IOBERT D.

STOLOROW
EORGE E. ATWOOD
 CONTEXTS OF BEING
The Intersubjective Foundations
of Psychological Life

Jeni Tyson, M.S-W.

Psychoanalytic Inquiry Book Series

Volume 12
/ph^ Psychoanalytic Inquiry
\{/ Book Series
VoL 1： Reflections on Self Psychology—Joseph D. Lichtenberg d?
Samuel Kaplan (eds J

VoL 2： Psychoanalysis and Infant Research—Joseph D. Lichtenberg

VoL 4： Structures of Subjectivity： Explorations in Psychoanalytic

Phenomenology-George E. Atwood d? Robert D. Stolorow

VoL 5： Towards a Comprehensive Model for Schizophrenic Disorders：

Psychoanalytic Essays in Memory of Ping-Ni匕 Pao, M.D.
-David B. Feinsiher

Vol. 6 & 7： The Borderline Patient： Emerging Concepts in Diagnosis,

Psychodynamics, and Treatment, 1 d2 Z—James S. Grotstein,
Marion F. Solomon, d? Joan A. Lang (eds.)

VoL 8： Psychoanalytic Treatment： An Intersubjective Approach

— Robert D. St시orow, Bernard Brandchaft, George E. Atwood

VoL 9： Female Homosexuality： Choice Without Volition —Elaine V. Siegel

VoL 10： Psychoanalysis and Motivation-Joseph D. Lichtenberg

Vol. 11： Cancer Stories： Creativity and Self-Repair

— Esther Dreifuss-Kattan

VoL 12： Contexts of Being： The Intersubjective Foundations of

Psychological Life —Robert D. Stolorow(幼 Gwrge E. Atwood

VoL 13： Self and Motivational Systems： Toward a Theory of

Psychoanalytic Technique—Joseph D. Lichtenberg Frank M. Lachmann, d?
James L. Fosshage
CONTEXTS OF BEING
The Intersubjective Foundations
of Psychological Life

Robert D. Stolorow
George E. Atwood

1念 THE
1992
ANALYTIC PRESS
Hillsdale, NJ London
 아＞

© 1992 by The Analytic Press, Inc., Publishers

First paperback printing 2002.

All rights reserved. No part of this book may be reproduced in any

form: by photostat, microform, retrieval system, or any other means,
without the prior written permission of the p니blisher.

Published by The Analytic Press, Inc.

101 West Street, Hillsdale, NJ 07642
www.analyticpress.com

Library of Congress Cataloging-in-Publication Data

Stolorow, Robert D.
Contexts of being: the intersubjective foundations of
psychological life I Robert D. Stolorow, George E. Atwood,
p. cm. _ (Psychoanalytic inquiry book series; v. 12)
Includes bibliographical references and index.
ISBN 0-88163-388-7
1. Psychoanalysis. 2. Intersubjectivity. 3. Psychotherapist and
patient. I. Atwood, George E. II. Title. III. Series.
[DNLM: 1 .Psychoanalytic Theory. 2. Psychoanalytic Therapy. W1
PS427F v. 12]
RC506.S738 1992
616.89’17-dc20
DNLM/DLC

for Library of Congress 92-21982

CIP

Printed in the United States of America

10 987654321
To the memory of Dede
우
i am through you so i.-e. c. cutntnings
Through the Thou a man becomes I. -Martin Buber
There is no such thing as an infant.-D. W. Winnicott
 Contents

Preface xi

Introduction 1

Theoretical Foundations

1. The Myth of the Isolated Mind 7

2. Three Realms of the Unconscious 29
3. The Mind and the Body 41
4. Trauma and Pathogenesis 51
5. Fantasy Formation 61

Clinical Applications

6. Varieties of Therapeutic Alliance 87

7. Varieties of Therapeutic Impasse 103

Epilogue 123

References 125

Index 135

ix
 Preface

hat this book would not have been written were it not for

T the late Daphne Stolorow—Dede; as she was called by her

loved ones and friends - is a statement that holds true in many
ways. Her unfailing love; boundless devotion, and enthusiastic
encouragement were the medium that for eight years nourished
her husbancPs creativity and courage to articulate himself.
어You're so provocative/7 she would often say to him; with an

approving twinkle in her eye. This book was conceived in the

wake of her death. We drew closer and decided to try to create
something lasting from the ashes of loss and sorrow.
Despite her youth-she was only 34 when she died-Dede
was already showing her brilliance as a psychoanalytic thinker.
Her vibrantly active mind lives on in many of the pages of this
book. She was the senior author of the original article (Stolorow
and Stolorow, 1989) that formed the basis for chapter 5. Her
ideas on affect integration and its derailment} originally pub­
lished in another article of which she was senior author (Soca-
rides and Stolorow, 1984/85)； were centrally important in the
development of chapters 2; 3; and; especially, 4. Dede;s dear
friend Sheila Namir also made major contributions to the devel-
opment of the ideas in chapter 4-her tribute to Dede and gift to
Dede;s husband. We all miss you; Dede; deeply.

xi
xii PREFACE

Bernard Brandchaft coauthored chapter 6; but the influence of

his thinking permeates the entire book. During the nearly 15
years of our collaboration with him; he has contributed so much
to the evolution of intersubjectivity theory that it would be
impossible to do justice to his impact in shaping this framework.
Jeffrey Trop coauthored chapter 7 and lent his enthusiasm to the
entire project-
We are deeply grateful to Elizabeth Atwood; who has ac­
tively supported our collaboration throughout its long history
and who sustained us both during the summer of 1991 when we
outlined this book at a cabin on Rangeley Lake in Maine. We
are indebted as well to Elena Bonn； whose love and encourage­
ment have also been vital to the completion of this work.
We wish to thank Lawrence Erlbaum and Joseph Lichtenberg
for their support of this project; Pa나 1 Stepansky for his valuable
editorial guidance, and Eleanor Starke Kobrin for her excellent
copy editing.
Some of the material in this book was originally published
elsewhere.
Several paragraphs in the section on The Ontogeny of Per-
sonal Experience77 in chapter 1 appeared in Psychoanalytic Inquiry
(1991； 11:171-184) and in The Relational Self, ed. R. Curtis (New
York： Guilford Press; 1991； pp. 17-33).
Portions of chapter 2 appeared in Psychoanalytic Inquiry (1989；
9:364-374) and in The Psychoanalytic Review (1992; 79:25-30).
An earlier version of chapter 3 appeared in Psychoanalytic Dia­
logues (1991, 1:181-195).
Portions of chapter 5 appeared in Psychoanalytic Inquiry (1989；
9:364-374) and in The International Journal of Psycho-Analysis (1989；
70:315-326).
An earlier version of chapter 6 appeared in The Annual of
Psychoanalysis (1990; 18:99-114).
An earlier version of chapter 7 appeared in Contemporary Psy­
choanalysis (1989; 25:554-573) and one of the case studies also
appeared in The Relational Self, ed. R. Curtis (New York： Guilford
Press, 1991； pp. 17-33).
We thank the editors and publishers of these journals and
books for giving us permission to include this material in our
book.
 Introduction

his book is the culmination of some 20 years of collabora­

T tive work elaborating what we have come to call the inter-

subjective perspective in psychoanalysis. Inters 니 bjectivity
theory is a field theory or systems theory in that it seeks to
comprehend psychological phenomena not as products of iso­
lated intrapsychic mechanisms; but as forming at the interface of
reciprocally interacting subjectivities. Psychological phenomena,
we have repeatedly emphasized； 어cannot be 니nderstood apart
from the intersubjective contexts in which they take form;;
(Atwood and Stolorow; 1984; p. 64). It is not the isolated
individual mind; we have argued, but the larger system created
by the mutual interplay between the subjective worlds of pa­
tient and analyst； or of child and caregiver, that constitutes the
proper domain of psychoanalytic inquiry. From this perspective,
as we shall see; the concept of an individual mind or psyche is
itself a psychological product crystalizing from within a nexus
of intersubjective relatedness and serving specific psychological
functions.
Early germs of the theory of interwbjectivity can be found in •
a series of psychobiographical studies in which we explored the
personal, subjective origins of the theoretical systems of Fre니d;
Jung; Reich, and Rank. From these studies, which formed the

1
2 INTRODUCTION

basis of our first book Faces in a Cloud (Stolorow and Atwood;

1979)； we concluded that； since psychological theories derive to
a significant degree from the subjective concerns of their cre­
ators； what psychoanalysis needs is a theory of subjectivity
itself-a unifying framework that can account not only for the
phenomena that other theories address but also for these theo­
ries themselves. We outlined a set of skeletal proposals for the
creation of such a framework； which we envisioned as a depth
psychology of human experience, purified of the mechanistic
reifications of Freudian metapsychology. Our initial framework
took the 우representational world;; of the individual as its central
theoretical constr니ct; picturing this world as evolving organi­
cally from the person's encounter with the critical formative
experiences that constitute his unique life history. Later (At-
wood and Stolorow, 1984) we dropped the term ^representa­
tional world;; because we became aware that it was being used
to refer both to the imagistic contents of experience and to the
thematic structuring of experience. Hence; we decided to use ^sub­
jective world77 when describing the contents of experience and
어structures of subjectivity77 to designate the invariant principles

unconsciously and recurrently organizing those contents ac-

cording to distinctive meanings and themes.
Although the concept of /wrersubjectivity was not introduced
in Faces in a Cloud, it was clearly implicit in the demonstrations
of how the subjective world of a psychological theorist influ*
ences his understanding of other persons7 experiences. Indeed；
the book;s central theme was captured in the phrase； 어the ob­
server is the observed77 (p. 17). The first explicit use of the term
수intersubjective;; in our work appeared in an article (Stolorow；

Atwood; and Ross; 1978) in which we conceptualized the inter-

play between transference and countertransference in psychoan­
alytic treatment as an intersubjective process reflecting the inter­
action between the differently organized subjective worlds of
patient and analyst. Foreshadowing much work to come; we
considered the impact on the therapeutic process of unrecog­
nized correspondences and disparities between the patient’s and
analyst's respective worlds of experience. In psychoanalytic
treatment the impact of the observer was grasped as intrinsic to
the observed (see also Kohut； 1982; 1984).
 INTRODUCTION 3

In subsequent studies, most conducted in collaboration with

Bernard Brandchaft (Stolorow, Brandchaft； and Atwood, 1983;
1987； Atwood and Stolorow; 1984； Brandchaft and Stolorow;
1984； Stolorow and Brandchaft； 1987); we demonstrated that
an intersubjective perspective can illuminate a vast array of
clinical issues, including negative therapeutic reactions and en-
actments; therapeutic action and therape니tic alliances; conflict
formation and resistance, affective development and pathogene-
sis; and borderline and psychotic states. We (Stolorow et al.;
1987) eventually concluded that 어the intersubjective context has
a constitutive role in all forms of psychopathology77 (p. 3) and
proposed that 化the exploration of the particular patterns of inter­
subjective transaction involved in developing and maintaining
each of the various forms of psychopathology is • … one of the
most important areas for continuing clinical psychoanalytic re-
search이 (p. 4).
We wish to emphasize here that our use of the term 化inter-
subjective;; has never presupposed the attainment of symbolic
thought, of a concept of oneself as subject； or of intersubjective
relatedness in Stern's (1985) sense. Although the word 化inter-
subjective개 had been used before by developmental psycholo-
gists; we were unfamiliar with this prior usage when we (Sto­
lorow et al.; 1978) first coined the term independently and
assigned it a particular meaning within our evolving framework.
Unlike the developmentalists, we 나se 어intersubjective7’ to refer
to any psychological field formed by interacting worlds of expe-
rience; at whatever developmental level these worlds may be
I

organized.
We also wish to emphasize that; although the development
of the theory of intersubjectivity owes much to psychoanalytic
self psychology (see Stolorow; 1992); significant differences
exist between Kohut;s (1971; 1977; 1984) concept of a self-
selfobject relationship (a relationship that serves to maintain,
restore, or consolidate the organization of self-experience) and
our concept of an intersubjective field. An intersubjective field is
a system of reciprocal mutual influence (Beebe and Lachmann;
1988a). Not only does the patient turn to the analyst for selfob­
ject experiences; but the analyst also turns to the patient for such
experiences (Wolf; 1979; Lee; 1988)； and a parallel statement
4 INTRODUCTION

can be made about the child-caregiver system as well. To cap-

ture this intersubjective reciprocity of mutual influence, one
would have to speak of a self-selfobject/selfobject-self relation-
ship.
More importantly, 어subjective world;; is a construct that
covers more experiential territory than 化self/7 Therefore, an
intersubjective field-a system formed by the reciprocal inter­
play between two (or more) s 나 bjective worlds-is broader and
more inclusive than a self-selfobject relationship. An intersubjec­
tive field exists at a higher level of generality and thus can
encompass dimensions of experience-such as trauma； conflict；
defense; and resistance-other than the selfobject dimension.
The perspective of intersubjectivity is; in its essence； a
sweeping methodological and epistemological stance calling for
a radical revision of all aspects of psychoanalytic thought. Our
earlier work brought into focus the implications of this stance
for a broad range of clinical issues and problems that are critical
in the practice of psychoanalytic therapy. In the present book
we extend the intersubjectivity principle to a rethinking of the
foundational pillars of psychoanalytic theory； including the con-
cept of the unconscious, the relation between mind and body,
the concept of trauma, and the understanding of fantasy. We
begin first with a critique of an idea that has long obstructed the
recognition of the intersubjective foundations of psychological
life-the concept of an isolated, individual mind. By offering a
critical exposition of this idea as it has appeared in various
psychoanalytic theories; we hope to bring the assumptions un-
derlying our own viewpoint more clearly into view and to
situate our framework within the spectrum of psychoanalytic
thought.
 I
Theoretical Foundations
 Chapter 1
The Myth of the
Isolated Mind

N contrast with the view that modern man suffers from an

I absence of myth; in this chapter we challenge a central myth

that pervades contemporary Western culture and has insinuated
itself into the foundational assumptions of psychoanalysis - The
Myth of the Isolated Individual Mind. By bringing into focus
the unconscious organizing power of this myth and proposing
an alternative perspective emphasizing the intersubjective foun­
dations of psychological life; we hope to contribute not only to
the advancement of psychoanalytic theory but also to the deep­
ening of reflective self-awareness. Liberated from the con­
straining grip of this myth; psychoanalytic theorizing will be
freed to picture human experience in radically new ways.

ALIENATION AND THE ISOLATED MIND

The myth of the isolated mind ascribes to man a mode of being

in which the individual exists separately from the world of
physical nature and also from engagement with others. This
myth in addition denies the essential immateriality of human
experience by portraying subjective life in reified, substantia­
lized terms. Viewed as a symbol of c니Itural experience; the

7
 、<>•

8 CHAPTER 1

image of the isolated mind represents modejrqj그으ifs_alienatiQn

from nature, from social life, aodjErom subjectivity itself- This
alienation; still so pervasive in our time； has much to do with
the culture of technocracy and the associated intellectual heri­
tage of mechanism that have dominated thought about human
nature in the 20th century (Matson; 1964; Barrett； 1979). Our
purpose in what follows, however, is not to offer a critique of
such cultural and historical factors; but rather to explore the
psychological meanings underlying the myth of the isolated
mind.
It is our view that modern man’s threefold alienation serves to
• •후''*-*、스 zWT■■으 ■ * 〜느*1 1 __ _ ___• _ .

disavow a set pf specific vulneraUilifies tKaf^FFTHRerent in

—■■■ ■ —_ 三- _
~~ - ■ 丁 ■■■ _ < —------------------- 프 h

human existence, vulnerabilities’ that otherwise may leadntp an

버*^퍼퍼*■■"퍼 •스"•그*心“****^■■퍼*““**르**"‘ ’ ‘ =*•• 디•丁■■■더■■■버•■■丁■저*^"퍼^■저퍼퍼1^■퍼^'1■■더*心*”■저퍼퍼*새러'^■누나

unbearable sense of anxiety and anguish. We shall consider first

= == = ■= ■■ =—* 느 ~―느w “="—=== “ T ■ ■■■•터•■■■、보' —비— 비一

the embeddedness of human life in the world of physical nature•

Alienation from Nature

Positing the existence of mind as an entity introduces a distinc­

tion within man's constitution between bodily and mental
forms of being. This distinction diminishes the experience of the 乂
수우유어■•牛아 —으네~수우
•旦*#<<6으*•牛이 ■서버~
리 <r크J 1
己>早 <1~、더~
허내’해시사히디느어히브는느스^—브 …_ _
리 …_ 느으 자 w 昌
丄 _후
•*

느시卜
inescapable physical
—— I _ / _ —_
— -embodi
— _
으- - - —— of the KurnAih히f Afid diereby
embodiment - 흐— '/ *u - —〜으 ____

: :三se ofbeing
7c attenuates a sense subf?6rterthF石Shditions and
oLb이ng wholly subJE6rterthT
___—느=. 그 — 주>_______ ____ i—
-— 4— 니 *rY-- --- --- • 厂—> ---------- ------- —*— •

cycles of biological existence. These conditions include absolute

dependence on the physical environment} kinship to other ani-
mals; subjection to biological rhythms and needs, and; perhaps
most important. man;s physical vulnerability and ultimate mor-
1T 드 7 으 주y ~ p 丁—~ 丄一…--즈— r•—으一p

tality. Inherent in an unalienated attitude toward mortality-tng

느…•——〜••…흐 三 허 •■퍼…

certainty and finality of biological^death - is anxiety

^*▲4— __ ._： _日_ _ _ . . |己 -r ■ ~ J
at the pros-
. IT -• n., - _ 三 으 Z _ 〜■〜. _三________________________ _ _ 厂

pect of physical annihilation and anguish in the face of the

Iransitoriness of all things. Insofar as tKE being of man is defined
-and located in mind; existing as an entity apart from the embed­
dedness of the body in the biological world； an illusion can be
maintained that there is a sphere of inner freedom from the
constraints of animal existence and mortality. This reassuring
differentiation from physical nature may pass over into frank
reifications of the self as an immortal essence that literally
transcends the cycle of life and death. Such reifications take 차
many forms, including the various concepts of the immortalj
 THE MYTH OF THE ISOLATED MIND 9
•* " »- -스느••너테가 서

soul; identifications of the self with ideas and works considered

to have everlasting significance and value, and projections of the
\ s이f into lines of descendants extending indefinitely into the
L—future (Rank； 1930； Becker, 1973; 1975). —
We distinguish between the unalienated experience of the
physical embodiment of the self just discussed and a class of
defensive states entailing wholesale identifications of the self
with the physical body. These latter states; corresponding on a
psychological level to philosophical doctrines of crude materi­
alism and behaviorism^ involve an effort to nullify subjectivity
and reduce human existence to the exclusive terms of p니re
physicality.
I / J
As the person becomes solely matter or body,
丁 . '—、드* 으-- W— J—
—
.…三;瓦1——
there、、휴 — ____ __
』一
WWTWWfW—*•**•=• 으하**그•“—’으'" 다 ■이-'— _丄 느 _ \、부［ < 으 허^^^^자

is no experie
is no nce of
experience
우느
of anguish
anguish inin reaction to mortality because
•으——一—'———
서 "

-» -- ~ —■으“오*i—느—•… J.-L.W 才 후 _丄차

experience itself^has been denied. Moreover, death loses much of f 丁z"

its^power in a vG6Hd UidETias become entirely material and 시 허
concrete, because there is then no life of a conscious subject that j p,
inevitably becomes obliterated, but rather only the cessation of a
particular set of physiological processes.

Alienation from Social Life

A second realm of alienation symbolized in the myth of the

isolated mindis that of the individuals relationship to other
human l>eing?7TEue iSeaTof mind aFa separa^enHty implies an
티느■豆^^■느0gB■耳<—*_ B ---- … 소 후 — 一’— — -~ —-Sv 느 >

inHependence
— r
of the essential being： of the person from engage-
. - _ jc? o
그 o—〜……스.…—!-…——、 —으—,，그가…

ment withr6甲ers< The image of this mental entity, located in

the midst of reality and subsisting alongside other minds； reifies
in the first place the widespread experience of psychological
aloneness. It is said by those who have fallen under the power of
this myth that each individual knows only his own conscious­
ness and is thus forever barred from direct access to experiences ,
belonging to other people. This ostensibly 어ontological77 alone­
ness (Mijuscovic; 1988); which ignores the constitutive role of |
the relationship to the other in a person;s having any experience)
at all; attributes universality to a quite particular wbjective state
characterized by a sense of imprisoning estrangement from othj
ers. This is a state in which one feels neither known nor under­
stood at the level of one's deepest affects; it is; moreover, one in
which the longing for such sustaining connection to others has
 10 CHAPTER 1

succumbed to resignation and hopelessness. This isolation, so

누1-- - —— ■ 느 —• 후그 _

pervasive and deeply rootecT in ou£_cult_mx4__pmvide으, in our

view, the specific intersubjective context thatI€ndklLihG_?xpai-
/ —_ 스"—스— — — 즈—-、— = 기 —* * — —_—으…’…' ~ = ―- -- 그、—나— ——— I ■

ence of anguish unbearable and necessitates the disavowals of

그- ___ 으^> _ _ _ _ —— _______ — … *■' " - 더 으 - 즈- — — —_ _■_■■■ - ■프 ■거

vulnerabiiny inherent in~Ehe myth of the iso]j[g^ mind. The

pain associated with modern man's alienated aloneness is; in그
，-addition, diminished within this myth by the calming vision of /
personal isolation being built into the human condition as thej
v common fate of all mankind. '
Other experiences reified in the image of the isolated mind
include those of psychological distinctness and self-constancy.
Inherent in the idea of the mind;s existence as an entity is a
notion of its separateness from other minds and from a sur­
rounding reality. Separateness is seen as belonging to the mind-
entity as an intrinsic feature of its being and is thus not under-
stood to be contingent on any particular relation between the
person and the surround. Thi^ wexonrrasf wit旦the experience of
_ __
psychological distinctness, a structuralization of sHEawareness
人. 으一 ....-------------------------------- ----- ------- ---- —■ * __ _____________ _ _______ _____________ _ —.… _ _ _____________________________ .…느..〜—

that is wholly
느^聞山^^^^^^ J
embedded in formative and sustaining intersub- 으에두구*•. 그느। wr

jective contexts. Similarly in the case of constancy; the mythical

image of mind is one of a quasi-spatial thing that retains an
enduring integrity as an absolute property of its nature. The
structure of mind as such is regarded as possessing its own
internal constancy; even though specific contents of mind may
be viewed as changing over time. This idea again strikes a
contrast with experiences of self-constancy and of the continuity
of personal identity； which always derive from constitutive
intersubjective contexts.
An un江jienat仁d attitude toward man;s irreducible engagement
with others
with others leads
-- 스 —
to an
leads to an experience
experience
I
of an
of
----------------- —G
--------------------------- ------
fK흐—fete
…
of _ - ―:—— — W- — ___________ —

human beings to Ee so irrevocably dependent on and vulnerable

tQ_cy丁으의의urring in the interpersonal mflieu7”The intrinsic
*** —； 흐- 그 - — • ■가 ■ I ■! »■■■★.= .」! J. …

embeddedness of self-experience in intersubjective fields means

that our self-esteem, our sense of personal identity, even…our
三—•*•外'。-‘누,仕5 三丄三노: 으 三L- … …―7— 丄 으 .-—p - ’ Z /

experience of ourselves as having distinct and enduring existence

are contingent on specific sustaining relations to the human
surround. The reifications being discussed create reassuring illu-
sions of self-sufficiency and autonomy and thus serve to dis­
I

avow the intolerable vulnerability of the very structure of psy-

 THE MYTH OF THE ISOLATED MIND 11

chological life to interpersonal events over which the individual

has only limited control.
오서느하玄,오*

Alienation from Subjectivity

The third and most important form of alienation is man's es­

trangement from the features of subjectivity itself. The dis­
avowals of vulnerability crystalized in the myth of the isolated
mind7 as noted earlier, are achieved through the reification of
various dimensions of subjectivity. These reifications confer
upon experience one or another of the properties ordinarily
attributed to things on the plane of material reality, for example.
o I — 너91너**'•너‘너이**’1*〜네라**수K—시恨호g 沙、.尺計 으 /

spatial localization, extension, enduring substantiality, and the

like. The mind thus takes its place as a thing among things• Lost
in the process are the properties of subjective life itself； which
becomes swallowed up inside the reified mind-entity and con­
ceived in terms of categories applying to tangible objects in the
physical world.
Invariably associated with the image of mind is that of an
external reality or world upon which the mind-entity is pre­
sumed to look out. Here too we encounter a reification; in this
_ —— - *• •소-‘—자計--W•사 =•'느 느' •■…수;W주—4 W■스 -

case one involving the experience of the world as real and

existing separately from the self. What psychological purpose
can be ascribed to the reifying of the experience that there is an
enduring world distinct from the self? Within the myth of the
isolated mind； this world is viewed as having a definitive exist­
ence of its own； its experienced substantiality thereby becomes
transformed into a metaphysical absolute, a universal that is
valid for all human beings. This stands in contrast to the subjec­
tive sense that there is an enduring and substantial world of
reality separate from the self； again an experience constituted
and sustained by particular inters니bjective fields. The vulnera­
bility disavowed by reifying the experience of the world outside
the self stems from a certain insecurity deeply rooted in the
conditions of modern life. If even the permanence and substanti-
1■ ‘ '■ ’’ Wl:. ☆，江. 느 _

ality of the world are constituted and maintained by intersubjec-

tive fields, in a culture of pervasive psychological aloneness
there is little to protect a person from feeling that the solidity of
things is dissolving into thin air.
 、아

12 CHAPTER 1

The image of the mind looking out on the external world is a

heroic image or heroic myth; in that it portrays the inner es­
sence of the person surviving in a state that is separated from all
that actually sustains life. This myth appears in many guises
and variations. One can discern its presence in tales of invincible
persons who overcome great adversity through solitary heroic
acts; in philosophical works revolving around a conception of
an isolated, monadic subject； and in psychological and psycho­
analytic doctrines focusing exclusively on processes occurring
within the autonomous person. We turn now to a discussion of
the guises of the myth of mind as they appear in classical and
contemporary psychoanalysis.

VARIANTS OF THE ISOLATED MIND

In psychoanalysis, the stage was set for the various versions of

the doctrine of the isolated mind by its founder, Freud. In virtu­
ally all phases of his metapsychological theorizing, Freud pic­
tured the mind as a 化mental apparatus/7 an energy-disposal
machine that channels drive energies arising endogenously from
within the interior of the organism. In this vision; the devel­
oping organization of experience is shaped by the mind's suc-
cesses; failures; and compromises in the processing of drive
energies emerging from within. The experience of one's sur-
round; for example, is shaped by the vicissitudes of innate drive
pressures, and the surround contributes to the organization of
experience only insofar as it affects those drive vicissitudes.
Accordingly, the organization of experience is ultimately the
product of internal forces; and the mind's insularity is symboli­
cally reified in the image of an impersonal machine. This image
has insinuated itself into all the variants of Freudian psychoana­
lytic theory.
In Freudian ego psychology, for example, the importance of
the surround in the regulation of early developmental experi­
ences is acknowledged - what Mitchell (1988) aptly terms the
어developmental tilt지一but the image of an isolated； individual

mind is retained in the form of an ideal endpoint of optimal

development. Hartmann (1939) conceptualized ego develop-
 THE MYTH OF THE ISOLATED MIND 13

ment as a process whereby regulation by the environment

comes to be replaced by autonomous self-regulation, an evolu­
tion that he cast in a reified spatial metaphor by designating it
어internalization/7 as if the surround eventually becomes unnec­

essary because it is literally 우taken in.;; This idolatry of the

autonomous mind finds vivid expression in Jacobson's (1964)
description of the experiential consequences of superego forma-
tion. Prior to this developmental achievement according to her
view, the chikPs self-esteem is highly vulnerable to the impact
of experiences with others. As a result of the consolidation of
the superego, by contrast, self-esteem is said to become stabi­
lized and relatively independent of relations with others, so that
it 우cannot be as easily affected as before by experiences of
rejection； frustration, failure and the Iike;; and is 우apt to with­
stand . . . psychic or even physical injuries to the self77 (p. 132).
In this model; the vulnerability of self-esteem that derives from
the embeddedness of self-experience in a shifting intersubjective
context is reserved for early childhood； prior to the structuraliza-
tion of the psyche. The autonomous ego of the healthy older
child or adult, by contrast, is presumed to have achieved immu­
nity from the 우slings and arrows77 encountered in experiences of
the surround-
This ego-psychological view of development； emphasizing
autonomy as its successful outcome; was preserved in Kohut/s
(1971) early theory of self-structure formation through 서optimal
frustration77 leading to ^transmuting internalization77 — the
gradual formation of particles of psychic structure that exercise
regulatory functions heretofore performed by others. As we
develop more fully in the next section and in chapter 4; we
would replace the theory of transmuting internalization; which
elevates a variant of the isolated mind to an ideal goal of devel­
opment with a conception of increasing affect integration and
tolerance evolving within an ongoing intersubjective system
(Socarides and Stolorow; 1984/85； Stolorow et al.; 1987). Emc드
tional experience, we contend, is always regulated and consti­
tuted within an intersubjective context.
As an example of the clinical consequences of ego psychol­
ogy^ idealization of autonomy； consider the familiar notion
that in the successful termination phase of an analysis the trans­
14 CHAPTER 1

ference should be resolved or dissolved； meaning that the pa-

tienfs emotional attachment to the analyst must be renounced.
In this view; residual transference feelings are seen as an infanti-
lizing element； undermining the patient's progress toward inde-
pendence. The autonomous, isolated mind is pictured here not
only as the endpoint of optimal early development but as the
ideal outcome of a successful psychoanalysis.1 In contrast, a
perspective that recognizes that experience and its organization
are inextricably embedded in an intersubjective context can ac­
cept and even welcome the patienfs remaining tie to the analyst
as a potential source of emotional sustenance for the future
(Stolorow and Lachmann; 1984/85； Stolorow et al.; 1987).
Remnants of the doctrine of the isolated mind can also be
found in a number of theoretical frameworks that have been
posed as radical alternatives to Freudian ego psychology-for
example; Schafefs action language, object relations theory, Ko-
hut;s self psychology, and interpersonal psychoanalysis.
Schafer (1976) has argued cogently that the structural-energic
constructs of Freudian ego psychology represent unlabeled spa­
tial metaphors, concretistic reifications of nonsubstantial subjec­
tive experiences such as fantasies. Metapsychological concepts
such as psychic structures; forces, and energies treat subjective
states as though they were thinglike entities possessing such
properties as substance; quantity； extension; momentum, and
location. Schafer proposes a new 化action language77 for psycho­
analysis. This would do away with mechanistic metapsycholo­
gical reifications and would focus on the person-as-agent- that
is; on the person as a performer of actions who; consciously and
unconsciously, authors his own life. Within this framework；
the subject matter of psychoanalytic conceptualization and in­
terpretation becomes action itself； especially disclaimed action,
along with the person's conscious and unconscious personal
reasons for his actions.
While we have found Schafefs critique of Freudian metapsy­
chology to be exceedingly valuable； it seems to us that he is no
less guilty of reifying an aspect of experience than those whom

jWe are grateful to Dr. Sheila Narnir for calling this point to our atten­
tion.
 THE MYTH OF THE ISOLATED MIND 15

he criticizes. The dimension that Schafer substantializes and

universalizes is the experience of personal agency. Indeed; in Scha­
fers system the experience of agency is elevated to the ontolog­
ical core of psychological life. Hence, his framework cannot
encompass those experiential states in which the sense of per­
sonal agency has remained atrophied or precarious in conse­
quence of developmental interferences and derailments- More
important, the continual embeddedness of the sense of agency;
and of self-experience in general, in a nexus of intersubjective
relatedness becomes, in Schafer;s vision, obscured by the reified
image of an omnipotent agent single-handedly creating his own
experiences - another variant of the isolated mind in action.
The omnipotence of the individual mind reaches its pinnacle
in certain versions of Kleinian object relations theory, most
notably in the clinical application of the concept of projective
identification. Kemberg (1975); for example, transforms Klein;s
(1950) description of a primitive fantasy into a ca니sally effica­
cious mechanism through which a person is presumed to trans­
locate parts of himself into the psyche and soma of another.
Consider, in this regard, his discussion of Ingmar Bergman's
movie; Persona：

A recent motion picture . . . illustrates the breakdown of an

immature but basically decent young woman, a nurse； charged
with the care of a psychologically severely ill woman presenting
... a typical narcissistic personality. In the face of the cold;
unscrupulous exploitation to which the young nurse is subjected,
she gradually breaks down. . . • The sick woman seems to be
able to live only if and when she can destroy what is valuable in
other persons. … . In a dramatic development； the nurse develops
an intense hatred for the sick woman and mistreats her cruelly at
one point. It is as if all the hatred within the sick woman had been
transferred into the helping one, destroying the helping person from the
inside [pp. 245-246; emphasis added].

