(in English)

CONTEMPORARY CONTROVERSIAL DISCUSSIONS, INTERSUBJECTIVITY AND THE FUTURE OF PSYCHOANALYSIS

This paper has been translated into Italian by Giuseppe Leo inside the psychoanalytic journal Frenis Zero ( www.freniszero.tk ) (n.16, june 2011) in a special number concerning "Psychoanalysis and Research". We thanks the author for the permission to translate and to insert the original paper inside Frenis Zero  and Thalassa web sites.

 Helmut Thomä is psychoanalyst and past president of the German Psychoanalytic Association. He directed the Ulm University Psychotherapy Department and the Psychoanalytic Institute of the same  town. He was one of the two leading German post war psychoanalysts who, together with A. Mitscherlich, established psychoanalysis within German academic circles, shaping the Heidelberg Psychosomatic Clinic in the 50’s and 60;’s. He was deeply influenced by his one year stay at the Yale Psychiatric Institute where he formed close lifelong relationships with John Kafka and Theodor Lidz. His first academic achievement was a monograph on anorexia nervosa in German in 1961. In 1967 it became the first German psychoanalytic work translated into English. His role as President of the German Psychoanalytic Association from 1968-1972 was critical for the growth of the German Psychoanalytic Association (DPV) Another year of training in London with Michael Balint stimulated his interests in psychoanalytic process research which became his major research focus when he became Director of the Ulm Department of Psychotherapy in 1967, where he served until 1989. Together with Horst Kaechele they established the Ulm Psychoanalytic Process Research Program that, among other academic achievements, led to the Ulm Textbook of Psychoanalytic Therapy, which has been translated, into 15 languages. It is available in German, English, Spanish, Italian and Russian on the web.

1. During the early 1940’s, the historical „controversial discussions“ (King und Steiner 1991) in London were mainly based on an ideological fundament. Anna Freud and Melanie Klein and their adherents claimed to represent the true heirs of Freud’s work.

Fortunately, the arguments led to a compromise that did not result in the exclusion of persons or groups from the IPA. For the first time in the history of psychoanalysis, quite different models were accepted in the same training institute. It took some decades until the loss of common ground was officially recognized (Wallerstein 1988, 1990). Casement’s publication „Who Owns Psychoanalysis?“ (2004) sheds light on the fact that psychoanalysis does not belong to the IPA only. The ideas of Freud are part and parcel of cultural history. The present crisis, in its nature different from previous ones, does not only have its bleak side. Sooner or later all schools of psychotherapy will discover anew various psychoanalytic findings, although this might happen without public acknowledgement. As we all know, crises potentially hold new possibilities. I hope my contribution will substantiate this point.

2. Although pluralism is widely accepted nowadays, old controversies continue in contemporary controversial discussions. Simultaneously, we witness how “true controversies” – a title introduced by Bernardi (2002) and Eizirik (2006) – develop.

They grow on the psychoanalytic soil as a human science. Our method exposes itself to adequate empirical validation of its foundation and investigation into its therapeutic efficacy and efficiency. I hope that our efforts will lead to a comparative psychoanalysis, i. e. to a comparison of psychoanalytic processes of different schools in respect to their outcome. In a nutshell, we have two quite different controversies.

On the one hand a scientific discourse, which will modernize psychoanalysis and potentially turn the current crisis into a productive direction. The other line of arguments can be characterized as dogmatic and anti-scientific, as the historical controversial discussions were. They disregard a very basic responsibility we all have.

I agree with Renik’s statements: „ ... many analysts do not consider clinical analysis primarily a therapy, as I do, and do not use therapeutic outcome as the primary dependent variable to be followed when testing psychoanalytic hypotheses. They conceptualize ‚analytic’ goals, distinct from ‚therapeutic’ ones.“ (Renik 1998, p. 495).

