Journal of Analytical Psychology, 2002, 47, 339–358
A cacophony of theories:
contributions towards a story-based
understanding of analytic treatments
Soren R. Ekstrom, New York
Abstract: The article addresses problems associated with analytic formulations from
the founders of psychoanalysis, including C. G. Jung. Although no longer able to claim
a scientific basis for these theoretical constructs, analytic practitioners still use this
outdated terminology when presenting their work with patients. By now there is a
cacophony of theories often concealing rather than explaining. Denial of loneliness,
notions of special knowledge, and idealization of the ‘The Founder’ seem to perpetuate
formulations which no longer carry a clear meaning. The article explores three proposals
for describing analytic treatments based on the works of the psychoanalyst Roy Schafer
and the cognitive psychologist Roger Schank: analytic attitudes, therapeutic narratives
and specific treatment perspectives. The first addresses findings from psychotherapy
research about the centrality of analytic attitudes. The second applies the findings about
story-based memory and narratives to therapy relationships, and the third takes note of
the fact that analytic attention often is more complex than can be described with terms
such as transference/countertransference.
Key words: analytic attitudes, cognitive psychology, concealment, dyadic descriptions,
narratives, scientific validity, story-based memory, theoretical formulations.
In this article I will explore why, as practitioners of psychoanalytically oriented
therapies, we reuse and reinvent often outdated theoretical constructs to
describe what we do. In the second part of the paper, I will also offer some ways
to recognize more precisely the basic dyadic nature of therapeutic interactions.
Rarely used with patients, analytic concepts become the main focus when
we present our work to the public or our colleagues. On these occasions,
we turn into defenders of jargon particular to the institute in which we were
trained, the analysts we trained with, and, most of all, the jargon of some
prominent founder of analysis, whether it be Freud, Jung, Klein, or Kohut.
By now, what we are dealing with is a cacophony of theories, all claiming to
explain the inner workings of the patient’s psyche.
Proponents of psychoanalysis – psychoanalysis proper so to speak – have
long insisted that the politically correct theoretical constructs had a scientific
0021–8774/2002/4703/339
© 2002, The Society of Analytical Psychology
Published by Blackwell Publishers Ltd, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
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basis. By adhering to ‘proven’ formulations, analytic cure was simply procedural. By the same logic, by following the not so politically correct theories,
from less infallible sources, only inferior treatments could follow.
Today we are left with the sobering realization that many of Freud’s theories
have been proven wrong and others are impossible to verify (Bornstein 2001).
It may still be possible to test some of Freud’s hypotheses, not by using data
from analytic therapies, but by controlled studies in non-analytic settings
(Flanagan 1984; Grunbaum 1993). From being viewed as a science at the forefront of the exploration of the human mind, psychoanalysis is increasingly
seen as an artful practice which rests on whatever outcomes can be established
by factorial analysis of sampled therapies (Miller, Luborsky et al. 1993). The
theories are, at best, regarded as historically important but antiquated.
The same is also true for all the other ‘infallible’ schools of thought. Although
much less attention has been directed towards scientific claims in the works of
Jung, Jungians may have felt some initial Schadenfreude when the scientific
claims by Freud were beginning to fall apart. After all, the Jungian paradigm
had been dismissed as one of those ‘unscientific’ and thus inferior theories
(Kernberg 1980; Leavy 1980).
There is some irony in this, since, in contrast to Freud, Jung began his career
by doing psychiatric research which at the time was both innovative and groundbreaking (Ellenberger 1970). Freud for one understood how valuable this
work was when he invited Jung into his circle, only to find that Jung had tired
of working for a large teaching hospital with a chronic patient population.
There can be no doubt, however, that Jung continued to see himself as a
researcher, long after leaving his hospital position and devoting himself exclusively to his own private analytic practice. Even late in his career, he would
speak of his therapies as research situations, claiming his experiences with
certain patients as proof for his theories (Jung 1937).
On other occasions, when it seemed more suitable to be iconoclastic, he
would express discouragement about ever confirming his theoretical edifice. In
those instances, he would instead appeal to the human striving towards spiritual
fulfilment and become the social critic pointing to the dire consequences of
modern man losing his sense of the life’s religious dimension (Jung 1961).
In spite of Jung’s undogmatic stance towards theory, holding on to the
founder’s formulations is no less of a problem among those practising analysis
with a Jungian background. Attempts to maintain philosophical purity continue
to burden our institutes and societies with self-destructive arguments about
what is the ‘true’ Jungian understanding of the psyche; critical assessments are
all too rare (Eisold 2001).
A language of promises
Why, as analytic practitioners, we continue to use the language of the
pioneers, long after it has lost its lustre and scientific credibility, may be
A cacophony of theories
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explained in several ways, all of which leads us back to the early days of
analysis:
1. The persistence of the pioneering approach of formulating general theory
instead of developing a language describing the particulars of what happened
in the treatment situation (Bornstein 2001).
2. A clinging to the theories of the pioneers since their formulations are
assumed responsible for the success of psychoanalysis.
3. A reluctance to admit that during the training to become an analyst the
promises of certain curative formulas never fully materialized.
