Influence and Autonomy in Psychoanalysis

Stephen A. Mitchell

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317771197
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Stephen A. Mitchell has been at the forefront of the broad paradigmatic shift in contemporary psychoanalysis from the traditional one-person model to a two-person, interactive, relational perspective. In Influence and Autonomy in Psychoanalysis, Mitchell provides a critical, comparative framework for exploring the broad array of concepts newly developed for understanding interactive processes between analysand and analyst. Drawing on the broad traditions of Kleinian theory and interpersonal psychoanalysis, as well as object relations and progressive Freudian thought, he considers in depth the therapeutic action of psychoanalysis, anachronistic ideals like anonymity and neutrality, the nature of analytic knowledge and authority, and the problems of gender and sexual orientation in the age of postmodernism. The problem of influence guides his discussion of these and other topics. How, Mitchell asks, can analytic clinicians best protect the patient's autonomy and integrity in the context of our growing appreciation of the enormous personal impact of the analyst on the process?

Although Mitchell explores many facets of the complexity of the psychoanalytic process, he presents his ideas in his customarily lucid, jargon-free style, making this book appealing not only to clinicians with various backgrounds and degrees of experience, but also to lay readers interested in the achievements of, and challenges before, contemporary psychoanalysis. A splendid effort to relate parallel lines of theorizing and derivative changes in clinical practice and informed by mature clinical judgment and broad scholarship into the history of psychoanalytic ideas, Influence and Autonomy in Psychoanalysis takes a well-deserved place alongside Mitchell's previous books. It is a brilliant synthesis of converging insights that have transformed psychoanalysis in our time, and a touchstone for enlightened dialogue as psychoanalysis approaches the millennium.

CHAPTER 1
INTRODUCTION

From Heresy to Reformation

Over the course of its century-long history, psychoanalysis has generated many different psychological understandings of the workings of the human mind. Of these, there are two understandings that are most important, most foundational to the entire psychoanalytic enterprise. The first, which we owe to Freud's earliest clinical explorations, is that the mind of an individual is extraordinarily complex, that there is much more going on in the mind of each of us than we are even dimly aware of. This is generally referred to as the discovery of the unconscious. The second, which was developed extensively in the second generation of psychoanalytic theorizing, particularly in the work of Harry Stack Sullivan and the American interpersonal school and Melanie Klein and her intellectual descendants, is that the apparent boundaries between individuals are much more permeable than they appear to be and that everyone handles threatening, disturbing fragments of mental complexity by locating and experiencing them in other people.

Analytic experience has taught us that people often employ a kind of externalization as an unconscious strategy for diverting attention from and controlling conflictual aspects of their own experience. That which is perceived everywhere outside a person actually originates within him. Klein (1946) called this externalizing process "projective identification"; that is, we unconsciously locate a repressed segment of the ego, a sector of self, in others, whom we then straggle to control or to avoid. Harry Stack Sullivan (1956) called this externalizing process the dynamism of "specious ideals"; that is, whatever we do not want to experience in ourselves becomes something we are preoccupied with discerning and condemning in others (pp. 101-105). Thus, someone having difficulty experiencing himself as having sexual desires might very well perpetually bemoan the sinking sexual mores of our youth; someone having difficulty experiencing herself as having aggressive thoughts might join the crusade against violence in movies or even in diet. (I once heard a vegetarian describe himself as a "non-flesh-eater.") The perception of pervasive external badness and threat generally reflects, decades of psychoanalytic experience has taught us, an inability to deal with conflictual internal processes that are difficult to accept, to come to terms with, to integrate with the rest of the personality.

Whatever contributions psychoanalysis has made to understanding group processes (beginning with Freud's, 1921, classic study, "Group Psychology and the Analysis of the Ego") have been based on the principle that groups often display the same dynamics that we find in individuals, but writ large. If we consider the psychoanalytic community as a group, and if we look back on the history of psychoanalytic ideas from our current vantage point, it becomes apparent that a massive process of externalization has for many decades been a central feature within the mainstream of psychoanalytic thought.

