Contemporary Controversies in Psychoanalytic Theory, Techniques, and Their Applications

By Otto F. Kernberg

Yale University Press

Copyright © 2004 Otto F. Kernberg
All right reserved.
ISBN: 978-0-300-10139-3

Contents

PREFACE..........................................................................................................................viiiPART ONE: THEORY AND APPLICATIONS................................................................................................1CHAPTER 1 Freud's Theories and Their Contemporary Variations....................................................................3CHAPTER 2 Psychoanalytic Object Relations Theories..............................................................................26CHAPTER 3 The Concept of Drive in the Light of Contemporary Psychoanalytic Theorizing...........................................48CHAPTER 4 Unresolved Issues in the Psychoanalytic Theory of Homosexuality and Bisexuality.......................................60CHAPTER 5 Mourning and Melancholia Revisited....................................................................................75CHAPTER 6 Resistances to Research in Psychoanalysis.............................................................................86CHAPTER 7 Authoritarianism, Culture, and Personality in Psychoanalytic Education................................................94CHAPTER 8 A Concerned Critique of Psychoanalytic Education......................................................................104CHAPTER 9 Some Proposed Complementary Solutions to the Problems of Psychoanalytic Education.....................................132CHAPTER 10 Sanctioned Social Violence: A Psychoanalytic View....................................................................142CHAPTER 11 Some Psychoanalytic Contributions to the Prevention of Socially Sanctioned Violence..................................170PART TWO: TECHNIQUE..............................................................................................................191CHAPTER 12 Listening in Psychoanalysis: The Importance of Not Understanding.....................................................193CHAPTER 13 The Analyst's Authority in the Psychoanalytic Situation..............................................................206CHAPTER 14 Validation in the Clinical Process...................................................................................221CHAPTER 15 The Interpretation of the Transference (with Particular Reference to Merton Gill's Contribution).....................232CHAPTER 16 The Influence of the Gender of Patient and Analyst on the Psychoanalytic Relationship................................246CHAPTER 17 Convergences and Divergences in Contemporary Psychoanalytic Technique................................................267CHAPTER 18 Recent Developments in the Technical Approaches of English-Language Psychoanalytic Schools...........................285REFERENCES.......................................................................................................................305INDEX............................................................................................................................325

Chapter One

freud's theories and their contemporary variations

Psychoanalysis is (1) a personality theory and, more generally, a theory of psychological functioning that focuses particularly on unconscious mental processes; (2) a method for the investigation of an individual's psychological functioning based on the exploration of his or her free associations within a special therapeutic setting; (3) a method for the treatment of a broad spectrum of psychopathological conditions, including the symptomatic neuroses (anxiety states, characterological depression, obsessive compulsive disorder, conversion hysteria, and dissociative hysterical pathology), sexual inhibitions and perversions ("paraphilias"), and the personality disorders. Psychoanalysis has also been applied, mostly in modified versions-that is, in psychoanalytic psychotherapies-to the treatment of severe personality disorders, psychosomatic conditions, and certain psychotic conditions, particularly chronic schizophrenic illness.

All three aspects of psychoanalysis were originally developed by Sigmund Freud (1916-17, 1938a; Breuer and Freud, 1895), whose theories of the dynamic unconscious, personality development, personality structure, psychopathology, the methodology of psychoanalytic investigation, and methods of treatment still influence the field heavily, both in the sense that many of his ideas continue to be the basis of psychoanalytic thinking and in the sense that subsequent divergences, controversies, and innovations can be better understood in the light of his contributions. Freud's concepts of dream analysis, mechanisms of defense, and transference have become central aspects of many contemporary psychotherapeutic procedures.

Freud's ideas about personality development and psychopathology, the method of psychoanalytic investigation, and the analytic approach to treatment gradually changed in the course of his dramatically creative life span. Moreover, his theory of the structure of the mind, which he assumed underlay the events he observed clinically, changed in major respects, so that an overall summary of his views can hardly be undertaken without tracing the history of his thinking.

