- Hello, and welcome to this course on
Relational Theory.
I'm gonna start by introducing myself, and then
orient you to the course, kind of introduce the course.
My name is David Levitt.
I'm a clinical psychologist and psychoanalyst.
I have a private practice in Amherst, Massachusetts,
just a few towns over from Smith,
and I teach now in the Continuing Education Program
at Smith, have taught there in the
masters and doctoral program before.
I'm currently on the faculty at the
Massachusetts Institute for Psychoanalysis, or MIP,
in Boston, and also at Tufts Medical School.
But I spend most of my time in my office
working with patients where these ideas really come alive.
So let me introduce you to what we're gonna do today.
Relational theory, I'm gonna talk about relational theory,
and relational theory developed both a theory of
psychotherapy and a theory about the mind.
So it's both a clinical theory,
and it's a theory about human psychology.
I'm gonna start today with the big picture,
in kind of broad brush strokes, and then get into
more elaboration and complexity about the theory.
Because you can only understand relational theory
if you understand it in the context of the other
psychoanalytic paradigms that came before it.
So here's the big picture, and this will be a
sort of schematic, simplified way of looking at it
that we're gonna get into in greater depth.
If you think about three major paradigms,
and even think about it spatially,
classical paradigm, the object paradigm
and the self paradigm.
The classical paradigm, also you can think about it
in terms of, it's talked about in terms of
drive and ego psychology.
It's the model developed originally by Freud,
developed originally in the 1890's,
and the foundation for that paradigm was really
evolved from the 1890's into roughly the 1930's.
Now it's developed over time.
There are contemporary thinkers
developing those ideas further.
But I'm gonna be laying out the foundations
of these paradigms and then talking about
the evolution of relational theory from that.
So we have the classical paradigm over here.
Then the object paradigm, very broadly speaking, object,
including, and you may be familiar with some of these
names and theories, including the British object
relations theorists, Klein, Fairbairn and Winnicott,
but I'm gonna be talking about
the object paradigm very broadly.
So it will include those theorists, but also include
interpersonal theory developed largely in the United States,
which is hugely important for relational theory
that evolved out of it.
So the relational paradigm, which developed the foundations,
excuse me, the object paradigm, where the foundations
developed roughly from the 1930's into the 1960's.
And then the third paradigm, the self paradigm,
associated most closely with Kohut, self psychology.
Then we're looking at the late 1960's,
really the 1970's and into the 80's.
So first just laying out those three paradigms
in very broad brush strokes, and then looking at how-
What we're gonna trace out today is how relational theory
developed in the 1980's, largely in the United States,
largely in New York originally, and we're gonna talk about
its relationship to these other three paradigms,
and that's how we'll kind of put together
what comprises the relational paradigm.
We'll talk about it as it developed largely in response to,
and in critical response, to the classical paradigm,
particularly about the stance of the therapist,
or the style of the therapist.
So that's one relationship.
We'll talk about how relational theory evolved in
an enormously important way from the object paradigm,
particularly interpersonal theory.
A lot of the original relational theorists
were from the interpersonal school.
We'll also talk about Fairbairn,
one of the object relations theorists.
But anyway, we'll talk about this direct line of,
legacy of theoretical ideas, from the object paradigm
into relational theory.
And then also we'll talk about the self paradigm
and ways in which relational theory,
even though there are important differences,
it incorporates a lot from that paradigm.
So that's, in terms of the theoretical landscape
of what we're gonna talk about today,
that kind of lays out the groundwork.
But one thing I wanna emphasize, and I will be emphasizing,
beyond that simplified way of looking at it is
I'm gonna be talking about particularly the relationship
between relational theory and the classical paradigm
because that relationship is very complex.
Even though in one sense they can seem like polar opposites,
or the relational rebellion or the revolution can seem like
it was trying to overthrow, in some ways,
the classical, the Freudian paradigm.
When looking at it in a more sophisticated and complex way,
those two paradigms, the classical and the relational,
even though they have major differences and in some ways
opposing sensibilities about many issues,
that they actually need each other, that there's a kind of
dialectic tension that needs to be sustained,
and that, this is from my perspective, one can't practice
as a relational therapist without an appreciation
of some of the classical sensibilities and how these
tensions are actually healthy and important
and need to be sustained.
So that's something I'll be developing
in the course of the talk.
So the first part of the course will be laying out
that groundwork, the three paradigms, the evolution of
the relational paradigm, and I'll then, when I talk about
the relational perspective or paradigm itself,
I'm gonna be tracing out six particular themes
or dimensions, and as you'll see, I'll be talking about
this is a relational approach to therapy.
How to think about therapeutic options,
therapeutic style, therapeutic action, in terms of these six
themes or dimensions that exists as kind of continua,
these themes or dimensions.
And we'll talk about relational theory on one side
of each of those dimensions and the classical view,
or classical voice, on the other side
of each of these dimensions, and we'll be tracing that out.
So that's the, a large part of the first part of the course
will be that, tracing out the theory.
I'll be presenting some case material interwoven in that
that we'll be using to highlight and illustrate those ideas.
The second part will be specifically on enactment,
enactment in the therapy relationship,
which is such a central idea for relational theory.
And then the third part of the day, the first two parts
are really focused on clinical process,
on psychotherapy or analysis.
The third part and last part of the day, we'll be shifting
over to talk about relational theory as a model
of human psychology, a model of the mind.
So it won't be focused as much on the therapeutic process
as it will be on understanding the essence of human nature
and the structure of the mind, as conceived of
in relational theory very differently from,
for instance, classical theory.
So one kind of preface to this now, the first part,
the theoretical part where we trace all these paradigms.
This part of the course is heavy on theory.
I'll be interspersing and intertwining clinical process,
but this will be heavier on theory because we have to
develop central ideas from these other paradigms.
The other parts of the day, the enactment part of the day
and the third part of the day where we talk about the mind
will be, the balance will be more on the,
also on the clinical process, kind of more even
with theory and clinical vignettes.
So this first part's a little dense on theory,
but just to let you know.
OK, so, here we go, and there are some handouts
that you can follow along with that I'll be referring to,
to just help stay oriented to what we're doing.
And you can start by looking at, if it helps, to refer to
the page three and four, first page three of the handouts.
So here we go into the theory section.
Relational theory, as it emerged in the 1980's
as a response to the classical paradigm, as I said.
