Relational Psychoanalysis – a theoretical summary

The aim of this study aid is to present the work of some of the most influential relational psychoanalysts (RP) and psychoanalytic psychotherapists working in the United Kingdom and United States of America. The term “relational” was first used in a psychoanalytic context by Greenberg and Mitchell (1983) to describe, retrospectively, a group of analytic theorists who privileged the individual’s need for relationships as opposed to the expression of intrapsychic drives. Like many other clinical frameworks, RP it is not a homogenous body of work. However, it can be provisionally understood as an extension of interpersonal psychoanalysis (IP), a movement that arose out of the work of Harry Stack Sullivan, an American psychiatrist who described his work as “interpersonal psychiatry” (Evans, 2006; Sullivan, 1940; 1953; 1962; 1964; 1965).

It is possible to suggest that the main concern of relational analysts has been a re-examination of psychoanalysis’ ontological and epistemological positions. Concepts such as analytic neutrality, the division between subject and object, the location of agency and responsibility in the analytic dyad, the nature of the analysts’ claims to knowledge, and the notion of truth have all been subjected to scrutiny. For example, in recent debates in analytic journals, British authors have emphasised that psychoanalysis should retain its modernist focus and search for the “truth” of the patient’s experience. Relational analysts tend to emphasise a postmodern position, and a constructionist and contextualist view of truth.

Mills (2005) provided a thorough critique of relational psychoanalysis from within the relational camp. He was particularly admonishing of the insufficient elaboration of philosophical concepts despite the relationalists’ professed interest in revising Freudian metapsychology from a postmodernist point of view. However he has suggested that the relational approach has provided many innovations in clinical practice. He argued that, overall, analytic relationships within relational analyses may resemble ordinary social interactions, with the proviso that these more raw and tense encounters are also placed under the lens of analytic scrutiny. According to Mills (2005) the following may be distinct characteristics of the conduct of many relational analysts:

(a) (They) “behave in ways that are more personable, authentic, humane, and reciprocal rather than reserved, clinically detached, and withholding” (p. 28). Analysts convey more “interpersonal warmth” (p. 28). (b) There appears to be more of a dialogue between analyst and analysand rather than a monologue by the analysand. (c) There appears to be less interpretation and emphasis on insight, and more attention paid to the analysand’s affective state. (d) Relational analysts are more likely to disclose their internal states to the analysand. (e) Relational analysts are more likely to behave in ordinary social ways rather than appear withholding, frustrating, and unsatisfying.

In the sections that follow, we attempt to provide an overview of the work of some of the key figures in relational psychoanalysis in order to demonstrate the above propositions.

Harry Stack Sullivan

Harry Stack Sullivan was a psychiatrist who worked and wrote in the 1930’s, 1940’s, and 1950’s. Sullivan did not train as a psychoanalyst, but his work was deeply influenced by Freud and often emerged in opposition to the traditional Freudian emphasis on biologically determined drives and intrapsychic conflict as key motivators of human development and psychopathology (Sullivan 1940, 1953, 1962, 1964, 1965). The task of developing an interpersonal psychoanalysis was actually taken up by some of his contemporaries such as Erich Fromm, Frieda Fromm, Karen Horney, and Clara Thompson.

Mitchell (1988), writing about the distinction between the intrapsychic and the interpersonal, observed that he had not been able to find a reference to the intrapsychic in Sullivan’s writings. Instead, he argued that Sullivan’s emphasis on using the term interpersonal was an attempt to take a position of contrast to Kraepelin’s psychiatry by insisting on the term “interpersonal psychiatry”. Mitchell argued that the distinction between intrapsychic and interpersonal was a later invention designed to differentiate relational from “classical” psychoanalysis in retrospect (Mitchell 1988).

Sullivan’s focus, from the beginning of his work, centred on a critique of Freud’s view that the individual mind should be the object of study in therapy. Sullivan argued against the idea that the individual mind has firm boundaries that only at times makes contact with other persons or cultural entities (Mitchell 1988: 478; Sullivan, 1964: 33). In contrast, he saw the human mind as being in continuous contact and interaction with others, from infancy onwards. The individual’s sense of his or her own self was an outcome of these interpersonal interactions. Because of this emphasis, Sullivan’s writing often paid much less attention to interiority, although he did not oppose the idea that persons develop unique subjectivities.

Sullivan introduced a number of key concepts in order to advance his vision of an interpersonal psychiatry. To begin with, like John Bowlby (1969, 1973, 1980) and Joseph Sandler in the UK, Sullivan believed that the primary human motivation was the attainment of security. One of Sullivan’s ongoing investigations involved the notion of unconsciousness, although he never made a reference to the “unconscious” as such. However, many of his concepts allude to a form of unconsciousness or unawareness. Sullivan makes a distinction between three different states of self: Me, bad-me, and not-me. The “me” states are the ones that an individual allows free conscious access to. The “bad-me” states refer to aspects of the self that, although unacceptable, can be brought to awareness without severe distress being experienced. In contrast, not-me states refer to a person’s views of the self that must not become conscious. These states have to be dissociated and interpersonal encounters have to be managed so that not-me states remain outside an individual’s attention. A person’s efforts to keep the preferred me states into awareness are achieved through “selective inattention”.