Here we see a caricature of the isolated mind unleashed. The

subject is viewed as creating not only her own experiences, but
even the other's experiences as well. A unidirectional influence
system is pictured, wherein everything that one experiences
16 CHAPTER 1

from the surround is seen as being the product of one's own

omnipotent intrapsychic activity. The impact of the surround is
nowhere to be found.
Kernberg (1976) has offered a revision of Freudian drive
theory in which he pictures the basic building blocks of person­
ality structure as units consisting of a self-image, an object
(other) image, and an affect. Units with a positive affective
valence are said to coalesce into the libidinal drive, while those
with a negative valence form the basis for the aggressive drive.
Although Kernberg acknowledges the developmental and moti­
vational importance of affect, once integrated into enduring
self-object-affect units; affect states are seen to behave like
drives, stirring within the confines of an isolated mind and
triggering all manner of distorting defensive activity. The life­
long embeddedness of affective experience in an ongoing inter-
subjective system thereby becomes lost.
Kohut/s self psychology has made enormous strides toward
loosening the grip of the doctrine of the isolated mind on con­
temporary psychoanalytic thought. The concept of 서selfobject
function77 (Kohut; 1971; 1977; 1984); in emphasizing that the
organization of self-experience is always codetermined by the
felt responsiveness of others, is a prime example. In striking
contrast to the ego-psychological view of development； Kohut
(1984) wrote：

Self psychology holds that self-selfobject relationships form the

essence of psychological life from birth to death, that a move
from dependence (symbiosis) to independence (autonomy) in the
psychological sphere is no more possible . . . than a corre­
sponding move from a life dependent on oxygen to a life inde­
pendent of it in the biological sphere [p. 47].

In regard to the psychoanalytic situation, one of the most

important contributions of self psychology has been the height­
ened attention to the impact of the analyst/investigator on the
field that he investigates. Kohut (1984) drew a parallel between
the shift from traditional analysis to self psychology and the
shift from Newtonian physics to the Planckian physics of
atomic and subatomic particles； in which 어the field that is ob­
 THE MYTH OF THE ISOLATED MIND 17

served, of necessity, includes the observer^ (p. 41). Whereas,

according to Kohut; traditional analysis 어sees the analyst only as
the observer and the analysand only as the field that the observer­
analyst surveys/' the self-psychological orientation ^acknowl­
edges and then examines the analyst's influence . . . as an intrin­
sically significant human presence77 (p. 37).
Despite such powerful challenges to the myth of the isolated
mind; relics of this myth still persist in self-psychological writ­
ings. One such remnant can be found in the persistent use of the
term self to refer both to an existential agent (an independent
initiator of action, Schafer;s focus) and a psychological structure
(the organization of self-experience). As we have discussed in
another context (Stolorow et al.; 1987), some of the theoretical
difficulties that result from the conflation of these two usages
can be illustrated by the following sentence; typical of many
that appear in the literature of self psychology： 우The fragmented
self strives to restore its cohesion.개 Here the term self has two
distinctly different referents： (1) an organization of experience
(called the self) has undergone fragmentation, and (2) an existen­
tial agent (also called the self) is performing actions to restore
cohesion to that organization of experience. This creates a theo­
retical conundrum. Clearly, it is not the pieces of something
(fragments of a self) that strive toward a goal (restoration). More
important, the second usage of self as an independent existential
entity transforms the experiential, agentic into a reified 어it/;
not unlike the impersonal mental apparatus of Freudian theory.
This residue of the doctrine of the isolated mind clouds Kohut's
central contribution — the recognition that self-experience is always
organized within a constitutive intersubjective context.
A second remnant of the myth of the isolated mind that
persists in self psychology can be seen in the idea that the self
possesses an innate nuclear program or inherent design (Kohut;
1984) awaiting a responsive milieu that will enable it to unfold
(see Mitchell, 1988). Unlike ego psychology; which postulates
the autonomous mind as the ideal endpoint of development； self
psychology seems here to locate this ideal in the prenatal or
genetic prehistory of the individual, as a preexisting potential
requiring only the opportunity to become actualized. Such an
idea contrasts sharply with our view that the trajectory of self-
 、흐＞

18 CHAPTER 1

experience is shaped at every point in development by the

intersubjective system in which it crystalizes.
As Bacal and Newman (1990) have pointed out; Kohut
seemed reluctant to consider his framework a relational theory;
probably because he wanted to preserve its link to the intrapsy­
chic tradition of Freudian psychoanalysis. Yet the pervasive
reifications of the concepts of the self； the selfobject； and the
self-selfobject relationship threaten to transform self psychology
into just the sort of crude interpersonalism or social interac-
tionism that Kohut wished to eschew. A solution to this quan­
dary can be found in the perspective of intersubjectivity. The
| concept of an intersubjective system brings to focus both the
| individuals world of inner experience and its embeddedness
j |with other such worlds in a continual flow of reciprocal mutual
^influence. In this vision; the gap between the intrapsychic and
j {interpersonal realms is closed, and; indeed, the old dichotomy
between them is rendered obsolete (see also Beebe; Jaffe; and
Lachmann; 1992).
Another variation on the theme of the isolated mind is found
in the recent theoretical formulations of Basch (1988). Basch;s
work is particularly interesting to consider because he is both a
prominent advocate of Kohut;s self psychology and an out­
spoken representative of a trend in contemporary psychoanal­
ysis that seeks to ground psychoanalytic theory in the neurosci­
ences, He presents a conceptual framework intended to bridge
the 우longstanding and counterproductive gap between psy­
chology and biology/7 a 어scientifically based . . . unified, and
unifying theory of psychotherapy77 (p. 15). The unification of
psychology and biology is here attempted in a way that returns
to the spirit of Freud's (1895) ill-fated 어Project for a Scientific
Psychology/7 namely, the reduction of psychological func­
tioning to mechanistic processes occurring within the human
nervous system. Basch; relying on metaphorical imagery drawn
from modern cybernetics and computer science； envisions psy­
chological activity as essentially pattern-matching, error­
correcting feedback cycles taking place inside the brain.
There are two major aspects of Basch;s (1988) thinking that
betray the infiltration of his writings by the myth of the isolated
mind. The first of these concerns his view of the relationship
 THE MYTH OF THE ISOLATED MIND 19

between the person and reality. He argues that the individual

stands in relation, not to an external world having an indepen­
dent existence of its own; but always and only to a reality that
化is a construction created by the brain of the beholder" (p. 60).

For example, he suggests that when he once went in search of a

lost piece of soap; although he may have felt that he was
looking for something located in a world outside of himself,
actually he was trying to find 어a pattern of sensory signals that
would add up to what [he] already had inside his head-an
encoded pattern of sensory features labeled rsoap;;; (p. 60). Even
one;s mother and father are seen as not possessing any literal
existence in a world apart from the self but are regarded instead
as examples of 化imaginary entities that exist only in the brain乃
(p. 101). Presumably when one searches for a missing parent； as
in the case of the lost soap; one is actually trying to find
perceptual and affective signals that add up to what is located
only in one's head： the assembly of characteristics labeled
化mother^ or 우father/7 Here we see a position of radical construc­

tivism verging on solipsism, and one moreover that situates

itself inside the physical boundaries of the human cranium. This
position appears to involve a self-contradiction： it contains on
one level a claim that at another level it denies. On one hand,
Basch denies the literal truth of the individuals experience of
the independent existence of objects outside the boundaries of
the self; he argues that such objects are only "constructions^
localized inside the human brain. On the other hand; Basch does
accord independent existence to one class of such external ob­
jects； the brains themselves. This seeming paradox arises, in our
view; from Basch;s unacknowledged use of the brain as a reified
symbol of the isolated mind7 which prod니ces experiences out of
its own autonomous constructive activity.
The second way in which the myth of the isolated mind
becomes manifest in Bascbfs conceptualizations appears in his
views of human motivation and especially the sources of indi­
vidual self-esteem. According to Basch; the prime motivator
underlying all psychological activity is the quest for competence,
which he defines as 써:he brain's capacity to establish order
among the disparate stimuli that continuously bombard the
senses기 (p. 27). On the level of introspection and reflection.
20 CHAPTER 1

competence becomes the experience of self-esteem. Basch elabo-

rates： "True self-esteem, a genuine sense of one's self as worthy
of nurture and protection . . . stems from the experience of
competence, the experience of functioning appropriately ... no
one can give another the experience of competence： one must achieve that
for oneself" (p, 26; emphasis added).
He further clarifies: 우the standard by which one judges one;s
own competence or incompetence is always internal, not exter­
nal^ (p. 59). This judgment of competence and self-esteem is
made in terms of matches or mismatches between brain repre­
sentations of one;s behavior or circumstances and preexisting
neural patterns functioning as the goal that is being pursued.
This c니rious doctrine specifically denies that experiences of
competence and self-esteem derive from interpersonal transac­
tions pertaining to one's sense of oneself in the human commu­
nity. Again we encounter the autonomous subject who needs
little more than internal arrays of sensory signals matching with
previously encoded neurological patterns in order to be sustained
and to function as a human being-
Consider now the central construct in Basch;s metapsychob
ogy; the so-called self-system. This system is defined as a biolog­
ical entity consisting of a hierarchical organization of interre­
lated； error-correcting feedback cycles. Aithough Basch states
that it is unsatisfactory to reduce the complex activity usually
denoted by the term mind to the neurological activity of the
brain, his concept of the self-system does precisely that. This
entity is a creation of the brain； is located within the brain; and
controls and guides the brain in its relation to the world. The
self-system moreover is pictured as enabling the brain to func­
tion 우as a self-programming computer77 (p. 106) using arrange­
ments of 어software77 that function as 씨:he guardians of order; the
ensurers of competence and; ultimately, of self-esteem개 (p. 105).
In this image of the brain as a self-programming computer
relating only to its own internal constructions； we find a dra­
matic materialization of the isolated mind within a physiolog­
ical organ that has been endowed with the attributes of person­
hood.
Interpersonal psychoanalysis grew out of Sullivan's (1953)
attempt to replace the intrapsychic determinism of Freudian
 THE MYTH OF THE ISOLATED MIND 21

theory with an emphasis on the centrality of social interaction.

Indeed； Sullivan wished to resituate psychiatry and psychoanal­
ysis within the domain of the social sciences. His efforts were
marred, in our view, by the vacillation of his investigatory
stance from one that assumed a position within the experiential
worlds of those involved in an interaction (an intersubjective
perspective) to one that stood outside the transaction and pre­
sumed to make objective observations that were subject to 어con-
sensual validation?7 The latter stance is illustrated by Sullivan's
concept of 어parataxic distortion/" a process through which a
person’s current experiences of others are said to be 化warped;; in
consequence of his past interpersonal history. We wish to em-
phasize here that the concept of parataxic distortion enshrines
another variant of the doctrine of the isolated mind; a mind
separated from an 어objective77 reality that it either accurately
apprehends or distorts. This objectivist stance contrasts with an
intersubjective one, in which it is assumed that one's personal
reality is always codetermined by features of the surround and
the unique meanings into which these are assimilated.
Contemporary interpersonal psychoanalysis is well repre­
sented by MitchelFs (1988) effort to develop an integrated ^rela­
tional model/7 drawing on the work of Sullivan and British
object relations theorists, most notably, Fairbairn (1952). Mit-
chelPs general description of relational-model theorizing in psy­
choanalysis is highly compatible with our own viewpoint：

In this vision the basic unit of study is not the individual as a

separate entity whose desires clash with an external reality； b니t
an interactional field within which the individual arises and
struggles to make contact and to articulate himself. Desire is
experienced always in the context of relatedness, and it is that con­
text which defines its meaning. Mind is composed of relational
configurations. - . . Experience is understood as structured
through interactions . . . [pp. 3-4].

Despite the harmony that exists between his overall vision

and an intersubjective perspective, remnants of the isolated
mind appear in MitchelEs work； particularly in the clinical appli­
cation of his ideas to the psychoanalytic situation. He describes
 22 CHAPTER 1

the analytic patient as continually engaging in 化gambits乃 de­

signed to draw the analyst into old relational patterns to which
the patient has remained committed and deeply loyal. The ana­
lyst； in turn, is said inevitably to find himself a 化coactor;; in the
patient's passionate drama; 우enacting the patient's old scenarios기
(p. 293) and inexorably falling into 서the patienfs predesigned
categories刀 (p. 295). The patient-or better; the patienfs mind-
is pictured here as the chief director of the analytic stage, much
in the manner of Schafefs (1976) omnipotent agent and the
unidirectional influence system embodied in the theory of pro­
jective identification. Insufficient attention is given to the pa­
tients becoming a coactor in the analyst's drama, to the recip­
rocal impact on the patients experience of the analyst's
predesigned categories (including the assumption that patients
engage in gambits); as conveyed, for example, by the analyses
interpretations. In his clinical approach; it seems to us7 Mit-
chelEs elegant relational model ultimately collapses into a
variant of the myth of the individual mind.
Why is it that the isolated mind; as we have seen; is such a
difficult demon to exorcise, even for those who have so assidu­
ously devoted themselves to the task? As we proposed earlier； it
is our view that this pervasive; reified image in its many guises
serves to disavow the exquisite vulnerability that is inherent to
an unalienated awareness of the continual embeddedness of
human experience in a constitutive intersubjective context. The
impersonal machine, the autonomous ego; the omnipotent
agent； the inviolable pristine self-all such images of the mind
insulated from the constitutive impact of the surround counter­
act to paraphrase Kundera (1984); what might be termed 저the
unbearable embeddedness of being?7 Analogously to isolated
states in early development (Ogden; 1991)； they provide a
| 이)uffer against the continual strain of being alive in the world of

워 human beings;; (p. 388).

수’I*

THE ONTOGENY OF PERSONAL EXPERIENCE

We contend that the development of personal experience al-

’ ways takes place within an ongoing intersubjective system.
 THE MYTH OF THE ISOLATED MIND 23

Earlier, in a chapter written in collaboration with Brandchaft,

we (Atwood and Stolorow; 1984) summarized the intersubjec-
tive perspective on psychological development：

[B]oth psychological development and pathogenesis are . . . con­

ceptualized in terms of the specific intersubjective contexts that
shape the developmental process and that facilitate or obstruct
the chilcFs negotiation of critical developmental tasks and suc­
cessful passage through developmental phases. The observational
focus is the evolving psychological field constituted by the inter­
play between the differently organized subjectivities of child and
caretakers [p. 65].

An impressive body of research evidence has been amassed

documenting that the developing organization of the child's
experience must be seen as a property of the child—caregiver system
of mutual regulation (see Lichtenberg, 1983; 1989; Sander; 1985;
1987； Stern； 1985; 1988; Beebe and Lachmann; 1988a;b； Emde;
1988a;b). According to Sander (1985; 1987), it is the infant-
caregiver system that regulates and organizes the infant’s experi­
ence of inner states. The development of self-regulatory compe-
tence; therefore； is a systems competence. In a more recent work；
Sander (1991) has shown that even the sense of distinctness；
uniqueness, and personal agency emerges and is sustained
within a developmental system in which there is a synchronous
化specificity of fittedness지 between the infanfs shifting states

and the caregivefs ability to recognize them. Stern (1985); too;

has described in great detail the formation of various senses of
self from the child;s interactions with 우self-regulating others?7
Beebe and Lachmann (1988a;b) have shown that recurrent pat­
terns of mutual influence between mother and infant provide
the basis for the development of self- and object representations.
They argue that in the earliest representations what is repre­
sented is 우an emergent dyadic phenomenon; structures of the
interaction, which cannot be described on the basis of either
partner alone시 (Beebe and Lachmann; 1988a; p. 305). A similar
view of the interactional basis of psychic structure formation is
implicit in Lichtenberg;s (1989) discussion of the schemas or
"scripts7" that underlie the experience of various motivational
 24 CHAPTER 1

systems and in Emde;s (1988a) description of personality struc­

tures developing from the internalization of ''infant-caregiver
relationship patterns.;; Each of these authors, in different lan-
guage; is describing how recurring patterns of intersubjective
transaction within the developmental system result in the estab-
lishment of invariant principles that unconsciously organize the
child;s subsequent experiences (Atwood and Stolorow; 1984；
Stolorow et al.; 1987); a realm of unconsciousness that we term
the 어prereflective unconscious77 (see chapter 2). It is these uncon-
scious ordering principles; crystalized within the matrix of the
child-caregiver system, that form the essential building blocks
of personality development-
Some may see a contradiction between the concept of devel-
opmentally preestablished principles that organize subsequent
experiences and our repeated contention that experience is al­
ways embedded in a constitutive intersubjective context. This
/ contradiction is more apparent than real. A person enters any
situation with an established set of ordering principles (the sub-
jecfs contrib니tion to the intersubjective system)； but it is the
context that determines which among the array of these princi-
卜pies will be called on to organize the experience. Experience

■j becomes organized by a particular invariant principle only when

there is a situation that lends itself to being so organized. The
organization of experience can therefore be seen as codeter­
mined both by preexisting principles and by an ongoing context
that favors one or another of them over the others.
Examples of this codetermination are readily seen during the
course of psychoanalytic treatment} in the shifting figure-ground
relationships between what we (Stolorow et al.; 1987) have
termed the 化selfobject;; and 어repetitive77 dimensions of the trans-
ference. In the former, the patient yearns for the analyst to
provide selfobject experiences that were missing or insufficient
during the formative years (Kohut； 1971; 1977; 1984). In the
latter, which is a source of conflict and resistance, the patient
expects and fears a repetition with the analyst of early experb
ences of developmental failure (Ornstein, 1974). These two
dimensions continually oscillate between the experiential fore-
ground and background of the transference in concert with
perceptions of the analyst's varying attunement to the patienfs
 THE MYTH OF THE ISOLATED MIND 25

emotional states and needs. For example, when the analyst is

experienced as malattuned； foreshadowing a traumatic repeti­
tion of early developmental failure; the conflictual and resistive
dimension is brought into the foreground, and the patienfs
selfobject longings are driven into hiding. On the other hand7
when the analyst is able to analyze accurately the patienfs
experience of rupture of the therapeutic bond and demonstrate
his understanding of the patient's reactive affect states and the
principles that organize them, the self object dimension becomes
restored and strengthened and the conflictual/resistive/repetitive
dimension tends to recede into the background­
in our experience; intractable repetitive transferences are code­
termined (in varying degrees) both by the relentless grip of the
patienfs invariant principles, a product of the absence or precar-
iousness of alternative principles for organizing experience, and
by aspects of the analyst’s stance that lend themselves to re­
peated retraumatization of the patient (see chapter 7). Successf나 1
psychoanalytic treatment, in our view; does not produce thera­
peutic change by altering or eliminating the patient's invariant
organizing principles. Rather, through new relational experi­
ences with the analyst in concert with enhancements of the；\
patienfs capacity for reflective self-awareness, it facilitates the *
establishment and consolidation of alternative principles and] |
thereby enlarges the patienfs experiential repertoire. More gen： |
erally; it is the formation of new organizing principles within ang
intersubjective system that constitutes the essence of develop-
mental change throughout the life cycle.
It should be clear that the intersubjective view of psycholog­
ical development is not to be confused with a naive environ-
mentalism. Rather, it embraces what Wallace (1985) felicitously
terms 어intersectional causation?" At any moment the child7s
formative experiences are understood to emerge from the inter­
section of; and to be codetermined by; his psychological organi-
zation as it has evolved to that point and specific features of the
caregiving surround. In this model; the development of the
child;s psychological organization is always seen as an aspect of
an evolving and maturing child-caregiver system.
Studies of the vicissitudes of the developmental system are
giving rise to a radically altered psychoanalytic theory of moti-
26 CHAPTER 1

vation. Clearly, it is no longer satisfactory to view motivation

in terms of the workings of a mental apparatus processing
instinctual drive energies. Instead, it has increasingly come to be
recognized； as Lichtenberg (1989) aptly argues, that ^motiva­
tions arise solely from lived experience”’ and that 서the vitality of
the motivational experience will depend . . . on the manner in
which affect-laden exchanges unfold between infants and their
caregivers77 (p. 2). Most important in our view; has been the
shift from drive to affect as the central motivational construct
for psychoanalysis (see Basch; 1984； Demos and Kaplan, 1986;
Jones； in press). Affectivity； we now know; is not a product of
isolated intrapsychic mechanisms; it is a property of the child­
caregiver system of mutual regulation (Sander; 1985; Rogawski；
1987； Demos, 1988). Stern (1985) has described in exquisite
detail the regulation of affective experience within the infant-
-caregiver dyad through processes of intersubjective sharing and
mutual affect attunement. The 우affective core of the self77
(Emde; 1988a) derives from the person;s history of intersubjec­
tive transactions； and thus the shift from drive to affect resit­
uates the psychoanalytic theory of motivation squarely within
the realm of the intersubjective. Early developmental trauma;
from this perspective; is viewed not as an instinctual flooding of
an ill-equipped mental apparatus. Rather, as we develop in
chapter 4; the tendency for affective experiences to create a
disorganized or disintegrated self-state is seen to originate from
early faulty affect attunements - breakdowns of the infant­
caregiver system-leading to the loss of affect-regulatory ca­
pacity (Socarides and Stolorow; 1984/85). These are the rock-
bottom dangers for which later states of anxiety sound the
alarm. As we demonstrate in chapter 2; the shift from drive to
affect leads inevitably to an intersubjective view of the forma­
tion of psychic conflict and of what has been traditionally
termed the 어dynamic unconscious?7
Let us now consider, from an intersubjective perspective, the
development of a constituent of personal experience that has
great clinical import-the sense of the real.

The Genesis of the Sense o£ the Real

We are concerned here with the process by which a child ac­
quires an experience of the world and the self as real. 化Reality/7
 THE MYTH OF THE ISOLATED MIND 27

as we use the term, refers to something subjective, something

felt or sensed, rather than to an external realm of being existing
independently of the human subject. In classical Freudian the-
ory; reality is pictured in the latter way; and psychological
development is conceptualized as a gradual coming into contact
with the constraints and conditions of this independent, ex­
ternal world. Central to the process of establishing contact with
reality, according to Freud (1923) and other classical theorists
(Ferenczi, 1913; Fenichel; 1945); are experiences of frustration
and disappointment. Such inevitable but painful moments sup­
posedly propel the child out of an undifferentiated mode of
functioning by contributing to the separation of an ego that
takes into account the independence of the external world and
operates under the so-called reality principle. Our focus; by
contrast； is on the child’s establishing a sense that what he
experiences is real, and on how this sense of the real develops
within a facilitating intersubjective matrix.
We have previously highlighted (Sto!orow; Atwood, and
Brandchaft, 1992) the developmental importance of a selfobject
function contributing to the articulation and validation of a j

child’s unfolding world of personal experience, and we have 午

designated this the self-delineating sdfobject function. It is our view

that the development of a child;s sense of the real occurs not
primarily as a result of frustration and disappointment, but
rather through the validating attunement of the caregiving sur- /
round, an attunement provided across a whole spectrum of \
affectively intense; positive and negative experiences. Reality ；『
thus crystalizes at the interface of interacting, affectively at-
tuned subjectivities.
The self-delineating selfobject function may be pictured along
a developmental continuum; from early sensorimotor forms of
validation occurring in the preverbal transactions between in­
fant and caregiver, to later processes of validation that take place
increasingly through symbolic communication and involve the
child;s awareness of others as separate centers of subjectivity.
Preverbal forms of validation are implicit in the sensorimotor
dialogue in which the caregiver;s sense of the infanfs shifting
subjective states is expressed. S니ch communication, occurring
primarily through modulations of touch； holding, facial expres­
sion and vocal rhythm and intonation (Stern; 1985); creates an
28 CHAPTER 1

intersubjective field echoing and mirroring the infanfs ongoing

experiences. This field provides sensorimotor patterns that artic­
ulate the different aspects of what the infant perceives and feels,
and lays the foundation of the sense of the reality of the world
and also of the infanfs own nascent self.
New forms of validation become possible once the child be-
comes aware of others as experiencing subjects (Stern; 1985). In
this phase; the caregiver’s acts of participatory identification
with the child's subjective states increasingly become communi­
cated through verbal and other symbols； permitting the gradual
evohition of a symbolic world of self and other experienced by
the child as real.
Derailments of this developmental process can occur in any
phase when validating attunement is profoundly absent. Under
these circumstances； the child； in order to maintain ties vital to
well-being, must accommodate the organization of his experi­
ence to the caregiver;s. With the advent of symbolic communi­
cation and awareness of others as centers of subjectivity, such
accommodation can result in a subjective world constituted in
large part by an alien reality imposed from outside (see Brand-
chaft, 1991).
Several pathological outcomes of the derailment of the sense
of the real are discussed in subsequent chapters： severe nar­
rowing of the domain of reflective self-awareness (chapter 2);
disturbances in the development of affectivity and mind-body
cohesion (chapter 3); tormenting doubts about the reality of
early traumatic injuries and about the validity of one's experi­
ence in general (chapters 4 and 5); and the elaboration of dra-
matic fantasy formations concretizing the process of psycholog­
ical 니surpation (chapter 5).
 Chapter 2
Three Realms of the
Unconscious

N this chapter we extend our intersubjective framework to a

I reconsideration of a cornerstone of all psychoanalytic

thought - the concept of unconscious mental processes.
In an earlier attempt to reconceptualize the unconscious; we
(Atwood and Stolorow; 1984) distinguished two forms of un­
consciousness that are important for psychoanalysis - the prere-
flective unconscious and the more familiar dynamic uncon-
scious. Both differ from Freud's (1900; 1915) 化preconscious;; in
that they can be made conscious only with great effort. The
term prereflective unconscious refers to the shaping of experi­
ence by organizing principles that operate outside a person;s
conscio니s awareness：

The organizing principles of a person's subjective world,

whether operating positively (giving rise to certain configura­
tions in awareness) or negatively (preventing certain configura­
tions from arising), are themselves unconscious. A person's expe­
riences are shaped by his psychological structures without this
shaping becoming the focus of awareness and reflection. We 서
have therefore characterized the structure of a subjective world as |
prereflectiwly unconscious. This form of unconsciousness is not the 후

product of defensive activity； even though great effort is required g /

to overcome it. In fact； the defenses themselves, when operating 사

29
30 CHAPTER 2

outside a person's awareness； can be seen as merely a special

instance of structuring activity that is prereflectively unconscious
[Atwood and Stolorow, 1984; p. 36].

In our view of psychological development, we pictured these

prereflective structures of experience as crystalizing within the
evolving interplay between the subjective worlds of child and
caregivers. Prime examples are those organizing principles, tradi­
tionally covered by the term superego, that derive from the chilcfs
perceptions of what is required of him to maintain ties that are
vital to his well-being.
In reconsidering the dynamic unconscious； we first attempted
to formulate its essence in experience-near terms, stripped of
metapsychological encumbrances：

[R]epression is 니nderstood as a process whereby particular config­

urations of self and object are prevented from crystalizing in
awareness. . , . The 어dynamic unconscious/7 from this point of
view, consists in that set of configurations that consciousness is
not permitted to assume, because of their association with emo­
tional conflict and subjective danger. Particular memories； fanta-
sies; feelings; and other experiential contents are repressed be­
cause they threaten to actualize these configurations [Atwood
and Stolorow; 1984; p. 35].

Later we (Stolorow et aL; 1987) proposed that the psycholog­

ical phenomena traditionally encompassed by the concept of the
dynamic unconscious derive specifically from the realm of inter-
subjective transaction that Stern (1985) refers to as "interaffec-
tivity;; —the mutual regulation of affective experience within the
developmental system. We wrote：

The specific intersubjective contexts in which conflict takes form

are those in which central affect states of the child cannot be
integrated because they fail to evoke the requisite attuned respon­
siveness from the caregiving surround. Such unintegrated affect
states become the source of lifelong inner conflict； because they
are experienced as threats both to the person's established psy­
chological organization and to the maintenance of vitally needed
 THREE REALMS OF THE UNCONSCIOUS 31

ties. Thus affect-dissociating defensive operations are called into

play; which reappear in the analytic situation in the form of
resistance. ... It is in the defensive walling off of central affect
states, rooted in early derailments of affect integration, that the
origins of what has traditionally been called the 化dynamic un-
conscious;; can be found [pp. 91-92].

