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Publications: Book Reviews
Review of Mourning, Spirituality, and Psychic Change: A New Object Relations View of Psychoanalysis

Title: Mourning, Spirituality, and Psychic Change: A New Object Relations View of Psychoanalysis
Author: Kavaler-Adler, Susan
Publisher: New York: Brunner-Routledge, 2003
Reviewed By: Mary Ellen Griffin, Fall 2004, pp. 46-48

In this ambitious and complicated book, Susan Kavaler-Adler seeks to “catapult developmental mourning to the center of the analytic stage” (p. 2). For Kavaler-Adler, developmental mourning is central to psychological growth and to therapeutic change in psychoanalysis. She shows how this is so in three ways which form the main divisions in the book. First, she provides a theoretical discussion, which is, in her own words, an “amalgam” of object relations concepts (Chapters 2-3). Second, she reviews the literature from Freud and Klein to more modern object relations writers, to examine “mourning as explicit and implicit in psychoanalytic theory” (Chapters 4, 5). And third, she provides extensive clinical material in three longer and two shorter case studies (Chapters 6-14), which describe “object relations treatment” as a “forum for mourning” (p. 274). Throughout the book, Kavaler-Adler relies heavily on theoretical concepts from the Kleinian and British object relations traditions. Readers will need a comfortable working knowledge of the main constructs and vocabulary of Freud, Klein, and Fairbairn. Other theorists—including Jung—play supporting roles.

Kavaler-Adler’s theoretical chapters are quite difficult. They will probably be of most interest to specialists in Klein and subsequent object relations theorists, who will find her arguments a thought-provoking contribution to technical dialogue about how to reinterpret and integrate these various theorists’ views, in the light of modern psychoanalytic thinking. Other readers may wish to skip her theoretical chapters, and proceed to her more accessible literature review, or onward to her detailed clinical chapters.

For Kavaler-Adler, patients with preoedipal psychopathology are best understood as developmentally arrested, in a state of “pathological mourning.” Closely following Fairbairn, she believes they are unable to make progress psychologically, because they are not conscious of the rage and grief they experience in relation to the split off good and bad part objects of their psychic world. They are condemned to compulsively reenact painful, self-defeating interpersonal and intrapsychic experiences that reflect their fixed psychic dynamics, which exist in a closed psychological system that is not affected by present-day relational experience. Alternately, these patients may be seen to operate with the psychic structure of Klein’s paranoid-schizoid position.

By contrast, “developmental mourning” is healthy mourning that not only allows for psychological development, growth, change, and healing, but is, in fact, the necessary process whereby such psychological growth occurs. Entry into the capacity for developmental mourning is equivalent to moving into the Kleinian depressive position, with its capacity for awareness of having harmed the internal loved object, and resulting capacities to regret, to grieve, and to attempt to repair injury to the other caused by one’s aggression.

What enables patients to begin to become “unstuck” from pathological mourning is the holding environment of object relations psychoanalytic psychotherapy or psychoanalysis. Following Klein, Kavaler-Adler believes that patients’ love must outweigh their hate, in order for them to be able to take the psychological risks inherent in depressive position mourning. It is the holding nature of the analytic relationship that enables patients to experience sufficient love to risk profound psychological change. As patients’ transference is allowed to develop and is interpreted empathically using object relations constructs, they feel safe enough to experience emotion on a deep level for the first time. It is this re-emergence of “heart experience” and “body experience,” felt first in the context of the transference relationship, that enables patients to discover deeply moving memories and fantasies about their parents. Thus, they recover deep rage, then sadness, then love for the deeply disappointing and/or aggressively traumatizing parents, who were internalized in part-object form by the patients during early childhood. These deep emotions, memories, and fantasies vis-à-vis early internal objects provide patient and analyst with now-conscious material which may be analyzed, so that patients are able to mourn developmentally; to let go of old traumas, hurts, and distortions, and to regain wholeness by reintegrating formerly split off parts of the self. Another theme important to Kavaler-Adler in this process is that of increasingly bringing formerly unconscious, split off, projected parts of the self into conscious dialogue and dialectic, as the individual’s experience of self and others becomes increasingly whole.

