Twenty-eighth Annual Conference: Developing Clinical Momentum

Summary of the Paper Sessions

Frank M. Lachmann, Ph.D.

The quality, depth and breadth of the paper sessions is the direct result of the dedicated work of the readers who refereed the papers. We received more than twice as many papers as we could accept, a sign that self psychology is alive and well among candidates and faculty in training institutes, among therapists in private practices and clinics and in academic settings in the U.S., Canada, Europe and the Far East. Choosing among so many worthwhile contributions is a difficult task and I want to thank the readers for providing us with such a varied and high-level group of papers. The readers were: Peter Buirski, Jackie Gotthold, Arthur Gray, Ruth Gruenthal, Sandra Hirschberg, Andy Karp, Peter Kaufman, Pauline Pinto, Dori Sorter, and Judy Teicholz.

Briefly, I will give you my impressions of the paper sessions as I surveyed them. I will not be mentioning the presenters by name, but rather offering a gloss of some of the topics and ideas.

Kohut's writings presented us with the big picture. He wrote in grand, often metapsychological terms, placing self psychology into the context of, and at the center of, psychoanalytic treatment and theory. He laid out an ambitious plan. The paper sessions at these meetings take up the details of that plan, plus. The "plus" refers to issues that were not so central to the psychoanalytic enterprise at the time Kohut was writing, but are of concern to us now. I will begin with the pluses.

In the psychoanalytic marketplace and in the competition for candidates at training institutes, self psychology is under pressure from relational theories in many quarters. The clinical material presented at the relational conferences is dramatic and engaging just as was true for Kohut when he offered his case presentations. They, too, were dramatic, novel, and so experience-near that they spoke to analysts and patients alike, and they spoke especially to analysts who were themselves undergoing their own analysis. Self psychology is now encountering the same - shall I call it threat or challenge?

One set of papers at this meeting addressed that challenge: shall we hold fast to the centrality of empathic understanding or expand our therapeutic repertoire to include the analyst's authenticity, spontaneity, playfulness, creativity, and humor? Several authors addressed the dilemma of the authenticity of the analyst. Rather than considering authenticity as a virtue and an end in itself, as some psychoanalytic practitioners do, self psychologists have their own unique take on authenticity, that is, an authenticity balanced by self-restraint and self-reflection. We do not confront our patients by telling them how they have enraged us, threatened us, or tried to seduce us. Rather, we carry on an internal dialogue in which we balance the desire for authenticity with an adherence to the "technical" principles of "wearing the attribution" of the qualities the patient ascribes to the therapist: for example, balancing the patient's belief that the analyst is in love with him, with the analyst's values, ethics and ideals. A self-imposed task for the analyst is to remain genuinely, personally engaged, while interacting professionally with the patient.

What self psychologists try to avoid is a retreat behind so-called proper analytic behavior. According to the papers presented, authenticity is a highly specific, co-created dimension of the analyst-patient interaction that is constantly subjected to self-examination and cannot be transported to any other patient or situation. Every treatment thus becomes unique, challenging, and damned difficult.

That brings me to a second plus. Once we leave the paved path of traditional psychoanalytic treatment, it is easy to trip. What if in the course of a difficult treatment with a suicidal patient, the patient requires being touched and hugged as evidence that the analyst really does exist? Or, a suicidal patient requires a home visit by the therapist who wants to make sure the patient is still alive and wants to prevent a catastrophe? What if the child's emotionally labile mother stays in the therapy room during sessions? What if you discover that you and your patient have friends in common and, to prevent a meeting from taking place, confidentiality has to be broken? What all these "what ifs" have in common is that none were addressed by the paper-presenters in a "by-the-book" manner. They all prompted the therapist to take a look both inward and outward to search for a "tailor-made" rather than "off-the-shelf" solution. The description of these challenges and struggles, by both patients and therapists has been, and still is, the essence and value of the paper sessions.

However, a caution was also introduced with respect to some of these heroic treatments. Specifically, to what extent are these measures a consequence of the therapist's countertransference interfering with the development of "self-care" in the patient?

The plus also refers to the so-called "difficult-to-treat" cases. These are patients who have been increasingly included among those treated by self psychologists. Their treatments have been presented at our plenary meetings and paper sessions. Yet these were the patients about whom Kohut had doubts about their accessibility to his empathy and introspection. One aspect of making these difficult-to-treat patients more accessible has been the recognition of similarities in humanity between these patients and ourselves, a theme that several papers shared. For example, although the life circumstances between a transvestite man and his female therapist could not have been more different, the therapist recognized that his story was also hers. She recognized that they both struggled to speak of gender in a voice uniquely their own. But sometimes the difficulty resides not so much in the patient but, in the case of children, in the family: parents who do not believe in therapy, demand that you fix their child quickly, and then summarily pull their child out of treatment as soon as some progress has been made. It is easy and counterproductive to let one's resentment toward the parents color what may eventually be in the best interests of the child.