Let's start, I'm gonna start with talking about
the classical paradigm, and particularly the critique of it.
If you think about the kind of satire, the satire version
of the classical analyst or therapist,
well-known in many New Yorker cartoons over the years,
and this is the satire image.
The orthodox Freudian, the blank screen,
the dispassionate surgeon of the psyche,
is caricatured in cartoons and films.
He, and I mean specifically he, is a gray-haired,
white-skinned man sitting behind the couch,
cold and objective, withholding, silent,
emotionally expressionless.
As patients bare their souls
and cry out to be understood,
the therapist strokes his beard and replies, "Um hmm."
Though he occasionally manages an entire sentence,
the austere character in these images
makes his pronouncements from afar,
and the picture is a bit chilly.
This iconic icicle is held up by the more vociferous critics
as evidence that Freud is dead.
This is, you know, the cover of Time Magazines.
If Freud Dead?
Newsweek, Freud is Dead.
And that psychoanalytic ideas are an irrelevant
anachronism in today's world.
The funeral dirge is inspired in part, in part,
by the unfortunate fact that the caricature is not
entirely without basis, at least historically.
Freud, in an attempt to establish his then radical
new field of psychoanalysis as a science,
he did emphasize the need for objectivity and warned
of the dangers of the analyst becoming emotionally drawn in.
The voice of caution, though, was greatly amplified
in North American psychoanalysis during the 1940's
through the 60's, resulting in sometimes stultifying,
austere stance by all too many analysts and therapists.
Hence the New Yorker cartoons.
Ironically, the American version
was more Freudian than Freud.
It's been well documented that the founder did not keep
as strictly kosher a consulting room
as many of the colleagues from across the Atlantic, for
he could be quite engaging and involved with his patients.
Despite this emphasis on neutrality, Freud clearly knew
that the analyst, and I'll quote here,
"cannot pull away, cannot merely sit back, observe,
"interpret and practice similar explanatory arts",
unquote, for it was Freud who said this.
In any case, relational theory developed, as I say,
in critical response to the perception
of a therapeutic stance that was problematic.
And the real beginning of this was in 1983.
There was a watershed book by Greenberg and Mitchell
that looked at all of the psychoanalytic paradigms to date.
It was a very scholarly work,
and it looked across these paradigms,
the classical, the object, the self paradigms,
and in looking across them, they made the case that
you can take those theories and basically break them down
into two categories.
Those that center around drive
and those that center around relationality.
And what they meant was that, if you look at these theories,
that each one has a kind of foundation or bedrock
in one of these two positions.
When each theory looks at what is the essence
of human motivation, of human psychology,
of the human condition, that it's either centered
on drive or relationality.
Drive, as you probably know, back in the Freudian sense,
sexual and aggressive drives, competitiveness,
seeking pleasure, are drivenness from within.
And the relational model, the notion that the essence
of the human condition is something more about seeking
some kind of attachment or relationality.
And what Greenberg and Mitchell traced out when they
looked across the paradigms was that the classical paradigm
was very much in the drive model, essentially by definition,
but of the object and self paradigms and all the
different theories within them, many of those theories
were in the relational direction, that they were
organized around relationality.
Not all of them, but most of them.
And in particular, the models that we're gonna look at,
the theories that we're gonna especially focus on today
of those, and in particular, interpersonal theory
and Fairbairn's object relations theory, those two
were very much relational theories.
And I'm using now relational with a small r.
We're not yet at the school, the relational school.
These are theories that focus on human relationality
at the center.
Now I'm gonna make, I'm just gonna make reference now
to the development of the Relational with a capital R,
the Relational with a capital R that develops in the 1980's
after this groundbreaking and watershed book in 1983.
Developed in a particular context
and a particular cultural, intellectual,
epistemological and philosophical context.
I'm not gonna be discussing this today.
It's beyond the scope of what-
But I wanna at least name some of this.
And this is on page four in the handout.
Relational Theory in the 1980's, now with a capital R,
was evolving and developing.
This was post 1960's, post Watergate.
There were changing views of authority,
very different from Victorian Viennese society.
This is post feminism with critiques of the ideal
of autonomy and separateness, and now a new prioritizing
of connectedness and relationality.
It's post Heisenberg, post modern.
There are changing views of what it means to
quote unquote know something.
There are shifts from the notion that we can hold
certainty and objective knowledge about many things
to the notion that what we think we know is much more
subjective and socially constructed.
And one other factor in the psych guides.
At this time, in the 1980's and 90's,
when these relational school was developing,
there was a revolution in infancy research,
and the discoveries of the remarkable abilities
of newborn infants and very young infants was just...
There were so many studies, one after another.
And one of the areas of study was how much was
developing from the get go about relationality
and relationships.
Even when babies can seem like
they're not so oriented yet towards the other-
When they're so little and so young,
and they seem not socially connected,
that there's more going on than what we can see and realize.
So those are some of the cultural, intellectual
and philosophical factors in the background.
Well, what is Relational Therapy?
I mean, what is it?
By the end of the course, you'll hopefully
have a lot you can say about that
added to what you already know.
I wanna start just for this moment before we launch into
the theories section, what it isn't.
Being a relational therapist, it doesn't mean one
necessarily talks more.
It doesn't mean one necessarily does an enormous amount
of self-disclosure.
These are some of the sort of stereotypes
of a relational therapist.
It doesn't mean one, it's not about being nicer,
or being more supportive.
That's not what it means.
Being relational, it's not a specific set of guidelines.
It's more a way of thinking about and understanding
and working with what's going on within our patients,
what's going on within ourselves,
what's going on within the therapeutic process,
and a way of expanding and thinking about
therapeutic options and therapeutic action.
OK, so now we're gonna move into talking about
the classical paradigm, and I wanna start by-
This is an homage to Freud, a kind of acknowledgement
of the centrality of Freud's ideas and that they
are enduring, even with all of the newer ideas
evolving in addition.
And this is a quote from Stephen Mitchell,
who was the most central founding figure
of the relational school.
Here's what Mitchell said, and he said that
psychoanalytic treatment, therapy, analysis,
would be unrecognizable without the following.
Without quote, "thinking about the mind
"in terms of unconscious processes".
And think about this list.
It's a long list of central,
crucial ideas going back to Freud.
