Psychic Equilibrium and Psychic Change

Selected Papers of Betty Joseph

Michael Feldman, Elizabeth Bott Spillius, Michael Feldman, Elizabeth Bott Spillius

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134953011
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

Betty Joseph's work has become an outstanding influence in the development and theory of psychoanalytic technique in the Kleinian tradition.

This collection of her most important papers examines the development of her thought and shows why a crucial part of her theory and practice is concerned with the detailed, sensitive scrutiny of the therapeutic process itself.

Fundamental and controversial topics explored and discussed include projective identification, transference and countertransference, unconscious phantasy, and Kleinian views on envy and the death instinct.

PART 1

Beginnings

Introduction

Michael Feldman and Elizabeth Bott Spillius

Several of the themes that were to become central in Joseph’s work are evident to some extent even in her earliest papers. In an unpublished paper of 1953, for example, she stresses the importance of observing what the patient does in the transference as well as attending to what he says. In the two papers reprinted here, ‘An aspect of the repetition compulsion’ (1959) and ‘Some characteristics of the psychopathic personality’ (1960), she introduces the theme of equilibrium, balance, and the patient’s need to maintain it even when he or she consciously wants to change.

In the first paper reprinted here Joseph is concerned with those patients who experience themselves as being passively and repetitively subjected to unpleasant treatment at the hands of others. She suggests that this passivity often in fact involves a very active deployment of defence mechanisms, primarily to protect the patient from overpowering anxieties linked with the experience of dependence. The patient she describes presented as a woman who needed no one, though everyone, she said, liked and needed her. She complained that she could not love anyone because they would let her down. She had very little feeling, positive or negative, about analysis or her analyst, though she gave her analyst the impression that she wanted her to think that she was different from other patients, more insightful, more accommodating, more helpful. Gradually it emerged in the sessions that the patient was splitting off the needy aspects of herself and projecting them into other people around her, including her analyst. Simultaneously she idealized the good aspects of her analyst and other important people in her life, had taken these aspects into herself unconsciously, and had become identified with them. She was them, and she had no awareness of the origin of the idealized qualities she felt herself to possess. Projective and introjective identification were thus being used simultaneously to avoid dependence and to avoid the resentment and envy that she might have felt if she had been able to value her objects more, But in this patient dependence aroused unbearable guilt as well as persecution, for it emerged in her analysis that she had a conviction that her ambivalence had caused immense damage to her primary object, her mother and her mother’s breast, so that unconsciously she felt this primary object existed inside herself in an extremely perilous condition which she could not face.

We have repeated the description of part of Joseph’s analysis of this patient’s defensive system—a combination of splitting, projective identification, idealization, and introjective identification—because it is a particularly clear exemplification of the views Klein put forward in her analysis of the paranoid-schizoid position (especially in her 1946 paper) and later in her work on Envy and Gratitude (1957), as well as Bion’s development of some of these ideas in his paper ‘Attacks on linking’ (1959). In her subsequent papers Joseph returns to this combination of defences again and again, elaborating the system and its interdependencies which she encountered in a number of the patients she describes, and which were important to them in maintaining their psychic equilibrium.

In the analysis described in this paper on repetition compulsion, Joseph interpreted to the patient both her active attacks on external and internal good objects and the projective processes she was using to avoid dependence and guilt. In the subsequent development of her technique and ideas, however, Joseph becomes much less convinced about the therapeutic value of making immediate and direct interpretations of motive, such as envy in the case of this patient, or mental mechanisms such as projective identification. By contrast, as we shall see, in her later work she focuses first on the immediate situation in the analytic relationship, especially on the way in which the patient perceives the analyst. She may point out, for example, that following a particular interpretation the patient seems to be seeing the analyst in a certain way—as crushed, let us say, or self-satisfied, or left out. But she does not immediately assume that she knows the motive for this perception or, even if she could guess the motive, that it would be useful to point it out to the patient before having more evidence about it from the patient himself. She has also become more cautious about making explicit to the patient the parallels between the patient’s relationship to the analyst and his current and past relationships to other people in the outside world —all in the interest of promoting psychic change by keeping the interpretive work as immediate and emotionally relevant as possible.

