How Does Analysis Cure?
A Candidate's View of the 27th Annual International Conference on the Psychology of the Self

Ann Marie Plane, PhD

I chortled when the brochure came in the mail. "How Does Analysis Cure?" My classmates and I had frequently asked each other just this question. Whoever chose this as a conference title made a clever play on both the title of Heinz Kohut's posthumously published last collection, and the uncertainties and ambiguities that accompany psychoanalytic self-psychology today (Kohut 1984). What a great title for an event. However, perhaps the organizers did not quite remember the depth of the patient's angst over this issue. It was an angst with which we candidates, both as analysands and as new practitioners, were all-too-familiar.

One of my classmates, Lucyann Carlton, was presenting a case in several panels over the first two days of the conference. So there was no question that I would be attending, along with many colleagues from the Institute of Contemporary Psychoanalysis in Los Angeles. It would be my first Self Psychology meeting, and I was not quite sure what to expect.

Doubtless the pre-conference workshops were a wonderful experience for participants new to the field, and to the approach of contemporary Self Psychology. Unfortunately, I had to content myself with purchasing them on tape so I could listen to them later. I found I had to do the same thing with the individual paper sessions on Saturday and Sunday. I was simply too exhausted after the main case presentations to take in even the three paper sessions to which I had been assigned - and that did not include the many other very interesting topics that ran concurrently. So I found I spent a lot of money on tapes of the sessions that interested me, and the conference experience continued for me even many weeks after we left San Diego.

The presentation began: "My name is Renée," Carlton declared, taking on the persona of her analysand. This was an analysand, we learned, whose journey to claim her own identity had been so long and arduous that she insisted that her real name be used in Carlton's presentation. The story that unfolded over the next two days was one of incredible abuse, torture and neglect. A single image has stuck with me - that of the infant Renée being thrown, high chair and all, out of the front door by her father. It stands as a sort of model scene through which I organized the horrific stories and states of mind that pervaded this case (Lichtenberg, Lachmann, and Fosshage, 1992, ch. 2).

As the conference proceeded, the audience took in the work that Carlton and Renée had accomplished together. Each panel presented a different section of the analytic work, from the formation of a therapeutic alliance and a holding environment - no easy task with such a traumatized patient - to the struggle of analyst and patient in self- and mutual-regulation. As she moved through the course of the analysis, Carlton described the development of greater resilience, vitality, and sense of self as well as the challenging and stimulating experiences of patient and analysand as they struggled with the idea of Renée's material being presented in public. Memorably, Renée was adamant that her case material be used, in the hopes that some of her pain might prove useful to another analytic pair.

Each of the four panels included comments by at least two senior analysts, followed by responses from Carlton and discussion from the audience. Each discussant developed his or her comments based on particular theoretical orientations both within and outside of Self Psychology, and Estelle Shane provided a closing synthetic discussion. This format proved especially useful as the audience was able to compare and contrast the clinical approaches of each presenter as based in each theory - including American Relational, Intersubjective Systems, Evolutionary Existential, and a variegated array of Self Psychology approaches. The San Diego meeting also saw the replacement of the International Council for Psychoanalytic Self Psychology by a new group, the International Association for Psychoanalytic Self Psychology. This new membership organization will, after a transitional period, have a democratically elected leadership, open to all, and thus it was fitting that the conference program invited contemporary Self Psychologists and friendly fellow travelers of several stripes to consider a diversity of approaches and conceptualizations. A "Spirit of Inquiry" truly prevailed in the meetings (cf. Lichtenberg, Lachmann, and Fosshage, 2002).

As the discussions proceeded, a variety of questions emerged, many of them centering on how Carlton experienced the work with Renée. Perhaps we were all comparing the case with our own work with patients from a variety of backgrounds. I know that I was thinking of two of my patients, both with significant trauma histories. Yet as I reflected on Carlton's work, I felt a mix of awe and shame. I felt awe at the way she hung in there with her patient, whose difficult history had left numerous levels of experience that could be expressed only in action - often very risky actions. I felt shame as I reflected on my own, much more ambivalent responses to patients - the self-states of dread, rage, victimization, and fear that such patients can sometimes evoke in me. I assume too that many of the audience and some of the discussants had the same reaction. As the presentation progressed, various comments and questions pointed to the need for greater expression of this side of the work. In particular, the comments of Donna Orange, who represented Intersubjective Systems Theory, underscored the need to explore the intersections and divergences of Renée's and Carlton's respective emotional experiences in the work. What was it, we all wondered, that gave Carlton the ability to access and to hold her patient's excruciating experience with such sensitivity and depth?

