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 신현근 박사 강의안 - 정신분석적 성격 진단  
첨부파일 : f1_20161122195021.pdf
 

과목:  진단과 평가

주제:  정신분석적 성격 진단

내용:  강의안 (Psychoanalytic Character Diagnosis)

교재Williams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd Ed.). New York: Guilford Press.

 

1.       OVERVIEW

1.1.    Classical psychoanalytic theory approached personality in two different ways, each deriving from an early model of individual development.

1.2.    In the era of Freud’s original drive theory, an attempt was made to understand personality on the basis of fixation (At what early maturational phase is this person psychologically stuck?).

1.3.    Later, with the development of ego psychology, character was conceived as expressing the operation of particular styles of defense (What are this person’s typical ways of avoiding anxiety?). This second way of understanding character was not in conflict with the first; it provided a different set of ideas and metaphors for comprehending what was meant by a type of personality, and it added to the concepts of drive theory certain assumptions about how we each develop our characteristic adaptive and defensive patterns.

 

2.       CLASSICAL FREUDIAN DRIVE THEORY AND ITS DEVELOPMENTAL TILT

2.1.    Freud’s original theory of personality development was a biologically derived model that stressed the centrality of instinctual processes and construed human beings as passing through an orderly progression of bodily preoccupations from oral to anal to phallic and genital concerns.

2.2.    Freud theorized that in infancy and early childhood, the person’s natural dispositions concern basic survival issues, which are experienced at first in a deeply sensual way via nursing and the mother’s other activities with the infant’s body and later in the child’s fantasy life about birth and death and the sexual tie between his or her parents.

2.3.    Drive theory postulated that if a child is either overfrustrated or overgratified at an early psychosexual stage (as per the interaction of the child’s constitutional endowment and the parents’ responsiveness), he or she would become “fixated” on the issues of that stage.

2.4.    Character was seen as expressing the long-term effects of this fixation: If an adult man had a depressive personality, it was theorized that he had been either neglected or overindulged in his first year and a half or so (the oral phase of development); if he was obsessional, it was inferred that there had been problems between roughly 1 ½ and 3 (the anal phase); if he was hysterical, he had met either rejection or overstimulating seductiveness, or both, between about 3 and 6, when the child’s interest has turned to the genitals andsexuality (the “phallic” phase, in Freud’s male-oriented language, the later part of which came to be known as the “oedipal” phase because the sexual competition issues and associated fantasies characteristic of that stage parallel the themes in the ancient Greek story of Oedipus). It was not uncommon in the early days of the psychoanalytic movement to hear someone referred to as having an oral, anal, or phallic character.

2.5.    In the 1950s and 1960s, Erik Erikson’s reformulation of the psychosexual stages according to the interpersonal and intrapsychic tasks of each phase received considerable attention.

2.5.1.Although Erikson’s work (e.g., 1950) is usually seen as in the ego psychology tradition, his developmental stage theory echoes many assumptions in Freud’s drive model.

2.5.2.One of Erikson’s most appealing additions toFreudian theory was his renaming of the stages in an effort to modify Freud’s biologism.

2.5.3.The oral phase became understood by its condition of total dependency in which the establishment of basic trust (or lack of trust) is at stake.

2.5.4.The anal phase was conceptualized as involving the attainment of autonomy (or, if poorly navigated, of shame and doubt). The prototypical struggle of this phase might be the mastery of toilet functions, as Freud had stressed, but it also involves a vast range of issues relevant to the child’s learning self-control and coming to terms with the expectations of the family and the larger society.

2.5.5.The oedipal phase was seen as a critical time for developing a sense of basic efficacy (“ initiative vs. guilt”) and a sense of pleasure in identification with one’s love objects.

 

3.       EGO PSYCHOLOGY

3.1.    With the publication of The Ego and the Id (1923), Freud introduced his structural model, launching a new theoretical era. Analystsshifted their interest from the contents of the unconscious to the processes by which those contents are kept out of consciousness.

3.2.    Arlow and Brenner (1964) have argued cogently for the greater explanatory power of the structural theory, but there were also practical clinical reasons for therapists to welcome the changes of focus from id to ego and from deeply unconscious material to the wishes, fears, and fantasies that are closer to consciousness and accessible if one works with the defensive functions of a patient’s ego

3.3.    The “id” was the term Freud used for the part of the mind that contains primitive drives, impulses, prerational strivings, wish– fear combinations, and fantasies.

