Abstract
As we celebrate APsaA’s centennial year, a group of analysts who root themselves in the Freudian tradition have given us a collection of papers that continues the spirit and rigor of the Controversial Discussions of the 1940s (see King and Steiner 1991). In an effort to articulate a contemporary Freudian perspective and possibly “a new Freudian synthesis,” each author was asked to explore and then to express how the work of the first and second generation of psychoanalytic theorists had shaped their thinking and practice. The contributions of Ferenczi, Winnicott, Loewald, and Kohut are considered foundational to this new synthesis. Not surprisingly, three questions quickly emerge as central. How can we integrate our understanding of the therapeutic impact of the relationship with the analyst in its many dimensions with our understanding of the roles of interpretation and insight? How do we integrate our understanding of the functioning of the dyad and of childhood trauma with our understanding of intrapsychic conflict? Can we integrate our understanding of narcissistic and self states and pathologies with our understanding of fantasy and unconscious conflict? As the discussion unfolds, a fourth question comes to mind. At what point is it useful to say that there has been a break with Freud’s ideas?
Andrew Druck begins with a focused and critical review of the evolution of conflict theory. His carefully and beautifully articulated critique establishes the theoretical context in which a contemporary Freudian perspective has been forged and so provides a setting for the clinical contributions. Loewald’s ideas are fundamental here. The clas-sical emphasis on drive, defense, and compromise formation is relatively silent as the emphasis shifts to internalization, integration, and the transformation of primitive mental states. The conflict model gives way to a “modern structural model” that takes account of the contribution of the level of development of structural capacities. Interpretation becomes a dyadic process whose primary function is to promote the development of new structural capacities that facilitate insight. The role of the relationship with the analyst broadens to include the growth and maintenance of psychic structure.
Druck offers the “modern structural model” as an umbrella that can encompass essential strands of new psychoanalytic theory and relate them to the defining concepts of traditional theory. He acknowledges that he wants to accomplish this by emphasizing similarities and deemphasizing differences. Leaning on Loewald’s efforts to bridge Freud’s ideas and object relations theory, he builds a bridge to developmental and intersubjective points of view. “There are always two processes simultaneously at work: the process of compromise formation (a dynamic process) and the process of structure building or maintenance (a structural process). These are two interwoven processes, highly determined by the patient-analyst relationship” (p. 12). Loewald’s parallel models (1960), which liken levels of psychic organization in interaction to the mother-child (analyst-patient) relationship, provided a theoretical matrix for ego psychology and object relations. The modern structural model provides such a matrix for diverse concepts such as ego and self and for diverse models of pathology such as conflict, deficit, and trauma. Also within this matrix, concepts that describe aspects of the analyst’s role (e.g., surrogate ego, selfobject, holding and containing functions) can be thought about in relation to one another. Druck describes the potential for synthesis masterfully.
The clinical papers that are the heart of the book illustrate the integration of new theory by working analysts. The analysts each chose a way to express what had shaped their work, a critical moment in an analysis, a particular aspect of the analytic situation, a contribution to theory. Space does not allow an adequate description of the ideas contained in these papers. I will offer a glimpse of a few.
Sheldon Bach makes states of consciousness his lens. He sees the analyst joining the emotional world of the patient by learning to enter into the patient’s flux of characteristic states of consciousness. These states are made up of patterns of affect, body schemata, and organizations of time, thought, and memory. If patient and analyst allow a sympathetic resonance, shared states of consciousness will occur. Each will exist in the mind of the other. Bach likens this to what happens between lovers or in a nursing couple. In these shared states, the analyst is able to participate in the patient’s inner world and to help organize and integrate the multiple worlds in which the patient lives. This special variety of intersubjectivity is critical in therapeutic action.
Marvin Hurvich hopes to add to the psychoanalytic formulation of anxiety as he investigates how anxieties and fantasies about annihilation, the “loss of the capacity to function or to exist” (p. 67), are related to trauma, unconscious fantasies, and aggression. This addition to Freud’s situations of danger offers a theoretical link between trauma and conflict.
Aaron Thaler continues the effort to accommodate traumatic experience in psychoanalytic theory. He movingly describes a time in the analysis of Ms. R when achievements in the analytic work allowed her to “breakdown” as she allowed herself to relive aspects of severe early trauma, thus paving the way for integration of these experiences and for recovery. As do many of the contributors, Thaler tries to work with the impact of unconscious memories and fantasies of experiences of trauma that leave annihilation anxieties as a residue and marker. Cycles of breakdown and recovery in the presence of an analyst able to experience the patient’s anxiety in manageable form allow for symbolization and integration as the analyst’s capacities are internalized. This is a trauma model reminiscent of early Freud as well as of Winnicott and Kohut, who are cited by Thaler, and of Loewald, who is not.
