Psychotherapy After Kohut

A Textbook of Self Psychology

Ronald R. Lee, J. Colby Martin

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9781138872370
• eBook ISBN:
  9781134884452
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Hailed as "a superb textbook aimed at introducing psychoanalytic self psychology to students of psychotherapy" (Robert D. Stolorow), Psychotherapy After Kohut is unique in its grasp of the theoretical, clinical, and historical grounds of the emergence of this new psychotherapy paradigm. Lee and Martin acknowledge self psychology's roots in Freud's pioneering clinical discoveries and go on to document its specific indebtedness to the work of Sandor Ferenczi and British object relations theory. Proceeding to readable, scholarly expositions of the principal concepts introduced by Heinz Kohut, the founder of self psychology, they skillfully explore the further blossoming of the paradigm in the decade following Kohut's death. In tracing the trajectory of self psychology after Kohut, Lee and Martin pay special attention to the impact of contemporary infancy research, intersubjectivity theory, and recent empirical and clinical findings about affect development and the meaning and treatment of trauma.

 1 

Introduction

The emergence of self psychology in the 1970s and 80s has brought significant changes to the theory and practice of psychotherapy. One change, for example, has been to increase understanding of, and improve treatment success with, narcissistic patients, who were considered untreatable using the old paradigm. A description of self psychology's ideas, how they developed, and the major changes they produced forms the subject matter of the chapters that follow.

Self psychology represents a major paradigm shift that was not evident until the later stage of its development. Paradigms can be said to be “universally recognized scientific achievements that for a time provide model problems and solutions to a community of practitioners” (Kuhn, 1962, p. viii). For example, a paradigm shift occurred in physics when Einstein's wave theory of light replaced Newton's corpuscular theory. In this volume, we present psychotherapy as employing three major paradigms: (1) healing based on what we refer to as a magical covenant, (2) classical analysis, and (3) self psychology. Our major interest is in the paradigm shift from classical analysis to self psychology and the divergent opinions of self psychologists about the nature of this shift.

The publication of an increasing number of books on the subject of self psychology signified its emergence as a new paradigm. Kohut himself, the pioneer theorist of self psychology, followed his two early papers on empathy (1959) and narcissism (1966) with three major books: The Analysis of the Self (1971), The Restoration of the Self (1977), and How Does Analysis Cure? (1984). These were then followed in the 80s by a stream of books from Kohut's former colleagues and students, who not only used Kohut's ideas, but extended them beyond the issues of narcissism. With such a plethora of books on the subject, why another?

This book arose out of a need for a textbook for psychotherapy students. The chapters initially evolved from material prepared for a class on self psychology at the Illinois School of Professional Psychology. At the beginning, the students knew buzzwords —“idealizing transference” and “mirror transference”—but seemingly little else. Those who attempted to study self psychology soon floundered in an overabundance of articles and books shaped for polemical debate rather than the systematic unfolding of ideas.

Students did not readily grasp the significance of the new ideas represented by self psychology. In clinical practicums they seldom encountered patients with the clearly definable narcissistic transferences Kohut had described, because they were assigned either brief counseling cases or very disturbed patients with difficult archaic transferences. Even when definable narcissistic transferences occurred, they were not recognized by students or supervisors untrained in a self-psychological approach.

Many who independently tried to study Kohut became confused and discouraged after attempting The Analysis of the Self, perhaps the most difficult of Kohut's books. Had they first read two early papers (Kohut, 1959, 1966), the going might have been easier. And the few who knew of the empathy paper (1959) mistakenly thought of self psychology as another version of Rogerian theory. Given such misconceptions, it was evident that the major problem with teaching self psychology to clinical psychology students (or social workers, pastoral counselors, or counselors), as compared with teaching students at a psychoanalytic institute, was a lack of grounding in psychoanalytic theory. Nonpsychoanalytic students were unfamiliar with such major works by Freud as “On Narcissism” (1914), “Mourning and Melancholia” (1917), and “The Ego and the Id” (1923). Although some had read about Dora, the Rat Man, and the Wolf Man in secondary sources, few had read the primary documents, the cases written by Freud himself.

