THE WIDENING SCOPE OF

SELF PSYCHOLOGY
Progress in Self Psychology

Volume 9
Progress in Self Psychology
Editor, Arnold Goldberg, M.D.

EDITORIAL BOARD

Michael F. Basch, M.D.

James L. Fosshage, Ph.D.

Robert Galatzer-Levy, M.D.

Charles Jaffe, M.D.

Robert J. Leider, M.D.

Arthur Malin, M.D.

Anna Ornstein, M.D.

Paul Ornstein, M.D.

Estelle Shane, Ph.D.

Morton Shane, M.D.

Robert D. Stolorow, Ph.D.

Marian Tolpin, M.D.

Paul H. Tolpin, M.D.

Ernest S. Wolff, M.D.

THE WIDENING SCOPE OF

SELF PSYCHOLOGY
Progress in Self Psychology

Volume 9

Arnold Goldberg
editor

THE ANALYTIC PRESS

1993 Hillsdale, NJLondon
Copyright © 1993 by The Analytic Press
365 Broadway

Hillsdale, NJ 07642

All rights reserved. No part of this book may be reproduced in any form, by photostat, microform,
retrieval system, or any other means, without prior written permission of the publisher.

ISBN 0-88163-163-9

ISSN 0893-5483

Printed in the United States of America

10987653421
Acknowledgment
We would like to thank Ms. Chris Susman, who provided secretarial and
editorial assistance.
Contents
Contributors

1.Introduction: Is Self Psychology on a Promising Trajectory?—Paul H.

Ornstein

I INTERPRETATION

2.The Role of Interpretation in Therapeutic Change–Ernest S. Wolf

3.Thoughts on the Nature and Therapeutic Action of Psychoanalytic

Interpretation—Robert D. Stolorow

4.Interpretation in a Developmental Perspective—Frank M. Lachmann and

Beatrice Beebe

5.Commentary on Papers by Stolorow and by Wolf—Robert ]. Leider

II SEX AND GENDER

6.Sex, Gender, and Sexualization: A Case Study–Estelle Shane and Morton

Shane

7.Primary Failures and Secondary Formations: Commentary on the Shanes’

Case Study of Kathy K—Paul H. Tolpin

8.Sharing Femininity—An Optimal Response in the Analysis of a Woman

by a Woman: Commentary on the Shanes’ Case Study of Kathy K—
Howard A. Bacal

9.The Bad Girl, the Good Girl, Their Mothers, and the Analyst: The Role of
the Twinship Selfobject in Female Oedipal Development —Diane Martinez

10.Sexuality and Aggression in Pathogenesis and in the Clinical Situation—

Paul H. Ornstein
III AGGRESSION AND RAGE

11.Rage Without Content–Richard C. Marohn

12.Chronic Rage from Underground: Reflections on Its Structure and

Treatment–Paul H. Ornstein

13.Commentary on Marohn's “Rage Without Content” and Ornstein's

“Chronic Rage from Underground”–Mark J. Gehrie

IV CLINICAL

14.Mourning Theory Reconsidered–R. Dennis Shelby

15.The Search for the Hidden Self: A Fresh Look at Alter Ego
Transferences–Doris Brothers

16.To Free the Spirit from Its Cell–Bernard Brandchaft

17.Reversals: On Certain Pathologies of Identification–Russell Meares

V APPLIED

18.Countertransference, Empathy, and the Hermeneutical Circle–Donna M.

Orange

19.The Child–Pet Bond–Lindsey Stroben Alper

20.Review of The Prisonhouse of Psychoanalysis by Arnold Goldberg—

Estelle Shane

Author Index

Subject Index
Contributors
Lindsey Stroben Alper, Ph.D., Member, San Diego Self Psychology Group;
Psychologist in private practice, San Diego and La Mesa, CA.

Howard A. Bacal, M.D., F.R.C.P.(C), Training and Supervising Analyst,

Toronto Institute of Psychoanalysis; Associate Professor, Department of
Psychiatry, University of Toronto.

Beatrice Beebe, Ph.D., Core Faculty, Institute for the Psychoanalytic Study
of Subjectivity; Clinical Associate Professor, New York University
Postdoctoral Program in Psychotherapy and Psychoanalysis.

Bernard Brandchaft, M.D., Training and Supervising Analyst, Los Angeles

Psychoanalytic Institute.

Doris Brothers, Ph.D., Cofounder and Training and Supervising Analyst,

The Training and Research Institute for Self Psychology; Founding
Member, Society for the Advancement of Self Psychology, New York City.

Mark J. Gehrie, Ph.D., Training and Supervising Analyst, Chicago Institute

for Psychoanalysis; private practice, Chicago.

Frank M. Lachmann, Ph.D., Senior Supervisor and Training Analyst,

Postgraduate Center for Mental Health, New York City; Core Faculty,
Institute for the Psychoanalytic Study of Subjectivity, New York City.

Robert J. Leider, M.D., Training and Supervising Analyst, Institute for

Psychoanalysis, Chicago; Assistant Professor, Department of Psychiatry,
Northwestern University Medical School.

Richard C. Marohn, M.D., Professor of Clinical Psychiatry, Northwestern

University Medical School, Chicago; Faculty, Institute for Psychoanalysis,
Chicago.
Diane Martinez, M.D., Teaching Analyst, Houston-Galveston
Psychoanalytic Institute; Clinical Associate Professor of Psychiatry, The
University of Texas Health Science Center at San Antonio.

Russell Meares, M.D., Professor of Psychiatry, University of Sydney;

Director of Psychiatry, Westmead Hospital, Westmead, Australia.

Donna M. Orange, Ph.D., Psy.D., Institute for the Psychoanalytic Study of

Subjectivity, New York City.

Paul H. Ornstein, M.D., Professor of Psychiatry and Codirector,

International Center for the Study of Psychoanalytic Self Psychology,
University of Cincinnati Department of Psychiatry; Training and
Supervising Analyst, Cincinnati Psychoanalytic Institute.

Estelle Shane, Ph.D., Training and Supervising Analyst, Los Angeles

Psychoanalytic Society/Institute; Founding Member, Training and
Supervising Analyst, Institute of Contemporary Psychoanalysis, Los
Angeles.

Morton Shane, M.D., Training and Supervising Analyst in Adult and Child,
Los Angeles Psychoanalytic Society/Institute; Founding Member, Training
and Supervising Analyst, Institute of Contemporary Psychoanalysis, Los
Angeles.

R. Dennis Shelby, Ph.D., Faculty, Institute for Clinical Social Work; private
practice, Chicago.

Robert D. Stolorow, Ph.D., Faculty, Training and Supervising Analyst,

Institute of Contemporary Psychoanalysis, Los Angeles; Core Faculty,
Institute for the Psychoanalytic Study of Subjectivity, New York City.

Paul H. Tolpin, M.D., Training and Supervising Analyst, Chicago Institute

for Psychoanalysis; private practice, Chicago.

Ernest S. Wolf, M.D., Assistant Professor of Psychiatry, Northwestern

University Medical School; Training and Supervising Analyst, Institute for
Psychoanalysis, Chicago.
Chapter 1
Introduction: Is Self Psychology on
a Promising Trajectory?
Paul H. Ornstein

How do we determine whether our discipline, our field of endeavor, the

clinical-empirical science in which we are all active participants, is or is not
on a promising developmental path? I do not know a satisfactory answer—
perhaps one can only find that out retrospectively—but I do sense that the
question is vital and that our periodic critical reflections on it may serve as
a compass to keep us on the right course.

Our first task, then, is to find a few appropriate criteria around which an
assessment of where we are and where we are heading might be possible. In
the search for such criteria, we soon realize that they form two clusters: one
relating to external successes, the other to intrinsic potentialities of self
psychology. The first cluster includes those issues that lend themselves to
historical—descriptive statements of self psychology or to the quantitative
measurements of a statistical study (e.g., reflecting the evidence of changes
in the level of interest in self psychology in this country and worldwide).
The second cluster includes those issues that require a conceptual analysis
of the foundational principles of self psychology and an estimate of its
contemporary relevance and future prospects. These two clusters are not
unrelated to each other. Measurable popularity and clinical–theoretical
relevance may well be linked in some way (we hope), but it would require a
sophisticated social psychological and historical research approach
combined to pinpoint their precise relationship in the case of self
psychology and its evident successes.
While I have chosen to focus mainly on some elements of the second
cluster—which I view as the more significant one for the long run–I want to
say a few words in passing about the first because the data, even without a
formal statistical study, are reassuring (and uplifting) for those who have
labored under the banner of self psychology during the last two decades.

Both interest in and knowledge about self psychology have been gaining
ground in all mental health fields and simultaneously in, though at a slower
pace, the humanities. Relevant articles in various publications, the selection
of topics at the scientific meetings of diverse mental health groups, the
popularity of CME credit courses nationwide that feature self psychology,
the steadily increasing demand for training and for self-psychologically
informed therapists all over the country–all attest to the increase in interest
in and the spread of knowledge about self psychology. Closer to home, the
expansion of the National Council for Psychoanalytic Self Psychology with
its regional small study groups, the continuation of our own annual
meetings with impressive attendance, the ensuing annual volumes of
Progress in Self Psychology, the frequently appearing and eagerly bought
books by self psychologists on self psychology—these developments are
rightly considered by insiders as well as outsiders to be the most directly
visible signs of activity on a promising track. But all this must be familiar to
each of you. What you might not fully realize, however, is what has been
happening worldwide.

As I thought of writing about the decisive increase in interest, enthusiasm,

and actual knowledge of self psychology in Germany, some revival of
interest in Holland and Switzerland, the efforts under way to make contact
with a small group of analysts in England, the increasingly intensive
teaching of self psychology and clinical supervision in Paris, the ongoing
teaching of self psychology at the University of Budapest, the small active
group in Italy, and the budding serious interest in the Scandinavian
countries emanating from Oslo, it occurred to me how informative it would
be to have representatives of each of these countries report to us at one of
our conferences on what they have achieved in their respective countries
thus far and on what they are contemplating for the future. Outside of
Europe, the Israel Psychoanalytic Society, as well as other mental health
professionals there, has become more actively inquisitive about self
psychology. The Japanese have translated selected essays from the first two
volumes of The Search for the Self (Ornstein, 1978). In Thailand there
appear to be a lively interest and serious study of self psychology. Sydney
has long been a stronghold of self psychology in Australia, and Perth, at the
other end of that continent, is now uniting with New Zealand in organizing
a psychotherapy society that puts self psychology into the center of its
clinical and theoretical orientation. We are beginning to forge a link to
China via Taiwan, where some self psychology literature will soon be
translated into Chinese. The surprise is the extent to which an earlier
definite but still limited interest in self psychology from Kleinian South
America has escalated within the last two or three years. In Mexico this
expansion has reached unexpected proportions: the Psychoanalytic Society
in Mexico City observed the tenth anniversary of Heinz Kohut's death with
a symposium on self psychology presented entirely by its own members.
The details and special circumstances surrounding this increase of interest
in self psychology from each of the countries I mentioned are fascinating
and instructive, but we shall have to wait to learn about them on some
future occasion.

I now turn to the second cluster of criteria, some of the intrinsic elements of
the self psychology paradigm, to pursue the question of whether self
psychology is on a promising developmental path or not. The answer–I do
not want to keep you in suspense—is a resounding YES. And in the
following pages I shall try to explain why.

The idea of a trajectory has been with me for quite some time, but I recall
that Brandchaft (1986) supplied me with the word when he said the
following in Toronto: “If in fact Heinz Kohut made it possible for us to see
and understand more of human experience and the psychoanalytic process
than before, it is important that this growing body of work follow its
trajectory toward the realization of its own potential” (p. 246; italics
added). What is this trajectory and how shall we know whether we are
moving toward the realization of its potential? Is there only one well-
defined and agreed-upon trajectory for self psychology or are there several
competing ones, without much agreement between us about them? On these
pages I only focus on Kohut's self psychology, but I shall return later to a
brief discussion of the issue of multiple trajectories. In order to consider
these questions I focus first on some aspects of the genesis of self
psychology and then on some characteristics of its clinical and theoretical
system as a whole in the hope of identifying what has put it and what may
keep it on a promising trajectory.

SOME ASPECTS OF THE GENESIS OF SELF

PSYCHOLOGY

When I once asked Heinz Kohut what enabled him to move into new
directions so soon after he began his analytic career, he paused for a
moment and said that by the time he was in his early twenties he had read,
digested, and made his own all that Freud had written and was thus able to
move on from there. Subsequent conversations and various additional
remarks in his writings expanded on this off-the-cuff response. Aspects of
his own childhood experiences (about which he spoke at times with analytic
reflection), his enormous erudition and wide general reading, and his
extensive clinical experience—in other words, his own childhood and adult
life-story—in combination with his unique talent for introspective-empathic
observation and theorizing enabled Kohut, within a particular historical
period in psychoanalysis and the surrounding Zeitgeist, to formulate his self
psychology in various stages over a period of about 15 years.

The potential for such specific creative developments is perhaps innate and
can be discovered in its then-unrecognized early manifestations throughout
the period prior to its full fruition in a retrospective scrutiny, once enough
relevant life history data become available. My own focus for tracing
Kohut's developing ideas on the self has not been his life history but only
his early psychoanalytic writings (and his frequent personal
communications about them), which permit a step-by-step tracing of the
evolving system of self psychology in the process of its gradual unfolding
and articulation.

There are, however—on this we would all agree—two thoroughly

intertwined aspects of the development of Kohut's ideas whose respective
contributions will have to be considered separately in any comprehensive
study in order to enable us to put self psychology some day into a proper
historical perspective. One aspect relates to the “nuclear program” laid
down in Kohut in response to his endowment and the specific life
experiences within his family and the Viennese, as well as the broader
European, culture of his time. This is undoubtedly the source or wellspring
of his unique contributions. The other aspect relates to the influences of the
contexts in which Kohut actually worked–the narrow one of Chicago; the
broader one of psychoanalysis as a whole; and the even broader one of the
spirit of his time, the Zeitgeist–all of which codetermined the form and
content of his scientific work.

I shall make some brief comments on these contexts to exemplify what I

mean. Hartmannian ego psychology and Alexander's biologizing and
sociologizing of psychoanalysis had a clearly acknowledged impact on the
timing and form of Kohut's (1959) well-known methodologic-
epistemologic essay, “On Introspection, Empathy and Psychoanalysis.”
Kohut was convinced that these influences were distorting the essence of
psychoanalysis. The deeper emotional and intellectual roots of the main
points of the essay converge on Kohut's view of reality (external as well as
internal reality), namely, that it is in principle unknowable and that we can
only grasp aspects of it on the basis of the specific operation(s) we apply to
it in the process of our inquiry. Hence the fundamental importance of the
method, as reflected in the subtitle of the essay: “An Examination of the
Relationship Between Mode of Observation and Theory.” Kohut grew up
with this modern, postpositivist, view of reality. It had become so much a
part of him that he took it for granted and incorrectly assumed that all
psychoanalysts shared it. It had become a foundation of his thinking and it
informed his view of psychoanalysis as an empirical science. And since
Kohut was thus not a radical empiricist, holding that we could ultimately
know reality as it actually existed out there, his notion of psychoanalysis as
an empirical science could still accommodate, without apparent
contradiction, the postpositivist “constructionist” (i.e., hermeneutic, or
interpretive) view of reality, in which the observer had a direct and definite
impact on the observed and in which a jointly forged reality emerged as a
result.

The 1959 essay thus established the psychoanalytic method afresh1 and
shifted its epistemology more decisively away from conventional, positivist
science, of which medicine, psychiatry, and even psychoanalysis were a
part. The essay also marked the actual beginning— although with some
latency period in its wake–of Kohut's later systematic study of the self and
its disorders. The latency period provided him, as president of the American
Psychoanalytic Association, with experiences regarding the “group self” of
the association, and these gave an immediate external impetus to his
recognition of the need to study the vulnerabilities of the self as he observed
them there and also in his clinical practice.

I regard Kohut's 1959 essay as a significant part of the “genetic

endowment” of self psychology, a part of its “nuclear program.” What I
mean is this: What Kohut established in the methodologic– epistemologic
realm—like it or not—significantly determined the path on which he put the
future development of self psychology. I will not recount the details of the
essay and what followed it. It should be enough to remark that these
methodologic–epistemologic innovations began to transform
psychoanalysis from a 19th-century mechanistic, objectivist-positivist
theory into a 20th-century constructivist-contextualist one. Kohut's brand of
psychoanalysis was therefore, even before any of its further developments,
already on a promising, avant-garde path.2

Let us now take a quick look at some of the characteristics of the clinical–
theoretical system Kohut proposed a few years later to see the further
outlines of the trajectory of self psychology and to see if it is indeed in the
process of fulfilling its potential.

SOME CHARACTERISTICS OF THE CLINICAL AND

THEORETICAL SYSTEM OF SELF PSYCHOLOGY

Kohut's method and epistemologic stance proved extremely fruitful. Jointly

and inseparably, these have led to a new paradigm in psychoanalysis. This
is now past history. The method and the epistemology in which this
paradigm is embedded have created an open clinical-theoretical system.
From within this open system, with its core concepts of the selfobject and
the selfobject transferences, we are able to maintain a continuous dialogue
with the patients of today, as well as with the surrounding culture, and to
become ever more attuned to both. Out of this ongoing dialogue we can fill
in, expand, and modify the details of the basic paradigm until it has fulfilled
its potentialities and can give way to a new one. His method and
epistemology might be the most enduring part of Kohut's entire system not
to mention the clinical insights it has helped us attain, which I think are
considerable and at this point appear quite durable.

As you know, self psychology first emerged out of Kohut's focus on what
he called “the leading psychopathology of our time.” It was this aspect of
The Analysis of the Self (Kohut, 1971) that spoke to all who immediately
grasped his message. It was the thrust of his approach from the outset to be
in tune with and understand, as well as explain, the psychopathology and
the psychology of our time, just as Freud understood and explained the
leading psychopathology and the psychology of the Victorian age. Kohut
decisively moved further toward this goal with The Restoration of the Self
(Kohut, 1977), which encompassed the whole spectrum of
psychopathology, and continued in this direction in all his subsequent
writings.

Self psychology thus became psychoanalysis at its best. We no longer

assumed that we could find “the truth” about the human condition, valid for
all times and throughout all cultures; that was a mirage. We now had a more
modest agenda but one no less important or less encompassing: a renewed
and intensified focus, using the method of empathy, on individual
subjective experience within the selfobject transferences and use of clinical
findings beyond the clinical setting to study men and women in history.

Had Kohut only captured the essence of the psychology and

psychopathology of our time, his permanent place in the annals of
psychoanalysis would already have been assured. But I believe he did much
more. And this is where I see self psychology on a promising trajectory and
in the process of fulfilling its potentialities—without an end in sight yet!
(Kohut was fond of saying that we have barely scratched the surface thus
far.)

The clinical concept of the selfobject transferences and the developmental

concept of selfobject needs and experiences—that is, the vicissitudes of the
selfobject phenomena throughout life–are the foundational constructs of
self psychology from which all the rest derives. These concepts have, in
turn, further anchored psychoanalysis in the postpositivist, constructivist
reality and have thereby restored to it its erstwhile revolutionary power in
the human sciences. Let me explain: these concepts have led us to view the
self, among other things, as an open system, one that is not delimited by the
physical boundaries, the skin, of the person. Thus, the self is open to
include others or to be included in the self of others. This view has
permitted us to transcend the concept of transference as a phenomenon
played out between two well-demarcated selves each of whom is the
recipient of projections and introjections in the transference–
countertransference experience within the closed system of each participant
in the analytic process. The new psychoanalysis has, Kohut held, turned
away from focusing on macro-events within the life cycle as the key
pathogenic elements and focuses instead on the micro-experiences
surrounding them. It has also turned away from regarding the macro-
structures of id, ego, and superego as adequately accounting for subjective
experience and pathogenesis. The new approach rivets our analytic
attention on the micro-structures of self-experience, the level on which
development and the treatment process can be more adequately accounted
for.

Self psychology is on a promising trajectory because it is open to an ever-

deepening grasp of the psychology and psychopathology of our time, as
well as in harmony with the contemporary postpositivist, contextualist,
constructivist philosophy of science.

No one among us—whichever trajectory he or she follows—seems to doubt

the central significance of the concepts of the selfobject and the selfobject
transferences. But among the various trends within self psychology, about
which much more can be said than can be included here, different clinical
and theoretical elements are stressed, leading to different emphases and
therefore to different trajectories.

Let me, therefore, mention a few of the consequences I consider important,

even at the risk of talking about the very familiar. (1) Although Kohut's
thinking in the 1959 paper replaced the awkward psychobiological concept
of the drives with a psychological concept of subjective drivenness, it was
only the selfobject concept that clearly established a substitute motivational
(developmental and clinical) context and could therefore more
meaningfully and persuasively do away with classical drive theory and pave
the way for a substitution of it with an affect theory congenial to self
psychology.3 The previous psychoanalytic paradigms, bar none, have not
achieved this transformation sufficiently, even if some could be viewed,
retrospectively, as having inched toward it. The second step was largely
missing; these paradigms did not offer a compelling substitute for drive
theory derived from the transference. (2) The selfobject concept brought
together within the self external and internal reality more felicitously than
did previous approaches and thereby put contextuality (the idea of meaning
as established in context) in the center of the psychoanalytic theory and
treatment process. In this connection the idea of a one-person, versus a two-
or three-person, psychology, initiated by Rickman and taken over by Balint
as a corrective measure, appears to me now as sociologizing the analytic
context. Of course, there are two persons in the analytic consulting room
(and often three in fantasy), but the selfobject concept retains the focus on
the inner experience of each participant, an experience that always includes
the other or others. Self psychology does not slight the “interpersonal,” but
it has a psychoanalytic intrapsychic view of it. This intrapsychic view of
self psychology may be considered by an external observer as a one-person
system and may be misinterpreted as disregarding the interpersonal unless
we understand the full implications of the selfobject concept. (3) This
selfobject concept, in fact, refocused our attention on the transforming
impact of lived experience, which, mediated through fantasy formation, is
responsible for the establishment of health or illness. This concept is
therefore a key element in the psychoanalytic treatment process, which
views cure as being brought about by a new lived experience– with or
without insight as the curative instrument. Mind you, the treatment is
always conducted with the steps of understanding and explaining (in varied
proportions as the individual context demands), but insight and relationship
can no longer be meaningfully separated. The argument of insight versus
the relationship as the curative element is no longer relevant. There is no
significant therapeutic relationship without insight, and no curative insight
is possible without a significant therapeutic relationship. You see how
ingrained certain loaded phrases are: if I want to be more pedantically
accurate, to avoid the ambiguity within psychoanalysis of the term
relationship, I should say that there is no significant therapeutic experience
without insight and no curative insight without a significant therapeutic
experience. All of psychoanalysis is a psychology of relationships on some
level, but that does not differentiate one psychoanalytic approach from
another. The term relationship, without further qualifying features that
separate and differentiate the various kinds of psychoanalyses, is too
ambiguous. This differentiation is what Kohut accomplished, but he did not
stop there. Rightly or wrongly, he drastically revamped the motivational
system of psychoanalysis and proceeded to elaborate on those structures
that genetically codetermine the particular quality of relationship patients
and analysts are capable of sustaining. This is why I view the self
psychological version of psychoanalysis as a structural theory par
excellence.

There are, of course, many other implications to the selfobject concept that
I have mentioned here, but I now turn my attention to summing up and
answering my questions more directly.

Obviously, there are multiple trajectories of self psychology today. In this

age of constructivist reality it could not be otherwise. We know that method
and epistemology, as well as the specific theories these have spawned, at
first expand and then inevitably limit our horizon. That is contextualism,
whether we can fully accept it or not.

We may now ask, Is Kohut's empiricism an irreconcilable contradiction to

the constructivist view of reality or not? I could not easily decide. I asked
Arnold Goldberg in order to obtain some consensual validation for my
perception that Kohut appeared to have been on the fence on this issue, like
most of the rest of us. Goldberg agreed without hesitation. Then I asked him
if he thought that Kohut would have moved more decisively toward
constructivism during the last ten years if he were still in our midst. “Oh
yes, without any doubt,” Goldberg said, to my great relief. But I found
myself unable to let go of what Kohut's modulated, benign empiricism has
provided for us as clinicians in his various clinical and theoretical
formulations. Nor, I thought, could other analysts fully move toward
constructivism. Read the volumes of Progess and note the language most of
us are using and the fondness we have for grand theories. I know I do. So I
have worked out a tentative solution, at least for the time being. An
empiricism that does not claim that there is a reality out there that is
ultimately knowable, an empiricism that considers theories not as verities
but as instruments of further observation, can perhaps be viewed as a
“constructivist empiricism.” There is one added demand: that our empirical
findings and theories be regarded as a significant part of our own context
and be as completely open to scrutiny as whatever the patient brings to the
analytic situation. It is this attention to the negotiability of our contributions
to the analytic situation that will keep us and our theories open to change
and truly attuned to the subjectivity of the patient. (This tentative solution
suggests to me that we shall have to clean up our epistemologic act sooner
or later more decisively.)

In the meantime, self psychology continues to fulfill its intrinsic potential,

as evidenced by the ongoing contributions by self psychologists to an
understanding of the curative process and of other clinical and
developmental problems. Self psychology continues to have great impact
on further developments of brief as well as long-term psychotherapy, and it
has finally caught the attention of some feminist psychologists and other
feminist writers—with mutual benefit to both fields—to name only a few
areas for additional expansion.

To conclude, let me encapsulate my message by referring to what McHugh

and Slavney (1983) call the four separate domains of psychiatry: the
concept of disease, the concept of dimensions, the concept of behaviors,
and the concept of the life story. Only the latter interests us here. These
authors maintain that very different, incompatible epistemologies prevail in
these various realms, thus creating all the conceptual confusion in
psychiatry today. They would not hesitate to commit themselves to a
constructivist approach without reservation because they have the other
domains in which radical empiricism might reign supreme. They call life
story reasoning the method appropriate to the domain of psychodynamics.
They claim that the hermeneutic (narrative) approach is central to our
domain. They see Freud as an imaginative, original storyteller whose life
story reasoning revolutionized our understanding of individual human
beings. It is storytellers who touch our lives most deeply. And McHugh and
Slavney elaborate richly on what Freud's main oedipal story line is all
about. That story line has enthralled Western man and woman ever since it
was first told by Freud (and, of course, without full awareness even before).
I believe Kohut was also a remarkable storyteller, one who reworked and
renamed Freud's story of pleasure-seeking Guilty Man and subsumed it
under the umbrella of his own original story of fulfillment-seeking Tragic
Man. Guilty Man since then is no longer a separate story but one made
more cohesive and more intelligible as an aspect of Tragic Man.
Contextualism at its best.

As a storyteller Kohut astounded a number of us many years ago when we

were listening with him to a case presentation none of us could make much
sense of. It was a Saturday afternoon as I recall, and most of us left the
meeting quite discouraged. We reconvened the next morning, not knowing
where to pick up the pieces. Kohut stepped up to the blackboard and offered
us a most cohesive, encompassing story that illuminated every aspect of the
confusing life story of the day before. Of course, we had no immediate way
of testing the validity or the reliability of Kohut's story, but the aesthetic
experience we all had was exhilarating. The story has continued to make
sense to many of us, and many of us have greatly embellished that story
since then. But the original story remains the core until it too will be
subsumed under the umbrella of a new story, whose outlines we cannot yet
fathom.

I say it without apology—even if it sounds like I have not yet transcended

my idealization of Heinz Kohut even after all this time— that I have never
met a storyteller like him, before or since!

REFERENCES

Basch, M. F. (1975), Toward a theory that encompasses depression: A

revision of existing casual hypotheses in psychoanalysis. In: Depression
and Human Existence, ed. E. J. Anthony & T. Benedek. Boston: Little,
Brown, pp. 202–227.

———(1976), The concept of affect: A re-examination, J. Amer.

Psychoanal. Assn., 24:759–777.

Brandchaft, B. (1986), British object-relations theory and self psychology.

In: Progress in Self Psychology, Vol. 2, ed. A. Goldberg. New York:
Guilford Press, pp. 286–296.

Kohut, H. (1959), Introspection, empathy and psychoanalysis: An

examination of the relation between mode of observation and theory. In:
The Search for the Self, Vol. 1, ed. P. H. Ornstein. New York: International
Universities Press, 1978, pp. 205–232.

———(1971), The Analysis of the Self. New York: International

Universities Press.

———(1977), The Restoration of the Self. New York: International

Universities Press.

McHugh, P. R. & Slavney, P. R. (1983), The Perspectives of Psychiatry.

Baltimore: The Johns Hopkins University Press.

Ornstein, P. H., ed. (1978), The Search for the Self: Selected Writings of
Heinz Kohut 1950–1978, Vols. 1 & 2. New York: International Universities
Press.

Stolorow, R. D., Brandchaft, B. & Atwood, G. E. (1987), Psychoanalytic

Treatment–An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.

1Iuse the phrase afresh deliberately because Kohut's own early claim and
that of other self psychologists that he merely restated or reemphasized the
psychoanalytic method as it was originally proposed by Freud is not borne
out by my reading of the pre-Kohutian literature and Kohut's own writings.
Not everyone agrees with this assessment, so further efforts to sort this out
are necessary.
2Itshould be noted that there were other successful efforts to transform
psychoanalysis into a postpositivist, pure psychology, notably those of
George Klein, Roy Schafer, Paul Ricoeur, and Jacques Lacan, among
others. However, except for Lacan, the others have not proposed a new
paradigm for psychoanalysis.
3See, for instance, the affect theories of Basch (1975, 1976) and of
Stolorow, Brandchaft, and Atwood (1987).
I
Interpretation
Chapter 2
The Role of Interpretation in
Therapeutic Change
Ernest S. Wolf

Of all the various procedures that in their totality make up the

psychoanalytic process, interpretation stands at the most pivotal center.
Other aspects of the analytic interaction, such as providing a comfortable,
undisturbed analytic setting or creating an appropriate analytic ambience,
are, in essence, just preparatory for the moment when the right
interpretation will result in a modification of the analysand's psychic life.
My definition of interpretation is a very wide one. It includes all those
intentional activities of the analyst that in their totality bring about a
modification of the analysand's psyche. The modification brought about
may be for the better (i.e., therapeutic), but it may fail or even be
antitherapeutic. The activities that are included in my definition are verbal
statements and any other consciously directed interventions by the analyst,
including those apparent noninterventions or omissions of an action that are
the cause for a modification in the analysand's mental world. Clearly, all
interpretations are experiences and are effective by virtue of their being
experienced as goal-directed interventions from the side of the analyst.1
Thus, I would exclude those experiences that accidentally or
nonintentionally emanate from the analyst. In this discussion I want to
highlight the interpretative process as understood and guided by the
principles of a self-psychologically informed psychoanalysis.

Interpretation has always been one of the most discussed aspects, and is
sometimes the most controversial, of the whole analytic procedure. The
reason for this intense interest is that the interpretation reflects not only the
analyst's technical methods and proficiency but also his or her theoretical
commitments, personality, character, and attitude toward the analysand.
One might say that looking through the interpretation is like opening a
window into the core of the analytic process, revealing analyst as well as
analysand in their depths. Many factors combine to shape the analyst's
interpretation. However, there is little agreement as to which of these is the
most important. Perhaps the majority of our colleagues hold that the
theoretical commitment of the analyst is the decisive particular that will
determine the outcome of the analysis. Others will underline the primary
importance of the analyst's attitude toward the analysand, insisting that this
orientation toward the patient is mainly determined by the analyst's
character and personality. It is universally accepted, therefore, that all
analysts should undergo some analytic therapy of their own during their
preparation for analytic practice, though this therapeutic analysis is
euphemistically labeled a “training analysis.” Presumably, the training
analysis will make the prospective analyst aware of any tendencies that
might be inimical to proper analytic functioning and will neutralize those
tendencies.

Most self psychologists would probably agree with their more traditionally
minded colleagues that the theoretical orientation of the analyst is of
decisive importance. This seems as it should be since the reason for
adopting a theoretical posture is precisely one's conviction of its scientific
truth as well as its therapeutic efficacy. It is also generally assumed that
committing oneself to a theory is a rational act in which one carefully
weighs the pros and cons of competing methods and conceptualizations. I
wish to dissent from this easy view (Wolf, 1991) by suggesting that it is the
analyst's personality-determined philosophical orientation and value system
that is reflected in the choice of a theoretical commitment. I believe that a
certain vulnerability of the self to its own excitements leads to a self-
protective posture of the analyst that favors structure, distance, laws, truth,
and scientific reasoning. Freud's emphasis on intrapsychic dynamics and the
associated emphasis on abstinence, neutrality, and denial of gratification in
treatment may well have been motivated by an anxiety-driven need to keep
his passions and those of his followers in check. On the other hand, I think
that a stronger self, one that is less vulnerable to its affects, can afford a
posture of flexibility, emotional closeness, spontaneity, and empathic
responsiveness. Ko-hut's reliance on empathic immersion and elucidation of
subjective experiences led him to downgrade abstinence and abandon
neutrality in favor of establishing an identification with the interests of the
analysand. Finally, allowing “optimal responsiveness,” as advocated by
Bacal (1985) and Terman (1988), to replace the deprivation imposed by
strict nongratification is evidence for the maturity and relative freedom
from anxiety of contemporary analysts.

SOME HISTORICAL NOTES

As a child of the 19th century, psychoanalysis carried from birth some of

the ideological struggles of the times. These contradictory tendencies were
heightened by the double rootedness of early contributors in both a
humanistic and a medical background. Like a child who manifests signs of
its parental heritage, psychoanalysis presents an uneasy mixture of classic
rationalism with romantic idealism. Any science aims for encompassing
explanations of the observed data. In the natural sciences the point of view
of the observer versus the observed is relatively uncomplicated; ideally, the
conclusions are not tainted by the personal prejudices of the investigators.
Not so in the sciences that study humans. Here the complications multiply.
The observer often has a significant impact on the observed merely by
making the needed observation. Pure unambiguous observations are
difficult to make even if one makes allowances for the unavoidable
interactions between observer and observed. Inevitably, there also are
conflicting interests that color the data. The observer and the observed do
not look at data from the same point of view; consequently, they frequently
perceive the same event very differently. Objectivity in the study of human
beings is not a given as it is in the natural sciences, where the observer's
potential emotional involvement and distortions can easily be controlled.
But no amount of control can eliminate human subjectivity. The point of
view of observer or of observed, from inside or from outside, always
remains a decisive determinant. This is also true of the observer of other
human beings who in order to be true to his scientific training attempts to
divorce himself from his own subjectivity in making his so-called objective
observations. The very effort to be objective and nonparticipating, like a
natural scientist, perverts his intentions. Does that mean psychoanalysis is
not a science? On the contrary, to the extent that psychoanalysts are aware
of the special conditions and limitations of their observations they are true
scientists. However, their science of psychoanalysis is not a natural science.
Neither is it a humanistic endeavor like history. It is a science of the human,
different from both the Naturwissenschaften and the Geisteswissen-
schaften.

These considerations are of special importance when discussing the role of

interpretation in psychoanalysis. The dictionary defines interpretation as an
“explanation of what is obscure,” but I find this definition rather obscure as
far as psychoanalysis is concerned because it leaves out the person to whom
the explanation/interpretation is addressed. Does the explanation serve to
make sense to the observing analyst or does it serve to enlighten the
analysand or is it primarily in the service of communicating to the
professional community? Is it designed to enhance the analyst's experience
of himself as a scientist or is it designed to bring the saving truth to the
analysand or is it designed to produce mutative effects on either, both, or on
the analytic process in which they are participating?

FREUD: THE AMBIVALENCEOF THE INVESTIGATING

PHYSICIAN

From their very beginning the theories and methods created by Sigmund
Freud were caught in a dilemma derived from their creator's basic conflict
of identity, that is, the conflict between being an investigative scientist or a
physician attempting to heal. If we could have asked Freud about this
dissonance of primary aims, he most likely would have insisted on being
the scientific observer whose researches were of therapeutic benefit to his
analysands mainly as a by-product. He repeatedly stressed the importance
of understanding and elucidating the psyche of his analysands while
disparaging therapeutic ambition. Indeed, the very word chosen for his
activity, psychoanalysis, alludes to serious observation and study rather than
to modifying actions. His career upon completion of his medical training
was in neurological research, and it was not until growing family
responsibilities forced him into active medical practice that he moved from
the laboratory into the consulting room. It seems he disliked being a doctor.
Yet, as a compassionate and humane person Freud was not indifferent to the
suffering of his patients. Furthermore, he knew that his patients came to him
to be succored and healed and not because they wanted to advance his
research ambitions. As a man with a strong sense of truth and justice he
therefore felt obligated to do the very best in his powers to help them.

However, the conflict between the scientist and the healer has remained a
source of hidden unease in psychoanalysis, as in all of medical practice.
Some analysts seem more identified with the exploring tradition, as
represented by Freud; others seem more in sympathy with the accent on the
patient, as represented by Freud's closest friend and collaborator, Sândor
Ferenczi. The difference between these two analytic postures is delicate and
mostly unconsciously determined by the analyst's personal history,
personality, and, perhaps, training. I believe that some of the controversies
that have arisen among psychoanalysts, historically as well as currently, are
an expression of these subtle differences. In this connection it is interesting
to read what Ferenczi wrote to Freud in 1930:

I do not share, for instance, your view that the therapeutic process is
negligible or unimportant, and that simply because it appears less
interesting to us we should ignore it. I, too, have often felt “fed up”2 in this
respect, but overcame this tendency, and I am glad to inform you that
precisely in this area a whole series of questions have now come into a new,
a sharper focus, perhaps even the problem of repression [Dupont, 1988, p.
xiii].

In his diary Ferenczi was more direct and outspoken about Freud's
therapeutic attitudes:

One learned from him [Freud] and from his kind of technique various
things that made one's life and work more comfortable: the calm,
unemotional reserve; the unruffled assurance that one knew better; and the
theories, the seeking and finding of the causes of failure in the patient
instead of partly in ourselves. The dishonesty of reserving the technique for
one's own person; the advice not to let patients learn anything about the
technique; and, finally the pessimistic view, shared with only a trusted few,
that neurotics are a rabble3 ... [Dupont, 1988, p. 185].

Ferenczi goes on to state his own views:

This was the point where I refused to follow him. Against his will I began
to deal openly with questions of technique. I refused to abuse the patient's
trust in this way, and neither did I share his idea that therapy was worthless.
I believed rather that therapy was good, but perhaps we were still deficient,
and I began to look for our errors.

Indeed, Ferenczi's openly experimental clinical attitude appears more

correct scientifically than Freud's theory-bound dogmatism.

It is against this historical background that I want to examine the

formulation and the clinical usage of the concept of interpretation in
psychoanalytic treatment. One of the earliest elucidations of the process of
therapeutic interpretation can be gleaned from Freud's discussion of the
psychotherapy of hysteria (Freud, 1895, pp. 281–283). It is a most
interesting essay because it illustrates Freud's ambivalent struggle between
the scientist and the humanist, as well as something about himself in the
roles of therapist and researcher. He does not in this work use the word
interpretation (Deutung), perhaps because he had reserved the term
Deutung for the interpretation of dreams, which was already occupying
him.

In this article Freud is still rather authoritarian in his approach, and he

mentions the pressure technique to elicit pathogenic recollections against
the patient's often stubborn resistance. He writes, revealingly; “It is of
course of great importance for the progress of the analysis that one should
always turn out to be in the right vis-à-vis the patient, otherwise one would
always be dependent on what he chose to tell one” (p. 281). And: “The
principle point is that I should guess the secret and tell it to the patient
straight out; and he is then as a rule obliged to abandon his rejection of it”
(p. 281). Freud then becomes the scientific investigator: “We may reckon
on the intellectual interest which the patient begins to feel after working for
a short time. By explaining things to him, by giving him information about
the marvellous world of physical process ... we make him himself into a
collaborator, induce him to regard himself with the objective interest of an
investigator” (p. 282). But then Freud goes on to confess his human
involvement:
One works to the best of one's power, as an elucidator (where ignorance has
given rise to fear), as a teacher, as the representative of a freer or superior
view of the world, as a father confessor who gives absolution, as it were, by
a continuance of his sympathy and respect after the confession has been
made. One tries to give the patient human assistance, as far as this is
allowed by the capacity of one's own personality and by the amount of
sympathy that one can feel for the particular case [p. 282–283].

Summarizing, Freud states, “Besides the intellectual motives which we

mobilize to overcome the resistance, there is an affective factor, the
personal influence of the physician, which we can seldom do without, and
in a number of cases the latter alone is in a position to remove resistance”
(p. 283).

But we can sense Freud's uneasiness at having given up the purely

intellectual, scientific posture, for he goes on, almost apologetically, “The
situation here is no different from what it is elsewhere in medicine and there
is no therapeutic procedure of which one may say that it can do entirely
without the co-operation of this personal factor” (p. 283).

As psychoanalysis gained adherents from diverse nonmedical branches of

the academic community, Freud began to worry about what we commonly
call “wild analysis.” He mentioned having the impression that some of his
colleagues thought the procedure an easy one that could be practiced
offhand: “I conclude this from the fact that not one of all the people who
have shown an interest in my therapy and passed definite judgments upon it
has ever asked me how I actually go about it” (Freud, 1905, p. 261).

Indeed, Freud (1910) published an article, “Concerning Wild Analysis,” in

which he expressed his misgivings. A few years later, in
“Recommendations on Analytic Technique,” he gave technical advice to
those of his colleagues who cared to read about his therapeutic posture.
Obviously writing for those who did not possess the self-discipline and
scientific neutrality that he himself displayed, Freud (1912) now reversed
his former humanistic approach in which he recognized the ubiquitous
necessity of a human factor, and wrote the following:
I cannot advise my colleagues too urgently to model themselves during
psycho-analytic treatment on the surgeon, who puts aside his feelings, even
his human sympathy, and concentrates his mental forces on the single aim
of performing the operation as skillfully as possible. Under present-day
conditions the feeling that is most dangerous to a psychoanalyst is the
therapeutic ambition [p. 115].

And further: “The justification for requiring this emotional coldness in the
analyst is that it created the most advantageous conditions for both parties”
(p. 115).

I am not sure that Freud really believed that the analyst's coldness creates
the most advantageous conditions. Rather, I think he was inspired by fear of
public ridicule and humiliation at the hands of his “wild” colleagues. Freud
made an effort to protect his brainchild, psychoanalysis, by resisting, at
least in his public writings, his own and his colleagues’ tendencies toward
an interactive and warmly human relationship with patients. However, as
revealed by some of the analysands who published memoirs of their therapy
with him, Freud remained the compassionate and empathically attuned
physician within the privacy of his own consulting room. Unfortunately, in
his publications he continued to exhibit the surgeonlike posture that became
the model for future generations of analysts and analytic students. Rather
than analyze Freud's anxiety motivated resistance to a full analytic
relationship, most of his followers heeded his words, not his actions. In so
doing they colluded with their hero's anxiety by copying their idealized
mentor's defenses even in the relative safety of their own consulting rooms.

INTERPRETATION AND THERAPEUTIC AMBIENCE

Interpretation is a rather awkward and even misleading word for an activity

that would be better referred to as an explanatory process. It is often loosely
applied to every voluntary verbal participation by the analyst in the
psychoanalytic treatment. Menninger (1958) thought it a presumptuous
term that gives young analysts the wrong idea about their main functions,
which he defined as quiet observation, listening, and occasional
commenting (p. 129). Glover (1949) recognized two distinctive
interpretative processes: “Interpretation can be either positive, when the
unconscious content giving rise to the difficulty is communicated to the
patient, or exploratory, when the unconscious emotions (usually anxiety
and/or guilt) causing the hitch are ventilated” (p. 315).

Greenson (1967) thought, like Glover, that the role of the interpretative
process was to make the unconscious conscious: “To interpret means to
make an unconscious phenomenon conscious. More precisely, it means to
make conscious the unconscious meaning, source, history, mode, or cause
of a given psychic event. This usually requires more than a single
intervention” (p. 39). Greenson thought of interpretation as essentially the
analytic procedure par excellence: “The most important analytic procedure
is interpretation; all others are subordinate to it both theoretically and
practically. All analytic procedures are either steps which lead to an
interpretation or make an interpretation effective” (p. 37).

Kohut (1984) was a great admirer of Glover, from whose writings he said
that he had probably benefitted more than from those of any other
psychoanalyst, with the exception of Freud (p. 93). I think it was Glover's
“in-tuneness” with his analysands that impressed Kohut. However, he found
himself in total disagreement with Glover's dismissal of the therapeutic
effect of what Glover termed “inexact” interpretations. Glover found a
nonpsychoanalytic explanation for the apparent effectiveness of inexact
interpretations; he proposed that it is the nonspecific suggestibility of the
analysand that leads to pseudosuccesses in such instances. It was a hallmark
of Kohut's approach to his analysands that he always paid serious attention
to what his patients told him, having learned not to dismiss the patient's
experiences too easily. If the patient reported a therapeutic success after an
inexact interpretation, Kohut was very reluctant to label such an
improvement a pseudosuccess unless he had independent evidence of the
patient's need to hide his misery. He believed that inexact interpretations,
like incomplete interpretations, could still be useful and effective
explanations that would fall within the definition of interpretation if they
had positive therapeutic consequences. One is therefore not surprised to
hear that in his last lecture a few days before he died Kohut (1981) gave
what is probably the most pithy of his definitions of the role of
interpretation in the therapeutic process of psychoanalysis: “Analysis cures
by giving explanations” (p. 532).
SELF-PSYCHOLOGICAL PRINCIPLES AND
INTERPRETATION

The following case vignette illustrates the interpretation of a fear of the

therapeutic situation, a fear that is often misleadingly called a resistance. I
also attempt to contrast a theory-bound approach to an empathic approach.4
The next vignette from the middle part of analysis illustrated a
disruption/restoration sequence evoked by the therapist that was associated
with a therapeutic gain.

Vignette: “Resistance” Interpretation

Quite a number of years ago a patient came to me because of chronic

depressions, hypochondriasis, occasional sexual impotence, and,
contrastingly, periods of sudden excitement during which he would spend
money rather loosely. This pattern had disturbed the patient

Vignette: “Resistance” Interpretation

Quite a number of years ago a patient came to me because of chronic

depressions, hypochondriasis, occasional sexual impotence, and,
contrastingly, periods of sudden excitement during which he would was
eager to try the insights I had recently learned from Kohut's
conceptualizations.

During the early weeks of the analysis the patient made sure that I learned
in detail the manifestations of his depression and hypochondriasis and
expressed his conviction that no one could help him. Occasionally he would
mention his work, generalizing that he was performing very poorly but then
giving specific instances where he had in fact accomplished certain tasks
with unusual skill and speed, leaving his competitors way behind. I cannot
ignore my reaction to this patient because it became an important aspect of
my recognizing and interpreting his fears. I felt annoyed by the long,
repetitious, seemingly never-ending recital of his depressive and
hypochondriacal suffering, particularly when this was combined with his
assuring me of my therapeutic impotence. I thought that he had to be very
angry with me (and probably with his family also) for he tried to make me
(and them) suffer also. I speculated that his aggression was mobilizing and
that he was defending himself against his hostile impulses by making
himself helplessly sick, crying for help, and developing all kinds of
debilitating hypochondriacal symptoms. Yet by making me and others
suffer while assuring us of our inability to do something, he was hurting our
self-esteem and impairing our ability to act. Thus, he was acting out his
hostile aggression.

I interpreted none of this at that time because I thought such an

interpretation based on a psychodynamic theory and not on my empathic
immersion would have little effect. Indeed, I sensed it would make him
more defensive. I now believe that such a theory-bound interpretation is
likely to be incorrect. Instead, I told the patient that he was confronting me
with my therapeutic impotence because he feared he could not be helped.
He was looking for reassurance of my therapeutic prowess and interest in
him. Not being helped would be a most painful disappointment for him, and
therefore he hoped that I would deny his assertion that I could not help him.
I told him that he was afraid I was not really interested in him and would
sooner or later turn away from him like others had done and that he felt it
necessary to tell me in great detail of his suffering to make sure I really
could appreciate how much he suffered, how really sick he was, how much
he needed me. And, I added, since he felt deeply humiliated by his
neediness, he felt it necessary to report some unusual accomplishments so
that I would not lose respect for him. Following these explanations he
seemed to relax a little, and there was some diminishment of his
defensiveness. We both felt more at ease and the analysis proceeded.

Of course, these interpretations are incomplete because they do not yet

include the genetic background. In other words, a complete interpretation
has to be a piece of personality dynamics seen not only in the context of the
here and now but also as a part of a life history that articulates with and
makes sense of what is known about the person's developmental history.

Vignette: Interpretation of Disruption Precipitated by

Therapist
Mr. G, a middle-aged lawyer, entered analysis complaining of anxiety and
depression that were at times so overwhelming that he could not
concentrate on his work. He was also aware of the fact that in spite of his
professional training and judgement he tended to become excessively and
personally involved with his clients. He was the fourth and youngest child
of successful upper-middle-class parents. Father was a busy corporate
executive who expected much from his children without, however, devoting
much time or directly relating to them. Although the patient had been a
superior student, he felt he had not lived up to father's expectations,
especially on the athletic field. His mother seemed to have been an
unreliable source of emotional support, sometimes appearing too concerned
and anxious and at other times too busy and distant. In the analysis Mr. G's
need for a constant, reliable relationship to a mirroring and confirming
selfobject manifested itself, for example, in symptomatic reactions to even
the most minor changes in his regular schedule of four appointments per
week. Concomitantly, his intense need to idealize me was reflected in his
gradual and mainly unconscious imitation of my style of dress and speech
as well as in concern mixed with depressive affect when he imagined that
some other patient was my favorite and would be thought by me to be more
worthwhile than he. During the week preceding the sequence of sessions I
am using to illustrate how a disruption of the transference became a
working-through episode, the patient had changed a Friday hour to the same
time on a Tuesday. On the following Monday he talked at length about the
struggle at his office to get rid of an unsatisfactory employee. Then he
commented on how much more convenient the new Tuesday appointment
was than the Friday sessions. While listening to these comments, I picked
up my appointment book and made a brief notation. I do not ordinarily take
notes during analytic sessions, and the patient heard me moving around.
Suddenly, he fell silent. After a while I suggested that my writing had
disturbed him. He was not sure, although he admitted that he was aware of
the noise and had become annoyed. Still, he doubted that his silence was
connected to this; he just felt he had nothing more to say.

On the next day Mr. G reported a surge of angry feelings after leaving my
office. It had made him furious to think that I was writing and not really
listening to him. His fury had mounted as he felt ignored and yet was
helpless to do anything about it. Reminding himself that my transgression
was relatively minor had not controlled the mounting tension, and that night
he slept fitfully. He remembered a brief dream fragment: He is at a friend's
house and in animated conversation with him when the friend's wife comes
in and then walks out with her husband into another room, leaving the
patient alone. I agreed with the patient that in the dream he felt ignored and
left out, just as he had in our previous analytic session when he noticed my
writing. Further associations led directly to memories of his parents,
particularly to incidents when the parents were so caught up in their own
interests that he felt similarly shunted aside, ignored, and neglected.

My matter-of-fact acceptance without either feeling or acting apologetic for

having precipitated the experience of affects reminiscent of his response to
childhood events helped the patient in lessening his self-blame for being so
sensitive as to lead to a disruption. His success in conveying to me how he
felt and how he experienced my lack of attention reduced his feelings of
helplessness and thus ameliorated his narcissistic rage. His recall of the
overwhelming intensity of similar affects during his childhood also
increased his acceptance of his own genuine need for a different response
from his parents then and from me now. At the same time, he gradually
came to feel, and finally to believe, that my understanding and acceptance
of his needs now, even without gratification, was enough legitimation of his
self. The intensity of the affect began to diminish, and the tension between
us began to fade away.

Vignette: Interpretation of Analyst's Empathic Lapse

A young lawyer, in his third year of analysis, reported that his cat had just
died. The cat had never been mentioned before, and rather perfunctorily,
without any real feeling, I acknowledged the loss. A period of silence
ensued and I said something like “Let's go on.” More silence. I commented
that the cat must have been quite important and that the loss must be very
painful to the patient. Yes, the patient acknowledged, the cat—he used the
cat's name—meant very much to him, but he did not think I could
understand that. He sounded upset. During the next session he was still
upset; I could tell by his coldly angry voice. I interpreted that he was angry
with me for not having been more sympathetic. Yes, he agreed, he did not
think I really cared, but, just like his mother, I acted as if I did. Mother
would put on a great show of concern, especially when other people were
watching, but the patient felt she didn't really care. I confirmed that I did
not feel about pets the same way that he and many other people do, and I
interpreted that he experienced my comments, like his mother's, as a
pretense of concern.

In this example of a disruption one can discern elements of both here-and-

now experience and of transference of the past into the present. Both
aspects always participate. In this case the analysand first experienced his
analyst as not empathic, as not understanding how he felt, and then he was
reminded of similar painful and traumatic malattunements in his childhood.
The transference of the expectation of not being understood made my lack
of attunement a repetition for the patient of a childhood trauma; not only
was I suddenly not available as a confirming selfobject experience in the
present but I even seemed to the patient to endorse and sanction the validity
of his mother's lack of empathy, as well as her need to pretend. I, for my
part, had thought myself well attuned to the patient. I knew about mother's
pretending to feelings she did not have, but I had never before been aware
that the analysand had any particular interest in pets. My perfunctory
response seemed an appropriate acknowledgment. In fact, it was an
appropriate acknowledgment, from my point of view. But not so from the
patient's perspective. He unquestionably experienced a lack of empathy and
understanding. The analyst must recognize and acknowledge the patient's
perspective because by so doing he restores the patient's experience of a
bond with the analyst and he provides the patient with an experience of
having effectively communicated to the analyst.

Generally speaking, it is an apparent consequence of such malattunement

that patients feel alone and overwhelmed by affects of anxiety, frustration,
anger, humiliation, helpless rage, or hopeless depression. It is useful to
remember that the disruption of the therapeutic relationship is associated
with crushed self-esteem; that is, a devastating sense of “badness”
characterizes the disrupted state of the analysand. Why is this so? Within
the frame of a self-psychologically oriented treatment we conceptualize that
the loss of attunement, the disjointed communication, is experienced as a
loss of intimacy, that is, as a threat to the attachment of analysand to
analyst. Or, in selfobject terminology, we could say that the experience of a
selfobject bond is lost and with it the experience of a cohesive self. Indeed,
numerous observations over many years allow us to assert with a high
degree of reliability that a selfobject bond—whether of a mirroring or
idealizing or alter-ego variety–is a necessary condition for a self state that is
experienced as being whole, cohesive, balanced, and energetic. During a
disruption the self-experience of the analyst will qualitatively include
similar feelings, if he allows himself to become aware of them, though one
may reasonably hope he will be able to resist the regressive and
fragmenting pull of the disruption more effectively than the patient can.

DISCUSSION

The role of interpretation in psychoanalysis depends on the function it is

intended to perform. In the initial phases of an analysis the patient's fear of
the mysteriously dangerous analytic process and fear of the unknown
analyst combine to restrict and distort his associations no matter how
faithfully he has promised to associate freely. During this phase the role of
interpretation is to free the patient of these fears, some of which are
conscious and some of which are unconscious. In accordance with
traditional Freudian precepts, interpretation should start from the surface,
that is, from what the analyst surmises are the analysand's conscious and
most highly charged fears. Conscious ideas and misperceptions can often be
successfully relieved by verbal interventions that are designed to
communicate elucidating and explanatory ideas for the analysand's perusal
and possible acceptance. Unconscious attitudes and anxieties transferred
from past experiences are much more difficult to modify. Simple dynamic
explanations about what is going on unconsciously are usually ineffective
even if they make good sense to the patient. Insight contained in a verbal
statement rarely reaches the analysand's unconscious. It is necessary to
provide an experience for the analysand that is contrary to the unconscious
expectation. Since the unconscious expectation is derived from an early
childhood experience, it leads the analysand to anticipate a relatively
authoritative, parental, guiding, and judging role for the analyst. The
experience of a proper analytic ambience that eschews the authoritarian
milieu of old-style (old country) nursery schools and kindergarten has the
best chance of counteracting the unconscious expectation. A consistent,
benign, listening, and nonmoralizing analyst will blunt the fears and raise
the analysand's hopes of finally being understood by someone who cares.
As the analyst gets to know his patient better, he can gradually address the
specific fears, the so-called resistances. I want to stress, however, that it is
not analysands’ fear of their own impulses, sexual or aggressive or
otherwise, that motivates their resistance. It is fear that past experiences
with the surround will be repeated.

Similar considerations should govern the management of the disruptions

that characterize the middle phase of an analysis. From the patient's point of
view these disruptions as a rule are precipitated by some act of omission or
commission of the analyst. The therapist suddenly is experienced as not
caring or not listening or being mostly concerned with his own agenda.
During this middle phase a unique dynamic situation exists that facilitates
such disruptions. The therapeutic ambience has diminished the patient's
fears, and the repressed archaic needs for selfobject responsiveness become
mobilized. The availability of the therapist as a caring and understanding
selfobject expedites the establishment of a selfobject bond with the
therapist. This newly established intra-analytic selfobject tie strengthens the
self and usually manifests itself as an increasing feeling of well-being as the
analysis progresses. The sudden disconnection of this selfobject tie is
correlated with some disorganization of the self and associated symptoms,
usually anger, anxiety, and depression. The role of interpretation now is to
repair the selfobject tie and through it to restore the therapeutic process.
And again, just as with the so-called resistance interpretations, the verbal
form of the explanation, that is, the content communicated, is much less
important than the experience evoked by the interpretation. Among the
experiences of the analysand elicited by a well-managed interpretation is
the experience of having brought about a modification in the analyst's
behavior: the analyst has admitted that he did something to precipitate the
patient's perception of him, a perception that caused the disruption. Thus the
analyst implies he is more than a mere commenting observer; he is a
responsibly acting and interacting participant. That relieves the patient of
much of his pain and humiliation. Having brought about the analyst's
admission of his part of the responsibility for what happened, the patient
has an experience of having been efficacious, an experience quite in
contrast to the expectation of always feeling helpless and impotent, as he
did in childhood.
In summary, therefore, the role of interpretation is manifold, depending on
the need of the analytic process. The role may be to lower fears or it may be
to provide experiences of efficacy or it may be to communicate insights by
explanations. All three are important and it would only be evidence of an
intellectual bias were I to assign special importance to the provision of
insight.

Let me say in concluding that my downgrading of the verbal aspect of

interpretations and insight does not mean that interpretations are less
important than we have always thought. Since merely knowing something
often has no effect on either thought, affect, or behavior, it has always been
mysterious why insight should be such an important therapeutic factor. Now
we can dynamically explain how the experience evoked by interpretations
and explanations strengthens the very fabric of the self via the strengthening
of the selfobject tie between analyst and analysand. Our therapeutic
approach has become that much more rational and effective.

REFERENCES

Bacal, H. (1985), Optimal responsiveness and the therapeutic process. In:

Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 202–227.

Dupont, J., ed. (1988), The Clinical Diary of Sańdor Ferenczi. Cambridge,
MA: Harvard University Press.

Freud, S. (1895), Studies on hysteria. Standard Edition, 2. London: Hogarth

Press, 1955.

———(1905), On psychotherapy. Standard Edition, 7:257–268. London:

Hogarth Press, 1953.

———(1910), Concerning “wild analysis.” Standard Edition, 12:221–227.

London: Hogarth Press, 1958.

———(1912), Recommendations to physicians practising psycho-analysis.

Standard Edition, 12:109–120. London: Hogarth Press, 1958.
Gay, P. (1988), Freud: A Life for Our Time. New York: Norton.

Glover, E. (1955), The Technique of Psychoanalysis. London: Bailliere,

Tindall & Cox.

———(1949), Psycho-Analysis. London: Staples Press, 2nd ed.

Greenson, R. (1967), The Technique and Practice of Psychoanalysis. New

York: International Universities Press.

Kohut, H. (1981), On empathy. In: The Search for the Self, Vol. 4, P.
Ornstein. New York: International Universities Press, 1991.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

Menninger, K. (1958), Theory of Psychoanalytic Technique. New York:

Basic Books.

Terman, D. (1988), Optimal frustration: Structuralization and the

therapeutic process. In: Progress in Self Psychology, Vol. 4, ed. A.
Goldberg. New York: Guilford Press, pp. 113–125.

Wolf, E. (1992), On being a scientist or a healer: Reflections on abstinence,

neutrality, and gratification. The Annual of Psychoanalysis,, 20:115–129.

1There is no good reason to exclude nonverbal experiences from the

experiences that are constructed by the analyst to bring about modifications
in the analysand. Such a restriction of the concept of interpretation would
miss many, if not most, of the effective interventions by the analyst.
2In English in the original.
3Ferenczi's characterization is called “not implausible” by Gay (1988, p.
529), who documents various instances of Freud's use of “rabble”
(Gesindel).
Chapter 3
Thoughts on the Nature and
Therapeutic Action of
Psychoanalytic Interpretation
Robert D. Stolorow

1 he most general statement that can be made about a psychoanalytic

interpretation is that it is an act of illuminating personal meaning. Since
meaning is something that exists only within a world of subjective
experience, all psychoanalytic interpretations, as Kohut (1959) eloquently
demonstrated, must be informed by the psychoanalyst's empathy, which
provides access to the patient's world of experience. Thus, any discussion of
the nature and therapeutic action of psychoanalytic interpretation must
begin with a consideration of the thorny question of what constitutes the
essence of analytic empathy.

In an important paper delivered at the Eleventh Annual Conference on the

Psychology of the Self in Washington, D.C., Brandchaft (1988) voiced
certain concerns and caveats about the conflation of two uses of the concept
of empathy appearing in Kohut's later writings. In one usage, consistent
with his original pathbreaking essay (1959) on the subject, Kohut (1982)
describes empathy as a “mode of observation attuned to the inner life of
man” (p. 396), an investigatory stance that constitutes the “quintessence of
psychoanalysis” (p. 398). In a second usage he depicts empathy as a
“powerful emotional bond between people” (p. 397) and claims that
“empathy per se, the mere presence of empathy, has ... a beneficial, in a
broad sense, a therapeutic effect—both in the clinical setting and in human
life, in general” (p. 397). The same term, empathy, is being used to
designate both a mode of psychological investigation and a mode of
affective responsiveness and bonding.

In agreement with Brandchaft (1988), I have come to believe that such

conflation of usages contains serious potential pitfalls, as do a number of
otherwise valuable formulations, such as Bacal's (1985) concept of optimal
responsiveness and my (1983) own previously proposed conception of
optimal empathy. Many people who become psychoanalysts have in their
childhood histories a common element of having been required unduly to
serve archaic selfobject functions for a parent (Miller, 1979), a requirement
that is readily revived in reaction to patients’ archaic states and
developmental longings. When empathy is equated with an ideal of optimal
human responsiveness and at the same time rightfully claimed to lie at the
heart of the psychoanalytic process, this can exacerbate the analyst's
counter-transference dilemma, which takes the form of a requirement to
provide the patient with an unbroken selfobject experience uncontaminated
by painful repetitions of past childhood traumata–a requirement now
invoked in the name of Kohut, Bacal, or Stolorow. As Brandchaft (1988)
observes, when an analyst comes under the grip of such a requirement, the
quintessential psychoanalytic aim of investigating and illuminating the
patient's inner experience can become significantly subverted.

Considerations such as these have led my collaborators and me (Stolorow,

Brandchaft, and Atwood, 1987) to reaffirm Kohut's (1959) original
conceptualization of analytic empathy as a unique investigatory stance. We
have characterized this stance as an attitude of sustained empathic inquiry,
an attitude that consistently seeks to comprehend the meaning of a patient's
expressions from a perspective within, rather than outside, the patient's own
subjective frame of reference. I suggest that we restrict the concept of
analytic empathy to refer to this distinctive investigatory stance and use
some other term, such as affective responsiveness, to capture the “powerful
emotional bond between people” (p. 397) that Kohut (1982) believed can
also produce therapeutic effects. By making this suggestion, I do not mean
to imply that analysts should routinely inhibit their natural affective
responsiveness, although under some circumstances it might be desirable to
do so. However, an essential ingredient of the analyst's attitude of empathic
inquiry is his commitment continually to investigate the meaning of his
affective responsiveness, or its absence, for the patient. After all, what is
affective responsiveness for the goose might be something quite different
for the gander. What the analyst experiences as affective responsiveness the
patient may experience as a covert seduction or a promise that revived
archaic longings will literally be fulfilled in a concretized form. On the
other hand, an analyst's emotional reserve can at times be experienced by a
patient as a yearned-for haven of safety in which his own experience can be
articulated free from the requirement to adapt to another's affectivity.
Whether or not the analyst's affective responsiveness will itself have a
beneficial or therapeutic effect will depend on its meaning for the patient.

I wish to stress that our emphasis on inquiry does not mean that the analyst
is constantly asking questions. On the contrary, the analyst uses all the
means at his disposal to facilitate the unfolding and illumination of the
patient's subjective world, which may include prolonged periods of silent
listening and reflection, in which the analyst searches his own world of
experience for potential analogues of what the patient is presenting to him.
Such analogues may be drawn from multiple sources, such as the analyst's
own childhood history, his personal analysis, his recollections of other
patients’ analyses or of case reports by other analysts, his readings of great
works of literature, his knowledge of developmental research, and his
studies of psychoanalytic theories. It is my view that psychoanalytic
theories vary greatly in their capacity to enhance empathic access to the
patient's subjective world and that differing psychoanalytic theories often
address fundamentally different realms of experience. When any theoretical
system is elevated to the status of a metapsychology whose categories are
presumed to be universally and centrally salient for all persons, then I
believe such a theory actually has a constricting impact on analysts’ efforts
to comprehend the uniqueness of their patients’ psychological worlds.

I also wish to emphasize that the attitude of sustained empathic inquiry is

not to be equated with an exclusive preoccupation with conscious elements
in a patient's experience, a common misconception voiced by self
psychology's critics. Indeed, empathie inquiry may be defined as a method
of investigating and illuminating the principles that unconsciously organize
a patient's experiences. Such unconscious principles become manifest, for
example, in the invariant meanings that the analyst's qualities and activities
recurrently come to acquire for the patient. Such meanings may contain
defensive purposes, and failing to investigate unconscious defensiveness
when a patient has shown a developmental readiness for such analysis is not
empathy (Trop and Stolorow, 1991).

I prefer the concept of sustained empathie inquiry to the commonly used

phrase prolonged empathie immersion (Kohut, 1977) partly because the
former, as I have indicated, underscores the analyst's investigative function.
In addition, I believe that the idea of empathie immersion contains another
potential countertransference pitfall, wherein the analyst feels required to
immerse himself completely in the patient's experience, banishing his own
psychological organization from the psychoanalytic dialogue so that he can
gaze directly upon his patient's subjective world with pure and
presuppositionless eyes-surely an impossible feat for even the most gifted
of analysts. Such a requirement defies the profoundly intersubjective nature
of the analytic process, to which the analyst's organizing principles,
including those enshrined in the theory through which he attempts to order
the analytic data, make an inevitable and unavoidable contribution.

My collaborators and I (Atwood and Stolorow, 1984; Stolorow et al., 1987)

have conceptualized the development of psychoanalytic understanding as
an intersubjective process involving a dialogue between two personal
universes. Hence, the process of arriving at a psychoanalytic interpretation
entails making empathic inferences about the principles organizing the
patient's experience, inferences that alternate and interact with the analyst's
acts of reflection upon the involvement of his own subjective reality in the
ongoing investigation. Thus, the attitude of sustained empathic inquiry,
which informs the analyst's interpretations, must of necessity encompass the
entire intersubjective field created by the interplay between the differently
organized subjective worlds of patient and analyst.