Despite Sullivan’s emphasis on the fact that the analyst affects the interpersonal encounter through his or her participation, Sullivan was still confident that through careful self-reflection the analyst would be able to factor out that contribution. Sullivan viewed the therapist as an expert in relationships and as being able to unproblematic able to adopt the position of a participant-observer. As we will see below, interpersonal and relational analysts take issue with this position. In summary, many of Sullivan’s concepts can be potentially understood as arising out of deliberate attempts to reframe Freudian insights into interpersonal language, given the similarities that sometimes appear between Sullivanian and Freudian terms.

Heinz Kohut

Kohut is widely considered to be one of the most influential psychoanalysts based in the USA. Although he trained and initially practiced in the framework of the ego psychology of his time, Kohut’s work with narcissistic patients and his formulation of “narcissistic rage” (Kohut 1971, 1977, 1984) provided the springboard for a paradigm shift in American psychoanalysis. Kohut was particularly interested in the role of empathy and would, at least some of the time, argue that psychoanalytic data could only be investigated through empathy and introspection. Additionally, he placed developmental deficit at the core of his analytic thinking.

Kohut assumed that narcissism, linked to self-esteem, constituted a distinct developmental line. He proposed that narcissistic pathology was the outcome when the necessary grandiosity and exhibitionism of the infant self had not been adequately “mirrored” by an early caregiver. When this was possible, and the inevitable frustrations were stage appropriate, the child would internalise the mirroring function of the parent in a process he called “transmutative internalisation”. He conceptualised the parent as a “self-object” whose role was to provide such a function based on empathic attunement. Clinically, patients who had not had a sufficiently attuned self-object would seek this in the analyst by forming specific attachments, observed in the transference. Once the developmentally arrested self was mobilised in analysis, three types of such selfobject relationships would be possible: Mirroring, idealizing, and twinship. In the first instance, the analysand would seek admiration and praise from the analyst. Another strategy would be to idealise the analyst as someone the patient cannot compare to and is therefore not threatened by. In the last instance, the analysand envisions the analyst as a partner in joint idealisation. Kohut would advocate that through the use of empathy the analyst should to some extent provide that function and, like the original selfobject, allow the inevitable frustrations to promote an ordinary giving up of exhibitionism and grandiosity in current life. Eventually, Kohut extended his developmental theory to the entire spectrum of psychological difficulties. Fonagy and Target (2003) cite the clinical example of agoraphobia to illustrate this: In agoraphobia, for instance, the failure of the selfobject has resulted in a developmental arrest of the child’s self-soothing capacities. Later in life, healthy assertiveness and affection that have not been mirrored are experienced as hostility and inappropriate sexual expression.

A general criticism of Kohut’s work (e.g. Fonagy and Target 2003) then concerns this latter point, regarding the generalisation the insights he developed by studying narcissistic pathology to a fundamental theory of personality development relevant to every individual. Likewise, intersubjective psychoanalysis (see below), which is an offspring of self-psychology, has further elaborated that this move resulted in a reversal of what had started as a contextualist psychoanalytic perspective and in the reification of the self as an overarching construct. All said and done, his emphasis on empathic attunement appears to have reached a number of clinicians, not necessarily of psychoanalytic persuasion.

Stephen Mitchell (23/07/1946 – 21/12/2000)

In 1983 Stephen A. Mitchell and Jay R. Greenberg (Greenberg and Mitchell, 1983) authored a landmark integrative psychoanalytic text entitled Object Relations in Psychoanalytic Theory. The purpose of this book was to juxtapose two different psychoanalytic traditions: One based on drives and one based on relationships. They coined the term “relational” in this context to designate a number of theoreticians who had departed from Freud’s drive model to place relationships with others at the heart of psychoanalytic enquiry. The relational stream in this book included British Object Relations (the “English” school of Melanie Klein and the “British” school of those practicing in the Independent tradition of the British Psychoanalytical Society, such as Balint, Fairbairn, and Winnicott) and the American school of self-psychology.

Mitchell presented his ideas as representing a position from the camp of Sullivanian interpersonal psychoanalysis (Mitchell 1988), establishing himself through the publication of key articles and books in the years that followed (Fonagy and Target 2003). Mitchell chose to break with the drive model altogether, unlike Greenberg who later attempt to find a middle point of view incorporating drive and relational perspectives. Mitchell proposed the concept of a “relational matrix” that included both the intrapsychic and the interpersonal (Mitchell 1988), in order to argue for the Sullivanian position that the mind is inherently relational and not an isolated entity that evolves under the pressure of internal drives. Mitchell occupied a position that is now mirrored in developmentally informed psychoanalytic psychology (Fonagy et al. 2002). However, he eschewed both a Freudian conflict model emphasising incompatible wishes and a British/American deficit model concerned with developmental arrest. Instead, he formulated the idea of conflict between relational configurations (Fonagy and Target 2003). Unlike hard interpersonalists, Mitchell was interested in the interface between fantasy and reality rather than real anxiety arising in the context of interpersonal exchanges (Fonagy and Target 2003). Mitchell reworked a number of psychoanalytic concepts such as sexuality, aggression, and narcissism from a relational point of view (Mitchell 1988). Sexuality and aggression were not seen as strictly biological forces, but ones that were evoked in response to either an internal or external object, suggesting that biology can only be given meaning in the context of relationships and the relatively stable interpersonal expectations that develop from infancy onwards. Mitchell conceptualised psychopathology as the rigidity of relational configurations that were sustained because they were perceived to be necessary to survival in infancy and early childhood. They are the only familiar routes to minimizing anxiety in interpersonal contexts (Mitchell 1988). Likewise, he rejected the idea of an unconflicted developmentally arrested “baby self” that requires mirroring and recognition, instead seeing the adoption of such a position as a particular way of relating to others (Fonagy and Target 2003).

