Academic journal article American Journal of Psychotherapy

Revolution and Evolution: A Brief Intellectual History of American Psychoanalysis during the Past Two Decades

Academic journal article American Journal of Psychotherapy

Revolution and Evolution: A Brief Intellectual History of American Psychoanalysis during the Past Two Decades

Article excerpt

The past twenty years have witnessed revolutionary changes in the theory and practice of psychoanalysis in the United States. The previously dominant clinical model of ego psychology with its emphasis on ubiquitous unconscious conflict between instinctual drives and the demands of reality and conscience, all mediated by the ego, is now but one of an array of differing theoretical views vying for attention. The alternative competing theoretical and clinical domains can be loosely categorized under the rubrics of object relations, self psychology, and the off-shoots of these which include the relational and intersubjective frames. These insurgent models of mental functioning and development, all of which grow out of object relations theory and thus overlap conceptually, have significant implications for psychoanalytic technique.

It is the purpose of this article to review aspects of these models and the historic and revolutionary changes that their appearance have effected in the psychoanalytic landscape. A brief summary will also be made of the more evolutionary advances that have occurred in ego psychology during the past two decades. The extant literature on these issues is complex and voluminous, not to say vast. In advance, I apologize for the necessarily selective and even idiosyncratic nature of this paper. Inevitably, many original and important contributions to the evolving mosaic that makes up contemporary psychoanalysis are ignored or short-changed.

SELF PSYCHOLOGY

'Love seeketh only Self to please, To bind another to its delight, Joys in another's loss of ease, And builds a Hell in Heaven's despite'

-Blake

The advent of Heinz Kohut's 1971 monograph, The Analysis of the Self (1), marks the beginning of the revolutionary movement in American psychoanalysis. Kohut's clinical work with narcissistic disturbances led him to postulate a separate narcissistic line of development occurring alongside psychosexual and ego development. As his theory evolved, he developed a complete self psychology and abandoned concepts of instinctual drives as primary (2). Kohut's view, like earlier object relations theorists, most notably Fairbairn (3), is an environmentalist one which posits that early and pervasive empathic failures on the part of parents or their surrogates leads to what he termed self-object failures and developmental arrests. Psychopathology is no longer viewed as a manifestation of inadequately resolved conflict as it is in the ego psychology model, but as a reflection of deficits in development that result in defective internal self-structures.

In a remarkable clinical paper "The Two Analyses of Mr. Z" (4), Kohut contrasted his use of the "classical" conflict model in his treatment of a male patient with the subsequent utilization of the self-psychology deficit model in the patient's second analysis. In the first analysis Kohut notes: The centre of the analytic stage was-occupied-by transference phenomena and memories concerning his, as I then saw it, pathogenic conflicts in the area of infantile sexuality and aggression-his Oedipus complex, his castration anxiety, his childhood masturbation, his fantasy of the phallic woman, and especially, his preoccupation with the primal scene. (p. 5)

Kohut's initial approach to the patient's narcissistic disturbances manifest in grandiosity and narcissistic demands was that

[they] were worked through, both in so far as they were the continuation of his fixation on the pre-oedipal mother and in so far as they were clung to as a defense against oedipal competitiveness and castration fear. (p. 8)

Pleased with the clinical work he had conducted, Kohut felt that,

everything seemed to have fallen into place. We had reached the oedipal conflict, the formerly unconscious ambivalence toward the oedipal father had come to the fore, there were the expected attempts at regressive evasion and temporary exacerbations of pre-oedipal conflict and there was ultimately a period of anticipatory mourning for the analyst and the relationship with him-It all seemed right. …

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