3.3.1. It seeks only immediate gratification and is totally “selfish,” operating according to the pleasure principle.

3.3.2.Cognitively, it is preverbal, expressing itself in images and symbols.

3.3.3.It is also prelogical, having no concept of time, mortality, limitation, or the impossibility that opposites can coexist.

3.3.4. Freud called this archaic kind of cognition, which survives in the language of dreams, jokes, and hallucinations, “primary process” thought.

3.3.5.Contemporary neuroscientists might locate the id in the amygdala, the ancient part of the brain involved in primitive emotional functioning.

3.3.5.

3.3.6.The id is entirely unconscious. Its existence and power can, however, be inferred from derivatives, such as thoughts, acts, and emotions.

3.4.    The “ego” was Freud’s name for a set of functions that adapt to life’s exigencies, finding ways that are acceptable within one’s family and culture to handle id strivings.

3.4.1.It develops continuously throughout one’s lifetime but most rapidly in childhood, starting in earliest infancy (Hartmann, 1958).

3.4.2.The Freudian ego operates according to the reality principle and is the seedbed of sequential, logical, reality-oriented cognition or “secondary process” thought.

3.4.3.It thus mediates between the demands of the id and the constraints of reality and ethics.

3.4.4.It has both conscious and unconscious aspects. The conscious ones are similar to what most of us mean when we use the term “self” or “I,” while the unconscious aspects include defensive processes like repression, displacement, rationalization, and sublimation.

3.4.5.The concept of the ego is relatively compatible with contemporary knowledge of the prefrontal cortex and its functions.

3.5.    With the structural theory, analytic therapists had a new language for making sense of some kinds of character pathology; namely, that we all develop ego defenses that are adaptive within our particular childhood setting but that may turn out to be maladaptive later in the larger world.

3.5.1.An important aspect of this model for both diagnosis and therapy is the portrayal of the ego as having a range of operations, from deeply unconscious (e.g., a powerful reaction of denial to emotionally disturbing events) to fully conscious.

3.5.2.During psychoanalytic treatment, it was noted, the “observing ego,” the part of the patient’s self that is conscious and rational and can comment on emotional experience, allies with the therapist to understand the total self together, while the “experiencing ego” holds a more visceral sense of what is going on in the therapy relationship.

3.5.3.This “therapeutic split in the ego” (Sterba, 1934) was seen as a necessary condition of effective therapy.

3.5.4.Observation of the presence or absence of an observing ego became of paramount diagnostic value, because the existence of a symptom or problem that is dystonic (alien) to the observing ego was found to be treatable much faster than a similar-looking problem that the patient had never regarded as noteworthy.

3.6.    The basic role of the ego in perceiving and adapting to reality is the source of the phrase “ego strength,” meaning a person’s capacity to acknowledge reality, even when it is extremely unpleasant, without resorting to more primitive defenses such as denial (Bellak, Hurvich, & Gediman, 1973).

3.6.1.Over the years of the development of psychoanalytic clinical theory, a distinction emerged between the more archaic and the more mature defenses, the former characterized by the psychological avoidance or radical distortion of disturbing facts of life, and the latter involving more of an accommodation to reality (Vaillant, 1992; Vaillant, Bond, & Vaillant, 1986).

3.7.    Another clinical contribution of the ego psychology movement was the conclusion that psychological health involves not only having mature defenses but also being able to use a variety of defenses (cf. D. Shapiro, 1965).

3.7.1.Concepts like “rigidity” of personality and “character armor” (W. Reich, 1933) express this idea that mental health has something to do with emotional flexibility.

3.8.    Freud coined the term “superego” for the part of the self that oversees things, especially from a moral perspective.

3.8.1.Roughly synonymous with “conscience,” the superego is the part of the self that congratulates us for doing our best and criticizes us when we fall short of our own standards.

3.8.2.It is a part of the ego, although it is often felt as a separate internal voice.

3.8.3.Freud believed that the superego was formed mainly during the oedipal period, through identification with parental values, but most contemporary analysts regard it as originating much earlier, in primitive infantile notions of good and bad.