Finally, Mitchell’s ideas not only offered a thorough and insightful integration and clarification of psychoanalytic models, but also kick-started the tradition of relational psychoanalysis as an American entity. Generally speaking, there has been an abandonment of the Cartesian dualism that is inherent in classical psychoanalysis and the adoption of a view that emphasises the construction, rather than discovery, of meaning within an interpersonal context, and an emphasis on pragmatism and what works, rather than seeking pre-established truths about the individual.

Philip M. Bromberg

(T)he human personality possesses the extraordinary capacity to negotiate continuity and change simultaneously, and will do so under the right relational conditions (Bromberg 1996: 509) .

Philip M. Bromberg is a New York based psychoanalyst who has always identified with the interpersonal/relational tradition and has built on aspects of Sullivan’s work (e.g. Bromberg 1979, 1980). A recent special issue of the journal Contemporary Psychoanalysis, a publication by the William Alanson White Institute where he and other relational psychoanalysts like Stephen A. Mitchell have taught, celebrates his work and contributions. Bromberg started to publish his work in 1974 often in the above US journal Contemporary Psychoanalysis. He first used of the term “relational perspective” and “relational matrix” in the first issued of the journal Psychoanalytic Dialogues (Bromberg 1991: 9, 1991: 11), in the title of a publication in 1993 in the journal of the American Psychological Association‘s Division (39) of Psychoanalysis‘ Psychoanalytic Psychology.

Like Donnel B. Stern (see next session) and Stephen A. Mitchell, Bromberg (2006) was interested in the Unconscious, a concept he believed was being neglected by many hardliner interpersonal psychoanalysts. One of Bromberg’s oft cited concepts related to unconsciousness is that of “self-states” (Bromberg 1996, 2006: 31). Bromberg sees selfhood as a “shifting configuration of mental states” (Bromberg, 2006: 32). In an optimal situation there is a fluid shifting between these different self-states while the individual is able to retain self-cohesion and self-validation in the face of novel experiences. Developmentally, this process is made possible through the attainment of affect regulation in early parent-infant relationships. However, in certain psychopathologies, different self-states are isolated from each other so that at any one time one self-state colonises consciousness.

Bromberg sees trauma from a developmental perspective, as the outcome of invalidation of states of being (Bromberg 1996). These experiences are linked to a threat of the infant being overwhelmed with affect without the possibility of becoming able to symbolise the experience. Dissociation is used as a defence to allow an escape from this situation. The use of dissociation at this stage leads to the formation of separate self-states that are kept isolated, with a resultant impoverishment of the self as a whole. In his most recent book (Bromberg, 2011) he describes the experience of living with trauma as living in the “shadow of the tsunami”. He conceptualises therapeutic action as the outcome of an ongoing encounter between the subjectivities of analyst and patient that involves “shrinking the “tsunami” little by little. One aspect of therapeutic action involves the patient’s capacity to symbolise previously non-verbal material that has become dissociated (Bromberg 2006).

An aspect of Bromberg’s work that appears to characterise the majority of relational psychoanalytic views is that these dissociated states cannot become known simply through interpretation, but require an enactment to take place between analyst and patient. Part of the enactment is a process of “objectification” (Bromberg 2006: 34). The patient objectifies an aspect of the self as being an aspect of the object, here the analyst. The analyst likewise may objectify the patient as the site of where the enactment is coming from, because of his or her own dissociation. This view is also prominent in the work of Jessica Benjamin (see below). This situation represents a lack of intersubjectivity that needs to be restored. At some point, Bromberg believes, the analyst stops seeing the patient as simply repeating something from the past and acknowledges the situation as occurring in the here and now between the two participants. Both parties can then begin to compare their perceived realities through a process of dialogue. The process of shrinking the tsunami involves the repetition and experience of these enactments allowing each time more of the dissociated inexperience to be integrated in the patient’s core self. Bromberg’s disclosure of personal experience, feelings, wishes, desires, and uncertainty during these exchanges may well be a staple of relational work.

Donnel B. Stern

I conceptualize unconscious psychic life as unformulated experience, vague psychic material that, under the right circumstances, becomes articulated or realized meaning. Unformulated experience is potential meaning, and in that way quite different from the fully formed meanings that are assumed in theories based on the concept of unconscious fantasy (Italics mine, Stern 2010: xiii).

Stern is another interpersonal/relational analyst trained at the William Alanson White Institute that has been inspired by the works of Sullivan. Like Bromberg, Stern is particularly interested in dissociation and enactment, and like Bromberg and Mitchell, his work involves maintaining the concept of an “unconscious”. Stern (1997) speaks of “unformulated experience” to designate that which is dissociated and therefore unconscious. Like Bromberg he makes use of Sullivan’s me, bad-me, and not-me distinctions to explain the outcomes of dissociation. Stern initially linked enactment to countertransference phenomena (Stern 1997) before explicitly linking enactment to dissociation.