To her credit, Carlton was able to respond to these concerns, both in her prepared responses to the discussants and in her impromptu answers to audience questions. Exploration of her countertransference appeared in the presentation primarily when contextualizing her own responses to Renée's behavior - Renée's promiscuity, for example, or her frequent resort to cosmetic surgery. Carlton's own delusional father, psychotic and paranoid, helped the analyst to tune in to her patient's experience of a murderously abusive father. However, the audience seemed to want still more. Carlton's dilemma - in what to reveal, and what to conceal; what was critical to the story, and what was too personal to be revealed by a candidate-analyst in front of an audience of hundreds of analysts and candidates - is one that we all face, as we present our work to supervisors, to colleagues, or even in our own reverie. This crucial dilemma seemed to me to point to a larger issue facing contemporary Self Psychology, and it is to this larger issue that I wish to turn in the remainder of this essay.

Self Psychology has often been stereotyped as emphasizing holding over challenging, and privileging the analyst's love over the analyst's hate in the Winnicottian sense (Lachmann 2000, ch. 1; cf. Winnicott, [1947] 1975). It is easy to see how Kohut's recommendations - themselves a correction to the overly antagonistic and patronizing stance of mid-century psychoanalysisÑlend themselves to this interpretation. Comments such as his note that "the greater relaxation of the self psychologist, his greater freedom to respond with deeply reverberating understanding and resonant emotionality, and the generally calmer and friendlier atmosphere of self psychological treatment . . . rest . . . on the expanded scope of empathy" have perhaps misled us to fetishize the warm, confident, unruffled and idealizable analyst (Kohut 1984: 82). Taken to extremes, this can make it virtually impossible, especially for the new practitioner, to speak openly about the other side of the coin - about the times in which the analyst must cope with feelings of hatred, revulsion, dread, terror, inadequacy and whatever else it is that he or she is called upon to bear. And yet it is precisely this ability to acknowledge and to embrace ambivalence that is the hallmark of emotional maturity, as well as one of the major contributions of both Freud in particular and psychoanalysis in general. The failure to maintain a broader view can, at its most extreme, lead to the collapse of the analytic process. As noted by Joseph Lichtenberg and his co-authors, "the question of a patient's acceptability to an analyst is rarely discussed. As the patient reveals himself to the analyst at his 'best' and at his 'worst,' can the analyst see herself responding to him without crippling aversiveness?" (Lichtenberg, Lachmann, and Fosshage, 2002: 183) The importance of publicly exploring and acknowledging these "negative" countertransference reactions - and the dangers in failing to do so - cannot be understated.

How does analysis cure, after all is said and done? This conference, and the case presentation that ran throughout, left me with a predominant sense that "cure" (which we must understand in its broadest sense, as growth) results only from the ability of the analyst and analysand to hang in there with each other, without denying or banishing feelings because they seem too horrible to bear. It is in hanging in there, on both sides of the couch, that new paths of connection to self and to others can be explored. Healing is a two-sided journey, and it can only be undertaken together. If either party quails in his or her commitment to the task, the journey is at risk of ending prematurely, even tragically. But when both can find the strength and the courage to risk a new experience, analysis can - and does - have the ability to "cure." That is the beauty of what Lucyann Carlton, and Renée, her patient, created together. It was that spirit of healing that made this conference so productive and enriching for this new and growing analyst.

References

Kohut, Heinz. 1984. How Does Analysis Cure? Ed. Arnold Goldberg with Paul Stepansky. Chicago: University of Chicago Press.

Frank M. Lachmann. 2000. Transforming Aggression: Psychotherapy with the Difficult-to-Treat Patient. Northvale, New Jersey: Jason Aaronson, Inc.

Lichtenberg, Joseph D., Frank M. Lachmann, and James L. Fosshage. 1992. Self and Motivational Systems: Toward a Theory of Psychoanalytic Technique. Hillsdale, New Jersey: The Analytic Press.

________. 2002. A Spirit of Inquiry: Communication in Psychoanalysis. Psychoanalytic Inquiry Book Series: vol. 19. Hillsdale, New Jersey: The Analytic Press.

D. W. Winnicott. 1975. Hate in the Countertransference [1947]. Pp. 194-203 in Through Paediatrics to Psycho-Analysis. New York: Basic Books.

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