On Relational Hierarchy: Friends or Parents? Discussion of Lisa Director and Robert Grossmark

Abstract

Two very successful clinical experiences are presented to illustrate each analyst’s preferred ways of engaging clinically with patients. In my discussion I contend that analysts’ preferred theories of therapy often drive the nature and texture of analytic engagement and that each analyst works best in the context of embracing those cherished theories. More specifically, I attempt to contrast psychoanalytic traditions that, on one hand, situate the analyst in a hierarchical parental role and, on the other hand, conceive of the analyst as more of a flawed peer.

Notes

¹ Since I know both parties under discussion, I prefer to use first names.

² I was trained at NYU Postdoctoral some time before the term Relational was first introduced by Greenberg and Mitchell (1983), both of whom were trained in the Interpersonal tradition at William Alanson White.

³ Readers must recognize that the Interpersonal tradition begins with Harry Stack Sullivan, best known clinically for his analytic work with regressed, hospitalized schizophrenic patients. Following Sullivan, Frieda Fromm-Reichmann and Harold Searles devoted their respective careers to working analytically with psychotic people and writing about this work.

⁴ I believe the term “trauma” is currently used far too freely and all too often used to describe the “normal” pain and bad experiences—the slings and arrows of life that are inevitable for all of us.

⁵ No single psychoanalytic writer captures the Interpersonal sensibility in the context of working analytically with severely disturbed patients more than Harold Searles (1965, 1979). Indeed, I view the mode of clinical engagement of Winnicott and Searles as lying at opposite poles, though there can be little doubt that both have achieved enormous success and notoriety for their work with seriously troubled individuals.

⁶ Part of Corbett’s critique of “noisy” Relational analysts is related to one of his preferred ways of engaging patients—an emphasis on the value of his use of reverie, in general priority to verbally addressing here-and-now transference–countertransference themes. As one who works best in the latter mode and finds my own personal reverie tantamount to useless self-absorption, “noisy” works far better for me. I do, however agree with him that there had been a trend in the Relational literature wherein a deliberate self-disclosure on the part of the analyst resulted in one after another, dramatic breakthrough in the therapy. Indeed, in conjunction with Corbett, I do not believe that therapeutic action occurs with such hysterical drama. Illustrations of dramatic breakthrough via moments of analysts’ self-disclosure can obscure how much consistent and often plodding hard work is necessary for change to gradually evolve. However, there are different registers of “noise,” and I view addressing transference–countertransference themes as often good “noise” and dramatic deliberate disclosures as a less productive source of “noise” than they have sometimes been portrayed. Indeed, there are many distinct varieties of “noise” (e.g., queries, observations, interpretations), and they ought not be lumped together as excessive intrusions.

⁷ These are my words. Robert did not attribute this tendency to the Interpersonal analytic tradition.

⁸ The most formative clinical experiences in my own development were the 3½ years spent working analytically with patients in a day hospital setting, after having made serious suicide attempts and/or suffering psychotic breaks. Searles served as my model for this most fascinating and challenging work.

⁹ Psychoanalysis began with a classical Freudian model of a most unobtrusive analyst and evolved in some circles to a noisier, perhaps more intrusive, verbally engaged, co-participant Interpersonal-Relational model. Robert and others now believe that this shift has gone too far, though as I noted earlier all verbal engagement is not equally meddlesome. For example, I personally distinguish between the most controversial verbal interaction—deliberate self disclosure of affective states—and the more traditional—questions, observations, and interpretive explanations.

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Notes on contributors

Irwin Hirsch

Irwin Hirsch, Ph.D., supervises and/or teaches at The Manhattan Institute for Psychoanalysis, The William Alanson White Institute, the NYU Postdoctoral Program, and the National Program of The National Institute for the Psychotherapies. He has authored more than 80 journal articles and book chapters and two books: The Goethe Award–winning Coasting in the Countetransference: Conflicts of Self-Interest between Analyst and Patient (2008) and The Interpersonal Tradition: The Origins of Psychoanalytic Subjectivity (2015), both from Routledge. Forthcoming, coedited with Donnel B. Stern, is The Interpersonal Perspective in Psychoanalysis, 1960s–1990s: Rethinking Transference and Countertransference.