Having elucidated my view of the empathie stance that forms the basis for
constructing psychoanalytic interpretations, I turn now to the primary focus
of this chapter: conceptualizing the therapeutic action of psychoanalytic
interpretation. My emphasis on the therapeutic effect of interpretation, as
opposed to noninterpretive elements within the therapeutic interaction,
parallels and complements my reaffirmation of the investigative function of
analytic empathy. I hope, thereby, to provide an answer to those critics—
Mitchell (1988), for example–who mistakenly portray self psychology as
attributing therapeutic action primarily to the analyst's “affective tone and
its emotional impact” (p. 294) rather than to the analyst's interpretations.

There has been a long-standing debate within psychoanalysis over the role
of cognitive insight versus affective attachment in the process of therapeutic
change (see Friedman, 1978, for an excellent historical review of this
controversy). In recent years the pendulum seems to have swung in the
direction of affective attachment, with a number of authors, each from his
own theoretical viewpoint, emphasizing the mutative power of new
relational experiences with the analyst: Kohut (1971, 1977, 1984), who
spoke in terms of the establishment, disruption, and repair of selfobject ties;
Modell (1984), who emphasizes the holding functions of the analytic
setting; Emde (1988) and P. Tolpin (1988), who view the emotional
availability and engagement of the analyst as correcting for early deficits;
and Gill (1982), Weiss and Sampson (1986), and Fosshage (1992), who
stress the new interpersonal experiences with the analyst as disconfirming
transference expectations (for earlier versions of this position see also
Strachey, 1934; Alexander, 1950; Stone, 1957; Fairbairn, 1958; Loewald,
1960). It is my view that once the psychoanalytic situation is recognized as
an intersubjective system, the dichotomy between insight through
interpretation and affective bonding with the analyst is revealed to be a false
one (Stolorow et al., 1987; Stolorow, 1991). The therapeutic impact of the
analyst's accurate transference interpretations, for example, lies not only in
the insights they convey but also in the extent to which they demonstrate
the analyst's attunement to the patient's affective states and developmental
longings. The analyst's transference interpretations, in other words, are not
disembodied transmissions of insight about the analytic relationship; they
are an inherent, inseparable component of that very bond. As Atwood and I
(1984) stated:

Every transference interpretation that successfully illuminates for the

patient his unconscious past simultaneously crystallizes an elusive present
—the novelty of the therapist as an understanding presence. Perceptions of
self and other are perforce transformed ... to allow for the new experience
[p. 60].
It is not so much, I would now add, that existing psychological structures
are thereby changed as that alternative principles for organizing experience
gradually come into being.

Kohut (1984) divided the interpretive process into two phases, a first in
which the analyst conveys an empathic understanding of the patient's
emotional experience and a second in which the analyst offers an
interpretive explanation of that experience. I have not found this
formulation especially congenial because it seems to me to separate the
affective and cognitive components of the analyst's investigative activity,
components that I believe are indissociable. Instead of the two discrete
phases proposed by Kohut, I envision a continuum of interpretations of
increasing cognitive compexity, with both the analyst's affect attunements
and cognitive inferences playing a part at every point along the continuum.
Despite my reservation, however, I find Kohut's formulation of the
interpretive process to be extremely valuable in that it makes explicit what
is implicit in all of his writings, namely, that if an interpretation is to
produce a therapeutic effect, it must provide the patient with a new
experience of being deeply understood. This emphasis on the therapeutic
benefit of new selfobject experiences provided by the analyst's
communications of empathic understanding has been usefully amplified by
a number of contributors to the self psychology literature (Ornstein and
Ornstein, 1980; M. Tolpin, 1987; Bacal, 1990; J. Miller, 1990; Wolf, 1990;
Lindon,1991).

But now, in an apparent reversal of my earlier position, I wish to point out a

potential pitfall of this emphasis on the newness of the selfobject
experiences provided by the analyst's empathic communications: the danger
of neglecting the contribution of the patient's psychological organization—
what Bacal (1990) describes as the patient's “creative phantasy” (p. 369)–to
the therapeutic impact of the analyst's interpretations (see also Brandchaft,
1991). To the current emphasis on new relational experiences, I wish to add
the essential therapeutic contribution of something old, something derived
from the patient's psychological depths, namely, the specific transference
meaning for a particular patient at a particular point in the analysis of the
experience of being understood, a meaning that itself will eventually need
to be investigated and interpreted (Gill, 1982). It is my central thesis here
that such specific transference meanings constitute a crucial ingredient of
the therapeutic action of psychoanalytic interpretations and that this applies
both to transference interpretations and to interpretations of
extratransference material (see A. Ornstein, 1990).

Winnicott (1954) claimed that “whenever we understand a patient in a deep

way and show that we do so by a correct and well-timed interpretation we
are in fact holding the patient” (p. 261). Winnicott here seems to assume
that the experience of being understood has a single transference meaning,
the feeling of being held, that applies universally to all patients across the
board. In contrast, I envision a vast multiplicity of possible transference
meanings, with the specific meaning of the analyst's attuned interpretations
being determined by the particular developmental needs and longings
mobilized in the transference at any given juncture. Let me illustrate with a
brief vignette.1

Stuart sought analysis at the age of 26 to find relief from tormenting states
of obsessional rumination that regularly followed injurious experiences that
made him feel intensely vulnerable, anxious, overwhelmed, and confused.
The older of two children, he described his father as a passive presence in
the home, seemingly controlled by his wife and appearing weak and
helpless in the face of her frequent outbursts of rage. In relation to himself,
Stuart experienced his father as distant, uninterested, and emotionally
unavailable. The patient described his mother as anxious, unhappy, and
frequently overwhelmed, and also as intrusive and “controlling [his]
identity.” He felt he had to function as a “substitute husband” for her and to
be a “father” to his younger sister, to “set an example for her” by
suppressing his own emotional reactions to events within the family. He
was always aware of his mother's emotions, he said, and felt responsible for
comforting her when she was upset. Being organized around her neediness
made him feel “special” to her, but his specialness had come at the price of
a constant requirement to be “big” and “strong” in order to take care of her
and maintain her emotional equilibrium. When he brought his own
difficulties to her in the hope of a comforting response, she would become
frustrated and overwhelmed and invariably tell him to leave her alone.
The most profound emotional truth of Stuart's childhood was his sense of
being totally alone with painful experiences, both within and outside the
family. He felt a complete absence of a strong, idealizable figure who could
protect him and help guide him through painful situations; hence, he turned
to his own excellent mind to find a sense of control and safety. Omnipotent
thought became his substitute for the missing idealizable parent, setting the
foundation for his later obsessional symptomatology.

As might be expected in light of this history of profound emotional neglect

and abandonment, the early months of Stuart's analysis centered around his
fears of exposing his needs to his female analyst. He felt that he had to be
big and strong and brave in order to please the analyst, and he expected her
to desert or punish him for expressing any wish to be taken care of. He
feared that the analyst, like his mother, would be overwhelmed by his needs
and painful feelings and that she would become injured and even
“destroyed” if he were to voice any angry reactions to her disappointing
him. Gradually and conflictually, Stuart began to acknowledge his growing
attachment to the analyst, along with the disruptive impact of separations
from her, which evoked severe anxiety and an intensification of his
obsessional brooding. After about 18 months of analysis, he was able to
articulate a deep yearning for the analyst to provide complete protection
from painful affect.

Around this time, the analyst's accurate interpretations of the meanings of

the patient's painful emotional experiences, both within and outside the
transference, began to produce remarkable effects. Here is a sampling of his
reactions to interpretations that provided him with the experience of being
understood:

I feel so good. You're an expert, taking care of me. I feel happy, protected,
in the right place.

I feel protected by you. I have a resource, so I'm able to feel sad and
uncertain.

Oooh! I'm feeling really happy. You're helping me, giving me direction.
You're calm and strong, not frivolous like my mother. This is big-time help!
I feel so good here, hearing your sweet voice behind me. You know things;
you're clear and logical. You're in charge of the situation, and I feel
protected, less vulnerable.

Following therapeutic moments such as these the patient would experience

states of calm of increasing duration, and his obsessional preoccupations
would diminish and even disappear. His anxiety and obsessional thinking
would return, of course, in reaction to misattunements and separations,
although less so as the treatment progressed, and his disruptive reactions,
wherein the analyst became the emotionally abandoning mother of his
childhood, still needed to be analyzed. But what I wish to stress here is that
at this point the powerfully ameliorative impact of the analyst's attuned
interpretations and of the patient's consequent feeling of being understood
derived from the profound transference meaning that both had come to
acquire for him. They materialized the analyst as the deeply longed-for,
calm, strong, knowing, and protective mother so sorely absent during his
childhood. To the extent that the patient now felt protected by an idealizable
parent, the illusory protection afforded by the activity of his own mind
became unnecessary and dispensable.

Similar observations can be made about the therapeutic effect of the

transference meaning of interpretations when other selfobject needs are in
the foreground. For a patient immersed in a primary mirror transference, the
experience of being understood can evoke a sense of being deeply treasured
by the analyst, of having attained a position at the very center of the
analyst's world. In the context of a twinship transference, the analyst's
understanding can be organized as evidence of the patient having found the
yearned-for soul mate whose experiential sameness promises to alleviate
lifelong feelings of painful singularity. Interpretations of defensiveness, in
some instances, can establish the analyst in the transference as an
idealizable, benign adversary (Lachmann, 1986; Wolf, 1988), facilitating
the patient's demarcation of self-boundaries. All such transference
experiences, as Kohut (1971, 1977, 1984) repeatedly emphasized,
reanimate stalled development and thereby fuel the process of therapeutic
transformation.
Anyone who has conducted an analysis from a self psychology perspective
has witnessed the enormous therapeutic benefits of analyzing ruptures in
selfobject transference ties. Throughout his writings, Kohut (1971, 1977,
1984) explained these therapeutic effects by invoking his theory of optimal
frustration leading to transmuting internalization, an explanation that has
been questioned by a number of self-psychologically minded authors
(Socarides and Stolorow, 1984/1985; Bacal, 1985; Stolorow et al., 1987;
Terman, 1988). How might the therapeutic action of analyzing disruptions
be explained according to the thesis I have been developing here?

Most patients who come to us for analysis have, as children, suffered

repeated, complex experiences of selfobject failure, which I conceptualize
schematically as occurring in two phases. In the first phase a primary
selfobject need is met with rebuff or disappointment by a caregiver,
producing a painful emotional reaction. In the second phase the child
experiences a secondary selfobject longing for an attuned response that
would modulate, contain, and ameliorate his painful reactive affect state.
But parents who repeatedly rebuff primary selfobject needs are usually not
able to provide attuned responsiveness to the child's painful emotional
reactions. The child perceives that his painful reactive feelings are
unwelcome or damaging to the caregiver and must be defensively
sequestered in order to preserve the needed bond. Under such
circumstances, as my collaborators and I (Socarides and Stolorow, 1984/85;
Stolorow et al., 1987) have stressed, these walled-off painful feelings
become a source of lifelong inner conflict and vulnerability to traumatic
states, and in analysis their re-exposure to the analyst tends to be
strenuously resisted.

In light of this developmental formulation, how might we conceptualize the

therapeutic impact of analyzing disruptions of selfobject transference ties,
that is, transference repetitions of experiences of primary selfobject failure?
In conducting such an analysis, the analyst investigates and interprets the
various elements of the rupture from the perspective of the patient's
subjective frame of reference–the qualities or activities of the analyst that
produced the disruption, its specific meanings, its impact on the analytic
bond and on the patient's self-experience, the early developmental traumata
it replicates, and, especially important, the patient's expectations and fears
of how the analyst will respond to the articulation of the painful feelings
that follow in its wake (Stolorow et al., 1987). I believe that it is the
transference meaning of this investigative and interpretive activity that is its
principal source of therapeutic action in that it establishes the analyst in the
transference as the secondarily longed-for, receptive, and understanding
parent who, through his attuned responsiveness, will “hold” (Winnicott,
1954) and thereby eventually alleviate the patient's painful emotional
reaction to an experience of primary selfobject failure. The selfobject tie
becomes thereby mended and expanded, and primary selfobject yearnings
are permitted to emerge more freely as the patient feels increasing
confidence that his emotional reactions to experiences of rebuff and
disappointment will be received and contained by the analyst.
Concomitantly, a developmental process is set in motion wherein the
formerly sequestered painful reactive affect states, the heritage of the
patient's history of traumatic developmental failure, gradually become
integrated and transformed and the patient's capacity for affect tolerance
becomes increasingly strengthened.

There is an additional transference meaning of the analyst's attuned

interpretive activity that I believe may contribute a therapeutic element in
all analyses but is especially important in the treatment of patients who
have suffered severe developmental derailments in the articulation of
perceptual and affective experience. These are patients often prone to
fragmented, disorganized, or psychosomatic states, for whom broad areas of
early experience failed to evoke validating attunement from caregivers and,
consequently, whose perceptions remain ill-defined and precariously held,
easily usurped by the judgments of others, and whose affects tend to be felt
as diffuse bodily states rather than symbolically elaborated feelings. In such
cases the analyst's investigation and illumination of the patient's inner
experiences, always from the patient's perspective, serve to articulate and
consolidate the patient's subjective reality, crystallizing the patient's
experience, lifting it to higher levels of organization, and strengthening the
patient's confidence in its validity. The analyst thereby becomes established
in the transference as the missing and longed-for validator of the patient's
psychic reality, a selfobject function so fundamental and basic that my
collaborators and I (Trop and Stolorow, 1991; Stolorow, Atwood, and
Brandchaft, 1992) believe that its appearance in analysis deserves to be
designated by a specific term: the “self-delineating selfobject transference.”

I would like now to place my discussion of the therapeutic action of

psychoanalytic interpretation within the broader framework of the
conceptualization of transference that my collaborators and I (Stolorow et
al., 1987) have previously proposed. In this formulation the transference,
viewed as the product of unconscious organizing activity (Stolorow and
Lachmann, 1984/1985), is seen to consist of two basic dimensions: In one
dimension are the patient's yearnings and hopes for selfobject experiences
that were missing or insufficient during the formative years. In the other
dimension, which is a source of conflict and resistance, are his expectations
and fears of a transference repetition of the original experiences of
selfobject failure (A. Ornstein, 1974). All well-conducted analyses, we have
suggested, are characterized by inevitable, continual shifts in the figure–
ground relationships between these two dimensions of the transference as
they oscillate between the foreground and background of the patient's
experience of the analytic bond, shifts and oscillations that are profoundly
influenced by whether or not the analyst's interpretive activity is
experienced by the patient as being attuned to his affective states and needs.
When the analyst's interpretations are experienced as unattuned or
misattuned, foreshadowing a traumatic repetition of early developmental
failure, the conflictual and resistive dimension of the transference is
frequently brought into the foreground, while the patient's selfobject
longings are driven into hiding. Attuned interpretations, by contrast, evoke,
strengthen, and expand the selfobject dimension of the transference, and
herein, I have argued, lies a principal source of their therapeutic effects.2

In closing, I wish to emphasize that by bringing to focus the therapeutic

impact of the transference meanings of psychoanalytic interpretations, I do
not discount the existence of other sources of therapeutic action, including
those that may derive from enhancements of the patient's self-reflective
capacity (Brandchaft and Stolorow, 1990) or from the meanings of
noninterpretive elements within the therapeutic process. I do hope to have
demonstrated that the therapeutic action of psychoanalytic interpretation is
something that takes form within a specific intersubjective interaction to
which the psychological organizations of both analyst and patient make
distinctive contributions. The analyst, through sustained empathic inquiry,
constructs an interpretation that enables the patient to feel deeply
understood. The patient, from within the depths of his own subjective
world, weaves that experience of being understood into the tapestry of his
unique, mobilized selfobject yearnings, enabling a thwarted developmental
process to become reinstated. Psychoanalytic interpretations, I am
contending, derive their mutative power from the intersubjective matrix in
which they crystallize.

REFERENCES

Alexander, F. (1950), Analysis of the therapeutic factors in psychoanalytic

treatment. Psychoanal. Quart., 19:482–500.

Atwood, G. & Stolorow, R. (1984), Structures of Subjectivity. Hillsdale, NJ:

The Analytic Press.

Bacal, H. (1985), Optimal responsiveness and the therapeutic process. In:

Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 202–226.

———(1990), The elements of a corrective selfobject experience.

Psychoanal. Inq., 10:347–372.

Brandchaft, B. (1988), Critical issues in regard to empathy. Presented at the

Eleventh Annual Conference on the Psychology of the Self, Washington,
DC, October 16.

———(1991), Countertransference in the analytic process. In: The

Evolution of Self Psychology, ed. A. Goldberg. Hillsdale, NJ: The Analytic
Press, pp. 99–105.

———& Stolorow, R. (1990), Varieties of therapeutic alliance. The Annual

of Psychoanalysis, 18:99–114. Hillsdale, NJ: The Analytic Press.

Emde, R. (1988), Development terminable and interminable: II. Recent

psychoanalytic theory and therapeutic considerations. Internat. J. Psycho-
Anal., 69:283–296.
Fairbairn, W. R. D. (1958), On the nature and aims of psycho-analytical
treatment. Internat. J. Psycho-Anal, 39:374–385.

Fosshage, J. (1992), Self psychology: The self and its vicissitudes within a
relational matrix. In: Relational Perspectives in Psychoanalysis, ed. N.
Skolnick & S. Warshaw. Hillsdale, NJ: The Analytic Press.

Friedman, L. (1978), Trends in the psychoanalytic theory of treatment.

Psychoanal. Quart., 47:524–567.

Gill, M. (1982), Analysis of Transference, Vol. 1. Madison, CT:

International Universities Press.

Kohut, H. (1959), Introspection, empathy, and psychoanalysis, J. Amer.

Psychoanal. Assn., 7:459–483.

———(1971), The Analysis of the Self. Madison, CT: International

Universities Press.

———(1977), The Restoration of the Self. Madison, CT: International

Universities Press.

———(1982), Introspection, empathy, and the semicircle of mental health.

Internat. J. Psycho-Anal., 63:395–407.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

Lachmann, F. (1986), Interpretation of psychic conflict and adversarial

relationships. Psychoanal. Psychol., 3:341–355.

Lindon, J. (1991), Does technique require theory? Bull. Menn. Clin., 55:1–
21.

Loewald, H. (1960), On the therapeutic action of psychoanalysis. Internat.

J. Psycho-Anal, 41:16–33.

Miller, A. (1979), Prisoners of Childhood. New York: Basic Books, 1981.

Miller, J. (1990), The corrective emotional experience. Psychoanal. Inq.,
10:373–388.

Mitchell, S. (1988), Relational Concepts in Psychoanalysis. Cambridge:

Harvard University Press.

Modell, A. (1984), Psychoanalysis in a New Context. Madison, CT:

International Universities Press.

Ornstein, A. (1974), The dread to repeat and the new beginning. The
Annual of Psychoanalysis, 2:231–248. New York: International Universities
Press.

———(1990), Selfobject transferences and the process of working through.

In: The Realities of Transference, ed. A. Goldberg. Hillsdale, NJ: The
Analytic Press, pp. 41–58.

Ornstein, P. & Ornstein, A. (1980), Formulating interpretations in clinical

psychoanalysis. Internat. J. Psycho-Anal., 61:203–211.

Socarides, D. & Stolorow, R. (1984/1985), Affects and selfobjects. The

Annual of Psychoanalysis, 12/13:105–119. New York: International
Universities Press.

Stolorow, R. (1983), Self Psychology: A structural psychology. In:

Reflections on Self Psychology, ed. J. Lichtenberg & S. Kaplan. Hillsdale,
NJ: The Analytic Press, pp. 287–296.

———(1991), The intersubjective context of intrapsychic experience.

Psychoanal. Inq., 11:171–184.

———Atwood, G. & Brandchaft, B. (1992), Three realms of the

unconscious and their therapeutic transformation. Psychoanal. Rev., 79:25–
30.

———Brandchaft, B. & Atwood, G. (1987), Psychoanalytic Treatment.

Hillsdale, NJ: The Analytic Press.
———& Lachmann, F. (1984/1985), Transference: The future of an
illusion. The Annual of Psychoanalysis, 12/13:19–37. New York:
International Universities Press.

Stone, L. (1957), Book review of Psychoanalysis and Psychotherapy by F.

Alexander. Psychoanal. Quart., 26:397–405.

Strachey, J. (1934), The nature of the therapeutic action of psychoanalysis.

Internat. J. Psycho-Anal., 15:127–159.

Terman, D. (1988), Optimum frustration: Structuralization and the

therapeutic process. In: Learning from Kohut, ed. A. Goldberg. Hillsdale,
NJ: The Analytic Press, pp. 113–125.

Tolpin, M. (1987), Discussion of “The Analyst's Stance” by M. Black. The

Annual of Psychoanalysis, 15:159–164.

Tolpin, P. (1988), Optimal affective engagement: The analyst's role in

therapy. In: Learning from Kohut, ed. A. Goldberg. Hillsdale, NJ: The
Analytic Press, pp. 160–168.

Trop, J. & Stolorow, R. (1991), A developmental perspective on analytic

empathy.J. Amer. Acad. Psychoanal., 19:31–46.

Weiss, J. & Sampson, H. (1986), The Psychoanalytic Process. New York:

Guilford Press.

Winnicott, D. (1954). Withdrawal and regression. In: Through Paediatrics

to Psycho-Analysis. London: Hogarth Press, 1958, pp. 255–261.

Wolf, E. (1988), Treating the Self. New York: Guilford Press.

———(1990), Clinical responsiveness: Corrective or empathic?

Psychoanal. Inq., 10:420–432.

1I
am indebted to Dr. Elizabeth Asunsolo for providing me with the clinical
material for this vignette.
2Sometimes disruptions can occur that are quite confusing to the analyst:
because of unrecognized shifts in the patient's psychological organization,
interpretations that were once experienced within the selfobject dimension
of the transference suddenly become assimilated into the
repetitive/conflictual/resistive dimension, producing unexpected
exacerbations of the patient's suffering and manifest symptomatology (Trop
and Stolorow, 1991).

This chapter is dedicated in loving memory to Dr. Daphne S. Stolorow.

Chapter 4
Interpretation in a Developmental
Perspective
Frank M. Lachmann

Beatrice Beebe

Historically, the role of interpretation in psychoanalytic treatment was

consonant with a model of development in which the child needed to be
enticed out of its autistic-narcissistic shell through the influence of reality as
mediated by parents. The infant was believed to be unaware of its
surroundings, protected by a stimulus barrier against impingements from
the external world, and responsive only to inner urges of hunger, pain,
aggressive discharges, and libidinal needs. Early development consisted of
a laborious process of distinguishing between id and ego, inside and
outside, fantasy and reality. For an adult patient to be able to utilize
interpretations, considerable sophistication in having made these
distinctions was necessary. Psychotic and narcissistic patients were
unenticeable and hence unanalyzable. The analyst's interpretations had to
strengthen the patient's relationship to reality and lessen the regressive pull
of the id, with the observing ego functions remaining relatively intact.

The advent of empirical work on infancy, reformulations of the concept of

transference, and the clinical-theoretical contributions of self psychology
challenged the traditional model of development and its role in explaining
the therapeutic action of psychoanalysis. Self psychologists have
demonstrated that patients previously regarded as unanalyzable turn out to
form analyzable selfobject transference. The analyst's interpretive activity is
now understood to include a range of therapeutic endeavors. According to
Wolf (this volume) it includes “all (the) intentional interventions by the
analyst, verbal and non-verbal, that modify the analysand's psyche.”
According to Stolorow (this volume), “the therapeutic action of
psychoanalytic interpretation ... takes from within a specific intersubjective
interaction to which the psychological organization of both analyst and
patient make distinctive contributions.” Together Wolf and Stolorow
recognize the totality of the analytic relationship in its effect on the patient's
psyche. They emphasize the emotional availability and responsivity of the
analyst and the effect of a loss of such attunement on the therapeutic
relationship. They consider affect to be a quality of the dyad and note that
breaches in the affective tie result in a loss of intimacy. The threatened
connection between the analysand and the analyst then requires attention so
that ruptures can be restored. For Stolorow this attunement is organized
within the patient-analyst interaction, an intersubjective field. Wolf
emphasizes that the analyst must continuously provide and maintain an
ambience in which the patient can experience the freedom to reflect upon
his anxieties. The contributions to the curative process made by the patient-
analyst interactions are recognized by both Stolorow and Wolf.

In the evolution of psychoanalysis the importance of affect, the moment of

affective urgency (Strachey, 1934; Fenichel, 1938–1939; Greenson, 1967),
has been recognized as optimal for the making of interpretations. There has
always been a concern that interpretations would fall prey to the patient's
resistive, intellectualizing processes. Self psychology and the contributions
by Wolf and Stolorow provide a clinical guide for avoiding this pitfall
through their emphasis on monitoring the patient's reactions and attending
to ruptures in the selfobject tie.

In addition, the clinical illustrations offered by Stolorow and Wolf permit us

to consider interpretations from the developmental perspective we have
been studying (Beebe and Lachmann, 1988a, b; Lachmann and Beebe,
1989). Our perspective on the therapeutic action of interpretations differs
from the one employed by traditional psychoanalysis and is consistent with
the clinical theory of self psychology.

In the case described by Stolorow, the analyst interpreted the patient's

obsessional symptomatology as derived from his need for idealizable
parents. The patient's excellent mind and the omnipotence accorded to his
thoughts shielded him from the danger of experiencing his need for his
unavailable father and overanxious mother. The interpretation had an
immediate effect on the patient's experience of the analytic situation. In the
past the patient needed to defend against the expectation that his yearnings
for his parents would be unmet. In contrast, he could now permit his
yearnings for the analyst to emerge. The patient's responses describe the
change in his state. From feeling bad about himself he felt “good ... taken
care of ... happy ... protected.” From an experience of jeopardy, feeling he
was in the hands of a parent who needed him to be the expert, he changed to
a state in which he felt relieved of this prematurely imposed burden. He
said to his analyst, “You're an expert.”

In his first case illustration Wolf described a patient who elaborated upon
his depression and sudden bursts of excitement. His pervasive state was one
of helplessness, hopelessness, and a dread of being left alone to this fate.
Wolf's interpretation addressed this sense of hopelessness and included his
impression that the patient wished to have these expectations disconfirmed.
Wolf indicated that this was not a complete interpretation because genetic
material was not included. If we follow the model presented in Stolorow's
case, we might include in the interpretation a recognition that in the past, in
contrast to the current analytic relationship, the patient had found it
necessary to conceal his reactive disappointment and anger. Nevertheless,
even without the genetic material and solely on the basis of the
interpretation that his superficially hostile facade concealed his fear of
being given up on, the patient's state changed and he felt “relaxed.” With
additional genetic material, additional affective and bodily states could have
been revived, and transformed as well.

Interpretations potentially organize a heightened affective and cognitive

moment; a visceral and kinesthetic shift may be experienced, as well as a
cognitive reorganization involving surprise and novelty (Reik, 1935; Wolf
1991). Both the Stolorow and the Wolf examples dramatically illustrate
these changes in the patient's self-state. We use these two illustrations to
propose that the interpretive process entails self-state transformations.

Our use of the term self-state draws on contributions from two sources:
Stern's (1983, 1985) and Sander's (1983) discussions of state transformation
and the self-regulating other and Kohut's (1980, 1984) discussion of self
states, as they are seen in self-state dreams.

Stern's (1985) use of the term self-regulating other refers to the caregiver
who regulates the infant's states of arousal, affect intensity, and security of
attachment. “The infant is with an other who regulates the infant's own self
experience” (p. 102). State refers to the variations in sleep and wakefulness
that occur as the infant passes between crying and alert periods; between
quiet activity, drowsiness, and sleep; between wet discomfort and dry
comfort; and between hunger and satiation. However, these states of
alertness, arousal, activity, and sleep are socially negotiated, a product of
the mutual regulation system (Sander, 1983). Sander suggests that the
earliest self is organized around the infant's recognition of recurrent,
predictable transitions of state, in particular, interactive contexts. Thus,
early state transformations are related to both self-regulatory capacity and
the expectation that the mutual regulatory system will facilitate or interfere
with these transformations.

In psychoanalytic theory state changes have generally been associated with

drive satisfactions. For example, being fed when hungry is assumed to lead
to libidinal attachment of the infant to the hunger-drive-satisfying object.
The caretaker's ministrations to the infant, whether through feeding,
diapering, or soothing, are assumed to strengthen the infant's attachment to
the caretaker.

Various clinicians and researchers (e.g., Ainsworth et al., 1978; Bowlby,

1980; Stern, 1983, 1985) have proposed a contrasting view. They hold that
there are numerous interactions that promote attachment between infants
and their caretakers that have nothing to do with drive gratification. The
interactions that promote attachment are mutually regulated, reciprocal
exchanges in which each partner influences the other on a moment-to-
moment basis. Stern (1983) categorizes these mutual regulations as state
sharing (e.g., mutual cooing) and self–other complementarity (e.g., a ball
pushed back and forth between the infant and the caretaker).

The caretaking ministrations that occur during feeding, changing, and

calming, Stern (1983) argues, are represented by the infant as state
transformations. However, Stern places state transformations in a different
category from state sharing and complementarity: “The experience of being
hungry, getting fed, and going blissfully to sleep does not, even when
associated with a particular person, lead to subjective intimacy with the
feeding person, unless accompanied by self-other complementing and state
sharing” (p. 79). We hold that these caretaking ministrations dramatically
transform self-states. With the advent of symbolic capacities and increasing
elaboration upon one's subjective experience, self-states in the child and
adult include the domain of the self in a psychological sense. Post-infancy
self-state transformations may increase a sense of control, mastery, or
agency.

Psychopathology can be reflected through a kind of dream, delineated by

Kohut (1984) as a self-state dream, in which the imagery is an undisguised
or only minimally disguised depiction of the dreamer's sense of self. Self-
states may be depicted in dreams as “an empty landscape, burned-out
forests, decaying neighborhoods ... an airplane out of control that wildly
flies higher and higher” (Kohut, 1980, p. 508). These dreams herald self
experiences such as aimlessness, depression, hypomania, fragmentation,
despair, or hopelessness.

The analyst's understanding and recognition of the self-state constitutes an

interpretation and contributes to the selfobject tie.

Our use of self-state is broader than Stern's inasmuch as we extend this

perspective into adult life. Like Stern, however, we distinguish affect,
cognition, and arousal. How each of these aspects of self-state is affected
will differ from one person to the next. Our use of the term is not confined
to the dream imagery. Dreams provide a glimpse into a person's self-state,
but moods, symptoms, and transference manifestations may reflect self-
states as well.

We use the term “self-state” to propose that it is at this level of

psychological organization that psychoanalysis exercises its therapeutic
action. And it is at this level that interpretations exercise their therapeutic
effect. We do not confine the impact of interpretations to affect alone.
Affect provides a significant dimension of the transformational experience
but it is not its totality. Affects are encoded in a meaningful, symbolically
rich context. The fact that an analyst's formulations contain elements of
surprise (Reik, 1935) and novelty to the patient that are instrumental in the
transformative experience illustrates the indispensable role of cognition as
well. We include cognitive, affective, and somatic dimensions of experience
as aspects of the self-state and its transformations.

Affects and moods reflect self-states, dream imagery conveys their

pervasive presence, and psychopathology or a sense of well-being arises
from them. These mediators of self-states may reach awareness and be
accessible to self-reflection and empathic inquiry by an analyst. “Feeling
different” may accompany the transforming experience.

It is in this context that we refer to Brandchaft's (1988) and Stolorow's

(1991) emphasis on distinguishing between empathy as a mode of
investigation and empathy as a description of a mode of responsiveness. As
discussed by Stolorow, the analyst's sustained empathic inquiry may be
experienced by a patient in a variety of ways; we propose that one of these
is as a sharing of states.

In his second and third illustrations Wolf described treatment incidents in

which the analytic ambience was disrupted, in one instance by the meaning
the patient gave to the analyst's jotting down a note and in the other instance
by the meaning for the patient of the analyst's perfunctory acknowledgment
of the death of the patient's cat. For these patients there was a disruption of
both the ongoing shared state and of the back-and-forth interaction between
analyst and patient.

These two illustrations differ significantly from Wolf's first case and from
Stolorow's case, which utilize interpretations par excellence. In the case of
the patient who relaxed after the interpretation and the patient who could
permit his longings for the analyst to be expressed, the dramatic self-state
transformation became foreground. Although the selfobject tie and the
relational dimension were critical at the moment of transformation, we are
proposing that an enhanced sense of self took precedence. These
interpretations par excellence “modified the analysand's psyche” (Wolf,
1991). In Wolf's second and third examples the nature of the therapeutic
interaction was different. The analytic ambience was disrupted and the
specific focus of the interpretation was to reestablish the ruptured selfobject
tie. It is this tie, rather than the self-state, that is retained in the foreground.
In early development, state transformations (e.g., from crying to calming or
from hunger to satiation) are socially negotiated, a product of the mutual
regulatory system (Sander, 1983). They contribute both the self-regulatory
capacity and the mutual regulatory system. In adult treatment,
interpretations transform self-states with respect to such dimensions as
intactness-fragmentation, depletion–vitality, and freedom of the self-
regulatory range. Self-state transformation is crucial for an understanding
from our developmental perspective of the therapeutic action of
interpretation.

We propose that the interpretive process involves all three aspects of the
self-with-other (Stern, 1983) but that its therapeutic action lies in the
transformation of the self-state, with state sharing and complementarity in
the background. In our use of Stern's concepts we do not assume direct
linear translations between infant and adult organizations. We use infant
research to provide evocative metaphors and organizing principles. Thus,
the two vignettes in which Wolf restored ruptures are instances in which
state sharing and complementarity are prominent but these vignettes do not
illustrate the heightened and poignant affective and cognitive
reorganizations that accompany the transformation of the self-state. In
Wolf's first case and in Stolorow's case the self-state became a foreground
experience, as reported by each patient and observed by each analyst.

An interpretation may be influential because it provides an experience of

mutuality through self-other complementarity or a sense of merger through
the sharing of an intimate moment. We include here the patient's experience
of the analyst's empathic inquiry and analyst-patient interactions such as
rupture and repair of the selfobject tie. However, interpretations par
excellence must in addition, as Wolf noted, “modify the analysand's
psyche” through self-state transformations.

Self psychology is often misunderstood and misrepresented as requiring

only empathic activity on the part of the analyst. Both Wolf and Stolorow
have emphasized the importance of interpretation and have distinguished it
from the centrality of sustained empathic inquiry. Empathie inquiry will be
represented by the analysand as part of the mutual regulatory system of
self-with-other, patient-with-analyst. As Stolorow pointed out, the meaning
of being the center of the analyst's empathie inquiry will be determined by
the patient's individual organizing themes. These themes will be subjective
elaborations of self-with-other. Being the subject of empathie inquiry is
often experienced by a patient as feeling understood, being understandable,
and expecting to be understood. However, empathie inquiry is not all that
the analyst contributes to the analytic process. Both Stolorow and Wolf
have outlined the critical role of the analyst's interpretive activity.

The analyst's interpretive activity transforms the patient's self-state. It

contributes the patient's capacity to reorganize his state— usually in a
positive direction. Interpretations are optimally effective when the patient
experiences the alteration in self-state against a background of the tie to the
analyst. We propose that these moments accrue to the patient's self-
regulatory capacity. As a consequence of the self-state transformation the
range and freedom of the self-regulatory capacity is enhanced, internal
reorganization occurs, and the state of the self is shifted along the
dimension of fragmentation-intactness toward greater cohesion and along
the dimension of depletion-vitality toward a richer affective repertoire.

There are two implications that we draw from these proposals. First,
treatments that only lead the patient toward interpretations or, on the other
hand, treatments that emphasize only the therapeutic relationship, supplying
“empathy” or providing a “holding environment,” may fail to offer the
patient the possibility of the transformations of self-state through
interpretation. For the patient, this dimension of experience contributes to,
elaborates, and affirms self-regulation. Second, treatments that emphasize
interpretation without attention to the patient's subjective experience fail to
offer the patient the possibility of self-with-other state sharing and
complementarity. These are required for the transformations of self-state
through interpretation. Interpretations without the sustained self-object tie,
or interpretations that rupture the selfobject tie (Lachmann and Beebe,
1992), can be experienced as shattering the sense of self.

Self-state changes are mutually organized events that transform and

reorganize experience and promote self-regulation, vitality, and cohesion.
The process of interpretation derives its effectiveness from its
transformation of the patient's subjective states. The chapters by Wolf and
Stolorow contain excellent illustrations of such self-state transformations:
interpretations par excellence.

REFERENCES

Ainsworth, M., Blehar, M., Waters, E. & Wall, S. (1978), Patterns of

Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ:
Lawrence Erlbaum Associates.

Beebe, B. & Lachmann, F. M. (1988a), Mother-infant mutual influence and

precursors of psychic structure. In: Frontiers in Self Psychology: Progress
in Self Psychology, Vol. 3, ed. A. Goldberg. Hillsdale, NJ: The Analytic
Press, pp. 3–25.

—————(1988b), The contribution of mother-infant mutual influence to

the origins of self and object representations. Psychoanal. Psychol., 3:305–
337.

Bowlby, J. (1980), Attachment and Loss, Vol. 3. New York: Basic Books.

Brandchaft, B. (1988), Critical issues in regard to empathy. Presented at the

11th Annual Conference on the Psychology of the Self, Washington, DC,
October 16.

Fenichel, O. (1938–1939), Problems of Psychoanalytic Technique, trans. D.

Brunswick. New York: Psychoanalytic Quarterly Press, 1941.

Greenson, R. R. (1967), The Technique and Practice of Psychoanalysis.

New York: International Universities Press.

Kohut, H. (1980), Selected problems in self psychological theory. In: The

Search for the Self, Vol. 4, ed. P. Ornstein. Madison, CT: International
Universities Press, 1991, pp. 489–523.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.
Lachmann, F. M. & Beebe, B. (1989), Oneness fantasies revisited.
Psychoanal. Psychol. 6:137–148.

—————(1992) Representational and selfobject transferences: A

developmental perspective. In: Progress in Self Psychology, Vol. 8, ed. A.
Goldberg. Hillsdale, NJ: The Analytic Press, pp. 3–15.

Reik, T. (1935), Surprise and the Psychoanalyst: On the Conjecture and

Comprehension of Unconscious Processes. New York: Dutton, 1937.

Sander, L. (1983), To begin with: Reflections on ontogeny. In: Reflections

on Self Psychology, ed. J. Lichtenberg & S. Kaplan. Hillsdale, NJ: The
Analytic Press, pp. 85–104.

Stern, D. (1983), The early development of schemas of self, of other, and of

“self-with-other.” In: Reflections on Self Psychology, ed. J. Lichtenberg &
S. Kaplan. Hillsdale, NJ: The Analytic Press, pp. 49–84.

———(1985), The Interpersonal World of the Infant. New York: Basic

Books.

Strachey, J. (1934), The nature of the therapeutic action of psycho-analysis.

Internat. J Psycho-Anal. 15:127–159.
Chapter 5
Commentary on Papers by
Stolorow and by Wolf
Robert J. Leider

In other chapters of this section Stolorow and Wolf consider the role of
interpretation in therapeutic change. Both follow a similar expository path.
Each provides a definition of interpretation, describes its role in the
therapeutic process, compares its role with that of other elements in the
therapeutic situation, and attempts to delineate the factors he considers
essential to the curative process. In addition, as a subsidiary topic, both
comment on the relation of theory to observation and understanding.

Unfortunately, I cannot do justice here to the topic or to the many ideas

presented by Stolorow and Wolf. I will, therefore, not note the many points
on which I agree but, rather, in the hope of stimulating further thought, will
focus on those with which I disagree. I will select salient topics, compare
the views of Wolf and Stolorow, and offer some comments of my own.

THE DEFINITION OF INTERPRETATION

Stolorow begins by saying that a psychoanalytic interpretation is “an act of

illuminating personal meaning.” He makes it clear that he, at least
theoretically, differentiates interpretation from other, noninterpretive,
elements within the therapeutic situation. Wolf, on the other hand, uses a
much broader definition of interpretation, one that includes not only verbal
statements but all intentional activities intended to bring about a
modification of the analysand's psyche. Stolorow's definition is consistent
with the customary meaning of interpretation, that of Wolf is not.1
Wolf does not explicitly delineate his reasons for adopting such an all-
inclusive definition, but two major considerations apparently inform his
thinking: first, the belief that an affectively responsive environment is
essential for therapeutic change and, second, the conviction that a distant,
detached translation of unconscious meaning is not therapeutic.

Though I agree with Wolf on the importance of those factors to the

therapeutic process, in my opinion they neither warrant nor justify the broad
definition of interpretation he advanced. Wolf himself finds it difficult to
adhere to his broad definition and reverts to the more usual narrow
definition when he states that “interpretation is a rather awkward and even
misleading word for an activity that would be better referred to as an
explanatory process.”

Wolf's definition interferes with efforts to understand the therapeutic

process for at least two reasons: First, redefinition of a word for which there
is a customary meaning confounds clear communication. Second, Wolf's
definition conflates two elements of the therapeutic process considered by
many to be separate and to have separate therapeutic effects.2

EMPATHY AND THEORY

Stolorow and Wolf both follow Kohut (1959) in recognizing empathy as the
means by which we gain access to the inner world of another human being.
However, they differ markedly in the role they accord theory in empathic
observation.

Stolorow views theory as a guide that helps direct attention, organize

observation, and facilitate recognition of the subjective experiences of the
patient. And he emphasizes that “theories vary in their capacity to enhance
empathic access to patients’ subjective worlds.” Stolorow is in agreement
with Kohut (1984), who also believed that theory permitted the observer
(the quattrocento painter, the contemporary psychoanalytic clinician) to
perceive formerly unrecognized configurations or, at the very least, to
increase his awareness of the significance of configurations he had but
dimly perceived” (p. 176).
Wolf, on the other hand, is suspicious of theory and concentrates on its
potential misuse. He asserts that theory is more often determined by the
personality and philosophical and moral value systems of the therapist than
by rational criteria such as scientific truth or therapeutic efficacy and that it
may be used to buttress rationalizations designed to avoid the therapist's
own anxiety. With these assertions Wolf places those who differ with him in
the uncongenial position of having to prove that defensive factors are not
the main determinants of the theoretical position they advance.

Wolf also fears that theory leads to experience-distant formulaic

interpretations. To illustrate this point, he describes a clinical vignette
intended to show how empathic understanding led him to avoid a “theory-
bound” interpretation (of hostile, aggressive wishes) and helped him to
make a different, better interpretation. Probably it did.

But that example does not expose theory as the impediment to empathic
understanding Wolf considers it to be; rather, it demonstrates that it is
essential to have the right theory. What happened was that, consciously or
unconsciously, Wolf realized than an interpretation based on classical drive
theory was wrong–that is, that it did not fit the patient's subjective state.
Wolf's interpretation was not based on empathy alone but on empathy
informed by a different theory, one more relevant to that patient and his
problems.

Clinical judgment is not based on empathie perception uninformed by

theory. Empathy provides access to the inner state of another. Theory
informs, but need not restrict, lines of empathie inquiry; it permits
prediction and explanation of our observations, and it guides our technical
interventions. But-and this is most important—when a patient's responses
do not match our expectations, we do not force them to do so; rather, we
strive to fashion a new theory that better articulates and better explains the
subjective experience of the patient.

INTERPRETATION AND THE PROCESS OF CURE

Both Stolorow and Wolf devote a considerable part of their discussions to

the process of cure. Wolf delineates several facets of interpretation
(interpretation of resistance, of disruptions of self-cohesion and selfobject
transferences, and of background genetics) and several experiential,
effective, noninterpretive elements that he deems central to the therapeutic
process. After considering the relative importance of verbal explanation
and of new experience, he concludes that (1) the contents communicated by
an interpretation are much less important than the experience it evokes and
that (2) the main role of interpretation is to repair the selfobject tie to the
therapist, thereby restoring the therapeutic process. In other words, it is
necessary to provide the patient with a new experience contrary to, and
more beneficial than, his unconscious expectation.

Wolf asserts that in downgrading the importance of the verbal aspects of

interpretation and insight he does not mean to imply that interpretation is
less important than previously thought. Perhaps not. But for Wolf the
importance of interpretation rests on the restoration of a selfobject bond. In
his view interpretation is important only insofar as it provides an experience
of being understood; explanation and cognitive elaboration (the customary
meaning of interpretation) have no specific effect on intrapsychic
organization and are of no special import.3

Wolf's position raises several questions: Is the only effect of an

interpretation, a good explanation, the reestablishment of a selfobject bond
with the therapist? When a patient says, “Gee, I never realized that before,
that makes sense out of it,” are we to doubt that statement, ignore his
pleasure and sense of mastery, and discount his belief that the interpretation
provided a new, integrating perspective? I think not!

Stolorow, on the other hand, distinguishes the therapeutic effects of

interpretive and noninterpretive elements in the treatment situation and
disagrees with those who would attribute primary therapeutic effect to the
therapist's affective tone and its emotional impact. In fact, Stolorow takes
considerable pain to disavow any obligation to provide the patient with a
selfobject experience uncontaminated by painful repetitions of past
childhood traumas, a requirement he states is often invoked in the name of
Kohut himself or other self psychologists.

The effects of insight and interpretation cannot, in Stolorow's opinion, be

separated from the effects of affective bonding; they are inextricably
interwoven. For him the therapeutic process is a continuum in which both
affective attunement and cognitive inference play a part at every point.

Were this Stolorow's final position I would be in almost complete

agreement with him. But he continues and, in my opinion, confounds the
matter by saying the following:

It is the transference meaning of this investigative and interpretive activity

that is its principal source of therapeutic action in that it establishes the
analyst in the transference as the secondarily longed-for, receptive, and
understanding parent who ... will ... eventually alleviate the patient's painful
emotional reaction to an experience of primary selfobject failure [emphasis
added].

This is a position with which I do not agree and which, I believe, conflicts
with his earlier statements.

The statement that the principal effect of an interpretation is its transference

effect—that is, the establishment of the analyst as a receptive and
understanding parent–gives no weight to the effect of verbal description,
articulation, and genetic explanation in changing the patient's subjective
reality and raising its level of cognitive and affective organization.

In my view, the effects that accrue from verbal explanation, interpretation,

and cognitive insight are separate from, and as essential to the curative
process as, the effects that accrue from empathic attunement,
“understanding,” and the emotional responsiveness of the therapist.
Separation of these factors, of the effects of explanation from those of
feeling understood, does not introduce a false dichotomy into an
intrinsically inseparable amalgam of therapeutic process, as Stolorow
asserts.

Insight and affective responsiveness are separable strands of the treatment

situation. The therapist's affective attunement and responsiveness make it
possible for patients to recognize and differentiate the unconscious
expectations they transferred to the present situation. The therapist's
explanations and interpretations facilitate that recognition and foster a new
integration on a different level of intrapsychic organization.
To borrow a metaphor from Stolorow, affect attunement and interpretation
are like the warp and woof–each separate and essential–from which is
woven a tapestry of therapeutic transformation.

REFERENCES

Bibring, E. (1954), Psychoanalysis and the dynamic psychotherapies. J.

Amer. Psycho-anal. Assn., 2:745–770.

Greenson, R. R. (1967), The Technique and Practice of Psychoanalysis, Vol.

1. New York: International Universities Press.

Kohut, H. (1959), Introspection, empathy and psychoanalysis: An

examination of the relationship between modes of observation and theory,
J. Amer. Psychoanal. Assn., 7:459–483. Also in: The Search for the Self,
Vol. 1, ed. P. Ornstein. New York: International Universities Press, 1978, pp.
205–232.

———(1977), The Restoration of the Self. New York: International

Universities Press.

———(1981), On empathy. In: The Search for the Self, Vol. 4, ed. P.
Ornstein. New York: International Universities Press, 1991, pp. 525–535.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

1Some authors (e.g., Bibring, 1954; Greenson, 1967) use the term
interpretation to refer to the illumination of unconscious meaning and use
clarification to refer to illumination of preconscious connections and
meanings. However, it is recognized that interpretations are most effective
when aimed at material on the verge of conscious recognition. The
distinction between clarification and interpretation is thus diminished and
is, in fact, ephemeral.
2Stolorow suggests that a false dichotomy is introduced by attempting to
separate the effects of insight from those of affective responsiveness.
However, even if that is correct, words that differentiate them are required
for discussion and examination of that view.
3Kohut, on occasion, expressed a view similar to Wolf's. For example: “The
beneficial structural transformations occurring in a successful analysis do
not take place as the result of insights” (1977, p. 30). But, after a period of
indecision, Kohut renounced that view.

Kohut's final statement was that empathy alone is not curative, that the
therapeutic process requires a phase of understanding, sometimes very
protracted, necessarily followed by a phase of explanation (1984, pp. 104–
108). He considered this so important that in his last public address he made
a special effort to emphasize it when he said, “Analysis cures by giving
explanations–interventions on the level of interpretation; not by
‘understanding’ “(1981, p. 532).
II
Sex and Gender
Chapter 6
Sex, Gender, and Sexualization: A
Case Study
Estelle Shane

Morton Shane

In this chapter our focus is on the many varieties of sexual experience

conceptualized in the psychoanalytic literature and required for a more
complete understanding of that aspect of human motivation. Thus, we
address not just sex, sexuality, and sexualization but, more precisely, sex,
sexuality, and sexualization as well as gender, gender self, gender identity,
and core gender identity. The truly voluminous literature on this topic will
be addressed only as it pertains to and illuminates the treatment of a young
woman whose sexual development had been greatly compromised by self
pathology.

Kathy K came into treatment six years ago at the age of 24, following her
move to Los Angeles. Kathy's decision to leave the East Coast, where she
had lived all her life and where she had attended college and graduate
school, was occasioned by the remarriage of her father, a remarriage she
experienced as a betrayal and as a narcissistic blow. Kathy's mother had
committed suicide several years before, when Kathy was in her last year of
college. Mrs. K had exhibited severe emotional difficulties throughout
Kathy's life, difficulties related, presumably, to the fact that she had been in
a concentration camp as a young woman, an experience she could neither
talk about nor forget. All Kathy could say about her mother's trauma was
that in some way it involved sexuality: her mother's youth and beauty had
led somehow to her being spared extermination by the Nazis. Kathy felt that
it was her mother's Holocaust experience that had prevented her from
discussing sexual issues—or, for that matter, any issues concerning female
development—with her daughter; such matters came to Kathy through
books, through her father, and through school. Moreover, nothing was
known of Kathy's mother's childhood nor of her family; apparently, no one
from her family except Mrs. K herself had survived the Holocaust, and the
matter was a forbidden topic in the household.

Kathy's father was a consulting engineer, and Mr. K's own father and
mother had died in an automobile accident shortly after his marriage. Mr. K
was an only child and, from what Kathy described, had lived a lonely,
emotionally deprived life. Mother and father had had no friends to speak of,
and quite early, Kathy, also an only child, was given the message that the
small family should stick together. Yet the parents were not involved with
one another either. Their relationship was not characterized by arguments
but, rather, by a coldness between them that extended to their having
separate bedrooms from early on. Kathy knew, because they had often told
her so, that her parents had remained together because of her; her father,
especially, had depended upon her, as she depended upon him, for
emotional closeness and support. In fact, her father's remarriage after her
mother's suicide came as a shock to Kathy that even exceeded the impact of
her mother's taking her own life. After all, Kathy had known her mother
was depressed and was accustomed to her mother's turning away from her;
she had not known that her father was involved with someone else and had
not anticipated his abandonment.

What characterized Kathy's childhood, then, was a mother who from the
beginning was cold, distant, self-preoccupied, and depressed. In addition,
Mrs. K was harshly critical of her only child, complaining that Kathy was
fat, selfish, and self-centered and predicting regularly that no one could ever
like her, let alone love her. Kathy's father, on the other hand, had been
deeply committed to her, deeply involved with her, and always supportive
of her needs. Kathy, then, turned to her father for the developmental
necessities her mother could not provide, particularly the phase-appropriate
affect attunement, stimulation, and modulation required for adequate
development of her self. Both the expression of her sexuality and the
unfolding of her gender identity had been compromised.
Kathy had been referred to me (E.S.) by a male analyst from the East Coast
who had seen her for about three months in twice-a-week psychotherapy to
provide help with her reactions to her mother's suicide. The referring
analyst had recommended more intensive work, and I, after seeing Kathy
several times, concurred with that recommendation. Kathy suffered from
low self-regard and a feeling of being different from, and inferior to,
everyone else, especially in the area of her sexual life. For example, she
told me with considerable shame that she had never had a sexual or
romantic experience. Moreover, she described, also with shame and in great
confusion, masturbation fantasies predominantly concerned with her having
intercourse with women, fantasies in which she played the male role,
accompanied by a vague sense of having a penis. This flawed sense of
gender self would seem to reflect, at least in part, the depth and intensity of
the poor relationship Kathy described having with her mother. We can
surmise that her fantasy of herself as a man making love to a woman was a
persistent effort to repair and strengthen this failed primary selfobject bond.
Thus, Kathy's masturbatory fantasies were not just expressions of sensual
sexuality but were, in addition, sexualizations motivated by her frustrated
attachment needs.

The concept of sexualization as an important motivational force was first

put forward by George Klein (1969) when he used the term sexualized, as
opposed to the term sexual, in an effort to call attention to the fact that
sensuality serves not just for the experience of pleasure or pleasurable
discharge in itself but serves just as often to achieve essentially nonsexual
aims. Klein noted that the individual may be drawn toward sensual pleasure
because it gives comfort, alters reality, or manufactures a sense of pride in
oneself; genital sex, therefore, may be used defensively and adaptively for
self-reparative and self-sustaining functions.

The noun sexualization and the adjective sexualized were not invented by
George Klein, however. He could easily have borrowed them from either
Freud or Hartmann, among others, but Klein provided a new meaning,
different from any in use before. For Freud, and then Hartmann and the ego
psychologists, an experience was seen as sexualized if it took on sexual
meanings not inherent in the activity per se. For example, if seeing, using
one's eyes, takes on sexual meaning, the activity of looking becomes
sexualized and it may become forbidden. In the same way, Hartmann
introduced the terms aggressivization and aggressivized activity to evoke
the suffusion of innocuous thought or behavior with aggressive energy or
meaning. Because classical analysis conceives of only two drives, or two
basic motivations, much neutral activity becomes explainable in sexual
terms or in aggressive ones. Thus, Kathy's fantasy of assuming the male
role in relation to a woman, in light of her frustrated relationship with her
mother, would not be conceptualized in classical theory as a sexualization
of the frustrated attachment tie to the mother, as we are viewing it here, but,
rather, would be seen as a sexually motivated and, undoubtedly,
aggressively tinged sexual displacement from father to mother in a negative
oedipal configuration partly fixated on a preoedipal level. The important
point we want to make is that the motivation to be uncovered in Kathy's
fantasy in classical terms would still be to achieve sexual pleasure, however
broadly defined. What George Klein introduced as totally new in clinical
psychoanalytic understanding with his construct of sexualized activity is the
concept of sex being used to express many self-motivations other than
sexual pleasure per se (even if that sexual pleasure is conceptualized in the
broad Freudian sense of sexuality experienced on oral, anal, and phallic
narcissistic, as well as genital, levels.) His term is the same as Freud's and
parallels Hartmann's, but his meaning is totally different from theirs.

Kohut, seeming to elaborate on Klein's idea and focusing primarily on the

attachment motivation so central to self psychology, advanced the concept
of sexuality (when “grossly expressed,” to use Kohut's words, as in the
subjective experience of being driven) as representing a breakdown product
of a fragmenting self. What Kohut accomplished through this
reconceptualizing shorthand was the explanation that sexuality can be
heightened and made more urgent in the service of establishing a
connection to the needed and heretofore frustrating selfobject, thereby
restoring cohesion to a shaky self. In Kathy's case, then, the masturbation
fantasy of a genital connection to a woman carried with it an even greater
need, that of an archaic selfobject bond necessary to maintain her self.

But aside from the presenting symptoms already described and aside from
the masturbation fantasies the significance of which she, in any case, mostly
disavowed, what urgently motivated Kathy to seek treatment with me at the
outset was her recognition that the relationships she had established with
particular girls throughout college and then into graduate school were
strange, unsatisfying, and quite disturbing to her. Once having left home for
college, Kathy had begun to attach herself to one special girl after another,
girls from whom she felt she could not separate. Her entire existence
seemed to depend upon being in the presence of that significant person, and
she suffered untold jealousies and rages when she was frustrated in that
wish. Each girl began her relationship with Kathy as a friend but eventually
withdrew as Kathy's demands upon her became insupportable. Each in turn
would protest in more or less clear terms that she could not provide Kathy
with what Kathy seemed to need and still maintain her own sense of
independence. Yet Kathy remained unable to free herself in subsequent
relationships from her demandingness, despite the fact that she had come to
acknowledge that her urgent need would invariably drive away the specially
chosen friend. One can easily recognize here the peremptory, archaic
selfobject quality to these involvements.

Kathy's history and her sense of the nature of her suffering convinced me
that analysis was the treatment of choice, but Kathy was not in a financial
position to follow this recommendation, even with the low fee offered. As it
happened, Kathy, discovering that I was scheduled to attend a conference in
the city in which her father lived, set up a meeting between us with the clear
hope that her father, upon meeting with me, would become convinced that
analysis was the appropriate treatment for her and would provide the
necessary finances. Kathy herself had just arrived in Los Angeles, having
recently dropped out of graduate school after a semester after completing a
bachelor's degree program in physics. At the time, therefore, Kathy was in
no way able to support the analysis on her own.

In the meeting with me Kathy's father supplied details of Kathy's life that
confirmed the picture the patient had already presented. Furthermore, he
described, albeit rather imprecisely, a genital variation in Kathy discovered
at birth: an enlarged clitoris necessitated that her anatomical and hormonal
development be monitored. Nothing untoward turned up, and by early
adolescence Kathy had been pronounced completely normal. Nevertheless,
there had been, and there still remained, a hint of anxiety in him (which
Kathy's mother had also felt) over his daughter's physical sexual
development, and then, later, over her psychological gender development.
(Here we use Stoller's clarifying distinction between sex and gender, which
we will refer to shortly. See Stoller, 1985, p. 6.) Kathy's father worried
about the fact that Kathy had never had a relationship with a boy, either in
high school or, insofar as he was aware, in college, and he wondered
whether this lag in emotional development was related to the reputed
variation in her genital anatomy. Further, Mr. K explained to me that Kathy
had been told nothing regarding her possible sexual abnormality. Finally, he
agreed to support Kathy's analysis, albeit at a substantially reduced fee.
Once back in Los Angeles, I shared openly with the patient the information
provided by her father. Kathy responded with anger that this too had never
been discussed with her. In regard to her father's disclosure, Kathy
remembered having appointments with doctors, her puzzlement as to why
she was going (yet, as with all else sexual, no one explained anything to
her), and the fear and humiliation that the examinations always engendered
in her. In all, her father's report confirmed Kathy's long-standing self-image
of being, as she said, “a puzzle piece that somehow did not fit,” of being
“different from everyone else, neither boy nor girl but some alien being in
between.”

The serendipitous meeting with Kathy's father obviously introduces

important issues and clinical complications most germane to this case and
to this overall topic. First, information came from outside the dyad,
imposing on the patient new facts about her life that had not previously
been disclosed, at least not directly. Second, the information suggested
possible biological, hormonal, and anatomical influences on the patient's
female development. Third–and, as it turns out, most important–the
information revealed an inevitable, unavoidable influence on the
development of the patient's core gender identity and consequent confused
sense of femininity. We will take these in order.

The first issue is somewhat apart from the topic of sex and gender and will
therefore be addressed mainly parenthetically. Here we have an instance of
important historical data—historical truth, if you will– coming in between
analyst and analysand, data not introduced introspectively, subjectively, or
vicariously introspectively; not arrived at through a hermeneutic
understanding of the patient; and not a creation of narrative truth (see Shane
and Shane, 1980). We can question, therefore, whether these are analytic
data in any pure sense, at least in an adult analysis; yet the data must
inevitably influence analysand and analyst, their relationship, and their
mutual reconstructions of the patient's infancy and childhood.

The second issue, that of new information about the patient's anatomical,
hormonal, and sexual development, and the third issue, that of her gender
development, require some clarification, best provided by Robert Stoller's
(1985) work on sex and gender. His distinctions have been generally useful
and are applicable here. According to Stoller, sex refers to a biological
realm of multiple dimensions, which include chromosomes, external
genitals, the internal sexual apparatus, hormonal states, secondary sex
characteristics, and the brain. Gender, on the other hand, refers to a
psychological state, masculinity versus femininity, with all the variations in
between. Stoller then invents the term gender identity to refer to the entire
psychological realm, the sense of being feminine versus the sense of being
masculine, or, as in Kathy's case, the sense of being confused in terms of
one's gender. Stoller further elaborates with the concept of core gender
identity, which develops very early in life; consolidates probably by age
two or three; and, once fixed, responds little if at all to any efforts to change
it. Stoller describes core gender identity as “a conviction that the
assignment of one's sex was anatomically and, ultimately psychologically
correct” (p. 11). The assignment of one's sex begins very early in life,
actually before birth, if the parents know, or believe they know, the sex of
the fetus, and is done mainly by one's parents in conformity with its sexual
biology, though ultimately, it is speculated, everyone with whom the
individual comes in contact, from birth on, contributes to some degree to
the individual's sex assignment. It is well known that girl infants are
handled differently from boy infants, are talked to differently, are responded
to with differing expectations, and so on.

It is clear that Kathy, upon entering treatment, suffered from a confused

sense of gender identity. What the external information provided by the
father did in the analysis was to shed some light on the development and
formation of her core gender identity and to supply us with data from which
we could infer possible sources of the core gender identity confusion with
which she presented. We cannot know if there were any contributions to
Kathy's psychological difficulties that stemmed from the arena of her sexual
(i.e., anatomical-biological) development. We do know that although her
clitoris was reportedly enlarged at birth, she was pronounced free of any
permanent anatomical or hormonal anomalies by the consulting endocrine
experts by the time she was 12.

In terms of gender, as opposed to sex, it is relatively easy to surmise that

both parents were disturbed and confused to some degree about how firmly
they could assign their child the role of feminine little girl, and, as we will
see, there were important psychological sequelaé, which would have been
apparent with or without the father's information.

For our purposes here, then, this case is illuminated by distinctions made in
the literature among sex, gender, gender identity, core gender identity, and
gender self. In self psychology, gender self tends to remain too global a
term. We believe there is a need to consider a primitive gender self (or a
core gender self) as well as a mature gender self, matching, more or less,
Stoller's core gender identity and gender identity. As to Stoller's contention
that core gender identity is fixed at age two or three and remains resistant to
any change, the successful analysis of Kathy's gender confusion leads us to
postulate that though core gender identity may be irreversible, core gender
identity confusion or core gender self-confusion is not. That is, the core
gender pathology in Kathy's case was embedded in self pathology. On the
basis of this case, along with another case of core gender confusion
(analyzed by M.S.), we postulate, first, that gender confusion is often linked
to self pathology and, second, that it can best be ameliorated by a self-
psychologically informed psychoanalysis.

Once in analysis, Kathy rather quickly developed a relationship with me

most accurately characterized as an archaic mirroring selfobject
transference. That is, her particular response to the analytic situation was to
elevate the experience to one of central importance in her life, to bask in the
analyst's presence, and to express her deep satisfaction at being so closely
and exclusively attended to. She told me that for the first time in her life her
needs were not frustrated, and her wish was that the analysis would go on
forever. These good feelings emerging in the analytic dyad seemed
somehow to influence her self-image: after only five to six months of
analysis Kathy's feeling that she was different from others, of some
unknown, uncertain gender, neither boy nor girl, man nor woman, gradually
receded. An important moment for Kathy during this phase of treatment
was when I told her, in an attempt at genetic reconstruction encompassing
many details of her life narrative, that I imagined she had never experienced
a woman who both recognized and appreciated her femininity. (It was
following this reconstruction, which carried with it a tacit, unplanned, yet
unavoidable acknowledgment on my part of the patient's actual femininity,
that Kathy began having for the first time masturbation fantasies about men,
beginning with a particular man whom she had met and with whom she had
developed a close friendship. Later in the analysis, four years later, Kathy
noted that when she attempted in a moment of feeling humiliated to create a
masturbation fantasy on the old model, so comforting as well as exciting to
her in the past, of being a man with a woman whom she admired, she found
that she had lost completely the capacity to do so; she noted ruefully that
she was now “forever fixed in [her] femininity.) Kathy went on to reflect
that while being with me made her feel like a girl, she did not yet feel like a
woman. She remarked also about another change in herself: in the past she
had always felt empty, dark, and hollow inside, but now she was aware of a
new vision, namely, that her analyst was the light that illuminated her
darkness and that clarified and defined her self. Here one can see most
clearly the inevitable interrelationship between Kathy's confused gender
self and her overall self pathology; as one responds to treatment, it seems,
so does the other. We can conceptualize this beneficial response to being in
analysis as both the delineation of an archaic transference and as a
development-enhancing, optimally responsive gratification deriving from it.

As the analysis progressed, what emerged in this archaic transference

formation was a high level of expectation that the analyst be there, almost
literally at the patient's beck and call. Kathy resented and resisted
adamantly any threatened interruption in my attentions to her; even now,
after six years of treatment, when asked to change an hour to another day,
Kathy can still take extreme umbrage, as if the times of her particular hours
are exclusively hers, never to be tampered with by any requirement so
unimportant as alterations in my schedule. Once this phase of the analysis
began, Kathy would watch the clock intently and argue vigorously about
minutes she felt she had coming to her, though she herself recognized that
at times the appointment extended some minutes beyond the allotted time.
She would threaten to tie herself to the couch or to refuse to leave at the end
of the hour and wondered insistently what I would do in such a case. She
longed for me to take her home or invite her to my house on weekends and
half expected, as if her reality-testing capacity were compromised, that such
a thing might actually happen, that I might really extend the hour, be
dissuaded from a planned vacation, or offer her an invitation for brunch.
What the patient expressed was a sense that she was, as she said, “merged”
with the analyst, with each being a part of the other, each participating in
the other's life, and therefore not to be separated. Kathy's experience
suggests the archaic nature of her transference, evoking the concept of
symbiosis, and while symbiosis itself is not, in our minds, a phase in normal
development, such a case demonstrates that the experience of symbiotic
merger is real enough in analysis and in pathological states. For Kathy, as
will be seen, the working through of the archaic transference mitigated this
sense of merger.

Through our continued work together, we came to understand, with some

surprise to the patient, that the feelings of oneness that Kathy experienced
with me and her sense of entitlement about me were very close to the
feelings that she had had in relation to her father throughout their life
together. She had learned early to turn to her father for a steady, reliable,
always available presence when she needed comfort and soothing. Each
night he would sit by her bed and listen avidly to all she had to say. When
she awoke in the middle of the night, she had only to call to him, and he
would without hesitation come and stay with her, even through her teens
and even when she was not frightened but only wanted his company.
Apparently, Kathy's mother did not object, at least not to Kathy's
knowledge, but merely remained a silent, though disapproving, presence in
the background. Kathy contrasted this long and idyllic period in her
relationship with her father, where her possession of him seemed exclusive,
to what occurred between them after her mother's suicide, when she was in
graduate school. Her father had already remarried. Kathy recounted with
strong and righteous indignation that upon visiting the newly wedded pair,
she was outraged when her step-mother announced that she was going to
bed and her father got up and followed her, rather than remain behind and
talk to Kathy. Kathy felt profoundly betrayed by her father and afterward
found she could no longer function in school; she began to cut classes and
to avoid work. It was following this experience that she left the East to
come to Los Angeles. Since that time, despite father's willingness to support
her treatment, relations between Kathy and her father (and stepmother) have
been cool and distant.