The clinical process and outcome research that has been at the centre of my work for 45 years is confronted with the same arguments put forward in the discussion between Wallerstein and Green, Kernberg and Perron, Fonagy and Perron. Often, empirical research is falsely identified with the natural science model of the so-called unity of science and with theory-free empiricism and outdated behaviorism. Many analysts are in opposition to any research and decline scientific reasoning of any kind. Green (2004), for instance, states that science of psychoanalysis does not exist, but only “psychoanalytic thinking”. Is it not an empty truism that all analysts think analytically? The section “Psychoanalysts at work” in the International Journal proves it. I regularly read it. Sometimes, I understand the thinking behind the descriptions of the vignettes. Usually, I am at a loss. Without additional information about categories and criteria the field is open for the readers’ fantasy about the countertransference fantasies of the treating analyst. Often one reads more about the analyst’s countertransference than about the patient’s associations. Analytic thinking cannot remain in an abstract space, so to say free-floating in mid-air, but must be anchored in tentative concepts related to psychological phenomena.

3. Many psychoanalytic schools participate in on a long-standing development that focuses on the reciprocal relationship of the intrapsychic to the intersubjective.

Intersubjectivity was Freud’s latent paradigm (Altmeyer und Thomä 2006). This is definitely the turning point from a monadic point of view towards the perspective of a network of intersubjective relations: The permanent exchange between the inner world of thoughts and feelings and reality of our human environment leads to the formation of individual psychic structures. Although this is very old psychoanalytic knowledge, the consequences implied by this for the psychoanalytic situation is of a new quality.

The rigid understanding of neutrality, for instance, resulted in a very impersonal attitude. Isn’t it characteristic that P. Heimann (1978) only at the end of her life entitled a paper “On the necessity for the analyst to be natural with his patient”? A self-disclosure within an intersubjective model has nothing to do with personal confessions. The therapeutic relationship remains asymmetrical. But the patient, of course, knows that his analyst is a human being and therefore emotionally involved. It was an essential step in my professional development towards a relational psychoanalysis when I discovered the therapeutic quality of a mitigated self-disclosure introduced by Winnicott (1949). In my experience, all patients are relieved and satisfied when I admit my affective reactions. Patients understand that my professional role and my knowledge bring about a kind of distance, which softens my emotional reactions. Generally , our professional role and knowledge diminish emotional extremes. Otherwise, psychoanalysis would indeed be an “impossible profession” (Freud 1937 c).

4. A major part of our present problems is due to the fact that Freud invented a method that serves two masters: the intersubjective quality of the exchange and objectivity. He was well aware of the fact that there is no observation free of theory (Freud 1915 c). It was quite natural for him to rely upon the natural sciences of his time in describing psychological phenomena. Originally an experimental researcher, he tried to transform the intersubjective analytic situation into a quasi-experimental “social null situation”, as de Swaan (1980 p. 405) called it almost a century later. A set of rules and regulations, often expressed in impressive metaphors, served this aim. He expressed his concern that “the therapy will … destroy the science” (1927 p. 254). Freud believed that with the help of a set of strict and non-tendentious treatment rules he would be able to secure the best possible prerequisites for etiological reconstructions.

Furthermore, he thought that he had created the best possible therapeutic conditions for uncovering repressed early memories. This conjunction is expressed in his famous “junktim”-assertion translated by Strachey as the “inseparable bond” between Heilen and Forschen. I quote this at first in German, because the most important words are usually omitted: „ … die Erkenntnis brachte den Erfolg, man konnte nicht behandeln, ohne etwas Neues zu erfahren, man gewann keine Aufklärung, ohne ihre wohltätige Wirkung zu erleben. Unser analytisches Verfahren ist das einzige, bei dem dies kostbare Zusammentreffen gewahrt bleibt.“ (Freud 1927 a, p. 293 f.; emphasis added).

