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The Evolution of American Psychoanalysis THE EVOLUTION OF AMERICAN PSYCHOANALYSIS: CHANGING REALITIES, CHANGING TECHNIQUES HUGO STEVENSON A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY GRADUATE PROGRAM IN PSYCHOLOGY YORK UNIVERSITY TORONTO, CANADA November, 2011 Library and Archives Bibliotheque et Canada Archives Canada Published Heritage Direction du Branch Patrimoine de I'edition 395 Wellington Street 395, rue Wellington Ottawa ON K1A0N4 Ottawa ON K1A 0N4 Canada Canada Your file Votre reference ISBN: 978-0-494-88714-1 Our file Notre reference ISBN: 978-0-494-88714-1 NOTICE: AVIS: The author has granted a non­ L'auteur a accorde une licence non exclusive exclusive license allowing Library and permettant a la Bibliotheque et Archives Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par telecommunication ou par I'lnternet, preter, telecommunication or on the Internet, distribuer et vendre des theses partout dans le loan, distrbute and sell theses monde, a des fins commerciales ou autres, sur worldwide, for commercial or non­ support microforme, papier, electronique et/ou commercial purposes, in microform, autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriete du droit d'auteur ownership and moral rights in this et des droits moraux qui protege cette these. Ni thesis. Neither the thesis nor la these ni des extraits substantiels de celle-ci substantial extracts from it may be ne doivent etre imprimes ou autrement printed or otherwise reproduced reproduits sans son autorisation. without the author's permission. In compliance with the Canadian Conformement a la loi canadienne sur la Privacy Act some supporting forms protection de la vie privee, quelques may have been removed from this formulaires secondaires ont ete enleves de thesis. cette these. While these forms may be included Bien que ces formulaires aient inclus dans in the document page count, their la pagination, il n'y aura aucun contenu removal does not represent any loss manquant. of content from the thesis. Canada Abstract Although statistical data about any aspect of psychoanalysis is famously scarce, a few available surveys indicate a steady decline of analytic practice. In 1976, for example, it was found that on average analysts had two (2) analytic patients only and that when more surveys were conducted ten years later, the situation was "far worse" (Pulver, 1978 & Lifson, 1987; cited in Kirsner, 1990, p. 182). Current estimates suggest that between forty to fifty percent of analysts have no analytic patients whatsoever and that the majority of hours of practice are devoted to psychotherapy (Fisher, N., 2004; cited by Eisold, 2005, p. 1182), which means that instead of assuming a neutral scientist-like position and seat behind free-associating patients with the intention to investigate and interpret their unconscious, analysts work under heavily modified technique in terms of the setting -infrequent sessions, the use of CBT (Cognitive Behavioral Therapy)-like techniques such as journaling and the use of homework, the abandonment of the hallmarks of psychoanalytic practice such as the couch, among others- and in terms of their posture: discarding of the blank-screen position in favor of one where the analyst is active and engaging: technique, in general, is seen as something one adapts to the patient's needs and not the other way around. iv Over the course of the 20th and 21st centuries attacks on psychoanalytic theory have been relentless and frequently vicious, bordering on infamy. Scholars have examined psychoanalysis from many angles and exploited every conceptual weakness to criticize and debunk psychoanalysis, with the upshot being that psychoanalysis is no longer taught in the psychology departments of mainstream universities, while psychiatry has long since parted ways with Freud. However, in spite of the many scholarly papers and books and the myriad of popular magazine articles, such attacks have for the most part left psychoanalytic institutions untouched in terms of structure and dynamics. Moreover, in the face of internal conflict, desertion and the constant challenge imposed by the dwindling numbers of candidates and patients, psychoanalysis has survived through its international and national societies and institutes as well as through congresses, books and peer-reviewed journals. The conclusion is simple: after over a century of existence and despite the onslaught, many psychoanalytic ideas and theoretical formulations are still alive and kicking while psychoanalytic practice is disappearing, threatened with the increasing possibility of extinction. This dissertation will not address the validity or the