Power of Understanding

Essays in Honour of Veikko Tahka

Veikko Tahka, Aira Laine

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367326104
• eBook ISBN: 9780429917455
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book, published in honour of Veikko Tahka, represents the synthesis of his thinking based on more than forty years' experience as a clinician, researcher, teacher, and supervisor, concerning the nature of understanding, a debate in which the psychoanalytic model was used as an example.

CHAPER ONE

Psychoanalytic understanding and psychoanalytic therapy: Veikko Tähkä’s contributions

Robert S. Wallerstein

From its inception, psychoanalysis has always been concerned to delineate its dimensions, its therapeutic reach and limitations, and the arc of the psychopathological spectrum amenable to its deployment. For Sigmund Freud, who almost single-handedly created psychoanalysis as a theory of mental life and a systematic therapy for the disorders of mental life, these concerns were not problematic. He developed psychoanalysis as a purified product out of the congeries of therapeutic approaches in vogue in his time, or experimentally introduced by him and his first co-worker, Josef Breuer—electrical stimulation, rest cures, hypnotic suggestion, forced associations on command—and it soon became the scientific psychology and the etiologically-based therapy.

By as early as 1905, Freud had already set down, in his paper “On psychotherapy”, his criteria for analysability, i.e., amenability to this rationally understood and powerful new tool for mental therapy. The criteria there stated are those that have always marked our conception of the “good analytic patient”—one who suffers from a chronic neurosis of the kind classically designated (by Freud) as a transference neurosis—who has “a reasonable degree of education … [and] a fairly reliable character” (1905, p. 263), who is well motivated (“driven to seek treatment by their own sufferings”, ibid.), who is beyond adolescence but still in the prime of adulthood, is not in any situation of emergency, and who possesses a “normal mental condition” (ibid., p. 264) (Eissler’s [1953] “normal ego”¹), that is, is not suffering, in Freud’s language, from psychosis, states of confusion, or deeply rooted depression. By implication—and in contrast—psychoanalysts had little or nothing to offer to patients not suited to the classical analytic method, beyond the same varieties of suggestive and hypnotic techniques that their non-analytically informed confrères employed.

It is this view, that proper psychoanalysis (“classical psychoanalysis”) directed at the amenable classically psychoneurotic patients (those suffering from hysterias, phobic states, or obsessional disorders) was the only truly scientific and curative psychotherapy available, that pervaded the period extending over most of Freud’s working lifetime. And it was reinforced by a number of articles, especially by Ernest Jones (1910) and Edward Glover (1931, 1954), which drew even more sharply the distinctions between psychoanalysis as an etiologically-directed and curative therapy and all other psychotherapeutic interventions, dismissed as but various species of outmoded suggestion. This viewpoint was carried to its furthermost by Glover as late as the 1954 article. He said then: “A further case exists: should the analyst’s interpretations be consistently inaccurate then quite clearly he is practicing a form of suggestion, whatever else he himself may call it. It follows then that when analysts differ radically as to the aetiology or structure of a case—as they nowadays do with increasing frequency—one side or the other must be practicing suggestion” (1954, p. 394). But Glover had earlier softened the blow: “bad analysis may conceivably be good suggestion” (1931, p. 407).

We all know of course that Freud’s fervent efforts to maintain his psychoanalysis as a theoretically coherent and unitary understanding of mental functioning, and a clinically unified vehicle for ameliorating the disorders of mental functioning, were not sustained, even in his lifetime, despite his creation in 1910, together with his followers, of the International Psychoanalytical Association (IPA), established at the second International Psychoanalytical Congress, held that year in Nuremberg,² and the creation two years later, in 1912, of the “Secret Committee” of the seven ring-holders; both of these moves being efforts to guarantee the stability of his central psychoanalytic doctrines against fractious divisiveness from within, and against diluting or hostile pressures from without. In this way, Freud and his continuing closest adherents sought to ensure the enduring capacity and loyalty to their reigning conceptions of all those who carried the psychoanalytic imprimatur.

