|Publications: Book Reviews
Review of Transforming Lives: Analyst and Patient View the Power of Treatment
Title: Transforming Lives: Analyst and Patient View the Power of Treatment
Author: Schachter, Joseph
Publisher: Jason Aronson
Reviewed By: Polly Young-Eisendrath, Vol. XXVIII, No. 3 (Summer 2008), pp. 63-65
A WELCOME NEW PRAGMATISM
Is it possible to find a new perspective in psychoanalysis that is both useful and original? If you’re like me, you might not be optimistic. Sometimes I avoid reading accounts of “new” trends in the professional literature because they seem either too arcane and idiosyncratic or simply new bottling of perfectly good old ideas (best left in their old bottles, in my view). But, if you’re longing for something new and helpful, and you’re generally inclined toward thinking in “relational” terms, then you’ll be happy with two new books: Awakening the Dreamer: Clinical Journeys by Philip Bromberg, and Transforming Lives: Analyst and Patient View the Power of Psychoanalytic Treatment by Joseph Schachter. They are both well written and innovative, challenging us to think in new ways. They both come from well respected and highly skilled clinicians who have been in the profession long enough to see trends come and go. And yet, these two seasoned writers and thinkers are likely to shake up your psychoanalytic reading group (they did mine) because they introduce views and methods that may forever change your approach to practice if you take them seriously.
INTERSUBJECTIVITY AND ANALYTIC INQUIRY
Both authors claim that a contemporary relational approach requires a new kind of theorizing, as well as new ways of working. Our theories now have to account for the fact that both members of the therapeutic dyad are truly and deeply affecting each other, moment to moment. Neither analyst nor patient can hide behind a mantle of authority in relation to their live experiences in the consulting room.
In Bromberg’s model, the via regia of therapeutic change is bringing into awareness what was previously defensively or affectively dissociated. This can be accomplished through interpreting dreams or working with affective enactments in the consulting room; he prefers the latter. To be deeply helpful in the process of finding meaning in such expressions, the analyst must reveal her or his own subjective and intersubjective experiences in such a way that “the disclosure is more one of sharing than covert indoctrination designed to look like sharing” (p. 134). Along these lines, Bromberg challenges his reader:
“I argue that the analyst’s experience as a real person is not only inevitable, because it is not something under his control, but is necessary. Why? Because the analysts’s experience while with his patient is linked to his patient’s experience as a part of a unitary affective, cognitive, and interactional configuration that is at once subjective and intersubjective. Some aspects of that configuration are dissociated in each person and must be processed jointly in the immediacy of the analytic interaction to achieve cognitive symbolization through language.” (p. 131)
Bromberg recommends a new clinical method that fits with his theory of a unitary interactive field: “I assert not only that the analyst’s self-revelation is permissible but that it is a necessary part of the clinical process if the therapeutic efficacy of analytic treatment is to be most enduring and far-reaching” (p. 132). Building his theory of mutative change on the foundation of working through enactments, Bromberg believes that the effective analyst is self-revealing in the service of therapeutic transformation.
What are the guidelines or boundaries for such self-disclosures from the analyst? Mainly, self-disclosures should not be motivated by a desire (revealed or hidden) to change the mind of the patient. Instead, the analyst shares his or her ongoing experiences as a way of clarifying and opening up the process of intersubjective discovery and negotiations, especially in reflecting on enactments that have taken place in the analytic relationship.
The classical model of psychoanalysis assumed that the mind of the patient was separate from the mind of the analyst. The analyst’s self-revelations were understood to intrude on the autonomy or subjectivity of the analysand; indeed, such self-disclosures would be understood as enactments themselves (typically bringing into expression something that was preconscious or unconscious in the analyst and should be kept hidden). Generally, the patient’s subjective experiences were considered “pure” if the analyst didn’t speak or otherwise reveal his or her subjectivity. Now we know, from myriad findings in research on emotional communication that affective messages are being sent all the time when people are together, whether or not they are speaking.
From Bromberg’s perspective then, “intrusiveness” on the part of the analyst means interfering with the process of intersubjective discovery and negotiation. The analyst’s silence (if it is a refusal to communicate something being felt) can easily be as intrusive as a knee-jerk formulaic interpretation is. According to Bromberg, the analyst intrudes when he or she is unwilling or unable to allow his or her subjectivity to be modified in response to the patient’s experience. If the analyst is stubbornly, perhaps “strategically,” protecting the sanctity of her or his mind, the analyst may be shirking responsibility. Effective therapeutic self-revelation is motivated by the desire to be influenced by the patient’s feedback and reactivity, but not to dominate the patient either directly or subtly. And the patient’s feedback is always to be taken seriously in the on-going discovery process.
WHEN PATIENTS AND ANALYSTS SPEAK ABOUT TREATMENT
Joseph Schachter’s revolutionary book, Transforming Lives, presents extensive clinical data (some from patients themselves) that illustrate and demonstrate the validity of many of the claims made by Bromberg. Schachter, as editor and originator of this unique volume that gathers together writings from therapists and their patients about psychoanalysis, asked seven very different kinds of analysts to report on seven patients that they had seen in an extended treatment. The analysts range from classical Freudians through various nontraditional approaches. Schachter remarks at the outset, “Evidence suggests that the analyst’s personal qualities and values as well as his or her technique may influence the treatment.” (p. 4)
For this reason, he asked a wide range of types of analysts to contribute, including “men and women, training analysts and non-training analysts, Americans and Europeans, heterosexuals and homosexuals, Democrats and Republicans, and, last but not least, people who vacation in the mountains and people who vacation by the sea” (p. 5). While he gives us the names and credentials of the contributors, he separates them from their case material. And so, we read their cases with additional interest and curiosity because we are unable to categorize their approaches through typical analytic stereotypes or other biases. Additionally, five of the seven analysts asked their patients if they would like to contribute a report of their own to the paper. Four of the five patients agreed and their contributions make this book a special opportunity to examine what is perceived as effective from the patient’s point of view.