The Heresy of Interactionism

There has been a largely unacknowledged feature at the heart of clinical psychoanalysis from its very inception, a feature that has been difficult to come to terms with, to integrate with other analytic principles; a feature that has been dealt with through externalization, so that it is detected as the telltale, sinister feature of many nonanalytic or discredited analytic treatments- This central, largely unacknowledged feature of psychoanalysis is its fundamentally interactive nature. Over and over across the history of psychoanalytic ideas, theorists and clinicians who have pointed to the importance of the analyst's participation in the analytic process, to the intersubjective nature of the analytic situation, have been isolated, as if with garlic cloves or fingers forming the sign of the cross. The debased form through which interaction is externalized and then detected in "fallen" analytic approaches is established through the incantation of the dreaded words: "suggestion," "reassurance," "interpersonal," "environmentalist" and "corrective emotional experience" (see, for example, Rangel, 1982; Kohut, 1984; Rothstein, 1983; Sugarman and Wilson, 1995; and Michaels, 1996). Until very recently, and still occasionally, this externalization process has been completed with the ultimate and final dismissal: "This is not really psychoanalysis." But, like all suppressed and projected mental content, the interactive nature of the psychoanalytic relationship keeps returning.

Consider the following clinical vignette.

Dr. Green, an experienced and skilled female analyst, has been working with Helen, a very difficult, easily bruised, quickly insulted patient for about a year. Dr. Green is also a mother, and her eight-year-old daughter is in a class that goes on trips every couple of weeks or so. The parents are strongly encouraged to go on at least one of these trips, and the analyst feels that it is important to her daughter that she go on one soon. Like that of most working parents, Dr. Green's life is fall of these conflicts. She decides that an upcoming trip a few weeks hence will be the one she will go on, and so Dr. Green notifies the patients she would normally see on that day and offers them alternative times.

All the patients accommodate to this change with no apparent problem, except Helen, who feels that she has been profoundly betrayed. Dr. Green simply cannot do this, she argues. It reflects a fundamental lack of caring for her and a professional irresponsibility to boot. Dr. Green patiently tries to explore Helen's fantasies about the reasons for this change. The reasons do not matter, Helen insists; it is a betrayal simply on the face of it. "Can't you imagine reasons that I would have to cancel?" Dr. Green asks, "Reasons that don't reflect a lack of caring or irresponsibility." "No," Helen insists. "It is obviously not a dire emergency, since it is planned three weeks ahead. Anything else, including medical appointments, should simply be scheduled at some other time."

Caught off-guard and feeling defensive, Dr. Green feels that there is a characteristically imperious, self-absorbed quality to Helen's perspective. She begins thinking in terms of primal-scene fantasies, oedipal rivalries, and so on and suggests to Helen that her intense reaction seems not commensurate with the situation. This interpretive judgment enflames Helen even more, adding insult (accusation) to injury (the clear betrayal). Luckily for Dr. Green, time is up, and she has a chance to collect herself and reconsider her approach.

Before the next session, Dr. Green took the opportunity to consult with a colleague about this situation. They discussed the year's analytic work: this patient had been severely traumatized as a child; it had been very difficult and risky for the patient to trust the analyst at all; important ground had been gained; and it was at just this point that the canceled appointment arose.

Thinking along developmental arrest lines (a la Winnicott and Kohut), Dr. Green shifted her stance in the next session and empathized with what she took to be Helen's experience of abandonment just at the point of increased trust and risk. This empathic response calmed the situation considerably, and this analytic couple was able to ride through the rescheduled appointment with no lasting damage. Everything seemed to be resolved, except for one problem. The stabilization of the situation allowed Dr. Green enough breathing room to reflect on these events, and she began to feel an increasing sense of bad faith on her part. The more she thought about it, the more she began to realize that Helen was right—Dr. Green had betrayed her. I do not mean "right" according to a trendy, leveling relativism, the frequently heard notion that whatever the patient feels is right within the patient's subjective reality and therefore that all convictions have the same truth value. Dr. Green began to realize that there was something in her decision to go on that trip at that time that did have to do with Helen (along with many other factors having nothing to do with her).

