BernheimV1, Istex, Corpus, bibRecord, 000727

Selfobject Disorders and Psychoanalytic Theory: A Historical Perspective

Identifieur interne : 000727 ( Istex/Corpus ); précédent : 000726; suivant : 000728

Selfobject Disorders and Psychoanalytic Theory: A Historical Perspective

Auteurs : Michael Franz Basch

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Journal of the American Psychoanalytic Association [ 0003-0651 ] ; 1981-04.

RBID : ISTEX:09E48B174B6C1909229FF47F2F2EEAFBE8739D29

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Teeft :
- Analysis terminable, Analytic community, Analytic process, Annual psychoanal, Basch, Causal hypotheses, Clinical generalizations, Early childhood, Empathy, Franz, Free association, Further recommendations, General psychology, Heinz kohut, Hlichael franz basch, Idealizing transference, Infantile sexuality, Kohut, Large group, Michael franz basch, Mirror transference, Oedipal, Oedipal conflict, Oedipal phase, Oedipal transference, Psychic reality, Psychoanal, Psychoanalysis, Psychoanalytic, Psychoanalytic method, Psychoanalytic theory, Second analysis, Selfobject, Selfobject disorders, Selfobject relations, Study child, Therapeutic transference, Transference, True feelings.

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https://api.istex.fr/document/09E48B174B6C1909229FF47F2F2EEAFBE8739D29/fulltext/pdf

DOI: 10.1177/000306518102900203

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ISTEX:09E48B174B6C1909229FF47F2F2EEAFBE8739D29

