Charcot demonstrated not only that ideas, rather than damaged nerves, were responsible for conditions like glove anaesthesia and hysterical paralysis and blindness, but that ideas could also effect (generally temporary) cures. Charcot would place patients in hypnotic trances and, through hypnotic suggestion, induce hysterical symptoms that hadn't been there before. He might say something like, "When you awake, you will be unable to see, unable to walk." And, even more startling, he would use hypnotic sugges tion to temporarily remove symptoms, to make the hysterically blind see, the hysterically paralyzed walk. The problem is not in the flesh-the hand, the eyes, the legs are intact. The problem is an idea, out of awareness-the idea that the patient cannot feel, cannot see, cannot walk. That pathogenic idea is counteracted by another idea, the hypnotist's injunction to feel, to see, to walk. That idea, introduced into the mind of the subject by the hypnotist, can control experience and behavior, despite the fact that it seems to be wholly unknown and inaccessible to the subject herself.

Breuer told an eager Freud about these experiences, and in 1893 the two published the first psychoanalytic essay, "A Preliminary Communication," which stated, "Hysterics stiffer mainly from reminiscences" (Freud & Breuer, 1895, p. 7). Hysteria was caused by trapped memories and the feelings associated with them, they argued. Those memories and feelings had never been lived through in an ordinary way; they had become split off from the rest of the mind, only to fester and rise to the surface in the form of disconcerting and seemingly inexplicable symptoms. If those symptoms were traced to their origins, their meanings would become apparent and the feelings would be discharged in a cathartic burst. Then the symptoms would disappear.

Whereas Breuer saw hysterics as people susceptible to altered states of consciousness, to being "spaced out," Freud saw hysterics as people rent with conflicts and harboring secrets, from themselves as well as from others.

Freud began to find hypnosis less helpful in gaining access to pathogenic memories and feelings than he and Breuer had initially perceived it to be. As his clinical experience grew, Freud realized that what was most crucial to a permanent removal of symptoms was for the objectionable, unconscious material to become generally accessible to normal consciousness. (For Pappenheim, for example, the unconscious thought might be something like "I hate this woman's loathsome dog and it angers me that she lets it drink from my glass.")

In terms of theory, he began to envision a topographical model of the mind, dividing it into three different realms: an unconscious, containing unacceptable ideas and feelings; a preconscious, containing acceptable ideas and feelings that are capable of becoming conscious; and the conscious, containing those ideas and feelings in awareness at any particular time.

The theoretical advances represented in the topographical model were accompanied by technical innovations. The clinical task shifted from the discovery of the hypnotized patient's secrets by the analyst to the removal of the defenses against those secrets in the patient's own mind. Freud struggled to find a method that would dismantle or dissolve the defenses rather than temporarily lull them as hypnosis did. Around the turn of the century, he settled on the method of free association, the basic procedure that has been the backbone of psychoanalytic technique ever since.

"Act as though ... you were a traveler sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside" (Freud, 1913, p. 135).

As a strategic device, free association helps the analyst discern the patient's secrets, the unconscious wishes, while the defenses remain active and can be addressed. By encouraging the patient to report on all fleeting thoughts, the analyst hopes to get the patient to bypass the normal selection process that screens out conflictual content. Yet the patient is fully awake and can be shown that her unintended flow of thoughts contains disguised ideas and feelings that she has been keeping out of awareness.

Free association is impossible to do for very long, Freud discovered. The defenses block the emergence of thoughts too closely linked to the repressed secrets. Furthermore, conflictual thoughts and feelings that constitute the center of the patient's difficulties are soon transferred to the person of the analyst, who becomes an object of intense longing, love, and/or hate.

By analyzing the patient's free associations and resistances to free associations, Freud believed, he could gain access to both sides of the pathogenic conflict: (1) the secret feelings and memories and (2) the defensesthe thoughts and feelings rejecting those secret feelings and memories.

Among Freud's most important clinical observations was that the patient's difficulties in the analytic situation (the resistance and transference) are not an obstacle to the treatment but the very heart of it.

The central focus of the analytic process shifted to the analysis of transference (the displacement onto the analyst of the patient's conflictual feelings and wishes) and the analysis of resistance (the impediments to free association).

Dreams are disguised fulfillments of conflictual wishes, Freud became convinced (Freud, 1900). In sleep, the dynamic force (the defenses) that ordinarily keeps forbidden wishes from gaining access to consciousness is weakened, as in a hypnotic trance.

The form that Freud delineated in his theory of dreams became the central structural pattern for his understanding of all important psychic phenomena. The structure of neurotic symptoms, slips of the tongue (Freudian slips), and motivated errors in general are all identical to the structure of the dream: a compromise is struck between an unacceptable thought or feeling and the defense against it. The forbidden material is allowed access into conscious experience only in disguised form.

Freud found that symptoms thought to have been removed with the cathartic method (adapted from Breuer's treatment of Pappenheim) often returned. When he inquired into these symptoms further, it turned out that the event that was considered to be the origination of the symptom concealed an earlier unpleasant experience. Unless the symptom was traced to the earlier episode, the symptom was likely to recur. Often there was a series of associatively linked episodes, beginning in early childhood, all of which needed to be exhumed. Current conflicts and symptoms were invariably tied, Freud began to suspect, to events in early childhood. Freud found that many of his patients, not just hysterics, were suffering from troubling memories of earlier experiences. If each exposed memory was examined to see whether it concealed earlier prototypes, all symptoms could be traced to traumatic incidents during early childhood (before the age of six). Even more surprising, these incidents invariably had to do with a precocious involvement with sexuality.

The mind, Freud reasoned, is an apparatus for discharging stimuli that impinge upon it.' There are two kinds of stimuli, external (such as a threatening predator) and internal (such as hunger). External stimuli can he avoided; internal stimuli keep mounting. The mind becomes structured so as to contain, control, and, if possible, discharge internal stimuli.

Central among the internal stimuli are the sexual instincts. These appear as a broad array of tensions arising from different body parts, demanding activity to effect their discharge, Freud believed. Thus, for example, oral libido arises in the oral cavity (its source), creates a need for sucking activity (its aim), and becomes targeted toward and attached to something (generally external to the person) such as the breast (its object), which is required for satisfaction. The source and aim are inherent properties of the drive, Freud believed; the object is discovered through experience. Thus in feeding for purposes of self-preservation, the infant discovers that the breast is a source of libidinal pleasure; hence, through experience, the breast becomes the first libidinal object.

There are people, for example, who are expert at spreading disorder. They cannot tolerate tidiness, which they experience as repressive and suffocating. As guests, they always leave your house a good deal messier than when they arrived. In terms of Freud's theory of infantile sexuality, they are perpetually finding outlets for slightly disguised anal erotic impulses to soil, to smell up.

