Progress in Self Psychology, V. 20

Transformations in Self Psychology

William J. Coburn

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138009844
• eBook ISBN: 9781134909650
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Transformations in Self Psychology highlights the manner in which contemporary self psychology has become, in the words of series editor William Coburn, "a continuing series of revolutions within a revolution." Of special note are contributions that explore the bidirectional influences between self psychology and other explanatory paradigms. The volume begins with Stern's thoughtful attempt to integrate self-psychological and relational perspectives on transference-countertransference enactments. Fosshage and Munschauer's presentation of a case of "extreme nihilism and aversiveness" elicits a series of discussions that constructively highlights divergent perspectives on the meaning and role of enactment in treatment and on the so-called empathy/authenticity dichotomy.The productive exploration of theoretical differences also enters in the redefinition of notions of gender and sexuality, a topic of increasing interest to self psychologists. Differing perspectives, which give rise to differing clinical emphases, emerge in the exchanges of Clifford and Goldner, and of VanDerHeide and Hartmann. The special "contextualist" demands of work with intercultural couples foster a more integrative sensibility, with self-psychological borrowings from interpretive anthropology and attachment theory.Clinical contributors to Volume 20 explore manifestations of a tension that permeates all analytic work: that between the patient's newly emerging ability to expand the self in growth-consolidating ways and the countervailing dread to repeat. Enlarged by Malin's personal reflections of "Fifty Years of Psychoanalysis" and by book review essays focusing on the writings of Lachmann and Stolorow, respectively, Transformations in Self Psychology bespeaks the continuing vitality of contemporary self psychology.

Part One
Integration and Syncretism

One
The Yin and Yang of Intersubjectivity

Integrating Self-Psychological and Relational Thinking

STEVEN STERN

Apatient has a dream that she is with her Buddhist husband on one of his retreats. She is not participating very much, but instead is using the time for biking and other nonmeditative activities. Then, she is in her living quarters when the teacher comes in and speaks to her. He says he is disappointed that she is not putting more of herself into the retreat, and that she needs to take her meditation more seriously. She knows he is right, and she feels bad. Among her associations to the dream are her bad feelings that she is never able to follow through on any of her self-improvement programs such as yoga, exercise, or improving her diet. She is overweight, which is one of the symptoms that brought her to therapy this time. One of my associations is that she has been having difficulty making both of her weekly sessions ever since she increased from once to twice a week, at my urging. She always has seemingly good excuses due to her successful and extremely busy academic career, and she has had to make changes in her prior commitments in order to fit the new session in.

In the following week she is late to one of her sessions and feels this is indicative of how out of control her life feels. In the week after that she calls the night before a session saying she has food poisoning and won't make her appointment the next afternoon. I am aware of feeling irritated when I get this message. I think: how does she know how she is going to be feeling by tomorrow afternoon? I wonder if I should, or will, charge her for this cancellation. I do not doubt her fundamental commitment to the treatment, and have believed her when she has said, recently, that she has started to look forward to coming, though she does not know why. But I feel frustrated that her cancellations seem to prevent us from getting any sense of consistency going.

In her next session she begins by saying she had lots of things she wanted to talk about, but now she has either forgotten them or they seem less important. Almost immediately, she reports feeling tired, like she could fall asleep. I am aware of feeling distant and vaguely angry with her—not my usual receptive self—and am not sure what to do with these feelings. She is feeling at a loss as to what to talk about. I suggest she talk about what she is feeling. She says she is feeling reluctant to talk because she is thinking that I am irritated with her. Instead of my absorbing things like a "sponge," I seem "slicker" today, as if her words are just bouncing off of me. She thinks I am irritated because of her missed session. At this point I hesitate briefly, but then reluctantly admit that there is truth to her experience: I am irritated with her. I do not doubt that her excuse was sincere when she called, but I feel there have been enough late arrivals and missed appointments since she increased her sessions that it feels more than coincidental. At this point I remember her dream and say I feel like the Zen teacher in the dream. She is quiet for a minute, obviously affected, though I am not sure how. Then she says that, although she felt angry and defensive at being criticized, she senses that I am right. She also says she is wide awake now and much more engaged than when she came in. We then go on to have an intense session in which she talks about her difficulty trusting me. She does not trust that I will not make the therapy more about my needs than hers; that I will not need her to come to sessions and participate, making her feel burdened. This anxiety relates to her mother, who, we have come to understand, subtly makes all interactions with the patient more about the mother's needs than the patient's.

In the weeks following this session the patient, for the first time, settles into our twice-weekly schedule. She also begins to bring forward, in a more determined and sustained way than previously, what I feel is truly her central and most painful concern: her feelings about her eating and her weight.

