the view from the tip of the iceberg - CiteSeerX

Lawrence Josephs 45/2

THE VIEW FROM THE TIP OFTHE ICEBERG

In recent years there has been a growing interest in refining the techniqueof ego defense analysis. All of these approaches share in common anattempt to work closely with the patient’s free associations, to interpretat a level that is accessible to the patient’s consciously observing ego, andto avoid bypassing the analysis of the patient’s most surface-levelresistances in an effort to understand unconscious conflict. These innova-tions reflect a commendable effort to work in a way that is rigorouslyempirical, that respects the patient’s autonomy, and that minimizes thepressure of the analyst’s transferential authority in the patient’s acceptanceof the analyst’s interpretations. Despite the undeniable value of thesetechnical innovations, such approaches to ego defense analysis mayinadvertently result in certain overemphases in technique that mayunnecessarily constrain the analytic process. They may result in a sort ofobsessive tunnel vision that is overly focused on small details to theexclusion of the larger picture. An approach that counterbalances themicroscopic and the macroscopic analysis of ego defense is recommended.

In recent years there has been growing interest in refining the techniqueof ego defense analysis, a trend best reflected in the work of

Apfelbaum and Gill (1989), Gray (1994), and Busch (1995). Theseauthors share in common an attempt to work closely with the patient’sfree associations, to interpret at a level accessible to the patient’sconsciously observing ego, and to avoid inadvertently bypassing theanalysis of surface-level resistances in an effort to understandunconscious conflict. These innovations reflect a commendable effortto work in a way that is rigorously empirical, that respects the patient’sautonomy, and that minimizes the pressure of the analyst’s transferen-tial authority in the patient’s acceptance of the analyst’s interpretations.These refinements in technique have also involved a more sophisticated

japa

Associate Professor, Derner Institute of Advanced Psychological Studies,Adelphi University.

Submitted for publication December 29, 1995.

at PENNSYLVANIA STATE UNIV on May 12, 2016apa.sagepub.comDownloaded from

http://apa.sagepub.com/

use of structural concepts. Appreciation of the relation between drive-defense sequences and the issue of ego syntonicity/dystonicity(Apfelbaum and Gill 1989), discovery of the moment in a patient’s freeassociations when a conscious drive derivative is rerepressed (Gray1994), and the careful adjustment of interpretations to the currentcapacity of the patient’s ego to assimilate them (Busch 1995) aretheoretical advances that allow the technique of interpretation to becomemore accurate, precise, and effective.

Despite the genuine value of these technical innovations, however,such approaches to ego defense analysis may inadvertently result in cer-tain overemphases in technique that may unnecessarily constrain theanalytic process. Not infrequently in the history of psychoanalysis, whena neglected area is investigated and new discoveries are made, a ten-dency arises to overemphasize the importance of these discoveries, lead-ing to a skewed approach to treatment. Sometimes the old is contrastedunfavorably with the new, or set in contradistinction to it, so that the oldwill be rejected. The two are viewed as mutually exclusive and irrec-oncilable, but if instead they are viewed as complementary, it can beappreciated that each requires the other as a counterbalance. Each sidecorrects and compensates for the blindspots and limitations of the other.

I would suggest that the “close process” monitoring approach ofcontemporary theorists (see Goldberger 1996), which focuses on theanalysis of microscopic defensive processes within the stream of thepatient’s free associations and accessible to the patient’s consciouslyobserving ego, may lead to a sort of tunnel vision. What may be neglectedis a recognition of the sort of macroscopic defensive processes (i.e.,character defenses) first described by Reich (1928). An exclusive focuson the microscopic can result in an obsessive type of analytic processin which the forest is not seen for the trees. A less constrained technique,I suggest, requires an optimal balance between microscopic andmacroscopic levels of defense analysis. I do not think that analytic worknecessarily unfolds in a linear sequence in which convincing explorationof small details leads gradually and invariably to an appreciation of thebigger picture. Instead the work typically unfolds in a more dialecticalmanner in which one goes back and forth between consideration of micro-and macrodefenses, appreciating that each can defend against awarenessof the other.

In the emphasis on interpreting material accessible to the patient’sconsciously observing ego can be found a tendency to think of that ego

L a w r e n c e J o s e p h s

426



THE VIEW FROM THE TIP OF THE ICEBERG

as a unitary structure capable of observing intrapsychic conflictobjectively, without becoming embroiled in it. Yet this seems to under-emphasize Freud’s original observation (1937) that there is no suchthing as a normal ego. As a result of defensive splitting of the ego, allegos are partially fragmented, at least into conscious and unconsciousaspects, and therefore all ego functioning is potentially compromised asa result of unconscious conflict. From this perspective, patients are seento possess a number of conflicting observing egos that often operateunconsciously. Self-observation, self-reflection, and self-analysis maybe biased for unconsciously wishful, defensive, and self-critical rea-sons. It might therefore be useful to think of the observing ego, just asBrenner (1982) has conceptualized the superego, as a compromise for-mation. The observing ego may well be composed of conflicting identi-fications, for it is established, after all, on the basis of a defensive splitin the ego that separates a rational ego from an experiencing ego. Toapproach the patient’s conscious observing ego solely as an objectivecollaborator in the analytic process is to forget the seminal insightthrough which Freud was able to establish that the presumably rationalego of consciousness has its basis in unconsciously wishful andirrational thought processes.

For Freud (1900), the conscious rational ego was but the tip of theiceberg, concealing while indirectly revealing hidden unconsciousprocesses. Of course, from the standpoint of clinical technique, it isinvaluable to be able to observe psychic processes with the pinpointaccuracy afforded by the view from the tip of the iceberg, and in thisregard the recent innovations in ego defense analysis have been quiteuseful. Yet if we realize that the observing ego cannot stand outside ofconflict but is in fact embroiled in it as part of a compromise forma-tion, we might assume that there are a number of conflicting views tobe had atop the iceberg, depending on the direction one is facing.Patients exercise multiple and conflicting modes of self-observation,self-reflection, and self-analysis, both conscious and unconscious. Anytime an analyst interprets in a manner that facilitates the patient’s useof one of these modes, the analyst unwittingly takes sides in a conflictand so cannot be considered fully neutral in a technical sense. There isno singular objective observing ego, one standing outside of conflictwith which the analyst can collaborate and form an alliance. The ana-lyst can only strive to interpret the conflict between whatever contrast-ing observational perspectives on the self the patient possesses. The

427



beneficial impact of analysis shows itself in the patient’s acquisition ofthe ability, not so much to observe the self in one singularly truthfuland objective manner, as to observe it from multiple perspectives,thereby transcending a narrow-minded, unidimensional approach toself-understanding.

A BRIEF HISTORY OF EGO DEFENSE ANALYSIS

In his papers on technique, Freud elucidated a variety of technicalprinciples that can be summed up in two well-known precepts: that oneshould always work from surface to depth and that one should alwaysinterpret resistance before content. Resistance to free association wasconceptualized as the main impediment to making the unconsciousconscious. Initially Freud viewed resistance as a surface phenomenonpreventing access to greater depth. The analyst, he wrote (Freud 1914),“contents himself with studying whatever is present for the time beingon the surface of the patient’s mind, and he employs the art ofinterpretation mainly for the purpose of recognizing the resistances whichappear there, and making them conscious to the patient” (p. 147). In hispaper on wild analysis Freud (1910) cautioned against interpreting toodeeply. “The pathological factor,” he wrote, is not the patient’s“ignorance in itself, but the root of this ignorance in his inner resistances.. . . Informing the patient of his unconscious regularly results in anintensification of his troubles” (p. 225). Freud (1913) provided thisrecommendation for adjusting the level of interpretation: “Even in thelater stages of analysis one must be careful not to give a patient thesolution of a symptom or the translation of a wish until he is already soclose to it that he has only one short step more to make in order to gethold of the explanation for himself” (p. 140).

Despite this recommendation, Freud discovered that resistanceanalysis was no simple task of clearing away surface inhibitions to freeassociation. With the advent of the structural model in 1923, he wasable to formulate theoretically the clinical phenomenon of resistance tothe awareness of resistance—patients were resistant to acknowledgingtheir resistances. In the structural model, resistance could be under-stood as in part a function of the unconscious defensive activity of thepatient’s ego: “There can be no question but that this resistanceemanates from his ego. . . . We have come upon something in the egoitself which is made conscious (Freud 1923, p. 17). Thus, the technical


428




rule of interpreting resistance before content could be amended to readas a recommendation to analyze ego before id—that is, ego defensebefore id wish. The elucidation of drive-defense sequences became thecornerstone of technique from the perspective of the structural model.With Freud’s second theory of anxiety (1926), it became clear that it isanxiety that triggers unconscious ego defense. As a forbidden drivederivative threatens to emerge into consciousness, evoking anxiety inregard to an anticipated situation of danger, unconscious ego defensescome into play to ensure the repression or re-repression of that anxiety-arousing drive derivative.

Reich (1928) refined the technique of resistance analysis bydeveloping an approach to the analysis of character resistances. Hecriticized the standard analyses of his day as being overintellectualizedand avoidant of the latent negative transference. Reich suggested that acrucial but heretofore neglected form of resistance was to be found inthe patient’s bearing and attitude: “The ‘how’ is just as important as the‘what’ the patient says as ‘material’ to be interpreted” (p. 135). Thepatient’s neurotic character structure serves as a resistance topsychoanalysis, a resistance that is difficult to analyze because it is ego-syntonic: “The symptom appears to be meaningless, whereas the neuroticcharacter is sufficiently rationally motivated as not to appear eitherpathological or meaningless. For the neurotic character traits a reasonis often put forward which would immediately be rejected as absurd ifit were applied to symptoms, such as: ‘He just is that way’—with itsimplication that he was born so, that this ‘happens to be’ his character,which cannot be altered” (p. 133).

The technique of character analysis is to render the ego-syntoniccharacter trait ego-dystonic so that it can be subjected to analysis: “Weisolate the character trait and confront the patient with it repeatedly,until he has attained objectivity towards it and experiences it like adistressing compulsive symptom. The neurotic character thus takes onthe nature of a foreign body, and becomes an object of the patient’sinsight” (p. 139). This technique, which seems to evoke considerablenegative transference of an adversarial nature, has been controversial.On the positive side, as Reich suggested, this technique brings the latentnegative transference to the fore to be analyzed. On the negative side,it seems to inflict unnecessary narcissistic injury. Perhaps the patientaccepts the analyst’s interpretations only under duress, under the pressureof the transferential authority of a confrontational analyst.

