Freud - Remembering, Repeating and Working Through

"What interests us most of all is naturally the relation of this compulsion to repeat to the transference and to resistance. We soon perceive that the transference is itself only a piece of repetition, and that the repetition is a transference of the forgotten past not only on to the doctor but also on to all the other aspects of the current situation. We must be prepared to find, therefore, that the patient yields to the compulsion to repeat, which now replaces the impulsion to remember, not only in his personal attitude to his doctor but also in every other activity and relationship which may occupy his life at the time—if, for instance, he falls in love or undertakes a task or starts an enterprise during the treatment. The part played by resistance, too, is easily recognized. The greater the resistance, the more extensively will acting out (repetition) replace remembering. For the ideal remembering of what has been forgotten which occurs in hypnosis corresponds to a state in which resistance has been put completely on one side. If the patient starts his treatment under the auspices of a mild and unpronounced positive transference it makes it possible at first for him to unearth his memories just as he would under hypnosis, and during this time his pathological symptoms themselves are quiescent. But if, as the analysis proceeds, the transference becomes hostile or unduly intense and therefore in need of repression, remembering at once gives way to acting out. From then onwards the resistances determine the sequence of the material which is to be repeated. The patient brings out of the armoury of the past the weapons with which he defends himself against the progress of the treatment— weapons which we must wrest from him one by one.

We have learnt that the patient repeats instead of remembering, and repeats under the conditions of resistance. We may now ask what it is that he in fact repeats or acts out. The answer is that he repeats everything that has already made its way from the sources of the repressed into his manifest personality—his inhibitions and unserviceable attitudes and his pathological character-traits. He also repeats all his symptoms in the course of the treatment. And now we can see that in drawing attention to the compulsion to repeat we have acquired no new fact but only a more comprehensive view. We have only made it clear to ourselves that the patient's state of being ill cannot cease with the beginning of his analysis, and that we must treat his illness, not as an event of the past, but as a present-day force. This state of illness is brought, piece by piece, within the field and range of operation of the treatment, and while the patient experiences it as something real and contemporary, we have to do our therapeutic work on it, which consists in a large measure in tracing it back to the past....

The main instrument, however, for curbing the patient's compulsion to repeat and for turning it into a motive for remembering lies in the handling of the transference. We render the compulsion harmless, and indeed useful, by giving it the right to assert itself in a definite field. We admit it into the transference as a playground in which it is allowed to expand in almost complete freedom and in which it is expected to display to us everything in the way of pathogenic instincts that is hidden in the patient's mind. Provided only that the patient shows compliance enough to respect the necessary conditions of the analysis, we regularly succeed in giving all the symptoms of the illness a new transference meaning1 and in replacing his ordinary neurosis by a ‘transference-neurosis’ of which he can be cured by the therapeutic work. The transference thus creates an intermediate region between illness and real life through which the transition from the one to the other is made. The new condition has taken over all the features of the illness; but it represents an artificial illness which is at every point accessible to our intervention. It is a piece of real experience, but one which has been made possible by especially favourable conditions, and it is of a provisional nature. From the repetitive reactions which are exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it were, after the resistance has been overcome."

　

Sigmund Freud (1914). Remembering, Repeating and Working-Through (Further Recommendations on the Technique of Psycho-Analysis II). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913): The Case of Schreber, Papers on Technique and Other Works, pp. 145-156

Verena Kast on the Clinical Use of Fairytales

"As an analyst who is convinced that the process of individuation is a most valuable theory (Jung, 1934b; Kast, 1992), I use fairy tales in my practice of therapy. This entails working with the tensions between the ego-complex and the personal and collective unconscious on one side and between the ego complex and the collective consciousness (roles, spirit of the times, current ideologies…) on another, and with the interactions between the collective unconscious and the collective conscious. This work occurs in the frame of an analytical relationship, in which transference/countertransference, the perception of symbols, and the formation of new symbols are of great importance. The therapy aims toward the constant restructuring of the identity of the analysand-more and more in accordance with him-or herself-and should be a most dynamic process, intending the development of the analysand toward more creativity in order to deal with life, to find meaning and some understanding of one's own life-in short to become more and more what he or she could be, to become more and more authentic. And that means becoming closer to emotions and intuitions and at the same time being more able to deal with them. Fairy tales are, at least in Europe, favorite stories of our childhood. Structurally, fairy tales begin with a typically problematic situation which can be easily transfered to everyday problems. Then they show how the situation might be dealt with by describing processes that have to be suffered through. A path of growth emerges that leads through and out of the problem that was described at the outset. The fairy tale's protagonist symbolizes a certain attitude in the face of a problematic situation. The fairy tale addresses universal human issues by means of the protagonist, whose difficulties, trials, and adventures can be compared with our own.