Stern (2010) adopts a post-modernist view that assumes there is no pre-existing meaning waiting to be revealed or discovered, but rather potentially able to be formulated within a relational context. Stern is at pains to emphasise that this position does not constitute relativism, where any meaning is possible, but rather that the possible meanings that can be formulated are delimited by pre-existing experience. He references the “relational or interpersonal field” that is created between analyst and analysand, without each participant’s awareness, and which shapes what they experience together. This relational field affects what they also experience in their own minds in the presence of each other, and often outside this presence. Stern also emphasises the continuity of clinical process by highlighting that the experience that is constructed between the two analytic participants’ influences the experience that follows. It would appear that Stern takes up a critical realist position describing his theory as mid-way between objectivism and relativism. What delimits the formulation of unformulated experience in the analytic encounter is a structure encompassing culture, history, and tradition that places constraints in how “reality” (although existing) is apprehended. These constraints can be “tight” or loose”. Unformulated experience is not located in a compartment of the mind’s topography as envisioned by Freud, but in relatedness. Each participant is creating experience and constituted by it so that, as mentioned before, transference and countertransference are seen as arising from a selection of available possibilities. They are not simply distortions of each participant’s experience, but they are based on rigidity rather than flexibility. They do not easily change with experience and can prevent the experiencing of new content. The task of analysis then becomes paying attention to the possibilities of formulating experience in ways that are not immediately automatic. The “choice” to formulate experience in new ways can be both a conscious and unconscious one. A dream, for example, may have been unconsciously dreamt in order to alert the analytic pair to new possibilities for meaning making that were previously unconsidered. Stern accepts the existence of character, but emphasises that different aspects of character are expressed in different contexts.

Stern (2010) also replaced repression with dissociation as the primary defensive process. In his reconceptualization of unformulated experience, he emphasises that newly formulated experience occurs not only in the verbal, but also in the non-verbal register, referring to “articulation” and “realization” respectively. He argues that although certain experiences can be formulated either in symbolic verbal terms or in non-verbal ones, dissociated content is such that it will not be formulated. Stern employs Sullivan’s distinction of me, bad-me, and not-me (Sullivan 1953, Bromberg 1996, 2006, 2011). Although, bad-me aspects of the self can be tolerated in consciousness when they become formulated during the analytic process, not-me aspects resist formulation and can only become known through enactment. Therefore, what is dissociated is not particular mental content, but specific aspects of identity. Stern is therefore in agreement with Bromberg who takes a similar position about enactment. If the analysand cannot and will not inhabit the dissociated self-states that may be at risk of being formulated during a relational interaction, then the analyst will be pressed to experience these self-states instead. This is referred to as the “interpersonalisation of dissociation” (Stern 2010: 14). Stern also refers to “passive dissociation”, “dissociation in the weak sense”, or “narrative rigidity” (Stern 2010: 14) to indicate the strategy of living a narrative that does not allow the individual to be faced with circumstances that can lead to not-me states. In highlighting the analyst’s participation, Stern talks of mutual enactment when the words or conduct of the patient who is defending against a not-me state activate dissociated material in the analyst. Not-me states are not necessarily the outcome of external trauma. Dissociation is seen a form of extreme selective inattention (Sullivan 1953).

Finally, Stern is amongst those interpersonal/relational analysts (e.g. Orange 2011) who have drawn on the complex body of work of Hans-Georg Gadamer (1975) to advance an understanding of clinical process based on hermeneutics and the concept of “authentic dialogue”. Stern (2010: 25) sees dissociation and enactment as the unconsciously motivated interruption of authentic dialogue. Authentic dialogue involves the immersion of the two participants in a process that does not lead to a predestined outcome set by either conversant, but has a life of its own and leads to understanding. Understanding refers to grasping another person’s point of view by accepting it as right, and using one’s own understanding in the process. Subjectivity and conversation are constrained by historical embeddedness that can be taken into account, and even transcended, but ultimately cannot be pushed aside.

Intersubjective Psychoanalysis: Robert Stolorow, George E. Atwood, Donna Orange, and Bernard Brandchaft

These authors have a background in self-psychology and along with a number of other colleagues have been responsible for a particular conception of relational psychoanalysis called “intersubjective psychoanalysis” (Atwood 2012, Atwood and Stolorow 1979, 1984, 2014, Stolorow 2007, 2011, Stolorow and Atwood 1992, Stolorow, Atwood and Orange 2002, Stolorow, Brandchaft and Atwood 1995, Stolorow, Atwood and Branchaft B 1994). Stolorow and colleagues have articulated a different conception of the unconscious than the Freudian one. They have suggested an alternative to what they view as the Cartesian isolated mind with compartments such as unconscious, unconscious and preconscious, or id, ego and superego. They advanced the case for a multiply contextualised experiential world constituted intersubjectivity, and consisting of the sum of the individual’s lived experience. This “World Horizon” (Stolorow et al. 2002) is “more or less conscious” and constitutes a system rather than a container. The ordering principles of the world horizon consist of expectations, meanings, and interpretative patterns formed in the context of significant life events such as trauma, loss, and other psychological injuries and are “prereflectively unconscious” (Atwood and Stolorow 1979, 1984). They cite Gadamer’s view that whatever the person is unable to know or feel, falls outside the world horizons (Gadamer 1975).

