Saturday, May 4, 2013

Essentials of Psychoanalytic Theory and Practice


For many years, I have taught “Introduction to Psychoanalysis” from the vantage point of Descriptive Psychology. The policy I try to follow is to use ordinary language and to avoid concepts and theory that do not actually inform my day-to-day practice. Each semester, given input from my students, this is revised.  Early in my training, I was strongly influenced by George Klein’s effort to separate clinically useful theory from Freud's metaphysics. What follows reflects my adaptation of his project and a liberal stealing from his work.

Below you will find 14 statements that I take to be basic beliefs and choice principles that define the psychoanalytic community. When the statement is in the form of theory or belief, the essential  questions the reader should ask are empirical: is the development of personality or the understanding of behavior accurately or usefully articulated? When the statement is in the form of a maxim, the essential questions are conceptual:  is the statement well formed and where should it be applied?  Following most statements is a brief note describing how the belief, theory or maxim is put into clinical practice.

As a work in progress, frequently updated for clarity and inclusion, your thoughts, comments and recommendations are welcome and valued.




                     The Pragmatic Essentials of Clinical Psychoanalytic
  
                                        Theory and Practice



1.  The formation of personality or character, whether healthy, normal, or pathological, develops, in part, from attempts to resolve incompatible intentions and dispositions. This starts very early in the family. Character or personality is to a significant extent a “compromise formation”.  Since people have hedonic, prudent, ethical, and aesthetic motivations, intra-personal and social conflict is inevitable. Conflict and crisis are expected and provide conditions for ordinary maturation. Neuroses and personality disorders are ways this process can go wrong. Maturation involves, in part, the incompatibility of old and new demands, crisis, impasse, and/or resolution.

(The therapist recognizes that resolution and recovery from personal and social conflict, including conflicts between therapist and client, are central to the process of individuation and maturation. The therapeutic session involves practice and experience in identifying, tolerating, and resolving conflict. Therapists also recognize that some conflicts are not resolvable and that some resolutions require the ability to tolerate conflict rather than needing conflict to disappear. For conflict to be managed, the therapeutic session must be a safe enough place for this to happen.)

2.  The affective experience of pleasure, satisfaction, anxiety and pain are central in the development of self-identity and in structuring motives. Pleasure, satisfaction, anxiety and pain are fundamental feelings generated by encounters with people, events, and objects. These feeling significantly guide the acquisition of knowledge, competence, and the development of talent.  Anxiety and pain is informative of estrangement, denoting threat or conflict; pleasure and satisfaction are informative of accord and wellbeing, of approachability and desirability.  Anxiety and pain motivates avoidance; pleasure and satisfaction motivates contact. The competent achievement of hedonic, prudent, ethical, and aesthetic aims is pleasurable and/or satisfying.  Helplessness or the expectation of incompetence is experienced as anxiety and/or depressive or painful affect.

(The therapist recognizes that the therapeutic interaction may elicit pleasure, satisfaction, and anxiety and with this may come opportunities for participating in and interpreting characteristic patterns of approach and avoidance. The therapist attempts to keep the experience of pleasure, satisfaction and anxiety appropriate and tolerable during the session.)


3.  Conflict provides a motive for self-integration.  People usually desire and action requires some sense of a coherence world. People generally want their abilities and dispositions to result in self-understandable behavior. The self is the referent of the experience of coherence, continuity, and integrity at every stage of life. Still,  the integration that is serviceable at one stage of life may prove problematic at later stages.

(A goal of psychoanalytic interpretation is to provide clarity and understanding of how past integrations, for better or worse, are manifested in current actions and patterns of life. When appropriate, the therapist attributes to the client some degree of agency in bringing about the analyzed or problematic state of affairs. The therapist is aware that badly timed or worded interpretations of agency can result in the client feeling blamed. Empathic interpretations and confrontations require an appreciation of what the client can tolerate. The therapist is interested in helping the client examine problematic unconscious, under-socialized or poorly understood behavior with the goal of enhancing the potential for deliberation and more serviceable choice.)

4.  Two major components of selfhood are the assertion of personal autonomy and the need for being an integrated and desired member of a more encompassing social unit. Selves require autonomy, family, and community and this inevitably creates conflict.

(The therapist recognizes the client’s struggles for autonomy and dependency and fosters and analyzes both given the inter-dependent nature of the therapeutic relationship.)


