Melanie Klein Today, Volume 2: Mainly Practice

Developments in Theory and Practice

Elizabeth Bott Spillius

• Publisher: Routledge
• Year: 2003
• Print ISBN: 9781138835085
• eBook ISBN: 9781134983537
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Although both Kleinian psychoanalysts and their critics take it for granted that there is a therapeutic technique distinctive to the Kleinian approach, comparatively little has been written about what it is.

In Melanie Klein Today, Volume 2, Elizabeth Bott Spillius brings together classic and new papers to make it possible to understand the main elements of the Kleinian therapeutic technique. In recent years there have been important refinements in this technique, notably in regard to the balance to be struck in interpreting destructiveness, the use of the so-called part-object language, and the precise ways to understand and interpret 'acting-in' and the role of the past in the present.

This collection draws these developments together and makes clear why an integral part of contemporary Kleinian theory and practice is concerned with the careful scrutiny of the therapeutic process itself. The volume includes detailed accounts of clinical work with both adults and children and takes further the theoretical ideas discussed in Melanie Klein Today, Volume 1.

The papers and the editorial commentary in this book together comprise the most illuminating and coherent rationale for the Kleinian technique yet published. The ideas will be of interest to members of many disciplines and a final section includes papers on the application of the Kleinian approach in other fields of work.

PART ONE

Developments in technique

Introduction

ELIZABETH BOTT SPILLIUS

Although Kleinian analysts take it for granted that a distinctive technique is basic to the Kleinian approach, comparatively little has been written about this technique in its own right until very recently. This dearth of papers on technique has occurred partly because Kleinian analysts were preoccupied with other areas of research, but perhaps also because it was thought for some time that it was novelty of content rather than novelty of method that makes Kleinian work distinctive. Thus, for example, in a paper specifically entitled ‘Melanie Klein's technique’ (1967) Segal describes the essentials of Klein's technique in less than one page and then spends the rest of the paper describing the effect of Klein's novel theories. The impression one gets from this paper is that the distinctive features of technique are so enmeshed with the distinctive features of clinical content that they cannot be usefully disentangled. Recently, however, there has been increased discussion among Kleinian analysts of problems specifically concerning technique, even though comparatively little of this discussion has been published as yet.

Most of the basic features of Kleinian technique, as Segal notes, are closely derived from Freud: rigorous maintenance of the psychoanalytic setting so as to keep the transference as pure and uncontaminated as possible; an expectation of sessions five times a week; emphasis on the transference as the central focus of analyst-patient interaction; a belief that the transference situation is active from the very beginning of the analysis; an attitude of active receptivity rather than passivity and silence; interpretation of anxiety and defence together rather than either on its own; emphasis on interpretation, especially the transference interpretation, as the agent of therapeutic change. In Kleinian thought there is a particular emphasis on the totality of transference. The concept is not restricted to the expression in the session towards the analyst of attitudes towards specific persons and/or incidents of the historical past. Rather the term is used to mean the expression in the analytic situation of the forces and relationships of the internal world. The internal world itself is regarded as the result of an ongoing process of development, the product of continuing interaction between unconscious phantasy, defences, and experiences with external reality both in the past and in the present. The emphasis of Klein and her successors on the pervasiveness of transference is derived from Klein's use of the concept of unconscious phantasy, which is conceived as underlying all thought, rational as well as irrational, rather than there being a special category of thought and feeling which is rational and appropriate and therefore does not need analysing and a second kind of thought and feeling which is irrational and unreasonable and therefore expresses transference and needs analysing.

Klein and her successors strongly disagree with the idea of encouraging regression and reliving infantile experiences in the consulting room through non-interpretive activities. Analytic care, in her view, should take the form of a stable analytic setting containing within it a correct interpretive process. Even in the development of play technique with children she adhered to these principles, except that play as well as talk was the medium of expression. Similarly, work with psychotic patients has been carried out with only minor changes in technique such as not insisting that the patient use the couch and seeing the patient in hospital if necessary.

