Peter Jay Stein, MD, MA
Something Of Value - From Drive Theory to Infant Research
"...The empathic, intersubjective, attachment bond of patient and psychotherapist is the therapeutic bridge through which both patient and therapist struggle together, towards the patient's gradual, healthy liberation from the tyranny of emotional bondage (or the bondage of emotional tyranny)..." (peter j stein md, ma - april 29, 2012). As per recent presentations by Anthony Bass, PhD (April, 2012), and Malcolm Slavin, PhD (March, 2012), current focus (as originally suggested by Sandor Ferenczi, 1873-1933), involves the dialogue between the unconscious of both the patient and the analyst, the patient needing the analyst to acknowledge the truths that the patient perceives of the analyst's unconscious.
Current psychoanalytic thought represents the amalgamated precipitant (or precipitating amalgam) of 117 years (from year 1895 - Freud's posthumously published "Project for a Scientific Psychology") of innovative synthesis, from Freudian instinct or drive theory, through many transformations and tributaries. One such contemporary tributary, motivational systems theory, is an ambitious theoretical framework, that explores meanings and relationships, evidenced in the patient/psychotherapist dyad, consistent with contemporary explanations in cognitive science, neuroscience, and infant research. It is within infant research, furthermore, that Beatrice Beebe, PhD, et. al., explore the structure of relatedness, itself, via the microanalysis, frame by frame, moment by moment, of mother-infant interactions (Beebe, Lachmann, 2002; with Knoblauch, Rustin, Sorter, 2005; with Jaffe, Markese, et al., 2010). Current neurobiological evidence validates that the quality of early caregiver attunement can trump genetic predispositions, and has causal connections to adult affect regulation (Pally, 2005, pp.109-202).
Freud (1856-1939), the towering, scientific, and cultural icon since 1900, the "Father of Psychoanalysis", postulated an 'intrapsychic' model of the mind, dynamically grounded in unconscious conflicts related to the inhibitions of sexual and aggressive instinctual impulses, derived from homo sapiens' mammalian heritage, expressed during infancy and childhood; however, Freud never systematically studied infants and children, but synthesized formulations from the retroactive reconstructions of his adult patients' memories, dreams, and associations. Freud emphasized the primacy of internal drives as more persuasive an explanation than relational influences, in understanding human motivation. Reflecting a "one-person" theory, the psychotherapist, in Freudian models, is the objective observer who dispassionately interprets the patient's inner conflicts between his/her wishes and prohibitions, as they are discovered, uncovered, and explored within the transference relationship between patient and psychotherapist.
A dramatic shift became evident in the 1970's, with precursors in Ferenczi, Sullivan ("participant-observer"), Winnicott, and others, when Heinz Kohut (1913-1981) gradually and eventually abandoned drive theory, formulating an empathic, interactive, psychological perspective, which more accurately captures the patient's pressing concerns: to be valued, mirrored, recognized, known, and praised in the eyes and mind of another. Presaged by Sullivan and Fairbairn, Kohut posited that significant others, throughout the life cycle, serve 'selfobject functions', that promote cohesiveness, validation, and emotional regulation, thereby fulfilling one's "selfobject needs", within a "self-selfobject matrix" (Fosshage (on Kohut, 1984), ibid, p.94). Unfortunately, there exists inevitable degrees of psychic trauma of parental and environmental empathic failure to provide "good enough" (Winnicott) selfobject functions. As Stolorow clarifies (Stolorow, R. 2007): "Trauma is constituted in an intersubjective context in which severe emotional pain cannot find a relational home in which it can be held. In such a context, painful affect states become unendurable- that is, traumatic".
