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Psychotherapy of the Young Adult: The Fallacy of UnderstandingCommentary by Marylou Lionells, Ph.D.
From a third millennium perspective, mid-twentieth century psychoanalytic thinking seems almost quaint. Neurosis was essentially a disease entity. Technique was prescriptive. Analyses were short. "Cure" was promised. Freud's genius had been discovered and the post- World War II world deeply needed the services of his followers. In Europe where psychoanalysis was already firmly established, adherents of various theories were beginning to develop separate camps, but in the United States the Classical establishment was dominant. American institutes were largely staffed by analysts who had fled their homelands and eagerly started anew in many different cities across the country. The developments of ego psychology, originating in mid-America and initially viewed with some suspicion, soon were embraced as offering psychoanalysis an enriched base, enhancing it's appeal to mental health professionals as well as to academics and intellectuals. Nonetheless, Freudian Institutes, organized into the American Psychoanalytic Association, sought to maintain prestige by limiting membership to members of the medical profession.
The 1950's and 60's were indeed the golden age for psychoanalytic practice. Anyone who was (or wanted to be) anyone needed the credential of serious couch-time. Popular novels and films introduced the image of the analyst to the public, and even the Broadway musical world celebrated this new method of liberating the human spirit. Practices were full, the standard $25 fee seemed amazingly high, and waiting lists were long. Analysts formed a new elite, all the more special for remaining aloof and mysterious.
Perhaps picking up from Freud's unfulfilled dream of a fully "scientific" psychoanalysis, theorists in the United States began refining their views of analytic technique. They elaborated the concept of the analyst as a tool, an analyzing instrument whose applications needed to be carefully calibrated. Analytic interventions were seen as intrinsically powerful and potentially dangerous. In time, the person of the analyst became considered an impediment, potentially distorting the use of curative analytic medicine, accurate, well timed, carefully honed interpretation. The core assumption was that understanding provided the key to psychic freedom, replacing id with ego, and that such insight depended on objectivity." Candidates were taught to restrict every indication of personal taste, values, attitudes, and life experience. Power was assumed to reside in anonymity and neutrality, extending to the consulting room itself, devoid of personal decoration or evidence of human habitation. Eventually, these prescriptions were distilled into a model called the "standard technique."
Despite the predominance of analytic orthodoxy, there remained a few outposts of radical dissent. Freud's most vocal challengers, Jung, Adler, Horney, each was the center of deeply committed analytic training groups. And perhaps the most flourishing alternative center in New York City was the William Alanson White Institute. White was distinctive in several ways. It had been organized by people who were originally part of the American Psychoanalytic. Its founder, Clara Thompson, was analyzed by Ferenczi. Erich Fromm, a co-founder, had attended the Berlin Institute. However the main intellectual influence on the Institute was Harry Stack Sullivan. Sullivan studied Freud's theory independently but had never attended an institute or even been seriously analyzed. And Sullivan started from a series of premises that were essentially American, informed by a spirit of optimism and egalitarianism. Of major importance however, Sullivan was influenced by the social and psychological insights of his generation into becoming a field theorist, following the lead of sociologists and philosophers of the "Chicago school." He found Freud's mechanistic, biological, evolutionary model of mind to be burdened by clumsy metatheory and based on outdated models. Sullivan could not imagine that the individual should ever be viewed as a scientific specimen, in isolation from his socio-cultural surround. People are always, inevitably interacting, in every aspect of living, and certainly in the therapeutic encounter. In his view, man does not need culture to tame and shape his bestial nature, but instead is pressured and sometimes oppressed by an unyielding environment into expression of the states of distress we know as pathological. In contrast to the ideal of neurosis based on a medical disease model, Sullivan labeled psychiatric disorders as "clinical entities" or "problems in living." Moreover, Sullivan defined the analytic practitioner as "participant observer," inevitably and intrinsically involved in the analytic relationship.
So the White Institute offered a radical alternative to the Freudian model of human nature, and especially to existing ideas about clinical technique and effectiveness. But Sullivan died young. Some of his followers at White were more interested in creating a creditable training program than in integrating his views into a coherent theory. In expanding Sullivan's rather sketchy ideas to a full blown model of psychoanalytic practice, many White Institute analysts pursued a modified version of "standard technique," including free association, interpretation, and avoiding expression of personal emotions or reactions. They, like more traditional analysts, defined counter-transference as an interference with the analytic process. And what constituted counter-transference was any unplanned intrusion on the part of the analyst into the patient's psychological space.