Early in the book, Kavaler-Adler presents an idea very important in her own thinking, that of the “demon lover complex.” This concept has been important to her in her work with patients who are writers and visual artists, and in her analyses of historical writers and artists, such as Emily Dickinson, about whom she’s written in greater detail in earlier publications. The demon lover complex is a way of talking about preoedipal psychopathology in which the patient’s internal world is composed of “split off instinctual aspects of the self and primitive object representations” (p. 7). For the artist who is arrested developmentally at this stage, his or her creative energy can be experienced as alien to the self, so that to experience creativity, the artist must have a relationship with an idealized other—often a lover—who can function as a muse, who provides the artist with sufficient feelings of well-being to create. However, when this person disappoints the artist, he or she is devalued and is experienced as if he or she were a demon. The artist’s libidinal tie to this now devalued other is disowned and projected, leaving the artist with the subjective feeling that he or she is “possessed” by this demon lover. While I don’t believe this concept is fundamental either to Kavaler-Adler’s theory of developmental mourning or to this book, I mention it because it is distinctive to her thinking, gives one a bit of the flavor of her approach to analytic thinking in her work with artists, and is mentioned in several places in both the theory chapters and her case studies.

In her case studies, the abundance of the clinical material that Kavaler-Adler gives us provides insight into the strange and wonderful world of psychoanalytic process. This is especially so when she includes transcripts of the patient’s material, or of dialogue between herself and her patient. At times, she enriches her clinical discussions with technical comments on why she withheld or offered a particular interpretation or countertransference disclosure. Her candid presentation of clinical material gives us a window into what analysis is like for Kavaler-Adler and a few of her patients. She gives us one model of how a seasoned analyst makes use of both Freudian and Object Relations theory in her clinical work, both to think about clinical process, and to guide interventions in the hour with the patient. At times, she uses complex theoretical concepts to characterize clinical data in her interpretations, so that the patients learn to analyze their own experience using these concepts. It is interesting to see her use various theoretical models in the case material as different lenses which enable her to make sense of the patients’ varying behavior in different ways at different points in the treatment. For example, she sometimes talks about alternative interpretations of particular transference events: should an instance of erotic transference be interpreted through a Freudian (Oedipal) or a Kleinian or Fairbairnian (preoedipal) lens? I would like to see her go further in explaining when theories can be “amalgamated,” (her word), and when they need to be used as distinctive and complementary lenses. I’d also like her to develop her thinking about how to make the choice to use one lens versus another in a given treatment context.

Readers will appreciate her timely commentary about the analysis of hetero- versus homosexual object choice, and its relation to gender identity, in the case of Laura. Readers interested in the psychoanalysis of artists will find her case studies of particular interest. Her two short cases at the end of the book include, respectively, verbal descriptions and both verbal descriptions and visual reproductions of her patients’ paintings, to demonstrate how changes in their art reflect psychological growth over the course of therapy.

In each of the cases, Kavaler-Adler shows how, with a variety of presenting complaints, and through a variety of analytic processes, patients go through a “critical developmental mourning process” that enables them to progress psychologically, to heal splits in the psyche, to become aware of sealed off, repressed emotion that ultimately initiates a developmental sequence required for becoming healthy and being able to enter into healthier relationships, to love, to be more productive and creative. In the case studies, she describes how developmental mourning can take different forms which may imply sequenced phases, beginning with the mourning associated with Masters’ “abandonment depression,” progressing to a more evolved Kleinian “depressive position mourning,” and, at least for some patients, including existential mourning associated with an awareness of the loss of life possibilities inevitable in experiencing human limitation.

Throughout the case material, Kavaler-Adler stresses how important it is for patients to experience psychological reality via bodily sensations. In her view, the therapist must make patients’ affective and somatic experience a priority. The analyst must sense what patients are feeling physically, and comment on this experience interpretively. She goes on to say that she believes patients’ capacity to experience a physically-based affective grief is central to deeply experiencing developmental mourning. She stresses this via clinical material in the first two of her long case studies (those of June and Phillip). For example, in the case of Phillip, she notes that his body-racking sobs indicate genuine developmental mourning. She comments that both June and Phillip have, as it were, a gift for mourning, which is essentially the same thing as their gift for sobbing.

