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Truth or What Matters: Commentary on Paper by Philip A. Ringstrom
A Relational Psychoanalytic Approach to Couples Psychotherapy presents an original model of couples treatment integrating ideas from a host of authors in relational psychoanalysis. It also includes other psychoanalytic traditions as well as ideas from other social sciences. This book addresses a vacuum in contemporary psychoanalysis devoid of a comprehensively relational way to think about the practice of psychoanalytically oriented couples treatment.
Extending the themes of Contemporary Psychoanalytic Foundations, The Therapeutic Situation in the 21st Century is a systematic reformulation of fundamental psychoanalytic concepts, such as transference, therapeutic action, and the uses of psychotropic drugs, in the light of recent developments in postmodernism, complexity theory, and neuroscience. Leffert offers formulations of areas not previously considered in any depth by psychoanalysts, such as power relations in the analytic couple, social matrix theory, and narrative theory informed by considerations of archaeology, genealogy, complexity, memory, and recall. He also considers new areas, such as the role of uncertainty and love in the therapeutic situation. This book is part of an ongoing effort to place psychoanalysis in the current century, and looks to outside as well as inside areas of thought to inform how we work and how we think about our work.
Because they see their Intersubjective Systems theory as an “instance” of the larger category of Relational psychoanalysis, Stolorow and Atwood claim that it is “logically incoherent” to compare their theory with Relational psychoanalysis in the manner done in the symposium (Volume 20, No. 2, 2010. pp. 195–250). Their sweeping dismissal of the symposium on the basis of what they refer to as a “category mistake” makes me wonder if they even read the five articles in it. Had they done so, they would have had to reckon with their argument being exactly the opposite of that of a key defender of their theory (Jacobs, 2010) who argues that Relational Psychoanalysis should be seen as a subset of Intersubjective Systems theory. The fact that Stolorow and Atwood employ ideas from philosophy that are exceedingly hard to keep straight—even among themselves—is why in my reply to the symposium discussants, I stated that arguments regarding “category mistakes”, “levels of abstraction” (e.g. “explanatory versus phenomenology”) and so forth are at best confusing and at worse, specious. Meanwhile, given that this comparison symposium follows in the footsteps of their own critique of Relational psychoanalysis, their efforts to cast doubt on it are not only poorly argued, they flagrantly are transparent.
Ringstrom's “comparison of relational psychoanalysis and intersubjective systems theory” exhibits a category mistake that renders the core of his argument logically incoherent.
This article formulates an object relations perspective based on the complementarity of intrapsychic and intersubjective aspects of self-development. Object relations theories, even those interested in intersubjectivity, have not followed up on Winnicott's (1971) crucial distinction between the subjectively conceived object and the objectively perceived, outside other. With few exceptions, notably Stern (1985), theorists have overlooked the core element of intersubjectivity, which is mutual recognition. The development of the capacity for mutual recognition can be conceived as a separate trajectory from the internationalization of object relations. The subject gradually becomes able to recognize the other person's subjectivity, developing the capacity for attunement and tolerance of difference. To elaborate on this process, the article discusses differentiation in the first 2 years of life. It suggests that Mahler's rapprochement period can be reinterpretated as a struggle for recognition in which the outcome is not simply object constancy, but the beginning ability to recognize another person's subjectivity. The differentiation process consists not merely of separation, but the continual breakdown and repair of mutuality in the psyche's stance toward the outside. Accepting the inevitability of breakdown and reconstruction of the outside other allows considerable room for the role of intrapsychic fantasy and aggression, which might otherwise be neglected in relational theories of the self. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The intersubjective field concept is a doorway to a dialogical sensibility. A dialogical attitude recognizes just how thoroughly and intimately any effort to understand another implicates both parties in the dialogue. The therapist's task is to engage in a dialogue that stands the greatest chance of enabling the therapist to understand how our patients' experiences--and ours--make perfect sense at this time in this situation together, even when our patients' statements challenge our equilibrium or raise our defenses. In addition, many patients also struggle toward an engagement with their analyst not just as a repetitive figure (and not even as someone who merely serves their developmental needs). I think they strive for a more complex experience of the analyst in his or her subjectivity. Our ability to welcome them into our experiential worlds is often transformative in restoring a sense of dignity to emotionally alienated patients. An extended case example demonstrates these ideas.
