The Schema in Clinical Psychoanalysis

Joseph W. Slap, Laura Slap-Shelton

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781317771586
• Topic: Medicina
• Subtopic: Psichiatria e salute mentale

Slap and Slap-Shelton proffer the schema as the basis of an internally consistent and clinically relevant model of the mind. Wedded to the dynamic and genetic points of view, the schema model accommodates the clinical realities of trauma, repetition, and sublimation while dispensing entirely with the abstract concepts of traditional metapsychology.

CHAPTER ONE

Trauma and Neurosogenesis

It is our thesis that psychoneurosis is a manifestation of the activity of a pathogenic organization of childhood residues at the core of which is some traumatic situation or circumstance. The organization, which we term the sequestered schema, consists of a central traumatic issue along with reactive fantasies and associated affects. Such an organization may be dormant; if it is active and produces psychopathology, we regard it as a pathogenic schema. Insofar as the pathogenic schema is active, relationships and events are cognitively processed according to this template rather than being treated objectively by the more realistic and adaptive part of the mind. In this way, subsequent experience is assimilated by this organization.

Case Illustration

The patient was a graduate student working as an intern in the local office of a national publication. In addition to writing assigned articles, his task was to generate ideas for articles. He thought of doing a story on a new concept in his major field of study. His proposal was accepted, and he was given permission to travel for the purpose of interviewing professionals prominently associated with this concept.

His first write-up was accepted and sent on to the head office. There the editors approved his story with some recommendations for change, which reversed changes he had made at the behest of the local editor. The revised version was accepted by the head office with high praise and without further change. He was informed that, when published, his article would be a lead story.

The patient was elated with his achievement. The following day he was given an assignment that was not challenging (he rated it “middle brow”) but found that he was having trouble researching and organizing it. He began to doubt himself. More disturbingly, he began to have regressive feelings (yearning for his mother) that were reminiscent of an incapacitating breakdown he had suffered a few years previously, and he became concerned that he was becoming seriously ill once more. During this crisis it became apparent that the patient had experienced the same sequence of events at the time of his breakdown. He had published an article in a journal that prompted a publishing house to approach him about the possibility of expanding his ideas in a book. He had reacted with jubilation, grandiose fantasies of financial success and fame, inhibition, anxiety, and regression.

The patient’s father was a highly placed editor in another national publication. The mother was an intelligent, educated woman who had remained in the home until the children were raised. The patient was the oldest of three boys. From his material it was apparent that the births of his siblings had been severely traumatic for him. He had felt betrayed by the mother for having the babies, and he felt excruciatingly inadequate when he compared himself with his father. He had to contain his rage against his parents and brothers and dealt with his sense of impotence by driving himself to be a superachiever. He had an outstanding high school and college record and went on to the most prestigious graduate school in his field. In high school he had been a varsity athlete and pursued his sport until it became apparent that his physical development was such that he could not hope to compete on a national level.

In this case the pathogenic schema might be outlined as follows: “Father is big and powerful and has a large organ with which he satisfies mother and makes babies while what I have is nothing; I cannot tolerate this, and I will find a way to surpass father and make him weak and inadequate; if I think this or try to do this, I will be severely punished; I had better back off and become a baby again and be close to mother in this way.”

Thus we see that this schema was active in his late adolescence and early adulthood; his publishing successes were perceived as the realization of the fantasy that he would become great and powerful and surpass his father; he reacted to this fantasy with a fear of reprisal and beat a retreat by becoming inhibited in his work and ultimately by regressing to a dependent, clinging attitude toward his mother.

Although the patient’s material did seem to indicate that the birth of the siblings had been significantly traumatic and had led to the formation of this pathogenic organization, other events, such as primal scene experiences, likely played their role. The patient may or may not have been destined to become neurotic even if no siblings had been born. It is difficult to reconstruct such matters precisely. Nonetheless, for this patient there was the central traumatic issue of abject inadequacy in reaction to which he developed various fantasies that became part of an enduring organization.

What Is Meant by Schema Theory?