3.9.    The superego is, like the ego from which it arises, partly conscious and partly unconscious.

3.9.1.Again, the assessment of whether an inappropriately punitive superego is experienced by the patient as ego alien or ego syntonic was eventually understood to have important prognostic implications.

3.9.2.The client who announces that she is evil because she has had bad thoughts about her father has a significantly different psychology from the one who reports that a part of her seems to feel she is evil when she entertains such thoughts.

3.9.3.Both may be depressive, self-attacking people, but the magnitude of the first woman’s problem is so much greater than that of the second that it was considered to warrant a different level of classification.

3.10.                     There was considerable clinical benefit to the development of the concept of the superego.

3.10.1.    Therapy went beyond simply trying to make conscious what had been unconscious.

3.10.2.    The therapist and client could view their work as also involving superego repair.

3.10.3.     A common therapeutic aim, especially throughout the early 20th century, when many middle-class adults had been reared in ways that fostered unduly harsh superegos, was helping one’s patients reevaluate overly stringent moral standards (e.g., antisexual strictures or internal chastisement for thoughts, feelings, and fantasies that are not put into action).

3.10.4.    Psychoanalysis as a movement— and Freud as a person— was emphatically not hedonistic, but the taming of tyrannical superegos was one of its frequent goals.

3.10.5.    We were learning that efforts to expose the operations of the id, to bring a person’s unconscious life into the light of day, have little therapeutic benefit if the patient regards such illumination as exposing his or her personal depravity.

3.11.                     Ego psychology’s achievement in describing processes that are now subsumed under the general rubric of “defense” is centrally relevant to character diagnosis.

3.11.1.    Just as we may attempt to understand people in terms of the developmental phase that exemplifies their current struggle, we can sort them out according to their characteristic modes of handling anxiety and other dysphoric affects.

3.11.2.    The idea that a primary function of the ego is to defend the self against anxiety arising from either powerful instinctual strivings (the id), upsetting reality experiences (the ego), or guilt feelings and associated fantasies (the superego) was most elegantly explicated in Anna Freud’s The Ego and the Mechanisms of Defense (1936).

3.12.                     Sigmund Freud’s original ideas had included the notion that anxious reactions are caused by defenses, most notably repression (unconsciously motivated forgetting).

3.12.1.    Bottled-up feelings were seen as tensions that press for discharge, tensions that are experienced as anxiety.

3.12.2.     When Freud made the shift to the structural theory, he reversed himself, deciding that repression is a response to anxiety, and that it is only one of several ways human beings try to avoid an unbearable degree of irrational fear.

3.12.3.    He began construing psychopathology as a state in which a defensive effort has not worked, where the anxiety is felt in spite of one’s habitual means of warding it off, or where the behavior that masks the anxiety is self-destructive.

 

4.       THE OBJECT RELATIONS TRADITION

4.1.    As the ego psychologists were mapping out a theoretical understanding of patients whose psychological processes were illuminated by the structural model, some theorists in Europe, especially in England, were looking at different unconscious processes and their manifestations.

4.2.    Some, like Klein (e.g., 1932, 1957), worked both with children and with patients whom Freud had regarded as too disturbed to be suitable for analysis.

4.2.1.These representatives of the “British School” of psychoanalysis were finding that they needed another language to describe the processes they observed.

4.2.2. Their work was controversial for many years, partly due to the personalities, loyalties, and convictions of those involved, and partly because it is hard to write about inferred primitive phenomena.

4.2.3.Object relations theorists struggled with how to put preverbal, prerational processes into rationally mediated words. Although they shared his respect for the power of unconscious dynamics, they disputed Freud on certain key issues.

4.3.    W. R. D. Fairbairn (e.g., 1954), for example, rejected Freud’s biologism outright, proposing that people do not seek drive satisfaction so much as they seek relationships.

4.3.1.In other words, a baby is not so much focused on getting mother’s milk as it is on having the experience of being nursed, with the sense of warmth and attachment that goes with that experience.

4.3.2.Psychoanalysts influenced by Sandor Ferenczi (such as Michael and Alice Balint, sometimes referred to as belonging to the “Hungarian School” of psychoanalysis) pursued the study of primary experiences of love, loneliness, creativity, and integrity of self that do not fit neatly within the confines of Freud’s structural theory.