We see evidence here, and it will be elaborated on later, of an unresolved

Oedipus complex, not surprising given Kathy's lifelong experiences with
her father. He had served as a replacement for her mother in her early years,
but his attentions throughout Kathy's life were obviously not adequately
attuned to her developmental needs. We speculate that his frustrations in his
relationship to his wife led him to be overly solicitous and probably
unconsciously seductive in phase-inappropriate ways, which nevertheless
did compensate Kathy, at least in part, for her mother's more global lack of
response to her. Kathy's departure for college disrupted the sustenance her
father had provided for her, which she then attempted, in vain, to replace
with special friendships in college, and later, more satisfactorily, in her
relationship with her analyst.

A particularly clear example of the patient's transference expectations for a

consistent, unyielding, attentive presence is revealed in the way in which
she responded to anticipated separations from me. The prospect of my first
long vacation, one year after her analysis began, filled Kathy with horror
and indignation. She could barely acknowledge that vacations were to be
expected, and she would not allow herself to conceive of the possibility of
my having either needs or a life of my own. Kathy reasoned that if I really
understood her and how much she needed me, it could only be considered
cruel on my part to leave her, a deliberate infliction of pain and misery.
Each vacation was experienced as a disruption in the treatment process, to
be anticipated, argued about, and guarded against; and then, once gotten
through, the sense of disruption had to be overcome. It was through these
complaints preceding and following interruptions that Kathy came to
understand that my leaving her without her protesting bitterly would make
her feel as if she didn't exist at all. That is, the protest itself-and, as the
patient articulated, the longer and more vehement the better—helped to
define her very selfhood (a phenomenon evoking Lachmann's and Wolf's
adversarial selfobject relationship). Kathy remembered that she could never
argue with her mother, who would respond, on those rare occasions when
Kathy dared to do so, with the silent treatment, lasting for days and making
Kathy feel, as she said, as if her very essence were destroyed. Kathy's
discovery, finally, during one protracted phase of arguing in the analysis,
that her protests allowed her to feel alive was of enormous relief to her. She
began to tolerate separations better, to provide substitutes for me in my
absence, and to preserve a sense of liveliness, cohesiveness, and self-
constancy without me.

During the fourth year of Kathy's analysis, the earlier feelings of delight at
being so perfectly understood, admired, and cared for by me were much
tempered. Kathy lamented the fact that it was no longer so easy for her to
maintain the illusion that I was a part of her, or she a part of me, despite her
struggles to convince herself that some day she would be able to feel that
way again. She dated the beginning of this sense of separateness to a period
that preceded one of my dreaded absences from her; it came to her as if in a
flash that my plans were made neither to spite her nor to please her but
without her in mind at all. For a short period Kathy actually believed that
this was, as she repeated often, the way it ought to be, that my separation
and independence from her allowed her to hope for a similar independence
for herself. At times Kathy would revert to symbiotic longings or, as she put
it, to the more familiar illusion that she and I were working toward a “re-
merger.” But try as she might, she could not reclaim that feeling. She
explained to me that in the past she would bask in my presence, a pleasure
that was interrupted only by my absences on weekends and vacations. But
with each experience of separation, it became clearer to her that she could
no longer reclaim the comforting illusion of oneness. She sadly stated that
while all of her life she had sought a relationship like the one she finally
had with me, this most perfect relationship was, ironically enough, to be her
last. She knew that she was losing me and that she would never be able to
replace me with another, as she had done so often in the past, not because of
my uniqueness but because of the inevitable changes she was already
experiencing in herself.

During the fifth year in analysis Kathy had a significant dream in which she
was being introduced to the wife of Steve, an attractive man with whom she
worked and who was included in many of her masturbation fantasies.
Steve's wife too was quite attractive, and in the dream Kathy felt the sting
of jealousy. Then she inadvertently looked into a mirror and realized, as if
for the first time, that she had sideburns and a mustache. She was shocked
but at the same time knew that while she herself had never before seen the
mustache and sideburns, this facial hair had come as no surprise to Steve
and to his wife, who, she realized, had always seen her that way. The dream
ended with Kathy thinking, “I must get rid of these.”

In her associations Kathy immediately said that the mustache and sideburns
stand for her fat, for her being overweight and unfeminine. She then talked
about the party she had gone to the night before at Steve's house, where, in
reality, she had met his wife for the first time. As she was dressing for the
party, she had looked down at her bare feet and then her glance moved up
her legs. She thought: “I've seen these feet before; I've seen those legs
before. They are like my father's.” She went on to note in her associations
that sometimes when she looks at her arms, she sees her father's arms; that
she sits like her father does, with her wrist on her forehead and her elbow
on the table, when she is trying to solve a problem; and that she twirls her
hair the way her father does. She throws a ball like her father does too. I
perceived Kathy's associations to the dream as indicating an increased
awareness of her previously repressed and disavowed identification with
her father, an identification that had contributed significantly to her gender
confusion and that had defended her from the painful competition with
more attractive women. At this point, I reminded Kathy that it was her
father who had taught her to play ball, and that it was her father with whom
she would sit each afternoon after school as they worked together, Kathy on
her homework and he on his reports. Indeed, I told her, she had needed her
father to learn from. She must have learned many skills from him—how to
work, how to play, and how to be with another person–and in the process
may have picked up his habits as well. In addition, she had wanted (and at
the same time had disavowed her wish) to be like a man; she wanted to
acquire her father's strength and his masculine power for many reasons. She
wanted to be close to her father; she wanted to be like her father; and,
indeed, she even wanted to become her father. Kathy responded that she
knew she had often felt like a man and that she understood now how
connected to her father these manlike wishes and feelings were. But also
she knew that in reality she looked like her father: he, her idealized father,
was fat and she was fat too whereas, in contrast, her demeaned mother was
thin. Then Kathy said, with sudden resolve, “I had better lose some
weight.”

This dream and the accompanying insight proved to be a key step in the
patient's dieting for the first time in her life, in her losing weight, in her
exercising, in her dressing attractively, and in her attracting the attention of
the men around her. That year Kathy, close to age 30, began dating for the
first time, had some preliminary sexual experiences, and then settled in on
one relationship for a time. As she prepared to separate from me for that
summer vacation, she noted that for the first time she didn't mind my
leaving, so long as I intended to come back. As Kathy said, she had work to
do, friends to see, and an interesting man to date. The archaic wish for
symbiosis was apparently resolved in the transference, as the following
statement, a kind of summary made by the patient in the last session before
vacation, suggests: “When I first saw you, I had a feeling of emptiness
inside myself, that something was missing in me, which I needed to fill with
you. I then became preoccupied with keeping you there at the core of me,
but lately I have been more aware of my own presence inside myself and
less aware of yours.”

That summer vacation marked the end of the patient's fifth year in analysis.
At the first meeting in the fall she reported a dream: She and I were sitting
facing one another, looking at one another's earrings. Mine were diamonds,
whereas hers were just plastic. We decided to exchange earrings, but then it
turned out that I really had no intention of giving up my own earrings; I
kept both pairs, hers and mine, and Kathy had none.

Kathy associated to the unusual summer she had dating men and to her fear
that I would be angry and jealous, first, because she was no longer so
involved with me and, second, because she would be competitive with me
for the attention of men, even for Mort, as she referred to my husband. She
was young, I was old; she would ultimately win, I would ultimately lose.
And as a result, I would be angry, feel hateful, and abandon her in response.
I connected this fear of punishment and abandonment owing to her sexual
attractiveness to men, and particularly to my husband, with Kathy's
mother's sullen, silent disapproval of her father's obvious preference for
Kathy. Nevertheless, neither Kathy's own insight nor my genetic
interpretation served to alter the sense of danger Kathy felt. As a result of
these feelings of sexual attraction and attractiveness and fear of my
disapproval and consequent withdrawal, Kathy began to put back some of
the weight she had lost. Currently, the analysis concerns this oedipal
struggle, with all of its underlying gender self ramifications.

Kathy knows now that being obese is not just her mother's label for her and
that dieting can change that condition, whereas failure to diet can reverse
that direction, all of which was heretofore denied by Kathy, who had felt
and insisted in the past that when she “got better” she would “get thinner,” a
cryptic reference to her unconscious belief that when she got better she
would feel more like her mother, more like a woman. Also for the first time,
she recognizes that there is a relationship between greater diligence and
better performance; the application of this recognition, combined with her
inherent capability and intelligence, has led to significant advancement in
her employment. Finally, she has understood that better social
responsiveness on her part leads to closer, more gratifying friendships.

We have presented this case to clarify the interrelationships among issues

pertaining to sex, sexuality, and sexualization, as well as to gender, gender
self, gender identity, and core gender identity, and to point to the connection
between these issues and self pathology.

REFERENCES

Freud, S. (1905), Three essays on the theory of sexuality. Standard Edition,

7:135–243. London: Hogarth Press, 1953.

Hartmann, H. (1964), Essays on Ego Psychology. New York: International

Universities Press.

Klein, G. S. (1969), Freud's two theories of sexuality. In: Psychology versus

Meta-psychology, ed. M. M. Gill & P. S. Holtzman. New York:
International Universities Press, 1976, pp. 14–70.

Kohut, H. (1977) The Restoration of the Self. New York: International

Universities Press.
———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.
New York: International Universities Press.

Lachmann, F. (1986), Interpretations of psychic conflict and adversarial

relationships: A self-psychological perspective. Psychoanal. Psychol,
3:341–355.

Shane, M. & Shane, E. (1980), An integration of developmental theories of

the self. In: Advances in Self Psychology, ed. A. Goldberg. New York:
International Universities Press.

Stoller, R. J. (1985), Presentations of Gender. New Haven, CT: Yale

University Press.

Wolf, E. (1988), Treating the Self. New York: Guilford.

Chapter 7
Primary Failures and Secondary
Formations: Commentary on the
Shanes’ Case Study of Kathy K
Although I differ with the Shanes’ formulation of one aspect of Kathy K's
Paul H. Tolpin
pathology, I have little disagreement with the essentials of their
understanding of the case. And, certainly, I can only express complete
pleasure with the fluency and effectiveness of their presentation.

My comments, then, will address what I consider to be the problematic

formulation, the role of the Oedipus complex in Kathy's pathology, and I
will also comment on the role of sexualization, about which Kathy's case
provides much relevant material. But both of these will be considered
within the context of the larger issue of the relationship between primary
developmental lacks and injuries in childhood self-selfobject experiences
and the secondary psychological formations that are often used to make up
for and ameliorate the painful consequences of primary deficiencies.

Recall that at the end of the fifth year of analysis and shortly before an
upcoming vacation interruption Kathy summarized the crux of her therapy
with an unusually insightful observation. She said, “When I first saw you, I
had a feeling of emptiness inside myself, that something was missing in me,
which I needed to fill with you [my emphasis]. I then became preoccupied
with keeping you there at the core of me, but lately I have been more aware
of my own presence inside myself and less aware of yours.” In a few
straightforward words Kathy described both the primary psychological fault
in her development–the lack of an essentially positive, self-solidifying
experience with her mother—and the gradual repair of that lack in the
analysis. The inner experience of repair was beginning to feel more reliably
part of her and not just on loan from and dependent on the analyst.
Without the new sense of herself, Kathy was a desperately unhappy woman
who had revealed with considerable shame that she had never, with anyone
at all, had a romantic or sexual experience. In relation to her peers Kathy
had apparently lived a rather isolated personal life interrupted by successive
short-lived, highly intense, and overly demanding relationships with several
girlfriends during college and graduate school. With each new girlfriend
Kathy's entire existence seemed to be centered on the current friendship, but
her embittered rages, when the friend found her tenacious demands
becoming intolerable, inevitably led to a termination of the relationship. I
believe this repeated sequence of events epitomizes Kathy's desperate
attempts to fill in what she felt was missing in her. That missing emotional
something was experienced as a void at the core of her, a void too terrible to
bear. She reexperienced that same feeling in the analytic transference when
her feeling of “oneness” with the analyst was disrupted. That sense of
emptiness and that desperate need to somehow obliterate the intolerable
experience of it were manifestations of Kathy's primary pathology: a deficit
in her core self-structure. This brings us to a related issue, the Oedipus
complex and what role it played in Kathy's psychological life.

Recall Kathy's outrage and sense of profound betrayal when her stepmother
decided to go to bed and Kathy's father followed after her. Kathy collapsed
psychologically: she was unable to function at school, she cut classes, she
avoided work. Shortly after, she left the East and moved to Los Angeles.
Was this series of events evidence of an unresolved Oedipus complex? At
first glance it might reasonably appear to be so. But wait. Recall also how
Kathy's father's devoted, affectionate attention to her had substituted in part
for the missing involvement and affection of her mother, a concentration
camp survivor, and a seriously damaged woman, who was self-absorbed,
cold, angry, and chronically depreciating. Understandably, from early on
Kathy had turned to her father for the love, the responsiveness, and the
feeling of invigorating life that flowed from him, that vitalized her, and that
she desperately longed to make a reliable part of her inner self-experience.

Did Kathy's deep attachment to her father arise from the developmental
level of object loss and rivalry one might expect to see at the height of the
oedipal period? In disagreement with the Shanes, I don't believe the
Oedipus complex is the most useful clinical formulation here. As I see it, it
is not love for her father, rivalry with her mother, and the consequent fear of
the loss of mother's love that is Kathy's central problem. No, the problem is,
rather, the deep underlying fragility of her self-organization, an organization
born of her unfortunate mother's depression, her relative emotional absence,
and her crushing criticalness. All this and more led to Kathy's desperate
need for an exclusive relationship with someone who could make up for the
basic emotional deprivation, the lack of normal positive selfobject
responses, she had had to endure and had somehow survived.

Again, Kathy's crucial problem was the feeling of painful emptiness, her
longing for the supportive, organizing presence of an engaged and loving
other. Kathy's father was the loving other of her childhood. He had been her
only hope and she could not bear the loss of him. The comment of a very
self-aware patient of mine is relevant here. In summarizing a currently
dominant transference experience and its momentous effect on her, she said,
“Without the us, there is no me.” I suggest that Kathy felt similarly about
her father, not because he went off to bed with another woman but because
at the moment of his leaving she had no “us”; she felt utterly deserted–as
she had with her special girlfriends–and she realized that she had lost an
essential part of her self, the something missing in her that she said she
needed “to fill with” the analyst.

While the traditional concept of the Oedipus complex may be a useful

clinical shorthand for both the expectable and the pathological experiences
of the oedipal period, I believe its elevation by Freud to a position of such
signal importance in normal and pathological development was misguided.
However useful it may be for the understanding of some pathologies, its
compelling manifest theme can overshadow more critical developmental
disturbances that should be recognized as more relevant. In certain types of
psychopathology, such as Kathy's, the oedipal drama is not a primary issue,
if it is an issue at all (in some cases it may be a secondary formation), and
can distract us from appreciating more basic and pervasive affective
disturbances in development. (See Kohut, 1977, pp. 228–237, for his
discussion of the Oedipus complex and the oedipal phase.)

Another issue: What about Kathy's identification with her father? While
dressing for a party she looked at her legs and suddenly thought they looked
like her father's. At other times she noticed the same thing about her arms
and was aware of the similarities in how she and her father sat, fingered
their hair while in thought, threw a ball, and so on. She realized how much
she wanted to be like her >father and how sometimes she even felt like a
man. Recall how she used to fantasize about having intercourse with
another woman during which she, Kathy, took the male role while vaguely
imagining she had a penis. In their discussion of these issues the Shanes
recognize how Kathy's need to maintain her necessary tie to her father took
a variety of forms. At one time it took the shape of what, from a classical
point of view, has been considered a perversion (not the Shanes’ term or
mine), at another time the form of confusion of gender, and at still another a
sense of entitlement in relation to her analyst (as when Kathy insisted on
being given what she wanted when she wanted it, on her terms, and not on
the analyst's).

But what I want to emphasize here is that these examples are only the tip of
the proverbial iceberg. They are the manifest forms of Kathy's pathology.
Constructed from bits and pieces of childhood life experiences, they are
indicative of an individualized mixture of past gratifications and moments
of security and a variety of injuries or lacks. These past experiences are
later expressed by way of symbolic concrete enactments or metaphorical
thoughts, but the manifest forms are secondary.

For example, Kathy's fantasy of being like her father-behaving like him
posturally, having legs like his, having a penis as he did–can be understood
as a concretized form of her desire to experience within herself the life
force that she felt emanated from him. This desire was expressed in a
sexualized form in the fantasy of having a penis with which she could
experience an erotically invigorating connection with a responding other;
with that fantasy she was at least briefly saved from the effect of her
devitalized and devitalizing mother. Her deepest feelings, as the Shanes
suggested, were centered on the dread of reexperiencing the cold absence
and the critical anger of her childhood mother, whose own private horrors
greatly interfered with her ability to respond positively to her child's need
foi the manifold varieties of affectionate attachment that lead to the
development of a securely cohesive self. Kathy attempted to make up for
the lack of those essentials by assuming her father's vitality through overt
manifestations, physical and otherwise. Later in treatment, when she was
unable to sustain that borrowed vitality on her own, she imperiously
demanded, out of desperation, that the analyst maintain that steady-state
feeling in her by being available at all times.

The point I am trying to make here—and I hope it does not come across as
reductionistic–is a simple one: Just as we must recognize our patients’
defensive retreat from experiencing the pain of their depths while we, at
appropriate moments, decipher and clarify for them the unique origins of
the overt features of their pathology, so too must we keep in mind that
broader, more basic vulnerabilities in the formation of the core self underlie
and provide the nurturant soil for the development of the more conspicuous,
attention-calling and attention-getting symptomatology. But it is the
primary deficits, the failures in good-enough parenting, that we must
ultimately recognize and attempt to remedy if we are to achieve more
substantive results from our analytic efforts. In addition, we must remain
aware of the salutary effect of innate temperament, talents, and skills; useful
defenses and adaptive, compensatory structures; family values, traditions,
and available social possibilities. In various combinations all of these can
shift the often expected outcome of damaging developmental experiences
by ameliorating the failures of early selfobject experiences and by
providing psychological avenues that can lead to more adaptively
successful personality organizations. These various built-in tendencies and
fortunate life experiences often play a critical role in the outcome of our
therapeutic efforts.

Finally, I want to summarize the essential thrust of my argument by quoting

some relevant thoughts of Martin Buber (1957) on the subject of a basic
human need1:

Man wishes to be confirmed in his being by man, and wishes to have a

presence in the being of the other. The human person needs confirmation. ...
Sent forth from the natural domain of species into the hazard of this solitary
category ... he watches for a Yes which allows him to be and which can
only come to him from one human person to another. It is from one man to
another that the heavenly bread of self-being is passed [p. 104].
I believe the Shanes have made a similar statement and recommendation,
and except for our differences about the role of oedipal issues in Kathy's
pathology we are in agreement in our understanding of this case.

REFERENCES

Buber, M. (1957), Distance and relation. Psychiatry, 20:97–104.

Kohut, H. (1977), The Restoration of the Self. New York: International

Universities Press.

1Iwant to thank Dr. Louis B. Shapiro for calling my attention to Buber's

observations.
Chapter 8
Sharing Femininity— An Optimal
Response in the Analysis of a
Woman by a Woman: Commentary
on the Shanes’ Case Study of
Kathy K
In their chapter, Sex, Gender, and Sexualization: A Case Study, Estelle and
Howard A. Bacal
Morton Shane address the multiple (biological and psychological)
determinants of gender confusion but focus on the inadequate selfobject
experience that underlies it. They illustrate this with a case in depth. The
Shanes’ study of the treatment of Kathy K by Estelle Shane is a tour de
force of explication of complexity in brief. In a chapter whose range and
content easily justify a discussion many times its length, we are offered an
impressive account of a successful self-psychological therapy of a case of
gender pathology along with a remarkably thorough consideration of the
multiple determinants that may have affected the patient's aberrant sexual
development.

I will direct my comments to their main focus: the nature of the patient's
self pathology, how it contributed to her core gender identity confusion and
her difficulty in proceeding with heterosexual relationships, and their
understanding of the therapeutic process that is curing her.

The Shanes’ central understanding of Kathy K is that she turned to her

father for selfobject responsiveness to compensate herself for the
experience of unmanageable selfobject failures in her early relationship
with her mother.
The archaic mirroring selfobject relationship that Kathy established with
her analyst seemed primarily an attempt, now with the analyst, to resume
the paternal selfobject relationship of childhood, a connection she
traumatically lost when her father remarried, a loss, we are told, that
affected Kathy more than the earlier suicide of her mother. There was some
evidence to suggest that the strength of Kathy's reaction to the father's
remarrying derived also from behavior toward her that had inappropriately
stimulated her expectations of a relationship that went beyond that of father
and daughter.

While this formulation makes sense, I am also impressed by Kathy's need to

correct her sense of self-defect through the experience of a relationship with
a woman who would meet specific self object needs. As much as the father
compensated her for what she felt deprived of by the mother, it was not
enough; it lacked some quality. In effect, Kathy had been trying to obtain
what she needed from women friends, who understandably could not
tolerate the archaic nature of her self object demands.

In a paper entitled “Technical Problems Found in the Analysis of Women

by a Woman Analyst: A Contribution to the Question ‘What Does a Woman
Want?’ “ Enid Balint (1973) discusses the cases of two of her female
analysands whose mothers were either depressed or withdrawn. The main
preoccupation of these patients was the satisfaction of their depressed
mothers’ archaic needs, a preoccupation that also manifested itself in the
transference. Because their attempts to satisfy their mothers entailed
unconscious identification with a penis, their pleasure in their genitals was
compromised and a satisfying sexual life of their own was impeded. Balint
recognizes, as do the Shanes, the challenge in following the threads of these
patients’ instinctual life as they relate to the struggle of the self to maintain
the needed tie to the object. She suggests that what

women want both in their relationship with men and with women [is] to use
that primitive structure in human relations, namely the capacity for mutual
concern (Balint, 1972). Owing to its primitive nature it can only be
satisfactorily expressed by the body itself. ... The vagina is that part of a
woman's body which is felt to be the most important area with which to
express mutual concern with men (this does not exclude the rest of her
body). However, in her relation to women she is at a loss to know how to
express it unless she has herself introjected and identified with a
satisfactory satisfying woman's body which satisfied her and which she felt
she satisfied when she was an infant ... unless a woman can experience
mutual concern with women her relationship with men is likely to be
impoverished [p. 200].

We know that Estelle Shane's patient was completely unsuccessful in

“righting” her depressed, cold, and preoccupied mother, who repeatedly
turned away from her, and that she turned to her father for the satisfaction
of all her psychological needs. Yet there is evidence to suggest that the need
for the mother's responsiveness lived latently in her unconscious. Kathy's
masturbation fantasies of using a penis to make love to a woman might
have been not only an expression of sensual sexuality, not only the
sexualization of frustrated attachment needs, now directed to the father, but
also the sexualized unconscious expression of her need to undo her primary
feminine self-defect by relating effectively to a woman.

Kathy could not, with her body, offer the mother what she needed. Because
of the deficit in her early psychosomatic experiences with the mother, along
with the inadequate affirmation she received from both parents for the
existence of a definite feminine self, she could not imagine achieving this
with her female body. There is much evidence to indicate that Kathy wished
to become like her admired father, but an unconscious motivation for this
identification might have been the wish to give her mother in fantasy the
only thing she felt or sensed the mother could value and be satisfied by: a
male body. We must also note that Kathy's masturbation fantasy was
operative while she was in analysis; thus, she also involved the analyst in
what may have been her deepest selfobject need, namely, to stimulate,
enliven, and satisfy, and be responded to in turn by, the analyst-as-mother.

Father saved the patient's psychological life, but he did not quite fill the bill.
Kathy lacked the sense of a valued and valuable feminine self, which she
could only have substantively got from the mother. I believe the Shanes
imply this when they state that her masturbation fantasy “carried with it an
even greater need, that of an archaic selfobject bond necessary to maintain
her self.”
Thus, I would understand Kathy's improvement as due to a significant
extent to the meeting of an essential therapeutic need: the sense of a
relationship with a woman (her analyst) who values what one woman can
give to another at the very deepest levels, a relationship with a woman who
knows, accepts, and enjoys her own femininity, both physically and
emotionally, and who can enable the patient to experience her deeply within
herself, “psychosomatically.” Kathy virtually confirmed this at a later point
when she, having lost the capacity to create the old masturbation fantasy
and now “forever fixed in her femininity,” noted “another change in herself,
that in the past she had always felt empty, dark, and hollow inside, but now
she was aware of a new vision, that her analyst was the light that
illuminated her darkness and that clarified and defined her self.” In effect, it
was important to Kathy that her analyst appreciated that she “had never
experienced a woman who both recognized and appreciated her femininity”
(I have italicized the word woman here, as I believe that this was of no
small importance for Kathy). I am curious why the therapist is apologetic
for her response that accompanied this reconstruction, that is, her “tacit,
unplanned, yet unavoidable acknowledgment ... of the patient's actual
femininity.” It was after this that Kathy first started having masturbation
fantasies about a man!1

The emergence in Kathy of insistent primitive archaic needs,2 which, when

not met, led to significant disruption, was understood as reflecting feelings
she had in relation to her father. Interestingly, however, they began to
recede when she experienced herself as alive and distinct when arguing
vehemently with the analyst, something she could never do with the mother.
And while her dream about having a moustache and sideburns and having
her father's feet and legs ushered in much insight about her extensive
identification with her responsive, fat father, her successful resolve to then
lose weight and become more feminine and attractive to men must surely
have had at least something to do with her growing identification with the
responsive,3 slim, attractive woman analyst from whom she was at the same
time struggling to differentiate herself.

I should like to offer a hunch about the dream of the earrings. I think the
dream shows Kathy's struggle to achieve these aims in the face of her fear
that the analyst will not wholly comprehend her conflicts about the wish to
fully commit to being a woman. That is, I suspect that her pulling back
from her progress arises not only from anxieties associated with competitive
oedipal issues and fear of the analyst's anger and jealousy but also from
residual fear that she might indeed become committed to being a woman,
which is to say, more like her mother, who had nothing valuable to give to
another woman. However, in order to value herself as a woman, she feels
she must not only differentiate herself from her analyst but become more
like her. In order to become more like her, the child in her needs to feel that
it is all right with the analyst that Kathy share with her her most valuable
possessions: all the earrings (her femininity) and the most desirable man.

REFERENCES

Bacal, H. (1990), The elements of a corrective selfobject experience.

Psychoanal. Inq., 10:347–372.

Balint, E. (1973), A contribution to the question “What does a woman

want?” Internat. J. Psycho-Anal, 54:195–201.

Balint, M. (1968), The Basic Fault. London: Tavistock.

1I am, of course, suggesting that the therapeutic effect of Kathy's experience

of the relationship with Estelle Shane—which may have been mediated at
times by interpretations–was considerably more powerful than any of the
insights the patient undoubtedly garnered from the analyst's accurate verbal
reconstructions.
2The patient's regression is to an archaic state most extensively studied by
Michael Balint (1968), which he called “primary love.” Balint termed its
disruption the “basic fault.”
3In further discussion, Anna Ornstein emphasized that the importance of the
analyst's femininity was mediated to her patient not through identification
but by an idealized woman's mirroring the confused little girl in her
femininity. I would agree, in part, with Dr. Ornstein. As I indicated above, I
believe it was important to Kathy that she received not only the
interpretative recognition of a need but that she also experienced a woman
responding with appreciation to her actual femininity. I would submit,
however, that the patient's experience of her analyst's response facilitated a
process of identification with her. I would add that it is not only idealization
and mirroring that constitute the “corrective selfobject experience” for this
patient (Bacal, 1990) but also the experience of another kind of
relationship: the enjoyment of sharing what is felt to be valuable (in this
case, to a woman). This may be regarded as a specific form of selfobject
experience (Dr. B. Herzog, personal communication, 1991).
Chapter 9
The Bad Girl, The Good Girl,
Their Mothers, and the Analyst:
The Role of the Twinship Selfobject
in Female Oedipal Development
If there is one lesson that I have learned during my life as an analyst, it is
Diane Martinez
the lesson that what my patients tell me is likely to be true—that many
times when I believed that I was right and my patients were wrong, it turned
out, though often only after a prolonged search, that my Tightness was
superficial whereas their Tightness was profound.

Heinz Kohut (1984)

The theoretical understanding of the normal oedipal phase and the

pathology that arises when the developmental steps of that period go awry
have never been the primary focus of self psychology. In The Analysis of
the Self (1971) Kohut discussed the role of narcissistic factors in the
modification of phallic narcissism and the idealization of the superego but
stated that development during and pathology derived from the oedipal
phase were satisfactorily explained by classical theory. In The Restoration
of the Self (1977) Kohut said that drive theory provides an incomplete but
adequate basis for understanding the oedipal phase. In his depiction of the
oedipal period from a self-psychological viewpoint, he emphasized the
importance of pride and joy in the parents’ response to the oedipal child's
phase-appropriate sexual yearnings and competitive strivings for firming
the child's independent self. Kohut speculated, “Could it not be that we
have considered the dramatic desires and anxieties of the oedipal child as
normal events when, in fact, they are the child's reactions to empathy
failures from the side of the self-object environment of the oedipal phase?”
[p. 247]. In How Does Analysis Cure? (1984) Kohut outlined in more detail
the sequence of events that he then saw leading to the development of the
Oedipus complex. In this description the child enters the oedipal phase with
the exhilaration that accompanies any forward developmental step.
However, the child's strong and vital self becomes weakened if his or her
phase-appropriate affection and assertiveness do not elicit proud mirroring
responses from the parents but instead encounter parental preconscious
sexual stimulation and/or hostile competitiveness. Kohut observed that such
flawed parental responses may occur overtly or may manifest indirectly
through prohibitive, rejecting, or withdrawing responses. In this situation
the child's healthy affection and assertiveness become grossly sexual and
hostile, with the final outcome being the pathological Oedipus complex.
Here, then, the oedipal child's fears are not primarily of their drive
experience or the possible consequences. Rather, he or she fears being
confronted by a seductive (rather than affection-accepting) parent of the
opposite sex or by a hostilely competitive (rather than pridefully pleased)
same-sex parent. Only when these latter fears are realized do the fears
related to drive experience become relevant. Kohut concluded that the set of
conflicts called the Oedipus complex is not the primary cause of
psychopathology but its result. He challenged others to differentiate
between the self weaknesses and selfobject failures that lead to the drive
phenomena encountered in narcissistic personality disorders and those that
lead to the isolation and intensification of drives that underlie classical
oedipal neuroses.

Appearing simultaneously with the publication of How Does Analysis

Cure? were two papers presenting analyses in which the basis of the
patients’ pathology lay in selfobject failure during the oedipal phase. A.
Ornstein (1983a) described the successful analysis of a man who developed
an idealizing transference to her as a strong father who delights in his son's
assertiveness and competitiveness. This selfobject transference arose in
relationship to a deficit in the patient's self created by the father's inability
to respond to his son's oedipal phase needs. In her discussion Ornstein
addressed the process of identification in the resolution of the Oedipus
complex from a self-psychological perspective. She stressed that the
exchange of a pathological identification with a depressed father for a
healthy one was not sufficient explanation for what transpired in the
analysis. She contrasted the concept of identification with Kohut's concept
of transmuting internalization, concluding that the grosser taking in of an
aspect of another as a part of one's own psychic structure (the identification
of classical theory) could only be regarded as defensive or compensatory.
Ornstein stated that disappointments in the same-sex parent during the
oedipal phase have special pathogenic significance because gender-linked
values and standards (what is masculine and what is feminine) become
relevant at this time. She proposed that the negative Oedipus complex, the
longing for sexual closeness with the same-sex parent, is an effort to
reengage the idealized same-sex parent as a “mirror-er” of phase-
appropriate development. The erotization under these circumstances, she
explained, represents the intensity of the child's longing. Ornstein felt that
her recognition of this patient's need for her to function as a paternal
selfobject was crucial and that the needed analytic process would not have
occurred had she viewed his transference to her as a response defined by
her being a woman.

Terman (1984–1985) described the analysis of a young woman whose

problems derived from the failure of her mother to function as a selfobject
for her oedipal development. As the analysis unfolded, the predominant
transference was to a maternal oedipal selfobject. The need was for the
analyst to mirror the patient's gendered sexual self. The patient feared that
the analyst would be a rejecting, punishing mirror, as her oedipal mother
had been. A turning point in the treatment was Terman's realization that he
could not interpret the patient's fears on the basis of her conflicts over her
impulses. Rather, he had to bear witness to the fact that her mother really
had responded to her proud little girl with inappropriate anger. In his
discussion Terman addressed the maturation of the grandiose self in the
oedipal phase. He stressed that the very heart of the oedipal frustration is
narcissistic: “One simply isn't ‘big enough.’ “A mirroring parental
acceptance of the child's phase-appropriate grandiosity is required to
decrease the distance between the oedipal child's idealized parental imago
and the grandiose self. In this way, for example, the little boy's archaic aim
of having his mother now is transformed into the realizable ambition of
having a girl just like mother when he grows up. Terman proposed that the
residue of this mirroring experience becomes the skeleton of the superego
in its regulating capacity.
Detrick (1985) and Basch (1992) have both proposed that twinship is the
most basic of the three selfobject experiences. However, there is far less in
the literature on the role of twinship (or kinship, as Basch prefers) in
development than on the mirroring and idealizing self-object experiences.
Kohut (1984) did suggest that there is a pivotal point in twinship selfobject
development from ages four to six. Solomon (1991) stated that the
preoedipal girl sorts out her anatomical realities and the meanings she will
attribute to them via twinship experiences with both parents. Logically, the
fundamental task of the oedipal phase of acquiring differentiated gender-
specific traits would seem to call for an experience of twinship with the
same-sex parent. Here, however, the concept of the transmuting
internalization of these aspects of the self begins to potentially overlap with
the concept of identification as it is used in classical theory to explain the
resolution of oedipal conflict. Ornstein (1983a, b) explored this issue with
regard to the mirroring and idealizing selfobject experiences with the same-
sex parent. The same specific task remains to be done with the experience
of twinship, as does the more general task of outlining the role of the
twinship selfobject experience during the oedipal phase.

It is with the concept of self pathology as the core of oedipal problems that I
have taken another look at two of my early analytic cases: one that “went
wrong” when in my frame of mind at the time I “did everything right” and
another that “went right” when I began to “do things wrong.” Both women
were diagnosed as having structural neuroses of the hysterical type and had
documented trauma during their oedipal phase. The nature of this trauma
could be more clearly appreciated than is often the case because remnants
of their mothers’ traumatic behaviors remained and/or were reactivated
during the course of the analyses. My discussion is an attempt to make a
general contribution to the self-psychological understanding of the oedipal
phase in female development and to explore the specific role of the
twinship selfobject experience during this time.

CASE 1: THE BAD GIRL

Marisol, a Mexican-American woman, was a single 30-year-old when she

entered analysis. Our initial contact was my returning her call to my
answering service. She did not recognize my name, although I returned her
call within the hour. In explanation, she said she had “expected a man or at
least an older woman with not soft a voice.” Her reaction was, “Aha, it is a
woman,” as if she had suspected fate might deal her this particular blow. At
our first meeting she complained of depression, low self-esteem and
problems with men. She told me about her pattern of involvement with
“unavailable” men, which she associated with her father's inability to let her
grow up. She described feeling hopelessly bogged down in finishing her
doctoral program in education. Her ultimate career goal was to develop
programs for minority students.

Marisol was born to a farming couple in a rural area of Mexico, the second
child of four. She described her early years as “happy”; in particular, she
had a special relationship with her father, from which her mother felt
excluded. When she was five, her father left for the United States. She
recalled this as being a complete and traumatic surprise. Her mother was
very distressed after his departure. She would repeatedly tell the children
that their father was squandering money on women and alcohol and would
never send for them. In fact, Marisol's father did send for her mother and
oldest brother six months later. The three youngest children stayed behind
with their punitive, controlling maternal grandmother. After another six
months the parents sent for them. From this point Marisol described her
experience and relationship with her parents in negative terms. The family
was poor and lived in a public housing project. Because her parents were
frightened by the environment, they were restrictive and intolerant of
problems the children had that necessitated their dealing with any authority.
From the time Marisol was eight until she was ten, her mother had frequent
hospitalizations for an unexplained sequence of illnesses. The children were
cared for by public aid housekeepers. Marisol recalled this as a time when
they were poorly fed, dirty, and harshly punished. The only history Marisol
felt was pertinent from her adolescence was a relationship with a man her
parents attempted to “force upon” her when she had no such interest. She
described her young adulthood as a series of battles with her parents over
her autonomy. She had been involved in brief romantic relationships with
men, some involving sex, but none had worked out. Her relationships with
female friends were equally unsatisfactory; she felt alienated from other
women, believing that they could not be trusted to be accepting or
supportive.
During the first six months of the analysis Marisol was often late. She said
it had to do with “giving in versus breaking the rules.” She painted a picture
of a dependent relationship as one in which she was at the whim of a
depriving and punitive person. I interpreted to her that her “rebelliousness”
was defending against feeling vulnerable with me. With this approach the
material shifted to a concern for her adequacy as a woman. Marisol said she
felt stuck in her life, “like in a pool of something heavy.” Wishes to be a
successful career woman with a husband and children painfully contrasted
with her conviction that this could never happen to her. In her fantasy either
other people resented her success or she failed. The only satisfaction she
could envision for herself was “revenge, which tastes good compared to
nothing.” Although she said she really enjoyed sex, she felt guilty about it:
“It's like getting away with something.” Any reference Marisol made to me
was followed by images of “tight-assed, girdled women” who thought they
were too good for her. However, she would adamantly deny categorizing
me in this way or holding any concern about her acceptability to me.

Upon my return from vacation 18 months into the analysis, Marisol wished
aloud to be “a more sociable, spontaneous, confident person.” She followed
with, “I guess I could start by trying here.” She reported dreams of being
with her sister, which were remarkable to her because of the exquisite
feeling of closeness between them. (In retrospect, these most likely
reflected a budding twinship selfobject experience.) It was in this
atmosphere that Marisol took a magazine from my waiting room without
asking and tried to return it furtively the next day. When I brought it up, she
said I was accusing her of stealing because she was “from the ghetto.” I
interpreted this act as revealing her competitive wish to have what was
mine. Marisol found this interpretation highly insulting.

Gradually, Marisol could acknowledge being curious about me but denied it

had any particular significance since she was always interested in people
who, she said, “lead the life I'd like to live.” She had a dream that took
place in the women's rest room of my building: She was looking in the
mirror and trying to put on lipstick. The harder she tried, the uglier she
looked. Associating to the image of herself as ugly, Marisol said, “I've been
made to feel that I am ugly. My mother has always used expressions like
‘whore,’ ‘low class,’ ‘dirty’ about me. When it comes to me, she is full of
bitterness, hatred, envy, and jealousy.” In response to my questions about
this, Marisol began to tell me about what amounted to her mother's chronic
paranoid distortions of reality. Marisol had been aware of this in her mother,
but its meaning and impact on her had been disavowed until this time. In
retrospect, we saw that her mother's distress during her father's absence and
her later hospitalizations were almost certainly psychotic episodes.

These disclosures and conclusions, which emerged over a period of weeks,

were accompanied by intense anxiety. A pattern of missing a session
following one in which she told me “too much” or spoke positively about
her own future emerged. I interpreted to Marisol that her progress
unconsciously equaled being destructive to her parents. In contrast to much
of what I had said, Marisol felt this made sense. What I failed to appreciate
was the extent to which her progress consisted of her growing attachment to
me; nor was I aware that my interpretations focusing on her drives were
being experienced as an ugly reflection. My strategy with regard to the
transference was to continue to suggest to Marisol that her now obvious
comparison of herself to me was rooted in frightening, hostile, competitive
feelings. She steadfastly maintained this was impossible: “You are in a
completely different class; it would be like a dog racing with a horse.” She
concurred with my observation that she viewed herself as not measuring up
but could never derive relief from my interpretation that this was a defense
against her competitiveness.

Marisol chose as her dissertation topic the effects of having a teacher from a
different cultural background, which, of course, was an issue for us. (I am
not Hispanic and my name was not Martinez at this time.) I recall viewing
this as hostile and devaluing of me-although, thankfully, I did not make that
interpretation. Marisol reported a striking dream during this period:

I was with my sister in a hotel. I went to what should have been my room,
but the other lady hadn't left yet. When she did, it was in a hurry and she
left her bath water. There was also a silver cup that said “Epsom Salt.” I
said to myself, “She wasn't as glamorous as I thought. She must have a skin
disorder.” I felt sorry for her and considered how I could get her things back
to her. Then I got into the bathwater.
At the time, I focused on the devaluation of the lady (me) in looking at the
dream. In retrospect, in this and numerous other examples, I see Marisol
attempting to bridge the intrapsychic gap she experienced between herself
and me. I had become a woman she wanted to emulate and by whom she
wished to be accepted. I also was the yearned-for (twin) sister whose like
presence made her journey more acceptable and less frightening. Her
devaluation of me was an expression of this painful gap and a defense
against her yearning. In other words, the transference was a selfobject
transference with idealizing and twinship characteristics.

About two and a half years into the analysis Marisol discovered that her
boyfriend was seeing another woman. His betrayal enraged her. I
interpreted her anger at the other woman as a displacement of a negative
maternal transference. In apparent response Marisol began to come 20 to 30
minutes late or miss sessions entirely. She tried to ignore everything I said
(which was a healthy thing to do, given the circumstance). When I
confronted her with this, she said, “My generalized hatred and contempt
prevents me from relating to anyone.” Her perception of me and the
external world became frankly paranoid. She had irrational fears that she
was pregnant and multiple other hypochondriacal concerns. Work on her
dissertation, which had been going extremely well, stopped. Previously
unreported memories of childhood with themes of malevolent “Anglo”
authority figures and hurtful doctors and nurses came to Marisol at this
time. I now see my failure, in the context of the intense selfobject
transference, to recognize the profound humiliation at her boyfriend's
betrayal as the precipitant of her fragmentation.

Not surprisingly, my interpretations of Marisol's “resistance” led to no

improvement in the situation. I finally began to talk to her about the
feasibility of continuing her analysis under the circumstances of her not
coming to sessions. Her response was that she felt we had made progress
with feelings about her family but that the issues now were with “society as
a whole.” She explained:

What you think is important, I don't. I am filled with the pure unadulterated
hatred of whites. I have no patience for Latinos, just pure contempt and
disgust. I am still being rejected because I am a poor Mexican. That is what
makes me rage inside. People who exploit and abuse me. Don't expect any
love from me for a society that thinks I'm shit. I think they are shit. If I
cannot use my analysis to vent my rage, there is no point to it.

I suggested that we continue to try to find a way to work with these issues,
and Marisol agreed. However, she continued to come late or miss sessions
altogether. Her functioning further deteriorated and she was in a continuous,
alienated rage. Ultimately, I suggested that we switch to twice-weekly
psychotherapy, as this would be a better approach to her difficulties.
Although she was concerned about being “a failure,” her primary reaction
was relief, and there was an immediate improvement in her functioning.

Once we were sitting face-to-face, Marisol began to report other painful

memories. In one such instance she tearfully recalled, “When I was about
five, my mother tortured a cat until it died. She said it was a bad cat that
killed its kittens. She tied it to a tree and beat it to death with a stick.” She
also related that her parents had physically hurt one another and the
children after the move to the United States. I told Marisol that the
childhood physical abuse had impaired her ability to trust and that this was
at the core of the impasse in the analysis. I now see this interpretation as
inexact in that it disregarded the “abuse” that Marisol had suffered in the
analysis. As it turned out, Marisol stayed in therapy only a few more weeks.
Once back to her baseline, she seemed to need to seal over the experience.
Unfortunately, I have no follow-up.

I now think Marisol could have had a successful analysis. I contributed to

her nontherapeutic regression by being insensitive to her vulnerability to
humiliation and to her healthy positive selfobject attachment to me. Kohut
(1984) said that in psychoanalysis “it is not possible to reactivate traumatic
situations of infancy and childhood to which the self had on its own
responded constructively during its early development.” He continued,
“Even if the revival of these situations were feasible, moreover, no good
purpose would be served if we could in fact bring it about” [p. 43]. Looking
back, I see that my need in my early development as a psychoanalyst to
make use of my theoretical orientation as a selfobject may in fact have
reactivated Marisol's childhood traumatic situation, leading to the described
profound fragmentation of her self.
CASE 2: THE GOOD GIRL

Paula was a 27-year-old who was engaged to be married when she was
referred to me. Her internist suggested she might benefit from
psychotherapy for what he diagnosed as functional abdominal pain. Paula
told me there were indeed stressful situations in her life. She and her
boyfriend had just decided to marry after living together for a year.
However, this decision was reached only after she threatened to leave,
making things tense between them. She had also recently been fired from a
position in the prominent advertising firm where they met. Paula did not
understand why this had happened and felt terribly humiliated.

Paula was the elder of two daughters in her upper-middle-class family. She
described her homemaker mother as “goal-oriented and intelligent.” She
depicted her father as “loving”; although his job demanded long hours and
extensive travel, Paula felt closer to him than to her mother. The only
problematic aspect of her childhood, she said, was that her mother
“discouraged expression of negative feelings.” Paula felt “out of the
mainstream” during her adolescence, a feeling she connected with twice
having to change high schools owing to family moves; she compensated by
putting her energies into her studies. Once in college she had a need to
prove herself socially. She dated extensively but the relationships, many of
which included premature sexual involvement, tended to end badly.
Friendships with other women always seemed to result in some painful
disappointment. After college Paula began graduate work but quickly lost
enthusiasm for her studies. She briefly saw a psychiatrist for depressive
feelings. He helped her to see that she had conflicts between what she felt
she should do and what she wanted to do. Ultimately, she decided to leave
school. Despite her mother's reassurance, Paula felt she had let her down by
not completing her doctorate.

Paula knew she had a problem related to her career. She was bright and
capable and had high ambitions. However, she had noticed that even when
she achieved her goals, she felt empty and dissatisfied. Paula also knew that
her boyfriend, as distinct from other men with whom she had been
involved, had the potential to be a good husband. She both loved and
admired him but felt she could not be as open emotionally or sexually as
she wanted. In addition, he wanted children but she felt a deep reluctance to
undergo a pregnancy and raise a child. After a few sessions Paula's
abdominal pain disappeared and she felt enthusiastic about her upcoming
wedding. However, it was clear she was struggling with some
characterologic issues, and we decided to start an analysis.

Just before my first vacation Paula casually mentioned that her mother had
suffered a “nervous breakdown” after the birth of her younger sister, when
Paula was four. Her mother's symptoms had been those of a major
depression with paranoid features. When I asked how she had failed to
mention this previously, Paula said she had been conscious of it but it had
never seemed important. I interpreted the timing of the revelation as having
to do with the anticipation of my absence. Paula agreed but felt she
probably wanted far too much.

Shortly after, Paula reported the following dream.

A friend and I were to be married on the same day. We got up in the

morning and had a fight. There was not enough time to prepare for my
wedding. She had relatives to help her. I felt I was being punished for
having gotten angry. She said, “How can you be mad? I had to put up all
night with your rolling all over the bed. Isn't that enough?” It was like she
had made a concession so I couldn't be angry.

Atypically, Paula had few and seemingly superficial associations to this

dream. I suggested that she might have wanted more help from me in
emotionally preparing for her recent marriage. While she agreed this made
sense on an intellectual level, she was not in touch with the corresponding
affects in relation to me.

As time passed, I emerged as an idealized figure whose approval Paula tried

to win by being “good.” Being good meant not complaining, arguing,
making demands, or being angry. Paula ultimately said, “I've operated
under the assumption that I had to portray an image you would like to get
the most out of the sessions. I was transferring my expectations onto you
without recognizing the origin.” She associated this experience of me with
her mother. Her mother's image of the perfect woman was that of a nun:
passive, forgiving, asexual. Paula saw her mother as having striven to live
up to this ideal herself, and Paula grew up feeling that the only way to
please her mother was to be just like her. She reported a vivid dream in
which she was a child and her adult husband followed her from room to
room, interrupting her just as she started to enjoy herself in play. Her
husband was a threatening figure in the dream, and her affect was of being
somewhat frightened and very oppressed. I proposed that this was how she
had experienced her mother's worried depression as a child.

A year and a half into treatment, as the aforementioned defensive position

was being worked through, Paula's mother was hospitalized for a major
depressive episode.1 In response to this event Paula relived her intense
anger at her mother and her associated sense of her own “badness.” Paula's
mother was also taking a look at what her previous depression had taken
away from her mothering ability, and she was able to validate Paula's
feelings and insights. The honest dialogue that developed between them
was quite moving. Paula learned that her mother had become depressed
when pregnant with Paula's younger sister to the point of being convinced
that she would die in childbirth. Her treatment ultimately required
electroconvulsive therapy. Paula's experience of her rigid, corporate work
environment as controlling, devaluing, and “full of meaningless rules”
brought her childhood affective experience of her mother's depression into
full awareness. Elements of this experience also served to remind Paula of
her maternal grandmother, who Paula learned had cared for her during her
mother's hospitalization.

I had no success at making Paula's intense anger a part of her transference

experience with me.2 Like Terman's patient, Paula demanded that I be a
witness to, rather than a participant in, this process. My pointing out
suggestions of her anger toward me or possible resistance to her experience
of it would cause Paula to retreat to a less affectful interchange of the earlier
“good girl” variety. In retrospect, I believe these interventions disrupted
Paula's transference to me as a mirroring selfobject. In contrast, my simple
reflection of her affective state or of her insights into how her past intruded
on her present served to vitalize her self experience and to move the
analytic work forward. Ultimately, we understood that my attempts to make
myself the object of her feelings led her to experience me as her fragile,
intolerant mother. I now see that these interventions corresponded too
closely to Paula's mother's preoccupation with containing her own anixiety.
Paula's earlier statement that her mother discouraged expression of negative
feelings now took on deeper meaning. We understood that her
characterologic “good girl” stance supported a desperately needed tie to her
mother. I began to suggest to her that she feared involving herself deeply
with me out of a fear of repeating her experience with her mother. This
approach made sense to Paula:

My mother put her worries on me and wasn't helpful with mine. I had to
deal with things on my own as best I could. I shut her out of a lot of things
because of this and so felt I was constantly rejecting her. I relied on myself
for the answers. I got used to doing things a certain way. This control gave
me a sense of identity and enabled me to get through times when mother
was hammering into me things I didn't want to do. My identity is formed
around the idea of “She doesn't know what she is doing.” To lose that brings
up vulnerable feelings. With mother it was all or nothing. I feel I have to
trust you completely or not at all.

This approach freed Paula to negotiate and handle her anger at her job
constructively. She developed a more balanced view of her mother and of
herself in relation to her mother. Only then could she acknowledge that
analysis could at times feel restrictive and controlling and ask for
appointment times more compatible with her own busy schedule.

On the heels of this work, status and respect became important to Paula.
Competing, however, seemed “unchristian.” I simply addressed the extent
to which she felt these healthy yearnings were unacceptable. Almost
overnight, her competitiveness and assertiveness began to overtly manifest.
She took on more responsibility at work and began running in organized
races. Paula was delighted with her “new self.” There were new memories
from the time of her mother's illness. Paula recalled turning her attentions to
her father then: “I would crawl into his bed for comfort, instead of my
mother's.” Apparently, her mother became uncomfortable with this and
insisted it stop. Paula recalled feeling responsible for her mother's “red
eyes.” I suggested that she had attached her mother's unhappiness to her
developmentally appropriate competitive and sexual fantasies and that this
had led her to reject these aspects of herself. As a result of this work Paula
began to make moves toward fulfilling her career goals. She took a course
to prepare for the Graduate Record Exam (GRE) and applied to graduate
school. Simultaneously, she sought and received a promotion at work.

Given our earlier experience, I was reluctant to try bringing Paula's

competitiveness into our relationship, but old theories die hard. After a
session in which she expressed particularly intense competitive feelings
with other females, Paula pulled a muscle by being too vigorous in an
exercise class. I could hold back no longer. I commented that with all her
growing she might be comparing herself to me. She, without missing a beat,
responded, “It would be so nice to have my own business like you do, not to
have to conform.” These feelings had not been unconscious, only unspoken.
Encouraged, I continued over the next few days to focus on her competitive
feelings toward me. In doing so, I again disrupted the selfobject
transference in which an idealizing component had become discernible.
Paula became less enthusiastic and this time came up with a variety of
“good girl” reasons to consider decreasing the frequency of her sessions.
Her associations led to thoughts of her mother's problems with
intrusiveness: “With my mother it was a feeling like she didn't have a life of
her own. Her attention was overwhelming. Not the kind of support I
needed.” Again, my attention to her drive experience was felt by Paula to be
an interference with her progress. Unexpectedly, this led to understanding
Paula's reluctance about having a child. In her fantasy, we discovered, a
child would restrict her ability to, she said, “move around and do just what I
want to do” and would make her resentful. An additional factor was her
refusal to be at all like her mother:

Another fear of having a child is that I might like it and that would make
me like my mother: Where would that fit in with what makes my life my
own? I've always sensed my mother as a negative role model. The thought
of being like her was an electric shock to have me jump ahead. If I look to
you as I wanted to be able to look to my mother, am I losing some hold on
myself? As a child, I'd have to say to my mother, “Yes, you are right,” but
inside I'd say, “You are a jerk.” It seems that being tied in this way means
giving up my right to disagree or be angry.
The experience of having Paula retreat to the good-girl “Yes, you are right”
state in response to my focus on hostile, competitive strivings directed at
me was often repeated. Her unspoken anger and resentment at this
“thwarting” would be palpable through the “good girl” armor and gradually
became speakable. Ultimately, I became convinced that Paula's requirement
that I serve an affirming, idealizable function was not a defense but a
developmental need.

About two and a half years into the treatment Paula reported a vivid dream.
This followed a session in which she had initially misheard me as
discouraging an assertive move and then realized her distortion:

I was showering after exercise class. A friend said, “Oh, you have a penis!”
I looked and I did. It was coming out of my vagina. My friend saw I was
shocked and said, “Everyone has one,” and then she showed me hers.

Paula felt slightly embarrassed at the manifest content of the dream. She
had read in the newspaper about penis envy but could not relate to the idea
of actually wanting a penis. As far as anatomy went, she said she would
prefer having her husband's firm derriere. What struck her about the dream
was the feeling of competence and self-sufficiency associated with the
realization of having a penis. This she said she would very much like to
have. I felt the dream was a representation of Paula's consolidation of a
sense of herself as a competent and assertive woman in the context of my
presence as an affirming feminine oedipal selfobject (Stolorow and
Lachmann, 1980) and, in so many words, told her so.

Paula began to speak openly of the importance of “role models” and to hint
at being curious about me. My pointing this out released a flood of
questions about me and my life. Paula related these questions to concerns
about the acceptability of the emerging aspects of her self. Meanwhile, she
competed for and received another job promotion. Finding herself with
much more work, she said, “It must be like when you first started practice.
You have to not do some of the usual things for yourself, like taking clothes
to the tailor you might once have repaired yourself.” She dreamt that her
office and my office were somehow one and the same. We looked back at
the early dream in which she was denied the help she needed to prepare for
her wedding. We saw how it had expressed her highly defended against
need for the kind of experience she was now having with me. In retrospect,
the experience was of an oedipal selfobject transference with prominent
idealizing and emerging twinship characteristics.

Paula was now notably more spontaneous with me, others, and herself. Her
fantasy life was more accessible and she began to do some art work. Also,
her sexual responsiveness increased and positive thoughts about having
children appeared. She began to express a vague longing to find out about
me that ultimately focused on my sexuality. Paula mused:

I probably wonder if I will get the same reception from you around these
things that I got from my mother. Will I be laughed at? I remember telling
my mother a dream I had about a man being short and fat, then getting
skinny and tall, and getting short and fat again. I've always thought that
dream was very sexual. My mother probably did too, because she said it
was a stupid dream.

She recalled that her mother's response to her announcement that she was
dating someone new was always, “You aren't sleeping with him, are you?”
Paula's curiosity about me peaked in her asking me directly and with some
urgency if I was or had been married. From her associations it seemed she
was trying to find out if I accepted my sexuality and, by extension, hers. In
retrospect, the specific oedipal feature of the transference here was Paula's
need to be able to idealize and feel twinned with me as a sexually
responsive female. With great trepidation, she revealed her speculation that
I had been married and was now divorced. She said that if this were true she
could “once and for all let go of the ideal of being a nun.” I saw this as her
being able to fully embrace an idealized feminine image that included
sexuality, healthy self-interest, and human limitation. Paula also described a
feeling of relief connected to the fantasy that I was divorced, relief that had
to do with thinking that I, as opposed to her mother, could survive her being
separate from me. Even after considerable analyzing, Paula had a need to
know if her fantasy was correct. Ultimately, I acknowledged that she in fact
was right; interestingly, this disclosure did seem to solidify the feminine
self that Paula had developed in relationship to me.

As the analysis drew to an end, Paula reported experiencing herself in a

new way, which she felt she could best describe by the phrase “My life is
my own.” She was expressive of a wide range of feelings about ending,
from proud excitement to sadness. This loss felt novel to her in that it was
the first loss she had the “luxury to mourn.” Occurring in the shadow of her
relationship with her mother, all previous separations had felt like
“escapes.” As our final session drew near, Paula looked back on the
analysis:

Since I was last here, I've been thinking about missing and mourning. My
thoughts went back to the start of therapy: all the images I've had of you
and how they've changed. How I was afraid of depending on you. It was
something I'd never been able to do. I will miss analysis, but I will also
miss you. And not just an image of you. I did make you into the mother I
never had, but I also appreciate what you have actually done for me, like
allowing me to look at the things I was afraid of without fear of losing you.
That is something I'd never had before.

DISCUSSION

When I examined these cases for the specific self weaknesses and selfobject
failures that led to each young woman's difficulty, the following ideas
seemed relevant: Marisol did not have a cohesive sense of herself as an
adult female. Ornstein (1983b) could have been speaking of Marisol's
growing up when she referred to the special neurosogenic significance of
the mother's jealousy of her little girl's relationship with her father during
the oedipal phase. Ornstein noted that this type of mother is unable to
delight in this specific progressive move in the little girl's development:
“Such a failure in parental selfobject responsiveness can severely affect a
girl's self perception in terms of her femininity and sexual functioning”
[p.388]. Her mother's skewed perception deprived Marisol of a way of
integrating her phase-appropriate assertiveness and sexuality into the fabric
of her self. As a result, she experienced herself as a little girl who would
never grow up to have a husband, babies, or a successful career. This was
the basis for her hostile, apparently competitive stance toward other
women. In her analysis Marisol established, after some work on her “bad
girl” defense, an idealizing transference to me as an oedipal mother. She
wanted to look at me in a way that would provide direction for her own
psychological maturation as a woman. My insistence that such yearning and
related behavior were hostile and competitive was experienced as a
repetition of her mother's psychotic view of her healthy assertiveness and
sexuality. Marisol's mother's most striking failure seems to have been as a
mirroring maternal oedipal selfobject. Marisol's turning to me as an
idealized oedipal selfobject is consistent with Kohut's (1984) observation
that development in psychoanalysis is likely to renew itself around the least
damaged pole of the self. Marisol, with her single-minded devotion to
helping minority students, had been primarily organized around her ideals
prior to her treatment, indicating that she had managed to erect a
compensatory structure around this pole of her self. I think that if I had been
able to provide her a more consistently empathic analytic experience, the
revision and strengthening of this structure would have been a major area of
intrapsychic change for Marisol.

Paula, on the other hand, could not idealize a feminine image consistent
with her nuclear self. The feminine ideal of the nun that she had been
offered by her mother did not fit, yet anything else seemed “second-rate.”
After a working through of her “good girl” defense, Paula established a
selfobject transference to me as an oedipal mother who was primarily
mirroring in nature. She responded with enhanced vitality to comments of
mine that merely appreciated the healthy significance of her feelings and
her renewed development. Paula experienced my interpretations focusing
on her competitive feelings about me as indications of my discomfort with
her affects and an insistence that she fit my mold. This, of course, was a
repetition of her relationship with her mother, whose character and acute
depression led her to fail Paula primarily as an idealized oedipal selfobject.
As Paula said, “The idea of being like her was like an electric shock that
made me jump ahead.” Paula's lifelong focus on her achievement and
appearance reflected the compensatory structure she had established around
the pole of the grandiose self. Although the analysis resulted in Paula's
being able to make use of a full range of selfobject experience in relation to
me as an oedipal mother, her renewed development also took place, at least
initially, around the least damaged pole of the self.

Turning to the role of the twinship selfobject experience, what specific self
weaknesses can be seen to derive from failures in this area during the little
girl's oedipal phase? Detrick (1985) describes the need for sameness
underlying the twinship experience, while Basch (1992) focuses on the
importance of the experience of acceptance that comes from being like the
other. Paula and Marisol both presented with a sense of badness about their
assertiveness and sexuality and felt alienated from other women. While this
symptomatology could be explained on the basis of a failure in a mirroring
or an idealizing selfobject experience, the absence of a sense of alikeness
with other females inherent in these complaints implicates the twinship
selfobject experience. And how does a little girl feel twinned with her
mother? Kohut called upon images of shared activities, like the little boy
shaving alongside his father, to capture this subjective state. I think of my
daughter, who at age two was inclined to joyfully announce in the most
unexpected places, “Daddy and Brother got penises. Mommy and me got
‘bulbas.’ “ Contrast this prideful state with Marisol and Paula's inability
and/or unwillingness to feel twinned with their oedipal mothers. I would
also suggest that it is significant, in light of the absence of healthy twinship
experience, that the mirroring and idealizing selfobject failures that both
young women suffered were in the nature of impingements, to borrow
Winnicott's term. Marisol's and Paula's mothers were not merely unable to
provide a healthy oedipal selfobject presence; their acute psychopathology
during their daughters’ oedipal phase made their presence noxious. Marisol
and Paula were required to actively keep their mothers away from contact
with their healthy oedipal selves. From these considerations I propose that
the oedipal twinship selfobject transference manifestations seen in these
two analyses were in the realm of new psychological experience.

Given Marisol's and Paula's overt rejection of their mothers as twins, what
is most curious is that in their “bad girl” and “good girl” defensive modes,
Marisol and Paula were near replicas of the failed maternal selfobjects from
whom they required protection. Marisol defended against her mother's
attacks on her self with an assault of her own. Paula warded off her mother's
attempts to mold her by adopting a facade that matched her mother's own
“good girl” defensive presentation. The “bad girl” and “good girl”
presentations can be seen to serve multiple functions. Newman (1980) and
Ornstein (1983b) have emphasized the role of defensive structures in
maintaining a connection to a desperately needed mother. Indeed, Marisol's
drawing fire by being a “bad girl” did guarantee an ongoing lively
involvement with her mother, and Paula's compromise of her self allowed a
placid relationship with her superficially idealized mother. Of course, true
engagement and the associated risk of retraumatization were simultaneously
warded off. The behaviors also provided a way of being a woman in the
world, filling in for missing psychic structure. Marisol's determined, angry
activism and Paula's compliant charm gave each a sense of who she was
and brought some real rewards along with the complications. In addition—
and perhaps most importantly—the “bad girl” and the “good girl”
presentations represented, I believe, a profound unconscious need to feel an
alikeness with the oedipal mother.

Ornstein (1983a, b), focusing on the realm of idealization, pro posed that
the formation of a gross identification with the homogenital parent during
the oedipal phase is the result of selfobject failure. In my mind, both the
“bad girl” and the “good girl” structures qualify as gross identifications. We
know that a child will perform to obtain a mirroring selfobject response and
will disavow disillusionment to try to maintain an idealizable selfobject.
Might not the child shape his or her self to be like the same-sex parent in an
attempt to provide something akin to a twinship selfobject experience when
one is not naturally forthcoming? In other words, can this type of
identification be conceptualized as a structure deriving from a twinship
selfobject experience gone awry? This structure would be more or less a
gross one, depending upon the extent of the gap between the child's genuine
propensities and those relevant personal qualities of the parent and upon the
degree of desperation for a psychic structure to maintain self functioning. I
also suspect that failures in the mirroring and idealizing oedipal selfobject
experience put more pressure on the area of twinship development as a site
for the formation of defensive or compensatory structure, while
simultaneously making the same-sex parent a less appealing figure with
whom to feel twinned. This could also help account for the apparent
paradox in these two cases in which the two women were so like the
mothers they vehemently rejected on a conscious basis.

Related to the issue of the twinship selfobject experience is another that

bears discussion: the influence of my being a woman on the course of these
analyses. I think that in both cases a twinship selfobject experience, with
my being a woman as the foundation, promoted the patient's renewed
oedipal development. I felt this most clearly with Paula; my being female
and my having much in common with her socially, culturally, and
generationally facilitated her relinquishing her defensive “good girl”
identification with her mother and enhanced the transmuting internalization
of an assertive and sexual addition to her feminine self. Kohut (1977)
proposed a developmental sequence in which the mother early on performs
as a mirroring selfobject and the father later enters as an idealized
selfobject. He noted, however, that the girl may direct both sets of selfobject
needs toward the mother. Ornstein (1983a, b) argued that it is the
homogenital parent that provides the crucial developmental experience for
the primary task of the oedipal phase, the acquisition of gender related goals
and delineations. I think the possibility that the gender of the analyst plays a
significantly limiting or facilitating role in this process as it is reactivated in
an analysis must be entertained.

Kohut (1984) suggested that there may be more than one road to an analytic
cure. He was tentative in this assertion, as I read him, possibly out of a
concern over having it seem that the actual person of the analyst plays a
determining role in shaping analytic outcome. More recently, Goldberger
and Holmes (1993) concluded, after studying transferences in male patients
with female analysts, that the analyst's gender can have evocative and/or
limiting effects on transference development. Solomon (1991) also suggests
that the reality of the therapist's gender can crucially affect a female
patient's selfobject relations. Ornstein (1983a) and Terman have shown that
a heterogenital analyst can provide mutative idealizing and mirroring
selfobject experiences for patients with oedipal phase problems. However, I
wonder if a patient can have a meaningful twinship selfobject experience
related to the oedipal phase task of acquiring highly differentiated gender-
specific traits in the transference with an analyst of the opposite sex. This
does not mean that oedipal phase problems could not be cured in an
analysis in which the patient and analyst are of opposite sex, only that the
process and the shape of that cure would be different. For example, the
patient might make use of an important same-sex person outside the
analysis for the needed twinship selfobject experience, or renewed
development might occur more around idealizing or mirroring selfobject
experiences in the transference.
In summary, the two cases presented here confirm the mother's central
importance as an oedipal selfobject who provides essential mirroring,
idealizing, and twinship selfobject opportunities for her daughter. The
clinical material also underscores the oedipal girl's vulnerability in the face
of her mother's impaired functioning as an oedipal selfobject. In addition,
these cases support Kohut's hypothesis that the twinship selfobject
experience is crucial during the oedipal phase. The need to feel alikeness
with a same-sex parent to accomplish the developmental task of acquiring
more differentiated gender-specific traits provides a rationale for this.
Failures in the mirroring and/or idealizing selfobject functioning of the
oedipal same-sex parent may put more pressure on the area of twinship
while simultaneously making the parent less desirable as a selfobject for
this experience. The grosser taking in of a defensive structure, which might
be labeled an identification from the perspective of classical theory, would
from this vantage point be understood as an attempt to compensate for the
deficits in the oedipal self via a distortion of the twinship selfobject
experience.

