Centering Psychoanalysis in Difference and Dialogue – Interview with Pratyusha Tummala-Narra, Ph.D.

RoY SCHAFER: and Change in Psychoanalysis. International Universities Press, Madison, CT, 1997, xvi + 271 pp., $42.50, ISBN 0-8236-6632-8. It is always a pleasure to read and review anything published under Roy Schafer's name. The present collection might have been better entitled Tradition and Change in Roy since it predominantly consists of essays published by him during the last decade or so. All the familiar elements are here to delight Schafer buffs-the easy style, the thoughtful balancing of ideas, the complexity of perspective and, above all, the careful probing of controversial frontiers of analytic exploration. The material is divided into three parts. The first extends Schafer's longstanding and ambivalent debate with Hartmann regarding conceptualizing clinical facts, aspects of gender, and more. The second is more clinical, focusing on humiliation and mortification, blocked introjection, enactment and countertransference, and the third offers an extended reflection on issues related to authority, morality, and their reverberations in therapeutic technique. Much of the discussion revolves around familiar themes-the role of narrative as encompassing the range of clinical content and, along the same line, theories as forms of master narratives. One is reminded in this regard of Wittgenstein's approach to language games. There is also the strain of relativism in terms of which narratives, following Spence's now classic distinction between narrative and historical truth, are evaluated more in terms of their coherence and subjective appeal than objective truth. There is also Schafer's more recent assimilation of current Kleinian persuasions, particularly the emphasis on total countertransference. Schafer makes his case on all three counts, as he always has, persuasively. Schafer buffs will find much to savor, but as a skeptical reviewer, I find much to question. The narrative approach is salient and, without question, the analytic endeavor can be meaningfully cast in such terms. And there is no argument that there is no one narration that carries all the weight. But Schafer seems to neglect the narrator behind the narration who should, I would think, claim our primary attention regardless of the narration. Further, I would insist that only that narrative will do that encompasses the patient's experience, the analyst's experience (especially in comprehending the patient) and the relevant and knowable facts. Rather than simple narrative, there is tension between the evolving narrative process of the analysis and some asymptotic endpoint-perhaps never reached or known, but nonetheless relevant. There is a similar tension in the realm of theory-not only between the analyst's theory or theories and the patient's theory (the patient does have a theory), but between the analytic theories themselves. Again, consistent with Schafer's perspective, there is no single theory that encompasses everything-they all have a piece of the action. …

The epilogue chapter describes the processes of change in psychoanalysis over a period of more than 120 years. It shows how the assumptions of most of the respective schools of mind developed during this time from a one-person to a two-person psychology. The historical background and the development of the terms are described and the nature of science is discussed. The methodologies of science and the meaning of the terms axiom and assumption are explained.The chapter shows how psychoanalysis became a science, however not a natural science, (as it considered itself at the start), but a human/social science using the method of hermeneutics, the theory of the interpretation of texts and understanding, with all the questions and problems that then arise. Models, concepts, and methods of psychoanalysis seem to have been influenced by the respective prevailing social, intellectual, and scientific currents and the increasing knowledge achieved by research. Nowadays, we can find analysts who are still working according to older models, concepts, and methods, and others according to more modern ideas. We have studied both.

This paper elaborates an aspect of the therapeutic experience of analysis that pertains to the examination of the past as it influences a patient's view of his self-worth and relationship to the world. It is complementary to the usual view of psychoanalytic process that involves analysis of transference resistance, revelation of transference, and the discovery of its genetic roots. I propose an additional therapeutic aspect of the reexperience of the past in which the changed representation of patient as child is validated by a new object, the analyst, who is experienced as a benevolent witness to the past and as a benevolent presence in the past, thereby consolidating the change and influencing the patient's adult self-representation. This therapeutic effect is more likely to be of significance in patients who have experienced parental loss or significant deprivation in childhood. Segments of the analysis of a patient illustrate this point. The patient described "listening to himself with compassion for the child he had been" and being listened to by me in the same way. He became thereby "tolerant and empathetic with the child he had been." The more general implications of this as a vehicle for change in psychoanalysis are discussed. Of ancillary interest was the patient's research into his past and ultimately his actualization of a family romance fantasy with a particular ironic twist.