In this volume we shall discuss at length the theoretical and clinical relevance of the schema concept in psychoanalytic thought. We do not claim the theory to be original in the sense of our having “discovered” the concept of the schema. The idea of the schema as a psychological entity can be dated back to Bartlett in 1932. Ideas suggestive of the schema model have existed for even longer (Freud, 1895; Janet, 1906). The schema model presented here grew out of a two-fold need 1) to develop a working model of the mind that better fits the clinical data of psychoanalysis, and 2) to create a more parsimonious and consistent theoretical model of the mind than the structural model currently provides.

Psychoanalytic theory has consistently attempted to explain and describe psychic structures, their genesis, and their role in neurosogenesis. Freud (1923) wrote of the ego’s being built out of identifications with significant figures. Since then the concepts of identification, incorporation, introjection, and internalization have been developed to explain the building of various psychic structures. Nunberg (1948) proposed the synthetic function of the ego. Kernberg (1967) wrote of the metabolizing of parental images, and Kohut (1971) wrote of transmuting internalizations as the source of structure building. It is hoped that the schema model, which broadly encompasses these theories, may offer a conceptual organization that brings into relief the features of the concepts of psychic structure and organization relevant to the treatment situation.

Although many psychoanalysts (e.g., Arlow, 1969a; Klein, 1976) have noted the presence of organized and persistent, yet repressed, psychic structures that appear to contain elements of fantasy, memory, and drives, no one has been able to incorporate such organizations into a cohesive psychoanalytic model of the mind. These organizations have been described as film clips that organize a person’s perception of current reality along the lines of a traumatic period in the person’s life; they have also been called complexes, motifs, templates, scenarios, configurations, and scripts. We are defining pathogenic schemas as organizations of memories, fantasies, theories of procreation and gender determination, primitive defenses, moral values, and other elements that, by virtue of their pressure and activity, give rise to symptoms and other influences on a person’s experience and behavior (Slap, 1986). We propose that neurotic behavior results when such repressed organizations interfere with the ego, by which we mean the “dominant mass of ideas” (Breuer and Freud, 1893–1895, p. 116) or the person’s integrated perception of self, knowledge, talents, goals, and moral codes. In this chapter we lay the groundwork for a deeper understanding of the schema model and its roots in early and current psychoanalytic theory. We discuss the nature of neurotic fantasy formation with regard to both the concept of trauma and the evolution of the psychoanalytic conceptualization of the psychic apparatus.

Early Theories of Neurosogenesis: Hysteria and the Idea of a Double Consciousness

In the years preceding Freud’s initial psychoanalytic theories, physicians, and particularly neurologists, were intrigued with the phenomenology of psychopathology, which came to be understood under the rubric of the hysterias. Many physicians at that time were practicing variations of hypnotism as a means of treating these maladies. This practice led to the observation that many behaviors relating to childhood traumas reappeared during such altered psychic states and that altering the suffering person’s level of consciousness at times appeared to bring about an alleviation of symptoms (Bliss, 1986; Breuer and Freud, 1893–1895; Janet, 1906). It was from the study of patients with hysterical symptoms of all types that the earliest theories about the mental apparatus arose. And it was in this period that a major theoretical shift away from purely physiological explanations for psychopathology occurred. Freud is quoted as having said that “Charcot used to say that by and large anatomy has finished its work and the theory of the organic diseases might be called complete; now the time of the neuroses has come” (Gay, 1988, p. 52).

One of Charcot’s contributions to the formulation of the understanding and treatment of neuroses was making hypnotism a legitimate medical practice (Gay, 1988, p. 50). Another was the rejection of the idea that only women were hysterical and that the disease was due to a disorder of the uterus. In Studies on Hysteria, Breuer and Freud (1893–1895) elaborated their theory of the underlying cause of hysterical symptomatology. There they set forth the famous premise that “hysterics suffer mainly from reminiscences” (p. 7). At this time they were using hypnosis as a therapeutic intervention designed to help the patient remember a traumatic event.

In the great majority of cases it is not possible to establish the point of origin by a simple interrogation of the patient. … This is in part because what is in the question is often some experience which the patient dislikes discussing; but principally because he is genuinely unable to recollect it and often has no suspicion of the casual connection between the precipitating event and the pathological phenomenon. As a rule it is necessary to hypnotize the patient and to arouse his memories … of the time at which the symptoms first made their appearance [p. 3].