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<meta-value> SELFOBJECT DISORDERS AND PSYCHOANALYTIC THEORY: A HISTORICAL PERSPECTIVE MICHAEL FRANZ BASCH, hf.D. SYCHOANALYSTS HAVE ALWAYS HAD PATIENTS who experienced disturbances in development prior to reaching the oedipal phase and, as a result, developed pathology that did not respond to interpretations made in terms of the oedipal conflict. These analysands were suffering not from neuroses, but from what we now call narcissistic personality and behavior disorders. We find the following comment by Freud (1919): P We cannot avoid taking some patients for treatment who are so helpless and incapable of ordinary life that for them one has to combine analytic with educative influence; and even with the majority, occasions now and then arise in which the physician is bound to take up the position ofteacher and mentor. But it must always be done with great caution, and the patient should be educated to liberate and fulfill his own nature, not to resemble ourselves [p. 1651. Presented at the panel on "The Birolar Self, "American Psychoznalytic Association, New York, December, 1979. The author wishes to thank Drs. Arnold Goldberg, Heinz Kohut, Paul H. Omstein, and Ernest S. Wolf for their helpful comments and suggestions while this paper was being written. 337 338 MICHAEL FRANZ BASCH Unfortunately, Freud's words lose significantly in translation. Erziehung and Erzieher respectively translated as "education" and "teache? do not connote, as does the German text, ' that the analyst is here being put in the position of exercising parental influence to make up for some defect in the way the patient grew up. "Erziehung."has much more to do with manners, tact, behavior, and attitude toward others, in other words, with upbringing, rather than with what we ordinarily associate with the word "education" in America, a term for which the German "Ausbildung" or "Schulwesen" is more appropriate. I also call your attention to Freud's observation that the analyst would find himself, so to speak, in locoparentis, at one time or another in most of the analyses he conducted and not only in the extreme cases of arrested development. Similarly, in Analysis Terminable and Inferminable (1937), Freud alluded to the difficulties in analyzing that group of patients who required character, as opposed to so-called therapeutic, analysis. The termination in these cases was not particularly satisfying nor clear-cut and, even though its goals were modest, the results of the treatment were limited and tenuous at best (p. 250). It was held that in their analyses these patients required what was elsewhere called "Nacherziehung," a belated attempt at completing their upbringing, in an effort to promote a reasonable level of maturity. The presence of more and more of these patients, as opposed to psychoneurotic ones, on analytic couches, led to the postulation of a so-called widening scope for the application of psychoanalysis. The intrusion of the analyst's personality in the form of educational and exhortative efforts was often deemed necessary to help such patients overcome their immature, fixed character traits: for example, their unreasonable demandingness, their "Wir k6nnen es nicht verrneiden, auch Patienten anzunehmen, die so haltlos und existenzunr5ig sind, dass man bei ihnen die analytische Beeinflussung mit der erzieherisohen vereinigen muss, und auch bei den meisten anderen wird sich hie und da cine Gelegenheit ergeben, w o der Arzt als Erzieher and Ratgeber aufzutreten genijtigt ist. Aber-dies sol1 jedesmal mit grosser Schonung geschehen, und der Kranke so11 nicht zur Ahnlichkeit rnit uns, sondern zur Befreiung und VolIendung seines eigenen Wesens erzogen werden" (Gcsammelte IVmke, 12, p. 190). SELFOBJECT DISORDERS 339 oversensitivity to slights, their tendency to deify the analyst and, subsequently, their intense rage when he was found to be only human and imperfect. The manner in which these cases had to be dealt with aroused significant apprehension in the analytic community. There were awkward differentiations made between the analyst as a human being and the analyst functioning as analyst. A label, parameters, was given to the extra-analytic maneuvers that analysts found themselves employing in these cases. These in.. trusions into classic technique were provisionally sanctioned as long as they were used only as a last resort and eventually understood and interpreted in terms of the oedipal conflict and its vicissitudes. It is not my purpose here to discuss the results or lack of results that were obtained through this modification of analysis in an attempt to deal more successfully with this large group of patients who we felt should be analyzable but in practice often were not. I bring this matter up only to emphasize the unease and concern in the analytic community over this issue. The fear voiced by many was that psychoanalysis was being left behind and that in the interest of clinical results we were increasingly employing psychotherapeutic techniques. But what does this mean? What is the difference between psychotherapy, even the psychotherapy derived from psychoanalytic insights, and psychoanalysis?To answer that we must review, briefly, the history of the development of the psychoanalytic method. Freud started treating the psychoneuroses by combining the methods of Charcot and Breuer. When the hypnotic-cathartic technique failed him often enough and was uncongenial to boot, Freud, using what the demonstration of another hypnotist, Bernheim, had taught him, maintained that the patient could and would recall his past without first being hypnotized. We are all familiar with how the intermediate technique of stimulating the patient's memories by pressing his forehead gradually evolved into the method that we call free association. Another significant step that paved the way for psychoanalysis was Freud's 340 MICHAEL FRANZ BASCH recognition that the sexual trauma of childhood on which later neurotic development was based could have been a fantasy as well