What is the most useful way to understand these interactions? This question goes to the heart of recent dialogue between relationally and self-psychologically oriented analysts. Relational analysts tend to view such interactions as repetitions or reenactments of something from the patient's past, something externalized from the patient's internal object world through the process of projective identification (Mitchell, 1988; Davies and Frawley, 1991; Ogden, 1994). Most self psychologists repudiate this kind of understanding on both theoretical and clinical grounds. Stolorow and his associates have been explicit about this repudiation. Theoretically, they argue that projective identification implies a "unidirectional influence system" that fails to recognize the mutually constituted nature of all transference-countertransference phenomena (Stolorow, 1994; Stolorow, Orange, and Atwood, 1998). Clinically, they feel the concept fails to take into account the analyst's own subjectivity, the analyst's "organizing principles," as significant contributors to the analyst's countertransference reactions. They also feel it predisposes the analyst not to focus empathically on the patient's current experience of the analyst that might be leading him or her to act in the defensive or provocative ways to which the analyst is responding (e.g., Brandchaft, 2002). Relationalists might, in turn, reply that they do take into account the analyst's contribution to cocreated enactments but that the co-creation process is often asymmetrical (privileging the patient's subjectivity) and thus provides an important window into the patient's unconscious relational world (Stern, 2002b).

Although it might not be apparent from this hypothetical argument, the gap between these two perspectives has actually been narrowing (Fosshage, 2003). In both the relational and self-psychological versions of intersubjectivity, the domain of interest is now defined as the fluid, context-sensitive, mutually constituting relationship between subjectivity and intersubjectivity, both in development and in the analytic process (Mitchell, 1988; Benjamin, 1990; Stolorow and Atwood, 1992; Ogden, 1994; Stolorow, 1997; Beebe and Lachmann, 2002). Yet differences do remain. One difference is that relationalists, reflecting their postmodern sensibilities, tend to resolve tensions among different frames of reference dialectically, while self psychologists, including self-psychological intersubjectivists, seem to be stuck in a more binary, categorical referencing system. Thus, where Stolorow and his collaborators (Stolorow and Atwood, 1992; Stolorow, Orange, and Atwood, 1998) eschew the concept of projective identification as a metapsychological demon, signaling doctrinal and linguistic adherence to an archaic one-person epistemology (i.e., a binary of bad old theory vs. good new theory), relationalists such as Ogden (1994), Hoffman (1998), and Pizer (1998) point toward paradoxical and dialectical solutions wherein such concepts are recontextualized within a contemporary intersubjective language and theoretical framework.

In sympathy with this latter view, I would say of the clinical sequence with which I began the paper that there is no question that my patient's ambivalent engagement with me is activating some of my own vulnerabilities and organizing principles. And it is certainly true that my openness to her experience of me as potentially narcissistic and untrustworthy is a crucial element in our deepening analytic project. But to stop there, and not be interested in how, exactly, I came to feel like a character in her dream, or in the impact of my acknowledging my irritation as an aspect of therapeutic action is, I believe, to seriously limit the analytic, intersubjective, exploration and potential transformation of our complex relational engagement.

Like a number of other psychoanalytic authors who, because of their identifications with both the relational and self-psychological perspectives, have been working to construct conceptual bridges between them (e.g., Sands, 1997; Ringstrom, 1998; Teicholz, 1999; and Fosshage, 2003), I have been working on my own synthesis (Stern, 1994, 2002a, b, c, 2003). In the present paper I pursue this project further by way of two theoretical strategies. The first is to make explicit the conceptions of the unconscious implicit in the two models. This is useful because theories of therapeutic action are so closely tied to theories of the unconscious, and any integration of the former must ultimately be grounded in an integration of the latter. The second strategy is to import the concepts of mutual and self-regulation from contemporary psychoanalytic infancy research (Beebe and Lachmann, 2002)—concepts that have been adapted to adult treatment by both relational and self-psychological authors—and demonstrate how these concepts might be used to form a bridge between relational and self-psychological thinking.

Strategy 1: Conceptions of the Unconscious

One of the fundamental differences between relational and self-psychological understandings of intersubjectivity is their different conceptualizations of the unconscious. The relational unconscious is an active, intrusive, controlling unconscious, whose power to evoke concordant and complementary identifications, and to thereby subject the analyst to cocreated versions of the patient's internal world, cannot be evaded (e.g., Bollas, 1987; Mitchell, 1988, 1997; Davies and Frawley, 1991; Ogden, 1994). Summarizing relational conceptions of the unconscious, Hirsch and Roth (1995) wrote: "the [relational] unconscious is lived out, negotiated and constructed within the transference-countertransference matrix" (p. 268). By contrast, the contemporary self-psychological unconscious is more self-contained: it consists of organizing principles (Stolorow and Atwood, 1992), disowned affects, negative selfobject representations (Gehrie, 1993), accommodations (Brandchaft, 2002), and selfobject longings, transferences, and fantasies (Bacal, 1990; Goldberg, 1995), all of which control the patient's subjective experience but do not necessarily compel or enable him or her to control the experience of the analyst. Within this model transference is experienced, but does not aggressively evoke complementary countertransference in the analyst. The core theories of therapeutic action differ accordingly. The self psychologist's empathic-introspective listening stance, and the interpretations and responses that derive from it, are sufficient to grasp, provide a new experience for, and transform the patient's more self-contained unconscious "world" (Stolorow, Orange, and Atwood, 2001), whereas the relationalist is always having to work her or his way out of co-created enactments, mutual projections, and cross-identifications to provide the transforming, needed new experience.¹