While the crucial role of the parent in providing selfobject experiences for
the oedipal child is now well established, we are far from meeting Kohut's
challenge of outlining the specific self weaknesses and selfobject failures
that lead to specific oedipal pathology, particularly with regard to the
twinship selfobject experience. The usefulness of these two cases in clearly
and specifically addressing this task is limited by my largely retrospective
understanding of the relevance of the self issues for these women. There are
many questions for self-psychologically informed analysts to investigate
about psychoanalytic cure in patients, like these women, who have more
complexly developed psyches. For example, the role of the father in the
oedipal development of these women was neglected in my presentation. In
this continued pursuit I think we are wise to keep an open mind in
considering the role of the unique person of the analyst as an influence in
shaping the renewed development of the patient's self. In particular, the
possibility that the analyst's gender may facilitate or limit opportunities for
growth in aspects of renewed oedipal phase development via the twinship
selfobject experience in the transference deserves further investigation.

REFERENCES
Basch, M. (1992), Practicing Psychotherapy. New York: Basic Books.

Detrick, D. (1985), Alterego phenomena and alterego transferences. In:

Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 240–256.

Goldberger, M. & Holmes, D. (1993), Transferences in male patients with

female analysts: An update. Psychoanal. Inq., 13:173–191.

Kohut, H. (1971), The Analysis of the Self. New York: International

Universities Press.

———(1977), The Restoration of the Self. New York: International

Universities Press.

———(1979), The two analyses of Mr. Z. Internat. J. Psycho–Anal, 60:3–

27.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

Newman, K. (1980), Defense analysis and self psychology. In: Advances in

Self Psychology, ed. A. Goldberg. New York: International Universities
Press, pp. 263–278.

Ornstein, A. (1983a), An idealizing transference of the oedipal phase. In:

Reflections on Self Psychology, ed. J. Lichtenberg & S. Kaplan. Hillsdale,
NJ: The Analytic Press, pp. 135–148.

———(1983b), Fantasy or reality? The unsettled question in pathogenesis

and recon-struction in psychoanalysis. In: The Future of Psychoanalysis, ed.
A. Goldberg. New York: International Universities Press, pp. 381–395.

Solomon, B. (1991), Self psychology may offer new ways to understand

how penis envy functions. Psychodynamic Letter, l(ll):l:l–4.

Stolorow, R. & Lachmann, F. (1980), Psychoanalysis of Developmental

Arrests. New York: International Universities Press, pp. 144–170.
Terman, D. (1984–1985), The self and the Oedipus complex. The Annual of
Psychoanalysis, 12/13:87–103. New York: International Universities Press.

1Kohut (1977) noted that on occasion a patient's parent will manifest

serious self pathology during the time the son or daughter is being
emancipated from a merger with that parent.
2Kohut (1979), in describing Mr. Z's analysis during his exploration of his
mother's psychopathology, concluded:

The author wishes to thank Drs. Michael Basch, Anna Ornstein, and
Morton Shane for their help with this paper.

It is my impression that the comparative underemphasis of transference

distortions in such cases is not a defensive maneuver but that it is in the
service of progress. In order to be able to proceed with the task of
perceiving the serious pathology of the selfobject in childhood, the patient
has to be certain that the current selfobject, the analyst, is not again
exposing him to the pathological milieu of early life [p. 13].
Chapter Sexuality and Aggression in Pathogenesis and in the
10 Clinical Situation

Paul H. Ornstein

Sexuality and aggression, in their varied forms, so deeply and thoroughly

permeate our individual and social existence that their clinical and
theoretical importance seems to require no further justification. History,
religion, art, and literature throughout the ages document their centrality in
everyday human affairs. Who could question their basic motivational role in
human behavior? Small wonder, therefore, that psychoanalysts of all
persuasions, ever since Freud, have recognized the ubiquitous presence of
these two complex human proclivities in health as well as in nearly every
form of psychopathology. Thus, there has long been a broad consensus
about the fact that on a clinical–empirical level sexuality and aggression are
inevitably aspects of both emotional health and emotional illness. Questions
and controversies have arisen only in connection with determining the
origin, development, and nature of human sexuality and aggression and in
specifying their role and function in pathogenesis.

What is normal sexuality and what is normal aggression? When does each
become pathological? Or, to ask it more pointedly, in reference to the
controversies about their role in development and pathogenesis: How do
they develop so that they, in turn, affect personality development, and when
are they primary and causative in psychopathology? And when are
abnormal sexuality and aggression the results of an unfolding
psychopathology that has other fundamental or primary causes?
Furthermore, what are the relationships between normal and abnormal
sexuality and aggression? How can we tell them apart, phenomenologically
and dynamico structurally?

Instead of answering these questions directly, I shall immediately turn to

Kohut's perspective on sexuality and aggression.
KOHUT'S PERSPECTIVE ON SEXUALITY AND
AGGRESSION

To introduce the comprehensive, major shift that has occurred in the clinical
and theoretical approach to sexuality and aggression in Kohut's work, it is
not only fitting but actually necessary to begin with a clinical vignette. How
else could we concretely underline the fact that Kohut's ideas derive from
that distinctive clinical approach that is characterized by the prolonged,
empathic immersion of the analyst in his patients’ transference experiences?
It does, indeed, need to be said at the outset that unless we keep in mind
that the empirical data on which these theories rest were, by dint of the
method of its gathering, deliberately delineated from biology on one hand
and sociology on the other, we would be able to neither grasp properly nor
appraise adequately Heinz Kohut's self psychology.

Mrs. A was a widowed professional women in her late thirties who had
come into analysis some years before because of a chronic depression,
apathy, and profound inability to experience any sustained and sustaining
joy or pleasure in her personal or professional life. She had made excellent
progress over a number of years, especially in the core areas of her initial
difficulties: She wanted to feel more comfortable in her body as a woman,
and now she did. She wanted to be able to shed her “masculine, tomboyish
image” of herself and feel comfortable in feminine, attractive clothes. Later
on she wished to be less frightened of intense bodily sensations and sexual
feelings on the couch, and these she had also attained to a degree.

On this particular Friday Mrs. A approached her analytic session with

considerable uneasiness and reluctance, the source and meaning of which
feelings she did not yet understand. In a muted tone, with barely a hint of
excitement, she described an experience that morning of having sat for
quite a while with an agitated, severely depressed women. “I was able to be
with her,” she said, “calmly, without offering meaningless reassurance,” as
she had never been able to do before. “Do you know what I mean by just
being with her?” she asked with a slight tinge of excited teasing, which we
both understood to refer to her having told me many times in the past how
much she needed and appreciated my just being with her (she often
explicitly asked that I not say anything for a while but just listen and let her
talk). She went on to say that the second thing she did before coming to her
session was to go to a meeting, where she was calmly effective with a good
degree of emotional presence. As soon as she finished her story, she
immediately recalled a feeling from childhood of vaguely wanting
something from her mother and wishing to turn to her, but she was never
quite able to turn to her mother and actually ask. She wondered if I
remembered her telling me about this in the past. I said I did. She then
reported that it was a frighteningly uncomfortable feeling to come to this
session “with that same sort of a vague expectation from you.” She both
wanted to come to her session and didn't want to come. Now there was
more of a trace of excitement in her voice but also some fear. I said, “You
are excited about your experiences this morning. You were in touch with
something in yourself, having been able to be with this depressed women.
You have never experienced this before in quite this way. It must have been
difficult to be alone with this excitement and also the pride in your calm
effectiveness at the meeting.”

“Yes,” she said tearfully, “I felt so alone, empty, and depressed.”

“You needed to share this discovery and excitement, like you wished you
could have done as a child with your mother but never did. Now you
brought it in here, reluctantly, fearfully, keeping your excitement in check,
and wondering how I would receive it.”

“No, I was more worried of how I would feel telling you about it.” I agreed
with her correction. What felt so exciting to her was that she had done what
I generally did–and successfully at that. Mrs. A continued to look at her
experiences of the morning for a while, including her excitement in talking
about it as freely and as animatedly as she was finally able to do. Then she
said, “Now that we talked about it, I am even more excited that I got your
attention. I knew I could not share this with anyone. Nobody would
understand.” After a brief pause she said that for the last few minutes
physical sensations were part of her excitement. These were diffuse, all
over her body. “Are you sure it's all right to talk about this?” she asked, as
she had done on many other occasions. “These are sexual feelings. I also
feel like eating. Both would get out of hand in this excitement, with the urge
to fill the emptiness and to do away with the depression.”
Mrs. A now understood the incongruity of her emptiness and depression in
the face of such a desirable step. She knew that she should have felt pride in
her effectiveness and in having made contact with a capacity in herself that
she longed to exercise, knew that she should have been happy that she was
able to bring these experiences into the analysis, albeit against great
resistance, to display to me and to have me admire. But she felt just the
opposite. The emptiness and depression on coming to her session, she now
thought, had to do with her childhood memory of never having been able to
report on her accomplishments to her mother or display them freely to her.
The poignancy of the memory on her way to the session was, she realized
on reflection, due to the fact that she was not even sure in the memory what
she wanted from her mother, just as she was not sure what she wanted from
me in anticipation of her session.

This brief vignette shows how quickly bodily sensations of excitement,

which escalated into diffuse sexual and alimentary sensations and feelings,
were introduced into the analytic moment. This occurred in a specific
context and in a fairly well delineated sequence, thereby opening a window
into this patient's sexuality but leaving me at that moment with some
ambiguity as to its precise nature. This episode, nevertheless, permitted a
crucial recognition: it is always only the sexual “experience,” its meaning in
context, that is available for our view. We as analysts are, therefore, in
search of a psychology of sexuality.

In order to explicate a bit more fully the meaning of this clinical vignette, I
should remind you of the fact that we have to limit our inquiry to what we
can encompass with empathy, our tool of observation, and, through it, with
our appreciation of the nature of the selfobject transferences. Mrs. A's
experience, which took the form of a diffuse sexual excitement, could thus
be interpreted in one of two ways: (1) as a defensive effort to overcome her
inner emptiness and depression, which she dreaded, or (2) as a
developmental achievement, however tentative it may have been at this
time.

In the first instance we would be dealing with a pathological structure.

Certainly, Mrs. A's sexual excitement could be seen as her effort to deal
with her emptiness and depression, as she herself put it, in which case it
would be more accurately designated as a “sexualized excitement.” Here,
Mrs. A's sexuality would have to be considered a breakdown product of her
enfeeblement- and fragmentation-prone self. Her experience on the couch
would then appear as an expression of her overstimulation from the telling
of her experiences–that is, from having been able to turn to the analyst as
she never could turn to her mother–and from the analyst's acceptance of her
excitement and pride at showing off her successes.

In the second instance, however, Mrs. A's sexual feelings would indicate
progress in the analysis. Her experiencing of the excitement could be
viewed as part of the newly found functions of an increasingly more
consolidated self, functions that signal a belated developmental
achievement in her analysis. As a result, Mrs. A could now feel more safely
sexual or, at least, she could respond to the overstimulation within much
more tolerable bounds than before. Indeed, she was not unduly embarrassed
or inhibited and could reflect on as well as communicate about her
experience.

To put this more generally, the selfobject transferences and their working
through help us in distinguishing two groups of sexual experiences: first,
those that are efforts to bolster an enfeeblement- or fragmentation-prone
self or to prevent a further, more serious, fragmentation (these experiences
exhibit a quality of compulsion and drivenness) and, second, those that
accompany the growth and expansion of a well-consolidated, cohesive self
and constitute its enrichment. There is an important qualitative difference
between these two “sexual” experiences. One creates intense discomfort;
there is a threat in the excitement that may then be quickly inhibited. The
other is experienced with an uplifting, genuine pleasure since this
constitutes an enrichment of the cohesive self. This qualitative difference is
similar to the distinction that can be made between the experience of self-
consciousness, which is accompanied by patchy, irregular blushing, and the
experience of inner pride, which is accompanied by a diffuse, undisturbed
warm glow.

Let us return to Mrs. A for another moment. She reported how well she had
done and what specifically she had done well: she contained someone else's
depression and felt effective at another aspect of her work, where she was
the center of attention at a meeting and did well. Though fearful of showing
her joy over these activities, she was capable of experiencing that joy. Once
she had her feelings accepted and thereby affirmed, it was as if she had
permitted a new kind of excitement to enter her body, an excitement that
made the experience of her own competence more intense and profound
rather than threatening or overwhelming. But the sexualization of this
process indicated that she could not yet adequately contain the
overstimulation caused by the analyst's responsiveness to her excitement
about and pride in her accomplishments. She experienced the analyst as
receptive to her affects whereas she had never been able to experience her
mother that way during her childhood. As a result, she felt an unusual
degree of intimacy with the analyst in that session, and this contributed to
her feeling overstimulated.

A brief sequence from the next session (which occurred after the weekend
interruption) will aid us in resolving the ambiguity we are left with
regarding the nature of Mrs. A's sexual experience on the couch. On
Monday she reflected further, with evident curiosity and puzzlement, both
about the Friday session and about her ensuing calm and reasonably
productive weekend. She did not miss me much, she said; it was as if I had
been with her in some fashion, even after the session, but not in conscious
awareness. Almost as an afterthought and in an effort to contrast this last
weekend with many others in the past, she reported that during some of
those weekends when she felt restless, upset, alone and depressed, she
would eat, read, and watch TV–all at the same time—for hours. And when
this did not help her calm down, she would masturbate and have an orgasm
and then fall asleep. This pattern of behavior is now a rare occurrence.

Additional data from the second session after the weekend indicate the
overall favorable changes in Mrs. A's general capacity for tension
regulation, which includes her sexual experiences. Slow accretions of
psychic structure, almost imperceptible, from day to day and week to week,
have finally led to better containment of her various disruptive affects, with
fewer constraints; Mrs. A can experience more, with less overstimulation or
fragmentation. The decisive change, however, is not in her sexuality per se
but in her more integrated use and experience of it, that is, in the
cohesiveness of her self.
I believe the foregoing analytic episode and its cursory explication bring us
face to face with certain clinical and theoretical issues, pertinent to our
theme, and we shall now turn to their more general and theoretical
consideration in Heinz Kohut's work.

Kohut's first decisive contribution to psychoanalytic drive theory, and hence

to the issue of sexuality and aggression, went almost unnoticed. As a matter
of fact, its full impact has still to be absorbed by the psychoanalytic
community. I am referring to his statement, by now widely familiar, that as
psychoanalysts we can only speak of drives as the experiences of
drivenness. We cannot learn via empathy about their known or assumed
biological underpinnings. Whatever the origin and nature of these drives,
their most significant element, in Kohut's view, is that they are “at the
beginning of psychological life ... already integrated into larger experiential
configurations” (Kohut, 1978, p. 790). These larger and more complex
configurations, within which the drives are integrated as their constituents
or building blocks, are the primary units of psychological experience. They
are to be encompassed in their wholeness through the analyst's empathic
observational mode. When these larger configurations are weak in their
structure, or crumble in the face of traumatic experiences, we witness the
emergence of intensified drivenness as a breakdown product of the self.
What we mean by the breakdown product—a term to which many take such
intense exception because it “slights the drives”–is similar to the well-
recognized “word salad” of schizophrenic patients, an example of the
extreme breakdown of cohesive and logical thought processes. Kohut used
the analogy of an organic molecule breaking down into its inorganic
components to suggest the psychological experience of a fragmentation of
the self. By calling certain forms of sexuality and aggression breakdown
products of the self, we are also indicating that we place the self in a
supraordinate position vis-à-vis “the drives.” Thus, the building blocks of
the self, such as normal sexuality and self-assertive aggression, attain their
particular pathological configurations upon the weakening or crumbling of
the structure into which they are built and within which, if this structure is
intact, they find their channels for normal expression. Our primary focus on
the whole structure thereby apparently “slights” the drives (if that is an
acceptable phrase in a scientific discussion), the same way that placing the
emphasis on the ego's response (at the behest of the superego) to sexuality
and aggression has “slighted” the supremacy of the drives with the
paradigm change from id psychology to ego psychology. In the paradigm of
ego psychology the responses of the ego seem to have attained greater
importance in pathogenesis. The claim was made that it was not so much
the drives themselves but the ego's response of intolerance, a weakness in
the ego's defensive structures, that contributed to the development of overt
neurosis. If this shift was not as jolting as the current one of Kohut's
reformulation of the position of the drives in pathogenesis—although some
contemporary observers of that era of Freud's paradigm shift experienced it
that way– it had to do with the fact that the then-new paradigm of ego
psychology did not seem to immediately require a radical revision of its
underlying drive theory, libido theory, and theory of infantile sexuality. But
this was, as we now know, only a temporary respite since Freud shifted his
focus again (now remaining within the newly established paradigm or
simply completing it) to the nature intensity of the anxiety as the ultimate
determiner of the outbreak of overt psychopathology (Freud, 1926).

Perhaps it still needs to be stressed that it was the systematic application of

the empathic observational mode that led Kohut to all of his innovative
formulations in every area of psychoanalysis. It is from this vantage point,
the view from within the self-experience of the patient, and from a
consideration of the bipolar self-structure as supraordinate that sexuality
and aggression assume their many different psychological configurations
and also come to have differently conceived roles and functions in
neurosogenesis as well as in the overt manifestations of psychopathology.
Added to the fundamental points made earlier, namely, that for us “drives”
are the experiences of drivenness and that they are integrated within the
psychological structures of the bipolar self from the outset, is the
recognition that our theoretical language properly de-emphasizes the
primary pathogenic significance of sexuality and aggression when it
focuses on the whole experience.

But to continue our systematic survey and assessment of Kohut's

contributions to the question of the pathogenic role of sexuality and
aggression, we should turn to the archaic selfobject transferences and their
later extensions, the oedipal selfobject transferences, for further insights.
Kohut's carefully and extensively presented clinical material in describing
these archaic selfobject transferences and their working through
demonstrated the revival during analysis of patients’ non-drive-related,
hitherto thwarted mirroring and idealizing needs and identified the resulting
deficits in the self-structure as the fundamental etiologic and pathogenic
factors in their psychopathology. At the same time, it became abundantly
clear that the traditionally postulated primacy of the drives and the ego's
defenses against them were in these transferences misleading assumptions.
Here was a significant and incontrovertible clinical refutation of the
ubiquitous centrality of the drives as well as of the Oedipus complex as
primary pathogenic agents in these transferences.

It was a mark of Kohut's careful empirical approach that he did not

immediately claim that his discoveries of needs, wishes, fantasies, and
demands other than those that could be traced to the two basic drives could
fundamentally alter our ideas about human motivational structures. Those
of us who recognized this wider implication in The Analysis of the Self
(Kohut, 1971) and saw in these first contributions already the beginning
development of a new paradigm (e.g., Basch 1973, Gedo, 1975; Ornstein,
1974, 1978) were impressed with several components of that work that are
immediately relevant to our topic. We should now examine some of these.

Not until Kohut was able to extend his approach to the oedipal selfobject
transferences in The Restoration of the Self (1977) did he introduce the
more encompassing, fundamental changes regarding the basic motivational
structures in normal development and in psychopathology. His
reconstruction of the basic infantile and childhood developmental needs in
relation to the two poles of the bipolar self drastically changed the
traditional view of psychosexual development. Infantile sexuality and the
ego's responses to it no longer seemed to be primary ubiquitous
motivational factors in health or disease. The emphasis is again on the word
primary. The proper overarching term is simply self development, or
personality development, within which the development of human sexuality
and aggression has to be traced in relation to the primary self-structures.

After having dealt with the neuroses, Kohut did indeed offer us a broader
motivational theory within which his concepts of normal and pathological
sexuality and aggression are embedded. The human infant, with its innate
capacity to elicit from its selfobject milieu what it needs for its emotional
survival and growth, is “motivated” to attain the cohesiveness of its nuclear
self with a basic life plan or program built into it. If a sufficiently stable
cohesiveness is achieved, the central motivating factor will be the effort to
put that intrinsic program at the disposal of ambitions, in keeping with
internalized values. The successful living out of this program constitutes the
cardinal factor in mental health. The vicissitudes of sexuality and
aggression have to be understood in terms of their either making a
contribution to and thereby implementing and enriching that nuclear
program or interfering with and thereby inhibiting the unfolding of the basic
design of the nuclear self.

After Kohut had identified in the clinical setting of the selfobject

transferences the many details for the mobilization and working through of
the motivating factors, he was also able to spell out many details of normal
and pathological development in the traditional manner, that is, on the basis
of reconstructions from the transference. He was fully aware of the need for
their continued verification in the clinical setting as well as from
independent observations of mother-infant pairs outside of the analytic
situation.

As you recall, Freud completed his theory of sexuality and aggression by

regarding the Oedipus complex as the culmination of infantile sexuality.
Kohut saw evidence in his own clinical findings not only for his own view
of the Oedipus complex but also for his ideas on the primacy and centrality
of mirroring and idealizing needs for all of normal development, their
unreliable or deficient availability being responsible for all forms of
psychopathology. The need for mirroring and idealization of the oedipal
boy or girl in order to consolidate the development of gender-specific
functions appeared to Kohut to be a continuation of the same needs of the
earlier period in life when gratification was necessary for the consolidation
of nuclear self-assertive ambitions as well as internalized nuclear values
and ideals. This consolidation appeared to be, indeed, the prerequisite for
making proper use of those gender-specific and phase-appropriate emerging
needs for mirroring and for idealizable parental imagos, that is, for bringing
sexuality as well as the capacity for assertiveness into free functional
availability within the bipolar self.
Kohut's conclusion that the oedipal experiences are fundamentally joyful
and not pathogenic, and that the pathological Oedipus complex is already a
secondary formation, was the empirical as well as the logical correlate of
what he discovered in the archaic and in the oedipal selfobject
transferences. In other words, the absence of the primary psychological
nutrients of development took the place of polymorphous perverse infantile
sexuality (or incestuous oedipal sexuality) and aggression as the key
neurosogenic agent. The possible innate biological factors that may
contribute to the development of neuroses were never discounted by Kohut,
but he knew that with the psychoanalytic method he could not contribute to
identifying their specific nature and how exactly they made their
contribution to development. Just as innate skills and talents—for which
biological anlagen are also assumed—become mobilized in the service of
self-assertive ambitions, in keeping with internalized values and ideals, so
does normal sexuality become mobilized at the behest of a healthy,
cohesive bipolar self. Likewise, pathological manifestations of sexuality are
mobilized at the behest of a deficient or fragmenting self-structure in either
one or both of its poles.

Rather than being either de-emphasized or denied as an important part of

human functioning—as is often asserted—sexuality is actually given its
proper place and due importance in self psychology. By not mixing up the
breakdown products of sexuality with healthy sexuality, as is inevitably the
case in considering its precursors as polymorphously perverse, Kohut's
concepts have made the psychology of sexuality in health and illness clearer
than have the primarily biologically oriented explanations of human
sexuality. In the latter, sexuality was considered to be part of our animal
nature, in need of taming, subduing, or neutralizing, rather than a feature
that was evolving and becoming increasingly better integrated into the total
fabric of the self and thereby enhancing its functioning. This description
applies to the psychology and psychopathology of aggression as well. By
not confusing the manifestations of rage and destructiveness (the
breakdown products of aggression) with healthy aggression (self-
assertiveness), Kohut has also opened up this area of human experience for
a fresh psychological appraisal of its role and function in health as well as
in psychopathology.
This last statement requires a more extensive elaboration. What precisely is
this window that Kohut has opened more directly into the psychology of
healthy as well as pathological sexuality, healthy as well as pathological
aggression? As is well known in the psychoanalytic literature, the concepts
of “sexualization” and “aggressivization” have played a prominent role in
psychoanalysis from its very inception.1

In Kohut's work the concepts of sexualization and aggressivization, as well

as their progressive neutralization, always played a prominent role. These
concepts were already present in his earlier work, although they were used
in a metaphorical and not concretely biological sense. That is, Kohut
accepted the standard language of metapsychology and used it to express
his empathically perceived psychological insights.

In the context of the archaic selfobject transferences Kohut repeatedly

observed the sexualization of various regressive self-structures, within the
grandiose self as well as within the idealized parent imago. Kohut
demonstrated this in many of his clinical examples.2

At one point, this is what Kohut (1977) found in connection with the
phenomenon of sexualization as reflecting pseudo-vitality:

Behind [it] lie low self-esteem and depression ... a deep sense of uncared-
for worthlessness and rejection, an incessant hunger for a response, a
yearning for reassurance ... an attempt to counteract, through self-
stimulation, a feeling of inner deadness and depression … through erotic
and grandiose fantasies [p. 5].

Since the basic neutralizing or tension-regulating structures of the psyche

are acquired through transmuting internalizations during early mirroring
and especially during early idealizations, defects in these structures lead to
a general structural deficiency whose functional correlate is the sexualized
relationship to selfobjects. Appearing in the transference, these
sexualizations provide the opportunity to study the structural deficits that
are their correlates. It is in this clinical context that we can study the manner
in which structural accretions during the analytic process occur and in this
context that we may distinguish between sexualization in which the
sexuality is a breakdown product and healthy sexuality and its correlated
self-assertiveness, that is, healthy, pleasure-seeking and pleasure-giving
sexuality and unencumbered self-assertiveness.

When the developmental phases of early mirroring and idealizations are

felicitously traversed and the child reaches the oedipal phase with a
reasonably cohesive self, the availability or relative unavailability of
oedipal mirroring responses or idealizable imagos will determine how
freely available or incestuously encumbered sexuality will be. Thus, here
too the conflicts involved in inhibiting or otherwise distorting sexual
responsiveness will be secondary to the structural weakness, which is the
primary cause in pathogenesis.

The decisive technical implications of these clinical-theoretical innovations

deserve a more extensive survey and explication than can be offered here,
along with additional clinical illustrations. For obvious reasons only the
initial clinical vignette and its brief explication could be included in this
chapter. However, a few additional remarks, contrasting the implications of
a drive-theory-based approach with those based on a self theory, should be
added to expand on my view that Freud's final drive theory has cast a long
shadow on clinical practice, even if most analysts claim to adhere only to a
drastically modified version of it (see especially Brenner, 1982).

The primacy of drives (however diluted or altered a particular drive theory

might be in comparison to Freud's) still commands a primary focus on
drive-defense constellations rather than on the underlying structural deficits
in the bipolar self. The technical stance dictated by all other approaches
contrasts sharply with the one developed by Kohut (cf. Gill, 1985). First,
the clinical atmosphere is very different when the analyst's attention has to
be directed toward the remobilized and unacceptable incestuous strivings
that were already taboo in childhood. These will, therefore, certainly have
to be viewed as anachronistic in the present, that is, as chronologically out
of place in terms of the patient's current reality and are considered to be the
manifestations of a revived oedipal transference neurosis. Thus, even the
most tactful and accepting interpretations carry with them a tone of
disapproval. By contrast, when the focus is on those wishes and needs that
were thwarted in infancy and childhood—when they should have been
phase-appropriately gratified—their remobilization is welcomed and
accepted as legitimate in the analyst's interpretive responses. If structure
building and the reestablishment of empathic contact with selfobjects are at
the core of the curative process, as Kohut claims they are, then drive–
defense interpretations will often thwart the feeling of being understood.
Hence, they will also thwart the felicitous underpinning for subsequent
transmuting internalizations.

To sum up the essential points in Kohut's work covered thus far: The
contrast with previous psychoanalytic contributions to drive theory and its
technical implications is here quite striking, but they need to be spelled out
briefly. The supraordinate position of the bipolar self directs our primary
focus to the state of the self, to its structural and functional weaknesses,
deficiencies, and defensive and compensatory structures on one hand, and
to its cohesiveness, vigor, and vitality on the other. The ubiquitous
sexualization of any mild or severe defects in the self–selfobject unit and
the vicissitudes of these sexualizations in the course of the analysis are, in
fact, our window into human sexuality in health and illness, just as
aggressivization under the same circumstances is our window into human
destructive aggression.

The breakdown products of the self have to be distinguished from healthy

sexuality and aggression, which are the unmistakable expressions of a
structurally and functionally intact self. The principle of focusing on the
state of the self and the vicissitudes of its fragmentation and cohesion
dictates the analyst's responsiveness in the transference.

CONCLUDING REMARKS

In this chapter I have focused on Kohut's clinical and theoretical

contributions to the role of sexuality and aggression in pathogenesis. I have
reviewed how he defined sexuality and aggression, how he saw their role
and function in pathogenesis, how he conceived of the phenomena of
sexualization and aggressivization, and how he used them. I have also
described Kohut's solution to many lingering clinical and theoretical
problems revealing that Kohut and self psychology have not underplayed—
as some critics have claimed—the role of sexuality and aggression in health
and illness.
To this last point I wish to add some additional remarks: I have on other
occasions (Ornstein, 1983) given some scattered responses to critiques that
claim that self psychology neglects or de-emphasizes sexuality and
aggression or, even worse, that it could not bear to behold the raw id in any
of its manifestations and therefore proceeded to sanitize psychoanalysis.
Kohut himself raised this question when he asked, “Is it not an escapist
move, a cowardly attempt to clean up analysis, to deny man's drive-nature,
to deny that man is a badly and incompletely civilized animal?” (Kohut,
1977). On balance, after having reviewed the literature and scrutinized
Kohut's own contributions, we can say that, yes, from the vantage point of
most— though by no means all!—earlier theories we do indeed de-
emphasize sexuality and aggression, regarding their primary role in
pathogenesis. But we definitely do not neglect or de-emphasize the
enormous importance and power of sexuality and aggression in human
experience. It is impossible to overlook the ubiquitous presence of sexuality
and aggression as components of manifest psycho-pathology. It is equally
impossible to overlook their ubiquitous presence as expressions of health,
vigor, and vitality and their capacity to generate pleasure through peak
experiences. Nor is it possible to overlook the fact that the sexual apparatus
of human beings is a channel for the satisfaction of a variety of other needs
and wants, under both normal and, especially, disordered circumstances.
The difficulty of separating the normal from the pathological remains a
problem, but a consideration of the structural deficiency or completeness of
the total self and of its functions is still our best available guide. In addition,
it is careful listening that subjectively distinguishes the experience of
drivenness from the experience of pleasure and the sense of fulfillment and
joy. Sociocultural and political influences of any era have their imprint on
our notions of health and illness. Kohut saw that clearly. But he also
claimed, in the same sense as did C. Daly King (as quoted by Kohut
[1984]), that “the normal is to be defined as that which functions in
accordance with its [structural] design” [p. 187]–a view that minimizes the
importance of cultural bias in arriving at our assessment of what is normal
and what is not.

But what of the claim that self psychology not only neglects and de-
emphasizes sexuality and aggression but in a cowardly and retrogressive act
attempts to “clean up” analysis and deny man's true drive nature, his
inescapable biology, and his being a deficiently civilized animal? This
particular accusation is perhaps—and I am trying to find the mildest
possible characterization—the most ridiculous nonsense.

This question would not deserve a special response were it not for the fact
that we ourselves have been searching for an answer to the legitimate and
recurrent concerns at the core of it. Are we, in fact, inadvertently
underplaying the obvious power of these passions that poets, novelists, and
playwrights have portrayed since the beginning of recorded history? Thus,
apparently, intuitive knowledge and overall sentiment—claimed as
conviction on the basis of personal and clinical experiences—holds that
sexuality and aggression are qualitatively unique passions. This view has
long had a deep anchoring in the Western mind. We must run through these
questions and concerns briefly in order to know what culturally and
personally ingrained convictions fuel and direct our scientific attitudes. We
often feel that sexuality and aggression are somehow more highly charged
and have a different quality to them than do other human motives for action.
Sexuality seems to have such an immense directing power or motivational
force. Calling its healthy version simply “pleasure seeking” and its
pathological version a “breakdown product” is too mild or too bland for a
description of its intensity and its many twisted forms. As an extension of
this, we also wonder at times whether inner tension regulation through
sensual experiences and the response of our culture to these does not,
indeed, place these “passions” into a different category from all other
“passions.” After all, are they not generally seen as the “prime movers of
things”; that is, are they not the ultimate and most powerful motivators of
human activity, from the most valued to the most dreaded? Does not
treating them in these pathological forms as breakdown products credit
them with much less than their full power, complexity, and place in human
affairs would warrant? Do we not fail to account for and in fact lose
something of their essence if we call them breakdown products? And are
we not also giving thereby our critics further ammunition? Even when we
differentiate between primary and secondary phenomena, we are essentially
saying that the sexuality and aggression we call secondary are merely the
by-products of the primary phenomena. It sounds to our critics, then, like
we are saying that sexuality and aggression are simply static, but they are
obviously more than that or so the challenge goes.3 It appears to those who
pose these searching questions that self psychology has not captured the
unique quality of normal or pathological sexuality and aggression as yet.
The same critics usually insist that sexual and aggressive phenomena do
stand out qualitatively even when they are integrated into the whole
personality and that they have a notable unique intensity and
peremptoriness even as pathological breakdown products. How do we
respond to some of these claims from the vantage point of our theory?

I have listed these questions in some detail since they require further
clinically documented responses. In this format I have to be brief. We
should not confuse normative and pathological forms of sexuality and
aggression. The normal human passions do not belong under the rubric of
pathogenesis; they are not in themselves illness-creating per se. Of course—
and Kohut was unmistakably clear on this—normal sexuality and
aggression are not just static. The concept of breakdown products is not
about normal, integrated sexuality or aggression. Breakdown products refer
to particular psychological conditions in which we have only the disordered
forms, the twisted forms, of sexuality and aggression in view. We are so
used to regarding archaic sexuality and aggression on a continuum with
their supposedly normal equivalents, as Freud suggested, that we generally
do not differentiate, as we should, between the normal and the pathological.
Thus, when we speak of breakdown products, it is not a question of
minimizing or denying the power of human passions but a question of what
elements of pathogenesis and psychopathology are at work that lead to the
appearance of these breakdown products. Adult sexuality may become
secondarily involved in neurotic disturbances. Freud's own tenet was that
intrusions of the memory of infantile sexual experiences or fantasies into
the ego in adulthood created the overt psychopathology. From that base of
secondary involvement, sexuality and aggression are frequent co-
participants with other causative factors in creating the manifest psycho-
pathology.

Many questions have been raised that remain unanswered or only partially
answered in this chapter. One question that is blatantly missing is this: How
do love and hate relate to sexuality and aggression? This is too complex a
question even to raise in this context and will have to be dealt with
separately on another occasion.
By means of the transference, the analytic microscope enlarges, as it has to,
human experience. This view is different—in spite of all the similarities in
content—from the perspective of poetry, fiction, and drama in its scientific
regard for the phenomena of sexuality and aggression. Reading Kohut's
clinical illustrations we witness not only the breakdown products but, along
with them, all the drama and passion of human existence, preserved, valued,
and illuminated. Anyone who sees in self psychology denial or cowardly
retreat from the intensity of the passions or from the “ugliness”—hardly a
value-neutral, scientific term—of its breakdown products will have to look
again, more carefully this time, at the clinical data and the claims of self
psychology for further dispassionate exploration.

REFERENCES

Basch, M. F. (1973), Psychoanalysis and theory formation. The Annual of

Psychoanalysis, 1:39–52. New York: International Universities Press.

Brenner, C. (1982), The Mind in Conflict. New York: International

Universities Press.

Freud, S. (1926), Inhibitions, symptoms and anxiety. Standard Edition,

20:75–175. London: Hogarth Press, 1959.

Gedo, J. E. (1975), To Heinz Kohut: On his 60th birthday. The Annual of

Psychoanalysis, 3:313–322. New York: International Universities Press.

Gill, M. M. (1985), Prespectives on countertransference. Presented at The

Austen Riggs Center, Stockbridge, MA, September 1.

Goldberg, A., ed. (1978), The Psychology of the Self. New York:
International Universities Press.

King, C. D. (1945), The meaning of normal. Yale J. Bio. Med. 17(no.

3):493–501.

Kohut, H. (1971), The Analysis of the Self. New York: International

Universities Press.
———(1977), The Restoration of the Self. New York: International
Universities Press.

———(1978), A note on female sexuality. In: The Search for the Self, Vol.
2, ed. P. H. Ornstein. New York: International Universities Press, pp. 783–
792.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: The University of Chicago Press.

Ornstein, P. H. (1974), On narcissism. The Annual of Psychoanalysis,

2:129–147. New York: International Universities Press.

———(1978), Introduction: The evolution of Heinz Kohut's psychoanalytic

psychology of the self. In: The Search for the Self, Vol. 1, ed. P. H. Ornstein.
New York:International Universities Press, pp. 1–106.

———(1983), Discussion of papers by Drs. Goldberg, Stolorow, and

Wallerstein. In: Reflections on Self Psychology, ed. J. D. Lichtenberg & S.
Kaplan. Hillsdale, NJ: The Analytic Press, pp. 339–384.

1We can now return to these earlier attempts and reexamine the many
beautiful case illustrations they contain, using the window Kohut opened
with his focus on sexualizations in the transference to study their
psychologically relevant (de-biologized) vicissitudes in the self-selfobject
matrix, and thereby demonstrate the increased explanatory power of the
new conceptualizations.
2Especially in those of Mr. A, Mr. E, Ms. F, Mr. M, and Mr. U. All
contributions in the Case Book (Goldberg, 1978) also amply illustrate
sexualization and/or aggressivizations in the transference.
3Itis rarely recognized by our critics that we differentiate more sharply than
they do between normal sexuality and normal aggression (self-assertive
ambition) and their pathological manifestations as breakdown products.
This differentiation decisively contradicts the critics’ claim that self
psychology considers normal sexuality and normal aggression as merely
“static.” If the designation “static” applies at all, it does so only to the
pathological breakdown products of the drives, never to their normal
equivalents—as discussed further below.
III Aggression and Rage
Chapter 11 Rage Without Content

Richard C. Marohn

Psychoanalytic thinkers have struggled with the concept of aggression

almost from the beginning. Freud's earliest dual instinct theory included not
the aggressive drive but libido and the self-preservative or ego instincts. As
Terman (1975) observed, what Freud later called aggression is similar to
today's formulation of narcissistic rage in that hate derives from the struggle
to preserve the self (ego) and is a derivative reaction by the ego instincts of
self-preservation.

Today a Kleinian may say that what Klein saw was not a destructive orality
but the urgency of an infant not responded to, an infant striving to extract
something from its mother. Or a traditionalist may say that he does not
consider the aggressive drive to be destructive in its aim but assertive, and
that destructiveness occurs when assertiveness is thwarted. Both my
Kleinian and my traditionalist colleagues consider these views consistent
with their specific school of psychoanalytic thinking, a surprise to the self
psychologist who thinks that other psychoanalysts all believe the aggressive
drive to be a destructive drive.

In her closing remarks to the 27th International Psycho-Analytical Congress

in 1971 in Vienna, Anna Freud (1972) took note of the disagreement:

Aggression can associate itself with aims and purposes of extraneous kinds,
lending them their force.... Aggression also comes to the aid, either
constructively or destructively, of purposes such as, for instance,
vengeance, war, honour, mercy, mastery, etc.... the intrinsic aim of innate,
primary aggression ... [is an] unsolved question [pp. 165, 170].

Contemporary infant research (Lichtenberg, 1983; Stern, 1985) does not

support the drive concept, certainly not the destructive drive formulation.
Stechler (1987; Stechler and Halton, 1987) sees assertion as proactive, the
experience of the active, outreaching, and engaging baby who establishes
contact with the world and acts upon it with interest, excitement, and joy.
Aggression, arising from the self-protective system, is a reactive response
to threats that trigger inherent or learned self-protective mechanisms,
including an attack mode designed to destroy or drive off the threat. Often,
the developing child confuses assertion and aggression because of faulty
parental responses, since one contaminates the other. Yet the perspective of
a destructive aggressive drive is fundamental to much contemporary work
with sicker patients, especially as formulated by Kernberg (1975) and his
colleagues.

THE PERSPECTIVES OF SELF PSYCHOLOGY

Early in his writings Heinz Kohut (1957) was strongly influenced by

psychoeconomics and the metapsychological point of view:

The earliest psychological organization (pre-ego, pre-object, and, of course,

preverbal) is characterized by increases and decreases of inner tensions. The
psyche can neither register its needs (that is experience them as wishes) nor
provide for their relief; the tensions remain, without psychological
elaboration, on the physical level. The rage caused by the mounting
“unpleasure” can be understood as a form of automatic tension relief which
is also not psychologically elaborated by fantasies [p. 244].

In those writings patients such as those with hypochondriasis were said to

be “characterized by absence or paucity of psychological elaboration of
their tension states, that is, by the absence of neurotic or psychotic symptom
formation” (Kohut, 1957, p. 250). This is the “unstructured psyche,” which
Gedo and Goldberg (1973) later described as their first stage of
development and which relates to their first level of psychopathology. Here,
the mental apparatus confronts overstimulation, and as structure is built,
tension regulation develops. Pacification is the appropriate treatment; there
is no dynamic to interpret.

Kohut (1971) returned frequently to psychoeconomic explanations– in

reformulating acrophobia, for example, or in comprehending the traumatic
state in an overstimulated analytic patient. When he later presented his
ideas on narcissistic rage, he saw the rage reaction as a psychoeconomic
imbalance involving the omnipotence of the grandiose self, just as shame is
a psychoeconomic imbalance of exhibitionism. When the environment or
the selfobject fails to respond, “smoothly deployed forces” are disrupted
and there is simultaneous or successive discharge and inhibitions: “The
disorganized mixture of massive discharge (tension decrease) and blockage
(tension increase) in the area of unneutralized aggression, arising after the
noncompliance of the archaic selfobject ... is the metapsychological
substratum of the manifestations and the experience of narcissistic rage”
(Kohut, 1972, pp. 655–656). As Paul Ornstein (1978) notes:

Kohut always stressed the uniquely psychoanalytic quality of the

psychoeconomic theory ... [His] sensitivity to increase or decrease of inner
tension, to the manifold distribution of cathexes, permitted him to
conceptualize psychic events, especially in early life, without
adultomorphic formulations, without resorting to the postulation of archaic
fantasies in the “prepsychologic” period of infancy. This classical Freudian
stance, coupled with the recognition of the limitations of introspection and
empathy in the reconstruction of the beginnings of psychic life—yet
applying both introspection and empathy consistently and persistently to the
limit—contributed considerably to the heuristic value of Kohut's early
work.... The psychoeconomic point of view in Kohut's work ... [is] one of
the most important methodologic precursors of his work on narcissism [pp.
8–9].

Freud's (1917) concept of the actual neurosis is predicated on just such an

imbalance, namely, a weakened self unable to cope with rising tension but
without psychological elaboration.

The immature self is inevitably vulnerable to such disruption, and though

this stirs the developing self to firm cohesion (Terman, 1975), the ultimate
reliability of the self rests with the degree of structuralization that the
parental selfobject environment can facilitate. Just as narcissistic injury and
some propensity for narcissistic rage are inevitable in development, so too
are they inevitable in treatment as transferences unfold. How disruptive
these treatment experiences are is a measure of the health of structures and
the propensity for psychoeconomic imbalance. As Kohut (1984) notes in his
last work, with “the transference clicking into place ... the analytic situation
has become the traumatic past and the analyst has become the traumatizing
selfobject of early life” (p. 178). We realize that even at the end Kohut had
not abandoned the economic perspective. He noted, for example, how the
classically reserved psychoanalyst protected certain patients from being
overstimulated again or how the self psychologist's type of interpretation
can protect the patient from entering “manic excitement” (p. 189).

How inevitable is a psychoeconomic imbalance in the treatment of

relatively healthy individuals? How often is an early imbalance, like a
phobia, telescoped into later dynamic psychopathology and later
remembered with genetic content? Since self psychology has progressed
from the study of the newly recognized narcissistic transferences and
attempted to become a more general psychology with the description of the
bipolar self and the self-selfobject paradigm, new and exciting formulations
have emerged. Psychoeconomics remains with us, but we do not emphasize
it. Clinically, we see angry, rageful, and/or destructive feelings, affects,
behaviors, and, sometimes, thoughts and fantasies. Content-laden material
with rich dynamics lies at one end of the spectrum. Vague forces with no
specific dynamics, primitive in nature and suggestive of an economic
imbalance, a random energy discharge, and a state of near chaos, are at the
other pole. A specific dynamic can overtax the system and create this
chaotic state, but the state itself does not contain specific dynamisms. Any
point along the entire range of this spectrum can be understood from a self
psychology perspective and approached with advantage.

What is significantly different today is that all pathology is now assessed in

the context of the self-selfobject relationship. We note how the selfobject
creates or regulates the traumatic overstimulation.

RAGE WITHOUT CONTENT

In thinking about narcissistic rage, we must remind ourselves that not all
injury leads to narcissistic rage and that not all fragmentation leads to rage,
but sometimes to panic, frantic behavior, depression, or emptiness. There
are instances when violent, rageful, or destructive behavior may not be
associated with any clearly delineated destructive thoughts, wishes, or
fantasies. In these instances the behaviors seem to have no content
associated with them, no psychodynamic meanings. Although these
episodes may follow an experience that has great psychodynamic
significance to the subject and that ends in fragmentation, the ragelike
behavior itself represents merely the disintegrated condition or, sometimes,
an effort to reorganize the self by restoring its primacy. As such, it may be
that the person is striking out randomly at the environment, which has so
fatefully failed the self. In Kohut's (1951) words, the borderline patient
seeks “reassurance” and to restore or maintain “a precarious balance of self-
esteem” (p. 163). This is a patient whose dysregulation needs pacification,
who needs to be held and contained psychologically just as one would hold
an overwrought and overstimulated child having a temper tantrum, which is
the frantic motor activity of an unregulated psyche needing pacification and
restraint. The developmentally more mature person is held by the empathic
bond established by explanation and interpretation.

The fragmented state encountered in a variety of pathologies demonstrates

what Kohut (1978) meant by the drives being “fragmentation products”:

Drives are secondary phenomena. They are disintegration products

following the breakup of the complex psychological configurations in
consequence of (empathy) failures in the selfobject matrix. Subsequent to
serious and prolonged or repetitive failures from the side of the selfobjects,
assertiveness becomes exhibitionism; enthusiasm becomes voyeurism; and
joy changes into depression and lethargy. Zonal eroticism (oral, anal,
phallic-genital) is pursued in an isolated fashion instead of being
experienced as the various pleasure goals of a joyfully assertive total self. It
aims either at consolation and soothing or has as its purpose the attempt to
regain the lost sense of the aliveness that characterizes the active, healthy
self [p.236].

Disjointed drive derivatives are the products of fragmentation when the self
loses its unity and coherence and experiences “single, isolated bodily and
mental functions” (Ornstein, 1978, p. 100). As Kohut (1981) said in his last
and posthumously presented paper,

Under normal circumstances we do not encounter drives via introspection

and empathy. We always experience the not-further-reducible psychological
unit of a loving self, a lusting self, an assertive self, a hostile-destructive
self. When drives achieve experiential primacy, we are dealing with
disintegration products ... the fragmenting self watching helplessly as it is
being replaced by a feverishly intensified rage experience, by the
ascendancy of a destructive and/or selfdestructive orgy and thus again of
the drive over the self [p.553].

One does not treat narcissistic rage but addresses the empathic break that
has stimulated it. Primitive psychoeconomic discharge occurs when there is
an intrapsychic imbalance, a state for which the selfobject therapist must
take some responsibility: he did not anticipate the problem, he
overstimulated the patient, he did not protect the patient, and so on. We do
no not speak here of blaming the therapist for his mistakes, but we know
that he participates in the disruption, including disruptions that occur when
there is an over-whelming transference response (like the one experienced
by Kohut's [1971] patient who fragmented after a correct interpretation).

How does a therapist empathize with people who are prone to this kind of
disintegration? With what aspect of the patient do we empathize? There are
several facets to the empathic process. One can become acquainted with the
dynamic and genetic issues that may tip the balance, issues either in the
patient's “outside” life or, more significantly, in the transference. One can
recognize rage that is not informed by logic or reason but is the result of
disequilibrium, rage that is contentless, without dynamic meaning, not
informed by fantasy. To stand firm in the face of this fragmentation and to
try to sustain the patient by recognizing the process that has just occurred is
the therapeutic task.

The word drive aptly captures the uncontrolled quality of these experiences,
and it may be that Freud, seeing such phenomena clinically, formulated the
actual neuroses and inferred the drive. Kohut affirmed Freud's position that
introspection does not uncover psychological content in the actual neuroses
or in the prestructural psyche. The analyst observes “tension instead of
wish, ... tension decrease instead of wish-fulfillment, and ... condensations
and compromise formation instead of problem solving” (Kohut, 1959, p.
215). The inability to empathize with such primitive mental states leads one
to perceive the situation as a social-psychological or biological problem
rather than as an intrapsychic disturbance. Viewing primitively organized
persons from the perspective of biology or flawed interpersonal relating
misses their propensity for fragmentation. “Persistent introspection in the
narcissistic disorders and in the borderline states thus leads to the
recognition of an unstructured psyche struggling to maintain contact with
an archaic object or to keep up the tenuous separation from it” (Kohut,
1959, p. 218). Even before he spoke of the forms and transformations of
narcissism, Kohut encouraged us to try to empathize with the primitive
unstructured psyche, characterized by fragmentation, lack of structure,
rising tension, dysregulation, and vulnerability to overstimulation.

The spectrum of narcissistic rage extends from the primitive at one pole to
the structured at the other. As Terman (1975) has written:

The more boundless violent forms of aggression usually occur in the

disruption of earlier phases of self-cohesion (e.g., mergers) or at the points
of transition between phases of self-development. ... The nature of the
structure determines the properties of aggression. Before self-cohesion,
aggression can be thought of as a pattern of diffuse discharge [pp. 253–
254].

With self-cohesion, aggression or assertiveness becomes more defined and

helps to elaborate the self more clearly, often in the context of an
“adversarial” selfobject (see Wolf, 1988). What contributes to the
movement from pre-cohesion to cohesion developmen-tally is not within
the scope of this chapter, nor is a consideration of how cohesion can be
achieved in the therapy of a persistently fragmented individual.

CLINICAL MATERIAL

The recognition of the important role dysregulation plays in the pathology

of primitive mental states first came to me when I, as a psychiatry resident,
treated a man with a persistent phobia of stuffed animals. His terror had
begun as a specific fear of a stuffed bird and had its genetic roots in his
attachment to mother and competitive fears of father. However, it later
generalized to all stuffed animals and bordered on agoraphobia, with
considerable social disability. I tried to interpret specific dynamic meanings
of the phobic objects—simultaneously scouring the psychoanalytic
literature to understand better the pregenital origins of the oedipal phobia.
My supervisor, now a recognized self psychologist, pointed out that the
primary issues for this person were the nature of his relationships with
others, serious difficulty with self-esteem regulation, problems dealing with
intense affect, and his “borderline” pathology. I recognized that although
the patient had memories of intense oedipal competition, he also
experienced his mother as enraged at him, out of control, and unable to
soothe him.

When I later encountered impulsive and violent adolescent boys and girls in
a hospital research and treatment program (Marohn et al., 1980), I could see
their “driven” quality and recognized that their difficulties did not seem
superego-related in nature, though many had been designated “juvenile
delinquents.” I was pleased, but puzzled, when a tough gang member who
had become violent on the living unit relaxed after we removed him from
the school program, which was housed in another part of the building, and
provided him tutoring on the unit. We thought he had been “overtaxed” by
pulling himself together to leave the living unit and attend school. Although
I could think in terms of drives, how well or how poorly he controlled or
regulated himself was not explained by the psychoanalytic theories I had
learned. While Fritz Redl's intuitive and empathic interventions (Redl and
Wineman, 1957) gave us practical methods for helping behaviorally
disordered adolescents modulate the intensity of their inner experiences, his
recommendations did not seem to fit the theories. Studying a riot on our
unit (see Marohn et al., 1973), and recognizing that many patients who
assaulted staff or other patients were not angry but disorganized and
overstimulated ... often by affectionate longings ... led me to appreciate the
problems our inpatients had with traumatic overstimulation, escalation of
tension, and violent behavior (Marohn, 1974).

For example, Nancy was 13 when she was admitted to the hospital. Before
admission she had been violent at home, at school, and at other treatment
facilities. She stole frequently, truanted, and ran away and had had multiple
group placements and psychiatric hospitalizations. After admission she
assaulted staff without any apparent precipitant. It was only after several
months that we could begin attaching dynamic meaning to her violence. For
a while there was considerable pressure to think of Nancy as having some
kind of biological or hormonal imbalance because it seemed that her
disruptive and assaultive behavior was not related to any apparent
precipitant. However, we held to our philosophy that all behavior has
meaning and can be understood psychologically and that if the structure of
the unit and of the daily program was maintained, the meaning of Nancy's
behavior would become clear. Eventually, Nancy's rage was brought into
the psychotherapy rather than displaced onto staff members. The eventually
formulated psychody-namic meanings of Nancy's violence are not germane
to our considerations here; what is important is that before she could speak
with either the ward staff or with her psychotherapist about her assaults,
Nancy needed to move psychologically from a more primitive stage of
organization, from a primarily psychoeconomic configuration, to a more
highly developed, structuralized level, at which she could describe and
explain the experiences that stimulated her. Nancy's early affect experiences
were ill defined, and all she felt before, during, and after a physical assault
was numbness, like the somatic reaction of a primitively organized psyche.
It was only later that she could rage at and threaten to kill her therapist. Her
early violent and rageful behavior was the manifestation of a disruption and
fragmentation, with no associated mental content, though it was stimulated
by primitive narcissistic transference issues. As her therapy progressed and
facilitated psychic structuralization, Nancy's violent behavior began to look
more and more like a narcissistic rage with specific psychodynamics.

Psychoeconomically related rageful responses like Nancy's are not limited

to hospitalized adolescent inpatients but can be seen in office patients as
well, including people in psychoanalysis. Bruce, a 30-year-old physician,
was confronted early in his psychoanalysis with his wife's decision to leave
him. He had already demonstrated marked difficulty with tension regulation
and narcissistic vulnerability, and as he tried in vain to convince his wife to
stay, while fantasizing about new women as replacements, he was flooded
with five dreams that he reported in one session. In one dream he was
counseling a young couple about a divorce, obviously an effort to gain
mastery over his impending loss. Three of the dreams involved cooking:
food enclosed in a casserole, cooking for the replacement woman, and
cooking without a stove for a colleague at the office. This suggested that as
he was losing important selfobject sustenance, he was facing fragmentation
and the emergence of strong orality, a need so hot he could cook without a
stove. He needed another selfobject to contain him and stay with him. The
analyst wondered aloud what was “cooking.” In the next session the patient
reported a childhood memory involving markedly unempathetic treatment
by both his parents in the cold of winter, suggesting his response to the
analyst's effort to uncover the dynamic that was “cooking” rather than
attend to his need for assistance in regulating himself.

Norbert, another physician-analysand about the same age, was much more
definite about what made him angry. After he taught his first class to a
group of clerkship students, he was elated with how well he had done and
how well he had been received. As he drove home on the expressway, he
felt as if he were flying in an airplane. When he arrived home, not only had
his wife failed to prepare the favorite meal she had promised to celebrate
the occasion but she was not even there! He was enraged and had fantasies
about retaliating against her. Norbert's rage was fantasy-related and
elaborated and could be worked with in specific transference
configurations, while Bruce's experience was one of living on the brink of
overstimulation, with his rage, as his self-state dream suggests, nearly
boiling over.

Sandra, a paralegal in her middle twenties, had great difficulty relaxing over
the course of her lengthy analysis. She had been traumatized by significant
losses, and although she could readily verbalize her disappointment and
dissatisfaction with family, friends, coworkers, and analyst, she seemed
frozen in anger. She lived in a psychological world devoid of soothing
selfobjects and struggled to ward off an empty and lonely fragmentation.
After lying down on the couch for the first time, she too expressed concern
about a pot boiling over; she dreamt that some punks had tied up her
boyfriend and threatened to rape her, thus expressing her concern about
being restrained and unable to feel or express herself as well as her fear that
she would be invaded by intense affects. Problems with affect regulation
and experience continued to trouble Sandra throughout her analysis. She
felt that my interpretations were correct, but she could not get in touch with
the feelings associated with the material under discussion. As she expressed
in another early dream, she was watching a party given in her honor, but she
was an outsider and could not join in. In other dreams she had the analyst
turn away from her to avoid being overstimulated herself. Angrily, she
complained that psychoanalysis did not help her defrost.

Carol, a 25-year-old physical therapist, had not only been victimized by

impulsive people but frequently engaged in rash behavior herself. During
her psychoanalysis of several years she and I used the opportunity to
discuss many issues and a variety of psychodynamic meanings for her
behavior, but it was the gradual accretion of an internal regulating system,
which contact with the selfobject-analyst provided, that made the
difference. Her rage attacks at her boyfriend and her parents and her tearful
confrontations with me, an analyst who could not regulate her outside the
office and who let her risk danger to herself, suggested an intense idealizing
transference and attendant disillusion and narcissistic rage. Often, Carol's
strong affects and impetuous behavior could not be explained in
psychodynamic terms but resulted from psychoeconomic disequilibrium. In
her 50th session, for example, she dreamt that she and another woman had
walked into a restaurant:

I don't know who she was. It was a dimly lit restaurant, posh. There were no
people around; it was empty. The maitre d’ walks us through it all to a
classy table, not a table for two but a round table for eight. People had been
there before us, and nobody had cleaned off the table. Then, all kinds of
people I know sit down and start eating, others standing behind us. Two
guys were behind me, and I was trying to eat; one was someone I had met at
a party. They kept reaching over me and getting food off my plate. I start
getting on them, and I woke up.

Certainly, the dream contained specific references to her mother and to me,
but, most remarkably, it depicted the chaos and disorganization in her
psychic life. Her hope was that I would clean up the mess. The genetics
were that she felt abandoned by her mother, who would leave the house
when the patient and her siblings argued.

About one hundred sessions later, after a two-week break, Carol presented
me with the following poem:

14 double-edged daggers
cutting thru the ridges of my brain

gushing putrid streams

and red-black clots

of what I've called my lifebath

now released and welling up inside my skull.

Wanting out

Wanting most of all

to trickle down your face

its acid eating ridges

plowing gulleys

into that hard implacable granite

probing for a mineral pool or cavern underground—

musty but alive and giving evidence of time and change.

But if my ruby-acid is too weak

or your granite too impenetrable

then I'll simply wait for sleep

to come softly and gently

whispering “nothing”

blowing cool white air

into the vacuum I have made for it

until it fills my mind with healing space

sealing off the gashes of Indifference.

My two-week absence (“14”) cut her deeply. The agony she experienced as
she disintegrated (“gushing”) and reexperienced the bloodletting of her past
injuries prompted her to want revenge. Knowing that she could not destroy
me (“implacable granite,” the same granite indifference that caused me to
leave her), she anticipated that, with reunion, she would be calmed and
would sleep. Yet during most of her analysis, she lived on the brink of
fragmentation, “a bottle that breaks.” When she struggled to control her
rage, she needed to sit up and face me, feeling contained by eye contact.
Often, she would be overstimulated by correct interpretations, would
disorganize, and would miss subsequent sessions. At other times she would
sob uncontrollably and be unable to leave the session until she could calm
herself.

CONCLUSION

Many clinicians and theorists have challenged the premise of a destructive

aggressive drive. Self psychology has clarified much of the confusion
within psychoanalysis by proposing and clarifying the concept and
experience of narcissistic rage. Most of us have found this to be a
conceptually useful and therapeutically efficacious formulation.

The initial psychoeconomic explorations of narcissistic rage gave way to a

greater emphasis on genetic and psychodynamic explanations. This chapter
is an effort to remind ourselves of the clinical value of a psychoeconomic
perspective: it helps us recognize and understand episodes of
overstimulation and fragmentation and traumatic states, as well as the
inhibitions, defenses, and resistances employed to maintain or regain self-
cohesion and self-equilibrium.
Many episodes of narcissistic rage are characterized by specific dynamic
issues and characterize how the self experiences the selfob-ject. Other
violent, ragelike behavior denotes no psychodynamic content but results
from an overwhelmed psychic apparatus in need of containment and
control. Although the person seems angry and may feel angry at being
overwhelmed and not managed, anger is not the issue; dysregulation is.
Such fragmentation may occur in the hospital or in the analytic office.
People may be enraged because of specific transference issues, or they may
be enraged because the therapist has permitted the disintegration to happen;
or they may appear enraged when they are actually fragmented and dazed,
or they may appear distant and enraged but are immobilized and
incapacitated in an attempt to preserve cohesion.

Therapists try to understand the psychodynamic and genetic experiences

that underlie these episodes. They try to empathize as well with the patient's
predicament of often (or always) being on the verge of collapse, even in the
presence of an attuned selfobject, sometimes precisely because that
selfobject is in contact.

If the therapist can maintain the proper empathic stance and recognize the
patient's plight, “cool white air” will again fill the “mind with healing
space” and composure will return.

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Hogarth Press, 1963.

Gedo, J. & Goldberg, A. (1973), Models of the Mind. Chicago: University

of Chicago Press.

Kernberg, O. (1975), Borderline Conditions and Pathological Narcissism.

New York: Aron-son. Kohut, H. (1951), Discussion of “The Function of the
Analyst in the Therapeutic Process” by Samuel D. Lipton. In: The Search
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Press, 1978, pp. 159–166.

———(1957), Observations on the psychological functions of music. In:

The Search for the Self, Vol. 1, ed. P. Ornstein. New York: International
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———(1959), Introspection, empathy and psychoanalysis: An examination

of the relationship between mode of observation and theory. In: The Search
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———(1971), The Analysis of the Self. New York: International

Universities Press.

———(1972), Thoughts on narcissism and narcissistic rage. In: The Search

for the Self, Vol. 2, ed. P. Ornstein. New York: International Universities
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———(1978), Self psychology and the sciences of man. In: The Search for
the Self, Vol. 3, ed. P. Ornstein. New York: International Universities Press,
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———(1981), Introspection, empathy, and the semicircle of mental health.

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Universities Press, 1991, pp. 537–260.

———(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

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———& Halton, A. (1987), The emergence of assertion and aggression

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Chapter Chronic Rage from Underground: Reflections on Its
12 Structure and Treatment

In his Notes from Underground

Paul H. Ornstein 1 Dostoyevski (1864) presents us with an
unparalleled portrayal of his protagonist's chronic rage. This rage resides
mostly within, a private inner experience that nevertheless dominates all
behavior from its internal hiding place. Only occasionally does the rage
burst forth into open, violent, vindictive, and revengeful attacks on those
whose real or imagined slights create immense suffering for the protagonist.
This suffering (as silent to the external observer as the rage it provokes) is
marked by a subjectively painful sense of humiliation and degradation; by
pervasive hypochondriacal preoccupations; by a constant elaboration of the
most detailed plans for revenge to right even the slightest, but greatly
magnified, wrong; and, most significantly, by a whole series of behaviors
that we would undoubtedly judge from the outside as self-defeating but that
Dostoyevski illuminates from the inside as desperate attempts to regain lost
self-regard. All these reactions are embedded in the context of a pervasive
sense of superiority and self-importance, which exists side by side with a
sense of utter worthlessness and unbearable shame.

Dostoyevski lets the fictitious author of Notes reveal his agonies in the first
person, thereby lending these compulsively honest, often monotonously
repetitious, yet courageous and cogent self-revelations a particular urgency
and dramatic intensity. This succeeds in drawing the reader inside the whole
experience, inside every detail of it. The immediacy of the communication
in the first person is so compelling that we cannot emerge from the reading
of these notes (or from listening to them on tape, as I have recently done)
unscathed. A whole gamut of reactions is mobilized in the process, as if we
were listening to a patient's free associations. And we can completely
extricate ourselves neither from the “underground man's” revelations nor
from our own affect-laden reactions to them. We admire him for being able
to see so clearly into every nook and cranny of his inner world, but we get
frustrated and annoyed that all this power of observation, all this cogent
knowledge, is unable to move him out of his self-defeating behavior. We get
bored with the repetitiousness of his reacting to such minuscule slights with
such huge investments of energy in planning his revenge; we see that it
brings him no relief, whether he is able to go through with his revengeful
act or not. If he does act, he agonizes over having done it; and if he does
not, he ends up in endless recriminations for his cowardliness. There is no
escape for him from self-loathing and self-torment. His constant inner
dialogue with those who already harmed him in the past and with those who
inevitably will in the future takes up every moment of his waking hours and
animates his inextinguishable memories of a lifetime of insults and injuries.

Notes from Underground reads as if Dostoyevski were familiar with

“Thoughts on Narcissism and Narcissistic Rage” (Kohut, 1972). In fact,
Dostoyevski has provided us with an independent data base of observations
and interpretations that not only buttresses our own but actually fills in
many of the details not yet fully articulated in our literature. These “notes”
present a remarkably vivid, pertinent microscopic study of the personality
structure and experiences of those who suffer from chronic rage.

But my goal here is not an exhaustive analysis of Dostoyevski's Notes from

Underground, tempting as it would be to offer a comprehensive exploration
of it in all its details. I have referred to it here only to set the stage for my
brief remarks on some theoretical as well as clinical issues related to the
broad topic of aggression and rage.

I shall first reflect briefly on Kohut's fundamental contributions to our

understanding and treatment of aggression and narcissistic rage and then
introduce a particularly difficult clinical problem in the analysis of a patient
of mine, Mr. K, who has been feeling dominated by his chronic, silent rage
and revengefulness and has long been presenting me with his own “notes
from underground,” to which it has often been difficult for me to find a
sustained, optimum analytic response.

REFLECTIONS ON KOHUT'S FUNDAMENTAL

CONTRIBUTIONS ON AGGRESSION AND RAGE

Kohut's (1972) “Thoughts on Narcissism and Narcissistic Rage” has long

been considered one of his most brilliant contributions (see Ornstein and
Ornstein, 1993). It is a veritable tour de force that further strengthened the
core of his clinical and theoretical innovations, presented in The Analysis of
the Self just one year earlier (Kohut, 1971). I have often regretted that he
did not extend it to a monograph-length study with more detailed, lengthier
clinical illustrations. But even in this relatively brief essay Kohut advanced
a number of clinical and theoretical formulations that are to this very day
the cornerstones of our approach to aggression and rage—even if some of
them (since they were advanced prior to 1977) have to be reformulated or
otherwise updated within the framework of an evolving psychology of the
self. I need not review here what Kohut said in 1972, but I wish to review
some of his key propositions in order to highlight why they are of such
fundamental significance and to indicate in what areas they need further
empirical validation as well as conceptual clarification.

It is remarkable that although he did not assemble his experiences and ideas
about narcissistic rage into a monograph, Kohut did deal rather
systematically with this topic: He offered an encompassing classification;
he postulated the etiology and pathogenesis of narcissistic rage and of a
whole spectrum of related phenomena; and, finally, he outlined the
principles of treatment and portrayed the gradual transformation of
narcissistic rage into mature aggression. I shall comment in passing on each
of these three main areas.

Classification

Kohut constructed a spectrum of rage experiences, starting with fleeting

annoyance and anger at one end and culminating in the furor of the
catatonic and the grudges of the paranoiac at the other. The spectrum
includes additional forms of rage, such as the well-known “catastrophic
reaction” of the brain-damaged and its many attenuated variations, as well
as the child's reaction to painful injuries, and Kohut left it to further
empirical research to delineate still other forms.

Kohut viewed narcissistic rage as just one specific band in this whole
spectrum, but because he considered this the best-known among all related
phenomena, he designated the entire spectrum as narcissistic rage. This has
created some ambiguity and has led to the frequent question, Is all
aggression narcissistic rage? Yes, from our current perspective I would say
that all destructive aggression is at its roots narcissistic rage—whatever its
outward manifestation, however mild or severe, acute or chronic. Kohut
(1972) himself wrote that “underlying all these emotional states [within the
spectrum] is the uncompromising insistence on the perfection of the
idealized selfob-ject and on the limitless power and knowledge of the
grandiose self” (p. 643). This “dynamic essence” of narcissistic rage is
common to all experiences within the broad spectrum of rage phenomena,
from the mildest and most fleeting to the most persistent and destructive.

