Interview with Howard Bacal
(Kohut Memorial Lecture Honoree)

Nancy VanDerHeide

Nancy VanDerHeide: Howard, I am delighted to have this opportunity to talk with you about your many contributions to contemporary psychoanalysis, as well as what you consider to be the defining influences on the development of your thinking.

Howard Bacal: It is always a pleasure to talk with you, Nancy. How can I add to what you already know about me, and my work?

NV: One of my favorite stories that you tell involves your handing Michael Balint a list of potential training analysts when you began at the Institute of Psychoanalysis in London. He expressed surprise that someone would include both Anna Freud and Melanie Klein on the same list, along with Willi Hoffer, Marjorie Brierley, and Paula Heimann. It certainly is a diverse list, and it seems to me to be emblematic of your tendency to think outside the box.

HB: Perhaps this recollection of my attempt to find a training analyst is an indicator of the way I am inclined to think; but this heterogeneous list of training analysts that was handed to me as I sailed for London did so dramatically reflect the unawareness of American psychoanalysts at the time about the work of their British confreres.

NV: Well, we have come a long way, then; thanks to writers like you. Something that really stands out for me about your work is your consistent emphasis on therapeutic efficacy. Who and what were some of the formative influences on your privileging that emphasis?

HB: Well, one of my early analytic experiences was with Michael Balint, who had trained with Sandor Ferenczi. The analytic tradition handed down by Ferenczi emphasized the importance of finding ways to be therapeutically helpful to the patient, rather than concluding that the patient didn't fit the standard method, and therefore could not be helped. Balint was, in particular, interested in discovering and conceptualizing non-interpretive ways of responding to traumatized patients, recognizing that their archaic states required something different in order to achieve therapeutic efficacy. He also maintained that it was the nature and quality of the relationship that was therapeutically central. To a large extent, I picked up the importance of relational specificity from Balint, but also from Ferenczi from whom it came through to me, indirectly, through Balint's teaching - that the analyst's therapeutic efficacy requires a continuous flexibility of responsiveness to the varying needs of the patient.

NV: I recall the saying that "if Freud was the father of psychoanalysis, Ferenczi was the mother", bringing into play a more relational, subjective, and experiential mode of being with the patient than was the case in more classical traditions. Your stance with patients, and supervisees as well, is certainly in accordance with those values. What other experiences informed your development as a theorist and clinician?

HB: In my psychiatric residency at the University of Cincinnati, prior to formal analytic training, the "corrective emotional experience" of Franz Alexander, as conveyed by his analysand and mentee, Maurice Levine, permitted us to question the primacy of insight over experience. And our clinical training there encouraged the use of creative means of individualizing therapeutic intervention.

NV: You also worked extensively with D.W. Winnicott, another extremely innovative analyst and theoretician. What are some of the things you gleaned from that relationship?

HB: Winnicott also placed a great deal of emphasis on the importance to the patient of the analyst's behavior, as opposed to the content of analyst's interpretations. I had the opportunity with Winnicott to access unique forms of responsivity that proved therapeutic with my patients.

NV: So, the theme of responsiveness was foreground for you in all of these experiences. You must have had a special sensitivity for the need of people to feel responded to in a personally meaningful way. After all, these notions flew in the face of many of the other traditions that considered (and some still do) the use of particular interpretations at particular times to be effective with all patients.

HB: That particular analytic stance subscribes to a belief that the analyst not only knows the patient better than the patient knows himself, but also knows what is best for him. For me, that is a reenactment of my relationship with my mother, and is not helpful. Throughout my childhood, and beyond, I yearned to be understood and responded to as I felt I needed to be, and I also became captivated by the appeal of providing this for others. From reading The Analysis of the Self, I felt that Kohut was someone who would be able to offer this to me. So I began a 6-1/2 year relationship with him that involved analytic work and consultation regarding my patients, as well as learning from him about this new perspective in psychoanalysis that he was calling Self Psychology.

NV: Did your experience with Kohut meet your expectations?

HB: To a very great extent. He did not confine himself to explanations but related to me in the ways that I needed at the time. He could not do it all the time, but that is also a key aspect of Specificity Theory. I became aware that the misses in that analytic relationship, as with those in the analysis with Balint, merely defined the limitations of these particular dyads.

NV: Your work with Kohut seems to have been pivotal in furthering your theoretical thinking.

HB: Kohut's work provided me with, among other things, the concept of selfobjects. The idea of a variably cohesive self whose integrity and vitality were centrally and legitimately affected by the responsiveness of others - selfobjects - was an essential addition to my own formulations.

NV: Responsiveness again. Yours is a particularly relational perspective. You talk about selfobject relationships as opposed to selfobject experiences.

HB: Yes. Although Kohut used the selfobject concept in a relational way, he explicated the selfobject as an intrapsychic experience. I could never make sense of the selfobject except as a relational concept, contextualized within the experience of a self-selfobject relationship.

NV: And growth and healing take place within that self-selfobject relationship. But you disagreed with Kohut about the logistics of the healing milieu and developed the concept of optimal responsiveness.