429



Fenichel (1953) expressed some concern as to the zealousness withwhich Reich’s principles might be applied: “I believe that the ‘shatteringof the armor plating’ could be done in a very aggressive way, but thatthe aggression and the consequent disintegration of the armor can bedosed, and indeed, that it is the task of the physician to make this procedureas little unpleasurable as possible for the patient. The first thing we mustbe clear about is that the consistent tackling of the patient’s charactertraits wounds his narcissism much more than any other analytic technique”(p.339). Unfortunately, patients may experience overaggressive characteranalysis as something rather akin to character assassination.

The historical evolution of ego defense analysis can be seen as aneffort to counterbalance and develop an alternative to Reich’soveradversarial approach to resistance analysis, with its overreliance onthe pressure of the analyst’s transferential authority. Sterba (1934)suggested that analysis proceeds through a collaborative alliance withthe patient’s observing ego. Any interpretation is too deep and ispremature if it bypasses and fails to make a connection to the patient’sconsciously observing ego. Fenichel (1941) put the issue quite well whenhe discussed his method of working from surface to depth: “When aninterpretation has no effect, one often asks oneself: ‘How could I haveinterpreted more deeply?’ But often the question should correctly be put:‘How could I have interpreted more superficially?’. . . For we mustoperate at that point where the affect is actually situated at the moment;it must be added that the patient does not know this point and we mustfirst seek out the places where the affect is situated” (pp. 44–45).

Fenichel (1941) provided the following criterion for assessing whenan interpretation is too deep: “When is an interpretation too deep? Whenthe patient cannot recognize its correctness by experiencing the impulsesin question” (p. 45). He suggested (Fenichel 1953) that one is interpretingat the surface “when there is a minimum of distance between allusionand what is alluded to” (p. 322) and “when the distance between whatis said and what is meant is at a minimum” (p. 324). According toFenichel, one never interprets repressed drives directly, only theirpreconscious derivatives (p. 341). In regard to interpreting unconsciousego defense and resistance, he suggested that “one cannot reveal moreto the patient than what he is able to discover in himself by self-observa-tion” (p. 341). All of Fenichel’s technical recommendations areeminently reasonable—if only it were clear what exactly is meant bythe concept of the psychic surface.


430




Glover (1955) complained that the concepts of surface and depthwere not given clear-cut definitions. Deep might refer to a develop-mental stage or to the relative inaccessibility of a psychic content toconsciousness. Loewenstein (1951) noted that the term surface possessesseveral meanings: it can refer to (1) the patient’s current reality situationand present interest; (2) accessibility to conscious awareness, thusincluding preconscious content and processes; (3) the point of emotionalurgency that highlights the state and nature of conflicts between driveand defense at the immediate moment; or (4) those aspects of the patient’smental activity, such as an observing ego, that are at the disposal of thepatient’s autonomous ego functions. More recently, Levy and Inderbitzen(1990) have given four somewhat different definitions of the psychicsurface: (1) the point of emotional urgency in the here-and-now transfer-ence; (2) the surface manifestations of unconscious conflict that can beobserved and scrutinized by the patient; (3) continuities and especiallydiscontinuities in the process of free association; and (4) the perceptualand experiential world of the patient, especially the patient’s experienceof the discrepancies between the psychic realities of patient and analyst.

Perhaps the best way to think of the surface-depth dimension, atleast when it comes to considerations of ego defense analysis, is tothink in terms of levels of defensiveness. Deep describes content ofwhich the patient is most defensive, whereas surface refers to contentof which the patient is least defensive. To interpret from surface todepth can then be defined simply as interpreting the latter before theformer. This would be relatively easy to accomplish if defenses wereclearly stratified top to bottom, an arrangement Freud’s topographicmodel (1900) had seemed to imply. Analysis was analogous to anarchaeological dig or to peeling the layers of an onion. Reich’sapproach also implied a stratification of the psychic apparatus, as onebroke through the “character armor,” the covering layer, to get at thesexuality, aggression, and anxiety that lay underneath.

Yet the advent of Freud’s structural model (1923) made it difficultto conceive of the mind as composed of clearly stratified layersdescending in linear sequence from surface to depth. On the new model,defenses may be unconscious and therefore deep, as may superego self-criticism and the workings of self-censorship. Paradoxically, explicitsexual and aggressive fantasies may be conscious, may serve defensivefunctions, and may therefore be surface phenomena. Fenichel (1941)noted that in the service of defense a reversal can occur between the

431



defensive side and the wishful side of a compromise formation. Notonly do defenses ward off the awareness of instincts (and of defensesthemselves), but “instinct serves for the suppression of instinct” (p. 57),just as there “are reaction-formations against reaction-formations”(p. 61). When drives can function as defenses and defenses as a meansof drive discharge, determining what is drive and what is defensebecomes confusing. Fenichel (1941) provided the example of a manwho became passively feminine as a defense against castration anxietybut then assumed an exaggerated masculinity as a defense againstpassive femininity. Were the passive femininity and exaggeratedmasculinity drive-determined expressions of, respectively, bisexualityand phallic narcissism, or was one (or both) a defensive attitude?

With the advent of the principle of multiple function (Waelder 1930),the question no longer must be posed as an either/or. The answer is thatboth passive femininity and exaggerated masculinity are compromiseformations serving multiple functions, both drive-gratifying anddefensive. Anna Freud (1936) had noted that the basic problem fordefense analysis is that “all the defensive measures of the ego againstthe id are carried out silently and invisibly. The most we can ever do isto reconstruct them in retrospect: we can never really witness them inoperation” (p. 8). What we can observe in consciousness are compro-mise formations; the multiple and conflicting functions of which thesecompromise formations are derivative phenomena remain unconscious.

Brenner (1982) resolved the question of what is drive and what isdefense by formulating a functional definition of the latter. He suggestedthat there are no special mechanisms of defense and that whatever occursin mental life that results in less anxiety or depressive affect can beconsidered a manifestation of defense. Whatever a person does thatreduces unpleasurable affects can be considered a defense against them,and any aspect of id, ego, or superego functioning can serve a defensivefunction if it serves to attenuate anxiety and depression. There is noaspect of personality functioning that does not include defense as oneof its multiple functions. Since all psychic phenomena are compromiseformations that include defensive functions, there is nothing a persondoes that is not, at least in part, defensively motivated. Defense analysisis therefore the analysis of the defensive function or motivation behindwhatever it is the person is doing, thinking, feeling, or imagining.

Schafer (1983) articulated an “affirmative” approach to defenseanalysis as a means of shearing defense analysis of its adversarial rem-


432




nants. Schafer recommended that the analyst “approach it not as resist-ing or opposing but as puzzling or unintelligible behavior that requiresunderstanding” (p. 168). This affirmative approach focuses largely onwhat resisting is for, rather than simply what it is against (p. 162). “Byemphasizing character’s value to the analysand in his or her psychicalreality this orientation avoids the kind of adversarial orientaion on theanalyst’s part which centers on the ways in which character functionsas resistance” (p. 148). Schafer’s affirmative approach to defense analy-sis is analogous in many respects to Kohut’s self psychological approach(1984): “Defense motivation in analysis will be understood in terms ofactivities undertaken in the service of psychological survival, that is, asthe patient’s attempt to save at least that sector of his nuclear self how-ever small and precariously established it may be” (p. 115).

This brief and certainly less than comprehensive review of the historyof ego defense analysis brings us to more recent developments. To sumup, there is consensus that defense analysis must begin at the psychicsurface, at a level accessible to the patient’s consciously observant ego.There is consensus also that defenses are not rigidly stratified in fixedlinear sequence progressing from surface to depth. Anything the patientdoes may serve a defensive function and be defensively motivated. Onedoes not analyze defense mechanisms or defenses as if they were reifiedpsychic entities. Rather, one analyzes the defensive functions or motiva-tions of the patient’s compromise formations. There is relative consensusthat to avoid an adversarial form of resistance analysis, defenses are bestapproached from an affirmative orientation that shows empathy for theiradaptive function in attenuating the anxiety inherent in an anticipatedsituation of danger and in enabling the patient to maintain a cohesivesense of self. The question remains, though, of just how it is that oneactually implements these technical recommendations in clinical practice.

THE RELATIVITY OF DEFENSE

Apfelbaum and Gill (1989) addressed the dilemma of how, when driveand defense are reversible, one ascertains what in a given instance isdefense and what the defended-against. They cited Kernberg’s method(1984) of addressing this issue in borderline conditions:

The predominance of splitting over repressive mechanisms permits thealternation in consciousness of the dynamically opposed componentsof intrapsychic conflict so that access to consciousness per se does not

433



serve to indicate which is the defense and which the impulse aspect ofthe conflict. Defense and impulse can be rapidly interchanged in thealternating reversals of activated object relations that are typical of part-object relations and conflictual impulses that are conscious and mutuallydissociated or split off rather than repressed. Here, consciousness andunconsciousness no longer coincide with what is at the surface and whatis deep, what is defense and what is content. But while the topographicapproach to interpretation (the ordering of material from surface todepth) no longer holds for such borderline structures, the moment-to-moment decision of which is the defensively activated ego state directedagainst which other impulsive ego state is very important. . . . That taskoften requires relatively rapid, imaginative tracking of what appear tobe chaotic interactions [pp. 224–225].

Apfelbaum and Gill suggested that the assessment of what is driveand what is defense can be made by determining what the patientcurrently experiences as ego-syntonic and ego-dystonic. The formerconstitutes defense, the latter the defended-against. Apfelbaum and Gillhave ingeniously employed a structural concept (the ego-syntonic / ego-dystonic distinction) to address both a topographic question (how tointerpret from surface to depth) and a structural question (how to interpretdefense before drive). An assessment of the ego-syntonicity/dystonicitydimension allows the level of defensiveness to be assessed. The greaterthe discrepancy, incongruence, or distance between an ego-syntonicperception and an ego-dystonic one, the greater the need for defense.The technical implication is that one interprets small discrepancies beforegoing on to large ones.