From this perspective, the dynamic unconscious is seen to

consist not of repressed instinctual drive derivatives; but of affect
states that have been defensively walled off because they failed
to evoke attuned responsiveness from the early surround. This
defensive sequestering of central affective states, which attempts
to protect against retraumatization； is the principal source of
resistance in psychoanalytic treatment； and also of the necessity
for disguise when such states are represented in dreams (Stolo-
row; 1989).
The shift from drives to affectivity as forming the basis for
the dynamic unconscious is not merely a change in terminol­
ogy. As we discussed in chapter 1; the regulation of affective
experience is a property of the child-caregiver system of recip-
rocal mutual influence• If we understand the dynamic uncon­
scious as taking form within such a system; then it becomes
apparent that the boundary between conscious and unconscious
is always the product of a specific intersubjective context.
With its focus on the vicissitudes of unconscious mental pro-
cesses; psychoanalysis has; until quite recently; had little to say
about the ontogeny of consciousness. It is our view; as we stated
in chapter 1; that the child;s conscious experience becomes pro-
gressively articulated through the validating responsiveness of the
early surround. The child's affective experience, for example,
becomes increasingly differentiated and cognitively elaborated
through the attuned responsiveness of caregivers to his emo­
tional states and needs (Socarides and Stolorow; 1984/85). Such
attunement must, of course, be communicated in a form that
coincides with the child;s unfolding psychological capacities.
It follows from this conception of consciousness becoming
articulated within an intersubjective system that two closely
interrelated forms of unconscio니sness may develop from situa-
32 CHAPTER 2

사
tions in which the requisite validating responsiveness is absent.
When a chilcfs experiences are consistently not responded to or
are actively rejected； the child perceives that aspects of his own
experience are unwelcome or damaging to the caregiver. Whole
sectors of the child's experiential world must then be sacrificed
(repressed) in order to safeguard the needed tie. This, we have
suggested； is the origin of the dynamic unconscious. In addition,
other features of the chilcfs experience may remain unconscious,
not because they have been repressed, but because; in the ab­
sence of a validating intersubjective context, they simply never
were able to become articulated. In both instances； the boundary
between conscious and unconscious is revealed to be a fluid and
ever-shifting one; a product of the changing responsiveness of
the surround to different regions of the child;s experience. We
believe that this conceptualization continues to apply beyond
the period of childhood and is readily demonstrated in the psy­
choanalytic situation as well, wherein the patienfs resistance
can be seen to fluctuate in concert with perceptions of the
analyst's varying receptivity and attunement to the patient's
experience. The idea of a fluid boundary forming within an
intersubjective system contrasts sharply with the traditional no­
tion of the repression barrier as a fixed intrapsychic structure； 수a
sharp and final division애 (Freud, 1915; p. 195) separating con­
scious and unconscious contents.
During the preverbal period of infancy, the articulation of the
child;s experience is achieved through attunements communi­
cated in the sensorimotor dialogue with caregivers (Stern; 1985).
During this earliest phase； unconsciousness results from situa­
tions of unattunement or misattunement. By the middle of the
second year, the child is able to use symbols, making language
possible. This is a momentous step in the development of con­
sciousness because henceforth the chikfs experience increasingly
becomes articulated by being encoded in verbal symbols. As
Stern (1985) emphasizes, symbols make possible 化a sharing of
mutually created meanings about personal experience이 (p. 172).

11n an earlier work (Stolorow et al.; 1987); we suggested that massive

developmental failure in the function of validation of perception is an impor­
tant factor in the predisposition to psychotic states.
 THREE REALMS OF THE UNCONSCIOUS 33

With the maturation of the child;s symbolic capacities, symbols

gradually assume a place of importance alongside sensorimotor
attunements as vehicles through which the chilcPs experience is
validated within the developmental system. In that realm of
experience in which consciousness increasingly becomes articu­
lated in symbols, unconscious becomes coextensive with
unsymbolized> When the act of articulating an experience is
perceived to threaten an indispensable tie; repression can now be
achieved by preventing the continuation of the process of en­
coding that experience in symbols. At this point in the develop­
ment of consciousness, aspects of Freud;s (1915) formulation of
the process of repression can be seen to apply： 어A presentation
which is not put into words . . . remains thereafter in the Ucs. in
a state of repression77 (p. 202).
To summarize, we can distinguish three interrelated forms of
unconsciousness: (1) the prereflective unconscious-the organizing
principles that unconsciously shape and thematize a person;s
experiences； (2) the dynamic unconscious - experiences that were
denied articulation because they were perceived to threaten
needed ties; and (3) the unvalidated unconscious - experiences that
could not be articulated because they never evoked the requisite
validating responsiveness from the surround. All three forms of
unconsciousness； we have emphasized, derive from specific,
formative intersubjective contexts.
We believe that this experience-near conceptualization of the
unconscious； its different realms and their origins; provides a
definitive answer to those critics (e.g.; Kemberg, 1982) who
claim that an empathic-introspective psychology of the subjec-
tive world can only remain a psychology of the conscious; and
also to those theorists (e.g.; Rubinstein, 1976) who argue that
the existence of unconscious mental processes can be explained
only by resorting to experience-distant concepts borrowed from
neurobiology. We define the stance of sustained empathic in-
quiry as a method for investigating the principles unconsciously
organizing experience. By emphasizing the analyses investigative
activity, this definition supplies an antidote to those counter­
transference-based misconstruals of analytic empathy that amal­
gamate it with a requirement literally and concretely to fulfill a
patient's selfobject longings and archaic hopes.
34 CHAPTER 2

It is our view that the mode of therapeutic action of psycho­

analytic treatment differs in each of the three realms of uncon­
sciousness that we have described. Psychoanalysis is; above all
else, a method for illuminating the prereflective unconscious,
and it achieves this aim by investigating the ways in which the
patient;s experience of the analytic relationship is unconsciously
and recurrently patterned by the patient according to develop­
mentally preformed meanings and invariant themes. Such anal-
ysis; from a position within the patienfs subjective frame of
reference, with the codetermining impact of the analyst on the
organization of the patienfs experience always kept in view,
both facilitates the engagement and expansion of the patienfs
capacity for self-reflection and gradually establishes the analyst
as an understanding presence to whom the patienfs formerly
invariant ordering principles must accommodate, inviting syn­
theses of alternative modes of experiencing self and other.
The dynamic unconscious becomes transformed primarily
through analysis of resistance-that is; the investigation of the
patienfs expectations and fears in the transference that if his
central affective states and developmental longings are exposed
to the analyst; they will meet with the same traumatogenic;
faulty responsiveness that they received from the original caregi­
vers. Such analysis, always taking into account what the patient
has perceived of the analyst that has lent itself to the patienfs
anticipations of retraumatization, establishes the analytic bond
as a gradually expanding zone of safety within which previ­
ously sequestered regions of the patienfs experience can be
brought out of hiding and integrated.
Analytic attention to the realm of the unvalidated uncon­
scious probably makes a contribution to 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 percep­
tions 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 as symbolically elaborated feel­
 THREE REALMS OF THE UNCONSCIOUS 35

ings. In such cases, the analyst's investigation of and attunement

to the patienfs inner experiences, always from within the pa­
tients perspective； serves to articulate and consolidate the pa­
tients subjective reality, crystalizing the patient's experience,
lifting it to higher levels of organization, and strengthening the
patienfs confidence in its validity. This, we contend； is a foun­
dation stone of the sense of self, a selfobject function so vital and
basic that we designate its appearance in analysis by a specific
term - the self-ddineating selfobject transference (Stolorow et al.;
1992).
Let us turn now to a visual analogy that we have found useful
in discussions of these ideas with students and colleagues. Our
purpose here is not to introduce a new topographic model of the
mind, complete with reified spatial metaphors, but rather to
highlight certain interrelationships between the three forms of
unconsciousness once they have become established in the
course of development. Imagine a building with several floors
and a basement that lies below the surface of the ground. Con­
sciousness corresponds here to the parts of the building above
ground level; the higher floors represent those areas of aware­
ness in which a person has achieved comparatively greater de­
velopment and integration. The dynamic unconscious appears
in the basement of the structure below ground and out of sight.
Here lie the contents that are driven out of conscious awareness,
because of their association with intolerable conflict and subjec­
tive danger. The prereflective unconscious has no concrete coun­
terpart in this image, but； rather, corresponds to an architect's
blueprint； which sets out the plan according to which a building
is constructed. A blueprint may be thought of as a set of orga­
nizing principles that specify a pattern of relationships between
the various parts of the building. Prereflective structures of expe­
rience likewise are not specific subjective contents, but are the
principles that organize those contents into characteristic pat­
terns. The unvalidated unconscious appears in our analogy in
the form of bricks, lumber, and other unused materials left lying
around the building and in the basement; materials that were
never made part of the construction but that could have been.
These various objects represent experiences that have never been
articulated and integrated into the structure of consciousness and
36 CHAPTER 2

that in consequence remain largely unconscious as long as the

requisite validation continues to be absent.

CLINICAL ILLUSTRATION

In what follows, we ill나strate; through a discussion of a dream;

the different forms of unconsciousness. The dream we have
selected is a very brief one that occurred at the onset of a
psychotic episode experienced by a 19-year-old woman.

The dreamer stood in a country setting before a small structure

that she said resembled an outhouse. Looking inside, she found a
toilet. As she peered into the bowl, the water began gurgling,
foaming; and then rising and overflowing. The flow became
more and more agitated until an explosive geyser of unidentified
glowing material erupted from the toilet, increasing in violence
without apparent limit. At this point the dreamer awoke in
terror.
9

The nuclear formative situation of this patient's childhood

history involved severe sexual exploitation by her father. Com­
mencing at the age of two; her father had used his daughter for
primarily oral sexual gratification several times each week.
These practices, carried o나t late at night; were kept entirely
secret from other family members and continued well into the
patient's teenage years. This was a family that maintained an
image of great normalcy before the community. It kept a well-
tended lawn; participated in neighborhood life, and regularly
attended church. A profound division th니s existed between the
normal life carried on during the day and the nighttime sexual
practices between father and daughter. Once she was old
enough to realize that their relationship was not the one all
fathers and daughters had; her father instructed her never to
speak of their physical intimacy; he explained that other people
had not evolved to the point where they could understand what
was taking place. He also pressured her to enjoy the sexual
episodes； which he said were akin to the practices of royal
families during other historical eras. The father told her that
 THREE REALMS OF THE UNCONSCIOUS 37

what was taking place between them heralded the future of

parent-child relations. Her need to comply with his vision of
their special relationship was reflected during the period of her
psychosis in a delusion that she had been sent to earth by God to
have sexual intercourse with all the men on the earth in order to
lighten their spirits and lift their gloomy moods. The tie to the
mother was also deeply problematic. On one occasion when the
patient was six and told her mother something of what had
been occurring with her father, she was screamed at and beaten
for making up lies. The truth about the incest did not begin to
emerge until her midteens； when another child in the family
complained about the father's sexual behavior.
During her childhood years； the patient appeared to be a
well-adjusted girl. She had many friends, received excellent
grades in school, and tried to make her parents proud. The only
sign of difficulty she showed was a tendency toward daydream-
ing; which her teachers and parents encouraged her to curb.
Cordoning off the nighttime experiences of sexual molestation
and blocking from awareness the destructive Impact of these
experiences, she consciously identified with the talented,
normal child she was known as. Allowing herself to experience
or express the confusing tangle of emotions occasioned by the
incest threatened her ties to the people closest to her; notably
her mother and father. As will be seen, a clear consciousness of
what was transpiring also had a disintegrating effect on her
sense of her own selfhood.
Hints of the nature of the effects of her situation, however,
made an appearance in her recurring dreams. Two repeating
nightmares haunted her early and mid시e childhood years,
dreams that were elucidated only many years later as part of her
psychotherapy. In one dream she stood in the kitchen of her
family's home and noticed the presence of strange dark spots on
the floor. Above each spot, any object or part of an object
vanished and was annihilated. Observing this； she was terrified
to see that the dark spots were beginning to expand, leaving less
and less area in the light. In the dream she began to step and
jump awkwardly between the growing spots in a desperate
effort to avert her own annihilation. This dream emerged during
the therapeutic sessions as a child's expression in metaphorical
38 CHAPTER 2

symbols of the increasing threat to her psychological survival

that she was experiencing in her family. In the second recurrent
dream; she lay prostrate as her body was pulled alternately in
opposite directions by two arrays of strings with little hooks on
them caught under her skin. Small elf-like creatures pulled on
these strings, stretching her skin first in one direction and then
in the other direction. This dream came to be understood as
concretizing the contradictory pulls on her sense of her own self
by her two fathers： one; the loving; responsible father of the
daylight world; and the other; the leering sexual abuser who
inhabited her nights. Here we find an additional and perhaps
even more central motive for her separating off and repressing
so much of the incest experience. To the extent that she re­
mained conscious of all that was taking place in the home；
during the night as well as the day, she faced the threat of being
pulled apart and ultimately ripped into pieces by the contradic­
tions that had been imposed upon her.
Let us return now to the dream that is the focus of our discus­
sion and examine it from the standpoint of the distinctions
between the various forms of unconsciousness. The dynamic
unconscious in this case; consisting in sectors of experience that
have been sacrificed in order to safeguard needed ties and protect
a sense of self-integrity, is represented in the dream by the
underground material that lay beneath the outhouse. The dream
actually portrays not the dynamic unconscious； bait rather a
breakdown of repression and the invasion of consciousness by
what earlier was dynamically unconscious. In terms of the pa­
tients life; we could say that the contents of the dynamic
unconscious here consisted principally of the overwhelming
affects generated by her situation in her family} affects that were
never fully articulated or communicated to anyone.
The prereflective unconscious in the dream appears in the
geometry of the imagery, wherein there is a spatial division
between the world above — the daylight； public, conscious realm
of a loving family-and the world below-the nighttime, mostly
unconscious life of betrayal and incest. A profound and central
invariant principle organizing the patienfs subjective universe
pertained to this dichotomy, according to which vitally needed
acceptance by others is gained and protected through the sys­
 THREE REALMS OF THE UNCONSCIOUS 39

tematic driving underground of one's own emotional truths•

The outhouse in the dream; a symbolic receptacle for such
unacceptable contents； provided a channel for expunging those
areas of her subjective life that threatened the integrity of the
daytime world of her family.
The unvalidated unconscious appears in the dream in the
undifferentiated, unidentifiable nature of the glowing material
that erupted from the toilet. What came up; it will be recalled;
was not specific objects that could be identified and labeled, and
that would have corresponded to a set of specifically articulated
feelings and memories. It was; rather, an overwhelming mass of
something she did not recognize. The experiences it had been
necessary for this patient to eliminate from her conscious life
had never been acknowledged or validated by anyone； indeed,
they had been specifically invalidated by both parents: by the
father when he redefined the incest as a special rite and insisted
that she enjoy it; and by the mother when she angrily punished
her daughter for making up lies. This patient, at the outset of
her treatment} did not have what one could call emotional
knowledge of what had happened to her. She was cognitively
aware of the incest, though not of its vast extent, but she had no
feeling that she had been victimized； abused, or exploited. Like-
wise she knew that her mother had ignored her sit니ation; but
she had never experienced a sense of betrayal or abandonment
by her mother. The exploration of the patient's history within
the validating context of the analytic dialogue resulted in the
emergence, element by element, in a process extending over
nearly two decades, of a more complete emotional sense of the
devastating position she had occupied in her family. Of great
assistance in the exploration was a detailed investigation of the
various delusions and hallucinations she developed during the
period of her psychosis； which seemed to encode or otherwise
be associated with previously unconscio니s features of her trau­
matic history, features that had been submerged in her accom­
modation to her parents7 needs. The result of this illumination
was a gradual redefinition of her identity to incorporate the felt
reality of having been victimized, exploited； and betrayed as the
central experiences of her childhood.
The dynamic unconscious and the 니nvahdated unconscious
40 CHAPTER 2

coincide with one another in this case; the patient's repressed

emotional reactions to her family situation were parts of experi­
ences that had never been validated by anyone during her child­
hood years. What emerged from repression at the onset of her
psychotic episode was not clear memories and feelings; which
could then perhaps have been integrated into her conscious life;
her experience at that time was; instead, one of being flooded by
disorganizing emotional impressions that she could not under­
stand or articulate. Although sharp distinctions between the
different forms of unconsciousness can be drawn theoretically,
in the realm of clinical reality； as this case illustrates, the dif­
ferent forms are likely to become manifest in intricately amal­
gamated ways.
 Chapter 3
The Mind and the Body

he focus of this chapter is the relationship between mind

T and body. The mind-body problem, considered as a meta­

physical question, has a long and complicated history within
philosophy and many proposed solutions - materialism^ ideal-
ism, parallelism; interactionism (see Wallace, 1988; for an over-
view). Classical psychoanalysis has adopted a materialist solu-
tion; assigning ontological priority to physical matter - the body
and its 어drives;;-and interpreting the organization of experience
as a secondary expression of bodily events. Concepts derived
from natural science are reified； and experience is seen as an
epiphenomenon of those reifications. Materialist doctrine, with
its inevitable reifications, lends itself nicely to the myth of the
isolated mind.
Our concern here is the relationship between mind and body
in experience. We thus eschew the philosopher's consideration
of these terms as referents for any kind of absolutes or tangibly
existing entities; nor do we discuss mind and body as terms of
linguistic discourse. The inquiry centers instead on mind and
body as poles or elements of self-experience and on the varied
forms in awareness that the mind-body relationship may take-
Hidden in this field of insoluble philosophical controversy is a
set of profoundly significant psychological research problems

41
42 CHAPTER 3

concerning the nature and determining conditions of the dif­

ferent relationships that may exist in experience between mind
and body.
We seek both a description of the major variations of the
subjective relationship between the mind and the body and a
characterization of the specific intersubjective context that is
associated with each form of this relationship that is considered.
By pursuing this theme; we hope to shed light on the psycho­
logical foundations of one of the great problems of metaphysical
philosophy and to contribute as well to an expanded under­
standing of this central dimension of human self-experience.

THE EXPERIENCE OF AFFECT

Our thesis here is that the boundaries between the subjectively

experienced mind and body are products of specific； formative
intersubjective contexts. One domain in which this can be
clearly demonstrated is the experience of affect. In the realm of
affective experience, the boundary separating mind and body
originates in intersubjective situations closely similar to those in
which the division between conscious and unconscious takes
form. Indeed, as we shall see; in the affective domain these two
experiential boundaries are in large part coextensive.
Krystal (1988) has suggested that a critical dimension of affec­
tive development is the evolution of affects from their early
form; in which they are experienced as bodily sensations； into
, •三三▲'三 ’ ' f *•三 •才 • 『개*스^으〒三수스出» 노

subjective states that can gradually be verbally articulated. He

also emphasizes the role of the caregivers ability to identify
correctly and verbalize the chilcfs early affects in contributing to
this maturational process. Empathically attuned verbal respon­
siveness fosters the gradual integration of bodily affective expe­
riences into symbolically encoded meanings, leading eventually
to the crvstalization of distinct feelings. The extent to which a
person comes tcTexperience affects as mind (i.e.; as feelings)
rather than solely as body thus depends on the presence of a
facilitative intersubjective context.
In the absence of a facilitating context； derailments of this
transformational process occur; whereby affects continue to be
 THE MIND AND THE BODY 43

experienced primarily as bodily states. The boundary thereby

established between mind and body is such that the experiential
territory covered by the body remains comparatively large, en-
— .〒 J
•나‘5 /
r-.☆.斗 J 리•'.門…키.-그、 O / 수...、. .사. ，•心 . 드 /

compassing affect states that ordinarily come to be experienced

引,…...，，—丁 …》수石*.wWL— —%— —호』一
as more prominently mental. This situation can be seen as
coming about in ways that closely parallel two forms of uncon­
sciousness discussed in chapter 2. On one hand, corresponding
to the origins of the unvalidated unconscious, affects may fail to
O • ..그— O’.r I ’M %心•★시-‘•다’'…

evolve from bodily states to feelings because, in the absence of

validating responsiveness, they are never able to become, sym-
। 三— j住丄三^느丕■="> • * ‘• 브**허 —' 즈*--' 흐姓■'수'투;方 t y ■ - » . _ • 三 .t — . '.'스V" 느 ；( 느 _ . /. • 1 ’ •，''•广 1 '

bolicallv articulated. Hence, the person remains literally ale- ?\{

.. …、아…•시놈저*" 7 V /•=.
xithymic (Krystal, 1988). On the other hand, corresponding t이⑴ /
^cfir^rmation of the dynamic unconscious, when a child regu­
larly perceives that his affective experiences are intolerable or / t
injurious to a caregiver, then the symbolic articulation of affect m
may become blocked or 우dispersed77 (McDougall, 1989) in order
to safeguard the needed bond. The persistence of psychosomatic
states and disorders in adults may be understood as remnants of
arrests in affective development- When there is an expectation
넉1저*'’**더'버드*z _、“•=—' V '上 ’" ' »

that more advanced; symbolically elaborated feelings will be

ignored, will be rejected, or will damage a tie. replicating the 시
그나.■ ,111! r , 1»-유."午리‘* =、'方、•；.-,『$.〈心. -리？■引.:= r -■ , 으 , 브… _ 흐구 r

faulty attunement of the childhood surround, the person reverts

to more archaic, exclusively somatic modes of affective experi-
ence and expression (Socarides and Stolorow. 1984/85):1 In the 入
psychoanalytic situation, when the analyst becomes reliably
established in the transference as an attuned, accepting, affect­
articulating presence, the psychosomatic symptoms tend to re­
cede or disappear, only to recur or intensify when the thera­
peutic bond becomes disrupted or when the patient's confidence
in the analyst's receptivity to or understanding of his affective
states becomes significantly shaken.

THE CONCRETIZATION OF EXPERIENCE

A second set of interrelationships between the subjectively expe­

rienced mind and body becomes unveiled through a consider
~ 1a. 소•• •우 砂’ 수 스*** •

1 Certain psychosomatic symptoms may develop when even the bodily

component of affective experience is blocked.
44 CHAPTER 3

ation of the psychological process that we (Atwood and Stolo-

row; 1984) have termed concretization - the encapsulation of
configurations of subjective experience by concrete; sensori­
motor symbols. Concretlzations may serve an array of psycho­
logical purposes (e.g.; wish-fuifilling; self-punishing; adaptive,
defensive, restitutive); but their most general, supraordinate
function is to dramatize, reify; and thereby maintain the organi­
zation of the subjective world. The concretization of experience
is a ubiquitous and fundamental process in human psychological
life, underlying a great variety of psychological activities and
products. Concretization can assume a number of forms, de­
pending on what pathways or modes of expression it favors. In
dreams and fantasies, for example, perceptual imagery is enr
ployed to actualize required configurations of experience. When
action predominates in the mode of concretization, then behav-
ioral enactments are relied upon to maintain the organization of
experience.
Concretization can mediate the relationship between mind
and body in a number of ways. One such relationship is illus­
trated by certain sexual enactments； in which intense bodily
experiences are relied on to restore or sustain a precarious, frag-
mentation-prone psychological organization (Kohut； 1971;
Goldberg, 1975； Stolorow and Lachmann, 1980; Socarides,
1988). In a previous work (Atwood and Stolorow; 1984)； we
discussed this phenomenon from the standpoint of the contribu­
tion of early psychosexual experiences to the development of
the subjective world and of the sense of self in particular. We
contended that the sensual experiences and fantasies that occur
in the co니rse of early development may be viewed as psychic
organizers that contribute importantly to the structuralization of
the sense of self. Specifically, psychosexual experiences provide
the child with an array of sensorimotor and anatomical symbols
that concretize and solidify developmental steps in the articula-
tion of his subjective universe. When these developments are
seriously impeded； leading to structural deficits and weaknesses,
the person may as an adult continue to look to psychosexual
symbols to maintain the organization of his subjective life. By
dramatically enacting these concrete; symbolic forms to the
accompaniment of orgasm, he gives vivi시y reified, tangible
 THE MIND AND THE BODY 45

substance to his efforts to restore a failing sense of selE In such

instances, contrary to what Freud (1905) maintained, it is not
the infantile erotic experience per se that has been fixated and
then regressively reanimated. Instead, it is the early function of
the erotic experience that is retained and regressively relied
upon-its function in maintaining the cohesion and stability of a
sense of self menaced with disintegration• Analytic exploration
of the details of sexual enactments, their origins and functions,
should reveal the particular ways in which they both encapsu­
late the danger to the self and embody a concretizing effort at
self-restoration.
In sexual and other physical enactments, the body is used in
the service of mind; substantializing a needed experience but not
substituting for it. In conversion symptoms, by contrast} con-
Crete symbolization creates a bodily substitute for some con-
flictual experience and thereby modifies the boundary between
mind and body in a manner similar to what occurs in psychoso­
matic states. The conversion-a 化symbol written in the sand of
the flesh;; (Lacan; 1953; p. 69)-enlarges the experience of body
at the expense of mind. The intersubjective situations giving rise
to conversion symptoms may be quite similar to those in which
some psychosomatic states occur, wherein the verbal articula­
tion of affective experience is prevented because it would
threaten a needed tie. Unlike psychosomatic states, however,
which follow presymbolic pathways of affect expression, con­
version symptoms are mediated by symbolic processes. They
express in concrete; anatomical symbols what one believes must
not be said or will not be heard, beliefs that； in analysis, become
a focus of intensive investigation and interpretation.
Whereas psychosomatic and conversion symptoms ordinarily
entail alterations in bodily functions, such alterations are not
present in hypochondriacal states. In these, the concretization
process results in the formation of anxiety-ridden fantasies abo니t
the body, in which its parts are pictured as diseased or deteriorat­
ing. In the imagery of failing body parts, concrete anatomical
symbols are being employed to dramatize and signal an im­
pending psychological catastrophe-the threat of self­
disintegration (Kohut； 1971； Stolorow and Lachmann; 1980).
The origins of such states can be found in intersubjective situa-
46 CHAPTER 3

tions in which the basic cohesion of self-experience is severely

compromised； a subject to which we now turn.

EMBODIMENT, UNEMBODIMENT, AND

DISEMBODIMENT

A central constituent of cohesive selfhood is the subjective expe­

rience of embodiment} what Winnicott (1945; 1962) refers to as
^indwelling?7 With the achievement of indwelling； the skin
becomes the subjective boundary between self and nonself and;
experientially； the psyche is felt to reside within the soma.
Contributions to this state of unity of mind and body are made
in early psychological development by the handling and holding
of the chilcfs body (Winnicott； 1945; 1962); by the sensual and
other stimulations of the child’s body surface that occur within
the early child-caregiver interactions (Hoffer; 1950; Mahler,
Pine; and Bergman, 1975; Krueger, 1989)； and by a variety of
early mirror and mirrorlike experiences (Lacan; 1949; Winni-
cott; 1967； Kohut, 1971; 1977).
The caregiver;s responses to the infant's affect states play an
especially central role in promoting mind-body cohesion. As we
have noted； early affective experiences are; for the most part； a
matter of physical sensations rather than psychologically elabo­
rated feelings； and the caregiver's affect attunement is communi­
cated primarily through holding and other sensorimotor con­
tacts with the infant's body. Early deficits in such attunement
show themselves in various deformations of the child;s body­
self and/or in an incomplete attainment of the sense of indwel­
ling. Mind-body unity remains linked to a sustaining selfobject
milieu throughout the life cycle, although the child's developing
use of symbols and images increasingly obviates the need for
immediate sensorimotor attunements and concrete mirroring in
order to maintain this aspect of self-cohesion.
The formative contexts of extreme states of disconnection of
mind and body typically involve profound failures of early
affect attunement} damaging physical intrusions; deprivation of
contact needs, and felt threats to physical survival. One can
distinguish two general classes of experiences involving a radical
 THE MIND AND THE BODY 47

separation of mind and body： (1) those reflecting an initial

failure to achieve the sense of psychosomatic indwelling, a
failure that leaves the person vulnerable to states of severe deper­
sonalization and mind-body disintegration (Winnicott; 1945y
1962; Stolorow and Lachmann; 1980); including dramatic out-
of-body 化journeys기 (see Atwood and Stolorow; 1984; chap, 4;
for a detailed case study) and (2) those reflecting active disidenti-
fication with the body in order to protect oneself from dangers
and conflicts associated with continuing embodied existence.
The intersubjective context of the former class is characterized
by deficits of early affect attunement; along with destructive
intrusions. The context of the latter is more variable, depending
on the specific danger that the disidentification with the body
serves to avert. These dangers may include immediate threats to
the physical self； as in traumatic, near-death experiences (Lifton;
1976), and dangers posed by other persons who are perceived as
threats to the psychological survival of the self (Laing; 1960;
Winnicott, I960).
Between the polar extremes of psychosomatic indwelling and
complete unembodiment or disembodiment； one may distin­
guish intermediate forms of disturbance of mind-body cohe­
sion. In one of these; often observed in cases of childhood sexual
abuse, there is a sense that the mind is somehow floating outside
or above the body; but a complete split between the two does
not develop. Here the separation of mind from body may be
seen as a less extreme form of defensive disidentification,
wherein an attempt is made to protect the integrity of the self
through its removal from the field of bodily violation and intru­
sion. A still less extreme form of disunity is illustrated by expe­
riential states in which the mind is localized in the person's
head, retaining its own distinct separateness from the rest of the
body. Such a split； which often is expressed as a division be­
tween head and body； tends to arise as a defensive organization
when there are unbearable conflicts over the expression of
아)odily개 needs and longings (for tenderness, sexual contact; etc.)

in what is felt to be a fundamentally unresponsive, rejecting

world. In such instances, the body and its needs tend to be
experienced as defective and repugnant to others, the defective
body concretizing the rejected, unacceptable self.
48 CHAPTER 3

A third group of experiences exemplifying an intermediate

level of disunity of mind and body involves a perso117s identifica­
tion with some external, usually critical viewpoint on the self,
an identification so complete that the sense of the self as an
embodied subjectivity is eclipsed by an externally situated view
of self-as-object. The developmental context of these subjective
states does not involve direct threats to the integrity of the self
but rather is characterized by interactions in which the chilcFs
ability to maintain secure connections to caregiving others was
made contingent on meeting stringent standards and expecta­
tions imposed from without. In the hope of safeguarding a
needed tie to the caregiver; the child here abandons his own
unmirrored experience and embraces an outside perspective in
its place. This accommodation may result in a sense of being
located outside one's body； the body then becomes the focus of
critical scrutiny and evaluation and often of intense shame and
self-consciousness.