The reader is soon reminded how much the nature of the patients we see or the way we understand them influences how we think and what we do. The patients as described in these papers suffer predominantly from narcissistic problems. The clinical focus is on trauma in early object relations, particularly in the relationship with mother. These analysts are concerned with how to work with states—states of consciousness, self states, and narcissistic states. Bach notes that this takes us back to the early interests of Freud and Breuer in hypnoid states and splits in consciousness.
Clinical moments bring theory to life. Mary Libbey describes her work with Dev, a young man who said of his mother, “Let’s imagine . . . I was nothing” to her, and who said of himself, “I feel I am always in the gap between many feelings, between one or more selves, and there is a nothingness in that gap” (p. 141). He moved between states of extreme self-consciousness while with others and a more comfortable feeling of nothingness when alone. Libbey immersed herself in Dev’s experience, trying to find words for his feelings and images. Dev felt a “blast furnace of shame” as he tried to be with her. Libbey understood Dev’s shame as a transitional state that emerged as he allowed himself to move between narcissistic self states as they worked together. A transference-countertransference based in mutual identifications and mutual idealizations gradually allowed for the differentiation of shame into other feeling states and finally to a sense of an authentic self. “In hindsight,” Libbey writes, “I believe he was trying to keep me gratified, loved, alive, interested in him. In this sense, he needed me to feel, to hold and contain his alive feeling self, so he did not have to own it until he became able, at which time he could identify with me” (p. 140).
In the concluding chapter, Norbert Freedman raises two questions: “What is Freudian about these papers?” and “ In what way are they no longer Freudian in the original sense?” (p. 249). I would like to add the question that emerged for me: At what point is it useful to say that there has been a break with Freud’s ideas? The authors argue for the possibility of integrating new trends that focus on the developing self and the self in relationship, within a frame that keeps, as theoretically and technically central, both the relationship with the analyst and the analysis of unconscious conflict using interpretation and insight. The argument draws on Loewald’s efforts to bridge Freud’s ideas with a developmental and object-relational model. One advantage of attempting a synthesis is theoretical and technical continuity, but it is worth asking, “What might be lost?”
Druck helps us organize the differences between the classical and the contemporary perspectives presented. He asks how each conceptualizes what is wrong with the patient, what will then “cure” the patient, and what the optimal role for the analyst is in facilitating this mutative process (p. 2). In my view, the conceptualizations concerning the nature of the problem, the mode of therapeutic action, and the optimal role for the analyst in the contemporary Freudian synthesis represent a significant break from Freud’s ideas. The editors acknowledge this but think it helpful to emphasize the similarities. I would suggest that recognizing and articulating the differences and the discontinuities with Freud might help us to maintain theoretical coherence and conceptual clarity, as well as to improve our understanding of the implications of the ways we have departed from Freud’s ideas.
Freud envisioned a mind in conflict and defending against an awareness of primarily sexual wishes rooted in drives seen as the source of psychic energy. Although Freud offered his metapsychology as a series of provisional hypotheses (Freud 1900), in it transformations of energy and the development and vicissitudes of the sexual drive are fundamental. Repression is considered the cornerstone of theory, and the oedipal constellation is at the heart of what is wrong with the patient. Freud’s focus is intrapsychic. The conflicts and fantasies of concern are unconscious and essentially triadic. The setting in which the relationship with the analyst is understood is psychical reality.
The theoretical structure of the perspective presented here, as I understand it, is fundamentally different. The authors envision a mind in need of development and integration. Dissociated mental states are in the foreground of theory, and traumatic aspects of early object relations are at the heart of what is wrong with the patient. The focus is intersubjective and developmental. The affects and fantasies of concern are both conscious and unconscious and largely dyadic. The setting includes a participant analyst who is available for internalization. Sexuality, conflict, and compromise are not central to interpretation.
The “widening scope” of the patients we see and the new ways we have come to understand them have changed the domain of psychoanalytic knowledge. The question for me, then, is how we best ensure the epistemological integrity of our discipline as we learn. I would opt for differentiation, as well as integration, at this stage of our knowledge. In that spirit, I would have liked to see the title of this excellent collection of papers be Toward a New Psychoanalytic Synthesis.