The apparent transparency of mind is an illusion; the psyche and the personality are highly complex, intricately textured layers of instinctual impulses, transformations of those impulses, and defenses against those impulses. Freud wrote: What we describe as a person's "character" is built up to a considerable extent from the material of sexual excitations and is composed of instincts that have been fixed since childhood, of constructions achieved by means of sublimation, and of other constructions, employed for effectively holding in check perverse impulses which have been recognized as being unuti- lizable. (1905, pp. 238-39)

Ideal mental health does not entail an absence of repression, but the maintenance of a modulated repression that allows gratification while at the same time preventing primitive sexual and aggressive impulses from taking over.

In his most widely read book on culture, Civilization and Its Discontents (1930), Freud painted a picture of man requiring culture for survival but, because of the instinctual renunciation it entailed, necessarily always being dissatisfied in some fundamental fashion."

Not just the impulses and wishes were unconscious, but the defenses seemed to be unconscious as well.

The id is a "cauldron full of seething excitations" (1933, p. 73) of raw, unstructured, impulsive energies; the ego is a collection of regulatory functions that keep the impulses of the id under control; the superego is a set of moral values and self-critical attitudes, largely organized around internalized parental imagoes.

The ego, with the aid of the internalized parental presences in the superego, represses and regulates bestial impulses in the id to maintain safety in a world of other people, Freud proposed. The result is a mind largely unknown to itself, filled with secrets and disavowed impulses, sex ual and aggressive. It is the pressure of those impulses in the "return of the repressed" that creates the neurotic symptoms whose code Freud felt he had broken.

The kinds of questions that became central to the ego psychologists were natural extensions of Freud's vision of the mind as structured around drive impulses and defenses: Are there phases, a kind of progressive ability, to accomplish the ego's defensive tasks? Is this progression an inherently predetermined process, one that inevitably unfolds, or do environmental factors aid or inhibit its development? Although initiated well before the crucial oedipal phase, is the development of the ego, like that of the superego, affected by contact with and internalization of aspects of caregivers? Although depicted as functionally opposed to and controlled by the ego, do the libidinal and aggressive drives play any part in the initial development of ego capacities

The structural model, introduced in 1923, depicted a more complex psyche containing a struggle among three internal agencies: ego, id, superego. According to this model, neurosis is the result of a compromiseformation worked out unconsciously among these fundamentally antagonistic parties: the id, pressing to gratify infantile wishes; the superego, striving to prevent this morally forbidden gratification; and the ego, mediating among the claims of the id, the superego, and the outside world.

Displaying some sympathy for the id, the ego works out a strategy that allows a certain amount of instinctual gratification but channels this gratification through a complex system of clever defenses. The ego disguises the appearance of the id's impulses, thereby both preventing social censure and keeping the impulses under careful regulation.

The psychoanalyst, whose interest is in making unconscious experience conscious, is the longed-for liberator to unconscious id impulses, but a menace to the embattled ego and its unconscious, characterological defenses.

If psychoanalysis was still to be conceived of as a battle, it had become less a rescue mission to release captives behind the lines and more a full-scale attack against a culture.

If these unconscious defensive processes are not decisively brought out into the open, Anna Freud came to believe, the therapeutic impact of psychoanalysis was severely curtailed. Simply bringing id impulses into consciousness is like a Cold War rescue of a few East Berliners, which fails to address the continuing existence of the Wall and the remaining intricate security system. Freeing some has little impact on the fate of others approaching the same border; the guards themselves must be won over, the defensive machinery dismantled.

Children regularly simply "get rid of unwelcome facts" (1936, p. 83) by negating their existence, while their overall reality testing remains unimpaired. Her work suggested that the use of denial, as well as that of projection and introjection, signaled, in the adult, disturbances that were rooted in developmentally early phases of childhood.

With Angela, the analyst ignored her provocativeness, commenting instead that there seemed to be something about having the wall between them that felt important; she encouraged Angela to tell her about the wall. Rather than interpreting her (id) aggression, the analyst described and expressed interest in Angela's (ego) need to protect herself. Assured that this crucial aspect of her psychic makeup was respected by the analyst, very gradually, Angela allowed a dialogue to develop.

From the perspective of the structural model, neurosis is a long-standing compromise arrived at by the psychic agencies of id, ego, and superego. The analytic process envisions inviting this triumvirate to the negotiating table. By maintaining a balanced interest in each side of the story (Anna Freud's "neutrality"), the analyst can help the patient achieve a more serviceable resolution among the competing claims.

Kris's patient's ego successfully mediated the conflict between infantile longing and the superego's moral code, instituting a clever system of defenses utilizing symbolism, displacement, and projection to hide the conflict and seamlessly absorb it into ongoing personality.

Nongratification (e.g., not answering the patient's questions) and interpretive confrontations were aimed at forcing the id-generated fantasies to seek gratification out in the open, exposing them to conscious scrutiny and analytic interpretation, thereby transforming them into more realistic, mature ways of thinking, generating increased ego functioning.

This model of psychic development had provided the conceptual underpinnings for the design of the classical therapeutic approach. Nongratification (e.g., not answering the patient's questions) and interpretive confrontations were aimed at forcing the id-generated fantasies to seek gratification out in the open, exposing them to conscious scrutiny and analytic interpretation, thereby transforming them into more realistic, mature ways of thinking, generating increased ego functioning.

If humans, like all organisms, are intrinsically designed to fit into their environment, this must also be true of not just their physical but their psychological self, Hartmann reasoned.

Reaction formation, for example, is a defense called into play to keep one consciously unaware of the continuing, socially unacceptable pleasures involved in bathroom activities; the toddler's original fascination with his bowel movements is transformed into a conscious attitude of disgust. Yet reaction formation, originating in conflict, may eventually serve a highly adaptive function in the overall personality as genuine pleasure in good hygiene and tidiness and thus graduate into a role outside of conflict, becoming "secondarily autonomous."

Freud had struggled with the same problem in different terms, in his efforts to reconcile higher cultural pursuits (such as literature and the arts), which he deeply loved, with a motivational theory that regarded all intentions as fundamentally sexual and aggressive. Freud's solution was the concept of sublimation, a quasi-defensive process that harnesses the power of the sexual impulse and channels it into acceptable, productive pursuits. Thus a voyeuristic fixation mif -it he transformed into a talent for photography.

Rene Spitz's heartbreaking publication Hospitalism (1940) played a seminal and dramatic role in deepening the interest in issues of environment. It left no doubt that whatever inborn psychological potential humans may have, its realization is doomed in the absence of emotional connectedness with another person.

As long as gratification is available via objects in the real world, identification is irrelevant. When gratification is interrupted, when the object is lost or becomes unavailable because of conflict, the object is internalized to permit fantasy gratification.

When exposed to painful shocks that cannot be patterned or avoided, experimental mice become catatonic.