CONCLUSIONS ■

Our conception of the mind-body dialectic falls broadly within

the relational perspective delineated by Mitchell (1988)； in that
we view the various boundaries and relationships forming be-
tween the subjectively experienced mind and body as taking
shape in specific relational contexts. The mind-body dialectic
can never be understood in isolation; it is always a property of a
우living system;; (Sander; 1985). This conceptualization holds

important implications for the specific framing of psychoana­

lytic interventions in the clinical situation and also for future
investigations of the psychological underpinnings of the various
metaphysical solutions to the mind-body problem found in
philosophy.
The analytic approach to the various mind-body relation­
ships must take into account what is understood about the
differing intersubjective contexts in which they crystalize. In the
analysis of psychosomatic disorders or conversion symptoms
originating in early situations in which the verbal articulation of
affective experience was blocked in order to protect a needed tie;
 THE MIND AND THE BODY 49

a principal focus of investigation and interpretation will be the

patient's expectations or fears in the transference that his
emerging feeling states will meet with the same pathogenic
reactions from the analyst that they evoked from the original
caregiver- An important aspect of such investigation is the delin-
eation of the patienfs perceptions of qualities or activities of the
analyst that for the patient signal the analyst's intolerance of
affect- In contrast} such resistance analysis will not be promi-
nent in the analytic approach to psychosomatic states that re­
flect the failure of affects to evolve from bodily states to feelings
because of the absence of validating responsiveness from the
childhood surround. Here the analyst's principal function will be
to help lift the patient's affective experience to higher levels of
organization by facilitating its articulation in verbal symbols-
an example of what we have termed the s시f-delineating selfob­
ject function.
In the analysis of sexual enactments, hypochondriacal fanta-
sies; and profound states of mind-body disintegration, the ana­
lyst will investigate the psychological injuries or the disruptions
of archaic ties, past and present; that have compromised the
basic cohesion of the patient's self-experience. Concomitantly；
the patient will be permitted gradually to form a transforming
selfobject bond with the analyst, through which the integrity of
the patienfs self-experience can eventually come to rest on a
more secure foundation. In contrast, when disidentification
with the body serves a protective purpose, the analytic investi­
gation will increasingly focus on the patienfs feeling of endan­
germent in the transference, as he anticipates that exposing to
the analyst sequestered and vulnerable regions of his self­
experience will evoke obliterating intrusions; stony unrespon-
siveness, or searing criticism.
It seems to us that the various mind-body relationships that
occur in experience correspond in a general way to the various
solutions to the mind-body problem that have been proposed
philosophically. The philosophical doctrine of materialism, for
example, resembles the mind-body relationship found in psy­
chosomatic states and conversion symptoms, in that the pri­
macy of the body is affirmed and its domain of influence is
greatly enlarged in comparison to that of the mind. Idealist
50 CHAPTER 3

doctrine； in contrast； is similar to unembodied or disembodied

states, in that the eternal forms of the mind reign supreme, with
the realm of the body being reduced to a mere shadow. Paral­
lelism may correspond to intermediate forms of mind-body
disunity wherein mind and body are felt to exist on different
planes or in separate Iocations; whereas interactionism may
speak to a greater degree of mind-body integration. The per-
sonal; subjective origins of various solutions to philosophical
problems are a fascinating area for future psychoanalytic re­
search. From this standpoint, investigations of the intersubjec-
tive contexts of mind-body relationships can be seen as a pro­
logue to the psychological study of metaphysical issues.
A number of the mind-body relationships delineated here are
illustrated by the case of Jessica in chapter 5.
 Chapter 4
Trauma and Pathogenesis

he concept of trauma has remained a pillar of psychoana­

T lytic thought since Freud's (Breuer and Freud, 1893-95)

early studies of the origins of hysteria. Even after Freud (1914)
abandoned the 주seduction theory/7 concluding that 外i]f hyster­
ical subjects trace back their symptoms to traumas that are
fictitious； then the new fact which emerges is precisely that they
create such scenes in phantasy乃 (p. 17); he continued to grant
trauma a central role in pathogenesis. Nevertheless, his concep­
tualization of trauma was thereafter tilted in a fateful direction,
from trauma as caused by external events to trauma as produced
by forces from within. As Krystal (1988) has pointed out; two
distinct models of psychic trauma were already present in Studies
on Hysteria. In one; trauma was the product of an unbearable；
overwhelming affect state; in the other it was caused by the
emergence of an unacceptable idea; such as a fantasy. Later;
Freud (1926) attempted to reconcile these opposing models by
conceptualizing trauma in terms of the ego;s helplessness in the
face of mounting instinctual tensions； whether these were pro­
voked from without or prompted from within. Signal anxiety
and defenses were seen as being mobilized to prevent a psychoe-
conomic catastrophe. Thus, as Freud's theory of the mind
evolved, his conception of tra나ma increasingly became absorbed

51
 ’아＞•

52 CHAPTER 4

into an unremitting intrapsychic determinism (Stolorow and

Atwood, 1979)； culminating in the reified image of an isolated；
faltering mental apparatus; unable to process the instinctual
energies flooding it from within its own depths.
This isolated-mind conception of psychic trauma, empha-
sizing quantities of instinctual excitation overloading the capaci­
ties of an energy processing apparatus; has persisted within
Freudian ego psychology (e.g.; Kris; 1956). It was retained as
well in Kohut's (1971) early attempt to distinguish 化optimal
frustrations/' which promote psychological development} from
the traumatic frustrations that result in self-pathology. In a
critique of Kohut/s conceptualization； one of us; in a chapter
written in collaboration with Daphne Stolorow (Stolorow et aL;
1987); wrote：

We are objecting here to the concept of 어optimal frustration개

because of its retention of economic and quantitative metaphors
that are remnants of drive theory. For example, when Kohut
(1971) describes an optimal frustration of the child's idealizing
need as one in which 어the child can experience disappointments
with one idealized aspect or quality of the object after another77
(p. 50) rather than with the total object, or one in which the
shortcomings of the object 어are of tolerable proportions개 (p. 64);
he places the emphasis on the 우size乃 of the disappointment - and;
by implication, the 어 amount" of the depressive affect-as the
decisive factor that determines whether the disappointment will
be pathogenic or growth-enhancing. In contrast； we are claiming
that what is decisive is the responsiveness of the milieu to the
child;s depressive (and other) reactions. We are thus shifting the
emphasis from 化optimal frustration^ to the centrality of affect
attunement [pp. 75—76; fn.].

In agreement with Krystal (1988); it is our view that the

essence of trauma lies in the experience of unbearable affect. As
was implied in the preceding quotation, however, the intolera­
bility of an affect state cannot be explained solely; or even
primarily, on the basis of the quantity or Intensity of the painful
feelings evoked by an injurious event. As we emphasized in
chapter 1; the child;s affective experience is a property of; and is
regulated within; the child-caregiver system. Developmentally;
 TRAUMA AND PATHOGENESIS 53

traumatic affect states must be understood in terms of the rela­

tional system in which they take form. Our central thesis in this
chapter is that early developmental trauma originates within a
formative intersubjective context whose central feature is a
failure of affect attunement-a breakdown of the child-caregiver
system of mutual regulation - leading to the chi!d;s loss of affect-
regulatory capacity and thereby to an unbearable, overwhelmed,
disintegrated； disorganized state (see Socarides and Stolorow,
1984/85； Stolorow et al.; 1987). Painful or frightening affect
becomes traumatic, we contend, when the requisite attuned
responsiveness that the child needs from the surround to assist
in its tolerance, containment, modulation, and alleviation is
absent.
The relational context of trauma was recognized by Balint
(1969)； who postulated three phases contributing to its occur­
rence in childhood. First, a child is dependent on a trusted adult.
Second； this adult proves to be unreliable through overstimula­
tion or neglect and rejection of the child. In the third and crucial
phase, the child attempts to 어get some understanding； recogni-
tion; and comfort기 (p. 432) from the adult who perpetrated the
disruption. The adult, however； refuses to acknowledge the
disturbance, denies that excitement or rejection occurred, often
blames the child for his distress, and rejects as well his efforts to
seek a trusting reconnection-
A similar conceptualization of developmental trauma; using
the framework of psychoanalytic self psychology and empha­
sizing the fate of the child's painful affect states within the
developmental system; has been offered by one of us (Stolorow;
in press)：

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 par­
ents who repeatedly rebuff primary selfobject needs are usually
not able to provide attuned responsiveness to the child;s painful
54 CHAPTER 4

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 . . . these walled-off painful feelings
become a source of lifelong inner conflict and vulnerability to
traumatic states, and in analysis their reexposure to the analyst
tends to be strenuously resisted.

It cannot be overemphasized that injurious childhood experi­

ences-losses； for example-in and of themselves need not be
traumatic (or at least not lastingly so) or pathogenic, provided
that they occur within a responsive milieu (Shane and Shane,
1990). Pain is not pathology. It is the absence of adequate
attunement and responsiveness to the child's painful emotional
reactions that renders them unendurable and thus a source of
traumatic states and psychopathology. This conceptualization
holds both for discrete, dramatic traumatic events and for the
more subtle 어impingements77 (Winnicott； 1949); overstimula­
tions (Greenacre, 1958); or narcissistic woundings (Kohut;
1971); the 어silent traumas77 (Hoffer, 1952) or 우cumulative trau-
mas기 (Khan; 1963) that occur continually throughout child­
hood. Whereas Khan (1963) conceptualized cumulative trauma
as the 化result of the breaches in the mother's role as a protective
shield over the whole course of the child's development^ (p. 46);
we understand such ongoing trauma more in terms of the failure
to respond adequately to the chilcfs painful affect once the
우protective shield77 has been breached. As Kohut (1971) repeat­

edly emphasized, such cumulative trauma often results from

specific character pathology in the parent； whose narcissistic use
of the child, for example, precludes the recognition of; accep­
tance of; and attuned responsiveness to the child;s painful reac­
tive affect states. Indeed； images depicting discrete, dramatic
trauma, whether derived from memories of events； fantasies； or
both in some combination； often metaphorically encode these
more subtle; recurrent early interaction patterns involving per­
vasive emotional exploitation of; and malattunement to; the
child (Stolorow et al.; 1987).
Lacking an affect-integrating； containing, and modulating in-
tersubjective context, the traumatized child must dissociate the
 TRAUMA AND PATHOGENESIS 55

painful affect from his ongoing experiencing, often resulting in

psychosomatic states or in splits between the subjectively expe­
rienced mind and body (chapter 3); or withdrawal behind a
protective shield or cocoon (Modell; 1976), safe from potential
injuries that would result from attachments to others. Even if
able to remember the traumatogenic experiences, the child may
remain plagued by tormenting doubts about their actuality； or
even about the reality of his experience in general (chapter 1); an
inevitable consequence of the absence of validating attunement
that we are contending lies at the heart of psychic trauma. The
traumatized child will fail to develop the capacity for affect
tolerance and the ability to use affects as information-providing
signals； and painful affects, when felt; will tend to engender
traumatic states (Socarides and Stolorow, 1984/85; Stolorow et
al.; 1987； Krystal, 1988). Such a child may feel compelled to
renounce 어imagining, hoping, and wishing for what is possible,
all of which have only brought unbearable vulnerability and
tremendous frustration77 (Shabad; 1989； p. 118) and may de­
velop a u 'doomsday orientation/ that is; profound pessimism
frequently accompanied by chronic fears and depressive life-
style” (Krystal, 1988, p. 148).
In general, it may be said that u[d]evelof가nental traumata derive
their lasting significance from the establishment of invariant and relentless
principles of organization that remain beyond the .. . influence of reflective
s아마wmeness or of subsequent experience" (Brandchaft and Stolorow,
1990; p. 108). The traumatized child； for example, may 化con-
clude;; that his own unmet needs and emotional pain are expres­
sions of disgusting and shameful defects in the self and thus
must be banished from conscious experiencing； he; in effect}
blames his own reactive states for the injuries that produced
them. The esta비ishment of such organizing principles； which
often entails wholesale substitution of the caregivers subjective
reality for the child's own (see the case of Jessica, chapter 5； also
Brandchaft; 1991)； both preserves the tie to the i피urious or
inadequately responsive caregiver and protects against retrauma­
tization. Once formed； such principles, which usually operate
unconsciously (chapter 2); acutely sensitize the traumatized
person to any subsequent experience that lends itself to being
interpreted as an actual or impending repetition of the original
56 CHAPTER 4

trauma; necessitating the mobilization of defensive activity

(Ornstein; 1974). Retra니matization later in life occurs when
there is a close replication of the original trauma, a confirmation
of the organizing principles that resulted from the original
trauma/ or a loss or disruption of a sustaining bond that has
provided an alternative mode of organizing experience; without
which the old invariant principles are brought back into the
fore.
Nowhere is the doctrine of the isolated mind more deleterious
than in the conceptualization of trauma. Despite Ferenczfs
(1933) early attempt to redress the neglect of abuse; particularly
sexual abuse; in the pathogenesis of the neuroses and his sugges­
tion that analysts actually reproduce the original trauma in their
blunders and blindnesses； it is only in recent years that the
frequent sexual and other physical abuse of children has been
systematically addressed by psychoanalysts (e.g.; Miller, 1986;
Levine; 1990; Kramer and Akhtar; 1991). To attribute the affec­
tive chaos or schizoid withdrawal of patients who were abused
as children to 化fantasy刀 or to ^borderline personality organiza-
tions;; is tantamount to blaming the victim and； in so doing,
reproduces features of the original trauma. The assumption that
trauma is produced by the chilcFs failure to channel drive ener­
gies arising from within, rather than by the relational creation of
intolerable excitement； pain; and feelings of helplessness； has
been paralleled in classical psychoanalysis;s explanation of nega­
tive transferences and resistances in terms of intrapsychic mech­
anisms located solely within the patient. Just as the abused child
could not blame his parents because of his need for them; and
therefore felt compelled to repress or disavow the experiences of
abuse； it is likely that； without the analyst's help; the trauma­
tized patient will feel compelled to suppress his awareness of
disruptions in the analysis or to blame himself for their occur-
rence; thereby attempting to survive the traumas of analysis as
he had the traumas of childhood.
Both Winnicott (1963) and Kohut (1959) stressed the crucial
therapeutic importance of recognizing and acknowledging the

1This pathway to retraumatization was helpfully clarified in discussions

with Claudia Kohner.
 TRAUMA AND PATHOGENESIS 57

validity, from within the patienfs perspective, of the reexperi­

encing of traumatogenic developmental failure in the transfer­
ence:
*

The reaction to the current [analytic] failure . . . makes sense

insofar as the Current failure is the original environmental failure
from the point of view of the child [Winnicott, 1963, p. 20이.

[For the severely traumatized patientj the analyst is not the

screen for the projection of internal structure . . . but the direct
continuation of an early reality that was too distant, too reject-
ing; or too unreliable. . . . [The analyst] is the old object with
which the analysand tries to maintain contact [I〈사iut; 1959； pp.
218-219].

Anyone who has used the clinical concepts of psychoanalytic

self psychology in conducting a psychoanalysis has witnessed
the therapeutic benefits of analyzing disruptions experienced
within the analytic bond. Throughout his writings, Kohut
(1971; 19771984) explained these therapeutic effects by in­
voking his theory of optimal frustration leading to transmuting
internalization, a formulation that； as we noted earlier; incorpo­
rates classical metapsychology;s quantitative and mechanistic
metaphors； relics of the doctrine of the isolated mind. We be­
lieve that the therapeutic impact of analyzing disruptions is
better explained in the light of the traumatized patienfs history
of absent or inadequate affect attunement. In conducting such an
analysis; the analyst investigates and interprets the various ele­
ments of the rupture from within the patient's subjective frame
of reference-the qualities or activities of the analyst that pro­
duced the disruption, the principles that organized its mean-
ings; its impact on the analytic bond and on the patienfs self­
experience； the early developmental trauma it replicated, and;
especially important, the patient's expectations and fears of how
the analyst will respond to the articulation of the painful feel­
ings that followed in its wake (Stolorow et al.; 1987). In our
view; it is the transference meaning of this investigative and
interpretive activity that is its principal source of therapeutic
action; it establishes the analyst in the transference as the sec­
ondarily longed-for; receptive; understanding parent who;
58 CHAPTER 4

through his attuned responsiveness; will 에iold;; (Winnicott,

1954) and thereby eventually alleviate the patienfs painful emo-
tional reaction to an experience of repetition of early develop­
mental failure. The analytic bond becomes thereby mended and
expanded； and primary developmental yearnings are permitted
to emerge more freely as the patient feels increasing confidence
that his emotional reactions to experiences of rebuff and disap­
pointment will be received, understood, and contained by the
analyst. Concomitantly, a developmental process is set in mo­
tion wherein the formerly sequestered painful reactive affect
states, the heritage of the patienfs history of developmental
trauma, gradually become integrated and transformed and the
patienfs capacity for affect tolerance becomes increasingly
strengthened.
The emotional intensity of the analytic relationship, in remo­
bilizing thwarted developmental longings and painful emotional
vulnerabilities in the transference, is fertile ground for potential
retraurnatizations of the patient. It is our view that the fear or
anticipation of retraumatization by the analyst is central to the
phenomenon of resistance in psychoanalysis. The fear of retrau­
matization may be evoked merely by the analyst's bodily pres­
ence or by his benign interest in knowing the patient;s experi-
ence; the latter of which raises the spectre of humiliating
exposure and searing shame. This dread of exposure, which can
be provoked by the analytic process no matter how 우empathic;;
and accepting the analyst perceives himself to be; is dramatically
illustrated by an analytic dream recently reported by Bromberg
(1991)：

In the dream； the analyst, undisguised and with an earnest

manner and a genuinely warm smile； throws into the patienfs
lap a bag containing a two-headed monster. The patient is terri­
fied because she knows she is expected to open the bag, but she
cannot tell the analyst how frightened she is because the monster will just get
larger [p. 401; fn.; emphasis added].

We infer from the imagery of this dream that this patient

expects her analyst to respond to the exposure of her escalating
painful feelings with the same malattunement they received
 TRAUMA AND PATHOGENESIS 59

from her original caregivers, thereby reinvoking the original

childhood trauma and the view of herself as a loathsome mon-
ster that resulted.
What we wish to emphasize is that a patienfs need to wall
himself off from his own affectivity； from his yearnings for
connection with the analyst, and from the analyst's interpreta­
tions is always evoked by perceptions of qualities or activities of
the analyst that lend themselves to the patienfs fears or anticipa­
tions of a repetition of childhood trauma. It is essential to the
analysis of resistance that this be recognized; investigated, and
interpreted by the analyst.
Our conceptualization of trauma and pathogenesis; and its
implications for the analysis of resistance, are well illustrated by
the case of Jessica in the next chapter.
、■으'
 Chapter 5
Fantasy Formation
(written in collaboration
with Daphne S. Stolorow)

reud(1900)used the term fantasy to refer to daydreams； con-

F sck)us and unconscious, and noted their similarity to night

dreams. Fantasies, like dreams, cast configurations of experience
into concrete perceptual images. Fantasies can subserve the en­
tire gamut of psychological functions encountered in clinical
psychoanalytic work - wish-fulfilling; defensive, self-punishing,
and so on. We emphasize the specific function of fantasy in
intersubjective situations wherein powerful affective experiences
fail to evoke adequate validating responses from the surround.
In such instances, the concrete sensorimotor images of the fan­
tasy dramatize and reify the person;s emotional experience,
conferring upon it a sense of validity and reality that otherwise
would be absent. An analogous function may be served by
certain types of enactment through which a person attempts to
articulate experiences that could never be encoded symbolically.
As one of many possible examples of this conception of
fantasy, consider the archaic grandiose-exhibitionistic fantasies
that Kohut (1971) believed were of central importance in the
early development of the self. Unlike Kohut, we do not regard
these grandiose fantasies as primary developmental building
blocks. Rather, it is our view that such fantasies are constructed
reactively in situations wherein the child;s primary affective

61
62 CHAPTER 5

experiences of excitement； expansiveness; pride, efficacy, and

pleasure in himself fail to evoke the requisite validating respon­
siveness from caregivers. The concrete imagery of the grandiose
fantasy both dramatizes and affirms the unvalidated affective
experience and depicts as well what the child perceived was
required of him in order to extract the missing responsiveness.
Another class of fantasies that may arise in consequence of
the experience of invalidation involves the picturing of the in­
validating other as somehow having been taken into one;s own
mind. Such fantasies, which object relations theorists have des­
ignated with the term introject, concretize the process whereby
regions of invalidity in the child's subjective world are filled in
by emotionally significant others. Although the imagery of
having an invalidating object within one;s own mind may also
serve the secondary function of providing an illusion of mastery
or control over its usurping power (Fairbairn, 1943); its primary
meaning is that it dramatizes the chi【d;s inability to maintain
the integrity of his own experience in the face of overwhelming
pressure from the invalidating other.
A distinction is sometimes drawn between 저positive"7 and
우negative77 introjects; the former referring to images of internal

objects possessing idealized； benign features； and the latter to

images emphasizing critical, sadistic, or otherwise destructive
features. It has even been suggested that a criterion of psycho­
logical health is the possession of one or more positive or
어good;; internal objects (Klein; 1940). The question may be

raised whether so-called positive introjects also exemplify the

process whereby regions of invalidity in a person;s experience
are filled in by others' perceptions and judgments. The essence
of intr이ection; as we are conceptualizing it; lies in the substitu­
tion of some part of the psychic reality of an invalidating other
for the child;s own experience- Such a substitution or filling in
could conceivably emphasize quite positive features of the object
and yet remain fundamentally a usurpation of the child;s subjec­
tivity in that the child feels required to affirm and incorporate
these qualities in order to maintain the needed tie to the object.

are grateful to Dr. Bernard Brandchaft for bringing this latter point to
our attention.
 FANTASY FORMATION 63

There are; however, occasions when the fantasy of possessing a

good object within one;s mind does not concretize an invalida­
tion but expresses an effort to support an unsteady capacity for
self-validation. Here too a substitution is occurring and being
concretized, but the portion of the other's psychic reality en­
tering the chilcfs experience contains as its most essential feature
the function of validating empathy. Such fantasies are often
observed in the course of psychoanalytic therapy when a patient
is experiencing the transition from reliance on the bond with the
analyst to provide understanding and validation and is begin­
ning to provide these functions for himself.
Daydreams or fantasies, like any content of experience, can
undergo repression when they, or the affective states they con-
cretize, are perceived to endanger a tie that is required for psy­
chological survival. However, the concept of unconscious fan­
tasy has been expanded to encompass much more psychological
territory than Freud's notion of a repressed or dynamically un­
conscious daydream. Arlow (1969)； for example, after affirming
that 서the term fantasy . . . is used in the sense of the daydream77
(p. 5); describes the role of what he terms 어unconscious fantasy77
in perception：

Unconscious fantasy activity provides the 어mental set;; in which

sensory stimuli are perceived and integrated. . . . Under the pres­
sure of [unconscious fantasies] the ego is oriented to scan the data
of perception and to select discriminatively from the data of
perception those elements that demonstrate some consonance or
correspondence with the latent} preformed fantasies [p. 8]. [Un­
conscious fantasying] supplies the mental set in which the data
of perception are organized； judged, and interpreted [p. 23].

As Slap (1987) has implied； s니ch formulations describe not

repressed daydreams but the operation of developmentally pre­
formed unconscious schemata-that is; psychological structures-
into which the person is assimilating his current experiences.
The phrase 수unconscious fantasy77 is being employed impre­
cisely to refer to the unconscious organizing principles consti­
tuting the domain of unconsciousness that we have termed the
prereflective unconscious. It is these unconscious ordering prin-
64 CHAPTER 5

ciples; formed within the intersubjective matrix of the child-

caregiver system, that underlie both the mental sets that orga­
nize perception and； when concretized, such phenomena as
symptoms; enactments, dreams, and fantasies.
We turn now to a clinical illustration demonstrating the spe-
cific; invalidating intersubjective context in which a vivid intro-
ject fantasy took form-

THE CASE OF JESSICA

Jessica, an attractive yet somewhat masculine-looking actress,

entered psychoanalytic therapy at the age of 26. The difficulties
she initially described pertained to painful feelings of jealousy,
which created arguments with her boyfriend； and a 어not-
so-good;; feeling abo니t herself that was longstanding. Neverthe-
less; it soon became clear that she suffered from a variety of
emotional and psychosomatic problems. Her disruptive affect
states were often experienced somatically as episodic spells of
dizziness, fainting, vomiting; and other gastrointestinal symp-
toms. She had very poor eating habits; would engage in self-
destructive behavior, and was unable to sleep normally. Her
sleep was disturbed by nightmares that depicted past traumatic
events and that continued to disrupt her after she had awakened-
She suffered from chronic boredom, persistent anxiety with
episodes of panic, and an intense fear of being alone. In general,
Jessica showed little capacity for self-care.
Within a few sessions it became apparent that Jessica had
been suffering from a serious, chronic depression punctuated by
states of emptiness and suicidal thoughts and behavior. Her
psychosomatic ailments, anxiety, insomnia, and nightmares ex­
acerbated her depressive states and made her feel that people
saw her as 우strange and not quite right?7 One of her initial fears
in the transference was that the therapist would see how 化bad개
she was and would realize that she should not be alive. Th니s;
Jessica craved reassurance that the therapist both wanted her to
live and would take a strong stand to this effect on her behalE It
was learned as the treatment progressed that this initial fear had
encaps니lated Jessica's essential life struggle, and it persisted as
 FANTASY FORMATION 65

one of her most painful fears in her relationship with the thera­
pist. Each time the therapist went away for a weekend or on a
vacation, Jessica would interpret the absence as confirmatory
evidence that she should be dead. If the therapist was aban­
doning their struggle for her life, she concluded, this must mean
that she had no right to be alive.
Jessica's fears became more understandable as aspects of her
inner world unfolded. When the anniversary of an older broth­
ers death approached； for example, she became overtly suicidal.
She was afraid both that she would die and that the therapist's
life also was in danger. Soon it became evident that Jessica
maintained a strong delusional belief that her brother, Justin,
who had died some 12 years prior to the beginning of treatment,
had literally taken over her life in a most profound and f니nda-
mental way： Justin had ^become part;; of her. Not only did he
live within her； she was convinced that she had become he. She
felt she had no distinct identity-Jessica did not really exist.
During the treatment this sense of nonbeing emerged as the
central feature of her self-experience. Each waking hour was
characterized by an eruiless battle against 化the force/7 as she
referred to her brother within her. She experienced intense and
often prolonged disorganized states in which his being would
take over her psychological and physical functioning. At these
times she would become seriously suicidal and would feel a
wave of anxiety concerning the welfare of those she loved. She
was sure that Justin would rob her of anyone that she truly
cared for. She feared having any interests, likes; or dislikes that
were different from those of her brother; and she felt intensely
guilty about any pleasure or joy that she could envision in her
lifetime. Jessica could not imagine that she would live very long.
Each year she lived past the age at which Justin had died only
intensified her panic and her conviction that her very existence
was a cruel and destructive act that would bring harm to her
family.
Jessica was the youngest of six; born to wealthy parents of
English descent. The family had been well known and respected
in the rather small New England community in which they
lived. Jessica's parents separated when she was under five years
of age; but the father often 어pretended개 to be part of the family
66 CHAPTER 5

어 for the sake of his reputation/' Jessica felt that a good show
was always put on for the neighbors, even though 어our house
was crumbling from within.;; She portrayed her mother as a
hard-driving, compulsive, and anxiety-filled woman who was
very concerned with the way things looked to other people. She
was quite active socially and was employed, along with Jessica;s
father, in the import-export business. Jessica's conviction that
her mother hated small children and felt burdened by them
crystalized around memories of being left at home while the rest
of the family went on trips-because she was the youngest and
would be too much trouble to care for on a pleasure trip.
Jessica's father was very career oriented and spent prolonged
periods of time completely engrossed in his work. Even as a
young child； Jessica knew of his many extramarital affairs.
Because of the nature of their work； her parents were regularly
called out of town on business trips that sometimes lasted for
months. At such times, Jessica was left at home with an assort­
ment of substitute caretakers. The parents did not call regularly
when they were away; nor did they provide accurate informa­
tion as to when they would return. Each time Jessica had to say
goodbye she feared it was for the last time. These separations
from her parents began soon after her birth and continued for
many years. Not surprisingly, she developed a deep feeling of
insecurity and an extreme vulnerability to absences. She also
failed to develop a firm sense that she existed in other people's
minds when they were not physically present. This remained a
powerful source of anxiety for her throughout her development.
She could not even imagine the reliable presence of a calming；
benign parental figure. The closest she had ever come to such an
experience was with her now-deceased brother} Justin, who
during his short life gave her a sense of being loved and cared
for.
When Jessica was 12 years old; Justin was diagnosed as
having a rare and usually fatal disease and for two painful years
went through a seemingly endless barrage of treatments. During
those years she experienced a sudden loss of Justin; who now
had to spend many hours with the doctors, and also of her
mother; who threw herself into the ultimately fruitless search
for a cure. From the time the disease was discovered until her
 FANTASY FORMATION 67

brother's death, Jessica saw very little of either of them. Her

mother would at times reassure her that Justin was really fine
and there was no reason to worry, but of course this was
contrary to what Jessica perceived. Even the night before Justin's
death, her mother was 어still swearing that he선 be OK.;;
Soon after Justin became ill； Jessica was taken out of school
for nearly two years to live with her godparents in a small rural
community because there was no one else to take care of her.
The abrupt and massive deprivations —emotional, intellectual,
and social - contributed to her sense that her life completely
stopped when Justin became ill. She had only sporadic tutoring
by a family friend, and; when she finally returned to school, she
was ostracized, laughed at; and； worst of all; feared； because the
other children knew of her brother's disease and believed they
could catch it from her. This was one in a series of experiences
that shaped her delusional conviction that she was Justin.
Jessica's father, who had been quite uninvolved with the
family, had a particularly difficult time with Justin;s illness.
During these years, and for many following Justin's death, the
father could not look at Jessica because he perceived such a
strong resemblance between her and Justin. Her father thereby
showed his inability to experience Jessica as a separate person,
distinct from his son. Like the experience of being shunned by
her schoolmates, this too contributed to Jessica;s dek】sion that
she was Justin. 이f your father carft even look at you; there must
be a good reason. I reminded him too much of Justin.;;
The family never talked openly about what was happening to
Justin or to the family. As Justin;s health worsened and death
became imminent} Jessica's parents seemed to picture Justin in
ever-more idealized, even godlike terms. At the same time they
began to 우see刀 more and more qualities that Jessica and Justin
shared in common. Both parents felt that the two children
looked more alike than ever before, and even Jessica, who since
Justifies illness had been very frightened of being like him;
started to become convinced that she really did bear a strong
mental and physical resemblance to her older brother. Her
mother began to cut Jessica;s hair in the same short, bl니nt style
that Justin wore and insisted that Jessica not only sleep in
Justin's room but literally make it her own. After that; Jessica
68 CHAPTER 5

was no longer even permitted back in her own room and was
expected literally to take Justin's place. After Justin's death, the
pressure of these demands to transform herself into her brother
became enormous. One week after the funeral the mother
switched jobs and left for an extended business trip to Australia,
and the father once again dropped out of sight. Jessica remem­
bered that there was absolutely no talk of what had happened
and that she slowly became confused about whether it had ever
really happened at all. She thus experienced a profound absence
of validation - indeed； a relentless disconfirmation - of her own
historical experience of her brother’s life and of his death. She
began to believe; in conformity with her parents7 wishes; that
Justin had never really died and instead had taken over her mind
and body.
Thus began her delusional merger and her lifelong struggle to
free herself without killing him. The brother she had loved so
dearly had saved himself by living in her body and taking over
her being. How could she murder him by asserting, or even
experiencing； her distinctness? How could she let him die when
she felt that she was to blame for his illness? If it hadn't been for
her; she thought； Justin would not have been sent away to
military school and her mother would have seen the signs of his
illness sooner-우perhaps in time to save his life.;; The mother
had felt overwhelmed by the demands of six children, and
Jessica； as she was repeatedly told; had become very difficult to
handle. Jessica felt that; had she not been so difficult during that
period； Justin would not have been sent away and so would still
be alive. In fact; Justin on occasion had actually accused her of
causing his disease.
Jessica's parents continued to fuel the delusion that their son
had been transported into the body and mind of his younger
sister. Jessica was; in effect, sacrificed to maintain the denial of
their son;s death. After Justin;s death, all pictures of Jessica were
removed from the house, except those in which Jessica showed
a striking resemblance to Justin. Additionally; her parents would
deny that Jessica had any likes or dislikes that were inconsistent
with what Justin had liked or disliked. She felt required to take
on all of Justin's qualities; feelings; and thoughts-his favorite
food; sport; and even the clothes he liked to wear. Jessica’s
 FANTASY FORMATION 69

father refused to see her for many years following the death;
which meant to her that he did not see her as a separate person
and could not face that he had lost a son. By incorporating and
becoming Justin; Jessica protected her parents from the loss they
could not tolerate.