HB: Yes. It became progressively evident to me that Kohut's conceptualization of analytic cure as entailing the transmuting internalization of analytic functions via so-called optimal frustration was an incongruous holdover from classical psychoanalytic theory.

NV: So you didn't find that optimal frustration facilitated the kind of therapeutic efficacy that was promised.

HB: No, to the contrary. The net effect is to limit the responsivity of the analyst to the patient. And, as Michael Basch pointed out to me upon reading my article, "Optimal Responsiveness and the Therapeutic Process," infant research does not support the claims of optimal frustration. In fact, the work of Daniel Stern and Louis Sander demonstrate that the optimal time for learning is when the infant is free from frustration and able to engage with his surroundings.

NV: It seems as though your decades of rich experience and thoughtful deliberation have led quite naturally to your over-arching psychoanalytic Specificity Theory. What is the essence of Specificity Theory?

HB: In a nutshell, Specificity Theory maintains that the effectiveness of a therapeutic process is determined by the spectrum of therapeutic possibility that emerges for a particular dyad.

NV: And that spectrum is comprised of...?

HB: That spectrum is a function of what I call the specific capability for requisite responsiveness of the particular participants interacting within a particular system.

NV: I think that an important implication of Specificity Theory is that it transcends particular psychoanalytic theories and puts the therapeutic action directly inside the clinical moment.

HB: Of course, a therapist's formal psychoanalytic orientation will variously inform and affect the way in which the analyst is with his patient, but more centrally the specific emerging and developing capacities of each particular dyad determine possibilities for therapeutic efficacy. An analyst's particular content theory is but one aspect, with potential to operate as an expansion or limitation, of any particular dyad's capabilities at any specific moment.

NV: And these capabilities will determine the emergence of interventions that are optimally responsive?

HB: Yes, Specificity Theory is the theoretical foundation that describes the process from which optimal responsiveness may emerge. It avers that the specific characteristics of a particular therapeutic constellation will always centrally determine any therapeutically useful experience. In psychoanalytic practice, this constellation constitutes the capacities and limitations for therapeutic relating of the two people involved in the treatment setting.

NV: Some people have misunderstood "optimal responsiveness" as implying that there is a correct response that the analyst should try to find and provide. That is not your intention, is it?

HB: Not at all. It is a concept that reflects a way of working that legitimizes the wide palette of both verbal and non-verbal responsivity offered by therapists that patients experience as significantly therapeutic. It also connotes the intersubjective process within which emerges a specific spectrum of therapeutic possibility for a particular analytic dyad. And any salutary spontaneous engagement that an analytic couple discovers will be only one of the many ways in which optimal therapeutic interaction can occur.

NV: Your consideration of the specific capacity for requisite responsiveness provides a platform for another of your major contributions to psychoanalytic theory, that is, you legitimized the analyst's own selfobject needs vis-à-vis the patient.

HB: The analyst brings conscious and unconscious expectations into the relationship in the same way that the patient does. Serious limitations in the analyst's ability to access a full range of responses can occur when the patient does not meet these relational selfobject needs. I prefer to think of the disruptions that occur at such times as "relatedness reactions" rather than as "countertransference reactions" as I believe the term better captures the situation. Recognition of this kind of reciprocal relatedness and its role in mutual regulation is essential to the therapeutic effectiveness of any particular dyad.

NV: Howard, I want to step back from the particulars of your theorizing for a moment and consider the ways in which the multiplicity of your highly varied experience has impacted your thinking. The range is breath-taking - in addition to Balint, Winnicott and Kohut, you have also worked with Marion Milner, Wilfred Bion, as well as having worked and studied at London's Tavistock Clinic with J. D. Sutherland and Charles Rycroft. You've traveled a unique road that seems so well suited to your intellectual curiosity and gives you a distinctive perspective from which to integrate the many facets of your own theoretical contributions. Not many people would have been able to articulate so clearly the synergism between Self Psychology and theories of Object Relations.

HB: I have been most fortunate and I am very grateful to have had the opportunity to learn from so many original and important thinkers, many of whom were singularly courageous in challenging accepted theory when its application was at variance with their experience of what was helpful to their patients. In particular - and in relation to your last observation - I have always regarded the synergism between relational theory and self psychology to be both natural and intrinsic.

NV: That is certainly made clear in your book, Theories of Object Relations: Bridges to Self Psychology. (Ed. Note: written with Kenneth Newman) One other comment that I want to make has to do with being in supervision with you. My work with my patients was so enriched by your ability to allow me to find my own way with them. In particular, my work with Josh, a challenging case involving a great deal of sexualization would have emerged very differently had I consulted with someone with rigid ideas about treating erotic transferences. You provided Josh and me with a space within which to be ourselves in a highly reciprocal relationship. Your trust in me gave me the courage to proceed in a somewhat unorthodox manner that proved catalytic in the treatment - that was the optimal response that I needed at the time. So Specificity Theory is as relevant to the supervisory process as it is to the therapy process.

HB: You should write a paper on that. And I may even offer a workshop on it at one of our conferences.

NV: Another optimal response.

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