In hindsight, the first generations of analysts made the mistake of assuming
that they could formulate a reliable theory to explain the causes for psychological disorders. In order to give credibility to what they discovered with their
patients, they theorized in broad terms, always with the intra-psychic
dynamics of the patient in mind. The result was a set of generalizations instead
of a language describing what happened in their therapies (Schafer 1976).
What they left us with, as a consequence, is a language that in the extreme
describes patients as inhabiting monadic bubbles; on the one hand, they are
supposed to be driven by an unconscious which only the analyst, as the expert,
has access to; on the other, they are thought capable of the most outrageous
distortions in how they view the analyst, the person with whom they are in
dialogue.
This language is descriptively weak, one-sided, and non-relational. At least
implicitly, it is condescending towards the patient. It seldom describes any direct
person-to-person interactions and instead it espouses to prove laws of general
psychology on the basis of very thin inductions (Cloninger 1996).
The following are some of the exaggerated and questionable claims that
have been made about analytic treatments:
– that the psychopathology of a patient can be determined from the type of
transference we think they exhibit. Knowledge of this particular psychopathological classification system is what matters (Freud 1923; Greenson 1967,
pp. 51–6);
– that the stories patients tell us of being abused, molested, or raped are solely
based on fantasy and wish fulfilment, not worthy of critical investigation
(Jung 1912; Freud 1914 [see also Herman 1992, chap. 1]);
– that, whether they know it or not, all patients struggle with conflicts
between the desire for incest and the fear of castration (Freud 1924);
– that patients who write down their dreams and ‘introvert’ will become healthy
because we point out that their dreams consist of meaningful and religious
symbols (Jung 1952);
– that we cure patients by offering to re-parent them, based on the perceived
needs of babies, even when they become more and more regressed and
dependent on us (Winnicott 1960).
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The perseverance of the founders
Even when admitting that these are outdated theories, the language of the
pioneers perseveres. Their theories are assumed responsible for the success of
psychoanalysis, when, in fact, the success is due to the thousands and thousands of successful treatments conducted by anonymous practitioners and
their willing patients. After all, these patients were the ones who allowed
analysis to develop, not as a scientific theory, but as a unique approach for
treating individuals willing to seek help for their problems (Luborsky et al.
1988).
The charm of the founders’ lofty language is particularly seductive when in
psychoanalytic training. It was probably the writings of one of the founders
that brought today’s practitioners into training. The institutes responsible for
their education, on the other hand, were not looking to supply personal transformations but finding new members and increased status of the existing ones.
While in training, the outdated theoretical frameworks are reinforced rather
than questioned. And when analytic training fails in all other aspects, it succeeds
in indoctrinating, often via its language. In fact, those who fail to become
competent, critical, and open-minded clinicians seem most vulnerable to the
indoctrination. As a result, there is nothing more difficult, more taboo, than
to confront the doctrinaire views of our colleagues (Bornstein 2001).
By many accounts, institute training is today under tremendous pressure
to change or become anachronistic. Based on interviews with 150 American
psychoanalysts, Douglas Kirsner (2000), in his book Unfree Association,
concludes that the communality which is supposed to be fostered in institute
training has been destroyed. He writes:
The claim to knowledge implied by qualification is far greater than the real level
of knowledge … A major aspect of this problem … is that a basically humanistic
discipline has conceived and touted itself as a positivistic science while organizing
itself institutionally as a religion.
(Kirsner 2000, pp. 32–3)
Theory as concealment
The main problem with theory, in other words, is that it easily serves as a
means to conceal. As analysts, in focusing on theory instead of relational
data, we ignore the fact that our theories will depend on whom we see, where
in a treatment we are and what the patient brings into the relational mix.
Without considering overarching theoretical implications, we may come to
new hypotheses at any point in a treatment. And at any point, new avenues
for explaining our involvement may open up. We are not testing theory but,
rather, we are recalling our own experiences and our own stories in order to
be understanding.
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Three particular ways of concealing stand out:
1. Theory as a denial of a particular form of loneliness that is intrinsic to the
profession.
2. Theory in the service of idealizing ‘The Founder’ and creating a sense of
being part of a lineage going back to the originator, the cultural hero.
3. Theory as a way to maintain that we have special knowledge which makes
us know everything about our patients.
By ‘intrinsic loneliness’ I mean that one of the great paradoxes of our profession is that we have to use ourselves, our histories, our vulnerabilities, and our
capacities to relate, without being able to be ourselves. This inevitably leads
to a sense of separateness and social isolation. At the same time, we have the
same need to relate to others what we do as any other profession. But the
intimate nature of the relationship to the persons seeking our help, and
the intimate nature of what they bring into each session, make this need so
much more complex than for others who are consulted for their expertise.
We cannot tell our friends about what has been revealed to us. According
to American law, everything that happens in the therapy belongs to the
patient, even our mistakes and slip-ups (Moline et al. 1998). So outside the
consulting room, we can only use generalizations to show how we are useful
and how we provide meaningful assistance.
However, we hide behind theory even when it clearly has nothing to do with
protecting the patient. In writing about our cases, instead of speaking of how
we notice certain inter-relational patterns developing – as much initiated by
ourselves, the analysts, as by our patients – we use worn terms, such as transference, resistance and regression, in order to appear detached and in control.