Stanley, for example, had suffered from an inguinal hernia, causing severe, unexpected, and unrelievable attacks of pain from six months on. When exposed to painful shocks that cannot be patterned or avoided, experimental mice become catatonic. Mahler described the similar impact of this kind of unmanageable pain on the immature psyche: Selective repression is impossible and the child is driven inward, away from developing any capacities that would help him order and make sense of his experience.

Previously fearless in action, the toddler may now become tentative, wanting his mother to be in sight so that, through action and eye contact, he can regulate this new experience of apartness. The risk is that the mother will misread this actually progressive need as regressive and respond with impatience or unavailability, precipitating an anxious fear of abandonment in the toddler, who does not yet possess the psychic capacities to function as an independent agent.

Because experience is subjectively processed, Jacobson stressed, there is no such thing as simply "good" mothering, in some objective sense, only mothering that feels good to this particular baby. Issues of temperamental predisposition (e.g., an easily frustrated infant), fit or misfit (e.g., a calm baby and an excitable mother), affective matching or mismatching (e.g., a happy baby and a depressed mother), and the mother's capacity to sense and respond to her baby's changing developmental needs-these will all he crucial in determining what affect is elicited in the infant at any given time. Ultimately, the basic drive constitution that finally emerges depends on the collective impact of many moments.

Following Hartmann, Kris, and Loewenstein (1946), and in agreement with Spitz, Jacobson proposed that when experiences feel good, images of a loving, giving mother and a happy, contented self accumulate in the infant's psyche; conversely, when experiences feel frustrating or upsetting, images of a frustrating, unloving mother and an angry, frustrated self accumulate.

For Jacobson, libido and aggression function as indispensable counterbalances to each other. Libido (evoked in moments of gratification) encourages pulling close, taking in; aggression (evoked in moments of frustration) prompts pushing off, moving out.'

Freud had, in his later writings (e.g., 1940), described libido as a synthetic force that brings things together, aggression as a force that undoes connections.

Jacobson felt that the libidinally motivated yearning to merge remains highly gratifying throughout life. Merger fantasies are evocative at all stages of psychic development, although the quality of one's ego boundaries greatly affects one's subjective experience of them. Normally, in later life, with boundaries between self and others clearly delineated, fusion fantasies can provide one of the deepest sources of gratification.

Evoking aggression can function similarly in emotionally vulnerable adults who, when confused or depressed, pick fights with others in order to experience greater psychic clarity. Aggression operates here not as a drive per se, but as an experience actively called up in the self to promote self delineation. Such temporary relief is, however, not always to be had. For aggression to come to function in this capacity, it must have consolidated in an atmosphere modulated by sufficient gratifying libidinal experience. If this balance is lacking the aggression evoked will feel too powerful, overwhelming and disrupting the attempt at self-delineation with fears that one has been too hurtful or destructive in the interaction.

Freud regarded the repression of conflictual impulses as the core of neurosis. The ego psychologists, as we have seen, came to pay increasing attention to disruptions in developmental processes that were felt to result in a broad range of problems in the structuralization of the psyche itself.

Freud viewed the transference as the centerpiece of the analytic process, providing access to the patient's hidden and forbidden wishes as she expressed and tried to gratify them with the analyst. The ego psychologists began to view the analytic relationship in broader terms. Particularly with more disturbed patients, the transference came to be understood not only as expressive of forbidden longings but as an arena within which remnants of ill-fated attempts at building normal psychic structure could he discerned in particulars of the relationship that the patient established with the analyst.

A chronic emotional misattunement in Angela's early environment would have precluded her building up a store of safe, gratifying experiences around which a solid libidinal drive could consolidate. Early experiences that register as frightening or anxiously unproccessable mobilize, as Jacobson had described, a stronger aggressive drive which itself becomes a dominant factor in the child's ongoing attempts at meaningmaking. If one is often anxious, frustrated, and angry, one might well feel unlovable, perpetuating a cycle of continuing negative experience of self and other.

The toning down of aggression is an outcome of the developmental accomplishment of tolerating separateness and then of simultaneously holding good and bad feelings for self and for other.

Angela's "wall" can he understood as her ego's attempt to force a psychic boundedness when a more naturally evolving separation between herself and others was impossible.

For ego psychologists, the experience between patient and analyst becomes an occasion to understand the nature of the patient's psychic disruption and her adaptive efforts to compensate. The analytic relationship also has powerful transformative potential, the transference providing an opportunity for reworking early disruptions, for the patient to use the analyst to try to fill unmet developmental needs, for the patient now as an adult to verbalize and experience with the analyst early fears and terrors that had, in childhood, seemed overwhelming.

In the classical analytic setup, the analyst waits silently for the hidden wishes to appear in disguised form in uncensored free associations and then interprets them. In Sullivan's approach, the analyst actively inquires into interactions; the relevant data will not simply appear, because the patient (without awareness) leaves out what is most important. "So we settle down with this patient and want as much as we can get of what he can recall of the current events in his relationship with the love object" (p. 49).

Sullivan went after details: Who is this other person? How was she selected? What happened? Who said what to whom? When precisely did the emotional climate in the relationship change? For Sullivan to get the data he needed, he had to know more than what the patient thought, felt, and fantasized about. He sought details about what actually happened, and it is only that interactional context, Sullivan suggested, that yields an understanding of the ways the patient was re-creating his fate over and over.

Some of the child's activities (e.g., touching the genitals or fussing) may make a particular caregiver anxious; that anxiety is communicated to the baby, who then begins to connect touching the genitals or fussing with an anxious state of mind. Some of the child's activities (e.g., resting quietly) may make a particular caregiver relax and generate approval; that approval is likewise communicated to the baby, who then begins to connect resting quietly with a peaceful, approved-of state of mind.

The self-system steers activities away from gestures and behaviors associated with rising anxiety in the child's caregivers (and therefore also in himself) and toward gestures and behaviors associated with decreasing anxiety in his caregivers (and therefore also in himself).

Gradually and incrementally, but inevitably, the self-system shapes the child to fit into the niche supplied by the personalities of his significant others. The myriad potentialities of the child become slowly and inexorably honed down, as he becomes the son of his particular mother, the son of this particular father. The outline of the child's personality is sharply etched by the acid of the parents' anxiety.

Each time a new need emerges, the constraints of the self-system are loosened, making possible a new, healthier integration. Old anxieties may be overridden by the force of the new pull toward interpersonal integration on a higher level.

Like Freud, Sullivan envisioned human experience as playing itself out in a tension between pleasure (Sullivan's "satisfactions") and the defensive regulation of wishes for pleasure (Sullivan's "security").

The more the patient understands about the workings of the self-system in its efforts to avoid anxiety, the more easily that patient can make different choices, Sullivan believed.

If you hate a person, you hate something in him that is part of yourself. What isn't part of ourselves doesn't disturb us. -Herrnann Hesse

Freud translator and biographer Ernest Jones to move to England (Jones's interest in Klein was partly as an analyst to his own children), where

Klein never departed from the language of Freud's instinct theory. All her contributions derive from and are framed in terms of Freud's postulation of libidinal and aggressive energies as the basic fuel of mind, and the gratification of and defense against libidinal and aggressive impulses as the underlying drama of mental life.

