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Psychoanalysis and the New Sciences of the Brain

John M. Watkins, Ph.D. Institute of Contemporary

Chapter 7

Strategy 2: Neurodevelopmental Psychoanalytic Approaches

The theories within Strategy 2, developed by Joseph Palombo and Daniel Stern, have in common a rejection of Freudian , including virtually the entire set of propositions that comprise metapsychology. These theories grew out of the tradition that followed George Klein and others in drawing a sharp boundary between metapsychology, which was rejected, and clinical , which formed the foundation for the development of relational theories, psychology, and intersubjectivity theory. The biological assumptions of drive theory were viewed as incompatible with modern neurobiology, as well as burdened with internal contradictions and noxious implications for practice.

Palombo, who had a long association with Kohut and the Chicago Institute of Psychoanalysis, works largely within the tradition of self psychology. Palombo’s approach is not hermeneutic, but instead, like Kohut, takes the position that psychoanalysis can develop within a natural science framework. Stern’s writings bear the influence of Kohut’s self psychology, but evolved to increasingly embrace hermeneutic assumptions, which unlike the assumptions of Kohut’s theory, positioned psychoanalysis outside the bounds of natural science. A substantial part of Stern’s thinking involves efforts to apply an intersubjective perspective to development and therapy. Though the influence the intersubjectivity theory of Atwood, Orange, and Stolorow is discernable in Stern’s formulations, in some important respects Stern’s application of neuroscience goes against the grain of intersubjectivity theory and its hermeneutic philosophical foundation. Stern’s framework for understanding the development of the sense of self and the processes of psychoanalysis thus represents a unique contribution to psychoanalysis and developmental psychology.

Palombo and Stern each approach neuroscience with a different set of questions. Palombo asks how psychoanalysis can be applied to individuals who are born with or acquire learning disorders or brain injuries. In pursuing this question, he presents a theory of development of the sense of self and of therapy that extends self psychology in a new direction. In addition, his examination of patients with learning disorders raises important questions about the nature of the sense of self, , and selfobject function as defined by Kohut. Stern, on the other hand, uses cognitive neuroscience as a source of a few key supporting ideas,

1 particularly as a source for defining models of representation and memory. Having rejected the drive-based paradigm of metapsychology, Stern asks how neuroscience can inform an alternative conceptualization of how relationships are experienced, represented, and remembered.

Palombo’s Narrative Coherence Theory: Self Psychology Applied to Learning Disorders:

Palombo (2001, 2006) proposes an integrated clinical theory in which self psychology formulations add an important clinical dimension to the treatment of children with learning disorders. His approach is based on the psychoanalytic self psychology of , but also includes elaborations of Kohut’s theory by Lichtenberg and Wolf (1997), developmental theory from Daniel Stern (1985), and narrative theory from Tompkins (1987). Unlike Solms and Schore, Palombo does not present a general theory of how the brain works in psychoanalytic terms (“generic brain theory”). He does not use neuroscience to explain how works or where in the brain psychoanalytic constructs operate. Instead, Palombo focuses on the application of self psychology and psychoanalytic developmental theory to the treatment of children with learning disorders—a population that has received little attention in the psychoanalytic literature. Current scientific consensus views learning disorders as resulting from neuropsychological deficits that originate in abnormalities in development of the brain (Pennington, 1991); so Palombo brings neuroscience into his theory through the light that it sheds on the origins and characteristics of learning disorders. Palombo defines learning disorders as reflecting neuropsychological deficits that result from genetic or environmental disruption in brain function during childhood. He uses Pennington’s (1991) broad definition of learning disorders, which includes ADHD and autism spectrum disorders, as well as dyslexia and other types of developmental learning disabilities. The learning disorders are a major presence in the lives of these children, through special education, prescription of psychotropic medications, doctor visits, and a myriad of other activities that are often involved in managing learning disorders.

