From psychoanalytic ego psychology to relational psychoanalysis, a historical and clinical perspective

In July 2019 one of us (M.C.) published a book with the title Freud, Sullivan, Mitchell, Bion, and the multiple voices of international psychoanalysis, in which he connected the clinical approach of those authors and their psychoanalytic perspective to their most important life experiences and to the scientific and interpersonal contexts in which their contributions developed, including the main partners accompanying their professional evolution. He thus tried to demonstrate not only the importance of the history of psychoanalysis for the practicing clinician, but also its relevance as a key to the pluralistic and international character of contemporary psychoanalysis.

In the fall of 2018, M.C. had been contacted by Eva Papiasvili (New York) and Arne Jemstedt (Stockholm), who invited him to collaborate on the preparation of the item “Ego psychology” for the Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED). The IRED was originally conceived by Stefano Bolognini at the time of his IPA presidency (2013–2017), and is published online by the International Psychoanalytic Association (IPA). The task that M.C. readily accepted was to contribute to the revisitation of the development of ego psychology in Europe, the reconstruction of its development in North and South America being the task of the other two regional teams, with Arne Jemstedt coordinating the European team, and Eva Papiasvili coordinating the whole work.

Fascinated by such a research project and determined to do his best, M.C. came to the following two discoveries. In the first place, ego psychology had been alive and well in Europe – and not only in North America – both before and after World War II. Important ego psychologists after the war were, for example, Alexander Mitscherlich (1908–1982) and Paul Parin (1916–2009), who both emphasized its critical potential – which they considered to have been lost in the North American emigration. Also ego-psychologically based is the German Kassensystem, that is, in the way in which a clinical report has to be written so that the treatment will be paid by the Kassen – the German Social Security System. The nature of the most important German analytic concept, that is, the concepts of “szenisches Verstehen” and “szenische Funktion des Ich” – scenic understanding and scenic function of the ego – is ego-psychological as well.

Second, M.C. came to realize that the line of thought he was articulating in the book he was then writing (see above) was in fact also applicable to ego psychology. In other words, we have almost as many approaches to ego psychology as we have pioneers dealing with it, according to their personalities and priorities. Some examples include the following: Heinz Hartmann, whose priority was the ego as the center of a new general psychology; Otto Fenichel, before him, who looked at ego psychology as the best way to formulate the analytic technique he used with his patients; Paul Federn, who developed his own ego psychology in order to better understand and work with severely disturbed patients; and, last but not least, Anna Freud, who saw Freud’s structural model as the best way to keep track of the child’s psychological development.

At this point, M.C. contributed the first result of his historical research to the final elaboration of the item “Ego psychology” of the IRED, which was put online in December 2020, and he then kept working on the second perspective on his own. Over the course of 2021, with the help of Paolo Migone (Parma), he was able to further develop this perspective to the point of trying to distinguish what he called Hartmann’s ego psychology (EP) from the abovementioned branches of what he called “psychoanalytic ego psychology” (Pep), as he was able to do in the article he published in 2021 in Italian in the journal Psicoterapia e Scienze Umane. In other words, just as we have learned to speak of “object relations theories” in the plural, so we could profit from doing the same with ego psychology, and talk in terms of the different “ego psychologies.” After discussing this point of view with the editorial board of this journal in the spring of 2022, M.C. translated his Italian text into English, and that text has been published in this issue of the International Forum of Psychoanalysis.

A significant confirmation of the existence of a plurality of ego psychologies comes from contemporary control mastery theory (CMT), which was originally conceived by the ego-psychologically trained San Francisco colleague Joseph Weiss (1924–2004), starting with the one-page 1952 article “Crying at the happy ending.” In this he showed how a feeling connected to a particular emotional situation is warded off until the situation has passed and it is perceived safe to release that particular feeling. This discovery stimulated him to study in detail the process notes of his analytic sessions, coming to the conclusion that patients make progress in therapy when they feel safe in the therapeutic relationship, and that patients continually make appraisals of conditions of safety in relation to others.