as an actual occurrence. This conclusion, as we know, was an offshoot of another of his monumental insights: the translation of the heretofore ununderstood language of dreams, symptoms, and some aspects of free association into logical, comprehensible, adult terms. Yet, momentous as all these discoveries were and still are for psychoanalysis, free association, dream interpretation, and the recognition of the signficance of psychic reality are not yet psychoanalysis. Psychoanalysis began when Freud was confronted by and accepted as valid the behavior of patients that he came to call "transference." I do not think that any psychoanalyst will dispute the basic and fundamental significance of the therapeutic transference for either practice or research. When Freud did not reject or flee, as had Breuer, from the inappropriate attitude of his patient toward him, but treated it as a symptomatic manifestation worthy of study, psychoanalysis proper hecame a reality, separate and distinct from its origin in hypnoslD-.id suggestion. Henceforth therapeutic investigation of the patient's difficulties rested on the development, examination, interpretation, and eventual resolution of the transference to the analyst. Freud was clear and unambiguous on this topic and definite in his prescription. In his articles on technique (Freud, 1911, 1912, 1913, 1914, 1915), he set forth the following six principles: (1) transference feelings are genuine feelings not imitations of feelings. (2) When the love for the analyst is the ally of the analytic process, i.e., as long as it provides the impetus for obeying the analytic rule of free association, it should be permitted to flourish. (3) Eventually transference becomes a resistance, i.e., the demands for fulfillment of transference wishes in the here-and-now become an obstacle to the exploration of the patient's psychic reality. Here, as Freud admonishes in no uncertain terms, (4) the analyst, without denying the feelings of the patient, must not take them at face value. (5) The patient's love is not for him per se, but for him insofar as he is the recipient SELFOBJECT DISORDERS 341 of a transference from figures in the past. (6) In the interest of analysis one interprets rather than indulges that feeling. The patient's and the analyst's satisfaction must come from understanding the patient's wishes, and one refrains from trying to fulfill them directly- the rule of abstinence. There have always been patients who persisted in attributing curative effects to the quasi-parental relationship in which they found themselves with the analyst and insisted that they needed more of that. From the time that Freud spoke, regretfully, of the need for Nacherziehung in a certain number of analysands until very recently, infantile attitudes and childlike demandingness on the part of a patient have been dealt with as resistances to the oedipal tranference. When in spite of our attempts to clarify his needs as regressive and evasive, a patient used us and the psychoanalytic situation to compensate himself for what he felt he had not had in earlier life in the way of understanding, recognition, and respect, we became understandably concerned that we were permitting him to indulge himself at the expense of the basic task on which an analytic cure depended. Heinz Kohut was no exception. The report of the first analysis of Mr. Z. (Kohut, 1979) demonstrates that he understood his patient's immaturities as resistances to the oedipal conflict and interpreted them accordingly. The patient accepted the interpretations, made some progress, attained some insight, and the analysis was ended, albeit with some vague apprehensions on the analyst's part that something was missing from the termination. Between Mr. Z.'s first and second analysis, Kohut treated Miss F., a case he described in The Analysis ofthe Sey(1971). This patient consistently and insistently rejected his interpretation to the effect that her indifference to him concealed her true feelings. After overcoming his countertransference, Kohut was able to see that Miss F. was attempting to transfer and recreate the circumstances of her early childhood rather than resisting the emergence of an oedipal transference. Through this insight he transformed a therapeutic stalemate into a successful psychoanalysis and laid the 342 MICHAEL FRANZ BASCH groundwork for further analytic investigation of preoedipal disorders. Through his clinical experience Kohut established that transference is not synonymous with the oedipal conflict nor limited to the recrudescence of infantile sexual wishes. In the second analysis of Mr. Z. the immaturities of the patient, which had already been manifested during his first period of treatment, were recognized not as resistances, but as attempts at transference that had to be permitted to unfold so as to enhance the analyst's understanding of a crucial childhood situation. With the emergence of these transferences, the analyst became the target of the distorted demands that resulted from Mr. Z.'s disturbed selfobject relations in childhood. These could now be clarified, their significance interpreted and eventually worked through in the traditional psychoanalytic manner. It might be well to emphasize here that although the nature of the transference changes in narcissistic disorders, its management does not. There is no role playing on the part of the analyst in a misguided attempt to provide the patient with a meaningful experience over and above the analytic one. It is the analyst's outlook that is different as a result of Kohut's addition to clinical theory. He no longer finds himself impelled to actively interfere with the development of the mirroring or the idealizing transference, either through premature and inexact interpretation or by pointing out external rather than psychic reality to the patient. The analyst no more offers himself as a potential ideal to a narcissistic patient than he poses as a seducer to a hysterical one. He does not have to; the patient's unconscious needs take care of that. Until