σκέψεις για την μεταβλητότητα του πλαισίου στην ψυχαναλυση

Μια μελέτη για την έννοια του πλαισίου -επαναπροσδιορισμοί και μεταμορφώσεις της έννοιας  του πλαισίου ,όπως έχουν προκύψει από τις διαφορετικές ψυχαναλυτικές θεωρίες και πρακτικές

 

ψυχαναλυτική τεχνική και θεωρία –

Θα ξεκινήσω την ανάρτηση στο μπλόγκ μου με ένα άρθρο του Irwin Z. Hoffman,  το οποίο δεν έχει δημοσιευθεί σε περιοδικό και για του οποίου την αναδημοσίευση έχω πάρει την άδεια του
συγγραφέα. Δυστυχώς για τα υπόλοιπα  άρθρα δεν μπορεί να γίνει αναδημοσίευση γιατι δεν υπάρχει η άδεια απο τον εκδότη.
Θα ξεκινήσω την περιήγηση  μου με τον συγκεκριμένο ψυχαναλυτή, γιατί θεωρώ ότι
έχει ασχοληθεί ιδιάιτερη με την θεωρητική επεξεργασία ζητημάτων που προκύπτουν απο την ψυχαναλυτική πρακτική.

Sixteen Principles of Dialectical Constructivism

Irwin Z. Hoffman, PhD

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I would like to present a set of principles that are central to the perspective I’ve been developing that I’ve called Dialectical Constructivism. That perspective overlaps in many respects with that of relational theory which however is a broader umbrella term encompassing many theorists with different points of view and emphases. I have been critical of some theorists (including Kohut, Loewald, and Winnicott) who are commonly identified as relational or at least as having relational leanings for their own forms of objectivism. I do believe however, that most contemporary relational theory (as Donnel Stern [2001] has suggested) is also implicitly or explicitly constructivist. Of the 16 principles that follow, I think the first eight are probably especially expressive of ideas held in common with relational theory, whereas the last eight belong more distinctively to dialectical constructivism in terms of emphasis although they are not necessarily incompatible with other relational points of view. So here are the principles. (I will be paraphrasing here occasionally and sometimes even quoting from my book [Ritual and Spontaneity in the Psychoanalytic Process: A Dialectical-Constructivist View, The Analytic Press, 1998] and from other published writing but I’m not going to stop to make a point of identifying those spots in the text)

Principles of Dialectical Constuctivism in Common with other Relational Perspectives

1. The patient’s experience is always understood in multiple contexts that are partly constituting of it: the context of his or her history, the context of his or her intrapsychic structure and internal object relations, the context of current relationships and activities, the context of the culture in which the patient lives, and — perhaps the most distinctively “relational” emphasis — the context of the analyst’s or analytic therapist’s immediate personal participation in the process.

2. There is nothing about this emphasis that is incompatible with understanding that both the patient and the analyst bring powerful internal structures into the analytic relationship and that the realities that are coconstructed there bear the stamp of those internal structures. Racker’s formulation of the interplay of transference and countertransference in the 50s did away, long ago, with the dichotomy of the intrapsychic and the interpersonal.

3. Along with the idea that the analyst is always involved and contributing, it is understood that the nature of that participation is not transparent, certainly not transparent to the analyst for a number of reasons. First, the analyst’s experience and behavior are intrinsically ambiguous; there is more than one good way to formulate it; to see it; to interpret it. Second, some dimensions of the analyst’s participation are just unknown to the analyst because he or she has not attended to them or is just ignorant of them. In the old language, perhaps they would qualify as “descriptively” unconscious rather than “dynamically” unconscious. Third, some aspects are resisted; the analyst is motivated in the countertransference not to know them, not to see them but to see something else instead. These aspects, might be regarded as “dynamically unconscious.”

4. The patient’s conscious and unconscious “take” on the analyst’s participation emerges as warranting a certain respect since the analyst cannot regard himself or herself as knowing about the objective truth of the matter. That does not mean that the analyst could not have conviction that differs from the patient’s. Indeed the patient is no more the arbiter of the truth about it than is the analyst.