Note that Kohut did not construct a spectrum from mature aggression at one
end to the most destructive rage at the other, arranging these phenomena on
a continuum, the usual analytic approach in portraying drive-related
phenomena being to place the normal at one end of a spectrum and the
pathological at the other. Instead, in 1972 Kohut properly contrasted
narcissistic rage with mature aggression and thereby indicated their separate
origins and development. Once he replaced the concept of mature (or
nondestructive) aggression with self-assertiveness (or self-assertive
ambition), he further sharpened the view that the latter was primary and the
former was secondary or reactive and that the two were clearly not within
the same developmental line.

Thus, we can reaffirm that it is appropriate to speak of the various forms of

rage as all belonging under the umbrella of narcissistic rage and contrast
these with self-assertiveness. To label one specific band in the spectrum as
well as the whole spectrum itself as narcissistic rage has the advantage of
indicating the commonality or fundamental characteristic of all phenomena
included in the spectrum. It would be desirable, however, to find an equally
evocative but more fitting designation to finally leave behind the now-
ambiguous and undesirable term narcissistic.2

Etiology and Pathogenesis

It is in relation to the etiology and pathogenesis of narcissistic rage and its

experiential content that Kohut made his most innovative contributions.
While many analysts before him had given up the notion of aggression as a
drive and considered it as arising secondarily due to frustration, Kohut
specified both the matrix from which the rage arose and the structural and
dynamic conditions under which this occurred. He pinpointed various kinds
of traumatic injuries to the grandiose self and traumatic obstacles to merger
with the idealized parent imago and thus located the propensity for rage
within this highly vulnerable, archaic, narcissistic matrix of the personality.
In this connection he elaborated in some detail on the experiential content
of the various forms of narcissistic rage.

The 1972 essay fits in with and also buttresses the conceptual edifice that
Kohut (1971) built in The Analysis of the Self. The key point he made is
this: It is not the rage as an intensification and unbridled expression of the
aggressive drive that is the essence of the pathology; the essence of the
pathology is the underlying structural deficiency of the self—its
vulnerability and periodic, transient collapse in response to certain types of
injury. The implication is clear: We do not achieve a direct transformation
of narcissistic rage into healthy self-assertiveness. To the degree that we can
restore the structural integrity of the self it will gradually become capable of
asserting itself and pursuing its ambition. To the degree that it still suffers
from enfeeblement or periodic fragmentation it will continue to show a
propensity for rage reactions as a consequence of fragmentation and/or
efforts at restitution. In other words, self-assertiveness is a function of the
healthy self whereas rage is a function of a vulnerable, structurally deficient
self.

Treatment Principles

Psychoanalysts frequently assert that there is only one way to understand

psychopathology, namely, analytically—and they have in mind their own
preferred psychoanalytic paradigm for this purpose— but that there are
many ways to treat the patient. While this may well be a widespread
attitude, I see it as a special advantage of Kohut's formulations that his
nosology (including etiology and pathogenesis), as well as his dynamic and
structural considerations, leads directly to the treatment principles he
espoused. There is in his work a closely intertwined connection between
theory and practice. Thus, it logically follows from his view of rage that it
is the underlying self disorder per se that occupies center stage within the
psychoanalytic or psychotherapeutic process via the particular self object
transference. The interpretive emphasis in the working through is on the
disturbances that produce the rage and/or on how the rage is used to prevent
further disintegration or to attempt to restore the integrity of the self.3

Certain forms of chronic rage, walled off from being experienced by the
patient and from reaching direct expression in the transference, present
particular difficulties in the treatment process. It is to such a difficulty that I
shall now turn with the aid of a brief clinical example.

I hope to illustrate aspects of the nature of the particular self disorder in

which the patient's chronic rage was embedded. Along with that I wish to
show that the usual effort of focusing on the repair of the various kinds of
disruptions of the mirror transference (rather than seeking direct access to
the rage), when successful, regularly diminished the outward manifestations
of the hidden rage to a good degree. The patient would behave in a calmer,
more integrated fashion but would still bitterly complain about not feeling
anything or not really participating in his own inner experiences, and he
would again, at the next disruption, feel nothing of his rage. It was only
after the discovery of an attitude in myself–a somewhat camouflaged
reluctance or reserve vis-à-vis the patient's concrete mirroring needs and
demands—that locked in his inability to feel his rage or to participate in any
of his own experiences that further progress could be made. The patient
sensed this reservation no matter how much I acknowledged the legitimacy
of his archaic needs and demands. This discovery and the changes I was
able to make in my approach as a result were followed by a slow
transformation of the patient's archaic expectations for concrete, overt
responses for mirroring into an expectation that I should know precisely and
accept without reservation all of his feelings, needs, and demands (and give
evidence of this acceptance through my emotional presence with him!). It
was only then that a prolonged stalemate began to be resolved.

MR. K'S PERVASIVE, CHRONIC UNDERGROUND4 RAGE

In Mr. K's prolonged and arduous analysis his profound and persistent
hunger for mirroring appeared to be the central theme. For quite some time,
however, this remained hidden and unavailable to our joint analytic
scrutiny. No matter what the varied contents of his free associations were,
our joint effort at their elucidation was frequently greeted by one of the
following remarks, uttered with painful resignation: “That didn't work for
me” or “That failed for me completely.” Since our understanding appeared
to hit the mark just moments before, I was often quite puzzled. “In what
way did it not work?” I asked. Mr. K had no immediate response. It took a
while to discover that the failure related to the fact that Mr. K secretly
expected some sign of explicit appreciation of his considerable interpretive
skills, his scrupulous honesty in not holding back anything, or the precision
and fearlessness with which he could describe inner experience, even of the
most disturbing kind. It was these that he wished to show off; the actual
content was of lesser significance. What we finally understood in this phase
of the analysis was that Mr. K cared little about what he alone or we jointly
discovered—although he sharply objected to every inaccuracy regarding his
subjective experiences that I may have introduced into our analytic
conversation. What mattered to him was whether or not he could feel that I
truly appreciated what he brought to the session. If he felt that I was not
with him in his (often considerably subdued or hidden) excitement but
maintained an analytic neutrality, as he viewed it, the failure was disturbing
to him and its consequences would last for days or weeks. He would
become withdrawn, apathetic, and without energy. He would then speak in a
colorless monotone for a while, without his usual vivid imagery and richly
expressive metaphors. This would tone me down too, and Mr. K would then
rightly point to my “apathy,” no matter how slight—and often not even
recognized by me until his comment on it or until it dawned on me that he
was holding up a mirror to me with his own behavior to express how he
experienced me. Nothing was more effective in reestablishing good
communication or in repairing the breach in the mirror transference than
when I could show him what in my attitude, tone of voice, or behavior he
experienced as hurtful to him and would then say that he was portraying
this feeling of having been assaulted in his own behavior toward me. This
not only made good sense to him, but he also experienced it as an accepting
stance on my part. He did not feel criticized for behaving the way he did or
feel he was being asked to modify his own behavior—which is how his
parents always responded (“You shouldn't feel this way!”). Thus, repair
could be established and Mr. K's inner rage would temporarily subside. I
say “inner rage” again because he could not feel the rage. He only knew that
he acted on it because his behavior revealed it to him.
An example will illustrate what I mean. Mr. K started one early morning
session with an apathetic demeanor and a long silence. It was difficult to get
going and we could make no headway until I realized that his
nonparticipation might have been triggered by something that transpired
between us. On my way to the waiting room a few minutes earlier I had
suddenly realized, with some concern, that I had forgotten to prepare for an
important meeting later that day. Preoccupied briefly with this thought, I did
not have a receptive smile for Mr. K on encountering him. When I inquired
at first in general terms as to what might have triggered his withdrawal, we
got nowhere. When I suggested that his gloomy demeanor perhaps reflected
how he experienced me on entering the waiting room, he immediately
confirmed my assumption. He added that whenever he felt that he was not
eagerly met but only “routinely” invited into the office, he rebelled against
being there: “If you are not present [emotionally], I won't be either. I will
not come out of my rabbit hole into a vacuum, it is dangerous for me.” He
then elaborated at great length on the poisonous atmosphere at home during
his infancy and childhood, and it became clearer how the analytic situation
at times inadvertently replicated for him his early environment.

It was henceforth somewhat easier for both of us to discern and deal with
disruptions and repair. After we recovered from such an episode, however,
the cycle would soon begin again. I admired Mr. K's tenacity and his, in
many subtle ways, unextinguished hopefulness in the face of repeated
“failures,” and I hoped that he would ultimately sense my full appreciation
of him and what he was accomplishing in gaining a better sense of the
nature of his inner experiences. What I still found myself reluctant to do
was to offer him an unrestrained, explicit admiration—at times it seemed he
wanted that escalated into outright jubilation—for his, admittedly, great
analytic feats of remarkable insightfulness, especially in relation to his
ingenious interpretation of his dreams. I was reacting to the fact that there
was no carryover from one such apparently successful session to the next. It
was as if in each session trust had to be built up again from the beginning.

Only much later did it become clear to me that since I truly admired Mr. K
in many ways, I had expected him to discover this without my having to
prove it to him at every turn. But before I knew this as explicitly as I am
relating it now, my expectation that he should discover it had become a
countertransference obstacle in the analytic process. As was usually the
case, Mr. K helped me discover it, which ameliorated it somewhat. His
frequent bouts of emotional withdrawal–his “defiant nonpresence in the
room,” as he put it–tipped me off. I could see his withholding and
reluctance, expressions of his unforgiving, chronic rage, as a magnified
reproduction of what he accurately perceived as some reservation or
reluctance on my part to give him the explicit admiration he craved. He
once characterized my withholding explicit approval and appreciation for
some brilliant work he had done in the session as the same “arrogance [his]
father would show under similar circumstances.” The word arrogance—as
you might imagine—prevented me for a time from seeing its relevance, that
is until I could calmly reflect on the fact that I held a certain view as to what
was a proper analytic response and to the degree that I held that view, I
could not listen to him from his vantage point without reservation. I then no
longer bristled at his description of my behavior as arrogance. (If Breuer
had refused to follow Anna O's request that he listen to everything she had
to say in a particular way, she might rightly have called him arrogant and
given up treatment. Where is the limit to the extent to which we have to
follow the patient's need [request or demand] for a certain kind of
responsiveness in order to enable the analytic process to move forward– and
without which it would stagnate? Who can tell? And why is it so difficult to
find it?)

Whenever the issue of my “withholding” could be included in the analytic

conversation, there were, at least temporarily, some salutary effects. At
other times Mr. K insisted that withdrawal and nonpresence constituted a
baseline state for him and that this could change only after we established
“rapport” (an emotional presence on my part that then—and only then—
allowed him to be present) in the session. Only under these conditions could
he climb out of his “rabbit hole.” Otherwise, he would have to remain
emotionally absent.

During some stretches of this period, Mr. K would sense my “presence”

only when he felt enough of an appreciation and affirmation from me
through my tone of voice (to which he was very sensitive), the amount I
talked (the more I did, the more valued and valuable he felt), and the
number of “genuine” questions I asked (the greater the number of
questions, the more he could feel my participation in his struggle;
otherwise, he felt alone with it). The accuracy or correctness of my
understanding mattered little, and that rankled me at times, even if only
mildly. Mr. K could acknowledge my having hit the nail on the head—“but
only intellectually,” he would add; something was always missing. Only the
absence of appreciation and affirmation was registered and put on the
ledger, rarely to be forgotten. Mr. K experienced these episodes as
devastating. He could not imagine that my repeated “stupidity” or
“callousness” was not a deliberate attempt to foil his efforts, put him in his
place, humiliate him, a belief that chronically fed his rage.

What sustained me in the interim, nevertheless, was the fact that while these
ruptures were frequent, painful, and lasting, the efforts at repair always
yielded significant memories from the past as well as some additional
understanding of what was going on in his experiences with me, namely,
how I affected him and how he needed to protect himself from feeling
“foiled, defeated, and humiliated.”

To give you just one telling example from this period: Mr. K would
frequently pepper his free associations (whatever the content, to which I
was listening attentively) with some hurried, offhanded, “tucked away”
remark about a physical sensation he was just having—such as “My anus is
tense now” or “There is a cramp in my rear end”—and would then, without
stopping, go on with whatever he was talking about. When I would later on
recap what he said and try to make sense of it, he would have two strenuous
objections. I almost said “violent objections,” but this was precisely the
problem; he could not feel his rage at me, just as on the many occasions
when he spoke of his inordinate rage at his mother and father (for their
emotional distance and other more specific hurtful behaviors) he was
unable to make contact with the rage on an experiential level by feeling it
and owning it. He only “knew” that he was enraged. His first objection was
that I was trying to make sense of what he said instead of just registering it
and letting him know that I heard it (this is reminiscent of Kohut's [1971,
pp. 283–293] Ms. F). He wanted me to first ask him what sense he made of
it; otherwise, he felt “annihilated” by my comments and felt that I was
appropriating his thoughts for my purposes, leaving him with nothing. His
second objection was that I did not pick up and reflect his reference to his
anal sensations. He felt that this was a deliberate disregard of him and that it
meant that I was as repulsed by his anal references as his mother had been
in wiping the feces off him in his infancy and childhood, a response that
contributed, he believed, to his feeling like a “repulsive little shit” ever
since. Furthermore, Mr. K insisted that those few references to his body and
its functions were the only real “feeling-communications,” that the rest was
all unreal (from his left brain) and of little consequence in this analytic
endeavor. It was not knowledge that he lacked but an ability to put thoughts
and feelings together, or, as he put it, “to experience fully and own what
was going on inside of [him].” It was late in this phase of the analysis that I
translated his many references to his anal sensations as his relentless efforts
at getting connected to his archaic mother. My earlier frequent misses
thwarted this development of finally understanding the meaning of the
patient's side-remarks, whereas my subsequent alertness to them enhanced
progress.

Through numerous such incidents we learned that Mr. K was putting

himself forward for acceptance and approval in this tentative and cautious
way, and that my “nonresponse” to his side remarks about his bodily
sensations were therefore understandably devastating to him. It was as if I
did not permit feelings to enter our relationship; I was putting obstacles in
the way of his establishing “rapport” with me and was thereby keeping him
at a distance and preventing him from bringing the two-year-old walled-off
child in him together with the adult.

It was evident from the beginning of the analysis that Mr. K's numerous
“dysfunctions” (as he called them) —his inability to attend to trivial
household chores, finish important tasks he began to work on, pay his bills
on time, and so forth—were almost lifelong behavioral expressions of his
rage and revengefulness at his parents, particularly his mother. They were
also his defiance vis-à-vis his coercive father and his expressed profound
need to extract from his parents, in fantasy, what they never gave him and
what he felt he could not go on without. This attitude and behavior led him
to an elaborate fantasy, his “symbiotic scenario,” in which he had to obtain
from the outside what he never received from his parents: a feeling of being
valued (and thereby gaining self-regard and a sense of personal dignity and
worthwhileness). These became central themes in the transference, and Mr.
K's rage became focused around his frustrations in obtaining them in the
analytic situation.

I shall now move quickly across a prolonged time span. I recognized that it
was not enough to acknowledge the legitimacy of Mr. K's archaic needs in
words, no matter how much I believed in the sincerity of my own
acceptance of them. The words of acknowledgment had to reflect genuine
receptivity to the emergence of these needs in the transference, whatever
form they took. This was not always easy to convey. Mr. K had to feel the
genuineness of my receptivity, the absence of any reluctance or reservation,
in order to experience himself as genuine and to be able to connect to his
inner feelings—but not yet to his rage. His expectations in this new phase
were clearly articulated by him at the tail end of a prolonged effort to repair
a painful disruption. He wanted to feel free to lambast me and express his
rage (even if only in words without feeling), and he wanted me “to
accompany [him] into the depth of [his] abyss, without criticism and
intolerance for [his] fury.” He was confident that if he could feel that I was
with him without reservation and without reluctance, he could make contact
with whatever he would find there.

Mr. K found an apt metaphor to help me accompany him on this journey

into his “underground”: he wanted to pull up to the screen of the analysis all
that he saw there and have me witness it, accept it, and thereby help him
detoxify it. He did not want me to do anything about it except to perfectly
reflect his inner experiences. Such a reflection, he believed, would make
them real for him, with a good chance that he would then be able to own
them with feeling and then, hopefully, let go of them. After what we had
been through before, this was an easier task to follow, I thought. And for a
while it was. But the demand for perfect attunement still leads to painful
disruptive episodes. Occasionally, Mr. K reflects on the fact that he is now
able to feel “somewhat better connected” to me and hence also to his own
inner self.

CONCLUDING REMARKS

Among the many lessons I have learned from my work with Mr. K and have
illustrated in this chapter, several stand out as of fundamental importance.
Although Mr. K undoubtedly suffered from lifelong “dysfunctions” (see
also Ornstein, 1987, p. 91), he began his second analysis with me with a
certain intensity of hope that he could overcome them. In spite of the fact
that he built around himself a “defensive wall of apparent tranquility ...
maintained with the aid of social isolation, detachment, and fantasied
superiority” (Kohut, 1972, p. 646), he began on the couch as if this wall did
not exist. Only after the first major disruption of his quickly developing
mirror transference did it seem to have been brought visibly into play. Mr.
K's fear of becoming retraumatized kept him behind his wall, with repeated,
subtle (indeed, to me often barely recognizable) forays outside his wall to
extract the appreciation and validation he felt I was deliberately
withholding. When I would inadvertently miss these efforts—rather than
notice, explicitly welcome, and admire them— Mr. K felt justified in
retreating again.

It would be an easy way out to say simply that at that point in the analysis
Mr. K's transference “clicked in” and we were dealing with the inevitable.
While this is true, this does not permit us the proper “reparative” focus. It is
more important for the treatment process to center on those elements of the
current precipitants for the disruptions that are truly unwelcome intrusions
into the treatment process, some of which can and should be remedied by
the analyst. These intrusions may be classified as countertransference
phenomena, inadequate understanding of the nature of the patient's
subjective experience, or incorrect application of existing theory and
treatment principles. The term failure in describing analytic interventions
that lead to severe disruptions has become very unpopular—to the
detriment of progress in the theory of treatment and in refining the analyst's
proper responsiveness.

The question of how to deal with persistent demands for the concrete
satisfaction of various archaic mirroring needs–the question, in other words,
of whether the self-psychologically informed analyst should actually mirror
his patients or not—is a frequent one, and the available answers are not
always clear-cut. Mr. K provided me with some additional guidelines,
worthy of further empirical study. A less reserved response to his initial
demands for mirroring (of the sort that Kohut acceded to with Ms. F?)
might well have prevented the escalation of these demands to the point of a
transference-countertransference stalemate. A tonally expressed emotional
receptivity on my part—which I thought was there from the beginning but
which he experienced as missing—might well have led us much earlier to
the point where Mr. K could accept me as a validating witness to his
experiences rather than as someone concretely fitting in with his archaic
“symbiotic scenario,” a function with which I obviously had some
difficulty.

The manifestations of Mr. K's chronic rage, as would be expected,

fluctuated very much in accordance with whether he felt my “receptive and
willing presence” or not. They were clearly secondary to disruptive
experiences in the transference and were both consequences of these
disruptions as well as relentless retaliations for them. Simultaneously, they
were also efforts to get reconnected to me and to attempt to extract penance:
“I need a dignity payment from you, because you defeated me and
humiliated me,” he said. At least in words, if not yet in feeling, at the point
where my narrative ends Mr. K is able to express his fury unsparingly.
Nothing appears to ameliorate his rage, however, more consistently than
“establishing rapport,” his phrase for getting emotionally reconnected to
me.

POSTSCRIPT

In comparing the protagonist of Dostoyevski's novel and Mr. K, there is one

striking observation that immediately attracts the attention of the clinician:
both are highly expressive in words, images, and metaphors, and both have
an extraordinary degree and quality of insight—without this being a
leverage for change.

The man from underground is deeply locked into a chronic, repetitive cycle
of behavior and experiences that constantly validate his negative self-
assessment, a situation that only reinforces his rage and revengefulness. He
strives to improve his situation and relationships, but he cannot elicit the
desired responses from his environment that would, it may seem to the
reader, make internal change possible. He is on the verge of reaching out to
others on a few occasions, but these end disastrously. The man's narrative
ends abruptly with this sentence: “I've had enough of writing these Notes
from Underground.” Dostoyevski appends the following remarks: “Actually
the notes of this lover of paradoxes do not end here. He couldn't resist and
went on writing. But we are of the opinion that one might just as well stop
here” (p. 203), indicating that there has been no movement thus far and
there will be none.

Mr. K, on the other hand, struggles with establishing a different kind of

relationship from his previous ones in the treatment situation. He rightly
expects that the therapist's responsiveness will make a difference. If that
responsiveness catalyzes Mr. K's ability to connect to his inner feelings, to
undo his internal polarization (as he describes it), and if his feelings from
underground then emerge into an analytic milieu of safety and are greeted
with acceptance rather than being recoiled from (even if ever so mildly), a
process of change may be initiated that predominant emphasis on insight
cannot achieve.

REFERENCES

Dostoyevski, F. (1864), Notes from Underground (new translation with

afterword by Andrew MacAndrew). New York: Penguin Books, 1961.

Freud, S. (1937), Analysis terminable and interminable. Standard Edition,

23:216–253. London: Hogarth Press, 1964.

Kohut, H. (1971), The Analysis of the Self. New York: International

Universities Press.

———(1972), Thoughts on narcissism and narcissistic rage. In: The Search

for the Self, Vol. 2, ed. P. H. Ornstein. New York: International Universities
Press, 1978, pp. 615–658.

———(1977), The Restoration of the Self. New York: International

Universities Press.

———(1978), Reflections on advances in self psychology. In: Advances in

Self Psychology, ed. A. Goldberg. New York: International Universities
Press, 1980, pp. 473–554.
Ornstein, P. H. (1987), On self-state dreams in the psychoanalytic treatment
process. In: The Interpretation of Dreams in Clinical Work, ed. A.
Rothstein. Madison, CT: International Universities Press, pp. 87–104.

———(1991), Why self psychology is not an object relations theory:

Clinical and theoretical considerations. In: The Evolution of Self
Psychology. Progress in Self Psychology, Vol. 7, ed. A. Goldberg. Hillsdale,
NJ: The Analytic Press, pp. 17–29.

——— & Ornstein, A. (1993), Assertiveness, anger, rage, and destructive

aggression: A perspective from the treatment process. In: Rage, Power, and
Aggression, ed. R. A. Glick & S. P. Roose. New Haven, CT: Yale
University Press.

1The literal translation of the original Russian title is, more accurately,
“Notes from a Hole in the Floor,” i.e., from a mousehole.
2In a more comprehensive discussion of our nosology I would draw the
analogy between Freud's 1937 assessment of the entire spectrum of
psychopathology, from the neuroses at one end through the various
personality disorders in the middle to the psychoses at the other end, using
the parameter of qualitatively different structural changes in the ego. Freud
described the ego in psychoses as characterized by a structural defect, in
personality disorders by a structural deformity, and in the neuroses—where
the ego was hitherto considered intact—by a structural modification. Each
of these ego alterations was then specified. Kohut did the same in 1977
when he assessed the entire spectrum of psychopathology using the
parameter of qualitatively different structural changes in the self. He
described the self in the psychoses as fragmented (never having attained
cohesiveness); in the personality disorders as enfeebled and/or
fragmentation-prone (but having at one time been cohesive); and, finally, in
the neuroses as cohesive (with sufficient stability) but capable—under the
impact of traumata during the oedipal phase—of becoming secondarily
enfeebled or fragmented. The main point is that each component of the
spectrum of psychopathology can profitably be viewed from this
perspective as a self disorder at bottom, albeit with qualitative differences in
both phenomenology and structure.

In a more thorough reassessment of our nosology the impact of Kohut's

1978 postulate that we need selfobjects from birth to death, i.e., that
development proceeds from archaic to mature selfobjects, would also have
to be considered. Would then the assumption that the mature selfobject
replaces the “object” in our theoretical discourse (Ornstein, 1991) further
affect our nosology of rage?
3Critics have claimed that self psychologists do not deal with narcissistic
rage interpretively but, instead, bypass it. These critics are superficially
accurate in that we pay no direct interpretive attention to tracing the source
of the rage to the aggressive drive at various developmental levels (oral,
anal, phallic, and oedipal) —if that is what is meant by its analytic
interpretation. That our interpretations focus on the surrounding
psychopathology and its amelioration—with salutary consequences for
decreasing the propensity for rage—has thus far not altered this particular
criticism. Nor have the critics acknowledged that this is primarily an
empirical question.
4Underground symbolically refers here to the hidden, sequestered, or
walled-off “depth of his soul,” as Mr. K frequently put it. It is where his
rage resides and where he cannot get to it. He does not feel the rage; he
cannot experience it or connect to it, but he knows it is there.
Chapter Commentary on Marohn's “Rage Without Content” and
13 Ornstein's “Chronic Rage from Underground”

Marohn begins by reminding us of the problems in the conceptualizations

Mark J. Gehrie
of aggression that have vexed psychoanalysts since Freud. He reminds us
that Kohut borrowed much from classical drive theory in his own
conceptualization of aggression, in particular, the economic aspect of the
concept and the idea that pleasure and unpleasure relate to discharge and
inhibition, respectively. In one of his most famous and evocative works,
“Thoughts on Narcissism and Narcissistic Rage,” Kohut (1972) described
narcissistic rage as a psychoeconomic imbalance arising from “the
noncompliance of the archaic selfobject” (p. 396). Marohn cites the
continuity of this idea with Freud's concept of actual neurosis, although
Freud did not link this imbalance with the particular failures of early
caretakers.

Marohn's argument has two prominent threads: First, as did Kohut, Marohn
relates the phenomenon of aggressive expression to disruption of the self,
where the state of the self is dependent upon the quality of the selfobject
environment. The parental selfobjects are understood as responsible,
developmentally speaking, for the optimal structuralization of the child's
psyche via their attentiveness to fundamental selfobject needs of the child.
Failures in such caretaking are evidenced in rageful (or depressive or
sexualized or whatever) breakthroughs, or “disintegration products,” related
to the drives (Kohut, 1977). The second thread is about cure: In treatment
these “inevitable” experiences—that is, the “empathic breaks”—are what
gets treated, not the expression of the rage itself. In other words, a
psychoeconomic imbalance is treated by addressing the presumed source of
that imbalance: a disturbance in the balancing effect of the self-selfobject
matrix. Optimal selfobject responses are understood as both maintaining the
(internal) environment (in the developing child) for structuralization and
providing a background for the management of self disruptions so that they
do not become traumatic. Analogously, that kind of empathically balanced
environment during an analysis is understood as providing a similar kind of
developmental opportunity, via transmuting internalizations, as well as
protection from traumatic repetitions during empathic breaks. Failures in
this process, Marohn says, are seen clinically as “angry, rageful, and/or
destructive feelings, affects, behaviors ... [on a spectrum from] content-
laden material with rich dynamics to, at the other extreme, the contentless
with no specific dynamics, only vague forces, primitive in nature and
suggestive of economic imbalance, a random energy discharge, and a state
of near-chaos.” He then adds that “points along the entire range of this
spectrum can be understood from a self-psychology perspective ... all
pathology ... is now assessed in the context of the self-selfobject
relationship.”

Marohn's concerns about early disruptions in the development of the self

that lead to psychoeconomic imbalance and to states such as “contentless
rage” direct our attention to a central and difficult issue in the theory of self
psychology. While acknowledging that “not all injury leads to narcissistic
rage” and also that some behaviors associated with psychoeconomic
imbalances have “no content or psychodynamic meanings,” Marohn
maintains that it is always the self-selfobject dimension that is at the crux of
the matter, regardless. In other words, he asserts (and, to be fair, so do a
number of others), first, that the relevant level of damage is always this
interpersonal aspect, that a psychoeconomic imbalance is always a product
of the relationship with the therapist, and, second, that its treatment always
involves the empathic repair of the “break” that led to the imbalance. Even
in instances of what he calls “contentless rage” we must presume that at its
root lies an empathic break in the relationship with the therapist. This view
is maintained despite his own emphasis on the enormous developmental
variation in the genesis of narcissistic rage—for example, from “primitive”
to “structured”—and his citation of several clinical examples that suggest a
broad range in meanings and significance of rageful experience.

How can so much developmental diversity be addressed from a single

unitary view of the cause of the problem and yield to a single treatment
modality? (see Gedo and Goldberg, 1973; Gedo, 1988, 1989). Taken at face
value, this position exposes us to the same criticism that we have levied
against classical analysts, whom we have accused of forcing all experience
into the procrustean bed of oedipal conflicts. While we pay lip service to
selfobject functioning along a developmental spectrum from primitive to
mature, our repertoire of understanding has remained rooted in the original
transference configurations described by Kohut, which may not represent a
complete picture of the elongated spectrum of disturbances in development
that we now wish to pursue (Modell, 1986; Gedo, 1988). And in particular I
refer to those very early states of disequilibrium, such as those that may
account for what Dr. Marohn refers to as “contentless states,” that may not
have at their root a disturbance in the self–selfobject matrix. Might they not
be profitably viewed, for example, as archaic transference states that are
repeated in the analysis not because of an empathic break but, rather,
because such states are expressions of a preexisting chronic condition of life
the organization of which is primarily presymbolic? Under such
circumstances it is not a question of “who did what” to create a difficulty
but, rather, an experience such as being overwhelmed, for example, which
is not necessarily always a function of selfobject failure in the present. The
fact that such states might be kept at bay by extraordinary responses of the
therapist is not evidence that the core level is being addressed (Gedo, 1988).
Obviously, any data can be pushed to fit a paradigm, and it could be insisted
that even “contentless overwhelmedness” must relate to a failure in early
selfobject tension-regulating functions, for example. But is this consistent
with the prescription that it must be the self-selfobject dimension in the
treatment that automatically evokes this level of experience? Might there be
some value to the concept of states such as these very early developmental
disturbances being understood as formed in a primordial selfobject context
and now an integral adaptive fixture of the psyche that a different kind of
approach (i.e., not by addressing self-selfobject relations more likely to
represent a later phase) is indicated if the core of the pathology is to be truly
accessed? Rather, this kind of core pathology might first require dealing
with the intervening layers of adaptation seen as effects of this adaptive
fixture. If we must try to empathize with “the primitive, unstructured
psyche,” with the fragmentation, overstimulation, and so forth, that Dr.
Marohn refers to, what does this mean? I suggest that it may not mean that
all such phenomena should be lumped together with more structured
experiences of self disorder and treated similarly. When in more structured
states we know that our failures have precipitated a regression, we attempt
to repair this damage by acknowledging our role in that process. However,
to force this paradigm on much more primitive states of disorder, which
may not have been caused by our failures and which may not represent
regressions from a more integrated position, is tantamount to insisting that a
single concept of disorder (with a single technique to treat it) is behind all
the phenomena that we see (Gedo, 1988; Modell, 1989; Gehrie, in press).

Marohn is correct, I think, when he suggests that aggressive breakthroughs

in a treatment situation may represent some failure in the selfobject bond,
but, as I have said, I don't think that this need always be the case.
Aggression is more than an indicator of psycho-economic imbalance, and
defining it as such doesn't help us understand why today the expression of
such an imbalance may be aggression and tomorrow (or with someone else)
it may be sexual or something else. If we consider that aggression is a
potential that always exists and that its expression may accompany a variety
of self states, not just disorder, then perhaps some light may be shed on the
problem of empathy that Marohn raises at the same time.

Suppose, for example, that in a given instance we are able to show that a
patient suffering from traumatic and very early failures in caretaking was
forced to identify with this primitive selfobject, in which case the tie was,
objectively speaking, fundamentally negative. And suppose that this
negative attachment supplied certain essential nutrients for life and led to a
psychic organization of a particular quality. A well-to-do patient of mine
from an upper-middle-class white family spends some volunteer time
tutoring a black child from a background of poverty and deprivation. My
patient often overhears telephone conversations at her Lake Shore Drive
apartment between her young student and his mother, for he calls home to
tell his mother about all the good stuff he's getting from his tutor: food,
small gifts, excursions to various museums, and so on. The boy's mother
reliably rages at and loudly threatens her son on these occasions, berating
him for not bringing some of this wealth home to give to her or for not
using the opportunity to get some gifts for her. Even at a polite distance my
patient could overhear the mother yelling over the phone, and this scenario
would be repeated at each visit. My shell-shocked patient once asked the
boy after he hung up from one of these conversations how he could stand
being yelled at like that all the time. He replied, “She's my mother,” and
returned to his lesson with an impassive expression. This mother is who this
boy has, and his way of surviving with her could already have become an
adaptive fixture contained within his self structure and not directly
accessible via our usual approach.

Although this example is obviously incomplete, it sets the stage for

considering that early and often fundamental ties with selfobjects may be
negative and that this negativity must come to form an essential piece of the
adaptive apparatus of the developing child. This would not be the result of a
fragmented or fragmenting self but, rather, of a self organized around an
adaptive strategy that permitted survival under otherwise unbearable
circumstances (Gedo, 1981, 1988). Certainly, this point is not relevant to all
or even many of the cases that we see, but in those instances to which Dr.
Marohn refers as “unstructured primitive mental states” it may be that
empathy requires a recognition of the role of the aggressive enactment in
the patient's adaptive organization and that treatment of such patients may
involve an engagement of that enactment on other levels. But more of that
in another paper (Gehrie, in press).

Ornstein begins by reviewing Kohut's paper on narcissistic rage and

highlights a critical question: Is all aggression narcissistic rage? Although
Dr. Ornstein answers this in the affirmative, it is not clear to me that this is
precisely what Kohut meant in the section that was cited. Kohut (1972)
wrote:

Strictly speaking, the term narcissistic rage refers to only one specific band
in [a] wide spectrum of experiences ... however, I shall use the term “a
potiori” and refer to all the points in the spectrum as narcissistic rage, since
with this designation we are referring to the most characteristic or best
known of a series of experiences which... with all their differences, are
essentially related to each other [p. 379].

Kohut goes on to inquire about the common elements in all these

experiences. But to follow up on his other point we should also ask, What is
different about them? If, as Ornstein says, the pathology is always the
“underlying structural deficiency of the self—its vulnerability to and
periodic, transient collapse in response to certain types of injury,” then it
follows that the interpretive emphasis should be “on the disturbances that
produce the rage.” But it is precisely this point that is at issue in the clinical
example he gives and that I think is involved in the difficulties that
presented themselves.

Ornstein is to be complimented on the sensitivity of his clinical description

and, most particularly, on his devotion to his task. There seems to be not a
fiber of his being that is not engaged in the continuous effort to understand
and process perplexing experience. He presents this case as an instance of
“underground rage” in which the usual approach “of focusing on the repair
of the various kinds of disruptions of the mirror transference ... regularly
diminished the outward manifestations of the hidden rage to a good
degree.” No problem there, except that there doesn't appear to have been
much improvement over the long term, and the cycle would keep repeating
itself regardless of the extent to which Ornstein “acknowledged the
legitimacy of [Mr. K's] archaic needs.” Mr. K clearly needed more than
empathy, in the usual sense, to deal with his injury, and what we hear is that
he required “explicit appreciation ... unrestrained, explicit admiration ...
[even] outright jubilation” in response to his demonstrated talents. To be
sure, this was beyond the bounds of management in the mirror transference,
in the ordinary sense.

Ornstein chose to focus on his own countertransference response to this

situation and to his personal struggle to overcome his reluctance to offer
such responses. Certainly, this is an admirable and essential self-analytic
position that we all aspire to, that is, attempting to examine just how our
own character may be interfering with the process. However, it may be that
in instances like this one this is not the problem and that Ornstein's
countertransference response was a sign, on the contrary, of something
essential in himself: a gut-level recognition that to provide what this patient
seemed to require— namely, an unrestrained form of mirroring in response
to all levels of his archaic neediness—was to address a level of the patient's
experience that was more a product of the core disturbance than it was the
core issue itself, which has remained hidden behind the enactment in the
transference. Ornstein's more perfect attunement, while temporarily
assuaging Mr. K's archaic needs, had no reliably curative effect on its own.
Indeed, the cycle seems to still be repeating itself despite Ornstein's
campaign of self-improvement as a source of mirroring. It is not, I suggest,
Ornstein's ability to finally overcome his counter-transference limits in
order to more clearly express his “true” admiration for his patient that is the
essential issue in this case. Or even that Mr. K's inability to feel his rage is
related to Ornstein's setting the stage so perfectly as to finally nurture its
emergence.

Although I don't wish to second-guess Ornstein's assessment of his patient,

I was struck by the power struggle involved in eliciting the desired response
that appeared to be such a prominent dynamic in their relationship. In any
case, we must keep in mind that the point behind the understanding that Dr.
Ornstein is at such pains to provide is for Mr. K to realize the nature of his
enactment in the negative transference. In no way is this the “easy way
out.” When primitive enactments are so global and seem inaccessible by
ordinary means, then perhaps we must consider that access to such states
may require a more flexible technique that accommodates the effects of the
primitive adaptive strategy rather than presuming that our standard
technique is being imperfectly applied.

Anyway, to get back to aggression, it seems likely to me that Mr. K's rages
were more than a result of Ornstein's presumed empathic failures. (If they
had been a result of such failure, Ornstein's perfectly acceptable empathy
would have had the desired result.) I think we have to look at Mr. K's early
history, particularly the nature of the “poisonous atmosphere” that he
described, for more clues about the underlying nature of the pathology, the
role that aggression plays in it, and the structure of his adaptive solution.
Unfortunately, I do not have these data.

Finally, I must once more suggest that when a theoretical framework fails
us under certain circumstances, it is not in the interest of science to insist
that the only possible explanation is that it was imperfectly applied
(Goldberg, 1988, 1990). We must, if we are to continue to grow, accept the
possibility that our system may not always match the data, even if it does a
good job much of the time. I think it remains prudent to maintain the
position that aggression, whether it be experienced as narcissistic rage or
healthy assertiveness, must be understood by us as a human potential that,
along with other broad sources of biologically based experience, plays
many kinds of organizing and expressive roles in our minds, roles that have
yet to be well understood.
REFERENCES

Gedo, J. E. (1981), Advances in Clinical Psychoanalysis. New York:

International Universities Press.

———(1988), The Mind in Disorder. Hillsdale, NJ: The Analytic Press.

———(1989), Self psychology: A post-Kohutian view. In: Self

Psychology: Comparisons and Contrasts, ed. D. Derrick and & S. Detrick.
Hillsdale, NJ: The Analytic Press, pp. 415–428.

———& Goldberg, A. (1973), Models of the Mind. Chicago: University of

Chicago Press.

Gehrie, M. J. (in press), Psychoanalytic technique and the development of

the capacity to reflect. J. Amer. Psychoanal. Assn.

Goldberg, A. (1988), A Fresh Look at Psychoanalysis. Hillsdale, NJ: The

Analytic Press.

———(1990), The Prisonhouse of Psychoanalysis. Hillsdale, NJ: The

Analytic Press.

Kohut, H. (1972), Thoughts on narcissism and narcissistic rage. The

Psychoanalytic Study of the Child, 27:360–400. New York: Quadrangle
Books.

———(1977), The Restoration of the Self. New York: International

Universities Press.

Modell, A. (1986), The missing elements in Kohut's cure. Psychoanal. Inq.,

6:367–386.

———(1989), The psychoanalytic setting as a container of multiple levels

of reality: A perspective on the theory of psychoanalytic treatment.
Psychoanal. Inq., 9:67–87.
IV Clinical
Chapter 14 Mourning Theory Reconsidered

The inspiration
R. Dennis Shelby
for the beginning reformulation of mourning theory
presented in this chapter came from two sources. The first was a research
endeavor designed to reconstruct the experiences of gay men whose long-
term partners contracted and died from acquired immunodeficiency
syndrome (Shelby, 1992). The second was the considerable reformulation
of clinical theory: the psychology of the self and long-overdue efforts to
reexamine analytic theory in light of cognitive and linguistic theories.

The study design consisted of a series of open-ended interviews with well

partners, ill partners, and surviving partners in long-term relationships
impacted by AIDS. Individuals and couples were interviewed over a 9- to-
12-month period. The interviews were then coded and analyzed according
to the grounded theory method of Glaser and Strauss (1967) and Glaser
(1975). This relatively open-ended interview approach, in which the study
participants were asked to tell me what was going on in their lives versus
answering my questions about their experience, yielded data not previously
elucidated in the analytic literature on mourning: The first topic is the
integral role other people play in facilitating the survivors’ mourning
process; the second concerns the impact on the mourning process of a
surviving partner when he too is infected with the same agent that resulted
in his partner's death.

Clinical theory has evolved considerably since the work of Pollock (1961)
in which mourning was conceptualized as a realignment and modification
of the self-representation and object representation. Self psychology has
gained an ever-increasing influence; analytic theorists such as Basch,
Goldberg, and Palombo, in addition to their many contributions, have begun
to reconsider analytic theory in light of cognitive and linguistic theories.
Stern, drawing on infant research studies, has also challenged many of our
long-held assumptions about the human mind and its development.
The results of the study and advances in clinical theory indicated that a
beginning reformulation of our theory of mourning is in order, if not long
overdue. The data also demand that attempts be made to give a theoretical
accounting for the observed differences in the mourning experiences of
seropositive and seronegative men. Though discussed in the context of a
population of gay men whose lives have been irrevocably changed by the
HIV virus, the theoretical formulations are applicable to mourning theory in
general and offer a framework for understanding not only the experience of
mourning per se but phenomena both environmental and intrapsychic that
can interfere with the process.

To develop the framework I will discuss the development of psychoanalytic

mourning theory, including the problems with the theory in general and for
the understanding of gay men in particular; offer a more elaborated self-
psychological model; and present two cases of surviving partners who were
experiencing a complicated mourning process. One case involves a man
who was seronegative for the HIV virus, the other a man who was
seropositive. Hopefully, the cases and the discussion will illustrate the
process of mourning and the complications in the mourning process often
observed in seropositive surviving partners.

THE DEVELOPMENT OF MOURNING THEORY

The basic formulation regarding the nature of the mourning process that has
guided our theoretical and clinical understanding for more than 70 years can
be found in Freud's (1912–1913) work “Totem and Taboo”: “Mourning has
a quite specific task to perform: its function is to detach the survivor's
memories and hopes from the dead. When this has been achieved the pain
grows less, and with it the remorse and self reproach” (pp. 65–66). The two
interrelated and enduring elements are the following: (1) Mourning
concerns two central figures, the mourner and the deceased, or, more
specifically, their memories, hopes, and affects. That is, mourning
essentially concerns the meaning of the particular relationship and its loss.
(2) Mourning is a process that, in an undistorted form, consists of a
reorganization of the ego of the mourner. Essentially, the loss of a central
person and the accompanying psychological manifestations of loss
gradually move from a central, painful, and often overwhelming aspect of
the survivor's experience to a less central affectively charged position.
When this reorganization has been achieved, the survivor is able to again
feel a part of the world of the living and has the psychological resources to
actively participate in new love attachments.

With the publication of “Mourning and Melancholia” Freud (1917) laid out
a theory of relationships, including their loss and subsequent role in the
structuralization of the mind. The process consists of a libidinal cathexis to
another person. With the loss of the person, the libidinal energy must be
withdrawn. The ego initially protests and resists as this represents the
abandonment of a libidinal position. In successful mourning the object is
eventually preserved in the form of an identification and libidinal energy is
available for new attachments. In pathological mourning, or melancholia,
the object is not decathected owing to unresolvable ambivalence; rather, the
libido is withdrawn into the ego and the ambivalence toward the lost object
becomes an aspect of the ego's structure.

Pollock (1961), using the framework of analytic ego psychology, describes

the mourning process as a gradual realignment of the self-representation
and the object representation, which are intrapsychic counterpoints to the
individual's experience of the world. Object representations consist of the
images and experiences with individuals to whom the person has formed an
attachment, while self-representations consist of images and experiences the
person has of himself. Over the course of the life cycle, reality calls for
modifications in both self and object representations. In the case of
mourning, the process consists of integrating the reality of the loss. The
object representation is decathected, giving rise to the pain associated with
the loss of an attachment. As part of the process, the mourner experiences a
gradually shifting series of identifications with the deceased. Eventually the
self-representation is modified and “reshaped,” partially in the image of the
dead individual. Two potential pathological outcomes to the process are (1)
an excessive identification with the lost individual, in which the object
representation becomes incorporated into the self-representation, and (2) an
inability to tolerate the process of mourning with the result that the object
representation remains intact and the fantasy evolves that the person never
died. Crucial to the mourning process is the ability to work through
ambivalent feelings toward the deceased. As the ambivaence toward the
deceased is resolved, the object representation is transformed into a set of
memories, cathexis is withdrawn, and the individual is available for new
attachments.

The emphasis on the ability to work through ambivalent feelings toward the
deceased indicates the extent to which traditional analytic theory is based
on the concept of drives, with their organization or psychic structures being
the primary determinants of behavior; consequently drives are key
determinants in the ability of the individual to mourn. The ability to resolve
ambivalence is contingent on the resolution of the oedipal phase and the
consequent laying down of the repression barrier. A reflection of the
importance of ambivalence resolution is seen in the debate concerning what
age and level of intrapsychic structure a child must theoretically obtain in
order to be able to mourn (see Shane and Shane, 1990, and Palombo, 1981,
for more thorough reviews of this literature). This connection between
ambivalence resolution and resolution of the oedipal phase is the very
problem that makes traditional analytic theories problematic in
understanding the mourning process of gay men; in the traditional analytic
framework, homosexual men and women have not reached the oedipal level
of drive organization (Lewes, 1988). Consequently, children and
homosexuals are considered to be infantile in terms of psychic structure and
hence, theoretically, unable to mourn. The theoretical consequences of an
unmourned loss in an individual incapable of mourning are considerable.
Shane and Shane (1990) observe:

. . . it has been felt that without the capacity to adequately mourn an

overwhelming loss, the child's development is significantly impeded. It is
postulated that because the child cannot mourn—that is, give up (decathect)
the attachment to an investment in the representation of the lost person—or
cannot preserve the relationship in the form of an identification, the search
goes on forever for the parent whose death is unconsciously denied, and the
person remains, in an important sense, the child at that phase or age when
the loss was sustained. Thus, the fantasy that the parent still lives and can
be found again precludes the possibility for true replacement, not just in
childhood, but throughout life [pp. 115–116].

CLINICAL THEORY AND HOMOSEXUALITY

The relationship between mourning, ambivalence, and homosexuality is but
one of the many theoretical problems one encounters when addressing
psychological phenomena in a homosexual population. Friedman (1988)
states: “Concepts about male homosexuality, of undeniable importance in
their own right, are also an organic part of the larger issues in the history of
psychoanalytic ideas” (p. 269). Given this centrality, a brief discussion of
homosexuality is in order.

Clinicians who strive to practice from a depth psychology model with gay
men or lesbian women face a central theoretical problem. Until fairly
recently, all of our depth, or analytic, psychological models were rooted in
libidinal drive theory. The self psychology framework helps us avoid the
multiple theoretical problems one encounters with libidinal and ego-
analytic theories, which ultimately rely heavily on the cornerstone of
Oedipus and the heterosexual functioning that successful resolution
represents (see Lewes, 1988, and Friedman, 1988, for more thorough
discussions of the multiple theoretical problems). Isay (1989) has attempted
to describe clinical intervention with gay men within a drive-theory-based
theoretical framework. However, his selective inattention to key aspects of
the theory—especially the resolution of the oedipal conflict and the
formation of the superego, the laying down of the repression barrier, and the
difference between homosexuality and neurosis–essentially leaves him
operating from an atheoretical position.

The basic issue comes down to the role of sexuality in the development or
organization of the mind. Does the development of sexual or libidinal drives
shape the mind, or does the self's organization and coherence influence the
experience of sexuality and the ability to form relationships that are
mutually enhancing? Clearly, the general direction in which analytic theory
is currently moving indicates that the latter provides a broader explanation
of the phenomena than the former.

In clinical work with gay men “the issue is not what caused the patients’
homosexuality, it is the meaning that being homosexual has for the
particular person” (Shelby, 1989). In the course of development
homosexual children live in the context of a selfobject environment (both
parental and the larger environment) that is culturally phobic, if not outright
hostile, toward homosexuality and its sexual expression. Consequently, the
developing self often experiences numerous selfobject failures and outright
narcissistic assaults.

The shared sense of sexuality or masculine competence is an important

element in the mirroring and alter ego components of the father–son
dialogue and often dramatically affects the idealizing sphere as well.
Temperamental differences that are often read and responded to along
gender lines, as well as the basic lack of a shared sexual orientation, often
result in distortions in the relationship with the same-sex parent.
Subsequently, the homosexual child does not experience selfobject
functions that pertain to the realm of gender in an uncomplicated manner,
and the self organization begins to include the experience of being different
and incompetent. If the child's temperamental and/or orientational
differences are experienced by the parent as a narcissistic injury, the child
may be subjected to narcissistic assaults. The implication of this perspective
is that there is a normative developmental process observed in homosexual
children and that the pathogenic process often centers around the lack of
environmental sustaining and modulating of the child's evolving self in the
areas of gender and sexual orientation.

A series of meanings often becomes structured around these frequently

painful experiences, and a gap often develops in the father-son dialogue that
is difficult to mediate. These early experiences become the organizers
through which messages from the larger homophobic environment are
understood and become the basis for the self-experience that Maylon (1982)
has referred to as “internalized homophobia.” In the course of the mourning
process these experiences and meanings are often reawakened. If the
environmental response is nonsupportive or attacking, they may take on a
central significance.

MOURNING AND SELF PSYCHOLOGY

Palombo (1981, 1982) points out that “in the self-psychological model, the
loss [of a significant relationship due to death] is viewed as the loss of a
selfobject relationship, which brings about an imbalance in self-esteem.” In
many cases the imbalance in self-esteem is more accurately described as a
massive disorganization of the self and a shattering of self-esteem.
Relationships vary in the degree to which individuals rely on one another
for specific selfobject experiences; hence, each relationship varies in terms
of the meaning of the loss and, consequently, in the psychological impact
on the mourner.

Shane and Shane (1990) extend formulations of mourning theory within a

self psychology framework. Though they focus on children, they assert that
it is not the degree of psychic structure that enables the child to mourn but,
rather, the presence and ability of the surviving parent or other adult to
tolerate, mirror, sustain, and share the range of the child's affects regarding
the lost parent, essentially the ability of that adult to provide “compensatory
self-structure . . . to repair the weakened aspects of the self, but facilitate
continued or renewed development” (p. 199).

In the face of the massive loss of selfobject functions of the decreased

parent, the surviving parent (when not overly compromised by his or her
own grief) serves as a selfobject that facilitates the mourning process. When
this supportive environment is available, the child is able “to face the
impact of the loss without feeling the risk of being overwhelmed,
annihilated, or fragmented.... The pain of the loss can be borne and the
necessary capacity to think, talk, and reflect about it can be sustained if the
child is helped to mourn” (pp. 118, 119). The Shanes postulate that for
many children the surviving parent's inability to perform these functions
results in a double loss for the child and accounts for the considerable
pathology observed later in life. The loss of the parent is complicated when
the surviving parent is so compromised by his or her own grief as to be
unable to provide the sustaining selfobject environment to support the
child's mourning process. Hence, in the face of an overwhelming loss the
child is once again abandoned.

It is reasonable to assert that adults as well as children require selfobject

experiences to facilitate the varying degrees of self-reorganization that
mourning involves. While Shane and Shane (1990) indicate that the
presence of a required “optimal selfobject environment [is] more available
to the adult” (p. 119), they do not elaborate on the nature of the role of the
selfobject matrix in adult mourning. The results of the study on which this
chapter is based illustrate the central role that selfobject encounters with
those individuals who exhibit their understanding and tolerance of the
mourners’ affects, concerns, and general psychological state play in
facilitating the reorganization of the self that mourning involves.

At this point in time an elaborated theory of mourning in a self-

psychological framework has not been posited. The basic elements exist in
the literature: Kohut's (1977) assertion that there is “no mature love in
which the love object is not also a selfobject, or, to put this depth
psychological formulation into a psychosocial context, there is no love
relationship without mutual self-esteem enhancing, mirroring and
idealization” (p. 141); Palombo's 1981 statement that “the loss must also be
viewed as the loss of a selfobject relationship which brings about an
imbalance in self-esteem”; and the Shanes’ 1990 statement that there exists
a “required optimal selfobject environment” for the mourning process. The
results of the present study and recent advances in clinical theory enable us
to make a beginning in the formulation of a theory of mourning within a
self-psychological framework.

In recent years many theorists have worked toward integrating linguistic

and/or cognitive theories into psychoanalytic theory. As Krystal (1990)
points out, analytic theory since the time of Freud has tended to develop in
a context of its own, generally ignoring advances in cognitive and linguistic
theories. This reexamination of psycho-analysis in the context of theories of
other parameters so basic to human experience—cognition, language, and
development—has resulted in a necessary revision of the philosophical
underpinnings of clinical theory, including issues such as how the mind
develops and is organized and, perhaps most importantly, the nature of the
therapeutic process itself (e.g, Stern, 1985; Saari, 1986; Basch, 1988;
Goldberg, 1990; Palombo, 1991).

Palombo (1991) presents an integration of numerous theorists into a

cohesive theory of the nature of meaning, of the processes by which it is
organized into the structure we refer to as the self, and of the process we
call psychotherapy. The central stance concerns the innate aspect of being
human, namely, that from birth onward humans strive to organize or give
meaning to their experience. “Meanings are initially constituted by the
sense a person makes of his or her lived experiences as filtered through his
or her own peculiar environment. These meanings are residues from these
experiences that are retained by the person but they go beyond the facts of
the experience itself. They initially are the definitions a person uses to
organize and integrate experiences” (p. 181). Central to the organization of
meanings is the role of others in the environment: “They [Meanings] evolve
out of the early affective states which in infancy occur in interaction with a
caregiver who attempts to both give significance to the affective states, to
modify them, and to share in them (p. 181). Meanings then, whether
personal or shared, are embedded within a matrix of affectivity and
cognition” (p. 182). The interplay between affect and the role of other
individuals in the formation of meaning is a key component: “The
integration of affect serves to organize experience. Affects constitute a
signaling system which when joined with cognitive faculties and a
caregiver's responses result in a residue of comprehension of the experience
by the child” (p. 182). This is the process by which the self-narrative, the
individual's account of his own experience, is formed. Palombo defines
narrative as “the means to which we organize and integrate our experiences.
They make our experiences coherent by integrating them into each other”
(personal communication, May 12, 1992).

Language plays a central role in the development and organization of the

mind. For Palombo (1991), “language ... is a medium through which
meanings become encoded and are capable of being recalled and of being
communicated to others” (p. 183). Thus, language is the central tool by
which we encode personal meaning and participate in the larger world.
Palombo states that language mediates “experience.” In a similar vein,
Goldberg (1990) states: “Language as a link to other people produces a
different kind of orientation that says that the signifiers allow for a
developmental process to take place, which process allows for the
completion of a configuration, in this case a configuration called the self,
one that was not completed during development” (p. 111).

The nature of the mind or the self is defined by Palombo (1991) as a

“hierarchy of meanings”; thus “psychic structure may be defined as a set of
symbols that remain stable over time” (p. 178). “Eventually the hierarchies
of the meaning systems acquire a coherence that defines the personality.
This coherence is experienced as a sense of cohesion ... the sum of these
coherent systems may be said to constitute a person narrative” (p. 184).
While there is a considerable degree of stability to the self's organization,
elements are subject to change and reorganization: “Experiences and events
may not retain their original meanings but are constantly re-interpreted” (p.
184).

While the basis of these theories is the development of meaning in the

context of childhood development, they include models that can be thought
of as part of a dynamic process that extends throughout the life span. As
human beings living in the context of the larger world, we are exposed to
events and experiences that tax our psychic resources, reactivate old
meanings, and challenge us to form new meanings and engage in
relationships that often serve a central role in the process.

Thus, while psychic structure is reasonably stable over time, elements of

our personal narratives are subject to change and revision. In defining the
therapeutic process Palombo quotes Saari (1986) as saying that it “involves
the organizing of old meanings into newly constructed consciousness. What
is curative is not so much the recovery of deeply rooted repressed material,
but the reordering of structures that underlie personal meaning and the
symbolic capacities of the individual so the new meanings can be
differentiated, constructed or abstracted” (p. 27).

THE PROCESS OF MOURNING AND THE ROLE OF THE

SELFOBJECT MATRIX

Drawing on current clinical thinking, I am proposing the following

definition of mourning: a process that involves a reorganization of central
aspects of the self, of major affect states, and, consequently, of the meaning
of the loss into a narrative that can be integrated into the overall structure of
the self. Mourning begins with a state of acute disorganization of the self,
with a resultant lack of coherence and disequilibrium in self-esteem,
brought about by the loss of a relationship in an individuals’ life. Central to
the disorganization and self-esteem difficulties are the massive loss of
selfobject functions that the survivor experienced within the context of the
relationship, the loss of the shared experience or dialogue that occurs within
a relationship, and any specific meaning that the loss entails (in the case of
an AIDS-related death, the potential that the survivor may also die of the
same disease).

Mourning as a process involves a gradual and often painful reorganization

of the affects secondary to the loss and an integration of the meaning of the
loss into the self. The degree of disorganization and intensity of the affects
involved depends on the centrality of the relationship and the degree to
which the individual relied on the deceased person to complete his own
experience of self. Initially, the self is in a deficient state; the person has
lost a sense of coherence because it is impossible to integrate the meaning
of the loss of a central person in his life, the selfobject dimensions of the
relationship, and the intense affects associated with the loss. Initially in the
mourning process the emphasis is on the missing of the lost individual and
the desire for the experience of the relationship. Cherishing the belongings
of the deceased, holding personal “conversations” with the deceased, and
visiting the gravesite offer the mourner a sense of continuing the
relationship with the lost individual.

This is a crucial distinction: The mourner is not missing, yearning, or

searching for a lost figure, “object,” or representation thereof; rather, what
is absent is his particular unique experience of that individual and the
shared experience, the dialogue, that an intimate relationship entails.
Goldberg (1990), using cognitive and linguistic theories, presents a
thorough and convincing argument for essentially dispensing with the
concept and theory of representations. He argues that analytic theories of
representations are not consistent with the findings of cognitive and
linguistic science, namely, that the mind is not structured or “mapped” by a
series of object representations. There are no “objects” in our minds, only
the subject— ourselves. For Goldberg, “the Kohutian analyst is not
concerned with the hidden representation of the object as with the
representation of the deficient self” (p. 110).

If mourning does not center on the preservation of the object in the form of
identifications or realignment of self and object representations, then just
what does the process entail? The process is the reorganization of affects
and the construction of a new or modified narrative: an account of the
meaning of the death that can then be integrated into the self organization.
The person who has become increasingly accustomed to an intimate,
ongoing dialogue, the bedrock of shared experience with another, must now
integrate the experience of being alone. In this disorganized and vulnerable
state, affects are intense and volatile and self-esteem is diminished and
unstable; consequently, the environment feels very unsafe and unfamiliar.
The work of mourning concerns the gradual reorganization of the affect
states and integration into the experience of the self. As the affects become
less intense, a narrative can be formed; the mourner makes meaning out of
his loss. Language and the narrative gradually supplant shifting affect
states. As this is achieved, the narrative can be integrated into the overall
self organization. The experience of the loss comes to be viewed as a
complicated and painful event in a larger life experience.

The central figures are not so much the mourner and the deceased as the
mourner and the selfobject environment. By responding to the mourner's
affect states and the meaning or centrality of the loss, the environment
assists in the organization of affect and, consequently, in the construction
and integration of the narrative. Stolorow, Brandchaft, and Atwood (1987)
state that “selfobject functions pertain fundamentally to the integration of
affect into the evolving organization of self experience” (p. 86). Hence,
selfobject encounters help modulate and regulate the intensity of affects,
which enables the individual to integrate the meaning of his experiences.
Socarides and Stolorow (1984/1985) assert that “what is crucial to the
child's (or patient's) growing capacity to integrate his sadness and his
painful disappointments in himself and others is the reliable presence of a
calming, containing, empathic selfobject, irrespective of the ‘amount’ or
intensity of the affects involved” (p. 113). Ultimately, the result of the
mourner's encounters with the responsive selfobject environment is the
transformation of the experience from one of massive selfobject loss, with
its attendant fragmentation states and loss of coherence, into a very sad and
painful life event, one that has been lived through and overcome, the
process often stimulating renewed growth.

Affects are soothed and organized, and the narrative is formed through the
mourner's personal and public activities and selfobject relationships. The
mourner's cherishing of, and interactions with, symbols of the relationship
and his shared experience with the deceased complete the configuration that
represents the deficient self in a personal manner. The empathic response of
the selfobject environment to the mourner's missing of the individual, the
associated affects, and the general psychological state complete the
configuration in a shared experience with living people.

Public encounters serve to orient the self toward the world of the living and
rekindle the hope that the self can become enriched through participating in
ongoing shared experiences with the living, rather than by attempting to
find meaning and solace by recreating the shared experience with the
deceased. Ultimately, these experiences often result in the formation of
idealizing relationships with living people, which can spur further growth,
enabling the person to take on new challenges in his career and form
relationships that reflect a higher level of self organization.

I am proposing that the mourning process consists of three distinct but

interrelated elements: The first is the cherishing of the deceased's
possessions and of photographs and memories of the relationship,
“conversations” with the deceased, and rituals such as visits to the gravesite
and acknowledging anniversaries. All these acts reflect not an identification
with the deceased but, rather, attempts to complete the familiar
configuration of the relationship, which ultimately serves to soothe and
modulate affect. The second element concerns the response of the selfobject
environment to affects associated with the loss. Mourners often turn to
others whom they experience as sharing the meaning of the loss—relatives
or close friends of the deceased during times of acute loneliness, which
holidays and anniversaries tend to represent. Mourners consider the sharing
of mutual affects regarding the loss as deeply meaningful and helpful, and a
greater degree of coherence is often evident. This represents the completion
of the configuration of the deficient self in a public way with living people.
The third element of the mourning process is the gradual formation and
integration of the narrative of the loss in the mourner's overall life
experience.

CASE ILLUSTRATIONS
An important finding of Shelby's study (Shelby, 1992) concerned the
differences in the mourning process of seropositive and seronegative
surviving partners. Essentially, seropositive partners tended to be in a more
protracted mourning process and were not able to reengage with the world
in the same manner as seronegative survivors. As I turn to clinical
application of the framework, I will present two cases: The first is of a man
who was seronegative, the second a man who was seropositive. Both men
had encountered difficulty in their mourning process, and both were
significantly depressed upon entering treatment. However, there were
significant differences between the two cases; hopefully, these important
differences will come through as I recount aspects of the clinical process.
The cases are presented in a way that emphasizes the process of mourning
and intervention aimed at reestablishing the process. The area of pre-
existing self pathology and its role in complicated mourning is another topic
entirely.

Case I: The Seronegative Survivor

Mr. B was a 35-year-old professional man who sought treatment at the

insistence of his physician. His partner had died approximately five months
earlier. He had gone to his physician with a long list of somatic complaints
and preoccupations, including lack of energy, chest pains, and headaches.
His physician had worked him up and could find nothing amiss. His
assessment was that Mr. B was severely depressed, and he prescribed
Prozac on the condition that Mr. B seek psychotherapy. Mr. B was rather
chagrined by this assessment but dutifully followed through with the firm
recommendation. Further questioning revealed that Mr. B was sleeping 14
to 16 hours a day; he would come home from work at lunchtime and sleep
and would go to bed shortly after he returned home in the evening.

Mr. B was very reluctant to enter treatment. Although his affect was
excruciatingly depressed, he was very resistant, maintaining that he was
only interested in short-term intervention and had come at the insistence of
his physician. I had worked with his partner and, periodically, with his
partner's family for over two years during a long, complicated illness. Mr. B
sought me out, he said, because I knew his partner and, therefore, he would
not have to explain everything to me the way he would to someone else.
Mr. B related that immediately following his partner's death the family
began harassing him by demanding things that went against the spirit and
specifications of the will. They had also begun a lawsuit challenging the
document even though they had been handsomely provided for. As Mr. B
had been given power of attorney, they demanded a thorough accounting of
the money spent during his partner's illness, outrightly accusing him of
embezzlement. The first two months after his partner's death were spent
attempting to account for every penny spent, an exhausting and complicated
task since Mr. B. often contributed his own money to pay the expenses even
though his partner had ample resources. Although he came up with an
accounting, the family went ahead with their lawsuits. Several of his
partner's cousins, whom Mr. B. had become quite close to, stopped
returning his calls, which enraged and devastated him. He felt all alone,
with sharks circling about him.

As we explored this, Mr. B came to realize that his desperate attempts to

account for the finances were also an attempt to convince his partner's
mother that he was not a bad person. Which, of course, was futile. He
related that he had come to question himself, at times believing he was the
awful, vile embezzler of a helpless, dying man's estate that his partner's
mother said he was.

As I listened to Mr. B I sensed no mourning process and heard mention of

none of the activities, concerns, and rituals that mourners often engage in;
instead, I heard depression and a questioning of his own integrity. Mr. B
also reflected on this, pointing out that he did not find himself missing his
partner or feeling grief stricken. At times he felt the lawsuits were not worth
the hassle of fighting them; he was not actively cooperating with his
lawyers and had begun to consider just turning over his partner's entire
estate to his parents. Shortly after he realized that he was engaged in a
desperate, futile effort to prove his integrity to his partner's mother, he
became less resistant and more engaged with me and began to actively
work with his attorney.

During the next session Mr. B obliquely hinted at regrets in his associations.
I asked him what regrets he had. He began to cry. He related that he had
fallen in love with his partner all over again during the last few months of
the illness and that he was devastated that his partner had died during the
night, by himself in his sleep, when neither he nor the family were present.
Mr. B also admitted that this was the first time he had cried since his
partner's death.

Following that session I began to hear evidence of a mourning process. Mr.

B flew to one of the places where his partner's ashes had been dispersed. He
began to seek out contact with his partner's best friend, someone also deeply
affected by the loss, and they would spend a great deal of time reminiscing.
He also began to reminisce with me and to try and sort out several old and
often painful conflicts between himself and his partner. Mr. B also became
determined to do his best in defending himself and the will–the will,
especially, because it was what his partner had wanted. Needless to say, his
depression was lifting considerably. Although he had been dreading his
partner's approaching birthday, he went alone on that day to a restaurant the
two of them had gone to practically every Sunday they were together. Mr. B
related that this visit was “sad and bittersweet, but it felt good, it felt right.”
He then began planning a panel for the AIDS Quilt and invited a group of
his partner's close friends to participate in making it and to make their own
contributions to the memorial.

Though the lawsuits continued to be quite taxing and a nuisance, Mr. B did
not become overwhelmed by them as readily as before. Concurrently, his
sleeping pattern returned to normal, and he became more actively engaged
socially and at work, even earning a promotion. Approximately six months
after beginning treatment he went off Prozac, his affect held, and he
continued his process of mourning and engagement. Nevertheless, he also
became preoccupied with his antibody status and became convinced that he
was seropositive. Though he had consistently tested negative prior to his
partner's death and had had no sexual contact since, he became convinced
that he too was positive. He eventually was tested and was again negative.

Discussion of Case I

The case of Mr. B illustrates a number of important aspects of working with

people who are having difficulty in the mourning process. The first
concerns the delicate balance between depression and mourning. When the
mourning process is thwarted in adults, one often sees depression.
Mourning does involve a great deal of sad affect, but if a process of
integrating the experience is occurring one also hears of efforts to soothe
the affect through rituals and by engaging with others who are also deeply
affected by the loss. In theoretical terms, efforts to complete the now-
missing configuration of the dialogue are made. When the process
essentially stops, depression and/or anxiety often comes to dominate. If a
person is too depressed he cannot sustain or soothe the sad affect and is
overcome by it. Clearly, Mr. B was in the midst of a major depressive
episode by the time he came to me. When this is the case, the use of
antidepressant medication, in conjunction with individual therapy, is often
necessary to essentially reestablish the process of mourning and to return
the patient to a more reasonable level of functioning.