5.  When in crisis, people tend toward regressive repetition. Crises are often the occasion for the enactment of earlier patterns of expectation, conflict, anxiety, satisfaction, pleasure, and resolution. Both growth and pathology may involve repetition. When a person’s context sufficiently resembles earlier states of affairs, e.g., those that involve the person’s family, it is unsurprising that past themes are reenacted consciously or unconsciously as transference.

(The therapist expects and welcomes the client’s transference neurosis as part of the client's response to the comfort and ordeal of treatment.  The therapist approaches the transference neurosis as an opportunity to work through earlier fixations, symptoms, and character formations. Therapists recognize they evoke both old and new ways of relating that include maternal, paternal, and sibling themes along with opportunity to act in ways not constrained by the past. The therapeutic relationship establishes forms of intimacy specific to the therapeutic dyad affected by the transference. The therapist when treated in ways that resemble the client’s father, mother, sister or brother is mindful not to respond automatically in kind.)

 6.   Four maxims: 

People take it that things are as they seem, unless they have reason enough to think otherwise.

What people take to be real is what they are prepared to act on.

People do not choose to put themselves in a worse position given their appraisal of their options.


It is also a maxim that if a situation calls for someone to do something they can’t do, they will do something they can do instead, i.e., something that their values, knowledge, and competence allows.  Faced with something a person “can’t do”, their resulting action follows from their appraisal of what is real and what helps them maintain or improve their position.  This may appear to be a distortion from the perspective of the observer. The various manners of distortion correspond to the ego defense mechanisms.

(The therapist must supply from the client’s history, memory, and associations reasons that things might not be as they appear to the client. The therapist attempts to build a case for alternative points of view fully recognizing the uncertainty of their own understanding. The therapist recognizes that what appears from their vantage point to be the client’s defensive distortion is from the client’s perspective the way things are. The therapist carefully acknowledges the client’s perspective by interpreting or re-describing tactfully and close to the client’s current awareness and toleration. "Baby-steps".)

7.   During any developmental period, a person’s capacity to bear the incoherence and anxiety of conflict, trauma, urge, fantasy, and memory is limited. Overwhelming conflict or trauma may result in dissociation:  “This is not happening to me”.  Overwhelming fantasy or urge may result in repression:  “This is not me”. Unmanageable memory may result in avoidance and reluctance to self-examine: “I won’t go there with myself”.

(The therapist attempts to foster a sense of safety in which fantasy, memory and urge are tolerable and can be examined. The therapeutic session provides a safe place to practice tolerating the memory or fantasy of trauma in the service of breaking free from a compulsion to repeat it.  Since defensive activity occurs when an immediate circumstance is recognized as unmanageable, the therapeutic session provides a safe place to develop skill in working through the problematic circumstance in the service of developing emotional competency. Emotional competency facilitates effective action in circumstances that otherwise would be defensively distorted, restricted and/or avoided.)

8.  Attempts at the mastery of passively endured traumatic circumstances, the experience of being a victim, may be accomplished through active reversals, i.e., engaging in behaviors that resemble those perpetrated on the victim:  “What I have experienced as being done to me, I must make happen compulsively and repeatedly to myself or others.” Repression, dissociation, avoidance, and active reversal are basic modes of confronting and resolving conflict, impasse, and crisis, for better or for worse.

(The therapist recognizes the power of the repetition compulsion in the client’s motivation for returning to a traumatic issue again and again in an attempt to resolve it. Unconscious attempts to develop mastery, i.e., the repetition compulsion, and conscious attempts to achieve competence both involve repeated practice and experience.  Cognizant attempts to develop mastery have the advantage of deliberation and the reality testing of effective alternatives. Unconscious or unacknowledged attempts to develop mastery lack the corrective feedback that comes from self-awareness and negotiation. The therapist tends to value cognizance as providing options that unconscious reactions lack, e.g., navigating circumstances that call for renunciation, ethical judgment or informed choice.)

