Theory of Psychoanalytical Practice

A Relational Process Approach

Juan Tubert-Oklander

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429922855
• Topic: Psychologie
• Subtopic: Geschichte & Theorie in der Psychologie

This book makes an original contribution to the study of the psychoanalytic process from a relational point of view, and at the same time serves as a textbook on the theory of technique. It provides a general exposition of the theory of psychoanalytic practice from a process perspective that emphasizes the analytic relationship, the dyadic nature of the psychoanalytic situation, and the impact of unconscious interaction between its two parties, and also includes the authors personal point of view and contributions on the subject.

Chapter One
Introduction

This text is an attempt to develop an integrative view of the theory of psychoanalytic practice. It is not, however, a theory of classical technique, but of a particular approach to clinical practice: that of relational psychoanalysis. Such view of our discipline is at odds with the traditional Freudian conception and with many of the prevailing schools in contemporary psychoanalysis. Nevertheless, it corresponds with the feelings and practice of many analysts, who have been trained in the various psychoanalytic traditions, but who have gradually found that their clinical experiences have led them to depart from some of the most cherished and adamantly sustained beliefs of their colleagues and friends. This new understanding of the nature and means of our work had been steadily unfolding in various areas of the psychoanalytic world, but until very recently it lacked a name that helped us to identify what the many clinical and theoretical contributions had in common. So, the various writers or groups developed their own terminology and concepts in order to account for their experience and practice. This tended to obscure the fact that they were unwittingly a part of an evolving collective movement.

Most of these developments tended to coalesce around the concept of object relations. Unlike traditional Freudian theory, which revolved around the theory of instinctual drives, for which the object was the most replaceable part of the instinct, a mere catalyst for the attainment of a discharge of organic tension, the object of object relations theory is always personal and non-replaceable, an object of love and hate, not only of pleasure and displeasure. This approach to the psychoanalytic understanding of the human being is also derived, of course, from Freud's original contributions—particularly in the second part of "Instincts and their vicissitudes" (1915c), in "Mourning and melancholia" (1917e), Group Psychology and the Analysis of the Ego (1921c), and The Ego and the Id (1923b). It was Ferenczi (1955, 1985), however, who initiated the systematic study of object relations.

Even though many object relations theorists have emphasised that this theory always refers to internal objects and the ego's fantasised relations with them, and not to interpersonal relations, presumably to avoid a conflict with the hallowed belief in the absolute priority of the intrapsychic, the fact remains that most of them—with the exception of Melanie Klein and her followers (Klein, Heimann, Isaacs, & Riviere, 1952)—consider that that psychic structure, what we may call the functional organisation of the mind, is derived from the internalisation of the child's relation with real persons in its entourage. A logical consequence of such belief is to acknowledge that the real person of the analyst—and not only his or her technical intervention—is involved in the analytic process and in the attainment of the cure.

Another characteristic of object relations theory is an emphasis on what came to be called a "two-person psychology", contrasted with the classic psychoanalytic theory, considered as a "one-person psychology" (Balint, 1968). Where Freudian metapsychology conceived the human mind as an almost closed system, which acted in a quasimechanical way, a conception that found an expression in terms such as "psychic apparatus", "mental mechanisms", "energy", "structure", "charge", and "discharge", object relations theory understood it as an open system, permeated by the individual's many relations with other significant people and with their environment, both social and nonhuman—physical and ecological, as Searles (1960) clearly described. When this point of view is applied to the analytic situation, it becomes a conviction that the observational data that pave the way for the analytic enquiry should be derived from the inner experience and the behaviour of both parties, and not only from one of them—the patient—as the objectivistic epistemology of classical theory demands. Such a view is either explicitly stated, or implied and thinly disguised, in the work of writers such as Fairbairn, Balint, Winnicott, Searles, Rycroft, Milner, Khan, Little, Bollas, Pines, and Hopper, all of them members (with the exception of Searles) of the Independent Group of the British Psychoanalytic Society, and all of them heirs to the rich legacy of Ferenczi (Aron & Harris, 1993).