These authors’ view of unconscious is multifaceted. Their starting point is that a child becomes able to develop and articulate his or her conscious experience in a progressive manner dependent on the attunement of the early caregivers. If there is a lack of consistency in responding or an active rejection of the child’s experiences, the child concludes that these experiences, constituting part of their total subjectivity, are unwanted or even destructive to the caregiver. There is therefore a mutilation of the child’s experiential world to reduce it to those aspects of subjective experience that do not threaten their attachment to their caregivers. This formulation is the closest that these authors come to repression. They link this process to Stern’s (2010) views of unformulated experience, but instead describe it as “dysformulated experience” to distinguish it from experiences that have never achieved any symbolic form. For these experiences they reserve the term “unvalidated unconscious” to designate experiences that in the absence of validating responses were never formulated in the first place. It is this group that closely resembles Stern’s view. As mentioned earlier, there is also the “prereflective unconscious” which cannot be made conscious because it is an organising principle of experience rather than experiential content, and closely resembles Sandler’s “past unconscious” or Bollas’ “unthought known”. In psychology’s terms this is “procedural” knowledge (see Confer’s online module Clinical Applications of Attachment Theory) and could be said to become intelligible in the way that individuals relate to each other, elsewhere the transference and defences. It is important hold in mind that Stolorow and colleagues do not use terms such as “defences” because in their framework of World Horizons, there is no subject-object or thought-feeling distinction. Rather defences are seen as the multitude of ways in which the horizons are limited by the prereflective organising principles that govern their breadth. The interested reader can consult (Stolorow et al. 2002) for a one of Stolorow’s analytic training cases, originally formulated in ego-psychological terms, that has now been re-evaluated within the framework of World Horizons.

We mentioned earlier that the version of psychoanalysis articulated by Stolorow and colleagues has been explicitly named “intersubjective psychoanalysis” and is based on a number of key challenges to the Cartesian model of the mind adopted by Freud and his followers. The emphasis on intersubjectivity eschews the view of an individual mind in relationship to its objects, in a manner again not broadly dissimilar to the work of most relational psychoanalysts. Stolorow and colleagues’ see the work of psychoanalysts as being contextualised historically, an approach drawn from hermeneutics. In addition, one of Stolorow’s collaborators, Donna Orange (Orange 2010, 2011), has elaborated Stolorow’s contextualist view into a formal ontological and epistemological position by advancing the position of “perspectival realism”. This is a form of critical realism and contextualism that assumes an individual can only apprehend reality through their current perspective, delimited by their social and historical location. Therefore, analyst and analysand each have their own grasp of the analytic encounter and the task of the couple becomes and comparison of their respective views in the form of an “authentic dialogue” in Gadamer’s (1975) sense.

Andrew Samuels

Samuels is a Jungian analyst with the UK based Society of Analytical Psychology. In addition to being a historian of Jungian thought, Samuels has been a staunch proponent of the relational analytic approach (e.g. Lowenthal and Samuels 2014). In his recent writings he has been refining his contribution to the political arena, both in real world politics and, like Orbach (2014) in “democratising” psychoanalysis and investigating the social dimensions of clinical work. Samuels (2014) endorses Jung’s view, articulated in the 1930’s, of creating a culturally relevant psychology that is sensitive to how the social environment etches itself in the individual psyche. Jung’s concept of the “transcendent function” is used as an entry point into understanding the contribution of analysis to politics. Just like the commonly held relational view of the inevitable participation of the analyst in the process, he criticises those analysts who engage with two different sides in politics, but attempt to maintain a dispassionate external standpoint throughout the process, a function he refers to as “triangulation” (Samuels 2014). He sees triangulation as the epitome of a “phobia” towards action, referring possibly to psychoanalysis’ traditional concern about acting out. “For politics is, quintessentially, a process in which unequals dispute and contest control of power resources and information” (Samuels 2010: 245). The transcendent function paints the analysand as attempting, at times, to obtain an equal standing in the asymmetrical nature of the analytic relationship. Historically, Samuels emphasises that armed conflict may be a necessary complement of dialogue between opposites perhaps alluding to the nature of enactment in analysis.

Samuels describes himself as a pluralist and gives a personal account of his personal and professional life (Samuels 2014). Because he considers the analytic relationship to be an “induced” (Samuels, 2014: 646) rather than a natural relationship, and one that embodies the structures of analytic history itself, his sees the potential of transference as an outcome of suggestion and less the product of the analysand’s involvement. He also sees the emphasis on countertransference as omitting the impact of the wider social context, for example what an analysand’s network thinks of therapy. He also cautions against assuming transferential potential to any reference to other persons or communication, but argues for accepting the reality of the analysand’s accounts. This is specifically the case for instance in interpreting a concern with a political situation is only as a preoccupation with a family situation and preventing the impact on an analysand of the “collective field of emotional distress” (Samuels 2014: 647). Finally, he argues that the emphasis on the analysand being able to achieve a relationship with the analyst may exclude the reality that the patient is already in other relationships in his or her life. He sees the emphasis in the relationship, the idea that the client’s well-being is defined by their capacity to relate to the therapist, as a potential factor that can undermine the client’s autonomy. Instead Samuels (2014) proposes a conceptualisation of the client as a healer, of themselves and others, someone who knows what they need, possesses in innate capacity for self-regulation in the Jungian sense, and one who may be more emotionally literate than they allow themselves to be in the context of a relationship. One of Samuels’ rather radical propositions is that the client can become a healer of the world, become in touch with their inner diversity and respond in a politically activist manner to “repair and restore the world” (Samuels 2014: 650).

