striving for correspondence with reality while remain­ ing aware of the epistemological problems that need to be considered (Ahumada, 1994; Cavell, 1999; Eagle, 2000; Hanly, 1990; Laplanche, 1992). In order for psychoanalysis to evolve and produce new knowledge, however, it would not suffice to discover a sophisticated philosophy suitable for producing new concepts and languages. A new climate, a new state of mind, is required for such developments to thrive. One thing is clear: progress, or a healthy state of knowl­ edge, is possible only if the image of newly achieved knowledge is a positive one; otherwise, decline is almost inevitable (Elkana, 1981). Individual analysts cannot undertake this third phase by themselves because they work in a powerful zeitgeist that must be transformed before new theories can be generated. Our institutions and organizations bear the responsibility for changing this zeitgeist. Psychoanalytic institutions need to revise their political agenda and address analysts who want to generate thick descriptions and solve new empirical problems. They need to do this in a pluralist manner, so there will be no turning back to indoctrination and suppression of new ideas. One alternative is to follow in the footsteps of Freudental (1996), who, in addressing similar problems in philosophy of science, described three types of political imperative in scientific establishments: institutionalized dogmatism, inter­ nalized pluralism, and institutionalized pluralism. These three types of political imperative might be seen as parallel to three phases in psychoanalysis: the era of psychoanalytic schools, postmodern psychoanalysis, and the third phase I now pro­ pose. My objective is not to present ideal solutions to problems, but to provide a theoretical framework that might facilitate such solutions. According to Freudental, in institutionalized dogmatism, statements of the rel­ evant conceptual scheme are valid not only within the dogma and according to its standards, but are also used to adjudicate the truth claims of competing theories: Being at the same time both party and judge, it is no wonder that one’s own party wins—not because of a psychological inclination of the judge but because the logical standards of judgment belong to this very theory or conceptual scheme. Second, if this universal truth claim merges with political power, it can be turned into a comprehensive political reality—i.e. the inter­ nal consistency of a theory is translated into an institutional reality, excluding all but one view. (Freudental, 1996, p. 153) Doesn’t this lively description echo the classical psychoanalytic institution? Internalized pluralism consists of taking the experience of the plurality of contemporary and historical conceptual schemes as the Archimedean point, and

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demanding of the scholar or scientist not to believe in or advocate any particular one. “The scholar should so to say internalize the existing historical and societal pluralism. It is because our societies are inclined toward this latter conception that we are less aware of its repressive consequences” (p. 153). As I have demonstrated, by emphasizing the fact that experience is open to multiple interpretations that cannot be verified, postmodern psychoanalysis demands a moderate internalized pluralism. There is a third alternative, however, which I believe can be modified and tuned to address the specific problems of psychoanalysis. In institutionalized plu­ ralism, pluralism is demanded not of individuals but of institutions. Institutions should secure the pluralism of monolithic points of view. In practice, relevant but incompatible conceptual schemes should be given the chance to develop accord­ ing to their own internal criteria. But institutionalized pluralism does not require that individual analysts be pluralists; rather, the contrary. Thus, the ideal head of a psychoanalytic institute represents pluralistic relativism on a level that allows for dogmatic realistic claims of truth in direct scholarly works. The director of a psychoanalytic organization that adopts a policy of institution­ alized pluralism should encourage analysts to build new theories. He or she should devote considerable thought to understanding the creative processes responsible for the generation of psychoanalytic theories. There is no need for the director to be either postmodernist or positivist, but he or she does need to be convinced that generating new psychoanalytic theories is vital for the psychoanalytic future. The director should also have a natural aversion to fundamentalism of any kind. He or she should encourage analysts to discover their own creative voices without ignoring, forgetting, or denigrating what they have learned from others. What should lead the psychoanalytic institute is not a sentimental yearning for an institutional past when “true ideas” were inspirational, or for the comforting certainty of old theories. If we want our body of knowledge to become a science and an academic clinical discipline, we need to create a university-style model that encourages empirically based research that generates new knowledge and thick descriptions. At the same time, we need to have considerably more information about which theory best explains change in the clinical situation. I think that the issue of hypothesis testing in institutes has been a major problem in this regard. Formulating and testing hypotheses are distinct steps that must be kept separate. Unhappily, they have too often been conflated. As a result, schools had disciples and followers, rather than a group of investigators trying to validate findings or develop them. The situation was not helped by a lack of univocal definitions (or anything even close) that would allow investigators to use the same meanings in moving on. New theories of mind should be, as much as possible, subjected to empirical validation, and we ought to be able to observe phenomena in a reliable and valid way across settings. It is important that divergent theories be challenged, stud­ ied, compared, and evaluated empirically. They can be compared based on their compatibility with clinical material or with data from adjacent fields; they can be

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evaluated for completeness, internal consistency, pragmatic usefulness, or ease of translation into clinical interventions. The crucial point is that it is the responsibility of institute directors to empower their analysts, make them feel relaxed and comfortable, encourage their generative capacities, and enable them to feel that they can be confident about their findings. At the same time, the director should not privilege any one doctrine as being supe­ rior to another. In such an institute, analysts will be able to focus on doing what they do best—explaining human conduct, generating new terms and concepts for unexplained phenomena, and finding new meanings for things that happen in therapy and in people’s lives.

9 THE VICES AND VIRTUES OF MONOLITHIC THOUGHT IN THE DEVELOPMENT OF PSYCHOTHERAPY

This chapter will show that fascinated and troubled communities are not unique to psychoanalysis, but rather characterize the entire world of psychotherapy.1 I explain how the integration movement (which tends to be critical of singleorientation schools) in fact relies on the essential and vigorous activity of fascinated communities (such as psychodynamics, cognitive, humanistic, or family therapy). The field of psychotherapy has dramatically changed over the past few decades. In the past, training and practice in psychotherapy were controlled by competing schools of thought that were mutually exclusive. Each school had its own supporters who identified themselves in an absolute way with one psychotherapeutic orientation. In today’s psychotherapy, the demand for integration has become a powerful voice. It is true that a large number of psychotherapists still maintain their loyalty to single orientation. However, a significant and growing number identify themselves as wholeheartedly integrationist, while an even greater proportion of the community admit that they make use of methods from a number of other schools of thought at least occasionally (Cook, Elhai, Biyanova, & Schnurr, 2010). I argue that the normative influence of contextualism and pluralism has led to a profound misunderstanding of the significant role that single orientations have within the integration movement. As we saw in Chapter 1, supporters of fascinated communities suffer from a bad reputation. They are accused of being unable to move beyond an attitude of superiority, contempt, and aversion, which frequently arises from the confrontation between competing therapeutic “cultures” (Safran & Messer, 1997). This was perhaps best described by Paul Wachtel (2010): “Those debates and divisions can also be usefully viewed as akin to ethnic conflict . . . Whereas genuine scientific debates can at least to some degree be settled by data, ethnic controversies center more thoroughly on the sense of ‘us’ and ‘them’” (p. 410). Although the criticism

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against fascinated communities had more than an element of truth attached to it, the issue as a whole is far too clouded by political correctness to be properly judged. That is to say, when one understands the shortcomings that Wachtel and others describe in their right context, an entirely different picture emerges. The emotional identification and deep-seated loyalty toward the theory have very positive aspects that are vitally important to the development of the theory, both at its building stage as well as in the period during which the psychotherapeutic school is evolving. My objective is to encourage clinicians to view integration and fascinated communities as two different intellectual approaches towards psychotherapy and to accept that both are essential to the healthy progress of the profession. This chapter joins a modest tradition of critiques that have attempted to turn attention away from the negative aspects of fascinated communities and examine its positive sides. Elsewhere I pointed (2006) to monism and objective truth as essential to theoretical creativity and to pluralism as diluting the originality of a theory, and Sorenson (2000) showed that within the psychoanalytic community a monolithic view of “us” versus “them” increases the cohesion and political power of the group. The present chapter complements these claims by showing that monism is also essential to the development of psychotherapy, and that such monolithic thinking is common to the development of all scientific paradigms. The argument I want to develop progresses across three main points. First, I will argue that because the association between adherers of fascinated communities and conservatism is so strong, we need a new and creative analogy in order to enable us to try to see matters differently. I will then liken the creation of new fascinated communities to an invention, and subsequently draw an analogy from the way in which major inventions linked to innovations in textiles, iron, mining, hardware, and instrumentation were developed in Britain during the Industrial Revolution. Finally, I will attempt to situate the integration movement along the evolutionary line that I have drawn and point to the important mutual links between integration on the one hand and identification with a single school on the other.

Inventors, tweakers, and implementers Up until now, we have seen the extent to which, according to the post-positivist philosophy of science, monism, and a deeply rooted identification with one method, are shared by many scientific communities. But in what way does the evolution and establishment of the psychotherapeutic orientation benefit from this deep-seated commitment? And what is the role of the integration movement in this development? To answer these questions, we need a new narrative that will free us from the mindset in which we find ourselves, a mindset that narrows our vision and our ability to think. For the most part, this narrative is another version of the war between the sons of light (those who side with integration and pluralism) and the

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sons of darkness (the adherers of one single orientation). In other words, we cannot think about fascinated communities within psychotherapy without equating them with rigidity, sectarianism, and extremist orthodoxy. Such a possible narrative might come from the world of technology.The Industrial Revolution was the first period in modern history during which technological progress and innovation played a major role in economic growth. For about a century, Britain led the world in innovation, after which its dominance slowly waned. What lay behind British leadership, and why was Britain the most technologically advanced economy in the world for so long? According to Ralf Meisenzahl and Joel Mokyr (2011), Britain owed its edge in technological development to the superior competence of its work force and, in particular, to those who in practice were the fulcrum of technological progress during this era. Meisenzahl and Mokyr argue that innovation in the period of the Industrial Revolution was animated by three distinguishable levels of activity. In the first place, there were the big inventions and other major breakthroughs that helped to unlock the door to new horizons. These, say the authors, were the creations of the “major inventors,” most of whose names are well-known and are written about economic history textbooks. At the next level, there were innumerable small and medium “mini-inventions” that enhanced existing discoveries, cleaned them of their faults, found new uses for them, and merged them into new applications. These were the “tweakers.” The tweakers had to have the ability to install, operate, adapt, and repair the newly developed equipment in various differing circumstances. Moreover, in the full sense of the term, tweakers had the ability to slightly improve and refine a technique. The third and most anonymous group among those directly responsible for Britain’s leadership in the field of nineteenth- and early twentieth-century innovation, were the large numbers of skilled builders, installers, machine operators, and workers, capable of maintaining complex equipment. Though, strictly speaking, such improvements may not in and of themselves have been regarded as miniinventions, they did clearly boost the drive towards greater innovation. These are referred to by Meisenzahl and Mokyr as the “implementers.” The line differentiating between tweakers and implementers is fuzzy, and it is apparent that some of the great innovators of the Industrial Revolution invented, tweaked, and implemented all by themselves. But the vast majority of first-rate skilled mechanics of that period did not invent anything of consequence, and their input has remained unacknowledged. With the exception of the very few inventors who were capable of all three levels of activity, the fact is that without the exceptional competence of those engaged in tweaking and implementing, the great inventors would also have been doomed to developing inconsequential curiosities— Leonardo da Vinci’s countless original creations being just one example. The financial success of the inventor hinged, among other things, on his being able to find competent tweakers capable of pinpointing the flaws in the invention and rectifying them, and implementers who could build, install, and put the invention into operation. A famous example of this was the inventor of the steam engine, James Watt, who epitomized that generation of discoverers. For his success, Watt

