(Ronald R - Lee, J - Colby Martin) Psychotherapy After Kohut

Psychotherapy
After Kohut
A Textbook of
Self Psychology
Copyrighted Material
Psychotherapy
After Kohut
A Textbook of
Self Psychology
Ronald R. Lee
J. Colby Martin
THE ANALYTIC PRESS

1991 Hillsdale, NJ London
Copyright © 1991 by the Analytic Press
All rights reserved. No part of this book may be reproduced in any form, by
photostat, microform, retrieval system, or any other means, without the prior
written permission of the publisher.
Published by
The Analytic Press
365 Broadway
Hillsdale, NJ 07642
Set in Garamond Light type by

Sally Ann Zegarelli, Long Branch, NJ 07740
Library of Congress Cataloging-in-Publication Data
Lee, Ronald R.
Psychotherapy after Kohut : a textbook of self psychology / Ronald
K. Lee, J. Colby Martin.
p. cm.
Includes bibliographical references and indexes.
ISBN 0-88163-129-9
1. Self psychology. 2. Psychotherapy. I. Martin, J. Colby.
II. Tide.
[DNLM: 1. Ego. 2. Psychoanalytic Theory. 3. Psychotherapy. WM
460.5.E3 L479]
RC489.S43143 1991
616.89'14'01—dc20
DNLM/DLC
for Library of Congress 91-31485
CIP
Printed in the United States of America

10 9 8 7 6
Contents
Acknowledgments vii
1 Introduction 1
2 The Magical Covenant 8
3 Freud as Clinician 21
4 Freud’s Mental Apparatus 37
5 Drive and Conflict Theory 50
6 Ferenczi, the Dissident 63
7 The British School 77
8 Metatheory: Theory about Psychotherapy Theory 92
9 Empathic Understanding 105
10 Narcissism 118
11 Mirror Transference 128
12 Idealizing Transference 139
13 Twinship and Merger Transferences 152
14 Selfobject Experiences 167
15 The Self System 178
16 Conflict and Deficit Theories 190
vi Contents
17 Psychoanalysis and Psychotherapy 204

18 Transference as Organizing Principle 223
19 Structuralization 237
20 Negative Therapeutic Reactions 250
21 Affects 264
22 Trauma 277
23 Mutual Influence Theory 292
24 Toward a General Theory 304
References 311
Author Index 331
Subject Index 337
Acknowledgments
We gratefully acknowledge pastoral counseling’s nourishment of our

early development as psychotherapists; the value of the New Eng-
land Educational Institute’s Cape Cod Seminars in self psychology;
and students at the Illinois School of Professional Psychology, whose
playful engaging of us helped shape the material that follows.
Our thanks to our families, who endured with us each step of
the writing/publishing process; to the Metra Conductors of the 4:50
a.m. train from Fox Lake, who made commuting-writing possible;
and to Paul Stepansky, Ph.D., Editor-in-Chief, and Eleanor Starke
Kobrin, Managing Editor, The Analytic Press, for their very valuable
assistance.
A special thanks to Richard Chessick, M.D., PhD., without
whose example of therapeutic skill, scholarly dedication, philo-
sophical wisdom and plain hard work, this project would never
have been attempted. We also thank the following people for their
valuable criticisms: Fred Levin, M.D., Marc Lubin, PhD., David
Terman, M.D., and Eduardo Val, M.D.
1
Introduction
T he emergence of self psychology in the 1970s and 80s has

brought significant changes to the theory and practice of psy-
chotherapy. One change, for example, has been to increase under-
standing of, and improve treatment success with, narcissistic
patients, who were considered untreatable using the old paradigm.
A description of self psychology’s ideas, how they developed, and
the major changes they produced forms the subject matter of the
chapters that follow.
Self psychology represents a major paradigm shift that was not
evident until the later stage of its development. Paradigms can be
said to be“universally recognized scientific achievements that for
a time provide model problems and solutions to a community of
practitioners” (Kuhn, 1962, p. viii). For example, a paradigm shift
occurred in physics when Einstein’s wave theory of light replaced
Newton’s corpuscular theory. In this volume, we present psycho-
therapy as employing three major paradigms: (1) healing based on
what we refer to as a magical covenant, (2) classical analysis, and
(3) self psychology. Our major interest is in the paradigm shift from
2 Chapter 1
classical analysis to self psychology and the divergent opinions of

self psychologists about the nature of this shift.
The publication of an increasing number of books on the
subject of self psychology signified its emergence as a new para-
digm. Kohut himself, the pioneer theorist of self psychology,
followed his two early papers on empathy (1959) and narcissism
(1966) with three major books: The Analysis of the Self (1971), The
Restoration of the Self (1977), and How Does Analysis Cure? (1984).
These were then followed in the 80s by a stream of books from
Kohut’s former colleagues and students, who not only used Kohut’s
ideas, but extended them beyond the issues of narcissism. With such
a plethora of books on the subject, why another?
This book arose out of a need for a textbook for psychotherapy
students. The chapters initially evolved from material prepared for
a class on self psychology at the Illinois School of Professional
Psychology. At the beginning, the students knew buzzwords
—“idealizing transference” and“mirror transference”—butseeming¬
ly little else. Those who attempted to study self psychology soon
floundered in an overabundance of articles and books shaped for
polemical debate rather than the systematic unfolding of ideas.
Students did not readily grasp the significance of the new ideas
represented by self psychology. In clinical practicums they seldom
encountered patients with the clearly definable narcissistic trans-
ferences Kohut had described, because they were assigned either
brief counseling cases or very disturbed patients with difficult
archaic transferences. Even when definable narcissistic transferences
occurred, they were not recognized by students or supervisors
untrained in a self-psychological approach.
Many who independently tried to study Kohut became confused
and discouraged after attempting The Analysis of the Self‚ perhaps
the most difficult of Kohut’s books. Had they first read two early
papers (Kohut, 1959, 1966), the going might have been easier. And
the few who knew of the empathy paper (1959) mistakenly thought
of self psychology as another version of Rogerian theory. Given such
misconceptions, it was evident that the major problem with teaching
self psychology to clinical psychology students (or social workers,
pastoral counselors, or counselors), as compared with teaching
students at a psychoanalytic institute, was a lack of grounding in
psychoanalytic theory. Nonpsychoanalytic students were unfamiliar
Introduction 3
with such major works by Freud as “On Narcissism” (1914),

“Mourning and Melancholia” (1917), and“ T h e Ego and the Id”
(1923). Although some had read about Dora, the Rat Man, and the
Wolf Man in secondary sources, few had read the primary docu-
ments, the cases written by Freud himself.
The students also were not aware that drive theory, the keystone
of classical analysis, had been subjected to mounting criticism in
recent decades and had actually been abandoned by many analysts.
Nor were they aware of the self psychology literature by such
analysts as Basch, Goldberg, Stolorow, and Wolf.
In developing the course, we initially set out to provide an
overview of the major concepts of self psychology. We used White
and Weiner’s (1986) The Theory and Practice of Self Psychology,
which followed a similar outline to our original course syllabus, as
our basic text. The problems we encountered using the White and
Weiner text were with the simple overview approach. Basic
concepts, disembodied from their historical nexus and the issues
and problems with which psychotherapy had wrestled for several
generations of therapists, were not given the importance and
meaning they deserve. The authors expounded solutions without
adequately presenting the problems the solutions were meant to
solve. Using the White and Weiner book meant that we were
constantly explaining the issues and showing how self psychology’s
ideas differed from those of the classical paradigm.
To reduce the need for repeatedly explaining aspects of the
classical paradigm to illuminate the importance of Kohut’s ideas, we
developed supplementary written material. We also found ourselves
frequently explaining how the self psychology paradigm itself
evolved and how it had originally been presented as an expansion
of the old paradigm, the“widening scope,” that Stone (1954) had
described.
Eventually, it became clear to us that we were committed to a
brief historical approach to the major concepts of self psychology,
a narrative describing the development of concepts, rather than a
general overview of concepts isolated from their context. We
deliberately developed a simplified narrative that invited later
refinements and modifications. Further, we wanted to avoid
becoming bogged down, spending an inordinate amount of time
teaching classical material as an introduction. We sought to cover
4 Chapter 1
enough of the introductory material to establish useful comparisons

and encourage students to dig deeper into both paradigms. We
were forced to be selective. We focused on the main issues of
classical analysis and other precursors of self psychology, with a
view to showing the emergence of self psychology theory all the
more clearly.
Another problem was the tendency for clinical psychology
students to think of self psychology as being solely Kohut. On the
contrary, in the decade since Kohut’s death, other self psychologists
have so expanded the Kohutian beachhead that to view self
psychology as solely Kohut is to miss the important clinical and
theoretical advances of the 80s. We decided to present self psychol-
ogy from a broad perspective. Narrowly conceived, self psychology
consists of the ideas of Heinz Kohut, ideas that apply to the
understanding and treatment of narcissistic disorders. Thought of
more broadly, self psychology strives to be a more general theory,
applicable to a broad range of clinical syndromes defined as
disorders of the self. How broadly self psychology theory can be
extended, and how useful these theoretical extensions are to
clinicians, has yet to be explored fully.
The early chapters here are designed to help the reader gain a
sense of continuity about self psychology. Though self psychology
is hailed by many as a new paradigm, writers differ on the extent
of its variation from the old. It had its forerunners. Self psychology
can be said to be“radical” only if the work of many pioneers,
including Ferenczi and theorists of the British school, are ignored.
Like Kohut, those pioneers (and the defectors, Jung and Adler) also
attempted to broaden the scope of psychoanalysis to include more
than the treatment of neurotics. When their work is conceptually
linked with self psychology, it can be argued that Freud, Ferenczi,
the British school, and self psychology constitute the mainstream of
psychotherapeutic thought. Classical analysis, thought originally to
be the major highway of psychotherapy, is increasingly being
viewed as a conceptual dead end, abandoned only with great
difficulty by those heavily invested in it. Emerging as a new major
paradigm in psychotherapy, self psychology takes us toward a more
functional,“experience-near” theory and better psychotherapeutic
results.
Introduction 5
Eventually a broad outline for a manuscript emerged. It divided

naturally into three parts: one covering the pre-Kohut material to
show the conceptual linkage and continuity between religious
healing, Freud, Ferenczi, the British pioneers, and self psychology;
the second about Kohut; and the third exploring attempts at a
broader theory beyond Kohut. By presenting the material this way,
we hope to reinforce a broad-based professional identity.
We also recognize that once the major ideas of the self psychol-
ogy paradigm are accepted, the old paradigms may be viewed
differently. The new paradigm unavoidably influences what we
consider important in religious and classical analytic paradigms and
in the pre-Kohutian material. Thus, when we looked for themes in
the old paradigms, such as idealization, it was because we already
knew it was a key concept in self psychology. This is a bias that we
openly acknowledge. In fact, the new paradigm enables us to see
new threads of continuity.
Using each chapter as material for a two-hour class session, we
found that students discussed more freely in class if the chapter
contained a clinical case. Where possible, we sought to include
well-known cases, already published, because these are the classics,
which will be discussed and debated in the years ahead. For
example, we included material on Freud’s cases of Dora and Ernst
Langer (the Rat Man), Kohut’s case of Mr. Z, and Tolpin’s case of
Mrs.A.The Wolf Man (Dr. Serge Pankejeff) is covered in chapter 20.
Where necessary, we included clinical material of our own to
illustrate and concretize theory. As the reading recommended for
each chapter reveals, we encouraged students not just to rely on our
summary, but to read the cases in the primary sources.
The subject of chapter 2 is the magical covenant. From a long-
range perspective, the development of modern psychotherapy is
merely another stage in the ubiquitous task of psychological healing.
Its beginnings are rooted in healing conducted by high-status
persons, especially religious authorities. Religious healing goes back
thousands of years; until 100 years ago, it was a major form of
psychotherapy. Then, when Breuer and Freud published“Studies on
Hysteria” (1893-1995), psychoanalysis was born. As Basch (1988a)
defines it,“psychoanalysis . . . refers to a research method into
human motivation, to a particular form of intensive psychotherapy,
6 Chapter 1
and to [Freud’s] proposed general theory of mental functioning” (p.

4n).
Even though psychoanalysis added a new method and theory to
the psychological approach to healing, it never completely replaced
religious healing. In the United States today, for example, because
of the sheer numbers of the clergy (priests, ministers, rabbis), the
total amount of counseling by religious professionals is probably
more than that of all other psychotherapists combined. Worldwide,
this is undoubtedly so. Yet even if classical psychoanalysis has never
been the only form of psychotherapy, undeniably it has been, for
almost a century, the major force in understanding the psychological
functioning of human beings and the conduct of healing. For this
period it was the predominant paradigm, just as religious healing
was for thousands of years before.
Now the influence of classical psychoanalysis is waning. Basch
(1988a) concludes that“Freud fell short of his goal. He was unable
to establish a theory that would serve both as a scientific basis for
psychotherapy generally as well as a foundation for the investigation
of human nature” (p. 3). Self psychology’s emergence as a dominant
paradigm now raises new issues and stimulates further research. It
has the added attraction of being far more inclusive than the
classical paradigm it replaces.
The critics of self psychology doubt whether this new paradigm
is truly psychoanalysis (see chapter 16, this volume). Perhaps more
important is the shift that self psychology has wrought in the
distinction between psychoanalysis and psychotherapy (see chapter
17, this volume). Self psychologists still see a difference between
them, even though they acknowledge that a similar dynamic process
takes place in all forms of psychotherapy, including psychoanalysis.
The distinction between these two modes of therapy lies in the aims
of the treatment and the extensiveness of the working through.
Self psychology’s view that psychoanalysis and psychotherapy
involve a similar process is an important shift in attitude based on
a change in theory. This shift is of great significance for all who
practice psychotherapy, especially those whose professional roots
are anchored in the broader psychotherapeutic community
—general psychiatry, psychology, social work, the ministry, and
counseling—yet who embrace self psychology’s theoretical contribu-
tion to their work. While self psychology had its birth and early
Introduction 7
nourishment in the psychoanalytic tradition, the issue is not whether

the new paradigm is psychoanalysis, but where in the new paradigm
the old psychoanalysis fits. In self psychology the ideas central to
psychoanalysis have been so transformed that it is now difficult to
consider psychotherapy an inferior form of healing.
The last section of the book, commencing with chapter 18, looks
at some trends in self psychology during the 80s and 90s after the
death of Kohut. These developments have been accompanied by a
proliferation of published material suggesting ways to build on the
theoretical advances of Kohut. The intersubjectivists, for example,
led by Atwood, Brandchaft, Lachmann, and Stolorow, claim that
psychoanalysis is the“science of the subjective” (see chapters 18, 19,
and 20, this volume).
Basch and Goldberg, on the other hand, emphasizing epistemo¬
logical issues, are among those who resist a strictly phenomeno¬
logical approach to psychotherapy and want to include the nomo-
thetic results of observational research in infant development
studies (see chapter 23, this volume) and new concepts emerging
from the neurosciences (see chapter 4, this volume). Yet another
position is held by Mitchell, whose relational theory subsumes the
self psychology ideas of Kohut, the object relations position of
Fairbairn, and the interactional approach of Sullivan in one broadly
based general theory that is oppositional to drive theory. Other
developments focus on affect theory in chapter 21 and trauma
theory in chapter 22.
Finally, to cover the wide range of healing from religious
counseling to psychoanalysis to self psychology, we use“psycho-
therapy” as a generic term for healing, from the Greek word to
make whole. Healing in the religious paradigm focuses on the soul;
in psychoanalysis, on the mind; and in self psychology, on the self.
To facilitate classroom discussion, we include recommended
reading for the next chapter in each preceding chapter.
General Readings: Kohut, 1984; Chessick, 1985; Stolorow,

Brandchaft and Atwood, 1987.
Readings for Chapter 2: Frank, 1963; Wise, 1966; Lee, 1979.
2
The Magical
Covenant
T he magical covenant, the basis of a long tradition of religious

healing, was the paradigm of psychotherapy practiced exten-
sively for thousands of years before Freud made the discoveries that
led to psychoanalysis. As Stone (1951) acknowledged,“Psychoanaly-
sis is a special and relatively new branch of psychotherapy” (p. 215).
In a magical covenant, a passive supplicant expects an active,
omnipotent healer to use status and power miraculously to bring
about healing. Known historically as“ t h e cure of souls,” religious
healing has been defined as“helping acts done by representative
Christian persons, directed towards the healing, sustaining, guiding
and reconciling of troubled persons” (Clebsch and Jaekle, 1964, p.
4). Such a definition may be applied to the healing by all religious
faiths.
Just as magical healing was the healing paradigm prior to the
therapeutic revolution initiated by Freud, self psychology may be
The Magical Covenant 9
the major new healing paradigm. Thus, it may be more appropriate

to compare the paradigm shift from psychoanalysis to self psycholo-
gy with that from magical healing to psychoanalysis than to compare
the shift with Einstein’s change in the theory of light from the views
of Newton. When self psychologists claim their new theory repre-
sents a paradigm shift, do they mean that it is as radical as the one
that took place under the leadership of Freud?
Magical healing was not completely eradicated with Freud, even
though he sought to purge psychoanalysis of any form of sugges-
tion. It is present in pastoral counseling today and also takes on
secular forms. It resurfaces in self psychology, in the transformation
of the narcissistic transferences. In what follows we examine (a) the
magical covenant in religious healing, (b) secular forms of the
magical covenant, (c) modern pastoral counseling, and (d) paradigm
shift.
THE MAGICAL COVENANT

IN RELIGIOUS HEALING
In a healing act, the religious representative (shaman, priest,

minister, rabbi) utilizes his status, enacts religious rites of his faith
community, refers to basic religious beliefs, and recommends a plan
of action to calm and relieve those among the faithful who are
distressed. This treatment, as Lévi-Strauss (1963) points out, is
almost an inversion of the psychoanalytic cure.
Both cures aim at inducing an experience, and both succeed by

recreating a myth which the patient has to live or relive. But, in
one case, the patient constructs an individual myth with elements
drawn from his past; in the other case, the patient receives from
the outside a social myth which does not correspond to a former
personal state. When a transference is established, the patient puts
words into the mouth of the psychoanalyst by attributing to him
alleged feelings and intentions; in the incantation, on the contrary,
the shaman speaks for the patient. He questions her and puts into
her mouth answers that correspond to the interpretation of her
condition, with which she must become imbued [p. 198].
10 Chapter 2
Religious healing is sanctioned by centuries of tradition. For

example, since the earliest days of the Church, if someone was sick,
a priest prayed, anointed with oil, administered the sacraments
(wine and bread) and prescribed herbs and medicine. Even though
the 20th century has seen a decline in these religious healing rites,
those still practiced give glimpses of a past when religious healing
was the only resource in the community for those with troubled
souls.
Example 1: Mr. J
The treatment of Mr. J, a 25-year-old single male, illustrates such

religious healing. Mr. J sought help from a religious healer for his
extremely“nervous” condition and his inability to sleep. His
personality was characterized by extreme conscientiousness,
overscrupulousness, self-doubt, phobias, and ruminating obsessions.
When agitated, he would pace nervously.
When Mr. J was five years old, his parents first noticed a
problem when, at a restaurant, he turned to his mother and
anxiously said,“I’m going to have a heart attack.” Years later, when
Mr. J graduated from high school, a major crisis occurred and the
symptoms enumerated earlier were overtly manifest. Following the
practice of his church’s tradition, he visited a religious lay woman
held in high regard, an expert in diagnosing and exorcising this
condition. She tested him by carefully placing drops of olive oil on
water, and when these did not float, he was diagnosed as having the
“evil eye.” After the exorcist recited prayers to“cure” this condition
and Mr. J was assured it would go away, he felt better.
Subsequently, on several occasions the“evil eye” took control
of Mr. J, once after John Lennon was assassinated and again when
Mr. J was complimented for being a“wonderful son” and a“nice
looking boy.” Every time this“ e v i l eye” took charge of Mr. J,
counseling consisting of assurances and religious rites of exorcism
gave him fairly prompt relief. As he grew older, the ceremony
progressively lost its potency and ability to relieve him with each
incident of the“evil eye.”
The power of suggestion played an important part in relieving
Mr. J’s subjective state. Such suggestions by a religious healer,
however, derive their efficacy from the perceived omnipotence of

the believer’s faith community and its god. Religious healing is
based on a magical covenant. The rites, rituals, and prayers, as well
as the priest’s presence, are mutative because of the depth of the
believer’s attachment to his faith community and its beliefs. These
beliefs form a shared world view between the religious healer and
the disturbed religious member, that enables expectations to be
realized (Torrey, 1972). To the extent that the healer and the patient
have divergent world views, religious healing becomes more
difficult, if not impossible.
Example 2: The Shaman
Gillin (1948) describes the treatment of a 63-year-old Guatemalan

Indian woman who had her eighth attack of“espanto,” or “soul
loss” (depression). This espanto occurred when she and her
husband passed the place where he had been seduced by another
woman. With the shaman’s encouragement, the woman complained
about her husband’s infidelity and then broadened her complaints
to many of life’s frustrations and anxieties. The healer gave her a
confident prognosis and detailed instructions about preparing for
a healing feast four days later.
The ceremony went from 4:00 in the afternoon until 5:00 the
next morning. It began with light refreshments and social chit chat
and then moved into a large meal. The patient did not eat, but was
complimented by all present on the food she had prepared. Then
the healer went through many rituals, including making wax dolls
of the chief of evil spirits to whom the healer appealed for the
return of the patient’s soul. The healer massaged the patient with
whole unbroken eggs, which were believed to absorb some of the
sickness from the patient’s body. The medicine man and the chief
took the eggs and other paraphernalia to the place where the
patient had lost her soul, and they pleaded with the spirit to restore
it.
On returning to the patient’s home, the shaman was comforting.
Then followed prayers at the house altar and rites to purify and
sanctify the house. The climax came at 2:00 a.m., when the woman,
naked except for a loin cloth, had her entire body sprayed with a
12 Chapter 2
“magical fluid” that had a high alcohol content. Then she had to sit
naked and shivering in the cold for 10 minutes before drinking a
pint of fluid. The healer massaged her vigorously with eggs and
with one of his sandals. The woman then dressed, lay down on a
bed, and was covered by blankets. She was thoroughly relaxed. After
the shaman pronounced the cure finished, the patient fell into a
snoring sleep. Eventually, when the woman recovered from her
fever, her hypochondriacal complaints, her nagging of her husband
and relatives, her withdrawal from social contacts, and her anxiety
symptoms all disappeared.
E x a m p l e 3: T h e Miracles at Lourdes
The magical covenant is evident in the healing rites still practiced
in such places as Lourdes, France. There is evidence that some
people who go to Lourdes for their afflictions are helped, tempo-
rarily at least (Weatherhead, 1951). To substantiate the claim of
religious healing, however, the religious authorities at Lourdes have
concentrated on carefully documenting“definite organic illnesses.”
A Dr. de Grandmaison, who studied 20“cures,” lists cases of
pulmonary tuberculosis, cancer of the tongue and the breast,
tuberculosis of the spine, ulcer of the leg of 12 years’ duration,
compound fracture of the leg for eight years, and fracture of the
femur of three months’ standing (Weatherhead, 1951, p. 147).
Example 4: N e w Testament H e a l i n g
The idea of a magical covenant forms the background to the New

Testament accounts of healing in the Early Church. Weatherhead
(1951) lists seven healing acts by Disciples Peter, John, Ananias,
Paul, and Silas. These acts include healing lameness, blindness,
palsy, paralysis, dysentery, and spirit possession. Although it is
evident from these New Testament accounts that the person being
healed is susceptible to the suggestions of the healer/disciple, it is
the healer’s imputed magical power that seems to be a major factor
in inducing change. Hence, religious healers act in the“name” of,
that is, the power of God or Jesus, or a status person, so as to invite
an aura of personal power and to increase suggestibility.
SECULAR FORMS OF THE MAGICAL

COVENANT
The magical covenant exists in secular forms. It can be seen in the

placebo effect, in the Hawthorne effect, in the unrealistic expecta-
tions of patients seeking psychotherapy, and issues of therapy
arrangements, such as scheduling.
Example 1: The Placebo
Studies of the placebo effect in medicine suggest that the magical

covenant is never completely eradicated in a secular society; it is
merely transformed. Frank (1963) defines a placebo as“ a pharmaco-
logically inert substance that the doctor administers to a patient to
relieve his distress when, for one reason or another, he does not
wish to use an active medication” (p. 66). He asserts:
Since a placebo is inert, its beneficial effects must lie in its

symbolic power. The most likely supposition is that it gains its
potency through being a tangible symbol of the physician’s role
as a healer. In our society, the physician validates his power by
prescribing medication, just as a shaman in a primitive tribe may
validate his by spitting out a bit of bloodstained down at the
proper moment [p. 66].
The placebo effect can be seen in the treatment of warts and

peptic ulcers and in patients resistant to using medications. Painting
a wart with a brightly colored but inert dye and telling the patient
the wart will be gone when the color wears off is as effective as any
other form of treatment. In a study of patients with bleeding peptic
ulcers, 70% showed excellent results when the doctor gave them an
injection of distilled water and assured them that it was a new
medicine that would cure them. And of patients who feared drugs
and distrust doctors, those given placebos had severe reactions of
nausea, diarrhea, and skin eruptions (Frank, 1963, p. 68).
Frank also thinks that the placebo effect operates in mental
healing.
14 Chapter 2
Using double-blind techniques, it has been found that some of the

beneficial effects of tranquilizers, especially when they were first
introduced into mental hospitals, were really due to the hope they
inspired in both staff and patients. They increased the therapeutic
zeal of the staff, and this in itself helped the patients. In this
connection, the mere introduction of a research project into a
ward in a veterans hospital was followed by considerable
behavioral improvement in the patients, although no medications
or other special treatments were involved at all. The most likely
explanation seemed to be that participation in the project raised
the general level of interest of the treatment staff, and the patients
responded favorably to this [pp. 68-69].
Example 2: The H a w t h o r n e Effect
That simply being part of social research can enhance functioning

and productivity is so well documented in social psychology that it
is named after the place where it was observed. The“Hawthorne
effect” was noted at Western Electric’s Hawthorne plant near
Chicago when it was found that no matter what changes were
introduced in the factory, they all temporarily improved productivity
and morale (Roethlesberger and Dickson, 1939). Apparently the fact
of being studied and contributing to“important” social research
energized and mobilized employees to greater efforts. This is a
subtle form of the magical covenant where the high status of the
research itself functions as a placebo.
Example 3: Miss Κ
Miss K‚ a very disturbed woman in her early 40s, sought a magical

covenant from a secular psychotherapist. Over the preceding 20
years, she had sought help from many counselors and psychothera
pists. These relationships had never lasted beyond three or four
sessions and always had a negative outcome. She reported a
well-practiced“package” of suicidal thoughts, seemingly to gain the
attention of the therapist. Her story was one of bitter recrimination
against her parents and other relatives, whom she had ostracized,
and against all the incompetent therapists she had seen and deemed
unworthy of her idealization.
After half an hour of invective, she stopped and began to notice

plants in therapist’s office. She stood up, walked to the plants, tested
for moisture, and declared they needed watering (even though they
had been watered the day before). She then watered the plants,
using a cup and water from an office sink. After finishing, she
criticized the therapist for his neglect and then proceeded to work
herself into a tirade. Miss Κ angrily demanded to know, because of
her disappointments with other therapists, if he could cure her.
When he would not guarantee such a cure, she stated that she
wanted someone with whom she could form a“special relationship”
(magical covenant), then left, never to return.
Example 4: Scheduling
Just as impatience over being evaluated and the need for an instant
cure are the signs of Miss K’s wish for an archaic magical covenant,
other signs may occur when the first appointment is set up.
Potential patients seeking a magical covenant often want the
scheduling to suit their convenience, and they expect to receive the
psychotherapist’s services for virtually no fee, even though they can
afford the fee. For example, one morning Dr. F, who worked in a
group practice in Chicago’s loop, received a telephone call from a
woman who had selected his name from the phone book because
his office was convenient to where she worked. She wanted to see
him and bring her boyfriend at 7:30 p.m. that evening but said that
she could not afford to pay more than a nominal fee.
When Dr. F indicated he had other commitments that evening,
but had an opening in his schedule several days later and would see
them for half fee, the woman declined. She could not wait; she had
fought with her boyfriend and wanted someone to confirm, in front
of the boyfriend, that she was right. When Dr. F mentioned two
marriage and family centers, the woman was not interested in a
referral. She then abruptly ended the conversation, obviously
annoyed that Dr. F would not drop everything to meet her need.
The usefulness of the magical covenant cannot be completely
discounted. Torrey (1972, pp. 102-114) provides evidence that
“therapists” from a wide variety of cultures, whether witchdoctors,
priests or psychiatrists, receive roughly the same kind of treatment
16 Chapter 2
results with their patients. It is possible, then, to make the case that
over the short term, as long as the patient is highly bonded to the
priest’s religious community, the priest with sacraments may be as
effective as the psychiatrist using medications, but without the side
effects!
MODERN PASTORAL COUNSELING

AND PSYCHOTHERAPY
Twentieth-century pastoral counseling and pastoral psychotherapy

are new developments in religious healing. These movements
involve attempts, in varying degrees, to incorporate the new
scientific theories and techniques of psychotherapy, especially of
Freud’s psychoanalysis, while employing, as much as possible,
shared religious beliefs and the natural idealization by parishioners
of a pastor as a person of religious status. Stated another way,
competent pastoral counselors often work within a magical alliance.
Where possible, the goal of pastoral counseling is to help
people move from a magical covenant where healing is done for
them, to an alliance where healing involves the patient’s taking
major responsibility for change. That pastoral psychotherapy is
thriving indicates that this blend of the traditional and the technical,
a mix of the magical and the therapeutic alliances, has made a
useful contribution to the mental health of a large number of
people.
One modern expression of religious healing, pastoral care, is
not a specific activity of the minister, but a stance taken while the
clergyman is engaged in activities associated with ministering to a
religious community. This stance is expressed through the caring
and commitment that a dedicated religious leader has toward his
community members. This caring is focused specifically and
concretely on the parishioners’ need. As Wise (1966) says,“Pastoral
care is the art of communicating the inner meaning of the Gospel
to persons at the point of their need” (p. 8). Without such a
commitment to a believer’s long-term interests, religious counseling
loses much of its potency.
The modern pastoral care movement, through an emphasis on
training in a clinical setting, has sought to enhance the pastoral
effectiveness of religious leaders. The movement is generally

acknowledged as having begun in the 1920s, when Anton Boisen,
the chaplain of Worcester (MA) State Hospital, established there the
first clinical training program (Boisen, 1960). A handful of theologi-
cal students spent three months at the hospital, full time, gaining
experience in a counseling ministry under Boisen’s supervision. By
the 1970s, most theological students in mainline Protestant seminar-
ies were benefiting from clinical training and receiving academic
credit for it.
In the early 1960s, pastoral counseling grew out of the clinical
training movement and became organized under the American
Association of Pastoral Counselors with the goal of providing
ordained pastors with specialized training in counseling (Wise,
1951). These pastoral counselors worked in large churches or
independent pastoral counseling centers. The centers became places
for local pastors to make counseling referrals. As part of their
training, pastoral counselors studied theories of crisis intervention,
grief, marriage and family counseling. They received supervision
and undertook their own personal psychotherapy.
Eventually some pastoral counselors acquired the knowledge
and skills to undertake intensive psychotherapy aimed at structural
change. They took further training at the doctoral level and
underwent their own extensive personal psychotherapy. After
training as psychotherapists, they were,“pastoral psychotherapists”
(Lee, 1981). They had retained their identities and ecclesiastical
standings as pastors, garnering at the same time as technical a
knowledge of the psychotherapeutic process as possible. In their
role as pastoral psychotherapists, which stressed acceptance more
than interpretation, such specialists often found themselves working
with narcissistic and borderline personalities at a time when such
disorders were considered untreatable. An emphasis on relationship
in the pastoral care tradition and the need to avoid religious dogma
made pastoral psychotherapists wary of an interpretive approach.
Pastoral counseling and pastoral psychotherapy, modern forms
of religious counseling using a therapeutic alliance, do not ignore
the magical covenant. Rather, they seek to change it. For example,
in the beginning sessions of pastoral counseling, it is not uncom-
mon for the person seeking help to request a prayer and receive it.
When the person returns for further sessions, the pastoral psycho¬
18 Chapter 2
therapist attempts to involve the patient in the treatment, thereby

building a working alliance out of a magical (totemic) covenant
(Lee, 1979). In a working alliance, the pastoral psychotherapist is
seen as less omnipotent, and the person seeking help feels more
accepted as an imperfect human being. A partially transformed
magical covenant sometimes stubbornly coexists with a therapeutic
alliance, with reasonable results, depending on the empathy and
skill of the pastoral psychotherapist.
The Pastoral Counseling and Consultation Centers of Greater
Washington exemplify the kind of service that pastoral psychothera-
py offers. Established in 1966 as a“not-for-profit” organization, this
organization employs 45 staff clergy with specialized training. They
conduct approximately 60,000 psychotherapy sessions a year to help
people cope with such“problems of living” as difficult or broken
marriages, feelings of failure, anxiety, depression, home or work
difficulties, alcohol and substance abuse, teen problems, the search
for meaning, grieving, school problems and senior citizen’s feelings
of neglect and isolation. These centers claim that the hallmarks of
their services are“caring and quality.”
The Center for Religion and Psychotherapy in Chicago (Mason,
1980), staffed by pastors with extensive training in psychotherapy,
offers services similar to those conducted at the Pastoral Counseling
and Consultation Centers of Greater Washington. At the Chicago
center,“predominant presenting problems relate to marital and
family issues and vocational concerns, though many clients come
with a vague sense of uneasiness and personal discomfort as well”
(p. 411). Because the center’s major consultant was a member of the
Institute for Psychoanalysis of Chicago, the center was introduced to
the ideas of Kohut and has operated out of this theoretical frame-
work. Of this self psychology influence, Mason has this to say:
The psychology of the self has helped clarify data previously

observed but unexplained, and called to attention other data
previously overlooked. While there is awesome power in the
broad theoretical sweep of the psychology of the self, it is the
clinical aspects of Kohut’s theories that have proven the most
powerful, convincing, and exciting in our work [p. 407].
On the basis of the work of these two pastoral counseling

centers and others throughout the country, there is every reason to
believe that pastoral psychotherapy, modern religious healing, offers
a valuable service to persons in need, especially those who are
committed members of faith groups.
PARADIGM SHIFT?
To summarize, traditional religious healing has been heavily

anchored in a magical covenant based on the projected power of
the religious leader. This alliance was undergirded by a theological
system of beliefs (metapsychology) that emphasized“God’s action”
and a set of rites and rituals (techniques) designed to induce God
to act. Religious counseling did not produce clearly defined
operational theories close to the experiential data. The techniques
that evolved, however, survived the winnowing of several thousands
of years. As Campbell (1975) contends, practice that has withstood
the test of time has its own evolutionary form of validation.
Our contention is that natural selection has left behind three
factors that make up the core of religious healing: the idealization
of the religious healer; the healer’s caring commitment to the
patient; and a community with a shared belief system. Religious
healing raises the question of whether these are components to any
successful psychotherapy.
The subject of a magical covenant has not received attention
from self psychology theorists. Yet this reminder of the radical shift
in the healing paradigm about 100 years ago provides another
context in which to place the claims of a paradigm shift from
psychoanalysis to“whatever,” in this case, self psychology. When self
psychologists say that self psychology is a new paradigm, do they
perceive it to be as radical as psychoanalysis was conceived to be in
comparison with religious healing? Or is self psychology another
modification, albeit major one, of the psychoanalytic paradigm, as
the more conservative self psychology theorists claim?
Religious healing also reminds us that Kohut’s change in attitude
toward the idealizing transference was, in one sense, a rediscovery
20 Chapter 2
of its constructive potential, an experience familiar to religious

healers. In another sense, however, as a manifestation of a therapeu-
tic bond, Kohut’s discovery of the idealizing transference was
unique. Both religious healing and self psychology were able to
accept that idealization could be useful. In religious healing the
idealization may be used, among other things, to restore the
patient’s oneness with the faith community and his trust of the
community’s values. In self psychology, the goal is to use the
idealizing transference to help form new structures in the patient
through micro-internalization and leave the patient with a lessened
need for archaic forms of dependency.
The magical covenant also makes clear that until Freud discov-
ered free association and understood the importance of transfer-
ence, his early attempts at healing were not markedly different from
the suggestions of religious healers functioning under a magical
covenant. This fact makes his discovery of psychoanalysis as a new
healing paradigm, discussed in the next chapter, all the more
remarkable.
Readings for Chapter 3: Breuer a n d Freud, 1893-1895; Freud,

1905b; Freud, 1909; Lipton, 1977; Swales, 1986.
3
Freud as Clinician
A knowledge of the major ideas of Freud is essential for under

standing the contribution of self psychology to the practice of
psychotherapy. Freud’s clinical challenges, discoveries, and theoreti
cal solutions heavily influenced the shape and direction of modern
psychotherapy. His ideas have left problems that self psychology has
sought to answer. So, any effort to understand the significance of
the self psychology paradigm, needs to take into account the
ongoing influence of Freud.
In this chapter, Freud’s discovery of free association leads to the
important case of the Rat Man (Dr. Ernst Lanzer). We also cover
seven early cases: Anna Ο (Bertha Pappenheim), Emmy Von Ν
(Baroness Fanny Moser), Lucy R, Katharina (Aurelia Kronich),
Elizabeth Von R (Ilona Weiss), Cäcilie Μ (Baroness Anna von
Lieben), and Dora. Freud’s famous case of the Wolf Man is exam
ined later in chapter 20. In the two chapters that follow this one, we
briefly review Freud’s theory of the mind and his drive/ conflict
theory of psychoanalysis. With the steady decline of support for his
theoretical model, Freud’s major legacy may turn out to be his
21
22 Chapter 3
discovery of free association and his example as a research-

er/clinician. In this chapter we view Freud’s clinical work under the
headings of the (a) seduction/ trauma theory, (b) technique of free
association, (c) transference of creativity, (d) case of Dora, and (e)
case of the Rat Man.
THE SEDUCTION/TRAUMA THEORY
As is well known, Freud first treated hysteria. He viewed the

hysterical condition as one in which a person, usually a woman,
suddenly finds her legs or arms paralyzed and is seized by dizzy
spells or headaches, or loses vision or hearing, all without“physical
cause.” The symptoms of Breuer’s case, the famous Anna O, give a
clear description. Anna’s mother says:
Since December 7, [Anna] has refused to get out of bed. I called

in neurologists because her right arm and both legs seem
completely paralyzed. But the neurologists couldn’t find any
physical cause. She can move the fingers of her left hand a little,
but not enough to eat. Her governess has to feed her, though all
she will eat is oranges. She has trouble turning her head. Her
neck seems paralyzed too [Freeman, 1972, p. 4].
In“The Aetiology of Hysteria,” published 16 years after Breuer

began treating Anna O, Freud (1896b) presented the seduction
hypothesis. He stated that the neurotic symptoms of hysteria
resulted from childhood sexual trauma instigated by servants,
relatives, family friends, or even by incest-prone parents. How did
Freud arrive at this conclusion?
First, Charcot taught Freud the importance of childhood trauma
in Paris during the autumn of 1885. Second, Freud attended
autopsies at the Paris morgue, where Professor Brouardel docu-
mented child sexual abuse (Masson, 1984). And, third, his own cases
provided evidence. In“Aetiology of Hysteria,” Freud said his theory
of hysteria was based on 18 cases. More specifically, in“Heredity
and the Aetiology of the Neuroses” (1896a), he said,“ I have been
able to carry out a complete psycho-analysis in thirteen cases of
Freud as Clinician 23
hysteria . . . . In none of these cases was an event of [sexual abuse]

missing” (p. 152).
The Viennese medical community responded to Freud’s linking
neurosis to sexual seduction with shocked rejection! One of the
most respected Viennese physicians at that time, Breuer, who had
developed the“talking cure” with Anna Ο and who had collaborated
with Freud on“Studies on Hysteria” (Breuer and Freud, 1893-1895),
immediately distanced himself from Freud. Professionally isolated,
Freud struggled with the issue of the importance of sexual trauma
in the etiology of hysteria.
By 1897, in a letter of September 21 to Fliess (Jones, 1961, I, p.
292), Freud was expressing doubts that patient reports of sexual
trauma were real. He suggested that sexual seductions might take
place in fantasy only. It was not until eight years later, in“Three
Essays on the Theory of Sexuality”, that Freud (1905a) publicly
abandoned the theory of sexual seduction as the basis of hysteria.
THE TECHNIQUE OF FREE ASSOCIATION
As he was developing his seduction theory of hysteria, Freud

experimented with techniques for treating these patients. Returning
to Vienna in February 1886 from his six months study under
Charcot, he began his private practice using electrotherapy, baths,
massage, and occasionally hypnosis.
In December 1887, he abandoned electrotherapy and placed
major emphasis on hypnotism. Then, in May 1889, he began the
case of Frau Emmy Von Ν (Baroness Fanny Moser), using tech
niques similar to those used in the treatment of Anna Ο as his point
of departure and encouraging talk about events associated with the
trauma while the patient was under hypnosis. He also used baths,
massage, and rest. This case revealed that many beneficial effects of
hypnotic suggestion are transitory because they arise from the
patient’s need to please the physician and fade when contact is
withdrawn (Jones, 1961). Associated with this desire to please was
the idealization of the physician.
The cases reported in“Studies on Hysteria” reveal steps along
the road to discovering free association. In addition to Breuer’s
24 Chapter 3
Anna Ο, and the case of Frau Emmy Von N, another case, that of
Katharina (Aurelia Kronich), involved a conversation at a mountain¬
top lodge where Freud often vacationed. This case has been
referred to as“wild analysis,” but because such a term conjures up
images of treatment“out-of-control,” Swales (1988) clarifies two
points. First, Freud was not attempting treatment with Katharina. He
was gathering data for his research, and Katharina’s history con
tained a clear example of incest and symptoms of hysteria. Second,
this was not the casual encounter depicted by Freud.
Swales, in an impressive piece of historical research, identifies
the mountain where Freud met Katharina as Raxaple in the Austrian
Alps and traces the ownership of the lodge in the early 1890s to
Gertrude Kronich, the mother of Katharina, who had separated from
her womanizing husband, Julius. Swales makes the convincing case
that Freud, who had climbed this mountain many times, knew a
great deal about the family, including Julius’s inability to leave
women alone. We wonder at the effect on Freud’s growing interest
in free association of Katharina’s unburdening of herself in one
informal session, compared with his wealthy clients who were
trained by upbringing to censor everything they said.
Another patient, Frau Elizabeth Von R (Ilona Weiss), Freud was
unable to hypnotize. Her resistance to hypnotism induced Freud to
use catharsis without hypnosis. Freud’s constant questioning so
irritated her that she criticized him for interrupting her flow of
speech. When he stopped the questioning, Freud found that her
speech flowed freely, and she demonstrated a talent for hermeneuti¬
cal inquiry (Swales, 1986). Hermeneutics is the theory of interpreta
tion developed by biblical scholars to establish the meaning of a
text. It involves an iterative process in which the meaning of a
particular text is determined by its relation to the whole passage,
and then the meaning of the whole is determined by studying
particular texts. The philosopher Dilthy applied hermeneutics to
history. Freud used it working with Frau Elizabeth von R as a part
of what he called free association.
In the case of Frau Lucy R, whom he also could not hypnotize,
Freud used hand pressure on the patient’s head, a holdover from
the laying-on-of-hands technique of the renowned hypnotist
Bernheim and plainly related to well-established religious healing
rituals. Freud then relaxed the pressure and asked the patient to tell
whatever came to mind. She, like Frau Elizabeth von R, responded

well to free association. Freud’s success gave him a distinctive
treatment and obliterated the controversies and sensationalism that
accompanied the increased use of hypnotism by physicians at that
time.
The fragment of the treatment of Frau Cäcilie Μ is reported by
Freud at the end of the case of Elizabeth von R. There are now
good reasons to believe that Cäcilie, even more than Elizabeth or
Lucy, led Freud to his revolutionary discoveries and to developing
further his theories of the mind. Frau Cäcilie was the name Freud
gave to the 40-year-old Baroness Anna von Lieben, whom he began
to treat intermittently around 1887. In a well-conducted piece of
historical inquiry, Swales (1986) discovered much about Anna, who
had mothered five children despite suffering“nervous illnesses” for
nearly 30 years. Breuer, the family doctor, eventually brought in
Freud after other specialists floundered.
Swales documents a pathogenic extended family with many
members showing signs of severe mental illness. Anna herself
suffered insomnia so severe and chronic that she hired a chess
player to be available outside her door at night and also summoned
her children to her bed in the middle of the night as company. At
times the whole household could hear her crying, screaming, and
raving while she went through yet another crisis. Swales, who thinks
she was a morphine addict, concludes“that she was in a chronically
borderline state, forever on the brink of lapsing into psychosis”
(p. 23).
In a tentative scenario, Swales has Freud, by 1887, being used
intermittently as a neuropathologist to treat Anna’s facial neuralgias
under the supervision of Breuer. Sometime in 1888 Anna received
treatment from Charcot in Paris and when she returned to Vienna
underwent regular hypnotic treatment by Freud, perhaps daily.
Using the technique of suggestive influence, Freud gained some
success by autumn, 1888. After an old memory returned to Anna,
“for nearly three years after this she once again lived through all the
traumas of her life” (Swales, 1986, p. 33). During this time Freud
saw her twice a day.
At first Freud used the cathartic method with Anna von Lieben
in conjunction with hypnosis. Swales, however, claims, on the basis
of material from Brill (the New York analyst who studied under
26 Chapter 3
Freud), that Freud’s introduction of the technique of free association

was primarily through this intelligent poetess with a vivid imagina-
tion. For reasons of discretion, help in the discovery of free
association was attributed to Lucy R and Elizabeth von R, but in an
encoded acknowledgment to von Lieben, Freud gave the name Anna
to Bertha Pappenheim. Not surprisingly, Freud later referred to
Anna von Lieben as his lehrmeister (teacher). Swales goes further
and says that“in discussing Freud and his ‘teacher,’ there can be no
question but that we are talking about the very birth of psychoanal-
ysis” (p. 52).
One aspect of this case is of special interest. In a diary entry
years later, Sandor Ferenczi noted that Freud had described how,
early in his practice, he had lain on the floor, sometimes for hours
at a time, accompanying a patient through hysterical crises. Swales
thinks this is a reference to Anna von Lieben (p. 50). He also
reports that the family descendants spoke of an“extraordinary kind
of rapport—some extraordinary intensity of mutual ‘infatuation’
—between Anna von Lieben and Freud” (p. 50). There is a hint here
of Freud’s efforts to be a“twin” to his patient similar to the twinship
transference discussed in chapter 13.
Sometime in 1893 Freud mentions having“lost” Frau von
Lieben. Apparently Anna talked so much that Freud instructed her
to write everything down, but even this grew out of hand. Swales
thinks that because the family believed Freud’s treatment was not
bringing a permanent improvement, and was devouring Freud, they
intervened, with Breuer’s approval, and ended it.
These six cases reflect Freud’s movement from techniques of
massage, hot baths, and hypnotic suggestions, to the cathartic
method during hypnosis, and then to free association. Unquestion-
ably, with free association, Freud made a major discovery. It was a
method for exploring the unconscious and created a common,
shared belief system between patient and therapist to enhance
therapeutic effect. Freud’s new method eliminated the need for
totemic representatives identified with a specific set of values of an
ethnic subculture, religious group, or social cause to serve as
therapists (Lee, 1979). Through free association, Freud gained access
to the patient’s unconscious world view and belief system.
In these six early cases, hysterical symptoms disappeared, at
least for a while. Freud’s psychoanalysis, like religious counseling,
had an effect; it brought relief, but did not yet produce what Freud
called a“complete restoration.” Psychoanalysis needed to demon
strate permanent changes in a patient if it was to be accepted over
other methods, religious or medical. For example, Freud treated
Frau Emmy Von Ν for approximately seven weeks (six times a
week) and a year later for about eight weeks; then several years
later she urgently sought treatment with someone else. Freud’s early
analytic treatment, nevertheless, created hope.
Most of Freud’s treatments in the beginning of his career were
relatively short. Frau Emmy’s lasted a total of 15 weeks. Lucy R’s
treatment took nine weeks; Elizabeth Von R’s took eight months. On
the other hand, the treatment of Frau Cäcilie Μ was intense: daily
or twice-daily treatments for nearly three years. The challenge to
demonstrate permanent change, however, proved more difficult
than the optimistic Freud and his colleagues anticipated.
THE TRANSFERENCE OF CREATIVITY
As important as Freud’s work with patients was eventually for the

theory and practice of psychotherapy, the way Freud sustained
himself during his creative discoveries may have been just as
valuable. For a decade Wilhelm Fliess played an important function
for Freud and hence for the evolution of psychoanalysis. Fliess“was
precisely the intimate [Freud] needed: audience, confidant, stimulus,
cheerleader, fellow speculator shocked at nothing” (Gay, 1988, p.
56). Freud recognized Fliess’s role as“the only Other . . . the alter”
(p. 56). Fliess, referred to as Freud’s intimate friend, was a diligent
and perceptive reader of Freud’s manuscripts; Freud may have
formed an idealizing (see chapter 12, this volume) or twinship
relationship (see chapter 13, this volume) with Fliess as a means of
energizing himself, an experience that Kohut (1984) later referred
to as a selfobject. A selfobject is“that dimension of experience of
another person that relates to this person’s shoring up of . . . self
(p. 49).
Kohut calls Fliess’s energizing function for Freud a“transference
of creativity.” This transference is reflected in Freud’s need for and
“overestimation of Fliess during the years when he made his most
daring steps forward into new territory and [in] his realistic
28 Chapter 3
reassessment and subsequent dropping of Fliess after he had made

his decisive discoveries” (Kohut, 1980, p. 493). Kohut sees Fliess’s
function with Freud as similar to the idealized Wagner’s function
with Nietzsche when Nietzsche began pouring out his most original
work. Kohut also compared Freud’s relationship with Fliess to
Eugene O’Neill’s“lifelong, desperate search for the selfobject that
would satisfy his need for perfect ‘mirroring,’ for that ‘gleam in the
mother’s eye’ which his drug-addicted mother had not provided for
him” (p. 493).
For Freud, this understandable need for an enlivening relation-
ship was not confined to Fliess. Gay (1988) indicates that Freud’s
nephew John was an intimate friend in Freud’s early childhood.
According to Jones (1961), Freud idealized six figures who played
an important part in his early life (p. 3). He lists Brucke, Meynert,
Fleischl- Marxow, Charcot, Breuer, and Fliess. Jones also thinks that
Freud’s self-analysis eventually eliminated the need for such an
idealizing relationship, but Jones’s statement may reflect Freud’s
theory of development from autoerotism to independence rather
than Freud’s actual experience. Any growth from Freud’s self-analy-
sis may be explained as a spreading of his dependency needs,
including his presumed need for affirmation from a special intimate,
to a number of devoted colleagues. In chapter 14, we see that
Freud’s need for a circle of reliable lieutenants corresponds to what
Kohut understands as a“selfobject matrix.”
THE CASE OF DORA
The search for a way to effect permanent change with hysterics led
Freud to publish“ T h e Interpretation of Dreams” (1900). In this
major book, Freud worked from a theory of a conscious and an
unconscious mind (topographic), a theory formed in treating
hysterics as they resisted making their traumatic memories con-
scious. Importantly, this work indicates Freud’s increasing interest
in unconscious wishes and fantasies as well as traumatic incidents
and memories. From“The Interpretation of Dreams” it is clear that
Freud had shifted away from a theory of sexual seduction as the
etiology of hysteria, even though it was not until 1905 that he
publicly renounced it. According to Freud, reports by patients of
sexual seduction reflected wishes and fantasies rather than what

actually occurred. He hoped that with free association, including
association to dreams, unconscious motivating fantasies would be
uncovered, leading to more permanent changes in hysterical
symptoms. The search for permanent change also led him to Dora.
Dora, who is described in“Fragment of an Analysis of a Case of
Hysteria” (1905b), was a vengeful 18-year-old female who saw Freud
for three months. Her termination of the analysis was unexpected:
“Her breaking off so unexpectedly, just when my hopes of a
successful termination of the treatment were at their highest, and
her thus bringing those hopes to nothing—this was an unmistakable
act of vengeance on her part” (p. 109). Chessick (1985) recom-
mends that this case be carefully read by every psychotherapist
because it represents a clinical failure. Those who believe that
progress in scientific knowledge is more dependent on experimen-
tal failures than on successes agree. We need to take advantage of
Freud’s courage as a scientist to report his failure and learn from it.
The case of Dora was written at the time Freud was preparing
“The Interpretation of Dreams” (1900) for publication. Writing it to
demonstrate the use of dreams in analysis, Freud spent nearly half
of the case analyzing two dreams in great detail. Freud waited five
years to publish that work, until he publicly changed his theoretical
focus from seduction to sexual fantasy in“ T h r e e Essays on the
Theory of Sexuality” (1905a). By then he may have felt that the need
to illustrate the role of sexual fantasy and the process of dream
interpretation outweighed the risks involved to Dora’s identity.
From Dora’s dreams, Freud made the point that Dora’s fantasy of
giving fellatio to a man was linked to the symptoms of an irritation
in her throat and coughing.
The case of Dora also alerted the psychotherapeutic community
to the importance of interpreting a patient’s negative transference
reactions. Freud believed that Dora had an erotic transference and
that the basis of this transference was Dora’s sexual impulses toward
her father. Dora then projected these impulses to her father, who
was bad because of them, and to all men, who were bad because
they were sexually interested in women. Freud believed that Dora’s
sexual feelings, and the accompanying belief that all men were bad,
were awakened in the analysis. By leaving treatment, Dora was
enacting her contempt of men and was avoiding facing her sexual
30 Chapter 3
longings. Freud admitted that he had disavowed the importance of

this erotic transference until after Dora had left treatment.
Reading the case, it is clear that Dora’s sexual impulses were
only one part of a complex web of intimate relationships. The Κ
family, who were among her parents’ closest friends, had Dora stay
with them many times, and Dora had shared with Frau Κ many
confidences. From the time Dora was six, her father had an affair
with Frau Κ the nurse who had taken care of him in a sanitarium
when he had tuberculosis. When she was 14, Dora was passionately
kissed by Herr Κ and reacted to it with great disgust.
Such disgust was exacerbated by Dora’s thinking“that she had
been handed over to Herr Κ as the price of his tolerating the
relations between her father and his wife; and her rage at her
father’s making such a use of her was visible behind her affection
for him” (Freud, 1905b, p. 34). Dora felt betrayed not only by her
father, but also by both Herr Κ and Frau K. She told her father
about Herr K’s sexual advances, and her father asked Herr Κ to
explain. Herr Κ denied the accusation and responded by speaking
disparagingly of her because she read pornographic books. He said
“no girl who read such books and was interested in such things
could have any title to a man’s respect” (p. 62). Thus, not only did
Herr Κ lie about his sexual advances, but Frau K, who was the only
one who knew about Dora’s pornographic books, had betrayed
Dora. It is easy to see how Dora could view relationships as
deceitful, manipulative, selfish, and ending with betrayal.
Deutsch (1957) inquired about Dora 20 years after the girl
broke off treatment with Freud. An informant described her as“ o n e
of the most repulsive hysterics” he had ever met (p. 167). The
middle-aged Dora suffered from migraine, unbearable noises in her
right ear, and dizziness when she moved her head. She was, as
predicted by Freud, a very hostile and bitter person, still acting out
revenge on men, especially her husband, who died tortured by her
reproaches. She expressed great disgust with marital sexual life and
clung to her son, the major object (selfobject) of her reproaches
once her husband died.
Wolf (1980b) takes another approach to the case of Dora by
empathizing with the 14-year-old. She has arranged to watch a
procession from a store owned by friends of her father. The owner,
alone with the girl, closes the shutters, clasps the girl to him, and
gives her a kiss. Wolf asks if she was sexually aroused, as Freud
claims she must have been. Wolf’s friends, after being told this story,
described her inner state with such adjectives as startled, frightened,
embarrassed, and angry, but not erotically stimulated. Dora herself
said she experienced disgust. Freud, however,“who usually was a
most introspective and empathic analyst, could not or did not really
empathize with Dora” (p. 41). Instead, Freud thought she was
sexually stimulated and that her disgust was simply a manifestation
of a reversal.
Wolf (1980b) writes:
It is clear that Freud is not thinking of a young girl, of a person,

or of a self in a particular situation, a situation which may be
experienced as a frightening attack, a humiliating assault, a
stimulating intimacy, or perhaps a betrayal of a trust. Freud
appears to be thinking only of seeing a nubile sexual apparatus
which in proximity to an arousing sexual stimulus failed to
respond with sexual excitement. It is as if the girl were merely an
appendage to this sexual apparatus, and, therefore, Freud is
bound to diagnose the failure to respond with overt conscious
sexual excitement as a kind of pathology, as hysteria. In this rare
instance Freud has not been empathic with the girl but has put
his theory first, the theory which says that the ubiquitous sexual
instincts are at the root of most psychopathology. . . . The disgust
experienced by Dora had little to do with whatever sexual arousal
may or may not have occurred. Her disgust was the appropriate
response of an adolescent to the betrayal of trust [p. 42].
Consistent with Wolfs position, the transference in Dora’s case

may not have been just a displacement from her past experiences
of betrayal by her father, Herr K, and Frau K, but also was grounded
in her experience of Freud. She entered the therapy hoping that
Freud would function as a selfobject, that is, be invested in her,
affirming her or allowing himself to be idealized by her. Instead,
she became the selfobject for Freud’s theory, just as she had been
a selfobject for others. Bitter about being constantly used as a
selfobject, Dora turned Freud into a selfobject of revenge. According
to Deutsch’s (1957) description of her 24 years later, Dora was a
person in need of selfobjects of revenge to maintain her self
cohesion.
32 Chapter 3
THE RAT MAN
The Rat Man was a 29-year-old single man who saw Freud for an 11-
month period commencing October 1, 1907. Mahony (1986)
discovered that he was Dr. Ernst Lanzer, previously referred to in
the literature as Paul Lorenz (Lipton, 1977). Dr. Lanzer’s presenting
symptoms“were fears that something might happen to two people
of whom he was very fond—his father and a lady whom he
admired. Besides this he was aware of compulsive impulses—such
as an impulse, for instance, to cut his throat with a razor” (Freud,
1909, p. 158). Freud evaluated this case as follows:
This case, judged by its length, the injuriousness of its effects, and
the patient’s own view of it, deserves to be classed as a moderate-
ly severe one; the treatment, which lasted for about a year, led to
the complete restoration of the patient’s personality, and to the
removal of his inhibitions [p. 155]·
More than anything, the treatment of Ernst Lanzer helped the

medical community accept psychoanalysis as a potentially effective
therapeutic agent. It was seen as a longer treatment, with more
permanent results. Mahony (1986), however, questions this
generally accepted belief. He claims that Freud saw the Rat Man for
regular, six-times-a-week psychoanalytic sessions for “ s e v e r a l
months” and that for the next six months Freud saw him very
intermittently. He also questions the“complete restoration of the
patient’s personality.”
Unfortunately, we have only limited evidence of the permanent
gains of Freud’s treatment because the Rat Man was taken prisoner
by the Russians during World War I and died four days later. In a
letter to Jung at the time of the Rat Man’s announced engagement
to be married, however, Freud wrote,“he is facing life with courage
and ability. The point that still gives him trouble (father-complex
and transference) has shown up clearly in my conversations with
this intelligent and grateful man” (Mahony, 1986, p. 84). Mahony
sees the Jung letter as evidence that the Rat Man was“ a public
instance of Freud’s therapeutic exaggeration” (p. 85). Mahony goes
on to explain that“Freud desperately wanted the appearance of a
complete case to impress his recently won international followers
and to promote the cause of the psychoanalytic movement” (p. 85).

This case also served as a selfobject for Freud’s theoretical interest.
Treatment of Ernst Lanzer shifted Freud’s theoretical attention
from hysteria to obsessional neurosis. In a brilliant extension of his
technique of dream interpretation, Freud’s strategy of treating
obsessional fantasies as elements of a dream led him to invite
Lanzer to associate to them. From these associations, Freud soon
realized that Ernst Lanzer’s fears of being punished, and the
accompanying fantasies, were the result of unacceptable wishes,
particularly wishes for revenge on those to whom he was deeply
bonded—his father and his girlfriend. Through a careful, painstak-
ing investigation and collaborative effort, Freud and Ernst Lanzer
gradually uncovered the revengeful wishes behind the fantasies of
punishment. This uncovering process so involved Lanzer, that he
became convinced that his symptoms were a manifestation of such
unacceptable affects.
Chessick (1980a) believes that Freud’s associative and interpre-
tive work played a minor part in the personality changes in Lanzer:
In my judgment, the case represents what is generally known in

psychotherapy as a transference cure; that is, it is the interaction
in the transference and the countertransference between the
patient and the therapist, rather than any brilliant symbolic
interpretations, that brought about improvement in the patient’s
mental health [p. 146].
Supporting Chessick’s position is Salzman (1980), who believes

that the obsessional’s intellectual and behavioral maneuvers are
designed to give the illusion of control over the obsessional’s
destiny and to substitute for significant personal relationships. He
writes,“There is now good reason . . . to believe that the obsession-
al defensive mechanism is the most widely used technique whereby
man achieves some illusion of safety and security in an otherwise
uncertain world” (p. xii). The obsessional can make brilliant
intellectual associations to dreams or symptoms with relish, without
changing his personality, because“ t h e ability to displace any
symptom into something far removed from its original conforma-
tion is a main characteristic of his illness” (p. xv). Salzman’s position
is bolstered by those patients, analyzed for years, who gain much
34 Chapter 3
insight into their own dynamics and can explain the theory behind
their condition, but who retain their symptoms. Clinical experience
suggests that Freud’s success came from other than what he
thought—many following his techniques literally, have not been
able to replicate his results.
Lipton (1977) also confirms Chessick’s position. From a detailed
analysis of the case of Ernst Lanzer (Paul Lorenz), Lipton concludes
that“Freud’s technique in that case was his definitive technique” (p.
255) and was different from the modern classical technique of strict
neutrality. Modern technique, has not been an advance, but a
“disadvantageous” development. The difference between Freud’s
technique in the Lanzer case and modern technique is a“ r e a l
relationship.” Lipton claims that Freud had a real relationship with
his patients separate from any techniques. He thinks“that a central,
important difference between Freud’s technique and modern
technique is the redefinition of technique to incorporate the
personal relationship which Freud excluded from technique” (p.
271). In the Lanzer case, the real relationship is reflected in Freud’s
behavior, which is now criticized by adherents to modern tech-
niques. For example, in the second hour Freud made a self
revelation and introduced general talking; he did not challenge
Lanzer when he got off the couch and paced in the room; he sent
him a postcard signed ‘cordially’; he asked for a photograph of
Lanzer’s lady friend; and he gave Lorenz a meal.
The meal was no more than a courtesy which Freud extended to

Lorenz personally and by no means a disguised therapeutic
measure. Exigencies which impel the analyst to offer the patient
some courtesy or some assistance on a personal basis occur
occasionally, and every experienced analyst I have spoken to
about this subject has had his own unique confirmatory experi-
ences to report [p. 259]·
Lipton’s arguments about Freud’s real relationship suggest that

Ernst Lanzer was changed by Freud’s honesty, integrity, and
genuine, humane attitudes and behavior while he kept him involved
in the analytic work of dream and symptom interpretation. Biegler
(1977) also thinks that an important therapeutic factor in the
analysis of Lanzer was Freud’s personality, implying the successful
result comes from a corrective emotional experience rather than

interpretation. Chessick (1980a) adds:
This case has led some therapists astray in that the exposition
emphasizes symbolic and intellectual material; in my opinion,
however, the key to the success of the treatment is Freud’s
personality as well as his interpretation of the patient’sfeelings in
the transference. I cannot help but wonder if such a case—in
which during the second session the dazed and bewildered
patient calls the analyst ‘captain’ and gets up from the sofa—
would these days be considered a suitable case for formal
psychoanalysis [p. 150].
Further support for the idea that the real relationship was the
major therapeutic agent of change in the case of Ernst Lanzer comes
from reports of those who had their training analysis with Freud.
Lipton (1977) states:
The books by Wortis (1954), Doolittle (’H.D.’, 1956) and Blanton

(1971) and the shorter accounts by Riviere (Ruitenbeek, 1973, pp.
128-131, 353-356), Grinker (ibid. pp. 180-185), de Saussure (ibid,
pp. 357-359) and Alix Strachey (Khan, 1973), all demonstrate the
cordial relationships which Freud established with his patients [p.
261].
Freud the clinician emerges from the cases he conducted,

especially that of Ernst Lanzer, as extremely dedicated and intuitive.
Gay (1976) writes of Freud,“ H e was more humane than he readily
allowed. His case histories and his private correspondence disclosed
his pleasure in a patient’s progress, his delicacy in managing a
patient’s feelings” (p. 44). Chessick (1980a) also says:
Freud’s overriding life purpose—to know and to understand what

goes on in the human mind—which tended to make him seem
single-minded, one-sided, and imperious, produced a high level
of concentration on his work that patients experienced as an
intense form of caring about them, and as an insistence that the
patient take a similarly scientific attitude toward his own psyche.
I am certain that both of these aspects of Freud’s approach to
36 Chapter 3
patients were essential to his therapeutic results; he wrote little

about these aspects simply because he took them for granted as
the obligation or calling of any physician who is dedicated to his
patient’s welfare [p. 154].
The case of the Rat Man was an important step forward for
Freud and psychoanalysis, even though Freud’s claim at the time
may have been overly optimistic. In the next chapter we turn from
Freud’s clinical experiences, and their theoretical implications to an
exploration of Freud’s theory of the mind. Using the analogy of a
machine, he called the mind a“mental apparatus.” We examine this
model’s philosophical assumptions and in the light of a modern
understanding of the brain’s functions, its inadequacy for the task
given it.
Readings for Chapter 4: Ryle, 1949; Basch, 1975a; Levin, 1990.
4
Freud’s Mental
Apparatus
I n seeking to explain psychotherapy, Freud developed a theory

of the mind that used the concept“mental apparatus.” The
inadequacy of this concept ultimately resulted in the loss of
scientific support for the drive theory of the classical psychoanalytic
paradigm. The mental apparatus model raises many issues, which
we examine under the following headings: (a) Descartes’s mechanis-
tic strategy, (b) materialistic thinking, (c) an energy model, (d) a
consciousness model of perception, and (e) an image theory of
thought.
DESCARTES’S MECHANISTIC STRATEGY
In theorizing about the mind, Freud built on Rene Descartes’s idea

proposed 400 years ago. Descartes expanded the boundary of
science by using the analogy of the then recently invented clock to
37
38 Chapter 4
replace the animistic notion of the human body with a mechanistic

one. By arguing that the health or disease of a body depended on
the body’s constitutional parts working harmoniously, he became
the father of modern medicine. The mechanistic model enabled the
body to be autopsied and studied without risking the hostility of
organized religion: viewed as a machine, the body is not a living
organism, which can then be examined or cut without risk of being
sacrilegious or guilty of killing. To his mechanical view of the body
Descartes made one exception—the brain.
Descartes deflected the issue of religious heresy by retaining the
notion that six weeks after conception, as a result of divine
intervention, the soul was implanted in the human brain’s pineal
gland. In keeping with church doctrine, this soul differentiated
human beings from all other earthly creatures by instilling in them
a sense of morality, the ability to reason, and the gift to know and
potentially to chose good and evil—that is, to will freely. Descartes’s
dichotomy of brain and soul was expanded to include brain/mind
and body/mind dichotomies. Descartes also equated reason with
thought, thought with consciousness, and consciousness with self-
awareness.
While extending Descartes’s mechanical model, Freud nonethe-
less challenged Descartes’s equating consciousness with mind by
demonstrating the existence of an unconscious reasoning process.
He also wanted to extend, through the idea of mental apparatus, the
deanimation of the body to the brain as well. Hence the brain was
a mental machine that ran on instinctually generated energy.
Thought was the discharge of such energy. To Freud, the brain
functioned like a steam boiler that constantly needs to discharge,
through thought or action, the excess energy produced by the
sexual (and later) the aggressive drives.
MATERIALISTIC THINKING
A major problem inherent in Freud’s idea of a mental apparatus was

the prevailing 19th-century physics’ materialism, which represented
reality as a thing. Freud reasoned that if the mind was not a material
thing, it had to be a nonmaterial“thing,” a mental rather than a
physical apparatus. Such a materialistic view of reality has become
Freud’s Mental Apparatus 39
outdated; under the influence of Einstein, physics itself has shifted

from a materialistic to a structuralistic (the pattern or structure of
the interaction) philosophical position (Basch, 1975a). Structuralism
and general systems theory describe the world as the ordered
relationships between events rather than as the events themselves.
Moreover, what is considered an event is altered by how it is
perceived in relationship to other events. By utilizing the prestige
of physics, particularly mechanics, to form a machinelike analogy for
the mind, Freud gave credibility to psychoanalysis as a scientific
endeavor. Freud’s use of the mechanistic thinking and materialistic
language of the physics of his time to make psychoanalysis scientifi-
cally respectable limited his drive theory.
Metapsychological theory, while useful, perhaps even necessary

for certain purposes, has led psychoanalysis into a virtual cut de
sac that is isolated from empirical and conceptual articulation with
biological sciences. When theoretical constructs that are beyond
the reach of psychological and physical methods are regarded as
real, the possibilities for fruitful dialogue and conceptual articula-
tion with the natural sciences slip away [Reiser, 1984, p. 7].
Once the materialistic philosophy of physics had changed

through the study of atomic and subatomic particles, the concept of
a mental apparatus lost theoretical appeal.
Using the ideas associated with structuralism, it is now possible
to describe mental functioning without resorting to such constructs
as“mind,” which the philosopher Ryle (1949) calls“the ghost in the
machine.” According to Ryle, “‘my mind’ does not stand for another
organ. It signifies my ability and proneness to do certain sorts of
things” (p. 168). He goes on:
To talk of a person’s mind is not to talk of a repository which is

permitted to house objects that something called“the physical
world” is forbidden to house; it is to talk of the person’s abilities,
liabilities and inclinations to do and undergo certain sorts of
things, and of the doing and undergoing of these things in the
ordinary world.
If we discard the concept of mind as a machine, we are left

with a neurophysiological organ of the body, the brain. This brain
40 Chapter 4
uses small amounts of calories to make signal processing possible.