Polumbo (2001) asserts that learning disorders profoundly alter development through their effect on the child’s subjective experience of the world, as well as through their effect on relationships with parents and other caregivers. The neuropsychological deficits that are associated with learning disorders act as filters that “restrict, modify, or impose constraints on the child’s experiences, while the caregivers influence the child’s interpretations of those experiences” (p. 5). The learning disorder evokes responses in caregivers that are different from those experienced by children without learning disorders. If caregivers do not understand the effect of a learning disorder on the child’s development, a negative pattern of responses between caregiver and child may emerge that disrupts the process by which the child develops a sense of cohesiveness and safety. In short, the learning disorder becomes a source of misattunement and misinterpretation in a child’s relationships, leading to an “incoherent self-narrative and a disorder of the self” (p. 6). Polumbo further maintains that different kinds of neuropsychological deficits are associated with different kinds of misattunement in caregiver-child relationships. In several publications (Palombo, 2001, 2006) illustrates his approach with a series of case studies that are organized by type of learning disorder (e.g., dyslexia, ADHD, nonverbal learning disabilities, Aspergers disorder).

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Recognizing the presence of a learning disorder thus inevitably leads to modifications in the way the treatment process is conceptualized. In describing his approach to therapy, Palombo distinguishes two aspects of self regulation: self cohesion, which is an experiential concept from Kohut’s theory, and self coherence, which refers to the cognitive and affective integrity of the self narrative. Palombo structures his approach to therapy around three types of “moments” that occur during interchanges in the . First, during concordant moments, the child feels understood and supported. Second, aspects of the transference and are played out during complementary moments, when the effects of the learning disorder may be seen in the behavior. During the third type of moment, disjunctive moments, there is a disruption in the relationship as the result of or the therapist’s countertransference. Each of these three types of “moments” reflects a different relational context from which the child derives meaning.

Much of the therapeutic work takes place in complementary moments, when the therapist performs what Palombo refers to as “complementary functions”. Complementary functions, an expansion of Kohut’s concept of selfobject function, provide the relational context necessary for the development of a sense of self-cohesion. Palombo distinguishes three types of complementary functions: Selfobject functions, adjunctive functions, and compensatory functions. Palombo uses the concept of selfobject function in the same sense as Kohut—the responsiveness to a child that is necessary for maintaining a sense of self-cohesion—with idealizing, mirroring, and alter-ego types of selfobject function. Polumbo believes that Kohut’s concept of selfobject function is too narrow, however and so he delineates two other types of functions that parents and therapists provide. Adjunctive functions occur when a caregiver provides any form of direct help to a child. For example, if parent organizes and structures activities for a child who is distractible, or provides special lined paper for a child that is having difficulty with writing; the parent is providing an adjunctive function for the child. Compensatory functions, meant by Kohut to denote the way a person may compensate for a missing selfobject function by turning to another person, is expanded by Palombo to include strategies used by an individual to compensate for a learning disability. For example, a child with a deficit in verbal expression may compensate through use of nonverbal gesture. A parent who helps this child learn nonverbal gestures is providing a compensatory function. In Palombo’s (2006) formulation, the provision of selfobject and adjunctive functions are an indispensable part of normal child development: “Selfobject functions as well as adjunctive functions are necessary for children to survive psychologically” (p. 148). Compensatory functions are especially important to children with learning disorders. Deficits in perception, thinking, and communication that result from learning disorders disrupt caregiver’s performance of these essential functions.

It is important to note that the term function, as Palombo uses it when describing selfobject, complimentary, adjunctive, and compensatory functions, is not the same as a biological function, such as respiration, or a neuropsychological function, such as working memory. Instead, the term function denotes an effect of experience on the private and shared meanings in a relationship: “The only indication we can have as to whether a function is a selfobject function and not a complementary function is to be found in the meaning the function has for the person (Palombo, 1991a: 458).