In this article, the clinical phenomenon of transference love is used to make 3 contributions: (a) to illustrate how the intersubjective field can encompass more than just patient and therapist, (b) to provide an intersubjective framework for understanding transference love, and (c) to demonstrate how selfobject and antidote functions of the therapeutic relationship can alternate within the same patient-therapist dyad as figure and ground.
Hypothese selon laquelle une cure psychanalytique semblant mener a une impasse peut neanmoins aboutir a une meilleure comprehension de soi (chez le patient et chez le psychotherapeute). Un transfert negatif peut s'averer aussi utile pour la comprehension et l'apprehension des mecanismes de l'Inconscient qu'un transfert positif
This article juxtaposes two orientations to psychoanalytic theory and clinical action—the prescriptive, embodied in the metaphor of classical theater, and the improvisational, embodied in the metaphor of improvisational theater. The metaphor of classical theater is analogous to how the theoretical predilections of each school of psychoanalysis has its own set of prescriptions (“sets,” “roles,” and “scripts”) for how an analyst influences mutative moments of change with a patient. In contrast, the metaphor of improvisational theater refers to actions that arise on the spur of the moment, without preparation. These improvisational moments ineluctably communicate to the patient a special instance of authenticity, which may well be antidotal to the crushing reality of the patient's life of pervasive inauthenticity. They also enable analysts to more readily engage disparate, often dissociatively disconnected parts of the patient through imaginative intersubjective engagement with each. This may take the form of reverie within the analyst—from which his own mental state of play informs his interpretation. Still, at other times, it may involve a form of spontaneous engagement that conveys not only a moment of deep recognition but also the purest state of authentic engagement—that is, one that cannot arise with comparable impact when reflection precedes the analyst's action. In sum, the capacity for engaging in improvisation may well be one of the most defining capacities for the development of a genuine psychoanalysis.
Psychoanalytic concepts, in general, are sorely lacking in addressing the present moment phenomenon of the psychoanalytic encounter. The relational perspective has comparably suffered from not addressing the issue of temporality. This paper addresses this lack by focusing on the present moment of the analytic encounter with special appreciation for what is referred to as improvisational moments. Although such moments arise unpredictably, they capture something of both the analyst's and analysand's fundamental personality organizations. These are represented in how each one's experience of the past, present, and future are organized in “scriptlike” manners. The improvisational interplay of their “scripts” lends itself to “scenes” from which a coconstructed relational unconscious emerges, that is, a quality of “thirdness” that neither can lay exclusive claim to authoring. This moves them beyond the more typical one-way intersubjectivity of sustained empathic introspection I know what you feel into an experience of two-way intersubjectivity, I know that you know that I know what you are feeling and visa versa. Such improvisational moments move each one beyond the constraints of their personality organization into considering the heretofore unimagined, unthought, and unspoken. The outcome of such moments challenges each participant's respective personality organization, necessitating their accommodation of new structure. The latter phenomenon is referred to as a positraum. Such dramatic shifts then provide model scenes for further change that can be reintroduced in later moments of resistance in treatment. One among many seminal points in the article is how to cultivate improvisation via a relational ethic— a “hovering” set of questions about what is going on between the analytic participants, the use of improvisational play with being “the bad object” as opposed to becoming fixed in that role, and the place of reintroducing the past in present scene-work. Three separate cases illustrate these points.If the therapist cannot play, then he is not suitable to work. If the patient cannot play, then something needs to be done to enable the patient to become able to play after which psychotherapy may begin.—D. W. WinnicottAll the world is a stage, and all the men and women merely players. They have their exits and entrances; each man in his time plays many parts.—William Shakespeare
