Forging Components Anew, Modes of Therapeutic Action: Reply to Discussions by Drs. Hirsch and Newirth

Abstract

I elaborate my view of the analyst’s role as catalyst, and use of an enlivening presence, to foment the growth of mentalized thought in some patients. The need to forge certain components anew in such patients’ rendering of experience mentally is highlighted, in contrast to an emphasis on patients’ capability, expressed by Dr. Hirsch. I argue for a place for deficit in relational thought, and for a relational reframing of the concept. Compatibility is seen with Dr. Newirth’s focus on the transformation of mental processes as integral to therapeutic action and the value of Bion’s models of containment and thinking in striving toward such ends.

Notes

¹ Dr. Hirsch is a leading chronicler of the Interpersonal school (e.g., 1987, 1997, 1998, 2006, 2012a, 2012b, 2015). He passionately defends Interpersonalism, and its varied component influences, against reductive misconceptions about the school. At the same time, Dr. Hirsch (1997) has admitted that certain characteristics of the Interpersonal approach—for example, “underelaboration” (p. 664) of the intrapsychic realm and model of development—formed in opposition to Freudian universals about development and abstract, internal constructs. I am sure to engage in theoretical oversimplifying in my reply, but only to sharpen the extent to which I drew my approach from prevailing object relations, as opposed to Interpersonal influences.

² Unmentalized experience is a term that Mitrani (1995) used to elaborate the phenomenon of raw sense data that had not yet been psychically processed.

³ Dr. Newirth offers his own view of the concepts of mentalization and symbolization (p. 713).

⁴ See Williams, 2012, on the need, at times, to build psychic elements from the start.

⁵ The phrase is excerpted from a vignette with a woman, in which Symington (2007) determined the task to be “to help the patient to grow her mind” (p. 1415). The vignette and others illustrate Symington’s premise, quoted more fully elsewhere in my paper (p. 688) and repeated here: “that a mind has to be created. We are not born with a mind but with the potential for creating a mind,” through “reflective communication with another” (p. 1410).

Additional information

Notes on contributors

Lisa Director

Lisa Director, Ph.D. is Adjunct Clinical Associate Professor of Psychology and Clinical Consultant at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis. She is a Faculty Member at the Stephen Mitchell Relational Study Center and a Faculty Member and Supervisor at the Psychoanalytic Psychotherapy Study Center. She serves on the editorial board of Psychoanalytic Dialogues, and is in private practice in New York.