Dialogue on the current status and the prospect of the American Psychoanalysis
From monism to pluralism: Glenn O. Gabbard
In a survey of 65 prominent British and American analysts, Hamilton (1996) asked her subjects to identify their predominant school within psychoanalysis. In contrast to their British colleagues, American analysts consistently defied facile classification. Indeed, it appeared to be of considerable importance to the American subjects to regard themselves as eclectic, drawing from a variety of theoretical influences without being pigeonholed into one specific category.
Only 30 years ago such results would have been unthinkable. American psychoanalysis was synonymous with a particular ego psychological perspective firmly ensconced in the structural model, comprise formation, and intrapsychic conflict. In fact, it was commonplace in discussions of analysis at an international level to substitute geography for theory in describing one’s analytic persuasion - e.g., the "American" perspective versus the British school.
This rather dramatic shift from monism to pluralism can be traced to a myriad of influences from the mid-1960s to the present. It was in the mid-60s that Kernberg (1967) published his seminal work on borderline personality organization. Connected with his concept of the borderline patient was the broad model of countertransference, an object relations theory of development, and an emphasis on defense mechanisms, such as splitting and projective identification, derived from the work of Melanie Klein. At almost the same period of time, Kohut was laying the seeds of self psychology in his writings on narcissism. Along with his emphasis on the self rather than the ego, Kohut was also spinning an argument that much of the psychopathology observed in analysis had its origins in deficit rather than conflict. Both Kernberg and Kohut, of course, were interested in the "widening scope" patient, and the growing interest in analyzing more disturbed patients undoubtedly contributed to the theoretical shift within American psychoanalysis.
The social constructivist perspective of Gill (1994) and Hoffman (1992) has also been a factor in the evolution of American thinking. The notion that the analyst’s real behavior is continuously affecting the patient’s transference paved the way for the recognition that psychoanalysis is at least in part a two-person psychology. No longer was the analyst seen as a dispassionate observer of the intrapsychic functioning of the patient, but rather a full-fledged partner in the exploration of what transpired in the dyad.
A further influence has been the so-called "American relational theorists" like Mitchell (1988), Greenberg (1991), and Aron (1996). Working outside the American Psychoanalytic Association, these contributors, influenced by Fairbairn and other members of the British independent school, regarded the seeking of objects as the primary motivator rather than the discharge of drive tensions. Ogden, on the other hand, more influenced by internal object relations theory than by American relational theorists, articulated an intersubjective theory that focused on the creation of "an analytic third" jointly created by the two subjectivities of analyst and patient (1994).
At the same time these influences outside of mainstream American ego psychology were having their impact, changes were occurring within the classical American orientation as well. The emphasis on countertransference enactments by such authors as McLaughlin (1991), Chused (1991), Jacobs (1986), and Renik (1993) helped to open the minds of American analysts to the notion that the analyst’s subjectivity was an ever-present factor. Moreover, the view of a countertransference enactment as the actualization in the analyst of the patient’s transference fantasy was conceptually close to the Kleinian notion of projective identification (Gabbard, 1995). Hence a common ground in countertransference emerged in which the analyst’s reactions to the patient were viewed as joint creations of the analyst’s subjectivity and the patient’s own unconscious efforts to elicit specific reactions in the analyst that resembled the patient’s own internal self- and object-representations.
While it is impossible to be encyclopedic in a brief communication, these influences and others have helped create an atmosphere of openness to innovation in theory and technique within American analytic practice. As the various theoretical perspectives have been examined, American analysts have increasingly become aware that no one theory has all the answers to the clinical problems they encounter in the daily crucible of analytic practice. A variety of efforts have appeared in the recent literature that attempt to integrate the various theoretical models into a useful synthesis for the clinician (Benjamin, 1995; Gabbard, 1996; Jacobson, 1994; Pine, 1990; Pulver, 1993). The opening up of American psychoanalysis to nonmedical analysts has introduced new voices into the current psychoanalytic dialogue as well. The result is an era of intellectual fervor in American psychoanalysis that has created an extraordinarily stimulating atmosphere in the institutes and societies throughout the country.
What lies ahead as we prepare to enter a new century? In an era when Freud is pronounced dead every two years in popular magazines, analysis continues to thrive. Within the academy, film and literature studies are making creative uses of psychoanalytic thinking as well. The stranglehold of managed care in the United States, with its emphasis on the "quick fix" may paradoxically contribute to a backlash in which patients will increasingly seek out clinicians who will understand them and get to know them. However, as the physicist Niels Bohr once noted, "Prediction is very difficult - especially about the future".
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Glen O. Gabbard, M.D.
The Menninger Clinic
Topeka, KS 66601, USA