Perhaps more than most psychological concepts, the concept of recognition is central to the most fundamental question: What does it mean to be human? Recognition underscores one of our basic ideas about being human; namely, that our selfhoods emerge from, are maintained within, and contribute to the shaping of our community of other human beings. However, I think the concept of recognition can also serve to illuminate a more hidden aspect of what it means to be human, what philosopher Charles Taylor calls a desire “to be rightly placed in relation to the good.” Our relationships to ourselves and others are transformed when we are recognized as orienting towards a “good.” I use phenomenological description and case examples to illustrate my thesis.Quizá en mayor grado que la mayoría de conceptos psicológicos, el concepto de reconocimiento es central para la pregunta fundamental por excelencia: ¿qué significa ser humano? El reconocimiento subraya una de nuestras ideas básicas acerca de ser humano, a saber que nuestro sentimiento de sí emerge de la comunidad de los seres humanos, es mantenido en ella, y al mismo tiempo contribuye a la formación de la misma. Pero creo que el concepto de reconocimiento puede también servir para iluminar un aspecto más escondido de lo que significa ser humano, lo que el filósofo Charles Taylor denomina el deseo de “ser correctamente situado en relación al bien.” Nuestra relación con nosotros mismos y con los demás queda transformada cuando nos sentimos reconocidos como orientados hacia “el bien.” Utilizo una descripción fenomenológica y ejemplos clínicos para ilustrar mi tesis.Peut-être davantage que la plupart des concepts psychologiques, le concept de reconnaissance est central dans la question la plus fondamentale: que signifie être humain? La reconnaissance souligne l'une de nos idées fondamentale au sujet d'être humain, à savoir que le sens d'être soi émerge, est maintenu à l'intérieur, et contribue au façonnement de notre communauté des autres êtres humains. Mais je pense que le concept de reconnaissance sert aussi à éclairer un aspect plus caché de ce que veut dire être humain, ce que le philosophe Charles Taylor appelle un désir «d'être à juste titre placé en relation au bon.» Nos relations à nous-mêmes et aux autres sont transformées lorsque nous sommes reconnus comme nous orientant vers le «bon.» J'utilise une description phénoménologique et des exemples de cas en illustration de ma thèse.Mehr als die meisten psychologischen Konzepte ist das Konzept der Anerkennung zentral für die grundlegende Frage: Was bedeutet es ein Mensch zu sein? Anerkennung unterstreicht eine unserer grundlegenden Vorstellungen des Menschseins: Unser Selbst-Sein entwickelt sich, wird aufrecht erhalten und liefert seine Beitrag zur Formgebung unserer menschlichen Gemeinschaft. Ich denke aber, dass das Konzept der Anerkennung auch dazu dienen kann, einen mehr versteckten Aspekt dessen, was es heiβt Mensch zu sein, zu erhellen; der Philosoph Charles Taylor benennt die Sehnsucht, “gut platziert in der Beziehung zum Guten zu sein.” Unsere Beziehung zu uns selbst und zu anderen verändert sich, wenn wir als etwas anerkannt werden, was sich zum “Guten” hin wendet. Um diese These darzustellen, benutze ich eine phänomenologische Beschreibung und Fallbeispiele.Forse più della maggior parte dei concetti psicologici, il concetto di riconoscimento è centrale per la questione più fondamentale: cosa vuol dire essere umani? Il riconoscimento sottolinea una delle idee di base circa gli esseri umani, cioè che il nostro sé emerge da, è mantenuto in, e contribuisce a dar forma a, la comunità di altri esseri umani. Ma io credo che il concetto di riconoscimento possa servire anche a chiarire un aspetto più nascosto di cosa significa essere umani, quello che il filosofo Charles Taylor chiama desiderio: “di essere giustamente collocati sin relazione al bene”. La nostra relazione con noi stessi e con gli altri si trasforma quando siamo riconosciuti come orientati al “bene”. Utilizzo una descrizione fenomenologica e degli esempi clinici per illustrare la mia tesi.