9.  Another maxim: “A person acquires a given personal characteristic by virtue of having the prior capacity and the relevant intervening history.”  Some intervening experiences may lead to active reversal, dissociation, repression or avoidance.   Repression and dissociation create introjects, i.e., unassimilated, uncomfortable, and anomalous personal characteristics with confusions of agency:  “Is this me, or is this something that is happening to me?” “Where is this intrusive thought or image coming from?”  Avoidance may result in phobia:  “Keep that away from me!”  In contrast, active reversals may establish identifications, resulting in behaviors recognized as one’s own:  “This is who I am, this is what I do, for better or for worse”.

(The therapist’s policy of attempted neutrality and abstinence, along with acts of empathic confrontation, re-description and interpretation, promotes self-observation and toleration as identifications available to the client.  As a therapeutic goal, unconscious and problematically enacted repetitions are made conscious in the service of the actor developing more appropriate competencies. Under-examined problematic repetitions are tactfully confronted.)

10.  A person's "emotional competence"  to manage, tolerate and/or enjoy sexuality, conflict, competition, hostility, intimacy, separation, solitude, and loss develops during early family life, in part, from having parents willing and able to provide a secure "holding environment".  The key parameters of the holding environment are the parent’s quality of self-reflection and their attunement to their child:  their empathy, availability, reliability, and containment. The good enough parent celebrates and supports their child's spontaneity while mindful of the effects of parental intrusion (Donald Winnicott, Heinz Kohut, and Peter Fonagy).

(The therapist tries to create a safe place and attempts to remain nonjudgmental, empathic, reliable and available while allowing tolerable frustration and disappointment. The therapist is open to surprise and affirmative engagement with their client's spontaneity and assertion.)

11.  Fixations may occur when a fundamental need results in either automatic gratification or an unpredictable or rarely gratifying response.

(Therapists are sensitive to the manner in which their response to their clients may be overly gratifying or unmanageably frustrating.  As a default stance or policy, tolerable frustration is maintained in the service of the client developing the skills needed to achieve appropriate satisfaction.)

12.  Autonomy grows out of successful dependency at its own rate.   Unsuccessful dependency may yield a defensive isolation or clinging neediness, the self-experience of badness and a dangerous world, along with a proneness to envy, rage, panic, and depression.  It may also yield a tendency to rigidly idealize and devalue others and to seek those who resemble the “bad objects” of unsatisfied early dependency (Ronald Fairbairn). Autonomy is mature interdependency.

(Therapists allow and foster an inter-dependent relationship and recognize that therapy takes as long as it takes, often a long time. Ideally, psychotherapy begins as an open-ended process.  Therapists also recognize that real world constraints will likely interfere with the open-ended process. Knowing that therapy might end too soon, therapists do not promise what is not likely to be accomplished, and try to cultivate the potential for future progress with or without treatment. Therapists are self-aware of their own reactions to being idealized and devalued and are aware that they may become an object of identification.)

13.  Maturation and the development of personal characteristics often involve relationships beginning in a dyad and then moving to the triangular in the fashion classically described as Oedipal.  Identifications start with a significant dyadic attachment followed by an appreciation of the Other’s key values and relationships. The social triangle consists of Self, Other, and the Other’s Other: “I begin by identifying first with you and then with your other defining relationships that are not about me.” Especially significant in the development of personal characteristics are repeated experiences that occur during periods of developmental growth and vulnerability.

14. The development of a child’s ambitions and talents are facilitated when the child is empathically admired by parents who are available for appropriate idealization along with a community of peers who value the child’s ambitions and facilitate the practice of his or her talents (Heinz Kohut).

(The therapist may be experienced in a manner than resembles parent and peer. Therapists are aware that their self-presentation and the various communities, values, and choice principles they represent are attributes the client will encounter. Knowingly or not, the therapist will affirm or degrade the client.  Therapy is quintessentially a period of growth, change, and vulnerability.)

Akin to the job of a parent, the psychotherapist's job is to help their clients become better version of themselves.


(Adapted from George Klein’s, Psychoanalytic Theory: an exploration of essentials, 1976, and Peter Ossorio’s, Place,
George S. Klein
1998/2012. The maxims are found in Ossorio's writings. The theory is taken largely from George Klein and others as noted.)


Background information on Descriptive Psychology and the work of Peter Ossorio can be found here: The Society for Descriptive Psychology and in the entry, A Short Course in Descriptive Psychology.