Apfelbaum and Gill criticized the topographic model for implyinga “layer” concept that makes defense seem like a simple cover or barrier,on the surface of the mind, that must be penetrated in order to go deeper.Rather than visualize defense topographically as an overall pattern ofdefense, they suggested that defense should be visualized microscopi-cally in the moment as a fluid dynamic relationship between two contentsthat are interchangeably drive and defense: “What appears clinically tobe a covering layer, if looked at in smaller units of experience, will befound to be warded-off by another, less apparent content” (p. 1080).They suggested that if a patient rejects an interpretation angrily it is theid-analytic view that the presence of a warded-off wish is confirmed,whereas it is the ego-analytic view that such a response may be expres-sive of unanalyzed superego effects. The interpretation is experiencedas a superego injunction because the analyst has missed the degree to


434




which the interpretation addresses an ego-dystonic issue withoutempathy for the bypassed ego-syntonic view that is the source ofresistance to the ego-dystonic elements of the analyst’s interpretation.

Apfelbaum and Gill (1989, pp.1077–1079) illustrated their approach indiscussing a case by Kanzer (1981). The hour immediately previous to thesession discussed had been canceled because it fell on a three-day week-end holiday. Kanzer inferred that the missed session was experienced asif it were a cancellation by the analyst, with the patient unconsciouslyreacting by feeling angry and affronted and wanting to retaliate, a trans-ference repetition involving a distant and rejecting father. The patientbegan the hour by expressing his enjoyment of the holiday weekend,which Kanzer thought of as a denial of the session’s loss. The patientalso expressed anger at the cabdriver who had made him late to the pres-ent session. He then said that he wanted to cancel a session at a later dateto help his son get settled at college; this Kanzer viewed as tit for tat.

Kanzer’s single intervention during the hour was a confrontation tothe effect that it was difficult for the patient to swallow the fact that hehad missed the analyst. The purpose of the interpretation was to preventa flight from recognition of dependency. Because the analysis was welladvanced and nearing termination, Kanzer felt, given the success ofearlier defense analysis, that the patient would be able to integrate sucha confrontation. The latter responded to the interpretation with a memoryof when at the age of eight he was in the shower with his father and feltclose to him. The patient then commented scornfully, “I suppose youwould say that I wanted to put his penis in my mouth, and that I wantto put your penis in my mouth.” As the patient ended the session androse from the couch, he lisped in a little boy voice, “Now I have to makea pee-pee,” and then smiled and left. Kanzer took the patient’s responseto his interpretation as evidence of its success—as indicating that thepatient was able to tolerate the humiliating fantasy of fellatio with hisfather and the analyst.

Apfelbaum and Gill noted that Kanzer was directly interpreting apresumably ego-dystonic wish. Because Kanzer had neglected to askwhat at that moment was ego-syntonic for the patient, the interpretationcould be experienced as a superego injunction to the effect that the patientshould “swallow” the analyst’s interpretation. They suggested an alterna-tive interpretive approach that acknowledged the patient’s ego-syntonicsense of how dependent or independent a mature adult should be. Theyproposed saying something along the lines of “There are some hints here

435



that you may have felt affronted by my canceling the last hour, but itlooks like you would really hate to feel that. It would make you feelpetty and childish, especially since it was a national holiday” (p. 1092).If independence is ego-syntonic and dependence ego-dystonic, theninterpretation of defended-against dependence must always include aninitial reference to wished-for independence, with which dependencywishes are in conflict. Apfelbaum and Gill suggested that when thepatient responded angrily to Kanzer’s interpretation, a good follow-upmight have been to inquire whether the interpretation was experiencedas an accusation, so that hidden superego effects could be analyzed ratherthan bypassed and enacted.

If we extend Apfelbaum and Gill’s ideas concerning the relativityof defense one step further, we might realize that as independence defendsagainst fears of dependence, the opposite may also be true. Kanzer’spatient might have been ashamed of his wishes to be dependent on hisanalyst/father, especially given the homoerotic implications, but he mightsimultaneously have been guilt-ridden about his wishes to be indepen-dent of the analysis as it approached termination, and so might havefeigned dependency in order to prolong the relationship. There is someambiguity here as to what is ego-syntonic and what ego-dystonic, andthe two may be reversible even within the session. For example, thepatient, though he “scornfully” parodies the interpretation he imputes toKanzer, ends the session self-effacingly, lisping like a little boy andperhaps implying homosexual submission. The patient, reluctant to rejectKanzer’s dependency interpretation openly, rejects it implicitly throughthe parody. Yet in the end the patient’s self-effacing humor seems toconfirm the interpretation that he is dependent in a passive homoeroticmanner. If shameful dependence is viewed as partially ego-syntonic anddefends against guilt-ridden independence that is partially ego-dystonic,one might interpret thus: “Though it angers you that I see you asdependent rather than independent, you seem to feel guilty aboutrejecting my interpretation, suppress your anger, and then act the roleof the dependent little boy you think I want you to be.”

If it is somewhat ambiguous here what is ego-syntonic and what isego-dystonic, is there a way of interpreting that does not require aneither/or choice? Perhaps the ambiguity reveals another level ofintrapsychic conflict. For example, Kanzer’s patient seems conflictedbetween independence and dependence vis-à-vis his analyst, and eachside of the conflict is both ego-syntonic and ego-dystonic. It would be


436




taking sides in the conflict to view each of the two sides as entirely oneor the other. The more comprehensive and technically neutral interpre-tation might sound something like this: “On the one hand, you wouldhate to feel that you missed our canceled appointment because you wouldfeel childish to feel that dependent on me; on the other hand, it is difficultfor you to assert your independence of me, and your anger at me whenI seem to deny your independence, so instead you act the part of adependent little boy.” Of course, before such an interpretation is made,the patient would have to have become familiarized with each side ofthe conflict through prior interpretive work. If syntonic independencedefends against shameful and therefore dystonic dependence, even assyntonic dependence defends against guilt-ridden and therefore dystonicindependence, it behooves the analyst to find a way to address both sidesof the issue.

Though the microscopic approach of Apfelbaum and Gill is illumi-nating, their rejection of the macroscopic approach that assesses theoverall patterning of defense seems premature. Kanzer’s patient at a“macro” level alternated between displays of dependence and indepen-dence in relation to the analyst and thereby manifestly presented a con-flict to him. Yet since all psychic phenomena, by virtue of beingcompromise formations, serve defensive functions among others, is itpossible that this conflict serves a defensive function that indirectlyreveals (even as it conceals) a deeper, warded-off conflict? A manifestconflict may well defend against a latent conflict. Perhaps the patient’smanifest conflict around dependence and independence defends againsta latent conflict around hierarchy versus mutuality in a relationship. Thepatient, though approaching termination, seems to have difficulty estab-lishing a more mutual, person-to-person relationship with his analyst.Perhaps the memory of taking a shower with his father reflected not onlythe wish for a passive-dependent homoerotic relation with the father/ana-lyst but also a deeper wish for a “man-to-man” relationship in whichboth are their “naked true selves,” the sort of relationship he might havewished he could have with the analyst but, because of an unanalyzedsuperego transference related to internalized but unanalyzed homo-phobia, feared he could not.

It could be that a focus on the microscopic issues obscures the big-ger picture that may need to be addressed as an analysis approaches ter-mination. To interpret at the macroscopic level, the analyst might saythe following: “As we near the end of the analysis, we seem to get

437



caught up in establishing whether you are independent or dependent inrelation to me. Though this is an important concern, it seems to obscureyour wish to have a more equal person-to-person relationship with me,a wish you feel is difficult to express if you see me as simply the dis-tant analyst who makes the interpretations with which you are supposedto agree and who shames you by seeing you as a dependent little boywho is expected to suck my penis.” At a macro level of analysis, anego-syntonic dependence/independence conflict defends against anego-dystonic conflict between mutuality and hierarchy. To remain inthe former conflict maintains the analyst’s position as a parental author-ity figure the patient may defy by becoming independent or obey byremaining dependent. Such a conflict leaves room to address wishes for(and fears of) a more mutual relationship between two equal adults con-cluding what has been a very intimate working relationship. Whetherthe patient celebrates his independence, like a defiant adolescent, ordisplays his homoerotic submission, he does not approach the analystas an adult and as an equal.

To ensure a balanced approach to technique, it is useful to appreciatethat each side of a conflict is syntonic in some respects and dystonic inothers. Just as an exclusive focus on character resistance may lead to asense that resistance analysis is akin to chipping away at an impene-trable stone wall, so an exclusive focus on the microscopic analysis ofdefense can lead to a sort of obsessive tunnel vision in which one doesnot see the forest for the trees. Micro and macro levels of defense analysismust be counterbalanced, as each can potentially obscure the other.

To present a general rule for interpretive sequencing, we recommendthat the analyst begin with the microscopic analysis of ego defense usinga close process monitoring approach that examines the sequence of thepatient’s free associations. As Apfelbaum and Gill have recommended,one listens here with an ear to the relations between the ego-syntonicand ego-dystonic aspects of the material. If one appreciates the relativityof drive and defense, syntonic and dystonic, it is understood that themicroscopic analysis of defense is incomplete until the reversibility ofdrive and defense is demonstrated to the patient. Failure to make thisdemonstration could be unconsciously experienced by the patient as theanalyst’s taking sides in a conflict and thereby abandoning the stance oftechnical neutrality. Once the relativity of defense has beendemonstrated, one can proceed to the macroscopic level of defenseanalysis. At this level an attempt is made to understand how the manifest


438




conflict presented by the patient at the psychic surface may serve todefend against awareness of a latent content the patient unconsciouslyrepudiates. Having interpreted the macro level of defense, one thenreturns to the micro level of analysis in order to demonstrate how thelarger pattern manifests itself in the small details.

RETURN OF THE REPRESSED AND ITS RE-REPRESSION

Gray (1994) has cautioned against overuse of the transference ofauthority in overcoming resistances. He considers such overuse routinein the technique of analysts he calls the “deep divers”—analysts sofascinated with the interpretation of drive derivatives that they neglectto elucidate the details of ego defense. This neglect is made all theeasier by the fact that these details are difficult to observe because thedefensive activity of the ego is ego-syntonic and is not driven to seekconscious representation, as are the drive derivatives of the id. Graymakes the important point that an often overlooked manifestation ofego defense is the patient’s transference of authority, in which the ana-lyst is imagined to be a critical superego figure who is then used as ajustification for the patient’s censoring of anxiety-laden id derivatives.The analyst who exploits this transference in order to overcome resis-tances paradoxically bypasses the analysis of one of the most pervasivesources of resistance in the analysis, the patient’s defensive need toview the analyst as a critical superego.