The patient seeks to avoid emotional retraumatization, i.e., being misunderstood, dismissed, or humiliated, triggering for some therapeutic dyads an adversarial relationship between the patient and the psychotherapist, particularly when the psychotherapist: "...fails to decenter from the structures of experience into which he has been assimilating his patient's communications..." (Stolorow, et al, 1987). The patient implicitly longs to resume efforts towards higher developmental aspirations, representative of emotional freedom and authenticity, with the help of the psychotherapist's vitalizing responses. The psychotherapist, recognizing the inertia generated by the patient's relationally-based "organizing principles" of infancy and childhood, aims to promote the resumption of the healthy "leading edge", "forward edge", or "growing edge" of emotional development from which the patient was side-tracked, her vitalizing responses recognizing, resonating with, and helping to reorganize the patient's unique inner strivings (Miller on Kohut, 1985; Tolpin, 2001, 2002).
The ramifications of Heisenberg's Uncertainty Principle for psychology; the recognition and elaboration of Bowlby's inborn attachment behaviors that compel (motivate) proximity to the caregiver; Kohut's introduction of vicarious empathic introspection; the influential writings of Gadamer's hermeneutics, emphasizing contextual interpretations; the elaboration of Relational theory by Mitchell (2000); the intersubjectivist sensibilities of "experience-near" formulations that recognize dynamically bi-directional mother-infant systems; and the recent psychoanalytic applications of complexity theory, have weakened Freud's influencial grip of mechanistic, deterministic concepts, that posit an objectively observable, isolated, intrapsychic mental apparatus, archeologically unearthed, about which one can hypothesize. The current focus on non-conscious, 'implicit' processing, memory, and relational knowing, however, must be compared to and contrasted with Freud's archeological, 'uncovering' metaphor, to clarify the heuristic value of these contemporary concepts.
The language of intersubjectivity (Stolorow, Atwood, Orange, Brandchaft) reflects a more refined appreciation of bi-directional, dyadic modes of communication, contextually embedded in wider, interactive, interpenetrating systems. A more precisely defined, subjectively-felt human psychological condition is grounded in implicit (non-conscious), "prereflective" (Contexts of Being, Stolorow & Atwood, 1992, p. 29), dimensions of organizing patterns of experience, that can be recognized, understood, productively transformed, or possibly circumvented through newly created implicit patterns, facilitated by explicit (conscious) modes of verbal communication, during the therapeutic encounter.
Recent neuroscientific hypotheses describe the vital imprinting, within the right orbital pre-frontal cortex, of mother-infant attachment experiences, within the first 2 years of infancy, deemed central to emotional development (Schore, 2003, p. 6; 2012), which also neuroanatomically localize Kohut's "mirroring" functions. Such mutually attuned, synchronized (or poorly attuned, non-synchronized) processes within the mother-infant dyad, are visibly identified through infant research video studies, mentioned above. For Beebe and Lachmann, these bi-directional, affect-regulating, intersubjective, implicit and explicit, fundamental mother/infant exchanges suggest a foundation for the accurate assessment of the individual's future capacities for emotional security, activity, and satisfying relationships, and may provide the guiding principles for adult psychoanalytic psychotherapy, including the structures of relatedness (2005), and the nature of therapeutic action. Lachmann further clarifies that "...When self- and interactive regulation are in balance, neither predominates or is exclusive in organizing the dyad's interactions. In this balance there is a flexible foreground-background relationship between the two, and interactive regulation is in the midrange, neither excessive nor insufficient..." (2000, p. 34).
Complexity theory, or nonlinear dynamic systems theory, posits yet a wider explanatory vision of emotions and therapeutic action: a multisystemic view, with multiple sources of influence, from "...past, present, and imagined future..." (Coburn, 2007), that contribute to emergent, spontaneous, unpredictable patterns of self-systemic and inrasystemic regulation and reorganization. How will such formulations influence the conceptions regarding the privileged status of the patient's subjectively-felt experience, as the authentic source of personal meaning and authentic being?
Drs. Lichtenberg, Lachmann, and Fosshage, in Psychoanalysis and Motivational Systems - A New Look (2010) have formulated an ambitious mapping of this evolving psychological terrain. Integrating the seminal ideas of complex, non-linear dynamic systems theory; fractals (the discarded patterns of systems in flux); and intersubjectivity sensibilities, the authors, expanding on their prior publications, propose a comprehensive theoretical framework, that encompasses the latest findings in the cognitive sciences, neuroscience, infant research, and psychoanalysis.