We also need a term to describe the vicissitudes of encoded
patterns that are stored and compared in the brain and for the
brain’s ordering-abstracting activity. The brain’s message processing
may itself be a signal leading to more message processing that is
unconnected to muscular or glandular reactions. Message process-
ing is thinking. Recent developments in identifying the localization
of brain functions indicate that thinking is associated with increased
regional cerebral metabolic rate and increased regional cerebral
bloodflow. The totality of past experience, abstracted, and ordered
becomes the“ s e l f ”in self psychology.
A way to understand the concept of the self is related to the
functions and communications between the two cerebral hemi-
spheres. Levin (1991) uses the term“bicameral” to refer to special-
ized and related anatomical asymmetries of the two cerebral
hemispheres. He concludes that one of the outcomes of successful
psychoanalysis (and by implication, of any successful in-depth
psychotherapy) is that there are greater connections, both function-
ally and anatomically, between the two hemispheres. These
increased connections help overcome repression and disavowal (p.
41).
Freud’s model, on the other hand, conceived of the brain, a
living organism, as a closed system in which the brain sought a
stimulus-free“nirvana.”“Conceived in this fashion, the brain, left to
its own devices, would follow the laws of thermodynamics and
move from a state of high organization and unstable differentiation
to an amorphous, stable steady state” (Rasch, 1975a, p. 492).
Far from seeking the lowest level of equilibrium, the brain is
continually in need of optimal stimulation. As sensory deprivation
studies have shown (Spitz, 1945; Rexton, Heron and Scott, 1954),
instead of welcoming a state of rest, the brain engages in a veritable
frenzy of activity in its search for stimuli. If none are available, it
artificially provides them through fantasies and hallucinations. In
contrast to Freud’s view, the brain is now conceived of as a living
system that proceeds from a less differentiated to a more complex
state and resists disintegration. Unlike Freud’s closed system, open
systems do not respond passively to intersystemic and intrasystemic
changes, but use these as signals that determine the nature of their
response. Open systems influence their environment by selective

interaction and actively participate in shaping their own future
through behavior.
AN ENERGY MODEL
Freud’s notion of psychic energy, even if understood as a metaphor,

is now considered scientifically untenable. The brain does not
function as an energy-transmitting organ. The passage of nerve
impulses is signal propagation, not an energy transmission,
according to neurophysiologists (Basch, 1975a). The brain has
signaling functions that control the systems that build up and
expend energy. The necessity for an energy theory of the mind
disappears once the concept that the brain seeks nirvana is
discarded. Only a brain that seeks inactivity needs to be“driven”
into action. Since the function of the brain—indeed its very
structure—depends on the reception and ordering of stimuli, there
is no more need to postulate driving forces for the brain than there
is for any other organ of the body. An alternative to this drive¬
energy theory of mentation is now provided by communication
theory.
Several theorists (Rubinstein, 1973; Kent, 1981; Basch, 1985;
Levin, 1990), for example, are firmly committed to an information¬
processing model. Basch (1975b) has pointed out that Freud (1895)
hinted at such an information-processing model but ultimately
chose the energy discharge model of drive theory. Given the
science of his time, especially the influence of physics, Freud can
hardly be criticized for pursuing his model. Yet it is now clear that
such a model has long been obsolete and unsatisfactory.
Communication theory depends on information. Information
consists of a coded signal that reduces the uncertainty about acting
when one is confronted by alternatives. It limits rather than expands
options and increases the readiness to act:“The amount of informa-
tion in . . . statements is a measure of how much they reduce the
number of possible outcomes” (Miller, 1963, p. 124). Every living
cell processes signals and creates order, but the brain carries this
function to specialized heights. It has the obligatory function of
42 Chapter 4
continuously abstracting, that is, of registering and connecting

sensory signals into figure–ground patterns that become strategies
for decision making and acting. The central nervous system selects,
collects, and connects these impulses into message patterns. In this
sense, reality is the product of the brain’s creative activity reflecting
external conditions in such a manner as to formulate effective
action.
Recent research and theorizing, relying on an information--
processing model, understands the brain as a complex computer
with the capacity to program and reprogram itself. In this view, the
cerebellum functions much as the central processor of a computer,
receiving input from and sending output to every other part of the
nervous system. Levin (1991) contends that, as such, it has “‘the
computing power’ to contribute to the integration and coordination
functions that we assume human learning involves” (p. 66).
Levin also assigns to the cerebellum the role of coordination of
several major functions of the central nervous system.
On this basis it seems possible that the cerebellum could be

involved in part of the overall orchestration of a number of
nervous system activities that range widely. These include the
major affective elements within the brain (prominently the limbic
system and thalamus), the motor system (of which it is the
principal regulator), and the brain’s systems of integrating sensory
modalities of every kind (which keep the cerebellum in continu-
ous touch with both the external and internal milieu) [p. 65].
Levin also believes that the cerebellum plays a critical role in

our emotional lives and preeminently contains a representative of
the body/self; it also monitors the body parts and their relationship
to each other, as well as posture, acceleration, and the like. The
view of the brain as a computer of exquisite complexity and with
the ability to program and reprogram itself is a far cry from Freud’s
energy-disposal mental apparatus, which functioned in a crude,
mechanical manner. Perhaps decades from now neuroscientists will
look back at the“computer model” and find it equally deficient.
A CONSCIOUSNESS MODEL
OF PERCEPTION
In the brain of mammals and especially humans, direct stimulation

to act is replaced by stimulation that has been delayed by and
compared with the beliefs and generalizations that form perception.
Thus, neocortical brain activity that is not blocked by percepts
stimulates the limbic system of the brain. The importance of
percepts shifts the emphasis from information processing to the
processes whereby percepts are formed and changed. The process
of perception refers to the ordering of signals into neural connec-
tions that form a permanent record of experience, making recogni-
tion and adaptation possible. Perception is another name for the
brain’s abstracting and generalizing activity.
Contrary to Freud’s formulation that perception equals con-
sciousness, we now know that perception is a not-conscious
process. The sensory experiences that we are aware of and
mistakenly call “seeing,” “hearing,” and so on come after the fact of
perception; that is, our percepts formed from past experiences play
a major role in what we see and hear now. Consciousness seems to
be one subpart of the perceptual feedback cycle. It consists of
signals and information that cannot be made to fit established
perceptual patterns and hence are recycled by the brain until they
are either incorporated into the established order or form the basis
for new patterns of abstraction. In other words, consciousness is not
the equivalent of thought; it is but one aspect of problem-solving
thought. Consciousness assures that signals arousing attention, but
not matching existing patterns, will be temporally retained and not
be disregarded until their significance, if any, for the organism
becomes comprehensible.
Levin (1990), pointing out how highly idiosyncratic the process
of abstracting sensory input is on an individual basis, writes:
This suggests that the abstracting phase of long-term memory

(LTM) is more individually variable than the sensory phase of
memory. That is, as we process information and go from the
44 Chapter 4
sensory to the LTM storage stage, we make progressively more

arbitrary choices about how to store particular knowledge. It is
possible that the meaning [italics added] of all experience is more
idiosyncratic than we might ever imagine. From this perspective
it seems logical that the “filing” code of LTM is probably highly
personal [pp. 51-52, n.6].
The highly personal meanings of long-term memory interest the

practitioners of psychoanalysis and intensive psychotherapy.
AN IMAGE THEORY OF THOUGHT
Freud’s (1911) theory of thought was based on the wish-fulfilling

hallucinations that take place as a part of the primary processes
operating according to the pleasure principle.
Whatever was thought of (wished for) was simply presented in a

hallucinatory manner . . . . It was only the non-occurrence of the
expected satisfaction, the disappointment experienced, that led to
the abandonment of this attempt at satisfaction by means of
hallucination [p. 219].
This abandonment of hallucinating pleasure coincides with the

development of the reality principle: “The psychical apparatus had
to decide to form a conception of the real circumstances in the
external world and to endeavor to make a real alteration in them”
(p. 219). Freud believed, for example, that through the visual image
of the breast associated with feeding, the baby learns to differentiate
between an hallucination and external reality. Thus, to Freud,
thought was a complex association of sensory images, an idea with
which cognitive psychologists disagree.
In answer to Freud, cognitive psychologists point to the first 16
months of life. Piaget’s (1969) findings, for example, indicate that
nonreflective action, not recall through symbolic representation, is
fundamental to learning. The first phase of development, termed the
sensorimotor phase, is imageless. As Church (1961) indicates, there
are “frames of reference,” “cognitive maps,” or “schema of mobiliza-
tion,” but not symbolic images. The idea that sensory stimuli set off
specific behavioral reactions, such as sucking, presents no problem

to physiologists (Basch, 1975a). It is precisely because infants are
incapable of representation of past experience, and therefore cannot
hallucinate, that their early attempts at pattern closure, when
stimulated by need alone, become frustrating and lead to adaptive
action and learning. Were an infant able to hallucinate, he would
die, for hallucinations totally gratify. Travelers who were about to
die of thirst in the desert and then were rescued have testified to
giving up trying to solve problems of surviving once they began to
hallucinate.
Disagreement with Freud today is not over the general idea that
the mind (self) forms images; it does, but after about 16 months of
age. Even then, however, such images should not be equated with
thinking, as Freud does, because they represent only one aspect of
thinking. Furthermore, even after 16 months, when we say we
“compare images,” we really do not. What is actually compared is
the neurological activity of the new stimulus to the past neurologi-
cal patterns established in the brain. Sometimes the end result of
the brain’s activity becomes conscious and assumes an image. It is
a mistake to call this end product thinking.
Another form of thought is sign behavior. In Pavlov’s famous
experiment, the bell set off complex gastrointestinal preparations
for digestion because the ringing sound had become a sign for
food. Gastrointestinal reactions had become reflex behavior. Such
reflex behavior does not come from the primitive, subcortical brain.
Although not voluntary, reflex behavior involves perceptual input
and evaluation. Once a pattern of sign behavior has been thorough-
ly mastered, it proceeds automatically when stimulated and turns
into reflex behavior essential to survival. The experienced pianist or
automobile driver is able to process and respond to many more
signals quickly and efficiently than is the novice, for whom the
activity has not yet become reflex. Absence of conscious reflection
is not an indicator of lack of complexity or of inferior thinking.
Quite the contrary, consciousness of action indicates a lack of
mastery.
Physiologically, the old brain, not the neocortex, initiates and
coordinates the actual activity that supports attraction or avoidance
behavior (Simeons, 1962). The diencephalon, cerebellum, and
46 Chapter 4
brainstem (the subcortical brain), precipitate and mesh the activities

of glands and muscles. As experiments with animals and the
experience of humans with massive strokes show (Simeons, 1962),
the vital activities of the body can go on without the participation
of the cortex; although the reverse, that the cortex can continue
without the vital functions, is not true. To Simeons, the associational
cortex is a complex set of feedback loops whose activity prevents
the older brain from overreacting to stimuli. The more primitive
animals must respond more directly to stimuli from the outside.
The lower the animal is on the evolutionary scale, the more likely
that every signal it receives is a sign initiating behavior of some sort.
More recent research indicates that the neocortex is not only
capable of inhibiting the older brain from overreacting to stimuli
but also that it remains almost infinitely “reprogramable” through-
out the life cycle. The most useful view of the brain is “an ecosys-
tem, not as ‘hardwired’ like that of lower animals” (Levin, 1991, p.
44). The connections between mammalian nerve cells are estab-
lished with a great deal more flexibility (Hagen, cited in Levin,
1991). This is a situation where “the synaptic deck is capable of
being continuously reshuffled . . . in which many mechanisms create
a flexible and dynamically changing pattern of connectivity . . . . To-
gether these studies illustrate that the human brain is a self-
organizing and plastic organ that continues to change and adapt
throughout life, not a static machine with unchangeable ‘hardware’”
(p. 44).
As animals became more independent of their environment, not
all stimuli required a response. Not every potential danger is a real
danger, nor does every inviting stimulus necessarily represent an
achievable goal. The associational cortex developed as an organ to
delay response, that is, to delay stimulation of the old brain, until
signals could be further evaluated. The primitive brain is the final
common pathway for motivation of behavior, and once it is
triggered, the reaction precipitated runs its course and will resist
interference.
Freud (1895) spoke of sheltering the cortex from overstimu-
lation, but, in fact, it is the cortex that acts as a protective mecha-
nism for the old brain. The diencephalon provides the key to
activity. It triggers inherited self-preservative or reproductive
patterns of behavior. These dispositional patterns are encoded in
the old brain’s blueprints. In mammals, inherited patterns of

behaving allow for considerable latitude in the manner of achieving
goals. For example, mammals have a wide choice of foodstuffs and
are not nearly as limited in what they may and must eat as are
amphibians, reptiles, and insects. Should a dietary deficiency arise,
mammals will become more alert to any nutrients containing the
needed ingredient and are free to search far and wide.
A major inherited disposition is the infant’s capacity to learn
from the environment (mother) in the first critical months of life.
The infant’s autonomic nervous system processes information about
the environment and facilitates communication with the mother.
The mimetic musculature of the infant’s face is also highly devel-
oped (Tomkins, 1962-63). There are eight or nine distinct sets of
muscle reactions that an infant can reveal facially. These reflect the
subcortically based affects of surprise/startle, interest/excitement,
enjoyment/joy, distress/anguish, anger/rage, fear/terror, con-
tempt/disgust, and shame/humiliation. Through these mimetic
responses, the infant gains significant control over the mother’child
symbiosis. Far from passively being shaped by the mother, the infant
forms a system with her, using her capabilities in the interest of his
needs. By his mimetic musculature, he indicates whether he is
optimally stimulated; if he is not, he sends signals that encourage
the mother to search for and correct whatever is wrong. It is not
the specific affect but the stimulus gradients that are responsible for
the infant’s behavior. Affective behavior is synonymous not with
emotion, feeling, or mood, but with the nervous system’s nonreflec¬
tive, involuntary responses to stimulation.
A clinical example of affect can be seen in a patient’s uncontrol-
lable crying and sadness during a session after his therapist notified
him of an impending vacation (Basch, 1975a). The patient had lost
his father when an infant. The infant was, of course, incapable of
experiencing emotions at the time of his father’s death. His crying
now represented distress he had experienced as an infant when his
mother became depressed and was unable to invest in him. Hence
as an infant he had experienced repeated frustration and mounting
but unrelieved tension. The sobbing was an automatic reaction to
prolonged helplessness, with its immobilizing disorganization.
Sobbing is a distress signal. The patient’s anguished crying was a
reliving of his early autonomic reaction to the indescribable
48 Chapter 4
experience of being helpless in the face of unrelieved tension. (In

the past this behavior has been seen as “blocked emotion,” rather
than an autonomic reaction that needs relief.)
Freud’s image theory, modified, has applicability after the age
of 18 months. Soon after 18 months, the infant begins imaginative
play, imitation in the absence of a model, daytime fantasy, and
nighttime dreams. All of these activities require symbolic capacity.
They thus mark the beginning of a symbolic life in which the infant
can re-present what has been experienced previously. A sign evokes
the action appropriate to the object signified, but a symbol arouses
the concept of the object (Langer, 1951). This symbolic capacity
represents an evolutionary advance with momentous consequences.
The child can now do more than match stimuli in the here and now
with established neural patterns; he can recall them and experience
a mental life independent of the immediate situation. Experience
can now be divided into past, present, future, and into subjects and
objects.
Our manner of objectifying reality is based on our abstractions
from, symbolization of, and reflection about our sensory experienc-
es. The world of so-called material objects is a part of the symbolic
world; it belongs to the world of ideas as much as our dreams do.
This is not to deny that there is a reality apart from our reflections
to which we react through perceptions, but this reality is one we
never know directly.
Conceptualization of experience as a generality precedes
conceptualization of individual objects. Indeed, the eventual
existence of particulars is made possible only by the conceptualiza-
tion of universals. This generalizing capacity, which Church (1961)
calls physiognomic perception, is based on the ability to extract and
symbolize the essential form from the totality rather than building
up a hierarchical classification atomistically. This formation of
universal symbols antedates the use of speech; indeed, the develop-
ment of language is based on the presence of symbolic concepts.
Rational verbal speech is a prime example of discursive symboliza-
tion. And with the advent of symbolic capacity the associational
cortex is no longer limited to triggering sign-induced behavior.
Now, instead of serving the old brain and its instinctual patterns of
self-preservation and reproduction, the associational cortex, through
symbolic function, to a great extent controls the dispositional power

of the subcortical patterns.
In summary, Freud’s attempt to build a mental apparatus theory
as the basis for psychoanalysis foundered under the accumulative
weight of empirically based knowledge of how the brain functions.
Freud’s brilliant guesses stimulated research. Yet his conception of
the way the mind functions and his notion of a machinelike mind
have come under increasing criticism as a basis for a theory of
psychotherapy. As Basch (1988a) summarizes, “Freud’s valiant
attempt at creating a mental machine survives to this day; but in
spite of the tinkering that it has undergone in the last one hundred
years, it still does not run and never will” (p. 13).
Not only has Freud’s theory of the mind been discarded by
many psychoanalysts, so has drive theory, for the two go together.
In the next chapter we examine drive theory and the metapsy-
chology associated with it.
Readings for Chapter 5: Bibring, 1941; Freud, 1923b; Hartmann,

1950; Klein, 1973.
5
Drive and Conflict
Theory
T o enhance the explanatory power of a mechanical model of the

mind, Freud found it necessary to propose some form of mind
energy. Just as a machine runs only with a power source driving it,
such as steam or electricity, a mental machine needs mental energy.
Freud originally thought this energy was sexual, but then used the
more general concept of libido, a “quantity of excitation” he
referred to as “Q” (Freud, 1895).
Freud’s concept of libido, which he probably arrived at from
philosophy prior to his early cases (Holt, 1976), helped explain
puzzling clinical phenomena. From his experience with hysteria
patients, Freud could view difficulties in recalling traumatic events
as repression of memories and thoughts, that is, without the concept
of the libido. Freud, however, took an important step by conceiving
of thought, sexual feelings, and action as manifestations of and
opportunities for the discharge of libido. This conceptual arrange¬
50
Drive and Conflict Theory 51
ment parallels Kant’s idea of phenomena (thoughts, feelings and

action) and noumena (libido).
According to Freud’s concept of libido, repression of thought
(memories are stored thoughts) is an example of repressed libido.
Libido blocked from discharge through thought seeks discharge in
some other way such as sex, overt actions, symptoms, or obsessional
rituals. The mechanistic model and libidinal theory offered a way to
link together and explain a multitude of functions and behaviors.
With time, however, what Freud began as an elegant, simple model
became excessively complex. In what follows we explore (a) the
evolution of drive theory, (b) Freud’s metapsychology, and (c)
conflict theory. Drive theory and conflict theory form an important
interface for the classical and self psychology paradigms.
DRIVE THEORY
Bibring (1941) summarizes how Freud’s drive theory developed

from its relatively simple beginning into a complex explanatory
analogy. Dualistic from the start, it underwent four major revisions.
In the first stage, Freud categorized two groups: the sexual (libidi-
nal) and the ego instincts. He first concentrated his theorizing on
the sexual instincts, leaving the ego instincts relatively unknown.
This theoretical emphasis on libidinal (sexual) repression and
discharge sufficed, provided Freud confined his explanations to the
clinical behavior of hysteria and obsessional neuroses.
In the second stage, Freud sought to explain clinical behavior
associated with narcissism, which, as Freud used the term, sub-
sumed what we now understand as the spectrum of narcissistic,
borderline, and schizophrenic disorders. He did so by developing
further the concept of ego instincts. The ego, he said, may become
the aim of the discharge of libido, even though the ego also retains
a nonlibidinal component called interest. To Freud, the ego
becomes the target of libido when all other aims are blocked. A
heavily libidinal attachment to the ego helps explain the symptoms
associated with the “narcissistic” disorders. This stage in Freud’s
thinking represents a significant step toward making drive theory
more inclusive.
52 Chapter 5
The third stage in drive theory attempted to explain what Freud

called sadistic behavior. He said there was an aggressive drive
essential to the ego instincts. In the last sections of “Instincts and
Their Vicissitudes,” Freud (1915) discusses how love and hate reveal
that the ego can discharge both libidinal and aggressive instincts.
This change in drive theory to include an aggressive instinct was
used to explain not only why love can turn so quickly into hate in
personal relationships, but also why nations can so quickly turn
from mutually beneficial activities to the bloodiness of a world war.
The fourth stage in drive theory came with the development of
the structures of the mental apparatus: the vital stratum (id), an
organized part (ego), and the unconscious part of the ego (super-
ego). This change meant that the aggressive drive was no longer
seen as primarily associated with the ego instincts, but as existing
independently, like sexual instincts, in the id (Freud, 1923). The ego
instincts now ceased to be independent entities and derived partly
from the libidinal and partly from the aggressive instincts.
In his final revision, a fifth stage was added to drive theory.
Freud then labeled the libidinal and aggressive instincts, postulated
as primary instincts, as the instincts of life and death. Thus, the
process of expanding drive theory into a more general explanatory
theory had resulted in increasing abstraction until eventually there
were two basic principles resting on biological assumptions. These
two basic drives—a life instinct of libidinal (sexual) energy and a
death instinct of aggressive drive—were perceived as the motivation
behind all human behavior.
Another important part of drive theory was Freud’s idea that
desexualized libido was a source of neutral energy available to the
ego. The ego as a subunit of the mental apparatus needs energy to
drive it. But if the energy that drives the ego is pure libido, its
defenses and organizing functions are immobilized, overwhelmed
by raw drive. The answer to this quandary is that while the id
supplies energy to the ego, this drive is neutralized by the ego
before it becomes available for the functions of the ego.
Hartmann (1950) greatly elaborated and refined this construct
of neutralization. He defined neutralization as energy that discharges
in a far less peremptory manner. Neutralization involves the
aggressive as well as the libidinal drives and takes place constantly
as a function of the ego. The idea of neutralized instincts enables us

to conceive of autonomous ego functions. Ego interests, that is,
goals set by the ego independently of the need for targets of
discharge for the libidinal and aggressive drives, are an example of
autonomous ego functions.
Rapaport (1959), hypothesizing ways the ego could neutralize
the drives, suggests neutralization occurs from actions of the ego
that introduce delay and detour. He talks about raising the discharge
thresholds of drive energies and building new dams to impede
direct discharge. Threshold levels are inborn but can be altered
through learning; they form the nucleus of the conflict free sphere
of the ego. Furthermore, building structures to increase discharge
thresholds utilizes drive energy. According to Hartmann, however,
structures are built from drives that first have been neutralized
(Applegarth, 1971).
FREUD’S METAPSYCHOLOGY
Freud’s instinct theory has been heavily criticized. Swanson (1977)

claims that a major reason for the unresolvability of the “psychic
energy” controversy is the difficulty in agreeing on a commonly
accepted definition. In reviewing Freud’s use of the term, Swanson
found five explicit frames of reference: interactional, subjective,
classificatory, abstract theory, and neurophysiological.
The first of these, interactional, refers to the interaction of mind
and body. The nonmaterial mind is activated by a nonmaterial
“fluid” that flows along nonmaterial pathways. This language, and
even the idea of psychic energy discharging through the motor
apparatus, is understandable as a metaphor; but when psychic
energy is said to convert into physical energy, the metaphor no
longer applies. This frame of reference is untenable because it
postulates energy discharge from the mind into the body, a process
with no support in contemporary biology, and employs an unaccept-
able shift from analogy to the language of causation.
The second frame of reference uses such terms as “psychic
energy” as descriptions of subjective experiences. Swanson argues
that as the language describing subjective experiences is already
54 Chapter 5
rich, he sees no value in adding a new set of technical terms. Even

so, it is clear that Freud was not just renaming subjective experienc-
es but trying to explain them. Swanson (1977) continues critically:
People do often feel as though they were seized with impulses,

suffused with excitement, paralyzed by fear, or otherwise over-
come with emotion. Furthermore, these feelings all must have
physiological correlates. But to hypothesize feelings as psychic
substances is to play games with words, not build a theory [p.
615].
The third frame of reference examines drive theory as classifica¬

tory. Psychic energy is defined as an abstract concept having no
referent that actually exists; it is merely convenient for organizing
clinical data. If this is so, writes Swanson, “there is no issue of
verification, refutation, or testability of statements, nor, of course, of
violating energy conservation, for this framework admits of no
theoretical-explanatory claims” (p. 615). Unfortunately this frame
also renders the theory useless.
The fourth frame of reference is abstract theory. Such theories
are intended to explain clinical data and predict behavioral
tendencies, but drive-discharge concepts cannot be verified by any
subsequent appeal to observation of behavior. Therefore psychic
constructs become irrelevant to the theoretical/investigatoryprocess.
The fifth frame of reference, the neurophysiological, creates a
hypothetical model of a living organism. Freud conceived of psychic
energy as being physical in nature, but he left the particular form
unspecified. The problem with this model lies in connecting this
physical energy with subjective experience. Freud kept trying but
never really succeeded. Freud’s clinical ideas are more useful when
they are “experience near” and not based on abstract analogies.
Klein (1973) made a similar case. According to him, Freud had
two theories of psyc0hoanalysis: a clinical theory and a metapsycho-
logical one. The 20th century responded with interest to Freud’s
clinical theories and not to his metapsychological explanations.
Unfortunately, when analysts began to formulate their ideas
systematically, they abandoned clinical theory for Freud’s metapsy-
chology and adopted the parlance and mannerisms of natural
scientists by talking about energies, forces, cathexes, systems, layers,

mechanisms, and physical analogies, rather than meanings.
Clinical theory is close to the factual, observational core of
analysis (Rapaport, 1959). Many clinicians still believe that Freud
derived his idea of Trieb (the German word Freud used for “drive”)
directly from clinical experience (Holt, 1976). Evidence supports the
idea that Freud brought his preconceived metaphysics to the clinical
situation:
In its starkest and clearest form—essentially as stated in the

“Project” (Freud, 1895b)—the metapsychology of motivation is an
explicit, coherent, but untenably mechanistic theory, which has
the virtue of being testable and the misfortune of being mostly
wrong. It is demonstrably the result of Freud’s effort to remain
true to Helmholtz and Brucke, his scientific ideal father imagos;
about all that is original to him in his theory is his synthesis of his
teacher’s ideas [Holt, 1976, pp. 162-163].
Freud thought that concepts of purposefulness and meaning

were unacceptable as terms of scientific explanation (Klein, 1973).
Behaviorism had the same assumption. Believing that regularities
described with concepts of purpose will ultimately be explained
through the use of purely physiological models, Freud wanted to
purge explanations of teleological implications. Freud thought it was
important to ask “how” rather than “why.” In emphasizing the word
“how,” Freud tried to convert and reduce psychology to the
universe of space, force, and energy (Gill, 1976). He considered
such constructs as meaning, purpose, and intention to be unscientif-
ic.
Freud’s philosophy developed in the tradition of the Brucke-
Meynert scientific value system, which held as axiomatic that no
phenomenon could be considered “explained” except in physical-
chemical terms. Thus, when, toward the end of his career, Freud
had doubts about the adequacy of the mind-machine/drive model
as a general theory to explain an expanding array of complex
clinical syndromes, he did not abandon neurophysiological
modeling as such (Klein, 1975). Nor did he abandon the notion of
a better metatheory to explain a clinical theory.
56 Chapter 5
“Freud . . . did not in fact abandon a single one of the major

errors of assumption that his medical and neurological training had
built into his thinking” (Gill, 1976, p. 76). When there is a conflict
between procedural evidence (assumptions) and validating evidence
(observations), procedural evidence always takes precedence
(Rychlak, 1968). The assumptions are not perceived as being wrong;
there is something wrong with our observations. For Freud the
positivist and determinist, the mechanisms of matter were all-
important for understanding, and he was unable to give up his
scientific assumptions.
Klein’s (1973) position, in contrast to Freud’s, is that metapsy-
chology is mostly irrelevant to the clinical enterprise, because one
cannot explain clinical data with metaphysical constructs. He
believes that “the essential clinical propositions concerning
motivation have nothing to do with reducing a hypothetical tension;
they are inferences of directional radiants in behavior and the
object-relations involved in these directions” (p. 108). There is need
for only one psychoanalytic theory, a clinical theory that is tied to
the treatment situation. In the analytic enterprise there are not
mechanisms, but challenges, crises, relationships, wishes, frustra-
tions, values good and bad, varieties of pleasure and pain. The core
of the analytic process consists of the meanings that emerge.
The idea of separate approaches to the “why” of meaning and
the “how” of mechanics gains support from Polanyi (1965a, 1965b,
1966), according to whom a comprehensive entity can have different
“orders of reality” depending on the “focus” or the “clue” domain.
Focus depends on what is foreground and what is background in
looking. Any act of knowing proceeds from incidental awareness of
the clues to focal awareness of the leading element of the entity.
When we look at an event as a clue, it has a different meaning from
when we look at it as a focus. When employed as a focus, it no
longer has a clue function; it now takes on a different level of
meaning.
Paraphrasing Polanyi, Klein (1973) indicates that statements of
purpose or meaning and principles of physiological regulation are
two mutually exclusive ways of being aware of our bodily activities.
The analyst can ignore the mechanistic language of physiology. For
Klein “there are no such things as stimuli and responses, but only
‘encounters’which have meaning” (p. 131).
As suggested by Bibring’s material, the most important explana-

tory construct in Freud’s metapsychology is the idea of an instinctual
drive or Trieb. Holt (1976) views it as following the idea of the
nervous system, which is passive, without energies of its own and
functioning so as to rid itself of the noxious input via action. Holt,
however, claims that neurological evidence does not support a
“passive reflex model.” Modern neurophysiologists say that the
nervous system is not passive when tested; that not all stimulation,
curiosity for example, is noxious; and that not all psychic tension is
experienced as unpleasant. Further, as stimulus deprivation studies
show,
it is virtually impossible to protect a person from physiologically

effective, external stimuli and keep him alive. We are bathed in a
continuous sea of inescapable stimulation, and in fact our normal
functioning seems to be dependent on an average expectable
environment of varied stimuli [Holt, 1976, p. 165).
Experimental evidence does not support Trieb theory either,

especially with the sex “drive.” Such a drive was thought to be
mediated through hormones. When these hormones were eradicat-
ed in rats by castration, sexual behavior tended to stop and then
dramatically increase after injections of the hormone. This result
was initially seen as support for the drive theory. However, long¬
term studies now indicate that the physiological capacity to engage
in sexual intercourse and have orgasm can persist for 30 years after
the removal of the gonads (Holt, 1976). Experiments also support
the idea that sexual behavior depends on more than a biochemically
based drive (see, for example, Beach, 1956).
The position that sexual behavior is more than biochemistry is
also supported by another experiment with rats. “When a male has
been allowed to copulate with a female to the point where he
shows no further interest in her and appears ‘sexually exhausted,’
his capacity to perform sexually is immediately restored when a
new mate is offered him” (Holt, 1976, pp. 174-175). This phenome-
non is found in rats, roosters, guinea pigs, monkeys, bulls, and,
anecdotally, in humans. No wonder Holt writes, “Drive is dead; long
live wish! Freud’s concept of Trieb served a useful function in his
58 Chapter 5
own theoretical development, but for us it is an anachronism

beyond hope of rehabilitation” (p. 194).
Freud’s metapsychology and his Trieb theory, considered pivotal
in classical analysis, have not only been thoroughly and systematical-
ly critiqued by the authors just quoted (Holt 1976; Klein, 1976;
Swanson, 1977) but also by Kubie (1975), Gill (1976), Peterfreund
(1971), Rubinstein (1967), and Schafer (1976). Stolorow (1986a)
believes the conclusions of these authors are definitive.
For those who persist in using drive theory, Michael Basch
(1986), a colleague of Kohut’s, has some scathing words:
The psychoanalytic establishment is rather, a ramshackle lean-to,

built by verbal sleight of hand, that hides epistemological and
clinical failures that must be faced if we are to be true to Freud’s
vision . . . . Why does [classical analysis] continue to flourish in
spite of the fact that, as I have already mentioned, adherence to
that theory is essentially nominal, and no one now practices, if
anyone ever did, what the theory actually mandates?
We should ask those who insist on the validity and necessity

of the instinct theory for psychoanalysis and who refuse to accept
evidence to the contrary what evidence they need to persuade
them that the instinct theory of motivation for human behavior
cannot serve as an explanation for the clinical findings of
psychoanalysis. If there is no answer to that question, if for our
adversaries the instinct theory is a given, not subject to disproof,
then, of course, we are dealing with a quasi-religious belief, not
with a scientific hypothesis, and such a position speaks for itself
[p. 23]·
Basch (1986) sees self psychology as “bringing psychoanalysis

to where it should have been, or could have been, had the
imposition of instinct theory not prevented Freud and other analytic
pioneers from following the lead of the transference” (p. 25).
CONFLICT THEORY
Conflict theory has always been a part of psychoanalytic thinking. In

Chapter 16, we compare conflict theory and deficit theory, so we
now explore briefly the nature of conflict as understood in classical

theory and later as modified by ego psychology.
Initially conflict theory was based on the topographical model.
In this frame, unconscious irrational impulses were in conflict with
conscious rational thought. Freud (1923) eventually introduced
structural theory as having greater explanatory power than the
topographical model. In structural theory, the three agencies—id,
ego and superego—are conceived as being in conflict. Freud had
found a more technical way to describe the struggles that take place
between passions, reason and conscience.
Fenichel (1945), using structural theory, defined neurosis as a
conflict between the ego and the id:
We have in psychoneurosis, first a defense of the ego against the

instinct, then a conflict between the instinct striving for discharge
and the defensive forces of the ego, then a state of damming up,
and finally the neurotic symptoms which are distorted discharges
as a consequence of the state of damming up—a compromise
between the opposing forces [p. 20].
The id/ego conflict is complex because the superego is also

involved. The superego sometimes sides with the ego, and some-
times with the id. With the compulsive disorders, for example, there
is an ego verses id and superego conflict.
Despite the persistent critiques of drive theory, which is the
underpinning of structural theory, structural theory has endured.
Such endurance is understandable because it is not enough to point
out the inadequacies of an old paradigm. For a paradigm shift to
occur, there has to be a better alternative (Kuhn, 1962). As there
was no convincing theoretical alternative to drive theory, a belea-
guered classical analysis, emphasizing drive and structural theory,
intrapsychic dynamics, oedipal conflicts, and strict use of the
techniques of neutrality, transference regression, free association,
and interpretation, continued as the predominant paradigm.
Ego psychology created a variation of the structural conflicts of
classical analysis. Ego psychology, following the theoretical modifica-
tions of Hartmann, placed greater emphasis on the functions of the
ego. It stressed the ego’s function in helping a person adapt to the
reality of the external world. Hartmann, Kris, and Loewenstein
60 Chapter 5
(1946) conceived of conflict between the ego and reality in addition

to the id/ego conflicts, such as with toilet training:
First, there is the conflict between two instinctual tendencies, that

of elimination and retention (instinctual conflict); second, there
is the conflict between either of these tendencies, and the child’s
attempts to control them and to time his function: it is a conflict
between the id and the ego (structural conflict); and third, there
is the conflict with the external world that has made the structural
conflict necessary: the mother’s request for timing of elimination
[p. 27].
Ego psychology also sees conflicts between the autonomous

substructures of the ego. For example, “Patients seem to be
emphasizing material that can best be explained in terms of ego
subsystems, their integration, and how they are synchronized with
each other” (Giovaccini, 1987, p. 275). Hartmann (1952), focusing
on the ego, stressed the idea of ego functions: neutralization,
adaptation, organizational synthesis, objectivation, anticipation,
perception, thought, action, and defenses. Theoretically, once
neutralized instincts are made available to autonomous ego func-
tions, ego conflicts invested with neutralized energy are inevitable.
Autonomy leads to conflict between “ego interests.”
The more familiar one becomes with ego psychology, the more
one realizes that Hartmann’s ideas suggest many of the concepts
later utilized by Kohut. For example, Hartmann (1953) referred to
B. Rank’s 1949 phrase “ego fragmentation” (p. 179). Kohut may have
turned this term into self-fragmentation and made it one of his
major constructs. Hartmann also shifted his conceptualization from
ego to self in discussing several key ideas. He defined narcissism as
a “libidinal cathexis of the self, not just the ego” (Hartmann, 1953,
p. 179). And he stresses ego functions, not ego structures, as if they
were objects. As will be seen in Chapter 14, Kohut used this
Hartmann maneuver to turn the concept of a selfobject into
selfobject functions to avoid the problem of reification.
Before he died, Kohut (1980) openly expressed his indebted-
ness to Hartmann:
I am grateful to Hartmann because his work gave me the courage

to move further along the road that his acknowledgment of the
legitimacy of analytic interest in healthy functions had opened.

And even though I know from many personal discussions with
him that he could not have accepted the “psychology of the self
in the broad sense” with which we are now working, I am very
happy that he still read the manuscript of my Analysis of the Self
(1971) and gave it his approval [pp. 544-545].
Kohut’s desire to record self psychology’s link to Hartmann is

important: “It points to the historicity of self psychology within a
psychoanalytic research tradition” (Stepansky, 1989, p. 65). This
tradition, which was not available for Adler to appeal to, had formed
by the time of Hartmann and thus prevented Freud’s tactic of
condemning Adler’s work as a nonanalytic “ego psychology
deepened by the knowledge of the psychology of the unconscience”
from being used to condemn Hartmann. Kohut was implicitly
appealing to this research tradition for the acceptance of self
psychology as a legitimate expansion of psychoanalysis.
Besides ego psychology’s theoretical modifications of psycho-
analysis’ idea of conflict, psychoanalysis also underwent an orthodox
hardening (Lipton, 1977). For example, in the decade following
Freud’s death, Kris (1951) repudiated Freud’s technique in the
analysis of Paul Lorenz (Ernst Lanzer). This hardening is also
reflected in Eissler’s (1953) paper on parameters in which, while it
is stated that parameters may be unavoidable in special cases, the
ideal (orthodoxy) is clearly strict adherence to free association and
interpretation. Lipton claimed that Eissler’s work was a counter-
argument to Alexander and French’s (1946) emphasis on experience
at the expense of insight, manipulating the transference instead of
analyzing it, and leaving unresolved the attachment of the patient to
the therapist. Such orthodoxy was aimed at devaluing and disavow-
ing the personal relationship between the patient and the therapist.
The resolution of intrapsychic conflict occurred only through a well-
timed and correct interpretation (Gill, 1954).
Brenner (1982) offers a modern view of drive theory. He does
not want to drop the clinical use of the term “drive,” even though
he admits there is no support for its somatic source and tension-
discharge elements. He proposes a psychological construct of drive
that rests on a pleasure principle that is the single most dominating
motivation for mental life.
62 Chapter 5
Criticizing Brenner’s position, Mitchell (1988) claims that this

truncated “pleasure” view of drive theory so distorts the idea of
pleasure that it is unnatural and obscure. In Brenner’s theory, for
example, it is difficult to understand “why sexual pleasures are any
more central motivationally than any other forms of pleasure” (p.
85). Brenner is then forced to defend his theory with the idea “that
whatever the person does, no matter how painful it feels and seems,
must be pleasurable in terms of some unconscious wish” (p. 85).
Brenner (1982) also has to claim that any wish, once activated,
follows its pleasure-seeking path until it succeeds (p. 32). But once
he makes this claim, argues Mitchell (1988), “Brenner portrays the
mind, instead of being pleasure seeking, as being fatefully commit-
ted to whatever early wishes happen to emerge within it” (p. 85).
Brenner’s psychologically based pleasure theory of motivation does
not hold up under scrutiny as a useful way out of the problems of
drive theory.
Thus, Freud’s psychoanalytic paradigm using the model of a
mental machine driven by psychic energy—a paradigm that has held
sway for nearly a century—is acknowledged as mobilizing much
valuable clinical research and theoretical debate. Nevertheless, it is
increasingly seen both within psychoanalytic circles and especially
in the newer therapeutic professions of psychology and social work,
as an inadequate general theory of psychotherapy. It is the theory,
nevertheless, against which new paradigms are compared.
Before we examine the new self psychology paradigm, two
chapters are devoted to important precursors: (1) Ferenczi and (2)
the British school. Other precursor theorists such as Adler and Rank
are examined elsewhere (Detrick and Detrick, 1989). We include
chapters on Ferenczi and the British theorists because their ideas,
in conjunction with Hartmann’s, are sufficient to demonstrate that
the concepts of self psychology did not suddenly emerge ex nihilo
to challenge the drive-theory paradigm. In the next chapter we turn
to the discoveries of Sandor Ferenczi.
Readings for Chapter 6: Ferenczi, 1928; Ferenczi, 1933; Gedo,

1986, Chap. 3; Rachman, 1989.
6
Ferenczi,
the Dissident
T he self psychology paradigm casts the work of Sandor Ferenczi

in a new light. Through the eyes of classical analysis, Ferenczi
was seen as becoming increasingly demented in his later life or,
more generously, as courageously experimenting with an “active
technique” and because of the poor results, saving the analytic
movement from going down a therapeutic dead end. In the light of
Kohut’s work, a radically different picture emerges of a Ferenczi on
the main clinical highway, too far ahead of his colleagues for his
work to be appreciated. We examine Ferenczi’s ideas under the
following headings: (a) background, (b) character analysis, (c) active
technique, (d) narcissism, (e) trauma, ( 0 collaborative analysis, (g)
last days, and (h) precursors to self psychology.
BACKGROUND
When the analytic phase of his career began in 1907, Ferenczi had
already published about 30 scholarly papers on various subjects in
63
64 Chapter 6
Hungarian and German journals. He was 34 years old. “His

predominant personal qualities were enthusiasm, warmth, tender-
ness, giving, optimism, and compassion” (Rachman, 1989, p. 90). As
the leader of the Hungarian analytic movement, Ferenczi made his
most important contribution, second only to Freud’s, in building
clinical theory. Freud described Ferenczi’s initial theoretical and
clinical contributions as “pure gold.” The esteemed Ferenczi
accompanied Freud to Clark University (Massachusetts) in 1909,
where they walked together every morning while Ferenczi suggest-
ed the topic for Freud’s lecture of the day (Freud, 1933). For the
next five years, Ferenczi’s published articles gained him a reputation
as the outstanding contributor among Freud’s early disciples.
During World War I, Freud analyzed Ferenczi. Gedo (1976) says
of this analysis:
Its partial failure must be attributed to the unavoidable historical

circumstance that it was performed at a time when psychoanalytic
knowledge had not yet reached the point that would have made
possible the successful treatment of Ferenczi’s type of pathology
[pp. 358-359].
Gedo meant narcissism. Supporting Gedo’s view is Rachman’s

(1989) belief that the Freud/Ferenczi correspondence verifies the
view that Ferenczi was maternally deprived.
Torok (1979), also after studying the Freud-Ferenczi correspon-
dence and Ferenczi’s scientific diary, writes that Freud had prohibit-
ed Ferenczi’s marriage to the woman Ferenczi loved. This injunction
may have led Ferenczi to experience Freud as the depriving mother
and retraumatizer. Ferenczi married the woman eventually in 1919
(Gedo, 1976), but the marriage led to an irredeemable bitterness in
Ferenczi and guilt about it in Freud.
This hostility/guilt impasse in their relationship may explain why
Ferenczi eventually came to be seen as a traitor to psychoanalysis.
For example, by 1930 Ferenczi was reproaching Freud for having
failed to analyze the negative transference when Ferenczi was being
treated during the war. Freud (1937), on the other hand, without
mentioning Ferenczi’s name, described the unsatisfactory results
with Ferenczi in “Analysis Terminable and Interminable.” It is
possible to understand Ferenczi’s later clinical thinking as having
Ferenczi, the Dissident 65
resulted from his attempts at self-analysis because of the failure of

his treatment with Freud. Ferenczi’s most important work really
consisted in the search for a suitable treatment for himself as a
narcissistic character (personality) disorder.
CHARACTER ANALYSIS
Ferenczi’s first step was to emphasize the difference between

symptoms and character structure, and the need to treat the
underlying character disorder. He was the first analyst to make this
distinction (Gedo, 1988). Even though Freud, in the 25 years
between 1895 and 1920, expanded diagnostic categories to include
entities other than hysteria, his broadened nosology was insufficient
for Ferenczi. Besides “transference neurosis” Freud (1895) had
included the “anxiety neuroses,” which reflected “psychical
insufficiency” and “narcissistic neuroses” (Freud, 1914), which
included psychoses, homosexuality, and melancholic depression.
Ferenczi was also not satisfied with Freud’s theories of pathology
and treatment techniques. Freud laid more emphasis on the
importance of genetic interpretations; Ferenczi stressed the crucial
importance of affective reliving in the here and now of the analysis,
a position that has become widely accepted in modern psychothera-
py (Gill, 1984).
Ferenczi set down his views about character analysis in The
Development of Psychoanalysis (Ferenczi and Rank, 1924). He
pointed out that henceforth psychoanalysis could not confine its
therapeutic aims to the elimination of isolated symptoms or of
dynamic “complexes”; it had to address itself to personality in all its
aspects. Freud’s partial disagreement with the book “shattered”
Ferenczi and was seemingly a failure in a twinship transference
(Kohut 1971; see also Chapter 13, this volume).
ACTIVE TECHNIQUE
Although Ferenczi stressed treating character structure, he conduct-

ed “experiments” with an “active technique” after resuming his
private practice in 1919. Jones (1920) reported on this technique.
66 Chapter 6
Ferenczi said he was encouraged to use the active technique

because of Freud’s statements at the Budapest Congress in 1918
suggesting that a phobic cannot change unless induced to face his
phobia and act despite it. Freud also suggested active measures with
obsessional neurosis.
Federn (1933), in support of Ferenczi, said that experimentation
in active methods was quite common during that period, although
nobody talked about it (Lorand, 1966). Federn himself and his
colleagues in Vienna had tried various methods for furthering
analysis in cases that had reached an impasse. This common practice
of experimentation suggests that the attack by Ferenczi’s analytic
colleagues on the active method was a displacement of a dissatisfac-
tion for other reasons, perhaps the threat that Ferenczi’s clinical
ideas in general posed to the growing intellectual edifice built on
drive and structural theories.
The central aspect of Ferenczi’s active technique was to request
that the patient, in addition to using free association, act or behave
in a certain way, in the hope of increasing tension and thereby
mobilizing unconscious material. It was used only after a stalemate
occurred. He urged patients to fight certain habits. Ferenczi also
cautioned that the technique could not be used with all patients.
Ferenczi (1920) called attention to the fact that interpretation itself
is an active interference with the patient’s psychic activity because
“it turns the thoughts in a given direction and facilitates the
appearance of ideas that otherwise would have been prevented by
the resistance from becoming conscious” (pp. 199-200).
By 1925, however, Ferenczi, ever the innovator, had discarded
the commands and prohibitions of his active technique in favor of
positive and negative suggestions. He also had modified his active
technique in “Contraindications to the Active Psychoanalytic
Technique” (Ferenczi, 1925), where he indicated the need for
retreat if there were no responses to a suggestion. He particularly
warned against being too emphatic or forceful lest this be experi-
enced by the patient as a sadistic attack. As Lorand points out,
Ferenczi was exploring what Eissler (1953) later referred to as
“parameters.” Ferenczi did so because he was probing for success
with the “dried up” cases that came to him from all over the world
as their last hope. Ferenczi, predating Winnicott by 40 years,

experimented with adjusting the analytic situation to the patient’s
needs—setting up a facilitating environment. These technical
experiments were later seen by Eissler (1953) as a “deviation” from
analytic orthodoxy and from the true techniques of free association
and interpretation.
Encouraged by the work of Ferenczi, Franz Alexander experi-
mented with the active technique in evolving the idea of a “correc-
tive emotional experience.” In this maneuver, Alexander (1953)
recommended manipulating the transference so that it was the
opposite of the traumatic relationships of the patient’s upbringing.
Alexander’s ideas were rigorously opposed in the psychoanalytic
climate of the 1950s as not being psychoanalysis and therefore
incapable of producing permanent structural changes in the patient.
When self psychology is accused of being another version of a
“corrective emotional experience,” it is important to understand that
it is being accused of manipulating the transference in the rejected
tradition of Ferenczi and Alexander. Self psychology claims,
however, that its theory does not sanction “active techniques.”
NARCISSISM
With increasing clinical experience, Ferenczi’s search for a way to

treat character structure became more focused on the narcissistic
character disorder. He called one narcissistic type involving archaic
character pathology “the wise baby.” Awareness of this syndrome
arose from Ferenczi’s self-reflection as well as from his work with
patients. He describes these patients as having been traumatized by
parental failures to help them with weaning, habit training, and
renouncing the status of childhood in favor of more mature modes.
In the course of the development of the “wise baby,” excessive
strictness or deficient external controls form harsh superegos in
children who have difficulty differentiating fantasy from reality.
Later, as patients they cannot trust the analyst’s dependability and
will test him repeatedly. Thus the negative transference must be
analyzed before a positive transference can blossom. These patients
cannot free associate; they need unlimited time in working through.
68 Chapter 6
Termination cannot be initiated by the therapist and should occur

only when the mourning for the lost gratifications of childhood has
been completed.
Many of these “wise baby” patients are suicidal, with an intense
self-destructiveness that might exemplify the concept of the death
instinct. Their oedipal problems are unresolved, and they are
preoccupied with what we have come to call existential concerns.
Their early traumatization acts like a constitutional adaptive defect,
as if a solid “life force” has failed to come into being because of the
deficiency of “good care.” The personality is fragmented by multiple
splits that defend against the affective recognition of infantile
traumata. Ferenczi saw this pathology as similar in some ways to
that of the psychoses.
The most sensitive issue for these “wise babies” is abandon-
ment, against which they defend themselves through narcissistic
withdrawal. Often, however, a precocious maturity emerges and
they take on a protective role toward their parents during child-
hood. This precocious behavior is seen as a masochistic surrender
involving an identification with an aggressor who is then uncon-
sciously devoured. A failure of these defenses leads to a profound
hopelessness and helplessness. The reality of the traumatic events
is ultimately defended against by pervasive doubt or depersonaliza-
tion. Ferenczi “was actually engaged in the pioneering study of
borderline patients and their treatment by psychoanalysis” (Gedo,
1976, p. 373).
TRAUMA
In working with narcissistic and borderline character disorders, it

did not take long for Ferenczi to recognize that sensitivity to being
traumatized was a central issue. His professional interest in trauma
began during World War I, when he collaborated with Abraham,
Simmel, and Jones on war neuroses (trauma). He recognized that,
as a result of the trauma of battle, there is regression to previously
abandoned methods of adaptation. Ferenczi’s interest in trauma
stayed with him throughout his professional career, as evidenced by
his final paper read to the Wiesbaden International Psycho-Analytic
Congress in September 1932 (Masson, 1984). The paper, “Confusion
of Tongues Between Adults and the Child” (Ferenczi, 1933), was

presented to the Congress but was not published until Balint’s
persistence was rewarded in 1949.
In that paper, Ferenczi’s “recent more emphatic stress [was] on
the traumatic factors, which have been undeservedly neglected of
late in the pathogenesis of the neuroses” (p. 156). (This emphasis
on trauma was also Freud’s (1896b) in “The Aetiology of Hysteria.”)
Ferenczi was again suggesting that many patients have been sexually
molested as children. It, in effect, gave a message that psychoanaly-
sis had been going down a blind alley by analyzing only intrapsy-
chic fantasies. Masson (1984) concludes, “It is Ferenczi’s ideas about
trauma that made him unacceptable to Freud, and not his experi-
ments with technique” (p. 166).
Masson’s position may not go far enough. Ferenczi’s emphasis
on trauma was only one aspect of a whole new approach to
psychoanalysis. Rachman (1989) wrote of Ferenczi’s 1933 paper:
It solidified the new method of humanistic psychoanalysis; reintro-

duced the seduction hypothesis; encouraged professional
acceptance of sexual abuse of children by parents and parental
surrogates; introduced the concept that analysts should retrauma¬
tize their patients in Freudian therapy, and precipitated the final
disruption of Ferenczi’s relationship with Freud and the analytic
community [p. 95]·
Ferenczi’s awareness of the theoretical importance of trauma led

him to believe that one of the consequences of trauma was the
arrested development of the patient (Ferenczi, 1913), a concept that
was taken up by Anna Freud (1965) and introduced into self
psychology by Gedo (1966, 1967). (It is discussed further in chapter
16, this volume.)
COLLABORATIVE ANALYSIS
In treating character disorders, Ferenczi developed a collaborative

approach to avoid fostering resistance and retraumatization in the
patient. It was this collaborative approach that made Ferenczi’s
treatment seem more humanistic. His collaborative method is
70 Chapter 6
discussed under the following topics: 1. empathy, 2. retraumatiza-

tion, 3. mutual analysis, 4. identification with the aggressor, and 5.
lay analysis.
Empathy
Through his clinical experience, Ferenczi gradually came to devote

more attention to the theory and use of empathy in conducting
psychotherapy. He arrived at this construct out of a concern for
resistances to the analyst’s interventions.
I recall, for instance, an uneducated, apparently quite simple,

patient who brought forward objections to an interpretation of
mine, which it was my immediate impulse to reject; but on
reflection not I, but the patient, turned out to be right, and the
result of his intervention was a much better general understand-
ing of the matter we were dealing with [Ferenczi, 1928, p. 94].
He also saw empathy as connected to the idea of tact: “I have

come to the conclusion that it is above all a question of psychologi-
cal tact whether or when one should tell the patient some particular
thing” (p. 89). Tact in determining when to interpret was more
important than the interpretation itself. But then he goes on, “But
what is tact?. . . It is the capacity for empathy” (p. 89).
Rachman (1989) points to evidence of Ferenczi’s use of
empathy:
Several published resources provide examples of Ferenczi’s

empathic functioning as an analyst. There are Ferenczi’sfirstcase
of psychoanalytic therapy (Ferenczi, 1919a), what I (Rachman,
1976) have termed Ferenczi’s “Case of the Female Croatian
Musician” (Ferenczi, 1920); the “Grandpa Encounter” in Ferenczi’s
discovery of the language of empathy (Ferenczi, 1931); and
Thompson’s (1964) report of “The Case of The Slovenly Soldier”
In the Croatian Musician case, Ferenczi seems to have participat-

ed in what we now call a mirror transference (chapter 11) because
he encouraged a woman to sing in his presence.
Ferenczi, the Dissident. 71
Retraumatization
With his increasing emphasis on trauma and empathy, “Ferenczi was

the first analyst to identify the traumatic aspects of the psychoanalyt-
ic situation” (Rachman, 1989, p. 98). Ferenczi thought that the
orthodox analytic stance did not encourage empathy.
The deliberate “restrained coolness,” “professional hypocrisy,” the

focus on the patient’s criticisms of the analyst as resistance, the
clinical facade behind which an analyst hides from a genuine
interpersonal encounter, all contribute to producing an ungen¬
uine and therapeutically limited experience [and trauma akin to
the patient’s childhood trauma] [p.99].
Mutual Analysis
Ferenczi also advocated the idea of mutual analysis, in which the

analyst shared with certain patients his own problems when they
overlapped with problems of the patient. This idea, although never
published, appears in Ferenczi’s diary and is hinted at by Ferenczi’s
reference to the professional hypocrisy of not focusing on the
analyst-patient relationship as an interactive process of responding.
In the diary, he also talks about the analyst’s admitting errors as a
way of earning the trust of the patient, a point that anticipated
Kohut’s recommendation to interpret the patient’s experience of
empathic failure.
Identification With t h e Aggressor
Another of Ferenczi’s original clinical constructs also relates to the

collaborative relationship between analyst and analysand. Long
before Anna Freud added “identification with the aggressor” to the
list of ego defenses, Ferenczi (1927) had discussed the idea in his
writings: “First we are afraid of punishment; then we identify
ourselves with the punishing authority” (p. 73).
This concept of identification with the aggressor was elaborated
five years later in Ferenczi’s (1933) last paper:
72 Chapter 6
Gradually, then, I came to the conclusion that the patients have an

exceedingly refined sensitivity for the wishes, tendencies, whims,
sympathies and antipathies of their analyst, even if the analyst is
completely unaware of this sensitivity. Instead of contradicting the
analyst or accusing him of errors and blindness, the patients
identify themselveswithhim; only in rare moments of an hysteriod
excitement, i.e., in an almost unconscious state, can they pluck up
enough courage to make a protest; normally they do not allow
themselves to criticize us, such a criticism does not even become
conscious in them unless we give them special permission or
even encouragement to be so bold. That means that we must dis-
cern not only the painful events of their past from their associa-
tions, but also—and much more often than hitherto supposed—
their repressed or suppressed criticism of us [pp. 157-158].
Lay Analysis
Ferenczi also supported the continuation of lay analysis. This was an

understandable position in view of his growing conviction about a
collaborative alliance and his fears that medicalizing the analytic
profession would only reinforce an authoritarian analytic stance.
Such a stance is signified by the Freudian notion of a two-tiered
hierarchical view of reality in which the therapist’s task is to change
the patient’s distorted view of reality as revealed in the transference.
In 1926, when Ferenczi visited New York at the invitation of the
American Psychoanalytic Association, the New York Society was cold
and distant, angry with him for his support of lay analysis. Jones
(1961) indicated, wrongly, that the New York Society’s coldness was
due to Ferenczi’s not informing the Society that he was coming.
Jones also stated that Ferenczi had been completely ostracized by
his colleagues, certainly an exaggeration in view of the fact that
some members of the New York Society attended his lectures.
There was, however, a coolness toward Ferenczi by the New York
Society’s leadership because of the lay analysis issue.
LAST DAYS
Despite Freud’s criticism of Ferenczi’s experiments in technique,

Freud and Ferenczi continued to correspond. Their relationship had
gradually become strained, beginning with Freud’s rejection of

Ferenczi’s idea on the need for character analysis (Ferenczi and
Rank, 1924).
The estrangement, which lasted until Ferenczi’s death in 1933,
became more obvious during the late 20s. Ferenczi had hoped for
a renewed closeness with Freud once he abandoned his active
techniques as not significantly improving therapeutic results. But the
differences between Ferenczi and Freud were far more substantial
than Ferenczi’s experiments with an active method. Ferenczi’s
clinical experiences and discoveries threatened Freud’s drive-
structural theory long before Freud was able to acknowledge the
weaknesses of his paradigm.
Ferenczi’s clinical discoveries also threatened Freud’s classical
paradigm to a degree that even Ferenczi was not aware. He almost
single-handedly attacked Freud’s approach to psychoanalysis on just
the clinical front, when what was needed was a broad attack on the
whole paradigm. It was not until Kohut made his broad-based
attempt to replace Freud’s mechanistic view of the mind with the
concept of the self, and to reject drive theory, that a new paradigm
emerged that could successfully challenge Freud’s classical one.
Compared with Kohut’s work, Ferenczi’s was a heroic gesture.
Fortunately, through Melanie Klein and Michael Balint, the seeds of
many of Ferenczi’s ideas later blossomed into the British school.
In 1933 Ferenczi was terminally ill with pernicious anemia. On
the basis of Ferenczi’s deviation from the classical technique, Jones
(1961) claimed that Ferenczi had a latent psychosis and that a
mental regression was apparent in Ferenczi’s later writings. There
does not, however, appear to be a shred of evidence that Ferenczi
ever suffered from a personality impairment or mental illness,
except for the last weeks of his life, when his spinal cord and brain
were effected by anemia (Lorand, 1966). Michael Balint (1958) and
others who were in contact with Ferenczi until his death have said
that, until the last week, he remained completely lucid and alert.
Gedo (1986) takes the slightly different position that some loss
of scientific rationality made its appearance in Ferenczi’s writings in
September 1932. Ferenczi spoke then of the possibility of an “ideal
power” working magically, each telekinetic action subordinating
externals to the will of “the ego” (p. 46). This regression of
Ferenczi’s sense of reality to a belief in the omnipotence of
74 Chapter 6
thoughts may have been in the service of disavowing his impending

death and his sense of helplessness.
Jones thought Ferenczi was conspiring against him (Lorand,
1966). Jones harbored negative feelings toward Ferenczi, often
expressed as irritation and criticism of Ferenczi even 20 years after
Ferenczi’s death in a conversation with Lorand. Why? Gedo suggests
that the ambivalence of Jones and others toward Freud was handled
through splitting. Freud was idealized, and his closest collaborator,
Ferenczi, became the target of their hostility.
Pernicious anemia was Ferenczi’s physical cause of death at the
age of 59. If one takes an empathic stance, however, it is difficult to
avoid feeling that he died of a broken heart. More accurately, he
died from lack of mirroring nourishment to sustain his brilliant,
creative work. The heir-apparent fell to palace intrigue. His death
was a tragic waste, coming at a time in his life when his clinical
experience, would have enabled him make further significant
theoretical contributions to psychotherapy. But, as we can now see,
his work was not fruitless. It took the perspective of time and the
work of Kohut for many to appreciate fully the contribution of
Ferenczi, who had the good fortune to be a collaborator with Freud
but the misfortune to wait in his shadow.
PRECURSOR TO SELF PSYCHOLOGY
Ferenczi’s ideas foreshadowed key clinical concepts in self psycholo-

gy. For example, nearly 30 years before Winnicott’s construct of the
transitional object, Ferenczi (1927) discussed the same notion: “The
natural tendency of the baby is to love himself and to love all those
things which he regards as parts of himself, his excreta are really a
part of himself, a transitional something between him and his
environment, i.e. between subject and object” (p. 67). We agree with
Rachman (1989, pp. 93-95), however, that Ferenczi’s thinking went
beyond the idea of a transitional object to something close to
Kohut’s general idea of a selfobject. This idea lies behind the
discussion of whether the family adapts to the child, or the child to
the family. Ferenczi wrote, “We are generally concerned with the
adaptation of the child to the family, not that of the family to the
child; but our special studies in psychoanalysis have shown that it

is we who should make the first adaptation” (p. 61). In Ferenczi’s
thinking, the family is meant to function as a selfobject to the child
and not the reverse.
Ferenczi’s writings show an awareness of the reparative reverse
selfobject experience (Lee, 1988), where the child acts as a selfob-
ject to the mother in the hope that the mother will function as a
selfobject for the child.
Children have the compulsion to put to rights all disorder in the

family, to burden, so to speak, their own tender shoulders with
the load of all the others; of course this is not only out of pure
altruism, but is in order to be able to enjoy again the lost rest and
the care and attention accompanying it. A mother complaining of
her constant miseries can create a nurse for life out of her child,
i.e. is a real mother substitute, neglecting the true interests of the
child [Ferenczi, 1933, p. 166].
Predating Kohut by many years, Ferenczi stressed introspection,

advocated the empathic method, urged therapists to admit their
interpretive errors, talked about the nuclear self, and was concerned
about a patient’s fragmentation and atomization. Kohut developed
similar clinical ideas but elaborated them more fully than Ferenczi
did. Kohut also offered conceptual alternatives to the outdated
philosophical assumptions of the classical paradigm. We believe that
Kohut, scholar as well as clinician, would not have neglected to read
Ferenczi and profit from him. If Kohut was not influenced by
Ferenczi, then the similarity of their ideas is a remarkable example
of a convergence of independently derived theory.
It is clear, then, that Ferenczi was a pioneer in formulating
theoretical ideas derived from working with severely disturbed
patients. He predated the modern interest in the borderline
syndrome by 50 years. Although his later clinical ideas were rejected
by Freud and Ferenczi’s palace rivals, who were committed to
classical analysis, his influence was felt in the British school,
especially through the work of Michael Balint. Unhampered by the
issue of orthodoxy, members of the British school were free to
explore the consequences of treatment by using explanations not
76 Chapter 6
tied to drive theory or the classical point of view. We turn to these

British theoreticians in the next chapter.
Readings for Chapter 9: Klein, 1935; Balint, 1968; Brandchaft,

1986; Bacal, 1989; Brandchaft, 1989.
7
The British
School
ollowing the example of Ferenczi, the theorists of the British

F School continued to explore the unchartered waters beyond
Freud’s classical theory. This school was not strictly British. Its first
major thinker, Melanie Klein, and another leader, Michael Balint,
were Hungarian expatriates, former students of Ferenczi. Others
were Heimann, Fairbairn, Guntrip, Winnicott, Khan, Bion, Suther-
land, and Bowlby. Their divergent ideas, covering 50 years, created
a “school” only in a broad sense. This chapter explores the clinical
and theoretical work of four members of the British School—Klein,
Fairbairn, Balint, and Winnicott—and discusses how their work
ultimately contributed to the development of a new psychotherapy
paradigm and to ideas that were the intellectual forerunners of self
psychology.
77
78 Chapter 7
KLEIN
Melanie Klein made her initial reputation as a pioneer of child

analysis. Behind her techniques was the assumption that the
spontaneous play of children is equivalent to free association in
adults. Following her mentor, Ferenczi, on the importance of
enactments, Klein understood that children communicate through
enactments rather than words (self psychology also understands
enactments as efforts to communicate) and respond to interpreta-
tions with further enactments.
On the basis of her work with infants, Klein challenged Freud’s
idea of the centrality of the Oedipus complex in the development
of psychopathology:
Her example and her teaching influenced a whole generation of

psychoanalysts outside the United States in the conviction that the
key to understanding and amelioration of basic psychological
disorders lay in the activation, observation, understanding, and
explanation of archaic transference configurations, together with
their displacements and disavowals, as entities in their own right
and not simply as evasions of or regressions from too intense an
oedipal rivalry. . . .
She maintained that the archaic tie was foundational when
she concluded from her psychoanalytic investigation and treat-
ment of small children that the basic structures of normal and
pathological development were laid down in earliest infancy. She
thereby signaled her departure from Freud and the theory of the
centrality for development of the oedipal conflict of the fourth
and fifth year [Brandchaft, 1989, p. 232].
Observing many symptoms of depression in child patients, Klein