effectiveness of psychoanalytic theory and practice. I will not take issue with whether psychoanalytic claims of therapeutic depth or accuracy are sound, or even sustainable. This dissertation will describe how the practice of psychoanalysis has behaved just like any other "merchandising": I attempt to show that v psychoanalysis has dealt with internal pressure to improve its services by appealing to a larger segment of the market. Ever since Franz Alexander's book Psychoanalytic Psychotherapy (1946) called for a flexible technique adapted to the patient's needs, capacities, and personal situation, many analysts have attempted to modify psychoanalytic technique to make it more capable of helping patients whose pathologies were considered outside the scope of psychoanalysis, such as (so-called) borderline conditions, and by making it accessible to patients who could not afford high fees and/or frequent sessions. Second, psychoanalysis, like any other commercial enterprise, has been pulled and pushed by its competition, regulations, and other market forces, forcing it to adapt. Succinctly put, my thesis is that having no other option than to yield to the power of such (internal and external) forces and to the realities of competition in a capitalist society, psychoanalysts have gone from being an elite group of practitioners, who were able to set a strict standard of practice to become practitioners who have abandoned "pure" psychoanalysis to survive as a viable treatment modality in the mental health field. I intend to show how, as a result, psychoanalytic practice has either completely disappeared or morphed into a technical practice that seriously affects its identity by increasingly making it impossible to distinguish from other therapeutic models. Again, practice and not theory is my concern, psychoanalysis' base and not its superstructure is what informs this dissertation vi To Tomas and Thomas Acknowledgments The author wishes to thank Dr. Fred Weizmann for playing a crucial role in the production of this dissertation. While it may be a clich6 to refer to someone as a support 'without whom this work could not have been written', it just happens to be true in this case. Dr. Weizmann had already retired when he accepted me as his last student, without knowing much about me, and at a time when I was struggling to find a supervisor for my work. For that, and for his advice and every suggestion and support, my gratitude will never end. The author wishes to thank Dr. Colman Hogan for his editorial suggestions, hints, discussions, and friendship during the course of the several drafts of the various chapters involved in this dissertation. When it comes to editing, first there is God, and then there is Colman. The author wishes to thank Luis Casac6, MA, PMP, for his support, his friendship, and his technical proficiency with word processing and printing. The author wishes to thank his dissertation committee for their attention to detail and the constructive feedback offered on the draft. The author wishes to articularly acknowledge the intelligent and supportive feedback offered by Dr. Daniel Burston during and after the oral defense. viii Finally, I wish to acknowledge the constant encouragement that Maria Clara Monteiro Pereira has lovingly provided during the long process of completing this project. ix Contents Abstract iv Acknowledgments viii Introduction: the setting versus the theory 13 Specific objectives and associated structure 15 Chapter 1: Dissent and heresy in the institution of psychoanalysis: from Modern Psychoanalysis to the relational scene 16 The 1950's and the origins of the psychotherapy VS psychoanalysis debate in the US 18 Frequency 21 The debates 23 Classical technique modified: the use of parameters 34 The mainstream's response 40 Bibring and the hierarchy of techniques: the role of interpretation and insight 46 Narrowing the spectrum of psychoanalytic practice 53 Extrinsic and intrinsic criteria in psychoanalysis: the work of Merton Gill 59 From 1954 to 2004: the debate 50 years later 69 Modern psychoanalysis and the emergence of relational psychoanalysis in the US 73 Chapter 2: Hyman Spotnitz and his Modern Psychoanalysis 78 The narcissistic defense 80 Modern psychoanalysis 89 A case by case approach: emotional maturity 96 Therapeutic strategy and the role of insight 98 A broader conceptualization of resistance 106 Technique and contact function Ill Joining the ego 120 The toxoid response 127 x Countertransference 131 Critical analysis 137 Spotnitz's pioneering efforts 139 Theoretical contributions: one-person versus two-person psychologies in modern psychoanalysis 147 Infant
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