In the USA, Freudian psychoanalysis was dominated by one of the versions of psychoanalytic theory—that of ego psychology, nowadays referred to as the structural theory—which emphasised a metapsychological description of the functional structures of the mind, and minimisied the consideration of the sort of actual personal relations described by object relations theory. The other quite distinct psychoanalytic tradition in that country—that of Harry Stack Sullivan's interpersonal psychoanalysis, represented by the William Alanson White Institute for Psychoanalysis—was completely isolated from the former. Both traditions had been utterly split from each other, and both had developed their own conceptual language, theory, technique, clinical practice, training procedures, institutions, and patient following. Hence, for many years, there was no dialogue between them, although the Washington Psychoanalytic Institute retained the influence of Fromm-Reichmann's interpersonal approach to psychoses, thus allowing a more diversified theoretical base. One of the graduates of its Institute, Harold Searles, who worked with Fromm-Reichmann in Chestnut Lodge, became a pioneer in the psychoanalytic treatment of psychotic patients in the USA and a radical explorer of the field of countertransference, whose writings strongly resembled Ferenczi's (1985) yet-unpublished Clinical Diary.

Such neat separation began to crack during the 1970s, when a growing interest in British object relations theory and the appearance of Kohut's (1971, 1977, 1984) self psychology reopened the question of the alleged opposition between one-person and two-person psychologies. These theories were shocking and unacceptable for the more conservative members of both psychoanalytic groups. The Freudians found them non-psychoanalytic, or even anti-psychoanalytic, since they rejected or minimised the importance of instinctual drives, questioned the absolute primacy of intrapsychic processes, emphasised the importance of real external objects, both during infancy and childhood and in later years, suggested that analysts offered their patients much more than interpretations, and demanded a serious consideration of the participation of the analyst's subjectivity in the analytic process. The interpersonalists, on the other hand, felt that these theories were too Freudian, since they did not espouse a wholesale rejection of drive theory, placed too much emphasis on childhood experiences and their consequences for the organisation of the patient's personality and relational patterns, and insisted that the analyst should give expression to his or her subjective experiences only seldom and cautiously. But many other analysts in both groups read and were interested in these new ideas, and this set in motion a collective process that finally became a new trend in psychoanalysis.

In 1983, Greenberg arid Mitchell, two analysts who came from the interpersonal field, wrote a book called Object Relations and Psychoanalytic Theory, in which they reviewed the Freudian and interpersonal points of view, and then contrasted them with that of British object relations theory. Thus, they identified and specified two widely diverging approaches to psychoanalysis: the drive-structure model and the relational-structure model, usually referred to simply as the "relational model".

Aron, from whose 1996 book, A Meeting of Minds, I have extensively drawn in order to present this historical evolution, recounts how some of the teachers at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, in which he was trained, met in order to choose a name for their particular orientation. Such a decision was necessary because of the programme's peculiar organisation. Having been planned as a university programme committed to diverse viewpoints and academic freedom, its faculty represented the variegated panorama of psychoanalysis in the USA. This soon turned, however, into a two-track system, which allowed the students to decide what sort of training they were willing to follow: Freudian or Interpersonal. But when a number of faculty members began to feel that they were joined by a common point of view that was not represented by either track, they decided that they should start a new track, and then a name for it became an urgent need.

The group considered several alternatives, such as "interpersonal", "intersubjective", "object relations", or "self-selfobject relations", but discarded them all, on account of their sectarian implications. They finally compromised, though rather reluctantly, on the term "relational", borrowed from Greenberg and Mitchell (1983), as Aron (1996) describes in his book:

At first no one was happy with the term because it seemed to minimize both the role of the self and the biologically given components of the personality. It had the advantage, however, of seeming to borrow from the object relations tradition, the interpersonal relations tradition, and the self-selfobject relations [Kohutian] tradition; and it clearly seemed to distinguish itself from the drive theory perspective, (p. 13)

After that, the name rapidly helped the consolidation of a group, which gave birth to a new magazine called Psychoanalytic Dialogues: A Journal of Relational Perspectives, founded in 1991, which opened its doors to writers from all fields, such as object relations, interpersonal psychoanalysis, self psychology, Jungian analytical psychology, and intersubjective psychoanalysis, who were willing to enter an open debate on the implications of the relational view. Years later, in 2000, the group was to become institutionalised as the International Association for Relational Psychotherapy and Psychoanalysis.