Breuer and Freud reviewed the panoply of hysterical symptoms commonly encountered in the clinical practice of that period, including anesthesias, neuralgias, epilepsy, and narrowed visual fields. They wrote that in some cases the connection between the precipitating event and the pathological behavior is not entirely obvious, but may be symbolic. An example would be having the sensation of nausea secondary to feeling moral reprehension. This symbolic process was considered to occur in the dreams of healthy people. Breuer and Freud introduced the idea that hysteria was analogous to what they termed the traumatic neuroses (p. 5). To the traumatic neuroses were reserved those mental disturbances created by exposure to a situation that created the affect of extreme fear. This fear was considered to be the psychical trauma and was differentiated from the physical trauma of the event. In their view, hysteria could also be explained as stemming from other unpleasant affects: “Any experience which calls up distressing affects—such as those of fright, anxiety, shame or physical pain …” (p. 6) may lead to a psychical trauma that may yield symptoms. The trauma need not be a single trauma; it could be the sum of many smaller disturbances acting together.

This idea of a summed group of experiences that produces the disturbed behavior is akin to the concept of the pathogenic schema. The pathogenic schema is considered to be made up of disturbing events or situations and related circumstances, ideas, fantasies, and associated affects; since this organization tends to interpret current life events in accordance with its own template, later life events and relationships are accreted to the pathogenic schema.

Breuer and Freud postulated that the real pathogenic element in these traumatic hysterias was the memory of the trauma, which “acts like a foreign body which long after its entry must continue to be regarded as an agent which is still at work” (p. 6). They felt that a memory or collection of memories became separated from the main body of ideas and acted independently to create pathology. They described the splitting of consciousness created by the suppression of a memory and the tendency to dissociate as the underlying basis for the manifestation of hysterical behavior (p. 12). Further, once split off from the general consciousness, this idea attracted or came into association with subsequent ideas or experiences, which then also became repressed:

It turns out to be a sine qua non for the acquisition of hysteria that an incompatibility should develop between the ego and some idea presented to it. … The actual traumatic moment then, is the one at which the incompatibility forces itself upon the ego and at which the latter decides on the repudiation of the incompatible idea. That idea is not annihilated by a repudiation of this kind, but merely repressed into the unconscious. When this process occurs for the first time, there comes into being a nucleus and centre of crystallization for the formation of a psychical group divorced from the ego—a group around which everything which would imply an acceptance of the incompatible idea subsequently collects [pp. 122–123].

This conceptualization of neurosogenesis is consistent with the schema theory’s understanding that a sequestered schema that contains memories and fantasies related to a traumatic event continues to take in and organize or assimilate new events according to its original infantile organization.

In their “Preliminary Communication,” Breuer and Freud described the pathological behaviors as appearing in hypnoid states. In these states ideas were intense, but were cut off from association with the major portion of consciousness. Breuer and Freud indicated that though some patients may have been predisposed to experience these hypnoid states, and thus were vulnerable to dissociative episodes, others acquired dissociative states in response to severe trauma, as well as from difficult and sustained suppression of sexual wishes. The latter two pathogenic factors were described as bringing about “a split-off of groups of ideas even in people who are in other respects unaffected” (p. 12).

Breuer and Freud reported that they were able to cure hysterics by having them recall the traumatic or causative event in a state of hypnosis. In the hypnotic state the patient could be induced to recall the event or events complete with the associated affects. This reexperiencing of the event and its affects allowed the experience to come into association with the general mass of conscious ideas. Once this occurred, the disruptive power of the memory greatly diminished. In “The Psychotherapy of Hysteria” (Breuer and Freud, 1893–1895, pp. 255–305) Freud reported his dissatisfaction with hypnosis as the means of cure, with the central importance of the hypnoid state, and with the separation of hysteria from the other neuroses. He wrote that it was not accurate to consider hysteria as a single entity and that in most cases it was part of a larger neurosis such as an anxiety neurosis or a sexual neurosis (p. 259). He introduced the idea of resistance and censorship, which in all cases of neurosis led to blocked memories and affects. In doing so, he opened to the entire range of psychopathology a single underlying mechanism that could account for disturbances in consciousness caused by the repression of memories, ideas, and fantasies that were in some way related to traumatic or disturbing experiences. An idea that was unacceptable to the ego was defended against by a censorship that denied it access to consciousness. It was the forcing away of the idea that gave the idea its pathogenic power. The very power that forced the idea away was understood to still be in operation when the patient was in therapy.