5. In dropping the aspiration to stay out of the fray of the interpersonal field for the purpose of promoting the emergence of a pure culture of the patient’s mental life free of the analyst’s influence, the analyst becomes freer to allow himself or herself to be involved more and to participate more freely both in getting somewhat caught up in transference countertransference enactments and in the effort to provide some kind of therapeutic new experience. The relationship between enactment or repetition and new experience is complex and often paradoxical. And again, the principle of uncertainty holds: the analyst does not presume to know that what he or she has offered is simply good for example or corrective. When we think we are being the “good object,” unwittingly we may be embodying aspects of the bad and vice versa.

6. An evolution theoretically that has contributed to the readiness of relational theorists to try to provide some kind of corrective experience within the analytic relationship, in addition to the exposure of the myth of analytic neutrality and objectivity, is the changed conception of the patient’s paradigmatic desires, from illicit wishes that were best left ungratified in childhood and are best left unmet as they reappear in the transference, to at least the addition of legitimate developmental needs, conceptualized in various ways, that ideally would have been met more fully in childhood and that might now be reactivated in the transference. Stephen Mitchell identified this as the part of the revolution in psychoanalytic theory that pertains to “what the patient needs,” as distinct from the part of the revolution that pertains to “what the analyst knows.”

7. What is especially important for dialectical-constructivism and relational perspectives is critical reflection on our contribution as analysts which then affects what we say to patients and how we say it. The alternative can take the form of attributing solely to the patient and to the patient’s psychopathology, features of experience and behavior for which the analyst shares significant responsibility. This kind of disclaiming of responsibility for aspects of the patient’s experience, coupled with a knowing, objectivist attitude, have the potential to enact a pattern of domination of patients that is likely to escape detection and critical reflection precisely because it is institutionally sanctioned. There is an ethical issue at stake here that transcends questions of technique and of effectiveness.

8. A relational-constructtvist perspective has its own costs and benefits, its own special promise and its own special dangers. Many relational theorists have been interested in particular in the seductive potentials that are inherent in the analyst’s greater emotional availability and greater readiness to be an involved, affirming, even loving presence in the patient’s life. Rather than chronic forms of disclaimed deprivation and oppressive domination which are, perhaps, more salient as the dangers of a more classical approach, seduction and abandonment emerge as more salient dangers in a relational approach. Within the latter, the outcome ought not be taken for granted. Instead, continual struggle is required to overcome the potential for retraumatization, to forge differentiation of present and past, and to promote new understanding, new experience, and growth.

Principles Belonging More Distinctively to Dialectical Constructivism

9. Constructing meaning in the face of mortality

As in Freud, what is valued in dialectical constructivism is a courageous facing up to the truth about one’s self and one’s world. But the nature of that truth is quite different than it was for Freud. The truth that emerges now is that, paradoxically, much of reality is ambiguous and indeterminate. While death is an absolute certainty, taxes, in fact, are not. Social reality is largely, in terms of specifics, socially constructed. The nature of the reality we create is not fully predictable and its sources not fully knowable. What emerges as “psychobiological bedrock,” as the immutable, transcultural, transhistorical truth, is that human beings collectively create their worlds and their sense of meaning in the teeth of the constant threat of nonbeing and meaninglessness. The inexorable flow of time and the anticipation of death force upon human beings generally, and upon the analyst and the patient in particular, a degree of urgency (which may be more or less denied) in the process of making choices, in struggling to resolve the ambiguity of experience in one direction or another, in sacrificing — and, thereby, often losing forever — the paths that are not chosen. Psychoanalysis does not provide a sanctuary from the relentless, irreversible authority of time. We must act, we must choose, often before we feel “ready,” despite knowing that we do not know the full nature of our motivation, and despite knowing that every choice closes innumerable doors, some known, and countless unknown.

10. Patients and Analysts as Agents: Responsibility for the Coconstruction of Reality

All the influences affecting the patient and the analyst, including those associated with the transference and the countertransference, may mitigate but do not eliminate the participants responsibility as free agents for what they do at any moment to shape their relationship, the patient’s experience, or aspects of the patient’s life. Since the patient is a free agent in a dialogue with the analyst, not an organ system undergoing “treatment,” how the patient will respond to anything the analyst says or does is never fully predictable. The meaning and import, moreover, of the analyst’s actions are codetermined by what the patient chooses to do in response to them. If the patient quits after the analyst discloses something very personal or expresses an intense feeling, it will seem like the analyst went too far. But if the patient overcomes his or her initial surprise or even shock and opens up about something that had previously been repressed or kept secret, it will seem like the analyst risked himself or herself courageously and constructively. Yet the handwriting may have been on the wall for both outcomes, and the patient bears significant responsibility for which one ensues.