Susie Orbach

Susie Obach is a UK based relational psychoanalytic psychotherapist who is perhaps best known for her work on eating disorders from within a feminist framework. Orbach describes her perception of the way that many analysts in the UK were practicing in 1984 when the Kleinian tradition was at its most influential. This extract is quoted at length as it likely captures the sentiment of many relational analysts:

(T)he patient � had become not so much an individual to be engaged with, as someone whose defense structure needed to be excavated to show the patient how much of his or her internal world was beset by envy and destructiveness. � The countertransference material was evaluated for what the patient “did,” and “put into”; for how he or she “showed contempt” or “attacked” the analyst or the analysis. � The patient, who invariably didn’t know the rules of therapy, would somehow transgress them. He or she would comment on the books on the therapist’s shelves (envy of the analyst’s knowledge or distrust of the analyst’s capacity to think without props), say hello on bumping into the therapist in the street (invading and inappropriate), talk too much (controlling the space), talk too little (not allowing anything to penetrate), feel too much (being unable to think), or not have sufficient affect (defending against desperation, devastation, depression), compliment the therapist for how the therapy was helping (seductive and avoiding), arrive early (overanxious) or late (controlling), or induce in the therapist the desire to care for him or her (manipulating the therapist) � (p. 398).

Orbach (2014) also conceptualises the analyst as “an active participant in the relational field”. She sees relational psychoanalysis as offering a “democratic” view of the analytic situation in which the analyst is not a neutral observer, but brings his own or her own subjectivity into the clinical process. She emphasises the rigidity of what she sees as British psychoanalytic interpretation of making specific interpretations of uncomfortable countertransference experience (as above). She urges clinicians to reflect on their own responses by paying careful attention to the context of the analysand’s communications rather than relying on premade formulations about what the analysand is “putting into” the analyst. Orbach references the work of analytically informed developmental researchers such as Beebe (see Confer’s online module on the Clinical Applications of Attachment Theory). She emphasises that within the relational model, conflict is conceptualised as a discrepancy between the desire to connect and to be a distinct self and the requirement that in order to form connections one’s distinctiveness must be recognised by the other.

Jessica Benjamin

Benjamin’s contributions to an “intersubjective” perspective in psychoanalysis centre on the concepts of the “third” and “mutual recognition”. She has written a number of papers on gender and has contributed to the clinical use of developmental research (Benjamin 2002). She defines mutual recognition as the core element of intersubjectivity (Benjamin 1990:33) and later equates intersubjectivity with a relationship of mutual recognition (Benjamin 2004, 2009). Mutual recognition (Benjamin 1990) refers to the perception and acknowledgement of another person as a subject who has a similar and yet separate mind. Benjamin’s concern throughout her writing career is the move away from what she sees as the limitations of subject-object relationships to subject-subject relationships. She sees this as not simply a lack of linguistic lack of precision, but an implicit position that affects the conceptualisation of analytic work.

For Benjamin, the development of the capacity for mutual recognition follows a separate developmental line to the internalisation of objects relations (Benjamin 1988, 1990). Her starting point is Mahler’s individuation-separation theory (Mahler 1975) viewed through the lens of Winnicott and Stern (1985) in an effort to realise what she sees as the theory’s unfulfilled potential. She sees a parallel between the infant’s struggle to develop intersubjective capacities and the struggle involved in analytic work that aims to transform the viewing of others from objects to subjects. This preoccupation echoes wide analytic formulations that view the increasing complexity of internal object representations as a sign of maturity and development, but Benjamin is keen to pick apart the way that this difficulty may also be at work in the analyst’s mind and the development of analytic theory. She sees the work of intersubjective psychoanalysts (see section above) and the adoption of “intersubjectivity” in the psychoanalytic lexicon as the first useful steps. She also refers to Winnicott’s “use of the object” as a radical position statement anticipating her concern with the difference between the “other perceived as outside the self and the subjectively conceived object” (Benjamin 1990: 34). She also insists on the need to hold on to both the intrapsychic and the interpersonal mind.

Benjamin explains that for the subject to experience the fullness of his or her own subjectivity in the other’s presence, the other must also be experienced as a subject. This need translates into the drive to recognise others and the need to be recognised in our own right. Developmentally, being recognised by the other results in a sense of having made an impact on someone else’s mind, and our sense of enjoyment at this is then also recognised by this other. Self-regulation is the outcome of regulating the other: Each participant calibrates how stimulating he or she is towards the other. This also means that the response of the baby can leave the mother feeling unrecognised. Although the awareness of other minds does not occur until 8-9 months, the affective interactions at an early stage of development set the ground for what is to follow. In the second year of life, a crisis develops between the need to assert the self and recognise the other. The paradox according to Benjamin is that at the moment when one’s will is asserted, one needs another to recognise it. The resolution to this dilemma is, again paradoxically, holding on to the tension in that it cannot be resolved.

