Progress in Self Psychology, V. 19

Explorations in Self Psychology

Mark J. Gehrie

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134909377
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

The contributors to Explorations in Self Psychology, volume 19 of the Progress in Self Psychology series, wrestle with two interrelated questions at the nexus of contemporary discussions of technique: How "authentic" and relationally invested should the self psychologically informed analyst be, and what role should self-disclosure play in the treatment process? The responses to these questions embrace the full range of clinical possibilities. Dudley and Walker argue that empathically based interpretation precludes self-disclosure whereas Miller argues in favor of authentic self-expression and against the self psychologist's frustrating attempt to "decenter" from frustration or anger. Consideration of the utility of a consistently empathic stance continues with Weisel-Barth's clinical presentation and the discussions that it elicits about management of her patient's primary destructiveness. Lenoff's critical rereading of Kohut's "Examination of the Relationship Between Mode of Observation and Theory" and Rieveschl & Cowan's "Selfhood and the Dance of Empathy" deepen still further a contemporary perspective on the nature (and advisability) of a consistently empathic stance in the face of interactive and enactive treatment challenges. Other timely self-psychological explorations examine the twinship selfobject experience and homosexuality; self-psychological work with adolescents; and Neville Symington's theory of narcissism. Contributions to applied analysis explore topics as diverse as an exchange of dreams between John Adams and Benjamin Rush; Mann's Death in Venice; the films of Ingmar Bergman; psychotherapy of the elderly; and disabilities in the sensory-motor integration in children. And Volume 19 concludes with Constance Goldberg's candid and enlightening reminiscence of Heinz Kohut, "a very complex man with whom to be in a relationship."

I
Theory

Chapter 1
"To Be or Not to Be?": The Question of Authenticity, Therapist Subjectivity, and the Role of Interpretive Moments in Treatment

Stan T. Dudley
Todd F. Walker
The authors are grateful to Paul Ornstein, M.D., Ben Blom, Ph.D., and Sr. Joan Williams, O.C.D. for their careful reading and critique of this chapter and to Gianni Nebbiosi, Ph.D. for his helpful suggestions. We thank Jeannie Busemeyer for providing invaluable assistance in editing.

Psychoanalysis has evolved well beyond the concept of the selfless analyst, who on theoretical grounds had to remain neutral, authoritarian, and withholding. This neutrality required the therapist to attempt to be emotionally uninvolved, thereby offering the patient a blank screen on which to project his or her inner world. In practice, this often led to the emotional unavailability of the analyst.

In sharp contrast, the current literature is replete with emphasis on the paramount importance of the analyst's human presence and participation in the interpretative process and nonverbal therapeutic engagement. The term authentic has been used to describe the overt expression of the therapist's distinct subjective experience. This type of sharing has been contrasted with working in the interpretive mode, where a primary emphasis is placed on achieving an in-depth, empathic understanding and explaining of the patient's experience; however, there is a glaring lack of consensus regarding authenticity and its role in the treatment process.

The current metapsychological emphasis on promoting the open expression of the therapist's feelings and viewpoints suggests that such self-expressions have primary curative power in their own right, which is independent of empathic understanding and interpretation. Teicholz (1999) differentiates empathy, subjectivity, and authenticity yet notes that affect is the common thread linking these essential factors in the therapeutic process. While Teicholz clarifies the need for integration of these therapeutic components, there has been relatively little detailed exploration and discussion of how this actually occurs in treatment.

In this chapter we first review models that focus on the concept of authenticity. We explore the potential dangers of the fundamental assumption that "genuine" therapist self-expression inherently provides missing selfobject experiences and transformative moments in the absence of empathic understanding and interpretation of the patient's subjectivity. We question the therapeutic significance of the current emphasis on therapist sharing of subjective experience as the primary means of providing the patient with experiences of closeness and support. Aren't empathic interpretations of both the understanding and explaining kind that are tailored according to the patient's chronic and current experiences rooted in and saturated with therapist subjectivity? What exclusive mutative power does spontaneous therapist self-expression—often offered without analytic self-reflection—have over empathic interpretations that contain the therapist's perceptual and subjective experiences? What dangers are present and need to be better understood before encouraging such a "technique" in the training of future psychotherapists?

Second, we present a frame through which to look at the transformation of the therapist's subjectivity into empathic interpretations that facilitate ever-deepening moments of understanding and connection with the patient. Finally, a case presentation illustrates how therapist understanding of self and patient facilitates an interpretive mode that promotes an empathic and experience-near therapeutic encounter.