Mr. B's selfobject environment was not supportive of him and his efforts to
mourn. The challenging of a will interjects chaos, uncertainty, and, often, a
profound sense of betrayal when the mourner is in such a highly vulnerable
state. Family members were attacking and abandoning Mr. B, rather than
engaging with him in a mutual process of mourning their loss. Relatives
with whom Mr. B might have shared his grief cut off contact with him. In
his disappointment he failed to engage with people who were available for
mutual reminiscing and the sharing of affect regarding the loss.

The clinician's role becomes one of helping the patient reestablish the
mourning process. In this case it was necessary to first help Mr. B sort out
his suspicions regarding himself so that he could then relate to me and the
memory of his partner without the fear of his being found out to actually be
an evil person. Survivors often experience ruminations of guilt. Many times
this feeling of guilt can be traced to the survivor's perceived or actual
empathic breaks with the deceased. However, if the ruminations are too
intense or are seemingly confirmed by an angry family, the survivor may
come to believe them as facts. He may become reluctant to relate them to
others for fear they will be found to be true, a reluctance that deprives him
of the possibility of an environment that can respond to and modulate his
painful self-doubts.
As the treatment relationship evolves, the therapist should express his
interest in the mourned relationship and its history and validate the rituals
that the survivor engages in. The personal “conversations” with the
deceased often provide important data for understanding the selfobject
dimensions of the relationship, dimensions that can be used by the clinician
in helping the patient understand the many aspects of the meaning of the
loss. The therapist's interest in the relationship and his encouragement of
the mourner to relate its history, including the good times and the bad,
enhances the process of reflection and reminiscing while establishing the
clinician as an active participant in the mourning process.

Like many men who have lost partners to AIDS, Mr. B became preoccupied
with his antibody status, convincing himself he was positive, despite
previous testing. This behavior was consistent with the study's findings in
that participants tended to become preoccupied with their antibody status
(regardless of prior test results) during the middle phase of mourning, when
they were beginning to feel more alive and more engaged with the world.
When survivors test negative, one often sees renewed efforts at self-
redefinition as a single person and in engagement with the world; when
they test positive (or already know they are positive), one often sees the
mourning process slow down, if not stop.

Case II: The Seropositive Survivor

One often finds a complicated and protracted mourning process in

seropositive surviving partners. In keeping with the theoretical framework I
propose, the problem becomes the continued shared experience with the
deceased partner that seropositivity represents. These men are infected with
the same virus that killed their partner, the implication being that they will
follow in their partner's footsteps. Even as these men attempt to integrate
the death of their partner from AIDS, they are faced with their own
infection and their own potential death. At this point the mourning process
often slows down, if not stops, and depression and anxiety come to
dominate their experience. Dynamically, one often observes the
combination of a strong continued idealization of the deceased partner and
an “identification”of the survivor's infection with the partner's death.
Though they may be medically stable, these men's experience of self may
nevertheless become organized around impending death. Consequently their
self-esteem is diminshed and their affects are unstable. Although they feel
painfully isolated, these men have considerable trouble feeling engaged
with the world and being part of it.

Mr. T was a 41-year-old white male whose partner of ten years had died
approximately one and a half years earlier. He had known that he was
seropositive a number of years before his partner's death. His chief
complaint upon entering treatment was expressed as follows: “Something is
wrong. I am not excited about anything. I have this new job with great
opportunities. I should be excited, but I am not.” The clinical interview
revealed several other problems: a significant level of depression and
periodic acute anxiety. Although his T-cells were in the 500 range and had
been for several years, Mr. T was convinced he was dying, and his self was
organized around the assumption of impending death. He had developed a
reputation in his seropositive support group as a rebel, actively challenging
the leader's “recipes” for seropositive people to remain that way and not
contract AIDS. He would often angrily point out that even though his lover
had been a vegetarian, had taken massive quantities of vitamins, had not
done drugs, and had gone to the gym daily for many years before he
became ill, he died anyway.

Mr. T's partner had died in San Francisco. After the death Mr. T dispersed
their belongings and moved to Chicago—a city where he had lived
previously and in which several family members resided— to live with his
sister and to take “time to heal.” After several months he took a job that was
well beneath his capabilities to “get back into practice.” After several
months he took the more challenging position that he held when he entered
treatment.

Mr. T reported that both his family and his partner's had been very
supportive and that he felt his need to mourn had been respected and
validated by them. However, in the community he felt like a pariah. Several
old acquaintances had become anxious and then had withdrawn when he
related that his partner had died of AIDS. When Mr. T attempted to go out
and meet new people, he quickly became anxious and gave up his plans,
fearing that he would eventually have to tell people about his partner and
his own seropositive status. This was in sharp contrast to his previous
experience of himself as outgoing and highly social.

In general, Mr. T felt that no one understood or cared to understand, though

he was not quite sure what he wanted people to understand. He felt that
moving to Chicago had been a mistake; he longed for San Francisco, where
he felt being a surviving partner and being seropositive was more readily
accepted as the norm rather than the exception. Perhaps there, he thought,
people would not treat him differently. Though he assumed he was dying
(he knew his lab counts via a research study), he was not being followed by
a physician. He resisted my attempts to get him engaged in a medical
assessment, stating that when the time came for him to have a physician, he
would find one. Though he had developed a number of friends in the
seropositive support organization, he was beginning to alienate them. In
fact, it was at their urging that he came for psychotherapy.

As treatment progressed, Mr. T related more of his personal experience to

me. He continued to carry on elaborate conversations with his deceased
partner, and a strong element of idealization of the partner was evident. He
felt very embarrassed to relate the extent of these conversations, fearing that
he would be labeled as crazy. Severe self-esteem problems were evident: he
felt diminished and unable to function as well as he had previously in job or
social settings. For example, he panicked at the idea of purchasing new
clothes, feeling that everything looked terrible on him; he was profoundly
anxious at the idea of looking in the mirror with salespeople nearby. (This is
especially interesting in that his partner had died of Kaposi's sarcoma and
was horribly disfigured.) It became increasingly clear that Mr. T felt
desperately out of control and that his anxiety over feeling out of control
was as disabling as his clinical symptoms.

After several weekly meetings Mr. T requested and began twice-weekly

sessions. He quickly formed an idealizing transference. Initially, some
erotized elements were evident but not to the extent that they threatened to
disrupt the treatment alliance. The erotized elements quickly diminished
over the next few weeks and were replaced by a more solid idealization of
the therapist.
Very quickly, I pointed out that a great deal of what Mr. T was experiencing
was due to his being a seropositive surviving partner and that at this point in
time after his partner's death he should be getting excited again and
probably would be if he were not carrying the same virus that killed his
partner. Although I validated and attempted to normalize the continued
dialogue or conversations with his partner, I was also interested in what he
talked about with his partner. I encouraged him to relate the story of their
relationship and of his partner's illness and death. Initially, in a very real
way I felt that there were three people in the consulting room: myself, Mr.
T, and his partner.

Mr. T proved to be a vivid dreamer, and his dreams often beautifully and
succinctly summed up the current themes in his treatment. Over the first
two months of our work, he related the following three dreams:

Jim [his partner] and I were on an island in a river. Jim was sick and lying
on a cot. The river was raging, it was storming, there was chaos all around
us. I was worried about keeping him dry and was busy making sure he did
not get wet. Though there was chaos all around us, I felt calm inside.

I was going somewhere on a train. All of sudden I was outside of the train. I
felt fine until I thought that I should hold on to something, since the train
was moving so fast. I panicked when I realized there was only a little rail to
hold on to that I could barely get my fingers around.

I was getting on a plane to go to Florida. I sat down in the cramped and

shabby tourist section. The stewardess approached and said there had been
a mistake, that I was to sit in first-class. She pointed to an escalator that was
going up. I rode up and was in a first-class section that had plush seats and
huge windows. I became anxious and thought, “I do not belong here; I am
going back to tourist were I belong.”

The first dream was understood to summarize the common experience of

men caring for their ill partners: though their world may be falling apart
around them as the partner becomes increasingly ill, the well partner is still
sustained by the relationship. He has an important job to do: caring for his
ill partner. The sense of duty and the sustaining power of the relationship
help the partner to feel grounded and to avoid feeling as vulnerable or
buffeted by chaos as he feels in the wake of a disruption in the relationship
(or as he will feel on the death of his partner). The second dream was
understood as symbolizing the panic that Mr. T came to experience as he
realized the world was still moving on, perhaps even toward his own
illness, and how little grounded he felt, let alone secure that there would be
a relationship that could sustain him the way he sustained his partner. The
third dream was understood as relating to Mr. T's own damaged and
diminished self-esteem, which ultimately was preventing him from
engaging in relationships that could help him feel grounded and secure and,
consequently, was enhancing his feeling of not belonging. (The dreams
could also be understood as reflecting the deepening transference; the
explanations are not mutually exclusive.)

Over the next five months of treatment Mr. T's depression lifted
considerably and his anxiety diminished. The dialogue with his partner
diminished over the first several months of treatment, and he became more
interested in other people. He became increasingly comfortable with
himself and was less abrasive in his support group. He pursued other
interests; took another, more challenging, job; hosted a holiday party (this
was especially significant in that he and his partner were avid entertainers,
and each event was very much an effort in teamwork); and eventually began
a dating relationship.

The continuing idealization of the deceased partner is often a central

component in the complicated mourning process of seropositive partners.
This must be handled appropriately and empathically: otherwise, one risks
traumatizing, if not enraging, the patient. The idealization cannot be
interpreted away; rather, it must be allowed to gradually deflate. One could
argue that the patient is gaining a sense of comfort through the idealization
at a time when the self may not be able to take comfort in other
relationships. As the surviving partner forms a relationship with the
clinician—one that will deepen the more the clinician is able to be
empathically in tune with his experience of mourning—the transference
will deepen and solidify. As this happens, one will also observe that the
idealization of the deceased partner gradually wanes.
As in this case, erotized elements may emerge in the transference. If this is
not distressing to the patient and does not threaten to disrupt the treatment,
no interpretation is in order; the erotized elements will also wane as the
transference deepens. If the patient is showing signs of distress, then a
discussion that points out that the erotization is a sign of his feeling
understood, comfortable, and excited about the possibility that perhaps he is
capable of forming new attachments may be called for.

Another aspect of work with these men involves the therapist pointing out
to them the distorting influence of seropositivity. While this may potentially
be an intellectual intrusion into the dialogue between the patient and the
therapist, it offers an important structure with which to help the patient
organize his experience. The patient is already feeling depressed, anxious,
isolated, and, perhaps most painful of all, weird and different, apart from
the rest of the world. The patient often explains his ongoing experience to
himself in these terms. Offering the patient the explanation that part of what
he is experiencing is due not to his personal pathology but to the distorting
effects of something beyond his control helps him organize the experience
as something considerably more benign, cuts into the negative experience
of self that often comes to dominate the self organization, and offers him
the opportunity to relate his fears, connected to the loss of his partner, about
his own health and life.

Pointing out the distorting effects of seropositivity also provides the

opportunity for the patient to experience with the clinician any angry affect
surrounding his experience. Several men expressed considerable anger
(once given permission to do so) as they related their feeling of being
cheated, of being in a situation that is “unfair.” I tend to respond that, yes,
they have been cheated, AIDS has taken a great deal away from them, and
they have every right to be angry over their situation. This can be especially
helpful in that often these seropositive men adopt a “walking on eggshells”
approach, fearing that the experience of any angry affect (save perhaps a
projected anger toward institutions or unhelpful individuals) may disrupt
their equilibrium and bring their world crashing down; essentially, they fear
that they will become ill.
Mr. T's selfobject environment was very supportive and responded to his
status as a mourner, recognizing his need to gradually regroup and helping
him make a new start. However, these responses were primarily to the more
readily understandable and recognizable human experience of loss. Unless
we know about the complicating and distorting effects of seropositivity on
the mourning process we cannot adequately respond to these individuals.
My experience is that they are at once surprised and highly relieved when
this complicating aspect of their attempt to mourn is addressed.

SUMMARY

This chapter is a cursory overview of a very complicated yet crucial aspect

of the human experience in general and the AIDS crisis in particular.
Though discussed in the context of men whose losses occurred in the
context of gay relationships and the current epidemic, the beginning
reformulation of mourning theory and the process of mourning is applicable
to the general population. Clearly, mourning involves more than the
mourner and the deceased: the selfobject matrix plays a crucial role in
modulating the mourner's affect, subsequently assisting in the formation of
the narrative and its integration into the overall structure of the self. The
empathic responses of the selfobject environment also serve to orient the
mourner back to the world of the living. The mourner's capacity to tolerate
the affective dimension of mourning and the environmental response to the
mourner's affect and situation in general are factors that may impede or
facilitate the process. Another implication of this perspective is that the
clinician is more than a facilitator of the mourning process; we are, instead,
integral participants.

REFERENCES

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Freud, S. (1912–1913), Totem and taboo. Standard Edition, 13:1–164.

London: Hogarth Press, 1957.

———(1917), Mourning and melancholia. Standard Edition, 14:243–258.

London: Hogarth Press, 1957.
Friedman, R. (1988), Male Homosexuality: A Contemporary Analytic
Perspective. New Haven, CT: Yale University Press.

Glaser, B. (1975), Theoretical Sensitivity. Mill Valley, CA: The Free Press.

———& Strauss, A. (1967), The Discovery of Grounded Theory. Chicago:

Aldine.

Goldberg, A. (1990), The Prisonhouse of Psychoanalysis. Hillsdale, NJ:

The Analytic Press.

Isay, R. (1989), Being Homosexual. New York: Farrar, Straus & Giroux.

Kohut, H. (1977), The Restoration of the Self. New York: International

Universities Press.

Krystal, H. (1990), An information processing view of object-relations.

Psychoanal Inq., 10:221–251.

Lewes, K. (1988), The Psychoanalytic Theory of Male Homosexuality. New

York: Simon & Schuster.

Maylon, A. K. (1982), Psychotherapeutic implications of internalized

homophobia in gay men. In: Homosexuality and Psychotherapy, ed. J.
Gonsiorek. New York: Haworth Press, pp. 59–70.

Palombo, J. (1981), Parent loss and childhood bereavement. Clinical Social

Work Journal, 9 (l):3–33.

———(1982), The psychology of the self and the termination of treatment.

Clinical Social Work Journal, 10 (l):46–62.

———(1991), Bridging the chasm between developmental theory and

clinical theory: Part II. The bridge. The Annual of Psychoanalysis, 19:152–
194. Hillsdale, NJ: The Analytic Press.

Pollock, G. (1961), Mourning and adaptation. Internat. J. Psycho–Anal,

42:341–361.
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Shane, M. & Shane, E. (1990), Object loss and selfobject loss: A

consideration of self psychology's contribution to understanding mourning
and the failure to mourn. The Annual of Psychoanalysis, 18:115–131.
Hillsdale, NJ: The Analytic Press.

Shelby, R. D. (1989), Internalized homophobia as narcissistic injury.

Unpublished paper.

———(1992), If a Partner Has AIDS. Binghamton, NY: Haworth Press.

Socarides, D. & Stolorow, R. (1984/1985), Affects and selfobjects. The

Annual of Psychoanalysis, 12, 13:105–120. New York: International
Universities Press.

Stern, D. (1985), The Interpersonal World of the Infant. New York: Basic
Books.

Stolorow, R, Brandchaft, B. & Atwood, G. (1987), Psychoanalytic

Treatment: An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.
Chapter The Search for the Hidden Self: A Fresh Look at Alter Ego
15 Transferences

When asked “What is a friend?” Zeno, the Greek philosopher (ca 362-ca
Doris Brothers
264 B.C.), is reported to have given the somewhat cryptic reply “Another I”
(or, in Latin, alter ego). Just what did Zeno mean? Did he consider a friend
to be a duplicate, a twin, of oneself? Or, as I prefer to believe, did he mean a
friend is an alternate or somewhat different version of oneself? I find
support for my understanding in The American Heritage Dictionary's
(1980) definition of alter ego as, first, “another side of oneself, a second
self” and, second, as “an intimate friend, a constant companion.” The word
twin, on the other hand, is defined as “one of two identical or similar
persons, animals, or things.” Clearly, the two words are not synonymous.

Heinz Kohut (1971, 1977, 1984) used the words twin and alter ego
interchangeably; at times, he used one word to amplify the meaning of the
other. For example, he often put the word alter ego in parentheses when
referring to twinship transferences, one of his major clinical discoveries. He
explained in a personal communication to Detrick, “The relationship to a
twin is that of an alterego” (Detrick, 1986, p. 300).

Detrick (1985, 1986), however, proposed a “sharp distinction” between

alter ego and twinship phenomena, urging that the term twinship he
reserved for “an experience of sameness or likeness [that] serves the central
function of the acquisition of skills and tools” and the term alter ego be
used for “experiences of sameness or likeness that anchor the individual in
a group process” (Detrick, 1986, p. 300).

This chapter represents a fresh attempt to separate the two concepts. It is

my contention that although Kohut often used the two terms as if they were
synonymous, his clinical illustrations reveal two very different kinds of
selfobject experiences. One of these selfobject experiences corresponds to
the aforementioned definition of twin while the other corresponds more
closely to the definition of alter ego as another aspect of oneself—or, more
specifically, as an aspect of oneself that has been disavowed. What is more,
with the blurring of the differences in meaning of these two phenomena, a
valuable category of selfobject experience has been overlooked.

I am in complete agreement with Detrick that twinship phenomena are well

defined as “the need to experience the presence of essential alikeness”
(Kohut, 1984, p. 194). Kohut (1984) poignantly illustrated this sort of
twinship transference in his clinical vignette of the woman who on being
apprised of Kohut's plan for a summer vacation reported a childhood
fantasy of “the genie in the bottle.” The genie, as the patient reluctantly
confessed to Kohut, was “a little girl, a twin, “someone who was, Kohut
pointed out, “just like herself and yet not herself” (p. 195). Kohut came to
realize that the announcement of his planned vacation had disrupted a
sustaining selfobject connection based on the woman's experience of him as
essentially like herself.

I have more difficulty with Detrick's assertion that the need to experience
sameness or likeness as a means of anchoring the individual in a group
process warrants the designation of an alter ego phenomenon. As I see it,
this is simply a variant of twinship experience. Instead, I propose that alter
ego phenomena within the treatment situation be reconceptualized as the
need to experience the presence of essential sameness or alikeness with
disavowed or hidden aspects of self.

MR. C'S ALTER EGO TRANSFERENCE

The case of Mr. C, summarized by Kohut (1971) in The Analysis of the Self,
powerfully illustrates an alter ego transference in which the analyst was
perceived as embodying disavowed aspects of the patient's self-experience.
The patient, a moderately successful professional in his mid-forties,
consulted Kohut after numerous attempts at treatment had failed to cure a
mild case of premature ejaculation and a lack of emotional involvement
during intercourse. Mr. C also complained of a variety of vague symptoms
that often attend disorders of self-experience, including “a pervasive feeling
that he was not fully alive ... and a brooding worrisomeness about his
physical and mental functions.” Kohut described Mr. C's treatment as
follows:
Concerning each new theme in the patient's analysis, his associations would
regularly, and for prolonged periods, refer at first not to himself but to the
analyst: yet this working-through phase, which manifestly dealt with the
analyst, always produced significant psychological changes in the patient.
... Even in the later phases of his analysis when he already anticipated that
he would end up talking about his own psyche, he continued to proceed in
the characteristic sequence: he would first, and for prolonged periods, see in
me the (usually anxiety provoking) affect, wish, ambition, or fantasy with
which he was dealing, and even then it was only after he had worked
through the currently activated complex in this way would turn to it with
reference to himself [p. 194; italics added].

Thus, despite the coexistence of contradictory evidence about Kohut, Mr. C

for a time maintained a perception of Kohut as “a person devoid of
ambitions, as emotionally shallow, pathologically even-tempered,
withdrawn and inactive” (p. 194). Only after a prolonged working-through
process involving his perception of Kohut's personality as being “torn by
conflict,” which was followed by some external events signifying that he
had made progress in areas corresponding to the disavowed aspects of
himself, did Mr. C gradually experience the conflict fully in himself. At this
point his experience of Kohut was no longer clouded by his perceptions of
himself. Kohut notes that the conflicts with which Mr. C struggled were
usually connected with “poignantly remembered childhood events and
childhood emotions” (p. 195).

ALTER EGO TRANSFERENCES, PROJECTION, AND

PROJECTIVE IDENTIFICATION

Kohut observed that if during periods in which Mr. C attributed to him

disavowed aspects of himself he would state or imply that Mr. C was
“projecting,” Mr. C would withdraw emotionally and complain that he had
been misunderstood. Although Kohut does not explain the reasons for Mr.
C's rejection of these interpretations, they are well worth considering. There
are many confusing similarities between projection, projective
identification—a concept that, as Sandler (1987) points out, is not always
fully differentiated from projection-and alter ego transferences. A brief
comparison of these concepts may prove helpful.
According to Anna Freud (1966), in projection “ideational representatives
of dangerous instinctual impulses [are] displaced into the outside world” as
a means of protecting oneself against various kinds of anxiety (p. 122).
Kernberg (1987) sees projection as having four components: “(a) repression
of an unacceptable intrapsychic experience, (b) projection of that
experience onto an object, (c) lack of empathy with what is projected, and
(d) distancing or estrangement from the object as an effective completion of
the defensive effort” (p. 94).

According to these definitions, Mr. C was not using projection as a defense.

That is, he was not attempting to distance himself from an object onto
whom he had projected an unacceptable intrapsychic experience. Rather,
Mr. C appears to have been striving to connect with previously disavowed
aspects of himself that he experienced as belonging to another person. His
selfobject fantasy of himself in relation to Kohut as an alter ego who
embodied hidden parts of himself enabled Mr. C to experience a sense of
self-cohesion that previously had been unattainable. Moreover, the working
through of this transference fantasy led to the integration of these
disavowed aspects of himself. If projection is understood as a need to rid
oneself of unacceptable impulses, wishes, and emotions, alter ego
transferences signify a longing for closeness with someone functioning as a
selfobject who embodies these hidden aspects of the self. Such closeness
provides an experience of self-cohesion otherwise impossible to achieve.

As Kernberg (1987) observes, the term projective identification, first

introduced by Melanie Klein, has been used to mean too many different
things by too many different people under too many differing
circumstances” (p. 93) (see also Sandler, 1987). Kernberg distinguishes
projective identification from projection in the following ways: Projection
is used primarily by patients with neurotic personality organizations
whereas projective identification is used by patients with borderline and
psychotic personality organization; projection involves repression whereas
projective identification depends on splitting or “primitive dissociation”;
unlike projection, projective identification involves the maintenance of
empathy with what is projected and, most importantly, “Induction in the
object of a corresponding intrapsychic experience.” Sandler (1987) points
out that the notion that the object is induced to have a corresponding
intrapsychic experience is a relatively recent elaboration of the concept.

My understanding of the clinical examples of projective identification

presented by Kernberg (1987) is that what most distinguishes projective
identification from alter ego transferences are differences in the way these
transference manifestations are regarded, differences that are largely
determined by countertransference reactions stemming from the therapist's
theoretical biases. Consider Kernberg's (1987) clinical example of a female
patient whom he diagnosed as having “a narcissistic personality disorder
with overt borderline functioning” (p. 104). After an inpatient
hospitalization for “severe suicidal tendencies” at the institution where
Kernberg serves as director, the woman beseeched him to treat her
privately. Soon after beginning treatment with Kernberg, however, the
patient expressed doubts about continuing. In a condescending manner she
put down Kernberg's provincial way of dressing and his lack of the “quiet
yet firm sense of self-assurance” that she admired in men. She also made
derogatory remarks about the small town in which he lived and had his
office.

Kernberg reports having a severe reaction to his patient's criticisms, which

included experiencing “a sense of futility and dejection,” believing he was
having “difficulties in thinking precisely and deeply,” and feeling
“physically awkward.” After becoming aware that he and the town in which
he lived represented the patient's devalued self-image projected onto him,
Kernberg interpreted this to the patient:

I now said that her image of me as intellectually slow, awkward, and

unnattractive, “stuck” in an ugly town, was the image of herself when she
felt criticized and attacked by her mother . . . and that her attitude toward
me had the quiet superiority, the surface friendliness, and yet subtle
devaluation that she experienced so painfully as coming from her mother
[p. 107]

Although, according to Kernberg, the woman said she felt better after this
interpretation, he notes that “she now reverted to a dependent relationship
with me, practically without transition, while projecting the haughty,
derogatory aspects of herself as identified with her mother” onto a man she
was dating. It would seem that the patient quickly abandoned her efforts to
establish an alter ego transference with Kernberg but may have tried to
experience her male friend as an alter ego embodying the aspects of herself
she needed to disavow in order to establish a relationship with Kernberg.

What shall we make of Kernberg's countertransference reactions, which he

refers to as a “complementary identification?” In the face of the patient's
devaluing statements about him, Kernberg appears to have experienced a
severe loss of trust in himself as a skillful therapist and as an attractive man.
From the perspective of self psychology, we might conjecture that the
patient failed to live up to her promise as a mirroring selfobject. When
Kernberg realized that she had attributed to him qualities she disavowed in
herself, he assumed that the patient had unconsciously induced in him what
she had found unacceptable in herself. In other words, Kernberg blamed the
patient for causing him to believe that her criticisms of him were warranted.
Thus, the notion that the analyst is induced by the patient to experience
projected intrapsychic experiences appears to be a way of understanding
strong countertransference reactions resulting from the analyst's
disappointment in the patient as a selfobject.

In keeping with his theoretical inclination to view this as an example of

projective identification and given his belief that “Interpretation of
projection identification in borderline conditions temporarily increases
reality testing and ego strength” (1987, p. 96), Kernberg interpreted the
transference to the patient. Unfortunately, in so doing he derailed her efforts
to experience him as an alter ego selfobject. I therefore propose that what is
commonly referred to as projective identification, and thought to be a
“primitive defense” common among psychotic and borderline patients, may
often represent efforts by patients to establish alter ego transferences.

DISSOCIATION, TRAUMA, AND THE SEARCH FOR THE

HIDDEN SELF

Alter ego transferences are likely to occur among patients who disavow
aspects of themselves. Who are these patients? Basch (1981, 1983) argues
that disavowal entails dissociative splits in vital realms of self-experience,
splits that arise in the context of narcissistic trauma. This conceptualization
is congruent with the “shattered fantasy” theory of trauma (Ulman and
Brothers, 1988), in which trauma is viewed as a dissociative phenomenon
resulting from the shattering and faulty restoration of fantasies of self in
relation to selfobject that organize self-experience.

Mr. C does appear to have suffered numerous developmental traumas

involving his “narcissistically enmeshing mother” (1971) (p. 249), whom
Kohut described as “a latent schizophrenic” (p. 257). For example, it seems
likely that Mr. C was traumatized by his mother's abrupt withdrawal from
him at the age of six when she was pregnant with his brother. During this
period, according to Kohut, Mr. C developed fantasies concerning an
imaginary playmate. In the clinical and child development literature,
imaginary playmates have been described in ways that suggest that they
function both as fantasized twins and fantasized alter egos (see, for
example, Manosevitz, Prentice, and Wilson, 1973; Harvey, 1975; Fraiberg,
1987). At times they seem to provide companionship for the lonely child
and at other times they seem to carry out in fantasy all the naughty, rude, or
otherwise unacceptable behaviors the child wishes to display but must
repudiate for fear of alienating parental selfobjects.

It may well be that as a child Mr. C availed himself of both imaginary

playmate functions. Kohut conjectures that Mr. C envisioned his still-
unborn brother as a twin who would be a companion. His imaginary
playmate, on the other hand, may well have functioned as an alter ego
embodying disavowed aspects of himself, an early version of his
transference to Kohut.

Mr. C's need for Kohut as an alter ego selfobject appears to derive primarily
from his having disavowed archaic grandiose fantasies; these were “bizarre
fantasies of greatness and power in which he had indulged for prolonged
periods and [which were accompanied by] the apprehension that he might
not be able to return from them to the world of reality” (Kohut, 1971, pp.
195–196). It seems likely that after having encouraged his grandiose
illusions, Mr. C's mother traumatically betrayed his trust in her as a
mirroring selfobject by suddenly abandoning him psychologically at the
time of her pregnancy. Deprived of the empathic responsiveness that would
have promoted the gradual transformation of his grandiose fantasies into
more mature forms, Mr. C appears to have dissociatively split off his
passionate claims to greatness for fear of succumbing to psychosis. Having
initially located his struggles to integrate disavowed aspects of himself in
Kohut, Mr. C was able, after the alter ego transference had been worked
through, to attain a sense of cohesive selfhood.

Another excellent example of the longing for alter ego selfobjects is to be

found in Anna Freud's (1966, pp. 123–128) clinical vignette of the analysis
of a young governess. The patient reported her childhood preoccupation
with two longings: to have beautiful clothes and to have a number of
children. Shabbily dressed, unmarried, and childless when she entered
treatment, the woman was enormously interested in the love life, the
clothing, and the children of other women. Having disavowed her own
ambitions and wishes for admiration, she apparently sought the company of
vain women and chose a career as a caretaker of their children in order to
achieve a measure of closeness with alter ego selfobjects who embodied
these disavowed aspects of herself.

Anna Freud explains the woman's situation as reflective of a “renunciation

of instinct” and the subsequent formation of “an exceptionally severe
superego” that stopped her from seeking gratification of her own wishes.
According to Freud, the case illustrates the defense of “altruistic surrender,”
a “normal” use of projection by means of which people “form valuable
positive attachments and consolidate relations with one another.” If we
attempt to translate Freud's explanation into terms more congruent with
self-psychological thinking, we might hypothesize that the governess, like
Mr. C, could not trust childhood caretakers to function as mirroring self-
objects and therefore disavowed her untransformed grandiose fantasies. Her
connection to women who possessed all that she disavowed in herself
appears to have offered her the opportunity to temporarily experience a
sense of cohesive selfhood.

In what follows I present a portion of my self-psychological treatment of a

young woman who had been severely traumatized by physical abuse and
neglect in childhood in the hope that it will further illuminate the nature of
alter ego transferences and their restorative role in cases of psychic trauma.
THE CASE OF LENA

“I can't stand the way you always agree with me. You remind me of those
wimpy shrinks in the movies. A therapist should have more guts.” Although
her treatment had begun only a few weeks earlier, Lena, a 30-year-old
nurse, seemed to have no qualms about bombarding me with criticism. Her
verbal attacks were usually aimed at two sets of flaws she perceived in my
personality; one set included my weakness, passivity, and cowardice while
the other included my “chutzpah,” exploitiveness, and self-indulgence. For
example, after I once failed to accommodate her request for a change of
appointment, she sneered, “You get everything your way, don't you? You're
so damned sure it's coming to you.”

One might imagine that being the target of Lena's relentless verbal assaults
would have been hard to bear. Surprisingly, however, I was rarely wounded
by her vituperations. On the contrary, I actually looked forward to sessions
with her. Perhaps it was the childlike delight she appeared to take in finding
fault with me or the warmth of her smile as she entered my office or her
reluctance to leave at the end of sessions that informed me of her growing
sense of pleasure in our relationship. Moreover, her criticisms rarely
addressed the failings I find most regrettable in myself.

After a while I realized that Lena experienced herself as possessing

qualities that were the diametric opposites of the qualities she found so
deplorable in me. She presented herself as strong, tough, and able to stand
up to the arrogant doctors with whom she worked; at the same time, she
considered herself highly principled, devoutly religious, and selflessly
devoted to the care of others.

Curiously, despite her protestations that she was a woman to reckon with,
Lena looked like a little girl. Slim and petite, she used no makeup. Her long
straight hair was either tied in pigtails or held down Alice-style with a
velvet band. With her “uniform” of jeans and sweatshirts, her speech
peppered with the latest slang, and the careless, uninhibited way she moved,
I frequently had to remind myself that I was in the presence of a grown
woman.
Lena's enthusiastic, almost gleeful haranguing of me during sessions
contrasted with the darker, more depressed tone of her complaints about her
mother. Although her father had subjected her to brutal beatings from the
time she entered puberty at around 11 to the time he died, when she was 18,
Lena rarely mentioned his faults. Instead, she enumerated her mother's
failings in great detail, portraying her as frail, nervous, and remarkably ill-
suited to the demands of motherhood, a woman so inordinately preoccupied
with herself she had little time for a daughter. As Lena put it, “She is always
on her mind.”

I subsequently learned that Lena's paternal grandmother had been the

principal caretaker in her early life. Lena believed her mother had always
hated her mother-in-law and had deeply resented her husband's attachment
to her. Nonetheless, the grandmother appears to have been tolerated as a
member of the household as long as she was useful in freeing Lena's mother
from the drudgery of child care. Lena described her grandmother as gentle
and caring but overindulgent toward her only son. Lena recalled her deep
sense of loss at the age of ten when bitter fights between her mother and
grandmother led her father to establish his mother in an apartment in a
distant city where one of her daughters lived.

It was only after his mother moved away that Lena's father began his
vicious beatings. Lena suspects that his rage was, in part, triggered by his
resentment at his wife for forcing his separation from his mother. Only his
mother and Lena herself as a young child were spared from the abusiveness
with which her father apparently treated everyone else in his life. Lena
recalls having been well aware that he was considered a tyrant by his
employees and a “willful hothead” by other family members.

Despite her avowed contempt for her mother, Lena still lived at home. She
explained that she had decided not to move out on her own after her father's
death: “My mother could never manage without me. She's so inept, it's a
wonder she can tie her own shoes.” Lena seemed to have virtually no social
life of her own but spent a great deal of time chauffeuring her mother on
frequent shopping excursions, accompanying her to various doctor's
appointments, and going out with her for dinner and the theater.
For all her criticisms of me, Lena never once expressed any doubt about my
ability to help her. However, after six months of sessions that seemed
repetitive almost to the point of ritual, I worried that the treatment was
stalemated. My failure to understand the strange nature of the transference
troubled me. Then, one day in her eighth month of treatment Lena entered
my office looking uncharacteristically depressed. She began to describe a
movie she had seen the night before in which a little girl had been beaten by
her drunken father. As she spoke, tears streamed down her cheeks. Without
changing her expression or pausing to wipe her eyes, Lena struggled to
continue her account of the movie until, at last, she broke into sobs. With
her face contorted by rage and pain, she screamed, “I'm not crying for
myself, I'm crying for the little girl in the movie.”

“Lena,” I asked quietly, “Would it be so bad to cry for yourself?”

“It would be disgusting!” she cried. “It would make me sick. I would be just
like my mother. She never stops moaning and groaning. She even used to
cry for herself when my father beat me.”

Asked to elaborate, Lena recalled the first time her father had hit her:

I had just tried on a new dress that I loved because it made me look so
grown-up—like a real teenager. I pranced over to my father to ask if I could
show my dress to a friend. Instead of beaming at me as I expected, his face
got all red and angry. Suddenly, he slapped me hard and he said. “Stop
showing off.” Then he stormed out of the house. I was stunned and began to
cry. My mother, who had been standing nearby, screamed at me and broke
into tears. “Look what you've done,” she said, “You drove Daddy away.
Now what am I going to do?” I ended up comforting her.

In the next few sessions Lena recounted many similar incidents in which
she had assumed a caretaking role vis-à-vis her mother at times when she
herself was at her neediest, that is, when her connection to her beloved
father was being threatened by his abusiveness. I understood Lena's
experience of his violence toward her as betrayals of her trust in him as a
mirroring and idealized selfobject (Brothers, 1989, 1990a, 1990b, 1992),
traumas that shattered the unconscious fantasies organizing her self-
experience (Ulman and Brothers, 1988).
Overwhelmed with disintegration anxiety at the rupture of these vitally
needed selfobject connections to her father and grandmother, Lena had
turned in desperation to her mother. It appears that her strongest hope of
establishing a trustworthy bond with her mother involved repudiating her
own neediness and offering herself as a caretaker. “I guess you could say
that my mother and I switched roles,” Lena said. “I'm a lot better at taking
care of her needs than she is at taking care of mine.” Consequently, Lena's
self-experience became increasingly organized by selfobject fantasies in
which she was the provider of selfobject functions for others (e.g., her
mother and her patients), rather than the recipient, a situation common
among abused children (see Brothers, 1989, 1990a, 1990b).

From a reconstruction of the trauma-filled years of Lena's childhood it

became apparent that an important way in which Lena took care of her
mother was by “staying a little girl for her.” Lena believed that she had been
conceived to keep her parents’ marriage alive. “I don't think my father liked
my mother very much,” she confided. “He stayed home with her because he
was crazy about me.” After a long pause she added, “Until I started to grow
up. Then he stayed out more and more. Whenever he spent time in the
house, I ended up getting beaten.”

I now realized that the flaws Lena decried in my personality represented

aspects of herself that she had disavowed as a means of maintaining a bond
with her mother. For example, what she took for my weakness, cowardice,
and passivity reflected her own disavowed neediness and fearfulness. What
she saw as my temerity, self-indulgence, and willingness to exploit others
reflected her own sense of entitlement, her ambitions, and her wishes for
gratification. Only by presenting herself as a strong, fearless, giving
caretaker who would not make demands of her own could she hope to
maintain a relationship with her mother. Her predominant transference
fantasy apparently involved a merger with me as an alter ego selfobject in
the presence of whom she was enabled to achieve a sense of connection
with hidden aspects of her own self. The more she condemned me for
possessing these “flaws,” the more she seemed to attain an experience of
herself as whole.
Although Lena often bragged about her altruistic devotion to others, she
appeared to have unconsciously elaborated numerous sadistic fantasies. In
many recurrent dreams and some intrusive waking fantasies she saw herself
as inflicting humiliating and painful torture on those entrusted to her care.
Her sadistic fantasies were often manifested in her interactions with her
mother. For example, in the guise of describing her own helpfulness Lena
would publicly reveal her mother's foibles; she once told a roomful of her
mother's guests that she had really cooked the food her mother had taken
credit for preparing.

Lena's sadistic fantasies and enactments may be understood as further

efforts at self-restoration following her shattering traumas. As the abuser
(like her father), instead of the abused, Lena may well have attempted to
regain an experience of herself as powerful and effective and may have
temporarily restored archaic selfobject fantasies of idealized merger with
her father. It is likely that in addition to experiencing me as an alter ego
selfobject, Lena may have used her critical attacks on me to serve similar
functions.

After some months of sessions filled with Lena's detailed descriptions of

traumatic scenes from her childhood, the character of the treatment slowly
began to change. Increasingly, as Lena related incident after incident in
which her parents had profoundly disappointed her need for them as
selfobjects, she gave greater expression to her pain and anger. At times she
wept unashamedly over her deep sense of loss for the father of her early
childhood, the father who had seemed to cherish and enjoy her as she was.
At other times she raged at his abusiveness.

Encouraged by Lena's growing freedom to express a fuller range of

feelings, I responded to her with many statements I hoped would convey
my empathic understanding. Whereas in sessions at the beginning of
treatment similar statements of mine had elicited a barrage of criticism,
Lena now seemed comforted and appreciative of them. With her growing
trust that I would respond to her affective expression with affirmation and
acceptance instead of the exasperation and withdrawal she had come to
expect from her self-absorbed mother, Lena increasingly acknowledged her
sense of deprivation and her conviction that she deserved more (“I have a
right to get what I need in life”). Moreover, she spoke freely about her
terror of “losing all sense of who [she was]” and admitted experiencing
deeply dissociated states in which “the edges of reality get blurred.” Her
criticisms of me decreased as she began to integrate these heretofore
disavowed aspects of herself. Her need to experience me as an alter ego
selfobject was diminishing.

Nevertheless, the therapeutic relationship remained turbulent for many

months. The following incident is representative of this period in treatment,
which was dominated by the working through of Lena's alter ego
transference. An unexpectedly lengthy phone conversation in my break
between patients caused me to be a few minutes late in inviting Lena into
my office for her session. Flushed and tense, Lena seemed to be fighting
back tears as she entered my office. “How can your patients put up with
your lack of professionalism?” she asked contemptuously. “You don't even
start your sessions on time.” After apologizing for starting late, I observed
that Lena seemed very upset with me and asked what my failure to begin
promptly had meant to her. Instead of answering, Lena berated me for being
selfish and inconsiderate. She then described a recent episode that vividly
illustrated her mother's selfishness and inconsiderateness. Obviously feeling
miserable, Lena fell into a stony silence that lasted until the session was
over. I doubted that my lateness was sufficient cause for her intense reaction
and tried, without success, to reconstruct our previous session in the hope of
finding the meaning of the disruption between us.

In her next session Lena reported the following dream:

I am in a subway train on my way to see you. A man who is sitting opposite

me unexpectedly stands up, walks up to me, and smacks my face. I get off
the train and run to your office. When I come in, I start to cry. You greet me
as usual. Suddenly you grab my shoulders and shake me. Then you say in a
hard voice, “Stop being a baby!” Another patient comes in and you tell me
that you have to give her my time.

Responding to my questions about the dream, Lena mentioned that she had
arrived early for her previous session and had watched me say good-bye to
the female patient I see before her. This stylishly dressed, middle-aged
woman had struck Lena as “someone who really doesn't need therapy.”
Somewhat hesitantly she noted, “You seemed sad to see her go.”

“And then I kept you waiting,” I said. “You must have wondered if I were
pleased to see you or if I wished to have another session with that woman.”

“I guess so,” Lena responded. “She looks so mature and self-sufficient. It's
probably like a tea party in here when she comes.”

I now surmised that Lena had interpreted my keeping her waiting after a
session with this seemingly self-suifficient woman as confirmation of her
fears about me, namely, that I, like her mother, could not be trusted to
accept her needs, demands, and fears. I would be happier with her, Lena
apparently concluded, if only she were more self-sufficient. Moreover, I
could hardly be depended on to comfort her after a humiliating blow (my
keeping her waiting). In that moment I had seemed the very personification
of her mother, whose own neediness prevented her from comforting Lena
following her father's brutal assaults. With all hope that I might serve her
mirroring and idealizing needs dashed and faced once again with the terror
of disintegration, Lena had attempted to reinstitute a much-needed
selfobject connection to me as an alter ego with her barrage of criticisms.

Lena accepted my interpretation that my actions before our previous session

had understandably alarmed her, that she felt I was really no more accepting
of her neediness than her mother and no more capable of soothing her
distress. As was true following many similar episodes during this period,
Lena's criticisms of me then abated. At the present, time, in the fourth year
of treatment, Lena no longer appears to experience me as an alter ego self
object. Her predominant transference fantasies now involve her experience
of me as a mirroring selfobject who admires and appreciates her with all her
needs and fears and as an idealized maternal selfobject in whose presence
she feels soothed and protected. She becomes critical of me mainly when
she experiences me as failing to provide these essential functions. For
example, on my return from a recent vacation she chided me for having
neglected her. “And I had begun to think you were someone I could depend
on,” she huffed.
Although Lena still struggles over the prospect of leaving her mother, she
has begun to spend time with people her own age. She also dresses more
age-appropriately and has cut her hair in a “grown-up” style, further
indications that she is integrating those aspects of herself that had been
disavowed.

LENA AND MR. C

There are several points of difference between the transferences of Lena

and Mr. C. First, Mr. C initially attributed to Kohut qualities in himself that
hid those he had disavowed (e.g., experiencing himself and Kohut as devoid
of ambition masked his untransformed grandiosity). In contrast, the
qualities Lena criticized in me directly corresponded to those she
disavowed in herself (e.g., her neediness, fearfulness, and sense of
entitlement). Second, the working through of Mr. C's alter ego transference
initially involved his locating the conflict over the integration of disavowed
aspects of himself within Kohut, whereas Lena did not experience me as
conflicted. In fact, it was only after finding it possible to express within the
transference aspects of herself that she had previously disavowed that Lena
appeared to become aware of her conflicts. And, third, unlike Mr. C, Lena
did not continue to find new qualities in me to criticize after one set of her
own disavowed attributes had been worked through.

Nevertheless, the function of the alter ego transferences in both cases

appears to have been very similar. Both Mr. C and Lena suffered traumatic
disappointments in parental selfobjects that shattered the fantasies of self in
relation to selfobject organizing their self-experience. Evidence of these
shattering traumas is to be found in their bizarre and sadistic fantasies,
which may be understood in several ways: (1) as disintegration products of
their fragmenting selves, (2) as expressions of the archaic (untransformed)
nature of these fantasies, and (3) as faulty efforts at (defensive) self-
restoration.

Moreover, in response to the shattering of their selfobject fantasies both Mr.

C and Lena disavowed aspects of themselves. Both apparently sought the
presence of the therapist as a means of experiencing, through transference
fantasies of alter ego merger, a sense of being reconnected with these
hidden parts of themselves. Having been split off and disavowed, these
aspects of self were unable to undergo further transformation. In the context
of alter ego transferences transformation is resumed.

Lena's disavowal of her sense of entitlement and her “altruistic devotion” to

her mother and her patients resemble the efforts undertaken by Anna
Freud's governess. In other words, like the governess who craved closeness
with vain women, Lena sought to experience her mother as an alter ego
selfobject in relation to whom she could obtain vicarious satisfaction of her
own needs. However, this effort was doomed to failure insofar as her
relationship to her mother foreclosed the possibility of reintegrating and
transforming split-off realms of herself.

Like Kohut, I never directly interpreted the patient's alter ego transference; I
did not tell Lena she criticized qualities in me that she disavowed in herself.
Had I done so, I would have interfered with her fantasy of me as an alter
ego, a fantasy she relied upon as a means of stemming the tide of self-
fragmentation. Instead, I would interpret my selfobject failures as they
threatened her with transference repetitions of traumatic betrayals in her
early life.

SUMMARY AND CONCLUSIONS

In keeping with the definition of alter ego as “another side of oneself, a

second self,” I have proposed a new understanding of alter ego
transferences. These transferences reflect a patient's need for the presence
of another person who functions as a selfobject in whom disavowed or
hidden aspects of self-experience are found. With the activation of an alter
ego transference fantasy an experience of self-cohesion is attained. Kohut's
case of Mr. C, Anna Freud's case of the “altruistic” governess, and my case
of Lena were used as illustrations.

It is my contention that alter ego transferences are most likely to arise

among trauma survivors who attempt to restore shattered selfobject
fantasies by means of disavowal and dissociation. It is the therapist's
trustworthy demonstration of empathic responsiveness to the affects,
wishes, and needs that were disavowed, in contrast to the dreaded response
typical of the traumatically disappointing selfobjects in the patient's life,
that sets the stage for the establishment and working through of these
transferences.

Twinship and alter ego transferences are similar in that both reflect the
patient's need to experience another person as like himself or herself.
However, each serves strikingly different functions. While twinship
transferences provide reassuring “confirmation of the feeling that one is a
human being among other human beings” (Kohut, 1984, p. 200), thereby
enabling patients to maintain a sense of cohesive selfhood, alter ego
transferences offer opportunities for patients to restore a sense of cohesive
selfhood following shattering traumas.

REFERENCES

The American Heritage Dictionary of the English Language, 1980, New

College Edition, s.v. “alter ego.”

Basch, M. F. (1981), Psychoanalytic interpretation and cognitive

transformation. Internat.J. Psycho-Anal., 62:151–175.

_____(1983), The perception of reality and the disavowal of meaning. The

Annual of Psychoanalysis, 11:125–153. New York: International
Universities Press.

Brothers, D. (1989), Treating trust pathology in trauma survivors: A self-

psychological approach. Presented at the Twelfth Annual Conference on the
Psychology of the Self, San Francisco, October 14.

_____(1990a), The trustworthy selfobject: Psychological giving and the

therapeutic relationship. Presented at the annual Conference of The
Training and Research Institute for Self Psychology/The Society for the
Advancement of Self Psychology, New York City, May 5.

_____(1990b), The recollection of incest as a consequence of working

through trust disturbances in the transference. Presented at the Sixth Annual
Meeting of the Society for Traumatic Stress Studies, San Francisco,
October 31.
_____(1992), Trust disturbance and the sexual revictimization of incest
survivors: A self-psychological perspective. In: New Therapeutic Visions:
Progress in Self Psychology, Vol. 8, ed. A. Goldberg. Hillsdale, NJ: The
Analytic Press, pp. 75–91.

Detrick, D. W. (1985), Alterego phenomena and the alterego transferences.

In: Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York:
Guilford Press, pp. 240–256.

_____(1986), Alterego phenomena and the alterego transferences. In:

Progress in Self Psychology, Vol. 2, ed. A. Goldberg. New York: Guilford
Press, pp. 299–304.

Fraiberg, S. (1987), Self representation in language and play. In: The

Selected Writings of Selma Fraiberg, ed. L. Fraiberg. Columbus, OH: Ohio
State University Press, pp. 536–537.

Freud, A. (1966), The Ego and the Mechanisms of Defense. New York:
International Universities Press.

Harvey, N. A. (1975). Imaginary playmates. In: A Study of Imagination in

Early Childhood, ed. R. Griffiths. New York; Arno Press.

Kernberg, O. F. (1987), Projection and projective identification:

Developmental and clinical aspects. In: Projection, Identification,
Projective Identification, ed. J. Sandler. New York: International
Universities Press, pp. 93–115.

Klein, M. (1946), Notes on some schizoid mechanisms. In: Developments

in Psycho-Analysis, ed. P. Heimann, S. Isaacs & J. Riviere. London:
Hogarth Press, 1952, pp. 292–320.

Kohut, H. (1971), The Analysis of the Self. New York: International

Universities Press.

_____(1977), The Restoration of the Self. New York: International

Universities Press.
_____(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.
Chicago: University of Chicago Press.

Manosevitz, M., Prentice, N. M. & Wilson, F. (1973), Individual and family

correlates of imaginary companions in preschool children. Develop.
Psychol, 8:72–79.

Sandler, J. (1987), The concept of projective identification. In: Projection,

Identification, Projective Identification, ed. J. Sandler. New York:
International Universities Press, pp. 13–26.

Ulman, R. B. & Brothers, D. (1988), The Shattered Self Hillsdale, NJ: The
Analytic Press.
Chapter 16 To Free the Spirit from Its Cell

Bernard Brandchaft

PASTOR MANDERS: I refuse to discuss such questions with you, Mrs.

Alving-not while you're in such an unstable state of mind. But what do you
mean by calling yourself a coward just because ...

MRS. ALVING: I'll tell you what I mean by it. I'm timid and frightened
because I can never be free of the ghosts that haunt me.

PASTOR MANDERS: What do you mean by that?

MRS. ALVING: I'm haunted by ghosts. When I heard Regina and Osvald
out there, it was just as if there were ghosts before my very eyes. But I'm
inclined to think we're all ghosts, Pastor Manders; it's not only the things
we've inherited from our fathers and mothers that live on in us, but all sorts
of old dead ideas and old dead beliefs, and things of that sort. They're not
actually alive in us, but they're rooted there all the same, and we can't rid
ourselves of them. I've only to pick up a newspaper, and when I read it I
seem to see ghosts gliding between the lines. I should think there must be
ghosts all over the country—as countless as grains of sand. And we are, all
of us, so pitifully afraid of the light.

Henrik Ibsen, Ghosts, Act Two

The conference out of which this volume grew marked the tenth
anniversary of the final appearance of Heinz Kohut at our deliberations. It
was a time to acknowledge how sorely we missed his presence. Our
memories turned to Berkeley and we were inevitably reminded of his
tearful farewell, a scene of unforgettable heroism and tragic eloquence.
Heinz Kohut's departure from our proceedings left a yawning space of
which we were acutely aware. In the past decade self psychology, the
discipline he founded, has confounded those critics who, too eagerly, wrote
it off as a fad and prophesied its demise (Rangell, 1982). It has firmly
established its importance in the therapeutic community. Self psychology
came into existence because Kohut had come to believe that by converting
hypotheses into doctrine classical analysis had brought psychoanalytic
development to a cul-de-sac. He contrasted the world of dogmatic religion
with that of creative science, and he recognized that to the latter, absolute
truth is essentially unknowable. And so, acting in fidelity to his own
observations and his own experiences, he forged a new and historic path
that freed frozen potentialities of his patients and his own.

I wish here to acknowledge my personal and professional debt to Heinz

Kohut. I was reminded again of this only recently, when I reread “The Two
Analyses of Mr. Z” (Kohut, 1979) a dozen years after I had last read it. I
was amazed to find how many of the understandings that I discuss in this
chapter were anticipated in that paper.

The ten years have, however, also provided us with a wealth of clinical
experience with the basic principles Kohut elaborated so brilliantly.
Nothing in a creative science stays the same. “Even the most convincing
conclusions, seemingly self-evident and beyond question, may ultimately
come into serious question “ (1984, p. 57), Kohut (1984) wrote, leaving this
as an essential part of his legacy. Now we face the challenge of addressing
the great tasks remaining before us. It is a time to take a fresh look at
problems yet unsolved. For us, as for Kohut, what is unquestioned cannot
be changed. Our theories are different, but to see only what our own
theories make recognizable to us remains a continuing hazard of our
occupation. These new concepts must not be allowed now to become
accepted and passed on as established or revealed truths. That is the danger
that Arnold Goldberg (1990) portrayed so elegantly in The Prisonhouse of
Psychoanalysis. Every previous innovative development within our field
has been overtaken and circumscribed by that somber fate. Perhaps my own
personal experience over the past 40 years in psychoanalysis especially
alerts me to this peril. Perhaps, equally, I choose this focus here as my way
of honoring that special bond that I share with colleagues with whom I have
had the privilege of collaboration in this unique enterprise over the past
nearly 15 years. It is a bond best defined in the words of Albert Einstein:
“The right to search for truth also implies a duty. One must also not conceal
any part of what one has recognized to be true.”
Over the past decade I have come to recognize certain problems that call
into question important concepts and common practices within self
psychology. In order the better to illustrate these problems I will present
some excerpts drawn from the treatment of two patients. The first, an
architect, and the second, a writer, were each painfully saddled with
conceptions whose underlying assumptions they had never recognized or
been able to question. These pretty much determined their perceptions and
ideas about who they were, which in turn predetermined what they were
doing—and were unable to do-on this planet. Both the concepts I brought to
the patients and those they brought to me had to be reconsidered in order to
establish the “space” in which, in one case, a new edifice might be created
and, in the other, a new script written. In the depths of that dimension of
experience which is my focus here there was operative a pervasive fear, one
more difficult to identify and engage directly and therapeutically: a fear not
to repeat, a terror of change.

The fear of repeating traumatic childhood experiences creates a resistance

that is now readily recognizable. It takes the form of defense structure that
Kohut (1984) described as involving

activities undertaken in the service of psychological survival, that is, as the

patient's attempt to save at least that sector of his nuclear self, however
small and precariously established ... , that he has been able to construct and
maintain despite serious insufficiencies in the development-enhancing
matrix of the selfobjects of his childhood [p. 115].

According to Ornstein (1990), these defense organizations “continue to be

reactivated whenever the patient is experiencing his environment as
unresponsive and unempathic” (p. 42). Their treatment constitutes a
challenge “to be able to interpret habitual, deeply unconscious defensive
positions from within the patient's own perspective and to recognize—and
appreciate—the functions they serve in protecting the vulnerable self in less
than optimal environmental circumstances” (p. 46). These defensive
structures are considered to constitute “the most powerful obstacles to
change” and must be subjected to the process of working through in a
successful analysis (pp. 41–42).
With the patients I am describing here our focus was drawn increasingly to
a defensive structure different from that described by Kohut in the passage
just quoted. Rather, operating at an unconscious level, this formation acted
as a stubborn resistance to change by dismantling and preventing the
consolidation of new structures of experience. It was triggered in response
to the patient's experiencing the analyst not as unresponsive or unempathic
but as an invaluableally in the maintenance of a therapeutic bond that was
based on sustained empathic inquiry into deepening recesses of the patient's
subjective experience. The fear here arose with the patient's perception of
the approach of imminent and profound change. It appeared whenever the
process of inquiry illuminated and thus threatened some deeply entrenched
unconscious principle of organization of experience of the self, a principle
in which the essence of an archaic tie to a primary caretaker continued to
live on.

The direct observation of the operation of this defense organization

indicates that resistance to change is stratified and multidimensional and
that the working-through process must provide access to and address this
layer of unconscious experience if the analysis is to have its most important
mutative impact. Thus, I would take the position that analysis of the defense
organizations that cluster around the need to protect vulnerable self-
structures is an essential but not ultimately conclusive target of the analytic
procedure. In order to become engaged in the serious task of analyzing the
more deeply embedded psychological configurations, “the patient has to be
certain that the current selfobject, the analyst, is not again exposing him to
the pathological milieu of early life” (Kohut, 1979, p. 13). On the other
hand, neglect of the more deeply embedded sources of resistance to change
will lead to a result in which improvement may be limited to certain areas
while the patient's essential perspective on himself and his world remains
unchanged, with the possibility foreclosed for examining and transcending
a relentless, unconscious contribution to the forms and quality of his life.

It was this deeper source of resistance to change that kept the patients I am
describing here imprisoned in gulags of their minds. Its treatment is
complicated, for it involves an investigation into and an essential
realignment of the ordering principles that shape experience and determine
the nature and structure of subjective realities. In order for this development
to occur in a patient, the analyst is likely also to have to undergo a painful
process of realignment in what he observes and in the focus of his
interpretive activity. It is to the case of the architect to which I now wish to
turn in order to illustrate my thesis.

Patrick, the architect, had earned an outstanding reputation for the quality of
his work and for the dedication and absolute integrity he brought to it. Still
youthful and athletic in appearance, he had achieved much of what he had
set out to do in life. He was looked up to and regarded as an unqualified
success by many who knew him. He had participated actively in his family
life, raising three children who appeared successful in their own right, and
he maintained a stable marital relation of many years’ duration.
Nevertheless, life had become not only joyless but a source of almost
ceaseless torment for him. His feelings of emptiness and depression had
some years ago driven him to a severe addiction. He acknowledged almost
wistfully that even such costly relief had become foreclosed for him.

What was it that continued to agonize Patrick so cruelly? He was the eldest
son of a father who had freed himself from his own childhood
impoverishment to become a legend in the ranks of pioneer developers of
housing tracts and shopping centers, a man who had amassed undreamed-of
wealth. The father attempted to pass on the lessons life had taught him to
his son, whom he loved, with the same tenacity that had served him so
successfully in his business affairs. He espoused the virtues of hard work
with a missionary ardor, and he heaped scorn and predictions of apocalypse
upon anyone whose zeal in this direction was less than his own. Attention
to detail he elevated to the status of the nuclear art form. “Make certain you
do the little things,” he would preach, “and the big things will follow.” As a
boy, Patrick had drawn the unfortunate “little thing” assignment of raking
the leaves of their fine new house each afternoon after school. In the
evening before the family could sit down to supper, dad would accompany
the lad into the yard and inspect the results of his labors. No white-gloved
marine sergeant was more dedicated to his task. His father's reproaches and
his own forebodings as neglected leaves were discovered and pointed to, his
indolence or fraudulence thus unmasked, remained indelibly seared in
Patrick's memory.
Having set an example in his own world that his contemporaries fell over
themselves trying to learn and emulate, Patrick's father could not
understand why he should be having such difficulties in getting his firstborn
son to follow simple instructions. Equally difficult for him to comprehend
was how Patrick could find appealing any interests or entertain any
ambitions other than those he had determined were in the boy's best interest.
Increasingly, Patrick's father came to treat such expressions with disdain
and as personal rejections of him and his values. He especially could not
understand why the boy was so offended whenever they visited one of his
new development projects. Instead of seeing his father's entrepreneurial
wizardry, Patrick could only see mindless and garish desecration being
inflicted on the environment, and having experienced it at shorter range on
himself, he reacted viscerally. Although dad regularly and cordially invited
Patrick to come along on his fishing trips or sailing boat excursions, he
never attended a baseball game in which his son, who took pride in his feats
as a second baseman, was playing.

This schism between what he saw and felt and what he was supposed to see
and feel-in general, between experiences as they were and as they were
supposed to be—remained for Patrick an enduring source of irreconcilable
torment. Somehow out of the woof and warp of this relationship Patrick
developed a firmly consolidated structure of experience. It was woven and
held together by an underlying perspective toward himself and his life that
created an architecture for his spirit that was almost as confining as his life
with father had ever been. Patrick could never really unlearn very much of
what his father had insisted on teaching him. Any spontaneous enthusiasm
or fun for anything he might design for himself, including his own lifestyle,
came inexorably to be erased, automatically and mysteriously, as if by some
unseen master hand and as if it-and, in a profound sense, he—had never
really existed.

Patrick was compelled to operate in his profession-one he had somehow

had the courage to choose for himself—exactly as if it were his father's first
venture in the development business. The possibility of little things turning
into very big and disastrous ones had become so enshrined as a principle of
not-to-be-questioned truth that Patrick could never again limit the
significance to him of any imperfection. In the tight confines of his mind
there was no time and no space for the enjoyment of his superbly innovative
spirit. He had to concern himself with every detail of any project he
undertook, as if it were the lawn that was to be inspected by his father.
Patrick drew each design and bird-dogged it through the detailed drafting
process. He took the plans to the building authorities himself and personally
followed the interminable procedures necessary to secure the required
permits. He even had to see that the garbage was taken to the street from his
office himself, for he was certain that anyone to whom he delegated the
responsibility would forget it sooner or later. If he departed in the slightest
from this ritualized existence, he was filled with terrible foreboding. He was
compelled to conclude what his father had always maintained-that his
insistence on choosing his own life for himself and not accepting what his
father chose for him was an unarguable demonstration of his stupidity or
willfulness.

Nor could Patrick enjoy even the acclaim and rewards his talents and
energies brought him. Helplessly manacled to his father's values and unable
to consolidate any of his own, he continued to harbor the unyielding
conviction in some corner of his mind that he was fraudulent and
undeserving of those tributes. His admirers were reacting to his beautiful
buildings; he, unyieldingly, to the neglected and unraked leaves they had
not yet seen!

Whatever transient feeling of well-being, confidence, enthusiasm, or hope,

arising from some still-active spring inside himself, Patrick experienced in
his sessions would regularly disappear, relentlessly vitiated by some self-
disparaging thought. Then the space that had been occupied by the feeling
of aliveness would be replaced by the more familiar empty malaise and
joylessness that had pervaded his childhood.

What happened in my consulting room, I was able to determine, was a

faithful replication of what occurred when Patrick was by himself.
Observing how his mental operations always came to ground zero in this
repetitive self-negating process, I got a vivid sense of how like a cell
Patrick's mind was. I could observe how each time the cell door opened
with a fresh, innovative thought or exuberant feeling it soon clanged shut
again. Only by immersing himself in work to the point of exhaustion had
Patrick been able to find some measure of relief from this process.

I have come to recognize this constellation of shifting feeling states as an

indication that there is an underlying process at work— ghosts, as it were—
that discloses skeletons below. Within this skeletal framework experience is
being shaped sequentially by two different and incompatible perspectives
according to two different sets of organizing principles. These in turn reflect
different and incompatible motivations. This process can assume many
forms, frequently insidious and difficult to detect, and one of the two sets of
perspectives and motivations, that which divests the self of what is
exquisitely personal, is always preprogrammed to prevail. Thus,
development on the basis of authenticity of experience and centrality of
differentiated choice is repetitively foreclosed. These principles operate
from within an area of experience that has been described as the
prereflective unconscious (Atwood and Stolorow, 1984). As Basch points
out, this corresponds to “the sensorimotor period delineated by Piaget, that
is, those first 18 months of life where infants establish patterns of
expectation that are not, and may never become, subject to symbolic
manipulation” (personal communication).

Caught up in the affective content of their experience, patients are likely to

be oblivious to the existence of the subterranean backdrop of other mental
operations. As Freud first noted, patients tend unreflectively to believe that
experience is explained by events and circumstance and are oblivious to the
role played by the unconscious in how events are being processed.
Analysts, especially those who lend themselves to sustained immersion in
their patients’ experience, also tend to become similarly trapped in its
content. Such entrapment blinds the analyst to the shifting of affect states
and subjective realities that is occurring beyond the focus of their eyes. In
these circumstances it is easy to fail to recognize that the forms or symbols
in which a particular constellation is finding expression are unimportant
except as they provide access to the underlying process. It is easy also to
fail to appreciate that the “reality” of the patient's affective state may need
not so much to be affirmed or resonated with as opened wide to the
processes of self-reflection so that its derivative and subjective origins can
be grasped.
In patients like Patrick the process by which one way of organizing
experience is usurped by another more forceful, is an internal and automatic
replication of crucial developmental events of the child-caretaker
experience. That point at which the shift in feeling state from enthusiasm to
malaise occurs continues to mark exactly the great divide of developmental
derailment. It reflects the fact that the child's attempts to differentiate were
stifled by attitudes and actions of caretakers. The patient cannot exit what
has become a closed and noxious system. He remains trapped in the
structural remains of an archaic tie. The perspective and motivation that
prevails is one in which the individual is compelled to submit to a definition
of himself determined by forces external to his control or volition, a
definition determined by the needs, wishes, and fears of caregivers or those
who continue to represent them psychically. “I must believe that I am and
must continue to be what you, my caretakers, see me to be” remains the
operative organizing principle.

Let me now turn to my second example.

I treated Marco, a writer, striking in his tall, ascetic, and unaffected

appearance, a number of years ago and he appeared in my office one
Monday after spending the previous Saturday night at the opening
performance of his play. He said that he felt “hung over,” although he had
not been drinking. The misgivings he had had about the staging and the
acting proved unwarranted, and the play, he said, went very well. He
noticed, however, that at the party afterward he felt sad-“melancholic” he
termed it-and he could not explain this to himself. He remembered that he
had stood in the rear of the theater while the performance was taking place,
listening carefully to his lines being delivered. He felt flashes of pride as he
found himself saying to himself “That's okay” and sometimes “That's
good!” But they vanished and were replaced by the sadness that enveloped
him. The actors at the party were effusive in their praise and the director
told him that he thought the play was a major piece of work, but Marco had
a sense of unreality about the whole thing. Feeling distant, dull, empty, out
of place, and alone as he mingled with the celebrators, he felt as though
they were talking about someone else. Surely the drama that he had
presented on the stage was no more dramatic than the one taking place
inside him. But whose drama was it and what part was he playing in it?
Some months before, Marco had begun to discuss the difficulties he was
encountering in his writing. He wrote for television and had two partners
who reviewed his work and then made suggestions for revision. Marco had
great difficulty in being able to preserve and protect his own contribution in
the face of their suggestions. It became clear that this difficulty arose
because a familiar configuration was constantly being triggered. Marco was
afraid of damaging the feelings of his partners, and this fear interfered with
his retaining as central his own purpose of producing what he felt was the
best possible script. He compromised himself repeatedly and thus interfered
with the unfettered development of his own creativity. As a consequence,
his efforts were robbed of the richness and enthusiasm only he could bring
to them, and he worked without zest.

A second severe problem occurred when he began with an idea that excited
him. Then he would regularly find himself procrastinating, and he was soon
overcome with fatigue and lethargy. Only when he approached a deadline
could he rouse himself, and then only because the fear of the consequences
of disappointing his employers outweighed the vague, sinister, and
unrelenting discomfort that brought his excitement, and with it his
creativity, to a halt.