For my part, I believe, as Owen Renik has asserted (see pp. 149-150 in Schachter for a fuller discussion of this issue), that eventually we must include our patients’ accounts of their treatment in our psychoanalytic literature if we are to understand its effectiveness. While asking patients for a narrative response to their treatment may seem to pose ethical concerns, not asking also poses ethical concerns. Schachter’s book is a step forward in taking up the discussion of such concerns from both sides.
What we see in several of the patients’s accounts in Schachter’s book proves the points that Bromberg makes about the significance of enactment, repair, analyst self-revelation, and the affective intersubjective engagement. For instance, a 28-year-old patient called Andrew says,
“I have gotten to the point in therapy that I can sense a process of rebuilding, reconstructing, my life in such a way that I am able to live fully. My problems have always been that I am afraid of life, of people, of people who may be better than me, of people criticizing me and realizing my weaknesses, my inferiority.” (p. 141)
Praising his analyst for helping in tangible ways with his relational problems with women and in his work, Andrew further says,
“What I think has facilitated the process is my analyst’s extreme active engagement in each session. He does not play the passive analyst, allowing me to simply talk and offering no direct commentary. Because the point of the treatment is to figure out how to change the way I deal with situations that occur on a daily basis, it has been extremely helpful to me that my analyst shares with me his own life experiences and how he has dealt with them. . . Our sessions take the form of a dialogue. Because I know more about him, I have a better understanding of where his input is coming from, and thus I understand it as emanating from a person with certain characteristics and life experience, not merely from a body of psychoanalytic knowledge. I am dealing less with someone who represents an ideology that posits itself as truth and more with a person who can critically relate his own experiences to my own.” (p. 142)
If the effective analyst is someone who does not represent “an ideology that posits itself as truth,” but is more of “a person who can critically relate his own experiences” to the patient, then such an analyst must be open not simply to reflecting on subjective and intersubjective events in a session, but revealing his own experience.
Schachter’s book, however, has a different aim than Bromberg’s. Bromberg’s is a collection of clinical essays that convey in often subtle and poetic terms a new relational method for doing psychoanalytic psychotherapy, with an emphasis on affective engagement between patient and therapist. Schachter, on the other hand, has written and edited a volume that makes a broad and popular appeal to readers who may not know much about psychoanalytic psychotherapy, but are interested in it for themselves as potential patients. It is a book that can be recommended to someone who is considering entering analytic psychotherapy. I have lent out this book to friends who knew little about analytic treatment and they found it very useful.
In a final succinct and incisive chapter, “Discussion and Conclusion,” Schachter summarizes what he takes to be the reasons that psychoanalytic psychotherapy and psychoanalysis are uniquely effective in bringing about lasting change in patients. They are the following: interpretation, construction of a personal narrative, and modification of habitual relationship patterns. And then he looks at the seven successful (or mostly successful) cases reported in his book. What are the common curative elements in these cases, Schachter wonders. As he relates them, they reflect exactly what Bromberg talks about in his recommendations for using enactments as the via regia (filled with potholes and bumps, as he says): mutual fondness between patient and analyst; moments of mutual intense feeling; and being able to express anger toward the analyst (p. 172-173). Bromberg would seem to concur,
“No matter which school of thought organizes one’s basic stance, the inherent structure of the analytic situation—the inevitable tension between the treatment frame and the human relationship—pulls for relational collisions. Enactments are what we count on to make the analysis of transference possible; it is only when seemingly unresolvable treatment crises emerge from enactments that we even question the role played by the relational collisions in the therapeutic action of psychoanalysis.” (p. 95)
Reading these two books side by side and discussing both in a small reading group, I gained a great deal in courage and understanding. Bromberg’s book assembles a whole new way of thinking about what we are doing within the therapeutic relationship—a way that accounts for moment-to-moment affective contact in our attempts to interpret transference and countertransference. There was a lot of argument, in my reading group, about the basic thesis that Bromberg puts forth: that enactments and self-revelations of the therapist are necessary components for therapeutic change. There was disagreement, even anger, with Bromberg’s stance. Then, when we read the seven cases in Schachter’s book, especially the five patient reports, we found evidence that reinforced Bromberg’s points. Moreover, Schachter’s account of what was curative in the cases further highlighted the significance of the affective communication and honesty in the consulting room.
But neither of these analysts is recommending that psychoanalytic therapy become a food fight with each person making subjective claims in unconscious or conscious opposition. Both analysts are highly respectful of the therapeutic framework or set-up that protects the relationship and allows for reflection, mental spaciousness and interactive play or humor. Both believe that interpretations, when they are alive and responsive to what’s actually happening in the room are transformative. And yet, each author in his own way is recommending a whole new perspective on what psychoanalysis means and how it is defined. If you believe that we need a new lens and some new methods to develop a “two–person” psychology that is theorized as interdependent and shared, then I highly recommend that you read these two books side by side. It might be even more fun to read them with some colleagues and talk about how they impact all of you in your clinical work. I guarantee it will be a lively and revealing conversation.
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