My own view is that both of these understandings have validity. Although ostensibly irreconcilable, they in fact represent a kind of yin andyang of intersubjectivity. Relational theory is the yang principle, portraying the unconscious as more aggressive, probing, and controlling. Self psychology is the more yin, characterizing the unconscious as self-contained and receptive. My experience is that both qualities are present in complex tension with one another, and that both our analytic listening stance and our model of therapeutic action need to take this complexity into account. Our listening stance must be able to hold in tension both a disciplined effort to empathically explore and grasp the patient's psychic reality and, at the same time, an equally empathic ongoing recognition of our own responses as we are affected by the patient.² Similarly, our model of therapeutic action needs to hold in balance more empathic and interpretive interventions that seek to convey our understanding of the patient's subjectivity, and more expressive interventions necessary to assert or reclaim our own subjectivity in the midst of reenactments.

Even as I advocate for integrating these two principles, I am aware that dichotomizing them in this way is a vast oversimplification. Attending to our own responses to the patient, for example, is always ultimately in the service of understanding the patient (Bollas, 1987). Attempting an empathic intervention is always, simultaneously, one form of expressing our own subjectivity. And choosing to express one's own subjectivity often has the unintended effect of making the patient feel recognized in a new way (Ehrenberg, 1996). The process is infinitely complex. Nevertheless, I think it is useful to recognize these two principles even though, like yin and yang, they are continuously and inextricably embedded in one another.

Relationalists such as Mitchell (1997) and Bromberg (1989) have been critical of self psychology for advocating adherence to a preordained empathic stance and failing to recognize the degree to which the analyst's subjectivity, including the capacity for empathy, is constantly subject to the shaping influence of the intersubjective context. One of my favorite metaphors for the relational listening perspective was offered by Black (2001) when she compared the relational analyst's receptivity to the patient to "warm and malleable clay": the analyst expects to be shaped by the patient's unique unconscious patterns of interacting and repeating. I resonate to this analogy, and I agree with the relationalists that we are always being affected by the patient's unconscious engagement with us. At the same time, what makes our participation analytic is that we are constantly, even in the midst of enactive pressures of all kinds, trying to stay sufficiently afloat or intact to be able to work toward empathic recognition of, and responsiveness to, the patient's subjectivity. The patient counts on our commitment to this process of progressive recognition, and, as Hoffman (1992) has argued, this commitment provides the necessary backdrop for the analyst's more expressive participation.

Strategy 2: The Concepts of Mutual and Self-Regulation as a Bridge

Relatiorialists, reflecting the Kleinian influence in relational theory, have tended to view the patient's unconscious, active, procedural engagements with the analyst as forms of projective identification or some similar process that goes unnamed but is responsible for the co-created reenactments of the patient's early relational scenarios. I suggest that many such enactments might usefully be reconceptualized as the patient's introduction into the analytic relationship of patterns of pathological interactive and self-regulation that were learned in his or her earliest relationships.

Beebe and Lachmann (2002), based on their own and others' developmental research (e.g., Stern, 1985; Sander, 1995; Tronick, 1998), and their creative application of these research findings to adult psychoanalytic treatment, have proposed a model of interaction and therapeutic action wherein the change process is understood to be mediated by a progressive coordination between patient and analyst in the movement toward more effective interactive and self-regulation of the patient's mental states. Both their theory and their clinical examples point toward a therapeutic model in which the therapist, based on an empathic reading of the patient's various regulatory strategies, seeks largely non-verbal ways of "entering" the patient's regulatory system and coordinating with the patient so as to facilitate a gradual revision of the patient's implicit relational expectations and regulatory competence.

Beebe and Lachmann (2002) state that in their "co-construction model, each partner's subjective experience is an emergent pr...

Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Dedication
• Contents
• Contributors
• Introduction
• I Integration and Syncretism
• II Working in Trauma
• III Multiculturalism
• IV Countertransference
• V Gender and Sexuality
• VI Personal Reflections
• VII Book Reviews
• VIII Addendum
• Author Index
• Subject Index