4.3.3.People with an object relations orientation put their emphasis not on what drive had been mishandled in a person’s childhood, or on what developmental phase had been poorly negotiated, or on what ego defenses had predominated.

4.3.4.Rather, the emphasis was on what the main love objects in the child’s world had been like, how they had been experienced, how they and felt aspects of them had been internalized, and how internal images and representations of them live on in the unconscious lives of adults.

4.3.5.In the object relations tradition, oedipal issues loom less large than themes of safety and agency, and separation and individuation.

4.4.    Freud’s own work was not inhospitable to the development and elaboration of object relations theory.

4.4.1. His appreciation of the importance of the child’s actual and experienced infantile objects comes through in his concept of the “family romance,” in his recognition of how different the oedipal phase could be for the child depending on the personalities of the parents, and also in his increasing emphasis on relationship factors in treatment.

4.4.2.Richard Sterba (1982) and others who knew Freud have stated that he would have welcomed this direction in psychoanalysis.

4.5.    By the middle of the 20th century, object relational formulations from the British and Hungarian schools were paralleled to a striking degree by developments among therapists in the United States who identified themselves as “interpersonal psychoanalysts.”

4.5.1.These theorists, who included Harry Stack Sullivan, Erich Fromm, Karen Horney, Clara Thompson, Otto Will, Frieda Fromm-Reichmann, and Harold Searles were, like their European colleagues, trying to work with more seriously disturbed patients.

4.5.2.They differed from object relations analysts across the Atlantic mainly in the extent to which they emphasized the internalized nature of early object relations: The American-based therapists tended to put less stress on the stubbornly persisting unconscious images of early objects and aspects of objects.

4.5.3.Both groups deemphasized the therapist’s role as conveyer of insight and concentrated more on the importance of establishing emotional safety. Fromm-Reichmann (1950) famously observed that “The patient needs an experience, not an explanation.”

4.6.    Freud had shifted toward an interpersonal theory of treatment when he stopped regarding his patients’ transferences as distortions to be explained away and began seeing them as offering the emotional context necessary for healing.

4.6.1.Emphasizing the value of the patient’s exorcising an internal image of a problematic parent by seeing that image in the analyst and defying it, he noted that “It is impossible to destroy anyone in absentia or in effigie” (1912, p. 108).

4.6.2.The conviction that the emotional connection between therapist and client constitutes the most vital curative factor in therapy is a central tenet of contemporary analytic therapists (Blagys & Hilsenroth, 2000).

4.6.3.It is also supported by considerable empirical work on psychotherapy outcome (Norcross, 2002; Strupp, 1989; Wampold, 2001; Zuroff & Blatt, 2006) and seems to apply to nonpsychodynamic as well as psychodynamic therapies (Shedler, 2010).

4.7.    The child’s movement from experiential symbiosis (early infancy) through me-versus-you struggles (age 2 or so) through more complex identifications (age 3 and up) became more salient in this theory than the oral, anal, and oedipal preoccupations of those stages.

4.7.1.The oedipal phase was appreciated as a cognitive milestone, not just a psychosexual one, in that it represents a victory over infantile egocentrism for a child to understand that two other people (the parents, in the classical paradigm) may relate to each other in ways that do not involve the child.

4.8.    Concepts from the European object relations theorists and the American interpersonalists heralded significant advances in treatment because the psychologies of many clients, especially those suffering from more serious psychopathology, are not easily construed in terms of id, ego, and superego.

4.8.1.Instead of having an integrated ego with a self-observing function, such persons seem to have different “ego states,” conditions of mind in which they feel and behave one way, often contrasting with the way they feel and behave at other times.

4.8.2.In the grip of these states, they may have no capacity to think objectively about what is going on in themselves, and they may insist that their current emotional experience is natural and inevitable given their situation.

4.9.    Clinicians trying to help these difficult patients learn that treatment goes better if one can figure out which internal parent or other important early object is being activated at any given time, rather than trying to relate to them as if there is a consistent “self” with mature defenses that can be engaged.

4.9.1.Thus, the arrival of the object relations point of view had significant implications for extending the scope and range of treatment (L. Stone, 1954).