now the difference has been that whereas Freud gave us a theoretical framework that prepared us for the onslaught of the sexualized transference of the psychoneurotic so that we were prepared to recognize its beginnings and to tolerate its unfolding, this was not the case for the impact of other selfobject transferences. Idealizations are no more directed at the analyst as a person than are another patient's attempts at seducing him. Though it might seem otherwise, it is not easy to sit SELFOBJECT DISORDERS 343 still and think about the unconsious meaning of what the patient is saying when you feel the discomfort of being assigned importance you do not have, of having virtues attributed to you that you do not possess, and of being extolled for powers, especially therapeutic ones, that imply demands you cannot possibly meet. The urge to set the patient straight or to insist that he harbors negative feelings behind his fulsome praise is very strong. As with the oedipal transference, only a theory that takes us beyond the affective impact of the patient's needs makes us sufficiently independent of the immediate meaning of what he says. Such a theory promotes the proper equidistant stance that enables us to experience the transfer of feelings without having to defend ourselves against them. Only under those circumstances can a patient, tentatively and bit by bit, bring out his childhood longings and fears, and in their recapitulation with the analyst let them be clarified and eventually interpreted. Similarly, Kohut's clinical generalizations based on his experience with the so-called mirror transferences prepare us to deal objectively with patients' grandiosity and need for merger with the analyst. Here we find our individuality painfully vitiated at the hands of a patient bent on recreating some phase of the objectless condition of infancy and childhood when others only existed in so far as they were used as means to an end. Once understood for what it represents, apatient's need to be mirrored (an evocative term describing a child's need to have his potential for individuality and significance empathically validated) can be met with an analytic response as the merger, twinship, or mirror transference unfolds. No role playing with or indulgence of the patient is called for. It is sufficient that the patient feel understood as opposed to being misunderstood. Miss F. felt mirrored, that is to say, understood, once her analyst stopped insisting that she must be evading her true feelings for him and focused his interpretations or reconstructions on her transference need for a selfobject that confirmed her presence and her activities rather than demanding, as her mother had done, that he be the tenter of her interest. Then she could make progress in her analysis. 344 MICHAEL F U N 2 BASCH I repeat, in the mirror transference as in the idealizing transference, Kohut advocates that we do no more and no less than we do with psychoneurotic patients. That is, foster the patient's associations, avoid premature closure, depend on the unconscious to provide the material, interpret it appropriately, and engage the patient in the working-through process till insight is demonstrably achieved. I hope that I have contributed to the correction of a misunderstanding that sometimes crops up when empathy- the analyst's considered attempt to decipher the message behind his patient's words, affect, attitude, and behavior-is confused with indulgence, sympathy, or projective identification. It is true that the patients we are talking about will often respond positively to the analyst's empathy. Initial amelioration of symptoms is a hopeful sign; it indicates trust and augurs well for the development of the therapeutic transference. It indicates that there were positive, healthy responses to the patient's need for selfobject relations in infancy and childhood even though negative factors intervened to distort what might have otherwise been a happier outcome. Is there anything wrong with such a positive response? Let me ask the converse. Is there anything that is therapeuticperse in causing our patients to suffer by frustrating them actively-that is, by an active recreation of the childhood trauma? Not according to Freud (1937). As long as the transference is allied with the analyst and the analytic process, it is useful, and one does not censure the patient for the benefits he derives temporarily from his relationship to the analyst while the transference is in balance. If an impotent neurotic man forms a positive father transference and, reading permission into the analyst's acceptance of him, becomes potent once more, do we get upset with ourselves or berate him for it? Obviously not. When during the positive phases of the transference the patient usually feels improved, the analyst will begin to define for himself what it is that now allows the patient to function better. The real understanding, however, of the nature of the positive result of the transference will come only after, inevitably, the balance begins to shift in response to a symbolic reenactment of a trauma SELFOBJECT DISORDERS 345 of childhood in the analysis. Now transference becomes resistance and the patient experiences varying degrees of dysphoria. It is then through a scrutiny of the events that brought about the change that we can make our most effective interpretations to the patient by helping him understand how he has recapitulated in the analysis his childhood need, the nature of its disappointment, and the effect this has had on his view of himself and on his relations with those around him. The criterion for establishing whether or not one is doing psychoanalysis is whether or not the patient's cure or improvement depends primarily on his pathology being brought into the transference to the analyst, interpreted so as to enhance the patient's understanding of himself and worked through to the point where the formerly malfunctioning structures have been restored or the defective structures strengthened to such an extent that the patient is