7 comments:

  1. As a Descriptive Psychologist, I would say that the initial statement unnecessarily roots the human experience in conflict. Statement 9 is a much better starting point: a person's personality is the sum of their personal characteristics, and characteristics are acquired via a history, which sometimes (though not always and not by necessity) involve resolving incompatible desires and reasons.

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    1. Joe, starting with conflict was a choice but perhaps a problematic one. Some classical psychoanalysts, such as Charles Brenner, in the tradition of "ego psychology" have called psychoanalysis "the science of conflict". Conflict is dead center in their formulations. Still, one of the founders of ego psychology, Heinz Hartmann, recognized that personality usually forms in an "average expected environment" and has a significant and necessary "conflict free sphere". I used the phrase, "to a significant extent" to allow for the "more or less" presence of conflict but with the recognition that conflict is a significant concern to most psychoanalysts. But, your point is part of the reason psychoanalytic writers such as Heinz Kohut moved their narrative away from a preoccupation with conflict to other equally vital issues in personality development. Thanks for your valuable reminder.

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    2. Joe's comment reflects a style of reminder typical of Descriptive Psychology. Descriptive Psychology provides formulations that allow for the representation of all formal possibilities without foreclosing or excluding. In this manner, conflict would not be privileged over other reasonable alternatives. This is reflected in Joe's phrase "though not always and not by necessity". He reminds us that it is an empirical matter how often and how significant conflict actually is in the lives of persons.

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    3. Love this, Wynn. Descriptively, "conflict free sphere" seems a double negative? Perhaps best to anchor on Identity?

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  2. Speaking Descriptively, I also feel like the initial statement is too constrained. I would take pleasure and satisfaction as successes; and I might take anxiety to be a failure. (If anxiety is a kind of fear, and fear has a reality basis, it might be success. I'm reasonably afraid of a lion; soldiers in a foxhole are reasonably anxious.) If so, then your statement becomes "Character or personality is...the result of success and failure." That seems reasonable to me. I would want psychoanalysts to then state something like, "The success we think most important is X; the failure we think most important is Y." Such a statement lets psychoanalysis become a "stratified sampling" of the full parametric formula for Behavior.

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  3. You've done a very nice job here, Wynn, of articulating psychoanalysis "from the vantage point of Descriptive Psychology." Reading through these 14 statements, the I am struck by the historically individual and biological roots of psychoanalysis. The focus is almost exclusively on the individual and person-specific issues, along with issues related to relationships with another, ofter the therapist. Descriptive Psychology also offers a great amount of useful insight through examining the significance of a person's behavior as participation in the social practices of their communities. Ossorio's book Place, which you referenced, contains literally scores of maxims addressing such matters. (BTW, Place was originally published in 1982, and republished as a currently available stand-alone volume in 2012. The 1997 version you cite is Vol.III of The Collected Works of Peter G. Ossorio.)

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  4. As one of your students, I absolutely appreciate your technique of using ordinary language and layman's terms. I can at least speak for myself when I say this since psychodynamic theory is a topic that is new to me and one that I am learning to appreciate more and more each day.

    Your 14 statements above which you consider to be the basic beliefs and choice principles of the psychoanalytic community bring much insight to me. I particularly appreciate numbers 3 and 6. Even as a young clinician, I see the third statement come alive in many of my sessions with adult clients. I strive to attribute a degree of agency to my client, however that proves to be somewhat difficult. Often times my clients want me to "give them an answer" or to "fix" their problems. However, as much as I would like to do that, do I really want to do that? My goal is to have them really see how their past patterns of behaviors are manifested in their current patterns of life. As you state, "the therapist is interested in helping the client examine problematic unconscious, under-socialized or poorly understand behavior," not solve it. I wish I had an answer to all of their questions but what good would that cause? Clients need to search for the answers themselves, and I am simply the tool that will help bounce back their same ideas with different perspectives.

    I also really appreciate statement 6. Peter Ossorio's quote is particularly fitting: "What a person takes to be real is what he is prepared to act on”. When someone is asked to do something they do not feel prepared to do, they'll do something else that they can do. This is a concept you have stressed often in class lecture. You mention that "The therapist recognizes that what appears from their vantage point to be the client’s defensive distortion is from the client’s perspective the way things are". It is our job to ultimately analyze and interpret our clients' response. They do what they do for a reason and it is out task to figure out why in order to gain a better understanding of the world around them according to their point of view.
    ~ G. Cruz

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