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대상관계이론의 역사
작성자  simonshin 작성일  2017.12.12 18:38 조회수 415 추천 0
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 신현근 박사 강의안: 대상관계이론에서의 임상적 개념의 진보 2부  
 

과목대상관계이론의 역사

주제대상관계이론에서의 임상적 개념의 진보 2

교수신현근 박사

내용강의안

교재Scharff, D. E. (1996). Object relations theory and practice: An introduction. Northvale, New Jersey: Jason, Inc.

_____________________________________________________________________________________________________________


Advances in Clinical Concepts 2

 

1)      Nina Coltart’s “Slouching Towards Bethlehem …’ or Thinking the Unthinkable in Psychoanalysis” (1982)

a)       Overview

i)        Nina Coltart is a senior member of the Group of Independent Analysts in London.

ii)       In this article, Coltart’s exploration of the concept of openness extends Bion’s use of the acts of faith and negative capability, the giving up of memory and desire, as she examines the struggles of the therapist striving to maintain an open mind in the midst of challenging work.

b)      Profession

i)        It is of the essence of our impossible profession that in a very singular way we do not know what we are doing.

ii)       The day that one qualifies as an analyst, the analyst that one is going to be is a mystery.

iii)     The process of doing analysis has slowly given birth to an identity which we have become, and are still becoming, which for us approximate to the notion of “being an analyst.”

c)       Analytic Work

i)        However much we gain confidence, refine our technique, decide more creatively when and how and what to interpret, each hour with each patient is also in its way an act of faith; faith in ourselves, in the process, and faith in the secret, unknown, unthinkable things in our patients which, in the space which is the analysis, are slouching towards the time when their hour comes round at last.

ii)       We have been waiting attentively, in Freud’s own words, “for the pattern to emerge.”

iii)     Those who learned from Bion value the stress which he laid on the need to develop the capacity to tolerate not knowing, the capacity to sit it out with a patient, often for long periods, without any real precision as to where we are, relying on our regular tools and our faith in the process, to carry us through the obfuscating darkness of resistance, complex defences, and the sheer unconsciousness of the unconscious.

d)      Act of faith

i)        Bion uses the phrase, the act of faith, and by it intends to signify the most highly desirable stance of the psychoanalyst.

ii)       The essence of its creation – and Bion sees it, as I do, as a positive, willed act - is refraining from memory and desire.

iii)     Bion says in Attention and Interpretation (1970, p. 31): “It may be wondered what state of mind is welcome if desires and memories are not. A term that would express approximately what I need to express is ‘faith’ – faith that there is an ultimate reality and truth – the unknown, unknowable, ‘formless infinite’ ” which can become at least partly known through evolution into objects of which the individual personality can become aware.

iv)     The channel for this evolution and the transformation of the apprehension of the ultimate truth, or a bit of it, is the analyst’s direct attention and perception, and his capacity to bring together hitherto meaningless fragments of the patient’s mental and verbal elements into a thinking process, and communicate back to the patient.

v)        Bion says that this form of attention, this act of faith, must be what he calls, “unstained by any elements of memory or desire or sensation.”

vi)     Bion says: “The more the psycho-analyst occupies himself with memory and desire the more his facility for harvouring them increases and the nearer he comes to undermining his capacity for F[the act of faith]”(Ibid, p.41).

vii)   It will be seen that Bion has intuition very high in his hierarchy of the tools at our disposal, and advocating a constant sternly self-disciplined practice. Indeed at one point, he actually equates intuition with “analytic observations.”

e)      Intuition and concept

i)        Kant (1781) said: “Intuition without concept is blind: concept without intuition is empty.”

ii)       It seems to me that Bion, and I in my way in this paper, are striving for the merging of the two.

iii)     Bion said, “I found that I could experience a flash of the obvious. One is usually so busy looking for something out of the ordinary that one ignores the obvious as if it were of no importance.” 

f)        Paradox

i)        The crucial thing about our technical development is that it hinges on a paradox.

ii)       There is a delicate balance between our reliance on our theories and on our knowledge about human nature in many of its dimensions and our willingness to be continuously open to the emergence of unexpected.

iii)     The seductive impulse to use the power of one’s thinking and theorizing to take possession of the patient too soon can be great, but will be of little ultimate value to him.

g)       Psychosomatic symptom

i)        A psychosomatic symptom represents that which is determined to remain unconscious, or unknowable, but which is at the same time has actually made itself conscious in a very heavy disguise; it is speakable about only in a dense and enigmatic code.

ii)       Some people suffer more from unthinkable than others, and for these we have to do all in our power to help towards the therapeutic transformation, to bring thoughts to the unthinkable and words to the inexpressible.

iii)     Gradually the rough beast may, within the framework of the analytic relationship, slouch towards being born, and the new creature emerging from the birth is the increased happiness and peace of the mind of the patient.

iv)     But in all of us there are some things which will never be within our reach; there is always a mystery at the heart of every person, and therefore in our job as analysts.