In attempting to understand this reaction, Marco recalled that his interest in

storytelling was preceded by a childhood passion for reading. In his own
room he found that he could enter into the magical worlds of the great
storytellers. There he sought and could find refuge from the grey weariness
of his home, his mother's unrelieved bitterness, his father's withdrawal and
addiction, and the interminable arguments between them. When he was
eight or nine, Marco remembered, his mother walked into his room and
caught him reading. “Why are you always spending your time that way?”
she scolded. “To avoid helping me?” He never showed her any of the stories
he subsequently began to write. When he was 12 he wrote the school play
and asked his mother to come to watch on the night it was being performed.
He wanted so for her to be pleased and proud, but she sat there unmoved
and unimpressed. When he was introduced on the stage at the end of the
play and the audience applauded, Marco noticed that his mother's hands
remained fixed at her sides.
How can one understand Marco's inability to sustain his prideful
enthusiasm and its collapse into a state of profound sadness at the premiere
of his play? Surely it is clear that Marco remained compelled to continue to
experience as his very own his mother's sadness at his early interests, which
took him away from her. His mother's perspective continued to replace his
own, and this process resulted in Marco's lack of initiative and his absence
of zest. It continued to paralyze him and prevented him from being able to
negotiate differences with his writing partners that would have protected his
own innovations from surrender. Marco's triumph at the opening of his play
was being reflected back to him as an example of naughtiness, and he was
responding as if he had no mind, no will, no credible experience of his own.

This process and its underlying principles also shaped Marco's personal
relationships with women and stripped them also of the quality of volition.
Every intimate relationship had inevitably become increasingly difficult for
Marco. In each he felt himself under constant pressure to demonstrate that
he continued to love his partner and had not grown tired of her, a
requirement that in itself inevitably became tiring. Consequently, Marco felt
burdened when he was with his partner and relieved when they were apart
—relieved, that is, until he would begin to worry that when he next saw his
loved one she would be expecting him to make love with her and would be
checking to titrate the level of his passion after their separation against what
it was before. Nothing could have been more lethal in its effect on his
appetite for lovemaking. He knew, moreover, that his partner would be hurt
and angry or cold and aloof. That reaction in her was intolerable to him
because it made him feel that he was totally bad. Thus, Marco could not
help sliding into an archaic definition of who he was. He was, he felt, the
very one, unchanged, his mother had reflected back to him so long ago, the
boy his mother was sorry she had. Thus he repeatedly surrendered any
definition of himself of his own to criteria imposed from outside. Whenever
he began to experience his personal self in a perspective of his own—for
example, when he began to feel as he was watching the opening night
performance of his play that he was for one brief, shining moment his own
person, not his mother's, his audience's, his collaborators’, or mine—he
would soon after feel that he was really selfish, uncaring, and therefore
undeserving. That was the principle that turned Marco's success into an
incipient melancholia.
Who Marco was remained dependent on the reflection he got from his
partner, a principle simple in its elegance. If she smiled, he felt he was
good; if she was aloof and cold, he was bad! The particular partner didn't
even have to be present for this circuitry to be activated. When he was
alone, Marco was preoccupied with her, could not get her off his mind. The
picture of her wounded expression, her angry mouth, or flaring eyes
imprisoned him. He heard her crying, “Look what you've done to me!” and
he could not turn away. He did not feel that he owned his own body, his
own affection, person, or mind. Each relationship was a prison cell in which
his spirit was trapped.

HISTORICAL NOTES

The phenomenology that I have been discussing has been the focus of much
interest, perturbation, and varying interpretation throughout the course of
psychoanalytic history. It was the basis of Freud's investigations in the case
of the Wolf man, in which Freud came to feel that “something in these
people sets itself against their recovery (so that) its approach is dreaded as
though it were a danger” (Freud, 1923, p.49). It has been described
exhaustively by analysts of the Kleinian school, who have noted repeatedly
the resistance of patients to change and their inability to sustain feelings of
well-being inside and outside the analysis. Operating on the basis of the
paradigm of the mind as an energy-processing apparatus, Kleinians have
attributed these repetitive reactions to the death instinct and to pathological
biological forces of destructive envy (Bion, 1962; Rosenfeld, 1987; Joseph,
1989). Every major theoretical innovation in psychoanalysis has involved a
search for a better understanding and solution to this underlying problem
(see, for example, Fairbaim, 1954, pp. 137–146). The inability of his
patients to sustain excitement and enthusiasm and to emancipate themselves
from protracted states of emotional shallowness and malaise except by
resorting to desperate and despairing attempts at self-stimulation was the
cardinal symptom that captured Kohut's interest. It was the failure of
classical concepts to solve this problem that ultimately motivated his call
for a return to the methods of empathy and introspection as “defining the
contents and limits of field and determining the theories” of psychoanalysis
(Kohut, 1959). The earliest descriptions that emerged from Kohut's
rededication to the empathic-introspective stance were of a particular
sequencing of feelings. He noted that “a pervasive hypochondriacal
brooding may disappear,” usually as a result of external praise or interest.

The patient suddenly feels alive and happy and, for a while at least, shows
initiative and has a sense of deep and lively participation in the world.
These swings are usually short-lived and they tend to become the source of
uncomfortable excitement. They arouse anxiety and are then soon followed
by a chronic sense of dullness and passivity, either experienced openly or
disguised by long hours of mechanically performed activities [Kohut, 1971,
p. 17].

To explain the anxiety that caused his patient's “heightened pleasure in

himself and his increased vitality” to be replaced by a state of depletion,
Kohut fell back on the concepts of ego psychology. “These and many other
similar complaints,” he wrote “are indicative of the ego's depletion because
it has to wall itself off against the claims of the grandiose self, or against the
intense hunger for a powerful external supplier of self-esteem and other
emotional sustenance in the narcissistic realm” (Kohut, 1971, p. 17). Kohut
never abandoned this explanation of the anxiety his patients experienced
when authentic, demarcated, and poorly consolidated structures began to
emerge. It was the crucial element in the dream interpretation that
distinguished the second analysis of Mr. Ζ from the first (Kohut, 1979).

It was inference based on the model of an inadequate mental apparatus that

led Kohut to conclude, fatefully, that the anxiety behind the failure to
sustain experiences of enthusiasm and joy in the self was triggered by a
deficit of psychological structure, thus providing self psychology with a
defining organizing principle at its outset as a psychology of deficit rather
than a complex psychology of empathically accessible subjective
experience. The joyless existence of “tragic man” was the outcome of
massively faulty responses to his strivings in childhood for mirroring and
idealizable experiences from caretakers. The transmuting internalization
that would have laid down cohesive structures in the presence of adequately
empathic and optimally frustrating responses had not taken place. The
enthusiasm and vitality that emerged episodically with expressions of
archaic self-structures (and affirming responses to these) could not be
sustained, and they collapsed.
However elegant this perspective, it fails to take adequately into account the
nature and extent of the structure that has evolved and become firmly
consolidated, a structure I have attempted to describe in the cases of Patrick
and Marco. That structure is the consequence of the attitudes reflected back
to the child in his formative relationships; within it the archaic ties to
parental caretakers are perpetuated. In the psychic reality of unconscious
organizing principles is to be found the enduring truth of Freud's
observation that the ego never willingly abandons a libidinal object choice
(Freud, 1917). The structure that develops out of the matrix of emotionally
enslaving early ties forestalls the emergence of new structures, based
centrally on inner and distinctive feelings, because these continue to
constitute a challenge to those of the parents.

In analysis, when the observational focus is placed on deficit, on what is

absent, the importance of identifying and analyzing the imprisoning
structure is obscured. The therapeutic endeavor shifts to ways of filling in
the deficit by processes of “optimal frustration” and “transmuting
internalization” and away from the task of liberating the patient from ties
that continue to bind him and that continue to impair his ability to sustain
experiences of “the exhilarating bliss of growing self-delimitation” (Kohut,
1979, p. 17) and the joy of recognizing and aggressively pursuing the
unfolding design of a self of his own.

In these circumstances it is apparent that the urgent needs for mirroring or

idealizable qualities that appear in the selfobject transferences cannot be
taken as identical to or comparable with the original selfobject needs now
revived in an empathic setting (Schwaber, 1983, p. 60). Only the extension
of the process of empathic inquiry can reveal a context in which such
selfobject needs are being derivatively activated in order to countermand
automatized self-depleting operations. Specific attunement to and
recognition of Patrick's and Marco's perceptions and experiential states
were unquestionably necessary for the establishment of a firm therapeutic
bond (Brandchaft and Stolorow, 1990). These preconditions must be
fulfilled if the analytic work is to focus on the enduring and defining impact
of early experience on the sense of self and to focus on its continuing
contribution to the automatic, invariant, and nonreflective organization that
expropriates, redefines, and redirects experience.
When Patrick experienced a reflection of himself, in or outside the analytic
transference, at variance with one that his tortured state of mind allowed
him to retain, he generally seemed appreciative. However, such
experiences, I noted, left him without the tools he needed to be able on his
own to identify and ultimately counteract the predetermined shift in
perspective that continued to nullify the impact of any beginning positive
experience of himself regardless of the source from which it emanated.
Consequently, expressions of pride or enthusiasm could be observed
regularly to be sucked back down into the more familiar organizing
perspective. I believe that continued therapeutic interaction of the kind that
purports to provide the “mirroring” affirmation that was denied the patient
in his childhood may, in fact, superimpose a well-intended but misguided
perspective of the analyst over that which is afflicting the patient. I have
observed that these therapeutic interactions tend to contribute to the
prolongation of the pattern that Kohut early took note of. “The analysand
becomes addicted to the analyst or the analytic procedure and the
transferencelike condition which establishes itself in such analyses is indeed
the reinstatement of an archaic condition” (Kohut, 1971, p. 46). The
uncritical and, I believe, erroneous application of the theory that the path of
development of the self consists of progress from archaic to mature
selfobject relations can lead to a situation in which addictive attachments
can be recycled and perpetuated, relatively unchanged in their depths,
through a succession of relationships, including the one between analyst
and analysand.

In the patients I am describing the nuclear structures are no longer freely

mobilizable. They have become inextricably enmeshed with highly
organized and unyielding internal structures in precisely the way their
psychological organizations became enmeshed with that of their caretakers
in childhood. Whatever the specific intersubjective factors that produced
this particular character structure, the mandate has been established that the
person continue to define himself by how well or poorly he fulfills what the
caretakers needed, expected, and required of him, in both positive and
negative aspects. No situation more clearly shows the influence of the
observer on the observed than the effect of caretaker on child, and in none
is the consequence of that influence more enduring. The first caretakers
occupy the role of reflector of an ultimate reality and the absolute definer of
who the child is. Their constructs, communicated in a thousand ways—
verbal, gestural, and attitudinal—impart meaning to the chüd's experience.
Enduringly negative or positive, hopeful or despairing, nourishing or
depleting, these meanings continue to shape the quality and direction his
inner life takes. It is the operation of this underlying configuration that
dooms people like Patrick and Marco to suffer the fate of Tragic Man,
realizing in despair that they have not been living their lives, have not “been
true to their inner design” (Kohut, 1977, p. 241).

If the shift in affect state that I have described can be carefully observed
over a protracted period and the invariance and automaticity of that shift
made evident to the patient, he can be helped to become aware of the
processes within him that are codetermining the nature and quality of his
life, processes that are outside his control and volition. The anxiety that
underlies and motivates the shift, no longer obliterated by unrecognized
surrender to an alternative perspective, will then become more accessible to
analytic investigation and work.

Perhaps I can illustrate the operation of these therapeutic principles in a

brief excerpt from the associations of a patient who has been described
previously (Stolorow, Brandchaft, and Atwood, 1987, chap. 4). I will here
omit pertinent details except to mention that the patient was getting his
chaotic professional affairs in order and, in the process, had engaged a
competent and professional office manager upon whom he had become very
dependent for the achievement of this goal. The patient's associations were
as follows:

I was aware of being swept along, away from the centrality of my own
center of initiative, and I noticed the tendency for this to occur whenever
others’ spheres of influence intersected with my own. For example,
Katherine. She is my office manager and she has certain priorities in the
organization of my time, so I found myself fitting in with her schedule for
me. If she couldn't fit my appointments with you into her schedule for me, I
found myself incredulously fitting in her priorities for me as if they were
my own. Her perspective became dominant and obscured any of my own. I
became aware of the importance to me of not interfering with her
enthusiasm and a gnawing apprehension of what would happen if I did.
Gradually and insidiously I became aware of a feeling of not being on top
of, but one step behind, always one step behind and never able to catch up. I
saw myself rationalize my behavior: “Things at the office are a mess and I
have to go along with this routine until things get straightened out and then
I'll be able to go back to my analysis.”

Not wanting to undermine her initiative, I found myself swept along,

becoming resentful and unhappy because my life was not my own, even
though it always seemed that what was going on was for my awn good!

I was aware that what was lacking was the quality of ownership, that it was
not I who was directing my life, and therefore there was an unmistakable
lack of pleasure even in those things that appeared to me to be in my own
best interest. What was enormously helpful to me was to continue to be able
to be reflective while all this was going on, and so to be able to stay in that
space with more wholeness, not lose my self.

Stolorow and I have proposed that “developmental traumata derive their

lasting significance from the establishment of invariant and relentless
principles of organization that remain beyond the accommodative influence
of reflective self-awareness or of subsequent experience” (Brandchaft and
Stolorow, 1990, p. 108).

The most serious and lasting damage incurred by developmental traumata is

that sustained by the emerging and fragile sense of self and involving the
establishment of rigid criteria by which the self is defined. Thus, it becomes
essential to observe how the shift in affect states I have described is rooted
in automatic relentlessly recurring translocations in the sense of self. Each
step toward the realization of a demarcated and authentic personality, each
appearance of an emerging sense of personal agency, is initially but
fleetingly accompanied by a vitalizing and transcendent sense of self. This
was the case with Marco, for example, when he initially felt exultant while
watching his play being performed, but such a basis for self-definition was
regularly erased and replaced by a feeling of debased fraudulence and
dishonor. I have described this process in detail in a previous work on a
patient with a seemingly intractable depression (Brandchaft, 1988). The
shift from liberating exuberance to the malaise and depletion of defeat and
surrender is rooted in this underlying shift in the foundations of the sense of
self. To make possible changes at this nuclear level, it is essential that the
therapeutic process open these unexplored areas of self-experience to the
processes of reflection and analysis in depth.

The operations of unconscious principles of organization that create and

maintain an established cohesive psychological structure while continuing
to disarticulate and prevent the consolidation of new psychological structure
are responsible, in one form or another, for the most frequent, pervasive,
and disabling of the disorders of the self. Marco's and Patrick's dullness of
existence is in its essence a function of the relentless enfeeblement of a
distinctive core, a core trapped and continuously drained of its own vitality,
part of the gift of life.

I have referred to the myriad of forms in which this underlying

psychological configuration and the unconscious organizing principles that
hold it in place can find expression. Marco and Patrick, for example, have
each been transfixed with tormenting doubt concerning the truth about who
and what they really are, and this doubt extends to the most profound and
nuclear of their feelings. In this ceaseless and paralyzing doubt are
contained the roots of the obsessive dilemma and its concretizing
compulsive rituals. Kohut (1979) described the appearance of this doubt in
the case of Mr. Z: as the patient became aware of the extent of his
enmeshment with organizing principles established in his early relationship
to his mother, as a consequence

of the crucial fact that the mother's emotional gifts were bestowed upon him
under the unalterable and uncompromising condition that he submit to total
domination by her, that he must not allow himself any independence,
particularly as it concerned significant relations with others, he retreated
from the pursuit of the analytic task, voicing instead serious doubts as to
whether his memories were correct, whether he was not slanting them in his
presentation to me [p. 13].

Patrick's enslavement to detail, another patient's periodic torment as to

whether he had left a gas jet open, compulsive hand-washing routines I
have observed—all have as a central organizing principle, as did the
behavior of Mr. Z, a persistent and agonizing doubt concerning the truth
about the essence of their humanness. These individuals are continually
asking if they are bad or good, destructive or innocent, hateful or lovable. In
this torment is the echo of the central and still-unresolved dilemma of
childhood: Whose versions and whose perspective is to be believed? The
failure of analysis to penetrate to this area of experience, which is
exquisitely available to the analytic method of empathic inquiry, has
resulted in the tragedy of the virtual therapeutic abandonment of the
treatment of this disorder to the neurobiologists, who operate according to
impersonal and statistical criteria and neglect the personal.

In a more florid form this oscillation between enthusiasm and malaise in the
experience of one's self can also be seen in the manic-depressive syndrome.
Narcissistic object choice has generally been recognized as the point of loss
in the melancholia that forms part of this picture whereas mania has been
ascribed to the defensive denial of that loss (Klein, 1950, pp. 282–283).
Without the primary focus on self-experience and the use of empathic
inquiry into that experience from within, it was not possible heretofore to
identify the manic phase as emerging from the experience of transient
shedding of an enslaving tie to a self-annihilating selfobject or to attribute
the melancholia to the reestablishment of that tie and, consequently, to the
loss of a vital part of the self (as described by my patient Marco in the
passage I referred to previously). And underlying an addiction to substances
and sexual enactments or rituals can regularly be found the deeper
imperative to countermand the tormenting effects of corrosive experience of
self not only as reflected in the eyes of another but as arising from within,
from an unyielding self-abusive or self-deflating structure.

In whichever of the myriad forms this underlying configuration may come

to expression, it is an unerring indicator of a specific developmental
derailment. The need of Patrick's and Marco's caregivers to commandeer
the child's developmental processes caused a fateful and specific transition,
In both cases the individual was deprived of that developmental progression
by which he could come increasingly to rely on his own spontaneous,
authentic, and noncompliant experience as central in his perception,
motivation, and interpretation. This failure has momentous consequences. It
renders the individual permanently the hostage of the responses of another
for the determination and definition of who he is. He is imprisoned by a
feeling of responsibility for the state of mind of another, and he is utterly
unable to use his own unfettered volition in the choices he makes in the
fulfillment of his attachments and in the interests he attempts to freely
pursue and fully enjoy. Thus, it becomes mandatory that the analytic
process reinstate the developmental process at the point at which it was
interrupted. This necessarily involves the analysis providing a setting in
which the patient can live through whatever anxiety lies in the path of his
reclaiming the ownership of his self and determining the laws by which his
sense and definition of self are governed. Only in that way will it be
possible for him at last to depend upon another without placing himself at
risk of surrendering the determination of who he is to that other.

The anxiety that accompanies the shift that occurs each time the person
strives once more to break free from the constraints of established
principles of organization and the habitual processes built up over a lifetime
may be so subtle as to escape notice. In attempting to provide a therapeutic
milieu the analyst must be aware of the extent to which this dreaded affect
state may have been repressed developmentally because it met with an
unattuned or misattuned responsiveness from caretakers. Socarides and
Stolorow (1984/1985) emphasize the sensitivity of patients to any
indication of such attitudes in the analyst and describe how these attitudes
initiate a resistance of their own, the dread to repeat (Ornstein, 1974). There
may be feelings of unreality and profound strangeness or estrangement.
Frequently, the anxiety takes the form of various concrete symbols of
disaster, such as earthquakes, thunder, lightning, and the like (Brandchaft,
1991), or of pervasive hypochondriacal concerns (Kohut, 1979, p. 19).
These experiences all convey the sense of threat to the self if there is a shift
in its familiar orientation and allegiance. The challenge to existing ways of
organizing experience continues always to constitute a painful and, not
infrequently, cataclysmic psychological event.

In understanding the resistance to change in the analysis of disorders of the

self and the fear that underlies it, Kohut's (1979) description in the case of
Mr. Ζ is pertinent: “As we discovered— without which progress would
surely ultimately be halted-his fears concerned the loss of the mother as an
archaic selfobject, a loss that ... threatened him with dissolution, with the
loss of a self that at these moments he considered to be his only one” (p. 13;
italics added). Kohut went on to write that the deepest anxiety experienced
by his patient was that in response to movements toward “independent
maleness.” These continued to reproduce in him the frightened reaction he
had had as a child at the “icy withdrawal” of his mother in response to
similar steps, a withdrawal to which he had always responded with an
emotional return to her. The account of the second analysis of Mr. Ζ is
replete with passages that describe the intense anxiety Mr. Ζ experienced
over and over again as his movements toward autonomous and demarcated
selfhood challenged the principles that had hitherto dictated his surrender of
such a developmental course.

The fear of being alone and, in that state, the terror that Kohut regarded as
the greatest, that of fragmentation, has been frequently isolated and
identified as a primary and irreducible factor in maintaining existing and
familiar organizations of experience (Adler and Buie, 1979). In treating
these patients, however, I observed, as Kohut recognized in the passages
cited, that this anxiety is itself an aspect of a more complex state. When he
is alone the patient has no access to any information or reflection with
which to counteract insistent representations arising from unchallenged
archaic and authoritarian definitions of self. He is trapped in an unreflected
perspective, one that he does not recognize as perspective but accepts as
not-to-be-questioned reality. He is apt to be unaware of the existence of any
core of self save that caught in the enmeshing perspective. There is an
escalating negation and abuse of the self which suggest experiences of
being browbeaten into submission. Unable to find refuge, the patient may
then begin dissociating from his experiencing self because he has developed
no strategies with which to defuse the bombardment of the stimuli of his
internal surround. He may suddenly feel overwhelmed and increasingly
frightened by the mechanical and robotic quality of existence. This cycle is
especially likely to occur when the patient is alone and at night, when there
are no distracting preoccupations and when it may be terminated by
desperate and joyless attempts at sexual stimulation, by chemical or
alcoholic means, or by sheer exhaustion.

The attempt to organize experience in a new way frequently results in a

pervasive and disarticulating doubt about the truth of subjective experience.
However, if the context in which this experience regularly recurs can
become familiar to the patient, that is, if it regularly follows an attempt to
free himself from some constricting relationship or ongoing organizing
principle, he will recognize it as a sign of forward movement, even if it is
subjectively frightening. When the therapeutic focus has resulted in
supporting the processes of self-reflection, the patient can become familiar
with the enmeshing structure and its invariant impact on the way experience
automatically evolves within it. A third perspective will then have become
established within which the assumptions underlying the patient's shifting
sense of self become accessible and are no longer sacrosanct and
immutable. Then also the experience of dissolution can come to be
recognized as involving only one sector of the patient's self-experience, not
its totality and not the central sector he wishes to consolidate. In each case
the frightening experience and the accompanying distress need
subsequently to be carefully investigated in a therapeutic environment in
which a firm bond has been established. At this point in the therapeutic
interaction the preconceptions of the therapist can have a determining effect
upon the subsequent course and outcome. Nowhere are the words of Kohut
(1984) more prophetic:

The difficulties, at times well-nigh insurmountable, that the observer faces

are not due to his influence on the field of observation, but to his own
shortcomings as an observing instrument. Prejudicial tendencies deeply
ingrained within us will often decisively influence what part of the
potentially available data we perceive, which among the perceived items we
consider important, and ultimately how we choose to explain the data that
we selectively perceive [p. 38].

If in the conduct of a therapeutic analysis of a self disorder the unfolding

process is not interfered with, the operations of the underlying defensive
structure will inevitably emerge. This will have a decisive impact upon the
subsequent course of the analysis. Such a process necessitates the formation
from the beginning of a therapeutic bond with the patient based upon a
commitment to the stance of empathic inquiry (Brandchaft and Stolorow,
1990). This will lead to an awareness, deepening investigation, and gradual
illumination of existing unconscious organizing principles and their
continuing contribution to the repetitive course that life takes. The
accompanying recognition that the existing structure must be disarticulated
and its power curtailed so that alternative ways of organizing experience
and new implementing structure may develop has profound implications
insofar as treatment modalities are concerned. Such a procedure involves a
reconsideration of the role of such modalities as affective attunement,
resonance, or engagement, as well as of the relative merits of optimal
frustration and responsiveness. Central to such reconsideration is an
assessment of the extent to which the tool facilitates or impairs the
processes of empathic investigation and illumination. I trust I will not be
misunderstood here as making a plea for a lesser responsiveness. It is my
intent, rather, to emphasize a greater discernment on the part of the
therapist, one that leads to continued curiosity and observation and that, so
informed, determines the nature of the response and the area to which it is
directed.

The basic tools of sustained empathic inquiry that led Kohut to his
revolutionary discoveries have persuaded me that a most essential facet of
the patient's developmental process is the shift from other-referenced to
independent and noncompliant criteria as the central basis for the sense of
self. Such a development is necessary in order for the individual to continue
to operate from a self that acts as a center of authentic and voluntary
initiative. I acknowledge here a similar thesis in The Sovereign Self by
Francesca von Broemsen (1991). In the cases of Patrick and Marco I have
described how their development was constantly being stripped of what was
most exquisitely spontaneous and personal and how malaise and
lifelessness accompanied that process. It is my impression that the truest
measure of the depth of the success of an analysis lies in the extent to which
it has helped the patient free himself from the organizing principles that
dictate this usurpation and surrender of the self. Only by reclaiming the
ownership of his own sense of self and proceeding from a center of
initiative within it can the patient experience the joy and enthusiasm of a
life more truly his own.

The empathic investigatory process that formed the basis of Kohut's

original theories of the psychology of complex states is uniquely suited to
the exploration of this area of continuing repetitive derailment and
resistance to change. It is to this enduring contribution that we need to
periodically return, and we continue to be inspired by Kohut's courageous
example. Beyond any specific set of concepts, it continues to be the
indispensable tool and compass of the creative science of psychoanalysis. It
is a sobering realization, but one we cannot evade, that the future of the
heritage Kohut left us is now in our charge. It can be a future of expanding
scope and influence if we ourselves, inspired by his example, recognize and
overcome our own resistances to change. This is our challenge if we are to
illuminate and free the still-imprisoned spirits of our patients from the
darkness of their cells and our spirits from the continuing fetters of our
own.

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The possible relevance of child development. Internat. J. Psycho-Anal,
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Atwood, G. & Stolorow, R. (1984), Structures of Subjectivity. Hillsdale, NJ:

The Analytic Press.

Bacal, H. (1985), Optimal responsiveness and the therapeutic process. In:

Progress in Self Psychology, Vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 202–227.

Bion, W. (1962), Learning from Experience. London: William Heinemann.

Brandchaft, Β. (1988), A case of intractable depression. In: Learning from

Kohut: Progress in Self Psychology, Vol. 4, ed. A. Goldberg. Hillsdale, NJ:
The Analytic Press, pp. 133–154.

_____(1991), Whose self is this anyway? Presented to a conference on self

psychology, Los Angeles, March 17.

_____& Stolorow, R. (1990), Varieties of therapeutic alliance. The Annual

of Psychoanalysis, 18:99–114. Hillsdale, NJ: The Analytic Press.

Fairbairn, W. R. D. (1954), An Object-Relations Theory of the Personality.

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258. London: Hogarth Press, 1957.

_____(1923), The ego and the id. Standard Edition, 19:12–63. London:
Hogarth Press, 1962.

Goldberg, A. (1990), The Prisonhouse of Psychoanalysis. Hillsdale, NJ:

The Analytic Press.

Joseph, B. (1989), Psychic Equilibrium and Psychic Change: Selected

Papers of Betty Joseph, ed. E.B. Spillius and M. Feldman. London:
Tavistock/Routledge.

Klein, M. (1950), A contribution to the psychogenesis of manic-depressive

states. In:

Contributions to Psycho-Analysis, London: Hogarth Press, pp. 311–338.

Kohut, H. (1959), Introspection, empathy and psychoanalysis. J. Amer.

Psychoanal. Assn., 7:459–483.

_____(1971), The Analysis of the Self. New York: International Universities

Press.

_____(1977) The Restoration of the Self. New York: International

Universities Press.

_____(1979), The two analyses of Mr. Z. Internat. J. Psycho-Anal, 60:3–27.

_____(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

University of Chicago Press.

Ornstein, A. (1974), The dread to repeat and the new beginning. The
Annual of Psychoanalysis, 2:231–248. New York: International Universities
Press.

_____(1990), Selfobject transferences and the process of working through.

In: The Realities of Transference: Progress in Self Psychology, Vol. 6, ed. A.
Goldberg. Hillsdale, NJ: The Analytic Press, pp. 42–58.
Rangell, L. (1982), The self in psychoanal5’tic theory. J. Amer. Psychoanal.
Assn., 30:863–892.

Rosenfeld, H. (1987), Impasse and Interpretation. London: Routledge.

Schwaber, E. (1984), Psychoanalytic listening and psychic reality. Internat.

Rev. Psycho-Anal, 10:379–392.

Socarides, D. and Stolorow, R. (1984/1985), Affects and selfobjects. The

Annual of Psychoanalysis, 12/13:105–119. Madison, CT: International
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Stolorow, R., Brandchaft, B, & Atwood, G. (1987), Psychoanalytic

Treatment: An intersubjective Approach. Hillsdale, NJ: The Analytic Press.

von Broemsen, F. (1991), The sovereign self. Unpublished manuscript.

Chapter 17 Reversals: On Certain Pathologies of Identification

Fluctuations in self-state are a feature of severe personality disorder. This

Russell Meares
chapter concerns a particular category of changing self-state, one that
involves pathological identification and that I am calling a “reversal.” This
phenomenon, though not uncommon, has received relatively little attention
and has generally been conceived in terms of defense. An alternative
explanation, given here, depends upon a psychology of self.

In order to approach this subject I figuratively conceive the experience of

self in relationship to the other, at any instant, in three dimensions. The first
of these dimensions is vertical. On this axis self experiences can be placed
up and down along the chronology of the individual's life. A second axis is
horizontal and consists of a range of selves of the individual at a particular
point in development. The third axis, also horizontal, is orthogonal to the
second and reflects the process of identification. It consists of the back-and-
forth oscillations between self-experience and the experience of the self as
other. The subject of this chapter lies in this dimension and focuses on
sudden, salient, and often perplexing “reversals” of the relation between
self and other. I begin with two examples.

REVERSALS AND THE INTEGRITY OF SELF

The first case is of a woman of 19. She has a history of multiple suicide
attempts. She is talking with a trainee psychiatrist who has recently become
her therapist and is asking him about the suitability of multiple sexual
liaisons. The question has arisen because several men have told her they
wished to live with her. Within a few sentences of listening to her inquiry,
however, the therapist finds himself accused of advocating a life of sexual
license. The patient reprimands him for this moral stance. The therapist is
bewildered because, as far as he knows, he has done nothing of the kind.
What is particularly baffling for him is that there has been a very rapid shift
in roles. At one moment the woman is treating him like a parent, asking for
advice about the complexities of relationships of late adolescent life. A few
moments later she becomes the parent, lecturing him about morality.

A second and more subtle reversal comes from a patient who does not have
a borderline personality, although she could be described as having a
disorder of self. She is sophisticated and intelligent and is telling the
therapist about a book she has been reading. The therapist's response is
misinterpreted by the patient and sensed as belittling. A few sentences later,
without apparent reason, the therapist finds that she is being lectured to by
the patient on Freudian theory, of which the patient has a very
comprehensive grasp. Once again the therapist is perplexed by a reversal of
roles, which in this case finds the patient switching from something like a
child/pupil role to that of parent/teacher.

What has happened in these two cases? Before we proceed to attempt an

answer, consider two more illustrations of reversals. The first of these is a
well-known case reported by Karl Abraham (1924). A woman was very
attached to her father. In Abraham's words, she clung to him “with all an
unmarried daughter's love” (p. 434). A terrible crisis occurred in her life
when her father was discovered to be a thief and was arrested. As a
consequence, she became psychotically depressed. The main feature of this
psychosis was that she held the delusional belief that she was a thief. It was
as if having lost her father—not only in a physical sense (since he was now
in prison) but also in her idealized view of him—she now became him.

The second story also concerns loss. Simone de Beauvoir (1969) described
her experience after visiting her mother in the hospital following an
operation in which it was discovered that she was in the last stages of
cancer. De Beauvoir's response was catastrophic. She went home late at
night and, after an outburst of tears, talked to Sartre:

I talked to Sartre about my mother's mouth as I had seen it that morning and
about everything I had interpreted in it—greediness refused, an almost
servile humility, hope, distress, loneliness-the loneliness of her death and of
her life—that did not want to admit its existence. And he told me that my
own mouth was not obeying me any more: I had put Maman's mouth on my
own face and in spite of myself, I copied its movements. Her whole person,
her whole being, was concentrated there, and compassion wrung my heart
[p. 28].

In a very subtle way, only detected by someone who knew her well, de
Beauvoir also showed a reversal following catastrophic loss.

Might it be that the transient reversals shown in the first two examples had
a somewhat similar basis? That is, they were responses to miniature losses
that precipitated a disruption of the sense of self. This, then, is the
hypothesis: Reversals are a consequence of a severe disruption of the sense
of self. This disruption occurs when there is a disjunction or disconnection
with the other who is sensed as necessary to the subject's going-on-being,
that is, with the selfobject. When the other is not available as selfobject or is
physically not there, the threat to self emerges. The reversal is an attempt to
shore up a sense of existence by becoming the necessary other who has
gone.

How does this idea help us to understand the first two vignettes? In the first
case the young woman was frightened by the possibilities that confronted
her. Although she seemed confident, in fact she was scared, not knowing
how to cope with the men around her. The therapist, however, responded to
her in a manner that he considered to be nonjudgmental. There was nothing
particularly wrong with this response except that he did not pick up the
patient's anxiety and so, for her, there was a feeling of being grossly
misunderstood. A disconnection or disjunction occurred of which the
therapist was unaware. In the second case, the therapist did not realize that
the book about which the patient spoke had an intense personal significance
for her. Although the therapist tried to respond in a way that was empathic,
the response was not perceived in this way. Once again, the patient was not
understood and a disconnection or disjunction occurred, and of a very
subtle kind. In both these cases, then, I postulate that the reversal was a
consequence of a break in the sense of connectedness between self and
selfobject that was experienced as a threat to the patient's sense of
existence, although this threat was slight and transient compared with the
massive losses of Abraham's patient and Simone de Beauvoir. A reversal,
then, is the consequence of a pathological situation in which anxiety of a
fundamental kind is aroused, in which something akin to annihilation or
disintegration is momentarily experienced.

It was perhaps Anna Freud who first drew attention to the phenomenon that
I am calling a reversal. In her essay “Identification with the Aggressor”
(1966) she suggests that behavior that seems to mimic the other is a form of
defense against an anxiety that was precipitated not long before. At the
beginning of the essay she gives an example of a boy who made faces in
class. These were so gross that at times the whole class would burst out
laughing. When the child was examined in the presence of the teacher, the
psychologist Aichorn saw that

the boy's grimaces were simply a caricature of the angry expression of the
teacher and that, when he had to face a scolding by the latter, he tried to
mask his anxiety by involuntarily imitating him. The boy identified himself
with the teacher's anger and copied his expression as he spoke, though the
imitation was not recognized. Through his grimaces he was assimilating
himself to, or identifying himself with, the dreaded external object [p. 113].

As Anna Freud put it, “a child introjects some characteristic of an anxiety

object and so assimilates an anxiety experience which he has just
undergone” (p. 113). How do these ideas of defense relate to the
phenomenon I have been describing?

If we consider the first example of the girl besieged by several men, we find
that a reversal is indeed due to anxiety. There are, however, two levels to
the anxiety. The first is the anxiety about not knowing how to manage her
relationships. Underneath this anxiety is a second and more fundamental
anxiety, one that arises from the failure of the therapist to understand her
feelings. This anxiety, which arises through the disjunction and which
momentarily poses, in a limited way, a threat to the sense of existence, is
fundamental; this more primitive kind of anxiety seems to be the necessary
trigger to a reversal. Following this postulate, one would suppose that the
boy who made faces was not merely afraid of scolding. Underlying this
fear, presumably, was a more basic and powerful form of terror associated
with a disintegration of self.
We must next consider whether, in fact, a reversal is a defense. What I am
saying is that a reversal is a consequence of a situation in which a
connection with the other is felt as necessary to going on being. When the
other fails as a selfobject, the child (or the patient) responds by taking on
for himself or herself a salient aspect of the other in order to shore up a
threatened sense of existence. Insofar as the reversal is a response to
anxiety, it is a defense. It is not, however, the kind of defense proposed by
Anna Freud (1966). She conceived the child's angry appearance as a
defense against an “external object” (p. 110). It was meant to frighten the
aggressor. However, I would speculate that the basis of this boy's behavior
was different. Most children are afraid of a scolding, but they do not make
bizarre faces. It seems not unreasonable to suppose that when the reversal
occurred, the little boy was so afraid of the teacher that all sense of self had
been obliterated.

The story of this boy suggests the possibility that originally in the chüd's
development the behavior of the other at the point of the disjunction
becomes the behavior of the subject during the reversal. This idea is
supported by a case report from Kohut (1984). In essence, the integrity of
self of his patient was threatened by the shaming responses of the
selfobject. However, “the patient was able to preserve the integrity of his
self by mobilizing his aggression, that is, by turning passive into active. In
this way, he became a sadistic voyeur, exposing the selfobject or its
substitutes and making the selfobject ashamed and embarrassed in its
exposure” (p. 144). Kohut believed that this tendency of his patient came
from early life and was a well-established or “ingrained” part of his
personality (p. 123).

REVERSAL AND TRANSFERENCE

Further evidence concerning reversals following disruptions of the self-

selfobject bond comes from a study whose principal aim was to evaluate the
outcome of cases in which patients with severe personality disorders were
treated according to the principles of a psychology of self by trainee
therapists working under close supervision. As far as can be judged, the
report of the findings describes the first prospective follow-up, at least in
the English language literature, of outpatient psychotherapy, of any kind,
with borderline patients (Stevenson and Meares, 1992). All sessions were
audiotaped, with the patients’ written consent. These tapes show that
disjunctions of the self-selfobject connectedness produced not only affect
shifts but also changes in language toward more linear and outer-directed
speech (Meares, 1990). They also precipitated transference phenomena
(Meares, 1993), which sometimes involved the mechanism of reversal when
the disjunction was severe. The following is an example:

The patient is 35. Her background includes repeated sexual abuse by her
father, with which, apparently, her mother colluded. The mother was an
unstable woman who was neglectful of her daughter and whose responses
to her were unpredictable. The patient has been admitted to a psychiatric
hospital over 30 times with manifestations of borderline personality,
including quasi-psychotic phenomena, suicide attempts, and self-mutilation.
She has responded to a change in session time by mutilating herself. At the
beginning of the following session the therapist notices that there is
something different about the patient and remarks on it. There is no initial
response but after about ten minutes the patient says, “The only thing I can
sort of think when I arrived, I had been pondering on what was different
about it ... the only thing I can think of ... you know, I felt such utter
contempt towards you.” She then goes on to talk about anger and how she
wants to hurt her husband when he hurts her. This, however, is an ordinary
anger, different from the extraordinary anger she felt for her therapist, an
anger that, although this was not made explicit, was expressed during her
self-mutilation.

The therapist replies by saying, “I was wondering if it seemed I was

contemptuous of you, that I was sort of dismissing you and your feelings.”

“Yeah, well it sort of felt like I'd been given the bum's rush,” says the
patient.

“I wondered if you'd had that feeling with your mum, that she was
contemptuous of you.”

“Very much, hmm.” Irrespective of what you thought or felt or what you
would have liked to have been, if she'd already decided on something, it
didn't matter, you didn't enter into the conversation.
Later in the session the patient describes the background to her self-
mutilation. When she was six or seven, she found that the only time she
would get a cuddle from her mother was when she would hurt herself
accidentally. She then started to cut herself to gain this solace, but her plan
soon began to fail since her mother realized what was happening and
reverted to her system of neglect. Nevertheless, the child found that cutting
herself was still soothing. There remained something of the soothing effect
of her mother's care within the act of cutting. In the patient's words: “I
remember I used to feel much better inside. I didn't feel so empty, so lonely
somehow.” In this way the self-mutilation, which involved something of a
reversal, was an integrating act.

A relationship between reversals and transference phenomena is evident in

the reverberations of contempt. We might suppose that the child's integrity
of self was originally threatened by parental contempt. In the case of the
self-mutilating patient the disjunction between self and selfobject comes
about in another way. Nevertheless, there is a reversal during which the
patient becomes contemptuous. Furthermore, she perceives the therapist as
also contemptuous. Put another way, “a whole series of psychological
experiences are revived, not as belonging to the past but as applying to the
physician at the present moment” (Freud, 1905, p. 116). In this case, then,
the reversal is accompanied by a transference experience.

A second illustration of the relationship between reversal and transference

comes from the therapy of another borderline patient, one who also suffered
from severe anorexia nervosa. Her relationship with her mother was fused
or symbiotic; that is, there was little sense of boundary between the child's
subjective space and that of the mother. Accordingly, the mother was able
to inflict severe sanctions upon the child by withdrawal. When this occurred
the patient was threatened with a sense of annihilation. A therapy session
that had been preceded by a severe disjunction, a vacation, opened with the
patient withdrawn and practically mute. Later in the session the patient was
able to say that she experienced the therapist as withdrawn and “cut off,”
although the tape showed that the therapist responded appropriately. In this
case also a severe disjunction brings about a reversal in which the patient
replicates the role of the original other in the earlier trauma. However, she
also experiences the other of the present in the same way.
INTROJECTS

How do these ideas relate to previous conceptualizations? The phenomenon

I have described has sometimes been seen as a manifestation of projective
identification that is “called upon to externalize aggressive self and object
images” (Kernberg, 1968). However, the connected mechanism of
introjection (the word Anna Freud used) might be more suitably invoked
since during the reversal the subject is as if inhabited by another. One of the
problems with the word introjection is that it is used to describe not only a
pathological situation based on anxiety but also a normal one. For example,
Melanie Klein (1955), in her famous paper “On Identification,” wrote that
“identification as a sequel to introjection is part of normal development” (p.
141). This collapsing of pathology and normality into one concept seems
unsuitable. Nevertheless, there is a case for retaining the use of the term
introjection, or introject, but using it in a specific and confined way.

I am suggesting that an introject is the end product of a reversal that has

become relatively fixed. Since it is hedged about with anxiety, it cannot be
integrated within the self-representation. The introject is “undigested”
(Kohut, 1971, p. 49). As Glasser (1986) suggests, introjection might be seen
as an incomplete process. The object does not become part of the self but
remains separate within it and is sometimes experienced as alien.

The normal process of identification is different. It is anxiety-free and is

fostered by an atmosphere in which the individual feels understood. Its first
phase is simple copying. For example, a little boy of two swaggers around
with his hands in his pockets, looking like his father. This is different from
the first stage of introjection, the reversal, which is almost echopraxic at
times (as in the case of the little boy who made faces) and where there is
little distinction between self and other. On the other hand, the two-year-old
who is swaggering around like his father shows this distinction. He is not
his father, he is like him. It is as if he were his father. His behavior has
about it a duality described by Stern (1985):

To perform delayed imitations, infants must have two versions of the same
reality available: the representation of the original act, as performed by the
model, and their own actual execution of the act. Furthermore, they must be
able to go back and forth between these two versions of reality and make
adjustments of one or the other to accomplish a good imitation [p. 164].

Identification progresses, we suppose, from a first stage in which the

experiences of the other is taken in as an “aliment,” as a kind of perceptual
food. Gradually, through the processes of assimilation and accommodation,
the object representation is taken into the self-representation completely. Or,
as Sandler and Rosenblatt (1962) put it, at the completion of the taking in of
the object representation the self-representation changes shape. The form of
the original other can no longer be found. This is the opposite of reversal, in
which the lack of integration causes the self to be experienced not as a
single “shape” but as a conglomerate. The absence of duality, or poor
differentiation between self and object, together with the impediment to
integration imposed by anxiety, leads to a collapsing together of
experiences of self and experiences of the other, without space between
them. This is exemplified by the patient who was contemptuous. When she
cut herself before the session, at least three experiences could be
distinguished: firstly, there was the child hurting herself; secondly, the child
hurting someone else; and thirdly, the mother soothing the child. Three
people, as it were, on top of each other. In some cases the “undigested”
nature of the introject is extreme. The individual has the experience of
being occupied or inhabited by somebody else, as in the following example.

A woman, frightened about her anger toward her small son, enters therapy.
There is a background of physical abuse by her father. During one session
she is able to describe her strange experience when she was about to strike
her son. She said, “I saw my dad and me in place of me and John [her son].
Him yelling and screaming and threatening me. Getting ready to hit me.
Fear, like a knot, in that situation. I was feeling it as a little girl. It was the
same feeling I'd had through my whole life, which is the trigger for a
worrying situation.” She went on:

I didn't want to be like that. The awful thing, I was repeating a memory that
was totally abhorrent to me and I didn't want to be like. I had no control. I
always said I would never be like him and here it was happening beyond
my control. It was as if subconscious, like I was being controlled by
something out of my power. It was like being demonized. Like having
someone in your body making you speak and making you act, even though
you're fighting it the whole time. Like your body's not your own. You don't
have control of your body or your speech.

This description supports the notion that a reversal first occurs in a situation
of high anxiety, even terror. Accounts such as this one are helpful in trying
to understand the phenomenon of the victim of abuse later becoming a
perpetrator (Johnson, 1988; Deltaglia, 1990). Such behavior is not
explicable in terms of, say, learning theory. The theoretical position put
forward here leads to the hypothesis that reversal is produced by the more
extreme form of abuse, in which little remains of the sense of self. This idea
conforms with the observations of some authorities in this area. Steele
(1986), for example, notes that

although there is no absolute correlation between the type of maltreatment

occurring in infancy and the type of maltreatment expressed in later life by
the adult parent, there seems to be a tendency toward direct literal
repetition. Victims of more severe physical punishment tend to repeat the
severe spankings and whippings with belts which they have undergone [p.
285].

“Literal repetition,” rather than a “digested” or transmuted form of

internalization, is a principal characteristic of the phenomenon of reversal.

SOME THERAPEUTIC IMPLICATIONS

Kohut (e.g., 1984, p. 70) regarded his conceptions of “transmuting

internalization” and the therapeutic error as central to his therapeutic
method. The method depends on appropriate responses to disjunctions that
occur in the sense of connectedness between self and selfobject. It is
essential, therefore, that the disjunction be detected. It sometimes appears as
a reversal, which may be brief, perhaps indicated only in a phrase or single
word, as in the following example.

A patient who had spent much of his early life in an orphanage could not
remember anything before the age of ten. He began a session by
announcing that his girlfriend was pregnant. This, he said, was “no
problem” since she would get an abortion. After a few connecting
sentences, the patient, showing little affect, went on to say that he wondered
if some early memories were beginning to be recovered since he had had
“images” of himself as a terrified child being dragged from under a bed,
presumably to be taken to the orphanage. The therapist then remarked that
the forthcoming abortion seemed to have triggered feelings relating to his
having been “got rid of” by his own mother. In a rather pompous voice the
patient replied, “Good point.” He then, without any apparent reason,
recounted successive incidents in which he had been physically attacked
and injured, humiliated after revealing an emotional state in which he had
been feeling “paranoid” and in which he had become enraged. The
disjunction was signaled by the momentary reversal indicated by the
authoritarian voice. There had been a swift change from “passive to active,”
to use Kohut's words. The therapist's response was sensed as an intrusion
threatening a precariously held inner zone, as in a paranoid system (Meares,
1988). The therapist, however, failed to notice the change of voice at “Good
point,” and afterward the session seemed to lose its way.

A second important reason for the need to detect a reversal is implied in the
concept of “intersubjectivity” (Stolorow, Brandchaft, and Atwood, 1987).
The reversal has an effect on the therapist, of which he or she may be
unaware. It creates a disruption that causes the therapist's behavior to
change. The language becomes grammatically less “impersonal” (Meares,
1983) and begins to focus on fact or reason rather than on the more
emotional “inner” aspects of the patient's experience. A further disjunction
is now inflicted upon the patient. Our tapes show that in the treatment of
those with a very attenuated and precarious sense of self, a spiral of anxiety
reminiscent of “the persecutory spiral” (Meares and Hobson, 1977) is now
set in motion. It may culminate in a relatively fixed reversal, in which the
patient seems relatively mature. The conversation that ensues may appear to
be useful and adaptive but, in fact, goes nowhere.

The notion of the relatively fixed reversal leads to another of the therapeutic
implications of the concept. The individual may present in this state. Since
the posture is frequently difficult to recognize, there may be a long period
of treatment in which nothing can happen because the wrong person, as it
were, is being spoken with. Sometimes the patient is able to describe what
is happening, sensing that his or her role is not quite real. In this sense, it is
one of the manifestations of a “false self system.” In extreme cases the
individual replicates his or her experience of someone else. In other cases,
in which the original anxiety was presumably less, the individual seems to
take on some of the functions of the failed selfobject. A variation of this
phenomenon may be the so-called “grandiose false self,” in which case the
individual maintains a stance of arrogance and superiority of a brittle and
unstable kind. This situation was described by Kohut (1971): “If the child
suffers severe narcissistic traumas, then the grandiose self does not merge
into the relevant ego content, but is retained in its unaltered form and strives
for the fulfillment of its archaic aims” (p. 28).

A final therapeutic implication concerns the possibility that reversals may

sometimes be iatrogenic. There is a style of therapy in which interpretations
are based on the idea that the patient's reality is disturbed by fantasy. When
the therapist's remarks are directed unremittingly at the unconscious, there
is a danger that those with a fragile sense of self will have this precarious
personal reality overthrown. Each interpretation has a strong potential to
create a sense of disjunction. In cases where the patient's response unsettles
the therapist, a “persecutory spiral” may develop. In the ensuing state of
high anxiety very little of the patient's self remains. The patient now takes
in, in undigested form, a reality which is not his or her own. He or she
becomes the other, even copying the therapist's mannerisms of speech and
gesture. This dispiriting picture is the end point of a therapy in which
neither partner detects the falseness.

SUMMARY

Reversal is the term applied to a fleeting change of self-state in which the

individual becomes the other. It is induced, in the first place, by intense
anxiety that obliterates inner reality. In the therapeutic situation it is
particularly likely to come about through a break in the connectedness
between self and selfobject. This break, however, is experienced as
massive, as compared to the break produced by an “optimal frustration,” in
which the individual's sense of personal existence remains. When the break
is optimal there emerges a duality, a double awareness made up on one hand
of an inner life, and on the other of a response to it that does not fit and that
is experienced as external. The reversal, on the other hand, is adualistic. In
the therapeutic situation a reversal is most likely to occur in those
individuals whose sense of self is somewhat precarious, that is, in
borderline personalities. An attenuated sense of self produces a
vulnerability that may lead to a series of rapidly changing, and often
perplexing, reversals during a single session.

When the personality structure is more stable than that of the borderline, the
reversal may become relatively fixed. In this case, it might be called an
introject. Since it is surrounded by anxiety, it cannot be integrated into the
self-representation and remains relatively sequestered. Its adualistic basis
fosters its permanence. Without reflection upon it, the system cannot
change. The concept of reversal may be useful in the understanding of
perpetrators of abuse who have themselves been victims.

These pathological identifications are contrasted with those that are normal
and anxiety-free and that arise in a state of connectedness with another who
is experienced as a selfobject. The way toward healthy identification begins
with the individual having within him or her the dual experience of both
self and other. It is supposed that something like an oscillation goes on
between these two poles, leading to an eventual integration of the
experience of the other into the self-representation so that the original form
of the experience of the other is no longer apparent.

REFERENCES

Abraham, K. (1924), A short study of the development of the libido, viewed

in the light of mental disorders. In: Selected Papers of Karl Abraham.
London: Hogarth Press, 1949, pp. 418–476.

de Beauvoir, S. (1969), A Very Easy Death, trans. P. O'Brian. London:

Penguin.

Deltaglia, L. (1990), Victims and perpetrators of sexual abuse: A

psychosocial study from France. Child Abuse & Neglect, 14:445–447.

Freud, A. (1966), The Ego and the Mechanisms of Defense, rev. ed. New
York: International Universities Press.
Freud, S. (1905), Fragment of an analysis of a case of hysteria. Standard
Edition, 7:7–122. London: Hogarth Press, 1953.

Glasser, M. (1986), Identification and its vicissitudes as observed in the

perversions. Internat. J. Psycho-Anal., 67:9–17.

Johnson, T. (1988), Child perpetrators: Children who molest other children:

Preliminary findings. Child Abuse & Neglect, 12:219–229.

Kemberg, O. (1968), The treatment of patients with borderline personality

organization. Internat. J. Psycho-Anal, 49:600–619.

Klein, M. (1955), On identification. In: Envy and Gratitude and Other

Words: 1946–1963, ed. R. Money-Kyrie, Β. Joseph, E. O'Shaughnessy & Η.
Segal. London: Hogarth Press, 1975, pp. 141–175.

Kohut, Η. (1971), The Analysis of the Self. New York: International

Universities Press.

_____(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

Meares, R. (1983), Keats and the “impersonal” therapist: Notes on empathy

and the therapeutic screen. Psychiatry, 46:73–82.

_____(1988), The secret, lies and the paranoid process. Contemp.

Psychoanal., 24:650–666.

_____(1990), The fragile Spielraum: An approach to transmuting

internalization. In: The Realities of Transference: Progress in Self
Psychology, Vol. 6, ed. A. Goldberg. Hillsdale, NJ: The Analytic Press.

_____(1992) Transference and the playspace. Contemp. Psychoanal.,

28(l):32–49.

_____(1993), The Metaphor of Play: On Disruption and Restoration in the

Borderline Experience. Northvale, NJ: Aronson.
_____Hobson, R. (1977), The persecutory therapist. Br. J. Med. Psychol,
50:349–359.

Sandler, J. & Rosenblatt, B. (1962), The concept of the representational

world. The Psychoanalytic Study of the Child, 17:128–148. New York:
International Universities Press.

Steele, B. (1986), Notes on the lasting effects of early child abuse

throughout the life cycle. Child Abuse & Neglect, 10:283–291.

Stern, D. (1985), The Interpersonal World of the Infant. New York: Basic
Books.

Stevenson, J. & Meares, R. (1992), An outcome study of psychotherapy in

borderline personality disorder. Amer. J. Psychiat., 149 (3):358–362.

Stolorow, R., Brandchaft, B. & Atwood, G. (1987), Psychoanalytic

Treatment: An intersubjective Approach. Hillsdale, N]: The Analytic Press.

An earlier version of this chapter appeared in Meares (1993). Reprinted by

permission of the publisher.
V Applied
Chapter Countertransference, Empathy, and the Hermeneutical
18 Circle

If Thou isM.
Donna said, the I of the combination I-Thou is said along with it.
Orange
Buber, I and Thou

. . . a human being who actually exists must be somewhere.

Schreber, Memoirs of My Nervous Illness

Countertransference, a favorite topic in many psychoanalytic circles since

the 1950s, has been until recently less than prominent in the literature, and
particularly in the case studies, of self psychology. Two questions thus
emerge: (1) Has the study of countertransference become peripheral in self
psychology, and if so, why? (2) Is the conception useful or necessary in self
psychology, and if so, how? A consideration of this second question will
involve some discussion of recent developments in philosophical
hermeneutics. This discussion will clarify the central claim of this chapter,
namely, that a self-psychological understanding of the psychoanalytic
process requires some notion like countertransference. It will also become
clear that we need to distinguish the narrower from the more inclusive
meaning of the term.

In part two of this chapter I use a broad conception of counter-transference

as the whole of the analyst's experience of the analytic relationship. For the
sake of clarity I suggest renaming this inclusive notion. In this first section,
however, the word countertransference will mean whatever the theorist
under discussion apparently intends, whether or not that theorist defines it.

THE APPARENT NEGLECT OF

COUNTERTRANSFERENCE IN SELF PSYCHOLOGY
Kohut (1971) began his revolutionary The Analysis of the Self as follows:
“The subject matter of this monograph is the study of certain transference
or transferencelike phenomena in the psychoanalysis of narcissistic
personalities, and of the analyst's reaction to them, including his
countertransferences” (p. 1). By countertransference Kohut meant those
remnants of the analyst's own narcissistic disturbances that interfered with
the development and analysis of the selfobject transferences. He cited, for
example, “the tendency of some analysts . . . to respond with erroneous or
premature or otherwise faulty interpretations when they are idealized by
their patients” (p. 138). If such countertransferences are stable, according to
Kohut, they often consist of “quasi-theoretical convictions or of specific
character defenses, or (as is frequently the case) of both” (p. 263). In the
final chapters of The Analysis of the Self Kohut devoted considerable
attention to countertransferential responses of analysts to the various
narcissistic transferences.

He returned to countertransference briefly in his posthumous How Does

Analysis Cure? where he continued to regard it as harmful by definition. “If
we want to see clearly,” Kohut (1984) wrote, “we must keep the lenses of
our magnifying glasses clean; we must, in particular, recognize our
countertransferences and thus minimize the influence of factors that distort
our perception of the analysand's communications of his personality” (p.
37). He went on to deny the applicability of the influence-of-the-observer-
on-the-observed principle in psychoanalysis and to attribute difficulties in
analytic understanding to the analyst's “shortcomings as an observing
instrument” (p. 38).

Since Kohut saw countertransference as interference, it has perhaps been

difficult for self psychologists to view it as an essential part of the theory
and process of psychoanalytic cure. In addition, Kohut (1971) thought that a
good psychoanalytic theory, like a good analytic treatment, should have
little or nothing to do with the analyst's personality (pp. 222–223n), that
analysis should be a nonidiosyncratic science that can be taught to
noncharismatic practitioners. The practitioners were not, however, to be
traditionally neutral; sustained listening to understand and to explain, he
thought, is not a neutral activity. To summarize, Kohut was torn between a
desire, even in his last years, to emphasize the human determinants in
psychoanalysis and his adherence to his classical training, which made him
want to sift the personal elements out. This ambivalence may have
prevented him from conceiving of countertransference as his survivors have
done.

Wolf (1988), for example, adopts Gill's (1982) usage and sees
countertransference as the analyst's experience of the relationship (p. 137).
He distinguishes among countertransferences, identifying (1) the analyst's
pleasure in effectiveness; (2) the “countertransferences proper,” which are
“based on the analyst's residual archaic selfobject needs” (p. 144); and (3)
reactive countertransferences, that is, the tendencies, identified by Kohut, to
defensively unmask the idealizing, mirroring, and merger transferences.
Wolf does not claim that his classification is exhaustive, nor does he explain
how analysts might use their experience of the analytic relationship.

Intersubjectivity theory, articulated by Stolorow, Brandchaft, and Atwood

(1987), goes even further toward making countertransference self-
psychologically respectable. For these authors the psychoanalytic process
emerges from the intersection and interplay of two differently organized
subjectivities. “Patient and analyst together form an indissoluble
psychological system,” they claim (p. 1). Their vision of psychoanalysis is
reminiscent of philosopher Hans-Georg Gadamer's (1976) account of play,
games, and language usage:

Now I contend that the basic constitution of the game, to be filled with its
spirit—the spirit of buoyancy, freedom, and the joy of success—and to
fulfil him who is playing, is structurally related to the constitution of the
dialogue in which language is a reality. When one enters into dialogue with
another person and then is carried along further by the dialogue, it is no
longer the will of the individual person, holding itself back or exposing
itself, that is determinative. Rather, the law of the subject matter [die Sache]
is at issue in the dialogue and elicits statement and counterstatement and in
the end plays them into each other [p. 66).

Within such a dialogue Stolorow, Brandchaft, and Atwood (1987)

understand countertransference as “a manifestation of the analyst's
psychological structures and organizing activity” (p. 42, chap. 3, written
with F. Lachmann) and hold that “transference and counter-transference
together form an intersubjective system of reciprocal mutual influence” (p.
42). We shall explore further some theoretical justifications for this view as
well as some of its further ramifications.

Self psychology has thus shifted significantly from Kohut's negative view
of countertransference toward a broader definition of the word. In addition,
we find a greater appreciation, at least in theory, of the importance of
recognizing the influence of the analyst/observer (whose experience of the
analytic relationship is countertransference in the inclusive sense) on the
observed. Where, then, are the discussions of the analyst's organizing
activity, history, and personality in our case reports? Why are many of us
still writing as if the analytic patient were the only one organizing or
reorganizing experience?

With a few notable exceptions (e.g., Goldberg, 1988; Thomson, 1991), we

self psychologists are, I think, so involved in and devoted to our efforts to
get and stay close to the patient's experience that we often forget that we are
there too. Thus, our cherished effort to understand patients from their own
vantage point may prevent us from recognizing our contribution to shaping
the patient's experience (the influence of the observer on the observed). It
may also interfere with our recognizing that we can understand another's
experience only through our own equally subjective experience. In the
words of Lomas (1987):

By the very nature of things people cannot attain perfect openness to each
other. Our perceptions are based on past experience. Nothing is entirely new
to us, otherwise we would completely fail to appreciate it. However much
we strive towards an unencumbered, receptive state of mind, we bring to
each exchange the sum total of our history, an interpretation that is unique
to us, the most coherent, manageable and least anguished Gestalt that we
have been able to attain [pp. 39–40].

The apparently spreading opposition to regarding transference as distortion,

which should expand to eliminate the distortion idea from
countertransference, is consistent with the acknowledgment that two
subjectivities are always at work.
In addition, I think the word countertransference sometimes puts off
clinicians who do not subscribe to theories of innate aggression. Instead, we
view anger and hostility as understandable responses to deprivation, to
abuse, and to the frustration of crucial emotional needs for appreciation,
affirmation, validation, and consistent support. Counter means, among other
things, “against” or “opposing,” and we self psychologists usually view
ourselves as allied with the patient. Perhaps cotransference would better
acknowledge our participation with the patient in the intersubjective field or
play space of the psychoanalytic dialogue. This inclusive term would
remove the assumption that the analytic relation is automatically or in most
respects adversarial.

The notion of cotransference, like the related ideas of intersubjectivity and

mutual influence, does not imply that there are no differences between the
participation of analysts and that of patients in the analysis. It does imply
and acknowledge that two differently organized subjectivities are always
involved in the dialogue. Nevertheless, the analyst or therapist is always
there primarily for the sake of the other. To acknowledge, as the
cotransference notion does, that two subjectivities are fully involved does
not preclude important differences between them.

COUNTERTRANSFERENCE AND SELF-

PSYCHOLOGICAL THEORY

Self psychology requires an inclusive notion of countertransference (or

cotransference) as a necessary, though not sufficient, condition for the
possibility of empathy. Empathy has occupied a pivotal place in the theory
of self psychology because Kohut (1959) insisted that the psychoanalytic
realm was by definition coextensive with whatever introspection and
empathy (or vicarious introspection) could reveal. By empathy Kohut did
not mean warmth or responsiveness—though he did regard these as
necessary conditions for analysis, he referred, instead, to the focused
attempt to enter another's subjective reality. Stolorow, Brandchaft, and
Atwood (1987) call this process “decenter-ing” to understand the patient's
subjectivity. Dialogic or perspectival realism (Orange, 1992) requires such
vicarious introspection for the communication and sharing of perspectives
in dialogue. Such empathic dialogue may result in both the understanding
of previous perspectives and the creation of new ones. Relying on one of
the old hermeneutic rules to achieve empathic understanding, I widen my
perspective (1 do not abandon it) by asking myself how the other . person's
point of view, feelings, convictions, and responses could make sense, could
be reasonable.

Philosophical hermeneutics may help us further here. Hermeneutics was

originally a set of rules or methods for interpreting biblical texts. More
recently, Schleiermacher and Dilthey saw hermeneutic inquiry as an attempt
to read the meaning of a text by reference to the author's intentions (mens
auctoris). How to gain access to the author's intentions was a further
practical problem. With the growth of historical consciousness in the past
century, hermeneutics has come to include history-we might say
development-as vital to understanding anything. Modern hermeneutics has
come to view a text or a painting or a dream as a “Sache selbst” (a thing
itself), partly understandable from the perspective of an interpreter. The
interpreter participates in a dialogue with the text. From this dialogue new
meanings are always emerging. We can know nothing of the text without
knowing the interpreter, including the interpreter's theories, personal
history, and organizing principles. There is no single completed truth about
the text, person, or dream. Rather, there is an indefinite number of possible
interpreters and perspectives whose communication may make possible
more inclusive and coherent—and thus truer-views, perspectives,
understandings, and theories.

Gadamer, quoted earlier, is now the most prominent proponent of this view.
Several of his favorite themes are pertinent to the more inclusive
psychoanalytic notion of countertransference. Gadamer claims, first, that
prejudice is inevitable. By prejudice he means the inevitability of being
somewhere vis-à-vis whatever we seek to know or understand. He thus
intends to strip the word prejudice of its negative connotations, as difficult a
task as making countenransference a neutral or positively valenced term.
Here is Gadamer's (1976) attempt:

It is not so much our judgment [about truth or value] as our prejudices that
constitute our being. This is a provocative formulation, for I am using it to
restore to its rightful place a positive concept of prejudice that was driven
out of linguistic usage by the French and the English Enlightenment. It can
be shown that the concept of prejudice did not originally have the meaning
we have attached to it. Prejudices are not necessarily unjustified and
erroneous, so that they inevitably distort the truth. In fact, the historicity of
our own existence entails that prejudices, in the literal sense of the word,
constitute the initial directedness of our whole ability to experience.
Prejudices are biases of our openness to the world. They are simply
conditions whereby we experience something—whereby what we encounter
says something to us. This formulation certainly does not mean that we are
enclosed within a wall of prejudices and only let through the narrow portals
those things that can produce a pass saying, “Nothing new will be said
here.” Instead we welcome just that guest who promises something new to
our curiosity [p. 9].

Similarly, American philosopher C. S. Pierce (1931–1935) explained:

We cannot begin with complete doubt [in the style of Descartes]. We must
begin with all the prejudices which we actually have when we enter upon
the study of philosophy. The prejudices are not to be dispelled by a maxim,
for they are things which it does not occur to us can be questioned
[Hartshorne and Weiss, 1931–1935, v. 5, p. 156].

Another way to speak of the necessity of prejudice (or of cotransference) is

to consider the historicity, or personal/relational history, of the interpreter.
For Gadamer, interpretation is not an attempt to read an author's mind, as
Schleiermacher and Dilthey believed. Instead, the dialogic process, the
interplay of interpreter and text (or patient), creates something new: the
interpretation. Interpreter and text are equally important, and the historicity,
including the prejudices (organizing principles), of the interpreter takes on
an organizing role. Gadamer regards the attribution of subjectivity to the
text and objectivity to the interpreter as a dangerous denial of the
interpreter's contribution to the making of meaning.

It is not that we should simply accept our prejudices or organizing

principles; rather, we must continually test them. We test them not by
empiricist criteria to check for distortion but in dialogue. Continental
philosophers often use the notion of horizon to mean the field of vision, or
whatever perspective is available from where one stands. We test our
prejudices by attempting to see whether they fit with broadening horizons.
Similarly, we revise organizing principles to take new experience into
account (as in Piagetian accommodation). Colloquially, we sometimes
speak of education or travel as “broadening our horizons,” enlarging our
perspective on the world. Rightly or wrongly, people commonly make the
assumption that a broader perspective is likely to be truer, that narrowness
is somehow wrong-headed. The psychoanalytic version of the assumption is
that deeper is better. (To the objection that delusional people claim to see
broadly and deeply into meanings, a response might be that we are speaking
of the elaboration of complexity whereas delusions usually oversimplify.)
In the hermeneutical view we attain a broader or deeper experience of
anything by knowing and acknowledging who we are — our historicity and
our prejudices. Only thus can we enter the playful dialogue that broadens
and deepens our understanding.

In psychoanalytic language, we must know and acknowledge our

countertransferences, our cotransference, our point of view or perspective,
if we are to become capable of empathy or vicarious introspection. We must
acknowledge the lenses through which we are reading the text in order to do
authentic psychoanalytic work, or to speak authentically of our work.

This is, by the way, not a discussion of the advisability or inadvisability of

countertransference disclosures. This question belongs under the principle
of optimal responsiveness (Bacal, 1985). Normally, I decide such matters
on pragmatic grounds. The central pragmatic maxim can be expressed as
follows: “By their fruits shall ye know them.” Thus, if an intervention or
response usually yields understanding and self-consolidation, then it
deserves serious consideration (and vice versa).