"thinking about the mind in terms of unconscious processes,
"exploring the dialectic between present and past,
"grounding states of mind and bodily experiences,
"a careful, patient listening
"to the analysand's, or patient's, associations,
"a play in the dialectic between fantasy and reality,
"a focus on feelings about the analyst or therapist,
transference, and psychical obstacles to uncomfortable
thoughts and feelings, defense or resistance.
But these ideas remain central.
But as I said, we're gonna be also talking about
important tensions between the relational and the classical.
Let's begin with the classical.
Let's begin our story with Freud.
First I wanna just think out loud with you
about Freud in a particular way.
This is from Joseph Schwartz talks about that in a book,
Cassandra's Daughter.
What he says about Freud is he says,
if you think about Freud, I mean you can think about Freud
as somebody who developed all these revolutionary ideas
about the mind, and of course, he did.
But he also said think about Freud as an inventor.
That Freud invented a means of studying the mind
in the analytic hour, or what we now have, the therapy hour.
Explore what comes to mind.
Follow the twists and turns.
Look at the obstacles to things coming to mind.
And that the creation, the invention of the analytic
or therapeutic hour was a monumental invention.
And the way that Schwartz puts it, it's equivalent to
the discovery of the microscope for the physical sciences.
So it's just an interesting way to think about
an aspect of Freud's contributions.
But what did Freud focus his microscope on?
He focused it on the depths and intricacies
of what goes on in the human mind,
the forces and counterforces.
He focused on the study of human subjectivity,
and he developed revolutionary ideas
based on what he saw there.
And if you now turn in the handout to page eight,
and we'll go on to page eight and nine.
I've traced out some basic ideas about the
classical or Freudian paradigm, and I'm gonna
largely read through that,
adding some commentary in addition.
We are born into this world.
What's the view of human motivation?
We are born in the classical position.
We are born into this world with the imperative to satisfy
deep, primordial drives, sexual, aggressive, competitive,
seeking pleasure, the id of Freud's model.
Freud emphasized our inner world of desires
and our fears and our fantasies, and the powerful role
of these inner forces in shaping
our ways of experiencing everything.
While actual outer reality is, of course,
tremendously important in terms of the world of others,
who our parents are, who our attachments figures are
when we grow up, Freud's emphasis was on how
our inner worlds shape our ways of experiencing
our outer world throughout life.
A brief clinical vignette.
This is a child case.
This was a six-year-old boy who was brought to therapy.
He used to be a very lively younger boy,
but he became very passive at home and at school.
Listless, he stopped doing his school work,
he stopped interacting very much.
And the parents brought him for therapy,
and the parents told the therapist about
a traumatic incident, an experience
the boy had at age about four.
The boy had some medical problems,
and it required a series of abdominal procedures
that involved a lot of pain for him in his abdomen.
So he went through that for a period of time at age four.
And then at age six, he's this listless little boy.
Well, they bring him for therapy, and in the play therapy,
he's doing drawings, and in one of the drawings,
there's a drawing of a little boy, and the little boy
is peeing on another little boy in the picture.
And there's a figure of a man stabbing the boy,
the boy who's doing the peeing, stabbing him in the stomach
with a big knife.
The therapist asks the boy in the therapy
to talk about the drawing, and as they explore
what his thoughts and fantasies are
about this drawing he did, what emerged was,
and you might already be guessing this,
what emerged was, and this is very much a Freudian story,
that the boy was being punished,
he was being savagely punished by this man,
being stabbed in the stomach, the boy in the picture.
Why is he being punished?
Well, here he is performing this aggressive act
towards another little boy.
Now the boy, this patient, the boy, had a younger brother.
So the Freudian understanding and interpretation of this
is that the little boy, like all little children,
has a whole range of sexual and aggres-
sensual and sexual and aggressive kind of wishes
and wishes for pleasure and competitive wishes.
And so here he is as a four-year-old
with those feelings and desires towards various people,
including his little brother.
And then he has this experience of terrible pain
in his abdomen, as in a confused four-year-old's mind,
being committed by these adults.
So in the fantasy construction within the boy's mind
and the way he put this together, the story is
that he was being punished for his aggressiveness
towards the younger brother.
And this aggressiveness, the image in the picture,
as the boy's peeing on the littler boy, there may also,
Freudian way of thinking, there may be some confused
sort of sexualized kind of desires also in that.
But even whether you put that in there or not,
that this is a story that gets created in the fantasy
is based on his desires and wishes that are sort of
forbidden, that he's supposed to be nice
to his little brother,
but yet he has these desires, etc., etc.
And so the four-year-old boy puts together
in his fantasy life that he's being punished for being bad.
And why, how is he bad?
He's being bad for being aggressive.
So as he moves into four-, five-, six-year-old,
the oedipal phase, when he's internalizing
the super ego, into the super ego, these outer figures,
a kind of harsh super ego that's telling him
he's bad because he's aggressive.
And so he better stop being aggressive.
And so the boy starts shutting down on lots of desires
and lots of activation of his wishes and expressions
of them in the world, and he's listless.
And in the therapy, this whole fantasy construction
gets explored and worked out, and the boy is freed up
and able to go on and be an active little person again.
If you imagine this boy not having gotten any treatment,
and let's say this persisted, and let's say
he's a 30-year-old coming in for therapy,
and he's still very passive and listless,
where this whole fantasy is in the unconscious.
Then what might happen?
We can just imagine.
Say he's meeting with his therapist.
He tends to be quiet and passive and restrained.
Let's make up a little vignette.
One day he starts talking with therapist about his work,
at his job, and how he wants to get a promotion.
And there's a competitor there,
but he wants to get it over this other colleague,
and he really wants this promotion.
And then after he says this,
he starts to get anxious and quiet.
And then the therapist asks what's going on,
and then he might say,
"Oh, I don't know where this came from, but I thought,
"you know, I was just talking,
"and I thought you might getting,
"becoming distant or you might even have been
"a little irritated with me."
So that's just, that's a story that starts to develop
in the therapy relationship, where something is getting
projected in the transference onto the therapist about,
something about this person being bad
for his aggressive, whatever, wishes.
So that's a Freudian way of understanding
something about the inner world.
Even though this case involved an outer experience,
and in fact, a traumatic one, but the Freudian sensibilities
are about appreciating how it get's put together inside.
So following along on page eight in the handout.
The drive ego model.
Throughout life, our inner drivenness
continues to play a central role.
Drives, passions, desires, impulses, our id nature.
Much is unconscious, and it's shaped and tamed,
as you may be familiar with in the model,
by the ego and super ego.