Our own role in the formation of the therapy relationships is one of the things
that disappears as soon as we begin theorizing (Plaut 1999).
One unfortunate consequence of this type of concealment is rigid adherence
to an analytic school. The school of analysis that we will adhere to is usually
the one where we trained and had our personal experience of the support
and acceptance that therapy can offer. It is therefore no surprise that the
label attached to this school takes on a particularly charged meaning. Soon,
often against our better knowledge, we are willing to claim its superiority over
all others, without much outcome data for a comparison (Allphin 1999).
Arguments about theory thus become a way to conceal our need for personal
recognition, projected onto an institution, a school of thought, or the professional group we identify with. Its recognition is what seems to matter to us. Lost
is the one unique resource which, more than any other, is needed in effectively
helping our patients: secure access to our own personal world of associations,
memories, emotions.
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The all-knowing doctor
Our theories also support the illusion that we have everything in our grasp
(Frank & Frank 1991). So when we describe our work with patients, it tends
to be done in a manner that supports this all-knowingness. We claim to know
their histories, their pathologies, their secret strivings, and their defences.
In reality, there are a great many things we do not know, either because
we forgot about them, they were withheld, or because we assumed to know
them.
It is in the nature of what we do to form all kinds of hypotheses about our
patients, some of which later turn out to be groundless. The temptation, when
faced with the uncertainty of such hypothesizing, is to fall back on the terms
the founders coined. Clinging to the notion that they constitute a special
knowledge, only available to those who have our particular kind of training,
may restore a dubious sense of competence. Meanwhile, we tend to accuse
other schools of analysis of being cults and of blindly holding on to the faulty
ideas of their founder (Kirsner 2001).
The fact is that all analytic institutes and societies are very exclusive. Not
that what we do is particularly secret, but it takes years of training and considerable financial sacrifice to become an analyst. In this sense our societies are
no more cults than alumni associations of a university or trade associations for
certain businesses. Once a member of a professional group, there is a natural
need to defend this personal investment (Frank & Frank 1991).
The elusive search for method
The task of better describing psychoanalytic treatments, without falling back
on outdated and ill-suited terminology, must begin with finding a language for
what we do which focuses on the attitudes of analysts and the expressions they
take. Research into psychotherapy outcome, projects by people such as Hans
Strupp and Lester Luborsky (Strupp & Binder 1984; Miller, Luborsky et al.
1993) have begun this process towards an ideologically neutral language
in which the dyadic nature of analytic therapies is recognized as a series of
relational interactions.
In describing the experiences of the Penn Project, Luborsky and his team
found five factors as particularly relevant when looking at the outcome with
groups of patients (Luborsky et al. 1988, p. 271):
1.
2.
3.
4.
5.
The patient’s experience of a helping alliance
The therapist’s ability to understand the patient
The patient’s level of self-understanding
The patient’s decrease in the pervasiveness of conflicts
The therapist’s as well as the patient’s ability to assist in internalizing
gains.
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These factors are pretty much stripped of any ideological or theoretical formulations and it is clear from the Luborsky team’s comments that no particular
measure, before or after treatment, predicts outcome (1988, p. 310).
This view is shared by Edward Teyber and Faith McClure (2001), two
psychotherapy researchers from California State University, San Bernadino, in
the most recent Handbook of Psychological Change. They write:
… It is time to drop the uniformity myth and better address the contribution of the
individual therapist to treatment outcome. Comparative studies of psychotherapy
outcome consistently find that therapy modalities are relatively equivalent in effecting client change. In contrast, there is considerable support for the view that the
individual therapist’s attributes, attitudes, and actions (e.g., interpersonal skills,
countertransference propensities, and personality) match or override the effect of
particular techniques.
(Teyber & McClure 2001, p. 80)
This conclusion comes after many years of trying to find the one approach
which is most effective (Wallerstein 2001). Fanciful theoretical formulations,
as well as recommended techniques, may imply certain attitudes. They do not
capture what happens in a successful treatment, or an unsuccessful one, for
that matter.
Instead, what the psychotherapy research is telling us is that we need to
de-emphasize hypothetical explanations as far as possible. What skews descriptions, and makes the clinical material seem mistreated, is letting adherence to
a theory be forced onto the clinical data.
In my discussion of analytic attitudes I will not pretend to know the variables
at work in specific therapies. I am assuming that the attitudes manifesting in
psychoanalytic treatments are so innumerable that we can as well think of
them as limitless. This is perhaps what makes meaningful research so difficult;
the variables which contribute to what happens in a given relational dyad are
difficult, if not impossible, to control (Haage & Stiles 2001).
The work on a descriptive language began in the late 70s by Roy Schafer
(1976). Inspired by the philosophical ideas of Witgenstein, he tried to develop
a new language for psychoanalysis based on the actions it tries to describe. The
resulting attempt was interesting as an exercise, but Schafer seemed to have
been too indebted to Freud’s drive theory to notice that without a clearly relational perspective the action language he proposed remained uni-directional.
I am suggesting that we let relational terms replace the various analytic concepts rather than translate metapsychology into clinical language. For instance:
– Transference/countertransference can be described as a particular relational
pattern. In so doing, we are naturally forced to think in terms of a dyadic
interaction.
