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  

Thursday, May 23, 2013

Coline Covington - Narrative in Analytic Process

"The construction of narrative is closely linked to identity formation, or the establishment of a sense of self, with its attendant notions of history and continuity and lineal development. Story-making within analysis is seen as being at the heart of symbolic process and of psychic change. The story serves as a form of transitional object combining factual with imaginal, internal and external realities, and reflects our desire to internalize one another." (p. 405)

Archetypal Features of Analytic Narratives

"Jung points to the archetypal foundation or origin of myth, as a form of story, implying that the narrative process is fundamentally archetypal. Jung makes the distinction with regard to myth that mythological motifs were not invented in the sense of having been created or made, but were pre-existing ideas waiting to be found or revealed. He refers to the Latin derivation of invent, invenire, meaning, ‘in the first place, to “come upon” or “to find” something and, in the second, to find something by seeking for it. In the latter case, it is not a matter of finding or coming upon something by mere chance, for there is a sort of foreknowledge or a faint inkling of the thing you are going to find’ (Jung 1977, para. 549). If we accept that what is going on in analysis is a process of inventing or discovering a story, or a series or inter-related stories, by which means a sense of self as agent can be found and established, we must ask not only how the story comes into being in the first place but also why it is that some stories (i.e. interpretations) appear to have a transmutative effect while others do not. Although we can see the destructive processes that are at work in the absent story, it is important to stress that the presence or creation of story does not in itself lead either to what Kohut refers to as ‘continuity of self’ or to psychic change.
There is an inbuilt tendency — indeed necessity — within analysis to describe and conceptualize the process as a narrative. The danger attached to this is that inconsistencies are smoothed over for the sake of maintaining the narrative form, that is, one narrative may take precedence over others and become central, thus distorting or inhibiting the emergence of what may turn out to be a ‘truer’ story. For this reason I think it is only possible to talk about degrees of truth in relation to story. In questioning the truth value of story, in his book, Rewriting the Self, Freeman points out that the assumption of what is ‘true’ does not necessarily entail correspondence with a former reality. He goes on to deal with the question of how we can then differentiate between so-called true and so-called false stories. Again truth is conceived other than in terms of correspondence (i.e. to the past). Consistently with the modernist concept of transference, he understands that the aesthetic impact of a given interpretation of reality within a narrative whole constitutes its own truth value. In my view, this is determined in the analytic relationship by the empathic capacity and expression of the analyst." (p. 411)
Coline Covington (1995). No Story, No Analysis?: The Role of Narrative in Interpretation.  Journal of Analytical Psychology, Vol. 40, pp. 405-417  

Monday, May 20, 2013

Betty Joseph - The Total Situation of the Tranference

Editors Note: included below is the conclusion to one of Betty Joseph's (1917-2013) most widely referenced papers.

"I have tried in this paper to discuss how I think we are tending to use the concept of transference today. I have stressed the importance of seeing transference as a living relationship in which there is constant movement and change. I have indicated how everything of importance in the patient's psychic organization based on his early and habitual ways of functioning, his fantasies, impulses, defences and conflicts, will be lived out in some way in the transference. In addition, everything that the analyst is or says is likely to be responded to according to the patient's own psychic make-up, rather than the analyst's intentions and the meaning he gives to his interpretations. I have thus tried to discuss how the way in which our patients communicate their problems to us is frequently beyond their individual associations and beyond their words, and can often only be gauged by means of the countertransference. These are some of the points that I think we need to consider under the rubric of the total situations which are transferred from the past." (pp. 453-454)

Betty Joseph (1985). Transference: The Total Situation. Int. J. Psycho-Anal., 66:447-454

Thursday, May 16, 2013

Betty Joseph 1917-2013

Prominent British psychoanalyst Betty Joseph passed away on April 4, 2013.  She was a student of Melanie Klein's and Klein's collaborators. Later she extended Klein's ideas - in particular developing her own thoughts about the difficult to reach patient.  Joseph's landmark publications are gathered in Psychic Equilibrium and Psychic Change (1989).  A fuller discussion of Joseph's life and work can be read here:

Monday, May 13, 2013

Judith Hubback - Deintegration and the Mutative Factor


"Many adult people seeking analytical therapy in Britain these days are suffering from the results of deep disturbances which started in infancy, or even earlier, so that increasingly analysts have had to work on the basic structural defects, the sickness of the primary self. Inevitably much attention has been given, on behalf of those patients, to the analytic problems surrounding regression to infancy states, so that Fordham's work on the primary self is of central importance. The research for which he is perhaps best known was on children and babies, and it is mainly from work on infancy that the concept of deintegration was launched into the corpus of theories in analytical psychology. For those of us who work with adults it has proved very valuable: the concept throws light on many experiences with them when they are in, and emerging from, regressive primitive states.
Since putting forward many years ago the idea that the self functions not only integratively but that it can de-integrate, Fordham has written about this often. His latest book contains a number of elucidations which draw together his early thesis and his developments of it (FORDHAM 2). In the search for how change is set going, reference can be made to his thinking, in order to test out its applicability to day by day clinical work. He writes (1) that in 1947 ‘I postulated a primary state of integration expressed in the infant's individuality, continuity of being and adaptive capacity' (p. 31); (2), ‘the self is no longer conceived of as a static structure, instead the steady state represents one phase in a dynamic sequence: integration is followed by deintegration, which in turn leads to a new integrate. The sequence is conceived to repeat throughout life and lies at the root of maturational development’ (p. 102); and (3) ‘the states arising from deintegration are often unadapted in the first place, since they arise when a new development is required under the stress of internal or external dynamisms’ (p. 119).
Time and again Fordham stressed the normal healthy infant's inborn capacity to adapt to the mother, and to activate her to adapt to her infant. The infant's adaptation is not mere acquiescence with the environmental demands and realities; Fordham sees it as including in a more important way an infant's capacity to bring influence to bear on outer reality, and to master that area of it in which he finds himself. The infant is making sense gradually of the inner and outer world. If we view the self in its primal state (as compared with the classical Jungian later-in-life-individuated-self) we see it as a body-psyche integrate. Jung conceptualised libido as consisting of energy bound up in such an integrate; libido in the primary self is neutral; it contains both a loving and creative driving possibility and an attacking and destructive one. The concept of deintegration takes both into account.
In patients whose interactions with their analyst are at times steady and benevolent, and a few sessions later are fraught with envious attacks, we can detect within the fact of the deintegrative process the different qualities or characteristics of the two contrasted driving energies, loving calmly and attacking fiercely. The regression is to early infancy within the transference and—if the analytic container is strong enough—only within the sessions. The swings from calmness to attack have to be tolerated. In such phases of an analysis the analyst has to use the model of the unanxious mother who tolerates her infant's swings from steadiness to agitation, and combine that with the analytic understanding that agitation and attack are the forms in which the process of deintegration manifests itself. Since patients often describe themselves as feeling that they are ‘going to pieces’, or ‘falling apart’ under the impact of more stress than they think they can bear, analysts know they have to work in such a way as to enable that fear to be lived with while the patient experiences change and development as in fact acceptable. The loss of the previous steady state can be integrated when the patient deepens his or her understanding that these fearful times do not have to be gone through alone: the presence of the other dispels the fundamental terror of abandonment, which is perhaps the ultimate loss (‘My God, my God, why hast thou forsaken me?’).
An essential aspect of the states and phases being discussed here is that the analyst and the patient are each still aware of being the people they are, of the continuity of the sessions and of the changes that the process entails. Their distinctiveness as individuals is maintained; fusion, if it occurs, in the course of the kind of experiences I am describing, is not facilitating. Very similarly to how the infant gradually discovers (as Jacobson wrote) that it is in contact with someone different from itself as well as distinct, so the patient benefits by the analyst not being drawn into an identification. Full empathy on the part of the analyst and emotional contact of a very deep kind do not entail loss of the essential boundaries. The ends of the sessions may be very painful and difficult for both people, but they make possible the acceptance of developmental differentiation. There is, I think, a close parallel between what is observable in a very elementary form in the young infant's discovery that the mother is different from itself, and what is experienced countless times during the working through in painful analytical therapy." (pp. 248-250)
Judith Hubback (1987). Change as a Process in the Self. Journal of Analytical Psychology, Vol. 32, pp. 241-255

Wednesday, May 8, 2013

Chana Ullman - Fear of Metamorphosis

Abstract: This article describes the fear of metamorphosis in analysis as a relational dynamic, and as a particular form of resistance to change that may lie at the heart of clinical impasses. The fear of metamorphosis is the patient's fear of a complete alteration of valued aspects of her or his self-hood, which she or he experiences as an imminent catastrophe. This fear of metamorphosis is understood here as the analysand's attempt to protect aspects of her or his self-hood from transformation, especially vis-à-vis the analyst's “otherness,” and the impasses that may ensue, reflecting the analyst's and the patient's coconstruction of this otherness. I will examine the dialectics of wishing for transformation and the fear of it. This presents an inherent paradox that may emerge in the clinical encounter as a mutual unspoken and unformulated demand affecting both patient and analyst. I argue that the fear of metamorphosis is a particular variation of the resistance to change. Drawing on Bromberg's (1998) reformulation of resistance as “staying the same while changing,” I reexamine the clinical significance of this fear in the context of traditional and contemporary definitions of resistance, illustrated with a clinical example.

Chana Ullman (2011) Fear of Metamorphosis: Between Resistance and Protection of Otherness, Contemporary Psychoanalysis, Vol. 47, pp. 480-496

Saturday, May 4, 2013

The Psychoanalytic Muse Passes 20,000 Views Milestone

After just three years of existence The Psychoanalytic Muse passed 20,000 views this week - making it one of the most frequently viewed psychoanalytic destinations on the internet.  In addition, the contents of The Psychoanalytic Muse have been viewed from 106 countries covering 6 of the 7 continents of the world (no visits from Antarctica yet!)  - indicating that interest in psychoanalysis and psychoanalytic psychotherapy continues to flourish widely. 

Thank you for making The Psychoanalytic Muse part of your exploration of the vast field of depth psychology.

Best Wishes,

Mark Winborn, PhD