Ritual and Spontaneity in the Psychoanalytic Process

A Dialectical-Constructivist View

Irwin Z. Hoffman

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317771340
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The psychoanalytic process is characterized by a complex weave of interrelated polarities: transference and countertransference, repetition and new experience, enactment and interpretation, discipline and personal responsiveness, the intrapsychic and the interpersonal, construction and discovery. In Ritual and Spontaneity in the Psychoanalytic Process, Irwin Z. Hoffman, through compelling clinical accounts, demonstrates the great therapeutic potential that resides in the analyst's struggle to achieve a balance within each of these dialectics.According to Hoffman, the psychoanalytic modality implicates adialectic tension between interpersonal influence and interpretive exploration, a tension in which noninterpretive and interpretive interactions continuously elicit one another. It follows that Hoffman's "dialectical constructivism" highlights the intrinsic ambiguity of experience, an ambiguity that coexists with the irrefutable facts of a person's life, including the fact of mortality. The analytic situation promotes awareness of the freedom to shape one's life story within the constraints of given realities. Hoffman deems it a special kind of crucible for the affirmation of worth and the construction of meaning in a highly uncertain world. The analyst, in turn, emerges as a moral influence with an ironic kind of authority, one that is enhanced by the ritualized aspects of the analytic process even as it is subjected to critical scrutiny.An intensely clinical work, Ritual and Spontaneity in the Psychoanalytic Process forges a new understanding of the curative possibilities that grow out of the tensions, the choices, and the constraints inhering in the intimate encounter of a psychoanalyst and a patient. Compelling reading for all analysts and analytic therapists, it will also be powerfully informative for scholars in the social sciences and the humanities.

1
The Dialectic of Meaning and Mortality in the Psychoanalytic Process

Sources of Embarrassment and Defenses Against Them

The occupation of psychoanalyst or psychoanalytic therapist is a rather peculiar one. What the analyst offers is complex, but to the extent that it includes some kind of caring involvement at its core, it can feel a little too close for comfort to what other personal relationships offer. To have people come and pay for one's time, attention, understanding, and concern can even be something of an embarrassment to both participants: to the patient for needing this kind of service, and to the analyst for making a living offering it.

The situation is somewhat less embarrassing to the extent that what one offers can be attributed readily to one's special expertise. The traditional "technical skills" of the analyst are most prominent when his or her personal participation is minimized as a factor in the process. Historically, such was the case when the therapeutic action of psychoanalysis could be seen as limited primarily to the development of insight, with the analyst's main contribution consisting of interpreting the dynamics of the neurosis and of the transference. Change was promoted, allegedly, when insight into the origins of symptoms was combined with a realization by the patient that, as an adult, he or she had more resources and options than were available in childhood. Repression and other maladaptive defenses became less necessary, not because conditions were created to compensate for early environmental failure, but because the patient's mature ego could now be brought to bear upon internally based conflict. In this model, the analyst attempted to provide a neutral presence, designed, allegedly, to have little or no impact on the patient's associations and unfolding transferences. Such an orientation reflected the classical Freudian ideal, one Freud (1912) himself felt had to be compromised because of the powerful influence of the "unobjectionable positive transference," according to which the analyst is invested with powers like those possessed by the parents in the patient's early life. Freud felt this aspect of the transference was unobjectionable, not so much because it was realistic as because the analyst could put it to good use (Friedman, 1969).

Building upon Freud's acknowledgment that such an interpersonal factor contributes to the therapeutic action of the process, Strachey (1934) offered the view that, coinciding with interpreting a forbidden wish in the transference, the analyst conveys an accepting attitude toward that very wish, an attitude that the patient internalizes, thereby mitigating the archaic, punitive aspects of his or her own conscience. More austerely, Macalpine (1950) proposed that the knowhow of the analyst includes a method for systematically inducing a regression by depriving the patient of an object relationship. In these accounts of the process, the emotional involvement of the analyst, the engagement of his or her personality, is largely a regrettable contaminant, creating a danger, in Strachey's view, that the influence of the archaic objects and of the current analyst will be indistinguishable or, in Macalpine's view, that the induction of the regressive transference neurosis will be impeded. These theorists seem to be emphasizing opposite factors, with Strachey identifying a positive aspect of what the interpersonal interaction offers the patient and Macalpine identifying the factor of systematic deprivation. What they have in common, however, is the idea that the analyst abstain from any personally expressive behavior. Strachey (1934) says, for example, "the analyst must avoid any real behaviour that is likely to confirm the patient's view of him as a 'bad' or a 'good' phantasy object," and further, "It is a paradoxical fact that the best way of ensuring that his [the patient's] ego shall be able to distinguish between phantasy and reality is to withhold reality from him as much as possible" (pp. 146–147). And Macalpine (1950) writes, "The continual denial of all gratification and object relations mobilizes libido for the recovery of memories, but its significance lies also in the fact that frustration as such is a repetition of infantile situations, and most likely the most important single factor" (p. 525). In both these conceptions of the process, the analyst and the patient are spared the sense that the service the analyst offers bears uncomfortable similarities to what people normally seek from family and from other loved ones.