FREUD'S THEORY OF THE MENTAL APPARATUS: MOTIVATION, STRUCTURE, AND FUNCTIONING

Unconscious Mental Processes: The Topographic Theory; Defense Mechanisms

Freud's starting point was his study of hysterical patients (1905a), which led him to the discovery that their conversion symptoms, dissociative phenomena, and pathological affective dispositions all could be traced to traumatic experiences in their past that had become unconscious. That is, these traumatic experiences continued to influence the patients' functioning despite an active defensive mechanism of "repression" which excluded them from conscious awareness. In the course of a few years Freud abandoned his early efforts to recover repressed material by means of hypnosis, instead adopting the technique of "free association," which remains an essential aspect of psychoanalytic technique today. Freud instructed his patients to eliminate all prepared agendas and try to express whatever came to mind, with as little censorship over this material as possible. He provided them with a non-judgmental and stable setting in which to carry out their task, inviting them to recline on a couch while he sat behind it. The sessions lasted for an hour and were conducted five to six times a week. The method of free association led to the gradual recovery of repressed memories of traumatic events. Originally, Freud thought that the recovery of such events into consciousness would permit their abreaction and elaboration and thus resolve the patients' symptoms.

Practicing this method led Freud to several lines of discovery. To begin, he conceptualized several unconscious mechanisms of defense that opposed the recovery of memories by free association-namely, repression, negation, isolation, projection, introjection, transformation into the opposite, rationalization, intellectualization, and, most important, reaction formation. Reaction formation involves overt, chronic patterns of thought and behavior that serve to disguise and disavow opposite tendencies linked to unconscious traumatic events and the intrapsychic conflicts derived from them. The discovery of reaction formations led Freud to the psychoanalytic study of character pathology and normal character formation, which still constitute important aspects of the psychoanalytic understanding and treatment of personality disorders. (For practical purposes, character pathology and personality disorders are synonymous concepts.)

A related line of development in Freud's theories was the discovery of the differential characteristics of conscious and unconscious thinking. Conscious thinking, the "secondary process," was invested by "attention cathexis" and dominated by sensory perception and ordinary logic in relating to the psychosocial environment: the "primary process" of the "dynamic unconscious" exerted constant pressure on conscious processes, against the active barrier constituted by the various defensive operations, particularly repression. The dynamic unconscious, Freud proposed, presented a general mobility of affective investments and was ruled by the "pleasure principle," in contrast to the "reality principle" of consciousness. It was characterized by the absence of the principle of contradiction and that of ordinary logical thinking, the absence of negation and of the ordinary sense of time and space, the treatment of a part as if it were equivalent to the whole, and a general tendency toward condensation of thoughts and the displacement of affective investments from one mental content to another.

Finally, Freud proposed a "preconscious," an intermediate zone between the dynamic unconscious and consciousness, representing the storehouse of retrievable memories and knowledge and of affective investments in general. The preconscious was the seat of daydreaming, in which the reality principle that ruled consciousness was loosened and derivatives of the dynamic unconscious might emerge. Free association, in fact, primarily tapped the preconscious as well as the layer of unconscious defensive operations opposing the emergence of material from the dynamic unconscious.

This model of the mind as a "place" with unconscious, preconscious, and conscious regions constituted the "topographic theory" (Freud, 1916-17). Freud (1923) eventually replaced it with the "structural theory," the concept of three interacting psychic structures, the ego, the superego, and the id. This tripartite model still dominates psychoanalytic thinking. A major determinant of the shift from the topographic to the structural model was Freud's recognition that the regions of conscious, preconscious, and unconscious were fluid and that the defense mechanisms directed against the emergence into consciousness of the dynamic unconscious were themselves unconscious. Another consideration was Freud's discovery (1923) of a specialized unconscious system of infantile morality, the superego. What follows is a summary of the characteristics and contents of these structures, an analysis that will lead us directly into contemporary psychoanalytic formulations.

The Structural Theory, the Dual-Drive Theory, and the Oedipus Complex The Id: Infantile Sexuality and the Oedipus Complex

The id is the mental structure that contains the mental representatives of the "drives"-that is, the ultimate intrapsychic motivations that Freud (1920a) described in his final "dual-drive theory" of libido and aggression, or metaphorically, the sexual or life drive and the destruction or death drive. Behind this categorical formulation lies a complex set of discoveries. In exploring patients' unconscious mental processes, Freud found that what at first appeared to be specific traumatic life experiences in fact reflected surprisingly consistent, repetitive intrapsychic experiences of a sexual and aggressive nature.

Freud (1905b) was particularly impressed by the regularity with which his patients reported the emergence of childhood memories reflecting seductive and traumatic sexual experiences, on the one hand, and intense sexual desires and related guilt feelings, on the other. He discovered a continuity from the earliest wishes to be taken care of (the psychology, as he saw it, of the baby at the mother's breast) during what he described as the "oral phase" of development, to the pleasure derived from exercising control and developing autonomy (the psychology of toilet training) in the "anal phase" of development, and, particularly, to the sexual desire toward the parent of the opposite gender and the ambivalent rivalry with the other parent for the desired parent's exclusive love, a state that he described as characteristic of the "infantile genital stage," from the third or fourth to the sixth year of life. He called its characteristic constellation of wishes and conflicts the positive Oedipus complex as differentiated from the negative Oedipus complex-that is, love for the parent of the same gender and the corresponding ambivalent rivalry with the other parent. Freud proposed that oedipal wishes came to dominate the infantile hierarchy of oral and anal wishes, becoming the fundamental unconscious realm of desire.

