Progress in Self Psychology, V. 11

The Impact of New Ideas

Arnold I. Goldberg, Arnold I. Goldberg

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134892853
• Edition: 1
• Topic: Psychologie
• Subtopic: Angewandte Psychologie

Volume 11 begins with a timely assessment of self psychology and intersubjectivity theory, with original contributions by Carveth, Trop, and Powell, and a critical commentary by P. Ornstein. Clinical studies span the transferences, the complementarity of individual and group therapy, the termination phase, and multiple personality disorder. A special section of "dying and mourning" encompasses women professionals and suicide, the self psychology of the mourning process, and the selfobject function of religious experience with the dying patient. The volume concludes with theoretical and applied studies of personality testing in analysis, writer's block, "The Guilt of the Tragic Man, " and the historical significance of self psychology. A testimony to the evolutionary growth of self-psychology, The Impact of New Ideas will be warmly welcomed by readers of the Progress in Self Psychology series.

IV

Theoretical and Applied

Chapter 14

The Use of Sequential Personality Testing in Analysis to Monitor the Uncovering of Childhood Memories of Abuse

Shirley C. Geller

Many adults who were abused as children have little or no conscious memory of their abuse. Frequently, such individuals enter psychotherapy for symptoms they do not initially relate to their early abusive treatment (Sands, 1991). As repression lifts and patient and therapist together begin to identify and label maltreatment and abusive events, how does the patient experience this process? How is this uncovering process revealed? This chapter seeks to provide answers to these questions.

The two patients to be discussed were and continue to be in four-day-a-week analysis with a graduate analyst who is most comfortable with a self psychology orientation. Both patients were administered the Wech-sler Adult Intelligence Scale-Revised (WAIS-R) (Wechsler, 1981) and the Rorschach Comprehensive System (Exner, 1986) yearly to assess original status and change during their analysis.

ASSESSMENT DURING ANALYSIS

Although psychoanalysis has looked quite unfavorably upon any practice that interferes with the developing of the transference neurosis, and testing during analysis would be perceived as one of those practices, this graduate psychoanalyst decided to break with tradition and have her analysands assessed yearly. This was done for the following reasons. First, although analytic belief views the successful resolution of the transference neurosis as a traditional measure of analytic success, current research does not bear this out. In a long term follow-up study of 17 analytic patients, Kantrowitz, Katz, and Paolitto (1987, 1990) found no correlation between the degree of resolution of the transference neurosis and four measures of psychological growth, specifically, the level and quality of object relations, the development of a self-analytic function, improved reality testing, and later growth. Second, Wallerstein (1989) found little evidence that the introduction of the interview and projective psychological tests in the assessment of 42 patients in psychoanalysis and long-term psychotherapy either delayed or impaired the treatment process. Third, the traditional concepts of resistance and defense long associated with the transference neurosis and its fullest possible resolution are being questioned and redefined (Kohut, 1984; Wolf, 1988). Fourth, adherence to strict neutrality and abstinence does not pose the same problem for the self psychologist as it does for the more classical analyst. Fifth, the analytic climate is apparently becoming more liberalized as recognized analysts are even suggesting that analysis needs to become more open to change and growth (Goldberg, 1990). Finally, the current focus on accountability and outcome measurement basic to insurance, managed health care, and national health care reform requires more specific criteria of treatment improvement. One way to provide such criteria is to utilize psychological assessment procedures on a regular (i.e., yearly) basis. In this manner, objective evidence of the efficacy of the psychoanalytic process and a show of good faith in attempting to quantify treatment outcome can be provided.

TEST AND TEST ADMINISTRATION

In this study, as stated earlier, the WAIS-R and the Comprehensive Rorschach System were employed as assessment tools. The WAIS-R is a test for measuring global and specific components of adult intellectual functioning. It consists of a series of 11 tasks requiring problem-solving and intellectual operations involving the verbal and the perceptual-manipulative spheres.

The Comprehensive Rorschach System is an objective method of assessing a person's perceptual-cognitive conceptualization using 10 inkblots. It is assumed that how a person structures and organizes an ambiguous stimulus field is directly or indirectly representative of behavior that can be expected in other situations requiring the same sort of structuring and organizing operations (Erdberg and Exner, 1984).

It is considered an objective test in that the test administration procedure, each score of the person's verbalizations of visual perceptions of the inkblots, and the score interpretations are fixed. This is doubly important for its use in analysis. The employment of the Comprehensive Rorschach System to assess change in analysis not only provides an answer to Grunbaum's (1984) challenge for analysts to go outside the analytic setting to validate what goes on inside of the analytic setting, but does so by utilizing an objective process that is itself based on empirical validation. Every verbal response the patient gives to 10 standard inkblots is typically assigned between 8 and 15 scores (i.e., parts of the blot the person uses to formulate his/her percept, use of achromatic or chromatic color, use of shading, etc.). These quantified scores are further utilized to construct ratios (e.g., achievement ratio, affect ratio, egocen-tricity ratio), and indexes (e.g., depression index, schizophrenic index, suicide constellation) (see Appendix A). These scores, ratios, and indexes, which number more than 200, have been normed on hundreds and thousands of people of various ages and diagnostic categories and both sexes. The Comprehensive Rorschach System has empirically related an individual's perceptual-cognitive responses to inkblots in such a manner as to allow the generation of descriptions and explanations for a person's thinking, feelings, and behaviors in the present, the past, and the future. Additionally, many of the levels of personality structure that are being measured not only have been laid down early in life, but are at such a depth that they are minimally affected by medication, psy-chotropic or otherwise.