(1935) posited the idea that, starting at 18 months, depression was
the major clinical issue. This depression arose from an attempt to
preserve the “good object.” Stripped of concrete images, such as
“devouring the breast,” her thesis “that the secure establishment of
a bond to a good internal object is the key to a useful, productive,
creative, and generative life, can hardly now be faulted” (Brandchaft,
1986, p. 254). Manic, schizoid, and paranoid defenses are variations
of this depressive problem.
The British School 79
Klein’s concept of projective identification bears some similarity

to Kohut’s selfobject construct. She was referring to a child’s fantasy
of expelling bad parts into the mother to be rid of unwanted,
aggressive elements. Projective identification was considered to be
a pathological, defensive operation whereby the other person in a
two-person relationship is denied independent volition because the
patient’s fantasies make the therapist an extension of the patient. In
conjunction with the concept of projective identification, Klein wove
into an elaborate theoretical narrative the technical concepts of
introjects, introjective identification and splitting.
Linked as Klein’s concept of projective identification was to the
idea of introjects, that is, “internal objects,” it depended on Freud’s
mechanistic and materialistic way of viewing the “mind.” When the
modern “mind” became viewed as an information-processing organ,
Klein’s concept of projective identification retained only limited
theoretical value. The concept, as originally understood by Klein,
nevertheless suggests that she and her mentor, Ferenczi, after
experiencing patients with pregenital problems, were groping
toward an idea akin to the selfobject function that Kohut made
central to his thinking.
Theorists since Klein have kept the concept of projective
identification theoretically useful by expanding its meaning. Malin
and Grotstein (1966), for example, assert that the concept covers a
“normal as well as abnormal way of relating which persists into
mature adulthood” (p. 27) and see it as building ego integration as
well as functioning for defensive purposes. Langs (1976) focuses on
the interactional dimension of projective identification, revealing the
efforts to which therapist and patient go to induce in others aspects
of their own internal state. Ogden (1979), in a view similar to
Kohut’s, characterizes projective identification as a basic way of
being with an object that is psychologically only partially separate.
Tansey and Burke (1989) generalize that projective identification has
“defensive, adaptive and communicative properties” (p. 44) and that
projective identification cannot take place unless the recipient has
a corresponding introjective identification.
Racker (1957) breaks down the idea of projective identification
into two basic processes: complementary identifications, and
concordant identifications. In one form of complementary identifica-
tion, the patient elicits from the therapist, through interpersonal
80 Chapter 7
influence, critical verbal behavior; thus the therapist identifies with

the sadistic experience while the patient experiences being a victim.
Another form of complementary identification is with a reversal,
where the therapist experiences being attacked and criticized. In the
concordant identification, the patient induces in the therapist an
experience similar to the one being experienced by the patient.
This idea of concordant (projective) identification comes close to a
primitive type of communication that Kohut conceived of as a
twinship experience.
Perhaps Melanie Klein’s most important, though unintended,
contribution to psychotherapy was her technique of interpretation.
Believing in the curative value of interpretations, Klein often made
them, usually commencing with the first session, and liberally used
technical imagery, such as, “devouring the breast.” She was stricter
about using interpretations than most of her classical colleagues
were, perhaps to avoid the kind of censure Ferenczi received in ex-
perimenting with his active techniques. Interpretations, as she used
them, came very close to being indoctrination. It was the counter-
productive results of interpretations used this way that so clearly
point to the dangers of seeking a cure through interpretations only.
Klein’s dogmatic personality, if not the major reason for her
doctrinaire approach to psychotherapy, certainly intensified it. Her
dogmatic rigidity has been reported by many colleagues. Judith Fay
(cited in Grosskurth, 1986) reports that “it was possible to criticize
or quarrel with (Paula) Heimann, who would laugh it off. With
Klein one would have felt in the wrong” (p. 422). Laing, for
example, detested Klein’s dogmatism and the way she beat her
followers into submission. He saw her early interpretations as
impingement, the techniques of a professional torturer (Grosskurth,
1986, p. 422). This seems like harsh criticism. Yet many who knew
Klein say something similar; there is strong evidence of her
indoctrinating approach to analysis. For example, Clare Winnicott,
the second wife of Donald Winnicott, was analyzed by Klein. Her
analysis became a battle of wills. Clare said of Klein that she was a
brilliant theoretician, but not a clinician; she implanted theory.
Ferenczi called such implanting “superego intropression” (Balint,
1968).
Edward Glover’s view of Melanie Klein (Grosskurth, 1986)
seems to have been expressed in a case he reported of a young
man whose mother had a “consistent policy throughout her life of

emotionally exploiting dependents, especially her children, and
preventing any exhibition of resentment by making them feel guilty.
She had a high opinion of herself as a mother but was, in fact, self
aggrandizing, tyrannical and selfish” (p. 311). She was an emotional
steamroller, glossing over environmental factors and accentuating
endopsychic factors. With her, the process of preconceived theories
influencing interpretation was overt. Many think this young man was
really Melitta, Klein’s daughter, whom Glover analyzed.
Further evidence that Klein’s interpretive approach could be
more of a liability than an asset in the therapeutic results comes
from Melitta, and from Richard, one of Melanie Klein’s child
patients. Melitta, herself an analyst, said that Kleinians brainwash
their patients “to believe they are incapable of making any decisions
or coping with life unless they have undergone a ‘thorough
analysis’” (Grosskurth, 1986, p. 229). Once fully analyzed, like the
true believer, they will be saved from hell and enjoy eternal bliss in
the life after death.
Richard, Melanie’s four-year-old patient, was interviewed 50
years after the experience. Referring to an interpretation made by
Klein that his father’s penis was incorporated inside his mother’s
body, Richard commented, “I think she could have cut this claptrap
out.” What he remembered as valuable was her soothing him when
he cried. Klein would say, “Life is not all bad.” These comments by
Richard suggest that it was not the content of what Klein said, but
the soothing function she served, that he found usable. Tolpin
(1971) describes such soothing as an important selfobject experi-
ence without which anyone is quite vulnerable to fragmentation.
Klein’s tough-minded, dogmatic personality, while it led to a
countertherapeutic, doctrinaire approach to interpretation, enabled
her to win one of the most important political/theoretical struggles
to occur in psychoanalysis. The conflict reached its zenith in the
British Psychoanalytic Society during 1942 and the London blitz
(Grosskurth, 1986). The Kleinians, who had been in power for
nearly 20 years, were challenged by the growing strength of the
classical analysts, who were supported by an influx of continental
refugee analysts. A change in leadership made the struggle overt.
Ernest Jones, a pro-Kleinian who had invited Klein to England
in the 20s, was replaced by Edward Glover, an anti-Kleinian, as
82 Chapter 7
chairman of the British Society (Grosskurth, 1986). Anna Freud was

another important ally of the classical analysts. Many Kleinians did
not attend the meeting because they had left London to escape the
blitz, but the classically oriented refugees, who were restricted to
the London area by order of the civil authorities, were strongly
represented. Glover also had the support of Melanie’s daughter,
Melitta, who may have used the conflict to reenact her own
individuation struggle.
The power struggle centered on the training of candidates. On
February 25, 1942, in an “Extraordinary Meeting,” Glover accused
the Kleinians of being a secret cabal and stacking the group of
training analysts with those of a Kleinian viewpoint. Payne answered
for the Kleinians by asserting that Glover’s figures were inflated.
These opening shots aroused emotions and rallied supporters to
both sides. The issue was joined. The British Society then went
through a very uncertain, uncomfortable period of unresolved
conflict. At another meeting, four months later, however, Payne
presented detailed figures clearly disproving Glover’s charge and
dissipating tensions. Glover’s attempt to undermine the influence of
Melanie Klein had failed.
The Kleinian–Classical power struggle in London reflected a
major policy issue for psychoanalysis. The issue was forced by the
growth of Nazism, which had eradicated most of the analytic
societies in Europe; the death of Freud three years earlier; the
ravages of World War II; and the problem of reestablishing the
analytic emigres in England and America. Was the next step for the
analytic survivors to be growth or retrenchment? Clearly the
Kleinians wanted to continue breaking new theoretical ground. The
orthodox group, particularly the newcomers, were naturally more
concerned about establishing new practices and about the cohesive¬
ness and continuity of psychoanalysis. They wanted the movement
to consolidate around the classical approach, even to the extent of
resisting the modifications to structural theory by the ego psycholo-
gy of Hartmann and Anna Freud.
Ironically, Klein very strictly adhered to the techniques of
classical theory, more, possibly, than the classical analysts did. She
stressed heavily the importance of interpretation, intrapsychic
factors, and drive theory. For example, she, more than other
theorists, accepted Freud’s dual drive theory, emphasizing the
importance of the death instinct as well as the libido. On structural

theory, while she still utilized the concepts of id, ego, and superego,
Klein’s seemingly “minor” modification of the superego as being
formed by an infant of 18 months rather than in the oedipal period,
began a process that under Fairbairn intellectually dismantled
structural theory.
Klein’s discarding of the centrality of the Oedipus complex was
a clear break with classical theory. Under her strong leadership,
acceptance that the mother-infant bond was crucial for the growth
of a healthy child—the concept of the “depressive posi-
tion”—legitimated the exploration of, and theorizing about,
pregenital character disorders. She paved the way for a number of
British theorists to build on and expand her hard-won bridgehead
of the centrality of the mother-infant bond. The first of these was W.
R. D. Fairbairn.
FAIRBAIRN
Fairbairn pioneered in the treatment of schizoid personalities. He

described their characteristics as follows: “(1) an attitude of
omnipotence, (2) an attitude of isolation and detachment, and (3)
a preoccupation with inner reality” (Fairbairn, 1940, p. 6). He saw
that schizoid behavior was not possible without a “split in the ego.”
Fairbairn appears to have been using Klein’s concept of splitting,
but when he referred to splitting as “resulting in all degrees of
integration of the ego” (p. 9), he obviously was using it more
broadly than the archaic form used by Klein. Fairbairn’s meaning is
close to Kohut’s idea of fragmentation and lack of cohesiveness
(Brandchaft, 1986). Also, with Fairbairn, splitting took place in the
ego as well as between the good and bad internalized objects of
Klein’s thinking. Fairbairn differed from Kohut in that he sought to
heal the “splits in the ego” in order to develop in the patient the
capacity for object relations, whereas Kohut sought the opposite:
object relations to consolidate the nuclear self (Brandchaft, 1986).
These differences indicate a move away from Klein, who was
still wedded to drive theory. Fairbairn’s major accomplishment was
to shift theoretical concerns from drive theory toward the idea of
a depressed, or hungry, ego. This word ego, as Fairbairn used it,
84 Chapter 7
was no longer a technical part of structural theory, but the self in

a broad sense. Similarly, Fairbairn still used the term libido, but it
no longer consisted of a drive or drives biologically based, urgently
seeking a target of discharge. For Fairbairn, the libido was the self
in a state of longing to be bonded to a nourishing source (“object”).
With the schizoid, there was a calm, detached surface self, repressed
affect, and a well-defended, hungry internal self that emerged
eventually in the therapeutic transference.
Fairbairn’s object relations theory was the first major attempt in
psychoanalysis to explain psychotherapy without referring to drive
theory. Fairbairn (1944) still spoke of an id, but of an id “impulse”
that “cannot be considered apart from objects, whether external or
internal” (p. 88). For this reason, he saw no further metapsycho-
logical use to claiming a distinction between the id and the ego:
Freud’s conception of the origin of the ego as a structure which

develops on the surface of the psyche for the purpose of regulat-
ing id-impulses in relation to reality will thus give place to a
conception of the ego as the source of impulse-tension from the
beginning [p. 88].
This was a significant theoretical leap. The ego, that is, self-struc-
tures, not the id, comes first. It took many years for infant studies
to build up substantial observational data to support Fairbairn’s
position.
Several other matters need to be considered in this brief
discussion of Fairbairn’s underrated, often ignored, contribution to
psychotherapy theory. First, Fairbairn used the diagnosis of schizoid
to cover a broad range of character disorders, many of which would
now be diagnosed as narcissistic or borderline. Second, Fairbairn
was the first theorist to challenge Freud’s developmental theory of
growth from narcissism to maturity, that is, from dependence to
independence.
To Fairbairn (1951), the self grew from an infantile dependence
through a period of transition to mature dependence (p. 163). The
stage of infantile dependence was characterized predominantly by
an attitude of taking. The transitional stage saw the use of paranoid,
obsessional, hysterical, and phobic techniques. The stage of mature
dependence had an attitude of giving, with accepted or rejected
objects exteriorized (Fairbairn, 1941, p. 39). Fairbairn saw depen-

dence on its own separate line of development years before Kohut
adopted a similar position.
A third issue was Fairbairn’s changes in technique. In working
with schizoid personalities he came to appreciate that a schizoid’s
major strategy was to avoid meaningful emotional engagement with
people and especially with the therapist. Fairbairn then realized that
using the couch strengthened the very character defenses that
needed changing, so he saw analytic patients seated and face to face.
This change in technique led him to question the value of tradition-
al analytic procedures.
Such a brief review barely does justice to Fairbairn, whose work
has influenced many modern theorists, such as Mitchell (1988).
BALINT
Michael Balint’s major contribution to a new therapeutic paradigm

consisted of a challenge to the classical theory of intrapsychic
processes and fantasies. Following his mentor, Ferenczi, Balint
believed that Freud had taken a wrong turn in stressing intrapsychic
at the expense of environmental influences and in neglecting to
develop an adequate theory of trauma. He thought that Freud, with
his original seduction theory of neurosis, and Ferenczi (1933) with
his “Confusion of Tongues Between Adults and the Child” paper,
which reopened the incest issue, had both been portraying trauma
in a specific form. That is, incest is the experience of one type of
psychological trauma, which also includes rape, torture, significant
personal losses, and other injurious “events.”
Balint’s view of trauma, however, went much further than
wounding or stressful events. Not only did he see a broad list of
potentially traumatic situations, he also thought that two other
factors effected how a person subjectively experiences a stressful
event: (1) the character of the person being stressed and (2) the
degree of psychological support received from emotionally sig-
nificant persons (selfobjects). Thus, Balint’s theory of trauma is a
combination of what happens and how a person experiences what
happens. That is, the theory includes the “external” and “internal”
86 Chapter 7
dimensions of the experience that are discussed in the theory of

trauma. (See chapter 22, this volume).
Balint (1968) also refined the theory of interpretation. He not
only rejected Klein’s indoctrinating style, he clearly saw interpreta-
tion as being of only limited value for psychotherapy:
Our technique was worked out for patients who experience the
interpretation as interpretation and whose ego is strong enough
to enable them to “take in” the interpretation and perform what
Freud called the process of “working through” [p. 10].
Interpretation was developed, according to Balint, for the

oedipal level, where there is an agreed upon, conventional use of
language. He then went on to develop the idea of the preoedipal
level, the level of the “basic fault,” where the patient does not
experience interpretation as interpretation, but as narcissistic
wounding. Therefore, interpretation cannot be the primary method
for preoedipal character disorders.
Anticipating Kohut’sempathic-introspective mode of observation,
Balint (1952, chapters 3, 5, 8, and 9) developed this methodological
principle in a series of papers. He saw the preoedipal period as
involving a two-person system where satisfaction comes from the
relational “fit.” When this fit takes place, the preoedipal person has
a quiet, tranquil sense of well-being. When this meshing is missing,
the subjective experience is one of emptiness, loss, deadness,
futility, and lifeless acceptance of everything that has been offered.
Another response to the absence of a personal fit is a sense of
persecutory anxiety, where bad things are perceived as not
happening by chance. For persons with a “basic fault,” the key
question is the fit of the therapeutic relationship, not interpretation.
Once Balint’s major focus became the therapeutic relationship,
he saw the need for a “new beginning.” This new beginning
involves regressing to a point before the faulty development started
and “discovering a new, better-suited, way which amounts to a
progression.” Thus the therapeutic process enables “regression for
the sake of progression” (Balint, 1968, p. 132). He uses the example
of a 30-year-old woman who, since earliest childhood, could never
do a somersault, although at various periods she tried desperately
to do one. In response Balint said, “What about now?—whereupon
she got up from the couch and to her great amazement, did a
perfect somersault without any difficulty” (pp. 128-129). This act
signaled her new beginning.
Such a constructive view of “acting out,” as reflected in the idea
of a new beginning and in Ferenczi’s and Klein’s view of enactment,
involves an understanding that therapeutic regression can be
beneficial. Balint also recognized that it could be malignant, as was
the regression of Breuer’s Anna Ο (Breuer and Freud, 1893-95).
With malignant regression, the patient seeks an external event, a
gratifying action. In the benign form, the patient seeks consent to
use the external world to solve an internal problem. That is,
malignant regression is regression aimed at gratification, whereas
benign regression is aimed at recognition. To Balint, these benign
regressions never had the qualities of despair and passion that
characterize the malignant type. So it was that Balint expanded on
Ferenczi’s (1913) idea of repairing deficits from arrested develop
ment.
Balint, like Kohut, rejected Freud’s idea of primary narcissism,
where the infant was incapable of attachment. For him, the concept
of primary narcissism was an unsupported theoretical extrapolation,
whereas secondary narcissism was clinically observable. This
secondary narcissism was largely a response to a disturbed infant
relationship with the mothering “environment.” Instead of experi
encing an early state of primary narcissism, an infant experiences
“primary love,” that is, a state of intense, harmonious relatedness to
the mother-environment. Like Kohut, Balint saw aggression as a
behavior emerging when disjunctures and discontinuities occurred
between the participants in primary love.
Like Fairbairn, Balint saw a person’s development as moving
from archaic dependence to mature dependence. He saw object
relations as developing from a passive, archaic type to a mature
interdependent form of love. Beginning with the earliest stage, the
“work of conquest” transforms the object relationship to one of
mutuality in which the object can no longer be taken for granted
and its own independent and interdependent needs must be
recognized and respected. To achieve such growth and mutuality,
an infant needs a “co-operative partner” (Brandchaft, 1986).
Balint also took an important step in delineating the nature of
pathogenic influence on the development of a person. He not only
88 Chapter 7
recognized the effects of insufficient selfobject responding, but also

realized that the use of an infant or child to satisfy a parent’s
unconscious needs can have a devastatingly noxious effect on the
child (Brandchaft, 1986). Brandchaft, reviewing the work of Michael
Balint and his wife, Alice, pays the high tribute of crediting their
work for “originality, courage and creativeness” (p. 255).
WINNICOTT
Donald Winnicott may be the most quoted theorist of the British

school. He idealized Ernest Jones, was analyzed first by James
Strachey and then by Joan Riviere, and was supervised by Melanie
Klein. Such analytic training initially shackled him to a biologically
based, innate-forces approach to psychoanalysis. It is not difficult to
see how, with his pediatric background, the creative Winnicott
eventually balanced his analytic training with an increasing focus on
the contribution of environmental factors, especially the environ-
ment of the therapeutic relationship. The mother is the infant’s
environment. Thus “his declarations that ’there is no such thing as
a baby’ and that ‘infant and mother together form an indivisible
unit’ (Winnicott, 1960, p. 39) were the most emphatic challenges to
the edifice Klein built that an unshackled mind could proclaim”
(Brandchaft, 1986, p. 269). In comparison, Klein saw the mother as
bonded to the infant rather than as one part of a larger moth-
er/infant system, as did Winnicott.
In 1962 Winnicott moved decisively away from Klein on the
subject of transference. He made the distinction between the
therapist as a displacement target for parents and the therapist as a
modern representative of the parents (Winnicott, 1962, p. 167).
Brandchaft (1986) sees Kohut’s position as closely resembling
Winnicott’s: “Here analysis is not the screen for the projection of
internal structure (transference), but the direct continuation of an
early reality that was too distant, too rejecting, or too unreliable to
be transformed into solid psychological structures” (Kohut, 1978,
pp. 218-219).
Early experience with the doctrinaire Klein may have influenced
Winnicott also on the issue of moving from a false self to a more
singular, unique, and creative true self. Here he seems to reflect
ideas close to Kierkegaard’s concepts of the authentic and unauthen-

tic modes of existence. Unauthentic existence is the modality of the
person who lives under the tyranny of the “plebs,” that is, anony-
mous collectivity. Under authentic existence a person accepts
responsibility for his own existence and suffers a great deal of
anxiety as a consequence (May, 1958).
Winnicott’s main goal in psychotherapy was to enable the
patient to experience growth of the true self. His major technique
was to establish what he called a “holding environment,” which
enabled a controlled regression to take place. What helped in the
holding environment was not interpretation, but flexibility in
technique such as hand holding, which he sometimes did, and
extending sessions to an hour and a half or more. Winnicott, more
than any other major psychoanalytic thinker, tried to use the
therapeutic arrangements to facilitate the emergence of the true self.
Winnicott allowed just about anything in a session, including
“play, silence, re-living, acting-in or acting-out, teasing, mourning,
and all feeling and its expression, whether by patient or analyst”
(Anderson, 1985, p. 7). Margaret Little, who was analyzed by
Winnicott, said that Winnicott would go to sleep and she would yell
at him to wake up (Anderson, 1985, p. 8). She was able to acknowl-
edge how boring it must have been for him to listen when she just
talked and talked. What is interesting about Little’s acceptance of
Winnicott’s falling asleep is her response to Ella Sharpe, her analyst
prior to Winnicott. Sharpe, who was authoritarian and gave
stereotypical interpretations, irritated Little. Little says of Sharpe,
“She didn’t touch my illness, and I knew it.” She did not resent
Winnicott’s “error” in falling asleep, because he had created the
overall environment that she needed, so any single piece of
behavior did not matter.
Margaret Little, who developed an excellent reputation as an
analyst, summarized her experience of Winnicott: “If I hadn’t been
helped by Winnicott, I would have committed suicide or I would
have become a chronic mental patient” (Anderson, 1985, p. 2). Her
statement, and those made by other analysands of Winnicott, such
as Enid Balint and Masud Khan, create the impression that Winnicott
was a masterful and gifted clinician. What shines through the
accounts of Winnicott’s work is his humanness. He did not hesitate
to go to the toilet during a session; he had a sense of humor; and
90 Chapter 7
he always wanted the patient to teach him. He did not attempt to

“mother” his patients by infantilizing them, yet he gave them great
attention, caring, and security. He managed to make patients like
Margaret Little believe that he cared intensely for them. One gains
the impression that this caring was authentic, because it placed
great demands on Winnicott’s strength and stamina. This intense
caring, however, achieved significant results with patients who were
beyond the scope of classical treatment.
Winnicott’s major theoretical contribution was in flexibility in
technique. Not only did he shatter the classical position of neutrali-
ty, regression neurosis, and interpretation (Gill, 1954), he demon-
strated the value of intense caring and commitment. In so doing, he
rediscovered what religious counselors and general medical
practitioners (including pediatricians) had known for a long time
and what Freud practiced. It may be a blessing that Winnicott was
trained as a pediatrician before he went through his analytic
training.
Bacal (1989) writes:
There is, in fact, compelling evidence that Winnicott understood

the idea of early selfobject functioning in much the same sense as
Kohut did, but did not, so to speak, organize the idea so precisely.
The caring functions of the mother are facilitated by the infant’s
capacity to experience her as a subjective object . . . . For Winni-
cott . . . the subjective object was “the first object, the object not
yet repudiated as a not-mephenomenon‚” that is, an object that
is experienced as an extension of the self [p. 261].
In summarizing the common contribution of these four British

theorists, Brandchaft (1989) writes, “They shared the determination
to continue the tradition of Freud not by the celebration and re-
affirmation necessarily of his concepts, but of his ideals” (p. 256).
Together with others, such as Ferenczi and Hartmann, they
developed ideas that were the major precursors to self psychology.
Having now completed the first phase of this text covering the
preparers of self psychology, we next explore a basic philosophical
stance that is consonant with self psychology—postempiricism.
Influenced generally by postempiricism, self psychology was able to
accept the ideas of a major philosophical shift that had occurred

while Freud was undertaking his clinical investigations. This
postempiricist philosophy, and its influence on the development of
self psychology, is covered in the next chapter.
Readings for Chapter 10: Kuhn, 1962; Goldberg, 1988, chapters

1-4.
8
Metatheory:
Theory About
Psychotherapy Theory
A fter World War II, a growing disenchantment with Freud’s

classical theory fostered a depreciation of the value of theory
in the practice of psychotherapy. This depreciating attitude,
widespread outside psychoanalytic circles, was also represented
within them. It led some people to emphasize the primacy of
clinical observation over theory and an empiricist philosophy, as
adopted for example, by Waelder (1962).
Waelder “suggested that we observe single facts, which then
become arranged in patterns in ascending order up to our general-
izations, theories, values and even our view of the world” (Gold-
berg, 1988, p. 92). His idea of building from simple facts to complex
configurations used the basic position of logical positivism that facts
can be validated or disproved. Commencing with this theory/
observational issue, what follows examines (a) empiricism and the
92
Metatheory: Theory About Psychotherapy Theory 93
inductive method, (b) the postempiridsts, and (c) postempiricism

in self psychology.
EMPIRICISM AND THE INDUCTIVE METHOD
In their attempt to deemphasize theory, the clinical observationists

represent the theoretical position of the 16th-century English
scientist Francis Bacon. He stressed the inductive method as the
starting point of knowledge. Using this inductive method, a clinician
open-mindedly accumulates observations, watches for emerging
patterns, forms hypotheses, and seeks further information based on
these hypotheses.
This inductive method of knowing has been thoroughly
discredited and abandoned by modern philosophers of science.
They say that science does not and cannot operate in this fashion.
Their“postempiricist” position is supported by four arguments: (1)
theory influences the perception and selection of facts, (2) subject
and object lack a clear division, (3) words fail to refer adequately to
the objects they denote, and (4) objectivity denies natural selection
of ideas. The cogency of these arguments means that empiricism is
an unrealizable ideal. We now look at these criticisms of inductive
theory in more detail.
Theory Influences the Perception and

Selection of Facts
Self psychology accepts the postempiricist position of modern

philosophy that ideas influence what are considered facts (Basch,
1988b). Kohut (1984), for example, states that“ a n observer needs
theories in order to observe” (p. 67). Goldberg (1988) takes the
same position with his“theory impregnation of facts” (p. 7). Once
it is accepted that theory precedes observation, then clinical
effectiveness depends on the outcome of the struggles among a host
of competing theories.
Basch (1988b) once demonstrated the power of theory over
observation by asking a woman student, who had just become a
mother, to describe the psychological life of an infant. She effort-
94 Chapter 8
lessly described Locke’s tabula rasa theory of egolessness. Then,

when asked to describe her own baby, she talked about its affective
responses from day one,“givens” already present and shaping what
is experienced.
Subject a n d Object Lack a Clear D i v i s i o n
This problem is evident in the area of measurement with complex

instruments or with the process of observation. In a famous address
before the 1927 International Congress of Physics, the atomic
physicist Niels Bohr discussed this problem (Chessick, 1979). He
said that in the atomic particle domain, the only way the observer
(and his equipment) can be uninvolved is if he observes nothing at
all. As soon as the observer sets up the observation tools on his
workbench, the system he has chosen to put under observation and
his measuring instruments for doing the job form an inseparable
whole. Therefore, the results depend heavily on the apparatus.
Bohr, illustrating what is known as Heisenberg’s uncertainty
principle, showed that any apparatus designed to measure position
at the level of atomic particles with ideal precision cannot provide
any information about momentum, and vice versa. Measuring a
particle’s position changes its velocity and measuring its velocity
changes its position. Two mutually exclusive experiments are
needed to obtain full information about the mechanical state, each
complementing the other. So, he conceived of methods as“comple-
mentary descriptions” of that being studied. To him, theories are
complementary descriptions of an area of knowledge.
John Archibald Wheeler, a colleague of Albert Einstein, said:
What is so hard is to give up thinking of nature as a machine that

goes on independent of the observer. What we conceive of as
reality is a few iron posts of observation with papier-mache
construction between them that is but the elaborate work of our
imagination [Quoted in Schwaber, 1983a, p. 273].
Similarly, there is no clear distinction in psychotherapy between

subject and object. The therapist (subject) uses theories of psycho-
therapy as instruments of observation and selects what of the patient
(object) is observed and therefore what influences the interaction

between them. Conversely, a patient (subject) views the therapist
(object) from a personal set of beliefs and this observing also
influences the interaction. Such interaction makes it difficult to
conceive of subject and object; there are two subjects. Object
represents a point of view, not a thing.
Words Fail to Refer Adequately to the

Objects They Denote
In its model of building from simple facts, the inductive method

assumes that words have simple, clear-cut definitions, as commonly
used and agreed upon. This simply is not so! No word can stand
alone outside a dictionary (Goldberg, 1988). It is only in the usage
of a word that we can say what it means. For example, even though
children begin to speak by using single words, these invariably
imply a sentence. The child’s word blanket (with idiosyncratic
pronunciation), stands for“ I want my blanket.” Moreover, words
may have many meanings. The word“star,” for instance, may refer
to a terrestrial body, a movie idol, or a shaped sticker on a child’s
school assignment. Only by the way the word is used in a sentence
can it be determined what the word denotes. Words are not
atomized, discrete entities. They are always in relationship with
other words in a narrative. The relationship of words to each other,
more than the words themselves, tells the story.
Behaviorism, once considered the hallmark of scientific
psychology because of its inductive method, was clearly shown by
Chomsky (1959), a linguist, merely to lend the appearance of
scientific rigor to the study of human verbal behavior. Chomsky
noted, for example, that while the terms stimulus, response, and
reinforcement can be used with logical consistency and coherence
in the tightly controlled environment of the laboratory, they lose all
meaning, and therefore explanatory usefulness, when applied to
normal human social interaction and verbal behavior. Further, such
constructs, when used to describe events as discrete as a human eye
blink and as broad as an exchange between nations, lack the
specificity to provide the clarity and precision necessary for
understanding meaningful relationships between events.
96 Chapter 8
Campbell (1969), arguing for“anchorless knowledge,” states that

only in context do words have meaning:
In linguistic epitomes of knowledge, the same principle holds: the

smaller the fragment the more equivocal the meaning. Somehow,
with long continuities, relatively precise meanings are recorded
and communicated, but this achievement is not to be attributed
in any manner to the incorrigibility or unequivocality of its
elements, be they words or sentences. As a statement of knowl-
edge or a communicative act, an isolated letter is more equivocal
than a syllable, a syllable than a word, a word than a sentence, a
sentence than a paragraph, a paragraph than a chapter. Alternative-
ly stated, a word is most equivocal in isolation, less so when
embedded in a paragraph .. . a word is but an intermediate stage
in a hierarchy of equivocalities, and no effort at clarification nor
improvement of definition will make it a firm foundation for
knowing [p. 44].
As Chomsky pointed out, it is only in the isolated context of the

laboratory that the words stimulus, response, and reinforcement
have any specificity of meaning. Such terms have little clinical
usefulness or scientific value if they cannot be meaningfully used in
the broader world as experienced by the clinician and his patient.
This world is usually best described by a narrative. As Goldberg
(1988) states,“Apparently random open systems need to be
described differently from hypothetico-deductive systems” (p. 10).
A narrative or a story has been proposed as a meaningful way to
describe open systems (Sherwood, 1969; Ricoeur, 1984).
Objectivity Denies Natural Selection

of Ideas
Modern philosophers of the postempiricist position have conceded

that there is no rock-solid anchor upon which all knowledge can be
built. Plato assumed the world of“forms” as immutable. And
Descartes built his on the assumption cogito ergo sum (“I think,
therefore I am”), to which Brinton (1963), somewhat tongue-in-
cheek responded,“ W h y not ‘I sweat, therefore I am’?” Every
supposedly irrefutable starting point has been thoroughly refuted by
postempiricist philosophy.
In agreement with both Kuhn (1962) and Popper (1959),

Goldberg (1988) states,“The heart of the scientific attitude toward
knowledge [is] that no concept, no idea, no truth is immune to
change. ”Goldberg (1988) points to the shifting, evolutionary state
of knowledge:
Thus, when a community of scholars says,“let us agree that loss

means . . . ,” they always parenthetically note“until we agree
otherwise.” This becomes tantamount to change by consensus and
truth by agreement rather than the correspondence theories that
are so appealing to us. We would rather point to the data to prove
our point instead of asking for a vote. However, we seem always
to return to some agreed upon or negotiated“reality” to which
our facts correspond. Truth is also hermeneutic since it is a
product of our understanding and interpretation, and so is not a
“given” [p. 15].
Although it is an ad hominem argument, it would appear that

the reluctance to accept this postempiricist position has more to do
with a discomfort with conflict and uncertainty inherent in the
position than it does with a lack of cogency of the postempiricist
position. Campbell (1969) describes the equivocal state of knowl-
edge:
In science we are like sailors who must repair a rotting ship

while it is afloat at sea. We depend on the relative soundness of
all the other planks while we replace a particularly weak one.
Each of the planks we now depend on we will in turn have to
replace. No one of them is a foundation, nor a point of certainty,
no one of them is incorrigible [p. 43].
The inductive method and empirical philosophy cater to the

wish for objectivity. By objectivity, the empiricists mean the
observer should observe without bias, that is, be theory neutral.
Such a hope for theory-neutral observations, however, may be a
naïve wish for a community of investigators who are like-minded
enough to agree on what they see. If so, the inductive method could
be associated with a deep-seated desire to avoid conflict and to
deny a Darwinian type of natural selection among ideas.
98 Chapter 8
THE POSTEMPIRICISTS
If the inductive method is not the mainstay of science today, how

then is scientific knowledge gained? To understand the postempiri-
cist position in science, we shall explore the ideas of philosophers
Karl Popper, Thomas Kuhn and Mary Hesse. Popper (1963), for
example, saw bold conjectures as the starting point of science.
These conjectures are then subjected to rigorous, critical discussion,
with the goal of discrediting them! The process is an attempt to
eliminate error. Those conjectures which survive such a process are
then submitted, where possible, to experimental investigation.
Even when our conjectures survive vigorous efforts to discredit
them, they are not knowledge (episteme), according to Popper.
These opinions are not Truth; they are simply guesses about the
truth, approximations that enable our lives to be more adaptable. To
Popper, the history of philosophy is not simply a record of past
errors, but a running argument, a chain of linked problems and
their tentative solutions.
Popper stressed falsifiability as a criterion of demarcation
between science and non-science. By this criterion, Marx and Freud
did not have scientific constructs. Although their theories are
nonfalsifiable and hence, not scientific, they are valuable. This
process of falsifying does not produce truth—just a greater approxi-
mation of truth. It indicates a degree of verisimilitude. Verisimili-
tude has three requirements: 1) that the new theory explain the
same facts the earlier theory explained; 2) that the new theory unify
new parts and suggest new connections and 3) that the new theory
pass a new test.
What Popper referred to as conjectures, Kuhn (1962) saw as
beliefs that cohered to form paradigms. To Kuhn, scientific knowl-
edge changed through a natural selection among competing
paradigms. Disagreeing with Bacon, he said that there was no such
thing as research in the absence of paradigms. For example, a
paradigm shift occurred when Newton’s 18th-century corpuscular
theory of light was challenged by Einstein’s 20th-century wave
theory.
Reasons for a paradigm shift lie in the function of paradigms.
Paradigms gain status by solving problems, making predictions, and
developing communities of practitioners with shared beliefs.

Paradigm change occurs when there are too many anomalies to the
old paradigm and when there is a workable alternative to the
reigning one that promises a better, broader range of problem
solving.
Unlike Popper, Kuhn thought falsifiability was not the sine qua
non of a scientific theory. Rather, it was the“coherence” of a theory
and its ability to“best fit” experience that determined its usefulness
and therefore whether it is better than another theory. The tenure
of one theory ends when a better theory comes along. To Kuhn,
testing was not the mark of science because experiments can be
challenged, and theories remain essentially unmodified because of
ad hoc adjustments.
Mary Hesse (1980), summarizes the postempiricist position as
follows:
1. Data are not detachable from theory, and so facts are to be

reconstructed in the light of interpretation.
2. Theories are not models externally compared to nature in a
hypothetico-deductive schema but are the way the facts them-
selves are seen.
3. The law-like relations are internal because what count as facts
are constituted by what the theory says about interrelations with
one another.
4. The language of natural science is metaphorical and inexact,
and formalizable only at the cost of distortion.
5. Meanings are determined by theory and are understood by
theoretical coherence rather than by correspondence with facts [p. 7].
POSTEMPIRICISM IN SELF PSYCHOLOGY.
The postempiricist philosophy of science helps explain self psycho-

logy’s heavy attention to theory. Stern (1985) says that“science
advances by shifting paradigms about how things are to be seen.
These paradigms are ultimately belief systems” (p. 17). Self
psychology involves a full-scale attempt to replace the classical
analytic paradigm with a new one. It sees any advance in the science
of understanding and changing human personality as coming from
a major paradigm shift. Grotstein (1983) agrees:
100 Chapter 8
In the span of just a few years the school of self psychology has
emerged as representing perhaps the most important para-
digmatic shift in psychoanalytic theory and practice in decades. Its
deceptive simplicity belies its conceptual sweep as a major
systematized alternative to classical theory [p. 165].
The postempiricist position that theory predominates over fact

surfaced in self psychology through the concepts of “experience-
near” and“experience-distant” theory. The term experience-near
was popularized by Kohut (1959) in his discussion of therapeutic
methodology. Empathy was deemed the way to explore a patient’s
inner experiences and develop a personal explanatory theory as a
subjective narrative. By experience-distant theory, Kohut was
referring to generalizations. He had in mind, among other things,
Freud’s metapsychology and such constructs as id and superego.
What is the self psychology paradigm? Commencing with
empathy as a method of observation, it uses the narcissistic
transferences (mirror, idealizing, twinship, and merger) to transform
therapeutically a patient’s archaic narcissism through microinternali-
zation, into a new personality structure. This therapeutic transforma-
tion is possible because the self-selfobject relationship is reenacted
in the treatment. Hence, self psychology would be better described
as selfobject psychology, or a selfobject theory of motivation.
Self psychology takes seriously the postempiricist emphasis on
the power of ideas to determine facts, as shown by the efforts made
to keep its theorizing as experience-near (clinically anchored) as
possible. Its one major metaphysical construct, the self, is openly
acknowledged as experience-distant. Even if ideas influence facts,
facts ought to be at least clinically demonstrable. For example,
infants have some kind of genetically derived predispositions. These
dispositions then act as primitive organizers of experience. Popper
anticipated this with his idea of a testable conjecture. Stern (1985)
now cites experimental evidence to support the notion that infants
are primed to look for regularities, to expect them, from day one.
Infants are born with invariance as an organizing principle already
in place.
From birth on, there appears to be a central tendency to form and

test hypotheses about what is occurring in the world (Bruner,
1977). Infants are also constantly “evaluating,” in the sense of

asking, is this different from or the same as that? How discrepant
is what I have just encountered from what I have previously
encountered (Kagen et al. , 1978)? It is clear that this central
tendency of mind, with constant application, will rapidly catego-
rize the social world into conforming and contrasting patterns,
events, sets, and experiences. The infant will readily discover
which features of an experience are invariant and which are
variant—that is, which features “belong” to the experience 0.
Gibson 1950, 1979; E. Gibson 1969). The infant will apply these
same processes to whatever sensations and perceptions are
available, from the simplest to the ultimately most complex—that
is, thoughts about thoughts [p. 42].
These invariants become organizing principles. They become

more complex with experience, determining what will be seen as
important and perceived as facts. An infant’s bad experiences,
consistent enough to be seen as an invariant, will lead to a radically
different set of beliefs about the nature of reality than will an
infant’s basically good experiences.
Once the idea of a newborn’s general organizing principle is
accepted, Freud’s concept of transference takes on a fresh signifi-
cance. The therapeutic experience of a patient’s distortion of
“reality” arises from his or her subjectively organized belief world,
which determines both perception of facts and the meaning of these
facts. This position is described by Stolorow and his colleagues
(1987):
Transference is neither a regression to nor a displacement from

the past, but rather an expression of the continuing influence of
organizing principles and imagery that crystallized out of the
patient’s early formative experiences [p. 36].
So it is that the postempiricist position, the primacy of theory

over fact, and self psychology’s understanding of transference
support each other.
Postempiricist views of science also suggest a new way to under-
stand interpretation as an interactive process. Chessick (1977)
writes, for example, that Popper’s view of science as conjectures we
try to invalidate “is (unintentionally) an excellent characterization
102 Chapter 8
of the process of interpretation and subsequent rejection or

confirmation that goes on in the everyday work of psychoanalytically
informed uncovering psychotherapy” (p. 321).
Such a process view of interpretation is not new to, nor
exclusive to, psychotherapy. Self psychology theorists such as
Atwood and Stolorow (1984) link it to the“hermeneutic circle,” a
method familiar to biblical scholars and historians:
In textual interpretation, the meaning of a particular passage is

established primarily by considerations relating the passage to the
structure of the text as a whole; parts of the work are thus
assessed in relation to an understanding of the totality while
knowledge of the whole is constituted by study of the parts. Dilthy
characterized historical inquiry as involving a similarly circular
movement between focus on particular events and a view of the
total meaning-context in which those events participate [p. 3].
The postempiricist philosophy, with its understanding of the

inability of facts, words, or even objects to be discrete, atomized
entities, is utilized in self psychology’s view of the self. To Kohut,
the self was never a completely individuated, absolutely indepen-
dent being, functioning in emotional isolation. The self is always in
need of selfobjects. For Kohut, the issue of personal growth and
maturity was one of transforming the nature of a self’s selfobject
relationships from archaic to more mature forms. Stated differently,
the issue of selfobject needs is whether these are met exclusively
with one person in their archaic form, or whether they can be met
in a diversity of ways and relationships, even intermittently. Under
no condition, according to Kohut, can a self exist for any extended
period without needing some form of selfobject relationship.
Self psychology’s success as a new psychotherapeutic paradigm
can be assessed by using Popper’s concept of verisimilitude. The
self psychology paradigm makes a reasonable claim to meeting, to
some degree, his three requirements: 1) the new theory explains
the same facts that earlier theory explains; 2) the new theory unifies
new parts and suggests new connections; and 3) the new theory
passes some new test. In more detail:
1. Self psychology’s new theory is able to explain neurotic

conflicts, not in terms of drive theory, but as signs of fragmentation
in the self.
2. Kohut widened the scope of psychoanalysis to include a
theoretical understanding of narcissism, enabling the successful
treatment of that disorder. Some of the post-Kohutians have
expanded self psychology theory to include an understanding of the
treatment of severe character disorders, including the borderline
syndrome and even the treatment of psychotic disorders.
3. The results of the use of self psychology theory in treatment
have been very encouraging. The claim that self psychology passes
Popper’s test of verisimilitude for a scientific theory evokes criticism
from those of other theoretical positions. These criticisms echo
those described by William James, that there are“ t h r e e phases
through which every new theory passes: its critics first condemn it
as absurd, then dismiss it as trivial and obvious, and finally claim it
as their own discovery” (Quoted in Goldberg, 1974, p. 254). It is a
major sign of the acceptance of the self psychology paradigm that
many theoreticians are now claiming that self psychology’s ideas are
not really new. Perhaps the greatest testimony to the scientific status
of self psychology, however, is that it still presents itself as an open
system, in the process of changing—until a paradigm of“better fit”
comes along.
Although Stolorow (1986a) works from a self psychology frame-

work, he reminds us that theories are ultimately judged by their
ability to enhance therapeutic effectiveness:
The point is that all psychological theories are to some degree

imbalanced and reductionistic, they all aim at ordering and
therefore simplifying the staggering complexity of clinical data,
and they all embody theoretical preconceptions and philosophical
assumptions. These are not meaningful criteria for evaluating the
superiority of one theory over another. The clinically valid criteria
are whether theoretical frameworks enlarge or constrict our
capacity to gain empathic access to patients’ inner lives and
104 Chapter 8
whether they therefore enhance or diminish our therapeutic

effectiveness [p. 44].
Accepting the limitations of an empiricist philosophy, Kohut

made empathy the method of self psychology. With this empathic
method of observation, Kohut was able to explore the workings of
the subjective self. He was not the first to use the concept of empa-
thy—Freud, Ferenczi, and Balint had discussed it—but Kohut gave
the term a precision and clarity it had not had before. He constantly
emphasized its place as the starting point of his theory. We explore
self psychology’s concept of empathic understanding in the next
chapter.
Readings for Chapter 11: Kohut, 1959; Wolf, 1983b; Basch, 1983b;
Chessick, 1985, chapter 18.
9
Empathic
Understanding
I n July 1957, Heinz Kohut delivered a brief version of his paper

“Introspection, Empathy, and Psychoanalysis” (Kohut, 1959) to a
meeting of the International Psycho-Analytic Association in Paris. It
was the first public notice of what was to evolve into the new major
paradigm of self psychology. In this paper, empathy was declared to
be the methodological door to this new theory. In what follows we
explore Kohut’s ideas on empathy under the following headings: (a)
vicarious introspection, (b) the process of knowing, (c) attenuated
knowing, (d) identification, (e) projection, (f) attunement, and (g)
cure.
VICARIOUS INTROSPECTION
In defining his therapeutic method, Kohut turned to the concept of

introspection. He believed that through introspection a person
105
106 Chapter 9
could observe his own inner world and that of another person if
there was also the capacity to introspect vicariously. Such vicarious
introspection he called empathy. Introspection and empathy were
the perceptual tools for the exploration of the world of the
subjective. They were means of observation, of gathering subjective
data. Basch (1986) adds that empathy is a“readiness to experience
what it is the patient is experiencing in the patient’s terms” (p. 25).
Kohut (1959) cited the example of a tall man to describe what
he meant by“vicarious introspection:”
Only when we think ourselves into his place, only when we, by
vicarious introspection, begin to feel his unusual size as if it were
our own and thus revive inner experiences in which we had been
unusual or conspicuous, only then do we begin to appreciate the
meaning that the unusual size may have for this person and only
then have we observed a psychological fact [pp. 207-208].
This concept of introspective (and vicarious introspective) data

is in contrast to the idea of objective data in the physical and
biological sciences. Wolf (1983a) says that these data represent two
types of perception, introspective and extrospective. Thus we live in
two worlds, an objective one based on extrospective schemata and
a subjective one, organized around introspective data. Wolf
elucidates with the example of a hand. Looked at extrospectively,
the hand is an object in the world; experienced introspectively, it is
a part of the self. Introspective and extrospective data are different
modes of experience. In arguing for the acceptance of introspective
data as being valid for the subjective world as extrospective data is
for the world of objects, Kohut says they are really two different
approaches to reality. Using Niels Bohr’s concept of complemen-
tarity, Kohut saw two complementary ways of measuring reality,
which neither represents fully because of their limitations as
perceptual instruments.
Brain studies support this notion of two distinct ways of
perceiving reality. As Grotstein (1983) indicates, only recently have
brain laterality studies revealed that duality of consciousness is a
neurological fact (Gazzaniga and Le Doux, 1978). In the terminology
of these studies, empathy can be considered as right-brain con-
Empathic Understanding 107
sciousness, whereas detached observation is a method pertinent to

left-brain consciousness—approximately.
When it comes to understanding the subjective self, Kohut
(1959) sees the introspective and extrospective methods as unequal
in value. The subjective is not yet graspable by extrospection. Kohut
concedes that one day it may be possible to measure subjective
reality through some physical data, such as brain waves. At present,
however, the psychological approach to subjective experience is the
only useful one. Even so, Kohut’s openness to the possibility that
the extrospective mode may assist the introspective method and vice
versa suggests the need for further thinking about the relationship
of these two methods. For example, in the following instance Wolf
(1983b) used introspection to gain a vicarious view of the extro-
spective world.
An analysand told Wolf about the large crowd at the Mass
celebrated by the Pope on his visit to Chicago, and Wolf imagined
the noise of all those people. In fact, as he learned, it was remark-
ably quiet. This process is an example of vicarious extrospection,
erroneous at first but quickly corrected through feedback. Similarly,
extrospective case history data, such as birth order, or other
objective data, such as personality tests available to the psychothera-
pist, may act as a starting point for the empathic method of gaining
introspective data. In fact, extrospective clues may reduce the
amount of hermeneutic circling and the length of time before a
psychotherapist’s attempts at vicarious introspection are experienced
by the patient as being“tuned in.”
Our position on the introspective/extrospective issue is very
close to that of Stolorow and his colleagues (1987). They claim that
“psychoanalytic investigation is always from a perspective within a
subjective world (patient’s or analyst’s); it is always empathic or
introspective” (P. 5). For self psychology, this subjective perspective
is clearly the aim. Yet, Wolf (1983b) and the Shanes (1986) hold
open the door for some extrospective role in psychotherapeutic
work. Wolf proposes that“we oscillate between extrospective and
introspective modes of gathering data” (p. 685). The Shanes argue
that some analytic understanding comes from“objective knowledge
of the patient’s life” (p. 148). These authors include the extrospec-
tive, but their thinking leaves unresolved the issue of which takes
108 Chapter 9
precedence in therapeutic work. Kohut (1959) saw introspection

and empathy as“linked and amalgamated with other methods and
observation. The final and decisive observational act, however, is
introspective or empathic” (pp. 209-210). We believe that when
extrospective data is viewed as a possible starting point, it is given
a useful role without undermining the primacy of the empathic
method.
By embracing empathy as his method, Kohut rejected the
classical analytic primacy of insight through interpretation. He
favored the empathic side in the running battle between cognitive
insight and empathic responding in the history of psychoanalysis, a
conflict which can be discerned first in the thinking of Freud where
insight and empathy were two separate strands. Whatever Freud said
about insight has to be balanced by his use of the term Einfuhlung
(empathic understanding) 15 times in his writings, thus indicating
its importance to him (Wolf, 1983b, p. 310). Even so, as important
as the concept of empathy was to Freud, it never featured centrally
in his thinking as it did with Kohut.
Others in the history of psychoanalysis also saw the importance
of empathy. Ferenczi (1928) developed the concept of empathy
through the idea of“tact” in giving interpretations. Balint (1952)
also developed the idea of an empathic methodology in a series of
papers. Basch (1988b) thinks that Glover’s term“inexact interpreta-
tion” is evidence that many in the previous generations of therapists
“became empathic with their patients and responded accordingly”
(p. 56). Friedman (1978), in assessing this insight/empathy struggle
throughout the history of psychoanalysis, sees insight as nearly, but
never really, in the ascendancy. He thinks that the patient’s positive
attachment to the therapist has been viewed as the more important
therapeutic agent. For example, by 1938 Freud’s (1940) position was
similar to that of the 1936 Marienbad Symposium, which accepted
Strachey’s (1934) paper about the patient’s introjecting the benign
attitudes of the analyst. This formulation implies the importance of
an affective bond and its internalization by the patient, not interpre-
tation.
Other analysts gave primacy to a patient’s attachment behavior
and focused on empathy. Reik (1937), for example, defined empathy
as the analyst’s sharing the experience of the patient as if it were his
own. Murray (1938) referred to the process of recipathy (reciprocal
empathy), while Schafer (1959) used the phrase “generative

empathy.” And Fliess (1942) described a“trial identification” in
which the analyst affectively reacts to the analysand’s material by
“tasting” or introjecting it. The skill of the therapist depends on the
ability“ t o step into [the patient’s] shoes, and to obtain in this way
an inside knowledge that is almost first hand. The common name
for such a procedure is empathy” (pp. 212-213).
In contrast to these theorists, Kohut made empathy central to his
theoretical system, and, initially anyway, used the term far more
precisely than did his predecessors. Once empathy lost Kohut’s
initial precision of meaning as an observational, data-gathering
process, the theoretical waters became muddied and thinking about
empathy became unclear.
Many issues arise when empathy is used as a broad, overinclu-
sive, idealized concept. One danger is the expectation of a cure
based on the magical covenant, often disavowed. Such idealization
of empathy surfaces where a person cannot tolerate any criticism of
the concept of empathy, nor consider empathy as having limitations
in any process of cure. The idealization is also revealed by the
belief that no amount of evidence can refute the fact that“true”
empathy always produces a therapeutic cure. If there is no cure,
then the therapist was ipso facto unempathic. Now, while the
absence of a positive therapeutic result may arise from lack of
attunement by the therapist, the empathic idealist sees this lack as
always the reason. Conversely, it is impossible to imagine a situation
where empathy is not the reason for a cure. This linking of empathy
and cure is not falsifiable (Popper, 1963) and hence is an unscientif-
ic proposition, no longer useful as an explanatory construct. The
idealized version of empathy belongs to the realm of faith, religion,
and magic.
The dangers of directly linking an idealized version of empathy
and cure are obvious from the thinking of Mitchell (1988):
It is often not the experience of“empathic failure,” but the

experience of empathic success that precipitates withdrawal,
devaluation, and fragmentation. For someone who has experi-
enced repeated failure of meaningful connection, whose essential
attachments are to constricted and painful relationships (in
actuality or in fantasy), hope is a very dangerous feeling. It may
110 Chapter 9
be precisely the sense of meaningful connection that precipitates

the analysand’s withdrawal, because the possibility of such a
connection calls into question the basic premises of the analy-
sand’s painfully constricted subjective world [pp. 160-161].
THE PROCESS OF KNOWING
Kohut initially saw empathy as the process of coming to know. This

understanding can be put to a variety of practical uses. For example,
empathy can be used by a corporation’s personnel department to
gather information from employees for management. Information
gained in this way then influences decisions made primarily for the
benefit of the corporation. Such an intelligence-gathering function
can be viewed as an abuse of the empathic method only if empathy
is assumed to be exclusively a therapeutic method. When empathy
is understood theoretically as data gathering for a variety of uses,
including but not limited to psychotherapy, much confused thinking
is avoided.
That empathy is not exclusively a therapeutic method is evident
in the empathic method of intelligence-gathering that has long been
a part of military tradition. For example, in World War II, a few days
after Rear Admiral Chester Nimitz became Commander-in-Chief of
the Pacific Fleet, he gave Commander Edwin Layton, the Fleet
intelligence officer, his new assignment:
I want you to be the Admiral Nagumo [Commander of the

Japanese First Air Fleet that attacked Pearl Harbor] of my staff. I
want your every thought, every instinct as you believe Admiral
Nagumo might have them. You are to see the war, their opera-
tions, their aims, from the Japanese viewpoint and keep me
advised what you are thinking about, what you are doing, and
what purpose, what strategy, motivates your operations. If you can
do this, you will give me the kind of information needed to win
this war [Layton, Pineau, and Costello, 1985, p. 357].
The eventual result of Layton’s efforts, including codebreaking,

was the ambushing and defeat of the Japanese carrier force at the
battle of Midway, considered the turning point in the Pacific war.
The military use of empathy to gather intelligence illustrates its

potential advantage in any struggle for power. Marriage raises a
similar issue. Is empathy used by a spouse in the service of
understanding, communication, and intimacy; or does empathic data
gathering, in the guise of intimacy, serve as a weapon in a marital
struggle for power? Sometimes a breakdown in marital communica-
tion occurs because one or both spouses are unable to communi-
cate. More often, however, the lack of communication occurs
because empathy has been consistently used by one spouse as a
means of gaining control, and the other spouse is refusing to be
manipulated by this maneuver.
If empathy is a process of knowing, and no more, other
theoretical constructs are needed to explain how psychotherapy
works. A major issue in psychotherapy is a therapist’s capacity to
care, that is, to invest in the long-term interests of the patient.
Psychotherapy places the client’s needs first, not those of the
corporation, the military, or the marriage. Stated another way, it is
not just empathic data gathering, but the use to which it is put, that
determines whether a patient changes in psychotherapy.
ATTENUATED KNOWING
Kohut also recognized that while empathy was a data-gathering

process, it inevitably stimulated affects. Such affects could be
negative ones, such as anger, distress, and disgust, or positive ones
such as interest and joy (Tomkins, 1962-63). By 1984, Kohut not
only was defining empathy as“the capacity to think and feel oneself
into the inner life of another person,” but also he added the idea of
empathic attenuation:“ I t [empathy] is our lifelong ability to
experience what another person experiences, though usually, and
appropriately, to an attenuated degree” (p. 82). Such a notion of
attenuation suggests that too much empathic understanding can
traumatize. This capacity for empathy to traumatize needs further
theoretical understanding and elaboration.
Kohut called the patient’s overstimulated experience of being
empathized with“empathic flooding.” Would not empathic overstim-
ulation indicate the therapist really was not being empathic? It
112 Chapter 9
would if empathy were considered an intuitive gift of instantaneous

knowing. But Kohut carefully defined empathy as not being
intuitive. On the contrary, it is a trial-and-error process of coming
to understand how the patient feels and thinks. It involves the
“feedback” of the hermeneutic method. Only by reading the signs
of overstimulation can the therapist make adjustments. Of course,
if the therapist avoids the hermeneutic process and ignores the
signs of a patient’s overstimulation for any length of time, the
therapist is being unempathic and the patient will experience an
empathic failure. Empathy is not the capacity to set up a perfect
relationship where there is no overstimulation, but the ability to
perceive, through vicarious introspection, overstimulated patient
responses as they occur.
The idea of empathic attenuation assumes a quantitative dimen-
sion. Is the amount of empathy experienced by the patient critical
to therapeutic change, or is the experience itself the key factor?
Thought of quantitatively, empathy can be conceived as a powerful
magical force as if it were an emotional medication. If a little is
good, a lot must speed up the process. Empathy then takes on a
similarity to a religious, sacramental agent (see chapter 2, this
volume) and not just a data-gathering function. Yet, if empathy is not
a byproduct of the magical covenant and is the means whereby one
person knows the subjective self of another, then the amount of
empathy is not as important as the experience of being empathically
known. If this is so, the patients get well not because the therapist
is“more empathic,” but as a result of other processes not adequate-
ly covered by the concept of empathy as vicarious introspection.
IDENTIFICATION
Kohut also indicated that empathy is not identification and hence is

not sycophancy. The problem of unempathic identification is
illustrated by an incident involving Adolf Hitler. In 1933, the
Germans opened the British diplomatic pouch and discovered that
Sir Eric Phipps, the British Ambassador to Germany, viewed Hitler
as“ a fanatic who would be satisfied with nothing less than the
dominance of Europe” (Manchester, 1988, p. 89). Hitler, enraged,
demanded a ‘“more modern’ diplomat who showed at least some
understanding of the changes taking place in Germany” (p. 90). So

Phipps was replaced by Sir Neville Henderson who could “enter
with sympathetic interest into Hitler’s aspirations,” and who quickly
became a friend of Herman Goring (p. 90).
In view of subsequent historical evidence, it is clear that
through identification with and idealization of the Nazis, Henderson
accepted at face value German propaganda to the effect that they
wanted nothing more than peace and self-respect, and thus he
moved close to becoming a Nazi sycophant. He identified with the
false, peripheral group-self that the German government presented
to the world. In hindsight, Phipps was empathic in his understand-
ing of how Hitler and the Nazi leaders thought and felt. He
correctly perceived that the core German self, as represented by the
Nazis, was intent on revenge and gaining domination of the world
to erase the shame of defeat in World War I.
PROJECTION
Kohut (1971) made it clear that empathy is not projection (p. 65).
In classical theory, projection is first and foremost a defense against
drives, but it is also a defense against self-understanding. In contrast
to projection, by vicarious introspection a person tries to imagine
what it is like to be in another person’s shoes. With projection, the
focus is the self; with empathy the motivation is to understand the
other person. Projection as understood classically not only interferes
with understanding another person but is experienced by the
patient as unempathic rejection because there is no obvious effort
to understand.
A second reason empathy is not projection is that empathy
involves the hermeneutic circle; projection does not want such
“feedback.” Trainee therapists, who frequently defensively project
because of fear, are unable to describe clues in support of their
“hunches,” especially those that may indicate what the patient is
feeling. They also miss all but the grossest signs of patient fragmen-
tation as a result of their unempathic projective stance. It is not just
that the projecting therapist misses the clues; there is a basic
resistance to the need for the clues themselves. Those who project
their intrapsychic dynamics tend to be self-righteous personalities
114 Chapter 9
to whom the idea of a mistake is anathema (Lax, 1975). Their first

priority is to protect the grandiose state of their self by remaining
invulnerable and not responding to the empathic needs of patients.
ATTUNEMENT
Although empathy was a data-gathering process in Kohut’s early

writings (1959, 1966, 1971), by 1975 he had expanded its meaning
in three ways: 1) empathy is the recognition of the self in the other
and is an indispensable tool of observation, without which vast areas
of human life, including man’s behavior in the social field, remain
unintelligible; 2) empathy is the expansion of the self to include the
other and constitutes a powerful psychological bond between
individuals, a bond that—more perhaps even than love, the
expression and sublimation of the sexual drive—counteracts human
kind’s destructiveness against fellow creatures; and 3), empathy is
the accepting, confirming, and understanding human echo evoked
by the self and is an essential psychological nutrient without which
human life as we know and cherish it could not be sustained. To
summarize, by 1975 Kohut was using the term empathy to describe
(a) an observational tool, (b) a bond, and (c) a necessary precondi-
tion for psychological health.
In conceptualizing the idea that empathy formed a bond, Kohut
had moved from the empathic process of knowing to the goal of
this process, the state of being in an empathic bond. The aim of
empathy, the process of coming to know a subjective self, became
subordinate to a higher goal of being“in-tune.” This bond consists
of an“empathic resonance between self and selfobject” (Kohut,
1984, p. 76). From this and other passages, it is very clear that
“empathic resonance” means a good deal more than“empathic
knowing” or “empathic understanding.”
As with empathy, so with attunement—Kohut was not the first
analyst or psychotherapist to use the construct. Loewald (1960)
wrote that a parent ideally is“in-tune” with the shifting levels of a
child’s particular stage of development. When Balint (1968) failed
to work“in-tune” with his patients, they reacted with noisy,
aggressive symptoms or with despair.
The formulation of the concept of empathic resonance, or

attunement, as the goal of empathic understanding, coincides with
an increased interest in attunement behavior in mother-infant
studies. For example, Stern (1985) refers to affect attunement as a
series of steps whereby (1) the parent reads the infant’s feeling state
from the infant’s overt behavior, (2) the parent performs some
“corresponding” behavior, and (3) the infant reads this correspond-
ing behavior as reflecting the infant’s experience.
Such attunement is more than imitation. Imitation mechanically
copies form, whereas attunement never copies exactly and always
involves feelings! These feelings consist of both categorical and
vitality affects (see chapter 21, this volume). Attunement is more
than empathy, that is, more than the cognitive form of vicarious
introspection. It is more like communion, where one shares
another’s experience without attempting to change that person. The
most important obstacles interfering with the use of such empathic
communion, especially for prolonged periods, are the narcissistic
difficulties in the therapist (Chessick, 1985).
Most investigators of mother-infant behavior have described in
detail chains and sequences of reciprocal behaviors that make up
“dialogues” during the infant’s first nine months. The mother
constantly initiates imitations of the infant’s behavior, but always
with slight modifications, in a manner similar to a classical piece of
music, which repeats a theme, but with countless variations. Thus,
in the mother-infant pattern there is a reinforcement of the experi-
ence of a basic invariance and structure to life, but with minor
variations.
Beebe and Lachmann (1988), who have closely observed the
mother-infant dyad, talk about the various kinds of sharing,
matching,“tuning in” and“being on the same wavelength” experi-
ences that exist in the mutual influence structures of the first six
months of life. These constitute precursors to the more cognitively
formed empathic understanding that Kohut used as his method of
psychotherapy.
The essence of a healthy empathic matrix for the growing self
of the child is a mature, cohesive parental self that is in tune with
the changing needs of the child. It can, with a glow of shared joy,
mirror the child’s grandiose display one minute. Yet, perhaps a
116 Chapter 9
minute later, should the child become anxious and overstimulated

by its exhibitionism, it will curb the display by adopting a realistic
attitude vis-à-vis the child’s limitations. Such optimal frustrations of
the child’s need to be mirrored and merged into an idealized
selfobject, go hand in hand with optimal gratifications and generate
the appropriate growth-facilitating matrix for the self (Chessick,
1985).
CURE
By 1984, Kohut had placed greater stress on the role of empathy in

a therapeutic cure. In his book, How Does Analysis Cure?, he
devoted a chapter to“The Role of Empathy in Psychoanalytic Cure”
but did not state that empathy alone effects a cure. Empathy has an
important role, but there are other factors necessary for a cure. In
fact, Kohut indicated that the analytic cure is a three-step process.
The first is“defense analysis”, the second, the“unfolding of the
transference”; while only the third opens“ a path of empathy
between self and selfobject” (p. 66).
Elaborating the third point, Kohut wrote about the“establish-
ment of empathic in-tuneness between self and selfobject on mature
adult levels” (p. 66). That is, through the process of vicarious
introspection, a self and a selfobject eventually become“in-tune,”
but only if this“in-tune” state is maintained over a considerable
period of time can a cure occur. A lengthy process of sustained in-
tuneness is especially necessary if the nature of the bond is archaic,
in order for the bond to be transformed gradually into more mature
one. To Kohut, the essence of an analytic cure is the gradual
acquisition of structure through an empathic contact with a mature
selfobject, accompanied by explanations that follow the understand-
ing phase of treatment. Cure is not the expansion of the self,
although expansion often occurs. And cure is not the ability to
express verbally an understanding of former personal pathology,
although this also frequently occurs after a cure.
With the new emphasis on the role of empathy in a cure, Kohut
focused more on an empathic milieu, because“in such a[n] [empty]
world it is human empathy that forms an enclave of human
meaning” (Chessick, 1985, p. 138). Kohut took a therapeutic stance
that stressed the legitimacy of the patient’s claim on caretakers. His

was a special nurture psychology. By 1984, Kohut had shifted further
from Freud’s truth-and-reality morality to empathy, from pride of
clear vision and uncompromising rationality toward pride in the
scientifically controlled expansion of the self.
In summary, much has been written about empathy during the
last decade. Once the concept gained acceptance, a major struggle
developed to prevent it from becoming so inclusive that it was used
to explain everything and thereby nothing. The whole of the
psychotherapeutic process cannot be adequately explained by the
single concept of empathy. When the meaning of empathy was held
to its precise, initial meaning as a process of understanding the
subjective self through vicarious introspection, pressure arose for
other, more precise theoretical constructs to describe aspects of
psychotherapy. The concept of empathy, for example, pointed the
way to attunement, that special bond between therapist and client.
The nature of that bond needed further exploration, which occurred
around the issue of the narcissistic transferences (see chapters 11-
13, this volume).
The inadequacy of empathy as an idealized curative construct
can be seen in an example from Kohut (1984):“ I f the mother’s
empathic ability has remained infantile, that is, if she tends to
respond with panic to the baby’s anxiety, then a deleterious chain
of events will be set in motion” (p. 83). In such a situation the
mother empathically knows how the child feels. She knows, through
empathy, that the child is anxious. But this empathic understanding
is not enough. Her ability to respond is faulty, not her capacity to
be empathic. This inability to respond invites us to examine
selfobject functions. As later chapters show, these functions play at
least as important a role in a therapeutic cure as empathy does. But
before turning to the subjects of narcissistic transferences and
selfobject functions, we explore the concept of narcissism in the
next chapter.
Readings for Chapter10:Freud, 1914; Kohut 1966.
10
Narcissism
H aving chosen empathy as his method for understanding the

subjective self, Kohut used it to undertake a major clinical
study of narcissism. He published this study as“Forms and Transfor-
mations of Narcissism” (Kohut, 1966). He had many reasons for
studying narcissism. First, he was experiencing an increasing num-
ber of patients in his practice with disorders reflecting narcissistic
needs rather than neurotic conflicts. Second, his experience of
growing to young adulthood in Germany during the Nazi era raised
questions about the pathologically narcissistic Nazi core of Germa-
ny. Third, he was concerned with his own narcissistic needs as a
creative thinker. In this chapter we explore (a) the definition of
narcissism, (b) the adaptive value of narcissism, (c) transformed
narcissism, and (d) narcissism and the autonomous self.
THE DEFINITION OF NARCISSISM
Self psychology redefines narcissism. Hartmann represented the old

view clearly when he said that narcissism is the cathexis of the self
118
Narcissism 119
(Kohut, 1971, p. xiii). He was following Freud’s (1914) view of

narcissism, represented in the polemical paper“On Narcissism.”
When Freud wrote this paper, he was“fuming with rage” (Chessick,
1980a). The defections ofJung and Adler not only had troubled him,
they forced him to define more precisely his theory of instincts.
Using his famous U-tube analogy, Freud (1914) defined narcissism
as the flowing of energy back into the ego. He cited paranoid
schizophrenia as an example of“secondary narcissism,” in which
most of the libido is directed to the self. In object love the energy
flows outward; the state of being in love exemplifies the libido
cathected to an object. A phase of autoerotic primary narcissism,
where the infant blissfully experiences the world as being itself, is
postulated at the beginning of life.“All major psychoanalytic
contributions to the concept of narcissism since Freud have largely
remained locked into the 1914 model” (P. Ornstein, 1974, p. 128).
Kohut (1966) challenged Freud’s notions of object libido and
narcissistic libido. According to Freud, there is a totally narcissistic
libido in the newborn, and as the infant becomes a child and then
an adult, there is a shift toward all libido being invested in objects
and none in the self. Using Freud’s theory, the therapist tries to
replace the patient’s narcissism with object love, an aim Kohut
thought not only difficult—if not impossible—but very undesirable.
Kohut challenged the assumption that narcissism had to be
eradicated. Such an eradicating solution, he argued, is itself
influenced by the absolute ideas of an archaic grandiose self and
hence is narcissistic. Kohut conceived of object libido and narcissis-
tic libido as developing along separate but parallel lines. They are
not on the opposite ends of the same continuum, as Freud contend-
ed, but move along two separate continua from archaic to more
mature forms.
Although the term narcissistic was first used by Freud in a 1910
footnote to“Three Essays on the Theory of Sexuality” (Freud,
1905a), Rank actually wrote the first paper on narcissism in 1911
(Chessick, 1985). Nonetheless, Freud stamped these disorders with
the implication of a poor prognosis for psychoanalytic psychothera-
py when he distinguished them from the transference neuroses. The
DSM-III description characterizes the narcissistic person as manifest-
ing a sense of self-importance, an exhibitionistic need for attention
and admiration, feelings of entitlement, lack of empathy for others,
120 Chapter 10
and interpersonal exploitativeness. Chessick points out that the

DSM-III diagnosis describes an extremely unlikable person,
obviously maladapted, and headed for trouble, obviously an
extreme view. In practice, clinicians treat patients with narcissistic
symptoms ranging from minimal to extreme, such as the sexual
perversions.
Kohut’s initial challenge to Freud’s view of narcissism used the
thinking and language of drive theory. In the evolution of Kohut’s
thought, however, once drive theory was dropped as an explanatory
tool, his idea of narcissism became clearer. Although he never
defined narcissism in a single, clear, and simple definition, he
described it through his understanding of the narcissistic trans-
ferences and their later form as selfobject functions. Self psychology
now sees narcissism as pertaining“ t o the maintenance, restoration,
and transformation of self experiences” (Stolorow et al., 1987, p.
16). In Hartmann’s language, narcissism is viewed as essential to the
cohesion (not cathexis) of the self. Mitchell (1988) sees narcissism
as a set of illusions. These illusions are not merely defenses against
internal drives, as Kernberg believes, or as growth enhancing as
Kohut held,“ b u t most fundamentally . . . a form of interaction, of
participation with others” (p. 204).
THE ADAPTIVE VALUE OF NARCISSISM
Kohut (1966) expressed the conviction that the modern view of

narcissism was prejudiced toward always seeing it as pathological.
Hence, it was seen as completely undesirable, devoid of any
redeeming features, and deserving of eradication. Kohut believed to
the contrary.
For Kohut, narcissism, which can take archaic, pathologically
destructive forms, has adaptive value, and the potential to make a
significant contribution to modern life. Wolf (1988a) wrote,“Mature
selfishness is really the expansion of the self and its selfobjects to
take in the whole world” (p. 130). If this is so, the central question
for Kohut was understanding how to harness narcissism for
constructive purposes, not how to get rid of it. He was interested in
the“transformation” of archaic narcissism to mature forms.
Narcissism 121
By asserting that narcissism can have adaptive value, Kohut

(1966) recognized that he was paddling upstream against the
prevailing“altruistic value system of Western civilization” (p. 98).
Such a value system was reinforced by the teaching and preaching
of the major religious bodies against the sin of being selfish. But, to
Kohut, most lamentable was the reinforcement given by Freud’s
theory to this negative bias against narcissism. In supporting
narcissism’s adaptive value, Kohut found himself in conflict with
Freud’s views. In discarding Freud’s views on narcissism, Kohut
eventually rejected Freud’s drive theory, the keystone of classical
analysis.
By diagnosing pathological narcissism, Kohut (1966) avoided the
behavioral symptoms outlined in DSM III and focused on “ t h e
painful affect of embarrassment or shame which accompanies them
and by their ideational elaboration which is known as inferiority
feeling or hurt pride” (p. 98). Following clues from Freud, Kohut
saw shame as arising from“exhibitionistic aspects of pregenital
drives” (p. 98) At this stage in his thinking, Kohut was still using the
language of drive theory to explain his new ideas. Narcissistic
tension also occurs as the self strives to live up to its ideal. He saw
the affective byproducts of narcissism as pointing to both the
ambitions and the ideals sectors of the self.
As early as 1966 Kohut had formulated the bipolar theory of the
self. The two poles of the self, ambitions and ideals, develop as a
differentiation from primary narcissism. Kohut reminds us that
primary narcissism is a psychological state:
The baby originally experiences the mother and her ministrations

not as a you and its actions but within a view of the world in
which the I-you differentiation has not yet been established. Thus
the expected control over the mother and her ministrations is
closer to the concept which a grownup has of himself and of the
control which he expects over his own body and mind than to the
grownup’s experience of others and of his control over them (pp.
99-100].
Kohut referred initially to the ambitions pole as the“narcissistic

self and the ideals pole as the “idealized parent imago.” These are
“new systems of perfection” that arise from disturbances to the
122 Chapter 10
primary narcissism because of inevitable imperfections in the

mother’s ministrations. The baby attempts to maintain the original
perfection and omnipotence either by imbuing the rudimentary self
or the rudimentary“you,” the adult, with absolute perfection and
power.
To Kohut, the establishment of a narcissistic self or an idealized
parent imago is not pathological per se. These subjective states
represent significant developmental achievements. Problems arise
only if traumatic experiences lead to fixations at these maturation
points and to an inability to internalize these idealized parents as
ideals. For example,“premature interference with the narcissistic
[grandiose] self leads to later narcissistic vulnerability because the
grandiose fantasy becomes repressed and inaccessible to modifying
influences” (Kohut, 1966, p. 104). When narcissistic forms of
arrested development occur, these patients present with a great deal
of grandiosity, expressed in a variety of ways, most often as
unrealistic expectations of the self shown through self-criticism or
condemnation for their not achieving impossible goals. This
grandiosity is transformed only with difficulty because the patient
is constantly overwhelmed by feelings of shame for failing to fulfill
unattainable expectations. An example of a fixation at the ideals pole
is seen when there is a failure to reach these ideals and the self
experiences a deep longing for connection with an idealized
parental imago.
TRANSFORMED NARCISSISM
If not traumatized, the grandiose and idealizing poles of the self

develop from archaic to more mature forms. Kohut evaluated both
poles as measures of the patient’s level of narcissistic development
from archaic to useful forms. On the grandiose line of development,
ambitions become more realistic and goal oriented, and energy is
released“for ego activities” (P. Ornstein, 1974, p. 135). On the
idealizing line of development, ideals act as guides rather than as
absolute controls and may be transformed into such forms of as:“(i)
man’s creativity; (ii) his ability to be empathic; (iii) his capacity to
Narcissism 123
contemplate his own impermanence (death); (iv) his sense of

humor; and (v) his wisdom” (Kohut, 1966, P. 111).
Creative Activity
That creative activity is a transformation of narcissism can be seen

in the creator’s idealized relationship to his work. Work functions
for the creative person as a transitional object (Winnicott, 1951). It
is similar to a mother’s love for her unborn fetus or newborn baby
or the single-minded devotion to the child who is taken into her
expanded self. Kohut placed heavy stress on creativity not autonomy
(Chessick, 1985, p. 225).
The creative individual is less separated from his surroundings
than is the uncreative person. The I-You barrier is not clearly
defined. The“external” is experienced more as a part of the internal
and, therefore, with far greater intensity and sensitivity. The creative
person is trying to recreate a perfection that was formally a part of
the self. During the creative act, the creative person does not relate
to work with the give-and-take mutuality that characterizes object
love. Once underway, creativity takes precedence over interpersonal
relationships.
Empathy
A second way narcissism is transformed is through the capacity for

empathy in adult life. Empathy (as discussed in chapter 9, this
volume), is a mode of gathering subjective data about another self
through vicarious introspection. It is the process of exploring what
another thinks and feels by placing oneself in another’s shoes. At
birth babies have a built-in capacity for attunement with their
mothers (Stern, 1985). Beebe and Lachmann (1988) call this capacity
for mutual influencing (see chapter 23, this volume), a precursor to
empathy. The educational processes of Western culture are designed
to replace this“inferior” narcissistic capacity with unempathic forms
of cognition that foster an objective, materialistic, and mechanical
view of life. In Kohut’s mature person, the primitive capacity for
attunement has not been expunged but is transformed into vicarious
124 Chapter 10
introspection for appropriate utilization in adult personal relation-

ships.
A c c e p t a n c e of T r a n s i e n c e
The acceptance of transience, that is, of finiteness and death, is a

third way in which narcissism is transformed. Freud (1916) pointed
out most people’s reluctance to accept the impermanence of objects
whether people or cherished values (P. 305). The acceptance of our
own impermanence—that the self is finite in time—is even more
difficult. Kohut (1966) believed that the ability to accept transience
“rests not simply on a victory of autonomous reason and supreme
objectivity over the claims of narcissism, but on the creation of a
higher form of narcissism” (p. 118). Those who genuinely accept
death face it with a quiet pride rather than a sense of resignation
and hopelessness. Such people share with Goethe the insight that
the acceptance of death leads to a richer feeling of being alive. Most
people, who, for example, are given a short time to live for medical
reasons, set about packing as much as they can into each precious
moment. Under such circumstances, death adds to rather than
detracts from the quality of life. Such a heightened sense of living
results in a cosmic narcissism that transcends the limits of the
individual and leads to a new awareness and interest in the broadest
issues of existence.
Capacity for H u m o r
The fourth sign of transformed narcissism is a capacity for humor.