As we noted in chapter 1, Freud's idea of instinctual impulse was a borderline concept between the physical and the psychical. He portrayed the impulse as beginning in an accumulation of substance in somatic tissues, outside the mind, which then generates a psychical tension in the mind, a "demand on the mind for work." "Objects" are "accidentally" discovered in the external world, such as the breast during feeding, which are found to be useful in eliminating the libidinal tension of the drive, and these objects are thereby associatively linked to the impulse.

For Freud, the aim of the impulse was discharge; the object was the accidentally discovered means toward that end. Klein regarded objects as built into the experience of the impulse itself.

The divided world Klein depicted was seen as being formed long before any capacity for reality-testing of any sort. The infant believes that his fantasies, both loving and hateful, have powerful actual impact on the objects of those fantasies: his love for the "good breast" a protective and restorative effect, his hatred for the "had breast" an annihilating destructiveness. It is precisely because of the omnipotence with which the child experiences his impulses that this world is an extremely dangerous place and the stakes are always very high.

vis-a-vis

Klein derived the paranoid-schizoid position from the urgent necessity to defend against the persecutory anxieties generated by the death instinct. All other major psychoanalytic theorists besides Klein treated Freud's notion of a death instinct as a biological, quasi-mythological speculation, but Klein built it into the center of her theorizing. Drawing on her work with disturbed children and psychotic patients, she portrayed the newborn's state of mind in terms of anxiety about imminent annihilation, deriving from a sense of the raw, self-directed destructive force of his own aggression. The most immediate and persistent problem throughout life becomes the need to escape this paranoid anxiety, this sense that one's very existence is endangered.

Klein portrays the state of relative mental health not as a developmental plateau to be reached and held but as a position continually lost and regained. Because love and hate are both perpetually generated in experience, depressive anxiety is a constant and central feature of human existence. At times of great loss, rejection, frustration, there are inevitable retreats into the security provided by the splitting of the paranoid-schizoid position and the manic defense.

In Freud's framework, sexuality concerns pleasure, power, and fear. For the woman, sexual intercourse, on the deepest unconscious levels, is seen as providing possession of the father's penis in compensation for the narcissistic wound of her own sense of castration. She longs to become pregnant as a sign of possession of the father and of her missing penis, and of triumph over the rival, the mother. For the man, sexual intercourse, on the deepest unconscious levels, is seen as being experienced as the ultimate possession of the mother, a triumph over the father, proof that he has not been castrated for his sexual ambitions. To make a woman pregnant is a demonstration of his uncastrated, potent status.

In Klein's framework, sexuality is about love, destructiveness, and reparation. Men and women are seen as deeply concerned about the balance between their own ability to love and to hate, about their capacity to keep their objects alive, both their relationships to others as real objects and their internal objects, their inner sense of goodness and vitality. Klein viewed sexual intercourse as a highly dramatic arena in which both one's impact on the other and the quality of one's own essence are exposed and on the line. The ability to arouse and satisfy the other represents one's own reparative capacities; to give enjoyment and pleasure suggests that one's love is stronger than one's hate. The ability to be aroused and satisfied by the other suggests that one is alive, that one's internal objects are flourishing.

For Freud, artistic creativity was a sublimated form of bodily pleasures. For Klein, both artistic creativity and bodily pleasures were arenas in which the central human struggle between love, hate, and reparation is played out.

Envy is a different response to the same situation. The envious infant no longer wants to gain access to and possess the good, but now becomes intent on spoiling it. The infant cannot tolerate the very existence of something so powerful and important, able to make such an enormous difference in his experience, yet outside his control. The infant would rather destroy the good than remain helplessly dependent on it. The very existence of goodness arouses intolerable envy, the only escape from which is the fantasied destruction of the goodness itself.

Envy is an attack not on the had breast, but on the good breast. Thus envy undoes splitting, crosses the divide separating good from had, and contaminates the purest sources of love and refuge. Envy destroys hope.

From Freud's perspective, the problem was oedipal guilt; because of incestuous and patricidal wishes, these patients did not feel they deserved a better life. It is illustrative of the difference between Freud and Klein that the latter located the roots of the negative therapeutic reaction not in guilt over sexual and aggressive impulses but in the envious destruction of the good breast, the obliteration of any sense of goodness out in the world that might be of help.

To believe that the analyst might actually possess something so important to them, so desperately sought, plunges them into a sense of envious helplessness they cannot endure

It is not as if the patient is simply revealing the contents of her own mind to a generally neutral (except when distracted by countertransference) observer; the patient experiences the analytic situation in terms of her primitive object relations. At times, the analyst is a good breast, magically transformative; interpretations are good milk, protective, nurturing, restorative. At times, the analyst is a had breast, deadly and destructive; interpretations are poisonous, destroying from within if ingested.

The patient's systematic envious destruction of the analyst's (hopefully reparative) interpretations is inevitably powerfully disturbing to the analyst

For Freud, psychoanalysis was an arena in which one person observes and interprets the affective experience of another from a measured distance. In the contemporary Kleiman perspective, psychoanalysis is an arena in which two persons struggle to organize and make meaningful the affective life of the patient into which the analyst is inevitably and usefully drawn.

It is precisely because the analyst has anxieties and conflicts similar to the patient's that the analyst is able to identify with the patient's projections onto her and then use those identifications to understand the patient.

The patient's intrapsychic fantasy becomes a form of interpersonal transaction that stimulates intense experiences in the analyst, whose countertransference offers clues to the patient's unconscious fantasies.

Bion's formulations provide a framework for analysts to tolerate and, in fact, become fascinated with their reactions to such patients by establishing the following assumptions: the apparent meaninglessness of the communications is generated by an active destruction of meaning; the apparent hopelessness and disconnection are generated by an active intent to destroy hope and connection; the agonizing feelings generated by sustained contact with such persons are the product of primitive efforts on their part to communicate and share their tortured states of mind. What appears disorganized and meaningless is organized and made meaningful, at first in the analyst's experience and, through interpretations over time, in the patient's.

She further argues against a focus on the past, against efforts to create facile and speculative reconstructions of the patient's early experience. What is most central, she feels, is the form of connection and disconnection between patient and analyst in the here and now of the analytic relationship.

By tapping his head and saying, "In my head what you say makes sense," George was expressing: I can't tolerate the possibility that you could give me anything that would really matter to me in a deep way; I treat your words as empty ideas, and I trivialize and thereby empty out arid destroy both your ideas and my own mind which contains them; I blow my brains out not in a sudden explosion, but through a subtle, perpetual destruction of meaning and the possibility for hope, and, in that same process, I also destroy you, and any faith you have in your own capacity for love and reparation. One might also speculate that George in some sense was provoking hope in the analyst, inducing the latter to keep trying, as a way of getting the analyst to contain the most feared segment of his own experience: the part of him that was still alive. He then systematically destroyed the hope he aroused in the analyst.