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To capture the effect of past experience on shaping future behavior, Palombo following Basch, employs Tompkin’s script theory. He sees script theory as the key to understanding the impact of failures in relationships to provide complementary functions on the child’s expectations in future relationships. The concept of scripts is used as an explanatory device to link a set of nine primary affects (innate scripts; excitement, joy, surprise, fear, distress, anger, disgust, “dismell”, and shame), with implicit memories of experiences (learned scripts). Scripts emerge as relational experiences become linked with the regulation of affects. Children come to anticipate future relationships from the perspective implicit in these past scripts—from the personal and shared meanings that accrue to events in the child’s life. Fragmentation and loss of coherence occur when the child confronts shared meanings, understandings imposed by others, that are hurtful and at odds with personal meanings. In the case of learning disorders, a child becomes emotionally fragmented when meanings associated with a learning disorder are imposed from the outside and not integrated into the child’s self-narrative. The task of the therapist is to provide essential complementary functions in a relationship that will form the basis for altering scripts and developing coherence in the self-narrative.

Linking Neuroscience and Psychoanalysis. The implicit point of contact between neuroscience and psychoanalysis in Polumbo’s theory is the neuropsychological deficit—the deficit in cognitive functioning that defines a learning disorder—as experienced in the context of parent-child relationships during the course of development. The neuropsychological deficit, by changing the child’s experience through limitations it imposes on perception, thinking, and expression, alters the course of development and invariably affects the quality of the child’s relationships. The deficit is thought to influence the development of the child’s sense of self through the meanings the deficit is given in the child’s relationships. These meanings are contained in scripts or thematic models that act as organizing principles in shaping the child’s perception of future relationships. In therapy, these schemas emerge in the transference.

The role of neuroscience in Palombo’s theory is highly specific; it is used to provide detailed descriptions of neuropsychological deficits and learning disorder syndromes. Neuropsychological data in Palombo’s case presentations reflect a philosophy of mind that is consistent with functionalism—the view that mental operations can be understood as functions that are carried out by different types of physical structures in the brain (Fodor, 1983), although he characterizes himself as a dual aspect theorist (Palombo, personal communication October 22, 2006). These descriptions fit a scientific model that is generally accepted by neuroscientists (Pennington, 1991).

A key feature of making learning disorders a focus of an approach to psychotherapy is that the deficits are necessarily understood from an adult’s objective point of view. For Palombo, knowledge of the learning disorder is essential for two broad reasons. First, it is necessary in working with parents, often in order to help the parents reframe their understanding of the child’s behavior. Second, recognition of the neuropsychological deficit is a prerequisite for providing the complimentary functions that lead to a sense of narrative coherence. Palombo’s theory provides no role for neuroscience beyond the characterization of learning disorders. This places his approach in sharp contrast to that of Solms and Schore, for whom neural mechanisms— specifically regional brain localization-- are central to their explanatory frameworks.

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The role of psychoanalysis in Palombo’s approach is to provide a theoretical framework for understanding development and relationships, through an expansion of Kohut’s concept of selfobject. Here, the subjective point of view moves to the foreground, although the language of schemas and narratives from Tompkin’s script theory is often from the adult objective point of view. Polumbo, following Kohut, rejects drive theory and metapsychology, defining his psychoanalytic framework within the boundaries of self-psychology as elaborated by Kohut, Lichtenberg and Wolf, and Basch. His approach differs from Solms and Schore in excluding metapsychology and working within a single psychoanalytic tradition (self psychology).

Stern and the Boston Process of Change Study Group: Moments in Context

In the course of over 30 years of original research and theoretical writing, Daniel Stern has pioneered the use of parent-infant observation to build an empirical method for refining psychoanalytic developmental theory. In more recent years, Stern and his collaborators in the Boston Process of Change Study Group used this emerging developmental framework as a springboard for understanding subtle interpersonal processes in psychotherapy. Their work is firmly grounded in developmental psychology, but has recently sought to integrate findings from the neuroscience laboratory into the formulation of some of their central ideas. Kandel (1999), in outlining his vision for bridging neuroscience and psychoanalysis, highlighted Stern’s use of the distinction between declarative and procedural memory to demonstrate the way neurobiological insights can have utility in psychoanalytic theory. This section focuses on those few instances where Stern has sought to link neuroscience findings with psychoanalytic ideas.