– Such a relational pattern is going to differ markedly among analysts and
depend on many factors, but by describing our understanding of it in each
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analytic dyad, we avoid using concepts which no longer have any agreed
upon meaning.
If we examine a parental transference, a parent/child pattern, many factors
contribute to the resulting attitude of the analyst (I am consciously leaving out
the patient’s attitude):
a) the analyst’s own experience of being parented and a parent;
b) the analyst’s ability to access these experiences, both those from childhood
and those learned from raising children;
c) the context in which these transference/countertransference patterns emerge;
d) the analyst’s understanding of the particulars of these patterns.
Other aspects of how we approach a given relational situation may be gleaned
from the psychoanalytic literature. Among them:
– focusing on the here-and-now;
– empathically eliciting reactions to similar feelings in the past;
– confronting the patient’s distorted views by interpreting his or her transference reactions.
Typology, the basis for the Myers-Briggs Type Indicator (Briggs & Myers
1979), in certain Jungian circles has been used to describe attitudes which
manifest in the analytic dyad. The analyst may explain complications in the
communication with a patient on the basis of a comparison with his or her
type and the patient’s (Quenck & Quenck 1982).
The problem with this approach is that it ignores the fact that as analysts
we will experience different relational patterns with each patient. We are seldom
true to our ‘type’ as it may appear in a type survey. Far more than we want to
admit, the powerful impact of transference and countertransference is going to
determine how we interact in a certain relationship, even in a certain phase of
it (Beebe 1984). In many instances our attempts to identify with a type will
only serve defensive purposes.
In a recent article in this journal, Joseph Cambray (2001) compares the
use of the techniques of enactments, on the one hand, and amplification, on
the other. The former is an approach described by psychoanalytic writers,
the latter an approach described by Jungians. One of Cambray’s conclusions
is that the use of these techniques is determined by subjective factors which
become conscious only after the fact. However, the attitude present in a particular situation is poorly described by using the analytic terms, be it the more
Freudian enactments or the Jungian amplification. In theory, however, both
techniques carry objective connotations.
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The fallacies of technique
As clinicians we seem, on the one hand, to exhibit rather stable attitudes in
many clinical situations. We tend to think of these attitudes as being based
on established therapeutic techniques. The fact of the matter is that we are still
dealing with personal attitudes with a great deal of variance between clinicians
(Teyber & McClure 2001). However, we may safely assume that these attitudes
were formed in situations to which repeated exposure had occurred.
It seems likely that, when we begin practising, stable clinical attitudes
conform to the particular paradigm in which we had our training. Later in our
professional lives, such attitudes may become more eclectic as we explore the
value of other types of approaches on our own (Mahoney 2001). On the other
hand, we also respond in much less stable and expected ways in a range of
treatment situations. Some of these responses do not stay in our memory for
very long, as supervisory experiences certainly show. Others seem to compel
reflection and the need for further understanding. Cambray (2001) shows that
such new attitudes emerge every day in our practices and relate to experiences
which we are eager to process since they carry a particular significance to
ourselves in a particular treatment.
At the point of reflecting on them, by note taking or otherwise, we are only
interested in understanding what just occurred. However, at some point we also
seek to place experiences of new attitudes within our previously established
understanding. Whether by modifying a previous understanding or adding new
elements to it, we are constantly seeking to expand our ability to understand.
What we are dealing with, in other words, is a rather complex learning
process. Simply in order to remember what occurs in a given therapy session,
we need to develop narratives. As analysts, this is the major part of the ongoing
process of doing therapy. But our particular responses, our analytic attitudes,
and the expressions we have for them, seem to need more than receptivity and
processing what we hear. And this is where theory comes into the picture. Only
when later naming our responses, do they become legitimized as techniques
and separated from our continuously developing narratives of each therapy
involvement.
This is where the danger of descriptively poor theories comes in. In naming
our responses to fit established theory, they no longer remain particular to a
therapy interaction. They have lost their relational context and terms which
imply unattainable empirical certainty easily take over.
Narratives instead of theories
By focusing on attitudes as the situational element in the analyst’s responses,
I think we will be able to produce more authentic descriptions of what
occurred in a given treatment. I also think that we will maintain a better understanding of the narrative nature of our work with patients, the next focus for
this article.
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Analytic formulations are attempting to describe several stories: the analyst’s
story, the patient’s story, and the analyst’s condensed version of previous
encounters, the latter serving as the template for what could be expected to
happen. The three narratives are fundamentally different, however. While the
first two relate to a specific treatment, the third is general in nature but helps
shape the first two, although in different ways.
Recent research into how memory is structured, particularly story-based
memory, suggests that narratives aid us when it comes to remembering and
making meaning of what happened. They also aid us when it comes to understanding other people’s stories.
According to Roger Schank (1990) of Northwestern University, in his book
Tell Me a Story, much of what is needed to manage daily living is remembered
in stories. Creating stories is the most efficient way to remember a large number of events. By fitting them into a story and making intelligent use of indexes
to it, far more than the simple event-based storage is possible. The more complex the data and decisions, the more we have to make new stories or update
old ones. He writes:
We need to tell someone else a story that describes our experience because the
process of creating the story also creates the memory structure that will contain
the gist of the story for the rest of our lives. Talking is remembering. It seems odd,
at first, that this should be true … But telling a story isn’t rehearsal, it is creation.