In English: “In psychoanalysis, there has existed from the very first an inseparable bond between cure and research. Knowledge brought therapeutic success. It was impossible to treat a patient without learning something new: it was impossible to gain fresh insight without perceiving its beneficent results (wohltätige Wirkung). Our analytic procedure is the only one in which this precious conjunction is assured. This prospect of scientific gain has been the proudest and happiest feature of analytic work”. (Freud 1927 a, p. 256, emphasis added). I repeat: The inseparable bond depends on the validation of the beneficent result. The proof, therefore, of all further questions regarding the validity of the reconstruction completely depends on the beneficent result. The philosopher and analyst Hanly has recently studied this issue (Hanly 2006). But I pose the question: to what extent does the alleged aimlessness and non-tendentiousness comply with the beneficent results brought about by the influence of the analyst by his personified method. There is a deep paradox in Freud’s work.

5. The negative effects of this unresolved paradox are huge. Analysts, who identitfy with the aimless method deceive themselves and subsequently their patients bona fide.

Many analysts have overlooked this destructive self-deception for many decades. Just analyzing was at the core of professional identity. It took the courage of former IPA president Joseph Sandler and his co-author Anna U. Dreher to boldly state: “… is analysis a therapy or is it a scientific procedure which has as its aim simply to analyze, but which may incidentally be therapeutic? The answer to this question has profound implications for the future of psychoanalysis. Our own view, about which we came to be increasingly convinced during the course of writing this book, is that those who believe that the aim of the psychoanalytic method is no more and no less than to analyze are deceiving themselves, and that all analysts are affected in their work by therapeutic aims, whether they know it or not. It will be seen that we regard as naïve the frequently heard view that as analysts we do not have any other aim in our work with our patients than that of analyzing. This view implies that the analyst is able to free himself completely of all therapeutic aims for the patient, keeping only to the goal of pursuing an ‘uncontaminated’ analysis.” (Sandler und Dreher 1996, p. 1-2) When we disclaim that we influence our patients by interpretations and other means, we deny the obvious. More so, if we try to avoid suggestions they reenter through the backdoor. We can even safely say with Strenger: „Instead of eliminating manipulations it opens the door to hidden manipulations“ (Strenger 1995, p. 106).

This is why Strenger argues to lay to rest the myth of purity of our interpretations and why he supports the notion that we have to fully recognize the intersubjective‚ contamination’ of clinical phenomena. The psychoanalytic interaction research starts with clinical discussions that distinguish between various forms of suggestions, i. e. by a kind of decontamination.

6. The motto “just analyzing” implies the myth of aimlessness. According to Bott Spillius’ (1997) investigations, almost all contemporary Kleinians (with the exception of Steiner) pursue no objective. This is an anti-movement directed against a psychoanalysis that maintains its enlightening function in modern times. This function is propelling the scientific advancement in a critical and interdisciplinary dialogue. At the same time, there is a growing insecurity and a deep concern about the loss of recious wisdom accumulated by creative practitioners in a century. There is a strong, very conservative tendency called psychoanalytic fundamentalism that is directed against intersubjectivity. We witness a revival of the practice to banish new developments as deviations from “true” psychoanalysis. Hanna Segal (2006), for instance, even accuses the British Middle Group, now called The Independents, of having given up to search for psychoanalytic truth. "In further developments, the Middle Group, which changed its name to the Independents, also established a new model of the mind, deriving from Ferenczi and developed by Balint, Winnicott, and, later in the United States, by Kohut. The fundamental difference between this model and those of Freud, Klein, and their followers lay not in the fact that it took into account new clinical evidence, but rather in the kinds of uses that it made of clinical evidence. A new concern emerged that focused on various notions of cure and change that did not rest on attaining truth and that considered the personal influences of the analyst - e.g., his support, advice, and comfort - to be integral to the analytic process.

Here the changes in technique were of a kind that made them essentially nonanalytic.

