Abstract
In Making Freud More Freudian, Arnold Rothstein demonstrates the clinical value of Charles Brenner’s theoretical contributions to psychoanalysis. For over fifty years, Brenner worked to make Freud more Freudian by clarifying and elaborating Freud’s fundamental concepts that have had enduring value. Ultimately, he discarded what he considered Freud’s misguided structural model of the mind, with its three agencies of id, ego, and superego.
Rothstein asserts that Brenner’s work might be seen as revolutionary in its rejection of the structural model, but it is evolutionary in the sense that he maintained the essential elements of Freudian theory. Perhaps Brenner’s most significant contribution was his elaboration of Freud’s concept of compromise formation, which originally referred to two psychic elements, a drive and a defense, resulting in a symptom. Brenner broadened the concept to include interacting drive derivatives, anxiety and/or depressive affect, defenses, and superego elements. Rothstein has elaborated Brenner’s insights about compromise formation and its clinical application in seven published papers. This book, divided into two parts, “Theoretical Considerations” and “Clinical Considerations,” is a compilation of these important articles.
The first chapter offers a valuable and concentrated review of the evolution of post-Freudian thought. Rothstein outlines the fundamental constructs of Freud’s evolving theory and then discusses three areas of Freud’s writings that are confusing and “anti-Freudian” in that they may be used “in the service of resistance to appreciating the ubiquitous and interminable influence of unconscious conflict on all human thought and activity” (p. x). These areas are Freud’s biological theories of motivation, the distinctions between the pleasure principle and the reality principle, and the concept of the repetition compulsion that is beyond the pleasure principle.
Rothstein hypothesizes that Freud’s need for a biological drive theory arose from his personal need to feel he was a physician and a scientist. Freud, he argues, resorted to experience-distant biological explanations to explain his therapeutic failures and to avoid considering the limits of his psychological understanding. In distinguishing between the pleasure principle and the reality principle, Freud believed that the human mind could make impartial judgments. This notion contradicts the idea that unconscious fantasy affects all perceptions and supports the illusion of objectivity and the idea that conflicts can be worked through and resolved. The more contemporary view, Rothstein explains, stresses the ubiquity of subjectivity and the interminable nature of conflict.
And finally, Freud’s conception of the repetition compulsion versus the pleasure principle, and the distinction between the traumatized mind and the conflicted mind, have been used to highlight the organizing impact of preoedipal rather than oedipal development. The contemporary Freudian view, Rothstein argues, eschews this sort of either/or thinking and asserts that conflict is ubiquitous in all minds. This first chapter provides an excellent historical perspective on the evolving nature of Freud’s thought and of modern conflict theory.
Rothstein’s appreciation of Brenner’s work and of his broadened concept of compromise formation lies at the heart of the book. We are reminded of Brenner’s gift for bringing Freud’s ideas to life in experience-near language and for capturing the richness and complexity of mental phenomena. For Brenner, notes Rothstein, compromise formation is “a general tendency of the mind, not an exceptional one” (Brenner 1982, p. 113), and it is not in itself pathological. Conflicts and compromise formations resulting from sexual and aggressive wishes in childhood persist throughout life. Compromise formations are pathological to the extent that they involve too much anxiety and/or depressive affect, too much inhibition, or too much need for self-punishment. For Brenner, when an analysis is successful, pathological compromise formations give way to normal ones.
Each subsequent chapter takes up a specific subject viewed through the lens of compromise formation. In chapter 2 the author redefines narcissism within a conflict model. For Rothstein, narcissism refers to the array of fantasies of perfection that function as the defensive component of a compromise formation that reduces the anxiety and depressive affect associated with childhood calamities. Clinical material is presented to illustrate the value of analyzing these fantasies of perfection as compromise formations and how they inevitably lead to associative links to conflicts related to childhood sexual and aggressive desires.
Chapter 3 explores the advantages of understanding sadomasochistic phenomena as compromise formations. In deemphasizing the organizing descriptive designations—perversion, character, and neurosis—sadomasochistic phenomena can be seen on a spectrum and as more alike than different. Chapter 4 discusses the clinical advantages of considering the similarities between shame and guilt and of understanding them from the standpoint of compromise formation. Clinical material is presented in both chapters.
The second part of the book addresses subjects ranging from the seduction of money, beginning analysis with a patient who is reluctant to pay the fee, psychoanalytic diagnoses as co-constructions, and finally Rothstein’s “trusting model” and the assumption that patients are analyzable until they prove otherwise through a trial of analysis.
In chapter 5 Rothstein describes a situation in which a patient offered to give him a large sum of money and how he worked with this as a transference fantasy that like any fantasy is an overdetermined compromise formation.
