The Anatomy of Psychotherapy

Lawrence Friedman

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134877171
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Over the past decades, Lawrence Friedman has emerged as one of the most erudite and provocative theoriss in contemporary psychotherapy. The Anatomy of Psychotherapy interweaves Friedman's major contributions to the analytic and psychiatric literature with extensive new material in arriving at an extraordinarily rich and nuanced appreciation of psychotherapy.

The Anatomy of Psychotherapy describes how the therapist makes use of theories and styles in order to achieve equilibrium under stress. This stress, according to Friedman, is related to the "absolute ambiguity" that is essential to psychotherapy. To cope with this ambiguity, the therapist alternates among three different roles, those of reader, historian, and pragmatic operator. Friedman examines these "disambiguating postures" in detail, paying special attention to their bearing on the therapist's narrative prejudice, the relativity of his knowledge, and the relationship of his work to natural science and hermeneutics.

Brilliantly constructed and masterfully written, The Anatomy of Psychotherapy traverses the same basic themes in each of its six sections. Readers who are interested in theory can hone in on relevant topics or the work of particular theorists. Readers seeking insight into the demands of daily clinical work, on the other hand, can bypass the systematic studies and immerse themselves in Friedman's engrossing reflections on the experience of psychotherapy. Best served will be those who ponder Friedman's writings and therapy as complementary meditations issuing from a single, unifying vision, one in which psychotherapy, in both its promise and frustrations, becomes a subtle interplay among theories about psychotherapy, the personal styles of psychotherapists, and the practical exigencies of aiding those in distress.

IV
Debate About Theory of the Mind: Revisions

17
Introduction

In the first part of this book we watched an interplay between the therapist’s practical dilemmas and his theories. Naturally the part of theory that first came into view was theory of therapy.

But we then noticed that the diffracting lens that filters everything between patient and therapist is theory of the mind. And so, in Part III we set out to see what theory of the mind is. We selected Freud’s theory as the most complete one available; we looked for the schematic criteria that guided it; and we tried to understand how those abstract criteria satisfy practical, treatment needs.

In Part I we found that disputes show what is at stake in theory of therapy. In the same fashion, disputes can help us to see what is at stake in theory of the mind. Although few theories rival Freud’s in scale, there is no dearth of passionate criticism and partial revisions. We want to see what vital treatment issues hinge on these disputes. It will help make those treatment issues visible to us.

Revisions can be approached in so many different ways, that we could easily lose our path. Schisms are caused by many forces. Theory of the mind is subject to the same diverse influences we chose to ignore when looking at theory of therapy, including socioeconomic forces and institutional politics. But theory of the mind is subject to other vectors as well. Intellectual pride is not a negligible force. The last century saw breathtaking advances in the physical and biological sciences. Psychotherapists, like other “soft” scientists, are likely to feel that their theory is stagnant and out-of-date, and may hunt for where it went wrong.

If we add to this a shift in philosophical fashions we have the recipe for many recent critiques, as stated boldly in almost all of their introductions. But we should beware these philosophical declarations of intent. They may not do justice to the contributions that they introduce. After all, the philosophy of science is a camp follower, and a clumsy, inexperienced one at that. Few problems have been solved either by trying to “think scientifically” or by deliberately thinking unscientifically. Constructive theory probably arises from natural difficulties, even if its maker thinks it comes from a more grown-up world view.

I do not wish to oversimplify the path that leads from practical difficulties to theoretical innovations. Theory has its own momentum, which directs it even while it is interacting with practical problems. My point is that insofar as psychoanalytic revisions resemble current trends in philosophy, they may simply be going through the same periodic resifting of their subject matter that all theories engage in. Rather than building on new philosophical idioms, psychoanalysts may be reacting to their own last theory the way philosophers happen to be reacting to theirs. Both in psychoanalytic theory and in philosophy, there seem to be alternating cycles in which problems are first elaborated and then dismissed. One generation entangles itself with increasingly difficult answers to a riddle, and then the next generation announces that the tangle is unnecessary because there is really no riddle. Then the riddle gradually makes itself felt again, first here and then there, and before long, the process begins anew.