They went against the psychoanalytic effort to bring about change through the search for truth. For when the analyst actively takes upon himself the parental role, he invites the patient to live in a lie. This in turn promotes concrete functioning rather than a symbolization and psychic growth." (Segal 2006, S. 288-289). Hanna Segal calls those changes in technique “essentially nonanalytic” that derive from the intersubjective nature of the analytic encounter and take into account the analytist’s subjectivity. It is implied that the aimless Kleinian “just analyzing” – a self deception according to Sandler and Dreher – does not only serve the search for truth but fulfills Freud’s junktim assertion. This is only an apodictic statement without any proof.

7. The therapeutic process depends mainly on the contribution of the analyst. Michael Balint emphasized this widely accepted point of view. I transformed his idea into a case-reporting schema. In this process, I was greatly influenced by Susan Isaacs’ (1939) paper “Criteria for Interpretation” and by discussions with the Kleinian trained philosopher John Wisdom (1956, 1967). Between 1963 and 1967, the case-report schema was used for the description of psychoanalytic processes at the Heidelberg-Frankfurt Psychoanalytic Institute (Thomä / Houben 1967, Thomä 1967). During those years I grew into an intersubjective psychoanalysis. Since 1976, supervisions by Merton Gill contributed to the development of my psychoanalytic thinking (Gill, Rotmann und Thomä 1999). The development of my psychoanalytic attitude and thinking is outlined in 18 treatment reports that eventually met Spence’s requirements (1986) for such papers. A. E. Meyer (1994) preferred to call such papers not “treatment reports”, but “interaction reports”. In the English version of the Ulm textbook volume 3 on psychoanalytic therapy (Kächele/Schachter/Thomä 2007) we demonstrate criteria for a comparative psychoanalysis.

8. Isaacs’ contribution went much further than just stating criteria for interpretation.

According to her, all psychoanalysts think in causal connections even when interpreting. They come up with tentative diagnostic considerations that subsequently lead to prognostic assumptions within the framework of statistical probabilities.

Fonagy shares this position (2001) in the Open Door Review. The disregard of Isaacs’ paper by the Kleinians speaks volumes toward their scientific attitude. It is neither included in Hinshelwood’s “Dictionary of Kleinian Thought” nor in Bott Spillius’¹ two-volume publication “Melanie Klein Today”. Hanna Segal’s completely unfounded apodictic statement follows the style of the historical controversial discussions. It does not only exclude the English Independents but also thousands of analysts as “essentially nonanalytic”. It is remarkable that most contemporary Freudians liberated themselves from the past. I take the liberty to interpret what true controversies are by referring to Freud: He reaches an encouraging conclusion in his reflection on the transience of beauty, art and intellectual achievement. Freud states that mourning is at some point exhausted and the loss is accepted. Young people then “replace the lost objects by fresh ones equally or still more precious” (Freud 1916 a, p. 307). Most of the contemporary Freudians recognize that their therapeutic function depends on being a new object in the sense of Hans Loewald’s milestone paper (1960). The therapeutic function of the new object lies in the fact that it differs from the old object, which of course was a subject. Similarity and difference are essential categories in human life.

Repetitions appear only contextualized and thus in a partial form. This is the reason for Merton Gill emphasizing the plausibility of the patient’s perception in the transference against its distortion. On the way towards an intersubjective psychoanalysis Merton Gill rehabilitated the recognition of the patient’s perceptions in the transference.

9. As a mystic, Bion is the most influential Kleinian of our time. There is something tragic to it because he himself described the difference between a true mystic and his adherents. He remained a student of Melanie Klein and recommended his technique only to those analysts “whose own analysis has been carried at least far enough for the recognition of paranoid-schizoid and depressive positions“ (Bion 1970 S. 47). On the other hand, his mysticism is serious business and contrary to many opinions his words have to be taken literally and not only figuratively. I quote his famous statements:

“The first point is for the analyst to impose on himself a positive discipline of eschewing memory and desire. I do not mean that ‚forgetting’ is enough: what is required is a positive act of refraining from memory and desire. It may be wondered what state of mind is welcome if desires and memories are not. A term that would express approximately what I need to express is ‚faith’ – faith that there is an ultimate reality and truth – the unknown, unknowable, ‚formless infinite’“(Bion 1970, p. 31).