Although neuroscience findings influence Stern’s thinking, he appears to be less (or perhaps not at all) concerned with the implications of neuroscience for revising Freudian metapsychology (footnote re disavowal). Instead, Stern has gradually formulated a sweeping developmental theory of intersubjectivity, the self, and the psychoanalytic process. Stern supports his theory with extensive research from developmental psychology, along with an examination of the implications of a few key neurobiological findings. In most of his work, metapsychology is implicitly rejected and replaced with an intersubjective framework that is largely within the hermeneutic tradition, although Stern (1991, 1995) also draws from Kohut’s self-psychology, particularly in his earlier work on the development of the sense of self (Stern, 1985).

In his approach to the psychoanalytic process—specifically his conception of the centrality of the “present moment” in psychotherapy--Stern (2004) follows a tradition that he traces to the existential philosopher Husserl, whose phenomenology attempts to capture the essential features of experience “just as it appears” in . Historically, Husserl’s thinking was closely allied with the hermeneutic theory of Dilthey (1926) that was later incorporated into psychoanalysis by Stolorow et al.

Stern uses a narrative coherence model, which views psychoanalysis as a narrative co- construction between patient and therapist. Stern views the narrative coherence model as also being within the hermeneutic tradition—a “hermeneutic-narrative model” (1995: 37). However, in contrast to the Husserlian preoccupation with present experience, the narrative coherence model is concerned with the influence of narratives about past experience. Though he associates

5 the narrative coherence model with a hermeneutic philosophical foundation, he supports his use of the model with observations from developmental research: “One of the more striking findings from this research…is that in many cases what is most predictive of the current pattern of attachment between mother and her new infant is not necessarily the kind of attachment experience that the mother herself had as a child (the historical truth) but rather the nature of the narrative that she tells about her own mother-as-mother (the narrative coherence). In effect, the narrative coherence of the mother’s representation can be more predictive than what actually happened to her as a child.” (1995: 37). This point is pivotal, because it shows a key point at which Stern links the intersubjective world of narrative coherence with the positivist world of research, a transition whose difficulty Stern recognizes: “One major challenge of the narrative model is what to do with historical truth—that is, “objective truth”—especially in a psychological domain such as attachment, which is so grounded in objective behavioral observation.” (1995: 37). Still, Stern (1989) carefully distinguished his narrative model from those of Freud and (1952), who emphasized the influence of inborn fantasies on the child’s narrative: “the interaction as subjectively experienced is construed or constructed by the infant, but not with significant distortions due to an inherent ontogeny of fantasy (p. 53).

Early in his writing, Stern put aside Freudian metapsychological models of memory and repression and instead based his theory on models of memory that were being developed in cognitive neuroscience. In his groundbreaking work The Interpersonal World of the Infant, Stern (1985: 91-95) adopted the distinction between episodic memory (Tulving, 1972) and motor memory or “memory without words” (Bruner, 1969). Episodic memory is “the memory for real- life experiences occurring in real time” (p. 94), whereas motor memory involves voluntary muscular patterns and their coordination, such as riding a bicycle or swimming. Stern also included several distinct processes that operate within these memory systems, including “chunking” of information during encoding, recognition, and cued recall—all well-established constructs in cognitive neuroscience at the time Stern was formulating his theory, but completely novel concepts in relation to Freudian metapsychology. Finally, Stern linked these memory processes to affects: “There are never cognitions without some affect fluctuations, even if only of interest. An episode occurs within a single physical, motivational setting; events are processed in time and causality is inferred, or at least expectations are set up.” (1985: 95). This conceptualization paralleled Stern’s linking of affect and amodal perception in his concept of “vitality affects”—elusive qualities of experience that emerge in an infant’s encounters with people such as “surging”, “fading away”, and “fleeting”. Again, the theoretical model for linking affect with cognition is not found in metapsychology, but instead can be traced to psychological theories that explicitly rejected Freudian drive theory, especially the theories of Silvan Tompkins’ (1962, 1963).