The fairy tale speaks to us in symbols and images. The symbol mixes experiences, psychic contents, and, especially, emotions into a sum total that can not be represented in any other form. Thus Bloch (1986) calls symbols "categories of condensation." Although we never give up trying to understand and to interpret symbols, each attempt can only bring a partial aspect to consciousness. The symbol has a surplus of meaning; it is "overdetermined." It reveals and opens up perspectives that gradually unfold before our eyes and stimulate our fantasy. In therapy there is an attempt to create an environment in which the tale can speak to us at the level of the imagination. Many of our inner images have become hardened and stereotyped. When they are softened in a therapeutic environment and become accessible to the imput of the fairy tale, there is a chance that our prejudices and fixations may stand some alteration. Maybe the power of fantasy can even be revived. Through the funnel of the inner image, the fairy tale can have a huge impact on the chemistry of our emotional transformations. Thus, listening to a fairy tale already has a therapeutic effect; if we are receptive, the story's images "work on us." Granted some motifs may strike us with greater immediate relevance than others. Those motifs that speak to us are quickly taken possession of. We become their proud and jealous owners because they seem to express the way we feel in a way that nothing else can substitute for. Unlike some feelings, the image is something that we can look at. In some respects, it is "my" image, but again it is triggered by a source outside myself-the fairy tale. This paradox often provides us with the closeness and, at the same time, the distance that is necessary to deal with the problem expressed in the image. The images in the fairy tales are in addition part of a narrative structure which draws a conflict to a creative solution. Therapeutic work with fairy tales refers and is dependent on this narrative process. We take our own images-evoked by the tale-and "enter" them into a developmental "program" that is encoded with the hope, characteristic of fairy tales, that difficulties can be overcome. According to Bloch, every living symbol-every symbol that speaks to us-contains the "hope that is encapsulated in the archetype" (1959, p. 187). Surely therapy should be about the business of making this power of the human psyche available." (pp. 509-510)

"A symbolic process, such as expressed in a fairy tale, can take on the function of a transitional object in the sense of Winnicott (1986). The storehouse of the archetypal symbols experienced in fairy tales can be seen as a collective motherground, from which the personal symbols can be evoked in the psyche of the singular person with the goal of better overcoming all kind of anxieties and of becoming more creative. I see the supporting elements of the collective unconscious, which become accessible to us in fairy tales, in myths, in parts of stories or poems, addressing in slightly different manners the same topic. And they offer something we can provide to others so that the problem might be reworked. This, in turn, also has an effect on the structure of the ego-and thus of the creativity and the competence in dealing with everyday life. Only rarely do we copy the solution offered by the inner image. Fairy tales spark imaginative processes that are unique to each individual, alter deeply entrenched feelings, and accompany us in the practical business of restructuring our daily lives.

I like to see all the stories we human beings (and our culture in general) have collected as a transitional space, as the reservoir of the collected creativity of all human beings in the past and in the present. The more the used symbols are reformulations of archetypal structures and dynamics-of very basic structures and dynamics-the more they seem to trigger the personal fantasy and the fantasy of survival, the more it helps to work on actual and repressed problems, in a way that we don't get stuck in the past and in a way that life becomes more meaningful." (pp. 522-523).

Verena Kast (1996). The Clinical Use of Fairy Tales by a "Classical" Jungian Analyst. Psychoanalytic Review, Vol. 83, pp. 509-523.