It seems to me that philosophy has traced three or four such cycles in matters of induction, substance, and abstraction. Psychoanalytic theories of the mind seem to be going through a few similar cycles. The best workers in the field once put enormous effort into Freudian exegesis, trying to smooth out Freud’s theory and piece it together seamlessly on the drawing board. There followed a tendency to dismiss the whole project as not, after all, just difficult, but fortunately unnecessary. We were told that theory of the mind is confusing only because it is the product of a confusion; something simpler is called for; we should start anew. We watch these new theories develop, and we see that the simpler picture needs a few finishing touches. A few questions are raised, and then a few more, and, creeping in again with different names, we spy elements that led to the Freudian complexity.

Not that we necessarily get back to the earlier stage. The Dialectic insists that we are wiser when we return. But we are probably wearier as well. Who will labor to erect a theory of the mind on the scale of Freud’s? Even if another such theoretical genius should come along, the hopefulness of the pioneer can never be recovered.

There is another, less dismal reason for this diminishing spiral of theoretical ambition. We have seen that Freud’s theory is comprehensive just because it is a mixed theory. It is mixed in all ways: It is a part/whole theory and a maturation theory. It is a dramatic theory and a causal theory. It is an abstract theory and a humanistic theory. It is not coherent on a single plane. It works by answering questions as they are raised. It cannot be set forth in a homogeneous fashion.

After every effort has been made to recast it in a linear fashion, the inevitable reaction to such a theory is to select one favorite phase to hold on to, and demolish the discordant others. But when theorists see that room has to be made for all of these ill-assorted schemas, will the prospect of building another, equally rambling edifice appeal to anyone’s architectonic instincts? Would Freud have gone so far so fast if he knew ahead of time that every answer he developed would be misleading except in the context of its development from his first guess to its final formulation?

But although we will probably never again see a full theory of the mind, there is considerable value in new beginnings and critical revisions. For one thing, a theory that is only elaborated and never shrewdly challenged will become a purely syntactic structure devoid of semantic content. (Nothing could have brought Freudian resistance theory to life again nearly as well as Schafer’s reformulation.) And for our investigation, we have special reason to thank the revisionists: The pendular swing of their allegience dissects for us the demands that the practice of psychotherapy makes on theory of the mind.

For even though psychoanalytic theorists are intellectuals, and hold themselves to high speculative standards, they are never disinterested theoreticians. The intensity, patience, and concern behind these revisions of Freudian theory could not come solely from a wish to make theory look better or sound more sophisticated, although the authors frequently ask us to believe that is their motive. Only a felt need, a professional disturbance, a mission that comes out of practice, could sustain these projects. It is clear that even the more “traditional” of these revisions makes a difference in practice— a difference that should be respectfully charted.

With that conviction, we must wrestle with these innovative theories until we can feel some of the fissiparous pulls of practice that had been cinched together in Freud’s theory of the mind and now claim special attention.

Of course, if these theories are simply better theories, they might not show us anything about the practice of therapy. They might only show us that therapists now think better than they used to. And because that is what these revisions claim, we must examine them first as rivals for the throne. Having done that, and concluded that they are not, we can use them more interestingly as mirrors of the therapist’s dilemmas.

II

Some reforms struggle to make psychoanalysis more scientific. Others, disappointed in its truth claims, cut bait and abandon scientific pretensions. But whether promising more or less “science,” what the revisions all have in common is a suggestion that theory of the mind has been living in its own world, and some way must be found to reconnect it with reality.

