Progress in Self Psychology, V. 7

The Evolution of Self Psychology

Arnold I. Goldberg

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780881631302
• eBook ISBN: 9781134884735
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

A special section of papers on the evolution, current status, and future development of self psychology highlights The Evolution of Self Psychology, volume 7 of the Progress in Self Psychology series. A critical review of recent books by Basch, Goldberg, and Stolorow et al.is part of this endeavor. Theoretical contributions to Volume 7 examine self psychology in relation to object relations theory and reconsider the relationship of psychotherapy to psychoanalysis. Clinical contributions deal with an intersubjective perspective on countertransference, the trauma of incest, and envy in the transference.

II Clinical

Chapter 6 Countertransference in an Intersubjective Perspective: An Experiment Peter Thomson

O wad some power the giftie gie us
To see oursels as others see us!
It wad frae monie a blunder free us,
An’ foolish notion.

Robbie Burns

From poem “To a Louse,” 1786

The stimulus for me to undertake this experiment arose from my special interest in the approaches to psychoanalytic therapy of Schwaber (1981a, b, 1983a, b, c, 1986, 1987) and an interest in the proponents of intersubjectivity, Stolorow, Brandchaft, and Atwood (Atwood and Stolorow, 1984; Stolorow, Brandchaft, and Atwood, 1987). It seemed to me that these approaches to psychoanalytic therapy were very promising, especially in the treatment of difficult patients, but that sufficient attention has not been given to the special countertransference problems associated with these approaches. There is a dearth of examples illustrating the countertransference experiences of the therapist. Consequently, I decided I would undertake a research project composed of an examination of the data of my countertransference experiences with my patients over a four-month period.

The four-month period of the study included a two-week vacation, taken after seven weeks of patient treatment. My intention was to try to discover the manner in which my own self-organization interacted with the patient’s unfolding transferences. I hoped to find out how the patient’s experience during analysis reverberated on my own experience and, thus, affected my responses; and how these responses then affected the patient. For the purpose of this presentation, I selected analytic material from the analyses of two patients. The events are described just as they happened.

HENRY

Henry, a young, single, librarian, was in the fourth year of analysis during the period of the experiment. A prominent feature of this analysis was periods of silence. Exploration of the silences showed them to be expressions of inhibitions arising from shame reactions caused by Henry’s parents inability to respond affectively to him in his early life. The material described arose during the first five weeks of the experiment. I will describe the disruption of an archaic mirror transference.

In one session early in the study period, I noted that I reacted to Henry’s continuing silence with some inner frustration. He spoke, at this point, of preferring to believe that I was truly nonresponsive and nonreceptive to him. I then commented, “So you feel more comfortable believing I am nonresponsive?” He replied, “Yes, and I am enraged at your nonresponsiveness.” I became inwardly angry because, according to my own experience, I had in fact gone to considerable lengths to be both responsive and encouraging.

A day or two later, an event took place that affected the course of the analysis for several weeks. One morning, after a long silence, Henry said, “It is upsetting to have to say this. My friend Rob (who had leukaemia) died over the weekend.” I responded, “You must have a lot of feelings about that, and I guess it is difficult to talk about them.” I believed myself to have been compassionate, but as this conversation transpired, his view was vastly different. He remained silent for several days, and all efforts to encourage him to speak were of no avail. Finally, four days after the aforementioned exchange, he responded to my saying, “I think you are angry with me.” He continued, “Yes, I needed a more intuitive response to my experience. My reaction has been to withdraw and to do things on my own.” I noted myself feeling defensive and I wished to protest that I had done my best to empathize with him. Henry continued, “You did not seem to understand how upset I was. I felt you were very distant and harsh. You sounded technical, not genuine or sympathetic. I would have appreciated a more simple and personal comment.” For some time, he continued to chide me. My experience of myself, so different from his experience, reminded me of Schwaber’s similar experience with her patient, Ms. M (Schwaber, 1983c). I had to work quite hard to decenter from my pressing need to believe that I had only been kind. I made a number of remarks over the next period of time that I considered to be understanding of his feelings, but they were not accepted as such; for example, I said, “I truly appreciate your feeling so mistrustful and that you need the right kind of response.” I also said, “Perhaps you could help me to become more usable.” The latter statement was a response to his remark that I was of no use to him.

Henry’s feeling that it was futile to talk to me, along with his anger and negativism, continued for two or three more weeks. He said, “If the quality, the tone and language, of your response isn’t exactly right, it leaves me enraged. My sense is that you are far away from what I am experiencing. You suggested at one point that I fear to let you come closer to me. That infuriates me, it is so far removed from where I am.”

Gradually, Henry’s rage dissipated. My concretized sense of guilt and responsibility failed to take into account the occurrence of the triggering in the patient Henry, at the time of Rob’s death, of a heightened sensitivity to a traumatic response.