Otto Kernberg on Ego Psychology and Object Relations Theory

"Because the term object relations theory has been used by different authors in varying contexts and within a wide spectrum of approaches to psychoanalytic theory and technique, I think it may be helpful to start out with my own brief definition.

As I have stated elsewhere (1976a), I conceive of psychoanalytic object relations theory as a special approach or focus within psychoanalysis that examines metapsychological and clinical issues in terms of the vicissitudes of internalized object relations. Object relations theory considers the psychic apparatus as originating in the earliest stage of a process of internalization of object relations. This process covers, roughly speaking, the first three years of life — and results in the formation of substructures of the psychic apparatus that will gradually differentiate. The stages of development of internalized object relations — that is, the stages of infantile autism, symbiosis, separation-individuation, and of object constancy — reflect the vicissitudes of these earliest substructures of the psychic apparatus. Discrete units of self-representation, object representation, and an affect disposition linking them are the basic oject-relations-derived substructures that gradually evolve into more complex substructures (such as real-self and ideal-self, and real-object and ideal-object representations). Eventually, they will become integrated as intrapsychic structures in the ego, superego, and id.

Underlying this conception is an assumption common to Jacobson (1964), (1971); Mahler (Mahler and Furer, 1968); (Mahler et al., 1975); and myself, namely, that the earliest internalization processes have dyadic features, that is, a self-object polarity — even when self- and object representations are not yet differentiated; by the same token, all subsequent developmental steps also imply the presence of dyadic internalizations, that is, internalization of an object not only as object representation but as an interaction of the self with the object, so that units of self- and object representations (and the affect dispositions — the clinical manifestations of a drive derivative — linking them) are the basic building blocks for later internalized object and self-representations and, still later on, of the overall tripartite structure (ego, superego, and id).

Object relations theory, as defined, based upon Jacobson's, Mahler's, and my own work, is in contrast to the British school of psychoanalysis in that it integrates contemporary ego-psychological approaches with structural development, avoids telescoping intrapsychic development into the first year of life, assumes a more complex and gradual development of both ego and superego than the British school, and considers the relationships between early development, intrapsychic genetics, and structure formation as complex, indirect, and not immediately available in the early stages of psychoanalytic exploration. Hence, the object relations approach I have outlined is closer to Fairbairn (1952), (1963), Balint (1965), (1968), and Winnicott (1958), (1965), than to Melanie Klein (1940), (1945), (1946), (1957) and Bion (1967). However, the neglect of instinctual development in Fairbairn is sharply contrary to my approach.

In contrast to what might be considered an object-relations approach of Sullivan (1953) and his followers, object relations theory as outlined here has to do not only with interpersonal object relations, but is predominantly a metapsychological approach — an attempt to account for normal and pathological development in terms of the structures comprising the psychic apparatus. Finally, my definition is compatible with the developmental thinking of Erikson (1956), (1959), (1963), although not with his emphasis on adolescence as opposed to earlier stages of identity formation. It is also related to Lichtenstein's (1977) and Loewald's (1978) recent formulations.

Psychoanalytic object relations theory as defined is an integral part of contemporary ego psychology. It is not an additional metapsychological viewpoint nor does it conflict with the structural, developmental-genetic, dynamic, economic, and adaptive viewpoints; rather, it represents a refinement of the structural viewpoint that links structure more closely with developmental, genetic, and dynamic aspects of mental functioning; further, it occupies an intermediary realm between psychoanalytic metapsychology, on the one hand, and direct clinical formulations in the psychoanalytic situation, on the other." (pp. 207-209)

Otto Kernberg (1979). Some Implications Of Object Relations Theory For Psychoanalytic Technique. Journal of the American Psychoanalytic Association, Vol. 27S, pp. 207-239

Richard Kradin on the Symbolic Aspects of the Psychosomatic Patient

"Invariably, at the root of psychosomatic dis-ease, one discovers an ailing soul that requires attention and renewed meaning. With time and the containment provided within the therapeutic vessel, affective connections may be re-established between the ego and the Self. In such cases, the psychosomatic symptom may gradually transform or disappear spontaneously, just as it first appeared.