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was dependent on not only the ability of John Wilkinson to pierce the cylinders for his engine with extreme accuracy, but also had to rely on a number of his most outstanding workers, such as William Murdoch (Griffiths, 1992), and highly skilled engineers, such as John Southern and James Lawson (Roll, 1968). The ability of these competent individuals to construct and maintain innovative machinery inexorably led them to making comparatively small modifications and adjustments that have to be seen as minor additional innovations. The powerful synergy between the three levels of technological activity during the Industrial Revolution is crucial to our being able to understand why Britain gained such ascendancy in this field. Its highly skilled workforce meant that Britain was in a position to put major inventions into practice wherever and whenever they were made. The country’s ability to forge ahead of everybody else at such an early stage owed much to the proficiency of the engineers and mechanics who supplied the inventors with levels of support without which their blueprints may never have seen the light of day. I believe we can draw a similar differentiating line between the great inventors, tweakers, and implementers within the world of fascinated communities within the psychotherapy world. In each of these activities, we will come to understand the role of the integration movement—where it is possible, and in what circumstances one cannot expect it to be viable. According to this analogy, schools of thought in psychotherapy develop in the following way: the inventor, or a group of inventors, develops a new method in psychotherapy that has usually been shaped by his clinical work with a limited number of patients. The method is learned by a small and restricted circle of psychotherapists, who quickly become enthusiastic supporters of the method. If the method is successful, this initial circle becomes increasingly larger across the world. Current and future proponents of the system continue to engage in two key activities: refinement and improvement of the method, so that it can be applied to a larger range of the patient population and mental disturbances (tweakers); and its assimilation by the professional community through teaching, the establishment of training institutions, journals, conferences, and books (implementers). As we will see, every one of the major psychotherapeutic methods has undergone many developments and changes. Each one of them includes within it new approaches that have been developed by additional inventors who have suggested a new development of an existing method. This further development must also be regarded as an invention. Major developments that stem from other important advances generally find the original model too restrictive and augment it with additional principles that enrich and widen its scope. These developments take place within each fascinated community. In what follows, I will present the counterparts in the world of psychology of the inventors, tweakers, and implementers of the Industrial Revolution, and illustrate the process of evolution within its various approaches. In addition, I shall show why integration is not possible in the workings of every group, and at what stage of evolution we might expect integrative efforts to be made. The following

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is by no means a systematic history, but rather a sketchy and anecdotal description by which I intend to illustrate why fascination and strong identifications are vitally important for the evolution of schools.

Super inventors: a new world-view I define a new invention in psychotherapy as a new psychology, one with conceptual roots, anchored in a philosophical tradition, that redefines psychopathology and human suffering and that is usually supported by a theory of psychopathology, development, and techniques of treatment. This includes all the thinkers who were responsible for pioneering the major psychotherapeutic methods and their developers: Sigmund Freud and psychoanalysis, Aaron Beck and CBT, Fritz Perls and Gestalt, Carl Rogers and Client Centered therapy, Salvador Minuchin and structural family therapy, to name but a few. According to this definition, a new school in psychotherapy is much more than a collection of effective therapeutic interventions. Every method in psychotherapy is based on a broad world-view “external” to the psychotherapeutic world. This world-view includes philosophy, values, a metatheory, and a set of beliefs about the nature of man. The method redefines the problem from which the patient is suffering and supplies a profound alternative meaning to the life of the patient; from this stems the therapeutic intervention. Paradoxically, many of the creators of the new method engaged in integration in the sense that they were influenced by the psychotherapies of their time. Sometimes, the new invention was a response against the existing psychotherapy, and sometimes it absorbed the ideas of other psychotherapies and gave them a new meaning. For example, many of the major figures in group and family approaches stressing bodily and sensory awareness, as well as in community approaches, had their original training in psychoanalysis. In some respects, their work may be seen as an outgrowth of psychodynamic thought that has now achieved independence from its origins and challenges the parent theory (Wachtel, 1997). Aaron Beck, the founder of CBT, is another example. Beck was trained in psychoanalysis and used concepts from several dynamic therapies as a basis for case formulations and treatment planning, as long as they were grounded in evidence from the case’s data. Beck is the classic example of an integrationist who produced a product. In 2000, Beck humorously acknowledged this when he referred to himself as “a closet psychoanalyst” (Edwards & Arntz, 2012), although in most of his writings he distanced himself from that approach.

The classical tweakers Classical tweakers are responsible for new and creative conceptualizations of theory within an existing single orientation. They are committed to one method and refine it within the theoretical framework they are identified with. The various journals are full of such articles. Given that the theories are very broad, the

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inventor of the method relates to the theory’s key principles, which he has put into practice in a limited number of cases. This will be followed by the tweakers” demanding donkey work, intended to extend the various principles of the approach’s founder to different kinds of problems, patient populations, and new therapeutic interventions. Take the following example: if psychoanalysis is prolonged and necessitates four to five sessions a week, then psychiatrists such as James Mann (1973) will come forward and refine the psychoanalytic method to a shorter period of therapy consisting of twelve sessions that would also work in a publicly run clinic. This happened to behaviorist theory in the 1960s after its principles were first published during the 1950s. The period between 1958 and 1965 saw the publication of six books that were decisively important in advancing the learning based therapeutic model (O’Donohue, 2009). The first of these was James Wolpe’s Psychotherapy by Reciprocal Inhibition (1958); this was followed two years later by Hans Eysenck’s Behavior Therapy and the Neuroses (1960). Then, in quick succession, came Cyril M Franks’ Conditioning Techniques in Clinical Practice and Research (1964); Eysenck’s Experiments in Behavior Therapy (1964); and Krasner and Ullmann’s two volumes, Case Studies in Behavior Modification (1965a) and Research in Behavior Modification (1965b). Each one of these six works included wideranging case studies, in-depth research, and a theoretical analysis that significantly increased the range of the original model. Conditioned reinforcement, modeling, generalization and discrimination, satiation techniques, punishment, the effects of schedules of reinforcement, and token economies were all investigated in these six publications. Occasionally, tweakers break away and join sub-groups, whereupon disagreements between them tend to erupt. For example, those influenced by B. F. Skinner sometimes tried to distinguish themselves from those influenced by non-operant principles, and particularly from those influenced by non-conditioning factors (O’Donohue, 2009). Tweakers almost always dramatically alter the method, while some of them develop a method of their own. Sometimes, it becomes apparent that the tweakers’ new principles are more effective or more convincing. These tweakers often encounter fierce opposition by traditional loyalists. At first, only a few members of the community shift ground, followed by an increasing number of them demonstrating their allegiance. This phenomenon happens in other sciences as well (Kuhn, 1970). For example, tweakers in psychoanalysis were usually rejected by mainstream psychoanalysis or by Freud himself. From the outside, one can describe Freud, Adler, Jung, Sullivan, and many others as psychodynamic therapists, but the schism between these sub-theories and mainstream psychoanalysis remains irreconcilable. This tweaking may lead to a whole community abandoning the old principles in favor of the new. In fact, none of the major psychotherapeutic methods—be it psychoanalysis, gestalt, person centered therapy, CBT, or family therapy—work in line with the original pure principles developed by their founders.

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The implementers: a quiet yet essential presence A new approach in psychotherapy is not viable without psychotherapists in the field to implement it, disseminate it, establish learning and research institutions, write about it, organize conferences around it, set up journals and internet web sites dedicated to it, and hand it down to a wide number of other psychotherapists eager to learn. These are the implementers of the method, the carriers of its message to the community of psychotherapists across the globe via clinical training programs in universities, schools of psychotherapy, institutions devoted to the teaching of the method, or special study workshops. While implementers are obliged to be enthusiastic about, and devoted to, the existing theory, and have to obtain a profound understanding of it, they are not expected to be creative. The line between tweakers and implementers is blurry, but, at the very least, new conceptions or techniques, or the expansion of the original theory to include new clinical phenomena, would be a clear signal of creativity. The first generations of psychotherapists who act as implementers of the new method are especially important because they not only teach but also disseminate the method. It is owing to this generation that the new approach takes root, is publicized to the broad public, and impacts on a large number of psychotherapists. During these early years, the system is especially dependent on implementers. Sometimes, the implementer explains the original ideas of the inventor in a clear, fluent, and much more communicative way than the inventor is able to do himself. This is what Hannah Segal did in relation to Melanie Klein. Her first book, Introduction to the Work of Melanie Klein (1964), in which Klein’s ideas were illustrated through clinical material from Segal’s own patients, became and remains a standard textbook in Kleinian theory. Paul Goodman played the same role vis-àvis Gestalt theory. While Fritz and Laura Perls were the originators of the ideas that culminated in Gestalt Therapy, Paul Goodman is credited with writing most of the theoretical material in the book Excitement and Growth in the Human Personality (Perls, Hefferline & Goodman, 1951), based on Perls’ original thinking. A major part of the implementation is done by means of spreading the ideas via enthusiastic loyalists. In one way or another, the new psychotherapy needs to go beyond the country in which it was created in order to be significant in the field. For Gestalt, this happened during the 1960s. By 1960, Perls was collaborating with James Simkin, and within a year two, training groups were formed. The training institutes founded on the West Coast included the Gestalt Institute of San Francisco and the Gestalt Therapy Institute of Los Angeles. The training staff of the two institutes (Walter Kempler, Robert Resnick, Janer Rainwater, Gery Yontef, Jerry Kogan, and Claudio Naranjo among them) brought word of Gestalt therapy to Mexico, South America, and eventually across the globe. The implementers are also responsible for establishing institutes, learning centers, and journals to disseminate the method at the point in time when it is being institutionalized. In the late twentieth century, large organizations devoted in one way or another to the propagation of Gestalt Therapy appeared on the scene. The Association for the Advancement of Gestalt Therapy (AAGT), The European

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Association for Gestalt Therapy (EAGT), and the International Gestalt Therapy Association (IGTA) are prominent examples. The Gestalt Journal was initially published in 1978 and was the first journal dedicated exclusively to Gestalt theory and practice. Today, there are eleven professional journals in English alone.

Super inventors, tweakers, implementers, and integration As described, inventors, tweakers, and implementers are psychotherapists with a single orientation who have an interest in advancing that idea and bequeathing it to others. They believe in the innovativeness and originality of their single orientation. They hold to a firm world-view and believe in its values, and are therefore unlikely to engage in integration. Classical tweakers’ biggest efforts are invested in seizing control of one field of clinical phenomena after another and applying the theory to each of them. It can be assumed that if they become aware of a more effective alternative method in treating a certain disorder, it will merely goad them to further develop their own method and refine it. The objective of implementers is to advance the psychotherapeutic method they come from. They do this out of a sense of belief, enthusiasm, and strong identification. People from all three groups wholeheartedly believe that their method works better than any other, and are immersed in a creative and productive effort to prove just that. Once group loyalties are engaged, it is difficult to change the psychotherapists’ minds by showing them empirical support for a supposedly different intervention backed up by a different psychotherapy with which they have no affiliation and no emotional connection. This is mainly because one of the salient characteristics of all psychotherapies is that the therapeutic technique is not isolated and separate from the world-view. As one of the earliest practitioners of gestalt therapy said in an interview: We Gestalt students were drawn to the approach not only because of the theory and method but also because of the implicit belief that we are going to change the world for the better. In the midst of a world-view climate supporting democratic models, as opposed to authoritarian models, we saw a way to help liberate the restricted conforming individual, and to promote authenticity and individuality. (Bowman & Nevis, 2005, p. 10) In conclusion, it is easy to see that in order to implement a method, teach it, disseminate it, refine it, and develop it, it requires people possessed of a righteous mind that will be faithful to one single approach.

