Psychoanalytic Approaches to Sexual Problems

Herbert S Strean

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781317774259
• Edition: 1
• Topic: Psicología
• Subtopic: Salud mental en psicología

Now you can more effectively help patients suffering from sexual conflict in its various manifestations. As sexuality has "come out of the closet, " people have become more willing to seek professional help in dealing with their sexual conflicts and unhappiness. Several leading authorities demonstrate how sexual conflicts arise--often in early childhood, and provide examples of effective therapeutic approaches for treating patients who experience sexual conflict about homosexuality, extramarital sex, voyeurism, and exhibitionism.

The Analytic Triad:
A Contribution to the Theory
of Transference

Reuben Fine

The theory of transference was set forth by Freud in a number of papers in the second decade. There the essential point was that the transference is made conscious to the patient by the analyst, and it is resolved by convincing him that in his transference-attitude he is reexperiencing emotional relations which had their origins in his earliest object attachments during the repressed period of his childhood (SE, XX, p. 42).

At the same time Freud maintained that transference is a universal phenomenon. In 1925 he wrote (XX, p. 42):

Transference is merely uncovered and isolated by analysis. It is a universal phenomenon of the human mind, it decides the success of all medical influence, and in fact dominates the whole of each person’s relation to his human environment.

Since transferences are found to all persons in the environment, the question naturally arises: what is the relationship between the transference or transferences to these other people and the transference to the analyst? And a corollary: suppose the transference to the analyst is resolved (a theoretical point of argument arises about whether this can really be done), what is the effect of such a resolution on the other transference(s) of the patient?

At another time, in Group Psychology (1921) Freud became more specific. There is always some other person who is important to the patient, or as Freud put it (XVIII, p. 69):

In the individual’s mental life someone else is invariably involved as a model, as an object, as a helper, as an opponent; and so from the very first individual psychology, in this extended but entirely justifiable sense of the words, is at the same time social psychology as well.

Thus putting these two statements together, there is for the analysand always the need to reconcile the two most important figures in his life: the analyst, and the important other person. For experience shows that it is almost always one other person who is the major transference figure outside the analysis, usually in the present, sometimes a person from the past. The analysis then revolves around the relative significance of these two transference figures. This is what I call the analytic triad. In practice every analyst knows that it is vital to resolve not only the transference to the analyst but also the transference to the other person, if that should be harmful to the individual in his life, which is often the case. Usually however less effort is directed toward resolving the other transference, unless it is blatantly destructive (and even then as we know many abrupt terminations are stimulated by the acting out of the transference to another person in a self-destructive way).

I

If we look for the childhood origins of the analytic triad, the first thought is to go back to the Oedipal situation. And of course the Oedipal conflict still plays a central role in all pathology.

But more recent investigation into the first year of life has revealed that a triadic situation is formed by the child much earlier, in some ways as early as the first week of life. Chiland (1982, p. 377), reviewing the infant literature, states: “The concept of a purely dyadic relationship between infant and mother is now as unacceptable as the concept of a stage of normal autism.”

Thus she implies that Mahler’s concept of a state of normal autism, like Freud’s stage of primary narcissism, has to be abandoned in the light of newer findings. The father is always present, somewhere in the background. Even when he is absent, his absence makes itself felt. Andre Green writes (1975):

(Since) there is no such thing as an infant because one never sees an infant without a crib, without arms holding it, without maternal care (Winnicott), we in turn may say that an infant with its mother does not exist. A mother-child couple does not exist without a father somewhere . . . Thus, we may state in the extreme that there is no dyadic relationship. (Chiland, 1982, pp. 368-369)

Among the luminous evidence she quotes to support the notion of an infant active and responsive from birth (and prenatally too in many respects, yet unresearched) is the following:

Imitation begins during the infant’s first week of life. If the mother, or another adult, sticks out her tongue in front of the child, he begins to stick out his tongue. If the mother stops sticking out her tongue and bats her eyelashes, the baby bats his eyelashes. If she opens or closes her mouth, he does the same thing. Moreover, he synchronizes himself with her, and he seems to take pleasure in these games of reciprocal imitation.

As early as the age of twelve hours, newborn babies who hear recordings of spoken English, of isolated vocal sounds, of regular beating noises, and of spoken Chinese do not react to isolated vocal sounds or to beating noises, but move themselves synchronically with the structure of English and Chinese speech coming either from a recording or from a living person. At birth, babies turn their heads toward a clicking sound. They are not interested in pure sounds, but actively react to complex sounds and in particular to the highpitched human voice.

They are sensitive to the smell of colostrum, and as early as the end of the first week (day six) they distinguish between a compress which has been in contact with their mother’s breast and one which has been in contact with the breast of another nursing woman.