Gray has developed a way of working designed to avoid such pit-falls. He sticks very closely in his clinical work to the patient’s spokenwords and to calling the patient’s attention to conflicting consciouscontents. Gray tries to ensure that the data on which he bases his inter-pretations are directly accessible to the patient’s observing ego. Graywaits until a drive derivative enters conscious awareness, evoking con-sciously experienced signal anxiety in the patient, who then takesdefensive action to eliminate the derivative from awareness. Only thendoes Gray interpret. In this manner he attempts to ensure that the drive-defense sequence he interprets is accessible to the patient, who is ableto review the recent sequence of associations. The patient may thusassess for him- or herself the validity of the analyst’s interpretation,without having to accept the interpretation by an act of faith in the ana-lyst’s interpretive authority. By working in such a manner, Gray aspiresto be a rigorous empiricist, eschewing speculation and undue inferences

439



and instead sticking closely to the observable, replicable, and con-firmable data of analysis.

Gray presents the case of a young lawyer who sought analysis foranxiety attacks in anticipation of his doing courtroom litigation. In anhour conducted a year into the analysis, the patient had been discussinghow his mother made his little brother wash his bed sheets every morningbecause of a single episode of soiling. As a perceptible degree of angerand disgust toward his mother began to creep into his voice, the patientsuddenly became quieter and then reported a dream. Following are Gray’sverbatim notes:

Patient: Yesterday I forgot to tell you a dream I had over theweekend. I think I was in a large room with a multitude of people. . . .I had on a black robe, like a judge. I guess it was a courtroom. Theywere listening to me. Then, it’s funny, I realized that actually I was inwhite . . . I was embarrassed, ’cause I hadn’t shaved. The crowd gotrestless, muttering . . . grumbling at me . . . I don’t know what . . . mymother was in the crowd . . . It looked as though she might be crushed. . . I couldn’t help her . . . I was upset . . . I woke up.

Analyst: In your description of the dream you seem to pick up onthe problem you were up against just before you told me the dream.

Patient: . . . It was something about my mother . . . the sheets.Analyst: You sounded as if you were hesitating to speak critically

about your mother, and then the memory of the dream interrupted.Patient: Yes, I remember.Analyst: Maybe it got unsafe to show me critical feeling toward

your mother.Patient: I don’t want you to think I’m being unfair to her.Analyst: In your memory of the dream you first pictured yourself

as a judge, and then you took that away by making a white-robed,unshaven figure out of yourself.

Patient: It was like several days’ growth . . . but the white robewas very clean.

Analyst: You spoke of becoming a white-robed figure . . . speakingto a crowd . . . a multitude who then grumbled at you.

Patient: Yeah . . . is it that Christ thing again? [The patient haspreviously discussed adolescent martyr fantasies in identification withChrist.]

Analyst: I guess it suddenly got safer for you to have me see youas sort of Christ-like and on the receiving end of someone else’s resent-ment, rather than my hearing your resentment toward your mother.

Patient: Well, I know you won’t be critical of me.Analyst: What I have in mind is the moment when you didn’t want

me to think of you as unfair to your mother. Patient: Well, I guess I expect you to be like other people.


440




Analyst: Could other people be one of the generalizations that’s asafer way of putting it?

Patient: Well, everyone at home . . . I guess I mean my father. Henever let up . . . Christ . . . He was always yelling I was being unfairto my brother . . . If he had only been as tough on my mother![pp.163–164].

Gray listens for an expression of an id derivative and believes hehas discovered one in the patient’s passing expression of disgust andanger toward his mother. Gray understands what follows in the asso-ciative sequence as the patient’s defense against expressing angertoward her. Gray points out the sequence of a childhood memory of themother followed by a dream. He goes on to interpret that perhaps fearof showing the analyst critical feelings toward his mother has led thepatient to avoid expressing those feelings. The patient seems to confirmthis interpretation in stating that he does not want the analyst to thinkhe is being unfair to his mother. Gray goes on to call attention to thesequence of images in the dream, that being a black-robed judge is fol-lowed by being a white-robed figure. Gray interprets that it is safer forthe patient to be seen as a Christ-like figure who is the target of resent-ment than as being a resentful person. The patient eventually makes theconnection that he expects Gray to be like his father, in that both maybe critical of him for treating others unfairly.

In this example Gray attempts to engage the patient’s observingego in focusing attention on the sequence of associations. The patient’sself-reflective and self-analytic capacities are engaged in a collabora-tive inquiry into the underlying meaning of the sequence. Gray encour-ages the patient to reflect on the possibility that what comes next in anassociative sequence may be a defense that serves to re-repress whathas immediately preceded. Anger at the mother is re-repressed by thememory of the dream. Being a judge in the dream is re-repressed bybeing a Christ-like figure. Gray also tries to help the patient’s observ-ing ego perceive the signal anxiety that triggered the defensive process,the patient’s fleeting anxiety that the analyst would think he was beingunfair. This brings into the transference the fear of re-creating a situa-tion of danger in which he was yelled at by his father. Thus Gray enablesthe patient to witness, unfolding within his own stream of conscious-ness, a drive / signal anxiety / defense sequence (anger at mother / fearof analyst’s disapproval / repression of anger by turning it inward inbecoming a Christ-like martyr).

441



Here we have what seems to be a case of superb analytic work. Theanalyst stays close to the surface, never interpreting beyond what isdirectly accessible to the patient’s observing ego. The analyst articulatesa drive-defense sequence, an intrapsychic conflict, that has transpiredconsciously. And the analyst has interpreted how the intrapsychic con-flict plays out as a transference resistance as the patient censors hisfeelings and associations in order to avoid the analyst’s anticipated dis-approval. The approach seems to be strictly empirical, with ample vali-dation of the analyst’s hypotheses. The analyst seems to be discoveringthe objective facts of this patient’s psychic life. Yet is it possible that thepatient’s associations could be observed and analyzed in a differentmanner, yielding different results? Is the patient discovering theobjective facts of his psychic life, or is he learning to observe andanalyze his associations as his analyst does?

Gray seems to apply certain organizing principles in analyzing thepatient’s associations. He looks for the open expression of a drivederivative, either sexual or aggressive, in this case the patient’s angryand critical feelings toward his mother. Gray assumes that what pre-cedes the open expression of a drive derivative is probably defensive(the becoming Christ-like) if it seems to replace the expression of thatderivative in the patient’s stream of consciousness. Gray assumes thatbetween the drive and the defense is probably a brief flash of signalanxiety (fear of the analyst’s disapproval) of which the patient iscapable of becoming aware as a motive for defense. These are Gray’sunquestioned assumptions, which may lead to a sort of tunnel vision, afailure to see the sorts of hypotheses one might generate in using a dif-ferent set of assumptions.

If we assume the relativity of drive and defense, the material mightbe approached differently. What Gray thinks of as drive could beconstrued as defense, and vice versa. The patient’s anger at his mothermight well be seen as a defense against a shameful wish to masochisti-cally submit to his mother in order to maintain her approval. If we lookat the dream, it would seem that the image of the white-robed figure,which Gray assumes is deployed defensively against that of the black-robed judge, is itself highly anxiety-laden; it is after its appearance thatthe patient wakes up. The dream may therefore be viewed as a nightmare.Though dreams function to preserve sleep by disguising unconsciouswishes, a dream in which one anxiously awakens represents a failure topreserve sleep. In this frame of reference, the image of the black-robed


442




judge is a defense against the white-robed figure, the very reverse ofGray’s formulation. Perhaps the anxiety-laden image of the white-robedjudge emerges from repression, as a result of a failed defense, and evokesoverwhelming anxiety, awakening the patient from his dream. Perhapsthe patient finds it more in keeping with his phallic narcissism to seehimself as a critical judge than as a Christ-like martyr. Then, when hisdefensive effort to see himself as a strong or critical judge fails and hisunderlying masochistic identification emerges into consciousness, he isflooded with feelings of anxiety and helplessness and he awakens. Hiswaking up may then be viewed as a defense against his anxiety-riddenidentification with Christ, with which Gray’s interpretive approach inthis instance lacks empathy, viewing it primarily as a defensive retreatfrom angry feelings.

Gray assumes that conscious self-blame defends against repudiatedanger, the traditional psychodynamic idea of anger turned inward. Butcould not the opposite also be true, that conscious anger serves to defendagainst unconscious self-blame? Might not people get angry if it seemsthey are being made to feel guilty (i.e., someone has triggered anunconscious self-criticism)? In this case the anger might defend againstthe association that preceded it. Perhaps the patient’s anger at his motherdefends against a self-criticism that he should have been strong enoughto defend his brother against his mother’s humiliating treatment, as helater wishes his father had been tough with his mother.

If we approach the material with self psychological assumptions,we assume that the patient is driven by narcissistic needs and sodefends against the repetition of narcissistic injuries. Perhaps his nar-cissistic need is to affirm his phallic grandiosity, and the injury againstwhich he defends is whatever he experiences as traumatically deflating.His mother’s humiliating treatment of his younger brother and his ownmasochistic identification with Christ may both be seen as deflating hisphallic narcissism. By contrast, his wish to be a judge and to have astrong father who puts his mother in her place may be construed as bol-stering that narcissism. In this frame of reference, being angry isempowering, as it defends against his feeling emasculated by hismother. Narcissistic rage defends against narcissistic injury. The selfpsychologist might have inquired into what angered the patient abouthis mother’s treatment of his brother and looked for the patient’sawareness of bypassed shame for having been witness to his brother’shumiliation, a brother with whom he identified. The self psychologist

443



might also have focused on the danger to the patient’s sense of self thatwas associated with being a Christ-like martyr, a sense of self soanxiety-arousing that it awakened him from his dream shortly after itemerged into consciousness.

My point is not to adjudicate between a traditional Freudian and amore contemporary self psychological interpretation of the patient’spsychodynamics. Rather, my point is that both interpretive approachesstick closely to the patient’s material—to what is at the surface, to whatis experience-near, to what is consciously accessible to the patient’sobserving ego. Yet each approach yields different results. And sinceboth stick closely to the material, the patient will be able to follow theanalyst’s lead and in identification begin to analyze himself with thesame strategy of interpretation the analyst deploys. The patient’sobserving ego is thus socially constructed in line with the analyst’s par-ticular interpretive strategies. The analyst teaches the patient how topartition the associative sequence in a particular manner and how tointerpret the relationships underlying its various elements.

