Therapeutic Impasses in Contemporary Psychoanalytic Treatment: Revisiting the Double Bind Hypothesis Philip A. Ringstrom, Ph.D. In 1956, Bateson and colleagues published their seminal paper on double bind theory. Though long ago discounted as a truly etiological theory of schizophrenia, the double bind hypothesis left an enduring and unshakable impression, for perhaps what is most maddening in life are repeated encounters with feeling “damned if one does and damned if one doesn't.” The double bind hypothesis, however, went much further than this colloquialism but, in so doing, often defied operational definition. In her review of the many attempts to empirically capture the double bind situation, Abeles (1976) concluded that investigators were “researching the unresearchable” (p. 113). Sluzki (1976) pointed out, however, that “what the group was really most interested in was not the observables per se, but the underlying pattern (structure) the observables eventually revealed” (p. 162). It is precisely the underlying patterns in the analytic relationship to which this investigation of the double bind hypothesis in contemporary psychoanalytic thought is devoted. It is my belief that the prevailing psychoanalytic dialogue in the United States from the early 1950s to the early 1960s was so grounded in Freudian-based ————————————— Dr. Ringstrom is faculty at the Institute of Contemporary Psychoanalysis, Los Angeles and at the California Institute for Clinical Social Work. I wish to express my deepest appreciation to the following friends and colleagues for their encouraging comments and helpful criticisms of earlier drafts of this paper: Lew Aron, George Atwood, Howard Bacal, Tony Bass, Bernie Brandchaft, Jack Dender, Jim Fosshage, Irwin Hoffman, Lynn Jacobs, Joe Lichtenberg, John Lindon, Elizabeth Lokan-Egdahl, Naomi Malin, Donald Marcus, Steve Mitchell, Thomas Ogden, Loretta Polish, Owen Renik, Estelle and Mort Shane, Marcia Steinberg, Steven Stern, Bob Stolorow, Gary Sattler, Norm Tabachnick, and Judith Vida. © 1998 The Analytic Press - 297 - drive-discharge theory that there was no bridge from that psychoanalytic perspective to the double bind research group's investigation of underlying interactional structures of communication. In contrast, the evolution of contemporary psychoanalytic theory, influenced by emerging theories of infant observation and child development, not to mention the relational, social constructivist, and intersubjective perspectives, now calls for a reevaluation of role of double bind theory in our thinking. My focus here is on those essential impasses, which can arise irrespective of the theoretical orientation of the analyst, ones from which neither analyst nor analysand initially knows the way out, but from which emerge essential transformative experiences. It is my hypothesis that such impasses arise from paradoxically no-win interactional themes, which define intersubjective experiences particular to given therapeutic dyads. The double bind situation I am exploring involves a paradox between two logical types. Logical types (a concept that will be discussed in greater detail shortly) pertain to rules of classification about levels of abstraction. As represented in this paper, they refer to classes of the therapeutic relationship: ones defined by themes of engagement coconstructed by the analyst and the patient on the basis of each one's own self-organizing principles (Stolorow and Atwood, 1992). The logical types entail classes of therapeutic dialogue involving unconsciously coconstructed verbal and nonverbal narrative themes. To establish the place of double bind theory in contemporary psychoanalysis, a brief review of the evolution of concepts that organize these classes of coconstructed narratives (logical types) is necessary. The beginning point of this discussion involves revisions and refinements of the concepts of transference and countertransference. Within the last decade-and-a-half, contemporary psychoanalytic theorists have recognized the inherent limitations in positing models of transference exclusively on the basis of either the patient's history of intrapsychic or object relational conflict, on one hand, and models based on developmental deficits or attachment problems on the other (Greenberg and Mitchell, 1983; Bacal and Newman, 1990). In developing broader, more inclusive conceptualizations of transference, theoreticians such as Greenberg (1986) and Stolorow, Brandchaft, and Atwood (1987) conceived of bidimensional models involving a) the repetitive, resistive, reenacted dimension of the transference versus b) the developmental, selfobject, or reparative dimension of the transference. The - 298 - former stresses the tendency of patients to organize and therefore engage