The students also were not aware that drive theory, the keystone of classical analysis, had been subjected to mounting criticism in recent decades and had actually been abandoned by many analysts. Nor were they aware of the self psychology literature by such analysts as Basch, Goldberg, Stolorow, and Wolf.

In developing the course, we initially set out to provide an overview of the major concepts of self psychology. We used White and Weiner's (1986) The Theory and Practice of Self Psychology, which followed a similar outline to our original course syllabus, as our basic text. The problems we encountered using the White and Weiner text were with the simple overview approach. Basic concepts, disembodied from their historical nexus and the issues and problems with which psychotherapy had wrestled for several generations of therapists, were not given the importance and meaning they deserve. The authors expounded solutions without adequately presenting the problems the solutions were meant to solve. Using the White and Weiner book meant that we were constantly explaining the issues and showing how self psychology's ideas differed from those of the classical paradigm.

To reduce the need for repeatedly explaining aspects of the classical paradigm to illuminate the importance of Kohut's ideas, we developed supplementary written material. We also found ourselves frequently explaining how the self psychology paradigm itself evolved and how it had originally been presented as an expansion of the old paradigm, the “widening scope,” that Stone (1954) had described.

Eventually, it became clear to us that we were committed to a brief historical approach to the major concepts of self psychology, a narrative describing the development of concepts, rather than a general overview of concepts isolated from their context. We deliberately developed a simplified narrative that invited later refinements and modifications. Further, we wanted to avoid becoming bogged down, spending an inordinate amount of time teaching classical material as an introduction. We sought to cover enough of the introductory material to establish useful comparisons and encourage students to dig deeper into both paradigms. We were forced to be selective. We focused on the main issues of classical analysis and other precursors of self psychology, with a view to showing the emergence of self psychology theory all the more clearly.

Another problem was the tendency for clinical psychology students to think of self psychology as being solely Kohut. On the contrary, in the decade since Kohut's death, other self psychologists have so expanded the Kohutian beachhead that to view self psychology as solely Kohut is to miss the important clinical and theoretical advances of the 80s. We decided to present self psychology from a broad perspective. Narrowly conceived, self psychology consists of the ideas of Heinz Kohut, ideas that apply to the understanding and treatment of narcissistic disorders. Thought of more broadly, self psychology strives to be a more general theory, applicable to a broad range of clinical syndromes defined as disorders of the self. How broadly self psychology theory can be extended, and how useful these theoretical extensions are to clinicians, has yet to be explored fully.

The early chapters here are designed to help the reader gain a sense of continuity about self psychology. Though self psychology is hailed by many as a new paradigm, writers differ on the extent of its variation from the old. It had its forerunners. Self psychology can be said to be “radical” only if the work of many pioneers, including Ferenczi and theorists of the British school, are ignored. Like Kohut, those pioneers (and the defectors, Jung and Adler) also attempted to broaden the scope of psychoanalysis to include more than the treatment of neurotics. When their work is conceptually linked with self psychology, it can be argued that Freud, Ferenczi, the British school, and self psychology constitute the mainstream of psychotherapeutic thought. Classical analysis, thought originally to be the major highway of psychotherapy, is increasingly being viewed as a conceptual dead end, abandoned only with great difficulty by those heavily invested in it. Emerging as a new major paradigm in psychotherapy, self psychology takes us toward a more functional, “experience-near” theory and better psychotherapeutic results.

Eventually a broad outline for a manuscript emerged. It divided naturally into three parts: one covering the pre-Kohut material to show the conceptual linkage and continuity between religious healing, Freud, Ferenczi, the British pioneers, and self psychology; the second about Kohut; and the third exploring attempts at a broader theory beyond Kohut. By presenting the material this way, we hope to reinforce a broad-based professional identity.

We also recognize that once the major ideas of the self psychology paradigm are accepted, the old paradigms may be viewed differently. The new paradigm unavoidably influences what we consider important in religious and classical analytic paradigms and in the pre-Kohutian material. Thus, when we looked for themes in the old paradigms, such as idealization, it was because we already knew it was a key concept in self psychology. This is a bias that we openly acknowledge. In fact, the new paradigm enables us to see new threads of continuity.