capable of leading a productive life. Judged by the criteria I have set forth, Kohut's contribution is in complete harmony with classical Freudian analysis. Indeed, it has made it possible once more to draw a definitive line between psychoanalysis and psychotherapy. Now that Nuchertiehung, the belated maturing, of patients with narcissistic personality disorder, which has given us so much trouble, can be attained in the traditional manner, through transference analysis, we can truly claim that the scope of psychoanalysis has been widened. It is for this reason that I object to a division that is often made between the analysis of psychoneuroses or psychoneurotic character disorders and the analyses of earlier selfobject or narcissistic personality disorders. This implies that there is something essentially different in the psychoanalytic management or understanding of these two groups of patients. I believe that my examination of Kohut's work in the framework of psychoanalytic theory has established that no such difference exists. However, self-psychology is important not just because it makes possible the application of traditional psychoanalytic technique to a large group of patients whose analyses could not 346 hlICHAEL FRANZ BASCH be carried to analytic termination heretofore. Just as significant as the practical contribution to our field is the demonstration that the psychoanalytic method as a research method is viable since it can lead to new discoveries that expand the horizons of the science it serves. Kohut's work refutes those who would say that Freud's method is circular, a self-fulfillingprophecy that always turns up what it expects to find. Clearly that was not the case here. Potentially then, there are other aspects of development that, just like selfobject transference, are always there to be studied and only await the application of Freud's method by a talented analyst whose background and whose capacity for selfanalysis are such that he can make the necessary connections between what he is experiencing in the analytic Situation and what its implications are for the larger theory of human development to which psychoanalytic theory belongs. As far as the implications of self-psychology for psychoanalytic theory are concerned, I have no more to say, much as I would like to develop further and give the extended attention they deserve to the various points that I could only sketch here. However, another issue remains to be raised that really has nothing to do with psychoanalytic theory per se, but is very troublesome indeed, having implications for psychoanalytic education and for psychoanalysis as a science that, though highlighted by Kohut's findings, go far beyond the narrower focus of this discussion. I am aware that there are analysts who do not see, as I do, the continuity between Freud's discoveries and self-psychology and, given their expectations of psychoanalysis, may not find my arguments persuasive. O u r disagreement is, however, not related to Kohut's work as such but is based on differing viewpoints as to just what constitutes psychoanalytic theory. Once again I must ask you to draw on your knowledge of the history of the development of Freud's ideas and recall that his avowed primary goal was always to establish a scientifically acceptable general psychology. This was Freud's aim before he became a psychoanalyst and, as his writings clearly show, did SELFOBJECT DISORDERS 347 not change thereafter. I have traced in some detail elsewhere, and will not attempt to repeat here, how Freud used the biology, physics, and linguistics of his time to generate a theory of mental functioning. Let me just say that I am in agreement with those psychoanalysts and philosophers of science who believe that many of the explanations that Freud advanced at that time are now in need of modification (Basch, 1973, 1975a, 1975b, 1976a, 1978). That is not to say that the concepts Freud was trying to express have lost their importance; on the contrary, the search for a larger framework that could connect Freud's findings with science at large is just as important today as it was then. The difference is that we have available the fruits of work in other fields that were not there for Freud to use. So, where he had to postulate a psychic energy to express the fact that ideas vary in intensity, we can now draw on the discoveries of communication and information theory to explain intensity of thought (Basch, 1975a, 1976a); where Freud had to depend on a teleological view of instincts to explain the variety and quality of goal-directed action, we now have a theory based on affect as the immediate source of motivation for behavior that does justice to psychoanalytic clinical findings (Tomkins, 1962-1963, 1970; Basch, 197613); where Freud could have no knowledge about mental development in infancy except for what he himself was able to discover regarding the vicissitudes of infantile sexuality, we now have amazingly sophisticated studies of how infants perceive, what they feel, how they communicate, and how the capacity for problem solving develops at various stages of infancy and beyond (Basch, 1975a, 1977). The primacy of wordless thought, the significance of sensorimotor development, the differentiation of right from left brain functioning which may turn out to be very important for our concept of the dynamic unconscious, all these findings and many more are coming together and, not surprisingly, complement Freud's psychoanalytic discoveries in the area of human motivation and the theory of meaning that can legitimately be derived from it. Freud labeled his hypotheses about general psychology "meta- 348 MICHAEL FRANZ BASCH psychology" and this evolved into the term "psychoanalytic metapsychology," giving the impression that these concepts were derived from psychoanalytic work. They were not. These theories antedated psychoanalysis. Specifically, as I have shown elsewhere (1975b), his book On Aphasia (1891) and the Projxt for a Scient$c Psychology (1895) contain in detail every one of the