It is impossible not to sympathize with the effort to catch freely flying theory and hold its nose firmly to the real, definite and demonstrable ground. For this laudable purpose, theoreticians use a wide variety of styles. They may insist that we talk about persons and action, or they may insist that we talk precisely about introspectively evident representations, or they may talk demonstrably about body feeling, or they may talk plainly about the self, or humbly about perspectives. These are very different things, but they are all vivid and ordinary. We are invited to compare them with the unreal, esoteric “things” of psychoanalytic theory, and see how far psychoanalytic theory had strayed from the stuff it wanted to explain.

A rebellion against abstraction is in progress, and a longing for concrete items. By and large, what the revisionists do is to palm the discarded abstractions that are necessary for understanding, and use them (without credit) in isolating their concrete items and in talking about those items. Although the revisions start out from many different positions, they all move toward presenting the mind as an organic whole, which is easily identified with concrete reality, and compared with which any generalization or abstraction is artificial and arbitrary, all theory a distortion. That is the trend we will see in the following chapters.

The reader will observe this convergence of dissimilar revisions when he compares Peterfreund’s theory with Gendlin’s. When we first see it, Peterfreund’s theory looks concrete and specific, and by comparison, Gendlin’s looks almost mystical and Bergsonian. Peterfreund uses a computer model. (One can visualize discrete circuitry while reading him.) Gendlin hates all “chop-chop” talk of parts and pieces. But we find that Peterfreund’s information processing is simply a code for the largest abstraction we can think of. The larger the abstractions denoted by a theory, the farther we get from arbitrary divisions, and the closer to the bare existence of the organism. Accordingly, Peterfreund ends up with a theory that is, no less than Gendlin’s, the portrait of a whole undivided organism. Levenson, like Gendlin, does little to hide his distaste for abstractions, and he challenges all particular understandings. Schafer tries to eliminate abstractions, but when faced with the consequences he will not part with the clinical understandings they bring. George Klein sought to straddle the fence, but the terminologic trick of explaining things by “equilibrium” does not save him from falling to the concrete-whole-organism side. Kohut tried the same procedure, and of these theorists, Kohut alone emerges with a statable theory. But that is because he retains the essential lumpiness of a theory of the mind, as found in Freud’s theory.

Klein and Kohut tried to make equilibrium the pivot of theory because the concept of equilibrium, unlike other contenders, is one abstraction that seems to keep its hold on reality. Because Jean Piaget’s work is the most exhaustive exploration of the equilibrium concept in science, I comment on his work at the end of this section. One test of whether psychoanalysis can be transformed into a more organismic theory is how much use psychoanalysis can make of Piaget. (Loewald’s [1980] project is the other promising test of an organismic theory of psychoanalysis.)

I have another reason for discussing Piaget, who, after all, is not a psychoanalytic revisionist. In chapter 8, I portrayed the actions of the therapist and the patient as efforts to establish an equilibrium, and I have claimed that what a therapist does is largely determined by how he seeks to balance himself when upset. So, for his bearing on my own account of therapy, no less than to evaluate revisions of theory of the mind, Piaget must be looked into carefully.

18
Peterfreund’s Information-Processing Theory

The Challenge

Emanuel Peterfreund’s book Information, Systems, and Psychoanalysis (1971) is an effort to reform psychoanalytic theory by substituting such concepts of computer technology as information, programs and processing.

The book carries a particularly useful appreciation by Benjamin Rubinstein, who argues for Peterfreund’s revision in a spirit so different from Peterfreund’s as to set up an independent standard for judging the text.

Peterfreund tends to view psychoanalytic concepts as ad hoc constructs, shaped by models of a dated physics and influenced by primitive modes of thought such as anthropomorphism. Scientific hypotheses should relate phenomena to progressively more general laws of nature. But, argues Peterfreund, physics has left psychoanalysis behind; analytic concepts once thought to be analogous to concepts of physics are now known to be unrelated. Peterfreund asks that psychoanalytic theory be replaced by concepts compatible with modern brain physiology, and thus put in touch with chemistry, physics and the whole corpus of scientific law.