Although affirming Freud by quoting him, Kohut had a different
view of humor. Freud (1927) said that“ h u m o r has something
liberating about it; but it also has something of grandeur and
elevation . . . [and] the triumph of narcissism, the victorious
assertion of the ego’s invulnerability” (p. 162). Freud was describing
grandiosity that disavows the meaning of events. By contrast, Kohut
(1966) described a genuinely transformed narcissism that does not
deny events; it is the ability of the self to deflect a wound, to
achieve a mastery that also accepts the unalterable realities that limit
the assertions of the narcissistic self.
Narcissism 125
Humor and cosmic narcissism .. . permit us to face death without

having to resort to denial... [and] are metapsychologicallybased
not on a decathexis of the self through a frantic hypercathexis of
objects . . . . A genuine decathexis of the self can only be achieved
slowly by an intact, well-functioning ego; and it is accompaniedby
sadness as the cathexis is transferred from the cherished self
upon the supraindividual ideals and upon the world with which
one identifies. The profoundest forms of human and cosmic
narcissism therefore do not present a picture of grandiosity and
elation but that of a quiet inner triumph with an admixture of
undenied melancholy [p. 121].
Wisdom
A quality of wisdom is a fifth indication of transformed narcissism.

Wisdom derives from the acceptance of limitations in one’s physical,
intellectual, and emotional powers. There is a recognition that the
grandiose self needs to compromise with time by rating priorities
and discovering what is truly important to be accomplished and
what can be left for others. Wisdom is reflected in a sense of
balance and proportion that takes into account the broad picture. It
is generally achieved, if at all, in a person’s more advanced years.
Kohut (1966) believed these five dimensions of experience to
be invaluable in evaluating psychoanalytic therapy:
The reshaping of the narcissistic structures and their integration

into the personality—the strengthening of ideals, and the achieve-
ment, even to a modest degree, of such wholesome transforma-
tions of narcissism as humor, creativity, empathy and wis-
dom—must be rated as a more genuine and valid result of
therapy than the patient’s precarious compliance with demands
for a change of his narcissism into object love [p. 123].
NARCISSISM AND THE AUTONOMOUS SELF
Kohut accepted a healthy, adaptive function for transformed

narcissism and rejected the goal of a completely autonomous self.
He rejected the concept of dependence altogether because on
introspective-empathic inspection it turned out to be a “further
126 Chapter 10
reducible psychic state” (Ornstein, 1978, p. 31). As Grotstein (1983)

says,“ K o h u t eschews the traditional notion of the increasing
independence of the self from its objects” (p. 176). It is a manifesta-
tion of nontransformed archaic narcissism for a person to value
absolute autonomy and perfect freedom.
To Kohut, a person’s striving for complete independence not
only sets an impossible goal, but disavows legitimate narcissistic
needs. These persons are“counterdependent” rather than maturely
adaptive in their behavior. The apparent“nonnarcissism” of the
completely autonomous person is a covert form of archaic but
disavowed narcissism. It is possible that the goal of classical
psychoanalysis, the complete autonomy of the patient, encourages
the disavowal of narcissism.
In addition to the classical goals of complete autonomy, another
traditional concern is strong ego (self) boundaries. It was deemed
that a narcissistic person had“weak ego boundaries,” whereas an
autonomous person had strong ones. But the focus on boundaries
does not address the issue of narcissism. It is possible to argue that
strong boundaries are necessary if there is a weak empty core; that
is, a person needs a strong outer (“false”) self to protect a weak
inner self. Kohut placed the emphasis not on boundaries, but on the
cohesion of the whole self. A selfs cohesion, or lack of it, is the
issue in narcissism.
With a strong cohesive self, boundary issues are not critical. A
boundary can be“penetrated” by the psychological presence of
another functioning as a selfobject (see chapter 14, this volume) and
the cohesive self is not imperiled or triggered into a state of
collapse. In fact, the presence of an empathic person functioning as
a selfobject is not experienced subjectively as an intrusion into self
boundaries, but as a cohesive presence. To Kohut, the selfs
cohesion, not boundary strength, was the critical issue.
In taking this stand against the disavowal of legitimate depen-
dency needs, Kohut was not alone. He joined, for instance, the
English poet John Donne, who said,“No man is an island, intire of
it selfe.” He also joined British analysts who, commencing with
Fairbairn, and including Balint, Winnicott, and Bion, suggested that
an infant grows from infantile dependence into mature dependence
(Grotstein, 1983). These British analysts understood that a person
feels autonomous by being properly“dependent-connected” to
Narcissism 127
someone who provides support. In making this same point, Kohut

used the concept of a selfobject function. To keep the self cohered,
a person needs others to function as selfobjects, which are objects
we experience as part of our self (Kohut and Wolf, 1978, p. 414). To
Kohut, then, the selfobject function never disappears, it only
undergoes transformation and maturation.
Kohut arrived at the idea of a selfobject function through an
understanding of the narcissistic transference. In the neurotic
transference, the therapist becomes a screen for displacements and
projections of actual past experiences with parents or significant
others. In the narcissistic transference, the longing for missed
experiences is relived with the therapist. In other words, neurotic
transferences involve experiences that have taken place; narcissistic
transferences, those which have not. Obviously, some patients
present with both types of transferences; nonetheless, the distinction
between these two transferences is useful.
The use of the term transference for the therapist’s relationship
with both narcissistic and neurotic patients created confusion. It
forced constant clarification of the type being referred to, whether
classical, or narcissistic as defined by Kohut. And because Kohut
initially also referred to two types of narcissistic transferences, the
idealizing and the mirroring (before he added rwinship as a third),
the term narcissistic transference began to be replaced by the term
selfobject function. Kohut saw idealizing, mirroring, and twinship
selfobject functions as being ways to describe specifically the needs
of the narcissistic transference.
In the next three chapters we see in detail how the needs for
these mirroring, idealizing, and twinship selfobject functions mani-
fest themselves, and the problems of managing psychotherapy when
these transferences are present so that growth occurs along the
narcissistic line of development. The mirror transference is ex-
plored in the next chapter.
Readings for Chapter 11; Kohut 1971, chapters 5-7.
11
Mirror Transference
T heaboutmirror transference takes us to the heart of Kohut’s ideas

the transformation of narcissism. It was Kohut’s under-
standing that narcissistic transferences represented arrested
developmental needs, not pathological aberrations, that opened the
door to their being utilized to bring about growth. This was
especially so for the mirror transference. Using these transferences
is not easy or simple; nevertheless, therapists can now achieve with
narcissistic persons good results that previously were accidental or
virtually impossible before Kohut published his ideas. In this
chapter we cover the mirror transference as (a) definition, (b)
clinical example, (c) responding, (d) the grandiose state, and (e)
conforming and creative states.
DEFINITION
Kohut (1971) defined a mirror transference as

the therapeutic reinstatement of that normal phase of the develop-
ment of the grandiose self in which the gleam in the mother’s
128
Mirror Transference 129
eye, which mirrors the child’s exhibitionistic display, and other

forms of maternal participation in and response to the child’s
narcissistic-exhibitionistic enjoyment confirm the child’s self-
esteem and, by gradually increasing selectivity of these responses,
begin to channel it into realistic directions [p. 116].
A mirror transference represents a therapeutic revival of the

grandiose self (Chessick, 1985), which awakens a demand for
validation (Rasch, 1988a) from a responsive selfobject (Goldberg,
1988) who recognizes, admires, and appropriately praises the
patient.
A patient whose exhibitionistic needs have been adequately
validated by parents does not develop a mirror transference during
psychotherapy. When a parent’s self-confidence is secure, then the
proud exhibitionism of the budding self of a child will be respond-
ed to with acceptance. However grave the blows may be to which
the child’s grandiosity is exposed by the realities of life, the proud
smile of the parents will keep alive a bit of the original omnipo-
tence (Kohut and Wolf, 1978). Faulty mirroring by the parents leads
to arrested development and a yearning for a significant growth-
producing mirroring experience.
In 1971 Kohut postulated three ways that the mirror transfer-
ence could express a patient’s exhibitionistic grandiosity. In the
archaic merger, the patient, who thinks the therapist knows what is
on his mind, demands total control, as if the therapist were an arm
or a leg. In the alter-ego/twinship type of merger, the patient insists
that he and the therapist are alike. With the mirroring type, the
mirror transference proper, the therapist has the task of praising,
echoing, and mirroring the patient’s performances.
Ry 1984, Kohut had changed his thinking. Instead of seeing the
alter-ego/twinship type as a subentity of the mirror transference, he
conceived of it as a separate transference, considerably different
from the mirror transference. (It is discussed in chapter 13, this
volume, as is the archaic merger transference, which Kohut left
unseparated from the mirror transference.)
Patients who seek a mirror transference with a therapist are
searching for the means to transform a primitive grandiosity into
wholesome pride in performance (Goldberg, 1974). Such archaic
grandiosity creates the illusion of being very powerful; it also makes
130 Chapter 11
unrealistic demands. When these grandiose demands are trans-

formed, they change into self-regulation and self-discipline (Ches-
sick, 1985). When mirroring focuses on genuine achievements, the
transference may shift to an idealizing one in which the grandiose
self gradually turns into an enthusiastic, realistically ambitious,
cohesive self.
CLINICAL EXAMPLE
Mr. I was a 25-year-old single male, mentioned by Kohut (1971,

1977) and written up in Goldberg (1978). Mr. I presented for
treatment because of his inability to perform on the job adequately
and because of a failure to establish an enduring relationship with
a woman, despite much dating.
After two years of treatment involving an idealizing transference,
the patient’s need turned into mirroring. This mirror transference
could be anticipated from his case material. The evidence is as
follows: He enjoyed masturbating in his girlfriend’s presence
because he liked“ a n audience”; he spent a great deal of time
looking at himself in a mirror; his hobby was photographing nude
women; he wanted the best analyst ever to think his sexual exploits
were great; his case was“ t h e greatest”; and he wanted to show off
his pictures, records, and poems to his analyst. All this points to a
grandiose self in need of transformation!
As further evidence of the grandiose state of his self, Mr. I acted
Like a Don Juan with women, conquering them and making them
participate in sadistic and bizarre sexual exploits. Goldberg writes:
He could be cruelly demanding of each one [of his girlfriends]:

showing up unannounced, leaving abruptly in the middle of the
night when expected to stay over, and, on the way home suddenly
deciding to spend the rest of the night with another.“If you treat
them badly, they’ll do everything you want them to do” [p. 22].
For example, with one of them, they urinated on each other and
then wallowed in the warmth of the urine.
Another indication of a mirror transference was Mr. I’s wanting
to be admired for the changes he had reported, yet he bemoaned
the fact that he needed recognition for every little accomplishment.

“He tried to attract the attention of the analyst’s applause at every
turn” (Goldberg, 1978, p. 35). He said of his sister,“Her admiration
had always made him feel great and powerful, and he has desper-
ately sought such admiration (for his ‘big penis’ and ‘great mind’)
from sister-figures ever since his sister married” (p. 43).
One of the important themes to emerge in Mr. I’s treatment was
the risk of his becoming“overstimulated.” He said that an early
memory was of a lake where“getting a strike on every cast had a
personal pleasure connected with it” (p. 56). He also wanted his
father to be there, to witness and admire his success, but he
wondered why all these exciting activities in this memory had
anxieties connected to them. Mr. I then associated to wanting the
analyst’s praise and approval, but he was afraid that the analyst
might debunk the activities that kept him (patient) calm, or on an
even keel. After one analytic session he said,“ a great hour, good
communication—really putting it together—makes me almost
ecstatic and I began to feel overstimulated” (p. 62). It is also clear
from the material (p.83) that being understood was overstimulating.
There is also evidence that when Mr. I sought a mirroring
response from his analyst, and did not get it, he was wounded. This
happened when he brought in some diaries, possibly a sign of
sharing some of his old, isolated, secret grandiose self. The analyst
made the mistake of focusing too much on the content of the
diaries. This mistake came out the next morning when Mr. I
reported a two-part dream (Goldberg, 1978):
[The first part:]
On a dock fishing, caught a big fish still on the pole,

carried it into the cottage to show it to Dad, and probably to
Mom too. Expected him to say, ‘Good fish.’ He said, you can
clean it. I didn’t want to; just wanted to show it. The fish then
shriveled up a bit as a result of the conversation [p. 75].
[The second part:]
The government has crucified one of my friends, G.C., for

some un-American behavior. I saw him on the cross, hugging
a statue of Jesus. Then it was Jesus on the cross; he was so
132 Chapter 11
big, splendid, great, the downfall of this man on the cross

added to the splendor of the occasion. He was suddenly
slumping, the muscles suddenly relaxing, and he was dying
[pp. 75-76].
In associating to these dreams, Mr. I complained that the analyst

had asked a lot of questions about the content of the diaries, instead
of saying“very interesting” and admiring them. Then he mused,“No
sense in bringing these in; you didn’t admire them.”
From this dream material, it is evident that when Mr. I became
wounded by the analyst’s lack of empathic responding to the diaries
(first part) he retreated into a merger transference (second part).
Combine with this retreat from mirror to merger transference the
two years of an idealizing transference before the mirror transfer-
ence emerged, and there is the suggestion of a narcissistic line of
retreat (regression) from idealizing through mirroring to merger,
as wounding occurs and inadequate repairs are made.
MIRRORING AS RESPONSE
As can be seen from the foregoing illustration, it is one thing for a

therapist to recognize the emergence of a mirror transference; it is
another matter to respond in such a way as to help transform the
grandiose self. For some self psychologists it is sufficient to affirm
the patient’s need for mirroring without in any other way respond-
ing directly to the need. This position is another expression of“its
wrong to gratify” the client because gratification produces the
“malignant regression” described by Balint (1968). Bacal (1985)
points out that a malignant regression, called fragmentation in self
psychology, occurs as a result of a catastrophic selfobject failure, not
as a result of gratifying.
Also in response to the“interpret the need for mirroring”
position, self psychologists experienced with mirror transferences
suggest that while affirming the need is sometimes sufficient to shift
the transference to an idealizing one, frequently it is not. In fact, the
actual interpretation of the mirroring need alone may be experi-
enced by the patient as withholding and hence a form of rejection

that results in an empathic break that needs repairing, on the other
hand, active mirroring may overstimulate patients, especially those
who have the greatest need for mirroring. Empathic monitoring of
the patient’s level of stimulation is necessary if the therapist actively
mirrors; and active mirroring should take place only after interpre-
tation of the need for mirroring has failed to reduce symptoms of
fragmentation. Because of the danger of overstimulation, active
mirroring is best introduced only tentatively.
Whatever the active response of the therapist, it is undesirable
to reduce mirroring to a therapeutic technique. First, a technique
implies a mechanical model of psychotherapy and thus a way of
avoiding involvement rather than being engaged in a bond with the
client. Second, the mirror transference is based on the client’s
subjective experience of being mirrored rather than any single thing
the therapist actively does. And, third, the nature of what is
experienced as mirroring is very much determined by the develop-
mental need. Thus, at one stage mirroring may be more like the
experience of“ s h o w and tell” in front of an obviously pleased
teacher or proud parents. At an earlier stage, it may be centered on
the fleeting but special look of the mother. At a later stage, the
mirroring experience may be part of an elaborate ceremony that
rewards and celebrates a significant accomplishment.
Mirroring also involves a process of mutual responding, referred
to as attunement. This attunement is analogous to the idea of
feedback loops, but because feedback as a concept is too easily
linked with computers and mechanistic thinking, the idea of
corrective mutual responding is preferred. Take, for example, the
case of Miss E. When she brought home her high school report
card, her preoccupied mother responded tersely with“That’s very
nice.” Superficially the mother gave a mirroring response, but its
mechanical, ritualistic quality failed the subjective expectations of
Miss E. She did not experience her mother’s response as the deeply
satisfying and vitalizing form of mirroring she needed. So Miss E
countered with,“ I get all As and all I get is ‘That’s very nice’?” Her
mother, adjusting her mirroring response, then said,“ N o , let me
give you a hug, its wonderful!”
134 Chapter 11
THE GRANDIOSE SELF
The idea of the mirror transference is linked to that of a grandiose

self. For the grandiose self, successes achieved are never enough;
because, imbued with perfectionism, the grandiose self is never
satisfied. It will brook no limits; its greed knows no bounds. Its
ideas are perfect; its control, absolute. It acts dangerously to prove
its omnipotence. Lying and name dropping are attempts to live up
to its expectations (Chessick, 1985).
If we heed the warnings of Schafer (1976) and others about the
dangers of reified thinking, we need to avoid using the term
grandiose self and speak instead of the self being in a grandiose
state. Otherwise we risk thinking of the grandiose self as a center
of initiative, separate from other parts of the self, and then self
psychology finds itself in the same reified position as classical
analysis, with its structural theory agents (id, superego, ego).
Initially self psychology’s discussions of the grandiose self reflected
this reifying tendency, but the issue of the reification of the
grandiose self faded as the theoretical emphasis shifted away from
the narcissistic transferences towards the selfobject experience (see
chapter 14, this volume).
A major concern among therapists is to avoid inflating the
grandiose self. There is a fear that actively mirroring the grandiose
self in a mirror transference may simply encourage more grandio-
sity. And it may. If increased grandiosity is a possibility, thought
needs to be given to the circumstances under which mirroring will
enhance the transformation of narcissism and those under which it
will only reinforce a grandiose state.
Circumstances that promote a grandiose state of the self are (1)
countertransference rejection, (2) mirroring without achievement,
(3) achievement without appropriate effort, and (4) excessive
mirroring even with appropriate success.
Countertransference Rejection
Countertransference rejection takes many forms. Grandiosity

irritates others, so invites rejection, and fosters the feeling that the
person“needs to be cut down to size.” Efforts aimed at puncturing
a person’s grandiose state by pointing out reality inevitably wound
and only increase narcissistic dynamics; if anything, they foster the

continuance or exacerbation of the grandiose state. Another way that
countertransference rejection emerges with patients who seek a
mirror transference is in the need of the therapist to compete with
the patient. A tendency to lecture the patient arises out of the
therapist’s counterexhibitionistic dynamics (Chessick, 1985). So does
the need to control the patient by using exhortation and persuasion.
Yet another type of countertransference occurs when the therapist
actively mirrors the patient because the patient’s case history
indicates a need for mirroring, rather than waiting for the mirror
need to manifest itself in the transference. The problem is further
compounded if an adequate idealizing bond has not had time to
develop.
All these countertransference-based behaviors wound the
patient, reinforce the grandiose state, and result in the emergence
of symptoms of a crumbling (fragmenting) self. Hypochondria,
compulsive sexuality, or sexual perversions are defenses against
such a crumbling self and the deadness felt within. They are
attempts magically to revitalize the self (Chessick, 1985). The patient
may also respond to the rejection of the mirroring needs by gross
identification with the therapist. Such an identification is a magical
attempt to solve the problem of the fragmenting self. Like anything
magical, it is impermanent. Yet another way a patient may respond
to rejection of mirroring is through yearnings for merger. Such a
merger, with its surrender of much of the self’s organization,
produces intense narcissistic rage, covertly expressed through the
demands and control of the merger transference.
Mirroring W i t h o u t A c h i e v e m e n t
If a therapist mirrors a patient’s wishes and fantasies or gives“false

mirroring,” that is, actively engages in praise and flattery of a patient
where no achievement is involved, the grandiose state of the self
can indeed be enhanced. Historical examples of monarchs, prelates,
presidents, military commanders and corporate chief executives,
who developed a more grandiose self when surrounded by a
coterie of sycophants supports this notion. Such leaders, who
become isolated, also become more grandiose and more out of
touch with what is practically useful. Further, because false mirror-
136 Chapter 11
ing raises false hopes, the grandiose self is susceptible to more

severe wounding and symptoms of fragmentation when trauma
inevitably occurs. Such trauma also increases the amplitude of the
oscillations between irrational overestimation and feelings of
inferiority when ambitions are thwarted. Such large oscillations are
manifestations of a person in a grandiose self-state.
A solution to the problem of a patient’s seeking flattery or
mirroring of wishes and fantasies during psychotherapy is to focus
on the patient’s real achievements, however small.
A c h i e v e m e n t Without Appropriate Effort
Grandiosity is also strengthened by the failure of the social system

to enforce laws and gain respect. It is, for example, a criminal’s
belief in his ability to beat the consequences of his behavior that
reinforces his sense of omnipotence. Of course, if such a person is
also admired and affirmed by a reference group for being able to
break laws with impunity, this kind of mirroring adds further
reinforcement to the grandiose self. Such a person was described
in The New York Times (March 22, 1989). Willie Bosket, a self-
proclaimed“monster,” had committed 2,000 crimes between the
ages of 9 and 15, including 25 stabbings. Silvia Honig, a social
worker who first met him at the age of 12, said that reformatories
let him conduct a reign of terror: attacking staff members with
clubs, smashing windows, stealing, sodomizing other inmates,
escaping in state vehicles.“After a while, he got the impression he
was omnipotent,” said Miss Honig, who became his closest friend.
Clearly, allowing persons to behave in whatever ways they like
without being answerable for their behavior reinforces their already
formed grandiose state of the self.
The military moves of the Nazis leading up to World War II also
exemplify the expansion of the grandiose self because of achieve-
ment through bluff. Encouraged by feeble Allied responses to his
earlier moves, Hitler, on Saturday, March 7, 1936, sent a few
thousand German troops to occupy the demilitarized zone of the
Rhineland, a move that broke agreements signed after World War
I. Two years later, emboldened by an Allied policy of appeasement,
Hitler ordered 100,000 German troops into Austria. The Sudeten
crisis followed, and a year later, encouraged by Chamberlain’s
Munich agreement, Hitler invaded Czechoslovakia. Then, encour-

aged by the lack of any significant Allied response to the Czech
takeover, Hitler made his next move, which was into Poland
(Manchester, 1988).
When clients encounter good news, congratulations on the good
fortune are appropriate. The grandiose ideas that sometimes
accompany such good fortune are not mirrored. The patient needs
calming, soothing responses for the overstimulation the good
fortune engenders.
Excessive Mirroring Even with

Appropriate Success
Even where mirroring reflects real achievements, a person’s self can

become overstimulated from an excessive state of grandiosity. Such
a person may have hungered for success for so long that when it
comes it is overwhelming despite selfobject mirroring. Dreams of
a hostile environment or a swarm of dangerous hornets (Kohut and
Wolf, 1978) can be signs of just such stimulation, which undermines
any possibility of the transformation of the grandiose self into
healthy ambition. When a child achieves without experiencing
mirroring, the experience of success in adult life may not leave a
residue of enjoyment. On the contrary, success to such a person is
as much a problem as a failure. Success means being flooded by
unrealistic archaic greatness fantasies which produce painful tension
and anxiety. Persons who are unduly shy after a very successful
accomplishment, may be defending against such retraumatization.
MIRRORING THE CONFORMING AND

CREATIVE STATES OF SELF
As indicated earlier, what is mirrored is as important as the

mirroring responsiveness of the therapist. Mirroring wishes and
fantasies can reinforce the grandiose state of the self rather than
transform it. To avoid such reinforcement, mirroring needs to target
the significant achievements of the patient. Such achievements,
however, will vary significantly, depending on whether they fulfill
138 Chapter 11
the expectations of others or whether they are spontaneous

creations.
What the therapist mirrors can determine whether a conforming
or creative state of the self is strengthened. One boy, for example,
was taken by his mother to swimming, skating tennis and piano
lessons each week. As small, significant progress was made in these
areas, she praised and affirmed him for the increased skill. When,
however, using pillows, cushions and blankets, he created his own
cubby house within the living room of his home and sought his
mother’s praise, it was not forthcoming. He was, in fact, rejected for
“making a mess.” Thus, what is mirrored by parents helps make and
shape who we are and how conforming or creative the self will
become.
The need for mirroring is only one way that a narcissistic
transference emerges during psychotherapy. We explore another, a
need to idealize the therapist, in the next chapter.
Readings for Chapter 12: Kohut, 1971, chapters 2 - 4; Tolpin, P.,

1983a.
12
Idealizing
Transference
F ors
or thousands of years, high-status religious leaders and counsel-
were idealized by persons seeking help. Freud recognized
the importance of idealization, maybe because he had sought a
relationship with a succession of idealized persons in the first part
of his own life (Gay, 1988). He also believed that much of the
temporary improvement in his early analytic cases had occurred
because they sought to please him as the idealized analyst. Balint
(1936) noted that the prospect of termination often triggered a
patient’s renewed yearning for the sustenance of an idealized
analyst.
Classical analysis, however, relegated the idealizing analytic
experience to the status of a pathological defense in need of
purging. Classical analysts see idealization not as a manifestation of
transference, but as a defense against libidinal drives. Their
technique is to interpret the defensive purpose of idealization to the
patient so that underlying primitive drives, especially aggression,
139
140 Chapter 12
emerge in the relationship. This is a move strongly advocated by the

neo-Kleinian Kernberg (1975).
In contrast, Kohut (1971) viewed idealization as a transference
not in the classical sense of a repetition with the therapist of key
experiences in the past, but as a narcissistic transference in which
the patient seeks to overcome arrested, unmet developmental
needs. Kohut seems to have been influenced in his view by Aichorn
(1951), his own analyst. Aichorn had facilitated the formation of
idealizing transferences in his adolescent patients through his
intuitive skills as a therapist and his charismatic personality (Kohut,
1971, pp. 161-164). This idealizing transference, one type of
narcissistic transference, has its own “line of development” from
archaic to mature forms. This chapter covers (a) definition, (b)
etiology, (c) signs, (d) countertransference, and (e) a clinical
illustration of an idealizing transference.
DEFINITION
Kohut (1971) viewed the idealizing transference as an attempt to

save “a part of the lost experience of global narcissistic perfection
by assigning it to an archaic, rudimentary (transitional) selfobject,
the idealized parental imago” (p. 37). Chessick (1985) sees the
idealized parent imago as a magical figure to be controlled and with
which to be fused. Wolf (1988) makes an idealizing transference the
“re-establishment of the need for an experience of merging with a
calm, strong, wise, and good selfobject” (p. 126). And Basch (1988a)
defines the idealizing transference as
one’s unrequited longing to be strengthened and protected when

necessary by an alliance with an admired, powerful figure . . . . It
is the need to be united with someone one looks up to, and who
can lend one the inspiration, the strength, and whatever else it
takes to maintain the stability of the self system when one is
endangered, frustrated, or in search of meaning [p. 141].
Kohut (1971) described Mr. A as an example of the idealizing

transference. Mr. A had a “tendency toward feeling vaguely de-
pressed, drained of energy, and lacking in zest (with an associated
Idealizing Transference 141
drop in his work capacity and creativity during periods w h e n this

m o o d had overtaken him)” (p. 57). His self-esteem was vulnerable,
as
manifested by his sensitivity to criticism, to lack of interest in him,

or to the absence of praise from the people whom he experi-
enced as his elders or superiors. Thus, although he was a man of
considerable intelligence who performed his tasks with skill and
creative ability, he was forever in search of guidance and approv-
al; from the head of the research laboratory where he was
employed, from a number of senior colleagues, and from the
fathers of the girls whom he dated. He was sensitively aware of
these men and of their opinion of him, attempted to get their
help and approbation, and tried to create situations in which he
would be supported by them. So long as he felt accepted and
counseled and guided by such men, so long as he felt they
approved of him, he experienced himself as whole, acceptable,
and capable; and under such circumstances he was indeed able
to do well in his work and to be creative and successful. At slight
signs of disapproval of him, however, or of lack of understanding
for him, or loss of interest in him, he would feel drained and
depressed, would tend to become first enraged and then cold,
haughty, and isolated, and his creativeness and work capacity
deteriorated [pp. 57-58].
In summing up this case Kohut said:
What he lacked, however, was the ability to feel more than a

fleeting sense of satisfaction when living up to his standards or
reaching his goals. He was able to obtain a sense of heightened
self-esteem only by attaching himself to strong, admired figures
whose acceptance he craved and by whom he needed to feel
supported [p. 62].
Etiology
Under optimal development the child idealizes the father (or

another person) and then, through a succession of minor disap-
pointments with him, experiences a slow diminution of the
142 Chapter 12
idealization. At the same time, there is internalization, that is,“ t h e

acquisition of permanent psychological structures which continue,
endopsychically, the functions which the idealized self-object had
previously fulfilled” (Kohut, 1971, p. 45).
Not all disappointment with an idealizing transference is
gradual. For example,“ t h e parents’ unempathic modesty . . . may
traumatically frustrate the child’s phase-appropriate need to glorify
him” (p. 43). Where the disappointment is traumatic, the idealized
parent imago is retained in its unaltered form, is not transformed
into a tension-regulating psychic structure, and remains an archaic,
transitional selfobject that is required for the maintenance of
narcissistic homeostasis. These people constantly seek an approving
relationship with someone they admire and look up to.
Even when some structuralization has taken place, it may be so
precariously established that a child’s disappointment with the
idealized selfobject may lead to a renewed insistence on, and search
for, an external object of perfection (Kohut, 1971, p. 44). An
idealized parent imago, not internalized gradually, is repressed as
an archaic structure. The patient, forever searching for an omnipo-
tently powerful person to merge with and from whose support and
approval the individual may gain magical strength and protection,
becomes unconsciously fixed on a yearning for an external
idealized selfobject (Chessick, 1985).
Transmuting internalization occurs only after sufficient idealizing
(mirroring, twinship, or all) experiences have taken place. It is a
consequence of the minor, nontraumatic failures in the response of
the idealized selfobjects that there is a gradual replacement of the
selfobjects and their functions by an expanded self and its functions.
While gross identification with selfobjects and their functions may
temporarily and transitionally occur, the ultimately wholesome
result, the autonomous self, is not a replica of the selfobject. The
analogy of the intake of foreign protein in order to build up one’s
own protein is very serviceable here—even as regards the detail of
the splitting up and arrangement of the material that was ingested
(Kohut and Wolf, 1978).
To Kohut, transmuting internalizations take place through
interpretations. These are not classical interpretations focused on
drives and their defenses, but interpretations focused on the
inevitable empathic failures of the therapist. Such interpretations are

most meaningful after the therapist has failed to understand the
patient and then linked these failures to a parent’s shortcomings by
not empathically comprehending the needs of the patient as a child.
No attempt is made to soothe or comfort the agitated and angry
patient for empathic failures; only an interpretation after the fact is
indicated (Goldberg, 1974).
Contrary to Balint’s (1968) experience of interpretations failing
to take effect with preoedipal patients, interpreting the therapist’s
empathic failure to a narcissistic patient can make for a noticeable
improvement. And such an interpretation does not wound, because
it is focused on the empathic lapse of the therapist and not on the
patient and thus avoids shaming the patient. Such an interpretation
also allows the patient to experience the therapist as being humane.
SIGNS
Silent Idealization
Silent idealization seems to be the most authentic idealizing

transference (Gedo, 1975, 1981). In contrast to the defensive
idealization, the silent idealizing transference repeats a more archaic
experience where the selfobject’s availability and perfection are
taken for granted; thus the idealizing transference tends to be silent.
Its focus will be on functional abilities of the idealized parental
imago rather than a specific person. If it becomes explicit, objecti-
fied, it is spoiled. Therefore, the silent idealization is not interpreted
to the patient. This uninterpreted silent idealization leads the patient
to experience increased energy and a sense of vitality in his day-to-
day life. This kind of idealization is frequently expressed in a
patient’s referring friends to the therapist.
Open Admiration of Therapist
The open admiration of a therapist’s character and values often

reflects a defensive idealization (Wolf, 1988). Such defensive
144 Chapter 12
idealizations usually involve a gross identification with a person

who is acknowledged as an independent source of initiative even if
the qualities attributed to him are illusory (Gedo, 1981).
The open admiration of the therapist may also be conceived as
an attempt to mirror the therapist, that is, a reverse selfobject
function (Lee, 1988), where the patient functions as a selfobject for
the therapist. Eventually this attempt by the patient to serve the
therapist needs to be interpreted, not just accepted as is the case
with a silent, true idealizing transference. Mirroring the therapist
may be one of the most mistaken misrepresentations of the
idealizing transference made by those who use the jargon of self
psychology without studying it or reading case material presented
from a self psychology point of view.
Resistance to Idealization
Resistance to idealization may be seen as a prolonged and bitter

depreciation of the analyst (Wolf, 1958). Overt hostility toward the
analyst can be regarded as a resistance against the establishment of
an idealizing transference (Tylim, 1978). Fear of the loss of ego
boundaries and a wish to merge can be sources of such resistance
(Chessick, 1985).
Once an idealizing transference has formed, swings from the
therapeutic activation of the idealizing transference to a transient
need for a mirroring transference as the patient feels more
grandiose are among the most common resistances in the analysis
of narcissistic personalities (Kohut, 1971). Other clinical signs of a
disturbance of the idealizing transference are cold, aloof, angry,
raging withdrawal, which also represents a swing to the grandiose
self, and feelings of fragmentation and hypochondria due to
separation and creation of eroticized replacements, especially
voyeurism (Chessick, 1985).
Defensive Idealization
Kohut’s thinking includes the idea of defensive idealization. He

believed that such defensive idealization is directed against oedipal
rivalries, and not aggressive drives. Thus, Kohut (1971, p. 75) spoke
about such idealization as buttressing secondarily repressions of,

reaction formation against, or denials of structurally deeper
underlying hostility. Where defensive idealizations occur, reactions
to disappointments in the selfobject are expressed through anger
and intensified longings for it. These defensive idealizations are best
not interpreted, yet are useful in alerting the therapist to explore
with the patient in what ways the patient is experiencing empathic
failure.
To illustrate: Miss S developed a defensive idealization to cope
with an older, competitive, and punitive sister. As a result of such
defensive idealization, Miss S felt inferior. These inferiority feelings
could be a sign of a defensive idealization reenacted in the
transference. A frequent comment by Miss S in the initial stages
treatment was, “I feel so stupid.” She also reported many situations
during the first 50 sessions that she said “proved how stupid she
was.” These expressions decreased dramatically after the therapist
gave careful attention to appropriate mirroring responses.
These defensive idealizations are best called “pseudoidealiza¬
tions” (Gedo, 1981) following Segal’s (1974) terminology. Pseudo-
idealizing transferences are reaction formations after the traumatic
destruction of childhood idealizations. Pseudoidealizations are often
only partially successful so that pseudoidealizations and disillusion-
ment are maintained at the same time through disavowal. Gedo
recommends interpreting such disavowal.
Where the predominant psychopathology involves arrested
developmental needs, interpretation of the transference idealization
as a defense will be largely incorrect. The patient’s expectable
reaction in such circumstances will still be primarily hostile; that is,
he will respond with appropriate outrage to the disappointment of
having been misunderstood. If the therapist wishes to disclaim
responsibility for such an iatrogenic impasse, he may be tempted to
compound his errors by further interpreting the patient’s anger as
confirmation of his hypothesis that the main issue is a defense
against aggressive drives.
Kohut’s ideas reflect a basic difference with Kernberg over
responding to rageful patients. Kohut (1975) stressed the rage¬
assuaging properties of correct empathy and insisted that Kernberg’s
neo-Kleinian focus on the primary envy-hostility complex was
146 Chapter 12
unempathic and provocative. Patients experience such interpreta-

tions as a repetition of the unempathic behavior of parents in early
childhood. They respond not only with hostility, but with renewed
disillusionment and its accompanying depressive affect.
Avoiding premature interpretation of the meaning of idealization
within the transference is tantamount to the indefinite acceptance
of the transference and its potential to enhance a patient’s adaptive
behavior (Goldberg, 1978). The establishment of a stable idealizing
transference often leads patients into unprecedented states of well-
being, contingent on the availability and continued “perfection” of
the analyst.
Those who would exploit an idealizing transference to promote
direct adaptive changes are in fact reverting to the psychotherapeu-
tic methods developed by Aichhorn (1951) for the management of
delinquent youths. To gain therapeutic leverage, Aichhorn advocated
the unimpeded unfolding of the transference with delinquents who
would otherwise fail to develop a meaningful contact with him.
Idealization and Line of Development
Idealization has its own separate line of development. Kohut (1971)

wrote of both the archaic and the comparatively mature stages of
development of the idealized parent imago (p. 74). Mr. A suffered
interference with the internalization process during the latent
period of development. He is an example of a more mature
idealizing transference at a relatively late stage of development.
Kohut cited hypomania as an example of an archaic idealizing
transference. Chessick (1985) notes that it is the failure of idealizing
the mother that leads to the more archaic type of transference that
seeks an ecstatic merger and mystical union with the godlike,
idealized parent.
COUNTERTRANSFERENCE
The idealizing transference can lead to the analyst’s resentment at

feeling belittled when a patient’s idealization begins to wane
(Kohut, 1971). This reaction occurs when the analyst looks upon
idealization as a realistic response to his actual qualities. A more

common countertransference problem in an idealizing transference
lies in the therapist’s being unable to tolerate the stimulated, covert
grandiosity.
In another form of countertransference, therapists show signs
of rejecting clients planning to terminate. This seems to be some
kind of reenactment of a mother’s attack on a child when the child
tries to idealize the father (Gedo, 1975). Such mothers often
succeed in making the child feel guilty for wanting to individuate.
This attack reflects the parent’s overuse of the child as a selfobject;
that is, it is a traumatic reverse selfobject experience (Lee, 1988).
Encouraging idealization is a form of countertransference that
reflects the therapist’s need, not the client’s. Kohut advocated
neither encouraging idealization nor preventing it by automatically
interpreting its emergence as a resistance (Gedo, 1975).
Shame also can be a source of countertransference. Kohut and
Wolf (1978) use the example of a little boy eager to idealize his
father. The boy wants his father to tell him about his life, the battles
he engaged in and won, but instead of joyfully acting in accordance
with his son’s need, the father is embarrassed by the request.
Yet another form of countertransference to the idealizing
transference is an embarrassed, defensive response by the therapist
in which he denies the patient’s idealization, jokes about it, or tries
vigorously to interpret it away. This countertransference generally
produces a retreat by the patient into the grandiose self (Chessick,
1985).
There is also a countertransference fear that an idealizing
transference will foster and reinforce an addictionlike need for it.
However, the very core of Kohut’s (1971) technical recommendation
is the inevitable, spontaneous, recurrent disruption—through
empathic failures—of the narcissistic equilibrium achieved in these
transferences. Such empathic failures enable reconstructions of the
traumatic effects of childhood disillusionments with idealized
parental objects. By means of such genetic interpretations, the
patient may understand and master his need for continuing
idealization of omnipotent others. The indefinite acceptance of the
patient’s idealizations is therefore the exact antithesis of Kohut’s
technical recommendations.
148 Chapter 12
CLINICAL ILLUSTRATION
Tolpin (1983a) presents the case of Mrs. A, a divorced woman in

her early 40s who was in analysis for four years. “While the most
prominent transference that emerged in the analysis was an
idealizing father transference, elements of other selfobject transfer-
ences were also apparent” (p. 461). Mrs. A had been in treatment
with three psychotherapists for approximately a year each before
they terminated, one with the therapist’s death, the others when
they moved away.
The patient was the second of two children born to a successful
middle-aged businessman. Her older brother, haughty and depreci-
ating of her, was never close to her. Lacking a strong need to
nurture, her mother gave over major care of her children to Miss
D, a governess. Mrs. A experienced the wonderful Miss D as being
devoted to and belonging to her. Miss D was
a lively person who, as Mrs. A recalled, bathed her, dressed her,

took her for walks, looked after her while she played with other
children in the park, and took her to her church where Mrs. A
was fascinated by chants and exotic rituals. Miss D told her
stories, read to her and helped her with difficult words in books.
Mrs. A loved her deeply. Then one day without warning, Miss D
was gone [p. 463].
Mrs. A’s loss of Miss D was a traumatic experience. Miss D, who

had gone to her native country for a year, returned to visit Mrs. A’s
household and brought a gift of a beautiful dress, but Mrs. A would
not put it on. What’s more, she treated Miss D as if she were a total
stranger. After Miss D made a few more visits, the family lost contact
with her. Many nursemaids came and went, but none won Mrs. A’s
affections.
When she was nine, a second major traumatic event occurred
when her father died of a heart attack in the street. Mrs. A had
experienced her father as a somewhat distant, remote, and mysteri-
ous figure who lived in a world apart, a world of business and
travel and absences from the home. Yet she was attached to him in
an awed kind of way. She recalled two pleasurable experiences with
her father. One occurred when the two of them were to go into the
house but did so secretly by ducking down beneath the kitchen
window so that no one in the house would see them returning. The
second occasion was when she went with her father to visit old
cronies, who made a great fuss over her. They said she was
beautiful and intelligent and were delighted with how sweet she
was.
Mrs. A’s response to the loss of her father also suggests the
extent of her trauma. After it,
she was frequently truant from school. She would leave the house
in the morning as if on her way to her classes but instead would
get on a bus, ride from one end of the line to the other, transfer
from one bus to the other, and at last after several hours return
home. Then she would go to her room and read. She felt like a
zombie. Sometimes she would begin to cry—on the bus, or
walking on the street. Once she was so self-absorbed that she
walked into a lamp post and bloodied her face [p. 464].
In her beginning year of high school Mrs. A developed a

reverence for a male science teacher who gave her a ride home in
his car on a cold, rainy day after she had locked herself out of her
locker. She took his class in science the next year; and although she
had never been interested in the hard sciences, she found herself
fascinated with the material and earned an A in the course. Once
she finished the course she utterly lost interest in the subject and
in him.
In her early 20s Mrs. A married a former neighborhood boy she
had known since grammar school. He was sincere and stable but
did not have the “magic” of her father and later, of her charismatic
lover. After her two children were born, Mrs. A found herself
needing her husband merely to be available, to be around, to be
present. During this period, there were episodes of kleptomania
and depression. Then she fell madly in love with an older man at
her place of work, who soon reciprocated her feelings. She was
enthralled by his intelligence and wisdom. She loved him to read
aloud the newspaper accounts of current political events on which
he commented wisely and to which she listened with rapt attention.
150 Chapter 12
Despite their plans to marry, years of high hopes and repeated

promises extinguished the fires of her passion for him.
As idealization faded, it was replaced by an archaic need to be
physically close.
Several years into their relationship, when for a variety of reasons

they could not spend the night together, Mrs. A sometimes could
not fall asleep. In an effort to induce sleepiness she would read
late into the night until she was exhausted. Sometimes she
resorted to sedatives, which often did not work, and at times, in
desperation, she would rush to her lover’s apartment, climb into
bed with him, and lying close to his body, immediately fall asleep
[p. 466].
Mrs A sought treatment for recurrent depressive states, insom-

nia, overuse of sleeping medication, and occasional kleptomania.
Her most painful problem was the love affair with this older man
who would not marry her. The analyst perceived these symptoms
as reflecting a basic need to reexperience an idealized transference.
On the basis of Mrs. A’s idealizing relationships with her
governess, father, lover, and former therapists, especially the second
one, it is relatively easy to anticipate the eventual unfolding of an
idealizing transference. For her, idealizing was not an unknown
experience. Rather, her pattern was to form an idealizing bond, but,
once it formed, to lose it.
After the analysis commenced at four times a week, Mrs. A
almost immediately demonstrated an intense bond with the analyst.
Her dreams reflected a sexualization of the transference, and she
became supersensitive to the analyst’s being away on vacation or
even for short absences. She became extremely anxious lest she be
retraumatized by losing the analyst for any reason. Even weekends
were difficult to tolerate without seeing her analyst.
For a long time this idealizing transference was of the silent
kind, always in the background. There were no overt expressions
of admiration of the analyst. Such overt idealizing points to a
reverse selfobject experience (Lee, 1988) in which the patient
mirrors the therapist as a means of retaining the bond. After two
years, Mrs. A was able to say, “In some way I have the feeling
—you’re perfect. Oh, I don’t mean perfect, but I mean perfect for
me here. Nothing was like this before” (p. 477). Early in the
treatment, however, the idealizing transference was revealed by an
increased sense of vitality, which was turned off during vacations
and short breaks in treatment.
There is evidence also of both a twinship and a mirror transfer-
ence, but these are more fleeting than the more “dominant”
idealizing one. In an example of a twinship transference, Mrs. A
said, “If I were not to leave at the end of the hour, I’d not be lying
here, but I’d sit and read and you’d read and we’d be in the same
room. That was the only thing I did with father—except for taking
walks with him. He’d read and I’d read and there’d be no talking
but I knew he was there” (p. 471). In an example of a mirror
transference, she related how she watched a farmer’s son jump from
box to box and look to see if she was watching. Then she said, “I
need to be looked at, I want to be watched the way he wants to be
watched” (p. 471).
While Tolpin’s case does not cover the working through and
termination phases of treatment, its excellent material reflects the
intense process through which patients often pass in overcoming
the shame of wanting an idealized bond to the therapist.
In summary, the ubiquitous idealizing transference is one way
a self with insufficient narcissistic capacities can feel cohered and
energized and can seek to repair the “basic fault.” Other ways are
to form mirror, twinship, or merger transferences or some variation
of all four. Kohut left relatively undeveloped the constructs of the
twinship and merger transferences. These are explored in the next
chapter.
Readings for Chapter 13: Kohut, 1979; Detrick, 1985,1986.
13
Twinship and Merger
Transferences
T he twinship and merger transferences represent unfinished

business in Kohut’s attempt to conceptualize the narcissistic
transferences. They were both originally seen as special forms of the
mirror transference, but as Kohut’s thinking evolved, he saw the
need to give the twinship transference separate and equal status
with the idealizing and mirror transferences. What follows (a)
describes the twinship transference, (b) explores the merger
transference, and (c) examines Kohut’s case of Mr. Z as an example
of the merger transference.
TWINSHIP TRANSFERENCE
Kohut (1984) described how he discovered the twinship transfer-

ence. One of his patients had a fantasy of a genie in a bottle. This
genie was experienced as a twin, an essential likeness of the patient
152
Twinship and Merger Transferences 153
to whom she could relate whenever she felt unsupported and alone.
This patient also remembered a time when as a little girl, perhaps
four years old, she had stood in the kitchen alongside her grandma,
kneading dough (p. 196).
She remembered that at age six her cold and unresponsive
parents had moved away from the grandparent, and, as a conse-
quence, she had experienced terrible feelings of loneliness. She had
replaced the self-validating experiences of the grandmother with a
genie in a bottle to whom she talked. She did not accept Kohut’s
conclusion that he was the genie in the bottle in view of his just-
announced long vacation plans. She claimed that the captive in the
bottle was a twin, just like herself, and understood by her. The
patient’s need was for a silent presence; she would talk to the twin,
but the twin did not have to respond to her. “Just being together
with the twin in silent communion was often the most satisfactory
state” (p. 196). Kohut then saw the significance of so many of the
long silences that had occurred in the treatment: they were not
resistances but a beneficial twinship experience the patient was
ashamed of needing.
To Kohut, the twinship transference is the “third chance” for a
cohesive nuclear self, because in it the experience of sameness or
likeness serves the function of acquiring skills and “tools.”
Within the context of the transference, an outline will gradually

come to light of a person for whom the patient’s early existence
and actions were a source of genuine joy; the significance of this
person as a silent presence, as an alter ego or twin next to whom
the child felt alive (the little girl doing chores in the kitchen next
to her mother or grandmother; the little boy working in the
basement next to his father or grandfather) will gradually become
clear [p. 204].
White and Weiner (1986), extending the idea of twinship

transference to twinship relationships (outside therapy), write: “The
essence of the twinship selfobject relationship is similarity in
interests and talents, along with the sense of being understood by
someone like oneself (p. 103). They cite the example of John, who
had a twinship relationship with his writer grandfather. He felt
154 Chapter 13
accepted and sustained by his grandfather’s warm response to his

budding literary interests. John eventually became a successful
editor. Culturally, twinship is referred to as a mentor or apprentice
relationship. It carries with it the experience of doing something
with another who is seen as basically the same as oneself.
While Kohut’s experience of a twinship transference has been
clinically validated by other therapists, twinship transference
seldom, if ever, occurs unless accompanied by the other narcissistic
transferences. Although Kohut raised it to the state of a separate
transference in association with developing a tripartite concept of
the self focused on ideals, ambitions and skills, the twinship
transference has had a peripheral role in self psychology theory.
Yet, by adding the twinship transference to the idealizing and
mirror transferences, Kohut was, in effect, expanding his theory of
motivation. No longer driven by Freud’s biologically based Trieb,
Kohut’s self is motivated to act because of ideals, ambitions, and the
need to develop competency in skills and talents.
As conceived by Kohut, the twinship transference represented
a major piece of underdeveloped theory in self psychology. Yet the
self psychology literature of the 80s reveals surprisingly little
research or writing on the subject, except for two articles by Detrick
(1985; 1986). The direction of self psychology during the 80s has
been, unwittingly perhaps, toward an exploration of the archaic
dimensions of the twinship transference. For example, investigations
into the attunement involved in an early mother-infant bond lead
to the idea of a mutual influence theory (see chapter 23, this
volume). Without the “dance” that takes place between mother and
child, growth and development are constricted. Such a mutual-
influence experience, especially involving synchronicity, suggests
that some form of primitive twinship is necessary from day one of
an infant’s life.
Brandchaft’s (1988) psychotherapy with a case of intractable
depression demonstrates that some difficult character disorder
patients are able to change only after they have experienced the
therapist as sharing their feelings in an archaic form of twinship. On
the other hand, where psychotherapy has been based on hierarchi-
cal views of reality (Schwaber, 1983a), it has been cluttered with the
wreckage of many failures.
Seen in the light of the post-Kohutian exploration of archaic

twinship transferences, Ferenczi’s work in the 1920s takes on new
meaning. In his attempt at collaborative analysis (see chapter 6, this
volume), Ferenczi can be viewed as offering some kind of twinship
experience. Moreover, Winnicott’s flexible, nonauthoritarian
approach, and his willingness to enter into a twinship experience
with his patients, made him both successful clinically and popular
with his students.
Once the importance of a primitive twinship experience is
accepted, the animal behavior that Lorenz (1966) observed can be
reinterpreted as a form of twinship. By connecting the dance of the
Greylag goose to drive theory, namely aggression, Lorenz interpret-
ed the female’s joining of her mate’s dance of triumph as ritualized
behavior to curb the male goose’s aggression toward her. Once
drive theory is rejected, the dance can be seen as an expression of
a twinship bond in which the female goose imitates the male
goose’s behavior in a process similar to the infant’s “reading” the
mother’s feelings from her facial muscles (see chapter 21, this
volume). That is, when the infant imitates the mother’s facial
expression, his own facial muscles stimulate his autonomic nervous
system and he thus feels what she is feeling. Clinical experience and
the imprinting studies of Lorenz point to the conclusion that
whatever the shape of self psychology in the future, it needs a
greater understanding of the function of archaic twinship experienc-
es.
Further, in view of the increasing realization of the pervasive-
ness of the archaic twinship experience, the issue of shared values
and beliefs, (raised originally in chapter 2, this volume) can be
understood in a new way. As Torrey (1972) notes, much of the
efficacy of religious healing and the magical covenant rests on the
powerful bond that comes from participating in a community of
shared values. With the breakdown of such totemic systems (Lee,
1979) in an urban/industrial society, the ability to form transactional
and personal relationships with those who do not share the same
basic beliefs has become an adaptive necessity. The price paid for
such an adaptation is the loss of common values as a major source
of narcissistic cohesiveness.
Freud’s free association, as a method to explore across the
boundaries of values, solved one problem of the breakdown of
156 Chapter 13
shared values, but left unresolved the need for twinship affirmation
that had formerly been taken care of through sibling relationships
and membership in an extended family or tribal structure. The basic
human need for twinship, that is, the experience of sameness,
becomes exacerbated in a society that stresses autonomy and
individualism. Self psychology’s increasing emphasis on the twinship
selfobject function arises from treating patients with neglected
childhood needs that manifest themselves in the transference
because of arrested development.
The more archaic the twinship transference, the more it
approaches a merger transference (Kohut, 1984). In clinical practice,
however, it is useful, even if somewhat artificial, to distinguish
between the two. There is in the twinship experience a great deal
of perceived concordance between the thoughts feelings and
behaviors of the two partners, but there is not a complete, overlap-
ping correspondence. In the merger transference, the one needing
the merger experience expects a total and complete concordance,
and any kind of difference or individuation not only is intolerable
to the patient, but is experienced as wounding. Such merger
transferences are much more archaic and difficult for the therapist
to manage than is the twinship transference.
THE MERGER TRANSFERENCE
In 1971 Kohut conceived of both the twinship transference and the

merger transference as subentities of the mirror transference. They
were potential candidates for eventually being considered separate
narcissistic transferences. By 1984, the twinship transference joined
the idealizing and mirror transferences as a full narcissistic
transference, but the merger transference did not. The idea of
merger was broadened to a process that takes place in each of the
three narcissistic transferences. Kohut (1984) then posited the self’s
shift from relying on archaic modes of nutrient to being sustained
by empathic resonances from the selfobjects of adult life. This shift
involves transformation of the mergers of the archaic dimension of
all three narcissistic transferences, that is, “mergers with the
mirroring selfobject, mergers with the idealized selfobject, and
twinship mergers” (p. 70).
Twinshipand Merger Transferences 157
A merger experience, then, was at the beginning of a line of

development for each of the narcissistic transferences, rather than
at the starting point of a general narcissistic line of development
through mirroring to idealizing and then to twinship. This means
that a merger regression can occur any time a therapist loses
empathic resonance during a narcissistic transference (idealizing,
mirror, twinship). For example, if there is an empathic failure, it is
not necessary for a regression to occur from an idealizing transfer-
ence to a mirror transference and then, if empathic failure persists,
to a merger transference. There is no longer the concept of a
narcissistic line of regression with twinship at the mature end,
idealizing and mirror in the middle, and merger at the archaic end.
They are not conceived of as being on a continuum. The twinship,
idealizing, and mirror transferences become different routes
through which archaic selfobject merger experiences are trans-
formed into mature selfobject needs.
Kohut’s (1971) clearest definition of a merger transference is as
the extension of the patient’s grandiose self to include the therapist:
In metapsychological terms, the relationship to the analyst is one

of (primary) identity. From the sociological (or sociobiological)
point of view we may call it a merger (or a symbiosis) if we keep
in mind that it is not the merger with an idealized object (as
striven for and temporarily established in the idealizing transfer-
ence) but an experience of the grandiose self which first regres-
sively diffuses its borders to include the analyst and then, after
this expansion of its limits has been established, uses the security
of this new comprehensive structure for the performance of
certain therapeutic tasks [p. 114].
An example of the merger transference in literature comes from

Eugene O’Neill’s play The Great God Brown, “which portrays a
lifelong struggle of a protagonist against fragmentation of the self.
The cold unrelatedness of the father and the joyless pathological
merger with the mother lead to a never-ending search for ‘glue’ to
hold the self together” (Chessick, 1985, p. 135). Kohut (1977)
remarked of this play, “nowhere in art have I encountered a more
accurately pointed description of man’s yearning to achieve the
restoration of his self than that contained in three terse sentences
158 Chapter 13
. . . ‘Man is born broken. He lives by mending. The grace of God is

glue’” (p. 287).
This idea of a merger transference as an extension of the
grandiose self is useful in understanding what happens when a
patient experiences a breakdown of the illusion of control over the
therapist. Merger-hungry personalities need to control their
therapists in an enactment of their need for structure. “Because they
experience the other as their own self, they feel intolerant of his
independence: they are very sensitive to separations from him and
they demand—indeed they expect without question—the selfobject’s
continuous presence” (Kohut and Wolf, 1978, p. 422). Those with a
merger transference are often very upset when a therapist is away
on a vacation or has to cancel a session for some legitimate reason.
Another way to recognize a merger transference is by the sleepi-
ness or boredom of the therapist. For example, one of the authors
diagnosed a merger transference when he could hardly keep
himself awake during the sixth session with a new patient. After a
good night’s sleep, he had no problem keeping alert in sessions
with patients who preceded or followed that patient. That a merger
transference existed was substantiated by the main topic of the
session, which was that the patient’s mother still clung pathological-
ly to her, an only child in her mid 30s. The mother phoned every
day, sometimes two or three times, and would be most upset if she
could not talk with the patient. As Wolf (1983b) explains, feelings of
boredom and a sleepy response may be “the consequences of a
defensive withdrawal of the analyst’s self from the engulfing
propensities of the analysand’s merger transference” (p. 322).
As noted, the key to understanding both the mirror transference
and the merger transference is the grandiose state of the self. One
difference between them is that in the merger transference the
grandiose state of the self is more archaic, more engulfing, and
more controlling of the therapist than in the mirror transference.
Another is that the mirror and merger transferences represent two
different ways of nourishing the self and keeping it cohered. In the
mirror transference, a person uses the therapist’s mirroring
responses to experience an alive sense of self. In the merger
transference, the person has abandoned hope of being mirrored
and so uses a sense of being in control to achieve the same end.
Both transferences involve a risk of being wounded, but the

mirror transference seems more dangerous to the patient because
it depends on more overt cooperation and responsiveness from the
therapist. “Objectively” the merger transference also needs the
cooperation of the therapist, yet subjectively it is not experienced
this way. Under the condition of an archaic grandiose state of the
self, the person in a merger transference has the illusion of more
control and less danger of being wounded than is actually so.
The issues previously conceived of as sadism and masochism
are covered, partially at least, by Kohut’s concept of the merger
transference. In 1971, when Kohut was trying to conceptualize his
new insights into narcissism within drive theory metapsychology, he
referred to the “heightening of oral-sadistic and anal-sadistic drive
elements” under the tyranny and possessiveness of the merger
transference (p. 124). Sadism here means taking pleasure in
inflicting pain or humiliation, whereas masochism takes pleasure
from receiving pain or being humiliated.
By 1984, drive theory had been discarded, but not the merger
transference. Also dropped from the lexicon of self psychology were
the terms sadism and masochism. Such persons are now understood
self-psychologicallyas merger-prone personalities. They maintain an
important sense of self-coherence through a merger in which they
subjectively experience control. In self psychology theory, the
feeling of being in control replaces drive theory’s feelings of
pleasure in inflicting or receiving pain in a sadomasochistic dyad.
The “sadist” and the “masochist” experience control in different
ways. The sadist seems to be the dominant person in any “sadomas-
ochistic” merger relationship. As understood by self psychology, a
narcissistic transference cannot be imposed; it is the subjective
experience of the patient. Thus, when Kohut’s notion of merger as
the extension of the grandiose state of the self is applied, the issue
of who is dominant or subservient, who is active or passive,
becomes irrelevant. Such constructs, which come from social and
interpersonal psychology, do not reflect underlying selfobject needs
or experiences of the merger-prone person. The “sadomasochistic”
relationship is seen in self psychology as a mutual merger relation-
ship in which both persons extend their grandiose state to include
160 Chapter 13
the other, and both perceive themselves in control of the other, for
different reasons.
The mutual merging explains the sticky enmeshment generally
encountered in such a relationship. The “sadist’s” experience of
being in control is obvious. The “masochist’s” more covert,
subjective sense of control can be seen in an ability to get the
“sadist” enraged any time it is necessary for the masochist to affirm
the sense of being in control and hence feel cohesive. Kohut’s
theory also satisfactorily explains why both the “sadist” and
“masochist” stay locked in such a mutual control arrangement; a
subjective sense of control is necessary for maintaining a sense of
self-cohesion in each of the participants in mutual merging.
The clinical observation of the frequent presence of pain in
merger-prone persons is an accurate one. Further, it is easy to
understand why the prevailing pre-Kohutian interpretation was that
the sadist enjoyed inflicting pain and humiliation and that the
masochist took pleasure from such pain and humiliation, since both
persons so actively contribute to the pattern. While there seems to
be a“payoff”for the pain and humiliation of a masochistic recipient,
it is not in a pleasure but as a defense against fragmentation.
Physical pain may be provoked when the fantasy of control is lost
and fragmentation feared and when masochistically sought pain is
needed to overcome the feelings of inner deadness. Pain under
these circumstances is an example of the process of concretization.
It is a concrete, external response to an inner experience of
fragmentation.
Many patients develop an archaic merger transference in
psychotherapy. The prime requirement of such a transference is that
the therapist accept this merger and all the behaviors that accompa-
ny it that test out the patient’s experience of being in control. As
Chessick (1985) says,
patients want us to respond as if we belong one hundred percent

to them; a benign view of this desire, rather than an angry retort
or harsh criticism, detoxifies patient’s attitudes towards themselves
and prevents withdrawal into arrogant grandiosity [p. 160].
For merger-prone persons enactments may serve a special

function. When such patients act dramatically, they are usually
asserting some form of control, even temporarily. Generally, such

enactments are a response to the therapist, who in some way has
made the patient feel helpless. Enactments, particularly dangerous
acting out, such as persistently driving a car while blind drunk, may
be to reinforce a conviction of omnipotence and grandiosity.
During a merger transference, a gross identification with the
therapist may take place in which the patient tries to be an absolute
replica of the therapist. Such a gross identification is a quick way to
gain a sense of control by magically and instantly gaining the power
and skill of the therapist. The difficulty of such a solution is that this
form of identification is not internalized and hence does not last. It
is a good sign, however, when a patient shows interest in under-
standing what is happening. The quest for such understanding and
the demand for explanation is the search for the type of control that
promotes growth and not regression.
Most persons who seek psychotherapy while needing a merger
transference do so because they have recently been traumatized by
the loss of control of some important relationship. One male
patient, an executive who managed many employees, presented for
treatment full of rage. His wife of 18 years had asked him for a
divorce and demanded that he leave the house immediately. Initially
he sought the therapist’s help to regain control of his wife. When
the therapist indicated that this was beyond his power, the patient
developed an intense merger transference that enabled him to
tolerate the divorce proceedings.
Another patient sought psychotherapy when she determined to
break off an enmeshed, 12-year courtship that “was going nowhere
and would never develop further.” The merger transference enabled
her to terminate with the boyfriend without experiencing symptoms
of fragmentation. She was then able to develop a new courting
relationship that eventually resulted in a happy marriage.
At a minimum, merger cases such as these involve a transitional
merger transference with the therapist, which allows time for a new
merger experience to develop socially after an old, crucial, self-
cohering merger experience has been lost or is about to be lost.
Merger transference cases can achieve more than this.
Once a merger transference develops, although the initial intent
of the patient was to use the therapist as a transitional source of
glue, the transference may grow beyond the need for merger. A
162 Chapter 13
major reason persons become locked into a permanent mer¬

ger/enmeshment is that their need for control is not accepted by a
significant selfobject. Under conditions of nonacceptance, even
though they may experience being in control, merger-prone
persons’ sense of control is precarious. They can never relax their
vigilance to celebrate the power they have achieved. On the other
hand, once secure in their sense of control, merger-prone people
naturally seek recognition and celebration, that is, mirroring, for the
significant achievement they experience gaining control to be. It is
the therapist’s calm, consistent acceptance of the patient’s experi-
ence of control, over a significant period of time, that leads to the
emergence of a mirror transference or one of the other narcissistic
transferences and the potential to transform the grandiose state of
the self.
Kohut’s (1979) case of Mr. Z is reported in the literature as a
case of a mirror transference. However, it more accurately illustrates
the treatment of the merger transference.
T h e Case o f Mr. Z
Mr. Z’s analysis took place in two installments, each conducted five
times a week and lasting about four years and separated by an
interval of five and one half years. During the first installment,
Kohut interpreted the material from a classical analytic position.
During the second installment, which began while he was writing
his “Forms and Transformations of Narcissism” (1966) and ended
while he was immersed in writing The Analysis of Self (1971), he
viewed the patient’s material differently, from a self psychology
perspective.
When Mr. Z began treatment, he was a graduate student in his
mid-20s. His father had died four years before, and he lived with his
widowed mother. A few months before Mr. Z consulted with Kohut,
an unmarried friend with whom he had been close since high
school formed a relationship with an older woman. This friend not
only excluded the patient from the relationship with this woman, he
also became less interested in seeing Mr. Z.
Mr. Z’s masturbation fantasies were masochistic. In these he
performed menial tasks submissively for a domineering woman. He
always reached sexual climax after imagining being forced into the
sexual act by a woman who was strong, demanding, and insatiable.