In the next paper, ‘Some characteristics of the psychopathic personality’ (1960), Joseph continues her exploration of a different group of patients, those who function in a psychopathic way. In spite of the different psychopathology, she found that the pattern of defences was similar to that of the preceding patient. But here the patient, an adolescent, was troubled by having a very limited capacity to tolerate anxiety or frustration; indeed, when forced to do so he felt threatened by feeling that he would go mad, fall apart. He approached activities and people in a greedy way, but his greedy desires stimulated in him feelings of intense envy, which led to his spoiling and devaluing what the other person could give him and thus led to his feeling deprived and greedy once again—a vicious circle of desire and attack.

The patient described in this paper was using omnipotence, projective identification, and introjective identification defensively to maintain a precarious state of mind in which guilt, depressive anxieties, and overwhelming persecutory anxieties were constantly evaded. His psychopathology and the quasi-delinquent acting out which he engaged in were part of the means by which he evaded a deep sense of guilt; he got himself accused or punished ‘for the wrong things’, as it were, When this system was disturbed, either within the analysis or outside, he felt a threat of catastrophic fragmentation and psychosis. When these manoeuvres were not completely successful, there was a brief emergence of some depressive pain, which seemed to be connected with an intense fear of the destruction of his good internal objects. In her later papers Joseph explores the emergence of this kind of pain in much greater detail.

In these later papers, too, she explores more fully the way in which the patient’s psychopathology is enacted in the transference, and the often very subtle countertransference pressures brought to bear on the analyst to fit in with this so as not to disturb the patient’s equilibrium. But one can also see, even in this early paper, Joseph using a method which was to become very important in her later technique; namely, a close tracking of the patient’s responses to interpretations with detailed observation of what happened when the interpretations disturbed the patient’s equilibrium.

1

An aspect of the repetition compulsion

This paper was first read at a meeting of the British Psycho-Analytical Society on 7 May 1958, and was published in the International Journal of Psycho-Analysis 40 (1959): 1–10.

In this chapter I want to discuss one aspect of the repetition compulsion which Freud first introduced in 1920 (Freud 1920). The question of the repetition compulsion as a whole has been discussed in a number of papers. I would refer especially to those of Kubie (1939), Hendrick (1947), and Bibring (1943).

Freud (1920) showed how neurotics, and, as he put it, ‘some normal people’ could be seen to be constantly, as if under pressure of a compulsion, re-experiencing situations in their lives which brought them only unhappiness, and the repetition of which therefore seemed to ‘override the pleasure principle’. He spoke of such people as giving the impression of being possessed by a daemonic compulsion, adding, however, ‘but psycho-analysis has always taken the view that their fate is for the most part arranged by themselves and determined by early infantile influences’; however, later in the same paragraph, he adds the following interesting point:

This ‘perpetual recurrence of the same thing’ causes us no astonishment when it relates to active behaviour on the part of the person concerned and when we can discern in him an essential character trait which always remains the same and which is compelled to find expression in a repetition of the same experiences. We are much more impressed by cases where the subject appears to have a passive experience, over which he has no influence, but in which he meets with a repetition of the same fatality. (p. 22)

It seems to me that we all, in our analytic practices, see a number of patients who show a marked tendency again and again in their lives to go through repetitive unhappy experiences, apparently passively. In this communication I am going to limit myself to considering this one aspect of the repetition compulsion. It will be remembered that it was the discovery of the repetition compulsion that was one of the factors that led Freud to put forward his theory of the death instinct. In my concluding remarks I shall try to make a very tentative connection between the apparently passive repetition compulsion and his theory of the death instinct. In this chapter I shall isolate and consider one group of patients who show markedly this type of repetition, that is, those patients whose repetition is blind, unconscious, very compulsive, apparently passively experienced and not provoked by them and almost invariably unpleasant in its results; it is very noticeable in their history and in their current relationships when they come into analysis.