She realized that she had begun to feel extremely crowded by Helen and fearful of her demandingness. Dr. Green felt uncomfortably responsible for Helen; she wished she could be the good analyst/mother that the patient longed for and felt entided to. But she felt, understandably, that she would never be able to be that. She felt gratified by the recent successes of their work, but fearful of the increased expectations that went along with that success. She was struggling, out of awareness, with various claims on her and with her own conflicts about responding to those claims. There was, therefore, an element of satisfaction in scheduling the trip at this point. She realized retrospectively that it was as if she were telling Helen that the latter was not, in fact, her real daughter; she had another daughter, a real daughter, to whom she would grant priority. She was, perhaps more significantly, also demonstrating this priority to herself. So, while Helen's conviction that Dr. Green's actions constituted a betrayal and abandonment of her was not the simple, singular truth, neither was it simply wrong and a transferencial distortion.¹

Is this moment in this treatment representative of analytic work in general? Any honest presentation of clinical material becomes an easy target for critics, not operating in the heat of the moment, to point to technical lapses, overinvolvement, another, more "correct" interpretation that could have been delivered, and so on. But at heart, I believe that each critic knows that his or her work with each analytic patient contains the same stresses, the same interactive complexity, the same challenges found here.

If analytic work is deeply engaged, the patient always gets under the analyst's skin. (For a recent study of analysands deeply personal impact on their analysts, see Kantrowitz, 1996.) As Heinrich Racker (1968) demonstrated more than 30 years ago, a patient's dynamics inevitably resonate with the analyst's dynamics; the patient's struggles with universal, human conflicts resurrect the analyst's struggles with those same conflicts; the patient's internal world becomes tangled up with the analyst's internal world; and the therapeutic action is located in the dyadic, interactive field that they constitute together. As Lawrence Friedman (1988) has put it,

If treatment as written about seems so discursive and intellectual and neat and cool, perhaps treatment as it happens really works on the basis of what every psychotherapist feels daily: personal push and pull; nameless, theory-less, shapeless, swarming interaction

(p. 12).

The challenge for every analytic pair is to find a way for the analyst to establish a different sort of presence in the analytic situation, preferring neither remote interpretations nor unconditionally empathic acceptance. In the dyad in question, Dr. Green needs to be able to find a way to get the patient interested in the impact of her demands on others and the way it destroys virtually all her important relationships. To find a voice to speak about these issues in a way the patient can hear, Dr. Green has to struggle through her own conflicts over responsibility and fear, her desire to repair and her guilt about disappointing, the part of herself that is deeply needful and longing, and her conflicts between career and motherhood.

Interpretations are central to the therapeutic action, but it is not the content of the interpretations alone that is crucial. It is the voice in which they are spoken, the countertransferential context that makes it possible for the patient's characteristic patterns of integrating relationships with others to be stretched and enriched. To find the right voice, the analyst has to recognize which conflictual features of her own internal world have been activated in the interaction with the patient, to struggle through her own internal conflicts to arrive at a position in which she may be able to interest the patient in recognizing and struggling with her own (the patient's) conflictual participation. This makes the work, inevitably, deeply personal and deeply interpersonal.

Scientific Objectivity, Negative Identity, and Boundaries

The conceptual tools that psychoanalytic theory has had available for understanding the interactive heart of clinical work have, until recently, been woefully inadequate. This is largely because it has seemed very important to think about the analytic process precisely in a noninteractive way. There are several important historical reasons for this commitment.

First, in the world in which Freud fought to establish psychoanalysis as a new discipline, it was essential to present psychoanalytic theory and therapy as a science among other sciences. Like many progressive intellectuals of his day, Freud saw human understanding as falling into two broad classifications: science and religion. The latter, in Freud's view, was pervaded by fantasy and illusion. Beliefs were generated and adhered to because they were appealing to the believer. Science, Freud and his contemporaries thought, was different. Science operates according to rationality and reality. Scientific beliefs describe the world as it really is, regardless of what is appealing or frightening to the believer.

Scientific disciplines of Freud's day were based on the strict separation between the subject matter of scientific study and the detached, scientific observer studying that subject matter. If psychoanalysis was to be a science, it was necessary for the analyst to remain outside the field of study, the patient's mind. Hence, the psychoanalytic situation, Freud believed, is composed of the mind of one person being studied objectively by a detached observer.