It has been argued that the psychosomatic patient has suffered a profound disturbance in the pathways of individuation. Psychosomatic integration has failed to occur and the ego-Self axis has been seriously interrupted. Whereas the psychosomatic symptom represents pathology, one might ask what synthetic purpose does it serve? I suggest that the psychosomatic symptom can be envisioned as an imaginal product of the Self — defined here after Jung with slight modification — as the totality of those psychosomatic processes that are responsible for generating, integrating, and directing the imaginings of the individual through the life cycle (Jung 1963). The psychosomatic symptom is hypothesized to be a derivative iteration of a ‘Self-state’. It is suggested that the psychosomatic symptom has the properties of fractals, that is they are self-similar iterations of form. Fractal forms permeate nature, and are readily identifiable, e.g. in the repetitive branching of trees, river beds, the vascular system and the neural networks of the brain (Bassingthwaighte 1994). As fractals are isomorphic, that is ‘self-similar’ with their source, both in form and function, the psychosomatic symptom necessarily displays the complexity of the Self. Such unfathomable complexity confers upon the psychosomatic symptom features of being both symbolic and paradoxical, so that no single meaning, or multideterminant set of meanings, can exhaust its possibilities. Like other hypothesized derivatives of the Self, including the fractal dream image, the psychosomatic symptom is informationally rich, both with respect to ego consciousness and the inter-subjective field. For example, Mary's symptoms focused my attention on her early narcissistic disturbance, reflected the poles of her mother and father complexes, and revealed her need to create meaning for her disengaged psychosomatic experience. In this way, I believe that her ‘Self-state’ was accurately communicated. Grasping the symbolic nature of the psychosomatic symptom is critical; and the failure to do so has led many to lose their way in its labyrinthine expressions. Freud barely escaped this fate, as he arduously quested after the specific cause of his patient's hysterical symptoms, only to find that uprooting one led eventually to the appearance of another. For like his beloved Oedipus, who attempted to save Thebes by an exercise of Apollonian logic (Hillman 1991), Freud had mistaken the source of the dis-ease and had confused the multifaceted metaphor of the ‘oracular’ symptom with a ‘sleight of hand’ concocted by a defensive psyche to disguise an unacceptable wish. Indeed, a major change in the direction of psychoanalysis may have been prompted by Freud's discovery that the eradication of the hysterical patient's symptoms was actually short-lived (Webster 1995).

As a fractal derivative of the Self, the purpose of the psychosomatic symptom must reflect the overarching purpose of the Self, which is to direct the process of individuation. I am suggesting that the psychosomatic symptom represents a persistent homeostatic effort by the Self to correct a developmental defect in psychosomatic experience. By focusing the attention of others on the dysphoric experiences of the body, the psychosomatic symptom urgently seeks to elicit empathy and psychological meaning for the disordered experience of interiority. Only when this has been achieved can the individuation process optimally proceed. Unfortunately, this persistent effort is often viewed within the intersubjective field as age inappropriate, and therefore fails to succeed. This must be especially true in a social milieu that is itself characterized by profound psychosomatic splitting and insufficient empathic resources. For these reasons, the issues of the psychosomatic patient are perhaps best treated in analysis, although theoretically any sufficiently empathic intersubjective dialogue could also suffice. However, it must be reiterated that these patients are notoriously difficult to treat, as they require a degree of psychosomatic empathy that may be near impossible to achieve within the boundaries imposed upon the analytical frame.

While the psychosomatic symptom cries to be relieved, it cannot be fixed. Its irrational nature can only be resonated with empathically. Unfortunately, the presence of those time-honoured guardians of irrational therapeutic approaches in modern society are dwindling. The therapeutic mainstream of our society no longer includes shamans and spiritual healers, and scientific progress also threatens the depth psychologists with extinction, as they are replaced by the behavioural and biologically oriented ‘scientists’ of the mind. However, it is clear that the psychosomatic symptom is an archetypal product of psyche, one that may change its ‘spots’ but not its nature. Therefore, the psychosomatic patient will continue to be a constant feature in society and each generation will be required to develop its own variant of the perennial therapeutic solution." (pp. 418-419)