The manner in which the analyst partitions associative sequencesand interprets the underlying relationships between their elements isinherent not in the material but in the analyst’s strategy of interpre-tation. What is defense and what is defended against is relative(Apfelbaum and Gill 1989). Indeed, what counts as the beginning andend of an associative sequence is an arbitrary determination made bythe analyst. Of course, any strategy of interpretation that sticks closelyto the material will be more convincing to a patient than one thatdoesn’t. Yet what is rarely appreciated is that there might be a numberof ways, at times conflicting, of sticking closely to the same material.There may simply not be one right way of sticking closely to thematerial, or one approach that is the very closest way of working withit. All ways of working require parceling out the patient’s free associa-tions in a particular manner and making inferences about the underlyingrelationships among their elements.

Nevertheless, in an attempt to achieve the ideal of technical neu-trality, one might try to interpret the material from contrasting observa-tional perspectives. For example, one could interpret to Gray’s patientthus: “On the one hand, it seems like it’s more comfortable for you toadopt the role of the martyr rather than be openly angry with yourmother [the Freudian interpretation], but on the other hand it seemsimportant for your manly self-regard for you to see yourself as an


444




angry, critical, and tough judge rather than as an impotent Christ-likemartyr of which you feel ashamed [the Kohutian interpretation].” Inshort, masochism defends against awareness of guilt-ridden anger, evenas being angry simultaneously defends against awareness of shame-ridden masochism.

The relativity of drive and defense having thus been demonstrated,the treatment can proceed to macroanalysis. Gray’s approach, like thatof Apfelbaum and Gill, is essentially a microscopic analysis of egodefense that may result in a sort of obsessional focus on small detailsthat runs the risk of missing the bigger picture. Gray’s patient may beembroiled in a conflict in which compliance defends against guilt-ridden defiance even as defiance defends against shameful compliance.This manifest conflict may in turn defend against some unknowndeeper conflict by maintaining an inhibiting transference of authorityin which the analyst remains a superego figure toward whom thepatient is either compliant or defiant. Perhaps the manifest conflict alsomaintains an image of the self as a child with conflicted wishes for theapproval of a critical authority figure, even while the patient’s identi-fication with that figure is repudiated. As long as the patient projectshis repudiated identifications with that unfairly critical authority ontothe analyst, the patient need not acknowledge these ego-dystonicidentifications as an aspect of his own personality. Whether the patientis the defiant child or the compliant martyr, he remains a victim ofirrational authority.

The interpretive strategy that is being developed here is one ofappreciating maximal relativity in the material. Whatever interpretationone considers, one entertains the possibility that the opposite could alsobe true. This interpretive strategy mirrors unconscious primary processthinking in which mutually exclusive and contradictory ideas cancoexist. This strategy also facilitates approximating the ideal of tech-nical neutrality. In addition, one always looks for the metaperspectivethat embraces conflicting positions. There is always an effort to make aconnection between the small details and the big picture, the largergestalt in which the details fit to make a coherent whole. Yet there is anappreciation that what manifestly seems to be the big picture could bebut another small detail, embodying one side of a conflict of an evengreater but as yet unforeseen metaperspective.

445



INTERPRETING IN THE NEIGHBORHOOD

Busch (1995) has advocated a “close process monitoring” (p. 154)approach in which the interpretive emphasis is always on what thepatient can hear and work with rather than on what the analyst knowsand can formulate. Busch notes that the patient’s thinking is most con-crete in areas of conflict. In resisting self-reflection and self-analysis byremaining defensively concrete, the patient is likely to allow a divisionof labor in which the patient supplies the associations and the analystdoes all the interpretive work. Because the patient’s self-analyticcapacity is not engaged, the analyst’s interpretations fall on the deafears of a defensively concrete patient. The analyst can end up inter-preting “absent content” (Searl 1936), further fostering the patient’spassivity and submission to the analyst’s interpretive omniscience.

Since the patient’s ego regression to a level of concrete operationsis a cardinal resistance to the patient’s reflecting on the meaning of freeassociations, and thereby defends against awareness of unconsciousconflict, Busch recommends that this resistance be addressed by workingfirst with what is most consciously tangible, knowable, and concrete tothe patient. The patient does not reflect on the content, form, andsequencing of the free associations and so does not notice any ambiguity,contradiction, or irrationality that might be a surface manifestation ofan underlying conflict. The analyst’s task is to call the patient’s attentionto those “break points” in the stream of associations in which theambiguity, contradiction, or irrationality of the patient’s thinking maybe demonstrated concretely. The analyst encourages the patient to recalland examine a recent associative sequence, but the patient may resistsuch reflection in an attempt to remain defensively prereflective. If theanalyst does not successfully work through the patient’s resistance toself-reflection or bypasses the analysis of this fundamental resistance,the patient never moves beyond the position of passive dependence onan authoritative omniscient analyst.

Busch is well aware of some of the problems that arise in applyinga close process monitoring approach to the analysis of ego defense. Hecriticizes Gray for not recognizing the relativity of drive and defense(p. 169) and also recognizes that analysis of the microscopic must leadto analysis at the macrolevel: “What initially might be amenable toobservation only by staying with the most immediate, surface observa-tion of a resistance, at a later time in the analysis might be the beginning


446




of a larger elaboration of a pattern of resistance and its possible causes”(p. 168). Yet Busch seems not to entertain the possibility that patientand analyst may remain focused on small details as a defense againstrecognizing the larger pattern. He seems to envision the analytic processas unfolding in a linear way, as analysis of concrete detail moves cumula-tively toward a more abstract analysis of larger patterns. In a more dialec-tical approach, concrete analysis of small details is counterbalanced bya more abstract attempt to interpret the broader gestalt. Once the relativityof defense has been demonstrated in the concrete details, it is time tointerpret the larger pattern.

A clinical vignette provided by Busch (1995) allows us to examinemore closely his manner of working:

In his first analytic session, Dr. A. began with the realization that dur-ing the consultation, he forgot to tell me of a weeklong convention hehad registered for several months prior to our initial meeting that wasto begin in one month’s time. At this point he wasn’t sure whether hewould go. Although his wife wanted to go, he was uneasy about leav-ing because of a recent bout of acting out by his adolescent daughter.He thought they should stay home to prevent her from doing some-thing self-destructive. He then recalled a time in college when he feltlike he was out of control and no one seemed to notice. Mostly hedescribed some drinking incidents that led to reckless driving. He alsoalluded to his impregnating his future wife, which led to their havingto get married and the birth of his daughter. Yet, when he was younger,there were times when his parents did try to put controls on him andhe resented it. I pointed out that he had come in talking about whetherto go to the convention. This was then followed by his sense that heshould be home to stop his daughter from doing something harmful,which reminded him of how he had no one to help him with his poten-tially harmful behavior. I told him that it seemed he was saying therewas a part of him that might wish I would stop him from going to theconvention. To not have controls put on him is to feel uncared for. Yethis dilemma is that he then resents these same controls he desires. Dr.A. noted this was a familiar feeling, but one he had not seen so clear-ly before. He then described how glad he was to get going in the analy-sis. It was clear to him that a lot was getting stirred up. Yet he was sur-prised at how easily he was talking about things [p. 81].

Here Busch demonstrates the patient’s conflicts in a manner that appreci-ates the relativity of drive and defense. The patient tries defensively tocontrol his impulses, out of a fear of doing something self-destructive.Yet the patient is simultaneously resentful and defiant as a defense against

447



his wish for and fear of being controlled. Controlled behavior serves asa defense against the danger of impulsive behavior even as impulsivebehavior defends against the danger of being controlled. The analyst iscareful not to take sides in this conflict, and the patient experiences theinterpretation as experience-near and insightful, enabling him to see aconflict that had never before been articulated so clearly. Also articu-lated is the manner in which the conflict plays out in the transference.

Busch goes on to demonstrate how in later sessions this themerepeatedly played out in the patient’s free associations:

Dr. A. began the second session by commenting on how he wasaware of feeling more anxious. He then went on to describe a numberof experiences in which he was unable to let his feelings emerge andhe stayed in control. There was a recent ski trip when he and somefriends, while in a small plane, were caught in a violent storm. Heshowed no feelings and was barely aware of any. As an adolescent, hewent with some friends to a prostitute but was unable to get an erec-tion. He still has this problem intermittently in sex with his wife, butoverall felt they had a pretty good relationship. Now that they are bothstarting treatment, he worried what this would do to their relationship.His mother-in-law had been married numerous times, and so had bothhis brothers. His next older brother had been a terrible tease when theywere growing up, and he used to get very mad at him. He thendescribed a hunting trip he went on with his father and this samebrother when they were in their teens. Dr. A. heard some rustling inthe tall grass, saw some movement, and then saw a bird take flight. Hewheeled and shot at the bird, and immediately he was stricken by afeeling of horror at the possibility he had not shot high enough andmight have hit someone kneeling in the grass where, of course, he hadlast seen his brother. His brother was not hurt, but the experience wasstill a vivid one that scared him.

I reminded him of how he started the session describing situationsin which he kept his emotions in check. After talking about his worriesover his anger toward his brother and the effect analysis might haveon his marital relationship he told of fearing that, while actingspontaneously on the hunting trip, he was afraid he shot his brother. Itsuggested that his anxiety about coming in today had to do with hisfear that the analysis would lessen his controls, leading him to hurtsomeone. I wondered whether one component of his question of theprevious day (i.e., whether he should be “allowed” to go to theconvention) was based on his feeling that he needed to be kept in check,or else he could be very dangerous. This led him to remember tempertantrums he had as a child, which was followed by a memory of apersistent childhood image of a desolate landscape with no other people.


448




It was a depressing and scary memory. I suggested that in his thoughtswe could see he was fearful that the emergence of his anger wouldleave him totally alone, and thus he felt the need to be kept in control.He then remembered how when he and his brother would squabble, hismother would threaten to leave and never come back if they didn’t stop[pp. 81–82].

Busch discusses how for the remainder of the week the theme wassimilar and, for that matter, that the major theme of the entire analysisproved to be “Dr. A.’s feeling that he needed to be slowed down, or elsehis destructive sexual and aggressive feelings would emerge and hewould be left alone. On the other hand, if he felt that others wereattempting to place limits on him, he would become irritated” (p. 83).It is curious that the conflict that emerges at the psychic surface, in themanifest content of the initial sessions, proves to be the core conflictaround which the entire analysis revolves. Yet if this is the patient’smanifest content at the beginning of treatment, we might wonder whatthe patient’s latent conflict is. Does he have a defensive need to presenthimself as fearful of losing control but as no less fearful of beingcontrolled? Does this initial self-presentation, which is enacted ratherthan articulated, obscure a deeper conflict that is hidden?