The integration movement: the tweaker’s tweaker As we have seen, integration is less likely to occur at the level of new psychotherapeutic “inventions” or among its loyal tweakers and implementers. At which stage, then, in the history of an “invention” can integration be expected to occur?

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Integrative efforts start with tweaking techniques but then become more sophisticated, which results in efforts to tweak entire theories. In the early stages of integration, the common factor approach and technical integration were focused on techniques. The common factor approach determines the core ingredients inherent in all successful psychotherapies, so that a more prudent understanding of therapy can be developed (Frank, 1961; Norcross & Goldfried, 2005). In technical integration, one borrows, purchases, pilfers, and imports methods and techniques (not theories) from diverse sources so as to harness their specific power (Lazarus, 2005). Other integrative efforts emphasize integration on the level of theory. In theoretical integration, “two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone” (Norcross & Goldfried, 2005, p. 8). The idea is that when theories and their methods come into close contact with other theories and methods that were previously foreign, subtle changes begin to show up in all of the components of the evolving synthesis (Wachtel, 1977). In assimilative integration, the therapist incorporates attitudes, perspectives, or techniques from an auxiliary therapy into a therapist’s primary, grounding approach and creates a mini-theoretical integration (Messer, 1992). There is a lively debate within the psychotherapy integration movement about the role of theory within integration (see Safran & Messer, 1997). The fact that integration efforts are not loyal to one single orientation does not mean that theory is of no significance. On the contrary, most of the important figures in psychotherapy integration are clearly identified with single orientations. For example, Messer and Wachtel are clearly committed to a psychodynamic view, whereas Goldfried and Lazarus are committed to CBT. This is true especially within assimilative integration, which relies on a single theory to guide a choice of integrated interventions. However, what makes them still integrationists, and not fully fledged psychodynamic or CBT therapists, is their need for accommodation, their need to alter the underlying theory to account for the failure of that theory to suggest the utility of the integrated techniques (Stricker, 2010). In contrast, when strict followers of single orientations run into empirical difficulties (e.g. their techniques do not apply to certain psychopathologies), they have no idea how to resolve many of their difficulties and are prepared to leave their problems unresolved for years, refusing in the meantime to change their assumptions. The difference between classical and integrationist tweakers is that a classical tweaker remains solely within the fascinated community, whereas an integrationist— even one that is oriented to a particular single orientation—moves outside it or moves back and forth between the single orientation depending on what kind of integration he or she endorses. Another important difference between classical and integrationist tweaker theories is their starting point. The great inventor’s starting point is a world-view of his own and a vision of upright ways of defining the psyche. His concerns revolve around such holistic issues as: what defines a person? What is the nature of human suffering? What is it that makes change a realistic possibility? The innovator’s responses to such questions are taken up by classical tweakers, who try to put

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them into effective use and apply them to a larger and wider number of patient populations and mental disorders. The integrationist, on the other hand, does not allow himself to become involved in such holistic enquiries or the refinement and perfection of just one single orientation. He has no ambition to develop a new school of psychotherapy. Instead, he takes the methods that have been bequeathed to him by the great inventors and subsequent developers and works on these in order to create a more efficacious psychotherapy. In fact, various groups representing differing kinds of integration (technical eclecticism, the common factor approach, theoretical integration, and assimilative integration) have two things in common. First, on the theoretical level, they are interested in weakening the link between the overriding theory with its closed world-view and the therapeutic intervention. They argue that specific therapeutic interventions do not have to be loyal to the overriding theory, but rather need to take more relevant and pragmatic considerations into account. In effect, what the different groups of the integrationist movement are saying to those who adopt a single orientation psychotherapy is: your successful therapeutic interventions also work without the world-view and perception of the nature of man that you are so proud of (technical eclecticism, e.g. Beutler, 1983; Beutler & Clarkin, 1990; Lazarus, 1967, 1989); they work because of factors other than those you had in mind and which are common to all other approaches (common factor, e.g. Duncan, Miller & Hubble, 2010; Frank, 1999; Frank & Frank, 1991; Garfield, 1992, 1995); they will work much better if you integrate and take into account the findings and interventions of the theories you are in competition with (theoretical integration, e.g. Prochaske & DiClemente, 1984; Ryle, 2005; Wachtel, 1977, 1987); a theoretical single orientation is only a basis enabling us to selectively assimilate therapeutic interventions from competing systems (assimilative integration, e.g. Castonguay et al. 2004; Messer, 1992, 2001; Safran, 1998; Stricker & Gold, 1996). As Wachtel (1997) writes on behaviorist therapists: The more sophisticated among behavior therapists recognize that there is often only a loose, analogic connection between the methods they use and the learning experiments on which the methods are purportedly based . . . Behavior therapists are often effective precisely because they are not behavioristic in any narrowly construed way. (p. 8) The second thing that they have in common is that members of the integration movement lack that sense of idealization of the theory that helps most psychotherapists have a feeling of belongingness, identification, and profound loyalty. In this sense, those engaged in integration are to a certain extent more solitary, in that they are set apart from a strong and ardent professional community. To accommodate this need, the Society for the Exploration of Psychotherapy Integration (SEPI) was formed in 1983. As Wachtel (2010), one of the SEPI’s founding fathers, noted, SEPI was a home for members “venturing outside the boundaries and borders of one’s home orientation” (p. 407).

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By saying that practitioners within the integration movement lack a “comprehensive world-view,” I do not mean to suggest that they have nothing to say on issues like human suffering or the human mind. I am merely saying that they do not put their world-view at the center of their techniques. They are not driven and directed by metaphysical, philosophical, broad metanarratives or grand theories in the way that therapists who endorse CBT, psychodynamics, person-centered, or Gestalt therapy are. Even if they are oriented toward a particular single orientation, their loose link to the grand narrative of their theory, and their interest in other single orientations, grant them the freedom to be explorative.

Fascinated communities are essential to integration Now that we have presented a model of the way in which psychotherapeutic schools evolve, it is possible to understand the extent to which fascinated communities are essential to integration. In effect, integration occurs when weaknesses, disparities, and unexplained “residuals” are found in a particular theory. Psychotherapists loyal to one orientation will continue to treat in line with their method, even in cases in which it is shown to be inefficient. They either try through a classical tweaker to find a way of dealing with their own method’s lack of a satisfactory solution, or else they simply accept the situation, ignore it, and give no further thought to it. This is exactly the point at which integration comes into the picture. It locates and finds solutions for the gaps, the weaknesses, the unsatisfactory answers, and all the clinical occurrences that the one single orientation tends to ignore and deny or, in Kuhn’s words, “put them to the side.” All strategies for psychotherapy integration created numerous mini-inventions that enhanced existing psychotherapies, cleaned them of their limitations, applied them in new ways, and merged them into new treatments. However, the flexible and effective therapeutic interventions of the integration movement would not have come about had it not been for the rigid world-view and uncompromising loyalty of the inventors and their supporters. The tension between them is positive and productive. Every attempt to extinguish it will lead to a weakening of the profession and damage its creative impulse.

Implications for theory, practice, and research What, then, are the implications of this approach? From a sociological perspective, it is important to understand that psychotherapy is not merely a set of successful interventions administered by a qualified therapist. Psychotherapy is a culture, a framework of relations, a community that works together and believes in common values and in a certain world-view. It is important that we honor and preserve the wish of psychotherapeutic communities to discover their own unique voice and unite around it. Psychotherapists who feel that they are part of a professional, broad, strong, and highly animated community

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can also imbue their patients with a sense of security. When they face their patients, they are not alone. Behind them is the body of knowledge on which they base themselves as well as their professional community. From the research perspective, we need to examine what every school requires in order to develop its ways of thinking and theories. We must honor the methodology of every community and its particular methods of research and not demand that all tools of analysis be standardized. From the integration movement’s perspective, it is important to remember that, paradoxically, some branches within the movement itself might turn out to be another fascinated community, another orthodoxy, counter to the very spirit of its founders. There are great debates about this issue within the integration movement (see Wachtel, 2010), the conflict between psychotherapy integration as a product, which simply might lead to another fascinated community and psychotherapy integration as an ongoing process “with each client viewed as a work in progress rather than as subject to a fixed approach” (Stricker, 2010, p. 398). From my perspective, there is nothing wrong with a new fascinated community evolving from the integration movement. As long as other psychotherapists continue to explore the process and tweak in flexible and open ways, I do not see why integrationists who become “hooked” on a single method (and for that are no longer considered to be part of the integration movement) should be thought of as posing a danger to the integration movement. In fact, I think one of the most positive outcomes of the integration movement is its success in producing new fascinated communities. CBT, for example, is such a product: it is an integration of traditional behavioral approaches (e.g. Wolpe & Lazarus, 1966) with cognitive therapy (e.g. Beck, Rush, Shaw, & Emery, 1979). In this sense, product producers in psychotherapy integration should be included in the group called super-inventors. In summary, we must not let psychotherapy become a specialized, narrow, and autonomous activity detached from tradition, something created by alienated individuals rather than historical communities. Advocates of integration regard the value of a psychotherapeutic technique as being solely related to its efficacy in bringing about change, rather than to the broader social relations and practices that shape theory creation and reception. But this standing comes at a high price, for it can divert attention from the impressive tradition of a psychotherapy school’s followers who refuse to be completely absorbed by either their own classical stance or by integration.

Note 1 See commentary to this chapter by Paul Wachtel, from Society for the Exploration of Psychotherapy Integration (SEPI), Paul H. Lysaker, Ph.D. and Giancarlo Dimaggio M.D. Center for Metacognitive Interpersonal, Rome (Journal of Psychotherapy Integration,Vol 24[2], Jun 2014, pp. 95–98).

AFTERWORD

This book has described the significant contributions made by both fascinated and troubled communities—and the tension between them—as engines of change and growth within the psychoanalytic community, as aiding its survival and renewal. Fascinated communities are praiseworthy for their contribution in anchoring and expanding the theories they believed in; for their ability to patiently delve the depths of canonical writings, always managing to interpret them in an innovative and creative ways; and for their unfashionable devotion and loyalty to one theory, their enthusiasm for that theory, and their willingness to bear the lack of understanding and contempt towards them displayed by other communities. Over the past few decades, psychoanalysis has become far more pluralistic and open. As a result of that, and because of cultural changes in the perception of truth, the standing and influence of fascinated communities has been lessened. The weakening of fascinated communities halted the establishment of new psychoanalytic schools of thought. However, it also reduced the negative phenomena associated with such schools: isolation from the non-analytic psychoanalytic world, the automatic rejection of new ideas, and the constant preoccupation with “pure” psychoanalysis and indifference to psychotherapy research. In addition, the boundary line between what is and what is not considered psychoanalytic became increasingly blurred. The diminishing influence of fascinated communities resulted in the prosperity of troubled communities. It would appear that the conditions for change, growth, and novel thinking beyond the restrictive psychoanalytic jargon were never better. Troubled communities are the future of psychoanalysis. Thanks to communities such as the relational approach and Fonagy’s mentalization-based treatment (two communities that greatly differ from one another and have very little in common), psychoanalysis has revived an interest among a broad spectrum of both young and senior professional practitioners.