Using each chapter as material for a two-hour class session, we found that students discussed more freely in class if the chapter contained a clinical case. Where possible, we sought to include well-known cases, already published, because these are the classics, which will be discussed and debated in the years ahead. For example, we included material on Freud's cases of Dora and Ernst Langer (the Rat Man), Kohut's case of Mr. Z, and Tolpin's case of Mrs. A. The Wolf Man (Dr. Serge Pankejeff) is covered in chapter 20. Where necessary, we included clinical material of our own to illustrate and concretize theory. As the reading recommended for each chapter reveals, we encouraged students not just to rely on our summary, but to read the cases in the primary sources.

The subject of chapter 2 is the magical covenant. From a long-range perspective, the development of modern psychotherapy is merely another stage in the ubiquitous task of psychological healing. Its beginnings are rooted in healing conducted by high-status persons, especially religious authorities. Religious healing goes back thousands of years; until 100 years ago, it was a major form of psychotherapy. Then, when Breuer and Freud published “Studies on Hysteria” (1893-1995), psychoanalysis was born. As Basch (1988a) defines it, “psychoanalysis … refers to a research method into human motivation, to a particular form of intensive psychotherapy, and to [Freud's] proposed general theory of mental functioning” (p. 4n).

Even though psychoanalysis added a new method and theory to the psychological approach to healing, it never completely replaced religious healing. In the United States today, for example, because of the sheer numbers of the clergy (priests, ministers, rabbis), the total amount of counseling by religious professionals is probably more than that of all other psychotherapists combined. Worldwide, this is undoubtedly so. Yet even if classical psychoanalysis has never been the only form of psychotherapy, undeniably it has been, for almost a century, the major force in understanding the psychological functioning of human beings and the conduct of healing. For this period it was the predominant paradigm, just as religious healing was for thousands of years before.

Now the influence of classical psychoanalysis is waning. Basch (1988a) concludes that “Freud fell short of his goal. He was unable to establish a theory that would serve both as a scientific basis for psychotherapy generally as well as a foundation for the investigation of human nature” (p. 3). Self psychology's emergence as a dominant paradigm now raises new issues and stimulates further research. It has the added attraction of being far more inclusive than the classical paradigm it replaces.

The critics of self psychology doubt whether this new paradigm is truly psychoanalysis (see chapter 16, this volume). Perhaps more important is the shift that self psychology has wrought in the distinction between psychoanalysis and psychotherapy (see chapter 17, this volume). Self psychologists still see a difference between them, even though they acknowledge that a similar dynamic process takes place in all forms of psychotherapy, including psychoanalysis. The distinction between these two modes of therapy lies in the aims of the treatment and the extensiveness of the working through.

Self psychology's view that psychoanalysis and psychotherapy involve a similar process is an important shift in attitude based on a change in theory. This shift is of great significance for all who practice psychotherapy, especially those whose professional roots are anchored in the broader psychotherapeutic community—general psychiatry, psychology, social work, the ministry, and counseling—yet who embrace self psychology's theoretical contribution to their work. While self psychology had its birth and early nourishment in the psychoanalytic tradition, the issue is not whether the new paradigm is psychoanalysis, but where in the new paradigm the old psychoanalysis fits. In self psychology the ideas central to psychoanalysis have been so transformed that it is now difficult to consider psychotherapy an inferior form of healing.

The last section of the book, commencing with chapter 18, looks at some trends in self psychology during the 80s and 90s after the death of Kohut. These developments have been accompanied by a proliferation of published material suggesting ways to build on the theoretical advances of Kohut. The intersubjectivists, for example, led by Atwood, Brandchaft, Lachmann, and Stolorow, claim that psychoanalysis is the “science of the subjective” (see chapters 18, 19, and 20, this volume).

