|Publications: Book Reviews
Review of A Spirit of Inquiry: Communications in Psychoanalysis
Title: A Spirit of Inquiry: Communications in Psychoanalysis
Author: Lichtenberg, Joseph D., Frank Lachmann and James L. Fosshage
Publisher: Hillsdale, NJ: Analytic Press, 2003
Reviewed By: Estelle Shane, Winter 2004, pp. 55-59
It is indeed a pleasure to read, study, and review this important contribution to psychoanalytic understanding. While a comparatively short book, one has the impression after having completed it of covering an enormous range of material, with the historical past in the field reviewed and put into some perspective, and the more contemporary, modern and even post-modern, psychoanalytic theory and practice arrayed before us for our integrative perusal and use. While I am familiar with the relevant findings these authors present from infant research, from neurobiology and cognitive science, and from attachment theory, as well as from nonlinear dynamic systems theory, I am nevertheless impressed by their uncommonly thoughtful, practical, and clinically valuable application of these ideas to psychoanalytic and psychotherapeutic practice.
A Spirit of Inquiry is all about communication in psychoanalysis, just as its subtitle suggests: how in so many forms and modalities psychoanalysts and their patients communicate with themselves internally and with one another, and just why it is of such importance to do so. The title itself, A Spirit of Inquiry, addresses what the authors perceive to be the foundation of the psychoanalytic process. “Inquiry” refers to the more linguistically mediated effort on the part, first of the analyst, and then of the analyst and patient together, to explore and connect with one another in an explicit/declarative, largely-in-awareness form. “Spirit,” on the other hand, refers to the implicit/procedural/nonverbal form of relatedness that goes on most often in the background and largely out of awareness.
Thus, as the authors say, “The spirit of inquiry…highlights both the autobiographical scenarios of the explicit memory system and the mental models of the implicit memory system …..each contribut[ing] to a sense of self, other, and of self with other, …facilita[ing] the extrication and suspension of the old [pathogenic] models, so that new models based on current relational experience can be gradually integrated into both memory systems for lasting change” (p. 103-104). One can see in this brief quotation, not only what the title means to convey, but also how these authors proceed in their discussion, integrating in this instance psychoanalytic, cognitive, and neurological data, and data from infant research, to understand and convey how change happens from a current perspective.
Lichtenberg, Lachmann, and Fosshage briefly review some of they had written before and then advance their own thinking with a wide array of new, helpful clinical ideas, ideas which are clearly illustrated in beautifully articulated vignettes. So, for example, reviewing concisely the five categories of motivation that comprise the motivational systems model Lichtenberg had first put forward in 1989, in Psychoanalysis and Motivation, and the three authors have continued to advance since then, Lichtenberg, Lachmann, and Fosshage now maintain that, while the exploratory-assertive motivational system remains in their model as a distinct, independent system unto itself as it had always been conceptualized, they currently postulate in addition that “exploration as a search for novelty and efficacy is present in all motivational systems; the overlapping of exploration across motivational systems facilitates the integration of all motivation into a cohesive sense of self.” (p. 7, italics mine). Exploration as a motive enhances other motives, as, for example, when in a relationship, an exploratory motive is connected with an attachment motive, a sense of safety in exploring as well as an openness and flexibility in attachment is generated. Or, applying Edelman’s (1987, 1992) neurological developmental model of the brain, when an exploratory motive is elaborated in the brain’s maps, or schemas, associated with activities in any other motivational system, novel reentrant possibilities are created, making way for positive new experience to challenge old, potentially pathogenic patterns. And in particular, it is in the exploratory mode that good analytic work is done, with the analyst (and, ideally, the patient, as well) feeling interest, curiosity, and a sense of efficacy or competence in exploratory efforts. Exploration may be the dominant motive in therapy, then, while the topic of investigation may be concerns derived from any of the other motivational systems, as well as from the explorative-assertive system itself.
Again, these authors are all, more or less, associated with and grounded in infant research, Lichtenberg having written in 1983 Psychoanalysis and Infant Research, Lachmann, co-authored with Beatrice Beebe, having published widely in that area, including, most recently, (2001) Infant Research and Adult Treatment, and Fosshage having always encompassed a developmental approach in his own writings. So it is with ease and expertise that the first two chapters, devoted to the development of communication with self and other in infancy and childhood, present contemporary ideas about development from multiple disciplinary perspectives in a manner both clear and cogent. Chapter one presents the development of communications from ages zero to l8 months, organized by Daniel Stern’s (1985) phases of self development, and integrating, among other research findings and psychological postulates, data from attachment theory (Bowlby, 1969, l973, 1980; Main, 2000; Hesse and Main, 2000) and data from the brain studies of Edelman (1987, 1992) and Damasio (1999). Two case studies, both involving the sensitivity of communication of affective state between caregiver and neonate, contrast a securely attached infant and her mother, with an insecurely attached pair, setting the clinical tone that is replicated throughout the entire book. Chapter Two concerns the remarkable development of verbal communication. Again with great charm the authors provide vignettes of monkeys and children as each subject acquires an understanding of words and the capacity to express themselves in symbolic conversation.