The act of creating is a memorable experience in itself.
(Schank 1990, p. 115)
As a highly selective process, story creation involves condensing of experiences
into ‘a story-size chunk that can be told in a reasonable amount of time’
(Schank 1990, p. 115). In so doing, not only can the number of events be much
smaller, the original experiences now have coherence. Furthermore, once a
story is created we can reuse it. This in turn makes reconstruction of missing
or loosely connected details easier than creating a new story each time.
These conclusions are echoed by those who study narratives in literature.
According to Jonathan Culler, a scholar in comparative literature, by studying
basic narratives, we can demonstrate the centrality of literary structures to
the organization of experience (1981, p. 215). The logic of story is something
which applies to most events in our lives. He writes:
Scientific explanation makes sense of things by placing them under laws – whenever
a and b obtains, c will occur – but life is generally not like that. It follows not a
scientific logic of cause and effect but the logic of story, where to understand is to
conceive of how one thing leads to another, how something might have come about:
how Maggie ended up selling software in Singapore, how George’s father came to
give him a car.
(Culler 1997, pp. 83–4)
In defining narrative, Culler proposes that it is the structure which underlies
any particular instance of presenting a series of events. Accordingly, he defines
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a narrative as ‘the representation of a series of events’. Once these events have
been identified, they become ‘a non-discursive, non-textual given, something
which exists prior to and independent of narrative presentation and which the
narrative then reports’ (Culler 1981, p. 171).
The distinction between discursive versions of a narrative makes it clear that
every analytic treatment is a many-faceted and complex story, a therapeutic
narrative retelling of the patient’s life from several angles.
The analyst’s stories
Stories, then, involve how we listen to someone else’s stories. Listening means
reviewing our own private storage of stories in order to find a fitting response.
How well we understand patients will greatly depend on how they perceive the
stories we retrieve in response to theirs. Our own stories are the basis for how
we interpret the stories of others. Schank (1990) proposes that this retrieval
occurs by extracting indices, in other words, the labels attached to the original
story. New indices are created each time the expected fails to occur (Schank
1982).
In this perspective, psychoanalysts are persons who train themselves to label
their own stories in such a way that they will be able to be perceived as understanding the stories of others. The analyst’s version of a treatment, accordingly, begins with wishing to remember, to hold on to the information, verbal
as well as non-verbal, that the patient supplies. In order to do so, the analyst’s
stories have to be used and reused. With each treatment, the analyst gains
further indexing to his or her stories.
According to this understanding, the capacity to listen analytically begins
in our personal analysis. It is here that we first told many of the stories later
to be reused when listening to the stories of patients. Our first patients in turn
made us create new story indices. Work with our training supervisors added
yet others.
Our stories are our way of remembering from session to session and of processing what happened with a particular patient. Every new patient activates
several of these stories and forces us to create yet another. The search for
fitting stories takes place in the initial phase of each treatment. As soon we
have them, we can also begin the creation of a story that is particular to the
person – and a relationship is established.
Without searching through a mental warehouse of stories, mostly old cases
but also our ongoing experiences outside the practice, we would not be able
to understand and relate. But we need a plot line, a narrative template, a story
skeleton, to organize all this material. And it is here that our favourite theories
come in handy, whether they come from case presentations, technique formulations, or from formulations by the pioneers. What we call theory is in fact our
own personal compilation from all these sources; it becomes a template for
what to expect that we can reuse.
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As stories these compilations, what Schank (1990) calls ‘story skeletons’, are
rather general, but they provide us with ways to validate what we are doing.
That the names we give them often are borrowed from one or several scientific
disciplines – biology, social psychology, neuroscience, etc – may not make them
more reliable, but the more scientifically sounding, the more believable they
may feel.
The patient’s stories
The patient’s story, on the other hand, begins with a different set of wishes. In
the end it may have a similar organization to that of the analyst, but patients
are from the beginning cast in the role of having to be the story-teller. With
this role comes the desire to please which means the telling of old stories, those
based on failure, rejection, and despair, not the ones which they favour and
find meaningful (Ulanov 1982). If the first set of stories feels understood, the
patient can begin to tell those stories which have the most personal meaning,
stories which concern his or her personal sense of self.
But successful therapy depends on the creation of a cohesive new story, a
story which can span over a longer time and encompass previously unintegrated memory. The inability to remember and make connections means that
the sense of self never becomes embodied (Covington 1995). So inevitably, the
patient is placed in the uncomfortable role of having to create a new story
from many old ones, previously seen as unrelated or non-existent.
For this process to occur, the analyst’s contribution is badly needed to let it
all fall into place. In the end, a story emerges, not of helplessness and pain, but
of having been understood and having overcome the problems which seem to
dominate at the beginning of the treatment. An entirely new sense of purpose and
perspective has been reached. The patient’s efforts to index his or her stories
have led to a narrative understanding of his or her life.
The therapeutic narrative
Robert Winer (1994), who first coined the term ‘therapeutic narrative’, has
focused on the case report as a particular product of the analyst’s story. The
case report, he argues, must be assumed to be co-authored. However, it can
never be about particular patients, only about particular treatments since
neither party in the analytic dyad can claim absolute and certain knowledge.