Richard Kradin (1997). The psychosomatic symptom and the self. Journal of Analytical Psychology, Vol. 42, pp. 405-423

Sanchez-Cardenas on Analytic Pluralism and Matte Blanco

Abstract: "It can be seen that, although psychoanalytic pluralism is widespread, there is still a spirit of intolerance among the different theoretical schools. Matte Blanco’s work allows us to think about these questions in a fresh way. Direct psychic experience, felt to be an indivisible whole, is characterized by the symmetrical mode (close to the unconscious) and projects itself in a multiple and decondensed manner on to the asymmetrical mode (consciousness, thought). Thus, psychical facts (for example, what the patient says and feels during the session) can be accounted for by multiple conscious representations which, however, are not mutually contradictory (e.g. in different theoretical approaches). Affective factors linked to the hope of reviving ‘oceanic feelings’ of fusion with a unified and unifying theory of the subject–analyst are also explored insofar as they lead to the tendency of analysts to exclude one another."

Conclusion: "Matte Blanco also helps us to see why pluralism poses a problem for the analyst from an affective point of view. We cling to our theories for several reasons (Poland, 2009): the narcissistic investment that we make in them, the pseudo-intellectual mastery that they seem to offer, and the group adhesion that they permit. Matte Blanco allows us to add an additional perspective. If, for the mind, the possibility of having an emotional life and the sense of feeling that we exist are rooted in the symmetrical mode (that of Feeling and Being), it is understandable that maintaining contact with it is essential. There exists a ‘‘desire for the invisible mode’’ (Matte Blanco, 1988, p. 218), to which pluralism runs directly contrary since it supposes by definition a dissection into distinct elements. This desire is based, says Matte Blanco (1975b) in his text, Creativit ed ortodossia [Creativity and orthodoxy], on nostalgia for the time when the baby experienced himself as being one with his mother. There is thus a desire to return to this ‘unitary’ state before the frustrating separation which underlies subject–object distinction and individuation. The fantasy of being able to find a single epistemology accounting for the whole of the mind echoes that of being able to communicate once again with the mythical lost Breast. Melanie Klein (1957, p. 46) has shown that the breast was the prototype of the infinite goodness of the mother and of all creation. This ‘‘unitary’’ desire can be satisfied by ‘‘one’’ single elected theory, by belonging to ‘‘just one group’’. I proposed above that the attempts of psychoanalysts to situate themselves in the Thinking mode made them nostalgic for their Feeling and Being mode. So they have to find a strategy to get around this risk: this may involve cultivating a universal breast-theory. Furthermore, Matte Blanco develops the idea that, once separation from the mother has occurred, the subject has only one choice: either to merge with the lost breast (and so lose once again his individuation, which is intolerable), or to kill the breast and become the breast himself (eliminating the frustrating breast and turning oneself into an absolutely self-sufficient breast). This is the dilemma of the creative person: in having become a creator by attributing to himself the powers of the breast, and by murdering the latter, he has carried out a ‘self-breastification–self-deification’ by means of a ‘breasticide–deicide’ which goes with it. Hence the extreme attitudes when faced with a new creation which is felt to be like the murder of Gods whose breast theories were hitherto venerated. These questions directly concern the reactions of analysts to epistemologies. Very often, they approach them as if they were referring to absolute divinities (psychoanalysis according to Saint Freud, Saint Melanie, Saint Winnicott or Saint Matte Blanco …) and every innovator–protester is regarded as the perpetrator of a deicide who must be silenced (… before he himself, eventually, is deified in turn). These affective factors torture psychoanalysts and regularly lead to major crises. They should be identified and explored at the beginning of every analyst’s training process. This would help analysts, knowing from the outset that the unity of psychoanalysis can only be founded on its diversity, not feeling torn apart by contact with theories as different as those that we are faced with and, eventually, avoiding many useless anathemas."

Michel Sanchez-Cardenas (2011) Matte Blanco’s Thought and Epistemological Pluralism in Psychoanalysis, Internaltional Journal of Psychoanalysis, Vol. 92, pp. 811–831