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| Modern Psychoanalysis: Be comfortable enough to say everything. Use your words, instead of acting out. Tell me your life story. Make the unconscious conscious. Be aware of obstacles and resistances. Psychotherapy establishes a safe environment in which present and
past experiences can be explored.
A therapist and patient enter into a
resonance of states of mind, which allows for the creation of a
co-regulating dyadic system.
This system is able to emerge in
increasingly complex dyadic states by means of attunement between the
two individuals.
The patient’s subtle nonverbal expressions of her
state of mind are perceived by the therapist and responded to with a
shift in the therapist’s own state, not just with words.
In this way,
there is a direct resonance between the primary emotional,
psycho-biological state of the patient and that of the therapist.
These
nonverbal expressions, words and induced feelings make up the contact function in the treatment, and influence the rapport.
Modern psychoanalysts have a greater understanding and a wider range of
techniques available to outflank Freud’s “stone wall of narcissism,”
and “…(i)f the analyst provides the proper environment, the patient
will re-experience emotional reactions in his relationship with the
analyst that resemble those he had at some point in the past when his
maturation was blocked.
Since Dr. Spotnitz described modern psychoanalysis as “… Freud’s method of therapy, reformulated on the basis of subsequent psychoanalytic investigation”
(1985, p. 25); the question is now asked - what are the important
differences between modern psychoanalysis and classical psychoanalysis?
I think it is most useful to look at this question in terms of the
theoretical and clinical practice distinctions between the classical
and modern schools.
Theoretical Foundations -
Dr. Freud’s opinion (1933, ch. 6) was that:
“The field in which analytical therapy can be applied is that of the
transference-neuroses, phobias, hysterias, obsessional neuroses, and
besides these such abnormalities of character as have been developed
instead of these diseases. Everything other than these, such as
narcissistic or psychotic conditions, is more or less unsuitable.”
This conception unfortunately resulted in huge numbers of people being
deemed “unsuitable” or “unanalyzable” by the classical school of
thought; while the modern theory of treatment considers most emotional,
mental and personal achievement problems to be reversible through its
treatment techniques.
According to Spotnitz, (1985, p.23):
“Freud and his contemporaries did not recognize the presence of
narcissistic transference as such, and they did not know how to utilize
it for therapeutic purposes. Since their day it has been repeatedly
demonstrated that the narcissistic transference is therapeutically
useful."
But, Freud (1914) did anticipate the possibility of such future
developments in psychoanalysis (previously quoted on this website);
when he stated the importance of:
“… the facts of transference and resistance. Any line of investigation
which recognizes these two facts and takes them as the starting point
of its work may call itself psychoanalysis, though it arrives at
results other than my own.”
Clinical Techniques
Modern psychoanalysts are able to take advantage of a wide range of
clinical techniques and interventions for ego reinforcement, emotional
communication and resistance resolution. Spotnitz says:
"The essential difference is that classical analysis believes in
interpretation and nothing else, no other intervention. Modern
psychoanalysis is open to all interventions, all verbal interventions…
Any communication that helps a patient resolve resistance to saying
everything is part of modern psychoanalysis.”
Meadow, 1999, p. 6.
Some have argued that classical psychoanalysis, with its emphasis on
interpretation as the sole method of “making the unconscious conscious”
can also be viewed as anti-therapeutic for vulnerable patients; the
same patients who are frequently seen by modern analysts.
Are modern analysts opposed to interpretation? Not at all. For modern psychoanalysts,
“…silent interpretation… is an essential ingredient of a successful
analysis… Resistance is analyzed – silently and unobtrusively – but
instead of trying to promote recognition, perception, or conviction,
the therapist intervenes to facilitate verbalization as a connective
integrative process. The patient is helped to discover for himself the
genetic antecedents of his resistant behavior, explore it in terms of
the analytic relationship, and articulate his own understanding.”
Spotnitz, 1985, p. 167, emphasis original.
Essentially, the vulnerable patient is protected from the likely
ego-damaging effects of interpretation when used as a blunt force
instrument. Clinically, modern psychoanalysis is:
“…applied to take advantage of the initial unresponsiveness of the
preverbal personality to interpretive procedures and to the patient’s
oscillating transference states… Safeguards against chaotic regression
figure prominently in the clinical approach of the modern
psychoanalyst; the therapeutic alliance is permitted to evolve at a
pace the patient is able to tolerate.”
Spotnitz, 1985, p. 37.
The vast armory of clinical techniques at the disposal of the modern analyst are not indiscriminately used:
“From patient to patient… regardless of the nature of the disorder, the
types of interventions employed are empirically determined by
individual responsiveness.”