The patient presents himself as an impulsive child who is bothwishful and fearful of structure and discipline from a strong parentalfigure. Perhaps the repudiated latent conflict reflects a reversal of thisconfiguration: the patient both wishes and fears to be the authoritarianparent who omnipotently controls others, thereby squelching the defiantattempts of others to assert their own autonomy in the face of control-ling behavior. Busch’s patient, like Gray’s, may unconsciously use thetransference of authority as a way of defending against awareness ofconflicted and highly ego-dystonic identifications with critical andcontrolling parental imagos. To spend the entire analysis working throughthe theme of the patient as an impulsive child ambivalent in regard toparental discipline could be to spend the entire analysis avoiding thetheme of the patient’s conflicted identifications with controlling,domineering, and critical parents.

Busch seems to accept at face value the patient’s concretely enactedpresentation of himself as fearful both of losing control and of beingcontrolled. That the patient is quite receptive to an interpretation of thisconflict in the first session suggests that this is a relatively ego-syntonicconflict, one he has little need to repudiate. The analyst’s interpretation

449



usefully clarifies for the patient an ego-syntonic conflict that heretoforehad not been explicitly formulated. If character analysis involves takingthe ego-syntonic and rendering it dystonic, one might also say to thepatient, fairly early in treatment, something along this line: “You seemconsistently to see yourself as someone who is fearful of losing controlas well as fearful of being controlled.” The analyst encourages the patientto reflect on the ego-syntonic character trait rather than take it at facevalue. The subtle point being made is that the patient has presentedhimself to the analyst as someone with conflicts around issues of self-control, and that that is but one way of perceiving himself. Are theseconflicts around impulse control the patient’s central problem or simplythe reflection of a neurotic need to see himself, and get the analyst tosee him, as someone with such conflicts? The answer need not beeither/or, but the second possibility is less likely to be entertained if onefeels compelled to stick to a close process monitoring approach thatdiscourages speculative leaps from the immediate data. From an objectrelations point of view, the patient is most likely identified both withthe impulsive child who wishes for yet fears parental containment andwith the parental authority figure who may control if not dominate thedefiant child. Whereas the identification with the child is ego-syntonicand therefore at the surface, the identification with the controlling parentis ego-dystonic and therefore deep. Psychoanalytic theory makes it quitereasonable to entertain the possibility that the patient’s readily observ-able transference of authority is the projection of a repudiated identifi-cation with controlling, even domineering parents. From the briefmaterial presented, a case could be made that this is an unconsciouslycontrolling patient. The patient’s ambiguity about scheduling, occasionalimpotence with his wife, and desire to stay home to provide his daughterwith supervision could all plausibly be interpreted as derivative expres-sions of his unconsciously disguised desire to exercise control over theimportant people in his life.

Given that it was possible to demonstrate the relativity of drive anddefense to this patient in the first session, it might be possible fairlyearly in the treatment to proceed to a deeper level of interpretation. Anintervention pointing to a “deeper” issue—e.g., “I wonder if you feelsome need to see yourself as someone with questionable impulsecontrol”—is one that could be made fairly early in an analysis withoutfalling into “wild analysis.” This would set the stage for eventuallymaking a “deep” interpretation, e.g., “You seem to need to see yourself


450




as someone who needs to be controlled because you are frightened ofadmitting how much you wish to control others, as you fear they willtry to control you.” This is to interpret a highly ego-dystonic issue, forthe patient does not consciously see himself as controlling—as father,as husband, or as patient. Yet unconsciously he may view relationshipsas power struggles in which one is either controlled or controlling. Thepatient consciously wishes and fears being controlled, while repudiatinghis deeper wishes to dominate others as an omnipotent parental authority.Yet this is a “deep” issue that could potentially be addressed early in theanalysis, especially if it emerges that his wife, his daughter, and hisanalyst all experience him as covertly controlling and domineering. Itmight be possible to establish fairly early in the analysis that on the onehand the patient experiences himself as an impulsive child ambivalentin relation to parental control but on the other hand experiences himselfas an authoritarian parent ambivalent about exercising control. Thatwould set the stage for entertaining the possibility that the patient’sconflicted view of himself as impulsive child or authoritarian parent isitself a defense against some deeper issue as yet unknown.

BALANCING MICRO AND MACRO LEVELS OFDEFENSE ANALYSIS

The patient, a thirty-seven-year-old corporate manager, was concernedabout the possibility of being laid off in a corporate downsizing.Showing an extremely rigid obsessive-compulsive character withschizoid trends, he had begun treatment feeling ashamed of neverhaving had a girlfriend and of having had no sex life except for occa-sional experiences with prostitutes. Initially the treatment was slowgoing. The patient was exceedingly concrete, intellectualized, emo-tionally constricted, and uncommunicative. After several years oftreatment he developed his first relationship with a girlfriend; though itlasted several years, he was unable to make a commitment. Now thathis confidence was boosted, however, he hoped to “sow his wild oats.”Now, several years after the breakup, the patient had fallen back intohis old pattern of social withdrawal. Currently he was dating a woman,but the relationship was superficial.

The approximately verbatim material that follows is taken from noteswritten during a single session. It is interesting because in it the patientdoes most of the defense analysis. The patient’s observing ego, in partial

451



identification with my way of working, goes back and forth betweenmicro and macro levels of defense analysis and also has some beginningappreciation of the relativity of defense. My retrospective understandingof the process appears in brackets as the session unfolds.

Patient: After commenting on Monday how I don’t rememberdreams, I remembered snippets of a couple. I was at a military inductioncenter. I was signing up. Everybody had to get their hair cut short. I hadto shave my beard. I’ve been debating whether to shave my beard for myjob search. I don’t see a lot of guys with beards in my field. It’s still con-servative. The excuse I’ve used to keep the beard for thirteen years isthat it covers up scars from my accident when I drove the snowmobilethrough barbed wire. After two plastic surgeries the scars were smaller.I got tired of looking at permanent scars. The beard is more attractive.I’m less willing to acknowledge that growing the beard is a kind ofrebellion. It’s hiding behind something. I’d have to grudgingly admitthat because I’m reluctant to shave it, it’s a kind of rebellion. One of myfantasies is that I should be able to get a job on the merits of my expe-rience and that whether I had a beard or not would not be important. I’vebeen turned down by all the internal interviews I’ve had so far. I wonderif it’s the beard. In the dream I’d only shave it if I was forced to.Otherwise I’d be defiant. [The patient has formulated a dynamichypothesis: though manifestly the beard functions to conform to appear-ances, latently it expresses defiance.]

The other snippet of a dream also involves the military. I was hangingaround the officers club. One of my brothers was there. I was nakedfrom the waist down. It was really weird. Maybe my defenses are showingenough to shut me up or maybe my defenses are not as impenetrable asthey usually are like when they don’t let me remember what I dreamabout. [Some appreciation of the relativity of defense: the possibledefensive function of increased openness, that he may be concealing ashe is revealing. Also reflects his usual obsessive self-doubt.] I think thereis something I should tell Linda about our relationship, that there isn’tany spark in it. Oh, I had the colonoscopy the doctor wanted me to get.The only problem was a couple of hemorrhoids. What a relief. I stillhave intestinal discomfort. (pause) Other people got the jobs Iinterviewed for. What was pissing me off was that the person whointerviewed me didn’t have the courtesy to call and tell me I didn’t makeit. I had a sense I wasn’t taken seriously. Maybe I’m paranoid but shereally wasn’t interested in seeing if I was qualified. I don’t like feeling


452




that I’m not being taken seriously. Is the message from her or am Imaking it up? I don’t like the suspicion that I’m making it up. [Here thepatient becomes caught up in his usual obsessive doubting: Does he haveaccurate reality testing or is he projecting?]

Twelve years ago my boss thought I was gay. I’m always afraid ofappearing that way because I don’t have a strong masculine identifica-tion. I must be a paranoid son of a bitch because last Thursday I askedmy colleague if he had heard any rumors I was gay. He said no but Ididn’t believe it. I know there’s a connection here but I’m missing it.I’m not sure. [Patient reports his awareness in the moment of hisresistance to continuing this line of associations related to his fear ofappearing gay.]

Analyst: It’s confusing whether you’re being paranoid or seeingsomething that’s really there. [I am feeling that the patient is beginningto look to me to adjudicate his conflicts to defend against his mountinganxiety: Is his reality testing accurate or is he projecting? Is he gay oris he straight? I reflect back the manifest conflict which I believe isserving as a defensive smoke screen for something deeper, hoping notto let myself get drawn into taking sides.]

Patient: I don’t know how to deal with it. It’s driving me nuts. I’llnever get to the bottom of it and get a true answer. There’s a flaw in thatstatement. I want proof I’m not paranoid but I wouldn't believe the proof.I want to be paranoid. I’m running in circles. I’m driving myself nutswith this line of thinking. I can’t let go. The control freak inside meneeds an answer but an answer is not possible. [Patient struggles withhis obsessional defenses of persisting doubt.] But I’ve been given ananswer. A fellow who is totally honest told me he hadn’t heard anyrumors that I’m gay. Why would I not want to believe him? Is mymasculine identity that weak? It must be defensive in nature, myreluctance to believe the guy. I feel really stuck here. Why is it hard tobelieve him? I’ve used it as a crutch of some kind. To believe him knocksa crack in some defense. [Patient is entertaining the possibility that hisdisbelief may serve a defensive function.] Could it be for some skewedreason? Maybe the fact that I fear people think I’m gay is an excuse fornot dating. Is that my stubbornness? Is there a connection?

Analyst: It seems important to you for me to validate that connec-tion. [I’m experiencing his questions as a demand for me to step in withan answer to alleviate his intensified self-doubt. I try to reflect that wishto bring the issue into the transference.]