And from his book „Attention and Interpretation“: „What is to be sought is an activity that is both the restoration of god (the Mother) and the evolution of god (the formless, infinite, ineffable, non-exitstent), which can be found only in the state in which there is NO memory, desire, understanding“. (Bion, 1970, p.129). Bion seeems to be proud of admitting not to know about his famous concepts. For instance, he says about Alpha and Beta-elements the following: „ ... I think there is a lot to be said for considering what I have previously called beta-and alpha-elements, but those are not psychological, because I keep them for something I don’t know and never will know; I am assuming some kind of physical counterpart. But when it does become conscious, then I think it becomes a somewhat fanciful, theoretical construct – speculative imagination, speculative reason.” (Bion 2005, 21). Bions very elusive metaphors are responsible for the theoretical chaos. Curiously enough, their elusiveness has a secret quality and mediates the feeling of being a true analyst. To belong to a group that has access to the deepest unconscious provides a firm security. In addition, the infinite space is open for all kinds of subjective interpretations. Still, we all want to be well contained. Bion created many of the leading metaphors for our profession.

10. The contemporary new edition of the historical controversial discussions follows the traditional struggles for a strict psychoanalysis identity. Instead of an endless repetition of our ideologically based struggle for psychoanalytic "truth" or a new "Schibboleth" I plead for a modern psychoanalysis that strives to resolve its controversies at a scientific level. Indeed, hope is more than justified: since some decades, reforms centering on competence that imply a critical attitude are on their way. I regard the IPA congress in Berlin as an historical moment for what seems to be just a minor reason. However, the program is somehow different. It is expected that “the method of discussion involves a degree of formality and focus … the group will try to look at each “intervention” the presenter made in depth, to try to decide what it seems to have been intended to achieve and what implicit and explicit ideas about psychoanalytic work lie behind it … the aim is to consider different elements of the analyst’s approach and to create an overall picture of how an analyst works based on these components”. This is the format, which makes comparative psychoanalysis and true controversies possible.

Bibliography

Altmeyer M, Thomä H (Hrsg) (2006) Die vernetzte Seele. Stuttgart, Klett-Cotta.

Bernardi R (2002) The need for true controversies in psychoanalysis. The debates on Melanie

Klein and Jacques Lacan in the Rio de la Plata. Int J Psychoanal 83:851-873.

Bion W R (1970) Attention and Interpretation. A scientific approach to insight in

psychoanalysis and groups. London, Tavistock Publications.

Bion W R (2005 a) The Italian Seminars. London, Karnac.

Bion W R (2005 b) The Italian Seminars. London, Karnac.

Bott Spillius E (1988) (ed.) Melanie Klein Today. 2 volumes. London, Routledge.

Bott Spillius E (1996) Ziele des psychoanalytischen Prozesses. In: Tagungsband DPV. Peters

H und Rollwagen T (eds.), p. 65-85.

Casement A. (Eds.). (2004). Who owns psychoanalysis? London, Karnac Books.

Eizirik C L (2006) Psychoanalysis as a work in progress. Int J Psychoanal 87:645-650.

Fonagy P et al. (2001) An Open Door Review of Outcome Studies in Psychoanalysis.

London, International Psychoanalytic Association.

Freud (1915 c) Instincts and their vicissitudes. SE vol. 14, p. 109-140.

Freud S (1916 a) On transience SE vol. 14, p. 303-307.

Freud S (1927a). Postscript to "The question of lay analysis". In SE XX: 251-258.

Freud S (1937 c) Analysis terminable and interminable. SE vol. 23, 209-253.