Rubinstein, on the other hand, recognizes that psychoanalytic concepts are not just images, but express relationships of data. The “core meaning” of a psychoanalytic concept is the empirical hypothesis that it expresses. In other words, after stripping away their pictorial and associational trappings, Rubinstein allows that psychoanalytic concepts have yet a significance in organizing clinical observations.

This recognition does not make Rubinstein less methodologically exacting. According to Rubinstein, psychoanalytic concepts are not necessarily arbitrary or illogical, as Peterfreund makes them appear, but they get no support from other sciences. Nor can psychoanalysis claim that clinical hypotheses— its core meanings—are credentials enough. For the same core meanings can be expressed in other ways. And since psychoanalytic core meanings are ultimately hypotheses about brain function they should be expressed in terms compatible with brain physiology.

… we can interpret the core model in terms that, by contrast to its energic interpretation, are compatible with what is currently known about neurophysiology. That is precisely what Dr. Peterfreund is trying to do, not only with the psychic energy model, but with the theoretical psychoanalytic model as a whole. I am not suggesting that he first constructed an explicit core model which he then proceeded to interpret in accordance with modern biology. I do believe, however, that this step is generally implicit in the development of theoretical formulations from clinical data and hypotheses [p. 5].

Satisfied that Peterfreund has implicitly taken this step, and observing the large number of psychoanalytic interests that Peterfreund casts into terms of information systems, Rubinstein concludes that the study is “not simply an introduction but a new departure involving a radical reorientation of our thinking” (p. 7).

The claim that Peterfreund’s work is a new departure thus rests on the conviction that he has implicitly reinterpreted psychoanalytic core models. After all, the call is not simply to talk more scientifically but to talk more scientifically about what psychoanalysis has been talking about.

Has Peterfreund’s work fulfilled the claims of its preface? Certainly the book demonstrates that it is easy to discuss many phenomena in terms of information, feedback and processing. Nor can we demand that such an ambitious undertaking be complete and detailed on first venture. Therefore Rubinstein is not disturbed that Peterfreund approaches the reinterpretation of psychoanalytic core meanings “only in a somewhat general way.” He regards it as a deficiency of completeness, not of conception. If Peterfreund is rather general in proposing alternative expressions for psychoanalytic hypotheses, “This is not a criticism but a reminder to ourselves of the fact, freely acknowledged by Dr. Peterfreund, that in spite of his pioneering efforts much work remains to be done.” But if Peterfreund’s reinterpretation of psychoanalytic core models has indeed made a new departure involving a radical reorientation of our thinking, it must already have dealt in depth with those issues, such as conflict and development, which stimulated the development of psychoanalytic concepts. No matter how effectively he criticizes the ego concept, his new departure can radically reorient us only after it gives us an adequate account of the kind of conflict that prompted Freud to frame his structural theory. A promise will not do for a radical reorientation. According to Rubinstein, psychoanalytic theory has its reasons. If those reasons are not dealt with by another theory we would be inclined to say that an alternative has not been offered. New theories are hardly developed overnight, it is true, but patience cannot deny that there are some nodal aspects of a theory which tell us immediately whether psychoanalytic core models are in fact being reinterpreted.

Theory of Treatment

A good sample to take for this examination is the theory of psychoanalytic treatment, because there conflict and development are conspicuous issues. To understand a theory of therapy we must first grasp the theory of pathogenesis. Here is Peterfreund’s:

Defective or inadequate programming may lead to pathological activity, behaviour, or subjective psychological experience, and these are often accompanied by stress, pain, and anxiety. In all cases, defective or inadequate programming must be evaluated with reference to a standard or norm. Programs which contain instructions that are logically incompatible with the attainment of a desired goal are important examples of defective programming. Clinically, these programs result in conflict.

Defensive activity, behavior, or subjective psychological experience can be viewed as the clinical manifestations of substitute programming. The organism tends to defend itself by automatically deactivating those programs which result in stress, pain, anxiety, and conflict. Substitute programs are activated; as a result, stress, pain, anxiety, and conflict are lessened. Any informa...