| A Meeting of
Minds: Mutuality in Psychoanalysis By Lewis Aron. New York: The
Analytic Press, 1996.
Reviewed by Glen O. Gabbard, M.D.
Psychoanalysis in the United States is
currently struggling to find a true center. The influence of concepts such as
intersubjectivity, mutual postmodernism, and social constructivism has made most of us
rethink the analytic process and conceptualize it as both a two-person and a one-person
psychology. Lewis Aron has been one of the most articulate contributors to this
shifting landscape. In this scholarly and cleverly written new volume, Aron takes
the reader on a guided tour of relational psychoanalysis and provides a thoughtful
perspective on contemporary psychoanalytic thinking.
Aron avoids many of the excesses of radical
postmodernists, making a careful distinction between mutuality and symmetry. He
stresses that while both parties in the analytic dyad influence one another and share in
common a variety of feelings generated in the process, the relationship must inevitably be
considered one that is relatively asymmetrical. The analyst is a professional, with
a specific set of responsibilities and a commitment to ethical behavior, who is billing
the patient for a service. This emphasis on asymmetry leads the author to be rather
cautious in his recommendations regarding self-disclosure. Eschewing any necessary
connection between intersubjectivity and self-disclosure, Aron observes that choosing not
to disclose feelings to the patient may often be the optimal way for analysts to express
their subjectivity. Although he has been one of the leading contributors to the
renaissance of interest in the work of Sandor Ferenczi (see Aron and Harris 1993), he is
appropriately critical of Ferenczi's compulsive self-disclosure in his experiments
with mutual analysis. He notes that Ferenczi confused mutuality and symmetry.
At the same time, Ferenczi was too eager to accent the patient's version of childhood
abuses as unquestionably veridical.
Early in the book, Aron traces the history
of interpersonal and relational psychoanalysis, giving an absorbing account of how the
postdoctoral program at New York University evolved as a series of tracks not unlike the
British system of training. Aron has a keen eye for the political struggles within
organized psychoanalysis. As he would be the first to admit, his own subjectivity is
embedded in the politics of New York psychoanalysis, and at times he confuses
clinical/theoretical matters with organizational and political issues. He is prone
to use terms like "mainstream psychoanalysis" and "the psychoanalytic
establishment" to describe analysts who belong to the American Psychoanalytic
Association, as though members of that organization are not theoretically diverse and
pluralistic in their thinking. Similarly, the portrait of the classical analyst he
paints is sometimes unrecognizable in terms of contemporary practice. Nevertheless,
to Aron's credit, he for the most part recognizes shifts within the so-called Freudian
perspective in recent years and has seriously studied many of the contributors to these
developments.
Despite my generally quite positive view of
Aron's contribution, I did find myself with a number of disagreements. He argues
that analysts who listen to patients in the expectation of hearing a transference
distortion are likely to elicit a pattern of responses based on compliance and submission
to authority. He suggests that analysts who proceed instead with intense curiosity
about the patient's experience of the analyst's subjectivity will convey a sense that they
are open to learning something new about themselves that the patient may have observed.
It seems to me, however, that the same problem of compliance and submission may
arise from a situation in which the patient feels that he or she must come forth with
fantasies about the analyst's subjectivity.
While I agree with Aron that psychoanalysis
is both a one-person and a two-person psychology, I think that his emphasis falls too
heavily on the two-person aspect of analysis and that he underplays its intrapsychic or
one-person dimension. Consider the following statement: "Resistances do
not occur in the patient but, rather, are interactional phenomena that can be
metaphorically located only in the space between analyst and patient" (p. 127).
This conceptualization, in my view fails to recognize that resistance has both
intrapsychic and interpersonal dimensions. For example, I once commented to a
patient that I thought he was concerned about discussing his homosexual longings because
he was afraid of what I would think. The patient corrected me and said, "Oh no,
it's not what you think, it's what I think. I can't even think about these feelings,
let alone accept them, when I'm by myself." Clearly, his resistance was
influenced by my presence, but it was both a preexisting intrapsychic resistance and an
interpersonal resistance converging in the session.
The test of any psychoanalytic theory is in
the clinical situation and Aron has chosen, for whatever reasons, not to provide extended
examples of clinical process from his own work. He does provide brief vignettes of
sessions with his own patients and with supervisees. Most of these show an admirable
clinical sensitivity, but I would have liked to have read more. Paradoxically, the
reader feels somewhat deprived of the author's own subjectivity in the analytic crucible.
As I noted at the outset, Aron is generally quite cautious and thoughtful in what
he chooses to disclose to patients. However, I found one vignette involving a
suicidal patient treated by one of his supervisees, to be somewhat problematic. Aron
suggests that the therapist he is supervising might deal with his own anxiety by saying to
the patient, "I need you to take care of me and help me keep my anxiety level at a
manageable level so that I can be free to work at my best with you" (p. 143).
Although sharing one's anxiety over the possibility that the patient might commit suicide
may be useful, in my view this intervention goes too far. I think it verges on
symmetry rather than mutuality. Certainly patients learn to empathize and feel
genuine concern for their analyst over the course of treatment, but reversing the roles by
telling the patient directly that the patient needs to take care of the analyst burdens
the patient unnecessarily with the analyst's needs, particularly at a time of suicidal
crisis. As suicide experts (e.g. Hendin 1982) have noted, anxiety in therapists
about suicide stems too often more from a fear that others will blame them for the
patient's death than from true concern for the individual patient's welfare.
Responsibility for these anxieties should not be placed on the patient's shoulders.
In spite of my quibbles with Aron, I find
his book to be a cutting-edge contribution to contemporary psychoanalytic discourse.
It is one of the most absorbing and articulate statements of the current status of
relational psychoanalysis to date. In this review I have touched only on some
selected highlights. He also compellingly demonstrates the neglected role of
interpersonal psychoanalysis in much of the writing on intersubjectivity, advances some
provocative notions about whether transference and countertransference continue to be
useful constructs, and gives some much deserved attention to the often ignored work of
Otto Rank. This superb new volume deserves a wide readership, and I heartily endorse
the book to analysts of all persuasions.
References
Aron, L., & Harris, A., EDS. (1993).
The Legacy of Sandor Ferenczi. Hillsdale, NJ: Analytic Press.
Hendin, H. (1982). Psychotherapy and
suicide. In Suicide in America. New York: Norton, pp. 160-174.
Glen O. Gabbard
The Menninger Clinic
P.O. Box 829
Topeka, KS 66609-0829 (B)
Fax: 913-272-9577
E-mail: Gabbargo@menninger.edu
Gabbard, G.
(1998). Review of A meeting of
minds:mutuality in psychoanalysis., J. Amer. Psychoanal. Assn., 46:627-630.
Glen O. Gabbard is Bessie
Walker Callaway Distinguished Professor of Psychoanalysis in the Karl Menninger School of
Psychiatry at the Menninger Clinic. He is also Director and training and supervising
analyst at the Topeka Institute for Psychoanalysis. He is the author or editor of 13
books, including Love and Hate in the Analytic Setting and Boundaries and Boundary
Violations in Psychoanalysis.
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