Tradition and Change in Psychoanalysis

Co-determination and change in psychoanalysis

Nonlinear Dynamic Systems Theory has been used by researchers in development for over 25 years. This paper demonstrates how this theory applies to psychodynamic development throughout the life cycle and illustrates how it can be used to explain change in psychoanalytic treatment.

As psychoanalysis approaches its second century, it seems no closer to being a science than when Freud first invented the discipline. This text analyzes the way pscyhoanalysis functions - as a clinical method, and as a scholarly discipline or science, and proposes remedies for the uncontrolled rhetoric that currently governs psychoanalytic practice. This reliance on rhetoric is the problem the author identifies, and he tributes the troubling lack of progress in psychoanalysis to its outmoded method of data collection and its preference for fanciful argument over hard fact. Paying particular attention to the role of self-analysis in the Freudian myth and the evidential drawbacks of the case study genre, this text shows how psychoanalysis was set on its present course and how rhetorical manoeuvres have taken the place of evidence. Donald Spence believes that by challenging the traditions and diminishing the power of rhetoric, psychoanalysis can remain a creative enterprise, but one based on a solid scientific foundation. Donald Spence has also written The Freudian Metaphor: Toward a Paradigm Change in Psychoanalysis and Narrative Truth and Historical Truth: Meaning and Interpretation in Psychoanalysis.

New Ideas addresses the problem and process of change in psychoanalysis from historical, theoretical, and clinical perspectives. Each section of the book is enriched by inclusion of a seminal historical paper (by M. Gitelson, P. Greenson, H. Hartmann, S. Lorand, and L. Stone), inviting the reader to compare integrative attempts of the past with those of the present.

The contemporary literature on change in psychoanalysis has struggled to integrate recent developments in theory. Reasons for its limitations are discussed. The present article brings to bear relevant concepts drawn from postmodernism and complexity theory on ideas about how change occurs in psychoanalysis. In elaborating these two skeins, it looks critically at some recent attempts to incorporate them and considers their relationship to each other. A general description of complexity theory is offered because it has not yet been well documented in the analytic literature. Postmodern theory is talked about in relation to change; it has been discussed more generally in the author's earlier work. Ways in which postmodernism and complexity theory can inform psychoanalysis but also constrain some of its assumptions are explored. The nature and occurrence of qualitative events of psychoanalytic change are described. Four kinds of such events are described and illustrated with clinical vignettes. Analytic change viewed from a macro rather than a micro level is also discussed.