Thinking in terms of the coconstruction of the reality of the analytic situation results in more subtle distinctions between the roles and responsibilities allocated to the analyst and to the patient. The usual notion that the patient’s task is to free associate, to say whatever comes to mind, whereas the analyst’s task is to speak responsibly, carefully, and judiciously in offering interpretations and other interventions designed to further the process is no longer tenable in every context. The patient shares responsibility with the analyst for the quality of relationship that is fostered by their dialogue from moment to moment. There is no question that the patient is asked to be far freer than the analyst in speaking of what comes to mind, but with fuller recognition of the analyst as a person, the patient also bears some responsibility for speaking in a manner that is consistent with the purposes of the analytic work and that takes into account the analyst’s humanity and vulnerability. Conversely, the analyst is encouraged to speak more spontaneously and expressively than has been the case traditionally. Some issues more than others bring out the importance of breaking down the dichotomous allocation of responsibility. For example, if the analyst and the patient are trying to talk openly about erotic transference and countertransference, it may be important for both participants to exercise “the art of understatement” in order to prevent the atmosphere from heating up more than is optimal for the work (see Davies, 1998; Hoffman, 1998)

Bearing responsibility for the coconstruction of reality is a heavy burden. Each of us needs to be affirmed as an agent, as a contributor to the social construction of the reality of the human community in which we live and of the reality of the specific relationships in which we are engaged. Parents have a powerful role to play in authorizing children as agents, as choosing subjects, responsible not only for themselves but also for the well being of others.

11. The analyst as intimate and ironic authority

The analyst inherits some of those functions as reflected in the “unobjectionable positive transference.” The built in asymmetry of the analytic arrangement promotes that aspect of the transference. It leaves the analyst with a degree of power and authority that is ironic because its basis is also explored, and often exposed through the analysis of the transference, as largely irrational. But for each individual the respect that empowers has to come from somewhere. The analytic situation is a special kind of ritual, a setup for affecting deeply entrenched aspects of a patient’s self and object representations. The analyst has special power within this ritual to influence another person’s life. The role-related aspects of the analyst’s authority have rational and irrational (or magical) components. The rational component has to do with the analyst’s expertise and with the analyst really having his or her best foot forward because of the protections against narcissistic vulnerability and injury that are afforded by the analytic situation. Part of what contributes to that protection is the very fact that the analyst is less personally exposed than is the patient. The irrational component has to do with the magnetism of the ritual setup itself, particularly with the magnetism of the analyst’s relative anonymity and self-subordination. In simply being the analyst, in being consistently the caregiver (despite interludes of role reversal), hour after hour for hundreds, even thousands, of hours, the patient is invited to attribute to the analyst, via the transference from parental figures, a kind of omniscient power, one that can do battle with the power of primary caregivers to the degree that it was negatively exercised and internalized before the patient was old enough to think critically. The ritualized conduct of the analyst is in a dialectical relationship with his or her personal spontaneous participation. Both ways of being with the patient, each exerting a moderating influence on the other, are essential to the therapeutic action of the process.

The form that the analyst’s authority takes can only be ironic, because it lacks sanction in our era and because, more than ever, it is vigorously challenged in the analytic situation itself. The heightened sense of the moral nature of analytic discourse is accompanied by a heightened sense of the absence of a solid foundation to support it. The analyst participates as a moral preceptor even while both participants come to appreciate how much the role is a social construction designed to meet a universal human need. The authority of the analyst, even an element of mystique, survives, and even feeds upon, two sources of challenge to it. One is a process of joint critical reflection on its place in the patient’s mental life, including its infantile prototypes, in other words, the analysis of the transference. The second is the analyst’s personal participation in the interaction in a spirit of mutuality, the kind of participation that exposes the analyst’s fallibility, vulnerability, and even exploitativeness. The dialectical interplay of the emergence of the analyst’s subjectivity and its relative submergence in the context of analytic discipline generates a position of “intimate and ironic authority” for the analyst. [EXAMPLE Manny in Ritual and Spontaneity, pp. 259-261]

12. The dark side of the analytic frame

The rituals that constitute the analytic frame are undoubtedly essential to the process and deviations from them are certainly as open, if not more open, to suspicion as to their self-serving nature as is their religious observance. Dialectical constructivism, however, challenges the neatness of the dichotomy: adherence to the frame creates safety, deviation from the frame creates danger. Even if the frame is mostly beneficial, it does not create a perfect sanctuary because it cannot eliminate the analyst as a personally involved, co-constructor of reality in the process and because its defining features are, in themselves, suspect.