At the moment of ejaculation he typically experienced a feeling of
desperately straining to perform in accordance with the woman’s
commands, similar, as he explained, to a horse that is made to pull
a load that is too heavy for its powers and that is driven on by the
coachman’s whip to give its last ounce of strength, or similar to
galley slaves whipped on by their overseer during a sea battle.
The theme most conspicuous during the first year of analysis
was a regressive mother transference. Kohut saw this transference
as unrealistic, deluded by grandiosity, and full of demands that the
psychoanalytic situation should reinstate the position of exclusive
control where Mr. Z was admired and catered to by a doting
mother. When Kohut interpreted the absence of sibling and oedipal
rivalries, these evoked intense rage in the patient. The rages became
worse when Kohut interpreted Mr. Z’s narcissistic demands and his
arrogant feelings of entitlement. They also increased with weekend
interruptions, occasional irregularities in the schedule, and especial-
ly during the therapist’s vacations.
In the childhood fantasies that Mr. Z reported, he imagined
himself a slave, being bought and sold, like cattle, by women for the
use of women. He was an object that had no initiative, no will of its
own. He was ordered about, treated with great strictness, had to
clean up his mistress’ excrement and urine. In one often repeated
fantasy, a woman urinated into his mouth, forcing him to serve her
as an inanimate vessel, as a toilet bowl.
As a result of the first installment of analysis, Mr. Z’s masochistic
preoccupations disappeared gradually until they were almost
nonexistent at the end. He moved out of his mother’s house to an
apartment on his own, and he began to date and become sexually
active with several girlfriends. During the second analysis, Kohut
saw these behavioral changes of the first analysis as evidence of a
transference cure in which Mr. Z conformed to what he thought
would please Kohut, and hence, this first analysis had been a
reinforcement of a false self.
The second installment began with an idealizing transference,
manifested in a dream in which a male figure is portrayed as having
an impressive appearance and a proud bearing. The patient was
proud of Kohut. This initial phase of idealization was of a short
duration, however. It was replaced by a merger transference in
164 Chapter 13
which the patient became self-centered and demanding, insisted on

perfect empathy, and was inclined to react with rage at the slightest
lack of attunement with his psychological states or at the slightest
misunderstanding of his communications. During this second
analysis, Kohut no longer saw Mr. Z as resisting change or opposing
maturation because he did not want to relinquish childhood
gratifications. Instead, he saw Mr. Z as desperately struggling to
disentangle himself from the noxious selfobject relationship with his
mother.
The description of Mr. Z’s relationship to his mother filled many
hours of the second installment of his analysis. In the first install-
ment, Mr. Z had presented a defensively idealized version of his
mother. This time, she was depicted as a person with intense,
unshakable convictions that translated into attitudes and actions that
emotionally enslaved those around her and stifled their indepen-
dent existence. She had enjoyed Mr. Z and mirrored him, but only
if he submitted to total domination by her and did not have
significant relationships with others. Mr. Z’s mother was pathologi-
cally jealous; father, son, servants were all strictly dominated by her.
The second installment of Mr. Z’s analysis saw a gradual recogni-
tion of just how pathological a relationship his mother had had with
him during childhood. This awakening seems to have been spurred
on by his mother’s psychosis a few months prior to his seeking the
second treatment. He feared that it was his leaving home that had
disrupted his mother’s merger with him and had, therefore,
precipitated the psychotic breakdown. He also felt a threat of self-
fragmentation because his mother’s illness had brought about a loss
not only of her archaic merger with him, but of his merger with
her.
The mother’s pathology showed up in three areas; her interest
in his feces, her involvement with his possessions, and her preoccu-
pation with small blemishes in his skin. These behaviors reflected
an ineradicable and unmodifiable need to retain her son as a
permanent selfobject. For example, she had insisted on inspecting
each of Mr. Z’s bowel movements until he was six. When she
abruptly ceased these inspections, she simultaneously became
preoccupied with his skin, particularly the skin on his face. Mr. Z
experienced his mother as not being interested in him personally.
She approached her inspections of him with a self-righteous
certainty that allowed no protest and created almost total submis-

sion. She also was passionately involved with collecting furniture,
art objects, and bric-a-brac. This obsessional behavior covered over
a feeling of internal emptiness and the tight control of a merger
transference, which she needed to shore up her fragmentation-
prone self.
The second treatment consisted of diminishing the merger-
enmeshment relationship of Mr. Z with his mother. During this
period, he discovered that to be separate from his mother was
neither evil nor dangerous but the appropriate assertion of health.
He also became aware of long-disavowed yearnings for a relation-
ship with an idealized father. As he became aware of this need, he
also discovered a pride in his father and a source of masculine
strength. Without any merger propensity, he could acknowledge that
despite his mother’s obvious pathology, she had given him a great
deal. His masochistic compliance was replaced by the joyful
activities of an independent self.
The case of Mr. Z not only exemplifies a merger transference,
it also raises the issue of defensive idealization. Mr. Z’s idealization
of his noxious, merger-prone mother was clearly defensive. This
defensiveness, however, was not a reaction-formed aggressive drive.
It functioned to protect the cohesive function the mother-merger
provided to the self. Any attack by the therapist on the idealization
of the mother in the name of individuation is a therapeutic blunder,
which only provokes the patient to defend the idealized person as
a way of preserving the merger function that is vital to self-
cohesion. Further, the strength of the defensive idealization
measures the archaic quality of the merger. Hence, a clue to Mr. Z’s
growth out of the merger with his mother was a decline in the
idealization of her.
Persons who present with merger transference needs are not
always casualties from a broken mutual-merger relationship.
Sometimes they seek help because of a regression after a severe
wound to the grandiose state of the self. Such wounding occurs
with an unexpected blocking of grandiose aspirations. Not only does
this blocking produce narcissistic rage, it also creates a yearning for
merger. When these efforts to merge are frustrated by a person’s
friends, resulting fragmentation symptoms encourage the seeking of
professional therapeutic help.
166 Chapter 13
The merger transference may be a more important clinical

experience to understand than are the other narcissistic transfer-
ences (idealizing, mirror, twinship); Kohut, in fact, made the merger
transference the archaic beginning of all the narcissistic transfer-
ences. Moreover, the merger transference takes us beyond narcis-
sism, as defined by Kohut, into the borderline and severe personali-
ty disorders and into psychosis itself. The archaic merger transfer-
ence emerges, then, as a transitional experience and as a potential
gateway through which more disturbed patients can grow into more
functional narcissistic disorders and eventually even into mature
adaptive functioning.
The four transferences explored in this and the two preceding
chapters are conceived of as functions that maintain, restore, or
transform the self. Generalized, these narcissistic functions are
called selfobject experiences. In the next chapter we shall explore
the concept of a selfobject experience, one of Kohut’s major
contributions to self psychology.
Readings for Chapter 16: Kohut 1971 chapter 4; Grotstein, 1983;

Atwood and Stolorow, 1984, chapters 2 and 3.
14
Selfobject Experiences
K ohut (Kohut and Wolf, 1978) defined selfobjects as follows:

Selfobjectsareobjects which we experience as part of our self; the
expected control over them is, therefore, closer to the concept of
the control which a grownup expects to have over his own body
and mind than to the concept of the control which he expects to
have over others [p. 414].
With this definition, Kohut appears to build on the idea of object

hunger first expressed by Fairbairn (1944) and elaborated by
Guntrip (1969).
Fairbairn said that the ego needed object relationships. He saw
“multiple egos (by which he meant selves) in intimate union with
repressed objects” (cited in Grotstein, 1983, p. 186). Kohut, moving
beyond the language of structural theory, saw the self as needing
not just objects, but selfobjects. These selfobjects are seen as less
differentiated than objects and more essential for the functioning of
167
168 Chapter 14
the self. Kohut realized that the self, to remain adaptive and
cohesive, always needed selfobjects.
Grotstein’s claim (1983) that “the subject of selfobjects has a
long history” (p. 186) alerts us to the fact that Kohut’s idea was not
entirely original. Not only did Klein and Fairbairn have a similar
idea, but Freud’s concept of secondary identification was close to it.
Terman (1980) also points out that “there is a great similarity
between the experience which they [Balints] describe as primary
love and Kohut’s description of a selfobject relationship” (p. 354).
Further, Boyer and Giovacchini (1967) came close to the idea of a
selfobject by acknowledging the analyst’s function as an “adjunctive
ego” or “alter ego” in borderline and schizophrenic cases.
Notwithstanding that Kohut’s idea of a selfobject was foreshad-
owed, no one else placed the construct at the center of a theory of
psychotherapy. Nor did anyone give it the specificity, with clinical
examples of idealizing, mirroring, twinship and merger that Kohut
did. Further, the ideas of others never led to sweeping changes in
the theory and practice of psychotherapy or to the prospects of even
further change, that Kohut’s emphasis on the selfobject achieved.
Kohut’s interest in the selfobject needs evident in the narcissis-
tic transferences eventually culminated in The Analysis of the Self
(1971), in which he said, “The subject matter . . . is the study of
certain transference or transferencelike phenomena in the psycho-
analysis of narcissistic personalities, and the analyst’s reaction to
them” (p. 1). Kohut’s clinical experience with patients who had
idealizing or mirroring transferences led him to see, initially, that
there are two kinds of selfobjects:
those who respond to and confirm the child’s innate sense of

vigor, greatness, and perfection [i.e., mirroring]; and those to
whom the child can look up and with whom he can merge as an
image of calmness, infallibility, and omnipotence [i.e., idealizing]
[Kohut and Wolf, 1978, p. 414].
To these selfobjects he added twinship in 1984. Kohut had

arrived at the concept of the selfobject by generalizing that each
narcissistic transference reflected a different kind of selfobject need.
With the evolution of the concept of selfobject from the
narcissistic transferences, the idea of a “line of development” was
Selfobject Experiences 169
retained. Each of the narcissistic transferences was conceived as

developing from archaic to mature forms. Similarly, then, selfobjects
can take archaic or mature forms. It is the mature forms that are
considered to be necessary in order for the self to function in
healthy and adaptive ways. Hence, as adults, we develop empathic
matrices, with others functioning as mature selfobjects of idealiza-
tion, mirroring, or twinship or as a combination of them.
Understandably, the idea of a selfobject led to some immediate
theoretical difficulties. These resulted from the selfobject being
conceived either as an object with substance, a reified “thing,” or as
a whole person. Neither view accurately portrays Kohut’s selfobject.
To avoid viewing a selfobject as if it were a billiard ball of Newtoni-
an atomic theory, Kohut and other self psychology theorists
emphasized the selfobject as a function. This stress on selfobject
function also clearly indicates that the infant is not responding to
parents as objects, but to the mirroring or idealizing supplied by the
parent or surrogate. As Stolorow (1986b) says, “‘Selfobject’ does not
refer to an environmental entity or caregiving agent. Rather, it
designates a class of psychological functions pertaining to the
maintenance, restoration, and transformation of self experience” (p.
274).
Elucidating further, Kohut saw that allowing the whole
therapist to be perceived as a selfobject encourages therapeutic
failure. It fosters an archaic identification with the therapist and
a therapeutic regression in which a massive emotional surrender
takes place. Such a surrender by a patient, defensive in nature,
actually prevents experiencing the selfobject functions that foster
growth and vitality.
The evolution of the concept of selfobject did not stop with
selfobject functions. Far from it. For while the emphasis on function
avoided the dangers of objectification, it opened the door to
another major problem. It placed too much responsibility in the
hands of the therapist and encouraged an active search for the
correct selfobject function to bring about a therapeutic effect on the
patient. Hence, the concept of selfobject function can be wrongly
used to justify a thinly disguised intrusive therapy and an overeager
attempt by the therapist to bring about a “corrective emotional
experience.”
170 Chapter 14
To counter the problems engendered by the idea of selfobject

functions, the stress in self psychology soon moved from selfobject
functions toward the concept of a selfobject experience. As Lichten¬
berg (1988) expresses it, “the overarching concept that conveys the
mutual relationship of self-regulation and regulation between self
and environment is of a ‘selfobject experience’” (p. 61). Roten¬
berg (1988) also indicates that “we use the term ‘selfobject’ to
refer to an object experienced subjectively as serving selfobject
functions” (p. 197).
With the concept of selfobject experience, it becomes clear
that parenting and psychotherapy are a lot more than technique.
It is not what the parent does or says that counts, but how the
infant experiences what the parent says or does, or does not say
or do, that determines if the infant’s selfobject needs are met.
This means that a parent or therapist has to listen carefully for
communications from the infant or patient and make adjustments
accordingly. One therapist’s attempt at mirroring by the use of
praise and affirmation may be experienced by a patient as
meaningless; another therapist’s casual comment may be felt by
the patient as deeply satisfying.
Atwood and Stolorow (1984) describe a serendipitous casual
comment that helped alleviate a patient’s paranoid transference
psychosis which had persisted for weeks.
The patient inquired about a day hospital program with which he

knew the analyst was familiar. The therapist responded spontane-
ously and non analytically, saying that he felt that the patient was
“too together” for this particular program. The patient became
utterly elated and revealed that he experienced the analyst’s
comments as an unexpected vote of confidence, a longed for
expression of approval [p. 58].
They go on to report that the patient’s improvement was sustained

by the analyst’s growing ability to make use of Kohut’s understand-
ing of archaic narcissism. Ultimately, only a pattern of mutual
responsiveness guides the therapy and assures that a therapist will
be experienced as the needed selfobject function.
By placing the idea of selfobject experiences at the center of his
thought, Kohut was, in effect, refining the concept of empathy.
Empathy, to him, still remained vicarious introspection, but the goal
of empathy became understanding the selfobject experiences for

which the patient hungered. As self psychology has evolved,
empathy is no longer “the central shibboleth” as Curtis (1986, p. 9)
claims. Thus, it is possible for a therapist to be unempathic in many
areas of a patient’s life, but empathic about selfobject needs and
hence enable significant therapeutic change. It is also possible for
a therapist to be empathic about many facets of a patient’s life, yet
not understand the patient’s disavowed selfobject needs, and hence
foster therapeutic stagnation and failure. The importance of making
selfobject needs the empathic focus is reflected in the following
case illustration.
Case Illustration
A patient who eventually manifested a deep hunger for mirroring

during psychotherapy could not understand this need because he
had experienced both his parents as affirming, mirroring persons.
The therapist, however, suggested that the mirroring function had
been defective in some way, even though the nature of this defect
was not obvious. Progress toward understanding the defect
eventually occurred after several empathic failures. These were
detected through a pattern of behavior where the patient would be
late and then have nothing to report. Exploration of the session that
preceded one of these unproductive sessions revealed that the
patient had not experienced the therapist as excited by the material
presented, material the patient felt was original.
The therapist had missed the importance of the patient’s insights
because they were not particularly new or fresh to him. He had
slipped out of the empathic mode and made an “objective”
evaluation of the originality of these insights. When the therapist
asked the patient what was new about the insight, the patient
experienced the therapist as belittling his subjective discovery and
felt wounded. This wounding led to an impasse for the rest of the
session that was resolved next session when the therapist, by
exploring the nature of his empathic failure in response to the
lateness/lack of association clues, realized that for the client, the
shared insight had been experienced as a creative thought. The
client had presented his discovery to the therapist in the hope of
receiving a joyful mirroring response.
172 Chapter 14
After the therapist took responsibility for the impasse, indicating

his realization that the patient had sought joyous affirmation, not an
objective evaluation, for his self-discovery the patient was able to
recall many incidents when his mother had insufficiently recognized
his creative efforts. She mirrored the obvious achievements of
getting a good report card, or his performance in the school play,
but such mirroring took place around her expectations, not the
original discoveries of her child. Hence, the patient experienced
mirroring as reinforcement of patterns of expected behavior in the
service of conformity, not personal growth. Such parental mirroring
fostered a false self and a walled-off, hungry part of the core self.
Once Kohut had defined the concept of selfobject experience
by using the three narcissistic transferences of mirroring, idealizing
and twinship as examples and accepted it as central to self psychol-
ogy theory, ideas for other selfobject functions emerged. For
example, Wolf (1988) lists adversary, merger, and efficacy selfobject
needs, in addition to the needs of mirroring, idealizing, and
alterego (twinship). Discovering additional selfobject functions was
encouraged by Kohut (1983): “This task of arriving at an optimum
number of explanatory clusters of specific selfobject failures with
their respective self pathologies still lies largely ahead of us” (p.
402).
Marian Tolpin (1986), in response to Kohut’s challenge, takes a
developmental point of view. She believes that “there are phase¬
appropriate selfobjects at all subsequent stages of life” (p. 120, n.2).
Lichtenberg (1988) concurs. He sees that “for each of the five
motivational systems at each period of life [physiological, attach-
ment, assertion, aversive and sensual], there are specific needs and
that when these needs are met the result is a selfobject experience”
(p. 61).
In stressing developmental stages, Tolpin (1986) indirectly
challenged the idea that each of the three narcissistic selfobject
functions develops from the archaic to the mature. To her, “the
term ‘archaic,’ used developmentally, is a misnomer,” carrying
pejorative overtones. She sees “simply phase appropriate selfobjects
of infancy” (p. 120).
Following Tolpin’s reasoning, we take the position that selfob-
jects can be grossly categorized as prenarcissistic and narcissistic.
Tolpin’s (1971) selfobject experience of infantile soothing can be
considered an example of a prenarcissistic selfobject function.

Encouraged by Kohut, Tolpin wrote about an overstimulated infant’s
need for soothing selfobject experiences. She saw this in the way
mothers sooth infants overcome by stranger anxiety or when infants
use what Winnicott (1951) called a transitional object—a favorite
blanket or teddy bear—to soothe themselves. Tolpin suggests that
selfobject experiences are broader than those associated with
narcissistic disorders, even though many self psychologists see
soothing needs as a manifestation of mirroring or idealizing
selfobject experiences.
When idealizing, mirroring, or twinship selfobject needs
emerge during intensive psychotherapy, they support a diagnosis
of a narcissistic personality. But what is the diagnosis of a person
who presents full of rage? If the patient calms down in a few
sessions in response to the therapist’s attempt to understand the
source of the wound, the need for narcissistic selfobjects often
emerges. If the rage is prolonged, or eventually deepens,
however, a transference is being sought that is akin to one
manifested by a borderline personality, where soothing is a
major selfobject need. Gedo (1979) too sees soothing as a
selfobject function separate from Kohut’s three narcissistic
functions when he talks about pacification. In addition, he sees
unification and optimal disillusionment as other needed func-
tions for a therapist working with character disorders.
Grotstein (1983), conceptualizing prenarcissisticselfobjects, uses
the idea of a “background selfobject of primary identification” (p.
187). He elaborates:
There is a considerable difference phenomenologically between

background objects and interpersonal objects which are im-
pressed into service as selfobjects. The concept of selfobject, I
strongly maintain, transcends far more than just simply the mother
or father. It includes tradition, heredity, the mother country, the
neighborhood, etc. [p. 185].
The idea of a selfobject is reflected in the use of the possessive

pronoun “our” when a person talks about “our flag,” “our village,”
“our church”; he or she may be referring to important background
selfobjects.
174 Chapter 14
After making this distinction between a background selfobject

and a narcissistic selfobject as Kohut conceived it, Grotstein suggests
its major function. The background selfobject promotes in an infant
a sense of being and safety, to be followed later by the achieve-

ment of self-affirmation. It corresponds to Winnicott’s (1963)
concept of the environmental mother, Sandler’s (1960) concept of
the background of safety, and Freud’s (1909) concept of idealized
parents of family romance [p. 187].
Such a view of the background selfobject is in contrast to the

narcissistic selfobject experiences that vitalize a depleted self and
decrease the risk of implosive collapses that are experienced as
fragmentation.
Grotstein’s background selfobject concept may be a useful way
to conceive of many prenarcissistic selfobject functions that surface
in the literature. Marian Tolpin (1986) for example, talks about a
carrying selfobject function with early infants (p. 118). Maybe the
functions of carrying, holding (Winnicott, 1960), soothing (Tolpin,
1971), feeding, and the other functions of what Winnicott (1966)
refers to as “good-enough” mothering, are all background selfob¬
jects fostering a sense of safety. These background selfobjects are
gradually expanded to include mother earth, mother country, and
mother church. Perhaps, too, Winnicott’s (1951) idea of a transition-
al object can be considered as an example of a selfobject experi-
ence that contains aspects of both background selfobjects and
narcissistic selfobjects.
The concept of background selfobject raises the question of the
major needs of an infant in the prenarcissistic period. The narcissis-
tic stage presupposes that a self has formed, however fragile or
inadequate, and that selfobject functions are now necessary to
vitalize, maintain, or expand it. On the other hand, in the prenarcis-
sistic stage of development, the task of self-formation, using an
imprinting-like process partly genetically triggered, needed invariant
background selfobjects. Through such a process, and by establishing
a bond with background selfobjects, four crucial elements of the
core self are able to emerge. These are a sense of agency, of
coherence, of affectivity and of history (continuity) (Stern, 1985).
These experiences of the core self, partially illusory in nature, are
given a certainty and absoluteness by the security afforded by the

presence of background selfobjects and a person’s attachment to
these.
The exploration of prenarcissistic selfobject functions was one
way of expanding the concept of the selfobject. Another way was to
investigate the nature of the “interaction between the self and
selfobject” (Wolf, 1980a, p. 119). Conceptually, this interaction came
to be expressed as the“self–selfobject unit” (M. Tolpin, 1983, p.
375) or the“self-selfobject experience” (P. Tolpin, 1983b, p. 262).
Referring to this interaction as a self-selfobject relationship, Gold-
berg (1980a) writes:“The self becomes the idea one has of one’s
relationships with others, with those who continue to sustain and
support and satisfy” (p. 5). Basch (1986), however, stresses“self–
selfobject experience, not selfobject relations or relationships to
indicate that we are dealing with endopsychic processes” (p. 27).
Once the idea of a self–selfobject unit is accepted, a dyadic
relationship between two persons is no longer seen as between two
“objects.” It is now conceived as being between two self–selfobject
units. Following this line of thought, a therapeutic relationship can
be described by the cumbersome expression“ t h e self–selfobject/
self–selfobject relationship.” This relationship suggests that not only
may the therapist serve as a selfobject experience for the patient,
the patient may serve as a selfobject experience for the thera-
pist—but, one hopes, not excessively.
One solution to such a cumbersome description may be to use
Atwood and Stolorow’s (1984) concept of the“intersubjective field”:
The conceptualization of an intersubjective field is, in part, an

attempt to lift the selfobject concept to a higher, more inclusive
level of generality. It is our view that the selfobject concept needs
to be significantly broadened in order to describe adequately the
specific unfolding developmental needs of a particular child and
how these are assimilated by the psychological world of each
caretaker [p. 68].
We are contending that every phase in a child’s development is

best conceptualized in terms of the unique, continuously changing
psychological field constituted by the intersection of the child’s
evolving subjective universe with those of caretakers [p. 69].
176 Chapter 14
Atwood and Stolorow’s idea of the“intersubjective field,” which

evolved from their psychobiological studies on the theoretical
systems of Freud, Jung, Reich, and Rank (Stolorow and Atwood,
1979), is similar to the position of Schwaber (1980), who wrote:
Bringing together as it does the self and the object, the selfobject
concept suggests a system—something I have called a“contextual
unit”—between patient and analyst (Schwaber, 1979). It is
therefore not to be viewed as a construct pertaining exclusively
to failures of differentiation between self and object or to a failed
recognition of the autonomy of each, but more fundamentally as
one which recognizes the immediacy of the surround as intrinsic
to the organization and perception of intrapsychic experience [p.
215].
Stolorow and his colleagues’ use of the broader concept of the

intersubjective field supplemented rather than supplanted the idea
of a selfobject function. Curtis (1986), in his criticism of the
selfobject construct, asserts that the term has been used too broadly.
Stolorow (1986a) agrees that this has sometimes been so. He sees
integration of affects (see chapter 21, this volume) as a criterion for
a selfobject function. The implication is that if such an integration
is not fostered, the claim of a selfobject function is not appropriate.
Another criterion applicable to a selfobject function is whether it
appears as a manifestation of transference. Anyone can spin off
theoretical labels for functions, but to be clinically useful, a
selfobject construct has to emerge in a transference consistently and
with a certain type of patient once a therapeutic bond develops.
Even so, Stolorow’s more universal notion of an intersubjective
context may help stem the conceptual litter of a plethora of newly
manufactured selfobject constructs.
Stolorow (1986b) is also careful to view the selfobject experi-
ence from a broader perspective. For example, he makes it clear
that the selfobject dimension is only one part of a relationship:“A
multiplicity of dimensions co-exist in any complex object relation-
ship, with certain meanings and functions occupying the experien-
tial foreground and others occupying the background, depending
on the subject’s motivational priorities at any given moment” (p.
275). Such a broad view allows for the possibility of background

selfobjects and objects as other dimensions of experience.
As we end this chapter, we note that all the preceding discus-
sion of the selfobject experience would be irrelevant if it were not
for the idea of a self, the central metapsychological assumption of
Kohut’s work. The self, as Kohut conceived it, is not a static thing,
a reified entity. It is a complex system. In the next chapter we shall
explore the complex issues involved in the idea of a self system.
Readings for Chapter 15: Kohut, 1977, chapter 4; Chessick,

1980a; Stern, 1985, chapters 3-8.
15
The Srlelf System
n self psychology the concept of the self replaces Descartes’s

I“mythological and inexplicable” (Basch, 1988a, p. 100) concept
of the mind as a machine. It also discards Freud’s version of the
mind as a mental apparatus with structures (id, ego, superego) and
defense mechanisms. And the selfs eventual central position in self
psychology goes well beyond Hartmann’s concept of a self-represen-
tation as a complement to object representations, although initially
Kohut (1971) saw the self as an agency of the mind. In its final
form, Kohut’s concept of the self as a supraordinate agency, an
independent center of initiative, is“without doubt the most
problematic one in the theory of self psychology” (Stolorow et al.,
1987, p. 17).
We begin with the belief that Freud’s drive metapsychology is
so inadequate (see chapter 5, this volume) and his concept of the
mind has been so heavily associated with mechanistic and determin-
istic ideas (see chapter 4, this volume) that they are best discarded
as unsalvageable. This chapter replaces the idea of a mind with the
concept of a self and then shifts from the idea of a self as an entity
178
The Self System 179
to that of a self-system. It explores the following: (a) Kant’s view, (b)

Kohut’s concept, (c) Stern’s invariants, (d) nuclear self, and (e)
organization of experience.
KANT’S VIEW
The decision to replace the idea of a mind with the concept of a

self is not new to self psychology. It was made by Kant in response
to the problem of the mechanical mind posed by Descartes and to
the issue of the mind as tabula rasa, the passive register of
empirical experience, raised by Locke and Hume. Kant’s initial
solution was to conceive of the mind as the“phenomenal self,”
which is actively and constantly involved with“empirical appercep-
tion” and a succession of mental states across time. With Kant’s
phenomenal self“there is no permanent or abiding ‘self” (Chessick,
1980a, p. 458).
Kant himself was not satisfied with the phenomenal self as a
solution to the mind problem. Eventually he postulated an enduring
self behind the knowable phenomenal self. There is“an antecedent,
unknowable, permanent, on-going ‘I’ [that] lies behind our experi-
enced activity of the mind” (Chessick, 1980b, p. 458). Kant claimed
that because of this cohesive sense of a continuous self, the
noumenal self, one is able to discern self-boundaries, hence the
external world, and thus the experiences coming from the external
world that are perceived by the phenomenal self.
Kant did not posit the noumenal self as an expansion of the
phenomenal self; on the contrary, the phenomenal self is an
expression of the noumenal self. To Kant, this noumenal, generat¬
ing-of-experience self is directly unknowable. All that can be said
about it is that it exists. It is only derivatively knowable through the
phenomenal self. This unknowable noumenal self is the noumenal
self in a negative sense.
In his later work, Kant, going against his earlier position of the
noumenal self being unknowable, moved beyond the negative
noumenal self. He moved to the noumenal self in the positive sense
and suggested that we proceed as if the self were a simple concrete
entity endowed with personal identity. At the same time, he
180 Chapter 15
believed that there remained an unknowable core that profoundly

influenced the conscious flow of inner and outer experiences.
KOHUT’S CONCEPT
Chessick (1980a) sees a remarkable similarity between the way the

concept of self developed in Kant and in Kohut. Kohut began with
a phenomenal self knowable not through empirical data but
through the data of empathy, vicarious introspection. Yet, by 1977
Kohut had moved toward a noumenal kind of self as a generaliza-
tion derived from data. He, like Kant, saw the need for the concept
of the noumenal self in the positive sense, that is, as a self that is
depleted or empty, or yearning for mirroring or merger. In a
fashion similar to Kant’s, Kohut’s self is an“ a s if” concept using
anthropomorphic language.
When critics accuse Kohut of anthropomorphizing, he and his
colleague Wolf (Kohut and Wolf, 1978, pp. 415-416, n1) plead
“guilty,” indicating that they use such language for evocativeness and
conciseness. Unapologetically, Kohut (1977) conceived of the self as
a supraordinate concept, that is, one beyond knowing empirically,
a configuration transcending the sum of its parts, which has
cohesiveness in space and continuity in time (p. 177). As an
independent center of initiative, Kohut’s self is a central metapsy¬
chological concept. In support of Kohut’s concept, Goldberg (1980a)
argues that any science must be granted the use of some metaphors
and hypothetical constructs (p. 7). Wolf (1988) more adamantly
states:
To infer the existence of a psychological structure, the self, as part

of a presumed psychological system is roughly on the same
theoretical level as the inference, from all kinds of observations,
of the existence of electrons as part of a presumed system of
electromagnetic phenomena [p. 23, n.1].
Tolpin (1980) reminds us that Kohut’s stress on the concept of

the self is more than a philosophical leap into an unsubstantiated
metaphysical supraordinate world. It is an illusion created in the
infant through parenting; when the illusion is not created, the infant
The Self System 181
experiences severe disturbances. She sees the importance of Kohut’s

“discovery of the psychic reality of a selfobject environment which
normally acts almost automatically to preserve and promote the
child’s automatic illusion (“delusion”) of independence and his
nuclear initiative” (pp. 63-64). Stern (1985), making a similar point,
notes that parents treat infants as the people they are about to
become and thereby participate in creating the illusion in the infant
of being an agent-self. As examples, parents impute intention when
they say to the infant,“ O h , you want to see that.” A mother sees
motive when she says,“You’re doing that so mommy will hurry up
with the bottle.” And parents see authorship when they say,“You
threw that away on purpose, huh?”
When Heinz Kohut conceived of the self as an agent, he had
another alternative to Freud’s concept of instinctual drives and
based his idea of the self
on the Zeigarnik phenomenon which postulates some kind of

inner motivation of undeveloped structures to resume their
development when given an opportunity; the energy behind this
motivation has nothing to do with Freud’s instinctual drives, and
the origin of it is not explained [Chessick, 1980b, p. 470].
Kohut saw in the development of selfobject transferences an

opportunity for this Zeigarnik phenomenon to occur.
Kohut appears to have been as entranced by the explanatory
power of the self as Freud was with the Oedipus complex. Even so,
by seeing the self as agent, Kohut was able to address problems of
faith, free will, and morality. To Kohut, psychotherapy alleviates the
tragedy of man’s suffocating in an increasingly inhuman environ-
ment that he himself continues to create.
At first Kohut (1971) saw the self as another structure of the
mind, existing alongside the id, ego, and superego and similar to a
self-representation:
The self, however, emerges in the psychoanalytic situation and is

conceptualized, in the mode of a comparatively low level, i.e.,
comparatively experience-near, psychoanalytic abstraction, as a
content of the mental apparatus. While it is thus not an agency of
the mind, it is a structure within the mind since (a) it is cathected
182 Chapter 15
with instinctual energy and (b) it has continuity in time, i.e., it is

enduring [p. xv].
By 1977, however, Kohut had clearly moved beyond that position to

a supraordinate view of the self.
Kohut used the supraordinate concept of the self as a replace-
ment for Freud’s structural theory (id, ego, and superego). In so
doing, he raised the question of how the self was formed. Kohut’s
(1971) self did not evolve as a coalescence of parts (p. 97), but was
present from the beginning in a rudimentary form. This idea, which
blossomed into the supraordinate self (Kohut, 1977, p. 177), follows
the position outlined by Fairbairn (1944) and is now supported by
Stern’s (1975) observational evidence of day-old infants. To Kohut,
the embryonic self is not a result of development; it is innate. What
happens during development into an adult is a change in organiza-
tion from an extremely rudimentary self to a complex one.
Tolpin (1986), expressing a similar point of view, writes:
From the beginning of life, the self is an amalgam of “givens” and

“experience,” and its vitality and intactness correspond to the
degree to which these two dimensions of selfhood complement
one another in growth-promoting ways [p. 115].
By experience Tolpin here means“experience of parental

selfobject functions.”
STERN’S INVARIANTS
Stern’s (1985) studies of infants a few days old made him aware that
they were born with a capacity to distinguish the invariants from the
variants in their“surround.” He concluded that“an invariant pattern
of awareness is a form of organization. It is the organizing subjec-
tive experience of whatever it is that will later be verbally refer-
enced as the ‘self’” (p. 7).
Stern sees the self as emerging as a more complex entity
through what he calls“domains of relatedness” rather than phases
or stages. By avoiding the concept of stages, he is being careful not
to reflect a mechanistic, deterministic drive theory. These domains
The Self System 183
are the emergent self from birth to two months; the core self
during the two-month to eight-month period; the subjective self
from the eight-month to fifteen month period; the verbal self from
fifteen months to about thirty-six months; and then the narrative
self.
We shall not discuss in detail here these five domains of related¬
ness. However, the idea of a core self as conceived by Stern merits
discussion because of its association to Kohut’s nuclear self. These
two concepts, core self and nuclear self, may sound interchangeable,
but they are“shorthand” for different processes. According to Stern,
the differentiation of the infant from the mother occurs during the
period between two and seven months, not later, as classical
analysts and Mahler believe. A core self experience and an experi-
ence of being separated from others are two facets of the same
process. Merger experiences (see chapter 13, this volume) are
secondary to and dependent on an already existing sense of self and
other. Major invariants of the core self are (1) self as agency
(control), (2) self as coherence, (3) self as affectivity, and (4) self as
history (memory).
Self as Agency
Volition may be the most fundamental area in which an infant gains

a sense of agency, especially with motor control. Movements of the
voluntary muscles are preceded by an elaborate motor plan of
which we are unaware. They make our actions as though they
belong to us, for example, when the hand goes to the mouth, in
gazing, and in sucking. Evidence of a motor plan comes from the
fact that small-sized and large-sized signatures are written by
different muscles, yet they are exact replicas.
Self as Coherence
Coherence is experienced when sound and sight come from the

same place. There is coherence of motion, when, for example, the
mother is seen moving against a stationary backdrop“because all
her parts are moving relative to some background” (p. 83). There
is coherence of temporal structure through a sense of time. There
184 Chapter 15
is also a coherence of form in which the infant knows the mother’s

face whether it shows fear or surprise.
Self as Affects
The capacity to experience affect does not significantly change over

a lifetime. The affective core guarantees continuity of experience
across development in spite of the many ways we change (Stern,
1985).
Affects are excellent higher order self-invariants because of their

relativefixity:the organization and manifestation of each emotion
is well fixed by innate design and changes little over development
[Izard, 1977, cited in Stern, 1985, p. 89].
Stern points out that the invariants of affect are (1) the proprio-
ceptive feedback from particular motor outflow patterns, to the face,
respiration, and vocal apparatus; (2) internally patterned sensations
of arousal or activation; and (3) emotion-specific qualities of feeling.
(Understanding the function of affects in human development is so
important that we devote chapter 21 to the subject.)
Self as History
History reflects a continuity of experience, a continuity that

Winnicott (1960) called“going on being.” Memory is a form of
history.“ I t is now clear that there are recall ‘systems’ in an infant
that are not language-based and that operate very early . . . . Motor
memory is one of them” (Stern, 1985, p. 91). For example, the
infant remembers how to suck a thumb.
DeCasper and Fifer (1980) believe that memory is present in the
womb. They asked mothers in the last trimester to read (Dr. Seuss)
scripts repeatedly to their pregnant bellies. After birth the infants to
whom the story had been read showed greater familiarity (based on
a sucking response) with the script than with a control story.
The basic unit of memory is an episode, a small piece of lived
experience.“ T h e r e are never emotions without a perceptual
context. There are never cognitions without some affect fluctuations,
even if it is only interest” (Stern, 1985, p. 95). Memory, however, is
The Self System 185
failure-driven in that a specific episode is relevant and memorable

as a piece of lived experience only to the extent that it violates the
expectation of the generalized episode. That is, we remember things
that fail to meet our expectations. It is for this reason one can
“commute” to a workplace for an hour and recall very little of the
trip.
Memory uses Generalized Event Structures (GERs)(Stern, 1985).
In a GER, a birthday, for example, means a series of events such as
decorate cake, greet guests, open presents, sing“happy birthday”,
blow out candles, cut cake, eat cake, and thank guests. Memory also
uses Representation of Interactions Generalized (RIGs). For
example, a ten-month-old can form a prototype from a variety of
faces.
THE NUCLEAR SELF
In contrast to Stern’s core self, in Kohut’s nuclear self three major

developments occur. These are (a) the consolidation of central
grandiose-exhibitionistic fantasies as ambitions, (b) the internaliza-
tion of the idealized parent as fundamental ideals, and (c) the
development of skills and talents. Realization of these nuclear
ambitions, ideals and skills leads to a feeling of triumph and a glow
of joy, not pleasure from tension discharge. These developments
form Kohut’s tripartite self, (initially called bipolar) believed by
White and Weiner (1986) to be the“capstone of the supraordinate
self (p. 104).
For Kohut (1977), the nuclear ambitions are acquired during the
second, third, and fourth years of a child’s development, whereas
basic ideals are gained mainly in the fourth, fifth, and sixth years of
life (p. 179). Skills and talents develop during the latency period.
These ambitions, ideals, and skills are so important in motivating
the self that they are conceived by Kohut as forming two poles of
the nuclear self with an intermediate area, a“tension gradient,”
between. This tension gradient consists of talents and skills gained
through twinship transferences. In this way, by stressing the
importance of (1) ambitions, (2) ideals, and (3) skills, Kohut arrived
at his model of the nuclear self.
186 Chapter 15
Kohut’s tripartite theory of the self has been criticized from

within self psychology itself. Stolorow and his colleagues (1987)
have openly stated that Kohut’s idea of a bipolar self, with its
ambitions and ideals, contains the danger of reification, while the
concept of a tension arc appeals to mechanistic thinking. They
accept the use of the self as a metaphor and the need for some
metapsychology but contend that Kohut did not heed sufficiently the
warnings of Schafer (1976) about reification. They also believe that
even though Kohut’s metapsychology is different from the classical
position, his concept of the bipolar (later, tripartite) self is open to
the criticism that like Freud’s, it is too objectified, materialistic, and
mechanized.
The problem of reification in self psychology goes beyond
Kohut’s idea of the bipolar or tripartite self. As long as adjectives are
used in conjunction with the word self, the grandiose self for
example, there is the danger of reification. What can be understood
as a description of the state of the self at a given moment, that is,
the self in a grandiose state, can also easily be viewed as a reified
object, that is, a separate subunit of the self. Thus, the reified
grandiose self takes on a life and agency of its own. Additionally,
there is a propensity for theorists to manufacture self concepts
when there is the need to explain something. But naming does not
explain. Naming a concept creates a tool to facilitate description. It
is the means to an end, the beginning of an explanatory process,
but not a substitute for the process itself.
The danger of seeing parts of the self as agents is present in
Kohut’s concepts of a nuclear self and a peripheral self. Both refer
to an area or location of the self. The temptation is to view the
peripheral self and the nuclear self as interacting with each other
as if they have agency. This kind of temptation increases when the
list of the various“selves” increases. Reiser (1986), for example,
delineates five selves: the endangered self, the enraged self, the
vulnerable self, the grandiose self, and the mirroring self (p. 230).
And what about such well-known concepts as the true self, the false
self, the disavowed self, and so forth? They are often used as if they
were entities rather than descriptions of an authentic but transient
quality of the self.
The danger of reifying and anthropomorphizing is less with the
concepts of the cohesive self and fragmenting self. These are more
The Self System 187
easily conceived of as states of the self, on a continuum, with

cohesion at one end and fragmentation at the other. Perhaps more
significantly, these concepts are supported by behavioral correlates.
By 1971 Kohut was proposing that symptoms of hypochondria,
homosexual behavior, and work inhibitions were indications of a
person whose self was in some degree of fragmentation, even if
stabilized. Other evidence of self-fragmentation comes from dreams,
especially of small bugs; sexual perversion; alcohol and drug abuse;
and somatic illness.
ORGANIZATION OF EXPERIENCE
To help curb the use of constructs of the self as subagents, Stolorow

and his colleagues prefer a different word for the idea of self as
agent. They suggest“person.”“ W e have found it important to
distinguish sharply between the concept of the self as a psychologi-
cal structure and the concept of the person as an experiencing
subject and agent who initiates action” (Atwood and Stolorow, 1984,
p. 34). By psychological structure they mean“organization of
experience” (Stolorow et al., 1987, p. 17). Thus, the idea of a
“fragmented self striving to restore cohesion,” in which the agent“I”
is transformed into a reified“it,” is better expressed as“the person
whose self experience is becoming fragmented strives to restore his
sense of self-cohesion” (p. 19).
By calling the self acting as an agent, a person, Stolorow paves
the way for self to be seen as“ a psychological structure through
which self experience acquires cohesion and continuity, and by
virtue of which self experience assumes its characteristic shape and
enduring organization” (Atwood and Stolorow, 1984, p. 34).
Stolorow and his colleagues (1987) add,“ t h e distinction between
person and self enables us to separate conceptually the various
functional capacities acquired by the person from the corresponding
reorganizations and structuralizations of his self-experience” (p. 19).
The concept of the self as the organization of experience has an
appealing simplicity. Not only does reorganization of experience
take place, it does so continually as new experiences occur. The
idea of the self is not of a static self; it is a self always in transition,
a changing self:
188 Chapter 15
The idea that the self, a product of earlier givens and previous
selfobject experiences, continues to be shaped by emergent
givens and new self–selfobject encounters, suggests that the self
is, throughout the life cycle, a self in transition, a changing self
[Tolpin, 1986, p. 116].
If the self, the organization of experience, is viewed as being in

transition, it has the characteristics of an open system. A system as
von Bertalanffy (1968) defines it, is an entity identified by its
function, rather than its physical attributes; it is a stable, informa-
tion-processing collective made up of a hierarchy of interacting
feedback cycles. Basch (1988a) sees that“the affective and cognitive
information-processing activities of the brain form such a system–
here called the self system which governs adaptation to the environ-
ment” (p. 100).
Lichtenberg (1988) defines the self as both the organizer of
experience and the independent center of initiative. He links the
initiating function to the idea of motivation (Lichtenberg, 1988, p.
61). He asks, what motivates the supraordinate“I,” the person who
is the self as agent? If Kohut’s thinking on the tripartite self is
viewed as motivation, then ambitions, ideals, and the need for skill
mastery motivate a person to take the initiative and act.
Lichtenberg (1989) proposes five subsystems that motivate the
self as agent. These are (1) the need for psychic regulation of
physiological requirements, (2) the need for attachment-affiliation,
(3) the need for exploration and assertion, (4) the need to react
aversively through antagonism or withdrawal, and (5) the need for
sensual enjoyment and sexual excitement. These motivational
systems, derived as they were from the study of infants, are different
from those which Kohut found through clinical work with narcissis-
tic patients. They encompass the idea that“psychoanalytic theory at
its core is a theory of structured motivation, not a theory of struc-
tures” (p. 1).
In contrast to, and yet basically congruent with, self psychology,
Mitchell (1988) offers a relational definition of the self.“Mind [self]
has been redefined from a set of predetermined structures emerg-
ing from inside an individual organism to transactional patterns and
internal structures derived from an interactive, interpersonal field”
(p. 17).
The Self System 189
To summarize, the self in self psychology replaces Descartes’s

concept of the mind and Freud’s mental apparatus. It is conceived
as having two major functions: that of a supraordinate agent and the
organization of experience. To avoid confusion and awkward
language, the self as agent is better referred to as“person.” Kohut’s
concept of the tripartite self, with its danger of reification, is better
conceived as motivating systems of the self system as a whole.
Stern’s concept of the core self and its correlates of agency,
cohesion, affectivity and history show potential usefulness in the
treatment of severely disturbed persons.
Whatever the process of development of the core self, access to
it in psychotherapy is through exploration of its organizing
principles. These organizing principles are uncovered through the
intersubjective context of the psychotherapeutic relationship. In
chapter 18, we explore how these organizing invariants emerge and
how they can be changed.
With the examination of the self system in this chapter, we have
completed the survey of Kohut’s major constructs, which began with
his emphasis on the empathic method. His new ideas evoked
responses from the analytic community that ranged from apprecia-
tive acceptance to outright rejection. To some, Kohut was Franz
Alexander reincarnated. Much of the reaction to the challenge of
self psychology emerged over the issue of conflict verses deficit
theory. This is the subject of our next chapter.
Readings for Chapter 16: Kuhn, 1962; Hanly and Masson, 1976;
Stolorow, 1983; London, 1985; Curtis, 1986.
16
Conflict and Deficit
Theories
S elftreating
psychology’s new theoretical constructs and its successes in
narcissistic disorders posed a major problem for
psychoanalysis. At first self psychology’s ideas broadened the scope
of psychoanalysis by adding new theory, but as this new theory
grew, the ideas of self psychology became a major complement to
drive theory. They became such a major complement that eventually
self psychology was proposed as an entirely new paradigm, able to
explain neurotic conflicts as well as narcissistic deficits.
Most psychoanalytic theorists were able to accept self psycholo-
gy’s broadening of psychoanalysis, and even saw its potential as a
major addition to drive-conflict theory. In general, however, they
rejected self psychology as a radically new paradigm. Psychoanalysis’
acceptance or rejection of self psychology’s ideas often focused on
the contrast between conflicts or deficits in psychic structure. In
what follows we examine the concept of structural deficit under (a)
deficit theory, (b) critical responses, (c) complementarity, (d) new
paradigm, and (e) scientific revolution.
190
Conflict and Deficit Theories 191
DEFICIT THEORY
As discussed in chapter 5, Freud’s drive-discharge theory was an

evolving theory of conflict. First, conflict was between the conscious
and unconscious mind (topographical model), then between
agencies of the mind (structural model); and, under the influence
of Hartmann, conflicts also took place within the ego or between
the ego and the external world. According to this drive-dis-
charge/conflict theory, narcissism was seen as a pathological
regression to avoid the conflicts of the Oedipus complex and was
to be interpreted as such to narcissistic patients, despite discourag-
ing results. The idea that longings expressed by narcissistic patients
reflected genuine needs because of developmental deficits was a
radical departure from this classical position.
The concept of arrested development, first introduced by
Ferenczi (1913), was revived by Glover (1943), made prominent by
Anna Freud (1965), and introduced to self psychology by Gedo
(1966, 1967).
Kohut (1971) used the theoretical contrast between structural
conflict and arrested development (structural deficit) to explain self
psychology’s contributions to psychoanalytic theory:
The patient’s reactions to the disturbance of his relationship with

a narcissistically experienced object . . . occupy a central position
of strategic importance that corresponds to the place of the
structural conflict in the psychoneuroses [p. 92].
Discussing this conflict/deficit contrast, Stolorow and Lachmann

(1980) noted a“crucial distinction between psychopathology which
is the product of defenses against intrapsychic conflict and psycho¬
pathology which is the remnant of a developmental arrest at
prestages of defense” (p. 5). In Stolorow’s early position, conflict
and deficit theory both coexisted. At first he and Lachmann
acknowledged both a pseudonarcissistic neurotic personality and a
narcissistic personality disorder. They did not completely reject the
classical position on narcissism, but by limiting classical theory to
one kind of narcissistic patient, they created space for Kohut’s
theorizing to describe a deficit kind of narcissism. Later, however,
192 Chapter 16
Stolorow (1988) rejected this view of the relative parity of the

conflict and deficit theories.
Early in the development of self psychology, Kohut attempted
to integrate his new insights on the treatment of narcissism into
psychoanalysis by“pour[ing] new wine into old bottles” (Stolorow,
1988). This phrase signifies Kohut’s effort to conceptualize his ideas
on the“Procrustean bed of Freudian metapsychology” (Stolorow,
1988), with its language of mental apparatus and drive-discharge.
Fixations along the object-instinctual line of development led to
neurotic disorders, whereas fixations along the narcissistic pathway
resulted in narcissistic disorders. Kohut envisaged different
theoretical models for different classes of psychopathology, a task
taken up by Gedo and Goldberg (1973) in Models of the Mind.
In this book, Gedo and Goldberg make a case for arranging
various modes of psychic functioning into an hierarchical schema.
Such modes employ Ferenczi’s (1913) concept of“lines of develop-
ment.” Gedo and Goldberg arrange these lines of development
according to five phases, each of which requires a different model
of the mind: the topographical model (introspection) for phase five;
the tripartite model (interpretation) for phase four; the self
psychology model (disillusionment) for phase three; a modified self
psychology model (unification) for phase two; and the reflex arc
model (pacification) for phase one.
Their hierarchical view of the mind enables Gedo and Goldberg
to define arrested development as taking place only“when the
crucial lines of development are all arrested within the same phase”
(p. 135). Examples of these lines of development are danger
situations, narcissism, sense of reality, and mechanisms of defense.
Gedo (1988) further clarifies the concept of arrested development:
“The concept does not apply to the numerous syndromes wherein
one nucleus of the self remains archaic while the rest of the
personality undergoes expectable maturation” (p. 56).
It is tempting to embrace an approach where drive theory
interpretations are made when treating neurotic patients and self
psychology explanations are given to patients suffering from
disorders of the self. Putting such an approach into practice,
however, is difficult and may be impossible, because people do not
generally fall into neat diagnostic categories. More important,
different theoretical models are often needed for the same patient
at different stages of treatment. Such a multiplicity of theories
applicable for a stage of treatment on the same patient points to the
need for an overarching theoretical frame for making decisions
about the use of a specific model. The hierarchical model of Gedo
and Goldberg is one way out of this quandary.
A hierarchical model of the mind that incorporated disparate
theories within its overarching frame paved the way for Kohut to
explore self psychology as a distinctive paradigm unencumbered by
drive theory. In The Restoration of the Self, Kohut (1977) sharpened
the distinction between structural conflict and structural deficit
theories by dropping drive-discharge concepts to explain the treat-
ment of narcissistic patients and by introducing the concepts of
Guilty Man and Tragic Man.
Man’s functioning should be seen as aiming in two directions. I

identify these by speaking of Guilty Man if the aims are directed
toward the activity of his drives and of Tragic Man if the aims are
toward fulfillment of the self. To amplify briefly: Guilty Man lives
within the pleasure principle; he attempts to satisfy his pleasure-
seeking drives, to lessen the tensions that arise in his erogenous
zones . . . . Tragic Man, on the other hand, seeks to express the
pattern of his nuclear self; his endeavors lie beyond the pleasure
principle. Here, too, the undeniable fact that man’s failures over-
shadow his successes prompted me to designate this aspect of
man negatively as Tragic Man rather than “self expressive” or
“creative man” [pp. 132-133].
Kohut also used deficit psychology to explain psychopathology

that was previously thought amenable to conflict psychology
explanation. Specifically, he indicated that structural deficits subtend
the oedipal neuroses. This trend in his thinking blossomed in his
later work, especially How Does Analysis Cure? (Kohut, 1984).
CRITICISM
Criticism of self psychology may be in direct proportion to its

perceived deviation from psychoanalysis. When viewed as supple-
194 Chapter 16
mental or additive, it received very little criticism. When seen as

separate but equal, it attracted considerable criticism. But when it
was thought of as a new paradigm that subsumed and replaced the
old analytic model, it elicited outright rejection.
Rejection took many forms, one of them a distortion of self psy-
chology’s position. For example, self psychology is seen by some as
“idealizing and romanticizing” empathy (London, 1985, p. 100). Such
a criticism, appropriate for the function of empathy in some theo-
ries, fails to appreciate Kohut’s efforts to avoid this very difficulty by
defining carefully empathy as vicarious introspection, a specific
method of gathering data. It also ignores Kohut’s idea of attenuated
empathy, which makes it clear that idealized empathy in the form
of empathic perfection is not only unnecessary but undesirable.
Rejection also emerges as “this theory is too different for me to
feel comfortable with it.” For example, in a critique that Friedman
(1980) calls “clinical moralizing,” Hanly and Masson (1976) attack
the idea of narcissism as a developmental deficit by disagreeing
with Kohut’s concept of narcissism as a separate line of develop-
ment. They claim (without substantiation either theoretically or
clinically) that narcissism is not a separate line of development and
therefore is a manifestation of conflict pathology, not a deficit.
Significantly, except for Kohut’s reference to the “oceanic experi-
ence,” they reject the idea of healthy narcissism by ignoring Kohut’s
(1966) paper on the subject of transformed narcissism. They present
no arguments to support the idea that narcissism is unhealthy and
simply appeal to the authority of Freud.
A dream reported by one of their patients, as well as her
behavior in the analytic relationship, suggests that she was hunger-
ing for a mirror transference as described by Kohut, but this
patient’s hunger was understood by Hanly and Masson as resistance
to a properly conducted analysis. One gains the impression that
Hanly and Masson have not been able to understand empathically
how Kohut successfully treated narcissistic patients. They reject
Kohut’s position apparently because it differs from the classical view
of narcissism.
Self psychology is also criticized for not using the techniques of
traditional psychoanalysis. Kernberg (1975) calls it essentially
supportive psychotherapy (pp. 285-309). For London (1985) self
psychology is not compatible with psychoanalysis because it avoids
conflicts, is not conducted from a neutral stance, and, he thinks,

relies exclusively on empathy to the exclusion of interpretation. The
idea that self psychology excludes interpretation, called by Kohut
“explanation,” is inaccurate. London is really presenting another
version of the argument that the unfamiliar is unacceptable,
irrespective of its merits. Loewald (1973) thinks that self psychology
leads to excessive gratification or indulgence and hence fosters
more narcissistic behavior, a view based on drive theory not on
clinical practice.
The rejection of self psychology as something “foreign” implies
that self psychology is a new paradigm outside of analysis. Stein
(1979), for example, sees self psychology as such a radical departure
from psychoanalysis that it is “difficult to accept as a genuine
addition to psychoanalytic theory and practice” (p. 680). When he
doubts that self psychology “is a sound piece of work, a true
advance, a paradigm in Thomas Kuhn’s sense” (p. 680), he clearly
rejects it as another psychoanalytic paradigm and ignores the larger
question of a new healing paradigm.
Stein apparently can reject self psychology only by oversimplify-
ing and distorting it. He thinks self psychology is “based ultimately
on the simple principle that disorders of the self are the result of
lack of parental empathy; cures are brought about by the (kindly)
efforts of an empathic analyst” (p. 677). He ignores such major
elements in the theory as empathic failures, which, when explained
(interpreted), lead to microinternalizations and structure building.
He also does not seem to understand that treatment of narcissistic
personalities involves eventual interpretations of the transference
after a long period of empathic immersion. Instead, Stein caricatures
Kohut’s work as “the product, not so much of painstaking explora-
tion, of trial and error, and of attempts to test the truth, as of a
more purely subjective and inspirational process, largely confined
to the empathic-introspective method” (p. 680).
In response Markson and Thomson (1986) suggest that such
criticisms are “simplistic” (p. 31). Basch’s (1986) response is more
pointed:
Analysts whose patients have benefited from supervision based on

Kohut’s insights will know from personal experience that accusa-
tions that Kohut and his students do not deal with aggression, do
196 Chapter 16
not know how to or choose not to analyze psychosexual conflicts,

remain on the surface and do not plumb the depths, do not
understand or do not work with unconscious fantasies, advocate
cures based on love and on unanalytic attempts to gratify patient’s
wishes, and so on, reflect the anxiety of the critic and not Kohut’s
ideas or practice [p. 19].
A different criticism comes from Mitchell (1988), who accepts

the need for a new paradigm to replace the drive-conflict model but
thinks—and we agree on the basis of the need for a theory of
trauma—that the concept of developmental arrest is an inadequate
basis for a new paradigm. He rejects the notion of “developmental
tilt,” which sees perseverating babies stuck in developmental time:
The two major problems generated by developmental tilt [are]:

psychopathology . . . characterized in terms of missing infantile
experiences rather than constricted patterns of relatedness in
general, and the missing needs . . . regarded as residing in the
patient, pressing to emerge, rather than a function of the interac-
tive relational field the analysand experiences herself as living in
[p. 155].
Mitchell would rather see a more interactive option than drive

theory. He regards:
developmental continuity as a reflection of similarities in the

kinds of problems human beings struggle with at all points in the
life cycle. Being a self with others entails a constant dialectic
between attachment and self-definition, between connection and
differentiation, a continual negotiation between one’s wishes and
will of others, between one’s own subjective reality and a
consensual reality of others with whom one lives. In this view the
interpersonal environment plays a continuous, crucial role in the
creation of experience. The earliest experiences are meaningful
not because they lay down structural residues which remain fixed,
but because they are the earliest representation of patterns of
family structure and interactions which will be repeated over and
over in different forms at different developmental stages [p. 149].
In contrast to the drive-conflict and developmental arrest models,

Mitchell describes his new paradigm as the relational-conflict
model.
COMPLEMENTARITY
By 1977 Kohut presented self psychology as a new paradigm freed

from the structures of Freudian metapsychology. He saw the
relationship between the old and the new as complementary and
wanted drive and deficit theories to coexist just as wave and particle
theories of light do in physics.
What I am suggesting is that one might employ here and else-

where two different theoretical frameworks—that, in analogy to
the principle of complementarity of modern physics, we might
indeed speak of a psychological principle of complementarity and
say that the depth-psychological explanation of psychological
phenomena in health and disease requires two complementary
approaches: that of conflict psychology and that of a psychology
of the self. [pp. 77-78]
Friedman (1980), on the other hand, sees self psychology as

supplementary, not complementary to psychoanalysis, because it is
an “elaboration of an unstressed aspect of existing theory” (p. 409).
In his view, it should not be given equal weight with drive theory
because it is not as comprehensive.
Schwartz (1978) also rejects the idea of complementarity
because it implies that these different frames of reference have
equal validity. He does not think they are equally valid, for he sees
self psychology as being without the explanatory power of drive
theory. He also doubts self psychology’s potential as a separate
theory of the future on the grounds that its useful ideas will
ultimately be integrated into the body of psychoanalytic literature.
Stolorow (1988), theorizing from within self psychology, also
dislikes the complementary approach to deficit and conflict theories.
198 Chapter 16
Although these formulations of complementary or combined

models are not without heuristic value, it is my view that they are
theoretically unsound. This is because conceptualizations of
self-selfobject experiences and constructions of drive-discharge
apparatus exist on entirely different theoretical planes deriving
from completely different universes of discourse [p. 65].
Curtis (1986), too, thinks that conflict and deficit are two different
levels of conceptualization.
Gediman (1989), however, concerned about the polarization
occurring in psychoanalysis over the issue of self psychology,
supports the idea of a psychoanalytic theory broad enough to
permit multiple points of view. Asserting that clinical material
suggests that the two points of view are not mutually exclusive, she
writes, “Both phenomena, the neurotic and the narcissistic, and their
underlying intrapsychic, prestructural and preoedipal and oedipal
conflicts may be seen as essential features of all patients, granted in
varying degrees” (p. 296).
Chessick (1980b), however, cautions:
It seems to me virtually certain that Freud would not have

accepted Kohut’s theory of the psychology of the self in the broad
sense as “complementary,” but rather as a rival theory which uses
a different treatment procedure from that of Freud’s classical
analysis [p. 470].
NEW PARADIGM
Kohut’s discarding drive-discharge metaphysics to explain narcissism

opened the way for him to see self psychology as a new paradigm.
His editor, Paul Ornstein (1978), describes self psychology as
undergoing a gradual advance and raises the question, “What was
it that led to the basic change in direction that may rightfully be
designated as the acquisition of a new paradigm?” (p. 105).
Blum (1982), a critic of self psychology, recognizes self
psychology as a new paradigm: “[Self psychology] offers itself in
many ways not only as an addition, supplement, or complement, an
extension of our present theories, but as a new paradigm and
theoretical advance” (p. 964). He is, however, critical of the struc¬

tural-conflict/structural-deficit dichotomy as an oversimplification.
Curtis (1983), who notes the “already tenuous ties between
psychoanalysis and the theoretical system of self psychology” (p.
285), questions whether self psychology is a “new paradigm” within
psychoanalysis or is actually a “new depth psychology,” derived
from but no longer part of psychoanalysis (p. 272). Noting in
Kohut’s later letters an increasing use of the phrase “depth psychol-
ogy” where ordinarily one might expect the word “psychoanalysis,”
he writes:
In the absence of an explanation for such a preference, one is

bound to speculate that this reflects a compromise between the
need to retain a place within psychoanalysis and the desire for
differentiation as “an independent psychology of theself”[p. 281].
How Does Analysis Cure? (Kohut,1984) reveals Kohut well down

the road toward viewing self psychology as a new paradigm:
We have begun to consider even the psychoneuroses—Freud’s

“transference neuroses”—as specific variants of self disturbances,
that is, as analyzable self disturbances in the wider sense [p. 80]
. . . . I believe the oedipal neuroses, too, should be viewed as self-
disorders in a wider sense [p. 218, n.5].
And Kohut (1984) further says:
Self psychology is now attempting to demonstrate, for example,

that all forms of psychopathology are based either on defects in
the structure of the self, on distortions of the self, or on weakness
of the self. It is trying to show, furthermore, that all these flaws in
the self are due to disturbances in the self–selfobject relationships
in childhood. Stated in the obverse, by way of highlighting the
contrast between self psychological and traditional theory, self
psychology holds that pathogenic conflicts in the object-instinctual
realm—that is, pathogenic conflicts in the realm of object love
and object hate and in particular the set of conflicts called the
Oedipus complex—are not the primary cause of psychopathology
but its result [p. 53].
200 Chapter 16
In this later view, Kohut understands psychic conflict as one of the

sequelae of structuralized selfobject failures.
Miller (1988) also sees Kohut as developing a new paradigm by
subsuming the old theory within his new framework.
As self psychology developed Kohut no longer viewed it primarily

as an alternative explanation for clinical phenomena of equivalent
importance. Rather, he increasingly saw self psychology as the
central, fundamental position of analytic psychology and believed
it subsumed the classical position. It did not eliminate the classical
position, certainly not entirely, but contained it and treated
classical concepts and findings, in essence, as “special cases”
within self psychology. This is analogous to viewing Newton’s laws
of motion as useful special cases within the more valid, larger
viewpoint of modern physics. For example, as posited by self
psychology, a pathological Oedipus complex is seen as a frequent-
ly occurring special-case deterioration of the normal oedipal stage
[p. 81].
Markson and Thomson (1986) “believe that there is no clear cut

distinction between neurotic and nonneurotic disorders. Conflict,
defective structure, and underlying deficit are present in all cases”
(p. 35). They also
believe that in all psychopathology, including psychoneurosis,

structural conflicts have their origin in deficits in the supporting
structures of the self. These deficits have arisen from the accumu-
lative trauma of failures within the child-parent selfobject milieu”
[p. 39].
Markson and Thompson’s position is consistent with Kohut’s

(1984) final view:
informed therapeutic approaches to the classical transference

neuroses relate to their different conceptions of the basic
pathogenesis. The classical position maintains that we have arrived
at the deepest level when we have reached the patient’s experi-
ence of his impulses, wishes, and drives, that is, when the patient
has become aware of his archaic sexual lust and hostility. The self
psychologically informed analyst, however, will be open to the
fact that the pathogenic Oedipus complex is embedded in an
oedipal self-selfobject disturbance, that beneath lust and hostility

there is a layer of depression and of diffuse narcissistic rage. The
analytic process will, therefore, not only deal with the oedipal
conflicts per se but also, in a subsequent phase or, more frequent-
ly, more or less simultaneously (though even then with gradually
increasing emphasis), focus on the underlying depression and the
recognition of the failures of the child’s oedipal selfobjects [p. 5].
Efforts to integrate theories with self psychology are focused at

a general level possibly because, as Stolorow (1988) points out,
Kohut’s (1980) third (and, I believe, final) position on this issue

was that efforts to integrate self psychology with other theoretical
viewpoints, including the classical one, shall be postponed until
the self-psychological system has become more fully elaborated
and consolidated [p. 65].
When such an integration proceeds, however, it needs to follow two

principles: (1) keeping the discussions “experience near,” and (2)
creating new constructs that are more general and inclusive. For
example, Stolorow’s idea of an intersubjective field is an attempt at
“synthesizing the clinical understandings of classical psychoanalysis
and self psychology into a unified psychoanalytic framework” (p.
69). The idea of an intersubjective field is suitable as an inclusive
construct because it can contain many dimensions of experience,
including both the self-selfobject deficiencies and the conflictual.
When Stolorow (1985) refers to the conflictual dimension of
experience, he means that it is
viewed always and only as a subjective state of the individual

person . . . . When conflict is freed from the encumbering image
of an energy disposal apparatus . . . the supposed antithesis
between conflict theory and self psychology vanishes. When
conflict is liberated from the primacy of instinctual drive, then the
specific meaning-contexts that give rise to subjective states of
conflict becomes an empirical question to be explored psychoana¬
lytically[p. 193].
By the end of the 80s the conflict-developmental issue had faded

in importance not only because self psychology could explain both
202 Chapter 16
arrested development and conflict by its paradigm, but because

arrested development pointed to the importance of an adequate
theory of trauma. “[Max] Stern [regards] the phenomenology of
arrested states of psychological development [as] secondary to early
emotional trauma” (Levin, 1991, p. 122). Stern (1988), for example,
believed that night terrors, pavor noctumns, reflect arrested
development. Hence, self psychology has given increased attention
to the theory of trauma, the subject of chapter 22.
SCIENTIFIC REVOLUTION
Late in its development, self psychology began struggling with issues

common to scientific revolutions. Kuhn (1962), adumbrating his
idea of scientific revolution, rejected the notion that significant
scientific changes come from piecemeal additions to an ever
growing stockpile of knowledge. Rather, his research into previous
scientific advances revealed long periods of “normal science” based
on the prevailing paradigm, interspersed with relatively short
periods of crisis, during which radical shifts to a new paradigm
occur.
During normal science, scientists engage in mopping-up opera-
tions, apply the paradigm with increased precision, and find new
applications for it. A revolutionary paradigm shift occurs when the
prevailing paradigm cannot account for persistent anomalies, and an
alternative paradigm presents itself that can explain what was
covered by the old paradigm, as well as the former anomalies. For
example, Roentgen “discovered” X-rays when he noticed the
anomaly of a glowing barium platinocyanide screen after he had
covered his cathode-ray tube with black paper. Whatever was
making the screen glow was passing through the paper and the
space between tube and screen. When he held his hand in this
space he could see his bones in the dark shadow (Rhodes, 1986, p.
41).
Science’s reorientation by paradigm change is analogous to
“picking up of the other end of the stick.” The process involves
“handling the same bundle of data as before, but placing them in a
new system of relations with one another by giving them a different
framework” (Kuhn, 1962, p. 85).
Kuhn also saw that each paradigm attracts a community of

professionals committed to the paradigm. Hence, struggles between
competing paradigms during a period of revolutionary science
become struggles for the loyalty of practitioners. Students, particu-
larly, become a target group. For example,
Max Planck, surveying his own career in his Scientific Autobi-

ography, sadly remarked that “a new scientific truth does not
triumph by convincing its opponents and making them see the
light, but rather because its opponents eventually die, and a new
generation grows up that is familiarwith it” [p. 151].
In a similar vein, a frustrated Ernest Rutherford, the father of atomic

theory, once commented tartly that science moves forward one
funeral at a time.
Using Kuhn’s constructs, we see many of the critics of self
psychology approaching it from the standpoint of “normal science,”
whereas self psychology represents a revolutionary scientific change.
Its proponents make the case that the traditional analytic paradigm
is in a crisis, that narcissism is the major anomaly with which the
old paradigm failed to help the practitioners and that the new
paradigm can explain treatment of a broader range of clinical
syndromes, including the neuroses. Still remaining is the question
of the allegiances of therapeutic practitioners, whose major work is
psychotherapy. We take up the question of the difference between
psychoanalysis and psychotherapy in the next chapter.
Readings for Chapter 17: Gill, 1951, 1954, 1984; Bibring, 1954;
Stone, 1954; Kohut, 1980; Wallerstein, 1986, chapters 37-39.
17
Psychoanalysis and
Psychotherapy
T he question of the differences between psychoanalysis and

psychotherapy preceded the emergence of self psychology.
With the acceptance of psychoanalysis in the United States during
the post World War II boom and the concomitant emergence of
new psychotherapies, the 1950s saw efforts to define more clearly
and distinguish these two modes of healing. Out of this debate
came the consensus that psychoanalysis was the superior therapeutic
treatment modality if the patient could undergo it, because it alone
produced permanent structural change. Research into the results of
analytic work since the 50s has not confirmed this belief, nor has
the success of the theory and practice of psychotherapy using a self
psychology paradigm supported this view. In what follows we
examine psychoanalysis and psychotherapy under the following
topics: (a) distinctions of the fifties, (b) The Menninger Psychothera-
py Research Project, and (c) self psychology, psychoanalysis, and
psychotherapy.
204
Psychoanalysis and Psychotherapy 205
DISTINCTIONS OF THE 50S
Until the 1950s, the word psychotherapy was used in two ways:
“First as a broad term to include all types of therapy by psychologi-
cal means, under which psychoanalysis is included, and second in
a narrow sense to designate methods of psychological therapy
which are not psychoanalysis” (Gill, 1954, p. 772). This usage
followed the lead of Freud, who “at times used the term ’psycho-
therapy’ in its historical inclusive sense, or for psychoanalysis,
or—when referring to ‘other’ psychotherapies—for explicitly
nonanalytic procedures” (Stone, 1954, pp. 572-573). Such usage
implied a distinction between psychoanalysis and psychotherapy as
specific treatment modalities but did little to clarify the differences.
By the 1950s the vagueness of the distinction between psycho-
therapy and psychoanalysis was a problem. In the aftermath of
World War II, the field of psychotherapy, and especially psychoanal-
ysis, gained widespread acceptance and status. With psychoanalysis’
dominance in Departments of Psychiatry, its “task became to
facilitate its growth while continuing to prevent its identity from
being blurred” (Rangell, 1981, p. 665).
The threat of blurring came from several quarters. A major
challenge came from Alexander and French (1946) who modified
psychoanalysis to a “corrective emotional experience” at the
expense of insight, and dropped what they considered to be an
artificial distinction between psychoanalysis and psychotherapy.
Alexander (1953) infuriated the psychoanalytic establishment with
his claim that the distinction between these two therapeutic modes
was maintained, not on theoretical grounds, but for professional
prestige. Coming from the President of the Institute for Psychoanaly-
sis, Chicago, his challenge could not be ignored.
Although Alexander and French posed a danger to established
psychoanalysis from within, they were not the only challenge.
Fromm-Reichmann (1950), from her work with borderlines and
psychotics, also saw that the “widening scope” of psychoanalysis
made it barely distinguishable from intensive psychotherapy.
Furthermore, at the “weller” end of the nosological spectrum, Carl
Rogers’s success using short-term counseling of college students
raised serious doubts about the supreme efficacy of the in-
sight/structural model.
206 Chapter 17
The analytic community responded to these new psychothera¬

pies with papers by Bibring, Stone, and Gill, all published in 1954.
Bibring’s paper was of particular importance. He discussed a
number of techniques used in psychotherapy and psychoanalysis
along a hierarchy of effectiveness for achieving structural change:
(1) suggestive, (2) abreactive, (3) manipulative, (4) clarifying, and
(5) interpretive, with suggestive being on the bottom of the
hierarchy and interpretive on the top.
Suggestive means the inducing of ideas, feelings and actions by
an authority independent of the patient’s critical thinking. Abreac¬
tion is the releasing of emotional tension, so that an emotionally
strong idea is transformed into a weak one. Its curative value comes
from its combination with manipulation or clarification.
Manipulation can take several forms, in one of which the
therapist neutralizes the obstacles to treatment by assuring a patient
who is afraid of being influenced that he should never accept any
explanation unless he is fully convinced of its validity and of the
evidence offered. Another is encouraging a phobic patient to
confront his fears. A third example is through experiential manipu-
lation in which the patient is exposed to a new experience, either
because the opportunity did not arise earlier or because—more
likely—the opportunity was not recognized owing to inhibition or
distorted conceptions. This is influence through a “corrective
emotional experience” (Alexander and French, 1946).
Clarification, a term used by Rogers, helps the patient “see much
more clearly.” Clarification must not transcend the descriptive or
phenomenological level. It does not seek to explain, nor does it
refer to unconscious processes. Insight through clarification has
some limited curative value.
Interpretation, aimed at insight, refers exclusively to uncon-
scious material. Interpretation seeks to explain, thereby lifting the
unconscious into the conscious and resolving pathogenic infantile
conflicts.
After defining these therapeutic techniques, Bibring (1954)
described psychotherapy as different combinations of these
techniques (p. 765). To him, psychoanalysis distinguishes itself from
psychotherapy by using primarily clarification and interpretation,
and especially interpretation (p. 763).
Stone (1954) also makes interpretation the distinguishing feature

of psychoanalysis: “It is interpretation which is ultimately relied on
for the distinctively psychoanalytic effect” (p. 571). He states that
“the mobilization of the transference neurosis holds a central place”
(p. 572). Gill (1954) adds the feature of the analyst’s neutrality. In
a more formal definition, often quoted in the literature, Gill
summarizes as follows: “Psychoanalysis is that technique which,
employed by a neutral analyst, results in the development of a
regressive transference neurosis and the ultimate resolution of this
neurosis by techniques of interpretation alone” (p. 775). Gill’s
definition builds on the work of Strachey (1934), who used the term
“mutative interpretation” to describe the interpretation of some
transference investment by the patient in his relationship with the
analyst.
Macalpine (1950) had four years earlier, offered a definition of
psychoanalysis very similar to Gill’s:
To make transference and its development the essential difference

between psychoanalysis and all other psychotherapies, psychoana-
lytic technique may be defined as the only psychotherapeutic
method in which one-sided, infantile regression—analytic
transference—is induced in a patient (analysand) analyzed,
worked through, and finally resolved [p. 536].
Thus three components—analyst neutrality, regressive transference

neurosis, and resolution of the regression by interpretation
alone—became the pivotal defenses of psychoanalysis against the
inroads of “experience” psychotherapy.
For a generation of psychoanalysts, each of these components
was considered a necessary but not sufficient condition for psycho-
analysis. Therefore, without an analyst’s strict adherence to neutrali-
ty, say, a regressive transference neurosis does not fully develop.
And even though the analyst may make extensive use of interpreta-
tion, as can happen in intensive psychotherapy, interpretations not
aimed at resolving a transference neurosis will not be mutative, and
so the process is not psychoanalysis. Similarly, even with strict
neutrality, a transference neurosis may not develop if the patient
lacks the capacity for one, and so psychoanalysis does not occur.
208 Chapter 17
Further, even properly conducted attempts at psychoanalysis with

both neutrality and a developing transference neurosis may not be
psychoanalysis for lack of interpretation of the transference.
The value of Gill’s definition is that it focuses on the analytic
process rather than on the “ritualistic details” of the “extrinsic
criteria” such as, frequency of sessions or the use of a couch. The
definition also clearly delineates psychoanalysis from psychothera-
py—but at a price. One problem is that Gill’s definition can be used
to argue that none of Freud’s cases was psychoanalysis. For
example, Dora was not in psychoanalysis according to Gill’s criteria,
because, as Freud himself reported, he did not interpret the
transference. As a further example, in the case of the Wolf Man (see
chapter 20, this volume) the major problem was not so much
Freud’s technical parameter (Eissler, 1953) of forcing a termination,
but that Serge Pankejeffs regressive transference was never
resolved, as evidenced in his “negative therapeutic reaction” and his
status as a virtual “therapeutic lifer” (Wallerstein, 1986) in the de
facto care of the analytic community.
Another problem with Gill’s definition is that it limits the range
of potential psychoanalytic patients to those who can undergo a
transference neurosis, such as neurotics and some with milder
character disorders. Further, Gill’s definition excludes psychothera-
py, but at the expense of theoretical flexibility and generalizability.
Having defined psychoanalysis as the optimal therapeutic
method for structural change, Bibring, Stone and Gill all concede
that psychotherapy can produce some change in patients who are
unable to undergo a transference regression. Agreeing, Ticho (1970)
notes:
When we read about psychoanalysis of very regressed patients, we

often discover, by carefully studying the therapeutic procedures,
that the author is really referring to supportive (suppressive) or
expressive-supportive psychotherapy. The same thing could be
said of the “widening scope of psychoanalysis.” Many of the case
reports sound like psychotherapy on the couch, and often the
difference seems to be a semantic one [p. 128].
Freud clearly saw the necessity and value of psychotherapy. In

his introduction to Aichhorn’s Wayward Youth, Freud (1925) wrote:
The possibility of analytic influence rests upon quite definite

preconditions which can be summed up under the term “analytic
situation”; it requires the development of certain psychical struc-
tures and a particular attitude to the analyst. Where these are
lacking—as in the case of children, of juvenile delinquents, and,
as a rule, of impulsive criminals—something other than analysis
must be employed, though something which will be at one with
analysis in its purpose [p. 274].
Gill (1951) is interested in more clearly defining psychotherapy.