In 1965 Joseph Weiss was joined in the development of this new point of view by Harald Sampson (1925–2015), beginning empirical research into it in 1972, when together they founded the Mount Zion Psychotherapy Research Group, later formulating their common point of view in the volume The psychoanalytic process (1986; see also Migone, 1993). Such was the success of CMT that in 2017 the International Control Mastery Therapy Center was formed, whose contributions we have already given room to in our journal – as was the case, for example, for with the article by Jessica Leonardi, Francesco Gazzillo, and Nino Dazzi, “The adaptive unconscious in psychoanalysis” (2022). As an aside, M.C. originally came into contact with CMT through the workshop on empirical research in psychoanalysis that Paolo Migone organized in Venice in the early 1990s, inviting not only Horst Kächele (1944–2020), but also George Silberschatz, a prominent member of the San Francisco research group.

In the article in this journal “When patients probe the analyst: Manifestations of patient testing and its complexity – An in-depth exploration of case examples of extant research,” Alexandra Nicole Novak, Jonas Luedemann, and Sylke Andrea from the Austrian University of Klagenfurt show how patients differ in their testing strategies, thus confirming the importance of applying a case-specific approach, based on a thorough understanding of the individual patient. They show not only the complexity of the testing concept, but also how the concept of the patient’s unconscious test of the analyst – originally formulated by Weiss and Sampson – may be especially useful for treatments that seem to stand still, and for analysts wanting to clarify countertransference reactions. Through their contribution the authors confirm how well CMT allows us to combine the clinical and the empirical dimensions of analytic work, which we (M.C. and G.C.) believe represents an important guiding principle of our profession.

Next comes an interview by Aleksandar Dimitrijevic (Berlin) with the distinguished American-relational psychoanalyst Jay Frankel (New York and Oslo), with the title “ ‘Being myself as the analyst I have become’. An interview with Jay B. Frankel.” This is part of a series of interviews that Aleksandar Dimitrijevic has been conducting for our own and other journals, such as the one recently published with Judith Dupont (Dimitrijevic, 2022) or the one with the former associate editor of this journal, Michael Buchholz (Dimitrijevic, 2020). As the conversational tone of the interview makes clear from the beginning, Jay Frankel and Aleksandar Dimitrijevic have for ten years been sharing more than one editorial project, one of the most important having been the project that one of us (G.C.) shared with them, that is, the anthology Ferenczi’s influence on contemporary psychoanalytic traditions (Dimitrijevic, Cassullo, & Frankel, 2018). Theirs is in fact an “intimate community of life, feeling, and interest,” to quote a letter from Freud to Ferenczi. Thanks to their fellowship, they accompany the reader on a journey through an important piece of history of contemporary psychoanalysis.

Their commitment to the realization of such a significant and creative dialogue is very impressive, and so too is their revisitation of Jay Frankel’s relationship to both relational and Freudian psychoanalysis. How can we belong to an analytic group and still remain faithful to ourselves? How does the immersion in a group stimulate or diminish our personal creativity? This is one of the professional dilemmas that our colleagues explore in detail in this interview. Jay Frankel belonged to the small group around Stephen Mitchell (1946–2000), which played a crucial role in the early development of relational psychoanalysis, but he later – carefully listening to himself – moved forward, went through a further training, and became a member of the IPA. What we can learn from such an original professional itinerary is one of the most important threads of this interview. One of us (M.C.) having himself dealt with the reception of Stephen Mitchell’s work in Italy and with his legacy to psychoanalysis (see Conci, 2019), we can say that this interview represents also a confirmation of the necessity to deal with such a legacy not only from the philosophical, theoretical, and clinical point of view, as Jon Mills has done in a series of articles (see, for example, 2006), but also from both a historical and a biographical point of view.

How an international congress can stimulate our scientific creativity, our capacity to come better in touch with ourselves and with our colleagues, and our overall professional development is documented in the report on the XXnd International Federation of Psychoanalytic Societies (IFPS) Forum held in October 2022 in Madrid, which one of us (M.C.) has written about for this issue of our journal. From this point of view, we need to closely interact and be part of an international community if we are to keep functioning well, both as persons and as psychoanalysts. Founded on July 30, 1962 in Amsterdam, the IFPS keeps trying to create and offer this kind of experience, and to keep it alive through this journal.