But what, exactly, is relational psychoanalysis? It is not a new dogma or a systematic theory, but, rather, a new way of looking at things that have been known to clinicians since the beginning of psychoanalysis. Such a position was clearly stated by Ghent (2002), a distinguished interpersonal psychoanalyst and musician, one of the founding members of the Association, in his Introduction to the First IARPP Conference, in the following terms:

There is no such thing as a relational theory, but there is such a thing as a relational point of view, a relational way of thinking, a relational sensibility, and we believe that it is this broad outlook that underpins the sea change that many of us recognize as breathing fresh life into our field. . . . [Among us], there are those who identify as Freudian, or Jungian, or intersubjectivists, or so called "relational analysts", (p. 7, my italics)

So, relational analysis is really a way of looking at the psychoanalytic experience, which is shared by numerous analysts formed by disparate traditions, and its community is a far cry from being uniform: a motley assembly of philosophers, artists, doctors, and freedom fighters of the mind, all sharing the same heart—as psychoanalysis was in its beginnings—rather than a battalion of well-trained soldiers, all marching to the same step. If relational analysis is a school, it is certainly not in the sense that Marxism is, a group unified by its adherence to its founder's point of view, to a set of established principles, or to a foundational text, but rather as Impressionism was—a collection of artists who share a similar interest and concern, that every one of them feels free to explore in his or her own particular way.

And what is this same heart, this shared interest? It is mainly a concern about relationships, with an emphasis on the emotional bond between human beings. This leads them to regard human affairs in the following terms.

1. A rejection of drive-orientated theories, in as much as these imply an impersonal causal explanation of human experience and behaviour, rather than a personal account of people's intentions and motives; therefore
2. A preference for those theories that conceive people as whole persons, with feelings, thoughts, perceptions, wishes, and fears, who relate to other whole persons who share this subjectivity, over those that postulate impersonal structures, mechanisms, and energies acting inside individuals—in Brierley's (1945) terms, personology rather than metapsychology;
3. An emphasis on the recognition, description, and understanding of subjective experience—both conscious and unconscious—of the two parties of the psychoanalytic encounter;
4. A conviction that a full understanding of what transpires during the analytic sessions should include a consideration of those relational events and processes that take place between analyst and patient—a two-person psychology—rather than solely relying on the study of the patient's internal processes (a one-person psychology); hence,
5. A special interest in the study of the mutual influences—both conscious and unconscious—that each of both parties of an analysis exert on the other, and on the process of negotiation— also conscious and unconscious—that lies under every event that occurs in it;
6. A constructivist epistemology, that understands psychoanalytic knowledge as the result of an interaction between two subjects who build together a new set of ideas, based on their shared experience and their mutual relationship that opens for them a new understanding of these;
7. A belief that all knowledge and ideas—including those of psychoanalysis—are determined by historical, linguistic, political, and contextual factors, and that they are based on emotional experiences derived from relationships;
8. A profound consideration of the effect of actual relations with other people—both past and present—on the conformation of the individual's experience and psychic structure and functioning; consequently,
9. A theory of the therapeutic process that attributes at least part of its results to the internalisation by both parties of the experience of their mutual relationship, and, finally,
10. A strongly held belief that, whenever a psychoanalytic treatment succeeds, it must necessarily have an effect on both parties, even though this is not equivalent for both of them.

Of course, this is my own construction of what I consider to be the basic principles of the relational approach to psychoanalysis, which would not be necessarily shared by many colleagues who consider themselves "relational analysts". On the other hand, many psychoanalysts who would not call themselves "relational" would share at least some of the propositions included in the previous list. This shows that the relational trend in psychoanalysis does not depend on the politics or the organisational aspects of our profession, but is, rather, an emerging tendency in the psychoanalytic community.