Under discussion here, instead, is the nature of understanding itself. At

issue is the thesis that co-transference (or countertransference in the
inclusive sense) is a necessary though not sufficient condition for the
possibility of empathy. Countertransference here includes both historicity
and the prejudices/horizons of philosophical hermeneutics, which are
roughly equivalent to personal history and organizing principles. To
understand psychoanalytically, and to understand psychoanalytic
understanding, we must acknowledge our historicity and examine our
prejudices. To work psychoanalytically we must have access to our
historicity and prepare ourselves to criticize our horizons and to revise those
prejudices that limit our capacity to understand another's experience.

Finally, to reexamine the whole question of the place of counter-

transference in self-psychological theory, let us turn to the old question of
the hermeneutical circle. The paradox that understanding is inevitably
circular has been expressed in many ways. Palmer (1969) summarizes the
view of the early Romantic philologist Friedrich Ast: “Because Geist is the
source of all development and all becoming, the imprint of the spirit of the
whole (Geist des Ganzen) is found in the individual part; the part is
understood from the whole and the whole from the inner harmony of its
parts” (p. 77). Similarly, for Schleiermacher, the whole of the text and the
parts of the text explain one another. Dilthey provides the example of a
sentence whose meaning can be grasped only via the inevitable interaction
of whole and parts. In Palmer's words:

Dilthey cites this example and then asserts that the same relationship exists
between the parts and whole of one's life. The meaning of the whole is a
“sense” derived from the meaning of individual parts. An event or
experience can so alter our lives that what was formerly meaningful
becomes meaningless and an apparently unimportant past experience may
take on meaning in retrospect. The sense of the whole determines the
function and the meaning of the parts. And meaning is something historical;
it is a relationship of whole to parts seen by us from a given standpoint, at a
given time, for a given combination of parts. It is not something above or
outside history but a part of a hermeneutical circle always historically
defined [p. 118].

Dilthey's view of understanding has implications for the debate between

those who favor here-and-now focus and those who emphasize history and
development in clinical work. Neglect of either, in his view, would hinder
understanding. For our purposes here, however, Dilthey illuminates the
necessity of the dialectic of whole and part, past and present, for
understanding. It has remained for Gadamer to include the future in the
dialectic and to show that the hermeneutic circle is not a vicious circle once
the historicity and horizons of the interpreter take their rightful place.
Gadamer sees clearly that the risking and testing of prejudices in “dialogical
encounter” is the path to understanding through the hermeneutical circle.
The nature of understanding is that we can come to understand only what
we already understand. Risking testing our organizing principles in dialogue
with a text or a person makes possible a new meaning, a newly
complexified organizing principle, a future form of experience that could
emerge only through the dialogue. This fully relational and intersubjective
account of the process of psychoanalytic understanding is completely
incompatible with objectivist and empiricist theories of truth or with an
exclusive focus on the subjectivity of the patient.

Gadamer's solution to the feared subjectivism and solipsism of the

hermeneutical circle is to say that the path to understanding in the
hermeneutical circle is via the self-knowledge of the interpreter. If for his
“understanding” we read “empathic understanding” and for “text” we read
“patient,” the implications for psychoanalytic self psychology become
clear:

In reading a text, in wishing to understand it, what we always expect is that

it will inform us of something. A consciousness formed by the authentic
hermeneutical attitude will be receptive to the origins and entirely foreign
features of that which comes to it from outside its own horizons. Yet this
receptivity is not acquired with an objectivist “neutrality”: it is neither
possible, necessary, nor desirable that we put ourselves within brackets. The
hermeneutical attitude supposes only that we self-consciously designate our
opinions and prejudices and qualify them as such, and in so doing strip
them of their extreme character. In keeping to this attitude we grant the text
the opportunity to appear as an authentically different being and to manifest
its own truth, over and against our own preconceived notions [1979, pp.
151–152].

To summarize, I use a perspective derived from philosophical hermeneutics

to elucidate my claim that countertransference in the inclusive sense is
indispensable to empathy, is a necessary condition for empathy, and thus
will find a prominent place in a self psychology aware of its own nature and
nuclear program. I further suggest that this inclusive sense be renamed
cotransference and that we reserve the term countertransference for the
analyst's emotional memories that interfere with empathic understanding
and optimal responsiveness.

REFERENCES

Bacal, H. (1985), Optimal responsiveness and the therapeutic process. In:

Progress in Self Psychobgy, Vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 202–227.

Gadamer, H. (1976), Philosophical Hermeneutics, trans. D. E. Linge.

Berkeley: University of California Press.

_____(1979), The problem of historical consciousness. In: Interpretive

Social Science, ed. P. Rabinow & W. Sullivan. Berkeley: University of
California Press, pp. 103–160.

Gill, M. (1982), Analysis of Transference, Vol. 1. New York: International

Universities Press.

Goldberg, A. (1988), A Fresh Look at Psychoanalysis. Hillsdale, NJ: The

Analytic Press.

Hartshorne, C. & Weiss, P., ed. (1931–1935), Collected Papers of Charles

Sanders Pierce. Cambridge, MA: Harvard University Press.

Kohut, H. (1959), Introspection, empathy, and psychoanalysis, J. Amer.

Psychoanal. Assn., 7:459–483.

_____(1971), The Analysis of the Self. New York: International Universities

Press.

_____(1984), How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.

Chicago: University of Chicago Press.

Lomas, P. (1987), The Limits of Interpretation. Northvale, NJ: Jason

Aronson.
Orange, D. (1992), Subjectivism, relativism, and realism in psychoanalysis.
In: Progress in Self Psychology, Vol. 8, ed. A. Goldberg. Hillsdale, NJ: The
Analytic Press, pp. 189–197.

Palmer, R. (1969), Hermeneutics: Interpretation Theory in Schleiermacher,

Dilthey, Heidegger, and Gadamer. Evanston, IL: Northwestern University
Press.

Stolorow, R., Brandchaft, B. & Atwood, G. (1987), Psychoanalytic

Treatment: An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.

Thomson, P. (1991), Countertransference in an intersubjective perspective:

An experiment. In: Progress in Self Psychology, Vol. 7, ed. A. Goldberg.
Hillsdale, NJ: The Analytic Press.

Wolf, E. (1988), Treating the Self. New York: Guilford Press.

Chapter 19 The Child-Pet Bond

It is the thesis of this chapter that pets can play a critical role in providing
Lindsey Stroben Alper
selfobject functions to the young and developing child, particularly in an
otherwise impoverished or exploitive selfobject environment. I will explore
some initial ideas on this topic, drawing from my clinical experience, case
material of other therapists, and empirical studies on the human-animal
bond. Together, I hope that these ideas will illuminate the variety of ways in
which pets may amend or enhance the fulfillment of the particular
developmental needs of a child whose available selfobjects are unable to do
so.

THE CHILD-PET BOND: RESEARCH

A number of studies have illustrated the positive role that pets can play with
special populations. Programs have been developed that place pets with the
elderly (Garrity et al., 1989), the handicapped (Frith, 1982; Ross, 1983),
psychiatric inpatients (Holcomb and Meacham, 1989), prison inmates
(Katcher, Beck, and Levine, 1989), and children with special needs
(Gonski, 1985; Redefer and Goodman, 1989). Absent, however, is a
theoretical explication of why human-pet relationships consistently have
been found to have positive psychological effects; in particular, “there is
very little analysis of the role of pets in child development” (Robin & ten
Bensel, 1985, p. 63).

Despite the lack of a theoretical conceptualization, several studies have

directly explored the child-pet bond. Levinson's early studies (1961, 1972)
suggest that in their roles as companions, confidants, playmates, and
admirers pets can provide rich learning experiences, expedite adaptation to
emotional trauma, regulate emotional problems, and enhance psychosocial
development. Condoret (1973) posits that pets are important in regulating
affective functioning, particularly in psychotic and mentally retarded
children.
Other research has confirmed the hypothesis that interactions with pets can
play a role in the emotional world of the child. In an exploration of
children's feelings about their pets, Kidd and Kidd (1985) found that 32
percent of the children they interviewed confirmed statements indicating the
emotional soothing they received from their pets (e.g., “comforts me when
I'm sad” and “keeps me from being lonely”). Twenty-eight percent of the
children confirmed that their pets provided a source of learning, teaching
them about responsibility and relationships. Twenty percent viewed their
pets as playmates, and 15 percent said that they received love from their
pets. In a study of adolescents, Wolfe (1977) suggested that pets can
function as “transitional objects” by providing consolation, reducing stress,
and mitigating maladaptive responses to traumatic events. Further support
for the salutary impact of pets includes Sherick's (1981) description of the
role of pets in a young girl's expression of unconscious conflicts and as a
symbolic substitution for her ideal self and Melson's (1990) work
suggesting the positive role of pets in the development of nurturance.

While the benefits of pets for children have been demonstrated, a

theoretical conceptualization of why child-pet relationships are beneficial is
lacking. An analysis of the child-pet bond from a self psychology
perspective provides a framework for a deepened understanding of this
bond and and of the past and current significance of adult patients’
relationships with their animals.

A SELF PSYCHOLOGY FRAMEWORK

Clinicians and theoreticians of personality development have long

contended that social stimulation and affective connection with others form
the bedrock upon which healthy growth proceeds (Spitz, 1965; Mahler,
Pine, and Bergman, 1975; Bowlby, 1982). Self psychology has elaborated
on these themes and has contributed to an understanding of the process of
self development by elucidating the crucial importance of empathic
responsiveness from the child's self-object environment (Kohut, 1971,
1977). According to self psychology, the ideal developmental scenario is
one in which the child's caretakers provide consistent recognition,
appreciation, and reflection of the child's actions and accompanying affect
states. Such an optimum environment enables children to form a sense of
themselves that is cohesive and resilient. The resultant self-structure has the
capacity to regulate affect and to withstand blows to self-esteem. Healthy
narcissism, ambitious strivings, and the capacity for empathy develop and
mature.

Research with infants suggests that structuralization and the unfolding of

inherent capabilities are potentiated through interaction with other people
(Stern, 1983). However, even in families where caretakers have some
capacity for emotional attunement, certain important selfobject functions
are not met or are met incompletely, ambivalently, or erratically, impairing
the growth and development of the child. The unfolding process stagnates,
and vital psychological structures do not develop. Stolorow, Brandchaft,
and Atwood (1987) define these “developmental derailments” as the
swerving off course of normal developmental lines owing to the failure of
caretakers to provide age-appropriate selfobject responsiveness. Another
way to view this process is in terms of the degree of derailment: The less
significant the deficits in the selfobject environment, the more cohesive and
unified is the self and the less significant the derailment. Minor detours are
not believed to preclude a later rekindling and integration of developmental
processes. The defensive structures protecting the nuclear self are less
firmly ensconced, and the archaic, nascent self is less ossified.

THE INTEGRATION OF AFFECT

Stolorow et al. (1987, p. 20) contend that “selfobject functions pertain

fundamentally to the integration of affect into the organization of self-
experience, and that the need for selfobject ties pertains most centrally to
the need for attuned responsiveness to affect states in all stages of the life
cycle.” In families where the range of allowable affect expression is
constricted, children may find it safer to explore the vicissitudes of
emotionality and affect with their pets because animals do not judge,
criticize, or humiliate the child's embryonic rehearsal of new behaviors and
emotions. They do not retaliate, feel overwhelmed, or reject the child who
is expansive in displaying her or his grandiose self. They can, however,
provide approximations of mirroring, idealization, and twinship selfobject
functions.
In “dysfunctional” families, where there is a paucity of emotional
attunement and a limited capacity for sustained intimacy, there are multiple
unmet needs and a greater likelihood that the child will be unable to
experience one or both parents as idealizable figures. Furthermore, when
clear mirroring or the capacity to maintain a consistent relationship of
attuned responsiveness with the child are compromised, the child forms an
inaccurate, negative, empty, or fluctuating sense of self, one that is
susceptible to disintegration and fragmentation.

Children, however, are often adept at seeking out and utilizing whatever
objects are available in order to supplement-or to provide altogether-the
functions that are necessary for the development of a cohesive self. In some
instances, members of the extended family provide crucial selfobject ties.
Neighbors, teachers, and peers can also assist in facilitating the growth of a
stable and coherent self through the selfobject functions they provide. The
term object has traditionally referred to a person, and the term selfobject has
to some extent absorbed and been limited by this connotation. My clinical
experience, however, has led me to understand that for many patients
animals have provided a primary attachment in which they feel comforted,
esteemed, and unabashedly loved. It is a relationship in which they receive
the longed-for gleam of love and delight that the dull eyes of their primary
caretakers do not reflect. I hope that through descriptions of experiences in
which a child's pet provided rough functional equivalents of important
selfobject responses the concept of selfobject can be expanded to the
nonhuman domain. The consequences of pets, rather than humans,
providing these needs will also be discussed.

CLINICAL EXAMPLE: HILARY

The following is a case study of a young woman whose relationship with

her dogs provided her with experiences of attuned responsiveness.
According to Stolorow, Brandchaft, and Atwood (1987), the overarching
selfobject need is for affect attunement, which when consistently available
forms the foundation for the integration of the child's affective states.

Hilary entered therapy at 28 years of age with vague complaints of

unhappiness, lack of self-esteem, and drug dependency. She described her
family of origin as close-knit, a family whose members enjoyed being
together and “had a lot of fun.” Hilary, her younger sister, older brother, and
her parents lived in the same town and spent most weekends together.

After several months of discussing her family, Hilary began to see that the
facade of a fun-loving family belied a pervasive sense of depression and
anxious interpersonal interactions. As therapy progressed, Hilary began to
reconnect to memories of her attempts to gain the interest and attention of
her parents and to express her emotional world through the writing of
stories and poems. Her father, a busy sales executive, was frequently away
on business trips. Hilary saw her mother as an emotionally reticent and
inhibited woman who had never fully recovered from the death of her twin
sister, who had died while she was pregnant with Hilary. The mother could
not allow herself to be emotionally spontaneous and responded with
palpable discomfort to her daughter's unbridled emotionality. She was also
unable to mirror aspects of the daughter's emotional experience that were
expressed through Hilary's writing; when Hilary excitedly showed her
mother her stories and poems, her mother appeared bored and unimpressed.
Repeated experiences of a flattened response from her mother eventually
resulted in a dampening of Hilary's exuberance and creativity. She turned
away from seeking out her mother for this need in order to avoid the painful
invalidation that came with exposure to her mother's “excitement
boundaries” (Benjamin, 1988). Other family members were not available to
provide the needed mirroring either. Hilary's sister was withdrawn, and the
unspoken but insidiously competitive relationship between them prevented
a close attachment.

About a year after therapy began, Hilary brought into a session several
scrapbooks that she had assembled as a young girl. These scrapbooks,
which resembled “baby books,” chronicled the life of each of her dogs in
exquisite detail. In the scrapbooks, which included snapshots of the dogs in
hundreds of poses, Hilary had described their personalities, favorite foods,
dog friends, relationships with each family member, and favorite activities.
Although she had spoken in therapy about her pets, it was through the
books’ careful accounting of her dogs’ lives that I began to think about the
importance of these pets in keeping alive and expanding Hilary's emotional
and affective capacities.
Idealizing

As we began to explore more deeply her relationship with her dogs, Hilary
revealed that she had spent a great deal of time training them in obedience
classes and entering them in professionally judged competitions. This
aspect of her relationship, with one dog in particular, was, I believe, central
in providing an idealizing selfobject function. Idealizing refers to the child's
need to merge with the perceived omnipotence and greatness of an admired
other, and it requires a selfobject who exhibits positive qualities and who
can tolerate the child's need to idealize. When idealizing needs are thwarted,
as when idealized figures are noxious or even when, more benignly, the
object cannot tolerate the idealization, children are deprived of a template
and cannot identify with an idealized other. In the best of circumstances,
such an identification allows the child to absorb and internalize a sense of
self-worth that evolves into healthy narcissism. In Hilary's family, the
prototype for the development of healthy narcissism was minimal. Her
mother's frequent self-disparaging remarks communicated to Hilary that she
was not worthy of idealization, thus preventing Hilary from internalizing
and establishing an ideal self. On the other hand, Hilary's dog embodied
many positive qualities and was “willing to tolerate” her idealization. This
was particularly important for Hilary because of her gradual disillusionment
in her mother.1 Showing her dog, an extension of herself, provided Hilary
with an avenue for the development of her thwarted narcissism, channeling
it into a form that was given public and familial approval; The dogs
provided her with an opportunity to feel proud and worthwhile.

Mirroring

According to Kohut (1971, 1977), mirroring refers to children's need for

positive recognition and confirmation of their uniqueness and greatness. In
the privacy of her room, Hilary conducted poetry readings in which her dog
was the enthusiastic audience. The dog sat attentively through the readings,
and when Hilary enthusiastically asked, “Did you like it?” the dog would
wag her tail, lick her mistress, and jump up and down. She responded with
enthusiasm and activity, a rough functional equivalent of the attuned
responsiveness Hilary's parents were unable to provide. The dog provided
Hilary with a positive image of herself, reflected back her own natural joy
in her creative productions. Her internal experience of excitement was
validated, allowing her to develop an awareness and appreciation of her
own creativity. Through her dog Hilary saw mirrored a worthwhile,
interesting, and expressive self, and it was this mirroring response that
made her feelings and actions meaningful.

I believe that repeated interactions of this nature greatly contributed to the

integration of Hilary's emotional experience into a more cohesive self.
Although Hilary entered into therapy with a certain fragility of self, I would
suggest that repeated interactions in which she experienced mirroring from
her dog contributed to a more resilient self-structure and mitigated against
other selfobject failures that rendered her susceptible to fragmentation.

Hilary attributed to her dog a capacity to understand her and to respond to

her feelings in a comforting way. Her dog's responses were validating and
affirming. She found in her dog a much needed recognizing other. In this
relationship was the self-other matrix where empathic resonance and
affective interchange were available. Although this may appear to be no
more than projection, Hilary's experience, like that of many pet owners, was
that her pet “knew” what she was feeling and responded to it. Like other
children with cold, withdrawn, or overwhelmed parents, whose lack of
responsiveness can leave them feeling impotent and dead, Hilary needed a
responsive other whom she could affect and allow herself to be affected by.
Recent research has confirmed that there exists a reciprocal relationship
between children and their dogs in which each acts upon and reacts to the
other (Filiatre, Millot, and Montagner, 1986). This mutual recognition is
crucial in the formation of the self. The lack of reciprocal recognition is
frequently a hallmark of dysfunctional families.

Hilary's experience is echoed in the work of Gonski (1985), who studied the
interactions between dogs and children in foster care who had been
abandoned, neglected, or abused. She found that these children were
significantly affected as a result of contact with a dog. Specifically, “the
mere presence of the dogs was often suifficient to elicit laughter, lively
conversation, and excitement among even the most hostile and withdrawn
of the children” (p.97).
Pets’ behaviors are frequently perceived as straightforward (i.e.,
unconflicted and unambivalent). This may help a child to begin to
differentiate between different affect states. Tail wagging, growling, hissing,
and purring (some dogs even “smile”) are relatively easy to differentiate
and correspond with other overt behaviors of the animal. This function of
assisting the child to distinguish and differentiate between different affect
states is particularly useful in homes where affect is repressed, ambiguous,
dulled, or unacceptable.

This is not to say that pets can completely compensate for absent or
distorted mirroring. It is likely that children who rely on pets as mirroring
objects may, later on, be unable to make subtle discriminations between
affective states because no pet can provide more than a rather gross
approximation of a child's state. Children may feel confirmed and their
affects may not be completely split off, but they may later lack the ability to
make subtle discriminations between their own (and others’) affective
states. This was certainly true for Hilary, who in stressful situations
frequently could make only gross differentiations between her own
affective states. For example, she would frequently make statements like
“I'm not sure if I'm sad or just bored.”

Hilary began to do more creative writing and to bring in her work soon after
we looked at her dog books together. Discussion of the dogs’ importance
seemed to unleash a flurry of creativity in the therapy. Because I was able to
value and appreciate the importance of Hilary's dogs, and in a manner
paralleling the dogs’ function, an intersubjective field was created that
provided an opportunity for the disavowed and undeveloped aspects of the
self to reemerge. I believe that this repository of creative energy was
accessible because it had been kept alive by Hilary's interactions with her
dog. Prior to our exploration, this patient had demonstrated a visible yet
inhibited remnant of this creative potential. It is possible that repeated
experiences of responsiveness from her dog prevented the total derailment
and splitting off of this capacity for affectively charged creative expression.

CLINICAL EXAMPLE: TERRY

Terry entered therapy at the age of 50, complaining of a repetitive pattern of
emotionally abusive relationships. She had been a diabetic for 42 years, and
her family's concern for her health had created an environment of
overprotection, particularly in the area of emotional expression: her mother
believed that if Terry became too excited, an insulin reaction would be
precipitated, resulting in convulsions, coma, or death. Because Terry was a
brittle diabetic, these fears were reinforced by frequent medical
complications, including severe insulin reactions, and periodic convulsive
episodes.

Terry's diabetic condition and her parents’ subsequent overprotective

behaviors isolated her from her playmates. Her cat Samuel was her primary
companion; he was constant, loyal, and devoted, remaining attentive
regardless of her emotional state. He provided a twinship selfobject
function. Terry could cry, feel upset, and be crabby, sullen, or hyperactive
without fear of criticism. In therapy Terry described many instances of
confiding her innermost feelings to Samuel. He provided the unconditional
acceptance that her parents, because of their own fears, and her siblings and
peers, because of Terry's “differentness and limitations,” could not
consistently provide. With Samuel, Terry had an opportunity to practice the
vicissitudes of her emotional world. Her affects could not be integrated in
the context of her family because family members were unable to provide
the requisite responsiveness.

In therapy sessions Terry spoke about her childhood and her current
relationship in a flat and matter-of-fact way. It was not until she began
discussing her relationship with her cat—fortunately, the therapist was able
to recognize its importance—that Terry began to show and experience
emotion in the therapy. During one session Terry described an incident that
occurred when she was eight: She and her sister had been playing a
“camping game” indoors when the makeshift tent they had built collapsed
and fell on her new kitten. The kitten's back was broken and he died. While
she was unable to grieve for her own disability, Terry was able to deeply
grieve over the death of her kitten. As she related this trauma in therapy, she
sobbed and finally said, “The only time I remember ever feeling anything
was when it had to do with one of my cats.” In discussions concerning her
cat, affects that were once available to her (and partially integrated) vis-à-
vis her cat were revivified and emerged in the therapeutic milieu. Although
these experiences were infrequent, they did give Terry some opportunity to
experience feelings, to label them, and to develop a vocabulary for
describing them, and, over time, to experience a sense of validity in her
own unique subjective inner experience.

Terry's bond with her cat also helped her to reexperience herself in a new
way. Because of the diabetes, others were always caring for her. Her
caretaking of her cat allowed Terry the opportunity to see herself as
nurturant and allowed her to incorporate an image of herself as caring, kind,
and giving, as opposed to needy, bad, and taking. This redefinition is
particularly important if it is in contradistinction to previously introjected
negative attitudes of the self, such as “bad,” selfish, mean, and so on. It
seems likely that Terry's prolonged attachment to Samuel and her
experience in caring for him assisted her in elaborating a narrow view of
herself into a fuller, richer sense of self that incorporated positive qualities.

In therapy Terry frequently described the sensual pleasure of stroking and

petting her cat. Research has shown that pets provide opportunities for
soothing tactile stimulation, and touching a pet has been shown to affect the
cardiovascular system by reducing blood pressure (Friedmann, 1979;
Friedmann et al., 1983). Stroking her cat enabled Terry, who felt isolated
and rejected, to feel soothed and connected with another sentient being.
From Terry's descriptions, it appeared that she actively sought out her cat to
hold and stroke when she experienced states of internal disorganization. She
described, for example, a frustrating experience with her father: He had
walked into the kitchen while she was eating a candy bar. He began to
criticize and lecture her and then told her not to get too excited when she
became agitated and angry. She tried to explain that she was aware that she
needed glucose and that she had been attempting to regulate her blood
sugar. This experience was pivotal for Terry as it represented both her
repeated attempts to take responsibility for and respond to her own internal
states and her father's implicit injunctions against her doing so. On that day,
as on many others, Terry sought out her cat to hold and to talk to. Her cat
was particularly reinforcing, settling into her lap and soothing her with
reassuring purrs.
In families where the boundaries for appropriate sexual expression are
blurry or nonexistent, this tactile connection with animals can provide a
safe outlet for affectional contact and sensual relating. On the other hand, if
this contact is the primary physical outlet, it may interfere with the
development of an expressive and comfortable sexual self. The primacy of
Terry's physical relationship with her cat may have contributed to the many
ambivalent feelings she had regarding her own sexuality.

WHAT ABOUT TURTLES? A NOTE ON PETS WHO DO

NOT RESPOND

Pets differ in the extent to which they are perceived to respond to one's
actions and affective states. The higher the animal on the phylogenetic
scale, the more likely it is that it will be perceived as differentially
responding to or mirroring the child. A goldfish, gerbil, snake, or hermit
crab, while not responsive in the traditional sense, can nevertheless function
as a stable or soothing selfobject that can mitigate the liability and
instability of a child's affect states and may thereby play a role in the
integration of affect. To learn to self-soothe, one first needs a soothing
other, and pets may become that soothing other. Evidence supporting the
calming effect of nonresponsive pets is seen in a recent study which found
that coronary patients were significantly less anxious and recovered faster
than control subjects when a well-stocked aquarium was placed in their
hospital room (King, 1989).

Clearly, the characteristics of the pet will affect the nature of the attachment
experienced by the child (this is true within as well as between species), but
any pet provides the child with an opportunity to caretake, to own, to name,
and to feed it and offers the child an outlet for expressive affectional needs
as well as an emotional/affective connection. Owning and caring for a pet
may facilitate the capacity to put oneself in another's position, the keystone
of empathy; in fact, there is evidence of a positive relationship between pet
ownership and empathy (Hyde, Kurdek, and Larson, 1983; Melson, Sparks,
and Peet, 1989; Michaels, 1989).

Secondarily, nonresponsive pets may function as a medium through which

selfobject functions are provided by others, that is, as a social catalyst. For
example, a recent program at the University of California, Davis Veterinary
School paired handicapped children with animals and found that the
children were approached more frequently by their peers, indicating that
owning a pet can help to mitigate a child's sense of social isolation and can
provide the child with opportunities for the development of social
competencies.

CLINICAL IMPLICATIONS

In addition to understanding and appreciating the client's relationship with a

pet, the particular meanings attached to that relationship, and the selfobject
functions provided by the pet, it is also important for the therapist to keep in
mind the fact that children who establish an intense or exclusive
relationship with a pet may suffer in the development of sophisticated and
meaningful relationships with people. If a child's primary affective tie is
with a pet (especially when it is developmentally appropriate to be making
attachments to peers), he or she may be at risk for problems in subsequent
psychosocial development.

An examination of the patient's bond with a pet can be a valuable avenue

for garnering information about the selfobject deficits of the family as
experienced by the child. Therapeutic efforts can be directed toward (1)
generalizing the positive aspects of the patient's relatedness from pets to
humans and (2) using the safety of the empathic therapeutic relationship to
establish the subtler and more differentiated human-human contact.

Although I have focused in this chapter on the child-pet bond, the variables
of age and gender need to be addressed in additional work. Adults do not
outgrow their need for selfobjects, and the refueling of selfobject ties is
crucial to the maintenance of cohesiveness, vigor, and self-esteem. The
bond with animals can be a vitalizing and beneficial attachment throughout
the human lifespan. As particular needs become ascendant, a person's
attachment to a pet may take on new shape and form.

A thorough discussion of the impact of gender is beyond the scope of this

chapter, but it is clear that gender is an important variable in how children
use their pets to provide particular selfobject needs. The affective
outpouring boys give to and receive from their pets may be particularly
crucial because of societal sanctions against emotional expression in boys.
Several interesting studies bear upon this issue. Guttman, Predovic, and
Zemanek (1985) found that ll-to-16-year-old boys with pets were better at
decoding facial expressions than were boys without pets, whereas girls,
who were generally superior on this task to boys, were unaffected by pet
ownership. G. F. Melson (personal communication, January 3, 1992) found
that while by age five boys and girls see mothering a child as a female
activity, nurturing and caring for a family pet was not seen as an exclusively
male or female activity, suggesting that a boy's relationship with his pet
may provide a socially acceptable context for the development of
nurturance.

SUMMARY

I have attempted in this chapter to explore the implications of self-

psychological theory for an understanding of the child-pet bond. I have
found from my work with patients and in my discussions with colleagues
that pets can play an essential role in preserving potentialities of the nuclear
self. As Atwood and Stolorow (1984) point out, “when the psychological
organization of the parent cannot accommodate to the changing phase-
specific needs of the developing child, then the more malleable and
vulnerable psychological structure of the child will accommodate to what is
available” (p. 69). Fortunately for many children who are at risk, a pet is an
integral part of the family and is available to play a vital role in remediating
derailments, remobilizing development, or redressing affective imbalances.
Aspects of the child's self that may otherwise have been thwarted or
defensively sequestered may be affirmed and kept alive vis-à-vis this
essential self-self object bond.

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1It is important to note that a confluence of societal factors also contribute
to the phenomenon of maternal disillusionment (Lang, 1990; Wolfe, 1990).
Sands (1989) argues that cultural devaluation of mothers results in a
premature deflation of little girls’ grandiose exhibitionistic self.
Chapter Review of The Prisonhouse of Psychoanalysis* by Arnold
20 Goldberg

To put Goldberg's third book, The Prisonhouse of Psychoanalysis, in

Estelle Shane
perspective, I should remind you that the author not only occupies a central
role in self psychology but was also the president and director of the
Institute for Psychoanalysis in Chicago and, as such, sat on the Board on
Professional Standards of the American Psychoanalytic Association. If ever
there was a member in good standing of a community of scholars that
represents American psychoanalysis, it is Arnold Goldberg. Yet he writes a
book that challenges the central position of organized psychoanalysis,
questioning the authenticity and validity of its training procedures, its
scientific publications, and its clinical theory and practice. He sees
established psychoanalysis as, if not already dead and confined to a
mausoleum of its own making, at least showing a senescent “creaking
stiffness” (p. 147) of its joints. And he views the individual practitioner in
the field as hamstrung and made excessively uncomfortable by the technical
restraints required of him if he wishes to be recognized by others and to
consider himself (as Goldberg ironically puts it) as an authentic member of
the profession, one who upholds the standards and ideals of Freudian
analysis.

“Shall we pity the poor psychoanalyst?” Goldberg is led to inquire in the

first chapter of the book (p. 16). His answer is that we shall indeed, and he
makes his points unrelentingly, convincingly, and with biting sarcasm and
humor. Now while it is always good to ask an author, in this case an
exceedingly well-established member of the community of psychoanalysts,
just who the audience he has in mind for his book is, in this case it becomes
an unusually relevant question. Whom does he think he will convince of the
rightness of his position? It seems clear to me—although it is not always
easy to separate out his irony from his straightforward efforts to persuade—
that Goldberg wants desperately to influence, so as to remain a respected
member of it, the community of psychoanalytic scholars, a community he
cannot help but respect, one he feels he cannot totally ignore, one he feels
no science can totally do without. Therefore, he wishes to enlighten at least
some of this community as to the error of their ways and to persuade them
to join with him in the direction he is suggesting that psychoanalysis must
go if it is to do more than merely survive, if it is to live well and prosper.

And yet I know Goldberg to be too much of a realist, too much of an ironist,
to be too hopeful about the numbers of authentic analysts he can influence
with this publication. At the same time I was rereading and thinking about
Goldberg's book for this discussion I happened to be reading a new novel
by Milan Kundera called Immortality. Given the context, it will not be hard
for you to understand why I was struck by a particular passage in Kundera's
book, a passage in which a leading scholar, not unlike Goldberg, who is
both intelligent and iconoclastic, given to irony, humor, and direct action,
wishes passionately to persuade his own community of scholars, in this case
a community of ecologists, of the importance of eradicating the automobile
so as to preserve the planet, just as Goldberg would like to eliminate the
polluting and choking constraints in the trade of psychoanalysis in order to
preserve the science of psychoanalysis. In this passage the author, Kundera,
is speaking in his own voice to this leading scholar, so like Goldberg, who
is named Professor Avenarius. The author says to the professor, “1 can
never quite understand to what extent one should take your projects
seriously.” And Avenarius responds, “Everything I do should be taken
absolutely seriously.” Kundera continues: “For example, I try to imagine
you as you were, actually lecturing the ecologists about your plan to destroy
cars. Surely you didn't expect them to approve it!” After a pause, during
which Avenarius too keeps silent, the author goes on: “Or did you by any
chance think they would burst into applause?” Avenarius replies, “No, I
didn't.” The author returns, “Then why did you make the proposal? In order
to unmask them? To prove to them that in spite of all their nonconformist
gesticulations they are in reality a part of what you call ‘Diabolum’ [a
reference to the devil and to the enemy]?” Avenarius responds, “There is
nothing more useless than trying to prove something to idiots.” “Then,”
says the author, “there is only one explanation: you wanted to have some
fun. But even in that case your behavior seems illogical to me. Surely you
didn't expect that any of them would understand you and laugh?” Avenarius
shakes his head and says rather sadly, “No, I didn't expect that. Diabolum is
characterized by the total lack of a sense of humor. Joking no longer makes
sense.” Finally, Kundera is driven to ask, “Well if it wasn't for the sake of
fun, why did you submit that plan? Why?” Avenarius is interrupted before
he can answer—and he never does.

We could pose this same question to Goldberg, along with a number of

others, but perhaps a review of some of the highlights of this truly
challenging, very funny, and deeply serious book will lead us to some
answers.

Prisonhouse is a book about the constraints that have arisen in the practice
of psychoanalysis and about the need to rethink and restructure these
constraints if we are to free ourselves from them and advance the field.
Goldberg's plan for the book, as well as the field, can be clearly discerned
merely by examining the table of contents. It is both liberating and
frightening to consider seriously what Goldberg is proposing here; it may
be, in fact, all too easy to dismiss all of it with cowardly relief because of
the very boldness of his design. He begins, after an introduction, with a
chapter on the prisonhouse within which we practice our field. He goes on
to propose a series of striking sacrifices as a way out of this prison. We are
to do without our heroes, including Freud, Klein, Hartmann, and Kohut; we
are to do without any foundations, including those traditionally held givens
that we have considered, perhaps naively, to constitute the bedrock on
which we stand; we are to do without mental representations, including self
and object representation; and we are even to do without the usual concept
of a subject, a self separate from others. With all of this, we must then,
perforce, give up the idea that an authentic analysis can be easily
distinguished from an inauthentic one. Finally, Goldberg requires us to give
up our addictions to the kind of theory and the kind of practice that have
kept us going, however inadequately, these many years. What Goldberg
proposes to offer us in exchange for all of these sacrifices is an unmitigated
freedom to teach, learn, practice, publish, advance the field and, finally,
redefine ourselves and resume our own development as analysts, which
development has been sadly neglected, arrested, stagnated, and skewed.

Of course, Goldberg offers us more: he offers us new ways of

conceptualizing these crucial topics in psychoanalysis and new possibilities
for a more active participation in the world. These ideas are based on a self-
psychological model that Goldberg supports with his understanding of
philosophy and neurophysiology.

Goldberg recognizes that psychoanalysis is peculiarly attached to its heroes,

those men and women who have provided its most fruitful ideas and who
seem to evoke a continued fealty far beyond what is necessary and useful,
and far beyond what characterizes the practice in most other sciences. He
asks, Is there something about our field that requires us to cling to our
heroes? Does it have something to do with the inherent lack of certainty in
what we know and practice? In other words, is there some unexamined
defect or deficit that leads us in this unusual direction, creating an inhibiting
and restraining force within us that restricts our critical examination of the
ideas as separate from the person who promulgated them? Consider, for
example, the obsessive study of Freud as a man, the unmitigated hero
worship that surrounds him, and, above all, the loyalty to his authority as a
godlike or fatherlike figure of supreme knowledge. We need only remember
Young-Breul's biography of Anna Freud, who could not free herself from
her father sufficiently to assess his ideas independently and use her own
powerful intellect and position to move psychoanalysis beyond him and his
thinking. This limitation is understandable in Anna Freud. What Goldberg
communicates is that the whole field remains in this same archaic trap, and
he uses his knowledge of self psychology to tell us why, that is, why we
need our heroes, why we remain addicted to them, and how we can free
ourselves from this limiting position.

Kohut delineated the line of development of idealization from archaic to

mature forms. He suggested that on the one end of the continuum there
exists the Tausk-influencing-machine-like merger with the untrusted and
diabolical other, leading to a frightened avoidance of any connection to
such a needed, powerful object. This category does not apply to analysts
but, rather, to a certain type of enemy of analysis, a person too fearful of the
powerful nature of psychoanalytic ideas to make any connection with them.
As a way station to the more mature form of idealization, there is a phase of
normal development characterized by an addictive thralldom to the
powerful and revered hero, the idealized other who completes the
undeveloped, immature self.
Goldberg suggests that our addiction to heroes in psychoanalysis is based
upon just such a deficit, just such a failure to fully mature to the point
where we can sustain ourselves with more personal values and ideals. What
keeps a whole group of analysts in this immature state is the particular
situation of our field, which provides no secure foundations, no steady
resting places, and which inevitably provokes insecurity and anxiety in its
practitioners. Finally, the mature form of idealization in the analyst is
characterized by a skepticism that allows for questioning, that alternates
with an achieved and more comfortable certainty, and that returns once
again. Goldberg notes that we as analysts are unable to remain alone with
our ideas for too long and that we must inevitably gravitate to points of
certainty. He asks us to periodically devalue our convictions and to worry
when we become too sure or too certain about ourselves, our clinical
technique, and our theoretical beliefs. Perhaps this seems foolhardy, he
says, but it is necessary in order to regain our freedom; we have to walk
through life uncertain, unsure, and a little frightened in order to redefine
and transform ourselves and to advance our field. The alternative is
insulated psychoanalytic groups isolated from one another and from the
world, and an inevitable stagnation.

Goldberg next demonstrates, through the example of a clinical conference,

the shakiness of the ground on which we stand. When a case is presented at
a conference, the presenter has a certain understanding of the patient. The
listeners have more or less different understandings, and each feels that his
interpretation of the material is more authentic than the others. Goldberg
notes that the goal of all such conferences is to find consensus and then
adds that perhaps that goal is wrong. Psychoanalysis may not be able to
enjoy such resolution, he says. The goal should be for each of us to
understand and remake ourselves as individuals.

Goldberg distinguishes among the kinds of discussions analysts engage in:

There are those discussions that psychoanalysis as a discipline carries on
with related scientific disciplines, wherein, perhaps, the status of the field is
under consideration; there are those discussions wherein analysts talk with
one another, the debate being about what is significant in the field, as in the
case conference where different psychoanalytic points of view are
considered; and there are, finally, the discussions between patient and
analyst, where, indeed, an exchange of meanings and an agreement about
meanings can and should be achieved. Goldberg asserts that it may be a
mistake to lump these three types of analytic discussion together, as if they
were the same. In terms of the first, the discussion about the position of
psychoanalysis as a scientific discipline, Goldberg questions our need for
support from infant observation, neurology, or biology to validate what
goes on inside our field and questions whether any more certainty is
provided us by concurrence stemming from such sources. At best, he says,
limits are placed by these disciplines on analytic speculations and
reconstructions.

At this point in my reading of his book, the following questions arose: How
does Goldberg reconcile his devaluation of the data gleaned from the
aforementioned sources to confirm or invalidate psychoanalytic theories
with his own heavy reliance on the outside fields of philosophy and
neurophysiology? And which proponents of gathering such data from
extreme sources, such as infant observation, would expect to establish any
more than limitations on analytic speculation and reconstruction? Is not the
establishment of such limitations sufficient to justify turning to outside
related disciplines, as Goldberg himself does?

In terms of the discussion regarding theoretical differences among analysts

themselves, Goldberg asserts, as the heart of his thesis, that there are no
common places in the field, that there is no agreement about the nature of
the unconscious, the value of the concepts of resistance and defense, the
importance of infantile sexuality and the Oedipus complex, or the nature of
transference. Rather than search for concepts upon which all analysts agree,
he says, we must rely on a hermeneutic approach to achieve, via a Socratic
dialogue, the synthesis of understanding that can only exist between a given
patient-therapist pair. It is only on this level, with this third type of
discussion, that there is any consistency or consensus or any sense of
certainty for the individual practitioner. And even here, the truth is never
final or complete; meanings can always change.

Having removed from us any general psychoanalytic concepts that can be

agreed upon and upon which we can hope to build permanent foundations,
Goldberg goes on to explain why the construct of representation, as
understood in classical analysis and object relations theory, is neither a
useful nor an accurate depiction of how experience is preserved in the mind.
Traditionally, self and object representations are conceptualized as contents
of the mind that, once laid down, are simply retrievable as such, as fixed
entities, like recorded pictures. Once having been laid down, these
representations, whether they approximate reality or are altered by
defensive operations, remain solipsistically contained within the individual
mind or brain. This view of representation influences the theory of
technique and of cure, so that the goal of classical analysis is to unearth the
hidden representations defensively buried within the mind.

Goldberg offers a reassessment of representation, borrowing generously

from neurophysiology's new concept of connectionism. In this view,
memory is not passive and representations are not laid down as complete, to
be recoverable as such; rather, memory is an active creation that requires
the external participation of a stimulating current object to complete the
pattern, without any intermediary mental representations being reached for
or discovered. This necessity for external input to complete a pattern fits
well with the concept that a selfobject serves to complete an incomplete
self.

This new view, then, also influences the theory of technique and of cure, so
that self psychology is not concerned, or not as much concerned, with the
hidden representation of the object buried in the psyche but with the
representation of the deficient self, which is to be completed by experience
with the selfobject analyst. That is, the analyst in the transference is most
concerned with the immediacy of the connection to the analyst and most
involved with the completion of the distorted and deficient self within the
transference.

Goldberg concludes this chapter by saying that the nature of patients’

improvement in therapy seems to depend so much on the immediate
participation of the analyst that a new way of explaining cure is called for.
He compares storehouse theories of representation with connectionism
theories, suggesting that the latter are more accurate and provide a more
useful way of understanding the person's connection with the world.
Connectionism serves to justify the self psychologist's focus and reliance on
the selfobject concept. However, I don't believe that Goldberg means to
eliminate storehouse views of representation entirely. There are
representational patterns sequestered for defensive purposes, incomplete
though they may be; these are object patterns rather than selfobject patterns.
There would seem to be room, therefore, for the enactment in the
transference of hidden and forbidden object retrieval within the current
relationship with the analyst. Perhaps Goldberg would agree but would
consider this a secondary matter.

Goldberg, in an important chapter dedicated to the self in psychoanalytic

theory, attacks the assumption made in almost all of psychoanalysis that
there is a separate and distinct subject, or self, that either begins as an
autistic being, as in classical theory, or emerges out of a merger state with
the mother, as in most object relations theories. The self in these theories is
viewed as coming into its own, then, by gaining distance from the object, as
well as by retaining contents derived from the object, and then existing in a
state of isolation only relieved by communication. Even in interpersonal
theory, the subject is seen as separate and distinct from the object.

Rather than trace this theory of self and object separateness, only to then
refute it, as Goldberg does so masterfully, I will instead cut right to the
chase and bring in Goldberg's own favorite philosopher, Heidegger.
Heidegger is the one who revolutionized the common notion of subject as
distinct from object, positing instead a fundamental position for man of
being in the world and being of the world. In effect, man is composed of
relationships with others, is completed by relationships with others, and
does not exist exclusive of others at all. There is no subject/object
dichotomy, unless something goes wrong and man is thrown out of this
normative world-connected relationship, under which circumstance the
object as such is then discoverable.

The connection to the selfobject concept is obvious. As Goldberg suggests,

if persons are composed of these relations with others, then we embrace the
self-psychological concept of the self as related to others and thereby made
up of others. Selfobjects are not experiences; they are not distinct and
separate beings. Selfobjects are the “others,” the entities that allow one to
achieve and maintain an individual integrity; they are what make us what
we are, our very composition. But the individual is not merely reduced to
these selfobjects. There is a self ownership (an ownness) inherent in the
individual that goes beyond and is logically distinct from these
relationships. And, as with Heidegger's conception, it is only when
selfobjects fail, when there are breaks in empathy, that one becomes aware
of the separateness of the self, of its isolation, and of its fragility. Goldberg
specifically distinguishes this position from the intersubjective view of
Stolorow, Atwood and Brandchaft. These theorists presuppose two separate
and distinct self entities that interact in an intersubjective field. Goldberg
does not specify his distinctions from other self-psychologically informed
analysts, such as Basch—though Basch certainly has a different conception
of the selfobject, defining it as a relationship that comes into being only
when the self is threatened and in need of selfobject sustenance and support.

Goldberg ends the chapter on the selfobject by stating that these ideas do
not mean the abandonment of more familiar psychoanalytic concepts, but,
he says, psychoanalysis must catch up with other ways of looking at the
world; in so doing, it will be more of this world and less autistically isolated
from the larger world of ideas that surrounds it.

We come now to the final section in Goldberg's book, where he questions

most specifically the concepts of authentic analysis and the authentic
analyst. He criticizes the training model, which is, he says, more concerned
with tests of allegiance and fidelity to established ideas than with creating
analysts who are capable of thinking for themselves and of challenging
accepted dogma. He views the literature as not helping much with this
condition, with the journal “referees” being more concerned with finding
agreement with their own ideas than with looking for what is new and
innovative. Goldberg notes, as well, the political use made of
psychoanalytic journals, namely, to keep in power those who concur with
establishment ideas.

In the final chapter Goldberg reminds us that the future of analysis is

unpredictable, as is any evolutionary process. His own personal prescription
has to do with a change in values and a change in the hierarchy of values
that has to date informed the field. Freud's principal concern, as Kohut
emphasized, was the search for truth, with other values only secondary.
Goldberg turns to the philosopher Rorty for a more solid debunking of truth
values. Rorty asserts that it is misguided and fruitless to seek foundations,
to search for the truth, to feel the world can ever be accurately represented.
Goldberg assures us that he himself is not diminishing the significance of
truth and knowledge, or even the value of accurately reconstructing the
patient's childhood; rather, he joins Kohut in the view that these truth
conditions must be secondary to other values, naming among these
alternative higher goals the empathic effort to understand our patients and
noting that it is really more important to understand what the patient
experienced than it is to know what really happened, with the effort to
discover the latter being considered less significant.

In the final chapter Goldberg also puts forward other values to be ranked
within a hierarchy of importance in determining the goals of
psychoanalysis, values such as aesthetic coherence (that is, how things fit
together); therapeutic ambition (the wish to actually help our patients being
elevated rather than shunned as a goal); and creativity, which deserves
affirmation from our mentors and peers since it fosters an atmosphere in our
training of intellectual stimulation, as opposed to an atmosphere of rules,
regulations, and certitude, and which is currently equated with deviance, an
unhealthy state for the individual and for the field.

With this I complete my review of Goldberg's book, but I am afraid I have

not done it justice. There is no way to communicate what makes the book
special by just revealing, however accurately, its contents. Goldberg has
presented very complicated ideas, which I have only hinted at, with great
humor, much lucidity, and admirable intensity. Moreover, he has illustrated
what is complex with clear, cogent, and entertaining case examples. Finally,
I am afraid I have conveyed the idea that the philosophical and
neurophysiological underpinnings of his ideas are limited to the few points I
have made, and this is far from the case. Obviously, one must read this book
to appreciate it and the man who has written it.

Moreover, I believe that Goldberg's view of the future of analysis is

prescient. While his fellow analysts may not all hear or regard what he has
to say, there are nevertheless a growing number of them who are currently
moving in the precise direction Goldberg points to.
*© 1988 by The Analytic Press.
 Author Index

Abraham, K., 232, 242

Adler, G., 227, 229

Ainsworth, M., 48, 52

Alexander, F., 35, 42

Atwood, G., 8, 11, 32, 34, 35, 39, 40, 41, 42, 43, 179, 190, 215, 221, 222,
223, 229, 230, 240, 243, 249, 251, 256, 259, 260, 268, 270

Bacal, Η., 17, 30, 32, 36, 39, 42, 84, 85, 253, 256

Balint, E., 82, 85

Balint, M., 84, 85

Basch, M. F., 8, 11, 89, 103, 107, 116, 124, 176, 190, 196, 206

Beck, Α. M., 257, 269

Beebe, Β., 46, 51, 52

Benjamin, J., 261, 268

Bergman, Α., 258, 269

Bibring, E., 54, 58

Bion, W., 219, 229

Blehar, M., 48, 52

Bowlby, J., 48, 52, 258, 268

Brandchaft, B., 3, 8, 11, 31, 32, 34, 35, 36, 39, 40, 41, 42, 43, 49, 52, 179,
190, 221, 222, 223, 224, 226, 228, 230, 240, 243, 249, 251, 256, 259, 260,
270

Brenner, C., 120, 124

Brothers, D., 196, 200, 201, 206, 207

Buber, M., 79

Buie, D., 227, 229

Condoret, Α., 258, 268

Dalle-Molle, D., 135, 136, 141

de Beauvoir, S., 232, 242

Deltaglia, L., 239, 242

Detrick, D. W., 89, 103, 107, 191, 206

Dostoyevski, F., 143, 157

Dupont, J., 19, 30

Emde, R., 35, 42

F
Fairbairn, W. R. D., 35, 42, 219, 230

Fenichel, O., 46, 52

Filiatre, J., 263, 268

Fosshage, J., 35, 42

Fraiberg, S., 196, 206

Freud, Α., 129, 140, 193, 197, 206, 234, 242

Freud, S., 19, 20, 21, 30, 115, 124, 131, 140, 146, 157, 170, 171, 190, 219,
220,

230, 236, 242

Friedman, L., 34, 42

Friedman, R., 172, 173, 190

Friedmann, E., 265, 268

Frith, G., 257, 269

Gadamer, H., 249, 252, 255, 256

Garrity, T. F., 257, 269

Gay, P., 19, 30

Gedo, J. E., 116, 124, 130, 140, 160, 161, 162, 163, 165

Gehrie, M. J., 162, 163, 165

Gill, M. M., 35, 36, 42, 120, 125, 249, 256

Glaser, Β., 169, 190

Glasser, M., 237, 242

Glover, E., 22, 30

Goldberg, Α., 119, 125, 130, 140, 160, 165, 176, 178, 190, 210, 230, 250,
256

Goldberger, M., 105, 107

Gonski, Y. Α., 257, 263, 269

Goodman, J. F., 257, 269

Greenson, R. R., 22, 30, 46, 52, 54, 58

Guttman, G., 268, 269

Halton, Α., 130, 141

Hartshorne, C., 252, 256

Harvey, Ν. Α., 196, 206

Hobson, R., 240, 243

Holcomb, R., 257, 269

Holmes, D., 105, 107

Hyde, K., 267, 269

Isay, R., 173, 190

Johnson, T. P., 239, 242, 257, 269

Joseph, B., 219, 230

Katcher, A. H., 257, 265, 268, 269

Kernberg, O. F., 130, 140, 193, 194, 196, 206, 237, 242

Kidd, Α. Η., 258, 269

Kidd, R. M., 258, 269

King, C. D., 122, 125

King, K. M., 266, 269

Klein, G. S., 63, 74

Klein, M., 225, 230, 237, 242

Kohut, H., 4, 5, 6, 8, 11, 22, 23, 30, 31, 32, 33, 34, 35, 39, 42, 47, 48, 52,
54, 56, 58, 77, 79, 87, 88, 89, 95, 97, 102, 105, 107, 114, 116, 119, 121,
125, 130, 131, 132, 133, 140, 141, 144, 145, 146, 147, 153, 155, 157, 159,
163, 165, 175, 190, 191, 192, 196, 197, 206, 207, 210, 211, 212, 219, 220,
221, 222, 224, 226, 228, 230, 235, 237, 239, 241, 242, 248, 251, 256, 258,
262, 269

Krystal, H., 175, 190

Kurdek, L., 267, 269

Lachmann, F., 39, 41, 42, 43, 46, 51, 52,

100, 107

Lang, J., 262, 269

Larson, P., 267, 269

Levine, D., 257, 269

Levinson, B., 257, 258, 269

Lewes, K., 172, 173, 190

Lichtenberg, J. D., 130, 141

Lindon, J., 36, 42

Linn, D., 135, 141

Loewald, H., 35, 42

Lomas, P., 250, 256

Lynch, J. J., 265, 268

Mahler, M., 258, 269

Manosevitz, M., 196, 207

Marohn, R. C., 135, 136, 141

Marx, M. B., 257, 269

Maylon, A. K., 174, 190

McCarter, E., 135, 141

McHugh, P. R., 10, 11

Meacham, M., 257, 269

Meares, R., 235, 240, 242, 243

Melson, G. F., 258, 267, 268, 269

Menninger, K., 22, 30

Messent, P. R., 265, 268

Michaels, Y., 267, 269

Miller, Α., 32, 42

Miller, J., 36, 42

Millot, J., 263, 268

Mitchell, S., 34, 43

Modell, Α., 34, 43, 161, 162, 165

Montagner, Η., 263, 268

Newman, Κ., 104, 107

Offer, D., 136, 141

Orange, D., 251, 256

Ornstein, Α., 36, 41, 43, 88, 90, 102, 104, 105, 107, 211, 226, 230

Ornstein, P. Η., 2, 11, 36, 43, 116, 121, 125, 131, 133, 141, 147, 154

Ostrov, E., 136, 141

Palmer, R., 254, 256

Palombo, J., 172, 174, 175, 176, 177, 190

Peet, S., 267, 269

Pine, F., 258, 269

Pollock, G., 169, 171, 190

Predovic, M., 268, 269

Prentice, Ν. M., 196, 207

Rangell, L., 210, 230

Redefer, L. Α., 257, 269

Redl, F., 136, 141

Reik, T., 47, 49, 52

Robin, M., 257, 269

Rosenblatt, Β., 238, 243

Rosenfeld, Η., 219, 230

Ross, S., 257, 269

Saari, C., 176, 177, 190

Sampson, H., 35, 43

Sander, L., 47, 50, 52

Sandler, J., 193, 194, 207, 238, 243

Sands, S., 262, 269

Schwaber, E., 221, 230

Shane, E., 66, 74, 172, 174, 175, 190

Shane, M., 66, 74, 172, 174, 175, 190

Shelby, R. D., 169, 173, 180, 190

Sherick, L., 258, 269

Slaveney, P. R., 10, 11

Socarides, D., 39, 43, 179, 190, 226, 230

Solomon, B., 90, 105, 107

Sparks, C., 267, 269

Spitz, R. Α., 258, 269

Stallones, L., 257, 269

Stechler, G., 130, 141

Steele, B., 239, 243

Stem, D., 47, 48, 50, 52, 130, 141, 176, 190, 238, 243, 259, 269

Stevenson, J., 235, 243

Stoller, R. J., 65, 66, 74

Stolorow, R., 8, 11, 32, 33, 34, 35, 39, 40, 41, 42, 43, 100, 107, 179, 190,
215, 221, 222, 223, 226, 228, 229, 230, 240, 243, 249, 251, 256, 259, 260,
268, 270

Stone, L., 35, 43

Strachey, J., 35, 43, 46, 52

Strauss, Α., 169, 190

ten Bensei, R., 257, 269

Terman, D., 17, 30, 39, 43, 89, 107, 129, 131, 134, 141

Thomas, S. Α., 265, 268

Thomson, P., 250, 256

Tolpin, M., 36, 43

Tolpin, P., 35, 43

Trop, J., 33, 40, 41, 43

Ulman, R. B., 196, 200, 207

von Broemsen, F., 229, 230

Wall, S., 48, 52

Waters, E., 48, 52

Weiss, J., 35, 43

Weiss, P., 252, 256

Wilson, F., 196, 207

Wineman, D., 136, 141

Winnicott, D., 36, 40, 43

Wolf, E., 16, 30, 36, 39, 43, 135, 141, 249, 256

Wolfe, B., 262, 270

Wolfe, J., 258, 270

Zemanek, M., 268, 269

 Subject Index

Acquired immune deficiency syndrome (AIDS), 169–170

mourning theory and, 172–174

case illustrations of, 180–189

Affect

and child-pet bonds, 259–260

importance of in therapeutic relationship, 46, 49, 56–57

impact on self-states, 49

Affective attachment, 34–35, 57

Affective response, 32–33

Age

and child-pet bonds, 267–268

Aggression, see also Narcissistic rage

case illustration, 110–112, 113–114

drives and, 121–122, 130

normal, 109–110

oedipal selfobject transferences and, 116–121

and sexuality in pathogenesis and clinical situations, 109–124

Aggressivization, 63, 118–119, 121

Alter ego, 173

transferences, 191–206

case illustrations, 192–193, 198–205

dissociation and trauma regarding, 196–198

distinguished from projective identification, 194–195

distinguished from twinship transference, 191

projection and projective identification regarding, 193–196

Ambivalence resolution, 172

homosexuality and mourning regarding, 172–173

Analysis, see also Psychoanalysis

empathy and, 31–36

fear of, 23–25

interpretation of empathic lapse of, 26–28

role of interpretation in, 15–30, 31–42, 55–58

training, 16

wild, 21

Analyst

patient bonding with, 29, 34–35, 56–57, 212, 221, 222

transference and gender of, 105–106

types of discussions engaged in, 275–276

Analyst-patient interaction, 4, 46, 47, 83

importance of affect in, 46

and countertransference, 32–34

Bonding, 29, 34–35

after successful mourning, 171

analyst-patient, 29, 34–35, 56–57, 212, 221, 222

child-pet, 257–268

Child development

interpersonal factors in, 108

Child-pet bond

age and gender regarding, 267–268

case illustrations, 260–266

idealization, 261–262

mirroring, 262–264

impact on relationships with people, 267

integration of affect, 259–260

and nonresponsive pets, 266–267

research on, 257–258

self-psychological framework for, 258–259

Childhood

experiences in, 28–29

trauma, 32

Consciousness vs. unconsciousness, 22, 28

Core self agency, 1

Countertransference-cotransference, 247, see also Transference

in analytic process, 32–34

hermeneutical view on, 251–255

intersubjective perspective on, 249

and self psychology, 251–255

neglect of in, 248–251

types of, 249

Defense structures, 211–212

case illustrations, 212–219

reversals as, 234–235

Disruption, 29, 39, 160

interpretation of, 25–26

reversals and, 233

Disjunction, 239–240, 241

Dissociation, 205–206

trauma and alter ego regarding, 196–198

Drives, 8

and aggression, 130

from fragmentation products, 133–134

innate sexual aggression, 121–122

and mourning process, 172

state changes and satisfying, 48

Drive theory, 8, 120–121

homosexual, mourning and, 173

Dysfunctional families, 259–260

Ego

alter, 173, 191–206

and mourning, 171

Empathic immersion, 110

prolonged, 33–34

Empathic inquiry, 32–34, 212, 221

definition of, 33

sustained, 33–34

Empathy, 4–5

countertransference and, 251, 254

child-pet bond and, 267

definition of, 31–32

interpretation of analyst's lapse in, 26–28

and mourning, 179–180

and psychoanalytic interpretations, 31–36, 54–55

and treating narcissistic rage, 133–134, 160, 162–163

Families, dysfunctional, 259–260

Fears, 28–29

of therapeutic situation, 23–25

Ferenczi, Sándor, 19

Fragmentation, 205

drives from products of, 133–134

and narcissistic rage, 132–135

Freud, Sigmund, 10, 117

drive theory, 120–121

views of, 16–17

on ambivalence of investigating physicians, 18–22

Gender

of analyst and transference, 105–106

case illustration of sex, sexualization, and, 61–74, 75–85

and child-pet bonds, 267–268

definition of, 66

and mourning in homosexuals, 172–174

-specific functions, 117

Gender identity

confusion, 67–68, 81

core, 66–67

definition of, 66–67

Gender self, 67–68

Hermeneutics

and countertransference, 251–255

Homosexuality

gender and, 172–174

mourning theory and, 172–174

ambivalence resolution and, 172

case illustrations of, 180–189

Idealization, 88–90, 102–107, 119–120, 175, 221, 274–275

case illustration, 90–102

and child-pet bonds, 261–262

and mourning, 186, 188

Identification, 83, 171, 231, 262

complementary, 195

distinguished from introjection, 237–238

and oedipal phase, 88, 90, 104–105

projective, 193–196

Identity, core gender, 66–67

Interpretation, 253

and affective bonding, 57

of analyst's empathic lapse, 26–28

cure, process of and, 55–58

definition of, 15, 18, 53–54

developmental perspective on, 45–52

and empathic inquiry, 31–36, 54–55

exploratory vs. positive, 22

inexact, 22–23

nature and action of, 31–42

role of, in psychoanalysis, 28–30, 45, 46–47

reasons for interest in, 16

resistance, 29

case illustration of, 23–25

role of, in therapeutic change, 15–30, 34

Stolorow's views on, 53–58

and self–state transformations, 47–52

and therapeutic ambience, 22–23

transference, 35–36, 38–41

verbal aspect of, 29–30, 56

Intersubjectivity, 240

theory of, 249

Introjects, 242

countertransference and, 251

definition of, 237

distinguished from projective identification, 237–238

reversals and, 237–239

Introspection, 4–5

Kohut, Heinz, 209–212, 219–220, 226–229

aggression and rage, views on, 110–121

classification of, 145–146

etiology and pathogenesis, 147

treatment of, 148–149

empathy and introspection, 4–5, 17

open clinical–theoretical system concerning, 6–11

and selfobjects, concept of, 7–10

self psychology, influence on, 3–6

sexuality, views on, 64, 110–121

Melancholia, 171

Manic–depressive syndrome, 225

Mirroring, 68, 81, 88–90, 102–107, 119–120, 175, 221

case illustration, 90–102

and child-pet bonds, 262–264

and narcissistic rage, 148–149, 155, 164

selfobjects, 195, 197–198

and sexuality, 173–174

Mood

impact on self-states, 49

Mourning theory, 169–170, 189–190

ambivalence resolution and, 172

case illustrations regarding, 180–181

seronegative survivor, 181–184

seropositive survivor, 184–189

clinical theory and homosexuality, 172–174

definition of, 177

development of, 170–172

drives and, 172–173

and empathy, 179–180

idealization and, 186, 188

role of selfobject matrix in process of, 174–175, 177–180

and self psychology, 174–177

successful vs. pathological mourning and, 171

three interrelated elements in mourning, 180

two potential outcomes for, 171–172

two sources for, 169–170

Narcissistic rage, 129–130, 132–135, 139–140, 159–165, 196, see also

Aggression

chronic, 143–156

case illustration of, 149–154

classification of, 145–146

etiology and pathogenesis regarding, 147

treatment of, 143–145, 148–149

clinical studies on, 135–139

defining, 159, 163

distinguished from self-assertiveness, 147

empathy and treating of, 133–134, 160, 162–163

fragmentation and, 132–135

mirroring and, 148–149, 155, 164

self psychological views on, 129–132

Narcissistic transferences, 248

Object representations

self and, 171–172, 178, 238, 276–278

Oedipal development
female

role of twinship selfobject in, 87–107

Oedipal phase, 70

ambivalence resolution and, 172

Oedipal selfobject, 88–90, 102–107

case illustration of mirroring, 90–102

Oedipal tranferences, 116–121

Pathological patterns, 225, see also Narcissistic rage

aggression and sexuality concerning, 109–124

of mourning, 171

Patient-analyst interaction, See Analyst-patient interaction

Personality disorders, see also Dissociation; Pathological patterns

Pet-child bonds, 257–268

Projection

alter ego and projective identification concerning, 193–196

definition of, 193–194

Projective identification

alter ego and projection concerning, 193–196

definition of, 194

distinguished from alter ego, 194–195

distinguished from introjection, 237–238

Psychoanalysis, 7, 17–18

goals of, 279

interpretation in, 18, 20

role of, 28, 29

and intersubjectivity, 34, 35

objective vs. subjective observations in, 17

as a science, 17

Psychoneurosis, 12

Psychotherapy, self psychology's impact on, 10

Rage. See Aggression; Narcissistic rage

Reactive countertransferences, 249

Relational experiences, new, 34–35

Relationships, 9

Representations

self and object, 171–172, 178, 238, 276–278

Resistance interpretation, 29

case illustration of, 23–25

Reversals, 241–242

case illustrations, 231–233

as a defense, 234–235

as disruptions in sense of self, 233

integrity of self and, 231–235

introjects and, 237–239

pathologies of identification regarding, 231–242

therapeutic implications concerning, 239–241

and transference, 235–237

Self, 7

disorder, 226, 228

Self-assertiveness

distinguished from narcissistic rage, 147

Self, sense of, 223–224, 227, 229

Self-esteem, 174

Selfobject, 159–160, 162, 235, 277–278

bonding 162

with therapist, 29, 56–57

concept of, 7–10

disruption, 50

experiences, 89–90

providing patient with, 32, 36, 41

twinship, 103, 105–106, 192

two types of, 192

failures, 39–41, 205

during oedipal phase, 88, 104

two phases of, 39

function and child-pet bonds, 259–267

mourning process, role of in, 174–175, 177–180, 183–184

transferences, 7, 39–41, 70, 112–113, 148, 211, 221, 248

mirroring, 68, 81, 195, 197–198

and oedipal phase, 88–89, 103, 116–121

twinship, 259

role of, in female oedipal development, 87–107

Self psychology

and countertransference, 247, 251–255

neglect of, 248–251

framework for child-pet bonds, 258–259

future of, 5–6

genesis of, 3–6

increased interest in various countries, 2–3

interpretation and resistance, 23–25

intrapsychic view of, 8

intrinsic and external elements of, 1–3

mourning theory and, 174–177

narcissistic rage and, 130–132

open clinical-theoretical system of, 6–11

and self-object transferences, concept of, 6–10

as a structural theory, 27–29

therapy, relationship between, 57

Self-regulating other, 47, 50, 51–52

definition of, 47

Self representations

object and, 171–172, 178, 238, 276–278

Self-selfobject, 132, 161

Self-selfobject bond

disruption of, 235–237

Self-state, 47–52

definition of, 47
Self-state transformations, 47–52

Self structure, 259

Self system, 259

false, 241

Seronegative survivor, 170, 180

case illustration, 181–184

Seropositive survivor, 170, 180

case illustration, 184–189

Sexuality, see also Homosexuals

and aggression in pathogenesis and clinical situations, 109–124

case allustration, 110–112, 113–114

child-pet bond and, 266

drives and, 121–122

normal, 109–110

oedipal selfobject transferences and, 116–121

Sexualization, 118–119, 121

case illustration of sex, gender, and, 61–74, 75–85

definition of, 63

Structuralization, 259

Subjectivity, 17, 34, 251

Τ

Therapist. See Analyst

Therapist-patient interaction. See Analyst-patient interaction

Therapy. See Analysis

Transference, 161, 164, 188, 204–205, see also Countertransference

alter ego, 191–206

gender of analyst and, 105–106

interpretation, 35, 36, 38, 40

meaning, 40–41

case illustration concerning, 36–38

specific, 36

mirror, 38

narcissistic, 248

reversal and, 235–237

selfobject, 39–41, 70

twinship, 38, 191–192

Transference-countertransference experience, 7

Training analysis, 16

Trauma, 32

dissociation and alter ego regarding, 196–198

Twinship selfobject

role of, in female oedipal development, 87–107

Twinship transference, 191–192

definition of, 192

distinguished from alter ego, 191

Unconscious, 22, 28, 215

Wild analysis, 21
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