their analysts in old pathogenic interactional scenarios; the latter embodies patients' organizing and engaging their analysts in new reparative and developmentally reconstituting relationships. Lending even fuller relational thrust to this idea, Steven Stern (1994) eloquently reconceptualized these two dimensions of transference into classes of the therapeutic relationship, the repetitive dimension representing the “repeated relationship” and the developmental dimension the “needed relationship.” In so doing, Stern implicitly decentered the emphasis on the patient's bidimensional transference by arguing that his relational model equally stresses the analyst's countertransferential reactions. For the analysis to work, Stern asserts, it is crucially important for the analyst, through the mechanism of projective identification, to become caught up fruitfully in both dimensions of the patient's transference; in such states the analyst should explore and master his countertransference reactions for the purpose of elucidating and interpreting what the patient is experiencing. It appears, however, that in his effort to refine and focus his innovative ideas, Stern is emphasizing that aspect of the definition of countertransference which attends primarily to the therapist's reactions to the patient's transference states. A more generalized definition of countertransference (Heimann, 1950; Kernberg. 1965; Racker, 1968) includes all the therapist's thoughts and feelings about the patient, not just his reactions. When we turn to a more inclusive view of countertransference, we can see that the therapist, for reasons of his own personality, may not be able to achieve the mastery that Stern advocates; especially, under circumstances such as those addressed in this paper.1 The third evolution of ideas building my argument advocates the abandonment of the concept of countertransference per se in favor of redefining the totality of the therapist's experience as organized simply by his own transference organization (Natterson, 1991; Stolorow, 1995; Aron, 1996) My viewpoint is that the analyst and the patient ————————————— 1 I see no evidence in his article that Stern would object to this more generalized definition of countertransference, but that in focusing his own thesis he simply, expeditiously focused on the more reactive aspect of the therapist's countertransference. - 299 - encounter one another from the vantage point of their own bidimensional transference systems. When analyst and patient come together, their psychoanalytic dialogue may be, for heuristic purposes (ones that I am advocating are especially helpful for understanding therapeutic impasses), bifurcated into two classes of interactive transferences: amalgams of both the analyst's and patient's transference organizations, henceforth defined as the needed transference relationship and the repeated transference relationship. The potential for amalgamation is suggested by Orange (1995), who, paraphrasing Loewald, argues that such conditions of “‘cotransference’ treat the organizing activity of patient and analyst as ‘two faces of the same dynamic’” (p. 67). In the case of the double bind, a confusion of these logical types (i.e., the needed and the repeated relationships) results in a state of mutual mystification in which both the analyst and the analysand come to experience a system of communicating in which each feels he is “damned if he does, and damned if he doesn't.” What I am positing is that double binds occur when what is being communicated on each of the needed and repeated transference relationship levels obliterates the meaning of the other level. To understand how this paradox between the needed and the repeated dimensions of the therapeutic relationship occurs, we must momentarily entertain the significance of Russell's “Theory of Logical Types” (Whitehead and Russell, 1910) in the shaping of the double bind hypothesis. Russell's theory deals with principles governing how logical types are distinguished into classes and members of classes. The central thesis of his theory is that there is a discontinuity between a class and its members; that a class cannot be a member of itself; and that one of its members cannot represent the entire class (Watzlawick, Beavin, and Jackson, 1967p. 193) Therefore, when the distinction between logical types or levels of abstraction, that is, levels of communication breaks down, a paradox is generated. Russell's solution to such paradox is known as the “levels of language” distinction. That is, at its lowest level, language forms statements about objects. The moment we say something about this level of language, we have to use metalanguage. To talk about metalanguage, we must employ metametalanguage, and so on. The ability