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Over the last decade, much has been written about the future of psychoanalysis. Richard Chessick’s The Future of Psychoanalysis (2007), Paul Stepansky’s Psychoanalysis at the Margins (2009), and Ahmed Fayek’s The Crisis in Psychoanalysis: The Search for a Lost Doctrine (2010), as well as articles by Carlo Strenger (2006, 2010) and Eric Kandel (1999), all point to the serious crisis facing psychoanalysis and paint a bleak future for the discipline. These writers describe real problems that are affecting psychoanalysis. One can begin with its tendency to withdraw into isolation, its detachment from academic psychology and relevant scientific fields of enquiry (Strenger, 2010) all the way to its lack of loyalty to the traditional Freudian truths and those of the other founding fathers and mothers (Chessick, 2007; Fayek, 2010). The prevailing tone in these writings is one of lament and frustration—lament for the loss of the position once held by psychoanalysis and frustration with respect to the reasons that led to this situation. These writers belong to one or other of the two communities described throughout the book. There are the fascinated writers—Chessick, Fayek—who feel uneasy about the radical and irreversible change the community has undergone; the troubled writers—Strenger, Kandel, Stepansky—on the other hand, are uncomfortable with what they regard as psychoanalysis’s stagnation irrelevancy, unscientific methods, and tendency to tread water. Scientifically troubled communities that hold images of knowledge similar to those of academic psychology are the most pessimistic communities of all. They simply refuse to ignore the indifference of fascinated communities to contrary external evidence and the irrelevance of psychoanalysis to contemporary psychological discourse. They regard the pluralism that has characterized psychoanalysis over the past few decades as evidence of its failure to unite around one proven theory (Stepansky, 2009). And yet, these two groups do have one thing in common: both miss psychoanalysis’s halcyon days and the special place it once occupied in psychotherapy, psychiatry, and the academic community. They yearn for a return to the time when psychoanalysis was renowned for its remarkable intellectual and scientific vigorousness. The fascinated tend to attach responsibility for psychoanalysis’s bleak situation to the shallowness of the non-psychoanalytic world, which prefers instant solutions rather than ones that are profound, while also blaming various approaches within psychoanalysis that cooperated with that non-analytic world. Troubled communities, on the other hand, tend to blame the psychoanalytic community—particularly fascinated communities—for the decline in psychoanalysis’s standing. Indeed, when one compares today’s psychoanalysis with the period when the discipline was in its prime, there are many reasons for pessimism and sadness. We have to be truthful. Within the field of academic psychology and evidence-based psychotherapy, psychoanalysis has been marginalized. Despite the fact that psychoanalytic institutes continue to blossom all over the world, and that psychoanalysis as a whole has experienced the growth of new ideas and pluralism, large segments of the community of therapists and university psychology departments

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remain unimpressed. Thus, these departments in which a new generation of therapists are being trained do not include psychodynamic psychotherapy as one of the methods taught. As I have shown, scientifically troubled communities place great importance on the linking of psychoanalysis to contemporary research and innovative discoveries in fields such as brain research and infant observations. Thanks to them, psychoanalysis has succeeded to remain scientifically up to date. But the attempt to limit psychoanalysis to one world-view and discard everything thought to be irrelevant to this research risks throwing out the baby with the bathwater. Employing this scientific filter is liable to leave few of the important and groundbreaking conceptualizations introduced by Freud, Klein, Bion, Winnicott, and Kohut intact. In fact, no member of the troubled communities has any kind of serious and practical suggestion as to how a scientifically sound, efficient, corroborative method can be developed to validate the conceptualizations of psychoanalytic thinkers and investigate clinical phenomena, such as projection identification, potential space, the grandiose self, or the analytic third. The few proposals there are by the likes of Kandel and Strenger to link psychoanalytic insights to research in biology or brain research are, at best, far too general and nebulous and, at worst, do not retain anything from the rich and complex psychoanalytical conceptualizations bequeathed by psychoanalytic theories. Scientific research takes place in the margins of psychoanalysis, and in most instances, does not lead to the creation of new ideas. As I have shown, to the sorrow of troubled communities, analysts continue to rely in their writings and methods on psychoanalytic “classics” and to regard the clinical situation as practically the exclusive source of new conceptualizations. However, very fortunately, scientifically troubled communities are doing useful and productive work in assimilating within psychoanalysis findings from other bodies of knowledge, and thus balancing the situation. Psychoanalysis’s critics find it difficult to accept psychoanalysis’s double identity, simultaneously occupying two niches: a medical-psychiatric-clinical niche, and an interpretational, hermeneutics, linguistic, playful niche that deviates from what science can offer and anchor. Acceptance of psychoanalysis’s double identity requires giving up on the idea that psychoanalysis will return to it days of glory and resume its centrality in the scientific world in the near future. At the same time, there is the wish that scientifically troubled communities will continue to constantly search for a link with the important discoveries in other fields. Let us think about the scientific world not as it is today but as it will look in a hundred years. Since most of the theories that were used a hundred or two hundred years ago are regarded today as groundless and have been replaced by updated theories, there is no reason to think that contemporary scientific theories won’t suffer a similar fate. Everything that is considered true and stable today will be challenged, and everything that seems certain today will, in the future, be doubted. The inexhaustible flow of new developments to come will create new research paradigms, which inevitably will change the face of science and even the human

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mind. Many bodies of knowledge will disappear, and the survivors will be those who, at one pace or another, are best at assimilating the changes and allowing in the new mood of the times. Psychoanalysis is a good candidate with which to face up to these periodic storms because of its flexibility and ability to be updated every now and again in line with the requirements of the time. Thus, something new is constantly happening in psychoanalysis. This is an absolute imperative if a body of knowledge wants to remain alive and active. But the new cannot be detached. It needs roots and sources. It needs to be perceived as a link in an existing chain, as a natural development of an extant body of knowledge anchored and well-embedded in therapeutic tradition.

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AUTHOR INDEX

Abbass, A. A., Joffres, M. R. & Ogrodniczuk, J. S. 175 Aguayo, J. 61, 125–6, 141 Ahumada, J. 197 Aisenstein, M. 9 Alford, C. F. 24 Altman, N. 105 Altman, N. & Davies, J. M. 111 Amati-Mehler, J., Argentieri, S., Canestri, J., & Whitelaw-Cucco, J. 161 Amir, D. 17 Aron, L. 22, 26, 57, 62, 94, 96, 97, 98, 99, 101, 102, 103, 105, 110, 141, 179, 180, 181, 183, 188, 196 Ascherman L. I., & Brett, E. 8–9 Bacal, H. A. 141 Baldwin, J. M. 74 Baranger, M., & Baranger, W. 31, 129, 130–1 Barber, J. P., Muran, J. C., McCarthy, K. S. & Keefe, J. R. 9, 36n.3 Basch, M. F. 56n.2, 113, 116, 141n.1, 168 Bass, A. 184 Bateman, A., & Fonagy, P. 36n.3 Beck, A. T. 172, 204 Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. 172, 211 Beebe, B. 81, 89, 90n.7 Beebe, B., & Lachmann, F. M. 81, 83, 84, 86, 114, 115 Beebe, B., & Stern, D. 81

Beebe, B., Knoblauch, S., Rustin, J. & Sorter, D. 81 Bell, D. 123 Benjamin, J. 31, 98, 189 Bentham, J. 12, 21, 142, 143, 144, 145–6, 147, 148, 149–50, 151–2, 153, 154, 155–6 Bergmann, M. S. 170 Berman, E. 158 Bernfeld, S. 74 Bernstein, R. 110 Beutler, L. E. 209 Beutler, L. E., & Clarkin, J. 209 Bick, E. 31, 76–8, 79, 80, 90, 122 Bilski-Piotrowski, M. 175 Bion, W. R. 2, 4, 12, 14, 15, 16, 19, 20, 22, 23, 24, 25, 27, 31, 32, 43, 44, 58, 59, 73, 75, 78, 80, 86, 87, 88, 89, 90n.6, 92, 93, 108, 111, 112, 114, 122, 123, 128, 129, 130, 131, 134–8, 139, 141n.4, 167, 179, 187, 196, 214 Blass, R. B. 57, 124, 158 Blass, R. B., & Carmeli, Z. 36n.4 Bloom, H. 159, 160–1 Bodnar, S. 105 Bohart, A. C. 167, 171 Boneau, C. A. 34 Bornstein, R. F. 3–4, 56, 58, 175 Bornstein, R. F., and Masling, J. M. 56n.2 Bowlby, J. 76, 80, 90n.4 Bowman, C. E., & Nevis, C. E. 207 Branch, M. N., & Malagodi, E. F. 35

Author Index  241

Brenner, C. 163, 164 Bromberg, P. M. 18–19, 31, 98, 101 Brown, L. J. 129 Bruner, J. 51 Bühler, C. 74 Burns, B., & Reyher, J. 56n.2 Busch, F. 17, 20, 30

Eisold, K. 30, 62 Eissler, K. R. 165 Elkana,Y. 2, 11, 19, 33, 38, 39, 40–1, 42, 185, 197 Elliott, A., & Spezzano, C. 180 Engels, F., & Marx, K. 156 Eysenck, H. J. 205

Castonguay, L. G., Schut, A. J., Alkens, D. E., Constantino, M. J., Laurenceau, J., Bologh, L., & Burns, D. D. 209 Cavell, M. 196, 197 Chaikilin, S. 180 Chessick, R.D. 54, 57, 213 Chiesa, M., & Fonagy, P. 36n.3 Chodorow, N. J. 192–4 Cocks, G. 170 Cohn, J. F., & Tronick, E. Z. 81 Collins, G. 175 Coltart, N. 8, 24 Cook, J. M., Biyanova, T., Elhai, J., Schnurr, P. P., & Coyne, J. C. 9 Curtis, R. C. 47 Cushman, P. 163, 169

Fayek, A. 213 Feldman, M. 102 Ferenczi, S. 57, 60–2, 63, 96, 98, 166, 167, 174 Ferro, A. 12, 20, 108, 114, 128–34, 135, 139 Ferro, A. & Donna, L. 129 Fonagy, P. 81, 89, 212 Fonagy, P., & Target, M. 31, 90n.4 Fonda, P. 9 Forman, R. K. C. 140 Frank, C. 205, 209 Frank, J. D. 208 Frank, J. D., & Frank, J. B. 209 Frank, K. A. 75 Franks, C. M. 205 French, T. M. 163 Freudental, G. 197 Freud, S. 3, 4, 5, 8, 12, 14, 19, 20, 21, 22, 23, 25, 27, 28, 30, 40, 42, 45, 47–8, 50, 55, 56, 57, 59, 60, 61, 63, 64, 65, 67, 68–9, 70, 72, 73, 74–5, 78, 79, 86, 87, 88, 90n.1, 90n.2, 92, 93, 94, 95–6, 101, 105, 109, 111, 117, 120, 126–7, 129, 134, 140, 142–57, 158, 162–3, 164, 165, 172, 173–4, 178n.1, 182, 186, 187, 191, 196, 204, 205, 214 Friedman, R. J., & Natterson, J. M. 103