The developments that undid Freud’s efforts to maintain this bounded unitary and unified theory and technique of psychoanalysis took place in two directions, distinct, but also complexly interrelated; (1) the rise, beginning with the Kleinian movement, even in Freud’s lifetime, of alternative metapsychologies, posing differing visions of the essential theoretical structure of psychoanalysis with then differing technical applications, unto today’s widely acknowledged diversity (or pluralism, as we call it) of theoretical perspectives; and (2) the derivation, out of psychoanalytic understanding, of modified and altered techniques—called expressive and supportive psychoanalytic psychotherapies—adapted to the clinical exigencies of the vast spectrum of mental patients not amenable to the “classical” psychoanalytic techniques devised by Freud, i.e., “sicker” or beyond the traditionally psychoneurotic.

I have written about both these developmental directions at length, in a sequence of articles (Wallerstein, 1988, 1989, 1990, 2002), and in two books (1992, 1995). Here I will trace, very briefly, relevant aspects of one of these developments, the historical growth and unfolding of psychoanalytically informed psychotherapy based on the psychoanalytical theoretical understanding of mental functioning, but with the modified and altered techniques necessary to bring the wider spectrum of psychopathological disorders, not amenable to proper psychoanalysis, within our therapeutic orbit.³ It is in this framework that I can then place the signal contribution to psychoanalysis propounded by Veikko Tähkä, to whom this volume is dedicated, in a sequence of articles and then developed most fully in his masterful volume, Mind and its Treatment: A Psychoanalytic Approach (1993).

Actually, psychoanalytic psychotherapy as we have come to know it was, at the start, a distinctively American development.⁴ For various reasons of historical and social context, which I have spelled out in detail elsewhere (Wallerstein, 1974, 1980), and with whatever degree of credit or blame we wish to attribute to the defensive responses of Freud and his followers, or to the hostile reactions of an unreceptive academic and intellectual milieu fearful of the Freudian idea, however we wish to parcel out the responsibility for the developing state of affairs, the fact is that psychoanalysis grew up in its European heartland essentially outside psychiatry, medicine, and academia—a major intellectual–educational enterprise run as a private night school carried on the tired energies of part-time men and women after working days spent in full-time clinical practice.

This was precisely the fate that the American psychoanalysts, swollen by the tide of Hitler refugee analysts in the 1930s which propelled America into the majority centre of organized psychoanalysis in the world, sought successfully to avoid. And in the post-Second World War decades of the 1950s and 1960s, this quest succeeded brilliantly; as the prior generation of Adolf Meyer-trained “psychobiological” psychiatrist⁵ chairs of departments of psychiatry in the nation’s medical schools came to retirement, full-time academic psychoanalysts were avidly sought to replace them, with the expectation of ensconcing psychoanalytic theory as the prevailing psychology of psychiatry, and applied psychoanalytic techniques as the prevailing therapeutic. But in this setting the psychoanalyst department chairs, and the supporting psychoanalysts brought in as teachers and supervisors, were confronted with the patient populations of the medical schools’ psychiatric hospitals and out-patient clinics, a more diverse and a sicker population than the out-patient psychoneurotic patients in the European analysts’ consulting rooms around whom the technical precepts of classical psychoanalysis had been originally elaborated by Freud and his colleagues.

It is in the adaptation of psychoanalytic understandings to the clinical exigencies of this new, sicker patient population, ranging all the way to the hospitalized overtly psychotic, that the principles of the psychoanalytic psychotherapies, in all their more expressive and more supportive forms, were elaborated. This in itself is a long and complicated developmental unfolding, which I have chronicled at length elsewhere (Wallerstein, 1989, 1995), in which some of the central names were, first, Robert Knight, Leo Stone, Merton Gill, Leo Rangell, Franz Alexander, Frieda Fromm-Reichmann, Edward Bibring, and Anna Freud, and then shortly after, Hans Loewald, Elizabeth Zetzel, and Ralph Greenson, to be followed then by the generation of Heinz Kohut, Otto Kernberg, and John Gedo, among many others. It is of note that in this listing of the major figures in the development of a distinctive psychoanalytic psychotherapy, linked to, and derived from, psychoanalysis proper, only Anna Freud, who was of course closely linked, theoretically and clinically, to the ego psychology metapsychological paradigm architected by Hartmann and his collaborators in America, did not work in the United States.⁶