He thinks that even though psychotherapy does not attempt to
induce a regressive transference neurosis, the psychotherapist has
to make decisions whether to support or uncover the patient’s
defenses. He says, “The two poles of either strengthening the
defenses or analyzing them as first steps towards integrating the
damaged ego, stand as the gross opposites of two theoretical modes
of approach” (p. 65).
Gill also thinks that these supportive and uncovering (expres-
sive) types of psychotherapy need to be distinguished. He sees
uncovering psychotherapy as effecting more permanent change than
supportive psychotherapy does, because the uncovering approach,
by using interpretation, is closer to psychoanalysis and hence is
more able to effect structural change. Kernberg and his colleagues
(1972) likewise think that “expressive psychotherapy is generally
preferable to supportive psychotherapy” (p. 169) because “support-
ive approaches, since they do not analyze negative transference
components, are doomed to fail, because the patients inevitably ’are
prevented from accepting the supportive aspects of psychotherapy”’
(Kernberg et al., 1972, cited in Wallerstein, 1986, p. 699).
Sporadic appearances of transference in psychotherapy, can be
usefully interpreted in expressive psychotherapy to foster some
structural change. Stone (1954) wrote, “Pathological fragments of
the transference relationship . . . [may] be utilized to great and
genuine interpretive advantage by a skillful therapist” (p. 578).
What are these supportive techniques? Gill (1951) sees anything
that strengthens a patient’s defenses as supportive, including
encouraging or praising the patient; avoiding attacking the patient’s
defenses; and making inexact interpretations (Glover, 1931) that
uncover fantasies that are related symbolically to the ones creating
210 Chapter 17
the conflict and thus enable partial abreactions of instincts. Chessick

(1974) sees the “essence of supportive psychotherapy as the
reduction of anxiety by various techniques” (p. 63). To Wallerstein
(1986) the basic feature of supportive psychotherapy is the “transfer-
ence cure” (p. 390).
In the transference cure, the patient willingly strives for certain
goals and changes “for the therapist” in gratitude for the therapist’s
gratification of his needs. The basis of a transference cure is a
therapeutic quid pro quo:
This mechanism of the transference cure operates widely, if not

totally persuasively, in the supportive psychotherapies, and to
varying degrees in the expressive psychotherapies (even psycho-
analysis) as well—in fact, wherever there are unanalyzed transfer-
ence components in the context of therapeutic changes [Waller-
stein, 1986, pp. 390-391].
Another idea associated with supportive psychotherapy is the

Alexander and French (1946) concept of a “corrective emotional
experience” In it, the therapist attempts
to alter or resolve expectations and behaviors of the patient by a

planned counteraction within the transference situation, in which
the patient is directly confronted with attitudes and behaviors of
the therapist that are deliberately contrary to the patient’s
transference expectations [Wallerstein, 1986, p. 451].
Chassel (1953), taking an even stronger position in support of

psychotherapy, wrote:
We keep assuming that psychotherapy is a watered down proce-

dure or is bound to be pure psychoanalysis alloyed with the baser
metals of suggestion, and so on. My present thesis is that really
psychodynamic psychotherapy is an approach as strong as or
stronger than classical psychoanalysis, has increasingly greater
range of applicability than classical psychoanalysis; is more
inclusive theoretically, and that classical psychoanalysis may turn
out to be a special procedure of limited but significant usefulness
in certain cases [pp. 550-551].
Gill (1954) does not go as far as Chassel, but having defined

psychoanalysis to distinguish it from psychotherapy, he does not
want psychotherapy devalued, especially the expressive, uncovering
type:
Discussion of therapeutic results in psychoanalysis and psycho-

therapy too often views them as qualitative polar opposites, with
psychoanalysis regarded as producing structural changes, and
psychotherapy as unable to produce any significant intrapsychic
change, but only altering techniques of adjustment through
transference effects or shifts in defensive techniques [p. 787].
Gill declines to view psychotherapy and psychoanalysis as polar

opposites:
I am not suggesting that psychotherapy can do what psychoanaly-

sis can do; but I am suggesting that a description of the results of
intensive psychotherapy may be not merely in terms of shifts of
defense, but also in terms of other intra-ego alterations [p. 793].
Influenced by the phenomenological viewpoint, Gill (1984), 30

years later, modified his position about psychoanalysis but contin-
ued to see the need for psychoanalysis and psychotherapy to be
distinguished. He sees how the setting and the analyst’s behavior
help codetermine the transference because of inadvertent sugges-
tions. This means that neutrality, an effort to avoid suggestive effects
on the transference, “cannot accomplish that aim because the
patient inevitably interprets the analyst’s behavior in ways other than
those the analyst intended” (p. 168). Therefore, the analyst inevitably
has to explore the meanings of his own behavior for the patient.
Gill now places great emphasis on analyzing the transference in
the here-and-now rather than on neutrality. Further, he discards the
idea of transference regression as a distinguishing feature of
psychoanalysis, because he believes that the idea of a regression as
a revival of an earlier infantile state is an illusion. He thinks that
analysis may induce an unnecessary, if not iatrogenic, regression: “I
consider that a well conducted analysis is marked by a transference,
not necessarily by a regressive transference” (p. 170). But in
212 Chapter 17
deemphasizing two of the three intrinsic criteria of his 1954

position, by discounting the extrinsic criteria, and by emphasizing
exploring the transference in the here and now, Gill has, it may be
argued, made it more difficult to distinguish psychoanalysis from
intensive, uncovering (expressive) psychotherapy, even though he
still views the differences as analyzing the transference in psycho-
analysis as opposed to utilizing it therapeutically in psychotherapy.
THE MENNINGER PSYCHOTHERAPY

RESEARCH PROJECT (PRP)
From 1954 to 1958, 42 patients who presented for treatment at the

Menninger Hospital in Topeka, Kansas, were subjects of a major
psychotherapy study. Twenty-two of these patients deemed suitable
for psychoanalysis were treated with this modality for an average of
about 1,000 hours each; twenty were given psychotherapy for an
average of about 300 hours each. The patients, who ranged in ages
from 17 to 50 and had a mean IQ in the “superior range” (124),
were balanced for gender.
The study used a naturalistic design. Patients were assigned to
the treatment modalities solely on the basis of anticipated best treat-
ment; no randomization or matching occurred to make the two
groups equivalent and establish a definitive sample for comparing
the efficacy of psychoanalysis with that of psychotherapy. Using an
idea similar to Rogers’s (1961) design, each patient served as his
own “control.” (Rogers used patients waiting for treatment as a
control group against whom he compared the results of a group of
patients being treated.) The Menninger study, however, used
Allport’s (1937) strategy of “control”; that is, it compared each
patient’s progress against an original prediction.
Wallerstein (1986) explains the value of such predictions as
follows:
It might have been felt that the major conflicts that constituted the
particular neurotic illness of a patient could only be resolved
through psychoanalysis, and that various desired and specified
changes would otherwise not occur. If the patient, for reality
reasons, were in only a once-a-week psychotherapy, and some of
the changes that had been postulated to be dependent on psycho-

analysis with the working through of the full-fledged regressive
transference neurosis, nevertheless did take place in this far less
intensive (and regressive) therapeutic effect, then the assumptive
bases on which particular predictions had rested would be
seriously shaken [p. 114].
At the beginning, the project used Gill’s (1951) conceptual

difference between supportive and expressive psychotherapy. Before
long, however, it was obvious that this supportive-expressive
distinction was not “a particularly clarifying or useful endeavor”
(Wallerstein, 1986, p. 686) because there was a significant blurring
between the two modes. Agreeing with this finding, Schlesinger
(1969) argued that all therapies are supportive and expressive and
that it is more useful to ask “expressive, how and when?” and
“supportive, how and when?” rather than “supportive or expres-
sive?”
The results of this study can be seen in the global improvement
ratings (p. 515) of the 42 patients. As Table 1 shows, there was as
much very good to moderate improvement in the psychotherapy
patients as there was in the psychoanalysis patients.
Additionally, measurements using a Health Sickness Rating Scale
(HSRS) support the findings of the global ratings (Wallerstein, 1986,
p. 532). The HSRS, with a range of 0-100, represents excellent
mental health with the score of 100. In Table 2, the psychotherapy
and psychoanalysis patients show equal improvement in scores at
TABLE 1
Percentage of Global Improvement
by Treatment Mode
Category Psychotherapy Psychoanalysis

Very Good 45% 36%
improvement
Moderate 15% 23%
improvement
Equivocal 15% 14%
improvement
Failure 25% 27%
214 Chapter 17
TABLE 2
Mean Scores of the HSRS
Follow-up
Modality Before After
(2+ yrs.)
Psychotherapy 43 56.5 58
Psychoanalysis 48 62 65
the termination of treatment and a slight improvement at the follow-

up stage over two years later. The persistent lower scores for the
psychotherapy patients, before, after, and at follow-up, reflect their
sicker status at the beginning of treatment. The slightly greater gains
by the analysis group is a common pattern in research where
preexisting differences between groups tend to increase over time.
Other results indicate that there was a significant tendency to
misdiagnose patients by underestimating their pathology. One
reason for this miscalculation was thepatients’frequent withholding
of significant negative diagnostic material until well into the
treatment. This underestimation of pathology was reflected in the
fact that of the 22 who commenced classical analysis, six had their
treatment modified by parameters (Eissler, 1953), such as taking
three months to explore an impasse and terminate if there was no
resolution, and six were shifted into psychotherapy.
On the basis of a battery of projective tests given to each patient,
Applebaum (1977) concluded that 19 of the 42 patients achieved
changes far in excess of their developing insights. Sixteen of these
patients were in psychotherapy. Wallerstein (1986) reports, “For 19
patients . . . the changes were substantially in excess of insights, and
were thus presumably based on other factors than the interpretation
of unconscious conflict leading to conflict resolution and concomi-
tant insight” (p. 717). Further study of the results indicates that 10
of 11 patients who showed conflict resolution on the tests also
showed structural change, as seen in lasting improvements in
feelings, attitudes and behavioral functioning. Also, 7 out of 16
revealed no conflict resolution, yet showed improved structural
changes. Applebaum (1977) concludes: “Both points of view, that
structural change is associated with resolution of conflict and that
structural change can come about in the absence of conflict

resolution, receive support” (p. 207).
These results suggest extremely important conclusions for the
issue of the difference between psychotherapy and psychoanalysis.
While supporting the efficacy of classically conducted psychoanaly-
sis, they indicate that the ability of psychotherapy to produce
significant permanent change has been greatly underestimated. What
has been challenged by these results is the supremacy of psycho-
analysis as a treatment modality and its claim that it alone, through
neutrality, the transference neurosis, and interpretation of this
transference, can produce structural change. To the contrary,
“fundamental changes can be brought about in people even though
they are unable to develop much insight” (p. 214), and “conflict
resolution cannot be considered essential to structural change and
may be independent of it in some instances” (Applebaum, 1977, p.
208).
Horwitz (1974), using the results of the prediction study, came
to similar conclusions. He focused on the stability of the change
from supportive treatment. Wallerstein (1986) discusses Horwitz’s
findings:
Patients who improved with supportive psychotherapeutic modes

could maintain and even consolidate their functioning through the
period of the follow-up observation. Furthermore, they could do
so just as often without significant continuing contact that had
initially been presumed to be required, since such supportive
based changes had been expected to be less stable, less able to
weather the stresses of subsequent life. Horwitz (1974) feels that
three major factors could be contributory to such relatively
enduring treatment gains in supportive psychotherapies (pp. 229-
230): (1) continuing supportive environmental factors, such as the
more appropriate marriages that some of these patients had by
now entered into (the therapeutic process has helped these
patients to understand better the nature of their needs, and thus
influenced them to make wiser choices); (2) the positive feedback
reinforcement from new, more adaptive behaviors, into which the
therapists had implicitly or explicitly encouraged these patients;
and (3) a continuing and durable positive feeling toward the
therapists, seen as the conscious manifestation of significant shifts
216 Chapter 17
in the patient’s inner world of object relationships and self and

object representations [pp. 719-720].
Another finding came from investigating the question of

transference cure among the study’s patients. In 21 of the patients
(50%), ten of the analytic cases and eleven of the therapy cases,
clear-cut evidence was adduced of the important operation of this

mechanism of transference gratification and transference cure in
the result achieved, admixed with whatever other supportive
and/or expressive mechanisms also characterized (or predominat-
ed) in their treatment courses [Wallerstein, 1986, p. 391].
Even more important was evidence during the follow-up studies of

a “surprising (to us) durability of such changes” (p. 391).
The durability of the changes induced by a “transference cure”
is of considerable significance. It cuts across the prevailing position
in psychoanalysis and supports self psychology’s theoretical position
of the centrality of selfobject functions in psychoanalysis and psycho-
therapy. The research is all the more trustworthy because the results
were obtained by professionals without any theoretical commitment
to self psychology. In fact, the project was well under way before
the emergence of Kohut’s ideas. Indeed, the unexpected support for
long-term changes based on a transference cure begs for a theoreti-
cal explanation. The traditional view of the impermanence of a
transference cure may be wrong, but why?
One explanation, based on self psychology theory, is that
selfobject functions are central to any form of psychotherapy,
including psychoanalysis. Thus, the Menninger findings about the
transference cure and the central place of selfobject functions in self
psychology support each other. At a minimum, the Menninger
findings help refute the critics of self psychology, such as Rothstein
(1980), who see self psychology as nothing more than “a corrective
emotional experience,” that is, a transference cure and, by implica-
tion, not productive of lasting change and by further implication,
not “true analysis.”
In summary: (1) Classical analysis is efficacious in producing
structural change with a carefully selected group of patients who
seek long term psychotherapeutic treatment; (2) supportive-
expressive psychotherapy is much more effective in producing

structural change than the theoretical model underlying classical
analysis predicts; (3) neutrality, regressive transference neurosis,
interpretation and insight form a limited general theory of structural
change; and (4) Bib-ring’s hierarchy of techniques for structural
change is an inadequate way of conceiving the psychoanalysis and
psychotherapy issue.
SELF PSYCHOLOGY, PSYCHOANALYSIS,

AND PSYCHOTHERAPY
Kohut (1980) thought there was value in differentiating psychoanaly-

sis from psychotherapy. Psychoanalysis is aimed at a person with
disorders of the self who need changes in a “sector” of the self,
whereas self-psychologically informed, intensive uncovering
psychotherapy is aimed at persons who need changes in a “seg-
ment” of the self (p. 532). Precisely what Kohut meant by these
terms is not defined, but it is clear that “sector” involves a more
major change than “segment.” It is also obvious that both psycho-
analysis and self-psychologically informed psychotherapy create new
structures in the self through transmuting microinternalizations.
Even though Kohut believed that psychoanalysis and psychother-
apy have different aims, he rejected the notion that they are polar
opposites. They have more in common than they have differences.
In both modes a selfobject transference emerges as the ana-
lyst/therapist becomes empathically immersed in the patient’s
narrative. In both modes, significant gross identifications may occur.
The difference between the two lies in the working through
process, whereby the patient gradually relinquishes the need for an
archaic selfobject. Kohut (1980) wrote:
In psychotherapy the working through process will play a less

significant role and will, in particular, not be carried out as
systematically in the transference as in psychoanalysis proper but
will be activated—by transference interpretations—only to that
minimal extent necessary to reach the psychotherapeutic goal. A
minimum of transference interpretations may thus be necessary
to enable the patient to make the shift from the selfobject analyst
218 Chapter 17
to other selfobject figures and to diminish his sensitivities

sufficiently to enable him to make use of the selfobject support
that he can obtain from appropriate people in the surroundings
without immediate withdrawal from them when they disappoint
him . . . . Our aim in psychotherapy is primarily the improvement
of functioning and well-being and only secondarily the attainment
of maximal structural change . . . . The goal of psychotherapy. .
. is the replacement of the deficits in the patient’s self structure by
appropriate self-selfobject relationships . . . support that can be
obtained from the patient’s family, or friends, or from various
social institutions (such as religious organizations).
Having attempted . . . to delineate the borders between

psychoanalysis proper and psychoanalytically informed psycho-
therapy, it behooves me to admit at the end that, in practice, these
differentiating lines cannot always be drawn sharply [p. 535].
Kohut (1984) cites as an example of what he means by a

psychotherapeutic result compared with a psychoanalytic one, the
curative work of Dr. Schweninger, Otto Von Bismark’s physician.
Bismark suffered from a sleep disturbance:
Schweninger . . . came to Bismark’s house at bedtime one evening

and sat next to the statesman’s bed until he had fallen asleep.
When Bismark awakened the next morning, after a full night’s
sleep, Schweninger was still sitting at his bedside, welcoming him,
as it were, into the new day. I believe it would be difficult to find
a more striking clinical instance demonstrating how, via a transfer-
ence enactment, the fulfillment of a patient’s need for an empathi-
cally responsive selfobject can restore the patient’s ability to fall
sleep [pp. 19-20].
Kohut continues, “Schweninger’s responsiveness to Bismark’s need

for a soothing idealized selfobject lead to psychotherapeutic but not
psychoanalytic results unless the transference is interpreted and
analytically worked through” (p. 20).
Kohut also saw that structuralization itself does not distinguish
between psychoanalysis and psychotherapy, because some structur-
alization occurs during the “understanding phase” in psychoanalysis
and psychotherapy. He (1984) raises the question:
Specifically should we characterize the acquisition of the minute

amounts of new psychic structures that are provided via the
understanding phase alone—even when the analyst is unable to
supplement his accurate understanding with a correct interpreta-
tion (e.g., because he is informed by a nonfitting theory or
because he has explained too soon)—a psychoanalytic success or
should we subsume it under the heading of “psychotherapy” [p.
103]?
Such thinking led Kohut to conclude that the essential difference

between psychoanalysis and psychotherapy consisted of the extent
to which explanations were a part of an extensive working-through
process.
In psychoanalysis, where gross identification plays a larger role,
there is a more extended and systematic working-through process;
the archaic selfobject is gradually relinquished; and there is a
strengthening of the goals and ideals of the nuclear self. The new,
firmly consolidated inner structures enable appropriate selfobject
needs to be met through interactions in the present-day surround-
ings (Kohut, 1980, p. 534).
In the Menninger Research Project, although the analysts did not
use self psychology theory, the extensive working through process
meant an additional 700 hours of sessions, on the average, for each
client (300 for psychotherapy and 1,000 for psychoanalysis). Perhaps
with a less “difficult to treat” population than was treated at the
Menninger Foundation, the amount of time for each mode of
healing might have been less, but the ratio might well have
remained the same. The issue of psychoanalysis verses psychothera-
py may eventually come down to a choice of how extensive and
permanent the patient needs the new structures to be and whether
the patient is willing to endure approximately three times the cost
and effort.
Goldberg (1980b), in basic agreement with Kohut, states the
matter a little differently. He too sees the difference as less in the
method and more on the goals of treatment. He views psychothera-
py as a repair of the self and psychoanalysis as a reorganization of
the self. By using the terms repair and reorganization, Goldberg
avoids Kohut’s use of the spatial metaphors of sector and segment.
220 Chapter 17
The distinction between repair and reorganization, however, may

not always be easy to discern.
Muslin and Val (1987) apply Kohut’s ideas to the three therapeu-
tic modalities of the 50s: supportive psychotherapy, intensive
psychotherapy and psychoanalysis. From a self psychology perspec-
tive, they see the link between these three treatment modalities as
the use of selfobject functions. Distinctive to these three modalities
is their use of these selfobject functions to achieve different
treatment aims. To Muslin and Val, supportive psychotherapy seeks
to restore a patient’s equilibrium by using the selfobject tie as an
uninterpreted transference cure. Intensive psychotherapy aims to
solve specific problems in the patient’s life by using the selfobject
tie to focus interpretations on major figures in the environment.
Psychoanalysis tries to change major defects in the self, relived in
the self–selfobject encounter, through interpretation and through
the microinternalizations of the working through phase.
Self psychology certainly recognizes that psychoanalysis and
psychotherapy have different treatment goals. Yet the very idea that
disorders of the self can be substantially engaged—and significant
therapeutic gains made—through either psychoanalysis or intensive
psychotherapy informed by self-psychological principles, flies in the
face of the traditional belief that narcissistic disorders need to be
treated with support, manipulation or by use of parameters. Paul
Ornstein (1974) summarizes this old position under two categories:
(1) “analysis,” for those patients more severely disturbed and for
whom various degrees of manipulative measures are instituted
when it is anticipated that an analyzable transference neurosis
cannot develop. This approach can be successful, but it leaves
unclear what has been useful; (2) “analysis with parameters,” for the
less severely disturbed for whom some form of active intervention
prepares a defective ego and eventually leads to a transference
neurosis. These parameters do not engage the central pathology and
are interpretively resolved prior to termination (pp. 129-130).
Ornstein emphasizes that Kohut’s new theoretical understanding
of narcissism built on clinical experience, “leads to an expansion of
the psychoanalytic method without evoking the use of parameters”
(p. 147). Nor did Kohut need to use the manipulative techniques of
Franz Alexander. Of course, Kohut’s method applies to the more
functional, higher level, narcissistic patients he saw in private

practice but is not necessarily applicable to the sicker end of the
narcissistic spectrum, such as borderlines and other severe character
disorders, where various types of parameters and supportive
techniques may need to be employed.
Rothstein (1980), a critic of self psychology, does not accept the
position taken by Kohut and other self psychology authors; he
thinks it is impossible to conduct psychoanalysis using a self
psychology paradigm. For Rothstein, treatment offered by self
psychology is neither psychoanalysis nor uncovering psychotherapy.
It is merely the supportive kind (p. 445) because “Kohut’s ‘cure’
occurs through nonverbal reparative internalizations” (p. 442) and
not through interpretation and insight. He sees it as another version
of Alexander and French’s (1946) “corrective emotional experience”
with its manipulative techniques, In the context of the distinctions
introduced in the 50s, this is strong condemnation. The difficulty
with Rothstein’s position is that this distinction has not held up after
40 years of practice. Nor has he grasped the fact that self psycholo-
gy, whether as intensive psychotherapy or psychoanalysis, does
eventually “explain” (interpret) the selfobject transferences.
The difficulty seen by Rothstein and other critics seems to come
from their commitment to a specific form of psychoanalysis,
narrowly defined to treat neurotic patients. Kohut’s new ideas feel
foreign unless a more general understanding of Freud and psycho-
analysis is taken. Basch (1983c) says of Kohut, for example:
His method of conducting an analysis had not changed; it

remained based on the fundamental premises laid down by
Freud, namely, that cure was effected through promoting the
patient’s understanding of his pathology. This understanding was
made possible by the interpretation and working through of the
patient’s transference to the analyst. What had changed was
Kohut’s grasp of the scope of transference [p. 234].
Basch, who has written two books about psychotherapy, Doing

Psychotherapy (1980), and Understanding Psychotherapy (1988a)
grounded in self psychology theory, says, “Kohut’s work finally
makes the method of psychoanalysis applicable to the various
psychotherapies” (Basch, 1983c, p. 237).
222 Chapter 17
Stolorow, who defines psychoanalysis as the science of the

intersubjective (Atwood and Stolorow, 1984, p. 64), states that self
psychology from an intersubjective perspective applies to psycho-
analysis and psychoanalytic psychotherapy interchangeably (Atwood,
Stolorow, and Trop, 1989).
In summary, Kohut and self psychology theory have made it
possible for competent, well-trained helping professionals to
practice self-psychologically informed psychotherapy without feeling
what they do is “second class.” As every new paradigm ultimately
stands or falls on the practitioners who find a paradigm useful, self
psychology has the potential to cut across the traditional barriers
that have long been a source of tension in the healing professions
and form a new base of mutual influence between psychoanalysis
and the broader therapeutic community. Like any successful
revolutionary paradigm, self psychology needs to become concre-
tized in a new community of scholars and practitioners, a communi-
ty that may be in the process of being born.
Even though Kohut’s self psychology paved the way for a new
healing paradigm for a broad group of professionals and for a new
approach to both psychoanalysis and psychotherapy, it still remained
incomplete in many ways when Kohut died. For the remainder of
this book we touch on the work of the post-Kohutians, former
colleagues, students, and others who have continued to develop the
self psychology paradigm. In the next chapter we take a look at the
concept of transference and the idea that it represents an uncon-
scious organizing principle. This leads us to the position of the
intersubjectivists and their stress on a phenomenological approach
to psychotherapy.
Readings (or Chapter 18: Stolorow et al., 1987, chapter 3.
18
Transference as
Organizing Principle
S elfence.psychology has significantly changed the concept of transfer-

These changes started when Kohut insisted that narcissis-
tic transferences (see chapters 11, 12 and 13, this volume) were
different from the transferences observed in the neuroses. The
traditional view of transference, the “false connection” idea of
Freud, was used by him “to describe both a process of exchange
between the unconscious and the preconscious across the repres-
sion barrier, and the consequences of that process for dreaming and
the analytic relationship” (Basch, 1986, p. 27).
In a general definition, Bacal (1988) states that transference is
“the patient’s experience of his relationship with the analyst as
determined by infantile experience” (p. 129). If viewed broadly,
such a definition covers both the traditional idea of transference and
Kohut’s narcissistic transference. The crucial issue is the nature of
the infant experience. In the traditional view, it is an actual
experience during childhood that affects the therapeutic relation-
223
Chapter 18
ship. In Kohut’s concept of the narcissistic transference, it is the

absence of a needed experience, or mismatches of caretaker and
child, that create a deficit in structure and transference longings.
Kohut did not deny that the traditional transference occurs with
neurotic patients. He thought, however, that the idea of transference
needed to be broadened to include the narcissistic kind. Opposed
to Kohut’s view are those who believe that a narcissistic transfer-
ence is not a “true” transference. Classical analysis defines transfer-
ence narrowly, as a projection of the analysand’s prior experience
with significant objects onto the blank screen of the analyst.
While a struggle was taking place over whether the narcissistic
transferences should be included within an expanded understanding
of transference, the idea of a narcissistic transference broadened
into the concept of a selfobject experience (see chapter 14, this
volume). The longings based on deficits, as seen in the narcissistic
transferences, were generalized into the seeking of formerly
unavailable selfobject experiences. In conceptualizing selfobject
experiences, Kohut opened up the possibility of primitive deficits
besides those that were a part of the narcissistic disorders. Further,
as a central construct of self psychology theory, the selfobject
experience had the advantage of no longer having the name
transference attached to it. Consequently, as the term selfobject
experience began to replace the term narcissistic transference,
debates over what was a true transference declined. Concomitantly,
the significance of the classical view of transference decreased
within self psychology.
There are good theoretical reasons why the traditional view of
transference imposes a severe limitation in clinical work with
nonneurotic patients. As initially described by Breuer and Freud
(1893-1895), transference was a “false connection” made by the
patient and later conceived as a “distortion” of the analyst’s “real”
qualities (Stolorow et al., 1988, p. 106). Schwaber (1983b) and
others have shown that such a view is based on a “hierarchically
ordered two-reality view” (p. 383), one reality experienced by the
patient and the other, known to be more objectively true, by the
analyst. This view of reality and classical analysis is firmly rejected
by Schwaber, and by Stolorow and his colleagues. They believe that
a hierarchically ordered, two-reality view is the reason analysis has
Transference as Organizing Principle 225
not been of therapeutic benefit to more disturbed patients, that is,

those with narcissistic disorders or psychoses.
Stolorow et al. (1987) are also critical of the classical view of
transference. They represent an intersubjective position in self
psychology that, following Kohut’s emphasis on empathy as a
methodology, conceives of psychoanalysis as the science of the
subjective. They represent one important position in the post-
Kohutian era of self psychology. From their point of view, they
critique four major views of transference: (a) regression, (b)
displacement, (c) projection, and (d) distortion. They then present
(e), transference as organizing principle, (f) the intersubjective field,
and (g) concretization.
TRANSFERENCE AS REGRESSION
Waelder (1956) stated:
Transference may be said to be an attempt of the patient to revive

and re-enact, in the analytic situation and in relation to the analyst,
situations and phantasies of his childhood. Hence, transference is
a regressive process [p. 367].
Stolorow et al. (1987) have difficulty with the idea of transfer-

ence as regression. A clinical regression model assumes an
isomorphic reenactment of traumatic relationships from the early
history. It is very doubtful that this is possible. For example, it has
been believed, based on Freud’s ideas, that serious disturbances
such as schizophrenia involve a regression to the earliest months of
infancy. Yet evidence from observations of infants strongly indicates
that adult autism and schizophrenia have no counterpart in infancy.
Even in the first few months of life, there is significant interaction
between mother and child. This is seen during the three-to-five
month period of infancy, when mothers give the infant control—or
rather the infant takes control—over the initiations and terminations
of direct visual engagement in social activities (Stern, 1985).
Evidence of significant interaction between mother and infant
in the first few months of life also means that there is no undiffer-
226 Chapter 18
entiated symbiotic stage in infancy to which to regress. Mahler

(1979) argued for such a symbiotic stage to describe the state of
fusion with the mother in which the “I” is not yet differentiated
from the “not I” (p. 78). But Stern’s (1985) infant research does not
support Mahler’s concept. Already in early infancy there is an
emergent sense of self in the infant, differentiated from the self of
the mother. Nor can it be said that a person regresses to an infant
state, because a prolonged or continuous period of symbiosis is
neither typical nor normative for an infant. Stern (1983) says that
the infant alternates between periods of oneness, as inferred from
synchronous patterns, and periods of disengagement.
Behind the assumption of the classical view of transference, that
persons regress to an oral, anal or phallic stage, is the idea of
regression as failure of renunciation. Having failed to renounce the
cravings associated with the id drives, a person’s ego becomes
weakened and a regression occurs. So the basic assumption behind
regression is drive theory. Once drive theory is discarded (see
chapter 5, this volume), the idea of regression loses its theoretical
underpinnings and its usefulness as a clinical explanation.
In contrast to conceiving of a patient as regressing, Stolorow
and his colleagues advocate understanding regression as movement
to another level of organization, an archaic level that had been
prematurely aborted, precluded, or disavowed. In psychotherapy,
the task is to integrate this archaic form of organization into more
mature modes. Rather than saying that the patient has regressed to
an infantile period, we can only say that a “patient’s experiences are
shaped by archaic organizing principles” (Stolorow et al., 1987, p.
32).
TRANSFERENCE AS DISPLACEMENT
The concept of displacement, also based on drive theory, was

initially used to describe one of the mechanisms of dream work.
Nunberg (1951), on the other hand, sees transference as displace-
ment: “[the patient] displaces emotions belonging to an unconscious
representation of a repressed object to a mental representation of
an object of the external world” (p. 1).
Transfererice as Organizing Principle 227
Stolorow et. al. (1987), reject the view that transference is

displacement because materialistic notions lie behind it:
In our view of transference, there is nothing removed from the

past and attached to the current situation. It is true that the
organization of the transference gives the analyst a glimpse of
what a childhood relationship was like or what the patient wished
or feared it could have been like. However, this insight into the
patient’s early history is possible not because an idea from the
past has been displaced to the present, but because the structures
that were organized in the past either continue to be functionally
effective or remain available for periodic mobilization [p. 33].
Stolorow and his colleagues are concerned that the concept of

transference as displacement has perpetuated the view that the
patient’s experience of the analytic relationship is solely a product
of the past and not determined by the analyst’s behavior. With such
a view, a therapist’s interpretation of transference is often followed
by a severe depression in the patient and an extreme feeling of
hopelessness.
TRANSFERENCE AS PROJECTION
This idea draws heavily on the ideas of Melanie Klein. Racker

(1954), for example, using Klein’s concepts, viewed transference as
the projection of rejecting internal objects onto the analyst whereby
internal conflicts become converted into external ones. The neo-
Kleinian Kernberg (1975) sees archaic transferences as arising from
the operation of projective identification, a primitive mechanism to
externalize all bad and aggressive self- and object images.
For Stolorow and his colleagues (1987) the idea of transference
as projection is too limiting. It obscures the developmental
dimension of transference from the more archaic to the less archaic.
Moreover, how can projection be a primitive defense if projection
can take place only after a self–object differentiation has occurred?
Instead of viewing splitting and projective identification as ways
of explaining archaic transference states, Stolorow et al. hold that
such transferences are best understood as developmental arrests at
228 Chapter 18
early modes of experience in which self and object are incompletely

distinguished. It is more plausible to believe that such difficulty with
distinguishing self and object is the result of psychic trauma—the
inability to integrate powerful affects by an immature nervous
system—than the result of elaborate mental processes such as
splitting and projective identification. Klein’s formulations “grant the
child perceptual and cognitive qualities that would not be compati-
ble with the immature state of his central nervous system” (Giovac¬
chini, 1979, p. 23; see also Glover, 1945, and Zetzel, 1956).
TRANSFERENCE AS DISTORTION
Sullivan (1953) used distortion as generalized regression, displace-

ment, and projection. His view assumes that the goal of treatment
is to correct the distortions of what the analyst knows to be
objectively real. This approach leaves judgments about “truth” to the
therapist and was abandoned for the same reasons mentioned
earlier by both Schwaber (1983a, 1983b) and Stolorow et al. (1987).
Stolorow and his colleagues (1987) think that “therapists often
invoke the concept of distortion when the patient’s feelings,
whether denigrating or admiring, contradict self-perceptions and
expectations that the therapist requires for his own well-being” (p.
35). Gill (1982), in accord with Stolorow and colleagues on this
point, suggests that rather than conceiving of transference as
distortion, it is better to say the experience is subject to other
interpretations. For Winnicott (1951), whose position was that
transference is contrary to the idea of distortion, transference is a
sampling of the psychic reality of a person. It belongs to the realm
of illusion, an “intermediate area” of experience, unchallenged in
respect of its belonging to inner or external reality (p. 239), a
statement that also is revelatory of Winnicott’s respect for illusion.
TRANSFERENCE AS ORGANIZING
PRINCIPLE
What analysts experience as transference is the patient’s revealing

his organizing principles. “Transference is conceived . . . as the
expression of a universal psychological striving to organize

experience and construct meanings” (Stolorow et al., 1987, p. 37)
Out of that striving, “organizing principles and imagery that
crystallized out of the patient’s early formative experiences” (p. 36)
continue to influence a person’s relationships. The concept of
transference refers to
all the ways in which the patient’s experience of the analytic

relationship is shaped by his own psychological structures—by the
distinctive, archaically rooted configurations of self and object that
unconsciously organize his subjective universe [p. 36].
Freud had two views of transference. One was as resistance to

remembering; the other as reexperiencing. The “resistance to
remembering” concept has to be abandoned, according to Stolorow
and his colleagues, because it is an archaeological metaphor. They
believe the view of transference as re-experiencing is much more
useful because it provides access to the patient’s psychic world, that
is, to the patient’s organizing principles. They also reject Gill’s
position on the resolution of the transference, because, in practice,
resolution becomes a synonym for renouncement.
Freud’s focus on the emergence of transference as reexperienc-
ing is clinically useful. Kohut (1977), going further, realized that
patients often resisted transference reexperiencing out of fear of
retraumatization and a fear of loss of self in merger. Writing about
the “dread to repeat” as a major impediment to the unfolding of the
patient’s organizing principles, Anna Ornstein (1974) made a similar
point.
In a significant theoretical move, Stolorow and his colleagues
define the ubiquitous countertransference as the analyst’s organizing
activity. Such a definition accepts countertransference as an
inevitable fact in itself neither good nor bad. It does not view
countertransference as a dangerous computer virus that has to be
eradicated as quickly as possible to make the mental apparatus, the
computer, function without error. Both transference and counter-
transference are necessary components of the configurations of self
and object, or self and selfobject, that take place within the thera-
peutic milieu, which Stolorow and his colleagues have termed the
intersubjective context.
230 Chapter 18
The idea that the transference constitutes the distortion of reality

by the patient leads to the corollary that the therapist avoids
contaminating the therapy so that the patient can see his or her own
distortion more clearly. Such a view of transference places the
whole burden of change on the patient, lowers the chances that a
therapeutic milieu can foster growth and development, and turns
the therapeutic relationship into a hostile one. All this implies that
the therapist’s organizing principles play no role in the therapy
whatsoever. This view is based on the illusion that the therapist can
invariably be objective and neutral, and abstain from instinctual
gratification in order to be a truly blank screen. Such a stance is as
undesirable to maintain as it is impossible to achieve. Brandchaft
(1989) writes:
[Kohut] came to see the role of the analyst and the stance he
adopts, which determines what he does and does not, what he
says or what he refrains from saying, as an immanent force in
principle and not simply as a factor of occasional and intrusive
countertransference [p. 240].
Further, if transference is viewed as emanating entirely from the

patient, it requires that the patient relinquish his organizing
principles and psychic reality in favor of the therapist’s. Such a
process, if pursued relentlessly, may invite a psychotic collapse,
force a masochistic surrender, or encourage the development,
through conformity, of a new false self. From self psychology’s point
of view, the patient’s resistance to relinquishing his own organizing
principles under such a condition is an indication of health rather
than a sign of pathology.
“Transference cure” has traditionally been applied pejoratively
to patients who have “recovered” because of the unanalyzed
influence of an unconscious instinctual tie to the analyst. The
implication of a transference cure is that because the tie to the
therapist remains unanalyzed, the cure is not permanent. By
contrast, self psychology sees the exploration of the transfer¬
ence/countertransference dyad, the intersubjective field, as perma-
nently changing the organization of the patient’s self, hence
alleviating the necessity for a continuing tie to the therapist. The
results of the Menninger Psychotherapy Research Project (see
chapter 17, this volume) support self psychology’s position: changes

that occurred from transference cures were surprisingly stable when
investigated in the follow-up evaluation.
Traditional transference analysis requires that the patient
renounce his infantile wishes toward the analyst. A better view of
these wishes is to include them in an expanded self-organization.
Self psychology holds that only as these transference longings are
responded to by the therapist, functioning as a needed selfobject, is
the patient able to transform his archaic wishes into mature
selfobject needs. These needs are expressed through the establish-
ment of a network of healthy adult relationships that provide an
ongoing “empathic matrix” for the patient after psychotherapy.
THE INTERSUBJECTIVE FIELD
Taking the position that transference is an expression of a self’s

organizing principles, Stolorow and his colleagues (1987) see
psychotherapy as an exploration and understanding of the interac-
tion between the organizing principles of two subjective selves. In
view of a selfs need for selfobjects (see chapter 14, this volume),
however, the idea of two selves interacting is an oversimplification.
More accurately, the patient, using the therapist as a selfobject (one
self/selfobject unit), interacts with the therapist, who uses the patient
as a selfobject (another self/selfobject unit).
Combining this idea of a self/selfobject unit with the concept of
organizing principles, we see that psychotherapy entails a very
complex, special relationship. This relationship consists of the
patient’s organizing principles, including the self/selfobject unit,
interacting with the therapist’s organizing principles, including a
self/selfobject unit. As can be readily understood, the description of
a psychotherapeutic relationship using these terms becomes
cumbersome indeed! Stolorow offers an alternative through the
concept of analysis as the science of the intersubjective.
Although the idea of intersubjectivity comes from philosophy
and has been familiar to infant developmentalists for some time
(Newson, 1977; Trevarthan, 1977), Stolorow has approached it
through Henry Murray’s ideas of personology. Nurtured in this
subjective tradition, Stolorow and Atwood eventually saw the need
232 Chapter 18
for the concept of intersubjectivity because of their psychobiological

studies of the personal origins of the theoretical systems of
Sigmund Freud, Carl Jung, Wilhelm Reich, and Otto Rank, which
they collected in the book, Faces in a Cloud (Stolorow and Atwood,
1979). After the publication of this book, Stolorow and his col-
leagues made the intersubjective context their central explanatory
concept for understanding psychotherapy. Stolorow sees the
intersubjective field as comprising the interaction of two subjectivi-
ties—of the patient and of the analyst. Because the observational
stance is always from within, there are often gross disparities
between the therapist’s and the patient’s respective worlds of
experience.
Stolorow uses the example of the borderline personality to
illustrate what he means. One view, Kernberg’s (1975), is that the
borderline personality has a discrete, stable, pathological character
structure rooted in instinctual conflicts and primitive defenses.
Stolorow et al. (1987) view the borderline syndrome much
differently. They see the clinical material believed to be indicative
of instinctual conflicts and defenses as evidence of (1) the need for
specific archaic selfobject ties and (2) the disturbances of such ties.
When a shift in psychotherapy occurs whereby the needed under-
standing is felt to be present, the borderline features tend to recede
and even disappear, only to return when the selfobject bond is
again significantly disrupted.
The idea of an intersubjective field challenges the assumption
of an “objective reality” that can be known by the analyst and
eventually by the patient, an assumption that lies at the heart of the
traditional view of analysis. Schwaber (1988b) argues against the
notion of transference as distortion because of its embeddedness in
“a hierarchically ordered two-reality view” (p. 383), “one reality
experienced by the patient and the other ‘known’ by the analyst to
be more objectively true” (Stolorow et al., 1987, p. 35). This concept
of “objective reality” is an example of concretization of subjective
truth (Stolorow et al., 1987, p. 134).
An early clinical issue surrounding the question of objective
reality was whether childhood seductions or infantile fantasies
accounted for the genesis of hysteria (Masson, 1984). Transcending
both these views is the idea that the images of seduction, regardless
of whether they derive from memories of actual events or from
fantasy reconstructions, contain symbolic encapsulations of critical,

pathogenic features of the patient’s early subjective reality.
Intersubjective reality is not “discovered” or “recovered” or
“created” or “constructed,” but crystallizes during treatment. Though
influenced by the analyst’s organizing activity, intersubjective reality
is articulated through a process of empathic resonance, that is,
through attunement.
Atwood and Stolorow (1984) claim that the importance of the
intersubjective field is evident in the variability of results of analysis,
depending on the analyst conducting it. The actual conduct of a case
consists of a series of empathic inferences about the nature of a
person’s life, inferences that alternate and interact with the analyst’s
acts of reflection on the involvement of his own reality in the
ongoing investigation.
CONCRETIZATION
Stolorow and his colleagues (1987) also see the idea of concretiza-
tion as an important construct for a psychoanalytic science of human
experience. They define concretization as the “encapsulation of
organizations of experience by concrete sensorimotor symbols” (p.
132). Concretization explains a variety of psychological phenomena,
including neurotic symptoms, symbolic objects, sexual and other

enactments, and dreams . . . . A broad range of psychopathological
symptoms are thereby recognized as concrete symbols of the
psychological catastrophes and dilemmas that emerge in specific
intersubjective fields [p. 132].
Neurotic Symptoms
The first major demonstration of the use of concretization in the

development of psychopathological symptoms came from Breuer
and Freud (1893-1895), who discovered that hysterical conversion
symptoms and other neurotic inhibitions could be relieved by
uncovering their unconscious meaning. Unfortunately drive theory,
mired in drive-energy formulations that resorted to cryptophysio¬
logical energy transformations for explanation, led therapists away
234 Chapter 18
from the idea that the use of concrete sensorimotor symbolism was
at the core of symptom formation.
Atwood and Stolorow (1984) give a clinical example of con¬
cretization. A 33-year-old woman in the midst of a four-year
treatment reported a new symptom—a tightening of her throat and
a difficulty with swallowing—that coincided with recent successes
she had in comparison with some other women. Investigation
uncovered childhood feelings of guilt whenever she presented her
chronically depressed mother with a success. The patient reported,
“Whenever I brought home an ‘A’ from school . . . it was like
shoving my success down my mother’s throat” (p. 86). As Atwood
and Stolorow point out, “the sensorimotor symbolism of the throat
encapsulated her sense of guilt over the injury her success might
inflict on her mother, and the concretization served the purposes
of atonement and self-punishment” (p. 87).
Symbolic Objects
Winnicott’s (1951) “transitional object” is a ubiquitous example of

concretization. He noticed that small children use something soft
and cuddly to temper the anxiety and depression evoked by
separations—both physical and psychological—from the mother.
The transitional object makes concrete the illusion of a maternal
presence. In Atwood and Stolorow’s terms (1984), “The material
object symbolically encapsulates the soothing, comforting, calming
qualities of the maternal selfobject, and the concretization serves a
restitutive function in mending or replacing the broken merger” (p.
88).
Clinical examples of transitional objects abound. A patient of
one of the authors carried his business card with raised lettering in
her pocket. When she needed soothing, she rubbed her fingers
across the raised lettering of the card. Another patient called the
office when she knew her therapist was not there just to hear his
voice on the answering machine; there was seldom a need to leave
a message. Other patients audiotaped portions of sessions for
listening over weekends and vacations. As Atwood and Stolorow
(1984) explain,
Winnicott’s conceptualization of the transitional object can . . . be

seen as a particular instance of a more general psychological
process whereby needed configurations of experience are
symbolically materialized by means of concrete physical objects”
[1984, p. 89].
Hence, they restore self-cohesion and defend against the experi-

ence of self fragmentation.
Enactments
Enactments, although referring to the same behavioral observation

or clinical experience as acting out, are in no way understood as the
same thing. Acting out is a concept based on classical analysis and
drive theory; erotic and aggressive drives are acted out as a result
of the failure of sublimation, repression, and ultimately renuncia-
tion. The importance of enactments in concretizing and maintaining
organizations of experience cannot be overstated. A self-psychologi-
cal view of character rests on the assumption that
recurrent patterns of conduct serve to actualize (Sandler and

Sandler, 1978) the nuclear configurations of self and object that
constitute a person’s character. Such patterns of conduct may
include inducing others to act in predetermined ways, so that a
thematic isomorphism is created between the ordering of the
subjective and the interpersonal fields [Atwood and Stolorow,
1984, p. 91].
Thus, enactments perform a vital function requiring concrete

courses of action to maintain the structural integrity of a subjective
world. Atwood and Stolorow (pp. 92-97) provide an excellent
analysis of the reasons so many people use sexual enactments to
restore and maintain precarious structures of subjectivity.
Dreams
Freud (1900) held two theories of dreams, one metapsychological,

the other clinical. The metapsychological theory, thoroughly
236
discredited by Klein (1976), received far more of Freud’s attention

than did the clinical theory. In it he conceptualized dreams as
mechanical consequences of energic charge “striving to find an
outlet.” In his clinical theory, he asserted that dreams are deliberate
and serve both defensive and wish-fulfilling purposes.
In stark contrast, Atwood and Stolorow (1984) contend that
dreams serve a vital psychological function:
By reviving during sleep the most basic and emotionally compel-

ling form of knowing—through sensory perception —the dream
affirms and solidifies the nuclear organizing structures of the
dreamer’s subjective life. Dreams . . . are the guardians of
psychological structure, and they fulfill this vital purpose by means
of concrete symbolization [p. 103].
Understanding the concept of concretization is important for

clinical practice, because concretization mediates the relationship of
experience and action. Concretization is the basis of neurotic
symptoms, symbolic objects, enactments, and dreams. All are used
for the concrete symbolization that crystallizes and preserves the
organization of the subjective world.
In summary, self psychology as understood by those stressing
intersubjectivity has changed the idea of transference as distortion
to one of transference as an organizing activity. When the organizing
activities of therapist and patient interact, they set up an intersubjec¬
tive field. Therapeutic change occurs as a result of exploring and
understanding this intersubjective context and the concretizations
that express the patient’s subjective experience. How to make such
change more lasting involves the process of structuralization, the
focus of discussion in the next chapter.
Readings for Chapter 19: Kohut, 1984, chapter 6; Mitchell, 1988,

pp. 46-52; Terman, 1988.
19
Structuralization
D uring the last hundred years, psychotherapy has amply demon-

strated its ability to help persons to change their thoughts,
feelings and behavior. Lasting personality changes, however, have
been more difficult to achieve. Issues of lasting changes raise
questions about structuralization. How does psychotherapy cure?
Can personality deficits be corrected through the building up of
new, permanent patterns of responding, traditionally called psychic
structures?
This chapter makes two points about structuralization. First, the
term better describes the process underlying lasting personality
change than do the terms internalization or introjection. Second,
structuralization best takes place under conditions of both optimal
empathy and repairs to empathic failures. We emphasize these
points during exploration of the following subjects: (a) definition,
(b) internalization, (c) optimal frustration, (d) selfobject failures, (e)
structuralization during empathy, and (f0 resistances to structuraliza-
tion.
237
238 Chapter 19
DEFINITION
Structuralization is the process of acquiring “structures of experi-

ence” (Atwood and Stolorow, 1984, p. 33). It is the opposite of self-
fragmentation (Stolorow, 1980, p. 164). A structure is defined as an
“enduring reorganization of the subjective field” (Atwood and
Stolorow, 1984, p. 39). By enduring organization or structure
Rapaport (1959) meant configurations with a slow rate of change.
Such structures are also called systems of ordering, organizing
principles (Piaget, 1970), cognitive-affective schemata (Klein, 1976),
and patterns (Goldberg, 1988). Terman (1988) defines structure
formation as the “acquisition of pattern and meaning” (p. 114).
INTERNALIZATION
Mitchell (1988, pp. 46-51) clearly describes Freud’s development of

the concept of internalization. He shows how Freud developed the
idea in searching for an explanation for pathological mourning. In
“Mourning and Melancholia” Freud (1917) argued that the self
accusations of the psychotically depressed patient who has lost a
loved one are but castigations directed to the internalized deceased
person. This explanation left Freud questioning the reason for the
internalization. His solution was to link internalization to a gross
identification with the lost object so as to preserve a channel for
drive regulation. The lost object is clung to in its internalized form,
a more pleasant experience than renouncing the lost object and
searching for new objects.
Freud (1921) expanded his concept of internalization in “Group
Psychology and the Analysis of the Ego”. He developed the idea that
identification is “the earliest expression of an emotional tie with
another person” (p. 105). Freud thus broadened the concept of
identification to a more general theory of child development and
seemed almost ready to abandon drive theory for a relational
model. Then Freud (1923) solved the problem by resorting to the
concept of the superego in his “The Ego and the Id”. The superego
derives from the internalization process that is compensation for the
child’s renouncing of oedipal wishes. Thus, the superego is “the
heir to the Oepidus complex” (p. 36). By postulating the superego,
Structuralization 239
Freud was able to retain drive theory and yet hold a view of
identification associated with what he believed was the pivotal
loss/wound of childhood—with oepidal defeat. To Freud, then,
internalization accompanies the identification that occurs from a
significant object loss.
Goldberg (1990) is critical of Freud’s view of internalization
because of its “storehouse” theory of mental representations. Such
a theory involves the storing and retrieving of perceptions about the
world. Representations are meant to be an accurate record of
everything that takes place, gradually filling the empty mind of the
child. As Goldberg notes, “The infant has no ideas until they are
given, no words until they are taught: the infant has no sense until
instructed” (p. 95). The purpose of such representations is to avoid
the inconvenience of literally carrying around the objects of the
world to use as a comparison, but they serve the same function. A
representation, as a substitute or stand-in, is an inner “picture” of an
outer phenomenon.
Freud’s concept of the mind as internalized representations is
considered by modern theorists as too simplistic and too limiting.
Only some parts of language, speech, and thought are connected to
internal pictures. According to Friedman (1980), internalization
involves high-level abstractions that have been heavily influenced by
theory. “Thus, representations are not records of raw experience as
much as they are inferences from a person’s experience” (Goldberg,
1990, p. 100). They are not the same as memory.
Representations involve unconscious organizing of experience.
Hence, searching for repressed representations in a classically
conducted psychoanalysis must inevitably lead to frustration. In
contrast to this storehouse theory of representation is connection
theory. As Goldberg states, “Connection theories are, in contrast, not
corrective; they do not assume that the world is initially copied and
periodically compared, but rather that it is continuously formed” (p.
112). If a theory of internalization is to be retained, it needs to be
different from Freud’s theory of representations.
Hartmann (1939) had a different view from Freud’s. As he con-
ceived it, internalization is a process through which autonomous
self-regulation replaces regulation from the external environment.
Kohut (1971) utilized Hartmann’s idea to conceptualize internaliza-
tion as the process by which the selfobject functions needed by
240 Chapter 19
narcissistic personalities are transmuted into psychic structure.

Kohut used the phrase “transmuting internalization” (p. 49), for
which there are three necessary prior conditions: (1) maturational
readiness, (2) frustration by a cathected object, and (3) a shift from
the whole object of cathexis to some of the object’s functions.
Transmuting internalization may have been the major, perhaps only,
way Kohut envisaged structuralization. Nevertheless, we take the
view that internalization is only one form of structuralization.
Schafer (1976) criticized Hartmann’s notion of internalization
because it used physicalistic and spatial reifications. Schafer thought
it could be too easily viewed as Melanie Klein’s introjective
identification, which uses the analogy of a person taking in an object
as if eating it. So Schafer attempted to do away with the construct
of internalization altogether and develop the idea of self-regulatory
capacities conceptualized in nonspatial terms. As Schafer (1968)
defines it, “Internalization refers to all those processes by which the
subject transforms real or imaginary regulatory interactions with his
environment, and real or imagined characteristics of his environ-
ment, into inner regulations and characteristics” (p. 9).
Goldberg (1983) also thinks that the concept of internalization
creates problems because it is linked to the idea “that continuing
growth and structuralization lead to adult positions of independence
and autonomy” (p. 298). He agrees with Schafer that we need an
alternative to the concept of internalization, but until we find one,
Goldberg finds some useful clinical advantage in shifting the focus
to ideas of ownership, privacy, and representability (p. 300). These
are subjective states that clients experience as being important.
Stolorow, however, retains the concept of internalization but
interprets it in the nonintrojective sense as “an enduring reorganiza-
tion of the subjective field in which experienced qualities of a
selfobject are translocated and assimilated into the child’s own self-
structure” (Atwood and Stolorow, 1984, p. 39). Wolf (1983b) too,
wants to redefine internalization as “a reorganization and reintegra-
tion of perceptions and their associated ideas, and not any location
in a space-occupying mind” (p. 314).
Grotstein (1983), taking a position similar to Stolorow’s and
Wolf’s, asks:
Does the infant (child) take in aspects of the selfobject and

internalize these as its own self-regulating function, as Kohut
indicates? Or is this self-regulating function always there potential-

ly from the beginning, and is it more maturation and develop-
ment that takes place under the auspices of the interpersonal
other? Perhaps what one internalizes is not so much the object
and its functions, as one’s experience with the object. If we take
Fairbairn’s and Bion’s point of view, we might rephrase Kohut’s
idea of transmuting internalizationsas transmutingrealizationsor
transformations of undeveloped functions that exist in the infant
from the very beginning. The selfobject experience then “shep-
herds” the development of these rudimentary functions [pp. 176-
177].
OPTIMAL FRUSTRATION
Most of the debate around Kohut’s ideas of structuralization in

narcissistic personalities centers on his belief in the necessity of
“optimal frustration” by a bonded selfobject. Some self psychologists
are uncomfortable with Kohut’s theory of transmuting internaliza-
tion through optimal frustration. They are not satisfied with his use
of internalization as a special form of introjection, even though
Kohut differentiated himself from Klein by describing internalization
as a whole series of minor introjections (microinternalizations) over
a period of time. To make sure that internalization does not mean
Klein’s macrointrojection, for example, Wolf (1988) refers to
internalization as structure formation. “Transmuting internalization
is Kohut’s term for a process of structure formation in which
aspects of the function of the self-selfobject transaction are internal-
ized under the pressure generated by optimal frustration” (p. 187).
Other self psychologists are dissatisfied with the idea that
structuralization takes place only through optimal frustration.
Stolorow, for example, is especially critical of Kohut’s use of the
term “optimal frustration.” He and colleagues (1987) remind us that
optimal frustration was formulated by Freud under the mechanical
assumptions of drive theory (p. 22). To Freud (1923), “the ego is
that part of the id which has been modified by the direct (frustrat-
ing) influence of the external world” (p. 25). Kohut (1984) thought
that the repeated interpretation of the patient’s experiences of
optimal frustration by the narcissistically invested selfobject would
result in a process of fractionalized withdrawal of narcissistic
242 Chapter 19
cathexis from the object and a concomitant redeployment of these

cathexes in the gradual formation of particles of psychic structure,
which then exercised the functions that had been performed by the
object. According to Stolorow et al. (1987), this classical interpreta-
tion of internalization is incompatible with self psychology.
Kohut, however, is not without some support for his position
that frustration can foster structuralization. For example, infant
researchers Stechler and Kaplan (1980) view self development as a
series of syntheses, active resolutions of crisis that occur when
expectancies about a relationship are violated. The child tries to
repair the “violations” by taking on aspects of the caretaker’s
functions and in so doing, develops self-regulating functions. This
form of support for Kohut’s position does not imply that optimal
frustration is the only means of structuralization, nor the most
effective.
SELFOBJECT FAILURES
By 1984 Kohut had shifted his thinking slightly from “optimal

frustration” to “temporary, and thus nontraumatic, empathy
failures—that is, his ‘optimal failures’” (p. 66). Kohut sees “the
acquisition of self-esteem-regulating psychological structure in the
analysand” (p. 67) as taking place through empathic lapses on the
part of the therapist. He still maintains that “psychological structure
is laid down (a) via optimal frustrations and (b) in consequence of
optimal frustration, via transmuting internalization” (pp. 98-99).
Supporting Kohut in his position is the observation of infant
specialists that “psychic structure is created when disruptions occur
and the infant is able momentarily to take over functions of the
parents” (Beebe and Lachmann, 1988, p. 20). Terman (1988)
responds that “Kohut put his concepts directly in line with classical
theory and carefully divorced his theories and techniques from the
onus of providing gratification” (p. 113). Even so, with usage,
Kohut’s optimal frustration became to mean “empathic failure.”
Clinical experience with narcissistic patients generally supports
the importance of monitoring a patient’s behavior for symptoms that
indicate an experience of “empathic failure.” Stolorow (1986a)
stresses that empathic failure refers “not to things that the analyst
does or fails to do, but to psychic reality—that is, to developmental¬

ly predetermined subjective experiences of the patient, revived and
analyzed in the transference” (p. 44).
When a therapist learns to recognize a patient’s way of signaling
an empathic lapse and is able to discuss this openly with the
patient, this discussion is usually enough to repair the bond
between the patient and the therapist. In fact, the therapist’s
acknowledgment of an empathic lapse may considerably strengthen
the bond and lead to the surfacing and exploration of deeper
material. Without interpretation of a patient’s experience of an
empathic lapse, the treatment of narcissistic disorders would be
difficult, if not impossible. This approach is now followed by many
self psychologists, not because they believe in the necessity of
optimal frustration, but because the recognition and repair of
empathic failure strengthens the therapeutic bond and is an
opportunity for structuralization to take place.
In chapter 9 it was posited that the major purpose of the
empathic method is to understand the selfobject functions the
therapist fulfills. If this is so, then the idea of a selfobject failure is
a more useful way of viewing the need for a repair of the therapeu-
tic bond than is the idea of an empathic lapse. Supporting this
selfobject failure position is the fact that there are many areas of a
patient’s life where a therapist’s lack of empathy does not produce
the experience of a “temporary and nontraumatic failure” in the
patient. On the other hand, where there is selfobject failure,
explaining what has happened, as a means of repairing the thera-
peutic bond, is essential. Stolorow and his colleagues (1987) prefer
to use the term selfobject failure rather than empathic failure
because selfobject failure “more clearly designates a subjective
experience of the patient in the transference” (p. 17, n.l).
A vignette from the senior coauthor’s case of Mr. B illustrates a
selfobject failure and its repair. Presenting as a depressed person,
Mr. B began twice-a-week psychotherapy that extended over an 18
month period and led to a bond that shifted between idealized,
mirror, and twinship transferences. Mr. B then sought disability
insurance requiring his therapist to fill in a short form. The
insurance company’s posted form to the therapist was returned
because of a wrong address and then sent to the patient. After a
brief discussion in which he expressed aversion to this intrusion
244 Chapter 19
into his privacy and a reluctance to have the information sent, the
patient acceded to the therapist’s answering the insurance compa-
ny’s questions.
Two sessions afterward, the patient arrived 15 minutes late. He
was clearly depressed. He had been rejected for the disability
policy, and his insurance agent blamed the therapist. When the
patient suspiciously asked about the diagnosis, the therapist said “It
was ’dysthymic disorder’ as we had discussed.”
Exploration confirmed that Mr. B was angry because he was
experiencing the therapist as not supporting him. He also experi-
enced painful, resurrected feelings of anger with a father who had
never supported him against the irrational control of his mother.
The therapist did not defend his own behavior or apologize. He
said that the patient was experiencing him (the therapist) as failing
him. After the patient had confirmed these feelings, the therapist
indicated a willingness to write a detailed letter to the insurance
company, supporting the liability insurance request and stating that
the patient was a low disability risk because he had sought psycho-
therapy and had a good prognosis. This offer was accepted and a
letter sent. Two sessions later the patient’s spontaneous flow of
material indicated that the bond had been repaired.
Even though the concept of structuralization, when viewed as
internalization or introjection, has dangers of spatial and physical-
istic reification, the subjective experience of having a nourishing,
sustaining presence “inside” seems to have brought great comfort
and been of immeasurable help to countless human beings
throughout history. Khan (1974) for example, wrote that the famous
“Montaigne established a private space in his library at Chateau de
Montaigne for himself, and in this space he lived through an
extremely devout relationship to an inner presence” of his dead
friend La Boetie (p. 102).
Before Montaigne, everything in human self-experience had
found its authenticity through an experience of God. This seculariza-
tion of self-experience was “Montaigne’s unique contribution
towards the epistemology of self-experience” (p. 103). It was a
revolutionary step, and it reminds us that “in the medieval ages, it
was not unknown for persons of sensibility and imagination to
retreat into monastic orders and concentrate on their self-experi-
ence in the presence of God” (p. 103). Such a phrase as the
“presence of God,” often seen as pious posing and not easily

understood by persons in a secular age, seems to have been a
religious way of expressing the valuable experience of structuraliza-
tion.
STRUCTURALIZATION DURING EMPATHY
Structuralization is also fostered by empathy. Empathy, especially in

conjunction with affective states, is experienced as a facilitating
medium reinstating developmental processes of self-articulation and
self-demarcation that were aborted and arrested during formative
years. Structure formation that occurs primarily when the bond is
intact or is in the process of being restored uses optimal empathy
(Stolorow et al., 1987). Most who support this view of optimal
empathy accept the idea that empathic failure may foster structur-
alization; they see it is a minor means, but certainly not the only
means of structuralization.
Terman (1988) is another who takes the position that structu-
ralization takes place under conditions of empathy and that changes
in his patients occur from experiences in the analysis that have
nothing to do with frustration. He supports his clinical experience
with the developmental studies of Vygotsky (1978), who stressed the
interpersonal genesis of the acquisition of language. He also saw all
higher cognitive functions as originating in actual relations between
people, for to him, “an interpersonal process is transformed into an
intrapersonal one” (p. 57). For Vygotsky “the structuralization of the
mind grew out of human relationships and could not be understood
apart from them” (Terman, 1988, p. 115).
Terman sees the work of Kaye (1982) as supporting the idea
that structuralization arises from other than frustration and internal-
ization. Vygotsky stresses the “outside in” process; on the other
hand, Freud and Piaget saw development as “inside out,” that is, as
the unfolding of innate, internally determined patterns. Like
Vygotsky, Kaye sees the infant as an apprentice who is induced into
a societal system by the goals and techniques of the parent. “Those
structures which appeared to Piaget to evolve autonomously seem,
for Kaye, to arise from the matrix parental goals and expectations”
(Terman, 1988, p. 115). According to Kaye, at two months sharing
246 Chapter 19
begins as a unilateral responsibility of the parent. Parents guess the

intentions underlying an infant’s activity, speak to their child
through many modes, and integrate the child into their already
existing social system. By eight months or so, the sharing of
intentions has become a two-way process. The development has
been from apprenticeship to full partnership.
Kaye describes seven ways that parents “frame” a child’s
behavior, that is provide essential regularities for the child. These
are nurturant, protective, instrumental, feedback, modeling,
discourse, and memory functions. Around these functions the
dialogue with the child takes place, with the child gradually taking
them over. Through these functions the mother creates the structure
of the dialogue with the infant.
This structuring changes the schemas, the patterns, with which
the child organizes the world. As Terman (1988) states:
The changing and growth of patterns occur in the context of

intense interaction. The interaction, not the spaces between the
interactions, changes the structures. It is not the loss of the
transaction, but rather its presence that structures . . . . It stretches
credulity to maintain that the withholding, or delay, of such
transactions is the essential step in development of the structures
that accrue from them. Further, to concentrate on a hypothetical
delay to the neglect of the transaction misses the central areas of
experience without which there can be nothing [p. 117].
Beebe and Lachmann (1988) emphasize the role of interactional

patterns in organizing an infant’s experience: “The model of psychic
structure formation underlying this discussion is that characteristic
patterns of interactive regulation organize experience” (p. 20). They
concede that structure is formed when a child resolves “breaches”
by taking on aspects of caretaking functions; they conclude that “a
combination of the two models yields a fuller picture of the
complexity of the early organization of experience” (p. 21).
Flexnor’s (1967) account of George Washington and political
structural change involving the 13 states during the American
revolutionary war, relates a process analogous to that of structural
change in an individual. Initially, the revolt was by 13 independent
colonies who formed an alliance to battle the forces of the British
king, George III. If the military forces of the 13 colonies had been
successful in the initial campaigns—Breed’s Hill and Long Is-
land—the result would have been 13 independent countries that
had temporarily united for a common task. The sovereignty of each
state would have remained unchanged.
As it was, the protracted eight-year struggle led to a permanent
army (Continental), whose formation became the first executive
function of a new corporate entity, the federal government. The
states resisted the symbolic representation of the emerging
nation—the army—by refusing to pay into the common treasury
from their taxes. They used the “power of the purse” to resist giving
up some state sovereignty. The army’s development forced structur-
al change over an eight year period that was difficult, indeed
impossible, for the states to reverse.
Structuralization becomes an issue in the corporate world under
the concept of “vertical integration” (Schonberger, 1982, p. 173).
With vertical integration, a major manufacturing corporation, for
instance, takes over the production of a part that was previously
made by one of its vendors. Options involved in this process
illustrate the differences between internalization as incorporation
and structuralization. Sometimes the manufacturer buys the vendor
company and manufacturers the part using the ex-vendor employees
in a move similar to incorporation. The manufacturer is then in a
position to control more closely the production of the part. Often
such vertical integration is precipitated by serious, repeated failures
by the vendor to supply a quality part on time and in accurate
quantities.
Even when a frustrated manufacturer seeks vertical integration,
the vendor firm, or another suitable vendor firm with a capacity to
produce the part, may not be for sale. The manufacturer may then
set up a department to manufacture the part. That is, influenced by
the experience with and knowledge of the vendor’s operations, the
manufacturer organizes (structures) the production of the part
within its own manufacturing plant. Thus, the business world
conceives of corporate structuralization as taking place both with
and outside the process of incorporation of the vendor into a larger
organization. More often than not, the structuralization involved in
vertical integration takes over the functions previously performed
by the vendor, without incorporating the vendor as a total unit
248 Chapter 19
(buildings, machinery, and personnel). That is, only the way