INTERSUBJECTIVE INTERPLAY AS AN ORGANIZING THEME

I comment on this vignette in terms of the intersubjective field, with emphasis on my own input. I first noted my frustration with Henry’s continued silence. Upon self-reflection, I recognized the influence of my classical training, which induced in me a prereflective need to regard his silence as a resistance. This aversive attitude caused me at times to match his silence with my own, and at other times to make excessive efforts to push Henry to speak. Unquestionably, my attitude had its effect on the intersubjective field, leading him to experience me as nonreceptive. Thus my comment, “So you feel more comfortable believing that I am nonresponsive” contains a denial of my contribution to his experience. His remark in response was “Yes, and I feel enraged at your nonresponsiveness.” His remark can be understood, therefore, as quite fitting, although at the time I saw myself only as responsively encouraging.

The event that affected the analysis for some time, Henry’s news of his friend’s death, along with my response to it, must be understood in the light of my prereflective attitude. Although I thought I had been compassionate, the intersubjective field had already been coloured by my response to his continued silence. I must add, however, that another powerful determining factor was Henry’s early life experience. But one can see how my prereflective attitudes interfered with my capacity to empathize. The silence was finally broken when I recognized and interpreted his anger with me. He was then able to tell me how he experienced me as harsh or technical, which can now be understood as my “classical” demand that he analyze; but at the time, I could hardly decenter from my belief that I had only been kind.

My next series of remarks, for example, “I truly appreciate your feeling so mistrustful” were, I think, a counterreaction to my feelings of failure. The latter feelings were a concretization of my sense of responsibility for his disappointment in me; I was thereby prevented from pursuing a genuine empathic inquiry into the source of his experience of me (Brandchaft and Stolorow, 1988).

Henry continued for another two or three weeks to feel that it was futile to talk to me, that I was far away from his experience. Why did his rage finally dissipate? I have no definitive answer but I think that as Henry sensed I was more in touch with his experience, this began to change the intersubjective “weather.” I also have the strong impression that Henry’s negative feelings gave expression to healthy adversarial strivings. A little later on, he commented on how he was pleased to, as he put it, have attained the freedom to “rant and rave.” I believe that the material I described illustrates the complex mutual regulation and dysregulation of intersubjective interplay to be an organizing theme of analysis.

Before turning to the second patient, I will outline the work of Schwaber and that of Stolorow, Brandchaft, and Atwood on inter-subjectivity and then relate the work to countertransference. Schwaber’s work is outlined in a series of papers published during the last decade (Schwaber, 1981, 1983a, 1983b, 1983c, 1986, 1987). The approach to intersubjectivity can be found in two recent books. These are Structures of Subjectivity by Atwood and Stolorow (1984) and Psychoanalytic Treatment: An Intersubjective Approach by Stolorow, Brandchaft, and Atwood (1987).

Schwaber

For approximately the last decade, Schwaber has been promulgating her thesis that the influence of the observer, the therapist, must be taken into account in the psychoanalytic situation (a view first put forward by Kohut, 1977). Her views are very clearly enunciated in her (1983c) paper, “Listening and Psychic Reality.” In this paper, as in others, Schwaber uses many examples from the psychoanalytic literature to demonstrate how analysts of all theoretical persuasions have been obstructed in their listening and understanding of their patient’s material by failing to take into account the influence of their theories and their own personal approaches upon the patient’s material. As a result “the analyst attunes to a reality other than that of the patient’s inner world, assuming the position of silent arbiter of what is or is not distorted in the patient’s perceptual experience” (Schwaber, 1986 p. 911). She is at pains to demonstrate that analysts are participators, inescapably involved in bringing about what is happening in the psychoanalytic process. Schwaber (1983c) states, “The shift in perspective is one in which the organization of behaviour, of intrapsychic experience, is seen as the property of the more inclusive system of which the individual is a part. Such a move has considerable impact on the gathering of psychoanalytic data". Schwaber (1981b) quotes Sander’s (1975) opinion that the change from viewing the organization of behaviour as the property of the individual to conceptualizing it as the property of a more inclusive system, of which the individual is a part, represents a major turning point in developmental research. “Listening from within the patient’s experience, weaving the perception of the analyst’s contribution, silent or stated, into the elucidation of the subsequently emerging material assigns different meaning to our understanding of transference and resistance” (Schwaber, 1983).

Schwaber wishes us to understand that, as psychoanalysts, we have not been listening from the vantage point of the patient’s intrapsychic reality. Our own truths, in particular our theories, have tended to take precedence. As a result, we have been viewing the patient’s experience of us and of his reality as distorted and our own as true. We have also failed to take into account all the influences that the analyst’s presence and personality, in his silence or in his interventions, are having on the patient’s material and behavior.

Intersubjectivity

The intersubjective viewpoint first appeared in Stolorow and Atwood’s study of the interplay between transference and counter-transference (Stolorow, Atwood, and Ross, 1978). They considered the impact of the correspondences and disparities that exist between the analyst’s and the patient’s respective worlds of experience on the treatment process (Stolorow, Brandchaft & Atwood, 1987, p. 2). Stolorow and Atwood, thereafter joined by Brandchaft, attempted to describe the conditions under which such phenomena obstruct or facilitate the unfolding of the psychoanalytic dialogue. Countertransference, considered in this context to be inclusive of all that comprises the analyst’s organization of self-experience, for good or for ill, clearly makes a major contribution to these conditions.