Course of Treatment and the

Working-Through Process

Jessica's therapy-five sessions per week over a nine-month pe­

riod-was initially stormy, unpredictable, and marked by nu­
merous crises. She became intensely involved with the therapist
from the start and tried desperately to engage her. In the first
session Jessica was upset with the therapist for not having more
books on the shelves, pictures on the wall, and papers on the
desk； because the absence of these articles symbolized for her the
constant threat o£ abandonment. It was as if the therapist were
ready to vanish from the office and from Jessica's life without a
moments notice. The more articles that were in the office, the
more Jessica would feel temporarily reassured. Hence; from the
first hour the therapist saw the emotional results of Jessica's
early experiences with loss, abandonment； and inconsistency.
Jessica asked many personal questions of the therapist： Was
she married? Did she have children? What was her favorite
food? Her favorite color? These questions were later understood
to reflect both her need for concrete information to provide a
sense of the therapist as real and tangible and the requirement
that Jessica become like the person she was with. She felt
frustrated whenever her questions were not answered； and this
feeling of frustration continued throughout the course of treat­
ment. Later, it was learned that the therapist's failure to answer
personal questions was disturbing to Jessica because it repeated
early painful experiences of not being included in her parents7
어secret lives.기 As this repetition was clarified and understood,

she became increasingly able to tolerate the lack of answers.

During the first week of treatment, after telling the therapist a
great deal about her life, Jessica began to express intense fears
that the therapist would take over her mind. These fears alter­
nated with worries about being found rep니gnant and a failure in
70 CHAPTER 5

her life; and an overwhelming guilt whenever she looked out for
herself. Sensing Jessica’s wrenching conflicts in the area of self-
differentiation; the therapist interpreted these fears as origi­
nating in Jessica;s fundamental confusion over who she really
was; her guilt over any acts of self-assertion or self-demarcation
and her profound sense of badness whenever she felt or did
something that did not correspond to what she believed was
required of her. These requirements possessed enormous power,
for she believed that the only way to maintain a relationship
was to fulfill the other person's needs-regardless of the violence
such compliance would do to the core of her being.
The principal focus of the early weeks of therapy was Jessica's
sense of self-other confusion and the guilt and ruthless self­
attack that followed any expression of her distinctness. As these
themes were repeatedly clarified； she became flooded with
memories of how her mother would feel injured and then be
rageful and attacking whenever Jessica was not organized
around her needs. Likewise, Jessica believed that now she had to
mold herself to whom and what the therapist needed her to be.
The understanding and interpretation of this requirement as it
emerged in the transference established a foundation of trust
that enabled therapy to proceed.
To illustrate the working-through process； our presentation of
the treatment is organized around five pivotal crises. The under­
standing and working through of each crisis ushered in a move
toward greater self-differentiation, and each succeeding step to­
ward more differentiated selfhood was more successful than the
one that had come before. These developmental advances led to
a gradual diminution of Jessica;s suicidal preoccupations, until
they finally dropped away completely. In describing the five
crises, we focus on how the therapist and the patient began and
maintained the process of Jessicas self-delineation; how the
prohibitions against differentiation were revived in the transfer-
ence; and how these conflicts and developmental arrests; along
with her unremitting suicidality； were worked through within
the archaic transference bond.
Prior to the first crisis; Jessica had been taking small but
notable steps in her struggle to assert her distinctness. She did so
particularly in her relationship with a woman friend by refusing
 FANTASY FORMATION 71

to take responsibility for the friencfs problems and declaring that

she needed things in their relationship too. These seemingly
small achievements were of enormous significance to Jessica and
produced intense conflicts. She felt an automatic sense of danger
and, in consequence, began to disconnect from the stand she had
taken with her friend.
The first crisis was a double devastation for Jessica. Her boy-
friend, who was in the Armed Services； was suddenly killed in a
plane crash, and her father was pronounced missing while on a
climbing expedition (he was found in relatively good health two
days later). Jessica became hysterical and seriously suicidal. Until
this point in treatment her suicidality had remained rather elu­
sive. She had spoken of numerous serious accidents that seemed
to indicate suicidal intent; but she had not overtly expressed any
wish to terminate her life. Now she was actually expressing a
fear of having to kill herself； rather than a wish to die. This fear
of having to kill herself derived directly from her delusional
merger with Justin. She 어knew;; that Justin was angry with her
for the steps she had been taking toward self-demarcation, and
she believed that he was taking revenge by bringing harm to
people she cared about. He had caused the death of her boy­
friend and their father's disappearance, and therefore Jessica felt
she would have to commit suicide to save others from his
wrath. This feeling alternated with her belief that she was
required to be her brother and therefore should be dead as he
was. Consequently； Jessica engaged in very dangerous activities
and also became terrified that the therapist would die. She could
not bear to be alone; and her pleas for personal information
became ever more intense. The sessions were filled with Jessi­
ca^ urgent demands for closeness and for reassurances that the
therapist not abandon her; and with further elaborations of her
merger experience with Justin.
Jessica's response to the crisis became comprehensible from
the vantage point of her archaic inner world. She believed that
her attempts at self-assertion with her woman friend had led
directly to her boyfriends death because; as she put it; she
"destroyed people77 whenever she made any steps toward self­
differentiation. Her boyfriends death and her fathers disappear­
ance powerfully confirmed something that she 에lad known all
72 CHAPTER 5

along개一that any attempt to have a life of her own would lead to

disaster. Her self-destructiveness, which included an almost total
cessation of eating and chronic involuntary vomiting； was pun­
ishment for even being alive. During the crisis； Jessica was
unable to maintain any mental image of the therapist, and she
felt increasingly anxious as the end of each session approached.
She lost all sense of satisfaction in her usual activities and began
to center her life entirely on her therapy.
Even with five sessions a week and frequent phone calls
during the weekends； Jessica needed to know the whereabouts
of the therapist at all times. She was plagued by the fear that she
or the therapist would literally disappear if they were not to­
gether. Additionally, she believed that Justin would eventually
retaliate against the therapist for attempting slowly to separate
the two siblings and break up the merger between them. Hence,
she desperately needed to feel united with the therapist to main­
tain even a rudimentary sense of herself and to stave off retalia­
tion from Justin. It was only through the archaic bond to the
therapist that she felt safe. When her need for oneness with the
therapist became especially urgent； it sometimes seemed to be
expressed in an eroticized form; as Jessica came to her sessions in
sexually provocative attire. Analytic investigation of this be­
havior revealed that erotization of archaic longings for oneness
had long been characteristic of her relationships with both males
and females.
Other fears at this point concerned what would be left of
Jessica if she separated from Justin. Her worst fears stemmed
from the experience of a total lack of being-a sense of herself as
an empty, disintegrated shell of a person. During this period； her
dread of not being remembered by the therapist after she left the
sessions became pervasive and overwhelming. She pleaded for
reassurance that the therapist would continue to think about her
when not in her presence. Only then could she be assured of her
own existence in time and space. She asked the therapist to
write down something about her on paper so that she would not
be forgotten. Yet; all along she feared that the therapist secretly
felt she should be dead. This fear seemed confirmed whenever
the therapist went away or when Jessica could detect any weari-
 FANTASY FORMATION 73

ness or exasperation in the therapists mood; which she con­

stantly monitored.
During separations Jessica would be calmed by phone con­
tacts with the therapist, which helped her to maintain an image
of the therapist, along with the desperately needed sense of
connection. The separations from the therapist on weekends or
holidays produced intense fears of people, fears that the thera­
pist would die, and a loss of any sense of security that may have
developed during the preceding week. Jessica would then begin
to experience a dawning awareness of how 어needy;; she was;
would degrade herself, and would then become convinced that
she was becoming a burden to the therapist as she had sensed
she had been to her mother. At these times she would fear that
she was all alone in her attempt to separate from Justin and have
her own life. The repeated clarification of her fears, however,
seemed to calm her somewhat, and; as the crisis slowly abated,
she reported a feeling of greater solidity within herself.
The second crisis was brought on by the approaching anniver­
sary of Justin's death. Strong suicidal urges were the most salient
feature of this period. These urges were repeatedly interpreted as
reflecting her feeling that she 주was supposed to be dead;; because
she was supposed to be Justin and her belief that each day she
lived represented a breach of that requirement. Jessica felt that
living her own life inflicted a lethal i피ury on her mother in
particular, because the mothers psychological survival seemed
to depend on Jessica's sacrificing her life for the 저greater cause?7
The suicidal urges were especially intense now; because she felt
that the therapist was firmly committed to helping her separate
psychologically from her brother. As the therapist consistently
interpreted the prohibition against Jessica;s existing as a distinct
person; the requirement that she sacrifice herself seemed to lose
some of its hold on her. She began to experience the therapist as
someone who could be completely aligned with her attempts at
self-differentiation, however dangerous such attempts might be.
Earlier Jessica had often believed that the therapist wanted her to
die, as she believed her mother had; but now; at least tempo-
rarily; she felt the therapist's 씨Eorce;; battling against her broth­
ers enormous power. As her suicidal thoughts came to be under-
74 CHAPTER 5

stood as fears of having to be murdered, this clarified for the

patient her essential wish to live and have a life of her own;
which helped her enormously during the crisis period. After she
recovered from the anniversary, she felt stronger and more able
to tolerate separations from the therapist. She was becoming
able to create a mental image of the therapist during these
separations and to question her belief that the therapist would
not return. Still; Jessica would need to ask； 어Are you glad Fm
still alive?;;
For a few days things seemed to settle down. Jessica felt
calmer than she had ever been since beginning treatment. The
third crisis seemed to result directly from her progress in treat-
ment so far and was marked by the first of many depersonaliza­
tion experiences. She had been performing at a local theater and
during the intermission realized that she was actually enjoying
herself-a very rare experience in her life until now; since any
enlivening feeling of pleasure represented separation from her
dead brother. On realizing her sense of enjoyment； she became
increasingly anxious； depressed； and panicky. Suddenly, she
could not recall her name, or where she lived, or who her family
were; and she became disoriented in time and space. She found a
piece of paper in her bag with the therapist's name and phone
number on it and; with great trepidation, called her. When she
arrived at the office； she was in a disoriented state. Familiar
objects and people were now strange and frightening, and she
was acutely sensitive to noise. Her panic over not knowing the
most basic facts about her life; induding the purpose for which
she was coming to the therapist； subsided gradually as the thera­
pist calmed her by supplying her with concrete information
about her existence. An understanding of why Jessica had be-
come disconnected from herself in such a profound way became
the focus of several sessions. For Jessica, even a momentary
experience of pleasure, self-confidence, or aliveness came into
direct conflict with the merged relationship she felt required to
maintain with her brother. At the theater； she began to feel like
herself and； if only for a moment； she was doing something
uniquely her own.
At times during the session that followed her enjoyable per-
formance; Jessica was quite delusional, exclaiming that Justin
 FANTASY FORMATION 75

really was alive and that if she separated from him she would kill
him. cc\ can't let him die! He7s not dead!개 The longed-for state of
aliveness and distinctness had produced an acute episode of
depersonalization, whose function was to protect the merger
with Justin and hence to save his 어life?7 At this point she voiced
the idea that the only way she could free herself was to commit
suicide (which the depersonalization state symbolically accom­
plished) because by doing so she could put an end to Justin;s
existence. But Jessica did not really want to die. Even though
Jessica had been suicidal for many years, she and the therapist
came to recognize that she had a very strong will to live.
Episodes of depersonalization occurred sporadically during the
course of treatment； triggered by Jessica;s acts of demarcation
from her brother. Gradually, the depersonalizations decreased in
frequency and intensity, as the origins; meanings, and functions
of the delusional merger, as well as the suicidal preoccupations,
became increasingly clarified.
As Jessica recovered from the third crisis, she seemed stronger
and better able to think about herself. For the first time in years,
she seriously focused on her career. She was now able to tolerate
two-day separations from the therapist and to reflect on her
own inner states without the therapist having to be present. Her
attention to her career had special meaning because it indicated
that she felt more permitted to embrace the idea that she could
have distinctive interests and goals of her own. During this
period Jessica felt the bond with the therapist to be 化life sustain­
ing.^ She felt she could now experiment with her life, but only
under the 어protective blanket77 of the therapeutic bond. This
bond had become established as a facilitating medium in which
aborted self-differentiating processes could once again be re­
sumed.
Just as things were settling down, Jessica was faced with a
five-day separation from the therapist. Since the therapist had
become established as the guardian of Jessica's essential self-
hood, such a separation produced profound effects. In reaction to
the loss of the vitally needed tie; she again became acutely
depersonalized. The therapist caref니！ly outlined for Jessica the
dangers to which the separation exposed her-that Jessica felt all
alone in her struggle for distinctness； that she became increas-
76 CHAPTER 5

ingly vulnerable to attacks by her brother; and that her parents7

requirement that she sacrifice herself returned in all its intensity.
In consequence of the separation, Jessica became more vulner­
able to slipping back into the merger with Justin. During this
period, her dreams often contained imagery dramatizing the
traumatic loss of the therapist's protective functions.
Significant changes in Jessica's psychological organization
were now taking place as a result of the careful investigation
and understanding of how she had been required to renounce
her strivings for self-definition. Her reaction to the fourth crisis
provided an example of how far Jessica had come in her uphill
battle for emotional freedom. She became pregnant and termi­
nated the pregnancy by abortion. With the creation and ending
of this new life within her came an array of intense emotional
reactions; including extreme anxiety； intolerable guilt； and a
profound sense of loss. The abortion reanimated her fantasy
that her own angry wishes had caused Justirfs death. Not unex­
pectedly, the transference was also affected by the loss of the
fetus. Jessica became afraid that the therapist would now clearly
see that she had killed her brother as she had killed her baby and
that any further disclosure would inevitably drive the therapist
away. After all; as a 12-year-old girl had she not wished that
Justin would finally die because he was taking away all of her
mother’s time, energy; and emotional resources? Jessica's feel­
ings of inherent destructiveness were pervasive, but she did not
become suicidal. For the first time in 12 years she was able to feel
the guilt; the loss; and the despair, without experiencing a con­
viction that she should die because of another;s suffering.
Jessica became immersed in intense guilt and what she called
어paranoia?7 She was afraid of everything and everybody and

was unable to take care of the details of her daily life. The
budding new sense of herself that had been developing was
profoundly shaken; and she imagined that almost anything
could harm her. The therapist interpreted these fears as arising
both from her guilt over being alive when Justin and the fetus
had died and from her expectation that the therapist； because of
the death of the fetus, would abandon their struggle for Jessica's
life. Jessica feared that she was losing her own sense of exist-
ence; but the therapist's close attention to how the abortion had
 FANTASY FORMATION 77

reanimated critical pathogenic experiences slowly restored and

strengthened her sense of herself.
When Jessica emerged from the crisis, she noticed that she
had not experienced any amnesia or depersonalization episodes
and was both pleased and somewhat disoriented by this change.
The therapist's upcoming weekend out of town was not antici­
pated by Jessica with her usual terror, because she 씨＜new기 the
therapist was corning back. She felt upset by the separation but
no longer believed that such a separation put her at the mercy of
her brother's awesome power. This transformation was under­
stood by both the patient and therapist as an important develop­
mental achievement in self-differentiation.
The fifth and final crisis of the treatment took place soon after
Jessica was beginning to feel a new sense of vitality and alive­
ness. She had recently been able to visit Justin's grave and feel
painfully saddened by his loss; although she was not yet com­
pletely free of the encumbering parental requirement that she be
Justin. Early one morning Jessica learned that her father, after
numerous dangerous climbing expeditions over the years, had
died f시lowing a bad fall down the side of a steep mountain.
Again her brother's 이force개 reared its ugly head, and she began
to feel that her existence was to blame for her fathers death. She
felt hopeless about anything ever changing in her life, but again
she did not become suicidal. She did; however, experience in­
tense anxiety, and she told the therapist that only their relation­
ship provided the support that she needed to sustain herself. She
reported dreams in which she and the therapist were transported
back into her past} so that she could relive critical formative
experiences but with the protective presence of the therapist by
her side. The imagery of these dreams dramatized the extent to
which Jessica experienced the therapist as a new object firmly
aligned with her attempts to develop and nurture her own life
and demarcate herself from her brother.
After many months of therapeutic work； Jessica began to
remember certain crucial details related to Justin's illness-mem­
ories that, up to this point； had to be repressed because they
threatened the powerful parental requirement that she embody
Justin. The memories contradicted Jessica's belief that she had
indirectly caused Justin's death.
78 CHAPTER 5

First, Jessica recalled that as a child she had often been told that
Justin had been a very sickly little boy from birth； and she re­
membered that his vulnerability to illness had been well known
in the family long before his enrollment in military school. She
had 이Forgotten77 this vital information and had imagined that he
was healthy until contracting his fatal disease, in order to pre­
serve the myth that she had caused his death by making it nec­
essary for him to go away to military school. By maintaining her
guilt and repressing any knowledge that challenged it; she com­
plied with her parents7 need for her to feel responsible for Justin
and for preserving him within the fabric of her own being.
Second; in contrast to her parents7 intense idealization of
Justin during the last phase of his illness-an idealization with
which she had felt required to comply-Jessica now came to
remember him as a frightened, bitter adolescent boy struggling
with the terrors of illness and impending death. She could now
see that when Justin blamed her for his illness; this was the
reaction of an angry and confused young boy; not a pronounce­
ment from an all-knowing god.
The recovery of these memories helped Jessica to realize that
her own continuing life had not been the cause of Justin;s death.
Indeed, despite her intense angry feelings toward him; she had
loved him more than anyone else on earth. As her idealization
of him subsided； along with the requirement that she preserve
him within herself, she began a painful mourning process that
had never been allowed before.
After much intensive therapeutic work； Jessica finally
emerged from her delusional state； and; concomitantly, the de­
personalization experiences disappeared, as did much of her
self-destructive behavior. As the merger with Justin was broken,
she expressed 어burning desires기 to have fun and to explore the
possibilities of her life. This new-found sense of aliveness alter­
nated with deep feelings of sadness and grief over the deaths of
her brother and father. She had just begun to immerse herself in
these feelings when she was accepted at a prestigious acting
school in another part of the country. After a period of intense
conflict, during which the multiple meanings of making such a
move were carefully explored, she decided to accept the schooFs
offer. On one hand； she was afraid that continuing to investi-
 FANTASY FORMATION 79

gate her inner experience would pull her back into the merger
with Justin, a danger from which she could flee by leaving
treatment. On the other hand； her decision to leave reflected her
considerable achievements in the area of self-differentiation,
which enabled her to feel that she deserved to have a life cen­
tered on her own ambitions. She continued to contact the thera­
pist from time to time; to reinstate their life-affirming bond.
Three years after termination, she continued to be free of both
the delusional merger and suicidality. While she is not without
considerable inner strife and turmoil; her continuing existence
seems assured.

DISCUSSION

The case of Jessica is a particularly clear example of derailment

of the developmental process of self-differentiation - the
evolving sense of being a distinct center of affective experience
and personal agency, with individualized airns and goals. In an
earlier work (Stolorow et al.; 1987); it was proposed that spe-
cific; maturationally evolving selfobject experiences are neces­
sary for facilitating, consolidating, expanding, and sustaining
the development of differentiated selfhood during the entire life
cycle. This developmental progression becomes disrupted when
the requisite selfobject experiences needed to support the child;s
self-differentiating processes are absent or unsteady.
Derailment of the self-differentiation process occurs in an
intersubjective situation in which central affect states associated
with the development of individualized selfhood are consis­
tently not responded to or are actively rejected. A fundamental
psychic conflict thereby becomes enduringly established be­
tween the requirement that one’s developmental course must
conform to the emotional needs of caregivers and the inner
imperative that its evolution be firmly rooted in a vitalizing
affective core of one;s own. As one of several possible outcomes
o£ this basic conflict, the child may be compelled to abandon or
severely compromise central affective strivings in order to main­
tain indispensable ties. As seen in the case of Jessica, this is the
path of submission and chronic depression.
80 CHAPTER 5

It will be recalled that a central theme in the transference in

the early weeks of treatment was Jessica's belief that she had to
mold herself to whatever the therapist needed her to be in order
to maintain the therapeutic relationship. Moreover, Jessica expe­
rienced a profound sense of badness whenever she felt or did
something that was not in harmony with what she thought the
therapist required of her. Analysis of this transference paradigm
produced a host of early memories in which the patienfs
mother would become injured, enraged, and attacking whenever
her daughter’s states of mind or behavior failed to conform to
the mother's needs.
Other memories seemed to show quite clearly that the
mother experienced attending to Jessica's emotional states and
needs as an odious burden, particularly when Jessica was very
small; and that her father was virtually unavailable as an
alternate source of caregiving functions. Furthermore, her
mother's many long absences； during which her contacts with
Jessica were irregular and her return home unknown, left Jessica
with a sense that her emotional importance to her mother was
negligible and that the bond between them was quite tenuous.
Jessica attempted to maintain this fragile tie by trying to be
exactly the child her mother wished her to be; at the expense of
her own affectivity and distinctness. Thus, Jessica;s self­
differentiating processes were already seriously compromised
quite early in her relationship with her mother, establishing a
pattern of self-subjugation and compliance with the require­
ments of others. It was with this preestablished organizing
principle - self-surrender as the price for maintaining vital ties-
that she entered the critical phase of her development ushered
in by her brother's fatal illness. This invariant organizing
principle set the stage for the pathological introjection that
formed the basis of her chronic suicidality. When she perceived
that her parents wanted her to incorporate and become Justin;
she felt she had no choice b나t to comply and to sacrifice herself
to their needs. Feeling that she was valueless and dispensable to
her parents as the child she was (she had been essentially
abandoned during the period of her brother's illness), she
unconsciously hoped that by becoming Justin she would
become as treasured by them as he seemed to be.
 FANTASY FORMATION 81

Historically, introjection has been explained as deriving from

the need to preserve a tie to an ambivalently loved lost object
(Freud; 1917). In this formulation, introjection is seen as a de­
fense against a mourning process that cannot be tolerated be­
cause the feelings toward the lost object are too conflictual.
Certainly, Jessica's feelings toward her brother were ambiva­
lent- increasingly so during the period of his illness-and the
intr이ection did preserve the bond； alleviate her guilt over angry
wishes, and protect her from the pain of mourning. However,
while these defensive functions were not absent} they were not
of primary pathogenic significance. On the contrary, Jessica
1ong&d to feel permitted to mourn the loss of her brother in order
to reclaim her own being; but this mo니rning process was prohib­
ited because it would violate her parents7 requirement that she
keep him alive.
As we have stated, it is our view that an introject can be seen
as a region of invalidity in a person's experience that has been
filled in by the perceptions； judgments, feelings, or needs of
some emotionally significant other. If the validity of one's own
perceptual reality comes under unremitting attack； then this
experience of psychological usurpation may become increas­
ingly dramatized and concretized until, ultimately} it reaches the
point of delusion. Such was the case with Jessica- Her parents
subjected her experience of her brother's illness and death to a
relentless regime of invalidation； to the point that she doubted
that he had died at all. In the same measure, their equally
relentless need to preserve him by seeing him in her profoundly
invalidated her experience of herself as a distinct person. The
resulting void in her subjective universe was filled by introjec-
tion. In compliance with her parents7 need, she brought Justin to
life within herself, and; finally； she became he; virt니ally eradi-
cating her own existence.
The transference relationship that became heir to this history
of developmental derailment was; in broad brushstrokes； essen­
tially bipolar in its organization (see Stolorow et al.; 1987). At
one pole of the transference was Jessicas longing to experience
the therapist as a protective presence who would enable her to
reinstate self-differentiating processes that had been thwarted
during her formative years. In this dimension of the transfer-
82 CHAPTER 5

ence; the patient hoped and searched for a new selfobject experi­
ence that would permit her to res니me her arrested psychological
development. At the other pole were her expectations and fears
of a transference repetition of the original pathogenic experi­
ences that had blocked the emergence of her own distinctness.
This second dimension of the transference became a focal source
of conflict and resistance in the therapy.
The course of treatment was characterized by continual shifts
in the figure-ground relationships between these two poles of
the transference, as they oscillated between the experiential
foreground and background of the therapy. These oscillations
were in large part determined by Jessica;s perception of whether
or not the therapist was firmly aligned with her struggle for
self-delineation.
Early in the therapy； the repetitive dimension of the transfer­
ence was preeminent. Jessica initially experienced the thera­
peutic relationship as very tenuous. She felt excluded from the
therapist's 化secret life刀 and doubted that she existed in the thera­
pists mind when not in her presence. She believed that she had
to do and be whatever the therapist required in order to main­
tain the precarious tie between them. Any feeling that might
have been out of harmony with; or a burden to; the therapist
had to be sacrificed； for to bring such a feeling into the open
would be to invite angry criticism, repulsion； and ultimate aban­
donment. The understanding and interpretation of these trans­
ference fears and expectations evoked much genetic material
pertaining to the patient's early experiences with her mother
and gradually mobilized Jessica’s hope that she could have a
different experience with the therapist.
As Jessica came to see the therapist as her only hope for
survival as a distinct person, she experienced desperate yearn­
ings for continuous union with her. Only when at one with the
therapist could Jessica feel safe from the inner 이Eorce;;-her
brother-that threatened her with extinction. Early in the treat-
men^ separations from the therapist or perceptions of any trace
of dysphoria in the therapist's state of mind would abruptly
obliterate this archaic selfobject transference experience and
bring the repetitive aspect of the transference back into the
foreground. When the therapist went away or seemed irritated.
 FANTASY FORMATION 83

this meant to Jessica that the therapist must feel that she should
be dead and would abandon her in her struggle to be free of
Justin. Jessica's perception of the therapist at those times repli­
cated her experience of her parents7 demands that she sacrifice
her own life to preserve Justin's.
Disturbances originating outside the therapeutic relationship
could also disrupt the bond and strongly evoke the repetitive
dimension of the transference. This was clearly seen in the first
four of the five crises we have described； triggered respectively
by the death of Jessica’s boyfriend and the disappearance of her
father, the anniversary of her brother's death, her enjoyment of
her acting performance, and her abortion. Each of these crises
evoked the familiar expectations in the transference that the
therapist would see her as a murderer, feel she should be dead；
and abandon the struggle for her life. In each instance; the
therapist carefully explored these transference experiences with
the patient and interpreted the invariant principles that orga­
nized them - the parental requirement that she sacrifice herself
and the absolute prohibition against existing as a distinct person.
The working through of each of these crises； and the analysis of
the repetitive transference patterns that accompanied them; re­
sulted； incrementally, in a gradual strengthening of the selfob­
ject dimension of the transference. By the time of the death of
her father, which precipitated the final crisis, the therapist had
become firmly established for Jessica as a longed-for protector of
her distinct selfhood. In the transference bond; she had found a
facilitating matrix within which her aborted self-differentiating
processes could safely be revitalized and her stalled development
resumed.
It is clear that at termination the transference; in both its
repetitive and selfobject dimensions； had not been fully worked
through or transformed. Jessica continued to need occasional
brief contacts with the therapist to sustain her. However, signif­
icant structural reorganization had been achieved. Partially liber­
ated from the grip of the requirement that she incorporate and
be her brother； she could now experience and affirm her own
distinctness and affective vitality without filing herself to be an
omnipotent destroyer. She felt a new freedom to embrace life
with enthusiasm, and her chronic suicidality had disappeared.
 II
Clinical Applications
 Chapter 6
Varieties of Therapeutic
Alliance
(written in collaboration with
Bernard Brandchaft)

ew would dispute that the establishment of a bond between

F analyst and patient that permits the work of analysis to un­

fold is a sine qua non of our work. Yet serious differences exist
regarding the essential nature of this bond, and the clinical impli­
cations of these differences are profound. The problem of resis­
tances has thwarted psychoanalysts in their efforts to bring
about more predictable structural change and led to the establish­
ment of criteria for analyzability that increasingly exclude large
numbers of persons seeking analysis (Waelder, 1960； Greenson;
1967). FreucFs (1937) final work； 어Analysis Terminable and In-
terminable/7 reflected his preoccupation with the severe limita­
tions posed by resistances on the therapeutic efficacy of psycho­
analysis. In this summary he held a large number of factors, all
intrapsychic； to account. If FreucFs conclusions were to be ac­
cepted as final, psychoanalysts would be faced with either an
analytic procedure severely restricted in its scope or the necessity
of having to alter significantly the basic principles and tech­
niques of psychoanalysis in the hope of increasing its therapeutic
effectiveness. This dilemma provided a powerful stimulus for the
reexamination of the nature of the therapeutic bond. And so the
concept of a therapeutic alliance, already implicit in m나ch of
Freucfs writings; became the foajs of great interest in the 1950s.