4.9.2.Therapists could now listen for the voices of “introjects,” those internalized others who had influenced the child and lived on in the adult, and from whom the client had not yet achieved a satisfactory psychological separation.

4.10.                     Within this formulation, character could be seen as stable patterns of behaving like, or unconsciously inducing others to behave like, the experienced objects of early childhood.

4.11.                     A new appreciation of countertransference evolved in the psychoanalytic community, reflecting therapists’ accumulating clinical knowledge and exposure to the work of object relational theorists writing about their internal responses to patients.

4.11.1.    In the United States, Harold Searles distinguished himself for frank depictions of normal countertransference storms, as in his 1959 article on efforts of psychotic people to drive therapists crazy.

4.11.2.    In Britain, D. W. Winnicott was one of the bravest self-disclosers, as in his famous 1949 article “Hate in the Countertransference.”

4.11.3.    Freud had regarded strong emotional reactions to patients as evidence of the analyst’s incomplete self-knowledge and inability to maintain a benign, physicianly attitude toward the other person in the room.

4.11.4.    In gradual contrast to this appealingly rational position, analysts working with psychotic clients and with those we now diagnose as borderline or traumatized or personality disordered were finding that one of their best vehicles for comprehending these overwhelmed, disorganized, desperate, tormented people was their own intense countertransferential response to them.

4.12.                     In this vein, Heinrich Racker (1968), a South American analyst influenced by Klein, offered the clinically useful categories of “concordant” and “complementary” countertransferences.

4.12.1.    The former term refers to the therapist’s feeling (empathically) what the patient as a child had felt in relation to an early object; the latter connotes the therapist’s feeling (unempathically, from the viewpoint of the client) what the object had felt toward the child.

4.13.                     Before we had functional magnetic resonance imaging (fMRI) studies, analytic theories created hypothetical structures to describe those processes, assuming that in making contact, we draw on early infantile knowledge that both predates and transcends the formal, logical interactions we easily put into words.

4.13.1.    The phenomenon of parallel process (Ekstein & Wallerstein, 1958), the understanding of which presumes the same emotional and preverbal sources, has been extensively documented in the clinical literature on supervision.

4.13.2.    The transformation of countertransference from obstacle to asset is one of the most critical contributions of object relations theory (see Ehrenberg, 1992; Maroda, 1991).

 

5.       SELF PSYCHOLOGY

5.1.    By the 1960s, many practitioners were reporting that their patients’ problems were not well described in the language of the existing analytic models; that is, the central complaints of many people seeking treatment were not reducible to either a problem managing an instinctual urge and its inhibitors (drive theory), or to the inflexible operation of particular defenses against anxiety (ego psychology), or to the activation of internal objects from which the patient had inadequately differentiated (object relations theory). Such processes might be inferable, but they lacked both the economy of explanation and the explanatory power one would want from a good theory.

5.2.    Rather than seeming full of stormy, primitive introjects, as object relations theory described so well, many mid-century patients were reporting feelings of emptiness— they seemed devoid of internal objects rather than beleaguered by them.

5.2.1.They lacked a sense of inner direction and dependable, orienting values, and they came to therapy to find some meaning in life.

5.2.2.On the surface, they might look self-assured, but internally they were in a constant search for reassurance that they were acceptable or admirable or valuable.

5.2.3.Even among clients whose reported problems lay elsewhere, a sense of inner feelings of emptiness— they seemed devoid of internal objects rather than beleaguered by them.

5.2.4.They lacked a sense of inner direction and dependable, orienting values, and they came to therapy to find some meaning in life.

5.2.5.On the surface, they might look self-assured, but internally they were in a constant search for reassurance that they were acceptable or admirable or valuable.

5.2.6.Even among clients whose reported problems lay elsewhere, a sense of inner confusion about self-esteem and basic values could be discerned.

5.3.    With their chronic need for recognition from outside sources, such patients were regarded by analytically oriented people as having core problems with narcissism, even when they did not fit the stereotype of the phallic” narcissistic character (arrogant, vain, charming) that W. Reich (1933) had delineated.

5.3.1.They evoked a countertransference noteworthy not for its intensity, but for boredom, impatience, and vague irritation.

5.3.2.People treating such clients reported that they felt insignificant, invisible, and either devalued or overvalued by them.