 

2)      Patrick Casement’s On Learning from the Patient (1985): “The Internal Supervisor”

a)       Overview

i)        Patrick Casement is a member of the independent group who has closely studied the process of the monitoring the analyst’s self in the conduct of therapy.

ii)       His original concept of the internal supervisor evolves out of the work of Winnicott, Fliess, Money-Kyrle, Bion, and others, but has, at the same time, a decidedly individual stamp.

b)      Supervising others

i)        Just as we can see our own errors more clearly in others, so too in supervising others.

ii)       Here there are endless opportunities for therapists to examine their own work, when looking closely at the work of the person being supervised.

c)       Renewed reflection

i)        Once I had come to recognize this unintentional maneuvering of the patient by those I supervise, it became imperative for me to monitor my own work more closely.

ii)       Some therapists might be surprised by how often they could be falling into modes of intervention that they had questioned when supervising someone else.

iii)     This realization can stir into life a renewed cycle of learning about technique, and about our own contribution to the responses that we see in our patients.

d)      Trial identification

i)        As part of the internal supervision, I often find it helpful to use trial identification. This can also be thought of as related to empathy in seeking to understand a patient. Reik pointed out that we develop empathy as a capacity to share in the experience of others, not just like own but as our own.

ii)       Money-Kyrle linked this to the analyst’s familiarity with his own unconscious.

iii)     It is not just the patient who needs to develop the capacity for a therapeutic dissociation within his ego, such as Sterba describes.  The therapist also has to be able to maintain this benign split within himself, whereby his experiencing ego is free to move between himself and the patient.

iv)     With practice it becomes possible to use these two viewpoints simultaneously, the patient’s and one’s own.

v)       The capacity to be in two places at once, in the patient’s shoes and in one’s own simultaneously, can only be encompassed if therapists can develop a capacity to synthesize these apparently paradoxical ego states. It is here, I believe, that the processing function of the internal supervisor comes to the fore. It is more than self-analysis and it is more than self-supervision.

 

3)      Neville Symington’s “The Analyst’s Act of Freedom as Agent of Therapeutic Change” (1983)

a)       Overview

i)        Neville Symington is a member of the group of independent analyst.

ii)       In the excerpt given here is from a journal article in which he discussed his realization of the constraint patient often visit on their therapist without either patient nor therapist being aware of it, and of the facilitation of the therapy at the moment of recognition.

b)       X-phenomenon

i)        Definition

(1)    I think the source of these favorable changes was in that moment of inner freedom when I had the unexpected thought: “Why can’t Miss M pay the same as my other patients?” I am calling this act of inner freedom the “x-phenomenon.”

ii)       Preverbal knowledge

(1)    The x-phenomenon implies that there is a knowledge that is preverbal and that it is anterior to speech and therefore to interpretation.

(2)    At this level of knowledge the patient knows unconsciously the analyst’s internal attitudes.

(3)    The moment the analyst becomes aware of his or her attitude and is freed from it then the patient perceives it.

(4)    That is to say he or she perceives a change within the self and make declarations to that effect without knowing the cause.

(5)    The interpretations that follow the x-phenomenon become conscious articulation at the ego to ego level.

(6)    The interpretations help them to reestablish the superego so that its myth and values change and become tuned into the changes that have occurred within the ego.

iii)     A corporate entity

(1)    With the exception of Winnicott I think that most analysts operate on the assumption that people are separate entities.

(2)    I think that the x-phenomenon and the particular form of knowledge that it must imply means that people are individuals and yet part of a corporate entity.