Gill M M (1982). Analysis of transference. Vol. 1: Theory and technique. New York:

International Universities Press.

Gill M M, Thomä H, Rotmann, J M (1999). Sich der Natur der Interaktion bewusst zu

werden. Psyche 53:905-929.

Green A (2004) Pluralität der Wissenschaften und psychoanalytiscches Deken. In:

Leuzinger-Bohleber M, Deserno H, Hau S (eds). Psychoanalyse als Profession und

Wissenschaft. Die psychoanalytische Methode in Zeiten wissenschaftlicher

Pluralität. Kohlhammer, Stuttgart, p. 33-48.

Green A (2005) The illusion of common ground and mythical pluralism. Int J Psychoanal

37:86:627-632.

Hanly C (2006 c) Pragmatism, Tradition and Truth in Psychoanalysis. American Imago,

63:261-282.

Heimann P (1978) On the necessity for the analyst to be natural with his patient. In: About

Children and Children-No-Longer. Collected Papers 1942-1980. (1989) Eds. Tucket

D, Tonnesmann M, London, Routledge, p. 311-323.

Isaacs S. (1939). Criteria for interpretation. International Journal of Psychoanalysis, 20, 853-

880.

Kächele H, Schachter J, Thomä H (2007) From Psychoanalytic Narrative to Empirical Single

Case Research. Routledge/Analytic Press, New York. (in print)

Kernberg O (2006) The pressing need to increase research in and on psychoanalysis. Int J

Psychoanal, 87:919-928.

Kernberg O (2006) Research anxiety: A response to Roger Perron’s comments. Int J

Psychoanal, 87:933-938.

King P and Steiner R (Hg.) The Freud-Klein Controversies 1941-1945. London, Routledge.

Loewald H W (1960) On the therapeutic acton of psychoanalysis. Int J Psychoanal 41:16-33.

Meyer A. E. (1994). Nieder mit der Novelle als Psychoanalysedarstellung - Hoch lebe die

Interaktionsgeschichte. Zeitschrift für Psychosomatische Medizin und

Psychoanalyse, 40, 77-98.

Perron R (2006) How to do research? Reply to Otto Kernberg. Int J Psychoanal 87:927-932.

Renik O (1998) The analyst’s subjectivity and the analyst’s objectivity. Int J Psychoanal

79:487-489.

Sandler J and Dreher A U (1996) What do Psychoanalysts want? London, Routledge.

Segal H (2006) Reflection on Truth, Tradition, and the Psychoanalytic Tradition of Truth.

American Imago, 63:283-291.

Swaan A. d. (1980). On the sociogenesis of the psychoanalytic situation. Psychoanalysos and

Contemporary Thought, 3, 381-413.

Spence D P (1986). When interpretation masquerades as explanation. Journal of the American

Psychoanalytic Association, 34, 3-22.

Strenger C. (1991). Between hermeneutics and science. An essay on the epistemology of

psychoanalysis. Madison, International Universities Press.

Thomä H (1967) Konversionstheorie und weiblicher Kastrationskomplex. Psyche - Z

Psychoanal 21: 827-847

Thomä H, Houben A (1967) Über die Validierung psychoanalytischer Theorien durch die

Untersuchung von Deutungsaktionen. Psyche - Z Psychoanal 21: 664-692

Wallerstein R S (1988). One psychoanalysis or many? International Journal of

Psychoanalysis, 69, 5-21.

Wallerstein R S (1990). Psychoanalysis. The common ground. International Journal of

Psychoanalysis, 71, 3-20.

Winnicott D W (1949) Hate in the countertransference. Int J Psychoanal 30: 69-74. Wisdom

(1963).

Wisdom J O (1956) Psycho-analytic technology. Br J Philosophy Sci 7: 13-28.

Wisdom J O (1967). Testing an interpretation within a session. International Journal of

Psychoanalysis, 48, 44-52.