Psychoanalytic rituals provide usefully ambiguous grounds not only for new experience and development but also for neurotic repetition. Acknowledging this reality has at least two important clinical implications. First, the patient’s conscious and unconscious objections to analytic routines, even his or her rage about them, must be taken seriously. By that I mean more than that we have to get into the patient’s world and see it from his or her point of view. That attitude can be subtly patronizing to the extent that we consider the patient’s perspective to stem from deficits or even from unresolved conflicts originating in childhood and to the extent that we hope that the patient will eventually come to see things from a more developmentally advanced perspective. Instead, I mean that we recognize what may be objectionable about the frame, even from the point of view of a mature, “healthy” adult, so much so that we may wonder what kind of pathology would result in a person being willing to go along with it at all. The one in need is the one who may be driven to accept an invitation to be exploited and the analytic arrangement can be construed, quite plausibly, as extending such an invitation. A second clinical implication of acknowledging the malignant aspects of the frame, in addition to recognizing a place for an unobjectionable negative transference (cf. Guidi, 1993) and for reasonable resistance, is that such acknowledgment provides theoretical grounds for considering the benign potentials of momentary deviations from the standard routine. A readiness to deviate in certain limited ways may offset the exploitative meanings that can get attached to maintaining the frame in an inflexible manner. There is no way for the analyst to know, with certainty, what course to pursue with respect to the balance between spontaneous, personal responsivity and adherence to psychoanalytic rituals at any given moment, nor can the balance that is struck be one that the analyst can completely control. The basis for the patient’s trust is often best established through evidence of the analyst’s struggle with the issue and through his or her openness to reflect critically on whatever paths he or she has taken, prompted more or less by the patient’s reactions and direct and indirect communications

13. The dialectic of the analyst’s personal involvement and technique

A constructivist attitude opposes a view of the analyst’s behavior as “technically rational” that is as merely the systematic application of a standardized technique for treating psychological conditions (Schön, 1983). When the analyst stops aspiring to such technical rationality he or she stops denying the inevitability of his or her own subjective participation. Conversely, when that participation is accepted, it opens the door to the possibility of a relatively spontaneous expression on the analyst’s part of his or her own subjectivity. That expression may be ongoing in a quality of naturalness of manner and voice, it may be part of an enactment reflecting an “externalization” of the analysand’s internal object relations (Sandler, Racker), it may be part of something new and liberating, or it may be an amalgam of something old and something new. What I want to stress here is that the wild card in the analytic process that a constructivist view recognizes and promotes is the analyst’s personal involvement. Now the analyst’s authenticity emerges as a central problem and as a key to the therapeutic action of the process. To the extent that an analyst locks into any one very specific theoretical point of view and tries to apply it systematically he or she falls into technical rationality. The result is likely to be suffocation of the analyst’s authentic emergence as a subject as well as the analyst’s potential fully to recognize the patient as a subject. I am not advocating, of course, that the analyst express every thought or feeling that crosses his or her mind. On the contrary, I am assuming that the analyst has in his or her bones a sense of the importance of the asymmetry of the analytic situation and of the value of theoretically-informed understanding. So self-expression and psychoanalytic discipline exist in a dialectical relationship. When one is figure the other is ground. The analyst’s authentic participation involves struggling with this dialectic, never allowing one pole to dominate at the expense of the other. And the patient’s deepest need is for the synergy of the analyst’s emotional involvement and his or her relatively detached, theoretically-informed analytic attitude. [EXAMPLE in Ritual and Spontaneity, the case of Ken, at the elevator, pp.232-235]