 

4)      Stephen A. Mitchell’s Relational Concepts in Psychoanalysis: An Integration (1988) and “Contemporary Perspectives on the Self: Toward an Integration” (1991)

a)       Overview

i)        Stephen Mitchell, an American affiliated with the William Alanson White Institute in New York and the New York University Postdoctoral Program in Psychoanalysis, is steeped in the tradition of object relations, as well as interpersonal analysis, which began with Sullivan and Fromm.

ii)       It is intrinsic to his model that individuals are seen as simultaneously self-creating and created by the environmental factors.

iii)     The process grows out of the paradox of Winnicott’s transitional phenomena, in which it can never be clear whether the infant created something or merely found what the mother placed there.

(1)    Personality and growth are created in the potential space between the infant and the mother, between any two people in intimate relationships, between analyst and patient.

(2)    Whose creation personality is can never be determined. It belongs to both the individual and the pair in the relationship (and by extension, to the wider family group.)

b)      A relational-conflict model

i)        The integrated relational perspective in therapeutic action of psychoanalysis represents a convergence of:

(1)    Object relations theories such as Fairbairn and Racker, and

(2)    Certain currents of both self-psychology and existential psychoanalysis.

ii)       Disturbances in early relationships with caretakers are understood to seriously distort subsequent relatedness, not by freezing infantile needs in place, but by setting in motion a complex process through which the child builds an interpersonal world (a world of object relations) from what is available.

iii)     This model locates the central mechanism of analytic change in an alteration in the basic structure of the analysand’s relational world.

iv)     From the point of view of self-organization, the analytic situation allows the analysand to recover, reconnect with, and fully experience aspects of himself previously disclaimed, hidden, disavowed.

v)       Other relational-model theorists (Fairbairn and Racker, for instance) describes the same process in terms of alteration of internal object relations.

(1)    The self here also is formed in complementarity with the character structure of the significant others.

(2)    Early object ties are maintained as powerful internal presences.

(3)    Current object relations are experienced projectively in terms of those internal object relations and subsequently through a reintegration of new experiences into never-changing old configurations.

(4)    Analytic change entails an alteration of these internal structures and relations.

vi)     Other relational-model theorists, particularly those in the interpersonal tradition, have focused on the way in which the analytic process facilitates changes in the analysand’s transactional patterns.

(1)    Anxiety about anxiety has focused the analysand into repetitive and constricted patterns in his transaction with others.

(2)    From this angle, it is the ritualized action that delimits the experience of both self and other, because the continued repetition of stereotyped integrations makes it impossible for the analysand to experience himself or anyone else in other than the collapsed, unidimensional ways.

(3)    The analytic process encourages the analysand to try something different, to permit himself in a different personal situation in which richer experiences of self and other are possible.

vii)   Conclusion

(1)    I regard each of these formulations as useful.

(2)    The analysand does not know any other way to be, and does not know any other way, because of the object loss and guilt, the fear of self-loss and loneliness, that behaving and experiencing oneself differently implies.

(3)    These approaches enrich one another in illuminating the tenacity and complexity of psychopathology.

c)        Emergence of self in analytic treatment

i)        New forms of experience of self … are learned only by being lived in, through participation in the psychoanalytic process in a variety of ways.

ii)       The inadequacy of medical model approach to psychoanalysis is no more apparent than when one considers the experience of self that is generated by the analytic process, which is not a return to “normality,” some premorbid standard of health, but rather a form of being that has its unique qualities.

iii)     At the end of analysis, the patient’s ways of representing himself to himself tend to be more fluid, complex, subtly textured. He becomes aware of how highly selective the presentation of self within analysis really is, and freedom and loneliness to that realization that are an important part of termination.

 

5)      Christopher Bollas’s Forces of Destiny: Psychoanalysis and Human Idiom (1989) and Being a Character: Psychoanalysis and Self Experience (1992): “Psychic Genera”

a)       Overview

i)        Christopher Bollas is a contemporary writer whose work has explored some of the most interesting areas of difficult interaction between patients and analysts.

ii)       Bollas proposes an extension of Winnicott’s notion of the role of the spontaneous gesture in the elaboration of the “true self,” thereby adding to our capacity to understand a person’s drive to become him and her self throughout the life cycle.

b)      Destiny drive

i)        The maternal provision of illusion of creativity, marries up with the destiny drive which we can think of as an internal sense of personal evolution through space and time.

ii)       A sense of destiny would be a feeling that the person is fulfilling some of the terms of his inner idiom through familial, social, cultural, and intellectual objects.

c)       Psychic genera

i)        Trauma and genera

(1)    I shall put forward the view that trauma has an opposite - genera – which is the psychic incubation of libidinal cathexes of the object world.