A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

Half a century ago, I enrolled in my first undergraduate psychology course, and about 45 years ago, at my initial practicum site, I saw my first patient. This brief paper will discuss what I see as a few of the significant changes (for good and bad) over these past 45-50 years. The predominance of psychoanalysis stands out as one of the most vivid realities of the 1950s. Some even boasted, into my third analysis - the first two were Freudian and now I'm in the second year of a Jungian analysis. Insight was everything; all else was merely palliative. The disciplined light of science was considered beyond the borders of psychoanalytic methods (a view that has been regenerated by current postmodernists and some social constructionists). This gave psychoanalysis an elitist veneer. By 1958 I had grown enamored of behavioral methods and was the first to use the terms and therapist in a scientific journal (1). Mainstream thinkers in psychiatry and clinical psychology regarded behavioral approaches as naive, mechanistic, symptom-centered, and superficial. Adherents on both sides of the fence went to battle, and many publications addressed the general theme of therapy versus psychoanalysis. At the same time, the proliferation of literally hundreds of other schools of psychotherapy emerged (2). At that juncture it seemed advisable to emphasize that no one school had all the answers, and I outlined what I saw as the virtues of technical - carefully selecting effective techniques form many disciplines without subscribing to the theories that had spawned them (3). Greater numbers of theoreticians and clinicians endorsed systematic and psychotherapy integration, and in 1983 the Society for the Exploration of Psychotherapy Integration (SEPI) was founded. Various combinations and amalgams of different treatment methods were debated, and one central question was whether a combination of different theories would generate more robust techniques. In essence, most seemed to agree that theoretical would produce confusion rather than enhance treatment outcomes. Nevertheless, whereas the term eclecticism had been strongly pejorative, surveys showed that most practitioners were now willing to call themselves eclectic, and it was considered myopic for individual schools of thought to lay claim to the Truth. Meanwhile, biological psychiatry became a significant force. In 1957, I recall treating a very depressed physician who was self-medicating with large quantities of Methedrine. At the time, my psychodynamic supervisor was urging me to explore the full ramifications of the patient's anger turned inward. (In today's world, the most likely treatment might be a combination of cognitive therapy and an SSRL) Some time in 1958, during my psychological internship, one of the psychiatrists announced that a new medication had been released (Imipramine) that was as effective as ECT. The spate of anxiolytics, antidepressants, and antipsychotic medications that soon followed gave rise to the discipline of psychopharmacology. More and more psychiatrists gained proficiency in the application of psychotropics. Clinical psychologists became the main purveyors of psychosocial therapies, often in tandem with psychopharmacologists who took responsibility for prescribing medications. There was a significant change in psychoanalysis, partly as a reflection of much more stringent insurance regulations. Those who had decried shortterm therapies as inferior modified their stand. Consequently, the advent of brief psychodynamic therapy offset the decimated enrollments in analytic training institutes and made outcome research more feasible. Meanwhile, behavior therapy developed a more sophisticated social learning-theory framework and advanced a range of elegant techniques. The term cognitivebehavior therapy was coined and widely accepted, and my own work in multimodal was offered in an attempt to further broaden the range and add precision to the enterprise (4,5). …

This article underscores and expands on a contextualist, complexity theory perspective in conceptualizing the organization of personal, subjective experience and the therapeutic process. It emphasizes that one's personal, lived experience originates and continues to evolve from within a relational matrix, with affect as its primary currency, and reevaluates what, exactly, is being analyzed and potentially transformed in the clinical setting. An extension of intersubjective systems theory, this article focuses on two complementary themes: the concept of the interpenetration of multiple worlds of experience and the idea of systemically derived organizing principles. These ideas enhance our understanding of the positive transformation of subjective experience and expand our perspectives about therapeutic change in psychoanalysis.

The central objective of this presentation is to reflect on the obstacles involved in the task proposed by the Chicago Congress, which is to explore convergences and divergences in psychoanalytic practice. The author discusses two major obstacles. First, the epistemological and methodological problems in relation to the construction of theory in psychoanalysis and especially the inaccessibility, in any reliable way, of what psychoanalysts really do in the intimacy of their practice. He proposes to separate, at least in part, theory from practice in psychoanalysis, in an attempt to grasp psychoanalysts' practice in its own merits. He then outlines a phenomenology of the practice of psychoanalysis, which reveals that, in their work with patients, analysts are guided more by practical reasons than theoretical reasons; that is, their interventions are predictions rather than explanations. Since these practical reasons need to be validated constantly in the analytic relationship based on their effects, he discusses the subject of validation in the clinical context of the core theory of therapeutic change in psychoanalysis, that is, the conditions required for clinical practice to satisfy the thesis of an inseparable union between gaining knowledge and cure. He ends by challenging the core of the psychoanalytic theory of change, arguing that it neither does justice to the practice of psychoanalysts nor to contemporary knowledge of processes and mechanisms of therapeutic change. Finally, he proposes that we detach practice from theory, in order to study the former in its own merits, utilising a plurality of methods ranging from systematic investigation to the recent methodology of the Working Party.