Freud, it will be remembered, started his discussion of the repetition compulsion with a consideration of its pathological manifestation in traumatic dreams and in the impulse to repeat seen in children’s play, from which he concluded, ‘we are therefore left in doubt as to whether the impulse to work over in the mind some overpowering experience, so as to make oneself master of it, can find expression as a primary event and independently of the pleasure principle’. I am suggesting in this chapter that patients of the type I have just described are dealing with unconscious anxieties that are felt by them to be potentially overpowering; that the anxieties relate primarily to problems stimulated by dependence on the primary object or part object, the mother or her breast; that the mechanisms which are compulsively used to master these anxieties consist of a specific combination of splitting, projective identification, and introjection, which deeply influences their behaviour and personality structure. I shall try to show how these methods of mastering anxiety are linked with the achievement of a particular balance between destructiveness and love, and how the very nature of this balance in itself can lead to no progress, but only to a blind compulsion to repeat.

I shall start by describing certain elements from the history of a patient in whom the working of the repetition compulsion could be very clearly seen. I am not here going to discuss the factors underlying these fragments of history, and I am only introducing those which are immediately relevant to my theme of passive repetition. I start with A.’s relationships to men, since it was here that in her analysis we first saw the repetitions emerging so markedly.

When A. came into treatment it soon became clear that from late adolescence onwards up to about the time of her marriage there had been a series of relationships with men of a very similar type, in which the men were deeply devoted to her, she much less attached to them. The relations always went wrong. The men very much needed her and depended on her, but she did not fall in love with them, believing that she was afraid of becoming too dependent on anyone for fear of being let down. As the analysis proceeded, it could slowly be seen that the relationships were patterned on elements of a very difficult relationship with her father and with a young brother. A. felt very disturbed by her father who had a bad relationship with the mother, criticizing the latter to my patient whom he openly preferred. He wanted A. to go on holidays with him and generally be with him. A. found his company extremely embarrassing. When she was in analysis he used sometimes to visit her, and would sit almost silent looking at her, she felt, adoringly and finding it pathetically difficult to leave her home. A. had herself connected her difficulties with men with her relationship with her brother. As a young child she had bullied and dominated him, believing that she did so because her mother was so inept with him. Subsequently he became increasingly dependent on her, desperately wanting to get at her, trying to break into her room, constantly disturbing her. She was unaware of doing anything to foment this behaviour. Subsequently, I learned about relationships with various uncles and cousins, showing a similar quality. They were a closely knit, lower-middle-class family from the North of England. One after the other, they appeared in the analysis as particularly devoted to my patient and needing her. One eccentric uncle, for example, could not manage unless she visited him daily after school; another talked freely only to her, and so on. By her they were felt mainly as a burden, but one which she shouldered.

As she described these relationships, the factor that began to stand out was the sense of devoted need these various people felt for her. During analysis I began to see that new men were being added to the list; if she had to see a professional or business contact, such as a solicitor or doctor, it would very quickly appear that this man began from her point of view to establish a very special relationship with her, would keep her chatting after the professional interview was over, would tend to turn into a family friend rather needing her family for companionship, good food or similar needs; she did not know how this happened. Linked with this we saw that if for any reason A. had to change doctors, lawyers, and so on, she would feel very guilty at leaving them. Only slowly as the analysis proceeded did she begin to realize that she was convinced that they needed her for some reason —for example, that her case was interesting, that they would miss her fees if she went. One aspect of this pattern emerged very clearly, that is, A.’s intense rivalry with her mother and myself—as shown, for example, in her unconscious need to be preferred by the men, her father, brother, and the current professional contacts. But it was only when this aspect had to some extent been worked through that certain other aspects, those which it is the main aim of this chapter to discuss, emerged behind the more obvious Oedipal material. Indeed, as I shall later try to show, genital Oedipal material was often stressed as a defence against the recognition of earlier failures in development.