453



Patient: I’m sorry. I know it’s not supposed to work that way. [Thepatient experiences my frustration of his wish for me to validate theconnections he’s making as a criticism of the wish. He compliantlycontinues his self-analysis, experiencing me as expecting him tocomplete his self-analysis by himself.] It’s a big piece of the puzzle:why I’m not dating. It seems to make sense. It’s a big piece I need youto validate. I rebel to the point of hurting myself. I think people thinkI’m gay and I react by not dating women. I can’t let myself see it. It’llknock a big hole in a defense. (pause) I’m wandering. (pause) [Patientreports his resistance in the moment to continuing this line of associa-tions: that he rebels by hurting himself.] My response to authority is torebel to the point of hurting myself. Not dating is hurting myself. Ifpeople think I’m gay I interpret it as saying you can’t have any women.So I say the hell with you, I don’t want any women. It’s all internal.[Patient develops the hypothesis that his self-doubt may be a defenseagainst an unconscious tendency to defy authority by hurting himself.]It’s all in my own mind. Except the boss who said twelve years ago hethought I was gay. But not in so many words.

Analyst: Even there it’s a little ambiguous. [The patient defensivelysearches for the exception to the rule that his self-doubts are all in hisown mind, but I note that even what seems to be the exception to therule may also be in his own mind.]

Patient: I was smoking a pipe. He asked why. I said I enjoy thearoma. He said that’s not why you enjoy it. I assumed there was an oralimplication. Why would I create an incredibly convoluted scenario togive myself a reason not to date? I created the whole thing out of thinair. Why would I do that? [The patient seems more comfortable workingwith the hypothesis that his self-doubts about his reality testing andsexual orientation are a “convoluted” defense against his underlyingconflicts with women.] If my aunt says, “Why aren’t you boys married?”I could see myself saying defiantly, “I’m not going to get married oreven date!” In high school I was sweet on the girl next door. She wasvery concerned after my accident. Once after I went out with her mymother said: “Don’t get serious because her mother has multiplesclerosis.” I was pissed at Mom for saying that. We’re not getting marriedjust ’cause we went out one time. It’s really arrogant to say not to marryher because her mother has multiple sclerosis. I feel I won’t date for therest of my life and the hell with you! In first grade I remember a girlwho had two older sisters. I remember the girl brought a 45 Beatles


454




record to school. It was great big kids’ music. I invited her over to listento records. Ma said that she would have to approve of any girl I decidedto marry. I feel very light-headed now. Like I’m levitating. [Patient isaware of his defense in the moment against his emerging awareness ofhis anger toward his mother.] I can see myself subconsciously respondingto that comment. Fuck you, you think I’ll let you approve who I’ll marry!I won’t even date!

Analyst: You punish your mother by not dating even though it hurtsyourself. [I want to highlight the relativity of defense. Even though hedefends against admitting his anger toward his mother, he also tends todefend against the awareness of hidden self-punitiveness in his defiance.]

Patient: Yeah, defiance to the point of masochism.Analyst: You’ll get even, even if it kills you. [I try to make the same

point more graphically that he is making more abstractly. I interpret thewish directly without commentary on his intellectual defenses.]

Patient: Talk about holding a grudge. I saw a book of T-shirts witha drawing of the grave of the Wicked Witch of the West with a lawnsprinkler spraying water on the grave. The caption read: “How to hold agrudge.” [The matricidal fantasy emerges into consciousness, expressedwith a sense of irony in regard to his stubborn desire to take revenge onhis mother for what he felt was her emasculation of him. Perhaps heexperienced my direct interpretation of his aggressive wishes, as thoughI were a permissive superego who would approve of the openexpression of a matricidal fantasy. Until now the tenor of the sessionhas been one of serious, rational self-analysis of his defenses. Thedirect and graphic interpretation of the wish evokes a more sponta-neous, playful, and imaginative response that stands in contradis-tinction to his usual self-control.]

Discussion. I hope I have illustrated how the patient’s observing egoalternated between noting resistances in the moment to his immediateline of free associations and being more self-reflective in analyzing hisoverall defensive pattern of obsessional self-doubt. In this session hisego-syntonic self-doubts about his reality testing and sexual orientationare gradually made dystonic. Most of his resistances in the moment areto rendering this ego-syntonic character trait ego-dystonic. In thetransference he is continually inviting me to participate in his self-doubtrather than to reflect on it, thereby enacting his usual compliance/defianceconflicts. It was quite tempting to reductively interpret his self-doubteither as only a defense against homosexual anxiety or as only a defense

455



against expressing his hostility toward those who offend his masculinepride. Rather than try to resolve the conflict as an adjudicating authorityfigure, I simply reflected the conflict to allow him to struggle with itand eventually discover its defensive function. Yet he experienced myanalytic stance as an austere demand to continue his autonomous self-analysis. When I interpreted his aggressive wish more directly andgraphically, he experienced this as permission to playfully indulge in anirreverent matricidal fantasy.

At the manifest level the patient is conflicted between wonderingwhether his reality testing is accurate or whether he is projecting hisinsecurities. Is he gay or straight? Is he defending against acknowledginghis fears of latent homosexuality, which others seem to see clearly? Oris he defending against expressing openly his hostility when he feelsothers have treated him unfairly and wounded his masculine pride? Giventhe relativity of defense, the answer cannot be either/or. This manifestconflict can be appreciated as an ego-syntonic obsessional defense. Itdefends against awareness both of his murderous rage toward his emascu-lating mother and of his self-punitive rage against himself for wantingto kill her. Unconsciously, defiance against conformity defends againstawareness of shame-ridden masochism, even as masochistic self-deprivation defends against awareness of murderous rage.

A reconsideration of some of the problems of character analysismay enable close process monitors to address some of the acknowl-edged challenges in effectively applying their technique. Landau(1996), for instance, writes as follows:

It is common clinical experience that the patient does not always reactwith ready and comfortable acknowledgment and interest when theanalyst attempts to reconstruct what the patient has just said. The patientmay react to the analyst’s repetition of the very same words the patienthimself has just said with surprise bordering on shock, accompaniedby intense affect (denial or disbelief), as though having just experienceda premature interpretation. What defines the comment as premature isthat the ego is presented with material of a greater degree of dystonicitythan it is ready to deal with. Some patients react to a demonstration ofdefensive activity, including tactful comments focusing on derivativesexpressed and then resisted, with narcissistic injury, feeling criticized,and a tendency to project their own emerging impulses onto the analyst.Externalization of an authoritarian image has occurred on the spot. Anexample of this type of reaction is displayed by the patient who says:“You’re never satisfied with what I say. No matter how much anger I


456




express [or some other affect], you always want more!” Or: “You’renever interested in what I say! You only pay attention to what I leaveout!” [pp. 283–284].

Such reactions should be expected if we assume that the analyst’stechnique will always be experienced as a demand characteristic of theanalytic situation to which the patient will respond ambivalently. Andto the extent the analyst (1) fails to appreciate the relativity of defenseand (2) consistently calls attention to the warded-off affect or to whatthe patient leaves out, the patient will feel the analyst is taking sides inthe conflict and is making a demand that the patient always expressrather than suppress affect and always attend to what is left out ratherthan to what is said. Landau suggests as a motto for close processmonitoring, “Where ego-dystonic elements were, there shall ego-syntonic elements be” (p. 277). This reverses the traditional goal ofcharacter analysis, which is to render the ego-syntonic character traitego-dystonic. From the point of view of character analysis it is to beexpected that any time the analyst intentionally or unintentionally makesan ego-syntonic trait ego-dystonic, the patient will feel narcissisticallywounded and a latent negative transference will be provoked. Thissituation is not to be avoided but to be worked through, and it is moreeasily worked through if the analyst has empathy for the narcissisticinjury inflicted in doing character analysis (Josephs 1995). When patientsrespond poorly to close process monitoring, they are implicitly experi-encing that technique as a form of unempathic character/defense analysis.

I would suggest that in clinical work there needs to be a dialecticalbalance between making the ego-dystonic ego-syntonic (i.e., closeprocess monitoring) and the reverse (i.e., character analysis). The tran-sition from ego-dystonic to ego-syntonic is an integrative experiencefor the patient, as something that was felt to be unacceptable is nowaccepted. By contrast, going from ego-syntonic to ego-dystonic is “dis-integrative”; something that was consciously felt to be acceptable(though perhaps unconsciously felt to be unacceptable) is now madeunacceptable. Where ego-syntonicity is used as a narcissistic defense ofthe ego, as Reich (1928) suggested it often is, to avoid interpreting itsdefensive function is to collude with a subtle character resistance. Themain form of resistance to the awareness of resistance is the patient’sresistance to enduring the narcissistic injury of making the ego-synton-ic character resistance ego-dystonic. Thus, the extent to which patients

457



resist close process monitoring is a function of their ego-syntonic char-acter resistances, which need to be analyzed.

CONCLUSION

If we realize that an exclusive focus on the microscopic analysis of egodefense at the psychic surface may obscure the ego’s macrodefensivestrategies, which serve to hide deeper unconscious conflicts, we mightwonder if indeed it is always necessary to work from surface to depth.Is there ever a time in the analysis when one should be a “deep diver” orshould confront the patient’s “character armor” in a more Reichianmanner, even if this evokes an adversarial negative transference? Mightalways focusing on the surface reflect a kind of defensively concreteempiricism that avoids the fears and anxieties inherent in making inter-pretations of a more speculative, inferential, and imaginative nature?Might the assiduous avoidance of any exploitation of the transference ofauthority be a way of defending against emergence of the patient’s expe-rience of the analyst as an omniscient and omnipotent purveyor of themagical power of interpretation? Certainly Kleinian analysts have hadlittle trepidation about making “deep” interpretations that patients expe-rience in primitive terms as the magical acts of an omnipotent analyst.These analysts then simply analyze the patient’s primitive experience ofthe interpretation. Not to interpret at the level of the deepest anxieties isconsidered by Kleinians, it would seem, to be collusively avoidant.

Freud, too, has regularly been criticized by contemporary analystsfor exploiting the patient’s transference of authority. Freud openlyacknowledged using the leverage afforded by the unobjectionablepositive transference to gain the patient’s acceptance of the painful truthshe interpreted. He believed that what differentiated psychoanalysis fromsuggestion was that in psychoanalysis the transference of authority wasdissolved at the end of the treatment. Perhaps Freud is more perspica-cious here than are the contemporary analysts who claim to havedeveloped a way of working that does not depend for its effect on thetransference of authority. It is likely that this transference remainsoperative but simply goes unremarked because of the presumption thatone’s technique is not a demand characteristic of the analytic situation.The difference between Freud and contemporary analysts is probablynot marked so much by whether the transference of authority is exploitedor not; rather, it is a question of different methods of exploiting that


458




transference. And it may well be argued that the way in which Freudexploited his authority was more obvious and therefore easier for thepatient to challenge than are the methods of today’s analysts who havesuch an investment in presenting themselves as having transcended“pressure techniques.”