We only become what we are by the radical and deep-seated refusal of that which others have made of us. -Jean-Paul Sartre

For Freud, in short, man was the ambivalent animal; for Winnicott, he would be the dependent animal.... Prior to sexuality as the unacceptable, there was helplessness. Dependence was the first thing, before good and evil. -Adam Phillips

Fairbairn questioned Freud's premise that the fundamental motivation in life is pleasure and proposed a different starting point: Libido is not pleasureseeking, but object-seeking. The fundamental motivational push in human experience is not gratification and tension reduction, using others as a means toward that end, but connections with others as an end in itself.

The child bonds to the parents through whatever forms of contact the parents provide, and those forms become lifelong patterns of attachment and connection to others.

Where is pleasure in Fairbairn's system? Pleasure is one form, perhaps the most wonderful form, of connection with others. If the parents engage in pleasurable exchanges with the child, the child becomes pleasure-seeking, not as an end in itself, but as a learned form of connection and interaction with others.

One formative clinical experience for Fairbairn was his work with abused children. He was struck by the intensity of their attachment and loyalty to abusive parents; the lack of pleasure and gratification did not at all weaken the bonds. Rather, these children came to seek pain as a form of connection, the preferred form of connection, to others. Children, and later adults, seek from others the kinds of contact they experienced early on in their development. Just as ducklings become imprinted onto and follow around whatever caretaking object shows up at the right time (Lorenz, 1966), so, in Fairbairn's view, do children become powerfully attached to and build their subsequent emotional lives around the kinds of interactions they had with their early caregivers.

Consider the centrality of "chemistry" in human romance and relationships in general. Others are not universally desirable according to their pleasure-giving potential. Others are desirable with respect to their resonance with attachments to old objects, avenues and tones of interaction laid down in early childhood as the basic paradigms of love.

For Fairbairn, libido is object-seeking, and the objects that are found early on become the prototypes for all later experience of connection with others.

Fairbairn's understanding of repression was quite different in some fundamental respects from Freud's. In Freud's early theorizing, the center of the repressed was an actual experience, the memory of which, because of its traumatizing impact, could not be allowed into consciousness. As Freud shifted from the theory of infantile seduction to the theory of infantile sexuality, he began to conceive of the center of the repressed as forbidden impulses, too dangerous to be allowed access to consciousness. Memories may very well be repressed as well, but they were now understood to be repressed not because of their traumatic nature in itself, but because they are associated with conflictual, forbidden impulses.

Fairbairn saw the center of the repressed as neither memories nor impulses but relationships, ties to features of the parents that cannot be integrated into other relational configurations. Memories and impulses may also be repressed, but not primarily because they are traumatic or forbidden in their own right; rather, they are representative of, and threaten to expose, dangerous object ties.

For Freud, the repressed was composed of impulses, but the repressor was composed essentially of an internal relationship, the alliance between the ego and the superego. The ego, concerned with reality and safety, and the superego, concerned with morality and punishment, combined to block forbidden impulses from access to consciousness. For Fairbairn, both the repressed and the repressor were internal relationships. The repressed was part of the self tied to inaccessible, often dangerous features of the parents; the repressor was a part of the self tied to more accessible, less dangerous features of the parents.

A child with depressed parents, detached parents, or narcissistically absorbed parents might begin to experience depression, detachment, narcissistic self-absorption in herself, through which she gains a sense of connection to the inaccessible sectors of the parents personalities. It is not at all uncommon for patients in the process of overcoming their own most painful affective states to feel they are losing touch with the parents as internal presences. As they begin to feel happier, they also feel somehow more alone, until they can trust in their growing capacity to make new, less painful connections with others.

It is through the absorption of these pathological character traits that he feels connected to the parent, who is unavailable in other ways. This internalization of the parents also necessarily creates a split in the ego: part of the self remains directed toward the real parents in the external world, seeking actual responses from them; part of the self is redirected toward the illusory parents as internal objects to which it is bound.

Each of us shapes his relationships according to the patterns internalized from his earliest significant relationships

It is because of this cyclical projection of old patterns and the reinternalization of self-fulfilling prophecies that character and disturbances in interpersonal relations are so difficult to change.

Fairbairn located analytic change not in the dawning of insight, but in a changed capacity for relatedness, an ability to connect with the analyst in new ways.

Winnicott's most profound and most productive insight was the connection he began to draw between false self disorders in adult patients and the subtle variations he observed in mother-infant interactions from the very beginning of life.

It is crucial that the mother he there when needed, but it is equally crucial that she recede when she is not needed. She creates what Winnicott termed a holding environment, a physical and psychical space within which the infant is protected without knowing he is protected, so that very obliviousness can set the stage for the next spontaneously arising experience.

The temporary experience of subjective omnipotence provided for the infant by the mother's holding and facilitating remains as a precious legacy and resource.

Adult love, in Winnicott's vision, entails periodic mutual object usage, in which each partner can surrender to the rhythms and intensity of his or her own desire without having to worry about the survivability of the other. It is a firm and solid sense of the durability of the other that makes a full and intense connection with one's own passions possible.

The psychoanalytic situation, as Winnicott understood it, is perfectly designed for exploring and regenerating personal subjectivity. The analyst, like the good-enough mother, provides an environment in which her own subjectivity is on hold. The analyst, like the good-enough mother, tries to grasp the deeply personal dimensions of the patient's experience, the patient's spontaneously arising desires. The patient is offered refuge from the demands of the outside world; nothing is expected except to "be" in the analytic situation, to connect with and express what one is experiencing. No continuity or order is demanded; unintegration and discontinuity are expected and accepted. The analyst and the analytic situation provide a holding environment in which aborted self-development can be reanimated, safe enough for the true self to begin to emerge.

Winnicott saw the patient as powerfully self-restorative, shaping and molding the analytic situation to provide the environmental features missed in childhood. Content and interpretations, were nearly irrelevant in Winnicott's account; what was crucial was experience of the self in relation to the other.

In hi., work with more disturbed patients, Winnicott made every effort to shape the treatment around their spontaneously arising needs. Even setting regular times for sessions creates an artificial, external structure to which the patient needs to adapt, like an infant being fed according to a schedule rather than on demand. So Winnicott would try to provide sessions on demand. He told of one young woman he would watch for from behind his curtains. Timing was crucial. As she approached his front door and raised her hand to knock, he would open the door, as if her wish for him in fact had created him.

The analyst offers himself to be used freely in providing the patient with missed experiences. The analyst allows the patient to feel she has created him and, by not challenging that use of him, enables the patient to rediscover her own capacity to imagine and fantasize, to generate experience that feels deeply real, personal, and meaningful.