Winer writes:
When we consider treatment as a two-person process, the field becomes immensely
more complex. Every treatment becomes unique in a way that greatly exceeds the
uniqueness of individuals … We discover that our personhood is both more and less
stable than we thought. Furthermore, to write about our work from a two-person
point of view requires far greater personal exposure than the traditional one-person
perspective demands.
(Winer 1994, p. 15)
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James Hillman (1983), relying on the work of narratologist Northrop Frye
(1971), comes to similar conclusions. He proposes that case histories should
be seen as a particular genre of fiction. The genre is an offspring of the heroic
tale of overcoming obstacles, thus ego psychology. He writes:
Have we produced ego psychology through our way of writing cases? And are our
case histories not so much empirical demonstrations of the way the psyche works
but empirical demonstrations of the way that poiesis works in organizing our vision?
(Hillman 1983, p. 21)
To Hillman, then, case histories are not mere accounts of what happened. The
way we write about them determines theory, since their plots, their underpinnings are what make them so persuasive, so seductive. The value of case
reports is how they fictionalize and make meaning; reading them, in Hillman’s
words, is ‘the gift of finding oneself in myth’ (1983, p. 22).
While the analyst’s case reporting is fiction, it is also, at the same time, a
peculiar fiction. The events described are not made up, they are not fiction, but
something that did occur (Winer 1994). We are acutely aware of this fact, even
when we are drawn into the story-telling, ‘fictional’ aspect of a report.
The fictional basis for case reporting may in fact be related to the analyst’s
story skeleton which Schank (1990) describes. As a condensed version of previous treatments, its function is to predict, to be a template for what could be
expected to happen and as such it clearly influences what is being reported.
The need to update this template may explain the fervour, noticed by Hillman
(1983), with which we write these reports. The case report is our way, as analysts,
to create stories for what we wish to remember and to hone our existing stories.
Theory as stories
Not only are case reports another version of an already existing narrative.
Work by Schafer (1981), Spence (1982), Hillman (1983), Sharpe (1987),
Hanly (1992), and Covington (1995), just to mention a few, have established
that our treasured theories are stories as well, stories we are loathe to give up
once we have created our own version of them.
Closely examined, Freud’s classical conflict theory is a narrative and so is
Self psychology. So are the Jungian approaches such as archetypal amplifications and a prospective understanding of dreams.
As early as 1979, at a symposium on narratives held at the University of
Chicago, Schafer translated Freud’s theories into stories. He found that they
consisted of two, one of the beast, the other of the machine. The beast is the
story of how the infant or the ‘id’ becomes domesticated, tamed by the frustrations of having to grow up into a civilized world away from nature. The machine
story, on the other hand, is Freud’s metapsychology, transmitted through the
physiological and neuroanatomical laboratories of the nineteenth century.
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According to this tale, the mind is a closed system, an apparatus which needs
the force of instincts to function (Schafer 1981, pp. 26–9).
Schafer argues that these archetypal stories have been, what he calls ‘mythologically enshrined’ (p. 28), but other psychoanalytic variants have also developed
over the years. This seems to prove that we are dealing with narratives. He
writes:
That Freud’s beast and machine are indeed narrative structures and are not dictated
by the data is shown by the fact that other psychoanalysts have developed their own
accounts, each with a more or less different beginning, course, and ending.
(Schafer 1981, p. 29)
Self psychology, as developed by Heinz Kohut, tells of a child driven to actualize a cohesive self in spite of being hampered by damages from the empathic
failures of its caretakers. And object relations theory, as developed by Melanie
Klein, is a story of a child ‘in some stage of recovery from a rageful infantile
psychosis at the breast’ (ibid., p. 29).
If we add Jung to this description, we may say that one of his stories is of
a child’s hidden wisdom and secret connection to God and how via dreams
and visions its search for eternal life is revealed (Jung 1961). His other story,
transmitted via ethnographic images of what was regarded as ‘the primitives’,
is more intellectually based. In it, the savage in us all, longing for redemption,
struggles against the civilized European with his rationalism and sense of moral
superiority.
Treatment perspectives
So far I have focused on the relational aspects of what we do as analysts, on
our responsiveness and how we maintain it, develop it, and describe it. But
there are times when responses to a patient’s immediate situation are not our
primary focus.
In the beginning of a treatment, for instance, analysts work on establishing
a mandate. We may call this ‘intake’, ‘establishing a treatment plan’ or ‘finding a working alliance’. We need to have a descriptive language also for this
activity because it constitutes the beginning of our analytic narratives. What is
established in the beginning of a treatment becomes the terms, the rules of the
game, to which we come back as the particular therapeutic narratives develop.
Secondly, the purpose of treatment is psychological change. We know that
such change is a process and our aim is to facilitate this process. At many
junctures in a treatment, the process of change becomes a major focus between
the patient and us. This also means that our treatment narratives rely on how
we view this process: as a heroic struggle to become free, a ritual for removing
disease or an initiation into wisdom? Whichever plot we ascribe to this process,
we think of it as having its stations, its challenges, its dangers.