87
88 CHAPTER 6

In retrospect； it is clear that in the United States the interest in

the therapeutic alliance; a particular object relationship between
patient and analyst (Sterba; 1934; Bibring; 1937； Fenichel; 1941;
Greenson; 1954； Zetzel; 1956; Stone; 1961)； was stimulated by
the development of ego psychology and paralleled the bur­
geoning interest in the more general subject of object relations in
Great Britain, as exemplified in the work of Klein, as well as
that of Winnicott； Baling and Fairbairn. Both developments
were rooted in the recognition that breakdowns of the thera­
peutic process come about because of disruptions within the
analytic dyad； and so it was to these subjects that analysts
turned their attention in attempts to extend the scope of analytic
influence.
The ego psychologists, focusing on the central role of the ego
in development and pathogenesis； visualized the analytic rela­
tionship as having two dimensions. One was rooted in the
patienfs identification with the analyst and especially with his
understanding of the patients unconscious. This； they held； was
the basis for the therapeutic alliance. The other part of the
patienfs ego was engaged in resistance to the unfolding of the
unconscious regressive instinctual forces and the structural con­
flicts that constituted the pathogenic oedipal complex of the
transference neurosis. The maintenance of the therapeutic alli­
ance was dependent on bringing about a split between an expe­
riencing ego and a more reasonable, detached, and observing ego
(Zetzel; 1956； Greenson; 1967) in order to deal with the resis­
tance. This was to be facilitated by the patienfs rational wish to
cooperate with the analyst in order to overcome his suffering
and by 어his ability to follow the instructions and insights of the
analyst77 (Greenson; 1967; p. 192). Greenson emphasized the
patienfs identification with the analyst's interpretive approach
as the specific goal of the therapeutic alliance. He took a step
away from the traditional view when he considered the estab­
lishment of this relationship between patient and analyst, the
어ingredient which is vital for the success or failure of psychoan­

alytic treatment/7 as 어relatively nonneurotic, rational77-in other

words; nontransference (p. 46).
It is to be emphasized that in describing the establishment of a
therapeutic alliance the ego psychologists were claiming not
only that the patient must identify with the analyst's basic
investigative methods and with such general principles as trans-
ference, resistance, and unconscious forces shaping subjective
experience. The process of identification also had to include the
analyst's theory-rooted assumptions about the patient's basic
motivations and about the contents of the patienfs mind. Th니s;
if the patient rejected or failed to recognize the correctness of the
analyses view that drive-related conflicts, particularly the oe-
dipal conflict； were central in his symptoms and in his develop­
ment this continued to be regarded as the ultimate expression of
the rivalry belonging to the very oedipal complex that the ana­
lyst had been seeking to uncover; now inevitably working its
way into the transference (Abraham; 1919).
Understanding the resistance as deriving from conflicts arising
solely from within the patient, the ego psychologists also re­
quired the patient to identify with the analyst’s view of himself
as essentially neutral in relation to the patienfs conflicts, a blank
screen upon which these were played o니t. Accordingly, transfer­
ence was to be seen as the result of the patient's displacements
or distortions, except where it might be influenced by those
countertransference intrusions that the analyst was able to rec­
ognize . Chronic and intractable resistances were believed to be
signs of negative therapeutic reactions or unanalyzability and
were ascribed to ego weakness or a masochistic need to fail.
The dominant school of object relations in Great Britain, that
of Melanie Klein； on the other hand, held that the therapeutic
alliance was embedded in the transference； which itself was a
complex object relation. The attachment of a 허normal77 depen­
dent part of the self to a 어good기 part-object, the breast, was
revived in the analysis, and the identification with it formed the
nucleus of the therapeutic alliance. Disruptions in this bond
were attributed to the operation of primitive defensive measures
of the ego; which shaped and distorted the patienfs perception
of 서real objects/" including the analyst, and resulted in patho­
genic introjections of cruel objects or objects damaged in omnip­
otent fantasy by the patienfs destructiveness. The reestablish­
ment of the therapeutic bond, and with it a secure tie with good,
protecting, and protected internal objects, was thought to be the
foundation of growth and creativity. This was bro니ght about by
 느O '

90 CHAPTER 6

the interpretation of the unconscious archaic defense mecha­

nisms； by the working through of the infantile conflicts of
ambivalence and pathological envy that the patient was de­
fending against, and by the patienfs developing trust in the
analyst and his explanations of the nature of the patienfs subjec­
tive experience, anxieties; and depressive feelings.
Klein (1950), unlike the ego psychologists, believed that the
functioning of the ego was at all times determined by its rela­
tionships to its external and internal objects. Archaic ties be­
tween the ego and primitive objects or part-objects existed from
the beginning, she insisted, and thus the history of any individ­
uals development could be found in the record of the complex
relationship between ego and objects. As a consequence of this
view; the scope of psychoanalysis was for her automatically
extended. The constitutional strengths or adaptability of the
patient's ego were not stressed as a prerequisite, and conse­
quently； children and psychotics were accepted, in principle, as
being suitable for analysis. This remained a point of contention
between the two schools.
Strachey;s (1934) conceptualization of the 우mutative interpre-
tation;; illustrates the Kleinian view of the therapeutic process.
Strachey believed； as did the ego psychologists, that identifica­
tion with the analyst occupied a central role- For him the opera­
tive mechanism was that of introjection; whereby the analyst's
interpretations enabled him to be installed as a less severe and
more benign influence than the patienfs existing internal objects
or superego. However; in Strachey;s fornudation the mutative
value of the object relation to the analyst lay not only in an
analytic attitude or stance that might open the possibility of a
transforming intr이ection. It was essential that the identificatory
process extend to the analyst's interpretations of the impulses
and defenses that characterize the paranoid-schizoid and depres-
sive positions postulated by Klein, since these were ass니med to
reappear in the transference. These 어mutative interpretations77
would have to be accepted as 우true/7 so that the patienfs view
of himself and his history would come to conform to what the
analyst had reflected to him.
Her followers adhered to a stance whose basic principles Klein
(1961) described as follows：
 VARIETIES OF THERAPEUTIC ALLIANCE 91

The psychoanalytic procedure consists in selecting the most ur­

gent aspects of the material and interpreting them with precision.
The patient's reactions and subsequent associations amount to further
material which has to be analyzed in the same way . . . I was determined
not to modify my technique and to interpret in the usual way
even deep anxiety situations as they came up and the corre­
sponding defenses [pp. 12-13; emphasis added].

The interpretive principles derive from Klein's view of the cen­

tral importance of primitive defense mechanisms, especially
splitting and projective identification； directed against internal
instinctual forces or internal objects distorted by projected con­
tents. Within this system intense and prolonged resistances
leading to negative therapeutic reactions were and continue to
be ascribed to the workings of pathological destructive envy; a
vicissitude of the death instinct (Klein, 1957； Joseph, 1982;
Rosenfeld； 1987). This clinical formulation is hardly surprising
in view of the primary etiologic role Klein's metapsychology
attributed to the innate conflict between life and death instincts.
Here also, as in the case of the ego psychologists, the unsuc­
cessful therapeutic result was assumed to demonstrate the cor­
rectness of the theory no less than the successful one. Despite
their profound differences, in this crucial aspect these two diver­
gent theoretical schools were in accord. The therapeutic alliance
and the success of the analysis were held to depend on the
ability of the patient ultimately to see the events of the analysis
according to the basic concepts that organized and informed the
analyst's observations and interpretations. This is a requirement
with which patients often felt compelled to comply as the price
for maintaining the vitally needed tie to the analyst.
We have chosen to discuss the concepts and practices of these
two dominant schools not only because of their leading position
and continuing influence on psychoanalytic thought, but also
because; in their approach to the therapeutic bond, they illus­
trate a basic and largely unchallenged philosophical ass니mption
that has pervaded psychoanalytic thought since its inception；
namely, the existence of an ^objective reality기 that is known by
the analyst and distorted by the patient (Atwood and Stolorow；
1984； Stolorow, Brandchaft; and Atwood, 1987). This assump-
92 CHAPTER 6

tion lies at the heart of the traditional view of transference and

its insistence on the dichotomy between the patienfs experience
of the analyst as distortion and the analyses experience of him­
self as real. This dichotomy is one of the foundation stones on
which the more elaborate and experience-distant theoretical
scaffoldings of the two divergent psychoanalytic schools have
been built. It is not the philosophical assumption with which
we are here concerned, but the serious and insufficiently
knowledged consequences of its clinical application.
In agreement with Schwaber (1983); we contend that the
only reality relevant and accessible to psychoanalytic inquiry
(that is; to empathy and introspection) is subjective reality-that of
the patient, that of the analyst； and the psychological field
created by the interplay between the two. The belief that one's
personal reality is objective is an instance of the psychological
process of concretization; the symbolic transformation of config­
urations of subjective experience into events and entities that are
believed to be objectively perceived and known (Atwood and
Stolorow, 1984). Attributions of objective reality, in other
words, are concretizations of subjective truth. As we have ob­
served this process in ourselves and others; we have become
aware that it operates automatically and prereflectively.
Adherence to the doctrine of objective reality and its corollary
concept of distortion has led both psychoanalytic schools to
view pathology in terms of processes and mechanisms located
solely within the patient- This emphasis blinds the clinician to
the impact of the observer on the observed as an intrinsic,
ever-present factor in the psychoanalytic situation； and it ob­
scures the profound ways in which the analyst himself and his
theories are implicated in the phenomena he observes and seeks
to treat. When the concept of distortion is imposed, a cordon
sanitaire is established, which forecloses the investigation of the
analyst's contribution in depth. The invitation that the patient
identify with the analyses concepts as a condition for a thera­
peutic alliance is an invitation to cure by compliance. Alterna­
tive^ it can trigger the appearance of what seems to be a
resistance. Investigation of the patient's experience may reveal,
however, an important attempt at self-differentiation, an at­
tempt to protect an independent center of perception and affec-
 VARIETIES OF THERAPEUTIC ALLIANCE 93

tivity from usurpation. When the patient reacts adversely to the

analyst's explanations, the idea that these disruptive reactions
arise from purely intrapsychic causes and are to be explained by
the same concepts that are producing the reactions sets the stage
for those chronic disjunctions that have been described as nega­
tive transference resistances or negative therape니tic reactions
(Brandchaft; 1983; Atwood and Stolorow； 1984). When ana­
lysts invoke the concept of objective reality along with its corol­
lary concept of distortion, this forecloses and diverts the investi­
gation of the subjective reality encoded in the patienfs
communications, a reality that is precisely what the psychoana­
lytic method is uniquely equipped to illuminate.
What; from our intersubjective perspective; constitutes the
essence of a therapeutic alliance? It is surely not the bond
formed by the patienfs commitment to follow the insights of
the analyst. In our view the foundations of a therapeutic alliance
are established by the analyst's commitment to seek consist
tently to comprehend the meaning of the patienfs expressions,
his affect states, and; most centrally, the impact of the analyst
from a perspective within rather than outside the patient's subjec­
tive frame of reference (Kohut； 1959). We have referred to this
positioning as the stance of 化sustained empathic inquiry.;; Let
no one believe that this commitment is an easy one to fulfill - it
is frequently like feeling the sand giving way under one's psy­
chological footing. Seeing himself and the world consistently
through the eyes of another can pose serious threats to the
analyses personal reality and sense of self, much as the patient
must feel threatened when his experience is treated as a distor­
tion of reality.
What are the advantages of this stance? It opens for further
psychoanalytic illumination those disruptions of the analytic
bond that produce stubborn resistances that threaten to become
entrenched. Disjunctions arising from frustration, disappoint­
ment； and experiences of misattunement are the inevitable con­
sequence of the profoundly intersubjective nature of the analytic
dialogue, the colliding of differently organized subjective galax­
ies. They are not to be regarded as errors in an 化objective77 sense.
They are; however； evidence that the impact of the analyst and
his understanding； or lack thereof； is central to the patienfs
 <%o»

94 CHAPTER 6

subjective reality, and thus they provide access to crucial areas of

the patient's
i inner world. The commitment to extend empathic
— 우'1 > -. _ 소 드 _

inquiry to these experiences of disruption and to view them

rom within the patient
ffrom ’s subjective framework
patienfs framework,； wiwith the ob-
server as animmanent part of tl)e expc___ repeatedly
Erience,7 __ _ . reestib-
lishes and mends the therapeutic bond. Access is then provided
to the specific ancf idiosyncratic ways in which the patient is
organizing his experience of the analyst and to the meanings
that this experience has come to encode. A window is thrown
open for a fresh look into the area of discrepant and conflictful
experience； into a room in which are locked the most intimate
of secrets and longings and the most personal of happenings. It
is from this space that a 서new beginning77 may take root.
What are the goals that join the participants in the therapeutic
alliance? They are the progressive unfolding； illumination； and
transformation of the patient’s subjective universe. When the
analyst and the patient are freed of the need to justify their
respective realities, the process of self-reflection is encouraged
and vitalized for both. Inevitably; it emerges that the central
motivational configurations mobilized in analysis are derailed
developmental strivings, and the course of the developmental
processes activated by the analysis becomes the focus of inquiry.
The experiences of vitality and devitalization, of buoyant alive­
ness and apathy； which are clues to the unfolding develop­
mental processes and their derailment； can be followed； while
the effect of the analyst as he is experienced in this ebb and flow
is always kept in view.
It cannot be emphasized too strongly that the analyst's accep­
tance of the validity of the patient's perceptual reality in the
ongoing delineation of intrapsychic experience is of inestimable
importance in establishing the therapeutic alliance. Any threat
to the validity of perceptual reality constitutes a deadly threat to
the self and to the organization of experience itself. When the
analyst insists that the patienfs perception is a secondary phe­
nomenon distorted by primary forces, this, more than any other
single factor, ushers in the conflictful transference-counter-
transference spirals that are so commonly described as resis­
tances to analysis or negative transferences. These can be recog­
nized as crises or impasses in which each partner in the

으 心#이L
 VARIETIES OF THERAPEUTIC ALLIANCE 95

erstwhile therapeutic alliance becomes engaged in desperately

attempting to maintain his own organization of experience
against the threat to it posed by the other. Schwaber (1984) has
also pointed out that many of our patients suffer from a primary
sense of uncertainty about the reality of inner experience. For
them the recognition and articulation of vaguely felt affect states
or perceptions is <sp££j흐Uy meaning뜨 (p. 161). For others the
development of the ability to sustain 그—belief in their own
subjective reality was derailed because their perceptions con-
tained inform a rion-that \vaq_아irearpning._tQ_caregivem The per­
ceptions thereby became the source of continuing conflict and
had to be repudiated. This familiar core experience has been
dramatized in the 어gaslight77 genre. We have presented three
cases (Stolorow et al.; 1987) in which the inability to maintain
one;s own perceptual reality appeared to be a factor predisposing
to psychotic states. In these cases delusion formation repre­
sented a desperate attempt to substantialize and preserve a per­
ceptual reality that had come under assault and begun to crum­
ble. We stressed particularly the noxious role unwittingly
played in therapeutic situations by failures of the analyst to
recognize the core of subjective truth encoded in the patient's
communications.
The specific attunement to 어the role of the analyst and of the
surround, as perceived and experienced by the patient . . . as
intrinsic to [his] reality . . . draws upon modalities which are
significant components of the essentials of parental empathy-
attunement to and recognition of the perceptions and experien­
tial states of another기 (Schwaber; 1984; p. 160). In the transfer­
ence such attunement is a constituent of a quintessential
self-delineating experience serving to reinstate aborted develop­
mental processes of articulating and consolidating subjective p
reality. No more active mirroring is ordinarily required than the \
analyst's continuing, active interest in; and acceptance of; the I
perceptual validity of his patienfs experience, together with his \
alertness to cues of disavowed affect states that signal percep­
tions the patient cannot as yet admit into his subjective world. v
The stance of sustained empathic inquiry consolidates the I
therapeutic alliance as it enhances and extends the domain of
safety and harmony within the intersubjective field. The con­
96 CHAPTER 6

tinuing articulation and consolidation of subjective reality is;

however, only a part of the therapeutic experience. The addi­
tional goal of the therapeutic alliance is the transformation of
subjective experience. We will not focus here on the transforma­
tional prospects for the analyst in discovering his impact and
that of his inferences on the patient or in reflecting on the
invariant principles that organize his experience of himself and
his patient. Instead we wish to emphasize that a milieu in
which the patient's perceptual reality is not threatened encour­
ages the patient to develop and expand his own capacity for
self-reflection. Access is thereby gained into unfolding patterns
of experience reflecting structural weakness; psychological con­
striction early developmental derailment} and archaic defensive
activity-that is; the specific patterns that await transformation.
Often analysts fear that the commitment to understanding
from within the patient's own subjective framework； and espe­
cially to recognizing and investigating the analyst's contribution
to the patienfs experience, will result in an obfuscation of the
patienfs contribution to his own circumstances- We find this
fear to be unwarranted- Central to the process of transformation
is the understanding of the ways in which the patienfs experi­
ence of the analytic dialogue is codetermined throughout by the
organizing activities of both participants- The patienfs uncon­
scious structuring activity is discernible in the distinctively per­
sonal meanings that the analyst's activities-and especially his
interpretive activity ~ repeatedly and invariantly come to acquire
for the patient.
We have often heard critics voice an erroneous impression
that the domain of empathic inquiry extends only to conscious
elements of subjective experience. On the contrary, an indis­
pensable part of the work of analysis involves the investigation
of how conscious experience is organized according to hierar
chies of unconscious principles. These determine the ways in
which the patienfs experiences are recurrently patterned ac­
cording to developmentally preformed themes and meanings. It
is in the illumination of these meanings； and of the subjective
truths they encode, that the therapeutic alliance and psychoanal­
ysis itself finds its most generative purpose.
Consider, for example, the difficulties regularly encountered
 VARIETIES OF THERAPEUTIC ALLIANCE 97

when attempting to treat patients whose severe developmental

deprivations have predisposed them to intense distrust, violent
affective reactions; or stubborn defensiveness. In such patients
we have become aware of underlying unconscious and invariant
organizing principles into which all experience tends to be as­
similated. From their early history has crystalized a certain con­
viction that nothing good could happen to them in relation to
another person, that no one could possibly care for them; that
they are doomed ultimately to live and die alone; and that any
hope for a meaningful life based on an inner design of their own
is an illusion and a certain invitation to disaster. Every experi­
ence of disappointment or limitation tends to confirm one or
another of these principles. The impact of such experiences is
not felt to be delimited and temporary, but global and eternal.
Consequently； such inevitable experiences lead inexorably to
resignation and walling off or to violent affective reactions. The
subsequent trajectory of self-experience is codetermined both by
the impact of external events and by the invariant ordering
principles into which these events are assimilated and from
which they derive their meaning.
We are not unmindful of certain dangers posed by the thera­
peutic alliance as we have conceptualized it. When the stance of
empathic inquiry, for example, facilitates the appearance of ar­
chaic longings expressed in concrete demands to occupy a spe­
cial place or to be given special consideration, there is a tendency
for the analyst to be catapulted into a concreteness of his own
and to react in either of two ways. On one hand, reacting
defensively, he may insist that his patient recognize the unreal­
istic nature of these demands. On the other hand, he may react
from a feeling of responsibility for the patienfs disappointment
and give covert encouragement to the patient's underlying hope
for a relationship purified of any repetition of childhood trau­
mata. Either course diminishes the likelihood of thoroughgoing
change through the transformation of existing structures. Only
the consistent working through in the analysis of the develop­
mentally determined； invariant organizing principles can
achieve the structural change so hopefully envisioned by the
pioneers of our calling.
To illustrate our view of the therapeutic alliance, we offer
98 CHAPTER 6

some critical commentary on a case report by a well-known and

respected psychoanalytic clinician and theoretician. Kernberg
(1987) writes of a woman who 化started her psychoanalysis
suffering from a hysterical personality； consistent inhibition of
orgasm in intercourse with her husband； and romantic attach­
ments in fantasy to unavailable men;; (p. 802). After the patient；
with the help of the analyst, had overcome her reluctance to
speak about her fears of him; she expressed the fantasy that he
어was particularly sensual, in fact； lecherous/ and might be

attempting to arouse her sexual feelings • … so as to obtain

sexual gratification from her;; (p. 802). She said that the basis for
her fears was that she had heard he came from a Latin American
country and had written about erotic love relations. Further-
more; the analyst writes.

She thought I had a particularly seductive attitude toward the

women working in the office area where I saw her. All this； she
considered； justified her fears. She expressed the fantasy that I was
looking at her in peculiar ways as she came to sessions, and that I
probably was trying to guess the shape of her body underneath
her clothes as she lay on the couch [p. 802; emphasis added].

Her attitude was not seductive. On the contrary; she was

어inhibited, rigid, almost asexual in her behavior77 (p. 802), and

there was very little eroticism in her nonverbal communica­

tions. The analyst took notice of all this and noticed also; on
reflection, that his own emotional reactions and fantasies about
her had a subdued quality and contained no conscious erotic
element. On the basis of these observations he concluded 써:hat
she was attributing to me her own repressed sexual fantasies and
wishes77 and that 化this typical example of a neurotic transference
illustrates the operation of projection/ with little activation of

1The assumption that transference experiences are to be explained by the

operation of defensive measures is undoubtedly shared by a majority of ana­
lysts. It is precisely for this reason that we are urging a reexamination of the
clinical evidence. We wish to emphasize that it is not the particular theory-
rooted content of Kernberg;s interpretations that we are questioning here.
What we are calling into question is the epistemological stance according to
which the analyst； through his acts of self-reflection, is presumed to have
 VARIETIES OF THERAPEUTIC ALLIANCE 99

countertransference material either in a broad ... or in the

restricted sense;; (p. 802).
The report goes on to describe changes that took place during
the ensuing year. The patient's fear of the analyst's sexual in­
terest in her was succeeded by expressions of her disgust for the
sexual interest older men have for younger women； and she
discovered features of her father in these lecherous old men. Her
own romantic fantasies, meanwhile, remained fixed on unavail­
able men; while she was terrified of sexual engagements with
men; including her husband, who were available to her. As she
became aware, the analyst writes, that her sexual excitement
was associated with forbidden sexual relations； there was a
decrease in her "repression and projection of sexual feelings in
the transference재 (p. 803). She stopped feeling that the analyst
was interested in her sexually and; as he had anticipated and
interpreted from the beginning; she began to have 化direct oedi-
pal7； sexual fantasies about him.
At one point； in response to her fantasies, the analyst found
himself responding erotically and with a fantasy of his own that
he in turn would enjoy a sexual relation with her; ^breaking all
conventional barriers^ and providing her 어with a gift of the
fullest acknowledgment of her specialness and attractiveness77
(p. 803). The analyst describes this as a transitory emotional
response to her seduction in the transference, which had acti­
vated in him 우the complementary attitude of a fantasied, seduc­
tive oedipal father" (p. 803). Subsequently the patient once more
accused the analyst of teasing and humiliating her and; finding
no indication of what the patient perceived, the analyst con­
cluded that the patient was projecting onto him experiences
with her father from the past.
In this latter series of associations and interpretations, as in the
others cited, there is no indication of an attempt to explore fully

gained privileged access to the objective truth about himself that the patient's
discrepant perceptions are then said to distort. This stance does not have to be
inferred from Kemberg's clinical material; it is readily demonstrated in his
descriptions of how he arrived at transference interpretations. Our growing
awareness of the unintended and unexamined impact of this epistemological
stance on the course of the therapeutic process was one of the central concerns
that motivated us to write this chapter.
100 CHAPTER 6

the basis of the patienfs experience from within the perspective

of her own subjective frame of reference. Perhaps she perceived
something in his tone or his manner that he had not intended or
even been aware of. Did his initial scrutiny of her for signs of
우eroticism;; mean something else for her? Did his fantasy of a

sexual affair with her; which he believed was reactive, commu-

nicate itself to her in some way and stimulate concerns in her?
The point here is not that the analyst ^objectively^ did anything
wrong； he clearly kept well within the boundaries of profes­
sional behavior. The point is that whatever singular meanings
these or other cues from the analyst might have had for the pa­
tient are left unexplored. Only what conformed to the theory
being employed was attended to. The analyst in this case used as
primary data his own self-reflections, and these persuaded him
that the patienfs experience was the consequence of distorting
mechanisms. Here the analyst's subjective frame of reference is
elevated to the status of objective fact; and the patient must ac-
cept the analyst's view as objective, as part of the working alii-
ance. Otherwise, as the report describes, the resistance has to be
worked through so that she can come to recognize her defenses
against accepting the analyst's perceptions, presumably because
she is afraid to face her own impulses. One reality； the analyst’s；
is apparently real; the other, the patient's, is false! The therapeu­
tic task is to account for the 어distortion?"
However, a crucial source of data is left unexplored. Access to
that source, that is, an investigation in depth of the elements of
the patienfs experience from within her subjective framework； is
bypassed when the stance of empathic inquiry is abandoned in
favor of doctrinal inference. A process is derailed that might
have disclosed how seduction was being signaled for this patient.
Acceptance of the perceptual (not objective) validity of the pa­
tients experience might have made possible a therapeutic allb
ance committed to an investigation of the exquisitely personal
meanings of seduction and humiliation into which the various
cues from the side of the analyst were being assimilated-
It is also possible that such investigation might have provided
a safer milieu wherein elements of the patienfs experience of
her husband that would have illuminated her aversion to his
sexual advances could have been articulated- Her extramarital
 VARIETIES OF THERAPEUTIC ALLIANCE 101

sexual fantasies might then have disclosed, not an oedipal fixa-

tion; but sequestered hopes for acceptance, responsiveness, and
enrichment not otherwise available to her.
The patient, it is reported； gradually came to realize her de­
fenses against her sexual feelings and produced oedipal wishes
toward the analyst. Such expressions are commonly taken as
proof of the correctness of the theory of drive and defense.
However, nothing illustrates more clearly the need for the ana­
lyst to investigate from within the patienfs subjective frame­
work the impact of his own theories on the direction and course
of the analysis. In the establishment of a therapeutic alliance; two
heads are surely better than one. Only this can enable patient and
analyst to distinguish between a 우pseudoalliance;; based on com­
pliance with the analyst's viewpoint and a therapeutically muta­
tive alliance based on empathic inquiry into the patienfs subjec­
tive world.
There is more than an echo here of the quandary Freud
encountered that changed the whole course of the evolution of
psychoanalysis. Freud found evidence that some of the child­
hood sexual seductions his patients complained of could not
have happened and; it is reported, he felt betrayed. He concluded
that these must have been fantasies that expressed the childhood
wishes of his female patients； and he built his subsequent theo­
ries of psychosexual development and of transference on that
foundation. For Freud these fantasies were mental representa­
tions of instincts. However; sustained empathic inquiry reveals
that such fantasies often encode experiences of traumatic devel­
opmental derailment and that Freud's dilemma was a false one.
It is common for experiences of abuse and seduction of a non-
sexual or covertly sexual nature to be concretized and preserved
in sexual symbolism. This insight into the kernel of truth en­
coded in a patienfs fantasies opens up a whole new pathway for
exploration, one that remains foreclosed when a patienfs per­
ceptions are dismissed as distortion.

CONCLUSIONS
We have offered a critique of the concept of the therapeutic
alliance implicit in both traditional ego psychology and Kleinian
102 CHAPTER 6

psychoanalysis> Specifically} we have objected to the notion that

the therapeutic alliance requires that the patient identify not
only with the analyst's analytic stance of empathic inquiry, but
also with his theoretical presuppositions as well. We hold that
such an alliance is actually a form of transference compliance;
which the patient may believe is necessary in order to maintain
the therapeutic bond on which all hopes for his future have
come to depend- We have contrasted this 化pseudoalliance기 with
a therapeutic alliance established through sustained empathic
inquiry into the patienfs subjective world. This latter alliance;
in which the perceptual validity of the patienfs transference
experience is accepted； promotes the illumination and transfor­
mation of the invariant principles that unconsciously organize
the patient's inner life. Material from a recently published case
report is examined in order to illustrate the differing clinical
consequences of fostering one or another of these two varieties
of therapeutic alliance.
We are aware that analysts of all persuasions approach their

work； including our own; can be perceived by patients as some­

thing with which they must compliantly identify. What we are
emphasizing is that the commitment to investigating the impact
of the analyst, of his interpretive activity, and of his theoretical
preconceptions, whatever they may be; from within the per-
spective of the patienfs own subjective reality is central to the
establishment of a therapeutic context in which the patienfs
unconscious organizing principles can be most sharply illumi­
nated and thereby become accessible to therapeutic transforma­
tion.
 Chapter 7
Varieties of Therapeutic
Impasse
(written in collaboration with
Jeffrey L. Trop)

ur thesis in this chapter is that impasses in psychoanalytic

O therapy, when investigated from the standpoint of the

principles unconsciously organizing the experiences of patient
and therapist, provide a unique pathway-a 어 royal road;; —to the
attainment of psychoanalytic understanding.
From the continual interplay between the patienfs and the
therapist’s psychological worlds two basic situations repeatedly
arise： intersubjective conjunction and intersubjective disjunction. The
first of these is illustrated by instances in which the principles
structuring the patienfs experiences give rise to expressions that
are assimilated into closely similar central configurations in the
psychological life of the therapist. Disjunction, by contrast, oc«
curs when the therapist assimilates the material expressed by the
patient into configurations that significantly alter its meaning
for the patient. Repetitive occurrences of intersubjective con­
junction and disjunction are inevitable accompaniments of the
therapeutic process and reflect the interaction of differently orga­
nized subjective worlds.
Whether these intersubjective situations facilitate or obstruct
the progress of therapy depends in large part on the extent of the
therapist’s ability to become reflectively aware of the organizing
principles of his own subjective world. When such reflective

103
104 CHAPTER?

self-awareness on the part of the therapist is reliably present,

then the correspondence or disparity between the subjective
worlds of patient and therapist can be used to promote empathic
understanding and insight. In the case of an intersubjective con­
junction that has been recognized, for example, the therapist
may be able to find in his own life analogues of the experiences
presented to him； his self-knowledge thus serving as an invalu­
able adjunct source of information regarding the probable back­
ground meanings of the patienfs expressions. Disjunctions,
once they are recognized, may also assist the therapist's ongoing
efforts to understand the patient； for then his own emotional
reactions can serve as potential intersubjective indices of the
configurations actually structuring the patienfs experiences.
In the absence of reflective self-awareness on the part of the
therapist； such conjunctions and disjunctions can seriously im­
pede the progress of therapy- For example, an intersubjective
conjunction may interfere with the course of treatment when
the patient's experiences so closely correspond to those of the
therapist that they are not recognized as containing psychologi­
cally significant material to be investigated and understood.
Descriptions of the patienfs life that are in agreement with the
therapist's personal vision of the world will accordingly tend to
be regarded as reflections of objective reality rather than as
manifestations of the patient's personality. Commonly； the spe­
cific region of intersubjective correspondence that escapes ana­
lytic inquiry reflects a defensive solution shared by both patient
and therapist. The conjunction results in a mutual strengthening
of resistance and counter-resistance and; hence, in a prolonga­
tion of the treatment.

The Case of Peter

Peter (whose treatment was discussed in Atwood and Stolorow,

1984); repeatedly complained about the mechanization and de­
personalization of American life and expressed longings for a
Utopian community within which his existence could have
significance and meaning. His therapist； who shared this nega­
tive image of our society; never responded analytically to these
expressions, for they seemed to him nothing more than indi­
 VARIETIES OF THERAPEUTIC IMPASSE 105

cants of good reality-testing regarding the modern condition of

life. Both of them were prone to attribute the difficulties in their
relationships to impersonal forces and institutions, and more­
over to longing for a world modeled on the idealized images of
vanished past eras in their respective lives. The preoccupation
with these images also served to prevent a painful confrontation
with certain conflictual issues concerning intimacy and attach­
ment. The conjunction between patient and therapist here ex­
tended not only to the content of the expressed imagery, but
also to aspects of its defensive purpose. The opportunity to
illuminate the meanings and sources of the material, which also
contained implications for the transference, was thus replaced
by an unwitting, silent collusion to limit the patient's (and
therapist's) attainment of self-knowledge.