Balint's extension of Ferenczi's innovations led him to the conviction that what patients, particularly more disturbed patients, are seeking in the analytic situation is not gratification of infantile sexual and aggressive wishes, but an unconditional love, a "primary object love," they were deprived of in childhood.

Within the traditional drive theory framework, the mother as a person becomes known and important to the child only because of her function as a need-gratifying object. It follows that early competent caretakers are interchangeable, and that early loss of the mother, when she is still a needgratifying (rather than libidinal) object, produces no great psychic trauma and no mourning. But Bowlby argued that the child's attachment to the mother is instinctual, not acquired, and primary, not derivative of the mother's need-gratifying activities.

At the root of all defenses, Bowlby suggested, is detachment, a deactivation of the fundamental and central need for attachment, around which emotional experience is organized.

Emotional security is a reflection of confidence in the availability of attachment figures, which is built up gradually through early childhood experiences, Bowlby believed. Different kinds of anxiety are all rooted in a basic anxiety concerning separation from the object of attachment; anger is, most fundamentally, a response to and protest against separation. At the root of all defenses, Bowlby suggested, is detachment, a deactivation of the fundamental and central need for attachment, around which emotional experience is organized.

Fairhairn and Guntrip both regarded the schizoid phenomena of withdrawal and detachment as underlying all other forms of psychopathology.

Thus the libidinal ego (hope and longing) is very much involved with the exciting object; the anti-libidinal ego (hate and hopelessness) is very much identified with the rejecting object

There are situations in which hope and fear run together, in which they mutually destroy one another, and lose themselves in a dull indifference. -Johann Goethe

One must learn to love oneself ... with a wholesome and healthy love, so that one can bear to he with oneself and need not roam. -Friedrich Nietzsche

For Freud, the process of socialization involved the taming of the beast. He saw infantile experience as dominated by raw sexual and aggressive impulses, culminating in the oedipal crisis. As that crisis was resolved under the threat of castration, it was essential that the sexual and aggressive energies be rerouted into less dangerous pathways, and it was this energy, now expressed in socially acceptable and sublimated forms, that was employed in the service of enculturation. For Freud, the distinctly human form of being was generated in the very process through which the primitive, bestial sexual and aggressive impulses were brought under control.

Freud's later work to an emphasis on the ego in addition to the drives (originating in the id) and the complex elaboration of that shift in subsequent Freudian ego psychology.

"Id" and "ego" are neither places nor things; they are words that embody an approach to organizing and thinking about the enormous complexities of human experience. The shift from id psychology to ego psychology signaled a shift in the way the fundamental project of psychoanalysis was conceived. In broad strokes, id psychology was the exploration of the implications of the Darwinian revolution for the study of the human psyche; ego psychology became an avenue for the study of the ways individuals develop a distinct and secure sense of themselves. But ego psychology itself never abandoned drive theory.

Freud had created a complex account of child development, centered on the sequential, maturational unfolding of body-based, instinctual drives. Freud's understanding was fundamentally psychobiological: the psyche is an extension and derivative of the body; the mind develops to channel and control instinctual energies that emerge as peremptory physical tensions demanding action and discharge. The social world, in Freud's scheme, is where the drives come up against a reality that necessitates their control, repression, or largely disguised gratification. From a traditional psychoanalytic viewpoint, society is simply an extension of the ego in its campaign to regulate the drives: cultural leaders are quasiparents; social forces are camouflaged defenses; group processes are psychodynamics writ large.

For Klein, good and bad derive from the infant's instinctual conflicts between libido and aggression, while for Erikson, trust and mistrust are experiences derived from the child's interactions, successful and unsuccessful, with caregivers. For Winnicott, the quality of the holding environment that provides opportunities for either true-self or false-self experiences is determined by the mother, her own psychodynamics and character. Similarly, Sullivan saw points of anxiety in the mother as the origin of the child's early splitting of good and had. For Erikson, the mother is the representative of and vehicle for a cultural approach to living that organizes and ranks safety and danger, pleasure and restraint, gratification and frustration.

Freud, as we have seen, envisioned the establishment of "human" nature as consequent to a long-standing battle between animal appetites and civilized standards of behavior. In his view, a painfully guilty conscience was a triumph of sorts, heralding a civilized code of ethics in an otherwise lower nature. Psychopathology, for Freud, reflected an imbalance in these necessarily conflictual internal forces.

Heinz Kohut (1923-1981) offered a very different vision of human experience, consistent with the major themes in late-twentieth-century literature and social analysis. He spoke not of battles but of isolation-of painful feelings of personal alienation, the existential experience anticipated and so hauntingly captured in Kafka's Metamorphosis, where a person is terrifyingly separated from a sense of his humanness and feels himself to be a "nonhuman monstrosity" (1977, p. 287). Kohut's man in trouble was not riddled with guilt over forbidden wishes; he was moving through a life without meaning. Devoid of that zest for life that infuses the mundane with interest, he looked and acted like a human being but experienced life as drudgery, accomplishments as empty.

Freud's man was appropriately guilty; Kohut's man was decidedly "tragic"

Human beings, Kohut came to feel, must be designed to flourish in a certain kind of human environment. That environment must in some way provide necessary experiences that allow a child to grow up not only being human but feeling human, an energized, connected member of the human community.

Freud believed that all the infant's libidinal energy was initially self-directed, a state that he termed primary narcissism. The infant's early experience was magical and fantastical. Caught up in what Freud called the omnipotence of thought, the infant feels herself to be perfect and all powerful. Early instances of frustration in gratifying herself through these fantasies of omnipotence and grandeur interrupt the infant's narcissistic self-absorption. Unable to secure gratification via this route, the infant turns her libidinal energy outward toward others in her search for palpable, albeit imperfect, satisfaction. In this process, narcissistic libido normally becomes transformed into object libido, and the child takes her parents as the crucial love objects of her infancy.

This attachment to the parents, and the oedipal fantasies that develop within it, pose the next psychic hurdle; if the child is unable to relinquish these oedipal fantasies, her libido becomes fixated on her infantile love objects and she becomes neurotic.

Later, when she enters psychoanalytic treatment as an adult, the transference of those enduring infantile attachments onto the person of the analyst allows them to be both intensely experienced as well as available to curative analytic interpretation

Freud understood schizophrenic states to be the product of a massive withdrawal of the libido from its objects into a state of secondary narcissism, which propels the individual past even her infantile attachments to parents, back into the state of magical self-absorption that characterizes the early months of life. Here she cannot transfer her libidinal attachments to her parents onto the person of the analyst because there are no attachments left to transfer. Contemporary analysts continued to draw upon this theory of narcissism to explain certain clinical difficulties they encountered.

Sometimes, attempting to break through a narcissistic patient's grandiosity, analysts would "adopt a joking, ironic stance that was supposed to kindle the patient's humor, but often slid into sarcasm, ridicule, even mockery" (Kligerman, 1985, p. 12).