And there are repressions and layers of defense.
Psychopathology or suffering or people's problems
are understood in terms of insufficiently resolved
unconscious conflicts, like our little boy.
The unconscious conflicts between his wishes
and his feelings of guilt.
Unconscious conflicts, drives, super egos, defenses, etc.,
the Freudian model.
And this creates inhibition symptoms, anxieties,
and character problems.
So if that's the way of understanding the inner world,
if that's the way of understanding
the nature of people's problems, therapeutic action.
The forbidden, deep, instinctual desires
and the inner conflicts about them
that are causing the suffering need to emerge
into consciousness to be worked through.
They emerge in free associations, dreams,
drawings, for children, play therapy.
They emerge in transference.
And as Freud famously said,
what was unconscious becomes conscious,
where id was, ego shall be.
The underlying conflicts are lifted and worked through.
Now as an aside, but an important aside,
Freud's early entree into psychoanalysis,
he started by focusing on free association,
not on transference, per se, but free association.
What's just gonna emerge in the free associations?
But one of the things that happened was that
problems emerged because sometimes patients
would feel fearful that he was gonna judge them
about whatever came out of their minds,
and they started to inhibit and shut down
and not be able to have the associations freely
or not be able to say, not want to say them,
fearing the therapist's judgment, negative transference.
And in this sense, transference looks like an obstacle.
It blocks things, it shuts things down.
But Freud, in his brilliance,
continued working with the model, and eventually
what he developed was the ways that transference,
which can, in one way, look like an obstacle,
can become a vehicle, because then what do you do?
You look at the transference itself.
You explore the patient's experience of their analyst
or therapist, and you work with that, and that becomes
one of the central inroads into the inner life
and where the problems are.
But, of course, with transference as a central aspect
of therapeutic action, there are implications of that.
How should the therapist be?
If you want the therapist to be a projective screen
upon which patients are free to project whatever,
including negative stuff, onto the therapist,
well you need a projective screen that's gonna be blank,
the blank screen model.
You don't wanna fill up the screen too much because
you wanna leave freedom, open space, for the patient
to experience and construct the therapist
from the patient's inner life.
So better start with a blank screen.
And hence Freud's three central ideas about the
therapist's stance, to be neutral, to be anonymous,
anonymous, not provide too much information
about the therapist, and abstinence, not to be
too gratifying of what the patient might want
because you want the forbidden desires to emerge.
It's like if you're hungry and you have an appetite.
If you eat, you don't experience the appetite anymore.
So the idea was something like that.
Being relatively abstinent, not being too gratifying
of what the patient might wish for in the
moment-to-moment from the therapist helps the appetites,
the wishes emerge more.
So that's a kind of overview of the Freudian model,
and if you look at page six in the handout.
We're gonna take a minute to orient towards this chart
because this combines all three paradigms,
the classical, the object and the self paradigms.
But we're now just gonna focus on the classical,
but I'm gonna take a minute
to help you orient to this chart.
It's page six of handout.
Three models of therapeutic action.
If we start with the boldface heading,
Classical Freud, at the top,
and if we go down to the middle.
The patient's problem, in this column, the classical column.
The patient's problem, driven by inner unconscious desires
that are overly conflictual.
This is just a schematic summary.
That's the nature of the patient's problem
in the classical paradigm.
If you look down in the column, therapeutic action.
Transference onto a neutral therapist,
the unconscious conflicts and desires emerge
and are interpreted and worked through and resolved.
That's a central aspect of therapeutic action.
If you look to the top of the column,
the therapist as interpreter, my term,
therapist as interpreter.
The therapist is gonna be interpreting
and helping the patient discover and work with
these inner conflicts that become visible.
Martha Stark's term is here the therapist is
a neutral drive object.
The therapist is the object of the patient's drives
and the desires and hence, this blank screen model.
So that column of this chart, that's a schematic way of
representing therapeutic action in the classical paradigm.
We'll come back to the other paradigms.
And now, to conclude about the classical paradigm,
I'm gonna trace out six themes,
six themes or dimensions about the therapist's stance
or therapist's ways of working, and I'm gonna trace out
the Freudian or classical end of these continua
around these six themes.
Later we'll come back to the corresponding relational ways
of looking at these same themes or dimensions.
But I'm gonna name the six dimensions now and just put
the Freudian part to the dimension on one side of it.
And this is on page ten of the handout.
It'll probably help if you look at that.
So the first theme or dimension, subjectivity.
This is about exploring the individual mind,
the intrapsychic world, and this was the richness
of Freud's theory.
How do you do that?
I mean, you're looking at free associations.
The associations come from the patient's mind.
There's the space in treatment to explore the interior.
This is also, subjectivity, this is also
sometimes called a one-person psychology.
We're looking at the mind of the patient.
Transference, in this subjective way of looking at it,
transference is brought.
It's brought by the patient.
The patient comes with an inner world and a readiness
to see and experience, to project that onto the therapist
and how they experience the therapist in the transference,
and that is revealed in the therapy.
Freud wrote about counter-transference, too,
in terms of also a one-person or subjective model.
He emphasized that the therapist also brings their own
inner stuff, and sometimes that gets stirred up
and can be a problem, and then the therapist needs
to get some consultation or some more treatment themselves
in order to work with that.
But the transference is brought by the patient.
Counter-transference is brought by the therapist.
This is the subjective model.
Number two, the talking cure, therapy as the talking cure.
It's about interpretation,
verbal interpretation and insight.
Communication from the therapist is informative.
It's to help inform the patient about their inner life.
And it's an archaelogical model.
In the talking cure, the idea is you,
through interpretation and insight, were unearthing
archaelogically, deeper layers of where
the problems are in the psyche.
The third dimension, analytic restraint or discipline.
This was what I referred to before, neutrality,
anonymity and abstinence.
Another term here is optimal frustration.
That's what I said about abstinence.
You don't wanna gratify too much because you want
the patient's desires to be there
and to be felt by the patient and to emerge.
But restraint or discipline for the therapist.
The fourth dimension on this side of it is asymmetry.
The therapeutic relationship has asymmetries.
From any school of thought, that's true.
In the original, sort of classical stance,
classical position, the emphasis was on
the patient free associates and the therapist interprets.
That's an asymmetry.
Another asymmetry in the original Freudian ideas,
about authority and knowledge, that the therapist
speaks from a position of authority and knowledge.