Davanloo, H. 172, 174, 175 Davies, J. M. 94, 102 Davies, J. M. and Frawley, M. G. 188 De Groot, J. M., & Rodin, G. 24 De Maat, S., de Jonge, F., de Kraker, R., Leichsenring, F., Abbass, A., Luyten, P., Barber, J.,Van, R., & Dekker, J. 9 De Salvarezza, R. R. 9 DiAmbrosio, E. P. 102 Dimen, M. 109 Dinwiddy, B. 145 Domenjó, B. A. 143 Donner, W. 146, 150 Douglas, M. 195 Dreifus, C. 45–6 Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. 209 Eagle, M. 197 Eagle, M. N. and Wolitzky, D. L. 19, 49 Edelson, M. 19 Edwards, D., & Arntz, A. 204 Eigen, M. 5, 12, 24, 25, 108, 114, 129, 134–9, 140 Eigen, M., & Govrin, A. 134

Gabe, S. 163 Gadot, S. 58 Gardner, H. 36 Garfield, S. L. 209 Gay, P. 47, 143 Ghent, E. 98, 188 Gill, M. M. 30, 92, 94 Giovacchini, P. L. 164, 170 Glover, E. 64, 67, 67–8, 71, 175 Glucksman, M. L. 162 Goldberg, A. 20, 113, 115, 141n.1, 158 Goldfried, M. R. and Lazarus, A. A. 208 Govrin, A. 53, 113, 201 Green, A. 30, 36n.4, 86–9 Greenberg, J. 102, 109, 129

242  Author Index

Greenberg, J. R., & Mitchell, S. A. 79 Greenson, R. R. 163 Griffiths, J. 203 Guntrip, H. 15–16, 166 Gustafson, J. P. 172 Hacking, I. 144 Hale Jr., N. G. 56n.7, 160, 163 Hamilton,V. 113, 146–7 Hanly, C. 196, 197 Hartman, H. 74, 87, 117, 146, 163 Hazan,Y. 166 Heimann, P. 22, 31, 64 Heimann, P., & Isaacs, S. 64 Hendrick, I. 87 Hersoug, A. G., Ulberg, E., & Høglend, P. 36n.3 Hildebrand, H. P. 176 Hinshelwood, R. D. 20, 36n.2, 42, 56n.1, 56n.4, 112, 122, 123, 183 Hirsch, I. 102 Hoffman, I. Z. 44, 53, 94, 98, 99–101, 179, 181, 184, 189, 191, 195, 196 Hug-Hellmuth, H. 74 Hunter,V. 116 Hutcheon, L. 139 Isaacs, S. 64, 67–8, 71, 72, 74 Ivey, G. 102 Jacob, F. 33 Jekels, L. 90n.1 Johansen, P. Ø., Krebs, T. S., Svartberg, M., Stiles, T. C., & Holen, A. 175 Jones, E. 48, 60, 143, 144, 145, 146, 151, 173 Joseph, B. 12, 90n.7, 108, 114, 122–6, 127–8, 129, 130, 131, 135, 139, 141n.4 Jung, C. 20, 57, 63, 117, 136, 143, 205 Kächele, H., Schachter, J., & Thomä, H. 27 Kahn, E. 167 Kahn, E., & Rachman, A. W. 167, 168, 169 Kallestad, H.,Valen, J., McCullough, L., Svartberg, M., Høglend, P., & Stiles, T. C. 175 Kandel, E. R. 45, 213, 214 Katz, D. A., Kaplan, M., & Stromberg, S. E. 54, 56n.6, 58 Kernberg, O. 4, 79, 117, 118, 169, 170, 184, 187

King, P. 64, 66 King, P., & Steiner, R. 64, 65–6, 69, 70, 71, 72, 74 Kirby, A. 139 Kirman, J. H. 61, 91, 92 Kirsner, D. 113, 184 Klein, Melanie 2, 4, 5, 6, 12, 14, 19, 20, 21, 23, 24, 25, 27, 31, 32, 36n.3, 43, 44, 57, 58, 59, 60–1, 62, 63–75, 80, 86, 88–9, 92, 97, 108, 109, 111, 112, 122–8, 129, 131, 135, 163, 167, 179, 187, 188, 196, 206, 214 Knight, R. P. 163 Kohut, H. 4, 12, 19, 20, 22, 23, 24, 27, 31, 43, 55, 57, 59, 60, 73, 75, 79, 99, 108, 112–13, 114, 115, 116–18, 121, 158, 159, 161–71, 172–3, 175, 176, 183, 187, 196, 214 Kolakowski, L. 180 Kramer, R. 178n.2 Krasner, L., & Ullman, L. P. 205 Kubie, L. S. 87, 163 Kuhn, T. S. 2, 19, 32, 40, 159, 195, 205, 210 Lakatos, I. 2, 19, 32, 40 Lander, J. 163 Laplanche, J. 197 Laplanche, J., and Pontalis, J-B. 183 Lasch, C. 169 Laudan, L., Donovan, A., Laudan, R., Barker, P., Brown, H., Leplin, J., Thagard, P., & Wykstra, S. 36n.6 Laudan, L. 186 Lazarus, A. A. 208, 209 Lear, J. 24, 25, 53 Leichsenring, F., Klein, S., & Salzer, S. 36n.3 Lemma, A., Target, M., & Fonagy, P. 172, 175 Leuzinger-Bohleber et al. 36n.2 Levenkron, H. 83, 85 Lev, G. 28, 139, 140 Levine, H., & Friedman, R. J. 102 Levy, R. A., Ablon, J. S. & Kächele, H. 9 Loewald, H. 24, 25, 31, 96, 157, 164 Luborsky, L. 36n.2, 172 Luyten, P. 16 Mahler, M., Pine, F., & Bergman, M. 78 Mahler, M. S. 4, 55, 73, 78, 79–80, 174, 188 Maki, U. 186 Malan, D. H. 172, 174, 175

Author Index  243

Mann, J. 172, 174, 205 Mann, J., & Goldman, R. 172 Maroda, K. 101 Masson, J. M. 1 Mayes, L. C. 81, 84, 89, 90n.7 Mayes, L. C., & Spence, D. P. 191 McWilliams, N. 47 Meizenthal, R. R., & Mokyr, J. 202 Menaker, E. 165 Mendelsohn, E. 160, 161 Menninger, K. 36n.2, 174 Messer, S. B. 208, 209 Michael, J. 35 Migone, P. 176 Miller, G. A. 34, 36 Miller, J. P. 30 Mill, J. S, 12, 21, 142, 143, 144–6, 147, 148, 149–50, 151, 152, 153, 154, 155–6 Mills, J. P. 32, 41, 97, 99, 109 Mischel, W. 49 Mitchell, S. A. 29, 57, 90n.4, 92–4, 98, 99, 110, 117, 167, 172, 179, 181, 188, 192, 193, 196 Molino, A. 25 Molnar, M. 143 Moses, I. 164 Nahum, J. P. 82, 83, 85 Norcross, J. C., & Goldfried, M. R. 208 Nunberg, H., & Federn, E. 75 O’Donohue, W. T. 205 O’Donohue W. T., Callaghan, G. M. & Ruckstuhl, L. E. 37n.9 Ogden, T. 24, 25, 31, 112, 123 Olden, C. 163 Orange, D. M. 110, 113, 116 Ornston, D. G. 144 Overskeid, G. 37n.9 Paskauskas, R. A. 146 Payne, S. 67, 69, 70 Peirce, C. S. 50, 110 Pepper, S. C. 14 Perkins, K A., & Reyher, J. 56n.2 Perls, F. S., Hefferline, R. F., & Goodman, P. 206 Phillips, A. 29, 135 Pigman, G. W. 162, 178n.1

Pine, F. 78, 79 Pinker, S. 34 Polkinghorne, D. E. 180 Popper, K. R. 3, 58 Post, S. L. 163 Priel, B. 161 Procci, W. 10 Proner, K. 90 Rachman, A. W. 166 Racker, H. 96, 97, 98 Rangell, L. 30, 159, 161, 172 Reik, T. 173 Renik, O. 92, 101 Reyher, J. 28, 56n.2 Reyher, J., & Basch, J. A. 56n.2 Reyher, J., & Smyth, L. D. 56n.2 Ricaud, M. M. 143 Richards, A. D. 62 Richardson, P., Renlund, C. & Kächele, H. 36n.3 Ricoeur, P. 143, 181 Robertson, R. 143 Robins, R. W., Gosling, S. D., & Craik, K. H. 175 Robles, U. R. 62 Roediger, H. L. 37n.9 Rogers, C. R. 12, 20, 166–9, 170, 171, 173, 178n.2, 204 Rogers, C. R., and Sanford, R. 168 Roll, E. 203 Rorty, R. 8, 181–2, 196 Rosenblum, S. 54 Roth, A., Fonagy, P., Parry, G., & Target, M. 36n.3 Rustin, J. 84 Rustin, M. 78, 84–5 Ryle, A. 209 Ryle, G. 185 Safran, J. D. 42, 44, 209 Safran, J. D., & Messer, S. B. 176, 200, 208 Sampson, E. E. 176 Sander, J., Sander, A., & Davies, R. 87 Sander, L. W. 80–1, 89, 90 Sass, L. A., and Woolfolk, R. L. 191 Schacht, R. 155, 156 Schafer, R. 28–9, 92, 94, 97, 117, 163 Schlösser, A. 9 Scholem, G. 112

244  Author Index

Schur, M. 143, 148 Schwaber, E. 166, 168 Schwartz, L. 165 Segal, H. 18, 19, 20, 31, 112, 123, 124, 127, 206 Seligman, S. 81, 86 Shahar, G. 28, 47 Shakow, D., & Rapaport, D. 47 Shane, M., & Shane, E. 108, 115, 116, 166 Shapiro, T. 22–3, 162, 163, 164 Shaughnessy, P. 178n.1 Shedler, J. 9 Shulman, D. G. 56n.2 Shulman, D. G., & Ferguson, G. R. 56n.2 Shweder, R. A. 11 Sifneos, P. E. 172, 174, 175 Silverman, L. H. 28, 56n.2 Sirote, A. 102, 103 Skinner, B. F. 33–5, 36, 37n.7, 205 Smith, J. H. 148, 157n.1 Smyth, L. D. 56n.2 Sommerschield, M., and Reyher, J. 56n.2 Sorenson, R. L. 113, 201 Spence, D. P. 29, 49, 50, 94, 97, 190–2 Spezzano, C. 57, 94, 179, 181, 195 Spillius, E. B. 102, 122, 127 Steiner, R. 48, 60, 74, 75 Stein, M. H. 164, 172, 191 Stein, R. 164 Stekel, W. and London, L. S. 171 Stepansky, P. E. 15, 213 Stern, D. B. 99, 131, 188 Stern, D. N. 73, 79–80, 81, 82, 86, 87, 88, 89, 90n.7 Stewart, D. A. 163 Stolorow, R. D. 12, 91, 108, 113, 114–20, 121, 139, 141n.1, 166, 167, 196 Stolorow, R. D., & Atwood, G. E. 91, 117, 118 Stolorow, Atwood, G. E., & Brandchaft, B. 119 Stone, C. 140 Strenger, C. 25, 29, 90n.2, 213, 214 Stricker, G. 208, 211 Stricker, G., & Gold, J. R. 209 Strozier, C. B. 165, 166