Back to table of contents Previous article Next article Book Forum: PsychoanalysisFull AccessThe Emergent Ego: Complexity and Coevolution in the Psychoanalytic ProcessHAROLD I. EIST, M.D., HAROLD I. EISTSearch for more papers by this author, M.D., Bethesda, Md.Published Online:1 Mar 2001https://doi.org/10.1176/appi.ajp.158.3.505AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In 1978, Stanley Palombo wrote Dreaming and Memory(1), a seminal volume that expanded understanding of dream function. He relied on empirical research in the sleep laboratory plus innovative integration of new neurobiological and computer science findings with current psychoanalytic ideas.Palombo’s new book skillfully continues these processes of integration and inclusion. He brings a new and lively version of psychoanalysis and psychoanalytic theory into the millennium as he combines modern evolutionary theory, computer models of evolution and information, complexity theory, neuroscience, and clinical psychoanalytic wisdom. This integration convincingly documents that psychoanalysis is quintessentially a biopsychosocial discipline that is alive, changing, growing, and relevant.Palombo challenges long-held, incorrect views that psychoanalysis is not science; that psychoanalysis deals with only outside influences on development (the one-way shaping of the individual through the pressures of learning and society on the drives or instincts, which create a dynamic, Möbius-strip effect) rather than the inner influences (the genetic or molecular bases of behavior); and that there is no way of measuring change in psychoanalysis. He does not get stuck at the level of molecular biology, however; rather, he recognizes the importance of the whole organism and the fact that change is reflected as an aspect of the organism. Palombo’s work is responsive to the important ideas of the sociobiologist Edmund O. Wilson, whom Jonathan Weiner (2) quoted as saying, “If everything else in biology is the product of evolution then surely we have to constantly examine and reexamine the human mind and human social behavior as products of evolution” (p. 220).Palombo argues compellingly that psychoanalysis induces changes within patients that are evolutionary in nature in that they alter adaptations from less effective to more effective. He also argues that these often small, nonlinear changes can lead to transformations with major enduring impact as new engrams. His views are in agreement with those of Eric Kandel, suggesting that the brain remains plastic throughout most of the life cycle and that new learning brought about by psychoanalysis can structurally alter the brain and the potential of the individual, which, like the brain, is changeable.Palombo points out that it is not essential for the reader to go through all of the chapters on computer models of self-sustaining and self-modifying systems to get the gist of his ideas and use them clinically. The concepts presented in these chapters are complex and require frequent rereadings and cogitation. However, reading these chapters is important not only as a strenuous mental exercise, which is good for the brain, but because they describe recent developments in post-Darwinian, modern evolutionary thinking. Evolution is often a glacial process, but it need not be, as documented in Jonathan Weiner’s exquisite volume, The Beak of the Finch(3), which Palombo refers to in this book and integrates into his ideas.Detailed clinical vignettes support the hypothesis that evolution is occurring in patients undergoing psychoanalytic treatment. Palombo’s writing also documents that he is a brilliant, creative thinker and one of the leading modern theory builders in psychoanalysis.For those interested in the advancement of psychoanalytic theory and understanding, for those desiring to break the intellectually stifling bonds of orthodoxy that have hurt psychoanalysis, for those feeling the need of a strong, intellectual, up-to-date perspective on psychoanalysis as an important science and an increasingly refined and clinically important art, this book is a major contribution. It richly deserves to be read.By Stanley R. Palombo, M.D. Madison, Conn., International Universities Press, 1999, 395 pp., $65.00.

Masculinity, Femininity and Change in PsychoanalysisGladys Branly GuartonGladys Branly GuartonFaculty and Supervisor, Suffolk Institute for Psychoanalysis and Psychotherapy.22 Robbins Lane, Lake Success, NY 11020Search for more papers by this authorPublished Online:July 2017https://doi.org/10.1521/jaap.1.1996.24.4.691PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesAron L. (1991), The patient's experience of the analyst's subjectivity, Psychoanal. Dialog., 1, 29–51. Crossref, Google ScholarBarratt B. (1993), Psychoanalysis and the Postmdern Impulse: Knowing and Being Since Freud's Psychology, Johns Hopkins University Press, Baltimore, MD. Google ScholarBenjamin J. (1988), The Bonds of Love: Psychoanalysis, Feminism and the Problem of Domination, Pantheon, New York. Google ScholarBetcher W., and Pollack W. (1993), In a Time of Fallen Heroes: The Re-Creation of Masculinity, Atheneum, New York. 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