The title of Kavaler-Adler’s book includes “spirituality.” However, readers seeking a contribution to psychoanalysis and religion or psychoanalysis and spirituality will be disappointed, as this theme is relatively minor and undeveloped in the book. In her case studies about June and Phillip, she includes clinical material about the patients’ spiritual experiences, but she does not adequately provide a theoretical or clinical context for understanding the meaning of these experiences. The first patient describes a kind of emotional/somatic experience that Kavaler-Adler describes as a subjective experience of self-transcendence. The second patient’s spiritual experiences include sexual ecstasy within an analytic session, past life regressions, “blockages in his energy field,” and visions of Christ. These are certainly unusual experiences, and it is admirable that Kavaler-Adler includes them in her case presentations for our consideration. She evades the issue with both the reader and the patient about whether she considers these experiences to be spiritual in nature, or reducible to psychological explanation. For example, she is content to respect Phillip’s experiences for “what is emotionally true to Phillip” without further analysis. In the conclusion, she makes a reference to one of her patient’s spiritual experience as “a useful metaphor,” but it is unclear whether she as the analyst saw it as metaphor, or whether the patient came to see it that way. Overall, however, she doesn’t develop her ideas about spiritual experience or spirituality in any depth. She does not make it clear in the text that spirituality is central either to her theory of developmental mourning, or to psychological growth.

By contrast, the emergence and interpretive working through of erotic transference plays a major role in Kavaler-Adler’s three longer case studies. However, she fails to sufficiently highlight either the theoretical importance of erotic transference, or theoretical and practical issues in the interpretation of erotic transference. Kavaler-Adler could have usefully elevated the importance of erotic transference to a major theme in her book. For example, in the case of Phillip, she provides a lengthy discussion of the analysis of erotic transference as a path to his ability to become aware of and tolerate aggression, necessary for moving from his previous pathological mourning into a depressive position capacity for developmental mourning. Kavaler-Adler might do well to develop this theme further, and to consider changing the name of her book to “Mourning, Erotic Transference, and Psychic Change.”

Kavaler-Adler’s case studies are most effective when she uses a straightforward narrative style that permits the reader to follow the relationship between patient and analyst as the story unfolds. A shortcoming in her longer case studies, however, is that she hasn’t “digested” the data sufficiently—it’s as if she’s not sure why she is presenting much of what she presents. There’s too much detail. She frequently repeats the same clinical episodes one or more times at different points in the chapter. The reader is left to sort through too much, too often left to draw his or her own conclusions. Kavaler-Adler could also do a better job of helping the reader by outlining her case studies more carefully. Material is often presented out of chronological sequence, which makes the cases hard to follow. She also includes so many interpretive themes in the longer cases, that the power of her conclusions is diluted. Given its centrality in the book, it might have been useful for Kavaler-Adler to stick closer to highlighting the process of developmental mourning, as an organizing theme in each case study.

In Mourning, Spirituality, and Psychic Change, Susan Kavaler-Adler offers us her unique perspective on object relations theory and psychoanalysis. Psychological growth and healing may be helpfully conceived as a process of developmental mourning. Object-relations psychoanalysis and psychotherapy can enable patients stuck in repetitive, developmentally-arrested pathological mourning to access previously split off emotional experience and move into this healthy form of mourning, in which growth is again possible. Her theoretical chapters are most appropriate for specialists in object-relations theory, given their dense, technical nature. Thus, many readers with a more basic working knowledge of object relations concepts will want to jump ahead from the introduction directly to the more accessible literature review, or even to the clinical chapters, in which ample and candid clinical data give an intriguing “window in” to psychoanalytic process. Readers interested in the psychoanalysis of artists will find the clinical chapters especially useful and interesting. Readers willing to make the effort necessary to become familiar with Kavaler-Adler’s ideas and clinical expertise as presented in this book will be rewarded with rich food for thought.

Mary Ellen Griffin is in private practice in Sylva, North Carolina, and teaches part-time at Western Carolina University, where she delights in introducing undergraduates to psychoanalytic thinking in the context of her courses, General Psychology, Psychology and Religion, and Freud and His Legacy.

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