Steven K. Gordon, LCSW*R

631.543.8577 X22

Adult, Adolescent, Child, and Family Psychotherapy

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Modern Psychoanalysis:

Be comfortable enough to say everything.
Use your words, instead of acting out.
Tell me your life story.
Make the unconscious conscious.
Be aware of obstacles and resistances.
Discharge tension constructively
Metabolize your aggression, collaboratively.

“The ultimate purpose, in every instance, is to help the patient mobilize and liberate the negative (as well as the positive) feelings he has long kept submerged. The analyst accomplishes this by first joining the patient’s resistance and supporting and reinforcing his uncooperative attitudes.”


Psychotherapy establishes a safe environment in which present and past experiences can be explored.  A therapist and patient enter into a resonance of states of mind, which allows for the creation of a co-regulating dyadic system.  This system is able to emerge in increasingly complex dyadic states by means of attunement between the two individuals.  The patient’s subtle nonverbal expressions of her state of mind are perceived by the therapist and responded to with a shift in the therapist’s own state, not just with words. In this way, there is a direct resonance between the primary emotional, psycho-biological state of the patient and that of the therapist.
These nonverbal expressions, words and induced feelings make up the contact function in the treatment, and influence the rapport. Modern psychoanalysts have a greater understanding and a wider range of techniques available to outflank Freud’s “stone wall of narcissism,” and“…(i)f the analyst provides the proper environment, the patient will re-experience emotional reactions in his relationship with the analyst that resemble those he had at some point in the past when his maturation was blocked.
Since Dr. Spotnitz described modern psychoanalysis as  “… Freud’s method of therapy, reformulated on the basis of subsequent psychoanalytic investigation” (1985, p. 25); the question is now asked - what are the important differences between modern psychoanalysis and classical psychoanalysis?

I think it is most useful to look at this question in terms of the theoretical and clinical practice distinctions between the classical and modern schools.

Theoretical Foundations -

Dr. Freud’s opinion (1933, ch. 6) was that:
“The field in which analytical therapy can be applied is that of the transference-neuroses, phobias, hysterias, obsessional neuroses, and besides these such abnormalities of character as have been developed instead of these diseases. Everything other than these, such as narcissistic or psychotic conditions, is more or less unsuitable.” This conception unfortunately resulted in huge numbers of people being deemed “unsuitable” or “unanalyzable” by the classical school of thought; while the modern theory of treatment considers most emotional, mental and personal achievement problems to be reversible through its treatment techniques.

According to Spotnitz, (1985, p.23):
“Freud and his contemporaries did not recognize the presence of narcissistic transference as such, and they did not know how to utilize it for therapeutic purposes. Since their day it has been repeatedly demonstrated that the narcissistic transference is therapeutically useful."
But, Freud (1914) did anticipate the possibility of such future developments in psychoanalysis (previously quoted on this website); when he stated the importance of:
“… the facts of transference and resistance. Any line of investigation which recognizes these two facts and takes them as the starting point of its work may call itself psychoanalysis, though it arrives at results other than my own.”

Clinical Techniques

Modern psychoanalysts are able to take advantage of a wide range of clinical techniques and interventions for ego reinforcement, emotional communication and resistance resolution. Spotnitz says:
"The essential difference is that classical analysis believes in interpretation and nothing else, no other intervention. Modern psychoanalysis is open to all interventions, all verbal interventions… Any communication that helps a patient resolve resistance to saying everything is part of modern psychoanalysis.”
Meadow, 1999, p. 6.

Some have argued that classical psychoanalysis, with its emphasis on interpretation as the sole method of “making the unconscious conscious” can also be viewed as anti-therapeutic for vulnerable patients; the same patients who are frequently seen by modern analysts.

Are modern analysts opposed to interpretation? Not at all. For modern psychoanalysts,
“…silent interpretation… is an essential ingredient of a successful analysis… Resistance is analyzed – silently and unobtrusively – but instead of trying to promote recognition, perception, or conviction, the therapist intervenes to facilitate verbalization as a connective integrative process. The patient is helped to discover for himself the genetic antecedents of his resistant behavior, explore it in terms of the analytic relationship, and articulate his own understanding.”
Spotnitz, 1985, p. 167, emphasis original.

Essentially,the vulnerable patient is protected from the likely ego-damaging effects of interpretation when used as a blunt force instrument. Clinically, modern psychoanalysis is:
“…applied to take advantage of the initial unresponsiveness of the pre-verbal personality to interpretive procedures and to the patient’s oscillating transference states… Safeguards against chaotic regression figure prominently in the clinical approach of the modern psychoanalyst; the therapeutic alliance is permitted to evolve at a pace the patient is able to tolerate.”
Spotnitz, 1985, p. 37.