And we'll see, there's other ways to look at this
in the relational thinking.
Another asymmetry, the therapist sets the frame
about time, about costs, about the fee.
Another aspect of asymmetry, which is true in any therapy,
is the priority is obviously on the patient's welfare
and well-being and growth.
But in any case, asymmetries within the relationship.
The fifth and sixth points, dimensions, relate to-
I'm gonna use a phrase to preface them.
It's used by Steven Stern in an article he wrote
that had in the title "needed and repeated relationships".
I like that.
Needed relationships and repeated relationships.
So first, what about repeated relationships?
This is the fifth dimension of these dimensions.
Actually, I already covered this.
This is about the transference.
The idea that the repetition, the patient's experience
of something being repeated in the therapy relationship
is generated from the patient's internal world.
That's the nature of the repetition.
With an engaged but neutral therapist.
The sixth theme, needed relationship with the therapist.
What about the needed aspects in the therapy relationship?
In a classical model, that's more of a background factor.
The way Otto Kernberg once put it was,
empathy is important, but empathy
is a precondition for treatment.
He didn't see empathy, when he was speaking about this,
he didn't see empathy itself as so much a curative factor.
It's a precondition, and that the classical model
tends to look at the interpretation and the insight
and the working out of the transference
as the therapeutic action, not things like empathy,
not the needed aspects of a relationship.
So we're now, now we're gonna really shift.
We're gonna come into the emergence of relational theory,
and I'm gonna be talking about the other two paradigms.
But the emergence of relationality
within the other paradigms.
Freud focused his microscope, as I said, on the study
of human subjectivity, the intrapsychic world,
not on intersubjectivity.
And I'm gonna use the terms relational and
intersubjective interchangeably as I speak.
And these weave throughout different theorists
in the object and self paradigms in differing degrees.
First, what does intersubjectivity mean?
One way it's been defined by Natterson and Friedman,
quote, "Intersubjectivity is the over-arching term
"that refers to the reciprocal influence of the conscious
"and unconscious subjectivities of two people
"in a relationship."
Let me read that again.
"Intersubjectivity is the over-arching term
"that refers to the reciprocal influence of the conscious
"and unconscious subjectivities of two people
"in a relationship."
This is different from, by the way, if you're familiar,
some of you may have familiarity with other very different,
and legitimate, but different ways of defining
and using the term intersubjectivity.
Stolorow has a whole school of thought
that's called intersubjectivity.
Benjamin develops really rich ideas,
Jessica Benjamin about intersubjectivity.
Daniel Stern uses the term.
But I'm meaning it differently than any of those.
I'm meaning it in the way that I'm talking about now.
An intersubjective view of the child's development.
Now this is shifting from a focus
more towards the intrapsychic view.
An intersubjective view of the child's development.
That it's shaped by not only what goes on inside
the psyche and soma of the child, but also what goes on
inside the parent or attachment figure, and what goes on
in the interplay within the child
and within the parent or attachment figure.
It's this rich view of interplay between what's going on
in the insides of each.
It includes the descriptions of their interpersonal
behaviors and interactions, you know,
like what would be on the video, but it's broader.
It's the unconscious and unconscious influences.
It's played out very subtly in the flow of verbal
and nonverbal communications, emotions,
contours of nervous system activation,
all sorts of back and forth flow
of synchronies and dyssynchronies.
The conscious and unconscious influence.
Now that was about a child's development
and it's attachment figures.
There's an exact parallel for an intersubjective view
of what goes on in therapy, in the therapy relationship.
That it's not only about what goes on inside the psyche
and soma of the patient,
but also what goes on inside the therapist,
about the interplay between what's going on
inside the patient and within the therapist.
It includes the easily observable behavioral interactions,
and it includes all those more subtle
interpersonal influences.
And as all of the paradigms developed and emerged,
there's increasing emphasis
on the intersubjective dimension.
This is the relational with a small r, and there's been
a whole relational turn in all of psychoanalysis,
including contemporary classical thinkers,
Freudian thinkers.
There's been a relational turn that is emphasizing
more of this in all the schools of thought.
But coming back to tracing out what we're doing.
Let me orient you now, this is now...
I wanna look together at a chart on page five.
And we're gonna take a few minutes looking at this
to orient to it.
It's a little, there are a lot of lines,
a lot of names and a lot of lines on it.
This is psychodynamic theories,
the theoretical and historical overview.
And some of this is what we've been speaking about,
but this chart really builds in a more complex way
what I introduced in the very beginning
about the different paradigms.
First, if you look across at the boldface at the top,
Drive, Ego, Object, Self.
Oh and by the way, there should be a line drawn
between drive and ego.
They're so connected to each other.
Between the word drive and ego there should be a line.
Drive and ego, the classical paradigm, and Freud,
Sigmund Freud and others, OK.
Object.
If you start where the boldface object at the top,
the object paradigm, there are lots of lines
coming out of object.
Let's trace out a few of them.
Just play with this a little bit to make sense of it.
For example, look at the line that goes down to Klein,
down towards the left, from object to Klein, Melanie Klein.
And there's a line from Klein, if you trace it out,
also up to drive.
Melanie Klein, the founding mother
of object relations theories.
Major, major figure in object relations theories.
The first major figure.
But her thinking was still very much influenced
by a drive paradigm, so she's kind of a hybrid
of object and drive paradigms.
But if you look at the lines coming down from object
to interpersonal theory, Sullivan and to Fairbairn.
Gun trip.
Let's talk about those two lines.
The line from object to interpersonal
and object to Fairbairn.
Interpersonal and Fairbairn don't have any other
connecting lines above.
They are purely, what I would call purely in this paradigm,
about relationality.
Most radically about relationality.
Really moving away from the notion of drive
as a central aspect of human nature.
And those two theorists, if you trace the lines downward,
they go towards Relational, now Relational with a capital R,
Relational theories.
From interpersonal and Fairbairn down to Relational.
That's why we're gonna talk about them in some detail.
If you look over on the right, the self paradigm
in boldface, there's a line that goes down to Kohut,
self psychology and connections there to relational theories
because relational theories do incorporate
much from Kohut.
I'm not gonna go through all the intricacies
of this diagram.
We won't have time to go through all of this today.
There's a separate online course that I do
on the object relations theorists.
On Klein, Fairbairn and Winnicott.