A cacophony of theories
353
When using passages from the great pioneers, from Freud, Jung, Klein,
Winnicott, and others, we often forget to place them in a context. Quotes from
the masters can be used as justifications for a variety of approaches, in a variety
of treatment situations. Tied to particular hypothetical goals, they soon become
admonitions for what ought to happen: sublimation, individuation, rational
living, etc. But how do these abstract goals reconcile with the particular mandate we have with the patient and with his or her process of change?
My point is that we have at least three different perspectives on what is
happening with our patients:
1. The therapeutic mandate, with its initial complaint, its psychiatric history
and particular psychopathology needing to be addressed.
2. The process of change, with its beginning and end, its important turning
points, its dangerous passages, etc.
3. The analytic relationship, with its particular patterns of relating and reliving
of familial relationships, patterns we call transference and countertransference.
The first category, the therapeutic mandate, may seem the most obvious one,
but psychoanalytic literature has a history of dealing rather parsimoniously
with how it becomes part of the treatment as a whole. As the term ‘mandate’
suggests, the outcome of any therapy is largely determined by how well analyst
and patient find an understanding of what can and what needs to be done in
their work together. A mandate is based on the understanding negotiated, on
an ongoing basis, between analyst and patient and it more or less precludes the
prescribed goals inherent in theory.
The issue here is not only the patient’s psychopathology. The mandate depends,
first and foremost, on the analyst’s ability to articulate what reasonably can be
expected and to continue such communication in the ongoing work with a
particular patient. To meet this need, the analyst has to have a language which
includes what may be relevant to the patient so that he or she can comfortably
be engaged in the work.
The second category, formulations about the process of change, tends to
stress movements and development, from regression to progression, from dissociation to integration. Traditional recommendations, accordingly, focus on
how to keep the process moving and how to let its various parts evolve into a
whole by having a full and explanatory narrative. But the same recommendations also describe the process of change as if it had nothing to do with the
mandate and all to do with ‘the transference’, as if the patient’s contribution
to the relational pattern is all that matters – while the analyst is merely the
score keeper.
The third category, finally, is really about relational patterns between analysts
and patients. Reviewing the analytic literature about transference/countertransference, several patterns stand out. There are the original descriptions of
the transference by Freud (1895), which are about a father–daughter pattern
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between analyst and patient. This pattern is extended into a father–son pattern
in Freud’s subsequent writings. Then we have the marriage pattern in Jung’s
(1945) ‘The psychology of the transference’, which he calls ‘the coniunctio’.
With the emergence of object relations theory we also have the mother–child
pattern, and finally, in the writings of Heinz Kohut, the more generic self–
selfobject pattern (Ekstrom 1995).
At least descriptively, distinctions between these three activities will help to
produce clarity without unnecessary theorizing.
Concluding remarks
I have tried to show how much of the psychoanalytic theory (and I include
analytical psychology) still being used is based on outdated terms. Its formulations belong to a past when analysis seemed to offer a scientific understanding far beyond what occurs in the consulting room.
I have also outlined three approaches to better describe what happens in
analytic psychotherapy. All three make confusing theoretical formulations
obsolete or, at least, secondary. Instead the approaches suggested have as their
starting point the recognition that analytic therapies are dyadic endeavours
producing unique relational interplays.
The article maintains that the only meaningful way to describe therapy
interactions is as two-way communication: as patient narratives, analyst narratives and, more tentatively, as therapeutic narratives. My suggestions for the
development of the latter include:
1. To de-emphasize hypothetical explanations and instead find common
formats for describing the relational events experienced with patients.
2. To give special attention to what we remember when the expected fails to
occur and how new attitudes are incorporated from it.
3. To truly embrace the fact that the understanding of our patients’ lives is
story-based: we have to use our own stories when we listen to theirs and
when we respond to them.
4. To recognize that, as analysts, we not only observe relational patterns between
our patients and ourselves, we also negotiate a therapeutic mandate and we
experience the effects of trying to facilitate each patient’s process of change.
As described in the beginning of the article, the most likely reason for holding
on to outdated theories is that they conceal some pretty painful aspects of our
profession: loneliness, blind loyalty, and arrogance among them. But is reluctance to deal with these problems enough of a reason to continue to use
outdated theories? Hopefully not.
A cacophony of theories
355
TRANSLATIONS
OF
ABSTRACT
Stat’ se věnuje problému° m spojeným s analytickými formulacemi od dob zakladatelu°
psychoanalýzy, mezi které patří i C. G. Jung. Ačkoli již není možné trvat na vědecké
bázi těchto teoretických konstruktu° , analytici při prezentaci svých případu° stále
používají zastaralou terminologii. V současnosti kakofonie teorií často spíše zastírá než
objasňuje. Odmítání osamocenosti, představa jedinečné znalosti a idealizace ‘Velkých
Zakladatelu° ’ chrání formulace, které nadále nemají jasný smysl. Stat’ zkoumá tři
návrhy popisu analytické léčby vycházející z díla psychoanalytika Roye Schafera a
kognitivního psychologa Rogera Schanka: analytický postoj, terapeutické příběhy a
specifické léčebné perspektivy. První se vztahuje k závěru° m výzkumu psychoterapie,
který zkoumal ústřední význam analytického postoje. Druhý se týká závěru° zkoumání
příběhové základny paměti a vyprávění v terapeutickém vztahu. Třetí si všímá
skutečnosti, že analytická pozornost je často komplexnější, než jak mohou vystihnout
výrazy jako přenos a protipřenos.