Very briefly, I can summarize this large volume of work—many contributors over a several-decade time span—under two temporal time frames, the earlier, centring around three panel discussions held sequentially at the meetings of the American Psychoanalytic Association, and all published together in one issue of the Journal of the American Psychoanalytic Association in 1954, which I have described in detail elsewhere (Wallerstein, 1989, 1995) under the rubric, “the era of consensus”, and the second time period, encompassing work during the 1970s and 1980s (also in Wallerstein, 1989, 1995), in what I have called “the era of fragmented consensus”. It is during that second period that Veikko Tähkä emerged as a central protagonist with a distinctive hierarchical and developmental model of the nature of mind and the treatment of the disorders of mind, in which the parameters of psychoanalysis proper as conceptualized for classically neurotic patients have been modified and extended “beyond interpretation” in order to encompass sicker and more disorganized patients within the purview of psychoanalytic understanding, where it becomes a matter of arbitrary choice as to where along this spectrum one wishes, for conceptual or heuristic reasons, to state that one has crossed the border into the realm of psychoanalytic psychotherapy. In fact, with Tähkä’s scheme, the designation psychoanalysis or psychotherapy hardly seems to matter—the entire theoretical conceptualization is indubitably psychoanalytic. More about that in explicit detail later.

First, some words about the preceding “era of consensus” out of which the work of Tähkä and all the other diverging directions emerged. In the earlier period—the 1940s and 1950s, starting with the pioneering papers of Robert Knight⁷—the aim was to clearly delineate psychoanalytic psychotherapy from the psychoanalysis from which it derived, as a distinctive technical modification of classical psychoanalytic therapy, geared to the clinical exigencies of those patients who were “sicker”, that is, beyond amenability to psychoanalysis proper, and/or also those patients whose life difficulties could be ameliorated without the need for the full psychoanalytic unravelling of the total life experience back to the early infantile oedipal configurations.

The first of these two groups, in the words of Merton Gill (1954) the “sicker” patients, would be candidates for a more supportive psychoanalytic psychotherapy, and the second group, “weller” patients (with more situationally based neurotic difficulties) would be candidates for a more expressive psychoanalytic psychotherapy. And with all of these, the effort would be to demarcate the distinctive characteristics of the three separable treatment modalities, psychoanalysis proper, expressive psychoanalytic psychotherapy, and supportive psychoanalytic psychotherapy, to clarify their similarities and their differences, and to specify their distinctive (and different) aims, technical implementations, and expected outcomes. That was essentially the majority consensus in the 1950s, based on the sharpening of distinctions. There was at the time a distinct minority, Franz Alexander and his followers, and Frieda Fromm-Reichmann (1950) and her followers, who were intent on blurring these distinctions, but they were essentially marginalized within the prevailing ego psychology metapsychological paradigm, monolithically regnant in American psychoanalysis at the time—when the Americans still represented the majority of the institutionally organized psychoanalytic world.

But it was also this majority consensus that fragmented over the succeeding twenty-five years, partly out of the growing preoccupation with categories of patients not encompassed within the classical psychoanalytic tradition (Kohut’s work with the narcissistic personality disorders, Kernberg’s work with the borderline personality organizations, etc.), and partly out of the growing recognition within American psychoanalysis of the theoretical diversity or pluralism that had come to characterize worldwide psychoanalysis, beginning with the Kleinian movement in Britain, and followed by the growth of the British object relational school (based on Fairbairn and Balint and Winnicott and Bowlby and many others), the Bionian extension of Klein, the Lacanian and, even in America, the creation of Kohut’s self psychology and Mahler’s developmental perspectives, as well as the particular hermeneutic emphases of Ricoeur in France and Habermas in Germany, and others as well.