5.3.3.The therapist could not feel appreciated as a real other person trying to help, but instead seemed to be regarded as a replaceable source of the client’s emotional inflation or deflation.

5.4.    The disturbance of such people seemed to center in their sense of who they were, what their values were, and what maintained their self-esteem. Within psychoanalysis, Heinz Kohut formulated a new theory of the self: its development, possible distortion, and treatment.

5.4.1.They would sometimes say they did not know who they were or what really mattered to them, beyond getting reassured that they mattered. From a traditional standpoint, they often did not appear flagrantly “sick” (they had impulse control, ego strength, interpersonal stability), but they nevertheless felt little pleasure in their lives and little realistic pride in themselves.

5.4.2.Some practitioners considered them untreatable, since it is a more monumental task to help someone develop a self than it is to help him or her repair or reorient one that already exists.

5.4.3.Others worked at finding new constructs through which these patients’ suffering could be better conceptualized and hence more sensitively treated.

5.4.3.1.              Some stayed within existing psychodynamic models to do so (e.g., Erikson and Rollo May within ego psychology, Kernberg and Masterson within object relations); others went elsewhere.

5.4.3.2.              Carl Rogers (1951, 1961) went outside the psychoanalytic tradition altogether to develop a theory and therapy that made affirmation of the client’s developing self and self-esteem its hallmarks.

5.4.3.3.              Within psychoanalysis, Heinz Kohut formulated a new theory of the self: its development, possible distortion, and treatment.

5.5.    Kohut emphasized the normal need to idealize and the implications for adult psychopathology when one grows up without objects that can be initially idealized and then gradually and nontraumatically deidealized.

5.5.1.Kohut’s contributions (e.g., 1971, 1977, 1984) proved valuable not only to those who were looking for new ways to understand and help narcissistically impaired clients; they also furthered a general reorientation toward thinking about people in terms of self-structures, self-representations, self-images, and how one comes to depend on internal processes for self-esteem.

5.5.2.An appreciation of the emptiness and pain of those without a reliable superego began to coexist with the compassion that analysts already felt for those whose superegos were excessively strict.

5.6.    Kohut’s body of work, its influence on other writers, and the general tone it set for rethinking psychological issues had important implications for diagnosis.

5.6.1.This new way of conceptualizing clinical material added to analytic theory the language of self and encouraged evaluators to try to understand the dimension of self-experiences in people.

5.6.2.Therapists began observing that even in patients not notable for their overall narcissism, one could see the operation of processes oriented toward supporting self-esteem, self-cohesion, and a sense of self-continuity— functions that had not been stressed in most earlier literature.

5.6.3.Defenses were reconceptualized as existing not only to protect a person from anxiety about id, ego, and superego dangers but also to sustain a consistent, positively valued sense of self (Goldberg, 1990b).

5.6.4.Interviewers could understand patients more completely by asking, in addition to traditional questions about defense (“ Of what is this person afraid? When afraid, what does this person do?” [Waelder, 1960]), “How vulnerable is this person’s self-esteem? When it is threatened, what does he or she do?”

5.7.    Diagnostic discrimination between the first kind of depression (“ melancholia” in the early psychoanalytic literature and “introjective depression” more recently [Blatt, 2008]) and the second, a more narcissistically depleted state of mind (Blatt’s “anaclitic” depression), is a critical one for very practical reasons.

5.7.1.The man with the first kind of depressive experience will not respond well to an overtly sympathetic, supportive tone in the interviewer; he will feel misunderstood as a person more deserving than he knows he really is, and he will get more depressed.

5.7.2.The man with the second kind of subjective experience will be relieved by the therapist’s direct expression of concern and support; his emptiness will be temporarily filled, and the agony of his shame will be mitigated.

5.7.3.Self psychological frames of reference have had significant diagnostic value.

 

6.       THE CONTEMPORARY RELATIONAL MOVEMENT

6.1.    Winnicott (1952) stated, provocatively and memorably, that there is no such thing as a baby. He meant that there is an interpersonal system of a baby and a caregiver, as the baby cannot exist except in a specific context of care.

6.2.    Similarly, recent psychoanalytic theorists have challenged the assumption that there is such a thing as a discrete, stable, separate personality; they prefer to conceive of a series of self-states that arise in different interpersonal contexts.