In later work, Stern and his colleagues, following the convention in neuroscience research, adopted the broader concepts of declarative (explicit) memory and procedural (implicit) memory to replace more specific episodic memory and motor memory (Stern et al, 1998; Lyons- Ruth, 1999). Procedural memory was then used as the substrate for their formulation of “implicit relational knowing”, which is a form of unconscious knowledge of relationships that is represented non-symbolically. Stern’s new framework for memory effectively replaced Freud’s entire apparatus of the dynamic unconscious and with a modern formulation of memory and affect that derived from contemporary cognitive and developmental neuroscience. Although

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Stern (1985, 2004) refers obliquely to repression and the dynamic unconscious, he does this generally in the context of distinguishing the concept of repression from his formulation of memory. This is consistent with the almost universal rejection of the concept of repression by both cognitive neuroscientists and intersubjectivity theorists (cf. McNally, 2003: 169-171; Stolorow, Atwood, & Orange, 2002: 40-45). Still, it is unclear why Stern (2004) lumps repression into his conceptualization of the “silent past”, the influence of the past on the present: “This kind of past is acting upon the felt present but is not, itself, felt. It is silent and only recognizable by taking an objective stance. It consists mainly of the repressed unconscious and the implicit nonconscious. In psychoanalysis this would include all repressed past influences (e.g., conflicts, fantasies, traumas) that have been rendered unconscious and thus not experienced as acting in the felt present.” (p. 202). The libido theory that motivates repression appears to have no other role in Stern’s theory or clinical accounts. Perhaps Stern is implicitly signaling us that repression should remain part the “silent past” of psychoanalysis. In any case, it is doubtful that Stern’s theory would be changed in any substantive way if references to repression and the dynamic unconscious were removed completely from his discussions.

It is important to understand the way in which Stern uses cognitive neuroscience in his formulations. For Stern, the distinction between declarative memory and procedural memory, together with the processes that operate in these systems, are central to his explanations of how a sense of self develops; how infants, parents, and therapists represent and experience relationships; and how the past influences future relationships. The distinction between these two memory systems is not simply a conceptual device, but is based on well established neuroscience research that has described the operations of two dissociable brain systems, associated with frontal neocortex and striatum respectively (Kandel, Schwartz, and Jessell, 2000, Chapter 62). However, within Stern’s theory, it really does not matter where in the brain these things happen. The fact that these memory systems are associated with distinct brain systems is relevant only as one means of supporting the construct validity of the distinction between declarative and procedural memory--it is not explanatory. If neuroscience research suddenly demonstrated that the brain localizations were reversed—that declarative memory was in the striatum and procedural memory in the neocortex—this new “fact” would not alter Stern’s theory one bit. Stern thus uses cognitive neuroscience as a source of conceptual constraint—a means of delimiting and validating key concepts--rather than as a source of explanation. This is in contrast to Solms and Schore, for whom localization within the brain often is the explanation.

Stern uses neuroscience in two other instances: in the formulation of mirror neurons as a neural basis for intersubjectivity and in the theory of neuronal group selection (TNGS) as the basis for selecting alternative schemas during development. In these instances, Stern uses neuroscience research to illustrate two speculative points, rather than as central constructs in his theory. The use of mirror neuron theory reveals some of the confusion that can arise when an essentially hermeneutic theory, with its emphasis on intersubjectivity, narrative coherence, and meaning, gets mixed together with the positivistic language of neuroscience: “Under certain conditions, when we act, some sets of our mirror neurons fire. It is as if we are mapping our own actions as we would those of another. For whom are we doing this? Perhaps it is for the others who are members of our own family of multiple . This would permit intersubjective traffic within ourselves and give a basis for reflective consciousness founded on two views from two selves operating within one person.” (2004: 129). A similar form of analogy occurs with Stern’s

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(1995: 95) idea that schemas may be subject to Darwinian natural selection in the same way that Edelman (1987) suggests that neural networks are selected. Edelman’s theory is complex, but contains the central idea that: “Neurons that fire together, wire together” (Edelman & Tononi, 2000: 85). This is suggestive and interesting, but the neuroscience evidence does not seem to be essential to Stern’s argument about schemas, where it is not entirely clear what might be wiring together.

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