Nonetheless, among the senior analysts at White there remained a strong tradition of experimentation and open-mindedness as well as an emphasis on clinical experience over theory. The legacy of Thompson, Sullivan, Fromm and Fromm-Reichman was enriched by a diverse cadre of provocative thinkers, including Arieti, May, Minuchin, Moulton, Schachtel, Singer, and Tauber. I entered analytic training at the White Institute in 1967. Drawn to the humanistic and individualistic spirit of the place, I was also aware that White was distinguished as one of the few centers where a psychologist could receive a fully structured and intensive analytic education. Although there were plenty of indications that the "golden age" of analytic practice was drawing to a close, we did not believe that T-groups, self-help books, and gurus would replace our jewels of insight. But psychoanalysis itself was facing a new set of challenges in that era. It did not always work. Time and again one heard tales of patients who did not thrive, who went from couch to couch, never seeming to improve. Such failure was generally attributed to faulty technique or an error in diagnosis. Not that there could be a serious problem with traditional analytic assumptions, but that they were not properly applied, or were applied to the wrong person. Certain groups of patients were deemed "analyzable" or "non-analyzable," although generally that determination could only be made after it was seen if the treatment worked! Patients who created too much difficulty, or who evoked unruly reactions from the analyst, were simply labeled incapable of sustaining the rigors of treatment. Unless of course the analyst (usually a candidate) was not well enough analyzed and therefore unable to curb and/or understand and contain associations, fantasies and other reactions to the patient.
One of the many traits that distinguished analysts at the White Institute was their insistence on extending the limits of analyzabilty. Starting with Sullivan and Frieda Fromm Reichmann, analysts at White had been treating a wide range of patient pathology, including paranoia, schizophrenia and psychosis. Tauber and Green, writing in the late 1950's, had even experimented with expressing personal reactions, including dreams, in the attempt to deepen the analytic relationship. And by the late 1960's the British object relations theorists had been discovered by White. Laing and Guntrip both presented at the Institute. Melanie Klein was taught in the required curriculum, and knowledge of Winnicott was fairly widespread. And in the wider analytic community people were beginning to accept the notion of borderline personality states, re-examining ideas about narcissism, and admitting that countertransference was more a fact of analytic life than an occasional eruption.
The White Institute celebrated it's twenty-fifth anniversary in 1968 with a major professional conference. A succession of the Institute's most eloquent faculty and graduates used the occasion to reflect on the state of analytic theory and practice. Even today, rereading the collected papers is impressive (including Schechter, Arieti, Singer, Schachtel, Wolstein, Fromm and May). But even in this notable group, Edgar Levenson's contribution is dazzling. Levenson headed a group that had been working for some years with college dropouts, the legacy of the notorious "tune-in, turn-on, dropout" sentiments of the 60's drug culture. He became fascinated with the problems of understanding a generation that seemed to turn its back on its elders, while at the same time holding a mirror to reflect conventional rigidity and hypocrisy. The beginning of the presentation did not seem so promising. Levenson spends the first portion of his essay urging his audience to rethink their prejudice concerning then-contemporary young adults, accepting the idea that the adolescent world is reflective of a new socio-cultural era. He then argues that to understand these patients requires a new analytic paradigm, one that is congruent with the new idiom that these patients represent.
This is where it gets interesting. Levenson goes on to outline an approach to psychoanalysis that breaks every rule, violates every tenet, turns both theory and method on their heads. Levenson looks at surfaces not depths. He puts his trust in the analyst's feelings, not ideas. Levenson suggests that the goal of treatment is the expansion of mind and possibility rather than resolution of conflict or "cure." He sees the analyst as artist, not scientist. Summarized as the "fallacy of understanding" Levenson presents his recognition that analytic growth and change is dependent upon an unraveling of mutual experience rather than an exposition of interpretations. He further argues that as the treatment relationship unfolds, patient and analyst are inexorably intertwined in an elaborate recurrence of unconscious patterns, and that the recognition and elaboration of these patterns constitutes the experiential information that will be ultimately helpful. What audacity! What heresy! What a relief! In this remarkable presentation, ostensibly tied to a particular patient population at a particular time, Levenson has burst the major assumption of psychoanalytic practice. He not only values the analyst's self experience, he argues that it is central to analytic process. He not only dismantles the need and value of objective interpretation, he dismisses them from the realm of significant interventions. He relieves us of the dehumanizing burdens of anonymity and strict neutrality, instead privileging personal experience and reactivity. In his 1972 book of the same name, Levenson goes beyond the self-imposed limitations in this article, recognizing that the principles he has discovered may be generally applicable rather than limited to young people of a certain generation. His ideas about the inevitability of mutuality and transformation and the importance of using countertransferential data have now become wholly mainstream.
Even though much of this article is couched in the language and themes of it's time, it is remarkable how relevant much of the material remains. Levenson's clinical acumen is such that his examples remain compelling even when the references begin to seem dated. Throughout his distinguished career, he has always appropriated the language and concepts of the cutting edge in his quest to push the boundaries of analytic practice and helpfulness. The piece concludes with a plea that as analysts we keep our "language uncalcified and our concepts young." (P. 167). Levenson himself certainly has done so.
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