Working Intersubjectively: Contextualism in Psychoanalytic Practice endeavors to ground intersubjective psychoanalysis in a larger philosophical context, largely that found in the writings of Aristotle, Gadamer, Wittgenstein, and Bakhtin. This version of intersubjectivity theory has been articulated by Stolorow, Atwood, Brandshaft, and Orange in four earlier volumes. Intersubjectivity "views psychoanalysis as the dialogic attempt of two people together to understand one person's organization of emotional experience by making sense together of their intersubjectively configured experience" (p. 5). The authors conclude that if "we can identify the contexts that have led to a particular experiential organization, we can play with it, question it, and experiment with its reorganization" (p. 90). These authors, both in the current volume and in those that have preceded it, have expanded self psychology from a "one-person" to a relational perspective. The authors do not discuss, however, how their intersubjectivity theory differs from that of Benjamin (1995), another relational psychoanalyst.The authors are to be commended for the readability of the text and the absence of questionable metapsychology and jargon. Even the empirical psychologists they appear to eschew will find few concepts with which to find fault. Psychologists of any stripe will likely not disagree with the ideas of unconscious organizing principles or the threat of psychological annihilation. The authors also are to be applauded for using the term "co-transference" instead of "transference" and "countertransference,"
The following case is presented to illustrate the treatment of a depressed individual within a social-learning theory framework. Some of the assumptions underlying the approach are as follows: (a) a reduced rate of positive reinforcement is a critical antecedent condition for the occurrence of depressed behaviors; (b) social interactions provide contingencies which strengthen and maintain depressive behaviors. The latter are seen as part of a vicious circle in which the depressive behaviors serve to maintain the individual's impoverished social relations and the latter serve to prolong his depression. Hence, the approach attempts to reduce the occurrence of depressive behaviors and to help the individual to engage in behaviors which are likely to restore an adequate schedule of positive reinforcement for him.Mrs. G. is a 38-year-old German warbride. She and her husband, an unskilled laborer, were married in 1953. Shortly after the death of her mother in 1961 Mrs. G. became intensely depressed. Since that time she has been seen by several psychiatrists and psychologists. In October of 1967 she was referred to the University of Oregon Psychology Clinic.Mrs. G. assumed that her treatment would be similar to her previous experiences and immediately launched into a detailed description of her many symptoms and complaints. She also complained about the absence of close friends, blaming this situation on her husband, who professes no need for people. She said that she no longer had any feelings for her husband and that she had neither the capacity nor the desire to love him. She indicated an interest in discussing past experiences about which she felt a great deal of guilt. Mrs. G. displayed a wide range of symptoms including severe anxiety attacks, feelings of illness and fatigue, and imagining her children to be in mortal danger. Mr. G.'s usual reaction to her depression, in the past as well as in the present, was to withdraw, thus even further reducing the interaction between them. Mrs. G. also described herself as being very lonely.
Adopting a post-Cartesian, intersubjective viewpoint that focuses on the interplay of worlds of experience leads to an opening up of the most severe ranges of psychopathology-the so-called psychoses-to psychoanalytic understanding and treatment. A Cartesian theory, inevitably preoccupied with the individual mind and its contact with a stable external reality, cannot encompass experiences of extreme self-loss and of the disintegration of the world. A sketch is offered of varieties of the experience of personal annihilation within an intersubjective, phenomenological framework of understanding. Features of the intersubjective fields typically associated with delusional states, manic episodes, and extreme trauma are discussed.
A critique is offered of four conceptions of neutrality that have been prominent in the psychoanalytic literature: neutrality as (1) abstinence, (2) anonymity, (3) equidistance, and (4) empathy. It is argued that once the psychoanalytic situation is recognized as an intersubjective system of reciprocal mutual influence, the concept of neutrality is revealed to be an illusion. Hence, interpretations are always suggestions, transference is always contaminated, and analysis are never objective. An alternative to neutrality is found in the investigatory stance of empathic-introspective inquiry. This mode of inquiry is sharply distinguished from the prescribing of self-expressive behavior on the part of analysis, and the distinction is illustrated with a clinical vignette.
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