Whether or not it is still useful to regard psychoanalysis as a science proper (as opposed, for example, to a hermeneutic discipline) has recently become a hody debated question. But even if one wants to regard psychoanalysis as a science, the implications of that claim today are very different from the implications in Freud's time (see Mayer, 1985) Contemporary philosophers of science regard the scientist/observer as more or less embedded in, and partially constructing, his understandings of the objects he is studying. The scientist/observer himself has now become part of the field of study. And whether or not one prefers to regard psychoanalysis as a science, it is now generally agreed on that there is no way for one person to study the mind of another without taking both minds and their interactive effects on each other into account. Of course, Freud cannot be faulted for assuming, like most others in his day, that science provides an objective, unedited access to reality. As Hans Loewald (1974) put it:

Freud does not appear to have recognized that the objective reality of science is itself a sort of reality organized (although not created in a solipsistic sense) by the human mind and does not necessarily manifest the culmination of mental development or represent any absolute standard of truth, as he assumed

[p. 364].

A second important reason for the powerful commitment, both conscious and unconscious, to suppress the interactive nature of the analytic relationship was that psychoanalysis was born of hypnotism. Just as persons develop counteridentifications with their parents to make room for a new, personal self, it was crucial for psychoanalysis to differentiate itself from its ancestor, hypnotism, and its reliance on the personal power and influence of the therapist.

The hypnotist cures through suggestion; the analyst cures through interpretation. Where hypnotism added influence, psychoanalysis removed historical influences; where hypnotism directed and shaped, psychoanalysis liberated and released. In Freud's (1905) compelling analogy, hypnotism operates like painting, adding pigment to canvas, whereas psychoanalysis operates like sculpture, removing unwanted material to reveal forms that had always existed beneath.

One of Freud's great teachers and heroes was Charcot, the brilliant, highly influential, and theatrical neurologist at the Salpêtrière in Paris, with whom Freud studied prior to his first psychoanalytic publications with Joseph Breuer. Freud admired Charcot's daring explorations, through the use of hypnotism, into the symptomatology of hysteria, and he named one of his children after his mentor. It is worth noting that by the time of his death in 1893, the same year of Freud's first specifically psychoanalytic publications, Charcot was widely discredited, and the charge was none other than "suggestion." It was discovered that the women patients whom Charcot used to demonstrate the flamboyant symptoms of grande hysteria had been coached prior to their performances. The symptoms that seemed to emerge spontaneously were, retrospectively, revealed to have been, at least in part, planted in the patients' minds through the doctor's suggestive influence.

Perhaps Charcot's fate served, for Freud, as a cautionary tale.² The problem of influence is at the heart of the struggles psychoanalysis has had with coming to terms with the centrality of the analyst's participation. Psychoanalysis has always placed fundamental value on guarding the patient's autonomy and self-direction throughout the analytic process. The use the patient makes of analytic exploration must, ultimately, be up to the patient. The use of hypnotism as a counteridentification has been comforting in this regard. It has allowed analysts to feel that their very methodology, unlike hypnotism, protects their patients from the problem of influence. It is as if the analysts' sitting behind the analytic couch rendered the patients invisible, much as the helmet Athena gave to Perseus made it possible for him to battle Medusa unseen. Analytic authors and clinicians who emphasize the interactive nature of the analytic relationship must quickly and necessarily confront the problem of influence, and, as we shall see in subsequent chapters, it is a bedeviling problem indeed. This is why these authors have quickly and summarily been branded "nonanalytic" and have been accused of practicing the black art of "suggestion." To acknowledge the two-person, interactive nature of the analytic relationship is to undermine the counteridentification with hypnotism through which psychoanalysis as a discipline was born.

The third important historical reason tor the traditional psychoanalytic commitment to a noninteractive understanding of the nature of the psychoanalytic relationship is one that analytic clinicians and writers have come to appreciate only recently. The psychoanalytic process is, by its very nature, so intensely interactional that it poses grave dangers to the constructive constraints of the analyst's participation. From the days of its inception to the present, psychoanalytic clinicians have struggled with the intense passions aroused by the analytic situation, and appropriate boundaries between analyst and patient have not infrequently been crossed.

Freud noted privately early on, in a warning to Jung, who was having complex problems in an analytic/romantic relationship with Sebina Spielrein³ that intense sexual and roma...