It might well be argued that this perspective has been a significant aspect of psychoanalysis from its very beginning, but the fact remains that psychoanalytic theory and practice acquire a very different feeling, organisation, and appearance when one takes personal relations as their basic concept, from when everything revolves around impersonal concepts such as "energy", "structure", "representation", or "drive". This is what Brierley (1945) was pointing out when she borrowed the term "personology" from General Smuts, to distinguish the science of personality from metapsychology. Smuts's (1926) argument is as follows:

The procedure of psychology is largely and necessarily analytical and cannot therefore do justice to Personality in its unique wholeness. For this a new discipline is required, which we have called Personology, and whose task it would be to study Personality as a whole and to trace the laws and phases of its development in the individual life. . . . Personology would study the Personality not as an abstraction or bundle of psychological abstractions, but rather as a vital organism, as the organic psychic whole which par excellence it is. (Smuts, quoted by Brierley, 1945, p. 89, my italics)

So much for the use of the term "relational". And what about "process", which is also featured in the subtitle of this book? My choice of this word to characterise my approach to psychoanalytic technique might seem odd, especially in conjunction with the former, since the idea of a process approach is frequently opposed to that of a personal relations one (Guntrip, 1961, 1971). In such a line of thought, "process" implies a theory of impersonal events, articulated by causal relations, in the context of an allegedly scientific discourse—what Brierley (1944) calls an "objective theory". This is in sharp contrast with that other way of conceiving psychoanalysis—the "subjective theory" of personology—that understands it in terms relations of whole persons with other whole persons. From this perspective, Brierley (1944, 1945), however, considered that psychoanalysis needs both the subjective approach of personology and the objective view of metapsychology, which is a process theory. This is a consequence of the fact that each of these two kinds of knowledge is derived from a different type of relationship: one of them in terms of emotional contact and experience (subjective theory), and the other which deals with the same data from the standpoint of a temporarily detached observer.

There may be only one event, the psychological event, but there are very definitely two distinct methods of approaching and describing it. The results of both approaches have to be correlated, and can be used to correct each other, (Brierley, 1943, p. 120)

Another use of the term "process approach" to describe psychoanalytic treatment refers to Meltzer's (1967) contention that there is a "natural history" of the analytic process, with predetermined stages organised around the maternal transference and experiences of separation. What both conceptions have in common is to see the process as determined by something else than the wishes, aspirations, and feelings of the concrete persons that take part in the analytic encounter.

My own use of this term refers to the observation that, even though both parties enter the analysis with all their beliefs, values, motives, and thoughts, something else is set in motion when they start to meet in a closed room, in order to "do psychoanalysis", and this something has its own life and evolution, independent from their personal wishes and mental processes, determines them and is determined by them, and appears almost as a separate entity. A similar perception led Ogden (1994a) to postulate the existence of an "analytic third", which is created by the patient-analyst interaction, generating "analytic objects", which are the very stuff of the psychoanalytic enquiry.

The recognition that something is going on, which is independent from the individuals involved...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• PSYCHOANALYTIC IDEAS AND APPLICATIONS SERIES IPA Publications Committee
• ACKNOWLEDGEMENTS
• Dedication
• ABOUT THE AUTHOR
• PROLOGUE
• CHAPTER ONE Introduction
• CHAPTER TWO The psychoanalytic situation
• CHAPTER THREE The analytic attitude
• CHAPTER FOUR The context of analysis
• CHAPTER FIVE The substratum of analysis
• CHAPTER SIX The analytic field
• CHAPTER SEVEN The analytic process
• CHAPTER EIGHT The dimensions of the process
• CHAPTER NIINE Interpretation, insight, and working through
• CHAPTER TEN The evolution of the analytic process (1): the beginning and the middle
• CHAPTER ELEVEN The evolution of the analytic process (2): the end
• CHAPTER TWELVE The healing process
• REFERENCES
• INDEX