The patient’s ego had been approached by an idea which proved to be incompatible, which provoked on the part of the ego a repelling force of which the purpose was defense against this incompatible idea. … If I endeavored to direct the patient’s attention to it, I became aware, in the form of a resistance, of the same force as had shown itself in the form of a repulsion when the symptom was generated [p. 269].

With the discovery of the resistances, Freud introduced the additional proposal that some aspect of the personality was actually willing this resistance in order to avoid processing the unwanted idea. While the patient may want to be helped, unconscious forces continue to work to prevent unpleasant experiences. This theory set the course for further explorations into the nature of the conscious and unconscious. The role of the trauma in the creation of neurosis had been the key to the understanding of hysterical symptoms. With the understanding that the memory of the trauma, rather than the trauma itself, was the main block in the path of recovery, trauma began to be understood as an external factor that could unleash inner disturbances. The nature of these inner disturbances became a major focus of Freud’s work. The importance of reactivating memories by making them conscious led to continued theorizing about the psychic apparatus and the way in which internal and external experiences attained consciousness.

The Topographic Model

The antecedents of the topographic model can be found in Freud’s “Project for a Scientific Psychology” (1895). This early model was loosely based on neurophysiological functioning as it was understood in Freud’s time. Behavior was defined as the outcome of the attempt to discharge tensions created by inner and external forces. The need to find appropriate means to discharge tension was also a motivational force that generated behavior. Inner tensions were described in terms of psychic energy, which later was understood to be derived from sexual forces and was defined as libidinal energy. If tensions were too great, symptomatic behaviors inappropriate to the environment resulted. By 1896 Freud (1887–1902) had defined the elements of the topographical model. He wrote that memory traces were transcribed several times before becoming conscious. The transcriptions took place at three levels: Perceptual signs (Pcpt.-s), the unconscious (Uc.), and the preconscious (Pc.). Memories were not directly or consciously perceived. They were recorded in the unconscious according to the principle of contiguity in time and then organized by the unconscious into meaningful units. They obtained consciousness by becoming linked with verbal images. The conscious was understood to be a sensory organ that perceived only transcribed information that originated in the unconscious.

With “The Interpretation of Dreams” Freud (1900) introduced the topographic model. The idea of the preconscious was carried over from the model described in “The Project.” Also consistent with his early theory was the understanding that new information was initially unconscious and became conscious only after passing through censorships that could disguise disturbing material in such a way that it could emerge in the preconscious and gain consciousness. The psychic apparatus of the topographical theory changed over time. In its final version, before Freud’s creation of the structural model, it consisted of the conscious, the preconscious, and the unconscious. At times the conscious and the preconscious were used interchangeably, and at one point the Cs. was assigned to the ego (Gill, 1963, pp. 27, 31, 32). The Pcs, and Cs. were assigned the properties of control of consciousness, motility, affects, some aspects of memory and censorship, and reality testing p. 27). The unconscious was understood to contain two different categories of unconscious material. One was material that remained in the unconscious owing to normal inhibition or repression. The other was material that had been defensively excluded from consciousness and could under certain circumstances attain consciousness (Freud, 1900, pp. 614–615; Gill, 1963, p. 10). Eventually the unconscious became more identified with the dynamic unconscious.

In describing these various structures and the process of transcription of material from the unconscious to the conscious, Freud warned against visualizing them as space-occupying entities. He introduced the idea that images or mental groupings are transcribed through different processes that he described as structure...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• Preface
• 1. Trauma and Neurosogenesis
• 2. The Schema Concept in Psychodynamic Theory
• 3. The Schema Model
• 4. Clinical Exposition
• 5. Dreaming, Transference, Working Through, and Other Psychoanalytic Concepts
• 6. Treatment
• 7. The Schema Model and the Structural Model
• 8. The Schema Model and the Self
• 9. A Note on Self-Analysis and Some Questions Frequently Asked About the Schema Model
• References
• Author Index
• Subject Index