The initial test administration was done at the time the patients commenced treatment. Subsequent testing was done yearly. All the tests were administered and scored by another psychologist¹ who was trained and experienced in the WAIS-R and the Comprehensive Rorschach System and institute-trained in psychoanalytic psychotherapy. The scores for each Rorschach protocol were quantified by using an IBM personal computer programmed with the Rorschach Interpretation Assistance Program (Exner, 1990).

CASE ONE, MRS. A

Mrs. A, Elizabeth,² 41 years of age, who has completed one year of analysis, initially entered weekly psychotherapy treatment because of her 11-year-old daughter. The child would go for days without speaking to either her mother or her father. Elizabeth found this difficult to understand, for she viewed her family life as comfortable and happy, and bolstered this belief by the fact that her six-year-old son showed no signs of disturbance. In essence, she perceived herself as happily married, with a contented husband, and two bright, rather special children. Relatively quickly, it was ascertained that the reason her daughter would go for days without speaking to her parents was that she felt that they were not only uninvolved with her but also made decisions for her that bore no relation to her needs and wishes. In early sessions the patient revealed that for the last four years her husband had become less emotionally available to her because of his work pressures. She in turn had become depressed, preoccupied with the emotional loss of her husband, and less available to her children. Several months after therapy was begun with the daughter, Elizabeth's husband and herself, the six-year-old son also demanded to enter treatment. The boy was refusing to attend school and having difficulty learning. Elizabeth was shocked; she saw her son as a model student. At that point all four family members were administered the Rorschach and other psychological tests. Significant disturbance was found in the whole family. Because Elizabeth was seen as playing a pivotal role in the family, analysis was suggested to her. The other three family members were referred to one of the analyst's associates.

The patient, who is an attorney and prides herself on her intellectual acuteness and immediate response to problems, felt extremely guilty about both her own depression and her insensitivity to her children, particularly in view of the detrimental effect this was having on them.

Initially, Elizabeth described her childhood, five siblings, and parents in idealized, grandiose, and special terms. Her father was portrayed by her mother as a brilliant attorney, a genius. As a result, he knew how to raise their six children and knew what was best for everyone. The children were expected to live up to his directives. The family was one that all families should emulate. Her father demanded strict obedience, insisted that feelings were a sign of weakness, and made it clear that no task was to be considered impossible. If he became upset and yelled or hit a child, it was because the child had not done what was expected.

As analytic treatment progressed, Elizabeth began remembering a terrified childhood. She remembered her parents drinking daily. She recalled being spanked painfully and frequently, often sent to her room without meals, and ridiculed for any sign of wanting anything for herself. Her father was subject to violent outbursts, at which time he would strike out. On one occasion, when she was around four, he hit her foot with a heavy tire iron. The bone in her foot is still deformed as a result. Eliza- beth learned early to “read” her father's features and gestures so she could appease him before he became violent. When her techniques of appeasement did not work, she hid so that she would not be beaten. As she lay on the couch, Elizabeth recalled a childhood in which she was constantly running away and hiding from both of her parents out of fear of verbal and physical abuse.

Congruent with her childhood experiences, Elizabeth's dominant transference expectations have contained ever-present fears of criticism, hostility, and rejection from the analyst.

As Elizabeth's fantasy of having an ideal family began to deteriorate so did some of her functioning. Her migraine headaches, which she had suffered on and off since adolescence, increased in frequency and severity.

Before treatment Elizabeth had been a rather competent, aloof, and demanding career woman. She considered herself to be quite special, viewed her approach to issues as the only correct one, seldom saw herself as being at fault, and was relatively free of self-doubt.

Elizabeth's initial test scores confirmed the clinical impression (Appendix B). Her intellectual functioning was at the superior level (WAIS-R: Verbal IQ, 119; Performance IQ, 118; and Full IQ, 122). On her first Rorschach she revealed a need to distance herself from people and a certain insensitivity to the concerns of others (Texture = 0).³ Her sense of self-importance was inflated to a point that dominated her perception of the world (Reflection = 2). And she experienced an intense inner pressure for her needs and desires to be met immediately (Animal movement = 8).

Correlation Between Uncovering Process and Test Data—Case One

Rather than adopting a “hierarchically ordered two-reality view” (Schwaber, 1983) that assumes one reality is experienced by the patient and the other is objectively “known” by the analyst, the therapist assumed a one-tier view of reality. This one-tier view, in conjunction with Gedo's (1979) belief that analytic treatment should discover the personal significance of psychic life in its specific meaning for a particular individual, led the analyst to ask the patient directly, “If you were to describe your experience during the time period you became aware that your fantasy of having had an ‘ideal family’ was not so but that instead you had endured a great deal of maltreatment and possible abuse, how would you describe your experience in the uncovering process?”

To this question Elizabeth responded: “It was a shock, a major disappointment. It left a big hole in my day-to-day life. Since my acting was based on something out of my fantasy, I didn't know how to act. Everything I did seemed pointless. My sense of depression and loneliness has increased completely. My migraine headaches increased so that some ...