This view is in contrast to the perception of one participant as a subject that “does” something to the other, who is then left feeling as an object that has been “done to” (Benjamin 2004). The difference between a subject-subject and a subject-object relationship is the difference between reciprocity (two-way directionality) and complementarity (one-way directionality). A subject-subject relationship in Benjamin’s view (2004) requires the position of a “third”: This is not an object (such as the analyst’s theory), but a sort of mental space that Benjamin likens to Winnicott’s potential space. “Surrendering” (Ghent 1990) to the third implies achieving a state of freedom involving accepting connectedness and difference rather than occupying a position of control and coercion.

For Benjamin (2004, 2009) a crucial component of the analyst’s surrender translates in practice into acknowledging their own feelings as well as their own responsibility for the state of an enactment. Benjamin (2004) criticises the position often taken by object relations theorists who try to discern “who does what to whom” in the analysand’s narrative and in the transference, an outcome of the theoretical position that the analysand’s mind is populated by internal objects that “do” to the analysand and to whom the analysand “does”. These object relationships, the related affects and thoughts, the defences against these affects constitute at any time the analysand’s unconscious phantasy, expressed in the here and now of the analytic encounter. In contrast, Benjamin (2009) argues that, at least some of the time, the analyst’s taking up a position of observation can constitute a dissociative distancing from the way that the analyst inevitably wounds the analysand in the process of helping him or her. When the analyst’s conduct has shamed or wounded in some way the analysand, the analyst struggles with their own shame and guilt. Benjamin argues for the importance of the analyst remaining in touch with these feelings in the service of undergoing a process of mutual self-regulation with the analysand. Like many other relational analysts Benjamin (2009) considers that hurting the analysand is an inevitable part of the work, i.e. enactments of some sort are unavoidable. She considers that “moments of excess that fail to evoke a mirroring knowledge can serve instead to signal the unformulated, undifferentiated malaise, despair or fear” (Benjamin 2009: 441). In other words enactment is the only way to access dissociated parts of the self. However, the analyst’s capacity to forgive himself or herself is an important part of the work too.

Lewis Aron

Lew Aron is a NY based relational psychoanalyst. He started to publish in 1989 in journals such as Contemporary Psychoanalysis, and Psychoanalytic Dialogues and published a key paper in the first issues of Psychoanalytic Dialogues (Aron 1991). Aron has made a number of contributions on “democratising” psychoanalysis, exploring its sociocultural assumptions, and elaborating Benjamin’s formulation of subject-subject relations by articulating his own understanding of how clinical technique flows from such conceptual revisions. Aron see the analyst’s examination of the patient’s experience of the analyst’s subjectivity as a central aspect of the analytic work. He believes that clinical psychoanalysis has not sufficiently considered the patient’s experience of the analyst as a centre of subjective experience. Traditional psychoanalysis in his view has applied the term countertransference to the totality of the analyst’s responsiveness to the patient. In contrast, he believes that the analyst is not simply reacting or responding to the patient, but can initiate interactions. He believes that the relationship between analyst and patient, although unequal and asymmetrical, is one of “mutual influence” (a topic he would later expand on) as Beebe and Lachmann (1988a, 1988b) have proposed.

One of Aron’s arguments (1991) is that a patient’s resistance is patterned according to their unconscious perception of the analyst’s unconscious psychology. For resistance to be successful it has to be tailored to this particular analyst’s personality, rather than simply expressing the patient’s idiosyncratic history. Aron continuously stresses that the analyst’s psychology refers to more than the countertransference, more than just the analyst’s responsiveness to this particular patient. Consequently, the patient’s insight extend beyond the confines of his or her own unconscious to encompass a progressive understanding of the analyst’s own repressed or dissociated material. However, because the patient is unconsciously aware that these aspects of the analysts are being kept outside the analyst’s awareness, they are likely to communicate about them only directly. Finally, the patients’ desire to know their analysts is not simply viewed as an attempt to control or retaliate, but as a fundamental need to connect with someone important to them.

One clinical implication is that Aron will ask patients to reflect on what had led them to believe that he is acting in a particular way towards them. He stresses that this question needs to be asked in a genuine attempt to learn something that he might not have previously been aware of. Aron believes that the patient may have indeed noticed something about him that he is not aware of yet. However, this is not a technique he recommends to be used out of context as he will often interpret the patient’s curiosity as a defensive manoeuvre to deflect attention from the patient’s present emotional state. Furthermore, questioning in this way may risk accessing one the more conscious aspects of the patient’s experience: If it is true that the patient’s resistance is partly due to their anxiety about formulating to themselves and the analyst what they perceive to be the analyst’s unconscious material, then the analysis of resistance needs to illuminate obstacles to verbalising these ideas. The patient may be frightened that the analyst will retaliate, withdraw, or collapse if the analyst’s unconscious is exposed.

Another clinical implication concerns self-disclosure. Having been invited or “tantalised (Aron 1991: 40) to elaborate on the analyst’s experience means that the patient may put increased pressure to confirm or refute the patent’s views: As such, this line of questioning may be foreclosed due to the analyst’s anxiety about self-disclosure. Additionally, the analyst’s self-disclosure would communicate that the analyst states what he feels of thinks as if he or she is assuming full consciousness of their current mental state. Another risk with this approach is that the analyst’s subjectivity could take over the patient’s psychic and analytic space. Furthermore, a central consideration should be that the patient may need to find the analyst as a separate person at their own rate: To be allowed to struggle with ambiguity, lack of resolution, uncertainty, and partial clarity.