Review of Select Contemporary Models of Therapist Authenticity and Expressive Relating

An increasing number of analysts and psychotherapists are writing about the explicit sharing of the therapist's subjectivity as the primary or exclusive way in which a patient can experience them as authentic (Ehrenberg, 1996; Preston, 1998; Renik, 1998; Stern et al., 1998; Davies, 1999). These and many other clinicians seem to be equating the patient's experience of genuine interest and caring as synonymous with the therapist sharing his feelings and perceptions. There is a corresponding emphasis in the literature on "moving the patient to a better place" (Shane and Weisel-Barth, 2000) and providing "shared tender moments" (Bacal, Lenoff, and Munschauer, 1999). These authors provide case presentations to show that patients often need explicit reassurance that they are acceptable and that the therapist can tolerate their feelings of horribleness. There is a strong implication that, when a therapist primarily works in the interpretive mode of understanding and explanation, the patient does not experience the therapist as fully present and engaged. Teicholz (1999) notes how many relational theorists believe that providing the patient an explicit expression of the therapist's subjective experience inherently facilitates psychological growth. She underscores that these authors do not fully appreciate that the therapist can recognize and effectively utilize their subjective experience and not necessarily explicitly express this to the patient.

At the heart of this issue is the question of how a caring and emotional presence can be expressed and whether it has to be stated to be felt by the patient. We believe that, when the patient's self-experience is grasped by the therapist and the patient feels deeply understood, explicit self-expression by the therapist may not be necessary for the patient to experience the therapist's genuine presence (P. Ornstein, 2000, personal communication). There also appears to be a relative lack of exploration and emphasis on how interpretive moments are often experienced as very affect-laden, personal, and experience-near by patient and therapist, which was identified by Tolpin (1988) as "optimal affective engagement." Providing the patient with direct expression of the therapist's experiences in a noninterpretive and supportive mode seems to run the risk of missing core aspects of the repetitive dimension or trailing edge of the transference. Stolorow (1999) explains that, when the therapist attempts to provide closeness and support in an effort to avoid painful repetition of past childhood trauma, the primary goal of working through of the patient's inner experience may be neglected. Thus, clinical models and techniques primarily oriented toward rescue and relief from enduring pain seem to lack the requisite empathic focus on the more shameful and agonizing self-states, which if left unresolved, will remain pathogenic.

Within self psychology, the model of optimal responsiveness proposed by Bacal and numerous contributors (1985, 1997; Bacal et al., 1999) promotes the explicit sharing of the therapist's experience as a distinct selfobject experience. Herzog (1998) notes that, when the therapist communicates that he or she shares the patient's experience and its associated affect state, it may provide an optimal response in psychoanalytic treatment. He emphasizes, "I believe that the need to engage in the sharing of affect with a significant other is one of the specific components involved in the establishment of an empathic connection in therapy" (p. 176). "The empathically attuned therapist may now consider that, in order to be optimally responsive to the patient, he might indicate in one way or another that he cannot only understand the patient's experience, but that he is actually sharing in that experience" (p. 189).

Similarly, L. Jacobs (1998) states, "But at crucial points in therapy, for instance, in efforts to address serious disruptions in the therapy relationship, or at certain developmental thresholds, the patient may be intensely interested in, and require, access to the therapist's experiencing" (p. 199). "There often comes a time when the empathic inquiry into the patient's experience leads to an apprehension that the patient seeks to meet the analyst's otherness" (p. 202). Preston (1998) describes "expressive relating" as "the authentic expression of feelings and perceptions on the part of the analyst, arising out of the immediacy of the interaction and conveyed in a conscious and responsive way" (p. 204). She adds, "Mutuality requires that the analyst cultivate an attitude of openness and personal sharing" (p. 211).

Many relational analysts propose that therapist self-disclosure validates the patient's emotional responses and promotes the feeling and recognition of hidden affects. Maroda (2002) refers to therapist self-disclosure of affect as the essential therapeutic action. She states "There are many times when neither interpretation nor empathy succeed in the difficult task of communicating with a patient who is in the throes of deep, primitive feelings. They (patients) want, and need, an emotional response and will typically keep stimulating the analyst until they get one" (p. 114). Safran (2002) notes that the therapist's ability to understand and disembed from unconscious enactments often involves countertransference disclosure. He states, "For example, by acknowledging to the patient one's feelings of being stuck or hopeless, one can reopen for oneself an analytic space that had previously been collapsed" (p. 183).