Because so little has been written about Kleinian technique until comparatively recently, I have tried to read all the clinical papers by Kleinian analysts that I could find, many of them unpublished; most of these papers were written early on in their authors’ careers and were intended only to be informal presentations of clinical work; the authors were not trying to make a contribution to theory. Because these papers include detailed clinical descriptions, they provide source material for drawing conclusions about the principles of technique that their authors were using. Over the period from the late 1940s to the 1980s certain trends of change in technique are evident.

There are certain strikingly original exceptions, but most of the papers of the 1950s and 1960s, especially those by young and relatively inexperienced analysts, tend to emphasize the patient's destructiveness in a way that we would now assume might have felt persecuting to the patient. A second feature of these early papers is that unconscious phantasies were evidently interpreted to the patient immediately and very directly in part-object language (breast, nipple, penis, etc.). In the earliest papers there were very few references to counter-transference or to protective identification, especially to projection of aspects of the patient into the analyst.

Gradually, though rather unevenly, several trends of change emerged in the papers of the 1960s and 1970s. First, destructiveness began to be interpreted in a more balanced way. Second, the immediate use of part-object language diminished. Third, the concept of projective identification began to be used more directly and explicitly in analysing the transference; similarly ideas on counter-transference began to be used more systematically, though counter-transference was not discussed in the papers as explicitly as projective identification. Fourth, there began to be increasing emphasis on acting-in, meaning living out experiences in the transference rather than thinking and talking about them, and more emphasis also on the patient unconsciously putting pressure on the analyst to join in. And finally, though this is as yet less evident in clinical papers than in verbal discussions, there is at the present rime much interest in reconstruction and in alternative ways of interpreting the way past experiences express themselves in the patient-analyst interaction.

Most of these trends of change have developed piecemeal and gradually without anyone being very much aware of them until some time after they had happened. They were ‘in the air’ rather than being the product of conscious striving by any particular analyst. The influence of Bion, however, is apparent throughout. His work on normal projective identification has had a very specific influence in changing analysts’ handling of transference and counter-transference, but his influence has also been more general and pervasive. As I have described in the Introduction to the section of the first volume called ‘On thinking’, Bion insisted throughout his working life that analysts should try to focus on the immediate emotional reality of their experience with the patient so that something new would have a chance of happening. He urged analysts to forget in the session what they knew, including psychoanalytic theories, and to forget what they hoped for either for themselves or for the patient; this meant, among other things, being prepared to face the possibility that no new understanding might emerge. His first presentation of these ideas in ‘Notes on memory and desire’ in 1967, reprinted here, met with the usual mixture of bewilderment, rejection, and idealization that Bion's statements tend to provoke. The ideas are now better accepted, and indeed recognized to be essentially similar to the attitude of mind recommended by Freud (1912).

I wish to discuss in more detail the trends of change in Kleinian clinical work. First, the question of interpreting destructiveness and self-destructiveness. Both Klein and her followers have often been accused of overemphasizing the negative. Perhaps a reason for this apparent overemphasis was that there had been little focusing on aggression in psychoanalytic theory before the 1920s, even though Freud's case histories give ample illustration of his interpreting rivalry and aggressiveness as well as unconscious sexual wishes. Certainly Klein was very much aware of destructiveness and of the anxiety it arouses, which was one of her earliest areas of research, but she also stressed, both in theory and practice, the importance of love, the patient's concern for his objects, of guilt, and of reparation. Further, in her later work especially, she conveys a strong feeling of support to the patient when negative feelings were being uncovered; this is especially clear in Envy and Gratitude (1957). It is my impression that she was experienced by her patients not as an adversary but as an ally in their struggles to accept feelings they hated in themselves and were therefore trying to deny and obliterate. I think it is this attitude that gave the feeling of ‘balance’ that Segal says was so important in her experience of Klein as an analyst (Segal 1982). Certainly that sort of balance is something that present Kleinian analysts are consciously striving for. In this respect, then, some of the authors of early clinical papers took a step backwards from the work of Klein herself, especially from her later work. Since that time there has been a change, not in the emphasis on death instinct and destructiveness, but in the way it is analysed, with less confrontation and more awareness of subtleties of conflict among different parts of the personality over it. This change has been influenced not only by the work of Bion but also by Rosenfeld's continued stress on the communicative aspect of projective identification and by Joseph's emphasis on the need for the analyst to become aware of subtleties of the patient's internal conflict over destructiveness and thus to avoid joining the patient in sadomasochistic and other forms of acting-out.