Strupp, H. H. 53, 172 Sulloway, F. J. 143, 149 Summers, F. 62, 158 Symington, N. 19, 24, 25 Tauber, A. I. 8 Teicholz, J. G. 113 Thagard, P. 32–3 Thomä, H., & Kächele, H. 13n.1 Tobin, S. A. 167, 171 Tracy, J. L., Robins, R. W., & Gosling, S. D. 34 Trevarthen, C. 81, 82, 90n.7 Tronick, E. Z. 81, 82, 90n.7 Tuttman, S. 165 Valen, J., Ryum, T., Svartberg, M., Stiles, T. C., & McCullough, L. 175 Wachtel, P. L. 200, 201, 204, 208, 209, 211 Wallerstein, R. S. 30, 36n.2, 49, 163 Wallerstein, R. S., & Sampson, H. 49 Wallon, H. 74 Watrin, J. P., & Darwich, R. 33, 34, 35, 37n.9 Watson, A. 143 Westen, D. 28, 56n.5, 131 Westen, D., Klepser, J., Ruffins, S. A., Silverman, M., Lifton, N., & Boekamp, J. 28 Winnicott, D. A. 2, 4, 6, 14, 17, 19, 20, 21, 22, 23, 24, 25, 27, 31, 43, 52, 53, 55, 59, 74, 75–6, 87, 88, 89, 90n.8, 99, 111, 112, 134, 137, 166–7, 179, 185, 186, 187, 195, 196, 214 Winokur, M., Messer, S. B., & Schacht, T. 175 Wolf, E. S. 17, 88, 116, 141n.1 Wolfe, T. 169 Wolpe, J. 205 Wolpe, J., and Lazarus, A. A. 211 Yankelovich, D. 28 Zerbe, K. J. 30 Zilcha-Mano, S., & Barber, J. P. 36n.3

SUBJECT INDEX

aesthetic appeal, and interpretation 190 Aguayo, J. 125–6 alpha elements 131, 133 Amati-Mehler et al. 161 American Psychoanalytic Association 169 analogy, as source of knowledge 39 Analysis of the Self,The 165, 166 analyst/patient transactions, deep level/ surface level 85 analysts, fascinated/troubled 25, 32, 52–3, 93–4 see also therapists analytic situation, myth of 97 anti-mentalism 34 anxiety of influence 160–1 Aron, Lew 96, 97, 98, 103, 105, 188 arts, and psychoanalysis 10 assimilative integration 208 assumptions, psychoanalytical 58 attachment, infants to their mothers 76 attachment patterns, secure/avoidant/ ambivalent 86 Atwood, George 116, 117 authority: of Sigmund Freud 69; as a source of knowledge 42 autistic-contiguous (AC) position 112 autistic phase, of infants 79–80 Baranger, William and Madeleine 129, 130–1 Basch, M. F. 116

Bass, A. 184 Beck, Aaron 172, 204 Beebe, B. and Lachmann, F. M. 81, 83, 84, 86 Beebe, B. and Stern, D. 81 behavioral observations, of children 70 behaviorism 33–6, 37n.7 behaviorist theory 205 behavior therapists 209 behavior therapy, and psychoanalytic therapy 176 Behavior Therapy and the Neuroses 205 beliefs: of fascinated communities 22; fixation of 50; in the success of psychodynamic therapy 53–4 Benjamin, J. 189 Bentham, Jeremy 142, 143, 144–6, 147, 148, 149–50, 151, 153, 155 beta elements 132, 133 Beyond the Pleasure Principle 147, 148, 156 Bick, Esther 76–8 big theory, estrangement from 26 Bionian community: Antonino Ferro 128–34; Michael Eigen 128–9, 134–40 Bionian Field Theory (BFT) 130 Bion, Wilfred: admiration of 19; firm/soft components of his theory 111; and infant observations 78; influence on Antonino Ferro 131; influence on Michael Eigen

246  Subject Index

134, 136, 137, 139; “O” 112; political/ organizational skills of 128–9; and selected fact 16; and use of theories 32 Bi-Personal Field,The 131 Blass, R. B. 124 Blatt, Sidney 28 Bloom, Harold 8, 160–1 Boneau, C. A. 34 books, and psychoanalysis 10 Bornstein, Robert F. 3–4 Boston Change Process Study Group (BCPSG) 81–2, 83, 85 Bowlby, John 76, 90n.4 Brenner, Charles 164 brief dynamic therapy 175 British Institute of Psychoanalysis 64, 66 British Object Relations School 15 British Psychoanalytic Society 64, 123 Bromberg, Philip 18–19 Brown, Lawrence J. 129 Bruner, J. 51 Bühler, Charlotte 74 Busch, Fred 17, 20, 30 caring, and empathy 171 Case Studies in Behavior Modification 205 causal mentalism 34 change: and fascinated communities 177; and insight 163; and the Kleinian community 122–3; and psychoanalytic communities 107, 108; and psychoanalytic theories 111; resistance to/benefits of 159; theory 177–8; and well-defined theories 112–13 Chessick, Richard 54, 213 children: analysis of 66; autistic phase of infants 79–80; behavioral observations of 70; fantasies in infants 71; infant observations 76–8, 84–5, 89; infant research 70, 73, 74–5, 80–9; observation of 74–5; theories of infancy 73–6 children’s playtime, and free association of adults 66 Chodorow, Nancy 192, 193–4 choices, made by therapists 100 cinematography, and psychoanalysis 10 Civilization and Its Discontents 147 classical therapists, and relational therapists 104 client-centered therapy 166

clinical findings, erroneous interpretations of 71 clinical objectives, of psychoanalytical theories 17–19 clinical relations, new theory of 97 clinical situations, as source of knowledge 47–9 Coburn, William 114 cognitive behavioural therapy (CBT) 211 cognitive movement, and behaviourism 34–6 cognitive revolution 36 cognitive therapy 172 common factor approach 208 common sense 146 communication see also language: nonverbal techniques 85; of patients 131 complex systems, therapy as 84 Conditioning Techniques in Clinical Practice and Research 205 conflict 152–3 connection, patient and therapist 17–18 consent, of patients 127 conservatism, pluralism of and fascinated communities 23–4 conservative approach, in psychological behaviorism 35 constancy principle 147, 150–2 constructivism 99–101 contact-shunning personality 17 Contact With the Depth 137 controversies: Anna Freud and Melanie Klein 63–73; and psychoanalysis 57–9 correspondence theory of truth 110, 182 countertransference 95, 99, 101, 125 Cranmer, Phebe 28 creative thinkers 21–2, 181 creativity 134 crises, contemporary in psychoanalysis 40, 213 Crisis in Psychoanalysis:The Search for a Lost Doctrine,The 213 criticisms, of fascinated communities 3–4, 59, 200–1 cultural and historical contexts, and psychoanalysis 93 cultural changes 25, 28, 97, 98 cultural environment, and images of knowledge 98 culturally troubled communities 42, 43

Subject Index  247

Davanloo, H. 174, 175 Davies, J. M. and Frawley, M. G. 188 Davies, Jody 94 deep level/surface level, analyst/patient transactions 85 Defense Mechanisms Manual (DMM) 28 development: emotional 17; role of in therapy 189; and transference 190–4 developmental theories 73–6, 191, 192 developmental trauma 120 development of self, and infant’s experience 85 dialectical constructivism 99–101, 189 see also intersubjective approach; two-person psychology dialectic, between fascinated and troubled communities 108–9 Dimen, M. 109 direct observation 74, 75, 76 direct remembrance 126 discourse, psychoanalytic 28, 62 disruption and repair 81 dissociation 18–19 DNA, structure of 33 dogmatism, institutionalized 197 Douglas, Mary 195 dreams: and psychoanalytic knowledge 48; and Wilfred Bion 131 Dreifus, Claudia 45 drive model 79, 187 DSM 16 dyadic model 83 Dynamic Interpersonal Therapy (DIT) 175 dynamic unconscious 118–19 Eagle, M. N. and Wolitzky, D. L. 49 “Economic Problem of Masochism, The” 150 Ecstasy 137 education, psychoanalytic 184 effectiveness: of psychoanalytic and psychodynamic therapy 9; of psychoanalytic therapeutic methods 28 “Ego Distortion in Terms of True and False Self ” 75 ego drives, and sexual drives 152–3 ego psychology 163–4 Eigen, Michael 5, 128–9, 134–40 Eisold, K. 30, 62 Eissler, Kurt 165

Ekbery, George 19 Elkana,Yehuda 33, 38, 39, 40, 41, 42, 185 Elliott, A. and Spezzano, C. 180 emotional development 17 “Emotional Life and Ego Development of the Infant with Special Reference to the Depressive Position, The” 64 Emotional Storm 137, 138 emotional trauma 120 emotions, and scientific work 32 empathic validation 162 empathy 27, 121–2, 133, 159, 161–71, 178n.1 empirical problems, solving new 186–9 empirical research 42, 46, 48, 50, 53, 56n.5 empirical validation, of new theories 198–9 empiricism: and Donald Spence 191–2; and Sigmund Freud 47, 48, 50 enactments 102, 103 epistemology, and fascinated communities 23 epistemology of psychoanalysis 52 Epstein, Mark 140 evidence-based psychotherapies, and mental health clinics 175 evidence-based research 42, 47 Examination of Sir William Hamilton’s Philosophy, An 146 excessive agreeableness 127 Excitement and Growth in the Human Personality 206 expansionists 116 Experiments in Behavior Therapy 205 Eysenck, Hans 205 facts: and Anna Freud and Melanie Klein 63–73; and philosophy 188; selected 16 failures, therapeutic 54–5 fantasies, in infants 71 fascinated analysts 25, 32, 52–3, 93–4 fascinated communities 14–15; beliefs of 22; and change 177; criticisms of 3–4, 59, 200–1; defined 2; and development of psychotherapy 203, 212; diminishing influence of 212; and images of knowledge 41–3, 110–11; and integration 210, 211; main characteristics of 20–5; and non-psychoanalytic knowledge 49–50, 55; and other