NEGATIVE THERAPEUTIC REACTIONS

Especially damaging are the interferences with treatment that

arise in consequence of protracted; unrecognized intersubjective
disjunctions. In such instances, the disparity between patient
and therapist can contribute to the formation of vicious counter-
therapeutic spirals that produce for each an ever more dramatic
confrontation with dreaded scenes having salience in their re­
spective subjective lives. Such persistent disjunctions, whereby
empathy is chronically replaced by misunderstanding, invari­
ably intensify and exacerbate the patienfs suffering and mani­
fest psychopathology. It is here that we find the source of what
analysts have euphemistically termed 어negative therapeutic re­
actions?7
The concept of a 어negative therapeutic reaction이 was created
by analysts to explain those disquieting situations in which
interpretations that were presumed to be correct actually make
patients worse rather than better. Typically, such untoward
reactions to the analyst's well-intended interpretive efforts are
attributed exclusively to intrapsychic mechanisms located en­
tirely within the patient, such as an unconscious sense of guilt
and a need for punishment； primal masochism (Freud, 1923;
1937); narcissistic character resistances (Abraham, 1919)； a need
106 CHAPTER 7

to ward off the depressive position through omnipotent control

(Riviere, 1936); or unconscious envy and a resulting compulsion
to spoil the analytic work (Kernberg; 1975； Klein, 1957). We are
contending, by contrast； that such therapeutic impasses and
disasters cannot be understood apart from the intersubjective
contexts in which they arise.
In our experience; exacerbations and entrenchments of pa­
tients7 psychopathology severe enough to be termed 어negative
therapeutic reactions^ are most often produced by prolonged；
unrecognized intersubjective disjunctions wherein the patienfs
emotional needs are consistently misunderstood and thereby
relentlessly rejected by the therapist. Such misunderstandings
typically take the form of erroneously interpreting the revival of
an unmet developmental longing as if it were an expression of
malignant, pathological resistance. When the patient revives
such a longing within the therapeutic relationship, and the ther­
apist repeatedly interprets this developmental necessity as if it
were merely a pathological resistance； the patient will experi­
ence such misinterpretations as gross failures of attunement.
Consequently； traumatic psychological injuries are repeatedly
inflicted； with impact similar to the pathogenic events of the
patient's early life (Kohut; 1971; Stolorow and Lachmann;
1980).

The Case of Robyn

An example of such a destructive turn of events is found in the

treatment of Robyn (discussed in Atwood and Stolorow, 1984)；
a woman whose difficulties traced back to her early family’s
consistent failure to provide the confirming and validating re­
sponsiveness necessary for the formation of a stable and co­
herent sense of self. The only exception to this pattern of
unresponsiveness that she could recall was her father's sexual
interest in her; which； according to her memories began when
she was nine years old. She subsequently developed a seductive
and coquettish style and ultimately a pattern of compulsive
promiscuity with father-surrogates, in a desperate effort to be
recognized and counteract terrible feelings of depletion and non-
being.
 VARIETIES OF THERAPEUTIC IMPASSE 107

Robyn's therapist began her treatment in accord with his

understanding of the precepts of classical psychoanalysis, which
included such an overly literal interpretation of the rule of absti­
nence that he responded to her urgent requests for affirming,
mirroring responses with silence or at most a brief interpreta­
tion. She began to experience his seeming aloofness and 서neu­
trality기 as a repetition of the traumatically depriving circum­
stances of her childhood and alternated in treatment between
sexualization of the transference and attempted seductions, on
one hand, and expressions of deep rage on the other.
A central configuration in the therapists subjective world
concerned issues of power and control. The salience of these
issues had largely arisen from a problematic childhood relation­
ship with his mother, in which he had violently resisted submit­
ting to what he felt was her tyrannizing and oppressive will.
The dilemma around which major aspects of his wbjective life
were organized was the danger of relinquishing control and
autonomy} which seemed to him equivalent to becoming the
slavelike extension of others. The patient's desperate demands
for mirroring responsiveness were unconsciously assimilated
into his emotionally charged themes of power and control,
evoking a reaction of stubborn resistance and entrenching his
already withholding and unresponsive style. Unaware of the
countertransference reaction that had been precipitated, he envi­
sioned his patient/s intensifying demands as expressive of a
malignant need for dominance. A vicious spiral was thereby
created, in which the disjunctive perceptions, needs; and reac­
tions of patient and therapist strengthened one another in a
reciprocally destructive way. The treatment continued in this
situation for 18 months until it was finally broken off when the
patient attempted to commit suicide.

IMPASSES： A ROYAL ROAD

Having reviewed and illustrated the kinds of intersubjective

situations that； when not recognized； can lead to serious ob­
structions of the therapeutic process, we turn now to the central
focus of this chapter-the new understandings and enhance­
108 CHAPTER 7

ments of the therapeutic process that can be achieved when the

principles unconsciously organizing the experiences of patient
and therapist in an impasse are successfully investigated and
illuminated.

The Case of Alice

Alice was a 34-year-old teacher of Oriental descent who had

entered therapy two years prior to the impasse to be described
because she felt depressed about a relationship she was having
with an older man whom she had been seeing for a year. She
felt that this man had become more interested in his own
activities than in her and was not attending to her needs. In
particular, she felt he had been ignoring her when she wanted
attention and physical affection. She appeared as an attractive
and well-dressed woman whose quiet manner often betrayed
her agitated state of mind.
She had been married in her early 20s for about a year; but the
marriage ended when her husband began to withdraw from her
and she became increasingly rageful with him. She had no
children; a lack that continued to be a disappointment to her;
and she experienced a chronic sense of loss, along with a persis­
tent feeling that she was not feminine and that she was a failure
as a woman- She was able to put these feelings aside only when
she was working; and she described how happy she was
teaching her students about reading and history. She often imag­
ined that they were her children and thereby achieved an illu-
sory sense of completeness.
Alice described a longstanding inner experience of deficiency
and lack of confidence in her attractiveness. She was an only
child, born when her parents were quite old. Consistent with
his cultural background, her father had desperately wanted a
male child- Throughout her childhood her mother and other
relatives had told her repeatedly about his disappointment when
she was born. Apparently he had become convinced that； be­
cause his wife was having a child late in their marriage, the child
was destined to be the boy he had always wanted. He was
devastated when she was born； and he precipitously left the
family for several months. When he returned, and continuing
 VARIETIES OF THERAPEUTIC IMPASSE 109

throughout her childhood, he virtually ignored her and had little

to do with her; leaving her care entirely to her mother. The
patient emphasized to the therapist that her father had never
been overtly cruel to her; but that it felt to her as if she did not
really exist in his eyes. He seemed completely absorbed in his
professional work； and she believed he regarded her as an ob­
stacle to his ambitions. He remained distant and 니ninvolved
with her until his sudden death when she was 16 years old.
Her mother was a very critical and perfectionistic woman
who often seemed overwhelmed by her household tasks. Her
mother had told her several times about her father's reactions to
her birth without showing much emotion, but the patient had a
persistent impression that her mother, too; had felt ashamed
because Alice was not a boy. Her mother did encourage the
patient’s love of books, and the patient became more and more
withdrawn growing up; retreating into the world of literature
and fantasy. She was very shy and isolated during her childhood
but distinguished herself academically and decided to go into
teaching.
As she described her relationship with her boyfriend during
the early sessions of her therapy, Alice continued to feel increas­
ingly that he was self-centered and preoccupied with himself.
He only wanted to talk about his work； she said; and was not
interested in her activities. She described how she felt neglected
and mistreated and became furious with him. Her relationship
with the therapist generally felt supportive to her; but on several
occasions when the therapist focused on how she felt about
herself when she was ignored； the patient felt that he was
implying that her experience with her boyfriend was not real
and that she was fabricating it. At these times she would be­
come angry with the therapist and insist that he was interested
in proving some theory of his own and did not really want to
understand her. The therapist would then return to her experi­
ence and clarify that she did not feel he was on her side and that
she needed him to 나nderstand how difficult her boyfriend was
for her. She was able at times to understand that her relationship
with her boyfriend automatically revived her childhood feeling
of not being valued as a female； and that this feeling reinforced
and fueled her anger at him. She did decide to stop seeing him
110 CHAPTER 7

about nine months after starting treatment} and this was very
diffic니It for her as she began to ruminate about how she might
have been more appealing to him. In particular, she focused on
her physical attributes and her overall feeling that she was
unattractive. The therapist clarified for her again how she orga­
nized the meaning of this experience according to her own
feeling of deficiency. It revived for her the recurrent and painful
feelings associated with her father's rejecting her because she
was a girl.
As she began to feel better about her decision, a pattern began
to take form in the transference. Alice began increasingly to
focus on the therapist as a source of romantic interest. This
occurred gradually but with greater intensity over a period of
several months. The patient was embarrassed at first but indi­
cated that she found the therapist attractive and wanted to meet
a man just like him. She told him she was concerned that he
would be uncomfortable with her and that he would pull away.
Assimilating the patienfs concerns into an organizing principle
of his own; the therapist reassured her that he would not with­
draw from her. He also communicated his understanding that
her feelings represented a longing to consolidate and build a
sense of herself as a female, as this had never happened in her
family. Soon the patienfs romantic interest became tinged with
sexual fantasy. She confided that she had sexual dreams in­
volving the therapist but said she was too embarrassed to de­
scribe the details. She began to ask for a more direct responsive­
ness from the therapist. She said she could sense that he found
her attractive, and she felt certain of this. The therapist ac­
knowledged how important it was that she feel special to him.
On a few occasions she would respond angrily and say that she
knew he felt she was unique and that she was upset that he
would not directly confirm this. The therapist, now in the grip
of a conflict within himself, replied equivocally; stating that she
was indeed a special person and that she needed to feel this
about herself.
After being in therapy for 18 months, the patient was away
for an eight-week trip in which she took a group of children on a
cultural tour of several foreign countries. When she returned she
was happy and excited about what she had done but acutely felt
 VARIETIES OF THERAPEUTIC IMPASSE 111

the absence of a man who might share her excitement with her.
She had thought of the therapist often during the trip and had
fantasized about the two of them enjoying the beauty together.
As she began to tell the therapist about a present she had
purchased for him; he reacted uneasily and told her that it was
not necessary for her to give him a gift. The patient was crest­
fallen and then became angry. She felt that the therapist had
completely rejected her and that； although he had previously
encouraged a special relationship with him; he was now
changing his attitude. She felt he had misled her; and she said
that she would seriously consider finding a new therapist.
During the next few sessions the patient expressed an intense
need for the therapist to indicate directly that he found her
attractive and sexually exciting. Her demands for a concrete
affirmation of her sexual self became increasingly strident. The
therapist； feeling enormous pressure; finally did acknowledge
that she was an attractive woman whom many men would find
appealing. The patient became furious at what she felt was a
lukewarm response. She continued to demand that he simply
acknowledge that he felt sexually excited by her. She reiterated
her awareness that they would actually never do anything sexu-
ally; but she still wanted him to demonstrate that he was inter­
ested and excited. In reaction to her increasing demands； the
therapist became more emotionally disengaged and, adopting a
more intellectual stance, asked why she was feeling so needy at
this time. The patient became even more incensed and felt that
he was abandoning her and that she should leave him. It was at
this point that the therapist sought consultation in an attempt to
understand what had happened between them.
As a result of the consultation it became clear that an intense
stalemate had developed from the interaction between the pa­
tients and therapist's organizing principles. The patienfs in­
variant principle was that no man would ever sustain an interest
in her as a female. This was the product of her repeated experi­
ence of her father being totally uninterested in her because she
was not male. She had mobilized with the therapist an intense
developmental longing for mirroring responsiveness to her fe­
maleness-a longing that had become eroticized. The therapist
had attempted to be flexible in response to the patient's needs.
112 CHAPTER 7

His efforts to be responsive； however, had been codetermined

by an archaic organizing principle of his own. As a child he had
felt required to devote himself to maintaining his mother's self-
esteem by mirroring her for her physical attributes. In addition,
his mother would periodically become enraged at him because
of some slight he had inflicted. Although these episodes were
infrequent； they were very frightening and powerful for him. It
became absolutely imperative for him to anticipate what would
make his mother angry and to avoid this at any cost. In the
treatment situation, the patienfs intense need for mirroring of
her sexual attractiveness； together with her propensity to be-
come enraged when injured, had revived these painful themes
from the therapist’s history. His self-esteem became focused on
maintaining the patienfs emotional equilibrium, instead of in­
vestigating and elucidating her inner experience. The patienfs
demands had become assimilated into an archaic organizing
principle of the therapist that required him literally and con-
cretely to fulfill the patient's longings for affirmation and to
prevent her from reexperiencing with him the painful develop­
mental failures of her childhood. However; continuing along the
path of direct fulfillment had increasingly put the therapist into
conflict with his personal ideals as an analyst. Thus the thera­
pist had been ambiguous in his message to the patient around
her developing sense of femininity. While at times he concretely
affirmed her in an attempt to be responsive and extend his own
boundaries, at other times he became alarmed about the poten­
tial consequences of his responsiveness and the patient's esca­
lating demands and then withdrew into cool intellectualization.
In the next several sessions the therapist conveyed to Alice his
understanding of their interaction and how it had unfolded. He
comm니nicated to her that he had tried to extend his range of
interactions with her in an attempt to be responsive to her
needs. She was; however, perceiving and reacting to his oscilla-
tion between a responsive mirroring stance and a retreat into
more distant intellectual inquiry, which made her feel like a
specimen. He stated that at this point he wanted to establish a
firmer definition of his own boundaries so that he could help
restore a therapeutic atmosphere between them. He told her that
his ideal of himself as an analyst prevented him from re­
 VARIETIES OF THERAPEUTIC IMPASSE 113

spending directly to her questions about whether he found her

sexually attractive and exciting. He acknowledged that because
of a conflict within himself - between a feeling that he must be
responsive to her and an equally strong feeling that he must live
up to his own analytic ideals-he had sometimes withdrawn
from her; as when he had rejected her gift. He said that; within
the limits of his own view of himself as an analyst} he would
like to work with her to reestablish their relationship. The
patient responded very favorably. She said that； although she
thought his training was somewhat stupid； she understood what
had happened and now had an idea of what she could expect.
She indicated, upon inquiry, that she did not experience the
analyst's new stance as a recoiling from her because she was
unappealing sexually, nor did she renounce her feelings and
wishes.
Clarifying the intersubjective disjunction both reestablished a
facilitating atmosphere between therapist and patient and made
possible a deepening understanding of the principles organizing
the patienfs experience in the transference. The patient con­
tinued to have romantic feelings toward the therapist； but the
demands for a concrete response receded. Concomitantly, the
patient became aware of her underlying conviction that the
therapist must surely be repulsed by her romantic and erotic
feelings. Alice and the therapist came to understand that her
central and most painful fear in the transference was not that
she would be rejected as sexually unattractive, but that her
feelings and longings for responsiveness in and of themselves
would repel and alienate the therapist. This fear was accompa­
nied by a belief that he must feel dirtied and disgusted by his
association with her and that he must be relieved when she left
his office. Thus; the successful illumination of the impasse had
unveiled the patienfs deep conviction that her affective longings
were repugnant, a sign of a loathsome defect within herself.
This conviction, along with its childhood roots, could then
become a primary focus of analytic investigation.
For the therapist, the new understanding of his own vulnera­
bilities and the firmer delineation to the patient of his analytic
ideals created an increased sense of confidence. The patient's
feelings of disappointment and anger co니Id then be seen as an
114 CHAPTER 7

inevitable component of the process of her consolidating her

sense of herself as a female; not as a harbinger of a disaster that
he had to forestall. The clarification of the intersubjective dis­
junction freed him of the requirement that he concentrate on
alleviating her distress and helped create an atmosphere wherein
he felt a greater freedom to be naturally responsive from within
a stance of sustained empathic inquiry.

The Case of Sarah

Sarah; a 27-year-old unmarried physical therapist entered treat­

ment because of recurring experiences of herself as a small,
vulnerable child lost in a threatening world of powerful grown­
ups. She was in actuality a successful, well-respected profes­
sional with many supervisees and disabled patients relying on
her expertise. Subjectively; however； she was increasingly prey
to feelings of extreme intimidation, as if she were a weak and
inadequate little girl suddenly thrust into high-powered adult
roles and responsibilities.
Sarah had made one earlier attempt at psychotherapy while
she was in college, but this had ended disastrously after two
years when her therapist began to use her for the fulfillment of
his own sexual needs. She was devastated when; after finally
expressing confusion and doubt concerning their physical inti-
macy; he angrily told her that he had made a mistake in be­
lieving she had become capable of 化mature Iove.;; Never
showing any understanding of her reactions, he made her feel
completely deserted by him. The final result of this was that she
resolved never to rely so deeply on another person again and
tried to block the entire episode out of her mind for the next
several years.
A pattern of being emotionally neglected and exploited actu­
ally was characteristic of her wh시e life history. During her
early years there was massive neglect by her depressed and
alcoholic parents; who for the most part relied on her to take
care of them. Being nurturant to the parents provided the only
consistent means of experiencing a connection with them; and
major aspects of her developing self became organized around
the caregiving role. This role specifically excluded showing any
 VARIETIES OF THERAPEUTIC IMPASSE 115

direct need for care from her mother or father； expressing such a
need seemed invariably to make the parents resentful; and they
reacted either by pressuring her to be grown-up or by angrily
rejecting her for being a burden to them. Illustrative of this
pattern were the patient's earliest memories； which were of
times when she cried uncontrollably in her crib and her mother
responded by screaming at her to be quiet and violently
throwing a bottle into her bedding.
Among the long-range consequences of Sarah;s early situation
was an interpersonal style of giving to others but asking nothing
directly for herself. This style affected not only her career choice
in the field of disability, but also her intimate relationships. Her
history was one of a series of romances in which she played a
nurturant role with men who gave little or nothing in return.
She always reacted to the depriving quality of these relation­
ships with upset and depression but regarded such feelings as
signs of something wrong with her rather than reflections of
how she was being mistreated.
The first months of Sarah's new therapy seemed to unfold
very smoothly. She told the long story of her life in all its sad
detail, including the story of her relationship to her first thera­
pist. Her new therapist listened sympathetically as she spoke;
and; although he noted the rapidity with which she seemed to
be opening up the various areas of her experience; he did not
anticipate the transference storms that were soon to arise. There
was an early dream, symbolizing the process that was occur-
ring; in which the patient traveled back to the town where she
had grown up; approached a large house and went in. She
passed through room after room and finally came to a small
closet in which an infant covered with dirt} cuts; and bruises
cowered against the wall. In discussing the dream, she and her
therapist understood the imagery as a picturing of their devel­
oping discovery of the sequestered, deeply hurt child within her.
The impasse to be described crystalized around the therapist's
telling Sarah of a six-week interruption in their work that was
to occur during the following summer. Recognizing that such a
long separation might be exceptionally difficult for her; he ex­
plained that he would be only a phone call away. She showed
no special reaction to the announcement for a few days but then
116 CHAPTER?

reported a dream of an old mangy animal left lying on its back

in the wilderness. When her therapist suggested that perhaps the
dream was related to his plans for the summer, she grew visibly
frightened, haltingly saying that maybe she was experiencing an
impending abandonment. At this point the therapist repeated
his reassurances that he could remain in touch with her by
phone and reminded her they still had a number of months to
decide how they would handle the separation. To his surprise;
Sarah reacted to the intended reassurance by becoming still more
upset and turning physically away from him. When asked what
she had felt； she said that she could not bear being in the room
for a moment longer and wanted to go home. Her therapist
asked her not to leave; but rather to stay and tell him more of
what she was feeling. Again she responded fearfully and was
now unable to talk- The session continued essentially in a tense
silence until the hour was finally over; at which point Sarah
rushed out the door.
The patient now began coming late to their meetings, re­
ported great difficulty restraining herself from running away
once she had arrived； and otherwise had little to say. The
therapist redoubled his efforts to understand the meaning of the
impending separation and continued to seek ways to ameliorate
its inexplicably growing disruptive impact. He told the patient
he was sure they could find their way through this period by
planning for it and having occasional contacts by telephone, and
he even offered to see her once during the middle of the six-
week interruption when he had to return briefly. With each of
these efforts to explore and soften the effect of his departure；
Sarah became still more frightened and unable to communicate
her feelings to him. She then told of recurring nightmares in
which she arrived at his building for a session, but somehow his
office had vanished and she was unable to find him. As the
situation worsened, the therapist began to feel more and more
helpless; at times becoming consumed with anxiety on her
behalf- Sarah noted her therapists growing distress, and this
added to her difficulties, for now she felt she had become a
painful burden to him.
During the vacation itself; the patient refused to have ongoing
contacts of any kind and rejected her therapist’s calls with what
 VARIETIES OF THERAPEUTIC IMPASSE 117

he experienced as icy hostility. Finally she sent a letter telling

him that he had treated her with brutal insensitivity. She added
that she felt completely betrayed by him and was therefore
terminating treatment. Still not understanding what had tran-
spired, he replied in writing that he regretted the ending of their
relationship and hoped she would feel welcome to come back if
she ever changed her mind. Sarah did finally return after several
more weeks had passed, and their sessions continued. The im-
passe; however, persisted through a series of subsequent epi­
sodes and was only very slowly clarified over the next 18
months. These episodes had in common a crisis around a phys­
ical separation interrupting their work or some other circum­
stance dramatizing an aspect of the therapist's unavailability to
the patient. In each instance Sarah again reacted to her thera­
pists attempts to understand and alleviate her pain by with-
drawing, and the treatment was maintained during this interval
only on the most precarious basis.
The illumination of the impasse occurred gradually and in­
volved not only a new understanding of the patient} but also a
concomitant change in the therapist's self-understanding. For
Sarah; the crises pertained most fundamentally to her sense that
her therapist showed no concern for the enormously frightened；
vulnerable child she repeatedly experienced herself as being. His
attempted reassurances that a way could be found to overcome
the disruptions of occasional separations she perceived as im­
plicit demands that she feel better and not become scared. This
replicated early childhood scenes in which her parents expected
her to withstand very trying circumstances； including some­
times long separations from them, and behave like the grown­
up girl they needed her to be. Her first therapist as well had told
her that he expected her to be 化mature개 and made her feel that
she had lost all connection to him on account of her failure to do
so. A fundamental truth of Sarah;s life was that she had never
been allowed to be a child, and with her new therapist she was
again experiencing the same disastrous situation. His expecta­
tion that she join with him in planning for a separation flew in
the face of her feeling that such a long break in their contacts
was utterly impossible to bear. What was most disruptive for
her was not; it was later understood； the six-week separation
118 CHAPTER?

itself; the more central problem was that she felt that her thera­
pist could neither understand nor accept the paralyzing sadness
and despair his departure was triggering. His well-meaning ef­
forts to arrange contacts to help her only dramatized this lack of
니nderstanding. She also had been experiencing his efforts as

containing the implicit message that she should not be so upset;

and thus as a rejection of her child-self. This self had originally
been disavowed in consequence of repeated events making her
believe that the expression of her needs threatened her ties to the
people closest to her. The specific danger associated with the
emergence of her long-suppressed childhood longing for under­
standing and loving care was that she would be rejected for
imposing such a loathsome burden on anyone around her. This
danger had seemed actually to materialize when her therapist
first informed her of his summer plans.
Throughout the period of the impasse the therapist did not
clearly perceive the patient's child-self as a distinct part of her.
He was aware of her intense suffering but did not fully compre­
hend the nature of this suffering as the boundless despair of a
small child. Instead he tended to see the difficulty she was
having in terms of the relationship between them and felt re­
sponsible for her pain. This feeling of magnified responsibility
contributed to his intense distress and formed part of a vicious
cycle by reinforcing her picture of herself as an intrinsically
burdensome； rotten creature that no one could ever love.
The changes in the therapist's self-understanding that contrib­
uted to the resolution of the impasse arose largely out of his
personal analysis; which was occurring in parallel to the treat­
ment being described. He was a person in whom there was also
a disavowed child-self, but with a background different from
that of his patient. He had grown up in a family that had been
profoundly affected by the sudden death of his mother when he
was eight years old. She had been the emotional center of family
life； and her loss had been utterly shattering to all the family
members. The therapist had as a child responded to this massive
upheaval in part by forming an identification with his mother
and assuming aspects of her nurturant； supporting role in rela­
tion to his grieving father and siblings. His own sense of inner
desolation was hidden in this process, becoming buried； as it
 VARIETIES OF THERAPEUTIC IMPASSE 119

were； with his mother. The result was that much of his style of
relating to others began to center on the themes of caretaking
and rescue,, which served to protect him from feelings of devas­
tating powerlessness and solit니de. His inability to rescue Sarah
as she spiraled into despair had thus challenged a central part of
his way of maintaining his own emotional equilibrium.
As a result of intensive analytic work； the therapist began to
have the immediate experience of his own child-self; with all its
attendant feelings. The gradual integration of this previously
disavowed part of himself occurred within the bond to his ana­
lyse which provided elements of the holding, containing con­
text that had been missing in the shattered family of his youth.
A central theme in his analysis was in fact the recognition of
how he had been hurt not only by the loss of his mother, but
equally by the emotional unavailability into which his father
and other family members had lapsed in the aftermath of her
death• As this integration slowly took place, his perception of
his patient also began to change. He now came to see her
child-self as a much more distinct entity than had been apparent
to him before. He understood also that within this part of her
there was an indescribable depth of despair and loneliness, feel-
ings that again and again had been triggered in the transference.
He specifically grasped why all his efforts to ease Sarah's pain
during their separations had failed: the separations were simply
impossible for the child within her to manage, and she had
needed from him a response showing his understanding and
acceptance of this fact. His efforts to reassure her contained the
expectation that she would do well while he was away; which
was very far from how she felt. This expectation had made it
seem that he was no longer available for contact with her; and
this was symbolized in the dreams of his office having disap­
peared. The reassurances were in addition felt as rejections of
her child-self, rejections that replicated the many traumatic inter­
actions with her parents and first therapist.
With the therapist's increasing acceptance and tolerance of the
catastrophically extreme emotions of his own childhood, he
became able to tolerate and contain the correspondingly extreme
feelings of his patient. No longer assimilating the circumstances
of the treatment to the trauma of his early family situation; he
120 CHAPTER 7

no longer felt a compelling need to rescue his patient from her

pain and despair. As he moved away from attempts to amelio­
rate her suffering and focused instead on conveying his under­
standing of what she felt; Sarah slowly began to relax in his
presence. The changing intersubjective field then made it pos-
sible for her to tell of a wishful fantasy concerning what she
most deeply yearned for from him; a fantasy that previously she
would have been far too frightened to disclose. It was that she
could be held protectively in her therapist’s arms and fall gradu­
ally into a peaceful sleep. This imagery concretized a needed
bond that was at this point crystallizing between them; a bond
of holding and containment within which the patient could
experience secure acceptance of her child-self and thus discover
the possibility of her own emotional wholeness.

DISCUSSION

We presented two brief clinical examples (the cases of Peter and

Robyn) in which; in the absence of reflective self-awareness on
the part of the therapist, patterns of intersubjective transaction
became established that resulted in 니nresolved therapeutic stale-
mates. In contrast, we offered two more extensive clinical re­
ports (the cases of Alice and Sarah) illustrating our thesis that
when the principles unconsciously organizing the experiences of
patient and therapist in an impasse can be investigated and
illuminated, significant new understandings and enhancements
of the therapeutic process can be achieved.
The cases of Robyn and Alice are similar in that; for both
patients; early unmet developmental needs for mirroring respon-
siveness took on a sexualized form when these needs were
revived but then rebuffed by the therapists. Robyn's therapist
remained unaware of the psychological configuration that led
him to reject his patient's longings, with the result that the
erotization of the transference became hopelessly entrenched.
Alice;s therapist, in contrast, became reflectively aware of his
unconscious organizing activity； in turn making it possible to
open up for investigation the more primary emotional constella­
tion underlying his patient's eroticized demands.
 VARIETIES OF THERAPEUTIC IMPASSE 121

The cases of Peter and Sarah are similar in that in both

instances an overlap between areas of the patient's and the
therapists defensive activity opposed the process of analytic
investigation. Unlike Peter;s therapist; however, Sarah's thera­
pist worked through the defensive disavowal of painf니 1 child­
hood feelings in his own analysis, enabling him to make em­
pathic contact with the traumatized child-self sequestered
within his patient.
In the cases of both Alice and Sarah, their therapists7 attain­
ment of reflective self-awareness permitted them to recognize
and comprehend the intersubjective disjunctions and conj니nc-
tions that had produced the therapeutic impasses. There was;
however; an important difference in the manner in which the
impasses were resolved in these two instances. Alice's therapist
disclosed to his patient aspects of his own psychological world
that had contributed to the impasse. This disclosure proved
highly facilitative because； by revealing himself to be torn be­
tween his wish to be responsive and his wish to uphold his
ideals, he distinguished himself from the dreaded father, who
had recoiled from Alice because she was female. In contrast；
Sarah's therapist wisely refrained from revealing to her what he
had discovered about the disavowals of his own childhood pain
that had interfered with his capacity to comprehend her child-
self, for she doubtlessly would have experienced such a disclo­
sure as a replication of her parents7 expectation that she disre­
gard her own distress and devote herself to nurturing them.
What the therapist may or may not reveal about his own
contribution to an impasse should be guided by his under­
standing of the specific transference meanings such disclosures
are likely to acquire for the patient.
We (Stolorow et al.; 1987) have argued that the analytic
stance is best conceptualized as an attitude of sustained empathic
inquiry. What we are emphasizing here is that inquiry must
include the therapists continual reflection on the involvement
of his own personal subjectivity in the ongoing therapeutic
process. Since the patienfs experience of the therapeutic rela­
tionship is codetermined by the organizing activities of both
participants in the therapeutic dialog니e; the domain of analytic
investigation must encompass the entire intersubjective field
122 CHAPTER 7

created by the interplay between the subjective worlds of patient

and therapist. As we have seen; an investigation conducted in
this manner can transform a therapeutic stalemate into a royal
road to new analytic understandings for both patient and thera-
pist.
 Epilogue

he doctrine of the isolated mind in psychoanalysis has

T historically been associated with an objectivist epistemol­

ogy. Such a position envisions the mind in isolation, radically
estranged from an external reality that it either accurately appre­
hends or distorts. Analysts embracing an objectivist episte­
mology presume to have privileged access to the essence of the
patient's psychic reality and to the objective truths that the
patients psychic reality obsc니res. In contrast, the intersubjective
viewpoint； emphasizing the constitutive interplay between
worlds of experience, leads inevitably to an epistemological
stance that is best characterized as 化perspectivalist;; (Rorty;
1989; Orange; 1992). Such a stance does not presume either that
the analyst's subjective reality is more true than the patient;s; or
that the analyst can directly know the subjective reality of the
patient. In contrast with a radically relativist position, which
denies the existence of a psychic reality that can be known, a
perspectivalist stance assumes the existence of the patienfs psy­
chic reality but claims only to be able to approximate this reality
from within the particularized scope of the analyst’s own per­
spective (cf. Hoffman, 1991).
We wish to emphasize that we are not enjoining analysts to
refrain from using guiding theoretical ideas to order clinical data.