With these two chapters as background on the development of communication in all modes, the authors can then turn to their approach to clinical work, applying the research data that had come before. Chapter 3 presents the case of Nick, illustrating “the contribution to therapeutic action of a variety of interpretive and noninterpretive interventions, as well as verbal and nonverbal procedural interactions and enactments” (p. 60). This wonderful depiction of rage transformed in the analytic process is merely one of a surprising and generous number of well-articulated case descriptions that clarify how insights and understanding born of developmental theory meld with more familiar psychoanalytic approaches. The analyst, in this instance Frank Lachmann, demonstrates how, as he says, “humor, irony, and playful exaggeration characterized [his and his patient’s] unique personal communication and connection,” with their fast-and-dirty witty exchanges surprising Nick and helping to modulate and transform Nick’s aggressive outbursts and to enhance Nick’s growing sense of trust in and comfort with his analyst. The creative uses of comedy and the absurd are amply illustrated in the verbatim material, then, as well as enactments and spontaneous emotional eruptions, but so, too, are the creative uses of dream interpretation and transference interpretation. In addition, this particularized clinical detail is accompanied by the reflections of Lachmann himself, sometimes in the moment, but more often in retrospect. Thus the reader is treated to what Lachmann did and why he did it, and if it worked, or at the least, seemed to work. Again, this descriptive method of case presentation is present throughout this book.
In Chapter 4, the authors explicitly present “relational centered moments” in treatment, moments where the main meaning is communicated principally in forms other than the verbal. Included are considerations of the implicit/procedural and the explicit/declarative domains, the analyst’s affective participation, forms of relatedness, and physical touch. Background literature is provided, current psychoanalytic theory is introduced, relevant contemporary research on development, cognition, and neuroscience is presented, and, as is their hallmark, the authors present masterfully describe clinical material to illustrate the broad range of topics considered, this time the analyst being James Fosshage.
In Chapter 5, providing a different focus, the authors maintain forthrightly their belief in the importance of verbal exchange, and at the same time present their approach to transference. Their use of brain research and infant research informs their understanding this familiar concept so that the old, familiar concept is retained but dressed in more contemporary garb. “Transference,” the authors say, “is a way to describe conscious and especially unconscious expectations people have that guide the manner in which they construe (give meaning to) their current experience.”
“[These expectations are formed from] repetitive, lived experiences [which] lead to an event map becoming categorized and generalized… Every expectation contains a dominant pattern and a pattern of exceptions…. [Especially in trauma the] dominant expectation leaves [the traumatized individual] hypervigilant to perceptions that confirm, “Oh my, here it’s happening again.” The coexisting alternative: “this time it can and will be different” provides the hope that leads the patient to seek, utilize, and sustain therapy. Expectations, and the inferences drawn from them, antedate the symbolic coding that is subsequently used to describe them” (p. 106).
With the more troubled patient, especially the traumatized or strongly aversive patient, expectations may be difficult for the analyst to comprehend, and for some, the channel for communicating expectations may be through bodily symptoms and sensations, which somatizations carry the patient’s meaning. One patient, Harry, was unable to recognize his own affect states or make connections to events in his life that disrupted him, so that working with him effectively required that his analyst, in this instance Lichtenberg, find words to communicate about Harry’s unverbalized experience that carried with it “the belief that his pain will not be appreciated nor his cries heard.” To quote Van der Kolk, “the body keeps the score” and the body tells the tale.
Again, the case of Harry is beautifully presented, with contemporary psychoanalytic theory, particularly self psychological and motivational systems theory, integrated with findings from related research disciplines as applied to this patient and his analyst. And again, the give and take of the analytic work and the conceptual understanding of it is conveyed as unique and particularized to this dyad, with interventions that go well beyond the verbal interpretive mode. The authors speculate that Harry would have been categorized as a Disorganized/Disoriented attachment disorder as a child with a subcategory of anxious-resistant; he then became an anxious preoccupied adult caregiver for his family. While from my reading Harry is never “cured,” he is certainly helped to grow up, to assume a professional life and to marry. Ultimately Lichtenberg reports that he becomes in this treatment “a reliable stabilizer, a counterforce against Harry’s disorganization and detachment” (p. 114).
