Sunday, May 26, 2013

Donnel Stern - A Clinical Process Theory of Narrative

"The psychoanalytic accounts of narrative with which we are most familiar (Schafer 1983, 1992; Spence 1982) are written as if the stories themselves are what matter. Problems in living are portrayed as the outcome of telling defensively motivated stories of our lives that deaden or distort experience, or of skewing experience by rigidly selecting one particular account. Therapeutic action revolves around the creation, through objective interpretation based on the analyst's preferred theory, of new and better stories—more inclusive, more coherent, more suited to their purpose. In the accounts of narrative by Schafer and Spence, while there is room for a good deal of flexibility in the way the analyst works, clinical psychoanalysis is defined by its technique, and its technique, in one way or another, is defined by the way interpretation is employed.
 
Schafer (1992) believes that psychoanalytic clinical work is very much like text interpretation. This “text” is both “interpenetrated” and “cohabited” by patient and analyst. But it remains a text. Consider what the analyst does with the patient who “talks back,” i.e., the patient who tells the analyst what he thinks of the analyst's interpretive offerings:
 
The analyst treats the analysand in the same manner that many literary critics treat authors—with interest in what the analysand says about the aims of his or her utterances and choices, but with an overall attitude of autonomous critical command rather than submission or conventional politeness, and with a readiness to view these explanatory comments as just so much more prose to be both heard as such and interpreted. [p. 176, italics in original]

It is hardly controversial for an analyst to claim that what the patient says often has meanings that the patient does not know. But there now exists a substantial body of literature that does take issue with the claim that an analyst can ever adopt “an overall attitude of autonomous critical command” (e.g., Bromberg 1998, 2006; Hoffman 1998; Mitchell 1993, 1997; Pizer 1998; Renik 1993; D. B. Stern 1997). This large group of writers, most of whom identify themselves as relational and/or interpersonal analysts, take the position that the relationship of patient and analyst is one of continuous, mutual unconscious influence. Neither the patient nor the analyst has privileged access to the meanings of his own experience.
 
This is the broad perspective within which the view developed in this essay belongs. While it remains undeniable that refashioned narratives change lives, the source of this change is the patient's newfound freedom to experience—an expansion of the self—created through events of the clinical interaction that are only partially under our conscious control. It is not so much that we learn the truth, but that we become more than we were. Our greatest clinical accomplishments are neither interpretations nor the stories they convey, but the broadening of the range within which analyst and patient become able to serve as one another's witnesses. This new recognition of each by the other is a product of the resolution of enactments and the dissociations that underlie them, and the resulting capacity of analyst and patient to inhabit more fully one another's experience, to listen more frequently through one another's ears. As dissociation and enactment recede, patient and analyst once again become partners in thought, and now the breadth of their partnering has grown.
 
Instead of thinking of narrative as a consciously purposeful construction, we should recast it as something on the order of a self-organizing system, in which outcomes are unpredictable and nonlinear (e.g., Galatzer-Levy 2004; Thelen and Smith 1994). Clinical process is the medium—or, to use the language of nonlinear systems theory, the event space—within which narrative stagnates, grows, and changes: the destabilization of old narratives and the emergence of new ones are outcomes of unpredictable relational events. I hope I have explained my perspective well enough by now to substantiate the claim I made at the beginning: that new narratives in psychoanalysis are the emergent, co-constructed, and unbidden products of clinical process.
 
Without denying for an instant the necessity for careful conceptualization or clinical discipline, I intend what I have said to serve as an argument against the claim that clinical psychoanalysis can be defined by any specification of technique. Psychoanalysis is, rather, a very particular way that one person can be of use to another—a way that depends on our possession of common practices, but also on our awareness that those practices are often inadequate to the experience that makes up our immersion in clinical process. For the analyst who believes that the recognition and resolution of enactments are central to clinical psychoanalysis, the personal is unavoidably linked with the professional, a point that reinforces something we have known at least since the work of Racker (1968): if the patient is to change, the analyst must change as well. In the end we find, as is so often the case, that when the mind is locked, relationship is the key."  (pp. 724 - 727)
 
Donnel Stern (2009). Partners in Thought: A Clinical Process Theory of Narrative. Psychoanalytic Quarterly, Vol. 78, pp. 701-731  

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