It's a whole separate course, and so we won't have time
to go into all of those theorists today.
Winnicott also, there are important ways that
Winnicott connects with relational theories too,
but that's beyond what we can talk about today.
OK, so that's, hopefully that chart will really help
kind of keep the theories from swimming all together,
and kind of a frame for how they flow into one another.
So turning now, we're gonna shift
from the classical paradigm.
Now we're gonna talk about the object paradigm.
And you can still refer to page five.
That just orients you to what we're talking about.
A radically relational view...
Let's talk about a radically relational view
of human development.
I'll talk about Fairbairn for a moment.
Fairbairn.
The infant completely-
He's a real revolutionary thinker for his time.
The infant, and this, we're talking about human nature.
The infant is not pleasure-seeking primarily.
The infant is, as he put it, object-seeking,
seeking the object, the other, the attachment figure.
Seeking contact and connection.
The infant wants the object of its love to love it,
and it wants the object of its love to accept its love.
Fairbairn developed a whole model of human psychology
where the infant develops an inner world
that is based on the internalizations
of interactions with attachment figures.
And now I'm gonna read a quote from Stephen Mitchell
talking about Fairbairn that expresses this beautifully.
Here's Mitchell on Fairbairn,
and I'm gonna read an extended quote.
It's one of my favorite quotes
in really all of psychoanalytic literature.
"Libido-
the sort of motivational energy,
"Libido is not pleasure-seeking", he, Fairbairn, argues,
"but object seeking.
"The superordinate need of the child is not for pleasure
"or need gratification, but for an intense relationship
"with another person.
"If the caretaker provides opportunities
"for pleasurable experiences, pleasure is sought,
"not as an end in itself, but as a vehicle
"for interactions with others.
"If-
now on the other hand,
"If only painful experiences are provided,
"the child does not give up and look for
"pleasurable experiences elsewhere, but the child
"seeks the pain as a vehicle for interaction
"with significant others."
That's a really radical idea.
"It is the contact, not the pleasure, which is primary.
"In Fairbairn's view, the central motivation
"in human experience is the seeking out and maintaining
"of an intense emotional bond with another person.
"If we start with that premise, the adhesiveness
"of early relationships and early modes of gratification
"and the ubiquity of the painful redundancies,
"of the repetition compulsion seem less puzzling.
"Painful feelings, self-destructive relationships,
"self-sabotaging situations, are recreated throughout life
"as vehicles for the perpetuation
"of early ties to significant others."
This is why we repeat patterns,
even though they're self-defeating or painful.
Mitchell goes on,
"The child learns a mode of connection,
"a way into the human family, and these learned modes
"are desperately maintained throughout life.
"In some families, sensuality is the preferred mode
"of emotional contact.
"In others, it is rageful explosions.
"In others, depressive longings.
"In Fairbairn's system, it is precisely
"the patient's character pathology to which the child
"becomes most compulsively connected
"and which he internalizes because it is there he feels
"the parents reside emotionally."
That's a radical idea, connecting specifically with
the characters problems of the parent.
Mitchell goes on,
"By becoming like the depressed, masochistic
"or sadistic parents, he, the child,
"preserves a powerful bond to them.
"Thus, in Fairbairn's system, at the core of the repressed
"is not a trauma, a memory or an impulse,
"but a relationship, a part of the self
"in close identification with a representation
"of actual caretakers which could not be contained
"in awareness and in continuity
"with other experiences of the self,
"so it becomes unconscious.
"To abandon these bonds and entanglements is experienced
"as the equivalent of casting oneself off
"from intense human contact altogether,
"an impossible option.
"Thus, patients in analysis or therapy,
"who are beginning to sense the possibility
"of living and experiencing themselves and their worlds
"in a different way are genuinely terrified
"of profound isolation."
Change can be frightening.
"To be different, even if that means being open
"to joyfulness and real intimacy with others,
"means losing ties to internal objects which have provided
"an enduring sense of belonging and connectedness,
"although mediated through actual pain and desolation."
That's, I think, a beautiful description
of the essence of what Fairbairn's relational,
with a small r, relational model was about.
Let's talk a little bit about Sullivan
and interpersonal theory, which is, as I said earlier,
in some ways the most contributing theory directly
to the formation of the relational school.
Sullivan, very much in line with Fairbairn,
radically different views of the inner world
than the Freudian view.
Here are quotes from Irwin Hirsch about Sullivan.
Quote, "Individual development and unconscious processes
"are based primarily on internalized and elaborated
"real experiences with significant others."
Another statement about interpersonal.
"Problems arise-
to talk about people's problems,
"Problems arise.
"Their identifications with troubled caregivers.
"Their anxieties-
the caregivers,
"and the child's attempt to adapt
"to the requirements of the caregivers."
If you turn to the handout on page 12 now,
I'm gonna partly read through that.
And these are some over-arching ideas
about the most relational core of the object paradigm
as we've heard about in Fairbairn and Sullivan.
We are born into this world, now human motivation,
with the imperatives to relate and connect to
attachment figures, regardless of how good or bad they are.
This is a sort of schematic.
It's reviewing some of what I said.
We're born with the imperatives to form internal
psychic structures based on these early experiences
of self in relation to others.
Internalizations and identifications in our inner worlds
based on these experiences.
And we have the imperative or motivation to sustain these
internally in order to sustain an internal connection.
So we have these internal configurations of self with other.
Psychic structure.
Now we're not talking about like id, ego, super ego.
We're talking about a different way of looking at structure.
Multiple configurations.
Configurations, templates, schemas, of self and others
imbued with certain specific relational themes or narratives
and certain emotional tones.
Different theorists and models
have different names for these.
Attachment theory calls them internal working models.
Klein has internal objects.
There's self and object representations.
There are different languages, but these ideas
of these internal templates or configurations.
Psychic structures serve as organizing framework
for how we experience and live our lives.
And there are two principles, just as Piaget
talked about them, assimilation and accommodation.
We have these inner templates, and so our new experiences,
moment-to-moment, we assimilate into existing frameworks
and templates and interpret things into them.
So our ways of experiencing things are shaped
by the templates, but if there's enough that's discrepant
and under certain conditions, the templates themselves
will revise, which in the Piagetian language
is accommodation.
What's the understanding in this model
of psychopathology or people's problems?
Continue on page 13 in the handout.
In early relationships, it's pathology, either pathology
of the attachment figures and/or problems
in the attachment relationships that are highlighted.