Spotnitz, 1985, p. 38, emphasis original.
Modern psychoanalysts anticipate that a successful analysis will bring
an individual to a state of maturity where the patient will be able to
tolerate verbal interpretations; but the final goals of modern
psychoanalysis go further:
“… modern psychoanalysis is dedicated to achieving far more than
transforming a miserable human being into one suffering from common
unhappiness – the therapeutic expectation stated by Freud… The patient
who has successfully undergone modern psychoanalysis emerges in a state
of emotional maturity. With the full symphony of human emotions at his
disposal, and abundantly equipped with psychic energy, he experiences
the pleasure of performing at his full potential.”
Narcissistic Transference
Freud (1926, pp 52-3, emphasis original) was describing the phenomenon of transference when he said:
The neurotic sets to work because he believes in the analyst, and he
believes in him because he begins to entertain certain feelings towards
him…. The patient repeats, in the form of falling in love with the
analyst, psychical experiences which he underwent before; he has
transferred to the analyst psychical attitudes which lay ready within
him…
Yet classical analysts soon found that many individuals appeared to be
unable to form this type of transference with their analysts. These
individuals were then often deemed “unanalyzable,” because of the
central role that transference plays in psychoanalysis. (See e.g.,
Fennessy, 2006).
How can individuals who seem to lack the capacity to develop this
“object transference” be helped? Modern psychoanalysts understand that
the difficulties experienced by many patients have their origins in the
pre-oedipal period. Another way of expressing this is that “(t)he
narcissistic patient is arrested at some point or points in
approximately the first two years of life.” (Margolis, 1981, p. 149).
Modern analysts are then able to use their skills to build a
transference on a narcissistic basis. In this narcissistic transference:
“(t)he patient is permitted to mold the transference object in his own
image. He builds up a picture of the therapist as someone like himself
– the kind of person whom he will eventually feel free to love and
hate.” (Spotnitz, 1976a, p. 109).
Dr. Spotnitz answers the question:
“’Do we want a narcissistic transference to develop?’ We do because in
a negative, regressed state, the patient may experience the analyst as
being like him or part of him. Or the analyst may not exist for him.
The syntonic feeling of oneness is a curative one, while the feeling of
aloneness, the withdrawn state, is merely protective. Because traces of
narcissism remain in everyone, we seek, when beginning treatment, to
create an environment that will facilitate a narcissistic transference
so that, first we can work through the patient’s narcissistic
aggression.” (Spotnitz, 1976b, p. 58).
Margolis further says that:
“In operational terms… the oedipal patient transfers the images of
distinctive objects of his oedipal period onto the analyst, whereas the
pre-oedipal patients transfers onto the analyst the fuzzy and ambiguous
images of his narcissistic period… In building the narcissistic
transference and eliciting the patient’s picture of the analyst, we are
actually eliciting his picture of himself.” (1979, p.140).
Therapists who have any experience with narcissism know that
narcissists are often consumed with themselves and themselves alone -
given the opportunity they may talk about nothing but their own
self-absorptions for years on end. Therefore, it should be apparent
that the narcissistic transference will not be come into being on its
own – it must be developed through the skills of the therapist.
What does the narcissistic transference look like? Spotnitz (1976a, p. 109) states that:
“On the surface it looks positive. He builds up this attitude: ‘You are
like me so I like you. You spend time with me and try to understand me,
and I love you for it.’ Underneath the sweet crust, however, one gets
transient glimpses of the opposite attitude: ‘I hate you as I hate
myself. But when I feel like hating you, I try to hate myself instead.”
Developing the narcissistic transference is normally an emotionally
charged process, that proceeds at the patient’s own pace. (See
generally, Fennessy, 2007). The training and clinical skills of the
modern analyst, including proper use of emotional reinforcement,
object-oriented questions and joining techniques, make all the
difference between success and failure in nurturing this relationship.
Spotnitz (1985, p. 201) describes the result when the narcissistic transference is successfully developed:
“(w)hen one focuses on the narcissistic patterns and works consistently
to help the patient verbalize frustration-tension, object transference
phenomena become increasingly prominent… Eventually, the patient’s
transferences are aroused by his emotional perceptions of the therapist
as a parental transference figure.”
In other words, personality maturation takes place. The symbiotic
relationship developed between analyst and patient (See, Spotnitz,
1984, p. 135) may help the patient’s emotional perceptions along.
Repeated emotional associations to the mental images of the analyst, as
constructed by the patient; strengthen the object field of the mind, or
form new neuronal connections.
The greater emotional maturity which results has enduring and important ramifications for the patient in therapy, and in life.
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