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Twenty-eighth Annual Conference: Developing Clinical Momentum
Keynote Presentations Summary
John Riker
James Fosshage began his address with the question of, "how
does analysis bring about change?" He iterated that the old answer
involved offering interpretations that were backed by the objective
epistemological authority of the analyst, but that self psychologically
informed analysts were working out a new answer: it is the relational
interaction of analyst and analysand that brings about change. The key
to an effective relational interaction is the presence of the analyst's
empathy, which he defined as an other-centered perspective that opens up
what it feels like to be another person and offers the possibility for a
reflective perspective on the self of the other. Within the relational
model, transference is re-defined from a previous model that understood
it as a displacement of the patient's feelings from earlier objects onto
the analyst to a new model in which transference is understood as the
presence of an unconscious organizational structure that produces
expectancies, selective attention, and attributions of meaning.
Within this transference relational matrix, the patient can
experience a selfobject pull - hope - stimulating a yearning for growth.
This hope threatens the dominant organization structure but opens up the
possibility of living beyond its confining rigidities. The patient has
two strong interactive tendencies, one which leans towards repeating
the familiar and one which is a nascent striving to achieve a new
organizing structure, one which opens up possibilities, allows for
differential responses to difference, and re-vitalizes life.
Fosshage then added a new way of "languaging" this change: it is the
production of a novel implicit procedural memory. Implicit procedural
memory is a memory that instructs us on 'how' to do something. What is
being learned in analysis is how to relate to another human being and
oneself in such a way as to be loving and better able to receive love,
where love is understood as the ability to affirm the worth and
singularity of one's own being and the being of others.
Fosshage's description of analytic love recalled to me Heidegger's
notion of authentic care. Authentic care involves a "leaping ahead" in
which one helps and allows the strengths and inherent possibilities of
the other emerge to solve her problems, whereas inauthentic care is a
"leaping in," an attempt to solve the problems of the other without
enhancing her ability to be a source of strength and vitality in
herself.
(A full transcript of James Fosshage's keynote address is available
on Psychology of the Self Online.)
Daniel Stern followed Fosshage's address with a talk on the
key features of the shift from an intrapsychic kind of analysis to an
interpersonal, intersubjective, and relational kind of analysis. He
described six key shifts: (1) A two-person field is inherently
unpredictable. A dyadic relationship is 'sloppy', full of mistakes, and
always in need of repair, but it allows for the possibility of something
new to emerge that can not be predicted. This kind of shift can only be
understood with a dynamic systems theory. (2) Relational analysis works
at the level of implicit and procedural knowledge, shifting unconscious
expectations about what constitutes a meaningful and caring human
interaction. (3) Intersubjective theory reverberates with
neuroscience's discovery of mirror neurons that sit next to motor
neurons and which fire when the motor neurons of another fire. Mirror
neurons allow babies to connect at a bodily level to the subjectivity of
a mother. (4) The fundamental psychological unit that carries meaning
is an intention. Both babies and adults scan others to detect their
intentions and have "intention-detecting centers in the brain. Grasping
an intention means that one can organize essential data about what
others are doing and are likely to do. (5) Relational analysis
understands that talking with another person, presenting facial
gestures, etc., are all actions. Everything is an enactment. An
interpretation is not just a set of words trying to accurately describe
a person's psyche, but can also be experienced as an attack, an act of
love, an attempt to control, etc. (6) Relational analysis is the
attempt to turn something upside down. It is in the interaction in
which old ways of being in the world (to use a Heideggerian phrase) are
transformed into a new way of being in the world in which both the world
is seen as having new possibilities and the patient experiences herself
as having the strength and vitality to seek these new forms of
experience.
In sum, the conference began with two quite stunning lectures, each
of which proposed that the heart of therapeutic action was the dynamic
relationship between patient and analyst, an empathic relationship that
can move the patient from organizational structures bent on repeating
the past with its traumas and limitations to one in which new vital
possibilities arise, especially possibilities for allowing others to be
seen as who they are rather than reducing them to variables in one's
scheme of repeated expectations. In this transformation one can see
that while analysis does not use moral judgment as a way of producing
change, it is an inherently ethical enterprise, for it opens up the
possibility of treating others as ends in themselves rather than as a
mere means to confirm past expectations.
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