Powerful fears motivated the repression of awareness of infantile desire: fear of loss of the object, and later of loss of the object's love, was the basic fear of the oral phase, directed against libidinal wishes to possess the breast; fear of destructive control and annihilation of the self or the object was the dominant fear of the anal phase, directed against libidinal wishes of anal expulsion and retentiveness; and fear of castration, "castration anxiety," was the dominant fear of the oedipal phase of development, directed against libidinal desire for the oedipal object. Unconscious guilt was a dominant later fear, originating in the superego and generally directed against drive gratification. Unconscious guilt over sexual impulses unconsciously equated with oedipal desires constituted a major source of many types of pathology, such as sexual inhibition and related character pathology. Prototypical intrapsychic infantile experiences linked to the Oedipus complex were fantasies and perceptions around the sexual intimacy of the parents (the "primal scene"), and unconscious fantasies derived from experiences with primary caregivers ("primal seduction"). The oedipal stage, developing gradually during the second through the fourth years and culminating in the fourth and the fifth years of life, is followed by more general repressive processes under the dominance of the installation of the superego, leading to a "latency phase" roughly corresponding to the school years and finally to a transitory reactivation of all unconscious childhood conflicts under the dominance of oedipal issues during puberty and early adolescence.

In all these phases of infantile development of drive motivated wishes and fears, powerful aggressive strivings accompanied the libidinal ones, such as cannibalistic impulses during the oral phase of physical dependency on the breast and psychological dependency on mother, sadistic fantasies linked to the anal phase, and parricidal wishes and fantasies in the oedipal stage of development.

The Id: Drives

The drives represent for human behavior what the instincts constitute for the animal kingdom-that is, the ultimate biological motivational system. The drives are constant, highly individualized, developmentally shaped motivational systems. Under the dominance of the drives and guided by the primary process, the id exerts an ongoing pressure toward gratification, operating in accordance with the pleasure principle.

Freud initially equated the drives with primitive affects. He described the libido or the sexual drive as having an "origin" in the erotogenic nature of the leading oral, anal, and genital bodily zones; an "impulse" expressing the quantitative intensity of the drive by the intensity of the corresponding affects; an "aim" reflected in the particular act of concrete gratification of the drive; and an "object" consisting of displacements from the dominant parental objects of desire.

After discarding various other models of unconscious motivation, Freud ended up with the dual-drive theory of libido and aggression. The idea of an aggressive or "death" drive (Freud, 1920a) stemmed from his observations of the profound self-destructive urges particularly manifest in the psychopathology of major depression and suicide and of the "repetition compulsion" of impulse-driven behavior that frequently seemed to run counter to the pleasure principle that supposedly governed unconscious drives. Freud never spelled out the origins of the aggressive drive in detail, an issue taken up later by Klein (1952), Fairbairn (1954),Winnicott (1965), Jacobson (1964), and Mahler et al. (1975). Freud (1915) described drives as intermediate between the body and the mind; the only thing we know about them, he suggested, are "representations and affects."

The Structure and Functions of the Ego

The ego, Freud (1923) proposed, is the seat of consciousness as well as of unconscious defense mechanisms that, in the psychoanalytic treatment, appear as "resistances" to free association. The ego functions according to the logical and reality based principles of "secondary process," negotiating the relations between internal and external reality. Guided by the reality principle, it exerts control over perception and motility, draws on preconscious material, controls "attention cathexes," and permits motor delay as well as the selection of imagery and perception. The ego is also the seat of basic affects, particularly anxiety as an alarm signal against the danger of the emergence of unconscious, repressed impulses. This alarm signal may turn into a disorganized state of panic when the ego is flooded with external perceptions that activate unconscious desire and conflicts or with traumatic experiences in reality that resonate with such conflicts and overwhelm the particularly sensitized ego in the process. The fact that Freud saw the ego as the seat of affects and that he had previously described affects as discharge phenomena reflecting drives (together with their mental representations) tended to dissociate affects from drives in psychoanalytic theory, although they were equated in Freud's early formulations. As we shall see, the centrality of affects in psychic reality and interactions has gradually reemerged as a major issue in contemporary psychoanalytic thinking.

(Continues...)

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