Chapters 6 and 8 deal with Rothstein’s well-known though controversial idea that analysts should approach every consultation with the conviction that analysis is the optimal treatment for most patients who seek our help and that a trial of analysis is the best way to assess a patient’s suitability for analytic work. If after a trial of analysis is suggested patients are reluctant to accept the recommendation, Rothstein will work with them on their own terms if they agree to try to understand why they would deny themselves the optimal treatment. Rothstein challenges the traditional pedagogy in institutes that use a model emphasizing the evaluation of analytic control patients and issues of analyzability. As an alternative, he advocates his “trusting” model for consultation and beginning analysis. Such a model regards impasses or failures as failures in collaboration rather than as proof the patient cannot be analyzed. Rothstein stresses the importance of a positive attitude toward the outcome of the trial of analysis and suggests that pessimism might well indicate a negative countertransference.
Chapter 7 proposes that psychoanalytic diagnoses such as borderline, narcissistic, and paranoid are compromise formations that derive from destructive countertransference in the analyst. Rothstein asserts that diagnoses are better understood as co-constructions that emerge in the mind of the analyst in response to the experience with the patient. Presenting his work with an analysand diagnosed by a previous analyst as a “severe borderline,” he suggests that the diagnosis was a way for the analyst to express his frustration and diminish the unpleasure he experienced with this patient. Rothstein presents examples of pathological compromise formations—diagnoses and labels used to reduce countertansference unpleasure—and of normal compromise formations—diagnoses that facilitate analytic work.
There is much that is thought-provoking in this slim book. The chapters in Part I are densely written, which makes them challenging to read, but Rothstein’s case material effectively demonstrates the clinical application of his ideas. Because most of these papers were written from 1986 to 1995, they lack the more contemporary and relational turn that is evident in Rothstein’s more recent work. While the emphasis on compromise formation may be useful for analysts working primarily with a conflict model, it has a metapsychological and experience-distant feel to it that limits its clinical utility for those working with other theoretical models. Steven Ellman’s ideas about Rothstein’s work are especially cogent. Ellman (2005) contends that while he believes compromise formation is a useful concept, the focus is too narrow and doesn’t allow for many elements encountered in the clinical situation and in most aspects of our daily lives. He goes on to say, “it is one thing to believe that compromise formation is a useful assumption, yet another to see this assumption as the leading edge of one’s ideas about the treatment situation”; the danger in taking this leading edge seriously, Ellman argues, is that “it frequently takes the analyst away from the patient’s experience of the analytic situation” (p. 463). In emphasizing compromise formation as he does, Rothstein indeed gives the impression that it is for him the leading edge in his work with patients, though in the book’s conclusion it is apparent that his thinking has evolved. It is interesting to observe in the conclusion how it has evolved and how he attempts to bridge modern conflict theory with intersubjectivity as he explores the intersubjective dimension of compromise formation theory. Since unconscious conflict is ubiquitous and interminable, it follows that that all thoughts and perceptions are subjective and that all experiences in relationships are intersubjective. He suggests that understanding the intersubjective aspect of compromise formation theory helps us appreciate the continual and reciprocal shaping and reshaping influence of analyst and analysand on their transferences.
Rothstein’s controversial assertion that a trial of analysis should be offered to almost all patients is a thread that runs throughout Part II. Sybil Ginsburg (1997) believes that it is misguided to eliminate careful evaluation of a patient’s ego functioning, object relations, capacity for self-reflection, and the current life situation when considering whether analysis may be the optimal treatment. Robert Wallerstein (2000) argues that there are many patients who because of considerations of their reality and the nature of their emotional difficulties do not need analysis. Other treatment options may be more appropriate. Susan Lazar (2000) contends that patients are not created; their entry into analysis is often the result of a gradual unfolding. She stresses the necessity of helping patients feel more autonomous by promoting the idea that it is the patient’s agenda that is paramount, not the analyst’s desire to have them enter analysis. Howard Levine (2010) makes the point that Rothstein’s position about analyzability is empowering to candidates who because of their inexperience need support and encouragement in making the recommendation that a patient begin analysis. I wonder, though, whether we have become too cautious and tentative about recommending analysis out of our own feelings about being psychoanalysts in the current culture of managed care and competing treatment options. There is merit to Rothstein’s point that having a solid identity as an analyst and a conviction about the efficacy of analysis may influence conscious and unconscious attitudes about recommending analysis to patients who might benefit from it. I recommend Making Freud More Freudian to those wishing to deepen their understanding of compromise formation theory and how to make use of it clinically.