Our tales of trauma revolve around a serious head injury my analyst suffered, the disruption of his life, our analytic relationship, my treatment, and, finally, the recovery process in which we were both intimately engaged. This is a story about values in psychoanalysis and their intimate implication in the conduct of a successful analysis. It is also a story about trauma and the forever ongoing process of recovery. How we weathered our extraordinary circumstance can illuminate themes that are important for analytic work in situations of the analyst's injury or illness and for analytic work more broadly.Translations of AbstractNuestros relatos sobre el trauma van alrededor del grave traumatismo craneal que mi analista sufrió, la importante repercusión en su vida, nuestra relación analítica, mi tratamiento, y finalmente el proceso de recuperación en el que los dos nos implicamos de forma íntima. Ésta es una historia sobre los valores en psicoanálisis, y su repercusión en la conducción de un análisis exitoso. Es también una historia sobre el trauma y del proceso continuado de “recuperación”. Cómo capeamos esta circunstancia extraordinaria puede iluminar temas que son importantes para el trabajo analítico en situaciones de enfermedad o accidente del analista, y para el trabajo analítico en general.Nos histoires de traumatisme tournent autour d'une blessure sérieuse à la tête que mon analyste a subi, la perturbation conséquente de sa vie, de notre relation analytique, de mon traitement et finalement du processus de rétablissement dans lequel nous étions tous deux intimement engagés. C'est une histoire au sujet des valeurs en psychanalyse et de leur implication dans la conduite d'une analyse réussie. C'est aussi une histoire au sujet du traumatisme, et du processus “de rétablissement” toujours en cours. La manière dont nous avons surmonté cette circonstance extraordinaire peut éclairer des thèmes qui sont importants pour le travail analytique dans des situations de maladie ou de blessures chez l'analyste, et pour le travail analytique en général.Unsere Darstellungen des Traumas drehen sich um eine schwerwiegende Kopfverletzung, unter der mein Analytiker littum diesen Bruch in seinem Leben, um unsere analytische Arbeit, meine Behandlung und schließlich um den Wiederherstellungsprozess, in welchem wir beide tief berührt miteinander verbunden waren. Dies ist eine Geschichte über Werte in der Psychoanalyse und ihre intimen Auswirkungen bei einer erfolgreichen Durchführung. Es ist aber auch eine Geschichte über Trauma und den fortwährenden Prozess der Wiederherstellung. Die Art, wie wir unsere ungewöhnlichen Umstände gemeistert haben, kann sowohl Licht auf die Themen werfen, die in der analytischen Arbeit in Situationen wichtig sind, wo ein Analytiker verletzt oder krank ist, als auch auf die analytische Arbeit im weiteren Sinn.Le nostre narrazioni traumatiche riguardano un serio danno alla testa subito dal mio analista, la rottura della sua vita, della nostra relazione analitica, della mia terapia, e alla fine il processo di recupero nel quale siamo stati entrambi intimamente coinvolti. Questa è una storia sui valori in psicoanalisi, e sulla loro intima implicazione nella conduzione di un'analisi ben riuscita. È anche una storia sul trauma e sul continuo e incessante processo di “recupero”. Il modo in cui abbiamo affrontato la straordinaria circostanza in cui ci siamo trovati può illuminare temi che sono importanti per il lavoro analitico in situazioni di danneggiamento o malattia dell'analista, e per il lavoro analitico più in generale.
This paper proposes a conceptual and clinical integration of contemporary psychoanalytic theories that emphasize the repetitive dimension of the transference (the repeated relationship) and those that stress the developmental or selfobject dimension (the needed relationship). Such an integration is accomplished by enlarging our conception of the communicative matrix that includes transference, projective identification, and countertransference. It is suggested that patients actively seek to enlist the therapist both in old pathogenic interactional scenarios and in new therapeutically needed relational configurations. Thus, contrary to recent criticisms of the developmental paradigm, the therapist does not have to look outside the transference‐countertransference matrix for a model of the developmentally needed relationship: the patient communicates it through a creative, proactive form of projective identification. The work of Racker, Sandier, Winnicott, Bollas, and various self psychologists is reviewed and found to support this reconceptualization. The paper then examines the theory of analytic cure in the light of this integrated perspective. It is suggested that the most compelling theories take into account the analyst's “embeddedness”; in the transference— countertransference while recognizing the importance of the analyst's “mastering the countertransference”; as the basis for providing a new developmental experience. The therapeutic models of Racker, Bollas, and Newman are described as exemplary in this regard.
