Modern psychoanalysis is the term used by Hyman Spotnitz [1] to describe the techniques he developed for the treatment of narcissistic (also called preverbal or preoedipal) disorders.
Narcissism is understood (by Spotnitz) as a state in which unexpressed aggression and hostility are trapped within the psychic apparatus with corrosive effects on mind and body. The bottled up aggression is turned against the self by a weak and undeveloped ego that is not capable of handling the stress of hateful feelings. The techniques of modern psychoanalysis [2] are aimed at allowing the ego to direct aggression outward in productive ways and at protecting a fragile ego against the self-attack seen in cases ranging from schizophrenia, depression, and somatization to neurotic forms of self-sabotage. [3] This is accomplished by helping the patient to "say everything."
The ego is protected by what is called "object oriented questions." These are questions directed toward the motives of other people rather than the patient, i.e., "What makes her do that?" or, "Why did I do that?” To guide the quality and number of such interventions modern analysts follow the "contact function," [1] [4] [5] [6] the efforts made by the patient to establish some discourse with the analyst. Questions asked by the patient indicate what the patient is ready to talk about and are explored to help the patient say more. Meadow describes the contact function as responding, "’in kind,’ thus replacing subjectively determined timing as used in traditional insight-oriented interpretation with what might be called ‘demand feeding’. [7]
In the interest of helping patients to say everything while functioning at an optimum level, the analyst refrains from interpreting defenses and instead "joins the resistance.” In joining, the analyst conveys acceptance of the patient's thoughts and feelings, stated or unstated, conscious or unconscious. Joining reduces the need for a particular defense by making the patient less defensive. [1] [8]
Although modern analysis forgoes interpretation as the main form of intervention, it retains the classical psychoanalytic focus on transference, countertransference, and resistance. [1] The transference is usually a narcissistic one in which feelings and patterns of defense from the first years of life are revived. The "narcissistic transference" is not so much a projection of figures from the past onto the analyst, as an externalization of parts of the patient's self. Often a benign feeling of oneness with the analyst prevails at the beginning of treatment. [9] [10] Such patients may make little or no contact with the analyst.
Modern analysts find that narcissistic transference develops in all patients, and to facilitate its full expression they recommend that the analyst not attempt to correct the patient's perceptions which would emphasize the differences between patient and analyst, undermining their narcissistic connection. [9] [11] Since patients who are struggling with bottled-up rage often hate themselves, they are apt to hate the analyst as well. The transference, which binds them to the therapist, permits the expression of feelings patients cannot own. In the negative narcissistic transference, they hate the analyst as they hate themselves. When the analyst is seen as an extension of the self, aggression may be more freely and safely expressed, lessening patients’ self-hatred and allowing them to slowly emerge from their narcissistic state. [1] [12]
Patients are encouraged to have and express all their feelings toward their analysts, including the most hostile and negative ones. Analysts are expected to have, but not necessarily express, all possible feelings for their patients. Eventually the analyst's emotional responses (objective countertransference) will be used for therapeutic purposes [13] but not until patients are able to hear them without narcissistic injury. [3] [14] In The Edinburgh International Encyclopedia of Psychoanalysis, [15] an entry describing modern psychoanalysis reads in part: "The analyst was advised to use induced countertransference emotions as the basis for responses to the patient rather than cognitive explanations….The modern talking cure emphasizes experiences lived and spoken in the analytic room: de-emphasizing reconstruction of the past." [16]
An outcome study by Meadow [4] explored the relative effectiveness of two types of interventions: interpretation and reflection. In the presence of a transference resistance she randomly offered either an interpretation of unconscious motives or a joining of the defense. However, this type of quantitative statistical study is unusual in the psychoanalytic community. The qualitative research method recommended by modern analytic institutes is described in an issue of the journal Modern Psychoanalysis. [17] [18] Candidates conduct single case studies in which the psychoanalytic sessions are used as laboratories to investigate the unconscious motives of specific transference resistances. [19] [20] [21] [22] Other modern analytic writings consider such topics as a comparison of the work of Kernberg, Kohut and Spotnitz; [23] the interactions of the psyche and soma; [24] [25] the application of modern techniques in schools; [26] [27] [28] [29] in analytic training; [30] [31] [32] in groups; [8] [33] and gender studies. [34]
Spotnitz's repeated advice to clinicians he trained was to "just get the patient to say everything." A book Just Say Everything [35] has contributions by those who were analyzed or supervised by Spotnitz who "say everything" about Spotnitz and themselves.
A number of institutes offer training in modern psychoanalysis leading to licensure, certification, and/or advanced academic degrees.
The Center for Modern Psychoanalytic Studies in New York offers a certificate leading to eligibility for New York state licensure as a psychoanalyst. The Boston Graduate School of Psychoanalysis in Massachusetts offers accredited masters and doctoral degrees in psychoanalysis. It also offers a non-clinical doctoral degree in psychoanalysis and culture. Other modern analytic institutes include The Center for Human Development in New York City, The Philadelphia School of Psychoanalysis, The Academy of Clinical and Applied Psychoanalysis in New Jersey, and the New Jersey Center for Modern Psychoanalysis.
Psychoanalysis is a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud, whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedia article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex." Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis. Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.
Otto Friedmann Kernberg is an Austrian-born American psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. In addition, his work has been central in integrating postwar ego psychology with Kleinian and other object relations perspectives. His integrative writings were central to the development of modern object relations, a theory of mind that is perhaps the theory most widely accepted among modern psychoanalysts.