123
 브+

124 EPILOGUE

Instead, we are claiming that analysts should recognize the

impact of their guiding frameworks in both delimiting their
grasp of their patients7 subjective worlds and in codetermining
the course of the analytic process; an impact that must itself
become a subject of analytic investigation.
We are led inexorably to a consideration of the limits of
self-reflection. How can an analyst be expected to reflect on the
nature and impact of his own organizing principles； including
especially those enshrined in his theoretical perspective, when
his acts of self-reflection will be shaped by the very principles
whose nat니re and impact he seeks to comprehend? Analysts are
in the position of the mythical snake devouring itself by swal-
lowing its own tail unless they are able to reflect from a position
that encompasses principles of organization alternative to the
ones being reflected upon. It would be difficult for us; for exam-
ple; to reflect fully on the particularizing impact of our principle
of intersubjectivity; insofar as this is the central constituent of
our analytic perspective. It must be left to others to integrate our
contributions within a still more general and inclusive view­
point.
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、아 •
 Index

Abandonment； fear of; 69； 71 verbal articulation of; 45

Abraham, K.; 89, 105, 125 Affective reactions； violent； 97
Absences, vulnerability to; 66 Affective states, central, 31
Abstinence, 107 Affectivity, dynamic unconscious and； 31
Abuse, neuroses and; 56 Agency, experience of; 15
Action language, 14 Aggressive drive, 16
Affect, 16, 26 Akhtar; S.; 56, 129
experience of; mind-body relationship Alexithymia； 43
and, 42-43 Alienated aloneness; 10
painful, 54-55 Alienation; 7-8
Affect attunement from nature, 8-9
caregiver's, 46 from social life; 9—11
failure of, 26, 46; 52 from subjectivity； 11-12
mutual, 26 Aliveness； 94
Affect integration, 13 Aloneness
Affect-regulatory process； loss of; 26 alienated, 10
Affect state, 16 ontological, 9-10
disruptive, 64 psychological, 9
infant;s; caregivefs response to; 46 Amnesia; 74; 77
traumatic； intolerability of; 52-53 Analysand； See Patient
Affective development, 3 Analyst, therapist
arrests in; 43 archaic bond with, 72
Affective experience, 52 disparity with patient； 105
articulation of; developmental identification with, 90
derailments in; 34-35 impact of; 93
attuned responsiveness of caregiver and; interpretive approach, patienfs
31 identification with； 88
early; 46 oedipal wishes toward； 101
regulation of, 31 ) organizing principles, 124

135
136 INDEX

archaic, 112 Baling W., 53; 125

patient's remaining tie with； 14 Barrett, W, 8, 125
personal reality； 93 Basch; M.7 18; 26; 125
real and tangible, 69 isolated mind and； 18—20
relationship with patient； 88; See also Becker, E., 9, 125
Therapeutic alliance Beebe; B.; 3y 18; 23; 126
romantic feelings toward； 113 Being, bodily and mental forms of; 8
self-esteem, 112 Bergman, A.; 46; 130
self-reflections, 100； 124 Bibring, E砂 88; 126
self-understanding, 117; 118 Biological existence, conditions and
sense of self, 93 cycles of; 8
separation from, 73; 75-76 Biology； unification with psychology, 18
as source of romantic interest, 110; 111 Body, See also Mind-body relationship
subjective world of; 103-104 disidentification with, 47; 49
traditional analysis and; 17 division from head； 47
transforming selfobject bond with； 49 Borderline personality, childhood abuse
union with, 82 and； 56
Analytic bond, disruptions in; 57-58; 93 Borderline states； 3
Analytic dialogue, patienfs experience of; Boundaries； defining of; 112
96 Brain, 19
Analytic ideals； 113 self-esteem and; 20
Analytic stance, 121 Brandchaft, B.; 3; 13, 14; 17; 23, 24; 28;
Anguish； experience of; 10 30; 32n? 35, 52; 53; 54; 55; 57,
Anxiety, signal, 51 62n, 79, 81, 87; 91, 93; 95, 121,
Apathy; 94 126, 132
Archaic defense mechanisms, Breast； attachment of self to; 89
unconscious; interpretation of; 90 Breuer, J.; 51; 126
Archaic organizing principle； therapist's, Bromberg； P.; 58; 126
112
Archaic selfobject transference, 82 Caregiver, See also Child-caregiver system；
Archaic transference bond, 70; 72 Infant-caregiver relationship;
Arlow7 ].} 63; 125 Mother； Father； Parent
Attunement affect attunement, 46
failures of; 106 attuned responsiveness of; affective
sensorimotor, 33 experience and, 31
validating, 28; 55 early affects and, 42
Atwood； G.; 1； 2; 3; 13; 14; 17, 23; 24, response to infanfs affect states, 46
27, 29, 30; 32n; 35; 44, 47, 52, 53, subjective reality； substitution of; 55
54, 55; 57; 79, 81, 91, 92, 93, 95, subjective world, 30
104, 106, 121, 125, 132 Caretaking, 119
Autonomous ego; 12 Central affective states； defensive
Autonomous mind; 13 sequestering of; 31
isolated, 14 Child, See also Infant
Autonomous self-regulation, 13 experience, articulation of; 32
Autonomy, 10 self-esteem； 13
idealization of; 13-14 sexual seductions, 101
Kohut's view, 13 subjective states； identification with, 28
relinquishing of; 107 subjective world； 30
Child-caregiver system
Bacal, H.; 18; 125 affective experience and, 52
Badness； sense of; 70; 80 of mutual regulation, 23
 INDEX 137

personality development and; 24 archaic, 90

Child-self, 119; 121 primitive, 91
acceptance of; 120 Defensive activity
analyst’s experience of; 119 therapeutic impasse and; 121
disavowed, 118 transference experience and; 98; 98n
Competence Defensive operations, affect-dissociating,
quest for, 19-20 31
self-regulatory; 23 Defensiveness, 97
systems, 23 Delusion formation； 95
Compliance, cure by; 92 Demos, E.V.; 26, 126
Compute!} brain as; 20 Depersonalization； 47; 74; 75
Concrete sensorimotor images of fantasy, Depression； chronic, 79
61 Depressive states； 64
Concretization Desire, relatedness and; 21
of experience, 43-46 Determinism； intrapsychic; 52
function of, 44 Development^ See also Psychological
Conflicts； Su also specific type of conflict development
drive-related, 89 affective, 3; 43
formation； 3 isolated mind and; 12
Conjunction Developmental failure
intersubjective; See Intersubjective organization of experience and, 24
conjunction traumatogenic； 57-58
therapeutic impasse and, 104 Developmental system, intersubjective
Conscious, 61 transaction within, 24
unconscious and; 32 化Developmental tilt/; 12

Conscious experience Devitalization, experience of; 94

articulation of; 31 Dialogue, analytic, 96
organization of; 96 Differentiation, See Self-differentiation
Consciousness Disappointment, 93; 97
development of; 32; 33 experiences of; 27
ontogeny of; 31 Disembodiment； 46-48; 50
Constancy； See also Self-constancy Disjunction, See also Intersubjective
mythical image of the mind and; 10 disjunction
Containment, 120 therapeutic impasse and; 104
Control, relinquishing of; 107 Disruptions
Conversion symptoms analysis of, 57
concretization of experience and, 45 experiences of; 94
mind-body relationship and; 48—49 Distinctness
Correspondence, intersubjective, 104 assertion of; 70-71
Countertransference, 89； See also psychological, 10
Transference-countertransference Distortion, 92; 100
interplay with transference, 2 concept of; 93
Creativity, 89 Distrust, 97
Cultural experience, symbol of; isolated 이Doomsday orientation/7； 55

으 mind and; 7-8 Dreams, 31

Cumulative trauma, 54 forms of unconscious and; 36—40
therapeutic impasse and, 116
Daydreams, 61； See also Fantasy Drive, 26
repression of; 63 dynamic unconscious and; 31
Death, 9; See also Mortality Drive pressures, innate； 12
Defense mechanisms, 51 Drive-related conflicts, 89
138 INDEX

Drive theory; 16 concretization of, mind-body

Dynamic unconscious； 29; 30—31, 33; 35; relationship and; 43-46
39-40 conscious； 31; 96
affective experience and； 43 contents of
affectivity in; 31 imagistlc; 2
analysis of resistance and; 34 subjective world and； 2
case illustration； 38 creating of; 15-16
drives in, 31 cultural, 7-8
interaffectivity and; 30-31 depth psychology of; 2
origin of; 32 emotional, 13
repression and； 30 inner, 95
introject and; 81
lived, 26
Ego mind-body relationship and； 46
autonomous, 12 organization of; 12; 24
functioning of; M. Klein's view; 90 bodily events in; 41
real object perception and, 89 determination of; 24-25
relationship with objects； 90 fragmentation of; 17
Ego development； Hartmann's view; personal, 22-28
12-13 prereflective structures of; 30; 35
Ego psychology； 12; 88; 90 self-delineating, 95
autonomous mind and; 17 subjective； 14; 89; 92; 96
therapeutic alliance and; 88—89； thematic structuring of； 2
101-102 External object； 19
Embodiment； 46-48; 50 External world； image of the mind and；
subjective experience of; 46 12
Emde; R.; 23? 24; 26, 126
Emotional experience, 13 Fairbairn, W, 21, 62, 127
fantasy and; 61 Fantasy(ies); 14; 51; 61
Emotional pain; trauma and; 55 archaic grandiose-exhibitionistic, 61-62
Empathic inquiry, 94 arising from experience of invalidation,
conscious experience and; 96 61-62
stance of; therapeutic alliance and; 97 childhood abuse and; 56
sustained, 33; 93—94; 95-96, 121 concrete sensorimotor images of; 61
therapeutic alliance and; 102 formation； 61-64; 79-83
Empathy, 92 case illustration, 64-69
misunderstanding and； 105 course of treatment and
parental； 95 working-through process； 69-74
validating, 63 intr이ect; 61; 64
Emptiness； states of; 64 primitive, 15
Enactments, 3 repression of; 63
Envy sexual, 101; 110
pathological destructive； 91 unconscious; 63-64
unconscious； 106 Father, 19
Epistemological stance, 98n; 99n Fenichel, O.; 27} 88; 127
Erotic experience, early function of; 45 Ferenczi; S.; 27, 56; 127
Erotization, of the transference； 120 Field theory, 1; See also Intersubjectivity
Existential agent, 17 theory
Experience^] 123; See also Self-experience Fittedness; specificity of； 23
affective； 31; 52 Frame of reference, subjective, analyst's,
articulation of; 32; 33 100
 INDEX 139

Freud, S, 18, 27, 29, 32, 33, 45, 51, 61, Innate drive pressures, 12
81, 87, 105, 126, 127 Inner experience, reality of, sense of
doctrine of isolated mind； 12; 14 uncertainty about, 95
drive theory； 16 Inner states； infant's, 23
Frustration, 93 Insecurity； feelings of; 66
experiences of, 27 Interaffectivity, dynamic unconscious
optimal, 13; 52; 57 and, 30-31
Internal objects, good, 62
Internalization, 13
Gambits, engaging in; 22 transmuting, 13; 57
Goldberg, A.; 44; 127 Interpersonal psychoanalysis
Good objects MitchelFs view, 21-22
internal, 62 Sullivan's view, 20-21
posession of, fantasy of, 63 Interpretive approach, analyst/s; patienfs
Good part-object, 89 identification with; 88
Greenacre; P.; 54; 127 Intersubjective, term of; 2
Greenson, R.; 87, 88; 128 Intersubjective conjunction, 103; 104
Growth, 89 repetitive occurrences of; 103
Guilt, 70 Intersubjective context, facilitative, 42
unconscious sense of; 105 Intersubjective correspondence,
therapeutic impasse and; 104
Hartmann, H.; 12y 128 Intersubjective disjunction, 103
Head； division from body, 47 clarification of; 113-114
Hoffer, W., 46, 54, 128 negative therapeutic reactions and,
Hoffman, I., 123； 128 105-107
Holding, 120 repetitive occurrences of; 103
Human beings, individuals relationship Intersubjective field, defined, 3-4
with, 9 Intersubjective perspective on
Humiliation； personal meanings of; 100 psychological development, 23
Hypochondriacal states； concretization of Intersubjective relatedness, 3y 15
experience in; 45 Intersubjective sharing, 26
Hysterical symptoms, 51 Intersubjective situations, function of
fantasy in; 61
Intersubjective system
Idealist doctrine, 49-50 fluid boundary within, 32
Identification subject's contribution to; 24
process of, 89 Intersubjective theory, 1-2, 123
projective, 22 clinical issues in; 3
Identity； personal, 10 development of; 3
Images, child's use of; 46 Intersubjective transaction, 3
Immortal essence； self as; 8-9 therapeutic impasse and, 120
Indwelling, 46 Intersubjectivity, 4; 18
psychosomatic； 47 Intrapsychic determinism, 52
Infant, affective states of, caregiver's Intrapsychic experience； delineation of；
response to, 46 94
Infant-caregiver dyad; regulation of Introject(s); 62; 64
affective experience within, 26 experience and; 81
Infant-caregiver relationship, negative； 62
internalization of; 14 positive, 62
Infant-caregiver system, breakdown of; Intr이ection, 81; 90
26 Introspection, 19； 92
140 INDEX

Invalidating other, psychic reality of; Mahler, M.; 46; 130

substitution of, 62-63 Masochism, primal； 105
Invalidation, 81 Material reality； 11
experience of; fantasy arising from, Materialism, 9
61-62 mind-body relationship and； 49
Isolated mind; 123 Materialist doctrine； 41
alienation and; 7—12; See also Alienation Matson, F.; 8; 130
doctrine of; remnants of； 14; 17-18 Maturational process, 42
MitchelPs view; 21-22 McDougall, ].j 43; 130
myth of; 7-28 Mechanism； 8
personal experience and; 22—28 Mental apparatus, mind as; 12
psychic trauma and； 52 Mental processes, unconscious, 33
variants of; 12-22 Metapsychological concepts； 14
Isolation, 10 Mijuscovic； B.; 9; 130
Miller, A.; 56, 130
Jacobson, E.; 13; 128 Mind
Jaffe, L, 18; 126 internal constancy of; 10
Jones, J.; 128 separateness of; 10; See also Isolated
Joseph, B., 91; 128 mind
Mind-body cohesion, disturbances in; 47
Kaplan, S砂 26; 126 Mind-body disintegration； 49
Kemberg, O.; 15, 16, 33, 98, 106; 128 Mind-body relationship, experience and,
Khan, M.; 54, 90, 128 41—42, 48-50
Klein, M.; 15, 62, 90, 91, 106, 101-102, and affect, 42-43
128 concretization of； 43-46
object relations theory, 15; 89—91 embodiment； unembodiment； and
Kohner; C.; 56n disembodiment,
Kohut, H., 2, 3; 13, 16, 17, 24, 44, 45, 46-48
46, 52; 54; 56, 57; 71; 93, 106, Mirroring, 95
129 responsive, 112
self-psychology theory, doctrine of Mirroring responsiveness； 107
isolated mind and, 16; 17 developmental needs for, unmet, 120
Kramer, S.; 56, 129 longing for. 111
Kris, E., 52; 129 Misattunement； 32
Krueger, D.; 46; 129 experiences of; 93
Krystal, H, 42; 43; 51; 52, 55, 129 Misinterpretations, 106
Kundera, M.; 22; 129 Misunderstanding, empathy and； 105
Mitchell, S, 17,21,48, 130
Lacan； ]., 45; 46, 129 interpersonal psychoanalysis view,
Lachmann, E; 3; 14; 18; 23; 44; 45; 47; 21-22
106, 126, 132 Modell, K., 55, 130
Laing； R.D.; 47; 129 Mortality, unalienated attitude toward,
Lee; R.; 3; 129 8-9
Levine, H.7 56; 129 Mother, 19
Libidinal drive, 16 Motivation(s)
Lichtenberg, J.; 23; 26, 130 lived experience and, 26
Lifton, R.; 47j 130 myth of isolated mind and； 19-20
Lived experience, motivations arising Mourning process； defense against, 81
from, 26 Mutative interpretation, therapeutic
Living system, 48 alliance and, 90
Lost object, feelings toward, 81 Mutual affect attunement, 26
 INDEX 141

Mutual influence Organizing principles, 2; 24-25; 29-30;

intersubjective reciprocity of; 3-4 33; 35, 38, 56, 63, 80; 83, 96-97,
reciprocal, 18 108; 120
Mutual regulation, 26 analyst’s, 103, 124
child-caregiver system of; 23 archaic, 112
patient-analyst's, stalemate in; 111
Namir; S.; 14n 〜 Ornstein, A.; 24; 56; 130
Narcissistic character resistances, 105 Other
Nature, alienation from； 8-9 invalidating, 62—63
Near-death experience, 47 self-regulating; 23
Needs, unmet, trauma and, 55 Other image, 16
Negative therapeutic reactions, 3 Ourselves, experience of; 10
therapeutic impasse and; 105-107 Out-of-body journeys, 47
Negative transference, 94
trauma and； 56 Painful affect, trauma and; 54-55
Negative transference resistances, 93 Paranoia, 76
Neurotic transference, 98 Parataxic distortion, Sullivarfs view;
New object, therapist as; 77 isolated mind and; 21
Newman, 18; 125 Parent, empathy, 95
Newtonian physics, 16 Parental figure, calming benign, 66
Nonbeing, sense of; 65 Part>object; good, 89
Nontransference, 88 Pathogenesis, 3
intersubjective perspective on; 23
Object Pathology, processes and mechanisms； 92
external, 19 Patient
good； 62-63 analyst’s views of, identification with,
relationship with ego; 90 89
Object image, 16 disparity with therapist； 105
Object relations, 14; 15; 88 relationship with analyst, 88; See also
therapeutic alliance and; 89-91 Therapeutic alliance
Object representations, development of; traditional analysis and; 17
23 Perception, validation of; 32n
Objective reality； 21; 91-92 Perceptual experience, articulation of;
attributions 0fl 92 developmental derailments in;
concept of; invoking of; 93 34-35
Objectivist epistemology; 123 Perceptual reality, 96
Observed; 2 maintaining of; inability in; psychosis
Observer, 2 and; 95
Oedipal conflict； 89 validity of, 94
Oedipal wishes； toward analyst, 101 Person, relationship with reality, 19
Ogden； Tv 22, 130 Personal agency, experience of, 15
Omnipotent agent； 22 Personal experience, ontogeny of; 22—26
Omnipotent control； 106 genesis of sense of the real, 26-28
Oneness, archaic longings for; erotization Personal identity, continuity of; 10
of, 72 Personal reality； 92
Ontological aloneness, 9-10 analyst's, 93
Optimal frustration, 13y 52, 57 Personal subjectivity, therapist's, 121
Orange； D.; 123; 130 Personality structures； development of;
Organization, principles of; 16, 24
developmental traumata and, 55 Perspectivalist stance, 123
Organizing activity, unconscious, 120 Pessimism, 55
142 INDEX

Physical abuse, 56 Real object, patient's perception of; 89

Physical body, identifications of self Reality
with, 9 material； 11
Physical nature, differentiation from, 8 objective, 21, 91-92, 93
Physical self, threats to; 47 perceptual, 94; 95; 96
Physicality, 9 personal, 92; 93
Pine; F.; 46; 130 psychic; 123
Planckian physics, 16 relationship with person, 19
Preconscious, 29 subjective, 55, 92, 93; 94; 95; 96
Prereflective unconscious； 24; 29-30; 33; Reality principle, 27
35; 63 Reality-testing； 105
case illustration, 38-39； 40 Reciprocal mutual influence； 18
defined, 29 intersubjective field as; 3-4
psychoanalysis and； 34 Reflection, 19
Primitive fantasy； 15 Reflective self-awareness
Projective identification, theory of; 22 absence of; 104; 120
Pseudoalliance; 101, 102 attainment of; 121
Psychic reality, existence of; 123 Relatedness
Psychic structure formation, interactional desire and; 21
basis of; 23—24 intersubjective, 3; 15
Psychic trauma, isolated-mind conception Representational world, 2
of, 52 Repressed； 32
Psychoanalysis Repression
action language for; 14 achievement of; 33
impasse in; See Therapeutic impasse dynamic unconscious and; 30
motivational construct for; 26 Repression barrier, 32
prereflective unconscious and; 34 Rescue, 119
Psychoanalytic inquiry, domain of; 1 Resistance； 3, 31; 87; 89； 93
Psychological aloneness； 9 analysis of; 49
Psychological development dynamic unconscious and, 34
intersubjective perspective on; 23 chronic and intractable； 89
reality and; 27 fluctuation of; 32
Psychological distinctness narcissistic character, 105
experience of; 10 trauma and； 56
isolated mind and； 10 working through of; 100
Psychology; unification with biology, 18 Responsive mirroring, 112
Psychosexual experience, self-body Responsiveness
relationship and； 44—45 feelings and longings for, 113
Psychosomatic indwelling, 47 mirroring, 107; 111, 120
Psychosomatic states Retraumatization
affective experience in; 45 fear of; 58
mind-body relationship and, 48-49 protection against； 31
analytic approach to; 49 Rivalry, expression of; 89
predisposition to; 32n Riviere, L； 106, 130
Psychotic states； 3 Rogawski； A.; 26; 130
perceptual reality maintenance and; Romantic feelings； toward therapist, 110;
95 113
Punishment； need for; 105 Rorty, R.; 123, 130
Rosenfeld； H.; 91, 130
Rank, O., 9, 130 Ross, ].j 2, 3, 132
Real; sense of; genesis of, 26-27 Rubinstein； B., 33, 130
 INDEX 143

Sander, L.; 23, 26; 48; 131 reinstatement of; 81-82

Scenarios, old； enacting of; 22 Self-esteem, 10
Schafer, R.; 14—15; 22, 131 child;s; 13
Schwaber, E.; 92, 95y 131 competence and, 20
Seduction myth of isolated mind and; 19-20
personal meanings of; 100 therapist's, 112
in transference, 99 Self-experience, 15; 17
Self, See also Child-self in intersubjective field； 10
affective core of; 26 organization of; 3; 16; 17
boundaries of; existence of objects self-esteem and, 13
outside of; 19 trajectory of, 17-18
concept of; reification of; 18 Self4mage, 16
development of; fantasy and； 61-62 Self-integrity, 38
disconnection from, 74 Self-object-affect units, 16
fragments of; restoration of; 17 Self-other confusion, 70
identification with physical body; 9 Self-programming computer； brains as;
as immortal essence, 8-9 20
as independent existential entity； 17 Self psychology, 14
isolated mind and, 17 doctrine of isolated mind and； 16;
mind-body cohesion and; 47 17-18
as real, 26-28 Self-reflection, 94; 96
sense of analyst's, 100
analyst's, 93 limits of; 124
development of; 44 Self regulating others, child7s interaction
failing, 45 with, 23
world separate from, 11 Self-regulation; autonomous； 13
Self-assertion； 70; 71 Self-regulatory competence； development
Self-attack, 70 of, 23
Self-awareness Self representations, development of; 23
psychological distinctness and； 10 Self-selfobject relationship, 3y 4
reflective, 120; 121 concept of; reification of, 18
therapist’s, 104 Self-structure formation, 13
Self-care, 64 Self'Subjugation; 80
Self-cohesion, 46 Self-sufficiency, 10
Self-constancy Self-system, Basch;s view, 20
experiences of; 10 Self-understanding； therapist's； 117
isolated mind and; 10 therapeutic impasse and, 118
Self-definition, 76 Self-validation, 63
Self-delineating experience, 95 Selfhood
Self-delineating selfobject function, 27; 49 differentiated, 70
Self-delineating selfobject transference, 35 development of; 79
Self-delineation, 70 protector of, therapist as; 83
transference and; 82 Selfobject
Self-demarcation； 70; 71 concept of; reification of, 18
Self-destructiveness, 72 organization of experience and； 24
Self-differentiation secondary, trauma and, 53-54
achievement of, 79 •self relationship, 3; 4
attempt at; 92-93 Selfobject bond； transforming, with
conflicts over, 70 analyst, 49
developmental process of； derailment Selfobject failure, trauma and； phases of;
of, 79-80 53—54
144 INDEX

Selfobject function, self-delineating； 27; Subjective reality, 92; 94

49 belief in, sustaining of; 95
Selfobject need; trauma and; 53 caregivers； 55
Selfobject transference investigation of; 93
archaic, 82 therape니tic experience of; 96
self-de!ineating; 35 Subjective states
Sensorimotor attunement, 33 child's, 28
Sexual abuse; 56 metapsychology and； 14
mind-body cohesion and; 47 Subjective world； 2
Sexual attractiveness, mirroring of; 112 chiktcaregiver; 30
Sexual contact； 47 development of; 44
Sexual enactments； concretization of grasping of, 124
experience and; 44-45 intersubjective field and； 4
Sexual fantasies； 101 therapist's, organizing principles of;
repressed, 98 103-104
toward therapist； 110 Subjectivity
Sexual feelings alienation from, 11-12
defenses against, 101 nullification of; 9
in transference, 99 personal, 121
Sexual seductions, childhood, 101 structures of; 2
Shabad, P, 55, 131 theory of; 2; See also Intersubjectivity
Shane; E.; 54; 131 theory
Shane; M.; 54; 131 Subrnission; 79
Sharing； intersubjective; 26 SuiciJality； 63, 64; 65; 70; 73-74; 83
Signal anxiety, 51 ffcU of; 71
Silent traumas, 54 Sullivan； H. S.; 20; 133
Slap, J.; 63; 131 Superego, 30
Socarides； C砂 44; 131 formation, 13
Socarides, D.D., xi; 13; 26; 31, 43; 53; Sustained empathic inquiry, 33, 93-94;
55, 131 121
Social life, alienation from； 9—11 stance of; 95-96
Spatial metaphors, 14 Symbol(s) 32-33
Specificity of fittedness, 23 child;s use of; 46
Sterba, R.; 88; 131 Symbolic thought； attainment of; 3
Stern; D.; 3; 23; 26; 27; 28； 30, 32; 131 Systems competence, 23
Stolorow, D.S.; xi; 52, 61, 132 Systems theory, 1; See also
Stolorow, R.; xi, 1, 2, 3, 13, 14; 17y 23, Intersubjectivity theory
24, 26, 27, 29; 30, 31; 32n, 35, 43,
44, 47, 52, 53, 54; 55; 57, 79, 81;
91, 92, 93; 95, 104, 106; 121, 125, Technocracy, culture of; 8
126, 131, 132 Tenderness, 47
Stone, L.; 88, 132 Therapeutic action, 3
Strachey, L； 90, 133 Therapeutic alliance, 3
Structuring activity； unconscious, 96 case illustration, 97—100
Subject； oneself as; 3 dangers posed by; 97
Subjective experience, 89 ego psychology and； 88—89
configurations of; 92 establishing of; 94-95
nonsubstantial； 14 foundation of； 93; 94; 96
transformation of; 96 object relations theory and, 89-91
Subjective frame of reference, analyst’s, varieties of; 87-102
100 Therapeutic bond, 75; 87; See also
Subjective life, properties of; 11 Therapeutic alliance
 INDEX 145

Therapeutic impasse, varieties of; Unattunement, 32

103-104, 120-122 Unconscious
case illustrations, 104—105, 108-120 conscious and； 32
negative therapeutic reactions, 105-107 dynamic. See Dynamic unconscious
Therapeutic reactions； negative, 3； experience-near conceptualization of； 33
105-107 prereflective. See Prereflective
Therapist, See Analyst； therapist unconsciousrealms of; 29—36
Thought, symbolic, 3 clinical illustration, 36-40
Tolerance, 13 interrelationships between, 35
Traditional analysis, self psychology and; unvalidated, 33; 34; 35; 39; 43
16 Unconscious envy; 106
Transference Unconscious fantasy, 63-64
erotization of; 120 Unconscious mental processes; 33
expectations in; 49, 82 Unconscious organizing activity； 120
fears in, 13, 49, 82 Unconscious structuring activity； 96
negative, 56y 94 Unconsciousness； interrelated forms of;
neurotic； 98 development of;; 31-32
nontransference; 88 Unembodiment; 46-48； 50
repetitive dimension of; 24y 83 Unvalidated unconscious, 33; 35
resolution or dissolution of; 13-14 affective experience and; 43
self-differentiating process in, 80; 81-82 case illustration, 39
selfobject dimension of, 24 psychoanalysis and; 34-35
archaic; 82
self-delineating, 35 Vacation, therape나tic impasse and;
sexual feelings in, 99 115-118
therapeutic alliance and, 89-90 Validating attunement； 28
traumatogenic developmental failure in; absence of; 55
57-58 Validating empathy, 63
Transference bond, archaic, 70 Validation, 28; See also Self-validation
Transference-countertransference, 2; 94 absence of; 68
Transference feelings, residual, 14 preverbal forms of; 27
Transference relationship, developmental Verbal responsiveness, affective
derailment and; 81-82 experience and; 42
Transference repetition, expectations and Violent affective reactions, 97
fears of; 82 Vitality; experience of; 94
Transference resistance, negative, 93 Vulnerability, disavowals of; 10; 11
Transformation； process of; 96
Transforming selfobject bond; with
analyst; 49 Waelder, R, 87, 133
Transmuting internalization, 13; 57 Wallace, E.; 25, 41; 133
Trauma Winnicott, D.W., 46, 47; 54, 56, 57, 58,
childhood, repetition of; 97; 106-107 133
cumulative； 54 Wolf, E, 3, 133
developmental； 26 Working through； 97
reexperiencing of; 55-56; 57—59 fantasy formation and, 69—79
FreucTs view; 51 World
past； 64 external, 12
psychic； 52 as real, 11; 26-28
relational context of; development of; representational； 2
53-59 subjective, 2, 4; 30; 44; 124
silent, 54
Trop; J.; 103 | Zetzel; E.; 88; 133
 Contexts o
The Intersubieci
Foundations of Psycnological Life
수Among the lines of theorizing developing from post-Kohut self psychology,
Stolorow and Atwood continue to thoughtfully and provocatively expand Ko-
hut;s contributions into a rich, more fully interactional perspective?7
Stephen A. Mitchell, Ph.D.
Editor, Psychoanalytic Dialogues

어In Contexts of Being Stolorow and Atwood explore the organizing and experi­
encing of psychological life through the lens of intersubjectivity； a lens which； in
the hands of the authors, can be widened to the whole of psychology and
narrowed to the details and meanings of the clinical exchange.개
Joseph D. Lichtenberg, M.D.
Editor-in-Chief, Psychoanalytic Inquiry

化Stolorow and Atwood are a brilliant voice in a powerful paradigm shift in

psychoanalysis toward a dyadic systems perspective?7
Beatrice Beebe, Ph.D.
NYU Postdoctoral Program in Psychoanalysis

서This book will light new therapeutic pathways for psychoanalysts and
psychotherapists, regar시ess of their theoretical persuasions?7
Howard A. Bacal, M.D.
Toronto Institute of Psychoanalysis

우Stolorow and Atwood carve out new territory for psychoanalytic theory 母
Contexts of Being》as they continue their ground-breaking work to establish
domain of intersubjectivity. Contexts of Being is a landmark in Stolorow 가서
Atwood's voyage of exploration. It is『must reading" for theoreticians, exj^fe
enced analytic therapists^ and students alike.개 g 흘
David E. Scharff, M.D.
Director, Washington School of Psychiatry
•g
패**

化Although grounded in self psychology； the authors have made a bold 骨

to critique and step beyond their own theoretical foundations. The
provocative and challenging contribution to psychoanalytic theory?7
Irwin Z. Hoffman, Ph.D.
Northwestern University Medical School

ISBN 0-88163-388-7 The Analytic Press, Inc.

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Hillsdale, NJ 07642
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