(pattern) the part was made by the vendor is structured into the
manufacturing process.
RESISTANCE TO STRUCTURALIZATION
Resistances that occur in the middle phase of psychotherapy often

interfere with structuralization. One form of resistance is the wish
to leave treatment as soon as the patient begins to feel better.
Another occurs when the patient experiences a boring stalemate
after months of meaningful sessions and a deep therapeutic bond
has developed. This growing bond may have awakened fears of an
unbreakable dependency and the loss of individuation and is a sign
that the patient recognizes value in the therapist’s functioning. If
these needs went unrecognized, there would be no conscious fear
of a life-long dependency on the therapist. Ironically, the success of
the initial phases of therapy is usually a precondition for resistances
to the processes of structuralization.
Such a resistance to structuralization is resolved by exploring
with the patient the reason for the stalemate, looking carefully for
evidence of dependency fears that the successful movement through
the initial stages has enabled to emerge. This exploration leads to
an explanation that a gradual, unconscious structuralizing of the
therapeutic functions the patient finds useful takes place over time
in psychotherapy. Once the structuralizing purpose of the last phase
of the therapy is accepted by the patient, resistance to structuraliza-
tion fades, if not disappears.
Another sign of resistance to structuralization is the patient’s
regular sharing of a “blow by blow” description of the therapy to a
spouse, parent, or close friend. Structuralization is fostered by
keeping what passes in the treatment as secret or private (Goldberg,
1983). The converse is that those who find it hard to keep secrets
lack many of the functions that make for a cohesive sense of self.
Not keeping secrets seems to serve as a form of triangulation, that
is, a three-person relationship (Bowen, 1978) that defends against
the dangers inherent in an overdependent two-person relationship
and is a special variation of the resistance to structuralization just
discussed.
Yet another type of resistance to structuralization may be taking

place when patients want to stay in therapy forever. Such a “thera-
peutic lifer” (Wallerstein, 1986) may have a strong need for a
merger transference in which the therapist is used as a transitional
selfobject. This patient feels secure by experiencing control over the
therapist as if the therapist were an intimate part of the patient.
Once the merger experience has continued long enough to satisfy
the patient’s need for cohesion, the patient gradually experiences
the therapist as more individuated and becomes motivated to
structuralize the functions that the therapist performs. As the need
for the therapist as a transitional selfobject recedes and the illusion
of control disappears, so the resistance to structuralization diminish-
es.
In summary, self psychology now views structuralization as a
broader process than was covered by Kohut’s construct of transmut-
ing internalization. Hartmann’s notion of internalization, as used by
Kohut, can be discarded because it too easily conveys the idea of
introjection. Drive notions of gratification can also be discarded to
allow for structuralization under conditions of empathy, as can
Kohut’s notion of structuralization as following the repairing of
empathic failures. Even Kohut’s idea of empathic failure is better
viewed as selfobject failure. Even so, Kohut’s emphasis on the
importance of structuralization in psychoanalysis and psychotherapy
is retained within self psychology. The amount of structuralization
attempted is seen as the major difference between psychoanalysis
and psychotherapy. Successful therapeutic work demands major
attention to the resistances to structuralization, especially the fears
of perpetual dependency.
Resistances to structuralization are not the only source of stale-
mates in psychotherapy. Termed originally by Freud as “negative
therapeutic reactions,” such impasses not only may threaten to
derail or undermine therapeutic gains, they may also present
powerful opportunities for therapeutic growth. We examine this
important subject in the next chapter.
Readings for Chapter 20: Balint, 1936; Brandchaft, 1983;

Schwaber, 1983a; Atwood, Stolorow and Trop, 1989.
20
Negative Therapeutic
Reactions
T oward the end of Freud’s life, growing reports of negative

therapeutic reactions in cases of even competent analysts, along
with Freud’s growing doubts about the long-term effectiveness of
psychoanalysis, suggested that something was seriously wrong with
the analytic paradigm. As Brandchaft (1982) says “Psychoanalytic
literature . . . abounds with descriptions of patients who react
negatively and relentlessly refuse to yield to analytic interpretation”
(p. 328). We examine the concept of negative therapeutic reaction
under the following topics: (a) definition, (b) the Wolf Man, (c)
narcissistic resistances, (d) intersubjectivity and impasses, and (e)
intersubjective conjunctions and disjunctions.
DEFINITION
A negative therapeutic reaction in psychotherapy is an exacerbation

of patient symptoms in response to a “correct” interpretation.
250
Negative Therapeutic Reactions 251
There are certain people who behave in a quite peculiar fashion

during the work of analysis. When one speaks hopefully to them
or expresses satisfaction with the progress of the treatment, they
show signs of discontent and their condition invariably becomes
worse. One begins by regarding this as defiance and as an attempt
to prove their superiority to the physician, but later one comes to
take a deeper and juster view. One becomes convinced, not only
that such people cannot endure any praise or appreciation, but
that they react inversely to the progress of the treatment. Every
partial solution that ought to result, and in other people does
result, in an improvement or a temporary suspension of symp-
toms produces in them for the time being an exacerbation of
their illness; they get worse during the treatment instead of better.
They exhibit what is known as a “negative therapeutic reaction”
[Freud, 1923, p. 49].
One would expect that if the interpretation is correct and well-

timed, then a negative reaction should not result. Theoretically a
correct, well-timed interpretation should lead to an amelioration,
not exacerbation of symptoms. This anomaly, first discovered by
Freud, has been a challenge to psychotherapy aimed at permanent
personality change, irrespective of theoretical orientation. Nor can
this negative reaction be attributed to idiosyncratic interpretations
of individual therapists, especially as the psychotherapy is some-
times conducted under close individual or group supervision. What
then accounts for such a negative reaction?
If the interpretation is “correct,” then the reaction can arise only
from some malignancy entirely within the patient’s psyche. This is
exactly the position taken by Kernberg (1975) and Masterson (1981),
who interpret the negative therapeutic reaction as an expression of
a self-destructive aggressive drive. Ironically, an interpretation of
this intrapsychic understanding of the negative reaction generally
results in its exacerbation. With circular logic, further exacerbation
of symptoms is then cited as evidence that the interpretation of a
self-destructive aggressive drive is itself correct.
THE WOLF MAN
Freud (1918) first described the negative therapeutic reaction in

“From the History of an Infantile Neurosis,” in which he related the
252 Chapter 20
case of the Wolf Man. The Wolf Man “never gave way to fresh ideas
without one last attempt at clinging to what had lost value for him”
(p. 68). The Wolf Man
showed a habit of producing transitory “negative reactions”; every

time something had been conclusively cleaned up, he attempted
symptoms which had been cleared up [p. 69].
The Wolf Man case illustrates the problem of negative therapeu-

tic reactions. This case, more than any other, established that
psychoanalysis was capable of treating seriously disturbed persons.
The Wolf Man, a wealthy Russian aristocrat named Dr. Serge
Pankejeff, had seen a succession of therapists before Freud, and he
saw another analyst (Ruth Mack Brunswick) after seeing Freud. He
also enjoyed the friendship of the analyst Muriel Gardiner for 30
years. Further, as Anna Freud indicates in the foreword to Gardi-
ner’s (1971) book, “The Wolf Man stands out among his fellow
figures by virtue of the fact that he is the only one able and willing
to cooperate actively in the construction and follow-up of his own
case” (p. xi). The Wolf Man also gave a valuable description of how
he subjectively experienced his four years of treatment with Freud
from 1910 to 1914.
The Wolf Man had an animal phobia, which was reflected in his
wolf dream at the age of four.
I dreamt that it was night and that I was lying in my bed. (My bed
stood with its foot towards the window; in front of the window
there was a row of old walnut trees. I know it was winter when
I had the dream, and night-time). Suddenly the window opened
of its own accord, and I was terrified to see that some white
wolves were sitting on the big walnut tree in front of the window.
There were six or seven of them. The wolves were quite white,
and looked more like foxes or sheep-dogs, for they had big tails
like foxes and they had their ears pricked like dogs when they
pay attention to something. In great terror, evidently of being
eaten up by the wolves, I screamed and woke up (Freud, 1918, p.
29].
Freud, through elaborate associations, linked this dream to the

primal scene of parental intercourse and to the Wolf Man’s fears of
castration.
The Wolf Man was very disturbed when, aged 23, he com-
menced his first session with Freud. The Wolf Man began by saying,
“This man is a Jewish swindler; he wants to use me from behind
and shit on my head” (Fish, 1989, p. 526). Years later, he said of
Freud,“ I had the feeling of encountering a great personality,”
something that we would now identify as a powerful idealizing
transference (Blum, 1974, p. 737). He also said that Freud would
“occasionally let fall some remark which bore witness to his
complete understanding of everything I had experienced” (Gardi-
ner, 1971, p. 138). Freud intuitively kept the idealizing transference
alive by making the Wolf Man feel less like a patient and more like
a co-worker. The Wolf Man experienced Freud’s behavior as
empathic. Freud also mentioned that a period of“long education”
was needed to facilitate the analysis of the Wolf Man.
For four months in 1919, Freud had further analytic sessions
with a demoralized Wolf Man, now a penniless refugee from the
Russian revolution, and helped him attain a relatively adequate level
of adult functioning. Remarkably, Freud also took up a collection
every spring for six years so that the Wolf Man could pay his wife’s
hospital bills and take a vacation. Clearly, Freud’s special treatment
encouraged Pankejeffs perception of being“Professor Freud’s
famous patient.”
In 1923, upon learning of Freud’s operation for a malignancy,
the Wolf Man became hypochondriacal and showed other signs of
self-fragmentation. This decompensation lasted until 1926, when the
Wolf Man was referred to Ruth Mack Brunswick. Brunswick forced
the patient to confront his rage about having been abandoned by
Freud, not only through Freud’s referral to her, but as a conse-
quence of the destruction, by Freud’s illness, of the illusion of
omnipotence required of an idealized parental imago (Gardiner,
1971).
Blum (1974) claims that the Wolf Man had a borderline
personality:
The paranoid states that subsequently erupted occasionally, the

hypochondriasis and life-long depressions, the tendency to act out
his fantasies, the lack of ego synthesis and cohesive personality
organization, recurrent crises requiring supportive interven-
tion—all point toward a borderline personality [pp. 724-725].
254 Chapter 20
Chessick (1980a) also speculates about the personality structure

of the Wolf Man. He mentions the uncanny capacity of the Wolf Man
to encourage the continuing interest of a vital segment of the early
analytic community.
Such a capacity for stirring up the interest of others is usually

absent in schizophrenic people, but it is not rare in a polished
and intelligent narcissistic personality. It seems clear that we are
dealing with a borderline personality disorder or at best a
narcissistic personality disorder in a man who never was really
capable of forming a mature, loving relationship with anybody,
but whose survival throughout a long life rested on an uncanny
capacity to keep more successful individuals interested in him [p.
95].
For example, when his wife committed suicide by turning on gas as

the Nazis occupied Vienna, the Wolf Man reacted narcissistically,
saying,“The question kept hammering away in my mind: how could
Therese do this to me? And as she was the only stable structure in
my changeable life, how could I, suddenly deprived of her, live on?”
(p. 122).
The possibility that the Wolf Man suffered a borderline syndrome
is supported by Mahony’s (1984) description of Pankejeff’s parents.
His mother was a“jealous, intensely hypochondriacal, obsessively
pious” woman who was“distant with her children . . . . The restless
father, diagnosed by Kraepelin as a manic-depressive psychotic, had
especially severe attacks every several years that necessitated
rehabilitation in a sanatorium” (p. 4). An anecdote illustrates the
mother’s lack of empathy:
She told her children she was taking them to town to see
something pleasant; but there the innocently expectant children
were taken aback to observe their father, absent for several
months, now pitiful looking and recuperating in a sanatorium [p.
4].
Magid (in press) has reexamined the Wolf Man from a self
psychology perspective. He sees a narcissistic person forever“at the
mercy of those who could promise some enlivening mixture of
excitement, idealization, attention, and maintenance.” Like Mahony,
Magid thinks the primal scene-based story is nonsense and that it

evolved out of Freud’s need to impose his theoretical expectations.
The terrifying stare of the wolves may represent a“malignant
transformation of the mirroring he wished to receive” from his
father, who had just humiliated him in front of guests for being
unable to play the accordion on command and whose image in
young Serge’s eyes was then undergoing a traumatic deidealization.
Magid then makes a crucial theoretical point:“ T h e fact that there
could be an alternative, equally cogent explanatory scheme
eliminates the very basis of Freud’s argument, that the primal scene
is necessary to make sense of the case.”
Geha (1988), who has studied Freud’s style as a fictionalist,
agrees with Mahony and Magid that the primal scene is a figment of
Freud’s imagination:
Once Freud arranges the stage of the primal scene, the entire
drama unfolds within a psychic reality from which there is no
egress. Freud constructs this passionate play. He creates it. Out of
what? Primarily out of dream material allegedly fashioned by a
four-year-old child and remembered twenty years later. Yet, to say
that from his patient’s recollection of a dream Freud builds a
primal scene misleads us somewhat. The dream text, of course,
did not manifestly reveal such an episode. No, Freud’s interpreta-
tion reveals, or, rather, creates, this mise en scène. And how is this
interpretation confirmed? Never directly; historical interpretation
can never be confirmed. And the reality that would confirm it by
correspondence is simply non-existent [p. 110].
To Magid (in press), the Wolf Man’s solution to his narcissistic

vulnerabilities was to employ a“masochistic” strategy. He constantly
accommodated his“subjective reality to the powerful influence of
Freud’s vision in order to maintain the desperately needed selfob-
ject tie.” This pattern was unrecognized and left unresolved by
Freud and also by Ruth Mack Brunswick.
Brandchaft (1983), who thinks Freud’s analysis of the Wolf Man
achieved a great deal, especially when viewed from a self psycholo-
gy perspective, says of the Wolf Man case:
Freud provided the Wolf Man with a potent source of self-esteem,

which enabled the patient to integrate himself. From a position of
256 Chapter 20
obscurity, a nonentity lost in a welter of symptoms designed to

frantically maintain a tenuous and primitive psychological
organization at whatever cost—to keep the wolves from his
door—the Wolf Man acquired, with Freud’s active assistance, a
healing sense of his own importance and uniqueness, a feeling of
being cared about, listened to, and understood [pp. 333-334].
NARCISSISTIC RESISTANCES
Freud’s experience of the negative therapeutic reactions of patients

led to three key theoretical concepts. The negative therapeutic
reaction was the basis of his concept of the superego (Freud, 1923).
It also forced an explication of his metapsychology, including
structural theory (Freud, 1933). Above all, the issue of negative
therapeutic reaction focused his mind on narcissism. It is significant
that Freud (1914) wrote the narcissism paper toward the end of the
Wolf Man’s four-year treatment.
While it is evident that Freud understood the importance of
narcissism for clinical theory, it was Abraham’s (1919)“A Particular
Form of Neurotic Resistance” that clearly identified narcissistic
resistances as the primary source of the negative therapeutic
reaction. Abraham noted several features of this narcissistic
resistance: an unusual degree of defiance, evidenced by a refusal to
free associate; an unusual sensitivity to injuring self-esteem,
including being humiliated by the findings of the analysis; an
attempt to convert the analysis from its objective of self-understand-
ing to one of narcissistic enhancement; and an inability to form a
“true” transference. Such patients begrudge the analyst the role of
father and are easily disappointed. Because these patients wish to be
loved and admired, and since the analyst cannot satisfy these
narcissistic needs, a true positive transference does not take place.
In its place, Abraham advocated focusing on their resistance to a
true transference by tracing it to its emergence as a drive. His
technique, however, assumed that narcissism was a regression from
or avoidance of an oedipal conflict rather than a developmental
deficiency.
Balint (1936) raised the same issue as Abraham, but for a
different reason. He had noticed that a narcissistic deficiency
became evident at the end of a long and successful analysis, at the
termination phase, when the wish for gratification emerged. When

he explored this wish, he concluded that it derived from childhood
failures. Such patients were in need of a“new beginning.”
Balint also suggested that sadism and masochism were not
normal stages of psychosexual development but were the products
of faulty environmental responses, especially empathic failure. He
therefore disagreed with those, including Freud, who viewed sadism
as an endopsychic cause of the negative therapeutic reaction.
Balint anticipated self psychology’s view of the negative
therapeutic reaction. He put forth the concepts of“primary love”
and“basic fault” in an attempt to explain transference-countertrans-
ference impasses with certain kinds of difficult patients (Mitchell,
1988). Such“patients become stuck in analysis, demanding a
responsiveness from the analyst without which they seem unable to
progress. Balint characterizes these longings and the patient’s efforts
to gratify them as a need for ‘primary love”’ (p. 141).
Riviere (1936) explained that narcissistic resistances come from
a highly organized system of defenses against a depressive condition
in the patient and operate as a disguise to conceal this. Narcissistic
resistances are also a defense against admitting dependence on
objects. Consequently, contempt and depreciation are marked
features of narcissistic resistances, as are attempts at tyrannical
control and mastery of the objects of dependency.
For Riviere, typical refractory patients were those who tried to
exercise omnipotent control (frequently masked) over the analyst;
refused to associate freely; denied anything that discredited them-
selves; refused to accept any alternative point of view or interpreta-
tion; were defiant and obstinate; lacked generosity; accepted help
from the analyst while refusing to help the analyst or acknowledge
his value; and, above all, were deceptive. According to Riviere, nar-
cissistic resistance arises from the imperative need to avoid depen-
dence at all costs and thus guard against depression. Change is a
profound threat to the precarious psychic organization of patients.
INTERSUBJECTIVITY AND IMPASSES
Self psychology understands the negative therapeutic reaction to be

a result of the analyst’s insisting on the correctness of well-intended
258 Chapter 20
interpretations and self psychology claims that the negative reaction

is exacerbated by the explanation that such reactions arise solely
from within the patient’s mental apparatus. The result of the
negative therapeutic reaction is to repeat severe, narcissistically
traumatic developmental failures.
Reading the case of the Wolf Man after becoming acquainted
with Kohut’s ideas, one discerns a link between Freud’s description
of negative therapeutic reactions and Kohut’s idea of empathic
failure. The aggravation of symptoms may have been a sign that the
Wolf Man was experiencing Freud’s interpretations, however
correct, as unempathic.
When Brandchaft’s (1983) client shows signs of a negative thera-
peutic reaction, the patient is experiencing and communicating
about a traumatic event. What is called for is an intensified effort to
identify and recognize the kernel of truth within the patient’s
complaint. From five cases with therapeutic impasses, Brandchaft
came to accept that his goals in each case were incompatible with
the goals the patient was pursuing:“ I had to conclude that I must
abandon my goals when they were incongruous with those of my
patients and stop insisting that in their opposition they were
defeating both themselves and me” (pp. 347-348).
Brandchaft’s experiences with these cases led him to concen-
trate more on the“primary factor,” which is the emergence of
archaic, intensified, distorted longings in the therapy sessions
following the therapist’s prolonged, empathic immersion in the
subjective experience of the patient. As one patient said,“The first
thing I had to get across to you . . . was how important what you
thought of me was” (p. 348).
In evaluating each of these cases where negative therapeutic
reactions occurred, Brandchaft found that“the patient had sustained
a significant injury to the self immediately prior to the reaction” (p.
349) and that, as the therapist, he had failed to recognize the
significance to the patient of the injury. Further, when the impasse
occurred, Brandchaft was initially inclined to interpret it as the
patient’s attempt to deny dependence or hostile envy; or as the
need to triumph over him; or as unconscious guilt that stood in the
way of patient’s getting well. He eventually realized that, whatever
his intention, these interpretations were experienced as blaming the
patient for the stalemate. Brandchaft had inadvertently turned the

patient into a selfobject of blame.
Brandchaft further describes wounding and the negative
therapeutic reaction:
Behind the precipitating injury, an old and decisive one had been
exacerbated. The intense drama reenacted before me [with the
negative therapeutic reaction] was a condensed, encapsulated, and
updated version of a host of earlier nuclear experiences in which
these patients, as children, had desperately attempted to get a
parent to see things from their point of view. These were efforts
to salvage and restore a needed and cherished part of a sinking
self and to keep open a developmental channel. The parents,
however, had insisted that these children see things from the
parents’ more “objective” view, always for the children’s own
ultimate good [p. 351].
It can be seen, then, that the philosophical assumption of

“objective reality,” long pervasive in classical analysis, can be a
major contributor to the formation of negative therapeutic reactions.
As Stolorow, Atwood, and Brandchaft (1988) indicate:
This assumption [of “objective reality”] lies at the heart of the

traditional view of transference, initially described by Breuer and
Freud (1893-95) as a “false connection” made by the patient and
later conceived as a “distortion” of the analyst’s “real” qualities
that analysis seeks to correct [pp. 106-107].
It seems now that this “objective” view of transference helped create

an iatrogenic effect. The classical view of transference as a distortion
can hinder psychotherapy because it reflects a “hierarchically
ordered, two-reality view” (Schwaber, 1983b, p. 383)—one reality
experienced by the patient and the other “known” by the analysts
to be more objectively true.
Once the superiority/inferiority assumptions of reality implied
by classical analysis are rejected, we are left with two different views
of reality, the therapist’s and the client’s. Discounting the automatic
assumption that the therapist’s view of reality is superior, however,
may not be sufficient to lessen iatrogenic effects. Iatrogenic effects
260 Chapter 20
may occur because the two-different-views-of-reality simply set off

a competitive struggle to see which one is superior—with obviously
nontherapeutic results. This second position still actually assumes
there is a superior view of reality but accepts that it is not automati-
cally the therapist’s view. In a third position, the two different views
of reality are accepted as an opportunity to explore each view of
reality mutually without either necessarily being superior to the
other. Where such mutual explorations take place through empathy,
feelings of being understood occur, and symptoms abate.
As Brandchaft (1989) states:
The understanding of development and the psychoanalytic

situation as profoundly intersubjective in nature, namely, the
product of the intersection of differently organized subjective
worlds, led to an interest in the further exploration of the
patient’s subjective reality from a stance within rather than outside
that perspective [p. 239].
Schwaber (1983a) writes:
Rather than being viewed as a distortion to be modified, it (the

transference) is seen as a perception to be recognized and
articulated, in the hope that it will facilitate a deeper entry into
the patient’s inner world . . . . We will, to be sure, still need to
check the patient’s perception and view of reality against our own,
but this is primarily to maintain vigilance against the superimposi-
tion of our view, which may be conveniently rationalized as our
theoretical stance [pp. 274-275]·
Support for Schwaber’s idea that the two-tiered, hierarchical

view of reality creates iatrogenic affects comes from the negative
therapeutic reactions that occur in treatments conducted according
to a wide variety of theoretical perspectives, including nonanalytic
intensive psychotherapies. Nor are those who practice psychothera-
py from a self psychology perspective immune to the experience,
especially if subtle nuances of a self-psychological theoretical
superiority pervade the intersubjective context. Thus, while self
psychology may have emphasized a greater awareness of, and a
newer understanding of, a negative therapeutic reaction, eradicating
this iatrogenic problem is another matter. Self psychology seemed,
at first, just as bedeviled by the negative therapeutic problem as was

any other treatment.
A promising approach to negative therapeutic reactions emerged
once impasses were recognized as ubiquitous to psychoanalysis and
to intensive psychotherapy aimed at structural change. The ubiquity,
even inevitability, of impasses stems from the conflict between two
different views of reality, the patient’s and the therapist’s. If these
impasses are not given analytic attention, they eventually become
entrenched as negative therapeutic reactions. Once self psycholo-
gists, such as Stolorow and his colleagues, recognized the ubiqui-
tous nature of impasses, they realized that these impasses“provide
a unique pathway—a ‘royal road’—to the attainment of psychoana-
lytic understanding” (Atwood, Stolorow, and Trop, 1989, p. 554).
INTERSUBJECTIVE CONJUNCTIONS
AND DISJUNCTIONS
The impasses that repeatedly occur in the interplay between the

subjective worlds of patient and therapist are of two major kinds:
intersubjective conjunctions and intersubjective disjunctions.
An intersubjective conjunction occurs when the organizing
principles structuring the patient’s experiences give rise to expres-
sions that are assimilated into closely similar configurations in the
psychological life of the therapist. Intersubjective disjunction, by
comparison, arises when the therapist assimilates the patient’s
material into a configuration that differs significantly from the
patient’s configuration. Atwood and his colleagues (1989) see
repetitive occurrences of intersubjective conjunctions and disjunc-
tions inevitably accompanying the therapeutic process.
So what if there are intersubjective conjunctions and disjunc-
tions? To such a query Atwood and his colleagues reply,“Whether
these intersubjective situations facilitate or obstruct the progress of
therapy depends in large part on the extent of the therapist’s
capacity to become reflectively aware of the organizing principles
of his own subjective world” (p. 555). For example, in a conjunctive
experience, if the therapist is aware of it, he may use the analogs of
his own experience as an invaluable supplementary source of
information regarding the possible background meanings of the
262 Chapter 20
patient’s material. Unrecognized for what they are, though, intersub¬

jective conjunctions can impede exploration of the meanings of
important issues. The intersubjective approach in self psychology
does not assume that similarities in experience guarantee greater
empathy, as tends to be assumed by many who make empathy the
central construct in their theory.
Atwood and his colleagues offer the case of Peter as an example
of an impasse resulting from an unrecognized intersubjective
conjunction. Peter repeatedly complained about the mechanization
and depersonalization of the American way of life. His therapist,
who shared this view of society, never explored with the patient the
subjective meaning of these beliefs, because he assumed they
represented good reality testing. This assumption led to an unwit-
ting silent collusion between therapist and patient that prevented
painful confrontations from occurring around issues of intimacy and
attachment and limited the patient’s potential to incorporate this
disavowed material into an expanded, more adaptive sense of self.
Intersubjective disjunctions can interfere with treatment. The
overt disparity between the subjective worlds of patient and
therapist may lead to dramatic confrontations and counterthera-
peutic spirals and replace empathy with misunderstanding. What
Freud called a“negative therapeutic reaction” in his analysis of the
Wolf man may be a description of an extreme impasse of a
prolonged and unrecognized form of intersubjective disjunction.
Freud’s negative therapeutic reaction explained the situation in
which interpretations assumed to be correct actually made patients
worse rather than better. Freud attributed these negative reactions
exclusively to intrapsychic mechanisms in the patient.
By contrast, Atwood and colleagues think that such therapeutic
impasses cannot be understood apart from the intersubjective
context. They illustrate an intersubjective disjunction with the case
of Robyn, a woman who traced her difficulties back to the lack of
confirming and validating responsiveness by her family. The only
exception to this pattern was her father’s sexual interest in her,
which led to her coy, seductive style and ultimately to a pattern of
compulsive promiscuity with father surrogates in a desperate effort
to stave off feelings of depletion.
Robyn’s analyst followed the precepts of classical analysis,
including an overly literal interpretation of the role of abstinence.
This abstinence meant responding to the patient’s urgent requests

for affirming and mirroring responses with silence or, at most, a
brief interpretation. Robyn experienced this neutrality and seeming
aloofness as a retraumatizing deprivation, to which she responded
either by sexualizing the relationship or with deep rage.
The central configuration of the therapist’s subjective world
concerned control. In his relationship with his mother, he had
resisted submitting to what he felt was her tyrannizing and oppres-
sive will. Hence the patient’s urgent demands for responsiveness
were assimilated into the therapist’s themes of power, evoking a
stubborn resistance and an entrenching of his unresponsive style.
Unaware of this countertransference reaction, the therapist saw the
increasing demands of the patient as a malignant need for domina-
tion.“A vicious spiral was thereby created, in which the disjunctive
perceptions, needs and reactions of patient and therapist strength-
ened one another in a reciprocally destructive way” (Atwood et al.,
1989, p. 559).
In summary, Atwood, Stolorow and Trop claim that when the
therapist explores with a view to understanding the unconscious
organizing principles of both himself and his patient, psychotherapy
becomes far more effective. It also becomes more effective if
attention is given to a patient’s affects, a subject we examine in the
next chapter.
Readings for Chapter 21: Basch, 1983a; Stolorow et al., 1987,

chapter 5; Demos, 1988.
21
Affects
A ffects play an important role in structuralizing the self. Stern

(1985), for instance, conceives of affectivity as a self-invariant
that enables the infant to experience a core sense of self. According
to Demos and Kaplan (1987), an infant’s sense of self develops from
an inner experience of recurrent affective states that are responded
to by a caregiver. Stolorow et al. (1987) also see affects as the prime
organizers of self-experience. This chapter covers affects under the
following headings: (a) definition, (b) theory of specific affects, (c)
infant studies and affect theory, and (d) affect integration and
psychotherapy.
DEFINITION
Basch (1983a) defines affect as“the reaction of the subcortical brain

to sensory stimulation” (p. 692). In doing so, he distinguishes affect
from feeling. A feeling is a cognition, a cortical association just like
any other thought. Feeling is the awareness of an affect, that is, the
264
Affects 265
cortical consciousness of an affective subcortical reaction. Technical-

ly, emotion is not a synonym for affect or feeling but has a complex
state, such as depression, that involves a mixture of primary feelings.
Basch (1988c), then, sees affect as having its own“line of develop-
ment” with a“ n o r m a l progression from affect, to feeling, to
emotion, and finally to the capacity for empathy with others” (p.
147).
SPECIFIC AFFECTS
Self psychologists such as Michael Basch have appropriated the

work of Silvan Tomkins, a pioneer in affect theory, in theorizing
about the function of affects in therapeutic change. For instance,
Basch (1983a) writes:
Discussions of psychoanalytic technique have been hampered in

the past by our acknowledged lack of an acceptable theory of
affect that could serve as a base and a reference point for such
deliberations . . . . [Previously,] I sought to show that this deficit
has been practically resolved by the work of the psychologist
Silvan Tomkins [p. 692].
Tomkins (1962-63) believes that affects are present in infants from

the first moments of birth. He conceptualized affects as biologically
inherited programs controlling facial muscles, the autonomic
nervous system, bloodflow, respiration, and vocal responses. On the
basis of a study of the facial muscles, he presents evidence for nine
primary affects: surprise, interest, enjoyment, distress, contempt,
disgust, anger, fear, and shame. Because the facial muscles in
humans are more finely articulated and can change more rapidly
than can the correlated autonomic responses (three-tenths of a
second verses one to two seconds), the face is the primary sight of
affect and takes the lead in establishing and creating an awareness
of an affective state, with other correlated responses coming in
more slowly.
Tomkins also asserts that the affect system is the primary motiva-
tional system in the personality. He postulates that affects function
as abstract and general amplifiers of variants in the density of neural
266 Chapter 21
stimulation. There are three classes of such variants, in which (1)

stimulation increases to activate surprise, fear, or interest depending
on the suddenness of the increase; (2) stimulation levels remain
nonoptimally high to trigger distress or anger depending on the
level; (3) and stimulation decreases to activate enjoyment. Affects
evoked in this way act as amplifiers, generating, by means of the
correlated sets of facial muscle, autonomic, blood-flow, respiratory,
and vocal responses, an analog of the gradient or intensity charac-
teristics of the stimulus. They also add a special analogic quality that
is intensely punishing or rewarding. Thus affects make either good
things better or bad things worse.
To Tomkins, affects motivate the organism to act. There are no
innate responses to affect; there are, instead, an infinite variety of
learned behavioral patterns. Discrete affects are present at birth, and
development consists of the gradual construction of affect complex-
es or ideoaffective organizations. That is, Tomkins sees affects as
having a line of development.
Contrary to Tomkin’s idea that specific affects are present at
birth is one that cognitive theorists follow: James-Lange’s (1890)
theory of a global visceral response, which, when given a cognitive
label, is experienced as an affective state. But this cognitive view
invites the question of how the labeling takes place. Tomkin’s
model suggests that it is through a selfobject experience of a
parent’s recognizing and responding to affective clues that the infant
becomes cognitively aware of affect.
INFANT STUDIES AND AFFECT THEORY
Tomkin’s theory of the specific nature of affects at birth has

received support from neurological studies reported by Pribrim
(1980). Evidence from Pribrim’s laboratory indicates that the
autonomic nervous system is involved in stabilizing emotional states
already set in motion at birth.
Ekman (1971, 1977) and Izard (1977b) independently explored
the validity of the facial expression patterns described by Tomkins.
Their work demonstrated that these expressions were produced,
recognized, and given similar meanings in a wide range of Western
and non-Western cultures. This cross-cultural consensus supports
Affects 267
the proposition that affects are biologically inherited responses,

shared by all humans. Other infant researchers (see chapter 23,
this volume) have demonstrated that infant facial expressions are
not random, but occur in the organized patterns isolated by
Tomkins.
Tomkin’s premise, following Darwin’s, is that the face is a valid
indicator of an internal state. Ekman, Levenson, and Friesen (1983)
have reported evidence to confirm this part of Tomkin’s theory. By
instructing experimental subjects to contract their facial muscles in
specific ways that replicated the universal emotion patterns, they
produced emotion-specific autonomic activity, as measured by
changes in heart rate, in right-hand and left-hand skin temperatures
and in skin resistance. Four negative emotions—disgust, anger, fear,
and sadness—showed distinct autonomic patterns that were
different from the patterns of the positive emotions of joy and
surprise.
Darwin (1872) argued that the expressive forms of emotion in
humans and animals were selected for evolutionary survival because
of their function as preparations for action. Thus, for example, the
baring of teeth in primates evolved as an expression of anger
because it prepared the animal to bite. It came secondarily to serve
a communicative function as a warning signal to an approaching
animal. The facial expression of anger in humans is characterized
by lowered and knitted brows, creating vertical lines between them;
by tensed upper and lower eyelids, so that the eyes have a hard
stare and may take on a bulging appearance; and by open, tensed
lips in a squarish shape, which bares the teeth, or by lips pressed
tightly together with the corners straight down, (Ekman and Friesen,
1975). This expression suggests preparation for biting or shouting.
Also, when anger is on the face, the heart rate increases and the
skin temperature rises. This correlated set of responses does,
indeed, seem to prepare the organism to act in a specific way.
Sroufe (1979) and Emde (1980; Emde, Gaensbauer and Harmon
1976), differ from Tomkins in that they view the physiological
responses of early infancy as precursors to affects; only when the
infant develops cognitions can we speak of psychophysiologic
tensions and affects. Brenner (1974, 1982) and Arlow (1977) argue
for global pleasure and unpleasure in the beginning. Tomkins is
alone in asserting that affect and cognition can vary independently
268 Chapter 21
of each other and that cognition need not be involved in activating

or prolonging an affective state.
Modern views of infant perception support Tomkin’s position.
From these views, a young infant is seen as a highly competent
perceiver, able to operate across sensory modalities and to abstract
from stimulus events their general properties.
We must, then, begin to accept the possibility that the young

infant is capable of experiencing the full range of primary affects,
and that this experience is real and meaningful, in the sense that
the discrete affective quality of each negative affect will be
experienced as uniquely punishing, and the distinctive qualities
of each positive affect will be experienced as uniquely rewarding
[Demos, 1988, p. 34].
Summarizing support for the idea of discrete affects, Demos

writes:
The interested baby will focus its eyes intently on a stimulus,

holding its limbs relatively quiet, and will tend to scan the
stimulus for novelty (Wolff, 1965; Stechler and Carpenter, 1967).
The joyful baby will smile and tend to produce relaxed, relatively
smooth movements of its limbs, savoring the familiar, (Tomkins,
1962; Brazelton et al., 1974). The angry baby will square its
mouth, lower and pull its brows together, cry intensely, holding
the cry for a long time, then pause for a long inspiration, and will
tend to kick and thrash its limbs forcefully, perhaps even strug-
gling against a caregiver, (Tomkins, 1962; Demos, 1986). By
contrast, a distressed infant will produce a more rhythmical cry,
with the corners of the mouth pulled down and the inner corners
of the brows drawn up, and will tend to move its head and limbs
around restlessly (Tomkins, 1962; Wolff, 1969). Thus the discrete
characteristics of each affect are important aspects of the infant’s
early experience because they create discrete motivational
dispositions in the infant and therefore become occasions for
learning. . . .
In a model such as Tomkin’s, where affect is seen as an
adaptive biological system, it is assumed that the occurrence of
negative affect is inevitable and unavoidable. The task for the
organism then becomes one of learning how to modulate,
endure, and tolerate such experiences in order to benefit from
Affects 269
the adaptive function of affect. This, in the case of negative affect,

is to create a punishing, urgent state that will focus the organism
to do something about the situation. Thus, the organism must
learn how to keep negative affects within some optimal range of
density that still contains sufficient information but allows the
organism to remain in the situation and to develop or produce
adaptive responses. Neonates possess some capacity to modulate
their negative affective states at a low level of intensity, but as the
intensity level rises they tend to continue to escalate, in a positive
feedback loop that can lead from distress, to intense distress, to
anger. Infants are therefore dependent on caregivers to modulate,
soothe, and maintain them at more moderate or optimal density
levels [pp. 34-36].
Sander’s work links in with Tomkin’s theory. Interested in an

infant’s state of organizational coherence, Sander (1970) makes
three propositions. The first is that the ego begins as a state ego and
not a body ego.“The organization of state governs the quality of the
inner experience” (Sander, 1982, p. 16). To Sander, this organiza-
tion comes from the sleep-wake cycles; Demos thinks that the
awake states are affective states.
Sander’s (1982) second proposition is“that the infant’s own
states, where coherent, recurrent, desired, or essential to key
regulatory coordinations that become established with the caregiver,
become the primary target or goals for behavior” (p. 16). Demos
(1988) illustrates Sander’s second proposition as follows:
Kaplan and I (1987) have reported elsewhere on two infant girls

whom we videotaped in their family settings every two weeks
during the first year. At roughly five and a half weeks of age, each
baby when left alone briefly was observed to regulate her gazing
behavior in order to modulate mild fussiness. The following
sequence occurred. As fussy vocalizations began and as arms and
legs began to cycle, each baby began to move her head from side
to side and started to scan the environment. They each found an
object, visually focused on it, became motorically and vocally
quiet, and continued to gaze for several minutes. Then they would
look away, the fussiness would begin to build up again, and they
would return their gaze to the object, once again becoming
focused and quiet. This cycle was repeated several times before
the mothers returned and intervened.
270 Chapter 21
We are assuming that although the initial scanning may have

been unmotivated and part of the fussy movements and thus the
first encounter with the object may have been accidental, the
subsequent refocusing on the same object looked like an active
attempt by each infant to repeat a successful organizing experi-
ence. In other words, the infants were motivated to recapture the
affective experience of interest with its organizingpotential,which
felt more rewarding than the unfocused fussy state [p. 43].
Sander’s third proposition is that infant competence in initiating

and organizing self-regulatory behaviors to achieved desired states
as goals represents a systems competence. The emergence of infant-
as-agent must be granted by the system because this emergence
means a reorganization of the system to admit the newcomer. If the
system is such that it can permit the entrance of a new agent within
it, it provides conditions that not only establish the capacity for self-
awareness, but insure the use of such inner awareness by the infant
as a frame of reference in organizing his own adaptive behavior, for
example, being in a position that permits him to appreciate which
behaviors lead to which states. The valence of this inner experience
under these conditions of self-initiated goal realization is felt as the
infant’s“own” (Sander, 1982, p. 17).
Demos (1988, p. 44) illustrates with the example of Cathy. At
three and a half weeks, whenever Cathy gazed intently at her
mother’s face, without smiling, the mother would interpret this
quiet, focused interest as boredom. The mother would then pull her
own face back, out of Cathy’s visual range, and jiggle a toy in front
of Cathy’s eyes. Also, whenever Cathy’s older brother was around,
the mother would turn away from Cathy and focus her attention on
him, even though this attention to her son often meant interrupting
or foreshortening an exchange with Cathy. Cathy’s response was to
diminish facial animation or look away with a somewhat blank
expression. From this interaction, Cathy learned (1) that her states
of interest and enjoyment did not last long; (2) that she had no
control over initiating, prolonging, or ending such experiences and
thus did not experience herself as an active agent; and (3) that she
was not a source of interesting events.
Affects 271
AFFECT INTEGRATION
AND PSYCHOTHERAPY
Affects function as organizers throughout development if they are

responded to by an affirming, accepting, differentiating, synthesizing,
and containing selfobject (Stolorow et al., 1987). If they are not
empathically responded to, affect integration is undermined, affects
are disavowed, and they then disrupt precarious structuralizations.
Affect integration occurs when“contradictory affect states [are
experienced] as issuing from a unitary continuous self (p. 71). The
role of selfobjects is crucial to this process of affect integration:
“Selfobject functions pertain fundamentally to the affective dimen-
sion of self experience, and the need for selfobject ties pertains to
the need for specific, requisite responsiveness to varying affect
states throughout development” (p. 67).
Stolorow’s view of affects as organizers of the self is supported
by Levin (1991), who, following the work of Maclean (1962), claims
that the use of affects as organizers goes back 200 million years to
the evolution of the therapsid, a mammal-like reptile. In mammals,
it is conjectured, memories are stored in the limbic system
according to the affects that have been experienced. The limbic
system developed in conjunction with the use of affects as organiz-
ers of a memory system, the mechanisms of the middle ear for
hearing in the air, the capacity for vocalization, and an increased
bonding between mother and child. A case can be made that all
these systems developed as a part of an evolving strategy of survival
in which mammals depend more on learning than did reptiles, who
respond to situations primarily from genetic inheritance. As Levin
(1991) says,“Reptiles communicate by means other than sounds,
and their affects, which are not an organizing principle of experi-
ence, are not apparent vocally” (p. 212).
Levin’s extensive exploration of the neurosciences from an
analytic perspective, suggests that affect integration may become
problematic when the three information-processing systems in the
brain—the vestibulocerebellar, the corticostriatal, and the cortico-
limbic—encounter interference with their“uploading” and“down-
272 Chapter 21
loading” of memories stored in an intermediate area (p. 136). When

affects are disavowed, memories filed under specific“affects” in the
limbic system (p. 56) are not available for this complex interchange
of perspectives among the three systems. It may be that information
exchange occurs during periods of sleep, when there is no rapid
eye movement (NREM)(p. 125). Through disavowal, affects are not
experienced as feelings.
Stolorow and his colleagues see Kohut’s conceptualization of the
mirroring and idealized selfobjects as special instances of the way
selfobject functions integrate affects. Kohut discussed the importance
of mirroring grandiose or exhibitionistic experiences so that healthy
pride, expansiveness, efficacy and pleasurable excitement are seen
as being a part of the self.
Discussing affectionate and assertive affect states characteristic
of the oedipal phase, Kohut (1977) referred to selfobjects as integra-
tors:
The affectionate desire and the assertive-competitiverivalry of the

oedipal child will be responded to by normally empathic parents
in two ways. The parents will react to the sexual desires and
competitive rivalry of the child by becoming sexually stimulated
and counteraggressive, and, at the same time, they will react with
joy and pride to the child’s developmental achievement, to his
vigor and assertiveness [p. 230].
Basch (1985) expands the concept of the mirror function to

encompass broad areas of“affective mirroring”:
Through affective attunement the mother is serving as the quintes-

sential selfobject for her baby, sharing the infant’s experience,
confirming it in its activity, and building a sensorimotor model for
what will become its self concept. Affect attunement leads to a
shared world; without affect attunement one’s activities are
solitary, private, and idiosyncratic.... [If] affect attunement is not
present or is ineffective during those early years, the lack of
shared experience may well create a sense of isolation and a
belief that one’s affective needs generally are somehow unaccept-
able and shameful [p. 35]·
Affects 273
AFFECT INTEGRATION DURING PSYCHOTHERAPY
Case Illustration # 1
Stolorow et al. (1987) illustrate the process of affect integration with

the case of Steven, a 26-year-old, single, male, computer program-
mer. Steven presented for treatment with an obsessive dread of his
feelings. This dread had arisen from
terrifying emotional reactions to countless disturbing childhood

experiences (especially his parents’ divorce and his mother’s
hospitalizations) that were dissociated and repressed, solidifying
his obsessional, cerebral character style. A state of pure, affect-
less intellectuality became his self-ideal of perfection, embodied
in his intense idealization of the Star Trek character Mr. Spock,
whose life seemed completely free of the“imperfections of
emotions.” His struggle to attain this affectless ideal became
poignantly clear as the treatment began to bring forth hitherto
disavowed aspects of his emotional life [pp. 82-83].
Steven feared the experience of depression. Whenever possible,

his female therapist
clarified his fears that she, like his mother, would find his feelings
intolerable and unacceptable and would thus respond to them
with spreading panic or angry belittlement,or become emotional-
ly disturbed herself. Through this repeated analysis in the
transference of Steven’s resistances to depressive affect and the
anticipated, extreme dangers that made them necessary, the
therapist gradually became established for him as a person who
would comprehend, accept, tolerate, and aid him in integrating
these feelings [p. 84].
This experience of the therapist’s empathy led Steven to recover

many painful memories of the past; to explore formerly dissociated
feelings of suicidal despair; to crystallize a conviction that his
dynamic feelings were a threat to others; and to become able to
immerse himself in intensely pleasurable experiences.
274 Chapter 21
The defensively formed affectless state of Steven is similar to the

analysis of the malaise that Soren Kierkegaard called “leveling.” In
this process of leveling, there is a replacement of “passion,” or
commitment, by detached intellectual reflection. Such commitment
is the means whereby a person defines his world and thereby
himself. Without such a commitment there is a despair, which is
“sickness unto death” (Rubin, 1989).
Case Illustration #2
Brandchaft also illustrates the process of affect integration. Mr. N, a

gifted musical composer, was treated over a 15-year span for an
“intractable depression” that became severe and disabling after any
success. During these depressions, Mr. Ν experienced a feeling of
despair, believed that his fate had already been determined, and
thought that he had an incurable and global defect. Such a depres
sion, a complex of emotions, is made up of a mixture of negative
primary affects, cognitive awareness of these affects (feelings), and
cognitions (beliefs) connected to these feelings.
Mr. N’s treatment was made difficult by his belief that the analyst
was critical of him for continuing to feel depressed and that the
analyst felt burdened by this depression. Brandchaft slowly devel
oped a strategy to hold Mr. N’s despair in check while sustaining his
own hopeful attitude. He did so by working hard to understand Mr.
N’s experience and his own response to it and not trying actively to
alter Mr. N’s mood. By way of demonstrating his understanding of
Mr. N’s experience, Brandchaft (1988) experienced depression
(attenuated) with Mr. N:
Repeated experiences of shared affect, though without confirma

tion of his perspective, had the ultimate effect of establishing for
Mr. Ν the necessary conditions for a feeling of safety and harmony
that subsequently carried over into other affect states and made
the understandings I could convey assimilable [p. 138].
Exposed to Brandchaft’s consistent stance of sharing Mr. N’s

depression with him, gradually Mr. Ν began to believe that he
could overcome his depression. He soon came to acknowledge that
it was his analyst’s hope that had sustained him. Whenever Brand-
Affects 275
chaft was disappointed with Mr. Ν or lost confidence in himself, Mr.

Ν experienced this disappointment as loss of the bond and saw
himself as a victim, unable to work. Only by persistent reinstate
ment of the therapeutic bond through the analyst’s renewed feelings
of hope could Mr. Ν regain a sense of buoyancy. Because of this
therapeutic experience with Mr. N, Brandchaft is convinced that
the deepest source of depression in Mr. Ν . . . was the underlying

belief that no tie could be formed and no pathway sustained in
which the central strivings to give meaning to a life of his own
and the disheartening internal obstacles he encountered could
find empathic resonance and understanding so that he might
ultimately prevail [pp. 149-150].
As can be seen from these two illustrations, a lack of needed

selfobject relationships leads not only to a failure in the process of
affect integration, but to the establishment of defenses against
experiencing the affects. Such defenses, according to Stolorow et al.
(1987)“become necessary to preserve the integrity of a brittle self-
structure” (p. 67).
Defenses against affect frequently emerge during treatment
when patients reveal a need to disavow, disassociate, or defensively
encapsulate affect. Such defensiveness seems to be rooted in the
patient’s expectation that his emerging feeling states will meet with
the same faulty responsiveness of the original caregiver. Once these
defenses against the“dread to repeat” are interpreted (A. Ornstein,
1974), the patient’s arrested developmental needs will be reawak
ened in the transference with the therapist. As Stolorow (1987) says:
The analyst’s ability to comprehend and interpret the feeling states

and corresponding selfobject functions as they enter the transfer
ence will be critical in facilitating the analytic process and the
patient’s growth toward an analytically expanded and enriched
affective life [p. 74].
As mentioned in chapter 14, a patient’s ability to integrate

previously disavowed affects is a test of a therapist’s functioning as
a needed selfobject. Hence, the emergence of previously disavowed
feelings is a sign of therapeutic progress. Attention to the previously
disavowed feeling is a valuable safeguard against the therapist’s
276 Chapter 21
being lulled into believing that the patient is using him as a

selfobject function, when, in fact, this is not the case. Just as the
theory of selfobject functions limits an overinclusive use of empathy
as an explanatory principle, so the theory of affects restricts the
overinclusiveness of a theory of selfobject functions.
In summary, self psychology views affects as important in the
organization of experience and in the structuralization of the self.
Affects are understood as biologically based in the subcortical brain,
with specific patterns of response as shown by Tomkins (1962-63).
When the affective systems, particularly the negative systems, are
extremely aroused, trauma occurs, and a person struggles to
maintain self-cohesion amid signs of fragmentation. In the next
chapter, we explore the extreme arousal of the affective systems in
a self-psychological theory of trauma.
Readings for Chapter 22: Freud, 1917e; Balint, 1969; Krystal, 1978;
Ulman and Brothers, 1988, chap. 1.
22
Trauma
ne of self psychology’s theoretical shifts has been from

O drive/conflict theory to trauma theory. Kohut’s trauma theory
differs from Freud’s (1917) theory, according to which trauma is
determined by both“environmental circumstances” (stressor events)
and the“disposition” of the person experiencing the event. Kohut’s
emphasis, on the other hand, is on the function of the self and
selfobjects in any traumatic experience. To understand the signifi-
cance of Kohut’s contribution and the increased role of trauma
theory for the conduct of psychotherapy, we cover the following: (a)
definition, (b) traumatogenic objects, (c) trauma and the self, (d)
trauma and selfobjects, and (e) trauma and psychotherapy.
DEFINITION
The word trauma comes from the Greek word meaning“wound”

(Figley, 1985). Freud initially defined psychic trauma as“ a n y
experience which calls up distressing affects—such as those of
fright, anxiety, shame or physical pain” (Breuer and Freud, 1893-95,
277
278 Chapter 22
p. 6). However, as Krystal (1978) indicates,“Alongside the (‘unbear-

able affects’) model of psychic trauma, Breuer and Freud developed
another one: that of the dynamics of unacceptable impulses” (p. 83).
Freud held both models in his mind for many years. Thus the
discrediting of Freud’s drive theory and the idea of unacceptable
impulses still leaves Freud’s unbearable affects theory of trauma
intact.
With the advances in affect theory by Tomkins and others (dis-
cussed in the previous chapter), trauma theory promises significant
advances in understanding the processes involved in psychotherapy.
Consistent with Freud’s affect theory of trauma and self psychology’s
emphasis on the self system, one way of defining trauma is as the
self s experience of its affect systems in an excessive or prolonged
state of excitation (Selye, 1950) In this view, trauma occurs when
“extensive regions of the body deviate from [a] normal resting state”
(p. 9). Physiologically, trauma is an“alarm reaction” in which an
organism’s defenses are overwhelmed, and the organism goes into
a full-blown shock, creating profound weakness, flaccidity of
muscles, pallor, perspiration, a weak pulse, and a low arterial blood
pressure. If the condition progresses, coma ensues and finally death.
Such excessive stimulation of the affective system occurs in
conjunction with the shattering of“central organizing fantasies of
self in relation to selfobject” (Ulman and Brothers, 1988, p. 295).
Trauma can be defined psychologically, therefore, as the shattering
(Kohut’s fragmenting) of these fantasies.
The definition of trauma as a process involving overstimulation
of the affective system and the shattering of self-fantasies contrasts
with a more“objective” view of trauma as a sudden, catastrophic,
stressor event, such as rape. Undoubtedly many events that are
violent, destructive, brutal, and tragic have a high probability of
producing a traumatic response in those who are made victims by
the event. But whether or not a trauma occurs depends on the
internal state of the person experiencing the event.
TRAUMATOGENIC OBJECTS
What Freud called environmental circumstances and social scientists

call stressor events Balint (1969) called traumatogenic objects.
Trauma 279
Historically, a sudden bereavement (Lindemann, 1944) has been the

model traumatogenic loss. In recent years this model has been
expanded to include such life events as death of a loved one,
divorce, loss of a job, children going to college, and change of
residence, a list that Holmes and Rahe (1967) incorporated into a
Social Readjustment Scale to measure the cumulative effect of
stressor events over a short period of time. Among the items in the
scale, and the stress points attached to them were death of a spouse,
100 stress points (maximum); divorce, 73; marriage, 50; pregnancy,
40; and beginning or ending school, 26. Holmes and Rahe showed
that the higher the stress score over a 12-month period, the higher
the probability of developing a medical illness in the following two
years. Their attempt to objectify and quantify trauma, useful though
it may have been in demonstrating one of the possible consequenc-
es of trauma, so focused on the stressor event that it helped
promote a reified view of trauma.
Catastrophic events also have a high probability of inducing
trauma. Parson (1985) lists a wide range of such events and cites
studies associated with them:
Many traumatic symptoms and reactions ranging from mild to

severe, from normal to pathological, and from acute to chronic
states, can be found in those who have experienced the horrors
of the Holocaust (Furst, 1967; Krystal, 1968); the Hiroshima Blast
(Lifton, 1968); severe head injuries (Adler [sic], 1945); rape trauma
(McDonald, 1979); industrial accidents (Bloch and Bloch, 1976);
and other personal injuries (Horowitz, Wilner, Kaltreider, and
Alvarez, 1980). Additionally, stress symptomatology is observed in
women with miscarriages (Friedman and Cohen, 1980); in
hostages taken in prison (Wolk, 1981); in repatriated prisoners of
war (Corcoran, 1982; Ursano, 1981; Ursano, Boydstun, and
Wheatley, 1981); in survivors of combat in the Yom Kippur War
(Moses, Bargel, Falk, HaLevi et al., 1976); in veterans of World War
II and Korea (Archibald and Tuddenham, 1965); and in veterans
of the Vietnam War (Figley, 1978; Parson, 1984b) [pp. 316-317].
Catastrophic natural disasters, such as tornadoes (Bloch, Silber,

and Perry, 1956), earthquakes, dam collapses (Tichener and Kapp,
1976), floods or blizzards (Burke et al., 1982), need to be added to
Parson’s list. Other events include witnessing a homicide (Bergen,
280 Chapter 22
1958; Schetky, 1978; Pruett, 1979), child abuse (Green, 1983),

kidnaping (Senior, Gladstone, and Nurcombe, 1982), and incest
(Donaldson and Gardiner, 1985), the last being the original stressor
event used by Freud to develop his theory of trauma. Undoubtedly
the list of stressor events, can be expanded.
Enough research has been done to establish that dramatic,
catastrophic events and the stress symptoms they induce have
attracted widespread interest and fostered the erroneous notion that
trauma is solely an objective event. Self psychology, like traditional
psychoanalysis, sees trauma as more than an objective stressor
event. But unlike traditional psychoanalysis, self psychology cannot
conceive of trauma without the presence of some kind of external
stressor event to trigger the internal processes. Where self psycholo-
gists disagree with social theorists is in the area of the objectifica-
tion of such stressor events as rape, so that all rape by definition is
traumatic to every person who goes through the experience. An
experience of rape is traumatic to most, but not all, who are forced
into the experience (see Kilpatrick et al., 1985). The external event,
therefore, by itself is not trauma, even though it is a very important
component.
TRAUMA AND THE SELF
Freud (1917) gave personality disposition a place in his theory of

trauma. His ideas about trauma associated with a death consisted of
the actual event itself and the premorbid personality of the person
experiencing the loss:“ I n some people the same influences
produce melancholia instead of mourning and we consequently
suspect them of a pathological disposition” (p. 243). Implied in this
theory is an explanation why two persons, each faced with a painful
loss, undergo completely different processes: one may go through
“normal” grieving, while the other may respond“pathologically” and
never recover because of a loss of“ego” (self-cohesion). General-
ized, Freud’s theory of trauma contains the idea of an external
stressor event and the personality structure (constitutional and
developmental) of the person experiencing this event.
Some current literature on trauma supports Freud’s theory of
trauma. Green et al. (1985), for example, acknowledge that in
Trauma 281
response to a catastrophic event “not all people develop a formal

stress disorder” (p. 57). These authors have developed a model that
takes “into account characteristics of a particular individual (survi-
vor) and characteristics of the environment in which that individual
experiences and attempts to recover from the trauma” (p. 57). Thus
“different people who are present at the same event will have
different outcomes because, not only will their experiences differ,
but the individual characteristics they bring to bear upon the
psychological processing are different” (p. 59). Green and col-
leagues also think that most who study disasters now take an
“interactional approach, assuming that neither individual characteris-
tics nor aspects of the stressful event solely determine the outcome”
(p. 60).
In a study of rape victims, Kilpatrick et al. (1985) found that the
victim’s personality was a key factor in the intensity of affect
stimulation experienced: “It is not unreasonable to assume that the
psychological distress produced by a rape might vary as a function
of the victim’s characteristics and the nature of the rape itself (p.
120). The authors cite several studies to support their contention:
Frank, Turner, Stewart, Jacob, and West (1981) found that victims
with histories of psychiatric treatment had poorer initial adjust-
ment than those without such histories. Atkeson et al. (1982)
reported similar findings in that pre-rape history of anxiety,
depression, or physical health problems was modestly predictive
of post-rape depression, while the amount of [apparent] trauma
that occurred during the rape itself was not predictive of subse-
quent depression. The McCahill et al. (1979) study also found that
victims with pre-rape history of adjustment problems had more
severe post-rape problems [p. 121].
The concept of the self is critical for a theory of trauma. Some

theorists accept that personality structure codetermines the
symptoms of trauma without the self s playing a crucial part in the
subjective experience of trauma itself. A person’s self-organization
may be prone to a subjective experience of trauma when confront-
ed with a stressful event, or it may interpret the meaning of a
stressor event so that the impact of the event on the self’s affective
and cognitive systems is modified and a subjective experience of
trauma does not occur. For example, of a sample of 65 U.S. Air
282 Chapter 22
Force prisoners of war in Vietnam, 15 showed no evidence of the

Concentration Camp syndrome, the normal way that stress was
manifest after a long, constricted confinement (Corcoran, 1982).
This finding supports the idea that persons with different self-
organizations have different levels of psychological immunity to
external stressors.
Ulman and Brothers (1988) place the selfs organization at the
center of trauma theory and reject the idea that trauma is a fantasy
event. They argue that real events shatter the narcissistic fantasies
that are central to the organization of the self. Thus they emphasize
the cognitive rather than the affective dimension of a traumatic
experience. They write:“in this shattering and subsequent faulty
(defensive and/or compensatory) attempts to restore these fantasies
lies the unconscious meaning of the traumatic event” (p. xii).
Consequently,“there is a severe ’developmental arrest’ (Stolorow
and Lachmann, 1980) in the psychic structuralization of the incest
survivor’s self-experience because these central organizing fantasies
are repeatedly shattered and faultily restored with each incestuous
assault” (p. xiii).
At the heart of their theory is the idea that the subjective experi-
ence of trauma is the shattering of a person’s beliefs about self.
The self has core archaic narcissistic fantasies that are representa-
tions of the self in relation to a selfobject. Ulman and Brothers see
their construct of the self as fantasy as an experience-near level of
theorizing, and not as the supraordinate, experience-distance self of
Kohut:“Kohut originally thought of archaic forms of narcissism (that
is, fantasies of self in relation to selfobject) as an ultimate ’psychic
reality’ or subjective frame of reference” (p. 19). Piaget (1970) might
have termed these fantasies“unconscious meaning structures.”
Ulman and Brothers claim no originality for their idea of trauma
as the shattering of archaic narcissistic fantasies. They borrowed the
concept of organizing fantasy from the work of Nunberg and
Shapiro (1983), who suggest that each person develops an orga-
nized system of fantasy. They also see their concept of trauma as
similar to the notion of shattering a person’s assumptive world.
Janoff-Bulman (1985), for example, sees three basic assumptions,
which if shattered, will constitute a trauma.“These three assump-
tions include: (1) the belief in personal invulnerability; (2) the
Trauma 283
perception of the world as meaningful and comprehensible; and (3)

the view of oneself in a positive light” (p. 18).
To test their idea of trauma as a shattering of archaic narcissistic
fantasies, Ulman and Brothers (1988) interviewed 150 survivors of
stressor events (50 incest victims, 50 rape victims, and 50 combat
survivors). Of these 88 (59%) had been diagnosed as having a
posttraumatic stress disorder. Eventually 10 from each trauma group
were selected for self-psychologically informed psychotherapy,
where it was quickly obvious that many were suffering from a
severe blow to their grandiosity or a sudden disillusionment of
their idealized figures.
Ulman and Brothers’s case of Fran illustrates the treatment of
trauma informed by self-psychological theory:
By the time Fran entered school, her trust, respect, and admira-
tion for both parents had been repeatedly shaken. Again and
again, her mother had rebuffed her efforts at closeness. Again and
again, she had submitted to her father’s bizarre sexual demands.
They were, in other words,figureswho constantly interfered with
Fran’s need to unconsciously enact a fantasy of idealized merger
with omnipotent parental imagos. In addition, her parents were
grossly unempathic to Fran’s need for mirroring . . . .
[Fran’s] central organizing fantasies of grandiose exhibition-

ism, as well as those of idealized merger, were repeatedly
shattered. As she grew up, Fran’s self-experience was increasingly
organized by these fantasies, which underwent ever greater
defensive and compensatory elaboration. For instance, the
exhibitionistic displays Fran staged during her school years, as
well as her inflated estimation of her musical ability, may be
understood as unconscious efforts at defensive restoration of her
grandiose fantasies [p. 35].
Ulman and Brothers’s concept of the self as fantasy diverges

from that of Atwood and Stolorow (1984), who conceive of
structures as subjective organizing principles.“Stolorow maintains
that structures of subjectivity are primary whereas fantasy is
secondary” (Ulman and Brothers, 1988, p. 20). Stolorow’s belief in
the primacy of structures is consistent with his understanding of
284 Chapter 22
concretizations: he sees subjective structures as being perceptually

concretized as sensorimotor symbols, such as fantasy.
As a consequence of their self-psychologically informed
treatment of trauma patients, Ulman and Brothers see a theory of
trauma as the key element in a paradigm shift away from conflict
theory. They note that Cohen (1980) has referred to the emergence
of a“trauma paradigm” in psychoanalysis and views their work as
supporting this position. It differs slightly from the thesis of the
present volume, which recognizes a major paradigm shift as
occurring, but one much larger than from conflict theory to trauma
theory. The question of the size of the paradigm shift, and whether
self psychology itself represents only one piece of a larger paradigm
shift, is taken up in the final chapter.
TRAUMA AND SELFOBJECTS
Balint (1969) paved the way for understanding the function of

selfobjects (before Kohut defined the term) for a theory of trauma.
He conceived a new theory that moved beyond seeing trauma as
“an external event causing a severe psychical upheaval with lasting
consequences” (p. 429) and also beyond the idea of trauma as
patient fantasies determined by the inner state of the self. This new
theory came from recognizing the potential of the infant-mother
relationship to act as a traumatogenic object. Conditions necessary
for a parent to function as a traumatogenic agent are that (1) the
child has a dependent, trusting relationship with a parent, (2) this
parent does “something exciting, frightening or painful” (p. 432),
and (3) when the child
approaches his partner again with a wish and an offer to continue

the exciting passionate game, or, still in pain and distress about
the fact that in the previous phase his approach remained
unrecognized, ignored or misunderstood, now tries again to get
some understanding, recognition and comfort. What happens
quite often in either case is a completely unexpected refusal [p.
432].
Trauma 285
In other words, it is not so much the excitement or fright or pain

that produces the trauma in an infant, but the faulty responding and
outright rejection by the adult with whom the infant has a depen-
dent relationship.
Balint illustrated his point by describing an incident (p. 433). A
baby of around six months old was placed on a table and left for a
moment unattended. Apparently he managed to wiggle over the
edge and drop to the floor. He was obviously shocked. His mother
picked him up and cuddled him, and when he calmed down
completely, she fed him and changed his diapers. Then she kept
him in her arms for a couple of hours although the boy was asleep.
With this incident Balint pinpointed the importance of the mother
as a calming selfobject, even though the actual term itself came later
with Kohut. Balint then raised the question of what would happen
if the“ m o t h e r did not recognize the child’s ‘communications,’
misinterpreted and misunderstood them, and in consequence her
response was wrong or inadequate” (p. 434). The lack of an
appropriate response, not the fall to the floor, is a traumatogenic
object. In taking this position, Balint touched on the idea that a
person’s selfobject experience is central to the concept of trauma.
Kohut (1984) thought that an infant would be traumatized by
the repeated absence of a developmentally needed selfobject experi-
ence. Referring to the unavailability of a therapist to his patient,
Kohut noted that“ t h e patient’s self disintegrates temporarily
because the withdrawal of the mirroring selfobject repeats the
traumatic unavailability of self confirming responses in early life” (p.
102). In infancy, then, it is the unavailability of the necessary
selfobject experience that is the major reason for the experience of
trauma. Ferenczi (1933), similarly, thought that the major element
in trauma was not the incestuous act per se, but the experience of
the parent’s betrayal of the child’s trust and, therefore, of the
needed selfobject function.
Some of the“objective” studies of the traumatic effects of cata-
strophic events touch on the selfobject factor in trauma theory. For
example, Green et al. (1985) mention the importance of a“recovery
environment”:“We found that family and friends of survivors often
formed a sort of membrane around the survivors which functioned
286 Chapter 22
to protect them from people and circumstances that threatened to

be further traumatic” (p. 61). And Kilpatrick et al. (1985), in
studying rape victims, write:
The victim’s post-rape interactions with significant others, family

members, friends, law enforcement agencies, hospitals, and/or
treatment providers can have either positive, negative, or mixed
effects on subsequent psychological adjustment in that they can
serve as additional sources of stress, enhancers of coping ability,
or some combination of the two [p. 122].
While the idea of the potential role of a supportive recovery

environment (and by implication, selfobject experience) is seen by
social researchers as a useful addition to a theory of trauma, their
view does not reflect the central function of selfobjects in maintain-
ing the selfs organization of experience. As“support,” selfobjects
are still viewed as auxiliary to an actual“traumatic event.”
In comparison, a self-psychological theory of trauma, while
acknowledging the catalytic role of traumatic events, understands
the experience of trauma as the loss of a selfobject, with resulting
affect overstimulation and self-fragmentation. Selfobject loss or
absence is seen as the key to the psychology of traumatization, and
the stressor event and the self-system as ancillary to such loss or
absence. The memory of early trauma involving persistent absences
of necessary selfobject experiences leaves the self vulnerable to
further potentially traumatizing events. These psychological
“allergies,” the defenses against their activation, and the components
of self-organization are involved in the experience of trauma. Later
stressor events retraumatize, that is, reproduce an uncomfortable,
overstimulated affective state without expectation of selfobject
soothing. On the other hand, adults with internalized experiences
of adequately responsive selfobjects when infants are more immune
to a subjective experience of trauma despite the impact of a
catastrophic event such as rape.
This new perspective on trauma based on selfobject experience
makes possible a less pessimistic view of the consequences of
catastrophic events. It leads to a disagreement with disaster
specialists who assume that all victims of a catastrophic event are
traumatized and who therefore believe that those showing no
Trauma 287
symptoms of stress are going through massive denial that will later
manifest as psychopathology. A theory of trauma with the selfobject
factor as the key does not hold that everyone will be traumatized by
a catastrophic event. Many, of course, will be traumatized, and
almost immediately show symptoms of trauma. Others exposed to
the stressor event and traumatized by it, but who disavow what has
happened, will have a delayed reaction to their traumatic experi
ence. Some, however, may not be traumatized in any significant way
as the following case illustrates:
Case Illustration
Mr. M, who suffered congestive heart failure, underwent successful

open-heart surgery for an aortic valve replacement without experi
encing trauma. His 800 hours of psychotherapy, which had ended
5 years before, resulted in the structuralized sense of the presence
of his therapist.
While in hospital preparing for the surgery, Mr. M, as a way of
coping with presurgery “jitters” and helping to evolve a strategy to
enhance surgical results, recalled his experiences of his therapist as
a calming selfobject in past situations. Under this strategy, he saw
and handled the valve that was to be placed in his heart, obtained
and read articles about the aortic valve in the medical literature for
the preceding five years, and learned that the five-year survival rate
for person’s using this valve was 83%.
Another part of the strategy was to introduce humor to the
surgical team. Mr. Μ had obtained an empty aortic valve box from
a nurse friend and placed a plumber’s valve in it. He handed it to
the surgeon the night before the surgery and said, “Doc, I’ve
changed my mind about that valve and want you to sew in this one.”
Mr. M’s fantasy was of a Monday morning surgical team, slow to get
going and still distracted by memories of their weekend, laughing
and quickening their attention to the task at hand when the surgeon
held up the plumber’s valve to show them what this “crazy guy” had
wanted them to do. Just imagining this scene helped Mr. Μ feel
better.
Three days after surgery Mr. Μ had another session with his
“internal therapist.” The operation and the first two days had gone
well, but on the third day, when Mr. Μ was transferred out of
288 Chapter 22
intensive care, he was exhausted from coping with the 42 persons

with whom he had interacted that day. There were two new nurses
each shift, a different physiotherapist every six hours; a resident
doctor; many medical students listening, poking, and asking
questions; student nurses; aides; a different blood technician every
four hours; a dietitian; the cardiologist; two surgeons; and others.
Every time he dozed off to sleep, someone soon awakened him for
something. The task (thing), always more important than his needs,
turned him into a selfobject to the schedules of others. In that
night’s imaginary therapy session, he told his therapist about the
psychological battering and exhaustion he was experiencing and
imagined his therapist saying, as he had done many times before,
“Well, what are you going to do about it?” So, in the presence of his
internalized therapist, he evolved a plan.
The next morning a nurse bounced into the room at 6 a.m. and
opened the blinds with“Good morning.” He deliberately greeted
her with a grumpy,“What’s good about it?” After she left the room
quickly, Mr. Μ felt better. The next interaction was with a physio
therapist who was greeted with“None today thank you.” The
shocked“physio” said,“But your doctor ordered it!” Mr. M:“I’ll deal
with him when he comes in!” Counter:“But you need it.” Counter
reply:“Like a hole in my head.” Then with a triumphant note of
finality, Mr. Μ said,“I’m refusing treatment!”
Next came the students. They received a,“School’s-out today, try
tomorrow.” By the time Mr. M’s wife visited in the early afternoon,
he was ready to sleep. While she sat“ o n guard” in the room’s
doorway and turned away numerous persons with the insistence
that Mr. Μ be left undisturbed, he had five hours of the best sleep
since coming into hospital. The cardiologist, who came later to a
refreshed and prepared Mr. M, said,“ I hear there has been a little
trouble.” Mr. M:“There was yesterday, but today’s been wonderful!”
Cardiologist:“ I hear you are refusing treatment.” Mr. M:“Yes, but
just physiotherapy.” Counter:“I’ll reduce it by half.” Reply:“No. I am
prepared to sign something absolving you of the legal responsi
bility.”
That night, as Mr. Μ recalled his day’s work, he felt good about
regaining his sense of agency. His recovery then was rapid; he left
the hospital a day earlier than the norm and was back at work four
weeks after the surgery, two weeks ahead of schedule. The internal¬
Trauma 289
ly structured presence of a calming, soothing selfobject had helped