Some of the papers addressed the challenge of relational thinking and classical analysis head-on. A paper about hope and dread, challenged the view that patient and analyst must first tolerate, then understand, and pass through a situation of dire straits before coming out the other side. Rather, from a self psychological perspective a different view is offered: heightened affective moments provide the essential ingredient necessary for achieving a balance between hope and dread that enables change to occur. Thus, dread is not a necessary precursor to hope.

Furthermore, the general psychoanalytic assumption that partnered relationships, lifetime pair-bondings are the likeliest guarantee of human happiness is questioned. Here, too, Kohut opened the door when he unhooked narcissism and object relationships, positing two separate lines of development.

Even the Oedipus Complex was challenged in that it was recontextualized with an emphasis on the father's abusive power and the struggle with one's mortality. And while we are at it, the whole authoritarian, privileged status according to analytic interpretation was challenged by post-Cartesian, postmodern epistemology. Finally, a view of "enactments" was presented that challenged the hierarchical view of one person interpreting another's deep motivations.

In the process of their struggles, self psychologists reported encountering their own areas of strain. They searched for ways to address their own experiences of dissociation. Following the path of introspection, clues as to the subjective experience of dissociation or its influence on the treatment process were sought. Following another path of exploring one's own reveries as they occurred spontaneously in the treatment process was examined as to their contribution toward understanding the patient's material.

Case presentations that illustrate the centrality of a self psychological perspective have always been the backbone of the paper sessions. As in the past, a defining characteristic of self-pathology has been the difficulty of patients' to experience themselves as in touch with their feelings. It is what is often discussed under the diagnosis of dissociation, a problem that received considerable attention directly and indirectly, from the side of its presence in the patient's treatment and its presence in the therapist. In treatment, a multimodal approach of individual, conjoint and family therapy addressed the dissociated life of an adolescent who preferred cyberspace to life in high school.

One aspect of being a self psychologist is the extent to which we examine our own experience in the treatment process. Several papers focused on the joint experience of therapist and patient in benefiting from the treatment experience. This was illustrated in a range of treatments from the dramatic, for example, treating men who had developed a style of being overly concerned with pleasing their partners at enormous expense to themselves. Treatments were carefully detailed so that we could follow the intricate path the therapist pursued in understanding their patients and themselves.

The treatment process itself was subjected to direct and indirect attention in these papers. The complexity of multiple modalities, combining individual and group treatment was examined with respect to problems that can emerge when these modalities are combined. Extending and refining Kohut's understanding and explaining model, papers and workshops that focused on making interventions specific in the service of optimizing the positive experience of the patient. That model was further expanded through discussions of enactments. Enactments were understood as occurring as part of and at specific unexpected moments in the moment-to-moment living together of the analytic dyad.

And the treatment process was also addressed with respect to complex problems raised by supervision. Even self psychologically informed supervision that emphasizes the mutuality of the process may touch on the competition, within the supervisor, between wanting to be open and self-revealing and working in a manner that would best maximize the supervisee's ability to learn.

My final survey concerns those papers and workshops that extend Kohut's ideas beyond the borders of psychoanalysis. Kohut led the way in the field of applied psychoanalysis in his papers on literature and music. The paper sessions this year included papers by analysts who have additional areas of expertise. We heard papers on the relationship between self psychology and art, dance, religion, philosophy and literature. What an impressive list of applications.

With respect to religion, Christianity and Judaism were represented. God was discussed as a collective selfobject, aiming toward an empathic and non-pathological attachment of one's attachment to personification, and some measure of peace with an intellectual disbelief in a personal, supernatural God.

With respect to dance, a case study of a depressed, suicidal woman illustrated the twinship that developed through the combined rhythms of dance and therapy, providing an opportunity to repair an early mind/body split, another variant of dissociation.

With respect to art, a case study illustrated the therapist's attention to a patient's nascent artistic creative strivings, leading specifically to a process of increased self-delineation.

With respect to literature, we ranged from the file, The Piano, to the greatest epic of all time, Don Quixote. What both of these works have in common is their celebration of the human spirit and that is in the best spirit of self psychology.

Top of this Page      Newsletter Front Page