explanatory concepts he later brought to psychoanalysis. Kohut's clinical reconstructions are in keeping with the aforementioned recent discoveries about the communicative, affective, and perceptual capacities of human infants, yet there are, nevertheless, some analysts who, out of what I believe to be a misplaced concern for psychoanalysis, do not feel they can extend even provisional credibility to the data uncovered through using the orientation made possible by self-psychology because these data do not corroborate or support Freud's hypotheses regarding the working of the brain or mental apparatus. I believe that the reason these critics of self-psychology fear a threat to analysis is that they have failed to make a rigorous distinction between the data of free association, the laws or clinical generalizations that can be abstracted from them, and the causal hypotheses from other fields adduced to explain them (Basch, 1973). Only the first two are directly related to the psychoanalytic method. The last, the causal explanatory theory, belongs to a different universe of discourse, and changes in these theories have nothing to do with the validity of psychoanalytic propositions. Kohut, by indirectly throwing new light on infancy and early childhood through psychoanalytic reconstructions, necessarily calls into question the exclusivity and centrality of the instincts and the oedipus complex as explanatory hypotheses by demonstrating that the vicissitudes in the development of the concept of self are more complex than we had suspected. Although Kohut himself has been reluctant to do so, I do not think we can or should avoid the far-reaching implications of his clinical discoveries for the general psychological theories with which psychoanalysis imbricates. As you know, he at first SELF-OBJECT DISORDERS 349 postulated two lines of development, the object-libidinal and the narcissistic (Kohut, 1971). My position is that development is a holistic enterprise and that everything we know mitigates against its division into the categories Kohut at first proposed. I think we should retain a unitary concept of development, but one in which the development of the self is central, subsuming the vicissitudes of infantile sexuality, with the oedipal phase and its attempted resolution representing a watershed in the evolution of the greater whole. After all, would any of us deny that infantile sexuality and the oedipal phase are part of the ontogeny of the self? That, however, is my opinion. At present Kohut (1977) goes only so far as to say that the pathology of the oedipal phase, as well as that of earlier infantile sexual phases, is not basic but is, rather, a consequence of a failure in empathy. In conclusion, let me take my argument one step further and reconsider Freud's hope for a general psychology that would have psychoanalysis as its foundation. As in Freud's day, psychology remains trapped by its essentially biological outlook. It is physical existence and the preservation of the species that are still seen as the fundamental goal of all animal life including that of man. This of necessity means that sooner or later psychology must be reduced to biology and ultimately to physics and chemistry. That is why the instinct theory made sense in Freud's time and was a logical, even inevitable step for someone trained in the tradition of Helmholtz. But what if man is not simply a genus in the class mammalia, but a member of a new class of vertebrates that, as mammals have been separated by evolution from amphibians and reptiles, is differentiated by its capacity for empathy and introspection from its forebears?2 Perhaps our existence as a class * The developmental significance of the essentially nonverbal communication we call empathy has long engaged the interest of psychoanalysts (Freud, 1921; Olden, 1953, 1958; Greenson, 1960; Burlingham, 1967; Loewald, 1970; Beres and Arlow, 1974). Spitz's (1946) observations that established the necessity of empathic communication for human life foreshadowed what Kohut was to demonstrate psychoanalytically, namely, that the birth of the human individual is not accomplished by the extrusion of the fetus from the uterus but is, rather, a lengthy process of more or less successful communication that eventually establishes the center of independent initiative we call the self. 350 hlICHAEL FRANZ BASCH should be measured in terms of ideas and their communication, with biological survival of the individual being only an incidental or secondary factor. In that case, it is the psychological continuity of the individual, the meaning that his life has for him, and the transmission of ideas over generations that are basic to the life of man. In such a conceptual hierarchy, psychoanalysis, which makes the systematic study of the meaning of human behavior possible, would have the focal position in a science of man that Freud envisioned. Much of the task that its founder set for psychoanalysis may still lie ahead. Kohut's work is proof that its requisite vitality to face the future is unimpaired. REFERENCES BAscIi, M. F. (1973). Psychoanalysis and theory formation. Annual Psychoanal., 1: 39-52. New York: Quadrangle. (1975a). Toward a theory that encompasses depression: a revision of existing causal hypotheses in psychoanalysis. In: Depression and Human Existence, ed. E. J. Anthony & T. Benedek. Boston: Little, Brown, pp. 485-534. (1975b). Perception, consciousness and Freud's "Project." Annual Psychoanal. 3:3-19. (1976a). Psychoanalysis and communication science. Annual Psychoanal., 4:385-421. New York: Int. Univ. Press. (1976b). The concept of affect: a re-examination. J. Amer. Psychoanal. Assn., 24: 759-777. (1977). Developmental psychology and explanatory theory in psychoanalysis. Annual Psychoanal., 5:229-263. New York: Int. Univ. Press. (1978). Psychic determinism and freedom of will. Znf. Rev. 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Selfobject Disorders and Psychoanalytic Theory: A Historical Perspective

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