Second, changes in the language of interpretation. Klein developed her very concrete, vivid language of part objects and bodily functions in work with small children for whom it was meaningful and appropriate. Extrapolating backwards, she assumed that infants feel and think in the same way, and, further, that this is the language of thinking and feeling in everyone's unconscious. Work since Klein's day has amply demonstrated that vivid bodily-based phantasies often become conscious in the analysis of adults, especially readily in the case of psychotic and borderline psychotic patients. No one who has read the accounts of Klein's work with children or the clinical reports of her more talented students and followers can fail to be impressed by their clinical imagination and their grasp of unconscious phantasy. In less skilled hands, however, this approach lost its freshness and became routinized. As I have described above, some of her more youthful and enthusiastic followers made interpretations in terms of verbal and behavioural content seen in a rigidly symbolic form which now seems likely to have been detrimental to the recognition of alive moments of emotional contact. Such interpretations are based not on the analyst's receptiveness to the patient but on the analyst's wish to find in the patient's material evidence for the analyst's already formed conceptions. ‘Memory’ and ‘desire’, in Bion's terms, replace hypothesis and receptivity. This prejudiced attitude can of course operate with any set of analytic concepts.

A number of Kleinian analysts, perhaps especially Donald Meltzer, find it appropriate to interpret unconscious phantasy directly and immediately in part-object bodily language, but the general tendency, as I have described in the General Introduction to Volume 1, is to talk to the patient, especially the non-psychotic patient, less in terms of anatomical structures (breast, penis) and more in terms of psychological functions (seeing, hearing, thinking, evacuating, etc.). Together with this emphasis on function, concentration on the patient's immediate experience in the transference often leads to discovery of deeper layers of meaning, some of which may be seen to be based on infantile bodily experience. Talking about unconscious phantasy in bodily and part-object terms too soon is likely to lead to analyst and patient talking about the patient as if he were a third person (Joseph 1975, Riesenberg Malcolm 1981). But there is a danger also that if the analyst concentrates too exclusively on the immediate present, the here and now, he will lose sight of the infantile levels of experience that the immediate expression in the here and now is based on, that the baby will get thrown out with the bath water so to speak. Both levels of expression need to be listened for together and linked with experience.

Third: changes in the use of the concept of projective identification in analysing the transference. Although Klein herself introduced the concept of projective identification, she does not seem to have envisaged its use in the analysis of the transference in the form which rapidly developed among her close colleagues. Indeed, we now regard transference as based on projective identification, using that term in the widest sense, as I have suggested in Volume 1. According to Segal, Klein frequently used the concept of projective identification in her own work, but phrased her interpretations about it as statements about the patient's wishes, perceptions, and defences. If, for example, a patient reported a dream in which a screaming baby had the face of the analyst, Klein would have said, ‘You can't tolerate your own infantile feeling of screaming, so that you wish to get rid of those feelings into me and therefore see me in your dream as a screaming baby’. If an analyst reported to her in supervision that he had actually felt like screaming, Klein's view would have been that the analyst needed a little self-analysis. Her emphasis was always on the patient's material, not on the analyst's feelings, which, she thought, were only aroused in a way that interfered with his analytic work if he was not functioning properly. Her view is illustrated in the now classic story about a young analyst who told her he felt confused and therefore interpreted to his patient that the patient had projected confusion into him, to which she replied, ‘No, dear, you are confused’, (Segal 1982), meaning that the analyst had not understood his patient's material and was interpreting his own lack of understanding as if it had been caused by the patient's projection.