Turning to A.’s relationships with women, it was striking that so many of her close women friends were gifted, quasi-homosexual people who valued and stuck to her, but whose relationships eventually became irksome, as they appeared to exploit or overwhelm her. This became apparent as a current problem with her maids and nurses who emerged as needing her and her family, being rather burdensome, often hardworking, moody, and somewhat martyred. We began to recognize an earlier version of this story, the history of which is this. In my patient’s childhood her family had been, and indeed still were, very poor. An orphaned girl cousin many years older than my patient came to live with the family at the time of A.’s birth, acting as nurse and mother’s help. She was a strange character, very ugly, had no life of her own, and was utterly devoted to my patient, but increasingly felt by A. to be like a ghastly shadow over her, always around doing things for and with her. She believes that she always wanted the mother to get rid of her, but the latter did not do so. There is, however, an Achilles’ heel to this story. The mother has told my patient that when she, A., was a tiny child she would crawl or toddle around the house after this cousin, calling after her to be with her, as if not able to let her out of her sight. This is not remembered at all by my patient. Underlying this relationship with the cousin, however, was a very unhappy relationship with the mother. A, described her as being a mother who saw that the children’s material needs were well satisfied, but who was herself always restless and on the go and would never sit down quietly with them. The mother seemed forgetful of the children, my patient and her two brothers—and apparently especially of my patient, whom she would often forget to serve at meals when visitors were there, or would fail to call for her from parties until long after all the other children had been fetched. It seems that she breast-fed A. for three months, after which her milk failed. As A. described the problems of her childhood one felt emerging a picture of resentment and hostility, and an awareness that something was lacking in her home and in her relationship with her mother that she wanted; but sadness and affection or conscious longing for affection from any of the family were markedly absent, and the resentment and a determination to be independent of the mother, a pattern apparently repeated with the cousin, were very much in the forefront. One slowly gained the impression that what was available emotionally in the home this child could not use. It seemed that there must be a connection between A.’s later inability to love men, as she thought, lest she should be let down, and her early need to make herself independent of her mother, whom she felt to be too unreliable to trust.

I should add one further piece of compulsive repetition which belongs to the general pattern. A. invariably found herself burdened by her friends; her house was constantly full of people who were passing through London, who wanted help or money. She felt overwhelmed by their needs, and there seemed little time when she and her husband could be alone without disturbance. When my patient came into analysis in her early forties, she had no idea that these were repeated patterns, nor that she was involved in any way in bringing them about. She only felt herself to be universally popular with friends and relatives of various ages. In these respects, although my experience of this type of patient is limited, I think that A. can be said to be typical of a particular group of people who come to us for treatment.

Although A. seemed to have lived through so many of these relationships apparently passively and without wanting these relatives and friends, nevertheless, as I have stressed, she had a sense of disappointment that something she wanted from her home was missing. But she was not aware that something was basically wrong about her own capacity to love and to accept goodness. Again, currently in the transference she would appear to appreciate that something was lacking in her feelings; for example, she would compare herself with friends who, when they were being analysed, seemed so much more involved emotionally in the treatment, happy about it, upset by it or missing it, none of which she felt. She did not miss it, or me, during breaks and seemed quite unaware of any feelings about myself, my consulting room, and so on. Superficially she gave the impression of being a well-organized and cooperative woman; but I soon began to get the impression that she was unconsciously needing to convey to me a sense of being different from my other patients, more adult, insighted, helpful to me in my work both analytically and practically—as, for example, fitting in with times that I might need, with no complaint. Slowly I saw I was destined to become one of the professional and business group who was soon to find her specially indispensable to me, both financially and as an interesting case —as I have described would occur with her doctors, lawyers, and so on, standing for the relatives of her childhood.

I shall now give some material from this patient. We had been working on her denial of feelings, especially feelings of dependence and rivalry connected with myself. She came on a Monday saying that she had again been very much concerned with a problem that she had spoken about in the previous week, that was whether she should spend the next weekend away from home in the North, with her husband who had to be away for some weeks on business. It would mean leaving her three children, including the youngest, a boy of about thirteen months, with the maid. Should she do so? She had approached various friends for advice. It was then becoming clear that my advice was being sought, and I thought that she wanted me to say that she should go. She went on to tell that she was angry with herself for getting so involved in difficulties with the maid. She gave a long-drawn-out description of an argument with the...