Friedman (1996), who believes that the analytic situation possessesa “demand structure” (p. 323), has suggested that the strength of Gray’stechnique is that he “points” rather than “characterizes.” To “charac-terize” is to place a moral demand on a patient to see things in a par-ticular way. To “point” seems to place less of a demand on the patient tosee things in any particular way. Yet Friedman does not seem to appre-ciate that “pointing” is like “leading,” and that it is easy enough to leadthe patient to the analyst’s preconceived characterization by consis-tently pointing to certain associations rather than to others. I wouldsuggest that all analysis is character analysis in that the analyst’s inter-pretations explicitly or implicitly reflect a particular manner of charac-terizing the patient’s personality functioning in the analytic situation(Josephs 1995).

It is curious that in the work of Apfelbaum and Gill (1989), Gray(1994), and Busch (1995), as well as in the edited volume by Goldberger(1996), there is relatively little discussion of typical resistances and neg-ative transferences to the close process monitoring approach theyadvocate. In my experience, patients demonstrate some fairly routineresponses to this manner of working. To the extent patients wish to ven-tilate rather than examine and reflect, there may be a feeling that theanalyst is not letting them express themselves. To the extent patientswish that the analyst would make magically healing empathic interpre-tations, there may be a feeling that the analyst is instead catching themin their ambiguities, contradictions, and inconsistencies, which they feelthe analyst should alleviate rather than interrogate. To the extentpatients wish the analyst to reveal the big picture, there may be a feelingthat the analyst is obsessed with the small and irrelevant detail. To theextent patients wish for deep and penetrating interpretations, there maybe a feeling that the analyst is being concrete and overliteral in focusingon the sequencing of the patient’s associations rather than intuiting theirdeeper meaning.

To the extent these common resistances and negative transferencesare routinely evoked by a close process monitoring approach, it shouldbe clear that this approach does not guarantee the formation of a

459



collaborative alliance with the patient’s consciously observing ego. Thatego is likely to be highly ambivalent about reviewing recent associativesequences with an eye to detecting the inconsistencies, contradictions,and ambiguities in small details that betray a mind in conflict. Only intel-lectually oriented obsessive patients, such as candidates in training,would demonstrate a predilection for this sort of painstaking detectivework. Working in this manner does not minimize the possibility that thepatient’s acceptance of an interpretation is significantly based on thepressure exerted by the transference of authority. If an analyst consis-tently interprets the patient’s free associations within a particular frameof reference, of whatever nature, the patient is going to feel considerabletransferential pressure to begin analyzing his or her associations in asimilar manner. The tenacity with which an analyst applies any con-sistent interpretive approach is going to play into the transference ofauthority, giving the patient a sense that this is how the data of analysis“should” be interpreted, rather than simply “could” be.

Perhaps a balanced approach to interpretation requires the counter-balancing of surface interpretations with deeper interpretations. (For abroader discussion of the issues involved in counterbalancing con-flicting technical recommendations, see Josephs 1995.) I have offeredone suggestion as to how this might be done. One interprets at the con-crete microlevel, remaining close to the small details of the patient’sassociations until the relativity of defense has been demonstrated. Thisenables the patient to articulate at the psychic surface a manifest con-flict that had remained unformulated, without the patient’s feeling com-pelled to take sides in that conflict. At this point the analyst may beginto consider the exploration of how a manifest conflict might defendagainst a deeper conflict. Freudians have always entertained the possi-bility that a manifest regression to oral or anal conflicts may defendagainst deeper oedipal conflicts that are hidden, whereas Kleinianshave always maintained that a manifest progression to anal or oedipalconflicts may defend against deeper oral conflicts. The idea, though, isbasically the same: that an initial presenting conflict may serve as asmoke screen for a deeper hidden conflict. Nevertheless, this level ofanalysis usually requires a higher level of abstraction and general-ization and can usually be demonstrated only by showing how the smalldetails fit together to form a larger pattern.

The dangers of exclusively deep interpretations are well known; thedangers of exclusively surface interpretations, outside of a fear of super-


460




ficiality, have yet to be articulated. A more significant limitation maybe that the patient’s capacity for playful, imaginative, and symbolicinterpretation is not engaged. What is engaged instead is a rationalisticobserving ego that is compelled to stick to the presumably observable,replicable, and confirmable facts of consciously experienced psychiclife, an ego capable only of an arid empiricism that forbids imaginativespeculation beyond the observables. Microanalysis of drive-defensesequences in the patient’s free associations is unlikely to engage thepatient’s symbol-making and imaginative capacities, ego functions thatoperate at a less reflective level of awareness.

But does engaging the patient’s ego in the task of self-analysismean engaging only the patient’s conscious ego functions, to theexclusion of preconscious or unconscious ego functions? Certain egofunctions such as symbol formation, synthesis, and integration tend tooperate preconsciously or unconsciously. By contrast, ego functionssuch as focal attention, detailed observation, and rational analysis tendto work at a more conscious level of mentation. Thus, the therapeuticeffects of deep interpretations may not rely exclusively on the power ofthe transference of authority, for deep interpretations may engage thepreconscious ego functions involved in symbolic, imaginative, inte-grative, and synthetic thought. The limitation, though, of analyses thatrely exclusively on deep interpretations for therapeutic effect is not thatthe cure is a transference cure but that the patient’s capacity for morerational self-analysis based on careful observation of events at thepsychic surface is not adequately developed. Self-understanding, ifbased only on broad intuitive and imaginative constructions that glossover many details that are important, becomes prone to vague over-generalization, overabstraction, and intellectualization.

Whereas surface interpretations stimulate and strengthen thepatient’s consciously observing ego, deep interpretations may stimulateand strengthen certain preconscious ego functions associated withimaginative and symbolic thought. Perhaps in their self-analysespatients need to achieve an optimal balance between self-reflectiongrounded in rational analysis of what is objectively observable withintheir stream of consciousness, and self-reflection involving imaginativeflights of fancy. To engage optimally the wide array of the patient’s con-scious, preconscious, and unconscious ego functions, the microanalysisof ego defense may need to be counterbalanced by its macroanalysis; inaddition, surface, minimally inferential interpretations may need to be

461



counterbalanced by deeper, mildly to moderately inferential interpreta-tions. To work in a manner optimally counterbalanced between con-trasting observational and interpretive perspectives may be to work in amanner that is also technically neutral. To do otherwise results in askewed approach to treatment that overemphasizes a particular methodof observing and interpreting the data of analysis, a method the patientis likely to experience unconsciously as a demand characteristic of theanalytic situation and as a form of taking sides in a conflict.

REFERENCES

APFELBAUM, B., & GILL, M.M. (1989). Ego analysis and the relativity of defense:Technical implications of the structural theory. Journal of the AmericanPsychoanalytic Association 37:1071–1096.

BRENNER, C. (1982). The Mind in Conflict. New York: InternationalUniversities Press.

BUSCH, F. (1995). The Ego at the Center of Clinical Technique. Northvale, NJ:Aronson.

FENICHEL, O. (1941). Problems of Psychoanalytic Technique. New York:Psychoanalytic Quarterly.

——— (1953). The Collected Papers of Otto Fenichel: First Series. NewYork: Norton.

FREUD, A. (1936). The Ego and the Mechanisms of Defense. New York:International Universities Press.

FREUD, S. (1900). The interpretation of dreams. Standard Edition 4/5. ——— (1910). “Wild” psycho-analysis. Standard Edition 11:219–227.——— (1913). On beginning the treatment. Standard Edition 12:121–144.——— (1914). Remembering, repeating, and working-through. Standard

Edition 12:145–156.——— (1923). The ego and the id. Standard Edition 19:1–66.——— (1926). Inhibitions, symptoms and anxiety. Standard Edition

20:75–175.——— (1937). Analysis terminable and interminable. Standard Edition

23:209–253.FRIEDMAN, L. (1996). What’s at stake in the truth controversy? In Danger and

Defense: The Technique of Close Process Attention, ed. M. Goldberger.Northvale, NJ: Aronson, pp. 317–336.

GLOVER, E. (1955). The Technique of Psycho-Analysis. New York: InternationalUniversities Press.

GOLDBERGER, M., ED. (1996). Danger and Defense: The Technique of CloseProcess Attention. Northvale, NJ: Aronson.

GRAY, P. (1994). The Ego and the Analysis of Defense. Northvale, NJ: Aronson.JOSEPHS, L. (1995). Balancing Empathy and Interpretation: Relational


462




Character Analysis. Northvale, NJ: Aronson.KANZER, M. (1981). Freud’s “analytic pact”: the standard therapeutic alliance.

Journal of the American Psychoanalytic Association 29: 69–87.KERNBERG, O. (1984). Severe Personality Disorders: Psychotherapeutic

Strategies. New Haven: Yale University Press. KOHUT, H. (1984). How Does Analysis Cure? Chicago: University of Chicago

Press. LANDAU, B.J. (1996). Consciousness as a beacon light. In Danger and Defense:

The Technique of Close Process Attention, ed. M. Goldberger. Northvale,NJ: Aronson. pp. 263–290.

LEVY, S.T., & INDERBITZIN, L.B. (1990). The analytic surface and the theory oftechnique. Journal of the American Psychoanalytic Association 38:371–391.

LOEWENSTEIN, R.M. (1951). The problem of interpretation. PsychoanalyticQuarterly 20:1–14.

REICH, W. (1928). On character analysis. In The Psychoanalytic Reader, ed.R. Fliess. New York: International Universities Press, 1948, pp. 129–147.

SCHAFER, R. (1983). The Analytic Attitude. New York: Basic Books. SEARL, M.N. (1936). Some queries on principles of technique. International

Journal of Psycho-Analysis 17:471–493. STERBA, R. (1934). The fate of the ego in analytic therapy. International Journal

of Psycho-Analysis 15:117–126. WAELDER, R. (1930). The principle of multiple function: Observations on

overdetermination. In Psychoanalysis: Observation, Theory, Application,New York: International Universities Press, 1976, pp. 68–83.

Derner Institute of Advanced Psychological StudiesAdelphi UniversityGarden City, NY 11530

463



the view from the tip of the iceberg - CiteSeerX

Documents

Transcript of the view from the tip of the iceberg - CiteSeerX