They become structuralized in the psyche of the child.
They become incorporated into the deep core
of these narrative configurations of self and other
and relational themes.
So then, there are these problematic, internalized schemas,
and that's what causes the problems later in life
because these schemas organize self-experience,
they organize experience of relationships,
and they organize how we engage or don't engage with others.
So psychopathology, in terms of these
internal configurations, one can be trapped
within overly confining and limiting narratives.
The narratives internally, themselves.
There can be configurations that are so much
in conflict with each other that it causes problems.
Different configurations of self and other.
Different stories that are too much in conflict.
There can be problems of excessive dissociation.
These are overlapping, some of these ideas.
Irreconcilable or poorly integrated configurations.
So one lives exclusively in one configuration
and can't connect with others, getting stuck.
What's the view of therapeutic action?
Now let's turn to therapy.
First I'll talk about Sullivan
and the interpersonal school.
And this is all gonna be extremely relevant
for the relational school on therapy.
Sullivan, the 1920's, 1930's, and the interpersonalists.
Three things to say here about Sullivan.
Two of them are radical, and one was conservative.
Radical for his day.
The first was, rather than looking at the therapist
as separate from the patient, the sort of, the interpreter,
the blank screen and the interpreter of what's going on
in the patient's subjective mind,
Sullivan talked about the therapist
as a participant observer, not just an observer,
and that the participation in the relationship
was part of the therapeutic process.
And with two ideas here, that the observer is part of
what's therapeutic, and also that the observer
affects what they observe.
I mean, this was post Heisenberg,
the idea that the active observing something,
observing a person, you influence them.
So the therapist is part and parcel of it,
in the participation.
And another aspect, Sullivan focused a lot on interactions.
He would do detailed inquiry with patients about
who said what to who and then,
and it was because he felt that through the interactions,
that's where the person's unconscious life would come alive
and emerge and could be worked with, is through interaction.
But the third point, which is the conservative one.
He focused away from the interactions
and the relationship with the therapist,
with like Sullivan himself with his patients.
He worked a lot with some people who were very fragile,
very disturbed people, so one thought was that this was
part of his way of helping modulate, help things
not get too intense and overwhelming.
But in any case, he tried to stay out of the fray
and sit, sort of metaphorically and literally
a bit side by side, looking out at the patient's world
with them, talking about their relationships out there.
This changed, though, as the interpersonal school evolved
past Sullivan, particularly Eric Frome.
What a major impact.
The participation aspect, and the therapist patient
relationship aspect, comes to the center
in the interpersonal school.
One shift in terminology, I think Hirsch said it,
from participant observer of Sullivan,
to observing participant.
The participation part is highlighted more.
In terms of Eric Frome,
think like encounter groups of the 1960's,
but in this case, a group of two in a therapy relationship.
An intense, existential human encounter.
Two people engaged in authentic, intimate interaction.
If the image of the Freudian therapist is sitting back
and neutral and reflective and interpreting, the Frome style
of therapist, the interpersonalist, is leaning forward,
nose to nose, engaged in an intense interpersonal encounter.
But, importantly, this is analytic.
Also reflecting and analyzing on what emerges
and comes out of the interaction.
That's what's worked with analytically, and interpreted.
And again, interpreting the ongoing internal ties
to early caregivers, early caretakers,
that's not conscious to the patient, but is being lived out.
To help the patient see how they are organizing
contemporary life and relationships to conform
to past configurations, which is a quote by Barnett.
An especially radical aspect of this, the therapist
now may at times share counter-transferential reactions,
how they are affected by the patient.
Why?
Because how the patient is affecting
the therapist's experience may reflect some
disavowed aspects of the patient's inner world.
So it's part of the analytic process.
And enactment is really right at the center here,
and we're gonna have a whole part of the seminar today
on enactment, specifically, where the therapists
gets drawn into repetitions.
One way, Levinson, an interpersonalist, said this is,
if the Freudian therapist asks, like,
what's going on inside you, the patient, Levinson asks,
so what's going on around here?
What's going on in this room, in this space,
in this relationship?
How can we work with this to help understand
the process here and understand the inner world
and work with the inner world of the patient.
The interaction is analyzed.
Another paraphrase of Levinson.
Treatment is what is said about what's been done.
So it's about what's already happening
and being done in the relationship.
And just to, as an overview of therapeutic action
in this model, you can refer to page 14 in the handout.
I'm gonna read through that.
Therapeutic action.
This is again in the object paradigm,
particularly Sullivan, Fairbairn.
What happens, various configurations of the patient's
internal world are engaged in the therapy.
And enactment, a central way to bring to life
and to work with these configurations,
and what better place than in therapy to have that happen?
Living out old dead end narratives,
old repetitives narratives.
But therapist and patient, after getting stuck for a time,
must get unstuck and find their way to new resolutions
within the therapeutic relationship.
This is a central aspect of therapeutic action
in this paradigm.
These new revisions to old internal narratives,
the old internal narratives evolved in the
therapeutic relationship, but the new revisions
are worked out intersubjectively in the relationship,
and that becomes internalized.
And the result is accommodation.
The result is revision, addition, elaboration and revision
of the patient's internal subject-
internal relational world, these internal configurations
by virtue of what's been worked out, old stories being
worked out in new ways in the therapeutic relationship.
Insight is a part of this process, an important part
and it consolidates growth, but there's a lot else
that's important in terms of the relational
working out of things in this paradigm.
And now, if you refer back to page six of the handout,
this is a familiar chart, it's one we looked at.
Because we're gonna pause now and just look at this chart
because now we've talked about the classical paradigm.
We went through the column on the classical paradigm
in the chart before.
This is three models of therapeutic action.
We talked about the classical.
Now, if you look in the third column now,
the third column is a sort of schematic or a brief statement
of the model of therapeutic action for this object paradigm.
I put relational on top, but for this paradigm.
If you start in the middle, under relational, interpersonal,
object relations, Fairbairn,
that column, start in the middle.
The patient's problems are understood as the internal world-
I'm repeating, but this is just to put it together.
The patient's problems are understood as the internal world
of self and others, multiple narrative schemas,
or configurations, that are overly problematic
or overly malevolent themes, or they're too irreconcilable
with each other, the different narratives.
But these narratives are what organize
how we live and experience life.
And they were internalized from early on
from relational patterns.
What's the therapeutic action?
