Working Intersubjectively - Contextualism in Psychoanalytic Practice
DONNA M. ORANGE - GEORGE E. ATWOOD - R. STOLOROW
"...Intersubjectivity theory intends to describe the emergence and modification of subjectivity, and defines these processes as irreducibly relational...", (p. 4)
"...all selfhood...develops and is maintained within, and as a function of, the interplay between subjectivities..." (ibid., p. 6)
"...the analytic situation [is] recognized as a dyadic intersubjective system of reciprocal mutual influence, to which the organizing activites of both participants make ongoing, codetermining contributions..." (Ibid., p. 43)
"...empathic-introspective inquiry...seeks to illuminate [3 dimensions: ]...the principles [that are] unconsciously organizing the patient's experience (empathy)......the analyst's experience (introspection), and......the oscillating psychological field created by the interplay between the two (intersubjectivity)..." (ibid, pgs 43-44)
"...the analytic process [is] the unfolding, exploration, illumination, and transformation of the patient's subjective world..." (ibid, p.44)"...clinically...psychoanalytic work [is] always embedded in constitutive process [which} means temporality and history. To work contextually is to work developmentally [i.e.]...to maintain a continuing sensibility to past, present, and future experience...[an] ongoing sensitivity and relentless attention to a multiplicity of contexts - developmental, relational, gender-related, cultural, and so on (Orange, Atwood, and Stolorow, 1997..." (Worlds of Experience, 2002, p. 83-84)).
"...intersubjectivity [refers]...to the relational contexts in which all experience, at whatever developmental level, linguistic or prelinguistic, shared or solitary, takes form (Stolorow and Atwood, 1992)...an intersubjective field [i.e.] any system constituted by interacting experiential worlds - is neither a mode of experience nor a sharing of experience. It is the contextual precondition for having any experience at all (Orange, Atwood, and Stolorow, 1997)..." (Worlds of Experience, 2002, p. 85)).
"...there are three indispensable components to an intersubjective clinical sensibility. First (are)...the ORGANIZING PRINCIPLES, whether automatic and rigid, or reflective and flexible...(are) often unconscious, (and) are the emotional conclusions a person has drawn from lifelong experience of the emotional environment, especially the complex mutual connections with early caregivers. Until these principles become available for conscious reflection, and until new emotional experience leads a person to envision and expect new forms of emotional connection, these old inferences will thematize the sense of self...[which] includes convictions about the relational consequences of possible forms of being..." (Orange, Atwood, Stolorow, 1997, p. 7).
"...the intersubjective field co-constructed by two individuals includes not just two minds but two bodies...at the psychobiological core of the intersubjective field is the attachment bond of emotional communication and interactive regulation..." (Schore, 2012, p. 40).
THE INTERSUBJECTIVE DYADIC ENCOUNTER
"...the implicit communication of affective states between the right brains of...the infant-mother and the patient-therapist dyads is...best described as intersubjectivity"..." (Schore, 2012, p. 36)
THERAPEUTIC ACTION - A SYNTHESIS
(ADAPTED FROM MARTHA STARK, MD, 2012)
'MUTUAL ENACTMENT AND NEGOTIATION BY BOTH PATIENT AND THERAPIST OF THE INEVITABLE ENTANGLEMENTS THAT EMERGE AT THE INTIMATE EDGE OF THEIR AUTHENTIC ENGAGEMENT'
WHAT THE PATIENT NEEDS:
A VALIDATING EXPERIENCE
In recent years, Stolorow, Atwood, Brandschaft, and Orange have presented further clarifications of the hermeneutic tradition, and the implications of abandoning a one-person psychology, whereby they organized, clarified, and redefined 'classical' terms, mapping out the fuller implications towards theory and treatment, of an intersubjective field, fully abandoning the Cartesian myth of the isolated mind:
"...phenomenology has pointed psychoanalysis towards its only legitimate starting point, the subject's experience [and]...requires that we put aside preconceptions...to work as completely as possible within the subjective experience of the patient..." (D. Orange, Emotional Understanding, 1995, p. 55).
AN OUTLINE OF INTERSUBJECTIVITY BASICS:
(from Contexts of Being, Stolorow & Atwood, 1992)
1) the intersubjective field (p. 3-4):
any psychological field formed by interacting worlds of experience...a system formed by the reciprocal interplay between two (or more) subjective worlds
2) transference (p.23-24):
a) repetitive dimension - a source of conflict and resistance, the patient fears a repetition with the analyst of early experiences of parental empathic failure.
b) selfobject dimension - the patient yearns for the analyst to provide selfobject experiences that were missing or insufficient during the formative years.
3) three realms of the unconscious (p. 33):
a) prereflective - contains the organizing principles that unconsciously shape and thematize a person's experience
b) dynamic - contains experiences/affects that were denied articulation (dissociated) because they were perceived to threaten needed ties
c) unvalidated - contains unintegrated affect states related to experiences that are denied articulation, due to their failure to evoke the requisite attuned responsiveness from the caregiver.
the fear of retraumatization, i.e., of being dismissed, negated, violated, humiliated, shamed, and misunderstood, manifested within the repetitive dimension of the transference
5) therapeutic action:
release, emergence, and integration of dissociated affect within the empathically attuned milieu of the dyad