Adrienne Harris

Adrienne Harris has been in the faculty of the New York University’s Post-Doctoral Program in Psychoanalysis and Psychotherapy for over two decades. Her first contribution was in 1985 on the impact of hermeneutics and Jacque Lacan’s work in American psychoanalysis. This paper also introduced readers to her enduring interest in feminism and gender, and particularly gender as a social construct rather than a natural category. Her next publication (Harris 1991) consolidated her position as a committed gender theorist in American psychoanalysis. Her thesis was that gender is a paradox: Either an aspect of the self or a defence, it can be coherent or incoherent. Her starting point was Freud’s essay on a case of female homosexuality and her project centred on situating Freud’s analysis in a historical context, discussing his ideas through the lenses of social theory in an effort to highlight Freud’s own contradictions. Gender, Harris argued, can be as solid as any other aspect of character, or vulnerable and fragile. Multiple gender identifications and sexualities can be integrated in an individual’s personality or split off. Female and male identifications are complicated by individual histories as well as both the parents’ and broader social contexts’ explicit and implicit views on sexuality and gender.

In 2011 Harris published a review of the relational tradition in psychoanalysis. She referenced a discussion held among prominent relational analysts that attempted to address a number of questions, starting with identifying the intellectual origins of American analysis. William James’ pragmatism and Charles S. Pierce’s semiotics were identified. James’ emphasis on experience, rather than abstraction, as the starting point of scientific investigation, and his interest in the “intersections” of private, relational, and publicly shared beliefs were seen as important predecessors of relational psychoanalysis current foci. Specifically, Harris saw relational psychoanalysts, starting with Mitchell’s work in the 1980’s, as being particularly interested in perspectivalism and the evaluation of theory and technique in its own right.

Muriel Dimen

Dimen is an American psychoanalyst who, like Adrienne Harris, has maintained an ongoing commitment to the exploration of gender and sexuality, as well as culture. She is adjunct clinical professor in NYU’s Postdoctoral Program in Psychoanalysis and Psychotherapy. She started to publish her analytic work in 1991 in Psychoanalytic Dialogues on gender with a starting point in Winnicott’s work, a choice that is not uncommon in relational circles. She has authored a number of books that can be found here.

Recently, Dimen and colleagues have elaborated a relational theory that allows for the social aspect of any given clinical moment to be taken into account alongside the psychological realities (Dimen 2011). The aim of the book illustrates the work of a group that assumes culture saturates subjective experience and both the social and psychological aspect of a clinical moment can both be considered without sacrificing either.

Neil Altman

Neil Altman has contributed important work on deconstructing the intersect of poverty and psychodynamic treatment. He is particularly interested in internalized racism in analytic theory and practice and to the influence of class (2005), race (2000), and politics (2004) as blind spots in the transference and countertransference. He has played a significant role in advancing relational theory as Editor of the journal Psychoanalytic Dialogues.

Doris Brothers

Brothers is a US based psychologist who identifies with a self-psychology approach and whose written work centres on the understanding of trauma. Like Bromberg (2006) (see below) Brothers (2008) stresses the disruption in continuity of the child’s sense of self due to early developmental failure or injury. She argues that when trauma occurs the result is a shattering of familiarity, loss of meaning, and loss of a coherent and recognisable sense of self. She proposes that trauma destroys what she calls “systemic emergent certainties” (SECs) that are subsequently replaced by “trauma generated certitudes” (TGCs). TGC’s use the mechanism of dissociation to exclude emotional knowledge and experience that threaten to disrupt the continuity of the traumatised self. The effect of dissociation is a loss in context sensitivity so that the same expectations come to be generalised across a vast range of situations resulting in the experience of post-traumatic symptomatology. The traumatised individual feels under threat from the affective expressions of the others, because the complexity of these presents a threat to the rigid and simplistic TGCs. Brother’s model also provides an explanatory framework for the intergenerational transition of trauma (see Confer’s online module of the same name). Because of the parent’s resulting failure to respond to the infant’s complex emotional behaviour, the infant also fails to advance his or her own sense of self in an ordinary developmental fashion due to the parent’s restricted affective responsiveness. The required therapeutic approach in Brothers’ model is broadly commensurate with the approaches of other relational analysts that emphasise not the uncovering of repressed emotional states but the reciprocal development of self-regulation through the experience of an analytic encounter based on mutuality and the understanding and processing of enactment as the only avenue of widening the experiential potential of the analysand.

Jeremy Safran

Jeremy Safran is not a psychoanalytically oriented therapist, but an integrator of different psychological therapies. He is well known for having emphasised the importance of the therapeutic relationship in CBT in a landmark text in 1992. He has also published about psychoanalysis, the therapeutic relationship, and the intersection between psychoanalysis and Buddhism. A list of his books can be found here. Safran writes eloquently about the therapeutic function of metacommunication in relational psychoanalysis, the capacity to talk with the patient about the quality of communication between them and the therapist. He is influential in creating a bridge between the technique of mindfulness, affect regulation and this communicative capacity. Safran argues that mindfulness can make a powerful contribution to the therapist’s self-regulation, thus allowing the time and space to process powerful feelings evoked in enactments. Enactments, he proposes, are a product of the therapists and patient’s overlapping psyches.