Joseph Sandler - The Distance Between Theory and Practice

"To round this paper out I want to point to three of the many areas in psychoanalysis where the distance between theory on the one hand and clinical practice and experience on the other is particularly wide, and to take the liberty of suggesting possible directions of theoretical clarification or modification.

1. Drives and Motives

However important the instinctual drives may be in our psychoanalytic thinking—and they will certainly always occupy a central position—the need for psychoanalysts to defend the significance of sexual and aggressive wishes has led to the building of theories in which everything tends to be brought back to the drives. I am convinced that for most psychoanalysts such reductionism plays a less significant part in their analytic work than in their theory. What they are often much more concerned with are the variety of motives for the use of defences, for the construction and development of fantasies and transference, and for many other phenomena with which we concern ourselves as clinical psychoanalysts. Certainly sexual and aggressive drives provide highly important motives, but so do threats to our feelings of safety (to the 'integrity of the ego'), injuries to our self-esteem, feelings of guilt and shame, and threats from the real ('external') world. Above all, anxieties of all sorts provide motives which are of central clinical significance. I believe that we need to accept into our theory, for example, the proposition that the latent content of a dream or of a piece of transference behaviour can be an unconscious wish or fantasy created to deal with anxiety, pain, or any other unpleasant affect from any source, and not necessarily to 'discharge' libidinal or aggressive drive energies. Not all unconscious wishes derive from the instinctual drives. Even if they may have done so in the past, such wishes need not be impelled by drives in the present. They may have other causes and other motivating forces.

2. Conflict

For how long will psychoanalysts continue to speak of conflict between id and the ego, between id and superego, between ego and superego, when clinically we address ourselves to the person who is in conflict? Certainly he may experience conflict between a sexual wish and his conscience, but what this means is that he is in conflict about his wish to gratify a sexual urge and his wish to avoid feelings of having done wrong (see Sandler, 1974). Moreover, from the point of view of the sorts of conflict which are clinically significant, what we usually see (and, I hope, interpret) is conflict over derivatives of wishes or wishful fantasies that have been, at some time, acceptable to the person—we might say consciousness-syntonic—but have become, in the course of development, unacceptable, i.e. consciousness-dystonic. The best examples of such conflictual wishes in ordinary everyday analytic experience are transference wishes. These often represent (often quite complicated) ways of interrelating with objects that were once acceptable but had later to be defended against, as a result appearing again in the transference in disguised form. Thus a patient who, as a child, developed a strong clinging tendency, might have turned against this later on. The transference might show a heightened wish to reject or move away from the analyst, for purposes of defence, and the conflict behind this might be over the wish to cling. The impulse to cling, in its turn, might have been a way of dealing with anxieties about losing the mother, and it would be a great error, both clinically and theoretically, to equate it automatically with an oral instinctual wish. If we take such a view of conflict, then we should have no problem over analysing conflict in our patients with so-called narcissistic character disorders. Whether or not an early defect in object relationships exists, whether or not the pathology is rooted in the pre-oedipal years, childhood wishes (and solutions to the problems caused by these) bring about future conflicts during development, which are then adapted to in turn, and show themselves in the narcissistic adult.

In this connexion I should like to suggest that every solution (defensive or otherwise) to a conflict, because it solves a problem during development, acquires a peremptory and urgent quality, and the urge to impose it in the face of renewed or revived conflict becomes the content of unconscious wishes driven towards actualization. Such wishes may then cause further conflict that might well be reflected in the here-and-now of the analytic situation. As solutions to conflict, both early and late, for the most part involve relationships to real or fantasied objects, conflict over such solutions will tend to reflect itself in the transference, even in the most narcissistic of our patients.

3. Object relationships and transference

Classical theory holds that object relationships reflect the cathexis of the object with instinctual energies, or with aim-inhibited drive energies. The inadequacy of such a view must be self-evident, and although there may still be some who pay lip-service to formulations like the one just given, most analysts conceive of object relationships in some very different way. My own preference is to regard the object relationship, inasmuch as it involves some external person, as a valued type of interaction with that specific person, in which the object plays as big a part as the subject. Such an interaction may satisfy instinctual needs, but (at least equally) satisfies needs for security and familiarity, for reassurance and affirmation of one's own value and identity. Needs of this sort develop from what Mahler (Mahler et al., 1975) has called processes of separation-individuation, and the satisfaction of these needs through an interchange of signals with the object, a dialogue with the object, is a vital part of our existence. As development proceeds, the external objects (together with their distortions by wishful fantasies and defences) are internalized, and the resulting introjected objects form the basis for dialogues with the objects in unconscious fantasy life.

It may be relevant to our understanding of transference if we consider that introjects are constantly being externalized, in a sense being actualized, so that they can be related to as external objects rather than as internal ones. Such a tendency to externalize one's introjects is probably a fairly general one, and deserves closer investigation. It is a tendency which can be observed particularly well in the psychoanalytic situation and we regularly see attempts to force, manipulate or seduce the analyst into taking over the role of one or other introject so that an internal fantasy scenario involving a dialogue between self and introject can be enacted. This externalization is as much what we mean by transference as anything else, and the analyst's experience of, and reaction to, this externalization of the introject (extrojection?) is part of his countertransference. I believe that this is implicitly if not explicitly understood by many analysts, who take such processes into account in their work. From the point of view of our theory, however, we should recognize that it is a gross mistake to regard the externalization of inner object relationships, the unpacking of mental furniture as the patient settles into the analysis, as simply the direct or indirect fulfilment of unconscious instinctual wishes, once directed to a figure of the past, and now transferred to the analyst in the present." (pp. 41-43)

　

Joseph Sandler (1983). Reflections on Some Relations Between Psychoanalytic Concepts and Psychoanalytic Practice. International Journal of Psycho-Analysis, Vol. 64, pp. 35-45.