The author describes his personal experience of sustaining a disabling head injury, which had a devastating effect upon an ongoing analysis of a patient who had been struggling to recover from the tragic loss of a previous analyst. The author demonstrates how his own recovery and the ultimate analytic transformation of his analysand were inextricably related. He points out the crucial importance of self-reflection and management of his own feelings of shame and inadequacy during the posttraumatic period as he struggled to regain his analytic footing. An unusual feature of this account is that it is paired with that of the analysand, who reports the same events through her perspective.Translations of AbstractEl autor describe su experiencia personal de sufrir un traumatismo incapacitante en la cabeza que tuvo un efecto devastador en el análisis en curso con una paciente que estaba esforzándose en recuperarse de la trágica pérdida de su analista. El autor demuestra que su propia recuperación y la transformación analítica final de su analizanda estaban relacionadas de manera inextricable. El autor señala la importancia crucial de la autorreflexión y del manejo de sus propios sentimientos de vergüenza e inadecuación en el periodo post-traumático durante el que se esforzó para recuperar su posición analítica. Una característica inusual de esta crónica es que se empareja con la de la paciente que cuenta los mismos hechos desde su perspectiva.L'auteur décrit son expérience personnelle d'une blessure incapacitante à la tête laquelle a eu un effet dévastateur sur l'analyse en cours d'une patiente aux prises avec la perte tragique de son analyste précédent. L'auteur démontre comment son propre rétablissement et l'ultime transformation analytique de sa patiente ont été inextricablement liés. Il montre l'importance cruciale de l'auto réflexion et de la gestion de ses propres sentiments de honte et d'inadéquation durant la période post traumatique alors qu'il s'efforçait de recouvrer sa posture analytique. Que ce récit soit pairé avec celui de l'analysante qui rapporte les mêmes évènements dans sa perspective en fait un témoignage très rare.Der Autor beschreibt seine persönlichen Erfahrungen bei der Bewältigung einer beeinträchtigenden Kopfverletzung, die eine verheerende Auswirkung auf die laufende Analyse einer Patientin hatten, die gerade dabei war, sich von dem tragischen Verlust des vorherigen Analytikers zu erholen. Der Autor stellt dar, wie seine eigene Wiederherstellung und die ultimative analytische Veränderung seiner Analysantin unlösbar miteinander verbunden waren. Er verweist auf die entscheidende Selbstreflexion und die Bewältigung der eigenen Gefühle (wie Beschämung und Unzulänglichkeit) während dieser posttraumatischen Periode als er darum kämpfte, seinen analytischen Standort wiederzugewinnen. Ungewöhnlich an diesem Bericht ist, dass er sich mit der der Analysantin paart, die die gleichen Geschehnisse aus ihrer Perspektive darstellt.L'autore descrive l'esperienza personale di subire un danno debilitante alla testa che ha avuto un effetto devastante sull'analisi in corso con una paziente che stava lottando per superare la tragica perdita di un precedente analista. L'autore dimostra come il proprio recupero e la definitva trasformazione analitica della sua analizzanda fossero inestricabilmente collegati. Sottolinea l'importanza cruciale dell'auto-riflessione e della gestione dei propri sentimenti di vergogna e inadeguatezza durante il periodo post-traumatico, man mano che lottava per riconquistare il proprio equilibrio analitico. Caratteristica inconsueta di questo resoconto è che esso viene messo in parallelo con quello dell'analizzanda che riporta gli stessi eventi dal suo punto di vista.
Intersubjective systems theory is the view that personal experience always emerges, maintains itself, and transforms in relational contexts. It is held for reasons of personal inclinations, philosophical belief, and clinical conviction. As a clinical sensibility, it primarily includes an emphasis on the emotional convictions or organizing principles that systematize experience, the personal engagement of the analyst, and the refusal to argue about reality.
This article outlines my essential paradigm as it relates to self psychology, how I arrived at it, and how I would position my perspective in the context of the larger psychoanalytic and scientific community. My dialogic complexity systems model is most closely aligned with the intersubjective systems theory of Atwood and Stolorow and was shown to have acquired its defining shape in the context of an in-depth exploration of the connection between the latter theory and Kohut's self psychology. My paradigm is part of the wider relational turn in contemporary psychoanalysis. I have characterized the evolution of my perspective as my continuous preoccupation with the deepening and refinement of my understanding of the limits of psychoanalytic theory and practice and the cultivation of a clinical attitude that allows me to fully embrace those limits, an attitude that combines the caring ambience of genuine dialogue with the spiritual calmness of nondual awareness. My perspective can, therefore, be understood as my ongoing attempt at unifying my intellect, my heart, and my spirit into one experiential whole. A dialogic complexity systems model grounded in a post-Cartesian nondual philosophy constitutes the explanatory reduction of my theory and philosophy as lived in real time.
In this chapter, clinical material illustrates key theoretical concepts and underscores the value of Heinz Kohut's radical approach to psychoanalysis. The psychodynamic treatment of "Matthew" spans over a decade and traces the therapist's immersion in four clinical modalities. The transition from Kleinian and British object relations orientations to a therapeutic style informed by psychoanalytic self psychology and intersubjective systems theory broke through impasses generated in the earlier chapters of Matthew's therapy. The empathic listening stance, the impact of the analyst's subjectivity on the treatment's progress, and the vital role of selfobject experiences in the development, restoration, and maintenance of an individual's sense of self constitute a few of the crucial and enduring curative elements brought to the field of psychoanalysis and psychodynamic therapy by Kohut's pioneering efforts.