6.2.1.The most important recent theoretical innovations were set in motion by a 1983 text by Jay Greenberg and Steven Mitchell that contrasted drive and ego psychological models with relational theories (interpersonal, object relational, self psychological).

6.2.2.Since that time, there has been a remarkable shift of conceptualization of the clinical process, generally dubbed the “relational turn” (S. A. Mitchell, 1988), in which the inevitably intersubjective nature of the clinical situation has been emphasized.

6.3.    Scholars such as Louis Aron, Jessica Benjamin, Philip Bromberg, Jodie Davies, Adrienne Harris, Irwin Hoffman, Owen Renik, and Donnell Stern have challenged prior notions that the therapist’s objectivity or emotional neutrality is either possible or desirable, and have emphasized the contributions to the clinical situation of the unconscious life of the therapist as well as that of the patient.

6.3.1. Despite its obvious asymmetricality, the relationship that any therapist– client pair experiences is seen as mutual and co-constructed (Aron, 1996), and the analyst is assumed not to be an objective “knower” but a codiscoverer of the patient’s psychology as it contributes to inevitable two-person enactments of the client’s major interpersonal themes.

6.4.    Relational psychoanalysts have been more interested in therapeutic process than in hypothesized structures such as character; in fact, many explicitly worry that talking about personality as a patterned, fixed phenomenon ignores the evidence for our ongoing construction of experience and for self-experiences that are more state dependent than personality driven.

6.4.1.Still, their paradigm shift has affected how we think about personality and its implications for practice.

6.4.2.By deconstructing prior conceits that analysts can somehow observe patients antiseptically (according to Heisenberg [1927], even electrons cannot not be studied without the act of observation affecting what is observed), relational analysts opened the door to appreciating the personality contributions of the therapist as well as the patient in the understanding of what is going on between them in therapy.

6.5.    In response to the clinical challenges presented by people with histories of emotional and sexual abuse, much relational thinking has returned to the early Freudian focus on trauma, but with an emphasis on dissociative rather than repressive processes.

6.6.    From the perspective of personality diagnosis, perhaps the most important contributions of analysts in the relational movement include their sensitivity to unformulated experience (D. B. Stern, 1997, 2009), social construction of meaning (Hoffman, 1998), multiple self-states (Bromberg, 1991, 1998), and dissociation (Davies & Frawley, 1994), all ways of thinking about self-experience that imply more fluidity and unfinishedness than traditional theory assumed.

 

7.       OTHER PSYCHOANALYTIC CONTRIBUTIONS TO PERSONALITY ASSESSMENT

7.1.    In addition to drive, ego psychology, object relations, self, and relational orientations, there are several other theories within a broad psychoanalytic framework that have affected our conceptualizations of character.

7.2.    They include, but are not limited to, the ideas of Jung, Adler, and Rank; the “personology” of Murray (1938); the “modern psychoanalysis” of Spotnitz (1976, 1985); the “script theory” of Tomkins (1995); the “control– mastery” theory of Sampson and Weiss (Weiss, 1993); evolutionary biology models (e.g., Slavin & Kriegman, 1990), contemporary gender theory (e.g., A. Harris, 2008), and the work of Jacques Lacan (Fink, 1999, 2007).

7.3.    I cannot resist noting my prediction in the first edition of this book that psychoanalysts would soon apply chaos theory (nonlinear general systems theory) to clinical issues, a prophecy that has since been realized (Seligman, 2005).

7.4.    In concluding this chapter, I want to stress that analytic theories emphasize themes and dynamisms, not traits; that is why the word “dynamic” continues to apply.

7.5.    Analytic theories offer us ways of helping our clients to make sense out of seemingly inexplicable ironies and absurdities in their lives, and to transform their vulnerabilites into strengths.

 

8.       SUMMARY

8.1.     I have briefly described several major clinical paradigms within psychoanalysis.

8.2.    I have emphasized their respective implications for conceptualizing character, with attention to the clinical inferences that can be drawn from seeing people through these different lenses.

8.3.    I have also noted other influences on dynamic ideas about character structure and implications for therapy.

8.4.    This review could only hit the highlights of over a hundred years of intellectual ferment, controversy, and theory development.


 
 
 
 
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