PANY Scientific Meeting: Summary

Monday, February 9, 2004, 8:15 pm
Einhorn Auditorium, Lenox Hill Hospital, 131 E. 76th Street, NYC

Coordinating the Developmental Process into Clinical Analysis
Samuel Abrams, M.D.
Training and Supervising Analyst, NYU Psychoanalytic Institute

Discussant: Claudia Lament, CSW

This presentation is made in cooperation with the Child Analysis Section, NYU Psychoanalytic Institute

The Aim The paper explores the clinical opportunities afforded by Anna Freud¹s concept of the developmental process.  Ms. Freud sees psychological growth as informed by an inherent maturationally driven program that is actualized through experiences with people and things.  The growth is epigenetic, that is, it proceeds discontinuously by way of a series of hierarchical steps of  newly transformed structures that emerge through childhood and adolescence into young adulthood.  Her concept underscores the influences of variations in maturational potential as they interact with the variations in familial and societal offerings.

A new orienting perspective Coordinating the developmental process into child work requires an orientation toward empirical data that stresses discontinuities in development as well as linear links, emergents as well as resultants. By adding such an orientation, the therapeutic potential of the treatment setting can become considerably enhanced.

Parsing the therapeutic interaction This potential is especially played out within the therapeutic interaction. Classical analysts stress the past object features of that interaction. By attending to the patients perceiving their analysts as an expression of their past, it is possible to discover many of the earlier pathogenic antecedents that account for the current disorder. This valued linear or continuous or reductionistic orientation enables analysts to propose the necessary genetic interpretations and reconstructions that directly link the present to the otherwise unrecognized past. It is this past object feature of the analytic interaction that classical clinicians refer to as ³transference.²

Patients also use their analysts as externalized aspects of their self-representations. Self psychologists and Kleinians, among others, leverage such attributions for the sake of the treatment, providing regulation and coherence and/or interpretation of the earliest introjected objects. However, they also call this externalization of the self-representation ³transference.²

All analysts also offer features of themselves in the course of treatment, features that can stimulate development either directly or by encouraging identifications that are useful for the work. Tolerance of affects and the value of knowing rather than not knowing are implicitly stimulated by the real analyst. Intersubjectivists find the leveraging of features of this real object relationship a useful way of helping people get better. Regrettably, they also use the same term, ³transference,² to describe this specifically differentiated feature of the therapeutic interaction.

Anna Freud¹s emphasis provides a fourth possibility, the analyst as a new object for an emerging fresh organization. Children and adolescents utilize persons and experiences in their surround to actualize the potential brought forward by the inherent program. This is not an old object, not an externalized aspect of the self, and not real either; but it is new. This facilitates transformations of antecedent structures and organizations. During childhood and adolescent the new object provides a most powerful tool for therapeutic action. Unfortunately, sometimes child analysts also call this ³transference². All these aspects of the treatment relationship provide different forms of therapeutic action and may not necessarily always be compatible with one other. For educational purposes, it seems wise to differentiate the potential aspects of the therapeutic interaction rather than subsume them all under a single global term.

Obstacles to coordination There are a variety of obstacles standing in the way of Anna Freud¹s developmental concept being embraced by contemporary analysts. One is definitional: there are many developmental models and many ways of conceptualizing the developmental process. Some serve certain schools of our discipline; hence, particular definitions are strongly guarded. A second obstacle arises from the required orientation of discontinuity. Some clinicians find it strange or awkward while others feel that such an orientation is not psychoanalysis. They contend that our discipline is founded upon and driven by the reductionist or analytic view of a particular empirical phenomenon, not a constructivist or synthetic one The added orientation may be experienced as a threat to consolidating a psychoanalytic identity. However, the most important obstacle to the teaching and learning of Ms. Freud¹s views may be the difficulties encountered in applying them to adult analytic work.

Basically, the difficulties are at least two fold. To include the vicissitudes of dispositional tendencies along with the variations of progressive hierarchies into our clinical judgment requires much more education in understanding the configuration of the human mind than presently is provided in most institutions. Global diagnostic terms such as neurosis, borderline and psychosis become preferred terms for clinical exchange, in spite of their obvious limitations. Incorporating this concept of development into diagnostic and therapeutic features of adult analysis introduces a complexity that seems far too daunting for teachers and students alike. This is reinforced with the additional argument that the perspective of discontinuity is outside the scope of our discipline altogether.

A second problem is also endemic in our culture. For many years there has been a tendency to equate maturationally driven hierarchal phases of childhood to phases in adult life that are more socially informed. Erikson¹s work on life cycle phases provided one important stimulant for such activity. But can an analyst truly be a ³new² object for a socially informed phase such as marriage or parenthood or would her facilitating such a path simply be a sanctioning of prevailing social norms? Under such circumstances, the well known technical tools of reconstruction and interpretation may be sacrificed to a dubious extension of the view of the developmental process. The extension has occurred. The ensuing controversies have further compromised the teaching and learning of Anna Freud¹s concepts since they are confused with something else.

Summary

An orientation toward discontinuous development can usefully supplement the prevailing values found in a reductionistic or linear perspective. This orientation has distinct therapeutic advantages in children and adolescence, particularly when it serves to differentiate features of the analytic interaction and influence technique. Despite such promise, however, there are several formidable obstacles to this view being more widely embraced within our discipline, not the least of which is determining its appropriate applications to the treatment of adults.