Here, in the context of this case, the authors reflect on how change happens. They invoke the Boston Process of Change study group’s contention that, in the context of “just moving along” in the course of ordinary analytic work, forming a background sense of trust and safety, suddenly “patient and analyst are moved emotionally to meet an encounter during which the authenticity of their more spontaneous relatedness transcends technique: a ‘now moment’ occurs” (p. 116). In Stern’s view, “[I]mplicit relational procedures that unconsciously governed enactive forms of “being with a person” become destabilized. An open space allows for “creative disorder and internal flux” during which the deconstructed enactive representation can be co-constructed into more adaptive but equally complex new ways of being together” (p. 117).
Lichtenberg, Lachmann, and Fosshage note that this idea about therapeutic change is consistent with their own notions. They suggest three processes inherent in ordinary growth that are integral to exploratory therapies: 1) self-righting or resilience when an inhibitory stress has been removed; 2) joint, or shared, expanding awareness akin to the mother and her baby increasing explicit and implicit knowledge of the other and of themselves as a dyad; and 3) reorganization of representational schema. The authors state that the Boston Study Group’s view of open space moments of creative disorder during which previously fixed aversive expectations can be coconstructed into an alternative positive expectation is compatible with their view of how representational schema become recategorized. “We regard a pivotal cause to be a discrepancy between a negative transferential expectation seeming to be realized in the on-going treatment and the contrasting alternative perception of the analyst as a consistent, reliable, empathic responder…” (p. 117).
The authors are then moved to ask: “If the basis for change lies in ‘now moments,’ in implicit relational learning, or even in experiences of mirroring, twinship sharing, and idealization, why talk at all...What part does exploratory talk play in recovery” (p. 118)? They assert that the processes of verbal linear exchange, contextualizing, highlighting and fixing in memory, speculating about alternative constructions, providing a scaffolding for reflective inner speech, and, finally, the way words exchanged in the dyad eventually change the way the patient speaks to himself, all of these elements in the analyst-patient system contain critically important functions in the nonlinear process of change, and the next several chapters elaborate the authors’ own creative approaches to the all important “talk” offered by the analyst, and co-constructed with the patient.
First, words serve the function of “designators;” that is, when an adult senses, names, and talks to the child about a significant intention focused on by the child, a new realm of experience is remapped in words. So too, in the analytic dyad: an analogous exchange between patient and analyst evokes the remapping of a realm of experience in dynamic, verbal, symbolic form. Such mapping allows the exploration of the appropriate subjective and intersubjective motivational system, and, just as with the child, having the motive recognized, named, and talked about has the effect of expanding implicitly and explicitly communicative ability with others and with the self.
As a second point, the authors note that when words connect with very strong affect, cognition is diminished and symbolic meaning and expression become inchoate. Communication thus becomes disrupted and the analyst’s focus must then be on responding in such a way as to prevent further disruption. Here they invoke the power of nonverbal gestural communication. They refer to the toddler in a temper tantrum as an analog to strong episodes with a highly disturbed patient, noting that in the moment, explanations have less restorative value than does the analyst’s remaining patiently present until the intensity abates, but then, and this is their point, words are needed: a verbal exploration by the analyst of feelings he imagines the patient is experiencing, feelings that are too powerfully dysphoric for spoken expression.
A depressed, seemingly hopeless patient, Sonya, is offered in illustration, Lichtenberg commenting, “When patients like Sonya offer little direct verbal communication, the most effective way to perceive and then elucidate verbally a perspective was through frequent moments of introspective awareness. My ability to perceive and describe the overt and unspoken process present in our exchange often offered Sonya the best opportunity to expand her awareness of her inner state. In addition…my intuitive, loosely formulated introspection provided messages delivered through comments, descriptions, and decisions that seemed to pop out of my mouth, what we have called ‘disciplined spontaneous engagements.’” (p. 132).
Lichtenberg explains that the combination of the verbal, the nonverbal, the linear and the nonlinear, stimulates receptivity to spontaneity: “Humor, use of metaphor, model scene building, and some measured personal disclosures facilitate a vitalizing contrast to the dreary entrapment of an unrelenting aversive affect state. Special impact relational moments that result from spontaneity, surprise, and direct affective communication stand in sharp contrast to an impoverished…inner and outer communication [of an aversively motivated, depressed patient such as Sonya]” (p. 132).