248  Subject Index

communities 58, 59; present day 25–6; and relational approach 91, 108–9; in science 32–3; and Stephen Mitchell 92–4; and troubled communities 29–31, 62, 63, 108–9; and world-views 25, 26, 94 fascination, as a social phenomenon 58–9 fascination-captivation-enchantment 59 Fayek, Ahmed 213 fear of obsolescence 171–2, 174 Fechner, Gustav Theodor 143, 147 Ferenczi, S. 60, 61, 63, 98, 166 Ferro, Antonino 128–34 Feuerbach, Ludwig 156 First Principle Theorem 151 Fixation of Belief,The 50 Flechsig, Paul 74 Forman, R. K. C. 140 “Formulations on the Two Principles of Mental Functioning” 146, 154 Franks, Cyril M. 205 free association of adults, and children’s playtime 66 Freud, Anna 60, 63–73, 165 Freudental, G. 197 Freudian structural theory 20 Freud-Klein Controversies 1941–1945,The 64 Freud, Sigmund: approach to empiricism 47, 48, 50; authority of 69; and Bentham and Mill 144–6, 147, 148; and the correspondence theory of truth 182; and dreams 48; and empathy 162, 178n.1; firm/soft components of his theory 111; and happiness 148; importance of 8; and infant research 74; and interpretation/ achievement of insight 162; and irrationality and hallucination 153–5; and observation of children 74–5; and philosophy 143; pleasure principle 21; and quality of pleasure 149–51; and the relationists 105; and religion 140; and science 63; short term treatments of 173; and transference/countertransference 95, 96, 126; and truths 182; and utilitarianism 21, 142–3, 148–9, 151, 154, 155–7; veracity of his theories 70; and William Hamilton 146–8; and world-views 14 Freud’s Last Session 10 Friedlander, Kate 69, 72 Fromm, Erich 96 frozen face experiment 82

fundamentalism, need to avoid 198 Future of Psychoanalysis,The 213 Gadot, S. 58 Gestalt Therapy 206–7 Ghent, E. 188 Giovacchini, P. L. 164, 170 Glover, E. 67–8, 71 God, and psychoanalysis 136–7 Goldberg, Arnold 115 Goldfried, M. R. and Lazarus, A. A. 208 Gomperz, Theodor 144 Goodman, Paul 206 Govrin, A. 201 Green, Andre 86–9 Greenberg, Jay 109 Greenberg, J. R. and Mitchell, S. A. 79 Guntrip, Harry 15–16 Hacking, I. 144 hallucination 153–5 Halpern, Jay 28 Hamilton,Victoria 113 Hamilton, William 146–8 Hanly, C. 196 happiness: maximizing 150; and pleasure principle 148; and utility 145, 154 hedonic calculus 155 heightened affective moments 83 Heimann, Paula 22, 64 here-and-now 192 hermeneutics: modern and cultural changes 97; and psychoanalysis 29, 190, 191, 192 Hinshelwood, R. D. 42, 112 historical and cultural contexts, and psychoanalysis 93 historical truths 190, 191 Hoffman, Irwin 99–101, 189 How Does Analysis Cure? 163, 173 humanistic psychology 169, 171 humanistic psychotherapy 168 human mind, understanding of 8 human psyche, theories of 185 Hutcheon, Linda 139 ICD-10 15 ideas: new 177–8, 204; well-defined 112–13 image of psychoanalysis 65–6 images of knowledge 38–9; and Anna Freud and Melanie Klein 63–73; and

Subject Index  249

fascinated/troubled communities 41–3, 110–11; gap in 55–6; and infant research 87; new 98; postmodern 181; in psychoanalysis 40–1, 74, 123; in psychoanalytic communities 44–9; and the relational approach 91, 96–7, 99–101 impasses in psychoanalysis 54–5 “Impending Death of Psychoanalysis, The” 3 implementers 202, 206–7 implicit knowledge 82, 83, 85 Improving Access to Psychological Therapies (IAPT) program 175 incorporation, process of 177 independent analysts, of psychoanalysis 24–5 Industrial Revolution 202–3 inertia, principle of 151 infancy, theories of 73–6 infant-mother observations 76–80, 90n.6 Infant Observation: International Journal of Infant Observation and Its Applications 90n.6 infant observations 74, 76–8, 84–5, 89 infant research 70, 73, 74–5, 80–9 infants: autistic phase of 79–80; fantasies in 71 inferred knowledge 71 Influence and Autonomy in Psychoanalysis 188 influence, anxiety of 160–1 innovations 122, 202–3 insight, and change 163 institutionalized dogmatism 197 institutionalized pluralism 198 institutionalized psychoanalysis 184 integration: and fascinated communities 210, 211; and inventors, tweakers, implementers 207–10; of new ideas 177–8, 204 integration movement 200, 211 internalized pluralism 197–8 internal working models 76 International Journal of Psychoanalytic Self Psychology 114 International Psychoanalytical Association 60, 169 interpersonal theory 96 interpretation, and aesthetic appeal 190 Interpretation of Dreams,The 47, 48, 152 interpretations, process of 129–30 intersubjective approach, and self-psychology 116–18, 121 see also

dialectical constructivism; two-person psychology “Intersubjective View of Self Psychology, An” 117 Introduction to the Principles of Morals and Legislation, An 145 Introduction to the Work of Melanie Klein 206 Introductory Lectures on Psychoanalysis 152 invention, in psychotherapy 204 inventors 202, 207 irrationality 153–5 Isaacs, Susan 64, 67–8, 72 isolated mind world-view 117 Jones, Ernest 48, 60, 145, 146, 151 Joseph, Betty 122–8 Journal of Experimental Analysis of Behavior (JEAB) 35 Kabalistic orientation, of Michael Eigan 139 Kabbalistic/mystical foundations, and psychoanalysis 136 Kächele et al. 27 Kahn, E. and Rachman, A. W. 167, 169 Kandel, Eric 45, 213 Kavka, Jerome 165 Kernberg, Otto 169, 184 King, P. and Steiner, R. 64, 65–6 Kirby, A. 139 Kirsner, D. 184 Kleinian approach 5–6 Kleinian community: animosity towards 113; Betty Joseph 122–8; cohesion of 108; demands for fidelity 123, 124; fidelity to Klein’s ideas 122; innovations and the 122–3; world-view of 21 Kleinian therapy, limitations of 126–7 Kleinian thinking and practice 122 Klein, Melanie: and Anna Freud 63–73; and Betty Joseph 124–5; clarity of ideas of 112; and Hannah Segal 206; and infant observation 74; and mood of the time 60–1; and non-psychoanalytical sources 69–71; and Sigmund Freud 67–9; theory of 61, 64–5, 111; work of 27 Knight, Robert 163 knowledge: clinical situations as source of 47–9; fascinated analyst’s perception of 93–4; images of see

250  Subject Index

images of knowledge; implicit 82, 83, 85; inferred 71; legitimization of 41; non-psychoanalytical 49–50, 52, 55; overt 82; and positivism 180, 181; and postmodernism 180–1, 196; psychoanalytic and non-analytic communities 55; sources of 39–40, 41–2, 63–73; theory of 38 knowledge base, for psychoanalysis 58 Kohut, Heinz: development of his thinking 114; and empathy 27, 161–71; epistemology of 112–13; and objective truth 117; pluralism of 115; and Sigmund Freud/classical psychoanalysis 173; and STDP 176; theory of 60; three transferences of 116; and the unconscious 118 Krasner, L. and Ullmann, L. P. 205 Kuhn, T. S. 159, 210 Lacan, Jacques 74 language see also communication; vocabulary: contingencies of 182; distorting nature of 190; and psychoanalysis 135–6; psychoanalytic 185–6 Lasch, Christopher 169 Laudan, Larry 186 leadership, of psychoanalytic schools 60 Lear, Jonathan 53 Lev, Gideon 28 139, 140 listening, to patients 168 loyalty, and fascinated communities 20 Lustprinzip 144 Mahler, Margaret 78–80, 174 Malan, D. H. 174, 175 Mammon 10 Mann, James 174, 205 Marx, Karl 156 Mason, Albert 122 Mayes, Linda 84 meaning, as a product of a meeting of minds 96 Meehl, Paul 49 Meeting of Minds: Mutuality in Psychoanalysis, A 188 Meisenzahl, Ralf and Mokyr, Joel 202 memory, procedural 82 Menninger, K. 174 mental development, theory of 64

mental disorders, classifying the structure of 15 mental growth 17 mental health clinics, and evidence-based psychotherapies 175 mentalism, in behavioral psychology 35 mental reality 48 Messer, S. B. 208 Middlemore, Merrell 74 Mill, John Stuart 142, 143, 144–6, 147, 148, 149–50, 151, 153, 155 Mills, John 99 Minimal Self,The 169 mirror-hungry personality 17 Mischel, W. 49 Mitchell, Stephen 92–4, 117, 188, 192, 193 modern hermeneutics, and cultural changes 97 Molino, Anthony 25 monism, and development of psychotherapy 201 Moses, I. 164 mother-infant interaction 81, 82, 85 mutuality, in the psychoanalytic relationship 94, 109 mystical experiences, and Michael Eigen 137 Nahum, Jeremy 82, 83, 85 narcissism 169 Narrative of a Child Analysis 125 narratives, power of psychoanalytical 50–5 narrative truth 190, 191, 192 Narrative Truth and Historical Truth 190 National Council of Self-Psychology 166 “Nature and Function of Phantasy, The” 64 negative therapeutic reaction (N.T.R) 5 neoliberalism, and cultural changes 25 neurosis 154, 155 Nietzsche, Friedrich W. 156 non-analytic communities, and psychoanalytic knowledge 55 non-analytic influences, fascinated communities 20–1 non-analytic psychotherapeutic counselling 169 non-interpretive psychotherapeutic counselling 169 non-psychoanalytical knowledge 49–50, 52, 55

Subject Index  251

nonverbal techniques, communication 85 now moments 83 O 112, 129, 136 object relations approach, and countertransference 95 object relations theory 90n.6 observations: of children and Sigmund Freud 74–5; direct 74, 75, 76; infant-mother 76–80, 90n.6; of infants 76–8, 84–5, 89 obsolescence, fear of 171–2, 174 Ogden, T. 112 old classical technique 20 On Aphasia 147 one-person psychology 22–3, 110–11, 118 opposition: and threat of new ideas 177; to tweakers 205 Orange, Donna 116 order, in clinical phenomena 16–17 Ornstein, Paul 114 outcome studies 54 overarching narratives 51 overt knowledge 82 parent-child system 120 Passionate Scientist: Emotion in Scientific Cognition,The 32 past and present 189 past events, and therapy 192–3 past-to-present transference interpretations, Kleinian therapy 125 pathological behavior 154 patient-analyst system 120 patients: communication of 131; consent of 127; impact on therapist’s personal life 102–6; listening to 168 patient-therapist relations 95 Payne, Sylvia 67, 69, 70 Peirce, Charles 50 Pepper, Stephen C. 14 Perls, Laura 206 personalities, contact-shunning/ mirror-hungry 17 personality disorder, schizoid 15–16 person-centered psychotherapy 171 perspectivalism 110 Petzl, Otto 47 Phillips, Adam 29 philosophically-culturally troubled communities 28–9, 43, 139

philosophy: and facts 188; and relational analysts 189; and Sigmund Freud 143 Pigman, G. W. 162 Pinker, S. 34 pleasure and pain 145, 146–7, 148, 149 pleasure principle 21, 143, 144, 146–8, 151, 155, 156 pleasure, quality of 149–52 pleasures: higher/lower 149; and Sigmund Freud 152 pleasure-unpleasure principle 146, 148 pluralism, internalized/institutionalized 197–8 political imperatives, and phases in psychoanalysis 197 political power, British Institute of Psychoanalysis 66 Popper, Karl 3 positivism: and knowledge 180, 181; and postmodernism 195 postmodern analysts, and empirical problems 188–9 postmodernism: and cultural changes 98; and fascinated communities 25; harmful effects of 189; and knowledge 180–1, 196; and new theories 183–4; and positivism 195; in psychoanalysis 179; and truths 179, 180, 184; waning of 139 postmodernists: and new theories 188–9; and psychoanalysis 26 postmodern theory, and therapeutics 191 postmodern therapists 180 post-positivist philosophers, of science 32 prereflective unconscious 118, 119 principle of inertia 151 Procci, W. 10 procedural memory 82 process of incorporation 177 “Project for a Scientific Psychology” 150–1 Proner, Karen 90 projective identification 22, 95–6, 102 psyche, as a system 152 psychoanalysis: achievements of 8–10; contemporary crisis in 40, 213; criticisms of 1–4; double identity of 214; growth of 8–9; isolation from academic psychology 55–6; marginalization of 213–14; relevance of 9, 93; term 13n.1 Psychoanalysis at the Margins 213 psychoanalytical assumptions 58