Countertransference is defined as redirection of a psychotherapist's feelings toward a client – or, more generally, as a therapist's emotional entanglement with a client.
Transference is a phenomenon within psychotherapy in which repetitions of old feelings, attitudes, desires, or fantasies that someone displaces are subconsciously projected onto a here-and-now person. Traditionally, it had solely concerned feelings from a primary relationship during childhood.
Heinz Kohut was an Austrian-born American psychoanalyst best known for his development of self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.
William Ronald Dodds Fairbairn FRSE was a Scottish psychiatrist, psychoanalyst and a central figure in the development of the Object Relations Theory of psychoanalysis. He usually used, and was known as and referred to as, "W. Ronald D. Fairbairn".
Projective identification is a term introduced by Melanie Klein and then widely adopted in psychoanalytic psychotherapy. Projective identification may be used as a type of defense, a means of communicating, a primitive form of relationship, or a route to psychological change; used for ridding the self of unwanted parts or for controlling the other's body and mind.
Self psychology, a modern psychoanalytic theory and its clinical applications, was conceived by Heinz Kohut in Chicago in the 1960s, 70s, and 80s, and is still developing as a contemporary form of psychoanalytic treatment. In self psychology, the effort is made to understand individuals from within their subjective experience via vicarious introspection, basing interpretations on the understanding of the self as the central agency of the human psyche. Essential to understanding self psychology are the concepts of empathy, selfobject, mirroring, idealising, alter ego/twinship and the tripolar self. Though self psychology also recognizes certain drives, conflicts, and complexes present in Freudian psychodynamic theory, these are understood within a different framework. Self psychology was seen as a major break from traditional psychoanalysis and is considered the beginnings of the relational approach to psychoanalysis.
Hyman Spotnitz was an American psychoanalyst and psychiatrist who pioneered an approach to working psychoanalytically with patients with schizophrenia in the 1950s called modern psychoanalysis. He also was one of the pioneers of group therapy.
Harold Frederic Searles was one of the pioneers of psychiatric medicine specializing in psychoanalytic treatments of schizophrenia. Searles had the reputation of being a therapeutic virtuoso with difficult and borderline patients; and of being, in the words of Horacio Etchegoyen, president of the IPA, "not only a great analyst but also a sagacious observer and a creative and careful theoretician".
Resistance, in psychoanalysis, refers to the client's defence mechanisms that emerge from unconscious content coming to fruition through process. Resistance is the repression of unconscious drives from integration into conscious awareness.
Identification is a psychological process whereby the individual assimilates an aspect, property, or attribute of the other and is transformed wholly or partially by the model that other provides. It is by means of a series of identifications that the personality is constituted and specified. The roots of the concept can be found in Freud's writings. The three most prominent concepts of identification as described by Freud are: primary identification, narcissistic (secondary) identification and partial (secondary) identification.
Psychoanalytic dream interpretation is a subdivision of dream interpretation as well as a subdivision of psychoanalysis pioneered by Sigmund Freud in the early 20th century. Psychoanalytic dream interpretation is the process of explaining the meaning of the way the unconscious thoughts and emotions are processed in the mind during sleep.
Ralph R. Greenson was a prominent American psychiatrist and psychoanalyst. Greenson is famous for being Marilyn Monroe's psychiatrist, and was the basis for Leo Rosten's 1963 novel, Captain Newman, M.D. The book was later made into a movie starring Gregory Peck as Greenson's character.
Transference neurosis is a term that Sigmund Freud introduced in 1914 to describe a new form of the analysand's infantile neurosis that develops during the psychoanalytic process. Based on Dora's case history, Freud suggested that during therapy the creation of new symptoms stops, but new versions of the patient's fantasies and impulses are generated. He called these newer versions "transferences" and characterized them as the substitution of the analyst for a person from the patient's past. According to Freud's description: "a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment". When transference neurosis develops, the relationship with the therapist becomes the most important one for the patient, who directs strong infantile feelings and conflicts towards the therapist, e.g. the patient may react as if the analyst is his/her father.
An auxiliary ego, also known as simply an auxiliary, is the position taken by other participants in a role-playing exercise, or psychodrama, in order to simulate particular situations for the protagonists. Additionally in psychodrama, it can also be a role of representative figures in the protagonist’s life assumed by any person between the group members on the stage, excluding the therapist. Another conceptualization describes it in psychodrama as "the representation of absentees, individuals, delusions, symbols, ideals, animals, and objects" that make the protagonist's world real and tangible.
"Acting in" is a psychological term which has been given various meanings over the years, but which is most generally used in opposition to acting out to cover conflicts which are brought to life inside therapy, as opposed to outside.
Annie Reich was a Viennese-born psychoanalyst who became a leading analytic theorist in post-war New York.
The Analysis of the Self is the first monograph by the Austrian born American psychoanalyst Heinz Kohut. His biographer Charles B. Strozier has called it a masterpiece.
Michael S. Porder, M.D., was an American psychoanalyst and psychiatrist best known for his involvement in the New York Psychoanalytic Society & Institute. In 1983, he coauthored the book Borderline Patients: Psychoanalytic Perspectives, a monograph of the institute’s Kris Study Group, which attempts to apply classical ego psychological approaches to borderline psychopathology.