The vast armory of clinical techniques at the disposal of the modern analyst are not indiscriminately used:
“From patient to patient… regardless of the nature of the disorder, the types of interventions employed are empirically determined by individual responsiveness.”
Spotnitz, 1985, p. 38, emphasis original.

Modern psychoanalysts anticipate that a successful analysis will bring an individual to a state of maturity where the patient will be able to tolerate verbal interpretations; but the final goals of modern psychoanalysis go further:
“… modern psychoanalysis is dedicated to achieving far more than transforming a miserable human being into one suffering from common unhappiness – the therapeutic expectation stated by Freud… The patient who has successfully undergone modern psychoanalysis emerges in a state of emotional maturity. With the full symphony of human emotions at his disposal, and abundantly equipped with psychic energy, he experiences the pleasure of performing at his full potential.”
 
Narcissistic Transference

Freud (1926, pp 52-3, emphasis original) was describing the phenomenon of transference when he said:

''The neurotic sets to work because he believes in the analyst, and he believes in him because he begins to entertain certain feelings towards him…. The patient repeats, in the form of falling in love with the analyst, psychical experiences which he underwent before; he has transferred to the analyst psychical attitudes which lay ready within him…''
Yet classical analysts soon found that many individuals appeared to be unable to form this type of transference with their analysts. These individuals were then often deemed “un-analyzable,” because of the central role that transference plays in psychoanalysis. (See e.g., Fennessy, 2006).

How can individuals who seem to lack the capacity to develop this “object transference” be helped? Modern psychoanalysts understand that the difficulties experienced by many patients have their origins in the pre-oedipal period. Another way of expressing this is that “(t)he narcissistic patient is arrested at some point or points in approximately the first two years of life.” (Margolis, 1981, p. 149).

Modern analysts are then able to use their skills to build a transference on a narcissistic basis. In this narcissistic transference:
“(t)hepatient is permitted to mold the transference object in his own image. He builds up a picture of the therapist as someone like himself – the kind of person whom he will eventually feel free to love and hate.” (Spotnitz, 1976a, p. 109).
Dr. Spotnitz answers the question:
“’Do we want a narcissistic transference to develop?’ We do because in a negative, regressed state, the patient may experience the analyst as being like him or part of him. Or the analyst may not exist for him. The syntonic feeling of oneness is a curative one, while the feeling of aloneness, the withdrawn state, is merely protective. Because traces of narcissism remain in everyone, we seek, when beginning treatment, to create an environment that will facilitate a narcissistic transference so that, first we can work through the patient’s narcissistic aggression.” (Spotnitz, 1976b, p. 58).
Margolis further says that:
“In operational terms… the oedipal patient transfers the images of distinctive objects of his oedipal period onto the analyst, whereas the pre-oedipal patients transfers onto the analyst the fuzzy and ambiguous images of his narcissistic period… In building the narcissistic transference and eliciting the patient’s picture of the analyst, we are actually eliciting his picture of himself.” (1979, p.140).
Therapists who have any experience with narcissism know that narcissists are often consumed with themselves and themselves alone - given the opportunity they may talk about nothing but their own self-absorptions for years on end. Therefore, it should be apparent that the narcissistic transference will not come into being on its own – it must be developed through the skills of the therapist.

What does the narcissistic transference look like? Spotnitz (1976a, p. 109) states that:
“On the surface it looks positive. He builds up this attitude: ‘You are like me so I like you. You spend time with me and try to understand me, and I love you for it.’ Underneath the sweet crust, however, one gets transient glimpses of the opposite attitude: ‘I hate you as I hate myself. But when I feel like hating you, I try to hate myself instead.”
Developing the narcissistic transference is normally an emotionally charged process, that proceeds at the patient’s own pace. (See generally, Fennessy, 2007). The training and clinical skills of the modern analyst,including proper use of emotional reinforcement, object-oriented questions and joining techniques, make all the difference between success and failure in nurturing this relationship.

Spotnitz (1985, p. 201) describes the result when the narcissistic transference is successfully developed:
“(w)hen one focuses on the narcissistic patterns and works consistently to help the patient verbalize frustration-tension, object transference phenomena become increasingly prominent… Eventually, the patient’s transferences are aroused by his emotional perceptions of the therapist as a parental transference figure.”
In other words, personality maturation takes place. The symbiotic relationship developed between analyst and patient (See, Spotnitz, 1984,p. 135) may help the patient’s emotional perceptions along. Repeated emotional associations to the mental images of the analyst, as constructed by the patient; strengthen the object field of the mind, or form new neuronal connections.

The greater emotional maturity which results has enduring and important ramifications for the patient in therapy, and in life.