252  Subject Index

psychoanalytical conceptualizations, infantmother observations confirming 76–80 psychoanalytical discourse 28, 62 psychoanalytical writings, dominance of the past in 31–2 psychoanalytic communities see also fascinated communities; troubled communities: and change 107, 108; character of 113; and images of knowledge 44–9; nature of 66; philosophically-culturally troubled community 28–9, 43, 139; reciprocity between fascinated and troubled 107; scientifically troubled communities 27–8, 41, 42, 43, 46, 55, 213, 214; selfpsychology community 21, 113, 114–22; socially troubled communities 42 psychoanalytic discourse, and cultural changes 28 Psychoanalytic Electronic Publishing Website (PEP) 31 psychoanalytic knowledge: and nonanalytic communities 55; and science 21, 22 psychoanalytic mind, development of 17 psychoanalytic narratives, power of 50–5 Psychoanalytic Quarterly 163 Psychoanalytic Review 165 psychoanalytic schools 15, 27, 60 see also schools of thought psychoanalytic theories: clinical objectives of 17–19; devotion to 59–63; and images of knowledge 44; modification of 108; and mood of the time 60; and research 46, 56n.5; success or failure of 62; thickness of 185 psychoanalytic therapy: and behavior therapy 176; scientific characteristic of 21 psychoanalytic training 7–8, 9 psychoanalytic truths 41, 65 psychodynamic psychotherapy 23–4, 30 psychology: ego 163–4; humanistic 169, 171; one-person psychology 22–3, 110–11, 118; psychoanalysis’s isolation from academic 55–6; two-person psychology 179 psychophysics 143 psychosis 154–5 psychotherapy: invention in 204; psychodynamic 23–4, 30

Psychotherapy by Reciprocal Inhibition 205 public, and psychoanalytic conceptions 55 quantity-quality problem 149–50 “Question of a Weltanschauung, The” 182 Racker, Heinrich 97, 98 radical behaviorism 34 radical postmodernism 184 Rage 137 realism: communitarian/intersubjective 110; and Kleinian theory 123 reality principle, and utilitarianism 146 relational analysts 111, 184, 189 relational approach: benefitting psychoanalysis 105; and cultural changes 98; and fascinated/troubled communities 91, 108–9; firm/soft components of 111; and images of knowledge 91, 96–7, 99–101; new conceptualizations of 57; and new perception of knowledge 96; as a philosophically-culturally troubled community 29; and psychoanalysis 103; rediscovering Ferenczi 61–2; and Stephen Mitchell 92; and truth 110, 181 relationalists, and Sigmund Freud 105 relational therapists 92–3, 94, 104, 180 relational tradition, and psychoanalysis 184 relationships: and infant’s experience 85; patient-therapist 95 relativist approaches 184 religiosity 140 religious world-view 140 “Remembering, Repeating and WorkingThrough” 126 repressed material, raising into awareness of 120 repression, and conflict 153 research: empirical 42, 46, 48, 50, 53, 56n.5; evidence-based 42, 47; infant 70, 73, 74–5, 80–9; and psychoanalytic theories 46, 56n.5; scientific research methods 47 Research in Behavior Modification 205 resistance, in psychoanalytic treatment 119, 127 Restoration of the Self,The 165 revelation, as source of knowledge 39 Reyher, Joseph 28 Richards, Arnold 62 Robles, Utrilla, 62

Subject Index  253

Rogers, Carl 166, 167–70, 173, 178n.2 Rogers, C. R. and Sanford, R. 168 Rorty, Richard 8, 181–2 Rosenzweig, Saul 47 Rustin, Margaret 78, 84–5 Ryle, G. 185 Safran, J. D. and Messer, S. B. 176 Sander, Louis 80–1 Sass, L. A. and Woolfolk, R. L. 191 satiation, and pleasure 151 Schacht, R. 155 Schafer, R. 29 schizoid personality disorder 15–16 Schmideberg, Melitta 68–9, 71 schools of thought see also psychoanalytic schools: competing 200; development of 203; and empirical problems 187; era of 181, 184; firm/soft components of 111; importance of 185–6; need for 194–5; new 212; and positivists/postmodernists 186 Schwaber, E. 168 science: fascinated/troubled communities in 32–3; and psychoanalysis 26, 45–6, 63, 87, 163, 191, 198, 214; and psychoanalytic knowledge 21, 22 science of intersubjectivity, psychoanalysis as 117 scientifically troubled communities 27–8, 41, 42, 43, 46, 55, 213, 214 scientific research methods 47 scientific theories 180 Segal, Hannah 18, 19, 112, 123, 124, 127, 206 self-delineating selfobject transference 119 self-disclosures, of therapists 101–6 self, in the 1960s/70s/80s 169 self-psychology: development of 108; and empathy 162, 171; and intersubjective approach 116–18, 121; and personality types 17; and psychoanalysis 167; rising interest in 166 self-psychology community 21, 113, 114–22 Seligman, S. 86 Sensitive Self,The 137 separation-individuation theory 78, 80 sexual drives, and ego drives 152–3 Shahar, Golan 28

Shane, M. and Shane, E. 115, 116 Shapiro, T. 22–3, 164 Shedler, J. 9 “Short Account of Psychoanalysis, A” 142 short-term dynamic therapy (STDP) 159, 172–6 short-term treatments 173–4 Shweder, R. A. 11 Sifneos, P. E. 174, 175 Silberstein, Eduard 144 Silverman, Lloyd 28 Simkin, James 206 Sirote, Alan 103 Skinnerian behaviorism 33–6, 37n.7 social environment, and images of knowledge 98 socially troubled communities 42 Society for the Exploration of Psychotherapy Integration (SEPI) 209 Society of Medical Psychoanalysts 176 “Some Aspects of the Role of Introjection and Projection in Early Development” 64 Sorenson, R. L. 201 sources of knowledge 39–40, 41–2, 63–73 Spence, Donald 49, 50, 190–2 Spezzano, C. 181 spirituality, and psychoanalysis 139, 140 spiritual nature, of Michael Eigan’s writing 137 Spitz, Rene 78, 165 Steiner, Riccardo 60, 74, 75 Stein, R. 164 Stekel, W. and London, L. S. 171 Stepansky, Paul 213 Stern, Daniel 79–80, 81, 88, 89, 188 Stolorow, Robert 114–22, 166, 167 Stone, C. 140 Strenger, Carlo 25, 29, 213 Strozier, Charles 165, 166 Strupp, Hans 53 subjectivity: in psychoanalysis 179; of therapists 100–1 suffering 138 Sullivan, Harry Stack 96 Summers, F. 158 surface level/deep level, analyst/patient transactions 85 Symington, Neville 19 systems theory 81

254  Subject Index

Tauber, Alfred 8 Tavistock Clinic 76, 78, 81 technical integration 208 Tel Aviv Institute of Contemporary Psychoanalysis (TAICP) 7 Thagard, Paul 32–3 theater, and psychoanalysis 10 theoretical trends, in psychoanalysis 31–2 theory(ies): competing 177; developmental 73–6, 191, 192; development of 161, 201; fascination with 15–16; firm and soft components of 111; of Heinz Kohut 60; idealization of 209; of infancy 73–6; and integration 208; Kleinian 61, 64–5, 111; of knowledge 38; of mental development 64; of mind 198; object relations theory 90n.6; scientific 180; separation-individuation theory 78, 80; study of 24; theory change 177–8; Theory of Groups 129; of thinking 129; transference theory 189; of Transformations 129; of transitional object 187 therapeutic failures 54–5 therapeutic process, and infant observation 84–5 therapeutic relationships 94–9, 102 therapeutics, and postmodern theory 191 therapists see also analysts: classical 104; influenced by their personal therapy 54; as a participant in the therapeutic process 100; personal non-involvement of 61; postmodern 180; relational 92–3, 94, 104, 108; self-disclosures of 101–6; single orientation 92; subjectivity of 100–1; troubled see troubled therapists therapy: aims of 138; as complex systems 84; empathetic 162; as experiencing the real 138; interpersonal 96; and past events 192–3 “Theses on Feuerbach” 156 thick descriptions 185, 189, 198 thin descriptions 185, 189 thinking: creative 21–2, 181; theory of 129; and thick descriptions 185; two-tier 41 threat, new ideas as 177 Three Essays on the Theory of Sexuality 74 training, psychoanalytic 7–8, 9

transference: and Betty Joseph 126; and childhood 194; and development 190–4; as a projection 96; and Sigmund Freud 95, 96, 126 transference repetition 5 transference theory 189 Transformations, theory of 129 transitional object, theory of 187 trauma, and Robert Stolorow 120 Triangle of Conflict/Triangle of Person 174 Tronick, E. Z. 82 troubled analysts 32 troubled communities: culturally troubled communities 42, 43; defined 2; and fascinated communities 29–31, 62, 63, 108–9; as future of psychoanalysis 212; and images of knowledge 41–3, 110–11; importance of 36, 214; philosophicallyculturally troubled communities 28–9, 43, 139; and relational approach 91, 108–9; in science 32–3; scientifically troubled communities 27–8, 41, 42, 43, 46, 55, 213, 214; socially troubled communities 42; types of 26–9 troubled therapists: Antonino Ferro 129–34; Betty Joseph 122–8; Michael Eigen 129, 134–40; Robert Stolorow 114–22 truths: actual 127; correspondence theory of 110, 182; deconstruction of 181; and Kleinian theory 123; narrative/historical 190, 191, 192; new perceptions of 97, 98; objective 94, 117; and postmodernism 179, 180, 184; pragmatic 26, 94; psychoanalytic 41, 65; and psychoanalytic concepts 110; and relational approach 110, 181; scientifically objective universal/pluralistic 25–6 TV series, and psychoanalysis 10 tweakers 202, 204–5, 207–10 Two Analyses of Mr. Z,The 173 two-person analysts 36n.1 two-person psychology 179 see also dialectical constructivism; intersubjective approach two-tier thinking 41 unconscious, intersubjective approach’s perception of 118–20 unpleasure principle 151

Subject Index  255

unvalidated unconscious 119 utilitarianism 145; and reality principle 146; and Sigmund Freud 21, 142–3, 148–9, 151, 154, 155–7 utility 145, 150, 152, 154 Vienna Psychoanalytic Society 75 visual pictograms 131 vocabulary, psychoanalytic 186 see also language Wachtel, Paul 200, 201, 208, 209 Watrin, J. P. and Darwich, R. 35 Watson, John B. 33 Westen, Drew 28, 56n.5 Winnicotian therapy, projective identification 22 Winnicott, Donald A.: and clinical infants 75, 76; and Heinz Kohut 166–7; and mothering 185; and a mother separated from her infant 74; theory of the transitional object 187; therapeutic

positions of 112; and transitional phenomena 195 Winnicottian community 21 Winokur et al. 175 Wolf, Ernst 116 Wolfe, Tom 169 Wolpe, James 205 “Working with Unwanted Patients” 134 World Health Organization, ICD-10 15 world-views: and fascinated communities 25, 26, 94; and integrationists 210; isolated mind 117; religious 140; of scientific researchers 46; shared and fascinated communities 21–2; and Sigmund Freud 14; and therapeutic techniques 207; Western philosophical and cultural 28 Yankelovitch, D. 28 Zero Principle 151