(2)    The sense of how to gather psychic investments to an inner area of work derives from the individual’s experience of elaborating his idiom, a process that involves the selection of specific objects which release idiom to its expression.

ii)       Development of trauma and genera

(1)    If genera develop through the succession of elaboration of idiom, trauma leads to the person’s binding of the self, which sponsors a type of psychic pain and leads to a very different kind of unconscious work.

(2)    Thus these two principles, a trauma and genera, begin as fundamental ego dispositions toward reality, derived from the infant’s and child’s experience of the mother and the father.

(3)    Perhaps it is possible to see how trauma-developed psychic processes will be conservative, fundamentally aiming to control the psychic damage, desensitizing the self to the toxic events.

(4)    The child who internalizes fundamentally generative parents aim to develop such inner processes and to seek excitation and novelty as means of triggering personal growth.

 

6)      Thomas Ogden’s Subject of Analysis (1994)

a)       Overview

i)        Thomas Ogden is a San Francisco analyst who spent a year at Tavistock Clinic in London, and who has subsequently explored many aspects of British tradition.

ii)       This excerpt expresses the theme that the creation of growth and development in therapy is a joint creation of patient and therapist.

b)      A dialectic relationship

i)        The subjects of analysis bear a dialectical relationship to one another.

ii)       From the elements of dialectic of subject and object, a new whole begins to emerge that almost immediately reveals itself to be a new source of dialectic tension.

iii)     The analytic process, which creates analyst and analysand, is one in which the analysand is not simply the subject of analytic inquiry: the analysand at the same time must be subject in that inquiry (that is, creating the inquiry) since his self-reflection is fundamental to the enterprise of psychoanalysis.

iv)     Similarly, the analyst cannot simply be the observing subject of this endeavor since his subjective experience in this endeavor is the only possible avenue through which he gains knowledge of the relationship he is attempting to understand.

v)       Having said something of the interdependence of analyst and analysand (as subjects creating and created, destroying and destroyed by one another), we must introduce a third term, for without it we will not have adequately described the psychoanalytic process in which the analyst and analysand as subjects of analysis create one another.

c)       Analytic third

i)        In the same moment that analyst and analysand are created, a third subject is generated that I refer to as the analytic third, since it is a middle term sustaining and sustained by the analyst and analysand as two separate subjects.

(1)    More Accurately, Analyst and analysand come into being in the process of creation of the analytic subject.

ii)       The analytic third, although it is created jointly by (what is becoming) the analyst and analysand, is not experienced identically by analyst and analysand since each remains a separate subject in dialectic tension with the other.

(1)    Moreover, although the analytic third is constituted in the process of negation/recognition of analyst and analysand, it does not reflect each of its creators in the same way any more than the third created in the experience of reading reflects the reader and writer in the same way.

(2)    In other words, transference and countertransference reflect one other, but not mirror images of one another.

d)      A form of subjectivity of the analytic third

i)        The analytic third is not only a form of experience participated in by analyst and analysand, it is at the same time a form of I-ness (a form of subjectivity) in which (through which) analyst and analysand become other than who they have been to the point.

ii)       The analyst gives voice to and participates in the creation of experience that is the living past of the analysand and in this way not only hears about the analysand’s experience, but experiences his own creation of it

iii)     At the same time, the analysand experiences his own living past as created intersubjectively in the third. The analysand experiences his past; the analysand experiences his past as it is being created for the first time in the process of its being lived in and through the analytic third.

e)      The shifting nature of dialectic

i)        To conclude (or better, to begin), psychoanalysis can be thought of as an effort to experience, understand, and describe the shifting nature of the dialectic generated by the creation and negation of the analyst by the analysand and of the analysand by the analyst within the context of the roles constituting the analytic setup.

ii)       The dialectic tension generated by this creative negation and recognition does not present a question to be answered, a riddle to be solved.

iii)     The answer to the riddle of the Sphinx must include all possible answers to the question of what it is to be human in a community of historically rooted human beings.

iv)     We must attempt not to allow the fundamental psychoanalytic questions about the nature of human experience generated in the confrontation of subjectivities in the analytic situation to be trivialized with answers that pretend to offer more that the effort to describe a moment in time that is disappearing and becoming something different as we are attempting to recognize what it is.


 

 
 
 
 
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