The essentials of intersubjectivity (Stolorow, Brandchaft, and Atwood, 1987) are outlined in these two passages, which originally appeared in Structures of Subjectivity (Atwood and Stolorow, 1984):

In its most general form, our thesis ... is that psychoanalysis seeks to illuminate phenomena that emerge within a specific psychological field constituted by the intersection of two subjectivities – that of the patient and that of the analyst. . . . Psychoanalysis is pictured here as a science of the intersubjective, focused on the interplay between the differently organized subjective worlds of the observer and the observed. The observational stance is always one within, rather than outside, the intersubjective field . . . being observed, a fact that guarantees the centrality of introspection and empathy as the methods of observation . . . Psychoanalysis is unique among the sciences in that the observer is also the observed.

Clinical phenomena . . . cannot be understood apart from the intersubjective contexts in which they take form. Patient and analyst together form an indissoluble psychological system, and it is this system which constitutes the empirical domain of psychoanalytic inquiry.

The intersubjectivity principal was applied to the developmental system as well:

Both psychological development and pathogenesis are best conceptualized in terms of the specific intersubjective contexts that shape the development process and that facilitate or obstruct a child’s negotiation of critical development tasks and successful passage through developmental phases. The observational focus is the evolving psychological field constituted by the interplay between the differently organized subjectivities of child and caretaker [pp. 1–2].

The intersubjective approach is closely related to, and an out-growth of, self-psychology. Intersubjectivity, however, places special emphasis on the examination of the minute and subtle effects of the analyst’s real presence and interventions as subjectively experienced by the patient. “The analyst seeks consistently to comprehend the meaning of the patient’s expressions, and centrally, the impact of the analyst from a perspective within rather than outside the patient’s subjective frame of reference. We have referred to this positioning as ‘the stance of empathic enquiry’ ” (Brandchaft and Stolorow, 1988).

The analyst is unable to claim that his knowledge, theory, or interpretations, have any ultimate validity. As Brandchaft and Stolorow (1988) stated, “Access is then provided to the specific and idiosyncratic, not standardized or theory-dictated, way in which the patient is organizing his experience of the analyst and the meanings which the experiences have come to encode.” The patient is free to question the analyst’s interventions or silences and to react with total spontaneity without his behaviour being considered distorted or mistaken. But this places the therapist in a much more vulnerable position. Since pathology is now no longer viewed in terms of processes located solely within the patient, it no longer protects the therapist from the various ways in which he himself and his theories are implicated in the phenomena he observes. As Brandchaft and Stolorow (1988, p. 12) indicated, there is no longer the presence of a “cordon sanitaire” as is the case when the concept of distortion is utilized. Brandchaft and Stolorow describe this situation for the therapist as “frequently like feeling the sand giving way under one’s psychological footing. Seeing oneself and the world consistently through the eyes of another involves a real danger that the analyst’s own organization of self-experience and perspective will come under threat” (p. 12). My second case presentation offers illustrations of this experience and includes details of the threat to the therapist’s self-organization as well as the mutual feedback cycle that ensued.

It may well be that the special value of the intersubjective approach is in allowing the greatest scope to the revelation of the patient’s subjective reality. As Kohut said, “If there is one lesson I have learned during my life as an analyst, it is the lesson that what my patients tell me is likely to be true . . . that many times when I believed I was right and my patients were wrong, it turned out, though only after a prolonged search, that my Tightness was superficial whereas their Tightness was profound” (Kohut, 1984, pp. 93–94). Many patients suffer from a primary difficulty in their lack of a sense of reality about their inner experience. As Brandchaft and Stolorow (1988) suggest, the patient’s ability to sustain a belief in their own subjective reality was derailed because their perceptions as children communicated to the caretakers information the caretakers did not want to hear, and so the patient’s perceptions and affects became the source of continuing conflict. Such structural weaknesses predispose to borderline psychotic states. These conditions have been treated by the intersubjective approach, with special attention being paid to restoration of the patient’s “core of subjective truth” (Stolorow, Brandchaft, and Atwood, 1987 p. 106–172). The intersubjective approach to these more than averagely disturbed patients is especially liable to give rise to countertransference problems for the therapist.

According to Stolorow and Lachmann, (1984/1985) the future of transference lies in the concept of organizing activity. Thus, transference would be the assimilation of the psychoanalytic relationship into the patient’s world. Conceived in this way, transference was seen by these authors as an expression o...

Table of contents

• Front Cover
• Half Title
• Progress in Self Psychology
• Title Page
• Copyright
• Acknowledgments
• Contents
• Contributors
• Introduction
• I THEORY
• II CLINICAL
• III CRITIQUE
• IV EXHIBITIONISM IN GROUP PSYCHOTHERAPY
• Author Index
• Subject Index