The “disciplined” in “disciplined spontaneous engagement” requires that the analyst track carefully what emerges from the enactment, especially what emerges in the nonverbal domain, and this close, respectful attention to his patient is clearly illustrated in minutely depicted clinical exchanges that exemplify Lichtenberg’s exquisitely sensitive work with Sonya. What is revealed is the use of both the exploratory and the attachment motivational systems to build a safe and increasingly intimate relationship in which the spirit of inquiry is displayed.
Another important clinical focus of these authors is the use of metaphor and, most creatively, the development of the model scene. They explain model scenes as extended metaphors: “Just as metaphors appeal to portions of the brain that process multiple modalities verbally and imagistically, a model scene invites reentrant signaling from multiple sources…. Model scenes work not only because they tap in on past significant events but because they are taken up by analysand and analyst as joint properties or shared stories to be amended, added to, and reflected on” (p. 145).
Model scenes have the effect of uniting patient and analyst in what seems to become a shared experience, creating aspects of a “family myth,” whose members “share and amend the story line and apply it to the present” (pp. 145-147). Many illustrations of model scenes are enfolded in the clinical material appearing throughout the book, evoking a clinical approach unique to the patient and poetic in its exploration and expression of the patient’s lived experience.
Chapter 7 presents detailed clinical material of the entire analysis of a patient treated by Lichtenberg. Each phase of analytic work is followed by a discussion of the analyst’s thoughts and reflections as the work proceeds, most often about the case in particular, but at times about theoretical issues arising from the material. Thus in one discussion Lichtenberg notes the problematic speech pattern of his patient, pressured speech, and how it recedes by means of the implicit message coming through in the treatment that such a self-protective, aversive strategy is no long necessary. He notes that implicit learning of this kind is greatly enhanced by explicit learning about the kinds of triggering situations that evoke the anxious excited state of pressured speech. Again, Lichtenberg is answering the question, why talk?
In their final chapter the authors summarize, reflect on, and address controversies evoked by their thinking, some of which I will review here. They pointedly assert, first, that they reject the polarization of insight and relationship, contending that communication includes sharing of information and knowledge of self and other by talking, but also by all the other multifaceted forms of relating, and that change is brought about not just by relation-centered moments but also by symbolic syntactical exchange.
Second, they argue for the usefulness of provision in the analytic relationship. They suggest a way to understand provision alternative to thinking of it as a means to address deficits in the patient. Instead, provision can be thought of as a means to address the patient’s inadequate regulation stemming from the manner in which he has organized experience in infancy and childhood. Thus, while insecure attachment can be understood in deficit terms, the authors posit instead that in insecure attachment, infant and caregiver have evolved a strategy for relatedness based on self and interactive regulation, a strategy that, despite its inherent difficulties, does preserve the attachment tie in stressful situations, an understanding of insecure attachment that is, parenthetically, perfectly consistent with that conceptualized in attachment theory. The authors argue that their shift from deficit to regulation doesn’t alter the value of provision itself, as the authors demonstrate to great effect in their clinical material.
Third, they address the important question of mentalization; that is, how are significant others held in mind, and how does that conception of the other get transmitted to the other? To address this question, they list three clinical strategies: Acceptance, Transparency and Acceptability. Acceptance refers to the patient being held in mind by the analyst, each shaping and being shaped by the other. Transparency is found in the analyst’s conveying to the patient how he is perceived now in the present and will be in the future, and conveying to the patient as well who the analyst is. A degree of such transparency is necessary, with transparency increasing so that the patient-in-mind and the analyst-in-mind are revealed and transformed through their interaction. Acceptability reflects the patient being acceptable to the analyst despite revealing himself at his worst as well as at his best. Acceptability depends upon the emergence and recognition of discrepant view of each by the other.
Fourth, despite the arguments for the concept of multiple selves in non-pathological states put forward by many relationalists, these authors accept Kohut’s notion of a cohesive self, the maintenance of an experience of continuity of identity over time, despite differing aspects of self and self-with-other emerging, depending on the motive that is dominant, which shifting promotes a multiplicity of self experience (not of multiple selves).
Lichtenberg, Lachmann, and Fosshage assert, in closing that the analyst must be able to form relationships, to encourage communication, and to provide what is needed for the patient’s experience of safety and stability, but that ultimately, analysis depends upon the analyst’s being able to sustain a spirit of inquiry throughout the treatment.
Estelle Shane is a Founding Member, Past President, and Training and Supervising Analyst at the Institute of Contemporary Psychoanalysis in Los Angeles, and a Training and Supervising Analyst at the Los Angeles Psychoanalytic Society and Institute. She is on the Clinical Faculty of UCLA and in the private practice of adults and children.
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