Freud once proposed that normality is defined by an ability to love and to work (Erikson, 1950, p. 264).

Kohut was struck by a crucial missing element in Freud's formula: the ability to feel joyful and proud of these capacities.

Before Kohut's arrival on the scene, empathic responsiveness, reflected in both attitude and intervention, was undoubtedly already part of any good analytic technique, but because nongratification was an essential principle of cure within a classical model, this aspect of the experience between patient and analyst was rarely discussed openly and consequently was never really refined.

Like the parent, the analyst cannot (indeed, should not) always be perfectly attuned to the patient's needs. Like the parent, the analyst cannot make the sun come up or protect the patient from the harsh realities of life. So the analyst, like the adequate parent, fails the patient slowly and incrementally, allowing the narcissistic transferences to become transformed (through transmuting internalization) into a more realistic, but still vital and robust, sense of self and other.

Just as a tree will, within certain limits, be able to grow around an obstacle so that it can ultimately expose its leaves to the life-sustaining rays of the sun, so will the self in its developmental search abandon the effort to continue in one particular direction and try to move forward in another. (1984, p. 205

Bitter fury could be understandably precipitated by the patient's perception of the analyst's unreliability, weakness, lack of attunement, when, having entered into a reanimation of this needed selfobject tie, he has become deeply and desperately dependent on its effective functioning. Aggression, for Kohut, was reactive, not fundamental.

Kohut came to regard selfobject needs for affirmation, for admiration, for connections with others who can buoy us up and whom we can respect, as undergoing maturation and change of form but operating continually from birth till death, and as fundamental to human experience as are the needs for companionship or solitude. We do not outgrow them.

As Rilke put it, "If my devils are to leave me, I am afraid my angels will take flight as well"

In Schafer's account, the basic transformation that takes place in the analytic process is the patient's gradual assumption of agency with respect to previously disclaimed actions.

For Schafer, the value of an interpretation of a dream lies not in its objectivity or correctness, but in its potential for opening up new forms of experience and allowing the dreamer to claim a deeper and broader sense of his own activity.

In Loewald's view, Freud really had two different understandings of the nature of the drives, before and after 1920. The earlier theory, drive as discharge-seeking, is generally taken to represent Freud's thinking in general. This earlier theory, Loewald argues, was wedded to nineteenth-century scientific materialism, and based on hydraulic and machine metaphors of Freud's day. In introducing the concept of Eros in 1920 (in Beyond the Plea sure Principle), Freud was radically altering his view of libido as a drive, Loewald believes, no longer discharge-seeking but connection-seeking, not using objects for gratification but for building more complex mental experience and for reestablishing the lost original unity between self and others.

In Freud's theorizing, the id is understood as never in contact with external reality. Its discharges in the real world are mediated through the ego. The id operates beneath external reality, expressing the archaic heritage that is present at birth. The digging of the archaeologist takes him deeper into the past; the interpretations of the psychoanalyst enables him to sift through the surface, daily interactions to uncover the deeper, inherited primal fantasies.

Freud's id is an unchanging biological force clashing with social reality. Loewald's id is an interactional product of adaptation rather than a constant biological force.

Loewald sees life as beginning in a union between the baby and the mother; the mother's handling of the baby, the mother's image of the baby, the mother's sensual experience of the baby all become essential dimensions of the baby's own experience of himself. Whatever "drives" come to motivate the developing child are shaped through interaction with the mother; they do not preexist and find the mother as their object.

Early love objects, like ancestors, provide guidelines to new experiences; when they have been properly buried and revered, they have continual access to the present and no longer have to dominate it from their anguished seclusion, seeking the "blood of recognition" (1980, p. 249).

Freud became convinced, all of culture is built on sublimation, the disguised gratification of infantile sexual and aggressive impulses

Thus the symbol for Loewald is not a disguised version of something that already exists; the symbol creates a novel experience. As in the relation between fantasy and reality, past and present, childhood and adult love, the symbol gives new and enriched life to the symbolized. Culture is a representation of infantile experience, but not only a camouflaged equivalent. Culture is a re-presentation and reconciliation of childhood experience on a new, expanded, and enriched level of organization.

Thus, for Lacan, the child comes to desire above all else to be the completing object of the (m)other's desire.

From Lacan's point of view, the big mistake (and it is a very big mistake) of all other schools of contemporary psychoanalytic thought is that they take the imaginary to be real: Ego psychology, by focusing on the ego, its defects and its development, is the psychology of a social construction, a mirage mistaken for a reality (1977, p. 238);

Lacan believed that these trends degraded psychoanalysis and buried what he took to be Freud's fundamental contribution: the discovery of the (linguistic) unconscious beneath the petty, everyday concerns of the patient and his social relations with others. The ordinary subjectivity of the patient, the character he takes himself to be and acts like, is precisely what needs to be subverted and dispersed in analysis to a deeper connection with the transpersonal, "transindividual" (1977, p. 49) unconscious and a more creative, revitalized life.

This disconnection from the mother and the disjointedness of the infant's experience of his body and his mental states reflect what Lacan considered a basic disjuncture fundamental to human experience, a congenital gap. "In man ... this relation to nature is altered by a certain dehiscence at the heart of the organism, a primordial Discord" (1977, p. 4). This gap gives rise to Desire, by which Lacan meant much more than sexual impulse or demands for the satisfaction of needs. Desire is ultimately insatiable, because desire is horn of the longing to heal the gap, to repair the disjuncture, to attain an impossible (imaginary) recollection, to be at one with mother and nature once again.

Second, the analysand would have a very different sense of his relationship to language. Rather than experiencing himself as the creator and agent of the language he generates, he would experience himself as a vehicle through which speaks his unconscious and the linguistic matrix of which he is a part. He learns that his own lines are simply a portion of a larger text (the "Discourse of the Other").

The surrealists, who shaped much of Lacan's experience of the unconscious, were interested in phenomena such as automatic writing, whereby one surrenders oneself to writing without conscious control or intent, and meaning emerges.

"Creative subjectivity has not ceased in its struggle to renew the never-exhausted power of symbols in the human exchange that brings them to the light of day" (Lacan, 1977, p. 71).

Third, the analytic process as redefined by Lacan would result in a different relationship between the subject and his own desire. Desire is not renounced in favor of a more rational and mature perspective; rather, by being named and recognized, desire is more fully owned. Analysis does not generate freedom-one remains caught in the constraints of the symbolic order and one's own particular history and destiny. Analysis makes possible a fuller embracing of one's destiny as one's own. Thus a Lacanian analyst would not push the patient Michael toward a more adaptive or consistent approach to women or marriage, but a realization that what drives him is the power of his longing for recognition as the object of desire for the Other. Eventually, love (as distinct from a desire to be loved) may be possible, but this would require, Lacan hinted, a renunciation.