This example, however, is a case of a wrong or inadequate use of the idea of projective identification; the analyst was not seeing his own problem and was therefore blaming his own deficiencies on the patient. Bion, however, made use of exactly the same process but based it on a brilliant grasp of the way his patients were attempting to arouse in him feelings that they could not tolerate in themselves but which they unconsciously wished to express, and which could be understood by the analyst as a communication. I summarized an example of this process in Volume 1 in the section called ‘Projective identification’ in which Bion felt frightened in a session with a psychotic patient and then interpreted to his patient that the patient was pushing into Bion his fear that he would murder Bion; the atmosphere in the session then became less tense but the patient clenched his fists, whereupon Bion said that the patient had taken the fear back into himself and now was (consciously) feeling afraid that he would make a murderous attack (Bion 1955). Bion was thus using the idea that a patient can behave in such a way as to get the analyst to feel what the patient unconsciously feels. Unlike Klein, he was explicitly prepared to use his own feelings as a source of information about what the patient was doing.

Our view now is that what matters is not whether the analyst's own feelings should be used as a source of information but whether they are used well or badly. In spite of Klein's doubts, her colleagues continued to use her idea of projective identification as an important factor in counter-transference and indeed it is hard to see how the analyses of psychotic patients reported by Segal, Rosenfeld, Bion, and others could have proceeded without it. Certainly it is now part of the standard approach of every Kleinian analyst. At the same time, most Kleinian analysts are aware of a tendency, especially in inexperienced analysts attempting to use their feelings constructively, to become overpreoccupied with monitoring their own feelings as their primary clue to what is going on in the session, to the detriment of their direct contact with their patient's material.

Klein was uneasy not only about possible misuse of the concept of projective identification but also about the closely related issue of widening the concept of counter-transference, as described by Heimann, to mean use of the analyst's feelings as a source of information about the patient (Heimann 1950). Nearly all Kleinian analysts, however, now use the concept of counter-transference in this wider sense, that is, as a state of mind induced in the analyst as a result of verbal and non-verbal action by the patient, thus giving effect to the patient's phantasy of projective identification. Bion himself, however, uses the literal word ‘counter-transference’ to mean the analyst's unconscious pathological feelings, his ‘transference’ in the restricted sense, towards the patient, which indicates a need for more analysis for the analyst. This is of course confusing, since, as I have described above, Bion constantly uses the idea of counter-transference in the widened sense; it is only when he uses the actual term that he means counter-transference in the more restricted pathology-in-the-analyst sense. In practice, however, the two types of counter-transference are not invariably separable, since arousing the pathology-in-the-analyst is often the means by which the patient effects his projective identification.

More papers have been written by Kleinian and kindred analysts on counter transference than on any other technical concept. In addition to Heimann's original paper in 1950, there is one by Money-Kyrle in 1956 (which is reprinted here), a book by Racker (1968, but written in the 1950s), and papers by Grinberg (1962), Segal (1977a), and Brenman Pick in 1985 (also reprinted here). All these authors advocate use of the counter-transference as a source of information about the patient; most also discuss the way the analyst can be thrown off his therapeutic balance by the patient but can sometimes use his own loss of composure to understand the therapeutic situation better.

Money-Kyrle's 1956 paper ‘Normal counter-transference and some of its deviations’ (reprinted here) describes what he calls ‘normal counter-transference’, a combination of curiosity and reparative wishes towards himself and his own internal objects whom the patient in part represents. This ‘normal counter-transference’ corresponds to the idea of the analyst's usual capacity to take in, contain, and transform the ...

Table of contents

• Cover Page
• Half Title page
• The new library of psychoanalysis
• Series Page
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• General Introduction
• Part One: Developments in technique
• Part Two: Clinical papers on adult psychoanalysis
• Part Three: The analysis of children
• Part Four: The application of Kleinian ideas in other fields of work
• References to General Introduction and Other Introductory Material
• Name Index
• Subject Index