Basch and Goldberg, on the other hand, emphasizing epistemological issues, are among those who resist a strictly phenomenological approach to psychotherapy and want to include the nomothetic results of observational research in infant development studies (see chapter 23, this volume) and new concepts emerging from the neurosciences (see chapter 4, this volume). Yet another position is held by Mitchell, whose relational theory subsumes the self psychology ideas of Kohut, the object relations position of Fairbairn, and the interactional approach of Sullivan in one broadly based general theory that is oppositional to drive theory. Other developments focus on affect theory in chapter 21 and trauma theory in chapter 22.

Finally, to cover the wide range of healing from religious counseling to psychoanalysis to self psychology, we use “psychotherapy” as a generic term for healing, from the Greek word to make whole. Healing in the religious paradigm focuses on the soul; in psychoanalysis, on the mind; and in self psychology, on the self.

To facilitate classroom discussion, we include recommended reading for the next chapter in each preceding chapter.

General Readings: Kohut, 1984; Chessick, 1985; Stolorow, Brandchaft and Atwood, 1987.

Readings for Chapter 2: Frank, 1963; Wise, 1966; Lee, 1979.

2

The Magical Covenant

The magical covenant, the basis of a long tradition of religious healing, was the paradigm of psychotherapy practiced extensively for thousands of years before Freud made the discoveries that led to psychoanalysis. As Stone (1951) acknowledged, “Psychoanalysis is a special and relatively new branch of psychotherapy” (p. 215). In a magical covenant, a passive supplicant expects an active, omnipotent healer to use status and power miraculously to bring about healing. Known historically as “the cure of souls,” religious healing has been defined as “helping acts done by representative Christian persons, directed towards the healing, sustaining, guiding and reconciling of troubled persons” (Clebsch and Jaekle, 1964, p. 4). Such a definition may be applied to the healing by all religious faiths.

Just as magical healing was the healing paradigm prior to the therapeutic revolution initiated by Freud, self psychology may be the major new healing paradigm. Thus, it may be more appropriate to compare the paradigm shift from psychoanalysis to self psychology with that from magical healing to psychoanalysis than to compare the shift with Einstein's change in the theory of light from the views of Newton. When self psychologists claim their new theory represents a paradigm shift, do they mean that it is as radical as the one that took place under the leadership of Freud?

Magical healing was not completely eradicated with Freud, even though he sought to purge psychoanalysis of any form of suggestion. It is present in pastoral counseling today and also takes on secular forms. It resurfaces in self psychology, in the transformation of the narcissistic transferences. In what follows we examine (a) the magical covenant in religious healing, (b) secular forms of the magical covenant, (c) modern pastoral counseling, and (d) paradigm shift.

THE MAGICAL COVENANT IN RELIGIOUS HEALING

In a healing act, the religious representative (shaman, priest, minister, rabbi) utilizes his status, enacts religious rites of his faith community, refers to basic religious beliefs, and recommends a plan of action to calm and relieve those among the faithful who are distressed. This treatment, as Lévi-Strauss (1963) points out, is almost an inversion of the psychoanalytic cure.

Both cures aim at inducing an experience, and both succeed by recreating a myth which the patient has to live or relive. But, in one case, the patient constructs an individual myth with elements drawn from his past; in the other case, the patient receives from the outside a social myth which does not correspond to a former personal state. When a transference is established, the patie...

Table of contents

• Front Cover
• Half Page
• Title Page
• Copyright
• Contents
• Acknowledgments
• 1 Introduction
• 2 The Magical Covenant
• 3 Freud as Clinician
• 4 Freud’s Mental Apparatus
• 5 Drive and Conflict Theory
• 6 Ferenczi, the Dissident
• 7 The British School
• 8 Metatheory: Theory about Psychotherapy Theory
• 9 Empathic Understanding
• 10 Narcissism
• 11 Mirror Transference
• 12 Idealizing Transference
• 13 Twinship and Merger Transferences
• 14 Selfobject Experiences
• 15 The Self System
• 16 Conflict and Deficit Theories
• 17 Psychoanalysis and Psychotherapy
• 18 Transference as Organizing Principle
• 19 Structuralization
• 20 Negative Therapeutic Reactions
• 21 Affects
• 22 Trauma
• 23 Mutual Influence Theory
• 24 Toward a General Theory
• References
• Author Index
• Subject Index