And within the fragmenting of the earlier (American) consensus on the nature of the relationship between psychoanalysis and the related and derived psychoanalytic psychotherapies, one of the major voices that emerged, articulating an integrated hierarchical and developmental overview, bringing the therapeutics of the whole range of technical approaches across the entire psychopathological spectrum from the highest function, classically psychoneurotic patients all the way to the disorganized psychotic patients, within an overall psychoanalytically understood and conceived framework, was the Finnish psychoanalytic leader, Veikko Tähkä. A member of the first generation, pioneering psychoanalytic community in his native land, and deservedly the first president of the Finnish Psychoanalytic Society, Tähkä’s various writings, and especially his already mentioned 1993 book, propelled him into an internationally recognized orbit as among the powerful voices redefining the relationship of psychoanalysis to the derived psychoanalytic psychotherapies in the era I have called that of the “fragmented consensus” (roughly, the 1970s and 1980s).

I had come to know Veikko Tähkä somewhere along the line, perhaps from reading his earlier work in the Scandinavian Psychoanalytic Review (published in English), perhaps during one of his two periods of sojourn in America, at the Austen Riggs Center (where Robert Knight had been the Director), in Stockbridge, Massachusetts. Out of our acquaintance and our shared deep interest in these issues—theoretical, clinical, technical—in psychoanalysis vis-à-vis psychoanalytic psychotherapy, Veikko asked if I would write the Foreword for his impressive 1993 book, an assignment that I accepted with pleasure, and which indeed gave me the opportunity to study in detail and to comment upon his masterful synthesis of a professional lifetime of creative and insightful thought on these very important psychoanalytic issues of such concern to both of us.

And I have thought that I can best carry out the assignment I have undertaken in contributing to this Festschrift in Veikko Tähkä’s honour, in celebration of his eightieth birthday, by providing my overview of his major contribution to this field of joint concern and of signal importance—drawn in very significant ways by direct quotations from his writing—and setting it then into the context of present-day discourse on these issues that have centrally concerned our discipline for over half a century now; that is, over the whole of both our professional lifetimes.

Actually, the main thrust of Veikko Tähkä’s book was presaged in a 1979 article published in the Scandinavian Psychoanalytic Review. There he carried his views distinctively beyond Freud’s original conceptualization—which I have outlined at the beginning of this chapter—of the nature of our psychoanalytic enterprise and its therapeut...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ACKNOWLEDGEMENTS
• CONTRIBUTORS
• FOREWORD
• CHAPTER ONE Psychoanalytic understanding and psychoanalytic therapy: Veikko Tähkä’s contributions
• CHAPTER TWO A Festschrift for Veikko Tähkä—2003
• CHAPTER THREE “Dissidence” in psychoanalysis: a psychoanalytic reflection
• CHAPTER FOUR Illusion and reality in the psychoanalytic relationship
• CHAPTER FIVE On transference: an historical and present-day perspective
• CHAPTER SIX Actualized unconscious fantasies and “therapeutic play” in adults’ analyses: further study of these concepts
• CHAPTER SEVEN The past in the present: a case vignette
• CHAPTER EIGHT Sexualities and neosexualities
• CHAPTER NINE Father makes a difference. The development of the son
• CHAPTER TEN Dreams in the therapeutic relationship
• CHAPTER ELEVEN A brief inquiry into the value of man
• CHAPTER TWELVE The religions of health and beauty
• CHAPTER THIRTEEN Descartes’ cogito as a model of reality
• CHAPTER FOURTEEN The conceptual space of psychoanalysis
• CHAPTER FIFTEEN On the conditions of understanding. Reflections from the patient’s point of view
• CHAPTER SIXTEEN On the idea of a new developmental object in psychoanalytic treatment
• CHAPTER SEVENTEEN When mother wasn’t there to be left From functional to developmental object: a case report
• SCIENTIFIC BIBLIOGRAPHY: Veikko Tähkä, M.D.
• INDEX