Mr. Μ become more adaptive and modify the traumatic effects of
the open-heart surgery.
Critics of a self psychological theory of trauma may misinterpret
aspects of this case. Dorpat (1990) for example, wrongly claims that
self psychology is wedded to drive theory and fantasies activated by
unconscious drives and is not interested in the“real occurrences in
the social world of shared experience” (p. 456). Van der Kolk
(1988) also thinks that self psychology undervalues“the interperson
al dimension of psychological agony” (p. 376). Both are wrong. The
fantasies that Ulman and Brothers mention derive from experiences
with selfobjects, not from id drives. And as we have previously
stated, self psychology sees the stressor event as a necessary
element in trauma theory. Self psychology does not deny that such
events can be so horrible, so overwhelming in nature, as to warrant
the descriptive appellation“traumatic.” But self psychology makes
the distinction between trauma as an event (perceived extrospec-
tively) and trauma as a process (experienced introspectively).
The process of traumatization involves both a traumatic event
and the psychological sequalae that follow in its wake. The strength
of a self-psychological theory of trauma resides in its sensitivity to
the whole process of traumatization, with an interest in minimizing
the devastating repercussions of a traumatic event and preventing
maladaptive structuralizations. Mr. Μ was subjected to a traumatic
event, and yet, owing to structuralized selfobject experiences, he
was largely successful in resisting the subjective experience of being
traumatized.
TRAUMA AND PSYCHOTHERAPY
Trauma theory enlarges our understanding of the process of

psychotherapy in three ways: (1) by helping explain the severe
resistances of many patients to the development of an empathic
bond in the beginning phase of treatment, (2) by illuminating
psychotherapy as an immunizer against future trauma, and (3) by
emphasizing the repair of selfobject failures as another means of
lessening sensitivity to trauma.
290 Chapter 22
Trauma Theory Helps Explain the Severe

Resistances of Many Patients to the
Development of an Empathic Bond in the
Beginning Phase of Treatment.
Not everyone reacts in this way, of course. But for many, despite
their hunger to be understood empathically and their need for
cohesive selfobject experiences, the fear of being retraumatized is
so great that they resist the very experience they most need. Anna
Ornstein (1974) offered a similar idea with her concept of the
“dread to repeat,” specifically“the ‘dread to repeat’ archaic infantile
defense patterns” (p. 232), because she sees these archaic defenses
as being“in response to childhood narcissistic traumata” (p. 232).
It is clear, however, that she views the dread as associated with both
retraumatization and the archaic defenses that accompany it.
Trauma Theory Illuminates the Experience

of Psychotherapy as Immunization Against
Future Trauma.
When psychotherapy acts as such an agent, the therapist is intensive-

ly and consistently available, is empathically understanding, is a
responsive selfobject, and is internally present.
Support for the idea that even brief psychotherapy can reduce
the subjective experience of trauma comes from the research of
Florell (1971). He studied 100 patients who received a psychothera-
py session the evening before they underwent elective orthopedic
surgery. Dependent measures of stress before and after the surgery
were compared with those of 50 orthopedic patients not given the
presurgery psychotherapy session. Significant differences were
obtained on most of the dependent measures. The comparison
group, who did not receive the treatment, stayed more than a day
longer in hospital, needed more pain medication, had higher pulse
and respiration rates for days after the surgery, had more lines of
nursing notes, made more calls to the nursing station, and showed
more anxiety on the Spielberger State Trait Anxiety Inventory
several weeks after the operation. Other studies cited by Florell
Trauma 291
showed similar results for brief psychotherapy conducted in

anticipation of a high-stress event.
To such experimentally designed studies of brief psychotherapy
for reducing stress, case studies of effective, long term, intensive
psychotherapy can be added. For example, the case of Mr M,
described earlier, showed the value of a therapeutic relationship in
modifying the subjective impact of a stressor event.
The Repair of Selfobject Failures During

Psychotherapy is Another Means of
Lessening Sensitivity to Stressor Events
or“Triggers.”
The recognition and repair of selfobject failures is a major task

already discussed under transmuting internalization and structurali-
zation (see chapter 19, this volume). The signs of such failures are
often indirect because of the urgent need to maintain the therapeu-
tic bond as a means of keeping the self cohesive. Problems with
paying bills, lateness, dreams of bugs (Stolorow, 1975), or excessive
drinking are examples of behavior suggesting the possibility of a
selfobject failure needing exploration.
In summary, we have seen how the responsive selfobject
functioning of the parent is crucial to a child’s becoming able to
function as an adult. The absence of a needed selfobject, on the
other hand, helps produce pathologically structured ways of
behaving. In the following chapter, we see the importance of the
selfobject experience in the mother/infant dyad and the patterns that
occur in the first few months of development.
Readings for Chapter 23: Beebe, 1985; Beebe and Lachmann,

1988.
23
Mutual Influence
Theory
T with
he clinical experience of patients needing a selfobject bond
the therapist raises questions about their early childhood.
Specifically, what was their interactive pattern with mother in the
early months of life? The mother/infant studies by Beebe and
Lachmann (1988) offer some answers. This chapter uses their
material extensively, but not exclusively, to discuss mutual influence
under the following topics: (a) theory of early infancy, (b) multi-
modal evidence, (c) self- and object representations, (d) matching
communication, (e) aversive interaction, (f) coactive and alternating
matching, and (g) psychotherapy.
THEORY OF EARLY INFANCY
Beebe and Lachmann (1988) state that“the mother-infant interaction

in the first six months of life can illuminate the development of
psychic structure” (p. 3). These early interactive structures are made
292
Mutual Influence Theory 293
up of“patterns of mutual influence” that provide an important

element in the organization of infant experience. They go on to say,
“The dynamic interplay between infant and caretaker, each influenc-
ing the other to create a variety of patterns of mutual regulation,
provide one basis for the representation of self and other” (p. 4).
These statements, and those of other infant researchers, for
example, Stern (1985), are in sharp contrast to Freud’s idea of an
infant’s autistic stage of development for the first two months of life.
In this autistic stage“ t h e infant is postulated as not only [being]
unaware of his person, but also as essentially unaware of his
environment” (Shane and Shane, 1980, p. 28). Infant researchers
also see a baby as very different from the one hypothesized by
Abraham, Klein, or Mahler, who conceived of it as
endangered from within by its own libidinal and hostile-aggres-

sive drives and their“early objects,” by introjective, projective, and
splitting mechanisms of defense against the dangers from drives
and drive objects, and by resultant archaic psychic conflict [Shane
and Shane, 1980, p. 51].
Nor do infant researchers see evidence that after the autistic

phase the infant fuses with a hallucinated representation of an
omnipotent maternal symbiotic object or part-object for the next
five to six months as Mahler, Pine, and Bergman (1975) assert. What
emerges from recent infant studies is a very active person from day
one.
Mutual influence theory also stands in contrast to the one-way
model, in which either the parent influences the child or the child
the parent. It reflects a systems perspective in which experiences
are perceived as the property of the infant-caretaker system, rather
than the property of the individual (Sander, 1977, 1983). It also
reflects Winnicott’s (1960a) declaration that“there is no such thing
as a baby” and that the“infant and mother together form an
indivisible unit” (p. 39).
The interaction of the mother-infant dyad includes feeding, the
management of tension states, social interaction, and play. From
birth, the infant is innately structured to actively seek stimuli.
Neonates show rooting, sucking, molding, and orienting behavior;

the ability to scan visually, focus on, and track a moving object;
294 Chapter 23
and the capacity to respond to visual stimuli by widened and

brightened eyes, changes in respiration, a decrease in random
movements, and fine nuances of facial expressions (Als, 1977;
Brazelton, 1974; Oster, 1978) . . . . Neonates not only seek and
initiate social interaction (Als, 1977) but can also modulate or
regulate social stimulation in the face of aversive conditions with
self-quieting measures, inhibiting their responsiveness or habita-
tion to a disturbing stimulus (Brazelton, 1974). These innately
organized patterns of behavior equip the infant to engage in
primary relatedness with the human partner [Beebe, 1985, p. 29].
MULTIMODAL EVIDENCE
Empirical literature on mother-infant interaction reinforces the

existence of mutual influence in the formation of organizing
structures in infants. Observations of mutual regulations have been
made with respect to (1) vocalizations, (2) sleep–wake states, (3)
gaze, (4) affective engagement, (5) shared rhythms (temporal
organization), and (6) expectancies.
Vocalizations
Two studies document mutual influence in mother–infant vocaliza-

tions (Stern et al., 1975; Anderson, Vietze, and Dokecki, 1977).
These studies show that if one partner in the dyad begins to
vocalize, there is a greater than chance probability that the other
partner will begin vocalizing. There is a tendency for the vocaliza-
tion to occur almost simultaneously, that is, as a coaction.
Sleep–Wake States
A mutual influence structure acts as a“basic regulatory core” that

jells in the early weeks of life in relation to the caretaker environ-
ment (Sander, 1983). Sander formed this idea from the regularities
in the sequence and duration of infant sleep-wake and feeding
states. Such regularities are established over the course of the first
days and weeks of life only as mother and infant mutually influence
each other to establish predictable sequences. Chapell and Sander
(1979) write:
The infant’s wakefulness determines the activities of the mother,

the activities of the mother determine in some degree the course
of infant state over the interaction period, and the modifiability of
infant state by maternal manipulation determines the mother’s
further activities [p. 106].
An infant’s“alert state” is greatly facilitated by the mother–infant

mutually influencing interaction.
Most healthy full-term infants have no difficultyachievinga robust,

lusty crying state and can return to a sleep state relatively readily.
The ability most neonates seem to establish in the first several
weeks after birth is increasing stabilization of the alert state in
their transition from sleep to aroused crying states and back down
to sleep states. In the two-day-old full-term infant the alert periods
are still much more difficult to achieve and are embedded in long
stretches of sleep and episodes of crying. By two and three weeks,
these periods of alertness have become increasingly reliable and
solidified; by one month to six weeks, many infants easily spend
an hour and more in an alert, socially and cognitively available
state [Als, 1986, pp. 11-12].
Gaze
According to Beebe and Lachmann (1988):
In studying the mutual regulation of gaze during face-to-face play

at four months, Stern (1974) similarly documented that each
partner influences the other . . . . The infant’s initiation of gaze at
mother increases the likelihood that mother will continue gazing.
When mother and infant are gazing at each other, it is more likely
that the infant will gaze away. In fact, it is the infant who makes
and breaks mutual gazes, since the infant initiates and terminates
94 percent of all mutual gazes, while the mother tends to gaze
steadily at the infant [p. 5]·
Affective E n g a g e m e n t
To study affective engagement, Stern (1977) set up two video

cameras for a split-screen view, one focused on the infant and the
other on the mother. He asked mothers to play with their children.
296 Chapter 23
Later analysis of 16mm films made from the tapes, pairs of frames
at a time, and use of a scale of“affective engagement” revealed
action patterns. These patterns showed an inexact matching of
emotional engagement, but mother and infant matched each other’s
direction of engagement change, both increasing and decreasing.
That is, they each tracked the process of change in the other. More
than this, a statistical time series regression analysis showed that
each partner influenced the other to follow his or her own
direction of affective change.
Tronick, Als, and Brazleton (1980) also conducted a study on
affect engagement and came to a similar conclusion. Viewing the
split-second by split-second affective involvement between mother
and infant in play at around three months, by noting positive or
negative responding, they found that the changes in involvement
tended to be simultaneous (coactive) rather than on an alternating
(reactive) basis.
Affective communication is critical to the guidance of an infant
in a social referencing situation. Researchers (for example, Emde et
al., 1978) placed year-old infants in uncertain situations, such as at
the brink of an apparent cliff. The infants were lured by an attractive
toy to crawl across a“visual cliff’ created by placing a thick piece
of glass over a real drop off. Infants facing this uncertain situation
look toward mother to read her face for its affective content to see
how they should feel. When the mother follows the instructions to
show facial fear, the infant turns back. When the mother’s face
shows encouragement, the infant crawls across to the toy.
Shared R h y t h m s (Temporal Organization)
Condon and Sander (1974) present evidence that infants move their
bodies in precise unison with adult speech. Even though Dowd and
Tronick (1983) failed to replicate this finding, other investigators
have discovered movements where both partners are synchronized.
Stern (1974), for instance, discovered simultaneous head movement
in three-month-old twins interacting with their mother. Perry (1980)
found coordination of the changes in the direction of head
movement with no noticeable lagtime by either partner. Beebe
(1985) reports that
both Stern and Perry explain their results as reciprocal mutual

regulation; where the behavior of each partner is influenced by
the other, so that the intensity and quality of social contact is
adjusted on a moment to moment basis [p. 31].
Studies indicate that mother–infant interaction patterns occur in

half a second or less. This rapidity of engagement suggests a process
that is either partially or fully out of conscious control. Adult
conversations can also have matching patterns.“ W h e n adult
strangers match rhythms, they like each other more and perceive
each other as warmer and more similar than when their rhythms do
not match” (Beebe and Lachmann, 1988, p. 13). If persons who walk
together do not match each other’s pace, one will soon be ahead of
the other. Similarly, in any conversation, if one participant never
pauses or waits too long before responding, the other may well
tune out. Studies of mother–infant interactions when the infant is
three months show that they match each other’s pauses, each other’s
“turns,” and the duration of such actions as orienting to look.
Expectancies
Mutual influence structures organize infant experience through

expectancies. Decasper and Carstens (1980) used infants’ capacity to
time events to teach them that if they paused longer (or shorter)
between sucking bursts, they could turn on music. When the infants’
expectations were confirmed, that is, when their longer pauses
between sucking produced music, the infants’ affect was positive. In
a second experiment, after the infants had learned to turn on music
by pausing longer between sucking bursts, the experimenter turned
on and off the music randomly. The infants’ affects then became
negative: the babies grimaced, whimpered, cried, and in some cases
stopped sucking altogether. In a third experiment, a new group of
infants was first randomly exposed to music before being subjected
to the first experiment, in which music was turned on after longer
pauses between sucking. The startling result was that the infants
could not learn the contingency between their behavior and the
music.
298 Chapter 23
The findings of their last experiment suggest that if the environ-

ment were completely noncontingent, which would be a very
extreme condition, then the infant’s very capacity to organize
experience within a dyadic relationship would be interfered with
[Beebe and Lachmann, 1988, pp. 6-7].
Decasper and Carstens’s (1980) work points to a new view of

infant memory. What the infant remembers is not simply an event,
but a particular contingency relationship between behavior and
environmental event. That is, the infant remembers an interaction!
Infants learn, remember, and anticipate from birth; they can, thus,
participate in many mutually regulated interactions from the
beginning of life. Those interactions that repeatedly reoccur, and are
thus characteristic of the infant, become generalized as structures
that organize the infant’s experience. Structures are understood in
Rapaport’s (1959) sense: as configurations or patterns with a slow
rate of change.
SELF-REPRESENTATION AND OBJECT

REPRESENTATIONS
Beebe and Lachmann (1988) point out that developmental theorists

such as Werner, Piaget, Church, and Schilder conceptualize repre-
sentation in a similar way. They all consider activity—that is,
sensoriaffective-proprioceptive experience—as the primary factor.
“Representation is defined as interiorized actions, so that children
can now do with mental images what before they did with their
own actions” (p. 7). Representational capacity can be seen after
seven months but does not reach full capacity until the third year.
Beebe and Lachmann take the theory of representation a step
further:
[Representation is] interiorized interaction: not simply the infant’s

action, nor simply the environment’s response, but the dynamic
mutual influence between the two (see Beebe, 1985). Interiorized
patterns include actions, perception, cognition, affect, and proprio-
ceptive experience [p. 8].
Seeing representation as interiorized interaction led Beebe and

Lachmann to a further conceptual step. They envisage a“transforma-
tional model of development where earlier structures are under-
stood both to shape and to be shaped by subsequent experience”
(p. 8). Such an interiorized interactive model of self-representation
is in sharp contrast to the analytic view that self- and object
representations grow out of the instinctual experiences of pleasure
and unpleasure (Jacobson, 1964). It also shifts the focus from a
representation clearly delineated from a“significant other” to one
that is a“self with a significant other.” Nor does the interactive
model see representations built up piecemeal; the capacities to
construct representations, memory, expectancies, and mutually
regulated interactive patterns are present at birth.
MATCHING AS COMMUNICATION.
The experience of matching provides each person in the dyad with

the means of entering the perceptual and affective world of the
partner. As Beebe and Lachmann put it,“ T h e implication is that
similarity in behavior is associated with a congruence of feeling
states; that there is a relationship between matching and empathy”
(p. 14). That is, matching offers a way of seeing how the sharing of
subjective states can occur.
In a very important experiment by Ekman (1983), professional
actors were taught a series of facial muscle movements that
reflected emotions. Then, when they were asked to relive various
emotions, their recorded autonomic indices indicated that simply
producing the facial-muscle action patterns resulted in more clear-
cut autonomic changes than the attempt to relive emotions.
The implication is that by contracting the same facial muscles as

perceived on another’s face, the onlooker can literally feel the
same autonomic sensations as the other person. Reproducing the
expression of another (for example, in mirroring) can produce in
the onlooker a similar emotional state [Beebe and Lachmann,
1988, p. 15].
300 Chapter 23
AVERSIVE INTERACTION
The importance of mutual influence is reflected in the filmed “chase

and dodge” sequences of behavior between a four-month-old infant
and his mother (Reebe and Lachmann, 1988). Instead of inhibiting
the normal gazing pattern, this infant glanced only briefly at the
mother during a six-minute period. The interaction reflected an
intense struggle of wills in which the mother tried to engage the
infant, but the infant was very determined not to be engaged.
To every overture by the mother, the infant ducked, moved back,

turned away, or pulled his hand out of her grasp. The infant
appeared to exercise near“veto” power over his mother’s efforts
to engage him. He also systematically affected the mother’s
behavior: his avoidance maneuvers elicited further maternal
“chase” movements, such as looming toward him, following the
direction of his movement with her head and body, or pulling
him toward her [p. 16].
During the chase and dodge behaviors of mother and infant, the
mother demonstrated signs of negative affect:“ S h e grimaced,
frowned, bit her lip, and thrust her jaw out” (p. 16). When finally
the infant went limp, so did the mother. Only in this way could the
infant induce the mother to lower her level of stimulation. This pair
was obviously“misattuned” even though they were still relating to
each other. The infant’s dodges and averting his head influenced the
mother to increase her stimulation.“The infant comes to expect that
he cannot benefit from his mother’s participation in the manage-
ment of his affect-arousal states” (p. 19). The infant was able to calm
himself down only by moving away.
At a public lecture in Chicago using the“chase and dodge” film,
Beebe remarked that the mother of the infant had been eager to
please the researchers. We believe that whatever the reason for the
mother’s need to please the researcher, whether that Reebe was a
displaced parental figure or that the play session reflect well on her,
or some other reason, her need obviously took priority over the
infant’s needs, thus leading to prolonged unempathic pressure on
the infant to perform. This pressure may have been experienced by
the infant as an intrusive, persecutory pattern of interaction. The
infant’s dodge behavior may also have been a refusal by the infant
to be a selfobject for the mother.
COACTIVE AND ALTERNATING TYPES

OF MATCHING
The two mutual influence patterns of coactive and alternating invite

speculation. Both types have been shown to occur in vocalization
and facial modes. The coactive pattern appears to promote bonding
and the feeling of“being with” the other person (Stern, 1985). The
alternating, or turn-taking, pattern fosters a learning process, such
as later speech development.
The coactive pattern, where both partners“join in”—for example,

cooing together at exactly the same moment, or both opening and
widening their mouths to achieve a wide-open“gape smile” at the
same split second—has a special evocative appeal. These coactive
episodes seem to have a powerful effect on observers, who feel
particularly empathic or“drawn into” the interaction at such
moments. The subjective experience for the adult partner
participating in these special coactive moments with the infant is
a“high,” an almost magical sharing [Beebe, 1985, p. 34].
With this pattern,“respect for the floor,” where the interrupter

backs off when challenged, is systematically violated. Instead, there
is relative pressure for the continuation of coaction. The follower,
whether mother or infant, joins in, presses on, and produces
synchrony. An absence of this experience deprives both partners of
sharing the same state, that is, the subjective experience of merging.
Coactive mirroring is the ultimate example of this kind of sharing.
Stern (1983) suggests that these coactive experiences play an
important role in the development of the capacity for subjective
intimacy and self esteem.
The alternating pattern is found in half-second cycles from the
onset of one partner’s behavior to the onset of the other partner’s
behavior (Beebe, 1985). Both partners contribute to the rhythmic
matching, which can be seen as a precursor to adult dialogue. With
this pattern, the“turn” of the leader is respected. An absence of this
302 Chapter 23
turn-taking experience may set back the development of speech and

some related sequential cognitive functions. In this mode, neither
partner“interrupts” the other, but, rather, each pauses and process-
es the information of the other before acting or responding.
It is important to note that both coactive and alternating patterns
perform important functions in the dyad and that the infant is an
active partner in both kinds of interactions.
PSYCHOTHERAPY
Infant studies, with their stress on mutual influence in the coactive

and alternating rhythms of mother-infant interactions and upon
affective engagement, suggest that rhythmic and affective empathy
on a primitive level take place outside of conscious awareness. The
empathic process, as described by Kohut in the treatment of nar-
cissistic disorders as“vicarious introspection,” uses a cognitive
approach in conjunction with the patterns of interaction discovered
in the study of early infancy. Some primitive empathy, necessary in
the treatment of narcissistic disorders, may be critical for the
treatment of more disturbed and heavily traumatized patients. This
is a promising area of research.
The discovery of such primitive patterns of empathy in infant
studies supports the idea that therapists either can interact with
coactive and alternating patterns of mutual influence or they can
not. This ability is learned either during early infancy from a good
partner or not at all, unless it is through an intense psychotherapeu-
tic experience. Recent infant studies of the earliest forms of
empathy reinforce the“pedagogical commonplace [that] as a rule,
students learn more about the analytic attitude from undergoing
their own personal analysis and the supervision of their clinical
work” (Schafer, 1983, p. 4) than they do from didactic experience.
What is certainly needed is a way to test therapists for their ability
to join in coactive or altering patterns of interaction. To do so
would move the therapeutic professions to a new level of effective-
ness.
In summary, the convergence of clinical observations and
infant–mother studies supports mutual-influence theory. Mutual
influence contributes to building psychic structure, occurs across
modes of experience and perception, facilitates communication, and

contributes to negative affects when misattunement occurs. Infant
studies also support the idea that psychotherapy is a much more
effective undertaking if it is more collaborative, if, in fact, it
incorporates some form of twinship transference.
24
Toward a General
Theory
T he idea of three major paradigms in the history of psychologi-

cal healing—religious healing, classical analysis and self
psychology—is a frame of reference for the development of a
theory of psychotherapy. Our major interests have been in the
emergence of the self psychology paradigm to challenge classical
analysis, and, on the basis of this paradigm, in affording clinicians
new insights into a broad range of clinical material, especially that
relating to the narcissistic disorders.
The emergence of the self psychology paradigm, through the
intellectual leadership of Heinz Kohut, took place gradually over a
period of 25 years. Step by step, Kohut developed the concepts that
became the building blocks of the new paradigm, many of which
had been adapted from the remains of past conceptualizations
scattered throughout the psychoanalytic literature. Employing
empathy as his method and making the transformation of narcissism
his goal, Kohut explored the treatment of patients with narcissistic
304
Toward a General Theory 305
transferences and discovered the utility of such concepts as the

selfobject, the supraordinate self (self as organizing principle and as
agent), and transmuting internalization. His was a major intellectual
achievement in which he was aided by a significant number of
colleagues and students. Nonetheless, Kohut knew that the paradigm
was incomplete.
Work on the self psychology paradigm after Kohut—self
psychology in the 80s and into the 90s—has been aimed at making
it more general and inclusive, with an emphasis on theories of
intersubjectivity, impasse, affect, trauma, and mutual influence. Self
psychology’s broadened inclusiveness may be summarized under
four categories: (a) pathological syndromes, (b) treatment modali-
ties, (c) interdisciplinary influence, and (d) other psychotherapy
theories.
PATHOLOGICAL SYNDROMES
Pursuing the appeal of the 1950s, self psychology invested in the

new theorizing involved in widening the scope of psychoanalysis
beyond the treatment of the narcissistic disorders to more severe
disorders of the self. Prominent is Galatzer-Levy’s (1988) work with
manic-depressives; Stolorow, Atwood, and Brandchaft’s (1988)
efforts with psychotics; Brandchaft’s (1988) persistence with patients
suffering severe depressive personality disorders; and Ulman and
Bothers’s (1988) treatment of those with posttraumatic stress
disorder. Out of participation, that is“doing,” new theory continues
to emerge. To the extent that any theory remains static, it becomes
a new“prisonhouse” (Goldberg, 1990).
TREATMENT MODALITIES
A self-psychologically informed psychotherapy can achieve consider-

able structural change and be of greater value in the therapeutic
armamentarium than was believed under the classical paradigm.
Admittedly, self psychology still sees a significant difference between
psychoanalysis and psychotherapy, with psychoanalysis committed
306 Chapter 24
to repeatedly interpreting the“here-and-now” transference and to

an extensive working-through. But self psychology does not
conceive of the two as different in kind, primarily because both
make selfobject functions central to the process. Nor is psychothera-
py seen as“second class” in self psychology. Acceptance of the
growing importance of psychotherapy in producing structural
change opens the possibility of, and paves the way for, including
other therapeutic modalities: family, marriage, group, within a self
psychology paradigm.
INTERDISCIPLINARY INFLUENCE
Self psychology is also open to ideas from other disciplines,

especially those having to do with subjective human experience.
Compared with classical analysis, long mired in drive theory, self
psychology enjoys a relationship of mutual influence, with mutual
benefits, to literature, history, philosophy, infant development, and
neurophysiology.
Kohut set an inclusive tone as he explored literature. For
example, his insights throw new light on Thomas Mann’s (1954)
Death in Venice where Mann illuminates homosexual longings as
an attempt to shore up a fragmenting self (Kohut, 1957). Kohut
(1976) also had a special appreciation for the value of history in
understanding clinical phenomena. For example, he saw the
development of Nazism in Germany as an expression of pathologi-
cal grandiose narcissism in the form of a“group self.”
Self psychology also sees philosophy as another field for the
enrichment of therapeutic work. Once psychotherapy is linked with
the“science of experience” (Atwood and Stolorow, 1984, p. 8), then
the insights of such philosophers as Husserl (Nissim-Sabat, 1989),
who conceived of phenomenology, become important. So do the
existentialists Heidegger and Sarte (Atwood, 1989), as well as
Kierkegaard (Rubin, 1989) himself. And as Chessick (1977) reminds
us, Descartes, Kant, Schopenhauer, Nietzsche, and Jaspers cannot be
ignored as crucial molders and shapers of modern thought. Another
philosopher important for self psychology is Maurice Merleau-Ponty
(Masek, 1989). Such philosophers have been able to express their
own profound subjective experiences as new ways of thinking. Their
ideas challenge self psychology to continue the task of broadening

the scope of psychoanalysis and psychotherapy.
It is also clear from the work of infant developmentalists, such
as Stern (1985), that ideas useful in explaining infant behavior can
be another rich source of material for developing new insights
about psychotherapy. Through self psychology’s openness, the
concepts of infant research, for example,“core self,” have presented
new challenges to the prevailing ideas of the therapeutic establish-
ment.
Neurophysiology is another field of study whose ideas have the
potential to influence the concepts of self psychology. Levin (1991)
has made“novel and detailed correlations between psychologi-
cal/psychoanalytic variables, on one hand, and neuroanatomical/
neurophysiological considerations on the other” (p. xxi). Reflecting
on the neurosciences, Gedo (1991) writes that“ t h e unfolding
breakthrough toward a biology of mind promises soon to relegate
hermeneutics to a secondary position in the analytic scheme of
things and to focus primary attention on learning processes. The
fruitful results of this coming revolution are incalculable” (p. xix).
PSYCHOTHERAPY THEORIES
Self psychology in the 80s has continued to explore other theories

of psychotherapy. The collection edited by Detrick and Detrick
(1989), Self Psychology: Comparisons and Contrasts, reflects self
psychology’s continuing interest in such pioneer thinkers as Jung,
Adler, Rank, and Ferenczi; such object relations theorists as Klein,
Fairbairn, Balint and Winnicott; and such American pioneers as
Sullivan and Rogers; as well as the range of modern theorists from
Masterson and Kernberg to Lacan and Mahler.
In an important reversal of self psychology’s inclusiveness,
Mitchell (1988) has portrayed self psychology as a part of a larger
paradigm, which he refers to as a relational theory in contradistinc-
tion to drive/conflict theory and to developmental arrest theory.
Mitchell conceives of this relational theory as an overarching
general theory that includes the interactional theory of Harry Stack
Sullivan; British object relations theory, especially that of Fairbairn;
308 Chapter 24
and“certain currents of both self psychology and existential

psychoanalysis” (p. 289).
Mitchell actually refers to the relational theory as the“relational-
conflict model,” because he sees conflict as an inherent property of
relatedness.“ T o regard conflict as the exclusive property of drive
theory and to present relational concepts as fundamentally
nonconflictual in nature is seriously to limit the clinical utility of
relational contributions” (p. 160).
The relational model of Mitchell has three dimensions:“ T h e
self, the other, and the space in between the two” (p. 33). Object
relations theory, interpersonal theory, and self psychology theorize
about these dimensions, but with different emphases. For example,
while Mitchell sees self psychology as interested in the“ s p a c e
between” and in the“other,” this interest basically subserves a more
primary interest in the cohesion of the self.
Mitchell sees the relationship among these three major psycho-
therapy theories as follows:
Interpersonal theory, object relations theory, and self psychology

generate what is essentially the same story line, but in different
voices. These traditions regard mind as developing out of a
relational matrix, and psychopathology as a product of disturbanc-
es in interpersonal relations. The differences among these
traditions concern the various kinds of questions they pursue,
based on these same fundamental assumptions. They tend to
generate complementary interpretations, and the question they
pose and the answers they generate do not provide alternative
visions, but instead, different angles for viewing the same,
consensually acknowledged scene [p. 35].
Associated with this relational model Mitchell offers a penetrat-

ing criticism of the developmental arrest model of psychopathology.
He depicts the developmental arrest model as assuming that
psychopathology exists because of the needy infant in the adult, a
need that originally arose from faulty parental responding. Mitchell
agrees that unempathic parenting is an important source of this
pathology but persuasively argues that psychopathology is best
conceived of as maladaptive (rather than infantile) forms of relating
to ensure some kind of relational bond despite the faulty parental
responding. He says,“Psychopathology is not a state of aborted,
frozen development, but a cocoon activity woven of fantasied ties to

significant others” (p. 163).
In reply to Mitchell, self psychology can claim that its paradigm
is much broader than an arrested development model. Admittedly,
(as discussed in chapter 16), in an effort to differentiate itself from
drive theory, self psychology resorted to a developmental arrest
model. However, developmental arrest in the sense of the“baby in
the adult” as Mitchell uses it, has never been crucial to the self
psychology paradigm. Kohut began with the centrality of the
narcissistic transferences, that is, with transferences presupposing a
relational model and then developed his concepts of the selfobject
(the“other”) and of the self to encompass both the organization of
experience and the sense of personal agency.
With these constructs of self and selfobject, self psychology has
had the conceptual tools to examine the relational model from
multiple perspectives. For narcissistic patients, for example, when
therapist and patient“relate,” the relationship may be perceived by
a third party as two selves interacting with each other. From the
point of view of the therapist, however, the relationship is between
a selfobject and a self, with the therapist serving as a selfobject for
the patient. From the patient’s view, there may be no perceived
relationship at all, just one self, that is, the patient, with the therapist
as an extension of that self. A self psychology theorist looking at this
same relationship may see a selfobject–self and self–selfobject
engaged in a complex interaction. Given these possibilities of
relating, self psychology can make the case that its model is more
useful than the interactional model because it covers more dimen-
sions of meaning. Similarly, a strong case can be made for self
psychology’s balanced interest among the major components of
Mitchell’s relational model, and for self psychology’s broad para-
digm having room for both the object-relational and interpersonal
models.
Additionally, self psychology has developed a concept of conflict
that is not drive based and, especially through the intersubjectivists,
has been able to incorporate a nondrive-based concept of conflict
into its expanding paradigm. Mitchell’s work does suggest an
interesting convergence between some theoretical developments in
self psychology and the work of other theorists who have attempted
to develop a nondrive-oriented paradigm for psychotherapy.
310 Chapter 24
The trend in self psychology toward a more general theory

reveals a creative ferment in process. Thus, when self psychology is
referred to as a new paradigm, it really is new: it is still being
formed. Any fear that with the death of Kohut the creative fires
would die out, has been quelled by evidence of the productivity of
the 80s. If anything, that decade witnessed a remarkable burst of
publications revealing an even greater expansion of theory, and
showing that self psychology was well prepared to grow beyond the
work of its founder.
Before Kohut died, he told his wife that even though he had
accomplished what he had set out to do for psychoanalysis, his
work remained incomplete.
[My husband] expressed the hope that his colleagues, particularly

those of the younger generation, would do further research on
the many questions he has raised during the course of his work.
He also expressed the hope that his thoughts would stimulate
them to raise questions of their own, in order to continue the
advance of the science of psychoanalysis [Kohut, 1984, p. ).
We think the theory and practice of psychotherapy after Kohut

is not only well, but thriving. Our belief is that if Kohut were alive
and present at the self psychology conferences of today, his eyes
would have a proud gleam.
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Author Index
A Beach, F., 57
Beebe, B., 115, 123, 242, 246, 291, 292,
Abraham, K., 256 294-301
Aichhorn, A., 140, 146 Bergen, M., 279
Alexander, F., 61, 67, 205, 206, 210, 221 Bergman, A., 293
Allport, G., 212 Bexton, W., 40
Als, H., 295, 296 Bibring, E., 49, 51, 203, 206
Anderson, B., 294 Biegler, J., 34
Anderson, J., 89 Bloch, D., 279
Applebaum, S., 214, 215 Blum, H., 198, 253
Applegarth, A., 53 Boisen, A., 17
Arlow, J., 267 Bowen, M., 248
Atwood, G., 7, 101-103, 107, 120, 166, Boyer, L., 168
170, 175, 176, 178, 186, 187, 222, Brandchaft, B., 7, 76, 78, 83, 87, 88, 90,
232-236, 238, 240, 242, 245, 249, 101-103, 107, 120, 154, 178, 186,
259, 261, 263, 264, 271, 273, 275, 187, 230, 242, 245, 249, 250, 255,
283, 305, 306 258-260, 271, 273, 274, 275, 305
Brazelton, T., 296
B Brenner, C., 61, 62, 267
Breuer, J., 5, 20, 23, 87, 224, 233, 277
Bacal, H., 76, 90, 132 Brinton, C., 96
Balint, M., 73, 76, 80, 86, 108, 114, 132, Brothers, D., 276, 278, 282-284, 305
139, 143, 249, 256, 276, 278, 284, Burke, J., 279
285 Burke, W., 79
Basch, M., 5, 6, 36, 39-41, 45, 47, 49, 58,
93, 104, 106, 108, 129, 140, 175, C
178, 188, 195, 221, 223, 263-265,
272 Campbell, D., 19, 96, 97
331
332 Author Index
Carstens, A., 297, 298 Figley, C., 277

Chappell, P., 294 Fish, S., 253
Chassel, J., 210 Flexner, J., 246
Chessick, R., 7, 29, 33, 35, 94, 101, 104, Fliess, R., 109
115, 116, 119, 123, 129, 130, 134, Florell, J., 290
135, 140, 142, 144, 146, 147, 157, Frank, J., 7, 13
160, 177, 179, 180, 181, 198, 210, Freeman, L., 22
254, 306 French, T., 61, 205, 206, 210, 221
Chomsky, N., 95 Freud, A., 69, 191, 252
Church, J., 44, 48 Freud, S., 3, 5, 20, 22, 23, 28-30, 32, 41,
Clebsch, W., 8 44, 46, 49, 50, 52, 59, 64, 65, 69,
Cohen, J., 284 87, 108, 117, 119, 124, 208, 224,
Condon, W., 296 233, 235, 238, 241, 251, 252, 256,
Corcoran, J., 282 276, 277, 280
Costello, J., 110 Friedman, L., 108, 194, 197, 239
Curtis, H., 171, 176, 189, 198, 199 Friesen, W., 267
Fromm-Reichman, F., 205
D
G
Darwin, C., 267
Decasper, A., 184, 297, 298 Gaensbauer, T., 267
Demos, E., 263, 264, 268-270 Galatzer-Levy, R., 305
Detrick, D., 62, 151, 154, 307 Gardiner, M., 252, 253
Detrick, S., 62, 307 Gardiner, R., 280
Deutsch, F., 30, 31 Gay, P., 27, 28, 35, 139
Dickson, W., 14 Gazzaniga, M., 106
Dokecki, P., 294 Gediman, H., 198
Donaldson, M., 280 Gedo, J., 62, 64, 65, 68, 69, 73, 143-145,
Dorpat, T., 289 147, 173, 191, 192, 307
Dowd, J., 296 Geha, R., 255
Gill, M., 55, 56, 58, 61, 65, 90, 203,
E 205-207, 209, 211, 213, 228
Gillin, J., 11
Eissler, K., 61, 66, 67, 208, 214 Giovacchini, P., 60, 168, 228
Ekman, P., 266, 267, 299 Gladstone, T., 280
Emde, R., 267, 296 Glover, E., 191, 209, 228
Goldberg, A., 91-93, 95-97, 103,
F 129-131, 143, 146, 175, 180, 192,
219, 238, 239, 240, 248, 305
Fairbairn, R., 83-85, 167, 182 Green, A., 280
Federn, P., 66 Green, B., 280, 281, 285
Fenichel, O., 59 Grosskurth, P., 80-82
Ferenczi, S., 62, 65, 66, 69-71, 73-75, 85, Grotstein, J., 79, 99, 106, 126, 166-168,
87, 108, 191, 192, 285 173, 174, 240
Fifer, W., 184 Guntrip, H., 167
Author Index 333
H Kubie, L., 58
Kuhn, T., 1, 59, 91, 97, 98, 189, 202, 203
Hanly, C., 189, 194
Harmon, R., 267 L
Hartmann, H., 49, 52, 59, 60, 239
Heron, W., 40
Lachmann, F., 115, 123, 191, 242, 246,
Hesse, M., 99
282, 291, 292, 295, 297-300
Holmes, T., 279
Langer, S., 48
Holt, R., 50, 55, 57, 58
Langs, R., 79
Horwitz, L., 215
Lax, R., 114
Layton, E., 110
I
Le Doux J., 106
Lee, R., 7, 17, 18, 26, 75, 144, 147, 150,
Izard, C., 266
155
Levenson, R., 267
J Levi-Strauss, C., 9
Levin, F., 36, 40-43, 46, 202, 271, 307
Jacobson, E., 299
Lichtenberg, J., 170, 172, 188
Jaekle, C., 8
Lindemann, E., 279
James, W., 266
Lipton, S., 20, 32, 34, 35, 61
Janoff-Bulman, R., 282
Loewald, H., 114, 195
Jones, E., 23, 28, 65, 72, 73
Loewenstein, R., 60
London, N., 189, 194
K
Lorand, S., 66, 73, 74
Lorenz, K., 155
Kaplan, S., 242, 264
Kapp, F., 279
M
Kaye, K., 245
Kent, E., 41
Kernberg, O., 140, 194, 209, 227, 232, Macalpine, I., 207
251 Maclean, P., 271
Khan, M., 244 Magid, B., 254
Kilpatrick, D., 280, 281, 286 Mahler, M., 226, 293
Klein, G., 49, 54-56, 58, 236, 238 Mahony, P., 32, 254
Klein, M., 76, 78 Malin, A., 79
Kohut, H., 2, 7, 27, 28, 60, 65, 88, 93, Manchester, W., 112, 137
100, 104-108, 111, 113, 114, Mann, T., 306
116-125, 127-130, 137, 138, Markson, E., 195, 200
140-142, 144-147, 151-154, 156-159, Masek, R., 306
162, 166-168, 172, 177, 178, Mason, R., 18
180-182, 185, 191, 193, 194, 197, Masson, J . M., 22, 68, 69, 189, 194, 232
199, 203, 217-219, 229, 236, 239, Masterson, J., 251
241, 242, 272, 285, 306, 310 May, R., 89
Kris, E., 60, 61 Miller, G., 41
Krystal, H., 276, 278 Miller, J., 200
334 Author Index
Mitchell, S., 62, 85, 109, 120, 188, 196, Riviere, J., 257
236, 238, 257, 307 Roethlesberger, F., 14
Murray, H., 108 Rogers, C., 212
Muslin, H., 220 Rotenberg, C., 170
Rothstein, A., 216, 221
N Rubin, J., 274, 306
Rubinstein, B., 41, 58
Newson, J., 231
Nissim-Sabat, M., 306 Rychlak, J., 56
Nunberg, G., 282 Ryle, G., 36, 39
Nunberg, H., 226
Nurcombe, B., 280 S
O Salzman, L., 33
Sander, L., 269, 270, 293, 294, 296
Ogden, T., 79 Schafer, R., 58, 109, 134, 186, 240, 302
Ornstein, A., 229, 275, 290 Schetky, D., 280
Ornstein, P., 119, 122, 126, 198, 220 Schlesinger, H., 213
Schonberger, R., 247
P Schwaber, E., 94, 154, 176, 224, 228,
232, 249, 259, 260
Parson, E., 279 Schwartz, L., 197
Perry, J., 296 Scott, T., 40
Perry, S., 279 Segal, H., 145
Peterfreund, E., 58 Selye, H., 278
Piaget, J., 44, 238, 282 Senior, N., 280
Pine, F., 293 Shane, E., 107, 293
Pineau, R., 110 Shane, M., 107, 293
Polanyi, M., 56 Shapiro, L., 282
Popper, K., 97, 98, 109 Sherwood, M., 96
Pribrim, K., 266 Silber, E., 279
Pruett, K., 280 Simeons, A., 45, 46
Spitz, R., 40
R Sroufe, L., 267
Stechler, G., 242
Rachman, A., 62, 64, 69-71, 74 Stein, M., 195
Racker, H., 79, 227 Stepansky, P., 61
Rahe, R., 279 Stern, D., 99, 100, 115, 123, 174, 177,
Rangell, L., 205 181-185, 225, 226, 264, 293-296,
Rank, O., 65, 73 301, 307
Rapaport, D., 53, 55, 238, 298 Stern, M., 202
Reik, T., 108 Stolorow, R., 7, 58, 101-103, 107, 120,
Reiser, D., 186 166, 169, 170, 175, 176, 178, 186,
Reiser, M., 39 187, 189, 191, 192, 197, 201, 222,
Rhodes, R., 202 224-229, 231-236, 238, 240-243,
Ricoeur, P., 96 245, 249, 259, 261, 263, 264, 271,
Author Index 335
273, 275, 282, 283, 291, 305, 306 V

Stone, L., 3, 8, 203, 205-207, 209
Strachey, J., 108, 207 Val, E., 220
Sullivan, H., 228 Van der Kolk, B., 289
Swales, P., 20, 24, 25 Vietze, P., 294
Swanson, D., 53, 54, 58 von Bertalanffy, L., 188
Vuckovitch, D., Vygotsky, L., 245
T
W
Tansey, M., 79
Terman, D., 168, 236, 238, 242, 245, Waelder, R., 92, 225
246 Wallerstein, R., 203, 208-210, 212-216,
Thomson, P., 195, 200 249
Tichener, J., 279 Weatherhead, L., 12
Ticho, E., 208 Weiner, M., 3, 153, 185
Tolpin, M., 172, 174, 175, 180, 182, 188 White, M., 3, 153, 185
Tolpin, P., 81, 138, 148, 175 Winnicott, D., 88, 123, 173, 174, 184,
Tomkins, S., 47, 111, 265, 276 228, 234, 293
Torok, M., 64 Wise, C., 7, 16, 17
Torrey, E., 11, 15, 155 Wolf, E., 30, 31, 104, 106-108, 120, 127,
Trevarthan, C., 231 129, 137, 140, 142-144, 147, 158,
Tronick, E., 296 167, 172, 175, 180, 240, 241
Trop, J., 222, 249, 261
Tylim, I., 144 Z
U Zetzel, E., 228
Ulman, R., 276, 278, 282-284, 305
Subject Index
A B
Abraham, K., 293 Background selfobject, 173-175

Adler, A., 4, 61, 62, 307 Bacon, F., 93, 98
“Aetiology of Hysteria, The,” 22, 69 Balint, A., 88
Affect integration, 176, 228, 271-276 Balint, E., 89
Affects, 33, 47, 65, 84, 111, 115, 121, Balint, M., 77, 85-88, 126, 168, 307
146, 184, 188, 228, 260, 263-278, Basic fault, (see Developmental
286, 295-298, 300, 303, 305 arrrest), 86, 151, 257
Agency, 174, 181-183, 186, 187, 270 Behaviorism, 95
Aggression, 52, 53, 87, 139, 144, 145, Belief, 9, 11, 19, 26, 43, 98, 99, 282
155, 195 Bernheim, H., 24
Alexander, F., 189 Biology, 52, 53, 88
American Association of Pastoral Bion, W., 77, 126, 241
Counselors, 17 Bipolar self, 121, 122, 185, 186
Analysis of the Self, The, 2, 162, 168 Bismark, O. von, 218
“Analysis Terminable and Bohr, N., 94, 106
Interminable,” 64 Boisen, A., 17
Anna O (Bertha Pappenheim), 21-24, Bond, 83, 84, 88, 114, 116, 117, 133,
87 135, 150, 151, 176, 230, 232, 241,
Attunement, 105, 114-116, 123, 133, 243-245, 248, 289, 290, 292, 301,
154, 272 309
Authentic, 89, 90 Borderline, 17, 25, 51, 68, 75, 84, 103,
Autonomic nervous system, 265-267 173, 205, 221, 231, 253, 254
Autonomous, 53, 125-127, 156 Bowlby, J., 77
337
338 Subject Index
Breuer, J., 28 D
British school, 4, 77-91
Brucke, E., 28, 55 Death, 124
Brunswick, R., 252, 253, 255 Death in Venice, 306
Defensive idealization, 144-146, 165
C Deficit, 190-202, 224
Dependence, 84, 85, 87, 257, 285
Cäcilie M. (Anna von Lieben), 21, Depression, 65, 78, 83, 146, 149, 150,
25-27 227, 257, 265, 273, 274, 281
Care, 16, 111 Descartes, R., 37, 38, 96, 178, 179,
Catharsis, 24, 25 189, 306
Cathy (case), 270 Developmental arrest, 69, 87, 122,
Chamberlain, N., 136 128, 140, 191, 192, 196, 197, 202,
Character analysis, 63, 65, 73 227, 275, 282, 307, 308
Charcot, J., 22, 23, 25, 28 Development of Psychoanalysis, The,
Classical analysis, 1-4, 6, 75-77, 81, 82, 65
85, 90, 113, 121, 126, 139, 142, Disavow, 78, 124, 126, 272, 275, 287
183, 186, 191, 214-217, 224-226, Displacement, 78, 88, 226, 227
239, 259, 262, 304-306 Distortion, 228, 259
Clergy, 6, 8-11, 13, 15-17, 139 Doing Psychotherapy, 221
Clinical psychology, 2, 4 Domains of relatedness, 182-183
Clinical theory, 54, 55 Donne, J., 126
Coherence, 99 Dora, 3, 5, 21, 22, 28-31
Cohesion, 120, 126 Drive theory, 3, 7, 21, 37, 38, 41, 42,
Complementarity, 197, 198 49, 51-62, 73, 76, 82, 83, 120, 121,
Concretization, 160, 232-236, 284 139, 142, 155, 159, 178, 182, 190,
Conflict, 21, 58-62, 190-202, 214-215 191, 195-197, 226, 233, 235, 306,
“Confusion of Tongues Between 307
Adults and Child,” 68, 85 Dr. F, 15
Conjecture, 98, 101 Dr. Seuss, 184
Consciousness, 43
“Contraindications to the Active E
Psychoanalytic Technique,” 66
Core self, 172, 174, 183, 189, 307 “Ego and the Id, The,” 3, 238
Corrective emotional experience, 35, Ego instincts, 51-52
61, 67, 169, 205, 206, 210, 216, Ego psychology, 59, 60, 82
221 Counseling, 2, 14 Einstein, A., 1, 9, 39, 94, 98
Countertransference, 33, 134, 135, Elizabeth von R (Ilona Weiss), 21, 24,
147, 229, 263 25, 27
Creative, 22, 42, 78, 88, 123, 138, 171, Emergent self, 183, 226
310 Empathy, 30, 70, 74, 75, 86, 104-117,
Cure, 9, 10, 80, 105, 109, 116, 117, 123, 124, 170, 195, 225, 242,
221, 230 245-248, 265, 273, 302, 304
Subject Index 339
Empathic failure, 31, 71, 143, 145-147, Fusion, 226

171, 249, 257, 258
Empiricism, 92-97 G
Emmy Von N (Fanny Moser), 23, 24,
27 Gardiner, M., 252
Enactment, 78, 82, 87, 147, 158, 160, General systems theory (see systems
161, 235 theory)
Espanto, 11 Generalized Event Structures, (GERs),
Evidence, 56 185
Evil eye, 10 Glover, E., 80-82
Exhibitionism, (see mirror Goethe, J., 124
transference), 116, 129, 135 Goring, H., 113
Experience-near, 4, 100, 282 Grandiose self, 114, 119, 121, 122,
Experience-distant, 100, 282 128-130, 134-137, 144, 147, 158,
Extroception, 106-108 165, 169, 185, 186, 283
Gratify, 132, 242, 249, 257
F Great God Brown, The, 157
“Group Psychology and the Analysis
Faces in a Cloud, 232
of the Ego,” 238
Fairbairn, R., 77, 83-85, 126, 241, 307
Guilty Man, 193
False Self, 88, 126, 138, 172, 186, 230
Guntrip, H., 77
Falsifiabilty, 98, 99
Fantasy, 23, 29, 33, 40, 48, 67, 69, 79, H
85, 109, 122, 136, 137, 152, 160,
163, 225, 232, 233, 278, 282-284, Hallucination, 44, 45
309 Hartmann, H., 82, 90, 118, 125, 178,
Ferenczi, S., 4, 5, 26, 63-80, 85, 87, 90, 191, 249
155, 307 Hawthorne effect, 13, 14
Fit, 86 Heidegger, M., 306
Fleischl-Marxow, E., 28 Heimann, P., 77
Fliess, W., 27, 28 Heisenberg uncertainty principle, 94
“Forms and Transformations of Helmholtze, H., 55
Narcissism,” 118, 162 Henderson, N., 113
“Fragment of an Analysis of a Case of “Heredity and the Aetiology of the
Hysteria,” 29 Neuroses,” 22
Fragmentation, 60, 75, 83, 113, 132, Hermeneutic, 24, 97, 102, 107, 112,
135, 136, 144, 157, 160, 161, 164, 113, 307
165, 186, 187, 235, 253, 276 Herr, K., 30, 31
Fran, 283 Hitler, A., 112, 113, 136, 137
Frank, J., 30 Homosexual, 65, 187
Free association, 21-27, 61, 66, 67 How Does Analysis Cure? 2, 116, 193,
Freud, A., 81 199
“From the History of an Infantile Hume, D., 179
Neurosis,” 251 Humor, 124, 125
340 Subject Index
Husserl, E., 306 J

Hypnotism, 23-26
Hypochondria, 12, 135, 144, 187, 253, James, W., 103
254 Jaspers, K., 306
Hysteria, 22, 23, 26, 28, 51, 65, 84, Jones, E., 88
232, 233 Jung, C., 4, 32, 176, 232, 307
I K
Kant, I., 51, 179, 180, 306

Idealization, 2, 14, 19, 23, 27, 28, 74, Katharina (Aurelia Kronich), 21, 24
88, 109, 113, 116, 139, 146 Kernberg, O., 120, 307,
Idealized parent imago, 121, 122, Khan, M., 77
140-143 Kierkegaard, S., 89, 274, 306
Idealizing transference, 19, 20, 127, Klein, Melanie, 78-83, 88, 168, 227,
130, 132, 139-151, 156 228, 240, 241, 293, 307
Illusion, 120, 129, 158, 159, 181, 230, Klein, Melitta, 81, 82
234, 249 Knowledge, 96
Impasse, 145, 171, 172, 214, 249,
257-262, 305 L
Incest, 22-24, 280, 282, 283
Independence, 87 Lacan, J., 307
Indoctrination, 80-81 Lay analysis, 72
Infant, 87, 88, 100 Layton, E., 110
Information processing, 41, 42, 47, 79, Left brain, 107
188, 271 Lennon, J., 10
“Instincts and Their Vicissitudes,” 52 Libido, 50-53, 83, 84, 119, 139
Interpretation, 17, 29, 34, 35, 61, Limbic system, 43, 272
65-67, 70, 80, 81, 86, 89, 90, 102, Little, M., 89, 90
108, 142-147, 192, 195, 206-209, Locke, J., 179
215, 217, 220, 221, 227, 250, 251 Lourdes, 12
“Interpretation of Dreams, The,” 28, Lucy R, 21, 24
29
Internalization, 20, 100, 108, 142, 146, M
195, 217, 238-241, 288, 305
Intersubjective, 175, 176, 186, 201, Magical, 1, 5, 8-20, 109, 112, 135, 140,
222, 225, 229, 231-233, 257-263, 155, 301
305 Mahler, M., 183, 293, 307
Introject, 79 Mania, 78, 146
Introspection, 75, 105, 106, 108, 192 Masochism, 68, 159-160, 162, 163, 230,
“Introspection, Empathy and Psycho- 255
analysis,” 105 Masterson, J., 307
Invariance, 100, 182, 189 Marx, K., 98
Subject Index 341
Matching, 43, 115, 299-302 Narcissism, 4, 17, 51, 63-65, 67, 68, 84,
Materialism, 38-41, 227 86, 87, 103, 115, 118-127, 159,
Mechanistic, 51, 73, 79, 186, 241 191, 192, 194, 240, 256, 257, 304
Menninger Psychotherapy Research Narrative, 96
Project, 212-217, 230 Narrative self, 183
Mental machine, 37-50 Natural selection, 97
Merger transference, 129, 132, Nazism, 82, 108, 113, 136, 254, 306
156-166 Negative therapeutic reaction, 28, 208,
Merleau-Ponty, M., 306 249-263
Metapsychology, 53-58, 84, 100, 180, Neocortex, 45, 46, 48, 264
186, 192, 197, 235, 256 Neutrality, 90, 207, 211, 215, 217, 263
Metatheory, 92-104 Neutralization, 52, 53
Meynert, T., 28, 55 New beginning, 86
Mimetic musculature, 47 Newton, I., 1, 9, 98, 169
Mind, 6, 7, 36-49, 73, 79, 178 Nietzsche, F., 28, 306
Mirror transference, 2, 70, 127-138, New Testament healing, 12
144, 151, 156-159 Nimitz, C., 110
Miss K, 14, 15 Nirvana, 40, 41
Miss S, 145 Noumenal self, 179
Models of the Mind, 192 Nuclear self, 83, 153, 183, 185, 186,
Montaigne, M., 244 219
Motivation, 188 Neurophysiological, 39, 42, 54, 55, 57,
Mourning, 68 307
“Mourning and Melancholia,” 3, 238
Mr. A, 140, 141, 146 O
Mr. B, 243, 244
Mr. I, 130-132 Object, 87, 93-97
Mr. J, 10 Objectification, 48, 169, 280
Mr. M, 287-289 Obsessive, 10, 33, 51, 66, 84, 254, 273
Mr. N, 274, 275 Oedipal, 68, 78, 83, 86, 144, 163, 181,
Mr. Z, 5, 152, 162-165 191, 193, 198, 199, 200, 201, 238,
Mrs. A, 5, 148-151 239, 256, 272
Murray, H., 231 O’Neill, E., 28, 157
Mutual analysis, 71 “On Narcissism,” 3, 119
Mutual influence, 87, 115, 123, 133, Organization of experience, 43, 187,
154, 292-303, 305 188, 223-236, 246
Myth, 9 Organizing principle, 100, 101,
228-231, 261
N Optimal frustration, 241-242
Nagumo, C., 110 P

Narcissistic transference, 2, 100, 117,
120, 127, 140, 156, 157, 168, 169, Paradigm, 1, 3-9, 19, 21, 59, 62, 73, 75,
223, 224 76, 85, 98, 99, 102, 103, 105,
342 Subject Index
198-203, 222 211, 225, 226

Parameters, 61, 66, 67, 208, 214, 220, Regressive transference neurosis,
221 207-209, 213, 217
Paranoid, 78, 84, 119, 170, 253 Reich, W., 176, 232
“Particular Form of Neurotic Relational theory, 307-309
Resistance, A,” 256 Religious healing, 5, 7, 9-12, 19, 20,
Pastoral counseling, 2, 9, 16-19 24, 26, 155, 304
Pavlov, I., 45 Renunciation, 226, 229, 235, 238
Perception, 43, 44 Representation of Interactions
Person (self as agent), 187 Generalized (RIG’s), 185
Peter, 262 Restoration of the Self, The, 2, 193
Phenomenal self, 179 Results, 4, 36
Phipps, E., 112, 113 Reverse selfobject experience, 75,
Phobia, 84, 206 144, 150
Piaget, J., 245 Right brain, 106, 107
Placebo, 13-16, Riviere, J., 88
Planck, M., 203 Robyn, 262, 263
Plato, 96 Rogerian counseling, 2, 205, 206, 307
Play, 78 Rutherford, E., 203
Postempiricism, 90, 91, 93, 98-104
Posttraumatic stress disorder, S
Preoedipal, 83, 86
“Project for a Scientific Psychology,” Sacrament, 10, 112
55 Sadism, 52, 66, 159, 160
Projection, 105, 113, 114, 227 Sarte, P., 306
Projective identification, 79, 80, 227 Schizoid, 78, 83-85
Psychotic, 65, 73, 230, 305 Schizophrenia, 51, 119, 253
Psychoanalysis, defined, 5-6 Schopenhauer, A., 306
Psychoanalysis and psychotherapy, Schweninger, 218
204-222 Seduction, 22, 23, 28, 29, 232
Self, 7, 40, 45, 84, 118, 120, 124, 166,
Q 168, 175, 178-189, 226, 229, 264,
278, 280-282, 305, 309
Q concept, 50 Self-cohesion, 31, 160, 276
Selfobject, 27, 28, 31, 33, 75, 81, 85,
R 88, 100, 102, 116, 117, 126, 127,
140, 166-177, 182, 216, 219, 220,
Rank, O., 62, 176, 232, 307 224, 229, 231, 239, 266, 276, 278,
Rape, 85, 278-281, 283, 286 284-287, 290, 291, 305, 309
Rat Man (Dr. Ernst Lanzer or Paul Selfobject failure, 132, 142, 200, 237,
Lorenz), 3, 5, 21, 22, 32-36 242-245, 249, 289
Reality, 44, 56, 60, 67, 72, 101, 117, Self Psychology: Comparisons and
134, 154, 196, 212, 224, 228-230, Contrasts, 307
232, 243, 259 Sensorimotor, 44, 233, 234, 272, 284
Regression, 78, 86, 87, 90, 132, 210, Sexual, 29-31, 50-52, 57, 135, 150, 263
Subject Index 343
Shaman, 9, 11-13 119

Shame, 121, 122, 147, 151, 153 Tragic Man, 193
Sharpe, E., 89 Transference, 9, 29-31, 33, 35, 67, 78,
Social workers, 2, 6 88, 101, 127, 176, 206-211,
Soothing, 81, 137, 172, 173, 218 215-217, 223-236, 243, 259, 309
“Soul loss,” 11 Transference cure, 33, 210, 216, 230,
Splitting, 74, 79, 83 231
Steven, 273-274, Transference of creativity, 27-28
“Studies on Hysteria,” 5, 23 Transmuting internalization, 142, 143,
Strachey, J., 88 217, 241-242
Stressors, 278-280 Transitional object, 74, 123, 140, 142,
Structural theory, 59, 83, 84, 167, 182, 173, 174, 234, 249
190, 191, 256 Trauma, 7, 22, 23, 28, 63, 64, 67-69,
Structuralism, 39 71, 85, 111, 122, 136, 137, 142,
Structuralization, 88, 142, 195, 211, 145, 147, 149, 161, 196, 202, 225,
215, 218, 224, 226, 237-249, 264, 228, 255, 258, 276-291, 305
266, 271, 287, 289, 298, 302, 305 Traumatogenic, 50, 278, 279, 284
Subcortical (old brain), 45-49, 264, Trieb, 55, 57, 58, 154,
276 Tripartite self, 154, 185, 186, 188, 189,
Subjective experience, 53, 54, 112, 192
122, 171, 196, 225, 231, 243, 263, True Self, 88, 89, 186
264, 266 Twinship transference, 26, 27, 65, 65,
Subjective self, 104, 107, 110, 114, 80, 122, 127, 151-156, 303
117, 183
Suggestion, 10, 12, 23, 25, 26, 66, 206, U
211
Suicide, 68, 88 Unconscious, 26, 28, 38, 61, 66, 88,
Sullivan, H., 307 191, 223, 226, 239, 248, 263, 282
Superordinate self, 180,, 185 Understanding psychotherapy, 221
Sutherland, J., 77
Symbol, 44, 45, 48, 49, 234, 284
V
Systems theory, 39-41, 96, 103, 188
Verbal self, 183

T
Verisimilitude, 98, 102, 103
Vertical integration, 247
Tabula Rasa, 94, 179
Vicarious introspection, 105-108, 112,
Technique, 23-26, 34, 61, 63, 65-67,
113, 115-117, 194
69, 72, 73, 78, 80, 84-86, 89, 90,
133, 139, 147, 170, 194, 206, 209,
256 W
Therapeutic alliance, 16-18
Theory and Practice of Self Wagner, R., 28
Psychology, 3 Washington, G., 246
Thought, 44-49 Wayward Youth, 208
“Three Essays in Sexuality,” 23, 29, Wheeler, J., 94
344 Subject Index
Winnicott, D., 77, 88-90, 126, 155 Working through, 67, 219, 221
Wisdom, 125
“Wise baby,” 67, 68 Z
Wolf man (Serge Pankejeff), 3, 5, 21,
251-256 Zeigarnik phenomenon, 181

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Psychotherapy

THE ANALYTIC PRESS

Set in Garamond Light type by

Library of Congress Cataloging-in-Publication Data

Printed in the United States of America

17 Psychoanalysis and Psychotherapy 204

We gratefully acknowledge pastoral counseling’s nourishment of our

T he emergence of self psychology in the 1970s and 80s has

classical analysis to self psychology and the divergent opinions of

with such major works by Freud as “On Narcissism” (1914),

enough of the introductory material to establish useful comparisons

Eventually a broad outline for a manuscript emerged. It divided

and to [Freud’s] proposed general theory of mental functioning” (p.

nourishment in the psychoanalytic tradition, the issue is not whether

General Readings: Kohut, 1984; Chessick, 1985; Stolorow,

Readings for Chapter 2: Frank, 1963; Wise, 1966; Lee, 1979.

T he magical covenant, the basis of a long tradition of religious

the major new healing paradigm. Thus, it may be more appropriate

THE MAGICAL COVENANT

In a healing act, the religious representative (shaman, priest,

Both cures aim at inducing an experience, and both succeed by

Religious healing is sanctioned by centuries of tradition. For

The treatment of Mr. J, a 25-year-old single male, illustrates such

however, derive their efficacy from the perceived omnipotence of

Example 2: The Shaman

Gillin (1948) describes the treatment of a 63-year-old Guatemalan

The idea of a magical covenant forms the background to the New

SECULAR FORMS OF THE MAGICAL

The magical covenant exists in secular forms. It can be seen in the

Example 1: The Placebo

Studies of the placebo effect in medicine suggest that the magical

Since a placebo is inert, its beneficial effects must lie in its

The placebo effect can be seen in the treatment of warts and

Using double-blind techniques, it has been found that some of the

Example 2: The H a w t h o r n e Effect

That simply being part of social research can enhance functioning

Miss K‚ a very disturbed woman in her early 40s, sought a magical

After half an hour of invective, she stopped and began to notice

MODERN PASTORAL COUNSELING

Twentieth-century pastoral counseling and pastoral psychotherapy

effectiveness of religious leaders. The movement is generally

therapist attempts to involve the patient in the treatment, thereby

The psychology of the self has helped clarify data previously

On the basis of the work of these two pastoral counseling

To summarize, traditional religious healing has been heavily

of its constructive potential, an experience familiar to religious

Readings for Chapter 3: Breuer a n d Freud, 1893-1895; Freud,

A knowledge of the major ideas of Freud is essential for under­

discovery of free association and his example as a research-

THE SEDUCTION/TRAUMA THEORY

As is well known, Freud first treated hysteria. He viewed the

Since December 7, [Anna] has refused to get out of bed. I called

In“The Aetiology of Hysteria,” published 16 years after Breuer

hysteria . . . . In none of these cases was an event of [sexual abuse]

THE TECHNIQUE OF FREE ASSOCIATION

As he was developing his seduction theory of hysteria, Freud

whatever came to mind. She, like Frau Elizabeth von R, responded

Freud), that Freud’s introduction of the technique of free association

THE TRANSFERENCE OF CREATIVITY

A knowledge of the major ideas of Freud is essential for under