From birth on, there is an object-background discrimination, a reflex of fixation, and a visual pursuit under certain conditions. At the age of two weeks, babies recognize the face of the mother; they look at it more than at the face of a stranger through a kind of window placed above the crib. When the voice of the mother or of a stranger is produced by a loudspeaker, babies have a “gaze aversion” and turn away their heads if voice and face do not match.

One of Chiland’s conclusions is (Chiland, 1982, p. 374):

In the light of the data obtained during the past 10 years, it seems clear that “normal autism” is a poorly chosen term for the description of the infant during the first months of life. We can see that his perceptions are in the service of the discovery and the recognition of the mother and of the interaction with her.

A mass of confirmatory evidence of these propositions is provided by Lichtenberg in his recent book (1983). His overall summary is (Lichtenberg, 1983, pp. 44-45):

We have already seen that human infants begin extrauterine life with demonstrable functional capacities. Rather than being amorphous organisms, beset by hunger and molded by the mother, infants show a lawful order of their functioning, with five organized behavioral states: alert wakefulness, quiescent wakefulness, REM sleep, NREM sleep and crying .... From birth on, in the full-term baby, these states organize the neonate’s life in temporal sequences, in conjunction with the stimuli of the extrauterine environment.

Thus this new material indicates that some differentiation between mother and father takes place from birth on. One might stretch a point, as Melanie Klein once did, by saying that the Oedipal conflict starts at birth. However, this would ignore the development of the ego. It seems clear that while some differentiation exists from birth on, as the ego grows, it handles the differences in ever more advanced ways. While this process still may be seen to culminate in the classical Oedipal conflict, the long pre-history of that conflict must now be taken into consideration in both theory and practice.

Much attention has been devoted in recent years to the period from fifteen months to three years. Greenspan (1980, 1982) has suggested the term “dyadic-phallic stage of development” to describe the early phallic stage, somewhere between Mahler’s rapprochement phase and the classical Oedipal period. During this stage, the father’s role is especially unique in helping the child to stabilize basic ego functions such as reality testing, impulse regulation, mood stabilization, delineation of self from others, and focussed concentration.

Greenspan delineates a number of stages of development: 1) homeostasis; 2) forming a human attachment; 3) somatopsychological differentiation; 4) behavioral organization, initiative and internalization; 5) forming mental representations and finally 6) the dyadic-phallic stage of development. Although he particularly emphasizes the role of the father in the dyadic-phallic stage, he stipulates a role for the father at each previous stage as well.

Herzog (1982) coined the term “father hunger,” and felt that the father’s role was primarily that of the modulation of aggressive drive and fantasy. He and his group studied children whose fathers were absent, either completely or partially, because of divorce. A striking feature of these children’s productions at all developmental stages was the predominance of aggressive themes and content. A second striking difference was the predominance of aggressive motives in boys thus bereft between the ages of eighteen and sixty months. Later on (between the ages of sixty and eighty-four months) little girls begin to be represented in equal numbers. These observations led to the hypothesis that a specific role is played by the male parent in the modulation of aggressive-drive fantasy in the young child, and that the father’s absence at this time may have specific and long-range consequences. A second hypothesis was that little boys are more vulnerable or at least feel more vulnerable to disruptions in the control of aggressive drives and fantasy than are their female counterparts, at least until the age of five years. Little boys therefore suffer more when family disruption leads to father loss.

To describe the affective state and longing experienced by father-deprived children, Greenspan introduces the notion of “father-hunger.” However, he does not consider the possibility that a good part of the aggression displayed by these boys, and some of the longing, may occur by identification with the abandoned mother, who usually is filled with resentment and hatred of the absent father, even when she herself has initiated the separation. I have elsewhere (Fine, 1975) hypothesized that an essential part of the intensity of the Oedipal situation is an identification with the hostility of the partner of the opposite sex, so that, e.g., the boy’s anger at the father derives from the mother’s hatred of the father, as well as from other psychological and biological sources.

In any case, it is already clear that a triadic situation exists for the child from birth on, that this triadic situation grows and changes with the maturing ego of the child, and that it is strongly affected by the emotional reactions of the parents to the child, to one another and to the outside world. This could serve then as the infantile origins of the analytic triad.

Such an assumption expands the classical image of a two-person symbiosis, primarily between the child and the mother, which is then recapitulated in the analytic situation as a transference. Just as the relationship with the mother cannot be properly understood without reference to the father, the transference to the analyst cannot be properly understood without reference to the important third party involved.

II

As is well known, Freud had no confidence in the treatment of the relatives. Quite the contrary; he saw them as expressing an “unavoidable” opposition to psychoanalytic treatment, and even warned against giving them any literature to read. He concluded (XII, p. 120):

As regards the treatment of their “relatives” [this word is put in quotation marks for some reason; the quotation marks are omitted by Strachey] I must confess myself utterly at a loss, and I have in general little faith in any individual treatment of them.

