Controversies and Critiques

1. Controversies and Critiques Geoff Goodman, Ph.D.

2. I. Drive/Structure Model • Treatment of neuroses • hysteria • obsessive- compulsive disorder • phobias B. Conflicts centered around resolution of the Oedipus complex C. Organized around wishes and defenses D. Analyst functions as “blank screen” or “reflecting mirror” (Freud, 1912)

3. Continued… E. Transference • reflects patient’s developmental history • consists of demands made upon early objects and defenses against these demands F. Countertransference • reflects unresolved neurotic conflicts in analyst • transference triggers countertransference (repressed material) • interferes with the unfolding of transference

4. Continued… G. Development • integration of infantile impulses into structured, unitary aims • interpretation of defenses and impulses helps to resume developmental processes H. Therapeutic action • interpretation • insight • care

5. II. Relational/Structure Model • Treatment of severe disturbance • borderline personality disorder • narcissism • schizoid personality disorder B. Deficits experienced prior to the Oedipus complex C. Organized around inconsistent experience of themselves and others (splitting, dissociation) D. Analyst functions as co-participant in the analytic process

6. Continued… E. Transference 1. reflects patient’s developmental history as well as analyst’s behavior 2. elicits specific behaviors in analyst, which in turn elicits further transference reactions F. Counter transference 1. inevitable product of the interaction between the patient and the analyst 2. provides clues to transference reactions 3. facilitates the unfolding of transference

7. Continued… G. Development • processes frozen in time (failure or arrest) • provision of caring, empathetic relationship that serves parental functions stimulates developmental processes H. Therapeutic action • relationship experience (“corrective emotional experience”) • interpretation used to deepen relationship experience • analyst becomes good object of identification

8. III. Attempts at Integrating Two Theoretical Models • Levels of disturbance • Oedipal patients require classical understanding of conflict and interpretation- driven insight • pre-Oedipal patients require relational understanding of deficits and curative relationship experiences

9. Continued… B. Relational model prerequisite to drive/conflict model • working alliance must be functioning first • interpretations accepted only with prior relationship • but working alliance develops only with transference interpretations (Greenson, 1967)

10. IV. Philosophical Differences Between the Two Models • Human beings pursue their own separate aims (e.g., Hobbes, Locke) • pursuit of private pleasures • need for state to protect human beings from themselves B. Human beings pursue community with each other (e.g., Rousseau, Hegel, Marx) • pursuit of social participation as gratifying • need for state to provide opportunities for social fulfillment

11. Continued… C. Drive theory = Hobbes + Locke vision of humanity D. Relational theory = Rousseau + Hegel + Marx vision of humanity

12. V. Trauma Versus Fantasy • Development disrupted by destructive events and actual experiences • Freud’s original idea-- specific event such as sexual abuse • Winnicott’s and Khan’s revision-- “cumulative trauma” “environmental insufficiency”, “impingements”

13. Continued… B. Development disrupted by fantasies based on genetically determined drives • Freud’s rejection of seduction theory-- fantasies distort memory of experience and conflict with each other • Contemporary view- actual events can aggravate or ameliorate fantasies • parenting shaped by inherent temperamental features of parent and child (e.g., Nathaniel)

14. VI. Conflict Verses Arrested Development (Pause Button) • Neurosis is product of mental warfare • drives in conflict with each other • drives in conflict with repressive forces B. Disturbance is product of failed parenting-- lack of empathy, responsiveness, mirroring • developmental processes halted by environmental deficits • parental functions must be provided to resume development • traumatic, unintegrated, dissociated, representations of early interactions

15. VII. Gender and Sexuality • Anatomy is destiny • gender development is fixed-corollary to sexual development • for boys, fear of losing penis • for girls, longing for penis substitutes

16. B. Sexuality in context 1. primary struggle to integrate love and hatred (Klein) 2. reproduction = proof of reparative strivings 3. penis envy represents wish for equality (Clara Thompson) 4. castration anxiety represents dread of vagina (Chassequet- Smirgel) 5. nature itself is a socially constructed category 6. heterosexuality is as puzzling as homosexuality

17. VIII. Empiricism Versus Hermeneutics • Psychoanalysis is an empirical discipline (Freud) • produces scientific facts • hypotheses testable through clearly defined procedures • analyst is objective investigator • psychoanalytic situation is lab environment • subject to confirmation through empirical evidence outside the psychoanalytic situation

18. Continued… B. Psychoanalytic interpretations help patient construct a coherent, consistent narrative (hermeneutic approach) • objective knowledge cannot be uncovered • analyst seeks narrative truth, not historical truth • theory might not operate independently of data collection (I.Z. Hoffman & D. Stern) • empirical validation is not ultimate adjudicator of psychoanalytic truth (Spezzano)