14. The dialectic of repetition and new experience

What gets constructed in the analytic process that is of special interest analytically can be divided into two broad categories: repetition and new experience. The pressure of the neurotic transference is to repeat, the pressure of the healthier aspects of the patient’s motivation is to find new ways of being in the world. The first is in a dialectical relationship with the second, and may be included, paradoxically, as a part of the second. Also paradoxically, the analyst’s participation in a repetition may also be part of his or her contribution to the creative development of new experience (Ghent, 1992; Pizer, 1992). Some aspects of the countertransference may become relatively stable organizations that are complementary to stable or chronic aspects of the transference. In other words, as Tower suggested in 1956, there may be a countertransference neurosis corresponding with every transference neurosis, and the two must be resolved together. The analyst can never know exactly what is going on and what is forthcoming in this regard. The “not knowing” is, in itself, part of the searching attitude that provides the patient with a “good” object in the present with the potential to promote new experience. The extent to which the analyst’s participation contributes to new experience as opposed to neurotic repetition is a matter that cannot be taken for granted but that must always be explored critically and retrospectively.

Moreover, enactments and transcendence of enactments, or, more broadly, neurosis and health, are hardly dichotomous. Indeed, all ways of being, all socially constructed realities, entail a constriction of awareness. None are free of an element of fetishistic passion since they are all driven, in part, by the wish to avoid contemplating, if not the wish to deny, the ultimate “lack,” the ultimate “castration,” which is death.

15. From Idealization, through malignant envy, to identification

The patient’s idealization of the analyst is always threatening to deteriorate as the patient discerns that the analyst is merely a person like the patient himself or herself. With that awareness might come not only a feeling that what the analyst offers is too little too late but also a sensing of the danger that the analyst may be exploiting the patient for monetary as well as narcissistic gain. The patient’s associated resentment and envy can promote a withholding of progress in the analytic work and in the patient’s life in order to deny the analyst any further satisfaction, such as a sense of success in having been a “good enough” therapist, in having offered enough to offset the “dark side” of the analytic arrangement, and enough also to atone for whatever specific “mistakes” he or she has made.

The factor of malignant envy is overcome, partly, to the extent that the patient can forgive the analyst for being a human being like himself or herself and can see and absorb whatever good the analyst has to offer. The patient’s and the analyst’s shared human condition, including the fact of mortality, can facilitate that forgiving attitude, as idealization gives way partially to empathic identification, allowing the patient to offer the analyst his or her own progress as a kind of reparative gift.

16. Theory of therapeutic action: the analyst as “good object”

“Dialectical constructivism” is not merely an epistemological point of view. Applying Stephen Mitchell’s way of organizing the issues, the perspective is not limited to addressing the question “What does the analyst know?” It also a theory of process and of the nature of the therapeutic action of psychoanalysis, one which has developmental implications. In that sense it is also a theory about “what the patient needs.” In effect, at a certain level of generality, what the patient needs is an analyst who, wittingly or unwittingly, has the kinds of attitudes that dialectical constructivism promotes. In other words, such attitudes are, in large measure, what constitute the new, good object in the analytic situation.

“[Conversely] the bad object that is lurking in every analytic situation is the one that pulls either of the participants into absolute commitment to one side of his or her conflict (for example, the side that wants to analyze) with the result that the other side (for example, the side that wants to respond in a more spontaneous, personal way) must be abandoned and repressed. The good enough parent maintains a balance among investments in each child, in spouse (or others) and in self. He or she recognizes the inevitable tensions among these interdependent yet rivalrous attachments but does not abandon any of them. The quality of the attention to the child (and to each of the others), moreover, respects and fosters the same kind of balance and tolerance of tension within him or her (cf. Benjamin, 1988). Similarly, analysts, through their capacity to uphold both sides of multiple polarities, can combat the threat of the “single-minded” bad object in themselves and in their patients and create the basis for new experience. Thinking dialectically can be a powerful expression, in itself, of the analyst’s struggle to come to grips with the complexity and ambiguity of the patient’s multiple aims and potentials as they interface with the analyst’s own. Potentiated by the ritually-based mystique and authority of the analyst’s role, that struggle assumes a position that is at the heart of therapeutic action in the psychoanalytic process.” (Ritual and Spontaneity, p.217).

Irwin Z. Hoffman, Ph.D.
55 East Washington Street, Suite 1217
Chicago, IL 60602
izhoffman@aol.com

© 2003 Irwin Z. Hoffman