This attitude toward the relatives (and other close persons) has changed considerably in the course of the years. Today it is customary, at least in large cities where plenty of analysts are available, to routinely refer the relatives for therapy or analysis to some other analyst (some may prefer to see the relatives themselves, as for instance Freud did with the betrothed of Ernest Jones, Loe Kann [Brome, 1983]). Various possibilities may then develop. A common problem stemming from the separation of analysts is that the battle between, say spouses, becomes a battle between analysts, each analyst taking the side of whichever spouse he or she is treating. In a few cases they have even appeared in court on behalf of the spouse they are treating. The extension of analysis to the broader segments of the population, especially those who are culturally normal, has played an important role in this development. It may be noted here that Ernest Jones, when he first came across Melanie Klein, sent his children to her for analysis, convinced (as most analysts were at that time and still are) that the normal process of growing up leaves all kinds of scars which can effectively be modified or erased by analytic treatment (Brome, 1983, pp. 154-155).

Classically, Freud stressed the centrality of the transference, and its concomitant resistance. In 1912 he wrote (SE, XII, p. 108):

It is on that field (transference) that the victory must be won—the victory whose expression is the permanent cure of the neurosis. It cannot be disputed that controlling the phenomena of transference presents the psychoanalyst with the greatest difficulties. But it should not be forgotten that it is precisely they that do us the inestimable service of making the patient’s hidden and forgotten erotic impulses immediate and manifest. For when all is said and done, it is impossible to destroy anyone in absentia or in effigie.

In the ensuing years a voluminous literature has developed about how to handle the transference properly. While certain general principles are commonly observed, such as the preservation of analytic neutrality, and the avoidance of social relations, in general the analysis of the transference has remained an art rather than a science. In 1972 Bird wrote: “Nothing about analysis is less well known than how individual analysts actually use transference in their day-to-day work with patients” (Bird, 1972, p. 271).

In spite of the importance attached to transference by Freud, Gill has recently argued that Freud did not make it important enough. In Gill’s 1982 monograph he writes (Gill, 1982, p. 177):

The point of this monograph is to argue that the analysis of the transference should play a greater and more central role in analytic technique than I believe it does in prevailing practice. The development of the analysis of the transference took place early in Freud’s work, and although his use of it doubtlessly grew in sophistication and centrality, I believe it never became as central as it should be. Freud remained of the view that the analysis of the transference is ancillary to the analysis of the neurosis rather than contending that the analysis of the neurosis should take place essentially by way of the transference.

In spite of his strictures against his contemporary fellow analysts, what Gill sets forth in his monograph is essentially a programmatic approach. He does not consider, or at least does not consider in any detail, the innumerable variations which occur in practice, the many ways in which the analysand reacts to the transference, the innumerable resistances that come up, nor what the reactions of the analysands are to pure transference analysis, of the kind that he urges. What he leaves out in other words is all the details of technique (Fine, 1982).

Although Langs has recently propounded an idiosyncratic theory of his own, to the effect that many of the analysand’s supposed transference reactions are more the consequences of the analyst’s incorrect interventions, especially in the first year, in his more comprehensive discussion of the literature on transference Langs (1976) came to a somewhat more sober conclusion. There he wrote (Langs, 1976, p. 19):

Freud created an ingenious foundation for the study not only of the psychoanalytic but of all therapeutic relationships, and his writings on this subject have spawned a massive and convoluted literature, striking still for its many unresolved issues.

Among these many unresolved issues a central one is the connection between the real relationship and the transference. The significance of this real relationship was particularly stressed by Greenson (1967, 1971). His position was that the successful outcome of an analysis depends more on the real relationship than on anything else; this goes together with his concept of the working alliance. Greenson states that for the full flowering and ultimate resolution of the patient’s transference reactions, it is essential in all cases to acknowledge, clarify, differentiate, and even nurture the nontransference or relatively transference-free reactions between patient and analyst. The technique of “only analyzing” or “only interpreting” transference phenomena may stifle the development and clarification of the transference neurosis and act as an obstacle to the actualization of the transference-free or “real” reactions of the patient.

There can be no question about the centrality of interpreting the transference, Green...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• A Letter from the Editor
• The Analytic Triad: A Contribution to the Theory of Transference
• Homosexuality: A Life-Style, a Civil Rights Issue or a Psycho-Social Problem?
• Negative Voyeurism and Its Application to Psychoanalytic Practice
• A Case of Exhibitionism: Self-Hatred Beneath a Mask
• Sex and Exclusivity