Enactment in the therapy relationship, down below,
enactment in the therapy relationship of central
internal organizing narratives of self and other.
Therapist and patient co-create new resolutions
to old stuck narratives.
New relational experience is internalized then,
and the inner world of the patient is revised.
If you look at the top of that column,
the therapist as co-actor, in my language.
Stark calls it the therapist as authentic subject.
That's like Eric Frome, the therapist as
an authentic subject in this interpersonal encounter,
who also is involved in analying and interpreting,
but is an authentic subject.
So that, we've now gone through that whole diagram
to just summarize two of these three paradigms.
And now what we're gonna do now is turn
to the third paradigm, to the self paradigm,
and I'll ask you to refer to page 15 of the handout.
That will help as I talk about this paradigm.
Actually, we'll just read through
the first page of that together.
Now again, these all start the same, right?
We are born into this world with.
We're talking about what's the inate, inately human,
about human motivation, the essence of our motivation.
We are born into this world with, in this case,
the self paradigm, inate personal potentials
and proclivities.
A kind of potential self, a nuclear program for a self
that needs to be facilitated for its emergence.
It's not we're born into this world to seek pleasure.
And it's not we're born into this world to seek contact,
like Fairbairn.
We're born into this world with this kind of
inate set of proclivities that want to emerge and develop
and give expression to them.
It's the imperative towards the self's
emergence and evolution.
Relationally speaking, there are specific needs
for types of support from others.
Kohut calls it, refers to self objects,
but specific needs for types of support
to support this self's development.
Well in this view, what's the view
of the patient's problems?
People's suffering and problems?
When the early environment failed to be good enough
to nurture this development, if there are excessive
impingements and failures by the environment,
impingements is a Winnicottian term,
impingements and failures by the environment
that happen too early-
I mean, there are failures all the time.
I mean, there are lots of ways as babies and young children
we feel failed by our attachment figures in moments,
you know, but also we get, there's the mixture
of little mini failures and then when we feel supported
in our expression of self and development.
But when the impingements and failures are too early,
too intense, too chronic, too traumatic,
then the baby and child have to adapt too much
to the failing environment, and these excessive failures
become structuralized internally
in the development of the self.
There are arrests or derailments
in the development and unfolding of this self.
The self structure is vulnerable
or has deficiencies or fault lines.
The person becomes prone often to poor regulation of emotions
and self-esteem, impaired capacity for self soothing.
And there's, in these sort of self models
where there's a deficit in the self,
in the ways that people experience themselves,
there's a lack of feeling of cohesion, cohesiveness,
or a lack of continuity, or a lack of vitality,
or a lack of authenticity.
In other words, people feel poorly integrated,
or they feel disjointed and unstable,
or they feel deadened and depleted,
or they feel false, like imposters.
Those are the ways that these self models
would talk about, would describe people's problems
and talk about it in terms of this inner self structure
and how the environmental failures led to problems
in this inner structure of self.
Now if we turn to therapeutic action in this model.
Because with all these models, right,
the view of human nature, what flows out of that
is the view of what causes people's problems
and the view of therapeutic action.
Within each paradigm there's a cohesiveness
among these factors.
Now we're turning to therapeutic action
in the self paradigm.
And the model here, it's a provision model of therapy.
And this is on page 16 of the handout.
Archaic needs, or early needs, are reactivated,
but this time sufficiently met in the therapy relationship.
There's a provision of, I'll use the phrase I used before,
the needed relationship in therapy.
Empathy here is a central factor in therapeutic action.
It's not a background factor or a precursor.
Important also are the repair of relational attunement
when inevitable ruptures occur in the therapy relationship.
And in this whole process of this provision model,
there's a healing of damaged aspects of this self structure
and the self resumes its development.
Some specific theorists, you know Kohut is the theorist
most closely associated with this paradigm.
He had a very particular model about how he talked about
aspects of the self.
I'm not gonna get into all of that.
And particular forms that the self objects,
or the parental figures, have to meet the needs of the baby,
and the therapist has to meet the needs sufficiently
of the patient.
If you're familiar with it, there's a whole
conceptual language of mirroring and idealizing
that's a part of the provision, but I'm not gonna go
into detail about that.
Winnicott also, although Winnicott is
an object relations theorist,
the earlier paradigm we talked about, the object paradigm,
there are a lot of aspects of his theory
that also blend with the self paradigm.
In my chart on page five with all the, that tree,
Winnicott has lines both to object and self 'cause Winnicott
talks a lot about true self, false self, self development.
So those two theorists both have important
connections to this self paradigm.
Now if we turn back to page six again, the same,
we're going back to the same chart in the handout
of models of therapeutic action,
we're now ready to complete this chart.
We've talked about the classical, the first column,
the classical Freud.
We've talked about the relational interpersonal object,
the third column.
Now we're looking at the middle column,
which is the self paradigm that I just talked about.
Starting in the middle of that column,
the patient's problems are understood in terms of
a self structure that's fragmented, vulnerable, deficient.
There are fault lines due to arrested or derailed
development because early needs were poorly met.
That's what I've been saying.
That just summarizes that.
That's the nature of the patient's problems in this model.
Therapeutic action follows from the view of the problems.
Provision, down below, same column,
provision of the needed relationship.
Early needs are reactivated and met well enough this time.
Healing of the damaged self and resumed development.
And if you look at the top of that column, the therapist as,
my term here is nurturer, Stark calls it
empathic self object.
So now that chart puts together in a very summarized form
all of what we've talked about.
And if you just think about just the therapist,
the top line, the classical model,
the therapist as interpreter, the blank screen,
projective screen, and the interpreter.
The middle column, the self paradigm,
the therapist as nurturer.
And the third column, the object paradigm,
the therapist as co-actor.
Interpreter, nurturer and co-actor.
That's three different aspects that are
emphasized differently in the different models.
Next I'm going to take a break from theory.
That was a lot.
That was the big push for developing the theoretical ideas.
And now that we've talked about the three paradigms
and the ways in which-
We've set the stage for how they're gonna contribute
to the central theoretical ideas for Relational,
with a capital R, the Relational school,
what we're focused on today.
We're gonna take a break from theory, though.
I'm gonna present a case, a man I'm gonna call Bill,
and talk about this case.
And then when I talk about central ideas of
Relational school, the Relational theory,
the case will be there as a live kind of illustration
and elaboration of some of the ideas
that I'll be developing.