In the last several decades, however, we've seen increasing attention to the role of the relationship itself as a factor, even as the crucial factor, in the therapeutic action of the analytic process. As recognition of the patient's legitimate developmental needs has grown, the aversion to the dangers of "transference cure" have decreased. That the analyst is a source of love is no longer unacceptable from the point of view of theory, since love in the analytic situation has lost at least some of the implication of inevitable incestuousness. But while gaining acceptance theoretically, the role of the relationship can be an awkward factor to acknowledge in practice. Even Macalpine (1950), whose focus was entirely on the influence of the analytic "setting," not on the analyst's personal contribution, said, in effect, let's admit to each other that we are not merely providing a neutral background for "free" associations, but that we are subjecting our patients to conditions of deprivation in order to make them regress. Nowhere does she go so far as to suggest that we admit this to the patients themselves. On the contrary, the "hoodwinking" of the patient (p. 527), the conveying of a double message (the analyst is there to help, the analyst is totally unavailable), is part of what may promote the regression, and it is not clear how being open about one's intentions would affect that objective.

Analogously, many contemporary analysts also often have something up their sleeves, although opposite to what Macalpine had in mind, that they may find awkward to share with their patients, If a naive patient asks in an early session for an account of how the process works, it is not easy, nor would it necessarily be wise, to say outright, "Assuming you attend sessions regularly and pay your bills, I will offer you a special kind of love and recognition to help compensate for what you did not get from your parents (or other caregivers) as a child." Doubts arise immediately as to the authenticity of "love and recognition" when they are offered as part of the "treatment plan." But regardless of that, the patient might find the idea that he or she is seeking love of some kind and is willing to pay for it abhorrent. It's more comfortable for both parties to talk about the more classical factors, the opportunity for the patient to speak freely and to explore and understand, with the aid of the analyst's interpretive skills, whatever has been unconscious and has interfered with the patient's chance to live a more fulfilling life.

Although awkward to acknowledge to our patients, it has nevertheless become relatively commonplace for us to admit to each other that some kind of nurturance is a big part of what we offer those who come to us for help. In keeping with what Mitchell (1993) has referred to as the revolution in "what the patient needs," a strong chorus of voices has spoken in favor of the analyst's availability as a "good object," offering an interpersonal experience that promises to compensate, in part, for whatever was lacking in the patient's childhood. Instead of defensively protecting the illusion of noninvolvement, we are inclined now to protect our sense of confidence that the "reparenting" that we offer is "good enough" to have therapeutic impact. So we start with the feeling that what we offer is basically good—an atmosphere of safety, a good holding environment, an empathic self-selfobject tie—and that the negative transference is either irrational or a result of hypersensitivity due to early traumas or deprivation. The fee itself, it is argued, contributes to the safety of the situation by ensuring consistent, unconditional compensation for the analyst and reducing his or her need for other kinds of interpersonal rewards. At the same time, however, it's hard to deny that the money also casts doubt upon the sincerity of the analyst's personal involvement and concern. We tend not to dwell on the fact that the integrity of our efforts is always on the verge of being compromised, or is actually compromised, in our patients' eyes as well as our own, simply by virtue of the fact that we are being paid for them. The exchange of money for therapy, which includes an intensely personal relationship, is usually a source of discomfort for both parties (Aron and Hirsch, 1992). As Muriel Dimen (1994) has written:

When money is exchanged in a capitalist economy, both buyer and seller—patient and analyst—come to be like commodities, or things, to one another because they enter into relation with each other through the mediation of a third thing (money) that, simultaneously, separates them. As money wedges them apart, so it estranges them from themselves, a distancing that creates anxiety in both [p. 81].¹

I suspect that at some level, for both participants, the association to prostitution is hard to escape. I once supervised a resident who had a high-class, expensive call girl among his patients. She was continually confronting him on the parallels between her profession and his. She said she had genuine interest in her johns and felt quite proud of the quality of her work. She failed to see how what she was doing with her life was any more demeaning to herself than what the therapist was doing with his, a perspective that made it a bit difficult for him to challenge her adaptation.

In addition to the money, the idea of the analyst as one who is sytematically implementing a certain treatment strategy or method detracts from the patient's sense of the analyst's interpersonal authenticity. This problem would not occur in dentistry, medicine, or other service professions in the same way, because there the treatment procedures and their effects are relatively independent of the treator's personal involvement. Whether or not one's dental cavities are filled properly has little or nothing to do, intrinsically, with the genuineness of the dentist's personal attitudes. Similarly, it is unlikely that those who minimize the importance of the analyst's personal involvement, and who (defensively in my view) continue to see insight as the sole or predominant basis for the therapeutic action of the process, would be particularly concerned with the problem of authenticity. For them, little about the relationship per se is critical to the therapeutic action of the process. But for those who see the quality of the relationship as at the core of the therapeutic action, considerations of authenticity become implicitly, if not explicitly, critical. It follows that factors that may compromise it also become more threatening to consider.

From Divine Authority to Analytic Authority: Ironic Affirmation

Yet the nature of the service the analyst offers may be more embarrassing still than its association with everyday interpersonal influences, even with love in ordinary personal relationships. Freud (1926b) identified the role of the analyst as that of a "secular pastoral worker," someone who serves as a guide to people as they struggle to find their way in life on the basis of personal, individual experience. The importance of such experience is relatively new historically. Nietzsche's announcement of the "death of God" called attention to a moral vacuum in Western society and to a need for a new kind of authority in the culture, one with the power to serve as a catalyst for individual self-fulfillment. Philip Rieff (1966) contends that the psychoanalytic therapist, more than any other figure in society, assumed that role. But such a mantle is hardly a comfortable one to bear. To be a source of love is one thing, but to inherit the psychological functions of a supernatural power is quite another. It is a particularly difficult position in an era that is so dubious about authority altogether.²

Freud's answer to the question of how can we find a way to live without divine sanction and without hope for an afterlife centered on the valuing of truth and the overcoming of self-deception. He held, as an ideal, that a person strive for an integrated awareness of self and of "Reality" or "Necessity" and for an adaptation that reflects that awareness. Reality, both internal and external, was considered relatively fixed and essentially knowable. The highest virtue was to come to grips with the truth about both. As I said earlier, the analyst, according to Freud, may be seen as a moral authority whose power stems from an unobjectionable positive transference that is not entirely rational, but the aim remains to discover and integrate truths that have a fixed quality. The end justifies the means, which may entail a certain element of manipulation, a benign though paradoxical use of aspects of the very transference that is the object of critical analytic scrutiny (Friedman, 1969). So, from a Freudian perspective, if the analyst is a moral guide, the values that he or she tries to instill in the patient remain the values of the objectivistic scientist, namely, to seek the truth about one's self and one's world and live in a way that is "true to oneself" within the constraints of Reality (Freud, 1927a, 1933; Wallerstein, 1983).

Although he recognizes the moral dimension of the analyst's role in the culture, Rieff (1966) seems uncritical of the classical Freudian claims to the effect that truth-seeking and the expansion of the individual's range of freedom are the only moral imperatives underlying the analyst's endeavors. Rieff's modernist leanings in this regard come across in much of his writing, including his sharp separation of "commitment therapies" and "analytic therapies" and a corresponding dichotomizing of "priestly" and "analytic" authority (pp. 74–78). Much in the spirit of an enlightenment sensibility, Rieff writes:

Earlier therapists, being sacralists, guarded the cultural super-ego, communicating to the individual the particular signs and symbols in which the super-ego was embodied or personified. In this sense, earlier therapists assumed priestly powers. The modern therapist, however, is without priestly powers, precisely because he guards against the cultural super-ego and, unlike the sacralist, is free to criticize the moral demand system. Rather, he speaks for the individual buried alive, as it were, in the culture [p. 77, italics added).³