L’article se penche sur les problèmes soulevés par les formulations analytiques utilisées
par les fondateurs de la psychanalyse, y compris C. G. Jung. Bien que ne pouvant plus
prétendre que ces constructions théoriques aient une base scientifique valable, les praticiens
de l’analyse continuent à utiliser cette terminologie dépassée lorsqu’ils présentent leur
travail avec leurs patients. Ce qui donne de nos jours une cacaphonie de théories qui
empêche de voir au lieu d’expliciter.
Le refus de la solitude, la notion de connaissance spéciale, et l’idéalisation des
‘fondateurs’ semblent perpétuer des formulations qui ne véhiculent plus une signification claire. L’article explore trois axes pour la description des traitements analytiques
se basant sur les travaux du psychanalyste Roy Schafer et du psychologue cognitiviste
Roger Schank: les attitudes analytiques, les récits dans la thérapie, et des perspectives
de traitement spécifique. Le premier concerne les découvertes dans la recherche sur la
psychothérapie relatives à l’importance des attitudes analytiques. Le deuxième met en
rapport les découvertes sur la mémoire et les récits de l’histoire avec les relations thérapeutiques. Et le troisième met l’accent sur le fait que l’attention analytique est souvent
plus complexe que ce qui est décrit par des termes tels que transfert/contre-transfert.
Die Arbeitsgruppe untersuchte, warum wir theoretische Konstrukte wiederverwenden
und neu erfinden, um zu beschreiben, was wir tun. Unsere Theorien können nicht mehr
für sich in Anspruch nehmen, auf wissenschaftlicher Gewißheit zu basieren, wie die
Pioniere in unserem Feld das gehofft hatten. Wir hängen immer noch an ihren Konzepten
und Zielen und nehmen an, daß wir die richitgen Antworten hätten, ob wir nun
Freudianer, Kleinianer oder einer anderen analytischen Schule zugehörig sind. Unsere
Theorien sind zu Mitteln des Verbergens geworden. Ich schlage eine Einteilung in drei
Formen des Verbergens vor: Verleugnung von Einsamkeit, Vorstellungen von
besonderem Wissen, und Idealisierung des ‘Gründers’. Alle drei dienen zur
Perpetuierung von Formulierungen, die nicht länger eine klare Bedeutung tragen. Statt
theoretische Formulierungen als wissenschaftliche anzusprechen, untersucht die
Arbeitsgruppe drei Vorschläge, basierend auf den Arbeiten von Roy Schafer, Robert
Winer und Roger Schank: analytische Haltungen, therapeutische Narrative und
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spezielle Behandlungsperspektiven. Ich werde zur Diskussion stellen, was diese Ansätze
anzubieten haben.
L’articolo si riferisce ai problemi associati con formulazioni analitiche da parte
dei fondatori, compreso C. G. Jung. Sebbene non più in grado di sostenere una base
scientifica per questi costrutti teorici, quando presentano i loro casi clinici gli analisti
ancora usano una terminologia datata. Tuttora vi è una cacofonia di teorie che spesso
confondono, più che spiegare. Negazione della solitudine, idee di conoscenze speciali,
idealizzazione del Fondatore sembrano perpetuare formulazioni che non sorreggono
più un significato chiaro. L’articolo considera tre proposte per descrivere le terapie
analitiche basate sui lavori dello psicoanalista Roy Schafer e dello psicologo cognitivista
Roger Schank: attitudini analitiche, narrazioni terapeutiche e prospettive di terapie
specifiche. Il primo si riferisce alle scoperte della ricerca psicoterapica sulla centralità
dell’attitudine analitica. Il secondo applica alle relazioni analitiche le scoperte che derivano
dalla memoria storica o dalle narrazioni, e il terzo tiene conto del fatto che l’attenzione
analitica è spesso molto più complessa di quanto possa essere descritta con termini
quali transfer-controtransfert.
Este taller explora por que re-usamos y re-inventamos constructos teóricos para
describir lo que hacemos. Nuestras teorías pueden ya reclamar que están basadas en
la evidencia científica como los pioneros de nuestro campo desearon. Sin embrago
nos aferramos a sus conceptos y puntos de vista, asumiendo que tenemos la respuesta
adecuada, no importa si somos Freudianos, Kleinianos, o pertenecemos a cualquier
otra escuela analítica. Nuestras teorías se han convertido en vehículos del
ocultamiento. Sugiero para este oscurecimiento: Negación de la soledad, tener la idea
de poseer un conocimiento especial e idealización del Fundador. Cada una de las tres
sirve para perpetuar fórmulas que ya no aportan un entendimiento claro. En lugar de
acercarnos a formulaciones teóricas como científicas el taller explora tres propuestas
basadas en los trabajos de Roy Shafer, Robert Winer y Roger Shank: actitudes analíticas,
A cacophony of theories
357
narrativas terapéuticas y perspectivas terapéuticas específicas. Abriré la discusión sobre
que tienen que aportar estoas aproximaciones.
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