De-Idealizing Relational Theory by Lewis Aron Sue Grand Joyce A. Slochower

Author:Lewis Aron,Sue Grand,Joyce A. Slochower
Language: eng
Format: epub
ISBN: 9781351625586
Publisher: Taylor & Francis (CAM)

Personal synthesis

I believe it is possible to integrate the important advances in relational theory within a framework that retains both a forward-edge orientation and the core therapeutic idea of meeting patients in their (ever-evolving) areas of therapeutic and developmental need. The following quote from S. Stern (2017) represents my current attempt at such a narrative:

Contemporary analytic theorists beginning with Winnicott (1965) have alerted us to the degree to which patient and analyst, like mother and baby, form an intersubjective system (e.g., Beebe & Lachmann, 2002, 2014; Boston Change Process Study Group, 2010, 2013; Coburn, 2002, 2014; Galatzer-Levy, 1978, 2002; Ghent, 2002; Marks-Tarlow, 2008, 2011; Ogden, 1994; Sander, 2008; Seligman, 2005; Stolorow, 1997a, b). The analytic process is in some ways analogous to successful problem-solving and interactive regulation between a caregiver and baby. Yet it is also far more complex because it is a system competence (Sander, 1995) that must be responsive to the patient’s history of relational trauma and system-incompetence, and the patient’s complex psychological organization growing out of that history, as these now constitute and drive the patient’s struggles. Because developmentally traumatized patients have grown up in situations that were decidedly unfitted to their early needs, their relational expectancies (transferences) and character adaptations incline them to be suspicious of, unpracticed in, resistant to, and even destructive of, the natural collaborative tendency observed between good-enough parents and their young children. Thus analytic collaboration and fittedness must begin by meeting patients in spaces where being met is an alien, distrusted experience, which patients may misread, avoid, negate, or attack even as they unconsciously long for and seek it. Analytic patients’ distrustful, terrified, fragmented, deadened, overwhelmed, dysregulated, somaticized, disorganized, dissociated, colonized, and otherwise turbulent mental states (which are always embedded in, reactive to, and emergent from the ongoing analytic interaction) can only be transformed through systemic processes wherein the analyst learns through complex ongoing feedback at all levels of processing how to understand and respond to (meet) these states in increasingly individualized and nuanced ways. Moreover, leaps in analytic system-competence often emerge from some form of enacted “incompetence” (Russell, 1998, 2006). Inevitably, there is trial and error, disruption and repair, negation and recognition, enactment and emergence from enactment, confusion or uncertainty and illumination, as the system gropes toward greater fittedness, specificity of recognition, mutual recognition, and hence greater system-competence.

(pp. 27–28)

Within this general frame, enactments are fully integrated but not viewed as always, necessarily, central to the meeting process. And within this frame, dissociation is recognized as one core “principle of mental functioning,” but is secondary to, and in pathology an aberration of, the more fundamental principle of healthy self-organization that evolves through recurrent experiences of being met and of coming to “know oneself as one is known.” The therapeutic aim is to meet the patient in the complexity of his current state, using “the tools at hand”—that is, all the wisdom we have managed to accrue from psychoanalytic theories, clinical experience, and life experience. I offer the following clinical example to illustrate the sensibility I’m trying to describe.

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