The values of truth seeking, coupled with those of individual freedom and self-realization, are not limited to Freudian theory, but are foundational for most psychoanalytic theory and practice. For example, in some respects, the place occupied by the id in classical theory is occupied by the "true self" in Winnicott. In Freud, however, unlike Winnicott, the "true self" is itself conflicted, a feature of Freud's thought that lends a tragic character to his view of humankind. In that regard, Freud is what I would call a "tragic objectivist," one who believes that what is discovered as a result of the investigation of mind is actually the impossibility of self-fulfillment, since the realization of one core wish or potential is inevitably achieved at the expense of another. Indeed, there is a bridge from Freud to postmodern moral uncertainty, since the structure of Freud's thought encourages consideration of multiple sources of conflict with no clear basis for their resolution.⁴ Also, for Freud the fact of irreducible conflict among the primary instinctual aims of the id precludes the possibility of anything approaching a utopian transformation of society. The implicit Freudian view that any socially constructed reality favors the realization of some aspects of the self while abandoning others contrasts with perspectives—like those of Winnicott, Kohut, and Loewald—in which a unified self becomes a guide that analyst and patient can find, and happily follow. These theorists might be termed "romantic objectivists" since they believe in the possibility not only of a harmony of ascertainable internal and external realities, but also in the ultimate harmony within the true self of the individual. Consider the following statement by Loewald (1960), one that I think captures the essence of romantic objectivism:

If the analyst keeps his central focus on [the] emerging core [of the patient] he avoids moulding the patient in the analyst's own image or imposing on the patient his own concept of what the patient should become. It requires an objectivity and neutrality the essence of which is love and respect for the individual and for individual development. This love and respect represent that counterpart in "reality, " in interaction with which the organization and reorganization of ego and psychic apparatus take place.

The parent-child relationship can serve as a model here. The parent ideally is in an empathic relationship of understanding the child's particular stage in development, yet ahead in his vision of the child's future and mediating this vision to the child in his dealing with him. This vision, informed by the parent's own experience and knowledge of growth and future, is, ideally, a more articulate and more integrated version of the core of being that the child presents to the parent [p. 20].

Although Loewald elsewhere (e.g., 1979) conveys a position that is more cognizant of the inevitability of conflict and uncertainty in mental life, in this particular statement we can see how the analyst can foster the patient's self-realization without concerns about inevitable extraneous sources of influence (intruding, for example, from the analyst's unconscious) or about anything within the patient's "emerging core" being left dormant and unrealized. Similarly, the parents can offer the child conditions for such full and relatively "uncontaminated" development (cf. Cooper, 1997).

The general project of promoting self-realization in some form, what Rieff (1966) calls the "gospel of self-fulfillment" (p. 252), becomes highly problematic when the patient's internal and external realities are understood to be, at least partially, historically, culturally, and individually relative constructions. The analyst emerges as a moral authority in a new and potentially more powerful sense the moment that preexisting realities are no longer considered adequate as moorings for analytic explorations. Now choices have to be made about what to make of one's life, past and present, and it is understood that these choices are not made in a social vacuum. Contrary to Rieff's view, which perpetuates the notion of analytic neutrality as both an ideal and as a real possibility, in a constructivist perspective the analyst becomes an immediate partner in the process through which those choices are made, choices that ent...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Acknowledgments
• Introduction
• 1. The Dialectic of Meaning and Mortality in the Psychoanalytic Process
• 2. Death Anxiety and Adaptation to Mortality in Psychoanalytic Theory
• 3. The Intimate and Ironic Authority of the Psychoanalyst's Presence
• 4. The Patient as Interpreter of the Analyst's Experience
• 5. Toward a Social-Constructivist View of the Psychoanalytic Situation
• 6. Conviction and Uncertainty in Psychoanalytic Interactions
• 7. Expressive Participation and Psychoanalytic Discipline
• 8. Dialectical Thinking and Therapeutic Action
• 9. Ritual and Spontaneity in the Psychoanalytic Process
• 10. Constructing Good-Enough Endings in Psychoanalysis
• References
• Index