We believe that patients and therapists can experience intense emotional resonance during deeply moving interpretive moments that contain and convey a sense of the therapist's subjective experience. We do not dismiss the possible therapeutic benefit of the therapist responding to questions about how he or she experiences the patient or a particular event in or out of the treatment setting. Spontaneous, improvisational and emotionally expressive responses by the therapist have an important role in promoting and deepening the treatment process (Stern et al., 1998; Ringstrom, 2001). Shared feelings, perceptions, or activities by the therapist are not a substitute for the interpretive process; they are different ways of responding and relating. As Siegel (1999) notes, there is a danger of diminishing, if not losing, the central role of the interpretive process because there is an increasing emphasis on providing missing psychological experiences (p. 77). This loss becomes particularly problematic in that the subtleties associated with explicit self-disclosure remain very unclear and may represent a number of attitudes toward the patient, some of which may not be therapeutically beneficial (Busch, 1998). It is important to clarify how intensely experienced emotions in the therapist can be conveyed through empathic interpretations and silent moments of emotional resonance. Such elucidation further assists us in identifying the connection-promoting and transformative aspects of working in the interpretive mode.

The Ornsteins (1996, 1998) have emphasized that "speaking in the interpretive mode" is the articulation of the therapist's perceptions of the patient's subjective experiences. They provide clinical illustrations of how articulating empathic understanding of the client's experience conveys the therapist's genuine involvement through his persistent effort at making contact with the patient's subjective world. Experiencing the therapist as making an effort to more deeply understand the patient also facilitates the use of the therapist as a needed selfobject. It is imperative to note that such empathic contact is usually experienced by patients and therapists as very connecting and genuine because it is based on a mutually constructed sense of meaning. As Kohut (1984) stated, the analyst's "on the whole adequately maintained understanding leads to the patient's increasing realization that, contrary to his experiences in childhood, the sustaining echo of empathic resonance is indeed available in this world" (p. 78). His reference to empathic responsiveness includes aspects of warmth and emotional presence that result from the therapist's deep involvement and concern. It is important to note that emotional responsiveness is not a technique, as has been suggested in the term countertransference technique. A sense of affective realness involves an empathic resonance with the patient's feelings and needs, which is dependent upon the therapist's capacity to recognize and connect with his or her own subjective experience as well as the patient's. The notion that this experience must be articulated by the therapist to be deeply felt by the patient is simplistic and does utilize more recent intersubjective and developmental theory. These models suggest that "understanding of the other and being understood by the other is an indivisible process that is mutually regulated on a moment-to-moment basis" (Sucharov, 2000, p. 275).

Stolorow (1994) defines interpretation as "an act of illuminating personal meaning" (p. 43). He underscores the importance of showing the analyst's attunement to the patient's affective states and developmental longings through interpretations that provide the patient with a new experience of being deeply understood. We are in agreement with Cooper (1998), who writes that analytic authenticity is the precondition of interpretation. He states, "To some extent the analyst's personal participation and subjectivity are involved in every interpretive effort. The subjectivity of the analyst is embedded in other functions besides self-disclosure" (p. 383). As such, a feeling of genuine connection is not necessarily more experientially present in self-disclosure than it is in interpretive moments. Mitchell (1998) echoes this sentiment in stating, "Authenticity in the analyst has less to do with saying everything than in the genuineness of what is said" (p. 86). Gill (1982) cautioned that "the analyst must recognize that his subjective experience may be as defensive on his own part as he believes the patient's conscious attitudes are. Therefore he cannot assume that if he reports his own experience that is the end of the story" (p. 228). Aron (1996) has cautioned that "for analysts simply and directly to say what they are experiencing may encourage the assumption that they are fully aware of their motivations and meanings" (p. 84). These cautions appear to be sorely needed at a time when many clinicians are promoting the therapist's explicit articulation of their own feelings, perceptions, and needs as an optimal response. These models suggest that this type of therapeutic interaction provide the patient with an experience of authentic and truthful "contact." We believe that this current emphasis fails to acknowledge that empathic interpretations are made up of the analyst's cognitive and emotional understanding, including the expressive use of the therapist's subjectivity, and that an interpretive process facilitates the patient's increased depth of insight and emotional connection with the psychotherapist.

The T...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Contributors
• Preface
• Introduction
• I THEORY
• II CLINICAL
• III APPLIED
• IV A PERSONAL MEMOIR
• Author Index
• Subject Index