Is psychopathology the result of trauma, healthy development thrown off course by destructive events and actual experiences? Or is it the result of the misinterpretation of early experience due to the warping impact of early childhood fantasy? Psychoanalysts are not alone in struggling with this problem.

For Davies and Frawley, the starting assumption is that abused children are most fundamentally damaged in the destruction of their reality-testing and capacity to deal with their experiences in a coherent and integrated way.

None of these theories regards analysis as actually fulfilling parental functions (Guntrip comes closest in describing analysis as involving "reparent- ing"); rather, the analytic relationship is seen as offering experiences that are analogues of parental provisions, close enough to revitalize stalled developmental strivings and to make possible an awareness and mourning for what was missed earlier.

For Freud, sexuality was a wholly natural phenomenon-the most deeply natural phenomenon in all of human experience. Civilization has transformed our lives in many complex ways, but civilization is always working against the dark, bestial pull of our persistent animal nature, dominated by sexuality.

above all else, as the instrument necessary to achieve drive gratification. They assume all humans have penises, and the shock involved in the discovery of the anatomical difference between the sexes organizes their major fear throughout life: their fear of losing their penis (castration anxiety) and hence becoming feminized. That fear underlies much of subsequent neurotic conflict.

Women, in Freud's view, long for penis substitutes (in the healthiest circumstances, a baby) and only with great difficulty can accept their biologically dictated gender role and its psychological sequelae.

In Freud's account, boys value their penis above all else, as the instrument necessary to achieve drive gratification. They assume all humans have penises, and the shock involved in the discovery of the anatomical difference between the sexes organizes their major fear throughout life: their fear of losing their penis (castration anxiety) and hence becoming feminized. That fear underlies much of subsequent neurotic conflict.

For Freud, whose thinking was grounded in the physical, sexuality was about tension reduction and was pervaded by oedipal struggle. For Klein, the body was also important, but as a source of symbolic meaning, represented in the mind. Sexuality, for Klein, figured primarily as yet another avenue for the expression of what she felt was the basic human dilemma: the integration of loving and hating feelings in the hoped-for demonstration of the reparative power of one's goodness.

For Freud, reproduction was an expression of phallic intactness for the boy and narcissistic compensation for the girl, made possible by her acceptance of her fantasied castrated status. For Klein, reproduction offered proof that something could survive and grow internally despite destructive feelings; pregnancy reflected the viability and goodness of one's internal object world.

As broader features of Klein's theoretical system changed, her understanding of the meaning of sexuality and of gender-related roles of sexuality was also transformed. Freud regarded personality as forming around sexuality as its natural, preexisting latticework. Klein and subsequent relational theorists regarded personality as forming around early relationships with others; sexuality inevitably emerges, but it is largely unformed and takes on its meaning within that context.

In Freud's account, the male superego is established under the threat of castration anxiety, which forces the boy to abandon his oedipal ambitions, but little girls experience themselves as already castrated, and thus have less motivation to keep infantile instinctual impulses in check; consequently they have less energy available for the sublimation that fuels higher-level organization and pursuits.

Each of us really understands in others only those feelings he is capable of producing himself. -Andre Gide

What is it that actually makes change possible for the patient? Freud said many different things about the analytic process, but he was always clear on what he felt was the central mechanism of change: the lifting of repression through insight produced by interpretation. The patient's problems are the result of repression; cure entails the release of impulses, fantasies, and memories from repression.

What difference would the concept of the superego make? Freud had conceptualized repression as a struggle between two forces, the repressed content and the defenses.

In this view (e.g., Pine, 1985), the very activities of reliable attendance, careful listening, and thoughtful interpreting are usually similar enough to attentive parenting to reanimate the stalled developmental process. The other path at the fork is taken by those theorists who argue that the analyst sometimes has to do something different from ordinary listening and interpreting, to create, in the analytic situation, real experience that evokes the specific missed provision of childhood. To establish oneself as different from the traumatizing parent, it may be necessary to be more available to patients in some fashion, to respond to their needs in a more individualized way. As we noted in chapter 5, Winnicott suggested an approach with more disturbed patients whereby the analyst bends the environment around the patient's spontaneously arising wishes and gestures; Kohut (chapter 6) advised mirroring responses to patients with specific kinds of disturbances in self-formation. Whereas the analyst operating out of the classical theory of technique is always (rightfully) concerned with not gratifying the patient because to do so would be to lose an opportunity for insight, the analyst operating out of this more developmentally grounded approach is always (rightfully) concerned with not retraumatizing the patient.

Erich Fromm was an important influence here. As both an existentialist and a Marxist, Fromm felt that one of the deepest problems in contemporary life was a profound dishonesty, both with oneself and with others, the squelching of authentic experience in order to adapt to social conventions. People lie to themselves and one another all the time, Fromm believed, and one of the deepest needs for the patient who seeks psychoanalytic treatment is for an honest response; what is curative in the analytic relationship, what is internalized in a freeing way, is precisely the capacity for a more authentic honesty and engagement.

Freud believed that because the core of psychopathology was the repression of conflictual, infantile impulses, which sought disguised gratification from the analyst in many different forms, it was essential for the analyst not to give the patient any gratification, because gratification allows the impulse to be discharged rather than be remembered, thought about, and renounced.

Freud believed that because the core of psychopathology was the repression of conflictual, infantile impulses, which sought disguised gratification from the analyst in many different forms, it was essential for the analyst not to give the patient any gratification, because gratification allows the impulse to be discharged rather than be remembered, thought about, and renounced. American Freudian technique, in particular, took on a marked austerity. Casual interactions with a patient-such as responding to questions, friendly conversation, divulging any personal information-were all strictly forbidden; they could easily satisfy needs and longings that the patient would consequently never come to articulate. If one can pilfer a little cash every now and then, one may never be forced to rob a hank! According to this American classical model, only frustration makes analytic insight possible.

This clear dichotomy between gratification and frustration is not possible for contemporary analysts who understand their patient's problems not just in terms of repressed conflicts but also in terms of aborted development and attachments to old object relations.

Fromm believed that people in our society rarely speak truthfully to each other about how they actually feel about each other. A major hope of many patients on entering analysis is that they will finally find someone who will speak frankly with them about what they are like, how they affect others, and what goes wrong between them and others.

The Kleinians, through recent extensions of the notion of projective identification, have come to regard the analyst's experience as the central site where the patient's dynamics are to be discovered and recognized. Object relations theorists tend to regard countertransference as a key device for gaining access to the repetitive self-object configurations of the patient's internal world.

An approach that makes one patient feel safe and "held" may make another feel endangered. Conditions that encourage one patient to deeply engage her inner experience and her past may cause another to flee. Therefore, many analysts now work in a variety of ways: one or two sessions a week, as well as three or four; the patient sitting up or lying on the couch; an active, occasionally confrontational style, sometimes expressive and somewhat self-revealing, as well as a more silent, interpretive style; and so on.